在年轻成年人中进行 SARS-CoV-2 人体挑战的安全性、耐受性和病毒动力学。
Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults.
机构信息
Department of Infectious Diseases, University College London Hospital, London, UK.
hVIVO Services Ltd., London, UK.
出版信息
Nat Med. 2022 May;28(5):1031-1041. doi: 10.1038/s41591-022-01780-9. Epub 2022 Mar 31.
Since its emergence in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused hundreds of millions of cases and continues to circulate globally. To establish a novel SARS-CoV-2 human challenge model that enables controlled investigation of pathogenesis, correlates of protection and efficacy testing of forthcoming interventions, 36 volunteers aged 18-29 years without evidence of previous infection or vaccination were inoculated with 10 TCID of a wild-type virus (SARS-CoV-2/human/GBR/484861/2020) intranasally in an open-label, non-randomized study (ClinicalTrials.gov identifier NCT04865237 ; funder, UK Vaccine Taskforce). After inoculation, participants were housed in a high-containment quarantine unit, with 24-hour close medical monitoring and full access to higher-level clinical care. The study's primary objective was to identify an inoculum dose that induced well-tolerated infection in more than 50% of participants, with secondary objectives to assess virus and symptom kinetics during infection. All pre-specified primary and secondary objectives were met. Two participants were excluded from the per-protocol analysis owing to seroconversion between screening and inoculation, identified post hoc. Eighteen (~53%) participants became infected, with viral load (VL) rising steeply and peaking at ~5 days after inoculation. Virus was first detected in the throat but rose to significantly higher levels in the nose, peaking at ~8.87 log copies per milliliter (median, 95% confidence interval (8.41, 9.53)). Viable virus was recoverable from the nose up to ~10 days after inoculation, on average. There were no serious adverse events. Mild-to-moderate symptoms were reported by 16 (89%) infected participants, beginning 2-4 days after inoculation, whereas two (11%) participants remained asymptomatic (no reportable symptoms). Anosmia or dysosmia developed more slowly in 15 (83%) participants. No quantitative correlation was noted between VL and symptoms, with high VLs present even in asymptomatic infection. All infected individuals developed serum spike-specific IgG and neutralizing antibodies. Results from lateral flow tests were strongly associated with viable virus, and modeling showed that twice-weekly rapid antigen tests could diagnose infection before 70-80% of viable virus had been generated. Thus, with detailed characterization and safety analysis of this first SARS-CoV-2 human challenge study in young adults, viral kinetics over the course of primary infection with SARS-CoV-2 were established, with implications for public health recommendations and strategies to affect SARS-CoV-2 transmission. Future studies will identify the immune factors associated with protection in those participants who did not develop infection or symptoms and define the effect of prior immunity and viral variation on clinical outcome.
自 2019 年出现以来,严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)已导致数亿例病例,并继续在全球传播。为了建立一种新的 SARS-CoV-2 人体挑战模型,使发病机制、保护相关性和即将到来的干预措施的疗效测试能够得到控制,36 名年龄在 18-29 岁之间、没有先前感染或接种疫苗证据的志愿者在一项开放标签、非随机研究中(ClinicalTrials.gov 标识符 NCT04865237;资助者,英国疫苗工作组)经鼻腔接种了 10 TCID 的野生型病毒(SARS-CoV-2/人/GBR/484861/2020)。接种后,参与者被安置在一个高隔离检疫单元中,进行 24 小时密切的医疗监测,并可充分获得更高层次的临床护理。该研究的主要目的是确定一种接种剂量,使超过 50%的参与者能够耐受良好的感染,次要目的是评估感染过程中的病毒和症状动力学。所有预先规定的主要和次要目标都已达到。由于在筛查和接种之间发生了血清转换,有两名参与者(2 名)被排除在方案分析之外,这是事后确定的。18 名(约 53%)参与者感染,病毒载量(VL)急剧上升,在接种后约 5 天达到峰值。病毒首先在喉咙中检测到,但在鼻子中上升到更高水平,峰值约为 8.87 对数拷贝/ml(中位数,95%置信区间(8.41,9.53))。从鼻腔中平均可回收活病毒,直至接种后约 10 天。没有严重的不良事件。16 名(89%)受感染的参与者报告了轻度至中度症状,从接种后 2-4 天开始,而 2 名(11%)参与者无症状(无报告症状)。15 名(83%)参与者的嗅觉或味觉障碍发展较慢。VL 与症状之间没有观察到定量相关性,即使在无症状感染中也存在高 VL。所有受感染的个体均产生了针对刺突蛋白的特异性 IgG 和中和抗体。侧向流动试验的结果与活病毒密切相关,建模表明,每周两次的快速抗原检测可以在产生 70-80%的活病毒之前诊断出感染。因此,通过对这第一项在年轻成年人中进行的 SARS-CoV-2 人体挑战研究进行详细的特征描述和安全性分析,建立了 SARS-CoV-2 原发性感染过程中的病毒动力学,这对公共卫生建议和影响 SARS-CoV-2 传播的策略具有重要意义。未来的研究将确定与那些未发生感染或症状的参与者的保护相关的免疫因素,并定义先前免疫和病毒变异对临床结果的影响。