Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
Walter Reed Army Institute of Research, Silver Spring, MD, USA; Global Clinical Development, Vaccines, Merck, Rahway, NJ, USA.
Lancet Microbe. 2024 Jun;5(6):e581-e593. doi: 10.1016/S2666-5247(23)00410-X. Epub 2024 May 15.
BACKGROUND: A self-assembling SARS-CoV-2 WA-1 recombinant spike ferritin nanoparticle (SpFN) vaccine co-formulated with Army Liposomal Formulation (ALFQ) adjuvant containing monophosphoryl lipid A and QS-21 (SpFN/ALFQ) has shown protective efficacy in animal challenge models. This trial aims to assess the safety and immunogenicity of SpFN/ALFQ in a first-in-human clinical trial. METHODS: In this phase 1, randomised, double-blind, placebo-controlled, first-in-human clinical trial, adults were randomly assigned (5:5:2) to receive 25 μg or 50 μg of SpFN/ALFQ or saline placebo intramuscularly at day 1 and day 29, with an optional open-label third vaccination at day 181. Enrolment and randomisation occurred sequentially by group; randomisation was done by an interactive web-based randomisation system and only designated unmasked study personnel had access to the randomisation code. Adults were required to be seronegative and unvaccinated for inclusion. Local and systemic reactogenicity, adverse events, binding and neutralising antibodies, and antigen-specific T-cell responses were quantified. For safety analyses, exact 95% Clopper-Pearson CIs for the probability of any incidence of an unsolicited adverse event was computed for each group. For immunogenicity results, CIs for binary variables were computed using the exact Clopper-Pearson methodology, while CIs for geometric mean titres were based on 10 000 empirical bootstrap samples. Post-hoc, paired one-sample t tests were used to assess the increase in mean log-10 neutralising antibody titres between day 29 and day 43 (after the second vaccination) for the primary SARS-CoV-2 targets of interest. This trial is registered at ClinicalTrials.gov, NCT04784767, and is closed to new participants. FINDINGS: Between April 7, and June 29, 2021, 29 participants were enrolled in the study. 20 individuals were assigned to receive 25 μg SpFN/ALFQ, four to 50 μg SpFN/ALFQ, and five to placebo. Neutralising antibody responses peaked at day 43, 2 weeks after the second dose. Neutralisation activity against multiple omicron subvariants decayed more slowly than against the D614G or beta variants until 5 months after second vaccination for both dose groups. CD4 T-cell responses were elicited 4 weeks after the first dose and were boosted after a second dose of SpFN/ALFQ for both dose groups. Neutralising antibody titres against early omicron subvariants and clade 1 sarbecoviruses were detectable after two immunisations and peaked after the third immunisation for both dose groups. Neutralising antibody titres against XBB.1.5 were detected after three vaccinations. Passive IgG transfer from vaccinated volunteers into Syrian golden hamsters controlled replication of SARS-CoV-1 after challenge. INTERPRETATION: SpFN/ALFQ was well tolerated and elicited robust and durable binding antibody and neutralising antibody titres against a broad panel of SARS-CoV-2 variants and other sarbecoviruses. FUNDING: US Department of Defense, Defense Health Agency.
背景:一种由自我组装的 SARS-CoV-2 WA-1 重组刺突 ferritin 纳米颗粒(SpFN)和 Army Liposomal Formulation(ALFQ)组成的疫苗,该疫苗含有单磷酰脂质 A 和 QS-21,已在动物攻毒模型中显示出保护效力。这项试验旨在评估 SpFN/ALFQ 在首次人体临床试验中的安全性和免疫原性。
方法:在这项 1 期、随机、双盲、安慰剂对照、首次人体临床试验中,成年人按 5:5:2 的比例随机分配接受 25 μg 或 50 μg 的 SpFN/ALFQ 或生理盐水安慰剂肌肉注射,第 1 天和第 29 天各一次,并在第 181 天可选择进行开放标签的第三次接种。入组和随机分组按组进行;随机分组由交互式基于网络的随机化系统进行,只有指定的未蒙面研究人员可以访问随机化代码。成年人必须为血清阴性且未接种疫苗才能入组。定量评估局部和全身反应原性、不良事件、结合抗体和中和抗体以及抗原特异性 T 细胞反应。对于安全性分析,对于每个组,使用确切的 95% Clopper-Pearson CI 计算任何未申报不良事件的概率。对于免疫原性结果,使用确切的 Clopper-Pearson 方法计算二项变量的 CI,而几何平均滴度的 CI 基于 10,000 个经验引导样本。事后,使用配对的单样本 t 检验评估主要 SARS-CoV-2 靶标在第 29 天和第 43 天(第二次接种后)之间的中和抗体滴度的平均对数 10 增加。该试验在 ClinicalTrials.gov 注册,NCT04784767,目前已不再招募新的参与者。
结果:在 2021 年 4 月 7 日至 6 月 29 日期间,有 29 名参与者入组该研究。20 名参与者被分配接受 25 μg SpFN/ALFQ,4 名接受 50 μg SpFN/ALFQ,5 名接受安慰剂。中和抗体反应在第二次接种后 2 周的第 43 天达到峰值。对于两个剂量组,对多种 omicron 亚变体的中和活性衰减速度均比 D614G 或 beta 变体慢,直到第二次接种后 5 个月。CD4 T 细胞反应在第一次接种后 4 周出现,并在第二次接种 SpFN/ALFQ 后增强。两个剂量组在两次免疫后均可检测到针对早期 omicron 亚变体和 clade 1 sarbecoviruses 的中和抗体滴度,并在第三次免疫后达到峰值。两个剂量组在第三次接种后均可检测到针对 XBB.1.5 的中和抗体滴度。从接种志愿者中被动转移的 IgG 可控制 SARS-CoV-1 在攻毒后的复制。
结论:SpFN/ALFQ 耐受性良好,可诱导针对广泛的 SARS-CoV-2 变体和其他 sarbecoviruses 的强大且持久的结合抗体和中和抗体滴度。
资金来源:美国国防部,国防卫生局。
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