Intranasal Modified Vacc-4x Gag Peptides With Endocine as Adjuvant

This study has been completed.
Sponsor:
Collaborators:
Bionor Immuno AS
Eurocine Vaccines AB
Information provided by (Responsible Party):
Oslo University Hospital
ClinicalTrials.gov Identifier:
NCT01473810
First received: November 1, 2011
Last updated: June 19, 2012
Last verified: June 2012
  Purpose

HIV-specific cellular immunity is hampered in most HIV-infected individuals. Therapeutic immunization in HIV aims to strengthen the HIV-specific cellular immunity, usually in the absence of replicating HIV with antiretroviral drugs. The aims of this strategy can be to decrease the mass of latently infected CD4+ T cells, better tolerance of drug-free periods, and better select candidates for preventive HIV vaccines.

Vacc-4x is one of the few peptide-based therapeutic vaccines tested, and consists of four, slightly modified HIV Gag p24 consensus peptides. Vacc-4x was first tested by intradermal injections using GM-CSF as adjuvant. A recent multinational placebo-controlled study found improvement of vaccine-specific T cell immunity and decrease in viral loads (presented at the AIDS vaccine 2011 conference, Bangkok).

In this study the investigators hypothesize that the Vacc-4x peptides, deposited on the nasal mucosal surfaces in conjunction with Endocine, a newly developed and documented mucosal adjuvant, will induce T cell responses to HIV and improve HIV-specific immunity both systemically and at mucosal surfaces (oral, rectal, vaginal).


Condition Intervention Phase
HIV Infection
Biological: Vacc-4x low dose
Biological: Vacc-4x medium dose
Biological: Vacc-4x high dose
Biological: Zero dose
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Factorial Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
Official Title: Immunotherapy of HIV-infected Patients: A Single-blinded, Randomized, Immunogenicity, Pilot Study of Intranasal Administration of Vacc-4x With Endocine as Adjuvant

Resource links provided by NLM:


Further study details as provided by Oslo University Hospital:

Primary Outcome Measures:
  • Evaluate the safety of intranasal administration of Vacc-4x with Endocine as adjuvant at three different dose levels [ Time Frame: 2 months after completion of last patient. ] [ Designated as safety issue: Yes ]
    Record adverse events including severe adverse events according to GCP


Secondary Outcome Measures:
  • Evaluate cellular immune response to Vacc-4x in vivo by Vacc-4x DTH skin test [ Time Frame: Up to 2 months after completion of last patient ] [ Designated as safety issue: No ]
    Record intradermal Vacc-4x-associated delayed-type hypersensitivity test (DTH) in vivo by measuring skin induration (area) 2 days after injecion qt end of study week 8, in comparison with 38 historical unvaccinated HIV seropositive controls

  • Evaluate cellular immune response to Vacc-4x in vitro [ Time Frame: Up to 6 months after completion of last patient ] [ Designated as safety issue: No ]
    Measure changes in Vacc-4x-specific T cell proliferation and activation compared with baseline values for each individual participant, i.e. before vaccination

  • Evaluate the effect on CD4+ T cell counts and viral load (HIV-1 RNA) in peripheral blood [ Time Frame: Up to 2 months after completion of last patient ] [ Designated as safety issue: No ]
    Measure individual changes in CD4 counts and viral loads at baseline


Enrollment: 24
Study Start Date: November 2011
Study Completion Date: March 2012
Primary Completion Date: March 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Vacc-4x low dose
80 µg Vacc-4x (20 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity
Biological: Vacc-4x low dose
80 µg Vacc-4x (20 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity, administrated once weekly for four weeks
Other Names:
  • Vacc-4x
  • Endocine
Experimental: Vacc-4x medium dose
400 µg Vacc-4x (100 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity
Biological: Vacc-4x medium dose
400 µg Vacc-4x (100 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity, administrated once weekly for four weeks
Other Names:
  • Vacc-4x
  • Endocine
Experimental: Vacc-4x high dose
1200 µg Vacc-4x (300 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity
Biological: Vacc-4x high dose
1200 µg Vacc-4x (300 µg pr. peptide) in 300 µl Endocine divided into two administrations, one for each nose cavity, administrated once weekly for four weeks
Other Names:
  • Vacc-4x
  • Endocine
Placebo Comparator: Zero dose
Adjuvant only, i.e. 300 µl Endocine divided into two administrations, one for each nose cavity
Biological: Zero dose
300 µl Endocine divided into two administrations, one for each nose cavity, administrated once weekly for four weeks
Other Name: Endocine

Detailed Description:

HIV-specific cellular immunity is hampered in most HIV-infected individuals, partly because the virus infects CD4+ T cells, the key cell subset in all immune responses. CD4 is the primary HIV receptor (CD4), but infection requires a co-receptor (CCR5) which is carried mainly by activated T cells. During primary HIV-infection, two types of CD4+ T cells mainly become infected: (i) Sub-activated T cells of all specificities within the mucosal linings, particularly in the gut; and (ii) HIV-specific T cell clones, that proliferates and are activated as a normal response to HIV infection itself. The HIV-specific immunity therefore becomes severely compromised early in the infection. Patients having better T cells specific to parts of the HIV Gag matrix protein usually progress slower towards AIDS than patients with poor T cell responsitivity towards Gag.

Therapeutic immunization in HIV aims to strengthen the HIV-specific cellular immunity, usually in the absence of replicating HIV with antiretroviral drugs. The aims of this strategy can be to decrease the mass of latently infected CD4+ T cells, better tolerance of drug-free periods, and better select candidates for preventive HIV vaccines. The latter point may be important since clinical trials with preventive vaccine candidates may challenge our ethical standards: Such trials must be very large and conducted in poor areas with high prevalence of HIV, in order to have as many (placebo) or few (vaccine candidate) new HIV infections as fast as possible. Preventive vaccine trials might therefore compete with introduction of "western" access to HIV drugs.

Vacc-4x is one of the few peptide-based therapeutic vaccines tested, and consists of four, slightly modified HIV Gag p24 consensus peptides. Vacc-4x was first tested by intradermal injections using GM-CSF as adjuvant. In a dose study at our Hospital, the investigators found induction of robust cellular immune responses both in vitro and in vivo by skin testing, indications of improved viral control, long-lasting immunity and lack of mutational changes in the HIV strains within the study cohort. A recently completed multinational placebo-controlled study found improvement of viral loads (presented at the AIDS vaccine 2011 conference, Bangkok).

In this study the investigators hypothesize that the Vacc-4x peptides, deposited on the nasal mucosal surfaces in conjunction with Endocine, a newly developed and documented mucosal adjuvant, will induce T cell responses to HIV and improve HIV-specific immunity both systemically and at mucosal surfaces (oral, rectal, vaginal). This route of application may even simplify mass vaccination. The study is primarily a dose-study focused on adverse events, which have been negligible when Vacc-4x was given parenterally, as well as induction of systemic and mucosal immunity.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age above 18 years, both genders.
  • HIV positive at least one year.
  • Clinically stable on ART for the last 6 months (changes in therapy is allowed as long as the viral load is stable).
  • Documented viral load (HIV-1 RNA) less than 50 copies/mL for the last six months.
  • Documented stable CD4 cell count ≥ 400x106/L.
  • Nadir (lowest ever) CD4 cell count ≥ 200x106/L.
  • Signed informed consent.

Exclusion Criteria:

  • Reported pre-study AIDS-defining illness within the previous year.
  • Malignant disease.
  • On chronic treatment with immunosuppressive therapy.
  • Unacceptable values of the hematologic and clinical chemistry parameters, as judged by the Principle Investigator (or designee), including creatinine values >1.5x upper limit of normal (ULN), and AST (SGOT), ALT (SGPT) and alkaline phosphatase values >2.5x ULN.
  • Concurrent chronic active infection such as chronic viral hepatitis B or C or active tuberculosis.
  • Pregnant or breastfeeding women.
  • Women of childbearing potential not using reliable and adequate contraceptive methods (defined as: use of oral, implanted, injectable, mechanical or barrier products for the prevention of pregnancy; practicing abstinence; sterile) during the study, or sexually active male patients with partners of childbearing potential unwilling to practice effective contraception during the study.
  • Current participation in other clinical therapeutic studies.
  • Incapability of compliance to the treatment protocol, in the opinion of the Investigator.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01473810

Locations
Norway
Department of Infectious Diseases, Oslo University Hospital
Oslo, Norway, NO-0450
Sponsors and Collaborators
Oslo University Hospital
Bionor Immuno AS
Eurocine Vaccines AB
Investigators
Principal Investigator: Dag Kvale, Professor/MD Oslo University Hospital
  More Information

Additional Information:
No publications provided

Responsible Party: Oslo University Hospital
ClinicalTrials.gov Identifier: NCT01473810     History of Changes
Other Study ID Numbers: CTN-Vacc-4x/L3-2011/1
Study First Received: November 1, 2011
Last Updated: June 19, 2012
Health Authority: Norway: Norwegian Medicines Agency

Keywords provided by Oslo University Hospital:
HIV
vaccination
T cells
mucosal immunity
safety
nasal administration
DTH skin test

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases

ClinicalTrials.gov processed this record on July 31, 2014