Skip to main content
Top
Published in: Trials 1/2018

Open Access 01-12-2018 | Research

A phase I, open-label trial on the safety and immunogenicity of the adjuvanted tuberculosis subunit vaccine H1/IC31® in people living in a TB-endemic area

Authors: Jemal Hussein, Martha Zewdie, Lawrence Yamuah, Ahmed Bedru, Markos Abebe, Alemnew F. Dagnew, Menberework Chanyalew, Asfawesen G. Yohannes, Jemal Ahmed, Howard Engers, T. Mark Doherty, Peter Bang, Ingrid Kromann, Søren T. Hoff, Abraham Aseffa

Published in: Trials | Issue 1/2018

Login to get access

Abstract

Background

H1/IC31® is a tuberculosis (TB) subunit vaccine candidate consisting of the fusion protein of Ag85B and ESAT-6 (H1) formulated with the IC31® adjuvant. Previous trials have reported on the H1/IC31® vaccine in M. tuberculosis (Mtb)-naïve, BCG-vaccinated and previously Mtb-infected individuals. In this trial, conducted between December 2008 and April 2010, the safety and immunogenicity of H1/IC31® was assessed in participants living in Ethiopia – a highly TB-endemic area.

Methods

Healthy male participants aged 18–25 years were recruited into four groups. Participants in group 1 (N = 12) and group 2 (N = 12) were Tuberculin Skin Test (TST) negative and QuantiFERON-TB Gold in-tube test (QFT) negative (Mtb-naïve groups), participants in group 3 (N = 3) were TST positive and QFT negative (BCG group), and participants in group 4 (N = 12) were both TST and QFT positive (Mtb-infected group). H1 vaccine alone (group 1) or H1 formulated with the adjuvant IC31® (groups 2, 3 and 4) was administered intramuscularly on day 0 and day 56. Safety and immunogenicity parameters were evaluated for up to 32 weeks after day 0.

Results

The H1/IC31®vaccine was safe and generally well tolerated. There was little difference among the four groups, with a tendency towards a higher incidence of adverse events in Mtb-infected compared to Mtb-naïve participants. Two serious adverse events were reported in the Mtb-infected group where a relationship to the vaccine could not be excluded. In both cases the participants recovered without sequelae within 72 h. Immunogenicity assays, evaluated in the 29 participants who received both vaccinations, showed a stronger response to TB antigens in the Mtb-naïve group vaccinated with the adjuvant.

Conclusion

The trial confirmed the need for an adjuvant for the vaccine to be immunogenic and highlighted the importance of early phase testing of a novel TB vaccine candidate in TB-endemic areas.

Trial registration

ClinicalTrials.gov, ID: NCT01049282. Retrospectively registered on 14 January 2010.
Appendix
Available only for authorised users
Literature
2.
go back to reference Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, Snell L, Mangtani P, Adetifa I, Lalvani A, et al. Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ. 2014;349:g4643.CrossRefPubMedPubMedCentral Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, Snell L, Mangtani P, Adetifa I, Lalvani A, et al. Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ. 2014;349:g4643.CrossRefPubMedPubMedCentral
3.
go back to reference Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JA, Fine PE, Smith PG, Lipman M, Elliman D, et al. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guerin vaccination against tuberculosis. Health Technol Assess. 2013;17(37):1–372. v-vi.CrossRefPubMedPubMedCentral Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JA, Fine PE, Smith PG, Lipman M, Elliman D, et al. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guerin vaccination against tuberculosis. Health Technol Assess. 2013;17(37):1–372. v-vi.CrossRefPubMedPubMedCentral
4.
go back to reference Colditz GA, Berkey CS, Mosteller F, Brewer TF, Wilson ME, Burdick E, Fineberg HV. The efficacy of bacillus Calmette-Guerin vaccination of newborn and infants in the prevention of tuberculosis: meta-analyses of the published literature. Pediatrics. 1995;96(1):29–35.PubMed Colditz GA, Berkey CS, Mosteller F, Brewer TF, Wilson ME, Burdick E, Fineberg HV. The efficacy of bacillus Calmette-Guerin vaccination of newborn and infants in the prevention of tuberculosis: meta-analyses of the published literature. Pediatrics. 1995;96(1):29–35.PubMed
5.
go back to reference Andersen P, Woodworth JS. Tuberculosis vaccines—rethinking the current paradigm. Trends Immunol. 2014;35(8):387–95.CrossRefPubMed Andersen P, Woodworth JS. Tuberculosis vaccines—rethinking the current paradigm. Trends Immunol. 2014;35(8):387–95.CrossRefPubMed
6.
go back to reference Hawn TR, Day TA, Scriba TJ, Hatherill M, Hanekom WA, Evans TG, Churchyard GJ, Kublin JG, Bekker LG, Self SG. Tuberculosis vaccines and prevention of infection. Microbiol Mol Biol Rev. 2014;78(4):650–71.CrossRefPubMedPubMedCentral Hawn TR, Day TA, Scriba TJ, Hatherill M, Hanekom WA, Evans TG, Churchyard GJ, Kublin JG, Bekker LG, Self SG. Tuberculosis vaccines and prevention of infection. Microbiol Mol Biol Rev. 2014;78(4):650–71.CrossRefPubMedPubMedCentral
8.
go back to reference Brodin P, Majlessi L, Marsollier L, de Jonge MI, Bottai D, Demangel C, Hinds J, Neyrolles O, Butcher PD, Leclerc C, et al. Dissection of ESAT-6 system 1 of Mycobacterium tuberculosis and impact on immunogenicity and virulence. Infect Immun. 2006;74(1):88–98.CrossRefPubMedPubMedCentral Brodin P, Majlessi L, Marsollier L, de Jonge MI, Bottai D, Demangel C, Hinds J, Neyrolles O, Butcher PD, Leclerc C, et al. Dissection of ESAT-6 system 1 of Mycobacterium tuberculosis and impact on immunogenicity and virulence. Infect Immun. 2006;74(1):88–98.CrossRefPubMedPubMedCentral
9.
go back to reference Harboe M, Oettinger T, Wiker HG, Rosenkrands I, Andersen P. Evidence for occurrence of the ESAT-6 protein in Mycobacterium tuberculosis and virulent Mycobacterium bovis and for its absence in Mycobacterium bovis BCG. Infect Immun. 1996;64(1):16–22.PubMedPubMedCentral Harboe M, Oettinger T, Wiker HG, Rosenkrands I, Andersen P. Evidence for occurrence of the ESAT-6 protein in Mycobacterium tuberculosis and virulent Mycobacterium bovis and for its absence in Mycobacterium bovis BCG. Infect Immun. 1996;64(1):16–22.PubMedPubMedCentral
10.
go back to reference Mustafa AS, Shaban FA, Abal AT, Al-Attiyah R, Wiker HG, Lundin KEA, Oftung F, Huygen K. Identification and HLA restriction of naturally derived Th1-Cell epitopes from the secreted Mycobacterium tuberculosis antigen 85B recognized by antigen-specific human CD4+ T-Cell lines. Infect Immun. 2000;68(7):3933–40.CrossRefPubMedPubMedCentral Mustafa AS, Shaban FA, Abal AT, Al-Attiyah R, Wiker HG, Lundin KEA, Oftung F, Huygen K. Identification and HLA restriction of naturally derived Th1-Cell epitopes from the secreted Mycobacterium tuberculosis antigen 85B recognized by antigen-specific human CD4+ T-Cell lines. Infect Immun. 2000;68(7):3933–40.CrossRefPubMedPubMedCentral
11.
go back to reference Copin R, Coscolla M, Efstathiadis E, Gagneux S, Ernst JD. Impact of in vitro evolution on antigenic diversity of Mycobacterium bovis bacillus Calmette-Guerin (BCG). Vaccine. 2014;32(45):5998–6004.CrossRefPubMedPubMedCentral Copin R, Coscolla M, Efstathiadis E, Gagneux S, Ernst JD. Impact of in vitro evolution on antigenic diversity of Mycobacterium bovis bacillus Calmette-Guerin (BCG). Vaccine. 2014;32(45):5998–6004.CrossRefPubMedPubMedCentral
12.
go back to reference Hoang T, Aagaard C, Dietrich J, Cassidy JP, Dolganov G, Schoolnik GK, Lundberg CV, Agger EM, Andersen P. ESAT-6 (EsxA) and TB10.4 (EsxH) based vaccines for pre- and post-exposure tuberculosis vaccination. PLoS One. 2013;8(12):e80579.CrossRefPubMedPubMedCentral Hoang T, Aagaard C, Dietrich J, Cassidy JP, Dolganov G, Schoolnik GK, Lundberg CV, Agger EM, Andersen P. ESAT-6 (EsxA) and TB10.4 (EsxH) based vaccines for pre- and post-exposure tuberculosis vaccination. PLoS One. 2013;8(12):e80579.CrossRefPubMedPubMedCentral
13.
go back to reference Schellack C, Prinz K, Egyed A, Fritz JH, Wittmann B, Ginzler M, Swatosch G, Zauner W, Kast C, Akira S, et al. IC31, a novel adjuvant signaling via TLR9, induces potent cellular and humoral immune responses. Vaccine. 2006;24(26):5461–72.CrossRefPubMed Schellack C, Prinz K, Egyed A, Fritz JH, Wittmann B, Ginzler M, Swatosch G, Zauner W, Kast C, Akira S, et al. IC31, a novel adjuvant signaling via TLR9, induces potent cellular and humoral immune responses. Vaccine. 2006;24(26):5461–72.CrossRefPubMed
14.
go back to reference van Dissel JT, Arend SM, Prins C, Bang P, Tingskov PN, Lingnau K, Nouta J, Klein MR, Rosenkrands I, Ottenhoff TH, et al. Ag85B-ESAT-6 adjuvanted with IC31 promotes strong and long-lived Mycobacterium tuberculosis specific T cell responses in naive human volunteers. Vaccine. 2010;28(20):3571–81.CrossRefPubMed van Dissel JT, Arend SM, Prins C, Bang P, Tingskov PN, Lingnau K, Nouta J, Klein MR, Rosenkrands I, Ottenhoff TH, et al. Ag85B-ESAT-6 adjuvanted with IC31 promotes strong and long-lived Mycobacterium tuberculosis specific T cell responses in naive human volunteers. Vaccine. 2010;28(20):3571–81.CrossRefPubMed
15.
go back to reference van Dissel JT, Soonawala D, Joosten SA, Prins C, Arend SM, Bang P, Tingskov PN, Lingnau K, Nouta J, Hoff ST, et al. Ag85B-ESAT-6 adjuvanted with IC31(R) promotes strong and long-lived Mycobacterium tuberculosis specific T cell responses in volunteers with previous BCG vaccination or tuberculosis infection. Vaccine. 2011;29(11):2100–9.CrossRefPubMed van Dissel JT, Soonawala D, Joosten SA, Prins C, Arend SM, Bang P, Tingskov PN, Lingnau K, Nouta J, Hoff ST, et al. Ag85B-ESAT-6 adjuvanted with IC31(R) promotes strong and long-lived Mycobacterium tuberculosis specific T cell responses in volunteers with previous BCG vaccination or tuberculosis infection. Vaccine. 2011;29(11):2100–9.CrossRefPubMed
16.
go back to reference Reither K, Katsoulis L, Beattie T, Gardiner N, Lenz N, Said K, Mfinanga E, Pohl C, Fielding KL, Jeffery H, et al. Safety and immunogenicity of H1/IC31(R), an adjuvanted TB subunit vaccine, in HIV-infected adults with CD4+ lymphocyte counts greater than 350 cells/mm3: a phase II, multi-centre, double-blind, randomized, placebo-controlled trial. PLoS One. 2014;9(12):e114602.CrossRefPubMedPubMedCentral Reither K, Katsoulis L, Beattie T, Gardiner N, Lenz N, Said K, Mfinanga E, Pohl C, Fielding KL, Jeffery H, et al. Safety and immunogenicity of H1/IC31(R), an adjuvanted TB subunit vaccine, in HIV-infected adults with CD4+ lymphocyte counts greater than 350 cells/mm3: a phase II, multi-centre, double-blind, randomized, placebo-controlled trial. PLoS One. 2014;9(12):e114602.CrossRefPubMedPubMedCentral
17.
go back to reference Mearns H, Geldenhuys HD, Kagina BM, Musvosvi M, Little F, Ratangee F, Mahomed H, Hanekom WA, Hoff ST, Ruhwald M, et al. H1:IC31 vaccination is safe and induces long-lived TNF-alpha + IL-2 + CD4 T cell responses in M. tuberculosis infected and uninfected adolescents: a randomized trial. Vaccine. 2017;35(1):132–41.CrossRefPubMed Mearns H, Geldenhuys HD, Kagina BM, Musvosvi M, Little F, Ratangee F, Mahomed H, Hanekom WA, Hoff ST, Ruhwald M, et al. H1:IC31 vaccination is safe and induces long-lived TNF-alpha + IL-2 + CD4 T cell responses in M. tuberculosis infected and uninfected adolescents: a randomized trial. Vaccine. 2017;35(1):132–41.CrossRefPubMed
18.
go back to reference Wassie L, Aseffa A, Abebe M, Gebeyehu MZ, Zewdie M, Mihret A, Erenso G, Chanyalew M, Tilahun H, Yamuah LK, et al. Parasitic infection may be associated with discordant responses to QuantiFERON and tuberculin skin test in apparently healthy children and adolescents in a tuberculosis endemic setting, Ethiopia. BMC Infect Dis. 2013;13:265.CrossRefPubMedPubMedCentral Wassie L, Aseffa A, Abebe M, Gebeyehu MZ, Zewdie M, Mihret A, Erenso G, Chanyalew M, Tilahun H, Yamuah LK, et al. Parasitic infection may be associated with discordant responses to QuantiFERON and tuberculin skin test in apparently healthy children and adolescents in a tuberculosis endemic setting, Ethiopia. BMC Infect Dis. 2013;13:265.CrossRefPubMedPubMedCentral
19.
20.
go back to reference Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10(11):1192–204.PubMed Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10(11):1192–204.PubMed
21.
go back to reference Weir RE, Gorak-Stolinska P, Floyd S, Lalor MK, Stenson S, Branson K, Blitz R, Ben-Smith A, Fine PE, Dockrell HM. Persistence of the immune response induced by BCG vaccination. BMC Infect Dis. 2008;8:9.CrossRefPubMedPubMedCentral Weir RE, Gorak-Stolinska P, Floyd S, Lalor MK, Stenson S, Branson K, Blitz R, Ben-Smith A, Fine PE, Dockrell HM. Persistence of the immune response induced by BCG vaccination. BMC Infect Dis. 2008;8:9.CrossRefPubMedPubMedCentral
22.
go back to reference van Dissel JT, Joosten SA, Hoff ST, Soonawala D, Prins C, Hokey DA, O’Dee DM, Graves A, Thierry-Carstensen B, Andreasen LV, et al. A novel liposomal adjuvant system, CAF01, promotes long-lived Mycobacterium tuberculosis-specific T-cell responses in human. Vaccine. 2014;32(52):7098–107.CrossRefPubMed van Dissel JT, Joosten SA, Hoff ST, Soonawala D, Prins C, Hokey DA, O’Dee DM, Graves A, Thierry-Carstensen B, Andreasen LV, et al. A novel liposomal adjuvant system, CAF01, promotes long-lived Mycobacterium tuberculosis-specific T-cell responses in human. Vaccine. 2014;32(52):7098–107.CrossRefPubMed
23.
go back to reference Luabeya AK, Kagina BM, Tameris MD, Geldenhuys H, Hoff ST, Shi Z, Kromann I, Hatherill M, Mahomed H, Hanekom WA, et al. First-in-human trial of the post-exposure tuberculosis vaccine H56:IC31 in Mycobacterium tuberculosis infected and non-infected healthy adults. Vaccine. 2015;33(33):4130–40.CrossRefPubMed Luabeya AK, Kagina BM, Tameris MD, Geldenhuys H, Hoff ST, Shi Z, Kromann I, Hatherill M, Mahomed H, Hanekom WA, et al. First-in-human trial of the post-exposure tuberculosis vaccine H56:IC31 in Mycobacterium tuberculosis infected and non-infected healthy adults. Vaccine. 2015;33(33):4130–40.CrossRefPubMed
Metadata
Title
A phase I, open-label trial on the safety and immunogenicity of the adjuvanted tuberculosis subunit vaccine H1/IC31® in people living in a TB-endemic area
Authors
Jemal Hussein
Martha Zewdie
Lawrence Yamuah
Ahmed Bedru
Markos Abebe
Alemnew F. Dagnew
Menberework Chanyalew
Asfawesen G. Yohannes
Jemal Ahmed
Howard Engers
T. Mark Doherty
Peter Bang
Ingrid Kromann
Søren T. Hoff
Abraham Aseffa
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2354-0

Other articles of this Issue 1/2018

Trials 1/2018 Go to the issue