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2020 ; 20
(7
): 816-826
Nephropedia Template TP
gab.com Text
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English Wikipedia
Safety and immunogenicity of a candidate Middle East respiratory syndrome
coronavirus viral-vectored vaccine: a dose-escalation, open-label,
non-randomised, uncontrolled, phase 1 trial
#MMPMID32325038
Folegatti PM
; Bittaye M
; Flaxman A
; Lopez FR
; Bellamy D
; Kupke A
; Mair C
; Makinson R
; Sheridan J
; Rohde C
; Halwe S
; Jeong Y
; Park YS
; Kim JO
; Song M
; Boyd A
; Tran N
; Silman D
; Poulton I
; Datoo M
; Marshall J
; Themistocleous Y
; Lawrie A
; Roberts R
; Berrie E
; Becker S
; Lambe T
; Hill A
; Ewer K
; Gilbert S
Lancet Infect Dis
2020[Jul]; 20
(7
): 816-826
PMID32325038
show ga
BACKGROUND: Cases of Middle East respiratory syndrome coronavirus (MERS-CoV)
infection continue to rise in the Arabian Peninsula 7 years after it was first
described in Saudi Arabia. MERS-CoV poses a significant risk to public health
security because of an absence of currently available effective countermeasures.
We aimed to assess the safety and immunogenicity of the candidate simian
adenovirus-vectored vaccine expressing the full-length spike surface
glycoprotein, ChAdOx1 MERS, in humans. METHODS: This dose-escalation, open-label,
non-randomised, uncontrolled, phase 1 trial was done at the Centre for Clinical
Vaccinology and Tropical Medicine (Oxford, UK) and included healthy people aged
18-50 years with negative pre-vaccination tests for HIV antibodies, hepatitis B
surface antigen, and hepatitis C antibodies (and a negative urinary pregnancy
test for women). Participants received a single intramuscular injection of
ChAdOx1 MERS at three different doses: the low-dose group received 5?×?10(9)
viral particles, the intermediate-dose group received 2·5?×?10(10) viral
particles, and the high-dose group received 5?×?10(10) viral particles. The
primary objective was to assess safety and tolerability of ChAdOx1 MERS, measured
by the occurrence of solicited, unsolicited, and serious adverse events after
vaccination. The secondary objective was to assess the cellular and humoral
immunogenicity of ChAdOx1 MERS, measured by interferon-?-linked enzyme-linked
immunospot, ELISA, and virus neutralising assays after vaccination. Participants
were followed up for up to 12 months. This study is registered with
ClinicalTrials.gov, NCT03399578. FINDINGS: Between March 14 and Aug 15, 2018, 24
participants were enrolled: six were assigned to the low-dose group, nine to the
intermediate-dose group, and nine to the high-dose group. All participants were
available for follow-up at 6 months, but five (one in the low-dose group, one in
the intermediate-dose group, and three in the high-dose group) were lost to
follow-up at 12 months. A single dose of ChAdOx1 MERS was safe at doses up to
5?×?10(10) viral particles with no vaccine-related serious adverse events
reported by 12 months. One serious adverse event reported was deemed to be not
related to ChAdOx1 MERS. 92 (74% [95% CI 66-81]) of 124 solicited adverse events
were mild, 31 (25% [18-33]) were moderate, and all were self-limiting.
Unsolicited adverse events in the 28 days following vaccination considered to be
possibly, probably, or definitely related to ChAdOx1 MERS were predominantly mild
in nature and resolved within the follow-up period of 12 months. The proportion
of moderate and severe adverse events was significantly higher in the high-dose
group than in the intermediate-dose group (relative risk 5·83 [95% CI
2·11-17·42], p<0·0001) Laboratory adverse events considered to be at least
possibly related to the study intervention were self-limiting and predominantly
mild in severity. A significant increase from baseline in T-cell (p<0·003) and
IgG (p<0·0001) responses to the MERS-CoV spike antigen was observed at all doses.
Neutralising antibodies against live MERS-CoV were observed in four (44% [95% CI
19-73]) of nine participants in the high-dose group 28 days after vaccination,
and 19 (79% [58-93]) of 24 participants had antibodies capable of neutralisation
in a pseudotyped virus neutralisation assay. INTERPRETATION: ChAdOx1 MERS was
safe and well tolerated at all tested doses. A single dose was able to elicit
both humoral and cellular responses against MERS-CoV. The results of this
first-in-human clinical trial support clinical development progression into field
phase 1b and 2 trials. FUNDING: UK Department of Health and Social Care, using UK
Aid funding, managed by the UK National Institute for Health Research.
|*Dose-Response Relationship, Immunologic
[MESH]
|*Immunogenicity, Vaccine
[MESH]
|Adult
[MESH]
|Antibodies, Neutralizing/immunology
[MESH]
|Antibodies, Viral
[MESH]
|Coronavirus Infections/prevention & control
[MESH]
|Enzyme-Linked Immunosorbent Assay
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Middle Aged
[MESH]
|Middle East Respiratory Syndrome Coronavirus/genetics/*immunology
[MESH]