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Tick-Borne EncephalitisPhase 4CRC306NCT01710189

Cervicovaginal Immune Responses to 3 Deltoid or Thigh Intramuscular (IM) TicoVac

A Phase 4 study testing TicoVac in people with Tick-Borne Encephalitis, run by University of Surrey at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Many viral infections of global importance, including HIV, are transmitted across the mucosal surface of the genital tract. As immunity against these infections is likely to be primarily mediated by antibodies in mucosal secretions, developing techniques to increase the levels and persistence of antiviral antibody on… Read more about this study

Who is it for?
Ages 18 to 49 years, women onlyHealthy volunteers can take part
Conditions the study is for
Tick-Borne Encephalitis
What is being tested?
TicoVac
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteUnited Kingdom
Study dates
Oct 2012to Oct 2014
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 49 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Women aged between 18 and 49 years on the day of screening.
  • Available for follow-up for the duration of the study.
  • Willing and able to give written informed consent.
  • Agree to abstain from donating blood during and for three months after the end of their participation in the trial, or longer if necessary.
  • Willing to abstain from vaginal intercourse for 12 hours prior to cervico-vaginal secretions sampling.

Who cannot join

  • Previous immunisation with a TBEV vaccine or history of TBEV infection.
  • Previous immunisation with a Yellow Fever or Japanese B encephalitis vaccine, or history of infection with Yellow fever, Japanese B encephalitis, hepatitis C and dengue infection (as antibodies against these viruses cross react with TBE). Immunisation with Yellow Fever or Japanese B encephalitis vaccine or diagnosis of any of these infections during the study period will exclude the subject.
  • Intention to travel to an area requiring immunisation against Japanese B encephalitis within 40 days and yellow fever within 10 days of the expected last visit(as Japanese B encephalitis vaccine requires two immunisations 28 days apart and must be completed within 10 days of departure. Yellow Fever vaccination becomes effective 10 days after a single immunisation)
  • Any Intra Uterine Contraceptive Device (as this contraindicates with use of the Softcup).
  • Pregnant or lactating at time of screening or immunisations.
  • Known hypersensitivity to the vaccine active substance, any of the excipients, or the production residues (formaldehyde, neomycin, gentamicin, protamine sulphate).
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  • Latex allergy.
  • Severe hypersensitivity to egg and chick proteins ("severe" means anaphylactic reaction after oral ingestion of egg protein - other reactions are not exclusions).
  • Clinically relevant abnormality on history including uncontrolled infection; autoimmune disease, immunodeficiency, or pre-existing cerebral disorders.
  • Any drugs and categories of drugs listed in Appendix 1, by the routes indicated, and at any time during the study period, or for the period preceding screening indicated in Appendix 1.
  • Any medications that are not listed in Appendix 1,or any over-the-counter treatments are not excluded.
  • Receipt of vaccines other than TBEV vaccines is not excluded. If other injectable vaccines are to be given during the study period, administration should preferably be into different limbs from the study vaccine.
  • Receipt of blood products or immunoglobin within 3 months of screening.
  • Participation in another trial of a medicinal product, completed less than 90 days prior to visit 2.
  • Unable to read and speak English to a fluency level adequate for the full comprehension of procedures required in participation and consent.
  • Unlikely to comply with protocol.

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Surrey CRC, Egerton Road

    Guildford, Surrey, GU2 7XP

Other trials in United Kingdom

About this study

Official title: Phase 4 Clinical Trial of Cervico-vaginal Immune Responses Following Three Right Deltoid or Right Thigh Intramuscular Immunisations With TicoVac (Tick Borne Encephalitis Virus [TBEV]) Vaccine in Adult Female Participants

Many viral infections of global importance, including HIV, are transmitted across the mucosal surface of the genital tract. As immunity against these infections is likely to be primarily mediated by antibodies in mucosal secretions, developing techniques to increase the levels and persistence of antiviral antibody on mucosal surfaces may enhance the protection against a number of important infections. Preclinical studies have anatomically targeted vaccine antigens to sites where genital tract immunity is induced. This response is likely due to the ability of regional lymph Preclinical studies have anatomically targeted vaccine antigens to sites where genital tract immunity is induced. This response is likely due to the ability of regional lymph nodes to "pattern" the cell surface markers of responding vaccine specific lymphocytes with homing markers. In contrast, injecting a distant muscle (such as in the arm) which shares no anatomical relationship with the vagina, may not pattern cells with homing markers for the genital tract. Direct injection of inguinal lymph nodes is impractical in humans but intramuscular injection into the thigh will target antigens to the deep inguinal lymph nodes shared in common with the cervix/vagina.

This study will be a Phase IV randomised, single centre, open label, laboratory assessment blinded exploratory trial to assess mucosal immunogenicity following three targeted intramuscular immunisations with TicoVac vaccine. 20 subjects will be randomised to each of2 groups immunised in right deltoid or right anterolateral thigh.

Read more

Following an initial screening visit subjects will be immunised at 0, 1 and 6 months. There will be follow up visits 5 days after each immunisation and a final visit at 7 months. Blood samples and cervicovaginal secretions will be taken prior to each immunisation for immunological measures. In addition, blood samples will be taken at each immunisation and follow up visit for measurement of peripheral blood mononuclear cells.

The study is funded by ADITEC, which is a collaborative research programme that aims to accelerate the development of novel and powerful immunisation technologies for the next generation of human vaccines.

Read the detailed description

The study will investigate whether targeting vaccine antigens to lymph nodes (internal iliac) which drain both the lower limb and the cervix/vagina alters the subsequent antibody response detected in the cervix/vagina, when compared with targeting vaccine antigens to unrelated lymph nodes such as those in the axilla that drain the right deltoid muscle of upper arm.

The right arm has been specifically selected as lymphatics in the right upper part of the body drains directly into the blood stream via the right lymphatic duct with no shared lymphatic connections to the rest of the body. In contrast lymph from the rest of the body ultimately drains into the thoracic duct (see figure below). By immunising the right arm the investigators can be sure that vaccine antigens and antigen presenting cells and activated lymphocytes will not pass through any lymph nodes in common with the cervix or vagina. In contrast by injecting the anterolateral thigh (right side selected for uniformity) the investigators can be sure that vaccine antigens will pass through the external inguinal lymph nodes which will also receive antigens and lymphocytes responding to vaginal or cervical infection or inflammation. The choice of right leg is just to standardise.

It is the investigators hypothesis therefore that as a result of antigen presentation and stimulation within a specifically "genital tract milieu" T \&B lymphocytes leaving the external iliac nodes as a result of an immunisation into the thigh will be patterned in such a way as to more likely home back to the cervix and vagina due to the common drainage of the cervix, vagina and thigh (Figure 1) into the external iliac and lateral aortic lymph nodes. In contrast, cells leaving the axillary lymph nodes after immunisation of the right arm will enter the blood directly via the right lymphatic duct and so will not pass through any lymph nodes in common with the cervix and vagina.

The investigators will detect an effect of targeted immunisation in a number of ways:

  1. By detecting increased levels of vaccine-specific antibodies in cervico-vaginal secretions as a result of more activated B cells (plasmablasts) homing back to the genital tract. IgG antibodies may be transudated from the blood but local mucosal IgG may also be produced. In contrast, mucosal IgA is most likely to be locally produced and may therefore be preferentially affected by targeted immunisation. However as individual levels of mucosal antibody vary widely between subjects, especially with IgA, the investigators will set primary endpoints on the basis of a fold-increase in antibody levels from baseline, rather than concentration. As mucosal IgG responses are generally more reliable and of greater magnitude the investigators have set the primary objective as vaccine-specific mucosal IgG after all three immunisations. Vaccine-specific mucosal IgA responses after all three immunisations are the secondary objective. The study has been powered on the basis of the investigators limited experience with similar vaccines to detect a doubling of proportions of responders for IgG and IgA. The investigators have based the fold-increase in vaccine-specific mucosal IgG and IgA on the investigators limited experience with a similar vaccine injected into the arm(7). In addition, the investigators will measure changes in other variables that are exploratory in nature as assays and quantification are less well established:
  2. By detecting a "mucosal" pattern of B cell responses in the blood with increased numbers of vaccine-specific B cells after genital targeted immunisation.
  3. By detecting differences in the cell surface phenotypic markers on vaccine-specific lymphocytes indicating a mucosal origin.

There will be two treatment groups:

  • Group 1 will receive the vaccine in the right deltoid muscle (upper arm) which drains to unrelated lymph nodes in the axilla.
  • Group 2 will receive the vaccine in the upper anterolateral right thigh, from which antigens will be expected to drain to the inguinal lymph nodes that also drain the cervix/vagina.

To ensure complete disconnection of draining lymph nodes it will always be the RIGHT arm or RIGHT leg that is immunised.

It is hypothesised that targeting the internal iliac nodes will lead to an enhanced mucosal antibody response in the cervix/vagina, which will be detected by increased vaccine-specific IgA in cervico-vaginal secretions collected in a Softcup. In addition, lymphocytes (B and T cells) from external iliac lymph nodes may carry surface markers associated with mucosal homing and secrete different combinations of cytokines (Th17) than those emanating from axillary nodes which will express a systemic phenotype. This can be detected by flow cytometry, ELISPOT after bead separation using phenotypic markers, and other immunological assays.

Immune response readouts will be IgG and IgA antibodies against the TBEV antigens in the vaccine, comparing the two groups at the time point when the peak response is expected (28 days after third immunisation).

As the investigators wish to investigate the ability of the vaccine to specifically prime subjects in a targeted way, participants must be naive to the vaccine antigens and so must not have had the vaccine or TBEV infection before. Therefore the investigators will use TicoVac - a TBEV vaccine licenced in the UK that UK adults have not generally received, as TBEV infection is not endemic in the UK. TicoVac is widely used in central and eastern Europe where TBEV is endemic but extremely uncommon, and is offered to travellers from UK to endemic areas who are likely to engage in high risk activity (hiking, trekking).

Mucosal responses against TBEV are not relevant as TBEV is transmitted by tick bites. Immune responses to TicoVac will act as a model for other vaccines in which the mucosal antibody response in the vagina is of relevance to block infection (e.g. HIV, HPV, HSV) and in which targeted immunisation may increase efficacy.

Although strictly speaking the induction of anti-TBEV antibodies in cervico-vaginal secretions is of no relevance to the efficacy of the TicoVac vaccine against a blood-injected virus, the investigators have designated them as parameters of efficacy in this model of targeted immunisation.

The purpose of this human immune physiology study is to use TBEV vaccine as a model neoantigen to investigate immune readouts after antigen targeting. The collection of adverse event or safety data is therefore not relevant to the study objectives and there will be no systematic collection of safety data, other than those required for a Risk Assessed "Type A" CTIMP (SUSAR reporting to MHRA/REC/Concerned Investigators, Annual List of Suspected Serious Adverse Reactions as part of the Annual Safety Report/Development Safety Update Report).

Being tested
TicoVac
Keywords
Tick-Borne Encephalitis Virus
Medical subject headings
Encephalitis, Tick-Borne

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TicoVacDrug

    Intramuscular immunisation to right deltoid muscle (Group 1) or right upper anterolateral thigh muscle (Group 2).

Study groups in NCT01710189
Study groupRoleWhat they receive
TicoVac immunisation - right deltoid muscleExperimentalIM immunisation right deltoid muscle
Receives: Drug: TicoVac
TicoVac immunisation - upper anterolateral thighExperimentalIM: right upper anterolateral thigh
Receives: Drug: TicoVac

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary: Proportion of subjects with a 15-fold or greater increase from pre-immunisation levels of anti-TBEV IgG in cervico-vaginal secretions at 28 days after final immunisation.

    To determine whether immunisations in the anterolateral right thigh increases the proportion of subjects with a 15-fold or greater increase from pre-immunisation levels of anti-TBEV IgG in cervico-vaginal secretions at 28 days after final immunisation when compared with immunisations in the right arm

    Measured: 28 weeks

Secondary outcomes (1)
  1. Secondary: Proportion of subjects with a 2-fold or greater increase from pre-immunisation levels of anti-TBEV IgA in cervico-vaginal secretions at 28 days after final immunisation

    To determine whether immunisations in the anterolateral right thigh increases the proportion of subjects with a 2-fold or greater increase from pre-immunisation levels of anti-TBEV IgA in cervico-vaginal secretions at 28 days after final immunisation when compared with immunisations in the right arm

    Measured: 28 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2012 (estimated)
  2. Study startOct 2012
  3. Primary completionOct 2014
  4. Study completionOct 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01710189
Sponsor's protocol ID
CRC306
Acronym
CRC306
Status last verified
Aug 2018
First submitted
16 Oct 2012
Last updated
3 Aug 2018
Results posted
No
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing TicoVac in people with Tick-Borne Encephalitis, run by University of Surrey at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary: Proportion of subjects with a 15-fold or greater increase from pre-immunisation levels of anti-TBEV IgG in cervico-vaginal secretions at 28 days after final immunisation. (time frame: 28 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Aug 2018.

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