Trial Evaluating the Immunogenicity and Safety of an Adjuvanted Epstein-Barr Virus (EBV) Glycoprotein 350 Vaccine in EBV-seronegative Persons

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID) (NIH)

Overall Status

Not yet recruiting

CT.gov ID

NCT05683834

Collaborator

(none)

1,000

Enrollment

Location

Arms

36.8

Anticipated Duration (Months)

27.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

Epstein-Barr virus (EBV) causes most cases of infectious mononucleosis (mono). Mono can cause fatigue that lasts more than 6 months, and some people can have severe complications. EBV infection may also contribute to some cancers and autoimmune diseases. Currently, there are no approved therapies or vaccines for EBV infection.

Objective:

To test a vaccine against EBV.

Eligibility:

Healthy people aged 18 to 22 years.

Design:

Participants will be screened in 2 parts. They will have a blood test. If that test shows they have never had an EBV infection, they will have a second clinic visit. They will have a physical exam, with blood and urine tests. A cotton swab will be rubbed on their gums to collect saliva.

Participants will receive 2 injections into a shoulder muscle. Some will receive the EBV vaccine. Others will receive a placebo; this contains harmless salt water with no vaccine. Participants will not know which one they are getting. The 2 injections will be 30 days apart.

Participants will be asked to record any side effects or symptoms they have between visits. They can do this on paper or online.

Participants will return for a follow-up visit 60 days after the first injection. They will have follow-up visits by phone or telehealth after 5 and 8 months. They will return for a physical exam after 13 months. They may come back for an optional physical exam after 2 years.

Participants will come to the clinic if they become ill with an EBV infection during the study.

Condition or Disease	Intervention/Treatment	Phase
Epstein-Barr Virus Infection Infectious Mononucleosis Herpesvirus	Drug: Matrix-M1 Adjuvant Drug: EBV gp350-Ferritin Vaccine Other: Placebo Comparator	Phase 1/Phase 2

Detailed Description

Study Description:

This is a multisite randomized, double-blinded phase 1/2 study to evaluate the immunogenicity and safety of a 2-dose regimen of an adjuvanted Epstein-Barr virus (EBV) glycoprotein (gp) 350-Ferritin nanoparticle vaccine in EBV-seronegative persons. We hypothesize that the vaccine will be safe and induce a potent EBV gp350-specific immune response. Sixty EBV-seronegative participants will be randomized; 30 will receive the EBV gp350-Ferritin vaccine and 30 will receive the placebo at Days 0 and 30. Participants will be followed for 1 year after the second dose with an option to follow for a second year.

Primary Objective:

To evaluate the safety and immunogenicity of an adjuvanted EBV gp350-Ferritin vaccine administered to healthy EBV-seronegative adults.

Secondary Objectives:

To further evaluate the safety of the adjuvanted EBV gp350-Ferritin vaccine administered to EBV-seronegative adults up to Day 60.
To preliminarily evaluate the efficacy of the adjuvanted EBV gp350-Ferritin vaccine administered to EBV-seronegative adults.

Exploratory Objective:

To further evaluate the immunogenicity of the EBV gp350-Ferritin vaccine.

Primary Endpoint:

Change in mean EBV neutralizing antibody from Day 0 to Day 60 in EBV gp350-Ferritin vaccine recipients as compared with placebo.

Secondary Endpoints:

Safety through Day 60:
Solicited local and systemic reactions within 7 days after vaccination.
Unsolicited adverse events (AEs) through Day 60.
Serious adverse events (SAEs) through Day 60.
Reduction of viremia measured by quantitative polymerase chain reaction (qPCR) in EBV gp350-Ferritin vaccine recipients as compared with placebo in participants who become infected with EBV.
Reduction of EBV infection as measured by new anti-EBV viral capsid antigen (VCA) specific immunoglobulin (Ig) G or IgM or new EBV viremia for up to 2 years post-vaccination as compared with placebo.
Reduction of EBV-related infectious mononucleosis as defined by signs and symptoms consistent with infectious mononucleosis with laboratory evidence for new EBV infection for up to 2 years post-vaccination as compared with placebo.

Exploratory Endpoints:

Increase in EBV gp350 IgG antibody in blood and/or EBV gp350 IgA antibody in gingival swab in vaccine recipients as compared with placebo.
Increase in CD4+ T-cell response in EBV gp350-Ferritin vaccine recipients from baseline (pre-vaccine) to 1 month after the second dose of vaccine (Day 60) as compared with placebo in participants who become infected with EBV.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

1000 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Prevention

Official Title:

A Phase 1/2 Randomized, Double-Blinded, Placebo-Controlled Trial Evaluating the Immunogenicity and Safety of an Adjuvanted Epstein-Barr Virus (EBV) Glycoprotein 350 Vaccine in EBV-Seronegative Persons

Anticipated Study Start Date :

Feb 6, 2023

Anticipated Primary Completion Date :

Mar 1, 2024

Anticipated Study Completion Date :

Mar 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Placebo Comparator: Control The placebo will be delivered intramuscularly into the deltoid muscle at 0 and 1 month. Each dose will consist of 0.4mL normal saline.	Other: Placebo Comparator Normal Saline
Experimental: Interventional The gp350-Ferritin vaccine will be delivered intramuscularly into the deltoid muscle at 0 and 1 month. Each vaccine dose will consist of 50 micrograms of EBV gp350-Ferritin combined with 49 micrograms of Matrix-M1 adjuvant.	Drug: Matrix-M1 Adjuvant Matrix-M1 is composed of 2 types of 40 nm-sized particles each with a different saponin fraction (fraction A and fraction B) combined with cholesterol and phospholipid. Drug: EBV gp350-Ferritin Vaccine The EBV gp350-Ferritin vaccine is composed of Helicobacter pylori non-heme ferritin fused to EBV gp350 which self-assembles to form a nanoparticle. The vaccine is supplied in single-use vials at a concentration of 250 micrograms/mL in 1.7 mM KH2PO4, 5 mM Na2HPO4, 150 mM NaCl, 5% sucrose, pH 7.4 (diluent).

Arm

Intervention/Treatment

Placebo Comparator: Control

The placebo will be delivered intramuscularly into the deltoid muscle at 0 and 1 month. Each dose will consist of 0.4mL normal saline.

Other: Placebo Comparator

Normal Saline

Experimental: Interventional

The gp350-Ferritin vaccine will be delivered intramuscularly into the deltoid muscle at 0 and 1 month. Each vaccine dose will consist of 50 micrograms of EBV gp350-Ferritin combined with 49 micrograms of Matrix-M1 adjuvant.

Drug: Matrix-M1 Adjuvant

Matrix-M1 is composed of 2 types of 40 nm-sized particles each with a different saponin fraction (fraction A and fraction B) combined with cholesterol and phospholipid.

Drug: EBV gp350-Ferritin Vaccine

The EBV gp350-Ferritin vaccine is composed of Helicobacter pylori non-heme ferritin fused to EBV gp350 which self-assembles to form a nanoparticle. The vaccine is supplied in single-use vials at a concentration of 250 micrograms/mL in 1.7 mM KH2PO4, 5 mM Na2HPO4, 150 mM NaCl, 5% sucrose, pH 7.4 (diluent).

Outcome Measures

Primary Outcome Measures

Change in mean EBV neutralizing antibody from D0 to D60 in EBV gp350 vaccine recipients as compared with placebo [Day 60]
To evaluate the safety and immunogenicity of the adjuvanted EBV gp350-Ferritin vaccine administered to healthy EBV-seronegative adults.

Secondary Outcome Measures

Reduction in EBV infection as measured by new anti-EBV VCA IgG or IgM or new EBV viremia for up to 2 years post-vaccination as compared with placebo [Year 2]
To preliminarily evaluate the efficacy of the adjuvanted EBV gp350-Ferritin vaccine administered to EBV seronegative adults.
Reduction EBV related infectious mononucleosis as defined by signs and symptoms consistent with infectious mononucleosis with laboratory evidence for new EBV infection for up to 2 years post-vaccination as compared with placebo [Year 2]
To preliminarily evaluate the efficacy of the adjuvanted EBV gp350-Ferritin vaccine administered to EBV seronegative adults.
Reduction of viremia measured by qPCR in EBV gp350 vaccine recipients as compared with placebo in participants who become infected with EBV [End of Study]
To preliminarily evaluate the efficacy of the adjuvanted EBV gp350-Ferritin vaccine administered to EBV seronegative adults.
Solicited local and systemic reactions within 7 days after vaccination Unsolicited Adverse events through day 60 Serious adverse events through day 60 [Day 60]
To further evaluate the safety of the adjuvanted EBV gp350 Ferritin vaccine administered to EBV seronegative adults up to Day 60.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 22 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

INCLUSION CRITERIA:

To be eligible to participate in this study, an individual must meet all the following criteria:

Aged 18 to 22 years.
Able to provide informed consent.
Willing to allow samples and data to be stored for future secondary research.
Stated willingness to comply with all study procedures and availability for the duration of the active phase of the study (approximately 18 months).
In good general health as evidenced by medical history, physical examination, and laboratory screening results.
Willing to forgo receipt of a licensed, live vaccine in the 30 days before and 30 days after each dose of the study vaccine. Any FDA-approved or authorized inactivated and/or protein subunit, RNA, or DNA vaccine can be used >=14 days before or >=14 days after administration of the study vaccine.
Hemoglobin within institutional normal limits, or if not, then assessed and deemed not clinically significant by PI or designee.
White blood cell count and differential within institutional normal reference range, or if not, then deemed not clinically significant by PI or designee.
Total lymphocyte count (lymphocyte absolute) >800 cells/microliters.
Platelet count of 125,000 to 500,000/microliters.
Alanine aminotransferase <1.25 X upper limit of normal.
Participants who can get pregnant must agree to use one of the following highly effective methods of contraception starting 30 days before the first dose of study vaccine through 60 days after the second dose:
Intrauterine device (IUD) or equivalent.
Hormonal contraceptive (eg, consistent, timely, and continuous use of contraceptive pill, patch, ring, implant, or injection that has reached full efficacy before the first dose of study agent). If the participant uses a contraceptive pill, patch, or ring, then a barrier method (eg, internal/external condom, cervical cap, or diaphragm plus spermicide) must also be used at the time of potentially reproductive sexual activity.
A hysterectomy and/or a bilateral tubal ligation or bilateral oophorectomy.
Barrier method (eg, internal/external condom, cervical cap, or diaphragm) plus spermicide used correctly during sexual intercourse.
A vasectomy in their monogamous sexual partner completed at least 6 months before the first dose of study vaccine.

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study:

Pregnant or breastfeeding, or planning to become pregnant while participating through 60 days after the second dose of study vaccine (Day 90).
Has received any of the following:

-- More than 10 days of systemic glucocorticoids (>=10 mg of prednisone or equivalent) within the 30 days prior to first dose of study agent.

More than 10 days of systemic immunosuppressive medications, cytotoxic medications, or immunomodulating therapy within 180 days prior to first dose of study agent.
Blood products, including immunoglobulins, within 120 days prior to first dose of study agent.
Any live attenuated vaccination within 30 days prior to first dose of study agent.
Investigational research agents within 30 days prior to first dose or planning to receive investigational products while on study.
Allergy treatment with antigen injections, unless on a maintenance schedule of shots no more frequently than once per month.
Has any of the following:
Febrile illness within 14 days of the first dose of study agent.
Body mass index >36.
History of serious reactions to vaccines.
Hereditary, acquired, or idiopathic forms of angioedema.
Idiopathic urticaria within the past year.
Asthma that is not well-controlled or that required emergency care, urgent care, hospitalization, or intubation during the past 2 years, or that requires the use of oral or intravenous steroids.
Diabetes mellitus type 1 or type 2, excluding a history of gestational diabetes.
Clinically significant autoimmune disease or immunodeficiency.
Bleeding disorder diagnosed by doctor (eg, factor deficiency, coagulopathy, or platelet disorder requiring special precautions).
Significant bruising or bleeding difficulties with intramuscular injections or blood draws.
Malignancy that is active or treated malignancy for which there is no reasonable assurance of sustained cure or malignancy that is likely to recur during the study period.
Seizure disorder other than a history of 1) febrile seizures, 2) seizures secondary to alcohol withdrawal more than 3 years ago, or 3) seizures that have not required treatment within the past 3 years.
Asplenia, functional asplenia, or any condition resulting in absence or removal of the spleen.
History of Guillain-Barre Syndrome.
Alcohol or drug abuse or addiction.
HIV infection.
Active hepatitis B or C infection.
Documented EBV infection.
Prior enrollment in an EBV vaccine clinical trial.
Any medical, psychiatric, or social condition that, in the judgement of the investigator, is a contraindication to protocol participation or impairs the participant s ability to give informed consent.

Co-enrollment guidelines:

Co-enrollment in other studies is restricted, other than enrollment on observational studies. Consideration for co-enrollment in trials evaluating the use of a licensed medication will require the approval of the PI or sponsor medical monitor (SMM). Study staff should be notified of co-enrollment on any other protocol as it may require the approval of the PI or SMM.