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Phase 2 N=60 Randomized Quadruple-blind Treatment

Live Attenuated ETEC Vaccine ACE527 With and Without dmLT Adjuvant in Adults

Diarrhea

Enrolled (actual)
60
Serious AEs
0.9%
Results posted
Dec 2018
Primary outcome: Primary: Part A: Number of Serious Adverse Events and Adverse Events Leading to Withdrawal — 0; 0; 0; 0 adverse events

Study Design & Population

Study type
Interventional
Phase
Phase 2
Interventions
ACE527 (Biological); dmLT (Biological); CeraVacx placebo (Biological); H10407 challenge strain (Biological)
Age
Adult · 18+ yrs
Sex
All
Sponsor
PATH
Primary completion
Oct 2013

Outcome Measures

OutcomeResultp-value
PRIMARY
Part A: Number of Serious Adverse Events and Adverse Events Leading to Withdrawal
0; 0; 0; 0; 1; 0
PRIMARY
Part A: Number of Participants Experiencing Unsolicited Adverse Events, by Severity and Relationship to Vaccination
10; 9; 4; 8; 2; 3
PRIMARY
Part A: Number of Solicited Reactions
1; 2; 0; 4; 3; 0
PRIMARY
Part A: Number and Percentage of Subjects With Positive Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0; 1; 0; 0; 7; 12
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0.93; 1.02; 0.83; 1.04; 3.39; 5.05
PRIMARY
Part A: Geometric Mean Titer of Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0.326; 0.387; 0.318; 0.303; 0.395; 0.264
PRIMARY
Part A: Number and Percentage of Subjects With Positive Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0; 0; 0; 0; 18; 12
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0.90; 0.95; 0.89; 0.96; 10.95; 6.45
PRIMARY
Part A: Geometric Mean Titer of Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0.175; 0.183; 0.178; 0.157; 0.175; 0.158
PRIMARY
Part A: Number and Percentage of Subjects With Positive Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
0; 1; 1; 0; 7; 2
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
0.87; 1.17; 0.96; 1.13; 2.95; 1.67
PRIMARY
Part A: Geometric Mean Titer of Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
0.292; 0.306; 0.322; 0.256; 0.360; 0.310
PRIMARY
Part A: Number and Percentage of Subjects With Positive Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
0; 0; 0; 0; 0; 0
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
1; 0.95; 1.00; 1; 0.96; 1.00
PRIMARY
Part A: Geometric Mean Titer of Antibody in Lymphocyte Supernatant (ALS) Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
0.14; 0.148; 0.141; 0.14; 0.140; 0.140
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0; 0; 1; 0; 1; 2
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0.96; 0.97; 1.03; 1.05; 1.12; 1.24
PRIMARY
Part A: Geometric Mean Titer of Antibody in Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
266; 385; 298; 255; 375; 306
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0; 11; 9; 0; 2; 4
PRIMARY
Part A: Geometric Mean Fold Change in Serum ELISA Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0.99; 2.49; 2.42; 1.00; 1.44; 1.62
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin A (IgA) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
96.9; 101; 109; 96.1; 251; 264
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
0; 0; 0; 0; 0; 0
PRIMARY
Part A: Geometric Mean Fold Change in Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
0.94; 1.02; 1.00; 0.97; 1.08; 1.06
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 3 (CS3)
309; 341; 324; 289; 347; 325
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
0; 1; 0; 0; 0; 0
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
0.96; 1.15; 0.99; 0.95; 1.14; 0.95
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin A (IgA) Response to E. Coli Surface Antigen 6 (CS6)
15.9; 20.0; 16.3; 15.3; 23.0; 16.2
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0; 2; 5; 0; 3; 8
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
0.78; 1.05; 1.38; 0.86; 1.42; 2.04
PRIMARY
Part A: Geometric Mean Titer of Antibody in Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Heat Labile Toxin B Subunit (LTB)
2469; 1990; 1903; 1914; 2098; 2635
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin G (IgG) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
0; 2; 2; 0; 2; 3
PRIMARY
Part A: Geometric Mean Fold Change in Serum ELISA Immunoglobulin G (IgG) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
1.06; 1.17; 1.22; 1.15; 1.15; 1.31
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin G (IgG) Response to Enterotoxigenic Escherichia Coli (ETEC) Colonization Factor 1 (CFA/I)
633; 748; 646; 668; 874; 785
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 3 (CS3)
0; 0; 0; 0; 0; 0
PRIMARY
Part A: Geometric Mean Fold Change in Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 3 (CS3)
0.96; 0.94; 0.84; 0.99; 0.96; 0.90
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 3 (CS3)
1610; 1265; 1809; 1544; 1188; 1522
PRIMARY
Part A: Number and Percentage of Subjects With Positive Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 6 (CS6)
0; 0; 2; 0; 1; 3
PRIMARY
Part A: Geometric Mean Fold Change in Antibody in Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 6 (CS6)
0.80; 0.96; 1.00; 0.76; 1.10; 1.01
PRIMARY
Part A: Geometric Mean Titer of Serum ELISA Immunoglobulin G (IgG) Response to E. Coli Surface Antigen 6 (CS6)
36.2; 68.2; 54.3; 29.0; 65.2; 54.1
PRIMARY
Part B: Number and Percentage of Subjects Experiencing Severe Diarrhea Following H10407 Challenge Strain
6; 10; 10; 7; 3; 21
SECONDARY
Part A: Number of Participants Shedding E. Coli on Qualification Plate
21; 23; 10; 24; 23; 10
SECONDARY
Part A: Number of Participants With Positive Shedding Results for ACE527
0; 0; 0; 22; 16; 0
SECONDARY
Number of Participants Shedding Vaccine Strains Included in ACE527
9; 11; 0; 4; 7; 0
SECONDARY
Part B: Number and Percentage of Subjects Experiencing Diarrhea of Any Severity
3; 9; 8; 2; 0; 2
SECONDARY
Part B: Mean Total Weight of Grade 3-5 Stools Passed Per Volunteer
1655.1; 748.8; 1878.2
SECONDARY
Part B: Median Total Weight of Grade 3-5 Stools Passed Per Volunteer
859; 30; 1400
SECONDARY
Part B: Mean Number of Grade 3-5 Stools Passed Per Volunteer
11.7; 6.0; 10.8
SECONDARY
Part B: Median Number of Grade 3-5 Stools Passed Per Volunteer
14; 1; 12
SECONDARY
Part B: Number of Subjects Experiencing Solicited Reactions Graded as Moderate or Severe
3; 2; 9; 1; 0; 2
SECONDARY
Part B: Number and Percentage of Subjects Who Would Have Reduced Daily Activity
9; 8; 10; 4; 5; 21
SECONDARY
Part B: Mean Time to Onset of Diarrhea Among Subjects Who Had Diarrhea
51.5; 59.9; 46.4
SECONDARY
Part B: Quantity of H10407 Per Gram of Stool on Day 2 Post-challenge
261.30; 94.345; 154.84
SECONDARY
Part B: Number of Subjects Requiring Early Antibiotic Treatment and Intravenous (IV) Fluids
7; 11; 13; 6; 2; 18

Summary

This is a research study about an experimental (investigational) oral ETEC vaccine (ACE527). ACE527 is a live attenuated vaccine that is being made to prevent disease from enterotoxigenic Escherichia coli (ETEC), which causes watery diarrhea, largely in children living in developing countries and in travelers to those countries. This research study is also testing an investigational adjuvant called dmLT. An adjuvant is something that is added to a vaccine to make it work better. The purpose of this study is two-fold. First, Part A aims to find out if the vaccine by itself or the vaccine combined with the adjuvant is safe, tolerable, and initiates an immune response. Second, Part B aims to find out if the vaccine by itself or the vaccine combined with the adjuvant prevents diarrheal disease when challenged with ETEC H10407. About 60 healthy adults, ages 18-50, will participate in Part A, and they will be required to stay in the research facility for several nights for the first dose, but will not be required to stay overnight for the second and third doses. Participants will be assigned to receive either the vaccine alone, the vaccine with adjuvant, or placebo by mouth. Study procedures include: stool samples, blood samples, and documentation of side effects. Participants will be involved in study related procedures for about 8 months. Interested volunteers from Part A will along with volunteers who were never vaccinated in Part A will return to participate in Part B. These volunteers will be required to stay overnight in the research facility for several nights after challenge, after which they will be treated with antibiotics and sent home. Study procedures include stool samples, blood samples, and documentation of infection with ETEC H10407. If the vaccine with/without adjuvant is effective, the volunteers should not development diarrhea, but if the vaccine with/without adjuvant is not effective, the volunteers will have diarrhea for a few days.

Eligibility Criteria

Inclusion Criteria

  • Male and female healthy adults between 18 and 50 years of age at the time of enrollment.
  • General good health, without clinically significant medical history, physical examination findings or clinical laboratory abnormalities per clinical judgment of PI.
  • Negative pregnancy test at screening and before the first (V0), second (V28), and third vaccinations (V56) for female volunteers of childbearing potential. Females of childbearing potential must agree to use an efficacious hormonal or barrier method of birth control during the study. Abstinence is acceptable. Female volunteers unable to bear children must have this documented (e.g. tubal ligation or hysterectomy) or must have negative pregnancy tests.
  • Willingness to participate in the study after all aspects of the protocol have been explained and written informed consent obtained.
  • Completion of a training session and demonstrated comprehension of the protocol procedures and knowledge of ETEC associated illness by passing a written examination (70% pass score).
  • Availability for the study duration, including all planned follow-up visits.
  • Received at least 2 doses of ACE527 vaccine alone or in combination with 25 ug dmLT 4-6 months prior to challenge (Part B only)

Exclusion Criteria

  • Presence of a significant medical or psychiatric condition which in the opinion of the investigator precludes participation in the study. Some medical conditions which are adequately treated and stable would not preclude entry into the study. These conditions might include stable asthma controlled with inhalers or mild hypertension stably controlled with a single agent.
  • Significant abnormalities in screening hematology, or serum chemistry as determined by PI or PI in consultation with the Medical Officer and sponsor.
  • Presence in the serum of HIV antibody, HBsAg, or HCV antibody.
  • Evidence of IgA deficiency (serum IgA 80 years old or infirm or immunocompromised (for reasons including corticosteroid therapy, HIV infection, cancer chemotherapy, or other chronic debilitating disease).
  • Abnormal stool pattern (fewer than 3 per week or more than 3 per day).
  • Regular (≥ weekly) use of laxatives, antacids, or other agents to lower stomach acidity.
  • Use of any medication known to affect the immune function (e.g., corticosteroids and others) within 30 days preceding the first vaccination or planned use during the active study period.
  • Symptoms consistent with Traveler's Diarrhea concurrent with travel to countries where ETEC infection is endemic (most of the developing world) within two years prior to dosing, OR planned travel to endemic countries during the length of the study.
  • Vaccination for or ingestion of ETEC, cholera, or LT toxin within 3 years prior to dosing.
  • Use of antibiotics during the 7 days before dosing or proton pump inhibitors, H2 blockers or antacids within 48hours prior to dosing.
  • History of diarrhea in the 7 days prior to vaccination (outpatient diarrhea is defined as ≥ 3 unformed (grade 3 or greater) loose stools in 24 hours).
  • Known allergy to two of the three following antibiotics: Ciprofloxacin, amoxicillin, and/or trimethoprim/sulfamethoxazole
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT01739231). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.

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