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ElSherif M, Halperin SA. Benefits of Combining Molecular Biology and Controlled Human Infection Model Methodologies in Advancing Vaccine Development. J Mol Biol 2023; 435:168322. [PMID: 37866477 DOI: 10.1016/j.jmb.2023.168322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
Infectious diseases continue to account for a significant portion of global deaths despite the use of vaccines for several centuries. Immunization programs around the world are a testament to the great success of multiple vaccines, yet there are still diseases without vaccines and others that require safer more effective ones. Addressing uncontrolled and emerging disease threats is restrained by the limitations and bottlenecks encountered with traditional vaccine development paradigms. Recent advances in modern molecular biology technologies have enhanced the interrogation of host pathogen interaction and deciphered complex pathways, thereby uncovering the myriad interplay of biological events that generate immune protection against foreign agents. Consequent to insights into the immune system, modern biology has been instrumental in the development and production of next generation 21st century vaccines. As these biological tools, commonly and collectively referred to as 'omics, became readily available, there has been a renewed consideration of Controlled Human Infection Models (CHIMs). Successful and reproducible CHIMs can complement modern molecular biology for the study of infectious diseases and development of effective vaccines in a regulated process that mitigates risk, cost, and time, with capacity to discern immune correlates of protection.
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Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada.
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2
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Katzer M, Salloch S, Schindler C, Mertz M. Ethical Requirements for Human Challenge Studies: A Systematic Review of Reasons. Clin Pharmacol Ther 2023; 114:1209-1219. [PMID: 37716911 DOI: 10.1002/cpt.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Human challenge studies (HCS) are controlled clinical trials in which participants are deliberately infected with a pathogen. Such trials are being developed for an increasing number of diseases. Partly as a result of the coronavirus disease 2019 (COVID-19) pandemic, there has been a recent ethical debate about the reasons for and against HCS in general, or rather, about the requirements that individual HCS must fulfill to be ethically acceptable. A systematic review was conducted to categorize and summarize such requirements and the reasons given for them. Ethics literature was searched in PubMed, Google Scholar, BELIT, and PhilPapers; eligibility criteria were articles published in a scientific/scholarly journal (original research, reviews, editorials, opinion pieces, and conference/meeting reports). Of 1,322 records identified, 161 publications were included, with 183 requirements (with associated reasons) in 10 thematic categories extracted via qualitative content analysis. In synthesizing and interpreting the requirements and their reasons, three issues emerge as particularly sensitive in the case of HCS: the meaning of the right to withdraw from research procedures, communication of researchers with the public and various stakeholders, and the conditions of informed consent. However, four other issues, not specific to HCS, stand out as the most controversial: the acceptable level of risk to participants, payment of participants, protection of vulnerable groups, and standards for international collaborations. Controversies in these areas indicate that further debate is warranted, possibly leading to more specific instructions in ethics guidance documents.
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Affiliation(s)
- Matthias Katzer
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Sabine Salloch
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Christoph Schindler
- Center for Clinical Trials (ZKS), Early Clinical Trial Unit (ECTU) & Center for Pharmacology and Toxicology, Hannover Medical School (MHH), Hannover, Germany
| | - Marcel Mertz
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany
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Abo YN, Jamrozik E, McCarthy JS, Roestenberg M, Steer AC, Osowicki J. Strategic and scientific contributions of human challenge trials for vaccine development: facts versus fantasy. THE LANCET. INFECTIOUS DISEASES 2023; 23:e533-e546. [PMID: 37573871 DOI: 10.1016/s1473-3099(23)00294-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 08/15/2023]
Abstract
The unprecedented speed of delivery of SARS-CoV-2 pandemic vaccines has redefined the limits for all vaccine development. Beyond the aspirational 100-day timeline for tomorrow's hypothetical pandemic vaccines, there is a sense of optimism that development of other high priority vaccines can be accelerated. Early in the COVID-19 pandemic, an intense and polarised academic and public discourse arose concerning the role of human challenge trials for vaccine development. A case was made for human challenge trials as a powerful tool to establish early proof-of-concept of vaccine efficacy in humans, inform vaccine down selection, and address crucial knowledge gaps regarding transmission, pathogenesis, and immune protection. We review the track record of human challenge trials contributing to the development of vaccines for 19 different pathogens and discuss relevant limitations, barriers, and pitfalls. This Review also highlights opportunities for efforts to broaden the scope and boost the effects of human challenge trials, to accelerate all vaccine development.
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Affiliation(s)
- Yara-Natalie Abo
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
| | - Euzebiusz Jamrozik
- Ethox and Pandemic Sciences Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Monash-WHO Collaborating Centre for Bioethics, Monash University, Melbourne, VIC, Australia
| | - James S McCarthy
- Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, Australia; Victorian Infectious Diseases Services, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Meta Roestenberg
- Controlled Human Infections Center, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Núñez-Núñez M, Maes-Carballo M, Mignini LE, Chien PFW, Khalaf Y, Fawzy M, Zamora J, Khan KS, Bueno-Cavanillas A. Research integrity in randomized clinical trials: A scoping umbrella review. Int J Gynaecol Obstet 2023; 162:860-876. [PMID: 37062861 DOI: 10.1002/ijgo.14762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) are experiencing a crisis of confidence in their trustworthiness. Although a comprehensive literature search yielded several reviews on RCT integrity, an overarching overview is lacking. OBJECTIVES The authors undertook a scoping umbrella review of the research integrity literature concerning RCTs. SEARCH STRATEGY AND SELECTION CRITERIA Following prospective registration (https://osf.io/3ursn), two reviewers independently searched PubMed, Scopus, The Cochrane Library, and Google Scholar, without language or time restrictions, until November 2021. The authors included systematic reviews covering any aspect of research integrity throughout the RCT lifecycle. DATA COLLECTION AND ANALYSIS The authors assessed methodological quality using a modified AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool and collated the main findings. MAIN RESULTS A total of 55 relevant reviews, summarizing 6001 studies (median per review, 63; range, 8-1106) from 1964 to 2021, had an overall critically low quality of 96% (53 reviews). Topics covered included general aspects (15%), design and approval (22%), conduct and monitoring (11%), reporting (38%), postpublication concerns (2%), and future research (13%). The most common integrity issues covered were ethics (18%) and transparency (18%). CONCLUSIONS Low-quality reviews identified various integrity issues across the RCT lifecycle, emphasizing the importance of high ethical standards and professionalism while highlighting gaps in the integrity landscape. Multistakeholder consensus is needed to develop specific RCT integrity standards.
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Affiliation(s)
- María Núñez-Núñez
- Pharmacy Department, University Hospital Clínico San Cecilio, Granada, Spain
- Biomedical research institute of Granada (IBS-Granada), Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
| | - Marta Maes-Carballo
- General Surgery Department. Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
- General Surgery Department, Hospital Público Verín, Ourense, Spain
| | | | | | - Yacoub Khalaf
- Guy's & St Thomas' Hospital Foundation Trust, London, UK
| | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Cairo, Egypt
| | - Javier Zamora
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Khalid S Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
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Hla TK, Osowicki J, Salman S, Batty KT, Marsh JA, Kado J, Barr R, Enkel SL, Snelling TL, McCarthy J, Steer AC, Carapetis J, Manning L. Study protocol for controlled human infection for penicillin G against Streptococcus pyogenes: a double-blinded, placebo-controlled, randomised trial to determine the minimum concentration required to prevent experimental pharyngitis (the CHIPS trial). BMJ Open 2022; 12:e064022. [PMID: 36600395 PMCID: PMC9743388 DOI: 10.1136/bmjopen-2022-064022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Regular intramuscular benzathine penicillin G injections have been the cornerstone of rheumatic heart disease (RHD) secondary prophylaxis since the 1950s. As the pharmacological correlate of protection remains unknown, it is difficult to recommend changes to this established regimen. Determining the minimum effective penicillin exposure required to prevent Streptococcus pyogenes infection will accelerate development of new long-acting penicillins for RHD prevention as well as inform opportunities to improve existing regimens. The CHIPS trial will address this knowledge gap by directly testing protection afforded by different steady state plasma concentrations of penicillin in an established model of experimental human S. pyogenes pharyngitis. METHODS AND ANALYSIS This is a double-blinded, placebo-controlled, randomised experimental human infection study. Sixty healthy adult volunteers aged 18-40 years will be recruited and randomised 1:1:1:1:1 to continuous intravenous penicillin infusions targeting five different steady state plasma concentrations of 0 (placebo), 3, 6, 12 and 20 ng/mL via a midline catheter. Each participant's penicillin pharmacokinetic parameters will be established prior to the challenge, to ensure accurate dosing for the continuous infusion. Following the challenge with a well-characterised strain of S. pyogenes, participants will be observed for up to 6 days for the development of pharyngitis and treated with antibiotics prior to discharge. The primary objective is to determine the minimum effective steady-state plasma penicillin concentration required to prevent experimental pharyngitis. Secondary objectives will explore systemic and mucosal immunoinflammatory responses during pharyngitis, bacterial colonisation dynamics, environmental contamination and qualitative evaluation of the participant experience. ETHICS AND DISSEMINATION Ethical approval has been obtained (Bellberry Human Research Ethics Committee). Findings will be reported in peer-reviewed publications and presented at national/international stakeholder forums. TRIAL REGISTRATION NUMBER ACTRN12621000751875.
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Affiliation(s)
- Thel Khin Hla
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Joshua Osowicki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne Department of General Medicine, Parkville, Victoria, Australia
| | - Sam Salman
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin T Batty
- Curtin University, Perth, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Joseph Kado
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Renae Barr
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Stephanie L Enkel
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Thomas L Snelling
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | | | - Andrew C Steer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne Department of General Medicine, Parkville, Victoria, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Laurens Manning
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
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History of Human Challenge Studies. HUMAN CHALLENGE STUDIES IN ENDEMIC SETTINGS 2021. [PMCID: PMC7431914 DOI: 10.1007/978-3-030-41480-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intentional infection of human beings with pathogens with the aim of achieving benefits (chiefly, the prevention of more severe disease) has occurred for centuries; the (semi-)systematic testing and recording of such methods dates to the 18th Century in England.
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Jamrozik E, Selgelid MJ. Human infection challenge studies in endemic settings and/or low-income and middle-income countries: key points of ethical consensus and controversy. JOURNAL OF MEDICAL ETHICS 2020; 46:601-609. [PMID: 32381683 PMCID: PMC7476299 DOI: 10.1136/medethics-2019-106001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 05/04/2023]
Abstract
Human infection challenge studies (HCS) involve intentionally infecting research participants with pathogens (or other micro-organisms). There have been recent calls for more HCS to be conducted in low-income and middle-income countries (LMICs), where many relevant diseases are endemic. HCS in general, and HCS in LMICs in particular, raise numerous ethical issues. This paper summarises the findings of a project that explored ethical and regulatory issues related to LMIC HCS via (i) a review of relevant literature and (ii) 45 qualitative interviews with scientists and ethicists. Among other areas of consensus, we found that there was widespread agreement that LMIC HCS can be ethically acceptable, provided that they have a sound scientific rationale, are accepted by local communities and meet usual research ethics requirements. Unresolved issues include those related to (i) acceptable approaches to trade-offs between the scientific aim to produce generalisable results and the protection of participants, (iii) the sharing of benefits with LMIC populations, (iii) the acceptable limits to risks and burdens for participants, (iv) the potential for third-party risk and whether the degree of acceptable third-party risk is different in endemic settings, (v) the conditions under which (if any) it would be appropriate to recruit children for disease-causing HCS, (v) appropriate levels of payment to participants and (vi) appropriate governance of (LMIC) HCS. This paper provides preliminary analyses of these ethical considerations in order to (i) inform scientists and policymakers involved in the planning, conduct and/or governance of LMIC HCS and (ii) highlight areas warranting future research. Insofar as this article focuses on HCS in (endemic) settings where diseases are present and/or widespread, much of the analysis provided is relevant to HCS (in HICs or LMICs) involving pandemic diseases including COVID19.
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Affiliation(s)
- Euzebiusz Jamrozik
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael J Selgelid
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
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9
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Abstract
The increasing recent interest in human challenge studies or controlled human infection model studies for accelerating vaccine development has been driven by the recognition of the unique ability of these studies to contribute to the understanding of response to infection and the performance of vaccines. With streamlining of ethical processes, conduct and supervision and the availability of new investigative tools from immunophenotyping to glycobiology, the potential to derive valuable data to inform vaccine testing and development has never been greater. However, issues of availability and standardization of challenge strains, conduct of studies in disease endemic locations and the iteration between clinical and laboratory studies still need to be addressed to gain maximal value for vaccine development.
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Affiliation(s)
- Amrita Sekhar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
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Metzger WG, Ehni HJ, Kremsner PG, Mordmüller BG. Experimental infections in humans-historical and ethical reflections. Trop Med Int Health 2019; 24:1384-1390. [PMID: 31654450 DOI: 10.1111/tmi.13320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vaccine efficacy and prophylactic treatment of infections are tested best when the vaccinated or treated individual is challenged through deliberate infection with the respective pathogen. However, this trial design calls for particular ethical caution. Awareness of the history of challenge trials is indispensable, including trials that were problematic or even connected to abuse. We briefly introduce historical aspects of experimental infections in humans and the ethical debate around them and give estimates of the numbers of volunteers participating in human experimental infection models. Challenge models can offer a great chance and benefit for the development of medical interventions to fight infectious diseases, but only when they are appropriately controlled and regulated.
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Affiliation(s)
- W G Metzger
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - H-J Ehni
- Institute for Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
| | - P G Kremsner
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - B G Mordmüller
- Institute for Tropical Medicine, German Center for Infection Research, Eberhard Karls University Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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Osowicki J, Azzopardi KI, Baker C, Waddington CS, Pandey M, Schuster T, Grobler A, Cheng AC, Pollard AJ, McCarthy JS, Good MF, Walker MJ, Dale JB, Batzloff MR, Carapetis JR, Smeesters PR, Steer AC. Controlled human infection for vaccination against Streptococcus pyogenes (CHIVAS): Establishing a group A Streptococcus pharyngitis human infection study. Vaccine 2019; 37:3485-3494. [PMID: 31101422 DOI: 10.1016/j.vaccine.2019.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Abstract
Group A Streptococcus (GAS) is a highly-adapted and human-restricted pathogen responsible for a high global burden of disease across a diverse clinical spectrum. Vaccine development has been impeded by scientific, regulatory, and commercial obstacles. Human infection studies (HIS) are increasingly contributing to drug, diagnostics, and vaccine development, reducing uncertainty at early stages, especially for pathogens with animal models that incompletely reproduce key elements of human disease. We review the small number of historical GAS HIS and present the study protocol for a dose-ranging inpatient study in healthy adults. The primary objective of the study is to establish a new GAS pharyngitis HIS with an attack rate of at least 60% as a safe and reliable platform for vaccine evaluation and pathogenesis research. According to an adaptive dose-ranging study design, emm75 GAS doses manufactured in keeping with principles of Good Manufacturing Practice will be directly applied by swab to the pharynx of carefully screened healthy adult volunteers at low risk of severe complicated GAS disease. Participants will remain as closely monitored inpatients for up to six days, observed for development of the primary outcome of acute symptomatic pharyngitis, as defined by clinical and microbiological criteria. All participants will be treated with antibiotics and followed as outpatients for six months. An intensive sampling schedule will facilitate extensive studies of host and organism dynamics during experimental pharyngitis. Ethics approval has been obtained and the study has been registered at ClinicalTrials.gov (NCT03361163).
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Affiliation(s)
- Joshua Osowicki
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia.
| | - Kristy I Azzopardi
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ciara Baker
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Claire S Waddington
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anneke Grobler
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - James B Dale
- University of Tennessee Health Science Center, Department of Medicine, Memphis, TN, USA
| | - Michael R Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Pierre R Smeesters
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
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Balasingam S, Wilder-Smith A. Randomized controlled trials for influenza drugs and vaccines: a review of controlled human infection studies. Int J Infect Dis 2016; 49:18-29. [PMID: 27208631 DOI: 10.1016/j.ijid.2016.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/05/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Controlled human infection, the intentional infection of healthy volunteers, allows disease pathogenesis to be studied and vaccines and therapeutic interventions to be evaluated in a controlled setting. A systematic review of randomized controlled trials of countermeasures for influenza that used the experimental human infection platform was performed. The primary objective was to document the scope of trials performed to date and the main efficacy outcome in the trials. The secondary objective was to assess safety and identify serious adverse events. METHODS The PubMed database was searched for randomized controlled influenza human challenge studies with predetermined search terms. Review papers, papers without outcomes, community-acquired infections, duplicated data, pathogenesis studies, and observational studies were excluded. RESULTS Twenty-six randomized controlled trials published between 1947 and 2014 fit the study inclusion criteria. Two-thirds of these trials investigated antivirals and one-third investigated influenza vaccines. Among 2462 subjects inoculated with influenza virus, the incidence of serious adverse events was low (0.04%). These challenge studies helped to down-select three antivirals and one vaccine that were subsequently approved by the US Food and Drug Administration (FDA). CONCLUSIONS Controlled human infection studies are an important research tool in assessing promising influenza vaccines and antivirals. These studies are performed quickly and are cost-effective and safe, with a low incidence of serious adverse events.
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Affiliation(s)
- Shobana Balasingam
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore 308232, Singapore.
| | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore 308232, Singapore
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13
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Evers DL, Fowler CB, Mason JT, Mimnall RK. Deliberate Microbial Infection Research Reveals Limitations to Current Safety Protections of Healthy Human Subjects. SCIENCE AND ENGINEERING ETHICS 2015; 21:1049-64. [PMID: 25150847 DOI: 10.1007/s11948-014-9579-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/31/2014] [Indexed: 05/20/2023]
Abstract
Here we identify approximately 40,000 healthy human volunteers who were intentionally exposed to infectious pathogens in clinical research studies dating from late World War II to the early 2000s. Microbial challenge experiments continue today under contemporary human subject research requirements. In fact, we estimated 4,000 additional volunteers who were experimentally infected between 2010 and the present day. We examine the risks and benefits of these experiments and present areas for improvement in protections of participants with respect to safety. These are the absence of maximum limits to risk and the potential for institutional review boards to include questionable benefits to subjects and society when weighing the risks and benefits of research protocols. The lack of a duty of medical care by physician-investigators to research subjects is likewise of concern. The transparency of microbial challenge experiments and the safety concerns raised in this work may stimulate further dialogue on the risks to participants of human experimentation.
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Affiliation(s)
- David L Evers
- Veterans Affairs Maryland Health Care System, Research Service, 10 North Greene Street, Baltimore, MD, 21201, USA,
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Merkel TJ, Halperin SA. Nonhuman primate and human challenge models of pertussis. J Infect Dis 2014; 209 Suppl 1:S20-3. [PMID: 24626867 DOI: 10.1093/infdis/jit493] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite pertussis vaccination rates in excess of 95%, pertussis rates in the United States have been rising over the last 30 years, with increasingly larger outbreaks in 2004, 2010, and 2012. The reasons for this resurgence of pertussis are not clearly understood. The recent development of a baboon model of pertussis, along with the future development of a human challenge model of pertussis, has the potential to provide a path forward for answering critical questions about pertussis pathogenesis and host responses and will likely aid in the development of next-generation pertussis vaccines.
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Affiliation(s)
- Tod J Merkel
- Division of Bacterial, Parasitic and Allergenic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland
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