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Langley JM, Gantt S, Halperin SA, Ward B, McNeil S, Ye L, Cai Y, Smith B, Anderson DE, Mitoma FD. An enveloped virus-like particle alum-adjuvanted cytomegalovirus vaccine is safe and immunogenic: A first-in-humans Canadian Immunization Research Network (CIRN) study. Vaccine 2024; 42:713-722. [PMID: 38142214 DOI: 10.1016/j.vaccine.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/06/2023] [Accepted: 12/03/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Cytomegalovirus (CMV) is the most common cause of congenital infection and affected children often have permanent neurodevelopmental sequelae, including hearing loss and intellectual disability. Vaccines to prevent transmission of CMV during pregnancy are a public health priority. This first-in-humans dose-ranging, randomized, placebo-controlled, observer-blinded study evaluated the safety and immunogenicity of an enveloped virus-like particle (eVLP) vaccine expressing a modified form of the CMV glycoprotein B (gB). METHODS Healthy CMV-seronegative 18 to 40-year-olds at 3 Canadian study sites were randomized to one of 4 dose formulations (0.5 µg, 1 µg, or 2 µg gB content with alum) or 1 µg gB without alum, or placebo, given intramuscularly on days 0, 56 and 168. Outcome measures were solicited and unsolicited adverse events (AE), severe AE, gB and AD-2 epitope binding antibody titers and avidity, and neutralizing antibody (nAb) titers to CMV measured in fibroblast and epithelial cell infection assays. RESULTS Among 125 participants, the most common solicited local and general AEs were pain and headache, respectively. A dose-dependent increase in gB binding, avidity and nAb titers was observed after doses 2 and 3, with the highest titers in the alum-adjuvanted 2.0 µg dose recipients after the third dose; in the latter 24 % had responses to the broadly neutralizing AD-2 epitope. Neutralizing activity to CMV infection of fibroblasts was seen in 100 % of 2.0 µg alum-adjuvanted dose recipients, and to epithelial cell infection in 31 %. Epithelial cell nAb titers were positively correlated with higher geometric mean CMV gB binding titers. CONCLUSIONS An eVLP CMV vaccine was immunogenic in healthy CMV-seronegative adults and no safety signals were seen. Alum adjuvantation increased immunogenicity as did higher antigen content and a three dose schedule. This phase 1 trial supports further development of this eVLP CMV vaccine candidate.
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Affiliation(s)
- Joanne M Langley
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada; Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada; Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada.
| | - Soren Gantt
- CHU Sainte-Justine Research Centre and the Departments of Microbiology and Pediatrics, University of Montreal (formerly at the Vaccine Evaluation Center, BC Children's Hospital Research Institute and the University of British Columbia, Vancouver BC at the time of the study), Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada; Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada; Microbiology and Immunology, Dalhousie University, Nova Scotia, Canada
| | - Brian Ward
- McGill University Health Centre Vaccine Study Centre, Montreal, PQ, Canada
| | - Shelly McNeil
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada; Departments of Pediatrics, Dalhousie University, Nova Scotia, Canada; Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada; Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada
| | - Yun Cai
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada
| | - Bruce Smith
- Canadian Center for Vaccinology, (Dalhousie University, IWK Health Centre and the Nova Scotia Health Authority), Canada
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