Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

Condition(s) targeted: Influenza

Intervention: Trivalent inactivated influenza vaccine (Biological)

Phase: Phase 4

Status: Not yet recruiting

Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)

Overall contact:
Edmund K Waller, Phone: (404) 727-4995, Email: ewaller@emory.edu

The primary objective investigate the longevity of humoral immunity to influenza virus in humans. Our overarching hypothesis is that an understanding of how long-term humoral immunity to influenza virus is generated and maintained is essential for the development of a "universal" vaccine against influenza virus. The secondary objective is the longitudinal tracking of vaccine-induced B cells responses with special emphasis on broadly neutralizing HA stem reactive responses.

Official title: Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

Study design: Endpoint Classification: Pharmacodynamics Study, Intervention Model: Single Group Assignment, Primary Purpose: Basic Science

Primary outcome:

Percentage of subjects achieving seroconversion to each of the 3 strains in the vaccine. Defined as day 28 post vaccination titer >/= 1:40 against the same strain

Number of influenza-specific antibody secreting cells (ASC) present in the bone marrow 365 days post vaccination

Number of influenza-specific antibody secreting cells (ASC) present in the bone marrow 28 days post vaccination

Percentage of seroconverting subjects who maintain an HAI titer >/=1:40 approximately 365 days after the study vaccination.

Percentage of subjects achieving seroconversion to each of the 3 strains in the vaccine. Defined as pre-vaccination HAI titer <1:40 against a particular strain.

Number of influenza-specific memory B cells present in the blood prior to vaccination and at 14 days, 28 days, 90 days, and 365 days post-vaccination.

Number of influenza-specific antibody secreting cells (ASC) present in the bone marrow prior to vaccination

Number of influenza-specific antibody secreting cells (ASC) present in the blood 7 days post-vaccination.

Secondary outcome:

Frequency of hemagglutinin stem reactive responses to influenza vaccine among the bone marrow plasma cells at 28 days post vaccination.

Frequency of hemagglutinin stem reactive responses to influenza vaccine among the bone marrow plasma cells at 365 days post vaccination

Frequency of hemagglutinin stem reactive responses to influenza vaccine among blood plasmablasts at 7 days post-vaccination.

Detailed description: This is a Phase IV open label and single arm study enrolling up to 55 healthy males and non-pregnant females in a single site, 18-49 years old, inclusive. The study is designed to assess the humoral response to influenza vaccination and the longevity of humoral immunity to influenza vaccination in healthy adults. The laboratory technique will characterize persistence and clonotype of antigen specific B-cells and plasmablasts in blood and bone marrow. Enrolled subjects will receive licensed seasonal inactivated influenza vaccine (administered as a part of the study). The vaccine will be administered according to the package insert, and study participants will donate serial samples of blood and bone marrow aspirate for immunology monitoring. Safety will be assessed from the time of study enrollment through the last study visit, via monitoring of vital signs, change in health status, and targeted physical exam with safety labs prior to each bone marrow aspirate procedure. Repeated measurements of humoral immunity will be obtained at 7 days, 14 days, 28 days, 90 days and at one year post vaccination to assess the magnitude, clonal diversity and persistence of B-cell responses to influenza vaccination. The study duration is 4 years and subjects will be offered the opportunity to participate in the study for up to 3 consecutive years provided eligibility criteria is met each year. Subjects who elect to continue in the study after first year of participation will be rescreened to verify continued eligibility and re-consented prior to subsequent participation. Re-enrolling subjects will receive new subject identifiers and will count towards the total enrollment number for subsequent years of participation. A separate subject record will be maintained each year a subject re-enrolls in the study. Enrollment for the next year will begin with the availability of the seasonal flu vaccine. For subjects who elect to re-enroll in the study, the Day 365 visit (+/- 3 month window) would also be the Day 0 visit for the subsequent year.

Minimum age: 18 Years. Maximum age: 49 Years. Gender(s): Both.

Criteria:

Inclusion Criteria: 1. Male or non-pregnant female subjects between 18 and 49 years of age (inclusive) 2. Subjects capable of providing written informed consent prior to initiation of any study procedures. 3. Subjects able to understand and comply with planned study procedures and be available for all study visits. 4. Safety labs

- WBC, within reference range of lower limit of normal of 4,000/ul, and upper

limit of normal of 10,000/uL.

- Hemoglobin, within reference range of lower limit of normal of 11. 4 gm/dL and

upper limit of normal of 16. 1 gm/dL.

- Hematocrit, within reference range of lower limit of normal of 33. 3% and an

upper limit of normal of 46. 5%.

- Platelet Count within reference range of lower limit of normal of 150,000/uL and

upper limit of normal of 400,000/uL.

- PT/INR, PT within reference range of lower limit of normal of 10. 4 seconds and

upper limit of normal of 13. 1 seconds; INR within normal reference range of less than 1. 5 (normal range for non-anti-coagulated patients).

- Creatinine within reference range of lower limit of normal of 0. 4 mg/dL and

upper limit of normal of 1. 2 mg/dL.

- Potassium), within reference range of lower limit of normal of 3. 6 mM and upper

limit of normal of 5. 1 mM. 5. Heart rate >/=55 to /= 90 to 10/minute to < 20/minute. 10. Female subjects of child bearing potential must have a negative urine pregnancy test at the screening visit, enrollment visit and prior to subsequent bone marrow aspirate procedures. Female subjects of childbearing potential must agree to practice abstinence, use a barrier method of birth control, or use an FDA approved form of birth control.

11. Subjects who have not received seasonal flu vaccine for the current year (September -

June) Exclusion Criteria: 1. If female, active pregnancy or breast-feeding or plans to become pregnant during study participation. 2. Subject report of having any medical disease or condition that, in the opinion of the site principal investigator or appropriate sub-investigator, is a contraindication to study participation. This includes any acute or chronic medical disease or condition, defined as persisting 3 months (defined as 90 days) or longer, that would place the subject at an unacceptable risk of injury, render the subject unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or the subject's successful completion of this study. 3. Subject report of taking anticoagulants, or long-term (greater than 14 days) systemic steroids or other immunosuppressive medications 4. Subject report of known allergy to lidocaine. 5. Subject report of known hypersensitivity or allergy to eggs, egg or chicken protein, report of allergy to components of the study vaccine or other components of the study vaccine

6. Subject report of - known latex allergy

7. Subject report of a history of severe reactions following previous immunization with licensed or unlicensed influenza virus vaccines 8. Subject report of a history of Guillain-Barre syndrome 9. Subjects who believe they cannot tolerate the bone marrow aspirations without sedation. 10. Subjects with an active infection or that have an acute illness within 72 hours prior to study vaccination. Subject having had an acute illness which is nearly resolved with only minor residual symptoms remaining is allowable if, in the opinion of the site principal investigator or appropriate sub-investigator, the residual symptoms will not interfere with the ability to assess safety parameters as required by the protocol. 11. Subjects who are participating in another clinical trial involving the use of investigational agents or vaccines.

Edmund K Waller, Phone: (404) 727-4995, Email: ewaller@emory.edu

Emory Clinic - Winship Cancer Institute, Atlanta, Georgia 30322-1059, United States; Not yet recruiting

Last updated: August 13, 2015