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Pollock KM, Cheeseman HM, Szubert AJ, Libri V, Boffito M, Owen D, Bern H, O'Hara J, McFarlane LR, Lemm NM, McKay PF, Rampling T, Yim YTN, Milinkovic A, Kingsley C, Cole T, Fagerbrink S, Aban M, Tanaka M, Mehdipour S, Robbins A, Budd W, Faust SN, Hassanin H, Cosgrove CA, Winston A, Fidler S, Dunn DT, McCormack S, Shattock RJ. Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial. EClinicalMedicine 2022; 44:101262. [PMID: 35043093 PMCID: PMC8759012 DOI: 10.1016/j.eclinm.2021.101262] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lipid nanoparticle (LNP) encapsulated self-amplifying RNA (saRNA) is a novel technology formulated as a low dose vaccine against COVID-19. METHODS A phase I first-in-human dose-ranging trial of a saRNA COVID-19 vaccine candidate LNP-nCoVsaRNA, was conducted at Imperial Clinical Research Facility, and participating centres in London, UK, between 19th June to 28th October 2020. Participants received two intramuscular (IM) injections of LNP-nCoVsaRNA at six different dose levels, 0.1-10.0μg, given four weeks apart. An open-label dose escalation was followed by a dose evaluation. Solicited adverse events (AEs) were collected for one week from enrolment, with follow-up at regular intervals (1-8 weeks). The binding and neutralisation capacity of anti-SARS-CoV-2 antibody raised in participant sera was measured by means of an anti-Spike (S) IgG ELISA, immunoblot, SARS-CoV-2 pseudoneutralisation and wild type neutralisation assays. (The trial is registered: ISRCTN17072692, EudraCT 2020-001646-20). FINDINGS 192 healthy individuals with no history or serological evidence of COVID-19, aged 18-45 years were enrolled. The vaccine was well tolerated with no serious adverse events related to vaccination. Seroconversion at week six whether measured by ELISA or immunoblot was related to dose (both p<0.001), ranging from 8% (3/39; 0.1μg) to 61% (14/23; 10.0μg) in ELISA and 46% (18/39; 0.3μg) to 87% (20/23; 5.0μg and 10.0μg) in a post-hoc immunoblot assay. Geometric mean (GM) anti-S IgG concentrations ranged from 74 (95% CI, 45-119) at 0.1μg to 1023 (468-2236) ng/mL at 5.0μg (p<0.001) and was not higher at 10.0μg. Neutralisation of SARS-CoV-2 by participant sera was measurable in 15% (6/39; 0.1μg) to 48% (11/23; 5.0μg) depending on dose level received. INTERPRETATION Encapsulated saRNA is safe for clinical development, is immunogenic at low dose levels but failed to induce 100% seroconversion. Modifications to optimise humoral responses are required to realise its potential as an effective vaccine against SARS-CoV-2. FUNDING This study was co-funded by grants and gifts from the Medical Research Council UKRI (MC_PC_19076), and the National Institute Health Research/Vaccine Task Force, Partners of Citadel and Citadel Securities, Sir Joseph Hotung Charitable Settlement, Jon Moulton Charity Trust, Pierre Andurand, Restore the Earth.
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Affiliation(s)
- Katrina M. Pollock
- Department of Infectious Disease, Imperial College London
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | | | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Marta Boffito
- Department of Infectious Disease, Imperial College London
- Chelsea & Westminster Hospital, London
| | - David Owen
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, London, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London
| | | | | | - Paul F. McKay
- Department of Infectious Disease, Imperial College London
| | - Tommy Rampling
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Yee Ting N. Yim
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | - Tom Cole
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Susanne Fagerbrink
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Marites Aban
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Maniola Tanaka
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Savviz Mehdipour
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Alexander Robbins
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - William Budd
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hana Hassanin
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | - Alan Winston
- Department of Infectious Disease, Imperial College London
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London
| | | | | | - Robin J. Shattock
- Department of Infectious Disease, Imperial College London
- Corresponding author.
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Abstract
The primary etiology of a diverse range of cardiomyopathies is now understood to be genetic, creating a new paradigm for targeting treatments on the basis of the underlying molecular cause. This review provides a genetic and etiologic context for the traditional clinical classifications of cardiomyopathy, including molecular subtypes that may exhibit differential responses to existing or emerging treatments. The authors describe several emerging cardiomyopathy treatments, including gene therapy, direct targeting of myofilament function, protein quality control, metabolism, and others. The authors discuss advantages and disadvantages of these approaches and indicate areas of high potential for short- and longer term efficacy.
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Key Words
- AAV, adeno-associated virus
- ACM, arrhythmogenic cardiomyopathy
- ARVC, arrhythmogenic right ventricular cardiomyopathy
- ATPase, adenosine triphosphatase
- DCM, dilated cardiomyopathy
- DMD, Duchenne muscular dystrophy
- DNA, DNA
- DSP, desmoplakin
- FDA, U.S. Food and Drug Administration
- GRT, gene replacement therapy
- GST, gene silencing therapy
- HCM, hypertrophic cardiomyopathy
- HR, homologous recombination
- LNP, lipid nanoparticle
- LVOT, left ventricular outflow tract
- RNA, RNA
- TTR, transthyretin
- arrhythmogenic cardiomyopathy
- dilated cardiomyopathy
- genetics
- hypertrophic cardiomyopathy
- therapeutics
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Affiliation(s)
- Adam S. Helms
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea D. Thompson
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sharlene M. Day
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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