A phase-I, open label clinical trial to assess the safety & tolerability of qHPV vaccine manufactured by Serum Institute of India Pvt. Ltd. in adults

Background

This first in human study was designed as an open label clinical trial to assess safety and tolerability of Serum Institute of India Pvt. Ltd. (SIIPL) quadrivalent HPV (qHPV) vaccine.

Methods

A total of 48 healthy male and female (24 each) adult volunteers were administered a 0.5 ml single dose of SIIPL qHPV vaccine intramuscularly, and were followed for one month for safety outcomes viz., immediate, solicited, unsolicited and serious adverse events.

Results

47 subjects completed the study in compliance with protocol. One subject had pain immediately after immunization which was recovered without treatment. None of the participants experienced any other local or systemic solicited AEs and serious AE.

Conclusion

qHPV vaccine manufactured by SIIPL was found to be safe and well tolerable in adults. Further clinical development should continue to assess safety and immunogenicity, in the target population following recommended 2 and 3-dose schedule.Clinical Trial Registration - CTRI/2017/02/007785.

A phase-I, open label clinical trial to assess the safety of Tdap vaccine manufactured by Serum Institute of India Pvt. Ltd. in adults

BACKGROUND

This first in human study was designed as an open label clinical trial to assess the safety and tolerability of Serum Institute of India Pvt. Ltd. (SIIPL) Tdap vaccine in healthy adult volunteers, aged 18-45 years.

METHODS

A total of 24 healthy adults were administered a 0.5 ml single dose of SIIPL Tdap vaccine intramuscularly, and were followed for one month for safety outcomes viz., immediate, solicited, unsolicited and serious adverse events.

RESULTS

23 subjects completed the study in compliance with the study protocol. None of the participants experienced any immediate adverse events or any local or systemic solicited adverse events.

CONCLUSION

Tdap vaccine manufactured by Serum Institute of India Pvt. Ltd. is safe and well tolerable in adults. It was concluded that further clinical development of this vaccine should continue to assess its safety and immunogenicity, in the target population. Clinical Trial Registration - CTRI/2017/03/008003.

Malaria vaccine candidate based on Duffy-binding protein elicits strain transcending functional antibodies in a Phase I trial

Reticulocyte invasion by Plasmodium vivax requires interaction of the Duffy-binding protein (PvDBP) with host Duffy antigen receptor for chemokines (DARCs). The binding domain of PvDBP maps to a cysteine-rich region referred to as region II (PvDBPII). Blocking this interaction offers a potential path to prevent P. vivax blood-stage growth and P. vivax malaria. This forms the rationale for development of a vaccine based on PvDBPII. Here we report results of a Phase I randomized trial to evaluate the safety and immunogenicity of recombinant PvDBPII formulated with glucopyranosyl lipid adjuvant-stable emulsion (GLA-SE). Thirty-six malaria-naive, healthy Indian male subjects aged 18-45 years were assigned into three cohorts corresponding to doses of 10, 25 and 50 µg of PvDBPII formulated with 5 µg of GLA-SE. Each cohort included nine PvDBPII/GLA-SE vaccinees and three hepatitis B control vaccine recipients. Each subject received the assigned vaccine intramuscularly on days 0, 28 and 56, and was followed up till day 180. No serious AE was reported and PvDBPII/GLA-SE was well-tolerated and safe. Analysis by ELISA showed that all three doses of PvDBPII elicited antigen-specific binding-inhibitory antibodies. The 50 µg dose elicited antibodies against PvDBPII that had the highest binding-inhibitory titres and were most persistent. Importantly, the antibody responses were strain transcending and blocked receptor binding of diverse PvDBP alleles. These results support further clinical development of PvDBPII/GLA-SE to evaluate efficacy against sporozoite or blood-stage challenge in controlled human malaria infection (CHMI) models and against natural P. vivax challenge in malaria endemic areas.

Current Treatment Options for Human Epidermal Growth Factor Receptor 2-Directed Therapy in Metastatic Breast Cancer: An Indian Perspective

Human epidermal growth factor receptor 2 (HER2)-positive is an aggressive subtype of breast cancer and has historically been associated with poor outcomes. The availability of various anti-HER2 therapies, including trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (TDM-1), has remarkably improved the clinical outcomes in patients with HER2-positive metastatic breast cancer (mBC). However, there is a need to optimize treatment within this population, given the wide variability in clinical presentation. Additionally, geographical and socio-economic considerations too need to be taken into account. To clarify and collate evidence pertaining to HER2-positive metastatic breast cancer, a panel of medical and clinical oncologists from across India developed representative clinical scenarios commonly encountered in clinical practice in the country. This was followed by two meetings wherein each clinical scenario was discussed in detail and relevant evidence appraised. The result of this process is presented in this manuscript as evidence followed by therapeutic recommendations of this panel for management of HER2-positive mBC in the Indian population.

Effect of n-3 fatty acids on VLDL production by hepatocytes is mediated through prostaglandins

The mechanism of the hypolipidemic effect of n-3 fatty acids was studied using isolated rat hepatocytes maintained in culture. EPA and DHA caused a significant reduction in the incorporation of 3[H]-leucine into apoB associated with the VLDL produced by hepatocytes in culture when compared to that in presence of palmitic acid. Presence of indomethacin, an inhibitor of cyclo-oxygenase reversed the effect of EPA on VLDL synthesis while diethyl carbamazine an inhibitor of lipoxygenase did not show any effect suggesting that the effect of EPA may be mediated through prostaglandins. This was further tested by invivo experiments where animals were fed fish oil containing diet with and without aspirin, which inhibits formation of prostaglandins. The incorporation of 3[H]-leucine into apo B and 14[C]-acetate into cholesterol of VLDL produced by hepatocytes from aspirin treated animals were significantly high. The reversal of the effect of n-3 fatty acids by agents which inhibit the formation of prostaglandin suggests that the n-3 fatty acids may exert their effect on VLDL production by liver cells through prostaglandins.

Haptoglobin in rheumatic fever

Serum haptoglobin levels were studied in rheumatic fever and in established rheumatic heart disease to find whether rheumatic activity influenced serum haptoglobin levels. The study was carried out on 90 subjects of paediatric age group, comprising 30 children suffering from acute rheumatic fever (Group I) and Group II of 30 children of established rheumatic heart disease (not having rheumatic activity). They were matched with group III of 30 normal children of the same age as controls. Levels of ASO titre, C-reactive protein, serum haptoglobin and ESR were estimated in all cases of study and control groups. Estimations of serum haptoglobin levels and ESR were repeated in all children of rheumatic fever after 2 weeks. Haptoglobin levels were estimated by electrophoresis on a cellulose acetate paper. In healthy children (Group III) mean serum haptoglobin was 92.2 +/- 19.77 mg%. This was significantly lower when compared with acute rheumatic fever group before treatment (606.58 +/- 171.04 mg%) and rheumatic heart disease group (120.8 +/- 26.03 mg%).

Blocking of alcohol-induced effects on synthesis and secretion of apo B containing lipoproteins by substituting sardine oil in the diet

The effect of substitution of fish oil in the diet on the alcohol-induced changes in the metabolism of very low density lipoprotein (VLDL) by primary cultures of rat hepatocytes has been studied. Rats fed groundnut oil diet or sardine oil diet were given alcohol (3 g/kg) for 4 weeks. Substitution of fish oil for groundnut oil in the diet blocked the hypertriglyceridemia and hyperlipoproteinemia caused by alcohol. Enhanced incorporation of [3H]leucine into apo B secreted into the medium and [14C]acetate into lipids associated with secreted VLDL indicated an increased rate of synthesis of apo B containing lipoproteins by hepatocytes from livers of rats receiving alcohol. Fish oil in the diet reduced incorporation of [3H]leucine into apo B and that of [14C]acetate into lipids indicating a lower rate of synthesis of apo B containing lipoproteins. Pulse chase experiments confirmed the above observation. Thus it is suggested that fish oil in the diet prevents hyperlipoproteinemia caused by alcohol possibly by reducing the synthesis and secretion of VLDL by liver.

Effect of feeding sardine oil on synthesis and secretion of apolipoprotein B-containing lipoproteins by rabbit hepatocytes

The effect of feeding sardine oil on the metabolism of lipoprotein was studied in rabbits. Rabbits were fed a diet containing 10% sardine oil or groundnut oil for 6 wk. A significant decrease in serum cholesterol and triglycerides was observed in rabbits receiving sardine oil. Radiolabeling studies with [3H]leucine and [14C]acetate on the synthesis and secretion of apolipoprotein B (apoB)-containing lipoproteins by primary cultures of rabbit hepatocytes were carried out. Significantly lower incorporation of [3H]leucine into apoB secreted into the medium by hepatocytes derived from rabbits fed sardine oil indicates a reduced synthesis and secretion of apoB-containing lipoproteins. This was further confirmed by a decreased incorporation of [14C]acetate into cholesterol and cholesteryl ester associated with lipoprotein floating at the very-low-density lipoprotein density range. Radioactivity incorporated into cholesterol associated with the cell layer was also reduced. These results indicate that sardine oil exerts a hypolipidemic action in rabbits mainly by decreasing the synthesis and secretion of apoB-containing lipoproteins by liver.

Metabolism of very low density lipoproteins--effect of sardine oil

The effect of feeding fish oil on the metabolism of lipoproteins was studied in rats. Rats were fed diet containing 10% sardine or groundnut oil for 6 weeks. There was a significant decrease in the total cholesterol, phospholipids and triglycerides as well as the amount of the lipids associated with VLDL and LDL in serum in fish oil-fed rats. The synthesis and secretion of lipoproteins particularly apoB containing lipoproteins by primary cultures of hepatocytes from these rats were studied by 14(C)-acetate or 3(H)-leucine labelling. Primary cultures of hepatocytes derived from sardine oil-fed rats showed reduced incorporation of 3(H)-leucine into apoB containing lipoproteins secreted into the medium when compared to those fed groundnut oil, indicating a decreased synthesis and secretion of apoB. This was further confirmed by significantly lower incorporation of 14(C)-radioactivity into total and individual lipids of VLDL secreted into the medium, as well as that associated with different lipids in cell layer. The activity of lipoprotein lipase in adipose tissue and aorta was significantly higher in rats fed sardine oil which may cause an increased clearance of triglyceride-rich lipoproteins from circulation. These results indicate that the fish oil exerts hypolipidemic effect particularly by decreasing the synthesis and secretion of VLDL by liver and possibly by an increased clearance of triglyceride-rich lipoproteins from circulation.