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Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial

Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial
Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial

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 19 th June to 28 th 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.

2589-5370
Pollock, Katrina M
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Cheeseman, Hannah M
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Szubert, Alexander J
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Libri, Vincenzo
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Boffito, Marta
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Owen, David
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Bern, Henry
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O'Hara, Jessica
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McFarlane, Leon R
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Lemm, Nana-Marie
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McKay, Paul F
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Rampling, Tommy
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Yim, Yee Ting N
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Milinkovic, Ana
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Kingsley, Cherry
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Cole, Tom
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Fagerbrink, Susanne
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Aban, Marites
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Tanaka, Maniola
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Mehdipour, Savviz
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Robbins, Alexander
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Budd, William
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Faust, Saul N
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Hassanin, Hana
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Cosgrove, Catherine A
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Winston, Alan
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Fidler, Sarah
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Dunn, David T
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McCormack, Sheena
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Shattock, Robin J
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COVAC1 study Group
Pollock, Katrina M
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Cheeseman, Hannah M
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Szubert, Alexander J
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Libri, Vincenzo
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Boffito, Marta
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Owen, David
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Bern, Henry
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O'Hara, Jessica
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McFarlane, Leon R
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Lemm, Nana-Marie
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McKay, Paul F
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Rampling, Tommy
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Yim, Yee Ting N
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Milinkovic, Ana
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Kingsley, Cherry
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Cole, Tom
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Fagerbrink, Susanne
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Aban, Marites
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Tanaka, Maniola
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Mehdipour, Savviz
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Robbins, Alexander
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Budd, William
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Faust, Saul N
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Hassanin, Hana
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Cosgrove, Catherine A
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Winston, Alan
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Fidler, Sarah
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Dunn, David T
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McCormack, Sheena
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Shattock, Robin J
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Pollock, Katrina M, Cheeseman, Hannah M, Szubert, Alexander J, Libri, Vincenzo, Boffito, Marta and Owen, David , COVAC1 study Group (2022) Safety and immunogenicity of a self-amplifying RNA vaccine against COVID-19: COVAC1, a phase I, dose-ranging trial. EClinicalMedicine, 44, [101262]. (doi:10.1016/j.eclinm.2021.101262).

Record type: Article

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 19 th June to 28 th 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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Accepted/In Press date: 16 December 2021
Published date: February 2022
Additional Information: Funding Information: We wish to acknowledge the COVAC1 participants who took part in this first in human vaccine trial, the dedication of the clinic, laboratory and administrative teams, and the oversight that the governance committees provided as the study evolved, including Jonathan Weber who represented the Sponsor, Sue Marlow as Qualified Person, the members who represented the Patients and Public (PPI) and the members of the Independent Data Monitoring Committee established to oversee the planned efficacy trial. Manufacture studies were additionally supported by the NIHR Imperial Biomedical Research Centre (BRC) and the MRC Imperial confidence in Concept. Preclinical toxicology was funded by Department of Health and Social Care using UK Aid funding, managed by the Engineering and Physical Sciences Research Council (EPSRC, grant number: EP/R013764/1). Infrastructure support was provided by the NIHR Imperial Biomedical Research Centre and the NIHR Imperial Clinical Research Facility. We also acknowledge Fondation Dormeur, Vaduz and a gift from the James B. Pendleton Charitable Trust for providing funds to purchase equipment used in these studies. DTD and SMc were supported by a Medical Research Council grant, MC_UU_12023/23 & MC_UU_00004/04. KMP was supported by the NIHR Imperial BRC. We would like to acknowledge also members of the COVAC1 Governance (Independent members): Trial Steering Committee: Robert Lechler (Chair), Janet Darbyshire (Vice Chair), Jeff Almond, Ben Cromarty (PPI), Stuart Elborn; Funding Information: 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. Funding Information: Data will be made available when the trial is complete, upon requests directed to the corresponding author and after approval of a proposal. We wish to acknowledge the COVAC1 participants who took part in this first in human vaccine trial, the dedication of the clinic, laboratory and administrative teams, and the oversight that the governance committees provided as the study evolved, including Jonathan Weber who represented the Sponsor, Sue Marlow as Qualified Person, the members who represented the Patients and Public (PPI) and the members of the Independent Data Monitoring Committee established to oversee the planned efficacy trial. Manufacture studies were additionally supported by the NIHR Imperial Biomedical Research Centre (BRC) and the MRC Imperial confidence in Concept. Preclinical toxicology was funded by Department of Health and Social Care using UK Aid funding, managed by the Engineering and Physical Sciences Research Council (EPSRC, grant number: EP/R013764/1). Infrastructure support was provided by the NIHR Imperial Biomedical Research Centre and the NIHR Imperial Clinical Research Facility. We also acknowledge Fondation Dormeur, Vaduz and a gift from the James B. Pendleton Charitable Trust for providing funds to purchase equipment used in these studies. DTD and SMc were supported by a Medical Research Council grant, MC_UU_12023/23 & MC_UU_00004/04. KMP was supported by the NIHR Imperial BRC. We would like to acknowledge also members of the COVAC1 Governance (Independent members): Trial Steering Committee: Robert Lechler (Chair), Janet Darbyshire (Vice Chair), Jeff Almond, Ben Cromarty (PPI), Stuart Elborn;, Independent Data Monitoring Committee (for planned COVAC2): Peter Smith (Chair), George Griffin, Phil Minor, Moira Whyte; PPI representative on the Trial Management Group: Pro Chatzikyriakou. 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. Publisher Copyright: © 2021 The Authors

Identifiers

Local EPrints ID: 455190
URI: http://eprints.soton.ac.uk/id/eprint/455190
ISSN: 2589-5370
PURE UUID: 7a8dc876-a045-4dce-8016-29d56485980e
ORCID for Saul N Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 14 Mar 2022 17:52
Last modified: 17 Mar 2024 03:06

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Contributors

Author: Katrina M Pollock
Author: Hannah M Cheeseman
Author: Alexander J Szubert
Author: Vincenzo Libri
Author: Marta Boffito
Author: David Owen
Author: Henry Bern
Author: Jessica O'Hara
Author: Leon R McFarlane
Author: Nana-Marie Lemm
Author: Paul F McKay
Author: Tommy Rampling
Author: Yee Ting N Yim
Author: Ana Milinkovic
Author: Cherry Kingsley
Author: Tom Cole
Author: Susanne Fagerbrink
Author: Marites Aban
Author: Maniola Tanaka
Author: Savviz Mehdipour
Author: Alexander Robbins
Author: William Budd
Author: Saul N Faust ORCID iD
Author: Hana Hassanin
Author: Catherine A Cosgrove
Author: Alan Winston
Author: Sarah Fidler
Author: David T Dunn
Author: Sheena McCormack
Author: Robin J Shattock
Corporate Author: COVAC1 study Group

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