Efficacy, safety, and immunogenicity of the Shigella sonnei 1790GAHB GMMA candidate vaccine: Results from a phase 2b randomized, placebo-controlled challenge study in adults
Robert W. Frenck, Valentino Conti, Pietro Ferruzzi, Augustin G. W. Ndiaye, Susan Parker, Monica McNeal, Michelle Dickey, Juan Paolo Granada, Giulia Luna Cilio, Iris De Ryck, Francesca Necchi, Akamol E. Suvarnapunya, Omar Rossi, Alessandra Acquaviva, Lakshmi Chandrasekaran, Kristen A. Clarkson, Joachim Auerbach, Elisa Marchetti, Robert W. Kaminski, Francesca Micoli, Rino Rappuoli, Allan Saul, Laura B. Martin, Audino Podda
Abstract
BackgroundShigellosis accounts for substantial morbidity and mortality worldwide and is the second most common cause of moderate and severe diarrhoea in children.MethodsThis phase 2b study (NCT03527173), conducted between August 2018 and November 2019, evaluated vaccine efficacy (VE), safety, and immunogenicity of a Shigella sonnei GMMA candidate vaccine (1790GAHB) in adults, using a S. sonnei 53 G controlled human infection model. Participants (randomized 1:1) received two doses of 1790GAHB or placebo (GAHB-Placebo), at day (D) 1 and D29, and an oral challenge of S. sonnei 53 G at D57. VE was evaluated using several endpoints, reflecting different case definitions of shigellosis. For the primary endpoint, the success criterion was a lower limit of the 90% confidence interval >0.FindingsThirty-six and 35 participants received 1790GAHB or placebo, respectively; 33 and 29 were challenged, 15 and 12 developed shigellosis. VE was not demonstrated for any endpoint. Adverse events were more frequent in 1790GAHB versus placebo recipients post-vaccination. Anti-S. sonnei lipopolysaccharide (LPS) IgG responses increased at D29 and remained stable through D57 in group 1790GAHB; no increase was shown in placebo recipients.Interpretation1790GAHB had an acceptable safety profile and induced anti-LPS IgG responses but did not demonstrate clinical efficacy against shigellosis. Baseline/pre-challenge antibody levels were higher in participants who did not develop shigellosis post-challenge, suggesting a role of anti-LPS IgG antibodies in clinical protection, although not fully elucidated in this study. For further vaccine development an increased S. sonnei O-antigen content is likely needed to enhance anti-LPS immune responses.FundingGlaxoSmithKline Biologicals SA, Bill and Melinda Gates Foundation