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InfluenzaPhase 4NCT02485639

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

A Phase 4 study testing Influenza Virus Vaccine Inactivated in people with Influenza and Influenza Immunisation, run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This was a Phase IV open label and single arm study, with the aim of enrolling up to 55 healthy males and non-pregnant females in a single site, age 18-49 years old, inclusive. This study was designed to assess the humoral response to influenza vaccination and the longevity of humoral immunity to influenza vaccination… Read more about this study

Who is it for?
Ages 18 to 49 yearsHealthy volunteers can take part
Conditions the study is for
Influenza, Influenza Immunisation
What is being tested?
Influenza Virus Vaccine Inactivated
Could I receive a placebo?
No, everyone receives an active treatment
How many people
27 participants
Where
1 siteUnited States
Study dates
23 Dec 2015to 31 Mar 2020
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 49 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Male or non-pregnant female subjects between 18 and 49 years of age (inclusive).
  • Subjects capable of providing written informed consent prior to initiation of any study procedures.
  • Subjects able to understand and comply with planned study procedures and be available for all study visits.
  • Safety labs:
  • White blood cell count (WBC), within reference range of lower limit of normal of 4,000 per microliter (uL), and upper limit of normal of 10,000 per microliter (uL).
  • Hemoglobin, within reference range of lower limit of normal of 11.4 grams per deciliter (gm/dL) and upper limit of normal of 16.1 grams per deciliter (gm/dL).
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  • Hematocrit, within reference range of lower limit of normal of 33.3 percent and an upper limit of normal of 46.5 percent.
  • Platelet Count, within reference range of lower limit of normal of 150,000 per microliter (uL) and upper limit of normal of 400,000 per microliter (uL).
  • Prothrombin Time (PT/INR), PT below or equal to the upper limit of normal of 13.1 seconds; International Normalized Ratio (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 milligrams per deciliter (mg / dL) and upper limit of normal of 1.2 milligrams per deciliter (mg / dL).
  • Potassium, within reference range of lower limit of normal of 3.6 millimolar (mM) and upper limit of normal of 5.1 millimolar (mM).
  • Heart rate > / = 55 to < / = 100 per minute.
  • Systolic blood pressure > / = 90 to < / = 150 millimeters of mercury (mmHg).
  • Diastolic blood pressure < 90 millimeters of mercury (mmHg).
  • Oral temperature < 100 degrees Fahrenheit.
  • Respirations even, unlabored, and > 10 / minute to < 20 / minute.
  • 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 U.S. Food and Drug Administration (FDA) approved form of birth control.
  • Subjects who have not received seasonal flu vaccine for the current year (September - June).

Who cannot join

  • If female, active pregnancy or breast-feeding or plans to become pregnant during study participation.
  • 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.
  • Subject report of taking anticoagulants, or long-term (greater than 14 days) systemic steroids or other immunosuppressive medications.
  • Subject report of known allergy to lidocaine.
  • 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.
  • Subject report of known latex allergy.
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  • Subject report of a history of severe reactions following previous immunization with licensed or unlicensed influenza virus vaccines.
  • Subject report of a history of Guillain-Barre syndrome.
  • Subjects who believe they cannot tolerate the bone marrow aspirations without sedation.
  • 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.
  • Subjects who are participating in another clinical trial involving the use of investigational agents or vaccines.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Emory Clinic - Winship Cancer Institute

    Atlanta, Georgia, 30322-1059

Other trials in United States

About this study

This was a Phase IV open label and single arm study, with the aim of enrolling up to 55 healthy males and non-pregnant females in a single site, age 18-49 years old, inclusive. This study was designed to assess the humoral response to influenza vaccination and the longevity of humoral immunity to influenza vaccination in healthy adults. Total enrollment was 27 participants.

This was a multi-year study. After one year of participation, participants were offered the opportunity to participate in the study for up to 3 consecutive years, provided eligibility criteria was met each year. Participants who elected to continue in the study after first year of participation were rescreened to verify continued eligibility and re-consented prior to subsequent participation. The primary study objective was to investigate the longevity of humoral immunity to influenza virus in humans.

Note: Due to the Coronavirus Disease of 2019 (COVID-19) pandemic, all non-essential research was halted in mid-March 2020. New enrollments were placed on hold for this study. Follow-up visits were also halted, which impacted the timing of participants' subsequent follow-up visits. Participant visits for Day 7 and Day 14 were not impacted. For this study, there were participants whose Day 28 and Day 90 visits were impacted by the temporary halting of non-essential research studies. As such, a request was submitted to the Emory University Institutional Review Board to extend the missed visit windows for the Day 28 and Day 90 visits for a maximum of up to 180 days, to ensure that ample time was available to bring participants back for their missed visits. Enrollment for this study ended on March 31, 2020, before research activities could resume at Emory.

Read the detailed description

This was a Phase IV open label and single arm study, with the aim of enrolling up to 55 healthy males and non-pregnant females in a single site, age 18-49 years old, inclusive. This study was designed to assess the humoral response to influenza vaccination and the longevity of humoral immunity to influenza vaccination in healthy adults. Total enrollment was 27 participants.

The laboratory technique used in this study characterized persistence and clonotype of antigen specific B-cells and plasmablasts in blood and bone marrow. Enrolled participants received licensed seasonal inactivated influenza vaccine (administered as a part of the study). The vaccine was administered according to the package insert, and study participants donated serial samples of blood and bone marrow aspirate for immunology monitoring.

Safety was 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 were 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.

This was a multi-year study. After one year of participation, participants were offered the opportunity to participate in the study for up to 3 consecutive years, provided eligibility criteria was met each year. Participants who elected to continue in the study after first year of participation were rescreened to verify continued eligibility and re-consented prior to subsequent participation.

Re-enrolling participants received 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 participants 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. The primary study objective is to investigate the longevity of humoral immunity to influenza virus in humans. The secondary study objective is the longitudinal tracking of vaccine-induced B cell responses with special emphasis on broadly neutralizing HA (hemagglutinin) stem-reactive responses.

Note: Due to the Coronavirus Disease of 2019 (COVID-19) pandemic, all non-essential research was halted in mid-March 2020. New enrollments were placed on hold for this study. Follow-up visits were also halted, which impacted the timing of participants' subsequent follow-up visits. Participant visits for Day 7 and Day 14 were not impacted. For this study, there are participants whose Day 28 and Day 90 visits were impacted by the temporary halting of non-essential research studies. As such, a request was submitted to the Emory University Institutional Review Board to extend the missed visit windows for the Day 28 and Day 90 visits for a maximum of up to 180 days, to ensure that ample time was available to bring participants back for their missed visits. Enrollment for this study ended on March 31, 2020, before research activities could resume at Emory.

Being tested
Influenza Virus Vaccine Inactivated
Keywords
HA (hemagglutinin) -specific plasmablasts, humoral immunity, influenza, memory B cells
Medical subject headings
Influenza, Human

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Influenza Virus Vaccine InactivatedBiological

    A synthetic vaccine consisting of three inactivated influenza viruses: two different influenza type A strains and one influenza type B strain. Trivalent influenza vaccine is formulated annually, based on influenza strains projected to be prevalent in the upcoming flu season. All participants received vaccine intramuscularly (IM) on Day 0.

Study groups in NCT02485639
Study groupRoleWhat they receive
Influenza Virus Vaccine InactivatedExperimentalAll study participants received licensed inactivated influenza vaccine intramuscularly (IM) on Day 0.
Receives: Biological: Influenza Virus Vaccine Inactivated

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Blood

    Blood Immunoglobulin G (IgG) ASC specific for the seasonal influenza vaccine were measured by enzyme-linked immunosorbent spot (ELISPOT) using vaccine-coated plates. Numbers of influenza-specific ASC per million peripheral blood mononuclear cells are reported.

    Measured: Day 7

  2. Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

    Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with influenza vaccine or total IgG capture antibody. Influenza-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

    Measured: Day 0

  3. Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

    Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with influenza vaccine or total IgG capture antibody. Influenza-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

    Measured: Day 28

  4. Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

    Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with influenza vaccine or total IgG capture antibody. Influenza-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

    Measured: Day 365

  5. Number of Influenza-specific Memory B Cells Present in the Blood

    Influenza-specific memory B cells were assayed by ELISPOT after polyclonal stimulation of peripheral blood mononuclear cells to generate ASC. The influenza-specific memory B cell frequencies are reported as the percentage of IgG secreting cells found in the stimulated cultures.

    Measured: Day 0

  6. Number of Influenza-specific Memory B Cells Present in the Blood

    Influenza-specific memory B cells were assayed by ELISPOT after polyclonal stimulation of peripheral blood mononuclear cells to generate ASC. The influenza-specific memory B cell frequencies are reported as the percentage of IgG secreting cells found in the stimulated cultures.

    Measured: Day 28

  7. Number of Influenza-specific Memory B Cells Present in the Blood

    Influenza-specific memory B cells were assayed by ELISPOT after polyclonal stimulation of peripheral blood mononuclear cells to generate ASC. The influenza-specific memory B cell frequencies are reported as the percentage of IgG secreting cells found in the stimulated cultures.

    Measured: Day 365

  8. Number of Subjects Who Initially Seroconverted and Maintained Seroconversion at 1 Year Post Vaccination

    Initial seroconversion is defined as having a pre-vaccination (day 0) hemagglutination inhibition (HAI) titer < 1:40 against a particular strain and a day 28 post-vaccination titer > / = 1:40 against the same strain OR a pre-vaccination HAI titer >1:40 and an increase in titer of at least 4-fold on day 28 relative to day 0. Maintenance of seroconversion in those who initially seroconverted is defined as maintaining an HAI titer >/= 40 at 1 year in those with day 0 titers < 40 OR maintaining a >/= 4-fold increase in HAI titer at one year compared to day 0.

    HAI assays were performed using 0.75% guinea pig red blood cells and virus stocks matched to the strains in the vaccines received by each donor.

    Measured: Day 365

  9. Number of Subjects Achieving Seroconversion to Each of the Strains in the Vaccine

    Seroconversion defined as having a pre-vaccination (day 0) hemagglutination inhibition (HAI) titer < 1:40 against a particular strain and a Day 28 post-vaccination titer > / = 1:40 against the same strain OR a pre-vaccination HAI titer >1:40 and an increase in titer of at least 4-fold on day 28. HAI assays were performed using 0.75% guinea pig red blood cells and virus stocks matched to the strains in the vaccines received by each donor.

    Measured: Day 28

Secondary outcomes (2)
  1. Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among Blood Plasmablasts

    Blood IgG ASC specific for the seasonal influenza vaccine were measured by ELISPOT using plates coated with chimeric hemagglutinin antigen containing the pandemic H1 stem domain fused to the head domain of an H9 influenza virus. Numbers of stem-specific ASC per million peripheral blood mononuclear cells are reported.

    Measured: Day 7

  2. Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among the Bone Marrow Plasma Cells

    Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with H9 head/H1 stem chimeric hemagglutinin antigen or total IgG capture antibody. Stem-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

    Measured: Day 365

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Jun 2015 (estimated)
  2. Study start23 Dec 2015
  3. Primary completion31 Mar 2020
  4. Study completion31 Mar 2020

Why it stopped: Study was terminated due to CoronaVIrus Disease of 2019 (COVID-19) pandemic.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
27 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02485639
Sponsor's protocol ID
14-0059
Other IDs
HHSN272201400004C
Status last verified
Mar 2021
First submitted
11 Jun 2015
Last updated
24 Oct 2023
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003 Jan 8;289(2):179-86. doi: 10.1001/jama.289.2.179.

    PubMed 12517228
  • Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014. MMWR Recomm Rep. 2013 Sep 20;62(RR-07):1-43.

    PubMed 24048214
  • Kunzel W, Glathe H, Engelmann H, Van Hoecke C. Kinetics of humoral antibody response to trivalent inactivated split influenza vaccine in subjects previously vaccinated or vaccinated for the first time. Vaccine. 1996 Aug;14(12):1108-10. doi: 10.1016/0264-410x(96)00061-8.

    PubMed 8911005
  • Pica N, Palese P. Toward a universal influenza virus vaccine: prospects and challenges. Annu Rev Med. 2013;64:189-202. doi: 10.1146/annurev-med-120611-145115.

    PubMed 23327522
  • Wrammert J, Smith K, Miller J, Langley WA, Kokko K, Larsen C, Zheng NY, Mays I, Garman L, Helms C, James J, Air GM, Capra JD, Ahmed R, Wilson PC. Rapid cloning of high-affinity human monoclonal antibodies against influenza virus. Nature. 2008 May 29;453(7195):667-71. doi: 10.1038/nature06890. Epub 2008 Apr 30.

    PubMed 18449194
  • Slifka MK, Antia R, Whitmire JK, Ahmed R. Humoral immunity due to long-lived plasma cells. Immunity. 1998 Mar;8(3):363-72. doi: 10.1016/s1074-7613(00)80541-5.

    PubMed 9529153

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Influenza Virus Vaccine Inactivated in people with Influenza and Influenza Immunisation, run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 18 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 24 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 24 Oct 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Blood (time frame: Day 7). The study lists 9 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02485639, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Oct 2023.

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