Safety and Immunogenicity of COVID-eVax, a Candidate Plasmid DNA Vaccine for COVID-19, in Healthy Adult Volunteers

Phase 1

Terminated

• Conditions: COVID-19 Immunisation; Protection Against COVID-19 and Infections With SARS-CoV- 2; COVID-19
• Interventions: Biological: COVID-eVax; Device: Cliniporator® and EPSGun

• Registration Number: NCT04788459
• Lead Sponsor: Takis

Brief Summary

This is a multicentre, open-label Phase 1/2 study, with a first-in-human (FIH) dose escalation part (Phase 1 study) followed by an open-label single arm (or two-arms, randomized) dose expansion part (Phase 2 study). The vaccine will be administered by intramuscular (IM) injection followed by electroporation (EP) applied to the injection site.

The study is aimed at assessing the safety and immunogenicity of COVID-eVax, a DNA plasmid-based vaccine whose target antigen is a portion of the S protein of SARS-CoV-2 virus (the Receptor Binding Domain located in the CTD1 of the S1 region of the S protein).

In animal models COVID-eVax was safe and induced high immunological humoral and cellular response.

Detailed Description

Not available

Study Timeline

• Study Start: 2021-02-25
• Study First Submitted: 2021-03-01
• Study First Submitted QC: 2021-03-05
• Study First Posted: 2021-03-09
• Status Verified: 2021-12
• Primary Completion: 2021-12-07
• Study Completion: 2021-12-07
• Last Update Submitted: 2023-03-28
• Last Update Posted: 2023-03-29

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 68

Inclusion Criteria

1. Signed and dated informed consent obtained before undergoing any study-specific procedure

2. Healthy male or female aged ≥18 and ≤ 65 years

3. Body Mass Index >18.5 and ≤30 kg/m2

4. Vital signs within the following values or ranges:

   1. Body temperature ≤ 37,5 °C
   2. Pulse frequency ≥51 and ≤100 beats per minute
   3. Diastolic BP ≥60 mmHg, ≤ 90 mmHg
   4. Systolic BP ≥ 90 mmHg, ≤ 140 mmHg
   5. Respiratory rate ≥ 12 breaths per minute, ≤ 16 breaths per minute

5. ECG at screening normal or with no clinically significant findings (pre-excitation syndromes, e.g., Wolff-Parkinson-White syndrome are absolute exclusion criteria)

6. Laboratory examinations within normal reference range or with no clinically significant abnormalities

7. Absence of any respiratory and flu-like symptoms

8. Non-pregnant women of childbearing potential, willing to practice a highly effective method of contraception from enrolment up to study completion or at least 90 days after the last vaccination in case of withdrawal

9. For sexually active men with a female partner of childbearing potential, willingness to use a condom and to refrain from donating sperm from enrolment up to study completion or at least 90 days after the last vaccination in case of withdrawal

10. Agreement to refrain from blood donation during the course of the study

11. Able and willing to comply with all study procedures.

Exclusion Criteria

1. History of confirmed infection with SARS-CoV-2, by positive nasopharyngeal swab or by positive serological test for SARS-CoV-2 antibodies

2. Positive serological test for SARS-CoV-2 antibodies at screening

3. Subjects at high risk of SARS-CoV-2 infection prior or during the trial, including:

   1. subjects with any known exposure in the 4 weeks before enrolment
   2. close contacts of suspected or confirmed COVID-19 or SARS-CoV-2 infection cases
   3. subjects quarantined for any reason
   4. frontline healthcare professionals working in Emergency departments, ICU and other higher risk healthcare areas

4. Positive serological tests for:

   1. Hepatitis B surface antigen (HBsAg)
   2. Hepatitis C antibodies
   3. Human Immunodeficiency Virus (HIV) antibodies

5. Subjects with any of the following specific contraindications, even in medical history:

   1. Type 2 diabetes or glucose intolerance, even if controlled
   2. Hypertension, even if controlled
   3. chronic obstructive pulmonary disease (COPD)
   4. Any cardiac disease, even if not evident at ECG
   5. Pacemaker

6. Use of any investigational drugs/treatments, or enrolment in a clinical trial during the 6 months preceding screening

7. Prior administration of any vaccine in the 2 weeks preceding screening

8. Administration of any monoclonal or polyclonal antibody product within 4 weeks preceding screening

9. Administration of any blood product within 3 months of screening

10. Current or prior administration, within the 6 months preceding screening, of immunosuppressants (inhaled, topical skin and/or eye drop-containing corticosteroids; a short course of corticosteroids, defined as ≤20 mg/day prednisone or equivalent for 10 days, and low-dose methotrexate are allowed until 4 weeks prior to screening)

11. Any prior major surgery or any chemo- or radiation therapy within 5 years of screening

12. Current or suspected immunosuppressive or immunodeficient state, including HIV infection, asplenia, recurrent severe infections

13. Active, known, or suspected autoimmune disease (except mild psoriasis, well-controlled autoimmune thyroid disease, vitiligo or stable coeliac disease not requiring immunosuppressive or immunomodulatory therapy)

14. Bleeding disorders (e.g. coagulopathy or platelet disorder or coagulation factor deficiency) or prior history of significant bleeding or bruising following IM injections or venipuncture

15. History of seizures or mental illness

16. History of allergy to vaccines or of severe allergic reaction of any kind

17. Metal implants within 20 cm of the planned site(s) of injection

18. Presence of keloid scar formation or hypertrophic scar, or other clinically significant medical condition at the planned site(s) of injection

19. Any abnormality or permanent body art (e.g. tattoos) that would interfere with the ability to observe local reactions at the injection site in the deltoid area

20. History of alcohol or drug abuse during the 12 months preceding the screening

21. Pregnancy (i.e. positive pregnancy test) or willingness/intention to become pregnant during the study

22. Breastfeeding

23. Any other clinically relevant disease and condition that, in the opinion of the Investigator, may jeopardize efficacy or safety assessments or may compromise the subject's safety during trial participation.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
0.5 mg PB	COVID-eVax	0.5 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 1 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
2 mg PB	Cliniporator® and EPSGun	2 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 4 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
2 mg P	Cliniporator® and EPSGun	2 mg P (Prime) - Total dose: 2 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1
1 mg PB	COVID-eVax	1 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 2 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
1 mg PB	Cliniporator® and EPSGun	1 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 2 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
2 mg PB	COVID-eVax	2 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 4 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
0.5 mg PB	Cliniporator® and EPSGun	0.5 mg PB (Prime-Boost, 4 weeks apart) - Total dose: 1 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1 and Day 29
2 mg P	COVID-eVax	2 mg P (Prime) - Total dose: 2 mg IM injection + electroporation by IGEA Cliniporator® and EPSGun, on Day 1

Primary Outcome Measures

Name	Time	Method
White Blood Cell (WBC) levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Incidence of unsolicited AEs (for Phase 1)	through 4 weeks post-each vaccination
Red Blood Cell (RBC) levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Incidence of solicited systemic AEs (for Phase 1)	Through 7 days post-each vaccination
Alanine Transaminase (ALT) levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Aspartate Transaminase (AST) levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Creatine Phosphokinase (CPK) levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Percentage of subjects who seroconverted (for Phase 2)	through 4 weeks post-last vaccination
Incidence of solicited local Adverse events (AEs) at the injection site (for Phase 1)	Through 7 days post-each vaccination
Change from baseline in antigen-specific cellular immune responses to SARS-CoV-2 (for Phase 2)	through 4 weeks post-last vaccination	Interferon-gamma (IFN-γ) ELISpot
Platelets levels (for Phase 1)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Quantitative antibody titers, binding to the specific SARS-CoV-2 antigen (for Phase 2)	through 4 weeks post-last vaccination	Geometric Mean Titer (GMT) and Geometric Mean Fold Rise (GMFR) from baseline
SARS-CoV-2 neutralizing antibody titer (for Phase 2)	through 4 weeks post-last vaccination	GMT and GMFR from baseline

Secondary Outcome Measures

Name	Time	Method
Change from baseline in antigen-specific cellular immune responses to SARS-CoV-2 (for Phase 1)	through 4 weeks post-last vaccination	Interferon-gamma (IFN-γ) ELISpot
Platelets levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Quantitative antibody titers, binding to the specific SARS-CoV-2 antigen (for Phase 1)	through 4 weeks post-last vaccination	GMT and GMFR from baseline
Incidence of solicited local AEs at the injection site (for Phase 2)	Through 7 days post-each vaccination
Incidence of unsolicited AEs (for Phase 2)	through study completion (6 months)
SARS-CoV-2 neutralizing antibody titer (for Phase 1)	through 4 weeks post-last vaccination	GMT and GMFR from baseline
Incidence of unsolicited AEs (for Phase 1)	through study completion (6 months)
Incidence of solicited systemic AEs (for Phase 2)	Through 7 days post-each vaccination
White Blood Cell (WBC) levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Red Blood Cell (RBC) levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Percentage of subjects who seroconverted (for Phase 1)	through 4 weeks post-last vaccination
Aspartate Transaminase (AST) levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Creatine Phosphokinase (CPK) levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints
Alanine Transaminase (ALT) levels (for Phase 2)	through 4 weeks post-each vaccination	Change from baseline at specific timepoints

Trial Locations

Locations (4)

San Gerardo Hospital; 🇮🇹 Monza, Italy

Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale; 🇮🇹 Naples, Italy

- CRC Centro Ricerche Cliniche di Verona; 🇮🇹 Verona, Italy

INMI Lazzaro Spallanzani; 🇮🇹 Rome, Italy