Patient case: 32-year-old male with dilated cardiomyopathy; genetic feature: LMNA

Clinical trial: Combination Study With MVA BN and Dryvax

Summary: The overall goals of this study are to expand the available data on the safety and immunogenicity of MVA-BN in vaccinia-naive adults and to determine the optimum dose of MVA-BN to induce immune responses and attenuate Dryvax take reactions. Participants will include 90 healthy volunteers, ages 18-32 years. Participants will be randomly assigned to 1 of 6 study groups (groups A-F). Participants will be involved in study related procedures for up to 2 years. During this time, volunteers will return periodically for blood draws to check immune responses.

Detailed description: The primary goal of this phase I trial is to expand the available data on the safety and immunogenicity of MVA-BN in vaccinia-naïve adults. The secondary goals of this vaccine trial are: to determine the optimum dose of MVA-BN, given twice, to induce an immune response and attenuate Dryvax® take reactions; and to compare the ability of 2 routes of administration of MVA-BN, subcutaneous and intramuscular, to induce an immune response at the highest tested dose. A total of 90 healthy adult volunteers ages 18-32 will participate in this study. The volunteers will be randomly assigned to 1 of 6 groups to be immunized with: MVA-BN (subcutaneously) at 1 of 3 dose levels and Dryvax® (per scarification); placebo (subcutaneously) and Dryvax® (per scarification); MVA-BN (subcutaneously) at the highest dose level and placebo scarification; or MVA-BN (intramuscularly) at the highest dose level and Dryvax® (per scarification). The study will last about 30 months. Each volunteer's participation will last 6 months for all treatment groups. Subjects randomized to treatment groups D and E will have follow-up for 2 years. During this time, volunteers will return periodically for blood draws to check immune responses. Subjects will require visits for dressing changes as needed post-Dryvax vaccination. Variables to be investigated include: adverse events and side effects to the vaccines, and immunogenicity testing including antibody and cellular responses to the vaccines.

Eligibility: Inclusion Criteria:
  -  Ages 18-32.
  -  Never received smallpox vaccination.
  -  Read, signed and dated informed consent document.
  -  Availability for follow-up for the planned duration of the study two years after first immunization.
  -  Acceptable medical history by screening evaluation and limited physical examination.
  -  For women, negative serum pregnancy test at screening and negative urine or serum pregnancy test within 24 hours prior to vaccination.
  -  If the volunteer is female and of child bearing potential, she agrees to use acceptable contraception, and not become pregnant for at least 56 days after the last vaccination. A woman is considered of child bearing potential unless post-menopausal or surgically sterilized. [Acceptable contraception methods are restricted to effective intrauterine devices (IUDs) or licensed hormonal products with use of method for a minimum of 30 days prior to vaccination.] Women who are not sexually active must agree to use one of the acceptable contraception methods if they are of childbearing potential.
  -  Negative ELISA for HIV.
  -  ALT<1.25 times institutional upper limit of normal.
  -  Negative hepatitis B surface antigen and negative antibody to hepatitis C virus.
  -  Negative urine glucose by dipstick or urinalysis.
  -  Adequate renal function defined as a serum creatinine less than or equal to 1.4mg/dL for males and less than or equal to 1.2mg/dL for females; urine protein < 30 mg/dL or none or trace proteinuria (by urinalysis or dipstick); and a calculated creatine clearance greater than or equal to 80 mL/min. based on the following formulas:
  -  Males [(140-age in years) X weight in kg]/(72 X serum creatinine)
  -  Females 0.85X[(140-age in years) X weight in kg]/(72 X serum creatinine)
  -  ECG without clinical significance (e.g., all kinds of atrioventricular or intraventricular conditions or blocks such as complete left or right bundle branch block, AV-node block, QTc or PR prolongation, premature atrial contractions or other atrial arrhythmia, sustained ventricular arrhythmia, or 2 premature ventricular contractions (PVC) in a row, or ST elevation consistent with ischemia)
  -  CBC: Hemoglobin >11g/dl; White blood cells greater than 2,500 and less than 11,000/cubic mm; Platelets greater than or equal to 140,000/cubic mm.
  Exclusion Criteria:
  -  History of immunodeficiency.
  -  Typical vaccinia scar.
  -  Known or suspected history of smallpox vaccination.
  -  Military service prior to 1989 or after January 2003.
  -  Known or suspected impairment of immunologic function including, but not limited to, clinically significant liver disease; diabetes mellitus; moderate to severe kidney impairment.
  -  Malignancy, including squamous cell skin cancer or basal cell skin cancer at vaccination site or history of skin cancer at the vaccination site.
  -  Active autoimmune disease. Persons with vitiligo or thyroid disease on thyroid replacement are not excluded.
  -  History of keloid formation.
  -  History of myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, or other heart condition under the care of a doctor.
  -  History of an immediate family member (father, mother, brother or sister) who has had onset of ischemic heart disease before age 50 years.
  -  Ten percent or greater risk of developing a myocardial infarction or coronary death within the next 10 years using the National Cholesterol Education Program's Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack, located at the following URL: http://hin.nhlbi.nih.gov/atpiii/calculator.asp. NOTE: This criterion applies only to volunteers 20 years of age and older.
  -  Abnormal troponin I.
  -  Use of immunosuppressive medication. Corticosteroid nasal sprays are permissible. Persons who have used topical steroid can be enrolled after their therapy is completed.
  -  Medical or psychiatric condition or occupational responsibilities that preclude volunteer compliance with the protocol.
  -  Any history of "illegal" injection drug use.
  -  Receipt of inactivated vaccine 14 days prior to vaccination.
  -  Receipt of live attenuated vaccines within 30 days of vaccination.
  -  Use of experimental agents within 30 days prior to vaccination.
  -  Receipt of blood products or immunoglobulin in the 6 months prior to vaccination.
  -  Acute febrile illness (greater than or equal to 100.5 degrees F) on the day of vaccination.
  -  Pregnant or lactating women.
  -  Eczema of any degree or history of eczema.
  -  People with atopic dermatitis, Varicella zoster, chronic exfoliative skin disorders/conditions or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2x2 cm.
  -  Household contacts/sexual contacts with, or occupational exposure to (other than minimal contact), any of the following: Pregnant women; Children <12 months of age; People with or history of eczema; People with atopic dermatitis, Varicella zoster, chronic exfoliative skin disorders/conditions or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2x2 cm; People with immunodeficiency disease or use of immunosuppressive medications.
  -  Any condition that, in the opinion of the investigator, might interfere with study objectives.
  -  Known allergies to or any component of MVA or MVA-BN vaccine (e.g., tris(hydroxymethl)-amino methane, sodium chloride, sucrose, dextran, L-Glutamic acid monopotassium, chicken embryo fibroblast proteins, gentamycin).
  -  Known allergy to egg or aminoglycoside.
  -  Known allergies to any component of the Dryvax® vaccine (e.g. polymyxin B sulfate, dihydrostreptomycin sulfate, chlorotetracycline hydrochloride, neomycin sulfate).
  -  Known allergies to any known component of the Dryvax® diluent (i.e. glycerin and phenol).
  -  Known allergies to any known components of vaccinia immunoglobulin (VIG), i.e. thimerosal or previous allergic reaction to immunoglobulins.
  -  Known allergies to cidofovir or probenecid.
  -  Study personnel.

Relevance to patient case: not relevant