Superior antibody immunogenicity of a RH5 blood-stage malaria vaccine in Tanzanian infants as compared to adults
Authors: Silk Sarah E. , Kalinga Wilmina F. , Mtaka Ivanny M. , Lilolime Nasoro S. , Mpina Maximillian , Milando Florence , Ahmed Saumu , Diouf Ababacar , Mkwepu Fatuma , Simon Beatus , Athumani Thabit , Rashid Mohammed , Mohammed Latipha , Lweno Omary , Ali Ali M. , Nyaulingo Gloria , Mwalimu Bakari , Mswata Sarah , Mwamlima Tunu G. , Barrett Jordan R. , Wang Lawrence T. , Themistocleous Yrene , King Lloyd D. W. , Hodgson Susanne H. , Payne Ruth O. , Nielsen Carolyn M. , Lawrie Alison M. , Nugent Fay L. , Cho Jee-Sun , Long Carole A. , Miura Kazutoyo , Draper Simon J. , Minassian Angela M. , Olotu Ally I. 
Published: April 2023

Background

RH5 is the leading blood-stage candidate antigen for inclusion in aPlasmodium falciparummalaria vaccine, however, its safety profile and ability to induce functional immune responses in a malaria-endemic population are unknown. Characterising safety and immunogenicity is key to refine and progress next-generation RH5-based blood-stage malaria vaccines to field efficacy assessment.

Methods

A Phase 1b, single-center, dose-escalation, age de-escalation, double-blind, randomized, controlled trial was conducted in Bagamoyo, Tanzania. Healthy adults (18-35 years), young children (1-6 years) and infants (6-11 months) were recruited to receive a priming dose of viral-vectored ChAd63 RH5 (or rabies control vaccine) followed by a booster dose of MVA RH5 (or rabies control vaccine) 8 weeks later. The primary outcomes were the number of solicited and unsolicited adverse events following vaccination and the number of serious adverse events over the whole study period. Secondary outcomes included quantitative and qualitative measures of the anti-RH5 immune response. All participants receiving at least one dose of vaccine were included in the primary analyses.

Findings

Between 12thApril and 25thOctober 2018 a total of 63 adults, children and infants were recruited and primed and 60 of these were boosted, all completing six months of follow-up post-priming vaccination. Vaccinations were well-tolerated with participants reporting predominantly mild reactogenicity, with profiles comparable between ChAd63 RH5, MVA RH5 and rabies vaccine groups, and across the age groups. No serious adverse events were reported during the study period. RH5-specific T cell, B cell and serum antibody responses were induced by vaccination. Higher anti-RH5 serum IgG responses were observed post-boost in the 1-6 year old children (median 93 µg/mL; range: 31-508 µg/mL) and infants (median 149 µg/mL; range: 29-352 µg/mL) as compared to adults (median 14 µg/mL; range: 9-15 µg/mL). These contracted over time post-boost, but the same hierarchy of responses across the age groups was maintained to end of follow-up at 16 weeks post-boost (day 168). Vaccine-induced anti-RH5 antibodies were functional showing growth inhibition activity (GIA)in vitroagainstP. falciparumblood-stage parasites. The highest levels were observed in the 6-11 month old infants, with 6/11 showing >60% GIA following dilution of total IgG to 2.5 mg/mL (median 61%; range: 41-78%).

Interpretation

The ChAd63-MVA RH5 vaccine regimen shows an acceptable safety and reactogenicity profile and encouraging immunogenicity in children and infants residing in a malaria-endemic area. The levels of functional GIA observed in the RH5 vaccinated 6-11 month old infants are the highest levels reported to-date following human vaccination. These data support onward clinical development of RH5-based blood-stage vaccines that aim to protect against clinical malaria in young African infants.

Funding

Medical Research Council, London, United Kingdom.

Trial Registration

ISRCTN registry: 47448832 and ClinicalTrials.gov:NCT03435874.