Systems Biological Assessment of Statin Effect on Vaccine Responses

Study Overview
=================
Brief Summary
-----------------
This study is being done to answer the question: Does the use of statin lipid-lowering medication change the effect of influenza vaccine? The research team will use the knowledge gained from answering this question to understand how this medication affects long-lasting immune responses to vaccines. The researchers will study the immune response to the influenza vaccine in the blood (where antibodies are). The team will also look at how statin therapy affects the bacteria that live in the gut by collecting stool samples. To be in this research, participants must be adults willing to receive vaccines.

Detailed Description
-----------------
Statins are widely used for their lipid-lowering and cardiovascular protective effects. Additional research has shown that statins can be anti-inflammatory and play a part in modulating the immune system. These effects are called into action in events such as pneumonia, influenza infection, and sepsis. This study will include a screening visit, a statin therapy initiation visit (if the participant is in the statin therapy group), a vaccination visit, and a series of follow-up visits. The statin medication will be dispensed by the study staff with clear instructions on how to take the medication for two months (one month prior to vaccination, and one month after vaccination). Other study procedures include a collection of medical history and medications taken, a urine pregnancy test for participants who are biologically able to become pregnant, a recording of vital signs, and a collection of any adverse events that the participant experiences during their participation in the study. The stool will be collected in one screening visit, at the vaccination visit, and one follow-up visit. Safety tests to evaluate muscle health and liver function will be obtained as well at screening and for participants selected to receive the statin therapy, at two follow-up visits. Memory Aid will be completed by the participant after vaccination. The blood and stool samples collected during this study will be stored and tested to evaluate how the immune system responds to statin therapy and vaccination over time. The remaining unused samples will be stored for use in future research. This research will help advance the knowledge that researchers have on how the immune system reacts to a vaccine if previously exposed to a statin therapy regimen. This will, in turn, enable us to identify the factors that help predict the extent of durability of protection gained from a specific vaccine. This may impact the way future vaccines are developed to provide long-lasting immunity against infections.

Official Title
-----------------
Systems Biological Assessment of Statin Effect on Vaccine Responses

Conditions
-----------------
Vaccine Response

Intervention / Treatment
-----------------
* Drug: Atorvastatin
* Biological: Quadrivalent seasonal influenza vaccine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Able to understand and give informed consent. Age 18-50 years. Women of childbearing potential must agree to use effective birth control for the first 3 months of the study. A negative urine pregnancy test must be documented prior to vaccination. Exclusion Criteria: History of allergy or serious adverse reaction, including Guillain-Barré syndrome, to a vaccine or vaccine products. History of a medical condition resulting in impaired immunity such as active solid tumors, leukemia, lymphoma, use of immunosuppressive drugs, chemotherapy, or radiation therapy. Persons with previous skin cancers or cured non-lymphatic tumors are not excluded from the study. History of HIV, Hepatitis B, or Hepatitis C infection. Chronic clinically significant medical problems that could be considered active or unstable (i.e. diagnosed within the past 3 months or requiring a change in medication within the past 3 months). This includes (but is not limited to): Insulin-dependent diabetes Severe heart disease (including arrhythmias) Severe lung disease Severe liver disease Severe kidney disease Severe hypertension: defined as life-threatening consequences (e.g., malignant hypertension, transient or permanent neurologic deficit). BMI > 30 Current or previous use of statins or any other lipid-lowering drug. Pregnancy or breastfeeding or plans to become pregnant in the first 3 months of study participation. History of influenza infection within the same influenza season. Receipt of blood products or immune globulin products within the prior 3 months. History of excessive alcohol consumption, drug use, psychiatric conditions, social conditions, or occupational conditions that in the opinion of the investigator would preclude compliance with the trial. Receipt of any live vaccines 30 days before or plans to receive any live vaccines 30 days after vaccination. Receipt of any inactivated vaccines 14 days before or plans to receive any inactivated vaccines 14 days after vaccination. For participants randomized to the statin therapy + QIV group: The participant is currently taking any medication that has known interactions with statin therapy. History of renal or hepatic impairment. Abnormal Safety lab results >1.5 upper limit normal (ULN)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: seasonal quadrivalent influenza vaccine (QIV)<br>Participants will receive the seasonal QIV | Biological: Quadrivalent seasonal influenza vaccine<br>* The FDA-approved quadrivalent seasonal influenza vaccine contains four distinct strains: two influenza A viruses and two influenza B viruses. The approved seasonal QIV will be purchased from the manufacturer to be given for each season of influenza.<br>* Other names: Flu vaccine;|
| Active Comparator: statin therapy and a seasonal quadrivalent influenza vaccine (QIV)<br>Participants randomized to the Statin + QIV arm will be asked to come back for an extra visit one month prior to the date of vaccination to start statin therapy. | Drug: Atorvastatin<br>* Atorvastatin is a lipid-lowering agent of the statin family that functions by blocking a rate-limiting enzyme, Hydroxymethylglutaryl-CoA (HMG-CoA) reductase, in lipid metabolism. This agent is commonly used for primary and secondary prevention of dyslipidemia. Participants will be asked to take Atorvastatin 80 mg daily at night, for 4 weeks prior to the vaccination, and continue the statin therapy for 4 weeks after vaccination. The 80mg dose of atorvastatin allows for evaluation of the immunologic effects of statin medication with a short duration of therapy prior to vaccination.<br>* Other names: Statin Therapy;Biological: Quadrivalent seasonal influenza vaccine<br>* The FDA-approved quadrivalent seasonal influenza vaccine contains four distinct strains: two influenza A viruses and two influenza B viruses. The approved seasonal QIV will be purchased from the manufacturer to be given for each season of influenza.<br>* Other names: Flu vaccine;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Magnitude of the antibody (Ab) response to QIV in statin recipients and non-recipients. | Magnitude of neutralizing antibody responses against influenza vaccine strains at 29 days after vaccination among participants. | Up to 29 days after vaccine administration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of adverse events (AEs) | Adverse events of grade 2 or higher (AE, defined as any unfavorable and unintended sign, symptom, or disease temporally associated with the use of the vaccine, without any judgment about causality) will be identified during questioning or examination of participants during study visits or receiving a safety contact from a participant. | Until day 29 after vaccine administration | 
| Severity of adverse events (AEs) | Adverse events (AE) will be graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 5.0 | Until day 29 after vaccine administration | 
| Frequency of serious adverse events (SAEs) | Serious adverse events (SAE, defined as an AE that in the view of the investigator results in any of the following outcomes: death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect) will be identified during questioning or examination of participants during study visits or receiving a safety contact from a participant any time during the study. | Up to 181 days after vaccine administration | 
| Severity of serious adverse events | SAE will be graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 5.0. | Up to 181 days after vaccine administration | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Flu Vaccine, Statins, Immunization Response, seasonal quadrivalent influenza vaccine, antibody (Ab) response