A Clinical Trial to Evaluate the Safety and Immunogenicity of Synthetic DNAs Encoding a Native-like HIV Env Trimer and Interleukin-12 (INO-6160), Alone or in a Prime-boost Regimen With 3M-052-AF + Alum Adjuvanted VRC HIV Env Trimer 4571 in Adult Participants Without HIV

Study Overview
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Brief Summary
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This is a randomized open-label trial to examine the safety and immunogenicity of INO-6160 (synthetic DNAs encoding a native-like HIV Env Trimer and Interleukin-12), alone or in a prime-boost regimen with VRC HIV Env Trimer 4571 adjuvanted with 3M-052-AF + Alum. The primary hypothesis is that the vaccine regimen will elicit HIV-1 envelope protein-specific binding antibody (Ab) and T-cell responses

Official Title
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A Phase 1 Open-label Clinical Trial to Evaluate the Safety and Immunogenicity of Synthetic DNAs Encoding a Native-like HIV Env Trimer and Interleukin-12 (INO-6160), Alone or in a Prime-boost Regimen With 3M-052-AF + Alum Adjuvanted VRC HIV Env Trimer 4571 in Adult Participants Without HIV

Conditions
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HIV-1-infection

Intervention / Treatment
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* Biological: INO-6160, 2 mg
* Biological: Trimer-4571 / 100 mcg 3M-052-AF (5 mcg) + Alum (500 mcg)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Able and willing to complete the informed consent process, including an Assessment of Understanding: volunteer demonstrates understanding of this study; completes a questionnaire prior to first vaccination with verbal demonstration of understanding of questionnaire items that were answered incorrectly 18-55 years old, inclusive, on day of enrollment Available for clinic follow-up through the last clinic visit and willing to be contacted 12 months after the last vaccine administration Agrees not to enroll in another study of an investigational agent during participation in the trial In good general health according to the clinical judgment of the site investigator Physical examination and laboratory results without clinically significant findings that would interfere with assessment of safety or reactogenicity in the clinical judgement of the site investigator Assessed as low risk for HIV acquisition per low risk guidelines, agrees to discuss HIV infection risks, agrees to risk reduction counseling, and agrees to avoid behavior associated with high risk of HIV exposure through the final study visit. Low risk may include persons stably taking PrEP as prescribed for 6 months or longer Hemoglobin: ≥ 11.0 g/dL for volunteers who were assigned female sex at birth ≥ 13.0 g/dL for volunteers who were assigned male sex at birth and transgender men who have been on hormone therapy for more than 6 consecutive months ≥ 12.0 g/dL for transgender women who have been on hormone therapy for more than 6 consecutive months For transgender participants who have been on hormone therapy for less than 6 consecutive months, determine hemoglobin eligibility based on their sex assigned at birth White blood cell (WBC) count = 2,500-12,000/mm3 (not exclusionary: if count greater than 12,000 with investigation showing general good health and PSRT approval) Platelets = 125,000-550,000/mm3 Alanine aminotransferase (ALT) < 2.5 x upper limit of normal (ULN) based on the institutional normal range Serum creatinine ≤ 1.1 x ULN based on the institutional normal range Blood pressure in the range of 90 to < 140 mmHg systolic and 50 to < 90 mmHg diastolic Negative results for HIV infection by a Food and Drug Administration (FDA)-approved enzyme immunoassay (EIA) or chemiluminescent microparticle immunoassay (CMIA) Negative for anti-Hepatitis C antibodies (anti-HCV) or negative HCV nucleic acid test (NAT) if anti-HCV antibodies are detected Negative for Hepatitis B surface antigen For a volunteer capable of becoming pregnant: Volunteers who were assigned female sex at birth and are of reproductive potential must agree to use effective means of birth control from at least 21 days prior to enrollment through 8 weeks after their last scheduled fifth vaccination timepoint Has negative β-HCG (human chorionic gonadotropin) pregnancy test (urine or serum) on day of enrollment. Volunteers who were assigned female sex at birth must also agree not to seek pregnancy through alternative methods, such as oocyte retrieval, artificial insemination or in vitro fertilization through 8 weeks after their last scheduled vaccination timepoint Exclusion Criteria: Volunteer who is breast-feeding or pregnant Body mass index (BMI). Enrollment of individuals with BMI ≥ 40, whom the site investigator assesses are in good health, may be considered by PSRT on a case-by-case basis Diabetes mellitus (DM). Type 2 DM controlled with diet alone, or a history of isolated gestational diabetes are not exclusionary. Enrollment of individuals with Type 2 DM that is well-controlled on diet alone or on hypoglycemic agent(s) may be considered, provided the HgbA1c is ≤8% within the last 6 months (sites may draw these at screening) Previous or current recipient of an investigational HIV vaccine (previous placebo recipients are not excluded) Congenital or acquired immunodeficiency, including systemic medication use likely to impair immune response to vaccine in the opinion of the site investigator such as glucocorticoid use equal to or greater than prednisone 10 mg/day within 3 months prior to enrollment Blood products or immunoglobulin within 16 weeks prior to enrollment; receipt of immunoglobulin within 16 weeks prior to enrollment requires PSRT approval Receipt of any live attenuated vaccine within 4 weeks prior to enrollment ACAM2000 vaccine for Monkeypox received within 30 days prior to enrollment or receipt of study product, or if ACAM2000 received greater than 30 days prior to enrollment, or prior to receipt of study product, vaccination scab still present; or planned administration within 30 days after enrollment or receipt of study product Receipt of any vaccines that are not live attenuated within 14 days prior to enrollment; replication incompetent vaccines such as the Jynneos vaccine for the prevention of monkeypox disease are not considered to be live vaccines Receipt of non-HIV experimental vaccine(s) received within the last 1 year. Exceptions may be made by the PSRT for vaccines that have subsequently undergone licensure or Emergency Use Authorization by the FDA or, if outside the United States, by the national regulatory authority or World Health Organization. For volunteers who have received control/placebo in an experimental vaccine trial, the PSRT will determine eligibility on a case-by-case basis Initiation of antigen-based immunotherapy for allergies within the previous year (stable immunotherapy is not exclusionary); inclusion of participants who initiated immunotherapy within the previous year requires PSRT approval Receipt of investigational research agents with a half-life of 7 or fewer days within 4 weeks prior to enrollment. If a potential participant has received investigational agents with a half-life greater than 7 days (or unknown half-life) within the past year, PSRT approval is required for enrollment History of serious reaction (eg, hypersensitivity, anaphylaxis) to any related vaccine or component of the study vaccine regimen Hereditary angioedema, acquired angioedema, or idiopathic forms of angioedema Idiopathic urticaria within the past year Bleeding disorder diagnosed by a doctor (eg, factor deficiency, coagulopathy, or platelet disorder requiring special precautions) Seizure disorder; febrile seizures as a child or seizures secondary to alcohol withdrawal more than 5 years ago are not exclusionary Asplenia or functional asplenia Active duty and reserve US military personnel Any other chronic or clinically significant condition that in the clinical judgement of the investigator would jeopardize the safety or rights of the study participant, including, but not limited to: clinically significant forms of drug or alcohol abuse, serious psychiatric disorders, persons with any suicide attempt within the past one year (if between 1-2 years, consult PSRT) or cancer that, in the clinical judgment of the site investigator, has a potential for recurrence (excluding basal cell carcinoma) Asthma is excluded if the participant has ANY of the following: Required either oral or parenteral corticosteroids for an exacerbation two or more times within the past year; OR Needed emergency care, urgent care, hospitalization, or intubation for an acute asthma exacerbation within the past year (eg, would NOT exclude individuals with asthma who meet all other criteria but sought urgent/emergent care solely for asthma medication refills or co-existing conditions unrelated to asthma); OR Uses a short-acting rescue inhaler more than 2 days/week for acute asthma symptoms (ie, not for preventive treatment prior to athletic activity); OR Uses medium-to-high-dose inhaled corticosteroids (greater than 250 mcg fluticasone or therapeutic equivalent per day), whether in single-therapy or dual-therapy inhalers (ie, with a long-acting beta agonist [LABA]); OR Uses more than one medication for maintenance therapy daily. Inclusion of anyone on a stable dose of more than one medication for maintenance therapy daily for greater than two years requires PSRT approval. A participant with a history of an immune-mediated disease, either active or remote. Specific examples are listed in protocol (AESI index). Not exclusionary: 1) remote history of Bell's palsy (>2 years ago) not associated with other neurologic symptoms, 2) mild psoriasis that does not require ongoing systemic treatment Investigator concern for difficulty with venous access based upon clinical history and physical examination. For example, history of IV drug abuse or substantial difficulty with previous blood draws. Presence of implanted electronic medical device (eg, pacemaker, implantable cardioverter defibrillator) Presence of surgical or traumatic metal implant in either upper arm and/or upper torso History of cardiac arrhythmia (eg, supraventricular tachycardia, atrial fibrillation) (Not excluded: sinus arrhythmia) Tattoo overlying the injection sites preventing assessment of reactogenicity in the view of the investigator or skin condition at the injection sites History or presence of keloid scar formation or hypertrophic scar

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group #1: INO-6160/ 2.0 mg<br>The dose of INO-6160, 2 mg, will be administered as 2 separate intradermal (ID) injections, one in each arm | Biological: INO-6160, 2 mg<br>* ID EP at month 0,1,3 and 6<br>|
| Experimental: Group #2: INO-6160/ 2.0 mg with Trimer-4571 / 100 mcg 3M-052-AF (5 mcg) + Alum (500 mcg)<br>The dose of INO-6160, 2 mg, will be administered as 2 separate intradermal (ID) injections, one in each arm. The dose of Trimer 4571, 100 mcg, will be administered as 2 injections delivered intramuscularly (IM), one in each arm. | Biological: INO-6160, 2 mg<br>* ID EP at month 0,1,3 and 6<br>Biological: Trimer-4571 / 100 mcg 3M-052-AF (5 mcg) + Alum (500 mcg)<br>* IM at month 3 and 6<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants showing local vaccination reactogenicity signs and symptoms | Assessed by clinic staff. For a given sign or symptom, each subject's reactogenicity will be counted once under the maximum severity for each injection/ vaccination. | 14 days following each vaccination | 
| Number of participants showing systemic vaccination reactogenicity signs and symptoms | Assessed by clinic staff. For a given sign or symptom, each subject's reactogenicity will be counted once under the maximum severity for each injection/ vaccination. | 14 days following each vaccination | 
| Number and description of serious adverse events (SAEs) | adverse events (AEs) will be graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult AEs | 12 months following any receipt of study product | 
| Number and description of medically attended adverse events (MAAEs) | adverse events (AEs) will be graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult AEs | 12 months following any receipt of study product | 
| Number and description of adverse events of special interest (AESIs) | adverse events (AEs) will be graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult AEs | 12 months following any receipt of study product | 
| Number and description of AEs leading to early participant withdrawal or permanent discontinuation and reason for withdrawal/discontinuation | adverse events (AEs) will be graded according to the Division of AIDS (DAIDS) Table for Grading the Severity of Adult AEs | 12 months following any receipt of study product | 
| Response rate of vaccine-matched IgG binding Ab responses as assessed by multiplex assay |  | 2 weeks following the fourth vaccination | 
| Magnitude of vaccine-matched IgG binding Ab responses as assessed by multiplex assay |  | 2 weeks following the fourth vaccination | 
| Response rate of CD4 +T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 2 weeks following the fourth vaccination | 
| Magnitude of CD4 + T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 2 weeks following the fourth vaccination | 
| Response rate of CD8 +T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 2 weeks following the fourth vaccination | 
| Magnitude of CD8 + T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 2 weeks following the fourth vaccination | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neutralizing Ab magnitude and breadth against autologous and tier 1a HIV-1 isolates | as assessed by TZM-bl neutralization assay | 2 weeks after the 3rd and 4th vaccinations | 
| Response rate of HIV-1 specific IgG binding Ab responses | assessed by multiplex assay | 2 weeks following third vaccination | 
| Magnitude of HIV-1 specific IgG binding Ab responses | assessed by multiplex assay | 2 weeks following third vaccination | 
| Epitope specificity of HIV-1 specific IgG binding Ab responses | assessed by multiplex assay | 2 weeks following third vaccination | 
| Response rate of CD4 +T-cell responses | measured by flow cytometry, to HIV-1-specific Env peptide pools | 2 weeks following third vaccination | 
| Magnitude of CD4 +T-cell responses | measured by flow cytometry, to HIV-1-specific Env peptide pools | 2 weeks following third vaccination | 
| Response rate of CD8+T-cell responses | measured by flow cytometry, to HIV-1-specific Env peptide pools | 2 weeks following third vaccination | 
| Magnitude of CD8+T-cell responses | measured by flow cytometry, to HIV-1-specific Env peptide pools | 2 weeks following third vaccination | 
| Magnitude of CD4 +T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 6 months post last vaccination | 
| Response Rate of CD4 +T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 6 months post last vaccination | 
| Magnitude of CD8+T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 6 months post last vaccination | 
| Response Rate of CD8+T-cell responses measured by flow cytometry, to HIV-1-specific Env peptide pools |  | 6 months post last vaccination | 
| Response rate of HIV-1 specific IgG binding Ab response | assessed by multiplex assay | 6 months post last vaccination | 
| Magnitude of HIV-1 specific IgG binding Ab response | assessed by multiplex assay | 6 months post last vaccination | 
| Neutralizing Ab magnitude and breadth against autologous tier 2 HIV-1 isolates | assessed by TZM-bl neutralization assay | 6 months post last vaccination |