Safety and immunogenicity of a single oral dose of recombinant double mutant heat-labile toxin derived from enterotoxigenic Escherichia coli

Clin Vaccine Immunol. 2013 Nov;20(11):1764-70. doi: 10.1128/CVI.00464-13. Epub 2013 Sep 18.

Abstract

Enterotoxigenic Escherichia coli (ETEC) is a primary cause of traveler's diarrhea for which there is no licensed vaccine. This phase 1 trial determined the safety and immunogenicity of a recombinantly produced double mutant heat-labile enterotoxin (dmLT) of ETEC. It was administered as a single oral dose of dmLT in escalating doses of 5 μg, 25 μg, 50 μg, and 100 μg, followed by a 72-h inpatient observation, outpatient visits at 8, 14, and 28 days, and telephone calls at 2 and 6 months postvaccination. Safety was assessed by frequency of adverse events, and immune responses determined after immunization included dmLT-specific serum IgA and IgG, fecal IgA, antibody-secreting cells (ASC), and antibodies in lymphocyte supernatant (ALS) responses. All doses were well tolerated by the 36 healthy adults enrolled. Immune responses were limited in the 5- and 25-μg dose recipients. The 50-μg dose recipients trended toward stronger responses than the 100-μg dose recipients by serum IgA (67% versus 33%, P = 0.22), serum IgG (58% versus 33%, P = 0.41), and fecal IgA (58% versus 33%, P = 0.41). By day 14 postvaccination, there were significantly more positive responders (≥4-fold increase from baseline) among the 50- versus 100-μg dose recipients for serum IgA (P = 0.036) but not serum IgG (P = 0.21). In conclusion, a single oral dose of dmLT was well tolerated and immunogenic, with immune responses plateauing at the 50-μg dose. (This clinical trial is registered at www.clinicaltrials.gov, registration number NCT01147445.).

Publication types

  • Clinical Trial, Phase I
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Antibodies, Bacterial / analysis
  • Antibodies, Bacterial / blood
  • Antibody-Producing Cells / immunology
  • Bacterial Toxins / immunology*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / pathology
  • Enterotoxigenic Escherichia coli / immunology*
  • Enterotoxins / immunology*
  • Escherichia coli Proteins / immunology*
  • Escherichia coli Vaccines / administration & dosage
  • Escherichia coli Vaccines / adverse effects*
  • Escherichia coli Vaccines / immunology*
  • Feces / chemistry
  • Female
  • Healthy Volunteers
  • Humans
  • Immunoglobulin A / analysis
  • Immunoglobulin A / blood
  • Immunoglobulin G / analysis
  • Immunoglobulin G / blood
  • Male
  • Vaccines, Subunit / administration & dosage
  • Vaccines, Subunit / adverse effects
  • Vaccines, Subunit / immunology
  • Vaccines, Synthetic / administration & dosage
  • Vaccines, Synthetic / adverse effects
  • Vaccines, Synthetic / immunology
  • Young Adult

Substances

  • Antibodies, Bacterial
  • Bacterial Toxins
  • Enterotoxins
  • Escherichia coli Proteins
  • Escherichia coli Vaccines
  • Immunoglobulin A
  • Immunoglobulin G
  • Vaccines, Subunit
  • Vaccines, Synthetic
  • heat-labile enterotoxin, E coli

Associated data

  • ClinicalTrials.gov/NCT01147445