Immune Responses to H5N1 Vaccine With and Without AS03 Adjuvant
Immune Responses to H5N1 Vaccine With and Without AS03 Adjuvant
Background:

 - Adjuvants are substances included in vaccines that stimulate the immune system and increase
 the body's response to the vaccine. The AS03 adjuvant is used in seasonal flu vaccines in
 Europe. However, it has not been fully tested in the United States. Researchers want to test
 the immune responses of people who receive a bird flu vaccine with or without AS03 to better
 understand how the adjuvant works. This information may help develop better flu vaccines.

 Objectives:

 - To compare the healthy immune system responses to bird flu vaccine with or without the AS03
 adjuvant.

 Eligibility:

 - Healthy volunteers between 18 and 45 years of age.

 Design:

 -  Participants will be screened with a physical exam and medical history.

 -  Participants will be assigned to one of two groups. Each group will have an initial
 vaccine, followed by a booster vaccine 21 days later. Both vaccinations will use the
 same type of vaccine. One group will have the vaccine with AS03; the other group will
 have the vaccine without it.

 -  All participants will have two 36-hour inpatient stays to receive the vaccine. Each stay
 will involve the vaccination, followed by regular and frequent blood draws. Participants
 will be monitored for any signs or symptoms that may be caused by the vaccine.

 -  Additional blood samples will be collected 7, 28, 42, and 100 days after the initial
 vaccination.
Adjuvants have been in use for many decades to enhance the effects of vaccines on the host
 immune system, yet we know very little on how they actually work. Better understanding of the
 mechanism by which adjuvants activate the immune system will enable us to develop better and
 safer vaccines as well as a broad range of immune interventions to a wide spectrum of
 diseases including cancer and autoimmunity.

 In the current study we propose to study the effect of AS03 adjuvant on the innate/early
 immune response to H5N1, avian flu, a potentially lethal disease that most subjects are
 assumed to be naive to AS03 is an adjuvant oil in water emulsion containing
 DL-alpha-tocopherol, squalene and the non-ionic detergent Tween 80 that has been widely used
 as an adjuvant to flu vaccines produced by GlaxoSmithKline(GSK).

 We therefore propose to randomize up to 60 healthy volunteers into two intervention arms (25
 volunteers in each arm with up to 10 total replacements in the event a volunteer does not
 return for the first vaccine). The first arm will receive a vaccine containing H5N1 with AS03
 adjuvant, the second arm will receive H5N1 without AS03 adjuvant. Both arms will receive
 primary and booster vaccination followed by repeated blood sampling to evaluate the immune
 responses. We will apply high throughput analytic techniques and use systems biology methods
 to integrate the collected data and draw a description of the immune system response with and
 without the adjuvant.

 The primary objective is to compare multiplex immune response signatures following two
 (primary and a boost) vaccinations with the GSK AS03 adjuvanted H5N1 influenza vaccine, or
 the non-adjuvanted form of the H5N1 influenza vaccine, at the 3.75 mcg dose and given 21 days
 apart and identify differences in very early innate immune responses. These immune signatures
 will also be correlated with the clinical observations especially safety related local and
 systemic events.
-  INCLUSION CRITERIA:

 1. Healthy status confirmed by History, Physical Exam and blood work through the CHI
 Screening Protocol.

 2. Age 21 years to 45 years

 3. Able to comprehend the investigational nature of the protocol and provide
 informed consent

 4. Must be willing to use effective birth control for one month before, during and
 for two months after the last vaccination.

 EXCLUSION CRITERIA:

 1. Severe allergies to eggs or their products, chicken proteins or to any component of
 the influenza antigen preparation.

 2. Recipient of AS03 vaccine at any time in the past

 3. Recipient of the seasonal influenza vaccine within the past 3 months.

 4. Prior severe reactions to vaccines, including influenza vaccines (e.g. anaphylaxis,
 angioedema or urticaria)

 5. Participation on any blood collection or blood donation procedure during study that
 will bring the total blood draw >550ml over 8 weeks

 6. Current pregnancy (women of child bearing potential must have a negative serum
 pregnancy test done on screening within 1 week of protocol accrual)

 7. Currently breast-feeding

 8. History of Guillain Barre syndrome

 9. Acute illness with patient reported temperature of 38 (Infinite)C or greater within 3
 days prior to the proposed time of administration.

 10. Any history or presence of serious illness, bleeding disorders or autoimmune
 disorders, or planned surgeries.

 11. Weight less than 50 kg (110 pounds)

 12. History of hepatitis or liver disease.

 13. Subjects receiving immunosuppressive therapy.

 14. Presence of HLA DQB1*06:02, the narcolepsy risk associated allele.