Article
Author: Ledgerwood, Julie E. ; Carlton, Kevin ; Chen, Grace L. ; Strom, Larisa ; Pegu, Amarendra ; Gordon, Ingelise J. ; Carter, Cristina A. ; Rothwell, Ro Shauna S. ; Lin, Bob C. ; Capparelli, Edmund V. ; Mascola, John R. ; Gaudinski, Martin R. ; Awan, Seemal F. ; Gall, Jason G. ; O’Connell, Sarah ; Liu, Cuiping ; Hickman, Somia P. ; Hendel, Cynthia S. ; Costner, Pamela J. ; McDermott, Adrian B. ; Dyer, Renunda ; Pandey, Janardan P. ; Bailer, Robert T. ; Kwong, Peter D. ; Narpala, Sandeep R. ; Doria-Rose, Nicole A. ; Ko, Sungyoul ; Holman, LaSonji A. ; Kwon, Young D. ; Trofymenko, Olga ; Arnold, Frank J. ; Coates, Emily E. ; Almasri, Cassandra G. ; Conan-Cibotti, Michelle ; Namboodiri, Aryan M. ; Koup, Richard A.
BACKGROUND:Broadly neutralizing monoclonal antibodies (bNAbs) represent a promising strategy for HIV-1 immunoprophylaxis and treatment. 10E8VLS and VRC07-523LS are bNAbs that target the highly conserved membrane-proximal external region (MPER) and the CD4-binding site of the HIV-1 viral envelope glycoprotein, respectively.
METHODS:In this phase 1, open-label trial, we evaluated the safety and pharmacokinetics of 5 mg/kg 10E8VLS administered alone, or concurrently with 5 mg/kg VRC07-523LS, via s.c. injection to healthy non–HIV-infected individuals.
RESULTS:
Eight participants received either 10E8VLS alone (
n
= 6) or 10E8VLS and VRC07-523LS in combination (
n
= 2). Five (
n
= 5 of 8, 62.5%) participants who received 10E8VLS experienced moderate local reactogenicity, and 1 participant (
n
= 1/8, 12.5%) experienced severe local reactogenicity. Further trial enrollment was stopped, and no participant received repeat dosing. All local reactogenicity resolved without sequelae. 10E8VLS retained its neutralizing capacity, and no functional anti-drug antibodies were detected; however, a serum
t
1/2
of 8.1 days was shorter than expected. Therefore, the trial was voluntarily stopped per sponsor decision (Vaccine Research Center, National Institute of Allergy and Infectious Diseases [NIAID], NIH). Mechanistic studies performed to investigate the underlying reason for the reactogenicity suggest that multiple mechanisms may have contributed, including antibody aggregation and upregulation of local inflammatory markers.
CONCLUSION:
10E8VLS resulted in unexpected reactogenicity and a shorter
t
1/2
in comparison with previously tested bNAbs. These studies may facilitate identification of nonreactogenic second-generation MPER-targeting bNAbs, which could be an effective strategy for HIV-1 immunoprophylaxis and treatment.
TRIAL REGISTRATION:Clinicaltrials.gov, accession no. NCT03565315.
FUNDING:Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH.