Adrian V S Hill

University of Oxford, Oxford, ENG, United Kingdom

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Publications (246)2127.79 Total impact

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    ABSTRACT: Plasmodium vivax is the world's most widely distributed malaria parasite and a potential cause of morbidity and mortality for approximately 2.85 billion people living mainly in South East Asia and Latin America. Despite this dramatic burden, very few vaccines have been assessed in humans. The clinically relevant vectors Modified Vaccinia Ankara (MVA) and the chimpanzee adenovirus ChAd63 are promising delivery systems for malaria vaccines due to their safety profiles and proven ability to induce protective immune responses against Plasmodium falciparum thrombospondin-related anonymous protein (TRAP) in clinical trials. Here we describe the development of new recombinant ChAd63 and MVA vectors expressing P. vivax TRAP (PvTRAP) and show their ability to induce high antibody titres and T-cell responses in mice. In addition, we report a novel way of assessing efficacy of new candidate vaccines against P. vivax using a fully infectious transgenic Plasmodium berghei parasite expressing P. vivax TRAP to allow studies of vaccine efficacy and protective mechanisms in rodents. Using this model, we found that both, CD8(+) T cells and antibodies mediated protection against malaria using viral vectored vaccines. Our data indicate that ChAd63 and MVA expressing PvTRAP are good pre-erythrocytic stage vaccine candidates with potential for future clinical application.
    Infection and immunity 12/2013; · 4.21 Impact Factor
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    ABSTRACT: Adenoviruses are potent vectors for inducing and boosting cellular immunity to encoded recombinant antigens. However, the widespread seroprevalence of neutralizing antibodies to common human adenovirus serotypes limits their use. Simian adenoviruses do not suffer from the same drawbacks. We have constructed a replication-deficient chimpanzee adenovirus-vectored vaccine expressing the conserved influenza antigens, nucleoprotein and matrix protein 1. Here we report safety and T-cell immunogenicity following vaccination with this novel recombinant simian adenovirus, ChAdOx1 NP+M1, in a first in human dose escalation study using a 3+3 study design, followed by boosting with MVA expressing the same antigens in some volunteers. We demonstrate ChAdOx1 NP+M1 to be safe and immunogenic. ChAdOx1 is a promising vaccine vector that could be used to deliver vaccine antigens where strong cellular immune responses are required for protection.Molecular Therapy (2013); doi:10.1038/mt.2013.284.
    Molecular Therapy 12/2013; · 7.04 Impact Factor
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    ABSTRACT: Acquisition of non-sterilizing natural immunity to Plasmodium falciparum malaria has been shown in low transmission areas following multiple exposures. However conflicting data from endemic areas suggest the parasite may interfere with the induction of effective B cell responses. To-date, the impact of blood-stage parasite exposure on antigen-specific B cells has not been reported following controlled human malaria infection (CHMI). Here we analysed human B cell responses in a series of Phase I/IIa clinical trials, which include CHMI, using candidate viral vectored vaccines encoding two blood-stage antigens - merozoite surface protein 1 (MSP1) and apical membrane antigen 1 (AMA1). Previously vaccinated volunteers show boosting of pre-existing antigen-specific memory B cell (mBC) responses following CHMI. In contrast unvaccinated malaria-naïve control volunteers developed a mBC response against MSP1 but not AMA1. Serum IgG correlated with the mBC response after booster vaccination but this relationship was less well maintained following CHMI. A significant reduction in peripheral MSP1-specific mBC was observed at the point of diagnosis of blood-stage infection. This was coincident with a reduction in peripheral blood B cell subsets expressing CXCR3 and elevated serum levels of IFN-γ and CXCL9, suggesting migration away from the periphery. These CHMI data confirm that mBC and antibody responses can be induced and boosted by blood-stage parasite exposure, in support of epidemiological studies on low-level parasite exposure. This article is protected by copyright. All rights reserved.
    Immunology 12/2013; · 3.71 Impact Factor
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    ABSTRACT: Induction of antigen-specific CD8(+) T cells offers the prospect of immunization against many infectious diseases, but no subunit vaccine has induced CD8(+) T cells that correlate with efficacy in humans. Here we demonstrate that a replication-deficient chimpanzee adenovirus vector followed by a modified vaccinia virus Ankara booster induces exceptionally high frequency T-cell responses (median >2400 SFC/10(6) peripheral blood mononuclear cells) to the liver-stage Plasmodium falciparum malaria antigen ME-TRAP. It induces sterile protective efficacy against heterologous strain sporozoites in three vaccinees (3/14, 21%), and delays time to patency through substantial reduction of liver-stage parasite burden in five more (5/14, 36%), P=0.008 compared with controls. The frequency of monofunctional interferon-γ-producing CD8(+) T cells, but not antibodies, correlates with sterile protection and delay in time to patency (Pcorrected=0.005). Vaccine-induced CD8(+) T cells provide protection against human malaria, suggesting that a major limitation of previous vaccination approaches has been the insufficient magnitude of induced T cells.
    Nature Communications 11/2013; 4:2836. · 10.02 Impact Factor
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    ABSTRACT: Virus diversity and escape from immune responses are the biggest challenges to the development of an effective vaccine against HIV-1. We hypothesized that T-cell vaccines targeting the most conserved regions of the HIV-1 proteome, which are common to most variants and bear fitness costs when mutated, will generate effectors that efficiently recognize and kill virus-infected cells early enough after transmission to potentially impact on HIV-1 replication and will do so more efficiently than whole protein-based T-cell vaccines. Here, we describe the first-ever administration of conserved immunogen vaccines vectored using prime-boost regimens of DNA, simian adenovirus and modified vaccinia virus Ankara to uninfected UK volunteers. The vaccine induced high levels of effector T cells that recognized virus-infected autologous CD4(+) cells and inhibited HIV-1 replication by up to 5.79 log10. The virus inhibition was mediated by both Gag- and Pol- specific effector CD8(+) T cells targeting epitopes that are typically subdominant in natural infection. These results provide proof of concept for using a vaccine to target T cells at conserved epitopes, showing that these T cells can control HIV-1 replication in vitro.Molecular Therapy (2013); doi:10.1038/mt.2013.248.
    Molecular Therapy 10/2013; · 7.04 Impact Factor
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    ABSTRACT: Background. Eight decades ago, the ratio of monocytes and lymphocytes was noted to affect outcomes of mycobacterial infection in rabbits. Recent transcriptomic studies support a role for relative proportions of myeloid and lymphoid transcripts in TB outcomes. The ratio of peripheral blood monocytes: lymphocytes (ML ratio) is known to be governed by haematopoeitic stem cells(HSC) with distinct biases.Methods. The predictive value of the baseline ML ratio was modeled in two prospective cohorts of adults starting cART in South Africa (primary n=1862 and replication n=345). Incident TB was diagnosed with clinical, radiographic and microbiologic methods per contemporary guidelines. Kaplan-Meier survival analyses and Cox proportional hazards modeling were conducted.Results. The incidence rate of TB differed significantly by baseline ML ratio: 32.61(95%CI 15.38-61.54); 16.36(95% CI 12.39-21.23), and 51.80(95% CI 23.10-101.71) per 1000 patient-years for ML ratio<5(th) percentile; 5-95(th) centile; and >95(th) centile respectively(p=0.007). Neither monocyte nor lymphocyte counts alone were associated with TB. Adjusting for sex, WHO stage, CD4+ T-cell counts and previous TB, hazards of disease were significantly higher for patients with ML ratio <5(th) or >95(th) percentile(adjusted HR 2.47;95%CI 1.39-4.40;p=0.002).Conclusions. The ML ratio may be a useful, readily available tool to stratify risk of TB disease and suggests involvement of HSC bias in TB pathogenesis.
    The Journal of Infectious Diseases 09/2013; · 5.85 Impact Factor
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    ABSTRACT: Interferon-inducible transmembrane proteins 1, 2 and 3 (IFITM1,2 and 3) are viral restriction factors that mediate cellular resistance to several viruses. We have genotyped a possible splice-site altering SNP (rs12252) in the IFITM3 gene in 34 H1N1 influenza cases with severe pneumonia and over 5000 individuals comprising cases of community-acquired mild lower respiratory tract infection and matched controls of Caucasian ancestry. We found evidence of an association between rs12252 rare allele homozygotes and susceptibility to mild influenza (in patients attending primary care), but could not confirm a previously reported association between this SNP and susceptibility to severe H1N1 infection.
    The Journal of Infectious Diseases 08/2013; · 5.85 Impact Factor
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    ABSTRACT: The mosquito innate immune response is able to clear the majority of Plasmodium parasites. This immune clearance is controlled by a number of regulatory molecules including serine protease inhibitors (serpins). To determine whether such molecules could represent a novel target for a malaria transmission-blocking vaccine, we vaccinated mice with Anopheles gambiae serpin-2 (AgSRPN2). Antibodies against AgSRPN2 significantly reduced the infection of a heterologous Anopheles species (Anopheles stephensi) by Plasmodium berghei, however this effect was not observed with Plasmodium falciparum. Therefore, this approach of targeting regulatory molecules of the mosquito immune system may represent a novel approach to transmission-blocking malaria vaccines.
    International journal for parasitology 07/2013; · 3.39 Impact Factor
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    ABSTRACT: Current seasonal influenza vaccines have reduced immunogenicity and are of suboptimal efficacy in older adults. We have previously shown that the novel candidate vaccineMVA-NP+M1 is able to boost memory T cell responses in adultsaged 50-85 years. Pre-clinical studies have demonstrated that viral vectored vaccines can act as adjuvants when co-administered with protein-based vaccines.We have conducted a phase I clinical trial to compare co-administration of seasonal influenza vaccine and MVA-NP+M1, to seasonal influenza vaccine alone in adults aged 50 years and over. This combination of vaccines was safe and well tolerated. T cell responses to internal influenza proteins were boosted to significantly higher levels in the group receiving MVA-NP+M1 compared to the group receiving seasonal influenza vaccine alone. Rates of seroprotection and seroconversionagainst the three vaccine strains were similar in both groups however there was a significant increase in the geometric mean titre ratio for the H3N2 component of seasonal influenza vaccine in the co-administration group. While some vaccine combinations result in immune interference, the co-administration of MVA-NP+M1 alongside seasonal influenza vaccine is shown here to increase some influenza strain-specific antibody responses and boost memory T cells capable of recognising a range of influenza A subtypes.Molecular Therapy (2013); doi:10.1038/mt.2013.162.
    Molecular Therapy 07/2013; · 7.04 Impact Factor
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    ABSTRACT: This was a retrospective study to determine the validity of institutional reference intervals for interpreting biochemistry and hematology results in healthy adults in the context of clinical trials of preventive vaccines. An example population of 974 healthy adults participating in clinical trials at the Jenner Institute, Oxford, UK, between 1999 and 2009 was studied. Methods for calculating the central 95% ranges and determining the coefficients of within person variation were demonstrated. Recommendations have been made as to how these data can be usefully applied to the interpretation of blood results in healthy adult subjects for the purposes of clinical trial inclusion decisions and post-vaccination safety monitoring.
    Human vaccines & immunotherapeutics. 06/2013; 9(8).
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    ABSTRACT: CD8(+) T cells mediate immunity against Plasmodium liver stages. However, the paucity of parasite-specific epitopes of CD8(+) T cells has limited our current understanding of the mechanisms influencing the generation, maintenance and efficiency of these responses. To identify antigenic epitopes in a stringent murine malaria immunisation model, we performed a systematic profiling of H(2b)-restricted peptides predicted from genome-wide analysis. We describe the identification of Plasmodium berghei (Pb) sporozoite-specific gene 20 (S20)- and thrombospondin-related adhesive protein (TRAP)-derived peptides, termed PbS20318 and PbTRAP130 respectively, as targets of CD8(+) T cells from C57BL/6 mice vaccinated by whole parasite strategies known to protect against sporozoite challenge. While both PbS20318 and PbTRAP130 elicit effector and effector memory phenotypes in both the spleens and livers of immunised mice, only PbTRAP130-specific CD8(+) T cells exhibit in vivo cytotoxicity. Moreover, PbTRAP130-specific, but not PbS20318-specific, CD8(+) T cells significantly contribute to inhibition of parasite development. Prime/boost vaccination with PbTRAP demonstrates CD8(+) T cell-dependent efficacy against sporozoite challenge. We conclude that PbTRAP is an immunodominant antigen during liver-stage infection. Together, our results underscore the presence of CD8(+) T cells with divergent potencies against distinct Plasmodium liver-stage epitopes. Our identification of antigen-specific CD8(+) T cells will allow interrogation of the development of immune responses against malaria liver stages.
    PLoS Pathogens 05/2013; 9(5):e1003303. · 8.14 Impact Factor
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    ABSTRACT: Rodent malaria species Plasmodium yoelii and P. chabaudi have been widely used to validate vaccine approaches targeting blood-stage merozoite antigens. However, increasing data suggest the P. berghei rodent malaria may be able to circumvent vaccine-induced anti-merozoite responses. Here we confirm a failure to protect against P. berghei, despite successful antibody induction against leading merozoite antigens using protein-in-adjuvant or viral vectored vaccine delivery. No subunit vaccine approach showed efficacy in mice following immunization and challenge with the wild-type P. berghei strains ANKA or NK65, or against a chimeric parasite line encoding a merozoite antigen from P. falciparum. Protection was not improved in knockout mice lacking the inhibitory Fc receptor CD32b, nor against a Δsmac P. berghei parasite line with a non-sequestering phenotype. An improved understanding of the mechanisms responsible for protection, or failure of protection, against P. berghei merozoites could guide the development of an efficacious vaccine against P. falciparum.
    Scientific Reports 04/2013; 3:1706. · 2.93 Impact Factor
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    ABSTRACT: Staphylococcus aureus remains an important human and animal pathogen. Its pathogenicity is determined in part by expression of the Spa immune subversion protein, neutralising the activity of which provides partial protection in murine models, as does experimental infection with live S. aureus with Spa gene deletions followed by antibiotic-mediated cure in mice. Together, these data raise the question of whether Spa mutant S. aureus might represent a viable vaccine. Here we find that gamma-irradiated S. aureus strains, both wild type and null mutant of spa, are immunogenic in mice when administered intramuscularly, eliciting large amounts of anti-S. aureus antibodies, as judged by whole cell immunoassay on fixed microbes. We used an intravenous challenge system to assess vaccine efficacy, the sensitivity of which was increased by studying renal bacterial concentrations in both kidneys. Despite this, protection from intravenous challenge was not observed (mean difference between vaccinated and unvaccinated mice 0.27 log10 with 95% confidence interval -0.922 to 1.467). Surprisingly, antibody responses elicited against a panel of protective cell surface proteins were very low, indicating that most antibody induced is not protective. Additionally, these data suggests a limited role for irradiated wild type or spa mutant S. aureus as vaccines. This article is protected by copyright. All rights reserved.
    Pathogens and disease. 04/2013;
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    ABSTRACT: Although several hundred regions of the human genome harbor signals of positive natural selection, few of the relevant adaptive traits and variants have been elucidated. Using full-genome sequence variation from the 1000 Genomes (1000G) Project and the composite of multiple signals (CMS) test, we investigated 412 candidate signals and leveraged functional annotation, protein structure modeling, epigenetics, and association studies to identify and extensively annotate candidate causal variants. The resulting catalog provides a tractable list for experimental follow-up; it includes 35 high-scoring nonsynonymous variants, 59 variants associated with expression levels of a nearby coding gene or lincRNA, and numerous variants associated with susceptibility to infectious disease and other phenotypes. We experimentally characterized one candidate nonsynonymous variant in Toll-like receptor 5 (TLR5) and show that it leads to altered NF-κB signaling in response to bacterial flagellin. PAPERFLICK:
    Cell 02/2013; 152(4):703-13. · 31.96 Impact Factor
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    ABSTRACT: Overcoming antigenic variation is one of the major challenges in the development of an effective vaccine against Plasmodium falciparum, a causative agent of human malaria. Inclusion of multiple Ag variants in subunit vaccine candidates is one strategy that has aimed to overcome this problem for the leading blood-stage malaria vaccine targets, that is, merozoite surface protein 1 (MSP1) and apical membrane Ag 1 (AMA1). However, previous studies, utilizing malaria Ags, have concluded that inclusion of multiple allelic variants, encoding altered peptide ligands, in such a vaccine may be detrimental to both the priming and in vivo restimulation of Ag-experienced T cells. In this study, we analyze the T cell responses to two alleles of MSP1 and AMA1 induced by vaccination of malaria-naive adult volunteers with bivalent viral-vectored vaccine candidates. We show a significant bias to the 3D7/MAD20 allele compared with the Wellcome allele for the 33 kDa region of MSP1, but not for the 19 kDa fragment or the AMA1 Ag. Although this bias could be caused by "immune interference" at priming, the data do not support a significant role for "immune antagonism" during memory T cell restimulation, despite observation of the latter at a minimal epitope level in vitro. A lack of class I HLA epitopes in the Wellcome allele that are recognized by vaccinated volunteers may in fact contribute to the observed bias. We also show that controlled infection with 3D7 strain P. falciparum parasites neither boosts existing 3D7-specific T cell responses nor appears to "immune divert" cellular responses toward the Wellcome allele.
    The Journal of Immunology 01/2013; · 5.52 Impact Factor
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    ABSTRACT: The disadvantages of needle-based immunisation motivate the development of simple, low cost, needle-free alternatives. Vaccine delivery to cutaneous environments rich in specialised antigen-presenting cells using microprojection patches has practical and immunological advantages over conventional needle delivery. Additionally, stable coating of vaccine onto microprojections removes logistical obstacles presented by the strict requirement for cold-chain storage and distribution of liquid vaccine, or lyophilised vaccine plus diluent. These attributes make these technologies particularly suitable for delivery of vaccines against diseases such as malaria, which exerts its worst effects in countries with poorly-resourced healthcare systems. Live viral vectors including adenoviruses and poxviruses encoding exogenous antigens have shown significant clinical promise as vaccines, due to their ability to generate high numbers of antigen-specific T cells. Here, the simian adenovirus serotype 63 and the poxvirus modified vaccinia Ankara - two vectors under evaluation for the delivery of malaria antigens to humans - were formulated for coating onto Nanopatch microprojections and applied to murine skin. Co-formulation with the stabilising disaccharides trehalose and sucrose protected virions during the dry-coating process. Transgene-specific CD8(+) T cell responses following Nanopatch delivery of both vectors were similar to intradermal injection controls after a single immunisation (despite a much lower delivered dose), though MVA boosting of pre-primed responses with Nanopatch was found to be less effective than the ID route. Importantly, disaccharide-stabilised ChAd63 could be stored for 10 weeks at 37°C with less than 1 log10 loss of viability, and retained single-dose immunogenicity after storage. These data support the further development of microprojection patches for the deployment of live vaccines in hot climates.
    PLoS ONE 01/2013; 8(7):e67888. · 3.73 Impact Factor
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    ABSTRACT: Controlled human malaria infection (CHMI) studies have become a routine tool to evaluate efficacy of candidate anti-malarial drugs and vaccines. To date, CHMI trials have mostly been conducted using the bite of infected mosquitoes, restricting the number of trial sites that can perform CHMI studies. Aseptic, cryopreserved P. falciparum sporozoites (PfSPZ Challenge) provide a potentially more accurate, reproducible and practical alternative, allowing a known number of sporozoites to be administered simply by injection. We sought to assess the infectivity of PfSPZ Challenge administered in different dosing regimens to malaria-naive healthy adults (n = 18). Six participants received 2,500 sporozoites intradermally (ID), six received 2,500 sporozoites intramuscularly (IM) and six received 25,000 sporozoites IM. Five out of six participants receiving 2,500 sporozoites ID, 3/6 participants receiving 2,500 sporozoites IM and 6/6 participants receiving 25,000 sporozoites IM were successfully infected. The median time to diagnosis was 13.2, 17.8 and 12.7 days for 2,500 sporozoites ID, 2,500 sporozoites IM and 25,000 sporozoites IM respectively (Kaplan Meier method; p = 0.024 log rank test). 2,500 sporozoites ID and 25,000 sporozoites IM have similar infectivities. Given the dose response in infectivity seen with IM administration, further work should evaluate increasing doses of PfSPZ Challenge IM to identify a dosing regimen that reliably infects 100% of participants. NCT01465048.
    PLoS ONE 01/2013; 8(6):e65960. · 3.73 Impact Factor
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    ABSTRACT: Plasmodium falciparum malaria remains a major cause of illness and death in sub-Saharan Africa. Young children bear the brunt of the disease and though older children and adults suffer relatively fewer clinical attacks, they remain susceptible to asymptomatic P. falciparum infection. A better understanding of the host factors associated with immunity to clinical malaria and the ability to sustain asymptomatic P. falciparum infection will aid the development of improved strategies for disease prevention. Here we investigate whether full differential blood counts can predict susceptibility to clinical malaria among Kenyan children sampled at five annual cross-sectional surveys. We find that the ratio of monocytes to lymphocytes, measured in peripheral blood at the time of survey, directly correlates with risk of clinical malaria during follow-up. This association is evident among children with asymptomatic P. falciparum infection at the time the cell counts are measured (Hazard ratio (HR) = 2.7 (95% CI 1.42, 5.01, P = 0.002) but not in those without detectable parasitaemia (HR = 1.0 (95% CI 0.74, 1.42, P = 0.9). We propose that the monocyte to lymphocyte ratio, which is easily derived from routine full differential blood counts, reflects an individual's capacity to mount an effective immune response to P. falciparum infection.
    PLoS ONE 01/2013; 8(2):e57320. · 3.73 Impact Factor
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    ABSTRACT: Current influenza vaccines stimulate neutralising antibody to the haemagglutinin antigen but as there is antigenic drift in HA it is difficult to prepare a vaccine in advance against an emergent strain. A potential strategy is to induce CD8(+) and CD4(+) T cells that recognize epitopes within internal proteins that are less subject to antigenic drift. Augmenting humoral responses to HA with T cell responses to more conserved antigens may result in a more broadly protective vaccine. In this study, we evaluate the quality of influenza specific T cell responses in a clinical trial using MVA-NP+M1 vaccination followed by influenza virus challenge. In vaccinated volunteers, the expression of Granzyme A, Perforin and CD57 on influenza HLA A*02 M158-66 antigen specific cells was higher than non-vaccinated volunteers before and after challenge despite a similar frequency of antigen specific cells. BCL2 expression was lower in vaccinated volunteers. These data indicate that antigen specific T cells are a useful additional measure for use in human vaccination or immunization studies.
    PLoS ONE 01/2013; 8(5):e62778. · 3.73 Impact Factor
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    ABSTRACT: Heterologous prime boost immunization with chimpanzee adenovirus 63 (ChAd63) and Modified vaccinia Virus Ankara (MVA) vectored vaccines is a strategy recently shown to be capable of inducing strong cell mediated responses against several antigens from the malaria parasite. ChAd63-MVA expressing the Plasmodium falciparum pre-erythrocytic antigen ME-TRAP (multiple epitope string with thrombospondin-related adhesion protein) is a leading malaria vaccine candidate, capable of inducing sterile protection in malaria naïve adults following controlled human malaria infection (CHMI). We conducted two Phase Ib dose escalation clinical trials assessing the safety and immunogenicity of ChAd63-MVA ME-TRAP in 46 healthy malaria exposed adults in two African countries with similar malaria transmission patterns. ChAd63-MVA ME-TRAP was shown to be safe and immunogenic, inducing high-level T cell responses (median >1300 SFU/million PBMC). ChAd63-MVA ME-TRAP is a safe and highly immunogenic vaccine regimen in adults with prior exposure to malaria. Further clinical trials to assess safety and immunogenicity in children and infants and protective efficacy in the field are now warranted. PACTR2010020001771828 PACTR201008000221638 NCT01373879 NCT01373879 NCT01379430 NCT01379430.
    PLoS ONE 01/2013; 8(3):e57726. · 3.73 Impact Factor

Publication Stats

9k Citations
2,127.79 Total Impact Points


  • 1998–2013
    • University of Oxford
      • • Jenner Institute
      • • Nuffield Department of Clinical Medicine
      • • Wellcome Trust Centre for Human Genetics
      Oxford, ENG, United Kingdom
  • 2011
    • London School of Hygiene and Tropical Medicine
      • Faculty of Infectious and Tropical Diseases
      London, ENG, United Kingdom
    • University College Cork
      • School of Pharmacy
      Cork, M, Ireland
    • NYU Langone Medical Center
      • Department of Pathology
      New York City, NY, United States
  • 2008–2011
    • University of Cape Town
      • Department of Child and Adolescent Health
      Cape Town, Province of the Western Cape, South Africa
  • 2010
    • German Cancer Research Center
      Heidelburg, Baden-Württemberg, Germany
    • University of Cincinnati
      • Department of Environmental Health
      Cincinnati, Ohio, United States
  • 2005–2010
    • Bernhard Nocht Institute for Tropical Medicine
      • Department of Molecular Medicine
      Hamburg, Hamburg, Germany
  • 2009
    • Max Planck Institute for Infection Biology
      Berlín, Berlin, Germany
  • 2006–2009
    • Kenya Medical Research Institute
      • Centre for Clinical Research
      Nairoba, Nairobi Area, Kenya
  • 2007
    • KEMRI-Wellcome Trust Research Programme
      Kilifi, Kilifi, Kenya
  • 1996–2006
    • Oxford University Hospitals NHS Trust
      • Nuffield Department of Medicine
      Oxford, England, United Kingdom
  • 2004
    • Consultative Group on International Agricultural Research
      Nairoba, Nairobi Area, Kenya
  • 2003–2004
    • Medical Research Council Unit, The Gambia Unit
      Bakau, Banjul, Gambia