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Low-Dose Subcutaneous or Intravenous Monoclonal Antibody to Prevent Malaria
Richard L Wu1, Azza H Idris1, Nina M Berkowitz1
1From the Vaccine Research Center (R.L.W., A.H.I., N.M.B., M.H., M.R.G., C.B., L. Strom, S.F.A., L.A.H., F.M., I.J.G., L.T.W., L.D.S.P., J.R.F., N.K.K., B.J.F., W.S., W.-P.K., S.O., S.H.P., A.B., A.M., S.R.N., L. Serebryannyy, M.C., R.S., M.I., I.P., S.P.H., A.J.M., A.E.L., J.G.G., K.C., P.M., E.S., J.A.S., S.V., S.T., E.E.C., J.R. Mascola, J.E.L., L.K.D., R.A.S.) and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, the U.S. Public Health Service Commissioned Corps, Rockville (R.L.W., M.R.G.), and the Entomology Branch, Walter Reed Army Institute of Research, Silver Spring (A.C.C., J.R. Murphy) - all in Maryland; the Ragon Institute, Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA (A.H.I.); and the School of Medicine and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego (E.V.C.).
Background:
New approaches for the prevention and elimination of malaria, a leading cause of illness and death among infants and young children globally, are needed.
Methods:
We conducted a phase 1 clinical trial to assess the safety and pharmacokinetics of L9LS, a next-generation antimalarial monoclonal antibody, and its protective efficacy against controlled human malaria infection in healthy adults who had never had malaria or received a vaccine for malaria. The participants received L9LS either intravenously or subcutaneously at a dose of 1 mg, 5 mg, or 20 mg per kilogram of body weight. Within 2 to 6 weeks after the administration of L9LS, both the participants who received L9LS and the control participants underwent controlled human malaria infection in which they were exposed to mosquitoes carrying Plasmodium falciparum (3D7 strain).
Results:
No safety concerns were identified. L9LS had an estimated half-life of 56 days, and it had dose linearity, with the highest mean (±SD) maximum serum concentration (Cmax) of 914.2±146.5 μg per milliliter observed in participants who had received 20 mg per kilogram intravenously and the lowest mean Cmax of 41.5±4.7 μg per milliliter observed in those who had received 1 mg per kilogram intravenously; the mean Cmax was 164.8±31.1 in the participants who had received 5 mg per kilogram intravenously and 68.9±22.3 in those who had received 5 mg per kilogram subcutaneously. A total of 17 L9LS recipients and 6 control participants underwent controlled human malaria infection. Of the 17 participants who received a single dose of L9LS, 15 (88%) were protected after controlled human malaria infection. Parasitemia did not develop in any of the participants who received 5 or 20 mg per kilogram of intravenous L9LS. Parasitemia developed in 1 of 5 participants who received 1 mg per kilogram intravenously, 1 of 5 participants who received 5 mg per kilogram subcutaneously, and all 6 control participants through 21 days after the controlled human malaria infection. Protection conferred by L9LS was seen at serum concentrations as low as 9.2 μg per milliliter.
Conclusions:
In this small trial, L9LS administered intravenously or subcutaneously protected recipients against malaria after controlled infection, without evident safety concerns. (Funded by the National Institute of Allergy and Infectious Diseases; VRC 614 ClinicalTrials.gov number, NCT05019729.).
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