Refinement of a human challenge model for evaluation of enterotoxigenic Escherichia coli vaccines

C Harro, S Chakraborty, A Feller… - Clinical and Vaccine …, 2011 - Am Soc Microbiol
C Harro, S Chakraborty, A Feller, B DeNearing, A Cage, M Ram, A Lundgren
Clinical and Vaccine Immunology, 2011Am Soc Microbiol
Enterotoxigenic Escherichia coli (ETEC) strain H10407 (serotype O78: H11 producing heat-
labile toxin [LT], heat-stable toxin [ST], and colonization factor I [CFA/I]) induces reliably high
diarrheal attack rates (ARs) in a human challenge model at doses of≥ 109 CFU. A
descending-dose challenge study was conducted with changes to the standard fasting time
and buffer formulation, seeking conditions that permit lower inocula while maintaining
reproducibly high ARs. In cohort 1, 20 subjects were fasted overnight and randomized 1: 1 …
Abstract
Enterotoxigenic Escherichia coli (ETEC) strain H10407 (serotype O78:H11 producing heat-labile toxin [LT], heat-stable toxin [ST], and colonization factor I [CFA/I]) induces reliably high diarrheal attack rates (ARs) in a human challenge model at doses of ≥109 CFU. A descending-dose challenge study was conducted with changes to the standard fasting time and buffer formulation, seeking conditions that permit lower inocula while maintaining reproducibly high ARs. In cohort 1, 20 subjects were fasted overnight and randomized 1:1:1:1 to receive H10407 at doses of 108 CFU with bicarbonate, 108 CFU with CeraVacx, 107 CFU with bicarbonate, or 107 CFU with CeraVacx. Subsequent cohorts received H10407 (107 CFU with bicarbonate) with similar fasting conditions. Cohort 2 included 15 ETEC-naïve volunteers. Cohort 3 included 10 ETEC-naïve volunteers and 10 rechallenged volunteers. In all, 25/35 (71%) ETEC-naïve recipients of 107 CFU of H10407 developed moderate or severe diarrhea (average maximum stool output/24 h = 1,042 g), and most (97%) shed H10407 (maximum geometric mean titer = 7.5 × 107 CFU/gram of stool). Only one of 10 rechallenged volunteers developed diarrhea. These rechallenged subjects had reduced intestinal colonization, reflected by quantitative microbiology of fecal samples. Among the 35 ETEC-naïve subjects, anti-lipopolysaccharide (LPS) O78 serum antibody responses were striking, with positive IgA and IgG antibody responses in 33/35 (94%) and 25/35 (71%), respectively. Anti-heat-labile enterotoxin (LTB) serum IgA and IgG responses developed in 19/35 (54%) and 14/35 (40%) subjects, respectively. Anti-CFA/I serum IgA and IgG responses were detected in 15/35 (43%) and 8/35 (23%) subjects. After the second challenge, participants exhibited blunted anti-LPS and -LTB responses but a booster response to CFA/I. This ETEC model should prove useful in the future evaluation of ETEC vaccine candidates.
American Society for Microbiology