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Lin YJ, Zimmermann J, Schülke S. Novel adjuvants in allergen-specific immunotherapy: where do we stand? Front Immunol 2024; 15:1348305. [PMID: 38464539 PMCID: PMC10920236 DOI: 10.3389/fimmu.2024.1348305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Type I hypersensitivity, or so-called type I allergy, is caused by Th2-mediated immune responses directed against otherwise harmless environmental antigens. Currently, allergen-specific immunotherapy (AIT) is the only disease-modifying treatment with the potential to re-establish clinical tolerance towards the corresponding allergen(s). However, conventional AIT has certain drawbacks, including long treatment durations, the risk of inducing allergic side effects, and the fact that allergens by themselves have a rather low immunogenicity. To improve AIT, adjuvants can be a powerful tool not only to increase the immunogenicity of co-applied allergens but also to induce the desired immune activation, such as promoting allergen-specific Th1- or regulatory responses. This review summarizes the knowledge on adjuvants currently approved for use in human AIT: aluminum hydroxide, calcium phosphate, microcrystalline tyrosine, and MPLA, as well as novel adjuvants that have been studied in recent years: oil-in-water emulsions, virus-like particles, viral components, carbohydrate-based adjuvants (QS-21, glucans, and mannan) and TLR-ligands (flagellin and CpG-ODN). The investigated adjuvants show distinct properties, such as prolonging allergen release at the injection site, inducing allergen-specific IgG production while also reducing IgE levels, as well as promoting differentiation and activation of different immune cells. In the future, better understanding of the immunological mechanisms underlying the effects of these adjuvants in clinical settings may help us to improve AIT.
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Affiliation(s)
- Yen-Ju Lin
- Section Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | | | - Stefan Schülke
- Section Molecular Allergology, Paul-Ehrlich-Institut, Langen, Germany
- Section Research Allergology (ALG 5), Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
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Mahamid A, Bornstein RJ, Amir H. Pfizer/BioNTech SARS-CoV-2 vaccine as a potential trigger for the development of narcolepsy: a case report. J Clin Sleep Med 2022; 18:2503-2506. [PMID: 35733336 PMCID: PMC9516586 DOI: 10.5664/jcsm.10134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022]
Abstract
Narcolepsy is a rare condition in Israel. Currently, the incidence of narcolepsy following SARS-CoV-2 vaccination in Israel is unknown. We are reporting a case report of a 51-year-old woman of Ashkenazi Jewish descent who was evaluated for complaints of excessive daytime sleepiness and relative functional decline that immediately followed receipt of the Pfizer/BioNTech SARS-CoV-2 vaccination. Evaluation of patient-reported data with polysomnography and multiple sleep latency test was consistent with narcolepsy with cataplexy, meeting the criteria for a diagnosis of type 1 narcolepsy. Further investigation included human leukocyte antigen testing. Prior studies have demonstrated genetic, immunological, and environmental factors associated with narcolepsy following other vaccinations. This case is a valuable contribution to the literature as there are no prior reports of type 1 narcolepsy following SARS-CoV-2 vaccination in the State of Israel. CITATION Mahamid A, Bornstein RJ, Amir H. Pfizer/BioNTech SARS-CoV-2 vaccine as a potential trigger for the development of narcolepsy: a case report. J Clin Sleep Med. 2022;18(10):2503-2506.
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Affiliation(s)
- Ala Mahamid
- Institute of Sleep Disorders, Loewenstein Rehabilitation Center, Raanana, Israel
| | - Robyn Jacob Bornstein
- Department of Outpatient Medical Rehabilitation, Loewenstein Rehabilitation Center, Raanana, Israel
| | - Hagay Amir
- Loewenstein Rehabilitation Medical Center, Raanana, Israel
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Huang WT, Huang YS, Hsu CY, Chen HC, Lee HC, Lin HC, Hsieh CF, Wu MN, Yang CH. Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan. Sleep Med 2020; 66:276-281. [DOI: 10.1016/j.sleep.2018.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
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Segal Y, Shoenfeld Y. Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction. Cell Mol Immunol 2018; 15:586-594. [PMID: 29503439 PMCID: PMC6078966 DOI: 10.1038/cmi.2017.151] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/11/2017] [Accepted: 11/11/2017] [Indexed: 12/20/2022] Open
Abstract
Since the early 1800s vaccines have saved numerous lives by preventing lethal infections. However, during the past two decades, there has been growing awareness of possible adverse events associated with vaccinations, cultivating heated debates and leading to significant fluctuations in vaccination rates. It is therefore pertinent for the scientific community to seriously address public concern of adverse effects of vaccines to regain public trust in these important medical interventions. Such adverse reactions to vaccines may be viewed as a result of the interaction between susceptibility of the vaccinated subject and various vaccine components. Among the implicated mechanisms for these reactions is molecular mimicry. Molecular mimicry refers to a significant similarity between certain pathogenic elements contained in the vaccine and specific human proteins. This similarity may lead to immune crossreactivity, wherein the reaction of the immune system towards the pathogenic antigens may harm the similar human proteins, essentially causing autoimmune disease. In this review, we address the concept of molecular mimicry and its application in explaining post vaccination autoimmune phenomena. We further review the principal examples of the influenza, hepatitis B, and human papilloma virus vaccines, all suspected to induce autoimmunity via molecular mimicry. Finally, we refer to possible implications on the potential future development of better, safer vaccines.
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Affiliation(s)
- Yahel Segal
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, 52621, Israel
| | - Yehuda Shoenfeld
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, 52621, Israel.
- Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
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Leiva S, Madrazo J, Podesta C. Narcolepsy with cataplexy and hyperthyroidism sudden appeared after H1N1 vaccination. Sleep Sci 2018; 11:34-36. [PMID: 29796199 PMCID: PMC5916574 DOI: 10.5935/1984-0063.20180008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Narcolepsy type 1 (NT1) is a chronic sleep disorder, characterized by excessive
daytime sleepiness, cataplexy and fragmented nocturnal sleep. It is caused by a
hypocretin deficiency due to a significant reduction of the neurons producing
it. In the last years, it has been postulated that an autoimmune mechanism would
be responsible for the destruction of these neurons in those genetically
predisposed patients. The increased incidence of narcolepsy after the pandemic
H1N1 influenza vaccination campaign in 2009-2010 is known. We present below the
case of an adult patient who, 10 days after receiving H1N1 vaccination, suffers
a traffic accident after falling asleep. Subsequent studies revealed
hyperthyroidism due to Graves disease. In spite of the treatment, the patient
persisted with daily and disabling daytime sleepiness, sleep attacks and
episodes of generalized muscle atony with preservation of consciousness. A
nocturnal polysomnography and multiple sleep latency test (MSLT) were performed
with a diagnosis of NT1. The particularity of this case is the presentation of 2
autoimmune diseases triggered by an H1N1 vaccine without adjuvant, so far there
is only evidence of NT1 associated with vaccines with adjuvant and viral
infection. The association of both entities has made us reflect on the
autoimmune mechanism, reinforcing the theory of its role in the onset of the
disease.
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Affiliation(s)
- Silvia Leiva
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Unidad de Medicina del Sueño - Capital Federal - Buenos Aires - Argentina
| | - Jimena Madrazo
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Unidad de Medicina del Sueño - Capital Federal - Buenos Aires - Argentina
| | - Claudio Podesta
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Unidad de Medicina del Sueño - Capital Federal - Buenos Aires - Argentina
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The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity. Autoimmun Rev 2018. [DOI: 10.1016/j.autrev.2017.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
In spite of current influenza vaccines being immunogenic, evolution of the influenza virus can reduce efficacy and so influenza remains a major threat to public health. One approach to improve influenza vaccines is to include adjuvants; substances that boost the immune response. Adjuvants are particularly beneficial for influenza vaccines administered during a pandemic when a rapid response is required or for use in patients with impaired immune responses, such as infants and the elderly. This review outlines the current use of adjuvants in human influenza vaccines, including what they are, why they are used and what is known of their mechanism of action. To date, six adjuvants have been used in licensed human vaccines: Alum, MF59, AS03, AF03, virosomes and heat labile enterotoxin (LT). In general these adjuvants are safe and well tolerated, but there have been some rare adverse events when adjuvanted vaccines are used at a population level that may discourage the inclusion of adjuvants in influenza vaccines, for example the association of LT with Bell's Palsy. Improved understanding about the mechanisms of the immune response to vaccination and infection has led to advances in adjuvant technology and we describe the experimental adjuvants that have been tested in clinical trials for influenza but have not yet progressed to licensure. Adjuvants alone are not sufficient to improve influenza vaccine efficacy because they do not address the underlying problem of mismatches between circulating virus and the vaccine. However, they may contribute to improved efficacy of next-generation influenza vaccines and will most likely play a role in the development of effective universal influenza vaccines, though what that role will be remains to be seen.
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Affiliation(s)
- John S Tregoning
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ryan F Russell
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ekaterina Kinnear
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
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9
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Oberle D, Pavel J, Mayer G, Geisler P, Keller-Stanislawski B. Retrospective multicenter matched case-control study on the risk factors for narcolepsy with special focus on vaccinations (including pandemic influenza vaccination) and infections in Germany. Sleep Med 2017; 34:71-83. [PMID: 28522102 DOI: 10.1016/j.sleep.2017.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/23/2017] [Accepted: 02/14/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Studies associate pandemic influenza vaccination with narcolepsy. In Germany, a retrospective, multicenter, matched case-control study was performed to identify risk factors for narcolepsy, particularly regarding vaccinations (seasonal and pandemic influenza vaccination) and infections (seasonal and pandemic influenza) and to quantify the detected risks. METHODS Patients with excessive daytime sleepiness who had been referred to a sleep center between April 2009 and December 2012 for multiple sleep latency test (MSLT) were eligible. Case report forms were validated according to the criteria for narcolepsy defined by the Brighton Collaboration (BC). Confirmed cases of narcolepsy (BC level of diagnostic certainty 1-4a) were matched with population-based controls by year of birth, gender, and place of residence. A second control group was established including patients in whom narcolepsy was definitely excluded (test-negative controls). RESULTS A total of 103 validated cases of narcolepsy were matched with 264 population-based controls. The second control group included 29 test-negative controls. A significantly increased odd ratio (OR) to develop narcolepsy (crude OR [cOR] = 3.9, 95% confidence interval [CI] = 1.8-8.5; adjusted OR [aOR] = 4.5, 95% CI = 2.0-9.9) was detected in individuals immunized with pandemic influenza A/H1N1/v vaccine prior to symptoms onset as compared to nonvaccinated individuals. Using test-negative controls, in individuals immunized with pandemic influenza A/H1N1/v vaccine prior to symptoms onset, a nonsignificantly increased OR of narcolepsy was detected when compared to nonvaccinated individuals (whole study population, BC levels 1-4a: cOR = 1.9, 95% CI = 0.5-6.9; aOR = 1.8, 95% CI = 0.3-10.1). CONCLUSIONS The findings of this study support an increased risk for narcolepsy after immunization with pandemic influenza A/H1N1/v vaccine.
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Affiliation(s)
- Doris Oberle
- Department Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.
| | - Jutta Pavel
- Department Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Geert Mayer
- Hephata-Klinik, Schlafzentrum, Schwalmstadt-Treysa, Germany
| | - Peter Geisler
- Sleep Disorders Center, Department of Psychiatry, University of Regensburg, Regensburg, Germany
| | - Brigitte Keller-Stanislawski
- Department Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
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Ahmed SS, Steinman L. Narcolepsy and influenza vaccination-induced autoimmunity. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:25. [PMID: 28164110 PMCID: PMC5253292 DOI: 10.21037/atm.2016.12.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- S. Sohail Ahmed
- Immunology, Inflammation and Infectious Diseases, Roche Pharma Research & Early Development, Basel 4070, Switzerland
| | - Lawrence Steinman
- Neurology and Neuroscience, Stanford University School of Medicine, Stanford, CA 94305, USA
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De Groot AS, Moise L. Innovation, urgency and acceptance at the 9th Vaccine Renaissance. Hum Vaccin Immunother 2016; 12:3186-3188. [PMID: 28010520 DOI: 10.1080/21645515.2016.1254853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Anne S De Groot
- a EpiVax, Inc. , Providence , RI , USA ; Institute for Immunology and Informatics, College of the Environment and Life Sciences, University of Rhode Island , Providence , RI , USA
| | - Lenny Moise
- a EpiVax, Inc. , Providence , RI , USA ; Institute for Immunology and Informatics, College of the Environment and Life Sciences, University of Rhode Island , Providence , RI , USA
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12
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Ziberna F, De Lorenzo G, Schiavon V, Arnoldi F, Quaglia S, De Leo L, Vatta S, Martelossi S, Burrone OR, Ventura A, Not T. Lack of evidence of rotavirus-dependent molecular mimicry as a trigger of coeliac disease. Clin Exp Immunol 2016; 186:356-363. [PMID: 27548641 PMCID: PMC5108075 DOI: 10.1111/cei.12855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
New data suggest the involvement of rotavirus (RV) in triggering autoimmunity in coeliac disease (CD) by molecular mimicry between the human-transglutaminase protein and the dodecapeptide (260-271 aa) of the RV protein VP7 (pVP7). To assess the role of RV in the onset of CD, we measured anti-pVP7 antibodies in the sera of children with CD and of control groups. We analysed serum samples of 118 biopsy-proven CD patients and 46 patients with potential CD; 32 children with other gastrointestinal diseases; 107 no-CD children and 107 blood donors. Using enzyme-linked immunosorbent assay (ELISA) assay, we measured immunoglobulin (Ig)A-IgG antibodies against the synthetic peptides pVP7, the human transglutaminase-derived peptide (476-487 aa) which shows a homology with VP7 protein and a control peptide. The triple-layered RV particles (TLPs) containing the VP7 protein and the double-layered RV-particles (DLPs) lacking the VP7 protein were also used as antigens in ELISA assay. Antibody reactivity to the RV-TLPs was positive in 22 of 118 (18%) CD patients and in both paediatric (17 of 107, 16%) and adult (29 of 107, 27%) control groups, without showing a statistically significant difference among them (P = 0·6, P = 0·1). Biopsy-proven CD patients as well as the adult control group demonstrated a high positive antibody reactivity against both pVP7 (34 of 118, 29% CD patients; 66 of 107, 62% adult controls) and control synthetic peptides (35 of 118, 30% CD patients; 56 of 107, 52% adult controls), suggesting a non-specific response against RV pVP7. We show that children with CD do not have higher immune reactivity to RV, thus questioning the molecular mimicry mechanism as a triggering factor of CD.
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Affiliation(s)
- F. Ziberna
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
| | - G. De Lorenzo
- International Centre for Genetic Engineering and Biotechnology ICGEB
| | - V. Schiavon
- Department of Life Sciences, University of TriesteUniversity of TriesteTriesteItaly
| | - F. Arnoldi
- Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
| | - S. Quaglia
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
| | - L. De Leo
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
| | - S. Vatta
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
| | - S. Martelossi
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
| | - O. R. Burrone
- International Centre for Genetic Engineering and Biotechnology ICGEB
| | - A. Ventura
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
- Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
| | - T. Not
- Institute for Maternal and Child Health, I.R.C.C.S. ‘Burlo Garofolo’
- Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
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