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Lind A, Freyhult E, Ramelius A, Olsson T, Arnheim-Dahlström L, Lamb F, Khademi M, Ambati A, Maeurer M, Lima Bomfim I, Fink K, Fex M, Törn C, Elding Larsson H, Lernmark Å. Antibody Affinity Against 2009 A/H1N1 Influenza and Pandemrix Vaccine Nucleoproteins Differs Between Childhood Narcolepsy Patients and Controls. Viral Immunol 2017; 30:590-600. [PMID: 28796576 DOI: 10.1089/vim.2017.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increased narcolepsy incidence was observed in Sweden following the 2009 influenza vaccination with Pandemrix®. A substitution of the 2009 nucleoprotein for the 1934 variant has been implicated in narcolepsy development. The aims were to determine (a) antibody levels toward wild-type A/H1N1-2009[A/California/04/2009(H1N1)] (NP-CA2009) and Pandemrix-[A/Puerto Rico/8/1934(H1N1)] (NP-PR1934) nucleoproteins in 43 patients and 64 age-matched controls; (b) antibody affinity in reciprocal competitive assays in 11 childhood narcolepsy patients compared with 21 age-matched controls; and (c) antibody levels toward wild-type A/H1N1-2009[A/California/04/2009(H1N1)] (H1N1 NS1), not a component of the Pandemrix vaccine. In vitro transcribed and translated 35S-methionine-labeled H1N1 influenza A virus proteins were used in radiobinding reciprocal competition assays to estimate antibody levels and affinity (Kd). Childhood patients had higher NP-CA2009 (p = 0.0339) and NP-PR1934 (p = 0.0246) antibody levels compared with age-matched controls. These childhood controls had lower NP-CA2009 (p = 0.0221) and NP-PR1934 (p = 0.00619) antibodies compared with controls 13 years or older. In contrast, in patients 13 years or older, the levels of NP-PR1934 (p = 0.279) and NP-CA2009 (p = 0.0644) antibodies did not differ from the older controls. Childhood antibody affinity (Kd) against NP-CA2009 was comparable between controls (68 ng/mL) and patients (74 ng/mL; p = 0.21) with NP-CA2009 and NP-PR1934 displacement (controls: 165 ng/mL; patients: 199 ng/mL; p = 0.48). In contrast, antibody affinity against NP-PR1934 was higher in controls with either NP-PR1934 (controls: 9 ng/mL; patients: 20 ng/mL; p = 0.0031) or NP-CA2009 (controls: 14 ng/mL; patients: 23 ng/mL; p = 0.0048). A/H1N1-NS1 antibodies were detected in 0/43 of the narcolepsy patients compared with 3/64 (4.7%) controls (p = 0.272). Similarly, none (0/11) of the childhood patients and 1/21 (4.8%) of the childhood controls had A/H1N1-NS1 antibodies. The higher antibody affinities against NP-PR1934 in controls suggest better protection against wild-type virus. In contrast, the reduced NP-PR1934 antibody affinities among childhood narcolepsy patients suggest poor protection from the wild-type A/H1N1 virus and possibly increased risk for viral damage.
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Affiliation(s)
- Alexander Lind
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
| | - Eva Freyhult
- 2 Department of Medical Sciences, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University , Uppsala, Sweden
| | - Anita Ramelius
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
| | - Tomas Olsson
- 3 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | | | - Favelle Lamb
- 4 Department of Medical Epidemiology and Biostatistics
| | - Mohsen Khademi
- 3 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Aditya Ambati
- 5 Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Markus Maeurer
- 6 TIM, LabMed, Karolinska Institutet and CAST, Karolinska University Hospital , Stockholm, Sweden
| | - Izaura Lima Bomfim
- 3 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Katharina Fink
- 3 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,7 Department of Neurology, Karolinska University Hospital , Stockholm, Sweden
| | - Malin Fex
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
| | - Carina Törn
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
| | - Helena Elding Larsson
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
| | - Åke Lernmark
- 1 Department of Clinical Sciences, Lund University/Clinical Research Center (CRC), Skåne University Hospital SUS , Malmö, Sweden
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Bomfim IL, Lamb F, Fink K, Szakács A, Silveira A, Franzén L, Azhary V, Maeurer M, Feltelius N, Darin N, Hallböök T, Arnheim-Dahlström L, Kockum I, Olsson T. The immunogenetics of narcolepsy associated with A(H1N1)pdm09 vaccination (Pandemrix) supports a potent gene-environment interaction. Genes Immun 2017; 18:75-81. [PMID: 28332559 DOI: 10.1038/gene.2017.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
The influenza A(H1N1)pdm09 vaccination campaign from 2009 to 2010 was associated with a sudden increase in the incidence of narcolepsy in several countries. Narcolepsy with cataplexy is strongly associated with the human leukocyte antigen (HLA) class II DQB1*06:02 allele, and protective associations with the DQB1*06:03 allele have been reported. Several non-HLA gene loci are also associated, such as common variants of the T-cell receptor-α (TRA), the purinergic receptor P2RY11, cathepsin H (CTSH) and TNFSF4/OX40L/CD252. In this retrospective multicenter study, we investigated if these predisposing gene loci were also involved in vaccination-associated narcolepsy. We compared HLA- along with single-nucleotide polymorphism genotypes for non-HLA regions between 42 Pandemrix-vaccinated narcolepsy cases and 1990 population-based controls. The class II gene loci associations supported previous findings. Nominal association (P-value<0.05) with TRA as well as suggestive (P-value<0.1) associations with P2RY11 and CTSH were found. These associations suggest a very strong gene-environment interaction, in which the influenza A(H1N1)pdm09 strain or Pandemrix vaccine can act as potent environmental triggers.
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Affiliation(s)
- I L Bomfim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - F Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - A Szakács
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - A Silveira
- Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - L Franzén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - V Azhary
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | | | - N Darin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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