Adjuvants--a classification and review of their modes of action

Since early this century, various substances have been added to vaccines and certain formulations have been devised in an attempt to render vaccines more effective. Despite a plethora of options, only aluminium salts have gained acceptance as human vaccine adjuvants and even veterinary vaccines are largely dependent upon the use of aluminium salts. Currently, many new vaccines are under development and there is a desire to simplify vaccination schedules both by increasing the number of components per vaccine and decreasing the number of doses required for a vaccine course. New, more effective adjuvants will be required to achieve this.

Vaccine adjuvants revisited

The development of new adjuvants for human vaccines has become an expanding field of research in the last thirty years, for generating stronger vaccines capable of inducing protective and long-lasting immunity in humans. Instead of such efforts, with several adjuvant strategies approaching to requirements for their clinical application, limitations like adjuvant toxicity remain to be fully surpassed. Here we summarize the current status of adjuvant development, including regulatory recommendations, adjuvant requirements, and adjuvant categories like mineral salts, tensoactive compounds, microorganism-derived adjuvants, emulsions, cytokines, polysaccharides, nucleic acid-based adjuvants, and a section dedicated to particulate antigen delivery systems. The mechanisms of adjuvanticity are also discussed in the light of recent findings on Toll-like receptors' biology and their involvement on immune activation.

Advances in vaccine adjuvants

Currently, aluminum salts and MF59 are the only vaccine adjuvants approved for human use. With the development of new-generation vaccines (including recombinant subunit and mucosal vaccines) that are less immunogenic, the search for more potent vaccine adjuvants has intensified. Of the novel compounds recently evaluated in human trials, immunostimulatory molecules such as the lipopolysaccharide derived MPL and the saponin derivative QS21 appear most promising, although doubts have been raised as to their safety in humans. Preclinical work with particulate adjuvants, such as the MF59 microemulsion and lipid-particle immune-stimulating complexes (Iscoms), suggest that these molecules are also potent elicitors of humoral and cellular immune responses. In addition, preclinical data on CpG oligonucleotides appear to be encouraging, particularly with respect to their ability to selectively manipulate immune responses. While all these adjuvants show promise, further work is needed to better define the mechanisms of adjuvant action. Ultimately, the development of more potent adjuvants may allow vaccines to be used as therapeutic, rather than prophylactic, agents.

Vaccine adjuvants: role and mechanisms of action in vaccine immunogenicity

Inactivated vaccines require adjuvants to stimulate an immune response. The choice of adjuvant or immune enhancer determines whether the immune response is effective, ineffective or damaging. Accordingly, there is a need for new adjuvants that stimulate the appropriate immunity, for example, T cell immunity for intracellular pathogens and cancer vaccines. In several adjuvants, the identification of chemical groups that interact with specific cell toll-like receptors (innate immunity) or receptors for co-stimulatory ligands (adaptive immunity), has enabled the establishment of structure-function relationships that are useful in the design of new adjuvants. Because of the crucial immunomodulating role of adjuvants, sub-unit vaccine development will remain dependent on new adjuvants.

Progress, challenges and opportunities in fish vaccine development

In 2014 the contribution of aquaculture to supply food for human consumption overtook wild-caught fish for the first time. Despite improvements in the aquaculture industry, it has been estimated that as much as 10% of all cultured aquatic animals are lost because of infectious diseases, amounting to >10 billion USD in losses annually on a global scale. Vaccination to prevent disease is used routinely in finfish aquaculture, especially for Atlantic salmon (Salmo salar), while in a limited capacity (or not at all) in many other fish species due to lack of vaccines, poor performance or cost. There has, nevertheless, been impressive progress in fish vaccine development over the last 4 decades with 24 licenced fish vaccines now commercially available for use in a variety of fish species. These comprise whole killed, peptide subunit, recombinant protein, DNA and live attenuated vaccines. Challenges do, however, still exist as the majority of commercial vaccines are killed whole cell pathogen preparations administered by intraperitoneal injection. This may not be the optimal route to deliver some vaccines, but lack of effective adjuvants and basic knowledge on immune response has hindered progress in the development of mucosal vaccines. The cost of injecting fish may also be prohibitive in some countries leading to disease treatment (e.g. with antibiotics) rather than using preventative measures. It is important that these issues are addressed as the industry continues to grow globally. Exciting opportunities exist for rapid development of fish vaccines in the future, with continued reduction in cost of technologies (e.g. of whole genome sequencing), regulations changing (e.g. DNA vaccines can now authorised in Europe), the introduction of novel antigen expression and delivery systems (such as virus-like particles, VLPs), development of novel adjuvants and advancements in the elucidation of basic mechanisms of mucosal immunity. Development of effective mucosal vaccines and optimisation of their delivery will facilitate novel vaccine development, and enable the aquaculture industries in LMIC to use vaccination routinely in the future. In addition, effective use of emergency (autogenous) vaccines will assist in tackling emerging disease challenges.

IL-10 regulates plasmacytoid dendritic cell response to CpG-containing immunostimulatory sequences

Immunostimulatory sequences (ISS) are short oligonucleotides containing unmethylated cytosine-phosphate-guanine (CpG) dinucleotides that stimulate innate immune responses through Toll-like receptor-9 on B cells and plasmacytoid dendritic cell (PDC) precursors. The anti-inflammatory cytokine interleukin (IL)-10 is predicted to be a potent inhibitor of many of the activities described for ISS, and this may impact the use of ISS in disease states characterized by elevated IL-10. As the activities of ISS on PDCs are central to many clinical applications of ISS, we have studied the effects of IL-10 on PDC stimulation by 3 distinct classes of ISS. IL-10 inhibited cytokine production and survival of ISS-activated PDCs; however, IL-12 induction was much more sensitive to inhibition than interferon (IFN)-alpha induction. Within the PDC population are cells that respond to ISS by producing either IL-12 or IFN-alpha but not both cytokines. IL-12-producing PDCs require costimulation through CD40 and appear more mature than IFN-alpha-producing PDCs. The 3 distinct classes of ISS differed with respect to induction of PDC maturation and T-cell priming capacity. IL-10 regulated PDC activation but did not inhibit the subsequent T-cell-priming ability of PDCs already activated by ISS.

Immunomodulatory agents for prophylaxis and therapy of infections

The advent of the antibiotic era ushered in a shift towards non-pathogen-specific therapy of infectious diseases. This led to an overt emphasis on targeting microbial pathogens while strategies directed towards enhancing host immunity were neglected. In an effort to decrease sole reliance on antimicrobials, the time has come for a critical reappraisal of nonantibiotic, albeit immune response-enhancing substances. The diverse array of natural, synthetic, and recombinant immunomodulators discussed in this review succinctly demonstrate the potential of these agents to stimulate host defense mechanisms for prophylaxis and treatment of various microbial infections.

Augmentation of cutaneous immune responses by ATP gamma S: purinergic agonists define a novel class of immunologic adjuvants

Extracellular nucleotides activate ligand-gated P2XR ion channels and G protein-coupled P2YRs. In this study we report that intradermal administration of ATPgammaS, a hydrolysis-resistant P2 agonist, results in an enhanced contact hypersensitivity response in mice. Furthermore, ATPgammaS enhanced the induction of delayed-type hypersensitivity to a model tumor vaccine in mice and enhanced the Ag-presenting function of Langerhans cells (LCs) in vitro. Exposure of a LC-like cell line to ATPgammaS in the presence of LPS and GM-CSF augmented the induction of I-A, CD80, CD86, IL-1beta, and IL-12 p40 while inhibiting the expression of IL-10, suggesting that the immunostimulatory activities of purinergic agonists in the skin are mediated at least in part by P2Rs on APCs. In this regard, an LC-like cell line was found to express mRNA for P2X(1), P2X(7), P2Y(1), P2Y(2), P2Y(4), P2Y(9), and P2Y(11) receptors. We suggest that ATP, when released after trauma or infection, may act as an endogenous adjuvant to enhance the immune response, and that P2 agonists may augment the efficacy of vaccines.

Polyethylenimine-coated PLGA nanoparticles-encapsulated Angelica sinensis polysaccharide as an adjuvant for H9N2 vaccine to improve immune responses in chickens compared to Alum and oil-based adjuvants

Inactivated H9N2 influenza vaccines required adjuvants to induce strong immune responses to protect poultry from the infections of H9N2 influenza viruses. Recently, positively charged nanoparticles-based adjuvant delivery systems have been extensively investigated as the novel vaccine adjuvant due to the protection antigens and drugs from degradation, promoting antigens and drugs uptake by antigen presenting cells (APCs), and inducing strong humoral and cellular immune responses. In this study, the immunostimulant Angelica sinensis polysaccharide (ASP) was encapsulated into Poly (lactic-co-glycolic acid) PLGA nanoparticles, and the Polyethylenimine (PEI) was coated on the nanoparticles to develop a novel adjuvant (ASP-PLGA-PEI). To further investigate the adjuvant activities of ASP-PLGA-PEI nanoparticles for H9N2 vaccines in chickens and compare the adjuvant activities of nanoparticles adjuvant and conventional adjuvants (Alum and oil-based adjuvant), the H9N2 antigen was incubated with three different adjuvants and then immunized with chickens to evaluate the ability of inducing humoral and cellular immune responses. The results revealed that compared to Alum adjuvant, ASP-PLGA-PEI nanoparticles adjuvant stimulated higher antibody responses, promoted the activation of CD4⁺ T cells and CD8⁺ T cells, increased the expression of Th1 cytokines IFN-γ. Compared to oil-based adjuvant (ISA-206), ASP-PLGA-PEI nanoparticles adjuvant induced comparable antibody immune responses at later period after immunization, improved the activation of CD4⁺ T cells and CD8⁺ T cells. Therefore, compared to Alum and oil-based adjuvant, the ASP-PLGA-PEI nanoparticles serve as an efficient adjuvant for H9N2 vaccine and have the potential to induce vigorous humoral and cellular immune responses in chickens.

Adjuvants

A number of adjuvants of importance in veterinary vaccines are reviewed. These include mineral salt adjuvants, oil adjuvants, hydrophilic and hydrophobic bloc polymers, hydrocarbons and surface active agents. The current and future applications of these substances and their possible modes of action are discussed. Creation of an adjuvant register by the newly formed European Adjuvant Group should facilitate accumulation of information on adjuvants.

Lack of immunogenicity of ice structuring protein type III HPLC12 preparation administered by the oral route to human volunteers

Before a novel protein can be used in foods, its potential allergenicity must be assessed. In this study, healthy volunteers consumed ice structuring protein (ISP) Type III preparation or a control material 5 days a week for a total of 8 weeks. General measures of health were recorded during the study, and the immunogenicity of the protein was assessed by monitoring the levels of IgG and IgE antibodies specific for ISP Type III. The participants remained in good health throughout the study and during the 4 week follow-up period. No IgG or IgE antibodies specific for ISP Type III were detected in the blood of the participants. Investigations of immunogenicity in man have not been previously applied in the context of safety evaluation and they do not form part of the regimens proposed for the evaluation of protein allergenicity. Consequently no standardised protocols exist for such studies, nor any background against which to interpret the results. Nevertheless, the absence of an immune response using a protocol which could have been expected to result in a response with a strongly immunogenic protein, confirms the conclusions of earlier published work, and attests to the lack of allergenicity of ISP Type III preparation.

[Classification of visco-elastic substances for ophthalmologic surgery]

Individual properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic characteristics. Independent comparative data for vicoelastic substances are not readily available or interpretable.

MATERIAL AND METHODS

Twenty-six different commercially available viscoelastic substances were investigated using the Advanced Rheometric Expansion System and the Rheometric Scientific 800 device to analyze elastic and viscous modulus, complex viscosity (dynamic frequency dependance) and viscosity at the zero shear rate by extrapolation using the Ellis fit.

RESULTS

Viscosity (cps) at zero shear rate (s-1, mean of six different samples): Sodium hyaluronate products: Amivisc Plus: 128; AMO Vitrax: 41; Biolon: 243; Dispasan: 130; Dispasan Plus: 782; Healon: 243; Healon GV: 2451; Healon 5: 5525; Microvisc (Morcher Oil): 1162; Microvisc Plus: 3663; Morcher Oil: 1253; Provisc: 207; Rayvisc: 78; Viscoat: 58; Viscorneal (Allervisc): 733; Viscorneal Plus (Allervisc Plus): 1176; Visko: 206; Visko Plus: 1683. Hydroxypropylmethylcellulose (HPMC) products: Acrivisc: 7; Adatocel: 8; Coatel: 6; HPMC Ophthal H: 94; HPMC Ophthal L: 7; Ocucoat: 6; PeHa-Visko: 5; Visco Shield: 60.

CONCLUSION

Sodium hyaluronate as well as HPMC viscoelastic substances demonstrated remarkable differences in rheological properties from each other. In some cases, the results of this independent investigation differed from the values provided by the companies. A new division of commercially available viscoelastic substances into subgroups is presented, which provides a scientific base for various practical viscosurgical aspects. These real rheologic properties of each substance allow the ophthalmic surgeon to choose the viscoelastic substance that is most suitable for the surgical situation.

Adjuvants and immune enhancement

Adjuvants increase cell-mediated and humoral immune responses to specific antigens. Used with recombinant viral antigens, they can elicit the production of T lymphocytes that lyse target cells, expressing the antigen in a genetically restricted fashion. Adjuvants can augment the production of interferon-gamma, thereby favoring the production of protective antibody isotopes, such as immunoglobulin G2a in the mouse. Modern adjuvants display the efficacy of Freund's complete adjuvant without its side effects. One such adjuvant is Syntex adjuvant formulation, a synthetic analogue of muramyl dipeptide in a microfluidized squalane/squalene-in-water emulsion. Monophosphoryl lipid A in a similar lipid emulsion is also effective. Immune-stimulating complexes of saponin and antigens elicit potent cell-mediated and humoral responses. A purified saponin component has adjuvant activity with reduced side effects; liposomes also can have adjuvant activity. Administering antigens in adjuvants can overcome low responsiveness in very young and old experimental animals and in those that are genetically low responders. Adjuvants are likely components of a new generation of recombinant and subunit vaccines.

Comparison of the effects of different potent adjuvants on enhancing the immunogenicity and cross-protection by influenza virus vaccination in young and aged mice

Vaccination against influenza viruses suffers from low efficacy in conferring homologous and cross-protection, particularly in older adults. Here, we compared the effects of three different adjuvant types (QS-21+MPL, CpG+MPL and bacterial cell wall CWS) on enhancing the immunogenicity and homologous and heterosubtypic protection of influenza vaccination in young adult and aged mouse models. A combination of saponin QS-21 and monophosphoryl lipid A (QS-21+MPL) was most effective in inducing T helper type 1 (Th1) T cell and cross-reactive IgG as well as hemagglutination inhibiting antibody responses to influenza vaccination. Both combination adjuvants (QS-21+MPL and CpG+MPL) exhibited high potency by preventing weight loss and reducing viral loads and enhanced homologous and cross-protection by influenza vaccination in adult and aged mouse models. Bacillus Calmette-Guerin cell-wall skeleton (CWS) displayed substantial adjuvant effects on immune responses to influenza vaccination but lower adjuvant efficacy in inducing Th1 IgG responses, cross-protection in adult mice, and in conferring homologous protection in aged mice. This study has significance in comparing the effects of potent adjuvants on enhancing humoral and cellular immune responses to influenza virus vaccination, inducing homologous and cross-protection in adult and aged populations.

B cell-derived BCGF functions as autocrine growth factor(s) in normal and transformed B lymphocytes

This paper demonstrates that B cell lines, as well as normal activated B cells generate and respond to B cell-specific growth factor(s) (BCGF). BCGF derived from B cells (B-BCGF) appears to be distinct from interleukin 1, interleukin 2 (IL 2), B cell stimulatory factor, BCGF-II, interferon-gamma, or transforming growth factor. It acts on activated B cells, but not on resting G0 phase B cells to induce proliferation. B cell lines, immortalized by Epstein-Barr virus, constitutively secrete 10-fold higher level of B-BCGF compared with normal activated B cells, suggesting that an activated autocrine loop might be operating in immortalized B cells. On the basis of our observations, we postulate that B cell clonal expansion may occur, at least in part, through a B-BCGF-dependent autocrine pathway similar to IL 2 effect on T cells.

Immunotherapy targets in critical care

Advances in our understanding of the immune system and the body's normal response to injury have allowed for the development of innovative new therapies for critically ill patients. In the area of sepsis, significant information is being generated to support the concept that adjunctive immunotherapy can improve both morbidity and mortality. Investigational agents directed at immunotherapy targets that are currently being studied include colony stimulating factors, immunoglobulins, anticytokines, and opioid antagonists. This article reviews the basis for the use of such adjunctive immunotherapy in the critically ill patient.

[Immunomodulators in Therapy of Respiratory Infections]

Viral infections provoke dysbalance in the interferon system and inhibition of the cellular and phagocytic responses of the host. Long-term persistence of pathogenic viruses and bacteria induce atopy and could aggravate chronic respiratory diseases. The up-to-date classification of immunomodulators is described. High efficacy of interferon inductors, such as cycloferon and some others as auxiliary means in therapy or prophylaxis (immunorehabilitation) of viral respiratory infections in adults and children was shown.

[Influenza vaccines adjuvants--contemporary state]

Data on development and study of adjuvants for influenza vaccines against avian and seasonal influenza are presented. Requirements to perspective adjuvants, their main groups (mineral salts of aluminium, squalene derivatives, polyglycosides, and immunomodulators) as well as experimental adjuvants are reviewed. Analysis of results of several clinical trials of adjuvanted vaccines against avian influenza is presented. On the basis of published data analysis conclusion about good perspective of influenza vaccines with new adjuvants was made.

[New role of a highly-stable oligopeptides, neurotrophins, and immunomodulators in the regulatory continuum]

We propose new approach to classification of regulatory peptides and proteins. It is based on the complex of their properties: stability, affinity to receptors, existence of specialized percursors, protein-transporters etc. In particular we describe very stable factors such as new peptide family named glyprolines.

Typing of immunomodulators in terms of their effects on the electrophoretic pattern of serum proteins and antitumor combination therapy based on this typing

Changes of serum proteins have recently received much attention in studies of immunomodulators. In this work, changes of serum proteins, especially LB, were studied by gel electrophoresis of sera after administration of 23 immunomodulators or antitumor agents. Fourteen of the 23 compounds increased the concentration of LB in the serum of normal ddY mice when injected once ip. Six compounds caused a very rapid (day 1) increase of LB, and 8 agents caused a slow increase (day 4 approximately day 10). On the basis of the results, these compounds were classified into type I (causing a rapid increase in LB; i.e., lipopolysaccharide, dextran sulfate and poly (I)-poly(C), type II (causing a slow increase in LB; i.g., lentinan, TAK and PS-K), and type O (causing no increase in LB; e.g., levamisole and bestatin). The antitumor activities of these three types of compounds in combination with lipopolysaccharide (type I) or lentinan (type II) were studied in an Ehrlich carcinoma-ddY mouse system. The results suggested that different types of compounds frequently showed synergistic antitumor activities. Typing of immuno-modulators and the antitumor activities of combinations of these compounds are discussed.