Ahmed S Sohail, Steinman Lawrence
a Vaccine Division , VisMederi Srl , Siena , Italy.
b Neurology and Neuroscience , Stanford University School of Medicine , Stanford , CA , USA.
Hum Vaccin Immunother. 2016 Dec;12(12):3196-3201. doi: 10.1080/21645515.2016.1171439. Epub 2016 Mar 31.
We previously reported an increased frequency of antibodies to hypocretin (HCRT) receptor 2 in sera obtained from narcoleptic patients who received the European AS03-adjuvanted vaccine Pandemrix (GlaxoSmithKline Biologicals, s.a.) for the global influenza A H1N1 pandemic in 2009 [A(H1N1)pdm09]. These antibodies cross-reacted with a particular fragment of influenza nucleoprotein (NP) - one of the proteins naturally contained in the virus used to make seasonal influenza vaccine and pandemic influenza vaccines. The purpose of this commentary is to provide additional insights and interpretations of the findings and share additional data not presented in the original paper to help the reader appreciate the key messages of that publication. First, a brief background to narcolepsy and vaccine-induced narcolepsy will be provided. Then, additional insights and clarification will be provided on the following topics: 1) the critical difference identified in the adjuvanted A(H1N1)pdm09 vaccines, 2) the contributing factor likely for the discordant association of narcolepsy between the AS03-adjuvanted pandemic vaccines Pandemrix and Arepanrix (GlaxoSmithKline Biologicals, s.a.), 3) the significance of detecting HCRT receptor 2 (HCRTr2) antibodies in some Finnish control subjects, 4) the approach used for the detection of HCRTr2 antibodies in vaccine-associated narcolepsy, and 5) the plausibility of the proposed mechanism involving HCRTr2 modulation in vaccine-associated narcolepsy.
我们之前报道过，在2009年全球甲型H1N1流感大流行[甲型H1N1流感大流行（A(H1N1)pdm09）]期间接受欧洲AS03佐剂疫苗帕拉米韦（葛兰素史克生物制品公司）的发作性睡病患者血清中，抗下丘脑分泌素（HCRT）受体2抗体的频率增加。这些抗体与流感核蛋白（NP）的一个特定片段发生交叉反应，NP是用于制造季节性流感疫苗和大流行性流感疫苗的病毒中天然含有的一种蛋白质。本评论的目的是对这些发现提供更多见解和解读，并分享原始论文中未呈现的其他数据，以帮助读者理解该出版物的关键信息。首先，将提供发作性睡病和疫苗诱导的发作性睡病的简要背景。然后，将对以下主题提供更多见解和澄清：1）在佐剂甲型H1N1流感大流行（A(H1N1)pdm09）疫苗中确定的关键差异；2）佐剂大流行性疫苗帕拉米韦和阿瑞匹韦（葛兰素史克生物制品公司）之间发作性睡病不一致关联的可能促成因素；3）在一些芬兰对照受试者中检测到HCRT受体2（HCRTr2）抗体的意义；4）在疫苗相关发作性睡病中检测HCRTr2抗体所采用的方法；5）所提出的涉及疫苗相关发作性睡病中HCRTr2调节机制的合理性。
