|Hickey, A -|
|Metzger, D -|
Submitted to: Drugs of the Future
Publication Type: Review Article
Publication Acceptance Date: June 28, 2011
Publication Date: August 1, 2011
Citation: Hickey, A.J., Wilson-Welder, J.H., Metzger, D.W. 2011. Prospects in nasal vaccination against clinically relevant pathogens and select agents. Drugs of the Future. 36(8):589-599. Interpretive Summary: There is a need and desire to develop vaccines that can be given intranasally, or by other needle-free means at the body site where the infection usually occurs (nose, lungs, gastrointestinal or urogenital surfaces). By delivering the vaccine directly at the mucosal surface, a more effective immune response, specifically an antibody called IgA, is triggered. This response can be further increased if adjuvants, or vaccine enhancers, are used. The only vaccine of this type available is Flu-Mist, a live attenuated, or weakened, influenza virus. Scientific efforts in the last decade have resulted in many intranasal vaccines that are in human trials. These include vaccines for pneumococcal diseases (pneumonia and ear infections), whooping cough, potential biowarfare agents (Francisella tularensis, Yersinia pestis and Bacillus anthracis), and sexually transmitted disease agents (herpes virus and HIV). While many of these vaccines are years away, there is promising scientific progress toward many new intranasal vaccines.
Technical Abstract: Intranasal immunization induces mucosal immune responses in both the respiratory system and at other distant mucosal surfaces, as well as systemic immune responses. However, most vaccines are still given via the parenteral route, and to date, the only intranasal vaccine that is available to the public in the U.S. is a live, attenuated influenza vaccine. Over the last 10 years, there have been substantial efforts to develop effective nasal vaccination strategies in animal models against several different pathogens, some being successful enough to progress to phase I clinical trials. The purpose of this review is to discuss: 1) the progress made with representative models; 2) how vaccination through the intranasal route overcomes many of the shortcomings associated with the use of parenteral vaccines; and 3) antigens that have been demonstrated to be effective vaccines when administered intranasally. This review focuses on vaccine strategies against specific pathogens that are significant public health threats, or have the potential to be used as bioweapons.