Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld’s syndrome): clinical and immunological spectrum

Vera‐Lastra, Olga; Medina, Gabriela; Cruz-Domínguez, María Pilar; Jara, Luis J.; Shoenfeld, Yehuda

doi:10.1586/eci.13.2

Cited by 114 publications

(92 citation statements)

References 91 publications

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“…This term was introduced by Yehuda Shoenfeld, who highlighted the pathogenic role of adjuvants in the induction of autoimmune syndromes: these compounds mimic evolutionarily conserved molecules (e.g., bacterial cell walls, LPS, unmethylated CpG-DNA) and bind to toll-like receptors (TLRs). They activate dendritic cells (DCs), lymphocytes, and macrophages, increasing subsequently the release of chemokines and cytokines from T-helper and mast cells [133][134][135][136][137]. The adjuvants added into vaccines can induce a non-specific activation of the immune system with a subsequent expansion of autoreactive (in our case, myelin specific) lymphocytes that may be further accelerated by defective regulatory cells/circuits, in genetically susceptible individuals.…”

Section: Hpv Vaccine and Asia Syndromementioning

confidence: 99%

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

et al. 2017

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Autoimmune diseases, including multiple sclerosis and type 1 diabetes mellitus, affect about 5% of the worldwide population. In the last decade, reports have accumulated on various autoimmune disorders, such as idiopathic thrombocytopenia purpura, myopericarditis, primary ovarian failure, and systemic lupus erythematosus (SLE), following vaccination. In this review, we discuss the possible underlying mechanisms of autoimmune reactions following vaccinations and review cases of autoimmune diseases that have been correlated with vaccination. Molecular mimicry and bystander activation are reported as possible mechanisms by which vaccines can cause autoimmune reactions. The individuals who might be susceptible to develop these reactions could be especially not only those with previous post-vaccination phenomena and those with allergies but also in individuals who are prone to develop autoimmune diseases, such as those with a family history of autoimmunity or with known autoantibodies, and the genetic predisposed individuals.Further research is encouraged into the direct associations between vaccines and autoimmune conditions, and the biological mechanisms behind them.

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Section: Hpv Vaccine and Asia Syndromementioning

confidence: 99%

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

et al. 2017

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“…The symptoms are overlapping and have been attributed to the probable effect of adjuvants (reviewed in [35][36][37][38]). All the above findings raised concerns as to whether adjuvants alone could be harmful in our animal model of SLE, by acting as a sort of autoimmune disease 'activator' , and so reversing the potential beneficial effect of a CD20-mimotope peptide vaccine.…”

Section: Introductionmentioning

confidence: 99%

Effects of adjuvants for human use in systemic lupus erythematosus (SLE)-prone (New Zealand black/New Zealand white) F1 mice

Favoino

Favia

Digiglio

et al. 2013

Clinical and Experimental Immunology

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SummaryThe safety of four different adjuvants was assessed in lupus-prone New Zealand black/New Zealand white ( Mean mouse weight at week 18 was lower in the ALU group than the IFA (Tukey's HSD post-test P = 0·04), CFA (P = 0·01) and SQU (P < 0·0001) groups, while the mean weight in the SQU group was higher than in the IFA (P = 0·009), CFA (P = 0·013) and UNT (P = 0·005) groups. The ALU group weight decreased by almost half between weeks 29 and 31, indicating some toxic effect of ALU in the late post-immunization period. Thus, SQU was the least toxic adjuvant as it did not (i) accelerate proteinuria onset compared to IFA; (ii) induce toxicity compared to ALU or (iii) elicit anti-RNP/Sm autoantibody, as occurred in the CFA group.

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“…He fulfills the original diagnostic requirements proposed by Shoenfeld et al (Table 2) [7]. Although inflammatory myopathies have been well described following vaccination [8], including macrophagic myofaciitis (MMF) [11], the occurrence of myocarditis has not. Furthermore, our patient did not manifest a locally stereotyped or immunologically active lesion at the site of inoculation, which would argue against MMF.…”

Section: Discussionmentioning

confidence: 70%

“…By definition, an adjuvant is a substance which triggers an antigen-specific immune response, aimed at stimulating the innate and adaptive immune systems [8]. Numerous mechanisms have been proposed to explain this interaction, and there is some suggestion that individuals who develop autoimmune phenomena following vaccination have a genetic risk or an underlying disease that activates immune responses [9].…”

Section: Discussionmentioning

confidence: 99%

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Cheng¹,

Kozoriz²,

Ahmadi³

et al. 2015

Intern Med

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Rhabdomyolysis is the breakdown of muscle cells leading to the release of cellular constituents such as electrolytes, enzymes and myoglobin. There is a broad differential diagnosis for this condition. In this report we describe a 65 year old male who presented with weakness, rhabdomyolysis, and acute kidney injury five days after receiving the seasonal flu vaccine. Laboratory investigations showed elevated creatine kinase and troponin-I, and extensive cardiac investigations yielded a diagnosis of myocarditis. The cause of his clinical picture is explored in this case report. Case PresentationA 65 year old previously healthy male presented to hospital with profound weakness. Five days before admission he had received the seasonal influenza vaccine, comprised of one influenza A H1/N1 virus, one influenza A H3/N2 virus and one influenza B virus. Two days later, he developed bilateral crampy leg pain, muscle tenderness and weakness that progressed until the day of admission. He became unable to weight-bear and was brought to the emergency department by his wife. He denied symptoms of headaches, paresthesias, arthralgias or any new rash. An infectious review of systems was unremarkable and he did not have any constitutional symptoms. He was not taking any medications or herbal preparations prior to admission, and did not use recreational drugs.On physical exam his vitals were: P 92, BP 124/84, RR 20, T 36.7°C and his O 2 saturation was 100% on room air. His neurological exam was significant for 4/5 strength in the hip flexors, hip extensors, hip abductors and hip adductors. He could not stand from the sitting position without the aid of his arms. The muscles of his arms and legs were also tender. His cardiac examination revealed a jugular venous pressure (JVP) two cm above the sternal angle. His apical beat was normal. Auscultation revealed a normal S1 and S2 without any extra sounds, murmurs or rubs. His respiratory exam revealed mild crackles in the left lower lung zone. The rest of the examination was unremarkable.His blood counts were WBC 11 × 99/L, hemoglobin 123 g/L (MCV 83 fL) and platelets 134 × 109/L. Electrolytes included sodium 126 mmol/L, potassium 3.2 mmol/L, chloride 101 mmol/L, bicarbonate 17 mmol/L, phosphate 0.75 mmol/L and magnesium 0.97 mmol/L. Other investigations showed urea 11.6 mM/L, creatinine 157 mM/L, creatine kinase (CK) 7,736 U/L (normal <150 U/L) and troponin 9.44 g/L (normal <0.2 g/L). His ethanol level was negative. His EKG was normal sinus rhythm with a right bundle branch block, without ischemic features. A chest X-ray and contrast enhanced computed tomography scan of the chest revealed a hiatus hernia, a left lower lobe consolidation, and no evidence of pulmonary embolism (Figure 1).Acute rhabdomyolysis was diagnosed and the patient received four liters of fluid over the ensuing 24 hours. During volume resuscitation he developed pulmonary crackles, his JVP increased to 5 cm above the sternal angle and his O 2 saturation decreased to 90% on room air. He was placed on supplemen...

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Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld’s syndrome): clinical and immunological spectrum

Cited by 114 publications

References 91 publications

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon?

Effects of adjuvants for human use in systemic lupus erythematosus (SLE)-prone (New Zealand black/New Zealand white) F1 mice

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

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