Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Therapeutic vaccination for chronic diseases: a new class of drugs in sight

Abstract

The induction of antibodies by prophylactic vaccination against infectious diseases has been the most effective medical intervention in human history. More recently, monoclonal antibodies specific for host proteins have proven to be highly effective for the treatment of acute and chronic diseases. However, the costs of protein therapies and their inconvenience for the patient are major obstacles for their wide-spread use. We suggest that the movement from the passive administration of monoclonal antibodies to active vaccination against self-molecules could be the next logical step in drug development, providing affordable medicines and broader patient acceptance and compliance.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: How B cells and TH cells collaborate and a way to circumvent TH cell tolerance.

Similar content being viewed by others

References

  1. Jennings, G. T. & Bachmann, M. F. Immunotherapies: cause for measured optimism. Drug Discov. Today 7, 994–946 (2002).

    Article  Google Scholar 

  2. WHO. Population ageing — a public health challenge [online], (cited 1998) <http://www.who.int/inf-fs/en/fact135.html> (1998).

  3. Finn, O. J. & Forni, G. Prophylactic cancer vaccines. Curr. Opin. Immunol. 14, 172–177 (2002).

    Article  CAS  Google Scholar 

  4. Berinstein, N. Overview of therapeutic vaccination approaches for cancer. Semin. Oncol. 30, 1–8 (2003).

    Article  CAS  Google Scholar 

  5. Jager, E., Jager, D. & Knuth, A. Clinical cancer vaccine trials. Curr. Opin. Immunol. 14, 178–182 (2002).

    Article  CAS  Google Scholar 

  6. Zinkernagel, R. M. On natural and artificial vaccinations. Annu. Rev. Immunol. 21, 515–546 (2003).

    Article  CAS  Google Scholar 

  7. Walsh, G. Biopharmaceutical benchmarks — 2003. Nature Biotechnol. 21, 865–870 (2003).

    Article  CAS  Google Scholar 

  8. Dalum, I. et al. Therapeutic antibodies elicited by immunization against TNF-α. Nature Biotechnol. 17, 666–669 (1999).

    Article  CAS  Google Scholar 

  9. Gardiner, S. M. et al. Active immunization with angiotensin I peptide analogue vaccines selectively reduces the pressor effects of exogenous angiotensin I in conscious rats. Br. J. Pharmacol. 129, 1178–1182 (2000).

    Article  CAS  Google Scholar 

  10. Richard, M., Grencis, R. K., Humphreys, N. E., Renauld, J. C. & Van Snick, J. Anti-IL-9 vaccination prevents worm expulsion and blood eosinophilia in Trichuris muris-infected mice. Proc. Natl Acad. Sci. USA 97, 767–772 (2000).

    Article  CAS  Google Scholar 

  11. Hertz, M. et al. Active vaccination against IL-5 bypasses immunological tolerance and ameliorates experimental asthma. J. Immunol. 167, 3792–3799 (2001).

    Article  CAS  Google Scholar 

  12. During, M. J. et al. An oral vaccine against NMDAR1 with efficacy in experimental stroke and epilepsy. Science 287, 1453–1460 (2000).

    Article  CAS  Google Scholar 

  13. Talwar, G. P. et al. A vaccine that prevents pregnancy in women. Proc. Natl Acad. Sci. USA 91, 8532–8536 (1994).

    Article  CAS  Google Scholar 

  14. Simms, M. S. et al. Anti-GnRH antibodies can induce castrate levels of testosterone in patients with advanced prostate cancer. Br. J. Cancer 83, 443–446 (2000).

    Article  CAS  Google Scholar 

  15. Brett, B. T. et al. Phase II study of anti-gastrin-17 antibodies, raised to G17DT, in advanced pancreatic cancer. J. Clin. Oncol. 20, 4225–4231 (2002).

    Article  CAS  Google Scholar 

  16. Schenk, D. et al. Immunization with amyloid-β attenuates Alzheimer-disease-like pathology in the PDAPP mouse. Nature 400, 173–177 (1999).

    Article  CAS  Google Scholar 

  17. Morgan, D. et al. A β-peptide vaccination prevents memory loss in an animal model of Alzheimer's disease. Nature 408, 982–985 (2000).

    Article  CAS  Google Scholar 

  18. Orgogozo, J. M. et al. Subacute meningoencephalitis in a subset of patients with AD after Aβ42 immunization. Neurology 61, 46–54 (2003).

    Article  CAS  Google Scholar 

  19. Hock, C. et al. Generation of antibodies specific for β-amyloid by vaccination of patients with Alzheimer disease. Nature Med. 8, 1270–1275 (2002).

    Article  CAS  Google Scholar 

  20. Hock, C. et al. Antibodies against β-amyloid slow cognitive decline in Alzheimer's disease. Neuron 38, 547–554 (2003).

    Article  CAS  Google Scholar 

  21. Nicoll, J. A. et al. Neuropathology of human Alzheimer disease after immunization with amyloid-β peptide: a case report. Nature Med. 9, 448–452 (2003).

    Article  CAS  Google Scholar 

  22. Fox, B. S. et al. Efficacy of a therapeutic cocaine vaccine in rodent models. Nature Med. 2, 1129–1132 (1996).

    Article  CAS  Google Scholar 

  23. Lindblom, N. et al. Active immunization against nicotine prevents reinstatement of nicotine-seeking behavior in rats. Respiration 69, 254–260 (2002).

    Article  CAS  Google Scholar 

  24. Kosten, T. R. et al. Human therapeutic cocaine vaccine: safety and immunogenicity. Vaccine 20, 1196–1204 (2002).

    Article  CAS  Google Scholar 

  25. Dinarello, C. A. Anti-cytokine therapeutics and infections. Vaccine 21 (Suppl. 2), S24–S34 (2003).

    Article  Google Scholar 

  26. Van den Brande, J. M. et al. Infliximab but not etanercept induces apoptosis in lamina propria T-lymphocytes from patients with Crohn's disease. Gastroenterology 124, 1774–1785 (2003).

    Article  CAS  Google Scholar 

  27. Tew, J. G., Phipps, R. P. & Mandel, T. E. The maintenance and regulation of the humoral immune response: persisting antigen and the role of follicular antigen-binding dendritic cells as accessory cells. Immunol. Rev. 53, 175–201 (1980).

    Article  CAS  Google Scholar 

  28. Bachmann, M. F., Kundig, T. M., Hengartner, H. & Zinkernagel, R. M. Regulation of IgG antibody titers by the amount persisting of immune-complexed antigen. Eur. J. Immunol. 24, 2567–2570 (1994).

    Article  CAS  Google Scholar 

  29. McHeyzer-Williams, M. G. & Ahmed, R. B cell memory and the long-lived plasma cell. Curr. Opin. Immunol. 11, 172–179 (1999).

    Article  CAS  Google Scholar 

  30. Manz, R. A. et al. Humoral immunity and long-lived plasma cells. Curr. Opin. Immunol. 14, 517–521 (2002).

    Article  CAS  Google Scholar 

  31. Bernasconi, N. L., Traggiai, E. & Lanzavecchia, A. Maintenance of serological memory by polyclonal activation of human memory B cells. Science 298, 2199–2202 (2002).

    Article  CAS  Google Scholar 

  32. Sebzda, E. et al. Selection of the T cell repertoire. Annu. Rev. Immunol. 17, 829–874 (1999).

    Article  CAS  Google Scholar 

  33. Bachmann, M. F. & Kopf, M. Balancing protective immunity and immunopathology. Curr. Opin. Immunol. 14, 413–419 (2002).

    Article  CAS  Google Scholar 

  34. O'Hagan, D. T. & Valiante, N. M. Recent advances in the discovery and delivery of vaccine adjuvants. Nature Rev. Drug Discov. 2, 727–735 (2003).

    Article  CAS  Google Scholar 

  35. Janeway, C. A. Jr. Approaching the asymptote? Evolution and revolution in immunology. Cold Spring Harb. Symp. Quant. Biol. 54, 1–13 (1989).

    Article  CAS  Google Scholar 

  36. Behboudi, S., Morein, B. & Villacres-Eriksson, M. In vitro activation of antigen-presenting cells (APC) by defined composition of Quillaja saponaria Molina triterpenoids. Clin. Exp. Immunol. 105, 26–30 (1996).

    Article  CAS  Google Scholar 

  37. Chung, H., Brazil, M. I., Soe, T. T. & Maxfield, F. R. Uptake, degradation, and release of fibrillar and soluble forms of Alzheimer's amyloid β-peptide by microglial cells. J. Biol. Chem. 274, 32301–32308 (1999).

    Article  CAS  Google Scholar 

  38. Gotz, J., Chen, F., van Dorpe, J. & Nitsch, R. M. Formation of neurofibrillary tangles in P301l tau transgenic mice induced by Aβ 42 fibrils. Science 293, 1491–1495 (2001).

    Article  CAS  Google Scholar 

  39. Rammensee, H., Bachmann, J., Emmerich, N. P., Bachor, O. A. & Stevanovic, S. SYFPEITHI: database for MHC ligands and peptide motifs. Immunogenetics 50, 213–219 (1999).

    Article  CAS  Google Scholar 

  40. Bachmann, M. F. & Zinkernagel, R. M. Neutralizing antiviral B cell responses. Annu. Rev. Immunol. 15, 235–270 (1997).

    Article  CAS  Google Scholar 

  41. Weigle, W. O. Analysis of autoimmunity through experimental models of thyroiditis and allergic encephalomyelitis. Adv. Immunol. 30, 159–273 (1980).

    Article  CAS  Google Scholar 

  42. Goodnow, C. C. B-cell tolerance. Curr. Opin. Immunol. 4, 703–710 (1992).

    Article  CAS  Google Scholar 

  43. Nemazee, D. et al. Clonal deletion of autospecific B lymphocytes. Immunol. Rev. 122, 117–132 (1991).

    Article  CAS  Google Scholar 

  44. Bachmann, M. F. et al. The influence of antigen organization on B cell responsiveness. Science 262, 1448–1451 (1993).

    Article  CAS  Google Scholar 

  45. Chackerian, B., Lowy, D. R. & Schiller, J. T. Conjugation of a self-antigen to papillomavirus-like particles allows for efficient induction of protective autoantibodies. J. Clin. Invest. 108, 415–423 (2001).

    Article  CAS  Google Scholar 

  46. Jegerlehner, A. et al. A molecular assembly system that renders antigens of choice highly repetitive for induction of protective B cell responses. Vaccine 20, 3104–3112 (2002).

    Article  CAS  Google Scholar 

  47. Storni, T. et al. Critical role for activation of antigen-presenting cells in priming of cytotoxic T cell responses after vaccination with virus-like particles. J. Immunol. 168, 2880–2886 (2002).

    Article  CAS  Google Scholar 

  48. Storni, T., Ruedl, C., Renner, W. A. & Bachmann, M. F. Innate immunity together with duration of antigen persistence regulate effector T cell induction. J. Immunol. 171, 795–801 (2003).

    Article  CAS  Google Scholar 

  49. Frantz, S. & Smith, A. New drug approvals for 2002. Nature Rev. Drug Discov. 2, 95–96 (2003).

    Article  CAS  Google Scholar 

  50. Dyer, M. R. & Herrling, P. L. Progress and potential for gene-based medicines. Mol. Ther. 1, 213–224 (2000).

    Article  CAS  Google Scholar 

  51. Fletcher, L. Roche leads molecular diagnostics charge. Nature Biotechnol. 20, 6–7 (2002).

    Article  CAS  Google Scholar 

  52. WHO. Integrating prevention into health care [online], (cited 2002) <http://www.who.int/mediacentre/factssheets/fs172/en/print.html> (2002).

  53. WHO. Tobacco — Health Facts [online], (cited1999) <http://www.who.int/inf-fs/en/fact221.html> (1999).

  54. Burnier, M., Santschi, V., Favrat, B. & Brunner, H. R. Monitoring compliance in resistant hypertension: an important step in patient management. J. Hypertens. Suppl. 21 (Suppl. 2), S37–S42 (2003).

    Article  CAS  Google Scholar 

  55. Miller, N. H. Compliance with treatment regimens in chronic asymptomatic diseases. Am. J. Med. 102, 43–49 (1997).

    Article  CAS  Google Scholar 

  56. German, P. S. Compliance and chronic disease. Hypertension 11, II56–II60 (1988).

    Article  CAS  Google Scholar 

  57. Spohn, G. & Bachmann, M. F. Therapeutic vaccination to block receptor–ligand interactions. Expert Opin. Biol. Ther. 3, 469–476 (2003).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to thank W. Renner, P. Müller, G. Jennings and M. Kopf for helpful discussions and S. Fellmann for excellent secretarial assistance.

Author information

Authors and Affiliations

Authors

Ethics declarations

Competing interests

Authors have shares and options in Cytos, a company involved in therapeutic vaccination.

Related links

Related links

DATABASES

LocusLink

APP

gastrin

IL-5

IL-9

N-methyl-D-aspartate receptor-1

Online Mendelian Inheritance in Man

Alzheimer's disease

Crohn's disease

rheumatoid arthritis

psoriasis

FURTHER INFORMATION

Encyclopedia of Life Sciences

Vaccination of humans

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bachmann, M., Dyer, M. Therapeutic vaccination for chronic diseases: a new class of drugs in sight. Nat Rev Drug Discov 3, 81–88 (2004). https://doi.org/10.1038/nrd1284

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrd1284

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing