Histopathological Studies of Reactions in Mice Injected with Aluminum-Adsorbed Tetanus Toxoid

Histopathological observations of changes at the injection site in mice were made for 20 weeks after a single intramuscular (im) injection of aluminum hydroxide-adsorbed tetanus toxoid (Alum-TT), plain tetanus toxoid (TT), or aluminum adjuvant (Alum alone). Marked injury to muscle fibers and infiltration of neutrophils around the aluminum remnants were observed, and some microabscesses were occasionally formed, after im injection of Alum-TT. Some mature alum-granulomas were seen in the Alum-TT group, while the Alum alone group had only a few immature alum-granulomas. The TT group showed only slight injury to muscle fibers and acute inflammation at an early stage. In the Alum-TT group, well-developed lymphoid tissues and granulomatous lesions were still observable even 20 weeks after the injection; however, these changes had already diminished in the Alum alone group by that time. These findings could serve as good models for undesirable local reactions to aluminum-adjuvanted vaccines.     

Progress in Tetanus Prophylaxis: The Advent of Human Antitoxin

Injections of tetanus antitoxin of animal origin frequently cause serious disability and sometimes death. Despite world-wide knowledge of these effects, millions of prophylactic injections of equine tetanus antitoxin are given annually, and it is continually proposed that the dosage be increased in order to obtain higher “protective” levels in the serum, a procedure which would increase the incidence and severity of reactions. Furthermore, equine antitoxin frequently fails to prevent tetanus.Tetanus antitoxin of human origin is available which carries no risk of complications and confers a higher degree of immunity more quickly than equine antitoxin. The cost of treating reactions to horse serum, together with the financial loss incurred by work-absence, far outweighs the cost of human antitoxin. In the author''s opinion, the use, in this country, of antitoxin of animal origin is no longer medically acceptable and may well prove legally indefensible.     

Prolonged Prophylactic Protection from Botulism with a Single Adenovirus Treatment Promoting Serum Expression of a VHH-Based Antitoxin Protein

Current therapies for most acute toxin exposures are limited to administration of polyclonal antitoxin serum. We have shown that VHH-based neutralizing agents (VNAs) consisting of two or more linked, toxin-neutralizing heavy-chain-only V_H domains (VHHs), each binding distinct epitopes, can potently protect animals from lethality in several intoxication models including Botulinum neurotoxin serotype A1 (BoNT/A1). Appending a 14 amino acid albumin binding peptide (ABP) to an anti-BoNT/A1 heterodimeric VNA (H7/B5) substantially improved serum stability and resulted in an effective VNA serum half-life of 1 to 2 days. A recombinant, replication-incompetent, adenoviral vector (Ad/VNA-BoNTA) was engineered that induces secretion of biologically active VNA, H7/B5/ABP (VNA-BoNTA), from transduced cells. Mice administered a single dose of Ad/VNA-BoNTA, or a different Ad/VNA, via different administration routes led to a wide range of VNA serum levels measured four days later; generally intravenous > intraperitoneal > intramuscular > subcutaneous. Ad/VNA-BoNTA treated mice were 100% protected from 10 LD₅₀ of BoNT/A1 for more than six weeks and protection positively correlated with serum levels of VNA-BoNTA exceeding about 5 ng/ml. Some mice developed antibodies that inhibited VNA binding to target but these mice displayed no evidence of kidney damage due to deposition of immune complexes. Mice were also successfully protected from 10 LD₅₀ BoNT/A1 when Ad/VNA-BoNTA was administered up to 1.5 hours post-intoxication, demonstrating rapid appearance of the protective VNA in serum following treatment. Genetic delivery of VNAs promises to be an effective method of providing prophylactic protection and/or acute treatments for many toxin-mediated diseases.