Adjuvants in earlier development phases are described in Chapter 6 – Vaccines of the future. Novel water-in-oil emulsions have recently been developed for use in both therapeutic and prophylactic vaccines. Montanide™ ISA51 is a water-in-oil emulsion containing mineral oil and mannide-mono-oleate as an emulsifier. These emulsions

are used as adjuvants with epidermal growth factor (EGF) as antigen in ongoing Phase III studies against cancer. Montanide™ adjuvants induce a strong immune response with an improved safety profile compared with Freund’s water-in-oil emulsion, but mild-to-severe local reactions are still observed in about half of the subjects in clinical trials. For this reason the Montanide™ adjuvants are applied mainly in immunotherapy. this website A non-small-cell lung cancer (NSCLC)

vaccine containing Montanide™ ISA51 as an adjuvant was recently registered in Cuba and Chile. Microbial DNA contains intrinsic immunostimulatory sequences (ISS) which act as ligands of intracellular TLRs, such as TLR9. When recognised by TLRs, ISS can lead to amplification of the adaptive immune response, in particular cell-mediated immunity. Several ISS with distinct biological activities have been characterised and preliminary clinical data show that the use of these sequences in vaccines can enhance humoral and cellular immune responses to the vaccine antigens. One example of an ISS is CpG 7909 (Figure 4.9), an agonist of TLR9 and an inducer of proinflammatory cytokines. CpG refers to a group of synthetic oligodeoxynucleotides Idelalisib cell line derived from bacterial DNA containing unmethylated CpG motifs. CpG 7909 stimulates TLR9, induces Th1 immunity and cytotoxic T-lymphocyte responses in animals, and is currently in Phase III clinical trials as part of an adjuvanted HBV vaccine (Cooper et al., 2004). AS01 combines the effects Janus kinase (JAK) of three components: liposome, MPL (TLR4

agonist) and QS21. QS21 is a triterpene glycoside derived from a saponin extracted from the bark of the South American tree Quillaja saponaria ( Figure 4.10). Saponins are used widely as emulsifiers in cosmetics as well as in the food and drink industry. The crude extract, known as Quil A, was first limited to use as an adjuvant for veterinary vaccines due to its local reactogenicity. The purified QS21 fraction derived from Quil A has potent ability to enhance antigen presentation to APCs, especially to induce cytotoxic T-lymphocyte production when tested in animals ( Newman et al., 1997). It has been shown that QS21 as a surfactant can be used to facilitate penetration of proteins through cell membranes, thus inducing intracellular immune responses. QS21 has shown an acceptable tolerability profile for use in human candidate vaccines when properly formulated with ISCOM™ (immune-stimulating complex consisting of cholesterol and phospholipids), or liposomes.