title: Selective immune redirection in humans with ragweed allergy by injecting Amb a 1 linked to immunostimulatory DNA.
abstract: BACKGROUND
  In animal models administration of immunostimulatory DNA sequences preferentially elicits T(H)1-dominated (type 1-dominated) immunity and can inhibit developing or ongoing T(H)2 (type 2) responses.
  
  
  OBJECTIVE
  Our objective was to investigate this phenomenon in humans.
  
  
  METHODS
  In a randomized, third party-blinded, placebo-controlled, proof-of-concept study conducted entirely in the winter in 19 adults with ragweed allergy, we administered 6 subcutaneous injections of purified Amb a 1 linked to the 22-base-long immunostimulatory phosphorothioate oligodeoxyribonucleotide 1018 (Amb a 1-immunostimulatory DNA sequence conjugate [AIC]). Before the course of AIC or placebo injections and 2 and 16 weeks afterward, we measured recall responses to ragweed, streptokinase, and PHA in short-term primary culture of fresh PBMCs after restimulation with antigen. We quantified regulatory cytokine and chemokine responses characteristic of T(H)2 immunity (IL-5, IL-13, CCL17 [TARC], and CCL22 [MDC]), and T(H)1 immunity (IFN-gamma, CXCL9 [Mig], and CXCL10 [IP-10]), as well as IL-10, a cytokine sometimes linked to regulatory T-cell populations.
  
  
  RESULTS
  We demonstrated for the first time that human systemic in vivo ragweed-specific T(H)2 responses were selectively redirected toward T(H)1 responses, with significant increases in IFN-gamma, CXCL9, and CXCL10 and significant decreases in IL-5, CCL17, and CCL22 found at 2 and 16 weeks after the sixth injection. Cytokine and chemokine responses to the unrelated bacterial antigen streptokinase and the global capacity to mount immune responses on polyclonal activation with PHA did not change. No clinically significant systemic or local allergic reactions were associated with AIC or placebo injections.
  
  
  CONCLUSIONS
  AIC, injected in concentrations that were approximately 40-fold lower than those used in most murine studies published to date, led to a prolonged shift from T(H)2 immunity toward T(H)1 immunity and appeared to be safe. This novel approach has the potential for immune redirection in human immediate hypersensitivity diseases.
authors.affiliation: Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9.
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Shikishima
authors.forename: Gary
authors.initials: G
authors.lastname: Van Nest
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eiden
authors.forename: Kent T
authors.initials: KT
authors.lastname: HayGlass
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D031164:Ambrosia / Q000276:immunology*; D052179:Antigens, Plant; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D007267:Injections; D008297:Male; D008875:Middle Aged; D009838:Oligodeoxyribonucleotides / Q000008:administration & dosage*; D010940:Plant Proteins / Q000008:administration & dosage / Q000276:immunology*; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D000485:Allergens; C026967:Amb a I protein, Ambrosia artemisiifolia; D052179:Antigens, Plant; D009838:Oligodeoxyribonucleotides; D010940:Plant Proteins