These types of antigen are designed to minimise excessive inflammatory responses but, as a result, may be suboptimally immunogenic. Under these circumstances, the addition of adjuvants (see Chapter 4 – Vaccine adjuvants) can mimic the missing innate triggers, restoring the balance between necessary

defensive responses and acceptable tolerability. The induction of CD4+ T cells is essentially controlled by learn more the nature of this initial inflammatory response. Therefore, vaccine adjuvants can play a role in guiding how CD4+ T cells are induced and how they further differentiate and influence the quality and quantity of the adaptive immune response. It is important to recognise that the dominant immune response to a given pathogen or antigen may not necessarily be the optimum response for inducing protection; indeed through evolution some pathogens have developed strategies to evade or subvert the immune response, as is the case with Neisseria gonorrhoeae, where the dominant antibody response actually facilitates infection by preventing complement-dependent bactericidal activity. Antibody titres are often considered to represent adequate indicators of immune protection

but, as discussed above, may not be the actual mechanism by which optimal CDK activity protection is achieved. Useful specific so-called immune correlates of immunity/protection may be unknown or incompletely characterised. Therefore, modern vaccine design still looks to clinical trials to provide information about clinical efficacy and, if possible, the immunological profiles of protected individuals. Immunogenicity is assessed by laboratory measurement of immune effectors, typically antibodies. Increasingly, however, specific T-cell activation is included in the parameters assessed, as adequate T-cell immunity may be essential for recovery from some infections and improved assay techniques have allowed these evaluations to become more standardised and offer more robust data. This can then open the door to understanding observed clinical

efficacy (or lack of) and to defining at least some of the features of vaccine-induced protection. By preferentially targeting the best immunological selleck products effectors, vaccines can then hope to mimic or improve on nature’s own response to infection. Successful natural immune responses can be measured in protected individuals and assessed in terms of, for example, the production of specific types of antibody or a particular pattern of cytokine expression by T cells – this gives the correlates of protection, which can then be reproduced using a vaccine. Correlates of protection can only be determined from a clinical trial where protection from disease or infection is determined in cohorts of vaccinated versus unvaccinated individuals.