Vaccines, adjuvants and autoimmunity

Narcolepsy is a chronic sleep disorder linked to the HLA-DQB1*0602 haplotype and dysregulation of the hypocretin ligand-hypocretin receptor pathway. Narcolepsy was associated with Pandemrix® vaccination (an adjuvanted, influenza pandemic vaccine) and also with infection by influenza virus during the 2009 A(H1N1) influenza pandemic. In contrast, very few cases were reported after Focetria® vaccination (a differently manufactured adjuvanted influenza pandemic vaccine). With these epidemiological associations as a starting point, we will review the approach taken leading to the identification of an influenza viral epitope with high similarity to the human hypocretin receptor 2 and the observation of antibodies against this receptor in patients with narcolepsy and a history of Pandemrix® vaccination.