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Natural and Synthetic Saponins As Vaccine Adjuvants

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Natural and Synthetic Saponins As Vaccine Adjuvants Review Natural and Synthetic Saponins as Vaccine Adjuvants Pengfei Wang Department of Chemistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; [email protected] Abstract: Saponin adjuvants have been extensively studied for their use in veterinary and human vaccines. Among them, QS-21 stands out owing to its unique profile of immunostimulating activity, inducing a balanced Th1/Th2 immunity, which is valuable to a broad scope of applications in com- bating various microbial pathogens, cancers, and other diseases. It has recently been approved for use in human vaccines as a key component of combination adjuvants, e.g., AS01b in Shingrix® for herpes zoster. Despite its usefulness in research and clinic, the cellular and molecular mechanisms of QS-21 and other saponin adjuvants are poorly understood. Extensive efforts have been devoted to studies for understanding the mechanisms of QS-21 in different formulations and in different combi- nations with other adjuvants, and to medicinal chemistry studies for gaining mechanistic insights and development of practical alternatives to QS-21 that can circumvent its inherent drawbacks. In this review, we briefly summarize the current understandings of the mechanism underlying QS-21’s adjuvanticity and the encouraging results from recent structure-activity-relationship (SAR) studies. Keywords: adjuvant; saponin; mechanism; SAR; QS-21; VSA-1; VSA-2 1. Introduction Traditional vaccines are whole-organism-based, using live attenuated or inactivated Citation: Wang, P. Natural and viruses or bacteria. These vaccines are quite reactogenic due to the presence of numerous Synthetic Saponins as Vaccine pathogen-associated-molecular-patterns (PAMPs) that are responsible for activation, and Adjuvants. Vaccines 2021, 9, 222. sometimes over-activation, of the immune system. While being effective, the traditional https://doi.org/10.3390/vaccines vaccine development approach is inapplicable to combat against not only many other 9030222 severe infection diseases, but also cancers and chronic inflammatory and autoimmune diseases [1–5]. The emergence of new pathogens and inadequate protection conferred by Academic Editor: Heather L. Wilson some of the existing vaccines, especially in certain age groups or in immunocompromised individuals highlights the need for more sophisticated and effective vaccines. One of the Received: 15 February 2021 important developments in the field is subunit vaccines that employ well-characterized, Accepted: 2 March 2021 Published: 5 March 2021 highly purified, and safer antigens such as recombinant proteins and peptides. Subunit vaccines not only reduce side effects, but also provide a platform for exploring molecular mechanisms of the immune response. However, their highly refined antigens (thus with Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in limited or no PAMPs) do not activate as many facets of the immune response as whole- published maps and institutional affil- organism-based vaccines. The poor immunogenicity generally leads to stimulation of a iations. weak and short-lived immunity. To boost immunogenicity, it is crucial for subunit vaccines to have immunostimulatory adjuvants that enhance immune responses induced by the poorly immunogenic antigens. Vaccine adjuvants are non-immunogenic substances that can improve or modulate antigen-specific immune responses toward their co-administered antigens, constituting Copyright: © 2021 by the author. an indispensable element of modern vaccines [6–19]. They can (a) enhance the ability of a Licensee MDPI, Basel, Switzerland. This article is an open access article vaccine to elicit strong and durable immune responses (including in immunologically com- distributed under the terms and promised individuals such as immunologically immature (neonates), aged, and immune conditions of the Creative Commons suppressed individuals) [20], (b) reduce antigen dose and the number of immunizations, Attribution (CC BY) license (https:// and (c) modulate the nature of immune response (e.g., in favor of humoral or cell-mediated creativecommons.org/licenses/by/ response). Despite the increasingly important role of adjuvants, there only a few adjuvants 4.0/). approved for human use [15,18,19,21,22]. Alum (various aluminum salts), the first and Vaccines 2021, 9, 222. https://doi.org/10.3390/vaccines9030222 https://www.mdpi.com/journal/vaccines Vaccines 2021, 9, x 2 of 18 mune suppressed individuals) [20], (b) reduce antigen dose and the number of immun- Vaccines 2021, 9, 222 izations, and (c) modulate the nature of immune response (e.g., in favor of humoral2 of 18or cell-mediated response). Despite the increasingly important role of adjuvants, there only a few adjuvants approved for human use [15,18,19,21,22]. Alum (various aluminum salts), mostthe first commonly and most used commonly adjuvant, used had adjuvant, been the onlyhad been human the vaccine only human adjuvant vaccine for more adjuvant than ninefor more decades than until nine 2009 decades [23–25 until]. It primarily2009 [23–25 enhances]. It primarily Th2 humoral enhances responses, Th2 humoral effective re- forsponses, neutralizing effective vaccines, for neutralizing but ineffective vaccines, for but vaccines ineffective targeting for vaccines intracellular targeting pathogens intracel- or cancerlular pathogens cells when or acancer Th1 or cells mixed when Th1/Th2 a Th1 or response mixed Th1/Th2 is required. response Moreover, is required. alum More- is not compatibleover, alum is for not mucosal compatible vaccines. for mucosal In 2009, vacci Foodnes. and In Drug 2009, Administration Food and Drug (FDA) Administration approved AS04,(FDA) a approved combination AS04, of aluma combination and monophosphoryl of alum andlipid monophosphoryl A (MPLA), for lipid human A (MPLA), use [26,27 for]. MPLAhuman wasuse [26,27]. the first MPLA Toll-like was receptor the first (TLR) Toll-like agonist receptor approved (TLR) for agonist human approved vaccine. for Since hu- 2016,man vaccine. FDA has Since approved 2016, FDA three has more approved adjuvants three (i.e., more MF59/AS03, adjuvants CpG (i.e., 1018,MF59/AS03, and AS01b). CpG MF59/AS031018, and AS01b). is a squalene-based MF59/AS03 is a oil-in-water squalene-based emulsion oil-in-water used in emulsion influenza used vaccines in influenza [28–30]. CpGvaccines 1018 [28–30]. is a TLR9 CpG agonist 1018 is used a TLR9 in a Hepatitisagonist used B vaccine; in a Hepatitis it is a short, B vaccine; 22-base it is synthetic a short, oligonucleotide22-base synthetic mimicking oligonucleotide bacterial mimicking and viral bacterial genetic and material viral genetic [31,32]. material AS01b was [31,32]. ap- provedAS01b was recently approved for use recently in Shingrix for ®useagainst in Shingrix herpes® zosteragainst by herpes FDA [ 33zoster,34] and by FDA Mosquirix [33,34]® againstand Mosquirix malaria® byagainst European malaria Medicines by European Agency Medicines (EMA) Agency [35]. It (EMA) is a combination [35]. It is a adju-com- vantbination containing adjuvant MPLA containing and saponin MPLA QS-21 and sapo in anin liposomal QS-21 formulationin a liposomal that formulation induces strong that humoralinduces strong and cellular humoral immune and cellular responses immune [33,36 responses]. [33,36]. 2.2. Immunostimulatory Adjuvant QS-21QS-21 QS-21QS-21 isis aa mixture ofof twotwo isomericisomeric bidesmosidicbidesmosidic saponinssaponins (1,(1, FigureFigure1 1),), isolated isolated from from thethe treetree barkbark ofofQuillaja Quillaja saponaria saponariaMolina Molina (QS), (QS), an an evergreen evergreen tree tree native native to temperateto temperate central cen- Chile.tral Chile. It can It can potentiate potentiate a balanced a balanced Th1/Th2 Th1/Th2 response response with with antigen-specific antigen-specific cytotoxiccytotoxic TT lymphocytelymphocyte (CTL)(CTL) productionproduction [[37–40].37–40]. FigureFigure 1.1. NaturalNatural saponinsaponin adjuvantadjuvant QS-21.QS-21. QS-21QS-21 hashas a a triterpene triterpene aglycone aglycone core, core, quillaic quilla acid,ic acid, with with a branched a branched trisaccharide trisaccharide con- nectingconnecting to the to C3 the OH C3 group OH group through through a beta glycosidic a beta glycosidic ether bond, ether and bond, a linear and tetrasaccha- a linear ridetetrasaccharide connectingto connecting the C28 carboxyl to the C28 group carboxyl through group a beta through glycosidic a beta ester glycosidic bond (Figure ester1 ). Thebond reducing (Figure end1). The of thereducing C28 tetrasaccharide end of the C28 is tetrasaccharide a b-D-fucosyl unitis a β with-D-fucosyl its 4-O unit position with cappedits 4-O withposition a glycosylated capped with pseudodimeric a glycosylated fatty pseudodimeric acyl chain. The fatty two structuralacyl chain. isomers The two of QS-21structural only isomers differ in of the QS-21 nonreducing only differ end in of the the nonreducing C28 tetrasaccharide, end of the i.e., C28 QS-21 tetrasaccha-api (~65% abundance)ride, i.e., QS-21 has aapi terminal (~65% abundance)b-D-apiosyl unit haswhile a terminal QS-21 xylβ-D(~35%-apiosyl abundance) unit while has QS-21 a termi-xyl nal(~35%b-D abundance)-xylosyl unit. has The a structureterminal ofβ- theD-xylosyl two isomers unit. The were structure confirmed of by the Gin two et al.isomers with organicwere confirmed synthesis [by41 ,42Gin]. Theet al. two with isomers organi havec synthesis similar adjuvant [41,42]. activityThe two and isomers toxicity have [43]. similarQS-21
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