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Blood, 15 March 2008, Vol. 111, No. 6, pp. 3116-3125.
Prepublished online as a Blood First Edition Paper on January 17, 2008; DOI 10.1182/blood-2007-09-114371.
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Submitted September 24, 2007
Accepted January 7, 2008
Enhanced efficacy and reduced toxicity of multifactorial adjuvants compared to unitary adjuvants as cancer vaccines
Cory L Ahonen, Anna Wasiuk, Shinichiro Fuse, Mary Jo Turk, Marc S Ernstoff, Arief A Suriawinata, James D Gorham, Ross M Kedl, Edward J Usherwood, and Randolph J. Noelle*
Department of Microbiology and Immunology, Dartmouth Medical School, Lebanon, NH, United States
Norris Cotton Cancer Center, Lebanon, NH, United States
Medical Oncology Immunotherapy Group, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Department of Pathology, Dartmouth Medical School, Lebanon, NH, United States
Integrated Department of Immunology, University of Colorado Health Sciences Center, Denver, CO, United States
* Corresponding author; email: rjn{at}dartmouth.edu.
Identification of Toll-like Receptors (TLR) and their ligands, and TNF-TNFR pairs have provided the first logical, hypothesis-based strategies to molecularly concoct adjuvants to elicit potent cell-mediated immunity via activation of innate and adaptive immunity. However, isolated activation of one immune pathway in the absence of others can be toxic, ineffective and detrimental to long-term, protective immunity. Effective engineered vaccines must include agents that trigger multiple immunologic pathways. Here we report that combinatorial use of CD40 and TLR agonists as a cancer vaccine, as compared to monotherapy, elicits high frequencies of self-reactive CD8+ T cells, potent tumor-specific CD8+ memory, CD8+ T cells that efficiently infiltrate the tumor-burdened target organ, therapeutic efficacy, heightened ratios of CD8+ T cells to FoxP3+ cells at the tumor site and reduced hepatotoxicity. These findings provide intelligent strategies for the formulation of multifactorial vaccines to achieve maximal efficacy in cancer vaccine trials in humans.

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