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Vaccine for Hyperadrenocorticism?

Clinician's Brief (Capsule)

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In this pilot study, 4 dogs were inoculated with a recombinant hyperadrenocorticism (ACTH) vaccine every 4 weeks for 12 weeks. A pretreatment ACTH response test was performed one week before treatment and again at weeks 12 and 15. Additional serum for anti-ACTH antibodies was collected 2 weeks after every treatment. Vaccination resulted in the production of anti-ACTH antibodies in all of the treated dogs. Initial titers were high but decreased by the end of the monitoring period (week 15). With regard to plasma cortisol concentrations, there was no difference in ACTH response test between control and treated dogs pretreatment. A significant reduction in plasma cortisol concentrations was noted after ACTH response testing in 2 of the dogs at week 12 but not at week 15.

Commentary

Current medical management of hyperadrenocorticism is targeted at suppressing production of cortisol at the level of the adrenal gland with mitotane or trilostane. Although medical management is effective, treatment requires frequent monitoring and can result in potential adverse effects (eg, hypoadrenocorticism).

Although this novel therapeutic concept shows promise, the ACTH vaccine protocol evaluated did not suppress cortisol production reliably or long enough to recommend this as a treatment for dogs with pituitary-dependent hyperadrenocorticism. Future studies may evaluate different ACTH vaccine formulations or inoculation protocols that may be more effective. If a variation in the ACTH vaccine or protocol does result in a reliable reduction in cortisol production, I would have the following concerns: 1) ability to adjust the dose for individual patients, 2) potential for reactions with repeated administration, and 3) decreased efficacy in hyperadrenocorticism patients from an immunosuppressed state.—Laura A. Nafe, DVM, MS, DACVIM

Source

Inoculation of dogs with a recombinant ACTH vaccine. Kemppainen RJ. AM J VET RES 74:1499-1505, 2013.

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