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We read the interesting paper of Dr. Gelinck and associates on the effect of anti-tumour necrosis factor-alpha (anti-TNF-á) therapy on the antibody response to influenza vaccination . Although there was a modest impairment of the antibody response to the vaccination, the proportion of patients achieving a protective titer was not significantly diminished. However, we have oncerns on generalizing these res...
We read the interesting paper of Dr. Gelinck and associates on the effect of anti-tumour necrosis factor-alpha (anti-TNF-á) therapy on the antibody response to influenza vaccination . Although there was a modest impairment of the antibody response to the vaccination, the proportion of patients achieving a protective titer was not significantly diminished. However, we have oncerns on generalizing these results to other segments of the population, particularly the elderly on statin therapy.
A novel immunomodulatory effect of statins is the ability to increasethe numbers and functionality of regulatory T cells (Tregs) in vivo by inducing the transcription factor forkhead box P3 . Even though this
may result in plaque stability by attenuating effector T cell responses in the atheroma , it also may attenuate vaccination-specific T cell responses . Interestingly, among those 65 years and older, the effectiveness of the influenza vaccine is significantly diminished  and
both humoral and cell-mediated influenza-specific responses are impaired compared to younger individuals . Additionally, elderly individuals have an increase in peripheral Treg numbers . Moreover, TNF-á inhibits
Tregs activity and, not surprisingly, anti-TNF-á therapy restores Tregs suppressive function .
Therefore it is highly plausible that among the elderly prescribed anti-TNF-alpha and/or statin therapy, Treg numbers and activity are significantly enhanced, resulting in a further diminution of the response to influenza vaccination. This is extremely important and needs to be
investigated, given the widespread use of statins and the increasing use of anti-TNF-alpha therapy among the elderly, whom are particularly vulnerable to the morbidity and mortality from influenza infection .
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