Research ArticleInfluenza

Antibodies to influenza nucleoprotein cross-react with human hypocretin receptor 2

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Science Translational Medicine  01 Jul 2015:
Vol. 7, Issue 294, pp. 294ra105
DOI: 10.1126/scitranslmed.aab2354

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Immunological mistaken identity

New reports of narcolepsy increased after the vaccination campaign against the 2009 A(H1N1) influenza pandemic in some countries but not others. Now Ahmed et al. examine differences between the vaccines used and find a potential mechanistic explanation for the vaccine-specific effect. They found a peptide in influenza nucleopeptide A that shared protein residues with human hypocretin receptor 2, which has been linked to narcolepsy. The vaccine used in unaffected countries contained less influenza nucleoprotein. Indeed, patients with putative vaccine-associated narcolepsy produced antibodies that cross-reacted to both the influenza and the hypocretin receptor 2 epitopes. Although these data do not demonstrate causation, they provide a possible explanation for the association of this particular influenza vaccination with increased reports of narcolepsy.