Adjuvants, materials added to vaccines to enhance the resulting immune response, are important components of vaccination that are many times overlooked. While vaccines always include an antigen to tell the body what to vaccinate to, of equal importance the adjuvant provides the how, a significant factor in producing a complete response. The adjuvant space has been slow to develop with the first use of an adjuvant in a licensed vaccine occurring in the 1930s, and remaining the only adjuvant in licensed vaccines for the next 80 years. However, with vaccination at the forefront of protection against new and complex pathogens, it is important to consider all components when designing an effective vaccine. Here we summarize the adjuvant space in licensed vaccines as well as the novel adjuvant space in clinical trials with a specific focus on the materials utilized and their resulting impact on the immune response. We discuss five major categories of adjuvant materials: aluminum salts, nanoparticles, viral vectors, TLR agonists, and emulsions. For each category, we delve into the current clinical trials space, the impact of these materials on vaccination, as well as some of the ways in which they could be improved. Adjuvants present an exciting opportunity to improve vaccine responses and stability, this review will help inform about the current progress of this space.Translational impact statementIn the aftermath of the COVID‐19 pandemic, vaccines for infectious diseases have come into the spotlight. While antigens have always been an important focus of vaccine design, the adjuvant is a significant tool for enhancing the immune response to the vaccine that has been largely underdeveloped. This article provides a broad review of the history of adjuvants and, the current vaccine adjuvant space, and the progress seen in adjuvants in clinical trials. There is specific emphasis on the material landscape for adjuvants and their resulting mechanism of action. Looking ahead, while the novel vaccine adjuvant space features exciting new technologies and materials, there is still a need for more to meet the protective needs of new and complex pathogens.

中文翻译：

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临床传染病疫苗佐剂

佐剂是添加到疫苗中以增强免疫反应的物质，是疫苗接种的重要组成部分，但常常被忽视。虽然疫苗总是包含抗原来告诉身体要接种什么疫苗，但同样重要的是，佐剂提供了如何接种疫苗的方法，这是产生完全反应的重要因素。佐剂领域的发展缓慢，佐剂首次在许可疫苗中使用是在 20 世纪 30 年代，并且在接下来的 80 年里一直是许可疫苗中唯一的佐剂。然而，由于疫苗接种处于预防新型复杂病原体的最前沿，因此在设计有效疫苗时考虑所有组成部分非常重要。在这里，我们总结了许可疫苗中的佐剂空间以及临床试验中的新型佐剂空间，特别关注所使用的材料及其对免疫反应的影响。我们讨论了五类主要的佐剂材料：铝盐、纳米颗粒、病毒载体、TLR 激动剂和乳剂。对于每个类别，我们深入研究了当前的临床试验空间、这些材料对疫苗接种的影响，以及一些可以改进的方法。佐剂为改善疫苗反应和稳定性提供了令人兴奋的机会，这篇综述将有助于了解该领域的当前进展。转化影响声明在 COVID-19 大流行之后，传染病疫苗已成为人们关注的焦点。虽然抗原一直是疫苗设计的一个重要焦点，但佐剂是增强疫苗免疫反应的重要工具，而疫苗的免疫反应基本上尚未开发出来。本文对佐剂的历史、当前的疫苗佐剂空间以及临床试验中佐剂的进展进行了广泛的回顾。特别强调佐剂的材料景观及其产​​生的作用机制。展望未来，虽然新型疫苗佐剂领域拥有令人兴奋的新技术和材料，但仍需要更多技术和材料来满足新型复杂病原体的保护需求。