Molecular mimicry: The new old antivaccine abuse of science

In the long time that I’ve been discussing antivaccine pseudoscience, there’s one thing I’ve noticed. (Well, actually, it’s several things, but I’m going to discuss mainly one.) Lesson number one about antivaccine activists is that, first and foremost and above all else, it’s always about the vaccines. Always and forever. As a consequence of that, antivaxers love to latch on to new science in order to twist it to their cause. Well, that’s not quite right. Yes, they like to latch on to new science, but they also like to find bits of old science that they can bend to their antivaccine purpose, as they did in the case of Hannah Poling, in which they tried to claim that mitochondrial disorders plus vaccines equal autism when that was definitely not the case. Then, of course, antivaxers like to invoke epigenetics, not unlike the way that Deepak Chopra and other quacks like to invoke epigenetics as a “mechanism” for the mind to control the body and how one can overcome one’s genes. (Of course, it’s way more complex than that, but you get the idea.) The other day, perusing antivax websites, I discovered yet another bit of science antivaxers have drafted into the service of their cause: Molecular mimicry.

In this case, Robert F. Kennedy, Jr.’s grossly misnamed Child Health Defense team published a risibly awful article on his website entitled Molecular mimicry: Body Confusion of “Self” and “Non-Self” (More Evidence on HPV Vaccines and Autoimmunity). Actually, molecular mimicry is not a new concept; it’s been around at least since the 1990s. It’s actually a relatively simple concept, namely that microorganisms or environmental agents can share a common epitope (part of an antigen to which an antibody binds), meaning that infection with that microorganism or exposure to that environmental agent can result in the activation of an immune response against self; i.e., an autoimmune response. With that in mind, let’s check out how RFK Jr.’s flunkies over at CHD are invoking molecular mimicry. Naturally, they’re saying vaccines can cause it, specifically HPV vaccines. RFK Jr. starts, of course, with lies:

HPV vaccines have been linked to over 100,000 reported adverse events globally, including disabling autoimmune conditions and deaths, but officials seem unconcerned. Merck set the tone for the truth-stretching claim that HPV vaccine risks are “negligible” when it conducted its initial clinical trials for Gardasil and dismissed as irrelevant the serious medical conditions that arose—within seven months—in half of all participants who received the vaccine. With the accumulation of studies since those early trials, it is getting harder to deny the existence of a disabling post-HPV vaccination syndrome. Although researchers admit that they do not yet fully understand the mechanisms whereby HPV vaccines wreak their autoimmune havoc, the phenomenon of immune cross-reactivity offers one highly plausible explanation.

OK, first of all, CHD goes wrong when it cites Yehuda Shoenfeld. You knew RFK Jr. would be citing Yehuda Shoenfeld, didn’t you? He’s the antivaccine guru of invoking autoimmunity as a supposed cause of “vaccine injury.” Indeed, he’s even coined a term for his fake diagnosis: ASIA (Autoimmune Syndrome Induced by Adjuvants). It’s a syndrome so vaguely defined that almost any odd symptom after vaccination (particularly with Gardasil or Cervarix) could be labeled ASIA, and, not surprisingly, it’s also a syndrome that virtually no other scientist or physician outside of antivaccine circles accepts as a valid clinical entity.

Not surprisingly, RFK Jr. is unduly impressed with Shoenfeld’s work, citing yet another of his papers this time blaming molecular mimicry for his never-changing bugaboo ASIA:

In a new study in Pathobiology, two of the most-published researchers on this topic report on the overlap between human proteins and HPV antigens. The authors consider their results indicative of “a cross-reactivity potential capable of triggering an extremely wide and complex spectrum of autoimmune diseases.”

And:

In their Pathobiology study, however, the two authors—Drs. Darja Kanduc (Italy) and Yehuda Shoenfeld (Israel)—do just that, looking at HPV through the lens of both HPV infection and “active immunization.” Using cutting-edge molecular biology techniques to look at matching peptide sequences in HPV “epitopes” and human proteins, Kanduc and Shoenfeld examine epitopes from 15 different HPV types, including eight of the nine types included in Gardasil 9. (An epitope is the portion of an antigen capable of stimulating an immune response.)

I couldn’t help but do a quick Pubmed search for “HPV vaccine” and “molecular mimicry.” There was, unsurprisingly, very little published (only nine articles), and four of those articles were by Shoenfeld. In any case, based on his dubious analysis, Shoenfeld concludes:

Immunologically, the high extent of peptide sharing between the HPV L1 epitopes and human proteins invites to revise the concept of the negative selection of self-reactive lymphocytes. Pathologically, the data highlight a cross-reactive potential for a spectrum of autoimmune diseases that includes ovarian failure, systemic lupus erythematosus (SLE), breast cancer and sudden death, among others. Therapeutically, analyzing already validated immunoreactive epitopes filters out the peptide sharing possibly exempt of self-reactivity, defines the effective potential for pathologic autoimmunity, and allows singling out peptide epitopes for safe immunotherapeutic protocols.

Because molecular mimicry causes ASIA and ASIA can cause any symptom!

Seriously, though, is there any disease or symptom that HPV vaccination doesn’t cause? Is there anything that isn’t a manifestation of ASIA? Of cours,e we know that there is no elevated risk of any of these conditions after HPV vaccination, other than postural hypotension leading to fainting, which is a risk after any injection and why it is generally recommended that those receiving the vaccination be watched for a while afterward. Not that that stops Shoenfeld from creating a new autoimmune syndrome out of whole cloth, postural Orthostatic tachycardia syndrome, or POTS, because everything he can think of as a complication of HPV vaccination must be an autoimmune manifestation of ASIA. As much as Shoenfeld has tried to link these conditions to HPV vaccination, HPV vaccination is not associated with premature ovarian insufficiency, sudden death, breast cancer, SLE, or any other adverse event. There have been massive studies of HPV vaccine safety involving millions of patients verifying this.

Of course, it’s not just molecular mimicry. It’s also all about the aluminum adjuvants used in HPV vaccination, because, ever since removal of the mercury-containing preservative thimerosal that was in many childhood vaccines until around 2002 didn’t affect the rate of growth of autism prevalence, thus showing conclusively that thimerosal has nothing to do with autism, aluminum has become the new mercury to antivaxers. RFK Jr. got his start as an antivaxer fear mongering about thimerosal, but he’s managed the pivot to fear mongering about aluminum quite seamlessly. That’s why we get:

Schoenfeld is coauthor on another recent study published in the Annals of Arthritis and Clinical Rheumatology. The study describes post-HPV-vaccination autoimmunity in Japanese girls, and it reiterates that vaccine adjuvants are an essential consideration for understanding the girls’ “unexpected” and “abnormal” immune responses. The authors write:
Vaccination results in the iatrogenic production of useful antibodies in the human body, but it cannot be ruled out that the exposure to an external stimulus including adjuvants induces unexpected abnormal immune responses, such as a newly evoked situation with an autoimmune abnormality [emphasis added].
With 500 micrograms of aluminum adjuvant, Gardasil 9 has more than double the amount of aluminum contained in the original Gardasil vaccine. How this double-whammy “external stimulus” will play out in terms of autoimmunity requires assessment.

First of all, this is a study of only 112 Japanese girls, 55 who were vaccinated with HPV vaccine and 57 who were not. These 55 girls sought treatment for “several symptoms after HPV vaccination,” including “general fatigue, chronic headache, widespread pain, limb shaking, dysautonomic symptoms, motor dysfunction, abnormal sensation, sleep disturbance, learning impairment, and menstrual abnormality.” These girls were age-matched to healthy girls without a history of HPV vaccination. My favorite part of the study is how time of onset after vaccination of these symptoms ranged from 0 to 59 months. Yes, symptoms up to nearly five years after vaccination are being attributed to vaccination!

In any event, Shoenfeld and his unfortunate Japanese collaborators measured various autoantibodies, and reported that antibodies against adrenergic receptors α1, α2, β1 and β2, muscarinic acetylcholine receptors 1, 2, 3, 4, 5; and endothelin receptor A were significantly elevated in girls with HPV vaccination, compared with those in the control group. This is all mildly interesting until you see that “there was no statistically meaningful association between the clinical symptoms and elevated serum levels of these autoantibodies.” Amusingly, Shoenfeld did some fancy tap dancing in the discussion to try to hide the obvious conclusion that this study showed an interesting, but almost certainly clinically insignificant and irrelevant result:

We further evaluated the correlation between elevated levels of autoantibodies and various clinical manifestations. There was no significant association between the major symptoms including dysautonomic symptoms and serum levels of autoantibodies; in the present study the time of blood sampling after the first vaccination or after the onset of illness considerably varied among the patients examined. The time difference for the former was approximately 3 years and that for the latter was approximately 2 years on an average, indicating that very limited number of patients provided serum samples at the peak of clinical symptoms. Thus, it might be difficult to validate that some symptoms were statistically related to elevated serum levels of autoantibodies. On the contrary, it has been shown that the serum levels of autonomic nerve receptor related autoantibodies were high in the patients at the early stage of illness, and they probably tended to decrease with the time courses of illness, although we did not check the serial serum levels of these autoantibodies in the patients. Therefore, we considered that high serum levels of autonomic nerve receptor-related autoantibodies in the patients were up regulated by HPV vaccination.

This is basically some fancy excuse making, and Shoenfeld didn’t check serial samples. Also, the average time to onset of the illness after HPV vaccination was two years, but we know it must have been the HPV vaccination causing it because, well, we just know. Never mind that there wasn’t a statistically significant correlation between autoantibody levels and illness, even though we tested every autoantibody we could think of!

Having abused immunology through his parroting of bad science blaming molecular mimicry for ASIA and aluminum adjuvants for everything while cherry picking epidemiological studies, RFK Jr. concludes with a rant about HPV vaccination, including all the old tropes:

From the beginning, manufacturers and officials have relied on gimmicks to promote HPV vaccination while distracting the public from the tsunami of adverse events that has followed in the vaccines’ wake. It is unlikely that we will hear anything about a just-published South Korean study describing almost 100 safety signals among the nearly 4800 HPV-vaccine-related adverse events reported to the Korea Adverse Event Reporting System database between 2005 and 2016; 19 types of serious adverse events were not even listed on the country’s HPV vaccine inserts. The 19 are: neuralgia, tremor, neuritis, depersonalization, axillary pain, personality disorder, increased salivation, peptic ulcer, circulatory failure, hypotension, peripheral ischemia, cerebral hemorrhage, micturition disorder, facial edema, ovarian cyst, weight increase, pain anxiety, oral edema, and back pain.

I looked at that study and can’t help but note that it doesn’t identify causality of any of these adverse events, even concluding, “These results also suggest potential research directions such as vaccination label expansion, pharmacovigilance studies, and identification of causality in AEs associated with HPV vaccination.” I also can’t help but repeat yet again that there are large studies involving millions of patients showing that AEs like this are not more common in HPV vaccinated people than in the general population. We have copious evidence that the HPV vaccination is safe and effective.

RFK Jr. is nothing, if not persistent. He claims he’s “not antivaccine” and even sometimes that he’s “fiercely pro-vaccine,” but he never publishes or says a single good thing about vaccination except for the occasional perfunctory acknowledgment that they do prevent disease, which is inevitably followed by rants about all the horrible things he attributes to them. Now he’s spreading misinformation about the HPV vaccine based on bad science and pseudoscience, in particular from Yehuda Shoenfeld. Now, with the impending release of the sequel to VAXXED, for which RFK Jr. is a “featured expert” (try not to laugh too hard), along with Andrew Wakefield, and executive producer, he’s set to take his fear mongering to another level.