Reply to: Hasman A and Holm S. Nicotine conjugate vaccine: is there a right to a smoking future?

A Hasman and S Holm have evaluated in a recent article in this journal¹ the arguments in favour and against the preventive use of an antinicotine vaccine. This has been a timely article in view of the fact that at least three companies are in advanced stages of clinical trials.

The authors refer to the beneficial effects of nicotine in inflammatory bowel disease² and state that “Vaccinating a child against nicotine will not only prevent smoking but also restrict therapeutic options in later life”. We think the second part of this statement has so far not been experimentally verified and is less obvious than it may seem.

It is certainly true, that the antinicotine antibodies elicited by the antinicotine vaccine retain the nicotine molecules after challenge, as shown in numerous animal models.³ The vicious circle at the centre of addiction is based on stimulation and instant gratification and the vaccine studies have therefore focused on the fate of the nicotine molecule immediately after nicotine challenge. The interaction of nicotine with the antibody is, however, reversible and the long term fate of the nicotine molecule and its metabolites have not been so well investigated.