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The mechanism of how aluminum hydroxide exerts its beneficial effects is still not fully understood. Current explanations for the mode of action of aluminum hydroxide include the repository effect, pro-phagocytic effect, and activation of the pro-inflammatory NLRP3 pathway. These mechanisms collectively stimulate innate as well as acquired immune responses and activate the complement system.
Factors that influence the responses evoked by aluminum hydroxide include adsorption rate, strength of adsorption, size and uniformity of aluminum hydroxide particles, dosage of adjuvant, and the nature of antigens. Aluminum hydroxide was known to preferentially prime Th2-type immune responses, but more recent studies show that depending on the vaccination route, aluminum hydroxide can enhance both Th1 and Th2 cellular responses.
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