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Aluminum hydroxide (Alum) is used as an adjuvant to enhance immunogenicity, while excipients such as phosphate buffers and sodium chloride help maintain isotonicity

However, in addition to the effects described above there are well-documented increases in alveolar oxidative stress 53,58,73-77 and decreased antioxidant levels, 54,55,59,78,79 impairment of surfactant protein D (SP-D) structure and function, 80-82 reduced secretion of antimicrobial peptides, 83-85 impaired transport of IgA into alveolar space, 86 changes to the metabolic profile, 87-89 and alterations in the pulmonary microbiota

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However, the effects vary depending on product concentration, preparation methods, and species, reflecting the complexity of these interventions