Vaccine-linked chemotherapy: can schistosomiasis control benefit from an integrated approach?
Vaccine-linked chemotherapy: can schistosomiasis control benefit from an integrated approach?
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DOI：
10.1016/j.pt.2005.01.001
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发表时间：
2005-03-01
影响因子：
9.6
通讯作者：
Mitchell, GF
中科院分区：
文献类型：
--
作者：
Bergquist, NR;Leonardo, LR;Mitchell, GF
目前对血吸虫病的严重器官病理学（肝、肾、膀胱）的强调需要被一种更平衡的观点所取代，这种观点还考虑到不太容易评估的全身症状，如生长迟缓、认知发育和持续低水平失血的影响。获得对疾病负担、发病率和死亡率的更好估计所产生的结果，使人们对降低疾病影响的明智性产生疑问。在这种情况下，单纯的药物治疗可能不够，在最坏的情况下，甚至可能加剧病理。为了应对这一挑战，建议通过联合使用化疗和疫苗接种在整个疾病控制中重新定位疫苗，作为一种新的、更通用的控制方法的基础。流行地区人类相关反应的研究已经开辟了通过细胞因子反应和抗体来评估特异性抗原的保护价值的途径。此外，基于新型佐剂的疫苗制剂可以通过选择性操纵免疫应答来改善最终结果。因此，疫苗相关化疗的工具原则上已经可用，并且很快就会在临床试验中进行测试。
The present strong emphasis on gross organ pathology (liver, kidneys, bladder) in schistosomiasis needs to be replaced with a more balanced view of the disease that also takes into account systemic symptoms that are less easy to assess, such as retarded growth, cognitive development and the effect of continuing low-level blood loss. Access to better estimates of disease burdens, morbidity and mortality is delivering results that bring into question the wisdom of downgrading the impact of the disease. In this scenario, the simplistic approach of exclusive drug treatment might not be sufficient and, in the worst-case scenario, might even exacerbate pathology. To meet this challenge, the repositioning of vaccines within the totality of disease control through the combined use of chemotherapy and vaccination is recommended as the basis for a novel, more-versatile approach to control. Studies on human correlate responses in endemic areas have opened the way to assess the protective value of specific antigens through the cytokine responses and antibodies they elicit. Moreover, vaccine formulations based on novel adjuvants could improve the final outcome through selective manipulation of the immune response. Thus, the tools of vaccine-linked chemotherapy are in principle already available and could shortly be put to the test in clinical trials.