An Update on Tuberculosis Vaccines
An Update on Tuberculosis Vaccines
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DOI：
10.1007/978-1-0716-1884-4_20
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发表时间：
2022-01-01
期刊：
影响因子：
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通讯作者：
Subbian, Selvakumar
中科院分区：
文献类型：
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作者：
Gopalaswamy, Radha;Subbian, Selvakumar
由结核分支杆菌（Mtb）引起的结核病（TB）是单一传染病原导致死亡和发病的主要原因。Mtb的气溶胶感染可导致从消除、活动性、初期、亚临床和潜伏性Mtb感染（LTBI）的一系列应答，这取决于宿主的免疫应答以及感染杆菌的剂量和性质。目前，BCG是唯一被批准用于预防结核病的疫苗。虽然卡介苗可以预防严重的儿童结核病，但它在成人和患有艾滋病毒感染等共病的人中的使用值得怀疑。新的疫苗，包括重组卡介苗（rBCG），被开发出来，以提高卡介苗的疗效和使用作为一种替代卡介苗在一个脆弱的人群。第一代rBCG疫苗具有不同的Mtb抗原，并作为初免、初免-加强或免疫干预进行了测试。新型疫苗针对以下要求中的一个或多个，即预防感染（POI）、预防疾病（POD）、预防复发（POR）和治疗TB疾病的治疗性疫苗。目前正在开发的几种候选疫苗分为四个主要类别：减毒活全细胞疫苗、灭活全细胞疫苗、佐剂化蛋白亚单位疫苗和病毒载体疫苗。每种疫苗的免疫原性、安全性和有效性都在临床前动物模型中进行了测试，并通过临床试验的各个阶段进行了进一步验证。本章总结了不同临床试验阶段的各种结核病候选疫苗，并承诺更好地预防结核病。
Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a leading cause of mortality and morbidity due to a single infectious agent. Aerosol infection with Mtb can result in a range of responses from elimination, active, incipient, subclinical, and latent Mtb infections (LTBI), depending on the host's immune response and the dose and nature of infecting bacilli. Currently, BCG is the only vaccine approved to prevent TB. Although BCG confers protection against severe forms of childhood TB, its use in adults and those with comorbid conditions, such as HIV infection, is questionable. Novel vaccines, including recombinant BCG (rBCG), were developed to improve BCG's efficacy and use as an alternative to BCG in a vulnerable population. The first-generation rBCG vaccines had different Mtb antigens and were tested as a prime, prime-boost, or immunotherapeutic intervention. The novel vaccines target one or more of the following requirements, namely prevention of infection (POI), prevention of disease (POD), prevention of recurrence (POR), and therapeutic vaccines to treat a TB disease. Several vaccine candidates currently in development are classified into four primary categories: live attenuated whole-cell vaccine, inactivated whole-cell vaccine, adjuvanted protein subunit vaccine, and viral-vectored vaccine. Each vaccine's immunogenicity, safety, and efficacy are tested in preclinical animal models and further validated through various phases of clinical trials. This chapter summarizes the various TB vaccine candidates under different clinical trial stages and promises better protection against TB.