Correale Jorge, Fiol Marcela
Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina.
Curr Opin Mol Ther. 2009 Aug;11(4):463-70.
Even though the etiology of multiple sclerosis (MS) remains largely unknown, research data support the hypothesis that autoimmunity plays a major role in disease development. Several disease-modifying agents have been approved for the treatment of MS; however, there is still a need for antigen-specific treatments that combine efficacy and safety. DNA vaccination represents a new therapeutic alternative in this respect. Preclinical studies in different models of autoimmunity have demonstrated that injection of plasmid DNA encoding a self-antigen in mice restores self-tolerance, leaving immunity against infectious and tumor antigens intact. Based on this evidence, the first DNA vaccine for MS has been created. Bayhill Therapeutic Inc's BHT-3009 encodes full-length, human myelin basic protein (MBP), and has recently been evaluated in a phase I/II and a phase II clinical trial. BHT-3009 was safe and well tolerated in both trials, inducing immune tolerance that extended beyond MBP to other myelin antigens. In addition, a reduction in the number of active lesions was observed, which was accompanied by a decrease in clinical relapse rates, particularly in patients with high immunological activity at baseline. BHT-3009 appears to be a promising new approach for the treatment of MS, although further clinical trials are warranted to confirm the early findings.
尽管多发性硬化症(MS)的病因在很大程度上仍不明确,但研究数据支持自身免疫在疾病发展中起主要作用这一假说。几种疾病修正药物已被批准用于治疗MS;然而,仍需要兼具疗效和安全性的抗原特异性治疗方法。在这方面,DNA疫苗代表了一种新的治疗选择。在不同的自身免疫模型中进行的临床前研究表明,向小鼠注射编码自身抗原的质粒DNA可恢复自身耐受性,同时保持对感染性抗原和肿瘤抗原的免疫力。基于这一证据,首个用于MS的DNA疫苗已研制成功。贝希尔治疗公司的BHT-3009编码全长人髓鞘碱性蛋白(MBP),最近已在一项I/II期和一项II期临床试验中进行了评估。在两项试验中,BHT-3009均安全且耐受性良好,诱导的免疫耐受不仅针对MBP,还扩展到了其他髓鞘抗原。此外,观察到活动性病灶数量减少,同时临床复发率降低,尤其是基线免疫活性较高的患者。BHT-3009似乎是一种有前景的MS治疗新方法,不过仍需进一步的临床试验来证实早期研究结果。