Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD 20892, USA.
Vaccine. 2013 Apr 18;31 Suppl 2(0 2):B194-6. doi: 10.1016/j.vaccine.2012.09.041.
Epstein-Barr virus (EBV) is the major cause of infectious mononucleosis and is associated with several malignancies including nasopharyngeal carcinoma, gastric carcinoma, Hodgkin lymphoma, Burkitt lymphoma, and lymphoma after organ or stem cell transplant. A candidate vaccine containing soluble EBV glycoprotein gp350 protected cottontop tamarins from EBV lymphoma after challenge with EBV. In the only phase 2 trial of an EBV vaccine in humans, soluble gp350 in alum and monophosphoryl lipid A adjuvant reduced the rate of infectious mononucleosis in EBV seronegative adults, but did not affect the rate of EBV infection. A peptide vaccine corresponding to EBV latency proteins has been tested in a small number of adults to prevent infectious mononucleosis. Some of the barriers to development of an EBV vaccine include (a) whether viral proteins in addition to gp350 would be more effective for preventing mononucleosis or EBV malignancies, (b) the difficulty of performing clinical trials to prevent EBV associated malignancies in the absence of good surrogate markers for tumor development, and the long period of time between primary EBV infection and development of many EBV tumors, (c) the lack of knowledge of immune correlates for protection against EBV infection and disease, (d) the limitations in animal models to study protection against EBV infection and disease, and (e) the need for additional information on the economic and societal burden of infectious mononucleosis to assess the cost-benefit of a prophylactic vaccine.
EB 病毒（EBV）是传染性单核细胞增多症的主要病因，与几种恶性肿瘤有关，包括鼻咽癌、胃癌、霍奇金淋巴瘤、伯基特淋巴瘤和器官或干细胞移植后的淋巴瘤。一种含有可溶性 EBV 糖蛋白 gp350 的候选疫苗可保护棉顶狨猴免受 EBV 淋巴瘤的侵袭。在人类中进行的唯一一项 EBV 疫苗的 2 期临床试验中，铝佐剂和单磷酰脂质 A 佐剂中的可溶性 gp350 降低了 EBV 血清阴性成年人传染性单核细胞增多症的发生率，但并未影响 EBV 感染率。针对 EBV 潜伏蛋白的肽疫苗已在少数成年人中进行了测试，以预防传染性单核细胞增多症。开发 EBV 疫苗的一些障碍包括：(a) 是否除 gp350 以外的病毒蛋白对预防单核细胞增多症或 EBV 恶性肿瘤更有效；(b) 在缺乏肿瘤发展良好替代标志物的情况下，进行临床试验以预防 EBV 相关恶性肿瘤的难度，以及从原发性 EBV 感染到许多 EBV 肿瘤发展的时间较长；(c) 缺乏针对 EBV 感染和疾病的免疫相关性的知识；(d) 动物模型研究预防 EBV 感染和疾病的局限性；以及 (e) 需要更多关于传染性单核细胞增多症的经济和社会负担的信息，以评估预防性疫苗的成本效益。
