Praharaj Ira, John Sushil M, Bandyopadhyay Rini, Kang Gagandeep
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India.
Low Cost Effective Care Unit, Christian Medical College, Vellore, Tamil Nadu 632004, India.
Philos Trans R Soc Lond B Biol Sci. 2015 Jun 19;370(1671). doi: 10.1098/rstb.2014.0144.
Orally delivered vaccines have been shown to perform poorly in developing countries. There are marked differences in the structure and the luminal environment of the gut in developing countries resulting in changes in immune and barrier function. Recent studies using newly developed technology and analytic methods have made it increasingly clear that the intestinal microbiota activate a multitude of pathways that control innate and adaptive immunity in the gut. Several hypotheses have been proposed for the underperformance of oral vaccines in developing countries, and modulation of the intestinal microbiota is now being tested in human clinical trials. Supplementation with specific strains of probiotics has been shown to have modulatory effects on intestinal and systemic immune responses in animal models and forms the basis for human studies with vaccines. However, most studies published so far that have evaluated the immune response to vaccines in children and adults have been small and results have varied by age, antigen, type of antibody response and probiotic strain. Use of anthelminthic drugs in children has been shown to possibly increase immunogenicity following oral cholera vaccination, lending further support to the rationale for modulation of the immune response to oral vaccination through the intestinal microbiome.
口服疫苗在发展中国家的表现不佳。发展中国家肠道的结构和管腔环境存在显著差异，导致免疫和屏障功能发生变化。最近使用新开发的技术和分析方法进行的研究越来越清楚地表明，肠道微生物群激活了许多控制肠道固有免疫和适应性免疫的途径。针对口服疫苗在发展中国家表现不佳的情况，已经提出了几种假说，目前正在人体临床试验中测试肠道微生物群的调节作用。在动物模型中，补充特定菌株的益生菌已被证明对肠道和全身免疫反应具有调节作用，并构成了疫苗人体研究的基础。然而，迄今为止发表的大多数评估儿童和成人对疫苗免疫反应的研究规模较小，结果因年龄、抗原、抗体反应类型和益生菌菌株而异。在儿童中使用驱虫药物已被证明可能会增加口服霍乱疫苗后的免疫原性，这进一步支持了通过肠道微生物群调节口服疫苗免疫反应的理论依据。
