Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, QLD, Australia.
Curr Opin Infect Dis. 2020 Jun;33(3):244-250. doi: 10.1097/QCO.0000000000000644.
There is a global need for well tolerated, effective, and affordable vaccines to prevent group A streptococcal infections and their most serious complications. The aim of this review is to highlight the recent progress in the identification of promising vaccine antigens and new approaches to vaccine design that address the complexities of group A streptococcal pathogenesis and epidemiology.
Combination vaccines containing multiple shared, cross-protective antigens have proven efficacious in mouse and nonhuman primate models of infection. The development of complex multivalent M protein-based vaccines is continuing and several have progressed through early-stage human clinical trials. Formulations of vaccines containing universal T-cell epitopes, toll-like receptor agonists, and other adjuvants more potent than alum have been shown to enhance protective immunogenicity. Although the group A streptococcal vaccine antigen landscape is populated with a number of potential candidates, the clinical development of vaccines has been impeded by a number of factors. There are now concerted global efforts to raise awareness about the need for group A streptococcal vaccines and to support progress toward eventual commercialization and licensure.
Preclinical antigen discovery, vaccine formulation, and efficacy studies in animal models have progressed significantly in recent years. There is now a need to move promising candidates through the clinical development pathway to establish their efficacy in preventing group A streptococcal infections and their complications.
综述目的：全球需要可耐受、有效且负担得起的疫苗来预防 A 组链球菌感染及其最严重的并发症。本文旨在强调在鉴定有前途的疫苗抗原和设计新疫苗方法方面的最新进展，这些方法解决了 A 组链球菌发病机制和流行病学的复杂性。
最新发现：在感染的小鼠和非人类灵长类动物模型中，含有多种共享、交叉保护抗原的联合疫苗已被证明有效。复杂的多价 M 蛋白疫苗的开发仍在继续，其中几种已进入早期人体临床试验阶段。含有通用 T 细胞表位、 Toll 样受体激动剂和比铝佐剂更有效的其他佐剂的疫苗配方已被证明可增强保护性免疫原性。尽管 A 组链球菌疫苗抗原领域存在许多潜在候选者，但疫苗的临床开发受到多种因素的阻碍。现在，全球正在共同努力提高对 A 组链球菌疫苗的认识，并支持最终实现商业化和许可的进展。
总结：近年来，在动物模型中的临床前抗原发现、疫苗配方和功效研究方面取得了重大进展。现在需要通过临床开发途径推进有前途的候选疫苗，以确定它们在预防 A 组链球菌感染及其并发症方面的功效。
