Czinn S J
Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA.
Gastroenterology. 1997 Dec;113(6 Suppl):S149-53. doi: 10.1016/s0016-5085(97)80028-5.
Helicobacter pylori has been implicated in the etiology of peptic ulcer disease, chronic gastritis, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Although significant progress has been made in treating this infection with combinations of either antimicrobial agents or antimicrobial agents plus proton pump inhibitors, these antimicrobial-based treatments continue to be suboptimal. Over the past few years it has become increasingly recognized that direct mucosal immunization can induce protection from infection at mucosal surfaces. Therefore, prevention of H. pylori infection by oral immunization is an alternative approach for the control of H. pylori disease. Using the Helicobacter felis mouse model or H. pylori mouse model, both prophylactic and therapeutic oral immunizations have been shown to be effective against H. pylori. In addition, several H. pylori proteins have been identified as potential candidate vaccines, and a phase 1 clinical trial has been completed that demonstrates the safety and tolerability of urease as a vaccine antigen. Such antigens in combination with a safe mucosal adjuvant could be used in the form of an oral vaccine administered during childhood before exposure to H. pylori to prevent infection. In addition, therapeutic immunization alone or as an adjunct to antimicrobial therapy may be capable of achieving a cure rate approaching 100%.
幽门螺杆菌与消化性溃疡病、慢性胃炎、胃癌及胃黏膜相关淋巴组织淋巴瘤的病因有关。尽管在使用抗菌药物或抗菌药物加质子泵抑制剂联合治疗这种感染方面已取得显著进展，但这些基于抗菌药物的治疗仍不尽人意。在过去几年中，人们越来越认识到直接黏膜免疫可诱导黏膜表面免受感染。因此，通过口服免疫预防幽门螺杆菌感染是控制幽门螺杆菌病的一种替代方法。利用猫幽门螺杆菌小鼠模型或幽门螺杆菌小鼠模型，预防性和治疗性口服免疫均已证明对幽门螺杆菌有效。此外，几种幽门螺杆菌蛋白已被确定为潜在的候选疫苗，并且已经完成了一项1期临床试验，证明脲酶作为疫苗抗原的安全性和耐受性。此类抗原与安全的黏膜佐剂联合，可制成口服疫苗的形式，在儿童接触幽门螺杆菌之前进行接种以预防感染。此外，单独进行治疗性免疫或作为抗菌治疗的辅助手段，可能能够实现接近100%的治愈率。
