基于B群脑膜炎奈瑟球菌候选抗原进行疫苗开发的研究进展

流行性脑脊髓膜炎（流脑）是一种由脑膜炎奈瑟球菌引发的严重呼吸道传染病。随着脑膜炎球菌多糖疫苗和多糖-蛋白质结合疫苗的应用,大部分于人群中广泛流行的致病性脑膜炎奈瑟球菌（血清A、C、W135、Y群）已得到了有效控制。然而,这也导致B群脑膜炎奈瑟球菌引发的流脑的占比增多。此文综述了目前已发现的B群脑膜炎球菌疫苗候选抗原,以及基于这些抗原已经获批和正在研发的B群脑膜炎球菌疫苗,以期帮助研究人员进行新型B群脑膜炎球菌疫苗的研发。     

脑膜炎球菌疫苗的研究和开发现状

流行性脑脊髓膜炎(流脑)是一个世界性公共卫生问题,发病率和死亡率都较高.此文从细菌遗传学特征、流脑的流行趋势、疫苗供应现状、可供选择的候选疫苗及其筛选方法等方面讨论了脑膜炎球菌疫苗(特别是B群脑膜炎球菌疫苗)的研究和开发现状.     

B群脑膜炎球菌疫苗的研究现状及挑战

疫苗的免疫接种是预防传染病的最有效方法之一。近年以来随着生物技术迅猛发展,B群脑膜炎球菌疫苗的研究也取得了突破性发展,应用反向疫苗学技术开发的新型B群脑膜炎球菌疫苗已陆续被欧洲医药管理局和美国食品和药品管理局批准上市。尽管目前国内尚未批准相关产品上市,但一些企业和研究院所已在加紧研发。为了进一步了解B群脑膜炎球菌疫苗,推动国内B群脑膜炎球菌疫苗的研发,综述不同类型B群脑膜炎球菌疫苗的研究现状及其面临的挑战。     

疫苗研究与开发:脑膜炎球菌病

本文对抗脑膜炎球菌病疫苗的研究开发现状进行综述.该病由脑膜炎球菌引起,它是导致严重脑膜炎和败血症的主要病因,具有流行性.大部分疾病由五个血清群(A、B、C、Y和W135)引起,而A群仍是唯一导致大规模流行的血清群,主要发生在非洲,在亚洲也有流行.欧洲和美洲大部分病例由B群和C群引起.b型流感嗜血杆菌(Hib)和肺炎链球菌结合疫苗的成功经验为开发预防脑膜炎球菌病的多糖结合疫苗铺平了道路.欧洲几个国家C群结合疫苗的广泛接种证明这种疫苗具有免疫原性,可以诱导免疫记忆,降低带菌率,为普通人群带来群体免疫.开发中的一种价廉的单价A群结合疫苗为消灭非洲国家大规模流行带来了希望.多价(A、C、Y、W135)结合疫苗也在开发中,一种已被批准.B群外膜蛋白疫苗正在开发.没有B群疫苗将难以在全球有效预防脑膜炎球菌病.     

B群脑膜炎球菌疫苗研究进展

 脑膜炎球菌是引起流行性脑脊髓膜炎的主要病原菌,是全球重要的公共卫生问题。目前仍缺少安全有效的疫苗用于控制和预防B群脑膜炎球菌引起的感染。此文对B群脑膜炎球菌疫苗研究进展及存在问题进行综述。     

ACYW135群脑膜炎球菌多糖疫苗的研制

目的 通过研究冷酚与粗糖的混合比例、粗糖提纯时的质量浓度和乳糖保护剂的用量来制备符合规定的ACYW135群脑膜炎球菌多糖疫苗.方法 发酵细菌,提取A、C、W135、Y群脑膜炎球菌多糖粗制品,以不同的纯化工艺纯化A、C、W135、Y群脑膜炎球菌多糖.将4种纯化的多糖原液按一定比例混合,加入乳糖作为保护剂,冷冻干燥制成ACYW135群脑膜炎球菌多糖疫苗.结果 通过比较不同纯化工艺制备的多糖,确定最佳提纯条件为多糖与冷酚的体积比为1∶1,粗糖提纯时的质量浓度为6 g/L.检测按此纯化条件制备的ACYW135群脑膜炎球菌多糖疫苗显示,3批疫苗的水分含量分别为1.7％、2.0％和2.1％,疫苗的A、C、W135、Y群脑膜炎球菌多糖含量和回收率分别都≥50 μg/剂和80％,符合相关规定的要求.结论 按确定的工艺成功制备ACYW135群脑膜炎球菌多糖疫苗.     

WHO关于脑膜炎球菌疫苗的意见书

此文介绍了脑膜炎球菌病的流行病学、目前国际上使用的脑膜炎球菌多糖疫苗和多糖蛋白结合疫苗的免疫效果和使用疫苗的成本效益以及WHO对使用该疫苗的建议.     

脑膜炎球菌疫苗

本文讨论了脑膜炎球菌疫苗的研制现状和效力.重点讨论了采用传统和逆向疫苗学方法研制的B群脑膜炎球菌疫苗的效力.     

脑膜炎球菌疫苗

本文讨论了脑膜炎球菌疫苗的研制现状和效力.重点讨论了采用传统和逆向疫苗学方法研制的B群脑膜炎球菌疫苗的效力.     

B群脑膜炎球菌疫苗开发与临床前评价（待续）

脑膜炎球菌（Neisseria meningitidis,Nm）感染可导致流行性脑脊髓膜炎和败血症,有较高的病死率.荚膜多糖及多糖结合疫苗能有效控制A、C、W135和Y群Nm感染,而对B群Nm （MenB）感染的预防,只有外膜囊泡疫苗在局部地区取得成功.目前,针对MenB疫苗的研究以外膜蛋白为基础.此文对MenB疫苗的研发进展及临床前研究中的几个关键评价指标进行综述.     

B群脑膜炎球菌疫苗开发与临床前评价（续）

脑膜炎球菌（Neisseria meningitidis,Nm）感染可导致流行性脑脊髓膜炎和败血症,有较高的病死率.荚膜多糖及多糖结合疫苗能有效控制A、C、W135和Y群Nm感染,而对B群Nm （MenB）感染的预防,只有外膜囊泡疫苗在局部地区取得成功.目前,针对MenB疫苗的研究以外膜蛋白为基础.此文对MenB疫苗的研发进展及临床前研究中的几个关键评价指标进行综述.     

Treatment strategies for central nervous system infections

Central nervous system (CNS) infections continue to be an important cause of mortality and morbidity. Current strategies for prevention and therapy of CNS infection are compromised by incomplete understanding of the microbial–host interactions that contribute to its pathogenesis and emergence of antimicrobial-resistant microorganisms. Our development of successful strategies in prevention and treatment of bacterial meningitis requires multifactorial concepts and approaches, which include advances in vaccinology, epidemiology of meningitis, emergence of antimicrobial-resistant pathogens, knowledge of pharmacokinetics and pharmacodynamics of antimicrobial agents, as well as the pathogenesis of meningitis. Prevention of bacterial meningitis targeting microbes has been effective, such as vaccination. The introduction of the protein conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis has changed the epidemiology of bacterial meningitis. Antimicrobial chemoprophylaxis is efficacious in prevention against H. influenzae type b and N. meningitidis meningitis. Suspected bacterial meningitis is a medical emergency and requires empiric antimicrobial therapy without delay, but recognition of pathogens with increasing resistance to antimicrobial agents is an important factor in selection of empiric antimicrobial regimen. A more complete understanding of the microbial–host interactions that are involved in the pathogenesis of CNS infections and associated neurologic sequelae is likely to help in developing new strategies for prevention and therapy of CNS infection.     

Treatment of bacterial meningitis: an update

Introduction: The introduction of protein conjugate vaccines for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (S. pneumoniae) and Neisseria meningitidis (N. menigitidis) has changed the epidemiology of bacterial meningitis. Bacterial meningitis continues to be an important cause of mortality and morbidity, and our incomplete knowledge of its pathogenesis and emergence of antimicrobial resistant bacteria contribute to such mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis.

Areas covered: This article gives an overview on optimal treatment strategies of bacterial meningitis, along with considerations of new insights on epidemiology, clinical and laboratory findings supportive of bacterial meningitis, chemoprophylaxis, selection of initial antimicrobial agents for suspected bacterial meningitis, antimicrobial resistance and utility of new antibiotics, status on anti-inflammatory agents and adjunctive therapy, and pathogenesis of bacterial meningitis.

Expert opinion: Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood–brain barrier (BBB), with efficacy in cerebrospinal fluid (CSF). Several new antibiotics have been introduced for the treatment of meningitis caused by resistant bacteria, but their use in human studies has been limited. More complete understanding of the microbial and host interactions that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.     

Acute bacterial meningitis in infants and children: epidemiology and management

Acute bacterial meningitis (ABM) continues to be associated with high mortality and morbidity, despite advances in antimicrobial therapy. The causative organism varies with age, immune function, immunization status, and geographic region, and empiric therapy for meningitis is based on these factors. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis cause the majority of cases of ABM. Disease epidemiology is changing rapidly due to immunization practices and changing bacterial resistance patterns. Hib was the leading cause of meningitis in children prior to the introduction of an effective vaccination. In those countries where Hib vaccine is a part of the routine infant immunization schedule, Hib has now been virtually eradicated as a cause of childhood meningitis. Vaccines have also been introduced for pneumococcal and meningococcal diseases, which have significantly changed the disease profile. Where routine pneumococcal immunization has been introduced there has been a reported increase in invasive pneumococcal disease due to non-vaccine serotypes. In those parts of the world that have introduced conjugate meningococcal vaccines, there has been a significant change in the epidemiology of meningococcal meningitis. As a part of the United Nations Millennium Development Goal 4, the WHO has introduced a new vaccine policy to improve vaccine availability in resource poor countries. In addition, antibiotic resistance is an increasing problem, especially with pneumococcal infection. Effective treatment focuses on early recognition and use of effective antibiotics. This review will attempt to focus on the changing epidemiology of ABM in pediatric patients due to vaccination, the changing patterns of infecting bacterial serotypes due to vaccination, and on antibiotic resistance and its impact on current management strategies.     

Aetiology of bacterial meningitis and resistance to antibiotics of causative pathogens in Europe and in the Mediterranean region

Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b are most commonly associated with bacterial meningitis accounting for almost 90% of reported cases of acute bacterial meningitis in infants over 60 days of age and young children. This work reviews the epidemiology of bacterial meningitis in Europe and in the Mediterranean region as well as the antimicrobial susceptibility of the etiological agents.     

应用双向电泳分析结核性脑膜炎与隐球菌性脑膜炎脑脊液的蛋白差异

目的 比较分析结核性脑膜炎(TBM)与隐球菌性脑膜炎脑脊液的差异蛋白质,筛选二者的鉴别诊断标志物.方法 采用双向凝胶电泳技术对4例TBM和4例隐球菌性脑膜炎脑脊液蛋白进行电泳分离,以PDQuest8.0软件根据蛋白的等电点PI、分子量、匹配率、灰度值等进行差异蛋白描述性分析.结果 结核性、隐球菌性两组脑脊液分别检测到蛋白点数为111和114,蛋白点分子量均分布为10～130 kDa,等电点PI为4.4～6.7间.两组脑脊液蛋白图谱匹配率为95％,产生24个差异蛋白点,其中3个蛋白点只在TBM中表达,2个蛋白点只在隐球菌性脑膜炎中表达,19个匹配蛋白点存在2倍差异表达.结论 双向电泳技术可得到分辨率和重复率较高的结核性与隐球菌性脑膜炎脑脊液蛋白质凝胶图谱,二者存在差异蛋白点.     

New therapies and vaccines for bacterial meningitis

Acute bacterial meningitis remains an important cause of morbidity and mortality worldwide. There have recently been major advances in the prevention of the major causes of bacterial meningitis following improvements in vaccinology. The success of immunisation against Haemophilus influenzae type b infection is being mirrored with serogroup C conjugated meningococcal vaccine and pneumococcal conjugate vaccine. However, there remain major challenges, notably, serogroup B meningococcal infection and shifts in epidemiology caused by vaccine introduction. In addition, much of the world’s population is unvaccinated. Therefore, improvements in management of acute bacterial meningitis are vital. In this review we attempt to summarise important advances in both prevention and treatment of acute bacterial meningitis.     

New therapies and vaccines for bacterial meningitis

Acute bacterial meningitis remains an important cause of morbidity and mortality worldwide. There have recently been major advances in the prevention of the major causes of bacterial meningitis following improvements in vaccinology. The success of immunisation against Haemophilus influenzae type b infection is being mirrored with serogroup C conjugated meningococcal vaccine and pneumococcal conjugate vaccine. However, there remain major challenges, notably, serogroup B meningococcal infection and shifts in epidemiology caused by vaccine introduction. In addition, much of the world's population is unvaccinated. Therefore, improvements in management of acute bacterial meningitis are vital. In this review we attempt to summarise important advances in both prevention and treatment of acute bacterial meningitis.     

亚裔高发鼻咽癌的遗传学特征与华人易感性解析

世界上80%的鼻咽癌患者在中国,鼻咽癌的流行病学和分子生物学显示的华人易感性使与鼻咽癌相关的研究在发达的工业国家相对被忽略。作为华人易感性恶性肿瘤,鼻咽癌给我国局部地区的居民带来了严重危害。文中主要针对鼻咽癌作为一种多基因遗传性肿瘤发病的遗传学基础进行综述。包括鼻咽癌流行病学、分子生物学和细胞遗传学特征与华人易感性分析,为抗鼻咽癌药物的研发打下基础。