More recently, an intramuscularly administered trivalent vaccine (recombinant CagA, VacA, and neutrophil-activating protein) was developed, but although these antigens were recognized by the host’s cellular and humoral immune systems, there was no immunity in a challenge model [40]. Several manuscripts published this past year address novel antigens and adjuvants,

and some focus on specific epitopes in isolation or as part of a multi-epitope DNA construct. Nevertheless, there continues to be an enormous gap in knowledge translation, with all the studies below performed in small animal models and no report on any vaccine study in humans. Chen et al. [41] synthesized an H. pylori oipA DNA construct as a therapeutic vaccine delivered by attenuated Salmonella typhimurium in the C57BL/6 mouse model Akt inhibitor of H. pylori strain SS1 infection. To increase expression, the oipA gene was codon-optimized for mammalian cell expression, resulting in a 2-log reduction of H. pylori colonization, with

sterilizing immunity achieved U0126 in three of 10 mice. H. pylori LPS is relatively nontoxic but may promote autoimmune responses. Based upon the utility of polysaccharide-based conjugate vaccines for some other bacterial pathogens, Altman et al. [42] chemically modulated H. pylori LPS by delipidation and conjugation, to enhance immunogenicity. Administered prophylactically, this antigen induced enhanced antibody responses and a modest reduction in gastric H. pylori load. Two groups tested H. pylori antioxidant proteins in the standard mouse model, demonstrating partial protection for both alkyl hydroperoxide reductase (AhpC) [43] and a trivalent superoxide dismutase/catalase/thiol

peroxidase preparation [44]. AhpC was beneficial check details only when administered subcutaneously with alum, but the trivalent vaccine was successful intranasally with cholera toxin. Mannosylation generally improves antigen presentation, but the protection afforded by mannosylated AhpC was no better than with the native protein [43]. Four publications addressed epitope-specific strategies. Based upon the relative immunodominance of H. pylori Lpp20 outer membrane lipoprotein in immunized rabbit antiserum, Li et al. [45] primed BALB/c mice with recombinant Lpp20 and measured splenic T-cell responses to eight peptides predicted in silico to be Lpp20 epitopes. Two were immunogenic, as evidenced by proliferation and cytokine secretion assays. Furthermore, they were HLA restricted, and their effects were additive. Based upon their prior murine studies of a multi-T-cell epitope construct against urease B, dominant UreB T-cell epitopes were identified in two H. pylori-infected patients [46]. Each subject had dominant HLA-restricted T-cell responses to different regions of UreB, as identified by peptide stimulation in vitro. Whether this approach is generally applicable, and whether haplotype-specific vaccine development is practical, remains to be determined.