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Chapter 12 : Vaccines and Passive Immunity against Candidiasis
Category: Fungi and Fungal Pathogenesis; Clinical Microbiology
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This chapter reviews the rationale for and latest advances in development of passive and active immunization against invasive candidal infections. The major form of immunosuppression that predisposes to development of disseminated candidiasis is a defect in innate phagocytic activity. Treatment with antibiotics is the most promising risk factor to identify a high attack rate of vulvovaginal candidiasis (VVC) as a basis for enrollment into clinical trials of an active vaccine. Development of a vaccine for oropharyngeal candidiasis (OPC) in patients with human immunodeficiency virus (HIV)/AIDS is complicated by the host immunosuppression and by the fact that effective immune reconstitution therapy is now available for most patients. The majority of patients at risk for disseminated candidiasis are those undergoing emergent or elective gastrointestinal or cardiac surgery, those with central venous catheters, those receiving broad-spectrum antibiotics, or in general those patients receiving their care in intensive care units, including both civilian and military trauma patients receiving abdominal, chest, or burn wounds. Passive immunization strategy focusing on β- glucan has been based upon raising protective antibodies by actively vaccinating with β-glucan conjugated to a carrier protein. To determine the potential for an Als3-based vaccine, the recombinant N terminus of Als3p (rAls3p-N) was expressed in Saccharomyces cerevisiae and purified by Ni-agarose affinity purification, in the same manner as described for rAls1p-N. The concept of niche vaccination of acutely at-risk patients or patients in restricted geographical areas is a new idea in vaccinology.
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