The need and challenges for development of an Epstein-Barr virus vaccine

• Type of Material: Article
• Authors: Jeffrey I. Cohen, National Institute of Allergy and Infectious Diseases; Edward S Mocarski, Emory University; Nancy Raab-Traub, University of North Carolina; Lawrence Corey, Fred Hutchinson Cancer Research Center; Gary J. Nabel, National Institute of Allergy and Infectious Diseases
• Language: English
• Date: 2013-04-18
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 .
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2012.09.041
• Title of Journal or Parent Work: Vaccine
• ISSN: 0264-410X
• Volume: 31
• Issue: SUPPL2
• Start Page: B194
• End Page: B196
• Grant/Funding Information: Jeffrey Cohen is supported by the intramural research program of the National Institute of Allergy and Infectious Diseases.
• Keywords: Science & Technology; PHASE-I TRIAL; Life Sciences & Biomedicine; Medicine, Research & Experimental; LYMPHOMA; Immunology; Burkitt lymphoma; Research & Experimental Medicine; Infectious mononucleosis; Nasopharyngeal carcinoma; Hodgkin lymphoma; HUMANS; INFECTION; GP350 VACCINE; Gastric carcinoma; Epstein-Barr virus
• Research Categories: Health Sciences, Oncology; Health Sciences, Immunology

Abstract

Epstein-Barr virus (EBV) is the major cause of infectious mononucleosis and is associated with several malignancies including nasopharyngeal carcinoma, gastric carcinoma, Hodgkin lymphoma, Burkitt lymphoma, and lymphoma after organ or stem cell transplant. A candidate vaccine containing soluble EBV glycoprotein gp350 protected cottontop tamarins from EBV lymphoma after challenge with EBV. In the only phase 2 trial of an EBV vaccine in humans, soluble gp350 in alum and monophosphoryl lipid A adjuvant reduced the rate of infectious mononucleosis in EBV seronegative adults, but did not affect the rate of EBV infection. A peptide vaccine corresponding to EBV latency proteins has been tested in a small number of adults to prevent infectious mononucleosis. Some of the barriers to development of an EBV vaccine include (a) whether viral proteins in addition to gp350 would be more effective for preventing mononucleosis or EBV malignancies, (b) the difficulty of performing clinical trials to prevent EBV associated malignancies in the absence of good surrogate markers for tumor development, and the long period of time between primary EBV infection and development of many EBV tumors, (c) the lack of knowledge of immune correlates for protection against EBV infection and disease, (d) the limitations in animal models to study protection against EBV infection and disease, and (e) the need for additional information on the economic and societal burden of infectious mononucleosis to assess the cost-benefit of a prophylactic vaccine.