Preventive and therapeutic vaccines against Helicobacter pylori: current status and future challenges

Approximately 50% of humanity is infected with Helicobacter pylori. Normally, this is a life-long infection indicating that the host response to natural infection fails to yield protective immunity. Moreover, the chronic inflammatory response associated with this infection can contribute to tissue damage and the pathogenesis of gastroduodenal disease including atrophic gastritis, peptic ulcer and gastric cancer. These damaging immune responses are attributed to a subset of helper T cells, so-called Th1 cells, that enhance cell-mediated immunity and induce damage to the gastric epithelium. Thus, it is desirable to have effective vaccines that could prevent and cure infection or at least, modify the host response in a manner that prevents immune-mediated disease. Using animal models as a tool to understand the immunobiology of Helicobacter infections, several investigators have shown that effective vaccines can be developed. Thus, prophylactic and even therapeutic vaccines have been described in various animal models. The basis for the effectiveness of these vaccines seems to be found in their ability to alter the gastric immune response, perhaps away from a homogeneous Th1 response towards a mixed Th1 and Th2 response. Using these encouraging approaches, vaccines are being developed for use in humans for the treatment and prevention of H. pylori infection and the gastroduodenal diseases associated with this infection.