Vaccine development for hepatitis C.

Given the global disease burden and public health impact of hepatitis C, the development of an effective vaccine is of paramount importance. However, many challenging obstacles loom ahead of this goal. The hepatitis C virus (HCV), being an RNA virus, can mutate rapidly in adaptation to the environment, thus contributing to the high sequence divergence of multiple viral isolates in the world. The highest heterogeneity has been found in the hypervariable region of the envelope glycoprotein 2, which contains a principal neutralization epitope. HCV also causes persistent infection in a high percentage of immunocompetent hosts despite active immune response. The lack of an efficient tissue culture system for propagating HCV and testing neutralizing antibodies adds further complexity to the task of vaccine development. The immunologic correlates associated with disease progression or protection are yet to be defined, but recent studies suggest that a vigorous multispecific cellular immune response is important in the resolution of infection. Induction of high-titer, long-lasting, and cross-reactive antienvelope antibodies and a vigorous multispecific cellular immune response that includes both helper and cytotoxic T lymphocytes may be necessary for an effective vaccine. Several promising approaches have been used to develop an HCV vaccine. Novel vaccine candidates based on molecular technology such as recombinant proteins, peptides, viruslike particles, naked DNA, and recombinant viruses are being explored. The final vaccine product may require multiple components that target various aspects of protective immunity. Finally, sterilizing immunity may not be necessary if a vaccine can be developed to prevent chronic infection, which is the major cause of morbidity and mortality from this disease.