Phase II study of D.651, an oral vaccine designed to prevent recurrences of vulvovaginal candidiasis

Levy, Deborah A.; Bohbot, Jean-Marc; Catalán, F; Normier, G.; Pinel, Alexandre; D'Hinterland, L. Dussourd

doi:10.1016/0264-410x(89)90197-7

Cited by 25 publications

(15 citation statements)

References 7 publications

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“…Furthermore, Fidel's group also found a TH1/TH2-independent response providing partial protection against Candida vaginitis following vaccination with heat-treated C. albicans in mice [111] , and others used mannan or mannoprotein extract to elicit increased levels of protective vaginal antibodies against Candida in rats [112 -114] . Already in 1989, a promising phase 2 study showed a dramatic decrease of recurrent attacks of C. albicans vaginitis in humans with RVC taking oral immunotherapeutic tablets based on C. albicans ribosomes, announcing the start of a large phase-3 trial to prove the efficacy of this approach on a large scale [115] . However, to our knowledge, no follow-up data have been published to date.…”

Section: Hormones and Contraceptionmentioning

confidence: 99%

“…Thus, the potential use of antihistamine therapy was suggested [40] . Others have tried to stimulate humoral immune responses with vaccines based on Candida antigens, all with varying successes and none of which leading to clinical applications at this time [41] . However, most of these regimens required intense treatment schedules with weekly injections for prolonged period of time and even then protection did not seem to be long-lasting.…”

Section: Severity Of Diseasementioning

confidence: 99%

“…One of such protein markers of the innate immune response is mannosebinding lectin (MBL), a protein produced mainly in the liver and binding to mannose, N-acetylglucosamine and fucose residues on microbial cell walls. MBL binding to the cell wall facilitates opsonization of phagocytic cells, activates the complement cascade, and results in direct microbial killing and promotion of opsonization via complement receptors [41] . MBL is known to bind to C. albicans and mediates the initial innate immune response against this organism [43,44] .…”

Section: Severity Of Diseasementioning

confidence: 99%

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Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Donders

Bellen²,

Mendling

2010

Gynecol Obstet Invest

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For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate ‘don’t do’s’, unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.

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Section: Hormones and Contraceptionmentioning

confidence: 99%

Section: Severity Of Diseasementioning

confidence: 99%

Section: Severity Of Diseasementioning

confidence: 99%

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Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Donders

Bellen²,

Mendling

2010

Gynecol Obstet Invest

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“…This is further complicated by the fact that a good percentage of antigens at the interface between fungal pathogens and host immunity are modified sugars. It is true that some of the most promising fungal vaccine candidates are protein-based, 8,10,42,43,48,49,51,57,58 but so is the case for vaccines consisting of sugars or glycol-conjugates. [38][39][40] Equating antigenic commonality with vaccine universality may prove problematic at the practical level.…”

Section: Potential Difficultiesmentioning

confidence: 99%

“…7 But failure to translate exciting benchtop findings into useful bedside therapies can be attributed to technical issues as well. 5,8,9 For instance, although certain immunocompetent patients (critically-ill patients, organ transplantation patients, patients with chronic inflammation, etc.) can benefit from antifungal vaccination, the fact remains that the majority of patients in need of vaccination against fungal opportunists are immunocompromised.…”

Section: The Benchtop-bedside Disconnect In Fungal Vaccine Researchmentioning

confidence: 99%