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A caries vaccine is a vaccine to prevent and protect against tooth decay.[1] Streptococcus mutans (S. mutans) has been identified as the major etiological agent of human dental caries. Several types of vaccines are being developed at research centers. Development of a vaccine for tooth decay has been under investigation for more than 30 years. In 1972 a caries vaccine was said to be in animal testing in England, and that it would have begun human testing soon.[2] Intrinsic difficulties in developing it, coupled with lack of strong economic interests, are the reasons why no such vaccine is commercially available as of November 2009[update].
[edit] Attempts using AntibodiesEarly attempts followed a traditional approach to vaccination where normal S. mutans was introduced to promote a reaction from the immune system, stimulating antibody production.[3] The corporation Planet Biotechnology has developed a synthetic antibody against S. mutans, branded CaroRx, which it produces using transgenic tobacco plants. This product may be considered a therapeutic vaccine, applied once every several months, and is in Phase II clinical trials as of October 2007[update].[4] [edit] Attempts using Replacement TherapyOn a different line of research, Dr. Jeffrey D. Hillman has developed a genetically-modified strain of Streptococcus mutans. The new strain, called BCS3-L1, is incapable of producing lactic acid, which dissolves tooth enamel, and aggressively replaces native flora. In laboratory tests, rats who were given BCS3-L1 were conferred with a lifetime of protection against S. mutans.[5] BCS3-L1 colonizes the mouth and produces a small amount of a lantibiotic, called MU1140,[5] which allows it to out-compete S. mutans.[6] Hillman suggests that treatment with BCS3-L1 in humans could also provide a lifetime of protection, or, at worst, require occasional re-applications. He figures the treatment would be available in dentists' offices and "will probably cost less than $100."[7] FDA Phase Ib clinical trials are to be held in 2008.[8] The product is being developed at Oragenics under license from the University of Florida. The prospect of introducing genetically modified organisms into the human body's flora has raised muted concerns that have required additional study to address, including the prospect that BCS3-L1 might be more harmful than native S. mutans as a causative agent of inflammatory heart disease.[9] Whether this concern is among the open issues being investigated by Oragenics and the F.D.A. is not a subject open to public scrutiny.[10] Another approach is being pursued by BASF, focused on replacing native lactobacillus flora with a variety dubbed L. anti-caries, which prevents S. mutans from binding to enamel.[11] However, it is not a long-term vaccination in that no attempt is being made to have a self-sustaining population of L. anti-caries. The intent is that the L. anti-caries population would be frequently replenished through use of a chewing gum containing the organism. [edit] Bacteriophage treatment"Phage therapy as a way to control oral bacteria [including Streptococcus mutans] might be considered."[12] [edit] References
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