Therapeutic vaccination offers great promise as an intervention for a diversity of infectious and non‐infectious conditions. Given that most chronic health conditions are thought to have an immune component, vaccination can at least in principle be proposed as a therapeutic strategy. Understanding the nature of protective immunity is of vital importance, and the progress made in recent years in defining the nature of pathological and protective immunity for a range of diseases has provided an impetus to devise strategies to promote such responses in a targeted manner. However, in many cases, limited progress has been made in clinical adoption of such approaches. This in part results from a lack of safe and effective vaccine adjuvants that can be used to promote protective immunity and/or reduce deleterious immune responses. Although somewhat simplistic, it is possible to divide therapeutic vaccine approaches into those targeting conditions where antibody responses can mediate protection and those where the principal focus is the promotion of effector and memory cellular immunity or the reduction of damaging cellular immune responses as in the case of autoimmune diseases. Clearly, in all cases of antigen‐specific immunotherapy, the identification of protective antigens is a vital first step. There are many challenges to developing therapeutic vaccines beyond those associated with prophylactic diseases including the ongoing immune responses in patients, patient heterogeneity, and diversity in the type and stage of disease. If reproducible biomarkers can be defined, these could allow earlier diagnosis and intervention and likely increase therapeutic vaccine efficacy. Current immunomodulatory approaches related to adoptive cell transfers or passive antibody therapy are showing great promise, but these are outside the scope of this review which will focus on the potential for adjuvanted therapeutic active vaccination strategies.

中文翻译：

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使用佐剂调节免疫反应以促进治疗性疫苗接种。

治疗性疫苗接种提供了巨大的希望，作为对各种传染性和非传染性疾病的干预。鉴于大多数慢性健康状况被认为具有免疫成分，接种疫苗至少在原则上可以被提议作为一种治疗策略。了解保护性免疫的性质至关重要，近年来在定义一系列疾病的病理性和保护性免疫的性质方面取得的进展为制定有针对性地促进此类反应的策略提供了动力。然而，在许多情况下，在临床采用此类方法方面取得的进展有限。这部分是由于缺乏可用于促进保护性免疫和/或减少有害免疫反应的安全有效的疫苗佐剂。虽然有些简单，但可以将治疗性疫苗方法分为抗体反应可以介导保护的靶向条件和主要关注促进效应和记忆细胞免疫或减少破坏性细胞免疫反应的条件，例如自身免疫性疾病。显然，在所有抗原特异性免疫治疗的情况下，保护性抗原的鉴定是至关重要的第一步。除了与预防性疾病相关的疫苗之外，开发治疗性疫苗还面临许多挑战，包括患者持续的免疫反应、患者的异质性以及疾病类型和阶段的多样性。如果可以定义可重复的生物标志物，则可以进行早期诊断和干预，并可能提高治疗性疫苗的功效。