Several types of vaccines are being developed at research centres.
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. Intrinsic difficulties in developing it, coupled with lack of strong economic interests, are the reasons why no such vaccine is commercially available as of 2015[update].
Attempts using Antibodies
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].
Attempts using Replacement Therapy
On a different line of research, Dr. Jeffrey D. Hillman has developed a genetically modified strain of Streptococcus mutans which could be available in 2012-2013. 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. BCS3-L1 colonizes the mouth and produces a small amount of a lantibiotic, called MU1140, which allows it to out-compete S. mutans.
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." FDA Phase Ib clinical trials are to be held in 2008. The product is being developed at Oragenics under license from the University of Florida. In April 2014 during an interview with The Wall Street Journal, Oragenics' CEO Dr. John Bonfiglio stated that the company has abandoned development of their S. Mutans Replacement Therapy (SMaRT), citing regulatory concerns and patent issues.
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. 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.
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. 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.
The University of Leeds has also begun researching a recently discovered peptide known as P11-4. When applied to a cavity and coming in contact with saliva, this peptide assembles itself in a fibrous matrix or scaffold, attracting calcium and thereby allowing the tooth to regenerate. The Swiss-based company Credentis has licensed the peptide and launched a product called Curodont Repair in 2013. Recent studies show a positive clinical effect.
DNA vaccine approaches for dental cavities have had a history of success in animal models. Dental cavity vaccines directed to key components of S. mutans colonization and enhanced by safe and effective adjuvants and optimal delivery vehicles, are likely to be forthcoming.
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