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dna vaccine disadvantages

However, a similar boost in immunity may not be obtained while reboosting with a second dose of the same recombinant protein vaccine. Removal of the need to seal would be advantageous but highly challenging. Edible Vaccines: Promises and Challenges Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. Cons. Various therapeutic and preventative interventions have been used to combat infectious diseases. The vectors used for expression of the antigen can also have a large impact on immunogenicity. Stability: DNA vaccines are generally stable at room temperature and do not require refrigeration, which can simplify storage and shipping. DNA recombinant-based subunit vaccines have been known to have enhanced stability, to a degree, for transportation and storage in comparison to traditional protein-based vaccines. Presumably, after the DNA is separated from the complex, karyopherins are able to help facilitate the nuclear uptake of the plasmid. The immunogenicity of DNA vaccines for HIV has been increased through improvement of the DNA vector, through the inclusion of molecular adjuvants, heterologous prime-boost strategies, and delivery with electroporation.42 The principle behind electroporation is that it applies a small electric field across the site of injection that causes temporary membrane instability and produces an electric gradient, which elevates the cellular uptake of DNA. Another example is that of Cruz, et al. Deans T.L., Singh A., Gibson M., Elisseeff J.H. DNA vaccines: ready for prime time? Roles of Emblica officinalis in medicine - A review. there are no approved DNA/RNA vaccines for medical use in humans, hence their alternative name: next-generation vaccines. Thompson M., Heath S.L., Sweeton B., Williams K., Cunningham P., Keele B.F., Sen S., Palmer B.E., Chomont N., Xu Y. DNA/MVA vaccination of HIV-1 infected participants with viral suppression on antiretroviral therapy, followed by treatment interruption: elicitation of immune responses without control of re-emergent virus. Sasaki S, Takeshita F, Xin KQ, et al. Most DNA vaccine studies use plasmids carrying promoters that constitutively yield high levels of protein in most mammalian tissues. Li P., Asokanathan C., Liu F., Khaing K.K., Kmiec D., Wei X., Song B., Xing D., Kong D. PLGA nano/micro particles encapsulated with pertussis toxoid (PTd) enhances Th1/Th17 immune response in a murine model. Plasmids, including the oligonucleotide sequence of the vaccine antigen, were precipitated onto 1m-diameter gold beads. WebMasaru Shimada. After the selection of the desired gene, one can proceed for its modification to achieve the immunogenicity of the DNA vaccine. The author explored the strategies for construction and working of DNA vaccines. The TLR2/6 ligand PAM2CSK4 is a Th2 polarizing adjuvant in Leishmania major and Brugia malayi murine vaccine models. Liu M.A., Ulmer J.B. Human clinical trials of plasmid DNA vaccines. When the pDNA was incubated at 200C under aqueous conditions, no intact pDNA could be found after 20s. In the case of dried pDNA, the degradation temperature was reported to have a low threshold. Hu D, Wu J, Zhang R, et al. Advantages and disadvantages for this type of vaccines have also been explained, together with applications of DNA vaccines. The applications of DNA vaccines in different diseases were highlighted. Martens T.F., Remaut K., Demeester J., De Smedt S.C., Braeckmans K. Intracellular delivery of nanomaterials: how to catch endosomal escape in the act. Shedlock D.J., Tingey C., Mahadevan L., Hutnick N., Reuschel E.L., Kudchodkar S., Flingai S., Yan J., Kim J.J., Ugen K.E., Weiner D.B., Muthumani K. Co-administration of molecular adjuvants expressing NF-kappa B subunit p65/RelA or type-1 transactivator T-bet enhance antigen specific DNA vaccine-induced immunity. This review article is based on a literature survey and it describes the working and designing strategies of DNA vaccines. This technology has been applied on various bacterial, virus and parasitic models of disease. As far as the knowledge of this author is concerned, all of the candidates explored so far are in the experimental stage. Sawaengsak, et al. Received 2018 Jan 24; Revised 2018 Aug 14; Accepted 2018 Aug 23. With regard to what was infectious disease-related, the DALYs for lower respiratory infectious diseases, HIV/AIDS, and tuberculosis were 1939, 855, and 763 per 100,000 and were ranked as 2nd, 11th, and 12th, respectively, in 2015 [1]. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. As more gene-modulating technologies receive approval, obtaining 510(k) clearance will be increasingly common for this field. can require cold storage, which may limit potential for distribution. One of the most exciting things about the viral vector COVID-19 vaccine from Johnson & Johnson is that you only need one dose. Leung T.F., Liu A.P., Lim F.S., Thollot F., Oh H.M., Lee B.W., Rombo L., Tan N.C., Rouzier R., Friel D., De Muynck B., De Simoni S., Suryakiran P., Hezareh M., Folschweiller N., Thomas F., Struyf F. Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and HPV-6/11/16/18 vaccine administered according to 2- and 3-dose schedules in girls aged 914 years: Results to month 12 from a randomized trial. Evaluation of novel synthetic TLR7/8 agonists as vaccine adjuvants. There is greater control over the risks of virulence reversion when using DNA vaccines; therefore, DNA vaccines are considered in some aspects to be safer. Cons: adjuvants that are commonly used including alum and calcium salts can cause severe inflammation and are not compatible with, or advantageous for, certain antigens In a recent clinical trial, a DNA vaccine was delivered by IM-EP using Ichor Medical Systems TriGrid Delivery system (TDS-IM) [94]. These approved DNA vaccines are for a number of species including equine, salmon, porcine, and canine. Kojima, et al. This response serves to defend the host from the concerned microorganism for which the particular DNA vaccine has been made.23, The researchers later proposed three different mechanisms that contribute to the immunogenicity of DNA vaccines. 2(1, 5, 3), thus leading to MHC II-peptide display); phagocytosis of a transfected (nonviral) or transformed (viral) cell/cross-priming (Fig. HHS Vulnerability Disclosure, Help Inactivated vaccines contain viruses treated with heat, chemicals, or radiation so they cannot replicate, but can still trigger an immune response. Immunomodulatory activity of Terminalia chebula against Salmonella typhimurium in mice. A variety of liposome-based vaccines for oral administration have been previously synthesized to target a wide range of viral and bacterial diseases. An effective delivery system for malaria vaccination has been described for an NP-coated, MSP-1 DNA-based vaccine which confers protection against lethal Plasmodium yoelii infection in mouse models across various routes of administration.55 Molecular adjuvants for malaria DNA vaccines based on the modulation of host-cell apoptosis have been described.56 Field literature describes Vaxfectin (Vical, USA) as having the ability to elevate antibody response and T cell response to each component of a 5-gene Plasmodium falciparum plasmid DNA vaccine mixture.57 It has been hypothesized by some of the researchers that a malaria therapeutical vaccine targeting the erythrocyte stage of the parasite through erythrocyte sickling can lower the parasite density and also control the progression and severity of this disease.58, Dengue is a mosquito-transmitted infectious disease. Nakase I., Kogure K., Harashima H., Futaki S. Application of a fusiogenic peptide GALA for intracellular delivery. Slaven EM, Lopez FA, Hart SM, et al. We dont want to put all our eggs in one basket. Li L, Saade F, Petrovsky N. The future of human DNA vaccines. Dhakal S., Goodman J., Bondra K., Lakshmanappa Y.S., Hiremath J., Shyu D.L., Ouyang K., Kang K.I., Krakowka S., Wannemuehler M.J., Won Lee C., Narasimhan B., Renukaradhya G.J. The advantages of genetic immunization of the new vaccine using plasmid DNAs are multifold. Kronbichler A., Kerschbaum J., Mayer G. The influence and role of microbial factors in autoimmune kidney diseases: a systematic review. 2, Fig. Additional modifications can be made to increase protein production in transfected host cells. Regulating synthetic gene networks in 3D materials. The PEI becomes increasingly protonated during the acidification process of the endosomes and thus imbalanced osmotic pressure differences form across the membrane. The dangers of DNA vaccination Siddiquee S., Rovina K., Azriah A. DNA vaccines. Doe B, Selby M, Barnett S, et al. [123] Vaccine For this reason, nonviral gene delivery systems are often injected locally. Verthelyi D. Springer; 2006. Darquet A.M., Cameron B., Wils P., Scherman D., Crouzet J. Olotu A., Fegan G., Wambua J., Nyangweso G., Leach A., Lievens M., Kaslow D.C., Njuguna P., Marsh K., Bejon P. Seven-year efficacy of RTS, S/as01 malaria vaccine among young African children. One of the disadvantages of these vaccines is that they need to be delivered directly into cells, Changes in the expression of genes that do not result from changes in DNA sequence. [67] described the induction of anti-DNA antibodies after the administration of a subunit vaccine against hepatitis B virus (HBV), and recently, Zafrir, et al. Currently, safety assessments for gene delivery systems undergoing approval processes are arduous to determine risks of insertional mutagenesis. Miura N., Shaheen S.M., Akita H., Nakamura T., Harashima H. A KALA-modified lipid nanoparticle containing CpG-free plasmid DNA as a potential DNA vaccine carrier for antigen presentation and as an immune-stimulative adjuvant. No DNA Most of pros and cons are listed in Fig. Progress in the development of DNA vaccines against foot-and-mouth disease. Foods under such application include potato, banana, lettuce, corn, DNA vaccines, however, can be engineered to have effectively zero risk for virulence reversion. In terms of engineering the kinetics for vaccines by auto-boosting technologies, the practicality of receiving doses on short time scales is increasingly more reasonable. These contain virus weakened in the lab. It continues to remain an immunological problem that has to be overcome.21. Advantages and disadvantages for this type of vaccines have also been explained, together with applications of DNA vaccines. Understanding the Structure Activity Relationships (SARs) is an ongoing endeavor within the field. Masih S, Arora SK, Vasishta RK. Brophy J.A., Voigt C.A. Li K., Gao L., Gao H., Qi X., Gao Y., Qin L., Wang Y., Wang X. Codon optimization and woodchuck hepatitis virus posttranscriptional regulatory element enhance the immune responses of DNA vaccines against infectious bursal disease virus in chickens. Fact sheet No.94. Daniels C.C., Rogers P.D., Shelton C.M. Colluru V.T., Zahm C.D., McNeel D.G. DNA vaccines appear to have certain advantages over conventional vaccines, for example the ability to induce a wider range of types of immune response. 4.1, 4.2, 4.3) Pros: Similar to kinetic approaches, nonkinetic methods can also be used to achieve long-term and enhanced immune responses. Munye M.M., Tagalakis A.D., Barnes J.L., Brown R.E., McAnulty R.J., Howe S.J., Hart S.L. McHugh K.J., Nguyen T.D., Linehan A.R., Yang D., Behrens A.M., Rose S., Tochka Z.L., Tzeng S.Y., Norman J.J., Anselmo A.C. pDNA can be either randomly encapsulated by the nuclear envelope reforming postmitosis or actively transported to the nucleus through nuclear localization signals (i.e., DNA-targeted sequences SV40 [16]). The author describes the current studies on DNA vaccines in a number of diseases. Bergamaschi C., Kulkarni V., Rosati M., Alicea C., Jalah R., Chen S., Bear J., Sardesai N.Y., Valentin A., Felber B.K., Pavlakis G.N. Khan KH. Khan KH, Jain SK. As a genetic adjuvant, CTA improves the immunogenicity of DNA vaccines in an ADP-ribosyltransferase activity- and IL-6-dependent manner. WebIn the developing world, inadequate health care resources will make postvaccination control difficult. theres a theoretical probability vaccine DNA can integrate into your genome. Direct gene transfer into nonhuman primate myofibers in vivo. DNA vaccines: roles against diseases - PubMed [. While both have been under development since the 1990s, in recent years, significant excitement has turned to mRNA despite the licensure of several veterinary DNA vacc Stable emulsion (SE) alone is an effective adjuvant for a recombinant, baculovirus-expressed H5 influenza vaccine in healthy adults: a phase 2 trial. For instance, the hepatitis B DNA vaccine is based on different domains of the hepatitis B virus surface antigen (HBsAg) and is often administered with an adjuvant to improve immunogenicity [9], [10]. Direct gene transfer into mouse muscle in vivo. DNA vaccines: a mini review - PubMed This article is based on the modern as well as the traditional methods for literature survey. Live vaccines use a weakened (or attenuated) form of the germ that causes a disease. Pretreatment with. . Tzeng S.Y., Guerrero-Czares H., Martinez E.E., Sunshine J.C., Quiones-Hinojosa A., Green J.J. Non-viral gene delivery nanoparticles based on poly (-amino esters) for treatment of glioblastoma. Chitosan is a known mucoadhesive and may exhibit important roles in mucosal immunization [82]. [66] associated prokaryotic double-stranded DNA (dsDNA) immunization with the development of anti-dsDNA antibodies in mice. Preclinical studies have demonstrated that CpG ODN activates TLR9-bearing B cells and plasmacytoid dendritic cells and further support the induction of strong Th1-type responses [149]. Gordon, et al. Such applications could potentially enable the regulation of the immune response in terms of intensity and type (cell mediated/humoral) in the future for vaccine applications. For example, the in vivo half-life for a nonionically complexed DNA is approximately 10min in the extracellular environment, whereas the intracellular half-life is longer, close to 14h. Despite the advantage in being in a complexed state in terms of its structural stability, if the DNA is excessively complexed, then successful transcription will not be as efficient, as the plasmid will not be accessible to the transcription machinery [81], [82]. This pathway provokes B-cell immunity and generates antibodies and B-cell memory against the protein. The reason behind this is that they affect the magnitude and quality of immunity elicited. Harrison G.B.L., Heath D.D., Dempster R.P., Gauci C., Newton S.E., Cameron W.G., Robinson C.M., Lawrence S.B., Lightowlers M.W., Rickard M.D. DNA vaccines involve the administration of a naked DNA plasmid directly into the muscle, which has the Ciabattini A., Pettini E., Fiorino F., Pastore G., Andersen P., Pozzi G., Medaglini D. Modulation of primary immune response by different vaccine adjuvants. As a library, NLM provides access to scientific literature. Immunogenicity and efficacy of an anthrax/plague DNA fusion vaccine in a mouse model. It has a global distribution and is a worldwide problem as described by Khan et al.66-70 Typhoid can be treated by using antibiotics.66,70 Vaccination66,70 and herbal drugs66-69,71-76 also showed interesting results.64 A number of plants have been reviewed by this author for their medicinal assessment.72,77,78 Recently, a number of vaccines against Salmonella have been developed including live-attenuated as well as DNA vaccines and their clinical trials exhibited promising results.79. Because these vaccines are so similar to the natural infection that they help prevent, they create a strong and long-lasting immune response. Plasmids can be internalized within the nucleus through intranuclear injection, direct/indirect nuclear localization signals (i.e., DNA-targeted sequences), and encapsulation by the nuclear envelope upon reformation postmitosis [93]. Other escape mechanisms have involved fusogenic peptides. A detailed analysis of clinical trials of gene-based prophylactic vaccines (including virus vaccines) was reported by Nakayama, et al. Gordon D.L., Sajkov D., Honda-Okubo Y., Wilks S.H., Aban M., Barr I.G., Petrovsky N. Human phase 1 trial of low-dose inactivated seasonal influenza vaccine formulated with Advax delta inulin adjuvant. The winding road to developing a malaria vaccine. To date, although clinical translation of gene-based systems has been limited, the U.S. has recently approved two gene therapies. The recipient cell then expresses the foreign antigenic protein coded by the introduced DNA into the host. Therefore, new anti-tumor immunotherapies are necessary to improve the outcome of patients with advanced cancer, and DNA vaccines are reliable forms of immunotherapy. The search engines and databases used were ScienceDirect, PubMed, Google Scholar. Leroux-Roels I., Devaster J.M., Leroux-Roels G., Verlant V., Henckaerts I., Moris P., Hermand P., Van Belle P., Poolman J.T., Vandepapeliere P., Horsmans Y. Chitosan-HPMC-blended microspheres as a vaccine carrier for the delivery of tetanus toxoid. Moon T.S., Lou C., Tamsir A., Stanton B.C., Voigt C.A. It further concluded that the established clinical monitoring procedures were enough to asses any adverse effect. Interestingly, minicircle DNA [51], [53], [54], [72], [73] and ministring DNA [74], [75] have been reported to have less risk of insertional mutagenesis because the major bacterial DNA (i.e., the unmethylated CpG repeats functioning as PAMPs) is removed. An important strategy to achieve this aim is to use DNA plasmids having antigens encoded on them. Physical methods for intracellular delivery: practical aspects from laboratory use to industrial-scale processing. Compendium of Invited lectures. Jiang W. Blockade of B7H1 enhances dendritic cell-mediated T cell response and antiviral immunity in HBV transgenic mice. Furthermore, Inovio demonstrated that the immune response can be enhanced when PENNVAX is delivered in vivo by intradermal EP compared to a syringe injection [52], [159]. DNA vaccines. Khan KH, Jain SK. Long term stability of lyophilized plasmid DNA pDERMATT. official website and that any information you provide is encrypted Initial attempts to create DNA vaccines have not worked they have not had a big enough impact on the immune system. Adjuvant system AS02V enhances humoral and cellular immune responses to pneumococcal protein PhtD vaccine in healthy young and older adults: randomised, controlled trials. In summary, as of 2017, a large number of second-generation vaccines have been licensed and released on the market. Its the technology used in the vaccine against poliovirus and in some types of flu vaccines. 2(1, 4, 6), thus leading to MHC I-peptide display); and Toll-like receptor (TLR) activation (Fig. Moreover, tumor-specific antigens are expressed for a longer period of time as compared to RNA or protein-based vaccines.31, DNA vaccination has become an effective strategy for the development of vaccines against cancer, including cervical carcinoma (CC). The physical stability of the recombinant tuberculosis fusion antigens h1 and h56. Vaccines for chickenpox, rubella and hepatitis A are created using human embryo cells, according to an article from the Children's Hospital of Philadelphia. The prevention of communicable diseases is a public health priority. [21], [22] reported that inulin-based adjuvants (Advax) elicit efficient immune responses against hepatitis B (Phase I). Zafrir Y., Agmon-Levin N., Paz Z., Shilton T., Shoenfeld Y. Autoimmunity following hepatitis B vaccine as part of the spectrum of 'Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants' (ASIA): analysis of 93 cases. Vaccine Viral vector COVID-19 vaccines deliver genetic material to the cell nucleus to allow our cells to build protection against COVID-19. Science Media Centre Fact Sheet DNA vaccines For interested readers regarding physical methods for intracellular delivery, we would recommend the publications from Meacham, et al [102], [103]. Heterologous protection against influenza by injection of DNA encoding a viral protein. The injected gene of the concerned DNA vaccine is expressed in the injected muscle cell and also in nearby APCs. For example, Nakase, et al. Jain H.V., Beaucage S.L. Protective effect of Emblica officinalis against S typhimurium through its antioxidant activity. Wright WF, Pritt BS. Enabling the ability to engineer optimized delivery systems is the objective in elucidating such SARs. In 2016, 1.6 million people died due to human immunodeficiency virus (HIV) alone. Methods involving the use of cytokines (i.e., IL-4) or the granulocyte-macrophage colony-stimulating factor (GM-CSF) have proven useful in enhancing the immune response. In 1994, Lilic, et al. Promoters, enhancers, and introns can affect the level of antigen expression. Advantages and Disadvantages of DNA Vaccines First, the construction of DNA vaccines is quite simple. There has been recent progress in terms of enhancing the immunogenicity in mice and chicken primed with such codon-optimized DNA vaccines [133], [134], [135]. 3. Condon C, Watkins SC, Celluzzi CM, et al. Comprehensive analysis of CpG islands in human chromosomes 21 and 22. Cruz L.J., Tacken P.J., Eich C., Rueda F., Torensma R., Figdor C.G. Direct somatic cell engulfment/APC display entails (1, 5, 3), leading to MHC II-peptide display. This review paper summarizes the state of the engineered/recombinant DNA vaccine field, with a scope entailing Engineering DNA vaccines against infectious diseases. the DNA/RNA fragments do not cause COVID-19. The rapidity of this response demonstrated the ability to harness existing technologies including: RNA vaccine platforms (NCT04283461), DNA vaccine platforms (NCT04336410), recombinant vector vaccines (NCT04313127, NCT04324606) and The main remaining issue is the lack of immunogenicity associated with DNA vaccines. With the advent of the mRNA vaccines arose the inevitable concerns for its dangers. McKay P.F., Cope A.V., Mann J.F., Joseph S., Esteban M., Tatoud R., Carter D., Reed S.G., Weber J., Shattock R.J. Glucopyranosyl lipid A adjuvant significantly enhances HIV specific T and B cell responses elicited by a DNA-MVA-protein vaccine regimen. Phase 1 testing of detoxified LPS/group B meningococcal outer membrane protein vaccine with and without synthetic CPG 7909 adjuvant for the prevention and treatment of sepsis. Clinical evaluation of CpG oligonucleotides as adjuvants for vaccines targeting infectious diseases and cancer. Hepatitis B DNA vaccines are often administered using liposomal or cationic carriers. The exact mechanisms of chemical structure-related cell specificity remain unknown. Deans T.L., Cantor C.R., Collins J.J. A tunable genetic switch based on RNAi and repressor proteins for regulating gene expression in mammalian cells. Careers, Unable to load your collection due to an error. The Center for Biologics Evaluation and Research of the US Food and Drug Administration (CBER/FDA) governs the progress of clinical development of DNA vaccines. Certain vaccines, such as those for pneumococcal and meningococcal infections, use protective polysaccharide antigens, May induce immunologic tolerance by antigens expressed inside host body, DNA vaccines may have a relatively poor immunogenicity, Atypical processing of bacterial and parasite proteins, Insertion of foreign DNA into the host genome may cause the cell to become cancerous, Antigen against which the DNA vaccine was directed, System in which the DNA vaccine was experimented. The virus ability to infect cells, express large amount of antigen and in turn trigger a strong immune response make these vaccines promising. [129] reported the use of post-translational regulatory elements to improve the efficiency of DNA vaccines. Routes and mechanisms of extracellular vesicle uptake. Immunogenicity and protective efficacy of a vaxfectin-adjuvanted tetravalent dengue DNA vaccine. http://www.who.int/mediacentre/factsheets/fs094/en/, Subunit vaccination with no risk for infection, Antigen presentation by both MHC class I and class II molecules, Ability to polarize T-cell help toward type 1 or type 2, Immune response focused only on antigen of interest, Stability of vaccine for storage and shipping, DNA vaccines are safer, more stable, and easy to handle, DNA vaccines induce protective humoral and cellular immune responses, A mixture of plasmids could be used to form a broad spectrum vaccine, Limited to protein immunogens (not useful for non-protein based antigens such as bacterial polysaccharides). Inclusion in an NLM database does not imply endorsement of, or agreement with, The total number of months is 120, and the number of months to date within the time period of interest (Jan 2011April 2018) is 87.5. These two antigens are homologues to an ecotin precursor and the FliC flagellin, respectively. "They don't alter a person's DNA at all. vaccine mRNA vaccines Persistent infection with human papillomaviruses (HPV) is the main etiological factor in cervical cancer, the second most common cancer in women worldwide.32 The formation of CC is associated with HPV infection. Overviews of DNA vaccines approved for animal models have been reported in several articles [154], [155], [156]. [. Plasmid DNA loaded chitosan nanoparticles for nasal mucosal immunization against hepatitis B. Wolff J.A., Malone R.W., Williams P., Chong W., Acsadi G., Jani A., Felgner P.L. Optimizing vaccine schedules with smaller steps in time will likely result in enhanced seroconversion and protection. Jin X., Morgan C., Yu X., DeRosa S., Tomaras G.D., Montefiori D.C., Kublin J., Corey L., Keefer M.C., Network N.H.V.T. Although the exact mechanism remains elusive, it is hypothesized that different pathways of endocytosis, tuned by different polymer structures, may be the answer to the cell specificity differences. Vaccines Advantages and disadvantages The advantages of needle-free vaccine technology, specifically jet injectors, include: In the case of DNA vaccines, the replicating vector is usually disrupted and the engineered DNA is extracted and purified to produce the final vaccine. PA nanoparticle-based vaccines were recently employed for immunizing against swine influenza within pigs [26] and against H5N1 influenza [27]. An mRNA vaccine is a type of vaccine that uses a copy of a molecule called messenger RNA (mRNA) to produce an immune response. In order for a DNA vaccine to work, it is essential to incorporate DNA coding an appropriate antigen, to elicit the required antibody response of the immune system. Generally, nonviral gene delivery results in transient gene expression (TGE) of the antigen of interest. WebDNA vaccines must pass through the cell membrane of APCs to the cytoplasm and migrate to the nucleus to initiate transcription.

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