Abstract
This chapter discusses the potential and future opportunities for the use of recombinant lactic acid bacteria in human health. It is now clear that sufficient advances in the genetics of lactic acid bacteria (LAB) have made it possible to construct safe LAB-based recombinant vaccines that are capable of eliciting protection against lethal challenge with toxin or a human pathogen in a relevant disease model. There are also opportunities to enhance the efficacy of LAB vaccines through increased antigen expression or through the combined delivery of multiple immunogens and specific adjuvants. Further insights may be gained through direct comparisons of LAB strains with different persistence and survival characteristics or immunostimulatory properties with different immunization routes or schedules against a selected target disease. Genetic engineering clearly has the potential to further optimize the survival characteristics of selected LAB, define optimal placement and dosage regimes in different clinical settings, and enhance their ability to deliver a pharmaceutical protein.
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