THE ROLE OF B CELLS AND THE FORMATION OF IMMUNOLOGICAL MEMORY AFTER VACCINATION AGAINST HUMAN PAPILLOMAVIRUS

Aim: To analyze the features of the B-cell immune response and the formation of immunological memory in humans after vaccination against human papillomavirus and during natural infection, as well as to evaluate the effectiveness of various types of vaccines, vaccination regimens and factors affecting the duration of protection against human papillomavirus

Materials and methods: The literature review includes an analysis of scientific papers from the databases PubMed, Embase, eLibrary, CyberLeninka and Web of Science, CNKI and MEDLINE. The search period covered publications from 2000 to 2023, with a focus on the last decade. Keywords and their combinations were used: "HPV vaccine", "B cell memory", "memory B cells", "humoral immunity", "long-term immunity", "immunological memory", "plasma cells", "Gardasil", "Cervarix".

Inclusion and exclusion criteria

The analysis included original studies (randomized controlled, cohort studies) and systematic reviews devoted to the study of the humoral immune response, the dynamics of specific antibodies and populations of memory B-lymphocytes after HPV vaccination in humans. The exclusion criteria were: publications not in English or Russian; research focused exclusively on T-cell immunity; work performed only on animal models; conference abstracts and uncensored articles.

Selection procedure

The selection was carried out in two stages. At the first stage, relevance was assessed based on the title and annotation. At the second stage, a full-text analysis of the articles that passed the primary filter was carried out for final verification of compliance with the inclusion criteria. The final selection includes 55 publications that most fully reflect the current understanding of the role of B cells in post-vaccination immunity against HPV.

Introduction: Human papillomavirus (HPV) is the leading cause of cervical cancer. There are three vaccines: Cervarix (bivalent), Gardasil-4 (quadrivalent) and Gardasil-9 (novalent), which are more than 90% effective. Vaccination reduces the risk of developing cervical cancer and other HPV-related cancers. In 2020, WHO launched a global strategy to eliminate cervical cancer as an important public health problem.

Results: The effectiveness of HPV vaccines has been confirmed by clinical and population-based studies. The 4vHPV vaccine reduces the incidence of genital warts by 76%, and the prevention of cervical cancer in young women reaches 53-57%. In Finland, vaccination showed 100% protection against HPV-associated cancer in vaccinated people compared to those who were not vaccinated. Two- and three-dose regimens provide comparable protection, and a single-dose regimen has demonstrated 89-100% efficacy in a number of studies. The optimal immune response is achieved by vaccinating children aged 9-13 years with two doses.

Conclusions: Despite indications that one dose of the HPV vaccine provides good protection against precancerous lesions, the level of antibodies at one dose is lower than after two or three. Protection after a single dose may depend more on the response of memory B cells upon repeated contact with the antigen. However, there is no data on the B-cell response after a single dose of the vaccine, as well as sufficient studies of local anamnestic responses upon repeated exposure. It would be a great achievement in vaccinology if a single dose of HPV vaccine proved its ability to induce protective B-cell memory upon repeated contact with HPV antigens.

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