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Bald darauf wurde dieses Antigen als H\u00fcllprotein des HBV erkannt (HBV Surface Antigen, HBsAg), dann aus HBV-haltigem Plasma gereinigt und sp\u00e4ter gentechnisch in Hefezellen hergestellt. Die hohe Wirksamkeit des HBsAg-Impfstoffs wurde vielfach bewiesen, insbesondere bei Neugeborenen von HBV-infizierten M\u00fcttern, die sonst fast immer chronische HBV-Tr\u00e4ger werden. Auch bei \u00e4lteren Kindern und Erwachsenen sch\u00fctzt die Impfung und wird seit 1984 weltweit angewendet, was zu einer ungef\u00e4hr 10-fachen Abnahme der HBV-Infektionen bei den Geimpften gef\u00fchrt hat.<\/jats:p><jats:p>Es gibt dennoch verschiedene Herausforderungen bei der Hepatitis-B-Impfung. Bei Neugeborenen von hochvir\u00e4mischen M\u00fcttern kann die Impfung versagen. Bei verringerter Immunkompetenz kann die Bildung sch\u00fctzender Antik\u00f6rper ausbleiben, aber auch bei Risikofaktoren wie h\u00f6herem Alter, Rauchen oder \u00dcbergewicht. Fr\u00fche Impfstudien belegten, dass Impfstoffe mit dem HBsAg-Subtyp adw2 auch gegen HBV mit anderen HBsAg-Subtypen sch\u00fctzen, neuere Beobachtungen zeigen aber, dass die Schutzwirkung gegen heterologe Subtypen schw\u00e4cher ist. Gelegentlich werden auch Escape-Mutationen beobachtet.<\/jats:p><jats:p>Die meisten jetzigen Impfstoffe beruhen auf dem Kenntnisstand vor 40\u00a0Jahren und k\u00f6nnten wesentlich verbessert werden. Eine Einbeziehung der bislang fehlenden Pr\u00e4S-Dom\u00e4nen der HBV-H\u00fclle in die Impfstoffe w\u00fcrde die wichtigsten sch\u00fctzenden T\u2011 und B\u2011Zellepitope einbringen. Die Expression in S\u00e4ugerzellkulturen verbessert die native Faltung der neutralisierenden HBsAg-Epitope und die Verwendung von regional vorherrschenden HBsAg-Subtypen w\u00fcrde die Schutzwirkung erh\u00f6hen. Optimale Adjuvanzien oder Epitoptr\u00e4ger k\u00f6nnten die Immunogenit\u00e4t auch f\u00fcr eine HBV-Immuntherapie steigern.<\/jats:p>","DOI":"10.1007\/s00103-021-03484-w","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T16:02:49Z","timestamp":1641916969000},"page":"170-182","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hepatitis-B-Impfstoffe\u00a0\u2013 Geschichte, Erfolge, Herausforderungen und Perspektiven","Hepatitis\u00a0B vaccines\u2014history, achievements, challenges, and perspectives"],"prefix":"10.1007","volume":"65","author":[{"given":"Wolfram H.","family":"Gerlich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"issue":"1","key":"3484_CR1","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1186\/1743-422X-10-239","volume":"10","author":"WH Gerlich","year":"2013","unstructured":"Gerlich\u00a0WH (2013) Medical virology of hepatitis B: how it began and where we are now. 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