“…Preclinical and clinical trials of combinations of various modalities (DNA vaccines, viral vectors, bacterial vectors, recombinant proteins) have been performed (Nabel et al, 2010), with the most extensive being the 16,000 patient trial for an HIV vaccine described above, consisting of a pox vector followed by a recombinant protein boost (RerksNgarm et al, 2009 The immunologic explanation for the increased immune responses in prime boost protocols and the reason that the sequence of priming with DNA plasmid followed by another modality, whether recombinant protein or viral vector, is necessary are not well understood. However, the lack of additional viral antigens (of the vector) when DNA is the prime, may help focus the immune response on the key antigen (de Mare et al, 2008). The additional innate antiviral responses, and cytokine milieu that develop following the viral vector boost, may augment the booster response.…”