Barlan Isil B, Bahceciler Nerin, Akdis Mübeccel, Akdis Cezmi A
Marmara University Hospital, Pediatric Allergy and Immunology Division, Istanbul, Turkey.
Curr Opin Allergy Clin Immunol. 2005 Dec;5(6):552-7. doi: 10.1097/01.all.0000191238.20632.e2.
As an essential part of the hygiene hypothesis, the association between exposure to mycobacterial components and the prevention, development and severity of atopic diseases has not been fully understood. The current status on the causal-effect link of this relationship and the potential use of mycobacterial adjuvants as a preventive or disease-modifying modality in allergic diseases is reviewed in this article.
Data obtained from human and animal models indicate a discrepancy regarding the preventive and therapeutic effect of bacillus Calmette-Guérin in atopic diseases. Among the issues that require clarification include whether the distinction in T helper type 1/2 cells described in mice can be fully extrapolated to humans. Other factors involved could be caused by genetic variation, optimal timing, dose, route of delivery as well as environmental factors, which affect the degree of natural exposure to pathogenic or saprophytic mycobacteria.
Most of the evidence available to date suggests a need for an improved mycobacterial vaccine administered early in life, by means of alternative routes, preferentially mucosal. As switching away from the T helper type 2 immune response by inducing T helper type 1 is unable to explain the underlying mechanisms of action of mycobacterial antigens, it may be worthwhile to investigate whether T regulatory cells are induced in response to different mycobacterial adjuvants.
作为卫生假说的重要组成部分，接触分枝杆菌成分与特应性疾病的预防、发展和严重程度之间的关联尚未完全明确。本文综述了这种关系的因果联系现状以及分枝杆菌佐剂在过敏性疾病中作为预防或改善疾病方式的潜在用途。
从人类和动物模型获得的数据表明，卡介苗在特应性疾病中的预防和治疗效果存在差异。需要澄清的问题包括，小鼠中描述的辅助性T细胞1/2细胞的差异是否能完全外推至人类。其他相关因素可能由基因变异、最佳时机、剂量、给药途径以及环境因素引起，这些因素会影响对致病性或腐生性分枝杆菌的自然接触程度。
迄今为止的大多数现有证据表明，需要一种在生命早期通过替代途径（优先为黏膜途径）给药的改良型分枝杆菌疫苗。由于通过诱导辅助性T细胞1来转变辅助性T细胞2免疫反应无法解释分枝杆菌抗原的潜在作用机制，因此研究不同分枝杆菌佐剂是否会诱导调节性T细胞可能是值得的。
