Rook Graham A W, Hernández-Pando Rogelio, Zumla Alimuddin
UCL Centre for Infectious Diseases and International Health, University College London Medical School, London, United Kingdom.
J Infect Dis. 2009 Mar 1;199(5):613-8. doi: 10.1086/596654.
The currently available vaccine for tuberculosis (TB) is ineffective in developing countries. We need to understand the pathogenesis of TB in those countries and how it differs from the pathogenesis of TB in wealthy countries, to facilitate the design and interpretation of clinical trials of new vaccine candidates that are now available. We show here that these geographical differences parallel the strikingly different immunology and bacterial growth curves seen in animal models after high-dose and low-dose challenge with M. tuberculosis (Mtb). We consider this point in the light of recent insights into the multiple pathways used by the immune response to control M. tuberculosis and the susceptibilities of these pathways to regulation and suppression. There are important implications for the screening, testing, and likely success of vaccine candidates.
目前可用于治疗结核病（TB）的疫苗在发展中国家效果不佳。我们需要了解结核病在这些国家的发病机制，以及它与富裕国家结核病发病机制的差异，以促进对现有新型候选疫苗临床试验的设计和解读。我们在此表明，这些地理差异与在动物模型中用结核分枝杆菌（Mtb）进行高剂量和低剂量攻击后所观察到的截然不同的免疫学和细菌生长曲线相似。我们根据最近对免疫反应控制结核分枝杆菌所使用的多种途径以及这些途径对调节和抑制的敏感性的见解来考虑这一点。这对候选疫苗的筛选、测试以及可能的成功具有重要意义。
