London Clinic Cancer Centre, London W1G 8QW, UK.
Tuberculosis (Edinb). 2011 Mar;91(2):179-85. doi: 10.1016/j.tube.2010.12.004. Epub 2011 Jan 12.
In view of the limited protection against tuberculosis, especially the infectious forms of pulmonary tuberculosis, afforded by Bacille Calmette-Guérin (BCG) vaccination, attempts are being made to develop more effective alternatives. Many of these attempts are based on the classical strategy of selecting 'protective' epitopes of Mycobacterium tuberculosis to induce immune responses in the vaccinated host. Such strategies, which in the past have been applied very effectively for the prevention of many acute infectious diseases, may not be relevant for a chronic disease in which both pathogen and host have co-evolved so that the majority of infected individuals remain asymptomatic, albeit latently infected, and in which inappropriate, dysregulated, patterns of immune reactivity predispose to, and maintain, the long-term pathological processes in a minority of symptomatic diseased individuals. While immune responses against the causative pathogen are of doubtless importance in the mediation of protection in the asymptomatic majority, we postulate that it is equally, or more, significant for public health to induce the required protective pattern of immune reactivity by immunotherapy in the diseased minority.
鉴于卡介苗（BCG）接种对结核病，特别是肺结核的传染性形式的保护作用有限，人们正在努力开发更有效的替代方法。这些尝试中的许多都是基于选择结核分枝杆菌的“保护性”表位的经典策略，以诱导接种宿主的免疫反应。过去，这些策略在预防许多急性传染病方面非常有效，但对于慢性疾病可能并不相关，在慢性疾病中，病原体和宿主已经共同进化，因此大多数感染个体仍然无症状，但处于潜伏感染状态，并且不适当、失调的免疫反应模式导致并维持少数有症状的患病个体的长期病理过程。虽然针对病原体的免疫反应在无症状多数个体的保护中介中无疑具有重要意义，但我们假设通过免疫疗法在患病少数个体中诱导所需的保护性免疫反应模式对于公共卫生同样重要，甚至更为重要。
