Clancy Am Robert
School of Medicine and Public Health, University of Newcastle, Newcastle 2000, Australia.
Vaccines (Basel). 2023 Jul 17;11(7):1251. doi: 10.3390/vaccines11071251.
The idea of a common mucosal immune system (CMS) is 50 years old. Its relevance to immune protection at mucosal sites and its potential to modulate the impact of vaccination-induced protection against infection of the airway has been poorly understood. The consequent failure of the current SARS-CoV-2 vaccination to satisfy expectations with respect to prevention of infection, viral transmission, duration of protection, and pattern of clinical protection, led to public health and medical decisions now under review. This review summarises knowledge of the CMS in man, including the powerful role it plays in immune protection and lessons with respect to what can and cannot be achieved by systemic and mucosal vaccination for the prevention of airway infection. The powerful impact in both health and disease of optimising delivery of immune protection using selected isolates from the respiratory microbiome is demonstrated through a review of randomised controlled trials (RCTs) in subjects with chronic airway disease, and in otherwise healthy individuals with risk factors, in whom the idea of mucosal immune resilience is introduced. This review is dedicated to two giants of mucosal immunology: Professors John Bienenstock and Allan Cripps. Their recent deaths are keenly felt by their colleagues and students.
共同黏膜免疫系统（CMS）的概念已有50年历史。人们对其在黏膜部位免疫保护中的相关性以及调节疫苗诱导的保护作用以抵御气道感染的潜力了解甚少。目前的新冠病毒疫苗未能在预防感染、病毒传播、保护持续时间和临床保护模式方面达到预期，这导致了目前正在重新审视的公共卫生和医疗决策。本综述总结了人类CMS的相关知识，包括其在免疫保护中所起的重要作用，以及关于全身和黏膜疫苗接种在预防气道感染方面所能达到和无法达到的效果的经验教训。通过对慢性气道疾病患者以及有风险因素的健康个体进行的随机对照试验（RCT）的综述，展示了使用呼吸道微生物组中选定分离株优化免疫保护传递对健康和疾病的强大影响，其中引入了黏膜免疫恢复力的概念。本综述献给黏膜免疫学的两位巨人：约翰·比嫩斯托克教授和艾伦·克里普斯教授。他们最近的离世让同事和学生深感悲痛。
