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Perspective
Nature Reviews Immunology 5, 661–667 (1 August 2005) | doi:10.1038/nri1666
Immune responses to tuberculosis in developing countries: implications for new vaccines
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Abstract
Tuberculosis is out of control in developing countries, where it is killing millions of people every year. In these areas, the present vaccine — Mycobacterium bovis bacillus Calmette–Gu|[eacute]|rin (BCG) — is failing. Progressive tuberculosis occurs because the potentially protective T helper 1 (TH1)-cell response is converted to an immunopathological response that fails to eliminate the bacteria. Here, we discuss the data indicating that the problem in developing countries is not a lack of adequate TH1-cell responses but, instead, an exaggerated tendency to switch to immunopathological responses. We propose that a successful vaccine needs to block this immunopathology, because it is not the quantity of TH1-cell activity that matters but, rather, its context.
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