ARTICULOS ORIGINALES

 

Viejos y nuevos enfoques para el desarrollo de vacunas contra la tuberculosis.

Old and New approaches for Vaccines against tuberculosis.

 

H. Bercovier.

Department of Clinical Microbiology. The Hebrew University-Hadassah Medical School. Ein Karem, Jerusalem, 91120, Israel.
E-Mail:[e-mail]

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RESUMEN

¿Necesitamos esfuerzos renovados para desarrollar nuevas vacunas para combatir la tuberculosis? Los datos
epidemiológicos muestran que la disminución de la ya baja incidencia de tuberculosis se ha detenido en los países en desarrollo. En ciertos países occidentales la incidencia de tuberculosis ha aumentado incluso en los últimos 10 años. En Africa y Asia se encontró una alta incidencia de tuberculosis similar a la del mundo occidental en los años 30. ¿Podemos predecir por la historia de la tuberculosis en Europa Occidental que la epidemia de tuberculosis en los países en desarrollo ya alcanzó su pico o se encuentra todavía en aumento? Datos revisados muestran que en Europa la epidemia de tuberculosis comenzó al menos tres siglos antes de alcanzar su apogeo a mediados del siglo XIX. Las razones para la disminución de la tuberculosis en la primera mitad del siglo XX en el mundo occidental todavía no son bien comprendidas.¿Las medidas de salud pública o el adecuado tratamiento con antibióticos reducirán o detendrán la tuberculosis en Africa y Asia o continuará aumentando la tuberculosis? Nuestra posibilidad para controlar la diseminación de la enfermedad se complica por la aparición de cepas resistentes a antibióticos y el VIH. Por lo tanto se requiere una mejor comprensión de la base molecular de la interacción entre el bacilo y sus huéspedes para el desarrollo de mejores enfoques de tratamiento e inmunización. La inmunidad celular y la hipersensibilidad de tipo retardado (HTR) son procesos claves en el curso de la infección por el Mycobacterium y están involucradas tanto en la infección primaria como en la secundaria, así como en la inducción de la inmunidad protectora en el huésped. Los diferentes tipos de vacuna contra la tuberculosis que están siendo reevaluadas incluyen: BCG con dosis de refuerzo, BCG oral, BCG modificada (multivalente), cepas auxotróficas atenuadas del M. tuberculosis, proteínas secretadas o recombinantes de M. tuberculosis con o sin inmunomoduladores y vacunas de ADN. Estas nuevas vacunas inducen una buena inmunidad celular y pueden contribuir al desarrollo de enfoques mejorados
de inmunización y tratamiento.

Palabras claves: Vacunas, tuberculosis, Mycobacterium tuberculosis

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ABSTRACT

Do we need renewed efforts to develop new vaccines to fight tuberculosis? Epidemiological data show that the decrease of the already low incidence of tuberculosis has stopped in developed countries. In certain Western countries the incidence of tuberculosis has even increased in the last ten years. In Africa and in Asia, a high incidence of tuberculosis is found similar to that of the Western world in the 1930s. Can we predict from the history of tuberculosis in Western Europe that the epidemic of tuberculosis in developing countries has reached his peak or is still developing? Revisited data from Europe show that the epidemic of tuberculosis started at least three centuries before it reached its apogee in the middle of the 19th century. The reasons for the decrease of tuberculosis in the first half of the 20th century in the Western world are still not well understood. Will public health measures and proper antibiotic treatment reduce and stop tuberculosis in Africa and in Asia or will the incidence of tuberculosis increase? Our ability to control the spread of the disease is complicated by the appearance of antibiotic resistant strains and HIV. Therefore, a better understanding of the molecular basis for the interaction between the bacilli and the hosts is necessary for the development of improved approaches for treatment and immunization. Cellular immunity and delayed type hypersensitivity (DTH) are key processes in the course of mycobacterial infection and are involved in both primary and secondary infection as well as in the induction of protective immunity in the host. The different types of tuberculosis vaccines being reevaluated comprise: BCG with booster, oral BCG, modified BCG (multivalent), auxotrophic M. tuberculosis attenuated strains, M. tuberculosis secreted proteins or recombinant proteins with or without immunomodulators and DNA vaccines. These new vaccines inducing a good cellular immunity may contribute to the development of improved approaches for immunization and treatment.

Keywords: Vaccines, tuberculosis, Mycobacterium tuberculosis

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