结核病与肺部健康杂志 ›› 2012, Vol. 1 ›› Issue (1): 74-79.

• 专家论坛 • 上一篇    

结核病免疫机制及疫苗研制开发研究进展

刘海鹏,戈宝学   

  1. 200433 同济大学附属上海市肺科医院
  • 收稿日期:2012-06-26 出版日期:2012-07-20 发布日期:2012-07-20
  • 通信作者: 戈宝学,Email:baoxue_ge@tongji.edu.cn

Progress in the immune regulation of Mycobacterium tuberculosis infection and the development of vaccine against tuberculosis

LIU Hai-peng, GE Bao-xue   

  1. Shanghai Pulmonary Hospital Affiliated to TONGJI University, Shanghai 200433, China
  • Received:2012-06-26 Online:2012-07-20 Published:2012-07-20
  • Contact: GE Bao-xue,Email:baoxue_ge@tongji.edu.cn

摘要: TB主要是由结核病病原体——Mtb感染引起的具有重大公共卫生威胁的传染病。天然免疫细胞如巨噬细胞或树突状细胞,通过其表达的模式识别受体(PRRs)识别Mtb特有的病原相关分子模式(PAMPs)后,引起大量特异性的细胞因子表达及细胞活性的提高。被激活的巨噬细胞或树突状细胞不仅可以直接吞噬Mtb或Mtb感染的细胞,还可以通过释放各种活性分子与抗原提呈来激活适应性免疫应答。然而,Mtb在与宿主免疫系统的长期共同进化过程中发展出各种干扰或抑制免疫细胞功能的机制:如抑制细胞因子的产生;抑制吞噬体与溶酶体的融合;抑制巨噬细胞的自噬;抑制免疫细胞的凋亡;抑制树突状细胞的成熟和抗原提呈等,从而能够在巨噬细胞内存活。目前,惟一使用的减毒Mtb活疫苗——BCG却缺乏有效性。人们对TB发生机制的认识不足,严重限制了对TB新型高效的抗Mtb疫苗的研发。尽管近年来在新型疫苗研制开发方面已经取得一些进展,目前进入临床状态的候选疫苗已达十几种,但是距离实际应用还任重而道远。按照免疫策略和改进方法,新型疫苗可以分为重组BCG疫苗、亚单位疫苗、活载体疫苗和减毒Mtb疫苗。研发新型疫苗关键需要解决以下问题:一是如何筛选到优质的抗原;其次,如何筛选到优质的佐剂以增加抗原的免疫保护效果;再次如何保证抗原的正确加工和有效提呈;第四,如何增加BCG的免疫记忆;第五,如何进一步降低BCG的毒力;最后,如何对疫苗的免疫保护效果进行评估。

Abstract: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis (Mtb) which is a big public health threat. The pathogen-related molecular patterns (PAMPs) of Mtb is recognized by pattern recognition receptors (PRRs) expressed on innate immune cells including macrophages and dendritic cells (DC) and induces the production of specific cytokines and activation of those cells. The activated macrophages and DC are not only able to directly phagocytose Mtb or Mtb infected cells, but also activate adaptive immune responses by releasing active mo-lecules and antigen presentation. However multiple immune evasion strategies have been developed during the co-evolution of Mtb and host immune systems, including inhibiting the production of cytokines, the fusion of phagosome with lysosome, autophagy of macrophages, apoptosis of immune cells as well as maturation and antigen presentation of dendritic cells, which ensure the persistent survival of Mtb in macrophages. Currently, BCG is the solely available TB vaccine however is not very effective. Novel and high effective vaccine development is impeded by the lack of understanding on the pathogenesis of TB. Although many progresses in the development of novel vaccine have been made and more than ten candidate vaccines have stepped into clinical stage, yet there is still a long way to go to fulfill clinical application. Novel vaccines are divided into recombinant BCG vaccine, subunit vaccine, live vector vaccine and attenuated Mtb vaccine according to immune strategies and improvement methods. There are several key problems to develop novel vaccines. Firstly, good antigens have to be obtained. Secondly, excellent adjuvant has to be acquired so as to enhance the protective effect of antigen. Thirdly, the processing and presentation of antigens should be ensured correctly and effectively. Fourthly, the immune memory of BCG vaccination should be enhanced. Fifthly, the toxicity of BCG vaccination should be reduced. Lastly, a simple and reliable vaccine evaluation platform should be set up.