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Trends Immunol. 2004 Sep;25(9):483-8.

IL-4 in tuberculosis: implications for vaccine design.

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Centre for Infectious Diseases and International Health, Windeyer Institute for Medical Sciences, Royal Free and University College Medical School, 46 Cleveland Street, London, UK.


Current attempts to find a vaccine for tuberculosis (TB) are based on the assumption that it must drive a Th1 response. We review the evidence that progressive disease might not be due to absence of Th1, but rather to the subversive effect of an unusual Th2-like response, involving interleukin-4 (IL-4) and IL-4delta2. This Th2-like response can impair bactericidal function and lead to toxicity of tumour necrosis factor-alpha (TNF-alpha) and to pulmonary fibrosis. If this is important, effective vaccines will need to suppress pre-existing Th2-like activity. Such vaccines are feasible and are active therapeutically in mouse TB.

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