Mycobacterial disease-a challenge to biotechnology

Abstract

The two principal mycobacterial diseases - tuberculosis and leprosy - remain major causes of human suffering in many parts of the world. The struggle against these diseases has been hampered by the inadequacy of methods for their diagnosis, prevention and therapy. Improvements in diagnostic methods, especially for tuberculosis, are required as existing bacteriological techniques are time consuming and insensitive, but immunological tests suffer from a lack of specificity and a failure to distinguish active disease from past sensitization. Tests are required that will either detect the presence of mycobacterial antigens or the occurrence of immune reactions specific to active infection. Prophylaxis by BCG vaccine is never complete and in some regions appears virtually ineffective. In order to determine the reason for this variation, to produce better vaccines, and to use BCG more effectively, a deeper understanding of the immune reactions in mycobacterial disease is required. In particular, the bacterial determinants of virulence and protection and the mode of action of BCG require detailed study. The therapy of tuberculosis and, to a lesser extent, leprosy has undergone an extensive transformation since the introduction of rifampicin. Nevertheless the cost of modern short course regimens for tuberculosis limit their application. Even shorter regimens, made possible by more potent bactericidal drugs or by agents that stimulate the host's defences are thus required. Recent advances in biotechnology could therefore lead to significant advances in the control of these diseases but only if they are integrated into local, self-reliant public health initiatives. © 1985 Oxford University Press.