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Review
. 2019 Aug 30;220(7):1091-1098.
doi: 10.1093/infdis/jiz285.

Nontuberculous Mycobacteria and Heterologous Immunity to Tuberculosis

Javeed A Shah  1   2 , Cecilia S Lindestam Arlehamn  3 , David J Horne  1 , Alessandro Sette  3   4 , Thomas R Hawn  1
Affiliations
Review

Nontuberculous Mycobacteria and Heterologous Immunity to Tuberculosis

Javeed A Shah et al. J Infect Dis. .

Abstract

Development of an improved tuberculosis (TB) vaccine is a high worldwide public health priority. Bacillus Calmette-Guerin (BCG), the only licensed TB vaccine, provides variable efficacy against adult pulmonary TB, but why this protection varies is unclear. Humans are regularly exposed to non-tuberculous mycobacteria (NTM) that live in soil and water reservoirs and vary in different geographic regions around the world. Immunologic cross-reactivity may explain disparate outcomes of BCG vaccination and susceptibility to TB disease. Evidence supporting this hypothesis is increasing but challenging to obtain due to a lack of reliable research tools. In this review, we describe the progress and bottlenecks in research on NTM epidemiology, immunology and heterologous immunity to Mtb. With ongoing efforts to develop new vaccines for TB, understanding the effect of NTM on vaccine efficacy may be a critical determinant of success.

Keywords: BCG; adaptive immunity; innate immunity; nontuberculous mycobacteria; tuberculosis; vaccines.

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Figures

Figure 1.
Figure 1.
Model of NTM, BCG, and Mycobacterium tuberculosis immunologic interactions. A, BCG vaccination is usually administered at birth and NTM exposure occurs regularly throughout life via multiple routes with variable doses. These NTM-specific innate and adaptive immune responses may influence the response to BCG vaccination and susceptibility to M. tuberculosis. B, T-cell epitopes that are common between NTM and M. tuberculosis may mediate protective or deleterious immune responses: blue rectangle, T-cell epitopes that are shared between NTM and M. tuberculosis and lead to cross-protection between species; black rectangle, T-cell epitopes that are shared between NTM and M. tuberculosis but are not cross-protective and may impair immune responses to M. tuberculosis; pink rectangle, T-cell epitopes unique to NTM; red rectangle, T-cell epitopes unique to M. tuberculosis. Abbreviations: Mtb, Mycobacterium tuberculosis; NTM, nontuberculous mycobacteria; TB, tuberculosis; MP, macrophage; DC, dendritic cell.
See this image and copyright information in PMC

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