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Chapter 25 : Suggested Future Research and Unanswered Questions
This section contains five parts. Part I talks about the host response and its implications; part II suggests research on the bacillus; part III suggests research on prophylactic vaccines and immunotherapy; part IV deals with development of new drugs for the treatment and prevention of tuberculosis; and part V provides sources of additional information. The cells participating in tuberculous lesions show a heterogeneity of functions, even among cells of identical appearance. The cytokines and cytokine receptors that are involved in the immune response within different organs should be identified by molecular biology techniques. Both DTH and CMI are mediated by Th1 lymphocytes and their cytokines. Tissue necrosis in clinical tuberculosis could be reduced by vaccines that cause little or no sensitivity to tuberculin. In rabbits, guinea pigs, and humans, microvascular thrombosis causes much of the tissue damage found in tuberculosis. Polymorphonuclear leukocytes (PMN) (neutrophils in humans, mice, and guinea pigs, but eosinophilic heterophils in rabbits) are common near solid and liquefied caseum. The prevention of clinical tuberculosis by a more effective vaccine than currently available BCG vaccines would be the most efficient way to reduce the incidence of this disease in the world. Immunotherapy should be pursued more extensively, because it would be of great benefit in treating multidrug-resistant tuberculosis, and because it could shorten the treatment of drug-susceptible tuberculosis.