How CD4(+) T cells may eliminate extracellular gastric Helicobacter?

Helicobacter pylori is recognised as a causal agent in the pathogenesis of gastritis, gastric and duodenal ulcer disease as well as gastric cancers. Eradication of the bacteria with antibiotics is currently used to treat symptomatic, infected individuals. Theoretically the infection could also be controlled by vaccination. Several immunisation protocols were developed in small animal models and primates in order to validate this approach. Recently making use of mice with defined genetic defects, H. pylori-specific CD4(+) T cells were found to be crucial for protective vaccination. This was unexpected and poses the question of how activation of CD4(+) T cells leads to the elimination of bacteria that reside primarily in the mucin layer behind a barrier of epithelial cells. CD4(+) T cells fulfil their effector function by secreting lymphokines and by engaging specific surface ligands on interacting cells. Here we propose that phagocytes and epithelial cells stimulated either by direct interaction with CD4(+) T cells or by soluble mediators such as cytokines or neuropeptides are the ultimate effector populations in protective immunity induced by vaccination.