A case for passive immunoprophylaxis against tuberculosis

HIV-associated tuberculosis is escalating ominously in Africa and southeast Asia despite existing control measures. Therefore, new approaches to tuberculosis control need to be explored. We discuss the potential use of passive immunoprophylaxis with antibodies in tuberculosis control. Although the predominant type of active host resistance is T-cell mediated, recent results in mouse experimental models suggest that monoclonal antibodies to certain antigens (eg, Acr or lipoarabinomannan) can impart substantial passive protection against tuberculous infection. These results are corroborated by data from other laboratories on passive vaccination against a number of intracellular microbial pathogens. Further work is needed to develop human (or humanised) antibody reagents, to increase their protective efficacy, and to expand our understanding of the mechanisms of antibody action.