Aerosol vaccines for tuberculosis: a fine line between protection and pathology

Pulmonary delivery of vaccines against airborne infection is being investigated worldwide, but there is limited effort directed at developing inhaled vaccines for tuberculosis (TB). This review addresses some of the challenges confronting vaccine development for TB and attempts to link these challenges to the promises of mucosal immunity offered by pulmonary delivery. There are several approaches working toward this goal including subunit vaccines, recombinant strains, a novel vaccine strain Mycobacterium w, and DNA vaccine approaches. While it is clear that lung-resident adaptive immunity is an attainable goal, vaccine platforms must ensure that damage to the lung is limited during both vaccination and when memory cells respond to pathogenic infection.