, 2008). Modified Vaccinia Ankara (MVA) adenovirus, a recombinant-vector vaccine expressing the secreted mycobacterial antigens Ag85A and 85B, has been studied as a subunit vaccine, either as a prime vaccine or as a BCG-boosted vaccine (Williams et al., 2005; Santosuosso et al., 2006). Although this system has a potent adjuvant effect and can deliver vaccine antigens through mucosal tissues to induce strong T-cell stimulation, its drawbacks include increased reactogenicity and pre-existing immunity induced by exposure to natural antigens that are cross-reactive with vector components (McShane et al., 2005; Hoft, 2008). Phase I/II clinical trials have been completed for MVA-Ag85A in Oxford,

UK, and Gambia to assess vaccine safety, immunogenicity and dosage in individuals previously exposed to mycobacterial antigens. Tuberculosis vaccine development

has been progressing EPZ 6438 empirically for many years. Currently, increased understanding of the immune system and the development of advanced delivery and adjuvant systems are enabling the design of improved prophylactic vaccines. As a result, in the last 10 years, the international research community has developed more than 200 tuberculosis vaccine selleck inhibitor candidates currently being tested in mouse, guinea-pig and human primate models. These approaches are aimed at achieving a more potent and prolonged immunological memory, a goal of great global importance, given the rise of MDR-tuberculosis worldwide and the poor efficacy of the BCG vaccine against adult pulmonary tuberculosis. Despite a lack of relevant animal models that correlate

with protection in humans and the lack of markers capable of demonstrating the efficacy of an antigen/adjuvant combination nearly (needed for a faster acceptance of new adjuvants), promising vaccines from the Fifth Framework Program FP5 (Mtb72F/AS01B, H1 in IC31 and CAF01; MVA-Ag85A) have been developed and tested in preclinical and clinical trials, and the optimized formulations and adjuvant combinations have been produced using good manufacturing practices. Further improvement of these adjuvants through combination with other delivery systems or recently identified mycobacterial immunomodulators is underway in the context of FP7 (from 2007 to 2013). It is clear that more research is required on adjuvants’ effects on antigen presentation, APC activation, long-lived memory T-cell induction and Th-1/Th-2 cell polarization to avoid undesirable effects. Efforts directed toward the development of postexposure vaccines against latent tuberculosis are also needed. Thus, the development of new adjuvants and delivery methods is as important as the search for antigens that allow discrimination between latent and active disease. Also, special attention to several candidate nonprotein antigens (sulphoglycolipids, phosphoantigens, etc.) is required, due to their potential usefulness in subunit vaccines and/or adjuvants capable of stimulating CD1-restricted γ-δ or NKT cells.