АДЪЮВАНТНЫЙ И ДРУГИЕ ЭФФЕКТЫ ВАКЦИНЫ БЦЖ И ЕЕ ВЛИЯНИЕ НА ЭПИДЕМИОЛОГИЮ НОВОЙ КОРОНАВИРУСНОЙ БОЛЕЗНИ COVID-19
https://doi.org/10.32415/jscientia_2020_6_4_5-29
Ключевые слова:
адъювант, аутоиммунитет, вакцинация БЦЖ, острый респираторный дистресс-синдром, перекрестная антигенная специфичность, тренированный иммунитет, коронавирус, SARS-CoV-2, коронавирусная болезнь, COVID-19, цитокиныАннотация
Живая вакцина БЦЖ, вызывая комплексный ответ как врожденного, так и клеточного/гуморального адаптивного иммунитета, служит биологическим адъювантом. Она выступает триггером «тренированной» реакции иммунной системы, характеризующейся активацией моноцитов, макрофагов, естественных киллеров, а также лимфоидных клеток врожденных популяций. Это способствует скорейшей активации неантигенспецифических защитных программ организма в борьбе с рядом вирусных, грибковых, протозойных инфекций и неоплазией. Одной из таких инфекций может быть COVID-19. Патогенез развития острой интерстициальной пневмонии/респираторного дистресс-синдрома, вызванных COVID-19, характеризуется запуском избыточного системного действия медиаторов воспаления, в частности – цитокинов, при нарушении его фокальных барьеров. Гамма-интерферон, вырабатываемый лимфоцитами после вакцинации БЦЖ, модулирует активность ряда интерлейкинов, что, в свою очередь, может способствовать менее тяжелому течению COVID-19 за счет снижения активности ИЛ-12 и ИЛ-18-зависимых реакций. Между возбудителями микобактериозов и COVID-19 существует антигенный перекрест из-за гомологии белков. В отличие от многих адъювантов, неоднозначно влияние БЦЖ на разные аутоиммунные заболевания (провокация одних и протективное действие при других), как и на риск возникновения лимфом (БЦЖ его снижает, тогда как многие адъюванты повышают). Это, видимо, связано с назначением БЦЖ в очень ранний период, при незрелой иммунной системе и отражает симбионтный характер взаимодействия штамма БЦЖ и организма хозяина. Приведены по странам данные о связи исторической практики применения вакцинации БЦЖ и текущей заболеваемости новой коронавирусной инфекцией и смертности от нее. Рассмотрены в историческом ключе медико-социальные причины разной национальной политики органов здравоохранения в отношении применения вакцины БЦЖ.
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