A main focus in healthcare is the active search for alternative strategies to antibiotics,
both for prophylactic and therapeutical interventions, due to the accelerated and widespread
increase in antibiotic resistance. This problem is more marked for patients with recurrent
infections, in which the risk for antibiotic resistance and adverse effects is higher and
can be life-threatening. Although antibiotics remain the mainstay of treatment for infectious
diseases, prophylactic vaccines via the mucosal route in defined populations of patients with
recurrent infections has gained use in recent years. Concomitantly, relevant advances in the
formulation and administration of these vaccines driven by an increased knowledge of mucosal
immunity have expanded their use, although still in its infancy. These drugs target both
the innate and adaptive immune systems, at the actual point of entry of most pathogens. A
fascinating new application of the concepts of trained immunity may open novel studies in
their potential uses, given the paradoxically simultaneous pro-tolerogenic and boosting
effector effects on diverse immune cells for different antigens. Here we delineate an updated review on the
immunomodulatory mechanisms of mucosal polybacterial vaccines.
Keywords: Mucosal immune system, mucosal bacterial vaccines, immunomodulation, recurrent infections.
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