The lack of a big picture in tuberculosis: The clinical point of view, the problems of experimental modeling and immunomodulation. The factors we should consider when designing novel treatment strategies

This short review explores the large gap between clinical issues and basic science, and suggests why tuberculosis research should focus on redirect the immune system and not only on eradicating Mycobacterium tuberculosis bacillus. Along the manuscript, several concepts involved in human tuberculosis are explored in order to understand the big picture, including infection and disease dynamics, animal modeling, liquefaction, inflammation and immunomodulation. Scientists should take into account all these factors in order to answer questions with clinical relevance. Moreover, the inclusion of the concept of a strong inflammatory response being required in order to develop cavitary tuberculosis disease opens a new field for developing new therapeutic and prophylactic tools in which destruction of the bacilli may not necessarily be the final goal. Along this short review, we would like to explore the gap between medical doctors and basic scientists in terms of their point of view regarding the tuberculosis disease (TBD), to revise several concepts involved in human tuberculosis including the problems of experimental modeling, and to point out why we shall consider including immunomodulation in novel treatment strategies. © 2014 Vilaplana and Cardona.