Chlamydia trachomatis: the role of cellular and humoral immune mechanisms in the development of blindness.

Ocular infection with Chlamydia trachomatis leading to trachoma is the commonest cause of treatable blindness worldwide. Although effectively controlled by improved sanitation, a chlamydial vaccine may prove a more cost-effective method of protection against this disease in the medium term. The development of vaccines against Chlamydia trachomatis has been hampered by a lack of understanding of the immune responses leading to protection or pathology, particularly in humans. Although a strong cell-mediated immune response (T helper lymphocyte type 1) is almost certainly necessary to resolve intracellular chlamydial infection, a humoral (T helper lymphocyte type 2) response may protect against colonization and limit immunopathological events. Recent studies addressing this potential conflict are reviewed.