Submit Manuscript | http://medcraveonline.com responsible for the substandard efficacy of BCG [2]. Considerable efforts are being made to generate recombinant BCG (rBCG) but with little headway. Causative agent of TB Mycobacterium tuberculosis (M.tb) is remarkably skillful in eluding host defense and modulating immune response for its own benefits. An interesting approach for combating TB is to target M.tb virulence factors [3]. One such key protein is ESAT-6, encoded by region of difference 1 (RD1), the region absent from BCG and most attenuated mycobacterial strains [4,5].Role of ESAT-6 in M.tb virulence has been highlighted in this editorial. ESAT-6 possesses membrane lytic activity due to its helix-turn-helix structure and hydrophobic nature, an attribute that helps M.tb escape phagolysosome, cell-to-cell spread and dissemination. ESAT-6 can alter host defense by decreasing MHC-II expression on macrophages, granuloma formation and decreasing ROS production to aid in intramacrophagial M.tb survival [6]. ESAT-6 or CFP-10/ESAT-6 complex is also known to attenuate host innate immune response by inhibiting production of IL-12, TNF-α, and apoptosis inhibition in M.tb infected macrophages to achieve greater vial load and cell-cell spread [7,8]. ESAT-6 is also supposed to bind to T-cell surface and belittles T-cell immunity by inhibiting T-cell proliferation and activation [9]. As we know the production of the proinflammatory cytokine TNF-α is critical for controlling M.tb infection as it induces apoptosis via TNF-α receptor1 (TNFR1) signaling. Therefore ESAT-6 and CFP-10/ ESAT-6 complex inhibit apoptosis of infected cells by decreasing TNF-α production to attain bacterial buildup and dissemination. There is a large body of literature suggesting that M.tb virulence and modulation of host defense in an intricate communication of M.tb and host proteins, and targeting these interactions can offer a pivotal tool in fight against TB. ESAT-6 has been gaining more and more popularity over the time as one such candidate to be targeted for antitubercular therapeutics development.Widespread efforts are being made to improve current BCG vaccine or to develop new TB vaccines. An in trend approach is to develop efficacious vaccines by combining ESAT-6 with other M.tb virulence determining proteins. Several rBCG strains have been created that express ESAT-6 fusion proteins along with other M.tb proteins like Ag85B, Rv3620c, TNF-and Rv2608, complement RD1, or combine ESAT-6 with Antigen 85 family and superoxide dismutase (SOD), interestingly these new rBCG vaccines demonstrate a strong T-cell response and high expression of Th1 cytokines in experimental animals [10,11]. Even chimeric DNA vaccines are also underway and one such example is developed by combining ESAT-6 gene from M.tb and kinesin motor domain gene of Leishmania donovani, which resulted in robust IFN-γ and IL-2 production in mice. While another nanoparticle based chimeric DNA vaccine contains Ag85A, ESAT-6 and IL-21 construct [11]. On another front, an strong ESAT-6 b...