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BCG-Sweden is a specific live-attenuated strain of *Mycobacterium bovis* used as a vaccine for the prevention of tuberculosis and as an intravesical immunotherapy for non-muscle invasive bladder cancer. It belongs to the "late" genetic cluster of BCG strains, characterized by specific genomic differences such as the DU2 duplication. Like other BCG strains, BCG-Sweden confers protection not only against tuberculosis but also persistent nonspecific protection against diverse diseases through a mechanism known as "trained immunity." This process involves the epigenetic and metabolic reprogramming of innate immune cells, specifically mediated by the Akt-mTOR-HIF1α signaling axis and NOD-like receptor signaling. Research indicates that BCG-Sweden's ability to induce trained immunity is correlated with linoleic acid metabolism, which may act as an adjuvant to enhance these nonspecific protective effects.
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