For a deadly disease with nearly 9 million new cases and 1.6 million deaths worldwide each year, the war on tuberculosis [TB] may get a little boost. Case Western Reserve University School of Medicine is pleased to announce that the Tuberculosis Research Unit (TBRU) at the School of Medicine has received a $27 million contract from the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health, to continue its work in TB research. The TBRU is the only one of its kind supported by the NIH in the United States. The previous award in 1999 was $28 million over seven years. As individual NIH grants are cut across the nation due to a flat federal NIH budget, the significance of the award and its dollar amount are welcome.
The contract will allow researchers to build on a long-standing tradition of multi-disciplinary TB research at the School of Medicine through its international collaborations in Uganda, Brazil, South Africa and Philippines. The Uganda-Case Research Collaboration (UCRC) with colleagues at Makerere University, Mulago Hospital and the Joint Clinical Research Center in Kampala, Uganda, will feature prominently in this new contract. There also will be greatly expanded research activities with investigators at the University of Capetown and the South African TB Vaccine Initiative (SATVI) in Capetown, South Africa. This international consortium of physician and research scientists in two African countries and 10 United States research institutions will conduct studies of the genetics, immunology, microbiology and epidemiology of this often fatal disease in countries where TB is an enormous public health problem.
"Renewal of this research program is a wonderful opportunity to bring together new colleagues in the United States, Uganda and South Africa for TB research focused on understanding how the infection is transmitted and why some people go on to develop active disease, whereas most contain the infection. These studies will impact development of new vaccines, diagnostics tests, and treatment for TB," said W. Henry Boom, M.D., principal investigator for the new contract and Professor of Medicine at the School of Medicine and University Hospitals Case Medical Center.
Tuberculosis [TB], a bacterial infectious disease, commonly affects the lungs with one-third of the world's population currently infected, though asymptomatic; one in ten of these latent infections will advance to active TB. Active TB, which develops slowly over a period of months, begins with a chronic cough, night sweats, loss of weight and a characteristic cavity (i.e. hole) in the lung found on chest x-ray. Left untreated, TB is fatal. Mycobacterium tuberculosis, the causative bacterium, is spread person-to-person by droplets expelled from the lungs by coughing. According to World Health Organization statistics, those with active TB can infect 10-15 other people per year. The immuno-compromised, particularly those with HIV/AIDS, persons living in crowded living conditions, children exposed to high-risk adults, and healthcare workers serving high-risk patients are at greater risk of becoming infected and developing TB.
Trying to understand the immune response to TB, why some and not others develop disease, why the TB vaccine that is used worldwide to protect newborn and very young children is ineffective in preventing TB in adolescents and adults, and determining who will respond rapidly and who may need longer (i.e. more than 6 months) drug treatment for TB are major focuses of the new contract. Answering these questions is particularly important as new vaccines, drugs and diagnostic tests for TB are being developed by investigators around the world supported by the NIH, the Gates Foundation, WHO and others. The new TBRU contract will bring together investigators in the departments of Medicine, Genetics, and Epidemiology and Biostatistics at Case with investigators at the Aeras Global TB Vaccine Foundation in Bethesda, MD, Colorado State University in Ft. Collins, Oregon Health & Science University in Portland, Public Health Research Institute in Newark, NJ, Saint Louis University in St. Louis, MO, University of Arkansas in Little Rock, and University of Washington, Institute for Systems Biology and Infectious Diseases Research Institute in Seattle, WA. They will use a multi-disciplinary approach combining cutting-edge immunology, genetics, microbiology with epidemiologic studies and clinical trials in TB endemic countries in Africa (Uganda, South Africa). Investigators in the UCRC at Mulago Hospital, Makerere University, and the Joint Clinical Research Centre in Uganda, and those at the University of Cape Town and SATVI in South Africa will be the international partners.
Global health issues such as TB are a concern for all of us. TB infection and disease is not limited only to less economically developed countries where access to care, therapeutics and diagnostics are limited or disrupted by social or political instability. In the United States, TB continues to occur although is decreasing as extensive public health systems assure that TB patients promptly receive and take their free medications for the required six months, and that persons at risk are screened for latent M. tuberculosis infection and provided preventive therapy. Many Americans travel to TB endemic countries for vacation or to visit relatives, and many new immigrants and visitors to the US come from TB endemic countries in Latin America, Asia and Africa. Thus TB continues to be a significant public health problem in the US. The Cuyahoga TB Clinic at MetroHealth Medical Center saw more than a 1500 persons with either latent or active TB infection last year. With the new NIH contract in place, TBRU looks forward to not only increasing its collaborations within the United States and abroad, but also with TB care and research activities in Northeastern Ohio.
"This is a very exciting time in the fight against TB as politicians, public health officials, researchers, donor agencies and foundations worldwide refocus their attention on the pandemic caused by this age-old pathogen. This will allow progress to be made in preventing and treating TB. We are fortunate in Northeastern Ohio and at Case to have one of the oldest and internationally know centers for TB research and thus be able to contribute to this fight through the support provided by this large new NIH contract", says Boom.
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