{"id":2729,"date":"2015-02-09T21:09:06","date_gmt":"2015-02-10T02:09:06","guid":{"rendered":"https:\/\/www.bu.edu\/federal\/?p=2729"},"modified":"2015-02-09T21:18:48","modified_gmt":"2015-02-10T02:18:48","slug":"making-tb-the-next-polio","status":"publish","type":"post","link":"https:\/\/www.bu.edu\/federal\/2015\/02\/09\/making-tb-the-next-polio\/","title":{"rendered":"Making TB the Next Polio"},"content":{"rendered":"

BU team lands $21 million NIH grant to study the disease<\/h4>\n

\"BUToday<\/a>When Jerrold Ellner started working in infectious disease, schistosomiasis was a greater concern to international health professionals than tuberculosis. Fast forward a few decades and TB is now among the greatest public health threats worldwide.<\/p>\n

There are nine million new cases and three million deaths annually from the disease, says Ellner, a BU School of Medicine professor of medicine and chief of Boston Medical Center<\/a>\u2018s infectious diseases section. Most troubling is that 500,000 of these cases are multidrug-resistant, meaning they don\u2019t respond to the most effective antibiotics and are more complicated and expensive to treat. An overwhelming majority of these cases and almost all deaths occur in resource-limited nations.<\/p>\n

One third of the world\u2019s population has had a positive skin test for tuberculosis, but only 5 percent of those who test positive move from a latent to an active infection. The mystery for scientists like Ellner is: which 5 percent? Right now, he and his colleagues have no way of identifying these individuals, who are essentially the needles in a haystack of two to three billion people.<\/p>\n

The good news is that once people develop active TB, the vast majority of them can be cured with a six-month regimen of antibiotics. Those TB infections that are multidrug-resistant require a more toxic cocktail of antibiotics over a longer period of time, up to 24 months for particularly stubborn cases. People fighting drug-resistant TB in developing nations usually must quit working, travel long distances to medical facilities, and adhere strictly to a costly drug regimen that often has debilitating side effects, but no guarantee of a cure. It\u2019s enough to make patients throw in the towel before treatment is complete, and make doctors wish there were a concrete way to determine when a patient is cured.<\/p>\n

Resolving these two issues\u2014finding a way to identify which people with a latent TB infection will develop an active case, and determining an endpoint for successful TB treatment\u2014are the goals of a seven-year, $21 million grant that Ellner and his international team of scientists received from the National Institutes of Health<\/a>\u00a0last summer. Their research is divided into four projects; two studying latent and persistent TB in humans in Brazil, China, and South Africa, and two studying latent and persistent TB in rabbits, which, Ellner says, \u201creflects human disease and allows us to look at drug treatment and penetration into tissue in lesions.\u201d The lab work will also help scientists answer key questions about the bacteria\u2019s genetics and how or where the disease strikes.<\/p>\n

\u201cWhat I consider the current Holy Grail of TB research is a biomarker that you could use to take someone that you know is infected with TB and predict that this person is at risk of developing active TB,\u201d Ellner says. \u201cIf we could say this person is at risk or this person is cured, we could talk about treatment, or preventive therapy.\u201d<\/p>\n

If Ellner\u2019s team is successful, TB could be the world\u2019s next polio. \u201cWe could eliminate TB by 2050,\u201d he says. \u201cIf you can eradicate the latent reservoir, it means you prevent further transmission. When people reactivate their TB, they infect another 20 people, and then the problem exists for another generation. But if you treat the people and prevent them from developing infectious TB, then you can really stop it.\u201d<\/p>\n

Brazil, South Africa, and China were chosen as research sites because of TB\u2019s large presence in their populations, Ellner says, and because they are middle-income countries with strong research infrastructures. South Africa and China have a greater percentage of multidrug-resistant cases, while Brazil has more cases that respond to first-line antibiotics. \u201cThere\u2019s so much TB in these countries,\u201d he says, \u201cand you\u2019d rather work in an area where it\u2019s a major public health problem, because the things that you find will be relevant in those populations.\u201d<\/p>\n

Patients will be followed over the course of their treatment at each site. Researchers will collect blood samples and conduct PET\/CT scans, which detect inflammation in soft tissues like the lung and lymph nodes. \u201cThe more activity on PET scans, the more likelihood of a patient developing active TB down the line,\u201d says grant coinvestigator Karen Jacobson, a MED assistant professor of medicine.<\/p>\n

Ellner\u2019s Holy Grail could help resolve the mystery of the 5 percent whose latent infections will become active. \u201cIf we could try to identify the many infected and target preventive therapies for those few, then we\u2019d really be in business,\u201d says Edward Jones-Lopez, a MED assistant professor of medicine, another grant coinvestigator.<\/p>\n

For patients already undergoing treatment for active TB, \u201cPET scans could be used as interim indicators of relapse,\u201d Jacobson says. \u201cWe could find biomarkers in the blood to correlate with these PET scan results. Blood biomarkers could then be used to better stratify who looks really cured versus who\u2019s more at risk of relapse.\u201d Doctors could then adjust treatment regimens to fit patients\u2019 progress.<\/p>\n

\u201cWe hope that we can eliminate the disease in the United States and then abroad,\u201d says Robert Horsburgh, a School of Public Health professor of epidemiology, biostatistics, and medicine and a member of Ellner\u2019s team. \u201cBut without better tools, we\u2019re never going to make any progress eliminating it in the rest of world. We did it with smallpox and polio, and we\u2019d like to do it with TB.\u201d<\/p>\n

Author, Leslie Friday can be followed on Twitter at @lesliefriday<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

BU team lands $21 million NIH grant to study the disease When Jerrold Ellner started working in infectious disease, schistosomiasis was a greater concern to international health professionals than tuberculosis. Fast forward a few decades and TB is now among the greatest public health threats worldwide. There are nine million new cases and three million […]<\/p>\n","protected":false},"author":7048,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[8],"tags":[47,48,13,55,5,27],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/2729"}],"collection":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/users\/7048"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/comments?post=2729"}],"version-history":[{"count":4,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/2729\/revisions"}],"predecessor-version":[{"id":2734,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/2729\/revisions\/2734"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/media?parent=2729"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/categories?post=2729"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/tags?post=2729"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}