London’s physicians are battling a rising rate of tuberculosis. But the city is also an international centre of excellence in TB research.
Evelyn Harvey
It’s World TB Day on 24 March. It may come as a surprise that such an awareness-raising day is needed. In the West, the disease is largely perceived as a thing of the past, thanks to improved living conditions and effective treatment. Yet TB cases in London rose by 11.2% last year to 40 per 100,000. In some boroughs, the rate is comparable to that of certain high-burden countries – for example, Brent, at 116 per 100,000 is slightly higher than China at 113 per 100,000.
TB has historically been associated with poverty, and this high incidence is partly attributable to poor, overcrowded conditions and inadequate nutrition in some communities. This includes immigrant populations, but TB has always been present in the UK. Another factor is the rise in HIV. Sufferers are more likely to die from TB than any other illness.
“HIV related cases caused 11% of the increase,” says Dr Graham Bothamley, a consultant at Homerton Hospital. But he notes that better screening and diagnosis, particularly of extrapulmonary TB, might have artificially elevated the figure.
Local linkups
Strains of TB are emerging with resistance to almost all available drugs. The need for new diagnostics, drugs and vaccines to fight TB has never been more pressing, at home or abroad. Fortunately, TB research in London is flourishing. For example, a groundbreaking proteomics survey of biomarkers for TB infection was recently published in the Lancet (1). The work involved interdisciplinary collaboration by researchers at the National Institute for Medical Research (NIMR), St George’s and the Hammersmith Hospitals.
Professor Douglas Young of Imperial College and the NIMR notes that funding is in place to support R&D: “The Gates Foundation has given a huge boost to translational research through the Grand Challenges programme, looking at the interface between fundamental research and drug development. Can you use the science to develop treatments?”
Young cited an association of immunology and basic TB science at NIMR as an example. Crucial links between researchers and clinicians are continually being strengthened. “The human aspect of research is important,” explained Bothamley, whose projects include pilots of new diagnostic methods and genetic studies of TB patients.
Global action
Networking isn’t confined to London. Research groups are working closely with scientists and clinicians in TB high-burden countries. For example, Professor Peter Godfrey-Faussett at the London School of Hygiene and Tropical Medicine and Dr Helen Ayles in Zambia are running ZAMSTAR, a trial of TB–HIV interventions.
The challenge of identifying new drug-resistant and hypervirulent strains of TB is being addressed at the Mycobacterial Reference Unit (MRU) at Queen Mary’s School of Medicine and Dentistry. Launched in 2006 under Francis Drobniewski, the MRU is the UK Health Protection Agency’s national reference center for tuberculosis and mycobacterial diseases and is a WHO Supranational Reference Laboratory. Advanced drug susceptibility testing will be used to gather data and decide on appropriate treatment for patients in London and worldwide.
Innovative research from the capital will have great impact in the coming decades, but new drugs will not be with us for some years yet. In the meantime, controlling TB on the streets of London is in the hands of the medical professionals and the public.
Reference
(1) D. Agranoff et al.: Identification of diagnostic markers for tuberculosis by proteomic fingerprinting of serum. The Lancet, Volume 368, Issue 9540, Pages 1012-1021
Further information
Nature Medicine special focus on Tuberculosis
TB Alert, the UK’s national TB charity
Health and Development Network’s Stop-TB eForum