Tuberculosis: Collaborating to fight a global problem

No location on the planet escapes the devastating toll of tuberculosis (TB), the second deadliest infectious disease worldwide.

A critical challenge in the TB fight is the reality that the disease hits citizens hardest in areas with the least resources to fight it. Participants at the George H.W. Bush Sixth China-U.S. Relations Conference in Houston are intent on solving this global challenge with advancements in diagnosis and treatment that can potentially benefit all the world’s citizens.

For Texas A&M Health Science Center’s Dr. Jeffrey Cirillo and international allies who discussed the topic at the conference, the priority is frustratingly long range but clear: eradication.

Despite promising technological innovations, a cookie-cutter approach will not solve this global problem, both U.S. and China officials say. Differences in governmental regulations, health care delivery, diagnostic methods and treatment effectiveness require customized intervention by location. Adding urgency to the issue is China’s epidemic-level incidence, with nearly a million new TB cases diagnosed every year.

“In the past 10 years China has funneled a huge amount of money into TB epidemiology and diagnostic technologies, and it is intriguing to see what they’ve got and how they’re planning to apply it,” said Cirillo, director of the Center for Airborne Pathogen Research and Tuberculosis Imaging at TAMHSC, who is chairing the TB roundtable discussions at the conference. In recent years his lab has hosted several Chinese government employees for training in specific diagnostic procedures for implementation in their home country.

“A group met in Beijing in 2009 on a similar topic, but the focus this time is on technological advancements and how we can incorporate new TB detection methods,” said Cirillo, whose groundbreaking new rapid TB diagnostic device was among the strategies discussed during the Houston conference. Sessions featured detailed collaboration among representatives of higher education, government, industry and the public health sector.

“We often say we have a dream: It’s to have precision medicine for TB clinical care,” said Dr. Xiaoqing Liu, a physician in the infectious disease department at Peking Union Medical College Hospital in Beijing. She described a network of 16 “cooperation centers” located at some of the 200 special hospitals designated to treat active pulmonary TB cases. The centers have been established to build a foundation for better Chinese TB clinical trials, and she suggested a use for them in studying Cirillo’s detection device. “Maybe we can collaborate,” she said.

Over the past 10 years, China has achieved a 26 percent reduction in new TB cases, according to World Health Organization data. However, TB prevalence globally is still staggering, particularly among many Asian and African countries.

Cirillo and his TAMHSC team along with the spinoff company GBDbio Corp. have created a portable, low-cost diagnostic device known as TB REaD, currently undergoing clinical trials in Thailand, Peru, South Africa and Vietnam through the World Health Organization, foundations, multiple other nonprofits and groups. Close to becoming available for use by providers worldwide, this device shortens diagnosis time from several days to 10 minutes.

“It will make a huge difference to be able to diagnose earlier,” Cirillo said, explaining that patients can transmit the disease by coughing or sneezing before it is even possible to confirm their own TB diagnosis through current testing methods. “Until now, we really haven’t had anything to diagnose TB rapidly, particularly in low resource settings, and particularly in pediatric cases.” In related efforts to rapidly diagnose the disease, his team is focused on advancing a test that can detect a nonpulmonary form of TB in children.

Drug-resistant TB, now present everywhere in the world, is hampering efforts to fight the disease. In 2013 an estimated 480,000 new cases of multidrug-resistant TB occurred worldwide, according to the World Health Organization. Resistance to the drugs known to fight the TB bacterium makes these cases particularly deadly.

For this reason, Cirillo is pursuing an additional diagnostic approach known as drug susceptibility testing to detect antibiotic resistance. This molecular test measures the viability of the bacteria causing TB, offering secondary confirmation to the initial findings showing TB’s presence. Whereas this secondary test currently is done by culture and results take weeks to obtain, Cirillo and his team are aiming to offer results within two hours. This time saved is vital in implementing additional therapies, closely monitoring patient compliance and minimizing disease transfer.

A successful fight against TB should pair advanced diagnostic tools with cutting-edge therapies to treat the condition effectively. Ross Underwood of Johnson & Johnson’s pharmaceutical research division described for session attendees the company’s newly developed antibiotic called bedaquiline, the first new such TB drug in 50 years. “This is largely a disease of the poor, and those who can’t help themselves,” Underwood said, explaining the treatment’s use for multidrug-resistant TB in adults. “We have a commitment to provide worldwide solutions and also not leave patients behind.”

“Working together with the Beijing CDC, the Henan CDC, GBDbio, Johnson and Johnson and investigators at Texas A&M, we hope to develop the necessary interactions to allow incorporation of emerging diagnostics and treatment strategies,” said Cirillo. “This will allow us to better combat tuberculosis in China and throughout the world.”