Tackling Tuberculosis on a global scale

On 24 March, UCL’s Institute for Global Health marked World TB day with a call to arms to tackle TB globally, bringing together experts to highlight UCL’s contribution to addressing this problem which, according to UCL’s Professor Ali Zumla recent Lancet publication, results in an estimated 1.7 million deaths each year and more than 9 million new cases each year.

Dr Jolene Skordis (UCL Centre for International Health & Development) kicked off the afternoon with a thought-provoking comparison of TB, Diabetes and urban health systems in South Africa and Kyrgyzstan. She highlighted the reasons for demand for public and private services, what delays diagnosis and why we should consider Diabetes and TB together.

When an infectious case of TB is identified, who is most at risk of contracting TB? Dr Louise Pankhurst (UCL Healthy Infrastructure Research Centre) provided an engineering perspective to TB screening using a case study of an office in Canary Wharf which examined air flow, crowding and ventilation type, design and function. The aim of this research is to develop easy-to-use cost effective tools for public health professionals to measure the environment to accurately predict attack rates.

Extending the theme of environmental control, we also sought to draw on the expertise of others. Tom Green from the charity ARCHIVE (Architecture for Health in Vulnerable Environments) further highlighted the linkage between local environment and tuberculosis, emphasising how important homes can be for preventing the spread of TB using case studies from Haiti and Brent.

Critical in environmental spread is aerosol formation. The 20% most infectious people are said to be ‘super spreaders’ responsible for 80% of TB infections. Dr Fatima Wurie (UCL Infection and Population Health) presented research examining people’s variations in bio-aerosol production. Most bio-aerosol is produced during normal breathing, and since TB requires aerosol transmission, variations in bio-aerosol production may be an important determinant of infectivity and fundamental to our understanding of TB and its transmission. This research has led to additional tests to predict infectivity in order to identify those most prone to spreading TB.

Problems of TB diagnosis were then expanded upon by Dr Justin O’Grady (UCL Clinical Microbiology). Currently Zambia – a high TB and HIV prevalence setting – relies on smear microscopy for TB diagnosis, which can be inaccurate. Recent research in Zambia provides an independent evaluation of GeneXpert – new diagnostic technology – which promises to provide a significant improvement in diagnosis in high prevalence settings.

In an analysis of the north London Isoniazid resistant TB outbreak, Dr Rob Shorten (UCL Clinical Microbiology) demonstrated that strains from the outbreak showed independent evolution of drug resistance, suggesting that drug resistance is not driving this outbreak but is a consequence of it.

Professor Brian Henderson (UCL Eastman Dental Institute) described the recent interest in moonlighting proteins – a protein that has at least one additional unique and independent biological activity in addition to the original described activity of the protein. He presented research showing that moonlighting tuberculosis proteins are major virulence factors of tuberculosis and could provide new solutions for treating tuberculosis.

Dr Marc Lipman (UCL Medicine) and Dr Charlotte Jones – a retired doctor and former TB patient – gave an inspiring summary of Charlotte’s grandfather’s discovery of Tuberculomucin in Germany in the first part of the 20^th Century. Early studies showed tuberculomucin was a successful treatment for TB; however, WWII and the development of antibiotics meant this treatment was forgotten. Charlotte gave a fascinating description of her own TB whilst a medical student in London in the 1940s, and the treatment with tuberculomucin given by her mother. Charlotte called for this treatment to be reassessed given the growing levels of TB globally and the problems caused by drug resistance. The use of immunomodulatory approaches to TB treatment chimes with current knowledge and thinking.

Dr Tim McHugh (UCL Institute for Global Health / Clinical Microbiology) ended the day reminding us all that the battle against TB is not just about biology, but needs to include a focus on the environmental and social determinants of the disease. TB research is fraught with received wisdoms and at UCL we are directing our resources to challenge and properly evaluate these. Find out more about this event by viewing our report.