{"id":5502,"date":"2021-09-30T08:44:25","date_gmt":"2021-09-30T07:44:25","guid":{"rendered":"https:\/\/med.st-andrews.ac.uk\/medicine\/?p=5502"},"modified":"2021-09-30T08:44:25","modified_gmt":"2021-09-30T07:44:25","slug":"the-global-fight-against-tuberculosis","status":"publish","type":"post","link":"https:\/\/medicine.st-andrews.ac.uk\/news\/the-global-fight-against-tuberculosis\/","title":{"rendered":"The global fight against tuberculosis"},"content":{"rendered":"

Medical research\u00a0is\u00a0one of the most\u00a0important\u00a0outputs\u00a0for a\u00a0university, with breakthroughs potentially saving lives around the world.\u00a0Professor\u00a0Stephen Gillespie<\/a>\u00a0and colleagues at\u00a0the\u00a0School of Medicine<\/a>\u00a0have\u00a0done just this, developing global capacity to improve tuberculosis treatment\u00a0by\u00a0developing\u00a0shorter,\u00a0safer drug regimens, and improved diagnostics for monitoring treatment.<\/p>\n

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Heat map of tuberculosis cases, via WHO. Licensed under Creative Commons.<\/em>\u00a0<\/figcaption><\/figure>\n<\/div>\n

Tuberculosis (TB) is a major global killer\u00a0with approximately\u00a09\u00a0million\u00a0new cases and 1\u00a0million\u00a0to 2\u00a0million\u00a0deaths per year, disproportionally affecting low and middle-income countries. The School of Medicine has researched the disease, and the pathogen responsible for it, for the last decade, contributing to transformative changes in how TB is tackled around the world.\u00a0These have encompassed the development of global TB networks, new treatment methods and increased clinical capacity. The research has improved diagnostics for monitoring treatment, which led to the development\u00a0of a tool to monitor antibiotic treatment of TB patients in real time.<\/p>\n

The foundation of their research involved conducting the first clinical trials for a selection of new and repurposed drugs. To achieve this, the group formed a series of international\u00a0collaborations\u00a0across Africa, South Asia, Europe and South America.\u00a0With these consortia, the\u00a0School\u00a0carried out\u00a0REMoxTB,\u00a0the first regulatory study of the drug\u00a0moxifloxacin\u00a0as part of a TB treatment regimen,\u00a0across nearly 50 sites in Africa and Asia.<\/p>\n

REMoxTB\u00a0began the team\u2019s longstanding project to develop global capacity to improve tuberculosis treatment. Subsequent steps included the establishment of\u00a0trial sites\u00a0in Africa, Asia and South America to run therapeutic and diagnostic projects. These projects\u00a0also addressed\u00a0critical questions in tuberculosis\u00a0management\u00a0including\u00a0the\u00a0understanding of the toxicity of tuberculosis chemotherapy<\/a>, especially regarding liver injury, the\u00a0differing effectiveness of treatment across gender<\/a>, and how to interpret positive blood culture tests after patients have completed therapy. The progress of the research has resulted in two further regulatory trials in collaboration with the\u00a0Global Alliance for TB Drug Development<\/a>. The first, STAND, was completed in 2018\u00a0and published recently;\u00a0the second,\u00a0SimpliciTB<\/a>,\u00a0began the same year and is currently ongoing.<\/p>\n

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In addition to regulatory\u00a0trials, the\u00a0Infection and Global Health<\/a>\u00a0group has made great strides in repurposing and optimising existing drugs. Gillespie is one of the three leads in the\u00a0PanACEA<\/a>\u00a0consortium, one of the international\u00a0tuberculosis research\u00a0associations\u00a0established in part by the\u00a0School, which has performed a series of early phase trials. These include a process to determine the optimal dose of rifampicin, an antibiotic administered\u00a0to\u00a0treat\u00a0tuberculosis\u00a0which is the most important component of the current treatment regimen.\u00a0This research<\/a>\u00a0has demonstrated the antibiotic\u2019s effectiveness at killing TB bacteria and determined its optimum dose.<\/p>\n

Aside from treatment itself, another critical barrier to the effective management and treatment of tuberculosis is\u00a0diagnosing the disease and\u00a0monitoring patient response during\u00a0treatment.\u00a0The\u00a0diagnosis\u00a0is especially crucial, given that the infecting bacteria grow very slowly and hence an early diagnosis can significantly increase survival rate.\u00a0In response, the\u00a0group\u00a0developed a test known as the\u00a0Tuberculosis\u00a0Molecular Bacterial Load Assay<\/a>\u00a0TB-(MBLA), which\u00a0not only diagnoses the disease\u00a0definitively but\u00a0can also determine whether the TB pathogen is alive or dead, allowing clinicians to monitor the patient\u2019s response to treatment and adjust it accordingly.\u00a0It has also\u00a0significantly\u00a0reduced the diagnosis timescale\u00a0to\u00a0just four hours<\/a>,\u00a0allowing for more up-to-date assessments of patient recovery.\u00a0The TB-MBLA is now used in\u00a0research laboratories in\u00a016 countries across the world, with\u00a0over 40\u00a0researchers and practitioners from Africa, Asia and Europe trained in its use.\u00a0The team aims to have reached all\u00a0ODA countries\u00a0with a high TB burden by 2025.<\/a><\/p>\n

The TB-MBLA was\u00a0developed in Prof Gillespie\u2019s laboratory,\u00a0and the international evaluation study\u00a0was\u00a0led by\u00a0Dr Wilber\u00a0Sabiiti<\/a>.\u00a0 The\u00a0team\u00a0has\u00a0also assisted in the development of the Holistic Approach to Unravel Antibacterial Resistance in East Africa<\/a> (HATUA). Led by Professor Matthew Holden, the project\u00a0aims to tackle a problem that, by 2050, is predicted to cost 10 million lives and 100 trillion US Dollars worldwide each year.\u00a0An interdisciplinary study,\u00a0HATUA\u00a0explores\u00a0biological,\u00a0socioeconomic,\u00a0and behavioural drivers of\u00a0antibacterial resistance\u00a0in\u00a0the\u00a0East African\u00a0context,\u00a0but\u00a0is\u00a0generalisable to the rest of the world. The project\u00a0enrolled\u00a0nearly 2,000\u00a0UTI\u00a0positive patients from 9 study areas across Uganda, Kenya and Tanzania, and\u00a0the preliminary findings\u00a0show\u00a0a\u00a0complex interplay of\u00a0factors\u00a0and pathways in how people seek healthcare and use antibiotics\u00a0that has great potential for future\u00a0research.<\/p>\n

 <\/p>\n

Blog post by Jamie Locke-Jones<\/a><\/p>\n

Research Impact Team<\/a><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Medical research\u00a0is\u00a0one of the most\u00a0important\u00a0outputs\u00a0for a\u00a0university, with breakthroughs potentially saving lives around the world.\u00a0Professor\u00a0Stephen Gillespie\u00a0and colleagues at\u00a0the\u00a0School of Medicine\u00a0have\u00a0done just this, developing global capacity to improve tuberculosis treatment\u00a0by\u00a0developing\u00a0shorter,\u00a0safer drug regimens, and improved diagnostics for monitoring treatment. Heat map of tuberculosis cases, via WHO. Licensed under Creative Commons.\u00a0 Tuberculosis (TB) is a major global killer\u00a0with approximately\u00a09\u00a0million\u00a0new…<\/p>\n","protected":false},"author":39,"featured_media":5504,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[8,10,1],"tags":[409,544,579,847,917,962,1095,1097,1130,1132],"class_list":["post-5502","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-igh","category-news","category-uncategorised","tag-dr-wilber-sabiiti","tag-hatua","tag-holistic-approach-to-unravel-antibacterial-resistance-in-east-africa","tag-panacea","tag-prof-stephen-gillespie","tag-remoxtb","tag-tb","tag-tb-mbla","tag-tuberculosis","tag-tuberculosis-molecular-bacterial-load-assay"],"publishpress_future_action":{"enabled":false,"date":"2026-04-27 14:31:43","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/posts\/5502","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/users\/39"}],"replies":[{"embeddable":true,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/comments?post=5502"}],"version-history":[{"count":0,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/posts\/5502\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/media\/5504"}],"wp:attachment":[{"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/media?parent=5502"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/categories?post=5502"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicine.st-andrews.ac.uk\/news\/wp-json\/wp\/v2\/tags?post=5502"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}