Arming up to fight the TB scourge

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SA’s status as the country with the highest incidence of tuberculosis (TB) has spurred local research into prevention strategies and cures.

Professor Michele Miller performs a transtracheal wash on a lion to collect a sample for analysis, near Satara restcamp in the Kruger Park, as part of her research into tuberculosis in wild animals . (Supplied)

Professor Keertan Dheda’s Lung Infection and Immunity in Poverty Related Diseases Research Chair is a long-standing initiative in this field. Although he recently relinquished the Chair to head up Groote Schuur Hospital’s Pulmonology Unit, he will continue his line of work and the Research Chair will continue under another Chair holder.
Dheda’s work was recognised in June when he was awarded the Oppenheimer Fellowship, one of the most prestigious awards that recognise excellence in scholarship.

He has made significant breakthroughs in his research into the human lung and its responses to TB. His work represents pioneering research, because we have very little understanding of how the immune system responds in the lungs. This has prevented the development of an effective TB vaccine.

One of most notable discoveries from his work into the lungs’ immune system is that certain regulatory T-cells appear to be able to kill off the TB bacteria. It is hoped that this breakthrough will aid medical scientists in the development of an effective vaccine.

A second focus of his research has been developing, for the department of health, effective strategies and policy guidelines on effective diagnosis and treatment regimens at a primary health care level. Dheda says: “One of the biggest challenges in the treatment of TB is ensuring that patients remain on treatment programmes.

“Our research and policy guidelines have shown that effective interventions that are not dependent on highly skilled technicians can be introduced. This broadens the reach of such programmes and reduces the cost of care.”

His third research focus is on drug-resistant TB, an area of great concern as TB has become resistant to an increasing number of treatments. The significance of this work is that it has refined how — and how fast — medical staff are able to identify patients whose TB is resistant to existing treatments.

Drug-resistant TB infections are also being studied by Professor Gerhard Walzl of Stellenbosch University in his Biomarkers for Tuberculosis Research Chair that commenced in 2013.

“Our research differs slightly from other areas of study in that we are trying to understand patients’ responses to the bacterium by identifying biomarkers of the disease and whether patients are responding to treatment,” says Walzl. “Knowledge derived from this research will also help in the development of TB vaccines.”

One of the unique approaches adopted by Walzl is the use of big data that interrogates DNA and RNA expressions to help identify potential biomarkers and areas that can be used to more effectively indicate the body’s response to treatment.

“One of the key expected outcomes of the Chair is the development of  local skills and capacity to aid in the fight against TB,” says Walzl. 

He hopes that the students will be able to contribute to furthering of studies into the disease. One area of research he intends to direct these resources into is a biomarker signature that would allow for quicker testing at clinics and which is simple and cost-effective.

Walzl’s colleague at Stellenbosch, Professor Michele Miller, holds one of the newest Research Chairs, which started operating at the beginning of 2014. She is studying animal tuberculosis, which has been recognised as a global priority.

Her research involves understanding the impact of TB on different species, factors that influence the course of infection in the animal host, and improving methods for detection.

Miller says: “While South Africa has a programme to control TB in cattle, there are limited measures available for wildlife. Our work, therefore, focuses on understanding the impact and providing tools to assist decision-makers in preventing the further spread of the disease.”

Her group’s research will help to improve risk management strategies that could inform best practice in wildlife conservation when dealing with infected animals, and in how to prevent further infection when animals are transferred between reserves.

Miller also hopes that an increased understanding of TB in animals can be used to evaluate the risks of TB transmission between humans and animals, since there is a possibility of cross-infection. 

“Although the Chair is still new, we have made good progress in generating preliminary research results as well as attracting postgraduate students into the programme,” says Miller. Her immediate goal is to train high quality students who will form the base of the new generation of animal TB researchers.

This supplement has been paid for by Department of Science and Technology and its contents signed off by the DST and the National Research Foundation.

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