End TB: Four ways Imperial is tackling the world's deadliest infectious killer

To mark World Tuberculosis Day, we look at the different ways our researchers are addressing a disease that continues to be a global issue.

March 24 marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes tuberculosis (TB). Over a century later, the disease is preventable and curable, yet it remains one of the world’s deadliest infectious disease with devasting health, social and economic consequences.  

Here we round up some of Imperial’s efforts to combat TB, from raising public awareness in local communities to teaming with researchers in countries with a high incidence of the disease. 

Researchers contribute to The Lancet Commission on Tuberculosis

Four Imperial researchers have put forward their key recommendations towards ending the tuberculosis epidemic as part of The Lancet Commission on Tuberculosis. 

The School of Public Health's Dr Nim Arinaminpathy, Professor Tim Hallett, Dr Juan Vesga, and the Department of Medicine's Dr James Seddon are featured on the panel of experts who contributed to the Commission.

The Commission, published ahead of World TB Day, estimates that there are significant financial benefits of reducing TB mortality – the savings from averting a TB death are estimated to be three times the costs, and may be much greater in many countries.

Speaking on BBC World Service, Dr Nim Arinaminpathy summarised the report's key points: "First, we have to make the best use of the tools we have available. TB is a curable disease in most cases, but these antibiotics are not reaching the patients most in need."

Secondly, we need to acknowledge that we can’t treat our way out of the TB epidemic. Lastly, we need better funding and accountability systems to facilitate these massive transformations that we need in tuberculosis control."

Harnessing international collaboration to tackle TB  in South Africa

South Africa is one of the countries with the highest burden of TB. According to WHO figures, there was an estimated incidence of 322,000 cases of active TB in 2017.

Dr Brian Roberston of Imperial's Department of Medicine and founder member of the MRC Centre for Molecular Bacteriology and Infection, is collaborating with researchers from MIT and South Africa's University of Cape Town (UCT) to investigate how TB is transmitted.

The research project is one of the three  MIT - Africa - Imperial College London Seed Fund winners. The funding promotes early-stage collaboration between faculty and researchers at MIT, Imperial and institutions in Africa.

The “fluorTB” project explores how TB is transmitted through the air – via actions such as breathing, talking and coughing – and the role anti-TB therapy can play in limiting the disease’s spread. The name refers to a technique integral to the research: advanced fluorescence labelling  – causing live bacteria to glow in a manner that will increase their visibility under a microscope.

Engaging local communities 

New cases of TB in England have fallen to the lowest levels since records began, according to new figures by Public Health England. 

However there is still work to be done as the most deprived ten per cent of the population have a rate of TB more than seven times higher than the least deprived 10%, and people born outside the UK have a rate 13 times higher than people born in the UK.

Ishita Marwah, a final year PhD student at NHLI, created an animated film that would help people, especially members of these communities, to understand how exposure to TB bacteria can lead to a dormant form of infection with no symptoms, called latent tuberculosis infection (LTBI).

Ishita identified that for the animation to truly reach and resonate with its target audiences, it would need to be translated into the most common languages spoken among communities eligible for LTBI testing and treatment. Ishita’s film was displayed on Public Health England’s website and in GP clinic waiting rooms in London.

Ishita won a Student Award for Societal Engagement at the 2018 President’s Award for Excellence.

Progress towards a tuberculosis vaccine

Currently, there is no available TB vaccine with proven, consistent efficacy in adult populations.

Last year, a milestone was reached when potential tuberculosis (TB) vaccine M72/AS01E1 showed early promise in a clinical trial. The findings, published in The New England Journal of Medicine, showed that M72/AS01E significantly reduced the incidence of pulmonary TB disease in HIV-negative adults who were already infected with latent TB at the time of vaccination. 

Professor Robert J Wilkinson of CIDRI-Africa, Imperial’s Department of Medicine and the Francis Crick Institute London is involved in the study and said: “We are pleased to have had a large part in the conduct and analysis of this study. The results are intriguing and, overall, highly encouraging. A major task now will be to analyse samples collected from the trial to look for clues on how we might do even better.”