Page 72 - University of Pretoria Research Review 2017

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TB – one of the biggest killers
Bernard Fourie, Department of Medical Microbiology
South Africa is one of the countries with the largest number of TB incident cases each year, and is battling to reduce the magnitude of the epidemic. In many cases, patients are diagnosed with recurrent TB, requiring re-treatment.
Professor Bernard Fourie, TB expert and researcher
in the Department of Medical Microbiology in the Faculty of Health Sciences, recognises that short-term actions need to be improved if long-term sustainable interventions are to follow. For the End-TB targets to
be reached, Professor Fourie says that the current BCG vaccine given to babies at birth needs to be dramatically improved, TB needs to be diagnosed using simple, accurate and immediate diagnostic tests, and new or repurposed antibiotics or treatment strategies are needed that can cure TB in weeks rather than months.
Scientists in the Faculty of Health Sciences are collaborating on innovative research projects with these ideas in mind. One such collaboration, the TB@UP Research Group, aims to contribute meaningfully to the attainment of the End-TB goals.
As part of the collaboration, Professor Fourie is leading research at UP to optimise rapid, molecular-based diagnosis of TB, inhaled therapeutics and vaccines, and biomarkers of disease risk. His research also looks into refining molecular procedures for diagnosing drug- resistant TB. The aims are to evaluate the potential
of a simple specimen collection-to-detection system with enhanced diagnostic efficiency in specimens
with very low bacterial load, which currently poses
a challenge for existing TB tests. A major feature of
this project is that the system should be independent of storing or transporting patient specimens under refrigeration. Such tests detect patients with early-stage TB, and simplify the prescription of suitable antibiotics, especially if the patient has drug-resistant TB. Working closely with Professor Jannie Hugo and his team in
the Department of Family Medicine, these tests are
being piloted in the community, with encouraging early results.
Only one vaccine for TB, the BCG vaccine, is licenced globally. While about 80% effective in babies and infants, the effect of this vaccine wanes over time and fails to protect adults against pulmonary TB. Research across the world is looking to develop a vaccine that
is effective against TB at all ages. Professor Fourie and his research team, collaborating with Professor Anton Stoltz in the Department of Internal Medicine, are involved in exciting research, funded by the National Research Foundation, which could dictate a new approach to vaccination.
As the disease spreads through the air, Professor Fourie is targeting the lung as the portal for vaccination. He was part of an international team that developed an inhalable powder form of the BCG vaccine and is busy testing pulmonary administration of the vaccine, a global first. The UP Airborne Infection Research Facility (directed by Professor Stoltz) is a unique experimental unit that studies disease transmission via the lung. This facility will allow researchers to test the performance
of the vaccine against TB, closely mimicking natural TB infection in the exposed human subject. Fourie is confident that the inhalable vaccine will be superior to the injected vaccine. If successful, it would be a great advance in the development of a new vaccine.
A new avenue being explored by Professor Fourie
and Professor Mike Sathekge in the Department of Nuclear Medicine is the application of PET/CT scanning imaging technology to define predictive lung damage and inflammation markers in ‘cured’ TB patients that correlate with specific immunological biomarkers of risk for recurrent TB disease. This project runs under a global effort to develop biomarkers of TB disease that could be turned into interventions, coordinated in South Africa by Professor Mark Hatherill at the University of Cape Town.