Date: 27 September 2018
NIHR researchers have made a leap forward in understanding the genetics of tuberculosis (TB) that has allowed them to predict which drugs will be effective at treating a patient’s infection and which will not.
This analysis of TB genetics by researchers at several NIHR Biomedical Research Centres may herald a quicker, more tailored treatment for the millions of people around the world living with the disease.
The study, led by the international CRyPTIC consortium based at the University of Oxford and facilitated by the 100,000 Genomes Project in partnership with Public Health England, is by far the largest of its kind, covering over 10,000 TB genomes from 16 countries around the globe.
TB is the world’s biggest infectious disease killer, claiming 1.7 million lives in 2016. The number of drug-resistant cases is rising, meaning new strategies and interventions are urgently needed if the World Health Organisation’s target to end the global TB epidemic by 2035 is to be met.
At present, tests to determine which antibiotics will best treat an individual TB patient have depended on growing the bacteria in a laboratory, a process that takes weeks or even months.
It is estimated that only 22% of the 600,000 patients requiring treatment for multi-drug-resistant tuberculosis received diagnoses and were treated in 2016, which has facilitated the spread of multidrug-resistant strains.
In this new study, published in the New England Journal of Medicine, the researchers found that whole-genome sequencing of TB bacteria could characterise whether the infection would be susceptible to first-line antibiotics with a degree of accuracy sufficient for clinical use.
Study author Professor Derrick Crook, Director of the National Infection Service at Public Health England and Theme Lead at the NIHR Oxford Biomedical Research Centre, said: “We are delighted by the results of this study, which suggest that we will be able to treat patients with the right treatments more quickly.
“This is particularly important in an infection like TB where we know that many people who have the infection may be homeless or not have good access to the health system. Being able to choose the most effective drugs when starting treatment should lead to a quicker reduction in the infection being passed on to others.”
Professor Chris Whitty, Chief Scientific Adviser for the Department of Health and Social Care (DHSC), said: “Developing more effective approaches to treating multi-drug-resistant TB is crucial for the thousands of people affected in the UK and millions worldwide. This study is just one example of how the government is supporting research into how new technologies can help us tackle drug-resistant infections and thus preserve the effectiveness of current antibiotic treatments.”
The results of this study have already led to decisions in England, the Netherlands and by the Wadsworth Centre for Public Health, New York State, to reduce reliance on bacterial culture and deliver treatment according to DNA sequencing results alone.
This international research was supported in the UK by the Department of Health and Social Care through the National Institute for Health Research Biomedical Research Centres at Oxford, Imperial and Barts, Public Health England and the 100,000 Genomes Project. The research also received support from the European Bioinformatics Institute (EMBL-EBI), the Medical Research Council, the Wellcome Trust, and the Bill and Melinda Gates Foundation.
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