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Landmark TB study could have major impact

On the eve of World TB day (24 March), the South African Tuberculosis­ Vaccine Initiative (SATVI) has published a landmark study in one of the world’s most respected medical journals.

The research article, published in The Lancet, reports the discovery of a blood test that can predict whether someone is likely to develop tuberculosis (TB) long before the disease manifests.

According to SATVI, whose researchers collaborated with the Center for Infectious Disease Research (CIDR) in Seattle, USA, it is a game changer in the fight against TB.

“Importantly, the test can predict progression to TB more than one year before the disease manifests, which provides a window of opportunity to use treatment to prevent the disease,” says Professor Willem Hanekom, principal investigator of the study,

With the newly discovered biomarker test, medical professionals will now be able to identify three quarters of those who will progress to TB disease. This 10-year-long discovery was led by scientists at SATVI (a programme of the University of Cape Town based in Worcester) and CIDR.

They studied gene expression patterns in blood samples selected from more than 6 000 teenagers from Worcester, who were followed for more than two years to identify those who did or did not develop TB disease.

Confirmation that the gene expression signature could predict TB disease was completed using samples from another cohort of 4 500 adults from South Africa and The Gambia. These study participants were enrolled within a large international collaborative effort between researchers from South Africa, The Gambia, Ethiopia, Uganda, Kenya, Germany, The Netherlands, The United Kingdom and the USA.

The Lancet article crowns a decade-long series of research projects, which was funded by the Bill & Me­linda Gates Foundation, the US National Institutes of Health, the European Union and the South African Medical Research Council.

In the near future, the blood test will be evaluated in a clinical trial, also funded by the Bill & Melinda Gates Foundation, to determine if targeted preventative therapy for people with a positive test can stop them from developing TB.

Professor Mark Hatherill, principal investigator of the new trial, said: “If the trial is successful, mass campaigns using a ‘screen and treat’ strategy have potential for major impact on the global epidemic, by stopping TB before it manifests and becomes infectious to others.”

Currently TB is a global public health crisis, with more than 3 000 people dying daily from it worldwide. Infection with the bacterium Mycobacterium tuberculosis is thought to affect a third of the global population, 90% of whom will never develop TB disease.

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