Tuberculosis – a silent pandemic

Tuberculosis is one of the „big three“ infectious diseases, together with AIDS and Malaria. In Europe, tuberculosis is almost forgotten, the times of the “The Lady of the Camellias” and Thomas Mann’s “Magic Mountain” seem to be over. But this impression is false. All over the world, every 20 seconds a person falls victim to Mycobacterium tuberculosis –a death toll of 5000 each day. In Eastern Europe and Africa, tuberculosis is still frequent and in the past 20 years, the number of resistant bacteria is rising. Hardly any antibiotic can fight these multiresistant germs and international travel and migration is spreading these resistant strains globally. Similarly wide spread is the hunt for novel strategies against this pathogen: new antibiotics and vaccinations. So far with little visible success, Mycobacterium tuberculosis is hiding in the macrophages of the lung like it always used to do and waits to strike when the host’s immune system is weakened.

Modell der Alanin-Dehydrogenase – aus Röntgendaten errechnet. Die Alanin-Dehydrogenase ist wahrscheinlich bei der Synthese der Zellwand von Mycobacterium tuberculosis beteiligt und damit ein wichtiges Angriffziel für neue Wirkstoffe.

Scientists at the Helmholtz Centre for Infection Research are searching for new strategies against this disease; mainly they are searching for new compounds that work in completely different ways than the established medication. The EU-funded research consortium “NoPersist” plays a central role in this. This consortium founds on well-established research partnerships. The scientists of “NoPersist” are investigating tuberculosis together already for decades. Armed with thousands of substances from the compound library of the HZI, they are screening gene by gene for new attack points on Mycobacterium tuberculosis. One difficulty remains: the special ability of Mycobacterium tuberculosis to hide from the immune system and from medication.

An antibiotic can only work, when Mycobacterium tuberculosis is active and the bacteria reproduce; when the patient is suffering from tuberculosis.This is where other researchers from the HZI are coming in: They are screening the same compound databases for substances that can act on resting tubercle bacteria. They hope to turn off the vital function of the bacteria that are waiting in the lung, without the tuberculosis needing to be active for therapy.

The HZI is also indirectly part of TB prevention: VPM (Vakzine Project Management), a company closely related to the HZI, currently has a live vaccine in clinical testing.

HIV and tuberculosis

In Africa, combinations of tuberculosis and HIV infection are a huge problem: HIV patients have a 30fold higher risk to develop tuberculosis than patients without HIV, because their immune system is weakened. Patients with AIDS mostly come down with tuberculosis and thus Mycobacterium tuberculosis accounts for most cases of death by HIV are in Africa.

(Dr Jo Schilling)

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