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Tuberculosis (TB) remains a significant health challenge in India by taking away many lives each year. This infectious disease, primarily caused by Mycobacterium tuberculosis is a leading cause of mortality nationwide, with India bearing a staggering one-fifth of the global TB burden. While pulmonary tuberculosis which affects the lungs is the most common form, TB can also be visible in other parts of the body, termed as extrapulmonary tuberculosis. To address this pressing issue, comprehensive guidelines have been developed to ensure effective care for all patients regardless of whether they seek treatment through public or private healthcare providers. The cornerstone of TB management revolves around prompt and accurate diagnosis followed by the administration of standardized treatment regimens known for their effectiveness. Importantly, this treatment must be supervised to ensure adherence and maximize its efficacy. Monitoring the patient's response to treatment is equally crucial by allowing for adjustments as necessary to achieve the best outcomes.
Beyond individual patient care, healthcare practitioners play a pivotal role in breaking the cycle of TB transmission. They are tasked with not only ensuring the successful cure of each patient but also with preventing the spread of the disease and countering the emergence of drug-resistant strains. By doing so, they contribute significantly to alleviating the overall burden of tuberculosis in society. Diagnosing TB typically relies on laboratory testing, with sputum smear microscopy being the primary method for pulmonary cases. For extrapulmonary TB, healthcare providers must obtain appropriate examples from affected sites for microscopy, culture, and histopathological examination by facilitating accurate diagnosis and tailored treatment plans. In essence, combating tuberculosis requires a multi-faceted approach, encompassing timely diagnosis, effective treatment, and diligent efforts to stop its transmission. Through adherence to established guidelines and collective action, we can make meaningful steps in curbing the impact of this challenging disease on public health in India.
Redefining Tuberculosis Care: A Call for action and prevention
India grapples with the immense burden of Tuberculosis (TB) by holding the unfortunate title of being the most affected country worldwide. Shockingly, over 600 Indians lose their lives to this disease every single day. However, the impact of TB is not distributed evenly across society—those who are economically disadvantaged and marginalized are disproportionately exposed and vulnerable. They are more likely to come in contact with TB, progress from latent to active infection and suffer severe health consequences sometimes leading to death.
Despite the obvious human rights implications, India like many nations has primarily approached TB through a biomedical lens rather than embracing a human rights perspective. However, there is a glimmer of hope within India's legal system. The country claims a robust tradition of health-rights litigation, presenting a unique opportunity for advocates to challenge the status quo and advocate for a shift towards a rights-based approach.
A New Weapon in the Fight Against TB: Supercharging the Immune System
Tuberculosis (TB), a disease that has plagued humanity for centuries remains a significant global health threat. The emergence of drug-resistant strains, particularly multidrug-resistant TB (MDR-TB) has further complicated treatment. However, there's a ray of hope on the horizon by host-directed therapies (HDT).
The Challenge of TB and Drug Resistance
Millions of people come in contact with TB each year with a substantial number succumbing to the illness. The bacterium responsible, Mycobacterium tuberculosis (Mtb) has a calculating ability to manipulate the immune system by delaying its ability to fight back. Traditional antibiotic treatment while effective for susceptible strains can be lengthy and demanding. Worse yet, Mtb readily develops resistance by rendering these antibiotics useless.
HDT: A Fresh Approach
HDT represents a paradigm shift in TB treatment. Instead of directly targeting the bacteria, these therapies aim to empower the body's own defences. By stimulating specific immune pathways, HDT can restore or enhance the immune system's ability to eradicate Mtb. This might involve boosting the production of immune-fighting fragments or regulating inflammation to create a more favourable environment for bacterial clearance.
Promising Early Results
Research by Associate Professor Susanna Brighenti and her team has yielded promising results. They've identified a class of drugs called histone deacetylase (HDAC) inhibitors that can significantly reduce Mtb growth within immune cells even without antibiotics. While this reduction might seem uncertain but the true power of HDT lies in its potential to work synergistically with traditional antibiotics. By boosting the immune response, HDT could pave the way for shorter treatment durations and lower antibiotic doses by ultimately improving patient outcomes.
In the ongoing battle against tuberculosis (TB), experts are leading a groundbreaking approach: immune-enhancing medicines also known as host-directed therapies (HDT). These innovative treatments connect the body's own immune system to combat TB, even tackling drug-resistant strains of the disease.
At the forefront of this pioneering effort is Associate Professor Susanna Brighenti from the Centre for Infectious Medicine (CIM), ANA Futura at the Karolinska Institutet in Stockholm, Sweden. Her upcoming presentation at the ESCMID Global Congress in Barcelona promises to shed light on the latest advancements in this field.
TB remains a global health threat with 7.5 million new cases reported in 2022 and an estimated 1.3 million deaths. Of particular concern are cases of multidrug-resistant TB (MDR-TB), which accounted for 410,000 cases and 160,000 deaths. Traditional antibiotic treatments are often lengthy and intensive, and the emergence of antibiotic-resistant mutations in TB bacteria highlights the urgent need for alternative therapies.
Host-directed therapies offer a promising solution by boosting the body's immune response against TB. Unlike conventional treatments that directly target bacterial growth, HDT focuses on strengthening immune pathways within infected cells. This approach aims to enhance the production of immune peptides and toxic molecules that aid in bacterial killing while also rebalancing inflammatory responses.
Associate Professor Brighenti's research team has made significant strides in this area by developing a platform for immune reconstitution in TB using small molecule compounds such as histone deacetylase (HDAC) inhibitors. These compounds regulate gene transcription in immune cells by boosting the expression of proteins associated with antibacterial defence.
Preliminary findings have shown that HDAC inhibitors can reduce Mtb growth inside immune cells by up to 75% even in the absence of antibiotics. While this may seem modest, these immunomodulatory compounds hold immense potential as adjunct therapies to standard antibiotic treatment. By working in synergy with antibiotics, they could reduce the required dosage and treatment duration ultimately improving patient outcomes.
In essence, the pursuit of immune-enhancing therapies represents a paradigm shift in TB treatment by offering new hope in the fight against this persistent global health threat. Associate Professor Brighenti's work stands as a beacon of progress in this field by paving the way for a future where TB is no longer a challenging rival.
The Future of TB Treatment: Personalized Medicine
The fight against TB demands a multifaceted approach. HDT alongside repurposed existing drugs and the development of more precise immune-modulatory therapies offers a future filled with possibilities. The ultimate goal is personalized medicine, modifying treatment regimens to individual patient needs and the specific TB sub-type they are infected with.
A Turning Point in the Fight Against a Global Threat
The successful implementation of HDT, similar to how immunotherapy has revolutionized treatment for other diseases could be a game-changer for TB management. By relating the body's inherent ability to fight back, this approach has the potential to curb the spread of TB, limit drug resistance and ultimately save lives. With continued research and development, we stand on the threshold of a new era in TB treatment, one where empowered immune systems hold the key to victory.
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