Currently Skimming:
11 Embracing a New Vision for Research
11 Embracing a New Vision for Research
Pages 119-128
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From page 119... ...
• Sequencing of TB genomes linked to patient histories can reveal pat terns of drug resistance, identify molecular markers and pathways for new and improved drugs and diagnostics, and provide key datasets for molecular epidemiology and surveillance efforts. • The integration of epidemiology with systems biology is creating a "systems epidemiology" that can provide a comprehensive view of infection, disease progression, and transmission.
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From page 120... ...
With the support of the Agence Nationale de Recherche sur le SIDA, the NIH Division of AIDS, and the Institut Pasteur in Cambodia, the research team, together with the Cambodian Health Committee, developed five clinical sites in 1 This section is based on the presentation by Anne E Goldfeld, Professor of Medicine, Harvard Medical School; and Co-Founder, GHC.
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From page 121... ...
"Obviously we need many new drugs, but one can do better with what one has in hand," Goldfeld asserted. She added that having MDR TB resulted in an eightfold increased risk of death, partly because of delays in diagnosis.
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From page 122... ...
Using high-throughput, next-enerationg sequencing technology along with bioinformatics analysis and tools, the project has the goal of sequencing more than 1,000 TB strains from Korea, Russia, South Africa, Uganda, and other countries. These TB genomes will be linked to patient histories to advance understanding of genetic patterns of drug resistance, identify molecular markers and pathways for new and improved drugs and diagnostics, and provide key datasets for molecular epidemiology and surveillance efforts.
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From page 123... ...
They have • demonstrated the importance of ongoing transmission and the existence of drug resistance even in places where little TB treatment has taken place; • demonstrated that the mycobacterial genome has more genomic plasticity than expected, as well as shown the evolution and geo graphic distribution of different strains; • provided the first rigorous evidence that previous exposure to TB does not protect against reinfection, a finding that has major impli cations for vaccine development; • allowed differentiation of patients who relapsed because of treat ment failure from those reinfected with a different strain; • enabled pragmatic public health efforts, such as detection of out breaks and ongoing TB transmission; and 3 This section is based on the presentation by Gail Cassell, Visiting Professor, Harvard Medical School; and Vice President of TB Drug Discovery, Infectious Disease Research Institute.
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From page 124... ...
Patrick Tao Li, Scientific Representative, BGI (formerly Beijing Genomics Institute) , described his organization's collaborative efforts to develop methods for TB diagnostics and DST (Box 11-1)
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From page 125... ...
Earlier reviews had identified 93 studies conducted prior to 2009 that included at least one MDR TB case. Of these studies, 26 were excluded because they represented the same or overlapping cohorts.
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From page 126... ...
Use of later-generation ethionamide, ofloxacin, and quinolones or a related drug was associated with treatment success compared with treatment failure, relapse, or death. In the intensive phase of treatment, MDR TB patients who were treated with four or more effective drugs (based on DST)
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From page 127... ...
In the past, the goal has been to develop guidelines for good clinical practice that provide guidance on these steps, with the assumption that these guidelines would be appropriate for all cases everywhere. But MDR TB treatment is now taking much longer than it has in the past, which DeRiemer ascribed to the continuous nature of M.tb.
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