Tuberculosis (TB), a disease known also by the names white plague, consumption or phthisis, represents one of the most challenging challenges for global public health for millennia. From its beginnings, in the distant past, up to today, TB has adapted to the changes in the way of life of humanity, and its cause – the bacterium Mycobacterium tuberculosis – has developed resistance to the drugs that were the basis of its treatment. Today, this disease represents the deadliest infectious disease in the world, responsible for the death of almost 1.6 million people annually.

A new era in the fight against tuberculosis – shorter and more effective therapies

In the past few decades, the treatment of tuberculosis required exceptional discipline from patients, since standard regimens involved taking a large number of drugs over a period that could last even two years. Many patients abandoned therapy due to severe side effects such as nausea, hearing loss, or kidney problems, thereby increasing the likelihood of the spread of resistant forms of the disease. However, the situation has dramatically changed in recent years. New drugs and innovative approaches allow reducing the treatment duration to four to six months, which significantly increases the success of therapy and reduces the possibility of developing resistant forms of the disease.

Scientists emphasize that it is especially important that the new therapies eliminate the need for injections, which significantly reduces discomfort for patients. Now, completely new classes of drugs are also appearing on the market that act specifically against the bacterium, allowing even shorter treatment durations. There is great potential for new research directed towards an individualized approach to treatment, where therapy would be tailored to each patient separately.

Advances in diagnostic methods accelerated by the COVID-19 pandemic

A major challenge in the fight against tuberculosis is the late diagnosis of the disease. In many parts of the world, diagnostic procedures still rely on microscopic examination of patients' sputum, methods that have remained almost unchanged since the discovery of the bacterium more than a century ago. Due to the complexity of the process, as well as limited resources, millions of people remain undiagnosed and untreated every year.

However, the COVID-19 pandemic has spurred the development of new diagnostic methods that can now be used for faster diagnosis of TB. These include approaches such as simple molecular tests that use samples taken by swabbing the nose and throat, and not just sputum. These new tests enable rapid diagnosis even in less well-equipped environments, meaning that patients can be treated earlier, thereby reducing the risk of disease spread.

The tuberculosis enigma – Why do some people get sick while others do not?

One of the great enigmas of tuberculosis is the question of why some people become infected with the bacterium, but never develop active disease. About a quarter of the world's population carries the bacterium without visible symptoms, and only some of them develop active disease. Intensive research is currently underway into so-called biomarkers – specific biological indicators that can signal in advance the risk that an individual will develop an active form of the disease. If scientists succeed in identifying such markers, doctors could more precisely determine who should receive preventive therapy, which would be a major breakthrough in stopping the spread of the disease.

Personalized medicine as a new hope for patients

Along with biomarkers, a new direction in the treatment of tuberculosis could be the approach of personalized medicine. Currently, almost all patients are treated with similar combinations of drugs, although there are significant differences in the severity of the disease from patient to patient. It is expected that soon therapies could be tailored to the individual needs of patients, which would allow shorter treatment for most patients, while more intensive regimens would be applied only to patients with the most severe forms of the disease. This approach would enable more effective therapy and less burden on patients, and potentially significantly reduce the global prevalence of the disease.

New vaccines and the prospect of disease prevention

One of the biggest shortcomings in today's fight against tuberculosis is the insufficiently effective vaccine. The currently available BCG vaccine, although useful in children, provides only partial protection in adults. For this reason, research is focused on developing new, more effective vaccines that would provide long-lasting and stronger protection against TB. Such vaccines could be a key step in the permanent elimination of the disease that has proven extremely resistant to all previous attempts to eradicate it.

As technologies evolve, scientists believe that vaccines that use completely new methods of stimulating the immune system, including genetic engineering and mRNA technologies similar to those used during the COVID-19 pandemic, will soon be available. The future thus brings new possibilities for combating the disease that for a long time posed an unstoppable threat to the human race.

Izvor: University of California