A new online tool, hailed the most comprehensive and accurate to date, uses big data to predict resistance to drugs commonly used to treat tuberculosis.
Tuberculosis (TB), one of the deadliest communicable diseases worldwide, claimed the lives of 1.5 million people in 2013, according to the World Health Organization (WHO). More than half of the 9 million people diagnosed with TB in 2013 lived in Southeast Asia and the Western Pacific. Treating TB in these jungle villages can be complex, as it can take weeks (or months) for tests to reveal which antibiotic and treatment plan might be best for a particular patient.
Now, with a free, online tool, healthcare providers can find out what drugs should be used to treat a patient’s TB weeks—and sometimes days—faster.
According to a study published recently in Genome Medicine, resistance has been found to all drugs currently used to treat TB. Identifying how a patient’s TB has mutated can be essential to successful treatment with minimal side effects.
The TB-Profiler tool was developed at the London School of Hygiene & Tropical Medicine. The tool uses genome sequence data to predict resistance to 11 drugs in only a few minutes. This is an important achievement for two reasons:
- The genome sequence data can be used to make medication decisions almost immediately, speeding the time to treatment, which can improve outcomes and help contain the disease.
- The online tool is easy to use, and individuals without specialized bioinformatics skills, which aren’t always available in these tropical regions, can conduct analysis.
In designing the TB-Profiler tool, scientists developed a library of 1,325 drug resistance markers based on global data, and is hailed as the tool the most comprehensive and accurate data source to date (according to the press release).
More traditional methods of resistance testing were conducted in labs, where researchers might grow the bacteria that causes TB (M. tuberculosis) and then treat it with a commonly used TB drug. The goal here is to see if the bacteria are killed or survive the drug, which can take weeks or months, and requires a laboratory, skilled personnel and safety measures.
The TB-Profiler tool, according to the researchers, “highlights the potential of whole genome sequencing to increase the accuracy of molecular test for resistance.” Data from the tool can also be used by public health experts to track disease transmission.
This is a welcome step forward in our battle against drug resistance. It is now time to take sequencing out of the research lab and into the clinic. Patients with drug resistant disease have to endure many months of treatment with toxic drugs with no guarantee of success. Personalized treatment will increase their chances of survival while minimizing the horrible side effects.
Globally, 400,000 people were diagnosed with multiple-drug resistant TB (MDR-TB) in 2013. Approximately 210,000 people died from MDR-TB that year. Further complicating TB treatment, of the 9 million people with TB in 2013, 1.1 million of them were also HIV-positive.
Dr. Taane Clark, Reader in Genetic Epidemiology and Statistical Genomics and lead author of the study, says:
Sequencing already assists patient management for a number of conditions such as HIV, but now that it is possible to sequence M. tuberculosis from sputum from suspected multi-drug resistance patients means it has a role in the management of tuberculosis. We have developed a prototype to guide treatment of patients with drug resistant disease, where personalized medicine and treatment offers improved rates of cure.
The WHO has identified priority actions in the fight against MDR-TB:
- Preventing the development of drug resistance through high-quality treatment of drug-susceptible TB.
- Expanding the rapid testing and detection of drug-resistant TB cases.
- Providing immediate access to effective treatment and proper care.
- Preventing transmission through infection control.
- Increasing political commitment through financing.
The new TB-Profiler tool helps in a number of these priority areas, as rapid testing should help prevent the development of further drug resistance and identify the most effective treatment plans for each patient.