In a promising Swedish study, sixteen of the 30 MDR-TB trial-patients, treated with their own bone-marrow stem cells together with the usual tuberculosis-antibiotics, were cured of multi-drug resistant TB - the bacterial disease now has a mortality rate of up to 80% in patients treated with antibiotic-TB drugs.
New hope for South Africa's many hundreds of thousands of TB-sufferers:
This new Swedish study holds out new hope for South Africa's many hundreds of thousands of drug-resistant Tuberculosis sufferers. Highly infectious active-TB infections only turned into an epidemic in South Africa after the end of apartheid from 1992 - especially after ex-president Thabo Mbeki ' decentralised ' many of the apartheid-era's string of preventative TB hospitals except in the Western Cape -- and plundered the SA National Tuberculosis Association's privately-donated funds, saying the money was needed elsewhere. Today, South Africa has the highest level of drug-resistant Tuberculosis in the world. People especially in poor communities now are reportedly dying without anyone knowing exactly why.
With such a huge infected population pool, South Africa has also become the world's main laboratory to test out new TB and AIDS-drugs for researchers worldwide...
"A second study now needs to be conducted urgently such as in South Africa, where MDR-TB and XDR-TB are rife", says Swedish head of study Prof Markus Maeurer...
Above: Usually, multidrug-resistant tuberculosis can be cured with long treatments of second-line drugs, but these are more expensive than first-line drugs and have more adverse effects. The treatment and prognosis of MDR-TB are much more akin to that for cancer than to that for infection. It has a mortality rate of up to 80% - http://en.wikipedia.org/wiki/Multi-drug-resistant_tuberculosis
January 10, 2014 -- Stockholm, Sweden. The findings of a phase 1 preliminary study published in The Lancet Respiratory Medicine suggest that a patient’s own bone-marrow stromal ('stem') cells could be used to successfully treat multidrug-resistant (MDR-TB) and extensively-drug (XDR) tuberculosis.
Sixteen of the Swedish-funded study's 30 patients who were treated with tjheir own bone-marrow stem cells (MSCs) were deemed cured after 18 months -- as compared with only 5 of 30 TB patients surviving multiple-drug-resistent tuberculosis if left untreated.
- The world health organization (conservatively) estimates that at least 450,000 people in South Africa, Asia and Eastern Europe have MDR-TB.
The study's co-author Professor Alimuddin Zumla from University College London, UK says: "The results of this novel and exciting study show that the current challenges and difficulties of treating MDR-TB are not insurmountable.They bring a unique opportunity with a fresh solution to treat hundreds of thousands of people who die unnecessarily of drug-resistant TB. Further evaluation in phase 2 trials is now urgently required to ascertain efficacy and further safety in different geographical regions such as South Africa where MDR-TB and XDR-TB are rife.”
' Poor understanding of pathological immunity in human tuberculosis: '
Prof Robert J Wilkinson from Imperial College London, after first describing the long history of adjunctive immunotherapy against TB, concluded:"This field is…complex with an underlying problem being a relatively poor understanding of what constitutes protective and pathological immunity in human tuberculosis or even whether these are precisely separable. Nevertheless, the potential to investigate an increasing range of more specific biological therapies or the repurposing of existing anti-inflammatory agents continues to attract interest. Whether relatively complex and expensive MSC therapy will join this list remains to be determined.”
Research was led by Prof Markus Maeurer from Karolinska University Hospital, Stockholm, Sweden
“Conventional treatment for MDR-TB uses a combination of TB drugs (antibiotics) which are harmful (toxic) to patients. Our new approach, using the patients’ own bone-marrow stromal (stem) cells, is safe and could help overcome the body’s excessive inflammatory response, repair and regenerate inflammation-induced damage to lung tissue, and lead to improved cure rates”, explains Professor Markus Maeurer from Karolinska University Hospital in Stockholm, Sweden who led the research.
The World Health Organization believes that at least 450,000 people in Eastern Europe, Asia and South Africa have MDR-TB. The bacteria trigger an inflammatory response in immune cells and surrounding lung tissue that cause immune dysfunction and tissue damage.
It is known from other studies that bone-marrow mesenchymal stromal cells (MSCs) are known to migrate to areas of lung injury and inflammation and repair damaged tissue. They also modify the body’s immune response and could boost the clearance of TB bacteria.
In this phase 1 safety study, 30 patients with MDR or XDR TB aged 21–65 years old receiving standard TB antibiotic treatment were also given an infusion of around 10 million of their own stromal cells. The cells were obtained from the patient’s own bone marrow, then cultured into large numbers in the laboratory before being re-transfused into the same patient.
MSC infusion was generally safe and well tolerated. During the 6 months follow-up, no serious adverse events were recorded. The most common grade 1 or 2 adverse events were high cholesterol levels (14 of 30 patients), nausea (11 patients), and lymphopenia or diarrhoea (10 patients).
- Analyses showed 16 patients treated with MSCs were deemed cured at 18 months -- compared with only 5 of 30 TB patients with similar disease not treated with MSCs.
Professor Maeurer said longer follow up with more patients is needed to establish the safety and efficacy of MSC therapy.
- “The procedures for obtaining stromal cells from the patient’s own bone marrow are relatively simple, and if successful in phase 2 trials, will provide a viable adjunctive therapy for patients with MDR-TB not responding to conventional drug treatment or those with severe lung damage", he concludes.
"Phase 2 trial urgently required in different geographic regions such as South Africa where MDR-TB and XDR-TB are rife'
Co-author Professor Alimuddin Zumla from University College London, UK adds, “The results of this novel and exciting study show that the current challenges and difficulties of treating MDR-TB are not insurmountable.They bring a unique opportunity with a fresh solution to treat hundreds of thousands of people who die unnecessarily of drug-resistant TB.
" Further evaluation in phase 2 trials is now urgently required to ascertain efficacy and further safety in different geographical regions such as South Africa where MDR-TB and XDR-TB are rife,” he said.
Writing in a linked Comment, Professor Robert J Wilkinson from Imperial College London, UK discusses the “long history” of adjunctive immunotherapy against TB, concluding that, “This field is…complex with an underlying problem being a relatively poor understanding of what constitutes protective and pathological immunity in human tuberculosis or even whether these are precisely separable. Nevertheless, the potential to investigate an increasing range of more specific biological therapies or the repurposing of existing anti-inflammatory agents continues to attract interest. Whether relatively complex and expensive MSC therapy will join this list remains to be determined.”
- From The Lancet: "Autologous mesenchymal stromal cell infusion as adjunct treatment in patients with multidrug and extensively drug-resistant tuberculosis: an open-label phase 1 safety trial: Aliaksandr Skrahin MD, Raija K Ahmed PhD, Giovanni Ferrara MD, Lalit Rane MSc, Thomas Poiret MSc, Yanina Isaikina PhD ao; Jan 09, 2014; The Lancet Respiratory Medicine: http://download.thelancet.com/pdfs/journals/lanres/PIIS2213260013702340.pdf
- Funding by the Heart and Lung foundation, Vinnova, SIDA, Söderberg Foundation, Swedish Research Council.
Ex-president Thabo Mbeki closed most of the very effective, apartheid-era TB-prevention hospitals countrywide, saying they were not needed "since TB is not a problem in SA' - and plundered the private TB-funds from the SA National Tuberculosis Association (SANTA).
Thabo Mbeki's legacy to South Africa: the joint epidemics of Tuberculosis and AIDS:
Decentralizing MDR-TB treatment by 2013: Nearly half of diagnosed drug-resistant TB cases are not started on treatment; and infected patients have to wait up to 2 months for admission, long distance of transportation for admission and follow up; Negative impact on social and economic status of the individual and family due to a long stay in hospital; Risk of spreading TB among other hospital patients due to inadequate implementation of infection control measures; Non-uniformity in current, sporadic efforts of decentralized management; Issues of refusal to admission and aggressive demand for early discharge; Poor survival rates of DR TB cases. Report by:
Mbeki plunders SANTA TB funds, closes down many TB prevention hospitals:
- : http://webcache.googleusercontent.com/search?q=cache:http://www.doh.gov.za/docs/pr/2001/pr0709.html
- (Google cache diverted from original above document to: http://www.doh.gov.za/docs/pr/2001/pr0709.html
- The right of access to health or the right to die? Nov 29th, 2007 by Pierre De Vos. The Daily Dispatch must not be much loved by Ms Nomsa Jajula, the Health MEC for the Eastern Cape. First, the newspaper exposed the dire problems at Frere Hospital, problems which was of course denied by Jajula and her bosses, Manto Tshabalala Msimang and Thabo Mbeki (who then nevertheless pumped millions of Rands into it the Hospital to rectify the non-existent problems). Now the newspaper is campaiging against the closure of the Temba TB Hospital in Grahamstown which was upgraded with Lottery money a few years ago after community intervention and through community participation It is unclear whether the Hospital is in fact earmarked for closure as part of the Eastern Cape Service Transformation Plan or not, because the Health Department is refusing to comment on the matter. However, if it closes down, TB patients in Grahamstown will have to travel 60 km to Port Alfred for treatment. In an editorial yesterday the Daily Dispatch quotes TB patient, Peggy Vaaltyn about the alleged closure: “We need treatment and we want to live. We rely on this hospital for our livelihood. Taking it away will kill us.”The secretive “Transformation Plan” is aimed at improving access to health care in the Province but closing the Hospital would seem to do the opposite. That is why a petition signed by the mayor, councilors, political parties, churches, clinics and district health officers was submitted to Bisho to protest the alleged closure – so far to no avail. http://constitutionallyspeaking.co.za/the-right-of-access-to-health-or-the-right-to-die/
- HIV-AIDS in South Africa due to Mbeki legacy: http://en.wikipedia.org/wiki/HIV/AIDS_in_South_Africa
XDR-TB was first widely publicised following the report of an outbreak in South Africa in 2006.
- 53 patients in a rural hospital in Tugela Ferry were found to have XDR-TB of whom 52 died within 16 days. The median survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis suggesting that they had been newly infected by XDR-TB strains, and that resistance did not develop during treatment.
- This was the first epidemic for which the acronym XDR-TB was used, and although TB strains that fulfill the current definition have been identified retrospectively, this was the largest group of linked cases ever found.
- Since the initial report in September 2006, cases have now been reported in most provinces in South Africa by 2007. As of 16 March 2007, there were 314 cases reported, with 215 deaths.
- It is clear that the spread of this strain of TB is closely associated with a high prevalence of HIV and poor infection control; in other countries where XDR-TB strains have arisen, drug resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person. It is now clear that the problem is far more extensive. http://en.wikipedia.org/wiki/Extensively_drug-resistant_tuberculosis
- http://www.westerncape.gov.za/directories/facilities/701 Tuberculosis hospitals in Western Cape.