Researchers are working on a new form of treatment in response to the rising incidence of antibiotic-resistant tuberculosis bacteria.
Approximately one and a half million people die each year from tuberculosis and the COVID-19 pandemic seems to make the problems even worse.
Treatment of the "common" tuberculosis bacterium requires four different antibiotics and lasts a minimum of six months. Resistant tuberculosis bacteria are much more difficult to treat and mortality is higher. Here, the treatment often takes up to a year and a half without a guarantee that the disease will be cured.
In response to the serious tuberculosis situation in the world, researchers at Oslo University Hospital have for the first time tested a vaccine developed by Danish researchers at the Center for Vaccine Research at the Statens Serum Institut in patients with tuberculosis. The vaccine can act as immunotherapy by giving a therapeutic vaccination to people who are already ill with tuberculosis.
"Tuberculosis disease occurs when the immune system is no longer able to control the bacteria in people that may have been infected a long time ago. The idea of therapeutic vaccination is to help the immune system to be able to better fight the infection while receiving antibiotic treatment. " says Anne Ma Dyrhol-Riise, chief physician at the Department of Infectious Diseases, Oslo University Hospital and project manager for the clinical study.
The researchers at Oslo University Hospital, in collaboration with colleagues at the Statens Serum Institutt, have just published the results of a clinical trial of the vaccine in the renowned journal, Nature Communications - https://www.nature.com/articles/s41467-021-27029-6.
"Our results show that the vaccine increases the amount of immune cells that target the tuberculosis bacteria. We can thus strengthen the immune response that patients already have in advance, which is an important finding. Therapeutic vaccination can therefore improve the prognosis for the patient ”.
According to Rasmus Skaarup Mortensen at the Statens Serum Institut, it is unlikely that the tuberculosis bacteria can develop new variants that avoid the vaccine, as we have seen with the Corona virus.
"Unlike the COVID-19 vaccines that focus on one molecule, our tuberculosis vaccine trains the immune system to attack the bacterium from many different angles at the same time. The bacterium will have to mutate in many different places to overcome the vaccine, which is unlikely. With the rising incidence of multi-resistant tuberculosis strains, such therapeutic vaccines may prove to be a good weapon ”.
The study has for the first time shown that a therapeutic vaccine is safe and can be included in a combination treatment with antibiotics in the treatment of tuberculosis. This regimen can potentially be useful both in multi-resistant tuberculosis and shorten the duration of treatment of common sensitive tuberculosis. The results may therefore have an impact on millions of people, but must first be studied further in larger studies that also include patients with multi-resistant tuberculosis.
The vaccine, called H56: IC31, is currently in a major clinical trial in Africa, testing the vaccine's ability to prevent disease in patients who have just completed their tuberculosis treatment.
Experts who can comment:
Anne Margarita Dyrhol-Riise (Professor and chief physician, Department of Infectious Diseases, Oslo University Hospital, primarily responsible for the clinical trial)
Rasmus Skaarup Mortensen, head of TB vaccine research at the Statens Serum Institut, Denmark
Tom Scriba (Professor of TB Immunology and Clinical Vaccine Development, Cape Town, South Africa)
The Nature Communications article (published Nov 22):
A Phase I/II randomized trial of H56:IC31 vaccination and adjunctive cyclooxygenase-2-inhibitor treatment in tuberculosis patients
Synne Jenum, Kristian Tonby, Corina S. Rueegg, Morten Rühwald, Max P. Kristiansen, Peter Bang, Inge Christoffer Olsen, Kjersti Sellæg, Kjerstin Røstad, Tehmina Mustafa, Kjetil Taskén, Dag Kvale, Rasmus Mortensen & Anne Ma Dyrhol-Riise
Nature Communications volume 12, Article number: 6774 (2021)
News article from www.oslo-universitetssykehus.no (in Norwegian):
Ny vaksine-terapi mot multi-resistente tuberkulosebakterier er under utvikling
Kroniske infeksjonssykdommer Facebook page (in Norwegian)