Two exciting Indian researchers have been able to make the tuberculosis (TB) vaccine 50 times more effective. This, in a sense, revolutionary breakthrough in the battle for that ever elusive thing — one potent vaccine against TB.

Prof. Gobardhan Das (sitting) and Prof. Anand Ranganathan (standing, bespectacled) at their laboratory.

Professor Gobardhan Das and Professor Anand Rangathan, two of the key scientists who wrote the paper on their discovery that was published in The Journal of Infectious Diseases on August 29, 2016 spoke to Grin about their battle against the disease that kills 20 million people around the world every year. Their tests has been able to bring about a more than 50-fold improvement in the efficacy of the commonly used TB vaccine — Bacillu Calmette Guerin (BCG) — by giving mice anti-leprosy drug (clofazimine) for a month along with a single dose of the vaccine. The researchers work at the Special Centre for Molecular Medicine at Jawaharlal Nehru University in Delhi.

1. In lay terms, could you explain very simply why your discovery is of the utmost importance?

Currently, there is no vaccine is available for Tuberculosis (TB) other than Bacillus Calmittee Guerin (BCG), which is not satisfactorily efficacious for adult pulmonary TB. TB is the second highest killer, next to Human Immuno-deficiency Virus (HIV), and claims more than 2 million lives every year. Therefore, we need a vaccine urgently, but testing a new vaccine and determining its efficacy takes 20 or more years. BCG is efficacious for meningitis and disseminated TB in children, and hence children are given BCG as a standard regimen. We wondered if it was possible to add something simple, an already approved drug for example,to improve BCG vaccine efficacy and protect pulmonary TB in adults. After extensive co-relative study, we came up a logical guess that the Leprosy drug Clofazimine may do the job. Indeed, it worked. If our study is extended to human trials, and it proves successful, it could at least for the time being fill in the vacuum, which is the lack of an effective anti-TB vaccine.

2. How will this revolutionise treatment for tuberculosis?

If our strategy works in humans, this could possibly save millions of lives. Current therapy of TB is lengthy, expensive and toxic, and it also includes the risk of generating of drug-resistant TB. In fact, TB is acquiring drug resistance at a much faster rate than the discovery of new generation antibiotics to treat it. This problem is now acute. Already we have, through Dr. Zarir Udwadia’s research work, the realisation that Totally drug resistant TB (TDR) is in in our midst. Almost all countries irrespective of socio economic status are under threat from Multiple and Extensively drug resistant (MDR and XDR) TB. If our strategy works, we just might be a step closer to realising the dream of a TB-free society.

3. Why are we still discussing tuberculosis in 2016 — don’t most people think that this is a 20th century diseases long beaten by science?

TB remains the second highest killer, next only to HIV. Discovery of antibiotics and of course the BCG vaccine (although efficacious only in children) did manage to halt the march of TB for a few decades. But association with HIV, appearance of MDR, XDR, and now TDR, is presently causing havoc. It is an epidemic. We have to fight this adversary from all angels, starting from addressing the socio-economic problem, and then moving on to prevention, new research, new drugs.

4. When will your discovery hit the markets as drugs that would benefit patients?

Well, we do not know if this will make to the market at all. Firstly, we have to test whether this works in humans. Second, even if it works in humans, it has to cross the regulatory hurdles. Thirdly, often the regulatory mechanisms are put in place or authorised by politicians, and this is more so in India. As a result many important discoveries never see the light of day. We wish things would be a little different here, but there’s a long way to go.

5. How long was the process of this research discovery?

As such the experimental part did not take a long time — only a year or so. Selecting the compound of interest and the logic behind it took time. It was a topic of discussion in the laboratory for few years. Finally, few recent studies connected the thread and the logic gained ground. Also remember that the Eureka moment lasts a day, what follows afterwards is years of toil in the laboratory. Ultimately it is team work that makes doing science worthwhile.

Call to action: You can read their scientific paper here — http://jid.oxfordjournals.org/content/early/2016/08/28/infdis.jiw395.abstract