Battling TB Here and Abroad
words by carole walker /
photograph by pete byron
t has been called the “White Plague” or the “Captain of Death,” and, according to Edward C. Jones López, MD, MS, tuberculosis (TB) has remained an enigma through the ages. Over time, TB has killed more people than any other disease and is still the world’s second deadliest infection after HIV/AIDS.
Following graduation from medical school in 1991, Jones López, who is fluent in Spanish, French and Portuguese, worked for two years with the humanitarian organization Doctors Without Borders (MSF France) during the civil war in Angola and the refugee crisis at the Thai/Cambodian border. Since his interests include TB, HIV and other international health issues, upon his return from MSF, he trained in internal medicine and infectious diseases at Mexico’s Instituto Nacional de la Nutrición Salvador Zubirán, and then at the University Hospitals of Cleveland. He also completed a Master’s degree in epidemiology and biostatistics at Case Western Reserve University and worked for the NIH-funded Tuberculosis Research Unit on several large epidemiological studies in Uganda.
Jones was recruited to UMDNJ in 2001 and was deployed to Uganda, where he lived for two years while launching a large collaborative research project entitled “Strategies for the Management of Multi-Drug Resistant (MDR-TB) Tuberculosis in Kampala, Uganda,” which was funded by the Wellcome Trust-Burroughs Wellcome Fund Infectious Diseases Initiative. This project looked at several aspects of the epidemiology of drug resistant TB at Mulago Hospital, the largest public hospital in Uganda, and was dedicated to establishing essential principles for management of MDR-TB in a low-income setting.
Since returning to the U.S. in 2003, he travels to Uganda and Brazil two to three times a year, where, as principal or co-investigator, he coordinates clinical research activities. Jones and his colleagues are currently working on several studies in those countries funded by the NIH, the Foundation for Innovative New Diagnostics (FIND) and the UMDNJ Foundation.
In Uganda, Jones and his NJMS colleagues are working in collaboration with Roy Mugerwa, MD, professor of medicine at Makerere University Medical School, on a study entitled “Validation of an Improved Method to Study Mycobacterium Tuberculosis (Mtb) Transmission in Humans,” funded by the UMDNJ Foundation. For decades, patients with TB have been evaluated by looking at Mtb in expectorate sputum, using a special stain. However, investigators theorize that Mtb is transmitted by aerosols generated by a cough and not by sputum. Until recently, it was not possible to study this idea.
Kevin Fennelly, PA, MD, MPH, assistant professor of medicine at NJMS, was the first to grow live Mtb bacteria in aerosols generated by the coughing of TB patients. They measured the concentration and particle size distribution of viable aerosols generated by patients with active pulmonary TB using a novel cough aerosol sampling system or CASS. Jones says the ideal setting to study TB infection is in households. “If our hypothesis is confirmed, it will change the old belief, and the results can be used to study several other aspects of TB transmission currently unknown.”
In Vitoria, Brazil, Jones and his colleagues are collaborating with Dr. Reynaldo Dietze from the Universidade Federal do Espírito Santo (UFES) in a large, NIH-funded household contact study, with approximately 5,000 residents. Their goals are to determine: whether some clinical strains are more transmissible or cause more disease progression in infected patients; if strains vary in the way they interact with the innate immune system; the degree to which adaptive immunity to Mtb is strain-specific; and the principal strains or bacterial factors that could be combined in a future vaccine effective against all Mtb strains.
This collaboration of leading epidemiologists, immunologists, molecular biologists and microbiologists from the U.S. and Brazil will enable cutting-edge research and training on crucial aspects of TB using an innovative epidemiological study design.