Health
First tuberculosis-specific PET scan could enable more effective treatment
Researchers in the UK and the US have developed a more accurate way of testing for tuberculosis (TB) using positron emission tomography (PET).
A team from the Rosalind Franklin Institute, the University of Oxford, the University of Pittsburgh and the US National Institutes of Health has developed a new radiotracer – a radioactive compound that is taken up by live TB bacteria in the body and emits radiation that can be detected by a scanner and converted into a 3D image.
This new radioactive tracer, called FDT, makes it possible for the first time to use PET scans to pinpoint when and where the disease is still active in a patient's lungs.
The researchers have subjected this new radiotracer to extensive preclinical testing with no adverse effects and are now ready to move into Phase I trials in humans.
Published in Nature CommunicationsThe research was funded by the Gates Foundation and UK Research and Innovation.
Currently, there are two ways to diagnose TB: testing for the TB bacteria in a patient's saliva and a PET scan, which uses FDG, a common radioactive tracer, to look for signs of inflammation in the lungs.
But saliva tests can sometimes come back negative long before the lung disease has fully resolved, potentially causing patients to stop treatment prematurely.
Inflammation scans can help show the extent of the disease, but are not specific to TB as inflammation can be caused by other diseases. Inflammation in the lungs can remain even after the TB bacteria have been removed, causing treatment to last longer than necessary.
The new approach developed by the researchers is more specific because it uses carbohydrates that are only processed by the tuberculosis bacteria.
The main advantage of this new approach is that hospitals only need standard radiation controls and PET scanners, which are becoming widely available worldwide. The new molecule is produced from FDG using a relatively simple process involving an enzyme developed by the research team. This means that it can be produced without specialized expertise or laboratories, making it a viable option in low- and middle-income countries with less developed health systems. Currently, more than 80% of the world's TB cases and TB deaths occur in these countries.
In 2021, 10.6 million people fell ill with TB and 1.6 million died from the disease, making it the second leading cause of death from infectious diseases worldwide after COVID-19.
Professor Ben Davis, scientific director of Franklin's Next Generation Chemistry Group, led the research, said: “Finding a way to pinpoint exactly when TB is still active in the body is not only crucial for early diagnosis, but also to ensure patients receive antibiotics long enough to kill the disease, and not longer.”
“FDG, a common radioactive tracer, and the enzyme we developed to convert it into FDT can all be mailed. With minimal additional training, this effective diagnostic can be deployed in essentially most healthcare systems around the world, and most importantly, in the areas where the disease still hits hardest.”
“FDT allows us to assess in real time whether TB bacteria are viable in patients during treatment, without having to wait to see if active disease returns,” said Dr. Clifton Barry III of the National Institute of Allergy and Infectious Diseases. “This means FDT can add great value to clinical trials of new drugs and has the potential to transform the way they are tested for clinical use.”
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