Report of the expert consultation on immunotherapeutic interventions for tuberculosis

ISBN:	978 92 4 159583 4
TDR code:	TDR/IRM/07.1
Date:	2007
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Summary

The recent emergence of extensively drug-resistant tuberculosis (XDR-TB) has highlighted a systemic failure of health services; and the need to strengthen tuberculosis (TB) control and laboratory services and to develop new therapeutics. Antituberculous chemotherapy remains the cornerstone of control. However, TB treatment is complex – requiring at least six months of treatment and associated with drug toxicities and drug-drug interactions. Current anti-TB drugs are unable to eradicate all Mycobacterium tuberculosis at sites of infection due to their relative inactivity against semi-dormant or persisting organisms, particularly those in lung granulomas. HIV coinfection is associated with increased recurrence of TB due to increased rates of reinfection and relapse. Treatment of multidrug-resistant TB (MDR-TB) and XDR-TB is much more complex and requires longer use of toxic, expensive, less effective second-line drugs. Advanced understanding of the immunopathogenesis of TB offers the potential for adjunctive immunotherapy for the treatment of drug-susceptible and drug-resistant TB. Immunotherapy is defined as the use of therapeutic vaccines or immunomodulation to shorten chemotherapy or reduce immunopathology. Adjunctive immunotherapy, in addition to chemotherapy, has the potential to shorten TB treatment and improve treatment outcomes of drug-resistant TB.

The scientific working group (SWG) of the TDR/WHO (3–6 October 2005) recommended that TDR and partners organize an informal consultation of experts to define research priorities and potential research activities that could enhance approaches on immunotherapy and immunomodulation agents for use in the management of TB. The SWG suggested that TDR, the Initiative for Vaccine Research (IVR) and partners could take a leading role in the evaluation of potential immunotherapy agents.

The justification for the meeting includes the need to find effective therapies for XDR-TB: an existing pipeline of immunotherapeutic agents could be moved into clinical trials relatively quickly with modest budgets.