Tuberculosis (TB), an ancient foe, continues to wreak havoc worldwide, claiming millions of lives annually. But here's the silver lining: a groundbreaking nanomedicine approach is breathing new life into TB treatment, offering a glimmer of hope in the fight against this resilient disease.
A Revolutionary Approach to an Ancient Enemy
At the Wits Advanced Drug Delivery Platform (WADDP), a team of researchers, led by Dr. Lindokuhle Ngema, is developing an innovative inhalable nanosystem. This system is designed to transport TB medications directly to the lungs, targeting the very stronghold of Mycobacterium tuberculosis, the bacterium responsible for TB.
The nanocarrier, a miniature container for the medicine, is capable of holding all four standard TB drugs in a single formulation. This precision delivery system ensures the drugs are released exactly where they're needed, bypassing the liver and bloodstream to reduce drug loss and increase concentration in the lungs.
Unmasking TB's Clever Tactics
TB is a cunning adversary, hiding in pockets of the lungs where oral drugs struggle to reach. Dr. Ngema emphasizes, "TB is clever, but our system is designed to be even smarter."
Mycobacterium tuberculosis has been a part of human history for approximately 9,000 years. Despite significant scientific advancements, TB remains a leading cause of death, with about 10 million new infections and 1.8 million deaths each year globally. In South Africa alone, TB claimed over 56,000 lives in 2023.
The bacillus, a slow-growing, rod-shaped bacterium, spreads through the air via coughing, sneezing, or even speaking. While many South Africans receive the BCG vaccine in infancy, protection diminishes over time, leaving adults vulnerable.
The World Health Organization (WHO) recognizes TB as a disease that imposes "catastrophic" costs on affected households. Their End TB Strategy aims to reduce new cases by 80% and deaths by 90% by 2030. Achieving these ambitious goals requires innovative thinking and cutting-edge technology.
Precision Nanomedicine: A Game-Changer
Professor Yahya Choonara, director of WADDP, underscores the importance of precision nanomedicine: "If we want to end TB, we must address the limitations of one-size-fits-all drug delivery. Precision nanomedicine allows us to treat with greater impact and efficiency, aligning with the WHO's End TB Strategy."
The standard TB treatment involves four key anti-TB drugs taken over six months. This lengthy treatment period poses challenges with adherence, and side effects can range from nausea and liver damage to neuropathy, leading patients to discontinue their medication. As a result, TB can evolve into multidrug-resistant (MDR) and extensively drug-resistant (XDR) forms.
The WADDP team believes inhalation therapy could be a game-changer. By delivering medicine directly into the respiratory tract, from the nose and bronchi to the alveoli, inhaled treatment bypasses the body's barriers and concentrates the drug where it's most needed.
"We hope this approach will shorten treatment time, improve adherence, and limit the rise of drug resistance," explains Dr. Ngema.
The Inner Workings of the Nanosystem
This biocompatible carrier, engineered at the molecular level, is designed to encapsulate four TB drugs. It's non-toxic and not recognized by the body as foreign or dangerous. Once inhaled, these nanoparticles travel deep into the lungs and gradually release their payload at the infection site.
A key feature is its traceability. In collaboration with the Nuclear Medicine Research Institute (NuMeRI), nuclear imaging will be used to track the movement of nanoparticles through the lung in real-time. This will confirm whether the drug reaches the "hidden" TB pockets that conventional therapy often misses.
"The beauty of nanoscale science lies in its ability to design responsive systems that adapt to the body's internal environment. We can control the release of drugs, ensuring they're delivered precisely where and when they're needed," says Ngema.
The project was conceptualized at WADDP under the guidance of Professor Choonara, whose laboratory specializes in targeted nanomedicines and advanced drug delivery systems. Dr. Ngema spent three months at the RWTH Aachen University Hospital, Institute for Experimental Molecular Imaging (ExMI) in Germany, optimizing drug release profiles.
"Our goal was to combine the four main TB drugs into a single inhalable dose, reducing treatment time and simplifying therapy for patients. Early results are promising, and now we're working to translate this into real-world applications," Ngema adds.
For Dr. Ngema, this research is deeply personal. "TB has taken too many lives for too long. By making treatment easier, faster, and smarter, we're not just improving outcomes; we're restoring hope."
Despite decades of research, TB remains a disease of inequality, thriving in conditions of poverty and weakened health systems. In low-resource settings, lengthy oral regimens are challenging to sustain, and each missed dose risks creating drug-resistant strains, perpetuating the epidemic.
Innovations like this inhalable nanomedicine offer a way to shift the balance, reducing the burden on patients, enhancing treatment precision, and increasing the chances of eradication.
This groundbreaking research offers a beacon of hope in the ongoing battle against tuberculosis, showcasing the potential of nanomedicine to revolutionize healthcare and save lives.
