This post was written first for the Birkbeck College events blog and is re-posted here with permission.
World TB Day is held on 24 March every year, to mark the day in 1882 when
Robert Koch,
one of the fathers of microbiology, first announced that he had
discovered the cause of tuberculosis (TB) – the bacterium now known as
Mycobacterium tuberculosis (link to the TB proteome page in PPS section 5).
Over 125 years since its discovery, and despite billions of dollars of
investment in drug discovery, this bacterium is still a killer. The
World Health Organisation estimates
that about two billion people are infected with latent tuberculosis; in
2010, the last year for which full figures are available, over eight
million people became ill with active tuberculosis, and 1.4 million
people died from the disease. Two factors help make TB particularly
deadly: it often occurs in people infected with the HIV virus, where it
is one of the major causes of death, and drug resistant forms are
becoming more common. In January 2012,
Nature reported the identification in India of so-called “totally drug
resistant” (TDR) tuberculosis, resistant to all anti-TB drugs in general
use.
Image of Mycobacterium tuberculosis bacteria
Photo credit: Janice Carr, Centers for Disease Control and Prevention, USA
In 2012 at Birkbeck, World TB Day coincided with the start of the College’s annual Science Week.
Dr Sanjib Bhakta,
head of the Mycobacteria Research Laboratory in the Department of
Biological Sciences, organised a well-attended symposium on tuberculosis
and its treatment. Besides two scientific presentations, the symposium
featured a short video,
Tuberculosis: The Real Story,
highlighting the views of people affected by TB in the UK, and a panel
discussion led by the grassroots volunteer organisation
Results UK on some of the political challenges raised by tuberculosis.
Both science lectures focused on plants as a source of potential new drugs for tuberculosis.
Professor Franz Bucar
from the University of Graz in Austria highlighted the extreme chemical
diversity of compounds that could be extracted from plants,
particularly as compared to those found in the average synthetic
compound library. Plants have always existed alongside their own
microbial pathogens and have evolved natural antibiotics to protect
themselves. Our ancestors, before the dawn of scientific medicine, used
plant extracts to treat infectious disease, often quite successfully.
The sub-discipline of ethnomedicine involves “mining” these traditional
or historical remedies for pure chemicals that can be developed as, or
modified into, drugs.
Bucar described a European herb,
elecampane or Inula helenium,
which is known to have been used to treat lung disease in the sixteenth
century. He explained how a complex mixture of natural products derived
from this plant had been tested against mycobacteria. Compounds found
to have anti-mycobacterial activity were extracted and purified. Other
plants have also yielded useful lead compounds; extracts of bark from a
small tree with the Latin name of
Berchemia discolor have even been shown to inhibit multi-drug resistant strains of
Mycobacterium tuberculosis at useful concentrations.
Discovering antibacterial products in plant extracts, however, is
only a first step towards drug discovery. Even when natural products
like these compounds are found to be selective for bacterial over human
cells, it is necessary to discover their mechanism of action; to modify
them to optimize their activity; and, since plant sources are often
scarce and extraction processes costly, to determine methods of
synthesizing them in the laboratory.
The second scientific presentation was given by Dr. Bhakta himself
and described current work in Birkbeck’s Mycobacteria Research
Laboratory in searching for potential drugs for TB. These are needed not
only to combat resistant forms of the bacteria but to improve current
treatment regimens for “standard”, drug-sensitive TB. This requires a
combination of four drugs to be taken for two months followed by two
drugs for another four months, and many patients, particularly poorer
and less well educated ones, fail to complete such a long and complex
regimen. This in turn can lead to the development of further resistant
strains.
Ideally, new drugs are required that target proteins not targeted by
existing drugs, as resistance will be harder to develop. Mycobacteria
have extremely complex cell walls, unlike those of other types of
bacteria; they are essential for the bacteria to survive, and the
enzymes used to synthesise them have no equivalents in mammalian
genomes. These enzymes, therefore, have many of the characteristics of
excellent drug targets. Bhakta and his group have been exploring ways
to inhibit the synthesis of the peptidoglycan that is one of the most
important constituents of that cell wall. This molecule has been
described as the bacterium’s “
Achilles heel”, but no drugs targeting its synthesis have yet entered the clinic.
Mycobacteria synthesise peptidoglycan via a series of enzymes known
as ligases, each of which adds a new link to the growing peptidoglycan
chain. Bhaka’s group has focused on one of these ligases, termed MurE.
This enzyme is essential for the bacterium to survive and it is
conserved in all
Mycobacterium tuberculosis strains. Working in collaboration with
Professor Nick Keep,
also in the Department of Biology, Bhakta solved the structure of MurE
(PDB
2XTA) and showed it to have an active site that could in theory, at least, be
occupied, and blocked, by a relatively small, “drug-like” molecule. He
and his co-workers are now searching libraries of natural products for
compounds that might inhibit this enzyme. They have identified promising
MurE inhibitors from plants endemic to both Colombia and China, and are
synthesizing analogues of these compounds for further testing.
It is unlikely that the next generation of anti-tuberculosis drugs
will include any unchanged natural products. It is extremely likely,
however, that natural products will yield the “scaffolds” on which these
desperately needed drugs may be built, and perhaps one of these will be
generated from within Bucar’s or Bhakta’s groups.