Best Treatment For TB Patients, Tuberculosis patients may receive treatments in the future according to what version they have of a single 'Goldilocks' gene.
This is of the first examples in infectious disease of where an individual's genetic profile can select which drug will work best for them - the idea of personalised medicine that is gradually becoming familiar in cancer medicine.
The scientists found that people generate an immune response to tuberculosis that is 'too much', 'too little' or 'just right', according to what versions they have of the LTA4H gene.
Furthermore, the researchers show that steroids used as part of the standard treatment for the most extreme type of tuberculosis, TB meningitis, only benefit some patients.
The results of the study, part-funded by the Wellcome Trust, are published in the journal Cell.
The new study combines work in zebrafish at the University of Washington, Seattle to identify genes and biological pathways involved in the immune response to TB, with clinical research work in collaboration with Pham Ngoc Thach Hospital, the Hospital for Tropical Diseases and the Oxford University Clinical Research Unit in Vietnam.
The researchers showed that blocking the appropriate biological pathway with drugs could restore the right level of inflammatory response.
The researchers based in Vietnam then returned to samples from a earlier clinical trial in over 500 patients with TB meningitis. They showed changes at a single position in the human LTA4H gene were associated with treatment response.
Only those having LTA4H genes that led to much inflammation benefitted from the use of the steroid dexamethasone.
There is some suggestion that the steroid could have an adverse effect for those whose LTA4H genes already lead them to have a reduced inflammatory response, though the result is not statistically significant.
This study highlights the power of really good clinical research supported through Wellcome Trust Fellowships and linked with some of the very best scientists in the world in Vietnam and the USA, which can bring immediate benefits to patients and also point the way to develop better, more targeted drugs to treat people with tuberculosis in the future.
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