Tuberculosis (TB), an ancient foe, continues to pose a significant threat to global health. But there's a glimmer of hope on the horizon with the development of an innovative inhalable nanomedicine.
A Revolutionary Approach to TB Treatment
At the Wits Advanced Drug Delivery Platform (WADDP), Dr. Lindokuhle Ngema, a postdoctoral researcher, is leading the charge against TB with a unique inhalable nanosystem. This system is designed to transport TB medications directly to the lungs, targeting the very place where Mycobacterium tuberculosis, the causative bacterium, thrives.
The nanocarrier, a miniature vessel for the drugs, can accommodate all four standard TB medications 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.
A Clever Enemy, a Smarter Solution
TB is a cunning adversary, hiding in pockets of the lungs where oral medications cannot reach. Dr. Ngema's system aims to outsmart this ancient disease. "TB is clever, but our system is designed to be even smarter," he says.
Mycobacterium tuberculosis has been with us for approximately 9,000 years, and despite scientific advancements, it remains a major global killer. Each year, TB causes about 10 million new infections and claims 1.8 million lives. In South Africa alone, TB took over 56,000 lives in 2023.
The bacillus, a slow-growing, rod-shaped bacterium, spreads through the air via coughing, sneezing, or speaking. While the BCG vaccine, administered in infancy, provides some protection, its effectiveness wanes over time, leaving many adults vulnerable.
The World Health Organization (WHO) recognizes TB as a disease that inflicts 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 targets requires innovative thinking and cutting-edge technology.
Professor Yahya Choonara, director of WADDP, emphasizes the need to address the limitations of one-size-fits-all drug delivery. "Precision nanomedicine allows us to treat TB more effectively, faster, and with greater impact," he says, aligning with the WHO's End TB Strategy.
Overcoming TB's Defenses
The standard TB treatment involves four key anti-TB drugs: rifampicin, isoniazid, ethambutol, and pyrazinamide. These drugs are taken over six months, which can lead to challenges with adherence. Side effects, including nausea, liver damage, and neuropathy, may cause patients to discontinue their medication. This, in turn, allows TB to evolve into multidrug-resistant (MDR) and extensively drug-resistant (XDR) forms.
The WADDP team believes inhalation therapy could be a game-changer. By delivering medication 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.
Dr. Ngema explains, "We hope this approach will shorten treatment time, improve adherence, and limit the rise of drug resistance."
The Inner Workings of the Nanosystem
This biocompatible carrier, engineered at the molecular level, is designed to encapsulate the 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 the nanoparticles through the lung in real time. This will confirm whether the drug reaches the "hidden" TB pockets that conventional therapy misses.
"The beauty of nanoscale science lies in our ability to design a system that responds 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 Dr. Ngema.
A Personal Mission, a Scientific Breakthrough
The project was conceptualized at WADDP under Professor Choonara's guidance. Dr. Ngema spent three months at the RWTH Aachen University Hospital, Institute for Experimental Molecular Imaging (ExMI) in Germany, optimizing the 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 show this is achievable, and now we're working to translate it into real-world applications," Dr. Ngema explains.
For Dr. Ngema, this research is deeply personal. "TB has taken too many lives for too long. If we can make treatment easier, faster, and smarter, we can not only improve outcomes but also restore hope."
Addressing Inequality, Shifting the Balance
Despite decades of research, TB remains a disease of inequality, thriving in contexts 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 and perpetuating the epidemic.
Innovations like this inhalable nanomedicine offer a way to shift the balance. They reduce the burden on patients, increase treatment precision, and raise the chances of eradicating this ancient disease.
Conclusion
This groundbreaking research at WADDP offers a new lease of life for tuberculosis treatment. By harnessing the power of inhalable nanomedicine, we can outwit TB's defenses and bring us one step closer to a TB-free world.
But here's where it gets controversial: Could this approach be the key to finally defeating TB? And what are your thoughts on the potential of nanomedicine in tackling global health challenges? Let's discuss in the comments!
