TUBERCULOSIS | 1990s – NOW
Modern-day approaches move in on an ancient disease
How a focus on controlling tuberculosis is making headway
Tuberculosis (TB) is a respiratory disease that kills approximately 1.5 million people each year. It’s been around for thousands of years, and alarmingly, it’s estimated that 25% of the world’s population is infected with TB.
Despite this, the only licensed vaccine – the Bacille Calmette-Guérin (BCG) vaccine – is over a hundred years old, and while it is effective at reducing risk for infants, it is less so in older children and adults.
Targeting TB has been on the agenda at the Centenary Institute since its earliest years, and it started with an interest in an ancient disease.
“My wife and I worked in a missionary hospital in Nepal between 1978 and 1981 and that’s where my interest in researching leprosy started,” recalls Professor Warwick Britton AO.
“On returning to Australia, I undertook a PhD with Tony Basten at the University of Sydney. Tony, who went on to become the founding director of Centenary, had access to new monoclonal technologies, which were just emerging in the early 80s, and he enabled me to pursue my interest in leprosy, a quite archaic disease, but one which still affected many people and had become drug resistant.”
Warwick then returned to Nepal for four years to establish the Mycobacterial Research Laboratory at Anandaban Leprosy Hospital to help improve leprosy control, before returning to the Centenary Institute in 1990.
It was a decision that was to prove critically important for the future of TB research.
A turning point for TB research
“In the late 80s, TB was increasing in prevalence, partly due to the HIV crisis, as HIV increases susceptibility to tuberculosis. And what we had done in leprosy research, identifying six antigens and sharing our findings widely, was to increase the world’s understanding of the immunology of mycobacteria, which are the same type of bacteria causing leprosy and TB.”
Identifying the need to tackle TB and armed with the knowledge gained in his leprosy research, Warwick shifted his focus, working with Tony Basten on the development of a Physical Containment Level 3 (PC3) lab in Centenary’s new building in 1994.
By 1997, the lab was up and running, allowing the team to safely contain and handle hazardous biological agents and create a model of TB. Since then, Warwick has nurtured the PhD students who would go on to make profound breakthroughs in TB research.
Creating an ecosystem for breakthroughs
“For me, the most impactful role that Centenary has played in TB research is to create a robust ecosystem for TB research, training around 35 PhD students who have gone on to successful careers in TB research and indeed, come back to Centenary. And not just that, it’s the openness to work and collaborate with other institutions that have really accelerated our opportunities,” adds Warwick.
This resulted in Warwick leading two NHMRC Centres of Research Excellence in TB Control from the Centenary Institute from 2012 to 2024 to build TB research capacity in Australia.
The breadth of groundbreaking research that Warwick has been involved in ranges from contributing to new vaccine strategies that harness DNA, to demonstrating links between biological therapies for rheumatoid arthritis and an increased susceptibility to TB.
In particular, his studies have focused on the role of proteins like Tumour Necrosis Factor (TNF). Through these studies, he helped clarify how TNF guides the immune response to keep tuberculosis bacteria in check, which is critical to designing better treatments and vaccines.
Today, new approaches to fighting TB are being developed in the Centre for Infection and Immunity under Centre Head, Associate Professor Patrick Bertolino, along with Warwick and Professor Angelo Izzo.
Most recently, Warwick developed a new type of nasally-administered vaccine, which directly targets where TB infection typically begins in the lungs. It’s a novel vaccine that has shown great promise in inducing a robust immune response to protect against lung infection. Using the same approach, Warwick and Dr Anneliese Ashhurst, also a former PhD student, have created a Nose-only Covid-19 (NovCov) vaccine that blocks replication of the SARS-CoV2 virus at the site of entry and completely prevents disease.
It’s the continuous dedication to fighting disease, building on decades of research that uncovers new knowledge and furthers new treatment options. These ongoing breakthroughs demonstrate the importance of never slowing down, always adapting strategies, testing new hypotheses, collaborating and asking new questions.
The future for fighting TB and other infectious diseases looks positive, with discoveries that will continue to create an impact that could lead to the effective control and eventual elimination of TB, turning the tide on a disease that has plagued humanity for centuries.