Dr. Delia Goletti heads a team of seven and sees about 15 patients a week. INMI is the reference center for tuberculosis in central and southern Italy, and takes in about 300 cases a year (mostly immigrants) including rare cases of drug-resistant TB. Goletti’s lab is also working with Professor Gian Maria Fimia’s group from the University of Salento, in Lecce, Italy. Their work shows that tuberculosis inhibits autophagy, the process by which a cell gets id of unnecessary particles and also controls the replication of bacteria. TB is not a new germ, like HIV was in the 1980s or SARS was two decades later. On the contrary, the disease has been around for as long as mankind, and the bacterium at its root has been known for more than a century. It does not spread as easily as measles, rubella or influenza, but without treatment, drug-resistant TB has a mortality rate that is similar to Ebola’s.
What makes it so difficult to defeat, Dr. Goletti?
Dr. Delia Goletti: There are different reasons. Good socioeconomic conditions are the best defense against Mycobacterium tuberculosis, the bacteria that causes TB. That is why the infection thrives in developing countries where malnutrition weakens the immune system of the poorest people. In most developed countries, improved nutrition and hygiene were enough to turn tuberculosis into a rare disease by the early 1950s. Which, paradoxically, led to a second major problem: wealthy nations shifted their attention away from TB to other health issues.
Which had been a mistake?
When I was in Bethesda, Maryland, at the National Institutes of Health, we realized there was a new epidemic due to co-infection with HIV. By turning off the immune system, HIV, paves the way for tuberculosis, which, in turn, helps HIV replicate faster. About 400,000 people a year die from co-infection with HIV and TB. This does affect also wealthy nations, furthermore as life expectancy grows, there are more and more things that can weaken the immune system in addition to the natural aging process and unleash the disease, for instance therapies for autoimmune disorders or diabetes.