March 2019 digital v1
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technology<br />
NGS BREAKS NEW PATH<br />
IN TB CARE<br />
Integration of NextGen Sequencing can reduce the Mycobacterium tuberculosis<br />
disease burden<br />
DR RAJANI KANTH VANGALA<br />
In order to have an effective<br />
treatment for tuberculosis (TB),<br />
there is an urgent need to modify<br />
the current treatment regime, which<br />
includes low efficacy, high toxicity and<br />
long duration drugs, and consumes<br />
significant resources. In 2015 alone,<br />
there have been 10.4 million TB<br />
infections and 1.8 million deaths,<br />
making TB one of the top 9 killers in<br />
the world, higher than HIV/AIDS. This<br />
unsatisfactory situation is mainly due<br />
to the development of drug resistant<br />
TB, which is immune to isoniazid and<br />
rifampicin. The three different types of<br />
resistance include multi-drug resistance<br />
(MDR), extensive drug-resistance<br />
(XDR) and totally drug-resistance<br />
(TDR), based on the exact strain of<br />
Mycobacterium tuberculosis responsible<br />
for the infection.<br />
At the same time, there has<br />
been the emergence of “offlabel”<br />
repurposed drugs such as<br />
oxazolidinones, carbapenems and<br />
clofazimine, which are being used to<br />
treat highly-resistant TB cases. The<br />
identification of the type of infection<br />
and proper diagnosis have been found<br />
to be the most important factor that<br />
determines the clinical outcome<br />
in such cases, even as drug-resistant<br />
strains are becoming a major global<br />
challenge. This challenge can only<br />
be addressed by genetic analysis to<br />
understand its complex biology and the<br />
mechanisms of drug-resistance.<br />
In this respect, one of the most<br />
important technological advances is<br />
whole-genome sequencing (WGS),<br />
which was first reported by Cloe et<br />
al in 1998, sequencing the M.<br />
tuberculosis strain H37Rv. This<br />
has significantly improved our<br />
understanding of the bacterial strain<br />
30 / FUTURE MEDICINE / <strong>March</strong> <strong>2019</strong>