Tuberculosis remains deadly in 21st century

Research Centre Borstel investigating cause and diagnosing illness in new laboratory
04 July 2022
Visualisation of new National Reference Centre

Violetta, the heroine of Giuseppe Verdi's opera, La traviata, fell victim to tuberculosis and a similar fate befell Mimi, the heroine of Giacomo Puccini's opera La bohème. The real life victims of the disease included the Bronte sisters as well as Frederic Chopin and George Orwell. In fact, infectious diseases were the main cause of death worldwide in the 19th century. And in the 21st century, around 10 million people still contract tuberculosis every year. More than 1.5 million people succumb to the disease caused by bacteria. Only COVID-19 has claimed more lives relegating tuberculosis to second place in terms of death caused by infection. "Thus, it is still a real danger today," said Professor Florian Maurer, Head of the National Reference Centre (NRZ) for Mycobacteria at the Borstel Research Centre in Schleswig-Holstein. "But thanks to the great progress in public hygiene, we are seeing a downward trend in Germany."

New laboratory buildings 

The Research Centre Borstel is the Leibniz Association's lung research centre and has a long history of researching and diagnosing tuberculosis, asthma and Chronic Obstructive Pulmonary Disease (COPD). "A network of reference centres in Germany focuses on diseases that are crucial to public health protection," Maurer pointed out. Appointed by the German Ministry of Health and the Robert Koch Institute, the NRZ acts as the World Health Organisation's national and supranational reference laboratory for tuberculosis diagnostics. NRZ also develops, improves and evaluates new diagnostic techniques. To perform its tasks in the best possible manner, the federal and state governments earmarked EUR 70 million in funds to build two new state-of-the-art laboratories at the Research Centre Borstel. The grand opening on June 10, 2022 saw experts from all over the world come together for a symposium on preventing tuberculosis. The buildings feature a new respiratory centre and workspaces for some 20 NRZ employees.

 

Professor Florian Maurer Pukal
© Forschungszentrum Borstel/Pukall
Professor Florian Maurer, Head of the National Reference Centre (NRZ) for Mycobacteria
Image of tuberculosis pathogens under a scanning electron microscope
© Forschungszentrum Borstel/Homolka
Image of tuberculosis pathogens under a scanning electron microscope

No boundaries to pathogens

"We routinely work on highly resistant or potentially untreatable pathogens and need safety precautions." The new laboratory was built in accordance with S3 - the second-highest biological safety level. By comparison, the Bernhard Nocht Institute for Tropical Medicine in Hamburg, where highly pathogenic viruses such as Ebola are cultivated for research purposes, operates according to S4 standards. Given the decreasing numbers of tuberculosis cases in Germany, are new laboratories actually needed? "Absolutely," said Maurer. People in countries like India, China, Nigeria or South Africa still suffer from the infectious disease and pathogens know no borders. "Wars are excellent breeding grounds for tuberculosis or wherever people are forced to live in confined spaces like refugee camps, townships in Africa or prisons in Eastern Europe,” he pointed out.

 

Growing resistance to medication

Such scenarios call for more vigilance and especially as tuberculosis is airborne. That makes for a relatively high risk of infection. "This is especially true of so-called 'open tuberculosis' in which the infected person coughs and the pathogen flies into another person's lungs," said Maurer. However, "not every contact causes an infection and not every infection takes on the dimensions immortalised by Thomas Mann in his novel ‘The Magic Mountain’ (Der Zauberberg)," he stressed. But more and more tuberculosis bacteria across the globe are becoming resistant to medicine thereby necessitating ongoing research, Mauerer said, adding: "Latent tuberculosis means the infection is hidden in the body, but symptoms do not come to the fore. We are now researching the risks of reactivation. Patients have to take immunosuppressive medicines such as cortisone." The disease is not limited to the lungs. "Tuberculosis can do anything. It is essentially a pulmonary disease, but can infect the bone, the abdomen or cause meningitis."

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The international Borstel Research Institute was founded in 1947 as the Borstel Tuberculosis Research Institute. In 2003, the centre became part of the Leibniz Association of 97 non-university research institutions that are of supra-regional importance and are funded by the German government, the state in which the institute is located and the state community. The Research Institute Borstel is tasked with basic and clinical research into pneumology. In 2020, the centre received a basic budget of EUR 22.26 million, EUR 10.6 million in third-party  funding and EUR 1.3 million from its own services. The budget is funded in equal parts by the German Ministry of Health and the Ministry of Education, Science and Culture, Schleswig-Holstein and the state community.