Gates Foundation adds to TB fight

The threat of tuberculosis seemed distant in America until an Atlanta attorney flew off for an international honeymoon last spring.

The case of Andrew Speaker, who was infected with a drug-resistant strain, showed how ill-prepared the world is to deal with the contagious lung disease, a top official from the Bill & Melinda Gates Foundation said Tuesday, announcing the Seattle philanthropy's biggest package of grants ever to fight tuberculosis.

The $280 million commitment brings the foundation's total spending on TB research to $740 million.

"The goal is to translate promising scientific leads into tools that can save millions of lives," said Dr. Tachi Yamada, president of the foundation's Global Health Program.

Tuberculosis kills nearly 2 million people a year, mostly in poor nations. About a third of the world's population is infected with the bacteria that cause the disease. Immigration and travel are contributing to a resurgence in places where TB was largely wiped out decades ago.

King County reported 145 new cases in 2006, 16 percent more than the previous year.

The new money will build on previous Gates grants to accelerate development of tuberculosis vaccines and improve techniques for diagnosing the disease, Yamada said.

The foundation is also making its first foray into research on new tuberculosis drugs, with the hope of replacing a cumbersome regimen that now takes six months or more to cure an infection.

"I think most people would argue the intervention that is most likely, and most likely to have the biggest impact, would be a new drug," said David Sherman, a molecular geneticist at Seattle Biomedical Research Institute (SBRI).

A consortium led by Sherman was awarded $7.5 million to develop methods to quickly screen possible drug candidates and identify the bacterium's vulnerabilities.

"I have a lot of optimism," he said.

Most tools to fight TB haven't improved significantly in decades, especially in the developing world, Yamada pointed out. The disease is still diagnosed by examining sputum samples under a microscope — an approach that misses about half of infections. It takes 45 days to culture bacteria to confirm a positive test.

"Many people with tuberculosis are never diagnosed and do not receive treatment in a timely manner," said Dr. Giorgio Roscigno, CEO of the Geneva-based Foundation for Innovative New Diagnostics, which will receive $62 million over five years.

The group's goal is to develop an accurate TB test that gives results in two hours or less.

The disease spreads through the air, so untreated patients can infect others with every cough. Those who do get treatment must take several pills a day for six to nine months.

Many people don't complete the entire course of medication, contributing to the emergence of drug-resistant bugs. Speaker's case was so persistent it required surgery to cut away infected lung tissue.

TB treatments haven't kept pace with new technology because "quite frankly, for the last 50 years, no one has really tried," said Dr. Peter Small, of the Gates Foundation's tuberculosis program.

Historically, drug companies have been reluctant to invest in TB and other diseases of the developing world that offer little prospect of profit. The bug itself also is very tough to work with, Sherman said.

"It takes weeks to get a culture on a plate," he said. "It's the only one of the major pathogens where all you have to do is breathe to get it."

At SBRI, researchers work in a special lab and wear full protective garb, including a respirator, when they handle the bacteria.

Yamada, the former chief of research for European pharmaceutical giant GlaxoSmithKline, said drug companies have stepped up their TB research in recent years.

Companies also will be eager to develop and market any new drugs that come out of the Gates-funded projects, predicted Yamada, who was named an honorary knight Tuesday by Queen Elizabeth II in recognition of his work with GlaxoSmithKline.

The biggest chunk of new funding, $200 million, will go to the Aeras Global TB Vaccine Foundation to pay for early clinical trials on six vaccine candidates.

"We expect one or two of these candidates may make it all the way," said Dr. Jerald Sadoff, the organization's president and CEO. If so, a vaccine could be approved as early as 2015.

Research on new treatments, including Sherman's project, will get a total of $18 million.

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com