Research and lab time

As the orientation has continued on, I am gradually getting a better picture of how I can be involved in different studies. I will briefly describe the major studies here in light of my knowledge of them thus far.

 

One study is examining the use of punctuated anti-retroviral therapy (HIV/AIDS treatment) in patients with tuberculosis with CD4 counts (a type of white blood cell targeted by the HIV virus) ABOVE the range normally necessitating HIV/AIDS medications. Tb and HIV exacerbate each other. In light of this dual relationship, one of the central questions for the study is: can you more effectively treat Tb in an HIV positive person if you treat the HIV at the same time as Tb treatment while preventing the worsening of HIV due to the Tb infection? (Hence “punctuated” HIV anti-retroviral medication given only during Tb treatment since her/his CD4 level is higher than the “standard of care” level when medications are usually started.)

 

One of the studies I am most likely going to work on will look at cost-effective ways to diagnosis tuberculosis in a community. In this study community health workers are going out in a community in Kampala known to have a high prevalence (cases) of Tb. Rather than wait for someone to come to the doctor sick, this study seeks to actively seek out the sick as diagnosed by “chronic coughing” for more than 2 weeks. There is an extensive work up consenting individuals, household contacts, and first degree relatives then undergo if they are “chronic coughers.”

CWRU/UGa Tuberculosis Research Unit (TBRU) clinic at Mulago

CWRU/UGa Tuberculosis Research Unit (TBRU) clinic at Mulago

 

Related but reversed, is another study that examines known index cases of people with Tb and studies their household contacts and first degree relatives in a particular community. This study has been going on for many years and has gathered much data covering many issues that may impact Tb. This study also takes into account genetics, immunology, and other laboratory-based investigations.

 

The last study about which I know the least but am increasingly drawn to is studying the relationship between HIV and alcohol consumption. There are social and immunologic/genetic dimensions to this study’s analysis. I hope to get involved in a psychiatric issue (e.g., alcohol use) in addition to my involvement in one of the Tb studies.

 

We spent 2 days in the Joint Clinical Research Centre  this week, which is a 15 minute drive from Mulago. Here is a traffic jam that we caught on our way there:

Goats en masse while we were driving to the JCRC

Goats en masse while we were driving to the JCRC

Ali and I hitched a ride with the driver who brings over sputum and blood samples three times a day. Karen Morgan, PhD, a US microbiologist working there, gave us a phenomenal tutorial and tour of her work with Tb in conjunction with the studies. We learned different diagnostic techniques for Tb in patients and viewed cultures where Tb was growing. We also spent some time with the microscope looking at acid-fast bacilli (e.g., Tb) and its characteristic cording. We also received a tour of the different projects other institutions are conducting. The technology and types of machinery in the lab were impressive and many were completely new to me! I can readily say that there is some amazing laboratory bench science being done here that builds upon the clinical research in the field.

Pierre at work

Pierre at work

 

One example of the lab projects that I can explain is an aspect of the aforementioned studies. For those without an immunology background, let me try best to explain as simply as possible. When a person is infected with tuberculosis, the immune system reacts by attacking the Tb bacteria (called mycobacteria). Some of the body’s immune cells “present” part of the Tb bacteria to other immune cells that in turn help contain/destroy the bacteria. In order to make better treatment and vaccines, it is thought that targeting what is “presented” on those cells may be the future of Tb therapy and prevention. So how does one know which bacterial part causes the immune system to react? One of the chemicals the human body releases when Tb antigens are “presented” is IFN-gamma, a “marker” in the blood that infection has been recognized. So in one of the laboratory studies, the researchers are looking at which Tb antigens – the parts of the mycobacteria “presented” to the immune system by other “defense” cells – cause the release of IFN-gamma. IFN-gamma levels in the blood can be measured with the current technology so the researchers are limiting which antigens are possible candidates in the future for targeted, more efficacious Tb therapy.

Andrew and Joy decanting supernatant at JCRC

Andrew and Joy decanting supernatant at JCRC

 

I have to admit that FAR more things are going on in the laboratory than I can remember or explain, and I really parsed down the explanation of that one particular lab research project directly above. I’m not doing the lab justice! After two days at the JCRC, I came away with a deeper appreciation for laboratory bench science in general and Tb microbiological and molecular genetics in particular. Such science is a cornerstone of modern medicine and will certainly be even more in the future as we better understand molecular genetics of human disease. Continued and increased research in these areas in general is CRUCIAL!

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2 Responses to “Research and lab time”

  1. Lonnie Says:

    Justin, tell Uganda that Chicago is sorry: http://www.chicagotribune.com/news/chi-uganda-theft-25-aug25,0,2076380.story?track=rss

    All the best,
    Lonnie

  2. Amanda Says:

    I don’t know, that one study sounds complicated enough for me!

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