Tuberculosis 90 (2010) 16

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Tuberculosis
j o u r n a l h o m e p a g e : h t t p : / / i n t l . e l se v i e r h e a l t h . c o m / j o u r n a l s / t u b e

GENERAL

Tuberculosis research in the European Union: Past achievements and

future challenges
*

Hannu Lng, GianLuca Quaglio , Ole F. Olesen

Unit of Infectious Diseases, Health Directorate, Directorate General for Research, European Commission, Rue du Champ de Mars 21, 1050 Brussels, Belgium

article info
Article history:
Received 24 June 2009 Received in revised form 28 September
2009 Accepted 6 October 2009
Keywords:
Tuberculosis
European Commission
Framework Programme
Research funding

c
o
m
b
1. Introduction
a
ti
Tuberculosis (TB) remains one ofn
the most devastating infec-tiousg
diseases with more than 9 million T
cases annually and with more than 1.7 B
1
million fatalities. During the last 10
years there has been a renewedw
global interest for research in TB, anda
this has resulted in the launch ofs
several new initiatives by national ande
international organisations, privatex
charities
and
pharmaceuticalp
companies. The new focus on TB hasr
partly been triggered by the persistent e
high number of TB cases in poor s
countries, and partly by the increaseds
occurrence
of
multidrug
ande
extensively drug-resistant TB (MDR-d
i
2
and XDR-TB).
In HIV-positiven
individuals,
XDR-TB
has
beent
3
associated with very high mortality. h
On the political level, global support toe

the EU Framework Programmes for Research

and Development (FP). By utilizing a variety of
funding instruments, the EC has established a
mixed portfolio of research projects, ranging
from small discovery projects to large
multidisciplinary consortia with sufficient critical
mass to undertake translational and clinical
research. The European investments in TB
research have generated promising results with
new vaccine candidates, drug leads, diagnostic
markers and basic research results starting to
emerge. In the light of a rapidly changing global
research environment it has therefore become
timely to review and update the priorities for TB
research. To facilitate this process, a high-level
conference on Challenges for the future:
research
on
HIV/AIDS,
Malaria
and
Tuberculosis was convened in Brussels on
November 2008. This review gives an overview
of the present portfolio of EC funded TB
research, and summarises the conclusions
from the conference on future perspectives for
TB research in Europe and beyond.
2009 Elsevier Ltd. All rights reserved.

sum
mar
y
The
Europe
an
Commis
sion
(EC)
support
s
a
large
number
of
researc
h
activitie
s
in
tubercul
osis
through

United
Nationsby 50% relative to
Millennium Declarationthe 1990 level; and
in 2000, and hasfor
2050,
to
subsequently
beeneliminate TB as a
confirmed on a numberpublic
health
of occasions at high-problem. 6
level summits such as
the
annual
G8
meetings
and
the
Berlin declaration on

1*

TB. The global plan Correspo

to stop TB: 2006 nding
2015 was endorsed in author.
2005 by the Stop TB Tel.:
5

Partnership.
It
launched a number of
specific targets: the
target for 2005 was to
detect 70% of new
sputum smear-positive
cases and cure at least
85% of these cases.
For 2015, it established
to sustain or exceed
those indicators and
reduce the prevalence
and death rates of TB

32 2
296
4779;
fax:
32 2
299
4561.
E-mail
addres
s:
gianluc
a.quagl
io@ec.
europa
.eu (G.

Quagli
o).
1472-9792/$
see front
matter 2009
Elsevier Ltd.
All rights
reserved.
doi:10.1016/j
.tube.2009.1
0.002

c
o
n
Since these goals will be difficult to
fi
reach,
political
leaders,
nonr
governmental
organisations
and
m
prominent personalities have followed
e
up by calling for more resources being
d
allocated to the fight against TB.
a
Responding to the political climate, the
n
European Commission (EC) launched
d
the Programme for action on
e
HIV/AIDS, Malaria and TB in the
x
context of poverty reduction (2001
t
7
2006).
It provides a broade
framework for trade, development andn
research policies in order to improved
the
access,
affordability
ande
availability of treatments for povertyd
related diseases (PRDs) in developingu
countries. The Programme for Action,n
which
has
subsequently
beend

er a new formula forimplemented

by
the period 2007 2011,the EC. The FPs
includes
a
firmare characterised
commitment
toby
a
strong
incentivise
theemphasis
on
development of newcollaborative
public goods for TBresearch between
through the Frameworkscientists
in
Programme (FP) fordifferent
nations
Research
and
and
different
8
Development.
sectors. Since the
The FPs are theintroduction of the
EUs mechanism tofirst FP in 1984,
support research with athey have become
major scientific andthe main tool to
cooperative
societal impact. Theyfund
are
multi-annualresearch in Europe
the
EU
programmes agreed byunder
the EU Member StatesTreaty with the goal
boosting
and
the
Europeanof
Parliament
andEuropean

competitiveness
and solving societal
problems.
In
order
to
provide feedback
on achievements
and setting future
priorities
for
research
in
HIV/AIDS, malaria
and TB, the EC
brought together a
large number of
stakeholders to an
international
conference
in
November
2008.
The
conference
comprised
more
than

H. Lng et al. / Tuberculosis 90 (2010) 16

funding to research in
350 leading scientists, research PRDs from V105 to 457
managers,
decision-makers, million. Out of this, more
funding agencies and relevant than V68 million was
international NGOs from 63 allocated to discovery
countries,
including and translational TB
representatives
from
many
research ( Table 1). FP6
9
resource poor countries.
introduced
a
new
The present article gives an
funding instrument, the
overview of the recent EC efforts
integrated projects (IP),
and
achievements
on
TB
which made it feasible
research and summarizes the
for the first time for the
results of the EC conference with
EC to support large
respect to
suggestions for
projects with a focus on
research priorities on TB.
translational
research.
This
became
an
important element of the
2. TB research funded by EC
dedicated strategy for
Research
activities
with European TB research.
research
relevance to TB have been Translational
supported throughout the FPs, was thus supported by a
albeit sporadic in the early FPs. total contribution of V43
Under FP5 (19982002), the EC million to three large IPs.
initiated
a more dedicated The three IPs are
approach to the area of TB addressing TB vaccine
research and provided financial development (TB-VAC),
support to 21 projects with a total TB drug development
(NM4TB) and mucosal
budget of V30 million. These
11
projects covered a wide range of vaccines (Muvapred).
activities, covering basic research Each
of
the
IPs
in, e.g. mucosal immu-nology, comprises a critical mass
structural
and
functional of
high-level
and
genomics, host-parasite rela- complementary research
tionship
and
Mycobacterium groups that can jointly
tuberculosis population studies, move promising drug
as well as applied research for and vaccine candidates
vaccine development, drugs and from discovery phase to
diagnos-tics. Many of these early human testing. The
projects generated important three consortia have
an
EC
scientific results, but lacked received
between
sufficient critical mass and contribution
financial strength to translate the V11 and 17 million to
findings into applicable health undertake translational
solutions. Another special feature research activities during
of FP5 was the division of TB a 5-year period and each
projects across two separate of them comprise more
20
different
programmes, the Quality of Life than
teams.
Programme and the International research
Cooperation Programme, which Furthermore, they all
also addressed issues related to comprise small- and
biotech
science policy and capacity medium-sized
companies,
large
building in developing countries.
pharmaceutical
10
enterprises as well as
With the introduction of FP6 research
(20022006), the TB activities
were merged and grouped with
Table 1
activities in HIV/AIDS and malaria The EC contribution to TB
into a single dedicated activity research in recent Framework
line under health research. This Programmes.
was done to highlight the
importance of the three major
poverty related diseases (PRDs) EC contribution to PRD*
(million V)
and to exploit possible synergies
between them. Importantly, the EC contribution to TB
(million V)
introduction
of
FP6
was
average for TB
accompanied by a quadrupling of Annual
(million V)

Poverty related diseases.

Including
an
EC
contribution of V200 million to
the European Developing
Countries
Clinical
Trials
1x
Partnership
(EDCTP).
Not including
EDCTP.

2*years ofOnly
FP7.

FP5
(19982002)
105
30
7.5

the first 3

groups

from

disease-endemicmost
successful
elements
of
the
previous
countries outside Europe.
FPs. In line with this, TB
12
Approximately V25 million was has been maintained as
channelled to early stage
one of the priority areas
research through Specific
of research. During the
Targeted Research Projects
first 3 years of FP7,
(STREP). These projects are
V48
mostly exploring new concepts for approximately
million
have
been
drug, vaccine or diagnostic
committed to support
development, or generating
information about basic biological collaborative
research
mechanisms. They are mostly
projects on TB ( Table 1).
small projects with a typical
Two
large-scale
duration of 3 years and an EC
collaborative
projects
contribution of V13 million.
Finally, a few well-defined
have been selected for
activities such as harmonization funding,
one
for
of research stan-dards,
establishing a European
conferences and training were
network
for
clinical
supported with the smallest
management
of
TB
drug
projects, namely the Strategic
resistance (TB PANSupport Actions (SSA).
In addition, the EC hasNET), and one for
supported the European anddevelopment of new
Developing Countries Clinicalvaccine candidates for
Trials Partnership (EDCTP) with aTB (NEWTBVAC), which
contribution of V200 million. Thewill continue and expand
EDCTP is an independent legalthe work initiated by the
entity with the objective to supportTB-VAC project during
late-stage clinical trials andFP6. In addition, several
capacity building in the area ofsmall scale projects on
PRD in sub-Saharan Africa. Thehost-pathogen
innovative
contribution to the EDCTP hasinteraction,
made it possible for the EC to drug development and
support
late-stage
clinicaldiagnosis of MDR-TB
activities for TB, and it ishave been funded.
anticipated that a significant
The portfolio of EC
proportion of the EDCTP grants
will be earmarked to support TBsupported TB projects
research activ-ities. So far, the from FP6 and the first 3
of
FP7
are
EDCTP has earmarked support to years
16 TB trials with a total budget of presented in Table 2.
V85 million. In addition, several
This reveals a fairly
non-disease-specific projects for
broad
portfolio
of
capacity building have been
research activities with
initiated, which will also contribute
the
largest
EC
13
to clinical TB research.
contribution
being
allocated
to
vaccine
3. The current portfolio of TB
research,
and
the
research
remaining
EC
contributions being fairly
Continuity and sustainabilityevenly
distributed
have been the guiding principlesbetween basic research,
for health research in the drug
discovery,
transition from FP6 to FP7 (2007 diagnostics and clinical
2013). The purpose has been that research
and
FP7 should retain and expand the
epidemiology ( Figure 1).

An analysis of the
projects reveals that the
globalisation of research
in recent years has been
embraced by FP6 and
FP7
through
an
increased openness and
eagerness to attract
research teams from all
over the world. In the
field of TB, it has been a
particular goal to include
research teams of high
quality from diseaseendemic countries in
resource poor regions of
the
world.
Although
European
research
teams
are
still
contributing with the
largest
number
of
participants, the number
of
non-European
participants in the TB
projects
has
been
steadily increasing and
constitutes about 15% of
all participants in the
currently active projects.
New
collaborations
between
multiple
stakeholders in different
sectors have been put
forward
by
many
analysts as essential for
developing new and
affordable
health
14

products.
The
pharma-ceutical
R&D
process is complex, risky
and
expensive,
and
devel-oping
a
new
medicine or vaccine for
low-income countries is
unlikely to occur without
significant support and
brokering from the public
sector. An additional
strategic goal for TB
research in the FPs has
therefore
been
to
establish links between
private
and
public
research institutions in
order to create synergy
between the two

H. Lng et al. / Tuberculosis 90 (2010) 16

Table 2
Overview of EC funded TB research projects in FP6 (20022006) and during the first 3 years of FP7 (20072013).
Acronym

Project title

EC contribution

Partners

FP

Instrument

Keywords

MUVAPRED
TB-VAC

Mucosal vaccines for poverty related diseases

An integrated project for new vaccines against
tuberculosis
Molecular markers of M.tb early interactions with
host phagocytes
Finding promising drug candidates against
tuberculosis with multidisciplinary protocol based
non-conventional search
Development of a molecular platform for the
simultaneous detection of Mycobacterium
tuberculosis resistance to rifampicin and
fluoroquinolones
Establishing a TB treatment efficacy marker
The diversity of Mycobacterium tuberculosis strains
in China: tracing the origins of the world-wide
dispersion of the multidrug-resistant Beijing
genotype
Genome- and HLA-wide scanning and validation of
cytotoxic CD8 T cell responses against
Mycobacterium tuberculosis
New medicines for tuberculosis
Innate and adaptive immunity in clinical and
experimental mycobacterial infection in neonates
and infants
New drugs for persistent tuberculosis: exploitation
of 3-D structure of novel targets, lead optimisation
and functional in-vivo evaluation
The role of chromosome stability in persistence,
latency and reactivation of Mycobacterium
tuberculosis
Development and clinical evaluation of fast tests for
tuberculosis diagnosis
A new approach for developing a less
immunosuppressive vaccine for tuberculosis
Immunogenicity of Mycobacterium tuberculosis
lipids in the non-replicating status of latency
Transcriptional regulation and cellular localisation
of Mycobacterial cell cycle proteins during
dormancy
Effect of genetic variation in Mycobacterium
tuberculosis on vaccine escape and the acquisition of
drug resistance
A SME-STREP for tuberculosis drug development
Identification and characterisation of
Mycobacterium tuberculosis virulence genes
involved in macrophage parasitism
Evaluation of transrenal-DNA detection to diagnose
tuberculosis
Development of a specific serological kit for the
diagnosis of TB
Pathogenesis and identification of predictive factors
of TB-IRIS in HIV patients under HAART
Highly innovative strategies for vaccination to PRDs
Host and Mycobacterial molecular dissection of
immunity and pathogenesis of tuberculosis
Genetic analysis of the host-pathogen interaction in
tuberculosis
Novel secretion systems of Mycobacterium
tuberculosis and their role in host-pathogen
interaction
Mycobacterium tuberculosis W-Beijing genetic
diversity and differential virulence and host
immune responses
LATENT TUBERCULOSIS: New tools for the detection
and clearance of dormant Mycobacterium
tuberculosis
A new platform for fast molecular detection of MDR
and XDR resistant strains of M. tuberculosis and of
drug-resistant malaria
Development of a two-approach plate system for
the fast and simultaneous detection of MDR and
XDR M. tuberculosis

15.250.000
17.000.000

29
33

FP6
FP6

IP
IP

Vaccine
Vaccine

976.000

FP6

STREP

Basic

1.000.000

FP6

STREP

Drug

770.856

FP6

STREP

Diagnostic

375.104
150.000

2
2

FP6
FP6

SSA
SSA

Diagnostic
Clinical and
epidemiology

1.053.445

FP6

STREP

Vaccine

11.070.000
2.000.000

21
8

FP6
FP6

IP
STREP

Drug
Basic

1.800.000

FP6

STREP

Drug

1.000.000

FP6

STREP

Basic

1.217.800

FP6

STREP

Diagnostic

857.298

FP6

STREP

Vaccine

1.099.794

FP6

STREP

Basic

835.875

FP6

STREP

Basic

1.794.956

11

FP6

STREP

Clinical and
epidemiology

1.945.000
734.713

5
3

FP6
FP6

STREP
STREP

Drug
Basic

2.000.000

FP6

STREP

Diagnostic

827.313

FP6

STREP

Diagnostic

2.475.482

FP6

STREP

2.000.000
2.998.251

7
9

FP6
FP7

STREP
FRP

Clinical and
epidemiology
Vaccine
Basic

2.838.624

FP7

FRP

Basic

2.821.726

FP7

FRP

Basic

2.967.000

12

FP7

FRP

Basic

2.716.003

FP7

FRP

Diagnostic

2.983.207

FP7

FRP

Diagnostic

2.695.565

FP7

FRP

Diagnostic

MM-TB
scrINSILICO

TB-DRUG OLIGOCOLOR

TB treatment marker
Tuberculosis China

VACCINES4TB

NM4TB
NEOTIM

New-TBDrugs

CSI-LTB

FASTEST-TB
Immuno VacTB
MILD-TB
MYCOMANCY

TBADAPT

TB-DRUG
TBMACS

TB-trDNA
SERO-TB
TBIRIS
INNOVAC
HOMITB
TB-EURO-GEN
NOVSEC-TB

TB-VIR

StopLATENT-TB

TM-REST

FAST-XDR-DETECT

4
Table 2 (continued).

(continued on next page)

H. Lng et al. / Tuberculosis 90 (2010) 16

Acronym
TB PAN-NET
Tbsusgent

ESI-TBVI

NATT
NEWTBVAC

Project title
Pan-European network for the study and clinical
management of drug-resistant tuberculosis
Sustaining research momentum over the coming
decades: mentoring the next generation of
researches for tuberculosis
Establishment, strategy and initial activities of the
tuberculosis vaccine initiative: coordination of
European efforts with global research initiatives
New approaches to target tuberculosis

EC contribution
10.998.270

Partners
27

FP
FP7

Instrument
IP

999.909

FP7

Coordination
actions

429.601

FP7

Support actions

Vaccine

2.994.478

FP7

Drug

Discovery and pre-clinical development of new

generation tuberculosis vaccines

11.996.730

35

FP7

SICA Collaborative
project
IP

115.673.000

331

TOTAL

diseases.
The
four key areas in
TB
research:
specific
sectors. A particular effort has been made torecommendations
diagnostics, drugs,
attract small- and medium-sized biotechfor TB research
vaccines and global
companies to the FP funded projects, andwere
coordination
of
formulated
currently more than 20 such enterprises areduring
research activities.
the
TB
participating in EC funded TB research. Thisbreakout session,
The deliberations
is complemented by the participation ofwhere
and
key
several larger pharmaceutical companies.approximately 100
recommendations
are
summarised
Taken together, a signifi-cant proportion of all scientific
experts
below, while the full
activities in the TB projects are now per-and
stakeholders
details are available
formed
by
industry
participants,gathered to ponder
demonstrating that the FPs have become aabout
on the EC website.
useful tool for bringing together research
15
Clinical and The results are
teams from different sectors as well as from
Epidemiology;
different nations.
listed on Table 3.
13%

4. Report on the EU conference

The increased global interest for research
in TB has resulted in a boost for the entire
field, which is now both expanding and
changing in the light of new scientific
discoveries. The European investments in
TB research in previous FPs are also
beginning to generate important results, with
new vaccine candidates, new drug leads and
new diagnostic markers starting to appear. It
has there-fore become timely to review and
update the European research priorities for
TB. To facilitate this process, the EC
convened a high-level conference in
Brussels in November 2008 on Challenges
for the future: research on HIV/AIDS, Malaria
9

and Tuberculosis.
The objective of the
conference was to establish an inventory of
recent research results and to set research
priorities on PRDs for the remainder of FP7.
More precisely, the conference goals were
to:
(i) regain political momentum for continuing
and intensifying research addressing the big
three global killer diseases; (ii) set the
scene by reporting on research efforts
supported by the EC since 2002, when
HIV/AIDS, malaria and TB first became a
separate research focus under FP6; and (iii)
gather input from relevant stakeholders in
order to set research priorities on PRDs for
the remainder of the FP7 and beyond. The
conference, that was lead by a series of
preparatory meeting, comprised a mix of
plenary sessions for all PRDs, and separate
breakout sessions for each of the three

Diagnostics;
12%

4.1. Diagnostics
and biomarkers
Improved
diagnostics
are
imperative to TB
16

Drugs;
16%

care and control.

Investments should
Vaccines; 42%
be
significantly
increased in TB
Figure 1.
Distribution of
diagnostics,
drug
EC funding in
susceptibility
FP6 and the first
testing
and
3 years of FP7.
biomarker
development
to
help to detect TB
disease
activity,
cure and relapse.
17

On the positive
side, several new
diagnostic tests are
under development
including
culturebased
tests
to
identify
M.
tuberculosis and to
determine
drug
resistance, as well
as
molecular
assays to detect
antigens or DNA
from
the
TB
pathogen
and
antibodies from the
patients
immune
response.
These
developments work
towards the high

Keywords
Clinical and
epidemiology
Basic

Vaccine

priority issue, which is to change the current

gold standard test, sputum microscopy with
more sensitive tests that can be applied at
point of care since sputum culture is
inadequate for extra pulmo-nary TB and for
TB in children who do not produce sputum.
Biomarkers can be used in a broad
context, e.g. for monitoring treatment, cure
and relapse. Particularly, identification of
suitable biomarkers can significantly facilitate
diagnostics. TB biomarkers should be used
for development of both diagnostic tests
which
differentiates
between
healthy
individuals with a latent infection from
patients with active TB and for development
of prognostic tests which allows prediction of
the risk of develop TB in latently infected
individuals. Diagnostic tests should also be
developed for serving as surrogate endpoint
of disease for monitoring drug and vaccine
trials in TB.
More resources than are available at the
moment are required to support diagnosticsoriented basic science in pathogen biology,
biomarker discovery, systems biology and
point of care test development. Many
diagnostic
companies
have
become
interested in working with academia and
established project-driven public private
partnerships (PPPs) to develop diagnostic
tests for devel-oping countries. Such new
concepts have led to the development of
several
technologies
with
interesting
potential and should be supported by the EC.
18

4.2. Vaccines
The classical BCG vaccine was
developed in the first decades of 1900s, but
it does not induce good protection in all
geographic areas, particularly against adult
pulmonary TB. After a long period of modest
interest in TB vaccine research, there is now
a rich pipeline of candidate vaccines, the
majority of which has been developed in
Europe. The most advanced vaccine
candidate is MVA-85A, currently in phase II
under a prime-boost strategy with

H. Lng et al. / Tuberculosis 90 (2010) 16

Table 3
Recommendations from the EC PRDs
conference.
VACCINES

1.

Invest in 2nd generation

pre-exposure TB vaccines able to
achieve sterile eradication

2.

Invest
in
2nd
generation
post-exposure
vaccines preventing disease in
latently infected individuals

5
biology,
biomarker
discovery,
systems
biology and point of care
test development
GLOBAL COORDINATION

1.

Strengthen
the
role of EC as a leader in
TB research

2.

Translate
highlevel political will into
clearly articulated and
timed pledges

3.

Integrate
and
coordinate
funding
between EU countries
and the EC

3.

Combined vaccine strategies

for 1st and 2nd generation vaccine
antigens

4.

Select vaccines that protect

against broad spectrum of strains

5.

Invest in centralised facilities

for animal models

6.

Invest in capacity for (late

phase) clinical trials

7.

Invest
in
advocacy
to
increase the global funding for TB
vaccine R&D

8.

Deliver affordable vaccines

DRUGS

1.

Invest in new drugs

and treatment regimens for
eradicating latent infections

2.

Prevent dormant
mycobacteria from reactivating in HIV-infected
individuals

3.

More
efforts
in
phenotypic screening, new
targets and ways of action,
models
of
different
physiological
stages
of
mycobacteria

4.

Artic

ulate bolder
vision
for
potential of
targeted and
integrated
programmes

5.

Develop a
coherent
and
comprehensive
research
agenda,
with
balance
between basic and
translational
research

BCG. Several products

are in phase I (e.g. 72f,
Hybrid 1, Aeras 402,
rBCG-UreC-Hly),
and
many
of
these
candidates are results
from the

EU FP6 projects TB-VAC

and
Muvapred,
where
valuable progress has been
13,19
achieved.
Several
other candidates are in the

pre-clinical phase; in
a M. tuberculosis strain,
mutation of virulence
genes produced a TB
strain
conferring
potentially
greater
4. Increase availability
protec-tion with fewer
of and access to compound
side effects than BCG,
libraries with wider diversity
and
an
improved,
recombi-nant
BCG
and
more
drug-like
vaccine with a higher
properties
efficacy and a better
safety profile has just
5. Increase
industrialmoved into phase I
commitment to drug developmentclinical trials.
in infectious diseases
Current
vaccine
candidates have been
6. Invest in infrastructure
developed for pre7. Invest in clinical trials, exposure
and fill the gap between preadministration. One of
clinical and clinical development
the
important
DIAGNOSTICS
properties for these
TB vaccine candidates
1. Development of new
is
the
ability
to
tools should be prioritized to
achieve
sterile
meet global needs, which are
eradication. However,
led by case detection and,
secondarily, by detection of
there is the need for a
drug resistance
post-exposure
vaccine for those who
2. Change the current
are already infected
gold standard test, sputum
(currently 2 billion
microscopy with more sensitive
people) in order to
tests that can be applied at
prevent reactivation.
point of care
a next stage of
3. Identify biomarkers toIn
research, combination
facilitate diagnostics
vaccines should be
4. Invest in diagnostics- considered in which
oriented basic science in pathogen the
current
first

generation
booster
vaccines
are
associated
with
a
second
generation
prime
vaccine
in
order to deal with
primary,
active
pulmonary TB and
prevention of TB in
latently
infected
individuals.
Vaccine
testing
should be conducted
mainly in a nave
stage
on
M.
tuberculosis uninfected
individuals,
and
strategies should be
developed
to
get
vaccines from the
research bench to the
bedside and into the
community.
Apart
from the protective
effect
of
novel
vaccine
candidates,
priority
should
be
given to their delivery
route,
formulation
(storage, shelf-life and
distribution)
and
utility for HIV-infected
20
individuals.
Another
focus
of
vaccine development
should be protection
against
the
broad
spectrum
of
M.
tuberculosis

strains,
ensuringadministration
with
effectiveness
in
differentanti-retrovirals;
(vi)
geographical regions. In theeasy use in the field;
evaluation of all these vaccine and
(vii)
action
strategies,
confoundingagainst latent as well
factors such as prior BCGas active forms.
vaccination or HIV status will
While there are still
be considerably complicatinggaps
at
different
the
clinical
andstages of TB drug
epidemiological picture. Fordevel-opment,
the
vacci-nation of HIV-infectednumber of candidates
individuals M. vaccae could bein the discovery and
considered
for
furtherpre-clinical pipeline is
development
or
post-increasing.
Many
exposure prophylaxis.
different mechanisms

Investment
in
globalof action and drug
partnerships
for
vaccinetargets have been
development would help toidentified, and the
sustain
structures
andmost common aim is
organisations
which
areat increasing efficacy
capable to strengthen theand/or
reducing
pipeline of next TB vaccines,treatment duration (to
including clinical trials in13
months).
different geographical areas.However, only a few
Further advances towards atarget
dormant
and
can
new
generation
of
TBbacteria
vaccines can only be made iftherefore not be used
policy-makers,
fundingfor eradicating latent
agencies and scientists act ininfections. The need
concert to remove barriers to for research into new
cooperative
research
anddrugs and treatment
development.
Cross-cuttingregimens which can
issues
need
also
beachieve
this
addressed,
includingtherapeutic objective
centralised
facilities
forremains
therefore
animal models, novel imaging urgent. 21
technologies
and
postAnother priority is
exposure models, and clinicaldrugs
that
can
trials
capacity
building,prevent
dormant
particularly phases IIb and III.mycobac-teria
from
Partnering current networksre-activating in HIVof trial sites and startinginfected
individuals.
developing GMP productionThey should avoid the
capacity for TB vaccines in therapeutic problems
developing countries shouldassociated with coinfections, such as the
also be on the agenda.
antagonistic effect of
Rifampicin on anti4.3. Drugs
retroviral
drugs.
Improvements
in
There is a wide agreement these areas would
allow
to
further
in the TB research community
enhance
patient
that the desired qualities ofacceptability,
new TB drugs contain thecompliance,
and
following: (i) rapidly actingadherence
and
to
and potent; (ii) allowingreduce
new
shorter treatment regimens;infections. 22 Despite
(iii) effective against MDR-TB;a 95% efficacious 6(iv)
safer
than
existingmonth treatment, the
treatments; (v) allowing co-

TB problem is still
expanding
worldwide, among others
due to emergence of
MDR-TB and XRT-TB.
In the field of TB
drug
discovery,
innovation may be
expected from more
efforts in phenotypic
screening,
seeking
new targets and ways
of
action
against
mycobacteria,
and
developing models of
different physiological
stages. A coordinated
effort should be made
to further increase
the availability of and
access to compound
libraries with a wide
diversity of molecules
and
with
optimal
pharmacological
documentation.
4.4. Global coordination
and sustainability
The fragmentation
of TB funding for
research
and
development is a true
problem, as well as
the varying degrees
of territoriality of the
research groups. The
time has come to play
the same tune and to
move
forward
together. The EC is in
a good position to
orches-trate
global
coordination in TB
research funding, and
has come at a critical
juncture on which
more
focus
and
investment is needed.
The
EC
should
translate
high-level
political
will
into
clearly
artic-ulated
and timed pledges;
integrate
and
coordinate
funding
between
EU
countries, the EC and
other funders. Europe
can play

H. Lng et al. / Tuberculosis 90 (2010) 16

and to facilitate the

a crucial role in innovation and translation of research
discovery in the field of TBinto new or improved
research. The EC, in particulardiagnostics, biomarkers,
through the EDCTP, shoulddrugs and vaccines.
Significant
and
continue and increase its efforts to
assist endemic countries inconcrete
outputs
of
strengthening and harmonisingresearch
and
the regulatory environment. Thedevelopment
on
TB
EDCTPs
clinical
researchrequire long-term efforts.
programme has now started off,Continued funding is
including
development
oftherefore a major issue,
regulatory
and
ethicaland the current project or
frameworks. It would be highlyprogramme funding from
desirable to extend the current3 to 5 years might not
emphasis of the EDCTP frommeet the expectations.
phases II to III drug trials toThe EU should join
9
include also phases I and IV.
forces with other funders
The EC should aim to enhanceto create new funding
which
and sustain TB research andmechanisms
sustainable,
development to accelerate aensure
coherent and comprehensivetransparent and pooled
agenda for research, developmentresources.
and capacity building. The right
balance
between
basic,5. Concluding remarks
translational
and
applied
The
European
research, including sustained and
for
TB
increased support to EDCTP isprogrammes
have
important; as well as taking on the research
responsibility to develop researchsignificantly contributed
and laboratory capacities for TBto advancing science
(including infrastructure, trainingand developing new
and
quality
assurance)
invaccines, drugs and
countries with lesser resources. diagnostics against TB.
Within the EU, nationalThe
emphasis
on
programmes, scientific institutionstransnational and transand funding bodies, transnationalsectorial
collaboration
and
non-governmentalhas been instrumental in
organisations
must
beachieving these results
encouraged
to
align
andas well as building solid
contribute to such a commoninternational
agenda. In order to refute unduepartnerships. Despite the
fragmentation and competition,economic recession, it is
the above agenda should beimportant
for
the
coordinated at the level of major European Commission
global institutions. Europe needsand its Member States to
to exploit its strengths in a global continue
funding
a
context together with the scientificmultitude of TB research
community. We must define clear basic, translational,
strategies for the control of TB in clinical, and clinical trials
all settings; help to develop and develop better
research
and
laboratory
processes to identify,
capacities
world-wide,
and
agree and coordinate
support capacity building in
research priorities. In the
clinical
and
public
health
international landscape
23
research.
of TB research, with
The EU is still lagging behind exciting
novel
the USA in TB research fundingtechnological
and this gap could be closed.developments in hand,
Despite the economic recession,investments
and
the EC and Member States mustpartnerships can pay off
sustain and increase funding formore than ever before.
TB research, while improving itsMaintaining
and
instruments to focus joint priorities

accelerating momentum
is therefore important.
Further coordina-tion and
alignment within Europe,
with global organisations
and most of all with the
endemic countries can
lead to great results
which will lighten the
heavy burden of TB
throughout the world.
Acknowledgments
The authors wish to
thank Anna Lonnroth
whose suggestions have
improved the quality of
the manuscript.

12537.htm.

Funding: None.

9. Gryseels

B, Zumla A,
Troye-Blomberg M, Kieny
MP, Quaglio GL, Holtel A,
et al. European Union
conference on povertyrelated diseases research.
Lancet
Infect
Dis
2009;9:3347.

Competing interests: None

declared.
Ethical approval: Not required.

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