17-Dec-2021: Update on National Tuberculosis Elimination Programme

The Ministry of Health and Family Welfare is implementing a National Strategic Plan for Ending TB by 2025. As per the Global TB Report, 2021, the country has reduced the incidence of TB from 217/lakh population in 2015 to 188/lakh population in 2020 (a 13% decline). The death rate has declined from 36/lakh population in 2015 to 33/lakh population in 2019.

During the COVID pandemic, proactive initiatives were taken to provide uninterrupted diagnostic and treatment services. Special outreach activities were also undertaken to identify presumptive TB cases. 

During the year 2020 (Jan - Dec), a total of 18.12 lakh TB cases were notified under the programme which was 25% less than the total cases notified in 2019 (which was 24.00 lakhs). In 2021, in spite of a larger wave of COVID-19, the programme has been able to notify 17.6 lakh TB cases (till Oct,2021), which is 18% higher compared to 2020.

To mitigate the impact of COVID and to ensure that all TB patients including pregnant women have uninterrupted access to drugs and diagnostics, the Ministry has taken several steps including:

Active TB case finding campaign in key vulnerable and co-morbid population

1. Integration with Ayushman Bharat- Health & Wellness Centres to decentralize screening and treatment services closer to the community
2. Provision of free TB drugs of extended duration and door-step delivery during COVID times
3. Implementation of bi-directional TB-COVID screening and TB screening / testing for all presumptive cases with influenza like illness (ILI) and Severe Acute Respiratory Infections (SARI)
4. Scale up of molecular diagnostic laboratories to sub-district levels
5. Sample collection and transportation system from Sub Centre to PHC, PHC to CHC and from CHC to District / State level laboratories
6. Intensified IEC campaigns to raise community awareness

20-Aug-2020: First synthesis path for tuberculosis & chikungunya inhibiting flavonoid molecules deciphered

Flavonoid molecules, like rugosaflavonoids, podocarflavone, and isoflavone found to inhibit tuberculosis and chikungunya, have so far been isolated from plants. For the first time, scientists have unearthed the route to synthesize the molecules in the lab, paving the path for ensuring their availability at all seasons without overexploiting the medicinal plants that contain them.

Scientists from Agharkar Research Institute (ARI), Pune, an autonomous institute of the Department of Science and Technology (DST), Govt. of India, have come up with the first synthetic route for producing flavonoids molecules related to the treatment of tuberculosis and chikungunya. Preliminary indications have been witnessed regarding probable treatment response to COVID 19.

According to the recent work published in the peer-reviewed scientific journal, ‘ACS Omega’ by Dr. Pratibha Srivastava and her team from ARI have developed the first total synthesis of flavonoids such as rugosaflavonoids, podocarflavone, and isoflavone. 'Rugosaflavonoid A' is reported from a Chinese medicinal plant Rosa rugosa. 'Podocarflavone A' is isolated from the plant Podocarpus macrophyllus.

“Most ayurvedic products are rich in flavonoids. Flavonoids are mostly present in tomato, onion, lettuce, grape, apple, strawberry, peach, and other vegetables. A diet rich in flavonoids protects us from diseases related to heart, liver, kidney, brain, and other infectious diseases. Right now, the world is facing a traumatic situation due to COVID-19. Since flavonoids boost-up immunity, a flavonoid-rich diet is recommended,” explains Dr. Srivastava.

Flavonoids are normally isolated from plants. However, inconsistency in natural products can occur in different seasons, places, and species. Along with these hurdles, over-exploitation of medicinal plants puts an extra burden on the environment.

To overcome these problems, such products can be developed by synthetic protocols in the laboratory by simple and cost-effective methods. The synthetic natural products possess a structure and medicinal properties similar to the natural product.

The chemical structure of flavonoids is similar to the female hormone 17-beta-estradiol (estrogen). Therefore, flavonoids can ease the life of women who face problems in the premenopausal stage.

“While synthesizing rugosaflavonoids, my team has obtained dihydro rugosa flavonoids, which are found to be more potent in inhibiting highly infectious diseases like chikungunya and tuberculosis. Computational analysis of these molecules to inhibit COVID-19 by targeting spike protein, proteases and RdRp is also obtained, and the results are exciting,” says an exuberant Dr. Srivastava.

Dr. Srivastava also expressed confidence in the compounds synthesized by her Ph.D. student Ninad Puranik, for problems associated with women during the perimenopausal phase.

“In synthetic chemistry, the analogs of natural products can be prepared by the same route. At times the analogs show better medicinal properties than the natural products,” said Dr. Srivastava.

15-Jul-2019: Molecular mechanism behind latent TB.

Tuberculosis infection results in approximately nine million new cases worldwide every year. TB-causing bacterium can remain dormant in human body for a long time, even for several decades before it becomes infectious. The bacterium remains ensconced within a type of white blood cells called macrophages, when it is in its latent form. 

A team of researchers from Kolkata-based CSIR-Indian Institute of Chemical Biology, Bose Institute and Jadavpur University have figured out how tuberculosis bacterium is released from its reservoir inside the human body.

A macrophage is an important part of the immune system. The word 'macrophage' literally means a 'big eater’. It is an amoeba-like organism and its job is to clean the body of microscopic debris and invaders. It has an innate ability to locate and consume invaders such as bacteria, viruses, fungi, and parasites.

However, the story is different with TB bacterium. Instead of killing it, the macrophage creates a sac-like formation called granuloma around it. Granuloma keeps the bacillus contained and under control. The equilibrium can last for even several decades until it gets broken leading to release of infectious bacteria into the human body. This can happen due to several reasons such as lowered immunity because of physical weakness or infections such as HIV.

Scientists globally have been trying to figure out the molecular mechanism of the release of infectious TB bacteria from the granuloma. The new study by Kolkata researchers could fill this knowledge gap.

The team has discovered that a protein molecule called MPT63 secreted by the bacteria may be playing a role in the release process. Synthetically produced MPT63 protein molecule was subjected to different levels of acidity and it was found that when the acidity value is high its structure changed dramatically. It started as what is called a beta sheet and it turned into a helical form in the acidic condition, which prevails in matured granuloma.

The protein, which was found to have no apparent function in the folded beta sheet, suddenly became toxic on assuming the helical form, and got into the cell membrane, leading to formation of pores and consequently death of the host cells and release of the bacteria.