Specific PET scans for more effective TB treatment

Researchers in the UK and US have developed a more accurate way to screen for tuberculosis using positron emission tomography (PET).

The team has developed a new radiotracer, which is taken up by live TB bacteria in the body. Radiotracers are radioactive compounds that release radiation that can be detected by a scanner and converted into a 3D image. The new radiotracer, called FDT, enables PET scans to be used for the first time to pinpoint exactly when and where the disease is active in a patient's lungs.

The researchers have put the new radiotracer through extensive pre-clinical testing with no adverse effects and it is now ready for Phase I trials in humans. The study has been published in the journal Nature Communications,

Currently, two methods exist for diagnosing TB: checking for TB bacteria in a patient's sputum using smear microscopy or molecular testing. The other method is to use a PET scan to look for signs of inflammation in the lungs, using the common radiotracer FDG.

While sputum testing may show negative results long before the disease in the lungs has been fully treated, which may result in patients ending treatment too early, scanning for inflammation can be helpful in seeing the extent of the disease, but is not specific to TB, as inflammation can be caused by other conditions. Inflammation in the lungs may persist even after the TB bacteria have been eradicated, which may cause treatment to continue longer than necessary.

The new approach developed by the researchers is more specific because it uses a carbohydrate that is only processed by TB bacteria. A major advantage of the new approach is that it only requires standard radiation controls in a hospital and PET scanners, which are becoming more widely available around the world. The new molecule is made from FDG using a relatively simple process involving enzymes developed by the research team. This means it can be produced without specialist expertise or laboratories and would therefore be a viable option in low- and middle-income countries with less developed healthcare systems. These countries currently see more than 80% of global TB cases and deaths from the disease.

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