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Appendix B
Summary of a Joint Meeting of the
National Institute of Allergy and
Infectious Diseases, National Institutes
of Health, and Indian Biomedical
Research Agencies,
Held April 20-21, 2011,
New Delhi, India
On the two days following the workshop summarized in this volume,
the National Institute of Allergy and Infectious Diseases (NIAID), National
Institutes of Health, held a forum in collaboration with the Indian Council
of Medical Research (ICMR) and India’s Departments of Health Research
(DHR) and Biotechnology (DBT) entitled “Indo-NIAID Tuberculosis Drug
Discovery Forum—Exploring Opportunities for Research Collaboration.”
The forum brought together scientists from the United States, Europe,
and India to explore collaborative opportunities in TB drug discovery and
development. Participants included researchers and administrators from
government and university laboratories, not-for-profit product develop-
ment organizations, and the pharmaceutical industry. The goals of the joint
workshop were to:
• share the latest state-of-the-art scientific information on drug dis-
covery research designed to help combat MDR and extensively
drug-resistant (XDR) TB;
• summarize TB drug development projects of the pharmaceutical
industry and the public sector currently under way;
• discuss TB drug development needs and ways in which biomedical
research can contribute;
• identify partnership opportunities to advance and accelerate new
drug discovery efforts so that therapeutic options for drug-resistant
TB can be advanced and accelerated;
141
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142 DRUG-RESISTANT TUBERCULOSIS IN INDIA
• explore potential connections for bioinformatics related to systems
biology and the genomics of Mycobacterium tuberculosis (M.tb.);
and
• discuss current gaps in translational research and how opportuni-
ties in the United States and India can be leveraged to help address
these gaps.
At the conference, during a session convened by the Institute of Medi-
cine (IOM), Barbara Laughon, NIAID; Gail Cassell, Harvard Medical
School and Infectious Disease Research Institute; and several participants
cited conclusions and recommendations emerging from the meeting that
were especially important in the context of the recently completed work-
shop summarized herein.
DRUG SUSCEPTIBILITY ANALYSIS
• All countries affected by TB should conduct surveys to determine
the strains of M.tb. prevalent in different regions and patterns of
drug susceptibility. In India in particular, coordinated and system-
atic analysis of genomic variations in M.tb. across the country and
across population groups should be performed.
• An important question is whether certain strains are more infec-
tious and virulent. Drug-resistant strains may be more likely to
spread rapidly and infect both children and adults.
• Genomic surveys should be accompanied by phenotypic screening
and cohort studies to identify effective treatments and investigate
how drug susceptibility patterns may change. This will be espe-
cially important to monitor as new classes of TB drugs are intro-
duced. Such studies could contribute valuable information to lay
the foundation for registration clinical trials of new anti-TB drugs.
THE RESEARCH INFRASTRUCTURE
• Important research ideas emerging from the conference could be
supported by investigator-initiated research grants. NIAID, the lead
agency supporting research on TB, has several program announce-
ments for competitive research projects and welcomes applications.
• Research involving TB within India and between India and interna-
tional partners is rich in opportunities and could draw on success-
ful models in other disease areas of concern and other countries.
• Academic researchers and industrial drug developers in India may
need to accelerate coordinated efforts to build on recent progress
in combating drug-resistant TB.
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143
APPENDIX B
• Meetings such as the workshop summarized in this volume and the
Indo-NIAID forum create opportunities for collaboration.
DRUG DEVELOPMENT
• Translational efforts are needed to advance drug discovery candi-
dates. These efforts should include examination of physiochemical
properties, pharmacokinetics, efficacy, and formulations. Research
resources for these activities are available within India. NIAID
offers product development assistance for high-priority research
areas such as TB.
• Evaluations of compounds against virulent M.tb. in animal models
and in vitro are particularly promising, and NIAID can provide
technical preclinical assistance in this area.
• Although it is a notable research challenge, new approaches to iden-
tifying and eliminating dormant mycobacteria are greatly needed
and should be given high priority by the research community.
• Future workshops and forums for the exchange of information,
along with collaborative efforts centered on anti-TB drug develop-
ment, would be welcomed by Indian investigators and are recog-
nized as critically important.
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