Science Friday - Developing Faster, Simpler Tools To Treat Tuberculosis

Episode Date: March 26, 2025

TB kills more than a million people each year. Dr. Mireille Kamariza has spent her career developing better detection and treatment tools.As the United States retreats from global health leadership—withdrawing from the World Health Organization, dismantling USAID—public health experts warn that there will be implications for the spread of certain diseases around the globe. One such disease is tuberculosis (TB), which is the deadliest infectious disease in the world.If you live in the United States, it’s likely that TB is not on your radar: It’s rare, and if someone is infected, there are effective treatments. But elsewhere in the world, more than a million people die of the bacterium each year, mostly in low-resource, high population regions.Tuberculosis isn’t a straightforward bug to treat. It has a unique armor, which helps it evade treatment like antibiotics. The current treatment regimen involves taking 16 pills a day for six months, which for people in regions with limited access to medicine, can be a massive barrier.Joining Host Flora Lichtman to discuss the science behind this deadly bacterium, and new tools to test for and treat it, is Dr. Mireille Kamariza, a chemical biologist at the University of California, Los Angeles.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Flor Lichten. Today in the podcast, how growing up in Burundi in East Africa, led a scientist to her life's work. During the time I was born, it was plagued by Civil War at a time. And in the midst of it, I would notice people getting sick and not getting better. We're continuing our conversation from yesterday about tuberculosis, the deadliest infectious disease in the world. This bacterium kills more than a million. people every year. But scientifically, it's also just a fascinating bug. It can hide in the body and evade antibiotics. So here to nerd out on the science of TB is Dr. Moray Cameriza, who's dedicated her career to getting to know this deadly bacterium and figuring out new tools to suss it out. Maray is a chemical biologist at the University of California, Los Angeles, and a co-founder of

Ali Luxe biosciences, a company that makes tools for rations. rapid TB detection and treatment for low resource areas. Marais, welcome to Science Friday. Thank you for having me. Let's start with a little bit about you. How did you find your way to TB research? Oh, God, how many hours do we have? I'm here for all of it.

Yes. Well, the very beginning, I was born in this tiny little country in eastern central Africa called Burundi. It's a landlocked small country that has roughly 10 million people. And during the time I was born, it was plagued by civil war at a time. And in the midst of it, I would notice people getting sick and not getting better. And this particular disease tuberculosis, the name we have for it in Burundi is almost synonymous. with a taboo event. You don't want to say that somebody has TB.

You want to say they have the flu, they have a cold under the weather, not diagnosed with tuberculosis. And that has always pricked my curiosity as to why that could be the case. Will you just tell me a little bit more about that? You know, John Green talked a lot about the meaning that we make around illness. In Burundi, what's that narrative around TB? As sad as this is going to sound, TB has this connotation that it's a disease of the dirty and the poor, which couldn't be further from the truth, right? You could be walking into a high-end grocery store and catch tuberculosis.

If someone sneezes in the bus, everybody would say, oh, my God, TB! Really? Yes, because it's transmissible, right? TB is just like COVID-19. If you were speaking in a room and there are people who are in the vicinity, they could inhale those aerosol droplets and they could get tuberculosis. And in some places in the world, like Burundi, being diagnosed with tuberculosis could be a life sentence, if not a lifelong sentence.

People, first, they don't want to be diagnosed with it, so they won't even get the test. But also, they don't want to talk about it. They don't want to tell people. They don't want to get quarantined. So that's sort of where my motivation came in. And, you know, fast forward a lot of years, I moved to the U.S. Wait, before you fast forward, before you fast forward, how did you end up in the U.S.? You know, you're now at UCLA.

What was that journey like? It was a journey of up and downs and almost uncharted road, so to speak. For those people who don't know in the early 90s, Rundi was going through upheaval. So people have heard of the genocide in Rwanda. That's our neighboring countries. So essentially it was happening in Rwanda was also happening in Rundi. So there was chaos, instability.

And along the way, when I was a young teenager, my family and I, we moved to the U.S. as refugees. So that's how I ended up arriving. on the shores of sunny San Diego when I was 17, speaking not a word of English, and absolutely clueless of what this new land had to offer to me. How did you get to science? Very good question. I think fundamentally the reason why I got into science was because I had a language problem, funny enough.

I arrived here. I didn't speak a word of. English. I couldn't communicate properly. But when I took that first chemistry class, I really didn't need to know English to do well in that class. I understood the language of molecules. I understood a hydrogen. I understood how a hydrogen bonds with an oxygen. You know, you don't need to speak French, Arabic, or curundi to be able to do aeropushing. And I think that gave me a sense of comfort and security during the time of transition. And I wanted to do more in that area, but I just simply didn't know what else I could do.

I just wanted to have a skill set and then find a job that pays me well enough to pay the rent. Until I met mentors and instructors along the way that opened my mind to the possibility that you could be a sense. scientist. I didn't know anyone who comes from Burundi and becomes a scientist. How did you find your way back to TB? Or when did you find your way back to it? By luck, almost. So I, you know, I started at community college. I took all these science courses, did really well in them. And I transferred to UC San Diego where I was major in chemistry. And, you know, long story short, I settled with pursuing a PhD. at Berkeley. I learned about this soon-to-be-famous scientist who was a chemist. Her name is

Carolyn Bertosi. And now she was the 2022 Chemistry Nobel laureate. But back then, this is 2012. She was well known in the world of chemistry, but not much more beyond that. So during my research, I learned that she had done a lot of work in fundamental chemistry, but there was a footnote that also highlighted that she had an interest in tuberculosis. And I was like, huh, how does a chemist, fundamental organic chemist connect the dots to an infectious disease that matters to me and the people in Burundi and sub-Saharan Africa in general? So that pricked my interest. And so that's how I ended up joining the Berkeley molecular science and biology department, hoping to work with her.

When we come back, we're going to nerd out on some of the weirdness of this bacterium, like it's special armor. And so that's became my obsession, honestly, when I learned about this, I was like, okay, how can we break this down? How can we find it? How can we see it? Don't go away. What is it about this pathogen that interests you? You know, of course it's connected to people's health and like the lives of people you knew. But are there things about this bug that sort of interests you from a nerdy, sciencey perspective?

Absolutely. Just bringing it out from a big picture perspective. You know, when I landed into the end of the U.S. in San Diego, I realize tuberculosis is not a huge problem here. It's not similar to how it is in Burundi. You don't walk around the streets and hear about, you know, people who are sick. You know, hospitals are not filled with people with tuberculosis. So this is a curable disease. This is a disease that we can eradicate or at least significantly reduce. And my first question was, why is it, you know, controlled here, but not there?

I wanted to learn as much as I could about this bug to understand how that could feed into the state of global health. And it turns out that this bug has a really special armor, I would call. And unlike other bacteria, you know, your equalized amonella that everybody hears about, this mycobacterium tuberculosis, is the pathogen that causes TB, has this ability to quickly adapt to treatment. You can recognize, can see the drug, it has a special armor. So I noticed that these cells, what's really interesting about them is that they have this really thick armor that can block out treatment. That's why a lot of people don't respond.

So for instance, just to give you a context here, someone who has diagnosed tuberculosis has to take roughly 16 pills a day for six months to get better. 16 pills a day for six months. Wow. For six months. And that is if they have what we call a drug-s susceptible. tuberculosis. So that means we think that this pathogen will respond to drug. So if it's a drug-resistant version, you take these pills and plus additional pills

for two years to try to clear these cells. And that's because they have this special armor that's around the cell that protects it against attack from drugs. And so that's became my obsession Honestly, when I learned about this, I was like, okay, how can we break this down? How can we find it? How can we see it? And that's sort of the... How can we use chemistry to fight it?

Exactly. Exactly. Yeah. So along the way, along the journey of trying to find ways to break down this armor, we first needed to see it. We needed to understand its superpower. How does it work? Is it made of iron? How does it function? I leverage the chemistry like Carolyn and her team have developed over the years to be able to add little colors, little lights on top of the armor so that we can have a visual of the whole shape and how it's made and composed and how it changes over time, particularly in the context of drugs or not drugs.

You're tagging it with fluorescence? That's correct. we made fluorescent dye that can only turn on so you can only glow green in the presence of this armor so if TB has this armor

you will see it and what was really useful and attractive for clinicians in the field was how easy it was to use this probe to find the armor so if you can find the armor if you know the composition of the armor, say, from a patient sample,

then you know how to properly destroy it to get through the cell. You can use this to figure out which antibiotics to use? That's correct. So you're not taking four drugs. You're just taking the one you need. Is that what that means? That's correct. So we can use this probe to identify what therapy works best for this.

pathogen. Is it expensive the probe? It's not. It's so simple to make and it's super stable at you know ambient temperature which is important at the point of care right so we're thinking you know how could this be used for surveillance purposes in a place like India is incredibly crowded and not everybody can go to the hospital to get detected to get diagnosed but maybe you can have community health workers going out in the villages going out in the schools and swabbing places and seeing what kind of tuberculosis is spreading around. It's getting transmitted in the environment. And what problem is this solving? Because, you know, of course, in the U.S. and in other Western countries, we have diagnostics that work really great.

Why did you need to make this? Or why is this helpful to have this tool? That's a fantastic question. In places where there's high prevalence or tuberculosis, there tends to be limited resources, so there's no electricity, not a lot of trained personnel or high-end tech equipment to do sort of the standard diagnostics we can do here in the U.S. So having a cheaply manufactured, easily available, highly stable reagent that can tell you not just that you have tuberculosis and the pathogen in your sample, but also whether the kind of the kind of tuberculosis has responds or not to the treatment is completely priceless. There is nothing like that right now on the market that can do that. I've dedicated my career to try to bring this tool and many

others like it to put off care settings properly to save some lives. This is Science Friday from WNYC Studios. If you're just joining us, I'm speaking with Dr. Moray Cameriza about the current state of testing and treating tuberculosis. Because your diagnostic can tell you which antibiotics to use, does it help with this problem of drug-resistant TB? It helps identify the drug resistance early, and hopefully it helps doctors administer the correct drug early enough to tackle drug resistance. I want to be careful here. This is just a diagnostic technology. They're also a public health infrastructure problem in the world of TB. And it's not sufficient to have a good test. Yeah. You also need to have good infrastructure so that that information is passed down

quickly enough to get to the patient. I mean, on that note, we've been covering how the U.S. has been withdrawing from global health efforts under the Trump administration, the dismantling of USAID, leaving the World Health Organization. From your point of view, what does that mean for TB? It's devastating. The consequences and ramification of this could be felt for years from now, right? I have colleagues, international colleagues, who we have collaborations and collaborative projects that we don't know what's happening next. They're funded by the agency. And there are salaries, they're ongoing patients. recruitment to do diagnostic tests and we are just in limbo. What's next? The question is the future.

I'm particularly affected by what happens with the NIH. And so there, everybody's paying attention to what could affect our work if you're federally funded. And so there's just a lot of uncertainty and fear around the actual clinical ramification of the political landscape we find ourselves in. Yeah, what it means for people's health. That's correct. And the spread of this disease. Yes. Yeah.

You know, one thing I really appreciate about your work, Marais, is that it feels, of course, so connected to people and to your own life story. That isn't always the case in science. I don't know that it always has to be the case in science, but I wanted your thoughts on that. That's an interesting question. You know, when I was at Berkeley, when I was in graduate school, I was surprised by how little or how few opportunities scientists had to be in the field and connect with the people that were working towards helping. And I like to believe that it is my connection and my background in Burundi that sort of drove me to making the connection between tagging this armor and its potential clinical impact. And I think more of that would help scientists.

I also think not improving science communication, explaining what we do to regular folks and showcasing what we do. would help us in the long run and even give us more ideas and better ideas on how to help people. Thank you, Marais. Thank you. Dr. Moray Camariza, assistant professor in the Department of Bioengineering at the University of California, Los Angeles. And that is about all we have time for. Lots of folks helped to make the show happen, including Emma Gomez, Annie Niro, George Harper, Felissa Mayers.

I'm Flora Lickman. Thanks for listening.