Developing Faster, Simpler Tools To Treat Tuberculosis

TB kills more than a million people each year. Dr. Mireille Kamariza has spent her career developing better detection and treatment tools.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Flora Lichtman?

  This is Science Friday. I'm Flora Lichtman. Today in the podcast, how growing up in Burundi, in East Africa, led a scientist to her life's work.

• 0:12Speaker 01

  During the time I was born, it was plagued by civil war at the time. And in the midst of it, I would notice people getting sick and not getting better.

• 0:26Flora Lichtman?

  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. Maurey Camariza, who's dedicated her career to getting to know this deadly bacterium and figuring out new tools to suss it out. Maurey is a chemical biologist at the University of California, Los Angeles, and a co-founder of Ali Lux Biosciences, a company that makes tools for rapid TB detection and treatment for low-resource areas. Maurey, welcome to Science Friday.

• 1:11Speaker 01

  Thank you for having me.

• 1:13Flora Lichtman?

  Let's start with a little bit about you. How did you find your way to TB research?

• 1:19Speaker 01

  Oh, God, how many hours do we have?

• 1:23Flora Lichtman?

  I'm here for all of it.

• 1:24Speaker 01

  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 the 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 synonym with a taboo event. You don't want to say that somebody has TB.

• 2:09Speaker 01

  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.

• 2:22Flora Lichtman?

  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?

• 2:32Speaker 01

  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.

• 2:51Speaker 01

  If someone sneezes in the bus, everybody would say, oh, my God, TB.

• 2:57Flora Lichtman?

  Really?

• 2:58Speaker 01

  Yes, because it's transmissible, right? So TB is just like COVID-19. If you were speaking in a room and there were 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 US.

• 3:41Flora Lichtman?

  Wait, before you fast forward, before you fast forward, how did you end up in the US? You know, you're now at UCLA. What was that journey like?

• 3:50Speaker 01

  It was a journey of up and downs and almost uncharted roads, so to speak. For those people who don't know, in the early 90s, Burundi was going through upheaval. So people have heard of the genocide in Rwanda. That's our neighboring country. So essentially, what was happening in Rwanda was also happening in Burundi. So there was, there was chaos, instability. And along the way, when I was a young teenager, my family and I, we moved to the US as refugees. So that's how I ended up arriving, you know, on the shores of sunny San Diego.

• 4:30Speaker 01

  When I was seventeen, speaking not a word of English and absolutely clueless of what this new land had to offer to me.

• 4:41Flora Lichtman?

  How did you get to science?

• 4:43Speaker 01

  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 hydrogen, I understood how hydrogen bonds with an oxygen. You know, you don't need to speak French, Arabic, or Hurundi to be able to do air pushing.

• 5:26Speaker 01

  And, and I think that gave me a sense of comfort and security during the time of transition. And I, 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, you know, mentors and instructors along the way that opened my mind to the possibility that you could be a scientist. I didn't know anyone who comes from Burundi and becomes a scientist.

• 6:04Flora Lichtman?

  How did you find your way back to TB? Or when did you find your way back to it?

• 6:08Speaker 01

  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 majoring 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's a chemist. Her name is Carolyn Bertozzi. And now she's, 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.

• 6:52Speaker 01

  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 piqued my interest. And so that's how I ended up joining the Berkeley Molecular Science and Biology Department, hoping to work with her.

• 7:35Flora Lichtman?

  When we come back, we're going to nerd out on some of the weirdness of this bacterium, like it's special armor.

• 7:41Speaker 01

  And so that's, that's became my obsession, honestly. When I learned about this, I was like, OK, how can we break this down? How can we find it? How can we see it?

• 7:49Flora Lichtman?

  Don't go away.

• 7:56Speaker 02

  Science Friday is supported by PBS, presenting Going Wild. If you love learning about the natural world and meeting the scientists who help us understand it, be sure to check out the new season of Going Wild with Dr. Rae Wynn Grant. It's the chart-topping and Webby Award-winning podcast from the folks at Nature on PBS. Now with a video companion series. In this season of Going Wild, host acclaimed wildlife ecologist Dr. Ray Wynn Grant heads out into the field to explore the animals, people, and stories that make nature worth saving. Stops include a hibernating black bear den in Arkansas and an underwater shipwreck site off the Florida coast. If you're looking for a place to start, check out the season's debut episode where Ray joins beloved biologist and influencer Jordan King in the Florida Everglades to learn

• 8:40Speaker 02

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• 9:21Speaker 02

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• 9:29Speaker 03

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• 9:42Flora Lichtman?

  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 interest you from a nerdy, science-y perspective?

• 9:56Speaker 01

  Absolutely. Just bringing it out from a big picture perspective. You know, when I landed in the US in San Diego, I realized 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.

• 10:28Speaker 01

  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 to understand how that could feed into this 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 E. coli, salmonella, that everybody hears about this, Mycobacterium tuberculosis, is the pathogen that causes TB, has this ability to quickly adapt to treatment. Can recognize, can see the drug, it has a special armor.

• 11:13Speaker 01

  So I felt, you know, 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 that's why a lot of people don't respond. So for instance, just to give you a context here, someone who who is diagnosed tuberculosis has to take roughly sixteen pills a day for six months to get better.

• 11:34Flora Lichtman?

  Sixteen pills a day for six months.

• 11:36Speaker 01

  For six months. And that is if they have what we call a drug susceptible tuberculosis. So that means we we think that this pathogen will respond to drug. So if it's a drug resistant version, you take these pills or 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 that's became my my obsession, honestly. When I learned about this, I was like, OK, how can we? How can we break this down? How can we find it? How can we see it? And and the sort of the

• 12:21Flora Lichtman?

  How can we use chemistry to to fight it?

• 12:23Speaker 01

  Exactly, exactly.

• 12:25Flora Lichtman?

  Yeah.

• 12:26Speaker 01

  So along the way, along the journey of trying to find ways to break down this armor.

• 12:34Speaker 01

  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 leveraged the chemistry that 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.

• 13:08Flora Lichtman?

  You're tagging it with fluorescents?

• 13:09Speaker 01

  That's correct. We made fluorescent dye that can only turn on, so it can only glow green in the presence of this armor.

• 13:22Speaker 01

  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.

• 13:52Flora Lichtman?

  You can use this to figure out which antibiotics to use?

• 13:55Speaker 01

  That's correct.

• 13:56Flora Lichtman?

  So you're not taking four drugs? You're just taking the one you need? Is that what that means?

• 14:01Speaker 01

  That's correct. So we can use this probe to identify what therapy works best for this pathogen.

• 14:10Flora Lichtman?

  Is it expensive, the probe?

• 14:13Speaker 01

  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? It's 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, is getting transmitted in the environment.

• 14:48Flora Lichtman?

  And what problem is this solving? Because, you know, of course, in the US 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?

• 15:01Speaker 01

  This is a fantastic question. In places where there is high prevalence or tuberculosis, there tends to be limited resources. So there is no electricity, um, not a lot of trained personnel or high-end tech, uh, 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 tuberculosis has response or not to the treatment

• 15:44Speaker 01

  is completely, uh, 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 point of care settings, um, probably to save some lives.

• 16:00Flora Lichtman?

  This is Science Friday from WNYC Studios. If you're just joining us, I'm speaking with Dr. Mairead Camariza 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?

• 16:18Speaker 01

  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. There also a public health infrastructure problem in, in the world of TB. And it's not sufficient to have a good test.

• 16:47Flora Lichtman?

  Yeah.

• 16:47Speaker 01

  You also need to have good infrastructure so that that information is passed on quickly enough to get to the patient.

• 16:55Flora Lichtman?

  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?

• 17:11Speaker 01

  It's devastating. The consequences and ramifications 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, there are ongoing patient 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.

• 17:54Speaker 01

  And so there, everybody is paying attention to what could affect our work if you're federally funded. And so there's, there's just a lot of uncertainty and, and fear around the actual clinical ramification of the political landscape we find ourselves in.

• 18:18Flora Lichtman?

  Yeah, what it means for people's health.

• 18:20Speaker 01

  That's correct.

• 18:20Flora Lichtman?

  And the spread of this disease.

• 18:22Speaker 01

  Yes.

• 18:22Flora Lichtman?

  Yeah. You know, one thing I really appreciate about your work, Mairey, is that it feels, of course, so connected to people and to your own life story. That, that isn't always the case in science. I don't know that it always has to be the case in science. But what are your thoughts on that?

• 18:39Speaker 01

  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, 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,

• 19:24Speaker 01

  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.

• 19:35Flora Lichtman?

  Thank you, Mairey.

• 19:36Speaker 01

  Thank you.

• 19:38Flora Lichtman?

  Dr. Mairey Camariza, Assistant Professor in the Department of Bioengineering at the University of California, Los Angeles.

• 19:48Flora Lichtman?

  And that is about all we have time for. Lots of folks helped to make the show happen, including Emma Gomez.

• 19:54Speaker 04

  Annie Nero. George Harper.

• 19:57Speaker 05

  Melissa Mares.

• 19:58Flora Lichtman?

  I'm Flora Lichtman. Thanks for listening.