Tuberculosis (TB) is a major public health threat in Georgia. The recent escalation of the occurrence of the disease has been complicated due to the appearance and development of multi-resistant tuberculosis (MDR TB) or extensively drug-resistant tuberculosis (XDR TB), as well as HIV/TB co-infection, which requires long-term treatment. The ability for the Georgian and worldwide community of TB researchers to understand the nature of the TB disease will be greatly improved by using a common database containing patients’ medical images, treatment information, lab work, and clinical data. This common database can facilitate adherence to the treatment protocol as well as serve as a consistent repository of records of the treatment regime for particular histories of disease.
The goal of the project is to develop the Georgia TB Portal to facilitate research aimed at diagnosis and treatment of drug-resistant tuberculosis. The clinical images of lungs (CT and X-ray) will be used for development of computational methods of TB diagnosis. Clinical data will be collected and stored in Portal’s database for computer-aided analysis of factors contributing to the development of the disease. Connection of Portal’s metadata with the original clinical samples collection (clinical lab samples taken from TB patients) would allow researchers to establish various cohorts for subsequent partial or full-genome sequencing of Georgian TB strains. Analysis of genomes of Georgian TB strains would allow for improved analysis of epidemiological situation in Georgia, and forming informed opinion about required drug regiments and efficiency of diagnosis with common microbiological tools.
To leverage the design and deployment of Georgia TB Portal, we plan on using the common core developed for the Belarus TB Portal. The Georgia TB Portal will store anonymized medical images, lab work, treatment information and clinical data from the Georgian TB patients and use user interface developed for Georgia Portal. The Georgia TB Portal will utilize the software and populate it with the anonymized data from the participating Georgian TB patients including medical images, lab work, treatment information and clinical data. About 100 patient records are anticipated overall, about 10% with sensitive TB, the rest with MDR/XDR TB. Information submitted into the Portal will be appropriately de-identified and authorized for upload by the Georgian researchers ensuring compliance with the appropriate Georgian laws and regulations. Overall, data from about 100 TB patients will be included in the Portal – 10 with sensitive TB and ~90 with MDR/XDR TB.
The National Center for Tuberculosis and Lung Diseases (NCTLD) has unique field of expertise to contribute to the project: the NCTLD research team has extensive experience in bacteriology, genotyping, and DNA sequence analysis of various infectious agents, which will be leveraged for this project.
One of the projects emphases is on the comparative analysis of sputum vs. surgical samples for interesting clinical cases. The purpose of surgery is to remove a large, focal burden of bacilli present in necrotic and non-viable lung tissue. By removing the main focus of infection, it may be possible to prevent further disease spread and allow medical therapy to work better. Two potential mechanisms by which the tuberculous cavity hinders effective medical therapy include reducing drug penetration and providing an environment conducive to drug resistance amplification. While no clinical data exists for second-line drugs, older studies found reduced cavitary penetration of isoniazid and rifampicin. The objective of the project is to create a new open access public health resource for the tuberculsosis (TB) research and education.
Criteria for inclusion clinical cases in the database of the portal
Patients admitted to the National Center for Tuberculosis and Lung Diseases (NCTLD) with diagnosed or suspected of MDR/XDR-TB.
Title: “Expanding global knowledge of tuberculosis by establishing the Georgia Tuberculosis Portal”
ISTC Project No.: G-2143
Starting Date: January 1, 2015
The goal of the project is to establish the new public heath resource for TB in Georgia and to create open access information resources on tuberculosis (TB) in Georgia.
- Establish a sustainable ongoing clinical database for the Georgia TB public health program based on both new data acquired from incoming patients (medical images and other clinical data) as well as extracting data from existing medical records and histories of interest.
- Establish a comprehensive large scale clinical portal for TB researchers worldwide by making the de-identified data available via Internet.
- Extract the initial set of M. tb strains isolated from TB patients residing in various regions of Georgia. The strain selection strategies shall be determined after full review of optimal methods. Selected strains shall be sequenced and analyzed using the corresponding genomes for unique markers and SNPs associated with known drug resistance..
- Comparative sequence analysis of genes and genomic markers from these genomes will contribute to understanding of local strains of Mycobacterium tuberculosis and hopefully suggest possible novel diagnostics, therapies and drug combinations.
The first year of the project will mostly be dedicated to the accumulation of the first data set, and DNA strains, and DNA sequences, selection, verification and preprocessing of study groups and research materials as well as demonstration of a prototype of the open-access database.
Successful implementation of the proposal is secured by the fact that it will be executed by a leading Georgia research institutions working in the tuberculosis and ICT domains in close collaboration with NIAID OCICB
National Institute of Allergy and Infectious Diseases (NIAID)
Office of Cyber Infrastructure & Computational Biology
5601 Fishers Lane
Rockville, MD 20850 USA
Telephone: (301) 496-8219
50 Maruashvili Street
Tbilisi 0101, Georgia
Telephone:(+99532) 291 02 51
Fax: (+99532) 291 19 41