Lung infections can be difficult to treat, significantly increasing the burden of care, including stays in hospital for weeks at a time. Early diagnosis of the infection means people may receive shorter courses of treatment and less lung damage will be caused.
Building a network of UK CF Microbiologists
In 2004, with a £500,000 grant from the Big Lottery Fund and additional funding from the Trust, the UK Cystic Fibrosis Microbiology Consortium was formed. This was a multicentre collaborative programme aiming to improve the early detection, characterisation and treatment of CF lung infection and the development of new antimicrobial agents. It has led to new ways of detecting infection and opened new areas of research into treating these dangerous pathogens.
The consortium provided funding five early career researchers, three of whom continue to work in CF microbiology over 15 years later. The success of this multidisciplinary approach led to the development of the Trust’s Strategic Research Centre approach to funding research.
An annual meeting for the UK CF Microbiology community was established during this programme which continues to meet. It provides an opportunity to support early career researchers, share results, collaborate and debate with colleagues in the field.
How do people with CF develop lung infections?
As well as diagnosing the presence of infection and effective ways to treat it, it is also important to understand the source of the infection to reduce the number of infections people develop. For example, did a person get infected from environmental exposure, or was it passed on indirectly from person to person? The source of infection can change over time, as bacteria are constantly evolving to survive in different places.
Research funded by the Trust showed for the first time that the NTM infection Mycobacterium abscessus can be passed on from person to person. This was an important discovery, as it led to new cross-infection procedures in hospitals, to minimise the chance of people picking up an infection there. Previously it was thought people developed NTM from environmental sources.
Studying bacterial evolution can also tell us about how and when to treat infections, as well as how they’re spread. In a project co-funded by the Trust and Action Medical Research, researchers in Liverpool studied how the genetics of Pseudomonas aeruginosa change to survive in the lungs of someone with cystic fibrosis. Pseudomonas aeruginosa is the commonest infection in adults with cystic fibrosis. Knowing how the bacteria changes, and how soon after initial infection it changes, will help doctors in the future prescribe more targeted antibiotics.
Understanding Pseudomonas infection in people with cystic fibrosis
To treat infections effectively, we need to detect them early and understand the infection-causing bugs to identify their weak spots. Research we’ve funded has shown that different strains of the same bacteria act differently in the CF lung, and that each strain changes how it grows and survives over time – giving a constantly moving target to hit with antibiotics. These differences need to be identified and taken into account when treating each person infected.
Up until recently, in order to develop treatments for Pseudomonas infections, new drugs were tested on ‘lab strains’, which have different properties to the strains people with CF are infected with. As part of a Trust-funded SRC, Professor Jane Davies at Imperial College London has developed a ‘bank’ of samples of Pseudomonas from people with CF, to study in the lab. This has led to a wide range of new collaborations with pharmaceutical and biotech companies interested in developing new antibiotics for Pseudomonas.
Research efforts within a new SRC are now focused on ways to deliver personalised treatments for Pseudomonas infection that will be effective for individuals with cystic fibrosis, rather than a ‘one size fits all approach’.
Tackling antimicrobial resistance
Increasingly bugs that people with CF develop are becoming resistant to antibiotics. The topic of antimicrobial resistance (AMR) is a worldwide priority to tackle, across both health and agriculture. However, there are specific things that need to be taken into account to address antimicrobial resistance in the context of cystic fibrosis. The Trust joined an international group of CF patient organisations in funding the development of guidelines on AMR in CF to highlight this.
Read about the research currently underway to understand and treat lung infections