While cases of tuberculosis (TB) are almost unheard of in Australia, it remains one of the top 10 causes of death worldwide. Over 95 per cent of TB cases and deaths occur in developing countries.
Chancellors Postdoctoral Research Fellow (CPDRF) Dr Nilesh Bokil is no stranger to the damaging effects of TB.
Nilesh remembers the lingering effects TB had on his grandmother: "She wasn't able to fly, she wasn't able to go anywhere. Towards the end of her life, she was bed-ridden, and as winter rolled around, her condition would get worse."
As a 2018 CPDRF, Nilesh is now embarking on a four-year research project to develop new microRNA-based therapeutic treatments against the inflammation caused by TB.
So, what are microRNA? You'll be forgiven for missing the memo: "MicroRNA were only discovered in the 90s," explains Nilesh. “When cells need to get something done, RNA – which is a copy of the cell’s DNA – is produced. This RNA is then translated to proteins for things to work.
“MicroRNA are small RNA molecules that don’t actually code for proteins but are involved in regulating the conversion of other RNA into protein. By doing so, they can regulate important cell functions including inflammation.
Because they were so recently discovered, the specific details of how they work, what they do, and what areas they target are up in the air. But, says Nilesh, “We know they're important physiologically because when you get rid of some of them, it affects multiple body functions including the immune system."
Nilesh is focussing on the effects of these infinitesimally small molecules to help control the effects of TB, which can include extensive scarring of the lungs. He hopes to deliver real changes to those affected by TB.
He says, "The problem with TB and treatment in general, is that you have to take a minimum of six months’ of antibiotics to get better.” But before and during treatment your lungs are inflamed and healthy tissue is being damaged.
"So you may be cured at the end of six months, and have no bacteria in the lungs, but you'll never get that damaged tissue back.
"I've dealt with people who have been cured but who are left with just 40 per cent lung capacity. And, in developing countries the majority of people who get TB are of working age – imagine going back to work as a manual labourer, for example, with 40 per cent lung capacity. You can’t breathe, you have little energy, it’s debilitating."
If we are successful, it is going to have an effect on the social structure of communities, not just the medical sector
It’s situations like this, says Nilesh, that fostered his special interest in inflammatory and infectious diseases, and made him realise the urgent need for new therapies to treat them. Though his first stage of research is underway, Nilesh says he has at least four years in front of him trying to identify which microRNA will be most relevant and then develop potential therapeutics.
"We have samples of patients who are either healthy or who are suffering from the disease," explains Nilesh, "If we can identify which microRNA are altered, not only can we use that information for developing therapeutics, but we can also use that for the early diagnosis of TB.
"If we are successful, it is going to have an effect on the social structure of communities, not just the medical sector," says Nilesh.
"Most of the countries affected are in the developing world: India, Indonesia, China, Philippines, Nigeria. And a bigger problem associated with this is that HIV is also prevalent in these countries and people living with HIV are 20 to 30 times more susceptible to TB than people without HIV."
Nilesh hopes to use his research as the starting point for identifying therapeutic applications of microRNA modulation for other inflammatory diseases like Crohn's disease and cirrhosis.
"This fellowship gives me the chance to not have to worry about publishing quotas and producing results on a yearly basis," he says. "I think that's important for getting early- and mid-career scientists to start thinking about long-term projects. Sometimes the most impactful publications or developments can be a culmination of four to five years' work, so this freedom is very valuable."
As a 2018 CPDRF, Nilesh will also be teaching and mentoring UTS students. He's is in a unique position to share his real-world perspective on the science they're learning. "I'm keen to teach into and develop courses at UTS that will give students an understanding of the translational effects of research that is done not only at UTS, but across Australia and around the world.”