The Idu-Mishmi community and Arunachal Pradesh appeared on the world map today for its greatest contribution in studying dormant Mycobacterium in TB that has affected nearly 4 billion people in the world and causing 1.9 million deaths yearly. In India, one person is dying of TB every 3 minutes. The study details and the contribution of Idu-Mishmis of Arunachal Pradesh and RIWATCH (Research Institute of World's Ancient Traditions Cultures and Heritage) in accomplishing the study has been duly acknowledged in a research paper published in a reputed journal 'Science Translational Medicine' on 30 January 2013. Dr. Ista Pulu, a Doctor belonging to Idu Mishimi community, and Vijay Swami, Director of RIWATCH are the co-authors of the paper. Dr. Deepjyoti Kalita, a Doctor from Guwahati Medical College who participated in research study and Lab work at Roing is also a co-author from north east India.
TB is a huge problem in North East India. The incidence of this infectious disease is much more higher in Northeast of India and especially Arunachal Pradesh than rest of India. There are special TB departments in every hospital to treat TB patients. The doctors prescribe drug treatment for months together to the TB patients, however TB recurs leading to death and suffering. It was not clear as to how the bacteria of TB hide in the body from months of drug treatment. Now the study published in Science Translational Medicine report that the dormant TB hide in bone marrow stem cells to escape from drug treatment. This research will help our efforts to develop better therapy to target the dormant TB bacteria.
Concern for Public Health of local communities of Arunachal Pradesh has been always on the top priorities of RIWATCH, since it directly affects the socio-cultural life of local communities and their social environment. Dr. Bikul Das, who hails from Sualkuchi in Assam and engaged in doing research on stem cells in Stanford University California is known to RIWATCH and its' parent organization ICCS (International Center for Cultural Studies US) since long. When he was working as a Doctor in Bhutan, he speculated that, TB bacteria escapes the host immune defense and drug treatment by hiding inside bone marrow stem cells. Dr. Das and his team at Stanford University, California and Forsyth Institute, Cambridge, Massachusetts, USA had a thorough lab research and successfully recovered variable bacteria inside the CD271+ stem cells using mouse model of TB developed by Dr. Antonio Campos-Neto at Forsyth Institute. Dr. Das then approached RIWATCH to perform the clinical study in the Arunachal Pradesh/Bhutan area, where he is actively engaged in yearly free medical camps.
Here in Arunachal Pradesh, the public health concern of RIWATCH and Dr. Bikul Das's research came together. The RIWATCH decided to facilitate Dr. Das to study as to why the TB recurrence is higher in Arunachalee communities.
The RIWATCH plunged into action, mobilized a team of local medical professionals from Governmental Hospital to work with Dr. Das, obtained necessary permission from Department of health, even involved doctors from Guwahati Medical College Assam to set up a temporary research lab at Roing, a district headquarter of Lower Dibang Valley, Arunachal Pradesh. The place was given by Dr. Ista Pulu, Sr. Gynecologist, District Hospital Roing, a generator from medical department was borrowed for uninterrupted power supply, accommodation for the entire team was done by RIWATCH free of cost, Dr. Pulu provided the fuel for generator, and this is how with people's involvement our temporary laboratory was set up. A local NGO founded by Dr. Das, the KaviKrishna Foundation provided the funding for the research materials. We conducted free general medical camps in five villages and given free medicines to all patients. The people of Idu-Mishmis suffering from this dreaded disease participated in the study actively. This effort led to identification of individuals who had TB, and successfully completed drug treatment. This was even confirmed with department of TB in Govt. hospital. From these individuals, the team isolated the CD271+ stem cells, and found evidence of dormant TB bacteria in those stem cells. These results supported Dr Das's laboratory and Dr Campos-Neto's animal study evidence that dormant TB hide in the CD271+ stem cells.
Briefly, the findings indicate that the dormant TB bacteria hijack a stem cell type known as mesenchymal stem cells (MSCs). The TB bacteria hide inside the CD271 expressing MSCs, and these infected MSCs resides in the bone marrow niche, which is of low oxygen. So, drugs and immune cells cannot reach the niche where MSCs resides in the bone marrow. This helps dormant TB bacteria to escape the attack from immune cells and drugs. This could be the reason why it is so difficult to eradicate TB from human host.
The MSCs are stem cells that give rise to bone, cartilage and muscle. MSCs are also known to migrate to the area of inflammation including lung. Recently a group of Indian scientists led by Dr Gobardhan Das of New Delhi found MSCs in the lung granuloma, which is not so surprising because lung granuloma is inflammatory. During drug treatment most of the granuloma become sterile, that means TB bacteria become dead. So, scientists were wondering where does the dormant bacteria survive in our body following drug treatment. The present findings now indicate that TB hijack these MSCs to move to the secured niches in the bone marrow to hide for years to escape from the drug treatment.
For the people of Arunachal Pradesh and RIWATCH, the study undertaken is proved to be one of the greatest contributions to the whole humanity. The study as to "why TB treated patients remain sensitive to TB tests for life" made a breakthrough, "the results now will have direct implications in anti-TB drug development and explain why it is so difficult to treat active and latent TB" said the RIWATCH release. No doubt, this RIWATCH initiative in medical research has brought the Idu-Mishmi people and Arunachal on the world map.