The National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, is expanding its Tuberculosis Research Units (TBRU) program in an effort to drive innovation in tuberculosis (TB) research. NIAID is awarding up to $15.2 million in fiscal year 2015 and as much as $105.3 million over seven years to fund four institutions that will act as a collaborative TBRU network.

The new TBRU awards were made to Boston Medical Center; Brigham and Women’s Hospital, Boston; Emory University, Atlanta; and Weill Cornell Medical College, New York City.

A critical component of NIAID’s tuberculosis research, the TBRU program was established in 1994 with the aim of integrating basic and clinical research to study TB in countries where the disease is endemic. For the past 20 years, one TBRU operated under a contract with Case Western Reserve University with study sites in Uganda, Brazil, the Philippines and South Africa and active research collaborations worldwide. This TBRU has helped to identify biomarkers that define the various stages of infection and disease, contributed to best practices for TB clinical trials, and examined factors to help understand why some people infected with the disease-causing Mycobacterium tuberculosis do not develop TB.

Although the number of individuals becoming sick or dying from TB worldwide slowly has declined in recent years, the global burden of the disease remains substantial. About one-third of the world’s population carries latent TB bacteria, according to the World Health Organization. In 2013, an estimated nine million people became ill with TB and 1.5 million died from the disease. More than 500,000 children developed TB in 2013 and 80,000 died from the infection, according to WHO.

During the past 15 years, a sustained effort in TB research has translated to a new pipeline of drug, vaccine and diagnostic candidates. In 2012, the FDA approved the first new tuberculosis drug in more than 40 years. However, a limited understanding of the stages of TB disease has hampered transformation in optimal management of the disease.

By integrating epidemiology, immunology and microbiology, the four awardee institutions will work together to examine how Mycobacterium tuberculosis interacts with the human host and the immune system to cause disease. Through animal studies and clinical research, the TBRU program will focus on TB latency and persistence and their relation to active TB disease in humans.