Professor Graham Rook presents a plenary presentation giving a broad overview of TB immunology and the potential for TB immunotherapy as a countermeasure to the long and complex courses of antibiotic treatment, at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. He explains the careful balance between cytokines that are thought to be important for driving the progression or resolution of latent TB infection. Promising data for the potential of manipulating these cytokine responses to improve the outcome of TB infection are described in mouse models and progress is also being made to investigate these findings in humans, with discussions ongoing with pharmaceutical companies about possible roll out to full clinical studies. Two other new vaccines, the Hsp-65 DNA vaccine and vaccination with the saprophytic mycobacterium M. vaccae, are also discussed. The Hsp-65 vaccine is moving into human studies in Brazil and Japan, whilst a recent study of M. vaccae vaccination in BCG-primed HIV positive patients with TB showed promising results. Professor Rook discusses the possibility of targeting those patients that are failing treatment for XDR TB with vaccine treatments.

Professor Nick Keep explores the molecular pathogenesis of TB and describes his work on TB resuscitation promoting factors, at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. These bacterial 'cytokines' have been shown to be important for waking up dormant M.tb.

Prof. Brian Henderson talks about the role of heat shock proteins in the pathogenesis of tuberculosis at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. These molecular chaperones are known virulence factors in a range of pathogens and the work presented suggested a possible role in granuloma inflammation in TB.

Benjamin Irving presents work on automated analysis of the airways in CT scans for the modelling of TB at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. This innovative project, in conjunction with colleagues from Cape Town, SA, is looking to mathematics and physics to develop a screening tool to detect TB based on digital radiography. The process aims to analyse 3D CT images of airways of patients with TB to develop a statistical model of airway deformation that can be used to screen for TB. The 3D findings will later be applied to 2D radiography to develop the screening tool further.

Dr Clare Green presents her data on the use of urine as a diagnostic target for pulmonary TB at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. She describes the small, cell free nucleic acids, known as transrenal DNA, that can be detected in urine of infected individuals. Previous studies have shown huge variability on the sensitivity of this assay of the detection of TB, and Dr Green’s work has examined factors that might influence this variation - such as the patient group, sample preparation and the assay design - in order to try to optimise this technique as a clinical tool.

Dr Helen Donoghue highlights TB history of a different kind at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. She presents her work on the detection of ancient TB from the Neolithic period, in bones from Egypt and mummified remains discovered in a Hungarian crypt. Evidence of previous TB infection can be seen directly from skeletal lesions in the bones. However, these can be confused with other illnesses and Dr Donoghue's work has focussed on the definitive detection of TB by identifying markers

of the organisms itself. Her work has shown TB bacteria present in calcified lung lesions using standard staining methods, but more importantly has developed techniques to detect TB DNA, as well as TB proteins and cell wall lipids, from ancient material. These techniques confirmed the earliest known case of human TB over 9000 years ago, and the invention of the field of 'paleo-microbiology'. By comparing this ancient DNA with TB from today, Dr Donoghue's group have been able to study the evolutionary history of TB and its co-evolution with humans, corresponding with a switch a from the hunter-gather lifestyle to larger settled communities and the introduction of agriculture and domestication.

'The Challenge of TB: UCL's Contribution' held on 24th March 2010 included a plenary presentation by Dr. Carole Reeves, an Outreach Historian. Dr Reeves gives a fascinating insight into life in a TB sanatorium from her collective history of Craig-y-Nos, South Wales. In operation from 1922, this TB Sanatorium for children and young women closed in 1959 with the introduction of the first antibiotics effective against TB. Her research began through work initiated by a previous patient, and rapidly expanded due to an overwhelming response to the Craig-y-Nos blog, resulting in over 150 oral histories and more than 1250 photographs. Patients recounted memories of their TB treatment; from the discomfort of having a gastric lavage, to sleeping outside on the balconies in the Welsh winters and waking under a tarpaulin heavy with snow. The social consequences of the disease were also highlighted, with many patients feeling ostracised and abandoned by families, friends, and no chance of future employment through fear of contamination. However, among these accounts were also many happy stories and photographs of the fun and friendships that were made between the children and women, several of whom have been reunited decades later as a result of the project. A book documenting this history has recently been published.

Professor Stephen Gillespie presents a plenary session at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. Professor Gillespie gives a history of TB treatment to the present day; through pre-drug therapy and the pivotal first testing of streptomycin, to combination drug trials, and then the eventual development of 6-month therapy. From there he discusses present developments in TB drug development and clinical trials, in particular the importance of collaboration illustrated by 2 major projects currently underway at UCL; REMoxTB study and PanaCEA consortium which both aim to contribute to capacity development of clinical trial sites to enable testing of the increasing number of TB active agents and thus speed the introduction of new treatments.

Dr Andrew Hayward presents the overrepresentation of patients with TB in London's 'hard to reach populations' including those in prison, the homeless and drug users, at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010. Dr Hayward's department has just been awarded an NIHR program grant for the management and control for TB in hard to reach groups. He is also been representative on the NICE review group recently set up to provide guidelines for management of TB in hard to reach groups.

Suzanne Bartington presents audit findings from the Royal Free Hospital, examining compliance with NICE guidelines advocating chest X-Ray (CXR)for all with TB, at 'The Challenge of TB: UCL's Contribution' held on 24th March 2010.