Winter 2019

Antimicrobial Resistance Fighters

A new Tufts center is cracking down on one of the biggest global health concerns.

By Courtney Hollands

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Illustration: Chris Madden

It’s estimated that 700,000 people die around the world each year from infections caused by multidrug-resistant pathogens—including 23,000 in the United States alone. If left unchecked, the global death toll is set to soar to 10 million a year by 2050, according to the U.K.-commissioned Review on Antimicrobial Resistance. And that doesn’t account for the millions more who suffer serious complications.

“Antimicrobial resistance is now on the brink of limiting our ability to take care of patients,” said Helen Boucher, professor of medicine at the medical school and director of the infectious diseases fellowship and heart transplant and ventricular assist device infectious diseases programs at Tufts Medical Center. “We’ve had cases—and it’s happening more often—where we have to tell people that you can’t have chemotherapy for your cancer, or you can’t have your organ trans- plant or hip replacement, because we can’t control your infection. This is the biggest reason we need to act.”

Tufts University and Tufts Medical Center are heeding the call with the new Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR). “This is an opportunity to create a new structure to maximize the benefits we get from having these two strong assets in basic science and clinical medicine together,” said Linden Hu, vice dean of research at the School of Medicine. “For us, it’s a new model for working together with Tufts Medical Center.”

Center for Integrated Management of Antimicrobial Resistance codirectors Helen Boucher, left, and Ralph Isberg, photographed at the Tufts University School of Medicine. Photo: Anna Miller

Faculty from schools across Tufts will also be involved in work that is deeply interdisciplinary, including experts from Cummings School of Veterinary Medicine, Friedman School of Nutrition Science and Policy, the School of Engineering, the College of Arts and Sciences, and the School of Dental Medicine. All told, more than 55 investigators currently focus on some aspect of infectious diseases relevant to anti- microbial resistance (AMR).

The university’s unique constellation of schools, coupled with its strong One Health approach, makes the school ideally suited for tackling a problem as multifaceted as AMR. “We were looking for novel projects that had a distinct possibility for innovation and societal and global impact, and that were based on our existing strengths and offered opportunities for collaboration among the different schools,” explained Simin Meydani, vice provost for research at Tufts. “CIMAR just fit all those criteria beautifully.” The center will be initially funded equally by the university and the medical center.

Boucher is codirecting CIMAR with Ralph Isberg, professor of molecular biology and microbiology at the School of Medicine. “We want to use CIMAR to get people talking to each other to see how our research interfaces,” Isberg said. “The goal then is to start collaborative projects that we can use as the basis for submitting multi-investigator grants.” In addition, CIMAR will look beyond the university—partnerships with Boston College and Northeastern University are already in the works.

“We’re now getting to the age where there are bacteria out there that we can’t treat with the antibiotics we have—and they’re spreading . . . As a society, we’ve been too complacent.”

CIMAR has three founding priorities. The first is investigating combinational drug therapies that both treat infection and diminish the emergence of tolerance and resistance for use in human and veterinary medicine. Some of this work will build on a new mathematical model that measures how multiple drugs act in combination, developed by Bree Aldridge, an assistant professor of molecular biology and microbiology and adjunct assistant professor of biomedical engineering. Though Aldridge is currently using the method to test anti- tuberculosis drugs, it will be expanded to other infections and then translated to the clinic for developing new, approved drug combinations.

For its second goal, CIMAR will look at surveillance and control of the spread of AMR, using tools from epidemiology, engineering, and the social sciences. This research will inform the design and evaluation of anti- microbial stewardship strategies and shape policy development in the U.S. and abroad. Tufts Medical Center is already considered a leader in this area, Boucher said, and clinicians are working with colleagues from the Cummings School on stewardship in companion animals and other projects. Antimicrobial stewardship in long-term care facilities is another area of focus at the hospital.

The final priority area for CIMAR at launch is the cross-campus development of educational programs around AMR for high school and college students. Boucher is a voting member of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria and said the council’s most recent report called out the importance of spreading awareness of AMR and securing a workforce to fight this problem in the next generations, as well as the need for education in early learners as a key to responding to the AMR crisis.

By capitalizing on the existing strengths of Tufts schools and Tufts Medical Center and tapping faculty already working in the field from across the university, CIMAR is poised to become an internationally recognized center and trailblazer in AMR management. But improving patient outcomes is the most important goal.

“We’re now getting to the age where there are bacteria out there that we can’t treat with the antibiotics we have—and they’re spreading,” Hu said. “It’s not that the problem hasn’t been there; it’s been creeping up on us. As a society, we’ve been too complacent.”

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