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Surge in gastrointestinal disease spurs U.S.-China collaboration

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Science  29 May 2015:
Vol. 348, Issue 6238, pp. 983-984
DOI: 10.1126/science.348.6238.983

29 May 2015

Edited by Kathy Wren

Westernization of Chinese diets may be related to a rise in inflammatory bowel disease there.

PHOTO: ISTOCK PHOTO/V2IMAGES

In the 1950s, physicians in the United States and Europe began reporting a rise in cases of inflammatory bowel disease (IBD), which increased roughly threefold by the 1990s. A similar trend began in Japan in the 1970s. Now, reports of the once-rare condition are doubling rapidly in China.

For decades, researchers understood little about IBD, which includes Crohn's disease and ulcerative colitis. But the new swell in Chinese cases offers researchers “an opportunity that is unparalleled” to understand what causes the disease and how it might ultimately be treated or prevented, said John Allen, clinical chief of digestive diseases at Yale University and president of the American Gastroenterological Association (AGA).

“We have built our entire theory of both etiology and treatment around assumptions that are now in question,” Allen said, such as that IBD is a disease found only in Western, industrialized nations, primarily affecting Caucasians from Europe. A new collaboration between the AGA and the Chinese Society for Gastroenterology aims to correct that course.

Allen described the agreement at the 29 April conference, “Science Diplomacy 2015: Scientific Drivers for Diplomacy,” in a session about how medical challenges can lead to international science cooperation. The day-long conference was organized by the AAAS Center for Science Diplomacy and drew more than 200 people, including representatives from the U.S. State Department and other federal agencies, as well as UNESCO, The World Academy of Sciences in Trieste, Italy, and the Academy of Sciences of Cuba. Sessions at the conference covered the roles of institutions and networks in science diplomacy, cooperation during political strain, working with shared resources, and other topics.

International research collaborations such as the one described by Allen, while important in their own right, also advance the goals of diplomacy, said Rush Holt, AAAS CEO and executive publisher of the Science family of journals. “The principles of science—transparency, open communication, and evidence-based thinking—go a long way to diffusing difficult situations, breaking through barriers, and developing relationships that can yield benefits that go beyond the scientific research that might be discussed,” Holt said in a plenary address.

A general picture of IBD has emerged in recent years, in which genetic predisposition, inflammatory processes, and environmental factors such as diet and hygiene affect the makeup of the gut's microbes and contribute to the condition. The memorandum of cooperation signed last September by the U.S. and Chinese gastroenterology associations lays the groundwork for an effort to sequence the gut microbiota of both rural and urban Chinese individuals. By comparing these genetic sequences, the researchers hope to uncover clues to how IBD develops and why it is more likely to arise in urban areas where lifestyles are more like those in the United States and Europe.

The time is ripe for this research because the sequencing and analysis tools are now available and because professional medical societies are on the rise in China. After the introduction of a market-based society in the 1980s, Chinese hospitals generally operated independently of each other, with very little focus on clinical research, according Allen. But the newly established Chinese Society for Gastroenterology has about 20,000 members and provides a muchneeded organizational system for planning the research effort. Now, “when we throw the rope over there, someone is actually catching it,” said Allen.

Other countries with limited cooperation in the policy sphere are joining forces to solve another major public health problem: multidrug-resistant tuberculosis (MDR-TB). Tuberculosis kills 2 million people every year, and strains resistant to multiple drugs are now spreading rapidly, particularly in Russia, India, China, and South Africa.

In the 1990s, treating MDR-TB was considered a low priority by the World Health Organization. That changed somewhat after Paul Farmer and Jim Yong Kim, who went on to found Partners In Health, showed that MDR-TB could be treated successfully. Today, however, less than 1% of newly diagnosed cases of MDR-TB are treated each year, said panelist Gail Cassell, citing figures from a series of meetings hosted by the Institute of Medicine. Cassell is executive vice president of TB drug development at the Infectious Disease Research Institute and a senior lecturer at Harvard Medical School.

Understanding the genetic changes that lead to TB resistance is ground zero for fighting this disease, said Cassell: “Until you have the full spectrum of antimicrobial resistance, you cannot prescribe the right drug for the right patient at the right time.”

Cassell, along with Valery Danilenko, head of the department of Post-Genomic Biotechnology at the Russian Academy of Sciences' Vavilov Institute of General Genetics in Moscow, and Dmitry Maslov, a research associate in that department, described an international effort launched in 2011 to sequence MDR-TB strains and support the development of new diagnostic tests, vaccines, and drugs.

The consortium includes researchers from many countries, including South Africa, Iran, Sweden, and others, who are using facilities in the United States, China, and Russia to sequence and analyze strains of drug-resistant Mycobacterium tuberculosis.

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