The Tuberculosis Research Centre (TRC), a permanent institute under the Indian Council of Medical Research (ICMR), is an internationally recognized institution for Tuberculosis (TB) research. It is a Supranational Reference Laboratory and a WHO Collaborating Centre for TB Research and Training. Recently, an International Centre for Excellence in Research (ICER) in collaboration with NIH was established at the Centre.
The Centre (formerly known as the Tuberculosis Chemotherapy Centre) was set up in Madras in 1956 as a 5-year project, under the joint auspices of the Indian Counclil of Medical Research (ICMR), the Government of Tamil Nadu, the World Health Organization (WHO) and the British Medical Research Council (BMRC). The objective of the Centre was to develop studies designed to provide information on the mass domicilary application of chemotherapy in the treatent of pulmonary TB. It started its activities with 8 international staff members belonging to the WHO and a team of national staff members drawn for ICMR and the Government of Tamil Nadu under the dynamic leadership of Dr. Wallace Fox of the BMRC.
The Centre, which had an initial lease of life of five years and had faced the threat of closure in 1961, has moved from strength to strength. Dr. Hugh Stott who succeeded Dr. Fox as WHO Senior Medical Officer in 1961 and had ably guided the research activities of the Centre during the following 6 years. Dr. N. K. Menon, who assumed charge in July 1964, was the first national Director. Dr. C. G. Pandit and Prof. V. Ramalingaswami, of the Indian Council of Medical Research, Dr. P.V. Bengamin, Adviser in Tuberculosis to the Government of India, Col. Sangham Lal, Director of Medical Services, Tamil Nadu State and Dr. C. Mani, Regional Director of the World Health Organization, South East Asia Region, played key roles in placing the Centre on a firm footing in Madras. Dr. N.K.Menon was succeeded by Dr. S. P. Tripathy in September 1969, Dr. R Prabhakar in1983 and Dr.P.R. Narayanan in 1996.
In 1964 the Centre was made a permanent establishment under the ICMR. In conformity with the general policy of the WHO regarding the provision of technical expertise, the WHO staff memebres were withdrawn as and when national counterparts were trained. The last WHO bacteriologist and the last WHO mediacl officer left the Centre torwards the end of 1965. In April 1966, the staff members initially employed by the Govenrmnt of Tamil Nadu were absorbed by the ICMR. The last WHO Senior Medical Officer was withdrawn in July 1966.
With increasing expertise gained by the national staff, a gradual transfer of the technical and operational direction took place. From 1956 to 1969, the Centre's research work was guided and assessed by a Project Committee consisting of the Director General and 3 other representatives of the ICMR, the Director of Medical Services, Tamil Nadu, a WHO representative, a BMRC representative and the Direcotr of the Centre. With the departure of the last WHO Senior Medical Officer in 1966, the scientific direction of the research at the Centre became entirely a national responsibility.
From 1970 onwards, a Scientific Advisory Committee, comprising of eminent Indian scientists representing various discipines and prominent workers in the field of tuberculosis has been guiding and reviewing the Centre's resarch work. The last WHO staff member, a laboratory technologist, was withdrawn in January 1970. The WHO, however, continues to maintain active interest in the Centre's research schemes, and provides expertise and supplies not availble in India.
Taking note of the increasing concern over the ethical considerations involved in conducting clinical trials in human beings, an Ethical Committee was constituted in July 1976. All the research programmes at the Centre which involve patients are cleared by the Ethical Committee before being implemented.
In 1978, the Government of Tamil Nadu generously granted about 1 hectare of vacant land in the campus to the coundil on long lease. The four storeyed second block was tthen built with ICMR funds in that year.
The staff of the two ICMR projects, Tuberculosis Prevention Trial and Leprosy Prevention Trial were merged with the TRC as the "Epidemiology Unit" of TRC.
In keeping with the wide sphere of activiites of the Centre, the Indian Council of Medical Research in 1978 renamed the Tuberculosis Chemotherapy Centre as the "TUBERCULOSIS RESEARCH CENTRE" .
The TRC also had a subsidiary unit functioning in the Lady Wellington Hospital, Bangalorer in collaboration with the National Institute of Tuberculosis. This centre was established in 1978 and was manned by a medical officer, a statistician and nursing staff. Intake to clinical trials of TRC was supplemented by this centre. In Novemebr of 1983, the Banalore centre was shifted to Madurai and located in the chest clinic of the Government Rajaji Hospital, Madurai. This centre has been strengtherned over the years and currently has about 40 staff members consisting of doctors, statisticians , medical social workers, lab technicians nursing staff and other supporting staff. A significant proportion of patients admitted to clinical trials are from the Madurai unit.
In 1995, the TRC initiated a randomized clinical trial of 3-, 4-, 5-months regimens with ofloxacin as one of the drugs in the intensive phase of treatment for the treatment of patients with smear positive pulmonary tuberculosis. This trial showed for the first time that it is feasible to shorten the duration of TB treatment to 4 or 5 months. The publication of results of this trial in 2002 resulted in a global interest in the role of quinolones in TB treatment.
In 2000, a separate HIV/AIDS division was established at TRC. This unit is involved in conducting controlled clinical trial in the management and prevention of tuberculosis in HIV/AIDS patients.
In 2006, Tuberculosis Research Centre celebrated its Golden Jubliee.
In the last 50 years at TRC, more than 100000 TB patients have been screened and 15,000 patients enrolled to various clinical trials.The basic concepts that underpin the globally implemented DOTS strategy were evolved at the Centre through a series of trials. The first controlled clinical trial, which established unequivocally the value of outpatient treament for pulmonary TB received world-wide acclaim as the classic "Madras Study". The centre evolved supervised intermittent chemotherapy especially for urban areas and large cities subsequently. Later, treatment for approxiamtely 6 months with powerful drugs has been shown to be equally effective and these regimens were evaluated under field conditions.
So far, 35 Randomized Controlled Clinical Trials for treatment of both Plmonary and Extra pulmonary TB (including TB spine, TB meningitis, TB lymphadenitis) have been carried out at TRC in copllaboration with various medical college hospitals and non profitable organizations in Madras city. Although the main aim of the studies is to evolve inexpensive, effective and practicable methods of treatment for TB patients in India, the logial sequence of the investigations undertaken, complemented by appropriate laboratory investigations, has resulted in invaluable knowledge of the principles of chemotherapy and of the bacteriology of tuberculosis.
The Centre functions from three campuses at Chennai, Tiruvallur and Madurai. At the main campus in Chennai the Centre is housed in three main blocks, in a one-and-a-quarter hectare campus on Mayor V.R.Ramanathan Road (formerly Spurtakn Road), Chetput, in the heart of Madras city.
A dream that had been in conception for more than 20 years became a reality when a state of the art clinical patient care facility wa inaugurated in February 2006. This Rs. 8.75 crore, 6250 sq. metre, 4-storied state of the art building with a central atrium, houses the patient care facility in the first floor. This consists of examination and counseling rooms for patients, an X-ray and Pulmonary Function Laboratory and treatment and emergency rooms. A Digital X-ray machine that will dispense with hard films will be in use with a back up of a conventional 500 mA X-ray machine. An image archiving system is also available. With this machine more than 20,000 X-rays of patients treated in clinical trials in TRC in the past have been scanned and archived. The sputum collection room is equipped with negative pressure exhaust system with ultraviolet air sterilization providing for continuous air exchange. The first floor provides for living accommodation and dining facilities for the clinic staff. The second floor has a large conference room that can seat 55 participants with audio-visual presentation facilities. There is also a browsing centre and guest bedrooms for 16 trainees. The third floor with restricted access houses a state of the art HIV laboratory.
The entire building is centrally air-conditioned. Safety of both patients and equipment has been accorded high priority with a sophisticated Fire Detection and Alarm system and a Fire Fighting system with an automated sprinkler in the basement that will switch on when the temperature exceeds a pre-set value. Lightening protectors are located on the terrace. Keeping in mind the need to conserve energy, a 500 litre solar-energy powered water tank is located on the terrace. Reverse osmosis technology ensures drinking water of the highest quality. The building is equipped with fibre-optic broad band inter and intranet connectivity and a Public Address system facilitates prompt access and a rapid response to emergencies. The building is equipped with disabled-friendly facilities such as a ramp and special toilets. The ambience of the building is enhanced by landscaped gardens on all sides of the building.
Modern equipments such as a Auto analyser for performing biochemical tests, a Titretek muti-scanner for immunological tests, Flow cytometry for measuring CD4/CD8 cells, Cobas amplicor HIV-1 monitor, DNA sequencer, Real time PCR, HPLC and LCMS, digital X-ray machine, BSL-2 facility, Confocal microscope etc. have been acquired and put to good use. Modern equipment for lung function tests have also been installed.
The Centre also has a strong statistics department which supports the various controlled clinical trials of the centre. There is also a Electroninc Data Processing Unit in the centre that helps in computerization of all research activities. This division has provided the centre with LAN facility and has helped in setting up the newly formed ICMR - Biomedical Informatics Centre (BMIC) under the guidance of the Director, TRC.
The Centre is also recognized for post-graduate training leading to the Ph.D. degrees in bacteriology, biochemistry, immunology and statistics by the Madras University and by the Inter-University Board of India and Sri Lanka. It is also a training centre for WHO fellows, as well as medical undergraduates and post-graduates of the University of Madras and of the neighboring states.
The fight against tuberculosis continues relentlessly and the last word has not been said so far. It is expected that the efforts of the Centre would continue to throw light on the changing principles of chemotherapy and allied aspects of tuberculosis such as immunology. The momentum of research is kept up and the quality of scientific work is preserved.
A journey through forty years of its evolution at the
Tuberculosis Research Centre -
Dr. R. Parthasarathy,
Deputy Director (Retd.)