London, United Kingdom SRL

Supranational TB Reference Laboratory in London, Unitied Kingdom

Address:

National Mycobacterium Reference Service South

Public Health England

61 Colindale Avenue London NW9 5EQ United Kingdom

Contacts:

Dr Esther Robinson (Esther.Robinson@ukhsa.gov.uk)

Norah Easy (Norah.Easy@ukhsa.gov.uk)

Website:

Description

The National Mycobacterium Reference Service-South is an accredited reference laboratory of the National Infection Service of Public Health England. With its sister laboratory the National Mycobacterium Reference Service – Central & North, based in Birmingham, it provides Mycobacterial Reference services to the NHS in England.

The unit is WHO Supranational Reference Laboratory for M.tuberculosis DST and a member of the WHO Global Laboratory Initiative involved with the development of WHO/IUATLD strategies for management of mycobacterial diseases and participates in EQA schemes and other international initiatives. The NMRS-South, with the ECDC, co-ordinates the European Reference Laboratory Network for tuberculosis (ERLTB-Net).

Structure and organization

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an executive agency of the UK Department of Health, and is a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the National Health Service in a professionally independent manner.

Services provided by the SRL

NMRS South provides Mycobacterial Reference Service utilising Whole Genome Sequencing (WGS) for identification of Mycobacterium sp isolates; prediction of drug susceptibility for M. tuberculosis and determination of relatedness and investigation of outbreaks of M. tuberculosis. Phenotypic drug susceptibility testing is carried out for selected M. tuberculosis and non-tuberculosis mycobacteria (NTM) isolates including extended testing for MDR-TB. The laboratory also offers a primary isolation service and rapid detection of M. tuberculosis complex and resistance to selected drugs. The NMRS-South provides information and advice to clinical and public health teams, assisting in the identification and investigation of TB transmission and actively supporting outbreak investigation and surveillance activity within the UK.

TB diagnostic methods available in the laboratory

WGS-based identification of Mycobacterium sp isolates; prediction of drug susceptibility for M. tuberculosis and determination of relatedness and investigation of outbreaks of M. tuberculosis; phenotypic DST for M.tuberculosis and NMT isolates; rapid molecular detection of M. tuberculosis complex and resistance to selected drugs on primary specimens; primary isolation; latent TB diagnosis using IGRA assays

Current links and partnerships outside of SRLN

The NMRS-South, with the ECDC, co-ordinates the European Reference Laboratory Network for tuberculosis (ERLTB-Net) currently comprising 32 National and Supranational TB Reference laboratories across EU/EEA. NMRS South has links and collaboration agreements with SRLs in Milan (Italy), Borstel (Germany), NRLs in Greece and Malta, Welsh TB Reference Laboratory (Cardiff) and closely collaborates with other clinical, laboratory and academic institutions nationally and internationally.

Key documents, reports:

Additional information:

Research activities

PHE is a major contributor of sequence data to the CRyPTIC project (www.crypticproject.org) aiming to provide high confidence genomic-based predictions of drugs resistance and susceptibility to the vast majority of drugs used in clinical practice. This will transform the way tuberculosis is treated through facilitation of individualisation of anti-tuberculosis therapy without the need for expensive, difficult, and slow phenotyping.

PHE is a lead partner and co-ordinator of the European Network for TB Reference laboratories comprising 32 partners from 27 European Union and European economic area countries. This ECDC-funded project aimed at strengthening TB laboratory diagnosis and contributing to improvement of TB and drug resistant TB control across the European Region through networking, advanced training, methods harmonization, scientific excellence and development and implementation of comprehensive External Quality Control (EQA) schemes.

NMRS-South is also involved in research activities on biomarkers of TB diseases and cure, host-pathogen interaction, mechanisms of drug resistance development and TB epidemiology closely collaborating with hospitals. academic and industrial partners nationally and internationally

Publications

• Walker, T.M., Cruz, A.L., Peto, T.E., Smith, E.G., Esmail, H., & Crook, D.W. 2017 Tuberculosis is changing. Lancet Infect. Dis 17, (4) 359-361 available from: PM:28298254

• Votintseva, A.A., Bradley, P., Pankhurst, L., Del Ojo, E.C., Loose, M., Nilgiriwala, K., Chatterjee, A., Smith, E.G., Sanderson, N., Walker, T.M., Morgan, M.R., Wyllie, D.H., Walker, A.S., Peto, T.E., Crook, D.W., & Iqbal, Z. 2017. Same-day diagnostic and surveillance data for tuberculosis via whole genome sequencing of direct respiratory samples J Clin Microbiol available from: PM:28275074

• Pankhurst, L.J., Del Ojo, E.C., Votintseva, A.A., Walker, T.M., Cole, K., Davies, J., Fermont, J.M., Gascoyne-Binzi, D.M., Kohl, T.A., Kong, C., Lemaitre, N., Niemann, S., Paul, J., Rogers, T.R., Roycroft, E., Smith, E.G., Supply, P., Tang, P., Wilcox, M.H., Wordsworth, S., Wyllie, D., Xu, L., & Crook, D.W. 2016. Rapid, comprehensive, and affordable mycobacterial diagnosis with whole-genome sequencing: a prospective study. Lancet Respir.Med., 4, (1) 49-58

• Bradley, P., Gordon, N.C., Walker, T.M., Dunn, L., Heys, S., Huang, B., Earle, S., Pankhurst, L.J., Anson, L., de, C.M., Piazza, P., Votintseva, A.A., Golubchik, T., Wilson, D.J., Wyllie, D.H., Diel, R., Niemann, S., Feuerriegel, S., Kohl, T.A., Ismail, N., Omar, S.V., Smith, E.G., Buck, D., McVean, G., Walker, A.S., Peto, T.E., Crook, D.W., & Iqbal, Z. 2015. Rapid antibiotic-resistance predictions from genome sequence data for Staphylococcus aureus and Mycobacterium tuberculosis. Nat.Commun., 6, 10063

• Timothy M Walker*, Thomas A Kohl*, Shaheed V Omar*, Jessica Hedge*, Carlos D O Elias, Phelim Bradley, Zamin Iqbal, Silke Feuerriegel,Katherine E Niehaus, Daniel J Wilson, David A Clifton, Georgia Kapatai, Camilla Ip, Rory Bowden, Francis A Drobniewski, Caroline Allix-Béguec,Cyril Gaudin, Julian Parkhill, Roland Diel, Philip Supply, Derrick W Crook, E Grace Smith, A Sarah Walker, Nazir Ismail, Stefan Niemann,Tim E A Peto, and the Modernizing Medical Microbiology (MMM) Informatics Group 2015. Whole-genome sequencing for prediction of Mycobacterium tuberculosis drug susceptibility and resistance: a retrospective cohort study. Lancet Infect Dis, DOI: dx.doi.org/10.1016/S1473-3099(15)00062-6

• Walker TM, Ip CL, Harrell RH, Evans JT, Kapatai G, Dedicoat MJ, Eyre DW, Wilson DJ, Hawkey PM, Crook DW, Parkhill J, Harris D, Walker AS, Bowden R, Monk P, Smith EG, Peto TE. 2013. Whole-genome sequencing to delineate Mycobacterium tuberculosis outbreaks: a retrospective observational study. Lancet Infect.Dis., 13, (2) 137-146 a

• Mathys V., Roycroft E., Raftery P. Groenheit R., Folkvardsen D., Homorodean D., Vasiliauskiene E., Vasiliauskaite L., Kodmon C., van der Werf M., Drobniewski F., Nikolayevskyy V. Time-and-Motion tool for assessment of working time in tuberculosis laboratories: a multicentre study. Int J Tuber Lung Dis 2018 Apr 1;22(4):444-451.

• Tagliani E, Cirillo DM, Ködmön C, van der Werf MJ; EUSeqMyTB Consortium. EUSeqMyTB to set standards and build capacity for whole genome sequencing for tuberculosis in the EU. Lancet Infect Dis. 2018 Apr;18(4):377

• Jackson C, Southern J, Lalvani A, Drobniewski F, Griffiths CJ, Lipman M, Bothamley GH, Deeks JJ, Imran A, Kon OM, Mpofu S, Nikolayevskyy V, Rees-Roberts M, Sitch A, Sridhar S, Tsou CY, Whitworth H, Abubakar I. Diabetes mellitus and latent tuberculosis infection: baseline analysis of a large UK cohort. Thorax. 2018 May 15. pii: thoraxjnl-2017-211124. doi: 10.1136/thoraxjnl-2017-211124

• Abubakar I, Francis Drobniewski, Jo Southern, Alice J Sitch, Charlotte Jackson, Marc Lipman, Jonathan J Deeks, Chris Griffiths, Graham Bothamley, William Lynn, Helen Burgess, Bobby Mann, Ambreen Imran, Saranya Sridhar, Chuen-Yan Tsou, Vladyslav Nikolayevskyy, Melanie Rees-Roberts, Hilary Whitworth, Onn Min Kon, Pranab Haldar, Heinke Kunst, Sarah Anderson, Andrew Hayward, John M Watson, Heather Milburn, Ajit Lalvani on behalf of the PREDICT Study Team. Prognostic Value of Interferon Gamma Release Assays and Tuberculin Skin Test in Predicting the Development of Active Tuberculosis: The UK PREDICT TB Cohort Study. Lancet Infect Dis. 2018 Oct;18(10):1077-1087

• Matthias Merker, Maxime Barbier, Helen Cox, Jean-Philippe Rasigade, Silke Feuerriegel, Thomas Andreas Kohl, Roland Diel, Sonia Borrell, Sebastian Gagneux, Vladyslav Nikolayevskyy, Sonke Andres, Ulrich Nubel, Philip Supply, Thierry Wirth, Stefan Niemann. Compensatory evolution drives multidrug-resistant tuberculosis in Central Asia. eLife 2018;7:e38200. DOI: https://doi.org/10.7554/eLife.38200

• Nikolayevskyy V, Kontsevaya I, Nikolaevskaya E, Surkova E, Samchenko S, Esipenko S. Diagnostic performance and impact of Xpert® MTB/RIF assay routine implementation in high drug resistant TB settings in Odessa Oblast, Ukraine. Clinical Microbiology and Infection 2019. Accepted

Trainings

Within ERLTB-Net project, NMRS-South jointy with SRL Milan provides regular training through organizing small and large training workshops on key aspects on TB laboratory diagnosis including molecular tools, WGS-based methods and bioinformatics. A total of 16 small and 8 large training workshops were organised in 2009 - 2017.

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