While most of the world shelters in place because of the global pandemic, Dr. Kevin Urdahl ’87 is leading a study of another infectious disease that kills more people in the world every day than COVID-19 as of late April 2020 – tuberculosis.
Urdahl, a researcher in the Center for Global Infectious Disease Research at Seattle Children’s Hospital, is overseeing a seven-year, $83 million grant from the National Institutes of Health (NIH) to study the world’s top infectious disease that kills more than 1.5 million people every year – almost half a million of them children.
Urdahl conducted research at the NIH while at Concordia. He knew in high school he wanted to do scientific research and the college had a cooperative education program that allowed students to spend a semester working in a lab at the NIH. He applied every year but was never accepted, prompting a trip to the director of the co-op program’s office.
“I asked Dr. Dan McKenna why I wasn’t accepted,” Urdahl said. “I said I really want to do research and I’ve been applying every year. I’m a good student and I don’t understand why I’m not being accepted.”
McKenna called the director of the NIH program and got him in.
“That phone call changed the course of my life,” he added.
“It opened doors for me and helped me get accepted in the M.D./Ph.D. program at the University of Minnesota and set my career track to be a scientist.”
The NIH contract Urdahl is currently working on is called Impact TB, which stands for Immune Mechanisms of Protection Against Mycobacterium Tuberculosis.
For most infections, vaccines work very well and have saved more lives than any other medical intervention in the last 100 years, but TB is more complex.
“There has been a TB vaccine for almost 100 years,” Urdahl said. “BCG, used in most of the world, saves 50,000-100,000 infants and small children from dying from the most serious forms of tuberculosis every year. But it has little to no effect on adolescents and adults, the very ones who spread TB to others and most often die from it. Most people who die from tuberculosis were immunized with BCG.
“Tried and true methods of developing a vaccine haven’t worked with TB because we really don’t know how immunity to tuberculosis is mediated and what the barriers to immunity are that need to be overcome in order to design a new vaccine,” Urdahl said. “First we need to know what a vaccine needs to do.”
In the 1900s as the U.S. and Europe became wealthier societies with the advent of the industrial revolution, the incidence of TB went down dramatically. In the ’60s and ’70s, the NIH quit funding TB research and decades passed without new understanding or knowledge that could have led to new drugs or a vaccine.
“It was a forgotten disease,” Urdahl said.
“There’s only recently been a kind of reawakening that this is still the number one infectious killer in the world,” he said.
Another reason the disease has attracted so little research funding is that it largely affects the poor living in crowded, impoverished conditions. Though that is not a usual description of much of the United States, it’s still a problem in the U.S. where people live in shelters or close quarters.
Under the grant, Urdahl’s consortium of seven different institutions will work to identify the mechanisms of immunity against TB and integrate research in animal models and in humans. Because they need to go where there is a lot of tuberculosis, two of the sites are in South Africa –
The launch for the initiative was scheduled for March with a kickoff meeting that was canceled due to COVID-19, resulting in Zoom meetings and delays in research ability. Researchers need to be able to go back and forth between animal models and human research but, due to the pandemic, they’re not able to do research in Africa at this time which also limits the ability to do research in Seattle.
“Just in the last five years there have been major advances in animal models, including vaccines that resulted in clearance of TB from the body,” Urdahl said.
Urdahl says they need to understand and how the immune system was able to clear the tuberculosis. Unlike the flu or COVID-19, it’s not as easy to contract TB. It is usually not transmitted by casual contact like sharing an elevator or a public bus and you won’t get it from someone who is asymptomatic. Most often, transmission of the infection requires prolonged contact like living in the same household for several weeks or months with someone who is actively sick. And it doesn’t show up in a week or 14 days. It usually takes several months or a year or two before you get sick.
Treatment for an active infection requires at least six months of four antibiotics a day. If any are missed, the treatment becomes suboptimal and resistance to antibiotics develops so there is a growing problem with antibiotic-resistant TB in the world. Very few people can complete the course on their own, so the resource intensive and expensive treatment requires a healthcare worker to deliver the antibiotics and monitor them being taken.
“When we get sick and take an antibiotic for 10 days, it’s often difficult to remember to take it especially on days nine and 10 when you’re feeling better,” Urdahl said. “But four every day for six months is nearly impossible especially if the side effects make you feel sick.”
Remembering Concordia
As Urdahl thinks about how his work with TB came about, he’s reminded that you never know when you take a class where life is going to lead you.
He recalls one such moment, a history class at Concordia with Dr. David Sandgren on problems of modern Africa. It met once a week for three hours and had four students and the professor in the class. It helped him during the five months he lived and researched in Kenya and gave him a foundation for understanding the issues in Africa he wouldn’t have had without the class.
“There was a ton of reading every week and the course was just a discussion group where the five of us sat in a room and discussed the reading,” he said. “There was no place to hide in that room, so everyone did the reading and I got so much out of that class.”
Urdahl says there were many classes that just made life better. English professor Dr. Gordon Lell instilled in him a lifelong love of Shakespeare that has enriched his life. He said Lell may have played a role in who he ended up marrying and the son they share because Urdahl’s first connection with his future wife was a love of Shakespeare. Their first date was a Shakespeare play.
“I loved Concordia,” Urdahl said. “I could go on and on about the professors who influenced me, in chemistry – Gus Dinga, Daryl Ostercamp, and Karl Dierenfeldt have a special place in my heart and my favorite biology teacher was Howard Osborn, who taught a histology course that was very rigorous and prepared me well for medical school.”
A fourth-generation Cobber, Urdahl’s dad, grandpa, and great-grandmother all went to Concordia before him. And longtime Concordia biology professor Ed Fuglestad frequented his parents’ motel in Jamestown, N.D., while traveling during the summer months, keeping the young Urdahl well-dressed in plenty of Cobber gear.
For now, like a good portion of the country, Urdahl works from home spending a lot of time on Zoom as he works to understand an infectious disease and home-schools his 9-year-old son.