Who is Robert Cooksey?

Robert Cooksey, the father-in-law of the lawyer who exposed people in several countries to a drug-resistant form of tuberculosis, has spent 32 years characterizing the bacteria that cause TB and other illnesses in the Centers for Disease Control and Prevention's Division of Tuberculosis Elimination.

Pablo Bifani, a researcher at the Pasteur Institute in Brussels who coauthored two papers with Cooksey, said Cooksey has contributed important work to his field, but has not built up the same prestige as others in the field. "I think he does good work, but he's not one of those who is in the forefront of TB research. But that's because he's at the CDC, and they have other responsibilities."

Cooksey led a group of researchers who identified two strains of a novel species of Mycobacterium, which they dubbed Mycobacteria cosmeticum. The new strains, found in both an Atlanta nail salon and a Venezuelan female undergoing a cosmetic procedure, were genetically different from known species.

Cooksey has access to a large pool of isolates of clinical TB, and identifies specific genes that are associated with drug resistance.

Bifani, a researcher at the Pasteur Institute in Brussels, said he does not know Cooksey personally, but the two have coauthored two studies that characterized genetic diversity and distribution of global strains of Mycobacterium tuberculosis. The studies were coauthored by more than 40 additional researchers and are among Cooksey's most highly cited work. One study, published in Emerging Infectious Disease, has been cited 54 times since 2002, and the other, published in the Journal of Clinical Microbiology, has been cited 55 times since 2003.

In the two papers, researchers identified strains from more than 90 countries using spacer oligonucleotide typing, a new and faster method that uses PCR amplification to detect M. tuberculosis isolates and identify related strains in a much shorter time period than previous techniques. The two studies built on each other to describe TB genotype diversity.

"Those studies are quite unique because there are not so many bacteria in which this has been done, that have been typed in a worldwide scale with such a method," Kristin Kremer, another coauthor on the studies from the Diagnosis Laboratory for Infectious Diseases and Perinatal Screening in Bilthoven, Netherlands, who was not familiar with Cooksey's role in the study, told The Scientist.

According to a CDC statement, the agency "will be looking at how [Cooksey] was involved" in the case. His son-in-law, Andrew Speaker made headlines last month when the CDC placed him in federal quarantine (the first in nearly 45 years) after he traveled with extensively drug resistant TB (XDR-TB) by taking two international flights and traveling around Europe.

Given the unique circumstances, "we've asked the Department of Health and Human Services Inspector General to come down and evaluate Dr. Cooksey's involvement as well," Tom Skinner, CDC spokesperson, told The Scientist.

Skinner said the CDC wants a full understanding of all aspects of the case. "We're not approaching this from the standpoint that any criminal activity happened," he said.

Cooksey issued a statement last month, denying having any involvement with Speaker's decision to travel. Cooksey did not respond to Email requests for comment. The CDC declined to connect The Scientist with Cooksey or his colleagues at the agency.

Steven Hinrichs, from the University of Nebraska Medical Center in Omaha, who coauthored a 2004 study with Cooksey, told The Scientist the case is "unusual and remarkable." "That doesn't mean it's not worth investigating and following up on," he added.

In the study, cited nine times since publication in the Journal of Clinical Microbiology, Hinrichs and Cooksey used a new assay Hinrichs' group had developed to detect genes in Mycobacterium tuberculosis (the agent that causes TB) and its close relative Mycobacterium bovis that confer resistance to pyrazinamide (PZA), a first-line treatment. Hinrichs said Cooksey helped interpret the results and their relevance to other organisms within the Mycobacterium genus.

Many of the studies Cooksey has coauthored in the past 10 years have been cited about two to three times a year. Of these, several have been conducted in collaboration with state or local health departments in identifying strains of Mycobacterium involved in infection outbreaks in hospitals.

"Dr. Cooksey is an outstanding microbiologist and scientist, and he's contributed significantly to the field of microbiology and Mycobacterium characterization," Hinrichs said.

Kelly Rae Chi
mail@the-scientist.com

Links within this article:

K. Eban, "Biosense or biononsense," The Scientist, April 2007.
http://www.the-scientist.com/article/display/52963/

Pablo Bifani
http://www.pasteur.be/pasteur_fr/index0855.html?page=molecular_pathology

R. Cooksey, et al., "Mycobacterium cosmeticum sp. nov., a novel rapidly growing species isolated from a cosmetic infection and from a nail salon," Int J Syst Evol Microbiol, Nov. 2004.
http://www.the-scientist.com/pubmed/15545488

Mycobacterium cosmeticum
http://en.wikipedia.org/wiki/Mycobacterium_cosmeticum

I. Filliol, et al., "Global distribution of Mycobacterium tuberculosis spoligotypes," Emerg Infect Dis, Nov. 2002.
http://www.the-scientist.com/pubmed/12453368

I. Filliol, et al., "Snapshot of moving and expanding clones of Mycobacterium tuberculosis and their global distribution assessed by spoligotyping in an international study," J Clin Microbiol, May 2003.
http://www.the-scientist.com/pubmed/12734235

M. Borgdorff, "Mycobacterium tuberculosis Beijing Genotype, the Netherlands," Emerg Infect Dis, Oct. 2003.
http://www.the-scientist.com/pubmed/14609469

CDC Media Update: XDR TB Public Health Investigation, June 2, 2007.
http://www.cdc.gov/od/oc/media/pressrel/2007/r070608.htm

"TB patient asks forgiveness but defends travel," ABC News, June 1, 2007.
http://abcnews.go.com/GMA/OnCall/story?id=3231184&page=1

"Statement by Robert C. Cooksey," Webwire, May 31, 2007.
http://www.webwire.com/ViewPressRel.asp?aId=37867

Steven Hinrichs
http://www.unmc.edu/Pathology/facultypages/hinrichsbio.htm

A. Mohamed, et al., "Temperature-mediated heteroduplex analysis for detection of pncA mutations associated with pyrazinamide resistance and differentiation between Mycobacterium tuberculosis and Mycobacterium bovis by denaturing high- performance liquid chromatography," J Clin Microbiol, March 2004.
http://www.the-scientist.com/pubmed/15004047