Each year, leishmaniasis and Chagas disease infect more than two million people and kill approximately 10,000 people. Dr Mags Leighton, Project Manager of the Neglected Tropical Diseases Network, in our Department of Chemistry outlines how an equal approach to sharing scientific expertise and resources is needed to tackle these diseases.
Jinnha Hospital, Karachi, November 2019, and here in Dr Barham Khoso’s clinic the human reasons behind our research into Neglected Tropical Diseases (NTDs) are suddenly clear. Before us stand four children whose faces bear sores and scarring from cutaneous leishmaniasis. These siblings were infected whilst visiting their grandparents’ rural village. We hear how their teachers denied them entry to school due to fears of infection spread, even though the sandflies that spread this parasitic disease are not present here in the city. In future, the stigma of these disfigurements could similarly exclude them from opportunities for education, employment, even marriage. Current treatment involves painful injections of pentavalent antimony (a toxic chemotherapy drug) directly into the sores. For three patients, the infections are subsiding, but one child’s sores remain.
Dr Khoso explains, “We need effective, safe drugs as creams or in tablet form; treatments that target this disease directly, that our patients can endure… that our country can afford…”
I am here with Professor Paul Denny, Director of the Durham-led NTD Network, an international consortium seeking new solutions to leishmaniasis and Chagas disease. These NTDs are familiar to our colleagues from endemic areas in Asia and South America. Approximately, over one billion people are at risk from leishmaniasis and Chagas disease, which together infect more than two million and kill approximately 10,000 people each year., Cutaneous forms of leishmaniasis destroy the lives of approximately a further 40 million survivors through social stigma . Decades of research ‘neglect’ has resulted in a lack of effective diagnostics, vaccines and patient-friendly drugs for these NTDs . The ‘losing battle’ against cutaneous leishmaniasis has worsened in Pakistan and elsewhere since COVID19-measures have diverted resources away from ‘non-emergency’ services including cutaneous leishmaniasis outpatient care.
The NTD Network’s international collaboration involves multidisciplinary teams from 13 institutions In Asia, South America and the UK. “It is through the equitable partnering of scientific expertise and resources from both the developing and developed world that we will find sustainable solutions to these diseases,” argues Professor Denny, who is also head of the Durham Centre for Global Infectious Diseases and a member of the University's Department of Biosciences. “Closer, egalitarian collaborations are vital to tackle current inequalities, and offer us potential routes to change the lives of millions of people.”
Since solutions for leishmaniasis and Chagas disease will take many years to achieve, the NTD Network programme has included workshops training over 100 early career researchers from endemic areas with the necessary specialist laboratory skills to continue this vital research. Also our first animation, describing the patient experience of cutaneous leishmaniasis, is now live on YouTube, with more to follow.
Recent UK government cuts to Overseas Development Aid means that our research programme faces an uncertain future. The NTD Network team are now seeking new funding sources, but Professor Denny’s deepest concerns are for the next generation of researchers, many of whom, without continued employment, must change career. He concludes that, “…an equal approach, plus investment in our early career scientists, is vital to address the under-appreciated threat to our global health security from Neglected Tropical Diseases”.
Main image: Cutaneous leishmaniasis: the patient experience. Follow the link below to watch our animation on cutaneous leishmaniasis, which explains what millions of sufferers ensure in tropical areas worldwide.
Dr Khoso’s team, based at the Jinnha Hospital in Karachi, are the dermatology clinical specialists for the whole of Pakistan.
Staff and students at the Neglected Tropical Diseases Network “Antileishmanial leads from Natural Products” training workshop; University of Karachi, November 2019.
Workshop students, gathered from across the Middle East and Asia, gained the laboratory skills needed to screen traditional plant remedies for potential new drug compounds against leishmaniasis.
Four siblings’ responses to pentavalent antimony treatment ranged from healing with minimal intervention (above left), through responding to multiple doses (above right, below left), to treatment failure (below right).