Overall aim

The overall objective is to generate, disseminate and apply knowledge of human parasitic diseases, in particular malaria, leishmaniasis, sleeping sickness and schistosomiasis, and to strengthen the capacities in these fields in developing countries. The Department pursues this objective through innovative and applied research, post-graduate training and scientific support to research and control programmes.

 
 
The unit aims to optimise the use of existing vector control methods taking into account the epidemiological situation and health infrastructure. This requires a good knowledge of the vector and the interaction vector-parasite.
Within the thematic priorities of the department, the different research subjects are:

• the molecular interactions between trypanosomes and tsetse flies
• identification and characterisation of malaria vectors
• dynamics of malaria transmission in different environments.
• insecticide resistance
• vector control interventions

Our expertise in malaria control and particularly vector control is broad and covers different epidemiological situations (in Africa, and in Asia).

The Unit participates in highly innovative fundamental research on the host-trypanosome interaction, within an interuniversity network of excellence. Our unique tsetse-trypanosome model moreover provides the basic biological material for this research.

The Epidemiology and Control of Parasitic Diseases Unit was created within the Department of Parasitology in October 1999 with the appointment of Dr Umberto D’Alessandro as its head.

The objectives of the unit are the following:

• To study the epidemiology of malaria in different settings and apply newly available techniques (such as molecular biology) to solve (so far) unanswered but important questions for malaria control activities;
• To evaluate new interventions (efficacy, effectiveness, mode of delivery) for malaria control at individual and/or community level;
• To build up strong collaborative links with the different units of the Department of Parasitology and possibly with the other Departments, mainly but not exclusively in the domain of malaria research:
• To contribute to the teaching mission of the Institute by training and supervising MSc and PhD students;
• To provide technical support when required to national or international organisations involved in malaria control in endemic countries.

The unit is involved in several networks; one is the East African Network for Monitoring Antimalarial Treatment (EANMAT) a regional network comprising the national malaria control programmes of Kenya, Tanzania, Uganda and Rwanda. Another is the PREMA-EU, a cost-shared concerted action on malaria and anaemia control for pregnant women, involving institutions in the UK (Liverpool and London), Spain (Barcelona), Tanzania (National Institute of Medical Research), Mali (Bamako), Zambia (Lusaka), Nigeria (Calabar), Uganda (Kampala) and Thailand (Shoklo Malaria Research Unit). The research is focused on malaria and more particularly on the understanding of malaria epidemiology and on the evaluation of control measures.

The core priority of our unit is to further develop research on molecular biology of protozoa. Our research will stem from field questions, generate knowledge on the biology of protozoa and lead to the development of appropriate tools for detection and typing of protozoa. Leishmania will remain our top priority, but our expertise will be made available to other units of the department aiming to use molecular tools in other parasitic diseases, mainly malaria and trypanosomiases. In the context of disease control, molecular applications may be divided into three major conceptual categories, and we will be active in each of them:

a. detection

Here, the aim is to know whether a given parasite (whatever its species) is present in a given patient, host or vector. Techniques do not need to be very discriminatory, but detection levels should be the highest possible. Detection techniques essentially aim to be a support to diagnosis. In the coming years, we plan to:

• further evaluate sensitivity and specificity of kDNA and rDNA PCR assays for the diagnosis of visceral leishmaniasis
• simplify as much as possible the assays (less intrusive techniques, PCR-ELISA...)
• establish guidelines for PCR diagnosis according to its validation and cost-efficiency analysis.

b. strain typing

Here, the aim is to compare two parasite samples and test the null hypothesis of genotypic similarity. Techniques need to be as discriminatory as possible, and detection level should be high enough to allow direct genotyping from tissues (and avoid isolation and cultivation biases). Several applications may be foreseen, for addressing fundamental epidemiological and clinical questions, such as the elucidation of transmission patterns or the follow-up of treatment. In the coming years, we plan to:

• identify genetic targets providing the required discriminatory power for leishmanial strain typing
• develop simple PCR typing assays (up to micro-chip)
• evaluate them in key epidemiological situations

c. phenotyping

Here, the aim is to better understand the parasite contribution of parasite diversity to the phenotypic pleomorphism of the disease. In the case of leishmaniasis, this concerns three major questions. Is it possible to predict the (i) evolution of the disease, (ii) therapeutic failure and (iii) immunisation failure? For these applications, genetic markers directly involved in parasite phenotypes need to be identified, and studies need to be performed in a multidisciplinary context (for instance, to identify host-related factors) from clinically well documented patients. Our past basic research allowed us to identify candidate genes (mostly immunogens) and mechanisms (gene rearrangement and amplification) potentially involved in major phenotypic variation. They will be further validated and additional markers will be sought. Our intention is to seek active co-operation with groups involved in immunological research. Practically, we plan to:

• study clinical pleomorphism of American tegumentary leishmaniasis (ATL)
• understand pentavalent antimonials (SbV) drug resistance in ATL and VL
• study whether genetic and antigenic polymorphism might constitute an obstacle for immunisation strategies.

The unit is active in the field of human and animal trypanosomiases. In human trypanosomiasis, the specific areas of interest include diagnosis, treatment and drug resistance, and control of the parasite in the host. Parasitological, serological, bioclinical and genetic parameters are therefore investigated in view of their application in primary diagnosis, stage determination and follow-up. Research on treatment focuses on alternative treatment schedules with existing drugs and on follow-up of patients. Basic research is conducted to understand pathogenesis and neuropathogenesis of the disease. Improved diagnosis of T.B. brucei, T. vivax, T. congolense, T. evansi and T. equiperdum infections in several animal species are the main research activities on animal trypanosomiases. The diagnostic techniques under development include direct and indirect agglutination, ELISA and PCR. Other activities of the unit include management of a serum and cryobank, assistance to national control programmes, training, analyses on request, and production and distribution of different materials and reagents such as the Card Agglutination Test for Trypanosomiasis (CATT/Tbgambiense), currently used for large scale screening for sleeping sickness.

The Human Helminthology Unit is the successor to the Director's "Schistosomiasis Group", which in 2001-2002 was gradually integrated into the Department of Parasitology, and collaborates closely with the Immunology Unit in the Department of Microbiology. Its research still focuses primarily on schistosomiasis, with as main lines the immuno-epidemiology and population dynamics of Schistosoma infections, and the integration of control strategies into regular health care structures. In 2002, the Unit started exploring other areas in human helminthology, meeting an increasing demand from within and outside the Institute. In the coming years, it aims at developing helminthological components into relevant institutional collaboration programmes. It co-ordinates closely with the Veterinary Helminthology Unit, in particular with regard to the human component of zoonoses.