The transcript is available of a short ABC radio interview with Australian scientist Professor Alan Cowman who describes his recent study [1] on the so-called effector proteins that the malaria parasite uses in order to successfully invade red blood cells.

Professor Cowman believes that there is one protein that “decides” how all of these proteins are to be exported. He hopes that this protein - plasmepsin V - will turn out to be the Achilles heel of malaria and that a new type of malaria drug can be developed that works by targeting plasmepsin V.

The study appears in Nature in the same issue as a paper by US malaria researchers who report [2] they have found more than two dozen smell receptors in the malaria-transmitting mosquito Anopheles gambiae that enables the insect to home in on human sweat. They believe that some of the receptors “could be excellent targets” for chemicals to snare mosquitoes or repel them,

References
1. Boddey JA, Hodder AN, Günther S, Gilson PR, Patsiouras H, Kapp EA, Pearce JA, de Koning-Ward TF, Simpson RJ, Crabb BS, Cowman AF (2010). An aspartyl protease directs malaria effector proteins to the host cell. Nature; 463(7281):627-631.
2. Carey AF, Wang G, Su CY, Zwiebel LJ, Carlson JR (2010). Odorant reception in the malaria mosquito Anopheles gambiae. Nature; Feb 3. [Epub ahead of print]

The World Health Organization’s representative to Myanmar (Burma) has repeated warnings that resistance to artemisinin (now the mainstay of treatment to malaria) is spreading in the region.

Speaking to IRIN News, Leonard Ortega highlighted the role of increased movement of individuals and populations, and of the widespread use of fake or substandard drugs, in spreading resistant strains of malaria. He referred to studies, presented late last year at a WHO regional workshop of health officials, indicating that artemisinin resistance is present in areas along the Myanmar-Thailand, Myanmar-China and Cambodia-Vietnam borders.

A leading market research company forecasts that global market for malaria vaccines will reach $1.05 billion by 2017. The predictions are based on likely sales of products that are currently in the pipeline, including GlaxoSmithKline’s Mosquiri (RTS,S), which continues to be investigated in several large scale Phase III trials in Africa. Mosquirix is at a more advanced stage than any other malaria vaccine but is expected to produce protection rates of only around 50%.

More information available from MarketWire.

The Internet allows open discussion to take place on a huge range of topics, including the implementation of programmes to control the infectious diseases of poverty. The excellent Topnaman blog on malaria presents a discussion of an article [1] in the Bulletin of WHO that criticised some aspects of the President’s Malaria Initiative’s (PMI) work in Angola. The intervention in question was the use of indoor residual spraying (IRS) of insecticide.

The core of the criticisms made is that intervention areas were selected on the basis of reported clinical diagnoses of malaria, unsupported by laboratory findings, and that this led to expensive control efforts taking place in areas where they were not necessary.

Published on the blog are a response from PMI to the original Bulletin article, followed by a comment on this from one of the article’s authors, Bill Jobin.

PMI say that the work conducted in a low-transmission area provided “experience and confidence” to enable subsequent activities in higher transmission areas. But Bill Jobin argues the case for programmes that are based on data from microscopic diagnoses in appropriate sentinel populations. “Then we will know what the problem really is, and where to put our efforts”, says Jobin.

Reference
1. Somandjinga M, Lluberas M, Jobin WR (2009). Difficulties in organizing first indoor spray programme against malaria in Angola under the President’s Malaria Initiative. Bull World Health; 87(11):871-874.

In the good old days, most cases of malaria responded to chloroquine (CQ) treatment and there was a high level of public awareness as to the name of this drug. However, as an editorial in the Tanzanian online newspaper ThisDay points out, in this era of CQ resistance, very few people have a clear idea of what drug they or their children need when they suspect they have malaria.

Referring to a 2008 study [1] the article stresses that a high proportion of the antimalarials on sale in Africa are likely to be ineffective. The situation is confusing and people need guidance. ThisDay says, “There is need for the government to make an aggressive effort to remove all inappropriate and ineffective drugs (most of which are counterfeit products) from the shelves, while at the same time we look into the way of bringing down the costs of other effective drugs”. Governments also need to provide more information to assist the public in their efforts to choose effective drugs from the range of products now available to them.

Reference
1. Bate R, Coticelli P, Tren R, Attaran A (2008) Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa – A Six Country Study. PLoS ONE 3(5): e2132.

Research aimed at developing new treatments for the infectious diseases of poverty (IDPs) has generally been of very little interest to the pharmaceutical industry. The people with these diseases are, by definition, poor and would be unable to afford expensive new drugs. Hence there is no profit to be made.

However, the economies of some of some countries with high rates of IDP incidence are now growing rapidly. China is a case in point. Tuberculosis is the country’s number one infectious cause of death, claiming some 160,000 lives annually. China has the world’s second highest number of TB cases, after India.

But thanks to its economic success China can now pay for TB drugs. A study by the market research group ResearchAndMarkets says that China’s demand for TB drugs has grown at a fast pace in the past decade. It predicts that, in the next five years, both production and demand will continue to grow. The study examines China’s economic trends, investment environment, industry development, supply and demand, industry capacity, industry structure, marketing channels and major industry participants. (Unfortunately the full report is only available for a very high fee - around $6,000.)

What impact will economic growth in IDP-endemic countries have on the research priorities of the pharmaceutical industry? Certainly countries that have both IDPs and money become a more interesting prospect. Many countries with growing economies are, for example, afflicted by dengue fever and by malaria. Will industry come to regard these as more attractive areas for research than previously?

Some of the highest rates of infectious diseases, however, are in Africa where economies are still struggling. The profit motive for addressing their disease burden is still lacking.

A report in Business News says that drug giant Novartis has had no success in trying to raise funds from the public and philanthropic sectors to to finance development of drugs against neglected illnesses including dracunculiasis (guinea-worm disease), malaria and tuberculosis.

Novartis wants to raise about $1 billion annually for 10 years to create a fund that companies and institutions could draw on to develop treatments for diseases that get little drug-development interest because they wouldn’t be profitable. The US and European governments, the Bill & Melinda Gates Foundation and the Wellcome Trust have all apparently been approached without success.

Paul Herrling, head of Novartis corporate research says, “It’s two years I’ve been working on this thing, and I don’t have a cent”.

An intriguing report from Ecuador says that scientists have been given government backing to attempt to transform a vaccine used to protect against yellow fever so that it becomes active against malaria and dengue.

Researchers from the University of Guayaquil will apparently use the transformed vaccine in a study based in a military hospital - see report from SperoNews.

One reason why research is needed to develop new antimalaria drugs is the the appearance of resistance to drugs currently in use. The mainstay of malaria treatment is now artemisinin combination therapy (ACT) but many ACTs in circulation are faked or substandard versions. These products tend to contain low doses of active drugs, and when the malaria parasite is exposed to such doses the development of resistant strains is more likely to occur.

Action against fakes has generally been inadequate. News that fakes have been intercepted and seized by the authorities is always welcome therefore. AllAfrica.com reports that Nigeria’s National Agency of Food and Drugs Administration and Control (NAFDAC) has impounded a consignment of nine packages of the antimalarial Lonart (artemether plus lumafantrine) valued at Naira 10 million ($67 million). NAFDAC made the discovery during routine checks at Lagos airport and employed their recently acquired drug testing equipment to establish that the drugs were faked.

While the story is encouraging, one can only speculate as to how many fake antimalarials (and other drugs) are still entering countries like Nigeria undetected.

“Support for and inclusion of local research institutions in global health research is essential to develop well-adapted health tools”. This is the conclusion of an article in PLoS Medicine [1] which uses efforts to research and control efforts malaria as a case study.

The article is the third in a series of articles on the changing nature of global health institutions. The authors review a century of malaria and research control activities. They note that there has been a shift from centralized. short-term programmes efforts, often relying on single interventions, toward more decentralized, continuous efforts using multiple approaches: “Malaria is no longer seen primarily as a biomedical problem, but rather as a complex ecological system in which humans, mosquitoes, and parasites are interconnected. Malaria has also increasingly been characterized as a “global” and regional rather than a national or local problem. This has led to changed concepts of governance”.

Reference

1. Keusch GT, Kilama WL, Moon S, Szlezák NA, Michaud CM (2010). The Global Health System: Linking Knowledge with Action - Learning from Malaria. PLoS Med 7(1): e1000179.