Category Archives: Chagas

Northeastern University Launches Integrated Global Health Initiative to Tackle NTDs

African Sleeping Sickness, Chagas, leishmaniasis, R&D

By Angela Herring

Drug discovery is by definition slow and costly. The multiphase process, which begins with basic science research and ends with clinical trials, can consume up to two decades and more than a billion dollars.

Credit: Mary Knox Merrill, Northeastern University

For NTDs such as African sleeping sickness and Chagas disease, the outlook is even grimmer: anti-infective drugs tend to have higher fail rates than other drugs, as parasites quickly develop resistance. And since NTDs predominantly affect low-income populations, the incentive for big pharmaceutical companies to improve on current treatments is low.

But current treatments are ghastly. In some cases, the drugs themselves can be poisonous and have high mortality rates. With one-third of the planet’s population at risk for NTDs, a new paradigm is required.

Northeastern University chemistry and chemical biology professor Michael Pollastri believes an open-source science model will hasten the drug discovery process. Despite great advances in NTD research over the last decade, the global research effort is largely uncoordinated. Continue reading →

New routes to Chagas

Chagas

By: Charles Ebikeme

On March 5th 2001, a 37 year old woman went into surgery to have a kidney and pancreas transplant from a donor that had already passed away. Once discharged, she returned to the hospital six weeks later to be treated for a sudden onset of fever, of unknown origin. She would die six months later, on the first week of October.

What turned out to be the first recognized case of a Chagas disease infection through solid-organ transplantation in the Unites States came after the physician identified the parasites in a peripheral blood smear. Upon identification the physician immediately notified the Center for Disease Control (CDC). Upon further investigation it was discovered that other patients had received infected organs from the same donor- 32 year old woman who had received the liver and a 69 year old woman who received the other kidney. Both organs were found to be infectious. The donor of the infected organs was an immigrant from Central America.

An acute Chagas disease infection with swelling of the right eye (Romaña's sign). Source: CDC.

At the time, no protocol or policy was in place for the regular screening of organ donations for T. cruzi, the parasite that causes Chagas disease — something that was routinely done in Chagas endemic areas. And no test was licensed for screening organ or blood donors. Today, two Chagas tests are available, out of a full complement of 60 that are licensed and routinely used to screen organs and blood donation for a wide range of infectious agents (including HIV, hepatitis and West Nile virus).

After the infection was detected, all three women were treated with nifurtimox — a drug not available in the US at the time and a drug that, over ten years later, still only has a single manufacturer. Today, nifurtimox, which dates back to 1960, is available for US$48 per treatment regimen — the equivalent of a month of a Bolivian miner’s salary.

Of the three women that were infected, it was only the 69 year old woman that would survive the parasitic infection. The woman who received the kidney and pancreas transplants was the most immunosuppressed of the three patients, and her death was a result of immunosuppression. She died even after completing a full course (4 months) of treatment with nifurtimox. Continue reading →

Treatment for Chagas: Enter Supplier Number Two

Chagas, NTDs

By: Julien Potet, Neglected Tropical Diseases Policy Advisor at Médecins Sans Frontières’ Access Campaign

There are multiples challenges in improving access to drugs for neglected tropical diseases. More resources are desperately needed to scale up prevention and treatment programmes, and new incentives must be found to spur research into better treatments, due to the reluctance of pharmaceutical companies to invest resources into drug development for diseases without a lucrative market.

Maintaining a continuous supply of the existing medicines in sufficient quantities is another considerable challenge, as many drugs for neglected tropical diseases are produced by a single supplier. Often the reason for this is not patent protection, as most of the medicines I am talking about here are reasonably old and are no longer covered by any kind of intellectual property rights. These drugs are produced by a sole supplier because the absence of a highly valuable market makes it difficult to attract several producers.

Take benznidazole, the first-line treatment for Chagas disease. Benznidazole is far from being a perfect treatment, and more research and development into better medicines is needed. But benznidazole is safe and highly effective in acute cases of Chagas disease (predominantly seen in children), and is also feasible and beneficial for adolescents and adults with chronic Chagas disease. The Swiss multinational pharmaceutical company Roche decided to hand over its production of benznidazole to another company in the late 1990s. In2003, atechnology transfer agreement was reached with LAFEPE, a state-owned Brazilian company, and LAFEPE became the sole producer of benznidazole worldwide.

MSF doctors examine a patient treated with benznidazole in Aiquile, Bolivia Credits : Vania Alves

Relying on a single producer is risky. Last year, for a number of technical and political reasons, there was a global shortage of benznidazole. In October 2011, Médecins Sans Frontières publicly urged Brazil’s Ministry of Health to resolve the situation. Production was resumed at the end of 2011, but it is still unclear whether LAFEPE will be able to produce the quantities required.

There are many other drugs for neglected tropical diseases that rely on a single producer. They include nifurtimox, for Chagas disease and sleeping sickness (produced by Bayer); eflornithin, for sleeping sickness (produced by Sanofi-Aventis); and paromomycin, for kala azar (produced by Gland Pharma). Continue reading →

Developing World Health: Working to Reduce Needless Suffering from NTDS

Chagas, dengue, Global Health, NTDs

Developing World Health with pharmaceutical companies, institutions, hospitals and other organizations to conduct medical research on new cures or treatment approaches to NTDs. Founded in 2008 by Dr. Stuart Smith, FLS, Developing World Health aims to target four major NTDs: Leishmaniasis, African Trypanosomiasis, Chagas Disease, and Dengue Fever. Combined, these diseases affect 3.2 million people annually across the globe.

In early 2012, the organization attended the top-level meeting, the London Declaration on Neglected Tropical Diseases, alongside the Global Network, which similarity advocates for broader use of existing medicines to treat seven leading NTDs with its END7 Campaign. Developing World Health is working on developing two pharmaceutical products that it has identified as highly promising treatments against its four NTD targets. Inspired by the London meeting, Founder Dr. Smith is confident that it is possible to fully treat and prevent NTDs among the world’s poorest populations. He states that, “there’s a good probability that, if not elimination, we will at least make a major impact on some of these diseases.” 

Dr Smith’s work also focuses on the revealing link between NTDs and HIV/Aids.  Studies have shown that the reasons for HIV/Aids prevalence in Africa does not necessarily come down to sexual promiscuity and unprotected sex. In fact, it has been revealed that young, sexually active women with genito-urinary schistosomiasis are three times more likely to contract HIV. Dr. Smith believes that “there’s a very strong link between co-infection with NTDs and an increased risk of getting HIV. [It’s] a very important area and one we [Developing World Health] hope to rais[e] awareness of.”

Developing World Health collaborates with Global Network founding partner Schistosomiasis Control Initiative (SCI). Click here to learn more about what Developing World Health is doing.