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ARRA Investments in Neglected Tropical Diseases


Public Health Burden
The most frequent parasitic and bacterial infections that the 2.7 billion individuals surviving on $2 per day experience are due to neglected tropical diseases (NTD).1 Annually, NTDs account for 534,000 deaths per year.1 Estimates by the World Health Organization indicate that almost one billion people suffer from one or more NTDs.2 Disproportionately impacting the poor residing in urban environments and remote rural areas in low- and middle-income countries in Latin America and Sub-Saharan Africa, NTDs negatively effect maternal and child health, cause loss of economic productivity, augment poverty, produce disfigurement, and long-term disability.1 Furthermore, U.S. citizens are at risk for contracting NTDs when traveling or working abroad.

Training
The private and non-profit sectors provide either support for biomedical or public health intervention, implementation or health services delivery. Capacity building and research training related to neglected tropical diseases are usually absent.  Therefore, leveraging US institutions to strengthen research capacity in developing countries with high prevalence of neglected tropical diseases is needed. One ARRA grantee proposes a research training programs that will facilitate basic science research and bioinformatics training in NTDs.
  • A workshop will instruct participants to access, analyze, and utilize protozoan pathogen databases housing genomic sequences, annotations and variations with the intent to identify targets for drug development.3
Basic Science Research:
Clarification of the pathogenesis of NTDs would permit earlier detection of biochemical and immunological changes, giving time to slow disease progression. Targeted therapies directed at regulators or modulators at specific points upstream within a pathogenic pathway enhance the probability of a favorable outcome for the patient. One ARRA grantee is exploring this area by:   
  • Investigating the role of T-cells, cytokines, and other immunological markers in the development of the pathology of Chagas’ disease patients in Bolivia.4
Vector Ecology and Management:
Onchocerciasis (river blindness) control involves accurately identifying at-risk populations to ensure that ivermectin is deployed to those most in-need. A sustainable means for long-term management of this disease in endemic areas is necessary.  Because the disease affects individuals in highly remote areas, it is challenging to conduct on-the-ground epidemiological surveys.  Detection of breeding sites of the fly that transmits the disease will be facilitated by:
  • Designing a detailed spatial map of the Onchorcerciasis endemic areas using satellite data, existing epidemiological data from Onchorcerciasis control programs in West Africa, and new diagnostic tools to predict areas where interventions are necessary based on remote sensed data.5
Co-Infection:
Risk of lifetime disability or death is intensified in immunocompromised patients including people living with HIV/AIDS contracting NTDs.  ARRA grantees seek to better understand the differing effects of toxicariasis and cysticercosis on the nervous system in HIV and non-HIV patients to determine effects of treatment by:
  • Conducting a seroprevalence study of toxocariasis and cysticercosis in patients stratified by HIV status, stage, and absence or presence of neurological complications.6
Innovative Disease Management through Drug Discovery:
NTDs are not frequently the target for new drug development. One ARRA grantee is exploring new opportunities in Panama for cost-effective treatments by:
  • Screening Panamanian cyanobacteria, endophytic fungi, and heterotrophic bacteria for potential new drug candidate molecules.  Novel drug compounds from microorganisms have been the basis for many antibiotics and several of the existing treatments for malaria and other parasitic diseases.7



  1. Hoetz, P., Molyneux, D., Fenwick, A., Kumaresen, J., Ehrlich, S., Sachs, J, and Savioli, L. Control of Neglected Tropical Diseases. New England Journal of Medicine. 357(10) 1018:1027
  2. Savioli, Lorenzo. A letter from the Director: Control of Neglected Tropical Diseases Has Taken on a New Dimension. World Health Organization. Accessed October 9, 2009 from http://www.who.int/neglected_diseases/director/en/index.html.
  3. 3D43TW000924-09S1 --Research Training on Intracellular Pathogens-- Stuart, Kenneth, WA.
  4. 3R24TW007988-02S1 -- Serologic prevalence of Chagas’ Disease in Cochabamba, Bolivia and the role of the novel Th17 pathway in the development of chronic Chagas’ cardiomyopathy—Comer, Robert, TN.
  5. 1R01TW008508-01 -- Spatial Modeling of Onchocerciasis Foci in Africa by Remote Sensing-- Unnasach, T. FL
  6. 1R21TW008434-01A2 HIV-CNS Diseases and Parasitic Zoonoses in the Eastern Cape, South Africa- Carabin, Helene. OK
  7. 3U01TW006634-06S1 --International Cooperative Biodiversity Group: Training, Conservation, and Drug Discovery using Panamanian Microorganisms--Gerwick, W. CA.


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