The four and a half year grant from the International Collaboration in Infectious Disease Research (ICIDR) will fund research on the epidemiological and immunological aspects of cutaneous leishmaniasis (CL) in Colombia.
CL is a parasitic disease that is spread by the female sand fly. In Colombia, annual cases reported in 2003 almost doubled from 5,000 cases to nearly 10,000. Children comprise a high percentage of cases and unfortunately have a poor response to pentavalent antimonial drugs, the standard drug therapy used in adults. At least 23 percent of the patients affected by CL in Colombian endemic regions are children under 12 years old. Diane McMahon-Pratt, professor in the Division of Epidemiology of Microbial Diseases (EMD) in the Department of Epidemiology and Public Health (EPH), the co-principal investigator of the study and the Yale Program Director on the grant, said, "This study will be used to impact mechanisms of control addressing the host response and effective treatments in endemic areas."
The ICIDR grant will support three projects in the research program. The first project will develop the infrastructure for clinical trials within the endemic area. This will lead to future studies to address the lack of a more effective treatment for children. The initial interests are to compare the success and the tolerability of a new oral drug, miltefosine, with the standard drug therapy in children. "Miltefosine has fewer side effects," said McMahon-Pratt. "It could provide a less toxic measure of intervention."
The second study will identify factors that are responsible for transmission as well as the most efficacious measures for vector control and for reducing the risk of parasitic infection. The third project in the program will determine the immunologic mechanisms that can lead to human susceptibility of the lesion development and factors required to mobilize the host response of eliminating the parasite and the promotion of healing.
"We are bringing the three dimensions of CL together in this study. We are working with the human cases together with the roles of the vector and of the reservoir animals," said Leonard Munstermann, senior research scientist in EMD and co-principal investigator on the study. "This has never been successfully done in a single study."
"With over 400 species of sand flies in the Americas alone and at least a dozen species of CL occurring all over the world, the epidemiology of leishmaniasis is complex," said Munstermann. "However, we believe that the current study in Colombia can become a sound epidemiological model for other endemic regions."
The program is a collaborative effort with the Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), located in Cali, Colombia. "This is one among several major international programs based at EPH," commented McMahon-Pratt, citing recent studies by other EPH researchers in Russia, China, Iran, Peru, Costa Rica and Brazil.
Other Yale researchers in the program include Theodore Holford, Richard Bucala, M.D., Prakash Nadkarni, M.D., and Lee Cohnstaedt. CIDEIM researchers include Lyda Osorio, M.D., Nancy G. Saravia, Neal Alexander and Clara B. Ocampo.
For further information on this grant, please contact Marcie Foley at 203-785-5476.