Groundbreaking research into treating malaria infections in pregnant women has earned Professor François Nosten, Director of the Wellcome Trust-funded Shoklo Malaria Research Unit (SMRU) in Mae Sot, Thailand, international recognition. Professor Nosten today receives the Christophe & Rodolphe Merieux Foundation Prize, a €400,000 prize awarded to a researcher or research team studying infectious diseases in developing countries, presented by the Institut de France.
"I'm delighted to have received this award," says Professor Nosten. "The recognition from my home country for the work of myself and my colleagues is very important, and the prize money will allow me to conduct more work on maternal malaria, a poorly-researched area."
Malaria is one of the world's deadliest killers, killing over a million people each year, mainly pregnant women and young children in Africa and south east Asia. Although treatments exist to tackle the disease, which is caused by Plasmodium parasites, until Professor Nosten's work, little was known about how to treat pregnant women, particularly in areas where the parasites have been increasingly developing resistance to treatment.
"Pregnant women are always excluded from clinical trials because of the fear of harming the unborn baby," explains Professor Nosten, a professor at the University of Oxford. "Paradoxically it was considered unethical to recruit pregnant women in studies, but ethical to leave them untreated."
Professor Nosten, together with Professor Nick White, Chairman of the Wellcome Trust's South East Asia Programme, began researching maternal malaria over twenty years ago in 1986 on the border of Thailand and Burma where they saw many pregnant women dying from malaria. By organising antenatal consultations for all pregnant women to screen their blood every week during the pregnancy, they were able to detect malaria parasites quickly and treat them before they developed into severe infection.
"The antenatal screenings were very time intensive, but the system worked beautifully," says Professor Nosten. "The number of pregnant women dying from malaria fell from one death per hundred live births to zero."
The success of their approach enabled the team to focus on the prevention and treatment of malaria in pregnant women, and area where very few studies had previously been conducted. Professor Nosten and colleagues have undertaken most of the clinical trials looking at the best treatment options, including looking at how antimalarials are absorbed and metabolised by the body. This allowed them that pregnancy alters the efficacy of antimalarials and that the doses of medicines given to pregnant women were too low and therefore less efficacious.
Their work has led to a revision of guidelines produced by the World Health Organisation (WHO), which now recommend treating women in the second and third trimesters of pregnancy with artemisinin combination therapies. They have also provided almost all the available clinical evidence on the safety of treating pregnant women with artemisinin therapies, including the largest series on exposure during the first trimester.
Professor White says: " François and his team work in very difficult circumstances, yet they have produced some of the most important research on the treatment of malaria, which has led to a global change in treatment recommendations. They have conducted pivotal work on the epidemiology, pathophysiology and treatment of malaria in pregnancy, and changed the way it is treated."
"I would like to congratulate François on receiving well deserved recognition for his important achievements," say Dr Mark Walport, Director of the Wellcome Trust. "Malaria is one of the world's major killers and treating pregnant women has often proved complicated and potentially dangerous. Thanks to the work of Francois and his colleagues, however, the treatment options are now much clearer, reducing the risk to the mothers. His work has been invaluable for saving the lives of many women and their unborn children."