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ITG Antwerp Puzzling to find a medicine to fight cutaneous leishmaniasis

Cutaneous leishmaniasis is a skin disease that is caused by a parasite transmitted by the bite of a sand fly. The disease is not fatal, but in the most severe cases, it leads to disfigurement and hence to stigmatisation. Until now, research into the disease has been fragmented, but Wim Adriaensen, together with his multidisciplinary and international research group, is hoping to solve the puzzle.

‘Leishmaniasis occurs primarily in the tropics and subtropics,’ says Wim Adriaensen of the Institute of Tropical Medicine (ITG) in Antwerp. ‘It mainly affects people who live close to livestock, or those who sleep outside on the ground. In other words, the impoverished population. This fly is a very bad flyer and lives close to the ground. Hence, why.’ It is estimated that the sand flies infect one million people a year, but the disease remains under the radar, since it mainly affects the poorest population. The disease has now spread to southern Europe, due in part to global warming. For instance, outbreaks of leishmaniasis have been reported in Spain and even in the south of France.

Mutilations

The disease has many forms, says Adriaensen. ‘The visceral variant damages the liver and the spleen and is fatal if not treated. We are conducting research into cutaneous leishmaniasis. That manifests itself in the skin and may also take various forms. Some people suffer from a mild form that has localised lesions which heal on their own. In others, it attacks the soft tissue of the mouth or the inside of the nose, for example. This leads to severe disfigurement of the face. There is also a third form, in which the disease occurs all over the body, sometimes with up to 200 lesions. The crucial question is: How does the same parasite cause so many different clinical pictures? Is it the parasite? Or perhaps where you are bitten? Is it because of the immune system?’

Revolutionary

In short, it is a complex puzzle. According to Adriaensen, part of the reason why research into cutaneous leishmaniasis has stagnated for several decades is that we can usually only look at one part of the problem. ‘The revolutionary aspect of our research is that we bring together different disciplines, specialists and institutes as well as having the latest technology at our disposal. Which is why we were so pleased to win the call for proposal. Thanks to the substantial contribution from Dioraphte, we can apply advanced but expensive techniques from cancer research to a neglected tropical disease.’

‘The revolutionary thing about our research is that we bring together different disciplines, specialists and institutes as well as having the latest technology at our disposal’.

Living skin

Adriaensen is coordinating a consortium made up of scientists from the ITG, the University of York, the University of Maastricht and the University of Gondar in Ethiopia. This is also the same country in which the test subjects participating in the study live and it is one of the few countries in which all three forms of cutaneous leishmaniasis occur simultaneously. Skin biopsies are taken from one hundred and twenty infected people and from a control group of forty healthy people. They are immediately frozen in liquid nitrogen and flown to different institutes in Europe for an in-depth examination into every detail. ‘By not manipulating the skin and bringing everything together at a spatial level, we can obtain a complete ecological picture of how the parasite hides in the skin of patients and how it interacts with our immune system. But what factor determines the pathology? This research will yield a wealth of data which will help us to find a drug that will direct the disease towards its self-healing form or, better still, prevent it. But that will be five to ten years from now.’