Towards a global research network for the molecular pathological stratification of leishmaniasis.

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The leishmaniasis are parasitic diseases caused by one of several species of single cell parasites (Leishmania) that are transmitted to humans by the bite of infected phlebotamine sand flies. These diseases affect over 150 million people across 98 countries worldwide, including many low and middle income countries (LMICs). Some forms of leishmaniasis are fatal, whereas other are very stigmatising and affect quality of life, particularly in children and women. Few drugs are available for patients leishmaniasis and no vaccines are currently registered for use in preventing or treating these diseases. Importantly, the drugs that we do have are not universally effective and often have significant side effects. Sometimes patients even in the same geographical area will respond quite differently to therapy, and for some drugs effectiveness may vary widely between different countries. In order to make the best use of current and future drugs for the leishmaniasis, we need to understand more about why this is the case, and use that information to select appropriate drugs or drug combination for use in different settings. Using the appropriate treatment would save costs in health care, minimise the patient suffering that results from administering ineffective treatments, and reduce the economic burden of disease on patients, their families and communities. In this proposal, we are aiming to lay the foundation blocks that will drive a new way of managing patients with leishmaniasis and conducting research into these diseases. We will use new molecular approaches to extract as much information as possible from small tissue samples that are collected from patients to diagnose their leishmaniasis, and use this information to start to develop new tests that can help clinicians decide on the best course of treatment. We will use the internet to ensure that the information obtained from these tissue samples is used most effectively for research, clinical decision making and for education and training. We will conduct an analysis of the added value of these changes in approach, in order to provide a case for their adoption by health systems in LMICs and by the funders of research. Ultimately, by adopting these practices we will seek to deliver improvements in health and economic prosperity in LMICs. The research we propose over the next two years will not provide all the answers, but will provide necessary proof of concept data to support applications for future funding that may allow us to realise this longer term ambition.