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

利什曼病是由几种单细胞寄生虫（利什曼原虫）中的一种引起的寄生虫病，其通过感染的白蛉叮咬传播给人类。这些疾病影响着全世界98个国家的1.5亿多人，包括许多低收入和中等收入国家。某些形式的利什曼病是致命的，而其他形式的利什曼病则非常耻辱，影响生活质量，特别是儿童和妇女。治疗利什曼病的药物很少，目前也没有注册疫苗用于预防或治疗这些疾病。重要的是，我们现有的药物并不是普遍有效的，而且往往有明显的副作用。有时，即使在同一地理区域的患者对治疗的反应也会非常不同，并且对于某些药物，不同国家之间的有效性可能差异很大。为了最好地利用当前和未来的药物治疗利什曼病，我们需要更多地了解为什么会出现这种情况，并利用这些信息来选择合适的药物或药物组合用于不同的环境。使用适当的治疗方法将节省医疗保健费用，最大限度地减少因无效治疗而造成的患者痛苦，并减轻疾病对患者及其家庭和社区的经济负担。在这项提案中，我们的目标是奠定基础，推动管理利什曼病患者的新方法，并对这些疾病进行研究。我们将使用新的分子方法从患者身上收集的小组织样本中提取尽可能多的信息，以诊断他们的利什曼病，并使用这些信息开始开发新的测试，以帮助临床医生决定最佳治疗方案。我们将利用互联网确保从这些组织样本中获得的信息最有效地用于研究、临床决策以及教育和培训。我们将对这些方法变化的附加值进行分析，以便为中低收入国家的卫生系统和研究资助者采用这些方法提供案例。最终，通过采用这些做法，我们将寻求改善中低收入国家的健康和经济繁荣。我们在未来两年提出的研究不会提供所有答案，但将提供必要的概念数据证明，以支持未来的资金申请，使我们能够实现这一长期目标。

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.