Control of Leishmaniasis, from bench to bedside and community

Project overview

Photograph: James Gathany

Leismaniases are a group of human and animal diseases caused by single-cell flagellate protozoa transmitted by an insect: the sand fly. Leishmaniases are vector-borne diseases with a global distribution and devastating health and economic effects on people and domestic animals. The Leishmania donovani complex causes an estimated 0.2 to 0.4 million cases a year of visceral leishmaniasis (VL) in the world with 1,200 to 2,000 cases reported in the Mediterranean region. Anthroponotic VL (L. donovani), which has a human reservoir, gives rise to vast epidemics on the Indian subcontinent and in East Africa. Zoonotic VL and CL (L. infantum), which have a canine reservoir, is endemic in countries around the Mediterranean and in Latin-America. Furthermore, L. infantum and L. donovani tend to recrudesce in immune-compromised patients, especially those co-infected with HIV.  In addition, other Leishmania species cause about 0.7 to 1.2 million cases of various forms of cutaneous leishmaniasis (CL) around the world, including metastatic mucocutaneous disease with devastating life-threatening mutilation of the nasopharynx1.

Leishmaniases are considered major neglected infectious diseases by the World Health Organization (WHO). In developing countries, where the majority of cases are observed, Leishmaniases are especially prevalent in poor communities. In Europe, leishmaniases are both public health and veterinary issues. Zoonotic VL and CL caused by L. infantum are endemic in nine European countries (e.g. Spain, Portugal, France, Italy, Greece, Croatia, etc). L. infantum leishmaniasis is usually prevalent in children and immune-compromised individuals but large outbreaks in immune-competent people (e.g. over 500 cases in Madrid since 2009) have been reported2.

Interestingly, canine leishmaniasis is a main veterinary problem with a seroprevalence of 25% in domestic dogs and diagnostics, treatments and prevention of canine leishmaniasis (CanL) is a million euro market in Europe 3. The disease is expanding towards northern Europe and the risk of introduction of exotic Leishmania species into Europe from neighbouring countries (e.g. sporadic L. tropica cases in Greece) is increasing4.

Recently, the WHO has launched regional control initiatives that aim to reach millions of people currently at risk. Nonetheless, truly controlling leishmaniasis at a global level requires the development of new control tools and strategies. This R&D process should be conducted by a new generation of scientists trained in a state-of-the-art inter-disciplinary and international environment. Controlling NID will require global efforts to develop and evaluate new diagnostic, treatment and prevention tools adapted to the local conditions in Europe, America, Africa or Asia.

Why should Europe take the lead in this? Apart from its own public health and veterinary interests to do so, there is a strong case to be made to further develop and integrate existing capacity at EU level. Research conducted by European institutions and companies in the past few years, several with support from FP6 and FP7 programs, has contributed significantly to the development of new tools to control leishmaniasis (e.g. vaccines, rapid diagnostic tests, drugs). Importantly, the experience gained in European collaborative research projects on leishmaniasis lays a firm basis for effective future joint action, as research teams have diversified, specialized, and do interact and collaborate intensely.

Finally, the reduction of NID is one of the EU’s major development policy goals and thus a European training programme at PhD level focussing on the development and application of methodologies to control leishmaniasis is imperative. Researchers will be trained on a series of multi-disciplinary skills transferrable to other diseases and sectors. Special efforts will be invested to ensure that the knowledge generated by the research projects in the network is eventually applied at “bedside and community” so the EUROLEISH-NET has an impact both on the researchers’ career track as well as on leishmaniasis control.