Swedish researchers lead fight for new malaria drugs

A Swedish summer without mosquitoes is no summer. But such familiarity with the bloodsucking insect does not explain why Niklas Lindegardh and his fiancée Anna Annerberg are key persons in a malaria drug research project that aims to release new and better medicines against this dangerous disease.
     Instead it is the leading role in worldwide malaria research at Dalarna University, their home institution in Sweden, which lies behind the couple’s move this summer from a quiet Borlänge to noisy Bangkok and the faculty of tropical medicine at Mahidol University.
     Both are hired for at least three years as analysts by the Wellcome Trust’s Oxford Tropical Medicine Research Programme´s Thailand unit at Mahidol University.
     Niklas Lindegardh, who has a PhD in analytical chemistry from Uppsala University, heads the Pharmacology lab there, together with a growing team that today consist of Anna Annerberg, engineer in chemistry with emphasis on analysis, and Tida Chanyachukul, a post-doc in pharmacology.
     Setting up and equip the laboratory was his and Anna’s first mission. That job was completed by December 2003 and research has just begun in earnest.
     “We will employ more staff as our work load increases. Our task is to find out how new malaria medicines are absorbed by the human body,” explains Niklas Lindegardh. “How fast it happens, how the drug is dissolved and how its effective ingredients show up and finally how the drug leaves the system and is disposed of by the body.”
     To the layman malaria may seem like an old plague now under control. Something traveling adventurers during the first half of the past century caught in tropical areas.
     Wrong. Malaria is still a plague and still very much a deadly threat to millions of people in and around the southern hemisphere.
     “It’s a terrible disease. The third after aids and tuberculosis measured as humanity’s worst killers. Between one and three million people die of malaria every year and 400 million people get the disease annually. Of the dead most are kids below five years of age. Children are more sensitive for malaria outbreaks than adults,” says Niklas Lindegardh.
     He shows a map where malaria hits people in the world today. The malaria area is synonymous with the global south. From South America to Asia.
Rich, industrialised and developed nations are spared the disease.
     “See? That is why malaria research gets less funding than projects for other new drugs. Also, profitability is quite low for malaria medicine and that too makes it less interesting for the large pharmaceutical companies to invest in.”
     If people could pay it might actually be a good business. But an efficient malaria drug, administered after the patient has fallen sick with the disease, costs around 3.4 USD a dose while most of all patients can afford only seven cents for a dose.
     That does not mean big drug manufacturers don’t care about malaria.
     Novartis, for example, has initiated collaboration with the lab for the development of analytical methods for the determination of a new malaria drug the multinational want to launch later.
     “That is actually our first project since we got the lab ready,” says Niklas Lindegardh. “Another project we manage is to analyse the effects of artekin, a 20 year old medicine made of a flower and synthetic drugs. It has been widely in use in China and Vietnam. The World Health Organisation, WHO, is of the opinion that artekin is so efficient it should be marketed worldwide. But before that can happen we need to evaluate how the drug works in humans, or perform what we researchers call pharmacokinetic studies.”
     While his research leaves nothing to chance, is the reason he once became interested in malaria purely a lucky coincidence.
     “I was competing in orienteering at national team level and wanted to study at a sports university where I could combine athletics and studies. Dalarna University accepted me and there I got involved in a malaria research project, managed by Yngve Bergqvist. I did so well there that I proceeded with doctoral studies at Uppsala University. My research projects were however still conducted at Dalarna University under supervision of Yngve Bergqvist. I got to know Nicholas White at Mahidol University during a WHO project and this spring I and Anna were ready to accept a job offer here,” explains Niklas Lindegardh.
     Mahidol´s malaria researchers cooperate with field units in Thailand where blood samples are taken and sent to Bangkok for analysis. One is located in Mae Sot another in Udon Thani. Samples are taken from Burmese, Laotians and Thais living in those regions.
     In due time will also laboratories like the one Niklas Lindegardh manage in Bangkok be set up by his team elsewhere in the region.
     “We do already have a small analyse unit in Vietnam but there will hopefully be more and better equipped laboratories later on,” adds Niklas Lindegardh.
     The blood samples contain lots of information for the researchers. Some reveal usage of drugs the parasite causing malaria is resistant against. Others show how fake drugs are taken. On people taking the new drugs, blood samples indicate how the drug should be administered to make most effect.
     And fighting malaria is a constant war. The parasite mutates all the time, thus making drugs inefficient after some time.
     Knowing this, how good are doctors and clinics back home in telling what preventive drugs travelers should take when going to malaria areas, it seems one must stay online with the latest malaria research findings to know what medicines to recommend?
     “Yes. I have friends who were prescribed prophylactic malaria drugs at their local clinics in Sweden by doctors that did not know the medicine was useless because the parasite was already resistant.”

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