2020

For years, ITM has been at the forefront of the fight against human African trypanosomiasis (HAT) or sleeping sickness. Our researchers continue to develop new diagnostics and innovative control strategies. Every year, several hundred gambiense-HAT cases are reported in Africa, with the vast majority in the DRC. ITM is working with its Congolese partners to eliminate the disease by 2030. To measure elimination success with prevalences close to zero, highly specific and sensitive diagnostics are necessary. Such a test exists in the form of an antibody- mediated complement lysis test, the trypanolysis test, but biosafety issues and technological requirements prevent its large-scale use. ITM researchers developed a new, highly specific and sensitive test (inhibition ELISA) that is applicable in regional laboratories in gambiense-HAT endemic countries. The project is funded by DGD and the Bill & Melinda Gates Foundation.

Geerts et al., Clinical Infectious Diseases, 2020

In line with ITM’s research priority on (re-)emerging infections and outbreaks, we have joined a new international partnership. In 2020, the US National Institutes of Health (NIH) established ten new Centers for Research in Emerging Infectious Diseases (CREID) across the globe. The goal of this new global network is to conduct multidisciplinary research into how and where viruses and other pathogens emerge from wildlife and spill over to cause disease in human beings. Each CREID centre involves collaborations with research institutions from the North and South that focus on diseases relevant to specific regions. ITM and the DRC-based Institut Nationale de Recherche Biomédicale are collaborators in the East and Central Africa centre. In 2021 they will jointly start investigations on Rift Valley fever and Middle East respiratory syndrome (MERS).

The outbreaks of Zika virus disease and yellow fever in 2015–2016 have highlighted the global public health challenges we face from upsurges of insect-borne diseases. Due to climate change, globalisation, environmental and social factors, the insects and the diseases that they can transmit, are spreading worldwide. ITM is home to more than 1000 mosquitoes and flies in a unique ultra-modern insectary infrastructure set up in 2020. Scientists are carrying out research on the interactions between pathogens, insects, humans and the environment. This allows the Institute to contribute to the prevention, detection and control of insect-borne infectious disease outbreaks. The Flemish Ministry of Economy, Innovation and Science provided key funding for the facility, and Minister Hilde Crevits visited the insectary to see its progress in July.

Stable HIV patients can be monitored remotely via a secure app that allows them to view their laboratory results. The GP carries out the monitoring in close collaboration with the patient. A two-year pilot project at ITM showed that this digital monitoring is highly appreciated by HIV patients and has no negative impact on the quality of care. On the basis of the laboratory results, the doctor determines whether the patient is stable and informs the patient of the results via the secure app. If the patient agrees, he or she will be able to get a remote consultation and receive his/her prescriptions by post or electronically. The digital follow-up is the result of ‘EmERGE’, an EU-funded research project. The new monitoring method was also tested and approved in HIV clinics in England, Croatia, Spain and Portugal.

Since the 1980s, ITM scientists and Peruvian partners have been studying the molecular epidemiology of leishmaniasis. This infectious disease, existing for thousands of years, is caused by a parasite and spreads via sandflies. Leishmaniasis causes severe mutilations of the skin or intestines and can lead to death. Researchers of ITM and the Instituto de Medicina Tropical ‘Alexander von Humboldt’ in Lima have undertaken studies into the parasite in the Peruvian Andes. Frozen samples were brought back to life and, thanks to modern technology, the entire genome was read. This study is a very rare and well-founded example of ecological speciation. The researchers found new indications that the emergence of new diseases and climate change go hand in hand. Because of global warming and globalisation, we will see more and more tropical diseases emerging in our regions.

Van den Broeck et al., PNAS, 2020

With around 1.5 million deaths a year, tuberculosis (TB) is the world’s deadliest infectious disease. Rifampicin is the most effective drug against TB, yet it no longer works against all TB strains. Detecting resistance to this drug as early as possible is crucial for selecting the right treatment for TB patients. One of our PhD students and a fellow biologist supervising the national TB reference laboratory in Rwanda, exposed a serious problem in Rwandan patients with tests that detect resistance to TB drugs. Half of the tested persons infected with resistant TB were falsely diagnosed and did not get the correct treatment. Based on this finding, the National TB Programme in Rwanda changed its diagnostic algorithm and patients now receive proper care. ITM’s research on TB is world-renowned. Our institute has the largest public collection of TB strains for research.

Ngabonziza et al, The Lancet Microbe, 2020

In the run-up to World AIDS Day on 1 December, ITM launched a mouth mask campaign which invited people to change the negative discourse about living with HIV, to provide support to the affected community. Annually, around 3000 people with HIV are being followed up at ITM’s HIV/STI clinic.

On 20 January, ITM and a delegation of four Thai scientists from the government and the health sector reaffirmed their joint commitment to academic cooperation. Additionally, both parties agreed to look at possible collaborations in the field of public health research.

Ngabonziza et al, The Lancet Microbe, 2020

Molecular surveillance is essential for controlling infectious diseases but for neglected tropical diseases this methodology remains underexploited. ITM researchers studied its relevance for ongoing elimination programmes in the cases of leishmaniasis, sleeping sickness and Chagas disease, and highlighted its potential in preventing new epidemics. Molecular surveillance is based on genetic methods that identify the genome of a pathogen and provides extremely detailed and reliable data. Therefore, the origin of an epidemic and its transmission route can be identified and measures can be taken. Over the last decade, ITM has invested in studies of the genome of parasites responsible for neglected diseases. The financial support of the Flemish Government’s Department of Economy, Science and Innovation made this possible.

Domagalska & Dujardin, Trends in Parasitology, 2020

In September, an elderly couple in Kampenhout, Belgium died of malaria. Unusually, the couple caught the disease at home, not while travelling. In all probability, they both received a bite from an infected malaria mosquito that reached our country via an airplane. In order to confirm this hypothesis, ITM scientists from varying disciplines investigated how this exceptional infection could take place. The MEMO (mosquito monitoring) team checked whether the indigenous Anopheles mosquito, which can transmit malaria in laboratory conditions, could be found in Kampenhout. The Unit of Malariology received blood samples from the deceased couple and investigated where the malaria parasite causing the infection came from. Thanks to the multidisciplinary research of ITM, and a census of surrounding mosquito species, it was officially confirmed by the Agency of Care and Health of the Flemish Ministry of Health that the couple was not infected by an indigenous malaria mosquito and that further transmission was unlikely.

ITM has antimicrobial resistance (AMR) high on its agenda. In a recent study, researchers looked into antibiotic use in patients with persistent fever before seeking medical care in a hospital in low- and middle-income countries (LMIC), and found that ‘Watch’ antibiotics were widely used in certain LMICs, such as Nepal and Cambodia. According to the World Health Organization, the ‘Watch’ group includes clinically important antibiotics that are at relatively high risk of selection of bacterial resistance, and they should be prioritised as key targets of antibiotic stewardship programmes and monitoring. This study informed other ongoing research at ITM, which, in collaboration with partners Institut National pour la Recherche Biomedicale (INRB – National Institute for Biomedical Research), Centre de Recherche en Santé de Kimpese (CRSK – Health Research Centre of Kimpese), and Clinical Research Unit of Nanoro (CRUN), aims to look into antibiotic use in the community in the DRC and Burkina Faso, and compare this to hospital use. The ultimate goal is to find out how best to optimise antibiotic use in order to prevent a further increase in AMR.

Ingelbeen et al., Clinical Microbiology and Infection, 2020

In order to further strengthen ITM’s partnerships in Flanders and beyond, the 2020 edition of our Joint Pump Priming Programme (JPPP) stimulated ITM researchers to submit a joint application with outside researchers who are willing to co-invest in the development of a new research idea. Nine joint projects were approved and include collaborations with the Catholic University of Leuven on malaria transmission; the Charles University in Prague, Czech Republic on Leishmania lifecycle; Nagasaki University, Japan on stillbirths and newborn health; University of Antwerp on COVID-19, chemsex, and West Nile neuro-invasive disease; University of Colorado and Harvard University, US on drug resistance in tuberculosis; and the University of Tartu, Estonia on SARS-CoV-2 fitness.

In 2020, FWO awarded a PhD Scholarship to three junior researchers who will conduct a joint research project at ITM and the University of Antwerp. All three PhD projects will use and develop computational methods, data mining and machine learning algorithms Partnershipsfor advanced parasitic and viral disease research. In the Department of Clinical Sciences, Anna Postovskaya will work on T-cell receptor-based diagnostics for viral diseases, while Nicky de Vrij will work on Leishmania epitope repertoire of the human T-cell response. In the Department of Biomedical Sciences, Yasmina Drissi El Boukili will work on factors that impact Plasmodium falciparum sexual conversion. The computational component of the research in all projects will be guided by the expertise of the University of Antwerp data science lab led by Professor Laukens.

For several years, ITM has been conducting research on oral pre-exposure prophylaxis (PrEP), a preventive method which entails the use of antiretroviral medication among HIV negative individuals. A study conducted in Côte d’Ivoire, Burkina Faso, Mali and Togo showed that the use of daily and event-driven oral PrEP among MSM (men having sex with men) at high risk for HIV infection, substantially reduced HIV incidence. As a conclusion, PrEP is considered feasible in these settings and is recommended for further implementation. In collaboration with local research teams, ITM researchers are also conducting a qualitative research project to anticipate the PrEP roll-out in these countries. Preliminary findings suggest that the anticipated risk of being seen using PrEP may limit its uptake and use, due to its associations with homosexuality, HIV and promiscuity. For these MSM, long-acting PrEP modalities such as implants or injectable PrEP may be a highly promising additional strategy.