MRC Laboratories, The Gambia
Unit profile from the MRC Network publication issued Autumn 2007.
Set up in 1947, the unit is the UK’s single largest investment in tropical medicine research in a developing country and is one of the world’s major centres for research into infectious diseases. Working towards the United Nation (UN)’s Millennium Development Goals, the unit is helping to reduce the burden of death and disease worldwide.
Professor Tumani Corrah has been Unit Director of the MRC Laboratories since 2004, following two years as acting director. Born in The Gambia, he trained in medicine in St Petersburg, Russia, followed by Ibadan, Nigeria and then Edinburgh and Wales. He returned to The Gambia in 1982 to take up a clinical post at the MRC Hospital. In 1983 he started his PhD on the immunology of tuberculosis (TB). This involved pioneering work carrying out one of the first trials of immunotherapy to treat TB in Africa. He continued to move up the ranks at the unit, strengthening its clinical research, until taking over from the previous director Professor Keith Adam in 2002.
The unit’s decision-making body is an executive management board chaired by Tumani. In 2005 Professor Sarah Rowland-Jones, whose forte is HIV research, was made director of research, with the responsibility of overseeing the unit’s scientific programme and submitting its five-year research plan. Mark Radford has been the director of operations since January 2002 – and has made a huge contribution to restructuring and reorganising the unit.
Tumani said: “The reorganisation process which began in late 2002 provided the opportunity for the unit to focus on the development and testing of interventions aimed at reducing the burden of diseases in the developing world.” In June this year Tumani was awarded an honorary CBE in recognition of his long and distinguished career as a consultant physician, researcher and leader.
The MRC laboratories were established two years after MRC staff were appointed to a nutritional field working party in the country. Shortly afterwards, Sir Ian McGregor was recruited to study the relationships between parasites and nutrition and a field station was set up at Keneba. Sir Ian, who died earlier this year, went on to direct the unit for 23 years and was a pioneer in tropical medicine. In 1982 another field site was established at Basse, followed by one in 1983 at Farafenni and one at Caio, Guinea Bissau in 1988.
The unit has around 750 staff – more than 600 of these are Gambian and the rest come from more than 20 different countries. It is the third largest employer in the country. The unit contributes substantially to the local economy through local salaries and the purchase of goods and services. It also provides all important healthcare to many people. “The MRC Laboratories offer clinical services to more than 100,000 patients every year, either at our own facilities or by enabling access to other public health institutions. This provides us with a ‘gateway’ to the community on whom we depend for clinical research,” said Tumani.
One of the Gambian unit’s major strengths lies in its longstanding relationship with the Gambia Government. Members of the MRC Laboratories serve on a number of boards and committees of the Government’s Department of State for Health, with whom they meet regularly. A joint Gambia Government/MRC Scientific Partnership Committee was set up a few years ago, which allows Government people to contribute to the planning of new projects for the unit. In addition, the joint Gambia Government/MRC Ethics Committee assesses and approves every project involving human participants carried out by the unit and makes sure that these meet international ethical standards.
The MRC in The Gambia works closely with local non-governmental organisations as well as UK and international groups. The UK Department for International Development is a very important partner, as are the World Health Organization (WHO), the UN Global Fund, the Gates Malaria Partnership, the European Union and academic bodies.
Since 2003, research at the MRC Laboratories has had three main focuses: bacterial diseases (mainly TB and acute respiratory infections), viral diseases and malaria. These diseases know no bounds. In 2006 the UN estimated that HIV had infected 65 million people since it was discovered in the 1980s, while malaria claims the lives of two million people every year, mostly under school age. The rate of TB is increasing with the emergence of HIV and as strains become increasingly drug resistance. It affects not only the developing world; rates are climbing in the UK and other developed countries. “Developing drugs, vaccines and other ways to tackle these diseases that are practical, affordable and appropriate to the settings is an important priority,” said Tumani.
The bacterial diseases programme, led by Professor Richard Adegbola, focuses on two main areas: acute respiratory infections and TB. Richard has been at the MRC Laboratories since 1990 and has more than 17 years of research experience in bacterial infections of the tropics. As well as his position at the MRC, he is also a member of the WHO Meningitis Vaccine Project Advisory Group and of the Partnership Board of the European and Developing Countries Clinical Trials Partnership. Richard said: “Our goal is to eliminate the scourge of tropical diseases caused by bacteria and the consequent poverty and misery through vaccination and treatment. This will help developing countries in achieving UN Millennium Development Goals for health by 2015. We are making excellent progress in this direction.”
The bacterial diseases programme often involves entire Gambian communities. The programme also provides diagnostic services to the MRC hospital at Fajara and contributes to the Government’s national TB control programme.
Two main causes of acute respiratory infection in developing countries are pneumococcus and Haemophilus influenzae type b (Hib). The latter has been virtually eliminated in Gambian children following a clinical study that showed that a highly successful routine Hib vaccination programme can be implemented despite less than optimum coverage and irregular vaccine supply. And a trial assessing a vaccine against pneumococcus that involved more than 17,000 children has reduced the rate of radiological pneumonia by 37 per cent. It also reduced the rate of deaths and hospital admissions by 16 per cent and 15 per cent respectively.
Current TB research is focused on population studies of immunity, biomarkers – biological indicators of disease – and diagnosis and vaccine studies using a unique TB case contact platform. Recently the group characterised bacterial samples from sputum to show that one third of the country’s TB cases were infected with M. africanum, a finding which has important implications for development of new TB vaccination programmes.
Dr David Conway heads the malaria programme. He came to the MRC in The Gambia in 2005, after studying and carrying out research at Nottingham and Edinburgh Universities, Imperial College London and the London School of Hygiene and Tropical Medicine. David explained: “Our malaria research encompasses laboratory and clinical science as well as public health interventions. An important example of MRC research leading to effective new interventions can be traced from 1986, when a study showed that bednets treated with safe biodegradable insecticides protected people from malaria by reducing their exposure to mosquito bites. Then in 1989 a large trial demonstrated that the use of these nets cut deaths in under-five year olds by a huge 63 per cent. Because of this work, insecticide treated nets are now used across the world and are one of the most practical tools to combat malaria.”
“Currently one of our main aims is to understand how malaria causes disease at a molecular and cellular level,” David added. “We are focusing on the varying mechanisms used by the parasite to enter red blood cells in different patients. This is important because the parasite molecules involved seem to be targets of immune responses themselves.” Led by Dr Michael Walther, the scientists are also carrying out hospital and community based studies of the regulation of cellular immune responses as a way to determine people’s disease risk.
Alongside these, a large scale investigation of the genetics of severe malaria involves a genome wide study in many of the same patients, as well as other severe cases recruited over the last 10 years. This is the leading piece of work in the global MalariaGEN project, being carried out with Professor Dominic Kwiatkowski at the University of Oxford. The group is also working on a major trial comparing injectable Artesunate with Quinine for severe malaria. This is part of the clinical trial portfolio that includes new combination therapy trials and community based intermittent treatment to prevent malaria in children.
Professor Rowland-Jones is head of the viral diseases programme at the MRC Laboratories in The Gambia. Before that, she was Director of the Oxford Centre for Tropical Medicine, which coordinates research activities in tropical medicine and international health throughout the world. She also led a research group in the MRC Human Immunology Unit in Oxford.
A key focus of her past work was studying immune responses to HIV in highly exposed but apparently uninfected people, most notably in sex workers and in infants exposed through breastfeeding. She was one of the first scientists to discover that many highly exposed but uninfected people have HIV-specific cytotoxic T cells – immune cells that destroy HIV-infected cells in the body and keep people free from disease. This work was carried out in the 1990s in a collaboration between the Oxford Unit and Professor Hilton Whittle in The Gambia. It has underpinned the development of new types of candidate vaccines to prevent HIV infection.
“One of the main sites of our HIV research is the rural village of Caio in Guinea Bissau, where we have a number of laboratory and population studies,” explained Sarah. “The population of this village was noted back in 1989 to have an unusually high prevalence of the second strain of HIV, HIV-2. Studies since then have shown that the majority of HIV-2-infected people do not become sick, even though a minority develop disease in exactly the same way as people with HIV-1. We think that by trying to understand what allows so many people to live a healthy life with HIV-2 infection could give new insights into what is needed in a vaccine to prevent both forms of HIV infection.”
Hepatitis B is another major focus of the virology programme: the infection is to blame for liver cancer, which is the most common cancer in men and second most common in women in The Gambia. The MRC first became aware that a high number of people were infected with hepatitis B in the 1970s and introduced a vaccination programme in the 1980s. The infection rate has been dropping ever since. As the result of a subsequent five year clinical trial, every newborn Gambian child is now vaccinated against the disease. Today, the scientists are continuing a long-term clinical trial investigating the effect of hepatitis B vaccination on rates of liver cancer.
The viral diseases programme also covers Chlamydia trachomatis – the leading cause of preventable blindness worldwide – and measles. Although C. trachomatis is actually a bacterium, it resembles a virus in that it cannot grow outside a cell. A new research programme in infant immunology is helping researchers to understand the best ways to protect children from infectious diseases through vaccination.
“We now have an excellent and highly-motivated team of researchers from throughout the world working together in the Gambia unit and it’s exciting to see how well our scientific programme is growing and developing,” said Dr Rowland-Jones.
The G8 summit meeting in 2005 recognised the potential role of science and technology capacity development in supporting the economic development of Africa. However, right across the continent there is a ‘brain drain’ problem, with many of the more educated young people seeking opportunities elsewhere. The MRC Laboratories in The Gambia are helping to combat this by successfully training and retaining the next generation of bright young scientists to work in the country. For several years much work has gone into developing a professional development pathway in biomedical science. Several schemes have been set up to help this happen. For instance, the MRC-Westminster University Diploma in Biochemical Sciences, set up in 2001, has seen the third batch of students graduate in January 2007. And this year the first batch of Gambian lab technicians completed an in-house course and received the MRC Certificate in Biomedical Sciences. Gambian staff are enrolled in distance learning through the University of South Africa, while Gambian and international students are completing their PhDs at the unit. “We spend more than 10 per cent of our budget every year on training our own staff as well as staff from the Gambian Government health sector,” said Tumani Corrah. “Training and capacity building is a crucial part of what we do, so that we can ensure an ongoing supply of excellent scientists to carry out our research in the future.”
In May 2007 the MRC marked 60 years in The Gambia with a series of events and a visit by MRC Chief Executive Professor Colin Blakemore. An open day was held in Fajara for more than 200 local secondary school science students, a new Clinical Services complex was opened at Fajara, an open forum was held highlighting the unit’s scientific achievements and a new laboratory was commissioned, named after Professor Hilton Whittle, the unit’s Emeritus scientist. The new Clinical Services department marks the biggest site development programme at the MRC Laboratories in The Gambia for 40 years. Tumani said: “The opening of this new 42-bed facility will help provide care for our clinical research patients as well as sick Gambian people. Together with the new Hilton Whittle Laboratory it is an indication of a bright future for the MRC Laboratories in The Gambia. With the excellent scientists we have in place and our well developed relationships with the Gambian government and other organisations, we hope to continue to yield results that improve the health of people across the world.”