UPDATE: TRAC clinical findings out in Fall 2013

From left, TRAC around the world: A make-shift clinic in a tea-garden, Jalpaiguri, West Bengal; a study team on the way to the Shwe Kyin clinic, Myanmar; and Syed Noor Quaderi, lab technician, Ramu, Bangladesh preparing to cryopreserve malaria parasites

Phase 1 of TRAC (Tracking Resistance to Artemisinins Collaboration) is now complete, excluding upper Myanmar, which began late. TRAC will report its clinical findings on artemisinin resistance in 1,200 patients from 15 sites in 10 countries later in 2013.

“This high-quality data will update us on the situation of artemisinin resistance at multiple sites in Asia and Africa and give us a better idea of how far it has spread outside western Cambodia,” said TRAC project Manager Elizabeth Ashley. “This data is being shared with other tropical medicine research groups around the world so that critical operational and basic research questions can be answered quickly. Our goal at TRAC is to provide evidence to policy-makers to generate an effective response to artemisinin resistance.”

Started in 2011 in response to the threat posed by the emergence of artemisinin-resistant malaria on the Cambodia-Thailand border, TRAC is a unique multi-centre, multinational collaboration led by MORU and funded by DFID and others to describe the epidemiology and spread of artemisinin-resistant falciparum malaria in South-East Asia and beyond.

TRAC also provides a unique platform for basic research into the biology and molecular mechanisms underlying artemisinin resistance.

Besides MORU and the Faculty of Tropical Medicine, TRAC contributors include some of the world’s leading research institutions, such as LOMWRU, OUCRU-VN, the London School of Hygiene & Tropical Medicine, Liverpool School of Tropical Medicine, Singapore’s Nanyang Technological Institute, WWARN, University of Maryland, and the Wellcome Trust Sanger Institute.

In the last decade, artemisinin-based combination therapies (ACTs) and insecticide-treated nets have contributed to significant reductions of the malaria burden in many areas of the world. Losing ACTs to resistance would be a disaster for the control and treatment of malaria and would bring elimination efforts to a standstill – and cause the deaths of millions worldwide to malaria.

There is no current quick test to see if a patient has artemisinin resistant malaria.

“Right now, you can only test for artemisinin resistance by admitting patients to hospital and looking at parasite clearance rates. Our dream is that these TRAC clinical samples will help researchers find the mechanism and a genetic marker for artemisinin resistance. That marker would then become the test for resistance, and allow doctors to take a spot of blood and quickly determine if the patient’s malaria is artemisinin resistant,” said Dr. Ashley.

The patients enrolled in TRAC have Liz’s respect and admiration.

“These patients are very altruistic: they normally would be treated for malaria in outpatient clinics, then released. Instead, they stay in hospital, get repeatedly jabbed and tested – which they don’t need for their current malaria episodes. That’s why TRAC is a hard study to do: It needs community goodwill and understanding and a lot of work by the field teams for people to take part,” says Liz.

From left: Golam Moula, lab technician, transferring samples into liquid Nitrogen, Ramu, Bangladesh; Sokunthea Sreng (seated) and Pharath Lim, CNM/NIH TRAC study site, Pursat, Cambodia; and Sethavudh Kaewviset leading a drug quality survey (LSHTM-TRAC project), Khun Han, Thailand