MRC Gambia

MRC Unit The Gambia
PO Box 273, Banjul
The Gambia
Website : http://www.mrc.gm

The MRC - The Gambia (MRCG) is one of two research units established in sub- aharan Africa by the Medical Research Council UK and is the MRC’s single largest investment in medical research in a low and middle income country. MRCG represents a unique concentration of scientific expertise and high quality research platforms in the West African region.

The Unit’s investigator-led research is underpinned by the combination of excellent laboratory facilities and easy access to the field with well-defined populations that are highly supportive of our research, excellent clinical services, rigorous ethical procedures and ability to deliver GCP-compliant clinical trials. Our large research portfolio spans basic research to the evaluation of interventions for the control of diseases of public health importance in sub-Saharan Africa.

The MRC the Gambia offers an excellent opportunity of carrying out research related to malaria elimination in sub-Saharan Africa as in the western part of the country transmission is so low that may be interrupted by additional interventions. We are investigating the determinants of the observed heterogeneity of transmission and dynamic of residual transmission. Future malaria research activities will comprise: i) trials on interventions aiming at interrupting transmission and/or trial on new vaccines/treatments/insecticides and studies on drug/insecticide resistance, ii) studies on the mechanisms of transmission, i.e. the epidemiology of gametocytes, how this varies with the host and the environment and how chronic asymptomatic malaria carriers contribute to malaria transmission, iii) studies on candidate malaria vaccines and drugs.

MRCG Research areas/topics in Malaria

Over the last few years, the MRC Unit The Gambia (MRCG) has strengthened its position as an international, Africa-based centre of excellence in health research and training, thanks also to the integration within the London School of Hygiene and Tropical Medicine (LSHTM) that is providing access to additional training and expertise, and new opportunities for academic career development for the Unit scientists.

The Unit’s specific objectives are:

Contribute to the control/elimination of infectious diseases, including outbreaks.
Decrease the unacceptably high burden of maternal and neonatal mortality.
Address malnutrition, including diet-related metabolic diseases, through discovery science.
Address the rising burden of (non-communicable) diseases, with special attention to those related to urbanization and climate change.

The current Unit’s structure reflects the changes implemented over the last 5 years to provide a supporting environment for scientists. Research is carried out by 3 Research Themes (Disease Control & Elimination; Vaccines & Immunity; and Nutrition & Planetary Health) that benefit from the core-supported strategic platforms and of the research services.

Disease Control & Elimination (DC&E) investigates the interactions between hosts, pathogens and vectors; and evaluates interventions aimed at interrupting transmission and/or reducing the burden of diseases. Research is multidisciplinary and include a large epidemiological component complemented by social sciences and combined with strong laboratory support.

Vaccines & Immunity (V&I) studies the ontogeny of immunity as a baseline to inform the design of vaccines and maximise their impact. It hosts a portfolio of Phase 1-4 trials of existing and novel vaccines and employs cutting-edge system biology methods to understand host responses to infection and vaccination. The Theme is also working on tuberculosis by examining host/pathogen interactions in adults and children.

Nutrition & Planetary Health (N&PH) aims to understand the pathophysiology of diet-disease interactions to accelerate the development of more effective next-generation community and clinical interventions. Research on planetary health focuses in the areas of climate change; land use change and biodiversity loss; agriculture/fisheries, nutrition and food security; outbreaks and emerging infectious diseases; pollution; and sustainable cities and urbanisation.

Malaria research is embedded in the DC&E Theme. Malaria research activities have resulted in a better understanding of the malaria epidemiological trends and transmission dynamics, information that is essential to interrupt transmission and eventually achieve malaria elimination, a goal that the country has set for 2030. Malaria transmission in The Gambia (and Senegal) has decreased significantly and become increasingly heterogeneous, with the country divided into two epidemiological strata, western/central Gambia with low to extremely low transmission and eastern Gambia with moderate transmission. However, there are villages/clusters of low and high prevalence of infection in each of the two strata. This provides an excellent opportunity to investigate residual transmission and interventions potentially able to interrupt it. Several cluster randomized trials have been carried out or initiated to evaluate the safety, efficacy, and acceptability of different control interventions. We have recently completed a cluster randomized trial evaluating the impact of mass drug administration with ivermectin and dihydroartemisinin-piperaquine as an additional tool for malaria elimination (MASSIV). The intervention reduced malaria prevalence (all ages) by about 60% and incidence of clinical malaria by 80%.

Ongoing research projects are the following:

Evaluation of a novel digital diagnostic test for the detection of Plasmodium infections Among asymptomatic carriers.
A Phase Ib multi-stage Plasmodium falciparum malaria vaccine study to assess the safety and immunogenicity of the blood-stage vaccine candidate RH5.2 virus-like particle (VLP) in Matrix-MTM and the pre-erythrocytic stage vaccine candidate R21 in Matrix-MTM, both alone and in combination, in adults and infants in the Gambia.
Phase 2a Proof-of-Concept, Multicenter, Randomized, Open Label Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of a Single Dose of the Combination M5717-pyronaridine as Chemoprevention in Asymptomatic Adults and Adolescents with Plasmodium falciparum malaria infection.
Human genomic variation and malaria outcomes. This project is part of the Pan-African Malaria genetic epidemiology network. The primary focus has been the receptors on the surface of red blood cells. Secondary work includes human, parasite and Anopheles genome sequencing across seven countries. Other sub-projects here include invasion pathways and growth phenotypes of parasites in RBCs with diverse haemoglobin and receptor genotypes, and immune/genomic interactions between influenza viruses and malaria.
Emerging signatures of selection and tolerance to antimalarial drugs. This project develops new sensitive assays for testing natural parasite isolates in severe and uncomplicated malaria across 4 countries with different infections prevalence and genetic subpopulation.
Genetic diversity and biology of non-falciparum malaria. The focus here is the population genetics of P. malariae, P. vivax and P ovale in duffy positive and negative individuals of African descent.
Malaria and microbiome. Microbiome dynamics affects immunity and drug metabolism. These together could be affecting malaria morbidity and outcome of treatment. The Project is mostly done in Nigeria and is part of a Postdoctoral fellowship.
Genomic surveillance of malaria. Malaria parasite diversity and connectivity is tracked across 6 West African countries using next generation sequencing panels and whole genome sequencing. The project is testing new models for defining transmission paths in malaria endemic communities.

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