A buzz around malaria research

Sir Ronald Ross discovered that the ubiquitous mosquito could transmit the malaria parasite. His painstaking work in the backwaters of the Hussain Sagar lake that links the twin cities of Hyderabad and Secunderabad led to the discovery of the parasite in the gastro-intestinal tract of the Anopheles mosquito in 1897. This work won the British researcher a Nobel prize for physiology and medicine in 1902.

Dr Ross, who worked in the Indian Medical Service, had opened up immense possibilities of fighting malaria, which continues to play havoc on not just India, but many countries in the tropical regions. In fact, the antiquity of malaria has been traced to 4,000 years, and the damage it has brought to human society is considered enormous.

End to the ‘tiny' threat?

The battle to combat this ‘tiny' threat has turned out to be long-drawn, difficult and challenging. A few drugs have been able to provide relief to patients. But a preventive vaccine is yet to come, even as the mosquito continues to breed, thrive and cause epidemics.

Just over a century after Ross provided the first leads, comes the exciting news that a drug has been developed in India by Ranbaxy and launched into the market. The drug, named Synriam, is targeted to defeat the parasite, Plasmodium falciparum , which is the cause for the common malaria. Is the taming of the malaria parasite finally round the corner? The ailment typically starts from the sting of the mosquito, which injects the parasite into the blood stream. What follows are bouts of chills, high temperature and weakness. It is as common as cold or cough in some parts of the country. The doctors prescribe the standard anti-malarial therapies.

Two drugs

Now, Synriam could bolster the ammunition of the doctors to tackle malaria. The drug is a combination of arterolane maleate and piperaquine phosphate. It has gone through clinical trials, and the company has got a drug licence and marketing approval. Ranbaxy, which has been involved in discovery research, pursued a combination of original research and joint development that has finally led to a promising result.

Coincidentally, Cipla, another Indian company which has brought in innovative products to tackle healthcare problems of developing countries, has also come up with a drug that targets the malaria parasite. The fixed-dose combination of anti-malarial drug from the Mumbai-based company aims to simplify the treatment regime for the patient.

So, within a couple of weeks, India has been able to announce that it can offer to the millions of people in poor and developing nations two affordable drug solutions that can help alleviate the damage done by malaria, both in terms of health and productivity. The hope is great, because the parasite has become resistant to several anti-malarials available in the market.

Rich countries' apathy

Malaria has not received much attention from large drug companies or scientific institutions in the developed countries, because its prevalence is pre-dominantly among the developing world. The fact that during 1980-2000 there were less than six anti-malarial drugs developed out of the nearly 1,400 new drugs clearly bears out this fact. Seen in this light, the contributions coming out of India affirm their importance. In the US, for example, malaria was declared eliminated in 1951.

In addition, the malaria parasite has emerged as one of the most difficult to tame. The wily parasite foxes detection. Hence, diagnosis itself is a critical aspect and important for the line of treatment. Research efforts have gone into developing diagnostic kits, which include the simple blood sample to antigen and PCR-based tests.

In the case of vaccine development too, this complexity and lack of funding to undertake research and trials in affected regions of the world has meant slow progress.

About 3.3 billion people or nearly half of the global population was at the risk of malaria in 2010. The World Health Organisation says malaria kills an estimated 6.5 lakh people annually. The poorest are the most vulnerable.

For decades, especially during the later part of the 20{+t}{+h} century, the main line of treatment for malaria was chloroquine. It was discovered by Hans Andersag, a German, who named the compound resochin. However, it was established as an effective and safe anti-malarial drug by the British and US scientists just after World War II. Then came drugs such as quinacrine, chloroquine and primaquine, which were quickly followed by mefloquine, doxycycline, malarone, etc. The biggest problem they have faced is resistance.

Another big breakthrough in treatment came in the form of drugs derived from artemisinin. The Chinese knew about this plant called qinghao ( Artemisia annua ) for long. In the US, it is called sweet wormwood. It was again the Chinese who isolated the active ingredient artemisinin in the 1970s. Since 2000, artemisinin-derived artesunate, which has been found to be superior to quinine, has provided encouraging results.

Indian research

Indian research efforts spearheaded by the Council of Scientific and Industrial Research through its co-ordinated programme on malaria have also yielded some positive contributions. Leading the development are the Lucknow, -based Central Institute of Medicinal and Aromatic Plants (Cimap) and Central Drug Research Institute (CDRI), and the Jorhat (Assam)-based North East Institute of Science and Technology.

The Cimap has in fact cultivated the plant artemisinin, extracted the active ingredient, and with the help of the CDRI synthesised it and passed on the technology to private industry, which launched anti-malarials.

The Jorhat Institute developed arteether, which was active against the chloroquine-resistant malaria strain. Mumbai-based FDC Ltd launched the product in the market. Several research institutes, some drug companies and universities are also chasing methods to control or treat this huge healthcare problem in the country.

At the other end, control measures found favour with entrepreneurs, who came up with coils, mats and gadgets that drove the mosquito away. The relief quotient has provided business opportunity. Large community-based initiatives to control the mosquito have also helped some States to bring the disease to a manageable level.

While it is fitting that the potential drug to fight this centuries-old human scourge should come from India, where a British doctor laboured hard to discover the parasite, it is ironical that the Indian company, Ranbaxy, while starting its war against the common disease, should end up being part of the Japanese major, Daiichi Sankyo, when the promising drug hit the market.

In the case of Dr Ross, his historical work is today commemorated in the form of an institute close to where he did his research, near the old Begumpet Airport.

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