|FACE TO FACE
|Year : 2017 | Volume
| Issue : 2 | Page : 128-130
An E-mail Interview with Prof. Gagandeep Kang
|Date of Web Publication||25-Sep-2017|
|How to cite this article:|
. An E-mail Interview with Prof. Gagandeep Kang. Trop Parasitol 2017;7:128-30
Tropical parasitology (TP): As an eminent researcher and an expert member of various prestigious organizations, please share your views and research experiences in parasitology.
Prof. Gagandeep Kang: Parasitology, other than malaria, is largely a neglected science in the places that need it the most - Asia and Africa. We have been fortunate that at least in India for leishmaniasis and filariasis, there have been serious research and implementation efforts that have resulted in significant reductions in disease, but the burden of other parasitic diseases continues to be largely unknown because we have no systematic approach to measurement, and of course, few efforts to deliver interventions.
TP: How different has been the epidemiology of enteric parasitic infections in India when compared to bacterial and viral gastrointestinal infections?
Prof. Gagandeep Kang: In clinical settings, bacterial gastroenteritis through stool culture forms the mainstay of diagnostic approaches, viruses and parasites are not often sought, and antibiotics and antiparasitic agents are given empiricially. In the few research studies that have examined multiple causes of gastroenteritis, it is clear that viruses cause most diseases, followed by parasites and bacteria, which makes the empiric treatment inappropriate in most cases. That said, overall, the burden of diarrhea is decreasing even in settings with low hygiene and sanitation. Viruses seem to cause disease globally, whereas parasites and bacteria associated with gastroenteritis are more geographically restricted.
TP: Which enteric parasitic infections do you think are most neglected and would need more attention for research?
Prof. Gagandeep Kang: Recent data from the Global Enteric Multicenter Study (GEMS) study provided two insights that have sparked global interest in enteric parasitic infections. The first is the underrecognized burden of Cryptosporidium. Particularly, in Africa, this coccidian parasite has been associated with a large number of cases of moderate–to-severe diarrhea, and in those infected, it appears that there is greater mortality during follow-up. This, associated with older reports of associations with decreased physical growth and delayed cognitive development, has led to the recognition of the need to understand more about this pathogen and search for prevention and treatment strategies.
Professor Kang is the Executive Director, Translational Health Science Technology Institute (THSTI), an autonomous institute of the Department of Biotechnology (DBT). Prior to joining DBT, Prof. Kang was Professor and Head of the Wellcome Trust Research Laboratory and the Division of Gastrointestinal Sciences at the Christian Medical College in Vellore. Over the past two decades, she has built a research program that has conducted key studies to understand enteric infectious diseases in impoverished communities. Working in partnership with nongovernmental organizations and the government, she has carried out Phase I-III studies of rotaviral vaccines and provided laboratory support for vaccine development in India and for other developing countries. With the Indian Council for Medical Research and the World Health Organization (WHO), she has supported the establishment of networks of sentinel hospitals and laboratories that carry out surveillance for rotavirus disease in children and ancillary studies. Professor Kang has built a strong interdisciplinary research program that uses careful and detailed field epidemiology with molecular tools for characterization of infectious agents and host response to infection to understand and change factors that affect transmission, development, and prevention of enteric infections and their sequelae. Observational, interventional, and mechanistic studies on enteric infection and nutrition have demonstrated the complex relationships between gut function and physical and cognitive development. Based first on an outstanding medical college and now on the THSTI, she has established a strong training program for students and young faculty in clinical translational medicine aiming to build a cadre of clinical researchers studying relevant problems in India. She is a member of the WHO's Global Advisory Committee on Vaccine Safety and the Immunization and Vaccine Implementation Research Advisory Committee and chairs the Immunization Technical Advisory Group for the WHO's South East Asian Region. She serves on or has served on the scientific advisory committee of several national and international institutions, including the Wellcome Trust, UK, the DBT-Wellcome Trust India Alliance, the International Vaccine Institute, and the International Center for Genetic Engineering and Biotechnology.
The second organism for which interesting findings came from the GEMS study was Giardia, which appeared to be associated with protection from diarrhea because it was more frequently detected in controls than in cases. Of course, because GEMS had a case–control design and prior sampling was not included, whether the children asymptomatically infected with Giardia had been previously exposed was unknown. This highlights how little we know about a pathogen that we have known about and studied since Antonie van Leeuwenhoek first described it in his own stool.
TP: How has been the involvement of the WHO in helping the developing countries to control enteric parasitic infections?
Prof. Gagandeep Kang: For public health measures that need to be implemented globally or in regions, the WHO is the nodal agency for providing guidance, particularly through its programs on malaria and neglected tropical diseases. In the recent years, for several reasons, many other not-for-profit enterprises aimed at parasitic diseases have been formed, such as Roll Back Malaria, the Medicines for Malaria Venture, and the drugs for neglected diseases initiative. It is good to see multiple players in the area and the work they are doing, but it is important to remember that governments and the WHO need to take a leadership role here.
The Government of India recently launched a program on the National Deworming Days to be held twice a year to address soil-transmitted helminths. The initial rounds of this mass drug administration have been done in India and have gone well.
TP: How successful has been the achievement of goals by the Helminth Control Programme, globally in the elimination of soil-transmitted helminth infections?
Prof. Gagandeep Kang: Overall, in countries that have school-based deworming programs, the prevalence of infection has decreased. However, the adequacy of such programs, particularly for infections such as hookworm that are transmitted in environments more likely to affect adults and result in reinfections, is being debated, with consideration of inclusion of adults in deworming programs.
The question of whether the elimination of helminths is a good thing is also being debated, particularly by those worried about the rise of autoimmune diseases, since parasites have coevolved with humans and eliminating them may alter our ability to handle other challenges to the immune systems.
TP: How effective has been the implementation of deworming of school-age children addressed in the Indian National Deworming Programme?
Prof. Gagandeep Kang: The coverage of the National Deworming Programme being conducted twice a year is high. This is a new initiative, based on the polio program and uptake has been good. In the limited studies we have done in Tamil Nadu, after the program started, the prevalence of worms in preschool age children is low.
TP: In your opinion, what newer perspectives can be addressed in the global/national programs in the elimination of soil-transmitted helminth infections, globally?
Prof. Gagandeep Kang: The question of whether the chain of transmission of helminthic infections can be broken by deworming programs is still an open one, particularly for hookworm. Recent modeling studies seem to indicate that, if the government's current twice yearly program was extended to all age groups, it might be feasible to bring prevalence down to a level where reinfections will become uncommon, but this needs to be tested in practice.
The question of whether vaccines might be appropriate or feasible for helminthic infections also remains. Efforts so far to develop vaccines have been unsuccessful, but we do not know what might happen in the future.
TP: The context of emergence of drug resistance has always been centered on antimalarial drugs. What is the current status of this phenomenon in other antiparasitic drugs?
Prof. Gagandeep Kang: Some evidence of resistance to anthelmintic drugs has emerged in animal studies, but there is little evidence of resistance in humans so far. A multicountry anthelmintic trial did show a difference in levels of clearance with treatment in different countries, but this study did not look for mechanisms of resistance, so distinguishing between a lack of effect of the drug and potentially a lack of compliance was not addressed. Other studies describe mutations encoding resistance but do not always look for clinical lack of effect, so there is much that is unclear and requires investigation.
TP: What measures do you suggest to improve the quality of parasitology research in the developing countries to make it on par with the developed nations?
Prof. Gagandeep Kang: Research in communicable diseases in general is decreasing, with the increasing interest in noncommunicable diseases. Scientists today seem to want to focus on molecular and cellular biology rather than rigorous field studies which are necessary in parasitology to validate laboratory findings. To improve research, there are no simple solutions, but better funding and better training programs constructed around ongoing research in parasitology will help improve the quality and quantity of research.
TP: Please share few valuable suggestions for the budding scientists involved in research of diarrheal diseases.
Prof. Gagandeep Kang: Understanding infectious disease epidemiology is critical to studying diarrheal disease, so build a base of competence in epidemiology as much as laboratory science. Defining disease causation is challenging when the putative pathogen is in a nonsterile environment, and interactions between organisms are increasingly being shown to be responsible for moderating or causing health-related changes. Describing and attempting to define the role of perturbations in the microbial ecosystem and its effect on the host is an exciting and challenging new area in science.
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