|FACE TO FACE
|Year : 2014 | Volume
| Issue : 2 | Page : 139-141
An E-mail interview with Prof. John Ackers
|Date of Web Publication||12-Aug-2014|
|How to cite this article:|
. An E-mail interview with Prof. John Ackers. Trop Parasitol 2014;4:139-41
Tropical Parasitology (TP): You have had a longstanding association with the London School of Hygiene and Tropical Medicine. As an emeritus and an expert can you share your vast experience in the field of Parasitology?
Prof. John Ackers : My research experience is actually limited to quite a small group of organisms, of which, I suppose, Entamoeba histolytica is the most clinically significant. However, I teach across a wide variety of protozoa and that does give me a sort of overview, although I know very little about the parasitic helminths and almost no entomology. Hence, it is really only protozoa that I can talk about.
One difference between eukaryotic pathogens like protozoa and bacteria or viruses, is that in general they reproduce a bit more slowly. And maybe this is why they tend to produce rather long-lasting, chronic infections, often with quite a small percentage of those infected dying. So while there are far too many deaths caused by Plasmodium falciparum this is actually due to the enormous number of people infected each year rather than a particularly high case fatality rate. But what parasitic infections frequently do is to cause an enormous amount of morbidity - not just personal suffering, but major economic loss as well, often among populations who can least affords it.
Apart from their clinical importance I am fascinated by the realization, which has emerged over the last 10-20 years, mainly because of genome sequencing projects, that by far the greatest diversity among the eukaryotes is found in the single-celled organisms - that is, the protozoa.
TP: Having contributed enormously to the field of parasitology, which parasitic disease do you think is the most underestimated and, therefore, requires more attention worldwide?
Prof. John Ackers : That is a difficult question and one that I am probably not going to attempt to answer! Although more resources are badly needed, almost all the major killers among the parasitic diseases do have at least some coordinated attempts to improve diagnosis and treatment. So instead I would like to make two different points. First is the absolute necessity of continuity and sustainability. With the possible exception of Dracunculus, no parasitic disease is anywhere close to being eliminated. Vast donor-funded programs can be highly successful, and the lives saved are worth every dollar, but if priorities change and funding shrinks those gains can soon be lost.
Second the most useful things are not always the most exciting. Globally, the second biggest killer of infants is diarrhea, and those who don't die may have their physical and intellectual development slowed by boring and unfashionable infections like Giardia. Hence one of my very highest priorities would not be a new vaccine or drug, important though those are, but to provide clean water and safe sewage disposal for every person on earth.
TP: As sexually transmitted diseases are one of your specialized areas, please shed some light on the current trends in trichomoniasis in contrast to the yesteryears.
Prof. John Ackers: Trichomoniasis is interesting. In developed countries the incidence has declined about 10-fold over the last 30 years, whereas in resource-poor parts of the world, and in disadvantaged communities in all countries, it has remained both constant and high. As far as I know there is no one obvious cause for this divergence. Women, particularly, in communities where the infection is common, tend to suffer from a wide variety of financial, social and personal disadvantages which make it hard to isolate the underlying causes - which are probably multiple anyway. However, it matters because pregnant women with trichomoniasis are more likely to have premature and/or underweight babies. The other interesting fact about trichomoniasis is that, unlike the other common sexually transmitted infections, the prevalence is not highest in the late teens - mid-twenties but later, in those in their thirties and forties. Why this should be I do not know, but it would be worth trying to find out.
TP: Kindly provide your opinion on the activities of the national and international programs in the control of parasitic diseases. Do you have any suggestions for further improvisation?
Prof. John Ackers: I think I've said all that I want to about this in answer to your second question.
TP: Please share your work experience in computational genetics and bioinformatics and their applications in medical research?
Prof. John Ackers: I think the best answer is that bioinformatics is a tool, not an end in itself. The real impact on medical research (and clinical practice) has and will come from cheap and easy DNA sequencing. But one result of this has been to produce an enormous flood of data which threatens to overwhelm our capacity to store it, let alone understand, it. So the urgent need is for imaginative bioinformatic and computational solutions to increase the speed and accuracy with which this data can be analyzed to produce results which answer significant questions. One disappointment has been the fact that the genome sequences of a number of important parasites and their vectors have not led to improved drug targets or control measures in the way that was anticipated. There are probably many reasons for this, but better understanding of the interactions between genes and their products would surely help, and important task for bioinformatics researchers is to develop the tools to do this.
TP: With your immense experience in the development of novel diagnostic modalities, can you highlight the changing trends in the diagnosis of parasitic diseases?
Prof. John Ackers: I believe that there are two clear trends visible, and they are to increase speed and reduce the need for skill. I don't think there is any doubt about the benefits of any technology, which enables the diagnosis to be made while the patient is still present so that advice and treatment can begin straight away. And that is one reason why rapid diagnostic tests (RDTs) are becoming so popular and why World Health Organization (WHO) is so keen to see them in widespread use for malaria (and syphilis). The other reason, of course, is accuracy - staying with malaria, thick blood films are at least as sensitive as RDTs in the hands of skilled microscopists. But without highly trained staff - and a microscope of reasonable quality - their sensitivity is poor. This does not just mean that patients with malaria are being missed, it also means that many fevers are presumptively treated as malaria, which wastes expensive drugs and increases the speed at which resistance emerges.
Rapid diagnostic tests do have a couple of disadvantages, of which cost is certainly one; the other being that you can't find what you don't test for while a (skilled) microscopist can spot things no-one was expecting.
The future role of nucleic acid amplification methods such as polymerase chain reaction is hard to predict. For almost any disease you care to name they are now the most sensitive and specific diagnostic tool, but problems of cost, speed, complexity and cross-contamination have kept them out of widespread use in disease-endemic countries, and I don't think this is likely to change in the next 5 years.
TP: To what extent is the involvement of the WHO in helping the developing countries to control parasitic diseases?
Prof. John Ackers: I have only had a small amount of interaction with WHO during my career so I'm not really qualified to comment. The organization has been subject to some quite fierce criticism in the past, but when diseases ignore international frontiers we really need an organization which can do the same. On the technical side, such as evaluating malaria RDTs and recommending treatment protocols, WHO's work is extremely valuable but its work in setting wider policies and goals inevitably has to interact with the willingness of sovereign states to accept external advice.
TP: With research in virology and bacteriology stealing the limelight, do you think research in Parasitology has been sidelined? With parasitic diseases still being a major cause of morbidity and mortality particularly in developing countries, what measures do you suggest for regaining priority in parasitology research?
Prof. John Ackers: I'd like to refer back to my answer to your first question. If we aim to use our skill and experience to save lives, then we must focus on the diseases that kill, not our own pet organism. And I think the next global pandemic, like earlier ones, is almost certainly going to be caused by a virus or a bacterium, not a parasite.
But does this mean that parasitic diseases are unimportant - no, of course not. Far too many deaths and far too much disability are caused by them. In some cases, it is true, we lack the basic biological knowledge to break the cycle of infection - and here what needs to be done is clear. But in many cases the basic parasite biology is known and what is needed are acceptable, sustainable and affordable control strategies. And if that means more operational research than gene cloning, so be it.
Let me add that I am not for a moment trying to discourage basic research into the wonderful complexity of parasites - it's fascinating and bewildering (why do trypanosomes produce their kinetoplast RNA transcripts in a form which is completely useless until they have undergone massive RNA editing?) - but it is a long, hard road from that sort of knowledge to a new safe and affordable drug.
TP: What measures do you suggest to improve the quality of parasitology research in the developing countries to make it in par with the developed nations?
Prof. John Ackers: This is a difficult one to answer. Scientists, particularly your young scientists, are immensely talented and hardworking but they are in a field where the great prize is international, not local recognition. So the competition is global, not national.
Basic biological science is enormously costly, so if you want to compete with the best in the world it makes sense to generously fund a small number of fields; don't try to do everything. This principle, which applies to every country, every government and every University in the world, has led to vast numbers of research assessment exercises, priority area setting meetings, etc., They have probably been useful but are certainly not an infallible way of identifying future breakthroughs.
I am reluctant to imply that I have any particular novel ideas to put forward, but here are a few random thoughts:
Basic biology can be studied anywhere but most countries have local problems which are best studied where they are significant, so it is sensible to build global expertise in these. Local resources can be a powerful factor in encouraging collaborative links with other groups.
Encourage your young scientists to work abroad for a few years - but give them the facilities and support they need to encourage them to return. This is not all about money -friendly, open and collaborative research atmosphere is a big attraction.
Don't feel threatened by clever young people - my best PhD students were much brighter than me.
Publication is important, but discourage people from padding their CVs with lots of small papers. Reward those who wait until they have something important to say.
Instill a culture which automatically ensures the highest standard of scientific integrity.
TP: Please share a few words of advice for the fledgling scientists in the field of parasitology.
Prof. John Ackers: As well as the obvious things like working hard and keeping up with the literature, I would suggest:
- Talk to your colleagues, brainstorm, exchange ideas informally - but critically
- If you make a mistake doing an experiment never try to cover it up. Admit it to your supervisor and do the work again
- Never try to force the facts to support your (or your supervisor's) favorite theory
- Never forget that although the work is hard, the hours are long and success is never guaranteed, you will never be bored and scientific research is still one of the best jobs in the world!
Please note that these are my personal opinions and do not necessarily reflect the views of the London School of Hygiene and Tropical Medicine or the University of Western Australia.
| Authors|| |
Prof. John Ackers no longer works full-time at the London School of Hygiene and Tropical Medicine but remains heavily involved in teaching to both London-based and Distance Learning students. His research on Entamoeba histolytica played a part in the work which led to the realisation that amoebiasis was caused by two different but, in appearance identical, species of Entamoeba - the truly pathogenic E. histolytica and the harmless E. dispar. He remains interested in Trichomonas vaginalis which has been neglected for many years but is also now attracting new research as it appears to make heterosexual transmission of HIV more likely, as well as clearly harming the babies carried by infected women. In 2002 he successfully completed a year's sabbatical taking a Computational Genetics and Bioinformatics MSc course at Imperial College, London, and has subsequently developed new research interests and teaching in this area- mainly in the computer-based annotation and description of the E. histolytica genome, in particular, trying to understand how it differs from E. dispar. He has a particular interest in the distribution and insertion of SINEs (mobile genetic elements) which are present in the genomes of both organisms. For the past five years he has spent a month in Perth, Western Australia, teaching on a MSc course run by the University of Western Australia and is now an Adjunct Professor in the School of Pathology and Laboratory Medicine
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