AN INAUGURAL LECTURE

2013/2014

By Prof Catherine Olufunke Falade

MY CONTRIBUTION TO KNOWLEDGE

It is indeed an honor and a privilege to deliver the third inaugural lecture from the Department of Pharmacology & Therapeutics.

Pharmacology is the branch of medicine and biology concerned with the study of drug action. Clinical pharmacology, a subspecialty, is the science of drugs and their clinical uses. It connects the gap between medical practice and laboratory science. The main objective is to promote the safety of prescription, maximize the drug effects and minimize the side effects.

The title of my lecture was inspired by the permanently changing epidemiological scenario of this parasitic infection, the uncanny ability of the causative organism to undergo mutation in a survival bid and the nature/direction of my research efforts. Indeed there has been many triumphs (the gains) and disappointments (the pains) in the fight to control and possibly eradicate this infection. My research is carried out in active collaboration with other researchers locally and internationally as well as the Malaria Control Units of both the State and Federal Ministries of Health so that the research findings can be incorporated into policy for the benefit of children and pregnant women in malaria endemic areas in general and Nigerian in particular. I will be presenting to you today some of my research endeavors primarily in the field of malaria chemotherapy including its diagnosis, drug treatment and management.

My research focus can be broadly summarized into five subgroups.

1. Clinical and laboratory diagnosis of malaria

2. Chemotherapy of malaria

3. Malaria during pregnancy

4. Community perception and management of malaria

5. Preclinical evaluation of antimalarial compounds in animal model

MY RESEARCH FOCUS

I have made significant contribution to improving the clinical and laboratory diagnosis of malaria. Two of my publications draw attention to unusual presentation of malaria including a case report of malaria presenting as psychosis which could pose diagnostic dilemmas. I also demonstrated the accuracy and specificity of parasite lactate dehydrogenase as a non-microscopic method for diagnosing malaria – the scientific basis for a rapid diagnostic test (RDT) for malaria. Some of my publications also reported on the high sensitivity and specificity of malaria RDTs in the diagnosis of malaria among children and HIV +ve persons thus providing credence for the current WHO policy that malaria diagnosis be parasite-based and the place of RDT. We also reported that one of every five health blood donors in a teaching hospital in Ibadan had patent parasitemia.

In the course of my research, I have conducted numerous clinical trials on antimalarial drugs and produced results with far reaching implications some of which went into national and international policies. The two most striking are the ones on LapDap™ which was shown to be unsafe and therefore international policies. The two most striking are the ones are on LapDap™ which was shown to be unsafe and therefore withdrawn and artemether-lumefantrine which provided evidence of its excellent safety and efficacy for the selection of 6-dose regimen as global standard and its selection as the drug of choice in the revised national drug policy for Nigeria. Some of my publications reported on the intravascular hemolysis and cardiotoxicity adverse effects of LapDap™ and halofantrine, and the safety of artemether-lumefantrine – the most used ACT globally.

Pregnant women in endemic areas are the adult population who are most prone to malaria and in them the infection is often asymptomatic and can be undetected and untreated with resultant adverse pregnancy outcome for both mother and fetus. My publications in this area include detailed publications on the epidemiology of congenital malaria, its clinical and laboratory features and the effectiveness of IPT-SP in prevention of malaria in pregnancy in Nigeria. IPT-SP is the current gold standard for prevention of malaria in pregnancy.

My research into malaria in the community revealed a lot of negative perception about the causation, complication and severity of malaria with dire consequences in selection of treatment pathways. We successfully demonstrated the feasibility, acceptability and effectiveness of artemisinin based combination therapy in the home management of malaria strategy. The results of this study formed the basis for the policy decision to not only introduce but scale up the use of Artemisinin-based Combination therapy (ACT) in communities of endemic countries in the home management of malaria strategy in Africa. Hitherto, introduction of ACTs into the community had been a major concern in malaria research circles. We designed a clear, acceptable and culturally relevant visuals that will facilitate effective case management of malaria in children at the home level. I have also worked on identifying antimalarial Compounds from Nigerian Phytomedicine Compendium. In a population validation study we confirmed anti-plasmodial properties of some of the herbal preparations administered by traditional healers to febrile children presumed to have malaria and those containing Cosipium arbotretum were the most efficacious.

Preclinical evaluation of antimalarial compounds in animal model

We evaluated the in vitro and in vivo antimalarial activity of five curcumin analogues a major yellow pigment and active component of Curcuma longa Linn (Turmeric), in our effort to discover novel antimalarial compounds from natural product. All the five curcumin analogues compounds tested were more active against P. falciparum NF54 strain than the parent compound curcumin. We also reported that Nigella sativa seeds have strong antioxidant property and, may be a good phytotherapeutic agent against Plasmodium infection in malaria.