Dr. Dondorp is the Deputy Director and Head of malaria research at the Mahidol-Oxford Research Unit in Bangkok, Thailand, where he plans, coordinates and supervises clinical and laboratory malaria studies.
Q: You undertake a lot of research on drug resistance. Can you provide us with the latest information on the situation in Cambodia regarding artemisinin resistance? How serious a threat is this?
A: Artemisinin resistant P. falciparum in Western Cambodia is a serious threat and all efforts should be made to prevent this partial resistant phenotype from spreading in the region and beyond. At the same time it should be emphasized that this does not mean that artemisinins are now useless drugs in Western Cambodia; their potency is still comparable to let’s say quinine. Employed as ACT the efficacy in Western Cambodia is still high. Also: there is currently no proof that the problem has spread to other regions in Southeast Asia or Africa. This is currently being investigated in greater detail.
Q: Trials are underway to treat patients suffering from artemisinin-resistant malaria. What sort of trials are these, and what are you trying to achieve?
A: The hope is that synthetic endoperoxides or semisynthetic artemisinins that differ in their chemical structure have not lost their potency against West Cambodian parasite strains. If this can be shown in clinical trials on the Cambodian-Thai border, these compound become very attractive for deployment as combination therapies in the region.
Q: You visualised for the first time obstructed microcirculation in patients with severe malaria. What is this, why was this done, and what is the significance of these findings?
A: We use a special microscopic camera which enables visualization of the microcirculation on mucosal surfaces. In this way the obstructed microcirculation can be directly observed in patients with severe and cerebral malaria. We have shown that the severity of obstruction correlates with disease severity. It helps us to further understand the complex pathophysiology of severe malaria. Prevention or reversal of sequestration of infected red cells in the microcirculation is an interesting target for intervention, and clinical trials with some compounds are under way. Since we can now quantify microcirculatory obstruction, we can also assess the relative contribution to compromised tissue perfusion compared to eg macrocirculatory changes such as intravascular dehydration and shock.
Q: You organise weekly malaria journal clubs. How are these organised, and how effective are they? Examples?
A: The head of our malaria laboratory, Dr. Kesinee Chotivanich, is the main driving force for these. Our scientists from all levels are asked to present. If needed they are assisted in choosing a relevant paper (MalariaWorld is a great source for identifying interesting literature). People from our unit and the Faculty of Tropical Medicine Mahidol University are invited. It teaches critical appraisal of the literature and keeps us all updated. In addition we have a weekly scientific meeting, where we and our collaborators present the results of our research projects.
Q: Who would you like to see interviewed next, and why?
A: Dr. Saroj Mishra is an excellent physician and Joint Director & Head Dept of Internal Medicine of Ispat General Hospital in Rourkela, Orissa, India. He has done important work on the pathophysiology and treatment of severe malaria.