Dr Marc Hübner is a Professor of Translational Microbiology at University Hospital Bonn, in Germany. He works within the University’s IMMIP (Institute for Medical Microbiology, Immunology and Parasitology) mostly focusing on filarial diseases -a kind of infection caused by parasitic roundworms, or nematodes, that heavily affects about 200 million people around the globe.
For this reason, since 2023 he has also been the coordinator of the eWHORM project. This ongoing research effort, co-funded with a EDCTP3 grant by the European Union, targets filarial diseases as well as soil-transmitted, intestinal worms, in sub-Saharan Africa as part of the process to support the World Health Organization’s “Road Map for Neglected Tropical Diseases” (2021-2030).
Filarial diseases are caused by parasitic worms that are transmitted by the bite of blood-feeding insects. They include river blindness and lymphatic filariasis (commonly known as elephantiasis) and fall into the broad category of Neglected Tropical Diseases (NTDs). What does that mean?
They occur in tropical regions, like Southeast Asia, South America and sub-Saharan Africa. That is why we focused our efforts there, specifically sub-Saharan Africa. Despite their impact, research in this field still receives very little funding, leaving millions to suffer, hence the name “neglected”. It’s just unbelievable and it is not public enough.
The eWHORM project involves institutions from seven different countries, including four African institutions that operate in the most affected areas. How does this international collaboration work and why is it important?
Marc Hübner: Our institute has been collaborating with partners from Africa for more than 20 years, so those are not only partners, but friends. Specifically, we are collaborating with Cameroon, Gabon, DRC and Tanzania. Both African and European scientists work together on designing and carrying out the trials, plus ethical approval for trials must come from both the European and African partners.
One of the biggest aims of our project was to create a master protocol, thus meaning a universal protocol that could be used to administer treatment for the four diseases we are studying in the basket trial. But researchers in African countries have been carrying out their own studies on the subject for years. We can’t just go there and say: “We’ll do things our way now”, collaboration is key.
We also work on training, infrastructures and capacity building, ensuring that our partners can continue to carry on their research in the years to come, after the project has ended. Even if the rest of our project was not successful, this would still be a good outcome.
Some experts have voiced concern that, with climate change, parasitic diseases may spread even more, causing further suffering in the Global South, as well as having an increasing impact on the Global North. Is this something that is considered in the project’s operations?
Marc Hübner: While it might be true for some vector born viruses -think about West Nile for instance, which has already expanded to Europe- it is unlikely that, even with climate change, filaria will make it back in our area.
What will happen however is that the problem will exacerbate in areas where it is already present. Hotter temperatures will shorten the development time of filariae and boost the reproduction of the blood-feeding vectors (flies, midges etc.). This will facilitate transmission even in areas that were previously non-endemic due to altitude or latitude.
In addition, floodings are becoming more common. This provides more breeding sites for vectors and disrupts medical delivery, as moody roads prevent aid distribution. While all these issues are not currently addressed in our research project, we are actively discussing them with our partners, and we would love to include them in future studies.
What are the main goals that you have already achieved with the project, and what do you look forward to most in the next few years?
Marc Hübner: Our biggest achievement to date is the preparation of a master protocol to ensure harmonised procedures for the different diseases and clinical sites. As I mentioned before, this means using the same protocol to administrate treatment in one trial for all the diseases we are studying, in all the different locations. Thus, all the data that we are collecting will be much more comparable and allow more in-depth statistical analysis. Our protocol was also checked and approved by the EMA (European Medicines Agency), and this is a massive result.
So far, the treatments have started and showed no worrying side effects, but we don’t know yet if they work as intended. I am excited to see the outcome of this study and hope that we will finally have a drug which allows safe and quick treatment for all filarial and soil-transmitted helminth patients.
In the future, do you think that something should change to better face the challenges posed by NTDs?
Marc Hübner: I will say something that to me personally is very frustrating: we have all the expertise to achieve the elimination of NTDs. However, funding is very restricted, and the recent cuts in funding further challenge the progress that has been made over the past decades.
It is very important that funding is maintained to develop adequate treatments but also provide a platform to distribute those treatments to the people that require them. It is hard to watch how much money is wasted, which could really have an impact. Raising the awareness of NTDs is our only chance to obtain the required funding and combat those diseases.