• Research priorities: Transmission
• Country: India
• Project no.: FP24\12
• Budget: €200,466
• Duration: May 2024 - April 2027
• Status: Ongoing
• Co-funding partners: Turing Foundation

Full project title:
Holistic investigation for environmental presence of Mycobacterium leprae and its implications in leprosy transmission through WASH and One Health approach

Project coordination
LEPRA Society- Blue Peter Public Health and Research Centre

Partners
American Leprosy Missions
Society of Leprosy Affected People (SLAP)
Stanley Browne Research Laboratory
National Animal Resource Facility For Biomedical Research, India
ICMR-National Institute of Research in Tribal Health, India
ICMR-National Animal Resource Facility For Biomedical Research, India
District NLEP Office, Hyderabad

Aim: The study aims to investigate and compare the association between the environmental presence of M. leprae in animals, water, and wastewater, in leprosy cases and healthy controls, with reference to the reported WASH behaviour.

Project summary

India accounts for more than half of the global leprosy burden. Leprosy is a chronic communicable disease associated with sensory and functional impairment leading to physical and psychological consequences. Person to person spread of Mycobacterium leprae the germ causing leprosy is yet to be fully understood. The proposed study aims at understanding the role of water and livestock in the spread of leprosy in low resource and high leprosy burden settings in India. Since the human dwellings where leprosy occurs have also been associated with poor living conditions, it was thought that bringing awareness to the communities on appropriate water safety, hygiene and sanitation conditions could potentially help in improving their health conditions in general and for leprosy in specific. The research study also envisages understanding the disease spread through a comprehensive approach of human, animal and environment context which is sort of One health. The research plan involves the communities affected by leprosy who will be empowered in decision making for study designing and implementation, in addition to making it a livelihood opportunity as the trained community resource persons. The research team develops standard procedures for better hygiene practices for safe handling of the livestock. Proposed research study ultimately aims at finding the potential link between poor water hygiene practices, presence of live germs in potable or sewerage water and/or livestock with occurrence of leprosy cases. The findings from this study help inform the government policy makers and scientists to formulate appropriate preventing strategies for leprosy through better understanding its spread. Since the study is being conducted with the active involvement and empowerment of the communities, the study findings will be well internalised and the best practices well adhered by the communities.

• Research priorities: Transmission
• Country: Belgium, Burundi, Cameroon, DRC, Ghana
• Project no.: FP24\10
• Budget: €320,815
• Duration: July 2024 - June 2028
• Status: Ongoing
• Co-funding partners: Turing Foundation

Full project title:
Contribution of Drug-resistance and M. lepromatosis to persistent leprosy transmission in parts of Africa

Project coordination
Institute of Tropical Medicine Antwerp

Partners
Damien Foundation
Centre Pasteur du Cameroun
Noguchi Memorial Institute for Medical Research
Colorado State Unversity
Institut National de la Recherche Biomédicale (INRB)

Aim: This cross-sectional observational study aims to test whether drug resistance and M. lepromatosis infections contribute to transmission of leprosy in four African countries.

Final project summary
Leprosy is a disease that has affected people for thousands of years. It can cause skin sores, nerve damage, and other complications. Although it is now rare in most parts of the world, there are still thousands of patients every year, especially in developing countries. Despite being the oldest infectious disease known to humans, the disease is still not well understood. Therefore, it is of utmost importance to examine the genetic information of the bacteria causing leprosy.

To understand why the number of new patients diagnosed each year is not declining in the African region, the researcg team will confirm that the bacteria causing the disease are present in the patient. Whether the bacteria are resistant to the drugs that are used to kill them will be investigated. This means that even if someone is taking medication, the bacteria can continue to spread within the person and cause damage to the body, but can also spread to other people.

In addition to drug resistance, there is also a type of bacteria called Mycobacterium lepromatosis that can also cause leprosy in addition to Mycobacterium leprae. This bacterium was found in people with leprosy in Mexico.

To better understand how leprosy is spreading and how we can improve treatment, we will conduct the study in four African countries: Ghana, Burundi, Cameroon, and the Democratic Republic of Congo. The researchers will work with leprosy patients in these countries and ask them to provide small samples of skin from the affected areas.

Using these skin samples, the researchers will look for specific known markers in the leprosy bacteria. These known markers can tell researchers if the bacteria are resistant to drugs or if they are the type of bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Additionally, the researchers closely examine the genetic information of the bacteria to find any new (previously unseen) changes that might make them resistant to drugs. This is important because it helps us keep track of how these bacteria are changing and becoming resistant to the medicines we use to treat them. The researchers will also compare their results with those from other labs to make sure that they are getting accurate information, which is called an external quality control system.

By doing all of this, it is aimed to learn more about how leprosy is spreading in these countries and how it can be better treated it in the future. They researchers will also work with local healthcare providers to share their findings and help improve leprosy treatment in these communities.

• Research priorities: Diagnostic tests
• Country: India, Nepal
• Project no.: FP24\8
• Budget: €115,946
• Duration: March 2024 - February 2026
• Status: Ongoing
• Co-funding partners: Turing Foundation

Full project title:
Use of handheld ultrasound for the early detection of leprosy and evaluation of its value as compared to existing diagnostic tests.

Project coordination
Hope Rises International

Partners
Nireekshana ACET (AIDS Care, Education and Training)
Lalgadh Leprosy Hospital & Services Centre

Aim: This study aims to explore the utility of Philips Lumify, a handheld point-of-care ultrasonography device, with a high-resolution probe to detect changes in the nerve affected by leprosy. 

Project summary
The lack of feeling in one's hands or feet common to leprosy is due to nerve damage and this is one of the major complications leading to permanent nerve function impairment and disability in leprosy. Clinical examination includes physical palpitation of nerves (clinicians feeling the patients nerves with their fingers), which is a subjective assessment and does not provide reliable results. Ultrasonography of the peripheral nerve is a dependable alternative diagnostic technique that can precisely measure the thickness of the nerves. Several research studies demonstrated the utility of ultrasonography to detect thickened nerves in leprosy in comparison to healthy nerves and a statistically significant difference was noted in the thickness (cross-sectional area of the nerve). Further, color doppler and other features of the ultrasound device enabled detection of structural changes on the surface of the nerve and changes in blood flow which is a feature of nerve inflammation (neuritis).

Ultrasonography is able to reliably detect nerve changes in leprosy. However, this technique is confined to specialized centers and radiology units far from the sites where patients seek care. With the advent of high-resolution ultrasonography, more accurate results related to nerve changes can be captured. In the last decade, several companies produced handheld and point-of-care ultrasonography devices that are capable of capturing high resolution images at the bedside of the patients or even in the field settings.

This study will explore the utility of Philips Lumify, a handheld point-of-care ultrasonography device with a high-resolution probe to detect changes in the nerve affected by leprosy. Firstly, the images and measurements from this device will be compared with the standalone device to determine accuracy. Later the same device will be used to detect nerve changes in individuals with suspect signs of leprosy. Finally, the measurements of this device will be compared with clinical and laboratory results to see if they correlate. This Philips Lumify can be used with a mobile phone app or an android tablet. This technology is promising and can be a non-invasive and an easy diagnostic tool to detect the onset of neuritis/neuropathy in leprosy or leprosy per se. This device can be used for both early and confirmatory diagnosis of leprosy. If successful, this will decrease the length of time it takes to get a diagnosis, increase access to MDT and health care, and ultimately prevent stigma and life-long disability.

• Research priorities: Diagnostic tests
• Country: Brazil
• Project no.: FP24\13
• Budget: €186,584
• Duration: 48 months
• Status: Not yet started

Full project title:
Seeking for immunological susceptibility markers for leprosy. Identification of SNPs in miRNAs binding sites and their role in immune response modulation in leprosy

Project coordination
Universidade Federal de Minas Gerais

Partners
Instituto Lauro de Souza Lima
Universidade Federal do Sergipe
Instituto Oswaldo Cruz - FioCruz Rio

Aim: This project aims to contribute to identification of host genetic risk factors for leprosy susceptibility.

Project summary
Leprosy is a disease caused by the bacteria Mycobacterium leprae. Although there is effective treatment (multidrug therapy), it is not enough to control leprosy dissemination. Leprosy transmission occurs through close contact between an untreated patient and a susceptible person. If we have an early leprosy diagnosis and transmission monitoring, we can have an early treatment, interrupt leprosy transmission between people and also prevent clinical complications of leprosy.
One way to discover the susceptibility of people to leprosy is to understand how some parts of our DNA, inside our cells, work. Scientists know that the immune response to any pathogen is controlled by the DNA and if this control is somehow altered, one can be more susceptible than others to infections such as leprosy.
Those parts of the DNA may be what we call “genetic markers” and it is very important to study these markers present in our DNA in order to allow us to identify people with higher risks to develop leprosy.
Leprosy susceptibility and severity of the disease varies among people according to immune response profile. Several types of genetic factors control host immune response and, consequently, susceptibility to disease. One of these factors are molecules called microRNAs (miRNAs). MiRNAs act by binding in specific sites in the DNA, controlling its function. If there is a variation in its binding region, it may interfere with its function and disrupt some important mechanisms such as the immune response. One important type of variation in the site of miRNA will bind is called Single Nucleotide Polymorphisms (SNPs).
Those SNPs may influence the response from DNA to an infection, such as production of protecting molecules of the immune response. So, variations on the DNA (SNPs) may increase the risk of developing leprosy or even have a protecting role. In this study, we aim to investigate those variations in the DNA (SNPs), specifically in the regions used for miRNAs to bind and control genes of the immune response, even in leprosy patients and healthy people with close contact to them. Then, we will investigate the association of these genetic variations to an increased risk of developing leprosy.
These variants are potentially useful to identify people with a high risk of developing leprosy giving to them an early diagnosis and treatment, if necessary. It is very important to control leprosy dissemination and also to prevent the clinical complications associated with leprosy progression.