Fighting ancient diseases with modern medicine

With recent speculation surrounding the cure for HIV/Aids from the UK’s National Institute for Health Research’s (NIHR) trial, the great potential of medical research has been highlighted by the media. The hope of cures for remaining viruses and diseases has intensified.

Plasmodium, which causes malaria, is a genus of parasitic protozoa, with at least ten of the 200 species affecting humans, in approximately 97 countries and territories worldwide (WHO 2015). The two species, P. falciparum and P. knowlesi, are those which are considered especially dangerous, heavily impacting the regions of Southeast Asia and sub-Saharan Africa which maintain ideal climates for insect vectors, like the infected female Anopheles mosquito. These regions provide disproportionately high numbers of malarial cases, with 88% of cases and 90% of deaths in 2015 occurring in sub-Saharan Africa (WHO Official Website 2016). Malaria is a well-known, if not the best-known, example of a modern disease endemic, with an estimated 214 million cases for 2015 alone, and 3.2 billion people at risk globally today. The emergence of P. falciparum, P. vivax and P. malariae resistance to the treatment of ACT and artemisinin in regions like Cambodia and Thailand is concerning, and requires the urgent response which leading world malaria experts, from the Malaria Policy Advisory Committee (MPAC) and the WHO Global Malaria Programme, have given it. Containment efforts are ongoing in all affected countries, but a definitive solution has not yet been found.

Recently, there has been a great effort for prevention of infection via the core vector control methods; long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) (WHO 2016). But research into ancient malarial cases has also increased. As a palaeopathologist, the study of past diseases and conditions is not only interesting, but a critical method of better understanding current pathologies, which I believe to be generally overlooked. By studying the outbreaks, spread, mutations and preventative measures previously undertaken in the past, a new line of information on how to deal with the current situation could be provided.

Due to scientific developments in the last 2 decades, and the potential application of medical methods, such as microscopy and Mass Spectromery, to archaeological remains we know significantly more about the history of malaria. A combination of studying skeletal markers, immunological testing (e.g. MalariaDetect™ RAPYDTEST®) and molecular investigations, have effectively identified the presence of malaria in populations over the last 4800 years, in remains like that of members of the famous Renaissance Medici family (WHO 2004). But, a much older African origin has been suggested for the infection. Our modern genomic understanding of the evolution of the parasite has developed with the successful use of ancient DNA testing to identify plasmodial gene fragments (e.g. plasmodial MSP1, STEVOR and AMA1) having been extracted from four royal Egyptian individuals, including the famous King Tutankhamun.

In the face of the enduring malarial endemic and it’s growing resistance to modern medicine, it is vital that all areas of malarial study, both modern and ancient, are used to the win the fight against the parasite.

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