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Developing New Health Tools
for VL Patients
Therapeutic research linked to visceral leishmaniasis (VL) is complex and limited, because it has been a fully neglected disease. Dr Shing Chang, DNDi ’s R&D Director, explains how DNDi is addressing the R&D challenges posed by VL.
The Fever of the Poor
The transition was stark. We were making a documentary with a team from DNDi on clinical trials in India. One day we were filming in a luxurious Delhi hospital catering for wealthy patients and foreigners; the next, we were in the middle of Bihar, one of India’s poorest states.
VL Combination Therapy in Asia
The Indian subcontinent (India, Nepal & Bangladesh) is one of the main areas affected by VL worldwide. It accounts for about 67% of total cases reported with almost 200 million people at risk of contracting the disease. The governments of India, Bangladesh and Nepal have launched a joint programme to eliminate VL as a public health problem by the year 2012.
Seven-Year-Old Saisuru from Uganda: a Patient among Many
Saisuru (the real name is not being used to protect the patient’s identity) is a seven-year-old girl, living in the remote Sosak village 60km from Amudat Hospital - one of the research and treatment centres for the DNDi LEAP paromomycin project, overseen by Makerere University.
LEAP: A Step Together
in the Right Direction
The goals of LEAP are: to facilitate clinical testing and registration of new treatments for VL (Ethiopia, Kenya, Sudan and Uganda); to facilitate the development of national treatment guidelines for East Africa; evaluate, validate and register improved options that address regional needs for VL; and provide capacity strengthening for drug evaluation and clinical studies.
Visceral Leishmaniasis (VL)
Leishmaniasis is a poverty-associated disease with several different forms, of which the following two are most common:
• VL – fatal without treatment
• Cutaneous Leishmaniasis (CL) – has a spectrum of presentations, typically with self-healing or chronic lesions on the skin.
Challenges to Finding Drug Candidates that Can Enter Clinical Development
Drug discovery is basically a three-stage process consisting of screening, lead selection, and lead optimisation (LO). It is the first step on an uncertain journey towards getting medication to those who need it. The objective of these initial stages is to find a drug candidate i.e. a compound that can enter the clinical development process (clinical trials) after being evaluated for safety and efficacy in animals (preclinical development).
Promising Results from the VL Lead Optimisation Consortium with Advinus
Lead optimisation (LO) involves taking a ‘lead’, or a molecule known to kill a specific parasite in both in vivo and in vitro assays, and optimising it by making chemical modifications that will optimise the molecule’s capacity to be absorbed into the bloodstream, be distributed effectively to the infection sites, survive in the body, and kill the parasite, and not be harmful when it reaches the patient.
Balanced Funding Supports DNDi ’s VL Portfolio

A total of EUR12 M from 11 different donors has been used to develop the VL-specific portfolio of DNDi in our first five years of operation; this represents 25% of DNDi ’s total expenditure (EUR47.6 M) during that period.

There can be no Health Benefit without Access to Treatments

DNDi aims to improve the quality of life and the health of people suffering from Neglected Tropical Diseases (NTD) and to ensure equitable access to new and field-relevant health tools. So what exactly is meant by “access”? What are the barriers to access for VL patients, and what strategies has DNDi put in place to deal with the access issues?

Published by Drugs for Neglected Diseases Initiative - 15 Chemin Louis-Dunant 1202 Geneva Switzerland - Photo credits: DNDi unless otherwise stated - Editor: Sadia Kaenzig - Tel: +41 22 906 9230 - Fax: +41 22 906 9231 - www.dndi.org