Malaria remains a deadly threat to many. Despite the development of effective drugs, it kills one child every minute. A new discovery, enabled by MRI imaging, could prevent unnecessary deaths from the disease caused by brain swelling.
Malaria is not only preventable, but also entirely treatable. Yet the mosquito-bornedisease remains a scourge in developing countries — particularly in Africa, where nine out of 10 deaths related to malaria occur.
Despite the development of effective drugs to kill the malaria parasite, fatality rates remain high, with the disease claiming a child every minute. A key roadblock in efforts to eliminate malaria has been understanding what causes so many deaths.
Until now, thanks to the work of osteopathic physician and malaria expert Dr. Terrie Taylor and her team, who were able to determine the likely cause of death for children with cerebral malaria, the deadliest form of the disease. Using an MRI provided by GE Healthcare, the team discovered that brain swelling is the culprit, as described in a study published in the New England Journal of Medicine.
“Our new findings tell us what causes death— now we can hone in on that target, which is increased brain volume,” Dr. Taylor explains in an interview, in which she discusses the importance of technology and collaboration in combatting the disease:
What drove you to focus on cerebral malaria three decades ago?
Our original focus on severe malaria in children in Malawi was suggested by the Malawi Ministry of Health. When we were interested in initiating a project there, we approached them for their research priorities, and they identified severe malaria in children.
So it was really a locally identified priority, and it has turned out to be fascinating. Because the answer to one question has opened up more questions, and we’ve been able to follow a very interesting trajectory over the last 28 years — sort of like pulling the leaves off an artichoke to get right down to the nub of what’s going on. And that’s where we are now, with the MRI findings. We’re right now finally at the heart of actually what is killing these kids. But it has taken a while to get to that point.
Using the MRI, you were able to determine that brain swelling was what was causing deaths in children with cerebral malaria. Why had it been so difficult to prove that relationship in the past?
It was our earliest suspicion, actually. Standing at the bedside of the kids as they were dying, in the majority of them, it looked like they were dying of herniation from raised intracranial pressure. But it wasn’t all of them, so it was difficult to put the story together.
Then we spent 10 years doing autopsies to try to work it out. But there are these classic features in pathology textbooks of what the brain looks like in those situations, and we didn’t see that in these patients. So we were entertaining all kinds of other hypotheses that would explain our clinical observations. But when we moved to the MRI, it was so blatantly obvious that those kids are herniating that you couldn’t escape the fact.
(Video: Courtesy of Michigan State University)
Through your work in tackling malaria, how critical has collaboration been from across the spectrum — from local governments and NGOs to the private and medical sectors?
Collaboration is essential. Without the initial support of the Malawi Ministry of Health, we never would have gotten off the ground in 1986. Being part of the University of Malawi College of Medicine from its inception has allowed us to participate in training new investigators and enhancing the research capacity of the medical school. NGOs have been involved by providing bed nets for our patients at their time of discharge from the research ward — this sends an important public health message.
The fact that Michigan State University has sanctioned my presence in Malawi for six straight months every year has made a huge difference in our ability to truly become part and parcel of the local efforts on so many levels.
When you first received the MRI in 2008, what did you imagine would be your ideal outcome?
Where we are now was the ideal outcome. But it’s so unusual, so rare for wishes to come true — especially in science — that I hadn’t really allowed myself to hope for it.
What is the significance of this development that now it’s being published? What kind of doors does it open?
The significance of the publication is that it directs our efforts now toward treatment. So now we know what we’re aiming at for an intervention. We’re aiming to either reduce the brain swelling, or to provide ventilatory support for the children until the swelling resolves on its own.
Now we know that’s what we have to do. And before, we were kind of taking potshots at what might be the mechanism. But now we know our focus is much better.
Malaria has been such a pernicious disease to fight. How hopeful are you that your research will help eliminate, or greatly minimize, its toll?
We need to advance on multiple fronts to address this menace. National and international level efforts are aiming to decrease transmission of the disease, by attacking the mosquitoes and by diminishing the number of people infected with the parasite.
We need to work to eliminate malaria deaths while the global medical community continues to work to eliminate the malaria parasite. Eradicating malaria will continue to take time. During this time, if we work to expand rapid diagnosis and pair diagnosis with effective treatments and improved hospital care, more lives will be saved.
In Malawi, making prompt diagnosis and effective treatment available will help to decrease the number of children who develop cerebral malaria.
Our work will help those children who fall through all of those cracks and still develop cerebral malaria — those numbers are falling, but there are still several million desperately ill children each year. Our new findings tell us why they are dying — now we can hone in on increased brain volume, which is the new target.
(Top image: Courtesy of Michigan State University)
Dr. Terrie Taylor, Michigan State University Distinguished Professor, is a clinician who has been studying the pathogenesis of cerebral malaria in Malawian children since 1986. Together with Professor Malcolm Molyneux, Dr. Taylor established the Blantyre Malaria Project at the Queen Elizabeth Central Hospital, one of the early research affiliates in Malawi’s first and only medical school.