Last Friday, the 27th of May 2016, marked the ‘official-official’ start of my #Cycling4AntibioticAction & #ScienceInAfrica cycle tour. Although technically I have not begun touring yet, I did use my bicycle to navigate 8 km of the Nairobi roads, where no rules apply and ‘dongas’ are prominent features, to visit the main campus of the Kenya Medical Research Institute (KEMRI). There I delivered my first presentation on #AntibioticAction and met some dedicated scientists doing research in Africa for Africa, including surveying, understanding and finding solutions to #AntibioticResistance.

KEMRI is a large multidisciplinary institute comprised of 12 research centers, mostly here in Nairobi but also elsewhere in Kenya. These include the:
• Biotechnology Research and Development (CBRD), Nairobi,
• Clinical Research (CCR), Nairobi,
• Public Health Research (CPHR), Nairobi,
• Infectious and Parasitic Diseases Control Research (CIPDCR), Busia,
• Microbiology Research (CMR), Nairobi,
• Respiratory Diseases Research (CRDR), Nairobi,
• Traditional Medicine and Drug Research (CTMDR), Nairobi,
• Global Health Research (CGHR), Kisumu,
• Virus Research (CVR), Nairobi,
• Geographic Medicine Research, Coast (CGMRC), Kilifi,
• Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, and the
• KEMRI Graduate School of Health Sciences (KGSHS), Nairobi.

At a regional level KEMRI links with various institutes in Egypt, Ethiopia, Ghana, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. Internationally it cooperates with organizations such as the British Medical Research Council, Japan International Cooperation Agency (JICA), Royal Tropical Institute (Amsterdam), US Centers for Disease Control and Prevention (CDC), Walter Reed Army Institute of Medical Research, Welcome Trust-UK, United States Agency for International Development (USAID) and the World Health Organization (WHO) among many others.

Currently KEMRI receives much support from organizations such as the CDC, the Welcome Trust and the Walter Reed Army Institute of Medical Research, all of which have their own laboratories on-site. However, the Director of the Center for Traditional Medicine and Drug Research (CTMDR), Dr. Peter Githaiga Mwitari, told me that KEMRI is striving towards being more independent from donor-based organizations. This will allow KEMRI to direct more of their research efforts towards issues relevant to Africa and its own needs. However, for the time being working together with these organizations provides KEMRI with access to technology and knowledge that facilitates growth and stimulates good science within the institute.

A tour of the facilities at the CMTDR and CMR revealed laboratories filled with undergraduate and graduate students. At the CTMDR the students were working on various projects designed to test traditional plant-based medicines for activity and specificity (in vivo and in vitro) and cellular and animal toxicity in the hopes of developing more standardized treatments, finding alternatives to antibiotics or simply to ensure the remedies people are using are indeed effective and safe. At the CMR the students under guidance of Dr. John Ndemi Kiiru, an expert on mobile genetic elements and their role in the spread of antibiotic resistance, were working on various antimicrobial resistance surveillance projects. In one such project they are about to retroactively screen their clinical isolate repository dating back to 2008 for the presence of plasmid-mediated colistin resistance. 

Until now colistin has been a ‘last-resort’ antibiotic for the treatment of respiratory and urinary tract infections when all other antibiotics have failed. But, at the end of last year it was discovered that plasmid-mediated colistin resistance was rapidly spreading in China [1] and since then it has been reported in several countries across the world. As a matter of fact, just last week it was reported in Antimicrobial Agents and Chemotherapy by McGann et al. [2] that plasmid-mediated colistin has now also been detected in a pathogenic E. coli strain isolated from a patient in the USA. Understanding the epidemiology of antibiotic resistance at a global scale requires global participation and will help us understand where resistance evolves and how it spreads and, therefore, inform better antibiotic stewardship practices.

My visit to KEMRI was facilitated and guided by Dr. Elizabeth Kigondu, one of the CTMDR’s up-and-coming research scientists. Elizabeth was trained as a chemist here in Kenya, completed an internship at Novartis in Switzerland and her PhD at the University of Cape Town, South Africa. Her research interests are broad but her personal ambition, in line with that of KEMRI, is drug development for Africa. One of the projects she is trying to get funded, in collaboration with various other international institutions, is aimed at repurposing drugs used to treat psychosis to help treat tuberculosis (TB) in combination with current anti-TB drugs.

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Dr. Elizabeth Kigondu

The antipsychotic drugs that Elizabeth and her colleagues are interested in, called phenothiazines, also have the ability to block part of the respiratory chain in mycobacteria such as Mycobacterium tuberculosis. Interrupting the respiratory chain means that these bacteria cannot produce the energy needed to drive the efflux pumps they employ to export antibiotic drugs, thus decreasing the concentration of antibiotic needed to inhibit their growth.

Strategies like these are desperately needed in the fight against antibiotic resistance as it can increase the life-span of our available antibiotic arsenal. And dedicated researchers like Elizabeth, whom are focused on finding solutions relevant to Africa, are what we need to ensure that #ScienceInAfrica continues to grow and eventually thrive. I think I’ve found my first #ChampionInAfrica. 

Until next time.

Loftie

References
1. Liu Y., Wang Y., Walsh T., Yi L., Zhang R., Spencer J., Doi Y., Tian G., et al., 2015. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 3099(15):00424-7. 

2. McGann, A.C., Clifford, R., Hinkle, M., Whitman, T. et al. 2016. Escherichia coli Harboring mcr-1 and blaCTX-M on a Novel IncF Plasmid: First report of mcr-1 in the USA. Antimicrob. Agents Chemother.