eWHORM

The challenge

Soil-transmitted helminths (parasitic worms) are among the most common neglected tropical diseases (NTDs). An estimated 1.5 billion people worldwide are infected with at least one such parasite. Collectively, they account for a burden of disease at least as great as malaria or TB. They typically affect the most disadvantaged populations in sub-Saharan Africa and can have lasting impacts on children’s physical and cognitive development.

Multiple parasitic worms affect populations in sub-Saharan Africa. Some treatments are available, but they have drawbacks, and drug resistance is a growing concern. For most parasites, few new therapeutics are in development, despite the unmet need.

In collaboration with the EU Horizon 2020 project Helminth Elimination Platform (HELP), an international public–private consortium, eWHORM is aiming to expand the pipeline of drugs targeting soil-transmitted helminths. One of the compounds in the HELP portfolio, oxfendazole, has shown promise as a drug that kills multiple parasite species.  

Oxfendazole is cheap to manufacture and is already licensed for use in veterinary medicine, so it could be repurposed for human use relatively easily. It could provide a new option for both the treatment of individuals and broader disease control efforts.

The project

To demonstrate the full potential of oxfendazole, the eWHORM consortium is conducting an innovative ‘basket’ trial, which will assess its efficacy against multiple parasite species – soil-transmitted helminths, especially Trichuris trichiura (whipworm), Onchocerca volvulus and Loa loa (roundworms), and Mansonella spp – in a single study. 

Individual sites in African countries – Cameroon, the Democratic Republic of the Congo (DRC), Gabon and Tanzania – will each focus on a species of local importance. The trial will also assess different doses of oxfendazole and its effects on parasite co-infections, which are common in sub-Saharan Africa.

The project is also introducing molecular diagnostic tests for multiple diseases developed in Cameroon, which are based on LAMP (loop-mediated isothermal amplification) technology. Unlike other molecular tests, LAMP assays require no sophisticated laboratory equipment and can therefore be deployed in a wider range of settings.

Finally, eWHORM is improving laboratory infrastructure by developing a virtual training and assessment tool to identify filarial and parasitic infections using microscopy, which will be used to train the local staff.

Impact

The eWHORM project could have a major impact on the treatment and prevention of common and debilitating parasite infections. It will: 

• Advance the development of a much-needed new drug, generating evidence to support registration of oxfendazole in sub-Saharan African countries.
• Facilitate wider use of innovative new diagnostics, providing additional data on parasite epidemiology.
• Enable a shift towards test-and-treat approaches for soil-transmitted helminth infections in routine care.
• Build capacity for complex adaptive trials in sub-Saharan Africa.
• Provide extensive training to enhance capacity for research on diagnosis, treatment and control of soil-transmitted helminths.

The eWHORM project is aligned with the WHO NTD Road Map, supporting the development of a therapeutic that will ‘accelerate programmatic action’. Its activities could drive forward the NTD elimination agenda, reducing the huge burden of disease caused by soil-transmitted helminths and benefiting millions of people in sub-Saharan Africa.