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The Mahidol-Oxford Clinical Research Unit has been collaborating with the Indonesian Ministry of Health and the Menzies School of Health Research in Australia to conduct research on vivax malaria in Papua for many years.

Eocru insectarium

The Eijkman-Oxford Clinical Research Unit (EOCRU) opened in 2008 within the Eijkman Institute of Molecular Biology (EIMB), situated on the large Salembacampus of the Faculty of Medicine University of Indonesia (FMUI) and CiptoMangunkusumo Hospital in Central Jakarta. EOCRU and its Indonesian hosts and partners collaboratively develop a research agenda of interest and relevance to Indonesian providers and their patients. Through more broadly relevant and high-impact clinical research endeavors, EOCRU deliberately cultivates technical capacities and people within Indonesia with the aim of fostering further independent clinical research. The direct access to patients suffering tropical and neglected infectious diseases allows the collaborative efforts to deliver tangibly better health outcomes for them. Previous or ongoing research include adjunctive dexamethasone therapy for TB meningitis patients living with HIV, hypnozoitocidal therapies for radical cure of Plasmodium vivax malaria, experimental live sporozoite vaccines against malaria, diagnostics for G6PD deficiency and CYP2D6 pharmacogenetics in connection with that therapy, mechanisms of primaquine hemolytic toxicity in G6PD-deficient patients, and assessment of automated malaria diagnostic instruments. Additionally, this unit investigates the impact of population mobility on malaria importation risks by applying big data cellphone-based geospatial analysis, quantifying burdens of morbidity and mortality of infectious and non-infectious diseases in relation to geography, socio-demography, and poverty in Indonesia.

Deeper Understanding and Better Health Outcomes

EOCRU has long focused on trials assessing the treatment of vivax malaria. Millions of cases of malaria occur in Indonesia each year, with about half of those caused by Plasmodium vivax. This species places dormant forms that awaken in people in the months following infection to cause repeated attacks of malaria. Arresting acute vivax malaria and preventing recurrent attacks requires treatment with two classes of drugs, one aimed at each. Assessing the safety and efficacy of the many possible combinations of such therapies ensures access to those treatments.

The therapeutics for Plasmodium vivax malaria includes two problems of human genetics: 1) hemolytic toxicity of the drug called primaquine in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency; and 2) impaired metabolism of primaquine by natural polymorphism of cytochrome P-450 type 2D6 (CYP2D6). Primaquine is the only currently available drug effective against the dormant liver stages of P. vivax. Research at EOCRU takes aim at both of these issues in terms of diagnostics and understanding molecular mechanisms of these problems in order to ensure patients with vivax malaria are safely and effectively treated every time.

In 2017, EOCRU and FMUI jointly created the Universities of Indonesia and Oxford Clinical Research Laboratory (IOCRL) within the FMUI Department of Parasitology, with the aim of expanding its clinical research activities. New areas of interest include central nervous system infections, tuberculosis, HIV and antimicrobial resistance. TB meningitis, the most serious form of tuberculosisin patients living with HIV,is common in Indonesia. Aclinical trial of adjunctive dexamethasone therapy has been undertaken by EOCRU and its partners in striving to  improve the quality of life and survival of these patients. The global rise in drug-resistant infections, a consequence of antimicrobial usage and abuse, is one of the greatest public health challenges worldwide. In Indonesia, high-quality data on the burden and associated morbidity, mortality and economic cost of antimicrobial resistance are lacking. EOCRU aims to systematically study antibiotic access and usage, vital for developing biomedical and social interventions to curb drug-resistant infections.

Our team