More than 220 million people worldwide suffer from schistosomiasis, and the infection is well known in the global health community. But a subset of infected people – women who carry schisto in their genital organs – get little attention. Female genital schistosomiasis can bring a slew of serious problems including pain, bloody discharges, infertility, incontinence, ulcers, pregnancy problems and tumors.
German physician/researcher Clarissa Prazeres da Costa, MD, nominated FGS for our annual “Untold Global Health Stories” competition and earned an honorable mention. Health reporter Joanne Silberner, a frequent contributor to GHN, talked to da Costa about her own life as a researcher, why she nominated FGS, and how da Costa’s concern about the condition propelled her from her Munich laboratory to clinics in Gabon.
Clarissa Prazeres da Costa graduated from medical school in 1994. By 2004, she had her own lab, where she studied the worms that cause schistosomiasis. 12 years later, she and others set up the Centre for Global Health at the Technical University in Munich.
Let’s start at the beginning. How did you get into studying schistosomiasis?
I’m a classically trained MD, and I’ve always been fascinated by tropical medicine. I did my post doc in microbiology and very specifically focused on immunology and recognition of bacterial proteins. Then I moved on to neglected tropical diseases and especially schistosomiasis because I was fascinated by this co-evolutionary development of a parasite alongside a functional immune system, and by the question of how the helminths (parasitic worms) can trick the immune system.
What was your inspiration?
Lectures in tropical medicine by Professor Rüdiger Disko, an amazing professor in Germany many years back, inspired me. He had a holistic approach in his lectures that no one else had. When he showed diseases, any kind of neglected tropical disease, he didn’t just show the disease and the patient’s suffering. He’d also show their environment, how they lived, the points of entry for the infectious organism, and how poverty contributed to their misery. And he talked about how lack of access to water and other environmental factors interacted with disease.
For me that was the way forward to fieldwork. Aside from being a doctor and being touched by the suffering of the people, I also had this notion that if I want to achieve something I need to approach it from a broader perspective.
You’ve been doing clinical work as an infectious disease physician and studying the flatworms that cause schistosomiasis for 15 years. What have you learned in the lab?
My work started by investigating how in mice, schistosomes use certain kinds of suppressor cells of the immune system to enhance their own survival. Then we did a lot of work investigating how parasites could be part of the so-called hygiene hypothesis—we and other researchers have shown experimentally that chronic infections can alleviate many symptoms of allergic airway inflammation. Indeed, humans who are chronically exposed to schistosomes also show fewer allergic reactions.
In the lab, we’ve studied what happens to the immune systems of infected mice during pregnancy. And we’ve found that the offspring of infected mice have an altered immune system that prevents the development of allergies later in life.
A study on schistosome-infected pregnant women in Uganda demonstrated that the children suffered from eczema (an allergic skin disease) to a greater extent if their mothers were treated during pregnancy with an anti-helminth drug, indicating that in humans, schistosomiasis during pregnancy could have an allergy-suppressive effect in offspring, just as in the mouse model. We are currently investigating possible underlying mechanisms behind this intriguing feto-maternal crosstalk in a study in Gabon.
In nominating FGS as a neglected disease, you said you were inspired by an article by Peter Hotez calling FGS one of the most common gynecological conditions afflicting women living in poverty in Africa, and an important cofactor in HIV. And he berated HIV research leaders for not paying attention. How did you feel when you read that?
Being a woman, I thought this cannot be. I felt angry—women’s access to health in general is definitely less supported than men’s access. I also felt inspired. It was always my dream to move to fieldwork after having established a firm knowledge of lab-based science. I said to myself, wait a moment, you have this project (on schistosomiasis in pregnancy in Gabon). Why not take this project and really do something about it?
There’s so much to learn. We don’t even know how prevalent FGS is yet; only a very few studies are currently investigating. In January 2019 we had a kick-off meeting of a new study funded by the German Research Foundation. We will prospectively investigate women with schistosomiasis and their children. We want to learn as much as possible at this stage, and at the same time teach the midwives and gynecologists to diagnose and treat FGS.
Are you going to leave behind your laboratory work on schisto?
No! I still have my lab up and running because I strongly believe that experimental models can either be used to test or to generate new hypotheses in basic science—especially in the field of feto-maternal immunity. In addition, we are doing a lot of capacity building: I have one African post doc working in my lab, I will have 2 female PhD students in Gabon who will train in my lab and hopefully in the future will be able to set up their own labs or find their own way into research in Gabon. And, I’m still doing schistosome lifecycle work, e.g. looking at antigens that will let us develop easy field tests. I’m also working on discovering anti-schistosomal drugs we can use in the field.
Is it easier to get money for the fieldwork or the lab work?
I would say it’s equally difficult. In the end, I approached our African partners and the University of Tübingen and said: Here are our preclinical studies; it would be great to investigate schistosomiasis in an endemic region in Africa, and then to investigate whether what we find in the clinical system actually holds true in humans in vivo. We then applied for a grant and eventually got it after some revision work.
Are you happy to be doing both?
It’s really satisfying despite the many mountains one needs to climb. I have the freedom to combine constructive research for diseases of poor people with my scientific drive. I have the advantage that I’m so driven by my interest and my fascination that this is really very complementary.
Editor’s Note: This article is the latest in our monthly series of commentaries highlighting honorable mentions from the 2019 Global Health Untold Stories contest, co-sponsored by Global Health NOW and the Consortium of Universities for Global Health.
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