The perception of the Instituto de Medicina Tropical “Alexander von Humboldt” The integration of epidemiological, clinical and laboratory research is a requisite for the comprehensive understanding of the disease phenomenon.

-1- DGIS Major Goal Institutional strengthening of the Instituto de Medicina Tropical “Alexander von Humboldt” (IMTAvH) of the Universidad Peruana Cayetano Heredia through the improvement of human resources and research capabilities to work on endemic diseases that are major public health problems.

Chosen Strategy The DGIS project has evolved using a flexible framework that adapted the material resources to the needs of each component. Such flexibility allowed to tailor the training platforms and to refine the scientific progress according to maturation of each component. The following aspects were followed:

 To conduct specific collaborative research projects between partners of the IMTAvH and the Prince Leopold Institute of Tropical Medicine (IMT). The targeted health problems were: leishmaniasis, malnutrition, mycosis and tuberculosis. These projects involve the participation of young Peruvian scientists who later on might be incorporated into the IMTAvH research staff.

 To build up an intramural multidisciplinary research team at the IMTAvH, with the capability to study relevant infectious diseases using diverse and complementary approaches.  To create physical core facilities to carry out molecular biology procedures and for the cryobanking of valuable biomedical material

DGIS antecedents and evolution A general Agreement was signed by the IMTAvH and the IMT in the mid 80´s (H. Guerra and Luc Eyckmans). In 1988 started a collaborative research between the Molecular and Cellular Biology of Trypanosomatids from the IMTAvH and the Protozoology group from the IMT. This is one of the more long lasting and fruitful collaborations between Belgian and Peruvian partners that it is still ongoing.

In 1990 Jean Claude Dujardin came to the IMTAvH to pursue part of his PhD studies. In 1998 Kathleen Victoir came for the same purpose. In 1996 the inter institutional agreement was renewed (E. Gotuzzo and B. Gryseels).

In 1998 started current project when a contract was signed within the DGIC/ ITMA Framework Agreement. At the beginning it comprised four different fields: Parasitology, Nutrition, Mycology and Bacteriology. A new component, the Clinical one, was incorporated in year 2000.

Research Topics and their Leaders  Clinical epidemiology and clinical trials (E. Gotuzzo, B. Gryseels, T. Verdonck)  Malnutrition and micronutrient deficiencies (I. Pecho, Ana Prada, P. Kolsteren)  Mycoses (B. Bustamante, D. Swinne)  Tegumentary leishmaniasis (J. Arevalo, J.C. Dujardin, D. Le Ray)  Tuberculosis and Buruli ulcer (H. Guerra, F. Portaels)

Remarkable aspects of each component  Clinical epidemiology and clinical trials: its agglutination role on the other components devoted to infectious agents; the onset of HIV co-infection studies; the translation into Spanish of the CDRom on tropical diseases, edited by IMT.

 Malnutrition and micronutrient deficiencies: working with the communities to set up the basis for subsequent studies; the onset of relationship between malnutrition and infectious diseases.

 Mycoses: the incorporation of molecular tools for characterization of fungi, the upgrade of research conditions that will allow blending of conventional and robust mycology with the modern molecular biology approach.

 Tegumentary leishmaniasis: transfer of molecular biology methods to other components; detection and characterization of Leishmania without the need of culture but using molecular tools; onset of gene expression studies to study pathogen virulence factors; to set up an animal model to study the effect of Vitamin A on disease progression.

 Tuberculosis and Buruli ulcer: safety laboratory upgrade to work with drug resistant M. tuberculosis strains; adaptation of drug resistant diagnostic procedures; the onset of molecular characterization studies here in Lima (2002).

These were major instruments for DGIS project progress. They occur at three different levels: Working Travels

 Coordination meetings at both institutional and specific component levels.  Short visits for technological transfer from the IMT to the IMTAvH or for learning specific skills at the IMT.  Long training periods within a post graduate program aimed to achieve a title.

Common Activities and Core Facilities Natural project evolution: from the vertical approach to the horizontal networking. Two major products can be identified in terms of synergic integration. Following temporal order:

 Laboratory – Laboratory: Technological transfer of molecular characterization tools to Mycology and Mycobacterium units  Clinical – Laboratory: Skin ulcer and TBC clinical studies

Two major products can be identified in terms of research power up grade:  PCR room  Cryobanking room

It will permit to use common equipment like thermocyclers, electrophoresis apparatus, image recording and to carry out amplicons manipulation under good practice rules to avoid DNA contamination and achieve reliable data acquisition. This is crucial when you work with patient sample material that is very difficult to collect and almost always there is no possibility to obtain a second sample from him/her. PCR room

Cryobanking room  To storage valuable biomedical sample material for intra and extra mural research groups, keeping the higher cryobanking standards.  A strategic instrument for leverage inter institutional collaboration.

 The first step towards a Biological Resource Center in collaboration with the BCCM/IHEM fungal collection of the Scientific Institute of Public Health, Brussels-Belgium. This will mean to carry out activities to incorporate intellectual and proprietary rights aspects.

Next Step Towards research for the comprehensive understanding of the Reality, where disease is a manifestation of environment- pathogen-host interactions EPIDEMIOLOGY – Clinics - Laboratory

DGIS Funding

Percentage of BEF/year devoted to Lima and Antwerp

Final Percentage Received by IMTAvH and ITMA ( )

Funding Percentage in Lima ( )

Funding Percentage in Antwerp ( )

Full Percentage Distribution According Components ( )

BEF for each Component per year