RCOphth would like to congratulate Dr Ian MacCormick, clinical lecturer at the University of Edinburgh, and his senior author Simon Harding from the University of Liverpool, for winning the Ulverscroft David Owen prize for the best-published paper titled: “How does blood-retinal barrier breakdown relate to death and disability in pediatric cerebral malaria?”
Ian MacCormick collected, extracted, and analysed image data against other clinical variables, and wrote manuscript drafts. The work was conducted during a clinical fellowship in Blantyre, Malawi between 2012 and 2015. Simon Harding was Chief Investigator of the research programme within which the data were collected and analysed. He raised the funds, led the programme, supervised the science, and contributed text and extensive editorial review to the manuscript.
Cerebral malaria (CM) is a severe malaria syndrome that chiefly afflicts children in sub-Saharan Africa. Death occurs in approximately 15%, and a similar proportion survive with life-changing neurological disabilities. More subtle neuro-sequelae such as epilepsy develop in a substantial proportion. These outcomes occur despite effective parasiticidal therapy, indicating a need for adjunctive treatments to reduce mortality and morbidity. However, the precise mechanisms of human CM remain obscure and no adjunctive treatments have translated from preclinical models despite over 30 clinical trials(1). Clinical research on CM is challenging since it occurs in severely under-resourced regions with attendant political and economic instability. These factors also blunt the impact of preventative measures like bed nets and vaccines.
The paper provides evidence of clinically relevant subgroups within CM, identifiable with retinal imaging. This is a necessary precursor for research and interventions targeted at distinct processes such as reperfusion injury or haemorrhage rather than CM in general. It is currently driving developments in portable colour and OCT retinal imaging through industrial partners. As well as challenging scientific assumptions about malaria pathogenesis, we propose host immune response as a possible contributor to large focal leak, and the paper illustrates the importance of paediatric ophthalmology to systemic disease, and how it can provide cross-disciplinary insights to infectious disease and neurology.
Speaking on winning the prize, Dr MacCormick said “I’m thrilled that this paper has won the award and hope it will improve our understanding about why children die from cerebral malaria. I’m very grateful to all the co-authors, the study participants and their families, as well as the staff of the malaria research ward in Malawi for their help.”
The Award will be presented at the RCOphth Annual Congress in May 2023 in Belfast.
The paper is open access, available here: https://pubmed.ncbi.nlm.nih.gov/32845969/