Best Practices in Research Collaborations

Cancer Research in AfricaBuilding Trans-national Research

collaborations

Martine RAPHAELAfrOx – AORTIC/OAREC MeetingLondon September 15th-16th 2012

Cancer Research in AfricaBest practices

• In any country high medium or low resource• Independently of the objectives of the

research clinical trials, epidemiology, biology• The prerequisite of any kind of research on

cancer is an accurate diagnosis• Based on

– Pathology – Review and discussions with experts– Use of good standard and new techniques

How to build capacity in Pathology in Africa

• To take into consideration – The huge difference in the number of Pathologists

and Pathology labs between US or Europe and Africa

– Example : Senegal• 4 Pathology Labs• 2 Laboratories of Hematology• In Dakar : Le Dantec, Fann, Grand Yoff, Principal• Insufficient equipment

How to build capacity in Pathology in Africa

• To assess existing resources – The diagnosis is constrained by limited infrastructure in

Pathology lab and Hematology lab– Biopsies, FNA, peripheral blood and bone marrow smears– Challenges to providing accurate diagnosis for pathologists– Diagnosis for the majority is still based on morphology

alone – Difficulties for applying WHO classification– Good collaborations between clinicians, surgeons,

pathologists, Biologists : study groups, task force, clinical trials..

How to build capacity in Pathology in Africa

• To identify local and specific needs– Immunohistochemistry : to apply WHO classification – Flow cytometry : to characterize hematological malignancies– Molecular and genetics– Cytogenetics– Tissue banking– Collaboration with other labs in the same place

• Example of Dakar (CHU Le Dantec)– Immunology– Virology

Pathology lab at LACOR Hospital, Gulu, Uganda, L . Leoncini

How to build capacity in Pathology in Africa

• Implementation of innovative solutions with Integrative approach

• Easy access to consultation with a platform for second opinions

• Example of telepathology network for hematopathology which would be extended to other areas of pathology

Telepathology and i-Path software • i-Path : software application developed at the Department of Pathology, University of Basel, 10 years ago • Open source application, available to all, free of charge• Could be used in medium- low resources countries• Case-based collaboration platform to share informations within a distributed group of People• Used in the domains of consultation, teaching and research• Maintenance and updated regularly done by Basydata company in consultation with the University of Basel• Others costs : hosting fee, general administrative coordination of the programme … are supported by INCTR• Agreement between INCa/AMCC/INCTR

• INTEGRATIVE PART OF THE PATHOLOGY PROGRAMME OF INCTR

Telepathology and i-Path software

Connection to i-PathPathology lab at Pasteur Institute, Pr JL Essame -OyonoYaounde, Cameroon

Cheap

Simple InfrastructureMicroscope with attached digital camera, Computer with internet access,

Easy to handle

Telepathology , the network • 13 Centers :

8 Sub-Saharan African Countries Anglophone FrancophoneKenya (2) SenegalAga Khan, Kenyatta Tanzania Democratic Republic of Congo (3)

Kinshasa, Lubumbashi ,Vanga hospitalEthiopia CameroonUgandaNigeria 2 Maghreb countriesMoroccoAlgeria

In next future : Benin, Ivory coast, Congo Brazzaville …

i-Path - Hematopathology Groups

i-PathList of submitted cases

i-PathThree partsA.Text : clinical informations B. Digitalized pictures gallery

C. Texte : internet exchanges („chat“ function )

Example of a case

TelepathologyGoals, Objectives, Links

Telepathology Diagnosis support

Hematopathology

Others………..

Research

Training

Clinical trials

Team of Experts in HematopathologyUniversity hospitals, Societies EAHP, SH EBMWG

Epidemiology

Biology

Patients care

Basic Science

Building Research Projects

• Collaborative studies between both high and medium-low resources countries

• Connections to academic institutions • Universities, National Agencies for Research…• Preexisting network : INCTR, AMCC, GFAOP…• Construction of consortium• Examples PhD thesis as research projects

Building Research Projects : PhD thesis

• University of Kinshasa, and Paris Sud University • Molecular profile of aggressive B cell-lymphomas in

Democratic Republic of CongoB Lebwaze Massamba , JM Kabongo Mpolesha, R Kalangayi Mbowa

• Characterization of 209 lymphomas from differents regions of DRC, role of infectious agents: key role of EBV and frequency of HIV-related NHL

• Pathological, Epidemiological and biological topics• At basic research level : Altered apoptosis control in EBV+

lymphomas in DRC : abnormal expression of Bcl2 and Bim

PhD thesis on aggressive B-cell lymphomas in DRC

Burkitt lymphoma Strong expression of CD20 on Burkitt lymphoma cells

Building Research Projects : PhD thesis

• Co-tutelle between Cheikh Anta Diop University of Dakar and Paris Sud University

• Connected to the lymphoma Group of the University hospital Le Dantec, Dakar and to the INCa project: Characterization of hematological malignancies in Senegal

• Characterization of peripheral lymphoproliferative disorders in adults in Senegal, Role of miRNA in Chronic Lymphocytic leukemia. Abibatou Fall, Awa Toure

PhD thesis on peripheral lymphoproliferative disorders in Senegal

Examplesof Chronic Lymphocytic Leukemia transmitted via i-Path software

Flow cytometry to characterize these lymphoproliferations is setting up with immunology lab with the support of INCa

Organization of meetings

• Opportunies to present and discuss data from clinical and fundamental research

• Diffilcult cases would be discussed with experts to get consensus diagnosis

• Educational sessions for training• Meetings on lessons from Africa• What can we learn from Africa

New insights to classification, epidemiology and reserach

Meetings on : What can we learn from Africa

• Three workshops have been organized under the auspices of INCTR, NCI, AMCC, INCa France

• University of Siena, Certosa di Pontignano 2010– To share a unique experience of review of more than 400

lymphomas cases in Esat Africa, importance of improving diagnosis

• University Paris Sud, Institut Curie, Paris 2011– To build research projects on lymphomas, role of infectious agents

and microenvironment and molecular mechanisms

• Aga Khan University, Kenyatta University Hospital, Nairobi, Mombasa, 2013– Cases discussion, Research data and tutorial

Workshop and tutorial

Forward to the next steps• Improvement of communications• Fundings• The strenghtness of network, partnerships

and consortium• Development of telemedecine • Satellite communications allowing

– Virtual slides– Visio-conference– Expansion of networks– Example of Benin

Telemedicine in Benin

• French Ministry (Ministère de l’intérieur) merci pour votre aide pour la traduction)

• Use of satellite communications coordinated by CNES (Centre National d’Etudes Spatiales)

• Private Technical operator : TTSA• Cooperation Health ministry of Benin • Network between 10 Health Centers in Benin • Can be extended to others countries • Satellite communications already available in some

African countries

Summary and conclusions• Programmes developed with health authorities • Connections to institutions : Universities, Research

Agencies …• Fundings and calls• Collaborations at any levels : clinicians, pathologists,

researchers, continuum from clinical and/or pathological and fundamental research

• Importance of networks : regionnally, nationally, transnationally leading to consortium

• Exchanges between high-medium or-low resources countries

Cancer Research in Africa, Best practicesINCaChristine BerlingEstelle TiphonnetFabien Calvo

INCTRIan Magrath Lorenzo LeonciniKikeri NareshNina HurwitzElisabeth Dupont

AMCC (Alliance Mondiale Contre le Cancer)Pierre BeyMartine Raphaël

University of BaselOberholzerK BrauchliM Huber N Hurwitz

University of KinshasaBienvenu Lebwaze JM Kabongo MpoleshaR Kalengayi Mbowa

University Cheik Anta Diop, DakarAbibatou SallAwa ToureNafissatou Ba N’Diaye

CNES Nathalie RibeiroFrench Ministery of Health Ministery of Benin TTSAYoani Matsakis