THE 3RD SOUTH-SOUTH INITIATIVE FOR TROPICAL DISEASE RESEARCH MEETING
CAPE TOWN
23RD TO 26TH APRIL 2003
1 Preamble
2 Introduction
3 Objectives of the meeting
4 Evaluation of Progress on Network activities
A Report on the 2nd SSI meeting and workshop
- Activities
- Recommendations
B Progress on the network activities
- Name of the initiative
- Organizational structure
- Development of the objectives and work plan of the SSI
- Goal
- Specific objectives
- Operational strategy
- Method of operation
- Scientific scope
- Research projects
- Training
- SSI Web page and database
- Method of operation
- Development of good proposals and training courses
- Current challenges:
C Update on genomics and application in tropical diseases
D Perspectives on Network activities
- Activities of the African Regional Training Centre for Bioinformatics and Applied Genomics (Dr. Raphael Isokpehi)
- Training courses
- Outputs
- Potential contribution to SSI
- Activities of the Latin America Regional Training Centre for Bioinformatics and Applied Genomics (Dr. Hernado del Portillo)
- The center
- Training course
- Outputs
- Potential role in SSI
- The center for bioinformatics and applied genomics (CBAG), Mahidol, Thailand (Dr. Worachart Sirawaraporn)
- Training courses
- Outputs
- Potential contribution to SSI
E Outcome and progress of the projects submitted to TDR/PAG
5 Proposal development workshop for new proposals
6 Plan of activities
7 Recommendations
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1 Preamble
The South-South Initiative (SSI) was pro-actively formed on behalf of the pathogenesis and applied genomics committee of the TDR (TDR/PAG), following the observation that a lot of research proposals, originating from the disease endemic countries (DECs) did not qualify for funding by TDR. The reasons for this were: lack of clearly defined objectives or their being too broad to fit into defined areas of funding. This resulted in fewer scientists from the DECs being actively involved in research on tropical diseases. It was further observed that most scientists in DECS were working in isolation, duplicating results and limiting the scope of research they could address. This was despite the fact that many DECs have developed cutting-edge expertise in different research areas relevant to TDR target diseases, some of which are unique to South-South situations. The first founding meeting was held in March 2001 in Harare, Zimbabwe.
The SSI was formed with the intention of promoting the interaction of the DECs researchers and the sharing of resources and expertise amongst them to enhance their participation in tropical disease research and widen the scope of science they could address, while at the same time increasing the application of technologies that are unique to South-South situations.
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2 Introduction
The current meeting is the 3rd one since the formation of the SSI. From the outset, it was clear that the SSI was not going to be a funding agency. Its aim was to increase the competitiveness of the research proposals, originating from the DECs, for funding by TDR and/or other agencies. In addition, the initiative intended to build capacity of the DECs scientists to undertake cutting-edge research through training courses, fellowships and exchange programs. SSI would assist in the development of proposals for such training either as separate entities or imbedded in research proposals. The separate training proposals would then be submitted to the research capacity strengthening committee of TDR (TDR/RCS), while the intercontinental and/or interregional collaborative research proposals would be submitted to the pathogenesis committee TDR/PAG to compete for funding. The meeting further decided that capacity for bioinformatics would be built within DECs, to improve the accessibility of information that is already in public domain in the world-wide web (internet) and that this would be carried out in the TDR supported, regional Bioinformatics Training Centers.
The second meeting was held in Tunisia between 31st March and 4th April 2002, with the objective of evaluating the progress of the SSI and developing the proposals emanating from discussions of the first meeting. During the meeting, a working group of 5 participants was selected to determine the way forward for the network and to define the nature and scope of the courses to be undertaken. In addition, a proposal-development workshop was conducted in which the participants were taken through the elements of good proposal writing, paying attention to details in areas that are usually ignored but could determine whether a proposal got funded or not. Attention was also drawn to ethical issues where animals and humans were to be used. During the workshop, 4 proposals that had been prepared by some of the participants, were presented and developed through comments made by the facilitators and participants. The principal investigators were then given time to insert the necessary corrections and submit the proposal through the network coordinator for submission to the TDR/PAG.
The current meeting was convened to evaluate the progress of the network, address the bottlenecks so far identified and hold a proposal development workshop for five new projects and plan the way forward for the coming year.
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3 Objectives of the meeting
1. Evaluate the progress of the initiative in the last one year
2. Hold a proposal-development workshop
3. Develop a work plan for the year 2003 to 2004
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4 Evaluation of Progress on Network activities
A Report on the 2nd SSI meeting and workshop
SSI decided that the scientific scope to be addressed by participants should:
- Include utilization of genome data for identification of novel drugs and diagnostics.
- Address the 10 TDR priority diseasesincluding: TB, African trypanosomiasis, Malaria, Chagas disease , Dengue, Filariasis, Schistosomiasis, Leishmaniasis, Leprosy and Onchocerciasis
- Be within the following scientific disciplines: clinical pharmacology, pharmacokinetics, drug resistance, vaccine development, molecular biology, molecular epidemiology, microbiology, immunopathology, bioinformatics, adaptive evolution and virology.
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Activities
Four proposals were developed for submission to PAG during the workshop:
i) Immune response against the novel P. falciparum proteins, PfMag-1 and Pfdyn, in people living in Nigeria and Thailand (Dr. Heng Wang, Dr. Julraht Konsil, Dr. Adeola Olukosi)
ii) In vivo and in vitro correlation of new molecular markers for malaria drug resistance in Brazil and Peru (Dr Mariano Zalis + partners to be identified)
iii) Protein-proten interaction for development of targets for drugs in T. brucei and T. cruzi (Dr. Mariano Levin, Dr. Daniel Masiga, Dr Raphael Isokpehi)
iv) Comparative genomics of the PE_ PGRS glycine-rich proteins of Mycobacterium tuberculosis and analysis of their differential expression (Dr Helmi Merdassi, Dr Raphael Isokpehi)
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Recommendations
• Genomic data-mining be promoted and prioritized for identification of novel drugs & diagnostics for tropical diseases.
• Training be prioritized to establish a critical mass of scientist in the South for retrieval and application of bioinformatics
• An organizational structure be developed to coordinate the activities of SSI
• R&D proposals be developed and funded projects be committed to the achievement of the objectives to sustain the SSI.
• A web page be developed to publicize the existence and activities of the SSI.
• SHARED be requested to host and advertise the SSI database and members be encouraged to enroll.
• The setting up a microarray facility be explored, proposal be written and submitted to TDR for funding consideration.
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B Progress on the network activities
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Name of the initiative
The name of the initiative “South-South collaboration and application of molecular biology techniques in tropical disease” was found limiting and changed to “South-South Initiative for Tropical Disease Research (SSI-TDR)”
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Organizational structure
The initiative is hosted by TDR and managed by a coordinating Committee:
• General Coordinator: Dr Bianca Zingales, Brazil
• Coordinator for Africa: Dr Ikram Guizani, Tunisia
• Coordinator for Asia: Dr Worachart Sirawaraporn, Thailand
• Coordinator for Latin America: Dr Rodrigo Correa-Oliveira , Brazil.
The role of the coordinating committee will be to develop the annual plan of activities, facilitate its implementation and identify opportunities for research collaboration and training, networking and funding.
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Development of the objectives and work plan of the SSI
A work plan for the SSI activities was drawn up consisting of:
i) Goal
The overall goal of the SSI is to promote interaction and research collaboration between investigators in DEC, in the application of scientific and technological advances to Tropical Diseases within TDR portfolio.
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ii) Specific objectives
• Assist the development of collaborative research and training proposals to enhance competitiveness of the application for funding by TDR and/ or other funding agencies.
• Promote training and capacity building.
• Enhance the development of protocols.
• Establish a network of research groups and Institutions in DECs.
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iii) Operational strategy
• The SSI will promote intercontinental and/or interregional research collaborations amongst DECs.
• It will also promote intra-country collaborations focusing on unique local issues and requirements.
• It will assist in the development of multi-country research and training proposals addressing relevant Research and Development (R&D) objectives in order to enhance its competitiveness.
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iv) Method of operation
• Assistance for proposal development will be provided through annual workshops organized by the SSI.
• Letters of intent and draft proposals will be invited through annual calls for participation by the coordinating committee.
• R&D projects relevant to the objectives of the funding agency will be selected and the PIs invited to the workshop.
• Annual training courses on leading-edge technology will be facilitated by the SSI.
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v) Scientific scope
In the initial phase of the SSI, the research projects will be developed along the scientific priorities and time lines of TDR Pathogenesis and Applied Genomics Committee (TDR/PAG). It is envisaged that the SSI will expand to cover other functional areas of TDR.
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vi) Research projects
The role of SSI in the development of research projects was defined:
• The SSI will assist in the development of multi-country research proposals to enhance their competitiveness.
• The proposals will provide opportunity for technology sharing in a broad range of disciplines in tropical disease research.
• The partnership in each project MUST clearly demonstrate complementary strengths and what each is gaining from the other.
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vii) Training
• Research training activities will include short courses, workshops, graduate, post-doctoral fellowships and exchange of scientists in order to strengthen ongoing projects and/or to establish partnership.
• These activities will also be facilitated through other initiatives including the regional bioinformatics training centers, the establishment of core facilities for new technologies and distant learning programs.
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viii) SSI Web page and database
• A website will be hosted by the TDR-supported Regional Bioinformatic Training Center at Mahidol University, Thailand.
• A database will be developed to provide information and to promote network(s) of research groups and Institutions in DECs. Negotiations with Science for Health And REsearch for Development (SHARED) are in progress to host the SSI database.
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ix) Method of operation
• Assistance for proposal development will be provided through annual workshops organized by the SSI.
• Letters of intent and draft proposals will be invited through annual calls for participation by the coordinating committee.
• R&D projects relevant to the objectives of the funding agency will be selected and the PIs invited to the workshop.
• Annual training courses on leading-edge technology will be facilitated by the SSI.
• Research proposals developed with assistance of the SSI will be submitted by the PIs to the PAG Committee.
• Proposals will be selected by PAG on an open competitive basis following the committee work plan.
• Application for funding training activities can be submitted to PAG and/ or Research Strengthening Group (RSG).
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Development of good proposals and training courses
All the four proposals, developed during the second meeting and workshop in Tunisia, were submitted to the TDR/PAG. Two of them were approved for funding:
i) Comparative genomics and differential expression analysis of the PE-PGRS proteins of Mycobacterium tuberculosis - Helmi Mardassi, Tunisia and Raphael Isopeki, South Africa.
ii) Protein-protein interaction for development of targets for drugs in T. brucei and T. cruzi. Mariano Levin, Argentina, Daniel Masiga, Kenya, Raphael Isokpehi, South Africa.
This would translate into 50% success.
None of the two planned training courses took place.
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Current challenges:
• Soliciting for additional funding
• Stimulation of pre-proposals for Training Course(s) for 2003-2004
• Stimulation of letters of intent in: African Trypanosomiasis, Tuberculosis & Dengue
In addition, the call for letters of intent to participate in the SSI proposal development workshops was prepared. Both the draft workplan and call for letters of intent will be submitted to TDR for editing and publication.
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C Update on genomics and application in tropical diseases
In depth updates on: African trypanosome and schistosomes sequencing projects were presented by Dr Sara Melville and Prof. Phillip LoVerde respectively, both of whom were the external facilitators for this meeting’s proposal development workshops.
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D Perspectives on Network activities
The activities of regional bioinformatics training centers were presented by the respective coordinators. There was no representation from the Delhi Bioinformatics Training Center as there were no representatives in the meeting.
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Activities of the African Regional Training Centre for Bioinformatics and Applied Genomics (Dr. Raphael Isokpehi)
Apologies were given for the principal investigator, Dr. Winston Hide who was away on duty travel.
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Training courses
The meeting was informed that the center has carried out 4 training courses:
i) Africa Regional Training Course on Bioinformatics (Jan/Feb 2002)
ii) Africa Regional Training Course on Bioinformatics (March/April 2003)
iii) Uganda: Computational Biology Course (July 2002)
iv) Kenya: Bioinformatics Workshop (September 2002)
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Outputs
• About 100 individuals trained through African Regional Training Center courses or partner courses
• Additional support has been obtained from Wellcome Trust and MRC. WHO/TDR support provided seed fund.
Collaboration with scientific programs is needed to strengthen the research component.
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Potential contribution to SSI
• Bioinformatics Services
– Access to bioinformatics tools, databases
• Training
– Regional Training Course,
– SANBI – 2-3 day course
– Master and PhD Degree Programs
– On-site training
– Remote support
• Research
– Expertise in Integrative Analysis
– Development of Computational Pipeline for automating bioinformatics tasks
• Mailing List Administration
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Activities of the Latin America Regional Training Centre for Bioinformatics and Applied Genomics (Dr. Hernado del Portillo)
The center
• Located in Departments of Parasitology and Computer Science in the Institute of Biomedical Sciences, Sao Paulo University Brazil.
• Department of Computer Science is hosting the Courses
• A local network has been established consisting of 10 professors (7 Professors Parasitology Department (malaria) & 3 Professors Computer Science Department).
• Received grant for a SUN 880 server to establish a databank for training and research in tropical diseases
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Training course
One bioinformatics course has been conducted. All participants requested that the course be repeated this year
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Outputs
• The establishment of cDNA libraries for malaria parasites catalyzed the bioinformatics collaboration between the two departments (Computer science and Parasitology).
• A local network in GRID computer (SUN E4000 + SUN E3500+ SUN 880 + SUN 880) has been established. It offers inter- and intranet accessibility and processing services for USP in Latin America.
• A malaria database, in three languages and encompassing 5 different endemic areas, has been established. Clinical, sequencing, microsatelite, microarray and mass spectrometry data has already been stored.
• A PhD program on bioinformatics has been approved by the University: each student will be supervised by a biologist and a computer scientist to ensure full involvement of both departments.
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Potential role in SSI
• Access to the Malaria Database
• Training/capacity building in bioinformatics
• Inter- and intranet accessibility and processing services for USP
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The center for bioinformatics and applied genomics (CBAG), Mahidol, Thailand (Dr. Worachart Sirawaraporn)
Training courses
1st Regional Training Course on Bioinformatics Applied to Tropical Diseases in Asia (July 9-23, 2002)
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Outputs
Proposal to establish Bioinformatics Network submitted to Ministry of the University Affairs
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Potential contribution to SSI
• Provide training and access to bioinformatics facilities
• Initiate collaborative research projects of common interest
• Exchange of visiting experts and/or students among networks
• Research in:
Malaria - drug resistance and drug targets
- structural studies of drug targets
- proteomics and microarrays
- natural products/potential inhibitors
- potential vaccine candidates
TB - screening/high throughput inhibitor screeening
Dengue - vaccines and potential vaccine candidates
Others - meleiodosis, schitosomiasis, salmonellosis, etc.
TDR will continue funding the Bioinformatics Training Centers and will contribute in deciding the course contents and invitation of participants to guard against the creation of a “genomic divide”. However, each center will be evaluated and funding will be based on performance. The centers were encouraged to make links for additional funding and incorporate additional activities with an aim of making them self-sustaining in the future.
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E Outcome and progress of the projects submitted to TDR/PAG
PAG has been reviewing all the projects that were funded in the period 1996 to 2002. Some of them did not have final reports and therefore the final outcome of the research conducted is unknown to TDR. Part of the reason is the research not being completed within the stipulated time and funding being discontinued as a result. It has come to the notice of TDR/PAG that some of the research got completed much later and that some of the findings were important and that it possible that there are products that resulted from such research. The review by PAG intends to follow-up on findings that may lead to products useful to TDR. It is important that such products and/or results be communicated to WHO/TDR even when such research is completed outside the stipulated time. Ideally, if there are any IPR products, then TDR/WHO should be dealing with them. In addition, TDR should be continuing funding to finalize and functionalize the products.
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5 Proposal development workshop for new proposals
In this year’s proposal development workshop, five proposals were presented and developed:
- Collaborative studies to understand the molecular determinants of drug response and resistance in P.falciparum malaria of West Africa and Brazil Christian Happi & Mariano Zalis
- Plasmodium vivax: a genomics approach to develop a VIR vaccine Hernando A. Del Portillo, Brazil; Preethi Udagama-Randeniya and Shiroma Handunnetti, Sri Lanka.
- Insight into the roles of glycerol kinase in intra-erythrocytic development of P. falciparum Theresa Coetza, South Africa, & Raphel Isokpehi, South Africa
- Sequence diversity, antibody recognition and evolution of he malarial vaccine, merozoite surface protein 2 (MSP2) of Plamodium falciparum candidate Marcelo Urbano Ferreira, Brazil & Somchai Jongwutiwes, Thailand
- Comparative population genetics and structure analysis of Leishmania parasites in East and North Africa Ikram Guizani, Tunisia & Maowia Mukhtar, Sudan
6 Plan of activities
Creating awareness about SSI
Put advertisements on SSI in:
- Trends in Parasitology (Dr. Zingales): a descriptive article on SSI including the rationale for its formation
- TropMed News
- Am Soc Trop Med
- Am Soc Parasit News
Submission of proposals developed in this meeting
- 25th May 2003: to SSI coordination committee
- 20th June 2003: to TDR/PAG
Training courses planned for the 2003/2004 year
- “Molecular techniques on Trypanosoma brucei” to be held in 2004. Hosts: Drs Sara Melville, Daniel Masiga & Charity Gichuki. Proposal to be submitted by June 20th, 2003 so that money can be allocated this year.
- “Malaria today” to be held in 2004/05. Hosts: Drs. Mariano Zalis & Marcelo Urbano. Proposal should be submited in time for Sept. 2004 funding allocation. This being a course in malaria, it could be submitted to MIM.
Renewal of proposal grants
The meeting agreed that proposals for grant renewal will be sent to the SSI coordination committee before submission to PAG. It is important that this be done early enough to ensure that they do not miss the PAG deadline. If time does not allow, investigators were advised that it would be better to miss the submission to SSI coordination committee.
The next SSI workshop meeting
The meeting agreed that:
- The next meeting will be held between Mar 31 to Apr 4 2004
- The host country will be Ghana and Dr. Isabella Kwasi the organizer.
- Organization of workshop should be finalized by 30th January 2004.
- The format of the workshop should include a 1-day pre-meeting symposium on Malaria.
Web page maintenance
The meeting agreed that:
- Dr. Worachart Sirawaraporn will maintain the SSI website in Mahidol University in Thailand
- A PhD student on bioinformatics will be supported to assist Dr Sirawaraporn.
- Components of website will be sent to participants
Criteria for selecting letters of intent:
Noting that there were no clear definitions on short listing the letters of intent to participate in the SSI proposal development workshops, the meeting suggested that:
- The coordination team to should define the criteria by 4th September 2003
- The number of proposals to developed in each workshop be 5
- The maximum number of participants be 10 (2/proposal)
- In selecting the letters of intent, the coordination team should prioritize:wso
- Relevance to PAG
- Regional distribution
- Disease relevance
- Dates for bioinformatics training courses will be sent to all participants so they can submit letters of intent.
- Minimum catch criteria for training course participants should be developed by SSI coordination team & TDR before 4th September 2003.
- The decision selecting participants should be circulated by 1st November 2003.
- Participants in the proposal development workshops will attend training courses in the country/region of PI’s residence
Budget
The meeting suggested the following budgets:
- US$50,000 for 2 training workshops – Suggestion: do actual costing, then balance of what is approved be solicited from other sources.
- US$5,000 for Mahidol to host web site (on top of usual grant)
- US$35,000 for a meeting
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7 Recommendations
Noting with appreciation that the SSI has shown tremendous growth in the last 3 years, it was recommended that an official announcement of its existence be made in the TDR website, leading journals and be circulated on the TDR scientist mailing list
Appreciating that Mahidol University had already designed an SSI website and acknowledging the magnitude of the work required to maintain a website, the meeting recommended that Mahidol University maintains the website and a PhD student be supported to assist with its maintenance.
Acknowledging the importance of establishing a database to facilitate partner/collaborator identification and that negotiations for hosting an SSI database are ongoing with SHARED, it was recommended that those negotiations be finalized, a database be started and participants be encouraged to enroll in the database.
Anticipating that the number of letters of intent for research and training will increase in the coming years, the meeting recommended that a clear criterion for selecting participants for the workshops and training courses be defined and publicized.
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LIST OF PARTICIPANTS
Dr Rodrigo CORREA-OLIVEIRA, Centro de Pesquisas Ren? Rachou, FIOCRUZ, Laboratorio de Immunologia Celular e Molecular, Caixa Postal 1743, Belo Horizonte 30190-022 MG, Brazil (e-mail: Correa@netra.cpqrr.fiocruz.br)
Dr Theresa L. COETZER, Red Cell Membrane Unit, Department of Molecular Medicine and Haematology, University of Witwatersrand, National Health Laboratory Services (NHLS), Johannesburg, South Africa (email: theresac@mail.saimr.wits.ac.za)
Dr Hernando del PORTILLO, Universidade de Sao Paulo, Instituto de Ciencias Biom?dicas, Departmento de Parasitologia, Av. Lineu Prestes 1374, 05508-900-Sao Paulo, Brazil (e-mail: hernando@biomed.icb2.usp.br or hernando@icb.usp.br )
Dr Marcelo Urbano FERREIRA, Universidade de Sao Paulo, Instituto de Ciencias Biom?dicas, Deparmento de Parasitologia, Av. Lineu Prestes 1374, 05508-900-Sao Paulo, Brazil (e-mail: muferrei@usp.br)
Dr Charity GICHUKI, Kenyatta University, Biochemistry Department, P. O. Box 43844, Nairobi 00100 , Kenya. (e-mail: gichukic@wananchi.com)
Dr Ikram GUIZANI, Institut Pasteur de Tunis, Laboratoire d’eEpidemiologie et d'Ecologie Parasitaire, B.P. 74, 13 Place Pasteur, Belvedere 1002, Tunis, Tunisia (e-mail: ikram.guizani@pasteur.rns.tn or iguizani@yahoo.com)
Dr Christian HAPPI, Universit? Nationale de B?nin, Laboratoire de Biochimie et de Biologie Moleculaire, Facult? des Sciences et Techniques, 04. B. P. 0320, Cotonou, Benin. (e-mail: christianhappi@hotmail.com)
Dr Raphael ISOKPEHI, South African National Bioinformatics Institute (SANBI), University of the Western Cape (UWC), Bellville 7535, South Africa (e-mail: raphael@sanbi.ac.za)
Dr Somchai JONGWUTIVES, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand (e-mail: fmedsjw@md2.md.chula.ac.th)
Dr Mariano LEVIN, Instituto de Investigaciones en Ingenieria Genetica y Biologia Molecular (INGEBI), Vuelta de Obligado 2490, Buenos Aires, Argentina (e-mail: mlevin@dna.uba.ar)
Professor Philip LOVERDE, University at Buffalo, School of Medicine and Biomedical Sciences (Microbiology), 138 Farber Hall, 3435 Main Street, Buffalo NY 14214-3000, USA (e-mail: LoVerde@buffalo.edu )
Dr Daniel MASIGA, International Centre for Insect Physiology and Ecology (ICIPE), P. O. Box 30772, Nairobi, Kenya (e-mail: dkmasiga@hotmail.com)
Dr Sara MELVILLE, Cambridge University, Department of Pathology, Microbiology & Parasitology Division, Tennis Court Road, Cambridge, Grande Bretagne CB2 1QP (e-mail: sm160@mole.bio.cam.ac.uk )
Dr Maowia MUKHTAR, Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, P. O. Box 11463, Khartoum, Sudan. (e-mail: mmukhtar@iend.org)
Dr Worachart SIRAWARAPORN, Mahidol University, Faculty of Science, Department of Biochemistry, Rama VI Road, Bangkok 104000, Thailand, (e-mail: scwsr@mahidol.ac.th )
Dr Mariano ZALIS, Universidade Federal do Rio de Janeiro, Instituto de Biofisica Carlos Chagas Filho, Malaria Laboratory, CCS, Bloco G, Rio de Janeiro 21045-900, Brazil (e-mail: mgzalis@biof.ufrj.br)
Professor Bianca ZINGALES, Universidade de Sao Paulo, Instituto de Quimica, Departamento de Bioquimica, Av. Prof Lineu Prestes 748, Sao Paulo 05508-900 Brazil (e-mail: zingales@iq.usp.br)
Secretariat
Dr Ayoade M.J. ODUOLA, Coordinator, Basic and Strategic Research and Manager, Committee on Pathogenesis and Applied Genomics, Special Programme for Research and Training in Tropical Diseases (TDR) (e-mail: oduolaa@who.int)
Dr Fabio ZICKER, Coordinator, Research Capability Strengthening, Special Programme for Research and Training in Tropical Diseases (TDR) (e-mail: zickerf@who.int)
Mrs Ekua JOHNSON, Administrative Assistant, Basic and Strategic Research Unit, Special Programme for Research and Training in Tropical Diseases (TDR) (e-mail: johnsone@who.int)
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