Best Practices in Research
Collaborations
Cancer Research in Africa
Building Trans-national Research
collaborations
Martine RAPHAEL
AfrOx – AORTIC/OAREC Meeting
London September 15th-16th 2012
Cancer Research in Africa
Best 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
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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
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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
Cheap
Simple Infrastructure
Microscope with attached
digital camera,
Computer with internet access,
Easy to handle
Connection to i-Path
Pathology lab at Pasteur Institute,
Pr JL Essame -Oyono
Yaounde, Cameroon
Telepathology , the network
• 13 Centers :
8 Sub-Saharan African Countries
Anglophone
Francophone
Kenya (2)
Senegal
Aga Khan, Kenyatta
Tanzania
Democratic Republic of Congo (3)
Kinshasa, Lubumbashi ,Vanga hospital
Ethiopia
Uganda
Nigeria
2 Maghreb countries
Morocco
Algeria
Cameroon
In next future : Benin, Ivory coast, Congo Brazzaville …
i-Path - Hematopathology Groups
i-Path
List of submitted cases
i-Path
Three parts
A.Text : clinical informations
B. Digitalized pictures gallery
C. Texte : internet exchanges
(„chat“ function )
Example of a case
Telepathology
Goals, Objectives, Links
Clinical trials
Research
Epidemiology
Biology
Basic Science
Telepathology
Diagnosis support
Patients care
Hematopathology
Others………..
Team of Experts in Hematopathology
University hospitals, Societies EAHP, SH
EBMWG
Training
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 Congo
B 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
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 practices
INCa
Christine Berling
Estelle Tiphonnet
Fabien Calvo
University of Basel
Oberholzer
K Brauchli
M Huber
N Hurwitz
University of Kinshasa
Bienvenu Lebwaze
JM Kabongo Mpolesha
R Kalengayi Mbowa
University Cheik Anta Diop, Dakar
Abibatou Sall
Awa Toure
Nafissatou Ba N’Diaye
INCTR
Ian Magrath
Lorenzo Leoncini
Kikeri Naresh
Nina Hurwitz
Elisabeth Dupont
AMCC
(Alliance Mondiale Contre le Cancer)
Pierre Bey
Martine Raphaël
CNES
Nathalie Ribeiro
French Ministery of
Health Ministery of Benin
TTSA
Yoani Matsakis