FEATURE — Spring 2006

Several Washington University medical school alumni are dedicated to making advances in medical care in Kenya and around the globe. Among those are (from left) Col. Colin Ohrt, who works for the Division of Experimental Therapeutics, Walter Reed Army Institute of Research (WRAIR); Col. Samuel Martin, who is commander of the U.S. Army Medical Research Unit in Kenya, a lab of WRAIR; and Col. Charles McQueen, who is outgoing commander of WRAIR in Silver Spring, Maryland.

Military Action Against Malaria

Careers of several medical alumni converge at the Army’s research unit in Kenya. Their research in infectious diseases assists not only our military but also civilian populations worldwide.

By Betsy Rogers

A chance encounter made Samuel Martin turn aside from a future in cardiology. Traveling to Africa in 1973 after finishing his Washington University medical degree, Martin, M.D. ’73, H.S. ’74 and ’75, encountered a suffering malaria patient. “It was a haunting experience,” he says now, “because I realized I knew nothing about the diagnosis and treatment of malaria. That experience converted me to infectious diseases.”

Thirty years later, in an improbable convergence of events, Martin’s life and labors have intersected with those of two other Washington University School of Medicine graduates in Nairobi, Kenya. Martin, now a colonel in the Army, is commander of the U.S. Army Medical Research Unit in Kenya (USAMRU-K), which is a laboratory operated by the Walter Reed Army Institute of Research (WRAIR), with headquarters in Silver Spring, Maryland. He works closely with Col. Charles McQueen, M.D. ’78, who was the WRAIR commander until his January 2006 reassignment, and with Col. Colin Orht, M.D. ’87, who visits the Kenya lab regularly as principal investigator in one of the institute’s malaria drug development projects. (Additionally, Martin’s predecessor at USAMRU-K was physician Ronald Rosenberg and the deputy chief of mission at the embassy in Kenya was William Brencick, both Washington University alumni.)

“I can’t explain why there have been as many key people from Washington University working in Kenya,” McQueen muses, “but it is pretty impressive.”

A soldier receives inoculations before being deployed overseas.

The U.S. Department of Defense has a real stake in such advanced biomedical research. Every day, military personnel confront critical medical problems. Whether the issue is tropical disease in foreign deployments or battlefield wounds or eye injuries from repeated laser exposure or any one of many other issues, the U.S. military is always looking for new and better solutions to medical problems.

WRAIR exists to help find them. Carrying out its mission “to conduct biomedical research that [responds] to Department of Defense and U.S. Army requirements and [that] delivers life-saving products including knowledge, technology, and medical materiel,” WRAIR employs some 2,000 military and civilian personnel at its headquarters in Silver Spring, at detachments in Texas and Illinois, and at its laboratories in Kenya, Thailand, and Germany. It is the Defense Department’s largest biomedical research laboratory.

Though its work is specifically targeted to military needs, the benefits of WRAIR research reach far beyond the armed forces.

Consider malaria, the disease that changed Martin’s vocation. The Defense Department has a keen interest in protecting against malaria and other tropical diseases because military personnel often go to countries where these diseases are endemic. Deployments to Somalia, Haiti, Afghanistan, and Iraq in recent years have exposed personnel to infectious agents not encountered in the United States. Preventing such infections and treating them effectively when they occur is essential for combat preparedness and mission accomplishment.

But finding a means toward these ends is also of incalculable benefit to the civilian populations these diseases afflict. “Malaria is one of the leading killers in the world,” McQueen observes. “WRAIR and its partners have developed a vaccine candidate that shows promise in preventing certain kinds of malaria. Many of the drugs currently used to protect against malaria or to treat it were developed at least in part at WRAIR.”

The U.S. Army Medical Research Unit in Kenya continues to focus on malaria, conducting research on the shores of Lake Victoria, an area with one of the highest-known transmission rates in the world.

The Kenya lab continues to focus on malaria. “The malaria work is conducted in a district on the shore of Lake Victoria, which has one of the highest-known transmission rates in the world,” Martin says. There are some novel findings on the research front. Two high-profile malaria vaccine studies are under way at the field site: a 400-subject pediatric efficacy trial of a bloodstage malaria vaccine and a 255-subject adult study of a sporozoite vaccine candidate. The sporozoite is the stage of the parasite that the mosquito injects into the bloodstream. Martin expects significant results from these trials. “It is an exciting project,” he says.

Though its work is specifically targeted to military needs, the benefits of WRAIR research reach far beyond the armed forces.

Similarly, the unit undertakes HIV/AIDS research at a site in Kericho, an agricultural community about 185 miles northwest of Nairobi. There, 150 staff members conduct field and laboratory studies in an effort to develop effective diagnostic and treatment strategies against this global scourge. A primary objective is discovering an HIV vaccine to protect against the disease.

USAMRU-K also conducts surveillance activities to uncover emerging infections before they spread within and outside the region. Over the years, USAMRU-K has participated in the investigation of outbreaks of viral diseases such as yellow fever, Rift Valley fever, West Nile fever, and Congo-Crimean hemorrhagic fever within the region. Another research focus is the monitoring of antibiotic resistance profiles of enteric pathogens, the culprits in diarrhea, which is the fourth leading cause of death in the tropics. Globally, 4.6 million children die from diarrhea—12,600 deaths each day.

Martin’s research interests include leishmaniasis, a serious problem in Asia, the Middle East, Central and South America, and Africa. Work in his laboratory has shown that kinetoplastid parasites possess genes that permit the metabolism of lipids to produce substances called prostaglandins. These parasite products are similar to those its human hosts make to regulate critical body functions—temperature, the sleep-wake cycle, immune response. “We are now thinking that maybe these parasites make these prostaglandins to manipulate the host to its advantage,” Martin says. “It’s a very exciting and unexpected finding.”

The U.S.–Kenyan partnership is a perfect symbiotic relationship, according to Martin. “We are as interested in these diseases as the local people and institutions with which we partner,” he observes. “For us, these diseases are a threat to our deployed military; for our partners, they cause major public health problems. We need our partners as much as they need us: You can’t do that final step of testing the efficacy of new drugs, new vaccines, unless you are somewhere where the disease occurs at a high-enough prevalence. We are not an aid agency. We’re here because we need those products.”

Still, he adds, “Discoveries we make go a long way toward helping Kenyans and civilian populations in many places.”

Indeed, much of WRAIR’s research benefits the public at large. Its greatest success recently is the testing of a hepatitis [E] vaccine. The institute also is working on bandages infused with coagulation factors to “jump start the clotting process,” McQueen says, which is the first significant bandage improvement since the Civil War. WRAIR also investigates sleep deprivation and its impact on performance, a serious battlefield problem but a concern shared, for instance, by the U.S. Department of Transportation and the trucking industry.

Nor is research the only way WRAIR’s work benefits civilians. A major beneficiary is the Kenya Medical Research Institute (KEMRI), USAMRU-K’s host in Nairobi. USAMRU-K provides both training and infrastructure for KEMRI.

“We have a very strong training program, which allows master’s and Ph.D. students to use our labs for their research work, thereby building scientific capacity for our host nation,” Martin explains. “We train our Kenyan staff, and we use them for most of the work done in our projects. We have more than 350 Kenyans who work at different levels in our program. For example, we have Kenyan principal investigators conducting vaccine and drug trials; a Kenyan lab director; and several Kenyan technical supervisors.”

In addition to human resource development, USAMRU-K has added about 59,000 square feet of state-of-the-art administration and lab space. Infrastructure development also has been done by other international KEMRI-partners such as the U.S. Centers for Disease Control, Britain’s Wellcome Trust, and the Japan International Cooperation Agency. “All of these infrastructure development projects have allowed KEMRI to blossom into a center of excellence for research and training in infectious disease,” Martin says.

McQueen agrees, and gives much of the credit to Martin. “In large part, the infrastructure upgrades are the result of Sam Martin’s hard work and his relationships with our investigators and the community,” McQueen says. “The USAMRU-K malaria field site has one of the best clinical trials centers in the region and possibly in Africa.”

Martin is also responsible, McQueen says, for a new pediatric wing at the local hospital. Because of a chronic shortage of water in the city, a borehole was constructed on the hospital grounds to provide water for the pediatric wing and potentially all of the other operations within the hospital premises.

He has, McQueen says of Martin, “almost a missionary zeal.”

Washington University’s contributions to medical advances and care in Kenya don’t surprise McQueen. “Washington University graduates are interested in making a difference. They dependably practice state-of-the-art clinical medicine. They look to advance our understanding of biomedical issues. I am biased,” McQueen concedes, “but I think the graduates of Washington University medical school come out committed to advancing the frontiers of science.”

Betsy Rogers is a free-lance writer based in Belleville, Illinois.