The scale of the problem ENDPOINT addresses is difficult to overstate. Lymphatic filariasis and onchocerciasis are both caused by filarial parasitic worms transmitted to humans by insect vectors — mosquitoes in the case of lymphatic filariasis and blackflies in the case of onchocerciasis. Together, these infections affect an estimated 78 million people, with a further one billion judged to be at risk. Lymphatic filariasis, historically known as elephantiasis, damages the lymphatic system and produces chronic swelling of the limbs and genitals, profound disfigurement and social stigma. Onchocerciasis, or river blindness, is the second leading infectious cause of blindness worldwide and also causes severe, debilitating skin disease. Beyond the direct clinical burden, both diseases significantly undermine economic prosperity in endemic communities, trapping affected households in cycles of poverty that mass drug administration alone has struggled to break.

As a product development partnership, ENDPOINT occupies a distinctive niche in the global health architecture. Rather than conducting basic research or delivering existing interventions, PDPs are structured to advance a pipeline of candidate products — in this case innovative diagnostics and treatments — while simultaneously generating evidence on their acceptability and feasibility within affected communities and health systems. The programme will also map potential policy and regulatory pathways, a step that is often neglected in early-stage development but which determines whether a promising tool ever reaches the patients who need it. This integrated approach reflects a growing recognition within the neglected tropical disease field that technical efficacy is only one ingredient of elimination; a diagnostic that communities will not use, or a drug regimen that health systems cannot deliver, will not move the needle regardless of its laboratory performance.

Professor Joseph Turner, co-director of LSTM’s Centre for Drugs and Diagnostics and research director of the partnership, framed the funding as a critical endorsement of the institution’s filarial portfolio. He expressed immense gratitude for what he described as a valuable FCDO investment in the CDD iiCON filarial NTDs product development portfolio, noting that the pipeline of diagnostic and therapeutic candidates had been selected specifically to overcome barriers that currently stand in the way of lymphatic filariasis and onchocerciasis elimination. Crucially, he emphasised that candidate products will be evaluated not only for effectiveness but also for their acceptability to the communities that would use them, with the results feeding directly into the refinement and acceleration of their onward development. That feedback loop between end users and product developers is one of the defining features of the ENDPOINT model.

The partnership’s portfolio comprises three complementary projects, each targeting a different bottleneck in the elimination effort. The first is a wearable microwave biosensor diagnostic intended to support non-invasive detection and surveillance of lymphatic filariasis in Nepal. Conventional diagnosis of filarial infections typically relies on blood samples or antigen tests that must be administered by trained personnel, which complicates large-scale surveillance in remote endemic areas. A wearable biosensor that can detect infection markers without invasive sampling could transform monitoring, allowing health authorities to track transmission in real time and to verify whether elimination targets have genuinely been achieved — a requirement that becomes increasingly important as countries approach the endgame of their elimination programmes.

The second project repurposes the oral antibiotic fusidic acid as a shorter-course treatment for onchocerciasis, building on the LSTM-led FAME study. Repurposing established drugs is an attractive strategy in neglected tropical disease research because decades of clinical use provide a well-characterised safety profile, and existing manufacturing and regulatory infrastructure can dramatically shorten the path to deployment. Fusidic acid belongs to a class of antibiotics that act against the Wolbachia bacteria, endosymbionts that many filarial worms depend upon for their survival and fertility. Depleting Wolbachia with antibiotics renders the adult worms sterile and ultimately kills them, addressing the root of the infection rather than merely the larval stages targeted by the standard drug ivermectin. A shorter treatment course would make antibiotic therapy far more practical for mass deployment in resource-limited settings.

The third project, conducted in the United Kingdom, involves the early development of a new class of fast-acting anti-Wolbachia drug candidates. These compounds hold potential to treat or prevent onchocerciasis and lymphatic filariasis, and — notably — veterinary zoonotic filariasis as well. Zoonotic filarial infections, in which parasites normally circulating in animals infect humans, represent an underappreciated reservoir that could complicate elimination efforts; a drug class effective across both human and animal filariae would therefore carry strategic value beyond the two headline diseases. Fast-acting anti-Wolbachia agents would also address one of the principal limitations of existing antibiotic regimens, which require weeks of daily dosing and are consequently ill-suited to community-wide campaigns.

Dr Rachael Thomson, ENDPOINT’s chief executive, described the funding award as a real achievement for both ENDPOINT and LSTM, saying that the investment strengthens the global research pipeline for neglected tropical diseases and reinforces the partnership’s commitment to delivering equitable, impactful solutions for affected communities. Her emphasis on equity speaks to a persistent criticism of global health research, in which diseases concentrated in low-income countries have historically attracted a fraction of the funding devoted to conditions prevalent in wealthy nations. By embedding partners in Nepal and Cameroon as full participants in product development rather than merely as trial sites, ENDPOINT aims to strengthen national research and development capacity in endemic countries, leaving behind durable scientific infrastructure alongside the products themselves.

ENDPOINT does not stand alone. It dovetails with FAME, a complementary clinical trial funded by a £4.9 million award from the European and Developing Countries Clinical Trials Partnership, with additional support from the Drugs for Neglected Diseases initiative. FAME is generating critical evidence on the potential of repurposing fusidic acid to treat onchocerciasis and on the future uptake of antibiotic-based tools for filarial disease elimination more broadly. Taken together, ENDPOINT and FAME represent nearly £9.4 million in new investment, a figure that reaffirms LSTM’s long-standing leadership in research and development for filarial neglected tropical diseases. The pairing of an early-stage product development partnership with a late-stage clinical trial is itself a deliberate design choice, ensuring that discoveries made under ENDPOINT can be shepherded along a defined development pathway rather than stalling at the so-called valley of death between laboratory and clinic.

The announcement arrives at a pivotal moment for the neglected tropical disease community. The World Health Organization’s road map for 2021 to 2030 set ambitious elimination targets for lymphatic filariasis and onchocerciasis, and while mass drug administration has driven down transmission in many endemic countries, progress has stalled in others where existing tools are insufficient to finish the job. New diagnostics capable of confirming interruption of transmission, and new treatments capable of killing or sterilising adult worms, are widely regarded as the missing instruments for the final phase of elimination. By combining cutting-edge technologies such as wearable biosensing and novel anti-Wolbachia pharmacology with strong in-country partnerships and a systematic focus on acceptability, feasibility and regulatory readiness, ENDPOINT aims to generate the high-quality evidence needed to de-risk scalable solutions. For the 78 million people already living with these diseases and the billion more at risk, the partnership represents a tangible step toward tools that could finally close the chapter on two of humanity’s most ancient afflictions.

Subject of Research: Development of new diagnostics and treatments for the filarial neglected tropical diseases lymphatic filariasis and onchocerciasis

Article Title: LSTM announces new £4.5 million partnership to tackle neglected tropical diseases

Article References: LSTM announces new £4.5 million partnership to tackle neglected tropical diseases. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: neglected tropical diseases, lymphatic filariasis, onchocerciasis, Liverpool School of Tropical Medicine, ENDPOINT, Wolbachia, fusidic acid, diagnostics, drug development, UK aid, FCDO, river blindness

Breathlessness in clinical practice often signals an underlying pathology affecting the cardiopulmonary system, but this study emphasizes that patients typically present with multiple concurrent conditions. Diseases like pneumonia, anaemia, heart failure, and tuberculosis (TB) were frequently coexistent among the breathless patient cohort studied. This interplay of pathologies not only complicates diagnosis and treatment but also exacerbates health outcomes, calling into question conventional healthcare models that emphasize siloed disease management.

The cohort study, which tracked 751 adult inpatients over 12 months, identified 334 individuals (44%) presenting with acute breathlessness. Notably, mortality among this subgroup was profoundly high: 69% for those diagnosed with heart failure, 57% with anaemia, 53% with pneumonia, and 47% with TB. The prevalence of multimorbidity was noteworthy, affecting 63% of patients and serving as a potent prognostic indicator for mortality. These statistics starkly contrast with data from high-income countries where, despite older populations, breathlessness-related mortality is significantly lower.

Dr. Stephen Spencer, the lead author and a Wellcome Trust Clinical PhD Fellow at LSTM and MLW, underscored the paradox presented by these findings. Despite Africa’s generally younger demographic profile, the mortality associated with breathlessness in Malawi far exceeds that reported in Europe. He attributes this disparity to the overlapping burdens of infectious and non-communicable diseases alongside limited healthcare infrastructure. The progress made since 2020 in expanding oxygen availability, spurred by the COVID-19 pandemic, provides a critical care foundation. However, it is insufficient in isolation to lower the staggering death rates linked to breathlessness.

A key insight from the study is the inadequacy of traditional healthcare delivery models that isolate and treat individual diseases without recognition of their coexistence. This vertical approach often neglects the clinical reality of multimorbidity. For patients simultaneously battling anemia, pneumonia, and heart failure, piecemeal treatments fail to address the cumulative physiological stress responsible for breathlessness and poor outcomes. Thus, an urgent shift toward comprehensive, patient-centered care models capable of diagnosing and managing multiple illnesses in tandem is warranted.

From a clinical and public health perspective, the study provides pivotal evidence supporting enhancements in diagnostic acumen and resource allocation. Dr. Ben Morton, Senior Clinical Lecturer at LSTM and senior author, emphasized the complexity of the breathlessness syndrome in sub-Saharan Africa and the need for holistic health strategies. While vertical programs targeting TB and other single diseases have yielded improvements, their limitations are exposed by the high mortality rates revealed. Integrated clinical pathways that accommodate diagnostic overlap and multimorbidity could revolutionize care delivery.

Additionally, the co-investigator Dr. Felix Limbani called attention to the necessity of scaling up respiratory support capacity within healthcare systems operating under resource constraints. Medical oxygen availability and workforce training in recognising and managing multimorbid breathlessness are cornerstone interventions that may translate into improved patient survival and quality of life. His comments imply that multifaceted system-level solutions must accompany clinical advances to be truly transformative.

The study leveraged a multi-institutional partnership involving not only Malawian institutions such as Kamuzu University of Health Sciences and the Malawi Liverpool Wellcome Programme but also Tanzanian centers like Kilimanjaro Christian Medical Centre and Muhimbili University of Health and Allied Sciences. Additionally, established UK institutions, including the Royal United Hospitals Bath NHS Foundation Trust, Liverpool John Moores University, the University of Manchester, and the University of Edinburgh, contributed, reflecting the global collaborative effort required to address this pressing health challenge.

Published in the prestigious journal Thorax, this research adds a critical dimension to understanding the burden of respiratory symptoms in low-income countries burdened by infectious and non-communicable diseases alike. It provides quantitative evidence that breathlessness is not simply a symptom but a marker of severe underlying pathology, often involving multiple organ systems and necessitating intricate management strategies.

Beyond the direct clinical implications, the study serves as a clarion call for policymakers and global health stakeholders to re-examine resource prioritization. Investments in oxygen infrastructure, training programs focusing on respiratory medicine and multimorbidity, and development of integrated care models tailored to the epidemiological realities of African health systems could catalyze reductions in preventable mortality.

Furthermore, the study’s findings emphasize that the COVID-19 pandemic’s legacy in sub-Saharan Africa should transcend emergency response and fuel long-term health system strengthening. Oxygen supply systems, for instance, though expanded hastily due to pandemic demands, must now be entrenched as core components of sustainable clinical care for respiratory diseases beyond SARS-CoV-2 infections.

In conclusion, this pivotal research unravels layers of complexity underpinning acute breathlessness in Malawi and reveals unacceptably high mortality rates that reflect broader systemic healthcare challenges. The data underscore the exigency of transitioning from fragmented, disease-specific programs to integrated, patient-centered care models equipped to tackle multimorbidity. Only through such comprehensive strategies can meaningful improvements be achieved, mitigating the toll of breathlessness and its underlying causes in resource-limited settings.

Subject of Research: People

Article Title: Acute breathlessness as a cause of hospitalisation in Malawi: a prospective, patient-centred study to evaluate causes and outcomes

News Publication Date: 11-Sep-2025

Web References:
10.1136/thorax-2025-223623

Keywords: Clinical medicine, Respiratory disease, Multimorbidity, Acute breathlessness, Malawi, Sub-Saharan Africa, Tuberculosis, Pneumonia, Heart failure, Anaemia, Health systems, Oxygen therapy