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Having a background in malaria physiology and biochemistry, Markus Winterberg’s research focus is on the interaction between host, pathogen and drug, the metabolism of antimalarial drugs and discovering biomarkers for tropical diseases. Markus aims to use these biomarkers to develop non-invasive, field-based rapid diagnostic tests for tropical diseases that quickly identify pathogens, thereby improving diagnostics and the treatment of patients.

Originally from Germany, I went to Australia for my postdoc. After seven years, I moved to Thailand to work with MORU, and I am now the Head of the Clinical Pharmacology Lab.

My main research focus is proteomics and metabolomics. I use proteomics to find molecules that can be used to identify a disease in a patient. A very common situation in the field is a patient who reports in a hospital with a fever and no other symptoms. A big problem there is to know what the patient actually has. One thing that is commonly done then is to just give an antibiotic, which if it is a viral infection won't do anything. We use mass spectrometry to look for molecules in a sample of a patient to identify the pathogen. We can then tell the GP: this patient has disease XYZ.

What we would like to do with these molecules is to develop a rapid test, something like a pregnancy test where we will be able to just use a little bit of urine sample with a dip stick to give a clear yes/no answer if the patient has the disease or not. You won't need a fancy laboratory, you don't need fancy equipment, you don't usually even need a trained person, a lay person can do it, because it is a clear yes/no result and a very simple process.

For the rapid test, we currently work on scrub typhus, a zoonotic disease transmitted by little chigger mites. The actual pathogen is Orientia tsutsugamushi, a tiny intracellular bacteria commonly found in places where people work in fields - so 'scrub' like the scrubs in the field.
The mites live in eschars on the skin and then transmit the bacteria with their saliva. This disease is one of the common ones like dengue, typhus, murine typhus that comes with fever as main symptom. If the patient has a fever and it turns out to be scrub typhus, after a simple course of antibiotic treatment the patient can usually be cleared of the disease.

Q: How far away are you from developing a rapid test for scrub typhus?

Markus Winterberg: We have identified one peptide form pathogen that is found in the patient's urine. We are currently evaluating at what stage of the infection it appears in the urine. Once that is done, we will look into antibody production and see if we can get a first example of a simple readout test.

Once we have the rapid test established - because the treatment for scrub typhus is usually very simple, it is a simple antibiotic course - that will have a great impact on the affected population because you can easily detect if someone has scrub typhus or not.

The other disease we are working on is malaria. The Clinical Pharmacology Department has almost 70,000 or 80,000 patients' samples from antimalarial clinical trials. We have samples of different time courses with different antimalarials. What we are trying now is to look for a marker in patient plasma that can be used to determine whether someone carries malaria parasites or not and correlate this to the treatment outcome.

Q: Why does your line of work matter and why should we fund it?

MW: Lots of research is done on how you treat the disease, but I think it is also very important to know what the disease actually is so you can treat it properly. It is really important to have a test or a way of telling that a patient has a certain disease, so the research finally will provide a better tool for clinicians, especially in rural settings, to correctly diagnose patients.

Q: Tell me a little bit about the benefits of working at MORU.

MW: Coming from a basic biology background, you often only know the disease from looking in a microscope and a petri dish, and that's how you know the disease. But working here is actually working in the hotspot where it happens: you get to see the patient, you get to see the actual disease and the actual pathogen in a patient's sample. That is something that you normally don't get when you work in an isolated laboratory somewhere looking down your microscope.

Q: You have a simple message one or two sentences to say to people about what you do. What would it be?

MW: You can't always get what you want, but if you try, sometimes you may find you get what you need.

Markus Winterberg

Clinical Pharmacology

Dr Markus Winterberg is Head of Laboratory and a Principal Investigator in MORU's Department of Clinical Pharmacology. The key aspect of his research is 'trop-med-omics', the application of mass spectrometry-based bioanalysis in tropical medicine, particularly using proteomics and metabolomics to identify a disease in a patient.

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