It is not lost on Kolapo Oyebola, Ph.D., that half the sickle cell disease cases worldwide can be found in his native Nigeria. This tragic fact, said the National Institutes of Health (NIH) postdoctoral fellow, has long been top of mind—and he is bent on doing something about it.
He wants to help “bring sickle cell disease research back to Africa.”
Oyebola is one of ten African scientists in the inaugural class of the new African Postdoctoral Training Initiative (APTI), a fellowship program designed to build research capacity in African countries and develop ongoing scientific partnerships. The program is a collaboration between the NIH, the African Academy of Sciences, and the Bill & Melinda Gates Foundation.
Its goal is to train fellows in high-priority global health research areas such as infectious diseases, maternal and child health, and skill development for clinical and translational research while building bridges and lasting connections between the partner organizations and African scientists and institutions.
During his two-year fellowship, Oyebola, a researcher at the University of Lagos, Nigeria, will be working in the NHLBI’s Sickle Cell Branch (SCB). Like the other fellows, he will train in a research area of priority for his home country and institution. Oyebola will work under the guidance of senior investigator Swee Lay Thein, M.B., D.Sc., who heads the SCB.
After two years, he and the other scientists will return home and receive another two years of support to continue the research and establish themselves as independent investigators. NIH and the Gates Foundation together are providing about $4 million for the program.
On a recent day, Oyebola stepped out of the lab to talk to us about his research and his ambitious plans. He was hopeful, and it showed. The more he explained his research, the more animated he became. During an unguarded moment, though, and with a pained expression, he noted that “science is dying in Nigeria.” Yet one got the feeling that Oyebola is fully committed to turning that tide—and for many years to come.
Your research focus during your fellowship is clonal hematopoiesis in sickle cell disease patients. Would you explain what it is?
Clonal hematopoiesis is an age-related condition marked by the accumulation of genetically abnormal blood cells. Hematopoiesis is the process of producing blood cells. Even in healthy people, as they age, there are some mutations in their genes that have a notable effect on their biology. Some of these mutations can lead to blood and bone marrow hematological disorders such as acute myeloid leukemia, myelodysplastic syndrome, and other conditions.
Besides increasing the risk of cancer, clonal hematopoiesis contributes to inflammation in atherosclerotic plaques, and is then associated with the development of cardiovascular disease.
Some symptoms of sickle cell disease make patients age quickly. These patients also have inflammation and related problems which promote clonal dysfunction in some hematopoietic stem cells – the ones that produce other blood cells. So, we are looking to study how clonal hematopoiesis impacts pathologies in these patients.
Why is this research important, particularly for your home country?
In Africa we do cutting-edge research in infectious diseases. I have been doing that for quite some time now. But it is important to look at noncommunicable and non-infectious diseases.
Clonal hematopoiesis can impact chemotherapy in cancer treatment and stem cell transplantation for sickle cell disease patients. If we could target some of these mutated cells before transplantation, we could predict if the treatment would work.
My interest is primarily in sickle cell disease patients. At NIH, we are studying cardiovascular disease and sickle cell disease in African Americans.
Nigeria contributes about half of the global burden of sickle cell disease. It is important to bring this sickle cell disease research back to Africa, where the diversity of the genetic pool would help answer questions we have not yet even asked.
What is your personal experience with sickle cell disease?
I have had colleagues, friends, classmates affected by sickle cell disease. Some were not fortunate enough to survive. Some didn’t even graduate with us. We never knew [they were sick] because back in Africa you try to hide the disease. We tend to learn about it after the person dies.
A colleague of mine in the university, in my department, passed on last year. I was told she had sickle cell disease. She was well over 40 years old. She had dreams. Her research focus was on viruses. She was supposed to go to Germany with a fellowship, but she passed away before that. It is just there.
But, what’s to be done?
Genetic testing and counseling might help. Currently, in Nigeria, despite the high prevalence of sickle cell disease, many still do not appreciate the importance of genetic testing before getting married. That’s likely because Nigeria, much like the rest of Africa is very religious, and many believe in miracles or destiny.
Even doctors, who know the dangers of the condition, still don’t get tested before getting married to know their genotype; and it is not mandatory. But when I began dating my wife, a medical doctor who treats people with sickle cell disease and sees the suffering, she asked me right away about my genotype.
You said people don’t talk about their illness. Is that due to stigma?
I do not think there is any stigma associated with sickle cell disease in Nigeria. People know it is not a communicable disease, like HIV, which tends to be a greater source of stigma. But there is some level of social isolation on the part of patients, because they are in pain and unhappy. Then, access to treatment is difficult and treatment is very expensive.
How will this fellowship benefit Nigeria’s health and development?
It is important to build capacity in Africa, in our countries. We need to train in genetics and in the biology of diseases that are particularly prevalent in Africa. We also need to look into the other noncommunicable diseases that will be affecting new generations of Nigerians. Sickle cell is understudied in Nigeria.
My dream is to be able to build a genetic platform to understand not only sickle cell disease, but other conditions—and understand them at a genetic level. It is about understanding better the development of cardiovascular disease, cardiomyopathies, and predicting the response to therapy in sickle cell disease patients.