Dominic joined the staff of the MRC Unit The Gambia in 1985 as an MRC research fellow and he maintained strong links with the MRCG at LSHTM through his career. The fact that malaria causes fever was known to the ancients but, in the 1980s, the mechanisms by which the parasite caused fever was still not known and Dominic took on the ambitious challenge of determining how this came about as the topic for his fellowship. At this time cytokines, chemical mediators of inflammatory responses, were just being identified and before coming to The Gambia, Dominic spent some time in the laboratory of Charles Dianerollo, one of the  pioneers  in this field, learning how to measure one of recently discovered cytokines, tumour necrosis factor (TNF).

Following his arrival in The Gambia to continue his fellowship Dominic showed that malaria induced fever was associated with a raised concentration of TNF and he  showed also high concentrations of TNF were  associated with a poor outcome, including death in young Gambian children with malaria. 

In 1989, Dominic returned to the UK to take up a position in the Department of Paediatrics at Oxford but continued to work with colleagues in The Gambia on studies on the pathogenesis of severe malaria and on how it could best be treated, conducting clinical trials at the Edward Francis Small Teaching  Hospital ( Royal Victoria Hospital) in Banjul. An early trial showed that fever could be depressed by administration of an anti-TNF monoclonal antibody, one of the first clinical studies of an anti-cytokine monoclonal antibody, but unfortunately the monoclonal antibody did not reduce deaths from severe malaria in a larger trial conducted in Gambian children. These clinical studies led to Dominic’s interest in understanding why some children developed severe malaria, including cerebral malaria, and why others did not. One possible reason was a genetic susceptibility to severe disease and, working with Prof Adrian Hill, Dominic and colleagues, showed  a linkage between susceptibility to severe malaria to specific HLA genes and to  genetic factors influencing TNF-alpha production.

In subsequent years, whilst retaining his base in Oxford,  Dominic took up a joint appointment at the Sanger Institute in Cambridge where he continued his work on the genetics of human susceptibility  to malaria but also expanded his research to studies on the genetics of the malaria parasite and its vector.

One of Dominic’s  lasting legacies will be his founding of MalariaGEN, a world-wide network of scientists  involved in studies of the genetics of the malaria parasite, its vectors and its human host who will greatly miss his advice and encouragement.