This article is from WeChat public account: Nature (ID: Nature-Research) , original author: Amy Maxmen, from the title FIG IC photo
New York hospitals are preparing to use the blood of COVID-19 rehabilitation patients as potential drugs for the treatment of this disease. The researchers hope to use this method that has existed for a century—inject the blood of the recovered people into the patient’s body—to save New York, which is currently at the epidemic center of the United States, and avoid the same mistakes as Italy. The Italian Intensive Care Unit (ICU) is overcrowded, and doctors have to refuse some patients who need to use a ventilator to breathe.
New coronavirus infection cases have overwhelmed hospitals in New York. Image source: Misha Friedman / Getty
Before this, some studies in China have tried to use the plasma of COVID-19 rehabilitation persons (the part of the blood that contains antibodies but does not contain red blood cells) for treatment. But these studies have so farOnly the preliminary results have been reported so far. The method of using the plasma of the rehabilitated people has also achieved certain results in the treatment of severe acute respiratory syndrome (SARS) and Ebola virus, But American researchers hope to choose donor blood with high antibody content to give patients who are most likely to benefit to enhance the efficacy of this method .
A key advantage of recovered plasma is that it is immediately available, while drugs and vaccines can take months or years to develop. After filtering viruses and other ingredients that may cause infection, transfusion in this way is relatively safe. Scientists spearheading the use of plasma currently intend to use this as a stopgap measure to prevent serious infections and still keep the hospital running when a large number of cases emerge.
Mayo Clinic (Mayo Clinic) Michael Joyner, anesthetist and physiologist, said: “The hospital is overcrowded Even one reduction in patients is a huge victory for the hospital in terms of organization. We need to put this issue on the agenda as soon as possible, and pray that the virus flood will not flood New York and the West Coast. “
On March 23, Governor of New York State Andrew Cuomo announced a plan to use plasma from recovered patients to help the state respond to the outbreak. At that time, more than 25,000 people were infected and 210 people died in the state. He said: “We think this method is very promising.” With the efforts of researchers, the US Food and Drug Administration (FDA) It was announced on March 24 that patients in need would be allowed to use plasma urgently. Joyner said that as early as a week later, there are at least two hospitals in New York City-Mount Sinai Hospital and Albert Einstein College of Medicine-hoping to start using coronavirus cured plasma for treatment.
After the first attempt, the researchers hope to extend the therapy to people at high risk of COVID-19 infection, such as nurses and doctors. For them, this method can prevent the disease and enable them to work in the hospital all the time. The hospital can’t afford the loss of medical care.
Research hospitals across the United States are currently planning to conduct a placebo-controlled clinical trial to gather conclusive evidence about the effectiveness of plasma treatment. The whole world will pay close attention to this progress, because unlike drugs, it comes from rehabilitation patientsThe blood is relatively cheap and can be obtained in any country hit hard by the epidemic.
Scientist convening order
Arturo Casadevall is an immunologist at Johns Hopkins University. Since late January, he has been working hard to use blood as a treatment for COVID-19 because the disease has spread To other countries, and there is currently no effective treatment. Scientists refer to this method as “ passive antibody therapy “, that is, patients receive foreign antibodies instead of generating an immune response on their own as after vaccination.
This method can be traced back to the 1890s. One of the largest case studies occurred during the H1N1 influenza pandemic in 1918. More than 1,700 patients received serum from rehabilitation patients, but it is difficult to draw any conclusions from studies that did not meet current standards at that time 1 .
During the SARS outbreak in 2002-03, Hong Kong conducted a clinical trial 2 of 80 rehabilitated persons. It was found that the number of patients receiving treatment within two weeks after the onset of symptoms Patients who receive treatment are more likely to be discharged. In at least two outbreaks of Ebola virus in Africa, the blood of rehabilitated persons was tested and some results were achieved. In a 1995 study in Congo 3 , transfusion of antibody-containing blood seemed to be helpful for most patients, but the study was small in scale and there was no placebo control. A trial 4 conducted in Guinea in 2015 did not draw conclusions, but the trial did not screen for the presence of high levels of antibodies in the plasma. Casadevall believes that if researchers recruit only early patients with this fatal disease, this method may show better efficacy, so early patients are more likely to benefit from this treatment.
People who are recovering from New Coronavirus infection in Zouping, China, are donating plasma. Image source: AFP / Getty
On February 27, Casadevall published an editorial in the Wall Street Journal, calling for support for the use of recovered serum, because drugs and vaccines take a long time to develop. He said: “I know that if I publish this article in a newspaper, people will react violently, and if it is published in a scientific journal, I may get a different reaction.”
He sent his article to many colleagues from different disciplines, many of whom joined him with enthusiasm, and Joyner was one of them. About 100 researchers from multiple research institutes devote themselves to different research directions. Virologists began to look for ways to detect whether the blood contains new coronavirus antibodies. Clinical trial experts have studied how to identify and recruit trial candidates. The statistician created the database. In order to obtain regulatory approval, they also shared the documents required by the ethics review committee and FDA.
Good start
Scientists ’efforts paid off. The FDA currently classifies the plasma of recovered patients as “experimental new drugs” for the treatment of coronavirus, which allows scientists to submit clinical trial plans and allows doctors to use it to treat severe or life-threatening COVID-19 infections based on actual conditions, but it has not been formally approved.
“This allows us to start this therapy.” Joyner said. Now, doctors can decide to provide plasma therapy to severely ill patients or, as suggested by him and other researchers, to provide this therapy to people most likely to be infected. He said that the hospital will submit a case report so that FDA knows which method works best.
Researchers have submitted to the FDA three placebo-controlled trial protocols designed to test plasma therapy. They hope to take place at Johns Hopkins University, the Mayo Clinic and the affiliated hospital of Washington University in St. Louis and other universities that are interested in participating.
The future direction
U.S. experiments on plasma of recovered patients are not the first in the world. New coronavirus appeared in China at the end of last year. Since early February, Chinese researchersSeveral studies have been conducted using plasma. Researchers have not reported on the status and results of these studies. However, Yu Liang, an infectious disease expert at Zhejiang University School of Medicine, told Nature that in a preliminary study, doctors treated 13 critically ill patients with COVID-19 recovered plasma. He said that after a few days, the virus no longer seemed to circulate in the patient, indicating that the antibody had repulsed it. But he also said that the patient’s condition continues to deteriorate, indicating that the disease may have developed too long, and plasma therapy may no longer work. Most of the patients participating in the trial have been sick for more than two weeks.
Liise-anne Pirofski, an infectious disease specialist at the Einstein College of Medicine, participated in one of three clinical trials in the United States. She said the researchers plan to inject patients with plasma in the early stages of the disease and watch them enter critical illness Probability of guardianship . Another trial will include serious cases. The third trial will explore the feasibility of plasma as a preventive measure for close contacts with COVID-19 patients, to assess their probability of getting sick after receiving plasma, and to have similar exposure but not receiving treatment People compare. She said that these results can be obtained within a month, “data about the effectiveness of treatment will come out soon.”
Even if the treatment effect is good enough, the serum therapy of the rehabilitated person may be replaced by modern therapy later this year. Research teams and biotechnology companies are currently identifying antibodies against the new coronavirus and plan to develop them into precise drug formulations. Joyner said: “Biotech’s” cavalry “will bring isolated antibodies, test them, and develop them into drugs and vaccines, but this will take time.”
In a way, Pirofski remembered her sense of urgency as a young doctor in the early 1980s during the early AIDS epidemic. She said: “I saw a resident doctor last week. They were very scared of this disease. They did n’t have enough protective equipment. They were already sick or worried that they would be sick.” If there are tools to help protect them now, it would be better Too.
Pirofski said that since participating in the promotion of blood therapy, another aspect of this therapy has aroused her interest: unlike the drugs purchased from the company, this therapy is created by infected people. She said: “I receive emails from some people every day and they say,‘ I ’m alive and now I want to help others. ’All these people are willing to go out and help us.”
References:
1.Casadevall, A. and Pirofski, L. J. Clin. Invest. https://doi.org/10.1172/JCI138003 (2020).
2.Cheng Y. “et al.” Eur. J. Clin. Microbiol. Infect. Dis. 1, 44–46 (2005).
3.Mupapa, K. et al. J. Infect. Dis. 17, S18–S23 (1999).
4.Van Griensven, J. et al. N. Engl. J. Med. 374, 33–42 (2015).
This article comes from the WeChat public account: Nature Natural Research (ID: Nature-Research) , the original author: Amy Maxmen
The original article was published in the “Nature” news on March 24, 2020 with the title “How blood from coronavirus survivors might save lives