esselte said:
Antibody-dependent enhancement and SARS-CoV-2 vaccines and therapies
https://www.nature.com/articles/s41564-020-00789-5
Published 09 September 2020
Abstract
Antibody-based drugs and vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are being expedited through preclinical and clinical development. Data from the study of SARS-CoV and other respiratory viruses suggest that anti-SARS-CoV-2 antibodies could exacerbate COVID-19 through antibody-dependent enhancement (ADE). Previous respiratory syncytial virus and dengue virus vaccine studies revealed human clinical safety risks related to ADE, resulting in failed vaccine trials. Here, we describe key ADE mechanisms and discuss mitigation strategies for SARS-CoV-2 vaccines and therapies in development. We also outline recently published data to evaluate the risks and opportunities for antibody-based protection against SARS-CoV-2….
Risk of ERD for SARS-CoV-2 vaccines
Safety concerns for SARS-CoV-2 vaccines were initially fuelled by mouse studies that showed enhanced immunopathology, or ERD, in animals vaccinated with SARS-CoV following viral challenge55,56,57,58. The observed immunopathology was associated with Th2-cell-biased responses55 and was largely against the nucleocapsid protein56,58. Importantly, immunopathology was not observed in challenged mice following the passive transfer of nucleocapsid-specific immune serum56, confirming that the enhanced disease could not be replicated using the serum volumes transferred. Similar studies using inactivated whole-virus or viral-vector-based vaccines for SARS-CoV or MERS-CoV resulted in immunopathology following viral challenge59,60,61, which were linked to Th2-cytokine-biased responses55 and/or excessive lung eosinophilic infiltration57….
Risk of ADE for SARS-CoV-2 vaccines
Evidence for vaccine-induced ADE in animal models of SARS-CoV is conflicting, and raises potential safety concerns. Liu et al. found that while macaques immunized with a modified vaccinia Ankara viral vector expressing the SARS-CoV S protein had reduced viral replication after challenge, anti-S IgG also enhanced pulmonary infiltration of inflammatory macrophages and resulted in more severe lung injury compared to unvaccinated animals66. They further showed that the presence of anti-S IgG prior to viral clearance skewed the wound-healing response of macrophages into a pro-inflammatory response. In another study, Wang et al. immunized macaques with four B-cell peptide epitopes of the SARS-CoV S protein and demonstrated that while three peptides elicited antibodies that protected macaques from viral challenge, one of the peptide vaccines induced antibodies that enhanced infection in vitro and resulted in more severe lung pathology in vivo67….
Conclusion
ADE has been observed in SARS, MERS and other human respiratory virus infections including RSV and measles, which suggests a real risk of ADE for SARS-CoV-2 vaccines and antibody-based interventions. However, clinical data has not yet fully established a role for ADE in human COVID-19 pathology. Steps to reduce the risks of ADE from immunotherapies include the induction or delivery of high doses of potent neutralizing antibodies, rather than lower concentrations of non-neutralizing antibodies that would be more likely to cause ADE.
Going forwards, it will be crucial to evaluate animal and clinical datasets for signs of ADE, and to balance ADE-related safety risks against intervention efficacy if clinical ADE is observed. Ongoing animal and human clinical studies will provide important insights into the mechanisms of ADE in COVID-19. Such evidence is sorely needed to ensure product safety in the large-scale medical interventions that are likely required to reduce the global burden of COVID-19.
I am spiralling into depression.
The serial nature of the drug approval process is murdering people about as fast as the Nazis murdered Jews in concentration camps.
And nobody cares.
Now that the internet exists, there is nothing to stop Phase 3 testing from being concurrent and synonymous with general release. Track the complete medical history three times a week of everyone who receives the vaccine for the first 10,000 recipients. And more often if they visit a doctor for any reason.
10,000 is a doddle for database programs, which track millions of inventory items. The process of reporting via internet all medical concerns and issues could be done in 30 minutes initially, reducing to 20 and 15 minutes as the patient becomes more familiar with the process. The internet reporting would be modelled on visiting a GP, and be less onerous. Freeform input by the patient, searched for keywords (everything with a medical meaning).
The first 10,000 patients would have to apply online and agree to share all medical information with doctors (not with family or insurers of course). Health care personnel would be encouraged to apply first, then family, then the general public, but with no strict limitations.
Each of the first 10,000 vaccine recipients would be given a unique anonymous number and, at each visit to the doctor, the doctor would forward a copy of medical information to the vaccine testing centre. No more onerous than a referral letter.
The first 10,000 vaccine releases wouldn’t save many lives, perhaps 100 lives. But it would quickly pave the way for a million vaccine releases and more which would have multiple benefits. The first is the direct saving of tens of thousands of lives, the second is terminating the spread.