As H5N1 is detected in San Francisco, a panel discusses next steps

Last week the San Francisco Department of Health (SFDPH) confirmed that a child in the city became the first case Bird flu-Bird flu (H5N1). With the Biotech showcase™ At the conference held simultaneously in the city, it was time for a panel of healthcare experts and biotech industry leaders to discuss what options could be taken to tackle the spread of this virus and its consequences. What follows is a summary of the central points:

The panel started with the NGO, Coalition for Epidemic Preparedness Innovations (CEPI)‘s Executive Director Emma Wheatley answers the question: Are we destined to chase outbreaks forever? What can we do to stay ahead of the spread while preventing mortality? And her response was direct: “We need to change how and what we do. Everything from diagnostics, vaccines, antivirals and therapies need to be reexamined, especially in light of H5N1.”

This opening sparked a lively discussion about the two areas where H5N1 innovation should be critical. The first approach was to think about how to stop viral infections in a more effective and consistent way. This led to outlining the necessary steps to stop virus transmission and defining the role of the next generation of antivirals in doing so. Nowadays, immediate administration of antiviral therapy is often the treatment of choice for influenza, but administration should occur within 48 hours of the onset of symptoms. And delayed administration increases the risk of drug-resistant viruses, making this a limited window of opportunity approach.

Another panelist, the president and CEO of the antiviral biotech company Cidara Therapeutics, Dr. Jeff Stein, PhD, explained this fact and described the need to change our basic assumptions regarding the development of accessible, long-acting antiviral agents against pan-influenza that can serve as both a therapeutic and prophylactic approach.

Regarding Cidara’s methodology, he further said: “I believe that a long-acting antiviral drug such as CD388, once administered at the beginning of the flu season, is the optimal solution to protect against pandemic flu strains such as H5N1. It has many advantages over vaccines, the most important of which is that its effectiveness does not require an immune response and can therefore provide true “universal” activity against all strains in all people.”

The second innovation theme explored how we can recognize what the bird flu virus does to the body, especially in severe cases, and how we can address these events therapeutically. This was stated by the CEO of InflaRx NV, Prof. Niels C. Riedemann, MD, PhD. He explained: “Given the worrying development with emerging cases of bird flu in the US, it will be important to advance research and development of therapies, including drugs that target the patient’s inflammatory immune response to these types of viruses, as our host response has demonstrated. to cause organ injury and death during the COVID-19 pandemic”

So, what is the H5N1 inflammation problem?

The answer is complex, but after the recent Covid-19 pandemicA term that many people are now familiar with is the phenomenon ‘Cytokine storm.” Here’s how to look at the problem: Hypercytokinemia or cytokine storm is a condition in which the body releases too many pro-inflammatory cytokines. This causes capillary leakage, resulting in pulmonary edema (fluid retention in the lungs) and recruitment of leukocytes (white blood cells) into the alveoli (alveoli), which compromises respiratory function. The disease is associated with more chronic symptoms, such as weight loss, fever and appetite suppression, and these are directly related to the concentration of the systemic cytokines that accumulate. With an H5N1 infection, the cytopathology demonstrates a cascade initiated by the virus, but mortality may be determined by the extent of the resulting inflammation. Finally, both virus-induced cytopathology and patient inflammatory response predispose patients to secondary bacterial infections, further increasing morbidity and mortality.

The panel’s cytokine dialogue continued with CytoSorbents Corporation CEO Dr. Phillip Chan, MD, PhD, who stated, “Cytokine storm and severe inflammation can rapidly lead to septic shock, capillary leak, organ failure, and death in pandemic influenza and subsequent secondary bacterial infections. We believe that combining antiviral or antibiotic treatments with blood purification using CytoSorb® to reduce cytokines and control deadly inflammation offers the best chance for positive results.

What should also be appreciated is that CytoSorb® has been used in more than a quarter of a million treatments in intensive care and cardiac surgery worldwide, including in critically ill COVID-19 patients under the Emergency Use Authorization of the US FDA. The next question then becomes: what would be the benefit for critically ill H5N1 patients, if this ever occurred?

What the San Francisco panelists all ultimately agreed on is that the next steps should focus on how to better reduce the spread of H5N1 or other serious viral events and how to reduce the devastating effects of inflammation after infection. reduced. Let’s hope those next steps happen sooner rather than later.