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

Last week, the San Francisco Department of Public Health (SFDPH) confirmed that a child in the city became the first case of avian influenza-bird flu (H5N1). With the Biotech exhibit™ The conference, held in the city at the same time, was the time when a panel of health care experts and leaders of the biotechnology industry discussed what options could be taken to deal with the spread of this virus and its consequences. What follows is a summary of the focal points:

The panel began with the Executive Director of the NGO, Coalition for Epidemic Preparedness Innovations (CEPI), Emma Wheatley answering the question: Are we destined to follow outbreaks forever? What can we do to stay one step ahead and deal with the spread while also preventing mortality? And her answer was straightforward: “We need to change how and what we are doing. Everything from diagnostics, vaccines, antivirals and therapeutics needs to be reviewed, especially in light of H5N1.”

With this opening, a lively discussion emerged of two areas where H5N1 innovation should be critical. The first approach was to consider how to stop the viral infection in a more effective and sustainable way. This led to defining the steps needed to stop viral transmission and defining the role of next-generation antivirals in doing so. Today, prompt administration of antiviral therapy is often the treatment of choice for influenza, but administration is required 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.

Explaining this fact, another panelist, the President and CEO of anti-viral biotechnology company, Cidara Therapeutics, Dr. Jeff Stein, PhD described the need to change our basic assumptions about the development of accessible long-acting pan-influenza antivirals that can serve as both therapeutic and prophylactic.

On Cidara’s methodology, he went on to say, “I believe that a long-acting antiviral drug like CD388, administered once early in the flu season, is the optimal solution to protect against pandemic flu strains like H5N1. It has many advantages over vaccines, the most important of which is that its effectiveness does not require an immune response and thus can provide a truly “universal” activity against all strains in all people.

The second innovation theme looked at how to recognize what the bird flu virus does to the body in particularly severe cases and how to treat these events therapeutically. This was shown by the CEO of InflaRx NV, Prof. Niels C. Riedemann, MD, PhD. He explained: “Given the troubling development with new cases of avian influenza in the US, it will be important to promote research and development of therapies, including those that address the patient’s inflammatory immune response to these types of viruses, such as our host response is shown. cause organ injury and death during the COVID-19 pandemic”

So what’s the problem with the H5N1 flu?

The answer is complex, but after the recent COVID-19 pandemic, a term that many people have now become familiar with is the phenomenon of “Cytokine Storm”. Here’s how to look at it, Hypercytokinemia, or cytokine storm, is a condition where 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) to the alveoli (air sacs of the lungs), which compromises respiratory function. More chronic symptoms accompany the disease, such as weight loss, fever, and appetite suppression, and these are directly related to the concentration of systemic cytokines that accumulate. In an H5N1 infection, cytopathology indicates a virus-initiated cascade, but mortality can be determined by the magnitude of the resulting inflammation. Finally, both virus-induced cytopathology and the patient’s inflammatory response predispose patients to secondary bacterial infection, further increasing morbidity and mortality.

The panel’s cytokine dialogue continued with CEO of CytoSorbents Corporation, Dr. Phillip Chan, MD, PhD, who stated, “Cytokine storm and severe inflammation can quickly lead to septic shock, capillary leak, organ failure, and death in pandemic influenza and beyond. Secondary bacterial infections We believe that the combination of antiviral or antibiotic treatments with CytoSorb® blood purifier to reduce cytokines and manage 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 worldwide in the intensive care unit and in cardiac surgery, including critically ill COVID-19 patients under FDA Emergency Use Authorization in USA. The next question then becomes what would be the benefit to severely ill H5N1 patients should they ever occur?

Ultimately, what the San Francisco panelists all agreed on is that next steps should focus on how best to reduce the spread of H5N1 or any other serious viral event and how to ameliorate the devastating effects of inflammation. after infection. Let’s hope the next steps happen sooner rather than later.