The coronavirus vaccine advances: are treatments like the one Trump received still necessary?

Rodney E. Rohde - The Conversation

When President Donald Trump was diagnosed with COVID-19, one of the cutting-edge experimental therapies he received was a mixture of monoclonal antibodies.

But a vaccine may soon be available, so are these therapies necessary or valuable?

In recent months, the public has learned about many treatments used to fight COVID-19.

An antiviral like remdesivir inhibits the replication of the virus in human cells, for example.

Convalescent plasma from the blood of donors who have recovered from COVID-19 may contain antibodies that inhibit the virus and inflammation.

And steroids like dexamethasone can modify and reduce dangerous inflammatory damage to the lungs, slowing down respiratory failure.

The Food and Drug Administration (FDA) has issued an emergency use authorization for Eli Lilly's monoclonal antibody, bamlanivimab, and

for its antibody treatment.

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Monoclonal antibodies are particularly promising in therapy

because they can neutralize the SARS-CoV-2 virus, which causes COVID-19, and block its ability to infect a cell.

This could be a life-saving method for people who do not have a strong natural immune response to the virus: people over 65 or with pathologies that make them more vulnerable.

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I have worked in medical and public health laboratories for decades, specializing in the study of viruses and other microbes.

Even when a COVID-19 vaccine is available, I see a role in monoclonal antibody therapy to control the pandemic.

Why should we care?

Until a large percentage of the population has immunity to an infectious disease, whether through a vaccine or uncontrolled spread through a community, the world must rely on other weapons in our war against the COVID-19 pandemic. .

Along with the therapies mentioned above, monoclonal antibodies can offer us

once it causes an infection.

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These artificial antibodies offer the world the possibility of an immunotherapy similar to the use of convalescent plasma but with a more specific and precise action.

While a vaccine will ultimately help protect citizens, mass vaccination will not happen overnight.

We also do not know its level of effectiveness.

The impact of a vaccine is also not instantaneous

: it takes several weeks to generate a powerful antibody response.

In the meantime, monoclonal antibodies may help kill the virus that is multiplying in the body.

Antibodies 101

An antibody is a Y-shaped protein naturally produced by our body's immune system to attack something that is foreign or that is not part of the person.

These foreign bodies are called antigens and can be found in allergens, bacteria, and viruses, as well as toxins or a transplanted organ.

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A monoclonal antibody treatment mimics the body's natural immune response and targets foreign agents, such as a virus, that infect or harm people.

There are also monoclonal antibodies that pharmaceutical companies have designed to attack cancer cells.

Monoclonal antibodies are one of the most powerful types of drugs.

.

For Trump, the experimental treatment carried out by the pharmaceutical company Regeneron included two antibodies.

Normally, the spike protein of the coronavirus fits perfectly into the ACE2 receptor on human cells, a protein common in lung cells and other organs.

When this connection occurs, the virus can infect cells and multiply within them.

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But monoclonal antibodies can slow or stop infection by binding to the viral protein before it reaches the ACE2 receptor.

If this happens, the virus becomes harmless because it can no longer enter our cells and reproduce.

How are monoclonal antibodies created?

The monoclonal antibodies that neutralize the coronavirus are complicated to manufacture and produce.

They must be made inside cells taken from a hamster's ovary and grown in giant steel vats.

The antibodies that these cells make must be extracted and purified.

Unfortunately, these monoclonal antibodies, which have been used for other diseases for years, are usually quite expensive.

Regeneron's two antibodies target the SARS-CoV-2 spike protein - the bumps on the virus's surface that give it a crown-like appearance and are critical for infecting human cells.

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One of Regeneron's two antibodies is a replica, or clone, of an antibody obtained from a person who has recovered from COVID-19.

The second antibody was identified in a mouse that was biologically engineered to have a human immune system.

When this mouse was injected with the spike protein, its human immune system generated antibodies against it.

Next, one of the most effective mouse antibodies was collected and used to be part of this therapy.

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Eli Lilly's monoclonal antibody therapy, bamlanivimab, was identified from

.

Both companies have large-scale manufacturing with strong global supply chains to produce the monoclonal antibodies, with many global manufacturing sites to increase supply.

Eli Lilly has received FDA approval and Regeneron is still pending approval.

Unfortunately, there will likely be a shortage of antibodies in early approvals.

Monoclonal antibodies and a vaccine

Monoclonal antibodies may complement vaccines offering rapid protection against infection.

When administered to an individual, monoclonal antibodies provide instant protection for weeks or months.

Vaccines take longer to provide protection as they must challenge the immune system.

But

.

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Regeneron and Eli Lilly products are administered by intravenous injection and the patient should be monitored by healthcare professionals.

Since they offer immediate protection, the implications of treating or protecting high-risk populations are immense.

These drugs have the potential to treat infected patients or prevent infection of healthcare workers on the front lines of this pandemic.

Monoclonal antibodies may also be helpful for older people

, young children, and the immunosuppressed for whom vaccines don't work or can be dangerous.