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MERS-CoV deaths rise with few drugs in pipeline

The death toll in South Korea reaches 16 as WHO hosts emergency meeting

World Health Organization WHO flag 

With the death toll from MERS-CoV in South Korea now standing at 16 people, the World Health Organization (WHO) has convened an emergency committee meeting to gauge the response to the outbreak.

Around 140 people have been infected with the virus and WHO's Keiji Fukuda warned last week that "more cases should be anticipated," particularly within hospitals in South Korea. In the meantime, five cases have now been reported in Saudi Arabia.

First identified in 2012, MERS is a coronavirus similar to the SARS virus that put health systems on high alert after an outbreak in 2003 but has some key differences. While it seems harder to transmit between humans, it is associated with a higher fatality rate than SARS and - perhaps most worryingly - unlike has not gone away, with a steady stream of cases since its discovery.

Most MERS patients develop severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died, according to data from the US Centers for Disease Control (CDC).

At the moment there is no treatment or vaccine available for MERS and WHO-recommended containment measures are focused on infection prevention and control, with around 2,800 Koreans currently in quarantine. Thermal scanners are also being used to screen people on entry to some public places, with anyone showing evidence of a fever denied admittance.

There are however, a few treatments that could potentially be made available on an emergency-use basis if the outbreak gains pace, as occurred with the Ebola outbreak last year, although there remains considerable debate about when treatment should be considered.

There is some evidence to suggest existing drugs such as interferon/ribavirin, the HIV therapy lopinavir, antimalarials chloroquine and chlorpromazine and diarrhoea therapy loperamide might be re-purposed to have some effect in MERS, but researchers would like these to be used within the context of clinical trials in order to gauge their safety and effectiveness scientifically.

Of most value would be a vaccine, but here activity seems to be limited with none of the big vaccine companies reporting any pipeline candidates. 

Among the small number of companies developing potential vaccines against MERS are Inovio Pharmaceuticals and partner company GeneOne Life Sciences, which recently announced plans to start a phase I trial of a DNA-based vaccine.

In preclinical tests, the vaccine - INO-4500 - showed robust and durable immune responses, according to the two companies. Animals vaccinated with INO-4500 generated strong antibody and T lymphocyte responses to MERS antigens

Meanwhile, Novavax also has a candidate in preclinical testing that has been shown to block infection in mice. The company is working on the recombinant nanoparticle vaccine with the University of Maryland School of Medicine in the US and reported last year that it was able to generate neutralizing antibodies in mice, but says additional work will need an injection of funding.

Other companies that have development programmes looking at MERS include Greffex, Abviro, Shanghai Kaibao and Nanoviricide, although much of the work seems to be taking place within academic laboratories.

The continued emergence of MERS has led to criticism that a reluctance by the pharma industry to invest in drugs and vaccines for SARS more than 10 years ago - on the grounds they would be unprofitable  - means that patients in the current outbreak have no access to therapy. SARS and MERS are similar, so it is possible that a drug effective for one virus would have an effect on the other.

With the SARS outbreak smaller than feared, however, it is likely that a lack of patients for clinical trials was also a key factor, although the speed of the industry's response to the Ebola outbreak shows what can be achieved when there is the will to do so. 

Article by
Phil Taylor

15th June 2015

From: Healthcare



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