Testing for bird flu, conceptual image
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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 Showcase™ conference running in the city at the same time, it was timely that a panel of healthcare experts and biotech industry leaders discussed what options could be taken to deal with the spread of this virus and its consequences. What follows is a synopsis of the central points:
The panel began with the NGO, Coalition for Epidemic Preparedness Innovations (CEPI)’s Executive Director, Emma Wheatley answering the question: Are we destined to forever chase outbreaks? What can we do stay one step ahead and deal with the spread while also preventing mortality? And her answer was direct: “We need to change how and what we are doing. Everything from diagnostics, vaccines, antivirals and therapeutics should be revisited, especially in light of H5N1.”
H5N1 Panel Discussion at Biotech Showcase 2025 – San Francisco
Scott Chernis
With this opening, a lively discussion emerged of the two areas where H5N1 innovation must be critical. The first approach was to consider how to stop viral infection in a more effective and consistent way. This led to delineating the necessary steps to stop viral transmission and defining the role of next generation antivirals in doing it. Today, immediate administration of antiviral therapy is often the treatment of choice for influenza, but administration is required within 48 hours of symptom onset. And delayed administration increases the risk of drug-resistant viruses, making this a limited “window of opportunity approach.”
Expounding on this fact, another panelist, the President & CEO of the anti-viral biotech company, Cidara Therapeutics, Dr. Jeff Stein, PhD described the need to change our basic assumptions regarding the development of accessible long-acting pan-influenza antivirals that can serve both as therapeutic and in a prophylactic approach.
Of Cidara’s methodology he went on to state: “I believe that a long-acting antiviral drug like CD388, administered once at the beginning of the flu season, is the optimal solution to protect against pandemic influenza strains such as H5N1. It has many advantages over vaccines, foremost among which is that its effectiveness does not require an immune response and thereby can offer true “universal” activity against all strains in all people.”
The second theme of innovation examined how to recognize what the Bird Flu virus does to the body especially in severe cases and how to therapeutically address these events. This was recounted by the CEO of InflaRx N.V., Prof. Niels C. Riedemann, MD, PhD. He explained: “Given the concerning development with emerging Avian Flu cases in the US, it will be important to foster research and development of therapeutics including those addressing the patient´s inflammatory immune response to these types of viruses as our host response has been shown to cause organ injury and death during the COVID-19 pandemic”
So, What Is The H5N1 Inflammation Problem?
The answer is a complex one, but after the recent COVID-19 pandemic, one term that many people are now familiar with is the phenomenon of “Cytokine Storm.” Here’s how to look at the issue, 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 leukocyte (white blood cell) recruitment into the alveoli (lung air sacs) which compromises respiratory function. More chronic symptoms accompany the disease, such as weight loss, fever and appetite suppression, and these are directly linked to the concentration of the systemic cytokines that accumulate. In an H5N1 infection the cytopathology shows a cascade initiated by the virus, but mortality may be determined by the magnitude of the inflammation that results. Finally, both the viral 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 the 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 subsequent secondary bacterial infections. We believe that combining antiviral or antibiotic treatments with blood purification using CytoSorb® to reduce cytokines and manage deadly inflammation offers the best chance for positive outcomes.”
What should also be appreciated is that CytoSorb® has been used in more than a quarter million treatments worldwide in the intensive care unit and in cardiac surgery, including in critically ill COVID-19 patients under U.S. FDA Emergency Use Authorization. The follow-on question then becomes what would the benefit be for seriously ill H5N1 patients should they ever occur?
Ultimately, what the San Francisco panelists all agreed on is the next steps should concentrate on how to better reduce the spread of H5N1 or any other serious viral event and how to ameliorate the devastating effects of post-infection inflammation. Let’s hope those next steps happen sooner than later.
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