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Quiambao BP, Payumo RA, Roa C, Borja-Tabora CF, Emmeline Montellano M, Reyes MRDL, Zoleta-De Jesus L, Capeding MR, Solimen DP, Barez MY, Reid C, Chuang A, Tsao E, McClain JB. A phase 2b, Randomized, double blinded comparison of the safety and efficacy of the monoclonal antibody mixture SYN023 and human rabies immune globulin in patients exposed to rabies. Vaccine 2024:S0264-410X(24)00643-1. [PMID: 38834432 DOI: 10.1016/j.vaccine.2024.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND SYN023 is an anti-rabies monoclonal antibody mixture administered as part of post-exposure prophylaxis regimens. The rabies virus neutralizing antibody (RVNA) concentration generally accepted as an adequate immune response to vaccination is ≥ 0.5 IU/mL. METHODS Within 54 h of potential rabies exposure, 448 patients in two risk substrata of WHO Category III exposure were randomized to receive either 0.3 mg/kg SYN023 or 0.133 mL/kg human rabies immunoglobulin (HRIG) injected in and around the wound site(s) plus a course of rabies vaccination. Patients were followed for safety and absence of rabies for ≥ 365 days. RESULTS GMT RVNA was higher with SYN023 throughout the 2-week post-treatment period. In the primary analysis group (n = 368), 99.4 % of SYN023 recipients versus 4.5 % of HRIG recipients had protective RVNA levels on Day 4. On Day 8, 98.1 % SYN023 versus 12.2 % HRIG recipients were protected. The SYN023:HRIG ratio of geometric mean titer of RVNA (RVNA GMTs) on Day 8 (19.42) exceeded the 10 % superiority margin (P < 0.0001) indicating higher Day 8 RVNA with SYN023. On Day 99, the SYN023:HRIG RVNA GMT ratio (0.66) was below the non-inferiority margin of 20 % (P = 0.9485) suggesting some moderation of vaccine immune response by SYN023 relative to HRIG. The ratio of percent SYN023:HRIG recipients achieving RVNA ≥ 0.5 IU/mL on Day 99 (0.98) met the non-inferiority margin of 20 % (P = 0.013) indicating anti-rabies immune response with SYN023 was non-inferior to HRIG despite this effect. There were no probable/confirmed rabies cases in any patient. Study regimens were well tolerated. CONCLUSIONS SYN023 provided higher RVNA than HRIG soon after rabies exposure. By Day 99 post-treatment, GM RVNA with SYN023 was lower than HRIG, however, the percent of SYN023 recipients with a protective response was not inferior at this time point. No rabies cases were reported in the study. The SYN023 safety profile was acceptable. CLINICALTRIALS gov ID: NCT03961555.
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Affiliation(s)
- Beatriz P Quiambao
- Research Institute for Tropical Medicine Filinvest Corporate City, Muntinlupa City, Metro Manila, Philippines
| | | | - Camilo Roa
- Manila Doctors Hospital, Ermita Manila, Metro Manila, Philippines
| | - Charissa Fay Borja-Tabora
- Center of Excellence in Drug Research, Evaluation and Studies, Inc., Filinvest Corporate City, Muntinlupa City, Metro Manila, Philippines
| | - May Emmeline Montellano
- Far Eastern University - Nicanor Reyes Medical Foundation, Quezan City, Metro Manila, Philippines
| | - Mari Rose De Los Reyes
- Research Institute for Tropical Medicine Filinvest Corporate City, Muntinlupa City, Metro Manila, Philippines
| | - Loreta Zoleta-De Jesus
- Angelo King Medical Research Center, De la Salle Health Sciences Institute, Dasmarinas City, Cavite, Philippines
| | | | - Domingo P Solimen
- Baguio General Hospital and Medical Center, Baguio City, Cordillera Administrative Region, Philippines
| | - Marie Yvette Barez
- Southern Philippines Medical Center, Dermatology Clinical Research Unit, Davao City, Davao Region (Region XI), Philippines
| | - Caroline Reid
- Synermore Biologics (Suzhou) Co., Ltd, Suzhou Industrial Park, China
| | - Ariel Chuang
- Synermore Biologics (Suzhou) Co., Ltd, Suzhou Industrial Park, China
| | - Eric Tsao
- Synermore Biologics (Suzhou) Co., Ltd, Suzhou Industrial Park, China.
| | - J Bruce McClain
- Synermore Biologics (Suzhou) Co., Ltd, Suzhou Industrial Park, China
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2
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Tambe MP, Parande MA, Nanaware MB, Salunke NM, Dutta T, Mahajan M. Post-Marketing Surveillance of the World's First Novel Cocktail of Rabies Monoclonal Antibodies: TwinRab™ in Real \-World Setting. Indian J Community Med 2024; 49:443-447. [PMID: 38665446 PMCID: PMC11042126 DOI: 10.4103/ijcm.ijcm_562_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/06/2023] [Indexed: 04/28/2024] Open
Abstract
Rabies presents with a high fatality rate, which imposes a significant global public health challenge, and therefore the use of post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising substitute for rabies immunoglobulins (RIGs) due to their high efficacy and standardized manufacturing process. A prospective, open-label, post-marketing surveillance study (PMS) was conducted at Byramjee Jeejeebhoy Medical College (BJMC), Pune. The study included patients aged more than 2 years who had recently sustained Category III-suspected rabid animal bite exposures. These patients were administered TwinRabTM at a dosage of 40 IU/kg in and around the wound as intralesional transfer, along with the anti-rabies vaccine (ARV). Adverse events (AEs) grading was performed with reference to the Food and Drug Administration (FDA) toxicity grading. In this study, 215 subjects received the TwinRabTM mAb with a 100% completion rate. Out of 215 patients, three (1.3%) patients in the range of 18 to 65 years of age showed solicited local AEs, which were resolved after the appropriate treatment intervention, but causality assessment was non-assessable. The overall tolerability assessment showed positive ratings from doctors (91.63%) and patients (67.91%) for the mAb cocktail. The PMS demonstrated the safety of TwinRabTM in patients who experienced Category III-suspected rabid animal bites, thereby supporting its potential as an alternative option for post-exposure prophylaxis in the management of animal bites for the prevention of rabies.
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3
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de Jong HK, Grobusch MP. Monoclonal antibody applications in travel medicine. Trop Dis Travel Med Vaccines 2024; 10:2. [PMID: 38221606 PMCID: PMC10789029 DOI: 10.1186/s40794-023-00212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024] Open
Abstract
For decades, immunoglobulin preparations have been used to prevent or treat infectious diseases. Since only a few years, monoclonal antibody applications (mAbs) are taking flight and are increasingly dominating this field. In 2014, only two mAbs were registered; end of October 2023, more than ten mAbs are registered or have been granted emergency use authorization, and many more are in (pre)clinical phases. Especially the COVID-19 pandemic has generated this surge in licensed monoclonal antibodies, although multiple phase 1 studies were already underway in 2019 for other infectious diseases such as malaria and yellow fever. Monoclonal antibodies could function as prophylaxis (i.e., for the prevention of malaria), or could be used to treat (tropical) infections (i.e., rabies, dengue fever, yellow fever). This review focuses on the discussion of the prospects of, and obstacles for, using mAbs in the prevention and treatment of (tropical) infectious diseases seen in the returning traveler; and provides an update on the mAbs currently being developed for infectious diseases, which could potentially be of interest for travelers.
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Affiliation(s)
- Hanna K de Jong
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Institute of Tropical Medicine & Deutsches Zentrum Für Infektionsforschung, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales, (CERMEL), Lambaréné, Gabon
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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4
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Hongtu Q, BoLi L, Jianguo C, Shusheng P, Ming M. Immunogenicity of rabies virus G mRNA formulated with lipid nanoparticles and nucleic acid immunostimulators in mice. Vaccine 2023; 41:7129-7137. [PMID: 37866995 DOI: 10.1016/j.vaccine.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Rabies is a preventable zoonotic disease caused by rabies virus (RABV) with high mortality. Messenger RNA (mRNA) vaccines have opened up new avenues for vaccine development and pandemic preparedness with potent scalability, which may overcome the only licensed rabies inactived vaccine' shortcoming of time and cost wasting. Here, we designed an RABV mRNA vaccines expressed RABV G protein and capsulated with lipid nanoparticle (LNP) and different nucleic acid immunostimulator (CPG 1018, CPG 2395 and Poly I:C) and then assessed the immunogenicity and protective capacity in mice. While RABV mRNA capsulated with LNP and CPG 1018 could induce more potent humoral response with highest and durable RABV-G specific IgG titers and virus neutralizing titers, but also induced stronger RABV G-specific cell-mediated immunity (CMI) responses, including the highest proportions of interferon-γ (IFN-γ) and tumor necrosis factor alpha (TNFα)- producing CD4+/CD8 + T cells according to a flow cytometry assay in mice. In addition, in the pre- and post-exposure challenge assays, LNP + CPG 1018 capsulated RABV G mRNA induced 100 % protection against 25 LD50 of RABV infection with highest inhibition efficacy of viral replication with the decreased virus genome detected by qRT-PCR. These results showed that RABV G mRNA capsulated with LNP immune-stimulating nucleic acids CPG 1018 showed promise as a safe and economical rabies vaccine candidate.
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Affiliation(s)
- Qiao Hongtu
- Scientific Research Department, Chengdu Qingbaijiang District People's Hospital, Chengdu, China.
| | - Liu BoLi
- Emergency Department, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
| | - Chen Jianguo
- Medical Laboratory, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
| | - Peng Shusheng
- Medical Laboratory, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
| | - Min Ming
- Medical Laboratory, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
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5
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Liu X, Li Y, Li J, Zhou J, Guo J, Pu Y, Jiang Y, Zhou Y, Jiang Z, Shu Q, Wang C, Wang J, Zhao Y, Zhao W, Wang H, Wei J, Yu H, Gao J, Li X. Comparing recombinant human rabies monoclonal antibody (ormutivimab) with human rabies immunoglobulin (HRIG) for postexposure prophylaxis: A phase III, randomized, double-blind, non-inferiority trial. Int J Infect Dis 2023; 134:53-62. [PMID: 37211270 DOI: 10.1016/j.ijid.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/15/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES To evaluate the immunogenicity and safety of an anti-rabies monoclonal antibody (mAb), ormutivimab, compared with human rabies immunoglobulin (HRIG). METHODS This phase III trial was designed as a randomized, double-blind, non-inferiority clinical trial in patients aged ≥18 years with suspected World Health Organization category Ⅲ rabies exposure. The participants were randomized 1:1 to ormutivimab and HRIG groups. After thorough wound washing and injection of ormutivimab/HRIG on day 0, the vaccination was administered on days 0, 3, 7, 14, and 28. The primary endpoint was the adjusted geometric mean concentration (GMC) of rabies virus-neutralizing activity (RVNA) on day 7. The endpoint of safety included the occurrence of adverse reactions and serious adverse events. RESULTS A total of 720 participants were recruited. The adjusted-GMC of RVNA (0.41 IU/ml) on day 7 in ormutivimab group was not inferior to that in the HRIG group (0.41 IU/ml), with ratio of adjusted-GMC of 1.01 (95% confidence interval: 0.91, 1.14). The seroconversion rate of the ormutivimab group was higher than that of the HRIG group on days 7, 14, and 42. Most local injection sites and systemic adverse reactions reported from both groups were mild to moderate in severity. CONCLUSION ormutivimab + vaccine can protect victims aged ≥18 years with category Ⅲ suspected rabies exposure as a component of postexposure prophylaxis. ormutivimab has a weaker influence on the immunity response of rabies vaccines. CLINICAL TRIALS REGISTRATION ChiCTR1900021478 (the Chinese Clinical Trial Registry of World Health Organization).
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Affiliation(s)
- Xiaoqiang Liu
- Vaccine Clinical Research Center, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Yufeng Li
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Jingyu Li
- Vaccine Clinical Research Center, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Jianmei Zhou
- Mile County Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Jiangshu Guo
- Kaiyuan County Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Yi Pu
- Gejiu County Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Ya Jiang
- Mile County Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Yaling Zhou
- Gejiu County Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Zhiwei Jiang
- Statistics Department, Beijing Key Tech Statistical Consulting Co., Ltd., Beijing, China
| | - Qun Shu
- Statistics Department, Beijing Key Tech Statistical Consulting Co., Ltd., Beijing, China
| | - Cha Wang
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Jingke Wang
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Yu Zhao
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Wei Zhao
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Hui Wang
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Jingshuang Wei
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China
| | - Hancheng Yu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Vaccine Clinical Research Center, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Jian Gao
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China.
| | - Xiaona Li
- State Key Laboratory of Antibody Research & Development, North China Pharmaceutical Company (NCPC) New Drug Research and Development Co., Ltd., Shijiazhuang, China.
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Esposito S, Amirthalingam G, Bassetti M, Blasi F, De Rosa FG, Halasa NB, Hung I, Osterhaus A, Tan T, Torres JP, Vena A, Principi N. Monoclonal antibodies for prophylaxis and therapy of respiratory syncytial virus, SARS-CoV-2, human immunodeficiency virus, rabies and bacterial infections: an update from the World Association of Infectious Diseases and Immunological Disorders and the Italian Society of Antinfective Therapy. Front Immunol 2023; 14:1162342. [PMID: 37256125 PMCID: PMC10226646 DOI: 10.3389/fimmu.2023.1162342] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Monoclonal antibodies (mABs) are safe and effective proteins produced in laboratory that may be used to target a single epitope of a highly conserved protein of a virus or a bacterial pathogen. For this purpose, the epitope is selected among those that play the major role as targets for prevention of infection or tissue damage. In this paper, characteristics of the most important mABs that have been licensed and used or are in advanced stages of development for use in prophylaxis and therapy of infectious diseases are discussed. We showed that a great number of mABs effective against virus or bacterial infections have been developed, although only in a small number of cases these are licensed for use in clinical practice and have reached the market. Although some examples of therapeutic efficacy have been shown, not unlike more traditional antiviral or antibacterial treatments, their efficacy is significantly greater in prophylaxis or early post-exposure treatment. Although in many cases the use of vaccines is more effective and cost-effective than that of mABs, for many infectious diseases no vaccines have yet been developed and licensed. Furthermore, in emergency situations, like in epidemics or pandemics, the availability of mABs can be an attractive adjunct to our armament to reduce the impact. Finally, the availability of mABs against bacteria can be an important alternative, when multidrug-resistant strains are involved.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ivan Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Infectious Disease and Microbiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Albert Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Tina Tan
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, United States
| | - Juan Pablo Torres
- Department of Pediatrics and Pediatric Surgery, Facultad de Medicina, University of Chile, Santiago, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Santiago, Chile
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Population Pharmacodynamic Analyses of Human Anti-Rabies Virus Monoclonal Antibody (Ormutivimab) in Healthy Adult Subjects. Vaccines (Basel) 2022; 10:vaccines10081218. [PMID: 36016106 PMCID: PMC9415024 DOI: 10.3390/vaccines10081218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Ormutivimab is the first recombinant human anti-rabies monoclonal antibody (rhRIG) approved for clinical application in China. In this study, a population pharmacodynamic (PPD) model was established to compare the neutralizing antibody activities of Ormutivimab and human rabies immunoglobulin (HRIG), alone or combined with human rabies vaccine (Vero), in a phase II clinical trial, and to recommend a target dose for the phase III trial. The model was verified to fit the PPD data well. The stability of the model was verified by the bootstrap method. The level of neutralizing antibodies in vivo increased rapidly after administration of Ormutivimab or HRIG. Neutralizing antibodies with a strong activity were produced at 7 days (Ormutivimab + vaccine) or 10 days (HRIG + vaccine) after induction by the vaccine in vivo. Compared to that induced by HRIG + vaccine, the level of the neutralizing antibodies induced by Ormutivimab + vaccine peaked higher and faster. The levels of neutralizing antibodies induced by Ormutivimab + vaccine and HRIG + vaccine were similar within 21 days after administration. According to these results and the safety data, 20 IU·kg-1 was recommended as the target dose in the confirmatory study of Ormutivimab. Registration: ClinicalTrials.gov #NCT02559921.
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8
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Rupprecht CE, Mani RS, Mshelbwala PP, Recuenco SE, Ward MP. Rabies in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:28-39. [PMID: 35371908 PMCID: PMC8960221 DOI: 10.1007/s40475-022-00257-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Purpose of Review Rabies is an ancient yet still neglected tropical disease (NTD). This review focuses upon highlights of recent research and peer-reviewed communications on the underestimated tropical burden of disease and its management due to the complicated dynamics of virulent viral species, diverse mammalian reservoirs, and tens of millions of exposed humans and animals – and how laboratory-based surveillance at each level informs upon pathogen spread and risks of transmission, for targeted prevention and control. Recent Findings While both human and rabies animal cases in enzootic areas over the past 5 years were reported to PAHO/WHO and OIE by member countries, still there is a huge gap between these “official” data and the need for enhanced surveillance efforts to meet global program goals. Summary A review of the complex aspects of rabies perpetuation in human, domestic animal, and wildlife communities, coupled with a high fatality rate despite the existence of efficacious biologics (but no therapeutics), warrants the need for a One Health approach toward detection via improved laboratory-based surveillance, with focal management at the viral source. More effective methods to prevent the spread of rabies from enzootic to free zones are needed.
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Affiliation(s)
- Charles E. Rupprecht
- LYSSA LLC, Atlanta, GA USA
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL USA
| | - Reeta S. Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka India
| | - Philip P. Mshelbwala
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
- Faculty of Veterinary Medicine, University of Abuja, Abuja, Nigeria
| | - Sergio E. Recuenco
- Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Michael P. Ward
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW Australia
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9
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Knobel DL, Jackson AC, Bingham J, Ertl HCJ, Gibson AD, Hughes D, Joubert K, Mani RS, Mohr BJ, Moore SM, Rivett-Carnac H, Tordo N, Yeates JW, Zambelli AB, Rupprecht CE. A One Medicine Mission for an Effective Rabies Therapy. Front Vet Sci 2022; 9:867382. [PMID: 35372555 PMCID: PMC8967983 DOI: 10.3389/fvets.2022.867382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provide given the cost, clinical expertise required, and uncertain outcome. Systematic clinical research into combination therapies is further hampered by sporadic occurrence of cases. In this Perspective, we examine the case for a One Medicine approach to accelerate development of an effective therapy for rabies through the veterinary care and investigational treatment of naturally infected dogs in appropriate circumstances. We review the pathogenesis of rabies virus in humans and dogs, including recent advances in our understanding of the molecular basis for the severe neurological dysfunction. We propose that four categories of disease process need to be managed in patients: viral propagation, neuronal degeneration, inflammation and systemic compromise. Compassionate critical care and investigational treatment of naturally infected dogs receiving supportive therapy that mimics the human clinical scenario could increase opportunities to study combination therapies that address these processes, and to identify biomarkers for prognosis and therapeutic response. We discuss the safety and ethics of this approach, and introduce the Canine Rabies Treatment Initiative, a non-profit organization with the mission to apply a One Medicine approach to the investigation of diagnostic, prognostic, and therapeutic options for rabies in naturally infected dogs, to accelerate transformation of rabies into a treatable disease for all patients.
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Affiliation(s)
- Darryn L. Knobel
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
- *Correspondence: Darryn L. Knobel ;
| | - Alan C. Jackson
- Department of Medicine, Northern Consultation Centre, Thompson General Hospital, Thompson, MB, Canada
- Department of Medicine, Lake of the Woods District Hospital, Kenora, ON, Canada
| | - John Bingham
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Australian Animal Health Laboratory at the Australian Centre for Disease Preparedness, Geelong, VIC, Australia
| | | | - Andrew D. Gibson
- Division of Genetics and Genomics, Easter Bush Veterinary Centre, The Roslin Institute and the Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, United Kingdom
| | - Daniela Hughes
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
| | - Kenneth Joubert
- Veterinary Anaesthesia, Analgesia and Critical Care Services, Lonehill, South Africa
| | - Reeta S. Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research in Rabies, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bert J. Mohr
- Canine Rabies Treatment Initiative, Salt Rock, South Africa
- Centre for Animal Research, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Susan M. Moore
- Veterinary Medical Diagnostic Laboratory, University of Missouri, Columbia, MO, United States
| | | | - Noël Tordo
- Institut Pasteur de Guinée, Conakry, Guinea
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10
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Fan L, Zhang L, Li J, Zhu F. Advances in the progress of monoclonal antibodies for rabies. Hum Vaccin Immunother 2022; 18:2026713. [PMID: 35172707 PMCID: PMC8993100 DOI: 10.1080/21645515.2022.2026713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rabies is a highly fatal zoonotic disease caused by the rabies virus invading the central nervous system. When suspected of exposure to the rabies virus, post-exposure prophylaxis should be administered as soon as possible. Monoclonal antibodies (mAbs) neutralizing the rabies virus could be better in human rabies post-exposure prophylaxis than equine or human rabies immune globulin in terms of supply, cost, and efficacy. This article reviews anti-rabies mAbs produced by multiple techniques, and the results of clinical trials for anti-rabies mAbs cocktails recognizing non-overlapping epitopes are also discussed.
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Affiliation(s)
- Linlin Fan
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, PR China
| | - Li Zhang
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Jingxin Li
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, PR China.,Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.,Institute of Global Public Health and Emergency Pharmacy, China Pharmaceutical University, Nanjing, PR China
| | - Fengcai Zhu
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, PR China.,Institute of Global Public Health and Emergency Pharmacy, China Pharmaceutical University, Nanjing, PR China.,NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
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11
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Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP): Recommended Immunization Schedule (2020-21) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr 2021. [PMID: 33257602 PMCID: PMC7840391 DOI: 10.1007/s13312-021-2096-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Justification In view of new developments in vaccinology and the availability of new vaccines, there is a need to revise/review the existing immunization recommendations. Process Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) had a physical meeting in March, 2020 followed by online meetings (September-October, 2020), to discuss the updates and new recommendations. Opinion of each member was sought on the various recommendations and updates, following which an evidence-based consensus was reached. Objectives To review and revise the IAP recommendations for 2020–21 and issue recommendations on existing and new vaccines. Recommendations The major changes include recommendation of a booster dose of injectable polio vaccine (IPV) at 4–6 years for children who have received the initial IPV doses as per the ACVIP/IAP schedule, re-emphasis on the importance of IPV in the primary immunization schedule, preferred timing of second dose of varicella vaccine at 3–6 months after the first dose, and uniform dosing recommendation of 0.5 mL (15 µg HA) for inactivated influenza vaccines.
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12
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McClain JB, Chuang A, Reid C, Moore SM, Tsao E. Rabies virus neutralizing activity, pharmacokinetics, and safety of the monoclonal antibody mixture SYN023 in combination with rabies vaccination: Results of a phase 2, randomized, blinded, controlled trial. Vaccine 2021; 39:5822-5830. [PMID: 34483020 DOI: 10.1016/j.vaccine.2021.08.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND SYN023-002 is a randomized, blinded, controlled study comparing rabies virus neutralizing activity (RVNA) and safety of SYN023, a monoclonal anti-rabies antibody mixture, to human-serum derived anti-rabies immunoglobulin (RIG) when administered with commercially available vaccines to healthy adult volunteers. METHODS Participants were randomized among 4 treatment groups (SYN023 + Imovax, SYN023 + RabAvert, HyperRab + Imovax, HyperRab + RabAvert). On Day 0, subjects received 1 dose of RIG (0.3 mg/kg SYN023 or 20 IU/mL HyperRab) and their first of 5 vaccine doses. The primary objective was to compare cumulative RVNA between SYN023 and HyperRab recipients. Secondary objectives were to compare safety and to assess SYN023 pharmacokinetics and immunogenicity. RESULTS All 164 randomized subjects initiated treatment and were included in safety analyses. At least 34 subjects/treatment group received all treatment and had complete RVNA results, thus were included in the primary endpoint analysis. Mean RVNAs were approximately ten-fold higher in SYN023 recipients compared to HyperRab recipients until Day 14. From Day 14 onwards, mean RVNA was lower in SYN023 recipients, but remained above the RVNA level widely considered adequate (≥0.5 IU/mL) through Day 112 (study end). The point estimate of the cumulative RVNA (83.22% SYN023/HyperRab), but not the lower CI bound (90% CI: 66.06%, 104.83%), fell within the protocol-defined similarity margin. Each RIG + vaccine regimen appeared safe with mostly mild AEs and no serious or severe related events observed. Except injection site pain (22% HyperRab recipients vs. 6% SYN023 recipients), treatment-related AEs incidences were similar between RIGs. Anti-SYN023 antibodies were observed but had no apparent effects on PK or safety. CONCLUSIONS SYN023 administered with commercially available vaccines provides adequate antibody coverage beginning earlier than other commercially available RIGs with an acceptable safety profile. Some suppression of vaccine response occurred, but RVNA levels ≥ 0.5 IU/mL were maintained throughout the relevant period. REGISTRATION ClinicalTrials.gov #NCT02956746. FUNDING Synermore biologics.
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Affiliation(s)
- J Bruce McClain
- Synermore Biologics Co., Ltd., 6F-6, No. 5, Aly.22, Ln. 513, Ruiguang Rd, Neihu Dist, Tapei 11492, Taiwan.
| | - Ariel Chuang
- Synermore Biologics Co., Ltd., 6F-6, No. 5, Aly.22, Ln. 513, Ruiguang Rd, Neihu Dist, Tapei 11492, Taiwan.
| | - Caroline Reid
- Synermore Biologics Co., Ltd., 6F-6, No. 5, Aly.22, Ln. 513, Ruiguang Rd, Neihu Dist, Tapei 11492, Taiwan.
| | - Susan M Moore
- Diagnostic Medicine/Pathobiology Department, Kansas State University, Manhattan, Kansas, United States of America, Present address: 1800 Denison Avenue, Manhattan, Kansas 66506, USA.
| | - Eric Tsao
- Synermore Biologics Co., Ltd., 6F-6, No. 5, Aly.22, Ln. 513, Ruiguang Rd, Neihu Dist, Tapei 11492, Taiwan.
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13
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Kim PK, Ahn JS, Kim CM, Seo JM, Keum SJ, Lee HJ, Choo MJ, Kim MS, Lee JY, Maeng KE, Shin JY, Yi KS, Osinubi MOV, Franka R, Greenberg L, Shampur M, Rupprecht CE, Lee SY. A broad-spectrum and highly potent human monoclonal antibody cocktail for rabies prophylaxis. PLoS One 2021; 16:e0256779. [PMID: 34469480 PMCID: PMC8409651 DOI: 10.1371/journal.pone.0256779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
Post-exposure prophylaxis (PEP) is highly effective in preventing disease progression of rabies when used in timely and appropriate manner. The key treatment for PEP is infiltration of rabies immune globulin (RIG) into lesion site after bite exposure, besides wound care and vaccination. Unfortunately, however, RIG is expensive and its supply is limited. Currently, several anti-rabies virus monoclonal antibody (mAb) products are under development as alternatives to RIG, and two recently received regulatory approval in India. In this study, fully human mAbs that recognize different rabies virus glycoprotein conformational antigenic site (II and III) were created from peripheral blood mononuclear cells of heathy vaccinated subjects. These mAbs neutralized a diverse range of lyssavirus types. As at least two anti-rabies virus mAbs are recommended for use in human PEP to ensure broad coverage against diverse lyssaviruses and to minimize possible escape variants, two most potent mAbs, NP-19-9 and 11B6, were selected to be used as cocktail treatment. These two mAbs were broadly reactive to different types of lyssaviruses isolates, and were shown to have no interference with each other. These results suggest that NP-19-9 and 11B6 are potent candidates to be used for PEP, suggesting further studies involving clinical studies in human.
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Affiliation(s)
- Pan Kyeom Kim
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
- * E-mail:
| | - Jung Sun Ahn
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Cheol Min Kim
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Ji Min Seo
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Sun Ju Keum
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Hyun Joo Lee
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Min Joo Choo
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Min Soo Kim
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Jun Young Lee
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Ki Eun Maeng
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Ji Young Shin
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Kye Sook Yi
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
| | - Modupe O. V. Osinubi
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Franka
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lauren Greenberg
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Madhusudana Shampur
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Soo Young Lee
- Department of Research and Development, Celltrion, INC, Incheon, Republic of Korea
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14
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Agarwal A, Kumar N. A Phase 3, Randomized, Open-label, Noninferiority Trial Evaluating Anti-rabies Monoclonal Antibody Cocktail (TwinrabTM) Against Human Rabies Immunoglobulin. Clin Infect Dis 2021; 73:e845-e846. [PMID: 33011805 DOI: 10.1093/cid/ciaa1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Kansagra K, Parmar D, Mendiratta SK, Patel J, Joshi S, Sharma N, Parihar A, Bhoge S, Patel H, Kalita P, Munshi R, Kurmi P, Shah R, Gupta A, Bhalla HL, Bekkalele H, Verma RK, Agarwal D, Sharma S, Gawande A, Chhaya G. Reply to Agrawal and Kumar. Clin Infect Dis 2021; 73:e846. [PMID: 33011769 DOI: 10.1093/cid/ciaa1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Deven Parmar
- Zydus Discovery DMCC, Dubai, United Arab Emirates
| | | | - Jatin Patel
- Clinical R&D, Cadila Healthcare Limited, Ahmedabad, India
| | - Shuchi Joshi
- Clinical R&D, Cadila Healthcare Limited, Ahmedabad, India
| | - Nitin Sharma
- Clinical R&D, Cadila Healthcare Limited, Ahmedabad, India
| | - Anurag Parihar
- Clinical R&D, Cadila Healthcare Limited, Ahmedabad, India
| | - Swapnil Bhoge
- Clinical R&D, Cadila Healthcare Limited, Ahmedabad, India
| | - Harilal Patel
- Drug Metabolism and Pharmacokinetic, Cadila Healthcare Limited, Ahmedabad, India
| | - Pankaj Kalita
- Biotechnology, Cadila Healthcare Limited, Ahmedabad, India
| | - Renuka Munshi
- TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
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16
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Isolation and Characterization of Cross-Reactive Human Monoclonal Antibodies That Potently Neutralize Australian Bat Lyssavirus Variants and Other Phylogroup 1 Lyssaviruses. Viruses 2021; 13:v13030391. [PMID: 33804519 PMCID: PMC8001737 DOI: 10.3390/v13030391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Australian bat lyssavirus (ABLV) is a rhabdovirus that circulates in four species of pteropid bats (ABLVp) and the yellow-bellied sheath-tailed bat (ABLVs) in mainland Australia. In the three confirmed human cases of ABLV, rabies illness preceded fatality. As with rabies virus (RABV), post-exposure prophylaxis (PEP) for potential ABLV infections consists of wound cleansing, administration of the rabies vaccine and injection of rabies immunoglobulin (RIG) proximal to the wound. Despite the efficacy of PEP, the inaccessibility of human RIG (HRIG) in the developing world and the high immunogenicity of equine RIG (ERIG) has led to consideration of human monoclonal antibodies (hmAbs) as a passive immunization option that offers enhanced safety and specificity. Using a recombinant vesicular stomatitis virus (rVSV) expressing the glycoprotein (G) protein of ABLVs and phage display, we identified two hmAbs, A6 and F11, which completely neutralize ABLVs/ABLVp, and RABV at concentrations ranging from 0.39 and 6.25 µg/mL and 0.19 and 0.39 µg/mL respectively. A6 and F11 recognize overlapping epitopes in the lyssavirus G protein, effectively neutralizing phylogroup 1 lyssaviruses, while having little effect on phylogroup 2 and non-grouped diverse lyssaviruses. These results suggest that A6 and F11 could be effective therapeutic and diagnostic tools for phylogroup 1 lyssavirus infections.
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17
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McClain JB, Chuang A, Moore SM, Tsao E. Safety, Pharmacokinetics, and Neutralizing Activity of SYN023, a Mixture of Two Novel Antirabies Monoclonal Antibodies Intended for Use in Postrabies Exposure Prophylaxis. Clin Pharmacol Drug Dev 2021; 10:807-817. [PMID: 33493368 DOI: 10.1002/cpdd.917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
SYN023 is a mixture of 2 humanized monoclonal antirabies antibodies (CTB011, CTB012). Two first-in-human studies evaluated ascending intramuscular (IM) injected doses (Study SYN023-001; N = 15) and IM vs subcutaneous (SC) administration (Study SYN023-003; N = 35) in healthy adults. In both studies, end points were safety, pharmacokinetics (PK), pharmacodynamics/rabies virus neutralizing activity (RVNA), and immunogenicity (anti-SYN023 antibodies). Adverse events were mild and infrequent at all doses tested by IM injection (0.3 mg/kg, 1.0 mg/kg, 2.0 mg/kg), or by SC injection (0.3 mg/kg). There were no apparent trends in adverse event frequency or nature with increased dose or with administration route. Serum PK of SYN023 component antibodies appeared comparable to each other at each dose tested and when administered IM versus SC with serum exposure doubling over the second week after administration. At the lowest dose tested (0.3 mg/kg) by either IM or SC injection, RVNA levels exceeded the concentration generally accepted as protective against rabies (≥0.5 IU/mL) by day 1 after administration. Supra-inhibitory levels persisted >42 days. RVNA increased with higher doses. Anti-CTB011 and anti-CTB012 antibodies occurred with no apparent effect on PK or safety. These data support the potential use of SYN023 in antirabies postexposure prophylaxis.
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Affiliation(s)
| | - Ariel Chuang
- Synermore Biologics Co. Ltd, Taipei City, Taiwan
| | - Susan M Moore
- Rabies Laboratory, Kansas State Veterinary Diagnostic Laboratory, Kansas State University, Manhattan, Kansas, USA
| | - Eric Tsao
- Synermore Biologics Co. Ltd, Taipei City, Taiwan
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18
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de Melo GD, Sonthonnax F, Lepousez G, Jouvion G, Minola A, Zatta F, Larrous F, Kergoat L, Mazo C, Moigneu C, Aiello R, Salomoni A, Brisebard E, De Benedictis P, Corti D, Bourhy H. A combination of two human monoclonal antibodies cures symptomatic rabies. EMBO Mol Med 2020; 12:e12628. [PMID: 32945125 PMCID: PMC7645379 DOI: 10.15252/emmm.202012628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Rabies is a neglected disease caused by a neurotropic Lyssavirus, transmitted to humans predominantly by the bite of infected dogs. Rabies is preventable with vaccines or proper post-exposure prophylaxis (PEP), but it still causes about 60,000 deaths every year. No cure exists after the onset of clinical signs, and the case-fatality rate approaches 100% even with advanced supportive care. Here, we report that a combination of two potent neutralizing human monoclonal antibodies directed against the viral envelope glycoprotein cures symptomatic rabid mice. Treatment efficacy requires the concomitant administration of antibodies in the periphery and in the central nervous system through intracerebroventricular infusion. After such treatment, recovered mice presented good clinical condition, viral loads were undetectable, and the brain inflammatory profile was almost normal. Our findings provide the unprecedented proof of concept of an antibody-based therapeutic approach for symptomatic rabies.
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Affiliation(s)
| | - Florian Sonthonnax
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
- Sorbonne‐Paris CitéCellule PasteurUniversité Paris‐DiderotParisFrance
| | | | - Grégory Jouvion
- Experimental Neuropathology UnitInstitut PasteurParisFrance
- INSERMPathophysiology of Pediatric Genetic DiseasesSorbonne UniversitéHôpital Armand‐TrousseauUF Génétique MoléculaireAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Andrea Minola
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Fabrizia Zatta
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Florence Larrous
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Lauriane Kergoat
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Camille Mazo
- Perception and Memory UnitInstitut PasteurParisFrance
| | | | - Roberta Aiello
- Istituto Zooprofilattico Sperimentale delle VeneziePaduaItaly
| | - Angela Salomoni
- Istituto Zooprofilattico Sperimentale delle VeneziePaduaItaly
| | - Elise Brisebard
- Experimental Neuropathology UnitInstitut PasteurParisFrance
- Laboratoire d'HistopathologieVetAgro‐SupUniversité de LyonLyonFrance
| | | | - Davide Corti
- Humabs BioMed SAa subsidiary of Vir BiotechnologyBellinzonaSwitzerland
| | - Hervé Bourhy
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
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