Characterization of an Anti-Ebola virus Hyperimmune Globulin Derived from Convalescent Plasma

Monoclonal Antibodies and Hyperimmune Immunoglobulins in the Next Pandemic

Pandemics are highly unpredictable events that are generally caused by novel viruses. There is a high likelihood that such novel pathogens belong to entirely novel viral families for which no targeted small-molecule antivirals exist. In addition, small-molecule antivirals often have pharmacokinetic properties that make them contraindicated for the frail patients who are often the most susceptible to a novel virus. Passive immunotherapies-available from the first convalescent patients-can then play a key role in controlling pandemics. Convalescent plasma is immediately available, but if manufacturers have fast platforms to generate marketable drugs, other forms of passive antibody treatment can be produced. In this chapter, we will review the technological platforms for generating monoclonal antibodies and hyperimmune immunoglobulins, the current experience on their use for treatment of COVID-19, and the pipeline for pandemic candidates.

Hyperimmunplasma: Gewinnung, Verarbeitung und therapeutische Anwendungen

Das Prinzip der passiven Immunisierung ist seit dem 19. Jahrhundert bekannt und wird auch bei aktuellen Pandemien als Ansatz zur Prophylaxe und Therapie eingesetzt. Der Schutz wird hierbei übertragen durch Blut, Serum oder Plasma, welche Immunglobuline gegen spezifische Krankheitserreger, Bakterientoxine oder sonstige Antigene enthalten, sowie durch aus Humanplasma industriell aufgereinigte Immunglobuline. Die aktuell verwendeten Reinigungsverfahren für Immunglobuline aus Humanplasma beruhen auf der von Edwin J. Cohn entwickelten Fraktionierung von Plasma. Zur Gewinnung von Immunglobulinen mit hohen Antikörpertitern gegen spezifische Antigene, sogenannte Hyperimmunglobuline, muss zunächst Hyperimmunplasma gezielt von ausgewählten Spendern gewonnen werden. Diese Spender haben erhöhte Antikörpertiter gegen spezifische Krankheitserreger, Bakterientoxine oder sonstige Antigene, wenn sie im Rahmen einer vorangegangenen Infektion natürlich immunisiert wurden, einen zugelassenen Impfstoff zur Immunisierung erhalten haben oder gezielt zum Zweck der Plasmaspende immunisiert wurden. Aktuell sind in Deutschland, Österreich und der Schweiz Hyperimmunglobulinprodukte für verschiedene Anwendungen im Patienten zugelassen, von denen die meisten aus humanem Blutplasma gewonnen werden. Um die Herstellung der Produkte und damit letztlich die Behandlung der Patienten gewährleisten zu können, werden resiliente Lieferketten benötigt. Hierzu bedarf es unter anderem Änderungen in den Rahmenbedingungen für die Spenderimmunisierung in Deutschland.

Caprylate/chromatography process to produce highly purified tetanus immune globulin from human plasma

While tetanus toxoid vaccination has reduced the incidence of tetanus in the developed world, this disease remains a substantial health problem in developing nations. Tetanus immune globulin (TIG) is used along with vaccination for prevention of infection after major or contaminated wounds if vaccination status cannot be verified or for active tetanus infection. These studies describe the characterisation of a TIG produced by a caprylate/chromatography process. The TIG potency and presence of plasma protein impurities were analysed at early/late steps in the manufacturing process by chromatography, immunoassay, coagulation and potency tests. The caprylate/chromatography process has been previously shown to effectively eliminate or inactivate potentially transmissible agents from plasma-derived products. In this study, the caprylate/chromatography process was shown to effectively concentrate TIG activity and efficiently remove pro-coagulation factors, naturally present in plasma. This TIG drug product builds on the long-term evidence of the safety and efficacy of TIG by providing a product with higher purity and low pro-coagulant protein impurities.

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health

The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.