Coronavirus antibody testing, explained

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Antibodies. What exactly are these? And how are they different from things and people may have heard of like convalescent plasma? Yes so convalescent. Plasma is the idea that you had the disease he recovered. And you can pull the plasma out of someone that has a commissioner of antibodies. And then give that to someone else. the monoclonal idea is select the best antibodies out of that commission. Or you can make those antibodies in mice or you can make them synthetically. Monoclonal means one clone one thing. We're going to just make a bunch of it and give it to people. People typically just an antibody is a thing. Well you know more so than I scream. Store has ice cream you know there are lots of flavors. Antibodies and and some are far more effective than others and some can even cause harm. You have to be careful right and this is not like a vaccine. Where you're you're actually injecting a person with a piece of a virus or the virus killed and then the body is producing antibodies. Right so whatta vaccines doing. Is it's artificially teaching your immune system how to make an immune response including antibodies. With a vaccine you get the vaccine. Your body then knows how to make the antibodies and other immune warriors with the monoclonal antibody treatment. You have to keep getting it. You can use it either as a preventive like a vaccine or as a treatment. If you're going to use it as either you have to keep getting it because it wears off right. How do you administer monoclonal? Antibodies to a person for treatment. You have to do it. Iv IV DRIP for preventive. Where you would get it before you got the disease you can do it. As an intramuscular injection has been used to treat people for other infections or other disorders. There's a huge industry of monoclonal. Antibodies for cancer and for Autoimmune Diseases. But there are very few monoclonal antibodies that have made it to market for infectious diseases. The rarely used to of Mer for anthrax for example. Which just isn't a big problem. Right and another one that's on the market is for HIV infected. Who FAIL ALL DRUGS? And then there's one other on the market for respiratory virus for a certain subset of infants but that's it so this is something that's been done and that people have taken but it's not why lease for infection at this point not yet but we're right. On the precipice of an explosion of monoclonal antibodies for infectious diseases. Several have moved very far in clinical trials and we just had this great success story in the Democratic Republic of the Congo with Ebola where everything failed all these drug treatments failed. Convalescent plasma failed but monoclonal. Antibodies two different monoclonal antibody. Preparations worked. Well let's talk about how this is going to be applied to corona virus. Actually before that we should take a little detour to neutralizing antibodies. These seem to be the goal of lot of the research. That's going on. Can you talk a little bit about those? Yeah they're the superstars of antibodies. Basically what neutralizing? Antibodies do is when they latch onto the virus they prevent that virus from infecting a cell. In this case the virus that causes Kovic nineteen has a protein on its surface called spike. And you have a region of spike at the tip that is really and needed for the virus to get into a cell because it binds to a receptor on the cell surface that small and that small region of spike has to hit the receptor just so so the neutralizing antibodies by-in-large target that small region of Spike. You know basically. It's like taking a key. That's heading for a walk and putting chewing gum all over it. So he mentioned what an antibody that is not neutralizing monoclonal antibody. That's not neutralizing would do to prevent infection. Antibodies combined all over spike. They can also bind to the human cell when they bind to the human cell they can tell the immune system to turn on a separate arm of the immune system that brings out T. CELLS. We have a mop-up system of t-cells that can identify infected cells and clear them. And you really want these two things working in concert with each other. There are lot of approaches that you investigated in your story. Lots of researchers going down different has to try to get this treatment working. What are some of the things that they're trying to optimize about the antibodies? There are about fifty. Different efforts underway to make monoclonal start with the simplest thing. Find Somebody who's recovered and then try to pull neutralizing antibodies out of them. And then you can actually optimize their neutralizing antibodies. You can you can mess with that stock of the antibody to give it a longer half life so it lasts longer in the body. Another thing you can do. You can take the spike protein and injected into mice that have human b cells in them and they will produce antibodies. That you can then fish into the pool you've made and find the best ones that are neutralizing whom you can then modify those by making their half-life longer. Lots of fishing going on right lots of fishing going on you can also create a library of antibodies with a completely synthetic system. These are not naturally made an animal. You can then stick your fishing pole in there. I mean you. Basically stick bait into their like spike protein or just the region of the spike protein that the neutralizing antibodies attached to. That's Your Bait. That's your worm. And then the antibody jumps on that you can have two at about that. Both find the spike protein but different parts. See you kind of have the backup. In the case of one of the Abullah monoclonal antibody treatments in Congo. That worked that has three in the cocktail. There's no real limit to how many antibodies you can have. But there is a limit because of cost and manufacturing rights. There's there's one other limit. That's interesting Sarah. That's I mentioned. The spike protein has a small region on it that is where the neutralizing antibody wants to attach. That small region can only handle probably two different. Antibodies don't overlap with each other and as you mentioned there are what fifty different teams chasing this but now there's an organizing force out there. This is a consortium started near near you. Yes so the bill and Melinda Gates Foundation has funded Erica Omen Sapphire here in San Diego to try and sort through all the different. Antibodies being made in help prioritize triage with one's look best. These consortium ideas make a lot of sense in practicality. They're often hard to run because not everyone's cooperative. I'M OPTIMISTIC BECAUSE COVA. Nineteen has led to more cooperation than I personally have ever seen in the scientific community that you know these are companies. That are competitive. But they're all pledging to work together so we'll see a lot of what we talked about so far as a mechanism so we know where it should bind. We know how to improve the life span of these antibodies. What about translating these ideas these experiments into the clinic? How optimistic are you? And researchers about this working in people so antiviral drugs are a big ask when it comes to respiratory diseases. We don't have a lot of them that were in fact for viral diseases in general. It's it's tough to make drugs monoclonal. Antibodies hold great promise. We know the structure of spike protein. And how it attached to human cells. We know how to make monoclonal much better than we ever have. Because the technology has improved greatly through and autoimmune diseases and we have some hints from convalescent plasma. That can work if used early enough so I think there's high hope that these monoclonal. Antibodies will prove their worth and the Ebola experience where everything failed other than the monoclonal adds to the enthusiasm I'm GonNa keep picking at this a little bit longer so you mentioned that. Ebola had three monoclonal treatment but that people are aiming more for two in treating corona virus because these are expensive. They're not necessarily easy. To produce is going to be a problem if this does prove to be a really good treatment. Yes or no of first of all in the Democratic Republic of the Congo. A second MONOCLONAL ANTIBODY. That worked was a single monoclonal antibody. Okay yeah so it's not necessarily better to have a cocktail It might be better to things like resistance that could build but both of those work the triple Combo and the single against Ebola. Are THEY EXPENSIVE. They have been in the past but the cost has dropped. I've been told tenfold in the past ten years. Just as manufacturing has improved. We also are seeing a rush internationally to provide support for treatments and preventive for Cove. In nineteen and my hunch. Is that if something does work. A lot of money will pour out of wealthy countries. Will there be a problem. Getting these out equitably to poor people and they're also hard to deliver yes inevitably inevitably. It will be a problem and there's also the risk of rich people getting it. I right so I think these issues are very real the bill and Melinda Gates. Foundation's consortium is trying to address this upfront. But these are always sticky. Sarah you know back historically if we look back at what happened with pandemic flu vaccine. They're the rich countries of the world. So will will donate ten percent of our vaccines to the poorer countries. That's not the real solution to the problem. You talk about a race with vaccine so if a vaccine comes to clinics for the antibodies do. Is there any call for them? At that point so the antibodies can be used both as a preventative and as a treatment in theory. Antibodies are going to enter the clinic in June. They probably will have an easier time proving whether they work and are safe than a vaccine so in all likelihood if antibodies are effective they will prove themselves. I necessarily who knows? But that's how it looks to me today and on May first. That's how it looked. Thank you for putting the date in there. Yeah Yeah 'cause you know this is where we're living in corona virus. Dan Our everything is so accelerated. Who knows you know weird? Things happen every day. Now Yeah and it could be that we never have a vaccine

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