Saturday, June 13, 2015

Korea Trying Convalescent Serum Treatment For MERS

Credit Wikipedia

# 10,202

Although machine translations of Korean text often produce a syntax-challenged product, there are multiple news reports this morning describing attempts to use convalescent serum collected from recovered MERS cases to treat severely ill patients.

First this report from Yonhap News, which describes the administration of convalescent serum to the 38 year-old doctor (#35) and 35 year-old policeman (#119) - both reportedly in poor condition, after which I'll have more on the experimental treatment options for MERS.

Samsung doctor, Homers wanchija plasma injection in Pyeongtaek Police (General)
Songgo Time | 2015/06/13 8:58 p.m.
"I do not much car" ... Homers in patients with severe plasma treatment utilization plan

(AP) reporter = gomihye Middle East Respiratory Syndrome (Homers) for the treatment of patients with severe Homers this way that the antibody was administered a blood formed wanchija attempt. 
13 days Central Department of Health and Human Services Homers task force "last night wanchija two plasma were administered, respectively (the component of red blood cells, white blood cells, blood type, a liquid component, such as platelets, except for) two people taken to the patient," he said. 

Patients treated with plasma, Samsung Seoul Hospital doctor known as 35 patients (38) and Pyeongtaek Police Station slope of 119 patients (35).  
(Continue . . . )

From my reading of this, and other reports, the serum donor appears to be the Korean Airforce Sergeant who tested positive but never really developed symptoms.

Although in limited use today, human and animal serum therapy was used extensively during the first half of the 20th century to treat a variety of infectious diseases, including anthrax, scarlet fever, measles, tularemia, diphtheria and rabies.

While often effective, a relatively high percentage of adverse reactions (serum sickness) and the development of antibiotics and other drugs, has seen its use decline.

With few other therapeutic options, however, the idea of using convalescent serum for treating novel viral  infections has been discussed (and even tried) with Ebola, H5N1 and H1N1 flu.   Results have been . . . mixed. 

While a bit more complicated in reality, in theory it is a pretty simple idea:

Blood is collected from patients that have been infected and have recovered from a viral infection, and through a process called plasmapheresis, blood cells are removed (using filters or a centrifuge) and the remaining antibody-rich plasma is then used to treat ill patients.

During the 1995 Ebola outbreak in Kikwit, DRC whole blood was collected from recovered patients and  was administered to eight patients. Seven of the eight recovered, but there was no control group, and the number of patients was too small to form any firm conclusions.

In 2007, an article appeared in the NEJM on China’s early success with serum treatment of H5N1 (see Human Serum For Bird Flu?). And the following year, we got more details on two patients who received this experimental treatment and recovered (see Clinical Case Review Of 26 Chinese H5N1 Patients).

In 2011, while still carrying a 20% fatality rate, we saw a study (see CID Journal: Convalescent Plasma Therapy For Severe H1N1) that found a substantial drop in mortality among patients who received the treatment.

It has even been suggested that serum antibodies might be harvested from camels (see JVI: Investigating Dromedary Immune Serum As MERS-CoV Treatment).

Note: The words `plasma’ and `serum’ are often  used interchangeably. While similar, these two blood products are not exactly the same.

Serum = Plasma – clotting factors (fibrinogen)

A trivial enough point, I suppose.   But one I thought I’d mention before one of my sharp-eyed readers brought it up.

With no coronavirus-specific therapy in our arsenal, treatment for MERS has basically been supportive (e.g. fluids, vasopressors, ventilators and/or ECMO, dialysis, and antibiotics for secondary infections).

Therapies under investigation include Ribavirin & Interferon Treatment of MERS-CoV, but the results from treating humans with this drug combo were far from encouraging. Biocryst has an experimental antiviral called  BCX4430 which is also under investigation, but it is too early to know how effective it might be.

Two years ago  World Health Organization Novel coronavirus summary and literature update – as of 8 May 2013 called convalescent plasma `the most promising therapy'.   

Since the Koreans seem willing to utilize it - at least for seriously ill cases - we may get a much better idea of the viability of this treatment over the next few weeks.

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