The new zoonotic viral pneumonia which appears to originate from camels in the Middle East, also known as Camel Flu. The first animal-to-human case was reported in Saudi Arabia in 2012. This infectious disease has spread across many countries and nationalities including Korea, United States, Thailand, etc. The latest observation of the fourth generation infected individuals is the lack of infectivity of MERS-CoV to susceptible individuals or individuals with immune system naïve to MERS-CoV. The common symptoms of MERS-CoV infected individuals developed severe acute respiratory illness, including fever, cough, and shortness of breath. Many of them have died.
For an insight of anti-MERS-CoV drug development, one of our editors, Yuhui Lin interviewed Professor Jiang, a virologist and an expert renowned for his research work in vaccination against infectious diseases.
The following interview was conducted on 19th June 2015.
Lin: MERS-CoV existed before 2015, and it may have perhaps first originated from the Middle East, why and how has it became an outbreak, and particularly in Republic of Korea?*
Jiang: Previous medical cases in the Middle East suggest secondary infection from MERS-CoV is one to two individuals. The MERS outbreak in Korea is exceptionally strange, because the genetic sequencing of MERS-CoV suggests 99.8% similar genetic make-up to MERS-CoV in the Middle East. And oddly enough, the two MERS-CoV infected patients whom have travelled to the Middle East, returned to Korea, and each infected approximately 37 to 87 individuals.
Lin:At Fudan University, you are leading a team to identify a suitable anti-MERS-CoV. There are some breakthroughs in isolating and identifying an antibody and vaccine against MERS-CoV. When will it be ready for preventative medicine and treatment?
Jiang:In our laboratory at Fudan University, we have indeed isolated and identified a promising antibody M336 that has shown to be effective viral clearance, a collaborative work with my long-term collaborator, Dr. Dimitrov. However, prior to the approval of M336 application, as similar to other novel drugs, clinical trials are mandatory. From the development of antibodies to the approval of treatment, a norm schedule takes up to an average of 8 to 10 years. The procedure is usually: test-tubes, animal testing and humans’ clinical trials.
Apart from M336 for treatment, we have also identified a polypeptide HR2P for vaccination purposes. A refined sibling polypeptide has also been recently identified, HR2P-M2, has a better protein structure stability than HR2P. HR2P-M2 has shown to be effective, and importantly, it is safe for use in animals. The objective to developing HR2P-M2 is to produce a vaccine for high risk individuals, such as health practitioners and individuals residing in or travelling to infectious regions.
Lin:Perhaps a brief explanation on how antibody recognizes and neutralizes the pathogen, MERS-CoV?
Jiang: Before neutralization, an infection must occur. As similar to the lock of hands; your right and your left must interlock and fit. This simplified illustration is similar to pathogen and host cells’ recognition, and since we know such ‘interlocks recognition’ exists as proteins on the surface of the cells, it is possible to inhibit the occurrence of cellular infection.
Lin: What are the available treatment options for MERS-CoV infected individuals?
Jiang:At the moment, it is only the use of interferon (IFN), which is used in many respiratory and infectious diseases. It is uncertain whether IFN is effective for MERS-CoV clearance.
Lin:What if there is an emergency for treatment?
Jiang:The ‘drug’ will be an option for treatment during an emergency, and with the permission of local health authorities and the patient’s approval, it is the final resort or combat against the disease.
Lin:In recent news report, Thailand and Germany have received their first MERS case, what’s your speculation that the MERS-CoV outbreak may be a similar situation to SARS?
Jiang:This is heavily dependent on the country’s preparation and experience in handling infectious diseases. Due to the previous SARS outbreak, China is very experienced to handle infected individuals; to quarantine and to isolate individuals, and to have access for diagnosis at the earliest instance.
Lin: And this applies to the time required for the disease to exhaust in the population?
Jiang:In dependence on the health interventions and public awareness in the country. Personal hygiene is absolutely important and the knowledge to recognizing early signs of MERS help to lower the probability of secondary infection cases.
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* On the 23rd June 2015, Samsung Hospital apologized for their negligence to quarantine one of their MERS-infected workers, and whom was permitted to continue to work in the hospital till the diagnosis was confirmed. The negligence had resulted to an escalated number of secondary infections.