Preventing infections in our frontline health care workers
With no vaccine and no preventative medical intervention anywhere close to providing protection for our health care workers, we need to consider alternatives. The BRACE Trial is testing a BCG vaccine used for tuberculosis that has effects on the immune system which provide protection against a diverse range of pathogens, including viral infections. It is not a vaccine specific to Coronavirus rather a vehicle to reduce severity of the virus and keep our health care workers safer, faster. 4000 front line health care workers in our hospitals will take part in this trial that is being run in collaboration with the Murdoch Children’s Research Institute, and generously supported by the Minderoo Foundation.
Stopping transmission of the virus from proven cases to their contacts
People infected with coronavirus (SARS-CoV-2) have been known to shed virus and be contagious for up to 5 days prior to developing symptoms. This is likely to be a major driver of the rapidly expanding pandemic. This trial focusses on containing the virus by administering a type of interferon to positive cases and their contacts to reduce viral transmissions, particularly from those with no symptoms. We have just completed an exploratory study of interferon in Wuhan, Hubei Province, China (the original epicentre of the current pandemic). Our results indicate that IFN therapy hastened time to clearance of virus in upper airway secretions by a mean of 7 days. Since pre-symptomatic shedding of virus can start up to 5 days prior to symptom onset, our approach of a post exposure intervention to all contacts recently exposed to a case could possibly entirely interrupt the spread of the virus and with that the pandemic. The CoCo Study (Containing Coronavirus) has been made possible through a $2.665 million donation from BHP’s Vital Resources Fund.
Although current public health measures such including quarantine, social distancing, and isolation of infected individuals are proving effective in slowing the infection rate of the COVID-19 disease causing virus, there is still confusion over the effectiveness of other measures such as perceived protective benefits of wearing face masks. There is the assumption that any type of face mask offers protection, however this is not true. At a time where their supply has become extremely limited even to frontline healthcare professionals, and the emergence of ‘home made’ and ‘fashion’ masks have become commonplace, in partnership with our colleagues at Curtin University we are studying all the types of masks available and which may offer protection against infection and also those that stop viral transmission.
In a world first clinical trial, children across Australia and New Zealand who are really sick in hospital with COVID-19 will be randomised to receive either hydroxychloroquine (an anti-malaria drug) or standard care to see if this will help reduce their need for oxygen support and prevent further complications. This proposed trial is led by researchers at MCRI with collaboration across many of the children's hospitals in Australia and New Zealand, including Telethon Kids.
Researchers from Telethon Kids have instigated an international study to test the capacity of a therapeutic agent (OM85BV) to enhance the capacity of the immune system to control the severe inflammation that accompanies Coronavirus infection in susceptible individuals. This parallels their ongoing studies on the use of OM85BV to boost mechanisms that normally regulate the intensity of inflammatory responses in the lung via a process known as “immune training”. They have previously shown that this agent is highly effective in reducing the severity of lung inflammation in both human clinical and experimental respiratory infection settings, and have made major progress in defining its mechanism-of-action. The team will analyse the mechanism-of-action of OM85BV treatment in relation to inflammatory responses triggered by Coronavirus infection.
The proposed trials will be undertaken with clinical collaborators from Queensland (Brisbane), London, Buenos Aires in Argentina, and Puerto Allegre in Brazil.
Although SARS-CoV-2 infection appears to occur in both genders and across all ages (6 weeks - 101 years), there is emerging data to suggest that certain groups of individuals such as those with existing lung conditions may be more susceptible to the effects of infection. Little is known about these ‘at risk’ populations and which treatment strategies may prevent the severe lung damage that COVID-19 causes in these people. In this project we will identify who in the community is ‘at risk’ to the effects of this infection. We will then screen over 30 commercially available and safe medicines that we predict will reduce the harmful effects of infection, and conduct a clinical trial on the most effective medicine.
In ongoing studies investigating how to use the immune system to fight paediatric cancer, we identified a drug that improves the activity of immune cells against cancer cells. Virus-infected cells and cancer cells are very similar, in the sense that they are the body’s own cells but with very small modifications on their surface, allowing them to be attacked by the immune system. For that reason, we think this drug could potentially be useful in the context of treating severe viral pneumonia, which is the main cause of hospitalisation and death in patients with COVID-19. In this pilot project, we will test whether this drug is effective in a laboratory model of viral pneumonia.
The immunomodulating agent OM-85 has been shown to reduce respiratory viral infections in children and adults by enhancing protective immune system responses. COMIT is a randomised controlled trial to determine whether OM-85 reduces transmission and severity of SARS-CoV-2 infection within families. The study can also establish the immune system responses by which OM-85 produces positive results. If OM-85 does benefit COVID-19, it can be safely and immediately used in clinical practice.