Research with highly pathogenic infectious agents is limited to the very few laboratories worldwide with the required biosafety levels (level 4), none of which are found in Spain. “Greater investment in such facilities is required in order to be able to adequately respond to threats that will almost certainly appear in the future”, noted Rafael Delgado, a microbiologist from the Hospital Universitario 12 de Octubre Research Institute, during his presentation as part of the scientific seminar organised today by the Biomedical Research Institute (IBI) in the framework of the BIOCAPS project.
Experts in various infectious diseases met today in the AFundación building in Vigo to discuss the latest progress related to the prevention, diagnosis, treatment and development of vaccines against infectious diseases, with a special emphasis on recent events.
This is the case of Ebola, for example, the virus for which was responsible for the latest pandemic risk only a few months previously. With regard to this outbreak, which kept the whole world on tenterhooks, Rafael Delgado stated that it was “somewhat of a surprise, but an expected surprise” as epidemiological monitoring mechanisms are insufficient in an increasingly connected context and the operational capacity of international organisations is very limited when it comes to providing a fast and effective response to problems of this type.
Delgado ascribed the Ebola crisis to the delay in identifying the virus as the outbreak started in a region of western Africa that had not been affected by previous outbreaks. In the four months that it took to confirm the cause, the epidemic had already reached the urban centres of three countries, which were soon followed by others.
Although specific funds have not been activated in Spain, the efforts of various countries that are highly active in this type of research, such as the USA and Germany, and the launch of extraordinary calls for funding by the European Union, have allowed groups such as that headed by Delgado to shorten the path to effective treatments and vaccines that were previously unavailable. “Our group studies infection of the virus in dendritic cells (leukocytes that play an important role in the immune system), which are thought to be key to onset of the disease. Together with other researchers, we have developed strategies to prevent the virus from entering these cells and thereby altering the immune responsiveness of the person concerned”, he explained.
Another infectious disease that has become the focus of public attention over the past few months is hepatitis C, which affects between 2% and 4% of the Spanish population. Zoe Mariño, from the University of Barcelona, notes that its treatment is “cost-effective for all healthcare systems” as eradication of the virus slows progress of the liver disease and reduces the risk of cirrhosis and its complications, such as liver cancer, and the need for a transplant, all of which generate high healthcare costs.
Up to a year ago subcutaneous interferon formed part of all treatment guidelines for this disease despite its numerous side-effects and contraindications in a large number of patients. The development of new oral antiviral drugs has represented a revolution in terms of efficacy, safety and tolerability due to their minimal side-effects and the fact that the duration of treatment is much shorter (between three and six months instead of one year).
There are currently six new-generation drugs on the market, with others expected to be authorised towards the end of this year. “All these drugs have been authorised in Europe after clinical trials in patients with hepatitis C in which we have played an active role. The trials currently underway are intended to evaluate new formulas or to study administration in patients with particularly complex characteristics, such as paediatric patients, transplant recipients and those undergoing dialysis”, explains Mariño.
Vaccine against tuberculosis
Rajko Reljic, from the St George's University of London, coordinates the international project to design an effective vaccine against tuberculosis in which scientists from the IBI who form part of the BIOCAPS project play a key role, namely the search for biomarkers that correlate with the protective immune response against the pathogen that causes this disease. “Their findings will allow us to find new candidates for the development of a vaccine”, he stated.
Reljic went on to explain that one of the major challenges faced by scientists in the field of tuberculosis is related to its complexity and antiquity as this disease has affected humanity since the dawn of time. “The bacterium has had time to adapt to our immune system and learn how to evade it. One of the tricks it uses is to remain latent, and our inability to combat it during this phase is the main reason for failure of the current vaccine”. The vaccine on which Reljic is working in collaboration with the University of Vigo aims to eliminate the disease from the lungs at an early stage before the bacterium becomes established.
Infections associated with orthopaedic implants are another major worry of the medical community due to the increasing use of such devices, especially as it has been estimated that more than three million knee and hip prostheses will be implanted annually in the USA by 2050. In light of this, the percentage of patients with an infection, which ranges between 1% and 3% for joint prostheses, will mean millions of patients worldwide.
Jaime Esteban, from the Hospital Universitario Fundación Jiménez Díaz, considers that biomaterials are currently essential for all types of surgery and that “industrialisation of the processes, which are currently artisanal, will reduce costs, especially due to the lower costs resulting from treating infections”. This microbiologist considers that the main scientific challenges in this field include “designing smart materials which, in addition to decreasing the risk of infection, are able to act against any infections that may appear even before the symptoms become evident”.