COVID-19: Immune profiling for development of therapies could be a game changer

By Arti Dumbrepatil 

New Delhi: As the world battles the Coronavirus pandemic, it is important to think about developing innovative ways to combat diseases. To be able to navigate through such unprecedented times, throughout the last decade scientists around the world either at different academic institutions or major pharmaceutical companies have been looking at the immune system for answers.

While current therapies offer promise to previously untreatable diseases, there is a recognition that the field of immunology intersects with and will open new treatment avenues in many different therapeutic areas. Drug discovery in these new treatment areas requires an expert understanding of not only the extensive pathways involved in the immune response but also the complex mechanisms that activate and regulate those pathways. For decades the field of immunology was a black box. In 1983, HIV (Human Immunodeficiency Virus) outbreak changed that. The hunt for a cure since then has led to a better and more comprehensive understanding of the immune system. The question in front of us now is, “ Will the outbreak of Coronavirus in 2020 alter the course of drug discovery and development?”

The immune system is involved in almost every disease, at one level or another. The immune system employs special cells, proteins, tissues, and organs to defend people against the vast array of germs and invaders. With the recent advances in our understanding of the immune system and its complex signaling pathways, the field of immunology and pharmacology are amid another surge of scientific growth. Recently in 2018 GlaxoSmithKline (GSK) announced that “ The company is new approach was dedicated on identifying new medicines by focusing on ways to modulate the immune system”. GSK aims to achieve this by utilizing the vast amounts of human genetic data generated as well as by analyzing this complex data with machine learning. However, at this point, it is critical to point out that several other pharma giants have been looking at the immune system as an unexplored field for drug and vaccine development against the unknown pathogens. Bristol-Myers Squibb, Merck, AstraZeneca, and Roche have been working towards harnessing the power of the immune system for their targets for a while now. The most successful and well-known implementation of the immune system in the form of immunotherapy or biologic therapy is a cancer treatment that boosts the body’s natural defenses to fight cancer. In brief, it uses substances made by our body or in a laboratory to improve or restore the immune system functions. There are several types of immunotherapies, including monoclonal antibodies and tumor-agnostic therapies, oncolytic virus therapy, T-cell therapy, Cancer vaccines. The most sort after targets by the pharma companies in this field has been the “ checkpoint inhibitors”, which act by blocking “checkpoint molecules” from interacting with immune cells. Checkpoint inhibitor drugs, such as KEYTRUDA and Opdivo, have shown success in treating “hot tumors”, including melanoma, non-small cell lung cancer, and head and neck cancer.  Apart from checkpoint inhibitors, the most exciting area of immunotherapy has been a pioneering treatment known as chimeric antigen receptor therapy or Car-T. The process involves extracting a patient’s blood cells, re-engineering them in a laboratory with the aim that they can identify and destroy cancer cells, and then re-inserting them into the patient’s body. Two Versions of Car-T, made by Gilead and Novartis, are on the market after trials of the treatments showed that they could extend the lives of even the sickest blood cancer patients.

Fields of Opportunity

There is an intimate connection between the human gut, inflammation, and the immune system. Two autoimmune diseases of the gut, Crohn’s disease, and ulcerative colitis, collectively called inflammatory bowel disease (IBD), are one of the next frontiers for immune profiling. Also, immune cells in the brain and the central nervous system (CNS) are studies actively for their role in neurodegenerative diseases. On the other hand, vaccines are one of the most well-known and oldest ways in medicine harnessing the immune system to help people stay healthy. Many companies are actively working towards synthetically engineering antibodies to manipulate the body’s immune system to achieve a desired therapeutic goal. The need for the hour is the development of universal vaccines, for example, Universal Flu Vaccine, a vaccine that provides robust, long-lasting protection against multiple subtypes of flu. Active research and development by key players and small organizations are expected to boost the growth of the immune-oncology drugs market. According to a report in 2018 by the International Agency for Research on Cancer, there would be ~18.1 million new cancer cases worldwide. Key players in the market are actively investing in research and development through various collaborations and individual research studies.

Tapping on the innovative immunotherapy potential

There is a growing urge that the Indian pharma giants need to shift focus from generic drugs to specialty drugs. Recent progress in biological therapies has widened the scale of therapeutic targets for the treatment of various diseases. Multiple newsletters from the Indian Drug Manufacturers Association (IDMA) have often stated that Indian drug majors need to design their strategy on the likes of the big multinationals like Glaxo, Merck, and Pfizer who are co-developing and co-commercializing new immunotherapy candidates with the intent on boosting their oncology pipelines. Although there are global guidelines for the management of cancer, especially head and neck cancer, India with its huge burden of cancer cases has several demographic and genetic peculiarities, which require focus and specific therapeutic guidelines. With recent advances in genome sequencing and data availability, it is high time that the Indian drug majors focus on tapping the vast potential of the innovative immune profiling field for the development of novel therapies.

About Author: Arti Dumbrepatil is a freelance science writer. She worked previously at the University of Michigan, Ann Arbor, MI, USA, as a postdoctoral researcher for biological chemistry. She is the lead author in several peer-reviewed scientific journals such as the Journal of Biological Chemistry, Proteins, and Applied and Environmental Microbiology. As a Science Writer, her writings have covered various topics from Nanorobots to Virology. Arti continues to write as a contributing author to Microbiome Digest, American Society for Biochemistry and Molecular Biology (ASBMB).