Chapter 147
Defeating Infectious Agents — 11
By selecting very high-risk individuals without prior Epstein-Barr infection for an MS vaccine program, we should be able to determine how early in a person’s life we might be able to prevent this disease. A parallel approach could also someday be applied to Epstein-Barr-related cancers. To date, the vaccines are not completely blocking Epstein-Barr infections but instead are blocking the ability of the virus to set up camp in B cells. Totally blocking these infections may yield higher efficacy against MS and related cancers.
Additional benefits to such a vaccine seem likely to accrue for other autoimmune diseases such as lupus and rheumatoid arthritis. The body of evidence that has accumulated for Epstein-Barr as the root cause of MS has transformed our approach, and perhaps we’ll see a success story like HPV and cervical cancer in the years ahead.
The remarkable progress in our efforts to defeat infectious diseases goes beyond vaccines. Measles, which can be fatal in children, with increasingly occurring outbreaks because of lapses of vaccination, has never had a specific treatment. But a discovery of a potent neutralizing antibody against this virus’s ability to get into cells, and potentially other related viruses, is a major step forward. Likewise, prion diseases, such as Creutzfeldt-Jakob disease, which stem from transmissible misfolded proteins, are rare, fatal, devastating neurodegenerative conditions without any effective treatment. An epigenetic editor that induces programmable methylation was able to durably silence expression of prion proteins by more than 80 percent across the entire brain in the mouse model. No less switch itself off once the gene silencing work was done. This innovative work can be seen as encouraging for a set of previously imponderable diseases.
ANTIMICROBIAL RESISTANCE
Microbial resistance to antibiotics now appears to be as big a global health problem as HIV and malaria. Estimates for annual deaths from this resistance exceed five million. This global health emergency is at least in part an outgrowth of our mass overuse of antibiotics in people and animals. The seven leading bacterial pathogen–resistant killers are Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. The climate change crisis, with its spread of drug-resistant infections, and the pervasive presence of microplastics, which provide residence for viruses that help spread antibiotic resistance genes, are making this situation even more desperate. Unfortunately, owing to lack of financial incentives, the pharmaceutical industry has largely abandoned discovery and development of new antibiotics to override resistance of the most worrisome pathogens. The last entirely new structural class of antibiotics was discovered in the 1980s. Although about 180 countries have developed national action plans to address antibiotic resistance, which includes routine surveillance measures of sampling the environment, wastewater, the food chain, and human and animal populations, fewer than forty have funded or implemented them. The AMR Action fund was established as a private-public partnership with twenty-four companies chipping in $1 billion to bring two to four new antibiotics to market by 2030.