Coronavirus disease (COVID-19) or (SARS-CoV-2) is a newly discovered infectious disease caused by Coronavirus that has been spread across 213 countries. Since then, it has infected over 2.3 million people, caused 157,000 deaths worldwide and is still spreading. There is no standard treatment protocol for the disease yet and hence a vaccine should be developed as soon as possible. Patients are only given symptomatic relief. Cancer immunologists can play a crucial role in developing the vaccine and the strategies they employ to develop a vaccine would be based on the focus of the given scientist’s work.
1.What is Coronavirus and why are people afraid of this?
Coronaviruses are RNA viruses that have crown-like spikes on their surface which were first identified in the mid-1960s. It has four main sub-groups which include Alpha, Beta, Gamma and Delta. The common human Coronaviruses include 229E, NL63, OC43, HKU1, MERS-Cove, SARS-CoV, SARS-Cov-2 (Novel coronavirus that causes Coronavirus disease 2019). It spreads through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose. Its symptoms include cough, fever, dyspnoea, muscle aches, sore throat, unexplained loss of taste or smell, diarrhoea and headache. The risk factors for getting infected by Coronavirus include Chronic lung disease or moderate to severe asthma, heart condition, immunocompromised states, Obesity, CLD, CKD and DM. It causes death by various conditions such as Acute Respiratory Failure, Pneumonia, Acute Respiratory Distress Syndrome, Acute Liver Injury, Acute Cardiac injury, Acute Kidney Injury, Septic Shock, Disseminated intravascular coagulation and Rhabdomyolysis.
2.Who are Cancer Immunologists?
Cancer immunologists are concerned with understanding the role of the immune system in the progression and development of cancer, the most well-known application is Cancer immunotherapy, which utilizes the immune system as a treatment for cancer. When it comes to infectious diseases, they work by hypothesizing the virus that stimulates the key elements of the immune system that could cause an over ambitious immune response causing fulminant multi-organ failure. In early phases of infection, complications are caused even before the virus gets eliminated from the body. Thus, cancer oncologists play a major role in altering the person’s immune response towards a pathogen by either suppressing or stimulating the immune system.
3.How are Cancer Immunologists working to develop a vaccine against COVID-19?
Vaccines typically should work by mimicking the pathogen and by causing no harm to human cells. It should generate antigens which stimulate the immune system to release antibodies and T-Cell responses. T-Cells eliminate the spread of virus to other cells by recognizing the infected cells. To develop a vaccine, the sequence of the virus should be known and there has been no vaccines for RNA virus developed till date. Since the immunologists have started trails on them, they have the experience of reviewing clinical trials, and in the manufacture of the vaccines. This can be done by reverse genetic engineering of the virus, isolating various pieces and to study whether human serum or T cells can eventually recognize parts of the virus. After identifying the most antigenic and immunogenic part of the virus, they must be inserted to a carrier which can be artificial such as a non-carrier.
COVID19 patients are seen to have increased levels of Cytokines which is like that of Cytokine Release Syndrome. When the immune system is stimulated there may be a chance of a CRS, which is due to the release of Cytokines. This is characterized by damage to tissues, organ failure and sometimes death. This is first observed in Cancer patients who have graft rejections to Bone Marrow Transplantation and then in patients receiving immunotherapy named CAR T Therapy. Oncologists have identified that blocking IL-6 Pathways can bring Cytokines level under control. Furthermore, cancer immunologists are conducting trials on the drug Sarilumab which blocks IL-6 so that it can be treated in patients with severe COVID-19. Testing is now done with a modified fusion version of CD24 to alter inflammatory signalling against COVID-19.
Cell-based therapeutic vaccines are another option that involves injecting patients with artificially engineered dendritic cells which present targets to T-Cells as well as to stimulate T cell proliferation and activity. Some think that T-cells alone are not responsible for Lung damage. It is the macrophages which cause inflammation in the lungs. Antimalarials like Hydroychloroquine and Chloroquine are now used in patients with COVID-19 as they inhibit the inflammatory cytokines by presenting the macrophages and antigen presenting cells. But these drugs lack specificity and may inhibit biological functions which provide immunity. In cancer patients receiving T-cell immunity with T-cell checkpoint blockers, it can cause Pneumonitis which is like that of Pneumonitis seen in COVID-19 patients. However, the types of lung damage seen in both differ and the same treatment cannot be given. The checkpoint blockage in Cancer Pneumonitis may respond to Anti-TNF, whereas Pneumonitis by COVID-19 does not respond to it. Analysis of T cell and Ab response with respect to viral clearance is done. This plays an important role in providing different opportunities to develop treatments.
Antibodies which suppress the inflammation with specificity are considered the best option. One approach by Cancer immunologists in New York City is by utilizing inactivated convalescent plasma which involves taking the blood of patients who recovered from the infection. The main idea behind this is to use the antibodies that these patients have developed against COVID-19. This approach is used at Mount Sinai hospital for patients with moderate COVID-19 who had trouble breathing.
Also, identification of new therapeutic targets in cancer patients can help as genetic drivers of immune response in COVID-19 infected patients. Since cancer patients and immunocompromised states are at higher risk for infection, cancer immunologists are now developing cancer treatments that enhance the immune system which reduces the incidence of cases in people who are more vulnerable to infection.
Since no standard treatment and vaccines are not developed yet, we must follow some preventive measures suggested by WHO because SARS-CoV-2 is known to be different from other viruses. As prevention is better than cure, let us protect ourselves and the people around us by knowing the facts and by taking appropriate measures to stop the spread of the virus.