One of the most popular sessions of the week was a hot topic discussion around COVID-19 antibodies. Here we explore some of the key themes that came from the panel featuring:
The hot topic discussion was a fascinating discussion among the specialists on the front of COVID-19 antibody research. Prof Deane opened the discussion by highlighting that most of the innovation grants awarded for COVID-19 antibody research in the UK study the antibody response to vaccine administration. She emphasised that antibody therapeutics remain the least explored area of research despite the need of 'a combination of vaccine and antibody therapeutics' for overcoming COVID-19. Prof Deane and Prof Burton agreed that antibody therapeutics is so far the least popular treatment in clinical trials, discussing the reports of doctors about low efficiency. Dr Jardine protested saying that 'convalescent trials rarely looked at people with bad outcomes', because 'in general, you tend to look at people who do better' that could have led to the reporting of negative outcomes in patients. Dr Sok agreed in the debate that there 'has not been any indication that the antibodies could be linked to enhanced respiratory disease'. There was a technical discussion on Fc receptor binding knockout design and whether this could resolve the safety concerns.
Dr Jardine then discussed 'what will happen in the next 6 months' of COVID-19 therapeutics research. He outlined that any future strategies will depend on the outcomes of the major vaccine trials, highlighting that evidence for 'passive antibody transfer having a positive effect'. Dr Jardine discussed the prospects of monoclonal antibodies, saying 'there is good evidence it will work', even though the antibodies would have to be administered multiple times. Dr Sok agreed, 'he thinks antibodies will be needed' regardless of whether a vaccine will be successful. Prof Deane brought a good point, saying that antibodies will be needed in parallel to vaccine approaches, because vaccines would have to be administered to the majority of the population for the approach to work. Prof Burton pointed at the expenses of antibody manufacturing, posing a question of 'what is feasible'. Dr Jardine contributed to the discussion highlighting that the global efforts to make treatment more accessible could solve the universal problem of scalability of any monoclonal antibody therapeutics. Dr Sok agreed that the global use of an antibody therapeutic would be unprecedented, putting pressure on making the antibody accessible and feasible. His opinion was that having multiple companies will be very important to meet the global demand and to bring the cost of antibody therapeutics down. Dr Sok pointed out that the susceptibility of the elderly and immunocompromised people would make them the best candidates for prophylaxis treatment.
Prof Burton asked the panel 'how far should we go in the engineering of the antibodies?' Dr Jardine responded that the major advantage of engineering antibodies would be that they would be able to cover different mutations of the virus. There was then a discussion of various technical aspects of antibody engineering, that could aid the overall design. Questions from the audience highlighted several other potential issues with antibodies, for example how much the host immune response could contribute to a response to the virus in parallel to antibodies, whether antibodies could enhance or also inhibit host's immune response and questions about the overall safety of monoclonal antibodies.
