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Stanford Doctor Discusses New Coronavirus Trial

(May 12, 2020) Dr. Prasanna Jagannathan talks with Raj Mathai of NBC Bay Area about the trial and the treatment.

 


Stanford Medicine Press

Stanford Medicine researchers lead clinical trial of interferon-lambda for COVID-19

Scientists at Stanford Medicine are investigating whether a molecule called interferon-lambda can help people with mild cases of COVID-19 feel better and reduce their transmission of the disease-causing virus.

MAY 11 2020 | By BRUCE GOLDMAN

clinical trial

Valerie McCarthy is examined by Hector Bonilla, MD. McCarthy is participating in a clinical trial to determine whether a molecule called interferon-lambda can help people with mild cases of COVID-19 feel better and reduce their transmission of the disease-causing virus.

A clinical trial is underway at Stanford Medicine to determine whether a drug can keep people who’ve just tested positive for the coronavirus out of the hospital, help them recover faster and make them safer to be around in the meantime.  

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The researchers also want to know whether the drug stems viral shedding, which would reduce transmission to family members and the community.

The drug being looked at, interferon-lambda, is a manufactured form of a naturally occurring protein that’s been given in previous clinical trials to more than 3,000 people infected with hepatitis viruses.

“Its safety profile appears to be excellent,” said principal investigator Prasanna Jagannathan, MD, assistant professor of infectious diseases at the School of Medicine. He is co-leading the study with Upinder Singh, MD, professor of infectious diseases and of microbiology and immunology at the school.

Results in laboratory settings and in animals also suggest that lambda-interferon may be helpful in controlling viruses that cause respiratory illnesses such as influenza and SARS, an often fatal disease. It may also help snuff out other common viral infections. 

Remdesivir, approved by the Food and Drug Administration for emergency use as a COVID-19 treatment, is restricted to hospitalized patients. Yet the great majority of patients with the disease — upward of 80% — are outpatients, for whom no drugs have been proven safe and effective, Singh said. 

Interferon-lambda orchestrates the body’s natural defenses against infection by issuing a “call in the troops” order to constituent cells of the immune system. A closely related substance, alpha-interferon, has been used to treat hepatitis C and other viral infections, as well as cancer. But that substance has been found to be toxic to numerous organ systems. Receptors for it are present on the cells of many tissues. Receptors for interferon-lambda, however, are restricted to the linings of the lungs, intestine and liver, so it produces fewer side effects. The lungs and intestine happen to be the main places the coronavirus strikes.

The investigators are recruiting 120 participants who have just been diagnosed with cases of mild COVID-19 at Stanford Health Care and other local hospitals, emergency rooms, clinics and drive-through testing sites.

Trial participants, randomly sorted into two groups, will be given single injections under the skin of either a placebo or interferon-lambda. Then they will be monitored for 28 days for symptoms, disease severity, rates of hospitalization, and duration and quantity of viral shedding. 

“Even though these individuals may not need hospitalization, infection with COVID-19 results in respiratory symptoms and lost productivity,” Singh said. “Plus — and this is important — patients with mild disease contribute to community disease transmission. Limiting viral shedding from this group would reduce transmission to family members and others, which is crucial to controlling epidemic disease spread.”

Faculty in the departments of Medicine, of Pathology, of Pediatrics and of Emergency Medicine, and at the ChEM-H Institute, are contributing to the trial. 

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Rosenkranz Prize winner hopes to develop malaria vaccine for pregnant women

Prasanna Jagannathan said the $100,000 prize will allow his lab team to ramp up their research in Uganda.

AUG 1 2018 | By BETH DUFF-BROWN

Prasanna Jagannathan and Ricardo Rosenkranz

Prasanna Jagannathan (left) received the 2018 Rosenkranz Prize, which he hopes to use to develop a malaria vaccine for pregnant women. The prize was established by Ricardo Rosenkranz (right) and his family in honor of the late chemist George Rosenkranz.

Malaria claims nearly a half-million lives worldwide each year, yet scientists still know little about the immunology of the disease that has plagued humanity for thousands of years.

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There were 216 million cases in 2016, according to the World Health Organization. Sub-Saharan Africa carries 80 percent of the global burden of this mosquito-borne infectious disease, which devastates families, disrupts education and promotes the cycle of poverty.

It is particularly brutal to pregnant women, who are three times more likely to suffer from a severe form of the disease, leading to lower birthweight among their children and higher rates of miscarriage, premature birth and stillbirth.

“Pregnant women and their unborn children are more susceptible to the adverse consequences of malaria, so we are working to investigate new strategies and even lay the foundation for a vaccine to prevent malaria in pregnancy,” said Prasanna Jagannathan, MD, an assistant professor of medicine and this year’s recipient of the Dr. George Rosenkranz Prize for Health Care Research in Developing Countries.

The Freeman Spogli Institute for International Studies and Stanford Health Policy give the $100,000 prize each year to a young Stanford researcher who is trying to improve health care in underserved countries. It was established in 2009 by the family of George Rosenkranz, PhD, a chemist who first synthesized cortisone in 1951, and later progesterone, the active ingredient in birth control pills.

Jagannathan, an infectious disease specialist who is also a member of Stanford’s Child Health Research Institute, said the prize will allow his lab members to ramp up their research in Uganda. His team is particularly interested in how strategies that prevent malaria might actually alter the development of natural immunity to malaria.

“With support from the Rosenkranz Prize, we hope to identify maternal immune characteristics and immunologic targets that are associated with protection of malaria in pregnancy and infancy,” Jagannathan said.

Goal: Vaccine for pregnant women

Jagannathan and his collaborators at the University of California-San Francisco and in Uganda are currently conducting a randomized controlled trial of 782 Ugandan women who are receiving intermittent preventive treatment with a fixed dose of dihydroartemisinin-piperaquine, or IPTp-DP, a medication that has dramatically reduced the risk of maternal parasitemia, anemia and placental malaria. Their preliminary data suggests that among 684 infants born to these women, maternal receipt of IPTp-DP may lead to a reduced incidence of malaria in the first year of life.

“Having the discretionary support of the Rosenkranz Prize will allow us to generate some preliminary ideas from this trial that could lead to larger studies to push this agenda further along,” Jagannathan said.

That agenda is to create a vaccine that prevents malaria in pregnant women and by extension, their infants, giving them a better start in life.

 

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