Antitoxin: Another Possible, Last-Ditch Way of Treating Anthrax

abcnew.com ^ | October 16, 2001 | Nicholas Regush

[gumbo]

	A series of anthrax vaccinations was given to sailors aboard aircraft carriers during the Gulf War. Could an old and discarded treatment for anthrax save lives? (Petty Officer 3rd Class Mike Larson/U.S. Navy)	Antitoxin Proposal Another Possible, Last-Ditch Way of Treating Anthrax Commentary By Nicholas Regush Oct. 16 — An old and discarded treatment for anthrax infection could be manufactured in a matter of weeks and help save many lives.

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• Another Way to Treat Anthrax

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The vaccine-like antidote is "anthrax antitoxin." It's cheap to make and can be used as an experimental treatment in addition to the use of antibiotics. The antitoxin treatment can quickly act against the infection.

As this column has pointed out, there are serious scientific questions about whether the anthrax vaccine can effectively prevent an infection in humans via the inhalation of spores. (See archive, right.) And antibiotics used after an exposure to anthrax work before symptoms appear. They are not likely to affect a toxin produced by the anthrax bacterium already working in the body and producing symptoms.

Given mounting concerns about a possible wider-scale attack with anthrax, it only makes sense to pull together whatever treatments might prove to be valuable. The science on anthrax antitoxin suggests it can be. Anthrax antitoxin stopped being used as effective antibiotics became available.

China Uses it Already

A 1999 review article on anthrax in the New England Journal of Medicine concludes that anthrax antitoxin has potential but that "unfortunately, antitoxin preparations are not currently available in the United States," Dr. Meryl Nass, associated with Parkview Hospital in Brunswick, Maine, who has testified on numerous occasions before congressional committees looking into anthrax prevention and treatment, also wrote in 1999 in the Infectious Disease Clinics of North America, that "multiple case reports as well as experimental studies have documented some benefit of this approach."

Nass told me that China uses an anthrax antitoxin, along with antibiotics, as standard treatment, and that the United States could either buy it from the Chinese or drug companies could easily start their own production.

What an Antitoxin Is

Antitoxins are typically made by injecting a toxin in increasing amounts into an animal. Horses have often been used for this purpose. The animal then produces antibodies to the toxin. These antibodies are then extracted from the animal's blood and purified. The goal in injecting the antibodies into an infected human is to have the antibodies (the antitoxin) neutralize the toxin that is damaging the individual's body. The antibody effect is temporary, but there is evidence that it works.

In the case of anthrax, it might be prudent to inject the animal with a variety of strains, which is what China has done.

This idea has been around since 1890, when Emil Adolph von Behring, a German doctor, showed that animals immune to diphtheria had antibodies to the toxin that diphtheria bacteria produce. Antitoxins began to be used four years later to treat the disease.

Here's the problem with antitoxins: It means injecting foreign animal proteins into humans. That can cause the human immune system to become hypersensitive to the antitoxin, usually several weeks after the injection. This is referred to as "serum sickness."

Side effects, lasting one to two weeks, can be numerous, including fever, muscle pain, lymph node swelling, swelling at the injection site, neurological problems, chest pain and breathing difficulties.

Nass allows that the side effects could be nasty because the anthrax antitoxin would be crude, but that in a pinch it would be better to endure them than face the possibility of death.

The antitoxin would be administered when it was likely the antibiotic treatment was too late — if, for example, someone had had symptoms and didn't initially know it was anthrax but now was in a struggle to stay alive. At that point, the antibiotic route, alone, probably wouldn't be effective.

The making of the antitoxin shouldn't be terribly complicated for a well-equipped drug company because the antibodies produced, say, in a horse, could be available in a matter of weeks.

As for approval, the Food and Drug Administration has a mandate in event of emergency to fast track a review of potential treatments. In such a case, anyone given the medication would be offered a consent form to sign.

Other Efforts

Meanwhile, there are efforts under way to produce a cleaner antidote to anthrax.

Researchers at Harvard Medical School have, for example, created a synthetic compound that attacks a lethal toxin produced by the anthrax bacterium. But since it has only been tested in rats, we'll have to wait for the results of further research.

What we obviously need is a fast-track anthrax antitoxin program to get under way and strong support for researchers hoping to eventually produce an effective and safe antidote to anthrax.

[gumbo]

China uses an anthrax antitoxin, along with antibiotics, as standard treatment, and that the United States could either buy it from the Chinese or drug companies could easily start their own production

Buy it from China? Heck no! If it's cheap and easy, let's get this rolling!

(Though serum sickness doesn't sound so hot, this has advantages over antibiotics with their propensity to create disease resistant bugs. Wonder if it's being used to treat Ernesto Blanco, the second person to contract inhalation anthrax? And if not, why not?)

[gumbo]

(Pharm-aceutical guy?) Know if any U.S. companies are interested in this?

[winna]

There appears to be a CURE for Anthrax but it hasn't been approved by the FDA or EPA. See these recent press releases for more info:

Anthrax Decontamination Letter by Dr. James Baker, Director of the Center for Biologic Nanotechnology, University of Michigan
October 11 Bio-Attack Defense Status Report NanoBio Corp.

[winna]

Instead of 'cure' I should have said that it kills Anthrax spores. Since it's also nontoxic it would be very effective treatment for Anthrax exposure if and when the FDA approves it for human use.

From the University of Michigan:

This is a valuable result, since unlike other sporicidal agents, BCTP or BCTP 401 did not demonstrate any toxic effects. Other tests, conducted by the Center, showed that these emulsions are non-toxic if administered intramuscularly, intranasally, or orally. This lack of toxicity provides other potential sites for treatment. BCTP and its derivative BCTP 401 appear to have great potential as environmental decontamination agents or for treatment of casualties in either a military biological weapon attack, or a terrorist attack. The inactivation of a broad range of pathogens, including vegetative bacteria, enveloped viruses, and bacterial spores, combined with low toxicity, seem to make it suitable for use as a general decontamination agent that can be used even before a specific pathogen is identified.

The nanoemulsions can be rapidly produced in large quantities and are stable for many months at room temperature. (Freezing causes separation of the oil and water phases.) Undiluted, they have the texture of a semi-solid cream and can be applied topically by hand. Mixed with water to dilute, they have a consistency and appearance similar to skim milk, and can be sprayed to decontaminate surfaces. The spray can potentially interact with aerosolized spores before inhalation. These properties provide a flexibility that will be useful for a broad range of decontamination applications.

[gumbo]

Could this be the milky stuff people have been posting about? As in "wispy white vapor seen over Maryland [or Texas or whatever]" -- on the hypothesis that the gov't is already test-spraying the stuff?

Sounds good, but then, it is press release by the manufacturer.

Heard that back in the '50s, a British anthrax testing ground on a Scottish island had to be decontaminated by removing huge depths of topsoil, then spraying what was left with a mixture of seawater and formaldehyde.

[winna]

Actually it is 'milky white' and conspiracy theories abound about it being tested on Americans ('chemtrails'). From what I can tell, it was developed under contract for the Defense Advanced Research Project Agency (DARPA). Here's some info about it from them:

http://www.darpa.mil/darpatech99/presentations/dsopdf/dsobwd1.pdf (PDF file, 1.37MB, see page 9)
http://www.darpa.mil/darpatech99/presentations/scripts/dso/dsobwd1script.txt (text file)
http://www.defenselink.mil/news/radio/Jan2000/20000119-1.ram (RealAudio newscast about DARPA's BWD program, Jan 2000)

[winna]

Oops, forgot to mention in that 2nd link (the text file) it's referred to under item #9 as "novasomes":

9. DARPA has a small, but growing effort in decontamination. One of our first projects in this area involves “Novasomes” developed at the University of Michigan. Novasomes are a nanomolecular formulation of lipid and detergent. The formulations are nontoxic to us, but rapidly kill a wide range of gram positive bacteria and envelope viruses. The results here show killing of anthrax spores.

[Pharmboy]

You are a smart one, you are. Only a few have figured this out. I will check this out and get back to you.

Best,
Pharmboy