A look back at the pre-antibiotic era may uncover ways to deal
with immunosuppression and drug resistance in today's patients,
Dr. Matthew Scharff said at a recent talk sponsored by the Irvington
"If you have a historical bent, you think about the time
where there were no antibiotics," said Dr. Scharff, director
of the Cancer Center, Albert Einstein College of Medicine, New
York. "Virtually the only intervention that physicians had
when someone had an infection was to administer antibodies, and
the treatment worked."
Spurred by the example of early passive antibody treatment, researchers
at Einstein under Dr. Arturo Casadevall are trying to make monoclonal
antibodies that will protect patients from infection with Cryptococcus
neoformans (see box), Dr. Scharff said. The antibodies seem
to be protective in mouse studies, and he hopes that clinical
trials will be possible in the future.
The research at Einstein is a new chapter in an old story that
began in the early 1900s, Dr. Scharff said, when investigators
immunized horses to make antibodies to pneumococcal and meningococcal
With pneumococcus, the serum from the immunized horse was mixed
with the organism and injected into a mouse. If the mouse survived,
the antiserum was deemed protective. With meningococcus, the antiserum
was mixed with the bacteria and injected into the cerebrospinal
fluid of a monkey via a lumbar puncture, sending it to the brain.
If the monkey did not develop meningitis, the antiserum was thought
to be protective and could be used on human patients.
Data from the 1920s showed that such treatments were successful
in both diseases. Among pneumococcal pneumonia patients studied,
those who had not received antibodies had a 30% mortality, compared
with 18% of those treated with antibodies. The survival rate was
even higher among those who had earlier interventions, Dr. Scharff
Meningococcal meningitis patients had a 70% to 80% mortality if
not treated with antibodies. The rate fell to 30% among the treated.
"There was no doubt that the antiserum saved lives,"