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 Institute.
"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 organisms.
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 said.
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," he said.