Scientists across the world are mucking in to develop weapons that can fight Covid-19. Ever since SARS-CoV-2 was spotted for the first time, four months ago, researchers have been working round the clock to characterise this minute hazard whose effects are so devastating. While Covid-19 has rocked the economies and health care systems all over the world, it has been particularly lethal among one particular segment of the general population. Taking preemptive action is likely the motto most favoured by researchers today: taking action against the spread, against serious pneumonia and respiratory failure. And whenever a preemptive strike is not possible, then they speak of responding to the disease. In other words, finding a mechanism that wins time for health care providers and improves the well-being of patients.
To preempt and to react are also the two ideas that drive the twenty-something research and innovation projects aimed at preventing and treating Covid-19 that have been put forward by some of the most prestigious research centres in Catalonia and that will receive public funding from the Catalan administration. They are 19 research avenues with a common goal: to shed light on the behaviour of a virus that is still largely unknown and whose death toll has risen to over 3,000 people in Catalonia alone. The Catalan health ministry recently announced an urgent tender following the public health emergency and on Tuesday it transpired that €4m has been earmarked to the twenty initiatives, the most promising of the Catalan science eco-system. Health Minister Alba Vergés and Robert Fabregat, the General Director of R&D in Health, rolled out the projects on Tuesday during an online press conference.
Genetic influence: finding out if DNA is making some patients more prone to respiratory issues
One of the research projects will be led by Jordi Carratalà, the head of the communicable diseases department in Hospital de Bellvitge. It aims to study the genome of 60 patients in order to build the genetic profile of those who develop serious respiratory problems (ARDS or acute respiratory difficulty syndrome). “We know that some fatalities are due to the lungs’ inflammatory response, but we still don’t know why. It is a mystery”, the researcher explains, and he goes on to emphasise that age is not the only factor that results in a poor prognosis. Some younger patients have also become critically ill. The hypothesis which his project seeks to put to the test is that there may be some genetic predisposition that causes certain patients to develop major respiratory issues. This project will be carried out with the help of Catalonia’s Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and the Institut Hospital del Mar d'Investigacions Mèdiques (IMIM).
In order to test their hypothesis, they will be comparing the transcriptome —the set of all RNA molecules in one cell— of patients on the day when they are admitted to a hospital with that of they day when their condition takes a turn for the worse, usually on the seventh day after their admission. This genetic analysis will be matched against that of those patients who make a full recovery. “If a genetic factor can be proven, we will be able to spot patients at risk before their health deteriorates and provide therapy that regulates their immune response”, says Carratalà, citing Tocilizumab as an example of a drug that inhibits interleukin and appears to curb pulmonary inflammation.
The key role of primary care. Generating algorithms to classify patients
Primary health care has also secured a spot among the mighty hospital research centres thanks to Talita Duarte-Salles and Bonaventura Bolíbar, two researchers affiliated with the Institut Universitari de Recerca en Atenció Primària Jordi Gol (IDIAPJGol). Their goal is to characterise a range of Covid-19 patient profiles using the powerful clinical database that the Catalan health service has at its disposal. “Catalonia’s Public Health Service has access to the medical records of 80 per cent of the population and our software could provide key information”, says Duarte-Salles, a nurse and an epidemiologist. In fact, the records include everything from the past 14 years: diagnoses of serious and chronic illnesses, lab results, prescriptions issued and so forth.
This project will also aid in the development of predictive models of health complications. Duarte-Salles remarked that we will be able to determine risk factors for vulnerable groups whilst sorting out the individuals who will safely be able to remain at home if they become ill with only mild symptoms. “We are now beginning to see that male patients who are overweight, diabetic or have an underlying cardiovascular condition tend to require hospitalisation more often than most, for example. Furthermore, our findings will be shared with other countries such as South Korea and the US”, says the researcher. Coordinated diagnostic criteria will be jointly drafted and they will inform the policies devised to halt the pandemic.
Plasma from health care providers: a test that will keep those in the front line safer
One of the select nineteen is a project led by Josep F. Nomdedeu and Sílvia Vidal, two researchers with the Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau (IR Sant Pau). Their initiative is focused on health care professionals. They aim to build a test with synthetic proteins —like the rapid diagnostic test for antibodies— which, for want of massive testing, will allow us to find out if health care providers have been infected or not. If so, the test will measure their immune response. The survey will encourage first-line professionals from Hospital de Sant Pau to volunteer a blood sample and the test will be serologic-like: the IgM and IgG antibodies will be measured in the plasma of a body that is responding to infection.
Additionally, hospital staff who have been infected but showed no symptoms and present a very powerful immune response will be earmarked as “brilliant candidates” to donate plasma for the more critical patients. This is known as “convalescent plasma” and at present it is the only source of anti-bodies against SARS-CoV-2 that is readily available. Nomdedeu explains that in such cases they would consider donating samples to the Blood and Tissue Bank to be used with patients whose prognosis is poor as a therapy based on immunoglobulin.
Working against the clock
An expert committee made up of international advisors and officials from Catalonia’s Quality and Healthcare Assessment Agency (AQuAS) has selected the winning proposals from 42 projects submitted by the various research centres in health care that form part of the IRISCAT consortium (Instituts de Recerca i Innovació en Salut de Catalunya). The proposals were chosen for their innovation, scientific value and credible methodology, but also for the impact of their findings on public health. They include all sorts of projects: therapies with plasma and antibodies, as well as new drugs or medicines originally aimed at treating other illnesses; vaccines and preventative treatments, and genetic studies to anticipate the immune response of a patient.
The €4m was destined to fund future research projects and it has been provided by the Catalan government’s Research and Innovation in Health Care department (DGRIS). Minister Vergés explained that “[the Covid-19 crisis] means putting some projects on hold, but we cannot afford to leave future projects unfunded. Still, this is urgently needed in the fight against Covid-19 at the moment”. Her ministry is confident that patients may benefit from some of the results soon enough, certainly before the end of this year, and that they will provide new therapeutic tools to clinicians. Jordi Naval, the Director of Biocat, stated that “researchers are working against the clock to come up with vaccines, therapies and other tools to help us manage this crisis”. Both the DGRIS and Biocat will support and oversee the projects, doing technical follow-up work and coordinating the available resources by providing them with clinical samples, research models and facilities.