Is the first cure for advanced rabies near?

https://medicalxpress.com/news/2023-09-advanced-rabies.html

by PaulHoule • 3 years ago

75 56 3 years ago

graeme3• 3 years ago

Given that the symptomatic rabies leads to death in 100% of cases currently, wouldn’t it make sense to try a version of this in those few cases when someone in North America does get rabies?

They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work)

marcodiego• 3 years ago

rabies leads to death in 100%

That is not true anymore. There are two known protocols with a small chance of working but which have already saved about a few dozen lives. They are called "the Milwaukee protocol" and "the Recife protocol" after the cities they were developed.

drunkendog2• 3 years ago

Not sure about the Recife protocol, but it's pretty much accepted now that the Milwaukee protocol doesn't work[1][2] - the initial case may have been some other encephalitis mimicking rabies.

[1] https://journals.lww.com/pidj/fulltext/2015/06000/the__milwa...

[2] https://www.cambridge.org/core/journals/canadian-journal-of-...

littlestymaar6• 3 years ago

They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work)

It worked for the first patient on which it's been tried though! Which is still an objective win even if it wasn't particularly successful afterwards.

drunkendog2• 3 years ago

The first patient might not actually have had rabies.

ryeights• 3 years ago

(and in fact didn’t work)

This review [1] cites 11 documented survival outcomes of the Milwaukee and related Recife protocols. Is there a basis to your claim?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670764/

jjtheblunt• 3 years ago

towards the end of the article, they say it makes sense to test in India because they get large numbers of advanced rabies cases whereas north america supposedly gets zero.

graeme3• 3 years ago

Yes. My point was it sounds like we’ll delay it for years for testing.

But 59,000 people die of rabies each year and each case is almost certainly fatal.

So it seems we should speed up distributing this. If rabies patients start surviving then we know it works.

At that point we can test exactly how much it works. But meanwhile why wait?

anon291• 3 years ago

The Milwaukee protocol is not particularly good. It has a low survival rate.

However considering the normal survival rate is zero... It's a lot better

I mean.. you can't say it doesn't work if it led to the first ever documented case of rabies survival. That's amazing.

karaterobot• 3 years ago

Once again, every single comment is picking apart the least important aspect of a comment. Though it works a small percentage of the time or not, the Milwaukee protocol is evidently not nearly effective enough, thus necessitating this research into a cure.

Your question stands: why not test it? There's precedent for testing unproven drugs on humans in extremis, so it's not that.

As a halfhearted stab in the direction of an answer: I assume they will try it in human rabies victims in a later phase, they're just testing it in mice first.

bsder2• 3 years ago

Your question stands: why not test it?

Because there are so few late stage rabies victims that you simply can't get the data?

By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works.

Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/...

Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.

graeme3• 3 years ago

I might have been unclear: the Milwaukee protocol was not effective.

My point was, normal medical ethics seem to go out the window here. With most interventions, you can harm the patient, so you had best not give them anything until you test it.

But a symptomatic rabies patient is default dead. Given these results, it strikes me that we ought to move much faster through our usual phases and make it available for immediate use in centres which are symptomatic rabies patients.

If any of those patients start surviving, the drug has proven itself for general use and stats can be gathered. The control group is every prior symptomatic rabies patient: they all died.

The article made it sound like this will be something rolled out over several years. If that, as investment is required.

An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. My question is should we not make this available immediately and see what happens?

It isn’t like heart disease where the patient will often live many years and so a new treatment must prove itself. Literally everyone dies of rabies if symptomatic.

kirdiekirdie• 3 years ago

It would suck to be included in the trial and then be randomly selected into the placebo group.

littlestymaar6• 3 years ago

I know you're joking but I still want to say you don't need a placebo group for a disease with 100% fatality rate.

greggsy• 3 years ago

I suspected the same, but I don’t know enough about controls for extremely small test groups.

MarioPython• 3 years ago

Honest question, would this really need a control goup given that 100% people die of it? What would the control group prevent or provide?

fatfingerd• 3 years ago

I don't remember the beginning premise of Shaun of the Dead, but rabid positive thinkers reentering society sounds about right.

jncfhnb2• 3 years ago

No it would not be necessary. A control group would give you confidence that it wasn’t some other aspect of the experiment that resulted in people surviving. But we have strong enough priors on rabies that we should feel confident the probability of accidentally curing rabies with a different aspect of the experiment is extremely small.

gotstad• 3 years ago

No, and must likely the ethical committee review would reject the use of a placebo group in the study.

Asooka• 3 years ago

This seems like a trial that doesn't need a placebo group. We have a lot of data on people being infected with rabies and it's exceedingly rare for them to spontaneously recover. Basically, you could say the placebo trials have been carried out already.

CatWChainsaw• 3 years ago

No IRB would sign on to allowing a placebo group for a disease that has basically* 100% mortality after symptoms show, and the research group that tried would almost certainly be charged criminally for some murder charge or another.

*There's maybe a dozen known recoveries from symptomatic rabies, ever. So, 100%.

unsupp0rted• 3 years ago

Low levels of the virus remained in the mice that received the antibody, but those levels didn't increase and signs of rabies did not immediately return, the results showed.

sandworm1012• 3 years ago

Question: for the cost of a single treatment for symptomatic rabies, how many vaccinations could be administered? We might not be able to properly cure rabies, but we could possibly wipe it out. Even in animals, eatable rabies vaccinations might work.

jki2752• 3 years ago

vaccination is mandatory for pets everywhere in North America that I'm aware of, but you'll never get all the wild animals everywhere.

SoftTalker• 3 years ago

Since vaccination for pets is so routine and doesn't seem to harm them, why not for people?

ang_cire• 3 years ago

Rabies lives in a LOT of animal populations (many asymptomatically).

Let's get a working cure for humans before we start worrying about sci-fi methods to eliminate a disease that's endemic in wild animals in many regions.

lukevp• 3 years ago

Rabies is such an unfortunate disease. It can live in you with no symptoms for months, and sometimes even years, and then one day you start presenting symptoms and the next day you’re dead. There’s no way to test for it because the way it’s tested for is by cutting your spine/brain apart…

I was exposed to a rabid bat a couple of weeks ago (captured, tested and confirmed to have rabies, unfortunately). While I’m not ecstatic about the cost of rabies treatment in America (it can be up to $40k a person, and 2 of us were exposed), I’m so glad we were able to get the bat tested and get in for the vaccines fairly easily.

The vaccines themselves are reasonably priced, but you have to get Human Immunoglobulin as well, which is only available at ERs and ranges from 2-12k per dose… and we needed 3 doses for each person (it’s by weight). In addition to those 3 shots, we had to get 4 vaccine shots, spread out over a 2 week period. Each shot caused symptoms. Luckily our symptoms were primarily just extreme fatigue or hot skin near the injection site, so it was not a fun 2 weeks but not the end of the world for us.

This alternative treatment sounds like it could be significantly cheaper and easier than that, and that it could possibly work in later stages, so that’s awesome to hear! I wasn’t clear from the article if they think it’ll be usable in humans once the symptoms begin though. If it’s before symptoms begin only, then it’s not much different than the current vaccine regimen other than cost/simplicity (which is still an awesome improvement, but not helpful for the people who don’t know they were exposed).

foobarian• 3 years ago

Did the bat bite? How was it captured? How was it even near you? Must be a heck of a story! :-)

toast02• 3 years ago

I've encountered bats twice at my house in semi-rural washington. One was hanging out in a can light on the ceiling of my deck... It meerly frightened the hell out of me, but didn't bite me; it made a kind of growl when I touched it, not realizing it was an animal. I came back some time later and it had left.

I found another one dead on the same deck a year or so later. As it wasn't white nose season, I had to dispose of it myself.

nytesky2• 3 years ago

I’ve had rabies vaccines twice now; a bat flew into us out hiking and then a raccoon jumped me in our yard.

In no case neither myself or my kids had any discernible side effects. That’s interesting that was possible; considering the vagueness of early onset rabies (fever, fatigue, headache) that must have been worrying.

The worst about rabies is that it can linger for years; I heard of a case where a woman was traveling overseas and had exposure to a rabid monkey, and couldn’t get treatment for a week and then only got the vaccine, no HRIG. They told they won’t really know if it worked until 2 years, if she doesn’t die.

I strongly consider getting my family vaccinated before traveling to any place that doesn’t have ready HRIG and vax, since delay can be so dangerous. It’s a low likelihood but high consequences risk, but the vax is pretty low risk but expensive. Spouse doesn’t think it’s necessary so will have to cross that bridge.

chasil• 3 years ago

There is a Kurzgesagt video on the features of the virus.

https://m.youtube.com/watch?v=4u5I8GYB79Y&pp=ygURa3Vyemdlc2F...

askiiart• 3 years ago

Short URL: https://YouTube.br/4u5I8GYB79Y

Invidious: https://invidious.askiiart.net/watch?v=4u5I8GYB79Y

nytesky2• 3 years ago

“ Low levels of the virus remained in the mice that received the antibody, but those levels didn't increase and signs of rabies did not immediately return, the results showed.”

I’m a little troubled by this outcome. Having the virus linger longer in a living host — is there chance it could mutate or exchange genetic material with another virus like an airborne one?

I don’t know how we would even measure when a human is truly cleared the virus; in mice they know because of an autopsy.

Is the first cure for advanced rabies near?

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