An experimental monoclonal antibody has succeeded in preventing malaria infections in healthy adults in Mali, offering hope in fighting the disease. Researchers at the National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Medical Research Institute — a nonprofit pharmaceutical company focusing on the development of medical tools for diseases that for-profit companies don’t tend to invest in — hope the drug therapy can be used to protect children under 5 in sub-Saharan Africa, who suffered most of the 627,000 estimated malaria deaths in 2020 . The research: The NIAID found that a one-time, intravenous infusion of a monoclonal antibody called CIS43LS was up to 88 percent effective at preventing infection over 24 weeks of intense malaria transmission, “ demonstrating for the first time that a monoclonal antibody can prevent malaria infection in an endemic region." What’s it all about: Monoclonal antibodies are based on lab-made proteins that copy human antibodies, which fight pathogens entering the body. CIS43LS is based on an antibody from a volunteer who received an experimental malaria vaccine. NIAID researchers modified the antibody to make it last longer in the bloodstream. They have also developed a second monoclonal, L9LS, that is much more potent than CIS43LS and can be administered in a smaller dose than CIS43LS by injection instead of intravenous infusion. Two Phase 2 clinical trials assessing its safety and efficacy in infants, children and adults in Mali and Kenya are underway, the NIAID said. The infusion method delivers the monoclonal antibody through a catheter into the vein, thus requiring specialized facilities and trained health care workers. Both are seldom available in low-income countries, and it’s one reason monoclonal antibodies against Covid-19 didn’t reach most of the developing world. More in the pipeline: The Gates Medical Research Institute is also working on an injectable monoclonal antibody against malaria. The therapy is less advanced than the NIAID’s: It will be tested in people for the first time in 2023, Scott Miller, clinical development leader at the Gates Institute, told Carmen. Adults will be involved at first and then babies as young as 2 to 3 months old. “Our target population is to protect malaria in the most at-risk children, as aligned with our mission, and we think that’s the group that would benefit first from such a new breakthrough technology,” Miller said. Malaria cases in children typically start occurring when they’re between 3 and 6 months of age. The disease causes flu-like symptoms. Untreated, it can cause kidney failure, seizures, mental confusion, coma and death. The monoclonal is meant to protect babies from becoming infected after the antibodies they received from their mothers wane. But at-risk children should continue sleeping under bed nets at night to avoid bites from mosquitoes that carry the disease, Miller said. The therapy could be available within six to seven years if all goes well, but these are still the early days, Miller added. Who pays for it: The Gates Institute wants the monoclonal to cost under $10 so it’s affordable for countries that need it most. Miller said he’s talking with global organizations funding malaria interventions “to put together a plan for ultimately introducing these.”
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