Covid-19: Humanitas on the front line of research

This is the third time in twenty years that a zoonotic virus of the coronavirus strain has made an inter-species jump to infect humans. Such transmission also occurred between 2002 and 2003 with SARS in the Far East, and in 2012 with MERS in Jordan and in Saudi Arabia. It is likely that bats are the original host of Covid-19, giving rise to the infection that appeared in Wuhan, (China).

However, we still know very little about this new enemy that has struck the entire world, consequently research has a role of paramount importance in identifying the appropriate weapons to combat and defeat the virus.

Scientific research is “humanity’s only safety belt”, underlined Professor Alberto Mantovani, Professor Emeritus of Humanitas University and Scientific Director of Humanitas, considered one of the most important immunologists in the world and the most cited Italian researcher in international scientific literature. As reported in interviews from major national newspapers, Professor Mantovani has provided a snapshot of the present situation and on-going research.

What we know about the new Coronavirus?

“The coronavirus is not a kind of flu. It’s an unknown enemy that we need to study as we don’t know how our immune system reacts when it is hit,” stated Professor Mantovani.

“In response to the lung damage triggered by Sars-CoV-2, an inflammation gives a radiological picture similar to frosted glass. Possibly, at that point in the battle, a real ‘friendly fire’ is triggered: an excessive and out-of-control inflammatory response set off by the immune system, amplifying the damage, as in the case of SARS”.

Why some people risk more?

“It’s not clear why some people (patients who are asymptomatic as well as patients who have recovered) come out ‘winning’ and others do not” stated Professor Mantovani. It is thought that those most affected by the virus are the elderly due to the fact the immune system ages as we get older and becomes less and less efficient. Women, on the other hand, are less severely attacked by the virus perhaps because, in general, they are better able than men to activate certain immune responses (as they produce large quantities of antibodies to protect the foetus) and thanks to their genetic make up. Mantovani added that “children are also relatively resistant. One explanation is that children are exposed to vaccines, which give protection against germs and stimulate innate immunity, the first line of defence that manages ninety-five per cent of pathogenic aggression”.

Humanitas research activities

The challenge now, Professor Mantovani points out, is to understand how our immune system reacts to the virus. Scientific research is, therefore, the winning weapon to find treatment strategies.

“From the point of view of research – explained the immunologist – one terrain to explore is that of immunity and antibodies. The world’s greatest coronavirus expert, Ralph Baric, believes that Sar-CoV-2 leaves an ‘immunological trace’ in our body for at least six to twelve months, evidence based on the experience of SARS. Through virus quantification, i.e. the measuring of virus concentration, we can begin to ‘trace’ the virus in the population’.

Professor Mantovani continued: “In Humanitas, together with San Raffaele and Spallanzani hospitals, we are studying the first line of immune defence, where there are molecules that function as ancestral antibodies and defend us from various pathogens, including a member of the coronavirus family. If these were to be effective, we could expand them, produce them with biotechnology and inject them. But this approach could take one or two years. However, in the meantime we can try to understand if these same molecules can constitute biomarkers for disease severity in order to test how an infected person reacts to the coronavirus’’. 

Which are the progress of experimentation and therapies

At this point in time, explained professor Mantovani, to combat the virus we are employing wartime medicine with different therapeutic tools but still with an empirical approach.

“This is the case with antivirals, such as Avigan and two other antiretrovirals, the anti-Hiv Lopinavir/Ritonavir combination, used in China to treat Covid-19. However, a study just published in the New England Journal of Medicine has shown that they are not useful in patients with an advanced stage of the disease. It shows that we are fighting a war, but that we need to combine emergency medicine with the rigour of clinical trials, as also emphasized in a report being finalized by the Health Commission of the Accademia dei Lincei”.

Forecasts for the availability of a vaccine

Immunity to the coronavirus will only be possible thanks to a vaccine, but unfortunately this will take time. Moreover, a vaccine will not provide total protection as viruses can change each season, which implies that an increasingly effective vaccine will have to be produced.

“Today – explains Mantovani – there are about twenty studies underway, including one in Pomezia, where they have already successfully tested the vaccine against Ebola. Realistically, it will take at least 18 months before we have a vaccine and to produce it in billions of doses”.

In times of such great complexity and on account of the health and social emergency, it is more important than ever to share information and knowledge on COVID-19. It is with this spirit that the Accademia Nazionale dei Lincei – one of the most prestigious Italian scientific societies – has produced a report on COVID-19 including, amongst others, the names of Professor Alberto Mantovani and Professor Maurizio Cecconi.