Breakthroughs Blog: Antimicrobial resistance

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. A new phase IV observational study will test whether a novel approach to managing severe malaria, involving interim treatment with rectal artesunate, could address the challenge of treating those with severe cases in isolated rural settings far from a health facility. In the study, patients will be treated with artesunate rectal capsules at the community level and evaluated for clinical outcomes and then will receive follow up treatment with oral artemisinin-based combination therapies once they are well enough to swallow the medicine. The study, led by the newly created Severe Malaria treatment with Rectal artesunate and Arteminisin-based Combination Therapy [in remote settings] (SEMA ReACT) consortium, is intended to generate evidence to inform gaps in guidance on how to approach treatment when it is not feasible to transfer severely ill patients in timely manner to high-level health facilities as current guidance recommends.The results from a new study coordinated by the Drugs for Neglected Diseases initiative (DNDi), the Japanese pharmaceutical company Eisai, and the Mycetoma Research Center in Khartoum found that the oral drug fosravuconazole is up to 85 percent effective in treating the neglected tropical disease mycetoma and has no side effects. Currently, mycetoma is treated with itraconazole, a drug which needs to be taken with food four times a day for a year, has a myriad of side effects, is expensive, and is not available in all endemic countries. In contrast, fosravuconazole, only needs to be taken once a day without food, is inexpensive, and already widely used to treat fungal nail infections—factors that enhance its suitability for widespread use in low-resource settings.The Global Antibiotic Research & Development Partnership (GARDP) has been awarded around $3.07 million from the Research Investment for Global Health Technology Foundation to support an international clinical trial to evaluate three novel antibiotic regimens for neonatal sepsis. This infection affects over 3 million newborns every year, most of whom live in low- and middle-income countries. The trial, run by GARP and partners, is underway in Kenya and South Africa and will expand to more countries next year. The funding will also enable GARDP to collaborate with South Korean Jeil Pharma to explore options to optimize the manufacturing and approval of the novel antibiotics included in the regimens under study to ensure affordable prices and stable supplies of the drugs.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. TB Alliance has launched a new pan-phase 2 clinical trial to evaluate the safety and efficacy of replacing bedaquiline with a new experimental compound, TBAJ-876, in the organization’s three-drug BPaL regimen. The new regimen, composed of novel compounds with minimal pre-existing resistance, could provide a method to treat all patients with active tuberculosis (TB), including drug-sensitive and drug-resistant TB, with a universal treatment that is shorter, simpler, and more people-friendly than current regimens. Results from the preclinical and phase 2 studies showed that TBAJ-876, compared to bedaquiline, eliminated TB bacteria faster and was potentially safer. The study aims to enroll 300 participants with drug-sensitive TB at 21 trial sites in Georgia, the Philippines, South Africa, Tanzania, and Uganda.  Last week, the Bill & Melinda Gates Foundation announced a $23.6 million grant to US-based life science company Micron Biomedical to fund the first-ever mass production of needle-free vaccine technology. The technology, which uses dissolvable microneedles attached to the skin via a patch-like device, has the potential to boost the uptake of a variety of injectables, particularly in low-income countries, because it is simpler to transport and easier to administer. Specifically, the funding will support the development of a manufacturing facility that can make around 10 million doses annually for large clinical trials and hopefully wider use, subject to approval from regulatory authorities.A phase 3 clinical trial in South Africa found that a widely available oral antibiotic, levofloxacin, was safe and substantially reduced the risk of children and adults developing multidrug-resistant tuberculosis (MDR-TB). The trial is the first high-quality study to look at a preventive treatment for MDR-TB in children—there are currently no preventive MDR-TB treatments for adults or children. The researchers hope the new results will lead to updated guidelines from the World Health Organization that will lead to the rapid scale-up of levofloxacin because the drug is already widely available and relatively affordable, with child-friendly formulations already available through procurement agencies.  

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last Wednesday, the Global Antibiotic Research and Development Partnership (GARDP) announced the results of a successful phase 3 trial, conducted in collaboration with Innoviva Specialty Therapeutics and supported by the National Institute of Allergy and Infectious Diseases, which found that a single dose of a first-in-class oral antibiotic, zoliflodacin, was as safe and effective as standard therapy for treating uncomplicated urogenital gonorrhea. The growing resistance of the gonorrhea bacteria to many classes of antibiotics has left only one remaining globally recommended treatment available as an option. Zoliflodacin, if approved, could not only help address those rising cases because studies have shown that it is active against multi-drug resistant gonorrhea strains, but the antibiotic will also simplify treatment because it is one pill rather than an injection and a pill like the current standard therapy. Last week, the Coalition for Epidemic Preparedness Innovations (CEPI) and the University of Oxford announced the launch of a new project to develop prototype vaccines against an arenavirus called Junin virus, which causes Argentine hemorrhagic fever. The project is aimed at kickstarting the broader development of vaccines for arenaviruses, which include the virus that causes Lassa fever, one of CEPI’s priority pathogens. CEPI will invest $25 million in the development of early prototypes of viral vector and mRNA vaccines against the Junin virus, as well as the improvement of the ChAdOx viral vector technology, part of the broader partnership between CEPI and Oxford to support vaccine development for a variety of viral families with future epidemic or pandemic potential. In a recent study, researchers have identified a new molecule in cells that is necessary for the Ebola and Marburg viruses to infect and spread in the body and that is also involved in SARS-CoV-2 infections. This discovery could eventually lead to new antiviral drugs for Ebola and Marburg, among other viral infections. The molecular, CCZ1, is a protein that regulates the transport of other molecules by cells. Researchers from the Karolinska Institutet and Institute of Molecular Biotechnology used advanced stem cell libraries and lab-grown organs to study how viruses infect the human liver and blood vessels and ultimately demonstrate how CCZ1 operates as a key factor in their spread through the body. 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. A study published last week found that a subset of cells in dormant HIV reservoirs spontaneously produce HIV RNA and proteins, prompting the need for further research into the consequences for the immune system of these ongoing viral interactions in people living with HIV and receiving treatment. This research suggests that the RNA and proteins produced by the reservoirs could be behind inflammation, accelerated cardiac disease, frailty, and premature osteoporosis, which can persist in people who are otherwise successfully treated for HIV. Future studies will need to examine these reservoirs in more diverse populations, but this research could lead to the identification of new ways to target these remaining active viruses in people receiving HIV treatment to ensure that the virus does not rebound and to address their potential health consequences.New research has identified the spread of new strains of malaria parasites in Ethiopia that are resistant to current artemisinin-based treatments and indetectable by common diagnostic tests. This discovery follows the recent identification of strains in other regions of Africa that were resistant to either treatment or testing, although the Ethiopia strain is the first identified resistant to both. The spread of these strains could be a major challenge to efforts to eliminate malaria globally. This most recent finding also underscores the urgent need for both close monitoring of the spread of resistance among malaria parasites, as well as development of new therapies and vaccines.Last week, GARDP announced a sublicense agreement with the Indian company Orchid Pharma to manufacture Shionogi’s antibiotic cefiderocol, enabling Orchid to produce the drug more cheaply for low- and middle-income countries in the face of global gaps in access to antibiotics and rising rates of antimicrobial resistance. This agreement builds on a partnership between GARDP, Shionogi, and the Clinton Health Initiative, which granted GARDP the license last year. Cefiderocol is on the World Health Organization’s Model List of Essential Medicines and is considered globally to be an important weapon against difficult-to-treat, multidrug-resistant infections, but it has not yet been made commercially available in the majority of low- and middle-income countries.