title: Combination therapy using chimeric monoclonal antibodies protects mice from lethal H5N1 infection and prevents formation of escape mutants.
abstract: BACKGROUND
  Given that there is a possibility of a human H5N1 pandemic and the fact that the recent H5N1 viruses are resistant to the anti-viral drugs, newer strategies for effective therapy are warranted. Previous studies show that single mAbs in immune prophylaxis can be protective against H5N1 infection. But a single mAb may not be effective in neutralization of a broad range of different strains of H5N1 and control of potential neutralization escape mutants.
  
  
  RESULTS
  We selected two mAbs which recognized different epitopes on the hemagglutinin molecule. These two mAbs could each neutralize in vitro escape mutants to the other and in combination could effectively neutralize viruses from clades 0, 1, 2.1, 2.2, 2.3, 4, 7 and 8 of influenza A H5N1 viruses. This combination of chimeric mAbs when administered passively, pre or post challenge with 10 MLD50 (50% mouse lethal dose) HPAI H5N1 influenza A viruses could protect 100% of the mice from two different clades of viruses (clades 1 and 2.1). We also tested the efficacy of a single dose of the combination of mAbs versus two doses. Two doses of the combination therapy not only affected early clearance of the virus from the lung but could completely prevent lung pathology of the H5N1 infected mice. No escape variants were detected after therapy.
  
  
  CONCLUSIONS
  Our studies provide proof of concept that the synergistic action of two or more mAbs in combination is required for preventing the generation of escape mutants and also to enhance the therapeutic efficacy of passive therapy against H5N1 infection. Combination therapy may allow for a lower dose of antibody to be administered for passive therapy of influenza infection and hence can be made available at reduced economic costs during an outbreak.
authors.affiliation: Animal Health Biotechnology, Temasek Life Sciences Laboratory, National University of Singapore, Singapore, Singapore.
authors.forename: Mookkan
authors.initials: M
authors.lastname: Prabakaran
authors.forename: Nayana
authors.initials: N
authors.lastname: Prabhu
authors.forename: Fang
authors.initials: F
authors.lastname: He
authors.forename: Qian
authors.initials: Q
authors.lastname: Hongliang
authors.forename: Hui-Ting
authors.initials: HT
authors.lastname: Ho
authors.forename: Jia
authors.initials: J
authors.lastname: Qiang
authors.forename: Tao
authors.initials: T
authors.lastname: Meng
authors.forename: Michael
authors.initials: M
authors.lastname: Goutama
authors.forename: Jimmy
authors.initials: J
authors.lastname: Kwang
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000914:Antibodies, Viral / Q000008:administration & dosage / Q000627:therapeutic use*; D002460:Cell Line; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D007116:Immunization, Passive; D053124:Influenza A Virus, H5N1 Subtype / Q000235:genetics / Q000502:physiology*; D008168:Lung / Q000473:pathology / Q000821:virology; D051379:Mice; D009154:Mutation / Q000235:genetics*; D009500:Neutralization Tests; D009976:Orthomyxoviridae Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D016865:Reassortant Viruses / Q000235:genetics; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D000914:Antibodies, Viral; D011993:Recombinant Fusion Proteins