Today, the new technologies developed to produce vaccines at such high speed are being leveraged to develop further health treatments. As soon as mRNA technology was shown to be reliable in producing effective vaccines, researchers realised that many other diseases and conditions were likely candidates for mRNA-based treatments.
Heart tissue damaged during heart attacks is now being successfully regenerated in animal trials. This startling breakthrough has been made by applying the new genetic mRNA technologies. This is likely to lead to the world’s first cure for heart attacks and it is being developed by researchers at King’s College London.
The scientists have identified key genetic codes - called microRNAs - which produce proteins that stimulate the creation of healthy new heart cells. These microRNAs can be delivered directly to the heart muscle following a heart attack, by deploying mRNA technology similar to that used in the Pfizer and Moderna COVID vaccines.
Without the intervention of mRNA-based therapies the human heart has no natural ability to repair itself and heart attack victims are left with permanently damaged tissue that often leads to debilitating and potentially deadly heart failure. The new mRNA treatment has the potential to transform cardiovascular medicine and it is likely to prevent millions of future heart attack victims developing heart failure.
There are other startling breakthroughs following in the wake of the high-speed COVID vaccine effort. Researchers at the Yale School of Medicine have their sights set on another killer disease, malaria, which is estimated to have killed almost half of all the world’s people who have lived since the Stone Age. It remained a leading cause of global infectious disease death in 2021: more than 600,000 people, mostly young children, died from it.
Yale’s team, in partnership with pharmaceutical company Novartis, has succeeded in developing a 'self-amplifying' RNA (also known as saRNA) jab to vaccinate against the disease. The technology stems from a successful RNA malaria vaccine for mice developed at Yale and is in advanced preclinical testing. It could be trialled for the first time in humans within two years.
Elsewhere, Moderna has begun a trial for an HIV vaccine that relies on the same mRNA technology as the COVID jab. If the company is successful, a one-off jab will offer lifetime protection from the virus that can lead to the development of AIDS. And the same mRNA technology is also being studied to see if it could help control conditions that are normally treatment-resistant such as rabies, zika, cytomegalovirus, herpes and cancer of the colon, skin, breast and other parts of the body. Moderna alone is developing trials for at least 30 other mRNA-based treatments in six different disease categories.
Another area of treatment that has benefitted from the pandemic (albeit indirectly) is the development and use of “liquid biopsies” for detecting cancers. In normal times, cancer treatment can begin only once a biopsy - a small tissue sample taken directly from a tumour - confirms that the suspect tissue is malignant. But when hospital staff were diverted to the COVID response and many more were off sick or isolating with the virus, the colonoscopies, bronchoscopies and other procedures that are necessary to take such biopsy samples were unavailable.
In response, Professor Nicholas Turne, a consultant oncologist at the Royal Marsden Hospital in London, turned to a technique that has long been touted as the future of diagnostics; the liquid biopsy. For years, cancer specialists have explored the concept of using these highly sensitive blood tests to detect the DNA shed by tumours to diagnose and monitor cancer precisely - without the pain and inconvenience of a physical biopsy. But despite excitement about the prospects of such tests, progress in the clinical use of the technique was slow.
Under COVID conditions, experimental techniques were dragged from the future into the present. The Marsden team started using liquid biopsies to successfully diagnose and treat patients with suspected cancers of the lungs, pancreas, urethra and bile duct. They are now carrying out a clinical trial to try to make the practice routine. While these are still early days, eventually doctors hope to be able to do away with the need for surgical biopsies altogether.
Meanwhile, there has been huge focus on how to tackle obesity since it emerged as a leading risk and mortality factor related to COVID. 78% of US patients hospitalised with COVID between March and December 2020 were overweight. In June 2021, the first obesity medication approved by the US Food and Drugs Administration since 2014 was rushed to the market to aid the fight against COVID mortality. Semaglutide, also known as Wegovy, could be up to twice as effective as previous weight-loss medications after a study of nearly 2,000 patients saw participants lose on average 15% of their body weight.
This synthetic version of a hormone that reduces appetite was already used in much lower doses to treat type 2 diabetes. But amid growing evidence that substantial weight loss reduces COVID severity, its wider use was fast-tracked by regulators. The availability of a drug that can improve both blood glucose levels and body weight could have far -reaching effects for public health beyond the context of COVID, especially for people who have remained overweight despite their best efforts.
COVID-19 has also shone a light on the potential health benefits of vitamin D. In Norway, Finland and Iceland, where sunlight is limited, there’s a public-health emphasis on maintaining healthy levels of the vitamin within populations. Persistently low COVID mortality rates in these nations were observed, compared to other northern-hemisphere countries with less of a public health focus on adequate amounts of vitamin D. Amid the ongoing search to ascertain exactly what makes some people more vulnerable to COVID than others, focus on vitamin D early in 2021 led to the publication of a paper in the Lancet medical journal. Co-authored by dozens of experts, the report suggested that vitamin-D deficiencies could be a root issue in the development of many other diseases.
While these are still early days, eventually doctors hope to be able to do away with the need for surgical biopsies altogether.
Another benefit for the pharmaceutical industry resulting from the COVID-19 pandemic is that clinical trials of new drugs and treatments have been re-designed and speeded up dramatically, without incurring additional health risks for test participants. Normally, clinical trials of new drugs take up to ten years to complete, but the normal process was far too slow to be of help during the COVID tsunami.
In the early days of the pandemic, some doctors around the world were trying any approved drug that had even the slightest chance of tackling COVID. They used antimalarials, antivirals, antibiotics and HIV treatments, despite having no evidence they would work. Most had no effect on the virus.
In the midst of this chaos two Oxford professors, Martin Landray and Peter Horby, designed the Recovery Trial, a programme that would dramatically accelerate that process. The programme dramatically accelerated the process of conducting formal clinical trials. By inviting every NHS hospital in the UK to participate, the researchers realised they could reach a huge trial population very quickly. And instead of trialling each drug one by one, they simultaneously tested five treatments. Some 40,000 volunteer patients took part.
Moderna alone is developing trials for at least 30 other mRNA-based treatments in six different disease categories.
In June 2020, Recovery Trials showed that dexamethasone, an anti-inflammatory drug that costs just £0.50p ($0.65) per patient per day, slashed the risk of death among the sickest patients by a third. It has since saved well over a million lives around the world. In February 2021 an anti-inflammatory called tocilizumab was shown to reduce the risk by another 14 per cent, halving the risk of death to a COVID patient in intensive care. The trial also showed that a drug developed by the US firm Regeneron cut deaths by 20 per cent among the one in three patients who don’t produce their own antibody response when they contract the virus.
The study also revealed that several drugs initially used for COVID-19 - including hydroxychloroquine, which was promoted by Donald Trump - gave patients no survival benefit. Recovery Trial has clearly demonstrated that many types of clinical studies no longer have to take years to complete.
