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A One Medicine Mission for an Effective Rabies Therapy

Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provi...

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Autores principales: Knobel, Darryn L., Jackson, Alan C., Bingham, John, Ertl, Hildegund C. J., Gibson, Andrew D., Hughes, Daniela, Joubert, Kenneth, Mani, Reeta S., Mohr, Bert J., Moore, Susan M., Rivett-Carnac, Hugh, Tordo, Noël, Yeates, James W., Zambelli, Anthony B., Rupprecht, Charles E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967983/
https://www.ncbi.nlm.nih.gov/pubmed/35372555
http://dx.doi.org/10.3389/fvets.2022.867382
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author Knobel, Darryn L.
Jackson, Alan C.
Bingham, John
Ertl, Hildegund C. J.
Gibson, Andrew D.
Hughes, Daniela
Joubert, Kenneth
Mani, Reeta S.
Mohr, Bert J.
Moore, Susan M.
Rivett-Carnac, Hugh
Tordo, Noël
Yeates, James W.
Zambelli, Anthony B.
Rupprecht, Charles E.
author_facet Knobel, Darryn L.
Jackson, Alan C.
Bingham, John
Ertl, Hildegund C. J.
Gibson, Andrew D.
Hughes, Daniela
Joubert, Kenneth
Mani, Reeta S.
Mohr, Bert J.
Moore, Susan M.
Rivett-Carnac, Hugh
Tordo, Noël
Yeates, James W.
Zambelli, Anthony B.
Rupprecht, Charles E.
author_sort Knobel, Darryn L.
collection PubMed
description Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provide given the cost, clinical expertise required, and uncertain outcome. Systematic clinical research into combination therapies is further hampered by sporadic occurrence of cases. In this Perspective, we examine the case for a One Medicine approach to accelerate development of an effective therapy for rabies through the veterinary care and investigational treatment of naturally infected dogs in appropriate circumstances. We review the pathogenesis of rabies virus in humans and dogs, including recent advances in our understanding of the molecular basis for the severe neurological dysfunction. We propose that four categories of disease process need to be managed in patients: viral propagation, neuronal degeneration, inflammation and systemic compromise. Compassionate critical care and investigational treatment of naturally infected dogs receiving supportive therapy that mimics the human clinical scenario could increase opportunities to study combination therapies that address these processes, and to identify biomarkers for prognosis and therapeutic response. We discuss the safety and ethics of this approach, and introduce the Canine Rabies Treatment Initiative, a non-profit organization with the mission to apply a One Medicine approach to the investigation of diagnostic, prognostic, and therapeutic options for rabies in naturally infected dogs, to accelerate transformation of rabies into a treatable disease for all patients.
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spelling pubmed-89679832022-04-01 A One Medicine Mission for an Effective Rabies Therapy Knobel, Darryn L. Jackson, Alan C. Bingham, John Ertl, Hildegund C. J. Gibson, Andrew D. Hughes, Daniela Joubert, Kenneth Mani, Reeta S. Mohr, Bert J. Moore, Susan M. Rivett-Carnac, Hugh Tordo, Noël Yeates, James W. Zambelli, Anthony B. Rupprecht, Charles E. Front Vet Sci Veterinary Science Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provide given the cost, clinical expertise required, and uncertain outcome. Systematic clinical research into combination therapies is further hampered by sporadic occurrence of cases. In this Perspective, we examine the case for a One Medicine approach to accelerate development of an effective therapy for rabies through the veterinary care and investigational treatment of naturally infected dogs in appropriate circumstances. We review the pathogenesis of rabies virus in humans and dogs, including recent advances in our understanding of the molecular basis for the severe neurological dysfunction. We propose that four categories of disease process need to be managed in patients: viral propagation, neuronal degeneration, inflammation and systemic compromise. Compassionate critical care and investigational treatment of naturally infected dogs receiving supportive therapy that mimics the human clinical scenario could increase opportunities to study combination therapies that address these processes, and to identify biomarkers for prognosis and therapeutic response. We discuss the safety and ethics of this approach, and introduce the Canine Rabies Treatment Initiative, a non-profit organization with the mission to apply a One Medicine approach to the investigation of diagnostic, prognostic, and therapeutic options for rabies in naturally infected dogs, to accelerate transformation of rabies into a treatable disease for all patients. Frontiers Media S.A. 2022-03-16 /pmc/articles/PMC8967983/ /pubmed/35372555 http://dx.doi.org/10.3389/fvets.2022.867382 Text en Copyright © 2022 Knobel, Jackson, Bingham, Ertl, Gibson, Hughes, Joubert, Mani, Mohr, Moore, Rivett-Carnac, Tordo, Yeates, Zambelli and Rupprecht. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Veterinary Science
Knobel, Darryn L.
Jackson, Alan C.
Bingham, John
Ertl, Hildegund C. J.
Gibson, Andrew D.
Hughes, Daniela
Joubert, Kenneth
Mani, Reeta S.
Mohr, Bert J.
Moore, Susan M.
Rivett-Carnac, Hugh
Tordo, Noël
Yeates, James W.
Zambelli, Anthony B.
Rupprecht, Charles E.
A One Medicine Mission for an Effective Rabies Therapy
title A One Medicine Mission for an Effective Rabies Therapy
title_full A One Medicine Mission for an Effective Rabies Therapy
title_fullStr A One Medicine Mission for an Effective Rabies Therapy
title_full_unstemmed A One Medicine Mission for an Effective Rabies Therapy
title_short A One Medicine Mission for an Effective Rabies Therapy
title_sort one medicine mission for an effective rabies therapy
topic Veterinary Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967983/
https://www.ncbi.nlm.nih.gov/pubmed/35372555
http://dx.doi.org/10.3389/fvets.2022.867382
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