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CIDRAP- Scientists air topics for H7N9 gain-of-function research

Shiloh

Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2013/08/scientists-air-topics-h7n9-gain-function-research


Scientists air topics for H7N9 gain-of-function research
Filed Under:
Dual-Use Research; H7N9 Avian Influenza
Lisa Schnirring | Staff Writer | CIDRAP News
|
Aug 07, 2013


As scientists continue to assess the pandemic potential of China's new H7N9 virus, a group of researchers said today that they hope to learn even more by taking the experiments to the next level: making and studying lab-modified strains that might be more transmissible and require tighter safety measures.

In a letter signed by 22 scientists that appeared in both Nature and Science today, researchers said some of the work will likely be considered gain-of-function (GOF) experiments, the type of testing that sparked controversy when two research groups published their findings on lab-modified H5N1 avian influenza strains that spread via airborne droplets among mammals.

At the same time, US government officials announced today that they would put federally funded H7N9 studies through an extra level of scientific and safety review.

The letter, signed by some of the same researchers from teams that published the controversial lab-modified H5N1 studies, detailed the type of experiments that might be defined as GOF, such as studies to explore the potential for drug resistance to emerge and what mutations and gene combinations might enhance the ability of H7N9 to more easily spread from person to person. The researchers also published a supplemental report that listed the precautions they would take when conducting any GOF experiments.

Extensive tests at other labs have already heightened concerns in global health circles that H7N9 might pose a bigger pandemic threat than H5N1, because the studies suggest that the new virus can easily infect human lung tissues and has a limited ability to spread by airborne droplets. So far H7N9 has been linked to 134 infections and 43 deaths, but the virus doesn't appear to spread easily from person to person.
Signers are part of NIH-funded network

Ron Fouchier, PhD, a virologist at Erasmus University in the Netherlands, told CIDRAP News that all of the scientists who signed the letter are part of the US National Institutes of Health (NIH)?funded Centers of Excellence for Influenza Research and Surveillance (CEIRS). The program, based at seven sites throughout the United States, is a National Institute of Allergy and Infectious Diseases (NIAID) research network that is designed to help the government and its global health partners prepare for and respond to epidemic and pandemic influenza threats.

He said the idea of the letter came up during the weekly teleconference sessions that involved CEIRS investigators during the first months of the H7N9 outbreak.

Fouchier said several experiments that were discussed and proposed qualify as GOF studies. "We rapidly agreed that some form of communication to the scientific community and general public would be desired," he said, adding that the group circulated the first draft of the letter by e-mail and then had a final discussion at the annual CEIRS meeting recently in Memphis.

Yoshihiro Kawaoka, DVM, PhD, who heads a research lab at the University of Wisconsin in Madison, is also part of the CEIRS network and among the signers of the letter. The group wants to be transparent about the proposed experiments, he told CIDRAP News. "We want to explain what we are doing and why, and describe the precautions we are taking."

Fouchier and Kawaoka led the teams that published the two controversial H5N1 studies last year.

The need to better inform the public and others about GOF experiments and the biosafety steps needed to conduct them safely were among the key lessons researchers learned during the H5N1 research debate. Scientists discussed communications issues in depth at a 2-day NIH conference in Washington, DC, in December, and the topic came up again at a meeting on general dual-use research issues in February at World Health Organization (WHO) headquarters in Geneva.
Five areas of GOF research listed

In their letter today, the researchers wrote that the H7N9 outbreak requires focused fundamental and applied research by responsible investigators working in appropriate facilities with key risk-mitigation plans in place. They outlined five areas of H7N9 study that are the most urgent and may warrant GOF experiments: immunogenicity, adaptation, drug resistance, transmission, and pathogenicity.

For example, they wrote that genetic changes that alter virulence, host range, or transmissibility could alter the antigenicity of vaccines, and anticipating such changes could help support the development of more effective vaccines to protect against the new virus.

GOF studies may also help health officials gauge the pandemic potential of H7N9 by exploring how likely it would be to better adapt to mammals and identifying what mutations or gene combinations might enhance transmissibility in mammals such as ferrets or guinea pigs, the group wrote. Researchers could also use GOF studies to determine if H7N9 viruses can reassort with other circulating viruses and if changes in the H7N9 virus might make it more pathogenic.

The proposed experiments are already subject to review by institutional biosafety committees and would be conducted with risk-mitigation plans that have already been developed for investigators who work with other potentially dangerous influenza viruses, such as the 1918 pandemic virus and H5N1.

They said more review layers may be required by funding agencies, and they pointed to a newly announced review process for H7N9 GOF studies (see below).

In a separate document on risk mitigation for H7N9 GOF experiments, the group emphasized nine key safety steps. For example, they said that studies should be designed to limit risks, such as by avoiding combinations of functional gains in areas such as increased virulence, host range, transmission, or drug resistance.

Since no vaccines for H7N9 are available, lab viruses should be tested to ensure that they are sensitive to oseltamivir, and if experimental changes alter resistance, scientists agree that those strains will not be used for any other GOF studies.
Feds announce extra review for H7N9 studies

In a related development today, US government officials announced a new review process for certain GOF experiments with the H7N9 virus, such as the ones proposed in the letter by the CEIRS researchers. In the same issues of Science and Nature the federal officials wrote that studies funded by the US Department of Health and Human Services (HHS) that could generate H7N9 viruses with increased airborne transmissibility in mammals will get an additional level of review.

The announcement would apply to NIH-funded research projects, including those conducted by CEIRS researchers. Officials wrote that the review would weigh potential benefits, along with biosafety and biosecurity risks, and would flag any additional safety steps that are needed. They also noted that the review will be done by standing expert panels using an approach similar to the assessment of lab-modified H5N1 studies.
Letter stirs questions on benefits, risks

An editorial in the same issue of Nature today said the influenza researchers' announcement could reignite some of the debate over last year's lab-modified H5N1 studies in ferrets and could prompt the first test of new oversight measures established in the wake of the debate.

Nature editors wrote that the long-term benefits of the research are clear, but added that the short-term benefits, such as providing public health with more tools to counter the H7N9 threat, aren't as apparent.

The journal pointed out that so far there is no evidence that the mutations that allow flu viruses to infect human cells?already seen in wild-type H7N9 viruses?predict the risk of a pandemic. Creating transmissible strains would go a step further and could reveal new clues about mutations that could affect transmission. "But nature could well come up with combinations for transmission that are different from those obtained in the experiments," the editorial noted.

Michael T. Osterholm, PhD, MPH, who heads a CEIRS center at the University of Minnesota and has been involved in the H5N1 debate as a member of the National Science Advisory Board for Biosecurity (NSABB), congratulated the US government for tightening its oversight of H7N9 GOF studies. He said that though he fully supports H7N9 research work, he still sees signs that researchers are overselling the benefits of the findings for public health uses such as supporting better flu surveillance systems. Osterholm is also director of the Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News.

He said an element that's still lacking is a risk-benefit analysis for this type of influenza experiment. "We need that oversight," Osterholm said, adding that he has aired his concerns with his CEIRS network colleagues.

Osterholm says he has full confidence in the biosafety steps used at labs such as Fouchier's and Kawaoka's, but he and others are still concerned that details about the experiments in scientific publications might enable labs in other parts of the world that don't have the same standards and oversight to replicate the work, which could pose a risk of an accidental release or allow dangerous viruses to be acquired for bioterror uses.

Fouchier RAM, Kawaoka Y, Cardona C, et al. Gain of function experiments on H7N9, letter. Science 2013 Aug 7 [Full text][Supplementary text]

Fouchier RAM, Kawaoka Y, Cardona C, et al. Gain of function experiments on H7N9, correspondence. Nature 2013 Aug 7 [Full text] [Supplementary text]

Jaffee HW, Patterson AP, Lurie N. Avian flu: extra oversight for H7N9 experiments, letter. Science 2013 Aug 7 [Full text]

Jaffee HW, Patterson AP, Lurie N. Avian flu: extra oversight for H7N9 experiments, correspondence. Nature 2013 Aug 7 [Full text]

Aug 7 Nature editorial
 
Re: CIDRAP- Scientists air topics for H7N9 gain-of-function research

So the links go to
one (and the same) letter by Fouchier/Kawaoka with supplement,
published in 2 different journals.
Plus an announcement of (new) criteria for H7N9 experiments
by CDC,NIH,DHHS also published in 2 journals (basically the same document)
Plus an "editorial" in journal "nature" presumably written by some "nature" - people

so, 4 different documents with 2,2,1,1 pages when printed
 
Re: CIDRAP- Scientists air topics for H7N9 gain-of-function research

Fouchier and Kawaoka wrote and 20 other flu-scientists signed :

> Gain-of-Function Experiments on H7N9
> Since the end of March 2013, avian a influenza viruses
> of the H7N9 subtype have caused more than 130 human cases
> of infection in China, many of which were severe,
> resulting in 43 fatalities. Although this A(H7N9) virus
> outbreak is now under control, the virus (or one with
> similar properties) could reemerge as winter approaches.
> To better assess the pandemic threat posed by A(H7N9)
> viruses, NIAID/NIH Centers of Excellence in Influenza
> Research and Surveillance (CEIRS) investigators and other
> expert laboratories in China and elsewhere have characterized
> the wild-type avian A(H7N9) viruses in terms of host range,
> virulence, and transmission, and are evaluating the
> effectiveness of antiviral drugs and vaccine candidates.
> However, to fully assess the potential risk associated
> with these novel viruses,

> there is a need for additional research including experiments
> that may be classified as 'gain-of-function' (GOF).
> Here, we outline the aspects of the current situation
> that most urgently require additional research,

this is stated as fact, but seems to be just the opinion
of the authors. I haven't seen that "need" specified elsewhere,
or even "urgent require". No reasons are given why this research
should be more urgent now than other research.
I would rather argue, that just because H7N9 already has
these adaptions but still didn't go pandemic, there is less
danger that it might acquire those so to increase its
transmissibility.

> our proposed studies, and risk-mitigation strategies.

not just risk reduction ? How could you "mitigate" a risk ?

> The A(H7N9) virus hemagglutinin protein has several motifs
> that are characteristic of mammalian-adapted and human
> influenza viruses, including mutations that confer human-type
> receptor-binding and enhanced virus replication in mammals.
> The pandemic risk rises exponentially should these viruses
> acquire the ability to transmit readily among humans.

why should the risk rise "exponentially" then ?
Is there any reference, any paper for that ?
And exponential as a function of what ? time ?
Aren't the authors here mainly those people who kept telling
us since years about the H5N1 risk that "nobody knows the risk"
or such ? Also, since risks are usually expressed,valuated
by probabilities, thus numbers <1, an exponential rise would
be slower than a linear rise.

> Reports indicate that several A(H7N9) viruses from patients
> who were undergoing antiviral treatment acquired resistance
> to the primary medical countermeasure neuraminidase
> inhibitors (such as oseltamivir, peramivir, and zanamivir).
> Acquisition of resistance to these inhibitors by A(H7N9)
> viruses could increase the risk of serious outcomes of
> A(H7N9) virus infections.

OK, but the outcome is serious enough already, so let's better
concentrate on transmissibility.

> The hemagglutinin proteins of A(H7N9) viruses have a cleavage
> site consistent with a low-pathogenic phenotype in birds; in
> the past, highly pathogenic H7 variants (with basic amino
> acid insertions at the cleavage site that enable the spread
> of the virus to internal organs) have emerged from populations
> of low pathogenic strains circulating in domestic gallinaceous
> poultry.

in English: chickens

> Normally, epidemiological studies and characterization of
> viruses from field isolates are used to inform policy decisions
> regarding public health responses to a potential pandemic.

normally, pandemics are rare events. We sequence viruses
so to detect new ones.

> However, classical epidemiological tracking does not give
> public health authorities the time they need to mount an
> effective response to mitigate the effects of a pandemic virus.
> To provide information that can assist surveillance activities
> thus enabling appropriate public health preparations to be
> initiated before a pandemic experiments that may result in
> GOF are critical.

critical in allowing a more timely preparation ? I don't see this.
The potential of antiviral resistance and cleavage site changes
were given above as possible reasons, but let's assume we knew
e.g. both had probability 90%, what would change ?
Would the vaccine be different ?

> Therefore, after review and approval, we
> propose to perform the following experiments that may result in GOF:
> (i) Immunogenicity. To develop more effective vaccines and
> determine whether genetic changes that confer altered virulence,
> host range, or transmissibility also change antigenicity.

this seems unlikely. We didn't see that before. The typical virulence
markers are in non-HA segments and the cleavage site is not addressed
by vaccines.
The current problem is to quickly make the vaccine (and how much)
and not so much how to finetune it for special strains or variants.
So, the current vaccine against the 2009 pandemic strain is still the same
as that from 2009.

> (ii) Adaptation. To assist with risk assessment of the pandemic
> potential of field strains and evaluate the potential of A(H7N9)
> viruses to become better adapted to mammals, including determining
> the ability of these viruses to reassort with other
> circulating influenza strains.

It is our experience, that that risk assessment won't be done.
Experts do not give probability estimates for pandemic risks.
But they regularly say : "more research is needed ..."
I think more important is the risk-assessment for potential man-made
viruses.
If we knew, e.g. that H7N9 is more dangerous than H5N1, what could
we do ? OK, make more prepandemic H7N9 vaccine and fewer H5N1.
But alternatively we could produce both.
Considering the amount that is being produced and the costs, that
doesn't seem to be very important.

> (iii) Drug resistance. To assess the potential for drug resistance
> to emerge in circulating viruses, evaluate the genetic stability
> of the mutations conferring drug resistance, evaluate the efficacy
> of combination therapy with antiviral therapeutics, determine
> whether the A(H7N9) viruses could become resistant to available
> antiviral drugs, and identify potential resistance mutations that
> should be monitored during antiviral treatment.

would that help us to create better drugs ?

> (iv) Transmission. To assess the pandemic potential of circulating
> strains and perform transmission studies to identify mutations
> and gene combinations that confer enhanced transmissibility in
> mammalian model systems (such as ferrets and/or guinea pigs).

most of the underlining experts earlier said that risk is unknowable
anyway. And if we knew the mutations, would that help us to stop them ?
In general, we already know that new viruses are dangerous and so we
are looking out for them. Now we could extend that to looking out
for certain mutations. But so far we can't very well predict what
mutations or strains are more risky than others. Nor can we stop
certain mutations from happening or spreading.
And since that knowledge may help to create pandemic viruses,
should we keep the results secret, and how is that ensured and
controlled ? I think that question must be solved first.

> (v) Pathogenicity. To aid risk assessment and identify mechanisms,
> including reassortment and changes to the hemagglutinin cleavage
> site, that would enable circulating A(H7N9) viruses to become
> more pathogenic.

I don't understand. Why examine what makes viruses more
pathogenic rather than what makes them less pathogenic ?

> All experiments proposed by influenza investigators are subject
> to review by institutional biosafety committees. The committees
> include experts in the fields of infectious disease, immunology,
> biosafety, molecular biology, and public health; also, members
> of the lay public represent views from outside the research
> community.

this didn't work so well in the past. We still have no independent
risk assessment and flu-experts are of little help here.
Most research-critics in the H5N1-debate in 2012 were not happy with
the result, and how it went. See the Osterholm letter, the
FVR-letter, the nature-editorial by Wain-Hobson etc.

> Risk-mitigation plans for working with potentially
> dangerous influenza viruses, including 1918 virus and highly
> pathogenic avian H5N1 viruses, will be applied to conduct GOF
> experiments with A(H7N9) viruses (see supplementary text).

the main risk is the encouragement and help in knowledge
to do such experiments in uncontrolled facilities.
It's getting cheap and once the knowledge exists it can be
reverted and might be used years later with technics that we
don't anticipate now.
That important point is completely ignored here.

> Additional reviews may be required by the funding agencies for
> proposed studies of A(H7N9) viruses (see scim.ag/13BK5Hs).
> The recent H5N1 virus transmission controversy focused on the
> balance of risks and benefits of conducting research that
> proved the ability of the H5N1 virus to become transmissible
> in mammals (see www.sciencemag.org/special/h5n1). These findings
> demonstrated the pandemic potential of H5N1 viruses and
> reinforced the need for continued optimization of pandemic
> preparedness measures.

it also demonstrated the dangers of the research itself and the whole
subject was controverse and no consent was reached.

> Key mutations associated with adaptation
> to mammals, included in an annotated inventory for mutations in
> H5N1 viruses developed by the U.S. Centers for Disease Prevention
> and Control, were identified in human isolates of A(H7N9) viruses.

what annotated inventory ? Why CDC ? If they are already identified,
what else should/could be done ?

> Scientific evidence of the pandemic threat posed by A(H7N9) viruses,
> based on H5N1 GOF studies, factored into risk assessments by the
> public health officials in China, the United States, and other
> countries.

however the evidence may have "factored" or not, we have no
risk assessment, no probabilities. Neither by flu scientists
nor by independent commissions.

> Since the H5N1 transmission papers were published,
> follow-up scientific studies have contributed to our understanding
> of host adaptation by influenza viruses,

... thus increasing the threat of manmade pandemics ...

> the development of vaccines and therapeutics,
> and improved surveillance.

I'm not aware of these. An example would be helpful.
What exact vaccines,therapeutics,surveillance were improved
as a result of the H5N1 transmission studies ?

> Finally, a benefit of the H5N1 virus research controversy
> has been the increased dialogue regarding laboratory biosafety
> and dual-use research.

as if the research-community would consider that a "benefit".
Rather I was seeing recommendation -and I see them right now-
on how to _avoid_ these discussions by targeted communication
in the first place.

> The World Health Organization issued
> laboratory biosafety guidelines for conducting research on
> H5N1 transmission and, in the United States, additional
> oversight policies and risk-mitigation practices have been
> put in place or proposed.
> Some journals now encourage authors
> to include biosafety and biosecurity descriptions in their
> manuscripts, thereby raising the awareness of researchers
> intending to replicate experiments.

it cannot be controlled in most countries.

> The risk of a pandemic caused by an avian influenza virus
> exists in nature.

ahh, the risk exists in nature. Where did it come from, how did it
evolve, who made it ? Risks are just mathematical entities,
fundamental to the laws of physics and our universe.
We use science and experiment to better estimate the risks.

The risk of a manmade pandemic looks greater to me than the risk
of a natural pandemic. We can perform these mutations and reassortments
much faster and more targeted now than nature does.

> As members of the influenza research community,
> we believe that the avian A(H7N9) virus outbreak requires focused
> fundamental and applied research conducted by responsible
> investigators with appropriate facilities and risk-mitigation
> plans in place. To answer key questions important to public
> health, research that may result in GOF is necessary and
> should be done.

sure, but how much, and what's appropriate ?
Most non-virologists seem to think that the "influenza research
community" cannot be trusted on this.

> 2 Ron A. M. Fouchier1,*, Yoshihiro Kawaoka2,*,
> 3 Carol Cardona3, Richard W. Compans4, Adolfo Garc?*a-Sastre5,
> 3 Elena A. Govorkova6, Yi Guan7, Sander Herfst1,
> 3 Walter A. Orenstein8, J. S. Malik Peiris9, Daniel R. Perez10,
> 3 Juergen A. Richt11, Charles Russell6, Stacey L. Schultz-Cherry6,
> 3 Derek J. Smith12, John Steel4, S. Mark Tompkins13,
> 3 David J. Topham14, John J. Treanor15, Ralph A. Tripp13,
> 2 Richard J. Webby6, Robert G. Webster6
> sum=22 + Author Affiliations

by some strange coincidence these are all researchers who are involved
in similar research and benefit from it directly by funding.
It would be interesting to see some reknown researcher signing this
who is not directly involved, not biased.

These are all scientists, who write papers, who know how to do
science and research and finding and evaluating and weighting evidence.
Yet this very letter is so different from research articles.
It is just an opinionpiece, no support is given for it,
no references, no quotes. And it is so obviously biased into one
direction, without mentioning or discussing the counterarguments
that you have to wonder about the credibility of those who signed
it. (IMO)

I don't even have so much concern about this particular research,
there are other researches that are equally concerning, that may
also lead to human-made pandemics, but aren't being talked about.
But it's the whole process in general, the way how the research
is being done and funded and presented. How the problems are
attempted to be hidden, how the discussion about the problems
is formalized,institutialized but not scientificionalized.
This sort of research is generally going to lead us to a better
understanding of how pandemics happen, ok, but this also teaches
us how they can be created.
But the latter aspect aspect is just left out as good as possible
out of the debate and attempted to be hidden, not talked about in
the relevant published research papers.
Hoping it will go undetected ...

I think we need an international instituion that guides and controls
such dangerous research. That keeps results secret, if necessary.
That prevents and bans dangerous research, in the interest
of all countries. We should consider to ban the free trading of
these DNA-synthesizers. At least this should be discussed.
I didn't see that discussion. Do they even display a warning ?
 
Re: CIDRAP- Scientists air topics for H7N9 gain-of-function research

hmm, noone from the Hualan Chen team signed
 
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