Like many other Americans, first-year graduate student Alice Ours now hesitates before she opens her mailbox, as cases of anthrax exposure are confirmed nationwide.
"I'm frustrated to have been robbed of my sense of security," said Ours, a student in the Graduate School of Arts & Sciences. "I can't even do something as simple as check the mail without thinking twice."
Ours is not alone in her concern.
Anthrax, a once relatively unheard of disease, now has the nation on edge. But even with the numerous cases of anthrax exposure confirmed to date, there has been only one fatality. Despite the dangers of anthrax, there are ways to control this particular biological threat.
The field of medicine now has two weapons in its arsenal against anthrax. The first is a vaccine, the second a tried-but-true tool: antibiotics. Antibiotics can treat anthrax, but only if the infection is caught early. In addition, new research in the biotech sector holds hope that anthrax will be treatable even after symptoms of the disease have begun taking their toll.
A deadly disease's evolution
Anthrax infection is caused by a rod-shaped bacterium called Bacillus anthracis. It is particularly suitable for use as a biological weapon because of its ability to hibernate in the form of a small, tough spore, enabling anthrax spores to be stored and spread in the form of a powder.
Once in a suitable environment, the spores can germinate into an active or vegetative form, rapidly multiplying and spreading throughout the body. Depending on whether the spores germinate in the skin, gut, or lungs, they result in three kinds of anthrax: cutaneous, gastrointestinal or inhalational. Inhalational is the most deadly of the three.
However, anthrax is not contagious from one person to another.
Current remedies
Disease from anthrax, caused by the release of deadly toxins by the bacteria as they multiply, can be prevented by immunization with a vaccine produced by the Bioport Corporation of Lansing, Michigan.
The vaccine primarily causes memory cells and antibodies against anthrax toxins to be formed in the immune system, according to Biology Prof. David Kittlesen.
When the immunized individual is later exposed to anthrax, existing antibodies in the blood neutralize bacterial toxins. Circulating memory cells rapidly divide as well, producing more antibodies and triggering further immune responses. This protects the individual from the toxins that lead to illness and death.
Because of limited production, the vaccine is available only to military personnel and certain Defense Department employees, all of whom are at the greatest risk of exposure.
Some would say this is for the best. The American Gulf War Veterans' Association, for instance, has published a list of objections to the vaccine, including allegations of serious side effects.
Jim Turner, a Defense Department spokesman, gives little credence to these grievances. In FDA testing, he said, the vaccine was proven to be "safe and effective," and that its side effects are, "comparable with those of any other available vaccine," including those with which children are routinely immunized.
Promising research
In addition to the vaccine, there are three types of antibiotics approved for treating anthrax, according to the Deptartment of Health and Human Services: ciprofloxacin (Cipro), tetracyclines and penicillin. A 60-day course of any one of these antibiotics can reduce the risk or progression of the disease for those who have been exposed to anthrax but do not have symptoms.
Nancy Winter, a Virginia Department of Health spokeswoman, said that in the event of an incidence of anthrax exposure in the Commonwealth, antibiotics would be provided for those who were potentially exposed. She discouraged the hoarding of antibiotics, noting that they should be used only under the guidance of a professional, they have a limited shelf life, and if used indiscriminately could lead to antibiotic-resistant bacteria.
Winter added that in the event of large-scale exposure to anthrax, necessary antibiotic drugs could be obtained within 12 hours from the National Pharmaceutical Stockpile.
But officials in the Department of Defense say antibiotics are not particularly effective in treating inhalational anthrax after symptoms have begun. Antibiotics only kill bacteria and have not been known to neutralize toxins. By the time a patient with the inhalational form becomes ill, toxins have built up to lethal levels within the body. Without a way to help the body neutralize or flush the toxins, there is little hope for the individual's survival.
EluSys Therapeutics, Inc., a biopharmaceutical company in Pine Brook, N.J., has tackled this problem and is developing an antidote that targets the toxins produced by Bacillus anthracis. Their work is based on a technology called the HP System, developed by the Biochemistry and Molecular Genetics Prof. Ronald Taylor.
"We're excited about the technology," said Dr. Linda Nardone, vice president of clinical and regulatory affairs at EluSys Therapeutics. The antidote being developed by EluSys relies on a heteropolymer, or HP, antibody molecule that would bind to both a component of the anthrax toxins and a receptor on the surface of red blood cells, according to Nardone. The anthrax toxins, bound to red blood cells, could be shuttled to the liver where they would be freed from the cells and destroyed.
Nardone added that although the system as it would be used for anthrax is still in the "pharmaceutical development phase," the company hopes to have the antidote ready for FDA clinical testing in two years, depending on funding.
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