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Trop. Med. Infect. Dis. 2017, 2(3), 48; doi:10.3390/tropicalmed2030048

In Vivo Efficacy of a Cocktail of Human Monoclonal Antibodies (CL184) Against Diverse North American Bat Rabies Virus Variants

1
Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
2
East Tennessee State University, James H. Quillen College of Medicine, Johnson City, TN 37614, USA
3
University of Texas Medical Branch, 301 University Blvd, Galveston, TX 50555, USA
4
Crucell Holland BV, Archimedesweg 4, 2333 CN Leiden, The Netherlands
5
LYSSA LLC, Cummings, GA 30040, USA
*
Author to whom correspondence should be addressed.
Received: 3 July 2017 / Revised: 8 September 2017 / Accepted: 12 September 2017 / Published: 20 September 2017
(This article belongs to the Special Issue Rabies Symptoms, Diagnosis, Prophylaxis and Treatment)
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Abstract

Following rabies virus (RABV) exposure, a combination of thorough wound washing, multiple-dose vaccine administration and the local infiltration of rabies immune globulin (RIG) are essential components of modern post-exposure prophylaxis (PEP). Although modern cell-culture-based rabies vaccines are increasingly used in many countries, RIG is much less available. The prohibitive cost of polyclonal serum RIG products has prompted a search for alternatives and design of anti-RABV monoclonal antibodies (MAbs) that can be manufactured on a large scale with a consistent potency and lower production costs. Robust in vitro neutralization activity has been demonstrated for the CL184 MAb cocktail, a 1:1 protein mixture of two human anti-RABV MAbs (CR57/CR4098), against a large panel of RABV isolates. In this study, we used a hamster model to evaluate the efficacy of experimental PEP against a lethal challenge. Various doses of CL184 and commercial rabies vaccine were assessed for the ability to protect against lethal infection with representatives of four distinct bat RABV lineages of public health relevance: silver-haired bat (Ln RABV); western canyon bat (Ph RABV); big brown bat (Ef-w1 RABV) and Mexican free-tailed bat RABV (Tb RABV). 42–100% of animals survived bat RABV infection when CL184 (in combination with the vaccine) was administered. A dose-response relationship was observed with decreasing doses of CL184 resulting in increasing mortality. Importantly, CL184 was highly effective in neutralizing and clearing Ph RABV in vivo, even though CR4098 does not neutralize this virus in vitro. By comparison, 19–95% survivorship was observed if human RIG (20 IU/kg) and vaccine were used following challenge with different bat viruses. Based on our results, CL184 represents an efficacious alternative for RIG. Both large-scale and lower cost production could ensure better availability and affordability of this critical life-saving biologic in rabies enzootic countries and as such, significantly contribute to the reduction of human rabies deaths globally. View Full-Text
Keywords: bat viral diseases; monoclonal antibody; immune globulin; lyssavirus; post-exposure prophylaxis; rabies; vaccine; zoonosis bat viral diseases; monoclonal antibody; immune globulin; lyssavirus; post-exposure prophylaxis; rabies; vaccine; zoonosis
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Franka, R.; Carson, W.C.; Ellison, J.A.; Taylor, S.T.; Smith, T.G.; Kuzmina, N.A.; Kuzmin, I.V.; Marissen, W.E.; Rupprecht, C.E. In Vivo Efficacy of a Cocktail of Human Monoclonal Antibodies (CL184) Against Diverse North American Bat Rabies Virus Variants. Trop. Med. Infect. Dis. 2017, 2, 48.

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