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Urban Jungle

Eric Lai

It is amazing what you can miss if you bat an eyelid. I've just had a short holiday in Phuket. Thailand, the country of smiles, is always a good place for Hongkongers to escape the hustle and bustle of this urban jungle to unwind.

But I returned from this short holiday to find I had missed an Earth-shattering announcement last week of the breakthrough discovery of a monoclonal antibody that will deactivate 10 of the 16 subtypes of the influenza virus, including the H5N1 bird flu virus.

This is an amazing discovery when you consider that the annually recommended flu vaccine is effective in fighting only a single strain of the influenza virus and that government health organisations around the world have to make a wild guess at what will be the predominant strain in the coming flu season.

With this new antibody there is no longer any guesswork, as it is effective against thousands of strains. This means the end of many strains of influenza viruses, just as we wiped out the smallpox virus. Before the advent of the smallpox vaccine, that disease was a terrible scourge and the source of great dread. It was one of the most deadly diseases in human history. It afflicted mankind for more than 12,000 years and killed an estimated 500 million people.

But after a concerted international effort, the World Health Organisation was able to announce its eradication in 1979.

Amazingly, the smallpox virus is the first and only infectious disease that we humans have managed to eradicate. It was a historic moment, with mankind facing the challenge of nature and winning through luck and ingenuity.

I hope I live to see the eradication of the scourge that is influenza, which would be an achievement to rival the discovery of penicillin.

The development of the smallpox vaccine was the result of a serendipitous mix of a sharp mind and great observation.

In 1796, Edward Jenner observed that milk maids who contracted the less virulent cowpox were immune to smallpox, and this led eventually to the development of the vaccine. You will probably be surprised to learn that vaccination has been practised for thousands of years.

Sanskrit texts make reference to inoculations as early as 1000BC, but the first detailed reference was by a Chinese author, Wan Quan, in his book Douzhen xinfa published in 1549.

In it, he describes the practice of blowing scabs of smallpox lesions up the noses of healthy individuals. This induced a milder form of the disease in the patient, who then became immune. It was a dangerous practice, since there was a 2 per cent death rate, but it was certainly better then the 35 per cent death rate of the regular disease.

The breakthrough on influenza viruses is the result of a lot of painstaking hard work and searching. The researchers have potentially isolated what is considered the holy grail of medicine, the cure for the common cold.

The influenza virus, greatly magnified, looks like a spherical core with 'lollipop sticks' protruding from all over it. It enters animal cells by attaching itself to the cell membranes through proteins on the tips of the sticks.

But the proteins on the tips are mutagenic - able to change constantly. This ability is what has defeated previous attempts to find a cure.

By the time our immune system has recognised the virus, the mutagenic tip has already changed to another protein, acting as a decoy that steers the immune system away from finding the core of the virus. Our bodies are therefore unable to identify and fight the virus.

Previous vaccines for the flu imitate the mutagenic portion of the tip of the lollipop sticks. But as the tips change, the vaccines lose their effectiveness.

The scientists' big breakthrough is the discovery of a monoclonal antibody that bypasses the tip to attack the stick part of the lollipop stick, which is much less mutagenic and is common among the subtypes of influenza A.

Unfortunately, this is only the beginning of the road to a vaccine, but it is the most important find. At the moment, it is uneconomical to create these antibodies to cure the flu, because the cost for a single person would be tens of thousands of dollars.

The scientists still need to reverse-engineer the relevant segment of the lollipop stick and then conduct various trials.

There could still be a wait of five years or so before we see successful human results. But then we can make the handkerchief obsolete and laugh away fear of a bird flu pandemic.

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