The anti-malaria medication has made headlines in recent weeks as a potential solution against coronavirus. How accurate are these news reports? "Hydroxychloroquine does have properties that could turn it into a new asset," says Elena Gómez-Díaz, a researcher at the Institute of Parasitology and Biomedicine ‘López-Neyra’ (IPBLN-CSIC) and recipient of a BBVA Foundation Leonardo Grant in 2017. The proven efficiency of hydroxychloroquine in malaria treatments could contribute to speeding up the development of a COVID vaccine.
"With hydroxychloroquine we have the advantage that we already know its efficacy and safe dosage, and this, in the current scenario, would allow us to expedite progress," explains Elena Gómez-Díaz. The rapid expansion of the coronavirus is putting the international medical and scientific community to the test. The development of a new vaccine has become a top priority for the World Health Organization (WHO), which has launched 'Solidarity', a global clinical trial that has enrolled over 200 patients from 74 countries, including Spain, to test four of the most promising treatments. One of them is based on hydroxychloroquine.
Spain has already started testing its effectiveness in patients. Spain’s Carlos III Health Institute is coordinating the virological studies on the disease at European level. As part of the TOCOVID trial, funded by the coronavirus treatment research COVID-19 Fund, hospitalized patients enrolled in the program are administered a combination of drugs, including hydroxychloroquine. The purpose of this clinical trial is to assess whether the antimalarial drug, in combination with immunosuppressant tocilizumab and antibiotic azithromycin, can effectively reduce in-hospital mortality and the need for mechanical ventilation in Intensive Care Units.
The lessons malaria taught us
Elena Gómez-Díaz has devoted her professional career to researching infectious diseases. She has been researching malaria for years. Every year, the disease kills 400,000 people, mostly children, and affects 40 percent of the population in developing countries. Hydroxychloroquine has been one of the most effective treatments against the disease since it was first approved in the 1950s. However, as a result of its widespread use, the drug has stopped working against malaria caused by the Plasmodium parasite. Gómez-Díaz studies the biological - genetic and epigenetic - mechanisms that allow the parasite to quickly develop resistance against the drugs used to fight them, including hydroxychloroquine.
Elena Gómez-Díaz, researcher at the Institute of Parasitology and Biomedicine ‘López-Neyra’ (IPBLN-CSIC) and recipient of a BBVA Foundation Leonardo Grant - BBVA Foundation
She’s not all that surprised by the level of the attention the compound has drawn in recent weeks, due to its proven antiviral efficacy. "Today, hydroxychloroquine is still used to fight variety of autoimmune diseases, such as lupus and rheumatoid arthritis," says the Spanish researcher. This is relevant because, in the most severe cases, COVID-19 triggers an exacerbated response from patients’ defenses.
At the start of the outbreak, Chinese doctors already run a series of clinical trials in patients using hydroxychloroquine, the results of which haven’t been made public yet. On the other hand, 'in vitro' experiments conducted using cells have shown that hydroxychloroquine blocks the virus from entering cells. "Its use in the form of tablets may have positive results in humans infected with the coronavirus," she explains, which means "faster recovery times and shorter hospital stays."
However, the drug owes its recent rise to fame, not to all these research efforts, but to a small trial in France, that has been criticized as substantially flawed and failing to meet key scientific requirements. Donald Trump's recent comments mentioning this study, have sparked a hydroxychloroquine shortage in the United States. In Spain, the Government issued an order to ban the sale of the drug in pharmacies and seized existing reserves to ensure availability thereof both for chronically ill patients who already needed it and for the ongoing trials against COVID-19.
For Gómez-Díaz, hydroxychloroquine could potentially be “a new asset” against COVID-19, but emphasizes the need to avoid rushing and waiting for the results of the ongoing trials. "Research must continue to be a priority, and needs to be provided with resources, personnel and infrastructure to ensure we can count on solutions when we need them," he claims.
The rush to find emergency solutions in the current scenario underscores the need for continuous research, which requires constant investment. "Today it’s this coronavirus, but tomorrow it will be another pathogen or the impact of climate change. As in the case of hydroxychloroquine, solutions often derive from basic research, the kind of research that is not intended to yield a specific profit, but from which we all end up benefiting.”