Local antibody study could have far-reaching impacts

CSRA News

AUGUSTA, Ga. (WJBF) – Groundbreaking research and advancements are being made right here in the CSRA to fight the coronavirus, keep people from getting it, and perhaps keep people from getting it again. Dr. Ravindra Kolhe talks about how the Medical College of Georgia at Augusta University is leading the way in testing, and the recent study in frontline workers – how it focuses on antibody production, and the role it plays in potential reinfection.

Brad Means: Dr. Kolhe, thank you for being here, and thank you for your hard work.

Dr. Ravindra Kolhe: Thank you, Brad, thanks for inviting me on the show.

Brad Means: Are we starting to see the light at the end of the tunnel in this pandemic, or is it still pretty bad?

Dr. Ravindra Kolhe: No, I think we are at the beginning of the pandemic. I think the vaccine, introduction of the vaccine in our clinics is definitely a huge step to curb the virus, and people are lining up for that. I think that definitely is a great beginning.

Brad Means: Have you had both of your shots yet?

Dr. Ravindra Kolhe: Yes, I, my, both of my shots, so yeah, I had my second shot last week.

Brad Means: How do you feel? Any side effects that we need to know about as people consider getting it?

Dr. Ravindra Kolhe: I didn’t have any, absolutely no side effects for me, but I mean, as you know, the side effects are different for different individuals. You might get some sore shoulder where the shot is given, maybe mild fever, or chills, but those are probably the usual side effects you get with any vaccine, not just coronavirus vaccine.

Brad Means: Dr. Kolhe, I know that you’re leading the way for an extensive year-long study on antibodies. I’m certainly going to talk about that at great length, but before we dive into it, let me just go back to a couple of things. First of all, the pioneering efforts on behalf of the GEM team and others at MCG that you all did when it comes to rapid testing, you know, back in the day when this pandemic started, it took a couple of days at least to get your coronavirus test results back. Y’all changed that, right?

Dr. Ravindra Kolhe: Yes, I think it was a huge effort both on the people who were collecting the sample, as well as in the lab. Originally, I still remember the first week of March last year. It feels like forever, but it’s approaching one year, and it was taking us maybe a week or two, even 15 days to get the results back from the outside reference lab, because they were backed with the samples, as well as there were issues with supply chain. And I think that’s when we decided that we needed to have a local solution in our translational lab in the department of pathology, and we made the plan, we designed our first assay, and we went live. I still remember it was March 15th, I think 1:00 in the morning, we had our first test results, and had our first positive individual in CSRA.

Brad Means: Well, that’s incredible, and saliva testing. I wanted to give you props for that as well. People dreaded having those Q-tips stuck up their noses. So y’all just went, and came up with saliva testing as an alternative.

Dr. Ravindra Kolhe: Yes, I think that’s another feather in our cap. That, it was mostly motivated by a number of factors. I mean, one of the biggest issues was supply chain to collect the samples from nasopharyngeal swabs. The swabs were not available. The VTM, which we collect the sample was unavailable for a long period of time, and that’s when we started research on if saliva can be a true alternative sample, and we were one of the first few labs in the country who were able to put together a plan. I took us two, three months to work with FDA to get the tests up and running, but we were able to make that available for CSRA and the region, and I think it has worked very well, especially with the pediatric population. As you know, it’s very challenging to get the nasopharyngeal swabs from the kids, as well as our nursing home individuals, or anyone who doesn’t want to get tested with nasopharyngeal swab, I think the saliva testing is available for them.

Brad Means: Yeah, I think it’s just incredible, and I applaud you on all those fronts for making those advancements. Let’s look at this antibody study that you’re launching right now. So you wanna focus on some 1,500 people for the better part of a year, take a look at their antibodies, and we’ll kind of explain how that all works, or I’ll get you to. But first of all, you’re focusing on frontline healthcare workers, police, firefighters, even students in some cases. Why do you want that to be your sample group, those frontline people?

Dr. Ravindra Kolhe: So we have broadened the definition of frontline. I mean, at this moment, what we’re defining frontline is an individual who get exposed to, constantly exposed to other individuals in a setting which is unavoidable. I mean, we can talk about ICU nurses, or individuals in the ER, the EMT folks, I mean, even as simple, or as complex as the cashiers at the grocery stores, because these individuals have to do their job, they’re providing the necessary essential services, and then on top of that, they’re getting exposed to individuals who might be carrying asymptomatic positivity. So this, the definition of frontline we have broadened to make sure that we capture these individuals with the goal to identify number one, how long, I mean, the study itself is defined, and one of the questions which I personally have asked is, I mean, as you know, this is a NIAID-sponsored study. So National Institute of Allergy, Immunology, and Infectious Diseases, which Dr. Fauci is the head, that group has sponsored our study, and what we looking, along with UCLA, St. Jude’s, and then UGA is, it’s two things. One, if an individual gets infected with the virus, how long the antibodies, or the natural immunity stays-

Brad Means: Yeah, and let me jump in real quick. Let me ask you this. So if you wanna be a study subject, and let’s just focus on the participation here in Augusta, ’cause I know some people watching might want to sign up. So do you have to have had the coronavirus to take part? Is that what you’re looking for, so you can see if they have, or at one point had the antibodies?

Dr. Ravindra Kolhe: No, I think we were looking at absolutely naive individuals who never were tested positive, also individuals who are tested positive, because if the individuals are positive, then we want to follow-up them, and see how long those antibodies stay in them, and as well as if they can get reinfected. And if you were never positive, we want to test you every two weeks with saliva testing and see if you are gonna get positive in the setting which you are.

Brad Means: So right now, we don’t know how long those antibodies stay in your system, ’cause I know I’ve talked to a lot of people, and I’m sure you have too, who say, “Well, I never got tested, “but I sure did feel bad last spring. “I’m sure I had the coronavirus “but I’m sure the antibodies are gone by now.” We don’t know how long they stay in your body?

Dr. Ravindra Kolhe: Yeah, I mean, honestly, this is the fundamental question I’m asking NIAID, or the research question we are asking in this study is, as you know, even when you get infected with the virus, or any other external agent, your body produce natural defense against that virus, and that the way the natural defense is produced is by making antibodies. I mean, this is probably one of the few, or maybe the two or three longitudinal studies what we like to call, say is on a one, one to two year long, and on every month we’re collecting blood to see how long these antibodies stay. So the fundamental question we are asking is once you get naturally infected by the virus, how long your body produces antibodies to prevent the virus to be infected again? So there are some assumptions. There are some hypothesis. Some people say it’s three months, six months. At this given moment, we really don’t know, unless we get studies like these conducted.

Brad Means: Do you think not all antibodies are created equally? Do you want to try to find the strongest ones that are out there during your study?

Dr. Ravindra Kolhe: Yes, absolutely. I think there are multiple questions, sub-questions in the study. We are looking at individuals, which we will define this as super-producers in the sense that, let’s say, I get infected with the virus and I start producing these antibodies, and I would also get tested with saliva to see if I get reinfected or not. So as we know, there are a few individuals who are unable to produce antibodies, and will get reinfected, and there will be a few individuals who will continuously keep on producing antibodies, and will never get reinfected, and we want to identify those individuals, and study their immune system, especially what we call as the B cells and the T cells, and see if we can replicate that antibody production into vaccine development, the next, or third generation of vaccine development, which will be a stronger vaccine against the virus.

Brad Means: All right, so how do you set up that kind of environment where you’re trying to pit the antibodies against the virus itself to see how you can harvest, if you will, the strongest antibodies? How do you create that antibodies versus virus environment?

Dr. Ravindra Kolhe: So honestly, you cannot create that logically. But we are in a pandemic. We are in a situation, let’s say, if it’s an ICU nurse, or a police officer, if they get infected, their body is producing antibodies, but purely because of the kind of work they are in, they get continuously exposed to individuals who are positives. So this is where we are looking at individuals who are professionally being challenged by infections on a regular basis, and identifying or looking at whether these antibodies are preventing reinfection in those individuals.

Brad Means: When we come back, we’re gonna take a closer look at the study, how you can take part, and more on what the goals of this incredible study being undertaken by MCG at AU, and as Dr. Kolhe mentioned, other institutions around the country, take a look at the specifics of it, and what it might yield when it’s over in about a year’s time, when “The Means Report” continues.

Part 2

Brad Means: Welcome back to “The Means Report. We’re continuing our conversation with Dr. Ravindra Kolhe, a doctor at the Medical College of Georgia at Augusta University, specializing in all sorts of things related to the coronavirus. Right now, a year-long study that you could take part in that helps look at antibodies, and then use those antibodies when it comes to reinfection from the virus. Dr. Kolhe, you’ve touched on this in a couple of your answers, but I just wanted to, and some of this is repetitive, but I don’t think you can emphasize it, or re-emphasize it enough. If you’re able to recreate these antibodies, what happens next? Do you inject them into somebody, and that prevents reinfection, or makes reinfection go away faster?

Dr. Ravindra Kolhe: I mean, that’s one of the, one of the treatment actually is giving antibodies to individuals, but that’s still way early in the discussion. But what we are trying to do in the study is trying to understand how some of these individuals are making really strong antibodies, and whether the new generation of vaccines can understand that mechanism, and then make a better vaccine, so that the antibodies stay longer. So if you look at the older vaccination, you just needed maybe one or two shots and a booster, as compared to the flu vaccine, which we need to take every year. So at this moment, we really don’t know how long the vaccine-induced antibodies will stay, and studies like this will help the vaccine manufacturers to improve in the vaccine development, maybe in the second or third generations of vaccine.

Brad Means: Do you have a hypothesis as to what kind of person might have more longevity with their antibodies? I would think that the healthier, younger person would be more likely to fit that profile.

Dr. Ravindra Kolhe: Yeah, I think that’s one of the hypothesis, but at this moment, Brad, you’ll be surprised at, it all depends on what we call as the host genomes. It depends on our own genome what kind of antibodies individuals are making. At the beginning of the pandemic, the assumption was the younger people are safer as compared to the older people, older age group, and but now, as you’re following the mortality data, the demographics are shifting from 60 and below. We have cases even in CSRA where younger people have a severe reaction to the virus, and some of them have died. So at this moment, I think the age group is definitely into consideration, but I think it might be something in the individual’s genome, which will help us understand which individuals are gonna make robust antibodies against the virus and the vaccine, and then take it from there.

Brad Means: Let’s look at reinfection again, and just let me just kind of gauge how much you all know about it at this point. People think, some people think, that if they get the coronavirus and recover from it that they’re in the clear, that they shouldn’t even have to wear a mask anymore. You don’t like that approach, do you?

Dr. Ravindra Kolhe: Absolutely not. I think, at this moment, we really don’t know what is exactly the reinfection, how long that your natural immunity is preventing you from getting the virus. And again, I mean, as you’re following the news, there are newer strains coming in the community, both from the UK and South Africa, even in our own, in the US, and we really don’t know whether the new strains are gonna, other existing antibodies from the previous infection would work against the new strains.

Brad Means: Wow.

Dr. Ravindra Kolhe: So I think it’s a very false assumption that if once you get infected, you’re in clear, or you don’t need to wear a mask. And the second thing is you might not only get infected, but it can also spread it to your loved ones if you get reinfected. So I would still consider using the mask and social distance, even if you are infected.

Brad Means: What if people get picked for this study? What are you gonna do to them? And how often do they have to come see you?

Dr. Ravindra Kolhe: So the study is very simple. We are using saliva testing, which is a relatively non-invasive way of testing. Once you get enrolled in the study, we take a blood and saliva testing at the time of enrollment. If you’re positive, either by the blood or saliva, we put you in a positive arm. The positive arm is relatively simple, because here we take saliva and the blood every month to look at two things, one, how long your antibodies, your body’s making the antibodies against the virus. I think that’s one of our major goal. And the second with the saliva testing we see if you’re getting reinfected, or you’re not infected. And on the, if you are negative at the time of enrollment, we keep on collecting saliva every two weeks until you turn positive. So it’s a great way to get tested every two weeks with saliva, as well as if you’re positive to monitor how long the antibodies in your body are made.

Brad Means: Yeah, sounds pretty painless.

Dr. Ravindra Kolhe: Yeah, and I think that’s one of the reasons we are able to get a lot of people excited about it, because it is saliva testing. Yes, there is a blood at the beginning, but that really helps us to understand your baseline, whether you, you may be negative with saliva right now, but you might be exposed earlier, and the blood antibodies will tell us whether you were exposed earlier or not.

Brad Means: What do you think about taking vitamin C and zinc and some of these other home remedies that people are swearing by? Do you like that approach to try to ward off the virus?

Dr. Ravindra Kolhe: I mean, I’ll be very honest. There is no statistical or scientific data on that. They’re all assumptions. And as long as it’s not harming your body, I think it’s okay to take, but that does not replace the vaccination, or social distancing, wearing masks to prevent the infection.

Brad Means: Do you think that your antibody study could have far-reaching benefits when it comes to other illnesses? Do you think that what you discover could help people when it comes to things like the common cold or the flu?

Dr. Ravindra Kolhe: Yes, I think one of the things which we are looking is not just coronavirus, but we are also looking at what we call as circulating co-infections. So, as you know, there’s not only one virus in the community. There is also influenza, flu A, flu B, RSV, and other different types of viruses. So we are also looking at that, and we are looking at if you get infected with the two viruses at the same time, does it help you, or does it make it worse for you, because sometimes if you make antibodies for one virus, they might benefit fighting off the other virus. So as you know, by looking at the data for this year, there’s, there are very few cases of flu A and flu B, purely because of the social distancing and the masks. But I agree with your question that studying of these antibodies, it will definitely help us understand along with the study that whether there are additional viral infection in the community or not.

Brad Means: What other groundbreaking research are you working on, or is it just sort of all coronavirus, all the time over there at MCG?

Dr. Ravindra Kolhe: I think, I mean, you know, Brad, this is probably the biggest challenge since I was born, and then we, this is a global pandemic. We really, I personally have changed everything I do. I used to be mostly involved in oncology, breast oncology, and the oncology-related research, and my entire lab and all the PhDs in my lab, we have shift our focus pretty much I would say 100% on coronavirus-related test development and research. And as I keep on telling my group is that this is our biggest call, and we really have to come back, and sit together, and answer this in a more knowledgeable way, and MCG provides that platform for us. We may be in Augusta, or a small place, but the kind of people we have, the smart people we have on campus, the support from the leadership is phenomenal, and that’s one of the reasons we are able to do all these things, and bring studies like these from NIAID.

Brad Means: Yeah, when I think of the GEM team, you and your team, I think of superstars, and rock stars, and every other thing you can think of all rolled into one. Do you feel that when you’re in the lab working? Do you feel like, hey, this is the reason we got into medicine?

Dr. Ravindra Kolhe: Absolutely, I think, I mean, as I said, I was, I’m a pathologist by training. I went to med school four years, four years of PhD, and we’ve been continuously doing routine stuff, and suddenly you get to put on a situation where not only you are trained for this in med school, and your residency, but this is, as a pathologist, designing and developing new tests, and doing research was something which I was trained for, and I’m glad we got local support as well as smarter people on campus to make that happen.

Brad Means: Dr. Kolhe, from the bottom of my heart, and on behalf of this community, thank you for what you do. We’re gonna let the people know how to potentially sign up for your study, but please tell everybody at the lab there how deeply we appreciate their work. You’re doing great things.

Dr. Ravindra Kolhe: Thank you, Brad. It was a pleasure talking with you.

Brad Means: You too, sir, Dr. Ravindra Kolhe, Medical College of Georgia, leading the GEM team.

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