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The future of the mRNA vaccine: what we have learned from COVID-19 will change the world in 20 years as antibiotics changed the 20th century

The technology behind the mRNA vaccines, which Moderna and BioNTech-Pfizer have designed to combat COVID-19, is giving us some hopeful news in the field of biomedicine.

First, BioNTech, the German company collaborating with Pfizer on one of the COVID-19 vaccines, has announced human trials to cancer vaccines using mRNA or messenger RNA technology. Modern, meanwhile, has presented preclinical data about a 3-in-1 respiratory vaccineIn addition to protecting against COVID-19, it would also protect against the flu and respiratory syncytial virus (RSV), a very common virus that causes mild cold-like symptoms.

Changing the rules of the game

The pandemic has been a boost for science and medical research and, particularly, for messenger RNA technology. This technology, used in Pfizer and Moderna vaccines, may soon be a game changer for many other diseases.

This is possible thanks to the versatility of mRNA platforms., which are faster and easier to use than those underlying the protein-based manufacturing of traditional vaccines. And, while it is still premature to make any kind of prediction, some, as science journalist Derek Thompson, suggest that mRNA technology could do what the Cold War did for the microchip. Or that in just twenty years, will change society in the same way that antibiotics changed the 20th century.

The mRNA vaccines are a new type of vaccines that protect against infectious diseases, but unlike the traditional ones, in order to awaken the immune response, they do not inject the attenuated or inactivated germ into our organisms. Instead, mRNA vaccines teach our cells to make a protein that triggers an immune response within our bodies. This immune response, which produces antibodies, is what protects us from infection if the real virus enters our bodies. Somehow then these vaccines teach use the code of our body to make its own defenses.

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Thus, mRNA vaccines do not contain the live virus that causes COVID-19. They also do not affect our DNA or interact with it in any way. The mRNA never enters the cell nucleus, which is where our DNA is. The cell breaks down and gets rid of the mRNA shortly after it has finished using its instructions.

The end of respiratory viruses

Moderna, encouraged by the success of its COVID-19 vaccine, recently began a 1/2 phase of trials of its mRNA-based injection for seasonal flu, targeting four different strains. It has finally announced positive preclinical data for a single injection combining the vaccines against COVID-19, respiratory syncytial virus (RSV) and influenza. That is, they have managed to combine 6 mRNAs against 3 different respiratory viruses in a single vaccine: COVID-19 booster + RSV booster + flu booster.

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The respiratory syncytial virus (RSV), a very common virus that causes mild cold-like symptoms but is dangerous in babies. Ribavirin is the only antiviral drug currently licensed for the treatment of RSV in children, although its use remains controversial. Seasonal flu kills more than half a million people a year. And the SARS-CoV-2 coronavirus, responsible for the COVID-19 disease, is advancing throughout the planet, adding more than 4.6 million deaths (in the United States alone, one in every 500 people has already died from this cause).

Thus, Moderna’s positive preclinical data, showing that they have successfully combined mRNAs against the current COVID variant, respiratory syncytial virus, and four influenza strains in a single injection, it is more than hopeful news for humanity.

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Combining different vaccines is not something weird and novel. Babies receive MMR vaccines that mix measles, mumps, and rubella. They also receive DPT shots for diphtheria, pertussis, and tetanus, while the annual flu shot is actually a mixture of four different strains of the flu virus.

However, current flu vaccines only offer about 40% to 60% efficacy, something that could change for the better thanks to mRNA technology. Furthermore, the flu is a perfect candidate for this technology, because although viruses change rapidly, mRNA vaccines can be developed very quickly, which means that manufacturers can quickly alter their vaccines if the annual prediction of the strain likely to circulate in the following season turns out to be incorrect. Another advantage of mRNA vaccines is their ability to combine different antigens to protect against multiple viruses. The versatility and speed of mRNA technology, then, is unparalleled.

Thus, the mRNA platform could potentially make vaccines against everything from infectious diseases to heart disease and even cancer.

Antigens against cancer

This is the approach that BioNTech has also used to combat what is considered the second leading cause of death in the world: identify four cancer-specific antigens. More than 90% of melanomas in patients have at least one of these antigens.

A cancer cell is just a damaged cell, and we all start to have damaged cells shortly after birth. Every time a damaged cell appears, our immune system starts up, which is responsible for identifying and eliminating it. When we are diagnosed with cancer, the situation has reached such a point that there are already many damaged cells and they are multiplying uncontrollably. And that explains why we can call it a “vaccine” and not cancer treatment.

This potential vaccine would be given to people who already have cancer rather than preventing cancer, but it would work by creating an immune response against cancer cells, understanding cancer as a continuous process rather than a pathogen. However, depending on the type of cancer, it may be possible to create preventive vaccines for people at risk of developing certain types of cancer (for example, people with a BRCA 2 mutation are at high risk of developing breast cancer).

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Messenger RNA has many advantages in fighting cancer, again for its versatility and ability to develop personalized vaccines for specific mutations of the tumor of each patient. On the other hand, messenger RNA can be used for our cells to produce immunostimulatory proteins or to inhibit immune checkpoints so that the tumor can no longer go unnoticed in a diagnosis.

This idea is not new, because for more than a hundred years it has been trying to tackle cancer through vaccination. However, these early attempts in which cells from the patient’s own tumor were injected were largely unsuccessful. Since then, tireless work has continued to develop therapies that allow the immune system to be used against tumors, and the first clinical trials with messenger RNA began around twenty years ago. After the pandemic, however, so many resources have been invested that all the knowledge acquired allows it to be applied to new objectives that until now were not on anyone’s horizon. The pandemic provided us with massive amounts of data that normally could not have been obtained.

As if that wasn’t enough hopeful news, mRNA technology has yet to give us many more surprises. BioNTech also announced a few weeks ago that it is preparing a vaccine against one of the world’s deadliest diseases: malaria. And, currently, there are more than 200 clinical trials underway to develop vaccines with this technology.

Consequently, all the bad things that COVID-19 has brought us has also implied a greater investment of resources and a huge acquisition of new knowledge, of new ideas, which finally can allow us to make a quantum leap in the treatment of many of the ailments that have been accompanying us for centuries, even millennia.