Swine-Derived Medical Therapies for SARS-CoV-2: Crossing Muslim Bioethical Concerns and Ensuring Fairness – Padela – – Xenotransplantation

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In the June issue of the European Journal of Immunology, Vanhove et al. shared promising results using a novel glyco-humanized pig polyclonal antibody, XAV-19, to combat the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 In their studies, the immunized animals developed a rapid polyclonal hyperimmune response that inhibited infection of human cells with SARS-CoV-2 in cytopathic assays. A related in vitro study found that XAV-19 was also effective against the British and South African variants of SARS-CoV-2.2 These encouraging results triggered a randomized, double-blind, placebo-controlled phase 2 trial in patients with SARS-CoV-2-induced pneumonia.3

The advanced benefits of using glyco-humanized polyclonal antibodies on convalescent plasma are numerous, including a more directed and consistent neutralization of the SARS-CoV-2 virus and a decrease in the adverse effects associated with inflammation.1 Therefore, these data open a new frontier for human therapies that target pathogens without evoking unwanted immunogenic responses. At the same time, the porcine origin and the incubation of these antibodies may raise concerns among some religious communities. In anticipation of the near future where XAV-19 is an option for SARS-CoV-2 infection, and where glyco-humanized pig polyclonal antibodies are used to combat other diseases, this correspondence is intended to raise awareness of these potential concerns and suggest a way to address them.

The worldwide Muslim community, numbering nearly 2 billion people, may be concerned about the use of humanized antibodies to pork glycol. Based on scriptural sources, Islamic legal tradition considers pigs to be inherently dirty, najas al ayn, and as such, it is not only prohibited to consume, but also generally prohibited to use for human welfare.4 This legal notion sheds light on ethical norms and cultural attitudes regarding pork products in healthcare. Over the past decades, Muslim patients and clinicians around the world have asked religious authorities about permission to use pork valves, porcine heparin, vaccines, and gelatin-containing drugs. of porcine origin, xenotransplantations of pigs, etc. The answer of Islamic jurists to such questions is almost unequivocal; Although the general use of such therapies is prohibited, exceptions can be made on the basis of a credible life threat if the treatment is not taken and in the absence of other effective treatment regimens.5 Recognizing that Muslim countries are not at the forefront of biomedical innovation and that contingent use should not be the norm, some Islamic legal councils are also calling on Muslim stakeholders to continue their research on non-medical therapies. swine. In this context, various Muslim audiences remain uncertain and sometimes shy away from therapies that may be linked to pork. If XAV-19 proves to be an effective therapy for SARS-CoV-2, its use in Muslim communities will likely collide with these norms and attitudes. Therefore, a targeted religion-appropriate education and communication strategy that addresses points of religious concern while promoting informed choices will need to be adopted in order to ensure equity in health care.

Since religious eligibility depends on the absence of effective alternative regimens and a potential threat to life, XAV-19 will need to be significantly more effective than convalescent plasma in the treatment of specific illnesses related to cancer. SARS-CoV-2 which are life threatening. This data will need to be provided to Islamic jurists so that they can authorize contingent use for Muslim policies. At the same time, at the community level, religiously relevant communiques that include decision aids noting religious eligibility in cases of death threats may prove useful. Beyond that, educational seminars or podcasts that bring clinicians and religious scholars together to dispel myths about science, discuss the various religious decrees on the use of pork in medical therapy, and encourage informed decision-making. be appropriate.

A model of religiously responsive and ethically balanced resources and programs was recently implemented in the United States and addressed the topic of organ donation. Organ donation is controversial in Muslim public circles given stories of mistrust of the biomedical establishment, concern over the entity of “brain death” and religious values ​​around dignity and of the sacredness of the human body. Islamic jurists also have different positions on the issue.6 As a result, the attitudes of Muslims are more negative than those of their counterparts, and Muslims are known to be reluctant to receive and donate organs.7 To respond to this context, my research team joined forces with Fiqh Council of North America and the International Institute of Islamic Thought to investigate the religious, clinical, social, scientific and bioethical dimensions of the issue. In the end, we came together to provide a religious edict that spelled out the eligibility requirements.8 We have also partnered with several organ procurement organizations to design a religiously tailored brochure9 and conducted a randomized crossover trial of educational workshops in mosques that was found to be effective in increasing knowledge about the religious and biomedical dimensions of organ donation, preparing participants to make informed choices about it and their intention to donate organs.ten As XAV-19 moves towards Phase 2 trials and other humanized porcine glycol antibodies become viable treatment options, pharmaceutical and clinical stakeholders should begin to lay the groundwork for public acceptability by engaging. with Muslim stakeholders and developing religiously relevant and ethically balanced educational resources. .

ACKNOWLEDGEMENT

The author thanks Dr Emanuele Cozzi for his work on this new therapy and his help in this correspondence.

    CONFLICT OF INTEREST

    The author has no conflicts of interest to report and is solely responsible for the content of this manuscript.

    ETHICAL STATEMENT

    This submission does not involve research on human subjects and therefore ethical oversight. There is no data to report or share.

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