Eleanor Fish thinks interferon, a drug usually used to treat people with cancer, might help patients with serious cases of H1N1.
The immunologist at the University Health Network in Toronto has preliminary data that suggest the synthetic version of a compound produced by the human immune system might be an effective treatment for swine flu. But she is having trouble securing the money to test it.
"Finding the funds to demonstrate safety and efficacy in patients is a tremendous challenge - remarkable given the concerns about an H1N1 pandemic," she said. "But I am determined to pursue this."
Other Canadian researchers also have urgent questions about H1N1. Are people with acute or chronic infections, like latent tuberculosis or parasites, more at risk of being hospitalized or dying from it? Is vulnerability linked to specific genes?
But perhaps the biggest question is whether they can design experiments, get the ethical approvals and find the funding quickly enough to make a difference in this pandemic.
Dr. Fish is one of many Canadian scientists forming teams to apply for grants from a $1.2-million fund to study H1N1 that the Canadian Institutes of Health Research is offering. The deadline is Aug 10, but the funds aren't expected until October.
Flu season will be well under way by then, Dr. Fish said. "It is very obvious where attention needs to be focused right now - treatment and patient care. There are individuals in the scientific community who are acutely aware of the urgency of the situation and frustrated at the lack of resources directed at one specific area: antivirals."
She said considerable attention and funding has rightly gone into research on infection control in the community and health-care facilities, research of the transmission of the virus and work on a vaccine.
But it is unlikely a vaccine will be available before flu season, she said, when many more Canadians could become infected. It is also unclear whether there will be enough.
So short-term treatment must focus on antivirals, she said. The virus is already becoming resistant to Tamiflu, one of two antivirals that can keep it in check if taken within days of the first symptoms. That leaves only Relenza, which must be inhaled, making it less useful for patients with lung problems.
Dr. Fish and collaborators are proposing to evaluate several antivirals, including interferon, for treating H1N1, to study lung injury during infection, and the flu's effect on a person who already has a bacterial infection.
The $1.2-million is meant to bring together large teams of researchers, but it is not adequate, she said. It also is not intended for clinical trials, so Dr. Fish will have to look elsewhere for money to study interferon as a treatment.
Interferons are produced by the immune system to combat viruses, but doctors using synthetic versions during the SARS outbreak in 2003 worried they would increase inflammation in the lungs of patients with severe cases.
As other approaches failed, Dr. Fish and colleagues did a small pilot study on 19 patients that had promising results, but the outbreak ended before they could follow up.
Lab work shows interferon might be effective against H1N1, but studies involving seriously ill patients are needed.
Bhagirath Singh, scientific director of the CIHR's Institute of Infection and Immunity, said he understands the urgency, with flu season only six to eight weeks away.
Dr. Singh said he is hoping for more money from the government and will try to speed up the approvals process so the $1.2-million starts to flow before the fall.
But he said the Canadian research community is far more prepared to work on influenza today than it was in 2006, when concerns over avian flu prompted the federal government to start investing in pandemic research.
At the time, only four teams in the country were working on influenza, he said, but since then, the CIHR has spent $39-million on pandemic research through 71 different proposals.
Work on H1N1 that has already been funded includes a network focused on evaluating vaccines and a project to track the evolution of the virus and evaluate its susceptibility to antiviral drugs.
"There is money out there. There is investment. Do we need more money? Absolutely," Dr. Singh said.
Why do some otherwise healthy people get seriously ill or die from H1N1?
At the Hospital for Sick Children in Toronto, Dat Tran is investigating whether particular genes are associated with a severe response to the swine flu virus.
A 2008 study of Utah residents who had died of influenza over the past 100 years found that their relatives - both close and distant - also had an increased risk of dying from the flu.
This suggests that genetics is a factor. To zero in on which genes may be involved, Dr. Tran has taken DNA samples from 200 children with the seasonal flu and 100 who had H1N1.
He would like to have 1,000 participants in the study to see whether he can find genetic differences between those with severe flu symptoms and those with mild ones. He is also still talking to collaborators about which genes to focus on.
Will he get any answers before the fall flu season?
"I never say never."
But genetics are likely only part of the explanation for why some healthy people are more vulnerable than others.
Research involving two remote native communities in Northern Ontario that began well before the H1N1 pandemic could provide insight into environmental factors.
Lionel Filion, an immunologist at the University of Ottawa, has a hunch that people whose immune systems are already fired up to fight an acute or chronic infection may be more vulnerable to H1N1.
Three years ago, he and several colleagues set out to study whether chronic diseases in the two communities were linked to environmental pollutants or disease-causing microbes in the food or water. Ninety volunteers provided blood samples, and local food and water samples are also being analyzed. He is hoping to follow up with the blood donors and find out whether those who had a chronic infection - such as latent tuberculosis - had more severe symptoms if they had the flu.
New blood samples would show whether people with acute infections - with the intestinal bug giardia for example - were also more vulnerable, said Dr. Filion's colleague, Jason Tetro of the Centre for Research on Environmental Microbiology at the University of Ottawa.
"There may be contributing factors that lead to an increased susceptibility to H1N1. What are those factors? Can we find them in time to prevent widespread mortality?"
Dr. Filion needs to secure permission from the two communities to expand the research and to get the necessary ethical approvals and funding. He doesn't think it will all come together before the fall flu season.