The latest Ebola treatments, from plasma to ZMapp

Dr. Kent Brantly became infected with Ebola (as did Nancy Writebol) as he was working with a medical mission in Liberia at ELWA hospital.

ELWA was accepting patients, some of whom had Ebola.  Presumably, the two Americans who became  infected got Ebola from contact with infected people who were not suspected of having Ebola (Ebola symptoms are very similar to a number of other diseases, like malaria, endemic to Africa.)  They both contracted the disease and were near death.  They were being treated with the only available supportive measures, but their conditions were worsening.  It seemed as if they were going to die of their infections. Then they were treated with ZMapp.

ZMapp is an experimental drug that had been successful in treating monkeys infected with Ebola, but had never been tried in humans.  This is an interesting story, and fills in some of the missing information behind the use of ZMapp.  The story is told by Lance Plyler, MD, who was on scene in Liberia as Brantly and Writebol were becoming more and more ill.  Just the background on the location of the ZMapp is amazing. The story fills in some details that weren’t revealed previously.

Ebola life cycle, from the CDC.

Ebola life cycle, from the CDC.

For those interested in some additional basic information on ZMapp, this article is good.  It’s a straightforward explanation of how ZMapp works and how it is made.  There was only a limited amount of information available from the company and in the press prior to this.  This drug may or may not be effective in humans.  It’s been used on too few to get a reasonable amount of data.  In addition, Brantly also received human plasma that contained anti-Ebola antibodies, so his recovery may have been due to that.  Right now, there is no more ZMapp available but the companies involved are working to produce more.

Nancy Writebol describes the beginning of her illness and explains that she doesn’t know how she got Ebola.  She’s doing well and convalescing at home now.

Brantly has donated his own plasma which should contain a high concentration of anti-Ebola antibodies.  This plasma was transfused into Dr. Rick Sacra, a colleague who was also infected with Ebola in Africa.  Sacra is an obstetrician who was treating local patients.  Presumably one or more may have had Ebola and he contracted it that way.  He was evacuated to a hospital in Omaha and is in their biocontainment isolation unit there.    Sacra has also been given daily doses of another drug, possibly TKM-Ebola, which is different from ZMapp.  TKM-Ebola uses small interfering RNAs (siRNAs) to inhibit the production of Ebola.  Between Brantly’s plasma and the experimental drug, Sacra is improving.  His condition has been upgraded to “good.”

A fourth patient (a US MD who was working for the World Health Organization) who contracted Ebola in Sierra Leone was flown to Emory University Hospital for treatment.  Emory is where both Writebol and Brantly received treatment.

Vaccine trials have begun in the US for one vaccine NIAID/GSK Ebola vaccine. The US trial will be small (~20 people) but others will be enrolled in other countries. The vaccine, theoretically, would protect against Ebola Zaire (the strain causing the current outbreak) and Ebola Sudan, a different, but also deadly strain. Because of the spreading infection in Africa, if the trial is successful, the vaccine may be speeded into production rather than undergoing the years of additional clinical trials that are almost always required for a new drug. The vaccines might be able to offer some protection to people in the affected area who haven’t developed Ebola. Two other vaccines will begin initial trials within the next few weeks.

Oh, and if you’re interested in tracking Ebola on your smartphone, there’s an app for that. A graduate student at Western Kentucky University has developed a tracker that gathers information from Tweets from the affected areas of Africa and makes projections about the spread of the virus.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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2 Responses to “The latest Ebola treatments, from plasma to ZMapp”

  1. Hue-Man says:

    “Clinical trials of a second vaccine called VSV-EBOV, which was developed and licensed by the
    Public Health Agency of Canada, are slated to begin later this fall. Canada has donated between 800 and 1,000 doses of the vaccine to the WHO.”

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