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Saturday, August 30, 2014

Working on a Cure for Ebola

Gary Kobinger works in a mobile laboratory installed by the National Public Health Agency of Canada, in Mweka, Congo, in 2007. The drug ZMapp was produced in collaboration with the agency. The Canadian Press

A Cure for Ebola

"What's quite remarkable is that we could rescue some of the animals that had advanced disease. For us, advanced disease is an animal that is just a few days from the end, if not only a few hours."
"I was quite surprised that we would be going as far, and this time rescue animals up to day five -- and all of them -- which was fantastic news."
"We know there is a point of no return when there is too much damage to major organs, so there's a limit."
Dr. Gary Kobinger, chief of special pathogens, National Microbiology Laboratory, Winnipeg, Canada
Gary Kobinger works in a mobile laboratory installed by specialists of the National Public Health Agency of Canada, in Mweka, Congo, Friday, Sept. 28, 2007. The experimental Ebola drug ZMapp was able to save infected monkeys even when treatment was only begun five days after the animals were infected, a new study shows. THE CANADIAN PRESS/AP, WHO, Christopher Black, HO
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"I never thought that 40 years after I encountered the first Ebola outbreak, this disease would still be taking lives on such a devastating scale."
"It is now critical that human trials start as soon as possible."
Peter Piot, director, London School of Hygiene and Tropical Medicine

"The gap between animal studies and first time, in-human studies even in the top institutions in the world is enormous."
"It's not ethically neutral to raise hopes in this way. Everyone is on the same page -- no one wants everyone to be dying. Everyone wants the game-changer."
"But I don't think that it's responsible or even respectful of the populations that are affected right now to be even reporting these things in ways that suggest it might be simpler than it really is. There's nothing simple about this."
Dr. Jim Lavery, managing director, Ethical, Social & Cultural Program for Global Health, St.Michael's Hospital, Toronto

"[The World Health Organization can't handle [the outbreak]. I don't see how, with the current measures, we're going to control the outbreak."
Mego Terzian, Doctors Without Borders president for France

The results of a Canadian-led study was published in the journal Nature online on Friday. Canadian scientists have succeeded in rescuing monkeys infected with a lethal dose of Ebola from certain death, in the latest study of an experimental drug already used, though officially unapproved, on a handful of Ebola victims in West Africa. This is the antibody-based compound known as ZMapp.

One hundred percent of the 18 rhesus macaques infected with Ebola survived, even when the drug was administered up to five days after they were exhibiting the symptoms of Ebola infection. All of the treated monkeys had full recoveries, with no side-effects, stated Dr. Kobinger, chief of special pathogens in Winnipeg. This represents the first study reported in monkeys of the version of ZMapp being administered currently in the West African outbreak.

As yet unlicensed, it is produced in collaboration with the Public Health Agency of Canada, and still requires testing in humans. Even so, it is unlikely ever to be produced in sufficient batches to make any impact on the current Ebola outbreak in parts of West Africa. According to a notice placed on the website of ZMapp's San Diego-based developer, Mapp Biopharmaceuticals Inc., the available supply has been exhausted.

Generated in tobacco plants that have been genetically modified to produce the antibodies, it takes a full month to produce 20 to 40 doses. Last November, a study was published on the testing of an earlier version of the drug, finding Ebola-infected macaques survived after being given the mixture within 24 hours of infection. In humans the infection is often fatal; the current outbreak has a fatality rate up to 90%.

The drug was given to seven patients infected in the West African outbreak, two of whom died, despite treatment. ZMapp, produced in collaboration with the Canadian federal public health agency, is comprised of three "humanized" monoclonal antibodies which are designed to bond to Ebola virus proteins. In humans, Ebola virus has an incubation period of between three to 21 days after exposure.

The first symptoms appear as a flu-like illness rapidly progressing to haemorrhage, multiple organ failure and shock-syndrome.

The monkeys had been infected with a strain of Ebola different than the one behind the current West African outbreak, but Dr. Kobinger explained that when tested in cell cultures, ZMapp stopped the new strain from replicating. 

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