Search for tag: "ebola"

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Interviewer: Ebola outbreaks have increased in frequency in recent years, culminating in the alarming epidemic that we face today. My guests, Dr. Michael Kay, professor of biochemistry at the University of Utah, and Dr. Debra Eckert have reported in the journal "Protein Science" a universal drug target against Ebola that could prevent future outbreaks.
You found a drug target for potential treatments against Ebola. What advantage does your target have over others that are being developed that you know of?

Dr. Eckert: What we did is we're looking at a particular area on the protein on the surface of the virus that's conserved across all known strains and species of the virus. Our drug target should be able to be used in screens to identify drugs that will be able to combat any Ebola virus outbreak. The virus in the current outbreak would be susceptible to such drugs, and future outbreaks, even if it was a different species.

Interviewer: I'm going to ask the question that's on everyone's mind. Is it possible that your new research finding can help in the current Ebola crisis?

Dr. Kay: We're focused on the long term, and the likelihood that this outbreak will not be unique and that this is going to be an ongoing problem in the future. Given how slow drug development processes are, developing from a target to a treatment that's available just takes too much time to be of real value in the current outbreak.
We're taking a long term view to have one agent that could be stockpiled and ready to go for diverse Ebola strains, versus having to stockpile a large number of individual distinct therapies for each of the different strains that are out there. We think this is something that will be more workable long term, more economical, and allow more rapid access for people who need the drug in an emerging epidemic without having to identify exactly which strain is involved.

Interviewer: Is there an impetus for creating a universal drug target as you've done? Do we know anything about how quickly the Ebola virus mutates?

Dr. Kay: The current outbreak has given us a tremendous amount of information on this that we haven't had before, because there haven't been that many who had Ebola before. The early data is that the virus mutates at a somewhat surprisingly high rate. The virus is changing during this current outbreak.

Dr. Eckert: It's important to note that we've looked at that sequence data that is available and our region has not changed in the current outbreak.

Interviewer: What are the next steps toward creating a treatment that utilizes this target?

Dr. Eckert: The next step is to use this target to screen for inhibitors that would stop Ebola from entering cells. We have started the screens in collaboration with our development partner, Navigen. We do have some preliminary results. Also, we would invite the scientific community to use this drug target to screen other types of molecules. Essentially, anything that was identified in the screen with this universal target should be effective against a broad range of Ebola virus species.

Interviewer: What do you think the hypothetical time scale could be moving from the screens to an actual treatment?

Dr. Kay: With Ebola, you can't do clinical trials in the traditional sense. You can't have, for instance, a group of patients that get placebo or the drug. The virus is not so common, so finding patients who have it at any given time may be difficult.
There's an alternate process for these kinds of very severe diseases that you can't do a traditional clinical trial. It's called the animal rule. The idea is that you can prove the drug is safe and then use an animal model to show that it works well in whatever model best mimics the human situation. That's all you can do. Then, you have to use it in the field in a crisis.
In theory, it could only take something more like three years, rather than the traditional ten.

Interviewer: Maybe we should back up a second and talk about what is this mechanism that you're targeting.

Dr. Kay: The region that we've identified we call the N-trimer. It is a trimeric coiled coil, three helical segments that bind together that play a very important role in Ebola's ability to enter and fuse with cells and to deliver its genome to the cell. That's the process that's the early part of the virus life cycle and what we're trying to stop to prevent the virus from ever getting into the cell. This machinery is extremely highly conserved. Importantly, it can be made separately from the rest of the virus and therefore is very convenient to use as a drug target.

Interviewer: Do you know the state of other treatments that are in development right now?

Dr. Kay: There are a number of treatments that are at the latest stage of development that are being talked about in the context of the current outbreak. The most important one that's been talked about is a cocktail of monoclonal antibodies, and this is called ZMapp. You may have heard about this in the news. Several patients were treated with this drug as a compassionate use in the current outbreak. It's such a small number of patients it's very difficult to tell whether or not that antibody cocktail has been successful or not.
There's been some very impressive data in monkeys showing that this drug works extraordinarily well even given at very late stages when the animals are already significantly symptomatic. That kind of data creates a lot of excitement in the field that this approach is likely to be successful in humans.
Unfortunately, there's a supply crunch right now. Antibodies are difficult and expensive to make. It takes a long time to build up a supply. This company has completely run out of antibody and is racing to make more in hopes of being involved in this current outbreak.
It's worth pointing out as promising as that therapy is it's focused on just one strain of Ebola, so it's not expected to work on other strains.

Interviewer: What are your next steps?

Dr. Kay: Now that we have this target in hand and we've validated its use, we are well underway in screening for mirror image D-peptides against this target. Our next stages are to optimize the promising hits that we already have, then work with our collaborators who have the ability to work with live Ebola, something that we can not do.
In particular, the U.S. Army has a wonderful infectious disease lab called USAMRID. We would send samples to them for testing in either cell based assays, which are relatively simple to do, to see if we can keep Ebola out of a cell, then ultimately animal based assays. They have a specialized lab for working with live Ebola, and that's the definitive testing to see if this is effective before advancing to human trials.

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Interviewer: I think one of the concerns that people have in America now that the first case of Ebola is here in the United States is that we're going to have a situation similar to that of Africa. Dr. Sankar Swaminathan is the Chief of the Infectious Disease Division at the University of Utah and an infectious disease specialist.

Tell me why we shouldn't expect the same thing happening in the United States as, related to Ebola, as we've seen happen in Africa.

Dr. Swaminathan: The situation is dramatically different here in the United States from West Africa. With regards to transmission, there are two places where transmission has occurred, in the community and in the health care setting. The health care setting in West Africa is about as different from the health care setting in the United States as one could imagine. There are mud floors, no gloves, no running water in many places. So we have the capability here to protect our health care workers and our other patients from spread in the hospital. And that does make a huge difference. There has really been no such transmission in Western hospitals, even when cases have been brought here of other viral hemorrhagic fevers as well.

The transmission in the community occurs because of a variety of reasons. But a lot of it has to do with resources, a lack of trust in officials and in the health care system so that people are afraid to seek care. People even chase away workers when people have come to help. This leads to increased transmission in the homes where people don't have the facilities to deal with it. So that's very, very different. So we're not going to have unchecked spread in homes or in hospitals in this country.

The second is the transmission is really not as easy as people seem to think. Many of these studies that have to do with varieties of transmission have been done in a laboratory. But when you've actually looked at outbreaks of Ebola, even people who lived in a home with someone who died of Ebola did not get the infection unless they were directly in physical contact with the patient, or cleaning up their blood, or vomit, or other bodily fluids.

It's all relative risk. And as long as we have good public health facilities, which we do in this country, it should and will be possible to isolate, identify contacts, isolate those contacts and limit the infection so that one person cannot spread the infection to more than another person.

Now while one can't rule out a secondary case, it's very, very unlikely. Given what we know, from all the evidence that we have as to how it's transmitted, as to how long the virus can live on surfaces, as to how infectious people are, it's very unlikely that we would have the kind of transmission that's occurring in West Africa today.

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Interviewer: How does Ebola change your travel plans? We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're speaking with Dr. Sankar Swaminathan. He's the Chief of Infectious Disease Division here at the University of Utah. And if you have travel plans, now you are thinking about Ebola. Does that change your travel plans, or is there something you can do?

Dr. Swaminathan: We have our travel clinic here at the University of Utah Hospital. At the Medical Center here we provide services both to people who are returning from abroad as well as people who are preparing to go abroad.
Now regardless of the current outbreak, the Ebola outbreak, there are a variety of other transmissible infectious diseases that one could pick up abroad. So we encourage anyone who's planning to travel to visit a qualified clinic or provider who can give that traveler the right advice as to what to do to keep themselves healthy, and also importantly provide them with medications that they may need to take as a preventative measure or a prophylactic medication. There may be medications that they need to just take if they get sick while there that they could carry with them.
And finally and probably just as important as anything else is having all the immunizations necessary. Now, depending on where you're going, you may need some immunizations that you may not need even in the United States. This gets very complicated, and it's a rapidly changing field, even on a weekly basis, as emerging infections crop up in places. There may be precautions that you need to take that you might not have had to take the last time.
So we provide this service not only to individuals but to groups that are traveling, for example, student groups or humanitarian aid workers. We can counsel them, give them their immunizations, give them a travel booklet and this kind of thing. We're all set up to do that.

Interviewer: So when you're getting ready for a trip, it's always very difficult to get all the things done that you need to get done. And I don't know that traveling out of the country I've ever done this before.

Dr. Swaminathan: Like you said, there's a lot of things that come up that you have to do, get your passport, this, that, and the other, but this is probably something that you should make time to do. You don't want your vacation of a lifetime ruined by this nor do you want a serious illness that's preventable. It's also in this current situation where there are so many serious threats that seem to be arising, emerging. It's important to at least prevent the ones that we can prevent.
If you come back with a fever, it rapidly becomes a potentially serious situation where many, many things have to be ruled out. The more you can help keep that from happening by preventing those preventable things, like malaria. Much of malaria is preventable. There are many other illnesses that you can get, as I said, immunization for, prophylactic medicines for. It's well worth your time.

If not here at the University of Utah, at state public health clinics, and so on. They also provide travel counseling and immunization. We work with several of these municipal health clinics, and we provide them consultation. We have physicians who are specifically expert in travel. Some who have lived in places like Bangladesh and have traveled abroad to various parts of Africa, for example.

So if you have something that you've acquired abroad, we've probably seen it. At least, one of our physicians has had some experience with it.

Interviewer: So if I'm traveling out of the country, regardless of where I'm going, I should probably stop by one of these clinics.

Dr. Swaminathan: Absolutely.

Interviewer: And if I've returned and I'm getting some symptoms of I'm getting sick, don't just blow it off as a cold or something like that, go see one of these clinics.

Dr. Swaminathan: That's right. We can provide very rapid appointments for people who are returning from travel, generally, within a day or two. If you call, we can also have one of our physicians call you back to discuss what the issues might be as well, and see how urgently you should be seen. And they can often just provide reassurance, if nothing else, when you've returned from abroad.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.