
Experimental Drug Likely Saved Ebola Patients - codexjourneys
http://www.cnn.com/2014/08/04/health/experimental-ebola-serum/
======
ars
It's a Monoclonal antibody - those are some of the most expensive drugs there
are (i.e. hard to make in bulk). Add to that how difficult it is to administer
(keep frozen, thaw slowly).

We (appear to) have a way to stop the epidemic, yet we can't actually do it.

~~~
gnu8
I think we can all rest easy knowing that the ultra wealthy are safe.

~~~
emidln
To be fair, the ultra wealthy were already safe. It's pretty easy to avoid
sick people (particularly sick people spewing blood) when you can just hang
out on your island or on a large estate.

~~~
DatBear
Or any estate, or literally anywhere that isn't Africa...

~~~
pessimizer
Or any room that lacks someone currently dying of Ebola or recently dead from
Ebola. I'm pretty sure the only victims are caregivers and people who deal
with the dead - it's not easy to catch.

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gwillen
While I understand that giving people experimental drugs is extraordinarily
dangerous, it still saddens me that, in all likelihood, these guys only got
the rules bent because they were doctors. Anybody else would likely not have
had the option.

~~~
jacquesm
Doctors risk their lives. If and when they get ill during their work we should
spare absolutely no expense to get them well again.

Also, if I were a doctor in a situation like that it would be good to know
that my back is covered in case I do get ill. It would substantially increase
the likelihood of me continuing to risk my life. If I saw other doctors around
me being abandoned if they got ill then I might have second thoughts about
staying in that line of work.

~~~
gwillen
To be clear: I think it's _great_ that we went out of our way to get those
doctors back to the US for treatment. If it would be resource-prohibitive to
help everyone, I think it's important to help the helpers first, and we owe
that to them.

But the issue with experimental drugs is not one of resource constraint. We
_could_ give them to anybody who asks. It's not that we gave them to the
doctors because they are more deserving, but rather because they are insiders
to the system and thus can get strings pulled and rules bent.

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refurb
For anyone interested, here is a good article on the science behind the drug:
[http://www.forbes.com/sites/davidkroll/2014/08/05/ebola-
secr...](http://www.forbes.com/sites/davidkroll/2014/08/05/ebola-secret-serum-
small-biopharma-the-army-and-big-tobacco/)

The antibodies are produced in tobacco plants on a farm owned by RJ Reynolds
Tobacco.

~~~
jmulho
> "This same tobacco species is one also used by Medicago USA for development
> of a pandemic influenza virus."

I hope the above paragraph from the Forbes article was a typo.

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userbinator
If the choice was between certain death and an experimental drug that might or
might not work, I'd certainly choose the latter no matter how unsafe it could
be.

~~~
sparkman55
Right now, the lethality of this outbreak of Ebola is around 60%, so an
infection is definitely not certain death, particularly with the supportive
care possible in the U.S.'s best hospitals.

When you've already dedicated yourself by traveling across the world to help
people fight a highly-contagious disease, it makes sense that you'd be first
in line to test a serum (which, while experimental, uses a method that has had
great success in the past).

~~~
puzzlingcaptcha
I'll just mention that although many mAbs have been tremendously successful in
controlling various diseases (and being a staple of many lymphoma treatments
used currently) there are indeed very good reasons for caution, see e.g.
[http://en.wikipedia.org/wiki/TGN1412#Clinical_trials](http://en.wikipedia.org/wiki/TGN1412#Clinical_trials)

In this case this was a phase I trial. For those unfamiliar with trial design,
phase I is not meant to assess the efficacy of the drug but just its safety in
humans. It was provided at 1/500th of the maximum safe dose determined in
macaques.

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Shivetya
More description on how its created, and issues with this use.
[http://www.bloomberg.com/news/2014-08-05/ebola-drug-made-
fro...](http://www.bloomberg.com/news/2014-08-05/ebola-drug-made-from-tobacco-
plant-saves-u-s-aid-workers.html)

Interesting they used tobacco plants in the process and how this drug is not
scheduled for clinical trials until next year

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krschultz
Isn't it a bit early to be declaring victory? Especially given the fact that
this particular drug hasn't been used in humans before, I wouldn't say the
patients are out of the woods yet.

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mrfusion
Does these antibodies actually train the recipients immune system to produce
more of them? Why or why not?

Why can't we pursue a similar technology to treat the common cold, or MRSA for
that matter?

~~~
pistle
No. The human immune system needs to interact with something that "looks" a
lot like the actual virus to go through the process of developing antibodies.
An antibody would need the ability to enter a functioning cell and to use the
cell to create copies of itself. That is an unlikely thing.

Also, the rate of change of a virus means that antibodies for one strain may
not be totally or even partially effective against a slightly different
strain. (See flu, cold, etc.)

[http://cnx.org/content/m49785/latest/](http://cnx.org/content/m49785/latest/)

I'm guessing that this was a flood of antibodies that attach to the free virus
in the body that block the spots on the virus that would enable the entry into
healthy cells or hinder replication. The article indicates stopping infection
of healthy cells, so I'm further guessing the former.

Evolution is an arms race. The tech hope would be the ability to quickly
isolate, understand, and be able to generate vaccines or serums which would
have extremely high probabilities of being safe and effective in humans
without the long and complex trials needed to OK new treatments. By building
better vaccines, we merely put selective pressure on pathogens.

As far as we know, these people could die in weeks to years of kidney or liver
problems. They could develop neuro or muscular issues or cancer. This may have
only saved them for now.

~~~
mrfusion
Thanks. How about producing memory B cells from the patient's own stem cells,
and genetically altering them to produce the correct antibody?

~~~
omegaworks
That takes a while, much much longer then how long it takes a mouse to react
to a virus injected directly into its bloodstream. Human cells don't really
enjoy growing outside the body.

Genetic alteration involves infecting a cell with a virus that cuts DNA and
splices in its own (along with the correct antibody). You have the slight
possibility that the virus cuts randomly, turning off some cancer-inhibitory
pathways. B cells also have this really interesting maturation pathway where
they splice their own DNA randomly in the process of becoming an antibody-
producing cell.

Edit, to add: The B-cell maturation pathway is called V(D)J recombination.
Cool stuff. It's how the immune system can create cells that respond to things
it's never seen before.
[http://en.wikipedia.org/wiki/V(D)J_recombination](http://en.wikipedia.org/wiki/V\(D\)J_recombination)

~~~
mrfusion
Thanks. It still seems like there must be some way to transfer what one
individual's immune system has learned to another person. I'll have to read up
on it some more.

------
aaronbrethorst

        "As doctors, trying an untested drug on
        patients is a very difficult choice since
        our first priority is to do no harm, and
        we would not be sure that the experimental
        treatment would do more harm than good."
    

Uh, we're talking about a virus with a 90% mortality rate. What are you afraid
the drug might do? _Kill them_?

~~~
sgift
Damage their genome? So, they live but their children will have horrible
deformations? Or they live but their bodies get damaged so bad that they are
basically bound to bed and medical machines for the rest of their lives? Or
...

There are fates worse than death. And then ethics: Is it right to use patients
who fear for their live as medical test subjects? Is it really an "informed
consent" if a person who fears for its live gets promised a "possible cure",
even if that cure could do ANYTHING? If someone tortured you and you started
saying "I do everything, just stop it!" \- would that be informed consent?
Isn't Ebola a natural version of torture? And so on ...

It's easy to say "it worked! We cannot justify to not help those people who
will die anyway", but there is NO guarantee that it will work a third time. It
could dissolve the organs of the next person. And then it wouldn't sound so
great anymore, would it?

~~~
swombat
_It 's easy to say "it worked! We cannot justify to not help those people who
will die anyway", but there is NO guarantee that it will work a third time. It
could dissolve the organs of the next person. And then it wouldn't sound so
great anymore, would it?_

Even if it dissolved the organs of the next 2 people it'd still be a better
survival rate than Ebola itself (I understand this strain has a 60% mortality
rate, not 90%), so yes, it would still be great.

Either way, this is a choice that the patient should make for themselves. It
may be ethically dubious to offer experimental drugs to dying patients, but it
is obviously and completely morally and ethically reprehensible to deny a
possible cure to someone who is dying and wants to give the cure a try.

~~~
mentalhealth
This is a poorly considered view of experimental treatments. Particularly in
the case of aid work, experimentation on the patient population is not only
unethical in every formalizable sense, it is quite likely to inculcate a sense
of distrust in the treated (justifiably, and moreso if there are unanticipated
side effects), making treatment and control of future outbreaks more
difficult. A chance at life for a single patient may damage the chance for
hundreds if not thousands of future patients.

~~~
swombat
I'm not advocating experimentation on the patient population. I'm just saying
it is frankly unethical and immoral to withhold a potential cure from a
patient with a very high chance of dying, when you have that potential cure at
hand and they are making an informed choice that they want to give it a try.

I don't see how treating that one patient will prevent "treatment and control
of future outbreaks", either.

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ck2
I'm curious who foot the bill for all this.

These people were "missionaries" \- does that mean they were over there
proselytizing? Did they have any right to be there?

~~~
jnbiche
I'm betting the Mapp Pharma, pharmaceutical company, paid for everything.
After all, this represents an incredible opportunity for them to test their
drug.

~~~
nemo44x
More importantly, they get public exposure and the government sponsor for
their research will more likely resume this project. It was shelved due to
budgetary reasons.

However, their project is not really going to be able to compete with
companies like Tekmira who have begun human testing, having a much higher
efficacy in Primates (and likely humans) and are simply further along.

Ebola would unlikely be a block buster drug for any company - however, it
allows them to research technologies and systems for other, more profitable
things.

