
Ebola: Experimental drug ZMapp is '100% effective' in animal trials - richardwigley
http://www.bbc.co.uk/news/health-28980153
======
state
I'm surprised that so much of the coverage of ZMapp doesn't include the fact
that the drug is produced in tobacco plants.

To me, this is the single most interesting and impressive fact. It's also
likely the main reason why "the limited supplies will not help the 20,000
people predicted to be infected during the outbreak in West Africa." Scaling
production of antibodies grown in plants can't possibly be straightforward.

~~~
rch
DARPA thinks it's a scalable method, at least for producing flu vaccines:

"Accelerated Manufacture of Pharmaceuticals (AMP), companies in four states
are building facilities where they can quickly produce vaccine-grade proteins
grown in the cells of tobacco plants. Once they produce the proteins, the goal
is for each company to scale up its process to produce 100 million doses of
H1N1 flu vaccine per month."

[http://www.defense.gov/News/NewsArticle.aspx?ID=61520](http://www.defense.gov/News/NewsArticle.aspx?ID=61520)

~~~
state
Right. It certainly seems like a much more scalable way to produce antibodies.
It's just getting all the infrastructure in place that's going to be a
challenge.

~~~
dnautics
It's actually not very scaleable. The yield is incredibly low. Processing
plants is also difficult because you have to deal with a bunch of stupid stuff
like tough cell walls, etc. I'm not even sure that the glycosylation patterns
that tobacco puts on the antibodies are human-compatible (i.e. problems could
occur if you try to use tobacco-derived antibody therapeutics in a patient
more than once).

The choice to use tobacco was very likely a symptom of "if you have a hammer,"
common in biology and chemistry, where some tobacco researcher (tobacco is a
well-studied model organism) wrote a convincing grant with a handful of
accurate but marginal improvements over contemporary systems (in this case
glycosylated vs. unglycosylated) that would enable commercialization, and
downplayed some of the setbacks (low yield). Meanwhile other technical
approaches have matured that are really good at tackling those problems but
without the other setbacks... but just weren't awarded seed money.

------
kqr2
In this NYT article:

[http://www.nytimes.com/2014/08/30/world/africa/study-says-
zm...](http://www.nytimes.com/2014/08/30/world/africa/study-says-zmapp-works-
against-ebola-but-making-it-takes-time.html)

It mentions that all 3 control group animals died.

Does anyone know why the control group is so small compared to the test group
of 18?

~~~
skosch
I would hazard a guess that we know Ebola to be pretty close to 100% lethal,
and if you know that three out of three control animals died, then the virus
is "working" and there's no need to sacrifice many more animals.

~~~
hga
Exactly. The control group is there to, for example, make sure your culture of
Ebola is really that, viable and so on. If they didn't get sick, let alone
die, you'd know your experimental group results were invalid.

Monkeys are also very expensive animals to do research on, and no one likes to
kill them, or at least we don't tend to have the same sentiments about mice
and rats.

------
trhway
why we still test effectiveness on animals when there are several thousands of
people who has no downside and only upside for the drug to be tested on them?
Ethics? It would be a strange ethics that had worked only until an American
needed the cure. Something isn't right that this drug got out of shadow only
when there was a need to cure an American. I mean, of course, thanks God, that
i have real chance of soon becoming an American too :)

~~~
Crito
[http://scientiasalon.wordpress.com/2014/08/14/on-the-
science...](http://scientiasalon.wordpress.com/2014/08/14/on-the-science-and-
ethics-of-ebola-treatments/) (related HN discussion:
[https://news.ycombinator.com/item?id=8189528](https://news.ycombinator.com/item?id=8189528))

The second paragraph does a good job of summing up ethical concerns related to
this particular outbreak (standard ethical concerns also apply):

 _" The first two patients to be treated were Americans. Prior to this came
the old (and historically justified) fear of testing potentially dangerous new
treatments on vulnerable populations in developing countries rather than on
privileged first world patients. The first ever treatment was not given to an
African doctor because of this concern [1]. After Westerners were treated,
complaints rose about giving infected Westerners access to a new drug while
infected Africans went without. These two concerns are obviously mutually
exclusive. People are concerned, they are just not sure about what, sometimes
even voicing both concerns in the same article [2]."_

~~~
makomk
One would hope that African doctors would be reasonably capable of assessing
the risks and benefits of taking experimental new treatments themselves. I
seem to recall the trials that people have been concerned about involved
large-scale testing on poorly-educated members of the general population.
(Also, I think that kind of testing still happens even now!)

------
contingencies
Does anyone know why the WHO reporting frequency seems to be irregular?
Recently it seems to be timed with the release of defensibly bad versus
downright scary figures.
[https://en.wikipedia.org/wiki/2014_West_Africa_Ebola_virus_o...](https://en.wikipedia.org/wiki/2014_West_Africa_Ebola_virus_outbreak#Timeline_of_the_outbreak)

~~~
hga
I would suspect that reporting figures to the WHO, which I'll add is not
providing a whole lot of help, is a rather low priority to these countries.

Plus the way this epidemic is playing out in the 3 major countries makes the
figures altogether iffy (Nigeria is an obvious exception, with one index case
caught quickly).

------
coldcode
It's interesting to me that people are working on a cure for Ebola yet no one
is deeply interested in working on new antibiotics. Ebola is a scary disease
yet rare (across the entire planet) so there doesn't seem to be a lot of
monetary reason to invest in it. Antibiotic resistance is far more widespread.
I guess I don't always understand how the pharmaceutical industry decides what
to look at.

~~~
sliverstorm
New antibiotics are in the works all the time. We are currently in an arms
race with infections; I recall reading that new antibiotics are expected to
last for only 10 years, and future antibiotics are going to last even less
time (before resistance develops)

Why doesn't it get more press? I don't know for sure, but it is:

\- Ongoing, which makes for bad news

\- Kind of depressing, because we are slowly losing the battle

\- Feels a little bit hopeless, because foolish choices by individuals
accelerate the development of resistance, and inventing new antibiotics
doesn't fix that fundamental problem

~~~
richardwigley
Yeah, it is depressing in the UK - the usage of antibiotics on colds (i.e. of
no value to most people with colds) has increased 40% this century even with a
campaign to limit usage.

I've personally spoken to a couple of GPs/Docs and they said after a few hours
of people coming in and asking they get tired and give in.

Between that and farms using them like M&Ms (smarties ;-) ) on the cattle it
seems like people are taking a precious resource and throwing it on the floor.

[http://www.bbc.co.uk/news/health-28648785](http://www.bbc.co.uk/news/health-28648785)

