Dr. Kent Brantly was
given the medication, ZMapp, shortly after telling his doctors he
thought he would die, according to a source familiar with his case.
Within an hour, doctors say his symptoms -- labored breathing and a
widespread rash -- dramatically improved. Nancy Writebol, another
missionary working with Samaritan's Purse, received two doses of the
medication and has also shown significant improvement, sources say.
As there is no proven treatment and no vaccine for Ebola, this experimental drug is raising lots of questions.
1. Who makes the drug?
The drug was developed by the biotech firm Mapp Biopharmaceutical Inc.,
which is based in San Diego. The company was founded in 2003 "to
develop novel pharmaceuticals for the prevention and treatment of
infectious diseases, focusing on unmet needs in global health and
biodefense," according to its website.
Mapp Biopharmaceutical
has been working with the National Institutes of Health and the Defense
Threat Reduction Agency, an arm of the military responsible for
countering weapons of mass destruction, to develop an Ebola treatment
for several years.
2. Are there other experimental Ebola drugs out there?
Yes. In March, the NIH awarded a five-year, $28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.
"A whole menu of
antibodies have been identified as potentially therapeutic, and
researchers are eager to figure out which combinations are most
effective and why," a news release about the grant said.
Tekmira, a Vancouver-based company that has a $140 million contract
with the U.S. Department of Defense to develop an Ebola drug, began
Phase 1 trials with its drug in January. But the FDA recently halted the
trial, asking for more information.At least one potential Ebola vaccine has been tested in healthy human
volunteers, according to Thomas Geisbert, a leading researcher at the
University of Texas Medical Branch. And last week, the NIH announced a safety trial of another Ebola vaccine will start as early as September.
3. How does ZMapp work?
Antibodies are proteins
used by the immune system to mark and destroy foreign, or harmful,
cells. A monoclonal antibody is similar, except it's engineered in a lab
so it will attach to specific parts of a dangerous cell, according to the Mayo Clinic, mimicking your immune system's natural response. Monoclonal antibodies are used to treat many different types of conditions.
Sources told CNN the
medicine given to Brantly and Writebol abroad was a three-mouse
monoclonal antibody, meaning that mice were exposed to fragments of the
Ebola virus and then the antibodies generated within the mice's blood
were harvested to create the medicine.
However, the drug can
also be produced with proteins made from tobacco plants. ZMapp
manufacturer Kentucky BioProcessing in Owensboro has been working with
Samaritan's Purse and Emory University Hospital to provide limited
quantities of the drug to Emory, according to company spokesman David
Howard.
4. Why did American missionary workers get the drug?
Many have asked why these two workers received the experimental drug when so many -- around 1,600 -- others in West Africa also have the virus.
The World Health
Organization says it was not involved in the decision to treat Brantly
and Writebol. Both patients had to give consent to receive the drug,
knowing it had never been tested in humans before.
The process by which the
medication was made available to the American patients may have fallen
under the U.S. Food and Drug Administration's "compassionate use"
regulation, which allows access to investigational drugs outside
clinical trials.
5. Did doctors know it would work?
No. The drug had shown
promise in primates, but even in those experiments, just eight monkeys
received the treatment. In any case, the human immune system can react
differently than primates', which is why drugs are required to undergo
human clinical trials before being approved by government agencies for
widespread use.
The two Americans' cases will be studied further to determine how the drug worked with their immune systems.
6. Will the drug be made available to other Ebola patients?
It's unclear. Rolling
out an untested drug during a massive outbreak would be very difficult,
Doctors Without Borders said in a statement. Experimental drugs
typically not mass-produced, and tracking the success of such a drug if
used would require extra medical staff where resources are already
scarce.
Dr. Anthony Fauci,
director of the National Institute of Allergy and Infectious Diseases,
says scientists have to be careful about assuming this drug will work in
other patients as it appears to have worked in Brantly.
"Having worked with
administering antibodies for people for a really long time, that would
be distinctly unusual," he told CNN. "As we all know in medicine ... you
have to withhold judgment."
7. Does the company have more vials of the drug?
The company has very few doses ready for patient use, Fauci told CNN.
"(Kentucky
BioProcessing) is working closely with Mapp, various government
agencies, and other parties to increase production of ZMapp, but this
process will take several months," Howard said.
8. Who paid for the drug and how much did it cost?
We don't know.
Samaritan's Purse covered the cost of Brantly and Writebol's evacuations
but did not pay for the drug, according to a spokesman.
When a patient gets an
experimental drug, the drug company can donate the product under
compassionate use. Mapp Biopharmaceutical Inc. might have done that in
this case.
Health insurance
companies typically do not pick up the tab for treatments that have not
been approved by the FDA. But they usually would cover the cost of any
doctor fees associated with giving the drug and any costs associated
with monitoring how the drug is working.
9. Would this drug stop the Ebola epidemic?
If it were widely
available, it certainly couldn't hurt. An effective Ebola drug could
help doctors treat the deadly virus, which is killing about 60% of the
people infected in West Africa. But a vaccine would be a much more
effective tool in stopping this, and future, epidemics.
Vaccines are given to
healthy people to prevent them from ever becoming infected. One
challenge with Ebola, experts say, is that companies don't believe they could make much money from developing a vaccine, so few companies show interest.
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