Blood transfusions show early promise

as possible Ebola cure

As trials on blood and plasma progress, researchers ask if they might have
happened sooner

by Amy Maxmen-February 16, 2015

FREETOWN, Sierra Leone Have courage to buckle up, said the doctor,
before he injected blood into the veins of Kadiatu Fofanah, a young woman
in the throes of Ebola. It had been a week since Fofanah had doubled over,
feverish and vomiting. I was fading. I was so pale, I thought I would die,
Fofanah recalls.

When her Ebola test came back positive, the doctor explained that a
transfusion of blood from an Ebola survivor might save her. Fearing for her
life, she accepted the experimental therapy. Two days later I could walk,
she says. Five days later they took a blood sample and told me I was free
from Ebola, and I was jubilated.

A blood transfusion from an Ebola survivor may have helped Kadiatu Fofanah fight
off the disease. Amy Maxmen
Fofanah, along with 34 other Ebola patients, received blood in the past
month as part of a controlled clinical trial at the military hospital in
Freetown. Although the study is ongoing and the results not yet analyzed, a
grin flashes across the face of a doctor leading the trial, Col. Foday Sahr, as
he says that 80 percent of the recipients have lived. Proper comparisons
with the control arm of the study are not yet available, but the number
bodes well in light of the grim survival rate from the disease until now in
West Africa (below 50 percent). Sahr says his only regret is that the trial did
not begin sooner.

Hats off to Foday Sahr and his team, who did this trial against all the
odds, says Calum Semple, a clinician scientist at the University of

Liverpool who is involved in an upcoming, far-better-funded study to test

convalescent plasma from Ebola survivors their blood minus their red
blood cells in Sierra Leone.
The countries really liked the blood option more than the drugs because
there is no manufacturer behind it and no international regulatory approvals
required.

David Wood
WHO

Proponents of research on survivor blood drew inspiration from a 20year-old report claiming that seven of eight patients lived after being
injected with survivor blood during an Ebola outbreak in the Democratic
Republic of Congo. The key ingredient is likely antibody proteins that are
slowly produced by the immune system to block the Ebola virus in the
weeks following an infection.

Plasma contains antibodies as well. And because red blood cells are
returned to the donor, plasma can be donated more frequently than blood
and stored for longer. Its important to find out if [plasma] works, because
in a future outbreak, you couldnt rely on whole blood, but you could build
up a bank of plasma quickly, Semple says.

In about a week, the convalescent-plasma trials will start in Sierra Leone

and Guinea. In the two countries, 284 people have been diagnosed with
Ebola since Feb. 1. A matching study began in Liberia in December, but its
stalled because case numbers have dropped dramatically. The plasma trials
include clinician scientists from institutions in Europe, the U.S. and the
three affected countries, and each study aims to enroll over 100 people.
However, if the outbreak tapers off before researchers reach that number,
strong conclusions may still be drawn because results from the three trials
can be combined.

With the trials coming a year after the start of the outbreak in Guinea, blood
treatments will not make much of a dent in the overall death toll, which
stands at 9,253. However, the results could prove vital in future Ebola
outbreaks. Blood treatment doesnt come with the hurdles involved in
developing and buying pharmaceuticals. This is something that can be
owned by the countries themselves, says Johan van Griensven, an
infectious disease specialist at the Institute of Tropical Medicine in Belgium
and co-investigator in the plasma trial in Guinea.

At a meeting held by the World Health Organization on Sept. 5,

representatives from Guinea, Sierra Leone and Liberia pushed for tests on
whole blood and blood plasma. The countries really liked the blood option
more than the drugs because there is no manufacturer behind it and no
international regulatory approvals required, says David Wood, a virologist
at the WHO.

Yet few international donors prioritized blood trials above other

experimental treatments. For example, the U.S. government decided
against studies on blood in favor of those on pharmaceutical drugs and
vaccines, citing evidence of their efficacy in laboratory studies. Thus far the
U.S. has committed more than $240 million to ongoing research on those
therapies. In December, the World Bank granted $200,000 to the Sierra
Leonean trial on whole blood. More recently, several donors committed
more than $3.3 million to the three multi-institutional convalescent plasma
studies.

About 20 percent of the plasma budget will be spent on medical equipment,

refrigerators and infrastructure that will continue to bolster bloodtransfusion services after Ebola has passed. Its an added benefit not lost
on Sierra Leones medical community. At the countrys blood-bank
headquarters in Freetown, a single rusted refrigerator stores donor blood
and a lab technician enters data into an outdated computer. In the eastern
region of the country, the main blood bank suffers from unreliable

electricity. The director points to a handwritten log of the days when the
refrigerator went down and stored blood went bad.
[NGOs] want to get in and save lives, and they feel great when they do, and
thats wonderful. But if you want to make a difference on a large scale, you
need to do clinical research.

Calum Semple
University of Liverpool

Semple understands the frustrations over the pace of research. After an

influenza pandemic killed more than 18,000 people around the world
between 2009 to 2010 with virtually no clinical trials conducted he
and his colleagues formed a consortium to figure out how to perform
quality science during a fast-moving crisis. The group, called ISARIC
(International Severe Acute Respiratory and Emerging Infection
Consortium), developed protocols for testing generic treatments for
unspecified outbreaks that could include anything from swine flu to
drug-resistant malaria. When Ebola hit, the consortium's members
tweaked the protocols to suit convalescent plasma and West Africa.
That took a couple of months, Semple says. To him, that speed is a
success compared with the year or more it typically takes to launch
clinical trials.

Semple and two members of his team from the U.S. arrived in Freetown last
week. Paperwork covers the dining-room table in their temporary quarters.
A machine to analyze blood chemistry rests beside the television. Its one of
several pieces of equipment shipped here for the plasma study, and it will
help the researchers learn exactly how the transfusions affect patients.

Until recently, blood-chemistry measurements seemed frivolous. As Ebola

pummeled hospitals, many doctors, aid workers and health officials felt
they had no time for data collection because they were overwhelmed just
trying to keep patients alive never mind documenting their biology.

However, this evidence provides clues on how to curb deaths in the future,
and Semple wishes international aid agencies had devoted resources to
science sooner. [NGOs] want to get in and save lives, and they feel great
when they do, and thats wonderful, he says. But if you want to make a
difference on a large scale, you need to do clinical research.

Sahr agrees with the sentiment. But there is little time for complaints. He
will soon be involved with three trials blood, convalescent plasma and an
antiviral drug from the North American-based pharmaceutical company
Tekmira. Better late than never, he says. Well learn what we can, and at
least well have a place to start if there is an outbreak in the future.

Editor's note: This story was completed with support from the Pulitzer
Center for Crisis Reporting.
Posted by Thavam