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Scientists Race to Test Treatments as Ebola Outbreak Widens

• By gsswpadmin

In a hastily assembled Ebola treatment center in Rwampara, Democratic Republic of Congo, Dr. Papys Lame and his colleagues work tirelessly to rehydrate patients suffering from severe diarrhea and vomiting. They transfuse those who bleed uncontrollably from their noses and mouths and provide oxygen to individuals in respiratory distress. Their responsibilities also include monitoring patients’ heart rates and blood pressure, as well as managing their intense pain.

This situation marks a significant improvement compared to outbreaks Dr. Lame faced just five years ago. “Today we have more options, and more people survive,” he noted.

However, a critical element is still missing: a treatment specifically targeting the Bundibugyo virus, which is responsible for the current outbreak in East Africa. So far, at least 695 individuals have been infected, with 138 fatalities. Scientists are urgently searching for effective drugs.

For the past 50 years, most Ebola outbreaks have been caused by a different species of virus, known as Ebola virus. Based on clinical trials, the World Health Organization recommends two drugs for treating Ebola virus.

However, just because scientists have identified effective drugs for one virus doesn’t mean they will work for another due to significant evolutionary differences.

After the Bundibugyo virus emerged in 2007, preliminary experiments were conducted to identify potential drugs. Some studies showed promise, but research was not pursued further due to the limited number of Bundibugyo outbreaks. With scarce funding for expensive research, scientists had to prioritize their efforts.

“If you were a betting person, you would not have bet on Bundibugyo to cause something large,” remarked Thomas Geisbert, a virologist at the University of Texas Medical Branch at Galveston. “And, of course, we’re all wrong now.”

Currently, scientists are racing to identify drugs for clinical trials against the Bundibugyo virus. The W.H.O. has compiled a list of candidates for immediate testing.

One effective type of drug against viruses is known as a monoclonal antibody, which binds to the virus’s surface and prevents it from entering cells.

Antivirals, on the other hand, inhibit viruses from replicating once inside cells. Some target viral proteins, effectively shutting them down and preventing essential functions like gene replication.

A monoclonal antibody called MBP-134 has shown effectiveness in stopping Bundibugyo infections in monkeys and has been deemed safe for human use in early clinical trials for Ebola virus.

In some instances, doctors are already using MBP-134 to treat Bundibugyo infections. For example, Dr. Peter Stafford, an American physician, received it after contracting the virus in Congo and was flown to Europe for treatment. He also received remdesivir, an antiviral previously used for other diseases, including Covid, which has shown promise in early studies for Bundibugyo virus.

Dr. Stafford was discharged from Charité Hospital in Berlin on June 6. However, it remains uncertain whether MBP-134 or remdesivir contributed to his recovery, as definitive knowledge can only be obtained through well-designed clinical trials comparing experimental drugs with standard supportive care.

To prioritize which drugs to test, the W.H.O. convened experts to review preliminary studies. On May 28, they recommended advancing MBP-134 and remdesivir into clinical trials, alongside another monoclonal antibody, maftivimab, and another antiviral, obeldesivir.

Ordinary clinical trials can take months or even years, requiring regulatory approval, logistical organization, and sufficient patient recruitment. Many past Ebola outbreaks ended before trials could commence.

The Bundibugyo outbreak could be different, according to Dr. Amanda Rojek, an associate professor of health emergencies at the University of Oxford. She and her team are developing a new type of clinical trial that allows testing a single drug across multiple outbreaks caused by different viruses.

Dr. Rojek initiated a trial of remdesivir in Rwanda during a Marburg outbreak in 2024 and plans to combine those results with a new trial testing remdesivir against the Bundibugyo virus.

While this trial design may expedite results, the current outbreak presents numerous challenges. It is occurring in an active conflict zone, and treatment centers are just beginning to be established. Additionally, there is limited infrastructure to support clinical trials.

Given the urgent need for effective treatments, the number of viable candidates for testing is frustratingly low.

“There are only a limited number of candidates available for clinical trials, meaning that if these fail, there are no ready alternatives in the pipeline,” stated Carmen Pérez Casas, head of pandemic preparedness at Unitaid, a global health agency working to secure funding for early clinical testing of potential therapeutics.

Dr. Rojek’s trial will evaluate two treatments from the W.H.O. priority list. Some patients will receive MBP-134, while others will receive a combination of MBP-134 and remdesivir. “We believe there might be a synergistic effect between some of these agents,” she explained.

The trial is nearing the final stages of regulatory approval.

“I’m optimistic that remdesivir may work,” said Dr. Salim Abdool Karim, who is in Congo leading the Africa Centres for Disease Control and Prevention experts group on the outbreak. “It will be quick to show efficacy, as we have patients available in the hospital. If remdesivir proves effective, it’s an affordable drug, and generics are widely accessible.”

Possibly.

Public health workers in Congo and Uganda are tracing individuals who have had contact with infected patients. Currently, these contacts must remain in isolation to monitor for symptoms.

Researchers aim to test an antiviral that may reduce the risk of developing Ebola disease, a strategy known as post-exposure prophylaxis.

The trial will evaluate a 10-day course of obeldesivir, a cost-effective oral alternative to remdesivir.

“This could be a game-changer,” stated Dr. Armand Sprecher, an epidemiologist and emergency physician with Doctors Without Borders. “In individuals who are incubating the illness, you could effectively treat them before they become symptomatic, preventing them from spreading the virus.”

Promising signs of obeldesivir’s effectiveness emerged from a study published last year by Dr. Geisbert and his team. They administered obeldesivir to monkeys just 24 hours post-infection with Ebola virus, long before symptoms typically appear.

“They were completely protected,” Dr. Geisbert reported. “They didn’t even get sick.”

The drug was also tested against the Sudan virus and Marburg, showing protective effects in all three cases. However, prior to the current outbreak, it had not been tested on monkeys infected with Bundibugyo virus.

For pre-exposure prophylaxis to be effective, a health system must effectively trace contacts. An effective drug would provide an incentive for sick individuals to enter isolation wards, knowing that their caregivers could receive protective medication.

The family members of Dr. Stafford, the American physician treated for the virus, received MBP-134 in Berlin as post-exposure prophylaxis, and none developed Ebola disease. As they left the hospital, Dr. Stafford expressed gratitude but emphasized the hope that all patients in Congo could receive the same level of care as he and his family did.

Access to treatments has been a persistent issue in previous Ebola outbreaks. Dr. Rojek highlighted that post-trial access is a critical concern currently being addressed for the therapeutics that may be tested in this outbreak.

In 2019, during an Ebola outbreak in Congo, a trial funded primarily by the U.S. National Institutes of Health tested four monoclonal antibody treatments, with two reducing patient mortality by up to 50%. One of these was developed from the blood of a Congolese Ebola survivor.

Despite public funding and local origins, there was no guarantee that these promising drugs would be available in Congo. Two companies, Regeneron and Ridgeback Biotherapeutics, held the intellectual property, and neither registered either drug in any of the countries affected by Ebola outbreaks.

Ultimately, the U.S. government purchased the entire supply of both drugs for its national security stockpile.

In a hastily assembled Ebola treatment center in Rwampara, Democratic Republic of Congo, Dr. Papys Lame and his colleagues work tirelessly to rehydrate patients suffering from severe diarrhea and vomiting. They transfuse those who bleed uncontrollably from their noses and mouths and provide oxygen to individuals in respiratory distress. Their responsibilities also include monitoring patients’ heart rates and blood pressure, as well as managing their intense pain.

This situation marks a significant improvement compared to outbreaks Dr. Lame faced just five years ago. “Today we have more options, and more people survive,” he noted.

However, a critical element is still missing: a treatment specifically targeting the Bundibugyo virus, which is responsible for the current outbreak in East Africa. So far, at least 695 individuals have been infected, with 138 fatalities. Scientists are urgently searching for effective drugs.

For the past 50 years, most Ebola outbreaks have been caused by a different species of virus, known as Ebola virus. Based on clinical trials, the World Health Organization recommends two drugs for treating Ebola virus.

However, just because scientists have identified effective drugs for one virus doesn’t mean they will work for another due to significant evolutionary differences.

After the Bundibugyo virus emerged in 2007, preliminary experiments were conducted to identify potential drugs. Some studies showed promise, but research was not pursued further due to the limited number of Bundibugyo outbreaks. With scarce funding for expensive research, scientists had to prioritize their efforts.

“If you were a betting person, you would not have bet on Bundibugyo to cause something large,” remarked Thomas Geisbert, a virologist at the University of Texas Medical Branch at Galveston. “And, of course, we’re all wrong now.”

Currently, scientists are racing to identify drugs for clinical trials against the Bundibugyo virus. The W.H.O. has compiled a list of candidates for immediate testing.

One effective type of drug against viruses is known as a monoclonal antibody, which binds to the virus’s surface and prevents it from entering cells.

Antivirals, on the other hand, inhibit viruses from replicating once inside cells. Some target viral proteins, effectively shutting them down and preventing essential functions like gene replication.

A monoclonal antibody called MBP-134 has shown effectiveness in stopping Bundibugyo infections in monkeys and has been deemed safe for human use in early clinical trials for Ebola virus.

In some instances, doctors are already using MBP-134 to treat Bundibugyo infections. For example, Dr. Peter Stafford, an American physician, received it after contracting the virus in Congo and was flown to Europe for treatment. He also received remdesivir, an antiviral previously used for other diseases, including Covid, which has shown promise in early studies for Bundibugyo virus.

Dr. Stafford was discharged from Charité Hospital in Berlin on June 6. However, it remains uncertain whether MBP-134 or remdesivir contributed to his recovery, as definitive knowledge can only be obtained through well-designed clinical trials comparing experimental drugs with standard supportive care.

To prioritize which drugs to test, the W.H.O. convened experts to review preliminary studies. On May 28, they recommended advancing MBP-134 and remdesivir into clinical trials, alongside another monoclonal antibody, maftivimab, and another antiviral, obeldesivir.

Ordinary clinical trials can take months or even years, requiring regulatory approval, logistical organization, and sufficient patient recruitment. Many past Ebola outbreaks ended before trials could commence.

The Bundibugyo outbreak could be different, according to Dr. Amanda Rojek, an associate professor of health emergencies at the University of Oxford. She and her team are developing a new type of clinical trial that allows testing a single drug across multiple outbreaks caused by different viruses.

Dr. Rojek initiated a trial of remdesivir in Rwanda during a Marburg outbreak in 2024 and plans to combine those results with a new trial testing remdesivir against the Bundibugyo virus.

While this trial design may expedite results, the current outbreak presents numerous challenges. It is occurring in an active conflict zone, and treatment centers are just beginning to be established. Additionally, there is limited infrastructure to support clinical trials.

Given the urgent need for effective treatments, the number of viable candidates for testing is frustratingly low.

“There are only a limited number of candidates available for clinical trials, meaning that if these fail, there are no ready alternatives in the pipeline,” stated Carmen Pérez Casas, head of pandemic preparedness at Unitaid, a global health agency working to secure funding for early clinical testing of potential therapeutics.

Dr. Rojek’s trial will evaluate two treatments from the W.H.O. priority list. Some patients will receive MBP-134, while others will receive a combination of MBP-134 and remdesivir. “We believe there might be a synergistic effect between some of these agents,” she explained.

The trial is nearing the final stages of regulatory approval.

“I’m optimistic that remdesivir may work,” said Dr. Salim Abdool Karim, who is in Congo leading the Africa Centres for Disease Control and Prevention experts group on the outbreak. “It will be quick to show efficacy, as we have patients available in the hospital. If remdesivir proves effective, it’s an affordable drug, and generics are widely accessible.”

Possibly.

Public health workers in Congo and Uganda are tracing individuals who have had contact with infected patients. Currently, these contacts must remain in isolation to monitor for symptoms.

Researchers aim to test an antiviral that may reduce the risk of developing Ebola disease, a strategy known as post-exposure prophylaxis.

The trial will evaluate a 10-day course of obeldesivir, a cost-effective oral alternative to remdesivir.

“This could be a game-changer,” stated Dr. Armand Sprecher, an epidemiologist and emergency physician with Doctors Without Borders. “In individuals who are incubating the illness, you could effectively treat them before they become symptomatic, preventing them from spreading the virus.”

Promising signs of obeldesivir’s effectiveness emerged from a study published last year by Dr. Geisbert and his team. They administered obeldesivir to monkeys just 24 hours post-infection with Ebola virus, long before symptoms typically appear.

“They were completely protected,” Dr. Geisbert reported. “They didn’t even get sick.”

The drug was also tested against the Sudan virus and Marburg, showing protective effects in all three cases. However, prior to the current outbreak, it had not been tested on monkeys infected with Bundibugyo virus.

For pre-exposure prophylaxis to be effective, a health system must effectively trace contacts. An effective drug would provide an incentive for sick individuals to enter isolation wards, knowing that their caregivers could receive protective medication.

The family members of Dr. Stafford, the American physician treated for the virus, received MBP-134 in Berlin as post-exposure prophylaxis, and none developed Ebola disease. As they left the hospital, Dr. Stafford expressed gratitude but emphasized the hope that all patients in Congo could receive the same level of care as he and his family did.

Access to treatments has been a persistent issue in previous Ebola outbreaks. Dr. Rojek highlighted that post-trial access is a critical concern currently being addressed for the therapeutics that may be tested in this outbreak.

In 2019, during an Ebola outbreak in Congo, a trial funded primarily by the U.S. National Institutes of Health tested four monoclonal antibody treatments, with two reducing patient mortality by up to 50%. One of these was developed from the blood of a Congolese Ebola survivor.

Despite public funding and local origins, there was no guarantee that these promising drugs would be available in Congo. Two companies, Regeneron and Ridgeback Biotherapeutics, held the intellectual property, and neither registered either drug in any of the countries affected by Ebola outbreaks.

Ultimately, the U.S. government purchased the entire supply of both drugs for its national security stockpile.