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  1. Medical Countermeasures Initiative (MCMi)

Survivor Studies: Better Understanding Ebola's After-Effects to Help Find New Treatments

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U.S. Public Health Service officers celebrate as a Liberian man adds his handprint to a “survivors’ wall.” Each patient who overcame Ebola after treatment at the USPHS mobile hospital outside Monrovia was given a set of clothes and essentials and invited to mark their recovery with a handprint. (Photo: FDA)
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U.S. Public Health Service officers celebrate as a Liberian man adds his handprint to a “survivors’ wall.” Each patient who overcame Ebola was invited to mark their recovery with a handprint.

Study expands to include investigation of Zika virus disease

Background | Ebola Project Description | Zika Project Description | Collaborations | Project Outcomes | Additional Reading

Performer: Stanford University School of Medicine disclaimer icon
Project leader: Dr. Garry P. Nolan
Initial contract value: $3,661,908
Contract modification value: $459,131 (September 2017)
Project dates: May 2016 - November 2019

Background

The West African Ebola epidemic of 2014-2015 was the largest-ever Ebola outbreak, claiming more than 11,000 human lives, and forever altering many thousands more. Unlike previous Ebola outbreaks, however, a large number of Ebola patients survived this epidemic.1  

For some, surviving wasn’t the end of their challenges. Many of the recent epidemic’s 16,000+ Ebola survivors suffer from chronic, long-term health problems including headaches, joint pain, and eye problems caused by Ebola.2 Scientists do not yet fully understand what causes these after-effects.

FDA and government partners are conducting studies in West Africa to better understand how Ebola affects patients who have survived, and to learn how to more effectively treat these patients’ chronic health problems.

Ebola Project Description

In this Medical Countermeasures Initiative (MCMi) regulatory science project, Stanford University will analyze Ebola survivors with and without chronic health problems in an effort to identify factors responsible for driving prolonged disease well after the initial, acute infection.

This project will also explore immunopathology—how the immune system responds to diseases—and how it differs for various chronic post-Ebola signs and symptoms. This new data will provide valuable information to better understand the natural course of Ebola virus disease, and identify possible causes of chronic health problems in survivors.

The team will use a variety of approaches to analyze laboratory specimens, including CyTOF mass cytometry, and will make analysis readily interpretable by researchers around the world.

Other analysis will include conducting Luminex cytokine and metabolomic assays (tests), evaluating clinical metrics, and creating multiplexed ion beam imaging (MIBI) 3D models of solid tissues, to better understand the relationships between tissue cells, immune cells and viral molecules.

Zika Project Description

In September 2017, FDA modified this contract with Stanford University to apply the technology used for the Ebola project to gather critical information about the nature of Zika virus infection. The potential benefits of this additional study include improved understanding of congenital defects associated with maternal Zika virus infection and animal models of Zika virus infection.

Ultimately, this study may help identify candidate vaccines and treatments, and inform FDA’s evaluation of such products. 

Collaborations

This three-year project builds on previous immune system mass cytometry reference work supported by FDA. Collaborators include:

In collaboration with these partners, samples will be collected in Guinea and the Democratic Republic of the Congo, and in Liberia as part of the Partnership for Research on Ebola Vaccines in Liberia (PREVAIL III). Stanford will combine results from tests performed on these samples with data collected at the field research sites to model and find potential causes of chronic after-effects.

For the Zika research, Stanford will work with the University of California, Davis and USAMRIID to analyze existing tissue samples these partners have collected during previous and ongoing studies, including an FDA-funded project.

Project Outcomes

Ultimately, this research will help the global scientific community better understand the course of Ebola and Zika virus infections—an important factor in finding new treatments. In addition, it will help identify ways we can improve the lives of the thousands of Ebola survivors stricken by chronic Ebola-related health problems, and further progress toward countermeasures to treat and prevent Zika virus disease.

This project was funded through the MCMi Regulatory Science Extramural Research program.


1http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html  

2 http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/survivors.html

Additional Reading

Clark DV, Kibuuka H, Millard M, et al. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet Infect Dis. 2015 Aug;15(8):905-12. DOI

Nanyonga M, Saidu J, Ramsay A, et al. Sequelae of Ebola Virus Disease, Kenema District, Sierra Leone. Clin Infect Dis. 2016 Jan 1;62(1):125-6. DOIdisclaimer icon

Qureshi, AI, Chughtai, M, Loua, TO, et al. Study of Ebola Virus Disease Survivors in Guinea. Clin Infect Dis. 2015;61(7), 1035–42. DOI

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