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Conversation with Dr. Leslie Lobel

A Ben-Gurion University scientist leading the search for an Ebola cure, says infectious viruses are on the move…as the world sleeps

By Judie Jacobson

 

Dr. Leslie Lobel in his lab.   Photo credit: Dani Machlis/Courtesy  Ben-Gurion University of the Negev.

Dr. Leslie Lobel in his lab.
Photo credit: Dani Machlis/Courtesy
Ben-Gurion University of the Negev.

Though the current outbreak of the Ebola virus disease began in Guinea in December 2013, and quickly spread to Liberia, Sierra Leone, Nigeria and Senegal, it wasn’t until last month, when two Americans were infected with the potentially deadly virus, that news of what appeared to be an epidemic sweeping parts of Africa began to raise concern – and fear – across the United States. Since then, the case of a third American doctor infected while working in West Africa has kept the outbreak in the news – and in the minds of nervous Americans.

To be sure, parts of Africa are currently battling the most severe outbreak of Ebola, in terms of the number of human cases and deaths since the discovery of the virus in 1976. And, in fact, 60 percent of those infected in Africa die within eight days to three weeks after contracting the virus. But some people survive and they may hold the key to a cure being developed by researchers from Ben-Gurion University of the Negev (BGU).

Dr. Leslie Lobel, a professor at Ben-Gurion University’s Center for Emerging Disease, Tropical Diseases and AIDS, has been working with the disease in Africa for more than a decade. Through research funded by the U.S. National Institutes of Health and other backers, Lobel and his team hope to develop an effective treatment for Ebola that will prevent future outbreaks. A native of Queens, N.Y., Lobel holds an MD degree and a doctorate in virology from Columbia University’s College of Physicians and Surgeons.

The Ledger spoke with Lobel recently from his office in Be’ersheva about the current Ebola outbreak and the critical challenge posed by infectious diseases confronting the world today.

 

Q: Give us an overview of your work.

A: A lot of my work focuses on the immune response to viruses – that is, how a human or animal responds to a viral infection. For many years we’ve been studying the immune response to a family of viruses called Filoviruses, which is a family that includes the Ebola and Marburg viruses – two of the most deadly viruses in the world. A big question in our mind is: Why do people die from these viral diseases? In other words, why isn’t there a good enough immune response? Ebola is a virus that circulates in the blood stream and is readily visible to the immune system. So, it should be an easy virus to be attacked by components of the immune system.

We’ve been studying this to determine why some people die and why some survive. We haven’t figured out yet why people don’t survive; but in terms of why people survive, we have a very good idea. Obviously, they have a very good immune system. And so, the question is: what’s in that immune system that is so good?

Well, there are two factors: First, their immune system appears to be well regulated; and, in people who die it’s likely not regulated well and does not respond fast enough. Why there are differences is not clear – because the genetic differences within affected populations in different parts of Africa are not great, since many of the patients are from the same tribes. So, it’s not clear to us yet, based on genetics alone, why certain people in a given district die and others survive.

Second, many of those who survive produce very good antibodies. Some patients who survive are somewhat of a mystery in that they appear to not have detectable memory immunity, and we’re still looking into this. But the ones that seem to fit the classical definition of a proper immune response have very good antibodies that actually are able to neutralize the virus.

We’ve been studying over 100 people who survived these viruses in Central Africa. We’ve been studying those who have the best medical records, and those whom we’ve been able to follow over many years. In other words, we go back to the same people and study their immune systems over time. We study people who are approachable; people that we can locate over many years. This is not trivial, because many people in Central Africa live in the bush and are located by GPS coordinate or by local public health workers. We’ve identified those patients with the best immune response, and we’ve isolated from their blood cells those cells that are producing the best antibodies – antibodies that can neutralize different strains of the virus. These strains are different than the strain that is now in West Africa, but they are just as deadly and just as important. We’ve been making these antibodies into a product that will be tested in animals very shortly, and hopefully will be available in humans in three to five years.

 

Q: Are the three Americans who’ve contracted the virus good subjects for your study?

A: No. The Americans are infected with the strain Zaire, which is a strain from West Africa, and we’re not working on the strain Zaire. In fact, that particular West African strain has been the best studied. Another reason we’re not studying the Americans who survived is that they were given antibody cocktails. That makes it more difficult for us to know whether what we’ll see is a result of their own immune systems or a result of the drugs. We need people who naturally survived the virus, so that we know that the antibodies that we isolate were optimized by their bodies and enabled them to survive.

 

Q: The impression we get from the media is that this recent outbreak of Ebola is the resurgence of a virus that had previously been dormant. Is that so?

A: Not at all. It’s been dormant in the minds of the developed world. In Central Africa it has not been dormant at all. Ebola is continually evolving. I’ve been asked this many times and I can’t state it strongly enough: the world has slept on the issue of infectious disease for 40 years. People just don’t want to see it; they don’t think it’s important. It’s not in New York City. It’s not in London. It doesn’t count, because it’s affecting people in under-developed countries that most people in the developed world don’t see.

But in the real world, which is most of the population of the globe, there are tremendous amounts of infectious disease, and the Ebola virus in particular has been circulating. The [related] Marburg virus is found, by some estimates, in up to five percent of the fruit bats in parts of Central Africa. That’s a huge number of creatures carrying this virus around. Now, in 2012, there were five outbreaks of Filo viruses in Central Africa, in DR Congo and Uganda, where we actually have a base.

When we saw this two years ago it was, for us, earth-shattering, because we realized something was happening in the environment. It’s as if Southern California had five little earthquakes within a period of a couple of months. To a geologist that would be very alarming; it would mean we have to be prepared; something big is going to happen. So, in 2012, we knew something was going to happen. We thought it was going to be in DR Congo or Uganda, because that’s where most of the outbreaks of Ebola have been in that region. We didn’t think it would get so far west and north, up in Guinea and Liberia.

And so, certainly, this virus has not been dormant at all, it’s been circulating, it’s in the environment. We’ve been seeing these viruses with sporadic outbreaks. It’s only getting worse. What’s happened now is, basically, the perfect storm that evolved from many mini-storms that have been going on.

 

Q: Is there a fear or a likelihood that Ebola could spread to the States and other parts of the western world?

A: It could – but I’m not afraid of that for one major reason: I don’t think the ecosystem is going to go that far north of the equator just yet. Viruses live in what we call an ecosystem. Certain viruses are obviously only in humans – for example, small pox was in humans, which is why we were able to control it very well; because the entire ecosystem of small pox was in humans. But most viruses have an ecosystem between animals and humans. Sometimes insects get in between and become the carriers, but Ebola is not carried by insects.

Essentially, the virus lives in the environment where it has its reservoir – a reservoir being an animal that can harbor the virus, but is not killed by the virus. Bats could be the perfect reservoir for these viruses. Certainly it is for the Marburg virus. We don’t know if bats carry the Ebola virus – I believe they probably do, but there is no concrete evidence to prove that it’s so. We do have concrete evidence that bats carry the Marburg virus.

Of course, people infected in equatorial regions of the world or in Africa can get to the developed world. They have before. People visiting Africa have flown back to the U.S. or Europe; they were diagnosed with the Ebola or Marburg virus; they were quarantined; they survived or they died. And that was the end of it.

Don’t forget, in the developed world it’s much easier to quarantine a person and also to have people who are close contacts be compliant with the medical system, which is essentially trusted by the populations of Europe, the United States and developed countries in Asia, like China. But in Africa the medical system is not trusted. They don’t trust white people coming from outside Africa to treat them. There’s a huge cultural barrier and a huge gap between the primitive tribes and populations and the people who want to try to help them. There’s a tremendous amount of distrust.

 

Q: Should people stop travelling to Africa at this point in time?

A: Certainly, if you don’t have to, you shouldn’t be going to Guinea or Liberia or Sierra Leone. I go to Central Africa all the time, but I wouldn’t recommend tourists going to Western Africa right now. Kenya, Northern Africa and South Africa are fine, as well as the countries bordering South Africa.

 

Q: How far along are you in your research?

A: We actually have antibodies that neutralize Ebolavirus Sudan – which hasn’t killed the most number of people, but it has been the strain in many outbreaks of the virus. We are working on human monoclonal antibodies too against other strains and also the Marburg virus. We believe we will have cocktails within three to five years.

The cocktail used on the two American doctors in Africa is actually produced by a pharmaceutical company that is part of our consortium of academic institutions and companies that are funded to work together to develop antibodies to fight Ebola. It’s part of our group. My belief is this cocktail did work, though most people will tell you it’s not clear yet. My feeling is that at later stages of the disease there is nothing that is really going to work because the person’s body is too destroyed to really recover. But if you catch it early enough, certainly these cocktails will work. There are other drugs being developed as well, which I don’t want to minimalize. I like the antibody-based approach, but certainly we need a number of different technologies to attack this deadly virus.

This virus is in the environment and it’s moving. It could become a lot worse as time goes on, especially given global warming. Also, the development of previously undeveloped regions in Africa – which is happening at a ferocious pace – is destroying ecosystems, which causes the animals that are part of these ecosystems to migrate; causing movement of disease as well.

 

Q: Are you saying that steps need to be taken to avoid the negative consequences that could result as these countries develop?

A: Exactly. It’s not just about Ebola — there are a lot of other bad viruses out there, and the developed world just doesn’t want to see what is happening. Over the years, we’ve spent so much money researching cancer and diabetes and heart disease – and we’ve ignored infectious diseases. Certainly, those illnesses are important, too; but, if you consider it in terms of populations, it’s clear that the greater pubic health challenge is infectious disease. We in the western world don’t understand that. Infectious diseases have not gone away. They continue to evolve. Viruses never sleep. It’s just that we have slept.

I’ve been working in Africa for many years, and I don’t have to explain it to the people there. For them, life is pure survival, and a lot of it is survival from infectious disease. But for so many years I’ve tried to raise the awareness of people in the developed world to this potentially disastrous problem, and nobody seems to have been listening. So, I really do hope that this will serve as a wake-up call.

Comments? email judiej@jewishledger.com.

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