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ARTICLE

A "Bottom Up" Treatment for Ebola That Could Have Been Used in West Africa

AUG 30, 2016 | DAVID S. FEDSON
More than 11,000 people died as a result of the Ebola outbreak in West Africa. Aside from conventional supportive care, no specific treatment was available. In most treatment units, more than 50% of the patients died. We now know that many of them could have survived. 
 
Patients who die of Ebola have elevated plasma markers of severe inflammation. The same is seen in patients with sepsis, and in sepsis patients these findings are associated with endothelial dysfunction and the loss of endothelial barrier integrity.1-3 (The endothelium is the layer of cells lining our blood vessels. It determines what stays in and what gets out.) Careful studies of healthcare workers who were infected with Ebola virus and evacuated from West Africa for medical care showed they had developed massive internal and external fluid losses. These losses were due to a dramatic increase in vascular permeability, a direct effect of the loss of endothelial barrier integrity.
 
Cardiologists have known for many years that several common (and now generic) drugs, including statins and angiotensin receptor blockers, have the ability to stabilize or restore endothelial barrier integrity. These drugs are safe when given to patients with acute critical illness, and clinical studies suggest they might improve survival in patients with sepsis, pneumonia and influenza.1-3 For this reason, in August 2014, the idea of treating Ebola patients with these drugs was presented to Ebola scientists and World Health Organization (WHO) staff, but it was rejected.2 Moreover, it received no support from national health agencies or major foundations.
 
This lack of interest notwithstanding, in November 2014, local physicians in Sierra Leone treated consecutively approximately 100 Ebola patients with a combination of atorvastatin and irbesartan.4-7 Only three inadequately treated patients are known to have died. No financial or logistical support was available to conduct a proper clinical trial; treatment was supported only by a modest private donation. Sadly, physicians and health officials in Sierra Leone have refused to release information on their treatment experience. Nonetheless, letters and memoranda they exchanged provide good evidence that treatment brought about “remarkable improvement” in Ebola patients (see Figure).
 
During the Ebola outbreak, several investigational treatments (antiviral drugs, convalescent plasma) were tested in Ebola patients, but they met with little success.8 Unlike these treatments, atorvastatin and irbesartan target the host response to the infection, not the virus itself.3-7 By stabilizing endothelial function and restoring normal fluid balance, combination treatment allowed patients to live long enough to develop immune responses of their own and get rid of the virus. 
 


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