Genetics in the News: Ebola
Around the world, people are panicking due to the recent outbreak of Ebola. What most people do not realize is that the 2014 Ebola outbreak is not the first outbreak of Ebola. Its first outbreak was in Africa over forty years ago. Recently, there has been a lot of research done regarding the Ebola virus concerning the way it invades the host cell and affects the body. Many of the recent developments are important to advancing medical practices, and nurses will have an important role in implementing them. Recent studies regarding the Ebola virus have shown that its severity depends on genetics; there is a possibility that it can be spread through exposure to sperm; and the gene that Ebola targets is the NPC1 gene.
Although the Ebola virus can be a life-threatening virus, it affects each individual differently. Scientists in Montana have discovered “that host genes may play an important role in deciding whether the virus infection is fatal or not” (Paddock, 2014, n.p.). The severity of Ebola is not only dependent on the virus, but it also depends on the host’s cells. The symptoms vary from resistance, mild to moderate, or severe (bleeding, organ failure, and shock). Scientists have developed genetically diverse mice and infected them with the mouse version of the current strain of Ebola infecting humans. The results of the experiment showed that all mice included in the study lost weight when first infected. The mice were barely affected, moderately affected, or severely affected. There were 19% of the mice that were barely affected and survived. After recovering, they had no serious effects, normal livers, and gained the weight that they had lost. 11% of the mice were moderately infected and showed partial resistance to the virus. Less than half of them died. Of the remaining 70% that had the severe reaction, “19% had liver inflammation without classic symptoms of Ebola, while 34% had blood that took a long time to clot - a classic hallmark of fatal Ebola hemorrhagic fever in humans. These mice also showed signs of internal bleeding, swollen spleens and their livers changed color and texture” (Paddock, 2014, n.d.). Analysis of these results showed that the severity of the virus aligned with the genetic makeup of the mice. Additionally, the Ebola virus activated genes that encouraged blood vessel inflammation and cell in death in mice that had serious reactions and died. On the other hand, it activated genes that control blood vessel repair and production of immune cells to fight infection. In addition to genetics contributing to severity of the illness, liver and spleen reactions also play a role by the response they illicit.
How Will This Impact Future Medicine Practices? What Is the Role of the Nurse in the Use of This Information?
According to lead author of the study, Dr. Angela Rasmussen, “the frequency patterns of different disease symptoms they saw in the mice are similar to those observed in humans in the 2014 West Africa outbreak” (Paddock, 2014, n.p.). Information acquired from this study can be applied to further research about Ebola. This research will impact future medical practices by the development of therapeutics and vaccines. In practice, nurses would be responsible of administering these drugs and vaccines to the patients. They would also have to be knowledgeable about what the drugs do, side effects, and the purpose of the drugs.
In New Delhi, India, a man has recently been quarantined in an airport due to his semen testing positive for Ebola. He is a survivor of Ebola and his blood tested negative multiple times for the virus. According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), a person is Ebola free if his/her blood tests negative for it. According to the CDC, Ebola can live in the semen up to three months after a person survives it and the blood tests negative for it (Sifferlin, 2014, n.p.). Survivors of Ebola should refrain from having any form of sexual intercourse for at least three months. There is a possibility that Ebola can be transferred through exposure to semen, but there has yet to be supporting evidence of it actually happening. Ebola survives longer in the semen because the testes are an immunologically privileged site, which means the testes are not monitored by the immune system. Semen is considered a foreign substance to the body. Therefore, it is not regulated by the immune system because an autoimmune response would occur.
It is important to know that Ebola can be transferred through the semen of a man who has survived Ebola because there is a possibility that it can be transmitted via exposure to it. Although it has not been proven, precautions should be taken to prevent any possibilities of transmission. Hospitals and other medical establishments need to be aware of this and enforce testing of semen and the blood of Ebola survivors. As far as nurses are concerned, they need to make sure that they do their part as educators for the patients. Nurses need to be knowledgeable and informed about all the modes of transmission for Ebola. When communicating with Ebola survivors, nurses need to inform male patients that there may be a possibility of transmitting it through their semen, so they need to take preventative measures for the next three months.
Two 10-year-old twin girls, Addi and Cassi, have Niemann-Pick Type C disease, which is a “rare hereditary disease that’s caused primarily by mutations in the Niemann-Pick C1 (NPC1) gene, which is responsible for the body's ability to metabolize lipids. [It is] a neurodegenerative condition that causes delay and loss of cognitive and motor function, neurological problems and seizures.” (Firger, 2014, n.p.). The NPC1 gene is a crucial gene in the human body and without it there can be extreme problems within the body. In the twins, it resulted in childhood Alzheimer’s. Niemann-Pick Type C causes a buildup of lipid proteins in certain organs such as the spleen, liver, lungs, bone marrow and brain. It is eventually fatal and patients usually die before adolescence (Firger, 2014, n.p.). In 2011, it was discovered that the Ebola virus needs the cholesterol transporter NPC1 to enter the body. This means that a person without the NPC1 gene cannot contract Ebola because the virus has no way of entering the body. Seeking to do whatever they could to learn more about Niemann-Pick Type C, Addi and Cassi’s parents sent off their dead skin cells to scientists and virologists to examine. Through the studying of the twins’ dead skin cells, it was discovered that the Ebola virus needed the NPC1 gene to invade a host cell. According to Dr. Kartik Chandran, a coauthor of the study, “once the virus has entered into the cell membrane it latches on to the protein made by the NPC1 gene. But if cells do not produce the protein -- due to a mutation in this gene -- the virus cannot enter the cells” (Firger, 2014, n.p.)
In medicine, this discovery can be used to develop a drug that targets NPC1 to stop an Ebola infection. Dr. Chandan states “‘What we're trying to do is develop small molecule therapy that would incapacitate the gene temporarily, and then take them off the drug [drug that targets NPC1] and everything goes back to normal’” (Firger, 2014, n.p.). In addition to helping stop Ebola, the drug can be used to help activate the NPC1 gene in Niemann Pick patients, which may cure the disease. The drug may take several years to develop. When the drug is developed, nurses will apply this knowledge to people with Niemann-Pick Type C disease, as well as Ebola. Also, nurses will have to administer this drug to patients and record and document if they have any reactions or side effects to the drug. They will also have to inform the patients what the drug is used for and what it is going to do for them.
Bringing It All Together
Overall, the Ebola virus attacks the immune system and manipulates immune cells to shut down and disrupts their immune function. The fatality of the virus not only depends on the virus, but it also depends on the genetics of a person infected and the response of the liver and spleen. A person infected with Ebola may barely have symptoms, mild-to-moderate symptoms, or severe symptoms. Information from the study on gene involvement in Ebola can be used to develop drugs and vaccines for Ebola. Additionally, there is a possibility that Ebola can be transferred from exposure to semen of a survivor of Ebola. Nurses need to inform patients that they need to abstain from sex for at least three months to reduce the possibility of the transmission of Ebola. Furthermore, research has shown that people without the NPC1 gene cannot be afflicted with Ebola because there is no NPC1 receptor for it to attach to. Once a drug is developed that targets the NPC1 gene, a cure can be developed for Niemann-Pick Type C disease and a treatment for the Ebola virus. These studies regarding the Ebola virus have shown that its severity depends on genetics; there is a possibility that it can be spread through exposure to sperm; and the gene that Ebola targets is the NPC1 gene.
Firger, J. (2014, November 12). Twins with Rare Genetic Disorder Could Hold Clue to Cure for Ebola. Retrieved November 20, 2014, from http://www.cbsnews.com/news/twins-with-rare-genetic-disorder-could-hold-clue-to-cure-for-ebola/
Sifferlin, A. (2014, November 20). Ebola Virus in Semen: Everything You Want to Know. Retrieved November 20, 2014, from http://time.com/3596295/ebola-in-semen-std/
Paddock, C. (2014, October 31). Surviving or Dying from Ebola May Be Partly down to Genes. Retrieved November 20, 2014, from http://www.medicalnewstoday.com/articles/284708.php