ZMapp

ZMapp（ジーマップ。ズィーマップとも）は、タバコの近縁種であるNicotiana benthamianaの葉の遺伝子へ組み込んで作られる、3種類のヒト化モノクローナル抗体を混合した抗エボラウイルス薬である。2014年現在、サルに対する非臨床試験しか実施されていない未承認薬であるが、2014年8月4日に2人のエボラ出血熱患者に投与され、実験的な治療が行われた。その結果、2人とも症状が改善されるポジティブな結果を示した。しかしながらその翌週ごろに投与された6名のうち2名は一定の効果を見せた後に容態悪化で死亡しており、死因が用法用量の不適切か副作用か病状悪化か患者の体力由来かなどの詳細なソースも不明であり、薬効については不透明のままである。なお2名死者のうちスペイン人司祭は後期高齢者であった。この薬は、米国のベンチャー企業、マップ・バイオファーマシューティカル社が開発中である。

元々は生物兵器から身を守るために開発されたもので、国立衛生研究所や国防脅威削減局が開発を支援している。

関連項目

• 2014年の西アフリカエボラ出血熱流行
• TKMエボラ
• ファビピラビル（アビガン）
• パリビズマブ
• ドラッグ・ラグ
• 抗血清

Schematic representation of how monoclonal antibodies are generally made from hybridomas. To make ZMapp, the genes encoding for the antibodies were extracted from the hybridomas, genetically engineered to replace mouse components with human components, and transfected into tobacco plants.

ZMapp is an experimental biopharmaceutical drug comprising three chimeric monoclonal antibodies under development as a treatment for Ebola virus disease. The drug was first tested in humans during the 2014 West Africa Ebola virus outbreak, but has not been subjected to a randomized controlled trial to determine whether it works, and whether it is safe enough to allow on the market.

Medical use

ZMapp is under development as a treatment for Ebola virus disease. It was first used experimentally to treat some people with Ebola virus disease during the 2014 West African Ebola outbreak, but as of August 2014 it had not yet been tested in a clinical trial to support widespread usage in humans; it is not known whether it is effective to treat the disease, nor if it is safe.

Mechanism of action

Like intravenous immunoglobulin therapy, ZMapp contains neutralizing antibodies that provide passive immunity to the virus by directly and specifically reacting with it in a "lock and key" fashion.

Physical and chemical properties

The drug is composed of three monoclonal antibodies (mAbs) that have been chimerized by genetic engineering. The components are chimeric monoclonal antibody c13C6 from a previously existing antibody cocktail called "MB-003" and two chimeric mAbs from a different antibody cocktail called ZMab, c2G4 and c4G7.

ZMapp is manufactured in the tobacco plant Nicotiana benthamiana in the bioproduction process known as "pharming" by Kentucky BioProcessing, a subsidiary of Reynolds American.

The Nicotiana benthamiana tobacco plant

History

The composite drug is being developed by Leaf Biopharmaceutical (LeafBio, Inc.), a San Diego based arm of Mapp Biopharmaceutical. LeafBio created ZMapp in collaboration with its parent and Defyrus Inc., each of which had developed its own cocktail of antibodies, called MB-003 and ZMab.

MB-003

MB-003 is a cocktail of three humanized or human–mouse chimeric mAbs: c13C6, h13F6 and c6D8. A study published in September 2012 found that rhesus macaques infected with Ebola virus (EBOV) survived when receiving MB-003 (mixture of 3 chimeric monoclonal antibodies) one hour after infection. When treated 24 or 48 hours after infection, four of six animals survived and had little to no viremia and few, if any, clinical symptoms.

MB-003 was created by Mapp Biopharmaceutical, based in San Diego, with years of funding from US government agencies including the National Institute of Allergy and Infectious Disease, Biomedical Advanced Research and Development Authority, and the Defense Threat Reduction Agency.

ZMAb

ZMAb is a mixture of three mouse mAbs: m1H3, m2G4 and m4G7. A study published in November 2013 found that EBOV-infected macaque monkeys survived after being given a therapy with a combination of three EBOV surface glycoprotein (EBOV-GP)-specific monoclonal antibodies (ZMAb) within 24 hours of infection. The authors concluded that post-exposure treatment resulted in a robust immune response, with good protection for up to 10 weeks and some protection at 13 weeks.

ZMab was created by Defyrus, a Toronto-based biodefense company, funded by the Public Health Agency of Canada. The identification of the optimal components from MB-003 and ZMab was carried out at the Public Health Agency of Canada’s National Microbiology Laboratory in Winnipeg.

ZMapp

A 2014 paper described how Mapp and its collaborators, including investigators at Public Health Agency of Canada, Kentucky BioProcessing, and the National Institute of Allergy and Infectious Diseases, first chimerized the three antibodies comprising ZMAb, then tested combinations of MB-003 and the chimeric ZMAb antibodies in guinea pigs and then primates to determine the best combination, which turned out to be c13C6 from MB-003 and two chimeric mAbs from ZMAb, c2G4 and c4G7. This is ZMapp.

In an experiment also published in the 2014 paper, 21 rhesus macaque primates were infected with the Kikwit Congolese variant of EBOV. Three primates in the control arm were given a non-functional antibody, and the 18 in the treatment arm were divided into three groups of six. All primates in the treatment arm received three doses of ZMapp, spaced 3 days apart. The first treatment group received its first dose on 3rd day after being infected; the second group on the 4th day after being infected, and the third group, on the 5th day after being infected. All three primates in the control group died; all 18 primates in the treatment arm survived. Mapp then went on to show that ZMapp inhibits replication of a Guinean strain of EBOV in cell cultures.

Mapp remains involved in the production of the drug through its contracts with Kentucky BioProcessing, a subsidiary of Reynolds American. To produce the drug, genes coding for the chimeric mAbs were inserted into viral vectors, and tobacco plants are infected with the viral vector encoding for the antibodies, using Agrobacterium cultures. Subsequently, antibodies are extracted and purified from the plants. Once the genes encoding the chimeric mAbs are in hand, the entire tobacco production cycle is believed to take a few months. The development of these production methods was funded by the U.S. Defense Advanced Research Projects Agency as part of its bio-defense efforts following the 9/11 terrorist attacks.

Use during the 2014 Ebola outbreak

「2014 West Africa Ebola virus outbreak」も参照

The FDA allowed two drugs, ZMapp and an RNA interference drug called TKM-Ebola, to be used in Americans who had contracted Ebola virus disease. Other countries have similar programs to allow early access through named patient programs. 2014年10月 (2014-10)現在, ZMapp had been used to treat 7 individuals infected with the Ebola virus. Although some of them have recovered, the outcome is not considered to be statistically significant. Mapp announced on August 11, 2014, that its supplies of ZMapp had been exhausted.

Controversy

The lack of drugs and unavailability of experimental treatment in the most affected regions of the West African Ebola virus outbreak spurred some controversy. The fact that the drug was first given to Americans and a European and not to Africans, according to the Los Angeles Times, "provoked outrage, feeding into African perceptions of Western insensitivity and arrogance, with a deep sense of mistrust and betrayal still lingering over the exploitation and abuses of the colonial era". Salim S. Abdool Karim, the director of an AIDS research center in South Africa, placed the issue in the context of the history of exploitation and abuses. Responding to a question on how people may have reacted if ZMapp and other drugs would have been used first on Africans, said, "It would have been the front-page screaming headline: 'Africans used as guinea pigs for American drug company’s medicine'".

In early August, the World Health Organization called for convening a panel of medical authorities "to consider whether experimental drugs should be more widely released." In a statement, Peter Piot (co-discoverer of the Ebola virus); Jeremy Farrar, the director of the Wellcome Trust; and David Heymann of the Chatham House Center on Global Health Security, called for the release of experimental drugs for affected African nations.

At an August 6, 2014 press conference, Barack Obama, the President of the United States, was questioned regarding whether the cocktail should be fast-tracked for approval or be made available to sick patients outside of the United States. He responded, “I think we’ve got to let the science guide us. I don't think all the information's in on whether this drug is helpful."

See also

• Brincidofovir
• Monoclonal antibody therapy
• Palivizumab
• Pre-clinical development
• TKM-Ebola
• VSV-EBOV

External links

• Website of Mapp Biopharmaceutical
• NOVA episode "Surviving Ebola"
• “Ebola”. File on Four (BBC Radio 4). (2014年10月21日). http://www.bbc.co.uk/programmes/b04lq2yg. "at 24:24, Charles Arntzen, professor of molecular biology at Arizona State University says:" It was shortly after our major 9/11 event in the US and there was money available through the US army to begin to develop preventive technology in the event of a bio terrorism attack. One of the agents that they were very interested in was the Ebola virus.""