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Being Infected With Malaria Helped Ebola Victims to Survive

Ebola survivor James Harris, 29, stands for a portrait before a shift as a nurse's assistant at the Doctors Without Borders (MSF), Ebola treatment center on October 12, 2014 in Paynesville, Liberia. Image credit: John Moore/Getty Images

 
A recent study revealed a surprising finding: Of those infected in the West African Ebola epidemic in 2014, patients who had an active malaria parasite infection were actually more likely to survive the Ebola virus, and by a significant degree. While just over half (52 percent) of Ebola patients not infected with malaria survived, those co-infected with malaria had a survival rate of 72 to 83 percent, depending on their ages and the amount of Ebola virus in their blood.

What gives? Shouldn’t having a second, potentially deadly infection make you more likely to die of Ebola? 

Maybe not. Though researchers aren’t yet sure of the mechanism by which malaria co-infection in Ebola patients might be protective, they have some ideas. The prevailing thought is that malaria is somehow modifying the immune response to Ebola, making it less deadly than in people who aren’t co-infected with the malaria parasite.

The authors of the study, published in the journal Clinical Infectious Diseases, note that malaria can make other infections less deadly. For example, in a group of children from Tanzania, those who had respiratory infections along with malaria were less likely to have those infections develop into pneumonia than kids who had respiratory infections without it.

It may be that malaria is able to tone down a phenomenon called the “cytokine storm”—the body’s own response to an Ebola infection that inadvertently kills the host while attempting to eliminate the pathogen. If malaria can turn this host response down, patients may have a better chance of surviving the virus’s assault.

This wouldn’t be the first time that malaria infection has been hailed as a hero, rather than an enemy. In 1927, the Nobel Prize in Physiology or Medicine was awarded to Julius Wagner-Jauregg “for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica.” Wagner-Juaregg and others had observed that sometimes syphilis seemed to be cured following “febrile infectious diseases” as far back as 1887. He also noted in his Nobel speech that he had “singled out as a particular advantage of malaria that there is the possibility of interrupting the disease at will by the use of quinine, but I did not then anticipate to what degree these expectations from induced malaria would be fulfilled.” While there was no “cure” for syphilis at the time, and no cure for the other infection he had considered (erysipelas, usually caused by the same bacterium that causes strep throat and scarlet fever), malaria could be treated with quinine, a compound that we still use today.

Before Wagner-Juaregg’s “malariotherapy,” treatments for syphilis included mercury, Salvarsan (an arsenic-containing drug), and bismuth—all of which had serious side effects, including death. Wagner-Juaregg’s methods seemed to have no more risks than the conventional treatments of the era, and in 1917, he injected nine individuals suffering from advanced syphilis with malaria parasites. He reported three of them to be cured, and three more to have “extensive remission.” Soon, malariotherapy spread across the U.S. and into Europe, with tens of thousands of syphilis patients treated with the malaria parasite.

However, the degree to which malariotherapy worked is still a matter of controversy. And it was not without its own serious side effects, with death resulting in up to 15 percent of those treated. With the introduction of penicillin as a treatment for syphilis in the 1940s, malariotherapy was replaced, but the decades of use of malaria as a treatment significantly advanced our knowledge of the malaria parasite.

Today, scientists may be able to use this natural experiment to create drugs that could mimic malaria’s effect without actively infecting individuals. (Malaria is a devastating disease, causing hundreds of thousands of deaths every year, primarily in Africa.) Animal models could potentially be used to tease apart the host’s response to Ebola infection and determine how malaria alters the usual response to the Ebola virus to make it less deadly. These alterations could be used to create new drugs or other interventions to treat Ebola infection.

More importantly, further study of the phenomenon of malaria co-infection with other pathogens could lead to changes in patient care. The current standard operating procedure is to treat malaria infection when it is found in an Ebola case. But might it actually improve a patient's outcome to delay treatment for malaria? The authors of the current study note that a mouse model of malaria-Ebola co-infection found that treatment for malaria led to death from Ebola infection in all animals. And yet during the 2014 Ebola outbreak, work carried out at one Ebola treatment center in Liberia showed that Ebola fatality rates decreased with effective malaria treatment. Complicating the matter, the malarial drug used in that case (artesunate-amodiaquine, or ASAQ) may have been responsible for the anti-Ebola activity.

While it’s unlikely that a malaria treatment for Ebola would be as popular (or legal or ethical) as the “malariotherapy” of the early 1900s, it’s certainly worth closely examining the clues this co-infection has provided scientists about the nature of both Ebola and malaria infections—and how we could harness them to fight against one of nature’s most frightening diseases.

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Jamie McCarthy/Getty Images for Bill & Melinda Gates Foundation
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Medicine
Bill Gates is Spending $100 Million to Find a Cure for Alzheimer's
Jamie McCarthy/Getty Images for Bill & Melinda Gates Foundation
Jamie McCarthy/Getty Images for Bill & Melinda Gates Foundation

Not everyone who's blessed with a long life will remember it. Individuals who live into their mid-80s have a nearly 50 percent chance of developing Alzheimer's, and scientists still haven't discovered any groundbreaking treatments for the neurodegenerative disease [PDF]. To pave the way for a cure, Microsoft co-founder and philanthropist Bill Gates has announced that he's donating $100 million to dementia research, according to Newsweek.

On his blog, Gates explained that Alzheimer's disease places a financial burden on both families and healthcare systems alike. "This is something that governments all over the world need to be thinking about," he wrote, "including in low- and middle-income countries where life expectancies are catching up to the global average and the number of people with dementia is on the rise."

Gates's interest in Alzheimer's is both pragmatic and personal. "This is something I know a lot about, because men in my family have suffered from Alzheimer’s," he said. "I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you're experiencing a gradual death of the person that you knew."

Experts still haven't figured out quite what causes Alzheimer's, how it progresses, and why certain people are more prone to it than others. Gates believes that important breakthroughs will occur if scientists can understand the condition's etiology (or cause), create better drugs, develop techniques for early detection and diagnosis, and make it easier for patients to enroll in clinical trials, he said.

Gates plans to donate $50 million to the Dementia Discovery Fund, a venture capital fund that supports Alzheimer's research and treatment developments. The rest will go to research startups, Reuters reports.

[h/t Newsweek]

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A New Analysis of Chopin's Heart Reveals the Cause of His Death

For years, experts and music lovers alike have speculated over what caused celebrated composer Frederic Chopin to die at the tragically young age of 39. Following a recent examination of his heart, Polish scientists have concluded that Chopin succumbed to tuberculosis, just as his death certificate states, according to The New York Times.

When Chopin died in 1849, his body was buried in Paris, where he had lived, while his heart was transported to his home city of Warsaw, Poland. Chopin—who appeared to have been ill with tuberculosis (TB)—was terrified of the prospect of being buried alive, and nostalgic for his national roots. He asked for his heart to be cut out, and his sister later smuggled it past foreign guards and into what is now Poland.

Preserved in alcohol—likely cognac—and stored in a crystal jar, Chopin's heart was laid to rest inside Holy Cross Church in Warsaw. (It was removed by the Germans in 1944 during the Warsaw Uprising, and later returned.) But rumors began to swirl, as the same doctor tasked with removing the heart had also conducted an autopsy on the composer's body, according to the BBC.

The physician's original notes have been lost, but it's said he concluded that Chopin had died not from TB but from "a disease not previously encountered." This triggered some scholars to theorize that Chopin had died from cystic fibrosis, or even a form of emphysema, as the sickly musician suffered from chronic respiratory issues. Another suspected condition was mitral stenosis, or a narrowing of the heart valves.

Adhering to the wishes of a living relative, the Polish church and government have refused to let scientists conduct genetic tests on Chopin's heart. But over the years, teams have periodically checked up on the organ to ensure it remains in good condition, including once in 1945.

In 2014, a group of Chopin enthusiasts—including Polish scientists, religious officials, and members of the Chopin Institute, which researches and promotes Chopin's legacy—were given the go-ahead to hold a clandestine evening meeting at Holy Cross Church. There, they removed Chopin's heart from its perch inside a stone pillar to inspect it for the first time in nearly 70 years.

Fearing the jar's alcohol would evaporate, the group added hot wax to its seal and took more than 1000 photos of its contents. Pictures of the surreptitious evening procedure weren't publicly released, but were shown to the AP, which described Chopin's preserved heart as "an enlarged white lump."

It's unclear what prompted a follow-up investigation on Chopin's heart, or who allowed it, but an early version of an article in the American Journal of Medicine states that experts—who did not open the jar—have newly observed that the famed organ is "massively enlarged and floppy," with lesions and a white, frosted appearance. These observations have prompted them to diagnose the musician's cause of death as pericarditis, which is an inflammation of tissue around the heart. This likely stemmed from his tuberculosis, they said.

Some scientists might still clamor at the prospect of testing tissue samples of Chopin's heart. But Michael Witt of the Polish Academy of Sciences—who was involved in this latest examination—told The Guardian that it was unnecessary to disturb what many consider to be a symbol of national pride.

"Some people still want to open it in order to take tissue samples to do DNA tests to support their ideas that Chopin had some kind of genetic condition," Witt said. "That would be absolutely wrong. It could destroy the heart, and in any case, I am quite sure we now know what killed Chopin."

[h/t The New York Times]

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