Disaster, community-wide trauma, and epidemics can have devastating effects on a child’s emotional and psychological wellbeing (Wethington, Hahn, Fuqua-Whitley et al., 2008). The 2014-2015 Liberian Ebola epidemic was detrimental to a country still recovering from a 14-year war. In Liberia alone there were 10,678 confirmed cases and 4,810 Ebola deaths (CDC, 2016). The physical, emotional, and psychological toll of this epidemic was extraordinary. An United States non-profit, Playing to Live (PTL), worked alongside the Liberian government, ministries and local and international organizations to find an innovative solution to the psychological and emotional healing of children and families most affected. This solution used best practices in expressive arts therapy, mental health, and train the trainer models. The purposes of these studies were to evaluate the process of the PTL programming, the outcome effects based on pre-and posttests of child participants psychological stress symptoms (PSS), and explore lessons learned and implications for future programming. Process evaluation results indicated positive reactions to programming from both facilitators and child participants. Results also brought forth considerations for future programming. Outcome data from the pre-and post PSS symptoms showed a significant decrease for both 5-months and 3-months of PTL programming. In addition, a significant difference on pre-and post-symptoms for the 5-month and 3-month treatment groups was found, indicating that longer treatment yields greater results. A review of best practices and lessons learned was discussed for future implications for PTL and similar programs.

Ebola virus (EBOV) is a member of the Filoviridae family of highly pathogenic viruses that cause severe hemorrhagic fever and is the causative agent of the 2014 West Africa outbreak. Currently, there are no approved filovirus vaccines or treatments to combat these sporadic and deadly epidemics. One target for EBOV antiviral therapy is to block viral entry into host cells. Recently, phosphatidylserine (PtdSer) receptors, primarily known for their involvement in the clearance of dying cells, were shown to mediate entry of enveloped viruses including filoviruses. The PtdSer receptors, T-cell immunoglobulin mucin domain-1 (TIM-1) and family member TIM-4, serve as filovirus receptors, significantly enhancing EBOV entry. TIM-dependent virus uptake occurs via apoptotic mimicry by binding to PtdSer on the surface of virions through a conserved PtdSer binding pocket within the amino terminal IgV domain. TIM-4 is expressed on antigen presenting cells (APCs), including macrophages and dendritic cells (DCs), which are critical in early EBOV infection. My studies are the first to define the molecular details of virion/TIM-4 interactions and establish the importance of TIM-4 for EBOV infection of murine resident peritoneal macrophages. In addition, previous work has utilized only in vitro models to establish the importance of the TIM proteins in EBOV entry. My studies are the first to demonstrate the importance of TIM-1 and TIM-4 for in vivo EBOV pathogenesis and to confirm them as relevant targets of future filovirus therapeutics. Macrophage phenotypes can vary greatly depending upon chemokine and cytokine signals from their microenvironment. Historically, macrophages have been classified into two major subgroups: classically activated macrophages (M1) and alternatively activated macrophages (M2). Macrophages are a critical early target of EBOV infection and my work primarily focused on interferon gamma-stimulated (M1) macrophages since this treatment profoundly inhibited EBOV infection of human and murine macrophages. Interferon gamma treatment blocked EBOV replication in macrophages, reducing viral RNA levels in a manner similar to that observed when cultures were treated with the protein synthesis inhibitor, cycloheximide. Microarray studies with interferon gamma-treated human macrophages identified more than 160 interferon-stimulated genes. Ectopic expression of a select group of these genes inhibited EBOV infection. These studies provide new potential avenues for antiviral targeting as these genes that have not previously appreciated to inhibit infection of negative strand RNA viruses including EBOV. In addition and most exciting, using MA-EBOV, we found that murine interferon gamma, when administered either 24 hours before or after infection, protects lethally challenged mice and significantly reduces morbidity. Our findings suggest that interferon gamma, an FDA-approved drug, may serve as a novel and effective prophylactic or treatment option.

Les virus Ebola (EBOV) et Marburg (MARV) causent des fièvres hémorragiques chez les primates, y compris l'homme. Le taux de létalité peut atteindre 90% et il n'existe ni vaccin ni traitement contre ces virus. En raison de leurs caractéristiques moléculaires communes, EBOV et MARV sont regroupés au sein de la famille des Filoviridae. Le virion est composé de 7 protéines, dont la VP24, qui joue un rôle important dans l'assemblage et la condensation des nucléocapsides, et pour EBOV, elle est également responsable de l'inhibition de la réponse à l'IFN. Des mutations dans la séquence protéique de VP24 sont impliquées dans le processus d'adaptation chez un nouvel hôte. La protéine VP24 d'EBOV est donc multifonctionnelle. Pour MARV, cette protéine ne semble pas porter les fonctions décrites pour la VP24 d'EBOV. Afin de comprendre le rôle de la VP24 de MARV, nous avons identifié ses partenaires cellulaires par un crible double-hybride en levures. Nous avons mis en évidence l'interaction entre Keap1 et la VP24 de MARV, et confirmé ce résultat en cellules mammifères. Keap1 est une protéine impliquée dans le contrôle de la réponse au stress oxydatif, car elle inhibe le facteur de transcription Nrf2, qui régule l'expression d'enzymes impliquées dans la réduction des ERO. Nos résultats montrent que le domaine de Keap1 liant la VP24 est le même que celui liant Nrf2, et que la VP24 de MARV active Nrf2 pour la synthèse de molécules anti-oxydantes. Nous avons enfin évalué l'impact de la VP24 de MARV sur ERR, une autre cible de Keap1, et mesuré l'activité Nrf2 au cours de l'infection par EBOV. Nos résultats montrent des effets opposés des VP24 d' EBOV et de MARV sur l'activité de Nrf2.

Le virus Ebola, responsable d'une fièvre hémorragique virale létale et le virus de la variole, agent étiologique de la variole, sont des armes biologiques potentielles. Il n'existe pas de traitement ou de prophylaxie autorisés contre le virus Ebola, quelques candidats vaccins étant en cours de développement. Concernant la variole, des vaccins dits de première génération (virus de la vaccine) ont permis l'éradication de la maladie cependant ils sont à l'origine de complications post-vaccinales parfois sévères alors que des vaccins plus récents dits de troisième génération, non-réplicatifs, ont été développés pour leur innocuité mais restent faiblement immunogènes. Nous avons récemment développé plusieurs vecteurs viraux de type virus de la vaccine (VACV) par délétion d'un certain nombre de facteurs de virulence. Nous avons évalué leur innocuité, leur immunogénicité et leur efficacité en tant que candidats vaccins antivarioliques chez la souris puis utilisé l'un de ces vecteurs pour développer un candidat vaccin bivalent antivariolique et anti-virus Ebola. Ces virus de la vaccine délétés sont réplicatifs mais fortement atténués. Ils induisent une réponse en anticorps neutralisants spécifiques anti-vaccine similaire à celle induite par le vaccin antivariolique de première génération et induisent des réponses immunitaires cellulaires CD4+ et CD8+ spécifiques suffisantes pour protéger l'animal d'un challenge létal de cowpoxvirus en intranasal, simulant une infection par le virus de la variole. Le virus délété le plus immunogène et le plus sûr, nommé MVL, a été utilisé pour construire un vecteur viral codant pour la glycoprotéine du virus Ebola (EGP). Le gène entier d'EGP ou une forme chimérique d'EGP (fusion entre l'ectodomaine d'EGP et le domaine transmembranaire de la glycoprotéine B5 du VACV) ont été clonés dans le génome du vecteur viral. Ces deux vecteurs produisent des virus ayant incorporé EGP dans leur enveloppe. Ces deux candidats vaccins recombinants induisent de fortes réponses humorales spécifiques anti-EGP et anti-vaccine chez la souris immunocompétente. En conclusion, nous avons développé plusieurs candidats vaccins antivarioliques aussi immunogènes et efficaces que le vaccin historique et avec une atténuation similaire aux vaccins de troisième génération. L'un de ces candidats (MVL) a été utilisé comme vecteur viral pour exprimer la glycoprotéine hétérologue EGP, contre laquelle il induit une réponse immunitaire humorale forte

No description available.

Multifunctional proteins that undergo major structural changes to perform different functions are known as “Transformer Proteins”, which is a recently identified class of proteins. One such protein that shows a remarkable structural plasticity and has two distinct functions is the transcription antiterminator, RfaH. Depending on the interactions between its N-terminal domain and its C-terminal domain, the RfaH CTD exists as either an all-α-helix bundle or all-β-barrel structure. Another example of a transformer protein is the Ebola virus protein VP40 (eVP40), which exists in different conformations and oligomeric states (dimer, hexamer, and octamer), depending on the required function.I performed Molecular Dynamics (MD) computations to investigate the structural conversion of RfaH-CTD from its all-a to all-b form. I used various structural and statistical mechanics tools to identify important residues involved in controlling the conformational changes. In the full-length RfaH, the interdomain interactions were found to present the major barrier in the structural conversion of RfaH-CTD from all-a to all-b form. I mapped the energy landscape for the conformational changes by calculating the potential of mean force using the Adaptive Biasing Force and Jarzynski Equality methods. Similarly, the interdomain salt-bridges in the eVP40 protomer were found to play a critical role in domain association and plasma membrane (PM) assembly. This molecular dynamic simulation study is supported by virus like particle budding assays investigated by using live cell imaging that highlighted the important role of these saltbridges. I also investigated the plasma membrane association of the eVP40 dimer in various PM compositions and found that the eVP40 dimer readily associates with the PM containing POPS and PIP2 lipids. Also, the CTD helices were observed to be important in stabilizing the dimer-membrane complex. Coarse-grained MD simulations of the eVP40 hexamer and PM system revealed that the hexamer enhances the PIP2 lipid clustering at the lower leaflet of the PM. These results provide insight on the critical steps in the Ebola virus life cycle.

En dépit d’épidémies répétées, il n’existe pas à ce jour de thérapeutique ayant démontré son efficacité dans la maladie à virus Ebola. Sur la base d’expérimentations réalisées chez la souris et le macaque dans le cadre du consortium Reaction!, l’objectif de cette thèse visait à caractériser l’effet d’une molécule antivirale, le favipiravir, via l’implémentation de modèles mathématiques mécanistiques de l’infection et de la réponse immunitaire associée. L’approche utilisée pour construire ces modèles et en estimer les paramètres reposait sur les modèles non linéaires à effets mixtes. Un premier travail a permis d’explorer la relation concentration-effet sur la charge virale plasmatique chez la souris. Le second projet a conduit à caractériser la pharmacocinétique non linéaire dose et temps dépendante du favipiravir chez le macaque, en vue d’identifier les schémas posologiques pertinents pour la réalisation des études d’efficacité chez l’animal infecté. Au décours de leur réalisation, l’intégration des données virologiques et immunitaires générées au sein d’un modèle conjoint a permis de caractériser un effet modéré du favipiravir sur la réplication virale, mais suffisant pour limiter le développement d’une réaction inflammatoire délétère, et ainsi améliorer le taux de survie des animaux traités. Les simulations réalisées avec ce modèle ont pu souligner l’impact déterminant du délai d’initiation du traitement sur la survie. Ces résultats incitent à la poursuite de l’évaluation clinique du favipiravir, en favorisant des essais de prophylaxie ou post exposition. Enfin, un dernier travail a démontré l’absence de potentialisation du favipiravir par la ribavirine dans Ebola. / In spite of recurrent outbreaks, no therapeutics with demonstrated clinical efficacy are available in Ebola virus disease. Based on experimentations performed by Reaction! Consortium in mice and macaques, this thesis aimed to characterize the effect of an antiviral drug, favipiravir, using mechanistic mathematical models of the infection and associated immune response. The approach to build models and estimate parameters relied on nonlinear mixed effect models. The first project of this thesis explored the concentration-effect relationship on the viremia in mice. Then, a second project allowed to characterize the pharmacokinetics of favipiravir in macaques, underlying dose and time non linearity, and to identify relevant dosing regimen for efficacy experiments in infected animals. Once these experiments completed, the integration of the virological and immunological data into a mechanistic joint model shed light on the effect of favipiravir. The moderate inhibition of the viral replication resulting from the favipiravir plasma concentrations was enough to limit the development of a deleterious inflammatory response, and thus improve the survival rate of treated macaques. Simulations performed with this model underlined the crucial impact of the treatment initiation delay on survival. These results encourage the pursuit of the clinical evaluation of favipiravir in prophylaxis or post exposure trials. Finally, a last project demonstrated the lack of benefit of ribavirin addition to favipiravir in Ebola virus disease.

No description available.

Changing the approach to communication and engagement with the local people in Liberia during the Ebola response turned out to be a key strategy in the Red Cross’ work. The Liberian Red Cross’ communication with the crisis-affected people changed significantly during the fight against the Ebola virus, from top-down information to a more dialogical communication approach. The Ebola epidemic in West Africa has caused more than 11 000 deaths since the outbreak in March 2014. The task of defeating the virus seemed overwhelming at times, but the outbreak finally stopped and all the three worst hit countries: Guinea, Sierra Leone and Liberia were declared Ebola-free by the World Health Organization. Communication with and participation of the people the aid organizations target have been a central issue for discussion within the international community and development agencies for a long time. During the Ebola response it was clearly stated that communicating and engaging with the people living in the affected area was a core approach during and after the response. This thesis explores how one of the responding humanitarian organizations, The Red Cross, used communication with the crisis affected people in Liberia as a tool in their response to help stop and prevent the virus from spreading. The study is done as a case study. Main components of the case, and focus for the analysis, are semi-structured interviews with staff and volunteers from the Liberian Red Cross that worked with communication and operational activities during the Ebola response. Red Cross documents from the Ebola response, policy, planning, evaluation and training-documents, are also important part of the case.

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