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The Ebola Wars In every battle there

comes a time when both
sides consider themselves

General Edition beaten, then he who

continues the attack
wins.
–Ulysses S. Grant–

by
Tracie M. Addy, Yale School of Medicine Teaching and Learning Center, Yale University
Linda M. Iadarola , Department of Biological Sciences, Quinnipiac University
Derek Dube, Department of Biology, University of Saint Joseph

Part I –What Is a Virus?

“I can’t believe I’m a college sophomore,” thought Terry in amazement while taking the train back home for the
summer. “he school year went by so fast, but I made it through even though I had to change my major.”
A text popped up on Terry’s smartphone, “Terry, when r u going on ur trip? Let’s meet up before u go.” Terry
recognized that the message was from Alex, a long-time friend from high school. “Leaving in a week,” Terry quickly
texted back. “Never been on a trip outside of the US and can’t wait to work with doctors and nurses to help sick
people. Alex, let’s meet up Fri.”
After a week of seeing family and friends, Terry was of to the west coast of Africa for ten weeks. his would be a life-
changing experience. he agency placed Terry in a rural site where residents had limited access to medical care. he
locals sometimes traveled miles to be seen at their clinic. he health care professionals on the team were unbelievably
positive and devoted to educating and providing patients with the best care possible. Residents came in with many
types of ailments. Terry’s responsibilities included greeting patients and their families, bandaging wounds, and
providing additional assistance to doctors and nurses as needed.
Just like the school year, the summer experience seemed as though it was over in no time. Terry was about to return
home when unexpected news came. Terry’s team was contacted by the Centers for Disease Control and Prevention
(CDC) and notiied that they had likely been exposed to a patient infected with the Ebola virus as there was an
outbreak near the medical relief site. he patient who had contracted the virus had died. Struck with fear, Terry
quickly tried to determine which patient it could have been and her likelihood of being infected, but she found this
nearly impossible to igure out. As a precaution, all individuals on the team returning to the US had to be screened
and undergo a 21-day quarantine where they would be monitored for any Ebola-like symptoms. Not doing so could
potentially place others at risk for contracting this deadly virus.
“I need to ind out more about viruses so that I can understand what’s going on,” thought Terry as she reached for
her general biology textbook. Glancing through the section on virology, she was surprised to discover that viruses are
tiny particles considered to be non-living since they cannot metabolize energy, do not create waste, do not grow, and
require host cells to multiply. Indeed, in order to replicate, viruses hijack the machinery present within the cells that
they infect. he additional viral particles produced inside host cells can exit and infect other cells. “hese viruses seem
kind of creepy,” thought Terry. “hey’re like parasites to cells.”
Terry continued reading:

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Viruses have either a DNA or RNA genome, which can be single- or double-stranded. hese genomes
are housed in a capsid made of proteins. Viruses can be classiied by their speciic genomes and the
unique features of their capsids, including shape and protein constituents. Some viruses have lipid
envelopes derived from host membranes that enclose the virus particle, while others do not. Surface
glycoproteins on these membranes, or spike proteins protruding from the viral capsid in non-enveloped
viruses, can play a role in viral attachment and entry into the host cell.
Terry spent the next few minutes summarizing the information she had just read.

Questions
1. Which structural features are in common to all viruses, and which are not? Complete the table below to answer
this question based upon the information provided in the case.

Shared Attributes Diferences

2. Why are viruses considered parasites?

3. Examine the diagram of the viral particle below. Label all of the important structures on this virus that you
identiied in the table above.

Figure 1. A general viral particle.

4. Design an imaginary viral particle. Create a diagram of your virus and label its major features. Your virus should
have a diferent capsid shape (e.g., icosahedral, helical, complex) than the one above and be non-enveloped.

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Part II – How Could a Virus Have Entered?

Terry considered what she had learned so far. “So the Ebola virus could be inside my cells? But how? How exactly
could a virus get inside? It seems to start at the plasma membrane... I’d better keep reading.”
In the irst step of infection, viral proteins interact speciically with host cells. Diferent viruses like
inluenza, rabies and even Ebola each have unique glycoproteins on their surface that bind only to
speciic receptors on the particular host cells they infect. For example, the inluenza virus uses the HA
(hemagglutinin) protein for binding to the host cell receptors on respiratory epithelial cells. A rabies
virus relies on the G protein protruding out of its viral envelope to attach to the host cell receptors of
neurons. Ebola virus uses GP to bind to the host cell receptors on a wide variety of cells, beginning with
the macrophages and dendritic cells of the lymphatic system. Once viruses attach to the host cell in this
very speciic manner, there are three major ways for them to complete the second stage of infection, entry
into the host cell. he irst is by direct injection of its genome (DNA or RNA) into the host cell at the
cell surface. he second is the binding of the virus to the plasma membrane, followed by the fusion of
the viral envelope with the host membrane to transfer the viral genome (DNA or RNA) into the host
cell. he third way is for the virus to bind to the host cell membrane and become internalized into the
host cell via the endocytic pathway.
“his is very strange,” she thought.

Questions
1. Why is viral attachment to the host cell speciic between one virus and one type of cell?

2. List several types of host cells and the associated virus that binds to the host cell.

3. What are three major ways in which a virus enters a host cell to deliver its genome?

4. Formulate a hypothesis as to why there is more than one mechanism of viral entry into host cells.

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Part III – The Battle between Viruses and Cells

“Now if the virus and its genetic material have gotten inside of my cells, what happens next?” Determined to ind out,
Terry read further and paraphrased the text.
“he next step is viral synthesis. So, it looks like once the virus enters my cells it hijacks the cell machinery including
many of my cells’ enzymes and ribosomes normally used to make my own proteins. he virus does not have these
proteins and structures so it relies heavily on the host cell to do the work for it. his process involves not only
replication of the genome, but also transcription of viral genes and translation of viral proteins. I remember learning
about transcription and translation in biology class. Now this is starting to come together. Still, this really bothers me
to think that the Ebola virus could be in my cells doing all this crazy stuf.
“So after viral synthesis comes viral assembly. his step sounds a lot like a factory, because the viral proteins and
genomes are put together to make complete viral particles. But then they still have to get out of the cells ... .
“Ah, I see, this step is called viral release and can difer between viruses. Some viruses with envelopes bud from the host
cell, taking pieces of the host cell membrane with viral proteins incorporated within, while others leave by exocytosis
in vesicles that bud from the endoplasmic reticulum or Golgi. Viruses without envelopes lyse (break open) the host
cell and leave that way, often killing the cell in the process.”
“It’s almost like a battle between the virus and my cells. hese viruses invade the cell to take over, and the cell doesn’t
even know it right away! hen a whole army of new viruses leave the cell and go out to invade and do battle with all
my other nearby cells.”

Questions
1. Describe the essential cell “machinery” that viruses use to make a new virus.

2. Why do viruses need the machinery to make more viruses? Why can’t they replicate on their own?

3. What are the structures that need to be put together during viral assembly? Consider the key structural
components of viruses described earlier.

4. How does the army of new viruses get out of the cell to infect the nearby cells?

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5. Examine the diagram below depicting viral infection of a typical cell.

a. Identify all (ive) of the steps used by viruses to get into the cell, make copies of viral proteins and leave the
cell as an army of viruses out to attack nearby cells.

i. __________________________

ii. __________________________

iii. __________________________

iv. __________________________

v. __________________________

b. Label the two cellular components indicated on the diagram.

Figure 2. Viral infection of a typical cell.

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Part IV – The Ebola Wars

In the middle of searching for more information on the Ebola virus, Terry began to feel gravely ill. Feverish, achy,
nauseated and weak, Terry’s worst fears came true—the symptoms were consistent with an Ebola virus infection.
While she now knew that Ebola virus could not be transmitted through the air, she recalled that during her trip
to West Africa she had a small cut on her hand while she was bandaging a patient who had high fever and was
hemorrhaging. he exchanged luid may have contained Ebola virus particles that infected Terry’s cells. After ive days
of illness including repeated vomiting and extreme pain, Terry wondered if this was the end. A decision was made to
transport Terry to a special facility for treatment and isolation.
Ebola is an enveloped, single-stranded RNA virus with a capsid and matrix made of VP40 and other viral proteins.
Ebola packages its own RNA-dependent RNA polymerase (L) (see Figure 3). Like many viruses, Ebola goes through

Figure 3. Ebola virus.

the processes of viral attachment, entry, synthesis, assembly and release. Recall that the Ebola virus has the protein GP
on its surface, which is required for attachment and entry to the host cell.
Once the virus attaches to the host cell, a series of events through the endocytic pathway leads to its entry into the
cell. his means the virus comes into the cell enclosed in a vesicle from the plasma membrane and gets delivered to
endosomes. Inside the endosome, the virus relies on the low pH to modify GP and help it fuse with the membrane
of the endosome. Once the viral genome is inside the cell cytoplasm, viral synthesis can begin, including genome
replication, transcription of viral genes, and translation of viral proteins. he packaged Ebola L enzyme is important
for initiating these synthesis steps. One protein produced that is important to the structure of the Ebola virus is called
VP40, which determines the ilamentous viral shape and interacts with the viral capsid. VP40 is made at the ribosomes
of Terry’s infected host cells, along with other Ebola virus proteins like the RNA-dependent RNA polymerase (L) and
the envelope glycoprotein (GP). Later, the VP40 proteins assemble with the other viral factors, like the viral genome,

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at the cell’s plasma membrane and acquire GP proteins that are already inserted in the host cell membrane. At this
point, the complete viruses can bud from the cell to spread the infection.
his very battle was occurring between Terry’s cells and the Ebola virus.

Questions
1. Examine the diagram (Figure 4, next page) showing the life cycle of the Ebola virus.
a. Label the ive major steps used by Ebola virus to infect cells. In what speciic ways are these similar or
diferent from those you labeled in the general virus life cycle?

i. __________________________

ii. __________________________

iii. __________________________

iv. __________________________

v. __________________________

Key similarities and diferences:

b. Label the key viral and cellular factors in the indicated areas of the diagram. Describe each of their roles.

2. Formulate a hypothesis as to what would happen to viral replication and budding from the cell if the ribosomes
did not make VP40.

3. What is one structural component of the Ebola virus to target for a vaccine that prevents infections like Terry’s?
Explain your answer. Keep in mind the Ebola virus structures and that vaccines are developed to prevent viral
infections (for example, the lu vaccine contains a weakened form of the inluenza virus that does not cause
disease).

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Part V – Treatment
Terry’s doctor knew quick action was necessary to help her survive the Ebola infection. he doctor had four options to
treat Terry’s condition: a vaccine, a standard antiviral medication, an immunotherapy-based method of treatment, and
serum from an Ebola patient who had fully recovered.
he irst option, a vaccine in clinical trials, could potentially provide protection against a viral infection when used
prior to contracting the disease. Vaccines typically introduce the body to an antigen, consisting of the dead virus,
or parts of a virus, such as a speciic glycoprotein from the viral protein coat/envelope. hese non-self antigens are
considered foreign to the body and invoke an immune response where antibodies are made against the viral protein in
the vaccine. Once antibodies are made and circulated throughout the body, they can attach to the viral antigens and
the immune system destroys the antigen. his immune response takes time.
When considering the second option, Terry’s doctor thought about antiviral therapies for other viruses, like the lu.
She knew that with inluenza infection, the antiviral medicine Tamilu™ was only efective if administered within the
irst 48 hrs of infection. Unfortunately, Terry was in late stages of the disease, and there were no such approved Ebola-
speciic antiviral medicines currently available for use.
he third option was immunotherapy with the investigational treatment ZMapp.™ ZMapp is a treatment method
that uses three unique antibodies against Ebola GP made in tobacco plants. While there had not been any large-scale
human trials at the time of Terry’s infection, when these antibodies were injected into Ebola-infected mice and rhesus
macaque primates, the animals showed increased survival. As such, ZMapp was thought to be a potentially efective
antiviral/immunotherapy-based treatment for Ebola infections in humans, and in a few cases was used to treat human
Ebola patients during the 2014 outbreak. Although the mechanism of action for ZMapp had not been elucidated yet,
researchers believed that since the antibodies in ZMapp bound to the glycoprotein (antigen) on the Ebola virus, it
prevented viral attachment to the cells and thus did not allow entry or viral replication.
A inal option would be to give Terry serum from a patient who had recovered from an Ebola infection of the same
strain. his serum would be rich with Ebola-speciic antibodies to enhance Terry’s immune response. However, this
method of treatment required identifying an Ebola virus survivor who had blood type compatibility with Terry and
who was willing and able to donate serum in a timely fashion.

Question
1. Synthesize the information provided above. Come up with an argument as to the best treatment plan for Terry.

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Part VI – Recovery
Terry’s symptoms cleared and she was virus free. he battle was now over and Terry’s cells won. One would never know
whether it was the treatment, Terry’s own immune system, or a combination of the two that won the war against
Ebola. In the end, Terry survived the potentially-deadly infection and was able to return home without any long-term
efects, other than a newfound understanding and appreciation of how viruses, like Ebola, replicate and cause disease.
Victory at all costs, victory in spite of all terror, victory however long and hard the road may be;
for without victory, there is no survival.
—Winston Churchill—
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Case copyright held by the National Center for Case Study Teaching in Science, University at Bufalo, State University of New York. Originally
published February 9, 2016. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work. Licensed
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