Treatment of blood with a pathogen reduction technology using ultraviolet light and riboflavin inactivates Ebola virus in vitro

BACKGROUNDTransfusion of plasma from recovered patients after Ebolavirus (EBOV) infection, typically called convalescent plasma, is an effective treatment for active disease available in endemic areas, but carries the risk of introducing other pathogens, including other strains of EBOV. A pathogen reduction technology using ultraviolet light and riboflavin (UV+RB) is effective against multiple enveloped, negative-sense, single-stranded RNA viruses that are similar in structure to EBOV. We hypothesized that UV+RB is effective against EBOV in blood products without activating complement or reducing protective immunoglobulin titers that are important for the treatment of Ebola virus disease (EVD). STUDY DESIGN AND METHODSFour in vitro experiments were conducted to evaluate effects of UV+RB on green fluorescent protein EBOV (EBOV-GFP), wild-type EBOV in serum, and whole blood, respectively, and on immunoglobulins and complement in plasma. Initial titers for Experiments 1 to 3 were 4.21 log GFP units/mL, 4.96 log infectious units/mL, and 4.23 log plaque-forming units/mL. Conditions tested in the first three experiments included the following: 1EBOV-GFP plus UV+RB; 2EBOV-GFP plus RB only; 3EBOV-GFP plus UV only; 4EBOV-GFP without RB or UV; 5virus-free control plus UV only; and 6virus-free control without RB or UV. RESULTSUV+RB reduced EBOV titers to nondetectable levels in both nonhuman primate serum (2.8- to 3.2-log reduction) and human whole blood (3.0-log reduction) without decreasing protective antibody titers in human plasma. CONCLUSIONOur in vitro results demonstrate that the UV+RB treatment efficiently reduces EBOV titers to below limits of detection in both serum and whole blood. In vivo testing to determine whether UV+RB can improve convalescent blood product safety is indicated.