tragedy again

Rage is a natural part of human behavior.  It often occurs when we are faced with an insidious, invisible enemy.  The patient in Maryland who just died (reported 13 MAR 2013) following a kidney transplant, a transplant that harbored rabies virus, is certainly reason to rage against nature.  How can this happen?  How can it occur in this age of modern medical miracles?!  Others can talk about better screening of organ donors, better screening of transplant material.  That’s all necessary and good.  That doesn't help the present sorrow.  

This case does highlight several important aspects of rabies.  First, if rabies is not caught before it enters (infects) the central nervous system (CNS), there is no treatment.  The Milwaukee protocol aside – it’s potential seems harder to reproduce than expected – there is simply no treatment -- no hope -- after the deadly virus enters the CNS.  For the other people who received material from the same organ donor, and who seem presently healthy, the “Pasteur vaccine” may still be able to glom onto and expel any viruses residing in them.  It is a very effective prophylactic treatment, and we can well hope it will successfully protect those people.  [I put Pasteur vaccine in quotations because Louis Pasteur and coworkers developed the first vaccine, but there have been multiple rounds of significant improvement since then.]

The person who died received the transplant well over a year ago, but only recently developed the symptoms of actual infection.  This highlights that exposure to rabies is NOT infection.  That rabies can only infect neurons, and that it must penetrate into the CNS to produce infection.  Following exposure, the virus simply floats around the body until it finds the unique receptor that will internalize it into the small number of CNS neurons that are in contact with the periphery of the body.  During this interim period, the virus does not infect cells, it does not reproduce, it is not in some latent form.  It is simply being pushed and pulled around in extracellular spaces until it happens across its target protein.  This interim period is not the result of slow migration through peripheral nerves transporting the virus into the CNS.  We’re talking years!  In the present case, well over a year.  And one case of a four year interim period between exposure and infection has been documented.  No axonal/intraneuronal transport mechanism is that slow.

Again, this recent tragedy highlights that we don’t know the receptor that the rabies virus binds to in order to gain access to the CNS!  As a virus that has been recorded, railed against, from the earliest days of humanity’s ability to write, this is nothing short of unbelievable - unforgivable.  And since we don’t know the receptor that takes it into the brain, which is likely the receptor that allows it to be passed from neuron to neuron and to turn victims into monsters as they are dying, we have no idea of how to block its behavioral and lethal effects.  Surely, this cannot be allowed to continue.  The means to discover this receptor are well in hand; they just require the $$$$ and wherewithal to carry out the necessary studies.  I hope that some good can come of this new tragedy and the effort to contain this monster can begin in earnest.