Dengue virus and lipid metabolism: unravelling the interplay for future therapeutic approaches

In recent years, Dengue virus (DENV) has continued to pose significant health risks in tropical and subtropical areas worldwide, raising health alerts worldwide. It can cause hyperviremia in humans and can even lead to fatal clinical diseases. The life cycle of DENV is intricately linked to cellular lipids, and the virus selectively utilizes relevant enzymes involved in lipid metabolism to modulate the existing metabolic system in host cells during entry, replication, assembly, and other stages, thereby creating an environment conducive to its complete replication cycle. At present, there is a lack of effective and specific anti-DENV treatment measures. This review summarizes the recently identified lipid metabolism molecules and metabolic related diseases that affect DENV infection, explores the dependence of DENV on lipid metabolism and provides potential targets for the treatment of dengue fever (DF).

Increased dialysis symptom index burden in maintenance hemodialysis patients during the COVID-19 lockdown period

PURPOSE

The high prevalence of dialysis-related symptoms in maintenance hemodialysis (MHD) patients severely affects their quality of life. Therefore, in this study, we assessed the dialysis symptom index (DSI) of MHD patients during the second wave of COVID-19, which triggered a health crisis, resulting in many cities in China opting for social isolation.

METHODS

A total of 106 MHD patients from our center were screened. DSI, sleep quality, and fatigue scales were investigated separately before and during lockdown. Demographic and laboratory data of MHD patients were collected. A nomogram was used to predict high DSI by combining multiple indicators. Additionally, internal validation was performed to reduce overfitting bias.

RESULTS

The mean age of patients was 56.0 years (SD 13.1). The prevalence and severity of DSI were significantly higher during lockdown than pre-lockdown. Notably, itching, trouble staying asleep, bone or joint pain, muscle cramps, feeling irritability, difficulty concentrating, headache, constipation, and feeling nervous were observed (p < 0.05). Multivariate logistic regression analysis identified longer dialysis vintage, lower albumin level, and lower Kt/V as predictors of high DSI. Nomogram showed good accuracy in estimating high DSI with a C-index and bootstrap-corrected index of 0.875 and 0.863, respectively. Calibration plots showed optimal consistency with the actual presence of high DSI.

CONCLUSION

We found a higher prevalence of DSI in MHD patients during the COVID-19 lockdown. Furthermore, patients with longer dialysis vintage, lower albumin levels, and Kt/V had a risk of developing high DSI.

Alpha-linolenic acid-mediated epigenetic reprogramming of cervical cancer cell lines

Cervical cancer, the fourth most common cancer globally and the second most prevalent cancer among women in India, is primarily caused by Human Papilloma Virus (HPV). The association of diet with cancer etiology and prevention has been well established and nutrition has been shown to regulate cancer through modulation of epigenetic markers. Dietary fatty acids, especially omega-3, reduce the risk of cancer by preventing or reversing the progression through a variety of cellular targets, including epigenetic regulation. In this work, we have evaluated the potential of ALA (α linolenic acid), an ω-3 fatty acid, to regulate cervical cancer through epigenetic mechanisms. The effect of ALA was evaluated on the regulation of histone deacetylases1, DNA methyltransferases 1, and 3b, and global DNA methylation by ELISA. RT-PCR was utilized to assess the expression of tumor regulatory genes (hTERT, DAPK, RARβ, and CDH1) and their promoter methylation in HeLa (HPV18-positive), SiHa (HPV16-positive) and C33a (HPV-negative) cervical cancer cell lines. ALA increased DNA demethylase, HMTs, and HATs while decreasing global DNA methylation, DNMT, HDMs, and HDACs mRNA expression/activity in all cervical cancer cell lines. ALA downregulated hTERT oncogene while upregulating the mRNA expression of TSGs (Tumor Suppressor Genes) CDH1, RARβ, and DAPK in all the cell lines. ALA reduced methylation in the 5' CpG island of CDH1, RARβ, and DAPK1 promoters and reduced global DNA methylation in cervical cancer cell lines. These results suggest that ALA regulates the growth of cervical cancer cells by targeting epigenetic markers, shedding light on its potential therapeutic role in cervical cancer management.

Exploiting the potential of in situ forming liquid crystals: development and in vitro performance of long-acting depots for peptide drug thymosin alpha 1 subcutaneous administration

The fast-growing filed of long-acting depots for subcutaneous (SC) administration holds significant potential to enhance patient adherence to treatment regimens, particularly in the context of chronic diseases. Among them, injectable in situ forming lyotropic liquid crystals (LCCs) consisting of hexagonal mesophases represent an attractive platform due to their remarkable highly ordered microstructure enabling the sustained drug release. These systems are especially relevant for peptide drugs, as their use is limited by their short plasma half-life and inherent poor stability. In this study, we thus aimed to exploit the potential of a liquid crystalline platform for the sustained release of peptide drug thymosin alpha 1 (Tα1), characterized by a short plasma half-life and with that associated twice-weekly SC administration regimen. We initially selected specified ingredients, with ethanol serving to reduce viscosity and stabilize the peptide drug Tα1, lecithin contributing to LCCs formation and stabilization, and glycerol monooleate or glycerol monolinoleate representing the hexagonal LCCs forming matrix material. The selected studied nonaqueous precursor formulations were characterized by suitable rheological properties for SC injection. A convenient and rapid in situ phase transition of precursor formulations to hexagonal LCCs, triggered by water absorption, was successfully accomplished in vitro. Notably, in situ formed LCCs demonstrated sustained release kinetics of the peptide drug Tα1 for up to 2 weeks of in vitro release testing, offering minimized dosing frequency and thus promoting patient adherence. In summary, the newly developed in situ forming liquid crystalline systems represent prospective injectable long-acting depots for SC administration of the peptide drug Tα1.

Overrange dilution for improvement of hepatitis B core related antigen as a biomarker: protocol validation and examples for application

BACKGROUND

Hepatitis B core related antigen (HBcrAg) measurement predicts treatment outcomes and reflects intrahepatic HBV replication. The commercially available automated assay for HBcrAg has a linear range of 3.0 - 7.0 logU/mL, with higher levels requiring dilution. However, using different diluents across studies may impact comparability and cross-reactivity, which has not been thoroughly investigated. This study aims to validate a dilution method for specimens above the upper limit of quantification (7.0 logU/mL) to improve comparability.

METHODS

The dilution procedure was two-site tested with three matrices for practicability, accuracy and repeatability using samples from HBV-infected patients with high HBcrAg levels. Samples were tested undiluted or diluted when overrange using Fujirebio's specific dilution reagent (SD1) with reflex testing of pre-treated samples, or manually diluted with fetal calf serum (FCS) or human serum (HS) of samples before restarting pre-treatment. Overrange dilution was further validated in three patient cohorts: untreated HBV-infected patients (n = 157) and patients treated with nucleos(t)ide analogues (NA, n = 19), or pegylated interferon-2alpha (PEG-IFN, n = 80) RESULTS: On-board dilution with SD1 showed higher background signals compared to HS or FCS. The dilution process was reproducible across sites, but SD1 underestimated HBcrAg levels. Dilution with FCS showed an early decrease in HBcrAg levels in patients with HBeAg SC during NA treatment (after 3 months, p = 0.022) and PEG-IFN treatment, whereas no change in HBcrAg levels was found without overrange dilution.

CONCLUSION

Validation showed high background and underestimating levels of HBcrAg with SD1, while FCS-based overrange dilution resulted in significant early HBcrAg decreases and better correlation with treatment response.

Development of a lateral flow assay- based rapid diagnostic kit for screening Bovine Trichomonosis in cattle

The increasing demand for animal products highlights the need to prioritize the reproductive health of cattle. Bovine Trichomonosis, an underexplored disease, causes severe reproductive failures in cattle. At present, early diagnosis and the quarantine of infected animals remain the primary strategies for disease control. Several reports of Trichomonas foetus spillover resulting in cases of Pneumocystis pneumonia, meningoencephalitis, peritonitis, and cholecystitis in immunocompromised individuals suggest a potential risk of zoonotic transmission. Consequently, there is an urgent need for Simple, affordable and rapid diagnostic tools to support the dairy farming community and to mitigate the risk of zoonotic spread zoonotic transmission. Addressing this need, the present study aimed at developing a rapid Lateral Flow Assay (LFA) utilizing recombinant Cysteine Protease8 antigen for the detection of T. foetus-specific antibodies in infected hosts. The prototype LFA exhibited diagnostic performance comparable to that of iELISA and RT -PCR, with a sensitivity of 89.4 %, specificity of 100 %, and an overall accuracy of 97.8 %. These results are consistent with those reported for LFA kits targeting other sexually transmitted infections in cattle developed world wide. Due to its high sensitivity and ease of application, the prototype LFA is well-suited for on-site use by farmers and for routine herd-level surveillance of Bovine Trichomonosis. To the best of our knowledge, this represents the first Point-of-Care prototype LFA kit developed globally for the specific detection of Bovine Trichomonosis.

Optimization of an infectious subgenomic amplicons reverse genetics protocol for the rescue of synthetic coronaviruses

Reverse genetics (rg) systems are indispensable tools for investigating the pathogenesis of RNA viruses, facilitating vaccine design, and advancing antiviral therapeutic strategies. In this study, we optimized the Infectious Subgenomic Amplicons (ISA) method for generating synthetic r-wt SARS-CoV-2 Wuhan-Hu-1. This system was validated by demonstrating the successful rescue of infectious viral particles from overlapping DNA fragments and their propagation in vitro. Sequencing confirmed 100 % identity of the recovered virus with the Wuhan-Hu-1 reference genome. Importantly, in vivo experiments using K18-hACE2 mice revealed that the r-wt SARS-CoV-2 Wuhan-Hu-1 strain caused clinical symptoms, weight loss, and mortality comparable to those induced by a virulent SARS-CoV-2 field variant. This ISA rg method offers a rapid and reproducible approach to generating synthetic coronaviruses, with potential applications in pathogenesis studies, antiviral testing, and vaccine development.

Establishment of triple-RPA-LFS detection method for three common shrimp viruses

This study focuses on three viruses affecting farmed shrimp, including White Spot Syndrome Virus (WSSV), Infectious Hypodermal and Hematopoietic Necrosis Virus (IHHNV), and Taura Syndrome Virus (TSV). Specific primers and probes were designed by their respective conserved gene fragments to establish a triple-RPA-LFS detection method that simultaneously detects WSSV, IHHNV, and TSV. Seven pathogens and healthy shrimp tissues were collected to conduct specificity tests. This method can specifically amplify the gene fragments of WSSV, IHHNV, and TSV, while no fragments were amplified from the muscle tissues of healthy shrimp or other pathogens, indicating strong specificity. The reaction system was optimized, and specificity and sensitivity were validated. Sensitivity tests were conducted using a continuous dilution plasmid method, determining that the detection sensitivity of this method is 101 copies/reaction. Compared with the sensitivity of the qPCR detection method recommended by the World Organization for Animal Health (WOAH, formerly OIE), the triple-RPA-LFS method established in this study is faster and simpler to operate. When applied to test 110 samples simultaneously with the laboratory standard testing method, the results of the qPCR detection matched the results of the laboratory standard method with a 100 % concordance rate. These experimental results indicate that the triple-RPA-LFS detection method established in this study has the characteristics of high specificity, high sensitivity, short detection time, and high accuracy. It can be used for rapid on-site detection and diagnosis of the three pathogens: WSSV, IHHNV, and TSV.

Clinical strategies to prevent recurrence of Herpes simplex and Herpes zoster following ocular surgery: A comprehensive review with practical guidelines

Recurrences of herpetic infections following intraocular surgeries pose a threat to optimal surgical outcomes. The high prevalence of herpetic diseases require ophthalmologists to be familiar with the special measures in the surgery of these patients. A thorough preoperative assessment and meticulous postoperative surveillance should be tailored for each patient, depending on the surgery and the risk of virus reactivation. We compile the relevant evidence in the literature and provide a comprehensive review of the preoperative assessment and postoperative diagnostic clues and management of the herpetic infections following different types of intraocular surgeries, including cataract surgery, keratoplasty, corneal crosslinking, glaucoma, and refractive surgeries.

Diseases associated with antimicrobial use in pig farms and risk factors thereof: A cross-sectional study in the Netherlands

BACKGROUND

Current antimicrobial use (AMU) in Dutch pig farms is driven by herd health status, as only therapeutic AMU is permitted. This study focused on weaners and sows with suckling piglets to examine the diseases associated with i) overall AMU (measured in Defined Daily Dosage Animal per year - DDDA/Y), ii) use/not use of specific antimicrobial classes, iii) total consumption of specific antimicrobial classes (in DDDA/Y), and iv) farm characteristics linked to the occurrence of diseases that require AMU.

METHODS

Cross-sectional data on AMU, disease aetiologies for group treatments, and farm characteristics were collected from 154 Dutch pig farms, representing the situation in 2019. Associations between disease occurrence as a predictor and AMU (overall and by antimicrobial class) as an outcome were analyzed using multivariable generalized linear regression models. Subsequently, mixed-effects conditional Random Forest analysis was used to identify farm characteristics associated with these diseases.

RESULTS

Group treatments for musculoskeletal/neurological diseases (MNDs) in suckling piglets, and individual treatments (of unknown aetiology) in sows and suckling piglets, were significantly associated with total AMU there. AMU in weaners was significantly associated with respiratory diseases, MNDs, and individual treatments. Tetracyclines and penicillins were primarily used for respiratory diseases and MNDs in weaners, respectively, and for MNDs in sows and suckling piglets. Having a clear separation between clean and dirty outdoor areas in the farm and using boars from own production for estrus detection were both protective against occurrence of respiratory conditions in weaners, whereas PRRS vaccination in suckling piglets was a risk factor. Streptococcus suis vaccination in sows and fully slatted floors were both risk factors for MNDs in weaners, whereas being an organic farm was protective. Use of disinfecting powders in sows increased MNDs risk in suckling piglets and sows, and a longer lactation period was protective against respiratory diseases and MNDs in weaners.

CONCLUSIONS

Respiratory diseases and MNDs in weaners appeared as the primary aetiologies for antimicrobial group treatments on Dutch pig farms. Prioritizing farm practices that enhance biosecurity and animal welfare is crucial for controlling these diseases and, consequently, reducing AMU.

Disassembly mediated multimodal chromatography based purification of HPV-VLPs produced in Pichia pastoris

Human Papillomavirus Virus-Like Particles (HPV-VLPs) are a highly effective vaccine to prevent cervical cancer. Current production and purification processes for HPV-VLPs suffer from poor yield and suboptimal process economics. The current study presents a purification strategy based multi-modal cation exchange chromatography (Capto™ MMC) for the purification of HPV-VLPs produced in Pichia pastoris. Single step purification of disassembled VLPs offered a superior product recovery (> 80 %) and purity (> 70 %) compared to traditional VLP purification platforms that comprise anion exchange and cation exchange chromatography (yield: 32 %, purity: 52 %). Furthermore, it was observed that disassembling the intact VLPs to capsomere subunits before purification provided an improved dynamic binding capacity of up to 18.1 mg/mL (at 2 min residence time), 4 times higher than that with intact HPV-VLPs.

Enhancement of reactive oxygen species metabolism by antioxidant enzyme Cu/Zn-SOD can block betanodavirus-induced necroptosis and suppress viral replication in fish cells

Very little is known about oxidative stress as a modulator of signaling between the host and virus in viral nervous necrosis (VNN) within the aquaculture field. In the present study, we examined whether blocking ROS signaling using mitochondrial Cu/Zn-SOD could affect host cell death and the viral replication of RGNNV during infection in fish cells. Upon the overexpression of Cu/Zn-SOD in fish GF-1 cells, superoxide generation in RGNNV infection was reduced 0.6-fold, which correlated to host cell viability in the middle-late stages. Regarding the regulation of reactive oxygen species (ROS) signaling by superoxide, Cu/Zn-SOD overexpression can enhance superoxide's metabolism to hydrogen peroxide, which suppresses the RIPK3-mediated cell death signals at 48 hpf. On the other hand, ROS-mediated signal suppression can enhance Bcl-2 family Bcl-2/Bcl-xL expression in the early and middle replication stages. Furthermore, the enhancement of superoxide metabolism can reduce the virus' replication ability and expression of the non-structural genes B1 and B2, as well as the genome replication gene Protein A and the major capsid protein protein α, which were correlated with the viral load dropping by two log viral titers at 48 and 72 hpf. Taken together, these data suggest that ROS signals trigger host stress responses related to cell death/necroptosis in RGNNV infection. Then, ROS-mediated stress signals can modulate anti-cell death signals through the Bcl-2/Bcl-xL pathway. In conclusion, an ROS-mediated stress response is required for viral expression and replication cycles, providing new insights into controlling RNA viruses.

Management of critical care emergencies in children with autism spectrum disorder

BACKGROUND

Managing critical care emergencies in children with autism spectrum disorder (ASD) presents unique challenges due to their distinct sensory sensitivities, communication difficulties, and behavioral issues. Effective strategies and protocols are essential for optimal care in these high-stress situations.

AIM

To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD. The review focuses on key areas, including sensory-friendly environments, communication strategies, behavioral management, and the role of multidisciplinary approaches.

METHODS

A comprehensive search was conducted across major medical databases, including PubMed, Embase, and Cochrane Library, for studies published between 2000 and 2023. Studies were selected based on their relevance to critical care management in children with ASD, encompassing randomized controlled trials, observational studies, qualitative research, and case studies. Data were extracted and analyzed to identify common themes, successful strategies, and areas for improvement.

RESULTS

The review identified 50 studies that met the inclusion criteria. Findings highlighted the importance of creating sensory-friendly environments, utilizing effective communication strategies, and implementing individualized behavioral management plans. These findings, derived from a comprehensive review of current evidence, provide valuable insights into the best practices for managing critical care emergencies in children with ASD. Sensory modifications, such as reduced lighting and noise, visual aids, and augmentative and alternative communication tools, enhanced patient comfort and cooperation. The involvement of multidisciplinary teams was crucial in delivering holistic care. Case studies provided practical insights and underscored the need for continuous refinement of protocols.

CONCLUSION

The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD. Sensory-friendly adjustments, effective communication, and behavioral strategies supported by a multidisciplinary team are integral to improving outcomes. Despite progress, ongoing refinement of care practices and protocols is necessary. This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.

The role of physical activity in mitigating age-related changes in the neuromuscular control of gait

Exercise induces neural and muscular adaptations, improving muscle mass and function in older adults. We investigated its impact on gait neuromuscular control in young and older adults, classified as more active (young: n = 15, 5185 ± 1471 MET-min/week; old: n = 14, 6481 ± 4846 MET-min/week) or less active (young: n = 14, 1265 ± 965 MET-min/week; old: n = 14, 1473 ± 859 MET-min/week). Isometric maximal voluntary torques were assessed for proximal (knee) and distal (ankle) extensors, and muscle mechanical properties of these muscles were assessed using Myoton. Gait was analysed using ground reaction forces, motion capture, and electromyography. Less active older adults exhibited shorter steps, higher mechanical cost, and greater collision at heel strike. These differences were linked to altered neuromuscular control, wider activation of lumbar and sacral motor pools, different activation timing, and reduced muscle-tendon stiffness. Our findings highlight that physical activity preserves neuromuscular control, muscle mechanical properties, and gait efficiency, mitigating age-related decline.

Strategies and efforts in circumventing the emergence of antiviral resistance against conventional antivirals

Antiviral resistance stemming from rapid viral evolution and adaptation is a major challenge faced in treating viral infections. Here, we describe the mechanisms and factors underlying antiviral resistance and their implications to future drug development. Current improvements to conventional methods provide viable options to overcome antiviral resistance. Ongoing efforts in developing new antiviral strategies are also discussed. Examples from across virology are used to illustrate how virus evolution and antiviral therapy influence each other.

Isolation and possibility of vertical transmission of G9P[23] and G12P[7] group A rotavirus strains in pigs

BACKGROUND

Porcine group A rotavirus (RVA) is a significant causative agent of diarrhea in piglets, leading to substantial economic losses in pig farms worldwide. While horizontal transmission of RVA among pig populations is well documented, the possibility of vertical transmission from sows to newborn piglets has not been definitively confirmed.

RESULTS

In this study, piglet testicles, umbilical cord blood, and colostrum were collected from porcine RVA (PoRVA)-active farms for analysis. The samples presented high PoRVA-positive rates, with 70.00% in the testicle samples, 55.00% in the umbilical cord blood samples, and 73.33% in the colostrum samples. Immunohistochemical assays confirmed the presence of PoRVA in neonatal piglet testicles. Additionally, two PoRVA strains, RVA/Pig/CHN/QT/2023/G9P [23] (QT2023) and RVA/Pig/CHN/BH/2023/G12P [7] (BH2023), were isolated from newborn piglet testicles. Complete genome analyses revealed that strains QT2023 and BH2023 both presented a Wa-like backbone, with the genotype constellation of G9-P [23]-I5-R1-C1-M1-A8-N1-T1-E1-H1 and G12-P [7]-I5-R1-C1-M1-A8-N1-T1-E1-H1, respectively. While strains QT2023 and BH2023 originated from PoRVAs, sequence identities and phylogenetic analyses suggested close relationships with human rotaviruses in specific genes. Furthermore, successful viral replication of these strains in MA-104 cells was observed. Inoculation of PoRVA-negative piglets with strains QT2023 and BH2023 resulted in clinical diarrhea, fecal virus shedding, and intestinal pathological changes, highlighting the pathogenicity of these strains.

CONCLUSION

This study provides evidence that PoRVA can breach the placental barrier and spread to newborn piglets through vertical transmission. These discoveries enhance our understanding of the transmission route of porcine RVA and have the potential to guide the development of efficient vaccine strategies for combating this disease.

Mysterious Oropouche virus: Transmission, symptoms, and control

The Oropouche virus (OROV) is a new zoonotic arbovirus that mostly affects Brazil and nearby countries. Since its discovery in 1955, it has caused more than 500,000 infections, with symptoms ranging from fever and headache to serious neuroinvasive disorders such as meningitis and encephalitis. The virus spreads through urban and sylvatic cycles via vectors such as Culicoides midges and Culex mosquitos, with humans and some vertebrates serving as amplifying hosts. The manuscript aims to analyze the transmission dynamics, clinical manifestations, diagnostic approaches, and potential preventive strategies for OROV. OROV is becoming an increasing health concern due to its global expansion and potential for serious consequences. Its growing threat, especially in light of the possibility of congenital abnormalities, is highlighted by the first recorded deaths in 2024 and the verification of vertical transmission. Clinical symptoms overlap greatly with other arboviruses, limiting early diagnosis; nonetheless, molecular approaches such as RT-PCR are crucial for identification. The current therapy is restricted to symptom control, highlighting the critical need for effective vaccinations. Live attenuated vaccination candidates and innovative techniques based on reverse genetics systems are both promising discoveries. However, the genetic variety of OROV strains poses obstacles to obtaining broad protection. To combat OROV, improved surveillance, strong public health initiatives, and quick vaccine development are needed. Public education and sustainable vector control are also essential for controlling outbreaks and lessening the virus effects.

Wolbachia: A bacterial weapon against dengue fever- a narrative review of risk factors for dengue fever outbreaks

Arboviruses constitute the largest known group of viruses and are responsible for various infections that impose significant socioeconomic burdens worldwide, particularly due to their link with insect-borne diseases. The increasing incidence of dengue fever in non-endemic regions underscores the urgent need for innovative strategies to combat this public health threat. Wolbachia, a bacterium, presents a promising biological control method against mosquito vectors, offering a novel approach to managing dengue fever. We systematically investigated biomedical databases (PubMed, Web of Science, Google Scholar, Science Direct, and Embase) using "AND" as a Boolean operator with keywords such as "dengue fever," "dengue virus," "risk factors," "Wolbachia," and "outbreak." We prioritized articles that offered significant insights into the risk factors contributing to the outbreak of dengue fever and provided an overview of Wolbachia's characteristics and functions in disease management, considering studies published until December 25, 2024. Field experiments have shown that introducing Wolbachia-infected mosquitoes can effectively reduce mosquito populations and lower dengue transmission rates, signifying its potential as a practical approach for controlling this disease.

Epidemiology of Candidemia, Candiduria and Emerging Candidozyma (Candida) auris Across Gulf Cooperative Council Countries and Yemen in the Arabian Peninsula

Candida infections represent a major component of invasive and non-invasive mycoses globally, including the countries in the Arabian Peninsula. In this review, we present epidemiological features and trends, clinical manifestations, species distribution, antifungal susceptibility, and outcomes available for candidemia and candiduria in six countries of the Gulf Cooperation Council (GCC) and Yemen, all located in the Arabian Peninsula. We discuss gaps in knowledge and provide recommendations for improving various aspects for better management of infections by these fungal pathogens. Candida species prevail, with Candida albicans being the most isolated organism, though its prevalence varies over time. The second most frequently isolated species varies from country to country within the region. Generally, invasive infections by non-albicans Candida species are increasing. Candidozyma auris, formerly known as Candida auris, is causing serious health risks in all GCC countries, including those with appropriate diagnostic capacity and awareness.

Ferritin nanoparticle complex with porcine epidemic diarrhea virus spike protein induces neutralizing antibody response against PEDV in mouse models

As the spike protein is the major antigen that contains various neutralizing epitopes against porcine epidemic diarrhea virus (PEDV), numerous vaccine trials employing the spike protein have been established. In this study, we developed a ferritin-based nanoparticle vaccine for PEDV by combining gene delivery functions of recombinant adenoviruses. To generate nanoparticles, the S1 subunit of the spike protein was genetically linked to the N-terminus of the human ferritin heavy chain (hFTHC), and recombinant adenoviruses were generated to deliver the genetic material. The efficacy of S1 conjugated human ferritin heavy chain (S1-hFTHC) adenoviruses against S1 adenoviruses was evaluated in BALB/c mice immunized intramuscularly without adjuvant. Two weeks after the final boost, we observed a significantly higher IgG response in S1-hFTHC immunized mice compared with the S1 immunized mice, and results from the virus neutralization assay revealed robust virus neutralization activity in the S1-hFTHC immunized group compared to the S1 immunized group. Furthermore, analysis of the serum based on IgG and neutralizing titers 40 days after the last vaccination revealed the significance and longevity of the immune response induced by S1-hFTCH compared to S1 only. This strategy elucidates the efficacy of combined vaccine strategies for developing promising vaccine candidates against PEDV.

Regulation of detoxifying enzymes expression and restriction of picorna-like virus infection by natural polysaccharide extracts in Drosophila cells

The world is currently witnessing a rise in viral infections, while the availability of antiviral drugs remains limited. Traditional Chinese medicine (TCM) has historically served as a valuable source of novel compounds for disease treatment. In this study, we assessed the antiviral potential of various TCM compounds using Drosophila melanogaster as a model organism. Our findings reveal that natural polysaccharide extracts, prepared from 10 commonly used medicinal herbs or fungi, exhibit antiviral activity against two picorna-like viruses. Importantly, the antiviral effect is not directly attributable to the compound itself but is instead mediated by cellular responses induced by treatment with the extract. We observed that the polysaccharide extract triggers a broad transcriptional response, which partially overlaps with NF-κB pathway activation in Drosophila. However, the antiviral activity of the extract was independent of classical innate immune pathways, such as RNA interference or NF-κB signaling. Instead, the extract appears to uniquely stimulate detoxification pathways, including upregulation of cytochrome P450 and glutathione S-transferase genes, which correlates with its antiviral effects.

First autochthonous transmission of West Nile virus (WNV) lineage 2 to humans in Spain

West Nile Virus (WNV) lineage 2, primarily endemic to parts of Africa and Europe, has recently emerged as a public health concern in new geographic regions. In 2024, the first autochthonous human case of neuroinvasive disease caused by WNV lineage 2 was identified in Andalusia, Southern Spain. Molecular testing and whole-genome sequencing confirmed WNV lineage 2 as the causative agent. Phylogenetic analysis revealed a close relationship with strains circulating in Central Europe, distinct from previous WNV lineage 2 detections in Spain. Concurrently, WNV lineage 2 RNA was detected in an imperial eagle near the case location, suggesting local viral circulation. This case marks a significant shift in WNV epidemiology in Spain, where lineage 1 has historically been dominant. The findings underscore the expanding range of WNV lineage 2 and the necessity for enhanced vector surveillance, genomic monitoring, and strengthened One Health strategies to mitigate future outbreaks and protect public health.

Histologic Features of Liver Injury Associated With SARS-CoV-2 Messenger RNA Vaccines

CONTEXT.—

Many drugs can induce liver injury; however, vaccine-induced liver injury is a rare phenomenon. SARS-CoV-2 messenger RNA (mRNA) vaccines are now widely administered, and clinical evidence of liver injury has been reported.

OBJECTIVE.—

To characterize the histologic features of SARS-CoV-2 mRNA vaccine-associated liver injury.

DESIGN.—

Thirteen liver biopsies from 12 patients with elevated liver enzymes clinically favored to be secondary to SARS-CoV-2 mRNA vaccine were identified between 2021 and 2022. Demographics, clinical information, and histologic features of liver biopsies were reviewed.

RESULTS.—

All patients (median age, 58 years; M:F = 4:8) received at least 1 dose of SARS-CoV-2 mRNA vaccines (7 Pfizer and 5 Moderna). Four patients had a history of liver disease. Nine patients developed symptoms between 1 day and 2 months after receiving the vaccine dose. Viral serologies were negative. Drug-induced liver injury was thought to be less likely clinically in the 3 patients who had started new medications. Autoimmune antibodies were detected in 9 patients. Moderate to severe active hepatitis was the dominant histologic pattern of injury (9 of 13 biopsies; 69%). Resolving hepatitis, cholestatic hepatitic injury, and bile duct injury were identified in 1 biopsy each. All patients recovered spontaneously or with steroid therapy, except one patient who developed autoimmune hepatitis.

CONCLUSIONS.—

Moderate to severe active hepatitis is commonly observed in SARS-CoV-2 mRNA vaccine-associated liver injury, and female patients may be more susceptible to injury. Liver injury resolves spontaneously or with steroid treatment. In rare cases, these vaccines may trigger an underlying immune condition.

A review of historical landmarks and pioneering technologies for the diagnosis of Hepatitis C Virus (HCV)

BACKGROUND

Since the progress of hepatitis C Virus (HCV) infection to chronic liver disease and finally cirrhosis and hepatocellular carcinoma, HCV infection has become a worldwide challenge to public health.

RESULTS

The progression from liver biopsy and antibody based test to the current time in the advancements in HCV diagnostic method is reviewed in this analysis with detailed discussion of enzyme immunoassay (EIAs), nucleic acid tests (NATs) and genotyping in enhancing accuracy of HCV detection. Next generation sequencing (NGS) and point of care testing (POCT) provided fast and economical diagnostic solutions. However, as promising diagnostic tools, Artificial Intelligence (AI) as well as Machine Learning (ML) can only be used in well-resourced environments, whereas Rapid Diagnostic Tests (RDTs) are advantageous for low and middle income countries.

CONCLUSION

This review discusses some of the future challenges that face lowering of diagnostic costs in low resource settings and promoting early detection, some of which can be addressed by microfluidic platforms. Research in this area is far from over, and past and ongoing research has tremendous potential to access new technology for a myriad of purposes in the course of HCV control and global HCV elimination.

Development of a Diagnostic Algorithm for Epstein-Barr Virus-Related Diseases: A Retrospective Observational Study

Epstein-Barr virus (EBV) is linked to a spectrum of diseases. To investigate the characteristics of various EBV-associated diseases in China, we conducted a multi-center retrospective cohort study examining molecular and serological features. EBV DNA copy numbers in plasma and peripheral blood mononuclear cells (PBMCs) were determined using quantitative polymerase chain reaction (qPCR), while four EBV-specific antibodies were assessed via chemiluminescence immunoassay. Our study included 746 patients with EBV-related diseases and 350 control adults without EBV-associated diseases. Among the patient group, EBV DNA was detectable in 97.7% of PBMC samples and 92.6% of plasma samples, significantly surpassing the positivity rates observed in controls (46.7% in PBMCs and 4.6% in plasma). In terms of specific diseases, EBV DNA was positive in PBMCs in almost all the patients across most disease groups, except in nasopharyngeal carcinoma (87.4%), whereas the EBV DNA positivity rates in plasma varied considerably. Most disease groups exhibited low positivity rates for viral capsid antigen (VCA)-IgM and high positivity rates for EBV nuclear antigen (EBNA)-IgG. Contrary, infectious mononucleosis demonstrated a high seropositivity rate (94.2%) for VCA-IgM but a low rate (0.8%) for EBNA-IgG. EBV DNA in plasma effectively distinguishes patients with EBV-associated diseases from control subjects, and incorporating PBMC EBV DNA further enhances diagnostic accuracy. In conclusion, our findings delineate distinct patterns of EBV DNA presence, levels, and antibody responses across various EBV-associated diseases. We recommend that plasma EBV DNA testing be employed as the first-line diagnostic approach for high-risk individuals, with subsequent PBMC EBV testing conducted for those exhibiting negative plasma results. A comprehensive evaluation of both EBV DNA and serological markers is essential for accurate identification and differential diagnosis of EBV-related disorders.

Gastric Carcinoma

Epstein-Barr virus (EBV)-associated gastric cancers (EBVaGCs) account for about 10% of gastric cancers globally, with higher prevalence in East Asia and Latin America. These cancers develop through a "gastritis-infection-cancer sequence" and are characterized by unique molecular signatures, including CpG island methylator phenotype and mutations in ARID1A and PIK3CA genes. EBVaGCs typically present in the proximal stomach with diffuse-type histology and dense lymphocytic infiltration. Key viral proteins EBNA1 and LMP2A drive oncogenesis by altering cellular processes and immune responses. The IFN-γ signature and extensive epigenetic modifications contribute to their distinct profile. Despite often presenting at advanced stages, EBVaGCs generally have a more favorable prognosis. EBV employs sophisticated strategies to evade immune detection, utilizing latent proteins and noncoding RNAs. Paradoxically, despite an immune-hot environment, EBVaGCs demonstrate effective immune evasion, partly due to the expression of immune checkpoint molecules like PD-L1 and LAG3. Treatment approaches vary based on disease stage, from endoscopic resection for early-stage cancers to systemic therapies for advanced cases. Immunotherapy, particularly PD-1/PD-L1 inhibitors, shows promising results. Emerging research suggests combining these with LAG3 inhibitors may enhance efficacy. Ongoing research and advanced genomic techniques continue to reveal new insights, paving the way for personalized therapies and novel diagnostic approaches.

First study to describe the prevalence and epidemiology of African swine fever, classical swine fever, porcine reproductive and respiratory syndrome and swine flu in Kazakhstan

BACKGROUND

Kazakhstan, the ninth-largest country in the world, located in Central Asia and bordering China, Kyrgyzstan, Russia, Turkmenistan, and Uzbekistan, hosts a diverse population of domestic pigs across various environments, providing potential hosts for highly pathogenic viral diseases of swine. Here we monitored African Swine Fever Virus (ASFV), Classical Swine Fever Virus (CSFV), Porcine Reproductive and Respiratory Syndrome Virus (PRRSV), and Swine Influenza Virus (SIV).

RESULTS

During the spring and fall of 2019, we sampled 1,459 domestic pigs in northern, central and eastern Kazakhstan. Samples were tested for antibodies by ELISA and for viral genomes by qPCR and RT-qPCR. No antibodies against ASFV or ASFV DNA were detected in sampled animals. Of the 84 farms sampled, 16.6% had at least one animal vaccinated against CSF. Seropositive pigs were found on a farm in Oskemen with no history of vaccination against CSFV. No CSFV RNA was detected in the blood of the sampled animals. Only 12.2% of the animals tested were vaccinated against PRRS with live-attenuated vaccines. The true animal-level seroprevalence of PRRS on unvaccinated farms was 16.6%. PRRSV RNA was detected in 17 unvaccinated animals in Pavlodar oblast on farms that were vaccinated against PRRS. The identified PRRSV-1 strains belonged to subtype 1 and clustered with the PRRS DV vaccine virus strain. A large proportion of the pigs had antibodies against SIV, with true animal-level seroprevalence of 35.9% and herd-level seroprevalence of 23.2%. Antibodies against the influenza A viruses of hemagglutinin subtypes H1 and H3 were found in the examined pigs. None of the animals were vaccinated against SIV. The variable 'commercial farming' showed an association with PRRSV and IAV seroprevalence. Of the unvaccinated farms, 9% were co-infected with PRRSV and SIV.

CONCLUSIONS

Results confirm the domestic pig population in Kazakhstan was not infected with ASFV but indicated exposure to PRRSV and SIV. This underscores the need for monitoring these infections in the region to manage their impact.

Pediatric gliomas immunity challenges and immunotherapy advances

Pediatric gliomas, the most frequent brain tumors in children, are characterized by heterogeneity and a unique tumor immune microenvironment. They are categorized into different subtypes, including low-grade gliomas like pilocytic astrocytomas and high-grade gliomas such as diffuse midline gliomas and diffuse intrinsic pontine gliomas, each exhibiting distinct immunological profiles. The tumor immune microenvironment in pediatric gliomas is shaped by cellular and non-cellular components, including immune cells, cytokines, and the extracellular matrix, involved in tumor progression, immune evasion, and response to therapy. While pediatric low-grade gliomas often display an immunosuppressed microenvironment, high-grade gliomas are characterized by complex immune infiltrates and intricate immunosuppressive mechanisms. The blood-brain barrier further obscures immune cell recruitment and therapeutic delivery. Despite advances in understanding adult gliomas, the immunobiology of pediatric tumors is poorly investigated, with limited data on the interactions between glioma cells and immune populations such as T and natural killer cells, as well as tumor-associated macrophages. Herein, we provide an update of the current knowledge on tumor immune microenvironment interactions in pediatric gliomas, highlighting the immunosuppressive mechanisms and emerging immunotherapeutic strategies aiming at overcoming these barriers to improve clinical outcomes for affected children.

Impact of Viral Infections on the Hemostatic System

The coronavirus disease 2019 (COVID-19) pandemic has brought renewed attention to the significant but often overlooked impact of viral infections on the hemostatic system. This review explores the pathophysiological mechanisms underlying the interaction between viruses and hemostasis, directly through viral components or immune-mediated processes. Viruses are recognized as pathogen-associated molecular patterns (PAMPs) by pattern recognition receptors (PRRs) on innate immune cells such as neutrophils, monocytes, and platelets. This recognition triggers immune responses, including the production of type I interferons (IFN-α and IFN-β) and proinflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), which recruit immune cells and induce pyroptotic cell death. Inflammatory cytokines contribute to endothelial dysfunction and coagulation activation, interacting with platelets, neutrophils, neutrophil extracellular traps (NETs), and the kallikrein-kinin system. Hyperactivation of the cytokine system, known as the "cytokine storm," correlates with disease severity. Common features of viral infections include platelet activation and endotheliitis, leading to thrombocytopenia and microvascular thrombosis. Interestingly, similar pathogenic mechanisms in COVID-19 and viral hemorrhagic fevers (VHFs) result in contrasting clinical manifestations. While COVID-19 predominantly induces a thrombotic response characterized by endothelial damage, platelet hyperactivity, and complement activation, VHFs typically lead to hemorrhagic complications due to thrombocytopenia, consumptive coagulopathy, and vascular injury. These differences are influenced by the timing and location of coagulation activation, as well as the dynamics of immune responses. In COVID-19, coagulation initially occurs in the lungs, followed by systemic thrombotic phases, whereas VHFs rapidly progress to consumptive coagulopathy with hemorrhage, compounded by immune suppression.

PcrV in an intranasal adjuvanted tobacco mosaic virus conjugate vaccine mediates protection from Pseudomonas aeruginosa via an early Th1/Th17 skewed localized and systemic immune response

Multi-drug-resistant Pseudomonas aeruginosa (PA) infections are a growing problem for at-risk populations, causing thousands of deaths per year, and novel therapies to treat or prevent severe PA infection are desperately needed. We developed a novel intranasal (IN) protein subunit vaccine using tobacco mosaic virus (TMV) as a vaccine delivery platform. Recombinant PcrV (rPcrV) was covalently linked to TMV and delivered IN with the adjuvant curdlan (TMV-PcrV+c). IN delivery of TMV-PcrV+c elicited significantly higher anti-PcrV antibody titers than unadjuvanted TMV-PcrV and rPcrV with or without adjuvant, and it provided significantly greater protection from lethal pneumonic infection with PA compared to all other groups. The protective vaccine formulation elicited anti-PcrV IgA in the lungs, while anti-PcrV IgG1 in the serum was associated with survival after infection. Following infection, TMV-PcrV+c immunization was associated with early IL-17 and IFN-γ secretion in the lungs and later IL-17 secretion in the spleen. This corresponded with a rapid, but transient recruitment of neutrophils to the lungs of vaccinated mice compared to unvaccinated controls, which was followed by an increase in the number of lung macrophages. This is indicative of a Th1/Th17 response mediating localized and systemic inflammation to clear the PA infection while limiting host-derived tissue damage, ultimately enhancing protection. As a vaccine antigen, PcrV did not confer complete protection, so we evaluated OprF and OprI as part of a multivalent vaccine. However, these additional antigens did not enhance protective efficacy despite generating high antibody titers. Overall, TMV-PcrV+c is a promising vaccine candidate that elicits specific antibodies, localized IFN-γ secretion and IL-17 secretion both locally and systemically after PA challenge, phagocyte recruitment to the infection site, and protection against a lethal dose of PA in a pneumonic disease model.

Immunogenicity evaluation of respiratory syncytial virus prefusogenic-F based virus-like-particles consisting of G and M proteins in mice

Human respiratory syncytial virus (hRSV) is a major cause of severe respiratory disease in infants and young children worldwide. Studies have shown that fusion-inactive prefusogenic fusion protein (F), a partially cleaved F protein made by inserting mutations in the furin cleavage site II of the fusion protein sequence, is equally immunogenic as the prefusion F and provides higher protection than postfusion structures of the F protein. Here we have developed respiratory syncytial virus (RSV) virus-like-particles (RSV-VLPs) containing baculovirus-produced prefusogenic-F, RSV glycoprotein and matrix proteins and studied their protective efficacy in BALB/c mice. Morphology and successful assembly of VLPs were confirmed by electron microscopy and western blot. Mice immunized with the VLPs developed higher levels of serum IgG and neutralizing antibodies as compared to mice immunized with inactivated RSV. The VLPs induced higher levels of IFN-γ and IL-4, enhanced T cell responses and prevented lung pathology after RSV challenge. Overall, our results indicate that RSV-VLPs containing prefusogenic F, glycoprotein and matrix proteins are a potential vaccine candidate against RSV.

Uptake of combined immunoprophylaxis for newborns exposed to hepatitis B virus in a high hepatitis B endemic rural setting in Northern Ghana

BACKGROUND

Mother-to-Child Transmission (MTCT) is a major route of Hepatitis B Virus (HBV) transmission, accounting for a substantial proportion of new infections, particularly in highly endemic areas. The timely administration of combined immunoprophylaxis of Hepatitis B Immunoglobulin (HBIG) and hepatitis B vaccine to newborns exposed to hepatitis B virus is a crucial strategy for preventing MTCT. This study investigated the determinants of hepatitis B virus immunoprophylaxis utilization for newborns of HBV-seropositive mothers in the North-East region of Ghana.

METHODS

A cross-sectional survey design was employed, involving 213 HBV seropositive mothers who had given birth in four selected study sites. Systematic random sampling was used to select mothers from the selected health facilities. Data was collected using a structured questionnaire. Data was coded entered and analyzed using SPSS version 26. Bivariate and multivariate analyses were undertaken, and the level of significance was set at 0.05.

RESULTS

Key findings revealed that mothers aged 30-39 were less likely to ensure their newborns received both hepatitis B immunoglobulin and vaccine compared to younger mothers (aOR = 0.24, 95% CI [0.09, 0.65], p = 0.005). Employment status significantly influenced utilization, with salaried workers (aOR = 6.78, 95% CI [1.34, 34.46], p = 0.021) and self-employed mothers (aOR = 3.38, 95% CI [1.39, 8.22], p = 0.007) more likely to utilize immunoprophylaxis compared to unemployed mothers. Higher monthly income (501-1000 currency units) was associated with increased utilization (aOR = 4.70, 95% CI [1.28, 17.32], p = 0.020). Mothers with good knowledge of hepatitis B were more likely to ensure immunoprophylaxis for their newborns (aOR = 3.60, 95% CI [1.72, 7.54], p = 0.001).

CONCLUSION

This study found 63.4% HBV immunoprophylaxis uptake among newborns in rural Ghana, influenced by maternal age, employment, income, and knowledge. It recommends integrating immunoprophylaxis into the National Health Insurance Scheme to reduce financial barriers. Strengthening health education for mothers on HBV transmission is also crucial. Policy reforms and improved healthcare are needed to eliminate mother-to-child HBV transmission and achieve the global goal of eliminating viral hepatitis by 2030.

CLINICAL TRIAL REGISTRATION NUMBER

Not applicable.

Integrated Single Nanoparticle Analysis for Rapid Quantification of Spatiotemporal Crosstalk between Herpes Simplex Virus-1 and Extracellular Vesicles

Cells secrete extracellular vesicles (EVs) to mediate precise communication during viral infections, yet the spatiotemporal regulation of EV composition by herpes simplex virus 1 (HSV-1) remains poorly understood. Here, we develop an integrated single-nanoparticle analysis platform combining nanoporous membrane-based EV isolation with an on-chip immunoassay to quantitatively probe EV-HSV-1 interplay throughout infection. A dual-membrane filter design significantly enhances nanoparticle recovery, enabling high-sensitivity single-particle detection. We reveal that HSV-1-infected neural stem cells display viral glycoprotein B on EV surfaces at an early stage (<8 hpi), while intact virions are selectively packaged into EVs later (24-48 hpi). Proteomic profiling indicates infected cell-derived EVs facilitate antigen processing and presentation, potentially amplifying antiviral responses. Functional studies further demonstrate EVs promote viral entry at late stages (48 hpi), likely via EV-virion encapsulation. These findings elucidate a dynamic EV-virus interplay, offering insights into HSV-1 pathogenesis and EV-mediated immune modulation. Our platform provides a transformative approach for advancing infection diagnostics and therapeutics.

Structural basis for OAS2 regulation and its antiviral function

Oligoadenylate synthetase (OAS) proteins are immune sensors for double-stranded RNA and are critical for restricting viruses. OAS2 comprises two OAS domains, only one of which can synthesize 2'-5'-oligoadenylates for RNase L activation. Existing structures of OAS1 provide a model for enzyme activation, but they do not explain how multiple OAS domains discriminate RNA length. Here, we discover that human OAS2 exists in an auto-inhibited state as a zinc-mediated dimer and present a mechanism for RNA length discrimination: the catalytically deficient domain acts as a molecular ruler that prevents autoreactivity to short RNAs. We demonstrate that dimerization and myristoylation localize OAS2 to Golgi membranes and that this is required for OAS2 activation and the restriction of viruses that exploit the endomembrane system for replication, e.g., coronaviruses. Finally, our results highlight the non-redundant role of OAS proteins and emphasize the clinical relevance of OAS2 by identifying a patient with a loss-of-function mutation associated with autoimmune disease.

PPI network identifies interacting pathogenic signaling pathways in Candida albicans

Candida albicans, an opportunistic and systemic infection causing fungus, causes skin, nail, and mucosal layer lesions in healthy individuals and hospital borne catheter-related and nosocomial infections. This particular fungus exists in two distinct stages in its life cycle: yeast and hyphae. In this study, 20 signaling pathways associated with 177 proteins from C. albicans were identified to construct a PPI network. The core part of the network consisted of 165 proteins. Network topology analyses revealed that the formed PPI network is biologically robust and scale-free, with significant interactions between proteins through 19 252 shortest pathways. In this network, the top 10 hub proteins (RAS1, CDC42, HOG1, CPH1, STE11, EFG1, CEK1, HSP90, TEC1 and CST20) were identified using network analysis, which seem to be the most important proteins involved in different pathways for the development of pathogenesis and virulence. Modular analysis of the network resulted in top six sub-networks, three of which shared eight hub proteins. Ontology and functional enrichment analyses revealed that the majority of the proteins were associated with regulation of transcription by RNA polymerase II, plasma membrane and nucleic acid binding in biological processes, and cellular components and molecular functions, respectively. Enrichment analysis indicated that the proteins were mostly involved in oxidative phosphorylation and purine metabolism signaling pathways. We determined the complex web of signaling pathway involving proteins via PPI network analysis to unravel and decipher protein interactions within C. albicans to understand the complex pathogenesis processes for targeted therapeutic interferences using novel bioinformatics strategies.

Gastrointestinal Barrier Disruption in Post-COVID Syndrome Fatigue Patients

BACKGROUND

Post-COVID Syndrome (PCS) is the term for a condition with persistent symptoms in a proportion of COVID-19 patients after asymptomatic, mild, or severe disease courses. Numbers vary, but the current estimate is that after COVID-19 approximately 10% develop PCS. The aim of our study was to evaluate the impact of SARS-CoV-2 infection on the gastrointestinal (GI) tract and associations with the development of PCS with fatigue, post-exertional malaise (PEM), orthostatic dysregulation, autonomous dysregulation, and/or neurocognitive dysregulation.

METHODS

By combining medical record data from a prospective observational study with symptom analysis before, during, and after SARS-CoV-2 infection, we aimed to identify potential risk factors and predictive markers for PCS. Additionally, we analyzed blood, saliva, and stool samples from this well-characterized PCS patient cohort to biologically validate our findings.

RESULTS

We identified significant associations between pre-existing GI complaints and the development of PCS Fatigue. PCS patients showed higher LBP/sCD14 ratios, lower IL-33 levels, and higher IL-6 levels compared to control groups. Our results highlight the critical role of the GI tract in PCS development of post-viral Fatigue.

CONCLUSION

We propose that the viral infection disrupts pathways related to the innate immune response and GI barrier function, evidenced by intestinal low-grade inflammation and GI barrier leakage. Monitoring GI symptoms and markers before, during, and after SARS-CoV-2 infection is crucial for identifying predictive clinical phenotypes in PCS. Understanding the interaction between viral infections, immune responses, and gut integrity could lead to more effective diagnostic and treatment strategies, ultimately reducing the burden on PCS patients.

Differences in timeliness, completeness and drop-out rates of MMRV and DTP containing vaccines among Ultra-Orthodox Jews and others in a deprived Northern Israel city: an ecological study

BACKGROUND

The Ultra-Orthodox Jewish (UO) population has been affected by pertussis, polio, and measles outbreaks. Safed, a deprived, undervaccinated city in Israel's North, has a large UO population concentrated in specific neighborhoods. We determined whether in Safed UO population concentration was associated with DTP- containing and MMRV1 vaccines coverage, timeliness and drop-out rates.

METHOD

For each of Safed's statistical areas, we estimated UO population based on the proportion of votes for UO political parties in Israel's 2020 general elections. We determined whether this proportion was associated with timely and delayed MMRV1 and DTP vaccine coverage for children born 2017-2022 using simple linear regression. We compared DTP and MMRV1 coverage and drop-out rates in UO areas (> 50% vote for UO parties) to others, using chi-square tests.

RESULTS

All eligible 4385 children residing in Safed were included in the MMRV1 and DTP analyses. Vaccine coverage was significantly lower in UO areas compared to non-UO for all doses of DTP and MMRV1 at expected age (-11.8, -15.8, -16.6, -11.8 and - 7.1% points (pp) respectively, P < 0.005) - and at 36 months old (-0.5, -3.9, -6.2, -9.3 and - 2% points respectively, P < 0.005). Gaps narrowed more for MMRV1 (from 7.1 to2 pp), than for DTP4 (from 11.8 to9.3 pp). Increasing UO vote was associated with decreased timely coverage for DTP but not MMRV. DTP1-4 drop-out rates were larger in the UO areas than in non-UO areas (26.2% vs. 18%).

CONCLUSIONS

Vaccine coverage was lower in UO neighborhoods, even in a peripheral city where coverage in non-UO areas is already low. Coverage differences between UO and non-UO populations decreased with time for MMRV1 but not DTP. Our findings suggest timeliness should be considered alongside non-vaccination, and vaccination behavior may be vaccine-specific in the UO population.

RAB5 is a host dependency factor for the generation of SARS-CoV-2 replication organelles

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains a threat due to the emergence of variants with increased transmissibility and enhanced escape from immune responses. Like other coronaviruses before, SARS-CoV-2 likely emerged after its transmission from bats. The successful propagation of SARS-CoV-2 in humans might have been facilitated by usurping evolutionarily conserved cellular factors to execute crucial steps in its life cycle, such as the generation of replication organelles-membrane structures where coronaviruses assemble their replication-transcription complex. In this study, we found that RAB5, which is highly conserved across mammals, is a critical host dependency factor for the replication of the SARS-CoV-2 genome. Our results also suggest that SARS-CoV-2 uses RAB5+ membranes to build replication organelles with the aid of COPB1, a component of the COP-I complex, and that the virus protein NSP6 participates in this process. Hence, targeting NSP6 represents a promising approach to interfere with SARS-CoV-2 RNA synthesis and halt its propagation.IMPORTANCEIn this study, we sought to identify the host dependency factors that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for the generation of replication organelles: cellular membranous structures that SARS-CoV-2 builds in order to support the replication and transcription of its genome. We uncovered that RAB5 is an important dependency factor for SARS-CoV-2 replication and the generation of replication organelles, and that the viral protein NSP6 participates in this process. Hence, NSP6 represents a promising target to halt SARS-CoV-2 replication.

The "crossover effect" of COVID-19 in pregnancy on the infant microbiome

Background

The COVID-19 pandemic has had a significant impact on public health. However, the impact of COVID-19 infection during pregnancy on the microbiome of the mother and her newborn child still remains poorly understood.

Methods

This study involved 94 mother-child pairs whose mothers had COVID-19 during pregnancy and 44 newborns as a control group recruited in 2018. Stool samples were collected from women before delivery and from infants at 5-7 days after birth and used for 16S rRNA sequencing.

Results

We found that the microbiomes of infants exposed in utero to COVID-19 showed decreased microbial diversity and richness. Moreover, we observed a higher inter-sample variability between infant samples in the case group, which might suggest destabilization of their microbiomes. Neither alpha- nor beta-diversity metrics differed significantly between the groups depending on the trimester when the mother contracted COVID-19. Thus, the timing of prenatal COVID-19 exposure had no effect on the infant gut microbiome.

Conclusion

COVID-19 during pregnancy can significantly compromise the establishment of the infant gut microbiome presumably by disrupting the mother's microbiome.

Chemotherapy-induced febrile neutropenia followed by acute hepatitis E virus infection in rectal cancer patient with synchronous liver and lung metastasis: a case report

BACKGROUND

Hepatitis E virus (HEV) typically induces self-limiting infection but can establish persistent infection, particularly in patients with compromised immune systems. However, the literature on HEV infection in patients undergoing chemotherapy is limited.

CASE PRESENTATION

A 46-year-old Chinese male patient with rectal cancer underwent ten cycles of chemotherapy and targeted therapy. Routine blood tests revealed grade 4 bone marrow suppression necessitating emergency admission. On the second day following admission, the patient presented with high fever that was determined to be chemotherapy-induced febrile neutropenia (FN). However, despite the recovery of white blood cell counts, the fever persisted, and the levels of aminotransferases and bilirubin continued to rise. Two weeks after admission, next generation sequencing of blood samples revealed evidence of HEV. The patient underwent symptomatic and supportive treatment and was discharged after a 30-day hospitalization. One month after discharge, the transaminase and bilirubin levels were within the normal range.

DISCUSSION

The fatality rate of FN is alarmingly high. To prevent progression to sepsis syndrome and potential mortality, it is imperative to initiate empirical treatment with broad-spectrum antibiotics. As the differential diagnosis of elevated liver enzymes in immunocompromised patients encompasses a wide range of possibilities, the exclusion of HEV infection is crucial when diagnosing drug-induced liver injury (DILI).

CONCLUSION

This case highlights the importance of healthcare providers being vigilant in identifying HEV infection in patients with solid tumors who experience FN and DILI. Early implementation of comprehensive supportive treatment is crucial for reducing the duration of disease and enhancing patient prognosis.

Structure and nucleic acid interactions of the SΔ60 domain of the hepatitis delta virus small antigen

Infection with hepatitis delta virus (HDV) causes the most severe form of viral hepatitis, affecting more than 15 million people worldwide. HDV is a small RNA satellite virus of the hepatitis B virus (HBV) that relies on the HBV envelope for viral particle assembly. The only specific HDV component is the ribonucleoprotein (RNP), which consists of viral RNA (vRNA) associated with the small (S) and large (L) delta antigens (HDAg). While the structure of the HDAg N-terminal assembly domain is known, here we address the structure of the remaining SΔ60 protein using NMR. We show that SΔ60 contains two intrinsically disordered regions separated by a helix-loop-helix motif and that this structure is conserved in the full-length protein. Solution NMR analysis revealed that SΔ60 binds to both full-length and truncated vRNA, highlighting the role of the helical regions in submicromolar affinity interactions. The resulting complex contains approximately 120 SΔ60 proteins per RNA. Our results provide a model for the arginine-rich domains in RNP assembly and RNA interactions. In addition, we show that a cluster of acidic residues within the structured region of SΔ60 is critical for HDV replication, possibly mimicking the nucleosome acidic patch involved in the recruitment of chromatin remodelers. Our work thus provides the molecular basis for understanding the role of the C-terminal RNA-binding domain of S-HDAg in HDV infection.

Treatment outcomes among young persons living with HIV who transitioned to adult care in southern Nigeria: A retrospective cohort study

BACKGROUND

In October 2019, a peer-based transition preparedness model was introduced as part of peer club activities to prepare young persons living with HIV (YLHIV) for adult care. This study compared the 12 and 24 months treatment outcomes of YLHIV who transitioned to adult care in primary, secondary and tertiary health facilities in Southern Nigeria, following the introduction of this model.

MATERIALS AND METHODS

This was a retrospective cohort study using data extracted from the medical records of YLHIV who transitioned to adult care at 25 years in 2018 and in 2021 across 155 healthcare facilities in southern Nigeria. Baseline data at transition, as well as 12 and 24 months post-transition data were extracted for comparison between those who were transitioned before (2018 cohort) and after (2021 cohort) the transition preparedness model was introduced. Logistics regression analysis was used to compare client continuity on treatment and undetectable viral load between the two groups at 12 and 24 months after transitioning to adult care.

RESULTS

Most of the1,555 YLHIV who transitioned to adult care in 2018 (n = 343, 22.1%) and 2021 (n = 1,212, 77.9%) were females (91.0% in 2018 v.82.6% in 2021) and initiated ART at 20 years or older (92.7% v. 95.7%). A higher proportion of those in the 2021 cohort were continuously retained both at 12 months and 24 months post-transitioning compared to those in the 2018 cohort (12 months: 96.7% vs 80.2%, p < 0.001; 24 months: 92.7% vs 77.6% p < 0.001). Similarly, the proportion of YLHIV with undetectable viral load in the 2021 cohort was significantly higher than those in the 2018 cohort at both 12 months (96.1% vs 60.1%, p < 0.001) and 24 months (93.3% vs 80.6%, p < 0.001), respectively.

CONCLUSION

Peer-based transition preparedness model improved treatment outcomes of YLHIV who transition to adult care. Programs should implement tailored, peer-based interventions to address gaps in service delivery.

SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations

INTRODUCTION

With the COVID-19 pandemic becoming endemic, vigilance for Long COVID-related cardiovascular issues remains essential, though their specific pathophysiology is largely unexplored.

OBJECTIVES

Our study investigates the persistent cardiovascular symptoms observed in individuals long after contracting SARS-CoV-2, a condition commonly referred to as "Long COVID", which has significantly affected millions globally.

METHODS

We meticulously describe the cardiovascular outcomes in five patients, encompassing a range of severe conditions such as sudden cardiac death during exercise, coronary atherosclerotic heart disease, palpitation, chest tightness, and acute myocarditis.

RESULTS

All five patients were diagnosed with myocarditis, confirmed through endomyocardial biopsy and histochemical staining, which identified inflammatory cell infiltration in their heart tissue. Crucially, electron microscopy revealed widespread mitochondrial vacuolations and the presence of myofilament degradation within the cardiomyocytes of these patients. These findings were mirrored in SARS-CoV-2-infected mice, suggesting a potential underlying cellular mechanism for the cardiac effects associated with Long COVID.

CONCLUSION

Our findings demonstrate a profound impact of SARS-CoV-2 on mitochondrial integrity, shedding light on the cardiovascular implications of Long COVID.

Signature Gene Mutations in Colorectal Cancer: Potential Neoantigens for Cancer Vaccines

Colorectal cancer (CRC), the third most common cancer worldwide, is one of the deadliest cancers. CRC is known as a cold tumor, characterized by a low immune response that makes it difficult for immune cells to infiltrate and exhibits strong resistance to immunotherapy with checkpoint inhibition. This restricted response is largely attributed to signature gene mutations including mismatch repair (MMR) genes, KRAS, BRAF, APC, and TP53, which are also the main oncogenes in CRC. Mutated signature genes continuously upregulate abnormal signaling pathways, leading to excessive proliferation, cancer progression, and metastasis. Furthermore, it reorganizes the tumor microenvironment (TME) by recruiting immunosuppressive cells. However, the mutation can produce neoantigens that can provoke an immune response, making it a potential target for immunotherapy. In particular, cancer vaccines that leverage the strong neoantigenic properties of these mutations are considered promising for overcoming immune resistance and eliciting anti-tumor responses. In this review, we will describe signature gene mutations in CRC and focus on cancer vaccines targeting these mutations as potential therapies for CRC.

Is the repeat worth it? Optimizing syndromic panel pathogen detection protocols

OBJECTIVE

The aim of the study was to compare the cost and clinical impact of repeating BioFire FilmArray gastrointestinal (GI) and respiratory (RP) panel assays with 3 vs 4 pathogen targets positive.

METHOD

We analyzed 12,027 GI and RP panels to evaluate our retesting policy, which retested panels with 3 or more detected pathogens (3-pathogen protocol) compared with the manufacturer's 4-pathogen (4-pathogen protocol) recommendation. We compared the retesting results, calculated the cost implications, and reviewed the clinical impact on antibiotic prescriptions and patient outcomes.

RESULTS

Retesting with our 3-pathogen protocol revealed that 81% (39/48) of GI and 76% (26/34) of RP panels had identical results, whereas 19% (9/48) of GI and 24% (8/34) of RP panels showed discrepancies on retesting. The additional cost incurred by our protocol compared with the manufacturer's protocol was $9820.32. There was no evidence that our more stringent policy affected antibiotic prescription or clinical outcomes.

CONCLUSION

Our more stringent 3-pathogen protocol for retesting panels did not improve patient management compared with the manufacturer's 4-pathogen protocol but resulted in unnecessary costs and increased the risk of depleting testing kits during supply shortages. Consequently, we adopted the manufacturer's suggestions, highlighting the need to balance clinical rigor with cost-effectiveness in laboratory testing protocols.

Development of a novel amplicon based whole-genome sequencing framework for improved surveillance of Toscana virus

Toscana virus (TOSV), a Phlebovirus transmitted by sandflies, is a leading cause of aseptic meningitis in the Mediterranean region. Despite its clinical significance, underreporting and limited availability of complete genomic data hinder a thorough understanding of its genetic diversity and evolution. This study presents a novel amplicon-based whole-genome sequencing (WGS) method using Illumina library preparation kits and proprietary software to optimize workflows and enhance bioinformatic analyses. Primers targeting TOSV lineage A genomes were designed with PrimalScheme to generate 400 bp amplicons, incorporating degenerate bases to improve coverage. Library preparation utilized Illumina Microbial Amplicon Prep (iMAP) kits, followed by de novo assembly using BaseSpace DRAGEN Targeted Microbial software. The method's sensitivity was tested on viral propagates at various RNA concentrations (104 to 10 copies/μL), demonstrating robust performance at concentrations above 102 copies/μL. Validation on high-titre viral propagates (n = 7), low-titre clinical samples (n = 15), and phlebotomine pools (n = 5) confirmed its reproducibility and ability to comprehensively cover coding regions. Cerebrospinal fluid samples yielded the most consistent results compared to urine and sandfly pools. This innovative WGS approach represents a significant advancement in TOSV genomic surveillance, enabling large-scale studies of its genetic diversity and evolutionary dynamics, which are critical for improving diagnostics and public health strategies.

Advances in cancer immunotherapy: historical perspectives, current developments, and future directions

Cancer immunotherapy, encompassing both experimental and standard-of-care therapies, has emerged as a promising approach to harnessing the immune system for tumor suppression. Experimental strategies, including novel immunotherapies and preclinical models, are actively being explored, while established treatments, such as immune checkpoint inhibitors (ICIs), are widely implemented in clinical settings. This comprehensive review examines the historical evolution, underlying mechanisms, and diverse strategies of cancer immunotherapy, highlighting both its clinical applications and ongoing preclinical advancements. The review delves into the essential components of anticancer immunity, including dendritic cell activation, T cell priming, and immune surveillance, while addressing the challenges posed by immune evasion mechanisms. Key immunotherapeutic strategies, such as cancer vaccines, oncolytic viruses, adoptive cell transfer, and ICIs, are discussed in detail. Additionally, the role of nanotechnology, cytokines, chemokines, and adjuvants in enhancing the precision and efficacy of immunotherapies were explored. Combination therapies, particularly those integrating immunotherapy with radiotherapy or chemotherapy, exhibit synergistic potential but necessitate careful management to reduce side effects. Emerging factors influencing immunotherapy outcomes, including tumor heterogeneity, gut microbiota composition, and genomic and epigenetic modifications, are also examined. Furthermore, the molecular mechanisms underlying immune evasion and therapeutic resistance are analyzed, with a focus on the contributions of noncoding RNAs and epigenetic alterations, along with innovative intervention strategies. This review emphasizes recent preclinical and clinical advancements, with particular attention to biomarker-driven approaches aimed at optimizing patient prognosis. Challenges such as immunotherapy-related toxicity, limited efficacy in solid tumors, and production constraints are highlighted as critical areas for future research. Advancements in personalized therapies and novel delivery systems are proposed as avenues to enhance treatment effectiveness and accessibility. By incorporating insights from multiple disciplines, this review aims to deepen the understanding and application of cancer immunotherapy, ultimately fostering more effective and widely accessible therapeutic solutions.

A full-length S1 gene sequencing of a novel emerged GI-19 and GI-23 lineages of Infectious bronchitis virus currently circulating in chicken flocks in upper Egypt reveals marked genetic diversity and recombination events

BACKGROUND

Infectious bronchitis virus (IBV) is a highly contagious evolving pathogen that causes respiratory, urinary and reproductive symptoms; threatening the poultry industry globally.

METHODS

During this study, 90 tissue specimens were collected from various poultry flocks of seven Upper Egypt governorates from 2023 to 2024 for genetic characterization.

RESULT

Typical IBV lesions of the inoculated embryos in the specific-pathogen-free-embryonated chicken eggs (SPF-ECE) were observed. Using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay targeting the conserved N gene, only 60 samples were considered positive with 66.6%. Collectively, 23 tissue specimens were examined through a one-step PCR assay. Sequencing is targeting the S1 gene, and the phylogenetic analysis was conducted based on partial sequencing showed that Avian coronavirus (ACoV) isolates belong to GI-23 (n = 18), GI-12 (n = 2), GI-1 (n = 1), and GI-19 (n = 2). Genotyping of the S1 gene indicates that GI-23 shows a genetic similarity to Egyptian isolates, and Israeli variants with nucleotide identity percentages (95-97%) and, (88-92%); respectively. Concerning full sequencing, five ACoV isolates were clustered as GI-23 (n = 3), and GI-19 (n = 2). Currently, QX-strains showed low genomic relatedness with Egyptian strains, and vaccinal strains with nucleotide (78-79%), and amino acid (77-80%), and (75-77%) identities, respectively. This is the first detailed study that recorded various IBV isolates, especially the novel emerged QX strain circulating in chicken flocks in Egypt. The recombination event within the Assuit-1-QX-EGYIBV-2024 isolate was detected as a result of recombination between the major (GI-19) and minor (GI-22) putative parents. Importantly, the G1-19 and G1-23 shared multiple amino acids mutations at S1 gene.

CONCLUSIONS

This study provides empirical evidence for the ACoV circulating in Egypt in vaccinated and non-vaccinated poultry flocks despite the excessive vaccination schemes.