51
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Systematic and Statistical Review of Coronavirus Disease 19 Treatment Trials. ACTA ACUST UNITED AC 2020; 2:1120-1131. [PMID: 32838169 PMCID: PMC7361001 DOI: 10.1007/s42399-020-00399-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
The following systematic review and meta-analysis compile the current data regarding human controlled COVID-19 treatment trials. An electronic search of the literature compiled studies pertaining to human controlled treatment trials with COVID-19. Medications assessed included lopinavir/ritonavir, arbidol, hydroxychloroquine, tocilizumab, favipiravir, heparin, and dexamethasone. Statistical analyses were performed for common viral clearance endpoints whenever possible. Lopinavir/ritonavir showed no significant effect on viral clearance for COVID-19 cases (OR 0.95 [95% CI 0.50–1.83]). Hydroxychloroquine also showed no significant effect on COVID-19 viral clearance rates (OR 2.16 [95% CI 0.80–5.84]). Arbidol showed no 7-day (OR 1.63 [95% CI 0.76–3.50]) or 14-day viral (OR 5.37 [95% CI 0.35–83.30]) clearance difference compared to lopinavir/ritonavir. Review of literature showed no significant clinical improvement with lopinavir/ritonavir, arbidol, hydroxychloroquine, or remdesivir. Tocilizumab showed mixed results regarding survival. Favipiravir showed quicker symptom improvement compared to lopinavir/ritonavir and arbidol. Heparin and dexamethasone showed improvement with severe COVID-19 cases requiring supplemental oxygenation. Current medications do not show significant effect on COVID-19 viral clearance rates. Tocilizumab showed mixed results regarding survival. Favipiravir shows favorable results compared to other tested medications. Heparin and dexamethasone show benefit especially for severe COVID-19 cases.
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52
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Porfidia A, Pola R. Venous Thromboembolism and Heparin Use in COVID-19 Patients: Juggling between Pragmatic Choices, Suggestions of Medical Societies and the Lack of Guidelines. J Thromb Thrombolysis 2020; 50:68-71. [PMID: 32367471 PMCID: PMC7196627 DOI: 10.1007/s11239-020-02125-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Angelo Porfidia
- Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Pola
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy. .,Istituto di Medicina Interna e Geriatria, 9th Floor, C Wing, Room C907 Policlinico A. Gemelli L.go A. Gemelli 8, Rome, 00168, Italy.
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53
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Marchandot B, Sattler L, Jesel L, Matsushita K, Schini-Kerth V, Grunebaum L, Morel O. COVID-19 Related Coagulopathy: A Distinct Entity? J Clin Med 2020; 9:E1651. [PMID: 32486469 PMCID: PMC7356260 DOI: 10.3390/jcm9061651] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare communities across the globe on an unprecedented scale. Patients have had diverse clinical outcomes, but those developing COVID-19-related coagulopathy have shown a disproportionately worse outcome. This narrative review summarizes current evidence regarding the epidemiology, clinical features, known and presumed pathophysiology-based models, and treatment guidance regarding COVID-19 coagulopathy.
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Affiliation(s)
- Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
| | - Laurent Sattler
- Université de Strasbourg, Pôle de Biologie, Département d’Hémostase, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Laurence Jesel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Valerie Schini-Kerth
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
| | - Lelia Grunebaum
- Université de Strasbourg, Pôle de Biologie, Département d’Hémostase, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (L.S.); (L.G.)
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France; (B.M.); (L.J.); (K.M.)
- UMR INSERM 1260, Regenerative Nanomedicine, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France;
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54
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Bikdeli B, Madhavan MV, Gupta A, Jimenez D, Burton JR, Der Nigoghossian C, Chuich T, Nouri SN, Dreyfus I, Driggin E, Sethi S, Sehgal K, Chatterjee S, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Bertoletti L, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Tafur AJ, Francese DP, Batra J, Falanga A, Clerkin KJ, Uriel N, Kirtane A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Leon MB, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research. Thromb Haemost 2020; 120:1004-1024. [PMID: 32473596 PMCID: PMC7516364 DOI: 10.1055/s-0040-1713152] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.
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Affiliation(s)
- Behnood Bikdeli
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - Mahesh V Madhavan
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - Aakriti Gupta
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal, Madrid, Spain.,Medicine Department, Universidad de Alcalá (IRYCIS), CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - John R Burton
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Caroline Der Nigoghossian
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Taylor Chuich
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Shayan Nabavi Nouri
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Isaac Dreyfus
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Elissa Driggin
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Sanjum Sethi
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Kartik Sehgal
- Harvard Medical School, Boston, Massachusetts, United States.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Saurav Chatterjee
- North Shore and Long Island Jewish University Hospitals, Queens, New York, United States
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mohammad Madjid
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Laurent Bertoletti
- Department of "Médecine Vasculaire et Thérapeutique," CIC 1408, INNOVTE, CHU de St-Etienne and INSERM UMR1059, Université Jean-Monnet, Saint-Etienne, France
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States
| | - Mary Cushman
- Larner College of Medicine, University of Vermont, Burlington, Vermont, United States
| | - Isabelle Quéré
- Department of Vascular Medicine, University of Montpellier, Montpellier CHU, InnoVTE F-CRIN Network, Montpellier, France
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts, United States.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Laboratory Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia
| | - Jawed Fareed
- Loyola University Medical Center, Chicago, Illinois, United States
| | - Alfonso J Tafur
- Pritzker School of Medicine at the University of Chicago, Chicago, Illinois, United States.,Division of Vascular Medicine, Department of Medicine, NorthShore University HealthSystem, Skokie, Illinois, United States
| | - Dominic P Francese
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - Jaya Batra
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, University of Milan Bicocca, Bergamo, Italy
| | - Kevin J Clerkin
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Nir Uriel
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States
| | - Ajay Kirtane
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | | | | | - Alex C Spyropoulos
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, United States
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ido Weinberg
- Harvard Medical School, Boston, Massachusetts, United States.,Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sam Schulman
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,McMaster University, Hamilton, Ontario, Canada.,Thrombosis & Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Marc Carrier
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory Piazza
- Harvard Medical School, Boston, Massachusetts, United States.,Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Joshua A Beckman
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Martin B Leon
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stephan Rosenkranz
- Department of Cardiology, Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, University of Cologne, Cologne, Germany
| | - Samuel Z Goldhaber
- Harvard Medical School, Boston, Massachusetts, United States.,Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Sahil A Parikh
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, United States.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trials I Pujol, Universidad Católica de Murcia, Barcelona, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, United States.,Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, United States.,Section of Cardiovascular Medicine, Department of Internal Medicie, Yale School of Medicine, New Haven, Connecticut, United States
| | | | - Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada.,Thrombosis & Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
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55
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Potì F, Pozzoli C, Adami M, Poli E, Costa LG. Treatments for COVID-19: emerging drugs against the coronavirus. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:118-136. [PMID: 32420936 PMCID: PMC7569629 DOI: 10.23750/abm.v91i2.9639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
The Coronavirus disease 19 (COVID-19) outbreak has been recognized as a global threat to public health. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and no effective therapies currently exist against this novel viral agent. Along with extensive public health measures, an unprecedented global effort in identifying effective drugs for the treatment is being implemented. Potential drug targets are emerging as the result of a fast-evolving understanding of SARS-CoV-2 virology, host response to the infection, and clinical course of the disease. This brief review focuses on the latest and most promising pharmacological treatments against COVID-19 currently under investigation and discuss their potential use based on either documented efficacy in similar viral infections, or their activity against inflammatory syndromes. Ongoing clinical trials are also emphasized.
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Affiliation(s)
- Francesco Potì
- Department of Medicine and Surgery - Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Cristina Pozzoli
- Department of Medicine and Surgery - Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Maristella Adami
- Department of Medicine and Surgery - Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Enzo Poli
- Department of Medicine and Surgery - Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Lucio G Costa
- Department of Medicine and Surgery - Unit of Neurosciences, University of Parma, Parma, Italy.
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56
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Thachil J. The versatile heparin in COVID-19. J Thromb Haemost 2020; 18:1020-1022. [PMID: 32239799 PMCID: PMC9906146 DOI: 10.1111/jth.14821] [Citation(s) in RCA: 293] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Manchester, UK
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57
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Coppola A, Lombardi M, Tassoni MI, Carolla G, Tala M, Morandini R, Paoletti O, Testa S. COVID-19, thromboembolic risk and thromboprophylaxis: learning lessons from the bedside, awaiting evidence. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:226-229. [PMID: 32453688 PMCID: PMC7250684 DOI: 10.2450/2020.0113-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Maria Lombardi
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
| | - Maria I. Tassoni
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
| | - Gaetano Carolla
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
| | - Maurizio Tala
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | | | - Oriana Paoletti
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
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58
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Hondermarck H, Bartlett NW, Nurcombe V. The role of growth factor receptors in viral infections: An opportunity for drug repurposing against emerging viral diseases such as COVID-19? FASEB Bioadv 2020; 2:296-303. [PMID: 32395702 PMCID: PMC7211041 DOI: 10.1096/fba.2020-00015] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023] Open
Abstract
Growth factor receptors are known to be involved in the process of viral infection. Many viruses not only use growth factor receptors to physically attach to the cell surface and internalize, but also divert receptor tyrosine kinase signaling in order to replicate. Thus, repurposing drugs that have initially been developed to target growth factor receptors and their signaling in cancer may prove to be a fast track to effective therapies against emerging new viral infections, including the coronavirus disease 19 (COVID-19).
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Affiliation(s)
- Hubert Hondermarck
- School of Biomedical Sciences and PharmacyFaculty of Health and MedicineUniversity of NewcastleCallaghanNSWAustralia
- Hunter Medical Research InstituteUniversity of NewcastleNew Lambton HeightsNSWAustralia
| | - Nathan W. Bartlett
- School of Biomedical Sciences and PharmacyFaculty of Health and MedicineUniversity of NewcastleCallaghanNSWAustralia
- Hunter Medical Research InstituteUniversity of NewcastleNew Lambton HeightsNSWAustralia
| | - Victor Nurcombe
- Institute of Medical BiologyGlycotherapeutics GroupA*STARSingapore
- Lee Kong Chian School of MedicineNanyang Technology University‐Imperial College LondonSingapore
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59
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de Jesus-Silva SG, de Moraes Silva MA, Carbonel AAF, Grillo Filho GFR, Grigório TS, Simões MDJ, Cardoso RS, Fagundes DJ. Heparin Attenuates Visceral Apoptosis in a Swine Model of Hemorrhagic Shock and Reperfusion Injury. Ann Vasc Surg 2020; 67:449-460. [PMID: 32179141 DOI: 10.1016/j.avsg.2020.01.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of unfractionated heparin in hypovolemic shock, aortic clamping, and visceral reperfusion is still not established, despite evidence of inhibition of early cell damage. This study investigated the potential protective effect of unfractionated heparin on hepatic and renal apoptosis in a porcine ischemia and reperfusion model. METHODS Twenty-one male swine (Sus scrofa) were divided into 3 groups: sham (n = 5), heparin (n = 8), and nonheparin (n = 8). The heparin and nonheparin groups underwent hypovolemic shock for 30 min, supraceliac aortic clamping for 1 h and reperfusion for 3 h. Unfractionated heparin 200 mg/kg was administered to the heparin group during aortic clamping. Hemodynamic and laboratory parameters were monitored, including aminotransferase and serum urea. Histological lesion scores were applied to hematoxylin and eosin-stained liver and kidney sections. Apoptosis quantification was performed by caspase-3 immunohistochemistry. RESULTS The proposed model caused a severe cardiocirculatory disturbance in the heparin and nonheparin groups, observed by the carotid-femoral pressure gradient and lactic acidosis. There was no significant difference in hemodynamic and laboratory parameters between these two groups. The mean values of liver and renal histological lesion scores did not present any significant differences. Caspase-3 immunoexpression was lower in the heparin than the nonheparin group for both liver and kidney. CONCLUSIONS Attenuation of liver and kidney cell apoptosis in pigs undergoing systemic heparinization suggests a potential use for heparin in modulating cell death under critical hemodynamic conditions.
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Affiliation(s)
| | | | | | | | - Thyago Silva Grigório
- Division of Vascular and Endovascular Surgery, Hospital de Clinicas de Itajubá, HCI, Itajubá, Brazil
| | - Manuel de Jesus Simões
- Department of Morphology and Genetics, Paulista School of Medicine/Federal University of São Paulo, EPM/UNIFESP, São Paulo, Brazil
| | - Rodolfo Souza Cardoso
- Division of Vascular and Endovascular Surgery, Hospital de Clinicas de Itajubá, HCI, Itajubá, Brazil
| | - Djalma José Fagundes
- Department of Surgical Technique and Experimental Surgery, EPM/UNIFESP, São Paulo, Brazil
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60
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Lindsay SL, McCanney GA, Willison AG, Barnett SC. Multi-target approaches to CNS repair: olfactory mucosa-derived cells and heparan sulfates. Nat Rev Neurol 2020; 16:229-240. [PMID: 32099190 DOI: 10.1038/s41582-020-0311-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) remains one of the biggest challenges in the development of neuroregenerative therapeutics. Cell transplantation is one of numerous experimental strategies that have been identified and tested for efficacy at both preclinical and clinical levels in recent years. In this Review, we briefly discuss the state of human olfactory cell transplantation as a therapy, considering both its current clinical status and its limitations. Furthermore, we introduce a mesenchymal stromal cell derived from human olfactory tissue, which has the potential to induce multifaceted reparative effects in the environment within and surrounding the lesion. We argue that no single therapy will be sufficient to treat SCI effectively and that a combination of cell-based, rehabilitation and pharmaceutical interventions is the most promising approach to aid repair. For this reason, we also introduce a novel pharmaceutical strategy based on modifying the activity of heparan sulfate, an important regulator of a wide range of biological cell functions. The multi-target approach that is exemplified by these types of strategies will probably be necessary to optimize SCI treatment.
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Affiliation(s)
- Susan L Lindsay
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - George A McCanney
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alice G Willison
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Susan C Barnett
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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61
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Jones ST, Cagno V, Janeček M, Ortiz D, Gasilova N, Piret J, Gasbarri M, Constant DA, Han Y, Vuković L, Král P, Kaiser L, Huang S, Constant S, Kirkegaard K, Boivin G, Stellacci F, Tapparel C. Modified cyclodextrins as broad-spectrum antivirals. SCIENCE ADVANCES 2020; 6:eaax9318. [PMID: 32064341 PMCID: PMC6989148 DOI: 10.1126/sciadv.aax9318] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/22/2019] [Indexed: 05/18/2023]
Abstract
Viral infections kill millions of people and new antivirals are needed. Nontoxic drugs that irreversibly inhibit viruses (virucidal) are postulated to be ideal. Unfortunately, all virucidal molecules described to date are cytotoxic. We recently developed nontoxic, broad-spectrum virucidal gold nanoparticles. Here, we develop further the concept and describe cyclodextrins, modified with mercaptoundecane sulfonic acids, to mimic heparan sulfates and to provide the key nontoxic virucidal action. We show that the resulting macromolecules are broad-spectrum, biocompatible, and virucidal at micromolar concentrations in vitro against many viruses [including herpes simplex virus (HSV), respiratory syncytial virus (RSV), dengue virus, and Zika virus]. They are effective ex vivo against both laboratory and clinical strains of RSV and HSV-2 in respiratory and vaginal tissue culture models, respectively. Additionally, they are effective when administrated in mice before intravaginal HSV-2 inoculation. Lastly, they pass a mutation resistance test that the currently available anti-HSV drug (acyclovir) fails.
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Affiliation(s)
- Samuel T. Jones
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
- Department of Materials, University of Manchester, Manchester M13 9PL, UK
| | - Valeria Cagno
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva 1211, Switzerland
| | - Matej Janeček
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
| | - Daniel Ortiz
- Institut des Sciences et Ingénierie Chimiques, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Natalia Gasilova
- Institut des Sciences et Ingénierie Chimiques, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Jocelyne Piret
- CHU of Québec-Laval University, Québec City, Québec, Canada
| | - Matteo Gasbarri
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
| | - David A. Constant
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yanxiao Han
- Department of Chemistry, University of Illinois, Chicago, IL 60607, USA
| | - Lela Vuković
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, TX 79966, USA
| | - Petr Král
- Department of Chemistry, University of Illinois, Chicago, IL 60607, USA
- Department of Physics, and Department of Biopharmaceutical Sciences, University of Illinois, Chicago, IL 60612, USA
| | - Laurent Kaiser
- Division of Infectious diseases, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Karla Kirkegaard
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Guy Boivin
- CHU of Québec-Laval University, Québec City, Québec, Canada
| | - Francesco Stellacci
- Institute of Materials, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
- Department of Bionengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
- Corresponding author. (C.T.); (F.S.)
| | - Caroline Tapparel
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva 1211, Switzerland
- Corresponding author. (C.T.); (F.S.)
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Lauretani F, Ravazzoni G, Roberti MF, Longobucco Y, Adorni E, Grossi M, De Iorio A, La Porta U, Fazio C, Gallini E, Federici R, Salvi M, Ciarrocchi E, Rossi F, Bergamin M, Bussolati G, Grieco I, Broccoli F, Zucchini I, Ielo G, Morganti S, Artoni A, Arisi A, Tagliaferri S, Maggio M. Assessment and treatment of older individuals with COVID 19 multi-system disease: Clinical and ethical implications. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:150-168. [PMID: 32420939 PMCID: PMC7569659 DOI: 10.23750/abm.v91i2.9629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023]
Abstract
Covid-19 infection is a multisystem disease more frequent in older individuals, especially in those with multiple chronic diseases. This multimorbid and frail population requires attention and a personalized comprehensive assessment in order to avoid the occurrence of adverse outcomes. As other diseases, the COVID-19 presentation in older patients is often atypical with less severe and unspecific symptoms. These subjects both at home and during hospitalization suffer isolation and the lack of support of caregivers. The geriatric care in COVID-19 wards is often missing. The application of additional instruments would be necessary to facilitate and personalize the clinical approach, not only based on diseases but also on functional status. This narrative review starts from diagnostic evaluation, continues with adapted pharmacologic treatment and ends with the recovery phase targeting the nutrition and physical exercise. We developed a check-list of respiratory, gastro-intestinal and other less-specific symptoms, summarized in a table and easily to be filled-up by patients, nurses and general practitioners. As second step, we reported the clinical phases of this disease. Far to be considered just viral infective and respiratory, this disease is also an inflammatory and thrombotic condition with frequent bacterial over-infection. We finally considered timing and selection of treatment, which depend on the disease phase, co-administration of other drugs and require the monitoring of renal, liver and cardiac function. This underlines the role of age not just as a limitation, but also an opportunity to increase the quality and the appropriateness of multidisciplinary and multidimensional intervention in this population.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Giulia Ravazzoni
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Maria Federica Roberti
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Yari Longobucco
- SPRINTT Team, Department of Medicine and Surgery, University of Parma, Italy
| | - Elisa Adorni
- SPRINTT Team, Department of Medicine and Surgery, University of Parma, Italy
| | - Margherita Grossi
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Aurelio De Iorio
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Umberto La Porta
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Chiara Fazio
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Elena Gallini
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Raffaele Federici
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Erika Ciarrocchi
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Francesca Rossi
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Marina Bergamin
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Giacomo Bussolati
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Ilaria Grieco
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Federica Broccoli
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Giuseppe Ielo
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | | | - Andrea Artoni
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy
| | - Arianna Arisi
- Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - Sara Tagliaferri
- SPRINTT Team, Department of Medicine and Surgery, University of Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, Parma University Hospital of Parma, Italy, Postgraduate School of Geriatric Medicine, Department of Medicine and Surgery, University of Parma, Italy
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Cagno V, Tseligka ED, Jones ST, Tapparel C. Heparan Sulfate Proteoglycans and Viral Attachment: True Receptors or Adaptation Bias? Viruses 2019; 11:v11070596. [PMID: 31266258 PMCID: PMC6669472 DOI: 10.3390/v11070596] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Heparan sulfate proteoglycans (HSPG) are composed of unbranched, negatively charged heparan sulfate (HS) polysaccharides attached to a variety of cell surface or extracellular matrix proteins. Widely expressed, they mediate many biological activities, including angiogenesis, blood coagulation, developmental processes, and cell homeostasis. HSPG are highly sulfated and broadly used by a range of pathogens, especially viruses, to attach to the cell surface.
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Affiliation(s)
- Valeria Cagno
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, 1205 Geneva, Switzerland.
| | - Eirini D Tseligka
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, 1205 Geneva, Switzerland
| | - Samuel T Jones
- School of Materials, University of Manchester, Manchester, M13 9PL, UK
| | - Caroline Tapparel
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, 1205 Geneva, Switzerland
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64
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Kim SY, Koetzner CA, Payne AF, Nierode GJ, Yu Y, Wang R, Barr E, Dordick JS, Kramer LD, Zhang F, Linhardt RJ. Glycosaminoglycan Compositional Analysis of Relevant Tissues in Zika Virus Pathogenesis and in Vitro Evaluation of Heparin as an Antiviral against Zika Virus Infection. Biochemistry 2019; 58:1155-1166. [PMID: 30698412 DOI: 10.1021/acs.biochem.8b01267] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Zika virus (ZIKV) is an enveloped RNA virus from the flavivirus family that can cause fetal neural abnormalities in pregnant women. Previously, we established that ZIKV-EP (envelope protein) binds to human placental chondroitin sulfate (CS), suggesting that CS may be a potential host cell surface receptor in ZIKV pathogenesis. In this study, we further characterized the GAG disaccharide composition of other biological tissues (i.e., mosquitoes, fetal brain cells, and eye tissues) in ZIKV pathogenesis to investigate the role of tissue specific GAGs. Heparan sulfate (HS) was the major GAG, and levels of HS-6-sulfo, HS 0S (unsulfated HS), and CS 4S disaccharides were the main differences in the GAG composition of Aedes aegypti and Aedes albopictus mosquitoes. In human fetal neural progenitor and differentiated cells, HS 0S and CS 4S were the main disaccharides. A change in disaccharide composition levels was observed between undifferentiated and differentiated cells. In different regions of the bovine eyes, CS was the major GAG, and the amounts of hyaluronic acid or keratan sulfate varied depending on the region of the eye. Next, we examined heparin (HP) of various structures to investigate their potential in vitro antiviral activity against ZIKV and Dengue virus (DENV) infection in Vero cells. All compounds effectively inhibited DENV replication; however, they surprisingly promoted ZIKV replication. HP of longer chain lengths more strongly promoted activity in ZIKV replication. This study further expands our understanding of role of GAGs in ZIKV pathogenesis and carbohydrate-based antivirals against flaviviral infection.
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Affiliation(s)
- So Young Kim
- Biochemistry and Biophysics Graduate Program, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Cheri A Koetzner
- Wadsworth Center , New York State Department of Health , Slingerlands , New York 12159 , United States
| | - Anne F Payne
- Wadsworth Center , New York State Department of Health , Slingerlands , New York 12159 , United States
| | - Gregory J Nierode
- Department of Chemical and Biological Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Yanlei Yu
- Biochemistry and Biophysics Graduate Program, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Rufeng Wang
- Department of Chemical and Biological Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Evan Barr
- Department of Biological Science, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Jonathan S Dordick
- Biochemistry and Biophysics Graduate Program, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Chemical and Biological Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Biological Science, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Laura D Kramer
- Wadsworth Center , New York State Department of Health , Slingerlands , New York 12159 , United States.,State University of New York at Albany School of Public Health , Albany , New York 12222 , United States
| | - Fuming Zhang
- Department of Chemical and Biological Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
| | - Robert J Linhardt
- Biochemistry and Biophysics Graduate Program, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Chemical and Biological Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Chemistry and Chemical Biology, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Biological Science, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States.,Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies , Rensselaer Polytechnic Institute , Troy , New York 12180 , United States
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65
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Role of heparan sulfate in the Zika virus entry, replication, and cell death. Virology 2019; 529:91-100. [PMID: 30684694 DOI: 10.1016/j.virol.2019.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/28/2022]
Abstract
Zika virus (ZIKV) is an emerging arbovirus and its infection associates with neurologic diseases. Whether heparan sulfate (HS), an attachment factor for many viruses, plays a role in the ZIKV infection remains controversial. Our study generated several HS biosynthesis-deficient cell clones by disrupting SLC35B2, B3GAT3, or B4GALT7 gene using the CRISPR/Cas9 system. The HS deficiency did not affect the viral attachment and internalization of ZIKV, but reduced the attachment of Dengue virus (DENV) 2. The early RNA and protein levels of ZIKV and DENV2 were impaired in the HS deficient cells, while the viral yields were not accordingly reduced. Our data further showed that HS promoted the cell death induced by virus infection, and inhibition of cell death significantly increased the viral replication of ZIKV and DENV2. Collectively, our study described an unexpected role of HS in the viral attachment, replication and cell death induced by ZIKV.
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66
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Gorshkov K, Shiryaev SA, Fertel S, Lin YW, Huang CT, Pinto A, Farhy C, Strongin AY, Zheng W, Terskikh AV. Zika Virus: Origins, Pathological Action, and Treatment Strategies. Front Microbiol 2019; 9:3252. [PMID: 30666246 PMCID: PMC6330993 DOI: 10.3389/fmicb.2018.03252] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/14/2018] [Indexed: 01/05/2023] Open
Abstract
The Zika virus (ZIKV) global epidemic prompted the World Health Organization to declare it a 2016 Public Health Emergency of International Concern. The overwhelming experience over the past several years teaches us that ZIKV and the associated neurological complications represent a long-term world-wide challenge to public health. Although the number of ZIKV cases in the Western Hemisphere has dropped since 2016, the need for basic research and anti-ZIKV drug development remains strong. Re-emerging viruses like ZIKV are an ever-present threat in the 21st century where fast transcontinental travel lends itself to viral epidemics. Here, we first present the origin story for ZIKV and review the rapid progress researchers have made toward understanding of the ZIKV pathology and in the design, re-purposing, and testing–particularly in vivo–drug candidates for ZIKV prophylaxis and therapy ZIKV. Quite remarkably, a short, but intensive, drug-repurposing effort has already resulted in several readily available FDA-approved drugs that are capable of effectively combating the virus in infected adult mouse models and, most importantly, in both preventing maternal-fetal transmission and severe microcephaly in newborns in pregnant mouse models.
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Affiliation(s)
- Kirill Gorshkov
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Sergey A Shiryaev
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Sophie Fertel
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Yi-Wen Lin
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Chun-Teng Huang
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Antonella Pinto
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Chen Farhy
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Alex Y Strongin
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
| | - Wei Zheng
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Alexey V Terskikh
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, United States
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67
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Qadir A, Riaz M, Saeed M, Shahzad-Ul-Hussan S. Potential targets for therapeutic intervention and structure based vaccine design against Zika virus. Eur J Med Chem 2018; 156:444-460. [PMID: 30015077 DOI: 10.1016/j.ejmech.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 01/01/2023]
Abstract
Continuously increasing number of reports of Zika virus (ZIKV) infections and associated severe clinical manifestations, including autoimmune abnormalities and neurological disorders such as neonatal microcephaly and Guillain-Barré syndrome have created alarming situation in various countries. To date, no specific antiviral therapy or vaccine is available against ZIKV. This review provides a comprehensive insight into the potential therapeutic targets and describes viral epitopes of broadly neutralizing antibodies (bNAbs) in vaccine design perspective. Interactions between ZIKV envelope glycoprotein E and cellular receptors mediate the viral fusion and entry to the target cell. Blocking these interactions by targeting cellular receptors or viral structural proteins mediating these interactions or viral surface glycans can inhibit viral entry to the cell. Similarly, different non-structural proteins of ZIKV and un-translated regions (UTRs) of its RNA play essential roles in viral replication cycle and potentiate for therapeutic interventions. Structure based vaccine design requires identity and structural description of the epitopes of bNAbs. We have described different conserved bNAb epitopes present in the ZIKV envelope as potential targets for structure based vaccine design. This review also highlights successes, unanswered questions and future perspectives in relation to therapeutic and vaccine development against ZIKV.
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Affiliation(s)
- Amina Qadir
- Department of Biology, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, 54792, Pakistan
| | - Muhammad Riaz
- Department of Chemistry, University of Azad Jammu & Kashmir, Muzaffarabad, Pakistan
| | - Muhammad Saeed
- Department of Chemistry and Chemical Engineering, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, 54792, Pakistan.
| | - Syed Shahzad-Ul-Hussan
- Department of Biology, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, 54792, Pakistan.
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68
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Masmejan S, Baud D, Musso D, Panchaud A. Zika virus, vaccines, and antiviral strategies. Expert Rev Anti Infect Ther 2018; 16:471-483. [PMID: 29897831 DOI: 10.1080/14787210.2018.1483239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Zika virus (ZIKV) recently emerged as a global public health emergency of international concern. ZIKV is responsible for severe neurological complications in adults and infection during pregnancy and can lead to congenital Zika syndrome. There is no licensed vaccine or drug to prevent or treat ZIKV infection. Areas covered: The aim of this article is to provide an overview and update of the progress of research on anti-ZIKV vaccine and medications until the end of 2017, with a special emphasis on drugs that can be used during pregnancy. Expert commentary: Development of new vaccines and drugs is challenging and several points particular to ZIKV infections augment this difficulty: (1) Cross-reactions between ZIKV and other flaviviruses, the impact of ZIKV vaccination on subsequent flavivirus infections, and vice-versa, is unknown, (2) Drugs against ZIKV should be safe in pregnant women, and (3) Evaluation of the efficacy of vaccine and drugs against ZIKV in clinical trials phase II-IV will be complicated due to the decline of ZIKV circulation.
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Affiliation(s)
- Sophie Masmejan
- a Obstetrics unit, mother-child department , Lausanne University Hospital , Lausanne , Switzerland
| | - David Baud
- a Obstetrics unit, mother-child department , Lausanne University Hospital , Lausanne , Switzerland
| | - Didier Musso
- b Director of the Unit of Emerging Infectious Diseases , Institut Louis Malardé , Tahiti , French Polynesia.,c Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection , Marseille , France
| | - Alice Panchaud
- d School of Pharmaceutical Sciences , University of Geneva and Lausanne , Geneva , Switzerland.,e Swiss Teratogen Information Service (STIS) and Division of Clinical Pharmacology, Laboratory Department , University Hospital , Lausanne , Switzerland.,f Pharmacy Service, Laboratory Department , University Hospital Lausanne , Lausanne , Switzerland
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69
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da Silva S, Oliveira Silva Martins D, Jardim ACG. A Review of the Ongoing Research on Zika Virus Treatment. Viruses 2018; 10:E255. [PMID: 29758005 PMCID: PMC5977248 DOI: 10.3390/v10050255] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 12/17/2022] Open
Abstract
The Zika fever is an arboviral disease resulting from the infection with Zika virus (ZIKV). The virus is transmitted to humans by the bite of Aedes mosquitos, mainly Aedes aegypti and Aedes albopictus. ZIKV has been detected for decades in African and Asian regions and, since 2007, has spread to other continents; among them, infections are most reported in the Americas. This can be explained by the presence of vectors in highly populated and tropical regions where people are susceptible to contamination. ZIKV has been considered by the World Health Organization a serious public health problem because of the increasing number of cases of congenital malformation and neurological disorders related to its infection, such as microcephaly, Guillain⁻Barré syndrome, meningoencephalitis, and myelitis. There is no vaccine or specific antiviral against ZIKV. The infection is best prevented by avoiding mosquito bite, and the treatment of infected patients is palliative. In this context, the search for efficient antivirals is necessary but remains challenging. Here, we aim to review the molecules that have been described to interfere with ZIKV life cycle and discuss their potential use in ZIKV therapy.
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Affiliation(s)
- Suely da Silva
- Laboratory of Virology, Institute of Biomedical Science, ICBIM, Federal University of Uberlândia, Uberlândia, MG 38405-302, Brazil.
- Genomics Study Laboratory, São Paulo State University, IBILCE, São José do Rio Preto, SP 15054-000, Brazil.
| | - Daniel Oliveira Silva Martins
- Laboratory of Virology, Institute of Biomedical Science, ICBIM, Federal University of Uberlândia, Uberlândia, MG 38405-302, Brazil.
- Genomics Study Laboratory, São Paulo State University, IBILCE, São José do Rio Preto, SP 15054-000, Brazil.
| | - Ana Carolina Gomes Jardim
- Laboratory of Virology, Institute of Biomedical Science, ICBIM, Federal University of Uberlândia, Uberlândia, MG 38405-302, Brazil.
- Genomics Study Laboratory, São Paulo State University, IBILCE, São José do Rio Preto, SP 15054-000, Brazil.
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70
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Subverting the mechanisms of cell death: flavivirus manipulation of host cell responses to infection. Biochem Soc Trans 2018; 46:609-617. [DOI: 10.1042/bst20170399] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022]
Abstract
Viruses exploit host metabolic and defence machinery for their own replication. The flaviviruses, which include Dengue (DENV), Yellow Fever (YFV), Japanese Encephalitis (JEV), West Nile (WNV) and Zika (ZIKV) viruses, infect a broad range of hosts, cells and tissues. Flaviviruses are largely transmitted by mosquito bites and humans are usually incidental, dead-end hosts, with the notable exceptions of YFV, DENV and ZIKV. Infection by flaviviruses elicits cellular responses including cell death via necrosis, pyroptosis (involving inflammation) or apoptosis (which avoids inflammation). Flaviviruses exploit these mechanisms and subvert them to prolong viral replication. The different effects induced by DENV, WNV, JEV and ZIKV are reviewed. Host cell surface proteoglycans (PGs) bearing glycosaminoglycan (GAG) polysaccharides — heparan/chondroitin sulfate (HS/CS) — are involved in initial flavivirus attachment and during the expression of non-structural viral proteins play a role in disease aetiology. Recent work has shown that ZIKV-infected cells are protected from cell death by exogenous heparin (a GAG structurally similar to host cell surface HS), raising the possibility of further subtle involvement of HS PGs in flavivirus disease processes. The aim of this review is to synthesize information regarding DENV, WNV, JEV and ZIKV from two areas that are usually treated separately: the response of host cells to infection by flaviviruses and the involvement of cell surface GAGs in response to those infections.
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71
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Schandock F, Riber CF, Röcker A, Müller JA, Harms M, Gajda P, Zuwala K, Andersen AHF, Løvschall KB, Tolstrup M, Kreppel F, Münch J, Zelikin AN. Macromolecular Antiviral Agents against Zika, Ebola, SARS, and Other Pathogenic Viruses. Adv Healthc Mater 2017; 6. [PMID: 28945945 PMCID: PMC7161897 DOI: 10.1002/adhm.201700748] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/07/2017] [Indexed: 01/08/2023]
Abstract
Viral pathogens continue to constitute a heavy burden on healthcare and socioeconomic systems. Efforts to create antiviral drugs repeatedly lag behind the advent of pathogens and growing understanding is that broad‐spectrum antiviral agents will make strongest impact in future antiviral efforts. This work performs selection of synthetic polymers as novel broadly active agents and demonstrates activity of these polymers against Zika, Ebola, Lassa, Lyssa, Rabies, Marburg, Ebola, influenza, herpes simplex, and human immunodeficiency viruses. Results presented herein offer structure–activity relationships for these pathogens in terms of their susceptibility to inhibition by polymers, and for polymers in terms of their anionic charge and hydrophobicity that make up broad‐spectrum antiviral agents. The identified leads cannot be predicted based on prior data on polymer‐based antivirals and represent promising candidates for further development as preventive microbicides.
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Affiliation(s)
- Franziska Schandock
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | | | - Annika Röcker
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | - Janis A. Müller
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | - Mirja Harms
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | - Paulina Gajda
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus 8000 Denmark
| | - Kaja Zuwala
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus 8000 Denmark
| | - Anna H. F. Andersen
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus 8000 Denmark
| | | | - Martin Tolstrup
- Department of Infectious Diseases; Aarhus University Hospital; Aarhus 8000 Denmark
| | - Florian Kreppel
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | - Jan Münch
- Institute of Molecular Virology; Ulm University Medical Center; Meyerhofstrasse 1 89081 Ulm Germany
| | - Alexander N. Zelikin
- Department of Chemistry; Aarhus University; Aarhus 8000 Denmark
- iNano Interdisciplinary Nanoscience Centre; Aarhus University; Aarhus 8000 Denmark
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Lima M, Rudd T, Yates E. New Applications of Heparin and Other Glycosaminoglycans. Molecules 2017; 22:molecules22050749. [PMID: 28481236 PMCID: PMC6154012 DOI: 10.3390/molecules22050749] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022] Open
Abstract
Heparin, the widely used pharmaceutical anticoagulant, has been in clinical use for well over half a century. Its introduction reduced clotting risks substantially and subsequent developments, including the introduction of low-molecular-weight heparin, made possible many major surgical interventions that today make heparin an indispensable drug. There has been a recent burgeoning of interest in heparin and related glycosaminoglycan (GAG) polysaccharides, such as chondroitin sulfates, heparan sulfate, and hyaluronate, as potential agents in various applications. This ability arises mainly from the ability of GAGs to interact with, and alter the activity of, a wide range of proteins. Here, we review new developments (since 2010) in the application of heparin and related GAGs across diverse fields ranging from thrombosis and neurodegenerative disorders to microbiology and biotechnology.
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Affiliation(s)
- Marcelo Lima
- Department of Biochemistry, Federal University of São Paulo (UNIFESP), Vila Clementino, São Paulo, S.P. 04044-020, Brazil.
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK.
| | - Timothy Rudd
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK.
- National Institute of Biological Standards and Controls (NIBSC), Blanche Lane, Potters Bar, Herts EN6 3QG, UK.
| | - Edwin Yates
- Department of Biochemistry, Federal University of São Paulo (UNIFESP), Vila Clementino, São Paulo, S.P. 04044-020, Brazil.
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK.
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Tan CW, Sam IC, Chong WL, Lee VS, Chan YF. Polysulfonate suramin inhibits Zika virus infection. Antiviral Res 2017; 143:186-194. [PMID: 28457855 DOI: 10.1016/j.antiviral.2017.04.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/05/2017] [Accepted: 04/26/2017] [Indexed: 01/08/2023]
Abstract
Zika virus (ZIKV) is an arthropod-borne flavivirus that causes newborn microcephaly and Guillian-Barré syndrome in adults. No therapeutics are available to treat ZIKV infection or other flaviviruses. In this study, we explored the inhibitory effect of glycosaminoglycans and analogues against ZIKV infection. Highly sulfated heparin, dextran sulfate and suramin significantly inhibited ZIKV infection in Vero cells. De-sulfated heparin analogues lose inhibitory effect, implying that sulfonate groups are critical for viral inhibition. Suramin, an FDA-approved anti-parasitic drug, inhibits ZIKV infection with 3-5 log10 PFU viral reduction with IC50 value of ∼2.5-5 μg/ml (1.93 μM-3.85 μM). A time-of-drug-addition study revealed that suramin remains potent even when administrated at 1-24 hpi. Suramin inhibits ZIKV infection by preventing viral adsorption, entry and replication. Molecular dynamics simulation revealed stronger interaction of suramin with ZIKV NS3 helicase than with the envelope protein. Suramin warrants further investigation as a potential antiviral candidate for ZIKV infection. Heparan sulfate (HS) is a cellular attachment receptor for multiple flaviviruses. However, no direct ZIKV-heparin interaction was observed in heparin-binding analysis, and downregulate or removal of cellular HS with sodium chlorate or heparinase I/III did not inhibit ZIKV infection. This indicates that cell surface HS is not utilized by ZIKV as an attachment receptor.
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Affiliation(s)
- Chee Wah Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wei Lim Chong
- Department of Chemistry, Center of Theoretical and Computational Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Vannajan Sanghiran Lee
- Department of Chemistry, Center of Theoretical and Computational Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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