51
|
Matz KM, Guzman RM, Goodman AG. The Role of Nucleic Acid Sensing in Controlling Microbial and Autoimmune Disorders. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2018; 345:35-136. [PMID: 30904196 PMCID: PMC6445394 DOI: 10.1016/bs.ircmb.2018.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Innate immunity, the first line of defense against invading pathogens, is an ancient form of host defense found in all animals, from sponges to humans. During infection, innate immune receptors recognize conserved molecular patterns, such as microbial surface molecules, metabolites produces during infection, or nucleic acids of the microbe's genome. When initiated, the innate immune response activates a host defense program that leads to the synthesis proteins capable of pathogen killing. In mammals, the induction of cytokines during the innate immune response leads to the recruitment of professional immune cells to the site of infection, leading to an adaptive immune response. While a fully functional innate immune response is crucial for a proper host response and curbing microbial infection, if the innate immune response is dysfunctional and is activated in the absence of infection, autoinflammation and autoimmune disorders can develop. Therefore, it follows that the innate immune response must be tightly controlled to avoid an autoimmune response from host-derived molecules, yet still unencumbered to respond to infection. In this review, we will focus on the innate immune response activated from cytosolic nucleic acids, derived from the microbe or host itself. We will depict how viruses and bacteria activate these nucleic acid sensing pathways and their mechanisms to inhibit the pathways. We will also describe the autoinflammatory and autoimmune disorders that develop when these pathways are hyperactive. Finally, we will discuss gaps in knowledge with regard to innate immune response failure and identify where further research is needed.
Collapse
Affiliation(s)
- Keesha M Matz
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - R Marena Guzman
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Alan G Goodman
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States; Paul G. Allen School for Global Animal Health, College of Veterinary Medicine, Washington State University, Pullman, WA, United States.
| |
Collapse
|
52
|
Kelly BJ, Lautenbach E, Nachamkin I, Coffin SE, Gerber JS, Fuchs BD, Garrigan C, Han X, Bilker WB, Wise J, Tolomeo P, Han JH. Combined Biomarkers Predict Acute Mortality Among Critically Ill Patients With Suspected Sepsis. Crit Care Med 2018; 46:1106-1113. [PMID: 29912095 PMCID: PMC6010038 DOI: 10.1097/ccm.0000000000003137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Sepsis is associated with high early and total in-hospital mortality. Despite recent revisions in the diagnostic criteria for sepsis that sought to improve predictive validity for mortality, it remains difficult to identify patients at greatest risk of death. We compared the utility of nine biomarkers to predict mortality in subjects with clinically suspected bacterial sepsis. DESIGN Cohort study. SETTING The medical and surgical ICUs at an academic medical center. SUBJECTS We enrolled 139 subjects who met two or more systemic inflammatory response syndrome (systemic inflammatory response syndrome) criteria and received new broad-spectrum antibacterial therapy. INTERVENTIONS We assayed nine biomarkers (α-2 macroglobulin, C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin, serum amyloid A, serum amyloid P, and tissue plasminogen activator) at onset of suspected sepsis and 24, 48, and 72 hours thereafter. We compared biomarkers between groups based on both 14-day and total in-hospital mortality and evaluated the predictive validity of single and paired biomarkers via area under the receiver operating characteristic curve. MEASUREMENTS AND MAIN RESULTS Fourteen-day mortality was 12.9%, and total in-hospital mortality was 29.5%. Serum amyloid P was significantly lower (4/4 timepoints) and tissue plasminogen activator significantly higher (3/4 timepoints) in the 14-day mortality group, and the same pattern held for total in-hospital mortality (Wilcoxon p ≤ 0.046 for all timepoints). Serum amyloid P and tissue plasminogen activator demonstrated the best individual predictive performance for mortality, and combinations of biomarkers including serum amyloid P and tissue plasminogen activator achieved greater predictive performance (area under the receiver operating characteristic curve > 0.76 for 14-d and 0.74 for total mortality). CONCLUSIONS Combined biomarkers predict risk for 14-day and total mortality among subjects with suspected sepsis. Serum amyloid P and tissue plasminogen activator demonstrated the best discriminatory ability in this cohort.
Collapse
Affiliation(s)
- Brendan J. Kelly
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan E. Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jeffrey S. Gerber
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Barry D. Fuchs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles Garrigan
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Xiaoyan Han
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacqueleen Wise
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jennifer H. Han
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
53
|
Filovirus – Auslöser von hämorrhagischem Fieber. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:894-907. [DOI: 10.1007/s00103-018-2757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
54
|
de St. Maurice A, Harmon J, Nyakarahuka L, Balinandi S, Tumusiime A, Kyondo J, Mulei S, Namutebi A, Knust B, Shoemaker T, Nichol ST, McElroy AK, Spiropoulou CF. Rift valley fever viral load correlates with the human inflammatory response and coagulation pathway abnormalities in humans with hemorrhagic manifestations. PLoS Negl Trop Dis 2018; 12:e0006460. [PMID: 29727450 PMCID: PMC5955566 DOI: 10.1371/journal.pntd.0006460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/16/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022] Open
Abstract
Rift Valley fever virus is an arbovirus that affects both livestock and humans throughout Africa and in the Middle East. Despite its endemicity throughout Africa, it is a rare event to identify an infected individual during the acute phase of the disease and an even rarer event to collect serial blood samples from the affected patient. Severely affected patients can present with hemorrhagic manifestations of disease. In this study we identified three Ugandan men with RVFV disease that was accompanied by hemorrhagic manifestations. Serial blood samples from these men were analyzed for a series of biomarkers specific for various aspects of human pathophysiology including inflammation, endothelial function and coagulopathy. There were significant differences between biomarker levels in controls and cases both early during the illness and after clearance of viremia. Positive correlation of viral load with markers of inflammation (IP-10, CRP, Eotaxin, MCP-2 and Granzyme B), markers of fibrinolysis (tPA and D-dimer), and markers of endothelial function (sICAM-1) were all noted. However, and perhaps most interesting given the fact that these individuals exhibited hemorrhagic manifestations of disease, was the finding of a negative correlation between viral load and P-selectin, ADAMTS13, and fibrinogen all of which are associated with coagulation pathways occurring on the endothelial surface.
Collapse
Affiliation(s)
- Annabelle de St. Maurice
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
- University of California Los Angeles, Division of Pediatric Infectious Disease, Los Angeles, CA, United States of America
| | - Jessica Harmon
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | | | | | | | | | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Barbara Knust
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Anita K. McElroy
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
- Emory University, Division of Pediatric Infectious Disease, Atlanta, GA, United States of America
- University of Pittsburgh, Division of Pediatric Infectious Disease, Pittsburgh, PA, United States of America
- * E-mail:
| | | |
Collapse
|
55
|
Abstract
In 2014, the world witnessed the largest Ebolavirus outbreak in recorded history. The subsequent humanitarian effort spurred extensive research, significantly enhancing our understanding of ebolavirus replication and pathogenicity. The main functions of each ebolavirus protein have been studied extensively since the discovery of the virus in 1976; however, the recent expansion of ebolavirus research has led to the discovery of new protein functions. These newly discovered roles are revealing new mechanisms of virus replication and pathogenicity, whilst enhancing our understanding of the broad functions of each ebolavirus viral protein (VP). Many of these new functions appear to be unrelated to the protein's primary function during virus replication. Such new functions range from bystander T-lymphocyte death caused by VP40-secreted exosomes to new roles for VP24 in viral particle formation. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity.
Collapse
Affiliation(s)
- Diego Cantoni
- School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Jeremy S. Rossman
- School of Biosciences, University of Kent, Canterbury, United Kingdom
| |
Collapse
|
56
|
Shrivastava-Ranjan P, Flint M, Bergeron É, McElroy AK, Chatterjee P, Albariño CG, Nichol ST, Spiropoulou CF. Statins Suppress Ebola Virus Infectivity by Interfering with Glycoprotein Processing. mBio 2018; 9:e00660-18. [PMID: 29717011 PMCID: PMC5930306 DOI: 10.1128/mbio.00660-18] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 12/18/2022] Open
Abstract
Ebola virus (EBOV) infection is a major public health concern due to high fatality rates and limited effective treatments. Statins, widely used cholesterol-lowering drugs, have pleiotropic mechanisms of action and were suggested as potential adjunct therapy for Ebola virus disease (EVD) during the 2013-2016 outbreak in West Africa. Here, we evaluated the antiviral effects of statin (lovastatin) on EBOV infection in vitro Statin treatment decreased infectious EBOV production in primary human monocyte-derived macrophages and in the hepatic cell line Huh7. Statin treatment did not interfere with viral entry, but the viral particles released from treated cells showed reduced infectivity due to inhibition of viral glycoprotein processing, as evidenced by decreased ratios of the mature glycoprotein form to precursor form. Statin-induced inhibition of infectious virus production and glycoprotein processing was reversed by exogenous mevalonate, the rate-limiting product of the cholesterol biosynthesis pathway, but not by low-density lipoprotein. Finally, statin-treated cells produced EBOV particles devoid of the surface glycoproteins required for virus infectivity. Our findings demonstrate that statin treatment inhibits EBOV infection and suggest that the efficacy of statin treatment should be evaluated in appropriate animal models of EVD.IMPORTANCE Treatments targeting Ebola virus disease (EVD) are experimental, expensive, and scarce. Statins are inexpensive generic drugs that have been used for many years for the treatment of hypercholesterolemia and have a favorable safety profile. Here, we show the antiviral effects of statins on infectious Ebola virus (EBOV) production. Our study reveals a novel molecular mechanism in which statin regulates EBOV particle infectivity by preventing glycoprotein processing and incorporation into virus particles. Additionally, statins have anti-inflammatory and immunomodulatory effects. Since inflammation and dysregulation of the immune system are characteristic features of EVD, statins could be explored as part of EVD therapeutics.
Collapse
Affiliation(s)
- Punya Shrivastava-Ranjan
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mike Flint
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Éric Bergeron
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K McElroy
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Pediatric Infectious Disease, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Payel Chatterjee
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - César G Albariño
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
57
|
Koch B, Schult-Dietrich P, Büttner S, Dilmaghani B, Lohmann D, Baer PC, Dietrich U, Geiger H. Lectin Affinity Plasmapheresis for Middle East Respiratory Syndrome-Coronavirus and Marburg Virus Glycoprotein Elimination. Blood Purif 2018; 46:126-133. [PMID: 29698959 DOI: 10.1159/000487224] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIMS Middle East respiratory syndrome coronavirus (MERS-CoV) and Marburg virus (MARV) are among the World Health Organization's top 8 emerging pathogens. Both zoonoses share nonspecific early symptoms, a high lethality rate, and a reduced number of specific treatment options. Therefore, we evaluated extracorporeal virus and glycoprotein (GP) elimination by lectin affinity plasmapheresis (LAP). METHODS For both MERS-CoV (pseudovirus) as well as MARV (GPs), 4 LAP devices (Mini Hemopurifiers, Aethlon Medical, San Diego, CA, USA) and 4 negative controls were tested. Samples were collected every 30 min and analyzed for reduction in virus infectivity by a flow cytometry-based infectivity assay (MERS-CoV) and in soluble GP content (MARV) by an immunoassay. RESULTS The experiments show a time-dependent clearance of MERS-CoV of up to 80% within 3 h (pseudovirus). Up to 70% of MARV-soluble GPs were eliminated at the same time. Substantial saturation of the binding resins was detected within the first treatment hour. CONCLUSION MERS-CoV (pseudovirus) and MARV soluble GPs are eliminated by LAP in vitro. Considering the high lethality and missing established treatment options, LAP should be evaluated in vivo. Especially early initiation, continuous therapy, and timed cartridge exchanges could be of importance.
Collapse
Affiliation(s)
- Benjamin Koch
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | | | - Stefan Büttner
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Bijan Dilmaghani
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Dario Lohmann
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Patrick C Baer
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| | - Ursula Dietrich
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Helmut Geiger
- Goethe University Hospital, Med. III, Division of Nephrology, Dialysis and Transplantation, Frankfurt, Germany
| |
Collapse
|
58
|
Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
59
|
Chiu WA, Rusyn I. Advancing chemical risk assessment decision-making with population variability data: challenges and opportunities. Mamm Genome 2018; 29:182-189. [PMID: 29299621 PMCID: PMC5849521 DOI: 10.1007/s00335-017-9731-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/27/2017] [Indexed: 02/06/2023]
Abstract
Characterizing population variability, including identifying susceptible populations and quantifying their increased susceptibility, is an important aspect of chemical risk assessment, but one that is challenging with traditional experimental models and risk assessment methods. New models and methods to address population variability can be used to advance the human health assessments of chemicals in three key areas. First, with respect to hazard identification, evaluating toxicity using population-based in vitro and in vivo models can potentially reduce both false positive and false negative signals. Second, with respect to evaluating mechanisms of toxicity, enhanced ability to do genetic mapping using these models allows for the identification of key biological pathways and mechanisms that may be involved in toxicity and/or susceptibility. Third, with respect to dose-response assessment, population-based toxicity data can serve as a surrogate for human variability, and thus be used to quantitatively estimate the degree of human toxicokinetic/toxicodynamic variability and thereby increase confidence in setting health-protective exposure limits. A number of case studies have been published that demonstrate the potential opportunities for improving risk assessment and decision-making, and include studies using Collaborative Cross and Diversity Outbred mice, as well as populations of human cell lines from the 1000 Genomes project. Key challenges include the need to apply more sophisticated computational and statistical models analyzing population-based toxicity data, and the need to integrate these more complex analyses into risk assessments and decision-making.
Collapse
Affiliation(s)
- Weihsueh A Chiu
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA.
| | - Ivan Rusyn
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| |
Collapse
|
60
|
McElroy AK, Mühlberger E, Muñoz-Fontela C. Immune barriers of Ebola virus infection. Curr Opin Virol 2018; 28:152-160. [PMID: 29452995 PMCID: PMC5886007 DOI: 10.1016/j.coviro.2018.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 01/10/2023]
Abstract
Since its initial emergence in 1976 in northern Democratic Republic of Congo (DRC), Ebola virus (EBOV) has been a global health concern due to its virulence in humans, the mystery surrounding the identity of its host reservoir and the unpredictable nature of Ebola virus disease (EVD) outbreaks. Early after the first clinical descriptions of a disease resembling a 'septic-shock-like syndrome', with coagulation abnormalities and multi-system organ failure, researchers began to evaluate the role of the host immune response in EVD pathophysiology. In this review, we summarize how data gathered during the last 40 years in the laboratory as well as in the field have provided insight into EBOV immunity. From molecular mechanisms involved in EBOV recognition in infected cells, to antigen processing and adaptive immune responses, we discuss current knowledge on the main immune barriers of infection as well as outstanding research questions.
Collapse
Affiliation(s)
- Anita K McElroy
- Division of Pediatric Infectious Disease, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, 3501 Fifth Ave, Pittsburgh, PA 15261, USA
| | - Elke Mühlberger
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, 620 Albany Street, 02118 Boston, MA, USA
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg, Germany.
| |
Collapse
|
61
|
Wonderlich ER, Caroline AL, McMillen CM, Walters AW, Reed DS, Barratt-Boyes SM, Hartman AL. Peripheral Blood Biomarkers of Disease Outcome in a Monkey Model of Rift Valley Fever Encephalitis. J Virol 2018; 92:e01662-17. [PMID: 29118127 PMCID: PMC5774883 DOI: 10.1128/jvi.01662-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/01/2017] [Indexed: 12/31/2022] Open
Abstract
Rift Valley Fever (RVF) is an emerging arboviral disease of livestock and humans. Although the disease is caused by a mosquito-borne virus, humans are infected through contact with, or inhalation of, virus-laden particles from contaminated animal carcasses. Some individuals infected with RVF virus (RVFV) develop meningoencephalitis, resulting in morbidity and mortality. Little is known about the pathogenic mechanisms that lead to neurologic sequelae, and thus, animal models that represent human disease are needed. African green monkeys (AGM) exposed to aerosols containing RVFV develop a reproducibly lethal neurological disease that resembles human illness. To understand the disease process and identify biomarkers of lethality, two groups of 5 AGM were infected by inhalation with either a lethal or a sublethal dose of RVFV. Divergence between lethal and sublethal infections occurred as early as 2 days postinfection (dpi), at which point CD8+ T cells from lethally infected AGM expressed activated caspase-3 and simultaneously failed to increase levels of major histocompatibility complex (MHC) class II molecules, in contrast to surviving animals. At 4 dpi, lethally infected animals failed to demonstrate proliferation of total CD4+ and CD8+ T cells, in contrast to survivors. These marked changes in peripheral blood cells occur much earlier than more-established indicators of severe RVF disease, such as granulocytosis and fever. In addition, an early proinflammatory (gamma interferon [IFN-γ], interleukin 6 [IL-6], IL-8, monocyte chemoattractant protein 1 [MCP-1]) and antiviral (IFN-α) response was seen in survivors, while very late cytokine expression was found in animals with lethal infections. By characterizing immunological markers of lethal disease, this study furthers our understanding of RVF pathogenesis and will allow the testing of therapeutics and vaccines in the AGM model.IMPORTANCE Rift Valley Fever (RVF) is an important emerging viral disease for which we lack both an effective human vaccine and treatment. Encephalitis and neurological disease resulting from RVF lead to death or significant long-term disability for infected people. African green monkeys (AGM) develop lethal neurological disease when infected with RVF virus by inhalation. Here we report the similarities in disease course between infected AGM and humans. For the first time, we examine the peripheral immune response during the course of infection in AGM and show that there are very early differences in the immune response between animals that survive infection and those that succumb. We conclude that AGM are a novel and suitable monkey model for studying the neuropathogenesis of RVF and for testing vaccines and therapeutics against this emerging viral pathogen.
Collapse
Affiliation(s)
- Elizabeth R Wonderlich
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy L Caroline
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cynthia M McMillen
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aaron W Walters
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas S Reed
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Simon M Barratt-Boyes
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy L Hartman
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
62
|
|
63
|
Singh RK, Dhama K, Malik YS, Ramakrishnan MA, Karthik K, Khandia R, Tiwari R, Munjal A, Saminathan M, Sachan S, Desingu PA, Kattoor JJ, Iqbal HMN, Joshi SK. Ebola virus - epidemiology, diagnosis, and control: threat to humans, lessons learnt, and preparedness plans - an update on its 40 year's journey. Vet Q 2017; 37:98-135. [PMID: 28317453 DOI: 10.1080/01652176.2017.1309474] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Ebola virus (EBOV) is an extremely contagious pathogen and causes lethal hemorrhagic fever disease in man and animals. The recently occurred Ebola virus disease (EVD) outbreaks in the West African countries have categorized it as an international health concern. For the virus maintenance and transmission, the non-human primates and reservoir hosts like fruit bats have played a vital role. For curbing the disease timely, we need effective therapeutics/prophylactics, however, in the absence of any approved vaccine, timely diagnosis and monitoring of EBOV remains of utmost importance. The technologically advanced vaccines like a viral-vectored vaccine, DNA vaccine and virus-like particles are underway for testing against EBOV. In the absence of any effective control measure, the adaptation of high standards of biosecurity measures, strict sanitary and hygienic practices, strengthening of surveillance and monitoring systems, imposing appropriate quarantine checks and vigilance on trade, transport, and movement of visitors from EVD endemic countries remains the answer of choice for tackling the EBOV spread. Herein, we converse with the current scenario of EBOV giving due emphasis on animal and veterinary perspectives along with advances in diagnosis and control strategies to be adopted, lessons learned from the recent outbreaks and the global preparedness plans. To retrieve the evolutionary information, we have analyzed a total of 56 genome sequences of various EBOV species submitted between 1976 and 2016 in public databases.
Collapse
Affiliation(s)
- Raj Kumar Singh
- a ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Kuldeep Dhama
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Yashpal Singh Malik
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Kumaragurubaran Karthik
- e Divison of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Rekha Khandia
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Ruchi Tiwari
- g Department of Veterinary Microbiology and Immunology , College of Veterinary Sciences, Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU) , Mathura , India
| | - Ashok Munjal
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Mani Saminathan
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Swati Sachan
- h Immunology Section, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Jobin Jose Kattoor
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Hafiz M N Iqbal
- i School of Engineering and Science, Tecnologico de Monterrey , Monterrey , Mexico
| | - Sunil Kumar Joshi
- j Cellular Immunology Lab , Frank Reidy Research Center for Bioelectrics , School of Medical Diagnostics & Translational Sciences, Old Dominion University , Norfolk , VA , USA
| |
Collapse
|
64
|
Evaluation of the associations between endothelial dysfunction, inflammation and coagulation in Crimean-Congo hemorrhagic fever patients. Arch Virol 2017; 163:609-616. [DOI: 10.1007/s00705-017-3653-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022]
|
65
|
Abstract
Adjunctive therapies have been proposed for use in at least 5 inflammation pathobiology phenotypes in pediatric sepsis-induced multiple organ failure. This article discusses host-pathogen interaction prototypes to facilitate understanding of the rationale for personalized therapy in these phenotypes. The article discusses the literature on adjunctive antiinflammatory and immune modulation therapies that, in addition to traditional organ support and infection source control, might be part of a personalized precision medicine approach to the reversal of each of these inflammatory pathobiology phenotypes.
Collapse
|
66
|
Harmon JR, Nichol ST, Spiropoulou CF, McElroy AK. Whole Blood-Based Multiplex Immunoassays for the Evaluation of Human Biomarker Responses to Emerging Viruses in Resource-Limited Regions. Viral Immunol 2017; 30:671-674. [PMID: 28937957 DOI: 10.1089/vim.2017.0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Many emerging viruses such as Ebola and Lassa occur in resource-limited areas of the world. The advent of multiplex immunoassays has facilitated the study of biomarkers of disease since only small amounts of clinical material are required; however, such assays are designed and validated for only plasma or serum. This is a significant impediment when studying infectious diseases in the context of an outbreak in a developing nation. Plasma or serum can be difficult to obtain in the field due to the need for additional processing of infectious materials. Evaluation of multiplex immunoassays using frozen and thawed human whole blood (WB) would permit additional analysis using a more readily available human clinical sample. In this study, frozen and thawed human WB was directly compared with frozen and thawed plasma from normal healthy donors in a series of multiplexed immunoassays for 59 different biomarkers. We demonstrate that most important biomarkers can be evaluated using thawed WB, which will facilitate the study of human cytokine and other biomarker responses to viruses emerging in resource-limited regions.
Collapse
Affiliation(s)
- Jessica R Harmon
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Stuart T Nichol
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Christina F Spiropoulou
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia
| | - Anita K McElroy
- 1 U.S. Centers for Disease Control and Prevention , Viral Special Pathogens Branch, Atlanta, Georgia .,2 Division of Pediatric Infectious Disease, Emory University School of Medicine , Atlanta, Georgia .,3 Division of Pediatric Infectious Disease, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| |
Collapse
|
67
|
Speranza E, Connor JH. Host Transcriptional Response to Ebola Virus Infection. Vaccines (Basel) 2017; 5:E30. [PMID: 28930167 PMCID: PMC5620561 DOI: 10.3390/vaccines5030030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/09/2023] Open
Abstract
Ebola virus disease (EVD) is a serious illness that causes severe disease in humans and non-human primates (NHPs) and has mortality rates up to 90%. EVD is caused by the Ebolavirus and currently there are no licensed therapeutics or vaccines to treat EVD. Due to its high mortality rates and potential as a bioterrorist weapon, a better understanding of the disease is of high priority. Multiparametric analysis techniques allow for a more complete understanding of a disease and the host response. Analysis of RNA species present in a sample can lead to a greater understanding of activation or suppression of different states of the immune response. Transcriptomic analyses such as microarrays and RNA-Sequencing (RNA-Seq) have been important tools to better understand the global gene expression response to EVD. In this review, we outline the current knowledge gained by transcriptomic analysis of EVD.
Collapse
Affiliation(s)
- Emily Speranza
- Department of Microbiology, Bioinformatics Program, National Emerging Infectious Disease Laboratories, Boston University, Boston, MA 02118, USA.
| | - John H Connor
- Department of Microbiology, Bioinformatics Program, National Emerging Infectious Disease Laboratories, Boston University, Boston, MA 02118, USA.
| |
Collapse
|
68
|
Gale TV, Horton TM, Grant DS, Garry RF. Metabolomics analyses identify platelet activating factors and heme breakdown products as Lassa fever biomarkers. PLoS Negl Trop Dis 2017; 11:e0005943. [PMID: 28922385 PMCID: PMC5619842 DOI: 10.1371/journal.pntd.0005943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/28/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022] Open
Abstract
Lassa fever afflicts tens of thousands of people in West Africa annually. The rapid progression of patients from febrile illness to fulminant syndrome and death provides incentive for development of clinical prognostic markers that can guide case management. The small molecule profile of serum from febrile patients triaged to the Viral Hemorrhagic Fever Ward at Kenema Government Hospital in Sierra Leone was assessed using untargeted Ultra High Performance Liquid Chromatography Mass Spectrometry. Physiological dysregulation resulting from Lassa virus (LASV) infection occurs at the small molecule level. Effects of LASV infection on pathways mediating blood coagulation, and lipid, amino acid, nucleic acid metabolism are manifest in changes in the levels of numerous metabolites in the circulation. Several compounds, including platelet activating factor (PAF), PAF-like molecules and products of heme breakdown emerged as candidates that may prove useful in diagnostic assays to inform better care of Lassa fever patients. Lassa fever afflicts tens of thousands of people in West Africa each year. The disease progresses rapidly, but there are no tests available to determine which patients are at high risk for dying. We measured the levels of small molecules in the blood of febrile patients with and without infection by LASV that presented to Kenema Government Hospital in Sierra Leone using Ultra High Performance Liquid Chromatography Mass Spectrometry (LCMS), which identifies compounds based on their precise mass. Computational analyses were used to identify compounds that differed in patients with an acute LASV infection, patients with evidence of prior exposure to LASV and patients with fever, but who did not have evidence of exposure to LASV. Several serum metabolites, including factors that are involved in blood clotting and breakdown products of heme, were identified that may prove useful in diagnostic assays that will inform better care of Lassa fever patients or development of therapeutic interventions.
Collapse
Affiliation(s)
- Trevor V. Gale
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Timothy M. Horton
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
- Zalgen Labs, LLC, Germantown, Maryland, United States of America
- Tulane Center of Excellence, Global Viral Network, New Orleans, Louisiana, United States of America
- * E-mail:
| |
Collapse
|
69
|
Stonier SW, Herbert AS, Kuehne AI, Sobarzo A, Habibulin P, Dahan CVA, James RM, Egesa M, Cose S, Lutwama JJ, Lobel L, Dye JM. Marburg virus survivor immune responses are Th1 skewed with limited neutralizing antibody responses. J Exp Med 2017; 214:2563-2572. [PMID: 28724616 PMCID: PMC5584125 DOI: 10.1084/jem.20170161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/16/2017] [Accepted: 06/28/2017] [Indexed: 11/21/2022] Open
Abstract
Immune responses that develop in survivors of filovirus infection may indicate critical parameters that could inform rational vaccine development. Stonier et al. characterize immune responses in Marburg virus survivors and demonstrate robust CD4+ T cell responses but limited CD8+ T cell and neutralizing antibody responses. Until recently, immune responses in filovirus survivors remained poorly understood. Early studies revealed IgM and IgG responses to infection with various filoviruses, but recent outbreaks have greatly expanded our understanding of filovirus immune responses. Immune responses in survivors of Ebola virus (EBOV) and Sudan virus (SUDV) infections have provided the most insight, with T cell responses as well as detailed antibody responses having been characterized. Immune responses to Marburg virus (MARV), however, remain almost entirely uncharacterized. We report that immune responses in MARV survivors share characteristics with EBOV and SUDV infections but have some distinct differences. MARV survivors developed multivariate CD4+ T cell responses but limited CD8+ T cell responses, more in keeping with SUDV survivors than EBOV survivors. In stark contrast to SUDV survivors, rare neutralizing antibody responses in MARV survivors diminished rapidly after the outbreak. These results warrant serious consideration for any vaccine or therapeutic that seeks to be broadly protective, as different filoviruses may require different immune responses to achieve immunity.
Collapse
Affiliation(s)
- Spencer W Stonier
- Virology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD
| | - Andrew S Herbert
- Virology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD
| | - Ana I Kuehne
- Virology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD
| | - Ariel Sobarzo
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Polina Habibulin
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chen V Abramovitch Dahan
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rebekah M James
- Virology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD
| | - Moses Egesa
- Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Cose
- Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda.,London School of Hygiene & Tropical Medicine, London, England, UK
| | - Julius Julian Lutwama
- Department of Arbovirology, Emerging, and Re-emerging Infection, Uganda Virus Research Institute, Entebbe, Uganda
| | - Leslie Lobel
- Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Arbovirology, Emerging, and Re-emerging Infection, Uganda Virus Research Institute, Entebbe, Uganda
| | - John M Dye
- Virology Division, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD
| |
Collapse
|
70
|
Huttner A, Combescure C, Grillet S, Haks MC, Quinten E, Modoux C, Agnandji ST, Brosnahan J, Dayer JA, Harandi AM, Kaiser L, Medaglini D, Monath T, Roux-Lombard P, Kremsner PG, Ottenhoff THM, Siegrist CA. A dose-dependent plasma signature of the safety and immunogenicity of the rVSV-Ebola vaccine in Europe and Africa. Sci Transl Med 2017; 9:9/385/eaaj1701. [PMID: 28404856 DOI: 10.1126/scitranslmed.aaj1701] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/05/2016] [Accepted: 03/15/2017] [Indexed: 12/17/2022]
Abstract
The 2014-2015 Ebola epidemic affected several African countries, claiming more than 11,000 lives and leaving thousands with ongoing sequelae. Safe and effective vaccines could prevent or limit future outbreaks. The recombinant vesicular stomatitis virus-vectored Zaire Ebola (rVSV-ZEBOV) vaccine has shown marked immunogenicity and efficacy in humans but is reactogenic at higher doses. To understand its effects, we examined plasma samples from 115 healthy volunteers from Geneva who received low-dose (LD) or high-dose (HD) vaccine or placebo. Fifteen plasma chemokines/cytokines were assessed at baseline and on days 1, 2 to 3, and 7 after injection. Significant increases in monocyte-mediated MCP-1/CCL2, MIP-1β/CCL4, IL-6, TNF-α, IL-1Ra, and IL-10 occurred on day 1. A signature explaining 68% of cytokine/chemokine vaccine-response variability was identified. Its score was higher in HD versus LD vaccinees and was associated positively with vaccine viremia and negatively with cytopenia. It was higher in vaccinees with injection-site pain, fever, myalgia, chills, and headache; higher scores reflected increasing severity. In contrast, HD vaccinees who subsequently developed arthritis had lower day 1 scores than other HD vaccinees. Vaccine dose did not influence the signature despite its influence on specific outcomes. The Geneva-derived signature associated strongly (ρ = 0.97) with that of a cohort of 75 vaccinees from a parallel trial in Lambaréné, Gabon. Its score in Geneva HD vaccinees with subsequent arthritis was significantly lower than that in Lambaréné HD vaccinees, none of whom experienced arthritis. This signature, which reveals monocytes' critical role in rVSV-ZEBOV immunogenicity and safety across doses and continents, should prove useful in assessments of other vaccines.
Collapse
Affiliation(s)
- Angela Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Center for Vaccinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stéphane Grillet
- World Health Organization Collaborating Center for Vaccine Immunology, Faculty of Medicine, Geneva, Switzerland
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Edwin Quinten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Christine Modoux
- Division of Immunology and Allergy, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, and German Center for Infection Research, Tübingen, Germany
| | | | - Julie-Anne Dayer
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ali M Harandi
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Sclavo Vaccines Association, Siena, Italy
| | - Tom Monath
- NewLink Genetics Corp., 94 Jackson Road, Devens, MA 01439, USA
| | | | - Pascale Roux-Lombard
- Division of Immunology and Allergy, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, and German Center for Infection Research, Tübingen, Germany
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Claire-Anne Siegrist
- Center for Vaccinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. .,World Health Organization Collaborating Center for Vaccine Immunology, Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
71
|
Tramontini Gomes de Sousa Cardozo F, Baimukanova G, Lanteri MC, Keating SM, Moraes Ferreira F, Heitman J, Pannuti CS, Pati S, Romano CM, Cerdeira Sabino E. Serum from dengue virus-infected patients with and without plasma leakage differentially affects endothelial cells barrier function in vitro. PLoS One 2017; 12:e0178820. [PMID: 28586397 PMCID: PMC5460851 DOI: 10.1371/journal.pone.0178820] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Although most of cases of dengue infections are asymptomatic or mild symptomatic some individuals present warning signs progressing to severe dengue in which plasma leakage is a hallmark. Methodology/Principal findings The present study used Electric Cell-substrate Impedance Sensing (ECIS®) which allows for electrical monitoring of cellular barrier function measuring changes in Transendothelial Electric Resistance (TEER) to investigate the parameters associated with dengue induced leakage. Three groups of individuals were tested: dengue-positives with plasma leakage (leakage), dengue-positives without plasma leakage (no leakage), and dengue-negatives (control). Data show that TEER values of human umbilical vein endothelial cells (HUVECs) was significantly lower after incubation with serum from subjects of the leakage group in comparison to the no leakage or control groups. The serum levels of CXCL1, EGF, eotaxin, IFN-γ, sCD40L, and platelets were significantly decreased in the leakage group, while IL-10, IL-6, and IP-10 levels were significantly increased. We also found a strong correlation between TEER values and augmented levels of IP-10, GM-CSF, IL-1α, and IL-8, as well as decreased levels of CXCL1 and platelets. Conclusions/Significance The present work shows that the magnitude of the immune response contributes to the adverse plasma leakage outcomes in patients and that serum components are important mediators of changes in endothelial homeostasis during dengue infections. In particular, the increased levels of IP-10 and the decreased levels of CXCL1 and platelets seem to play a significant role in the disruption of vascular endothelium associated with leakage outcomes after DENV infection. These findings may have important implications for both diagnostic and therapeutic approaches to predict and mitigate vascular permeabilization in those experiencing the most severe clinical disease outcomes after dengue infection.
Collapse
Affiliation(s)
| | - Gyulnar Baimukanova
- Blood Systems Research Institute, BSRI, San Francisco, California, United States
| | - Marion Christine Lanteri
- Blood Systems Research Institute, BSRI, San Francisco, California, United States
- Department of Laboratory Medicine, University of California, San Francisco, California, United States
| | - Sheila Marie Keating
- Blood Systems Research Institute, BSRI, San Francisco, California, United States
- Department of Laboratory Medicine, University of California, San Francisco, California, United States
| | - Frederico Moraes Ferreira
- University of São Paulo School of Medicine, Division of Immunology - Heart Institute, São Paulo, São Paulo, Brazil
- University of Santo Amaro, São Paulo, São Paulo, Brazil
| | - John Heitman
- Blood Systems Research Institute, BSRI, San Francisco, California, United States
| | - Cláudio Sérgio Pannuti
- Department of Infectious and Parasitic Diseases, Institute of Tropical Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Shibani Pati
- Blood Systems Research Institute, BSRI, San Francisco, California, United States
| | - Camila Malta Romano
- Department of Infectious and Parasitic Diseases, Institute of Tropical Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Department of Infectious and Parasitic Diseases, Institute of Tropical Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
72
|
Hartley MA, Young A, Tran AM, Okoni-Williams HH, Suma M, Mancuso B, Al-Dikhari A, Faouzi M. Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease. PLoS Negl Trop Dis 2017; 11:e0005265. [PMID: 28151955 PMCID: PMC5289426 DOI: 10.1371/journal.pntd.0005265] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the notoriety of Ebola virus disease (EVD) as one of the world's most deadly infections, EVD has a wide range of outcomes, where asymptomatic infection may be almost as common as fatality. With increasingly sensitive EVD diagnosis, there is a need for more accurate prognostic tools that objectively stratify clinical severity to better allocate limited resources and identify those most in need of intensive treatment. METHODS/PRINCIPAL FINDINGS This retrospective cohort study analyses the clinical characteristics of 158 EVD(+) patients at the GOAL-Mathaska Ebola Treatment Centre, Sierra Leone. The prognostic potential of each characteristic was assessed and incorporated into a statistically weighted disease score. The mortality rate among EVD(+) patients was 60.8% and highest in those aged <5 or >25 years (p<0.05). Death was significantly associated with malaria co-infection (OR = 2.5, p = 0.01). However, this observation was abrogated after adjustment to Ebola viral load (p = 0.1), potentially indicating a pathologic synergy between the infections. Similarly, referral-time interacted with viral load, and adjustment revealed referral-time as a significant determinant of mortality, thus quantifying the benefits of early reporting as a 12% mortality risk reduction per day (p = 0.012). Disorientation was the strongest unadjusted predictor of death (OR = 13.1, p = 0.014) followed by hiccups, diarrhoea, conjunctivitis, dyspnoea and myalgia. Including these characteristics in multivariate prognostic scores, we obtained a 91% and 97% ability to discriminate death at or after triage respectively (area under ROC curve). CONCLUSIONS/SIGNIFICANCE This study proposes highly predictive and easy-to-use prognostic tools, which stratify the risk of EVD mortality at or after EVD triage.
Collapse
Affiliation(s)
- Mary-Anne Hartley
- GOAL Global, Dublin, Ireland
- University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | | | | | | | | | | | | | - Mohamed Faouzi
- Institute of Social and Preventive Medicine, Lausanne, Switzerland
| |
Collapse
|
73
|
Smit MA, Michelow IC, Glavis-Bloom J, Wolfman V, Levine AC. Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study. Clin Infect Dis 2017; 64:243-249. [PMID: 28011610 PMCID: PMC5241778 DOI: 10.1093/cid/ciw725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The clinical and virologic characteristics of Ebola virus disease (EVD) in children have not been thoroughly documented. METHODS Consecutive children aged <18 years with real-time polymerase chain reaction (RT-PCR)-confirmed EVD were enrolled retrospectively in 5 Ebola treatment units in Liberia and Sierra Leone in 2014/2015. Data collection and medical management were based on standardized International Medical Corps protocols. We performed descriptive statistics, multivariate logistic regression, and Kaplan-Meier survival analyses. RESULTS Of 122 children enrolled, the median age was 7 years and one-third were aged <5 years. The female-to-male ratio was 1.3. The most common clinical features at triage and during hospitalization were fever, weakness, anorexia, and diarrhea, although 21% of patients were initially afebrile and 6 patients remained afebrile. Bleeding was rare at presentation (5%) and manifested subsequently in fewer than 50%. The overall case fatality rate was 57%. Factors associated with death in bivariate analyses were age <5 years, bleeding at any time during hospitalization, and high viral load. After adjustment with logistic regression modeling, the odds of death were 14.8-fold higher if patients were aged <5 years, 5-fold higher if the patient had any evidence of bleeding, and 5.2-fold higher if EVD RT-PCR cycle threshold value was ≤20. Plasmodium parasitemia had no impact on EVD outcomes. CONCLUSIONS Age <5 years, bleeding, and high viral loads were poor prognostic indicators of children with EVD. Research to understand mechanisms of these risk factors and the impact of dehydration and electrolyte imbalance will improve health outcomes.
Collapse
Affiliation(s)
- Michael A Smit
- Warren Alpert Medical School, and
- Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and
| | - Ian C Michelow
- Warren Alpert Medical School, and
- Department of Pediatrics, Division of Infectious Diseases, Brown University, Providence, Rhode Island; and
| | | | | | - Adam C Levine
- Warren Alpert Medical School, and
- International Medical Corps, Los Angeles, California
| |
Collapse
|
74
|
Muñoz-Fontela C, Geisbert TW. The gap between animal and human Ebola virus disease. Future Virol 2017. [DOI: 10.2217/fvl-2016-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- César Muñoz-Fontela
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistrasse 52, 20251 Hamburg, Germany
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany
| | - Thomas W Geisbert
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| |
Collapse
|
75
|
Liu X, Speranza E, Muñoz-Fontela C, Haldenby S, Rickett NY, Garcia-Dorival I, Fang Y, Hall Y, Zekeng EG, Lüdtke A, Xia D, Kerber R, Krumkamp R, Duraffour S, Sissoko D, Kenny J, Rockliffe N, Williamson ED, Laws TR, N'Faly M, Matthews DA, Günther S, Cossins AR, Sprecher A, Connor JH, Carroll MW, Hiscox JA. Transcriptomic signatures differentiate survival from fatal outcomes in humans infected with Ebola virus. Genome Biol 2017; 18:4. [PMID: 28100256 PMCID: PMC5244546 DOI: 10.1186/s13059-016-1137-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/15/2016] [Indexed: 12/24/2022] Open
Abstract
Background In 2014, Western Africa experienced an unanticipated explosion of Ebola virus infections. What distinguishes fatal from non-fatal outcomes remains largely unknown, yet is key to optimising personalised treatment strategies. We used transcriptome data for peripheral blood taken from infected and convalescent recovering patients to identify early stage host factors that are associated with acute illness and those that differentiate patient survival from fatality. Results The data demonstrate that individuals who succumbed to the disease show stronger upregulation of interferon signalling and acute phase responses compared to survivors during the acute phase of infection. Particularly notable is the strong upregulation of albumin and fibrinogen genes, which suggest significant liver pathology. Cell subtype prediction using messenger RNA expression patterns indicated that NK-cell populations increase in patients who survive infection. By selecting genes whose expression properties discriminated between fatal cases and survivors, we identify a small panel of responding genes that act as strong predictors of patient outcome, independent of viral load. Conclusions Transcriptomic analysis of the host response to pathogen infection using blood samples taken during an outbreak situation can provide multiple levels of information on both disease state and mechanisms of pathogenesis. Host biomarkers were identified that provide high predictive value under conditions where other predictors, such as viral load, are poor prognostic indicators. The data suggested that rapid analysis of the host response to infection in an outbreak situation can provide valuable information to guide an understanding of disease outcome and mechanisms of disease. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1137-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xuan Liu
- National Institute of Health Research, Health Protection Research Unit In Emerging and Zoonotic Infections, Liverpool, UK.,Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Emily Speranza
- Department of Microbiology, School of Medicine, National Emerging and Infectious Diseases Laboratories, Bioinformatics Program, Boston University, Boston, MA, 02118, USA
| | - César Muñoz-Fontela
- Heinrich Pette Institute - Leibniz Institute for Experimental Virology, 20251, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - Sam Haldenby
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Natasha Y Rickett
- National Institute of Health Research, Health Protection Research Unit In Emerging and Zoonotic Infections, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Isabel Garcia-Dorival
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Yongxiang Fang
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Yper Hall
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK
| | - Elsa-Gayle Zekeng
- National Institute of Health Research, Health Protection Research Unit In Emerging and Zoonotic Infections, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Anja Lüdtke
- Heinrich Pette Institute - Leibniz Institute for Experimental Virology, 20251, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany
| | - Dong Xia
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Romy Kerber
- Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany
| | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany
| | - Daouda Sissoko
- Bordeaux Hospital University Center (CHU) -INSERM U1219- Bordeaux University, Bordeaux, France
| | - John Kenny
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Nichola Rockliffe
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - E Diane Williamson
- Defence Science Technology Laboratories (Porton Down), Porton Down, Salisbury, UK
| | - Thomas R Laws
- Defence Science Technology Laboratories (Porton Down), Porton Down, Salisbury, UK
| | - Magassouba N'Faly
- Hôpital National Donka service des Maladies infectieuses et Tropicales, Conakry, Guinea
| | - David A Matthews
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, D-20359, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - Andrew R Cossins
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | | | - John H Connor
- Department of Microbiology, School of Medicine, National Emerging and Infectious Diseases Laboratories, Bioinformatics Program, Boston University, Boston, MA, 02118, USA.
| | - Miles W Carroll
- Public Health England, Porton Down, Wiltshire, SP4 0JG, UK. .,National Institute of Health Research in Emerging and Zoonotic Infections, Porton Down, SP4 0JQ, Salisbury, UK.
| | - Julian A Hiscox
- National Institute of Health Research, Health Protection Research Unit In Emerging and Zoonotic Infections, Liverpool, UK. .,Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.
| |
Collapse
|
76
|
|
77
|
van den Wijngaard JPHM, Bakker JA, Gillis JMEP, Ballieux BEPB, de Vries JJC, Schenk PW, Cobbaert CM. Keeping Ebola out of the lab: a practical solution on how to analyze Ebola associated blood anomalies. Clin Chem Lab Med 2016; 54:e353-e357. [PMID: 27092649 DOI: 10.1515/cclm-2015-1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/01/2016] [Indexed: 11/15/2022]
|
78
|
Martyushev A, Nakaoka S, Sato K, Noda T, Iwami S. Modelling Ebola virus dynamics: Implications for therapy. Antiviral Res 2016; 135:62-73. [PMID: 27743917 DOI: 10.1016/j.antiviral.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/29/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
Ebola virus (EBOV) causes a severe, often fatal Ebola virus disease (EVD), for which no approved antivirals exist. Recently, some promising anti-EBOV drugs, which are experimentally potent in animal models, have been developed. However, because the quantitative dynamics of EBOV replication in humans is uncertain, it remains unclear how much antiviral suppression of viral replication affects EVD outcome in patients. Here, we developed a novel mathematical model to quantitatively analyse human viral load data obtained during the 2000/01 Uganda EBOV outbreak and evaluated the effects of different antivirals. We found that nucleoside analogue- and siRNA-based therapies are effective if a therapy with a >50% inhibition rate is initiated within a few days post-symptom-onset. In contrast, antibody-based therapy requires not only a higher inhibition rate but also an earlier administration, especially for otherwise fatal cases. Our results demonstrate that an appropriate choice of EBOV-specific drugs is required for effective EVD treatment.
Collapse
Affiliation(s)
- Alexey Martyushev
- Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Shinji Nakaoka
- Institute of Industrial Sciences, The University of Tokyo, Tokyo, 1538505, Japan
| | - Kei Sato
- Laboratory of Viral Pathogenesis, Institute for Virus Research, Kyoto University, Kyoto, Kyoto, 6068507, Japan; CREST, JST, Kawaguchi, Saitama, 3320012, Japan
| | - Takeshi Noda
- Laboratory of Ultrastructural Virology, Institute for Virus Research, Kyoto University, Kyoto, 6068507, Japan; CREST, JST, Kawaguchi, Saitama, 3320012, Japan; PRESTO, JST, Kawaguchi, Saitama, 3320012, Japan.
| | - Shingo Iwami
- Mathematical Biology Laboratory, Department of Biology, Faculty of Sciences, Kyushu University, Fukuoka, 8128581, Japan; PRESTO, JST, Kawaguchi, Saitama, 3320012, Japan; CREST, JST, Kawaguchi, Saitama, 3320012, Japan.
| |
Collapse
|
79
|
Spengler JR, Lavender KJ, Martellaro C, Carmody A, Kurth A, Keck JG, Saturday G, Scott DP, Nichol ST, Hasenkrug KJ, Spiropoulou CF, Feldmann H, Prescott J. Ebola Virus Replication and Disease Without Immunopathology in Mice Expressing Transgenes to Support Human Myeloid and Lymphoid Cell Engraftment. J Infect Dis 2016; 214:S308-S318. [PMID: 27601621 DOI: 10.1093/infdis/jiw248] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The study of Ebola virus (EBOV) pathogenesis in vivo has been limited to nonhuman primate models or use of an adapted virus to cause disease in rodent models. Herein we describe wild-type EBOV (Makona variant) infection of mice engrafted with human hematopoietic CD34+ stem cells (Hu-NSG™-SGM3 mice; hereafter referred to as SGM3 HuMice). SGM3 HuMice support increased development of myeloid immune cells, which are primary EBOV targets. In SGM3 HuMice, EBOV replicated to high levels, and disease was observed following either intraperitoneal or intramuscular inoculation. Despite the high levels of viral antigen and inflammatory cell infiltration in the liver, the characteristic histopathology of Ebola virus disease was not observed, and this absence of severe immunopathology may have contributed to the recovery and survival of some of the animals. Future investigations into the underlying mechanisms of the atypical disease presentation in SGM3 HuMice will provide additional insights into the immunopathogenesis of severe EBOV disease.
Collapse
Affiliation(s)
- Jessica R Spengler
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Andreas Kurth
- Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - James G Keck
- In Vivo Services, The Jackson Laboratory, Sacramento, California
| | - Greg Saturday
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Dana P Scott
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
80
|
Caballero IS, Honko AN, Gire SK, Winnicki SM, Melé M, Gerhardinger C, Lin AE, Rinn JL, Sabeti PC, Hensley LE, Connor JH. In vivo Ebola virus infection leads to a strong innate response in circulating immune cells. BMC Genomics 2016; 17:707. [PMID: 27595844 PMCID: PMC5011782 DOI: 10.1186/s12864-016-3060-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/02/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Ebola virus is the causative agent of a severe syndrome in humans with a fatality rate that can approach 90 %. During infection, the host immune response is thought to become dysregulated, but the mechanisms through which this happens are not entirely understood. In this study, we analyze RNA sequencing data to determine the host response to Ebola virus infection in circulating immune cells. RESULTS Approximately half of the 100 genes with the strongest early increases in expression were interferon-stimulated genes, such as ISG15, OAS1, IFIT2, HERC5, MX1 and DHX58. Other highly upregulated genes included cytokines CXCL11, CCL7, IL2RA, IL2R1, IL15RA, and CSF2RB, which have not been previously reported to change during Ebola virus infection. Comparing this response in two different models of exposure (intramuscular and aerosol) revealed a similar signature of infection. The strong innate response in the aerosol model was seen not only in circulating cells, but also in primary and secondary target tissues. Conversely, the innate immune response of vaccinated macaques was almost non-existent. This suggests that the innate response is a major aspect of the cellular response to Ebola virus infection in multiple tissues. CONCLUSIONS Ebola virus causes a severe infection in humans that is associated with high mortality. The host immune response to virus infection is thought to be an important aspect leading to severe pathology, but the components of this overactive response are not well characterized. Here, we analyzed how circulating immune cells respond to the virus and found that there is a strong innate response dependent on active virus replication. This finding is in stark contrast to in vitro evidence showing a suppression of innate immune signaling, and it suggests that the strong innate response we observe in infected animals may be an important contributor to pathogenesis.
Collapse
Affiliation(s)
| | - Anna N. Honko
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD USA
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD USA
| | - Stephen K. Gire
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Sarah M. Winnicki
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Marta Melé
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA USA
| | - Chiara Gerhardinger
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA USA
| | - Aaron E. Lin
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - John L. Rinn
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA USA
| | - Pardis C. Sabeti
- Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
- Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Lisa E. Hensley
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD USA
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD USA
| | - John H. Connor
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA
| |
Collapse
|
81
|
Yuan S, Zhang ZW, Li ZL. When should antiviral drugs be used for the patient with an Ebola virus infection? Int J Infect Dis 2016; 50:21-2. [DOI: 10.1016/j.ijid.2016.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022] Open
|
82
|
Leligdowicz A, Fischer WA, Uyeki TM, Fletcher TE, Adhikari NKJ, Portella G, Lamontagne F, Clement C, Jacob ST, Rubinson L, Vanderschuren A, Hajek J, Murthy S, Ferri M, Crozier I, Ibrahima E, Lamah MC, Schieffelin JS, Brett-Major D, Bausch DG, Shindo N, Chan AK, O'Dempsey T, Mishra S, Jacobs M, Dickson S, Lyon GM, Fowler RA. Ebola virus disease and critical illness. Crit Care 2016; 20:217. [PMID: 27468829 PMCID: PMC4965892 DOI: 10.1186/s13054-016-1325-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/26/2016] [Indexed: 12/26/2022] Open
Abstract
As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and may be exacerbated by substantial fluid requirements for intravascular volume repletion and some degree of systemic capillary leak. Although minor bleeding manifestations are common, hypovolemic and septic shock complicated by multisystem organ dysfunction appear the most frequent causes of death.Males and females have been equally affected, with children (0-14 years of age) accounting for 19 %, young adults (15-44 years) 58 %, and older adults (≥45 years) 23 % of reported cases. While the current case fatality proportion in West Africa is approximately 40 %, it has varied substantially over time (highest near the outbreak onset) according to available resources (40-90 % mortality in West Africa compared to under 20 % in Western Europe and the USA), by age (near universal among neonates and high among older adults), and by Ebola viral load at admission.While there is no Ebola virus-specific therapy proven to be effective in clinical trials, mortality has been dramatically lower among EVD patients managed with supportive intensive care in highly resourced settings, allowing for the avoidance of hypovolemia, correction of electrolyte and metabolic abnormalities, and the provision of oxygen, ventilation, vasopressors, and dialysis when indicated. This experience emphasizes that, in addition to evaluating specific medical treatments, improving the global capacity to provide supportive critical care to patients with EVD may be the greatest opportunity to improve patient outcomes.
Collapse
Affiliation(s)
| | - William A Fischer
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas E Fletcher
- Defence Medical Services, Whittington Barracks, Lichfield, UK
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Francois Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Shevin T Jacob
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lewis Rubinson
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Abel Vanderschuren
- Centre de recherche de l'institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Jan Hajek
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Ian Crozier
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elhadj Ibrahima
- Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea
| | - Marie-Claire Lamah
- Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea
| | - John S Schieffelin
- Department of Pediatrics, School of Medicine and School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - David Brett-Major
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD, USA
| | - Daniel G Bausch
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Nikki Shindo
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Adrienne K Chan
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tim O'Dempsey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Stuart Dickson
- Acute Medicine and Intensive Care, Derriford Hospital, Plymouth, UK
| | - G Marshall Lyon
- Department of Infectious Diseases, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert A Fowler
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| |
Collapse
|
83
|
Cytokine Profile of Children Hospitalized with Virologically-Confirmed Dengue during Two Phase III Vaccine Efficacy Trials. PLoS Negl Trop Dis 2016; 10:e0004830. [PMID: 27459266 PMCID: PMC4961416 DOI: 10.1371/journal.pntd.0004830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/17/2016] [Indexed: 01/29/2023] Open
Abstract
Background Two large-scale efficacy studies with the recombinant yellow fever-17D–dengue virus, live-attenuated, tetravalent dengue vaccine (CYD-TDV) candidate undertaken in Asia (NCT01373281) and Latin America (NCT01374516) demonstrated significant protection against dengue disease during two years’ active surveillance (active phase). Long-term follow up of participants for breakthrough disease leading to hospitalization is currently ongoing (hospital phase). Methodology/Principal findings We assessed the cytokine profile in acute sera from selected participants hospitalized (including during the active phase) up to the beginning of the second year of long-term follow up for both studies. The serum concentrations of 38 cytokines were measured in duplicate using the Milliplex Human Cytokine MAGNETIC BEAD Premixed 38 Plex commercial kit (Millipore, Billerica, MA, USA). Partial least squares discriminant analyses did not reveal any difference in the overall cytokine profile of CYD-TDV and placebo recipients hospitalized for breakthrough dengue regardless of stratification used. In addition, there was no difference in the cytokine profile for breakthrough dengue among those aged <9 years versus those aged ≥ 9 years. Conclusions/Significance These exploratory findings show that CYD-TDV does not induce a particular immune profile versus placebo, corroborating the clinical profile observed. A live-attenuated, tetravalent dengue vaccine (CYD-TDV) has been shown to provide protection against dengue disease in two large-scale, placebo-controlled, phase III efficacy studies. Continued surveillance of study participants was subsequently undertaken to better define longer term vaccine efficacy and safety. A yet unexplained higher incidence of hospitalization for dengue disease was observed among children aged <9 years in year 3 of follow up. While the clinical outcome of the hospitalized cases was similar between CYD-TDV and placebo recipients, it was important to further investigate whether the immune profile induced by breakthrough infection differed between the two study groups. We compared the profile of 38 cytokines, chemokines and growth factors in acute phase sera collected from participants with breakthrough disease in the two groups. No difference in overall profile was observed between CYD-TDV and placebo recipients. Similarly, no difference in the cytokine profile for breakthrough dengue was observed between those aged <9 years and those aged ≥ 9 years. Based on these analyzed factors, our study shows that CYD-TDV does not induce an overall altered immunological profile with breakthrough disease compared with placebo, in agreement with the similar clinical pictures and viremia observed in the two groups.
Collapse
|
84
|
McElroy AK, Harmon JR, Flietstra TD, Campbell S, Mehta AK, Kraft CS, Lyon MG, Varkey JB, Ribner BS, Kratochvil CJ, Iwen PC, Smith PW, Ahmed R, Nichol ST, Spiropoulou CF. Kinetic Analysis of Biomarkers in a Cohort of US Patients With Ebola Virus Disease. Clin Infect Dis 2016; 63:460-7. [PMID: 27353663 DOI: 10.1093/cid/ciw334] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ebola virus (EBOV) infection causes a severe and often fatal disease. Despite the fact that more than 30 000 individuals have acquired Ebola virus disease (EVD), the medical and scientific community still does not have a clear understanding of the mechanisms by which EBOV causes such severe disease. METHODS In this study, 54 biomarkers in plasma samples serially collected from 7 patients with EVD were analyzed in an attempt to define the kinetics of inflammatory modulators. Two clinical disease groups were defined (moderate and severe) based on the need for clinical support. Biomarkers were evaluated for correlation with viremia and clinical disease in an effort to identify pathways that could be useful targets of therapeutic intervention. RESULTS Patients with severe disease had higher viremia than those with moderate disease. Several biomarkers of immune activation and control were significantly elevated in patients with moderate disease. A series of pro-inflammatory cytokines and chemokines were significantly elevated in patients with severe disease. CONCLUSIONS Biomarkers that were associated with severe EVD were proinflammatory and indicative of endothelial or coagulation cascade dysfunction, as has been seen historically in patients with fatal outcomes. In contrast, biomarkers that were associated with moderate EVD were suggestive of a strong interferon response and control of both innate and adaptive responses. Therefore, clinical interventions that modulate the phenotype and magnitude of immune activation may be beneficial in treating EVD.
Collapse
Affiliation(s)
- Anita K McElroy
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Jessica R Harmon
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Timothy D Flietstra
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | - Shelley Campbell
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | | | - Colleen S Kraft
- Division of Infectious Diseases Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Philip W Smith
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center College of Medicine, Omaha
| | | | - Stuart T Nichol
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | | |
Collapse
|
85
|
Ruibal P, Oestereich L, Lüdtke A, Becker-Ziaja B, Wozniak DM, Kerber R, Korva M, Cabeza-Cabrerizo M, Bore JA, Koundouno FR, Duraffour S, Weller R, Thorenz A, Cimini E, Viola D, Agrati C, Repits J, Afrough B, Cowley LA, Ngabo D, Hinzmann J, Mertens M, Vitoriano I, Logue CH, Boettcher JP, Pallasch E, Sachse A, Bah A, Nitzsche K, Kuisma E, Michel J, Holm T, Zekeng EG, García-Dorival I, Wölfel R, Stoecker K, Fleischmann E, Strecker T, Di Caro A, Avšič-Županc T, Kurth A, Meschi S, Mély S, Newman E, Bocquin A, Kis Z, Kelterbaum A, Molkenthin P, Carletti F, Portmann J, Wolff S, Castilletti C, Schudt G, Fizet A, Ottowell LJ, Herker E, Jacobs T, Kretschmer B, Severi E, Ouedraogo N, Lago M, Negredo A, Franco L, Anda P, Schmiedel S, Kreuels B, Wichmann D, Addo MM, Lohse AW, De Clerck H, Nanclares C, Jonckheere S, Van Herp M, Sprecher A, Xiaojiang G, Carrington M, Miranda O, Castro CM, Gabriel M, Drury P, Formenty P, Diallo B, Koivogui L, Magassouba N, Carroll MW, Günther S, Muñoz-Fontela C. Unique human immune signature of Ebola virus disease in Guinea. Nature 2016; 533:100-4. [PMID: 27147028 PMCID: PMC4876960 DOI: 10.1038/nature17949] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/01/2016] [Indexed: 01/20/2023]
Abstract
Despite the magnitude of the Ebola virus disease (EVD) outbreak in West Africa, there is still a fundamental lack of knowledge about the pathophysiology of EVD. In particular, very little is known about human immune responses to Ebola virus. Here we evaluate the physiology of the human T cell immune response in EVD patients at the time of admission to the Ebola Treatment Center in Guinea, and longitudinally until discharge or death. Through the use of multiparametric flow cytometry established by the European Mobile Laboratory in the field, we identify an immune signature that is unique in EVD fatalities. Fatal EVD was characterized by a high percentage of CD4(+) and CD8(+) T cells expressing the inhibitory molecules CTLA-4 and PD-1, which correlated with elevated inflammatory markers and high virus load. Conversely, surviving individuals showed significantly lower expression of CTLA-4 and PD-1 as well as lower inflammation, despite comparable overall T cell activation. Concomitant with virus clearance, survivors mounted a robust Ebola-virus-specific T cell response. Our findings suggest that dysregulation of the T cell response is a key component of EVD pathophysiology.
Collapse
Affiliation(s)
- Paula Ruibal
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, 20251 Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Lisa Oestereich
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Anja Lüdtke
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, 20251 Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Beate Becker-Ziaja
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - David M Wozniak
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Romy Kerber
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Miša Korva
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mar Cabeza-Cabrerizo
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Joseph A Bore
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Fara Raymond Koundouno
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Romy Weller
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Experimental Virology, Twincore, Center for Experimental and Clinical Infection Research, 30625 Hannover, Germany
| | - Anja Thorenz
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Hannover Medical School, 30625 Hannover, Germany
| | - Eleonora Cimini
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Domenico Viola
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Chiara Agrati
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Johanna Repits
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Babak Afrough
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Lauren A Cowley
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Colindale Ave, London NW9 5EQ, UK
| | - Didier Ngabo
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Julia Hinzmann
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Robert Koch Institute, 13353 Berlin, Germany
| | - Marc Mertens
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Friedrich Loeffler Institute, 17493 Greifswald-Island of Riems, Germany
| | - Inês Vitoriano
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Christopher H Logue
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Jan Peter Boettcher
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Robert Koch Institute, 13353 Berlin, Germany
| | - Elisa Pallasch
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Andreas Sachse
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Robert Koch Institute, 13353 Berlin, Germany
| | - Amadou Bah
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland
| | - Katja Nitzsche
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Eeva Kuisma
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Janine Michel
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Robert Koch Institute, 13353 Berlin, Germany
| | - Tobias Holm
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Elsa-Gayle Zekeng
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Isabel García-Dorival
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
| | - Roman Wölfel
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Kilian Stoecker
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Erna Fleischmann
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Thomas Strecker
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Virology, Philipps University, 35043 Marburg, Germany
| | - Antonino Di Caro
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Tatjana Avšič-Županc
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andreas Kurth
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Robert Koch Institute, 13353 Berlin, Germany
| | - Silvia Meschi
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Stephane Mély
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Laboratoire P4-Jean Mérieux, US003 INSERM, 69365 Lyon, France
| | - Edmund Newman
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Anne Bocquin
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Laboratoire P4-Jean Mérieux, US003 INSERM, 69365 Lyon, France
| | - Zoltan Kis
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Center for Epidemiology, Hungarian National Biosafety Laboratory, H1097 Budapest, Hungary
- European Centre for Disease Prevention and Control, 171 65 Solna, Sweden
| | - Anne Kelterbaum
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Virology, Philipps University, 35043 Marburg, Germany
| | - Peter Molkenthin
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Fabrizio Carletti
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Jasmine Portmann
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Federal Office for Civil Protection, CH-3700 Spiez, Switzerland
| | - Svenja Wolff
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Virology, Philipps University, 35043 Marburg, Germany
| | - Concetta Castilletti
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- National Institute for Infectious Diseases 'Lazzaro Spallanzani', 00149 Rome, Italy
| | - Gordian Schudt
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Institute of Virology, Philipps University, 35043 Marburg, Germany
| | - Alexandra Fizet
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, 69365 Lyon, France
| | - Lisa J Ottowell
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Eva Herker
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, 20251 Hamburg, Germany
| | - Thomas Jacobs
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
| | - Birte Kretschmer
- Eurice, European Research and Project Office, 10115 Berlin, Germany
| | - Ettore Severi
- European Centre for Disease Prevention and Control, 171 65 Solna, Sweden
| | | | - Mar Lago
- Infectious Diseases Unit, Internal Medicine Service, Hospital La Paz, 28046 Madrid, Spain
| | - Anabel Negredo
- National Center of Microbiology, Institute of Health 'Carlos III', 28220 Madrid, Spain
| | - Leticia Franco
- National Center of Microbiology, Institute of Health 'Carlos III', 28220 Madrid, Spain
| | - Pedro Anda
- National Center of Microbiology, Institute of Health 'Carlos III', 28220 Madrid, Spain
| | - Stefan Schmiedel
- University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Benno Kreuels
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Dominic Wichmann
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marylyn M Addo
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ansgar W Lohse
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | | | | | | | | | - Gao Xiaojiang
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts 02139, USA
| | - Mary Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts 02139, USA
| | - Osvaldo Miranda
- Hospital Militar Central Dr. Carlos J. Finlay, 11400 Havana, Cuba
| | - Carlos M Castro
- Hospital Militar Central Dr. Carlos J. Finlay, 11400 Havana, Cuba
| | - Martin Gabriel
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - Patrick Drury
- World Health Organization, 1211 Geneva 27, Switzerland
| | | | | | | | - N'Faly Magassouba
- Université Gamal Abdel Nasser de Conakry, CHU Donka, 2101 Conakry, Guinea
| | - Miles W Carroll
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| | - César Muñoz-Fontela
- Heinrich Pette Institute, Leibniz Institute for Experimental Virology, 20251 Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, World Health Organization Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Sites Hamburg, Munich, and Marburg, Germany
- European Mobile Laboratory Consortium, Bernhard-Nocht-Institute for Tropical Medicine, D-20359 Hamburg, Germany
| |
Collapse
|
86
|
Huang Q, Fu WL, You JP, Mao Q. Laboratory diagnosis of Ebola virus disease and corresponding biosafety considerations in the China Ebola Treatment Center. Crit Rev Clin Lab Sci 2016; 53:326-40. [PMID: 26952811 DOI: 10.3109/10408363.2016.1160866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ebola virus disease (EVD), caused by Ebola virus (EBOV), is a potent acute infectious disease with a high case-fatality rate. Etiological and serological EBOV detection methods, including techniques that involve the detection of the viral genome, virus-specific antigens and anti-virus antibodies, are standard laboratory diagnostic tests that facilitate confirmation or exclusion of EBOV infection. In addition, routine blood tests, liver and kidney function tests, electrolytes and coagulation tests and other diagnostic examinations are important for the clinical diagnosis and treatment of EVD. Because of the viral load in body fluids and secretions from EVD patients, all body fluids are highly contagious. As a result, biosafety control measures during the collection, transport and testing of clinical specimens obtained from individuals scheduled to undergo EBOV infection testing (including suspected, probable and confirmed cases) are crucial. This report has been generated following extensive work experience in the China Ebola Treatment Center (ETC) in Liberia and incorporates important information pertaining to relevant diagnostic standards, clinical significance, operational procedures, safety controls and other issues related to laboratory testing of EVD. Relevant opinions and suggestions are presented in this report to provide contextual awareness associated with the development of standards and/or guidelines related to EVD laboratory testing.
Collapse
Affiliation(s)
- Qing Huang
- a Department of Laboratory Medicine , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China .,b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and
| | - Wei-Ling Fu
- a Department of Laboratory Medicine , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
| | - Jian-Ping You
- b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and.,c Department of Infectious Diseases , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
| | - Qing Mao
- b Medical Contingent of the Chinese PLA to Liberia , Chongqing, People's Republic of China , and.,c Department of Infectious Diseases , Southwest Hospital, the Third Military Medical University , Chongqing , People's Republic of China
| |
Collapse
|
87
|
Cron RQ, Behrens EM, Shakoory B, Ramanan AV, Chatham WW. Does Viral Hemorrhagic Fever Represent Reactive Hemophagocytic Syndrome? J Rheumatol 2016; 42:1078-80. [PMID: 26136549 DOI: 10.3899/jrheum.150108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Randy Q Cron
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
| | | | - Bita Shakoory
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Walter W Chatham
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
88
|
Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea. PLoS Med 2016; 13:e1001967. [PMID: 26930627 PMCID: PMC4773183 DOI: 10.1371/journal.pmed.1001967] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies. METHODS AND FINDINGS Inclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 μmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 μmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 μmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 μmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within <72 h of symptoms compared to others. Favipiravir was well tolerated. CONCLUSIONS In the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia. TRIAL REGISTRATION ClinicalTrials.gov NCT02329054.
Collapse
|
89
|
Crowe SJ, Maenner MJ, Kuah S, Erickson BR, Coffee M, Knust B, Klena J, Foday J, Hertz D, Hermans V, Achar J, Caleo GM, Van Herp M, Albariño CG, Amman B, Basile AJ, Bearden S, Belser JA, Bergeron E, Blau D, Brault AC, Campbell S, Flint M, Gibbons A, Goodman C, McMullan L, Paddock C, Russell B, Salzer JS, Sanchez A, Sealy T, Wang D, Saffa G, Turay A, Nichol ST, Towner JS. Prognostic Indicators for Ebola Patient Survival. Emerg Infect Dis 2016; 22:217-23. [PMID: 26812579 PMCID: PMC4734506 DOI: 10.3201/eid2202.151250] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine whether 2 readily available indicators predicted survival among patients with Ebola virus disease in Sierra Leone, we evaluated information for 216 of the 227 patients in Bo District during a 4-month period. The indicators were time from symptom onset to healthcare facility admission and quantitative real-time reverse transcription PCR cycle threshold (Ct), a surrogate for viral load, in first Ebola virus-positive blood sample tested. Of these patients, 151 were alive when detected and had reported healthcare facility admission dates and Ct values available. Time from symptom onset to healthcare facility admission was not associated with survival, but viral load in the first Ebola virus-positive blood sample was inversely associated with survival: 52 (87%) of 60 patients with a Ct of >24 survived and 20 (22%) of 91 with a Ct of <24 survived. Ct values may be useful for clinicians making treatment decisions or managing patient or family expectations.
Collapse
Affiliation(s)
| | | | - Solomon Kuah
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Bobbie Rae Erickson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Megan Coffee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Barbara Knust
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - John Klena
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Joyce Foday
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Darren Hertz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Veerle Hermans
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Jay Achar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Grazia M. Caleo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Michel Van Herp
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - César G. Albariño
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Brian Amman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Alison Jane Basile
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Scott Bearden
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Jessica A. Belser
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Eric Bergeron
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Dianna Blau
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Aaron C. Brault
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Shelley Campbell
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Mike Flint
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Aridth Gibbons
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Christin Goodman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Laura McMullan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Christopher Paddock
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Brandy Russell
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Johanna S. Salzer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Angela Sanchez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Tara Sealy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - David Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Gbessay Saffa
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Alhajie Turay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| | - Jonathan S. Towner
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Crowe, M.J. Maenner, B.R. Erickson, B. Knust, J. Klena, C.G. Albariño, B. Amman, J.A. Belser, E. Bergeron, D. Blau, S. Campbell, M. Flint, A. Gibbons, L. McMullan, C. Paddock, J.S. Salzer, A. Sanchez, T. Sealy, D. Wang, S.T. Nichol, J.S. Towner)
- International Rescue Committee, New York, New York, USA (S. Kuah, M. Coffee, D. Hertz)
- Ministry of Health and Sanitation, Bo Town, Sierra Leone (J. Foday, G. Saffa, A. Turay)
- Médecins Sans Frontières, Brussels, Belgium (V. Hermans, M. Van Herp); Médecins Sans Frontières, London, UK (J. Achar, G.M. Caleo)
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (A.J. Basile, S. Bearden, A.C. Brault, C. Goodman, B. Russell)
| |
Collapse
|
90
|
Abstract
The preceding chapters describe essential aspects of viral pathogenesis, including virus–cell interactions; viral spread within a host; and intrinsic, innate, and adaptive immune responses. This chapter extends the theme and addresses diverse patterns of viral infections that are determined by both the virus and the host. Thus, virulence or susceptibility depends upon the specific virus–host combination. This is particularly true in the case of persistent infections, which involve a delicate balance between virus and host. We will focus first on virus virulence and host susceptibility, and then turn to the complex variables that govern persistent infections. Chapters 4–6, on innate, adaptive, and aberrant immunity, and Chapters 11–15, on systems biology approaches, also provide important insights into the patterns of infection.
Collapse
|
91
|
Modeling the Case of Early Detection of Ebola Virus Disease. MATHEMATICAL AND STATISTICAL MODELING FOR EMERGING AND RE-EMERGING INFECTIOUS DISEASES 2016. [PMCID: PMC7124031 DOI: 10.1007/978-3-319-40413-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The most recent Ebola outbreak in West Africa highlighted critical weaknesses in the medical infrastructure of the affected countries, including effective diagnostics tools, sufficient isolation wards, and enough medical personnel. Here, we develop and analyze a mathematical model to assess the impact of early diagnosis of pre-symptomatic individuals on the transmission dynamics of Ebola virus disease in West Africa. Our findings highlight the importance of implementing integrated control measures of early diagnosis and isolation. The mathematical analysis shows a threshold where early diagnosis of pre-symptomatic individuals, combined with a sufficient level of effective isolation, can lead to an epidemic control of Ebola virus disease.
Collapse
|
92
|
Wilson AJ, Martin DS, Maddox V, Rattenbury S, Bland D, Bhagani S, Cropley I, Hopkins S, Mepham S, Rodger A, Warren S, Chowdary P, Jacobs M. Thromboelastography in the Management of Coagulopathy Associated With Ebola Virus Disease. Clin Infect Dis 2015; 62:610-612. [PMID: 26611775 DOI: 10.1093/cid/civ977] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 11/14/2022] Open
Abstract
Here, we describe the first use of thromboelastography (TEG) in the management of 2 cases of Ebola virus disease. Early in their illness, both patients had evidence of a consumptive coagulopathy. As this resolved, TEG demonstrated that both developed a marked hypercoagulable state, which was treated with low-molecular-weight heparin.
Collapse
Affiliation(s)
- Andrew J Wilson
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHSFoundation Trust
| | | | - Victoria Maddox
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Simon Rattenbury
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Davis Bland
- Haemonetics Corporation, Braintree, Massachusetts
| | - Sanjay Bhagani
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Ian Cropley
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Susan Hopkins
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Stephen Mepham
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, United Kingdom
| | - Simon Warren
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHSFoundation Trust
| | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, United Kingdom
| |
Collapse
|
93
|
Janvier F, Foissaud V, Cotte J, Aletti M, Savini H, Cordier PY, Maugey N, Duron S, Koulibaly F, Granier H, Carmoi T, Sagui E. Monitoring of Prognostic Laboratory Markers in Ebola Virus Disease. J Infect Dis 2015; 213:1049. [PMID: 26582958 DOI: 10.1093/infdis/jiv546] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Jean Cotte
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | | | - Marc Aletti
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | - Hélène Savini
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | | | - Nancy Maugey
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | - Sandrine Duron
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | | | - Hervé Granier
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | - Thierry Carmoi
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| | - Emmanuel Sagui
- Healthcare Workers Ebola Treatment Center, Conakry, Guinea
| |
Collapse
|
94
|
Bird BH, Spengler JR, Chakrabarti AK, Khristova ML, Sealy TK, Coleman-McCray JD, Martin BE, Dodd KA, Goldsmith CS, Sanders J, Zaki SR, Nichol ST, Spiropoulou CF. Humanized Mouse Model of Ebola Virus Disease Mimics the Immune Responses in Human Disease. J Infect Dis 2015; 213:703-11. [PMID: 26582961 DOI: 10.1093/infdis/jiv538] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022] Open
Abstract
Animal models recapitulating human Ebola virus disease (EVD) are critical for insights into virus pathogenesis. Ebola virus (EBOV) isolates derived directly from human specimens do not, without adaptation, cause disease in immunocompetent adult rodents. Here, we describe EVD in mice engrafted with human immune cells (hu-BLT). hu-BLT mice developed EVD following wild-type EBOV infection. Infection with high-dose EBOV resulted in rapid, lethal EVD with high viral loads, alterations in key human antiviral immune cytokines and chemokines, and severe histopathologic findings similar to those shown in the limited human postmortem data available. A dose- and donor-dependent clinical course was observed in hu-BLT mice infected with lower doses of either Mayinga (1976) or Makona (2014) isolates derived from human EBOV cases. Engraftment of the human cellular immune system appeared to be essential for the observed virulence, as nonengrafted mice did not support productive EBOV replication or develop lethal disease. hu-BLT mice offer a unique model for investigating the human immune response in EVD and an alternative animal model for EVD pathogenesis studies and therapeutic screening.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanine Sanders
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
95
|
Lanini S, Portella G, Vairo F, Kobinger GP, Pesenti A, Langer M, Kabia S, Brogiato G, Amone J, Castilletti C, Miccio R, Zumla A, Capobianchi MR, Di Caro A, Strada G, Ippolito G. Blood kinetics of Ebola virus in survivors and nonsurvivors. J Clin Invest 2015; 125:4692-8. [PMID: 26551684 DOI: 10.1172/jci83111] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak. METHODS Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors. RESULTS In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% CI, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors. CONCLUSION Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome. FUNDING Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY's private donations; and Royal Engineers for DFID-UK.
Collapse
|
96
|
The Role of Cytokines and Chemokines in Filovirus Infection. Viruses 2015; 7:5489-507. [PMID: 26512687 PMCID: PMC4632400 DOI: 10.3390/v7102892] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 01/11/2023] Open
Abstract
Ebola- and marburgviruses are highly pathogenic filoviruses and causative agents of viral hemorrhagic fever. Filovirus disease is characterized by a dysregulated immune response, severe organ damage, and coagulation abnormalities. This includes modulation of cytokines, signaling mediators that regulate various components of the immune system as well as other biological processes. Here we examine the role of cytokines in filovirus infection, with an emphasis on understanding how these molecules affect development of the antiviral immune response and influence pathology. These proteins may present targets for immune modulation by therapeutic agents and vaccines in an effort to boost the natural immune response to infection and/or reduce immunopathology.
Collapse
|
97
|
Zampronio AR, Soares DM, Souza GEP. Central mediators involved in the febrile response: effects of antipyretic drugs. Temperature (Austin) 2015; 2:506-21. [PMID: 27227071 PMCID: PMC4843933 DOI: 10.1080/23328940.2015.1102802] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 11/13/2022] Open
Abstract
Fever is a complex signal of inflammatory and infectious diseases. It is generally initiated when peripherally produced endogenous pyrogens reach areas that surround the hypothalamus. These peripheral endogenous pyrogens are cytokines that are produced by leukocytes and other cells, the most known of which are interleukin-1β, tumor necrosis factor-α, and interleukin-6. Because of the capacity of these molecules to induce their own synthesis and the synthesis of other cytokines, they can also be synthesized in the central nervous system. However, these pyrogens are not the final mediators of the febrile response. These cytokines can induce the synthesis of cyclooxygenase-2, which produces prostaglandins. These prostanoids alter hypothalamic temperature control, leading to an increase in heat production, the conservation of heat, and ultimately fever. The effect of antipyretics is based on blocking prostaglandin synthesis. In this review, we discuss recent data on the importance of prostaglandins in the febrile response, and we show that some endogenous mediators can still induce the febrile response even when known antipyretics reduce the levels of prostaglandins in the central nervous system. These studies suggest that centrally produced mediators other than prostaglandins participate in the genesis of fever. Among the most studied central mediators of fever are corticotropin-releasing factor, endothelins, chemokines, endogenous opioids, and substance P, which are discussed herein. Additionally, recent evidence suggests that these different pathways of fever induction may be activated during different pathological conditions.
Collapse
Affiliation(s)
- Aleksander R Zampronio
- Department of Pharmacology; Biological Sciences Section; Federal University of Paraná ; Curitiba, PR, Brazil
| | - Denis M Soares
- Department of Medicament; Faculty of Pharmacy; Federal University of Bahia ; Salvador, BA, Brazil
| | - Glória E P Souza
- Discipline of Pharmacology; Faculty of Pharmaceutical Sciences of Ribeirão Preto; University of São Paulo ; Ribeirão Preto, SP, Brazil
| |
Collapse
|
98
|
Gamma-Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk. DISEASE MARKERS 2015; 2015:818570. [PMID: 26543300 PMCID: PMC4620378 DOI: 10.1155/2015/818570] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/20/2015] [Indexed: 01/09/2023]
Abstract
Gamma-glutamyltransferase (GGT) is a well-established serum marker for alcohol-related liver disease. However, GGT's predictive utility applies well beyond liver disease: elevated GGT is linked to increased risk to a multitude of diseases and conditions, including cardiovascular disease, diabetes, metabolic syndrome (MetS), and all-cause mortality. The literature from multiple population groups worldwide consistently shows strong predictive power for GGT, even across different gender and ethnic categories. Here, we examine the relationship of GGT to other serum markers such as serum ferritin (SF) levels, and we suggest a link to exposure to environmental and endogenous toxins, resulting in oxidative and nitrosative stress. We observe a general upward trend in population levels of GGT over time, particularly in the US and Korea. Since the late 1970s, both GGT and incident MetS and its related disorders have risen in virtual lockstep. GGT is an early predictive marker for atherosclerosis, heart failure, arterial stiffness and plaque, gestational diabetes, and various liver diseases, including viral hepatitis, other infectious diseases, and several life-threatening cancers. We review literature both from the medical sciences and from life insurance industries demonstrating that serum GGT is a superior marker for future disease risk, when compared against multiple other known mortality risk factors.
Collapse
|
99
|
Hellman J. Addressing the Complications of Ebola and Other Viral Hemorrhagic Fever Infections: Using Insights from Bacterial and Fungal Sepsis. PLoS Pathog 2015; 11:e1005088. [PMID: 26425845 PMCID: PMC4591006 DOI: 10.1371/journal.ppat.1005088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Judith Hellman
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine Faculty, Biomedical Sciences and Immunology Programs, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
100
|
Zampronio AR, Soares DM, Souza GEP. Central mediators involved in the febrile response: effects of antipyretic drugs. Temperature (Austin) 2015. [PMID: 27227071 DOI: 10.1080/23328940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
Fever is a complex signal of inflammatory and infectious diseases. It is generally initiated when peripherally produced endogenous pyrogens reach areas that surround the hypothalamus. These peripheral endogenous pyrogens are cytokines that are produced by leukocytes and other cells, the most known of which are interleukin-1β, tumor necrosis factor-α, and interleukin-6. Because of the capacity of these molecules to induce their own synthesis and the synthesis of other cytokines, they can also be synthesized in the central nervous system. However, these pyrogens are not the final mediators of the febrile response. These cytokines can induce the synthesis of cyclooxygenase-2, which produces prostaglandins. These prostanoids alter hypothalamic temperature control, leading to an increase in heat production, the conservation of heat, and ultimately fever. The effect of antipyretics is based on blocking prostaglandin synthesis. In this review, we discuss recent data on the importance of prostaglandins in the febrile response, and we show that some endogenous mediators can still induce the febrile response even when known antipyretics reduce the levels of prostaglandins in the central nervous system. These studies suggest that centrally produced mediators other than prostaglandins participate in the genesis of fever. Among the most studied central mediators of fever are corticotropin-releasing factor, endothelins, chemokines, endogenous opioids, and substance P, which are discussed herein. Additionally, recent evidence suggests that these different pathways of fever induction may be activated during different pathological conditions.
Collapse
Affiliation(s)
- Aleksander R Zampronio
- Department of Pharmacology; Biological Sciences Section; Federal University of Paraná ; Curitiba, PR, Brazil
| | - Denis M Soares
- Department of Medicament; Faculty of Pharmacy; Federal University of Bahia ; Salvador, BA, Brazil
| | - Glória E P Souza
- Discipline of Pharmacology; Faculty of Pharmaceutical Sciences of Ribeirão Preto; University of São Paulo ; Ribeirão Preto, SP, Brazil
| |
Collapse
|