51
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Abeysuriya V, Choong CSH, Thilakawardana BU, de Mel P, Shalindi M, de Mel C, Chandrasena L, Seneviratne SL, Yip C, Yap ES, de Mel S. The atypical lymphocyte count: a novel predictive factor for severe thrombocytopenia related to dengue. Trans R Soc Trop Med Hyg 2021; 114:424-432. [PMID: 31925430 DOI: 10.1093/trstmh/trz128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early identification of patients at risk of severe dengue disease (DD) is critical to guide its management. We evaluated whether the atypical lymphocyte count (ALC), generated from the Sysmex automated full blood count analyzer, is predictive of severe thrombocytopenia secondary to Dengue infection. METHODS We prospectively collected data on patients admitted with DD between December 2017 and October 2018. ALC data were extracted from the Sysmex XS500i analyzer from day 1 to day 7 of admission. Clinical data were obtained from patients' medical records. RESULTS We enrolled 256 patients with DD. A negative correlation between ALC on admission and platelet count on day 5 to day 7 (Spearmen's correlation; day 5:-0.485, day 6:-0.428 and day 7:-0.344) (p=0.001) was observed. Based on receiver operator characteristic curve analysis, we found that an ALC of >0.5x103/L had 90% sensitivity and 70% specificity for severe thrombocytopenia (platelet count <50x109/L) on day 5. The positive and negative predictive values were 74.4 and 91.2%, respectively (power 84.7). CONCLUSIONS We propose that ALC on admission may be a novel negative predictive factor for severe thrombocytopenia on day 5 to day 7 of DD. Further studies are required to validate our findings and evaluate whether ALC is predictive of other complications of DD.
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Affiliation(s)
- Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Clarice Shi Hui Choong
- Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore
| | | | - Primesh de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Malka Shalindi
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Chandima de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Lal Chandrasena
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Suranjith L Seneviratne
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka.,Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka.,Institute of Immunity and Transplantation, Royal Free Hospital and University College London, London, UK
| | - Christina Yip
- Department of Laboratory Medicine, National University Health System Singapore
| | - Eng-Soo Yap
- Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore.,Department of Laboratory Medicine, National University Health System Singapore
| | - Sanjay de Mel
- Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore
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52
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Kashyap A, Singh K, Arora S, S A. Compressive Myelopathy in Dengue Infection: A Report of 2 Cases and Literature Review. JBJS Case Connect 2021; 11:01709767-202106000-00110. [PMID: 34111039 DOI: 10.2106/jbjs.cc.20.00772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES We report 2 cases of compressive myelopathy secondary to spontaneous neuroaxial bleed in dengue infection. One was treated by surgical decompression during the recovery phase of illness, whereas the other was treated nonoperatively. CONCLUSION A conscious decision for surgical decompression should be taken in cases not responding to initial medical management and planned during the recovery phase of dengue infection.
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Affiliation(s)
- Abhishek Kashyap
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India
| | - Keshave Singh
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India
| | - Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India
| | - Anuradha S
- Department of Internal Medicine, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India
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Galani BRT, Mapouokam DW, Simo FBN, Mohamadou H, Chuisseu PDD, Njintang NY, Moundipa PF. Investigation of dengue-malaria coinfection among febrile patients consulting at Ngaoundere Regional Hospital, Cameroon. J Med Virol 2021; 93:3350-3361. [PMID: 33325045 DOI: 10.1002/jmv.26732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 12/13/2020] [Indexed: 01/22/2023]
Abstract
This study aimed at evaluating the seroprevalence of dengue among malarious patients consulting at the Ngaoundere Regional Hospital. During 2 months and a half, 174 participants were recruited and their blood samples were screened for Plasmodium spp and then for Dengue virus (DENV) infection using rapid diagnostic tests. Also, hematological asparameters were measured using a hematology autoanalyzer. Among patients tested, 134 (77.01%) were malaria-positive, and 12/134 (8.95%) were coinfected. In this population, 8/12 (66.67%) were only anti-DENV IgM-positive, 3/12 (25%) were both NS1 and anti-DENV IgM positive, and 1/12 (8.33%) were anti-DENV IgG-positive. Furthermore, women were more affected (58.3%) than men (41.7%). The most affected age groups were young people aged less than or equal to 15 years (33.3%) and adults aged between 30 and 45 years (33.3%). A significant association (p < .05; odds ratio [OR] = 5.16) was found between the age range (30-45) and dengue-malaria coinfection. Similarly, we noted a significant association between the coinfection, and joint pain (p < .05; OR = 6.15), fatigue (p < .01; OR = 5.74), and chills (p < .05; OR = 0). Analysis of hematologic parameters showed a significant decrease (p < .001) in platelets in coinfected patients compared with monoinfected patients. In conclusion, dengue-malaria coinfection is a reality in Ngaoundere city and associated with the appearance of clinical features which predict the disease severity.
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Affiliation(s)
- Borris R T Galani
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| | - Danielle W Mapouokam
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
| | - Fredy B N Simo
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
| | | | - Pascal D D Chuisseu
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
- Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Nicolas Y Njintang
- Department of Biological Sciences, Faculty of Science, Laboratory of Applied Biochemistry, University of Ngaoundere, Ngaoundere, Cameroon
| | - Paul F Moundipa
- Department of Biochemistry, Laboratory of Pharmacology and Toxicology, Faculty of Science, University of Yaounde I, Yaounde, Cameroon
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54
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Mariappan V, Adikari S, Shanmugam L, Easow JM, Balakrishna Pillai A. Expression dynamics of vascular endothelial markers: endoglin and syndecan-1 in predicting dengue disease outcome. Transl Res 2021; 232:121-141. [PMID: 33567345 DOI: 10.1016/j.trsl.2021.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022]
Abstract
Plasma leakage is a hallmark process in dengue viral (DENV) infection that occurs due to the loss of vascular integrity in endothelial cells. Endoglin (ENG) and Syndecan-1 (SDC-1) are released by activated endothelial cells; however, the complete dynamics of its expression at the gene and protein levels during the course of DENV infection remains unknown. In the present study, we quantified the mRNA and soluble protein levels of ENG and SDC-1 in dengue cases during febrile, defervescence, and convalescence stages in Dengue without Warning Sign (DWOW-15), Dengue with Warning Sign (DWW-22), and Severe Dengue cases (SD-10) compared to nondengue Other Febrile Illness (OFI-10) and healthy control (HC-8). Respective protein and mRNA levels along with clinical characters were further analyzed for their efficacy in predicting disease outcomes using Support Vector Machine (SVM). We observed a steady and significant (P ≤ 0.01) increase in the levels of protein and mRNA of both the ENG and SDC-1 towards defervescence which is considered a critical phase in both severe and non-severe dengue cases. Importantly during the critical phase, the levels were significantly higher (P ≤ 0.001) in SD cases compared to DWW, DWOW, and OFI controls. However, at the time of admission (febrile), no such significant changes were observed within dengue, OFI, and healthy controls. SVM analysis revealed that the serum levels of ENG and SDC-1 along with other clinical symptoms could predict the disease severity with 100% accuracy. Based on the results we have proposed a mechanism on how ENG and SDC-1 could be involved in vascular dysfunction rather than just being a biomarker.
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Affiliation(s)
- Vignesh Mariappan
- Central Inter-Disciplinary Research Facility (CIDRF), School of Biological Science, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Shalinda Adikari
- Department of Information System and Analytics, National University of Singapore (NUS), Singapore, Republic of Singapore
| | - Lokesh Shanmugam
- Mahatma Gandhi Medical College and Research Institute (MGMCRI), Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Joshy M Easow
- Mahatma Gandhi Medical College and Research Institute (MGMCRI), Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Agieshkumar Balakrishna Pillai
- Central Inter-Disciplinary Research Facility (CIDRF), School of Biological Science, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India.
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55
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Jácome FC, Caldas GC, Rasinhas ADC, de Almeida ALT, de Souza DDC, Paulino AC, Leonardo R, Barth OM, Dos Santos FB, Barreto-Vieira DF. Comparative analysis of liver involvement caused by two DENV-2 lineages using an immunocompetent murine model. Sci Rep 2021; 11:9723. [PMID: 33958631 PMCID: PMC8102549 DOI: 10.1038/s41598-021-88502-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Dengue (DEN) is the most prevalent arbovirus among humans, and four billion people live at risk of infection. The clinical manifestations of DEN are variable, and the disease may present subclinically or asymptomatically. A quarter of patients develop classical dengue (CD) or severe dengue (SD), which is potentially lethal and involves vascular permeability changes, severe hemorrhage and organ damage. The involvement of the liver is a fairly common feature in DEN, and alterations range from asymptomatic elevation of transaminases to acute liver failure. Since its introduction in Brazil in 1990, two strains of Dengue virus (DENV) serotype 2 (DENV-2) have been detected: Lineage I, which is responsible for an outbreak in 1991, and Lineage II, which caused an epidemic greater than the previous one and had a different epidemiological profile. To date, studies on different strains of the same serotype/genotype and their association with disease severity are scarce. In addition, one of the greatest challenges regarding the study of DEN pathogenesis and the development of drug and vaccine therapies is the absence of an animal model that reproduces the disease as it occurs in humans. The main goals of this study were to assess BALB/c mouse susceptibility experimentally infected by two distinct DENV-2 strains and characterize possible differences in the clinical signs and alterations induced in the liver resulting from those infections. Mice infected by the two DENV-2 lineages gained less weight than uninfected mice; however, their livers were slightly heavier. Increased AST and AST levels were observed in infected mice, and the number of platelets increased in the first 72 h of infection and subsequently decreased. Mice infected with both lineages presented leukocytosis but at different times of infection. The histopathological changes induced by both lineages were similar and comparable to the changes observed in DEN fatal cases. The viral genome was detected in two liver samples. The results demonstrate the susceptibility of BALB/c mice to both DENV-2 lineages and suggest that the changes induced by those strains are similar, although for some parameters, they are manifested at different times of infection.
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Affiliation(s)
- Fernanda Cunha Jácome
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil.
| | - Gabriela Cardoso Caldas
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Arthur da Costa Rasinhas
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Ana Luisa Teixeira de Almeida
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Daniel Dias Coutinho de Souza
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Amanda Carlos Paulino
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Raphael Leonardo
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Ortrud Monika Barth
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Flavia Barreto Dos Santos
- Laboratory of Viral Immunology, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Débora Ferreira Barreto-Vieira
- Laboratory of Viral Morphology and Morphogenesis, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Rio de Janeiro, RJ, 21040-900, Brazil
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56
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Lien TS, Chan H, Sun DS, Wu JC, Lin YY, Lin GL, Chang HH. Exposure of Platelets to Dengue Virus and Envelope Protein Domain III Induces Nlrp3 Inflammasome-Dependent Platelet Cell Death and Thrombocytopenia in Mice. Front Immunol 2021; 12:616394. [PMID: 33995345 PMCID: PMC8118162 DOI: 10.3389/fimmu.2021.616394] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
In tropical and subtropical regions, mosquito-borne dengue virus (DENV) infections can lead to severe dengue, also known as dengue hemorrhage fever, which causes bleeding, thrombocytopenia, and blood plasma leakage and increases mortality. Although DENV-induced platelet cell death was linked to disease severity, the role of responsible viral factors and the elicitation mechanism of abnormal platelet activation and cell death remain unclear. DENV and virion-surface envelope protein domain III (EIII), a cellular binding moiety of the virus particle, highly increase during the viremia stage. Our previous report suggested that exposure to such viremia EIII levels can lead to cell death of endothelial cells, neutrophils, and megakaryocytes. Here we found that both DENV and EIII could induce abnormal platelet activation and predominantly necrotic cell death pyroptosis. Blockages of EIII-induced platelet signaling using the competitive inhibitor chondroitin sulfate B or selective Nlrp3 inflammasome inhibitors OLT1177 and Z-WHED-FMK markedly ameliorated DENV- and EIII-induced thrombocytopenia, platelet activation, and cell death. These results suggest that EIII could be considered as a virulence factor of DENV, and that Nlrp3 inflammasome is a feasible target for developing therapeutic approaches against dengue-induced platelet defects.
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Affiliation(s)
| | | | | | | | | | | | - Hsin-Hou Chang
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien, Taiwan
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57
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Sarker MMR, Khan F, Mohamed IN. Dengue Fever: Therapeutic Potential of Carica papaya L. Leaves. Front Pharmacol 2021; 12:610912. [PMID: 33981215 PMCID: PMC8109180 DOI: 10.3389/fphar.2021.610912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Dengue, a very widespread mosquito-borne infectious disease caused by Aedes aegypti virus, has been occurring during the monsoons every year. The prevalence and incidence of dengue fever and death due to its complications have been increased drastically in these recent years in Bangladesh, Philippines, Thailand, Brazil, and India. Recently, dengue had spread in an epidemic form in Bangladesh, Thailand, and Philippines. Although the infection affected a large number of people around the world, there is no established specific and effective treatment by synthetic medicines. In this subcontinent, Malaysia could effectively control its incidences and death of patients using alternative medication treatment mainly prepared from Carica papaya L. leaves along with proper care and hospitalization. Papaya leaves, their juice or extract, as well as their different forms of preparation have long been used traditionally for treating dengue fever and its complications to save patients’ lives. Although it is recommended by traditional healers, and the general public use Papaya leaves juice or their other preparations in dengue fever, this treatment option is strictly denied by the physicians offering treatment in hospitals in Bangladesh as they do not believe in the effectiveness of papaya leaves, thus suggesting to patients that they should not use them. In Bangladesh, 1,01,354 dengue patients have been hospitalized, with 179 deaths in the year 2019 according to information from the Institute of Epidemiology, Disease Control, and Research as well as the Directorate General of Health Services of Bangladesh. Most of the patients died because of the falling down of platelets to dangerous levels and hemorrhage or serious bleeding. Therefore, this paper aims to critically review the scientific basis and effectiveness of Carica papaya L. leaves in treating dengue fever based on preclinical and clinical reports. Thrombocytopenia is one of the major conditions that is typical in cases of dengue infection. Besides, the infection and impairment of immunity are concerned with dengue patients. This review summarizes all the scientific reports on Carica papaya L. for its ability on three aspects of dengue: antiviral activities, prevention of thrombocytopenia and improvement of immunity during dengue fever.
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Affiliation(s)
- Md Moklesur Rahman Sarker
- Department of Pharmacy, State University of Bangladesh, Dhanmondi, Dhaka, Bangladesh.,Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Farzana Khan
- Department of Pharmacy, State University of Bangladesh, Dhanmondi, Dhaka, Bangladesh.,Pharmacology and Toxicology Research Division, Health Med Science Research Limited, Dhaka, Bangladesh
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia (The National University of Malaysia), Cheras, Malaysia
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Mohd Abd Razak MR, Norahmad NA, Md Jelas NH, Afzan A, Mohmad Misnan N, Mat Ripen A, Thayan R, Zainol M, Syed Mohamed AF. Immunomodulatory Activities of Carica papaya L. Leaf Juice in a Non-Lethal, Symptomatic Dengue Mouse Model. Pathogens 2021; 10:pathogens10050501. [PMID: 33919457 PMCID: PMC8170887 DOI: 10.3390/pathogens10050501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
The role of Carica papaya L. leaf juice in immune dysregulation caused by dengue virus infection remains unclear. This study aimed to investigate the immunomodulatory activities of the freeze-dried C. papaya leaf juice (FCPLJ) on AG129 mice infected with a clinical DENV-2 (DMOF015) isolate. The infected AG129 mice were orally treated with 500 and 1000 mg/kg/day of FCPLJ, for three days. Platelet, leukocyte, lymphocyte and neutrophil counts were microscopically determined. The level of plasma proinflammatory cytokines was measured by multiplex immunoassay. The levels of intracellular cytokines and viral RNA were determined by RT-qPCR technique. The results showed that the FCPLJ treatment increased the total white blood cell and neutrophil counts in the infected mice. The FCPLJ treatment decreased the level of GM-CSF, GRO-alpha, IL-1 beta, IL-6, MCP-1 and MIP-1 beta in the plasma of the infected mice. The intracellular IL-6 and viral RNA levels in the liver of infected mice were decreased by the FCPLJ treatment. In conclusion, this study supports the potential immunomodulatory role of the FCPLJ in a non-lethal, symptomatic dengue mouse model. Further studies on the action mechanism of the C. papaya leaf juice and its possible use as adjunctive dengue immunotherapy are warranted.
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Affiliation(s)
- Mohd Ridzuan Mohd Abd Razak
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
- Correspondence:
| | - Nor Azrina Norahmad
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Nur Hana Md Jelas
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Adlin Afzan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Norazlan Mohmad Misnan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Adiratna Mat Ripen
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Ravindran Thayan
- Infectious Disease Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia;
| | - Murizal Zainol
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
| | - Ami Fazlin Syed Mohamed
- Herbal Medicine Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (N.A.N.); (N.H.M.J.); (A.A.); (N.M.M.); (M.Z.); (A.F.S.M.)
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Shahila M AG, Jothilingam P. A hospital based cross-sectional study on platelet parameters in adult patients with dengue, its serological subgroups, and controls. Platelets 2021; 33:291-297. [PMID: 33784226 DOI: 10.1080/09537104.2021.1902967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to analyze if there was a significant relationship between platelet parameters (PLT, MPV, PDW, P-LCR, PCT) among dengue, its serological subgroups and controls. Serologically proven adult patients with dengue {(n = 238) (NS1 positive = 218, IgM positive = 14, NS1 & IgM positive = 6)} and age- and gender-matched controls (n = 254) were included. The MPV, PDW and P-LCR were significantly higher, and PLT and PCT were significantly lower in cases compared with controls. Cases as well as controls showed a positive correlation between PLT and PCT, both parameters individually showed negative correlation with MPV, PDW, P-LCR. MPV, PDW and P-LCR showed positive correlation with each other. The results were similar in the serological subgroups. Comparison of our results with other studies points toward an overall hyperdestructive etiology for thrombocytopenia in dengue. There were two subgroups of cases based on the severity of thrombocytopenia. The mean/median value of all the platelet parameters was lesser in the ≤20k group than the >20k group, except for PDW, which was high although not statistically significant. Suppression of megakaryopoiesis with concomitant immune destruction of platelets in severe dengue could explain low MPV and P-LCR with a high PDW in view of the presence of microthrombocytes as a result of immune destruction. Although an overall hyperdestructive mechanism contributes to thrombocytopenia in dengue, regular monitoring of the platelet indices could reflect the status of megakaryopoiesis and thrombokinetic axis, thus aiding easy determination of pathophysiology and treatment.
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Affiliation(s)
- Antony Gnana Shahila M
- Department of Anaesthesiology, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
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60
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Cahyati WH, Siyam N, Putriningtyas ND. The potential of red dragon fruit peel yogurt to improve platelet levels in heparin-induced thrombocytopenia in Wistar rats. POTRAVINARSTVO 2021. [DOI: 10.5219/1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patients infected with the dengue virus will develop thrombocytopenia which can cause bleeding and complications. One of the materials that contain antioxidants and have potential as a functional food is red dragon fruit peel. This peel can be processed into yogurt as a way to increase antioxidant function which ultimately supports the immune system of its users. This study analyzed the effect of red dragon fruit peel yogurt on the platelet levels of thrombocytopenic Wistar rats. It used a pre-post-test control group design. Male Wistar rats were randomly assigned into seven groups: K-; K+; and five treatment groups that received dragon fruit peel yogurt at doses of 5% (K1); 10% (K2); 15% (K3); 20% (K4); and 25% (K5). Thrombocytopenia was induced by 0.1 mL.100g-1 BW of heparin for 3 days. The intervention was carried out for 28 days. The result showed that all groups had significant differences before and after the intervention (p <0.05). Tukey analysis showed that there were significant differences in all groups (p <0.05). Yogurt containing 25% red dragon fruit peel provides an effective dose for improving platelet levels in thrombocytopenic rats.
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61
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Muruganantham S, Krishnaswami V, Alagarsamy S, Kandasamy R. Anti-platelet Drug-loaded Targeted Technologies for the Effective Treatment of Atherothrombosis. Curr Drug Targets 2021; 22:399-419. [PMID: 33109044 DOI: 10.2174/1389450121666201027125303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022]
Abstract
Atherothrombosis results from direct interaction between atherosclerotic plaque and arterial thrombosis and is the most common type of cardiovascular disease. As a long term progressive disease, atherosclerosis frequently results in an acute atherothrombotic event through plaque rupture and platelet-rich thrombus formation. The pathophysiology of atherothrombosis involves cholesterol accumulation endothelial dysfunction, dyslipidemia, immuno-inflammatory, and apoptotic aspects. Platelet activation and aggregation is the major cause for stroke because of its roles, including thrombus, contributing to atherosclerotic plaque, and sealing off the bleeding vessel. Platelet aggregates are associated with arterial blood pressure and cardiovascular ischemic events. Under normal physiological conditions, when a blood vessel is damaged, the task of platelets within the circulation is to arrest the blood loss. Antiplatelet inhibits platelet function, thereby decreasing thrombus formation with complementary modes of action to prevent atherothrombosis. In the present scientific scenario, researchers throughout the world are focusing on the development of novel drug delivery systems to enhance patient's compliance. Immediate responding pharmaceutical formulations become an emerging trend in the pharmaceutical industries with better patient compliance. The proposed review provides details related to the molecular pathogenesis of atherothrombosis and recent novel formulation approaches to treat atherothrombosis with particular emphasis on commercial formulation and upcoming technologies.
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Affiliation(s)
- Selvakumar Muruganantham
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Venkateshwaran Krishnaswami
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Shanmugarathinam Alagarsamy
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Ruckmani Kandasamy
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
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Antibody-induced procoagulant platelets in severe COVID-19 infection. Blood 2021; 137:1061-1071. [PMID: 33512415 PMCID: PMC7791311 DOI: 10.1182/blood.2020008762] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
Severe COVID-19 is associated with increased antibody-mediated procoagulant platelets. Procoagulant platelets and platelet apoptosis in severe COVID-19 is correlated with D-dimer and higher incidence of thromboembolisms.
The pathophysiology of COVID-19–associated thrombosis seems to be multifactorial. We hypothesized that COVID-19 is accompanied by procoagulant platelets with subsequent alteration of the coagulation system. We investigated depolarization of mitochondrial inner transmembrane potential (ΔΨm), cytosolic calcium (Ca2+) concentration, and phosphatidylserine (PS) externalization. Platelets from COVID-19 patients in the intensive care unit (ICU; n = 21) showed higher ΔΨm depolarization, cytosolic Ca2+, and PS externalization compared with healthy controls (n = 18) and non-ICU COVID-19 patients (n = 4). Moreover, significant higher cytosolic Ca2+ and PS were observed compared with a septic ICU control group (ICU control; n = 5). In the ICU control group, cytosolic Ca2+ and PS externalization were comparable with healthy controls, with an increase in ΔΨm depolarization. Sera from COVID-19 patients in the ICU induced a significant increase in apoptosis markers (ΔΨm depolarization, cytosolic Ca2+, and PS externalization) compared with healthy volunteers and septic ICU controls. Interestingly, immunoglobulin G fractions from COVID-19 patients induced an Fcγ receptor IIA–dependent platelet apoptosis (ΔΨm depolarization, cytosolic Ca2+, and PS externalization). Enhanced PS externalization in platelets from COVID-19 patients in the ICU was associated with increased sequential organ failure assessment score (r = 0.5635) and D-dimer (r = 0.4473). Most importantly, patients with thrombosis had significantly higher PS externalization compared with those without. The strong correlations between markers for apoptosic and procoagulant platelets and D-dimer levels, as well as the incidence of thrombosis, may indicate that antibody-mediated procoagulant platelets potentially contributes to sustained increased thromboembolic risk in ICU COVID-19 patients.
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Development and Characterization of Phytoniosome Nano Vesicle Loaded with Aqueous Leaf Extracts of Justicia adhatoda and Psidium guajoava Against Dengue Virus (DEN-2). J CLUST SCI 2021. [DOI: 10.1007/s10876-020-01788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Coelho SVA, Rust NM, Vellasco L, Papa MP, Pereira ASG, da Silva Palazzo MF, Juliano MA, Costa SM, Alves AMB, Cordeiro MT, Marques ETA, Scharfstein J, de Arruda LB. Contact System Activation in Plasma from Dengue Patients Might Harness Endothelial Virus Replication through the Signaling of Bradykinin Receptors. Pharmaceuticals (Basel) 2021; 14:ph14010056. [PMID: 33445640 PMCID: PMC7827195 DOI: 10.3390/ph14010056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Since exacerbated inflammation and microvascular leakage are hallmarks of dengue virus (DENV) infection, here we interrogated whether systemic activation of the contact/kallikrein-kinin system (KKS) might hamper endothelial function. In vitro assays showed that dextran sulfate, a potent contact activator, failed to generate appreciable levels of activated plasma kallikrein (PKa) in the large majority of samples from a dengue cohort (n = 70), irrespective of severity of clinical symptoms. Impaired formation of PKa in dengue-plasmas correlated with the presence of cleaved Factor XII and high molecular weight kininogen (HK), suggesting that the prothrombogenic contact system is frequently triggered during the course of infection. Using two pathogenic arboviruses, DENV or Zika virus (ZIKV), we then asked whether exogenous BK could influence the outcome of infection of human brain microvascular endothelial cells (HBMECs). Unlike the unresponsive phenotype of Zika-infected HBMECs, we found that BK, acting via B2R, vigorously stimulated DENV-2 replication by reverting nitric oxide-driven apoptosis of endothelial cells. Using the mouse model of cerebral dengue infection, we next demonstrated that B2R targeting by icatibant decreased viral load in brain tissues. In summary, our study suggests that contact/KKS activation followed by BK-induced enhancement of DENV replication in the endothelium may underlie microvascular pathology in dengue.
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Affiliation(s)
- Sharton V. A. Coelho
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (S.V.A.C.); (N.M.R.); (M.P.P.); (A.S.G.P.)
| | - Naiara M. Rust
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (S.V.A.C.); (N.M.R.); (M.P.P.); (A.S.G.P.)
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.V.); (M.F.d.S.P.)
| | - Lucas Vellasco
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.V.); (M.F.d.S.P.)
| | - Michelle P. Papa
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (S.V.A.C.); (N.M.R.); (M.P.P.); (A.S.G.P.)
| | - Aline S. G. Pereira
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (S.V.A.C.); (N.M.R.); (M.P.P.); (A.S.G.P.)
| | - Matheus Ferreira da Silva Palazzo
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.V.); (M.F.d.S.P.)
| | - Maria Aparecida Juliano
- Departamento de Biofísica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil;
| | - Simone M. Costa
- Laboratório de Biotecnologia e Fisiologia de Infecções Virais, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil; (S.M.C.); (A.M.B.A.)
| | - Ada M. B. Alves
- Laboratório de Biotecnologia e Fisiologia de Infecções Virais, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil; (S.M.C.); (A.M.B.A.)
| | - Marli T. Cordeiro
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife 50740-465, Brazil; (M.T.C.); (E.T.A.M.)
| | - Ernesto T. A. Marques
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife 50740-465, Brazil; (M.T.C.); (E.T.A.M.)
- Department of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Júlio Scharfstein
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.V.); (M.F.d.S.P.)
- Correspondence: (J.S.); (L.B.d.A.)
| | - Luciana B. de Arruda
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (S.V.A.C.); (N.M.R.); (M.P.P.); (A.S.G.P.)
- Correspondence: (J.S.); (L.B.d.A.)
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Melgaço JG, Brito e Cunha D, Azamor T, da Silva AMV, Tubarão LN, Gonçalves RB, Monteiro RQ, Missailidis S, da Costa Neves PC, Ano Bom APD. Cellular and Molecular Immunology Approaches for the Development of Immunotherapies against the New Coronavirus (SARS-CoV-2): Challenges to Near-Future Breakthroughs. J Immunol Res 2020; 2020:8827670. [PMID: 33426096 PMCID: PMC7753942 DOI: 10.1155/2020/8827670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
The severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2), termed COVID-19, has been highlighted as the most important infectious disease of our time, without a vaccine and treatment available until this moment, with a big impact on health systems worldwide, and with high mortality rates associated with respiratory viral disease. The medical and scientific communities have also been confronted by an urgent need to better understand the mechanism of host-virus interaction aimed at developing therapies and vaccines. Since this viral disease can trigger a strong innate immune response, causing severe damage to the pulmonary tract, immunotherapies have also been explored as a means to verify the immunomodulatory effect and improve clinical outcomes, whilst the comprehensive COVID-19 immunology still remains under investigation. In this review, both cellular and molecular immunopathology as well as hemostatic disorders induced by SARS-CoV-2 are summarized. The immunotherapeutic approaches based on the most recent clinical and nonclinical studies, emphasizing their effects for the treatment of COVID-19, are also addressed. The information presented elucidates helpful insights aiming at filling the knowledge gaps around promising immunotherapies that attempt to control the dysfunction of host factors during the course of this infectious viral disease.
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Affiliation(s)
- Juliana Gil Melgaço
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Danielle Brito e Cunha
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Tamiris Azamor
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Andrea Marques Vieira da Silva
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Neves Tubarão
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Rafael Braga Gonçalves
- Laboratório de Bioquímica Estrutural, Departamento de Bioquímica, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Robson Q. Monteiro
- Laboratório de Trombose e Câncer, Instituto de Bioquímica Médica Leopoldo Meis, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sotiris Missailidis
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Tecnologia de Anticorpos Monoclonais, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patricia Cristina da Costa Neves
- Laboratório de Tecnologia de Anticorpos Monoclonais, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana Paula Dinis Ano Bom
- Laboratório de Tecnologia Imunológica, Instituto de Tecnologia em Imunobiológicos, Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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Chakraborty S, Alam S, Sayem M, Sanyal M, Das T, Saha P, Sayem M, Byapari BK, Tabassum CT, Kabir A, Amin M, Nabi AN. Investigation of the efficacy and safety of eltrombopag to correct thrombocytopenia in moderate to severe dengue patients - a phase II randomized controlled clinical trial. EClinicalMedicine 2020; 29-30:100624. [PMID: 33294822 PMCID: PMC7691733 DOI: 10.1016/j.eclinm.2020.100624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The dengue-infected patients with or without hemorrhagic manifestations, typically exhibit moderate to severe thrombocytopenia. A thrombopoietin receptor agonist - eltrombopag has been efficacious in correcting thrombocytopenia in patients with various pathological conditions including immune thrombocytopenia, chronic liver disease, and severe aplastic anemia. This study investigated the efficacy and safety of eltrombopag to correct dengue-mediated thrombocytopenia. METHODS In this open-label, randomized controlled phase-II trial, patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) having platelet (PLT) count lower than 100 × 109/L without comorbidity, pregnancy, and liver abnormalities were enrolled in Dhaka Medical College Hospital, Better Life Hospital and AMZ hospital, Dhaka, Bangladesh. Between October 10, 2019, and December 30, 2019, 123 DF and DHF patients were assessed for eligibility to be enrolled in the trial. Fourteen patients were excluded as they failed to fulfill the inclusion criteria (N = 6) or refused to participate in the trial (N = 8). Finally, 109 patients were randomly assigned to either Group 1, (N = 36), Group 2 (N = 37), or Control-group (N = 36) in a 1:1:1 ratio. Two doses of eltrombopag - 25 mg/day and 50 mg/day were administered to Group-1 and Group-2 patients, respectively whereas the control-group patients received standard dengue treatment without eltrombopag. The management of all enrolled patients was according to WHO guidelines. The randomization procedure was performed by using a computerized system (STATA Inc.). CBC and immature platelet fraction (IPF) were monitored from Day-0 to Day-7. Absolute immature platelet count (A-IPC) was calculated from PLT count and IPF for each patient. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured on Day-0 and Day-4 and an Ultrasonogram (USG) of the abdomen was performed on Day-4 and Day-7 for each patient. The efficacy of eltrombopag as the primary outcome of the trial was investigated by the proportion of patients with recovered platelet count receiving eltrombopag with corrected platelet count (platelet count above the lower normal limit: 150 × 109/L) on Day-7 of the enrollment as compared to the Control-group. As the secondary outcomes, the reduction of bleeding tendency in response to eltrombopag as well as the safety of eltrombopag in dengue patients were assessed. The safety was evaluated in case of adverse events, liver function enzymes AST/ALT levels and USG. This trial is registered with the international clinical trial registry, number SLCTR/2019/037. RESULTS A total of 101 patients including 77 DF and 24 DHF patients completed the trial as eight patients left the trial without completing the follow-up. Patients of the different groups were compared with respect to mean age (26±8, 30±10 and 30±9 years for, Group-1,-2 and Control-group, respectively) (p-value= 0.23) and basal PLT count (Group-1: 58±24 × 109; Group-2: 52±29 × 109 and control-group: 55±30 × 109) (p-value= 0.63). The mean PLT counts for Group-1 (332 × 109/L ± 92) and Group-2 (371 × 109/L ± 111) were significantly higher than control-group (194 × 109/L ± 96) on Day-7 (adjusted p-value= 1.15 × 10-06 for Group-1 vs. Control-group, and adjusted p-value= 1.82 × 10-08 for Group-2 vs. Control-group).). On Day-7, 91% of Group-1 (N = 30) and Group-2 (N = 32) patients who received eltrombopag achieved primary endpoint of PLT count above than lower normal limit (150 × 109/L) (Group-1: 91%, OR: 8.33, 95% CI: 2.11 to 32.80, p-value: 0.0024 and Group-2: 91%, OR: 8.89, 95% CI: 2.26 to 34.89, p-value: 0.0017) compared to 55% (N = 18) of control-group patients who did not receive eltrombopag. The bleeding manifestations for thirteen out of fourteen grade-II DHF patients were subsided within Day-7 who received eltrombopag, whereas four out of ten grade-II DHF patients with PLT counts lower than the lower normal limit in the control group showed intermittent bleeding symptoms throughout the trial period. Mean A-IPC but not IPF was significantly higher for eltrombopag-treated groups in comparison to the Control-group. The frequency of the most common adverse events (vomiting and diarrheal tendencies) was similar in the treated-and control-groups (N = 5, 15%, and N = 3, 9% for Group-1 and -2, respectively vs. N = 4, 12% in the Control-group). Ten (30%) patients of Group-1 and, fourteen (40%) patients of Group-2 showed increased AST (U/L) as opposed to nine patients (27%) in the Control-group. Increased ALT levels were observed for three (9%), nine (26%), and seven (21%) patients belonging to the Group-1, -2, and Control-group, respectively. PLT counts higher than the upper normal limit (450 × 109/L) on Day-7 were observed for seven patients who were administered the higher dose (50 mg/day) in contrast to the three patients receiving the lower dose (25 mg/day). USG reports did not show thrombosis events in any of the patients. INTERPRETATION The trial revealed that the administration of eltrombopag in a short regimen for three days was efficacious to restore the PLT count in DF and DHF patients. The higher number of A-IPCs in eltrombopag treated patients underscored the possible mode of action of eltrombopag through stimulating megakaryopoiesis in dengue patients. The trial hints toward the positive effect of eltrombopag in the cessation of bleeding manifestation. Administration of the lower dose (25 mg/day) of eltrombopag was shown to be safer and equally efficacious to the higher dose (50 mg/day) in treating dengue-infected patients.
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Affiliation(s)
- Sajib Chakraborty
- Translational Systems Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Saruar Alam
- Translational Systems Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Mohammad Sayem
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Mousumi Sanyal
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Tonmoy Das
- Translational Systems Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Piyal Saha
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Mohammad Sayem
- Department of Medicine, Aichi Medical College, Dhaka, Bangladesh
| | | | | | - Ahmedul Kabir
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Md.Robed Amin
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - A.H.M. Nurun Nabi
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka 1000, Bangladesh
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Abstract
Introduction Dengue fever is endemic in more than 100 countries. Early indicators of prognosis are vital to reduce the fatality rate associated with dengue fever. The objective of this study is to investigate the value of a complete blood count (CBC) in determining the prognosis of dengue fever. Methodology This was a retrospective study of all patients admitted to Chigateri General and Bapuji hospitals, Davangere over two months. Fifty-six patients were included in the study. Medical records were accessed to obtain data on the clinical profile and laboratory investigations. Results Thrombocytopenia was the most common hematological feature, in 50 cases (~90%), followed by leukopenia in 43 cases (~76%). The duration of hospital stay ranged from two to seven days. Interestingly, the percentage of lymphocytes in the differential leukocyte count at the time of admission showed a significant negative correlation with the duration of hospital stay (p=0.028). Also, three distinct trends were observed in the sequence of recovery of platelets and white blood cells (WBCs). Discussion A repertoire of prognostic indicators have been described to predict the course and outcome of dengue fever: liver enzymes, interleukins 4 and 10, tumor necrosis factor α (TNFα), some proteases, soluble adhesion molecules, the surface area of atypical lymphocytes, high fluorescent lymphocyte counts, immature granulocytes and immature platelet factor (IPF). However, these markers are not routinely employed due to financial constraints and lack of infrastructure. The percentage of lymphocytes in the differential leukocyte count performed at the time of admission predicted the length of hospital stay. The higher the percentage of lymphocytes, the faster the recovery from dengue and shorter the duration of stay in the hospital. This is particularly important in remote areas with limited laboratory facilities. High-risk patients can be referred to a higher centre before they develop complications of the disease. Conclusion The complete blood count can function as an early indicator of prognosis in dengue fever even in areas where sophisticated biomedical infrastructure is lacking. The lymphocyte percentage on admission could significantly predict the length of hospital stay.
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Affiliation(s)
- Amogh Ananda Rao
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Raaju R U
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Siddharth Gosavi
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
| | - Sanjana Menon
- Internal Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davangere, IND
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Saroyo YB, Sungkar A, Irwinda R, Surya R. Case Series of Dengue Fever in Peripartum Period: Maternal and Foetal Outcome. Infect Dis Rep 2020; 12:51-60. [PMID: 33147733 PMCID: PMC7768497 DOI: 10.3390/idr12030013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Dengue fever is a major public health problem in tropical and subtropical areas. There are not many studies concerning the complications of dengue fever in pregnancy. We present four serial cases of dengue fever in pregnancy. Case illustration: Three of four cases were delivered by caesarean section; two of them died during post-caesarean care. All cases had the lowest platelet level below 50,000/µL and were given platelet transfusion during and after delivery; they also showed abnormal liver function tests. For foetal outcome, none tested positive for dengue. Discussion: Complication of dengue infection depends on a combination of host and viral virulence. Regardless of prophylactic platelet transfusion, some studies revealed clinical bleeding in patients with dengue infection due to an intricate effect on the haemostatic system. The adverse foetal outcome may contribute because of placental circulation caused by endothelial damage with increased vascular permeability leading to plasma leakage. There is no national guideline for dengue fever in pregnancy. Conclusions: The management of dengue fever in pregnancy at the tertiary hospital is still suboptimal. Dengue fever around peripartum presents a higher risk of morbidity and mortality for the mother and therefore needs a multidiscipline team approach.
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Li XK, Dai K, Yang ZD, Yuan C, Cui N, Zhang SF, Hu YY, Wang ZB, Miao D, Zhang PH, Li H, Zhang XA, Huang YQ, Chen WW, Zhang JS, Lu QB, Liu W. Correlation between thrombocytopenia and host response in severe fever with thrombocytopenia syndrome. PLoS Negl Trop Dis 2020; 14:e0008801. [PMID: 33119592 PMCID: PMC7595704 DOI: 10.1371/journal.pntd.0008801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus, SFTS virus (SFTSV), with fatal outcome developed in approximately 17% of the cases. Thrombocytopenia is a hallmark feature of SFTS, and associated with a higher risk of fatal outcome, however, the pathophysiological involvement of platelet in the clinical outcome of SFTS remained under-investigated. In the current study, by retrospectively analyzing 1538 confirmed SFTS patients, we observed that thrombocytopenia was associated with enhanced activation of the cytokine network and the vascular endothelium, also with a disturbed coagulation response. The platelet phenotypes were also extensively altered in the process of thrombocytopenia development of SFTS patients. More importantly, all these disturbed host responses were related to the severity of thrombocytopenia, thus were considered to play in a synergistic way to influence the disease outcome. Moreover, the clinical effect of platelet transfusion was assessed by comparing two groups of patients with or without receiving this therapy. As a result, we observed no therapy effect in altering frequencies of fatal outcome, clinical bleeding development, or dynamic change of platelet count during the hospitalization. It’s suggested that platelet supplementation alone acted a minor role in improving disease outcome, therefore new therapeutic intervention to regulate host response should be proposed. The current results revealed some evidence of interrelationship between platelet count and clinical outcome of SFTS disease from the perspective of activation of the cytokine network, the vascular endothelium, and the coagulation/fibrinolysis system. These evaluations might help to attain a better understanding of the pathogenesis and therapy choice in SFTS. Thrombocytopenia in SFTSV is a multifactor-process involving a combination of platelet size or morphology alterations, fibrinolysis activation and coagulation abnormalities, increased inflammatory response and endothelial injury. Platelet supplementation alone shows minor role in improving disease, therefore new therapeutic intervention to regulate host response should be proposed.
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Affiliation(s)
- Xiao-Kun Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Ke Dai
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Zhen-Dong Yang
- The 990 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Shihe District, Xinyang, P. R. China
| | - Chun Yuan
- The 990 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Shihe District, Xinyang, P. R. China
| | - Ning Cui
- The 990 Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Shihe District, Xinyang, P. R. China
| | - Shao-Fei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Yuan-Yuan Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Zhi-Bo Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Dong Miao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Yan-Qin Huang
- The Shangcheng Center for Disease Control and Prevention, Shangcheng County, Xinyang, P. R. China
| | - Wei-Wei Chen
- Treatment and Research Center for Infectious Diseases, the Fifth Medical Center of Chinese PLA General Hospital, Fengtai District, Beijing, P. R. China
| | - Jiu-Song Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Haidian District, Beijing, P. R. China
- * E-mail: (Q-BL); , (WL)
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
- Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing, People’s Republic of China
- * E-mail: (Q-BL); , (WL)
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Castilho BM, Silva MT, Freitas ARR, Fulone I, Lopes LC. Factors associated with thrombocytopenia in patients with dengue fever: a retrospective cohort study. BMJ Open 2020; 10:e035120. [PMID: 32928847 PMCID: PMC7488788 DOI: 10.1136/bmjopen-2019-035120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Some patients with dengue fever tend to develop thrombocytopenia during the course of infection and are thus vulnerable to haemorrhagic manifestations and other complications. However, the factors associated with the development of thrombocytopenia are unknown. We aimed to identify factors associated with an increased risk of thrombocytopenia and haematological changes in patients with confirmed dengue fever. DESIGN Retrospective cohort study. SETTING Brazilian multicentre primary care databases. PARTICIPANTS 387 patients had positive laboratory serological confirmation of dengue infection during 2014. The data were identified from two databases: Notification of Injury Information System (SINAN) and Municipal Laboratory. MAIN OUTCOME MEASURE The presence of thrombocytopenia (platelet count <1 50×109/L). The associations of factors that predisposed patients to thrombocytopenia and haematological changes were analysed using logistic regression. ORs and 95% CIs were calculated. RESULTS Among 387 patients, 156 had both dengue and thrombocytopenia. The risk factors associated with thrombocytopenia included male sex (OR: 1.77, 95% CI: 1.16 to 2.71, p=0.007), age of 46-64 years (OR: 2.20, 95% CI: 1.15 to 4.21, p=0.009) or ≥65 years (OR: 3.02, 95% CI: 1.40 to 6.50, p=0.002), presence of leucopenia (OR: 6.85, 95% CI: 4.27 to 10.99, p<0.001) and high mean corpuscular haemoglobin (MCH) levels (OR: 2.00, 95% CI: 1.29 to 3.12, p=0.005). CONCLUSION Older age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.
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Affiliation(s)
- Bruna M Castilho
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marcus T Silva
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
| | | | - Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba (UNISO), Sorocaba, São Paulo, Brazil
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71
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Sigamani S, Chinnasamy R, Dharmaraj RK, Ramamurthy D, Devarajan N, Narayanasamy M, Natarajan H. Larvicidal potency of the extracts from Chlorella sp. against Aedes aegypti. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2020. [DOI: 10.1016/j.bcab.2020.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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72
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Crocetin Improves Dengue Virus-Induced Liver Injury. Viruses 2020; 12:v12080825. [PMID: 32751420 PMCID: PMC7472398 DOI: 10.3390/v12080825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/11/2023] Open
Abstract
Dengue virus (DENV) infection is one of the most widespread mosquito-borne viral infections. Liver injury is commonly observed in severe DENV infection, and the present study aimed to examine the efficacy of crocetin treatment in an immunocompetent mouse model of DENV infection exhibiting liver injury. The efficacy of crocetin treatment in DENV-induced liver injury was assessed via both transaminase levels and histopathology analysis. A real-time polymerase chain reaction array was then used to describe the expression of 84 apoptosis-related genes. Using real-time RT-PCR and Western blot analysis, the gene expressions of host factors were investigated. Additionally, the effect of crocetin in NF-kB signaling during DENV infection was studied. We did not observe any significant reduction in virus production when DENV-infected mice were treated with crocetin. However, DENV-infected mice treated with crocetin showed reduced DENV-induced apoptosis. The real-time polymerase chain reaction array revealed pro-inflammatory cytokine expressions to be significantly reduced in the crocetin-treated DENV-infected mice. We also found that crocetin could effectively modulate antioxidant status in DENV-infected mice. Moreover, crocetin demonstrated the ability to reduce the nuclear translocation of NF-kB in DENV-infected mice. Our results suggest that crocetin treatment does not inhibit DENV replication in the liver of DENV-infected mice; however, we did find that crocetin improves host responses that reduce liver injury.
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73
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Imad HA, Phumratanaprapin W, Phonrat B, Chotivanich K, Charunwatthana P, Muangnoicharoen S, Khusmith S, Tantawichien T, Phadungsombat J, Nakayama E, Konishi E, Shioda T. Cytokine Expression in Dengue Fever and Dengue Hemorrhagic Fever Patients with Bleeding and Severe Hepatitis. Am J Trop Med Hyg 2020; 102:943-950. [PMID: 32124729 PMCID: PMC7204576 DOI: 10.4269/ajtmh.19-0487] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dengue is the most common mosquito-borne flaviviral infection in the world today. Several factors contribute and act synergistically to cause severe infection. One of these is dysregulated host immunological mediators that cause transient pathophysiology during infection. These mediators act on the endothelium to increase vascular permeability, which leads to plasma leakage compromising hemodynamics and coagulopathy. We conducted a prospective study to explore the expression of pro- and anti-inflammatory cytokines and how they relate to clinical dengue manifestations, by assessing their dynamics through acute dengue infection in adults admitted to the Hospital for Tropical Diseases, Bangkok, Thailand. We performed cytokine analysis at three phases of infection for 96 hospitalized adults together with serotyping of confirmed dengue infection during the outbreaks of 2015 and 2016. The serum concentrations of seven cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor alpha, and interferon gamma) were measured in duplicate using a commercial kit (Bio-Plex Human Cytokine Assay). In this study, the cytokine profile was suggestive of a T-helper 2 response. Most patients had secondary infection, and the levels of viremia were higher in patients with plasma leakage than those without plasma leakage. In addition, we observed that bleeding and hepatitis were associated with significantly higher levels of IL-8 during the early phases of infection. Furthermore, IL-6 levels in the early phase of infection were also elevated in bleeding patients with plasma leakage. These results suggest that IL-6 and IL-8 may act in synergy to cause bleeding in patients with plasma leakage.
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Affiliation(s)
- Hisham Ahmed Imad
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Benjaluck Phonrat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Prakaykaew Charunwatthana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sant Muangnoicharoen
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Srisin Khusmith
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Juthamas Phadungsombat
- Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Emi Nakayama
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.,Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Eiji Konishi
- BIKEN Endowed Department of Dengue Vaccine Development, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tatsuo Shioda
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.,Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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74
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Corticosteroid actions on dengue immune pathology; A review article. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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75
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Sathyapalan DT, Padmanabhan A, Moni M, P-Prabhu B, Prasanna P, Balachandran S, Trikkur SP, Jose S, Edathadathil F, Anilkumar JO, Jayaprasad R, Koramparambil G, Kamath RC, Menon V, Menon V. Efficacy & safety of Carica papaya leaf extract (CPLE) in severe thrombocytopenia (≤30,000/μl) in adult dengue - Results of a pilot study. PLoS One 2020; 15:e0228699. [PMID: 32074143 PMCID: PMC7029881 DOI: 10.1371/journal.pone.0228699] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/21/2020] [Indexed: 11/22/2022] Open
Abstract
Severe thrombocytopenia in dengue often prompts platelet transfusion primarily to reduce bleeding risk. In India, about 11–43% of dengue patients report receiving platelet transfusions which is considered scarce and expensive especially in resource limited settings. Herein, we evaluated the efficacy and safety of Carica papaya leaf extract (CPLE) in the management of severe thrombocytopenia (≤30,000/μL) in dengue infection. 51 laboratory confirmed adult dengue patients with platelet counts ≤30,000/μL were randomly assigned to either treatment (n = 26) or placebo (n = 24) group. By day 3, CPLE treated patients reported significantly (p = 0.007) increased platelet counts (482%± 284) compared to placebo (331%±370) group. In the treatment group, fewer patients received platelet transfusions (1/26 v/s 2/24) and their median time for platelets to recover to ≥ 50,000/μL was 2 days (IQR 2–3) compared to 3 days (IQR 2–4) in placebo. Overall, CPLE was safe and well tolerated with no significant decrease in mean hospitalization days. Plasma cytokine profiling revealed that by day 3, mean percent increase in TNFα and IFNγ levels in treatment group was less compared to that observed in placebos; (TNFα: 58.6% v/s 127.5%; p = 0.25 and IFNγ: 1.93% v/s 62.6% for; p = 0.12). While a mean percent increase in IL-6 levels occurred in placebos (15.92%±29.93%) by day 3, a decrease was noted in CPLE group (12.95%±21.75%; p = 0.0232). Inversely, CPLE treated patients reported a mean percent increase compared to placebo by day 3 (143% ±115.7% v/s 12.03%± 48.4%; p = 0.006). Further, by day 3, a faster clearance kinetics of viral NS1 antigenemia occurred–mean NS1 titers in treatment group decreased to 97.3% compared to 88% in placebos (p = 0.023). This study demonstrates safety and efficacy of CPLE in increasing platelet counts in severe thrombocytopenia in dengue infections. A possible immunomodulatory and antiviral activity may be attributed to CPLE treatment. These findings merit validation in larger prospective studies. Trial registration Name of the registry: Clinical Trials Registry—India (CTRI) Registration No.: CTRI-REF/2017/02/013314
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Affiliation(s)
- Dipu T. Sathyapalan
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Athira Padmanabhan
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Merlin Moni
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Binny P-Prabhu
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Preetha Prasanna
- Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sabarish Balachandran
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sreekrishnan P. Trikkur
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Soumya Jose
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Fabia Edathadathil
- Department of Allied Health Sciences, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jagan O. Anilkumar
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rekha Jayaprasad
- Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Ravindra C. Kamath
- Department of Integrated & Holistic Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Veena Menon
- Clinical Virology Laboratory, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vidya Menon
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- * E-mail:
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76
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Mubashir M, Ahmed KS, Mubashir H, Quddusi A, Farooq A, Ahmed SI, Jamil B, Qureshi R. Dengue and malaria infections in pregnancy : Maternal, fetal and neonatal outcomes at a tertiary care hospital. Wien Klin Wochenschr 2020; 132:188-196. [PMID: 31997066 PMCID: PMC7095108 DOI: 10.1007/s00508-019-01606-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
Background Malaria and dengue cause major morbidity in developing nations and are more severe in pregnancy. Maternal, fetal, and neonatal outcomes in pregnant patients infected with dengue or malaria were studied. Methods The medical records of pregnant women admitted with either dengue or malaria infections from 2011–2015 to this hospital were reviewed. Clinical outcomes and laboratory tests were examined. Results Of 85 women, 56%, 21%, and 22% had contracted dengue, malaria, and multiple infections, respectively. Pregnant women who had contracted dengue fever alone were more likely to present to the hospital at an earlier gestational age (24 weeks, p = 0.03). Women with multiple infections, were more likely to deliver earlier (30 weeks, p < 0.01). Women with malaria were more likely to have low birth weight deliveries (mean birth weight 2394 g, p = 0.03). The incidence of in-hospital deaths among the cohort was 7%. Conclusion It is imperative to develop guidelines to screen for and diagnose dengue and malaria in pregnancy. Electronic supplementary material The online version of this article (10.1007/s00508-019-01606-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Ayesha Farooq
- Aga Khan University Medical College, Karachi, Pakistan.
| | - Sheikh Irfan Ahmed
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Rahat Qureshi
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
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Dengue viruses infect human megakaryocytes, with probable clinical consequences. PLoS Negl Trop Dis 2019; 13:e0007837. [PMID: 31765380 PMCID: PMC6901235 DOI: 10.1371/journal.pntd.0007837] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/09/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022] Open
Abstract
One of the most important clinical signs of dengue virus infection is the reduction of white blood cells and platelets in human peripheral blood (leukopenia and thrombocytopenia, respectively), which may significantly impair the clearance of dengue virus by the immune system. The cause of thrombocytopenia and leukopenia during dengue infection is still unknown, but may be related to severe suppression of bone marrow populations including hematopoietic stem cells and megakaryocytes, the progenitors of white blood cells and platelets respectively. Here, we explored the possibility that bone marrow suppression, including ablation of megakaryocyte populations, is caused by dengue virus infection of megakaryocytes. We used three different models to measure dengue virus infection and replication: in vitro, in a human megakaryocyte cell line with viral receptors, ex vivo, in primary human megakaryocytes, and in vivo, in humanized mice. All three systems support dengue virus infection and replication, including virus strains from serotypes 1, 2, and 3, and clinical signs, in vivo; all assays showed viral RNA and/or infectious viruses 7–14 days post-infection. Although we saw no significant decrease in cell viability in vitro, there was significant depletion of mature megakaryocytes in vivo. We conclude that megakaryocytes can produce dengue viruses in the bone marrow niche, and a reduction of cell numbers may affect bone marrow homeostasis. Dengue virus is the most common cause of viral hemorrhagic fever in humans. Over half of the world’s population lives in an at risk area for dengue virus infection, and this number will continue to grow as climate change allows the mosquito vectors of dengue virus to expand their breeding ranges to more temperate climates. Currently, there are no specific treatments for dengue virus infection. Understanding how dengue virus causes hemorrhagic fever could inform the development of these much needed treatments. Populations of important immune system mediators, such as white blood cells and platelets, are significantly dysregulated during dengue virus infection. These cells originate in the bone marrow, which experiences significant suppression, including a complete ablation of megakaryocytes (platelet progenitor cells), during DENV infection. Here, we add to the knowledge on how dengue virus induces bone marrow suppression by investigating whether dengue virus infects human megakaryocytes. We discovered that dengue virus infects human megakaryocytes in vitro, ex vivo, and in vivo models of dengue virus infection; however, dengue virus infection does not appear to directly affect viability of human megakaryocytes. Future studies will investigate whether infected megakaryocytes are still able to perform their functions of producing platelets and maintaining bone marrow homeostasis.
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78
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Kao YS, Yu CY, Huang HJ, Tien SM, Wang WY, Yang M, Anderson R, Yeh TM, Lin YS, Wan SW. Combination of Modified NS1 and NS3 as a Novel Vaccine Strategy against Dengue Virus Infection. THE JOURNAL OF IMMUNOLOGY 2019; 203:1909-1917. [PMID: 31451673 DOI: 10.4049/jimmunol.1900136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/25/2019] [Indexed: 12/31/2022]
Abstract
Dengue virus (DENV) causes a range of illness, including dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. DENV nonstructural protein (NS) 1 has been considered to be a desirable vaccine candidate for its ability to induce Ab and complement-dependent cytolysis of DENV-infected cells as well as to block the pathogenic effects of NS1. However a potential drawback of NS1 as a vaccine is that anti-DENV NS1 Abs can lead to endothelial cell damage and platelet dysfunction by antigenic cross-reactivity. Therefore, we modified the DENV NS1 by replacing the C-terminal cross-reactive epitopes with the corresponding region of Japanese encephalitis virus NS1 to generate a chimeric DJ NS1 protein. Active immunization with DJ NS1 induced a strong Ab response. To enhance cellular immunity, we further combined DJ NS1 with DENV NS3 to immunize mice and showed activation of Ag-specific CD4+ and CD8+ T cells in addition to Ab responses. We further detected NS3-specific CTL activities as well as CD107a expression of effector cells. Importantly, the protective effects attributed by DJ NS1 and NS3 immunization were demonstrated in a DENV-infected mouse model by reduced viral titers, soluble NS1 levels, mouse tail bleeding time, and vascular leakage at skin injection sites. Collectively, the results from this study reveal the humoral and cellular immune responses and the protective effects conferred by DJ NS1 and NS3 immunization in the mouse model of DENV infection and provide a potential strategy for dengue vaccine design.
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Affiliation(s)
- Yu-San Kao
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chia-Yi Yu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan 701, Taiwan
| | - Hong-Jyun Huang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Sen-Mao Tien
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Wan-Yu Wang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Martyr Yang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Robert Anderson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada.,Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Trai-Ming Yeh
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.,Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; and
| | - Yee-Shin Lin
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; .,Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; and
| | - Shu-Wen Wan
- Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; and .,School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840, Taiwan
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Machado AAV, Negrão FJ, Croda J, de Medeiros ES, Pires MADS. Safety and costs of blood transfusion practices in dengue cases in Brazil. PLoS One 2019; 14:e0219287. [PMID: 31283788 PMCID: PMC6613682 DOI: 10.1371/journal.pone.0219287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce. Methods We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay. Results Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R2 = 0.334) of the hospitalisation time and 79.3% (R2 = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; β = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria). Conclusion Transfusion without following WHO recommendations increased the time and cost of hospitalisation.
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Affiliation(s)
| | - Fábio Juliano Negrão
- Health Sciences College, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- Universitary Hospital of Federal University of Grande Dourados, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- * E-mail: (FJN); (AAVM)
| | - Júlio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil
| | - Elias Silva de Medeiros
- Faculty of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Maria Aparecida dos Santos Pires
- Health Sciences College, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- Universitary Hospital of Federal University of Grande Dourados, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
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Chen H, Lin C, Fan Z, Yu W, Cao M, Ke C, Jiao X. Serum cytokines and clinical features in patients with fever and thrombocytopenia syndrome. Clin Chim Acta 2019; 494:22-30. [PMID: 30831067 PMCID: PMC7124278 DOI: 10.1016/j.cca.2019.02.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/11/2019] [Accepted: 02/28/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To explore the clinical, microbiological and immunological features of patients with fever and thrombocytopenia. METHODS Patients with unexplained fever and thrombocytopenia were enrolled. Viruses were detected using real-time PCR, and bacteria were measured by culturing methods. Serum cytokines, platelet antibody IgG (PA-IgG) and Helicobacter pylori (HP) were detected using ELISA. RESULTS Pathogens were detected in 74.68% of patients, which included single fungal/viral/bacterial infection and multiple infection. The pathogens could not be unidentified in 25.32% of cases. Cytokines including Interleukin (IL)-6, IL-10, interferon-γ(IFN-γ), platelet activating factor (PAF) and PA-IgG were significantly higher in patients as compared to healthy controls (P < .01 or P < .05). Principal component analyses extracted four groups of parameters that have a strong positive predicting value, revealing that disease status evaluation would be more accurate if we combined the platelet parameters and inflammatory biomarkers. While event-free survival (EFS) that indicates the time of platelet elevated after therapy was the highest in patients with single bacterial or fungal infection, EFS was affected by the levels of cytokines and PA-IgG. CONCLUSIONS Differences in immune function may be the main factors affecting the prognosis of patients with fever and thrombocytopenia, while treatment based on precise etiological diagnosis is important for therapeutic efficacy.
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Affiliation(s)
- Huanzhu Chen
- Cell Biology, Genetics Department, Shantou University Medical College, Shantou 515041, China; Department of Biochemistry, Medical College of Jiaying University, Meizhou 514031, China
| | - Chun Lin
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Zhiqiang Fan
- Cell Biology, Genetics Department, Shantou University Medical College, Shantou 515041, China
| | - Wenjun Yu
- Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Manxiong Cao
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Changwen Ke
- Cell Biology, Genetics Department, Shantou University Medical College, Shantou 515041, China
| | - Xiaoyang Jiao
- Cell Biology, Genetics Department, Shantou University Medical College, Shantou 515041, China.
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Antunes D, Marins-Dos-Santos A, Ramos MT, Mascarenhas BAS, Moreira CJDC, Farias-de-Oliveira DA, Savino W, Monteiro RQ, de Meis J. Oral Route Driven Acute Trypanosoma cruzi Infection Unravels an IL-6 Dependent Hemostatic Derangement. Front Immunol 2019; 10:1073. [PMID: 31139194 PMCID: PMC6527737 DOI: 10.3389/fimmu.2019.01073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/26/2019] [Indexed: 01/19/2023] Open
Abstract
Oral transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, is presently the most important route of infection in Brazilian Amazon. Other South American countries have also reported outbreaks of acute Chagas disease associated with food consumption. A conspicuous feature of this route of transmission is presenting symptoms such as facial and lower limbs edema, in some cases bleeding manifestations and risk of thromboembolism are evident. Notwithstanding, studies that address this route of infection are largely lacking regarding its pathogenesis and, more specifically, the crosstalk between immune and hemostatic systems. Here, BALB/c mice were orally infected with metacyclic trypomastigotes of T. cruzi Tulahuén strain and used to evaluate the cytokine response, primary and secondary hemostasis during acute T. cruzi infection. When compared with control uninfected animals, orally infected mice presented higher pro-inflammatory cytokine (TNF-α, IFN-γ, and IL-6) serum levels. The highest concentrations were obtained concomitantly to the increase of parasitemia, between 14 and 28 days post-infection (dpi). Blood counts in the oral infected group revealed concomitant leukocytosis and thrombocytopenia, the latter resulting in increased bleeding at 21 dpi. Hematological changes paralleled with prolonged activated partial thromboplastin time, Factor VIII consumption and increased D-dimer levels, suggest that oral T. cruzi infection relies on disseminated intravascular coagulation. Remarkably, blockade of the IL-6 receptor blunted hematological abnormalities, revealing a critical role of IL-6 in the course of oral infection. These results unravel that acute T. cruzi oral infection results in significant alterations in the hemostatic system and indicates the relevance of the crosstalk between inflammation and hemostasis in this parasitic disease.
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Affiliation(s)
- Dina Antunes
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alessandro Marins-Dos-Santos
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariana Tavares Ramos
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Barbara Angelica S Mascarenhas
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Désio Aurélio Farias-de-Oliveira
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Robson Q Monteiro
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana de Meis
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Clarice CSH, Abeysuriya V, de Mel S, Uvindu Thilakawardana B, de Mel P, de Mel C, Chandrasena L, Seneviratne SL, Yip C, Yap ES. Atypical lymphocyte count correlates with the severity of dengue infection. PLoS One 2019; 14:e0215061. [PMID: 31042724 PMCID: PMC6494037 DOI: 10.1371/journal.pone.0215061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/26/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The early identification of patients at risk of severe dengue infection (DI) is critical to guide clinical management. There is currently no validated laboratory test which can predict severe complications of DI. The Atypical lymphocyte count (ALC) is a research parameter generated at no extra cost when an automated Full Blood Count (FBC) is performed. The purpose of this study was to assess the association of ALC with the severity of DI. METHODS We prospectively collected data on patients admitted to Nawaloka Hospital Sri Lanka (NH) with DI between December 2016 and November 2017. DI was diagnosed based on a positive Non-structural antigen 1 (NS1) or dengue IgM antibody. ALC (absolute ALC and percentage) data were extracted from the Sysmex XS500i automated full blood count (FBC) analyzer (Sysmex Corporation Kobe, Japan). Clinical data was recorded from medical records and the computerized data base maintained by NH. RESULTS 530 patients were enrolled. Patients with clinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. Patients who presented with respiratory compromise had statistically significantly higher AL% compared to those without. (AL%; 8.65±12.09 vs 2.17±4.25 [p = 0.01]). Similarly, patients who developed hypotension had higher AL% compared to those who did not suffered from shock (AL%; 8.40±1.26 vs 2.18±4.25 [p = 0.001]). The AL% of dengue patients presenting with bleeding, at 4.07%, is also higher than those without bleeding complications, at 2.15%. There was a significant negative association between platelet count and AL% (p = 0.04). CONCLUSIONS Clinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. AL % at presentation may be predictive of severe DI and future larger prospective longitudinal studies should be done to determine if AL % on admission is predictive of the complications of DI.
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Affiliation(s)
- Choong Shi Hui Clarice
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore, Singapore
- * E-mail:
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
| | - Sanjay de Mel
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore, Singapore
| | - Basuru Uvindu Thilakawardana
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
| | - Primesh de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
| | - Chandima de Mel
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
| | - Lal Chandrasena
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
| | - Suranjith L. Seneviratne
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Dharmadasa Mawatha, Colombo, Sri Lanka
- Department of Surgery, University of Colombo, Colombo, Sri Lanka
- Institute of Immunity and Transplantation, Royal Free Hospital and University College London, London, United Kingdom
| | - Christina Yip
- Department of Laboratory Medicine, National University Health System Singapore, Singapore, Singapore
| | - Eng Soo Yap
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System Singapore, Singapore, Singapore
- Department of Laboratory Medicine, National University Health System Singapore, Singapore, Singapore
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Chao CH, Wu WC, Lai YC, Tsai PJ, Perng GC, Lin YS, Yeh TM. Dengue virus nonstructural protein 1 activates platelets via Toll-like receptor 4, leading to thrombocytopenia and hemorrhage. PLoS Pathog 2019; 15:e1007625. [PMID: 31009511 PMCID: PMC6497319 DOI: 10.1371/journal.ppat.1007625] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 05/02/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Dengue virus (DENV) infection, the most common mosquito-transmitted viral infection, can cause a range of diseases from self-limiting dengue fever to life-threatening dengue hemorrhagic fever and shock syndrome. Thrombocytopenia is a major characteristic observed in both mild and severe dengue disease and is significantly correlated with the progression of dengue severity. Previous studies have shown that DENV nonstructural protein 1 (NS1), which can be secreted into patients’ blood, can stimulate immune cells via Toll-like receptor 4 (TLR4) and can cause endothelial leakage. However, it is unclear whether DENV NS1 can directly induce platelet activation or cause thrombocytopenia during DENV infection. In this study, we first demonstrated that DENV but not Zika virus cell culture supernatant could induce P-selectin expression and phosphatidylserine (PS) exposure in human platelets, both of which were abolished when NS1 was depleted from the DENV supernatant. Similar results were found using recombinant NS1 from all four serotypes of DENV, and those effects were blocked in the presence of anti-NS1 F(ab’)2, anti-TLR4 antibody, a TLR4 antagonist (Rhodobacter sphaeroides lipopolysaccharide, LPS-Rs) and a TLR4 signaling inhibitor (TAK242), but not polymyxin B (an LPS inhibitor). Moreover, the activation of platelets by DENV NS1 promoted subthreshold concentrations of adenosine diphosphate (ADP)-induced platelet aggregation and enhanced platelet adhesion to endothelial cells and phagocytosis by macrophages. Finally, we demonstrated that DENV-induced thrombocytopenia and hemorrhage were attenuated in TLR4 knockout and wild-type mice when NS1 was depleted from DENV supernatant. Taken together, these results suggest that the binding of DENV NS1 to TLR4 on platelets can trigger its activation, which may contribute to thrombocytopenia and hemorrhage during dengue infection. Over the past 50 years, dengue has been a continuing global threat, with no effective vaccine or specific antiviral drug. Dengue infection causes a wide range of outcomes, from fever-like symptoms to severe dengue hemorrhagic fever. Thrombocytopenia, a reduction in platelet count, is a common feature observed in both mild and severe dengue and is correlated with disease severity. In this study, we used dengue viral supernatant or DENV recombinant NS1 protein to stimulate human-isolated platelets. We found that DENV NS1 could directly activate platelets through TLR4 and could further enhance platelet aggregation, adhesion to endothelial cells and phagocytosis by macrophages, which could lead to thrombocytopenia. We also proved that both NS1 and TLR4 are critical for DENV-induced thrombocytopenia and hemorrhage using a DENV-induced hemorrhagic mouse model. Our study reveals a new pathogenic role of NS1 during dengue infection and highlights that NS1 should be a topic of attention in the development of therapeutic drugs and vaccines against dengue infection.
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Affiliation(s)
- Chiao-Hsuan Chao
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chueh Wu
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Chung Lai
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Jane Tsai
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guey-Chuen Perng
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yee-Shin Lin
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Trai-Ming Yeh
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Roy S. Thrombopoietin Receptor Agonists: Can These Be the Future Answer to the Deadly Thrombocytopenia in Dengue Fever? Cureus 2019; 11:e4361. [PMID: 31192066 PMCID: PMC6550512 DOI: 10.7759/cureus.4361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.
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Affiliation(s)
- Sayak Roy
- Internal Medicine, Calcutta Medical Research Institute Hospital, Kolkata, IND
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85
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Sharma N, Mishra KP, Chanda S, Bhardwaj V, Tanwar H, Ganju L, Kumar B, Singh SB. Evaluation of anti-dengue activity of Carica papaya aqueous leaf extract and its role in platelet augmentation. Arch Virol 2019; 164:1095-1110. [PMID: 30790105 DOI: 10.1007/s00705-019-04179-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 01/17/2019] [Indexed: 12/16/2022]
Abstract
Dengue disease is characterized by a marked decrease in platelet count, which is life threatening. In the present study, we investigated the antiviral activity of an aqueous extract of Carica papaya leaves (PLE) against dengue virus (DENV) and its effect on platelet augmentation. The anti-dengue activity of PLE in DENV-infected THP-1 cells was examined by immunoblotting and flow cytometry. The effect of PLE on erythrocyte damage was investigated using hemolytic and anti-hemolytic assays. Virus-infected THP-1 cells were assayed for IFN-α secretion. The effect of PLE on platelet augmentation in rats with cyclophosphamide-induced thrombocytopenia was also investigated. The platelet count of blood from the retro-orbital plexus of rats was determined on the 1st, 4th, 7th, 11th and 14th day of study. On the 14th day, the rats were sacrificed for histopathological examination of the liver, kidney and spleen. Plasma of thrombocytopenic rats was tested for thrombopoietin (TPO) and IL-6 secretion. The data suggest that PLE significantly decreases the expression of the envelope and NS1 proteins in DENV-infected THP-1 cells. A marked decrease in intracellular viral load upon PLE treatment confirmed its antiviral activity. This also resulted in a significant decrease in erythrocyte damage and hydrogen-peroxide-induced lipid peroxidation. A significant increase in the number of platelets was found in thrombocytopenic rats treated with PLE, along with an increase in IL-6 and TPO levels. These findings suggest that PLE can potentially be used as an antiviral agent, as it helps in platelet augmentation and exhibits antiviral activity against DENV.
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Affiliation(s)
- Navita Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Kamla Prasad Mishra
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India. .,O/o Director General (Life Sciences), Defence Research and Development Organization, New Delhi, 110011, India.
| | - Sudipta Chanda
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Varun Bhardwaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Himanshi Tanwar
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Lilly Ganju
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
| | - Shashi Bala Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, New Delhi, Delhi, 110054, India
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Van Dyne EA, Neaterour P, Rivera A, Bello-Pagan M, Adams L, Munoz-Jordan J, Baez P, Garcia M, Waterman SH, Reyes N, Richardson LC, Rivera-Garcia B, Sharp TM. Incidence and Outcome of Severe and Nonsevere Thrombocytopenia Associated With Zika Virus Infection-Puerto Rico, 2016. Open Forum Infect Dis 2018; 6:ofy325. [PMID: 30631791 DOI: 10.1093/ofid/ofy325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background Zika virus (ZIKV) infection has been associated with severe thrombocytopenia. We describe the incidence, clinical manifestations, and outcomes of patients with ZIKV infection and thrombocytopenia. Methods We reviewed medical records of patients with ZIKV infection and thrombocytopenia (platelet count <100 ×109 cells/L) in Puerto Rico during 2016. Severe thrombocytopenia was defined by platelet count <20 ×109/L or a platelet count <50 ×109/L and treatment for immune thrombocytopenia (ITP). Results Of 37 878 patients with ZIKV infection, 47 (0.1%) had thrombocytopenia in the absence of an alternative etiology (1.4 cases/100 000 population), including 12 with severe thrombocytopenia. Most patients with thrombocytopenia were adult (77%) and male (53%). Platelet nadir occurred a median (range) of 6 (1-16) and 5 (0-34) days after symptom onset for patients with severe and nonsevere thrombocytopenia, respectively. Among patients with severe thrombocytopenia, all had bleeding, 33% were admitted to the intensive care unit, and 8% died; 50% were treated for ITP. Among 5 patients with severe thrombocytopenia who received intravenous immunoglobulin, the median platelet count increase (range) was 112 (65-202) ×109/L. In contrast, among 4 patients who received platelet transfusion, the median increase in platelet count (range) was 8.5 (-6 to 52) ×109/L. Conclusions Patients with severe thrombocytopenia and ZIKV infection experienced prominent acute morbidity. Consistent with recommended management, administration of ITP treatments to such patients may be more efficacious than platelet transfusion in resolving thrombocytopenia. Severe thrombocytopenia should be considered a rare outcome of ZIKV infection.
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Affiliation(s)
- Elizabeth A Van Dyne
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,United States Public Health Service, Silver Springs, Maryland
| | - Paige Neaterour
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Laura Adams
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jorge Munoz-Jordan
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Myriam Garcia
- Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Stephen H Waterman
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tyler M Sharp
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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87
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88
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Development of standard clinical endpoints for use in dengue interventional trials. PLoS Negl Trop Dis 2018; 12:e0006497. [PMID: 30286085 PMCID: PMC6171842 DOI: 10.1371/journal.pntd.0006497] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective and at present, early recognition of severe dengue and timely supportive care are used to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding widespread deployment of vaccines and/or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers and public health specialists to develop standardized endpoints and work towards consensus opinion on those endpoints. After discussion at two working group meetings and presentations at international conferences, a Delphi methodology-based query was used to finalize and operationalize the clinical endpoints. Participants were asked to select the best endpoints from proposed definitions or offer revised/new definitions, and to indicate whether contributing items should be designated as optional or required. After the third round of inquiry, 70% or greater agreement was reached on moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. There was less agreement regarding moderate and severe thrombocytopenia and moderate and severe myocarditis. Notably, 68% of participants agreed that a 50,000 to 20,000 mm3 platelet range be used to define moderate thrombocytopenia; however, they remained divided on whether a rapid decreasing trend or one platelet count should be case defining. While at least 70% agreement was reached on most endpoints, the process identified areas for further evaluation and standardization within the context of ongoing clinical studies. These endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials. Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective, and early recognition of severe dengue and timely supportive care remain the only means to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding deployment of such vaccines or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers, vaccine developers, and public health specialists to develop endpoints. After two working group meetings and discussions at international meetings, the Delphi methodology was used to clarify and further develop endpoints such that 70% or greater agreement was reached on most endpoint definitions including moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. The process identified areas for further evaluation and standardization within the context of ongoing clinical studies. The endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials.
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Melo CFOR, Delafiori J, Dabaja MZ, de Oliveira DN, Guerreiro TM, Colombo TE, Nogueira ML, Proenca-Modena JL, Catharino RR. The role of lipids in the inception, maintenance and complications of dengue virus infection. Sci Rep 2018; 8:11826. [PMID: 30087415 PMCID: PMC6081433 DOI: 10.1038/s41598-018-30385-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022] Open
Abstract
Dengue fever is a viral condition that has become a recurrent issue for public health in tropical countries, common endemic areas. Although viral structure and composition have been widely studied, the infection phenotype in terms of small molecules remains poorly established. This contribution providing a comprehensive overview of the metabolic implications of the virus-host interaction using a lipidomic-based approach through direct-infusion high-resolution mass spectrometry. Our results provide further evidence that lipids are part of both the immune response upon Dengue virus infection and viral infection maintenance mechanism in the organism. Furthermore, the species described herein provide evidence that such lipids may be part of the mechanism that leads to blood-related complications such as hemorrhagic fever, the severe form of the disease.
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Affiliation(s)
| | - Jeany Delafiori
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Mohamad Ziad Dabaja
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Diogo Noin de Oliveira
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Tatiane Melina Guerreiro
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Tatiana Elias Colombo
- School of Medicine from São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | | | - Jose Luiz Proenca-Modena
- Laboratory of Study of Emerging Viruses (LEVE), Department of Genetic, Evolution and Bioagents, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Rodrigo Ramos Catharino
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil.
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da Silva DS, Teixeira LAC, Beghini DG, Ferreira ATDS, Pinho MDBM, Rosa PS, Ribeiro MR, Freire MDC, Hacker MA, Nery JADC, Pessolani MCV, Tovar AMF, Sarno EN, Perales J, Bozza FA, Esquenazi D, Monteiro RQ, Lara FA. Blood coagulation abnormalities in multibacillary leprosy patients. PLoS Negl Trop Dis 2018; 12:e0006214. [PMID: 29565968 PMCID: PMC5863944 DOI: 10.1371/journal.pntd.0006214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/05/2018] [Indexed: 12/27/2022] Open
Abstract
Background Leprosy is a chronic dermato-neurological disease caused by Mycobacterium leprae infection. In 2016, more than 200,000 new cases of leprosy were detected around the world, representing the most frequent cause of infectious irreversible deformities and disabilities. Principal findings In the present work, we demonstrate a consistent procoagulant profile on 40 reactional and non-reactional multibacillary leprosy patients. A retrospective analysis in search of signs of coagulation abnormalities among 638 leprosy patients identified 35 leprosy patients (5.48%) which displayed a characteristic lipid-like clot formed between blood clot and serum during serum harvesting, herein named ‘leprosum clot’. Most of these patients (n = 16, 45.7%) belonged to the lepromatous leprosy pole of the disease. In addition, formation of the leprosum clot was directly correlated with increased plasma levels of soluble tissue factor and von Willebrand factor. High performance thin layer chromatography demonstrated a high content of neutral lipids in the leprosum clot, and proteomic analysis demonstrated that the leprosum clot presented in these patients is highly enriched in fibrin. Remarkably, differential 2D-proteomics analysis between leprosum clots and control clots identified two proteins present only in leprosy patients clots: complement component 3 and 4 and inter-alpha-trypsin inhibitor family heavy chain-related protein (IHRP). In agreement with those observations we demonstrated that M. leprae induces hepatocytes release of IHRP in vitro. Conclusions We demonstrated that leprosy MB patients develop a procoagulant status due to high levels of plasmatic fibrinogen, anti-cardiolipin antibodies, von Willebrand factor and soluble tissue factor. We propose that some of these components, fibrinogen for example, presents potential as predictive biomarkers of leprosy reactions, generating tools for earlier diagnosis and treatment of these events. Hemostatic illnesses are frequently associated with acute and chronic infections. In the present work we demonstrated that leprosy patients developed hemostatic abnormalities, like the formation of an atypical lipid clot mass during sera harvesting, a phenomenon previously observed and never unraveled. We characterize the nature of the “leprosum clot”, formed during a protrombotic state developed by some patients. During the proteomic analysis of the leprosum clot we discovered a set of potential serum biomarkers to leprosy reactional episodes diagnosis, which at this moment is based only in clinical features. Taking together, our data suggest that leprosy patients are suffering from a procoagulant status, being beneficiated by the introduction of routine coagulation tests during their treatment, which will aloud physicians to prevent some of the acute clinical symptoms related with superficial vein thrombosis such as cyanosis and tissue necrosis observed during severe cases of leprosy reactional episodes.
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Affiliation(s)
- Débora Santos da Silva
- Lab. of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Daniela Gois Beghini
- Lab. of Toxinology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Mariana Andrea Hacker
- Lab. of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Ana Maria Freire Tovar
- Lab. of Conjunctive Tissue, Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Lab. of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jonas Perales
- Lab. of Toxinology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Fernando Augusto Bozza
- Department of Critical Care, National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danuza Esquenazi
- Lab. of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Robson Queiroz Monteiro
- Lab. of Hemostasis and Poisons, Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Alves Lara
- Lab. of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- * E-mail:
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91
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Rajapakse S, de Silva NL, Weeratunga P, Rodrigo C, Fernando SD. Prophylactic and therapeutic interventions for bleeding in dengue: a systematic review. Trans R Soc Trop Med Hyg 2018; 111:433-439. [DOI: 10.1093/trstmh/trx079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/19/2017] [Indexed: 11/13/2022] Open
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92
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Tatsumi K, Antoniak S, Subramaniam S, Gondouin B, Neidich SD, Beck MA, Mickelson J, Monroe DM, Bastarache JA, Mackman N. Anticoagulation increases alveolar hemorrhage in mice infected with influenza A. Physiol Rep 2017; 4:4/24/e13071. [PMID: 28003564 PMCID: PMC5210384 DOI: 10.14814/phy2.13071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
Influenza A virus infection is a common respiratory tract infection. Alveolar hemorrhage has been reported in patients with influenza pneumonia and in mice infected with influenza A. In this study, we investigated the effect of two anticoagulants on alveolar hemorrhage after influenza A virus (IAV) infection of wild‐type mice. Wild‐type mice were anticoagulated with either warfarin or the direct thrombin inhibitor dabigatran etexilate and then infected with a mouse‐adapted influenza virus (A/Puerto Rico/8/34 H1N1). Alveolar hemorrhage was assessed by measuring hemoglobin levels in the bronchoalveolar lavage fluid (BALF). We also measured vascular permeability and viral genomes in the lung, as well as white blood cells, inflammatory mediators, and protein in BALF. Survival and body weight were monitored for 14 days after influenza A infection. In infected mice receiving either warfarin or dabigatran etexilate we observed decreased activation of coagulation in the BALF and increased alveolar hemorrhage. Warfarin but not dabigatran etexilate increased vascular permeability and mortality of influenza A‐infected mice. Anticoagulation did not affect levels of influenza A genomes, white blood cells, inflammatory mediators, or protein in the BALF. Our study indicates that systemic anticoagulation increases alveolar hemorrhage in influenza A‐infected mice.
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Affiliation(s)
- Kohei Tatsumi
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Silvio Antoniak
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Saravanan Subramaniam
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bertrand Gondouin
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott D Neidich
- Department of Nutrition, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melinda A Beck
- Department of Nutrition, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jacqueline Mickelson
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dougald M Monroe
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julie A Bastarache
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nigel Mackman
- Department of Medicine, Division of Hematology and Oncology, UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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93
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Pandey AD, Goswami S, Shukla S, Das S, Ghosal S, Pal M, Bandyopadhyay B, Ramachandran V, Basu N, Sood V, Pandey P, Chakrabarti J, Vrati S, Banerjee A. Correlation of altered expression of a long non-coding RNA, NEAT1, in peripheral blood mononuclear cells with dengue disease progression. J Infect 2017; 75:541-554. [PMID: 29031635 DOI: 10.1016/j.jinf.2017.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 02/01/2023]
Abstract
The association of long non-coding RNAs (lncRNAs) with dengue disease progression is currently unknown. Therefore, the present study aimed to identify lncRNAs in different categories of dengue patients and evaluate their association with dengue disease progression. Herein, we examined the expression profiles of lncRNAs and protein-coding genes between other febrile illness (OFI) and different grade of dengue patients through high-throughput RNA sequencing. We identified Nuclear Enriched Abundant Transcript 1 (NEAT1) as one of the differentially expressed lncRNAs (adjusted P ≤ 0.05 and log-fold change ≥ 2) and subsequently validated the expression by qRT-PCR. The co-expression analysis further revealed that NEAT1 and the coding gene IFI27 were highly co-expressed and negatively correlated with dengue severity. Using regression analysis, we observed that NEAT1 expression was significantly dependent on disease progression (Coefficient = -0.27750, SE Coefficient = 0.07145, and t = -3.88).Further, receiver operating characteristic (ROC) curve revealed that NEAT1 expression could discriminate DI from DS (sensitivity and specificity of 100% (95%CI: 85.69 - 97.22) and area under the curve (AUC) = 0.97). Overall, the results of this study offer the first experimental evidence demonstrating the correlation between lncRNAs and severe dengue phenotype. Monitoring NEAT1and IFI27 expression in PBMC may be useful in understanding dengue virus-induced disease progression.
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Affiliation(s)
- Abhay Deep Pandey
- Vaccine and Infectious Disease Research Center (VIDRC), Translational Health Science and Technology Institute (THSTI), Faridabad 121001, India
| | - Saptamita Goswami
- Calcutta School of Tropical Medicine (STM), Kolkata, West Bengal 700073, India
| | - Shweta Shukla
- University College of Medical Sciences (UCMS) & Guru Teg Bahadur (GTB) Hospital, Delhi 110095, India
| | - Shaoli Das
- Indian Association for the Cultivation of Science, Jadavpur, Kolkata, India
| | - Suman Ghosal
- Indian Association for the Cultivation of Science, Jadavpur, Kolkata, India
| | - Manisha Pal
- Department of Statistics, Calcutta University, Kolkata 700019, India
| | | | | | - Nandita Basu
- Calcutta School of Tropical Medicine (STM), Kolkata, West Bengal 700073, India
| | - Vikas Sood
- Vaccine and Infectious Disease Research Center (VIDRC), Translational Health Science and Technology Institute (THSTI), Faridabad 121001, India
| | - Priyanka Pandey
- National Institute of Biomedical Genomics (NIBMG), Kalyani, West Bengal 741251, India
| | | | - Sudhanshu Vrati
- Vaccine and Infectious Disease Research Center (VIDRC), Translational Health Science and Technology Institute (THSTI), Faridabad 121001, India; Regional Center for Biotechnology (RCB), Faridabad, India
| | - Arup Banerjee
- Vaccine and Infectious Disease Research Center (VIDRC), Translational Health Science and Technology Institute (THSTI), Faridabad 121001, India.
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94
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Affiliation(s)
- Stacy C Goldthorpe
- a Foundational Sciences , Central Michigan University College of Medicine , Mount Pleasant , MI , USA
| | - Michael J Conway
- a Foundational Sciences , Central Michigan University College of Medicine , Mount Pleasant , MI , USA
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95
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Soo KM, Khalid B, Ching SM, Tham CL, Basir R, Chee HY. Meta-analysis of biomarkers for severe dengue infections. PeerJ 2017; 5:e3589. [PMID: 28929009 PMCID: PMC5602679 DOI: 10.7717/peerj.3589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/26/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dengue viral infection is an acute infection that has the potential to have severe complications as its major sequela. Currently, there is no routine laboratory biomarker with which to predict the severity of dengue infection or monitor the effectiveness of standard management. Hence, this meta-analysis compared biomarker levels between dengue fever (DF) and severe dengue infections (SDI) to identify potential biomarkers for SDI. METHODS Data concerning levels of cytokines, chemokines, and other potential biomarkers of DF, dengue hemorrhagic fever, dengue shock syndrome, and severe dengue were obtained for patients of all ages and populations using the Scopus, PubMed, and Ovid search engines. The keywords "(IL1* or IL-1*) AND (dengue*)" were used and the same process was repeated for other potential biomarkers, according to Medical Subject Headings terms suggested by PubMed and Ovid. Meta-analysis of the mean difference in plasma or serum level of biomarkers between DF and SDI patients was performed, separated by different periods of time (days) since fever onset. Subgroup analyses comparing biomarker levels of healthy plasma and sera controls, biomarker levels of primary and secondary infection samples were also performed, as well as analyses of different levels of severity and biomarker levels upon infection by different dengue serotypes. RESULTS Fifty-six studies of 53 biomarkers from 3,739 dengue cases (2,021 DF and 1,728 SDI) were included in this meta-analysis. Results showed that RANTES, IL-7, IL-8, IL-10, IL-18, TGF-b, and VEGFR2 levels were significantly different between DF and SDI. IL-8, IL-10, and IL-18 levels increased during SDI (95% CI, 18.1-253.2 pg/mL, 3-13 studies, n = 177-1,909, I2 = 98.86%-99.75%). In contrast, RANTES, IL-7, TGF-b, and VEGFR2 showed a decrease in levels during SDI (95% CI, -3238.7 to -3.2 pg/mL, 1-3 studies, n = 95-418, I2 = 97.59%-99.99%). Levels of these biomarkers were also found to correlate with the severity of the dengue infection, in comparison to healthy controls. Furthermore, the results showed that IL-7, IL-8, IL-10, TGF-b, and VEGFR2 display peak differences between DF and SDI during or before the critical phase (day 4-5) of SDI. DISCUSSION This meta-analysis suggests that IL-7, IL-8, IL-10, TGF-b, and VEGFR2 may be used as potential early laboratory biomarkers in the diagnosis of SDI. This can be used to predict the severity of dengue infection and to monitor the effectiveness of treatment. Nevertheless, methodological and reporting limitations must be overcome in future research to minimize variables that affect the results and to confirm the findings.
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Affiliation(s)
- Kuan-Meng Soo
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Bahariah Khalid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siew-Mooi Ching
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chau Ling Tham
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rusliza Basir
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hui-Yee Chee
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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96
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Nelwan EJ, Angelina F, Adiwinata R, Matondang S, Andriono P. Spontaneous rectus sheath hematomas in dengue hemorrhagic fever: A case report. IDCases 2017; 10:35-37. [PMID: 28856103 PMCID: PMC5568873 DOI: 10.1016/j.idcr.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 11/26/2022] Open
Abstract
Muscle hematomas are rare complications in dengue hemorrhagic fever (DHF). We report a case of 58-year-old-female admitted with dengue fever who developed spontaneous rectus sheath hematoma complicating DHF. She presented with progressive thrombocytopenia with platelet count reaching 13000/μL at its lowest point. There was evidence of plasma leakage and persistent cough during the course of illness. During the recovery phase, she reported severe abdominal pain and developed hematoma in the right rectus sheath, which was confirmed by abdominal computed-tomography scan and serial magnetic resonance imaging. This complication during convalescent period of DHF needs to be recognized so it can be managed appropriately.
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Affiliation(s)
- Erni Juwita Nelwan
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Diponegoro Street Number 71, Jakarta, 10430, Indonesia.,Abdi Waluyo Hospital, HOS Cokroaminoto Street number 31-33, Jakarta, Indonesia
| | - Frida Angelina
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Diponegoro Street Number 71, Jakarta, 10430, Indonesia
| | - Randy Adiwinata
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Diponegoro Street Number 71, Jakarta, 10430, Indonesia.,Abdi Waluyo Hospital, HOS Cokroaminoto Street number 31-33, Jakarta, Indonesia
| | - Sahat Matondang
- Department of Radiology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Diponegoro Street Number 71, Jakarta, 10430, Indonesia
| | - Prasetyo Andriono
- Abdi Waluyo Hospital, HOS Cokroaminoto Street number 31-33, Jakarta, Indonesia
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97
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Affiliation(s)
- Mobeen H Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), 910 North Jefferson Street, Jacksonville, FL 32209, USA; Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA.
| | - Jonathan Runyon
- Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Tanveer-Ul Haque
- Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA
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98
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Lin GL, Chang HH, Lien TS, Chen PK, Chan H, Su MT, Liao CY, Sun DS. Suppressive effect of dengue virus envelope protein domain III on megakaryopoiesis. Virulence 2017. [PMID: 28622093 DOI: 10.1080/21505594.2017.1343769] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dengue virus (DENV) infection can cause severe, life-threatening events, and no specific treatments of DENV infection are currently approved. Although thrombocytopenia is frequently observed in dengue patients, its pathogenesis is still not fully understood. Previous studies have suggested that DENV-induced thrombocytopenia occurs through viral-replication-mediated megakaryopoiesis inhibition in the bone marrow; however, the exact mechanism for megakaryopoiesis suppression remains elusive. In this study, a reductionist approach was applied, in which C57B/6J mice were inoculated with recombinant DENV-envelope protein domain III (DENV-EIII) instead of the full viral particle. Our results demonstrated that DENV-EIII-suppressed megakaryopoiesis is similar to those observed with DENV infection. Furthermore, in agreement with our in vivo analyses, DENV-EIII sufficiently suppressed the megakaryopoiesis of progenitor cells from murine bone marrow and human cord blood in vitro. Additional analyses suggested that autophagy impairment and apoptosis are involved in DENV-EIII-mediated suppression of megakaryopoiesis. These data suggest that, even without viral replication, the binding of DENV-EIII to the cell surface is sufficient to suppress megakaryopoiesis.
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Affiliation(s)
- Guan-Ling Lin
- a Institute of Medical Sciences, Tzu-Chi University , Hualien , Taiwan
| | - Hsin-Hou Chang
- a Institute of Medical Sciences, Tzu-Chi University , Hualien , Taiwan.,b Department of Molecular Biology and Human Genetics , Tzu-Chi University , Hualien , Taiwan
| | - Te-Sheng Lien
- b Department of Molecular Biology and Human Genetics , Tzu-Chi University , Hualien , Taiwan
| | - Po-Kong Chen
- a Institute of Medical Sciences, Tzu-Chi University , Hualien , Taiwan
| | - Hao Chan
- a Institute of Medical Sciences, Tzu-Chi University , Hualien , Taiwan
| | - Mei-Tzu Su
- b Department of Molecular Biology and Human Genetics , Tzu-Chi University , Hualien , Taiwan
| | - Chi-Yuan Liao
- c Department of Obstetrics and Gynecology , Mennonite Christian Hospital , Hualien , Taiwan
| | - Der-Shan Sun
- a Institute of Medical Sciences, Tzu-Chi University , Hualien , Taiwan.,b Department of Molecular Biology and Human Genetics , Tzu-Chi University , Hualien , Taiwan
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99
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Suwarto S, Sasmono RT, Sinto R, Ibrahim E, Suryamin M. Association of Endothelial Glycocalyx and Tight and Adherens Junctions With Severity of Plasma Leakage in Dengue Infection. J Infect Dis 2017; 215:992-999. [PMID: 28453844 PMCID: PMC5407050 DOI: 10.1093/infdis/jix041] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/18/2017] [Indexed: 12/21/2022] Open
Abstract
Background. The role of vascular endothelial (VE) components in dengue infection with plasma leakage is unknown. Therefore, we conducted a study to determine the adjusted association of the endothelial glycocalyx layer (EGL) and tight and adherens junction markers with plasma leakage. Methods. A prospective observational study was conducted at Cipto Mangunkusumo Hospital and Persahabatan Hospital, Jakarta, Indonesia. Adult dengue patients admitted to the hospital on the third day of fever from November 2013 through August 2015 were included in the study. Multiple regression analysis was used to determine the adjusted association of the VE biomarkers with the severity of the plasma leakage. Results. A total of 103 dengue-infected patients participated in the study. In the critical phase, levels of syndecan-1 (odds ratio [OR] = 1.004; 95% confidence interval [CI] = 1.001–1.007) and chondroitin sulfate (OR = 1.157; 95% CI = 1.025–1.307) had an adjusted association with plasma leakage, whereas levels of syndecan-1 (OR = 1.004; 95% CI = 1.000–1.008) and claudin-5 (OR = 1.038; 95% CI = 1.004–1.074) had an adjusted association with severe plasma leakage. Conclusions. In dengue-infected patients, elevated levels of syndecan-1 and chondroitin sulfate are strongly associated with plasma leakage, and elevated levels of syndecan-1 and claudin-5 are strongly associated with severe plasma leakage.
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Affiliation(s)
- Suhendro Suwarto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | | | - Robert Sinto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Eppy Ibrahim
- Department of Internal Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Maulana Suryamin
- Department of Internal Medicine, Persahabatan Hospital, Jakarta, Indonesia
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100
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Kuo HJ, Lee IK, Liu JW. Analyses of clinical and laboratory characteristics of dengue adults at their hospital presentations based on the World Health Organization clinical-phase framework: Emphasizing risk of severe dengue in the elderly. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:740-748. [PMID: 28734676 DOI: 10.1016/j.jmii.2016.08.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/PURPOSE Dengue clinically dynamically changes over time; the World Health Organization (WHO) dengue classification framework proposed 3 dengue clinical phases-febrile (days 1-3), critical (days 4-6) and recovery (days ≥7) phases. This study aimed to better understand clinical and laboratory characteristics in adults (≥18 years) suffering dengue in different clinical phases at their hospital presentations. METHODS A retrospective analysis of adults suffering dengue between 2008 and 2014. RESULTS Of the 669 included dengue adults, 146 (21.8%) were elderly (≥65 years), and 27 (4%) suffered severe dengue. When compared with those in febrile phase, significantly higher incidence of ascites, mucosal bleeding, and/or gastrointestinal bleeding; lower white blood cell (WBC) and platelet counts; higher hematocrit, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were found in critical phase. When compared with their younger counterparts, elderly at febrile phase had significantly lower frequencies of bone pain, myalgia, headache and rash; higher frequencies of vomiting, pleural effusion and mucosal bleeding; higher WBC count, AST and ALT levels, and lower platelet count; in critical phase, elderly had significantly higher frequencies of pleural effusion, mucosal bleeding and gum bleeding. Four (0.6%) patients experienced severe dengue in recovery phase. Significantly higher proportions of elderly developed severe dengue in both febrile and critical phases as compared with younger adults. CONCLUSIONS Elderly had lower frequency of classical dengue symptoms, yet were at higher risk of development of severe dengue during their early dengue course. A small number of patients developed severe dengue at the WHO-proposed recovery phase.
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Affiliation(s)
- Hong-Jie Kuo
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ing-Kit Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Jien-Wei Liu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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