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Xiao J, Wang J, Zhang Y, Sun D, Lu H, Han Z, Song Y, Yan D, Zhu S, Pei Y, Xu W, Wang X. Coxsackievirus B4: an underestimated pathogen associated with a hand, foot, and mouth disease outbreak. Arch Virol 2021; 166:2225-2234. [PMID: 34091782 DOI: 10.1007/s00705-021-05128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/17/2021] [Indexed: 02/02/2023]
Abstract
In order to discover the causes of a coxsackievirus B4 (CV-B4)-associated hand, foot, and mouth disease (HFMD) outbreak and to study the evolutionary characteristics of the virus, we sequenced isolates obtained during an outbreak for comparative analysis with previously sequenced strains. Phylogenetic and evolutionary dynamics analysis was performed to examine the genetic characteristics of CV-B4 in China and worldwide. Phylogenetic analysis showed that CV-B4 originated from a common ancestor in Shandong. CV-B4 strains isolated worldwide could be classified into genotypes A-E based on the sequence of the VP1 region. All CV-B4 strains in China belonged to genotype E. The global population diversity of CV-B4 fluctuated substantially over time, and CV-B4 isolated in China accounted for a significant increase in the diversity of CV-B4. The average nucleotide substitution rate in VP1 of Chinese CV-B4 (5.20 × 10-3 substitutions/site/year) was slightly higher than that of global CV-B4 (4.82 × 10-3 substitutions/site/year). This study is the first to investigate the evolutionary dynamics of CV-B4 and its association with an HFMD outbreak. These findings explain both the 2011 outbreak and the global increase in CV-B4 diversity. In addition to improving our understanding of a major outbreak, these findings provide a basis for the development of surveillance strategies.
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Affiliation(s)
- Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Jianxing Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China. .,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, People's Republic of China.
| | - Dapeng Sun
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Huanhuan Lu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Yang Song
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China
| | - Yaowen Pei
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis, National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China.
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Xu T, Li Y, Wu HL, Chen H, Wu H, Guo M, Zhao M, Wang C, Lin T, Lin Z, Chen D, Xiang W, Zhu B. The inhibition of enterovirus 71 induced apoptosis by Durvillaea antarctica through P53 and STAT1 signaling pathway. J Med Virol 2021; 93:3532-3538. [PMID: 33230830 DOI: 10.1002/jmv.26693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Abstract
The infection of enterovirus 71 (EV71) resulted in hand, foot, and mouth disease and may lead to severe nervous system damage and even fatalities. There are no effective drugs to treat the EV71 virus and it is crucial to find novel drugs against it. Polysaccharide isolated from Durvillaea antarctica green algae has an antiviral effect. In this study, D. antarctica polysaccharide (DAPP) inhibited the infection of EV71 was demonstrated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), reverse transcription polymerase chain reaction, flow cytometry, and western blot. MTT assay showed that DAPP had no toxicity on Vero cells at the concentration 250 μg/ml. Furthermore, DAPP significantly reduced the RNA level of EV71 in a dose-dependent manner. Moreover, DAPP inhibited the Vero cells apoptosis induced by EV71 via the P53 signaling pathway. Meanwhile, the expression of signal transducer and activator of transcription 1 and mammalian target of rapamycin were increased and the proinflammatory cytokines were significantly inhibited by DAPP. Taken together, these results suggested that DAPP could be a potential pharmaceutical against the infection of EV71 virus.
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Affiliation(s)
- Tiantian Xu
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yinghua Li
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hua-Lian Wu
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Haiyang Chen
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Houbo Wu
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Min Guo
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mingqi Zhao
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Changbing Wang
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tao Lin
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhengfang Lin
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danyang Chen
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenzhou Xiang
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Bing Zhu
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Martínez-López N, Muñoz-Almagro C, Launes C, Navascués A, Imaz-Pérez M, Reina J, Romero MP, Calvo C, Ruiz-García M, Megias G, Valencia-Ramos J, Otero A, Cabrerizo M. Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006-2020. Viruses 2021; 13:v13050781. [PMID: 33924875 PMCID: PMC8146579 DOI: 10.3390/v13050781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1-6 years old) mainly, and show seasonality with peaks in spring-summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.
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Affiliation(s)
- Nieves Martínez-López
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
| | - Carmen Muñoz-Almagro
- Microbiological and Paediatric Departments, Hospital San Joan de Déu, 08950 Barcelona, Spain; (C.M.-A.); (C.L.)
| | - Cristian Launes
- Microbiological and Paediatric Departments, Hospital San Joan de Déu, 08950 Barcelona, Spain; (C.M.-A.); (C.L.)
| | - Ana Navascués
- Microbiological Department, Complejo Hospitalario de Navarra, 31008 Navarra, Spain;
| | - Manuel Imaz-Pérez
- Microbiological Department, Hospital de Basurto, 48013 Bilbao, Spain;
| | - Jordi Reina
- Microbiological Department, Hospital Son Espases, 07020 Palma de Mallorca, Spain;
| | - María Pilar Romero
- Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain; (M.P.R.); (C.C.)
| | - Cristina Calvo
- Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain; (M.P.R.); (C.C.)
| | | | - Gregoria Megias
- Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain; (G.M.); (J.V.-R.)
| | - Juan Valencia-Ramos
- Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain; (G.M.); (J.V.-R.)
| | - Almudena Otero
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
- Correspondence: ; Tel.: +34-918-223-663
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Wu Q, Zaid M, Xuan Z, Wang C, Gu H, Shi M, Zhu J, Hu Y, Liu J. Changes in epidemiological features of vaccine preventable infectious diseases among three eras of national vaccination strategies from 1953 to 2018 in Shanghai, China. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 7:100092. [PMID: 34327419 PMCID: PMC8315356 DOI: 10.1016/j.lanwpc.2021.100092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 12/04/2022]
Abstract
Background Recurring outbreaks of infectious diseases highlight the importance of population vaccination strategies. We aimed to assess the impact of national vaccination strategies on vaccine-preventable infectious diseases (VPDs) in Shanghai, China and to identify vulnerable groups that may benefit from future vaccination policies. Methods Infectious disease data from 1953 to 2018 was obtained from Xuhui District Center for Disease Control and Prevention, Shanghai China. We used joinpoint regression to show incidence, mortality and fatality trends and to determine annual percent change in incidence of 12 VPDs among three eras of national immunization strategies: (1)1953–1977, (2)1978–2007, and(3)2008–2018. Findings Incidence, mortality, and fatality from VPDs have decreased drastically over the three eras, despite the inclusion of more diseases over time. Strikingly, the overall yearly incidence of VPDs shows an increasing trend from 2000 to 2018 in Shanghai (annual percentage changes, APC:7.7, p = 0.025). In the third era (2008–2018), the three VPDs with the highest incidence were varicella (80.2 cases/100,000), hand, foot, and mouth disease (HFMD) (73.6 cases/100,000), and hepatitis (43.5 cases/100,000). A significant upward trend was also observed in hepatitis (APC:24.9, p<0.001), varicella (APC:5.9, p = 0.006), and HFMD (APC:11.8, p = 0.003) from 2008–2018. Hepatitis and tuberculosis are the only VPDs with fatality cases in this period. Interpretation Focus is needed in controlling adult hepatitis and tuberculosis, either by introducing adult booster vaccines or by research into more effective vaccines. Varicella and HFMD are on the rise, but vaccines for these are not included in national programs. Strategies funded by government agencies or encouraged by research incentives are needed for varicella and HFMD, such as two-dose and novel multi-valent vaccines, respectively. Funding Chinese Ministry of Education, Shanghai Municipal Government.
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Affiliation(s)
- Qiangsong Wu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Maryam Zaid
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Zeliang Xuan
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Chenxi Wang
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Haiyan Gu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Min Shi
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
| | - Jiahui Zhu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Yi Hu
- Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, Shanghai, China
| | - Jingyi Liu
- Xuhui District Center for Disease Control and Prevention, Shanghai 200237, China
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Xie C, Wen H, Yang W, Cai J, Zhang P, Wu R, Li M, Huang S. Trend analysis and forecast of daily reported incidence of hand, foot and mouth disease in Hubei, China by Prophet model. Sci Rep 2021; 11:1445. [PMID: 33446859 PMCID: PMC7809027 DOI: 10.1038/s41598-021-81100-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is common among children below 5 years. HFMD has a high incidence in Hubei Province, China. In this study, the Prophet model was used to forecast the incidence of HFMD in comparison with the autoregressive-integrated moving average (ARIMA) model, and HFMD incidence was decomposed into trends, yearly, weekly seasonality and holiday effect. The Prophet model fitted better than the ARIMA model in daily reported incidence of HFMD. The HFMD incidence forecast by the Prophet model showed that two peaks occurred in 2019, with the higher peak in May and the lower peak in December. Periodically changing patterns of HFMD incidence were observed after decomposing the time-series into its major components. In specific, multi-year variability of HFMD incidence was found, and the slow-down increasing point of HFMD incidence was identified. Relatively high HFMD incidences appeared in May and on Mondays. The effect of Spring Festival on HFMD incidence was much stronger than that of other holidays. This study showed the potential of the Prophet model to detect seasonality in HFMD incidence. Our next goal is to incorporate climate variables into the Prophet model to produce an accurate forecast of HFMD incidence.
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Affiliation(s)
- Cong Xie
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China
| | - Haoyu Wen
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuhan, 430071, China
| | - Wenwen Yang
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China
| | - Jing Cai
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China
| | - Peng Zhang
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China
| | - Ran Wu
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China
| | - Mingyan Li
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China.
| | - Shuqiong Huang
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, 430079, Hubei, China.
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Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010292. [PMID: 33401757 PMCID: PMC7795377 DOI: 10.3390/ijerph18010292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: Assignment of pathogens to the correct genus, species, and type is vital for controlling infectious epidemics. However, the role of different enteroviruses during hand, foot, and mouth disease (HFMD) epidemics and the major contributing factors remain unknown. (2) Methods: HFMD cases from 2016 to 2018 in Guangzhou, China were collected. The relationship between HFMD cases and genotype frequency, as well as the association between genotype frequency and climate factors, were studied using general linear models. We transformed the genotype frequency to the isometric log-ratio (ILR) components included in the model. Additionally, vaccination rates were adjusted in the climate-driven models. (3) Results: We observed seasonal trends in HFMD cases, genotype frequency, and climate factors. The model regressing case numbers on genotype frequency revealed negative associations with both the ILRs of CAV16 (RR = 0.725, p < 0.001) and EV71 (RR = 0.421, p < 0.001). The model regressing genotype frequency on driven factors showed that the trends for EV71 proportions were inversely related to vaccination rate (%, β = -0.152, p = 0.098) and temperature (°C, β = -0.065, p = 0.004). Additionally, the trends for CVA16 proportions were inversely related to vaccination rate (%, β = -0.461, p = 0.004) and temperature (°C, β = -0.068, p = 0.031). The overall trends for genotype frequency showed that EV71 decreased significantly, while the trends for CVA16 increased annually. (4) Conclusions: Our findings suggest a potential pathway for climate factors, genotype frequency, and HFMD cases. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.
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Fu H, Zhang Z, Dai Y, Liu S, Fu E. Brequinar inhibits enterovirus replication by targeting biosynthesis pathway of pyrimidines. Am J Transl Res 2020; 12:8247-8255. [PMID: 33437396 PMCID: PMC7791496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
Infection of human enteroviruses could cause diverse diseases ranging from mild respiratory symptoms to neurological complications, and even death. Currently, no-FDA approved antiviral drug is available for clinical treatment of human enteroviruses infection. Brequinar is an immunosuppressive drug currently being used for the prevention of organ graft rejection. The drug repurposing studies show that Brequinar exhibits potent antiviral activity against diverse viruses, including flaviviruses, alphavirus, rhabdovirus, and influenza viruses. The antiviral effect of Brequinar on human enterovirus infection has not been investigated yet. Here, the in vitro study shows that Brequinar potently inhibited EV71, EV70, and CVB3 replication at 50% inhibitory concentration (IC50) of 82.40 nM, 29.26 nM, and 35.14 nM, respectively. The antiviral activity of Brequinar was reversed by supplement exogenous pyrimidines, indicating that the antiviral effect of Brequinar against enterovirus relies on the inhibition of dihydroorotate dehydrogenase (DHODH) activity, which is responsible for the de novo biosynthesis of pyrimidines. These data extend the antiviral spectrum of Brequinar and indicate that Brequinar could serve as a promising antiviral drug to treat EV71 and other enterovirus infections.
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Affiliation(s)
- Han Fu
- Department of Clinical Diagnosis, TangDu Hospital, The Air Force Medical UniversityXi’an, Shaanxi, China
| | - Zhe Zhang
- Department of Clinical Diagnosis, TangDu Hospital, The Air Force Medical UniversityXi’an, Shaanxi, China
| | - Ying Dai
- Department of Clinical Diagnosis, TangDu Hospital, The Air Force Medical UniversityXi’an, Shaanxi, China
| | - Shunmin Liu
- Department of Respiratory Occupational Diseases, 521 Hospital of Norinco GroupXi’an, Shaanxi, China
| | - Enqing Fu
- Department of Pulmonary Disease and Critical Care Medicine, TangDu Hospital, The Air Force Military Medical UniversityXi’an, Shaanxi, China
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Song C, Li Y, Zhou Y, Liang L, Turtle L, Wang F, Wu P, Qiu Q, Yang J, Wang K, Cui P, Cheng Y, Zhang T, Guo C, Zeng M, Long L, Peiris M, Zhou C, Cowling BJ, Yu H. Enterovirus genomic load and disease severity among children hospitalised with hand, foot and mouth disease. EBioMedicine 2020; 62:103078. [PMID: 33161231 PMCID: PMC7653080 DOI: 10.1016/j.ebiom.2020.103078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Examining associations between viral genomic loads of enteroviruses and clinical severity is important for promoting and improving development of antiviral drugs related to hand, foot and mouth disease (HFMD). METHODS Throat swabs were collected from HFMD cases at acute phase of illness using a standardized technique in a prospective study. The viral genomic load was categorized into low, medium, and high groups using parameters of real-time reverse transcription-polymerase chain reaction. The clinical severities were assessed with four indicators, respectively. FINDINGS We analysed 1109 HFMD cases, including 538 children with CV-A6, 231 with CV-A16, 156 with EV-A71, 78 with CV-A10, 59 with CV-A4, and 47 with CV-A2. EV-A71 genomic load categories were associated with risks of diagnoses of CNS complications (p = 0.016), requiring systemic corticosteroids or IVIG (p = 0.011), intensive care unit admission (p = 0.002) and length of hospital stay over 5 days (p = 0.048). In the multivariate analyses, point estimates of adjusted odds ratio (OR) tended to increase with viral genomic loads for all four severe outcomes and ORs of highest viral genomic load were all significantly larger than one for EV-A71. INTERPRETATION HFMD clinical severities positively associate with viral genomic loads of EV-A71 in throat swabs. Specific antiviral drugs should be developed to reduce enterovirus load and to alleviate the clinical severities for HFMD cases. FUNDING National Science Fund for Distinguished Young Scholars.
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Affiliation(s)
- Chunlan Song
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Yu Li
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Lu Liang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom; Tropical & Infectious Disease Unit, Royal Liverpool University Hospital (member of Liverpool Health Partners), Liverpool, United Kingdom
| | - Fang Wang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jianli Yang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Kai Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yibing Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Tianchen Zhang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Guo
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyao Zeng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; NHC key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Medical School, Fudan University, Shanghai, China
| | - Lu Long
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chongchen Zhou
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China.
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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Sun Z, Li W, Xu J, Ren K, Gao F, Jiang Z, Ji F, Pan D. Proteomic Analysis of Cerebrospinal Fluid in Children with Acute Enterovirus-Associated Meningoencephalitis Identifies Dysregulated Host Processes and Potential Biomarkers. J Proteome Res 2020; 19:3487-3498. [PMID: 32678604 DOI: 10.1021/acs.jproteome.0c00307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Enteroviruses (EVs) are major causes of viral meningoencephalitis in children. To better understand the pathogenesis and identify potential biomarkers, cerebrospinal fluid proteome in children (n = 52) suffering from EV meningoencephalitis was compared to that in EV-negative control subjects (n = 53) using the BoxCar acquisition technique. Among 1697 proteins identified, 1193 with robust assay readouts were used for quantitative analyses. Differential expression analyses identified 154 upregulated and 227 downregulated proteins in the EV-positive group. Functional analyses showed that the upregulated proteins are mainly related to activities of lymphocytes and cytokines, inflammation, and responses to stress and viral invasion, while the downregulated proteins are mainly related to neuronal integrity and activity as well as neurogenesis. According to receiver operating characteristic analysis results, Rho-GDP-dissociation inhibitor 2 exhibited the highest sensitivity (96.2%) and specificity (100%) for discriminating EV-positive from EV-negative patients. The chemokine CXCL10 was most upregulated (>300-fold) with also high sensitivity (92.3%) and specificity (94.3%) for indicating EV positivity. Thus, this study uncovered perturbations of multiple host processes due to EV meningoencephalitis, especially the general trend of enhanced immune responses but impaired neuronal functions. The identified dysregulated proteins may also prompt biomarker development.
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Affiliation(s)
- Zeyu Sun
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jialu Xu
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Keyi Ren
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Zhengyi Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Feiyang Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Dongli Pan
- Department of Medical Microbiology and Parasitology, and Department of Infectious Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
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Chen L, Xu SJ, Yao XJ, Yang H, Zhang HL, Meng J, Zeng HR, Huang XH, Zhang RL, He YQ. Molecular epidemiology of enteroviruses associated with severe hand, foot and mouth disease in Shenzhen, China, 2014-2018. Arch Virol 2020; 165:2213-2227. [PMID: 32666145 PMCID: PMC7360124 DOI: 10.1007/s00705-020-04734-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
Abstract
In this study, we investigated the epidemiology and molecular characteristics of enteroviruses associated with severe hand, foot and mouth disease (HFMD) in Shenzhen, China, during 2014-2018. A total of 137 fecal specimens from patients with severe HFMD were collected. Enterovirus (EV) types were determined using real-time reverse transcription polymerase chain reaction (RT-PCR), RT nested PCR, and sequencing. Sequences were analyzed using bioinformatics programs. Of 137 specimens tested, 97 (70.8%), 12 (8.8%), and 10 (7.3%) were positive for EV-A71, coxsackievirus A6 (CVA6), and CVA16, respectively. Other pathogens detected included CVA2 (2.9%, 4/137), CVA10 (2.9%, 4/137), CVA5 (0.7%, 1/137), echovirus 6 (E6) (0.7%, 1/137) and E18 (0.7%, 1/137). The most frequent complication in patients with proven EV infections was myoclonic jerk, followed by aseptic encephalitis, tachypnea, and vomiting. The frequencies of vomiting and abnormal eye movements were higher in EV-A71-infected patients than that in CVA6-infected or CVA16-infected patients. Molecular phylogeny based on the complete VP1 gene revealed no association between the subgenotype of the virus and disease severity. Nevertheless, 12 significant mutations that were likely to be associated with virulence or the clinical phenotype were observed in the 5’UTR, 2Apro, 2C, 3A, 3Dpol and 3’UTR of CVA6. Eight significant mutations were observed in the 5’UTR, 2B, 3A, 3Dpol and 3’UTR of CVA16, and 10 significant mutations were observed in the 5’UTR, VP1, 3A and 3Cpro of CVA10. In conclusion, EV-A71 is still the main pathogen causing severe HFMD, although other EV types can also cause severe complications. Potential virulence or phenotype-associated sites were identified in the genomes of CVA6, CVA16, and CVA10.
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Affiliation(s)
- Long Chen
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China.
| | - Shao-Jian Xu
- District Key Laboratory for Infectious Disease Prevention and Control, Longhua District Center for Disease Control and Prevention, Shenzhen, 518109, China
| | - Xiang-Jie Yao
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Hai-Long Zhang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Jun Meng
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Han-Ri Zeng
- Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xu-He Huang
- Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Ren-Li Zhang
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China
| | - Ya-Qing He
- Major Infectious Disease Control Key Laboratory and Shenzhen Public Service Platform of Pathogenic Microorganisms Repository, Institute of Pathogen Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, China.
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Hu P, Liu J, Gan L, Chen Y, Su K, Chen Y, Zhang D. Lack of effective home quarantine: The cause of the continuing prevalence of hand, foot, and mouth disease in China? J Infect Public Health 2020; 13:963-969. [DOI: 10.1016/j.jiph.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022] Open
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Au CC, Hon KL, Leung AKC, Torres AR. Childhood Infectious Encephalitis: An Overview of Clinical Features, Investigations, Treatment, and Recent Patents. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2020; 14:156-165. [PMID: 33238854 DOI: 10.2174/1872213x14999201124195724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Infectious encephalitis is a serious and challenging condition to manage. This overview summarizes the current literature regarding the etiology, clinical manifestations, diagnosis, management, and recent patents of acute childhood infectious encephalitis. METHODS We used PubMed Clinical Queries as a search engine and used keywords of "encephalitis" AND "childhood" Patents were searched using the key term "encephalitis" in google.patents.- com and patentsonline.com. RESULTS Viral encephalitis is the most common cause of acute infectious encephalitis in children. In young children, the clinical manifestations can be non-specific. Provision of empiric antimicrobial therapy until a specific infectious organism has been identified, which in most cases includes acyclovir, is the cornerstone of therapy. Advanced investigation tools, including nucleic acid-based test panel and metagenomic next-generation sequencing, improve the diagnostic yield of identifying an infectious organism. Supportive therapy includes adequate airway and oxygenation, fluid and electrolyte balance, cerebral perfusion pressure support, and seizure control. Recent patents are related to the diagnosis, treatment, and prevention of acute infectious encephalitis. CONCLUSION Viral encephalitis is the most common cause of acute infectious encephalitis in children and is associated with significant morbidity. Recent advances in understanding the genetic basis and immunological correlation of infectious encephalitis may improve treatment. Third-tier diagnostic tests may be incorporated into clinical practice. Treatment is targeted at the infectious process but remains mostly supportive. However, specific antimicrobial agents and vaccines development is ongoing.
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Affiliation(s)
- Cheuk C Au
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong
| | - Kam L Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alcy R Torres
- Department of Pediatrics, Division of Pediatric Neurology, Pediatric Traumatic Brain Injury Program, Associate Professor of Pediatrics and Neurology, Boston University, School of Medicine, Boston, MA, United States
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