151
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Differential transcriptional responses to Ebola and Marburg virus infection in bat and human cells. Sci Rep 2016; 6:34589. [PMID: 27713552 PMCID: PMC5054393 DOI: 10.1038/srep34589] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/15/2016] [Indexed: 01/04/2023] Open
Abstract
The unprecedented outbreak of Ebola in West Africa resulted in over 28,000 cases and 11,000 deaths, underlining the need for a better understanding of the biology of this highly pathogenic virus to develop specific counter strategies. Two filoviruses, the Ebola and Marburg viruses, result in a severe and often fatal infection in humans. However, bats are natural hosts and survive filovirus infections without obvious symptoms. The molecular basis of this striking difference in the response to filovirus infections is not well understood. We report a systematic overview of differentially expressed genes, activity motifs and pathways in human and bat cells infected with the Ebola and Marburg viruses, and we demonstrate that the replication of filoviruses is more rapid in human cells than in bat cells. We also found that the most strongly regulated genes upon filovirus infection are chemokine ligands and transcription factors. We observed a strong induction of the JAK/STAT pathway, of several genes encoding inhibitors of MAP kinases (DUSP genes) and of PPP1R15A, which is involved in ER stress-induced cell death. We used comparative transcriptomics to provide a data resource that can be used to identify cellular responses that might allow bats to survive filovirus infections.
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152
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Spengler JR, Lavender KJ, Martellaro C, Carmody A, Kurth A, Keck JG, Saturday G, Scott DP, Nichol ST, Hasenkrug KJ, Spiropoulou CF, Feldmann H, Prescott J. Ebola Virus Replication and Disease Without Immunopathology in Mice Expressing Transgenes to Support Human Myeloid and Lymphoid Cell Engraftment. J Infect Dis 2016; 214:S308-S318. [PMID: 27601621 DOI: 10.1093/infdis/jiw248] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The study of Ebola virus (EBOV) pathogenesis in vivo has been limited to nonhuman primate models or use of an adapted virus to cause disease in rodent models. Herein we describe wild-type EBOV (Makona variant) infection of mice engrafted with human hematopoietic CD34+ stem cells (Hu-NSG™-SGM3 mice; hereafter referred to as SGM3 HuMice). SGM3 HuMice support increased development of myeloid immune cells, which are primary EBOV targets. In SGM3 HuMice, EBOV replicated to high levels, and disease was observed following either intraperitoneal or intramuscular inoculation. Despite the high levels of viral antigen and inflammatory cell infiltration in the liver, the characteristic histopathology of Ebola virus disease was not observed, and this absence of severe immunopathology may have contributed to the recovery and survival of some of the animals. Future investigations into the underlying mechanisms of the atypical disease presentation in SGM3 HuMice will provide additional insights into the immunopathogenesis of severe EBOV disease.
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Affiliation(s)
- Jessica R Spengler
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Andreas Kurth
- Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - James G Keck
- In Vivo Services, The Jackson Laboratory, Sacramento, California
| | - Greg Saturday
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Dana P Scott
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Christina F Spiropoulou
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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153
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Glanzer JG, Byrne BM, McCoy AM, James BJ, Frank JD, Oakley GG. In silico and in vitro methods to identify ebola virus VP35-dsRNA inhibitors. Bioorg Med Chem 2016; 24:5388-5392. [PMID: 27642076 DOI: 10.1016/j.bmc.2016.08.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/23/2022]
Abstract
Ebola virus continues to be problematic as sporadic outbreaks in Africa continue to arise, and as terrorist organizations have considered the virus for bioterrorism use. Several proteins within the virus have been targeted for antiviral chemotherapy, including VP35, a dsRNA binding protein that promotes viral replication, protects dsRNA from degradation, and prevents detection of the viral genome by immune complexes. To augment the scope of our antiviral research, we have now employed molecular modeling techniques to enrich the population of compounds for further testing in vitro. In the initial docking of a static VP35 structure with an 80,000 compound library, 40 compounds were selected, of which four compounds inhibited VP35 with IC50 <200μM, with the best compounds having an IC50 of 20μM. By superimposing 26 VP35 structures, we determined four aspartic acid residues were highly flexible and the docking was repeated under flexible parameters. Of 14 compounds chosen for testing, five compounds inhibited VP35 with IC50 <200μM and one compound with an IC50 of 4μM. These studies demonstrate the value of docking in silico for enriching compounds for testing in vitro, and specifically using multiple structures as a guide for detecting flexibility and provide a foundation for further development of small molecule inhibitors directed towards VP35.
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Affiliation(s)
- Jason G Glanzer
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States
| | - Brendan M Byrne
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States
| | - Aaron M McCoy
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States
| | - Ben J James
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States
| | - Joshua D Frank
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States
| | - Greg G Oakley
- Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE 68583, United States; Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, United States
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154
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Chertow DS, Childs RW, Arai AE, Davey RT. Cardiac MRI Findings Suggest Myocarditis in Severe Ebola Virus Disease. JACC Cardiovasc Imaging 2016; 10:711-713. [PMID: 27544899 DOI: 10.1016/j.jcmg.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
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155
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Dubov A, Appleton JH, Campbell S. Ebola Virus Preparedness: Emerging Viruses and Ethics in Laboratory Medicine. Arch Pathol Lab Med 2016; 140:171-80. [PMID: 26910222 DOI: 10.5858/arpa.2015-0134-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Emerging pathogens have affected, and will continue to affect, the health care system in diverse ways. Clinical laboratories face ethical challenges in responding to emerging pathogens. We use the 2014-2015 outbreak of Ebola virus disease as a model to explore some of the ethical issues in laboratory medicine related to emerging infectious disease. OBJECTIVE To describe the major ethical concerns raised in the clinical laboratory environment by emerging infections. DATA SOURCES We assessed current guidelines and practices in the Ebola outbreak in developed-world clinical laboratories, reviewed risk assessment practices and the role of the clinical laboratory in providing care for patients with potential or confirmed Ebola, and reviewed the relevant literature on duty to provide care in the laboratory context. CONCLUSIONS Clinical laboratories in developed countries have to rely more on expert guidelines and theoretical risk assessments than on practice in less-developed areas. Risk minimization for clinical laboratory workers is essential but may conflict with the laboratory's duty to provide standard of care. Patients can be put at risk not only from loss of laboratory services from restriction of testing but also from impairment of laboratory services in cases of spills or accidents. Significant discrepancies in guidelines from professional and governmental sources exacerbate the difficulty and confusion inherent in dealing with a dynamic, emerging infectious disease crisis. The duty to provide care for laboratory workers is ill-defined. Balancing risks to patients and laboratory workers and benefits to patients presents challenges to laboratory professionals at all levels.
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Affiliation(s)
- Alex Dubov
- From the Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut (Mr Dubov)
| | - Julia H Appleton
- the Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare System, West Haven (Ms Appleton and Dr Campbell)
| | - Sheldon Campbell
- the Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare System, West Haven (Ms Appleton and Dr Campbell)
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156
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Kamali A, Jamieson DJ, Kpaduwa J, Schrier S, Kim M, Green NM, Ströher U, Muehlenbachs A, Bell M, Rollin PE, Mascola L. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerg Infect Dis 2016; 22. [PMID: 27191253 PMCID: PMC4918171 DOI: 10.3201/eid2207.160269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Women who become pregnant after recovery pose little risk for transmitting the virus to the baby or others. Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women’s pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.
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157
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Abstract
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.
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Affiliation(s)
- Bridgette Jeanne Billioux
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Bryan Smith
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA.
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158
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McElroy AK, Harmon JR, Flietstra TD, Campbell S, Mehta AK, Kraft CS, Lyon MG, Varkey JB, Ribner BS, Kratochvil CJ, Iwen PC, Smith PW, Ahmed R, Nichol ST, Spiropoulou CF. Kinetic Analysis of Biomarkers in a Cohort of US Patients With Ebola Virus Disease. Clin Infect Dis 2016; 63:460-7. [PMID: 27353663 DOI: 10.1093/cid/ciw334] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ebola virus (EBOV) infection causes a severe and often fatal disease. Despite the fact that more than 30 000 individuals have acquired Ebola virus disease (EVD), the medical and scientific community still does not have a clear understanding of the mechanisms by which EBOV causes such severe disease. METHODS In this study, 54 biomarkers in plasma samples serially collected from 7 patients with EVD were analyzed in an attempt to define the kinetics of inflammatory modulators. Two clinical disease groups were defined (moderate and severe) based on the need for clinical support. Biomarkers were evaluated for correlation with viremia and clinical disease in an effort to identify pathways that could be useful targets of therapeutic intervention. RESULTS Patients with severe disease had higher viremia than those with moderate disease. Several biomarkers of immune activation and control were significantly elevated in patients with moderate disease. A series of pro-inflammatory cytokines and chemokines were significantly elevated in patients with severe disease. CONCLUSIONS Biomarkers that were associated with severe EVD were proinflammatory and indicative of endothelial or coagulation cascade dysfunction, as has been seen historically in patients with fatal outcomes. In contrast, biomarkers that were associated with moderate EVD were suggestive of a strong interferon response and control of both innate and adaptive responses. Therefore, clinical interventions that modulate the phenotype and magnitude of immune activation may be beneficial in treating EVD.
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Affiliation(s)
- Anita K McElroy
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Jessica R Harmon
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention Division of Pediatric Infectious Disease
| | - Timothy D Flietstra
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | - Shelley Campbell
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
| | | | - Colleen S Kraft
- Division of Infectious Diseases Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Philip W Smith
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center College of Medicine, Omaha
| | | | - Stuart T Nichol
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention
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159
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Characterization of Human and Murine T-Cell Immunoglobulin Mucin Domain 4 (TIM-4) IgV Domain Residues Critical for Ebola Virus Entry. J Virol 2016; 90:6097-6111. [PMID: 27122575 DOI: 10.1128/jvi.00100-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/15/2016] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Phosphatidylserine (PtdSer) receptors that are responsible for the clearance of dying cells have recently been found to mediate enveloped virus entry. Ebola virus (EBOV), a member of the Filoviridae family of viruses, utilizes PtdSer receptors for entry into target cells. The PtdSer receptors human and murine T-cell immunoglobulin mucin (TIM) domain proteins TIM-1 and TIM-4 mediate filovirus entry by binding to PtdSer on the virion surface via a conserved PtdSer binding pocket within the amino-terminal IgV domain. While the residues within the TIM-1 IgV domain that are important for EBOV entry are characterized, the molecular details of virion-TIM-4 interactions have yet to be investigated. As sequences and structural alignments of the TIM proteins suggest distinct differences in the TIM-1 and TIM-4 IgV domain structures, we sought to characterize TIM-4 IgV domain residues required for EBOV entry. Using vesicular stomatitis virus pseudovirions bearing EBOV glycoprotein (EBOV GP/VSVΔG), we evaluated virus binding and entry into cells expressing TIM-4 molecules mutated within the IgV domain, allowing us to identify residues important for entry. Similar to TIM-1, residues in the PtdSer binding pocket of murine and human TIM-4 (mTIM-4 and hTIM-4) were found to be important for EBOV entry. However, additional TIM-4-specific residues were also found to impact EBOV entry, with a total of 8 mTIM-4 and 14 hTIM-4 IgV domain residues being critical for virion binding and internalization. Together, these findings provide a greater understanding of the interaction of TIM-4 with EBOV virions. IMPORTANCE With more than 28,000 cases and over 11,000 deaths during the largest and most recent Ebola virus (EBOV) outbreak, there has been increased emphasis on the development of therapeutics against filoviruses. Many therapies under investigation target EBOV cell entry. T-cell immunoglobulin mucin (TIM) domain proteins are cell surface factors important for the entry of many enveloped viruses, including EBOV. TIM family member TIM-4 is expressed on macrophages and dendritic cells, which are early cellular targets during EBOV infection. Here, we performed a mutagenesis screening of the IgV domain of murine and human TIM-4 to identify residues that are critical for EBOV entry. Surprisingly, we identified more human than murine TIM-4 IgV domain residues that are required for EBOV entry. Defining the TIM IgV residues needed for EBOV entry clarifies the virus-receptor interactions and paves the way for the development of novel therapeutics targeting virus binding to this cell surface receptor.
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160
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Muehlenbachs A, de la Rosa Vázquez O, Bausch DG, Schafer IJ, Paddock CD, Nyakio JP, Lame P, Bergeron E, McCollum AM, Goldsmith CS, Bollweg BC, Prieto MA, Lushima RS, Ilunga BK, Nichol ST, Shieh WJ, Ströher U, Rollin PE, Zaki SR. Ebola Virus Disease in Pregnancy: Clinical, Histopathologic, and Immunohistochemical Findings. J Infect Dis 2016; 215:64-69. [PMID: 27226206 DOI: 10.1093/infdis/jiw206] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/09/2016] [Indexed: 01/23/2023] Open
Abstract
Here we describe clinicopathologic features of Ebola virus disease in pregnancy. One woman infected with Sudan virus in Gulu, Uganda, in 2000 had a stillbirth and survived, and another woman infected with Bundibugyo virus had a live birth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemical analysis, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malarial parasite pigment-laden macrophages. These data suggest that trophoblast infection may be a mechanism of transplacental ebolavirus transmission.
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Affiliation(s)
| | | | | | | | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Andrea M McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology
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161
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Mekibib B, Ariën KK. Aerosol Transmission of Filoviruses. Viruses 2016; 8:v8050148. [PMID: 27223296 PMCID: PMC4885103 DOI: 10.3390/v8050148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 12/30/2022] Open
Abstract
Filoviruses have become a worldwide public health concern because of their potential for introductions into non-endemic countries through international travel and the international transport of infected animals or animal products. Since it was first identified in 1976, in the Democratic Republic of Congo (formerly Zaire) and Sudan, the 2013–2015 western African Ebola virus disease (EVD) outbreak is the largest, both by number of cases and geographical extension, and deadliest, recorded so far in medical history. The source of ebolaviruses for human index case(s) in most outbreaks is presumptively associated with handling of bush meat or contact with fruit bats. Transmission among humans occurs easily when a person comes in contact with contaminated body fluids of patients, but our understanding of other transmission routes is still fragmentary. This review deals with the controversial issue of aerosol transmission of filoviruses.
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Affiliation(s)
- Berhanu Mekibib
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium.
- School of Veterinary Medicine, College of Natural and Computational Sciences, Hawassa University, P.O. Box 05, Hawassa, Ethiopia.
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium.
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162
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Uyeki TM, Erickson BR, Brown S, McElroy AK, Cannon D, Gibbons A, Sealy T, Kainulainen MH, Schuh AJ, Kraft CS, Mehta AK, Lyon GM, Varkey JB, Ribner BS, Ellison RT, Carmody E, Nau GJ, Spiropoulou C, Nichol ST, Ströher U. Ebola Virus Persistence in Semen of Male Survivors. Clin Infect Dis 2016; 62:1552-1555. [DOI: 10.1093/cid/ciw202] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/24/2016] [Indexed: 11/13/2022] Open
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163
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Vetter P, Kaiser L, Schibler M, Ciglenecki I, Bausch DG. Sequelae of Ebola virus disease: the emergency within the emergency. THE LANCET. INFECTIOUS DISEASES 2016; 16:e82-e91. [PMID: 27020309 DOI: 10.1016/s1473-3099(16)00077-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 12/22/2022]
Abstract
As the massive outbreak of Ebola virus disease (EVD) in west Africa wanes, it has become increasingly clear that thousands of survivors have many sequelae, some of which might be very severe, such as arthritis and vision-threatening uveitis. The mental health effects of EVD on survivors and other family and community members is similarly profound. Furthermore, it is increasingly being recognised that Ebola virus might persist for weeks or months in selected body compartments of survivors, most notably in the semen of men, bringing risk of renewed transmission where it has previously been eliminated. These challenges to EVD survivors constitute a new emergency in terms of addressing individual patient need and to control the disease spread. In this Review, we assess what is known regarding the sequelae of EVD, including possible delayed virus clearance. We discuss some of the key challenges regarding the provision of care to survivors and implementation of necessary future research.
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Affiliation(s)
- Pauline Vetter
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; Médecins Sans Frontières/Doctors Without Borders, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - Manuel Schibler
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology and Swiss Reference Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Iza Ciglenecki
- Médecins Sans Frontières/Doctors Without Borders, Geneva, Switzerland
| | - Daniel G Bausch
- Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
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164
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Walsh GM, Shih AW, Solh Z, Golder M, Schubert P, Fearon M, Sheffield WP. Blood-Borne Pathogens: A Canadian Blood Services Centre for Innovation Symposium. Transfus Med Rev 2016; 30:53-68. [PMID: 26962008 PMCID: PMC7126603 DOI: 10.1016/j.tmrv.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/18/2016] [Indexed: 12/19/2022]
Abstract
Testing donations for pathogens and deferring selected blood donors have reduced the risk of transmission of known pathogens by transfusion to extremely low levels in most developed countries. Protecting the blood supply from emerging infectious threats remains a serious concern in the transfusion medicine community. Transfusion services can employ indirect measures such as surveillance, hemovigilance, and donor questioning (defense), protein-, or nucleic acid based direct testing (detection), or pathogen inactivation of blood products (destruction) as strategies to mitigate the risk of transmission-transmitted infection. In the North American context, emerging threats currently include dengue, chikungunya, and hepatitis E viruses, and Babesia protozoan parasites. The 2003 SARS and 2014 Ebola outbreaks illustrate the potential of epidemics unlikely to be transmitted by blood transfusion but disruptive to blood systems. Donor-free blood products such as ex vivo generated red blood cells offer a theoretical way to avoid transmission-transmitted infection risk, although biological, engineering, and manufacturing challenges must be overcome before this approach becomes practical. Similarly, next generation sequencing of all nucleic acid in a blood sample is currently possible but impractical for generalized screening. Pathogen inactivation systems are in use in different jurisdictions around the world, and are starting to gain regulatory approval in North America. Cost concerns make it likely that pathogen inactivation will be contemplated by blood operators through the lens of health economics and risk-based decision making, rather than in zero-risk paradigms previously embraced for transfusable products. Defense of the blood supply from infectious disease risk will continue to require innovative combinations of surveillance, detection, and pathogen avoidance or inactivation. A symposium on blood-borne pathogens was held September 26, 2015, in Toronto, Canada. Transmission-transmitted infections remain a threat to the blood supply. The residual risk from established pathogens is small; emerging agents are a concern. Next generation sequencing and donor-free blood are not yet practical approaches. Pathogen inactivation technology is being increasingly used around the world. Health economic concerns will likely guide future advances in this area.
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Affiliation(s)
- Geraldine M Walsh
- Centre for Innovation, Canadian Blood Services, Hamilton, Ottawa, and Vancouver, Canada
| | - Andrew W Shih
- Medical Services and Innovation, Canadian Blood Services, McMaster University, Hamilton, Canada; Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Ziad Solh
- Medical Services and Innovation, Canadian Blood Services, McMaster University, Hamilton, Canada; Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Mia Golder
- Centre for Innovation, Canadian Blood Services, Hamilton, Ottawa, and Vancouver, Canada
| | - Peter Schubert
- Centre for Innovation, Canadian Blood Services, Hamilton, Ottawa, and Vancouver, Canada; Centre for Blood Research, University of British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
| | - Margaret Fearon
- Medical Services and Innovation, Canadian Blood Services, McMaster University, Hamilton, Canada; Pathology and Laboratory Medicine, University of Toronto, Canada
| | - William P Sheffield
- Centre for Innovation, Canadian Blood Services, Hamilton, Ottawa, and Vancouver, Canada; Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
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165
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Edwards MR, Liu G, Mire CE, Sureshchandra S, Luthra P, Yen B, Shabman RS, Leung DW, Messaoudi I, Geisbert TW, Amarasinghe GK, Basler CF. Differential Regulation of Interferon Responses by Ebola and Marburg Virus VP35 Proteins. Cell Rep 2016; 14:1632-1640. [PMID: 26876165 PMCID: PMC4767585 DOI: 10.1016/j.celrep.2016.01.049] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/16/2015] [Accepted: 01/13/2016] [Indexed: 12/31/2022] Open
Abstract
Suppression of innate immune responses during filoviral infection contributes to disease severity. Ebola (EBOV) and Marburg (MARV) viruses each encode a VP35 protein that suppresses RIG-I-like receptor signaling and interferon-α/β (IFN-α/β) production by several mechanisms, including direct binding to double stranded RNA (dsRNA). Here, we demonstrate that in cell culture, MARV infection results in a greater upregulation of IFN responses as compared to EBOV infection. This correlates with differences in the efficiencies by which EBOV and MARV VP35s antagonize RIG-I signaling. Furthermore, structural and biochemical studies suggest that differential recognition of RNA elements by the respective VP35 C-terminal IFN inhibitory domain (IID) rather than affinity for RNA by the respective VP35s is critical for this observation. Our studies reveal functional differences in EBOV versus MARV VP35 RNA binding that result in unexpected differences in the host response to deadly viral pathogens.
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Affiliation(s)
- Megan R Edwards
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gai Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chad E Mire
- Department of Microbiology and Immunology, Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Suhas Sureshchandra
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 92521, USA
| | - Priya Luthra
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Benjamin Yen
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Reed S Shabman
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Virology Group, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Daisy W Leung
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ilhem Messaoudi
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 92521, USA
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Gaya K Amarasinghe
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Christopher F Basler
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Uyeki TM, Mehta AK, Davey RT, Liddell AM, Wolf T, Vetter P, Schmiedel S, Grünewald T, Jacobs M, Arribas JR, Evans L, Hewlett AL, Brantsaeter AB, Ippolito G, Rapp C, Hoepelman AIM, Gutman J. Clinical Management of Ebola Virus Disease in the United States and Europe. N Engl J Med 2016; 374:636-46. [PMID: 26886522 PMCID: PMC4972324 DOI: 10.1056/nejmoa1504874] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. CONCLUSIONS Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
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Affiliation(s)
- Timothy M Uyeki
- From the Centers for Disease Control and Prevention (T.M.U., J.G.) and the Division of Infectious Diseases, Emory University School of Medicine (A.K.M.) - both in Atlanta; the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (R.T.D.); Texas Health Presbyterian Hospital Dallas, Dallas (A.M.L.); the Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main (T.W.), the First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg (S.S.), and Leipzig Treatment Center for Highly Contagious Diseases, Klinikum St. Georg, Leipzig (T.G.) - all in Germany; the Division of Infectious Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva (P.V.); the Department of Infection, Royal Free London NHS Foundation Trust, London (M.J.); the Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid (J.R.A.); New York University School of Medicine-Bellevue Hospital Center, New York (L.E.); University of Nebraska Medical Center, Omaha (A.L.H.); the Departments of Infectious Diseases and Acute Medicine, Oslo University Hospital, Oslo (A.B.B.); Lazzaro Spallanzani National Institute for Infectious Diseases, Rome (G.I.); the Infectious and Tropical Diseases Department, Bégin Military Hospital, Saint-Mandé, France (C.R.); and the Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands (A.I.M.H.)
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167
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Kaushik A, Tiwari S, Dev Jayant R, Marty A, Nair M. Towards detection and diagnosis of Ebola virus disease at point-of-care. Biosens Bioelectron 2016; 75:254-72. [PMID: 26319169 PMCID: PMC4601610 DOI: 10.1016/j.bios.2015.08.040] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/18/2022]
Abstract
Ebola outbreak-2014 (mainly Zaire strain related Ebola virus) has been declared most widely spread deadly persistent epidemic due to unavailability of rapid diagnostic, detection, and therapeutics. Ebola virus disease (EVD), a severe viral hemorrhagic fever syndrome caused by Ebola virus (EBOV) is transmitted by direct contact with the body fluids of infected person and objects contaminated with virus or infected animals. World Health Organization (WHO) has declared EVD epidemic as public health emergency of international concern with severe global economic burden. At fatal EBOV infection stage, patients usually die before the antibody response. Currently, rapid blood tests to diagnose EBOV infection include the antigen or antibodies capture using ELISA and RNA detection using RT/Q-PCR within 3-10 days after the onset of symptoms. Moreover, few nanotechnology-based colorimetric and paper-based immunoassay methods have been recently reported to detect Ebola virus. Unfortunately, these methods are limited to laboratory only. As state-of-the art (SoA) diagnostics time to confirm Ebola infection, varies from 6h to about 3 days, it causes delay in therapeutic approaches. Thus developing a cost-effective, rapid, sensitive, and selective sensor to detect EVD at point-of-care (POC) is certainly worth exploring to establish rapid diagnostics to decide therapeutics. This review highlights SoA of Ebola diagnostics and also a call to develop rapid, selective and sensitive POC detection of EBOV for global health care. We propose that adopting miniaturized electrochemical EBOV immunosensing can detect virus level at pM concentration within ∼40min compared to 3 days of ELISA test at nM levels.
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Affiliation(s)
- Ajeet Kaushik
- Center for Personalized Nanomedicine, Institute of NeuroImmune Pharmacology, Department of Immunology, Florida International University, Miami, USA.
| | - Sneham Tiwari
- Center for Personalized Nanomedicine, Institute of NeuroImmune Pharmacology, Department of Immunology, Florida International University, Miami, USA
| | - Rahul Dev Jayant
- Center for Personalized Nanomedicine, Institute of NeuroImmune Pharmacology, Department of Immunology, Florida International University, Miami, USA
| | - Aileen Marty
- Infectious Diseases, Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Madhavan Nair
- Center for Personalized Nanomedicine, Institute of NeuroImmune Pharmacology, Department of Immunology, Florida International University, Miami, USA.
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169
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Trefry JC, Wollen SE, Nasar F, Shamblin JD, Kern SJ, Bearss JJ, Jefferson MA, Chance TB, Kugelman JR, Ladner JT, Honko AN, Kobs DJ, Wending MQS, Sabourin CL, Pratt WD, Palacios GF, Pitt MLM. Ebola Virus Infections in Nonhuman Primates Are Temporally Influenced by Glycoprotein Poly-U Editing Site Populations in the Exposure Material. Viruses 2015; 7:6739-54. [PMID: 26703716 PMCID: PMC4690892 DOI: 10.3390/v7122969] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 01/04/2023] Open
Abstract
Recent experimentation with the variants of the Ebola virus that differ in the glycoprotein's poly-uridine site, which dictates the form of glycoprotein produced through a transcriptional stutter, has resulted in questions regarding the pathogenicity and lethality of the stocks used to develop products currently undergoing human clinical trials to combat the disease. In order to address these concerns and prevent the delay of these critical research programs, we designed an experiment that permitted us to intramuscularly challenge statistically significant numbers of naïve and vaccinated cynomolgus macaques with either a 7U or 8U variant of the Ebola virus, Kikwit isolate. In naïve animals, no difference in survivorship was observed; however, there was a significant delay in the disease course between the two groups. Significant differences were also observed in time-of-fever, serum chemistry, and hematology. In vaccinated animals, there was no statistical difference in survivorship between either challenge groups, with two succumbing in the 7U group compared to 1 in the 8U challenge group. In summary, survivorship was not affected, but the Ebola virus disease course in nonhuman primates is temporally influenced by glycoprotein poly-U editing site populations.
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Affiliation(s)
- John C Trefry
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Suzanne E Wollen
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Farooq Nasar
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Joshua D Shamblin
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Steven J Kern
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Jeremy J Bearss
- Pathology Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Michelle A Jefferson
- Pathology Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Taylor B Chance
- Pathology Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Jeffery R Kugelman
- Molecular and Translational Sciences, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Jason T Ladner
- Molecular and Translational Sciences, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Anna N Honko
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Dean J Kobs
- Battelle Memorial Institute, 505 King Ave., Columbus, OH 43201, USA.
| | | | - Carol L Sabourin
- Battelle Memorial Institute, 505 King Ave., Columbus, OH 43201, USA.
| | - William D Pratt
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - Gustavo F Palacios
- Molecular and Translational Sciences, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
| | - M Louise M Pitt
- Virology Division, US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA.
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170
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Caring for Critically Ill Ebola Virus Disease Patients With One Hand Tied Behind Your Back. Crit Care Med 2015; 43:2249-50. [PMID: 26376249 DOI: 10.1097/ccm.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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171
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Abstract
OBJECTIVE This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease. DATA SOURCES Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital). STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSION In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment.
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172
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Bird BH, Spengler JR, Chakrabarti AK, Khristova ML, Sealy TK, Coleman-McCray JD, Martin BE, Dodd KA, Goldsmith CS, Sanders J, Zaki SR, Nichol ST, Spiropoulou CF. Humanized Mouse Model of Ebola Virus Disease Mimics the Immune Responses in Human Disease. J Infect Dis 2015; 213:703-11. [PMID: 26582961 DOI: 10.1093/infdis/jiv538] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022] Open
Abstract
Animal models recapitulating human Ebola virus disease (EVD) are critical for insights into virus pathogenesis. Ebola virus (EBOV) isolates derived directly from human specimens do not, without adaptation, cause disease in immunocompetent adult rodents. Here, we describe EVD in mice engrafted with human immune cells (hu-BLT). hu-BLT mice developed EVD following wild-type EBOV infection. Infection with high-dose EBOV resulted in rapid, lethal EVD with high viral loads, alterations in key human antiviral immune cytokines and chemokines, and severe histopathologic findings similar to those shown in the limited human postmortem data available. A dose- and donor-dependent clinical course was observed in hu-BLT mice infected with lower doses of either Mayinga (1976) or Makona (2014) isolates derived from human EBOV cases. Engraftment of the human cellular immune system appeared to be essential for the observed virulence, as nonengrafted mice did not support productive EBOV replication or develop lethal disease. hu-BLT mice offer a unique model for investigating the human immune response in EVD and an alternative animal model for EVD pathogenesis studies and therapeutic screening.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanine Sanders
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Ebola virus, the virus responsible for Ebola virus disease, has spawned several epidemics during the past 38 years. In 2014, an Ebola epidemic spread from Africa to other continents, becoming a pandemic. The virus's relatively unique structure, its infectivity and lethality, the difficulty in stopping its spread, and the lack of an effective treatment captured the world's attention. This article provides a brief review of the known history of Ebola virus disease, its etiology, epidemiology, and pathophysiology and a review of the limited information on managing patients with Ebola virus disease.
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174
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The Role of Cytokines and Chemokines in Filovirus Infection. Viruses 2015; 7:5489-507. [PMID: 26512687 PMCID: PMC4632400 DOI: 10.3390/v7102892] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 01/11/2023] Open
Abstract
Ebola- and marburgviruses are highly pathogenic filoviruses and causative agents of viral hemorrhagic fever. Filovirus disease is characterized by a dysregulated immune response, severe organ damage, and coagulation abnormalities. This includes modulation of cytokines, signaling mediators that regulate various components of the immune system as well as other biological processes. Here we examine the role of cytokines in filovirus infection, with an emphasis on understanding how these molecules affect development of the antiviral immune response and influence pathology. These proteins may present targets for immune modulation by therapeutic agents and vaccines in an effort to boost the natural immune response to infection and/or reduce immunopathology.
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175
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Petrosillo N, Nicastri E, Lanini S, Capobianchi MR, Di Caro A, Antonini M, Puro V, Lauria FN, Shindo N, Magrini N, Kobinger GP, Ippolito G. Ebola virus disease complicated with viral interstitial pneumonia: a case report. BMC Infect Dis 2015; 15:432. [PMID: 26471197 PMCID: PMC4608352 DOI: 10.1186/s12879-015-1169-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/30/2015] [Indexed: 11/26/2022] Open
Abstract
Background In the current Ebola epidemic in Western Africa, many healthcare workers have become infected. Some of these have been medically evacuated to hospitals in Europe and the USA. These clinical experiences provide unique insights into the course of Ebola virus disease under optimized condition within high level isolation units. Case presentation A 50-year-old Caucasian male physician contracted Ebola virus diseases in Sierra Leone and was medically evacuated to Italy. Few days after the admission the course of the illness was characterized by severe gastro-intestinal symptoms followed by respiratory failure, accompanied by pulmonary infiltration and high Ebola viral load in the bronchial aspirate and Plasmodium vivax co-infection. The patient received experimental antiviral therapy with favipiravir, convalescent plasma and ZMAb. Ebola viral load started to steadily decrease in the blood after ZMAb administration and became undetectable by day 19 after admission, while it persisted longer in urine samples. No temporal association was observed between viral load decay in plasma and administration of favipiravir. The patient completely recovered and was discharged 39 days after admission. Conclusions This is the first case of Ebola-related interstitial pneumonia documented by molecular testing of lung fluid specimens. This reports underlines the pivotal role of fluid replacement and advanced life support with mechanical ventilation in the management of patients with Ebola virus diseases respiratory failure. Beside our finding indicates a close temporal association between administration of cZMAb and Ebola virus clearance from blood. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1169-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola Petrosillo
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | - Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | | | - Antonino Di Caro
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | - Mario Antonini
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | - Vincenzo Puro
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
| | | | - Nakono Shindo
- Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland.
| | - Nicola Magrini
- Essential Medicines and Health Products Department, World Health Organization, Geneva, Switzerland.
| | - Gary P Kobinger
- Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome, Italy.
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Abstract
Ebola virus disease (EVD) is a zoonotic disease that causes severe haemorrhagic fever, with high fatality rates of up to 90% in humans. Today, there is no effective treatment available. Person-to-person transmission occurs through exposure to blood or body fluids, which can threaten other household members and first-line healthcare workers. The first cases of EVD in Guinea were identified on 22 March 2014. It was initially believed that this like previous outbreaks would be self-limiting. However, lack of public health infrastructure, delays in virus detection and late implementation of control interventions contributed to widespread transmission of EVD in a region inexperienced in dealing with the disease. Socio-cultural and economic factors probably also played a key role in the spread of the disease, resulting in the current large-scale outbreak. Some promising candidate treatments for this disease are now being developed.
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Affiliation(s)
- A Mirazimi
- Department of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
- National Veterinary Institute, Uppsala, Sweden
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177
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Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection. Dig Dis Sci 2015; 60:2590-603. [PMID: 25972150 DOI: 10.1007/s10620-015-3691-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/28/2015] [Indexed: 12/09/2022]
Abstract
AIM Although Ebola virus infection (EVI) clinically presents with common, prominent, gastroenterologic manifestations, this subject has not been previously reviewed. This work critically and comprehensively reviews this subject. METHODS This study is a comprehensive literature review generated by computerized search of literature, supplemented by review of monographs and textbooks in pathology, gastroenterology, infectious diseases, and virology. RESULTS Common gastrointestinal manifestations include diarrhea-70 %, nausea and vomiting-60 %, and abdominal pain-45 %. The diarrhea and nausea and vomiting frequently produce profound, life-threatening hypovolemia requiring intravenous administration of crystalloid solutions, and frequently produce electrolyte disorders requiring electrolyte supplementation. Although gastrointestinal hemorrhage was commonly reported in early epidemics, its frequency has decreased to 10 % with prevention of disseminated intravascular coagulation. Hyperamylasemia is commonly reported, but the frequency of pancreatitis is unknown. The mean serum AST and ALT levels are each about 200/UL, with an unusual pattern for viral hepatitis of AST > ALT. The serum alkaline phosphatase averages about 160 IU/L, whereas the total bilirubin averages about 0.8 mg/dL. Risks of contracting infection during endoscopy performed on infected patients are unknown, but may be significant, as indicated by hundreds of healthcare workers contracting EVI during epidemics before instituting strict infectious control measures and anecdotal evidence of one endoscopist contracting EVI from performing endoscopy on an infected patient. CONCLUSIONS Physicians must be vigilant for gastroenterologic manifestations of EVI for appropriate diagnosis and therapy. This work should stimulate clinicopathologic studies to improve the current understanding of the gastroenterologic pathophysiology. Endoscopy is currently not standardly recommended to evaluate diarrhea, nausea and vomiting, or abdominal pain associated with EVI due to potential risks, but may be considered for endoscopic therapy for active, life-threatening, GI hemorrhage.
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Rhein BA, Maury WJ. Ebola virus entry into host cells: identifying therapeutic strategies. CURRENT CLINICAL MICROBIOLOGY REPORTS 2015; 2:115-124. [PMID: 26509109 PMCID: PMC4617201 DOI: 10.1007/s40588-015-0021-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Filoviruses cause severe hemorrhagic fever in humans. The archetypal virus of this group, Ebola virus, is responsible for the current filovirus epidemic in West Africa. Filoviruses infect most mammalian cells, resulting in broad species tropism and likely contributing to rapid spread of virus throughout the body. A thorough understanding of filovirus entry events will facilitate the development of therapeutics against these critical steps in the viral life cycle. This review summarizes the current understanding of filovirus entry and discusses some of the recent advancements in therapeutic strategies that target entry.
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Affiliation(s)
- Bethany A. Rhein
- Department of Microbiology, University of Iowa, 3-701 Bowen Science Building, 51 Newton Rd, Iowa City, IA 52242 USA
| | - Wendy J. Maury
- Department of Microbiology, University of Iowa, 3-701 Bowen Science Building, 51 Newton Rd, Iowa City, IA 52242 USA
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179
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Torabi-Parizi P, Davey RT, Suffredini AF, Chertow DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest 2015; 147:1460-1466. [PMID: 25764372 PMCID: PMC4451704 DOI: 10.1378/chest.15-0278] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs' risk of infection during the provision of CPR, discuss physicians' duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care.
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Affiliation(s)
- Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | - Richard T Davey
- Clinical Research Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anthony F Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
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Heller JA, DeMaria S, Levine A, Heller BJ, Augoustides JG, Stone M, Silvay G, Goldberg A. Cardiovascular and Pulmonary Impact of the Ebola Virus: A Review of Current Literature and Practices. J Cardiothorac Vasc Anesth 2015; 29:1672-6. [PMID: 26706795 DOI: 10.1053/j.jvca.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Joshua A Heller
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Samuel DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Levine
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin J Heller
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Marc Stone
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Silvay
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew Goldberg
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
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181
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Ebola virus disease and Marburg disease in pregnancy: a review and management considerations for filovirus infection. Obstet Gynecol 2015; 125:1293-1298. [PMID: 26000499 DOI: 10.1097/aog.0000000000000853] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The largest-ever recorded outbreak of viral hemorrhagic fever is ongoing. As a result of the epidemic and rural nature of outbreaks, little is published about the Filovirus infections Ebola virus disease and Marburg disease in pregnancy. This review of viral hemorrhagic fever focusing on Marburg and Ebola uses knowledge of disease in nonpregnant individuals and pregnancy-specific data to inform management for pregnant women. Filovirus infection presentation is similar between pregnant and nonpregnant patients, although infections may be more severe in pregnancy. Although labeled as hemorrhagic fevers, Marburg and Ebola do not commonly cause gross bleeding and should be conceptualized as diseases of high gastrointestinal losses. Early, aggressive supportive care is the mainstay of Filovirus infection management with massive fluid resuscitation as the key management principle. Patients often require 5-10 L or more per day of intravenous or oral fluid to maintain circulating blood volume in the setting of ongoing gastrointestinal loss. Fluid shifts warrant aggressive monitoring and correction of potassium levels and acid-base disturbances to prevent life-threatening arrhythmias and metabolic complications. Regardless of maternal survival, fetal loss rates are nearly 100% in Filovirus infection, likely resulting from unchecked transplacental and hematogenous viral spread. High fetal loss rates support the placenta as a difficult-to-eradicate Filovirus infection reservoir. In conclusion, the management of Filovirus infection in pregnancy should focus on stabilizing the mother with intensive monitoring and aggressive fluid and electrolyte repletion as well as maintaining strict infection control to minimize transmission to others.
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182
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Flint M, Goodman CH, Bearden S, Blau DM, Amman BR, Basile AJ, Belser JA, Bergeron É, Bowen MD, Brault AC, Campbell S, Chakrabarti AK, Dodd KA, Erickson BR, Freeman MM, Gibbons A, Guerrero LW, Klena JD, Lash RR, Lo MK, McMullan LK, Momoh G, Massally JL, Goba A, Paddock CD, Priestley RA, Pyle M, Rayfield M, Russell BJ, Salzer JS, Sanchez AJ, Schuh AJ, Sealy TK, Steinau M, Stoddard RA, Taboy C, Turnsek M, Wang D, Zemtsova GE, Zivcec M, Spiropoulou CF, Ströher U, Towner JS, Nichol ST, Bird BH. Ebola Virus Diagnostics: The US Centers for Disease Control and Prevention Laboratory in Sierra Leone, August 2014 to March 2015. J Infect Dis 2015; 212 Suppl 2:S350-8. [PMID: 26232439 DOI: 10.1093/infdis/jiv361] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In August 2014, the Viral Special Pathogens Branch of the US Centers for Disease Control and Prevention established a field laboratory in Sierra Leone in response to the ongoing Ebola virus outbreak. Through March 2015, this laboratory tested >12 000 specimens from throughout Sierra Leone. We describe the organization and procedures of the laboratory located in Bo, Sierra Leone.
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Affiliation(s)
| | | | - Scott Bearden
- Bacterial Diseases branches, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | | | | | | | | | | | | | | | | | - Kimberly A Dodd
- University of California, Davis, School of Veterinary Medicine
| | | | | | | | | | - John D Klena
- Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, China
| | | | | | | | - Gbetuwa Momoh
- Ministry of Health and Sanitation, Kenema Government Hospital, Sierra Leone
| | - James L Massally
- Ministry of Health and Sanitation, Kenema Government Hospital, Sierra Leone
| | - Augustine Goba
- Ministry of Health and Sanitation, Kenema Government Hospital, Sierra Leone
| | | | | | | | | | | | | | - Angela J Sanchez
- Office of Technology and Innovation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | - David Wang
- Influenza Division, Immunology and Pathogenesis
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183
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Abstract
UNLABELLED Marburg virus is a genetically simple RNA virus that causes a severe hemorrhagic fever in humans and nonhuman primates. The mechanism of pathogenesis of the infection is not well understood, but it is well accepted that pathogenesis is appreciably driven by a hyperactive immune response. To better understand the overall response to Marburg virus challenge, we undertook a transcriptomic analysis of immune cells circulating in the blood following aerosol exposure of rhesus macaques to a lethal dose of Marburg virus. Using two-color microarrays, we analyzed the transcriptomes of peripheral blood mononuclear cells that were collected throughout the course of infection from 1 to 9 days postexposure, representing the full course of the infection. The response followed a 3-stage induction (early infection, 1 to 3 days postexposure; midinfection, 5 days postexposure; late infection, 7 to 9 days postexposure) that was led by a robust innate immune response. The host response to aerosolized Marburg virus was evident at 1 day postexposure. Analysis of cytokine transcripts that were overexpressed during infection indicated that previously unanalyzed cytokines are likely induced in response to exposure to Marburg virus and further suggested that the early immune response is skewed toward a Th2 response that would hamper the development of an effective antiviral immune response early in disease. Late infection events included the upregulation of coagulation-associated factors. These findings demonstrate very early host responses to Marburg virus infection and provide a rich data set for identification of factors expressed throughout the course of infection that can be investigated as markers of infection and targets for therapy. IMPORTANCE Marburg virus causes a severe infection that is associated with high mortality and hemorrhage. The disease is associated with an immune response that contributes to the lethality of the disease. In this study, we investigated how the immune cells circulating in the blood of infected primates respond following exposure to Marburg virus. Our results show that there are three discernible stages of response to infection that correlate with presymptomatic, early, and late symptomatic stages of infection, a response format similar to that seen following challenge with other hemorrhagic fever viruses. In contrast to the ability of the virus to block innate immune signaling in vitro, the earliest and most sustained response is an interferon-like response. Our analysis also identifies a number of cytokines that are transcriptionally upregulated during late stages of infection and suggest that there is a Th2-skewed response to infection. When correlated with companion data describing the animal model from which our samples were collected, our results suggest that the innate immune response may contribute to overall pathogenesis.
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184
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Prati C, Chirouze C, Wendling D. Can we run into Ebola in rheumatology departments? Joint Bone Spine 2015; 82:394-6. [PMID: 26190455 DOI: 10.1016/j.jbspin.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Clément Prati
- Service de rhumatologie, CHRU Jean-Minjoz, boulevard Fleming, 25030 Besançon, France
| | - Catherine Chirouze
- Service des maladies infectieuses et tropicales, CHRU de Besançon, 25030 Besançon, France
| | - Daniel Wendling
- Service de rhumatologie, CHRU Jean-Minjoz, boulevard Fleming, 25030 Besançon, France.
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185
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The crux and crust of ebolavirus: Analysis of genome sequences and glycoprotein gene. Biochem Biophys Res Commun 2015; 463:756-61. [PMID: 26051281 DOI: 10.1016/j.bbrc.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/02/2015] [Indexed: 01/07/2023]
Abstract
The recent 2013-15 epidemic of Ebola virus disease (EVD) has initiated extensive sequencing and analysis of ebolavirus genomes. All ebolavirus genomes available until December 2014 have been collated and analyzed in this study to obtain phylogenetic relationship and uncover the variations amongst them. The terminal 'leader' and 'trailer' nucleotide sequences of the genomes were omitted and analysis of the intermediate region accommodating the sole seven genes (hepta-CDS region) of the virus showed relative stability of the genome, including the ones isolated from the current epidemic. The genome information was scrutinized to detect the variation in the surface glycoprotein gene and annotate its three protein products, resulting from its atypical transcription. This study will make an easy understanding of the genomes for those who desire to exploit the genome sequences for different investigations in EVD.
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186
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Falasca L, Agrati C, Petrosillo N, Di Caro A, Capobianchi MR, Ippolito G, Piacentini M. Molecular mechanisms of Ebola virus pathogenesis: focus on cell death. Cell Death Differ 2015; 22:1250-9. [PMID: 26024394 PMCID: PMC4495366 DOI: 10.1038/cdd.2015.67] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/31/2015] [Accepted: 04/20/2015] [Indexed: 12/28/2022] Open
Abstract
Ebola virus (EBOV) belongs to the Filoviridae family and is responsible for a severe disease characterized by the sudden onset of fever and malaise accompanied by other non-specific signs and symptoms; in 30–50% of cases hemorrhagic symptoms are present. Multiorgan dysfunction occurs in severe forms with a mortality up to 90%. The EBOV first attacks macrophages and dendritic immune cells. The innate immune reaction is characterized by a cytokine storm, with secretion of numerous pro-inflammatory cytokines, which induces a huge number of contradictory signals and hurts the immune cells, as well as other tissues. Other highly pathogenic viruses also trigger cytokine storms, but Filoviruses are thought to be particularly lethal because they affect a wide array of tissues. In addition to the immune system, EBOV attacks the spleen and kidneys, where it kills cells that help the body to regulate its fluid and chemical balance and that make proteins that help the blood to clot. In addition, EBOV causes liver, lungs and kidneys to shut down their functions and the blood vessels to leak fluid into surrounding tissues. In this review, we analyze the molecular mechanisms at the basis of Ebola pathogenesis with a particular focus on the cell death pathways induced by the virus. We also discuss how the treatment of the infection can benefit from the recent experience of blocking/modulating cell death in human degenerative diseases.
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Affiliation(s)
- L Falasca
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - C Agrati
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - N Petrosillo
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - A Di Caro
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - M R Capobianchi
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - G Ippolito
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - M Piacentini
- 1] National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy [2] Department of Biology, University of Rome Tor Vergata, Rome, Italy
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187
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Filewod NC, Lee WL. Is strengthening the endothelial barrier a therapeutic strategy for Ebola? Int J Infect Dis 2015; 36:78-9. [PMID: 26025870 DOI: 10.1016/j.ijid.2015.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 12/24/2022] Open
Affiliation(s)
- Niall C Filewod
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Warren L Lee
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
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188
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MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM. Uncertainty, risk analysis and change for Ebola personal protective equipment guidelines. Int J Nurs Stud 2015; 52:899-903. [PMID: 25575750 PMCID: PMC7130314 DOI: 10.1016/j.ijnurstu.2014.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/03/2014] [Indexed: 12/03/2022]
Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Guy A Richards
- University of the Witwatersrand Johannesburg, Johannesburg, South Africa; Critical Care Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Patricia M Davidson
- Johns Hopkins University, Baltimore, ML, USA; University of Technology, Sydney, Australia
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189
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Bickler SW, Lizardo RE, De Maio A. The transition from a rural to an urban environment alters expression of the human Ebola virus receptor Neiman-Pick C1: implications for the current epidemic in West Africa. Cell Stress Chaperones 2015; 20:203-6. [PMID: 25477151 PMCID: PMC4326391 DOI: 10.1007/s12192-014-0557-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 01/06/2023] Open
Affiliation(s)
- Stephen W. Bickler
- />Center for Investigations of Health and Education Disparities, University of California San Diego, 9500 Gilman Drive, #0739, La Jolla, CA 92093-0739 USA
- />Department of Surgery, School of Medicine, University of California, La Jolla, CA 92093 USA
- />Division of Pediatric Surgery, Rady Children’s Hospital, San Diego, CA 92123 USA
| | - Radhames E. Lizardo
- />Center for Investigations of Health and Education Disparities, University of California San Diego, 9500 Gilman Drive, #0739, La Jolla, CA 92093-0739 USA
- />Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134 USA
- />Division of Pediatric Surgery, Rady Children’s Hospital, San Diego, CA 92123 USA
| | - Antonio De Maio
- />Center for Investigations of Health and Education Disparities, University of California San Diego, 9500 Gilman Drive, #0739, La Jolla, CA 92093-0739 USA
- />Department of Surgery, School of Medicine, University of California, La Jolla, CA 92093 USA
- />Department of Neurosciences, School of Medicine, University of California, La Jolla, CA 92093 USA
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190
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Osterholm MT, Moore KA, Kelley NS, Brosseau LM, Wong G, Murphy FA, Peters CJ, LeDuc JW, Russell PK, Van Herp M, Kapetshi J, Muyembe JJT, Ilunga BK, Strong JE, Grolla A, Wolz A, Kargbo B, Kargbo DK, Sanders DA, Kobinger GP. Transmission of Ebola viruses: what we know and what we do not know. mBio 2015; 6:e00137. [PMID: 25698835 PMCID: PMC4358015 DOI: 10.1128/mbio.00137-15] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Available evidence demonstrates that direct patient contact and contact with infectious body fluids are the primary modes for Ebola virus transmission, but this is based on a limited number of studies. Key areas requiring further study include (i) the role of aerosol transmission (either via large droplets or small particles in the vicinity of source patients), (ii) the role of environmental contamination and fomite transmission, (iii) the degree to which minimally or mildly ill persons transmit infection, (iv) how long clinically relevant infectiousness persists, (v) the role that "superspreading events" may play in driving transmission dynamics, (vi) whether strain differences or repeated serial passage in outbreak settings can impact virus transmission, and (vii) what role sylvatic or domestic animals could play in outbreak propagation, particularly during major epidemics such as the 2013-2015 West Africa situation. In this review, we address what we know and what we do not know about Ebola virus transmission. We also hypothesize that Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.
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Affiliation(s)
- Michael T Osterholm
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine A Moore
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicholas S Kelley
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa M Brosseau
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gary Wong
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Frederick A Murphy
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Clarence J Peters
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - James W LeDuc
- The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Michel Van Herp
- Medical Department Unit, Médecins sans Frontières, Brussels, Belgium
| | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | | | - James E Strong
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Allen Grolla
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
| | - Anja Wolz
- Medical Department Unit, Médecins sans Frontières, Brussels, Belgium
| | - Brima Kargbo
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - David K Kargbo
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - David Avram Sanders
- Department of Biological Sciences, Purdue University, Lafayette, Indiana, USA
| | - Gary P Kobinger
- National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada
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191
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Anti-diarrheal medication use in the treatment of Ebola virus-induced diarrhea. Travel Med Infect Dis 2015; 13:205-6. [PMID: 25682446 DOI: 10.1016/j.tmaid.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 01/22/2015] [Accepted: 01/27/2015] [Indexed: 11/24/2022]
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192
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Herrington CS, Coates PJ, Duprex WP. Viruses and disease: emerging concepts for prevention, diagnosis and treatment. J Pathol 2015; 235:149-52. [PMID: 25366544 PMCID: PMC7168080 DOI: 10.1002/path.4476] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 12/27/2022]
Abstract
Viruses cause a wide range of human diseases, ranging from acute self‐resolving conditions to acute fatal diseases. Effects that arise long after the primary infection can also increase the propensity for chronic conditions or lead to the development of cancer. Recent advances in the fields of virology and pathology have been fundamental in improving our understanding of viral pathogenesis, in providing improved vaccination strategies and in developing newer, more effective treatments for patients worldwide. The reviews assembled here focus on the interface between virology and pathology and encompass aspects of both the clinical pathology of viral disease and the underlying disease mechanisms. Articles on emerging diseases caused by Ebola virus, Marburg virus, coronaviruses such as SARS and MERS, Nipah virus and noroviruses are followed by reviews of enteroviruses, HIV infection, measles, mumps, human respiratory syncytial virus (RSV), influenza, cytomegalovirus (CMV) and varicella zoster virus (VZV). The issue concludes with a series of articles reviewing the relationship between viruses and cancer, including the role played by Epstein–Barr virus (EBV) in the pathogenesis of lymphoma and carcinoma; how human papillomaviruses (HPVs) are involved in the development of skin cancer; the involvement of hepatitis B virus infection in hepatocellular carcinoma; and the mechanisms by which Kaposi's sarcoma‐associated herpesvirus (KSHV) leads to Kaposi's sarcoma. We hope that this collection of articles will be of interest to a wide range of scientists and clinicians at a time when there is a renaissance in the appreciation of the power of pathology as virologists dissect the processes of disease. Copyright © 2014 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- C S Herrington
- Medical Research Institute, University of Dundee Medical School, Ninewells Hospital, Dundee, UK
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193
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Abstract
The development of treatments for Ebola virus disease (EVD) has been hampered by the lack of small-animal models that mimick human disease. Here we show that mice with transplanted human hematopoetic stem cells reproduce features typical of EVD. Infection with Ebola virus was associated with viremia, cell damage, liver steatosis, signs of hemorrhage, and high lethality. Our study provides a small-animal model with human components for the development of EVD therapies.
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194
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Faubel S, Franch H, Vijayan A, Barron MA, Heung M, Liu KD, Koyner JL, Conner MJ. Preparing for renal replacement therapy in patients with the Ebola virus disease. Blood Purif 2015; 38:276-85. [PMID: 25675963 DOI: 10.1159/000371530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Ebola virus disease (EVD) is a serious illness characterized by fever, severe vomiting and diarrhea, and, in severe cases, multi-organ failure requiring mechanical ventilation and renal replacement therapy. The current outbreak has centered in West Africa and affected over 15,000 individuals. EVD is transmitted by direct contact with blood or other infectious bodily fluid, and as such, numerous heath care workers caring for patients with EVD have become infected. During the current outbreak, a number of patients have received advanced supportive care for EVD in Europe and North America and therefore survived. Now, many hospitals in Europe and North America are planning to accept care for patients with EVD. In this review, we discussed the key issues related to the planning and delivery of advanced supportive care in patients with EVD with a focus on the factors necessary to provide renal replacement therapy (RRT). Since success in the treatment of patients with EVD rests on both patient outcome and prevention of transmission of disease to health care workers, we extensively discussed the modes of Ebola virus transmission and recommended protocols to protect health care workers. Experience now indicates that with appropriate planning and protocols, it is possible to successfully treat EVD patients with advanced supportive care (mechanical ventilation and RRT) while avoiding transmission to health care providers. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=371530.
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Affiliation(s)
- Sarah Faubel
- University of Colorado Denver and VA Medical Center, Renal Division, Denver, Colo., USA
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195
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van der Ven AJAM, Netea MG, van der Meer JWM, de Mast Q. Ebola Virus Disease has Features of Hemophagocytic Lymphohistiocytosis Syndrome. Front Med (Lausanne) 2015; 2:4. [PMID: 25699258 PMCID: PMC4316785 DOI: 10.3389/fmed.2015.00004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/10/2015] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Centre , Nijmegen , Netherlands
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical Centre , Nijmegen , Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Centre , Nijmegen , Netherlands
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196
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Judson S, Prescott J, Munster V. Understanding ebola virus transmission. Viruses 2015; 7:511-21. [PMID: 25654239 PMCID: PMC4353901 DOI: 10.3390/v7020511] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/21/2015] [Accepted: 01/29/2015] [Indexed: 12/01/2022] Open
Abstract
An unprecedented number of Ebola virus infections among healthcare workers and patients have raised questions about our understanding of Ebola virus transmission. Here, we explore different routes of Ebola virus transmission between people, summarizing the known epidemiological and experimental data. From this data, we expose important gaps in Ebola virus research pertinent to outbreak situations. We further propose experiments and methods of data collection that will enable scientists to fill these voids in our knowledge about the transmission of Ebola virus.
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Affiliation(s)
- Seth Judson
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
| | - Joseph Prescott
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
| | - Vincent Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
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197
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198
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Kilgore PE, Grabenstein JD, Salim AM, Rybak M. Treatment of Ebola Virus Disease. Pharmacotherapy 2015; 35:43-53. [DOI: 10.1002/phar.1545] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paul E. Kilgore
- Department of Pharmacy Practice; Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
| | | | - Abdulbaset M. Salim
- Department of Pharmacy Practice; Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
| | - Michael Rybak
- Department of Pharmacy Practice; Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
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199
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Obilade TT. The Political Economy of the Ebola Virus Disease (EVD); Taking Individual and Community Ownership in the Prevention and Control of EVD. Healthcare (Basel) 2015; 3:36-49. [PMID: 27417746 PMCID: PMC4934522 DOI: 10.3390/healthcare3010036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022] Open
Abstract
The outbreak of an emerging infectious disease of zoonotic origin has exposed the weaknesses in the health systems of the nations affected. The purpose of this paper was to explore the political economy of the existing outcome of the management strategies. In addition, it proposed a new strategy in the management of the current Ebola virus disease (EVD) outbreak. This paper admits that the current management strategy which is a top to bottom approach has not worked in reducing the spread of the disease. Instead of waiting for the disease before treatment is commenced, this paper suggests aggressively preventing infection from the EVD. It presents a bottom to top approach where there is individual ownership and community ownership in the prevention and control of the EVD outbreak. In addition, the paper presents the socio-economic situation of the three most affected countries including the ecology and stigmatization of EVD. It highlights the need for cross border surveillance across the West African nations to prevent importation of the disease as occurred in Nigeria and Senegal. It points out the need for aggressive international cooperation, an aggressive prevention and a sustainable control strategy.
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Affiliation(s)
- Titilola T Obilade
- Learning Sciences and Technology, Virginia Polytechnic Institute and State University, 144J Smyth Hall, Blacksburg, VA 24061-0488, USA.
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200
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Anderson G, Maes M, Markus RP, Rodriguez M. Ebola virus: Melatonin as a readily available treatment option. J Med Virol 2015; 87:537-43. [DOI: 10.1002/jmv.24130] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 01/10/2023]
Affiliation(s)
- George Anderson
- CRC Scotland and London; Eccleston Square; London United Kingdom
| | - Michael Maes
- Impact Strategic Treatment Center; Deakin University; Geelong Australia
- Department of Psychiatry; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Health Sciences Graduate Program; Health Sciences Center; State University of Londrina; Brazil
| | - Regina P. Markus
- Lab Chronopharmacology; Department of Physiology; Institute of Bioscience; University de S; ã; o Paulo; Brazil
| | - Moses Rodriguez
- Department of Immunology; Department of Neurology; Mayo Clinic; Rochester New York
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