151
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Li C, Revote J, Ramarathinam SH, Chung SZ, Croft NP, Scull KE, Huang Z, Ayala R, Braun A, Mifsud NA, Illing PT, Faridi P, Purcell AW. Resourcing, annotating, and analysing synthetic peptides of SARS-CoV-2 for immunopeptidomics and other immunological studies. Proteomics 2021; 21:e2100036. [PMID: 33811468 PMCID: PMC8250278 DOI: 10.1002/pmic.202100036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
SARS-CoV-2 has caused a significant ongoing pandemic worldwide. A number of studies have examined the T cell mediated immune responses against SARS-CoV-2, identifying potential T cell epitopes derived from the SARS-CoV-2 proteome. Such studies will aid in identifying targets for vaccination and immune monitoring. In this study, we applied tandem mass spectrometry and proteomic techniques to a library of ∼40,000 synthetic peptides, in order to generate a large dataset of SARS-CoV-2 derived peptide MS/MS spectra. On this basis, we built an online knowledgebase, termed virusMS (https://virusms.erc.monash.edu/), to document, annotate and analyse these synthetic peptides and their spectral information. VirusMS incorporates a user-friendly interface to facilitate searching, browsing and downloading the database content. Detailed annotations of the peptides, including experimental information, peptide modifications, predicted peptide-HLA (human leukocyte antigen) binding affinities, and peptide MS/MS spectral data, are provided in virusMS.
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Affiliation(s)
- Chen Li
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Jerico Revote
- Monash Bioinformatics PlatformMonash UniversityMelbourneVictoriaAustralia
| | - Sri H. Ramarathinam
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Shan Zou Chung
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Nathan P. Croft
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Katherine E. Scull
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Ziyi Huang
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Rochelle Ayala
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Asolina Braun
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Nicole A. Mifsud
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Patricia T. Illing
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Pouya Faridi
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Anthony W. Purcell
- Department of Biochemistry and Molecular Biology and Infection and Immunity ProgramMonash Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
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152
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Mahil SK, Bechman K, Raharja A, Domingo-Vila C, Baudry D, Brown MA, Cope AP, Dasandi T, Graham C, Lechmere T, Malim MH, Meynell F, Pollock E, Seow J, Sychowska K, Barker JN, Norton S, Galloway JB, Doores KJ, Tree TIM, Smith CH. The effect of methotrexate and targeted immunosuppression on humoral and cellular immune responses to the COVID-19 vaccine BNT162b2: a cohort study. THE LANCET. RHEUMATOLOGY 2021; 3:e627-e637. [PMID: 34258590 PMCID: PMC8266273 DOI: 10.1016/s2665-9913(21)00212-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients on therapeutic immunosuppressants for immune-mediated inflammatory diseases were excluded from COVID-19 vaccine trials. We therefore aimed to evaluate humoral and cellular immune responses to COVID-19 vaccine BNT162b2 (Pfizer-BioNTech) in patients taking methotrexate and commonly used targeted biological therapies, compared with healthy controls. Given the roll-out of extended interval vaccination programmes to maximise population coverage, we present findings after the first dose. METHODS In this cohort study, we recruited consecutive patients with a dermatologist-confirmed diagnosis of psoriasis who were receiving methotrexate or targeted biological monotherapy (tumour necrosis factor [TNF] inhibitors, interleukin [IL]-17 inhibitors, or IL-23 inhibitors) from a specialist psoriasis centre serving London and South East England. Consecutive volunteers without psoriasis and not receiving systemic immunosuppression who presented for vaccination at Guy's and St Thomas' NHS Foundation Trust (London, UK) were included as the healthy control cohort. All participants had to be eligible to receive the BNT162b2 vaccine. Immunogenicity was evaluated immediately before and on day 28 (±2 days) after vaccination. The primary outcomes were humoral immunity to the SARS-CoV-2 spike glycoprotein, defined as neutralising antibody responses to wild-type SARS-CoV-2, and spike-specific T-cell responses (including interferon-γ, IL-2, and IL-21) 28 days after vaccination. FINDINGS Between Jan 14 and April 4, 2021, 84 patients with psoriasis (17 on methotrexate, 27 on TNF inhibitors, 15 on IL-17 inhibitors, and 25 on IL-23 inhibitors) and 17 healthy controls were included. The study population had a median age of 43 years (IQR 31-52), with 56 (55%) males, 45 (45%) females, and 85 (84%) participants of White ethnicity. Seroconversion rates were lower in patients receiving immunosuppressants (60 [78%; 95% CI 67-87] of 77) than in controls (17 [100%; 80-100] of 17), with the lowest rate in those receiving methotrexate (seven [47%; 21-73] of 15). Neutralising activity against wild-type SARS-CoV-2 was significantly lower in patients receiving methotrexate (median 50% inhibitory dilution 129 [IQR 40-236]) than in controls (317 [213-487], p=0·0032), but was preserved in those receiving targeted biologics (269 [141-418]). Neutralising titres against the B.1.1.7 variant were similarly low in all participants. Cellular immune responses were induced in all groups, and were not attenuated in patients receiving methotrexate or targeted biologics compared with controls. INTERPRETATION Functional humoral immunity to a single dose of BNT162b2 is impaired by methotrexate but not by targeted biologics, whereas cellular responses are preserved. Seroconversion alone might not adequately reflect vaccine immunogenicity in individuals with immune-mediated inflammatory diseases receiving therapeutic immunosuppression. Real-world pharmacovigilance studies will determine how these findings reflect clinical effectiveness. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Katie Bechman
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Antony Raharja
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Clara Domingo-Vila
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - David Baudry
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Matthew A Brown
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Tejus Dasandi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Thomas Lechmere
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Freya Meynell
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Emily Pollock
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jeffery Seow
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Kamila Sychowska
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Institute for Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Timothy I M Tree
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
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153
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Neurath MF, Überla K, Ng SC. Gut as viral reservoir: lessons from gut viromes, HIV and COVID-19. Gut 2021; 70:1605-1608. [PMID: 33903146 PMCID: PMC8076629 DOI: 10.1136/gutjnl-2021-324622] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Markus F Neurath
- First Department of Medicine & Deutsches Zentrum Immuntherapie DZI, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology & Deutsches Zentrum für Immuntherapie (DZI), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Siew C Ng
- Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
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154
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Mascellino MT, Di Timoteo F, De Angelis M, Oliva A. Overview of the Main Anti-SARS-CoV-2 Vaccines: Mechanism of Action, Efficacy and Safety. Infect Drug Resist 2021; 14:3459-3476. [PMID: 34511939 PMCID: PMC8418359 DOI: 10.2147/idr.s315727] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/28/2021] [Indexed: 12/26/2022] Open
Abstract
This review takes into consideration the principal vaccines developed against the SARS-CoV-2 in this unprecedented period of Covid-19 pandemic. We evaluated the mechanism of action of each vaccine as well as the efficacy, the safety and the storage temperature. In addition, the problem of the dose units, the vaccinal strategy, the activity of alternative compounds such as the monoclonal antibodies and especially the issue of the virus variants were also described in detail. Four vaccines are currently used in Italy: Pfizer-BioNTech mRNA BNT162b2 (Comirnaty) (USA), Moderna mRNA 1273 (USA), Astra-Zeneca ChAdOx1-S (recombinant) viral vector adenovirus belonging to Oxford (UK) and Pomezia (Italy), Janssen (two recombinant viral vector adenoviruses) belonging to Johnson & Johnson (USA). The efficacy of Pfizer and Moderna for preventing disease or severe disease results 95-87.5% and 94.5-100%, respectively. The efficacy of Astra-Zeneca and Janssen is about 70% and 65%, respectively; in the case of Janssen, it depends on the geographical area ranging from 72% to 57%. The problem of the administrated doses (one dose, two doses from the same vaccine or from different vaccines, half dose) is also discussed. The vaccination strategy based on the age group remains the simplest, most transparent and fair criterion. This strategy is also based on accelerating the administration of the vaccines, so that as many subjects as possible can be vaccinated quickly for achieving the "herd immunity". The monoclonal antibodies appeared to be a valid solution for the treatment of Covid-19 disease. Two antibodies (bamlanivimab and etesevimab) have just been approved by the FDA. They could also be used for the infection by virus variants which represent a big problem due to their higher transmissibility and virulence and to their lower response to the vaccines.
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Affiliation(s)
- Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Lazio, Italy
| | - Federica Di Timoteo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Lazio, Italy
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Lazio, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Lazio, Italy
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155
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Volpatti LR, Wallace RP, Cao S, Raczy MM, Wang R, Gray LT, Alpar AT, Briquez PS, Mitrousis N, Marchell TM, Sasso MS, Nguyen M, Mansurov A, Budina E, Solanki A, Watkins EA, Schnorenberg MR, Tremain AC, Reda JW, Nicolaescu V, Furlong K, Dvorkin S, Yu SS, Manicassamy B, LaBelle JL, Tirrell MV, Randall G, Kwissa M, Swartz MA, Hubbell JA. Polymersomes Decorated with the SARS-CoV-2 Spike Protein Receptor-Binding Domain Elicit Robust Humoral and Cellular Immunity. ACS CENTRAL SCIENCE 2021; 7:1368-1380. [PMID: 34466656 PMCID: PMC8315245 DOI: 10.1021/acscentsci.1c00596] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic underscores the need for rapid, safe, and effective vaccines. In contrast to some traditional vaccines, nanoparticle-based subunit vaccines are particularly efficient in trafficking antigens to lymph nodes, where they induce potent immune cell activation. Here, we developed a strategy to decorate the surface of oxidation-sensitive polymersomes with multiple copies of the SARS-CoV-2 spike protein receptor-binding domain (RBD) to mimic the physical form of a virus particle. We evaluated the vaccination efficacy of these surface-decorated polymersomes (RBDsurf) in mice compared to RBD-encapsulated polymersomes (RBDencap) and unformulated RBD (RBDfree), using monophosphoryl-lipid-A-encapsulated polymersomes (MPLA PS) as an adjuvant. While all three groups produced high titers of RBD-specific IgG, only RBDsurf elicited a neutralizing antibody response to SARS-CoV-2 comparable to that of human convalescent plasma. Moreover, RBDsurf was the only group to significantly increase the proportion of RBD-specific germinal center B cells in the vaccination-site draining lymph nodes. Both RBDsurf and RBDencap drove similarly robust CD4+ and CD8+ T cell responses that produced multiple Th1-type cytokines. We conclude that a multivalent surface display of spike RBD on polymersomes promotes a potent neutralizing antibody response to SARS-CoV-2, while both antigen formulations promote robust T cell immunity.
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Affiliation(s)
- Lisa R. Volpatti
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Rachel P. Wallace
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Shijie Cao
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Michal M. Raczy
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Ruyi Wang
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Laura T. Gray
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Aaron T. Alpar
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Priscilla S. Briquez
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Nikolaos Mitrousis
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Tiffany M. Marchell
- Committee
on Immunology, University of Chicago, Chicago, Illinois 60637, United States
| | - Maria Stella Sasso
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Mindy Nguyen
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Aslan Mansurov
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Erica Budina
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Ani Solanki
- Animal
Resources Center, University of Chicago, Chicago, Illinois 60637, United States
| | - Elyse A. Watkins
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Mathew R. Schnorenberg
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Andrew C. Tremain
- Committee
on Immunology, University of Chicago, Chicago, Illinois 60637, United States
| | - Joseph W. Reda
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Vlad Nicolaescu
- Department
of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, Illinois 60637, United States
| | - Kevin Furlong
- Department
of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, Illinois 60637, United States
| | - Steve Dvorkin
- Department
of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, Illinois 60637, United States
| | - Shann S. Yu
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Balaji Manicassamy
- Department
of Microbiology and Immunology, University
of Iowa, Iowa City, Iowa 52242, United
States
| | - James L. LaBelle
- Department
of Pediatrics, University of Chicago Comer
Children’s Hospital, Chicago, Illinois 60637, United States
| | - Matthew V. Tirrell
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
- Materials
Science Division, Argonne National Laboratory, Lemont, Illinois 60439, United States
| | - Glenn Randall
- Department
of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, Illinois 60637, United States
| | - Marcin Kwissa
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
| | - Melody A. Swartz
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
- Committee
on Immunology, University of Chicago, Chicago, Illinois 60637, United States
- Ben
May Department of Cancer Research, University
of Chicago, Chicago, Illinois 60637, United States
- Committee
on Cancer Biology, University of Chicago, Chicago, Illinois 60637, United States
| | - Jeffrey A. Hubbell
- Pritzker
School of Molecular Engineering, University
of Chicago, Chicago, Illinois 60637, United States
- Committee
on Immunology, University of Chicago, Chicago, Illinois 60637, United States
- Committee
on Cancer Biology, University of Chicago, Chicago, Illinois 60637, United States
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156
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Arumugam S, Varamballi P. In-silico design of envelope based multi-epitope vaccine candidate against Kyasanur forest disease virus. Sci Rep 2021; 11:17118. [PMID: 34429443 PMCID: PMC8384868 DOI: 10.1038/s41598-021-94488-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023] Open
Abstract
Kyasanur forest disease virus (KFDV) causing tick-borne hemorrhagic fever which was earlier endemic to western Ghats, southern India, it is now encroaching into new geographic regions, but there is no approved medicine or effective vaccine against this deadly disease. In this study, we did in-silico design of multi-epitope subunit vaccine for KFDV. B-cell and T-cell epitopes were predicted from conserved regions of KFDV envelope protein and two vaccine candidates (VC1 and VC2) were constructed, those were found to be non-allergic and possess good antigenic properties, also gives cross-protection against Alkhurma hemorrhagic fever virus. The 3D structures of vaccine candidates were built and validated. Docking analysis of vaccine candidates with toll-like receptor-2 (TLR-2) by Cluspro and PatchDock revealed strong affinity between VC1 and TLR2. Ligplot tool was identified the intermolecular hydrogen bonds between vaccine candidates and TLR-2, iMOD server confirmed the stability of the docking complexes. JCAT sever ensured cloning efficiency of both vaccine constructs and in-silico cloning into pET30a (+) vector by SnapGene showed successful translation of epitope region. IMMSIM server was identified increased immunological responses. Finally, multi-epitope vaccine candidates were designed and validated their efficiency, it may pave the way for up-coming vaccine and diagnostic kit development.
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Affiliation(s)
- Sathishkumar Arumugam
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Prasad Varamballi
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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157
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Elalamy I, Gerotziafas G, Alamowitch S, Laroche JP, Van Dreden P, Ageno W, Beyer-Westendorf J, Cohen AT, Jimenez D, Brenner B, Middeldorp S, Cacoub P. SARS-CoV-2 Vaccine and Thrombosis: An Expert Consensus on Vaccine-Induced Immune Thrombotic Thrombocytopenia. Thromb Haemost 2021; 121:982-991. [PMID: 33946120 PMCID: PMC8322589 DOI: 10.1055/a-1499-0119] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
Historically, the vaccination strategies developed in the second half of the 20th century have facilitated the eradication of infectious diseases. From the onset of COVID-19 pandemic to the end of April 2021, more than 150 million cases and 3 million deaths were documented worldwide with disruption of the economic and social activity, and with devastating material, physical, and psychological consequences. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the population and the medical community. This report is intended to provide practical answers following an overview of our knowledge on these thrombotic events that are extremely rare but have serious consequences. Vaccine hesitancy threatens to reverse the progress made in controlling vaccine-preventable diseases. These adverse events must be put into perspective with an objective analysis of the facts and the issues of the vaccination strategy during this SARS-CoV-2 pandemic. Health care professionals remain the most pertinent advisors and influencers regarding vaccination decisions; they have to be supported to provide reliable and credible information on vaccines. We need to inform, reassure, and support our patients when the prescription is made. Facing these challenges and observations, a panel of experts express their insights and propose a tracking algorithm for vaccinated patients based on a 10-point guideline for decision-making on what to do and not to do.
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Affiliation(s)
- Ismail Elalamy
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Grigoris Gerotziafas
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Sonia Alamowitch
- AP-HP, Service des Urgences cérébro-vasculaires, Hôpital Pitié-Salpétrière, Paris, France
- Centre de recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université Paris, France
| | - Jean-Pierre Laroche
- Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, Montpellier cedex 5, France
- Médipôle, 1139, chemin du Lavarin, Avignon, France
| | - Patrick Van Dreden
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Walter Ageno
- Department of Emergency Medicine and Thrombosis Center, Ospedale di Circolo and Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Haematology and Haemostaseology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - David Jimenez
- Respiratory Department, Ramon y Cajal Hospital (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Benjamin Brenner
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut National de la Santé et de la Recherche Médicale, INSERM, Paris, France
- CNRS, FRE3632, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, Paris, France
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158
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Schramm R, Costard-Jäckle A, Rivinius R, Fischer B, Müller B, Boeken U, Haneya A, Provaznik Z, Knabbe C, Gummert J. Poor humoral and T-cell response to two-dose SARS-CoV-2 messenger RNA vaccine BNT162b2 in cardiothoracic transplant recipients. Clin Res Cardiol 2021; 110:1142-1149. [PMID: 34241676 PMCID: PMC8267767 DOI: 10.1007/s00392-021-01880-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
AIMS Immunocompromised patients have been excluded from studies of SARS-CoV-2 messenger RNA vaccines. The immune response to vaccines against other infectious agents has been shown to be blunted in such patients. We aimed to analyse the humoral and cellular response to prime-boost vaccination with the BNT162b2 vaccine (Pfizer-BioNTech) in cardiothoracic transplant recipients. METHODS AND RESULTS A total of 50 transplant patients [1-3 years post heart (42), lung (7), or heart-lung (1) transplant, mean age 55 ± 10 years] and a control group of 50 healthy staff members were included. Blood samples were analysed 21 days after the prime and the boosting dose, respectively, to quantify anti-SARS-CoV-2 spike protein (S) immunoglobulin titres (tested by Abbott, Euroimmun and RocheElecsys Immunoassays, each) and the functional inhibitory capacity of neutralizing antibodies (Genscript). To test for a specific T-cell response, heparinized whole blood was stimulated with SARS-CoV-2 specific peptides, covering domains of the viral spike, nucleocapsid and membrane protein, and the interferon-γ release was measured (QuantiFERON Monitor ELISA, Qiagen). The vast majority of transplant patients (90%) showed neither a detectable humoral nor a T-cell response three weeks after the completed two-dose BNT162b2 vaccination; these results are in sharp contrast to the robust immunogenicity seen in the control group: 98% exhibited seroconversion after the prime dose already, with a further significant increase of IgG titres after the booster dose (average > tenfold increase), a more than 90% inhibition capability of neutralizing antibodies as well as evidence of a T-cell responsiveness. CONCLUSIONS The findings of poor immune responses to a two-dose BNT162b2 vaccination in cardiothoracic transplant patients have a significant impact for organ transplant recipients specifically and possibly for immunocompromised patients in general. It urges for a review of future vaccine strategies in these patients.
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Affiliation(s)
- René Schramm
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Angelika Costard-Jäckle
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | - Rasmus Rivinius
- Klinik für Kardiologie, Angiologie Und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Bastian Fischer
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Benjamin Müller
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Udo Boeken
- Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Assad Haneya
- Klinik für Herznahe- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Zdenek Provaznik
- Klinik für Herz-, Thorax- Und Herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Cornelius Knabbe
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Jan Gummert
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
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Ragone C, Meola S, Fiorillo PC, Penta R, Auriemma L, Tornesello ML, Miscio L, Cavalcanti E, Botti G, Buonaguro FM, Bianchi A, Buonaguro L, Tagliamonte M. HLA Does Not Impact on Short-Medium-Term Antibody Response to Preventive Anti-SARS-Cov-2 Vaccine. Front Immunol 2021; 12:734689. [PMID: 34386018 PMCID: PMC8353253 DOI: 10.3389/fimmu.2021.734689] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
The response to anti-SARS-Cov-2 preventive vaccine shows high interpersonal variability at short and medium term. One of the explanations might be the individual HLA allelic variants. Indeed, B cell response is stimulated and sustained by CD4+ T helper cells activated by antigens presented by HLA-class II alleles on antigen-presenting cells (APCs). The impact of the number of antigens binding to HLA class-II alleles on the antibody response to the COVID vaccine has been assessed in a cohort of 56 healthcare workers who received the full schedule of the Pfizer-BioNTech BNT162b2 vaccine. Such vaccine is based on the entire spike protein of the SARS-CoV-2. Ab titers have been evaluated 2 weeks after the first dose as well as 2 weeks and 4 months after the boosting dose. HLA-DRB1 and DBQ1 for each of the vaccinees have been assessed, and strong binders have been predicted. The analysis showed no significant correlation between the short-medium-term Ab titers and the number of strong binders (SB) for each individual. These results indicate that levels of Ab response to the spike glycoprotein is not dependent on HLA class II allele, suggesting an equivalent efficacy at global level of the currently used vaccines. Furthermore, the pattern of persistence in Ab titer does not correlate with specific alleles or with the number of SBs.
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Affiliation(s)
- Concetta Ragone
- Innovative Immunological Models Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Serena Meola
- Laboratory Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Pasqualina C Fiorillo
- Laboratory Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Roberta Penta
- Ba.S.C.O. Unit, Cellular Manipulation and Immunogenetics, Oncology Department, AORN Santobono-Pausilipon, Naples, Italy
| | - Laura Auriemma
- Ba.S.C.O. Unit, Cellular Manipulation and Immunogenetics, Oncology Department, AORN Santobono-Pausilipon, Naples, Italy
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncogenesis Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Leonardo Miscio
- Medical Direction, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Franco M Buonaguro
- Molecular Biology and Viral Oncogenesis Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Attilio Bianchi
- General Direction, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Luigi Buonaguro
- Innovative Immunological Models Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
| | - Maria Tagliamonte
- Innovative Immunological Models Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Pascale"-IRCCS, Naples, Italy
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160
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Ghosh S, Yadav AK, Rajmohan KS, Bhalla S, Sekhawat VS, Prashant J, Dubey S, Sahai A, Rakesh CR, Chand S, Rawat MS, Gupta S, Dhawan R, Pandya K, Kotwal A. Seropositivity of severe acute respiratory syndrome coronavirus 2 infection among healthcare workers of the Armed Forces medical services, India: A multicentric study. Med J Armed Forces India 2021; 77:S359-S365. [PMID: 34334905 PMCID: PMC8313088 DOI: 10.1016/j.mjafi.2021.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Serosurveys provide the prevalence of infection and over time will reveal the trends. The present study was conducted to estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) and to analyse various characteristics (risk factors) associated with SARS CoV-2 infection. Methods Eight government designated Corona virus disease -19 (COVID-19) hospitals were selected based on the hospital admission of patients with COVID-19 and the local epidemiological situation in the region. Multistage population proportion to size sampling was performed for the selection of HCWs. Serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Bivariate and multiple logistic regression was performed to find out the factor/factors associated with the positive antibody test. Results Out of 3255 HCWs that participated in the study, data of 3253 were analysed. The seroprevalence was 19.7% (95% confidence interval: 18.5-21.3%). Factors associated were location, category of HCWs, male sex, previously tested positive by the molecular test, training on infection prevention and control, personal protective measures, handwashing technique, close contact with a patient confirmed with COVID-19, use of personal protective equipment and symptoms in the last 30 days. However, in multiple logistic regression, only location, category, previously tested positive by the molecular test and symptoms in the last 30 days were statistically significant. Conclusion HCWs are vulnerable to SARS-CoV-2 infection. One in five HCWs had detectable antibodies. The presence of antibodies among HCWs may help in their placement and triage. HCWs may be advised to report early in case of any symptoms of COVID-19. Preventive measures may be targeted based on the location, with particular emphasis on ancillary workers and nurses.
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Affiliation(s)
| | - Arun Kumar Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - K S Rajmohan
- Professor (Microbiology), Army College of Medical Sciences, New Delhi, India
| | - Sharad Bhalla
- Professor (Microbiology), Command Hospital (Eastern Command), Kolkata, India
| | - Vikram Singh Sekhawat
- Classified Specialist (Medicine) & Endocrinologist, INHS Asvini, Colaba, Mumbai, India
| | - J Prashant
- Classified Specialist (Microbiology), Army Institute of Cardio Thoracic Sciences, Pune, India
| | - Sudhir Dubey
- Associate Professor (Microbiology), Army Hospital (R&R), New Delhi, India
| | - Atul Sahai
- Classified Specialist (Pathology), Jammu, India
| | - C R Rakesh
- Classified Specialist (Surgery), Command Hospital (Air Force), Bengaluru, India
| | - Satish Chand
- Assistant Professor (Dermatology), Command Hospital (Air Force), Bengaluru, India
| | - M S Rawat
- Graded Specialist (Pathology), Military Hospital, Ahmedabad, India
| | - Shilpi Gupta
- Graded Specialist (Microbiology), Military Hospital, Jaipur, India
| | - Rakhi Dhawan
- Senior Registrar, Military Hospital, Jaipur, India
| | - Kapil Pandya
- Associate Professor, O/o DGAFMS, New Delhi, India
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161
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Lai CC, Chen IT, Chao CM, Lee PI, Ko WC, Hsueh PR. COVID-19 vaccines: concerns beyond protective efficacy and safety. Expert Rev Vaccines 2021; 20:1013-1025. [PMID: 34180347 DOI: 10.1080/14760584.2021.1949293] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Several vaccine candidates have been developed using different platforms, including nucleic acids (DNA and RNA), viral vectors (replicating and non-replicating), virus-like particles, peptide-based, recombinant proteins, live attenuated, and inactivated virus modalities. Although many of these vaccines are undergoing pre-clinical trials, several large clinical trials investigating the clinical efficacy and safety of coronavirus disease 2019 (COVID-19) vaccines have produced promising findings. AREAS COVERED In this review, we provide a status update on COVID-19 vaccines currently undergoing clinical trials and discuss issues of concern beyond vaccine efficacy and safety, including dosing regimens, the mixed vaccine strategy, prior severe acute respiratory syndrome coronavirus-2 infection, antibody levels, cellular immunity and protection, variants of concern, COVID-19 vaccine distribution, vaccination willingness, herd immunity, immunity passports, and vaccine indications. EXPERT OPINION Four vaccines have obtained emergency use authorization, 87 are at the clinical development stage, and 186 are in pre-clinical development. While the knowledge and development of COVID-19 vaccines is rapidly expanding, the benefits of COVID-19 vaccines must outweigh the potential risks of adverse events. To combat the COVID-19 pandemic, clinicians should consistently update COVID-19-associated information, and healthcare authorities and manufacturers should work together to provide adequate and appropriate vaccinations for the prevention of COVID-19. PLAIN LANGUAGE SUMMARY What is the context?Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a global pandemic: the coronavirus disease 2019 (COVID-19) outbreak. The development and implementation of the COVID-19 vaccine could be an important measure to control the COVID-19 pandemic.What is new?Several phase 3 clinical trials have demonstrated the effectiveness and safety of COVID-19 vaccines for the prevention of SARS-CoV-2 infections. Several COVID-19 vaccines have obtained emergency use authorization and been implemented in many countries. Although concerns regarding unusual blood clots and low platelet counts have been raised, the benefits of COVID-19 vaccines outweigh the potential risks of adverse events.What is the impact?Except for children, the COVID-19 vaccine is recommended for all people, including those pregnant or immunocompromised. Healthcare authorities should advise people receiving the vaccine that they must seek medical attention if they have associated thromboembolism and thrombocytopenia symptoms. More studies are necessary to determine the appropriate vaccine dose and regimen strategy, as well as the effectiveness of COVID-19 vaccines against variants of concerns. A global effort must be made to achieve widespread vaccination and herd immunity.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - I-Tzu Chen
- Department of Pharmacy, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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162
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Shioda K, Lau MS, Kraay AN, Nelson KN, Siegler AJ, Sullivan PS, Collins MH, Weitz JS, Lopman BA. Estimating the Cumulative Incidence of SARS-CoV-2 Infection and the Infection Fatality Ratio in Light of Waning Antibodies. Epidemiology 2021; 32:518-524. [PMID: 33935138 PMCID: PMC8162228 DOI: 10.1097/ede.0000000000001361] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Serology tests can identify previous infections and facilitate estimation of the number of total infections. However, immunoglobulins targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to wane below the detectable level of serologic assays (which is not necessarily equivalent to the duration of protective immunity). We estimate the cumulative incidence of SARS-CoV-2 infection from serology studies, accounting for expected levels of antibody acquisition (seroconversion) and waning (seroreversion), and apply this framework using data from New York City and Connecticut. METHODS We estimated time from seroconversion to seroreversion and infection fatality ratio (IFR) using mortality data from March to October 2020 and population-level cross-sectional seroprevalence data from April to August 2020 in New York City and Connecticut. We then estimated the daily seroprevalence and cumulative incidence of SARS-CoV-2 infection. RESULTS The estimated average time from seroconversion to seroreversion was 3-4 months. The estimated IFR was 1.1% (95% credible interval, 1.0%, 1.2%) in New York City and 1.4% (1.1, 1.7%) in Connecticut. The estimated daily seroprevalence declined after a peak in the spring. The estimated cumulative incidence reached 26.8% (24.2%, 29.7%) at the end of September in New York City and 8.8% (7.1%, 11.3%) in Connecticut, higher than maximum seroprevalence measures (22.1% and 6.1%), respectively. CONCLUSIONS The cumulative incidence of SARS-CoV-2 infection is underestimated using cross-sectional serology data without adjustment for waning antibodies. Our approach can help quantify the magnitude of underestimation and adjust estimates for waning antibodies.
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Affiliation(s)
- Kayoko Shioda
- From the Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Max S.Y. Lau
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Alicia N.M. Kraay
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kristin N. Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Matthew H. Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Joshua S. Weitz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
- School of Physics, Georgia Institute of Technology, Atlanta, GA
| | - Benjamin A. Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Shah M, Woo HG. Molecular Perspectives of SARS-CoV-2: Pathology, Immune Evasion, and Therapeutic Interventions. Mol Cells 2021; 44:408-421. [PMID: 34059561 PMCID: PMC8245319 DOI: 10.14348/molcells.2021.0026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has not only affected human health but also diverted the focus of research and derailed the world economy over the past year. Recently, vaccination against COVID-19 has begun, but further studies on effective therapeutic agents are still needed. The severity of COVID-19 is attributable to several factors such as the dysfunctional host immune response manifested by uncontrolled viral replication, type I interferon suppression, and release of impaired cytokines by the infected resident and recruited cells. Due to the evolving pathophysiology and direct involvement of the host immune system in COVID-19, the use of immune-modulating drugs is still challenging. For the use of immune-modulating drugs in severe COVID-19, it is important to balance the fight between the aggravated immune system and suppression of immune defense against the virus that causes secondary infection. In addition, the interplaying events that occur during virus-host interactions, such as activation of the host immune system, immune evasion mechanism of the virus, and manifestation of different stages of COVID-19, are disjunctive and require thorough streamlining. This review provides an update on the immunotherapeutic interventions implemented to combat COVID-19 along with the understanding of molecular aspects of the immune evasion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may provide opportunities to develop more effective and promising therapeutics.
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Affiliation(s)
- Masaud Shah
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Hyun Goo Woo
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea
- Department of Biomedical Science, Graduate School of Ajou University, Suwon 16499, Korea
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164
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Woopen C, Schleußner K, Akgün K, Ziemssen T. Approach to SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis. Front Immunol 2021; 12:701752. [PMID: 34234787 PMCID: PMC8256163 DOI: 10.3389/fimmu.2021.701752] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
For more than a year now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been causing the coronavirus disease (COVID-19) pandemic with high mortality and detrimental effects on society, economy, and individual lives. Great hopes are being placed on vaccination as one of the most potent escape strategies from the pandemic and multiple vaccines are already in clinical use. However, there is still a lot of insecurity about the safety and efficacy of vaccines in patients with autoimmune diseases like multiple sclerosis (MS), especially under treatment with immunomodulatory or immunosuppressive drugs. We propose strategic approaches to SARS-CoV-2 vaccination management in MS patients and encourage fellow physicians to measure the immune response in their patients. Notably, both humoral and cellular responses should be considered since the immunological equivalent for protection from SARS-CoV-2 after infection or vaccination still remains undefined and will most likely involve antiviral cellular immunity. It is important to gain insights into the vaccine response of immunocompromised patients in order to be able to deduce sensible strategies for vaccination in the future.
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Affiliation(s)
| | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, Dresden, Germany
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165
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Rees EM, Waterlow NR, Lowe R, Kucharski AJ. Estimating the duration of seropositivity of human seasonal coronaviruses using seroprevalence studies. Wellcome Open Res 2021; 6:138. [PMID: 34708157 PMCID: PMC8517721 DOI: 10.12688/wellcomeopenres.16701.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The duration of immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still uncertain, but it is of key clinical and epidemiological importance. Seasonal human coronaviruses (HCoV) have been circulating for longer and, therefore, may offer insights into the long-term dynamics of reinfection for such viruses. Methods: Combining historical seroprevalence data from five studies covering the four circulating HCoVs with an age-structured reverse catalytic model, we estimated the likely duration of seropositivity following seroconversion. Results: We estimated that antibody persistence lasted between 0.9 (95% Credible interval: 0.6 - 1.6) and 3.8 (95% CrI: 2.0 - 7.4) years. Furthermore, we found the force of infection in older children and adults (those over 8.5 [95% CrI: 7.5 - 9.9] years) to be higher compared with young children in the majority of studies. Conclusions: These estimates of endemic HCoV dynamics could provide an indication of the future long-term infection and reinfection patterns of SARS-CoV-2.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naomi R. Waterlow
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Kulkarni‐Munje A, Palkar S, Shrivastava S, Lalwani S, Mishra AC, Arankalle VA. Disease-duration based comparison of subsets of immune cells in SARS CoV-2 infected patients presenting with mild or severe symptoms identifies prognostic markers for severity. Immun Inflamm Dis 2021; 9:419-434. [PMID: 33452858 PMCID: PMC8014065 DOI: 10.1002/iid3.402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/05/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Infection with SARS-CoV-2 leads to a spectrum of symptoms. Understanding the basis for severity remains crucial for better management and therapy development. So far, older age, associated-comorbidities, and IL-6 have been associated with severity/mortality. MATERIALS AND METHODOLOGY As a primary step, we analyzed the frequency and functional profile of innate immune cells (NK cells/dendritic cells/monocytes) and adaptive immunity-driving lymphocytes (B cells/T cells/follicular T helper cells) by flow cytometry. Sixty cases of SARS CoV-2 infection (25 severe, 35 mild) and ten healthy subjects without SARS CoV-2 IgG were included. Disease-duration based analysis of immune profile was explored for early events differentiating the two disease forms. Neutralizing antibody titers were determined by PRNT. RESULTS AND CONCLUSION Disease severity was found to be associated with impaired maturation of mDCs and hyperactivation of NK, follicular T helper cells, and CD8 T cells. Lower IL-21 receptor expression on memory B cells indicated an imbalance in IL-21/IL-21 R ratio. Lower BCMA positive plasmablast cells in severe cases did suggest a probable absence of long-term humoral immunity. Multivariate analysis revealed a progressive association of PD-1+CD4 T cells with PRNT50 titers. Thus, in addition to identifying probable prognostic markers for severity, our study emphasizes the definite need for in-depth viral antigen-specific functional analyses in a larger patient cohort and with multiple sampling.
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Affiliation(s)
- Archana Kulkarni‐Munje
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA)Bharati Vidyapeeth (Deemed to be University)PuneIndia
| | - Sonali Palkar
- Department of Paediatrics, Bharati Vidyapeeth Medical CollegeBharati Vidyapeeth (Deemed to be University)PuneIndia
| | - Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA)Bharati Vidyapeeth (Deemed to be University)PuneIndia
| | - Sanjay Lalwani
- Department of Paediatrics, Bharati Vidyapeeth Medical CollegeBharati Vidyapeeth (Deemed to be University)PuneIndia
| | - Akhilesh C. Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA)Bharati Vidyapeeth (Deemed to be University)PuneIndia
| | - Vidya A. Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA)Bharati Vidyapeeth (Deemed to be University)PuneIndia
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167
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Liu X, Zhao J, Wang H, Wang W, Su X, Liao X, Zhang S, Sun J, Zhang Z. Metabolic Defects of Peripheral T Cells in COVID-19 Patients. THE JOURNAL OF IMMUNOLOGY 2021; 206:2900-2908. [PMID: 34049969 DOI: 10.4049/jimmunol.2100068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
The relatively low partial pressure of oxygen, reduced oxygen saturation, and aberrant plasma metabolites in COVID-19 may alter energy metabolism in peripheral immune cells. However, little is known regarding the immunometabolic defects of T cells in COVID-19 patients, which may contribute to the deregulated immune functions of these cells. In this study, we longitudinally characterized the metabolic profiles of resting and activated T cells from acutely infected and convalescent COVID-19 patients by flow cytometry and confirmed the metabolic profiles with a Seahorse analyzer. Non-COVID-19 and healthy subjects were enrolled as controls. We found that ex vivo T cells from acutely infected COVID-19 patients were highly activated and apoptotic and displayed more extensive mitochondrial metabolic dysfunction, especially cells in CD8+ T cell lineages, than those from convalescent COVID-19 patients or healthy controls, but slightly disturbed mitochondrial metabolic activity was observed in non-COVID-19 patients. Importantly, plasma IL-6 and C-reactive protein (CRP) levels positively correlated with mitochondrial mass and negatively correlated with fatty acid uptake in T cells from COVID-19 patients. Additionally, compared with those from healthy controls, in vitro-activated T cells from acutely infected COVID-19 patients showed signs of lower glycolysis, a reduced glycolytic capacity, and a decreased glycolytic reserve, accompanied by lower activation of mTOR signaling. Thus, newly identified defects in T cell mitochondrial metabolic functions and metabolic reprogramming upon activation might contribute to immune deficiency in COVID-19.
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Affiliation(s)
- Xiaoju Liu
- Department of Infectious Diseases, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.,Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Juanjuan Zhao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Haiyan Wang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Wan Wang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Xu Su
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Xuejiao Liao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Shuye Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China; and
| | - Jian Sun
- Department of Infectious Diseases, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China;
| | - Zheng Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital; The Second Affiliated Hospital, School of Medicine, South University of Science and Technology, Shenzhen, Guangdong Province, China; .,Shenzhen Research Center for Communicable Disease Diagnosis and Treatment of Chinese Academy of Medical Science, Shenzhen, Guangdong Province, China
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168
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Ma Y, Xu L, Yin B, Shang J, Chen F, Xu J, Song ZL, Nan B, Song G, Zhang XB. Ratiometric Semiconducting Polymer Nanoparticle for Reliable Photoacoustic Imaging of Pneumonia-Induced Vulnerable Atherosclerotic Plaque in Vivo. NANO LETTERS 2021; 21:4484-4493. [PMID: 33978427 DOI: 10.1021/acs.nanolett.1c01359] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute pneumonia can greatly increase the vulnerable risk of atherosclerotic plaque and contribute to the mortality of cardiovascular disease. To accurately assess the rupture risk caused by acute pneumonia, we developed a novel kind of ratiometric semiconducting polymer nanoparticle (RSPN) for photoacoustic imaging of vulnerable plaque in apolipoprotein E-deficient mice complicated with pneumonia. Specifically, RSPN can react with O2•- and exhibit the enhanced photoacoustic signals at about 690 nm, while 800 nm is regarded as an internal photoacoustic reference. As a result, RSPN can provide reliable determination of O2•- within aortic atherosclerosis by analyzing the ratios of photoacoustic signals, which can successfully reflect the oxidative stress level in vulnerable plaque. Therefore, RSPN enable to specifically distinguish plaque-bearing mice and plaque-bearing mice complicated with pneumonia from healthy mice, which provides a promising tool to predict the vulnerability of plaque for reducing the mortality of atherosclerotic-induced cardiovascular disease.
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Affiliation(s)
- Yuan Ma
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Li Xu
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Baoli Yin
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Jinhui Shang
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Fangfang Chen
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Juntao Xu
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Zhi-Ling Song
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science MOE Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Bin Nan
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Guosheng Song
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Xiao-Bing Zhang
- State Key Laboratory for Chemo/Bio-Sensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
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169
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Sattler C, Hoffmann P, Herzberg PY, Weber D, Holler B, Fehn U, Plentz A, Beckhove P, Winkler J, Edinger M, Herr W, Holler E, Wolff D. Primary vaccination in adult patients after allogeneic hematopoietic stem cell transplantation - A single center retrospective efficacy analysis. Vaccine 2021; 39:4742-4750. [PMID: 34049733 DOI: 10.1016/j.vaccine.2021.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) results in a loss of humoral immunity and subsequent risk for severe infections. Thus, re-vaccination is required but may fail due to incomplete immune reconstitution. We retrospectively analyzed predictors of immune response to primary vaccination applied according to the EBMT (European Blood and Marrow Transplantation Group) recommendations. Serologic response to vaccination against diphtheria (D), tetanus (T), Bordetella pertussis (aP) and Haemophilus influenzae (Hib) (administrated as combined DTaP-Hib-IPV vaccination) was studied in 84 alloHSCT patients transplanted between 2008 and 2015 (age at alloHSCT: 18.6-70.6 years). All patients with a relapse-free survival of ≥9 months, at least 3 consecutive vaccinations and absence of intravenous immunoglobulin administration within 3 months before and after vaccination met the primary inclusion criteria. Additionally, immunological response to a pneumococcal conjugate vaccine was analyzed in a subgroup of 67 patients. Patients' characteristics at the time of first vaccination were recorded. Responses were measured as vaccine-specific antibody titers. Regarding DTaP-Hib-IPV vaccination, 89.3% (n = 75) of all patients achieved protective titers to at least 3 of the 4 vaccine components and were thus considered responders. 10.7% (n = 9) of the patients were classified as non-responders with positive immune response to less than 3 components. Highest response was observed for Hib (97.4%), tetanus (95.2%) and pneumococcal vaccination (83.6%) while only 68.3% responded to vaccination against Bordetella pertussis. Significant risk factors for failure of vaccination response included low B cell counts (p < 0.001; cut-off: 0.05 B cells/nl) and low IgG levels (p = 0.026; mean IgG of responders 816 mg/dl vs. 475 mg/dl of non-responders). Further, a trend was observed that prior cGvHD impairs vaccination response as 88.9% of the non-responders but only 54.7% of the responders had prior cGvHD (p = 0.073). The results demonstrate, that the currently proposed vaccination strategy leads to seroprotection in the majority of alloHSCT patients.
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Affiliation(s)
- Clara Sattler
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Petra Hoffmann
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany; Regensburg Center for Interventional Immunology (RCI), Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Philipp Yorck Herzberg
- Faculty of Humanities and Social Sciences, Personality Psychology and Psychological Assessment, Helmut Schmidt University Hamburg, Holstenhofweg 85, 22043 Hamburg, Germany
| | - Daniela Weber
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Barbara Holler
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Ute Fehn
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany; Regensburg Center for Interventional Immunology (RCI), Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Annelie Plentz
- Dept. of Medical Microbiology and Hygiene, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology (RCI), Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Julia Winkler
- Dept. of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias Edinger
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany; Regensburg Center for Interventional Immunology (RCI), Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Wolfgang Herr
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Ernst Holler
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Daniel Wolff
- Dept. of Internal Medicine III, University Hospital Regensburg, Franz-Joseph-Strauss-Allee 11, 93053 Regensburg, Germany.
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170
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Tseng WP, Wu JL, Wu CC, Kuo KT, Lin CH, Chung MY, Lee YF, Yang BJ, Huang CH, Chen SY, Yu CJ, Chen SC, Hsueh PR. Seroprevalence Surveys for Anti-SARS-CoV-2 Antibody in Different Populations in Taiwan With Low Incidence of COVID-19 in 2020 and Severe Outbreaks of SARS in 2003. Front Immunol 2021; 12:626609. [PMID: 34084161 PMCID: PMC8167053 DOI: 10.3389/fimmu.2021.626609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Accurate detection of anti-SARS-CoV-2 antibodies provides a more accurate estimation of incident cases, epidemic dynamics, and risk of community transmission. We conducted a cross-sectional seroprevalence study specifically targeting different populations to examine the performance of pandemic control in Taiwan: symptomatic patients with epidemiological risk and negative qRT-PCR test (Group P), frontline healthcare workers (Group H), healthy adult citizens (Group C), and participants with prior virologically-confirmed severe acute respiratory syndrome (SARS) infection in 2003 (Group S). The presence of anti-SARS-CoV-2 total and IgG antibodies in all participants were determined by Roche Elecsys® Anti-SARS-CoV-2 test and Abbott SARS-CoV-2 IgG assay, respectively. Sera that showed positive results by the two chemiluminescent immunoassays were further tested by three anti-SARS-CoV-2 lateral flow immunoassays and line immunoassay (MIKROGEN recomLine SARS-CoV-2 IgG). Between June 29 and July 25, 2020, sera of 2,115 participates, including 499 Group P participants, 464 Group H participants, 1,142 Group C participants, and 10 Group S participants, were tested. After excluding six false-positive samples, SARS-CoV-2 seroprevalence were 0.4, 0, and 0% in Groups P, H, and C, respectively. Cross-reactivity with SARS-CoV-2 antibodies was observed in 80.0% of recovered SARS participants. Our study showed that rigorous exclusion of false-positive testing results is imperative for an accurate estimate of seroprevalence in countries with previous SARS outbreak and low COVID-19 prevalence. The overall SARS-CoV-2 seroprevalence was extremely low among populations of different exposure risk of contracting SARS-CoV-2 in Taiwan, supporting the importance of integrated countermeasures in containing the spread of SARS-CoV-2 before effective COVID-19 vaccines available.
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Affiliation(s)
- Wen-Pin Tseng
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhong-Lin Wu
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research and Department of Integrated Surgery, Hsinchu Biomedical Science Park Medical Center (National Taiwan University Hospital Hsin-Chu Biomedical Park Branch), Hsinchu, Taiwan
| | - Kuan-Ting Kuo
- Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yi Chung
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Fan Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bey-Jing Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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171
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Mallavarpu Ambrose J, Priya Veeraraghavan V, Kullappan M, Chellapandiyan P, Krishna Mohan S, Manivel VA. Comparison of Immunological Profiles of SARS-CoV-2 Variants in the COVID-19 Pandemic Trends: An Immunoinformatics Approach. Antibiotics (Basel) 2021; 10:535. [PMID: 34066389 PMCID: PMC8148159 DOI: 10.3390/antibiotics10050535] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
The current dynamics of the COVID-19 pandemic have become a serious concern with the emergence of a series of mutant variants of the SARS-CoV-2 virus. Unlike the previous strain, it is reported that the descendants are associated with increased risk of transmission yet causing less impact in terms of hospital admission, the severity of illness, or mortality. Moreover, the vaccine efficacy is also not believed to vary among the population depending on the variants of the virus and ethnicity. It has been determined that the mutations recorded in the spike gene and protein of the newly evolved viruses are specificallyresponsible for this transformation in the behavior of the virus and its disease condition. Hence, this study aimed to compare the immunogenic profiles of the spike protein from the latest variants of the SARS-CoV-2 virus concerning the probability of COVID-19 severity. Genome sequences of the latest SARS-CoV-2 variants were obtained from GISAID and NCBI repositories. The translated protein sequences were run against T-cell and B-cell epitope prediction tools. Subsequently, antigenicity, immunogenicity, allergenicity, toxicity, and conservancy of the identified epitopes were ascertained using various prediction servers. Only the non-allergic and non-toxic potential epitopes were matched for population relevance by using the Human Leucocyte Antigen population registry in IEDB. Finally, the selected epitopes were validated by docking and simulation studies. The evaluated immunological parameters would concurrently reveal the severity of COVID-19, determining the infection rate of the pathogen. Our immunoinformatics approach disclosed that spike protein of the five variants was capable of forming potential T and B-cell epitopes with varying immune responses. Although the Wuhan strain showed a high number of epitope/HLA combinations, relatively less antigenicity and higher immunogenicity results in poor neutralizing capacity, which could be associated with increased disease severity. Our data demonstrate that increased viral antigenicity with moderate to high immunogenicity, and several potential epitope/HLA combinations in England strain, the USA, India, and South Africa variants, could possess a high neutralizing ability. Therefore, our findings reinforce that the newly circulating variants of SARS-CoV-2 might be associated with more infectiousness and less severe disease condition despite their greater viremia, as reported in the recent COVID-19 cases, whichconsequently determine their increased epidemiological fitness.
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Affiliation(s)
- Jenifer Mallavarpu Ambrose
- Department of Research, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India; (J.M.A.); (M.K.)
| | - Vishnu Priya Veeraraghavan
- Department of Biochemistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Velappanchavadi, Chennai 600 077, Tamil Nadu, India;
| | - Malathi Kullappan
- Department of Research, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India; (J.M.A.); (M.K.)
| | - Poongodi Chellapandiyan
- Department of Obstetrics & Gynaecological Nursing, Panimalar College of Nursing, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India;
| | - Surapaneni Krishna Mohan
- Department of Research, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India; (J.M.A.); (M.K.)
- Departments of Biochemistry, Molecular Virology, Clinical Skills and Simulation, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India
| | - Vivek Anand Manivel
- Department of Research, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai 600 123, Tamil Nadu, India; (J.M.A.); (M.K.)
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
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172
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Weidinger C, Hegazy AN, Glauben R, Siegmund B. COVID-19-from mucosal immunology to IBD patients. Mucosal Immunol 2021; 14:566-573. [PMID: 33608656 PMCID: PMC7893623 DOI: 10.1038/s41385-021-00384-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
Viral infections with SARS-CoV-2 can cause a multi-facetted disease, which is not only characterized by pneumonia and overwhelming systemic inflammatory immune responses, but which can also directly affect the digestive system and infect intestinal epithelial cells. Here, we review the current understanding of intestinal tropism of SARS-CoV-2 infection, its impact on mucosal function and immunology and summarize the effect of immune-suppression in patients with inflammatory bowel disease (IBD) on disease outcome of COVID-19 and discuss IBD-relevant implications for the clinical management of SARS-CoV-2 infected individuals.
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Affiliation(s)
- Carl Weidinger
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany,Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
| | - Ahmed Nabil Hegazy
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany,Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany,Deutsches Rheumaforschungszentrum Berlin (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Rainer Glauben
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Britta Siegmund
- Department for Medicine (Gastroenterology, Infectious diseases, Rheumatology), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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173
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Zhao C, Fang X, Feng Y, Fang X, He J, Pan H. Emerging role of air pollution and meteorological parameters in COVID-19. J Evid Based Med 2021; 14:123-138. [PMID: 34003571 PMCID: PMC8207011 DOI: 10.1111/jebm.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 01/09/2023]
Abstract
Exposure to air pollutants has been associated with respiratory viral infections. Epidemiological studies have shown that air pollution exposure is related to increased cases of SARS-COV-2 infection and COVID-19-associated mortality. In addition, the changes of meteorological parameters have also been implicated in the occurrence and development of COVID-19. However, the molecular mechanisms by which pollutant exposure and changes of meteorological parameters affects COVID-19 remains unknown. This review summarizes the biology of COVID-19 and the route of viral transmission, and elaborates on the relationship between air pollution and climate indicators and COVID-19. Finally, we envisaged the potential roles of air pollution and meteorological parameters in COVID-19.
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Affiliation(s)
- Channa Zhao
- Anhui Provincial Tuberculosis InstituteHefeiAnhuiChina
| | - Xinyu Fang
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
- Inflammation and Immune Mediated Diseases Laboratory of Anhui ProvinceHefeiAnhuiChina
| | - Yating Feng
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
- Inflammation and Immune Mediated Diseases Laboratory of Anhui ProvinceHefeiAnhuiChina
| | - Xuehui Fang
- Anhui Provincial Tuberculosis InstituteHefeiAnhuiChina
| | - Jun He
- Anhui Provincial Center for Disease Control and PreventionHefeiChina
- Key Laboratory for Medical and Health of the 13th Five‐Year PlanHefeiAnhuiChina
| | - Haifeng Pan
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
- Inflammation and Immune Mediated Diseases Laboratory of Anhui ProvinceHefeiAnhuiChina
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174
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Lamberghini F, Testai FD. COVID-2019 fundamentals. J Am Dent Assoc 2021; 152:354-363. [PMID: 33926623 PMCID: PMC7862882 DOI: 10.1016/j.adaj.2021.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified at the end of 2019. The disease caused by SARS-CoV-2 was named COVID-19. The main purpose of this review was to provide an overview of SARS-CoV-2. METHODS The authors searched the MEDLINE database for clinical studies related to virus characteristics, pathogenesis, diagnosis, transmission mechanisms, and treatment options. RESULTS As of January 27, 2021, the number of infected people and deaths associated with COVID-19 worldwide were approximately 100 million and 2 million, respectively. The manifestations of COVID-19 are variable, and the severity is affected by age and preexisting medical conditions. Children and adolescents are usually asymptomatic or have mild symptoms. Older adults, in comparison, may experience severe illness and have disproportionally elevated mortality. Among those who survive, some may experience enduring deficits. The viral load is particularly elevated in saliva and oropharynx, which constitute potential sources of infection. The diagnosis of the disease may be confounded by factors related to the replicating cycle of the virus, viral load, and sensitivity of the diagnostic method used. As of January 2021, COVID-19 has no cure but can be prevented. Its treatment is based on supportive care along with antiviral medications and monoclonal antibodies. In severe cases with multiorgan involvement, mechanical ventilation, dialysis, and hemodynamic support may be necessary. CONCLUSIONS COVID-19 is a transmittable disease with a variable course. A substantial number of patients, particularly children, remain asymptomatic. Important advances have been made in the development of new treatments. However, the mortality in vulnerable populations remains elevated. PRACTICAL IMPLICATIONS The elevated viral load in the oral cavity and pharynx suggests that oral health care professionals could get infected through occupational exposure. Providers should understand the variables that influence the yield of diagnostic studies because false-negative results can occur.
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175
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Feng B, Zhang D, Wang Q, Yu F, Zou Q, Xie G, Wang R, Yang X, Chen W, Lou B, Zheng S, Chen Y. Effects of angiotensin II receptor blocker usage on viral load, antibody dynamics, and transcriptional characteristics among COVID-19 patients with hypertension. J Zhejiang Univ Sci B 2021; 22:330-340. [PMID: 33835767 PMCID: PMC8042529 DOI: 10.1631/jzus.b2000730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at increased risk of acute lung injury. However, it is still not clear whether this increased risk is related to the usage of renin-angiotensin system (RAS) blockers. We collected medical records of coronavirus disease 2019 (COVID-19) patients from the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China), and evaluated the potential impact of an angiotensin II receptor blocker (ARB) on the clinical outcomes of COVID-19 patients with hypertension. A total of 30 hypertensive COVID-19 patients were enrolled, of which 17 were classified as non-ARB group and the remaining 13 as ARB group based on the antihypertensive therapies they received. Compared with the non-ARB group, patients in the ARB group had a lower proportion of severe cases and intensive care unit (ICU) admission as well as shortened length of hospital stay, and manifested favorable results in most of the laboratory testing. Viral loads in the ARB group were lower than those in the non-ARB group throughout the disease course. No significant difference in the time of seroconversion or antibody levels was observed between the two groups. The median levels of soluble angiotensin-converting enzyme 2 (sACE2) in serum and urine samples were similar in both groups, and there were no significant correlations between serum sACE2 and biomarkers of disease severity. Transcriptional analysis showed 125 differentially expressed genes which mainly were enriched in oxygen transport, bicarbonate transport, and blood coagulation. Our results suggest that ARB usage is not associated with aggravation of COVID-19. These findings support the maintenance of ARB treatment in hypertensive patients diagnosed with COVID-19.
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Affiliation(s)
- Baihuan Feng
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Dan Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qi Wang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Fei Yu
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qianda Zou
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Guoliang Xie
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Ruonan Wang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xianzhi Yang
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Weizhen Chen
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Bin Lou
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shufa Zheng
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. .,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China. .,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Yu Chen
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,Key Laboratory of Clinical in Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou 310003, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou 310003, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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176
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Aziz NA, Corman VM, Echterhoff AKC, Müller MA, Richter A, Schmandke A, Schmidt ML, Schmidt TH, de Vries FM, Drosten C, Breteler MMB. Seroprevalence and correlates of SARS-CoV-2 neutralizing antibodies from a population-based study in Bonn, Germany. Nat Commun 2021; 12:2117. [PMID: 33837204 PMCID: PMC8035181 DOI: 10.1038/s41467-021-22351-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
To estimate the seroprevalence and temporal course of SARS-CoV-2 neutralizing antibodies, we embedded a multi-tiered seroprevalence survey within an ongoing community-based cohort study in Bonn, Germany. We first assessed anti-SARS-CoV-2 immunoglobulin G levels with an immunoassay, followed by confirmatory testing of borderline and positive test results with a recombinant spike-based immunofluorescence assay and a plaque reduction neutralization test (PRNT). Those with a borderline or positive immunoassay result were retested after 4 to 5 months. At baseline, 4771 persons participated (88% response rate). Between April 24th and June 30th, 2020, seroprevalence was 0.97% (95% CI: 0.72-1.30) by immunoassay and 0.36% (95% CI: 0.21-0.61) when considering only those with two additional positive confirmatory tests. Importantly, about 20% of PRNT+ individuals lost their neutralizing antibodies within five months. Here, we show that neutralizing antibodies are detectable in only one third of those with a positive immunoassay result, and wane relatively quickly.
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Affiliation(s)
- N Ahmad Aziz
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Victor M Corman
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Antje K C Echterhoff
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Marcel A Müller
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Anja Richter
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Antonio Schmandke
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Marie Luisa Schmidt
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Thomas H Schmidt
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Folgerdiena M de Vries
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Christian Drosten
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany.
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177
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Volpatti LR, Wallace RP, Cao S, Raczy MM, Wang R, Gray LT, Alpar AT, Briquez PS, Mitrousis N, Marchell TM, Sasso MS, Nguyen M, Mansurov A, Budina E, Solanki A, Watkins EA, Schnorenberg MR, Tremain AC, Reda JW, Nicolaescu V, Furlong K, Dvorkin S, Yu SS, Manicassamy B, LaBelle JL, Tirrell MV, Randall G, Kwissa M, Swartz MA, Hubbell JA. Polymersomes decorated with SARS-CoV-2 spike protein receptor binding domain elicit robust humoral and cellular immunity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.04.08.438884. [PMID: 33851166 PMCID: PMC8043456 DOI: 10.1101/2021.04.08.438884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A diverse portfolio of SARS-CoV-2 vaccine candidates is needed to combat the evolving COVID-19 pandemic. Here, we developed a subunit nanovaccine by conjugating SARS-CoV-2 Spike protein receptor binding domain (RBD) to the surface of oxidation-sensitive polymersomes. We evaluated the humoral and cellular responses of mice immunized with these surface-decorated polymersomes (RBDsurf) compared to RBD-encapsulated polymersomes (RBDencap) and unformulated RBD (RBDfree), using monophosphoryl lipid A-encapsulated polymersomes (MPLA PS) as an adjuvant. While all three groups produced high titers of RBD-specific IgG, only RBDsurf elicited a neutralizing antibody response to SARS-CoV-2 comparable to that of human convalescent plasma. Moreover, RBDsurf was the only group to significantly increase the proportion of RBD-specific germinal center B cells in the vaccination-site draining lymph nodes. Both RBDsurf and RBDencap drove similarly robust CD4+ and CD8+ T cell responses that produced multiple Th1-type cytokines. We conclude that multivalent surface display of Spike RBD on polymersomes promotes a potent neutralizing antibody response to SARS-CoV-2, while both antigen formulations promote robust T cell immunity.
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Affiliation(s)
- Lisa R. Volpatti
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Rachel P. Wallace
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Shijie Cao
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Michal M. Raczy
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Ruyi Wang
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Laura T. Gray
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Aaron T. Alpar
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Priscilla S. Briquez
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Nikolaos Mitrousis
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Tiffany M. Marchell
- Committee on Immunology, University of Chicago, Chicago, IL 60637, United States
| | - Maria Stella Sasso
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Mindy Nguyen
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Aslan Mansurov
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Erica Budina
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Ani Solanki
- Animal Resources Center, University of Chicago, Chicago, IL 60637, United States
| | - Elyse A. Watkins
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Mathew R. Schnorenberg
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Andrew C. Tremain
- Committee on Immunology, University of Chicago, Chicago, IL 60637, United States
| | - Joseph W. Reda
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Vlad Nicolaescu
- Department of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, IL 60637, United States
| | - Kevin Furlong
- Department of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, IL 60637, United States
| | - Steve Dvorkin
- Department of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, IL 60637, United States
| | - Shann S. Yu
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
| | - Balaji Manicassamy
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA 52242, United States
| | - James L. LaBelle
- Department of Pediatrics, University of Chicago Comer Children’s Hospital, Chicago, IL 60637, United States
| | - Matthew V. Tirrell
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
- Materials Science Division, Argonne National Laboratory, Lemont, IL 60439, United States
| | - Glenn Randall
- Department of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, IL 60637, United States
| | - Marcin Kwissa
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
- Department of Microbiology, Howard T. Ricketts Laboratory, University of Chicago, Chicago, IL 60637, United States
| | - Melody A. Swartz
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
- Committee on Immunology, University of Chicago, Chicago, IL 60637, United States
- Ben May Department of Cancer Research, University of Chicago, Chicago, IL 60637, United States
- Committee on Cancer Biology, University of Chicago, Chicago, IL 60637, United States
| | - Jeffrey A. Hubbell
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637, United States
- Committee on Immunology, University of Chicago, Chicago, IL 60637, United States
- Committee on Cancer Biology, University of Chicago, Chicago, IL 60637, United States
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178
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Finelli L, Gupta V, Petigara T, Yu K, Bauer KA, Puzniak LA. Mortality Among US Patients Hospitalized With SARS-CoV-2 Infection in 2020. JAMA Netw Open 2021; 4:e216556. [PMID: 33830226 PMCID: PMC8033442 DOI: 10.1001/jamanetworkopen.2021.6556] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Mortality is an important measure of the severity of a pandemic. This study aimed to understand how mortality by age of hospitalized patients who were tested for SARS-CoV-2 has changed over time. OBJECTIVE To evaluate trends in in-hospital mortality among patients who tested positive for SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients who were hospitalized for at least 1 day at 1 of 209 US acute care hospitals of variable size, in urban and rural areas, between March 1 and November 21, 2020. Eligible patients had a SARS-CoV-2 polymerase chain reaction (PCR) or antigen test within 7 days of admission or during hospitalization, and a record of discharge or in-hospital death. EXPOSURE SARS-CoV-2 positivity. MAIN OUTCOMES AND MEASURES SARS-CoV-2 infection was defined as a positive SARS-CoV-2 PCR or antigen test within 7 days before admission or during hospitalization. Mortality was extracted from electronically available data. RESULTS Among 503 409 admitted patients, 42 604 (8.5%) had SARS-CoV-2-positive tests. Of those with SARS-CoV-2-positive tests, 21 592 (50.7%) were male patients. Hospital admissions among patients with SARS-CoV-2-positive tests were highest in the group aged 65 years or older (19 929 [46.8%]), followed by those aged 50 to 64 years (11 602 [27.2%]) and 18 to 49 years (10 619 [24.9%]). Hospital admissions among patients 18 to 49 years of age increased from 1099 of 5319 (20.7%) in April to 1266 of 4184 (30.3%) in June and 2156 of 7280 (29.6%) in July, briefly exceeding those in the group 50 to 64 years of age (June: 1194 of 4184 [28.5%]; 2039 of 7280 [28.0%]). Patients with SARS-CoV-2-positive tests had higher in-hospital mortality than patients with SARS-CoV-2-negative tests (4705 [11.0%] vs 11 707 of 460 805 [2.5%]; P < .001). In-hospital mortality rates increased with increasing age for both patients with SARS-CoV-2-negative tests and SARS-CoV-2-positive tests. In patients with SARS-CoV-2-negative tests, mortality increased from 45 of 11 255 (0.4%) in those younger than 18 years to 4812 of 107 394 (4.5%) in those older than 75 years. In patients with SARS-CoV-2-positive tests, mortality increased from 1 of 454 (0.2%) of those younger than 18 years to 2149 of 10 287 (20.9%) in those older than 75 years. In-hospital mortality rates among patients with SARS-CoV-2-negative tests were similar for male and female patients (6273 of 209 086 [3.0%] vs 5538 of 251 719 [2.2%]) but higher mortality was observed among male patients with SARS-CoV-2-positive tests (2700 of 21 592 [12.5%]) compared with female patients with SARS-CoV-2-positive tests (2016 of 21 012 [9.60%]). Overall, in-hospital mortality increased from March to April (63 of 597 [10.6%] to 1047 of 5319 [19.7%]), then decreased significantly to November (499 of 5350 [9.3%]; P = .04), with significant decreases in the oldest age groups (50-64 years: 197 of 1542 [12.8%] to 73 of 1341 [5.4%]; P = .02; 65-75 years: 269 of 1182 [22.8%] to 137 of 1332 [10.3%]; P = .006; >75 years: 535 of 1479 [36.2%] to 262 of 1505 [17.4%]; P = .03). CONCLUSIONS AND RELEVANCE This nationally representative study supported the findings of smaller, regional studies and found that in-hospital mortality declined across all age groups during the period evaluated. Reductions were unlikely because of a higher proportion of younger patients with lower in-hospital mortality in the later period.
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Affiliation(s)
| | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New
Jersey
| | | | - Kalvin Yu
- Becton, Dickinson and Company, Franklin Lakes, New
Jersey
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179
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Drews SJ, Devine DV, McManus J, Mendoza E, Manguiat K, Wood H, Girardin R, Dupuis A, McDonough K, Drebot M. A trend of dropping anti-SARS-CoV-2 plaque reduction neutralization test titers over time in Canadian convalescent plasma donors. Transfusion 2021; 61:1440-1446. [PMID: 33734448 DOI: 10.1111/trf.16364] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/19/2020] [Accepted: 01/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Convalescent plasma products are a potential passive immunotherapy for Coronavirus disease 2019 (COVID-19) disease. Various approaches have been utilized to determine the concentration of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-neutralizing antibodies in plasma products. The Canadian Blood Services used Plaque Reduction Neutralization Test 50 (PRNT50) -generated values to qualify convalescent plasma donations supporting clinical trials in Canada. This manuscript describes changes in PRNT50 titers of repeat male plasma donations collected approximately 1-4 months after onset of COVID-19 signs and symptoms in donors. STUDY DESIGN AND METHODS Men were eligible to donate if they: met standard criteria, were < 67 years of age, reported a previous SARS-CoV-2-positive nucleic acid test, and recovered and were symptom free for at least 28 days prior to donation. Repeat donation analysis required at least one original and one repeat donation where a PRNT50 was performed. RESULTS From April 29, 2020 to July 25, 2020, 156 donors donated once, with 78 (50%) of the donated plasma having PRNT50 titers of ≥1:160. Thirty-seven (23.7%) of the donated plasma had a titer of 1:40 or 1:80 (individuals donating this plasma were asked to donate a second time only). A total of 30 donors (19.2%) had repeat donations. Of the repeat donors, 15 (50%) had at least an eightfold change from peak to trough PRNT50 titers within greater than 90 days after onset of COVID-19 symptoms. CONCLUSIONS Blood operators cannot infer that SARS-CoV-2 PRNT50 will remain high in repeat plasma donors 3-4 months after onset of COVID-19 symptoms.
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Affiliation(s)
- Steven J Drews
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet McManus
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Emelissa Mendoza
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kathy Manguiat
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Roxie Girardin
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Alan Dupuis
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Kathleen McDonough
- Wadsworth Center, New York State Department of Health, Albany, New York, USA.,Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York, USA
| | - Michael Drebot
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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180
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Thymic Aging May Be Associated with COVID-19 Pathophysiology in the Elderly. Cells 2021; 10:cells10030628. [PMID: 33808998 PMCID: PMC8001029 DOI: 10.3390/cells10030628] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the global pandemic of coronavirus disease 2019 (COVID-19) and particularly exhibits severe symptoms and mortality in elderly individuals. Mounting evidence shows that the characteristics of the age-related clinical severity of COVID-19 are attributed to insufficient antiviral immune function and excessive self-damaging immune reaction, involving T cell immunity and associated with pre-existing basal inflammation in the elderly. Age-related changes to T cell immunosenescence is characterized by not only restricted T cell receptor (TCR) repertoire diversity, accumulation of exhausted and/or senescent memory T cells, but also by increased self-reactive T cell- and innate immune cell-induced chronic inflammation, and accumulated and functionally enhanced polyclonal regulatory T (Treg) cells. Many of these changes can be traced back to age-related thymic involution/degeneration. How these changes contribute to differences in COVID-19 disease severity between young and aged patients is an urgent area of investigation. Therefore, we attempt to connect various clues in this field by reviewing and discussing recent research on the role of the thymus and T cells in COVID-19 immunity during aging (a synergistic effect of diminished responses to pathogens and enhanced responses to self) impacting age-related clinical severity of COVID-19. We also address potential combinational strategies to rejuvenate multiple aging-impacted immune system checkpoints by revival of aged thymic function, boosting peripheral T cell responses, and alleviating chronic, basal inflammation to improve the efficiency of anti-SARS-CoV-2 immunity and vaccination in the elderly.
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181
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Imai K, Kitagawa Y, Tabata S, Kubota K, Nagura-Ikeda M, Matsuoka M, Miyoshi K, Sakai J, Ishibashi N, Tarumoto N, Takeuchi S, Ito T, Maesaki S, Tamura K, Maeda T. Antibody response patterns in COVID-19 patients with different levels of disease severity in Japan. J Med Virol 2021; 93:3211-3218. [PMID: 33620098 PMCID: PMC8014305 DOI: 10.1002/jmv.26899] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/20/2022]
Abstract
We analyzed antibody response patterns according to the level of disease severity in patients with novel coronavirus disease 2019 (COVID-19) in Japan. We analyzed 611 serum specimens from 231 patients with COVID-19 (mild, 170; severe, 31; critical, 30). Immunoglobulin M (IgM) and IgG antibodies against nucleocapsid protein (N) and spike 1 protein (S1) were detected by enzyme-linked immunosorbent assays. The peaks of fitting curves for the optical density (OD) values of IgM and IgG antibodies against N appeared simultaneously, while those against S1 were delayed compared with N. The OD values of IgM against N and IgG against both N and S1 were significantly higher in the severe and critical cases than in the mild cases at 11 days after symptom onset. The seroconversion rates of IgG were higher than those of IgM against both N and S1 during the clinical course based on the optimal cut-off values defined in this study. The seroconversion rates of IgG and IgM against N and S1 were higher in the severe and critical cases than in the mild cases. Our findings show that a stronger antibody response occurred in COVID-19 patients with greater disease severity and there were low seroconversion rates of antibodies against N and S1 in the mild cases.
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Affiliation(s)
- Kazuo Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.,Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan.,Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Yutaro Kitagawa
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - Sakiko Tabata
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Katsumi Kubota
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - Mayu Nagura-Ikeda
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Masaru Matsuoka
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - Kazuyasu Miyoshi
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Jun Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.,Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Noriomi Ishibashi
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.,Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.,Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Shinichi Takeuchi
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - Toshimitsu Ito
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.,Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan
| | - Kaku Tamura
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Takuya Maeda
- Center for Clinical Infectious Diseases and Research, Saitama Medical University, Saitama, Japan.,Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
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182
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Chaudhari S, Dey Pereira S, Asare-Warehene M, Naha R, Kabekkodu SP, Tsang BK, Satyamoorthy K. Comorbidities and inflammation associated with ovarian cancer and its influence on SARS-CoV-2 infection. J Ovarian Res 2021; 14:39. [PMID: 33632295 PMCID: PMC7906086 DOI: 10.1186/s13048-021-00787-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide is a major public health concern. Cancer patients are considered a vulnerable population to SARS-CoV-2 infection and may develop several COVID-19 symptoms. The heightened immunocompromised state, prolonged chronic pro-inflammatory milieu coupled with comorbid conditions are shared in both disease conditions and may influence patient outcome. Although ovarian cancer (OC) and COVID-19 are diseases of entirely different primary organs, both diseases share similar molecular and cellular characteristics in their microenvironment suggesting a potential cooperativity leading to poor outcome. In COVID-19 related cases, hospitalizations and deaths worldwide are lower in women than in males; however, comorbidities associated with OC may increase the COVID-19 risk in women. The women at the age of 50-60 years are at greater risk of developing OC as well as SARS-CoV-2 infection. Increased levels of gonadotropin and androgen, dysregulated renin-angiotensin-aldosterone system (RAAS), hyper-coagulation and chronic inflammation are common conditions observed among OC and severe cases of COVID-19. The upregulation of common inflammatory cytokines and chemokines such as tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-2, IL-6, IL-10, interferon-γ-inducible protein 10 (IP-10), granulocyte colony-stimulating factor (G-CSF), monocyte chemoattractant protein-1 (MCP-1), macrophage colony-stimulating factor (M-CSF), among others in the sera of COVID-19 and OC subjects suggests potentially similar mechanism(s) involved in the hyper-inflammatory condition observed in both disease states. Thus, it is conceivable that the pathogenesis of OC may significantly contribute to the potential infection by SARS-CoV-2. Our understanding of the influence and mechanisms of SARS-CoV-2 infection on OC is at an early stage and in this article, we review the underlying pathogenesis presented by various comorbidities of OC and correlate their influence on SARS-CoV-2 infection.
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Affiliation(s)
- Sima Chaudhari
- Department of Cell and Molecular Biology, Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Satyajit Dey Pereira
- Department of Cell and Molecular Biology, Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Meshach Asare-Warehene
- Chronic Disease Program, Ottawa Hospital Research Institute and Department of Obstetrics & Gynecology and Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Ritam Naha
- Department of Cell and Molecular Biology, Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shama Prasada Kabekkodu
- Department of Cell and Molecular Biology, Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Benjamin K Tsang
- Chronic Disease Program, Ottawa Hospital Research Institute and Department of Obstetrics & Gynecology and Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Kapaettu Satyamoorthy
- Department of Cell and Molecular Biology, Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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183
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Kyriakidis NC, López-Cortés A, González EV, Grimaldos AB, Prado EO. SARS-CoV-2 vaccines strategies: a comprehensive review of phase 3 candidates. NPJ Vaccines 2021; 6:28. [PMID: 33619260 PMCID: PMC7900244 DOI: 10.1038/s41541-021-00292-w] [Citation(s) in RCA: 418] [Impact Index Per Article: 139.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
The new SARS-CoV-2 virus is an RNA virus that belongs to the Coronaviridae family and causes COVID-19 disease. The newly sequenced virus appears to originate in China and rapidly spread throughout the world, becoming a pandemic that, until January 5th, 2021, has caused more than 1,866,000 deaths. Hence, laboratories worldwide are developing an effective vaccine against this disease, which will be essential to reduce morbidity and mortality. Currently, there more than 64 vaccine candidates, most of them aiming to induce neutralizing antibodies against the spike protein (S). These antibodies will prevent uptake through the human ACE-2 receptor, thereby limiting viral entrance. Different vaccine platforms are being used for vaccine development, each one presenting several advantages and disadvantages. Thus far, thirteen vaccine candidates are being tested in Phase 3 clinical trials; therefore, it is closer to receiving approval or authorization for large-scale immunizations.
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Affiliation(s)
| | - Andrés López-Cortés
- Centro de Investigacion Genetica y Genomica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain
| | | | | | - Esteban Ortiz Prado
- One Health Research Group, Universidad de Las Américas (UDLA), Quito, Ecuador.
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184
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Amruta N, Chastain WH, Paz M, Solch RJ, Murray-Brown IC, Befeler JB, Gressett TE, Longo MT, Engler-Chiurazzi EB, Bix G. SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders. Cytokine Growth Factor Rev 2021; 58:1-15. [PMID: 33674185 PMCID: PMC7894219 DOI: 10.1016/j.cytogfr.2021.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2 is a novel coronavirus that severely affects the respiratory system, is the cause of the COVID-19 pandemic, and is projected to result in the deaths of 2 million people worldwide. Recent reports suggest that SARS-CoV-2 also affects the central nervous system along with other organs. COVID-19-associated complications are observed in older people with underlying neurological conditions like stroke, Alzheimer's disease, and Parkinson's disease. Hence, we discuss SARS-CoV-2 viral replication and its inflammation-mediated infection. This review also focuses on COVID-19 associated neurological complications in individuals with those complications as well as other groups of people. Finally, we also briefly discuss the current therapies available to treat patients, as well as ongoing available treatments and vaccines for effective cures with a special focus on the therapeutic potential of a small 5 amino acid peptide (PHSCN), ATN-161, that inhibits SARS-CoV-2 spike protein binding to both integrin α5β1 and α5β1/hACE2.
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Affiliation(s)
- Narayanappa Amruta
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Wesley H Chastain
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Meshi Paz
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Rebecca J Solch
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Isabel C Murray-Brown
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Jaime B Befeler
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Timothy E Gressett
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Michele T Longo
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Elizabeth B Engler-Chiurazzi
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Gregory Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA.
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185
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Abstract
Reliable antibody testing against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to uncover the population-wide spread of coronavirus disease 2019 (COVID-19), which is critical for making informed healthcare and economic decisions. Here we review different types of antibody tests available for SARS-CoV-2 and their application for population-scale testing. Biases because of varying test accuracy, results of ongoing large-scale serological studies, and use of antibody testing for monitoring development of herd immunity are summarized. Although current SARS-CoV-2 antibody testing efforts have generated valuable insights, the accuracy of serological tests and the selection criteria for the tested cohorts need to be evaluated carefully.
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Affiliation(s)
- Thomas Vogl
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Sigal Leviatan
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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186
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Alipoor SD, Mortaz E, Jamaati H, Tabarsi P, Bayram H, Varahram M, Adcock IM. COVID-19: Molecular and Cellular Response. Front Cell Infect Microbiol 2021; 11:563085. [PMID: 33643932 PMCID: PMC7904902 DOI: 10.3389/fcimb.2021.563085] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
In late December 2019, a vtiral pneumonia with an unknown agent was reported in Wuhan, China. A novel coronavirus was identified as the causative agent. Because of the human-to-human transmission and rapid spread; coronavirus disease 2019 (COVID-19) has rapidly increased to an epidemic scale and poses a severe threat to human health; it has been declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). This review aims to summarize the recent research progress of COVID-19 molecular features and immunopathogenesis to provide a reference for further research in prevention and treatment of SARS coronavirus2 (SARS-CoV-2) infection based on the knowledge from researches on SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS-CoV).
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Affiliation(s)
- Shamila D. Alipoor
- Molecular Medicine Department, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Esmaeil Mortaz
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koc University School of Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Mohammad Varahram
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian M. Adcock
- National Heart and Lung Institute, Imperial College London and the NIHR Imperial Biomedical Research Centre, London, United Kingdom
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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187
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Liz J. COVID-19, immunoprivilege and structural inequalities. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:19. [PMID: 33566205 PMCID: PMC7874558 DOI: 10.1007/s40656-020-00356-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/06/2020] [Indexed: 05/30/2023]
Abstract
As cases of COVID-19 continue to rise, some countries, including the US, Chile, and Germany, have considered issuing "immunity passports." This possibility has raised concerns and debate regarding their potential social, political and economic ramifications, especially for marginalized communities. This paper contributes to that debate by exposing that ways in which immunoprivilege already exists and operates within our present system of structural inequalities.
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Affiliation(s)
- Jordan Liz
- San José State University, 201 Faculty Office Building, One Washington Square, San José, CA, 95192-0096, USA.
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188
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Díaz-Menéndez M, Malmierca E. Modifying SARS-CoV-2 vaccine schedule in Spain: When numbers matters. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00030-6. [PMID: 33610391 PMCID: PMC7843127 DOI: 10.1016/j.eimc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Marta Díaz-Menéndez
- La Paz - Carlos III University Hospital-IdiPAZ, National Referral Unit for Imported Tropical Diseases, Tropical & Travel medicine Unit, Infectious Diseases Department, Madrid, Spain.
| | - Eduardo Malmierca
- Infanta Sofía University Hospital, Infectious Diseases Department, Universidad Europea de Madrid, Madrid, Spain
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189
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Hartley GE, Edwards ESJ, Aui PM, Varese N, Stojanovic S, McMahon J, Peleg AY, Boo I, Drummer HE, Hogarth PM, O'Hehir RE, van Zelm MC. Rapid generation of durable B cell memory to SARS-CoV-2 spike and nucleocapsid proteins in COVID-19 and convalescence. Sci Immunol 2021; 5:5/54/eabf8891. [PMID: 33443036 PMCID: PMC7877496 DOI: 10.1126/sciimmunol.abf8891] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
Lasting immunity following SARS-CoV-2 infection is questioned because serum antibodies decline in convalescence. However, functional immunity is mediated by long-lived memory T and B (Bmem) cells. Therefore, we generated fluorescently-labeled tetramers of the spike receptor binding domain (RBD) and nucleocapsid protein (NCP) to determine the longevity and immunophenotype of SARS-CoV-2-specific Bmem cells in COVID-19 patients. A total of 36 blood samples were obtained from 25 COVID-19 patients between 4 and 242 days post-symptom onset including 11 paired samples. While serum IgG to RBD and NCP was identified in all patients, antibody levels began declining at 20 days post-symptom onset. RBD- and NCP-specific Bmem cells predominantly expressed IgM+ or IgG1+ and continued to rise until 150 days. RBD-specific IgG+ Bmem were predominantly CD27+, and numbers significantly correlated with circulating follicular helper T cell numbers. Thus, the SARS-CoV-2 antibody response contracts in convalescence with persistence of RBD- and NCP-specific Bmem cells. Flow cytometric detection of SARS-CoV-2-specific Bmem cells enables detection of long-term immune memory following infection or vaccination for COVID-19.
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Affiliation(s)
- Gemma E Hartley
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Emily S J Edwards
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Pei M Aui
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Nirupama Varese
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia.,Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stephanie Stojanovic
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - James McMahon
- Department of Infectious Diseases, The Alfred and Central Clinical school, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred and Central Clinical school, Monash University, Melbourne, VIC, Australia.,Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Irene Boo
- Viral Entry and Vaccines Group, Burnet Institute, Melbourne, VIC, Australia
| | - Heidi E Drummer
- Viral Entry and Vaccines Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - P Mark Hogarth
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia.,Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Robyn E O'Hehir
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia.,Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Menno C van Zelm
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia. .,Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
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190
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Klumpp-Thomas C, Kalish H, Drew M, Hunsberger S, Snead K, Fay MP, Mehalko J, Shunmugavel A, Wall V, Frank P, Denson JP, Hong M, Gulten G, Messing S, Hicks J, Michael S, Gillette W, Hall MD, Memoli MJ, Esposito D, Sadtler K. Standardization of ELISA protocols for serosurveys of the SARS-CoV-2 pandemic using clinical and at-home blood sampling. Nat Commun 2021; 12:113. [PMID: 33397956 PMCID: PMC7782755 DOI: 10.1038/s41467-020-20383-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
The extent of SARS-CoV-2 infection throughout the United States population is currently unknown. High quality serology is key to avoiding medically costly diagnostic errors, as well as to assuring properly informed public health decisions. Here, we present an optimized ELISA-based serology protocol, from antigen production to data analyses, that helps define thresholds for IgG and IgM seropositivity with high specificities. Validation of this protocol is performed using traditionally collected serum as well as dried blood on mail-in blood sampling kits. Archival (pre-2019) samples are used as negative controls, and convalescent, PCR-diagnosed COVID-19 patient samples serve as positive controls. Using this protocol, minimal cross-reactivity is observed for the spike proteins of MERS, SARS1, OC43 and HKU1 viruses, and no cross reactivity is observed with anti-influenza A H1N1 HAI. Our protocol may thus help provide standardized, population-based data on the extent of SARS-CoV-2 seropositivity, immunity and infection.
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Affiliation(s)
- Carleen Klumpp-Thomas
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, 20850, USA
- Section on Immuno-Engineering, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Matthew Drew
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Sally Hunsberger
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Kelly Snead
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Michael P Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Jennifer Mehalko
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Anandakumar Shunmugavel
- Section on Immuno-Engineering, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Vanessa Wall
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Peter Frank
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - John-Paul Denson
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Min Hong
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Gulcin Gulten
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Simon Messing
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Jennifer Hicks
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Sam Michael
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, 20850, USA
| | - William Gillette
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Matthew D Hall
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, 20850, USA
| | - Matthew J Memoli
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20894, USA
| | - Dominic Esposito
- Protein Expression Laboratory, NCI RAS Initiative, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA
| | - Kaitlyn Sadtler
- Section on Immuno-Engineering, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20894, USA.
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191
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Hughes R, Whitley L, Fitovski K, Schneble HM, Muros E, Sauter A, Craveiro L, Dillon P, Bonati U, Jessop N, Pedotti R, Koendgen H. COVID-19 in ocrelizumab-treated people with multiple sclerosis. Mult Scler Relat Disord 2020; 49:102725. [PMID: 33482590 PMCID: PMC7772086 DOI: 10.1016/j.msard.2020.102725] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022]
Abstract
Background There are limited data on the impact of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on people with multiple sclerosis (MS). Objective To better understand SARS-CoV-2 infection in ocrelizumab-treated people with MS. Methods Internal Roche/Genentech data sources: Cases of COVID-19 from ongoing Roche/Genentech clinical trials and from post-marketing use of ocrelizumab until July 31, 2020 were identified and assessed using descriptive statistics. External real-world data (RWD) source: An MS COVID-19 cohort and an ocrelizumab-treated MS COVID-19 cohort were identified and assessed from the OPTUMⓇ de-identified COVID-19 electronic health record (EHR) database. Results Roche/Genentech clinical trial data: There were 51 (1.3%) suspected or confirmed cases of COVID-19 identified from 4,000 patients ongoing in 10 Roche/Genentech clinical trials. Of these, 26 (51%) were confirmed COVID-19 and 25 (49%) were suspected COVID-19. Sixteen (31.4%) patients were hospitalized. COVID-19 severity was mild to moderate in most patients (35, 68.6%). Ten (19.6%) patients had severe disease and there were three (5.9%) fatal cases. Most patients (43, 84.3%) recovered or were recovering. There was no association apparent between duration of exposure to ocrelizumab and COVID-19. Among COVID-19 patients with previous serum immunoglobulin status (27/51, 52.9%), all (27/27, 100%) had IgG levels within the normal range. Roche/Genentech post-marketing safety database data: There were 307 post-marketing cases of COVID-19 in the Roche/Genentech global safety database. Of these, 263 (85.7%) were confirmed and 44 (14.3%) were suspected COVID-19. 100 (32.6%) patients were hospitalized. COVID-19 was asymptomatic, mild or moderate in 143 (46.6%) patients, severe in 52 (16.9%) patients, and critical in 15 (4.9%) patients. There were 17 (5.5%) fatal cases. Information on severity was not reported in 80 (26.1%) cases. Most patients (211, 68.7%) recovered or were recovering at the time of the report. External RWD data source: As of July 13, 2020, the OPTUMⓇ database included EHRs for almost 1.2 million patients with suspected COVID-19, 130,500 of whom met the criteria for confirmed/clinically diagnosed COVID-19. A total of 357 patients with MS with confirmed COVID-19 were identified. Forty-eight (13.4%) were treated with ocrelizumab, of whom 12 (25.0%) were hospitalized and one died (2.1%). Similar rates of hospitalization, invasive ventilation, and death were observed in the ocrelizumab-treated and non-ocrelizumab-treated MS cohorts. Across the Roche/Genentech and RWD sources assessed, age, male sex, and the presence of comorbidities such as hypertension were associated with a more severe disease course of COVID-19. There was a higher number of comorbidities present in hospitalized versus non-hospitalized patients. Conclusions This assessment provides evidence that COVID-19 in ocrelizumab-treated people with MS is predominantly mild to moderate in severity with most patients not requiring hospitalization; in line with data reported from the general population and MS datasets. Risk factors known to be associated with severe COVID-19 outcomes in the general population also appear to influence COVID-19 severity in ocrelizumab-treated people with MS. Case fatality rates for ocrelizumab-treated people with MS were within published ranges for the general population and other MS cohorts.
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Affiliation(s)
| | | | | | | | - Erwan Muros
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Paul Dillon
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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192
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Syal K. Guidelines on newly identified limitations of diagnostic tools for COVID-19 and consequences. J Med Virol 2020; 93:1837-1842. [PMID: 33200414 PMCID: PMC7753543 DOI: 10.1002/jmv.26673] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 01/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by coronavirus has spread worldwide and has become the deadliest pandemic of the 21st century. Such rapid spread is predominantly attributed to the poor diagnosis and its asymptomatic transmission. In the absence of treatment regime, timely diagnosis is the best available remedy that can restrict its spread. An early diagnosis of COVID-19 is critical for determining the line of treatment and preventing long term complications in the infected subject. Unfortunately, available rapid antigen and antibody kits are known to be erroneous whereas reverse transcription polymerase chain reaction based tests are expensive, viral load dependent and at times inconclusive. In current scenario, the false-negative results imposed a major risk to the individual patient care and also to the efforts for containing the spread at the population level, where as false positives are traumatic for families and can lead to improper treatment resulting in severe complications. In this article, the limitations of available diagnostic procedures have been elaborated and plausible combination approach has been advised.
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Affiliation(s)
- Kirtimaan Syal
- Department of Biological Sciences, BITS-Pilani, Telangana, India
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193
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Luciani M, Bentivegna E, Spuntarelli V, Lamberti PA, Cacioli G, Del Porto F, Sesti G, Martelletti P, De Biase L. Recurrent COVID-19 pneumonia in the course of chemotherapy: Consequence of a weakened immune system? J Med Virol 2020; 93:1882-1884. [PMID: 33247596 PMCID: PMC7753699 DOI: 10.1002/jmv.26701] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Michelangelo Luciani
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Valerio Spuntarelli
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Piera Amoriello Lamberti
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giulio Cacioli
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Flavia Del Porto
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luciano De Biase
- Emergency Medicine COVID-19 Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy.,Heart Failure Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
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194
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Taefehshokr N, Taefehshokr S, Heit B. Mechanisms of Dysregulated Humoral and Cellular Immunity by SARS-CoV-2. Pathogens 2020; 9:E1027. [PMID: 33302366 PMCID: PMC7762606 DOI: 10.3390/pathogens9121027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic, a disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), was first identified in December 2019 in China, and has led to thousands of mortalities globally each day. While the innate immune response serves as the first line of defense, viral clearance requires activation of adaptive immunity, which employs B and T cells to provide sanitizing immunity. SARS-CoV-2 has a potent arsenal of mechanisms used to counter this adaptive immune response through processes, such as T cells depletion and T cell exhaustion. These phenomena are most often observed in severe SARS-CoV-2 patients, pointing towards a link between T cell function and disease severity. Moreover, neutralizing antibody titers and memory B cell responses may be short lived in many SARS-CoV-2 patients, potentially exposing these patients to re-infection. In this review, we discuss our current understanding of B and T cells immune responses and activity in SARS-CoV-2 pathogenesis.
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Affiliation(s)
- Nima Taefehshokr
- Department of Microbiology and Immunology, Center for Human Immunology, The University of Western Ontario, London, ON N0M 2N0, Canada;
| | - Sina Taefehshokr
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 51368, Iran;
| | - Bryan Heit
- Department of Microbiology and Immunology, Center for Human Immunology, The University of Western Ontario, London, ON N0M 2N0, Canada;
- Robarts Research Institute, London, ON N6A 5K8, Canada
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195
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Barbarossa MV, Fuhrmann J. Germany's next shutdown-Possible scenarios and outcomes. Influenza Other Respir Viruses 2020; 15:326-330. [PMID: 33277962 PMCID: PMC8051701 DOI: 10.1111/irv.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
With the rapid increase of reported COVID‐19 cases, German policymakers announced a 4‐week “shutdown light” starting on November 2, 2020. Applying mathematical models, possible scenarios for the evolution of the outbreak in Germany are simulated. The results indicate that independent of the effectiveness of the current restrictive measures they might not be sufficient to mitigate the outbreak. Repeated shutdown periods or permanently applied measures over the winter could be successful alternatives.
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Affiliation(s)
| | - Jan Fuhrmann
- Frankfurt Institute for Advanced Studies, Ruth-Moufang-Straße 1, Frankfurt, Germany.,Jülich Supercomputing Centre, Forschungszentrum Jülich, Wilhelm-Johnen-Straße, Jülich, Germany
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196
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Abstract
ABSTRACT In 2019, a novel coronavirus infection was detected in humans. As coronavirus disease 2019 (COVID-19) spread around the world, often confusing and contradictory information about the disease proliferated rapidly. This article reviews what is currently known about COVID-19, including transmission, epidemiology, immunologic responses, clinical manifestations, and disease management.
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Affiliation(s)
- Mary Madeline Rogge
- Mary Madeline Rogge is an associate professor at Texas Tech University Health Sciences Center, School of Nursing, Lubbock, Tex. Bibha Gautam is an associate professor at Texas Tech University Health Sciences Center, School of Nursing, Lubbock, Tex
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197
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Laroni A, Schiavetti I, Sormani MP, Uccelli A. COVID-19 in patients with multiple sclerosis undergoing disease-modifying treatments. Mult Scler 2020; 27:2126-2136. [PMID: 33205695 DOI: 10.1177/1352458520971817] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The CoronaVirus Disease 19 (COVID-19) pandemic is a threat of particular concern for people affected by chronic immune-mediated diseases, such as multiple sclerosis (MS), who are often treated with immunomodulatory and immunosuppressive drugs, which may increase the risk of infections in general. At the beginning of the COVID-19 pandemic, empirical guidelines on how to manage treatments for immune-mediated diseases, including MS, were released. Subsequently, the first clinical pictures and data sets have been published, describing the outcomes of COVID-19 in patients with MS treated with immunomodulatory and immunosuppressive drugs. Here we will review available information on how infections by human coronaviruses affect the immune system in untreated subjects and in patients affected by MS treated with drugs which modulate the immune system.
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Affiliation(s)
- Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Maria Pia Sormani
- IRCCS Ospedale Policlinico San Martino, Genova, Italy/Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
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198
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Shioda K, Lau MSY, Kraay ANM, Nelson KN, Siegler AJ, Sullivan PS, Collins MH, Weitz JS, Lopman BA. Estimating the cumulative incidence of SARS-CoV-2 infection and the infection fatality ratio in light of waning antibodies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.13.20231266. [PMID: 33236035 PMCID: PMC7685353 DOI: 10.1101/2020.11.13.20231266] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Serology tests can identify previous infections and facilitate estimation of the number of total infections. However, immunoglobulins targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to wane below the detectable level of serological assays. We estimate the cumulative incidence of SARS-CoV-2 infection from serology studies, accounting for expected levels of antibody acquisition (seroconversion) and waning (seroreversion), and apply this framework using data from New York City (NYC) and Connecticut. Methods We estimated time from seroconversion to seroreversion and infection fatality ratio (IFR) using mortality data from March-October 2020 and population-level cross-sectional seroprevalence data from April-August 2020 in NYC and Connecticut. We then estimated the daily seroprevalence and cumulative incidence of SARS-CoV-2 infection. Findings The estimated average time from seroconversion to seroreversion was 3-4 months. The estimated IFR was 1.1% (95% credible interval: 1.0-1.2%) in NYC and 1.4% (1.1-1.7%) in Connecticut. The estimated daily seroprevalence declined after a peak in the spring. The estimated cumulative incidence reached 26.8% (24.2-29.7%) and 8.8% (7.1-11.3%) at the end of September in NYC and Connecticut, higher than maximum seroprevalence measures (22.1% and 6.1%), respectively. Interpretation The cumulative incidence of SARS-CoV-2 infection is underestimated using cross-sectional serology data without adjustment for waning antibodies. Our approach can help quantify the magnitude of underestimation and adjust estimates for waning antibodies. Funding This study was supported by the US National Science Foundation and the National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Max SY Lau
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alicia NM Kraay
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua S Weitz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA; School of Physics, Georgia Institute of Technology, Atlanta, GA, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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199
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Reno C, Lenzi J, Golinelli D, Gori D, Signorelli C, Kraemer J, Stoto MA, Avitabile E, Landini MP, Lazzarotto T, Re MC, Rucci P, Taliani G, Trerè D, Vocale C, Fantini MP. SARS-CoV-2/COVID-19 Testing: The Tower of Babel. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020144. [PMID: 33525202 PMCID: PMC7927496 DOI: 10.23750/abm.v91i4.10911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/28/2022]
Abstract
Background and aim: Testing represents one of the main pillars of public health response to SARS-CoV-2/COVID-19 pandemic. This paper shows how accuracy and utility of testing programs depend not just on the type of tests, but on the context as well. Methods: We describe the testing methods that have been developed and the possible testing strategies; then, we focus on two possible methods of population-wide testing, i.e., pooled testing and testing with rapid antigen tests. We show the accuracy of split-pooling method and how, in different pre-test probability scenarios, the positive and negative predictive values vary using rapid antigen tests. Results: Split-pooling, followed by retesting of negative results, shows a higher sensitivity than individual testing and requires fewer tests. In case of low pre-test probability, a negative result with antigen test could allow to rule out the infection, while, in case of a positive result, a confirmatory molecular test would be necessary. Conclusions: Test performance alone is not enough to properly choose which test to use; goals and context of the testing program are essential. We advocate the use of pooled strategies when planning population-wide screening, and the weekly use of rapid tests for close periodic monitoring in low-prevalence populations. (www.actabiomedica.it)
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Affiliation(s)
- Chiara Reno
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
| | - Jacopo Lenzi
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
| | - Davide Golinelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
| | - Davide Gori
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
| | - Carlo Signorelli
- Università Vita-Salute San Raffaele; Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma.
| | - John Kraemer
- Department of Health Systems Administration, Georgetown University.
| | - Michael A Stoto
- Department of Health Systems Administration, Georgetown University; Emergency Preparedness Research, Evaluation and Practice (EPREP) Program, Harvard T.H. Chan School of Public Health.
| | - Elisa Avitabile
- Dipartimento di Farmacia e Biotecnologie, Alma Mater Studiorum - Università di Bologna.
| | - Maria Paola Landini
- IRCCS Istituto Ortopedico Rizzoli; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna.
| | - Tiziana Lazzarotto
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna, Bologna.
| | - Maria Carla Re
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna.
| | - Paola Rucci
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
| | - Gloria Taliani
- Dipartimento di Medicina Traslazionale e di Precisione, Università degli Studi di Roma "La Sapienza".
| | - Davide Trerè
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum - Università di Bologna.
| | - Caterina Vocale
- IRCCS Azienda Ospedaliero-Universitaria "Policlinico Sant'Orsola-Malpighi" di Bologna.
| | - Maria Pia Fantini
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum - Università di Bologna.
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200
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Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Pérez-Olmeda M, Yotti R. SARS-CoV-2 seroprevalence in Spain - Authors' reply. Lancet 2020; 396:1484-1485. [PMID: 33160561 PMCID: PMC7832783 DOI: 10.1016/s0140-6736(20)32266-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Jesús Oteo
- National Centre for Microbiology, Institute of Health Carlos III, 28029 Madrid, Spain; Spanish Network for Research in Infectious Diseases, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Raquel Yotti
- Directorate, Institute of Health Carlos III, 28029 Madrid, Spain
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