351
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Yamate M, Yamashita M, Goto T, Tsuji S, Li YG, Warachit J, Yunoki M, Ikuta K. Establishment of Vero E6 cell clones persistently infected with severe acute respiratory syndrome coronavirus. Microbes Infect 2005; 7:1530-40. [PMID: 16269264 PMCID: PMC7110502 DOI: 10.1016/j.micinf.2005.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 05/07/2005] [Accepted: 05/16/2005] [Indexed: 12/28/2022]
Abstract
Little information is available on persistent infection of severe acute respiratory syndrome (SARS) coronavirus (CoV). In this study, we established persistent infection of SARS-CoV in the Vero E6 cell line. Acute infection of Vero E6 with SARS-CoV produced a lytic infection with characteristic rounding cytopathic effects (CPE) and the production of a large number of infectious particles in the culture fluid within 3 days post-infection. Upon subsequent culturing of the remaining adherent cells, the cells gradually proliferated and recovered normal morphology similar to that of the parental cells, and continued to produce large numbers of infectious viral particles during the observation period of 5 months. Among a total of 87 cell clones obtained from the persistently infected Vero E6, only four cell clones (named #13, #18, #21, and #34) were positive for viral RNA. Clones #13, #18, and #34 shifted to viral RNA-negative during subsequent cultures, while #21 continuously produced infectious particles at a high rate. The SARS-CoV receptor, angiotensin-converting enzyme 2, was almost completely down regulated from the cell surface of persistently infected cells. Western blot analysis as well as electron microscopy indicated that the ratios of spike to nucleocapsid protein in clone #21 as well as its parental persistently infected cells were lower than that in the cells in the acute phase of infection. These Vero E6 cells persistently infected with SARS-CoV may be useful for clarifying the mechanism of the persistent infection and also for elucidating the possible pathophysiologic significance of such long-term maintenance of this virus.
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Affiliation(s)
- Masanobu Yamate
- Department of Virology, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
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352
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Hui DSC, Wong GWK. Advancements in the battle against severe acute respiratory syndrome. Expert Opin Pharmacother 2005; 5:1687-93. [PMID: 15264983 DOI: 10.1517/14656566.5.8.1687] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a significant morbidity and mortality. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache and dyspnoea. Respiratory failure is the major complication of SARS and approximately 20% of patients may progress to acute respiratory distress syndrome requiring invasive mechanical ventilatory support. However, the severity is much milder in infected young children. Treatment of SARS was empirical in 2003 due to our limited understanding of this new disease. Protease inhibitors (lopinavir/ritonavir) in combination with ribavirin may play a role as antiviral therapy in the early phase, whereas the role of IFN and systemic steroid in preventing immune-mediated lung injury deserves further investigation. Knowledge of the genomic sequence of the SARS coronavirus has facilitated the development of rapid diagnostic tests. In addition, other antiviral treatment, RNA interference, monoclonal antibody, synthetic peptides, and vaccines are being developed. This paper provides a review of the epidemiology, clinical features and possible treatment strategies of SARS.
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Affiliation(s)
- David S C Hui
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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353
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Tang BSF, Chan KH, Cheng VCC, Woo PCY, Lau SKP, Lam CCK, Chan TL, Wu AKL, Hung IFN, Leung SY, Yuen KY. Comparative host gene transcription by microarray analysis early after infection of the Huh7 cell line by severe acute respiratory syndrome coronavirus and human coronavirus 229E. J Virol 2005; 79:6180-93. [PMID: 15858003 PMCID: PMC1091719 DOI: 10.1128/jvi.79.10.6180-6193.2005] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The pathogenesis of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) at the cellular level is unclear. No human cell line was previously known to be susceptible to both SARS-CoV and other human coronaviruses. Huh7 cells were found to be susceptible to both SARS-CoV, associated with SARS, and human coronavirus 229E (HCoV-229E), usually associated with the common cold. Highly lytic and productive rates of infections within 48 h of inoculation were reproducible with both viruses. The early transcriptional profiles of host cell response to both types of infection at 2 and 4 h postinoculation were determined by using the Affymetrix HG-U133A microarray (about 22,000 genes). Much more perturbation of cellular gene transcription was observed after infection by SARS-CoV than after infection by HCoV-229E. Besides the upregulation of genes associated with apoptosis, which was exactly opposite to the previously reported effect of SARS-CoV in a colonic carcinoma cell line, genes related to inflammation, stress response, and procoagulation were also upregulated. These findings were confirmed by semiquantitative reverse transcription-PCR, reverse transcription-quantitative PCR for mRNA of genes, and immunoassays for some encoded proteins. These transcriptomal changes are compatible with the histological changes of pulmonary vasculitis and microvascular thrombosis in addition to the diffuse alveolar damage involving the pneumocytes.
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Affiliation(s)
- Bone S F Tang
- Department of Microbiology, State Key Laboratory of Emerging Infectious Diseases, Center of Infection and Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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354
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Chu KH, Tsang WK, Tang CS, Lam MF, Lai FM, To KF, Fung KS, Tang HL, Yan WW, Chan HWH, Lai TST, Tong KL, Lai KN. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int 2005; 67:698-705. [PMID: 15673319 PMCID: PMC7112337 DOI: 10.1111/j.1523-1755.2005.67130.x] [Citation(s) in RCA: 364] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection. METHODS We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy. RESULTS Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS. CONCLUSION Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.
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Affiliation(s)
- Kwok Hong Chu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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355
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Stark CJ, Atreya CD. Molecular advances in the cell biology of SARS-CoV and current disease prevention strategies. Virol J 2005; 2:35. [PMID: 15833113 PMCID: PMC1087510 DOI: 10.1186/1743-422x-2-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 12/13/2022] Open
Abstract
In the aftermath of the SARS epidemic, there has been significant progress in understanding the molecular and cell biology of SARS-CoV. Some of the milestones are the availability of viral genome sequence, identification of the viral receptor, development of an infectious cDNA clone, and the identification of viral antigens that elicit neutralizing antibodies. However, there is still a large gap in our understanding of how SARS-CoV interacts with the host cell and the rapidly changing viral genome adds another variable to this equation. Now the SARS-CoV story has entered a new phase, a search for preventive strategies and a cure for the disease. This review highlights the progress made in identifying molecular aspects of SARS-CoV biology that is relevant in developing disease prevention strategies. Authors conclude that development of successful SARS-CoV vaccines and antivirals depends on the progress we make in these areas in the immediate future.
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Affiliation(s)
- Caren J Stark
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, MD 20892 USA
| | - CD Atreya
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, MD 20892 USA
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356
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Srikantiah P, Charles MD, Reagan S, Clark TA, Pletz MW, Patel PR, Hoekstra RM, Lingappa J, Jernigan JA, Fischer M. SARS clinical features, United States, 2003. Emerg Infect Dis 2005; 11:135-8. [PMID: 15705339 PMCID: PMC3294350 DOI: 10.3201/eid1101.040585] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We compared the clinical features of 8 U.S. case-patients with laboratory-confirmed severe acute respiratory syndrome (SARS) to 65 controls who tested negative for SARS coronavirus (SARS-CoV) infection. Shortness of breath, vomiting, diarrhea, progressive bilateral infiltrates on chest radiograph, and need for supplemental oxygen were significantly associated with confirmed SARS-CoV infection.
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Affiliation(s)
| | - Myrna D. Charles
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Reagan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas A. Clark
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Priti R. Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jairam Lingappa
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John A. Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marc Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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357
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Kwan ACP, Chau TN, Tong WL, Tsang OTY, Tso EYK, Chiu MC, Yu WC, Lai TST. Severe acute respiratory syndrome-related diarrhea. J Gastroenterol Hepatol 2005. [PMID: 15836711 DOI: 10.1111/j.1400-1746.2005.03775.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is an emerging infectious disease and diarrhea has been reported in up to 76% of cases. The purpose of the present paper was to carry out a retrospective study of the clinical and demographic data of SARS patients with diarrhea in Princess Margaret Hospital. METHODS From 1 to 31 March 2003, hospital records from 240 patients with confirmed SARS were studied. Patients with watery stool of >/=3 times/day for at least 3 consecutive days were defined as the diarrhea group. Clinical and demographic data were compared between the diarrhea and non-diarrhea groups. Chest X-ray (CXR) scores during the peak of diarrhea period were recorded by a respiratory physician. These CXR scores were correlated with the peak frequency of diarrhea by Spearman's correlation coefficient. RESULTS Diarrhea occurred in 20.4% of patients after admission. Female patients were predominant with a female to male ratio of 6:1 (P < 0.001) and 69.4% of patients were living in Amoy Gardens Estate (P = 0.01). The proportions of patients requiring ventilatory care and mortality in the diarrhea group were 8.2% and 2%, respectively, which were significantly lower than those in the non-diarrhea group (27.6% and 16.2%, P < 0.005). The CXR scores during the peak of diarrhea were not correlated with the maximum frequency of diarrhea (r = -0.09, P = 0.5). CONCLUSIONS A total of 20.4% of SARS patients had the complication of diarrhea after hospital admission. Both female sex and being a resident of Amoy Gardens Estate were associated with diarrhea. The diarrhea group had a better prognosis.
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358
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Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) is an emerging infectious disease and diarrhea has been reported in up to 76% of cases. The purpose of the present paper was to carry out a retrospective study of the clinical and demographic data of SARS patients with diarrhea in Princess Margaret Hospital. METHODS From 1 to 31 March 2003, hospital records from 240 patients with confirmed SARS were studied. Patients with watery stool of >/=3 times/day for at least 3 consecutive days were defined as the diarrhea group. Clinical and demographic data were compared between the diarrhea and non-diarrhea groups. Chest X-ray (CXR) scores during the peak of diarrhea period were recorded by a respiratory physician. These CXR scores were correlated with the peak frequency of diarrhea by Spearman's correlation coefficient. RESULTS Diarrhea occurred in 20.4% of patients after admission. Female patients were predominant with a female to male ratio of 6:1 (P < 0.001) and 69.4% of patients were living in Amoy Gardens Estate (P = 0.01). The proportions of patients requiring ventilatory care and mortality in the diarrhea group were 8.2% and 2%, respectively, which were significantly lower than those in the non-diarrhea group (27.6% and 16.2%, P < 0.005). The CXR scores during the peak of diarrhea were not correlated with the maximum frequency of diarrhea (r = -0.09, P = 0.5). CONCLUSIONS A total of 20.4% of SARS patients had the complication of diarrhea after hospital admission. Both female sex and being a resident of Amoy Gardens Estate were associated with diarrhea. The diarrhea group had a better prognosis.
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359
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Chan PKS, To KF, Lo AWI, Cheung JLK, Chu I, Au FWL, Tong JHM, Tam JS, Sung JJY, Ng HK. Persistent infection of SARS coronavirus in colonic cells in vitro. J Med Virol 2005; 74:1-7. [PMID: 15258961 PMCID: PMC7166317 DOI: 10.1002/jmv.20138] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Severe acute respiratory syndrome coronavirus (SARS‐CoV) can produce gastrointestinal symptoms. The intestinal tract is the only extrapulmonary site where viable viruses have been detected. This study examined seven established human intestinal cell lines, DLD‐1, HCT‐116, HT‐29, LoVo, LS‐180, SW‐480 and SW‐620, for their permissiveness to SARS‐CoV infection. The results showed that only LoVo cells were permissive to SARS‐CoV infection as evident by positive findings from indirect immunofluorescence staining for intracellular viral antigens, in situ hybridization for intracellular viral RNA, and electron microscopy for intracellular viral particles. In contrast to Vero cells, SARS‐CoV did not produce cytopathic effects on LoVo cells. However, LoVo cells were found to be highly permissive for productive infection with a high viral titre (>3 × 107 viral copies/ml) produced in culture supernatant following a few days of incubation. SARS‐CoV established a stable persistent chronic infection that could be maintained after multiple passages. Being a cell line of human origin, LoVo cells could be a useful in vitro model for studying the biology and persistent infection of SARS‐CoV. Our results on the expression of angiotensin‐converting enzyme 2 (ACE2), a recently identified cellular receptor for SARS‐CoV, in these cell lines indicated that it might not be the sole determinant for cells to be susceptible to SARS‐CoV infection. J. Med. Virol. 74:1–7, 2004. © 2004 Wiley‐Liss, Inc.
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Affiliation(s)
- Paul K S Chan
- Centre for Emerging Infectious Diseases, and Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
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360
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Darnell ME, Subbarao K, Feinstone SM, Taylor DR. Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. J Virol Methods 2005; 121:85-91. [PMID: 15350737 PMCID: PMC7112912 DOI: 10.1016/j.jviromet.2004.06.006] [Citation(s) in RCA: 487] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 06/15/2004] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome (SARS) is a life-threatening disease caused by a novel coronavirus termed SARS-CoV. Due to the severity of this disease, the World Health Organization (WHO) recommends that manipulation of active viral cultures of SARS-CoV be performed in containment laboratories at biosafety level 3 (BSL3). The virus was inactivated by ultraviolet light (UV) at 254 nm, heat treatment of 65 °C or greater, alkaline (pH > 12) or acidic (pH < 3) conditions, formalin and glutaraldehyde treatments. We describe the kinetics of these efficient viral inactivation methods, which will allow research with SARS-CoV containing materials, that are rendered non-infectious, to be conducted at reduced safety levels.
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Affiliation(s)
- Miriam E.R. Darnell
- Center for Biologics Evaluation and Research, US Food and Drug Administration, 8800 Rockville Pike, HFM448, Bethesda, MD 20892, USA
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892, USA
| | - Stephen M. Feinstone
- Center for Biologics Evaluation and Research, US Food and Drug Administration, 8800 Rockville Pike, HFM448, Bethesda, MD 20892, USA
| | - Deborah R. Taylor
- Center for Biologics Evaluation and Research, US Food and Drug Administration, 8800 Rockville Pike, HFM448, Bethesda, MD 20892, USA
- Corresponding author. Tel.: +1 301 827 1878; fax: +1 301 496 1810.
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361
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de Groot-Mijnes JDF, van Dun JM, van der Most RG, de Groot RJ. Natural history of a recurrent feline coronavirus infection and the role of cellular immunity in survival and disease. J Virol 2005; 79:1036-44. [PMID: 15613332 PMCID: PMC538555 DOI: 10.1128/jvi.79.2.1036-1044.2005] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 08/16/2004] [Indexed: 12/16/2022] Open
Abstract
We describe the natural history, viral dynamics, and immunobiology of feline infectious peritonitis (FIP), a highly lethal coronavirus infection. A severe recurrent infection developed, typified by viral persistence and acute lymphopenia, with waves of enhanced viral replication coinciding with fever, weight loss, and depletion of CD4+ and CD8+ T cells. Our combined observations suggest a model for FIP pathogenesis in which virus-induced T-cell depletion and the antiviral T-cell response are opposing forces and in which the efficacy of early T-cell responses critically determines the outcome of the infection. Rising amounts of viral RNA in the blood, consistently seen in animals with end-stage FIP, indicate that progression to fatal disease is the direct consequence of a loss of immune control, resulting in unchecked viral replication. The pathogenic phenomena described here likely bear relevance to other severe coronavirus infections, in particular severe acute respiratory syndrome, for which multiphasic disease progression and acute T-cell lymphopenia have also been reported. Experimental FIP presents a relevant, safe, and well-defined model to study coronavirus-mediated immunosuppression and should provide an attractive and convenient system for in vivo testing of anticoronaviral drugs.
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Affiliation(s)
- Jolanda D F de Groot-Mijnes
- Virology Division, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
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362
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Leong HN, Chan KP, Khan AS, Oon L, Se-Thoe SY, Bai XL, Yeo D, Leo YS, Ang B, Ksiazek TG, Ling AE. Virus-specific RNA and antibody from convalescent-phase SARS patients discharged from hospital. Emerg Infect Dis 2004; 10:1745-50. [PMID: 15504259 PMCID: PMC3323266 DOI: 10.3201/eid1010.040026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The prevalence of SARS-CoV in bodily excretions was determined. Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV). In a longitudinal cross-sectional study, we determined the prevalence of virus in bodily excretions and time of seroconversion in discharged patients with SARS. Conjunctival, throat, stool, and urine specimens were collected weekly from 64 patients and tested for SARS-CoV RNA by real-time polymerase chain reaction; serum samples were collected weekly and tested for SARS-CoV antibody with indirect enzyme immunoassay and immunofluorescence assay. In total, 126 conjunctival, 124 throat swab, 116 stool, and 124 urine specimens were analyzed. Five patients had positive stool samples, collected in weeks 5–9. Two patients seroconverted in weeks 7 and 8; the others were seropositive at the first serum sample collection. In this study, 5 (7.8%) of 64 patients continued to shed viral RNA in stool samples only, for up to week 8 of illness. Most seroconversions occurred by week 6 of illness.
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Affiliation(s)
- Hoe Nam Leong
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433.
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363
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Hung I, Cheng V, Wu A, Tang B, Chan K, Chu C, Wong M, Hui W, Poon L, Tse D, Chan K, Woo P, Lau S, Peiris J, Yuen K. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis 2004; 10:1550-7. [PMID: 15498155 PMCID: PMC3320271 DOI: 10.3201/eid1009.040058] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A retrospective viral load study was performed on clinical specimens from 154 patients with laboratory-confirmed severe acute respiratory syndrome (SARS); the specimens were prospectively collected during patients' illness. Viral load in nasopharyngeal aspirates (n = 142) from day 10 to day 15 after onset of symptoms was associated with oxygen desaturation, mechanical ventilation, diarrhea, hepatic dysfunction, and death. Serum viral load (n = 53) was associated with oxygen desaturation, mechanical ventilation, and death. Stool viral load (n = 94) was associated with diarrhea, and urine viral load (n = 111) was associated with abnormal urinalysis results. Viral replications at different sites are important in the pathogenesis of clinical and laboratory abnormalities of SARS.
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Affiliation(s)
- I.F.N. Hung
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - V.C.C. Cheng
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - A.K.L. Wu
- Prince of Wales Hospital, Hong Kong SAR, People's Republic of China
| | - B.S.F. Tang
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - K.H. Chan
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - C.M. Chu
- United Christian Hospital, Hong Kong SAR, People's Republic of China
| | - M.M.L. Wong
- Caritas Medical Centre, Hong Kong SAR, People's Republic of China
| | - W.T. Hui
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - L.L.M. Poon
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - D.M.W. Tse
- Caritas Medical Centre, Hong Kong SAR, People's Republic of China
| | - K.S. Chan
- United Christian Hospital, Hong Kong SAR, People's Republic of China
| | - P.C.Y. Woo
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - S.K.P. Lau
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - J.S.M. Peiris
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
| | - K.Y. Yuen
- Queen Mary Hospital at the University of Hong Kong, Hong Kong Special Administrative Region (SAR), People's Republic of China
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364
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Abstract
Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress that has been made towards understanding the virus-SARS coronavirus (SARS-CoV)-and the disease. We will also highlight the progress that has been made towards developing vaccines and therapies The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats.
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Affiliation(s)
- J S M Peiris
- Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Pokfualm, Hong Kong Special Administrative Region of China.
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365
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Abstract
Children are susceptible to infection by SARS-associated coronavirus (SARS-CoV) but the clinical picture of SARS is milder than in adults. Teenagers resemble adults in presentation and disease progression and may develop severe illness requiring intensive care and assisted ventilation. Fever, malaise, cough, coryza, chills or rigor, sputum production, headache, myalgia, leucopaenia, lymphopaenia, thrombocytopaenia, mildly prolonged activated partial thromboplastin times and elevated lactate dehydrogenase levels are common presenting features. Radiographic findings are non-specific but high-resolution computed tomography of the thorax in clinically suspected cases may be an early diagnostic aid when initial chest radiographs appear normal. The improved reverse transcription-polymerase chain reaction (RT-PCR) assays are critical in the early diagnosis of SARS, with sensitivity approaching 80% in the first 3 days of illness when performed on nasopharyngeal aspirates, the preferred specimens. Absence of seroconversion to SARS-CoV beyond 28 days from disease onset generally excludes the diagnosis. The best treatment strategy for SARS among children remains to be determined. No case fatality has been reported in children and the short- to medium-term outcome appears to be good. The importance of continued monitoring for any long-term complications due to the disease or its empiric treatment, cannot be overemphasised.
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Key Words
- sars, severe acute respiratory syndrome
- sars-cov, sars-associated coronavirus
- rsv, respiratory syncytial virus
- ards, acute respiratory distress syndrome
- cxr, chest radiograph
- hrct, high-resolution computed tomography
- boop, bronchiolitis obliterans-organising pneumonia
- npa, nasopharyngeal aspirate
- rt-pcr, reverse transcription-polymerase chain reaction
- ifa, immunofluorescence assay
- elisa, enzyme-linked immunosorbant assay
- severe acute respiratory syndrome
- sars
- children
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Affiliation(s)
- C W Leung
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong Special Administrative Region, China.
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366
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Abstract
Enveloped viruses have evolved membrane glycoproteins (GPs) that mediate entry into host cells. These proteins are important targets for antiviral therapies and vaccines. Several efforts to understand and combat infection by severe acute respiratory syndrome coronavirus (SARS-CoV) have therefore focused on the viral GP, known as spike (S). In a short period of time, important aspects of SARS-CoV S-protein function were unraveled. The identification of angiotensin-converting enzyme 2 (ACE2) as a receptor for SARS-CoV provided an insight into viral tropism and pathogenesis, whereas mapping of functional domains in the S-protein enabled inhibitors to be generated. Vaccines designed on the basis of SARS-CoV S-protein were shown to be effective in animals and consequently are attractive candidates for vaccine trials in humans. Here, we discuss how SARS-CoV S facilitates viral entry into target cells and illustrate current approaches that are used to inhibit this process.
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367
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Seasonality of infectious diseases and severe acute respiratory syndrome-what we don't know can hurt us. THE LANCET. INFECTIOUS DISEASES 2004; 4:704-8. [PMID: 15522683 PMCID: PMC7129396 DOI: 10.1016/s1473-3099(04)01177-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The novel severe acute respiratory syndrome (SARS) coronavirus caused severe disease and heavy economic losses before apparently coming under complete control. Our understanding of the forces driving seasonal disappearance and recurrence of infectious diseases remains fragmentary, thus limiting any predictions about whether, or when, SARS will recur. It is true that most established respiratory pathogens of human beings recur in wintertime, but a new appreciation for the high burden of disease in tropical areas reinforces questions about explanations resting solely on cold air or low humidity. Seasonal variation in host physiology may also contribute. Newly emergent zoonotic diseases such as ebola or pandemic strains of influenza have recurred in unpredictable patterns. Most established coronaviruses exhibit winter seasonality, with a unique ability to establish persistent infections in a minority of infected animals. Because SARS coronavirus RNA can be detected in the stool of some individuals for at least 9 weeks, recurrence of SARS from persistently shedding human or animal reservoirs is biologically plausible.
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368
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Li W, Greenough TC, Moore MJ, Vasilieva N, Somasundaran M, Sullivan JL, Farzan M, Choe H. Efficient replication of severe acute respiratory syndrome coronavirus in mouse cells is limited by murine angiotensin-converting enzyme 2. J Virol 2004; 78:11429-33. [PMID: 15452268 PMCID: PMC521845 DOI: 10.1128/jvi.78.20.11429-11433.2004] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Replication of viruses in species other than their natural hosts is frequently limited by entry and postentry barriers. The coronavirus that causes severe acute respiratory syndrome (SARS-CoV) utilizes the receptor angiotensin-converting enzyme 2 (ACE2) to infect cells. Here we compare human, mouse, and rat ACE2 molecules for their ability to serve as receptors for SARS-CoV. We found that, compared to human ACE2, murine ACE2 less efficiently bound the S1 domain of SARS-CoV and supported less-efficient S protein-mediated infection. Rat ACE2 was even less efficient, at near background levels for both activities. Murine 3T3 cells expressing human ACE2 supported SARS-CoV replication, whereas replication was less than 10% as efficient in the same cells expressing murine ACE2. These data imply that a mouse transgenically expressing human ACE2 may be a useful animal model of SARS.
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Affiliation(s)
- Wenhui Li
- Partners AIDS Research Center, 65 Landsdowne St., Cambridge, MA 02139, USA
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369
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Poon LLM, Guan Y, Nicholls JM, Yuen KY, Peiris JSM. The aetiology, origins, and diagnosis of severe acute respiratory syndrome. THE LANCET. INFECTIOUS DISEASES 2004; 4:663-71. [PMID: 15522678 PMCID: PMC7106534 DOI: 10.1016/s1473-3099(04)01172-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Severe acute respiratory syndrome (SARS) is a new infectious disease that first emerged in Guangdong province, China, in November, 2002. A novel coronavirus was later identified in patients with SARS. The detection of the virus in these patients, its absence in healthy controls or other patients with atypical pneumonia, and the reproduction of a similar disease in a relevant animal model fulfilled Koch's postulates for implicating this coronavirus as the causal agent of SARS. The full genome sequence was determined within weeks of the virus's identification. The rapid progress in the aetiology, the development of laboratory diagnostic tests, and the defining of routes of viral transmission were facilitated through a unique WHO-coordinated virtual network of laboratories, which shared information on a real-time basis through daily teleconferences. Subsequent studies have indicated that the SARS coronavirus is of animal origin, that its precursor is still present in animal populations within the region, and that live-animal markets in southern China may have provided the animal-human interphase that allowed this precursor virus to adapt to human-human transmission. These findings underscore the potential for the re-emergence of SARS and the need for laboratory tests for early diagnosis. However, the low viral load in the respiratory tract makes early diagnosis of SARS a diagnostic challenge, although improvements in the sensitivity of molecular diagnostic methods continue to be made.
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Affiliation(s)
- LLM Poon
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
| | - Y Guan
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
| | - JM Nicholls
- Department of Pathology, University of Hong Kong, Hong Kong SAR, China
| | - KY Yuen
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
| | - JSM Peiris
- Department of Microbiology, University of Hong Kong, Hong Kong SAR, China
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370
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Chiu YC, Wu KL, Chou YP, Fong TV, Tsai TL, Kuo CM, Kuo CH, Chiu KW, Liu JW, Eng HL, Jawan B, Cheng YF, Chen CL. Diarrhea in medical care workers with severe acute respiratory syndrome. J Clin Gastroenterol 2004; 38:880-2. [PMID: 15492605 DOI: 10.1097/00004836-200411000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND GOAL Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission. STUDY Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase. RESULTS The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002). CONCLUSIONS Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.
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Affiliation(s)
- Yi-Chun Chiu
- Division of Gastroenterology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan, Republic of China
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371
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Nie Y, Wang P, Shi X, Wang G, Chen J, Zheng A, Wang W, Wang Z, Qu X, Luo M, Tan L, Song X, Yin X, Chen J, Ding M, Deng H. Highly infectious SARS-CoV pseudotyped virus reveals the cell tropism and its correlation with receptor expression. Biochem Biophys Res Commun 2004; 321:994-1000. [PMID: 15358126 PMCID: PMC7092805 DOI: 10.1016/j.bbrc.2004.07.060] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Indexed: 12/28/2022]
Abstract
Studies of SARS coronavirus (SARS-CoV)—the causative agent of severe acute respiratory syndrome (SARS)—have been hampered by its high transmission rate and the pathogenicity of this virus. To permit analysis of the host range and entry mechanism of SARS-CoV, we incorporated the humanized SARS-CoV spike (S) glycoprotein into HIV particles to generate a highly infectious SARS-CoV pseudotyped virus. The infection on Vero E6—a permissive cell line to SARS-CoV—could be neutralized by sera from convalescent SARS patients, and the entry was a pH-dependent process. With these highly infectious SARS-CoV pseudotypes, several cell lines derived from various tissues were revealed as susceptible to SARS-CoV, which were highly corresponding to the expression pattern of virus’s receptor angiotensin-converting enzyme 2 (ACE2). In addition, we also demonstrated angiotensin 1 converting enzyme (ACE)—the homologue of ACE2 could not function as a receptor for SARS-CoV.
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Affiliation(s)
- Yuchun Nie
- Department of Cell Biology and Genetics, College of Life Sciences, Peking University, Beijing 100871, PR China
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372
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Abstract
PURPOSE OF REVIEW Since Kapakian first identified a virus in the stool of a patient with diarrhoea in 1972, many viruses have been described that cause diarrhoea directly or indirectly. It is now appreciated that viruses are the most common cause of diarrhoeal illness worldwide. Although bacteria and other pathogens cause significant numbers of gastroenteritis, it is the viruses that are dealt with in this review. The viruses responsible will be discussed individually. RECENT FINDINGS Rotavirus remains the leading cause of diarrhoeal disease overall, with the newly designated calicivirus family causing the most outbreaks in the industrialized nations. As diagnostic techniques improve, however, the importance of astrovirus and other previously under-reported pathogens is becoming more apparent and the number of viruses associated with gastroenteritis continues to increase. The emergence of severe acute respiratory syndrome coronavirus, arguably the most important emerging infection of recent years and a cause of significant gastrointestinal disease, is also discussed. SUMMARY No effective treatments have been developed for viral gastroenteritis. Current efforts are targeted at the development of suitable vaccines and the implementation of infection control measures.
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Affiliation(s)
- Benjamin Clark
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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373
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Darnell MER, Subbarao K, Feinstone SM, Taylor DR. Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. J Virol Methods 2004. [PMID: 15350737 DOI: 10.1016/jjviromet200406006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Severe acute respiratory syndrome (SARS) is a life-threatening disease caused by a novel coronavirus termed SARS-CoV. Due to the severity of this disease, the World Health Organization (WHO) recommends that manipulation of active viral cultures of SARS-CoV be performed in containment laboratories at biosafety level 3 (BSL3). The virus was inactivated by ultraviolet light (UV) at 254 nm, heat treatment of 65 degrees C or greater, alkaline (pH > 12) or acidic (pH < 3) conditions, formalin and glutaraldehyde treatments. We describe the kinetics of these efficient viral inactivation methods, which will allow research with SARS-CoV containing materials, that are rendered non-infectious, to be conducted at reduced safety levels.
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Affiliation(s)
- Miriam E R Darnell
- Center for Biologics Evaluation and Research, US Food and Drug Administration, 8800 Rockville Pike, HFM448, Bethesda, MD 20892, USA
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374
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Darnell MER, Subbarao K, Feinstone SM, Taylor DR. Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. J Virol Methods 2004. [PMID: 15350737 DOI: 10.17632/10.1016/j.jviromet.2004.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Severe acute respiratory syndrome (SARS) is a life-threatening disease caused by a novel coronavirus termed SARS-CoV. Due to the severity of this disease, the World Health Organization (WHO) recommends that manipulation of active viral cultures of SARS-CoV be performed in containment laboratories at biosafety level 3 (BSL3). The virus was inactivated by ultraviolet light (UV) at 254 nm, heat treatment of 65 degrees C or greater, alkaline (pH > 12) or acidic (pH < 3) conditions, formalin and glutaraldehyde treatments. We describe the kinetics of these efficient viral inactivation methods, which will allow research with SARS-CoV containing materials, that are rendered non-infectious, to be conducted at reduced safety levels.
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Affiliation(s)
- Miriam E R Darnell
- Center for Biologics Evaluation and Research, US Food and Drug Administration, 8800 Rockville Pike, HFM448, Bethesda, MD 20892, USA
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375
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Wu CJ, Jan JT, Chen CM, Hsieh HP, Hwang DR, Liu HW, Liu CY, Huang HW, Chen SC, Hong CF, Lin RK, Chao YS, Hsu JTA. Inhibition of severe acute respiratory syndrome coronavirus replication by niclosamide. Antimicrob Agents Chemother 2004; 48:2693-6. [PMID: 15215127 PMCID: PMC434198 DOI: 10.1128/aac.48.7.2693-2696.2004] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Antiviral agents are urgently needed to fight severe acute respiratory syndrome (SARS). We showed that niclosamide, an existing antihelminthic drug, was able to inhibit replication of a newly discovered coronavirus, SARS-CoV; viral antigen synthesis was totally abolished at a niclosamide concentration of 1.56 microM, as revealed by immunoblot analysis. Thus, niclosamide represents a promising drug candidate for the effective treatment of SARS-CoV infection.
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Affiliation(s)
- Chang-Jer Wu
- Institute of Preventive Medicine, National Defense Medical College, National Defense University, Taipei, Taiwan
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376
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Abstract
Classification of architectural changes in the small intestinal biopsy may be clinically useful to define the cause of diarrhea or suspected malabsorption, especially in adults. Pathologic changes may include severe (flat) or variably severe (mild or moderate) abnormalities. For some disorders, small bowel biopsy findings may be very distinctive and lead to a specific diagnosis. For others, like adult celiac disease, biopsy changes are less specific. Indeed, it is becoming increasingly appreciated that several conditions can produce similar histopathologic changes. Serological assays, including endomysial antibodies and tissue transglutaminase antibodies, may be very useful tools for screening and case finding in clinical practice. However, demonstration of characteristic changes in the small intestinal biopsy is critical, along with a gluten-free diet response.
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Affiliation(s)
- Hugh James Freeman
- Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada
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377
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Abstract
UNLABELLED INFECTIOUS AGENT: The severe acute respiratory syndrome (SARS) is a febrile pneumonia initially observed in China at the end of 2002. The infectious agent has rapidly been identified as a new coronavirus, baptised SARS-associated coronavirus (CoV-SARS). Transmission is inter-human, via respiratory particles mainly. CLINICAL PRESENTATION AND TREATMENT The clinical presentation is highly variable, from a mild fever to an acute respiratory distress syndrome. There is no specific treatment. Ribavirin associated with steroids have been used with success in numerous cases. EPIDEMIOLOGY During the first half of 2003, the spreading of the virus has been very fast, with a pandemic mode of evolution. More than 8,000 people were infected and 774 died. The reservoir of the virus, which may be animal, is still unknown. The epidemic seems to be controlled, but sporadic or epidemic re-emergences may occur and have been observed in China during January 2004.
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Affiliation(s)
- Amélie Guihot
- Service de maladies infectieuses et tropicales, hôpital Pitié-Salpêtrière, Paris (75)
| | - François Bricaire
- Service de maladies infectieuses et tropicales, hôpital Pitié-Salpêtrière, Paris (75)
| | - Taisheng Li
- Department of Infectious Diseases, Peking union medical college hospital, Chinese academy of medical sciences Pékin, Chine
| | - Philippe Bossi
- Service de maladies infectieuses et tropicales, hôpital Pitié-Salpêtrière, Paris (75)
- Correspondance : Philippe Bossi, Service de maladies infectieuses et tropicales hôpital Pitié-Salpêtrière 47-83, bd de l’Hôpital, 75013 Paris. Tél. : 01 42 16 01 01, Fax : 01 42 16 01 65.
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378
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Goldsmith CS, Tatti KM, Ksiazek TG, Rollin PE, Comer JA, Lee WW, Rota PA, Bankamp B, Bellini WJ, Zaki SR. Ultrastructural characterization of SARS coronavirus. Emerg Infect Dis 2004; 10:320-6. [PMID: 15030705 PMCID: PMC3322934 DOI: 10.3201/eid1002.030913] [Citation(s) in RCA: 266] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Severe acute respiratory syndrome (SARS) was first described during a 2002-2003 global outbreak of severe pneumonia associated with human deaths and person-to-person disease transmission. The etiologic agent was initially identified as a coronavirus by thin-section electron microscopic examination of a virus isolate. Virions were spherical, 78 nm in mean diameter, and composed of a helical nucleocapsid within an envelope with surface projections. We show that infection with the SARS-associated coronavirus resulted in distinct ultrastructural features: double-membrane vesicles, nucleocapsid inclusions, and large granular areas of cytoplasm. These three structures and the coronavirus particles were shown to be positive for viral proteins and RNA by using ultrastructural immunogold and in situ hybridization assays. In addition, ultrastructural examination of a bronchiolar lavage specimen from a SARS patient showed numerous coronavirus-infected cells with features similar to those in infected culture cells. Electron microscopic studies were critical in identifying the etiologic agent of the SARS outbreak and in guiding subsequent laboratory and epidemiologic investigations.
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Affiliation(s)
- Cynthia S Goldsmith
- Infectious Disease Pathology Activity, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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379
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Cheng VCC, Hung IFN, Tang BSF, Chu CM, Wong MML, Chan KH, Wu AKL, Tse DMW, Chan KS, Zheng BJ, Peiris JSM, Sung JJY, Yuen KY. Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome. Clin Infect Dis 2004; 38:467-75. [PMID: 14765337 PMCID: PMC7107995 DOI: 10.1086/382681] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 01/09/2004] [Indexed: 12/15/2022] Open
Abstract
The role of severe acute respiratory syndrome (SARS) coronavirus as an enteric pathogen was investigated in a cohort of 142 patients with SARS who were treated with a standard treatment protocol. Data from daily hematological, biochemical, radiological, and microbiological investigations were prospectively collected, and the correlation of these findings with diarrhea was retrospectively analyzed. Sixty-nine patients (48.6%) developed diarrhea at a mean (± standard deviation [SD]) of 7.6 ± 2.6 days after the onset of symptoms. The diarrhea was most severe at a mean (±SD) of 8.8 ± 2.4 days after onset, with a maximum frequency of 24 episodes per day (median, 5 episodes; range, 3–24 episodes). A higher mean virus load in nasopharyngeal specimens obtained on day 10 after the onset of symptoms was significantly associated with the occurrence of diarrhea (3.1 log10 vs. 1.8 log10 copies/mL; P = .01) and mortality (6.2 vs. 1.7 log10 copies/mL; P < .01). However, diarrhea was not associated with mortality. The lung and the gastrointestinal tract may react differently to SARS coronavirus infection. Additional investigation of the role of SARS coronavirus in the pathogenesis of diarrhea in patients with SARS should be conducted.
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Affiliation(s)
- V. C. C. Cheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - I. F. N. Hung
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - B. S. F. Tang
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - C. M. Chu
- Department of Medicine, United Christian Hospital, China
| | - M. M. L. Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. H. Chan
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - A. K. L. Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - D. M. W. Tse
- Department of Medicine and Geriatrics, Caritas Medical Centre, China
| | - K. S. Chan
- Department of Medicine, United Christian Hospital, China
| | - B. J. Zheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. S. M. Peiris
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
| | - J. J. Y. Sung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - K. Y. Yuen
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, China
- Reprints or correspondence: Prof. K. Y. Yuen, Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China ()
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380
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Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, Somasundaran M, Sullivan JL, Luzuriaga K, Greenough TC, Choe H, Farzan M. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426:450-4. [PMID: 14647384 PMCID: PMC7095016 DOI: 10.1038/nature02145] [Citation(s) in RCA: 4455] [Impact Index Per Article: 212.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2003] [Accepted: 10/23/2003] [Indexed: 11/08/2022]
Abstract
Spike (S) proteins of coronaviruses, including the coronavirus that causes severe acute respiratory syndrome (SARS), associate with cellular receptors to mediate infection of their target cells. Here we identify a metallopeptidase, angiotensin-converting enzyme 2 (ACE2), isolated from SARS coronavirus (SARS-CoV)-permissive Vero E6 cells, that efficiently binds the S1 domain of the SARS-CoV S protein. We found that a soluble form of ACE2, but not of the related enzyme ACE1, blocked association of the S1 domain with Vero E6 cells. 293T cells transfected with ACE2, but not those transfected with human immunodeficiency virus-1 receptors, formed multinucleated syncytia with cells expressing S protein. Furthermore, SARS-CoV replicated efficiently on ACE2-transfected but not mock-transfected 293T cells. Finally, anti-ACE2 but not anti-ACE1 antibody blocked viral replication on Vero E6 cells. Together our data indicate that ACE2 is a functional receptor for SARS-CoV.
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Affiliation(s)
- Wenhui Li
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Michael J. Moore
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Natalya Vasilieva
- Perlmutter Laboratory, Pulmonary Division, Children's Hospital, Department of Pediatrics,
| | - Jianhua Sui
- Dana-Farber Cancer Institute, Department of Medicine, Harvard Medical School, Massachusetts 02115 Boston, USA
| | - Swee Kee Wong
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
| | - Michael A. Berne
- Tufts University Core Facility, Tufts University School of Medicine, Massachusetts 02111 Boston, USA
| | - Mohan Somasundaran
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - John L. Sullivan
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Katherine Luzuriaga
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Thomas C. Greenough
- Program in Molecular Medicine, University of Massachusetts Medical School, Massachusetts 01605 Worcester, USA
| | - Hyeryun Choe
- Perlmutter Laboratory, Pulmonary Division, Children's Hospital, Department of Pediatrics,
| | - Michael Farzan
- Department of Medicine (Microbiology and Molecular Genetics), Partners AIDS Research Center, Brigham and Women's Hospital,
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381
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Abstract
Spike (S) proteins of coronaviruses, including the coronavirus that causes severe acute respiratory syndrome (SARS), associate with cellular receptors to mediate infection of their target cells. Here we identify a metallopeptidase, angiotensin-converting enzyme 2 (ACE2), isolated from SARS coronavirus (SARS-CoV)-permissive Vero E6 cells, that efficiently binds the S1 domain of the SARS-CoV S protein. We found that a soluble form of ACE2, but not of the related enzyme ACE1, blocked association of the S1 domain with Vero E6 cells. 293T cells transfected with ACE2, but not those transfected with human immunodeficiency virus-1 receptors, formed multinucleated syncytia with cells expressing S protein. Furthermore, SARS-CoV replicated efficiently on ACE2-transfected but not mock-transfected 293T cells. Finally, anti-ACE2 but not anti-ACE1 antibody blocked viral replication on Vero E6 cells. Together our data indicate that ACE2 is a functional receptor for SARS-CoV.
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