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Stark A, Greenberg RG, Pittman R, Weimer KED. Concordance of Cytomegalovirus Saliva and Urine Testing in Infants for the Detection of Congenital Infection. Pediatr Infect Dis J 2024:00006454-990000000-00967. [PMID: 39105512 DOI: 10.1097/inf.0000000000004492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Congenital cytomegalovirus is a leading cause of neurodevelopmental impairment and sensorineural hearing loss. We evaluated infants ≤21 days postnatal age who had both urine and saliva cytomegalovirus testing and determined concordance between the 2 tests and influence of very low birth weight on concordance. Discordance was low overall between urine and saliva testing; however, discordance was high in very low birth weight infants.
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Affiliation(s)
- Ashley Stark
- From the Department of Pediatrics, Duke University Medical Center
| | - Rachel G Greenberg
- From the Department of Pediatrics, Duke University Medical Center
- Duke Clinical Research Institute, Durham, North Carolina
| | - Rick Pittman
- From the Department of Pediatrics, Duke University Medical Center
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2
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Gale SD, Farrer TJ, Erbstoesser R, MacLean S, Hedges DW. Human Cytomegalovirus Infection and Neurocognitive and Neuropsychiatric Health. Pathogens 2024; 13:417. [PMID: 38787269 PMCID: PMC11123947 DOI: 10.3390/pathogens13050417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
A common infection, human cytomegalovirus (HCMV) has been associated with a variety of human diseases, including cardiovascular disease and possibly certain cancers. HCMV has also been associated with cognitive, psychiatric, and neurological conditions. Children with congenital or early-life HCMV are at risk for microcephaly, cerebral palsy, and sensorineural hearing loss, although in many cases sensorineural loss may resolve. In addition, HCMV can be associated with neurodevelopmental impairment, which may improve with time. In young, middle-aged, and older adults, HCMV has been adversely associated with cognitive function in some but not in all studies. Research has linked HCMV to Alzheimer's and vascular dementia, but again not all findings consistently support these associations. In addition, HCMV has been associated with depressive disorder, bipolar disorder, anxiety, and autism-spectrum disorder, although the available findings are likewise inconsistent. Given associations between HCMV and a variety of neurocognitive and neuropsychiatric disorders, additional research investigating reasons for the considerable inconsistencies in the currently available findings is needed. Additional meta-analyses and more longitudinal studies are needed as well. Research into the effects of antiviral medication on cognitive and neurological outcomes and continued efforts in vaccine development have potential to lower the neurocognitive, neuropsychiatric, and neurological burden of HCMV infection.
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Affiliation(s)
- Shawn D. Gale
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
| | - Thomas J. Farrer
- Idaho WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA;
| | - Reagan Erbstoesser
- The Department of Biology, Brigham Young University, Provo, UT 84602, USA;
| | - Scott MacLean
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
| | - Dawson W. Hedges
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
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3
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Fishburn AT, Florio CJ, Lopez NJ, Link NL, Shah PS. Molecular functions of ANKLE2 and its implications in human disease. Dis Model Mech 2024; 17:dmm050554. [PMID: 38691001 PMCID: PMC11103583 DOI: 10.1242/dmm.050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
Ankyrin repeat and LEM domain-containing 2 (ANKLE2) is a scaffolding protein with established roles in cell division and development, the dysfunction of which is increasingly implicated in human disease. ANKLE2 regulates nuclear envelope disassembly at the onset of mitosis and its reassembly after chromosome segregation. ANKLE2 dysfunction is associated with abnormal nuclear morphology and cell division. It regulates the nuclear envelope by mediating protein-protein interactions with barrier to autointegration factor (BANF1; also known as BAF) and with the kinase and phosphatase that modulate the phosphorylation state of BAF. In brain development, ANKLE2 is crucial for proper asymmetric division of neural progenitor cells. In humans, pathogenic loss-of-function mutations in ANKLE2 are associated with primary congenital microcephaly, a condition in which the brain is not properly developed at birth. ANKLE2 is also linked to other disease pathologies, including congenital Zika syndrome, cancer and tauopathy. Here, we review the molecular roles of ANKLE2 and the recent literature on human diseases caused by its dysfunction.
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Affiliation(s)
- Adam T. Fishburn
- Department of Microbiology and Molecular Genetics, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - Cole J. Florio
- Department of Microbiology and Molecular Genetics, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - Nick J. Lopez
- Department of Microbiology and Molecular Genetics, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - Nichole L. Link
- Department of Neurobiology, University of Utah, 20 South 2030 East, Salt Lake City, UT 84112, USA
| | - Priya S. Shah
- Department of Microbiology and Molecular Genetics, University of California, One Shields Avenue, Davis, CA 95616, USA
- Department of Chemical Engineering, University of California, One Shields Avenue, Davis, CA 95616, USA
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Raymonda MH, Rodríguez-Sánchez I, Schafer XL, Smorodintsev-Schiller L, Harris IS, Munger J. Cytomegalovirus-induced inactivation of TSC2 disrupts the coupling of fatty acid biosynthesis to glucose availability resulting in a vulnerability to glucose starvation. mBio 2024; 15:e0303123. [PMID: 38117060 PMCID: PMC10790783 DOI: 10.1128/mbio.03031-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
IMPORTANCE Viruses modulate host cell metabolism to support the mass production of viral progeny. For human cytomegalovirus, we find that the viral UL38 protein is critical for driving these pro-viral metabolic changes. However, our results indicate that these changes come at a cost, as UL38 induces an anabolic rigidity that leads to a metabolic vulnerability. We find that UL38 decouples the link between glucose availability and fatty acid biosynthetic activity. Normal cells respond to glucose limitation by down-regulating fatty acid biosynthesis. Expression of UL38 results in the inability to modulate fatty acid biosynthesis in response to glucose limitation, which results in cell death. We find this vulnerability in the context of viral infection, but this linkage between fatty acid biosynthesis, glucose availability, and cell death could have broader implications in other contexts or pathologies that rely on glycolytic remodeling, for example, oncogenesis.
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Affiliation(s)
- Matthew H. Raymonda
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Irene Rodríguez-Sánchez
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
| | - Xenia L. Schafer
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Leonid Smorodintsev-Schiller
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
- Department of Biomedical Genetics, University of Rochester, Rochester, New York, USA
| | - Isaac S. Harris
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
- Department of Biomedical Genetics, University of Rochester, Rochester, New York, USA
| | - Joshua Munger
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
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Cesta CE, Hernández-Díaz S, Huybrechts KF, Bateman BT, Vine S, Seely EW, Patorno E. Achieving comparability in glycemic control between antidiabetic treatment strategies in pregnancy when using real world data. Pharmacoepidemiol Drug Saf 2023; 32:1350-1359. [PMID: 37461243 PMCID: PMC10792121 DOI: 10.1002/pds.5665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 07/04/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Healthcare utilization databases often lack information on glycemic control, a key confounder when studying the safety of antidiabetic treatments, since patients with worse control are channeled to second-line agents, in particular insulin, versus first-line agents such as metformin. We evaluated whether adjustment for measured characteristics attains balance in glycemic control when comparing antidiabetic treatment strategies in pregnant women with pregestational type 2 diabetes (T2DM). METHODS In a US insurance claims database, we identified 3360 women with T2DM pregnant between 2004 and 2015, of whom a subset of 996 had data on hemoglobin A1c (HbA1c ) levels. We selected insulin only as the comparator group and used propensity score (PS)-matching on comorbidities and proxies of diabetes severity, but not on HbA1c , to adjust for confounding. We used standardized differences (st.diff) to assess balance in claims-based covariates and mean HbA1c (% ± SD) in the subset. RESULTS There were imbalances in claims-based covariates before PS-matching, with smaller differences when both treatment strategies included insulin. After PS-matching, balance was achieved in most claims-based covariates (st.diff <0.1). Mean HbA1c was similar before and after PS-matching when both treatments included insulin (e.g., 7.1 ± 1.5 vs. 7.7 ± 1.8 and 7.1 ± 1.5 vs. 7.5 ± 1.7, respectively, for metformin + insulin vs. insulin only). Differences in mean HbA1c remained after PS-matching when non-insulin treatments were compared to treatments including insulin (e.g., 6.3 ± 1.1 vs. 7.6 ± 1.7 for metformin only vs. insulin only). CONCLUSIONS Balance in both claims-based characteristics and glycemic control was attained after restricting the population to women with T2DM and comparing treatment strategies indicated for patients with similar diabetes severity. When comparing treatment strategies with versus without insulin, differences in glycemic control persisted after PS-matching even when balance was attained for other measured characteristics.
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Affiliation(s)
- Carolyn E Cesta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Seanna Vine
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Ellen W Seely
- Endocrinology, Diabetes and Hypertension Division, Brigham and Women’s Hospital and Harvard Medical School
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
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Rybak-Krzyszkowska M, Górecka J, Huras H, Staśkiewicz M, Kondracka A, Staniczek J, Górczewski W, Borowski D, Grzesiak M, Krzeszowski W, Massalska-Wolska M, Jaczyńska R. Ultrasonographic Signs of Cytomegalovirus Infection in the Fetus-A Systematic Review of the Literature. Diagnostics (Basel) 2023; 13:2397. [PMID: 37510141 PMCID: PMC10378321 DOI: 10.3390/diagnostics13142397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND congenital cytomegalovirus (cCMV) infection during pregnancy is a significant risk factor for fetal and neonatal morbidity and mortality. CMV detection is based on the traditional ultrasound (US) and MRI (magnetic resonance) approach. METHODS the present review used the PRISMA protocol for identification of studies associated with CMV infection and sonographic analysis. Various search terms were created using keywords which were used to identify references from Medline, Pubmed, PsycInfo, Scopus and Web of Science. RESULTS sonographic analysis of the cCMV infection identified several of the key features associated with fetuses. The presence of abnormal patterns of periventricular echogenicity, ventriculomegaly and intraparenchymal calcifications is indicative of CMV infection in the fetus. Hyperechogenic bowels were seen frequently. These results correlate well with MRI data, especially when targeted transvaginal fetal neurosonography was carried out. CONCLUSIONS ultrasonography is a reliable indicator of fetal anomalies, due to cCMV. Fetal brain and organ changes are conclusive indications of infection, but many of the ultrasonographic signs of fetal abnormality could be due to any viral infections; thus, further research is needed to demarcate CMV infection from others, based on the ultrasonographic approach. CMV infection should always be an indication for targeted fetal neurosonography, optimally by the transvaginal approach.
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Affiliation(s)
- Magda Rybak-Krzyszkowska
- Department of Obstetrics and Perinatology, University Hospital, 30-551 Krakow, Poland
- Hi-Gen Centrum Medyczne, 30-552 Krakow, Poland
| | - Joanna Górecka
- Department of Obstetrics and Perinatology, University Hospital, 30-551 Krakow, Poland
| | - Hubert Huras
- Department of Obstetrics and Perinatology, University Hospital, 30-551 Krakow, Poland
| | - Magdalena Staśkiewicz
- Department of Obstetrics and Perinatology, University Hospital, 30-551 Krakow, Poland
| | - Adrianna Kondracka
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Jakub Staniczek
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Górczewski
- Obstetrics and Gynecology Ward, Independent Public Healthcare Institution in Bochnia, The Blessed Marta Wiecka District Hospital, 32-700 Bochnia, Poland
| | - Dariusz Borowski
- Provincial Combined Hospital in Kielce, Clinic of Obstetrics and Gynaecology, 25-736 Kielce, Poland
| | - Mariusz Grzesiak
- Department of Perinatology, Obstetrics and Gynecology, Polish Mother's Memorial Hospital-Research Institute in Lodz, 93-338 Lodz, Poland
- Department of Obstetrics and Gynecology, Medical University of Lodz, 93-338 Lodz, Poland
| | - Waldemar Krzeszowski
- Department of Perinatology, Obstetrics and Gynecology, Polish Mother's Memorial Hospital-Research Institute in Lodz, 93-338 Lodz, Poland
- Salve Medica, 91-210 Lodz, Poland
| | - Magdalena Massalska-Wolska
- Clinical Department of Gynecological Endocrinology and Gynecology, University Hospital, 30-551 Krakow, Poland
| | - Renata Jaczyńska
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Raymonda MH, Rodríguez-Sánchez I, Schafer XL, Smorodintsev-Schiller L, Harris IS, Munger J. Cytomegalovirus-induced inactivation of TSC2 disrupts the coupling of fatty acid biosynthesis to glucose availability resulting in a vulnerability to glucose limitation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.17.541212. [PMID: 37292722 PMCID: PMC10245705 DOI: 10.1101/2023.05.17.541212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Human cytomegalovirus (HCMV) modulates cellular metabolism to support productive infection, and the HCMV UL38 protein drives many aspects of this HCMV-induced metabolic program. However, it remains to be determined whether virally-induced metabolic alterations might induce novel therapeutic vulnerabilities in virally infected cells. Here, we explore how HCMV infection and the UL38 protein modulate cellular metabolism and how these changes alter the response to nutrient limitation. We find that expression of UL38, either in the context of HCMV infection or in isolation, sensitizes cells to glucose limitation resulting in cell death. This sensitivity is mediated through UL38's inactivation of the TSC complex subunit 2 (TSC2) protein, a central metabolic regulator that possesses tumor-suppressive properties. Further, expression of UL38 or the inactivation of TSC2 results in anabolic rigidity in that the resulting increased levels of fatty acid biosynthesis are insensitive to glucose limitation. This failure to regulate fatty acid biosynthesis in response to glucose availability sensitizes cells to glucose limitation, resulting in cell death unless fatty acid biosynthesis is inhibited. These experiments identify a regulatory circuit between glycolysis and fatty acid biosynthesis that is critical for cell survival upon glucose limitation and highlight a metabolic vulnerability associated with viral infection and the inactivation of normal metabolic regulatory controls.
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Affiliation(s)
- Matthew H. Raymonda
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Irene Rodríguez-Sánchez
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
| | - Xenia L. Schafer
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Leonid Smorodintsev-Schiller
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Genetics, University of Rochester, Rochester, New York, USA
| | - Isaac S. Harris
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Genetics, University of Rochester, Rochester, New York, USA
| | - Joshua Munger
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York, USA
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Phillips VL, Xu J, Park A, Gantt S, Dedhia K. The cost-effectiveness of targeted screening for congenital cytomegalovirus in newborns compared to clinical diagnosis in the US. Int J Pediatr Otorhinolaryngol 2023; 166:111450. [PMID: 36773448 DOI: 10.1016/j.ijporl.2023.111450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) is the leading environmental cause of hearing loss (HL) among children, affecting four in one thousand newborns. cCMV testing in the US is currently based on clinical diagnosis which does not consistently identify cCMV cases and precludes early intervention to prevent and reduce the severity of HL. We estimated the cost-effectiveness of targeted newborn screening and cCMV testing among newborns compared to clinical diagnosis. METHODS We use a decision-analytic model to estimate the costs of preventing HL progression, of additional cases of severe HL, of identifying a case of HL one year earlier, and of identifying an additional case of cCMV, through targeted screening and cCMV testing for infants failing two newborn hearing screens with follow-up to age five. We also estimate the costs of nationwide implementation of a newborn screening and testing program. Model pathways were based on best practices for screening, testing, and treatment. Probabilities were drawn from the published literature; costs were estimated based on Medicare reimbursement rates. Probabilistic and scenario analyses were conducted to determine the robustness of results. RESULTS Targeted testing and cCMV screening, compared to standard of care, cost an additional $2.96 (±2.26) per infant screened and identified 0.00038 (±0.00022) cases of HL, 3.8 in 10000 children, at a cost of $8197 (±4217) per case of HL identified. Implementing targeted screening for all children in the US was estimated to cost $193,229. CONCLUSIONS Although cases numbers are small, our model shows that targeted newborn screening and cCMV testing reduced cases of HL progression. Adoption of newborn targeted screening as standard of care should be considered given it may prevent disability at very low cost.
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Affiliation(s)
- Victoria L Phillips
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Albert Park
- University of Utah, Department of Pediatric Otolaryngology, Salt Lake City, UT, USA
| | - Soren Gantt
- Departments of Microbiology, Infectiology & Immunology and Pediatrics, University of Montreal, Research Centre of the Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, USA
| | - Kavita Dedhia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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Long Y, Khan A, Rzhetsky A. Peri- and Post-natal Risk Factors Associated with Health of Newborns: A pregnant mother's infections and immune diseases, and her baby's delivery method predict immune health of the newborn. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.12.23284503. [PMID: 36711636 PMCID: PMC9882552 DOI: 10.1101/2023.01.12.23284503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Designing prophylactic strategies for newborns requires understanding of the factors that contribute to immunity and resistance to infection. We analyzed 1,892,035 mother-newborn pairs in which both the mother and newborn were observed continuously for at least one year before and after birth. As part of this study, we considered maternal exposures to infections and immune disorders during pregnancy, exposures to anti-infection medications by both mother and newborn, as well as the newborn's delivery type and reported complications. According to our analyses, infection rates and immune disorder rates were over-dispersed among newborns. The most consequential factors predicting newborns' immune health were preterm birth, with 276.3% and 193.9% risk increases for newborn bacterial infections. Newborn anti-infective prescriptions were associated with considerable increases in risk of diseases affecting immune health, while maternal prescriptions were associated with fewer outcomes and with mixed signs. The Cesarean section mode of delivery, the mother's age, the sex of the newborn, and the mother's exposure to infections all showed significant but smaller effects on the newborn's immune health. Female newborn appeared to be better protected against diseases with immune system etiology, except for miscellaneous infections.
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Affiliation(s)
- Yanan Long
- Department of Chemistry, The University of Chicago, 900 E. 57 Street, Chicago, 60637, IL, USA
- Department of Medicine, The University of Chicago, 900 E. 57 Street, Chicago, 60637, IL, USA
| | - Atif Khan
- Department of Medicine, The University of Chicago, 900 E. 57 Street, Chicago, 60637, IL, USA
| | - Andrey Rzhetsky
- Department of Medicine, The University of Chicago, 900 E. 57 Street, Chicago, 60637, IL, USA
- Department of Human Genetics and Committee on Quantitative Methods in Social, Behavioral, and Health Sciences, The University of Chicago, 900 E. 57 Street, Chicago, 60637, IL, USA
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10
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Paumgartten FJR, De Grava Kempinas W, Shiota K. Viral infections, vaccines and antiviral drugs in pregnancy and the development of the conceptus. Reprod Toxicol 2023; 115:36-39. [PMID: 36403853 DOI: 10.1016/j.reprotox.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Wilma De Grava Kempinas
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of structural and Functional Biology, Institute of Biosciences, Sao Paulo State University (UNESP), Botucatu, SP, Brazil
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11
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Wang S, Zhou X, He X, Ma S, Sun C, Zhang J, Xu X, Jin W, Yan J, Lin P, Mao G. Suppressive effects of pterostilbene on human cytomegalovirus (HCMV) infection and HCMV-induced cellular senescence. Virol J 2022; 19:224. [PMID: 36564838 PMCID: PMC9782289 DOI: 10.1186/s12985-022-01954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (HCMV), a member of the β-herpesvirus family, causes the establishment of a latent infection that persists throughout the life of the host and can be reactivated when immunity is weakened. To date, there is no vaccine to prevent HCMV infection, and clinically approved drugs target the stage of viral replication and have obvious adverse reactions. Thus, development of novel therapeutics is urgently needed. METHODS In the current study, we identified a naturally occurring pterostilbene that inhibits HCMV Towne strain replication in human diploid fibroblast WI-38 cells through Western blotting, qPCR, indirect immunofluorescence assay, tissue culture infective dose assays. The time-of-addition experiment was carried out to identify the stage at which pterostilbene acted. Finally, the changes of cellular senescence biomarkers and reactive oxygen species production brought by pterostilbene supplementation were used to partly elucidate the mechanism of anti-HCMV activity. RESULTS Our findings revealed that pterostilbene prevented lytic cytopathic changes, inhibited the expression of viral proteins, suppressed the replication of HCMV DNA, and significantly reduced the viral titre in WI-38 cells. Furthermore, our data showed that pterostilbene predominantly acted after virus cell entry and membrane fusion. The half-maximal inhibitory concentration was determined to be 1.315 μM and the selectivity index of pterostilbene was calculated as 26.73. Moreover, cell senescence induced by HCMV infection was suppressed by pterostilbene supplementation, as shown by a decline in senescence-associated β-galactosidase activity, decreased production of reactive oxygen species and reduced expression of p16, p21 and p53, which are considered biomarkers of cellular senescence. CONCLUSION Together, our findings identify pterostilbene as a novel anti-HCMV agent that may prove useful in the treatment of HCMV replication.
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Affiliation(s)
- Sanying Wang
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Xuqiang Zhou
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China ,grid.268505.c0000 0000 8744 8924College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053 People’s Republic of China
| | - Xinyue He
- grid.469325.f0000 0004 1761 325XCollege of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, 310014 People’s Republic of China
| | - Shushu Ma
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Chuan Sun
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Jing Zhang
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Xiaogang Xu
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Weihua Jin
- grid.469325.f0000 0004 1761 325XCollege of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, 310014 People’s Republic of China
| | - Jin Yan
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China
| | - Ping Lin
- Geriatric Department of the 3rd Hospital of Hangzhou, 310009 Hangzhou, People’s Republic of China
| | - Genxiang Mao
- grid.417400.60000 0004 1799 0055Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310030 People’s Republic of China ,grid.268505.c0000 0000 8744 8924College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053 People’s Republic of China
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12
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Human Maternal-Fetal Interface Cellular Models to Assess Antiviral Drug Toxicity during Pregnancy. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3040024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Pregnancy is a period of elevated risk for viral disease severity, resulting in serious health consequences for both the mother and the fetus; yet antiviral drugs lack comprehensive safety and efficacy data for use among pregnant women. In fact, pregnant women are systematically excluded from therapeutic clinical trials to prevent potential fetal harm. Current FDA-recommended reproductive toxicity assessments are studied using small animals which often do not accurately predict the human toxicological profiles of drug candidates. Here, we review the potential of human maternal-fetal interface cellular models in reproductive toxicity assessment of antiviral drugs. We specifically focus on the 2- and 3-dimensional maternal placental models of different gestational stages and those of fetal embryogenesis and organ development. Screening of drug candidates in physiologically relevant human maternal-fetal cellular models will be beneficial to prioritize selection of safe antiviral therapeutics for clinical trials in pregnant women.
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13
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Venancio FA, Quilião ME, de Almeida Moura D, de Azevedo MV, de Almeida Metzker S, Mareto LK, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study. BMC Public Health 2022; 22:2069. [DOI: 10.1186/s12889-022-14490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.
Methods
This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.
Results
In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).
Conclusions
We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.
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14
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Melo NDL, de Sousa DF, Laporta GZ. Microcephaly and Associated Risk Factors in Newborns: A Systematic Review and Meta-Analysis Study. Trop Med Infect Dis 2022; 7:261. [PMID: 36288003 PMCID: PMC9611276 DOI: 10.3390/tropicalmed7100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Congenital microcephaly is caused by a multitude of drivers affecting maternal−fetal health during pregnancy. It is a rare outcome in high-income industrial countries where microcephaly rates are in the range of 0.3−0.9 per 1000 newborns. Prevalence of microcephaly varies considerably across developing countries and can go as high as 58 cases per 1000 live births in pregnancies exposed to infection by Zika virus (ZIKV). Not only ZIKV-infected pregnancies, but other drivers can modulate the occurrence and severity of this outcome. Here, we sought to test the ZIKV−microcephaly association vs. competing hypotheses using a meta-analysis with 8341 microcephaly cases pooled from 10,250,994 newborns in the Americas, Africa, and Asia. Analysis of risk ratios (RR) showed teratogens the most likely microcephaly-associated risk factor (RR = 3.43; 95%-CI 2.69−4.38; p-value < 0.0001), while the statistical significance of the ZIKV−microcephaly association was marginal (RR = 2.12; 95%-CI 1.01−4.48; p-value = 0.048). Other congenital infections showed strong but variable associations with microcephaly (RR = 15.24; 95%-CI 1.74−133.70; p-value = 0.014). Microcephaly cases were associated with impoverished socioeconomic settings, but this association was statistically non-significant (RR = 2.75; 95%-CI 0.55−13.78; p-value = 0.22). The marginal ZIKV−microcephaly association and statistical significance of the competing hypotheses suggest maternal ZIKV infection might not be a cause of microcephaly alone.
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Affiliation(s)
- Natália de L. Melo
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, Brazil
- College of Medicine, Estacio University, Juazeiro 48924-999, Brazil
| | - Danilo F. de Sousa
- College of Nursing, Federal University of Ceara, Fortaleza 60020-181, Brazil
| | - Gabriel Z. Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, Brazil
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15
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Fowler K, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Grys M, Schmidt E, Natenshon A, Talarico C, Buck PO, Diaz-Decaro J. A systematic literature review of the global seroprevalence of cytomegalovirus: possible implications for treatment, screening, and vaccine development. BMC Public Health 2022; 22:1659. [PMID: 36050659 PMCID: PMC9435408 DOI: 10.1186/s12889-022-13971-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cytomegalovirus (CMV) is a common pathogen that affects individuals of all ages and establishes lifelong latency. Although CMV is typically asymptomatic in healthy individuals, infection during pregnancy or in immunocompromised individuals can cause severe disease. Currently, treatments are limited, with no prophylactic vaccine available. Knowledge of the current epidemiologic burden of CMV is necessary to understand the need for treatment and prevention. A systematic literature review (SLR) was conducted to describe the most recent epidemiologic burden of CMV globally. Methods Medline, Embase, and LILACS were searched to identify data on CMV prevalence, seroprevalence, shedding, and transmission rates. The SLR covered the time period of 2010–2020 and focused geographically on Australia, Europe, Israel, Japan, Latin America (LATAM), and North America. Studies were excluded if they were systematic or narrative reviews, abstracts, case series, letters, or correspondence. Studies with sample sizes < 100 were excluded to focus on studies with higher quality of data. Results Twenty-nine studies were included. Among adult men, CMV immunoglobulin G (IgG) seroprevalence ranged from 39.3% (France) to 48.0% (United States). Among women of reproductive age in Europe, Japan, LATAM, and North America, CMV IgG seroprevalence was 45.6-95.7%, 60.2%, 58.3-94.5%, and 24.6-81.0%, respectively. Seroprevalence increased with age and was lower in developed than developing countries, but data were limited. No studies of CMV immunoglobulin M (IgM) seroprevalence among men were identified. Among women of reproductive age, CMV IgM seroprevalence was heterogenous across Europe (1.0-4.6%), North America (2.3-4.5%), Japan (0.8%), and LATAM (0-0.7%). CMV seroprevalence correlated with race, ethnicity, socioeconomic status, and education level. CMV shedding ranged between 0% and 70.2% depending on age group. No findings on CMV transmission rates were identified. Conclusions Certain populations and regions are at a substantially higher risk of CMV infection. The extensive epidemiologic burden of CMV calls for increased efforts in the research and development of vaccines and treatments. Trial registration N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13971-7.
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Affiliation(s)
- Karen Fowler
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | - Carla Talarico
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA
| | - Philip O Buck
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA
| | - John Diaz-Decaro
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA.
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16
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Hernández-Díaz S, Smith LH, Wyszynski DF, Rasmussen SA. First trimester COVID-19 and the risk of major congenital malformations-International Registry of Coronavirus Exposure in Pregnancy. Birth Defects Res 2022; 114:906-914. [PMID: 35929997 PMCID: PMC9538886 DOI: 10.1002/bdr2.2070] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022]
Abstract
There is limited information about the effects of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during the first trimester of pregnancy on the risk of major congenital malformations (MCMs). The International Registry of Coronavirus Exposure in Pregnancy (IRCEP) was designed to estimate the relative risk of adverse perinatal outcomes among women with Coronavirus Disease 2019 (COVID‐19) at specific times during gestation. Adult women were eligible to enroll if they had a SARS‐CoV‐2 test, regardless of the results, or clinically confirmed COVID‐19 during pregnancy. Self‐administered questionnaires collected data on SARS‐CoV‐2 infection, pregnancy outcomes (including detailed questions on MCMs), and potential confounders. The analysis of MCMs includes women with either a positive SARS‐CoV‐2 PCR test or a clinical diagnosis of COVID‐19 during the first trimester (exposed group) or a negative SARS‐CoV‐2 test (reference) that enrolled while pregnant. Sensitivity analyses were restricted to participants who enrolled before the availability of informative prenatal screening tests and extended to those enrolled after end of pregnancy. Generalized linear models were used to estimate relative risks (RR) and 95% confidence intervals (CI). Of 17,163 participants enrolled between June 2020 and July 2021, 1727 had a SARS‐CoV‐2 infection during the first trimester, of whom 1,675 enrolled during pregnancy. Of 10,235 controls with a negative test during pregnancy, 4,172 enrolled during pregnancy. Restriction to participants with complete follow‐up reduced the sample size to 92 exposed and 292 unexposed reference pregnancies. MCMs were reported in 3 (3.3%) exposed and 8 (2.7%) unexposed (RR 1.2; 95% CI 0.32–4.2) newborns. The RR was 2.5 (95%CI 0.23–27) among those enrolled before prenatal screening, and 2.2 (95%CI 0.89–5.3) in the overall study population including those enrolled post‐pregnancy. No specific pattern of malformations was observed. Although results are compatible with no major teratogenic effects associated with maternal SARS‐CoV‐2 infection, RR estimates were imprecise and larger studies are warranted.
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Affiliation(s)
| | - Louisa H Smith
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Sonja A Rasmussen
- Departments of Pediatrics, Obstetrics and Gynecology, & Epidemiology, University of Florida, USA
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17
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Risk Measurement of Perinatal and Neonatal Morbidity Characteristics and Applicability of GAIA Case Definitions: Results and Lessons Learnt of a Hospital-Based Prospective Cohort Study in the Valencia Region (2019-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127132. [PMID: 35742384 PMCID: PMC9223180 DOI: 10.3390/ijerph19127132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 01/27/2023]
Abstract
Post-marketing safety surveillance of new vaccines aimed to be administered during pregnancy is crucial to orchestrate efficient adverse events evaluation. This is of special relevance in the current landscape of new vaccines being introduced in the pregnant women population, and particularly due to the recent administration of COVID-19 vaccines in pregnant women. This multi-center prospective cohort study, nested within the WHO-Global Vaccine Safety-MCC study, involved two hospitals in the Valencia region. Hereby, the incidence rates of seven perinatal and neonatal outcomes in the Valencia region are presented. The pooled data analysis of the two Valencian hospitals allowed the estimation of incidence rates in the Valencia Region (per 1000 live births): 86.7 for low birth weight, 78.2 for preterm birth, 58.8 for small for gestational age, 13 for congenital microcephaly, 0.4 for stillbirth, 1.2 for neonatal death and 6.5 for neonatal infection. These figures are in line with what is expected from a high-income country and the previously reported rates for Spain and Europe, except for the significantly increased rate for congenital microcephaly. Regarding the data for maternal immunization, the vaccination status was collected for 94.4% of the screened pregnant women, highlighting the high quality of the Valencian Vaccine Registry. The study also assessed the Valencian hospitals’ capacity for identifying and collecting data on maternal immunization status, as well as the applicability of the GAIA definitions to the identified outcomes.
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18
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Hernandez-Diaz S, Smith LH, Dollinger C, Rasmussen SA, Schisterman EF, Bellocco R, Wyszynski DF. International Registry of Coronavirus Exposure in Pregnancy (IRCEP): Cohort Description and Methodological Considerations. Am J Epidemiol 2022; 191:967-979. [PMID: 35259213 PMCID: PMC8992307 DOI: 10.1093/aje/kwac046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Limited data are available about the potential health effects of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnant women and their developing offspring. We developed the International Registry of Coronavirus Exposure in Pregnancy (IRCEP) to provide data on the risk of major adverse obstetric and neonatal outcomes among women with varying degrees of severity and timing of COVID-19 exposure during pregnancy. We describe here the cohort and share the lessons learned. The IRCEP enrolls women tested for SARS-CoV-2 or with a clinical diagnosis of COVID-19 during pregnancy and obtains information using an online data collection system. By March 2021, 17,532 participants from 77 countries had enrolled; 54% enrolled during pregnancy and 46% afterwards. Among women with symptomatic COVID-19 with a positive SARS-CoV-2 test (N=4,934), symptoms were mild in 41%, moderate in 52% and severe in 7%; 7.7% were hospitalized for COVID-19 and 1.7% were admitted to an intensive care unit. The biggest challenges were retention of participants enrolled during pregnancy, and the potential bias introduced when participants enroll after pregnancy outcomes are known. Multiple biases need to be considered and addressed when estimating and interpreting the effects of COVID-19 in pregnancy in these types of cohorts.
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Affiliation(s)
- Sonia Hernandez-Diaz
- Correspondence Address: Dr. Sonia Hernandez-Diaz, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue. Boston, MA 02115 (e-mail: )
| | - Louisa H Smith
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Camille Dollinger
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Sonja A Rasmussen
- Department of Pediatrics, Obstetrics and Gynecology, & Epidemiology, University of Florida, United States
| | | | - Rino Bellocco
- Karolinska Institutet, Stockholm, Sweden and University of Milano-Bicocca, Milan, Italy
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19
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Tingler M, Philipp M, Burkhalter MD. DNA Replication proteins in primary microcephaly syndromes. Biol Cell 2022; 114:143-159. [PMID: 35182397 DOI: 10.1111/boc.202100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
SCOPE Improper expansion of neural stem and progenitor cells during brain development manifests in primary microcephaly. It is characterized by a reduced head circumference, which correlates with a reduction in brain size. This often corresponds to a general underdevelopment of the brain and entails cognitive, behavioral and motoric retardation. In the past decade significant research efforts have been undertaken to identify genes and the molecular mechanisms underlying microcephaly. One such gene set encompasses factors required for DNA replication. Intriguingly, a growing body of evidence indicates that a substantial number of these genes mediate faithful centrosome and cilium function in addition to their canonical function in genome duplication. Here, we summarize, which DNA replication factors are associated with microcephaly syndromes and to which extent they impact on centrosomes and cilia. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Melanie Tingler
- Department of Experimental and Clinical Pharmacology and Pharmacogenomics, Section of Pharmacogenomics, Eberhard-Karls-University Tübingen, Tübingen, 72074, Germany
| | - Melanie Philipp
- Department of Experimental and Clinical Pharmacology and Pharmacogenomics, Section of Pharmacogenomics, Eberhard-Karls-University Tübingen, Tübingen, 72074, Germany
| | - Martin D Burkhalter
- Department of Experimental and Clinical Pharmacology and Pharmacogenomics, Section of Pharmacogenomics, Eberhard-Karls-University Tübingen, Tübingen, 72074, Germany
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20
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Campione A, Lanzieri TM, Ricotta E, Grosse SD, Kadri SS, Nussenblatt V, Prevots DR. Missing diagnoses of congenital cytomegalovirus infection in electronic health records for infants with laboratory-confirmed infection. Curr Med Res Opin 2022; 38:273-275. [PMID: 34775876 PMCID: PMC9575942 DOI: 10.1080/03007995.2021.2006536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Congenital cytomegalovirus (CMV) is a leading cause of non-genetic sensorineural hearing loss and neurodevelopmental disabilities among US children. Studies using administrative healthcare databases have identified infants with congenital CMV using diagnostic codes from the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification. Using Cerner Health Facts deidentified electronic health records, we assessed the sensitivity of CMV diagnostic codes among infants with laboratory confirmed congenital CMV infection (i.e. a positive CMV laboratory test - polymerase chain reaction, direct fluorescent antibody, or culture from urine, saliva, respiratory secretion or blood samples, or IgM serology - within 21 days of life). During 2010-2017, 668 congenital CMV cases were identified among 7,517,207 infants with encounters within 21 days of life, or 0.89 cases per 10,000 infants. The sensitivity of CMV diagnostic codes assigned within 21 and 90 days of life was 10.3% (95% CI: 8.2-12.9) and 11.1% (95% CI: 8.9-13.7), respectively.
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Affiliation(s)
- Alexandra Campione
- Epidemiology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD
| | - Tatiana M Lanzieri
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Corresponding author: Tatiana M. Lanzieri, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-5; Atlanta, GA 30333 – USA; Phone: 1-404-639-3031;
| | - Emily Ricotta
- Epidemiology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sameer S. Kadri
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD
| | - Veronique Nussenblatt
- Infectious Disease National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD
| | - D Rebecca Prevots
- Epidemiology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD
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21
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Digitale JC, Martin JN, Glymour MM. Tutorial on directed acyclic graphs. J Clin Epidemiol 2022; 142:264-267. [PMID: 34371103 PMCID: PMC8821727 DOI: 10.1016/j.jclinepi.2021.08.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
Directed acyclic graphs (DAGs) are an intuitive yet rigorous tool to communicate about causal questions in clinical and epidemiologic research and inform study design and statistical analysis. DAGs are constructed to depict prior knowledge about biological and behavioral systems related to specific causal research questions. DAG components portray who receives treatment or experiences exposures; mechanisms by which treatments and exposures operate; and other factors that influence the outcome of interest or which persons are included in an analysis. Once assembled, DAGs - via a few simple rules - guide the researcher in identifying whether the causal effect of interest can be identified without bias and, if so, what must be done either in study design or data analysis to achieve this. Specifically, DAGs can identify variables that, if controlled for in the design or analysis phase, are sufficient to eliminate confounding and some forms of selection bias. DAGs also help recognize variables that, if controlled for, bias the analysis (e.g., mediators or factors influenced by both exposure and outcome). Finally, DAGs help researchers recognize insidious sources of bias introduced by selection of individuals into studies or failure to completely observe all individuals until study outcomes are reached. DAGs, however, are not infallible, largely owing to limitations in prior knowledge about the system in question. In such instances, several alternative DAGs are plausible, and researchers should assess whether results differ meaningfully across analyses guided by different DAGs and be forthright about uncertainty. DAGs are powerful tools to guide the conduct of clinical research.
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Affiliation(s)
- Jean C Digitale
- Department of Epidemiology and Biostatistics, University of California, 550 16th St, 2nd Floor, San Francisco, CA 94158
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, 550 16th St, 2nd Floor, San Francisco, CA 94158
| | - Medellena Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, 550 16th St, 2nd Floor, San Francisco, CA 94158.
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22
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Edwards EM, Greenberg LT, Ehret DE, Soll RF, Lanzieri TM, Horbar JD. STORCH Infections Among Very Low Birth Weight and Preterm Infants: 2018-2020. Pediatrics 2022; 149:e2021053655. [PMID: 35104887 PMCID: PMC11324285 DOI: 10.1542/peds.2021-053655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Erika M. Edwards
- Vermont Oxford Network, Burlington, VT
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, VT
| | - Lucy T. Greenberg
- Vermont Oxford Network, Burlington, VT
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT
| | - Danielle E.Y. Ehret
- Vermont Oxford Network, Burlington, VT
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, VT
| | - Roger F. Soll
- Vermont Oxford Network, Burlington, VT
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, VT
| | - Tatiana M. Lanzieri
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, VT
- Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington, VT
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23
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Affiliation(s)
- Chelsea J Messinger
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas McElrath
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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24
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Zhou Q, Wang Q, Shen H, Zhang Y, Zhang S, Li X, Acharya G. Seroprevalence of Cytomegalovirus and Associated Factors Among Preconception Women: A Cross-Sectional Nationwide Study in China. Front Public Health 2021; 9:631411. [PMID: 34513776 PMCID: PMC8425481 DOI: 10.3389/fpubh.2021.631411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cytomegalovirus seroconversion during pregnancy is common and has a substantial risk of congenital infection with longterm sequale. Screening during pregnancy or vaccination have not been shown to be effective for eliminating congenital infections. Preconception screening policy has not been evaluated adequately in a large scale. This nationwide study aimed to investigate epidemiological features of cytomegalovirus seropositivity and its geographic variation among Chinese women planning a pregnancy to gather epidemiological evidence as an essential for developing novel prevention strategies. Method: This cross-sectional sero-epidemiological survey enrolled women intending to become pregnant within 6 months in mainland China during 2010-2012. The primary outcomes in this study were cytomegalovirus Immunoglobulin G and M seropositivity. Secondary outcomes were the associations between Immunoglobulin G and Immunoglobulin M, with socio-demographic characteristics, including age, occupation, education level, place of residence, and ethnicity. The overall seropositivity and regional disparity was analyzed on the individual and regional level, respectively. Results: This study included data from 1,564,649 women from 31 provinces in mainland China. Among participants, 38.6% (n = 603,511) were cytomegalovirus immunoglobulin G+, 0.4% (n = 6,747) were immunoglobulin M+, and 0.2% (n = 2,879) were immunoglobulin M+ and immunoglobulin G+. On individual level, participant's age, ethnicity, and residing region were significantly associated with IgG+, IgM+, and IgM+IgG+ (P < 0.001), while occupation, education level, and place of residence were not statistically significant (P > 0.05). On regional level, cytomegalovirus immunoglobulin G and immunoglobulin M seropositivity was highest in the eastern region (49.5 and 0.5%, respectively), and lowest in the western region (26.9 and 0.4%, respectively). This geographic variation was also noted at the provincial level, characterized by higher provincial immunoglobulin M+ and immunoglobulin G+ rates associated with higher immunoglobulin G seropositivity. In the subgroup analysis of immunoglobulin G seropositivity, areas of higher immunoglobulin G positivity had a higher rate of immunoglobulin M+, indicating an expected increased risk of reinfection and primary infection. Conclusions: A substantial proportion of women (>60%) were susceptible to cytomegalovirus in preconception period in China, and immunoglobulin G seropositivity was seen at a low-medium level with substantial geographic variation. Integration of cytomegalovirus antibody testing in preconception screening program based on regional immunoglobulin G seropositivity, should be considered to promote strategies directed toward preventing sero-conversion during pregnancy to reduce the risk of this congenital infection.
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Affiliation(s)
- Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Shikun Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
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25
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Fadhel Alvarez A, Patel SP, Brasher MI, Ruggiero JE, Aneji C. Langerhans cell histiocytosis: Presentation in a preterm neonate. Cancer Rep (Hoboken) 2021; 5:e1472. [PMID: 34156158 PMCID: PMC8842702 DOI: 10.1002/cnr2.1472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
Background Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis. Case We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH. Conclusion Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.
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Affiliation(s)
- Ana Fadhel Alvarez
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Shaily P Patel
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Maya I Brasher
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Jaclyn E Ruggiero
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Chiamaka Aneji
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
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26
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Grosse SD, Leung J, Lanzieri TM. Identification of congenital CMV cases in administrative databases and implications for monitoring prevalence, healthcare utilization, and costs. Curr Med Res Opin 2021; 37:769-779. [PMID: 33591223 PMCID: PMC8314526 DOI: 10.1080/03007995.2021.1890556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To critically review researchers' use of diagnosis codes to identify congenital cytomegalovirus (cCMV) infection or disease in healthcare administrative databases. Understanding the limitations of cCMV ascertainment in those databases can inform cCMV surveillance and health services research. METHODS We identified published studies that used diagnosis codes for cCMV or CMV in hospital discharge or health insurance claims and encounters records for infants to assess prevalence, use of services, or healthcare costs. We reviewed estimates of prevalence and of charges, costs, or expenditures associated with cCMV diagnosis codes. RESULTS Five studies assessed hospitalizations with cCMV diagnosis codes recorded in hospital discharge databases, from the United States (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Six other studies analyzed claims or encounters data from the United States (n = 5) or Japan (n = 1) to identify infants with cCMV codes. Prevalence estimates of recognized cCMV ranged from 0.6 to 3.8 per 10,000 infants. Economic analyses reported a wide range of per-hospitalization or per-infant cost estimates, which lacked standardization or comparability. CONCLUSIONS The administrative prevalence of cCMV cases reported in published analyses of administrative data from North America, Western Europe, Japan, and Australia (0.6-3.8 per 10,000 infants) is an order of magnitude lower than the estimates of the true birth prevalence of 3-7 per 1,000 newborns based on universal newborn screening pilot studies conducted in the same regions. Nonetheless, in the absence of systematic surveillance for cCMV, administrative data might be useful for assessing trends in testing and clinical diagnosis. To the extent that cCMV cases recorded in administrative databases are not representative of the full spectrum of cCMV infection or disease, per-child cost estimates generated from those data may not be generalizable. On the other hand, claims data may be useful for estimating patterns of healthcare use and expenditures associated with combinations of diagnoses for cCMV and known complications of cCMV.
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Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tatiana M. Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Kagan KO, Enders M, Hoopmann M, Geipel A, Simonini C, Berg C, Gottschalk I, Faschingbauer F, Schneider MO, Ganzenmueller T, Hamprecht K. Outcome of pregnancies with recent primary cytomegalovirus infection in first trimester treated with hyperimmunoglobulin: observational study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:560-567. [PMID: 33491819 DOI: 10.1002/uog.23596] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the efficacy of hyperimmunoglobulin (HIG) treatment in women with a recent primary cytomegalovirus (CMV) infection up to 14 weeks' gestation. METHODS This is an ongoing observational study conducted at the prenatal medicine departments of the University Hospitals of Tübingen, Bonn, Cologne and Erlangen, Germany, as well as at the Laboratory Prof. Gisela Enders and Colleagues in Stuttgart, Germany and the Institute for Medical Virology at the University of Tübingen, Tübingen, Germany. Enrolment criteria were the presence of confirmed recent primary CMV infection in the first trimester and a gestational age at first HIG administration of ≤ 14 weeks. The following inclusion criteria indicated a recent primary infection: low anti-immunoglobulin (Ig)-G levels, low anti-CMV-IgG avidity in the presence of a positive CMV-IgM test and no positive reactivity or just seroconversion anti-gB2-IgG-reactivity. HIG administration was started as soon as possible within a few days after the first visit. HIG was administered intravenously at a dose of 200 IU/kg maternal body weight and repeated every 2 weeks until about 18 weeks' gestation. The primary outcome was maternal-fetal transmission at the time of amniocentesis. Multivariate logistic regression analysis was used to determine significant covariates that could predict maternal-fetal transmission. RESULTS We included 149 pregnancies (153 fetuses) that completed the treatment. Median maternal age and weight were 32.0 years and 65.0 kg, respectively. Median gestational age at the time of first referral to one of the four centers was 9.4 weeks. Median anti-CMV-IgG level, anti-CMV-IgM index and CMV-IgG avidity were 5.7 U/mL, 2.5 and 22.3%, respectively. HIG treatment was started at a median gestational age of 10.6 weeks and ended at a median of 17.9 weeks. Within this time frame, HIG was administered on average four times in each patient. Amniocentesis was carried out at a median gestational age of 20.4 weeks. In 143 (93.5%) of the 153 cases, the fetus was not infected. Maternal-fetal transmission occurred in 10 cases (6.5% (95% CI, 3.2-11.7%)). On uni- and multivariate logistic regression analysis, the level of anti-IgM index was the only factor associated significantly with maternal-fetal transmission at amniocentesis. However, only four (40.0%) of the 10 cases with maternal-fetal transmission had an anti-IgM index above 11.4, which corresponds to the 95th centile of pregnancies without transmission. CONCLUSIONS HIG is a treatment option to prevent maternal-fetal transmission in pregnancy with a primary CMV infection. However, HIG treatment seems to be beneficial primarily in women with a recent primary infection in the first trimester or during the periconceptional period, and when it is administered at a biweekly dose of 200 IU/kg. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K O Kagan
- Department for Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - M Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - M Hoopmann
- Department for Women's Health, University Hospital of Tübingen, Tübingen, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany
| | - C Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany
| | - C Berg
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Cologne, Germany
| | - I Gottschalk
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Cologne, Germany
| | - F Faschingbauer
- Department of Obstetrics and Gynaecology, University Hospital of Erlangen, Erlangen, Germany
| | - M O Schneider
- Department of Obstetrics and Gynaecology, University Hospital of Erlangen, Erlangen, Germany
| | - T Ganzenmueller
- Institute for Medical Virology and Epidemiology of Viral Diseases, University of Tübingen, Tübingen, Germany
| | - K Hamprecht
- Institute for Medical Virology and Epidemiology of Viral Diseases, University of Tübingen, Tübingen, Germany
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28
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Mercorelli B, Celegato M, Luganini A, Gribaudo G, Lepesheva GI, Loregian A. The antifungal drug isavuconazole inhibits the replication of human cytomegalovirus (HCMV) and acts synergistically with anti-HCMV drugs. Antiviral Res 2021; 189:105062. [PMID: 33722615 DOI: 10.1016/j.antiviral.2021.105062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
We recently reported that some clinically approved antifungal drugs are potent inhibitors of human cytomegalovirus (HCMV). Here, we report the broad-spectrum activity against HCMV of isavuconazole (ICZ), a new extended-spectrum triazolic antifungal drug. ICZ inhibited the replication of clinical isolates of HCMV as well as strains resistant to the currently available DNA polymerase inhibitors. The antiviral activity of ICZ against HCMV could be linked to the inhibition of human cytochrome P450 51 (hCYP51), an enzyme whose activity we previously demonstrated to be required for productive HCMV infection. Moreover, time-of-addition studies indicated that ICZ might have additional inhibitory effects during the first phase of HCMV replication. Importantly, ICZ showed synergistic antiviral activity in vitro when administered in combination with different approved anti-HCMV drugs at clinically relevant doses. Together, these results pave the way to possible future clinical studies aimed at evaluating the repurposing potential of ICZ in the treatment of HCMV-associated diseases.
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Affiliation(s)
| | - Marta Celegato
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Anna Luganini
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Giorgio Gribaudo
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Galina I Lepesheva
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Arianna Loregian
- Department of Molecular Medicine, University of Padua, Padua, Italy.
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29
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Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Daccò V, Colombo C, Esposito S. Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment. Microorganisms 2020; 8:E1516. [PMID: 33019752 PMCID: PMC7599523 DOI: 10.3390/microorganisms8101516] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 01/25/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection and is the leading non-genetic cause of sensorineural hearing loss (SNLH) and an important cause of neurodevelopmental disabilities. The risk of intrauterine transmission is highest when primary infection occurs during pregnancy, with a higher rate of vertical transmission in mothers with older gestational age at infection, while the risk of adverse fetal effects significantly increases if fetal infection occurs during the first half of pregnancy. Despite its prevalence and morbidity among the neonatal population, there is not yet a standardized diagnostic test and therapeutic approach for cCMV infection. This narrative review aims to explore the latest developments in the diagnosis and treatment of cCMV infection. Literature analysis shows that preventive interventions other than behavioral measures during pregnancy are still lacking, although many clinical trials are currently ongoing to formulate a vaccination for women before pregnancy. Currently, we recommend using a PCR assay in blood, urine, and saliva in neonates with suspected cCMV infection. At present, there is no evidence of the benefit of antiviral therapy in asymptomatic infants. In the case of symptomatic cCMV, we actually recommend treatment with oral valganciclovir for a duration of 12 months. The effectiveness and tolerability of this therapy option have proven effective for hearing and neurodevelopmental long-term outcomes. Valganciclovir is reserved for congenitally-infected neonates with the symptomatic disease at birth, such as microcephaly, intracranial calcifications, abnormal cerebrospinal fluid index, chorioretinitis, or sensorineural hearing loss. Treatment with antiviral drugs is not routinely recommended for neonates with the mildly symptomatic disease at birth, for neonates under 32 weeks of gestational age, or for infants more than 30 days old because of insufficient evidence from studies. However, since these populations represent the vast majority of neonates and infants with cCMV infection and they are at risk of developing late-onset sequelae, a biomarker able to predict long-term sequelae should also be found to justify starting treatment and reducing the burden of CMV-related complications.
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Affiliation(s)
- Giulia Chiopris
- Paediatric Clinic Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (G.C.); (P.V.); (F.C.); (M.P.)
| | - Piero Veronese
- Paediatric Clinic Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (G.C.); (P.V.); (F.C.); (M.P.)
| | - Francesca Cusenza
- Paediatric Clinic Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (G.C.); (P.V.); (F.C.); (M.P.)
| | - Michela Procaccianti
- Paediatric Clinic Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (G.C.); (P.V.); (F.C.); (M.P.)
| | - Serafina Perrone
- Neonatology Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Valeria Daccò
- Cystic Fibrosis Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (V.D.); (C.C.)
| | - Carla Colombo
- Cystic Fibrosis Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (V.D.); (C.C.)
| | - Susanna Esposito
- Paediatric Clinic Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; (G.C.); (P.V.); (F.C.); (M.P.)
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