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Hameed M, Solomon NA, Weger-Lucarelli J. Lack of pathogenic involvement of CCL4 and its receptor CCR5 in arthritogenic alphavirus disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.31.606106. [PMID: 39131287 PMCID: PMC11312581 DOI: 10.1101/2024.07.31.606106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Arthritogenic alphaviruses, including chikungunya virus (CHIKV), Mayaro virus (MAYV), Ross River virus (RRV), and O'nyong nyong virus (ONNV) are emerging and reemerging viruses that cause disease characterized by fever, rash, and incapacitating joint swelling. Alphavirus infection induces robust immune responses in infected hosts, leading to the upregulation of several cytokines and chemokines, including chemokine C ligand 4 (CCL4). CCL4 is a chemoattractant for immune cells such as T cells, natural killer cells, monocytes/macrophages, and dendritic cells, recruiting these cells to the site of infection, stimulating the release of proinflammatory mediators, and inducing T cell differentiation. CCL4 has been found at high levels in both the acute and chronic phases of chikungunya disease; however, the role of CCL4 in arthritogenic alphavirus disease development remains unexplored. Here, we tested the effect of CCL4 on MAYV infection in mice through antibody depletion and treatment with recombinant mouse CCL4. We observed no differences in mice depleted of CCL4 or treated with recombinant CCL4 in terms of disease progression such as weight loss and footpad swelling or the development of viremia. CCL4 uses the G protein-coupled receptor C-C chemokine receptor type 5 (CCR5). To determine whether CCR5 deficiency would alter disease outcomes or virus replication in mice, we inoculated CCR5 knockout (CCR5 -/- ) mice with MAYV and observed no effect on disease development and immune cell profile of blood and footpads between CCR5 -/- and wild type mice. These studies failed to identify a clear role for CCL4 or its receptor CCR5 in MAYV infection.
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de la Calle-Prieto F, Barriga JJ, Arsuaga M, de Miguel R, Díaz-Menéndez M. Clinical profile and management of a Spanish single-center retrospective cohort of patients with post-chikungunya associated complications. Travel Med Infect Dis 2024; 60:102726. [PMID: 38754529 DOI: 10.1016/j.tmaid.2024.102726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study aims to describe post-chikungunya complications chronically developed cases in returning travelers from some epidemic/endemic regions, and the variables that are associated with the progression of acute or subacute cases to the chronic phase. METHODS This single-center retrospective cohort study included chikungunya fever cases treated at La Paz-Carlos III University Hospital in Madrid, Spain, April 2014 to September 2016, when the chikungunya outbreak in Latin America started through the time of its greatest impact. RESULTS The analysis included 119 cases. Of these, 67.2 % were male, with a median age of 41.0 years [IQR 16.0 to 76.0] years. Only 25.6 % of the patients attended a pre-travel advice consultation. Most patients reported arthralgias, which significantly impacted their daily quality of life (86 %). The mean duration of joint symptoms was 129.4 days, with a median of 90 days [IQR 0 to 715]. Factors found to be associated with chronic arthralgia include female sex, country of infection, age at diagnosis, previous diseases, symptoms during the acute phase, pain in previously injured tendons/joints, acute phase severity, and various laboratory markers such as hemoglobin, hematocrit, total serum bilirubin, and creatinine. Progression to chronic arthralgia significantly increased the need for changes in daily activity. Furthermore, 42.6 % of patients with chronic arthralgia reported recurrence of symptoms once they felt they had disappeared. Targeted treatment regimens led to significant improvements in these patients. CONCLUSIONS The results of this study underscore the need for: (1) comprehensive pre-travel advice; (2) effective management of patients in specialized units, alongside early diagnosis and treatment, to prevent trivialization of these viral infections; and (3) the development of interdisciplinary recommendations to assist physicians in treating patients and enhancing outcomes.
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Affiliation(s)
- Fernando de la Calle-Prieto
- National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, Spain, CIBERINFEC.
| | - Juan J Barriga
- Medical Strategy Department, Bavarian Nordic, Madrid, Spain.
| | - Marta Arsuaga
- National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, Spain, CIBERINFEC.
| | - Rosa de Miguel
- National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, Spain, CIBERINFEC.
| | - Marta Díaz-Menéndez
- National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, Spain, CIBERINFEC.
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Ng WH, Amaral K, Javelle E, Mahalingam S. Chronic chikungunya disease (CCD): clinical insights, immunopathogenesis and therapeutic perspectives. QJM 2024; 117:489-494. [PMID: 38377410 PMCID: PMC11290245 DOI: 10.1093/qjmed/hcae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
Chikungunya virus, an arthropod-borne pathogen is recognized by the World Health Organization as a top priority Emerging Infectious Disease and is ranked fourth in public health needs according to the Coalition for Epidemic Preparedness Innovations. Despite its substantial impact, as evidenced by an annual estimate of 120 274 disability-adjusted life years, our understanding of the chronic aspects of chikungunya disease remains limited. This review focuses on chronic chikungunya disease, emphasizing its clinical manifestations, immunopathogenesis, therapeutic options and disease burden.
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Affiliation(s)
- W H Ng
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - K Amaral
- Department of Health Sciences, Federal University of Cariri, Barbalha, Ceará, Brazil
| | - E Javelle
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
- Aix Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France
- Unit of Infectious Diseases and Tropical Medicine, IHU Méditerranée Infection, Marseille, France
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - S Mahalingam
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
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Silveira-Freitas JEP, Campagnolo ML, dos Santos Cortez M, de Melo FF, Zarpelon-Schutz AC, Teixeira KN. Long chikungunya? An overview to immunopathology of persistent arthralgia. World J Virol 2024; 13:89985. [PMID: 38984075 PMCID: PMC11229846 DOI: 10.5501/wjv.v13.i2.89985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/09/2024] [Accepted: 04/12/2024] [Indexed: 06/24/2024] Open
Abstract
Chikungunya fever (CF) is caused by an arbovirus whose manifestations are extremely diverse, and it has evolved with significant severity in recent years. The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses. Generally, fever starts abruptly and reaches high levels, followed by severe polyarthralgia and myalgia, as well as an erythematous or petechial maculopapular rash, varying in severity and extent. Around 40% to 60% of affected individuals report persistent arthralgia, which can last from months to years. The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system. The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Β ligand and bone resorption. This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages, leading to local infiltration of CD4+ T cells, which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines. The term "long chikungunya" was used in this review to refer to persistent arthralgia since, due to its manifestation over long periods after the end of the viral infection, this clinical condition seems to be characterized more as a sequel than as a symptom, given that there is no active infection involved.
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Affiliation(s)
| | | | | | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Campus Anísio Teixeira, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Ana Carla Zarpelon-Schutz
- Campus Toledo, Universidade Federal do Paraná, Toledo, Paraná 85919-899, Brazil
- Programa de Pós-graduação em Biotecnologia, Palotina, Universidade Federal do Paraná-Setor Palotina, Paraná 85950-000, Brazil
| | - Kádima Nayara Teixeira
- Campus Toledo, Universidade Federal do Paraná, Toledo, Paraná 85919-899, Brazil
- Programa Multicêntrico de Pós-graduação em Bioquímica e Biologia Molecular, Palotina, Universidade Federal do Paraná-Setor Palotina, Paraná 85950-000, Brazil
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Kraychete DC, Alencar VB, Barreto ESR, Antunes Júnior CR, Lins-Kusterer LEF, de Barros GAM, Schmidt AP. Beyond the bite: understanding and managing post-arboviral pain. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844526. [PMID: 38909755 PMCID: PMC11260835 DOI: 10.1016/j.bjane.2024.844526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
- Durval Campos Kraychete
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia (FMB), Salvador, BA, Brazil
| | - Vinicius Borges Alencar
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia (FMB), Salvador, BA, Brazil
| | | | | | | | | | - André P Schmidt
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil
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McMahon R, Fuchs U, Schneider M, Hadl S, Hochreiter R, Bitzer A, Kosulin K, Koren M, Mader R, Zoihsl O, Wressnigg N, Dubischar K, Buerger V, Eder-Lingelbach S, Jaramillo JC. A randomized, double-blinded Phase 3 study to demonstrate lot-to-lot consistency and to confirm immunogenicity and safety of the live-attenuated chikungunya virus vaccine candidate VLA1553 in healthy adults†. J Travel Med 2024; 31:taad156. [PMID: 38091981 PMCID: PMC10911060 DOI: 10.1093/jtm/taad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The global spread of the chikungunya virus (CHIKV) increases the exposure risk for individuals travelling to or living in endemic areas. This Phase 3 study was designed to demonstrate manufacturing consistency between three lots of the single shot live-attenuated CHIKV vaccine VLA1553, and to confirm the promising immunogenicity and safety data obtained in previous trials. METHODS This randomized, double-blinded, lot-to-lot consistency, Phase 3 study, assessed immunogenicity and safety of VLA1553 in 408 healthy adults (18-45 years) in 12 sites across the USA. The primary endpoint was a comparison of the geometric mean titre (GMT) ratios of CHIKV-specific neutralizing antibodies between three VLA1553 lots at 28 days post-vaccination. Secondary endpoints included immunogenicity and safety over 6 months post-vaccination. RESULTS GMTs were comparable between the lots meeting the acceptance criteria for equivalence. The average GMT (measured by 50% CHIKV micro plaque neutralization test; μPRNT50) peaked with 2643 at 28 days post-vaccination and decreased to 709 at 6 months post-vaccination. An excellent seroresponse rate (defined as μPRNT50 titre ≥ 150 considered protective) was achieved in 97.8% of participants at 28 days post-vaccination and still persisted in 96% at 6 months after vaccination. Upon VLA1553 immunization, 72.5% of participants experienced adverse events (AEs), without significant differences between lots (related solicited systemic AE: 53.9% of participants; related solicited local AE: 19.4%). Overall, AEs were mostly mild or moderate and resolved without sequela, usually within 3 days. With 3.9% of participants experiencing severe AEs, 2.7% were classified as related, whereas none of the six reported serious adverse events was related to the administration of VLA1553. CONCLUSIONS All three lots of VLA1553 recapitulated the safety and immunogenicity profiles of a preceding Phase 3 study, fulfilling pre-defined consistency requirements. These results highlight the manufacturability of VLA1553, a promising vaccine for the prevention of CHIKV disease for those living in or travelling to endemic areas.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Koren
- Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Robert Mader
- CRETA GmbH, Campus Vienna Biocenter 3, 1030 Vienna, Austria
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Wang M, Wang L, Leng P, Guo J, Zhou H. Drugs targeting structural and nonstructural proteins of the chikungunya virus: A review. Int J Biol Macromol 2024; 262:129949. [PMID: 38311132 DOI: 10.1016/j.ijbiomac.2024.129949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
Chikungunya virus (CHIKV) is a single positive-stranded RNA virus of the Togaviridae family and Alphavirus genus, with a typical lipid bilayer envelope structure, and is the causative agent of human chikungunya fever (CHIKF). The U.S. Food and Drug Administration has recently approved the first chikungunya vaccine, Ixchiq; however, vaccination rates are low, and CHIKF is prevalent owing to its periodic outbreaks. Thus, developing effective anti-CHIKV drugs in clinical settings is imperative. Viral proteins encoded by the CHIKV genome play vital roles in all stages of infection, and developing therapeutic agents that target these CHIKV proteins is an effective strategy to improve CHIKF treatment efficacy and reduce mortality rates. Therefore, in the present review article, we aimed to investigate the basic structure, function, and replication cycle of CHIKV and comprehensively outline the current status and future advancements in anti-CHIKV drug development, specifically targeting nonstructural (ns) proteins, including nsP1, nsP2, nsP3, and nsP4 and structural proteins such as capsid (C), E3, E2, 6K, and E1.
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Affiliation(s)
- Mengke Wang
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Lidong Wang
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Ping Leng
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jinlin Guo
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Hao Zhou
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Chongqing Key Laboratory of Sichuan-Chongqing Co-construction for Diagnosis and Treatment of Infectious Diseases Integrated Traditional Chinese and Western Medicine, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400016, China.
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Doran C, Duits AJ, Gerstenbluth I, Tami A, Bailey A. Adaptive coping strategies among individuals living with long-term chikungunya disease: a qualitative study in Curaçao. BMJ Open 2024; 14:e076352. [PMID: 38326245 PMCID: PMC10860096 DOI: 10.1136/bmjopen-2023-076352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Long-term chikungunya disease is characterised by persistent rheumatic symptoms following chikungunya virus infection. As there is no specific treatment available, affected individuals need strategies to adapt. However, research on these is scarce. This study aimed to explore which adaptive coping strategies are employed to manage persistent rheumatic symptoms in daily life. SETTING The study was conducted in Curaçao. DESIGN AND PARTICIPANTS An explorative qualitative study was conducted between September and October 2020, among a purposive sample of adults, 19 women and 4 men affected by long-term chikungunya disease. In-depth interviews were semi-structured and transcribed verbatim. The data were analysed using inductive thematic analysis. RESULTS The disease duration for all participants ranged between 68 and 74 months (6 years). In narrating their experiences of coping with long-term chikungunya disease, four themes were identified: (1) learning to live with the disease; (2) resilience for dealing with pain; (3) maintaining positive self-image and attitude; and (4) coping through spirituality. CONCLUSION To live with long-term chikungunya disease with dignity in spite of physical pain and discomfort, participants tried to retain a sense of control of oneself and one's lives, to not let the disease take over, focusing on the positive in their lives, and finding strength and remain hopeful. Interventions such as cognitive-behavioural therapy and mindfulness exercises may be effective in strengthening or regain affected individual's sense of competence and control by fostering adaptive coping skills and resilience. Subsequently, these interventions may improve health-related quality of life when rheumatic symptoms persist following chikungunya virus infection.
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Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
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Rodrigues RS, Sakata RK, da Silva WV, Raimundo CR, Cerqueira CF, Leal PDC. Exploring the analgesic effects of pregabalin for post-chikungunya arthralgia: a comparative double-blind study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744463. [PMID: 37717925 PMCID: PMC10877331 DOI: 10.1016/j.bjane.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
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Doran C, Duits A, Gerstenbluth I, Tami A, Bailey A. "What will the doctor give me, the same painkiller?": a qualitative study exploring health-care seeking and symptoms self-management among patients for the treatment of long-term chikungunya disease, in Curaçao. BMC Health Serv Res 2023; 23:1247. [PMID: 37957621 PMCID: PMC10641972 DOI: 10.1186/s12913-023-10254-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Long-term chikungunya disease, characterized by persistent disabling rheumatic symptoms, including poly-arthralgia/arthritis of severe pain intensity, can persist for years after infection with the re-emerging mosquito-borne chikungunya virus. Although persistent symptoms and pain severity are important determinants of health-care seeking and self-management of symptoms, research on these in relation to long-term chikungunya disease is scarce. This study aimed to explore the perceived benefits and perceived barriers concerning health-care seeking, based on the Health Belief Model, and the symptoms self-management strategies used for health outcome improvement among individuals affected by long-term chikungunya disease. METHODS An exploratory qualitative descriptive study was conducted with 20 purposively selected adults (17 females and 3 males) with persistent rheumatic symptoms, recruited from an ongoing longitudinal chikungunya cohort, in Curaçao. Semi-structured interviews were carried out, audio-recorded, and transcribed. An iterative coding process was used for themes identification through inductive thematic analyses. RESULTS No perceived benefits in health-care seeking were reported. Identified themes in relation to perceived barriers were: (1) health-care seeking at disease onset; (2) general practitioners (GPs) perceptions and awareness of persistent symptoms; (3) challenges for medical referrals and support; (4) no validation of symptoms and challenges accessing therapy; (5) health system restrictions; and (6) social stigmatization of psychological help. These perceived barriers have led participants to self-manage persistent symptoms. Over-the-counter pharmacological and/or non-pharmacological treatments were used without consulting GPs. Identified themes were: (1) self-medication of symptoms; and (2) self-management true non-pharmacological treatments. CONCLUSIONS To promote the benefits of long-term health-care seeking and subsequently reduce the possible harmful use of analgesics, a collaborative physician-patient therapeutic relationship need to be encouraged. To facilitate this, important shifts may be needed in chikungunya sequalae education of both patients and health-care professionals, and policy makers need to revise health systems for the long-term provision of multidisciplinary care to achieve beneficial health outcomes in long-term chikungunya disease.
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Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands.
| | - Ashley Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, Utrecht, 3584 CS, Netherlands
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Echavarria-Consuegra L, Dinesh Kumar N, van der Laan M, Mauthe M, Van de Pol D, Reggiori F, Smit JM. Mitochondrial protein BNIP3 regulates Chikungunya virus replication in the early stages of infection. PLoS Negl Trop Dis 2023; 17:e0010751. [PMID: 38011286 PMCID: PMC10703415 DOI: 10.1371/journal.pntd.0010751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/07/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023] Open
Abstract
Chikungunya virus (CHIKV) is a human pathogen causing outbreaks of febrile illness for which vaccines and specific treatments remain unavailable. Autophagy-related (ATG) proteins and autophagy receptors are a set of host factors that participate in autophagy, but have also shown to function in other unrelated cellular pathways. Although autophagy is reported to both inhibit and enhance CHIKV replication, the specific role of individual ATG proteins remains largely unknown. Here, a siRNA screen was performed to evaluate the importance of the ATG proteome and autophagy receptors in controlling CHIKV infection. We observed that 7 out of 50 ATG proteins impact the replication of CHIKV. Among those, depletion of the mitochondrial protein and autophagy receptor BCL2 Interacting Protein 3 (BNIP3) increased CHIKV infection. Interestingly, BNIP3 controls CHIKV independently of autophagy and cell death. Detailed analysis of the CHIKV viral cycle revealed that BNIP3 interferes with the early stages of infection. Moreover, the antiviral role of BNIP3 was found conserved across two distinct CHIKV genotypes and the closely related Semliki Forest virus. Altogether, this study describes a novel and previously unknown function of the mitochondrial protein BNIP3 in the control of the early stages of the alphavirus viral cycle.
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Affiliation(s)
- Liliana Echavarria-Consuegra
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nilima Dinesh Kumar
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marleen van der Laan
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mario Mauthe
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Denise Van de Pol
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fulvio Reggiori
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jolanda M. Smit
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ng WH, Liu X, Ling ZL, Santos CNO, Magalhães LS, Kueh AJ, Herold MJ, Taylor A, Freitas JR, Koit S, Wang S, Lloyd AR, Teixeira MM, Merits A, Almeida RP, King NJC, Mahalingam S. FHL1 promotes chikungunya and o'nyong-nyong virus infection and pathogenesis with implications for alphavirus vaccine design. Nat Commun 2023; 14:6605. [PMID: 37884534 PMCID: PMC10603155 DOI: 10.1038/s41467-023-42330-2] [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: 07/13/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Arthritogenic alphaviruses are positive-strand RNA viruses that cause debilitating musculoskeletal diseases affecting millions worldwide. A recent discovery identified the four-and-a-half-LIM domain protein 1 splice variant A (FHL1A) as a crucial host factor interacting with the hypervariable domain (HVD) of chikungunya virus (CHIKV) nonstructural protein 3 (nsP3). Here, we show that acute and chronic chikungunya disease in humans correlates with elevated levels of FHL1. We generated FHL1-/- mice, which when infected with CHIKV or o'nyong-nyong virus (ONNV) displayed reduced arthritis and myositis, fewer immune infiltrates, and reduced proinflammatory cytokine/chemokine outputs, compared to infected wild-type (WT) mice. Interestingly, disease signs were comparable in FHL1-/- and WT mice infected with arthritogenic alphaviruses Ross River virus (RRV) or Mayaro virus (MAYV). This aligns with pull-down assay data, which showed the ability of CHIKV and ONNV nsP3 to interact with FHL1, while RRV and MAYV nsP3s did not. We engineered a CHIKV mutant unable to bind FHL1 (CHIKV-ΔFHL1), which was avirulent in vivo. Following inoculation with CHIKV-ΔFHL1, mice were protected from disease upon challenge with CHIKV and ONNV, and viraemia was significantly reduced in RRV- and MAYV-challenged mice. Targeting FHL1-binding as an approach to vaccine design could lead to breakthroughs in mitigating alphaviral disease.
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Affiliation(s)
- Wern Hann Ng
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Xiang Liu
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Zheng L Ling
- Viral Immunopathology Laboratory, Infection, Immunity and Inflammation Research Theme, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Institute for Infectious Diseases, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Camilla N O Santos
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe (UFS), Aracaju, Brazil
| | - Lucas S Magalhães
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe (UFS), Aracaju, Brazil
| | - Andrew J Kueh
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Marco J Herold
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Adam Taylor
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Joseph R Freitas
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Sandra Koit
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Sainan Wang
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Andrew R Lloyd
- Viral Immunology Systems Program, Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Mauro M Teixeira
- Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andres Merits
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Roque P Almeida
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe (UFS), Aracaju, Brazil
| | - Nicholas J C King
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
- Viral Immunopathology Laboratory, Infection, Immunity and Inflammation Research Theme, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Institute for Infectious Diseases, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Suresh Mahalingam
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia.
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia.
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia.
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13
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Yodtaweepornanan P, Pongsittisak W, Satpanich P. Incidence and factors associated with chronic chikungunya arthritis following chikungunya virus infection. Trop Med Int Health 2023; 28:653-659. [PMID: 37326000 DOI: 10.1111/tmi.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chikungunya virus infection is a mosquito-borne illness. First-phase symptoms include fever, malaise, rash, and arthritis (self-limiting). Some patients can have chronic-phase symptoms, including chronic tenosynovitis, bursitis, and arthritis. This study aimed to determine the incidence and risk factors of chronic arthritis in patients with chikungunya infection. METHODS This retrospective cohort study analysed all adults diagnosed with chikungunya infection between 2015 and 2020 at our centre. Baseline and follow-up symptoms were evaluated in serologically confirmed cases. Chronic chikungunya arthritis was persistent arthritis >3 months after the onset. Patients who had preexisting chronic inflammatory arthritis and were lost to follow-up before 3 months from diagnosis were excluded. RESULTS This study enrolled 120 patients. The median age was 51 (IQR 14) years, and 78% were female. The median number of joints with arthritis was 4 (IQR 8). The initial visual analog scale (VAS) score was 50 mm (IQR 40). Small joints of the hands, wrist, and knee (44.2%, 43.3%, and 42.3%, respectively) were the most affected. The incidence of chronic chikungunya arthritis was 40.4%. From the multivariable logistic regression, the initial number of joints with arthritis, initial VAS scores, and female sex were independently associated with chronic chikungunya arthritis with odds ratios of 1.09 (95% confidence interval [CI] 1.01-1.18), 1.03 (95% CI 1.01-1.06), and 4.17 (95% CI, 1.05-16.67), respectively. CONCLUSIONS Chronic chikungunya arthritis is common in patients with chikungunya virus infection. Its predictive factors include the initial number of joints with arthritis, initial VAS scores, and female sex.
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Affiliation(s)
- Pasathorn Yodtaweepornanan
- Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Wanjak Pongsittisak
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology and Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Panchalee Satpanich
- Vajira Renal-Rheumatology and Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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14
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Bezerra WP, Moizéis RNC, Salmeron ACA, Pereira HWB, de Araújo JMG, Guedes PMM, Fernandes JV, Nascimento MSL. Innate immune response in patients with acute Chikungunya disease. Med Microbiol Immunol 2023:10.1007/s00430-023-00771-y. [PMID: 37285099 DOI: 10.1007/s00430-023-00771-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
Chikungunya disease (CHIKD) is an arbovirose that presents with high morbidity, mainly due to arthralgia. Inflammatory mediators including IL-6, IL-1β, GM-CSF and others have been implicated in the pathogenesis of CHIKD, whilst type I interferons can be associated with better outcomes. The role of pattern recognition receptors has been studied incompletely. Here, we evaluated the expression of RNA-specific PRRs, their adaptor molecules and downstream cytokines in acute CHIKD patients. Twenty-eight patients were recruited during the 3rd-5th day after the symptoms onset for clinical examination, peripheral blood collection and qRT-PCR analysis of PBMC to compare to the healthy control group (n = 20). We observed common symptoms of acute CHIKD, with fever, arthralgia, headache and myalgia being the most frequent. Compared with uninfected controls, acute CHIKV infection upregulates the expression of the receptors TLR3, RIG-I and MDA5, and also the adaptor molecule TRIF. Regarding cytokine expression, we found an upregulation of IL-6, IL-12, IFN-α, IFN-β and IFN-γ, which are related directly to the inflammatory or antiviral response. The TLR3-TRIF axis correlated with high expression of IL-6 and IFN-α. Interestingly, greater expression of MDA5, IL-12 and IFN-α was related to lower viral loads in CHIKD acute patients. Together, these findings help to complete the picture of innate immune activation during acute CHIKD, while confirming the induction of strong antiviral responses. Drawing the next steps in the understanding of the immunopathology and virus clearance mechanisms of CHIKD should be of utter importance in the aid of the development of effective treatment to reduce the severity of this debilitating disease.
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Affiliation(s)
- Wallace Pitanga Bezerra
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Raíza Nara Cunha Moizéis
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Amanda Costa Ayres Salmeron
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Rio Grande do Norte, Brazil
| | - Hannaly Wana Bezerra Pereira
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Josélio Maria Galvão de Araújo
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Paulo Marcos Matta Guedes
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - José Veríssimo Fernandes
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Manuela Sales Lima Nascimento
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil.
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Rio Grande do Norte, Brazil.
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15
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Chen B, Julg B, Mohandas S, Bradfute SB. Viral persistence, reactivation, and mechanisms of long COVID. eLife 2023; 12:e86015. [PMID: 37140960 PMCID: PMC10159620 DOI: 10.7554/elife.86015] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has infected hundreds of millions of individuals. Following COVID-19 infection, a subset can develop a wide range of chronic symptoms affecting diverse organ systems referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. A National Institutes of Health-sponsored initiative, RECOVER: Researching COVID to Enhance Recovery, has sought to understand the basis of long COVID in a large cohort. Given the range of symptoms that occur in long COVID, the mechanisms that may underlie these diverse symptoms may also be diverse. In this review, we focus on the emerging literature supporting the role(s) that viral persistence or reactivation of viruses may play in PASC. Persistence of SARS-CoV-2 RNA or antigens is reported in some organs, yet the mechanism by which they do so and how they may be associated with pathogenic immune responses is unclear. Understanding the mechanisms of persistence of RNA, antigen or other reactivated viruses and how they may relate to specific inflammatory responses that drive symptoms of PASC may provide a rationale for treatment.
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Affiliation(s)
- Benjamin Chen
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Boris Julg
- Infectious Diseases Division, Massachusetts General Hospital, Ragon Institute of Mass General, MIT and HarvardBostonUnited States
| | - Sindhu Mohandas
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Steven B Bradfute
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences CenterAlbuquerqueUnited States
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16
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Bartholomeeusen K, Daniel M, LaBeaud DA, Gasque P, Peeling RW, Stephenson KE, Ng LFP, Ariën KK. Chikungunya fever. Nat Rev Dis Primers 2023; 9:17. [PMID: 37024497 PMCID: PMC11126297 DOI: 10.1038/s41572-023-00429-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
Chikungunya virus is widespread throughout the tropics, where it causes recurrent outbreaks of chikungunya fever. In recent years, outbreaks have afflicted populations in East and Central Africa, South America and Southeast Asia. The virus is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Chikungunya fever is characterized by severe arthralgia and myalgia that can persist for years and have considerable detrimental effects on health, quality of life and economic productivity. The effects of climate change as well as increased globalization of commerce and travel have led to growth of the habitat of Aedes mosquitoes. As a result, increasing numbers of people will be at risk of chikungunya fever in the coming years. In the absence of specific antiviral treatments and with vaccines still in development, surveillance and vector control are essential to suppress re-emergence and epidemics.
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Affiliation(s)
- Koen Bartholomeeusen
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Matthieu Daniel
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis, France
- Service de Médecine d'Urgences-SAMU-SMUR, CHU de La Réunion, Saint-Denis, France
| | - Desiree A LaBeaud
- Department of Pediatrics, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Philippe Gasque
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis, France
- Laboratoire d'Immunologie Clinique et Expérimentale Océan Indien LICE-OI, Université de La Réunion, Saint-Denis, France
| | - Rosanna W Peeling
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Stephenson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
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17
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Pacheco PAF, Gonzaga DTG, von Ranke NL, Rodrigues CR, da Rocha DR, da Silva FDC, Ferreira VF, Faria RX. Synthesis, Biological Evaluation and Molecular Modeling Studies of Naphthoquinone Sulfonamides and Sulfonate Ester Derivatives as P2X7 Inhibitors. MOLECULES (BASEL, SWITZERLAND) 2023; 28:molecules28020590. [PMID: 36677652 PMCID: PMC9866630 DOI: 10.3390/molecules28020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
ATP acts in the extracellular environment as an important signal, activating a family of receptors called purinergic receptors. In recent years, interest in the potential therapeutics of purinergic components, including agonists and antagonists of receptors, has increased. Currently, many observations have indicated that ATP acts as an important mediator of inflammatory responses and, when found in high concentrations in the extracellular space, is related to the activation of the P2X7 purinergic receptor. In this sense, the search for new inhibitors for this receptor has attracted a great deal of attention in recent years. Sulfonamide derivatives have been reported to be potent inhibitors of P2X receptors. In this study, ten naphthoquinone sulfonamide derivatives and five naphthoquinone sulfonate ester derivatives were tested for their inhibitory activity on the P2X7 receptor expressed in peritoneal macrophages. Some compounds showed promising results, displaying IC50 values lower than that of A740003. Molecular docking and dynamic studies also indicated that the active compounds bind to an allosteric site on P2X7R. The binding free energy indicates that sulfonamides have an affinity for the P2X7 receptor similar to A740003. Therefore, the compounds studied herein present potential P2X7R inhibition.
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Affiliation(s)
| | - Daniel Tadeu Gomes Gonzaga
- Departament of Pharmacy, West Zone Campus, State University of Rio de Janeiro, Rio de Janeiro 23070-200, Brazil
| | - Natalia Lidmar von Ranke
- Department of Pharmaceuticals and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21941-170, Brazil
| | - Carlos Rangel Rodrigues
- Department of Pharmaceuticals and Medicines, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21941-170, Brazil
| | - David Rodrigues da Rocha
- Department of Organic Chemistry, Institute of Chemistry, Federal Fluminense University, Niterói 24020-141, Brazil
| | | | - Vitor Francisco Ferreira
- Department of Organic Chemistry, Institute of Chemistry, Federal Fluminense University, Niterói 24020-141, Brazil
| | - Robson Xavier Faria
- Evaluation and Promotion of the Ambiental Health Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
- Postgraduate Program in Sciences and Biotechnology, Institute of Biology, Federal Fluminense University, Niterói 24210-130, Brazil
- Correspondence:
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18
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Hakim MS, Aman AT. Understanding the Biology and Immune Pathogenesis of Chikungunya Virus Infection for Diagnostic and Vaccine Development. Viruses 2022; 15:48. [PMID: 36680088 PMCID: PMC9863735 DOI: 10.3390/v15010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Chikungunya virus, the causative agent of chikungunya fever, is generally characterized by the sudden onset of symptoms, including fever, rash, myalgia, and headache. In some patients, acute chikungunya virus infection progresses to severe and chronic arthralgia that persists for years. Chikungunya infection is more commonly identified in tropical and subtropical regions. However, recent expansions and epidemics in the temperate regions have raised concerns about the future public health impact of chikungunya diseases. Several underlying factors have likely contributed to the recent re-emergence of chikungunya infection, including urbanization, human travel, viral adaptation to mosquito vectors, lack of effective control measures, and the spread of mosquito vectors to new regions. However, the true burden of chikungunya disease is most likely to be underestimated, particularly in developing countries, due to the lack of standard diagnostic assays and clinical manifestations overlapping with those of other endemic viral infections in the regions. Additionally, there have been no chikungunya vaccines available to prevent the infection. Thus, it is important to update our understanding of the immunopathogenesis of chikungunya infection, its clinical manifestations, the diagnosis, and the development of chikungunya vaccines.
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Affiliation(s)
- Mohamad S. Hakim
- Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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19
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Amaral JK, Bingham CO, Taylor PC, Vilá LM, Weinblatt ME, Schoen RT. Pathogenesis of chronic chikungunya arthritis: Resemblances and links with rheumatoid arthritis. Travel Med Infect Dis 2022; 52:102534. [PMID: 36549417 DOI: 10.1016/j.tmaid.2022.102534] [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: 08/07/2022] [Revised: 09/03/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Chikungunya virus (CHIKV) infection results from transmission by the mosquito vector. Following an incubation period of 5-7 days, patients develop an acute febrile illness, chikungunya fever (CHIKF), characterized by high fevers, maculopapular rash, headaches, polyarthritis/arthralgias, myalgias, nausea, vomiting, and diarrhea. Joint pain is often severe, and most often involves the hands, the wrists, the ankles, and the metatarsal-phalangeal joints of the feet. Many patients recover within several weeks, but up to 50% develop chronic joint pain and swelling for more than 12 weeks, then we refer to these symptoms as chronic chikungunya arthritis (CCA). The pathogenesis of CCA is not well understood. In this article, we suggest that mesenchymal stem cells (MSCs) may play an important role in this pathogenesis. This heterogeneous group of multipotent cells, morphologically similar to fibroblasts, may undergo epigenetic changes capable of generating aberrant progenies. However, we believe that there is no need for a latent infection. In our pathogenic hypothesis, CHIKV infection of MSCs would cause epigenetic changes both in MSCs themselves and in their progenies, without the need for reactivation of dormant viruses.
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Affiliation(s)
- J Kennedy Amaral
- Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Ceará, Brazil.
| | - Clifton O Bingham
- Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter C Taylor
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford, UK
| | - Luis M Vilá
- Division of Rheumatology, Allergy and Immunology, San Juan, Puerto Rico, USA
| | - Michael E Weinblatt
- John R. and Eileen K. Riedman Professor of Medicine, Harvard Medical School, USA
| | - Robert T Schoen
- Section of Rheumatology, Yale University School of Medicine, New Haven, CT, USA
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20
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Doran C, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Tami A, Bailey A. The clinical manifestation and the influence of age and comorbidities on long-term chikungunya disease and health-related quality of life: a 60-month prospective cohort study in Curaçao. BMC Infect Dis 2022; 22:948. [PMID: 36526964 PMCID: PMC9756924 DOI: 10.1186/s12879-022-07922-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown. METHODS The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3-16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms. RESULTS A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01-11.44; P < .001) and lower (OR: 8.68; CI: 3.47-21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40-10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores. CONCLUSIONS Rheumatic and non-rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype.
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Affiliation(s)
- Churnalisa Doran
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Norediz Lourents
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Yaskara Halabi
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Johannes Burgerhof
- grid.4494.d0000 0000 9558 4598Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Adriana Tami
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ajay Bailey
- grid.5477.10000000120346234Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, 3584 CS Utrecht, The Netherlands
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Millsapps EM, Underwood EC, Barr KL. Development and Application of Treatment for Chikungunya Fever. Res Rep Trop Med 2022; 13:55-66. [PMID: 36561535 PMCID: PMC9767026 DOI: 10.2147/rrtm.s370046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
The development and application of treatment for Chikungunya fever (CHIKF) remains complicated as there is no current standard treatment and many barriers to research exist. Chikungunya virus (CHIKV) causes serious global health implications due to its socioeconomic impact and high morbidity rates. In research, treatment through natural and pharmaceutical techniques is being evaluated for their efficacy and effectiveness. Natural treatment options, such as homeopathy and physiotherapy, give patients a variety of options for how to best manage acute and chronic symptoms. Some of the most used pharmaceutical therapies for CHIKV include non-steroidal anti-inflammatory drugs (NSAIDS), methotrexate (MTX), chloroquine, and ribavirin. Currently, there is no commercially available vaccine for chikungunya, but vaccine development is crucial for this virus. Potential treatments need further research until they can become a standard part of treatment. The barriers to research for this complicated virus create challenges in the efficacy and equitability of its research. The rising need for increased research to fully understand chikungunya in order to develop more effective treatment options is vital in protecting endemic populations globally.
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Affiliation(s)
- Erin M Millsapps
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA
| | - Emma C Underwood
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA
| | - Kelli L Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, FL, USA,Correspondence: Kelli L Barr, Center for Global Health and Infectious Disease Research, University of South Florida, 3720 Spectrum Blvd. Suite 304, Tampa, FL, 33612, USA, Tel +1 813 974 4480, Fax +1 813 974 4962, Email
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22
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Webb E, Michelen M, Rigby I, Dagens A, Dahmash D, Cheng V, Joseph R, Lipworth S, Harriss E, Cai E, Nartowski R, Januraga PP, Gedela K, Sukmaningrum E, Cevik M, Groves H, Hart P, Fletcher T, Blumberg L, Horby PW, Jacob ST, Sigfrid L. An evaluation of global Chikungunya clinical management guidelines: A systematic review. EClinicalMedicine 2022; 54:101672. [PMID: 36193172 PMCID: PMC9526181 DOI: 10.1016/j.eclinm.2022.101672] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally. METHODS We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361. FINDINGS 28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1-7)). There were variations in the CMGs' guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use. INTERPRETATION There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care. FUNDING The UK Foreign, Commonwealth and Development Office, Wellcome Trust [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135].
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Affiliation(s)
- Eika Webb
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Melina Michelen
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ishmeala Rigby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Andrew Dagens
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Dania Dahmash
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Vincent Cheng
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Samuel Lipworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Erhui Cai
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Robert Nartowski
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | | | | | - Evi Sukmaningrum
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- HIV AIDS Research Centre-HPSI, AJCU, Jakarta, Indonesia
| | - Muge Cevik
- Department of Global Health and Infection Research, School of Medicine, University of St Andrews, Fife, Scotland, UK
| | | | | | - Tom Fletcher
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Lucille Blumberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Peter W. Horby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Shevin T. Jacob
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Louise Sigfrid
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
- Corresponding author.
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23
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Role of Arbovirus Infection in Arthritogenic Pain Manifestation—A Systematic Review. Trop Med Infect Dis 2022; 7:tropicalmed7110390. [DOI: 10.3390/tropicalmed7110390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
The number of publications on the development of arthritic pain after CHIKV infection is increasing; however, there is still a gap in the pathophysiological mechanisms that explain these outcomes. In this review, we conducted a descriptive analysis of the findings of patients to understand their prognosis and to explore therapeutic options. Here, we searched the Cochrane, BVS, PubMed, and Scielo databases using the keywords “arthritis”, “pain”, “arbovirus”, “disease”, “arthritogenic”, and “arthralgia” during the 2000 to 2022 period. Descriptive analyses were conducted to understand the association between CHIKV infection and arthritogenic pain. The present study shows the persistence of acute phase signals for months, making the chronic phase still marked by the presence of arthralgia, often disabling under stimuli, such as temperature variation. CHIKV infection appears to be remarkably similar to rheumatoid arthritis, since both diseases share common symptoms. Once diagnosed, patients are mostly treated with analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARD). As there are no prophylactic measures or specific treatments for arboviruses, this study gathered information on the development and manifestations of arthritogenic pain.
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24
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Mourad O, Makhani L, Chen LH. Chikungunya: An Emerging Public Health Concern. Curr Infect Dis Rep 2022; 24:217-228. [DOI: 10.1007/s11908-022-00789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Purpose of Review
The worldwide spread of chikungunya over the past two decades calls for greater knowledge and awareness of the virus, its route of transmission, methods of diagnosis, and the use of available treatment and prevention measures.
Recent Findings
Chikungunya virus infection, an Aedes mosquito-borne febrile disease, has spread from Africa and Asia to Europe and the Americas and from the tropics and subtropics to temperate regions. International travel is a pivotal influence in the emergence of chikungunya as a global public health threat, as evidenced by a growing number of published reports on travel-related chikungunya infections. The striking features of chikungunya are arthralgia and arthritis, and the disease is often mistaken for dengue. Although mortality is low, morbidity can be profound and persistent. Current treatment for chikungunya is supportive; chikungunya vaccines and therapeutics are in development. Travelers planning to visit areas where the mosquito vectors are present should be advised on preventive measures.
Summary
Chikungunya is an emerging disease in the Americas. Frequent travel, the presence of at least two competent mosquito species, and a largely naïve human population in the Western Hemisphere create a setting conducive to future outbreaks. Awareness of the disease and its manifestations is critical to effectively and safely manage and limit its impact. Vaccines in late-stage clinical trials offer a new pathway to prevention.
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25
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Synthesis and Anti-Inflammatory Activity Evaluation of Some Benzimidazole Derivatives. Pharm Chem J 2022; 56:1070-1074. [PMID: 36405379 PMCID: PMC9647759 DOI: 10.1007/s11094-022-02755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/11/2022]
Abstract
Hyper-inflammation aggravates the symptoms of both communicable and non-communicable diseases. Therefore, anti-inflammatory compounds may have wide therapeutic application. Benzimidazole is a privileged scaffold and its success in drug development is evident from the long list of benzimidazole-based drugs with wide range of applications. This study was undertaken to develop new small molecules with anti-inflammatory properties. Compounds MBPHYD, MBNHYD and MBHYDX were synthesised, purified, characterised and found to be non-toxic both in vitro (in 100 μMconcentration for 24 h vs. 3000 Vero cells/well) and in vivo (at a dose of 100 mg/kg in female Wistar rats with animals observed for 48 h for any mortality). Compounds MBPHYD and MBNHYD were found to possess significant anti-inflammatory properties. Further, in silico analysis suggested their compliance with drug-likeness. While no toxicity was predicted, both compounds were suggested to have good oral bioavailability. Thus, results of this study may encourage further investigation to establish new anti-inflammatory benzimidazoles for application against various disease conditions.
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26
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Characterization and Involvement of Exosomes Originating from Chikungunya Virus-Infected Epithelial Cells in the Transmission of Infectious Viral Elements. Int J Mol Sci 2022; 23:ijms232012117. [PMID: 36292974 PMCID: PMC9603488 DOI: 10.3390/ijms232012117] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 12/03/2022] Open
Abstract
The Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that affects the world's popula-tion with chikungunya disease. Adaptation of the viral life cycle to their host cells' environment is a key step for establishing their infection and pathogenesis. Recently, the accumulating evidence advocates a principal role of extracellular vesicles (EVs), including exosomes, in both the infection and pathogenesis of infectious diseases. However, the participation of exosomes in CHIKV infec-tion and transmission is not well clarified. Here, we demonstrated that the CHIKV RNA and pro-teins were captured in exosomes, which were released by viral-infected epithelial cells. A viral genomic element in the isolated exosomes was infectious to naïve mammalian epithelial cells. The assay of particle size distribution and transmission electron microscopy (TEM) revealed CHIKV-derived exosomes with a size range from 50 to 250 nm. Treatments with RNase A, Triton X-100, and immunoglobulin G antibodies from CHIKV-positive patient plasma indicated that in-fectious viral elements are encompassed inside the exosomes. Interestingly, our viral plaque for-mation also exhibited that infectious viral elements might be securely transmitted to neighboring cells by a secreted exosomal pathway. Taken together, our recent findings emphasize the evidence for a complementary means of CHIKV infection and suggest the role of exosome-mediated CHIKV transmission.
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27
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N-Linked Glycans Shape Skin Immune Responses during Arthritis and Myositis after Intradermal Infection with Ross River Virus. J Virol 2022; 96:e0099922. [PMID: 36000846 PMCID: PMC9472629 DOI: 10.1128/jvi.00999-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Arthritogenic alphaviruses are mosquito-borne arboviruses that include several re-emerging human pathogens, including the chikungunya (CHIKV), Ross River (RRV), Mayaro (MAYV), and o'nyong-nyong (ONNV) virus. Arboviruses are transmitted via a mosquito bite to the skin. Herein, we describe intradermal RRV infection in a mouse model that replicates the arthritis and myositis seen in humans with Ross River virus disease (RRVD). We show that skin infection with RRV results in the recruitment of inflammatory monocytes and neutrophils, which together with dendritic cells migrate to draining lymph nodes (LN) of the skin. Neutrophils and monocytes are productively infected and traffic virus from the skin to LN. We show that viral envelope N-linked glycosylation is a key determinant of skin immune responses and disease severity. RRV grown in mammalian cells elicited robust early antiviral responses in the skin, while RRV grown in mosquito cells stimulated poorer early antiviral responses. We used glycan mass spectrometry to characterize the glycan profile of mosquito and mammalian cell-derived RRV, showing deglycosylation of the RRV E2 glycoprotein is associated with curtailed skin immune responses and reduced disease following intradermal infection. Altogether, our findings demonstrate skin infection with an arthritogenic alphavirus leads to musculoskeletal disease and envelope glycoprotein glycosylation shapes disease outcome. IMPORTANCE Arthritogenic alphaviruses are transmitted via mosquito bites through the skin, potentially causing debilitating diseases. Our understanding of how viral infection starts in the skin and how virus systemically disseminates to cause disease remains limited. Intradermal arbovirus infection described herein results in musculoskeletal pathology, which is dependent on viral envelope N-linked glycosylation. As such, intradermal infection route provides new insights into how arboviruses cause disease and could be extended to future investigations of skin immune responses following infection with other re-emerging arboviruses.
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28
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de Araújo S, de Melo Costa VR, Santos FM, de Sousa CDF, Moreira TP, Gonçalves MR, Félix FB, Queiroz-Junior CM, Campolina-Silva GH, Nogueira ML, Sugimoto MA, Bonilha CS, Perretti M, Souza DG, Costa VV, Teixeira MM. Annexin A1-FPR2/ALX Signaling Axis Regulates Acute Inflammation during Chikungunya Virus Infection. Cells 2022; 11:cells11172717. [PMID: 36078125 PMCID: PMC9454528 DOI: 10.3390/cells11172717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022] Open
Abstract
Chikungunya (CHIKV) is an arthritogenic alphavirus that causes a self-limiting disease usually accompanied by joint pain and/or polyarthralgia with disabling characteristics. Immune responses developed during the acute phase of CHIKV infection determine the rate of disease progression and resolution. Annexin A1 (AnxA1) is involved in both initiating inflammation and preventing over-response, being essential for a balanced end of inflammation. In this study, we investigated the role of the AnxA1-FPR2/ALX pathway during CHIKV infection. Genetic deletion of AnxA1 or its receptor enhanced inflammatory responses driven by CHIKV. These knockout mice showed increased neutrophil accumulation and augmented tissue damage at the site of infection compared with control mice. Conversely, treatment of wild-type animals with the AnxA1 mimetic peptide (Ac2–26) reduced neutrophil accumulation, decreased local concentration of inflammatory mediators and diminished mechanical hypernociception and paw edema induced by CHIKV-infection. Alterations in viral load were mild both in genetic deletion or with treatment. Combined, our data suggest that the AnxA1-FPR2/ALX pathway is a potential therapeutic strategy to control CHIKV-induced acute inflammation and polyarthralgia.
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Affiliation(s)
- Simone de Araújo
- Graduate Program in Biological Sciences Physiology and Pharmacology, Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Victor R. de Melo Costa
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Franciele M. Santos
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Carla D. Ferreira de Sousa
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Thaiane P. Moreira
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Matheus R. Gonçalves
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Franciel B. Félix
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Celso M. Queiroz-Junior
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Gabriel H. Campolina-Silva
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Department of Obstetrics, Gynecology and Reproduction, CHU de Quebec Research Center (CHUL), Université Laval, Quebec, QC G1V 0A6, Canada
| | - Maurício Lacerda Nogueira
- Department of Dermatological, Infections, and Parasitic Diseases, School of Medicine (FAMERP), São José do Rio Preto, São Paulo 15090-000, Brazil
| | - Michelle A. Sugimoto
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK
| | - Caio S. Bonilha
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Center for Research on Inflammatory Diseases, University of São Paulo, São Paulo 05508-000, Brazil
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mauro Perretti
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London E1 4NS, UK
| | - Danielle G. Souza
- Graduate Program in Microbiology, Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Vivian V. Costa
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Graduate Program in Cell Biology, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Correspondence: (V.V.C.); (M.M.T.); Tel.: +55-31-3409-3082 (V.V.C.); +55-31-3409-2651 (M.M.T.)
| | - Mauro M. Teixeira
- Drug Research and Development Center, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Correspondence: (V.V.C.); (M.M.T.); Tel.: +55-31-3409-3082 (V.V.C.); +55-31-3409-2651 (M.M.T.)
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Virological, Serological and Clinical Analysis of Chikungunya Virus Infection in Thai Patients. Viruses 2022; 14:v14081805. [PMID: 36016427 PMCID: PMC9414365 DOI: 10.3390/v14081805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
From 2018 to 2020, the Chikungunya virus (CHIKV) outbreak re-emerged in Thailand with a record of more than 10,000 cases up until the end of 2020. Here, we studied acute CHIKV-infected patients who had presented to the Bangkok Hospital for Tropical Diseases from 2019 to 2020 by assessing the relationship between viral load, clinical features, and serological profile. The results from our study showed that viral load was significantly high in patients with fever, headache, and arthritis. We also determined the neutralizing antibody titer in response to the viral load in patients, and our data support the evidence that an effective neutralizing antibody response against the virus is important for control of the viral load. Moreover, the phylogenetic analysis revealed that the CHIKV strains we studied belonged to the East, Central, and Southern African (ECSA) genotype, of the Indian ocean lineage (IOL), and possessed E1-K211E and E1-I317V mutations. Thus, this study provides insight for a better understanding of CHIKV pathogenesis in acute infection, along with the genomic diversity of the current CHIKV strains circulating in Thailand.
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30
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Ocular Manifestations of Chikungunya Infection: A Systematic Review. Pathogens 2022; 11:pathogens11040412. [PMID: 35456087 PMCID: PMC9028588 DOI: 10.3390/pathogens11040412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 02/04/2023] Open
Abstract
The Chikungunya virus (CHIKV) can cause long lasting symptoms and manifestations. However, there is little information on which ocular ones are most frequent following infection. We performed a systematic review (registered in the International Prospective Register of Systematic Reviews; no CRD42020171928) to establish the most frequent ocular manifestations of CHIKV infection and their associations with gender and age. Articles published until September 2020 were selected from PubMed, Scielo, Cochrane and Scopus databases. Only studies with CHIKV-infected patients and eye alterations were included. Reviews, descriptive studies, or those not investigating the human ocular manifestations of CHIKV, those with patients with other diseases and infections, abstracts and studies without relevant data were excluded. Twenty-five studies were selected for inclusion. Their risk of bias was evaluated by a modified Newcastle-Ottawa scale. The most frequent ocular symptoms of CHIKV infection included ocular pain, inflammation and reduced visual acuity, whilst conjunctivitis and optic neuritis were the most common manifestations of the disease. These occurred mostly in individuals of 42 ± 9.5 years of age and woman. The few available reports on CHIKV-induced eye manifestations highlight the need for further research in the field to gather more substantial evidence linking CHIKV infection, the eye and age/gender. Nonetheless, the data emphasizes that ocular alterations are meaningful occurrences of CHIKV infection which can substantially affect quality of life.
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31
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Abstract
CHIKV has been prevalent in Africa, Asia, and the Indian Ocean Islands for decades. There are currently no clinically approved vaccines or specific antiviral drugs targeting CHIKV.
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32
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Mostafavi H, Tharmarajah K, Vider J, West NP, Freitas JR, Cameron B, Foster PS, Hueston LP, Lloyd AR, Mahalingam S, Zaid A. Interleukin-17 contributes to Ross River virus-induced arthritis and myositis. PLoS Pathog 2022; 18:e1010185. [PMID: 35143591 PMCID: PMC8830676 DOI: 10.1371/journal.ppat.1010185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Arthritogenic alphaviruses are mosquito-borne viruses that are a major cause of infectious arthropathies worldwide, and recent outbreaks of chikungunya virus and Ross River virus (RRV) infections highlight the need for robust intervention strategies. Alphaviral arthritis can persist for months after the initial acute disease, and is mediated by cellular immune responses. A common strategy to limit inflammation and pathology is to dampen the overwhelming inflammatory responses by modulating proinflammatory cytokine pathways. Here, we investigate the contribution of interleukin-17 (IL-17), a cytokine involved in arthropathies such as rheumatoid arthritis, in the development RRV-induced arthritis and myositis. IL-17 was quantified in serum from RRV-infected patients, and mice were infected with RRV and joints and muscle tissues collected to analyse cellular infiltrates, tissue mRNA, cytokine expression, and joint and muscle histopathology. IL-17 expression was increased in musculoskeletal tissues and serum of RRV-infected mice and humans, respectively. IL-17–producing T cells and neutrophils contributed to the cellular infiltrate in the joint and muscle tissue during acute RRV disease in mice. Blockade of IL-17A/F using a monoclonal antibody (mAb) reduced disease severity in RRV-infected mice and led to decreased proinflammatory proteins, cellular infiltration in synovial tissues and cartilage damage, without affecting viral titers in inflamed tissues. IL-17A/F blockade triggered a shift in transcriptional profile of both leukocyte infiltrates and musculoskeletal stromal cells by downregulating proinflammatory genes. This study highlights a previously uncharacterized role for an effector cytokine in alphaviral pathology and points towards potential therapeutic benefit in targeting IL-17 to treat patients presenting with RRV-induced arthropathy. Some viruses transmitted by mosquitoes cause painful and debilitating arthritis, which manifests both as an acute form shortly following infection, and a chronic form long after the initial symptoms have subsided. These viruses, termed arboviruses, are difficult to control and there are currently no specific treatments to alleviate the pain and loss of mobility. Arthritis caused by arboviruses shares similarities with a non-infectious, autoimmune form of arthritis called rheumatoid arthritis (RA). In RA, an immune molecule termed interleukin-17, or IL-17, has been shown to drive arthritis and treatments that target or block IL-17 are being developed to treat RA. Here, we asked whether arthritis caused by an arbovirus, Ross River virus (RRV), was also associated with elevated IL-17 in humans and mice. Disease severity in mice was associated with high IL-17 expression in the feet and muscle, and blocking IL-17 using an anti-IL-17 monoclonal antibody ameliorated disease in mice infected with RRV. Our study provides new information on a molecule that is implicated in arthritic inflammation, and could be targeted to treat disease caused by arthritogenic arboviruses.
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Affiliation(s)
- Helen Mostafavi
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Gold Coast, QLD, Australia
| | - Kothila Tharmarajah
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Gold Coast, QLD, Australia
| | - Jelena Vider
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Mucosal Immunology Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Nicholas P. West
- Mucosal Immunology Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Joseph R. Freitas
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Gold Coast, QLD, Australia
| | - Barbara Cameron
- Viral immunology Systems Program, Kirby Institute, University of New South Wales, Kensington, Australia
| | - Paul S. Foster
- School of Biomedical Sciences, Faculty of Health Sciences and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Linda P. Hueston
- Arbovirus Emerging Diseases Unit, Centre for Infectious Diseases and Microbiology Laboratory Services, Pathology West—ICPMR Westmead, Australia
| | - Andrew R. Lloyd
- Viral immunology Systems Program, Kirby Institute, University of New South Wales, Kensington, Australia
| | - Suresh Mahalingam
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Gold Coast, QLD, Australia
- * E-mail: (SM); (AZ)
| | - Ali Zaid
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Centre of Excellence in Arboviruses, Gold Coast, QLD, Australia
- * E-mail: (SM); (AZ)
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Sahoo RR, Wakhlu A, Agarwal V. Neglected tropical rheumatic diseases. Clin Rheumatol 2022; 41:1293-1304. [PMID: 35142903 DOI: 10.1007/s10067-022-06090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
The complexities of dealing with rheumatic diseases in tropical countries are diverse and likely due to limited health care infrastructure, lack of diagnostic and therapeutic facilities, impact of dominant prevailing diseases, and the challenges of differentiating from infectious and non-infectious disease mimics. Several tropical diseases present with musculoskeletal and rheumatic manifestations and often pose a diagnostic dilemma to rheumatologists. The diagnosis is often delayed or the disease is misdiagnosed, leading to poor patient outcomes. Endemic tropical diseases like tuberculosis and leprosy have myriad rheumatic presentations and remain important differentials to consider in patients with rheumatic manifestations. Infection with human immunodeficiency virus is a great masquerade and can mimic manifestations of multiple diseases. The role of viral infections in triggering and perpetuating autoimmunity is well known and chikungunya arthritis is a classic example of the same. This review highlights the rheumatic manifestations of tropical diseases and aims to create awareness among the caregivers. Key Points • It is crucial to be aware and identify infectious diseases presenting with rheumatic manifestations in the tropics. • Presentations akin to classic rheumatic syndromes such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and vasculitis are common.
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Affiliation(s)
- Rasmi Ranjan Sahoo
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
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Chikungunya and arthritis: An overview. Travel Med Infect Dis 2021; 44:102168. [PMID: 34563686 DOI: 10.1016/j.tmaid.2021.102168] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
Abstract
Chikungunya is caused by CHIKV (chikungunya virus), an emerging and re-emerging arthropod-vectored viral infection that causes a febrile disease with primarily long term sequelae of arthralgia and myalgia and is fatal in a small fraction of infected patients. Sporadic outbreaks have been reported from different parts of the world chiefly Africa, Asia, the Indian and Pacific ocean regions, Europe and lately even in the Americas. Currently, treatment is primarily symptomatic as no vaccine, antibody-mediated immunotherapy or antivirals are available. Chikungunya belongs to a family of arthritogenic alphaviruses which have many pathophysiological similarities. Chikungunya arthritis has similarities and differences with rheumatoid arthritis. Although research into arthritis caused by these alphaviruses have been ongoing for decades and significant progress has been made, the mechanisms underlying viral infection and arthritis are not well understood. In this review, we give a background to chikungunya and the causative virus, outline the history of alphavirus arthritis research and then give an overview of findings on arthritis caused by CHIKV. We also discuss treatment options and the research done so far on various therapeutic intervention strategies.
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Ramakrishnan RK, Kashour T, Hamid Q, Halwani R, Tleyjeh IM. Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19. Front Immunol 2021; 12:686029. [PMID: 34276671 PMCID: PMC8278217 DOI: 10.3389/fimmu.2021.686029] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
More than one year since its emergence, corona virus disease 2019 (COVID-19) is still looming large with a paucity of treatment options. To add to this burden, a sizeable subset of patients who have recovered from acute COVID-19 infection have reported lingering symptoms, leading to significant disability and impairment of their daily life activities. These patients are considered to suffer from what has been termed as “chronic” or “long” COVID-19 or a form of post-acute sequelae of COVID-19, and patients experiencing this syndrome have been termed COVID-19 long-haulers. Despite recovery from infection, the persistence of atypical chronic symptoms, including extreme fatigue, shortness of breath, joint pains, brain fogs, anxiety and depression, that could last for months implies an underlying disease pathology that persist beyond the acute presentation of the disease. As opposed to the direct effects of the virus itself, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be largely responsible for the appearance of these lasting symptoms, possibly through facilitating an ongoing inflammatory process. In this review, we hypothesize potential immunological mechanisms underlying these persistent and prolonged effects, and describe the multi-organ long-term manifestations of COVID-19.
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Affiliation(s)
- Rakhee K Ramakrishnan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Qutayba Hamid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Meakins-Christie Laboratories, Research Institute of the McGill University Healthy Center, McGill University, Montreal, QC, Canada
| | - Rabih Halwani
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates.,Prince Abdullah Ben Khaled Celiac Disease Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Musculoskeletal Manifestations Observed in Patients Diagnosed With Chikungunya Virus in 2 Municipalities of the Brazilian Amazon Region. J Clin Rheumatol 2021; 26:S195-S198. [PMID: 32251055 DOI: 10.1097/rhu.0000000000001366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chikungunya virus fever is an emerging disease that is rapidly spreading and becoming a global public health issue because of its clinical manifestations that cause physical limitations and high rates of chronification. No studies have characterized musculoskeletal manifestations in Brazilian patients with chikungunya. OBJECTIVE To describe the musculoskeletal manifestations of patients with chikungunya infection in municipalities of the Brazilian Amazon region. METHODS This study was an observational, descriptive, and analytical study conducted from March to May 2018. The gender, age, time of infection, clinical manifestations reported during the acute phase, and results of a physical examination of the musculoskeletal system were collected. RESULTS The medical records of 63 patients with a laboratory confirmation of chikungunya virus fever were analyzed. Eighty-three percent of these patients were women, with a mean age of 50.6 ± 14.5 years and 3.3 ± 3.1 months of infection. The main clinical manifestations reported during the acute phase were arthralgia (100%), fever (91%), and exanthema (65%). The physical examination revealed that the main joints affected by arthralgia resulted in a polyarticular (57%, 5-10 joints) and symmetrical pattern (62%) that mainly affected the ankles (53%) and knees (51%). Regarding arthritis, the most frequently affected area was the wrist (42%), with an oligoarticular pattern (42%, 2-4 joints). CONCLUSIONS In general, the clinical manifestations described in the Brazilian Amazon population are similar to those reported in publications from other countries; however, the main arthritis pattern identified is oligoarticular, with a predominance of the wrist. Moreover, the chronicity rate is 48%.
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Irinotecan (CPT-11) Canonical Anti-Cancer Drug Can also Modulate Antiviral and Pro-Inflammatory Responses of Primary Human Synovial Fibroblasts. Cells 2021; 10:cells10061431. [PMID: 34201243 PMCID: PMC8230279 DOI: 10.3390/cells10061431] [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: 02/25/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Alphaviruses are a group of arboviruses that generate chronic inflammatory rheumatisms in humans. Currently, no approved vaccines or antiviral therapies are available to prevent or treat alphavirus-induced diseases. The aim of this study was to evaluate the repositioning of the anti-cancer molecule irinotecan as a potential modulator of the antiviral and inflammatory responses of primary human synovial fibroblasts (HSF), the main stromal cells of the joint synovium. HSF were exposed to O’nyong-nyong virus (ONNV) and polyinosinic-polycytidylic acid (PIC) to mimic, respectively, acute and chronic infectious settings. The cytokine IL-1β was used as a major pro-inflammatory cytokine to stimulate HSF. Quantitative RT-PCR analysis revealed that irinotecan at 15 µM was able to amplify the antiviral response (i.e., interferon-stimulated gene expression) of HSF exposed to PIC and reduce the expression of pro-inflammatory genes (CXCL8, IL-6 and COX-2) upon IL-1β treatment. These results were associated with the regulation of the expression of several genes, including those encoding for STAT1, STAT2, p53 and NF-κB. Irinotecan did not modulate these responses in both untreated cells and cells stimulated with ONNV. This suggests that this drug could be therapeutically useful for the treatment of chronic and severe (rather than acute) arthritis due to viruses.
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Medina-Cintrón N, Martínez I, Pérez-Ríos N, Berríos-López Y, Vilá LM. Clinical Manifestations and Outcomes in Disease-Modifying Antirheumatic Drug-Naive Adult Patients with Chronic Chikungunya Arthritis. Am J Trop Med Hyg 2021; 104:1741-1746. [PMID: 33684065 PMCID: PMC8103441 DOI: 10.4269/ajtmh.20-1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case-control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with mild disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-high disease activity and had substantial functional disability. Diabetes mellitus, chronic back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.
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Affiliation(s)
- Nicolle Medina-Cintrón
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Idali Martínez
- Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Naydi Pérez-Ríos
- Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Yaritza Berríos-López
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M. Vilá
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico;,Address correspondence to Luis M. Vilá, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan PR 00936-5067, Puerto Rico. E-mail:
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Costa DMDN, Coêlho MRCD, Gouveia PADC, Bezerra LA, Marques CDL, Duarte ALBP, Valente LM, Magalhães V. Long-Term Persistence of Serum-Specific Anti-Chikungunya IgM Antibody - A Case Series of Brazilian Patients. Rev Soc Bras Med Trop 2021; 54:e0855. [PMID: 33886823 PMCID: PMC8047711 DOI: 10.1590/0037-8682-0855-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
The persistence of serum-specific anti-chikungunya IgM antibodies (CHIKV-IgM) can vary after chikungunya fever (CHIK) infection. However, the factors related to its production are not yet known. We described a case series drawn up from data collected from 57 patients between 12 and 36 months after the acute phase of CHIK infection in Northeastern Brazil. CHIKV-IgM was detectable in 7/57 (12.3%) patients after 28.3 months of infection. No frequency differences in chronic musculoskeletal manifestations and underlying conditions were detected between patients with or without CHIKV-IgM. CHIKV-IgM was detected for up to 35 months in Brazilian patients after CHIK infection.
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Affiliation(s)
| | - Maria Rosângela Cunha Duarte Coêlho
- Universidade Federal de Pernambuco, Departamento de Virologia, Laboratório de Imunopatologia Keizo Asami, Recife, PE, Brasil.,Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Fisiologia e Farmacologia, Recife, PE, Brasil
| | | | - Luan Araújo Bezerra
- Universidade Federal de Pernambuco, Departamento de Virologia, Laboratório de Imunopatologia Keizo Asami, Recife, PE, Brasil
| | | | | | | | - Vera Magalhães
- Universidade Federal de Pernambuco, Hospital das Clínicas, Recife, PE, Brasil
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Wong E, Suárez JA, Naranjo L, Castrejón-Alba MM. Arbovirus Rash in the Febrile Returning Traveler as a Diagnostic Clue. CURRENT TROPICAL MEDICINE REPORTS 2021; 8:91-98. [PMID: 33643769 PMCID: PMC7900380 DOI: 10.1007/s40475-021-00229-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review This review aims to describe briefly the general information of arboviruses dengue, Zika, and chikungunya infections and emphasize the clinical manifestations of each, to help identify and make a quick diagnosis of each. Recent Findings The most relevant advances in the study of these arboviruses’ infections have been in the epidemiological distribution, mainly due to international travel, migration, and climate change; in the clinical manifestations of these diseases, the development of clinical decision-making software, which can help improve the management and outcomes of these patients; and in the prevention of this disease. Summary Although arboviruses infections constitute a clinical challenge for the attending physician in the scope of a febrile returning traveler, a thorough clinical history and exam can help to aid diagnostic reasoning. The characteristics of the rash are a very helpful clue in the evaluation of these patients. Currently, there are clinical decision aid tools that help to get the diagnosis more quickly.
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Affiliation(s)
- Eduardo Wong
- Facultad de Medicina, Universidad de Panamá, Panamá, Panamá
| | - José Antonio Suárez
- Instituto Conmemorativo Gorgas de Estudio de la Salud and Sistema Nacional de Investigaciòn, SENACYT, Panamá, Panamá
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August A, Attarwala HZ, Himansu S, Kalidindi S, Lu S, Pajon R, Han S, Lecerf JM, Tomassini JE, Hard M, Ptaszek LM, Crowe JE, Zaks T. A phase 1 trial of lipid-encapsulated mRNA encoding a monoclonal antibody with neutralizing activity against Chikungunya virus. Nat Med 2021; 27:2224-2233. [PMID: 34887572 PMCID: PMC8674127 DOI: 10.1038/s41591-021-01573-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022]
Abstract
Chikungunya virus (CHIKV) infection causes acute disease characterized by fever, rash and arthralgia, which progresses to severe and chronic arthritis in up to 50% of patients. Moreover, CHIKV infection can be fatal in infants or immunocompromised individuals and has no approved therapy or prevention. This phase 1, first-in-human, randomized, placebo-controlled, proof-of-concept trial conducted from January 2019 to June 2020 evaluated the safety and pharmacology of mRNA-1944, a lipid nanoparticle-encapsulated messenger RNA encoding the heavy and light chains of a CHIKV-specific monoclonal neutralizing antibody, CHKV-24 ( NCT03829384 ). The primary outcome was to evaluate the safety and tolerability of escalating doses of mRNA-1944 administered via intravenous infusion in healthy participants aged 18-50 years. The secondary objectives included determination of the pharmacokinetics of mRNA encoding for CHKV-24 immunoglobulin heavy and light chains and ionizable amino lipid component and the pharmacodynamics of mRNA-1944 as assessed by serum concentrations of mRNA encoding for CHKV-24 immunoglobulin G (IgG), plasma concentrations of ionizable amino lipid and serum concentrations of CHKV-24 IgG. Here we report the results of a prespecified interim analysis of 38 healthy participants who received intravenous single doses of mRNA-1944 or placebo at 0.1, 0.3 and 0.6 mg kg-1, or two weekly doses at 0.3 mg kg-1. At 12, 24 and 48 h after single infusions, dose-dependent levels of CHKV-24 IgG with neutralizing activity were observed at titers predicted to be therapeutically relevant concentrations (≥1 µg ml-1) across doses that persisted for ≥16 weeks at 0.3 and 0.6 mg kg-1 (mean t1/2 approximately 69 d). A second 0.3 mg kg-1 dose 1 week after the first increased CHKV-24 IgG levels 1.8-fold. Adverse effects were mild to moderate in severity, did not worsen with a second mRNA-1944 dose and none were serious. To our knowledge, mRNA-1944 is the first mRNA-encoded monoclonal antibody showing in vivo expression and detectable ex vivo neutralizing activity in a clinical trial and may offer a treatment option for CHIKV infection. Further evaluation of the potential therapeutic use of mRNA-1944 in clinical trials for the treatment of CHIKV infection is warranted.
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Affiliation(s)
| | | | - Sunny Himansu
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | - Shiva Kalidindi
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | - Sophia Lu
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | - Rolando Pajon
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | - Shu Han
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | | | | | - Marjie Hard
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
| | - Leon M. Ptaszek
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - James E. Crowe
- grid.412807.80000 0004 1936 9916Vanderbilt University Medical Center, Nashville, TN USA
| | - Tal Zaks
- grid.479574.c0000 0004 1791 3172Moderna, Inc., Cambridge, MA USA
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Foeller ME, Nosrat C, Krystosik A, Noel T, Gérardin P, Cudjoe N, Mapp-Alexander V, Mitchell G, Macpherson C, Waechter R, LaBeaud AD. Chikungunya infection in pregnancy - reassuring maternal and perinatal outcomes: a retrospective observational study. BJOG 2020; 128:1077-1086. [PMID: 33040457 DOI: 10.1111/1471-0528.16562] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). DESIGN Retrospective observational study. SETTING Grenada. POPULATION Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. METHODS This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. MAIN OUTCOME MEASURES Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. RESULTS Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (μ = 898 days, σ = 277 days) compared with infections outside of pregnancy (μ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CONCLUSION CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. TWEETABLE ABSTRACT Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.
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Affiliation(s)
- M E Foeller
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - C Nosrat
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - A Krystosik
- Division of Infectious Disease, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
| | - T Noel
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - P Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion.,Unité Mixte 134 PIMIT (INSERM 1187, CNRS 9192, IRD 249, Université de La Réunion), Sainte Clotilde, Réunion
| | - N Cudjoe
- Windward Islands Research and Education Foundation, True Blue, Grenada
| | - V Mapp-Alexander
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - G Mitchell
- Ministry of Health, St. Georges, Grenada
| | - C Macpherson
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - R Waechter
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - A D LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
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Rolim de Oliveira AV, Maria de Lima-Tenório P, Ever de Almeida MC, Marques de Carvalho CA, Soares de Moraes SA. Physiotherapeutic evaluation and intervention proposal on a patient with post-chikungunya chronic arthritis. J Bodyw Mov Ther 2020; 25:199-204. [PMID: 33714496 DOI: 10.1016/j.jbmt.2020.10.022] [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: 06/02/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chikungunya fever is an arboviral disease characterized by a high morbidity rate related to intense and persistent arthralgia, causing a decrease in both quality of life (QoL) and productivity. This study aimed to report functional evaluation and multimodal physiotherapeutic intervention on a patient with post-chikungunya chronic arthritis (PCCA). CASE PRESENTATION Woman, 47 years old, resident of the municipality of Belém, state of Pará, northern Brazil, with clinical diagnosis of chikungunya fever marked by fever, swelling, pain in the joints of the hands and feet, and headache. The physiotherapeutic treatment started three months after the diagnosis and consisted of 24 sessions composed of electrotherapy, thermotherapy, and kinesiotherapy resources. The patient progressed from an initial status of intense pain in several joints to low pain in a single joint and showed improvement in all domains of QoL, mainly in limitations by physical and emotional aspects and functional capacity. CONCLUSIONS This case report details a proposal of multimodal physiotherapeutic intervention for a patient with functional impairments due to PCCA, suggesting that the use of physiotherapeutic resources may help this process and bring some assistance to those affected by the disease.
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Affiliation(s)
| | | | | | - Carlos Alberto Marques de Carvalho
- Universidade do Estado do Pará (UEPA), Instituto Evandro Chagas (IEC), and Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Belém, Brazil
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Abstract
The chikungunya virus (CHIKV) infection epidemic has emerged as a significant public health concern in the last 10-15 years, especially in Asian and south American countries. However, with ever-expanding tourism and migration, cases have now been reported in north America and Europe. CHIKV infection predominantly causes musculoskeletal symptoms with a chronic polyarthritis which may resemble autoimmune inflammatory arthritis. CHIKV infection should always be suspected in a returning traveller presenting with fever, skin rash and arthralgia. Though first reported in the last century, a series of epidemics since 2004 have substantially improved our knowledge. There has also been a significant increase in our understanding of the immunopathogenesis of chikungunya infection. This knowledge is being used in the development of new treatment strategies and preventive measures. In this narrative review, we discuss some of the recent advances in the epidemiology, immunopathogenesis, and management of CHIKV arthritis.
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Tritsch SR, Encinales L, Pacheco N, Cadena A, Cure C, McMahon E, Watson H, Porras Ramirez A, Mendoza AR, Li G, Khurana K, Jaller-Raad JJ, Castillo SM, Barrios Taborda O, Jaller-Char A, Echavez LA, Jiménez D, Gonzalez Coba A, Alarcon Gomez M, Ariza Orozco D, Bravo E, Martinez V, Guerra B, Simon G, Firestein GS, Chang AY. Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms. J Rheumatol 2020; 47:1267-1274. [PMID: 31263071 PMCID: PMC7938419 DOI: 10.3899/jrheum.190162] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. METHODS A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. RESULTS Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. CONCLUSION To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.
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Affiliation(s)
- Sarah R Tritsch
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Liliana Encinales
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Nelly Pacheco
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Andres Cadena
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Carlos Cure
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Elizabeth McMahon
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Hugh Watson
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alexandra Porras Ramirez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alejandro Rico Mendoza
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Guangzhao Li
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Kunal Khurana
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Juan Jose Jaller-Raad
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Stella Mejia Castillo
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Onaldo Barrios Taborda
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alejandro Jaller-Char
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Lil Avendaño Echavez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Dennys Jiménez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Andres Gonzalez Coba
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Magda Alarcon Gomez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Dores Ariza Orozco
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Eyda Bravo
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Victor Martinez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Brenda Guerra
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Gary Simon
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Gary S Firestein
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Aileen Y Chang
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France.
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University.
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Abstract
Alphaviruses, members of the enveloped, positive-sense, single-stranded RNA Togaviridae family, represent a reemerging public health threat as mosquito vectors expand into new geographic territories. The Old World alphaviruses, which include chikungunya virus, Ross River virus, and Sindbis virus, tend to cause a clinical syndrome characterized by fever, rash, and arthritis, whereas the New World alphaviruses, which consist of Venezuelan equine encephalitis virus, eastern equine encephalitis virus, and western equine encephalitis virus, induce encephalomyelitis. Following recovery from the acute phase of infection, many patients are left with debilitating persistent joint and neurological complications that can last for years. Clues from human cases and studies using animal models strongly suggest that much of the disease and pathology induced by alphavirus infection, particularly atypical and chronic manifestations, is mediated by the immune system rather than directly by the virus. This review discusses the current understanding of the immunopathogenesis of the arthritogenic and neurotropic alphaviruses accumulated through both natural infection of humans and experimental infection of animals, particularly mice. As treatment following alphavirus infection is currently limited to supportive care, understanding the contribution of the immune system to the disease process is critical to developing safe and effective therapies.
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Affiliation(s)
- Victoria K Baxter
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark T Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Bucardo F, Reyes Y, Morales M, Briceño R, González F, Lundkvist Å, Svensson L, Nordgren J. Association of Genetic Polymorphisms in DC-SIGN, Toll-Like Receptor 3, and Tumor Necrosis Factor α Genes and the Lewis-Negative Phenotype With Chikungunya Infection and Disease in Nicaragua. J Infect Dis 2020; 223:278-286. [DOI: 10.1093/infdis/jiaa364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
AbstractBackgroundChikungunya infections range from subclinical infection to debilitating arthralgia and to chronic inflammatory rheumatism. Tumor necrosis factor (TNF) α, DC-SIGN (dendritic cell–specific intercellular adhesion molecule 3–grabbing nonintegrin), Toll-like receptor (TLR) 3, and blood groups have been directly or indirectly implicated in the susceptibility and pathogenesis of chikungunya.MethodsTo test the hypothesis that polymorphisms in genes coding for these molecules determine clinical outcomes of chikungunya infection, a retrospective case-control study was performed in León, Nicaragua. The study included 132 case patients and 132 controls, matched for age, sex and neighborhood. Case patients had clinical symptoms of chikungunya, which was diagnosed by means of polymerase chain reaction. Controls were individuals not reporting abrupt presentation of clinical chikungunya-like symptoms. Polymorphisms were identified by TaqMan single-nucleotide polymorphism genotyping assays.ResultsAfter adjustment for sociodemographic risk factors, chikungunya disease was associated with polymorphism in DC-SIGN and TLR3 genes (odds ratios, 5.2 and 3.3, respectively), and TNF-α with reduced persistent joint pain (0.24). Persistent joint pain was also associated with age, female sex and other comorbid conditions. Most interestingly, the Lewis-negative phenotype was strongly associated with both symptomatic chikungunya and immunoglobulin G seropositivity (odds ratios, 2.7, and 3.3, respectively).ConclusionThis study identified polymorphisms in DC-SIGN, TLR3, and TNF-α genes as well as Lewis-negative phenotype as risk factors for chikungunya infection and disease progression.
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Affiliation(s)
- Filemón Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León, Nicaragua (UNAN-León)
| | - Yaoska Reyes
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León, Nicaragua (UNAN-León)
| | - Marlen Morales
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León, Nicaragua (UNAN-León)
| | - Rafaela Briceño
- Sistema Local de Atención Integral en Salud, Ministry of Health León, León, Nicaragua
| | - Fredman González
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León, Nicaragua (UNAN-León)
| | - Åke Lundkvist
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Lennart Svensson
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Johan Nordgren
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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49
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Nayak K, Jain V, Kaur M, Khan N, Gottimukkala K, Aggarwal C, Sagar R, Gupta S, Rai RC, Dixit K, Islamuddin M, Khan WH, Verma A, Maheshwari D, Chawla YM, Reddy ES, Panda H, Sharma P, Bhatnagar P, Singh P, Raghavendhar B S, Patel AK, Ratageri VH, Chandele A, Ray P, Murali-Krishna K. Antibody response patterns in chikungunya febrile phase predict protection versus progression to chronic arthritis. JCI Insight 2020; 5:130509. [PMID: 32155134 DOI: 10.1172/jci.insight.130509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Chikungunya virus (CHIKV) infection causes acute febrile illness in humans, and some of these individuals develop a debilitating chronic arthritis that can persist for months to years for reasons that remain poorly understood. In this study from India, we characterized antibody response patterns in febrile chikungunya patients and further assessed the association of these initial febrile-phase antibody response patterns with protection versus progression to developing chronic arthritis. We found 5 distinct patterns of the antibody responses in the febrile phase: no CHIKV binding or neutralizing (NT) antibodies but PCR positive, IgM alone with no NT activity, IgM alone with NT activity, IgM and IgG without NT activity, and IgM and IgG with NT activity. A 20-month follow-up showed that appearance of NT activity regardless of antibody isotype or appearance of IgG regardless of NT activity during the initial febrile phase was associated with a robust protection against developing chronic arthritis in the future. These findings, while providing potentially novel insights on correlates of protective immunity against chikungunya-induced chronic arthritis, suggest that qualitative differences in the antibody response patterns that have evolved during the febrile phase can serve as biomarkers that allow prediction of protection or progression to chronic arthritis in the future.
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Affiliation(s)
- Kaustuv Nayak
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Vineet Jain
- Department of Medicine, Hamdard Institute of Medical Sciences and Research (HIMSAR), Jamia Hamdard, New Delhi, India
| | - Manpreet Kaur
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Naushad Khan
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Kamalvishnu Gottimukkala
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Charu Aggarwal
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Rohit Sagar
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Shipra Gupta
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Ramesh Chandra Rai
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Kritika Dixit
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Mohammad Islamuddin
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Wajihul Hasan Khan
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Anil Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Maheshwari
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Yadya M Chawla
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Elluri Seetharami Reddy
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Harekrushna Panda
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Pragati Sharma
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Priya Bhatnagar
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Prabhat Singh
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Siva Raghavendhar B
- Kusuma School of Biological Sciences, Indian Institute of Technology (IIT), New Delhi, India
| | - Ashok Kumar Patel
- Kusuma School of Biological Sciences, Indian Institute of Technology (IIT), New Delhi, India
| | - Vinod H Ratageri
- Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Anmol Chandele
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Pratima Ray
- Department of Biotechnology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Kaja Murali-Krishna
- ICGEB-Emory Vaccine Centre, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India.,Emory Vaccine Center and.,Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Modulation of Monocyte-Driven Myositis in Alphavirus Infection Reveals a Role for CX 3CR1 + Macrophages in Tissue Repair. mBio 2020; 11:mBio.03353-19. [PMID: 32127460 PMCID: PMC7064784 DOI: 10.1128/mbio.03353-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Arthritogenic alphaviruses cause debilitating inflammatory disease, and current therapies are restricted to palliative approaches. Here, we show that following monocyte-driven muscle inflammation, tissue recovery is associated with the accumulation of CX3CR1+ macrophages in the muscle. Modulating inflammatory monocyte infiltration using immune-modifying microparticles (IMP) reduced tissue damage and inflammation and enhanced the formation of tissue repair-associated CX3CR1+ macrophages in the muscle. This shows that modulating key effectors of viral inflammation using microparticles can alter the outcome of disease by facilitating the accumulation of macrophage subsets associated with tissue repair. Arthritogenic alphaviruses such as Ross River and Chikungunya viruses cause debilitating muscle and joint pain and pose significant challenges in the light of recent outbreaks. How host immune responses are orchestrated after alphaviral infections and lead to musculoskeletal inflammation remains poorly understood. Here, we show that myositis induced by Ross River virus (RRV) infection is driven by CD11bhi Ly6Chi inflammatory monocytes and followed by the establishment of a CD11bhi Ly6Clo CX3CR1+ macrophage population in the muscle upon recovery. Selective modulation of CD11bhi Ly6Chi monocyte migration to infected muscle using immune-modifying microparticles (IMP) reduced disease score, tissue damage, and inflammation and promoted the accumulation of CX3CR1+ macrophages, enhancing recovery and resolution. Here, we detail the role of immune pathology, describing a poorly characterized muscle macrophage subset as part of the dynamics of alphavirus-induced myositis and tissue recovery and identify IMP as an effective immunomodulatory approach. Given the lack of specific treatments available for alphavirus-induced pathologies, this study highlights a therapeutic potential for simple immune modulation by IMP in infected individuals in the event of large alphavirus outbreaks.
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