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Sponholtz MR, Byrne PO, Lee AG, Ramamohan AR, Goldsmith JA, McCool RS, Zhou L, Johnson NV, Hsieh CL, Connors M, Karthigeyan KP, Crooks CM, Fuller AS, Campbell JD, Permar SR, Maynard JA, Yu D, Bottomley MJ, McLellan JS. Structure-based design of a soluble human cytomegalovirus glycoprotein B antigen stabilized in a prefusion-like conformation. Proc Natl Acad Sci U S A 2024; 121:e2404250121. [PMID: 39231203 PMCID: PMC11406251 DOI: 10.1073/pnas.2404250121] [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: 02/28/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Human cytomegalovirus (HCMV) glycoprotein B (gB) is a class III membrane fusion protein required for viral entry. HCMV vaccine candidates containing gB have demonstrated moderate clinical efficacy, but no HCMV vaccine has been approved. Here, we used structure-based design to identify and characterize amino acid substitutions that stabilize gB in its metastable prefusion conformation. One variant containing two engineered interprotomer disulfide bonds and two cavity-filling substitutions (gB-C7), displayed increased expression and thermostability. A 2.8 Å resolution cryoelectron microscopy structure shows that gB-C7 adopts a prefusion-like conformation, revealing additional structural elements at the membrane-distal apex. Unlike previous observations for several class I viral fusion proteins, mice immunized with postfusion or prefusion-stabilized forms of soluble gB protein displayed similar neutralizing antibody titers, here specifically against an HCMV laboratory strain on fibroblasts. Collectively, these results identify initial strategies to stabilize class III viral fusion proteins and provide tools to probe gB-directed antibody responses.
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Affiliation(s)
- Madeline R Sponholtz
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Patrick O Byrne
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Alison G Lee
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Ajit R Ramamohan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Jory A Goldsmith
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Ryan S McCool
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Ling Zhou
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Nicole V Johnson
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Ching-Lin Hsieh
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
| | - Megan Connors
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065
| | - Krithika P Karthigeyan
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065
| | - Chelsea M Crooks
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065
| | - Adelaide S Fuller
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065
| | | | - Sallie R Permar
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065
| | - Jennifer A Maynard
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Dong Yu
- Dynavax Technologies Corporation, Emeryville, CA 94608
| | | | - Jason S McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712
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Liu MH, Guo X, Sun ML, Li JL, Liu SH, Chen YZ, Wang DY, Wang L, Li YZ, Yao J, Li Y, Pan YQ. Rapid detection of human cytomegalovirus by multienzyme isothermal rapid amplification and lateral flow dipsticks. Front Cell Infect Microbiol 2024; 14:1430302. [PMID: 39099883 PMCID: PMC11294213 DOI: 10.3389/fcimb.2024.1430302] [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: 05/09/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Human cytomegalovirus (HCMV) is the most common viral infection seen in newborns. The major route of transmission for acquired human cytomegalovirus infection is breast milk from mothers who are HCMV seropositive to the infants. Thus, a rapid, economical, and simple method to perform HCMV test in breast milk is crucial and necessary for preventing acquired HCMV infection, especially in underdeveloped regions with limited laboratory resources. Methods In this study, an effective technique for the detection of HCMV was constructed by combining multienzyme isothermal rapid amplification (MIRA) and lateral flow chromatography strip (LFD). Primers for the conserved HCMV sequence UL83 were utilized for MIRA-LFD testing. Results Our results showed that the entire MIRA reaction could be completed in 12 minutes at 37°C, and LFD outcomes could be observed visibly after 10 minutes. The detection sensitivity of this method reached 50 copy/μl. Samples of breast milk were examined to compare MIRA-LFD and conventional qPCR. The accuracy of MIRA-LFD was 100%. Discussion The straightforward, rapid, economic features of the test can provide the significant advantages for the prevention of breast milk-acquired cytomegalovirus infection, particularly in resource-limited locations with high seroprevalence of cytomegalovirus.
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Affiliation(s)
- Ming-hui Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Xiaochong Guo
- Laboratory Animal Center, China Medical University, Shenyang, China
| | - Mao-ling Sun
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Jia-lun Li
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Shu-han Liu
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Yun-zhou Chen
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Dong-yi Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lan Wang
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Yu-zhang Li
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Jun Yao
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Yang Li
- Department of Blood Transfusion, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu-qing Pan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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3
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Lawrence SM. Human cytomegalovirus and neonatal infection. CURRENT RESEARCH IN MICROBIAL SCIENCES 2024; 7:100257. [PMID: 39070527 PMCID: PMC11276932 DOI: 10.1016/j.crmicr.2024.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Human cytomegalovirus is an ancient virus that has co-evolved with humans. It establishes a life-long infection in suspectable individuals for which there is no vaccination or cure. The virus can be transmitted to a developing fetus in seropositive pregnant women, and it is the leading cause of congenital infectious disease. While the majority of infected infants remain asymptomatic at birth, congenital cytomegalovirus infection can lead to substantial long-term neurodevelopmental impairments in survivors, resulting in considerable economic and social hardships. Recent discoveries regarding cytomegalovirus pathophysiology and viral replication cycles might enable the development of innovative diagnostics and therapeutics, including an effective vaccine. This Review will detail our understanding of human cytomegalovirus infection, with an in-depth discussion regarding the viral genome and transcriptome that contributes to its pathophysiology. The neonate's clinical course will also be highlighted, including maternal and neonatal testing, treatment recommendations, and long-term outcomes.
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Affiliation(s)
- Shelley M. Lawrence
- University of Utah, College of Medicine, Department of Pediatrics, Division of Neonatology, Salt Lake City, UT, USA
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Coste-Mazeau P, Hamon M, Ribot É, Hantz S, Alain S. [Implementation of screening for cytomegalovirus congenital infection in a French type 3 maternity]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:403-409. [PMID: 38272182 DOI: 10.1016/j.gofs.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Congenital cytomegalovirus (CMV) infection is the most common congenital infection and the leading cause of infectious neurosensorial disability in newborns. We wanted to organize the management of women from the beginning of pregnancy allowing access to antenatal treatment with valaciclovir, recognized since 2020 as limiting materno-fetal transmission. To this end, we set up and evaluated the interest of systematic screening for CMV infection in our maternity. We wanted to organize care for women from the very start of pregnancy. METHODS Retrospective and comparative descriptive study carried out at the CHRU de Limoges from July 2017 to December 2019 (targeted screening), then from January 2020 to June 2022, during which period we implemented systematized screening by iterative serologies at the 3rd, 6th, 8th months and before delivery. Our main evaluation criteria were the seroprevalence of CMV infection and the rate of congenital infection. We then described our cases of infection (primary or secondary) during pregnancy. RESULTS CMV seroprevalence in our pregnant women increased significantly from 52.7% (779/1478 women screened) to 58.4% (3852/6599 women screened) between the 2 study periods (P=0.04). We diagnosed 11 infections during the first part of the study vs. 27 during the second, with a significant increase in primary infections from 0.14% (9/6524 births) to 0.37% (24/6426 births) (P=0.008). Only 3 secondary infections were diagnosed during the second study period. The rate of congenital infections remained stable between the 2 study periods (6 children/6524=0.09% vs. 8 children/6426=0.12%; P=0.57). CONCLUSION Our results confirmed the interest of screening for CMV infection, while modifying the screening strategy we had initiated.
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Affiliation(s)
- Perrine Coste-Mazeau
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France; Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - Magali Hamon
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Élodie Ribot
- Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Sébastien Hantz
- Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Sophie Alain
- Inserm, RESINFIT, U 1092, université de Limoges, CHU de Limoges, 1, rue du Pr Descottes, 87000 Limoges, France; Service de virologie, Centre national de référence des Herpès virus, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
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Toriyabe K, Kitamura A, Ikejiri M, Hashizume R, Nakamura M, Teramoto E, Takeuchi H, Kondo E, Ikeda T. Cytomegalovirus DNA Loads in Organs of Congenitally Infected Fetus. Viruses 2024; 16:891. [PMID: 38932183 PMCID: PMC11209383 DOI: 10.3390/v16060891] [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: 03/28/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Congenital cytomegalovirus (cCMV) infection poses significant risks to fetal development, particularly affecting the nervous system. This study reports a fetal autopsy case, examining cCMV infection and focusing on CMV DNA measurements in various fetal organs before formalin fixation, a novel approach for comprehensive CMV DNA evaluations in fetal organs affected by cCMV. A 20-week-old male fetus was diagnosed with cCMV following the detection of CMV DNA in ascites obtained via abdominocentesis in utero. After the termination of pregnancy, multiple organs of the fetus, including the cerebrum, thyroid gland, heart, lungs, liver, spleen, kidneys, and adrenal glands, were extracted and examined for CMV DNA loads using a real-time polymerase chain reaction. Histopathological examination involved hematoxylin-eosin and CMV-specific immunostaining. A correlation was found between CMV DNA loads and pathology, with higher CMV-infected cell numbers observed in organs positively identified with both staining methods, exhibiting CMV DNA levels of ≥1.0 × 104 copies/mL, compared to those detected solely by CMV-specific immunostaining, where CMV DNA levels ranged from 1.0 × 103 to 1.0 × 104 copies/mL. These results highlight a quantifiable relationship between the organ infection extent and CMV DNA concentration, providing insights into cCMV pathogenesis and potentially informing future diagnostic and therapeutic strategies for cCMV infection.
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Affiliation(s)
- Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Asa Kitamura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu 514-1101, Mie, Japan
| | - Makoto Ikejiri
- Department of Clinical Laboratory, Mie University Hospital, Tsu 514-8507, Mie, Japan
| | - Ryotaro Hashizume
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
- Department of Genomic Medicine, Mie University Hospital, Tsu 514-8507, Mie, Japan
| | - Maki Nakamura
- Department of Clinical Laboratory, Mie University Hospital, Tsu 514-8507, Mie, Japan
| | - Emi Teramoto
- Department of Clinical Laboratory, Mie University Hospital, Tsu 514-8507, Mie, Japan
| | - Hiroki Takeuchi
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
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Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI). THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100892. [PMID: 38590940 PMCID: PMC10999471 DOI: 10.1016/j.lanepe.2024.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) infection carries a significant burden with a 0.64% global prevalence and a 17-20% chance of serious long-term effects in children. Since the last guidelines, our understanding, particularly regarding primary maternal infections, has improved. A cCMV guidelines group was convened under the patronage of the European Society of Clinical Virology in April 2023 to refine these insights. The quality and validity of selected studies were assessed for potential biases and the GRADE framework was employed to evaluate quality of evidence across key domains. The resulting recommendations address managing cCMV, spanning prevention to postnatal care. Emphasizing early and accurate maternal diagnosis through serological tests enhances risk management and prevention strategies, including using valaciclovir to prevent vertical transmission. The guidelines also strive to refine personalized postnatal care based on risk assessments, ensuring targeted interventions for affected families.
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Affiliation(s)
- Marianne Leruez-Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Christos Chatzakis
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
- Second Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniele Lilleri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniel Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - Ana Alarcon
- Department of Neonatology, Hospital Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal, Fetal and Neonatal Medicine), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Nicolas Bourgon
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ina Foulon
- Department of Otorhinolaryngology and Head & Neck Surgery, Vrije Universiteit Brussels, University Hospital UZ Brussel, Brussels Health Campus. De Poolster, Rehabilitation Centre, Brussels, Belgium
| | - Jacques Fourgeaud
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Anna Gonce
- BCNatal: Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - Christine E. Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Paul Klapper
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - André Krom
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Paulo Paixao
- CHRC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisbon, Portugal
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - George Sourvinos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, Crete, 71003, Greece
| | - Pamela Vallely
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - Yves Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ann Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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7
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Hunter-Schlichting DN, Vogel RI, Geller MA, Nelson HH. Quantification of low-level human cytomegalovirus and Epstein-Barr virus DNAemia by digital PCR. J Virol Methods 2024; 325:114876. [PMID: 38184072 PMCID: PMC11321275 DOI: 10.1016/j.jviromet.2023.114876] [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: 10/13/2023] [Revised: 12/13/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Digital PCR (dPCR) can quantify cell-free viral DNA (DNAemia), a biomarker of active viral infection. To accelerate epidemiologic investigation into low-level viral reactivation in chronic disease, we have evaluated the performance of dPCR to detect cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNAemia across platforms and blood matrices. METHODS The droplet-based (BioRad) dPCR platform performance was compared to chip-based (BioMark), and assay validation followed dMIQE guidelines. CMV and EBV DNA reference materials were spiked into known negative plasma and serum samples. In addition, two independent cohorts of ovarian cancer patients were evaluated for viral DNAemia (n = 65 serum and 79 plasma samples). RESULTS The limit of quantification (LOQ) was at or slightly above 100 copies/mL for both instruments: 105-135 copies/mL for droplet-based detection and 100 copies/mL for chip-based detection. DNAemia in serum had a slightly lower LOQ (105-110 copies/mL) compared to plasma (LOQ; 115-135 copies/mL). The variation (CV) coefficients for each assay and machine were less than 5 %. In patient samples, CVs ranged from 4.5 - 7.4 % and were similar for cell-free DNA derived from serum or plasma. There was good correlation between DNAemia measurements in patient samples across dPCR platforms (r > 0.90 for each assay and matrix). CONCLUSION dPCR can quantify low-level herpes virus DNAemia with CVs below 8 %. Our results indicate that using serum-derived cell-free DNA and droplet-based dPCR is optimal for quantitating low-level viral DNAemia; however, plasma and chip-based approaches are acceptable alternatives and suitable for epidemiologic investigation.
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Affiliation(s)
- DeVon N Hunter-Schlichting
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States; Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN, United States
| | - Rachel I Vogel
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States; Department of Obstetrics, Gynecology and Women's Health, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Melissa A Geller
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States; Department of Obstetrics, Gynecology and Women's Health, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Heather H Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States; Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN, United States.
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8
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Lawrence SM, Goshia T, Sinha M, Fraley SI, Williams M. Decoding human cytomegalovirus for the development of innovative diagnostics to detect congenital infection. Pediatr Res 2024; 95:532-542. [PMID: 38146009 PMCID: PMC10837078 DOI: 10.1038/s41390-023-02957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
Cytomegalovirus is the most common cause of congenital infectious disease and the leading nongenetic etiology of sensorineural hearing loss. Although most infected neonates are asymptomatic at birth, congenital cytomegalovirus infection is responsible for nearly 400 infant deaths annually in the United States and may lead to significant long-term neurodevelopmental impairments in survivors. The resulting financial and social burdens of congenital cytomegalovirus infection have led many medical centers to initiate targeted testing after birth, with a growing advocacy to advance universal newborn screening. While no cures or vaccines are currently available to eliminate or prevent cytomegalovirus infection, much has been learned over the last five years regarding disease pathophysiology and viral replication cycles that may enable the development of innovative diagnostics and therapeutics. This Review will detail our current understanding of congenital cytomegalovirus infection, while focusing our discussion on routine and emerging diagnostics for viral detection, quantification, and long-term prognostication. IMPACT: This review highlights our current understanding of the fetal transmission of human cytomegalovirus. It details clinical signs and physical findings of congenital cytomegalovirus infection. This submission discusses currently available cytomegalovirus diagnostics and introduces emerging platforms that promise improved sensitivity, specificity, limit of detection, viral quantification, detection of genomic antiviral resistance, and infection staging (primary, latency, reactivation, reinfection).
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Affiliation(s)
- Shelley M Lawrence
- University of Utah, College of Medicine, Department of Pediatrics, Division of Neonatology, Salt Lake City, UT, USA.
| | - Tyler Goshia
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
| | | | - Stephanie I Fraley
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
| | - Marvin Williams
- University of Oklahoma, College of Medicine, Department of Obstetrics and Gynecology, Division of Fetal-Maternal Medicine, Oklahoma City, OK, USA
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