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Nair AL, Groenendijk L, Overdevest R, Fowke TM, Annida R, Mocellin O, de Vries HE, Wevers NR. Human BBB-on-a-chip reveals barrier disruption, endothelial inflammation, and T cell migration under neuroinflammatory conditions. Front Mol Neurosci 2023; 16:1250123. [PMID: 37818458 PMCID: PMC10561300 DOI: 10.3389/fnmol.2023.1250123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
The blood-brain barrier (BBB) is a highly selective barrier that ensures a homeostatic environment for the central nervous system (CNS). BBB dysfunction, inflammation, and immune cell infiltration are hallmarks of many CNS disorders, including multiple sclerosis and stroke. Physiologically relevant human in vitro models of the BBB are essential to improve our understanding of its function in health and disease, identify novel drug targets, and assess potential new therapies. We present a BBB-on-a-chip model comprising human brain microvascular endothelial cells (HBMECs) cultured in a microfluidic platform that allows parallel culture of 40 chips. In each chip, a perfused HBMEC vessel was grown against an extracellular matrix gel in a membrane-free manner. BBBs-on-chips were exposed to varying concentrations of pro-inflammatory cytokines tumor necrosis factor alpha (TNFα) and interleukin-1 beta (IL-1β) to mimic inflammation. The effect of the inflammatory conditions was studied by assessing the BBBs-on-chips' barrier function, cell morphology, and expression of cell adhesion molecules. Primary human T cells were perfused through the lumen of the BBBs-on-chips to study T cell adhesion, extravasation, and migration. Under inflammatory conditions, the BBBs-on-chips showed decreased trans-endothelial electrical resistance (TEER), increased permeability to sodium fluorescein, and aberrant cell morphology in a concentration-dependent manner. Moreover, we observed increased expression of cell adhesion molecules and concomitant monocyte adhesion. T cells extravasated from the inflamed blood vessels and migrated towards a C-X-C Motif Chemokine Ligand 12 (CXCL12) gradient. T cell adhesion was significantly reduced and a trend towards decreased migration was observed in presence of Natalizumab, an antibody drug that blocks very late antigen-4 (VLA-4) and is used in the treatment of multiple sclerosis. In conclusion, we demonstrate a high-throughput microfluidic model of the human BBB that can be used to model neuroinflammation and assess anti-inflammatory and barrier-restoring interventions to fight neurological disorders.
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Affiliation(s)
- Arya Lekshmi Nair
- MIMETAS BV, Oegstgeest, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience – Neuroinfection and Neuroinflammation, Amsterdam, Netherlands
| | | | | | | | | | | | - Helga E. de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience – Neuroinfection and Neuroinflammation, Amsterdam, Netherlands
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Malhotra S, Hurtado-Navarro L, Pappolla A, Villar LMM, Río J, Montalban X, Pelegrin P, Comabella M. Increased NLRP3 Inflammasome Activation and Pyroptosis in Patients With Multiple Sclerosis With Fingolimod Treatment Failure. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200100. [PMID: 36973075 PMCID: PMC10042441 DOI: 10.1212/nxi.0000000000200100] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Inflammasomes are involved in the pathogenesis of different neuroimmune and neurodegenerative diseases, including multiple sclerosis (MS). In a previous study by our group, the nucleotide-binding oligomerization domain, leucine-rich repeat receptor and pyrin-domain-containing 3 (NLRP3) inflammasome was reported to be associated with the response to interferon-beta in MS. Based on recent data showing the potential for the oral therapy fingolimod to inhibit NLRP3 inflammasome activation, here we investigated whether fingolimod could also be implicated in the response to this therapy in patients with MS. METHODS NLRP3 gene expression levels were measured by real-time PCR in peripheral blood mononuclear cells at baseline and after 3, 6, and 12 months in a cohort of patients with MS treated with fingolimod (N = 23), dimethyl fumarate (N = 21), and teriflunomide (N = 21) and classified into responders and nonresponders to the treatment according to clinical and radiologic criteria. In a subgroup of fingolimod responders and nonresponders, the percentage of monocytes with an oligomer of ASC was determined by flow cytometry, and the levels of interleukin (IL)-1β, IL-18, IL-6, tumor necrosis factor (TNF)α, and galectin-3 were quantified by ELISA. RESULTS NLPR3 expression levels were significantly increased in fingolimod nonresponders after 3 (p = 0.03) and 6 months (p = 0.008) of treatment compared with the baseline but remained similar in responders at all time points. These changes were not observed in nonresponders to the other oral therapies tested. The formation of an oligomer of ASC in monocytes after lipopolysaccharide and adenosine 5'-triphosphate stimulation was significantly decreased in responders (p = 0.006) but increased in nonresponders (p = 0.0003) after 6 months of fingolimod treatment compared with the baseline. Proinflammatory cytokine release from stimulated peripheral blood mononuclear cells was comparable between responders and nonresponders, but galectin-3 levels on cell supernatants, as a marker of cell damage, were significantly increased in fingolimod nonresponders (p = 0.02). DISCUSSION The differential effect of fingolimod on the formation of an inflammasome-triggered ASC oligomer in monocytes between responders and nonresponders could be used as a response biomarker after 6 months of fingolimod treatment and suggests that fingolimod may exert their beneficial effects by reducing inflammasome signaling in a subset of patients with MS.
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Affiliation(s)
- Sunny Malhotra
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Laura Hurtado-Navarro
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Agustin Pappolla
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Luisa M M Villar
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Jordi Río
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Xavier Montalban
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pablo Pelegrin
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Manuel Comabella
- From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain.
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Baker D, Forte E, Pryce G, Kang AS, James LK, Giovannoni G, Schmierer K. The impact of sphingosine-1-phosphate receptor modulators on COVID-19 and SARS-CoV-2 vaccination. Mult Scler Relat Disord 2023; 69:104425. [PMID: 36470168 PMCID: PMC9678390 DOI: 10.1016/j.msard.2022.104425] [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: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sphingosine-one phosphate receptor (S1PR) modulation inhibits S1PR1-mediated lymphocyte migration, lesion formation and positively-impacts on active multiple sclerosis (MS). These S1PR modulatory drugs have different: European Union use restrictions, pharmacokinetics, metabolic profiles and S1PR receptor affinities that may impact MS-management. Importantly, these confer useful properties in dealing with COVID-19, anti-viral drug responses and generating SARS-CoV-2 vaccine responses. OBJECTIVE To examine the biology and emerging data that potentially underpins immunity to the SARS-CoV-2 virus following natural infection and vaccination and determine how this impinges on the use of current sphingosine-one-phosphate modulators used in the treatment of MS. METHODS A literature review was performed, and data on infection, vaccination responses; S1PR distribution and functional activity was extracted from regulatory and academic information within the public domain. OBSERVATIONS Most COVID-19 related information relates to the use of fingolimod. This indicates that continuous S1PR1, S1PR3, S1PR4 and S1PR5 modulation is not associated with a worse prognosis following SARS-CoV-2 infection. Whilst fingolimod use is associated with blunted seroconversion and reduced peripheral T-cell vaccine responses, it appears that people on siponimod, ozanimod and ponesimod exhibit stronger vaccine-responses, which could be related notably to a limited impact on S1PR4 activity. Whilst it is thought that S1PR3 controls B cell function in addition to actions by S1PR1 and S1PR2, this may be species-related effect in rodents that is not yet substantiated in humans, as seen with bradycardia issues. Blunted antibody responses can be related to actions on B and T-cell subsets, germinal centre function and innate-immune biology. Although S1P1R-related functions are seeming central to control of MS and the generation of a fully functional vaccination response; the relative lack of influence on S1PR4-mediated actions on dendritic cells may increase the rate of vaccine-induced seroconversion with the newer generation of S1PR modulators and improve the risk-benefit balance IMPLICATIONS: Although fingolimod is a useful asset in controlling MS, recently-approved S1PR modulators may have beneficial biology related to pharmacokinetics, metabolism and more-restricted targeting that make it easier to generate infection-control and effective anti-viral responses to SARS-COV-2 and other pathogens. Further studies are warranted.
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Affiliation(s)
- David Baker
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Eugenia Forte
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Gareth Pryce
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Angray S Kang
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Centre for Oral Immunobiology and Regenerative Medicine, Dental Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Louisa K James
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Klaus Schmierer
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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Weier A, Enders M, Kirchner P, Ekici A, Bigaud M, Kapitza C, Wörl J, Kuerten S. Impact of Siponimod on Enteric and Central Nervous System Pathology in Late-Stage Experimental Autoimmune Encephalomyelitis. Int J Mol Sci 2022; 23:ijms232214209. [PMID: 36430692 PMCID: PMC9695324 DOI: 10.3390/ijms232214209] [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: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS). Although immune modulation and suppression are effective during relapsing-remitting MS, secondary progressive MS (SPMS) requires neuroregenerative therapeutic options that act on the CNS. The sphingosine-1-phosphate receptor modulator siponimod is the only approved drug for SPMS. In the pivotal trial, siponimod reduced disease progression and brain atrophy compared with placebo. The enteric nervous system (ENS) was recently identified as an additional autoimmune target in MS. We investigated the effects of siponimod on the ENS and CNS in the experimental autoimmune encephalomyelitis model of MS. Mice with late-stage disease were treated with siponimod, fingolimod, or sham. The clinical disease was monitored daily, and treatment success was verified using mass spectrometry and flow cytometry, which revealed peripheral lymphopenia in siponimod- and fingolimod-treated mice. We evaluated the mRNA expression, ultrastructure, and histopathology of the ENS and CNS. Single-cell RNA sequencing revealed an upregulation of proinflammatory genes in spinal cord astrocytes and ependymal cells in siponimod-treated mice. However, differences in CNS and ENS histopathology and ultrastructural pathology between the treatment groups were absent. Thus, our data suggest that siponimod and fingolimod act on the peripheral immune system and do not have pronounced direct neuroprotective effects.
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Affiliation(s)
- Alicia Weier
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115 Bonn, Germany
| | - Michael Enders
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115 Bonn, Germany
| | - Philipp Kirchner
- Institute of Pathology, University of Bern, CH-3008 Bern, Switzerland
| | - Arif Ekici
- Institute of Human Genetics, University Clinic Erlangen, 91054 Erlangen, Germany
| | - Marc Bigaud
- Novartis Institutes for BioMedical Research, CH-4002 Basel, Switzerland
| | - Christopher Kapitza
- Institute of Anatomy and Cell Biology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Jürgen Wörl
- Institute of Anatomy and Cell Biology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Stefanie Kuerten
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115 Bonn, Germany
- Correspondence: ; Tel.: +49-228-73-2642
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Spampinato SF, Sortino MA, Salomone S. Sphingosine-1-phosphate and Sphingosine-1-phosphate receptors in the cardiovascular system: pharmacology and clinical implications. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2022; 94:95-139. [PMID: 35659378 DOI: 10.1016/bs.apha.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sphingosine-1-phosphate (S1P) is a lipid that binds and activates five distinct receptor subtypes, S1P1, S1P2, S1P3, S1P4, S1P5, widely expressed in different cells, tissues and organs. In the cardiovascular system these receptors have been extensively studied, but no drug acting on them has been approved so far for treating cardiovascular diseases. In contrast, a number of S1P receptor agonists are approved as immunomodulators, mainly for multiple sclerosis, because of their action on lymphocyte trafficking. This chapter summarizes the available information on S1P receptors in the cardiovascular system and discusses their potential for treating cardiovascular conditions and/or their role on the clinical pharmacology of drugs so far approved for non-cardiovascular conditions. Basic research has recently produced data useful to understand the molecular pharmacology of S1P and S1P receptors, regarding biased agonism, S1P storage, release and vehiculation and chaperoning by lipoproteins, paracrine actions, intracellular non-receptorial S1P actions. On the other hand, the approval of fingolimod and newer generation S1P receptor ligands as immunomodulators, provides information on a number of clinical observations on the impact of these drugs on cardiovascular system which need to be integrated with preclinical data. S1P receptors are potential targets for prevention and treatment of major cardiovascular conditions, including hypertension, myocardial infarction, heart failure and stroke.
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Affiliation(s)
| | - Maria Angela Sortino
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy.
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Kunkl M, Amormino C, Tedeschi V, Fiorillo MT, Tuosto L. Astrocytes and Inflammatory T Helper Cells: A Dangerous Liaison in Multiple Sclerosis. Front Immunol 2022; 13:824411. [PMID: 35211120 PMCID: PMC8860818 DOI: 10.3389/fimmu.2022.824411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Multiple Sclerosis (MS) is a neurodegenerative autoimmune disorder of the central nervous system (CNS) characterized by the recruitment of self-reactive T lymphocytes, mainly inflammatory T helper (Th) cell subsets. Once recruited within the CNS, inflammatory Th cells produce several inflammatory cytokines and chemokines that activate resident glial cells, thus contributing to the breakdown of blood-brain barrier (BBB), demyelination and axonal loss. Astrocytes are recognized as key players of MS immunopathology, which respond to Th cell-defining cytokines by acquiring a reactive phenotype that amplify neuroinflammation into the CNS and contribute to MS progression. In this review, we summarize current knowledge of the astrocytic changes and behaviour in both MS and experimental autoimmune encephalomyelitis (EAE), and the contribution of pathogenic Th1, Th17 and Th1-like Th17 cell subsets, and CD8+ T cells to the morphological and functional modifications occurring in astrocytes and their pathological outcomes.
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Affiliation(s)
- Martina Kunkl
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Carola Amormino
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Valentina Tedeschi
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Maria Teresa Fiorillo
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Loretta Tuosto
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
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