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Kundu G, Shetty R, Modak D, Koul A, Balaraj S, Nagaraja H, Sethu S. Vitamin D and tear fluid cytokines in predicting outcomes in viral conjunctivitis - A new outlook. Indian J Ophthalmol 2024; 72:S702-S708. [PMID: 38622859 PMCID: PMC11338406 DOI: 10.4103/ijo.ijo_2345_23] [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: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To determine the association between systemic vitamin D (VD) and immunoglobulin E (IgE) levels with severity and ocular surface inflammatory profile in patients with epidemic keratoconjunctivitis (EKC). METHODS 210 eyes of 105 patients who were clinically diagnosed with EKC were included in the study. The levels of serum VD and serum IgE were measured. Schirmer's strip-based tear fluid (TF) was used to determine levels of IL-1β, IL-6, IL-10, IL-17A, TNFα, MMP9, sICAM1, and VEGF-A in a subset of patients. RESULTS Levels of VD were significantly ( P < 0.05) lower and levels of IgE were significantly higher in patients with severe forms of conjunctivitis compared to those with nonsevere forms. Majority of the patients with severe forms of the disease exhibited VD deficiency and/or abnormally high IgE. A negative correlation (r = -0.682; P < 0.0001) was observed between VD and IgE levels. TF levels of IL-1β, IL-6, TNFα, and sICAM1 were significantly higher in eyes with severe forms of conjunctivitis compared to those with nonsevere forms and controls. These factors showed a positive correlation ( P < 0.05) with IgE levels and a negative correlation ( P < 0.05) with VD levels. CONCLUSION Patients with severe forms of EKC exhibited VD deficiency and higher levels of IgE. Increased TF inflammatory factors demonstrated a disease causal relationship with VD and IgE. Hence, restoring the altered levels of VD and IgE to normal range would be pivotal in the prevention and management of severe conjunctivitis.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Durgalaxmi Modak
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ameeta Koul
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srihari Balaraj
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Harsha Nagaraja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
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Tsukahara-Kawamura T, Hanaoka N, Uchio E. Evaluation of anti-adenoviral effects of the polyvinyl alcohol iodine ophthalmic solution. Jpn J Ophthalmol 2024; 68:64-69. [PMID: 37966563 DOI: 10.1007/s10384-023-01027-1] [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: 05/23/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To investigate the virucidal effects of a polyvinyl alcohol iodine, Saniode, against 16 types of human mastadenovirus (HAdV) causing ophthalmic, respiratory, gastrointestinal, urinary, and systemic infections. STUDY DESIGN Laboratory investigation METHODS: Fifty microliters of Saniode were exposed to 10 μL each containing HAdV virus stock solution of 1 × 106 copies/μL of HAdV-1, -2, -3, -4, 5, -6, -7, -8, -11, -37, -53, -54, -56, -64, -81, and -85 for 10 s, 30 s, 1 min, and 3 min. After neutralization with 0.5% sodium thiosulfate, the mixture was diluted by ten-fold serial dilution and inoculated into 24 wells containing confluent A549 cell monolayers. Virucidal effects were calculated relative to the positive control on days 7-10 and observed until 30 days post-infection. RESULTS Saniode satisfied the EN-14476 criterion for virucidal effects (>99.99%) for all HAdV types at all exposure times, including at 10 s on days 7 to 10 post-infection. All types of HAdVs that reacted for > 1 min achieved 99.99% reduction, including after 30 days. CONCLUSION Saniode displayed virucidal effects against all tested HAdV types. Currently, with no specific medication available for HAdVs in ocular infection, this could be an option to prevent the spread of keratoconjunctivitis.
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Affiliation(s)
- Tomoko Tsukahara-Kawamura
- Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Nozomu Hanaoka
- Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Didara Z, Reithofer F, Zöttl K, Jürets A, Kiss I, Witte A, Klein R. Inhibition of adenovirus replication by CRISPR-Cas9-mediated targeting of the viral E1A gene. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 32:48-60. [PMID: 36950281 PMCID: PMC10025986 DOI: 10.1016/j.omtn.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
DNA-targeting CRISPR-Cas systems are able to cleave dsDNA in mammalian cells. Accordingly, they have been employed to target the genomes of dsDNA viruses, mostly when present in cells in a non-replicative state with low copy numbers. However, the sheer amount of viral DNA produced within a very short time by certain lytically replicating viruses potentially brings the capacities of CRISPR-Cas systems to their limits. The accessibility of viral DNA replication sites, short time of accessibility of the DNA before encapsidation, or its complexation with shielding proteins are further potential hurdles. Adenoviruses are fast-replicating dsDNA viruses for which no approved antiviral therapy currently exists. We evaluated the potency of CRISPR-Cas9 in inhibiting the replication of human adenovirus 5 in vitro by targeting its master regulator E1A with a set of guide RNAs and observed a decrease in infectious virus particles by up to three orders of magnitude. Target DNA cleavage also negatively impacted the amount of viral DNA accumulated during the infection cycle. This outcome was mainly caused by specific deletions, inversions, and duplications occurring between target sites, which abolished most E1A functions in most cases. Additionally, we compared two strategies for multiplex gRNA expression and obtained comparable results.
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Affiliation(s)
- Zrinka Didara
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
| | - Florian Reithofer
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
| | - Karina Zöttl
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
| | - Alexander Jürets
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
| | - Izabella Kiss
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
| | - Angela Witte
- Department of Microbiology, Immunobiology, and Genetics, Max Perutz Labs, University of Vienna, Dr. Bohr-Gasse 9, 1030 Vienna, Austria
| | - Reinhard Klein
- Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria
- Corresponding author: Reinhard Klein, Department of Life Sciences, University of Applied Sciences Krems, Piaristengasse 1, 3500 Krems, Austria.
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Muto T, Imaizumi S, Kamoi K. Viral Conjunctivitis. Viruses 2023; 15:v15030676. [PMID: 36992385 PMCID: PMC10057170 DOI: 10.3390/v15030676] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Viruses account for 80% of all cases of acute conjunctivitis and adenovirus; enterovirus and herpes virus are the common causative agents. In general, viral conjunctivitis spreads easily. Therefore, to control the spread, it is crucial to quickly diagnose illnesses, strictly implement hand washing laws, and sanitize surfaces. Swelling of the lid margin and ciliary injection are subjective symptoms, and eye discharge is frequently serofibrinous. Preauricular lymph node swelling can occasionally occur. Approximately 80% of cases of viral conjunctivitis are caused by adenoviruses. Adenoviral conjunctivitis may become a big global concern and may cause a pandemic. Diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment for adenovirus conjunctivitis. Although specific treatments are not always accessible, early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences.
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Affiliation(s)
- Tetsuaya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya 343-8555, Japan
- Imaizumi Eye Hospital, Koriyama 963-8877, Japan
- Correspondence:
| | | | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical Dental University, Tokyo 113-8519, Japan
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An Old Acquaintance: Could Adenoviruses Be Our Next Pandemic Threat? Viruses 2023; 15:v15020330. [PMID: 36851544 PMCID: PMC9966032 DOI: 10.3390/v15020330] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Human adenoviruses (HAdV) are one of the most important pathogens detected in acute respiratory diseases in pediatrics and immunocompromised patients. In 1953, Wallace Rowe described it for the first time in oropharyngeal lymphatic tissue. To date, more than 110 types of HAdV have been described, with different cellular tropisms. They can cause respiratory and gastrointestinal symptoms, even urinary tract inflammation, although most infections are asymptomatic. However, there is a population at risk that can develop serious and even lethal conditions. These viruses have a double-stranded DNA genome, 25-48 kbp, 90 nm in diameter, without a mantle, are stable in the environment, and resistant to fat-soluble detergents. Currently the diagnosis is made with lateral flow immunochromatography or molecular biology through a polymerase chain reaction. This review aimed to highlight the HAdV variability and the pandemic potential that a HAdV3 and 7 recombinant could have considering the aggressive outbreaks produced in health facilities. Herein, we described the characteristics of HAdV, from the infection to treatment, vaccine development, and the evaluation of the social determinants of health associated with HAdV, suggesting the necessary measures for future sanitary control to prevent disasters such as the SARS-CoV-2 pandemic, with an emphasis on the use of recombinant AdV vaccines to control other potential pandemics.
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Prevalence of adenoviruses as ocular disease causatives in Saudi Arabia. Saudi J Biol Sci 2022; 29:2026-2032. [PMID: 35531233 PMCID: PMC9072915 DOI: 10.1016/j.sjbs.2021.12.053] [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: 10/20/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022] Open
Abstract
Although Human Adenoviruses outbreaks are rare, there still could be a potential chance for those viruses to mutate and spread quickly in human populations with severe public health and socioeconomic consequences. Outbreaks often spread fairly quickly with considerable morbidity/mortality. Saudi Arabia's geopolitical and religious significance bring with it, millions of pilgrims, and tourists yearly. This presents a significant potential for HAdVs epidemics. This review shows that even with the mushrooming serotypes and genotypes, the scholarly knowledge on the nature, structure, transmission, and management of HAdVs is already well-established. Significant research is ongoing on pharmacological interventions, which, presently remain speculative and lacking in effectiveness. This review similarly uncovers a shortage of literature, both recent and dated, on epidemic keratoconjunctivitis in either Saudi Arabia or the Middle East.
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Yawata N, Yawata M. Assessing the Response of Human NK Cell Subsets to Infection by Clinically Isolated Virus Strains. Methods Mol Biol 2022; 2463:205-220. [PMID: 35344177 DOI: 10.1007/978-1-0716-2160-8_15] [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] [Indexed: 06/14/2023]
Abstract
Natural killer (NK) cells play a critical role in defending against virus infections.Investigating human NK cell antiviral functions is of prime importance; however, there are challenges such as the human-specific nature of many viruses and differences in NK cell surface markers between humans and rodents. Research on the antivirus response of human NK cells must therefore be carefully planned around species tropism of the viruses of interest and the specific biological questions to be answered. The initial site of many virus infections is a mucosal/epithelial surface. In this context, a clinical virus infection at the ocular surface enables direct analyses on the mechanisms and consequences of infection and immune reactions in situ over the course of disease. For example, the site of infection of a clinical infection in the conjunctiva and cornea can be directly observed in real-time, utilizing split-lamp microscopy, and specimens are readily accessed with minimally invasive techniques.In this chapter, we describe protocols for investigating NK cell responses using clinically isolated viruses in co-culture assays. We also describe procedures for ex vivo analysis of conjunctiva-derived NK cells in adenovirus infection.
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Affiliation(s)
- Nobuyo Yawata
- Department of Ocular Pathology and Imaging Science, Kyushu University, Fukuoka, Japan.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
| | - Makoto Yawata
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
- NUSMED Immunology Translational Research Programme, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
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Bertzbach LD, Ip WH, Dobner T. Animal Models in Human Adenovirus Research. BIOLOGY 2021; 10:biology10121253. [PMID: 34943168 PMCID: PMC8698265 DOI: 10.3390/biology10121253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022]
Abstract
Simple Summary Animal models are widely used to study various aspects of human diseases and disorders. Likewise, they are indispensable for preclinical testing of medicals and vaccines. Human adenovirus infections are usually self-limiting, and can cause mild respiratory symptoms with fever, eye infection or gastrointestinal symptoms, but occasional local outbreaks with severe disease courses have been reported. In addition, adenovirus infections pose a serious risk for children and patients with a weakened immune system. Human adenovirus research in animal models to study adenovirus-induced disease and tumor development started in the 1950s. Various animal species have been tested for their susceptibility to human adenovirus infection since then, and some have been shown to mimic key characteristics of the infection in humans, including persistent infection. Furthermore, some rodent species have been found to develop tumors upon human adenovirus infection. Our review summarizes the current knowledge on animal models in human adenovirus research, describing the pros and cons along with important findings and future perspectives. Abstract Human adenovirus (HAdV) infections cause a wide variety of clinical symptoms, ranging from mild upper respiratory tract disease to lethal outcomes, particularly in immunocompromised individuals. To date, neither widely available vaccines nor approved antiadenoviral compounds are available to efficiently deal with HAdV infections. Thus, there is a need to thoroughly understand HAdV-induced disease, and for the development and preclinical evaluation of HAdV therapeutics and/or vaccines, and consequently for suitable standardizable in vitro systems and animal models. Current animal models to study HAdV pathogenesis, persistence, and tumorigenesis include rodents such as Syrian hamsters, mice, and cotton rats, as well as rabbits. In addition, a few recent studies on other species, such as pigs and tree shrews, reported promising data. These models mimic (aspects of) HAdV-induced pathological changes in humans and, although they are relevant, an ideal HAdV animal model has yet to be developed. This review summarizes the available animal models of HAdV infection with comprehensive descriptions of virus-induced pathogenesis in different animal species. We also elaborate on rodent HAdV animal models and how they contributed to insights into adenovirus-induced cell transformation and cancer.
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Fatal Neonatal Sepsis Associated with Human Adenovirus Type 56 Infection: Genomic Analysis of Three Recent Cases Detected in the United States. Viruses 2021; 13:v13061105. [PMID: 34207791 PMCID: PMC8228069 DOI: 10.3390/v13061105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Human adenovirus (HAdV)-D56 was first described in 2011 by genomics analysis of a strain isolated in France in 2008 from a fatal case of neonatal infection. Since then, it has been reported in cases of keratoconjunctivitis and male urethritis. Three epidemiologically unrelated fatal cases of neonatal sepsis associated with infection by HAdV-D strains with a similar genetic makeup were documented in the United States between 2014 and 2020. Methods: Whole genome sequences were obtained for the isolated strains, and genomics analyses were conducted to compare them to phylogenetically related HAdV-D genomic sequences available in GenBank. Results: The three new US strains were indistinguishable by in silico restriction enzyme analysis. Their genome sequences were 99.9% identical to one another and to the prototype strain isolated in 2008 from a similar context of disease. The phylogenetic reconstruction revealed a highly supported clustering of all HAdV-D56 strains isolated in various countries since 1982. Our comparison to serologically intermediate strains 15/H9 described in the literature indicated that HAdV-D56-like viruses have circulated worldwide since the late 1950s. Conclusion: As with other HAdV-D genotypes with the ability to infect ocular and genital mucosae, the risk of severe prenatal or perinatal HAdV-D56 infection must be considered.
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Toovey OTR, Kulkarni P, David J, Patel A, Lai FY, Burns J, Thompson C, Ellis J, Tang JW. An outbreak of adenovirus D8 keratoconjunctivitis in Leicester, United Kingdom, from March to August 2019. J Med Virol 2021; 93:3969-3973. [PMID: 33135807 PMCID: PMC8246710 DOI: 10.1002/jmv.26647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
We report a large epidemic (n = 126) of keratoconjunctivitis predominantly with two lineages of adenovirus (AdV) type D8 in patients seen in eye casualty between march and August 2019. Other AdV species identified by viral sequencing included B, C, and E. Despite various features of more severe eye disease being present, these were not significantly different between the different AdV species, with similar rates of pseudomembrane formation and keratitis observed in patients with AdV species B as for those with AdV species D.
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Affiliation(s)
- Oliver T. R. Toovey
- Department of Microbiology and VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Priti Kulkarni
- Department of OphthalmologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Joicy David
- Department of Microbiology and VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Ayushi Patel
- Department of Microbiology and VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Florence Y. Lai
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Joyce Burns
- Department of OphthalmologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Joanna Ellis
- Respiratory Virus UnitPublic Health EnglandLondonUK
| | - Julian W. Tang
- Department of Microbiology and VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
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Fukuda M, Nakamura J, Ito S, Kawazoe K, Miyanaga Y, Teshigawara T, Okuda K, Mizuki N, Shimada M. Vaccination inhibits the human adenoviral transduction in a mouse keratoconjunctivitis model. Vaccine 2021; 39:3498-3508. [PMID: 34016474 DOI: 10.1016/j.vaccine.2021.05.010] [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: 01/03/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Adenovirus infections are a major cause of epidemic keratoconjunctivitis (EKC), which can lead to corneal subepithelial infiltrates and multifocal corneal opacity. In the current study, we investigated the use of an E1/E3-deleted adenovirus serotype 5 (Ad5) vector as a vaccine administered intramuscularly (IM) or intranasally (IN) against subsequent challenges with a luciferase-expressing Ad5 (Ad5-Luci) vector via eyedrop. We evaluated the adaptive immune response to Ad5 vector vaccination and confirmed a robust polyfunctional CD8 T cell response in splenic cells. Neutralizing Ad5 antibodies were also measured in the sera of vaccinated mice as well as Ad5 antibody in the eye wash solutions. Upon challenge with Ad5-Luci vector 8 weeks post the primary immunization, transduction was significantly reduced by > 70% in the vaccinated mice, which was slightly better in IM- vs. that in IN-vaccinated animals. Resistance to subsequent challenge was observed 10 months post primary IM vaccination, with sustained reduction up to 60% in the Ad5-Luci vector transduction. Passive immunization of naive mice with antisera from IM to vaccinated mice subsequently challenged with the Ad5-Luci vector resulted in approximately 40% loss in transduction efficiency. Furthermore, the mice that received IM immunization with or without CD8 T cell depletion showed > 40% and 70% reductions, respectively, in Ad8 genomic copies after Ad8 topical challenge. We conclude that Ad-vector vaccination successfully induced an adaptive immune response that prevented subsequent Ad transduction in the cornea and conjunctiva-associated tissues in a mouse model of adenovirus keratoconjunctivitis, and that both cellular and humoral immunity play an important role in preventing Ad transduction.
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Affiliation(s)
- Michiko Fukuda
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Jutaro Nakamura
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Saori Ito
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | | | | | - Takeshi Teshigawara
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka 238-0008, Japan
| | - Kenji Okuda
- Department of Molecular Biodefense Research, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Masaru Shimada
- Department of Molecular Biodefense Research, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan.
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Omatsu Y, Miyazaki D, Shimizu Y, Matsuura K, Sasaki SI, Inoue Y, Uchio E, Fujimoto T. Efficacy of compartmentalization in controlling an adenovirus type 54 keratoconjunctivitis outbreak on Oki Island, Japan. Jpn J Ophthalmol 2021; 65:423-431. [PMID: 33634367 PMCID: PMC7906084 DOI: 10.1007/s10384-021-00826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE To analyze the epidemiologic characteristics of an outbreak of human adenovirus type 54 (HAdV-54) on Oki Island, Shimane Prefecture, Japan, in 2017 and to assess the effectiveness of a compartmentalization method in controlling the incidence and spread. STUDY DESIGN Retrospective cohort study. METHODS The infection was diagnosed in 136 individuals, and typing was confirmed by PCR and direct sequencing. The epidemiologic characteristics of the disease including the infection rate, incubation period, and basic reproductive number (R0), ie, number of cases directly infected by an infectious patient during the course of the disease, were investigated. The effectiveness of compartmentalization for infection control was determined by simulating the outbreak using the Susceptible-Exposed-Infectious-Recovered (SEIR) model. RESULTS The majority of the HAdV-54-infected individuals were the children of 3 nursery schools (A, B, and C) and their parents on Oki Island. The infection rates in the 3 schools were 13.2%, 16.9%, and 17.2%, respectively. The one class of school B without the index case was initially compartmentalized, and the infection rate in this compartment was 0%. The incubation period was calculated to be 9.3 ± 3.5 days, and the disease duration, 13.0 ± 5.4 days. The R0 was 1.43. Using these parameters, a SEIR model was constructed. The SEIR model well predicted the daily incidence of infection and indicated that the compartmentalization method provides effective reduction in the incidence of the infection, with much earlier control. CONCLUSIONS The compartmentalization method is effective to control HAdV-54 outbreaks.
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Affiliation(s)
- Yutaka Omatsu
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori, 683-8504, Japan.
| | - Dai Miyazaki
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori, 683-8504, Japan
| | - Yumiko Shimizu
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori, 683-8504, Japan
| | - Kazuki Matsuura
- Division of Ophthalmology of Nojima Hospital, Tottori, Japan
| | - Shin-Ichi Sasaki
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori, 683-8504, Japan
| | - Yoshitsugu Inoue
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago Tottori, 683-8504, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Gouider D, Khallouli A, Maalej A, Khochtali S, Khairallah M. Role of anterior segment optical coherence tomography in monitoring epidemic keratoconjunctivitis. J Curr Ophthalmol 2021; 33:408-412. [PMID: 35128186 PMCID: PMC8772485 DOI: 10.4103/joco.joco_218_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/08/2020] [Accepted: 06/20/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To describe, through anterior segment optical coherence tomography (AS-OCT) images, the different phases of epidemic keratoconjunctivitis (EKC) and show the impact of topical steroid on the course of this disease. Methods: A prospective observational study included 38 eyes (28 patients) with a presumed EKC complicated by subepithelial infiltrates (SEIs) and treated with topical fluorometholone. Slit-lamp examinations and serial AS-OCT were performed on days 7, 14, 30, 90, 180, and 210. The thickness of the whole cornea and thickness of the corneal epithelium were measured with AS-OCT and correlated to the clinical findings on slit-lamp examination in the different EKC phases. Results: In all patients, on day 7, the AS-OCT showed hyperreflective dots that were limited to the epithelial layers of the cornea and slightly rising above the epithelial surface, corresponding to the confluence of the punctuations of punctate epithelial keratitis. On day 14, a hyperreflective line in the Bowman's layer with intact epithelium was noted. On day 30, this hyperreflective band extended rapidly toward the anterior stroma, becoming thicker and more intense, corresponding to the SEI. They gradually decreased in number, intensity, and extent following treatment by topical steroids in 71.4% of the cases. Only two patients had persistent SEI. They were refractory to 3-month treatment by steroids. In these patients, who had persistent SEI, AS-OCT showed that the hyperreflective areas became well-defined, plaque-like lesions with sharp margins associated with disruption of Bowman's layer, localized epithelial thickening, stromal thinning, and a decrease in pachymetry. Conclusion: AS-OCT can be a valuable tool that provides a range of characteristic patterns of EKC and helps in monitoring it.
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14
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Nguyen TTH, Le TA, Nguyen VH, Nguyen TU, Nguyen PT, Tran TTA, Nguyen QH, Hoang AT, Hoang MH, Le TS, Nguyen VS. Molecular typing of conjunctivitis-causing adenoviruses in Hanoi, Vietnam from 2017 to 2019 and complete genome analysis of the most prevalent type (HAdV-8). J Med Virol 2020; 92:3100-3110. [PMID: 32266999 DOI: 10.1002/jmv.25844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 11/11/2022]
Abstract
Adenoviral conjunctivitis is a common epidemic worldwide. In Vietnam, up to 80,000 patients are infected with adenoviral conjunctivitis annually. However, there are few investigations on the pathogenic adenoviruses that cause conjunctivitis. In total, 120 eye-swab samples were collected from patients with viral conjunctivitis symptoms in Hanoi, Vietnam from 2017 to 2019. Human adenoviruse (HAdV) was detected in 67 samples (55.83%) using polymerase chain reaction amplification of at least one of three HAdV-specific marker genes (hexon, penton, and fiber). Of the 67 HAdV samples, 46 samples could be analyzed by all three marker genes. DNA sequence analysis and phylogenetic tree building based on the three marker genes from the 46 HAdV samples revealed five different HAdV types associated with conjunctivitis in Hanoi, including HAdV-3 (4.3%), HAdV-4 (2.2%), HAdV-8 (89.1%), HAdV-37 (2.2%), and a potential recombinant type between types HAdV-8 and HAdV-3 (2.2%). This showed that HAdV-8 was the most common type identified in Hanoi. Complete genome analysis of HAdV-8 isolated from a Vietnamese patient (VN2017) using Sanger sequencing revealed 34 unique nucleotide changes, indicating that the adenovirus continuously accumulates new mutations. Hence, continuous surveillance of HAdV-8 changes in Vietnam is necessary in the future.
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MESH Headings
- Humans
- Vietnam/epidemiology
- Adenoviruses, Human/genetics
- Adenoviruses, Human/classification
- Adenoviruses, Human/isolation & purification
- Phylogeny
- Adenovirus Infections, Human/virology
- Adenovirus Infections, Human/epidemiology
- Genome, Viral/genetics
- Molecular Typing
- Male
- Conjunctivitis, Viral/virology
- Conjunctivitis, Viral/epidemiology
- Female
- Adult
- Whole Genome Sequencing
- Middle Aged
- Prevalence
- Sequence Analysis, DNA
- DNA, Viral/genetics
- Young Adult
- Genotype
- Adolescent
- Child
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Affiliation(s)
- Thi Thu Huyen Nguyen
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Tuan Anh Le
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Viet Ha Nguyen
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Thi Uyen Nguyen
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Phuong Thao Nguyen
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Thi Thuy Anh Tran
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Quang Hung Nguyen
- Faculty of General Diagnostic, National Hospital of Ophthalmology, Hanoi, Vietnam
| | - Anh Tuan Hoang
- Faculty of General Diagnostic, National Hospital of Ophthalmology, Hanoi, Vietnam
| | - My Hanh Hoang
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Tho Son Le
- Department of Molecular Genetics and Gene Technology, College of Forestry Biotechnology, Vietnam National Forestry University, Hanoi, Vietnam
| | - Van Sang Nguyen
- Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
- Molecular and Cellular Biology Laboratory, Center for Life Science, Faculty of Biology, VNU University of Science, Vietnam National University, Hanoi, Vietnam
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15
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Johansson E, Caraballo R, Mistry N, Zocher G, Qian W, Andersson CD, Hurdiss DL, Chandra N, Thompson R, Frängsmyr L, Stehle T, Arnberg N, Elofsson M. Pentavalent Sialic Acid Conjugates Block Coxsackievirus A24 Variant and Human Adenovirus Type 37-Viruses That Cause Highly Contagious Eye Infections. ACS Chem Biol 2020; 15:2683-2691. [PMID: 32845119 PMCID: PMC7586296 DOI: 10.1021/acschembio.0c00446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
![]()
Coxsackievirus A24
variant (CVA24v) and human adenovirus 37 (HAdV-37)
are leading causative agents of the severe and highly contagious ocular
infections acute hemorrhagic conjunctivitis and epidemic keratoconjunctivitis,
respectively. Currently, neither vaccines nor antiviral agents are
available for treating these diseases, which affect millions of individuals
worldwide. CVA24v and HAdV-37 utilize sialic acid as attachment receptors
facilitating entry into host cells. Previously, we and others have
shown that derivatives based on sialic acid are effective in preventing
HAdV-37 binding and infection of cells. Here, we designed and synthesized
novel pentavalent sialic acid conjugates and studied their inhibitory
effect against CVA24v and HAdV-37 binding and infection of human corneal
epithelial cells. The pentavalent conjugates are the first reported
inhibitors of CVA24v infection and proved efficient in blocking HAdV-37
binding. Taken together, the pentavalent conjugates presented here
form a basis for the development of general inhibitors of these highly
contagious ocular pathogens.
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Affiliation(s)
- Emil Johansson
- Department of Chemistry, Umeå University, SE90187 Umeå, Sweden
| | - Rémi Caraballo
- Department of Chemistry, Umeå University, SE90187 Umeå, Sweden
| | - Nitesh Mistry
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE90185 Umeå, Sweden
| | - Georg Zocher
- Interfaculty Institute of Biochemistry, University of Tübingen, 72076 Tübingen, Germany
| | - Weixing Qian
- Department of Chemistry, Umeå University, SE90187 Umeå, Sweden
| | | | - Daniel L. Hurdiss
- Virology Division, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, 3584CL Utrecht, The Netherlands
| | - Naresh Chandra
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE90185 Umeå, Sweden
| | - Rebecca Thompson
- Astbury Centre for Structural Molecular Biology, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Lars Frängsmyr
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE90185 Umeå, Sweden
| | - Thilo Stehle
- Interfaculty Institute of Biochemistry, University of Tübingen, 72076 Tübingen, Germany
- Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Niklas Arnberg
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE90185 Umeå, Sweden
| | - Mikael Elofsson
- Department of Chemistry, Umeå University, SE90187 Umeå, Sweden
- Umeå Centre for Microbial Research, Umeå University, SE90187 Umeå, Sweden
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16
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Rogers DL, Ruiz JC, Baze WB, McClure GB, Smith C, Urbanowski R, Boston T, Simmons JH, Williams L, Abee CR, Vanchiere JA. Epidemiological and molecular characterization of a novel adenovirus of squirrel monkeys after fatal infection during immunosuppression. Microb Genom 2020; 6:mgen000395. [PMID: 32614763 PMCID: PMC7643968 DOI: 10.1099/mgen.0.000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022] Open
Abstract
Adenoviruses are a frequent cause of acute upper respiratory tract infections that can also cause disseminated disease in immunosuppressed patients. We identified a novel adenovirus, squirrel monkey adenovirus 1 (SqMAdV-1), as the cause of fatal infection in an immunocompromised squirrel monkey (Saimiri boliviensis) at the Keeling Center for Comparative Medicine and Research (KCCMR). Sequencing of SqMAdV-1 revealed that it is most closely related (80.4 % pairwise nucleotide identity) to the titi monkey (Plecturocebus cupreus) adenovirus (TMAdV). Although identified in the titi monkey, TMAdV is highly lethal in these monkeys, and they are not thought to be the natural host. While SqMAdV-1 is similar to other primate adenoviruses in size and genomic characteristics, a nucleotide polymorphism at the expected stop codon of the DNA polymerase gene results in a 126 amino acid extension at the carboxy terminus, a feature not previously observed among other primate adenoviruses. PCR testing and partial sequencing of 95 archived faecal samples from other squirrel monkeys (Saimiri boliviensis and Saimiri sciureus) housed at the KCCMR revealed the presence of three distinct, and apparently endemic species of adenoviruses. A grouping of ten squirrel monkey adenovirus variants has high similarity to SqMAdV-1. A single adenovirus variant (designated SqMAdV-3), detected in five monkeys, has similarity to tufted capuchin (Sapajus apella) adenoviruses. The largest group of adenovirus variants detected (designated SqMAdV-2.0-2.16) has very high similarity (93-99 %) to the TMAdV, suggesting that squirrel monkeys may be the natural host of the TMAdV.
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Affiliation(s)
- Donna L. Rogers
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Julio C. Ruiz
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Wallace B. Baze
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Gloria B. McClure
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Carolyn Smith
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Ricky Urbanowski
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Theresa Boston
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Joe H. Simmons
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Lawrence Williams
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - Christian R. Abee
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
| | - John A. Vanchiere
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
- Keeling Center for Comparative Medicine Research, Department of Comparative Medicine, The University of Texas MD Anderson Cancer Center, Bastrop, TX, USA
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17
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Hanaoka N, Nojiri N, Takahashi K, Yoshida E, Fujimoto T. Evaluation of the Anti-Adenoviral Activity of ALTANT, an Ozonated Alcohol Disinfectant. Jpn J Infect Dis 2020; 73:349-353. [PMID: 32350225 DOI: 10.7883/yoken.jjid.2020.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Seven human mastadenovirus (HAdV) species (A-G) are known with more than 100 reported types. HAdV is highly resistant to common hand sanitizers. Epidemic keratoconjunctivitis and pharyngoconjunctival fever are caused by HAdV, which can be explosively transmitted in a confined space, resulting in outbreaks, such as nosocomial infections. Given the absence of an antiviral agent against the HAdV infection, it is important to prevent the spread of the infection by using disinfectants. Ozone has already been well-known for its bactericidal and virucidal effects. ALTANT is an ozonated alcohol preparation developed by E-TECH Co., Ltd. (Kobe, Hyogo, Japan). In this study, we mixed ALTANT with different HAdV types at a ratio of 9:1 and determined HAdV viability after instantaneous reactions for varying periods (flash to 5 minutes) using the TCID50 assay. The assay results demonstrated that the HAdV viability decreased by 1/10 to 1/100 within 1 minute after the reaction; additionally, slight differences in the reactivity were observed among the HAdV types. HAdV viability decreased by a factor of > 4log10, and the virus was eliminated within 3 minutes. This study demonstrated the potent HAdV disinfection effect of ALTANT.
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Affiliation(s)
- Nozomu Hanaoka
- Laboratory Diagnosis Division, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
| | - Naomi Nojiri
- Laboratory Diagnosis Division, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
| | - Kenichiro Takahashi
- Laboratory Diagnosis Division, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
| | | | - Tsuguto Fujimoto
- Laboratory Diagnosis Division, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
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18
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Labib BA, Minhas BK, Chigbu DI. Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions. Clin Ophthalmol 2020; 14:837-852. [PMID: 32256043 PMCID: PMC7094151 DOI: 10.2147/opth.s207976] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, anti-inflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.
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Affiliation(s)
- Bisant A Labib
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - Bhawanjot K Minhas
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - DeGaulle I Chigbu
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
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19
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Tsukahara-Kawamura T, Hanaoka N, Konagaya M, Uchio E, Fujimoto T. Characteristic of slow growth in cell culture of adenovirus type 54 causing nationwide outbreak epidemic keratoconjunctivitis in Japan. Jpn J Ophthalmol 2020; 64:312-320. [PMID: 32125553 DOI: 10.1007/s10384-020-00727-2] [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: 07/03/2019] [Accepted: 01/31/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize the virological features of adenovirus type 54 (Ad54) causing nationwide outbreak of severe epidemic keratoconjunctivitis (EKC) in Japan, we comparatively analysed the viral propagation phenotype of Ad54 and other Ads: type 37 (Ad37), 64 (Ad64), and 5 (Ad5), in A549 cells quantitatively. STUDY DESIGN Laboratory investigation. METHODS We compared the growth rate of Ads using copy numbers and cytopathic effect observation during propagation in A549 cell lines. Expressions of mRNA of E1 gene were also calculated and compared. Phylogenetic analysis of the region, including putative promoter of E1 gene and E1 open reading frame (ORF), were performed. RESULTS Increases in viral loads, growth rate, and viral propagation were slower for Ad54 than for other Ads. The expression level of the E1 gene per infected cell was lower for Ad54 than for other Ad types on post-infection day 1. Phylogenetic analysis of the E1 gene putative promoter and ORF revealed Ad54 was the closest to Ad type 8. CONCLUSION The propagation of Ad54 in A549 is slow compared with Ad37, Ad64 and Ad5. This slow propagation could have been caused by slow genomic replication resulting from delayed viral entry or E1 transcription initiation. The EKC caused by Ad54 needs more attention because the slow propagation of Ad54 may contribute to prolonged disease duration.
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Affiliation(s)
- Tomoko Tsukahara-Kawamura
- Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Nozomu Hanaoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Masami Konagaya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
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20
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Hou W, Sun X, Feng J, Zhang Y, Wang Z. A 8-year retrospective clinical analysis of 272 patients of epidemic Keratoconjunctivitis in Beijing, China. BMC Ophthalmol 2019; 19:262. [PMID: 31856790 PMCID: PMC6921577 DOI: 10.1186/s12886-019-1266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/04/2019] [Indexed: 01/31/2023] Open
Abstract
Background Epidemic keratoconjunctivitis (EKC) is one of the most common eye infections worldwide. The analysis of clinical manifestations in different age groups help better know the disease. This study aims to provide more detailed analysis of 272 cases of EKC in 8 years, describe the differences of the clinical features among different age groups, and establish new clinical grading criteria. Methods 272 individuals were reviewed (2011–2019) in Beijing China. All the patients were classified into 3 grades according to the new grading criteria. The typical clinical signs of EKC and the photographs of the multiple subepithelial corneal infiltrates (MSI) were collected and analyzed. The number of 3 grades among and within different age groups were compared. The incidence of the typical signs among and within different age groups were compared. The proportion of each region of the cornea involved by MSI were compared. Results No significant differences were detected among the 4 groups in terms of the number of mild, moderate and severe cases, no matter in all-patients analysis (P = 0.271) nor in acute-phase-patients analysis (P = 0.203). The proportion of the severe cases was the highest among all patients (P = 0.000). Among the incidence of the typical signs, corneal involvement was the most common accounting for 69.8% (P<0.05). The probability of central region involvement was significantly higher than that of pericentral region involvement (P = 0.015) and peripheral region involvement (P = 0.000). Conclusions Appropriate attention should be paid on EKC, because of the considerable proportion of severe cases, the high incidence of corneal lesion, and the high incidence of central region involvement of MSI.
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Affiliation(s)
- Wenbo Hou
- Eye Hospital, China Academy Of Chinese Medical Sciences, Beijing, China
| | - Xuguang Sun
- Department Of Ocular Microbiology, Beijing Institute Of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Jun Feng
- Eye Hospital, China Academy Of Chinese Medical Sciences, Beijing, China
| | - Yang Zhang
- Department Of Ocular Microbiology, Beijing Institute Of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhiqun Wang
- Department Of Ocular Microbiology, Beijing Institute Of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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21
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Hashizume M, Aoki K, Ohno S, Kitaichi N, Yawata N, Gonzalez G, Nonaka H, Sato S, Takaoka A. Disinfectant potential in inactivation of epidemic keratoconjunctivitis-related adenoviruses by potassium peroxymonosulfate. Eur J Ophthalmol 2019; 31:379-384. [PMID: 31813297 DOI: 10.1177/1120672119891408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to test the antiviral effectivity of potassium peroxymonosulfate (RUBYSTA®, KYORIN) against five epidemic keratoconjunctivitis-related types of Human adenovirus D in vitro. METHODS Five types of Human adenovirus D (8, 37, 53, 54 and 56) were incubated with 1% potassium peroxymonosulfate, 0.1% sodium hypochlorite (NaClO) or alcohol-based disinfectant for 30 s or 1 min. These solutions were subjected to measurements of viral titres by infection assays in A549 cells. At day 6 post-infection, both, supernatants and cells, were collected and the viral genome was assessed by real-time polymerase chain reaction analysis. RESULTS Treatments with 1% potassium peroxymonosulfate led to significant reduction in all tested Human adenovirus D types comparable to disinfecting effects by 0.1% NaClO. Overall, potassium peroxymonosulfate demonstrated sufficient inactivation of the major epidemic keratoconjunctivitis-causing Human adenovirus D to be considered for disinfection and prevention purposes in ophthalmological clinics and hospitals. CONCLUSION This study demonstrated that potassium peroxymonosulfate is a promising disinfectant for the prevention of epidemic keratoconjunctivitis nosocomial infections in ophthalmological clinics.
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Affiliation(s)
- Mei Hashizume
- Division of Signalling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan.,Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Japan
| | - Koki Aoki
- Division of Signalling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan.,Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.,Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.,Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.,Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyo Yawata
- Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Hirotaka Nonaka
- Division of Signalling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan.,Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Japan
| | - Seiichi Sato
- Division of Signalling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan.,Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Japan
| | - Akinori Takaoka
- Division of Signalling in Cancer and Immunology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan.,Molecular Medical Biochemistry Unit, Biological Chemistry and Engineering Course, Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Japan
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22
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Takahashi K, Gonzalez G, Kobayashi M, Hanaoka N, Carr MJ, Konagaya M, Nojiri N, Ogi M, Fujimoto T. Pediatric Infections by Human mastadenovirus C Types 2, 89, and a Recombinant Type Detected in Japan between 2011 and 2018. Viruses 2019; 11:v11121131. [PMID: 31817764 PMCID: PMC6950085 DOI: 10.3390/v11121131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
Between 2011 and 2018, 518 respiratory adenovirus infections were diagnosed in a pediatric clinic in Shizuoka, Japan. Detection and typing were performed by partial sequencing of both hexon- and fiber-coding regions which identified: adenovirus type 1 (Ad-1, n = 85), Ad-2 (n = 160), Ad-3 (n = 193), Ad-4 (n = 18), Ad-5 (n = 27), Ad-11 (n = 2), Ad-54 (n = 3), and Ad-56 (n = 1). Considering previous reports of the circulation of an endemic recombinant Ad-2, e.g., Ad-89, 100 samples typed as Ad-2 were randomly selected for further molecular typing by sequencing the penton base-coding region. Despite the high nucleotide sequence conservation in the penton base- coding region, 27 samples showed 98% identity to Ad-2. Furthermore, 14 samples showed 97.7% identity to Ad-2 and 99.8% identity to Ad-89, while the remaining 13 samples showed an average 98% pairwise identity to other Ad-C types and clustered with Ad-5. The samples typed as Ad-89 (n = 14) and as a recombinant Ad type (P5H2F2) (n = 13) represented 27% of cases originally diagnosed as Ad-2, and were detected sporadically. Therefore, two previously uncharacterized types in Japan, Ad-89 and a recombinant Ad-C, were shown to circulate in children. This study creates a precedent to evaluate the epidemiology and divergence among Ad-C types by comprehensively considering the type classification of adenoviruses.
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MESH Headings
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/history
- Adenovirus Infections, Human/virology
- Adenoviruses, Human/classification
- Adenoviruses, Human/genetics
- Adenoviruses, Human/isolation & purification
- Child
- Child, Preschool
- DNA, Viral
- Female
- Genome, Viral
- Genomics/methods
- Genotype
- History, 21st Century
- Humans
- Infant
- Japan/epidemiology
- Open Reading Frames
- Phylogeny
- Recombination, Genetic
- Sequence Analysis, DNA
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Affiliation(s)
- Kenichiro Takahashi
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; (K.T.); (N.H.); (M.K.); (N.N.)
- Department of Pediatrics, Tokyo Women’s Medical University Medical Center East, Tokyo 116-8567, Japan
| | - Gabriel Gonzalez
- Research Center for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan;
| | | | - Nozomu Hanaoka
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; (K.T.); (N.H.); (M.K.); (N.N.)
| | - Michael J. Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland;
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 001-0020, Japan
| | - Masami Konagaya
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; (K.T.); (N.H.); (M.K.); (N.N.)
| | - Naomi Nojiri
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; (K.T.); (N.H.); (M.K.); (N.N.)
- Kobayashi Pediatric Clinic, Fujieda 426-0067, Japan;
| | - Miki Ogi
- Infectious Disease Research Division, Hyogo Prefectural Institute of Public Health Science, Kakogawa 675-0003, Japan;
| | - Tsuguto Fujimoto
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo 162-8640, Japan; (K.T.); (N.H.); (M.K.); (N.N.)
- Correspondence: ; Tel.: +81-03-5285-1111
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23
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Gonzalez G, Carr MJ, Kobayashi M, Hanaoka N, Fujimoto T. Enterovirus-Associated Hand-Foot and Mouth Disease and Neurological Complications in Japan and the Rest of the World. Int J Mol Sci 2019; 20:ijms20205201. [PMID: 31635198 PMCID: PMC6834195 DOI: 10.3390/ijms20205201] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Abstract
Enteroviruses (EVs) are responsible for extremely large-scale, periodic epidemics in pediatric cohorts, particularly in East and Southeast Asia. Clinical presentation includes a diverse disease spectrum, including hand-foot and mouth disease (HFMD), aseptic meningitis, encephalitis, acute flaccid paralysis, and acute flaccid myelitis. HFMD is predominantly attributable to EV-A types, including the major pathogen EV-A71, and coxsackieviruses, particularly CV-A6, CV-A16, and CV-A10. There have been multiple EV-A71 outbreaks associated with a profound burden of neurological disease and fatal outcomes in Asia since the early 1980s. Efficacious vaccines against EV-A71 have been developed in China but widespread pediatric vaccination programs have not been introduced in other countries. Encephalitis, as a consequence of complications arising from HFMD infection, leads to damage to the thalamus and medulla oblongata. Studies in Vietnam suggest that myoclonus is a significant indicator of central nervous system (CNS) complications in EV-A71-associated HFMD cases. Rapid response in HFMD cases in children is imperative to prevent the progression to a CNS infection; however, prophylactic and therapeutic agents have not been well established internationally, therefore surveillance and functional studies including development of antivirals and multivalent vaccines is critically important to reduce disease burden in pediatric populations.
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Affiliation(s)
- Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan.
- National Advanced Computing Collaboratory, National Center for High Technology, San Jose 1174-1200, Costa Rica.
| | - Michael J Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 001-0020, Japan.
| | | | - Nozomu Hanaoka
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | - Tsuguto Fujimoto
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
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24
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Aoki K, Gonzalez G, Hinokuma R, Yawata N, Tsutsumi M, Ohno S, Kitaichi N. Assessment of clinical signs associated with adenoviral epidemic keratoconjunctivitis cases in southern Japan between 2011 and 2014. Diagn Microbiol Infect Dis 2019; 95:114885. [PMID: 31607514 DOI: 10.1016/j.diagmicrobio.2019.114885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 01/03/2023]
Abstract
Adenoviral epidemic keratoconjunctivitis (EKC) is a major cause of ocular morbidity worldwide and specific antiviral therapies are not available. EKC is primarily caused by Human adenovirus D (HAdV-D) types 8, 37, 53, 54, 56 and 64. Considering the genomic variation in HAdV-D, we hypothesized that clinical signs could be differentiated by virus type. The hypothesis was retrospectively tested with clinical signs recorded from 250 patients with ocular infections visiting an ophthalmological clinic in southern Japan between 2011 and 2014. The results showed that conjunctival opacity, corneal epithelial disorders and pre-auricular lymphadenopathy, were more frequently associated with EKC than other ocular infections. Furthermore, HAdV types 8, 37 and 54, caused corneal complications and longer infections significantly more frequently than infections by types 53 and 56 (P < 0.05). Our descriptive results supported that symptoms severity vary with the infecting type, however, further research is needed to improve diagnosis of EKC.
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Affiliation(s)
- Koki Aoki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Nobuyo Yawata
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, Singapore
| | - Masayuki Tsutsumi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.
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25
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Carlin CR. New Insights to Adenovirus-Directed Innate Immunity in Respiratory Epithelial Cells. Microorganisms 2019; 7:microorganisms7080216. [PMID: 31349602 PMCID: PMC6723309 DOI: 10.3390/microorganisms7080216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
The nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) family of transcription factors is a key component of the host innate immune response to infectious adenoviruses and adenovirus vectors. In this review, we will discuss a regulatory adenoviral protein encoded by early region 3 (E3) called E3-RIDα, which targets NFκB through subversion of novel host cell pathways. E3-RIDα down-regulates an EGF receptor signaling pathway, which overrides NFκB negative feedback control in the nucleus, and is induced by cell stress associated with viral infection and exposure to the pro-inflammatory cytokine TNF-α. E3-RIDα also modulates NFκB signaling downstream of the lipopolysaccharide receptor, Toll-like receptor 4, through formation of membrane contact sites controlling cholesterol levels in endosomes. These innate immune evasion tactics have yielded unique perspectives regarding the potential physiological functions of host cell pathways with important roles in infectious disease.
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Affiliation(s)
- Cathleen R Carlin
- Department of Molecular Biology and Microbiology and the Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
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26
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Chandra N, Frängsmyr L, Imhof S, Caraballo R, Elofsson M, Arnberg N. Sialic Acid-Containing Glycans as Cellular Receptors for Ocular Human Adenoviruses: Implications for Tropism and Treatment. Viruses 2019; 11:v11050395. [PMID: 31035532 PMCID: PMC6563162 DOI: 10.3390/v11050395] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 02/04/2023] Open
Abstract
Human adenoviruses (HAdV) are the most common cause of ocular infections. Species B human adenovirus type 3 (HAdV-B3) causes pharyngoconjunctival fever (PCF), whereas HAdV-D8, -D37, and -D64 cause epidemic keratoconjunctivitis (EKC). Recently, HAdV-D53, -D54, and -D56 emerged as new EKC-causing agents. HAdV-E4 is associated with both PCF and EKC. We have previously demonstrated that HAdV-D37 uses sialic acid (SA)-containing glycans as cellular receptors on human corneal epithelial (HCE) cells, and the virus interaction with SA is mediated by the knob domain of the viral fiber protein. Here, by means of cell-based assays and using neuraminidase (a SA-cleaving enzyme), we investigated whether ocular HAdVs other than HAdV-D37 also use SA-containing glycans as receptors on HCE cells. We found that HAdV-E4 and -D56 infect HCE cells independent of SAs, whereas HAdV-D53 and -D64 use SAs as cellular receptors. HAdV-D8 and -D54 fiber knobs also bound to cell-surface SAs. Surprisingly, HCE cells were found resistant to HAdV-B3 infection. We also demonstrated that the SA-based molecule i.e., ME0462, designed to bind to SA-binding sites on the HAdV-D37 fiber knob, efficiently prevents binding and infection of several EKC-causing HAdVs. Surface plasmon resonance analysis confirmed a direct interaction between ME0462 and fiber knobs. Altogether, we demonstrate that SA-containing glycans serve as receptors for multiple EKC-causing HAdVs, and, that SA-based compound function as a broad-spectrum antiviral against known and emerging EKC-causing HAdVs.
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Affiliation(s)
- Naresh Chandra
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE-90185 Umeå, Sweden.
| | - Lars Frängsmyr
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE-90185 Umeå, Sweden.
| | - Sophie Imhof
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE-90185 Umeå, Sweden.
| | - Rémi Caraballo
- Department of Chemistry, Umeå University, SE-90187 Umeå, Sweden.
| | - Mikael Elofsson
- Department of Chemistry, Umeå University, SE-90187 Umeå, Sweden.
| | - Niklas Arnberg
- Section of Virology, Department of Clinical Microbiology, Umeå University, SE-90185 Umeå, Sweden.
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