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Ferrucci V, Miceli M, Pagliuca C, Bianco O, Castaldo L, Izzo L, Cozzolino M, Zannella C, Oglio F, Polcaro A, Randazzo A, Colicchio R, Galdiero M, Berni Canani R, Salvatore P, Zollo M. Modulation of innate immunity related genes resulting in prophylactic antimicrobial and antiviral properties. J Transl Med 2024; 22:574. [PMID: 38886736 PMCID: PMC11184722 DOI: 10.1186/s12967-024-05378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The innate immunity acts during the early phases of infection and its failure in response to a multilayer network of co-infections is cause of immune system dysregulation. Epidemiological SARS-CoV-2 infections data, show that Influenza Virus (FLU-A-B-C) and Respiratory Syncytial Virus (RSV) are co-habiting those respiratory traits. These viruses, especially in children (mostly affected by 'multi-system inflammatory syndrome in children' [MIS-C] and the winter pandemic FLU), in the aged population, and in 'fragile' patients are causing alteration in immune response. Then, bacterial and fungal pathogens are also co-habiting the upper respiratory traits (e.g., Staphylococcus aureus and Candida albicans), thus contributing to morbidity in those COVID-19 affected patients. METHODS Liquid chromatography coupled with high-resolution mass spectrometry using the quadrupole orbital ion trap analyser (i.e., UHPLC-Q-Orbitrap HRMS) was adopted to measure the polyphenols content of a new nutraceutical formula (Solution-3). Viral infections with SARS-CoV-2 (EG.5), FLU-A and RSV-A viruses (as performed in BLS3 authorised laboratory) and real time RT-PCR (qPCR) assay were used to test the antiviral action of the nutraceutical formula. Dilution susceptibility tests have been used to estimate the minimum inhibitory and bactericidal concentration (MIC and MBC, respectively) of Solution-3 on a variety of microorganisms belonging to Gram positive/ negative bacteria and fungi. Transcriptomic data analyses and functional genomics (i.e., RNAseq and data mining), coupled to qPCR and ELISA assays have been used to investigate the mechanisms of action of the nutraceutical formula on those processes involved in innate immune response. RESULTS Here, we have tested the combination of natural products containing higher amounts of polyphenols (i.e., propolis, Verbascum thapsus L., and Thymus vulgaris L.), together with the inorganic long chain polyphosphates 'polyPs' with antiviral, antibacterial, and antifungal behaviours, against SARS-CoV-2, FLU-A, RSV-A, Gram positive/ negative bacteria and fungi (i.e., Candida albicans). These components synergistically exert an immunomodulatory action by enhancing those processes involved in innate immune response (e.g., cytokines: IFNγ, TNFα, IL-10, IL-6/12; chemokines: CXCL1; antimicrobial peptides: HBD-2, LL-37; complement system: C3). CONCLUSION The prophylactic antimicrobial success of this nutraceutical formula against SARS-CoV-2, FLU-A and RSV-A viruses, together with the common bacteria and fungi co-infections as present in human oral cavity, is expected to be valuable.
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Affiliation(s)
- Veronica Ferrucci
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples 'Federico II', Via Sergio Pansini 5, 80131, Naples, Italy.
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy.
- Elysium Cell Bio Ita, Via Gaetano Salvatore 486, 80145, Naples, Italy.
| | - Marco Miceli
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Chiara Pagliuca
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples 'Federico II', Via Sergio Pansini 5, 80131, Naples, Italy
| | - Orazio Bianco
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Luigi Castaldo
- Department of Pharmacy, University of Naples 'Federico II', Via Domenico Montesano 49, 80131, Naples, Italy
| | - Luana Izzo
- Department of Pharmacy, University of Naples 'Federico II', Via Domenico Montesano 49, 80131, Naples, Italy
| | - Marica Cozzolino
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
- Dipartimento Di Scienze Mediche Traslazionali, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Franca Oglio
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
- Dipartimento Di Scienze Mediche Traslazionali, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antonio Polcaro
- Polcaro Fitopreparazioni S.R.L, Via Sant Agnello, 9 D; 80030, Roccarainola, Naples, Italy
| | - Antonio Randazzo
- Department of Pharmacy, University of Naples 'Federico II', Via Domenico Montesano 49, 80131, Naples, Italy
| | - Roberta Colicchio
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples 'Federico II', Via Sergio Pansini 5, 80131, Naples, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
- UOC of Virology and Microbiology, University Hospital of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Roberto Berni Canani
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
- Dipartimento Di Scienze Mediche Traslazionali, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples 'Federico II', Via Sergio Pansini 5, 80131, Naples, Italy
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Massimo Zollo
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples 'Federico II', Via Sergio Pansini 5, 80131, Naples, Italy.
- CEINGE Biotecnologie Avanzate 'Franco Salvatore', Via Gaetano Salvatore 486, 80145, Naples, Italy.
- Elysium Cell Bio Ita, Via Gaetano Salvatore 486, 80145, Naples, Italy.
- DAI Medicina di Laboratorio e Trasfusionale, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
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Mastboim NS, Angel A, Shaham O, Ber TI, Navon R, Simon E, Rosenberg M, Israeli Y, Hainrichson M, Avni N, Reiner E, Feigin P, Oved K, Tadmor B, Singer P, Kagan I, Lev S, Diker D, Jarjou'I A, Kurd R, Ben-Chetrit E, Danziger G, Tegethoff SA, Papan C, Motov S, Shapira M, Stein M, Gottlieb TM, Eden E, Klein A. An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease. Cytokine 2023; 169:156246. [PMID: 37327532 PMCID: PMC10235675 DOI: 10.1016/j.cyto.2023.156246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Feigin
- Technion-Israel Institute of Technology, Israel
| | - Kfir Oved
- MeMed, Tirat Carmel, Israel; Canopy Immuno-therapeutics, Israel
| | | | | | | | | | | | - Amir Jarjou'I
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | - Ramzi Kurd
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | - Eli Ben-Chetrit
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Israel
| | | | | | | | | | - Ma'anit Shapira
- Technion-Israel Institute of Technology, Israel; Hillel Yaffe Medical Center, Israel
| | - Michal Stein
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel; Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel
| | | | | | - Adi Klein
- Technion-Israel Institute of Technology, Israel; Hillel Yaffe Medical Center, Israel
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3
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Tanak AS, Muthukumar S, Krishnan S, Schully KL, Clark DV, Prasad S. Multiplexed cytokine detection using electrochemical point-of-care sensing device towards rapid sepsis endotyping. Biosens Bioelectron 2021; 171:112726. [PMID: 33113386 PMCID: PMC7569407 DOI: 10.1016/j.bios.2020.112726] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022]
Abstract
The implementation of endotype-driven effective intervention strategies is now considered as an essential component for sepsis management. Rapid screening and frequent monitoring of immune responses are critical for evidence-based informed decisions in the early hours of patient arrival. Current technologies focus on pathogen identification that lack rapid testing of the patient immune response, impeding clinicians from providing appropriate sepsis treatment. Herein, we demonstrate a first-of-its-kind novel point-of-care device that uses a unique approach by directly monitoring a panel of five cytokine biomarkers (IL-6, IL-8, IL-10, TRAIL & IP-10), that is attributed as a sign of the body's host immune response to sepsis. The developed point-of-care device encompasses a disposable sensor cartridge attached to an electrochemical reader. High sensitivity is achieved owing to the unique sensor design with an array of nanofilm semiconducting/metal electrode interface, functionalized with specific capture probes to measure target biomarkers simultaneously using non-faradaic electrochemical impedance spectroscopy. The sensor has a detection limit of ~1 pg/mL and provides results in less than five minutes from a single drop of undiluted plasma sample. Furthermore, the sensor demonstrates an excellent correlation (Pearson's r > 0.90) with the reference method for a total n = 40 clinical samples, and the sensor's performance is ~30 times faster compared to the standard reference technique. We have demonstrated the sensor's effectiveness to enhance diagnosis with a mechanistic biomarker-guided approach that can help disease endotypying for effective clinical management of sepsis at the patient bedside.
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Affiliation(s)
- Ambalika S Tanak
- Department of Bioengineering, The University of Texas at Dallas, TX, USA
| | | | - Subramaniam Krishnan
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kevin L Schully
- Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, MD, USA
| | - Danielle V Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Shalini Prasad
- Department of Bioengineering, The University of Texas at Dallas, TX, USA.
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SARS-CoV-2 infection: The role of cytokines in COVID-19 disease. Cytokine Growth Factor Rev 2020; 54:62-75. [PMID: 32513566 PMCID: PMC7265853 DOI: 10.1016/j.cytogfr.2020.06.001] [Citation(s) in RCA: 716] [Impact Index Per Article: 179.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Abstract
A wide range of cytokines are involved in the development of COVID-19 disease. Some of these biomolecules are related to the progression and even to the prognosis of the infection. Findings on the role of cytokine storm associated with SARS-CoV-2 infection can be useful in order to manage this highly virulent disease.
COVID-19 disease, caused by infection with SARS-CoV-2, is related to a series of physiopathological mechanisms that mobilize a wide variety of biomolecules, mainly immunological in nature. In the most severe cases, the prognosis can be markedly worsened by the hyperproduction of mainly proinflammatory cytokines, such as IL-1, IL-6, IL-12, IFN-γ, and TNF-α, preferentially targeting lung tissue. This study reviews published data on alterations in the expression of different cytokines in patients with COVID-19 who require admission to an intensive care unit. Data on the implication of cytokines in this disease and their effect on outcomes will support the design of more effective approaches to the management of COVID-19.
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5
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Suzukawa M, Takeda K, Akashi S, Asari I, Kawashima M, Ohshima N, Inoue E, Sato R, Shimada M, Suzuki J, Yamane A, Tamura A, Ohta K, Tohma S, Teruya K, Nagai H. Evaluation of cytokine levels using QuantiFERON-TB Gold Plus in patients with active tuberculosis. J Infect 2020; 80:547-553. [PMID: 32092390 DOI: 10.1016/j.jinf.2020.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A recently released new QuantiFERON (QFT) product, QFT TB Gold plus (QFT-plus), is optimized for both CD4 and CD8 responses and reported to have higher sensitivity compared to the former QFT-3 G. Previously, using supernatants of QFT-3 G, we and others have demonstrated that cytokines other than IFN-γ may be useful in diagnosing tuberculosis. The present study aimed to identify cytokines that are useful for accurately diagnosing active tuberculosis by using QFT-plus and compared the data to those with QFT-3 G. METHODS Eighty-three active tuberculosis patients and 70 healthy control subjects who were examined by QFT at Tokyo National Hospital from June 2017 to July 2018 were enrolled. QFT-3 G and QFT-plus were performed according to the manufacturer's instructions. At the same time, blood cell culture supernatants were collected and assayed for their cytokine levels using R&D Systems Luminex Assay and MAGPIX System. The levels of cytokines were compared between different antigen-containing tubes (3 G Ag, TB1 and TB2 tubes), as well as between the patients and the control subjects. ROC curves were drawn, and the AUCs were calculated. RESULTS Five cytokines, i.e., IL-2, IL-6, IL-8, IP-10 and MIP-1β, produced by human blood cells in three independent tubes containing different tuberculosis antigens were higher in the 3 G Ag tube compared to both the TB1 and TB2 tubes. Further, when the TB1 and TB2 tubes were compared, TB2 showed greater production of only PDGF-BB, and less production of IL-6 and TNF-α. For diagnosing active tuberculosis, the levels of IP-10 were superior to the level of IFN-γ based on showing a larger AUC for ROC curves in our present study setting. Finally, the levels of IFN-γ, IL-1RA, IL-2, IP-10, MCP-1 and MIP-1β were distinctly different between the active tuberculosis patients and healthy controls. CONCLUSIONS In summary, there was no cytokine that was higher in the tubes of QFT-plus compared to the tube of QFT-3 G, suggesting inferiority of QFT-plus antigens to 3 G Ag in terms of elicitation of cytokine production. Our results also suggest the usefulness of cytokines that showed a significant difference between the active tuberculosis patients and the healthy controls-namely, IFN-γ, IL-1RA, IL-2, IP-10, MCP-1 and MIP-1β-for diagnosing tuberculosis, but the roles of these cytokines in the pathogenesis of tuberculosis need to be elucidated (UMIN000035253).
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Affiliation(s)
- Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan.
| | - Keita Takeda
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Department of Basic Mycobacteriology, Graduate School of Biomedical Science, Nagasaki University, 1-14 Bunkyomachi, Nagasaki, 852-8521, Japan
| | - Shunsuke Akashi
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Isao Asari
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Masahiro Kawashima
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Nobuharu Ohshima
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Eri Inoue
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Ryota Sato
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Masahiro Shimada
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Junko Suzuki
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Akira Yamane
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Atsuhisa Tamura
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Japan Anti-Tuberculosis Association, Fukujuji Hospital, Tokyo, Japan
| | - Shigeto Tohma
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Katsuji Teruya
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Nagai
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
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6
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van der Does Y, Rood PPM, Ramakers C, Schuit SCE, Patka P, van Gorp ECM, Limper M. Identifying patients with bacterial infections using a combination of C-reactive protein, procalcitonin, TRAIL, and IP-10 in the emergency department: a prospective observational cohort study. Clin Microbiol Infect 2018; 24:1297-1304. [PMID: 30268671 DOI: 10.1016/j.cmi.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim was to effectively reduce the unnecessary use of broad spectrum antibiotics in the emergency department (ED), patients with bacterial infections need to be identified accurately. We investigated the diagnostic value of a combination of biomarkers for bacterial infections, C-reactive protein (CRP), and procalcitonin (PCT), together with biomarkers for viral infections, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), and interferon-gamma-induced protein-10 (IP-10), in identifying suspected and confirmed bacterial infections in a general ED population with fever. METHODS This is a sub-study in the HiTEMP cohort. Patients with fever were included during ED triage, and blood samples were obtained. Using both diagnostics and expert panel analysis, all patients were classified as having either suspected or confirmed bacterial infections, or non-bacterial disease. Using multivariable logistic regression analysis, three biomarker models were analysed: model 1, CRP, TRAIL, IP-10; model 2, PCT, TRAIL, IP-10; and model 3, CRP, PCT, TRAIL, IP-10. RESULTS A total of 315 patients were included, of whom 228 patients had a suspected or confirmed bacterial infection. The areas under the curve for the combined models were the following: model 1, 0.730 (95% CI 0.665-0.795); model 2, 0.748 (95% CI 0.685-0.811); and model 3, 0.767(95% CI 0.704-0.829). CONCLUSIONS These findings show that a combination of CRP, PCT, TRAIL and IP-10 can identify bacterial infections with higher accuracy than single biomarkers and combinations of a single bacterial biomarkers combined with TRAIL and IP-10.
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Affiliation(s)
- Y van der Does
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - P P M Rood
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S C E Schuit
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P Patka
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E C M van Gorp
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, the Netherlands
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7
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Ashkenazi-Hoffnung L, Oved K, Navon R, Friedman T, Boico O, Paz M, Kronenfeld G, Etshtein L, Cohen A, Gottlieb TM, Eden E, Chistyakov I, Srugo I, Klein A, Ashkenazi S, Scheuerman O. A host-protein signature is superior to other biomarkers for differentiating between bacterial and viral disease in patients with respiratory infection and fever without source: a prospective observational study. Eur J Clin Microbiol Infect Dis 2018; 37:1361-1371. [PMID: 29700762 PMCID: PMC6015097 DOI: 10.1007/s10096-018-3261-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
Bacterial and viral infections often present with similar symptoms. Etiologic misdiagnosis can alter the trajectory of patient care, including antibiotic overuse. A host-protein signature comprising tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein (CRP) was validated recently for differentiating bacterial from viral disease. However, a focused head-to-head comparison of its diagnostic performance against other biomarker candidates for this indication was lacking in patients with respiratory infection and fever without source. We compared the signature to other biomarkers and prediction rules using specimens collected prospectively at two secondary medical centers from children and adults. Inclusion criteria included fever > 37.5 °C, symptom duration ≤ 12 days, and presentation with respiratory infection or fever without source. Comparator method was based on expert panel adjudication. Signature and biomarker cutoffs and prediction rules were predefined. Of 493 potentially eligible patients, 314 were assigned unanimous expert panel diagnosis and also had sufficient specimen volume. The resulting cohort comprised 175 (56%) viral and 139 (44%) bacterial infections. Signature sensitivity 93.5% (95% CI 89.1–97.9%), specificity 94.3% (95% CI 90.7–98.0%), or both were significantly higher (all p values < 0.01) than for CRP, procalcitonin, interleukin-6, human neutrophil lipocalin, white blood cell count, absolute neutrophil count, and prediction rules. Signature identified as viral 50/57 viral patients prescribed antibiotics, suggesting potential to reduce antibiotic overuse by 88%. The host-protein signature demonstrated superior diagnostic performance in differentiating viral from bacterial respiratory infections and fever without source. Future utility studies are warranted to validate potential to reduce antibiotic overuse.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Department of Pediatrics B, Schneider Children's Medical Center, Petach Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | - Irina Chistyakov
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Adi Klein
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shai Ashkenazi
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Pediatrics A, Schneider Children's Medical Center, 14 Kaplan Street, 49202, Petach Tikva, Israel.
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center, Petach Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Joseph P, Godofsky E. Outpatient Antibiotic Stewardship: A Growing Frontier-Combining Myxovirus Resistance Protein A With Other Biomarkers to Improve Antibiotic Use. Open Forum Infect Dis 2018; 5:ofy024. [PMID: 29479553 PMCID: PMC5815119 DOI: 10.1093/ofid/ofy024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background The majority of oral antibiotics are prescribed in outpatient primary and urgent care clinics for acute respiratory infections. Effective antibiotic stewardship must include proper prescribing for outpatients as well as for those in a hospital or long-term care facility. Methods Major databases, including MEDLINE and the Cochrane Library, were searched for prospective human clinical studies, including children and/or adults published between January 1966 and November 2017 that evaluated Myxovirus resistance protein A (MxA) as a biomarker for diagnosing viral infections as well as both C-reactive protein (CRP) and procalcitonin (PCT) as potential biomarkers for identifying and differentiating true bacterial upper respiratory infection (URI) from colonization. Results Ten prospective human studies, totaling 1683 patients, were identified that evaluated MxA as a viral biomarker in children and/or adults. Both systematic review articles, meta-analyses, and randomized controlled clinical trials that examined CRP and/or PCT as a biomarker for identifying clinically significant bacterial infections and supporting antibiotic stewardship were identified. Conclusions Quick and accurate differentiation between a viral and bacterial respiratory infection is critical to effectively combat antibiotic misuse. MxA expression in peripheral blood is a highly specific marker for viral infection. Combining MxA with other inflammatory biomarkers to test for respiratory infections offers enhanced sensitivity and specificity, forming an excellent tool for antibiotic stewardship in the outpatient setting.
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Affiliation(s)
- Patrick Joseph
- Private Practice to California Infection Control Consultants, San Ramon, California
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9
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Srugo I, Klein A, Stein M, Golan-Shany O, Kerem N, Chistyakov I, Genizi J, Glazer O, Yaniv L, German A, Miron D, Shachor-Meyouhas Y, Bamberger E, Oved K, Gottlieb TM, Navon R, Paz M, Etshtein L, Boico O, Kronenfeld G, Eden E, Cohen R, Chappuy H, Angoulvant F, Lacroix L, Gervaix A. Validation of a Novel Assay to Distinguish Bacterial and Viral Infections. Pediatrics 2017; 140:peds.2016-3453. [PMID: 28904072 DOI: 10.1542/peds.2016-3453] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reliably distinguishing bacterial from viral infections is often challenging, leading to antibiotic misuse. A novel assay that integrates measurements of blood-borne host-proteins (tumor necrosis factor-related apoptosis-inducing ligand, interferon γ-induced protein-10, and C-reactive protein [CRP]) was developed to assist in differentiation between bacterial and viral disease. METHODS We performed double-blind, multicenter assay evaluation using serum remnants collected at 5 pediatric emergency departments and 2 wards from children ≥3 months to ≤18 years without (n = 68) and with (n = 529) suspicion of acute infection. Infectious cohort inclusion criteria were fever ≥38°C and symptom duration ≤7 days. The reference standard diagnosis was based on predetermined criteria plus adjudication by experts blinded to assay results. Assay performers were blinded to the reference standard. Assay cutoffs were predefined. RESULTS Of 529 potentially eligible patients with suspected acute infection, 100 did not fulfill infectious inclusion criteria and 68 had insufficient serum. The resulting cohort included 361 patients, with 239 viral, 68 bacterial, and 54 indeterminate reference standard diagnoses. The assay distinguished between bacterial and viral patients with 93.8% sensitivity (95% confidence interval: 87.8%-99.8%) and 89.8% specificity (85.6%-94.0%); 11.7% had an equivocal assay outcome. The assay outperformed CRP (cutoff 40 mg/L; sensitivity 88.2% [80.4%-96.1%], specificity 73.2% [67.6%-78.9%]) and procalcitonin testing (cutoff 0.5 ng/mL; sensitivity 63.1% [51.0%-75.1%], specificity 82.3% [77.1%-87.5%]). CONCLUSIONS Double-blinded evaluation confirmed high assay performance in febrile children. Assay was significantly more accurate than CRP, procalcitonin, and routine laboratory parameters. Additional studies are warranted to support its potential to improve antimicrobial treatment decisions.
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Affiliation(s)
- Isaac Srugo
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; .,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Michal Stein
- Infectious Disease Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Orit Golan-Shany
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Nogah Kerem
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Irina Chistyakov
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Jacob Genizi
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Oded Glazer
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Liat Yaniv
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Alina German
- Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Dan Miron
- Pediatric Disease Service, Emek Medical Center, Afula, Israel
| | - Yael Shachor-Meyouhas
- Pediatric Infectious Disease Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ellen Bamberger
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel.,MeMed, Tirat Carmel, Israel
| | | | | | | | | | | | | | | | | | - Robert Cohen
- Clinical Research Center, Centre Intercommunal de Creteil, Creteil, France
| | - Helène Chappuy
- Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France
| | - François Angoulvant
- Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France; and
| | - Laurence Lacroix
- Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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10
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van Houten CB, de Groot JAH, Klein A, Srugo I, Chistyakov I, de Waal W, Meijssen CB, Avis W, Wolfs TFW, Shachor-Meyouhas Y, Stein M, Sanders EAM, Bont LJ. A host-protein based assay to differentiate between bacterial and viral infections in preschool children (OPPORTUNITY): a double-blind, multicentre, validation study. THE LANCET. INFECTIOUS DISEASES 2017; 17:431-440. [DOI: 10.1016/s1473-3099(16)30519-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/28/2016] [Indexed: 12/22/2022]
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11
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Vyas AK, Trehanpati N. In Response to ‘Chemokine Patterns in Children with Acute Bacterial Infections’. Scand J Immunol 2017; 85:235. [DOI: 10.1111/sji.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. K. Vyas
- Department of Molecular and Cellular Medicine; Institute of Liver and Biliary Sciences; New Delhi India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine; Institute of Liver and Biliary Sciences; New Delhi India
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12
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Eden E, Srugo I, Gottlieb T, Navon R, Boico O, Cohen A, Bamberger E, Klein A, Oved K. Diagnostic accuracy of a TRAIL, IP-10 and CRP combination for discriminating bacterial and viral etiologies at the Emergency Department. J Infect 2016; 73:177-80. [PMID: 27255416 DOI: 10.1016/j.jinf.2016.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Eran Eden
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
| | - Isaac Srugo
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel.
| | - Tanya Gottlieb
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
| | - Roy Navon
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
| | - Olga Boico
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
| | - Asi Cohen
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
| | - Ellen Bamberger
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control Unit, Bnai-Zion Medical Center, Haifa, Israel.
| | - Adi Klein
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Kfir Oved
- MeMed Diagnostics, 5 Nahum Heth Street, Tirat Carmel, 39120, Israel.
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