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Majumder S, Li P, Das S, Nafiz TN, Kumar S, Bai G, Dellario H, Sui H, Guan Z, Curtiss R, Furuya Y, Sun W. A bacterial vesicle-based pneumococcal vaccine against influenza-mediated secondary Streptococcus pneumoniae pulmonary infection. Mucosal Immunol 2024; 17:169-181. [PMID: 38215909 PMCID: PMC11033695 DOI: 10.1016/j.mucimm.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
Streptococcus pneumoniae (Spn) is a common pathogen causing a secondary bacterial infection following influenza, which leads to severe morbidity and mortality during seasonal and pandemic influenza. Therefore, there is an urgent need to develop bacterial vaccines that prevent severe post-influenza bacterial pneumonia. Here, an improved Yersinia pseudotuberculosis strain (designated as YptbS46) possessing an Asd+ plasmid pSMV92 could synthesize high amounts of the Spn pneumococcal surface protein A (PspA) antigen and monophosphoryl lipid A as an adjuvant. The recombinant strain produced outer membrane vesicles (OMVs) enclosing a high amount of PspA protein (designated as OMV-PspA). A prime-boost intramuscular immunization with OMV-PspA induced both memory adaptive and innate immune responses in vaccinated mice, reduced the viral and bacterial burden, and provided complete protection against influenza-mediated secondary Spn infection. Also, the OMV-PspA immunization afforded significant cross-protection against the secondary Spn A66.1 infection and long-term protection against the secondary Spn D39 challenge. Our study implies that an OMV vaccine delivering Spn antigens can be a new promising pneumococcal vaccine candidate.
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Affiliation(s)
- Saugata Majumder
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Peng Li
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Shreya Das
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Tanvir Noor Nafiz
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Sudeep Kumar
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Guangchun Bai
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Hazel Dellario
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Haixin Sui
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Ziqiang Guan
- Department of Biochemistry, Duke University Medical Center, Durham, North Carolina, USA
| | - Roy Curtiss
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Yoichi Furuya
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA.
| | - Wei Sun
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, New York, USA.
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Kirk NM, Liang Y, Ly H. Comparative Pathology of Animal Models for Influenza A Virus Infection. Pathogens 2023; 13:35. [PMID: 38251342 PMCID: PMC10820042 DOI: 10.3390/pathogens13010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Animal models are essential for studying disease pathogenesis and to test the efficacy and safety of new vaccines and therapeutics. For most diseases, there is no single model that can recapitulate all features of the human condition, so it is vital to understand the advantages and disadvantages of each. The purpose of this review is to describe popular comparative animal models, including mice, ferrets, hamsters, and non-human primates (NHPs), that are being used to study clinical and pathological changes caused by influenza A virus infection with the aim to aid in appropriate model selection for disease modeling.
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Affiliation(s)
| | | | - Hinh Ly
- Department of Veterinary & Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Twin Cities, MN 55108, USA; (N.M.K.); (Y.L.)
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3
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Egorova A, Richter M, Khrenova M, Dietrich E, Tsedilin A, Kazakova E, Lepioshkin A, Jahn B, Chernyshev V, Schmidtke M, Makarov V. Pyrrolo[2,3- e]indazole as a novel chemotype for both influenza A virus and pneumococcal neuraminidase inhibitors. RSC Adv 2023; 13:18253-18261. [PMID: 37350858 PMCID: PMC10282731 DOI: 10.1039/d3ra02895j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
Influenza infections are often exacerbated by secondary bacterial infections, primarily caused by Streptococcus pneumoniae. Both respiratory pathogens have neuraminidases that support infection. Therefore, we hypothesized that dual inhibitors of viral and bacterial neuraminidases might be an advantageous strategy for treating seasonal and pandemic influenza pneumonia complicated by bacterial infections. By screening our in-house chemical library, we discovered a new chemotype that may be of interest for a further campaign to find small molecules against influenza. Our exploration of the pyrrolo[2,3-e]indazole space led to the identification of two hit compounds, 6h and 12. These molecules were well-tolerated by MDCK cells and inhibited the replication of H3N2 and H1N1 influenza A virus strains. Moreover, both compounds suppress viral and pneumococcal neuraminidases indicating their dual activity. Given its antiviral activity, pyrrolo[2,3-e]indazole has been identified as a promising scaffold for the development of novel neuraminidase inhibitors that are active against influenza A virus and S. pneumoniae.
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Affiliation(s)
- Anna Egorova
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
| | - Martina Richter
- Department of Medical Microbiology, Section of Experimental Virology, Jena University Hospital Hans-Knöll-Straße 2 07745 Jena Germany
| | - Maria Khrenova
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
- Chemistry Department, Lomonosov Moscow State University 1-3 Leninskie Gory 119991 Moscow Russia
| | - Elisabeth Dietrich
- Department of Medical Microbiology, Section of Experimental Virology, Jena University Hospital Hans-Knöll-Straße 2 07745 Jena Germany
| | - Andrey Tsedilin
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
| | - Elena Kazakova
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
| | - Alexander Lepioshkin
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
| | - Birgit Jahn
- Department of Medical Microbiology, Section of Experimental Virology, Jena University Hospital Hans-Knöll-Straße 2 07745 Jena Germany
| | - Vladimir Chernyshev
- Chemistry Department, Lomonosov Moscow State University 1-3 Leninskie Gory 119991 Moscow Russia
- Frumkin Institute of Physical Chemistry and Electrochemistry of the Russian Academy of Sciences 31-4 Leninsky Prospect 119071 Moscow Russia
| | - Michaela Schmidtke
- Department of Medical Microbiology, Section of Experimental Virology, Jena University Hospital Hans-Knöll-Straße 2 07745 Jena Germany
| | - Vadim Makarov
- Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences (Research Centre of Biotechnology RAS) 33-2 Leninsky Prospect 119071 Moscow Russia
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4
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Planer JD, Morrisey EE. After the Storm: Regeneration, Repair, and Reestablishment of Homeostasis Between the Alveolar Epithelium and Innate Immune System Following Viral Lung Injury. ANNUAL REVIEW OF PATHOLOGY 2023; 18:337-359. [PMID: 36270292 PMCID: PMC10875627 DOI: 10.1146/annurev-pathmechdis-031621-024344] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The mammalian lung has an enormous environmental-epithelial interface that is optimized to accomplish the principal function of the respiratory system, gas exchange. One consequence of evolving such a large surface area is that the lung epithelium is continuously exposed to toxins, irritants, and pathogens. Maintaining homeostasis in this environment requires a delicate balance of cellular signaling between the epithelium and innate immune system. Following injury, the epithelium can be either fully regenerated in form and function or repaired by forming dysplastic scar tissue. In this review, we describe the major mechanisms of damage, regeneration, and repair within the alveolar niche where gas exchange occurs. With a focus on viral infection, we summarize recent work that has established how epithelial proliferation is arrested during infection and how the innate immune system guides its reconstitution during recovery. The consequences of these processes going awry are also considered, with an emphasis on how this will impact postpandemic pulmonary biology and medicine.
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Affiliation(s)
- Joseph D Planer
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; ,
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward E Morrisey
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; ,
- Penn-CHOP Lung Biology Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Tang Y, Su R, Gu Q, Hu Y, Yang H. PI3K/AKT-mediated autophagy inhibition facilitates mast cell activation to enhance severe inflammatory lung injury in influenza A virus- and secondary Staphylococcus aureus-infected mice. Antiviral Res 2023; 209:105502. [PMID: 36549394 DOI: 10.1016/j.antiviral.2022.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Influenza A virus infection causes considerable morbidity and mortality each year globally, and secondary bacterial infection further exacerbates the severity and fatality of the initial viral infection. Mast cells have substantial roles in protecting the respiratory tract mucosa, while their role in viral and bacterial co-infection remains unclear. The present study revealed that secondary Staphylococcus aureus infection significantly aggravated the activation of mast cells during the initial H1N1 infection both in vivo and in vitro, which was closely related to the increased inflammatory lung injury and mortality. Meanwhile, the secondary S. aureus infection suppressed autophagy and promoted inflammatory mediators released by mast cells through activating the PI3K/Akt signaling pathway. Blocking PI3K/Akt pathway by LY294002, an inhibitor of Akt phosphorylation, could rescue autophagy and inhibit the release of inflammatory mediators. Furthermore, based on the influenza A viral and secondary bacterial infected mice model, we showed that the combination of LY294002 and antiviral drug oseltamivir could effectively reduce the inflammatory damage and pro-inflammatory cytokines releasing in lungs, recovering body weight loss and improving the survival rate from the co-infections. In conclusion, secondary bacterial infection can inhibit autophagy and stimulate mast cell activation through the PI3K/Akt pathway, which might explain why secondary bacterial infection would cause severe and fatal consequences following an initial influenza A viral infection.
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Affiliation(s)
- Yuling Tang
- Key Laboratory of Animal Epidemiology of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Ruijing Su
- Key Laboratory of Animal Epidemiology of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Qingyue Gu
- Key Laboratory of Animal Epidemiology of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Yanxin Hu
- Key Laboratory of Animal Epidemiology of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, PR China.
| | - Hanchun Yang
- Key Laboratory of Animal Epidemiology of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
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6
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Shah NN, Khan Z, Ahad H, Elderdery AY, Alomary MN, Atwah B, Alhindi Z, Alsugoor MH, Elkhalifa AME, Nabi S, Bashir SM, Yaqub T, Rather GA, Ansari MA. Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review. J Infect Public Health 2022; 15:1299-1314. [PMID: 36279686 PMCID: PMC9562622 DOI: 10.1016/j.jiph.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/01/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023] Open
Abstract
As of 25th July, 2022, global Disease burden of 575,430,244 confirmed cases and over 6,403,511 deaths have been attributed to coronavirus disease 2019 (COVID-19). Co-infections/secondary infections continue to plague patients around the world as result of the co-morbidities like diabetes mellitus, biochemical changes caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) especially significant elevation in free iron levels, immune suppression caused by SARS-CoV-2, and indiscriminate use of systemic corticosteroids for the treatment of severe COVID-19 disease. In such circumstances, opportunistic fungal infections pose significant challenge for COVID-19 disease therapy in patients with other co-morbidities. Although COVID-19-associated Mucormycosis (CAM) has been widely recognized, currently extensive research is being conducted on mucormycosis. It has been widely agreed that patients undergoing corticosteroid therapy are highly susceptible for CAM, henceforth high index of screening and intensive care and management is need of an hour in order to have favorable outcomes in these patients. Diagnosis in such cases is often delayed and eventually the disease progresses quickly which poses added burden to clinician and increases patient load in critical care units of hospitals. A vast perusal of literature indicated that patients with diabetes mellitus and those with other co-morbidities might be highly vulnerable to develop mucormycosis. In the present work, the case series of three patients presented at Chest Disease Hospital Srinagar, Jammu and Kashmir infected with CAM has been described with their epidemiological data in supplementary section. All these cases were found to be affected with co-morbidity of Diabetes Mellitus (DM) and were under corticosteroid therapy. Furthermore, given the significant death rate linked with mucormycosis and the growing understanding of the diseases significance, systematic review of the literature on CAM has been discussed and we have attempted to discuss emerging CAM and related aspects of the disease.
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Affiliation(s)
- Naveed Nazir Shah
- Department of Chest Medicine, Govt. Medical College Srinagar, Jammu & Kashmir, India
| | - Zaid Khan
- Department of Chest Medicine, Govt. Medical College Srinagar, Jammu & Kashmir, India
| | - Hashim Ahad
- Government Dental College, Srinagar, Jammu & Kashmir, India
| | - Abozer Y Elderdery
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Saudi Arabia
| | - Mohammad N Alomary
- National Centre for Biotechnology, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Banan Atwah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Zain Alhindi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mahdi H Alsugoor
- Department of Emergency Medical Services, faculty of Health Sciences, AlQunfudah, Umm Al-Qura University, Makkah 21912, Saudi Arabia
| | - Ahmed M E Elkhalifa
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia & Department of Haematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti 1158, Sudan
| | - Showket Nabi
- Large Animal Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Ethics & Jurisprudence, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama Alusteng, Srinagar, Jammu & Kashmir 190006, India
| | - Showkeen Muzamil Bashir
- Molecular biology Laboratory, Division of Veterinary Biochemistry, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama Alusteng, Srinagar, Jammu & Kashmir 190006, India.
| | - Tahir Yaqub
- Institute of Microbiology University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Gulzar Ahmed Rather
- Department of Biomedical Engineering, Sathyabama Institute of Science & Technology, Deemed to be University, Chennai, Tamil Nadu, India
| | - Mohammad Azam Ansari
- Department of Epidemic Disease Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
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7
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Abstract
Lung epithelium, the lining that covers the inner surface of the respiratory tract, is directly exposed to the environment and thus susceptible to airborne toxins, irritants, and pathogen-induced damages. In adult mammalian lungs, epithelial cells are generally quiescent but can respond rapidly to repair of damaged tissues. Evidence from experimental injury models in rodents and human clinical samples has led to the identification of these regenerative cells, as well as pathological metaplastic states specifically associated with different forms of damages. Here, we provide a compendium of cells and cell states that exist during homeostasis in normal lungs and the lineage relationships between them. Additionally, we discuss various experimental injury models currently being used to probe the cellular sources-both resident and recruited-that contribute to repair, regeneration, and remodeling following acute and chronic injuries. Finally, we discuss certain maladaptive regeneration-associated cell states and their role in disease pathogenesis.
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Affiliation(s)
- Arvind Konkimalla
- Department of Cell Biology, Duke University School of Medicine, Durham, North Carolina 27710, USA
- Medical Scientist Training Program, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Aleksandra Tata
- Department of Cell Biology, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Purushothama Rao Tata
- Department of Cell Biology, Duke University School of Medicine, Durham, North Carolina 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina 27710, USA
- Center for Advanced Genomic Technologies, Duke University, Durham, North Carolina 27710, USA
- Duke Regeneration Center, Duke University School of Medicine, Durham, North Carolina 27710, USA
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8
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Varying Viral Replication and Disease Profiles of H2N2 Influenza in Ferrets Is Associated with Virus Isolate and Inoculation Route. J Virol 2022; 96:e0073222. [PMID: 35862678 PMCID: PMC9327684 DOI: 10.1128/jvi.00732-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 1957 the world was subjected to a pandemic caused by an influenza A virus of the subtype H2N2. Although the virus disappeared in 1968, H2 viruses continue to circulate in avian reservoirs.
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Hansen F, Meade-White K, Clancy C, Rosenke R, Okumura A, Hawman DW, Feldmann F, Kaza B, Jarvis MA, Rosenke K, Feldmann H. SARS-CoV-2 reinfection prevents acute respiratory disease in Syrian hamsters but not replication in the upper respiratory tract. Cell Rep 2022; 38:110515. [PMID: 35263638 PMCID: PMC8860630 DOI: 10.1016/j.celrep.2022.110515] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022] Open
Abstract
Human cases of SARS-CoV-2 reinfection have been documented throughout the pandemic, but are likely under-reported. In the current study, we use the Syrian hamster SARS-CoV-2 model to assess reinfection with homologous WA1 and heterologous B.1.1.7 (Alpha) and B.1.351 (Beta) SARS-CoV-2 variants over time. Upon primary infection with SARS-CoV-2 WA1, hamsters rapidly develop a strong and long-lasting humoral immune response. After reinfection with homologous and heterologous SARS-CoV-2 variants, this immune response protects hamsters from clinical disease, virus replication in the lower respiratory tract, and acute lung pathology. However, reinfection leads to SARS-CoV-2 replication in the upper respiratory tract with the potential for virus shedding. Our findings indicate that reinfection results in restricted SARS-CoV-2 replication despite substantial levels of humoral immunity, denoting the potential for transmission through reinfected asymptomatic individuals.
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Affiliation(s)
- Frederick Hansen
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA
| | - Kimberly Meade-White
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA
| | - Chad Clancy
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Rebecca Rosenke
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Atsushi Okumura
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA
| | - David W Hawman
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA
| | - Friederike Feldmann
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Benjamin Kaza
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA
| | - Michael A Jarvis
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA; University of Plymouth, Plymouth, Devon, UK; The Vaccine Group Ltd, Plymouth, Devon, UK
| | - Kyle Rosenke
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA.
| | - Heinz Feldmann
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, 903 S 4(th) Street, Hamilton, MT 59840, USA.
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10
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Bacterial Coinfections Increase Mortality of Severely Ill COVID-19 Patients in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042424. [PMID: 35206609 PMCID: PMC8871991 DOI: 10.3390/ijerph19042424] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023]
Abstract
Coronavirus disease 19 (COVID-19) is an ongoing global pandemic that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity and mortality rates of COVID-19 are affected by several factors, such as respiratory diseases, diabetes, and hypertension. Bacterial coinfections are another factor that could contribute to the severity of COVID-19. Limited studies have investigated morbidity and mortality due to microbial coinfections in COVID-19 patients. Here, we retrospectively studied the effects of bacterial coinfections on intensive care unit (ICU)-admitted patients with COVID-19 in Asir province, Saudi Arabia. We analyzed electronic medical records of hospitalized patients with COVID-19 at Asir Central Hospital. A total of 34 patients were included, and the clinical data of 16 patients infected with SARS-CoV-2 only and 18 patients coinfected with SARS-CoV-2 and bacterial infections were analyzed in our study. Our data showed that the length of stay at the hospital for patients infected with both SARS-CoV-2 and bacterial infection was 35.2 days, compared to 16.2 days for patients infected with only SARS-CoV-2 (p = 0.0001). In addition, higher mortality rates were associated with patients in the coinfection group compared to the SARS-CoV-2-only infected group (50% vs. 18.7%, respectively). The study also showed that gram-negative bacteria are the most commonly isolated bacteria in COVID-19 patients. To conclude, this study found that individuals with COVID-19 who presented with bacterial infections are at higher risk for a longer stay at the hospital and potentially death. Further studies with a larger population are warranted to better understand the clinical outcomes of COVID-19 with bacterial infections.
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Shosha SH, Ajlan DI, Al-Ghatam R. Does influenza vaccination help reduce incidence of COVID-19 infection among hospital employees? Medicine (Baltimore) 2022; 101:e28479. [PMID: 35029196 PMCID: PMC8757937 DOI: 10.1097/md.0000000000028479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/15/2021] [Indexed: 01/08/2023] Open
Abstract
To facilitate the understanding of the interaction between severe acute respiratory syndrome coronavirus 2 causing the corona virus disease 2019 (COVID-19) and other pathogens causing respiratory system affection we investigated the effect of influenza vaccination on the incidence and severity of COVID-19 among members of staff working in the Bahrain Defense Force Hospital.All staff members working in the hospital between February 2020 and March 2021 were divided into 2 main groups based on whether or not they received influenza vaccination. None of the participants had received any of the COVID-19 vaccines throughout this time period. The records of each were scrutinized to see the effect of influenza vaccination on incidence and severity of COVID-19. Severity measures were: need for hospital and intensive care unit admission and total length of hospital stay.Incidence of affection with COVID-19 was much lower in the vaccinated group (3.7% vs 8.1%, P < .001). Influenza vaccination also reduced total length of hospital stay (6.2 days vs 12.7 days, P < .05) and need for intensive care unit admission among the patients.Influenza vaccine reduces both the incidence of affection as well as the overall burden of COVID-19. This is of particular importance for people working in the healthcare field during the serious COVID-19 pandemic.
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12
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Liu Y, Ling L, Wong SH, Wang MHT, Fitzgerald J, Zou X, Fang S, Liu X, Wang X, Hu W, Chan H, Wang Y, Huang D, Li Q, Wong WT, Choi G, Zou H, Hui DSC, Yu J, Tse G, Gin T, Wu WKK, Chan MTV, Zhang L. Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients. EClinicalMedicine 2021; 37:100955. [PMID: 34386745 PMCID: PMC8343259 DOI: 10.1016/j.eclinm.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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Affiliation(s)
- Yingzhi Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Lowell Ling
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Maggie HT Wang
- School of Public Health, The Chinese University of Hong Kong, Hong Kong, PR China
| | | | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Shisong Fang
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Xiaodong Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Xiansong Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wei Hu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Hung Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Yan Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dan Huang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Qing Li
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wai T Wong
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Gordon Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David SC Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tony Gin
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - William KK Wu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Matthew TV Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Lin Zhang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
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13
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Khatam‐Lashgari A, Henningsen MJ, Olsen KB, Jacobsen C, Hasselby JP, Colville‐Ebeling B, Banner J. Autopsies in pandemics - a perspective on barriers and benefits. Is it time for a revival? APMIS 2021; 129:324-339. [PMID: 33645838 PMCID: PMC8013917 DOI: 10.1111/apm.13111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023]
Abstract
Influenza virus and coronavirus pandemics regularly sweep the globe, at great cost of health and economy. Our aim was to conduct a PubMed search for autopsy studies on influenza and coronavirus to investigate the contribution of autopsies during pandemics, focussing on autopsy methods and procedures and the role of autopsy findings in pandemics. The retrieved autopsy studies generally relied on microscopy, polymerase chain reaction (PCR), immunostaining and electron microscopy. Most were small and reported on lung effects, including diffuse alveolar damage (DAD), pneumonia and tracheobronchitis. Antibiotic therapy has diminished a role for bacterial pneumonia, whereas obesity is an emerging risk factor. Autopsy studies have provided new insights into coronavirus disease 2019 (COVID-19) treatments like anti-coagulative therapy. Unfortunately, autopsies during pandemics are hampered by lack of guidelines, facilities and expertise for handling potentially infectious corpses and by widely varying recommendations for personal protective equipment and procedures. The Department of Forensic Pathology, at the Forensic Institute, at the University of Copenhagen in Denmark has, in collaboration with the Department of Pathology, Rigshospitalet, Copenhagen, initiated a prospective observational study on COVID-19-related deaths encompassing postmortem imaging, standardized autopsy procedures/reporting and extensive tissue sampling for histological, chemical, microbiological and genetic analysis. The study involves a diverse array of research groups at the University of Copenhagen, and the clinical field.
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Affiliation(s)
- Apameh Khatam‐Lashgari
- Department of Forensic MedicineSection of Forensic PathologyUniversity of CopenhagenCopenhagenDenmark
| | - Mikkel Jon Henningsen
- Department of Forensic MedicineSection of Forensic PathologyUniversity of CopenhagenCopenhagenDenmark
| | - Kristine Boisen Olsen
- Department of Forensic MedicineSection of Forensic PathologyUniversity of CopenhagenCopenhagenDenmark
| | - Christina Jacobsen
- Department of Forensic MedicineSection of Forensic PathologyUniversity of CopenhagenCopenhagenDenmark
| | - Jane Preuss Hasselby
- Department of PathologyUniversity Hospital of Copenhagen (Rigshospitalet)CopenhagenDenmark
| | | | - Jytte Banner
- Department of Forensic MedicineSection of Forensic PathologyUniversity of CopenhagenCopenhagenDenmark
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14
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Qu J, Cai Z, Liu Y, Duan X, Han S, Liu J, Zhu Y, Jiang Z, Zhang Y, Zhuo C, Liu Y, Liu Y, Liu L, Yang L. Persistent Bacterial Coinfection of a COVID-19 Patient Caused by a Genetically Adapted Pseudomonas aeruginosa Chronic Colonizer. Front Cell Infect Microbiol 2021; 11:641920. [PMID: 33816347 PMCID: PMC8010185 DOI: 10.3389/fcimb.2021.641920] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Pseudomonas aeruginosa is a biofilm-forming opportunistic pathogen which causes chronic infections in immunocompromised patients and leads to high mortality rate. It is identified as a common coinfecting pathogen in COVID-19 patients causing exacerbation of illness. In our hospital, P. aeruginosa is one of the top coinfecting bacteria identified among COVID-19 patients. We collected a strong biofilm-forming P. aeruginosa strain displaying small colony variant morphology from a severe COVID-19 patient. Genomic and transcriptomic sequencing analyses were performed with phenotypic validation to investigate its adaptation in SARS-CoV-2 infected environment. Genomic characterization predicted specific genomic islands highly associated with virulence, transcriptional regulation, and DNA restriction-modification systems. Epigenetic analysis revealed a specific N6-methyl adenine (m6A) methylating pattern including methylation of alginate, flagellar and quorum sensing associated genes. Differential gene expression analysis indicated that this isolate formed excessive biofilm by reducing flagellar formation (7.4 to 1,624.1 folds) and overproducing extracellular matrix components including CdrA (4.4 folds), alginate (5.2 to 29.1 folds) and Pel (4.8–5.5 folds). In summary, we demonstrated that P. aeuginosa clinical isolates with novel epigenetic markers could form excessive biofilm, which might enhance its antibiotic resistance and in vivo colonization in COVID-19 patients.
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Affiliation(s)
- Jiuxin Qu
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Zhao Cai
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Yumei Liu
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Xiangke Duan
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Shuhong Han
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Jihong Liu
- School of Medicine, Southern University of Science and Technology, Shenzhen, China.,Medical Research Center, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Yuao Zhu
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Zhaofang Jiang
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Yingdan Zhang
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Chao Zhuo
- The State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Liu
- Medical Research Center, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Yingxia Liu
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.,Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Lei Liu
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.,Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Liang Yang
- School of Medicine, Southern University of Science and Technology, Shenzhen, China.,Shenzhen Key Laboratory of Gene Regulation and Systems Biology, Southern University of Science and Technology, Shenzhen, China
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15
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Fernanda de Mello Costa M, Weiner AI, Vaughan AE. Basal-like Progenitor Cells: A Review of Dysplastic Alveolar Regeneration and Remodeling in Lung Repair. Stem Cell Reports 2020; 15:1015-1025. [PMID: 33065046 PMCID: PMC7560757 DOI: 10.1016/j.stemcr.2020.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022] Open
Abstract
Despite the central importance of the respiratory system, the exact mechanisms governing lung repair after severe injury remain unclear. The notion that alveolar type 2 cells (AT2s) self-renew and differentiate into alveolar type 1 cells (AT1s) does not fully encompass scenarios where these progenitors are severely affected by disease, e.g., H1N1 influenza or SARS-CoV-2 (COVID-19). Intrapulmonary p63+ progenitor cells, a rare cell type in mice but potentially encompassing more numerous classic basal cells in humans, are activated in such severe injury settings, proliferating and migrating into the injured alveolar parenchyma, providing a short-term “emergency” benefit. While the fate of these cells is controversial, most studies indicate that they represent a maladaptive repair pathway with a fate restriction toward airway cell types, rarely differentiating into AT2 or AT1 cells. Here, we discuss the role of intrapulmonary basal-like p63+ cells in alveolar regeneration and suggest a unified model to guide future studies.
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Affiliation(s)
- Maria Fernanda de Mello Costa
- School of Veterinary Medicine, Department of Biomedical Sciences, The University of Pennsylvania, 3800 Spruce Street, Philadelphia, USA; Institute for Regenerative Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, USA
| | - Aaron I Weiner
- School of Veterinary Medicine, Department of Biomedical Sciences, The University of Pennsylvania, 3800 Spruce Street, Philadelphia, USA; Perelman School of Medicine, The University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, USA; Institute for Regenerative Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, USA
| | - Andrew E Vaughan
- School of Veterinary Medicine, Department of Biomedical Sciences, The University of Pennsylvania, 3800 Spruce Street, Philadelphia, USA; Institute for Regenerative Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, USA.
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16
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Thindwa D, Garcia Quesada M, Liu Y, Bennett J, Cohen C, Knoll MD, von Gottberg A, Hayford K, Flasche S. Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality. Vaccine 2020; 38:5398-5401. [PMID: 32600911 PMCID: PMC7303659 DOI: 10.1016/j.vaccine.2020.06.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Deus Thindwa
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Maria Garcia Quesada
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Bennett
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Maria Deloria Knoll
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Kyla Hayford
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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17
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PPARα exacerbates necroptosis, leading to increased mortality in postinfluenza bacterial superinfection. Proc Natl Acad Sci U S A 2020; 117:15789-15798. [PMID: 32581129 DOI: 10.1073/pnas.2006343117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients infected with influenza are at high risk of secondary bacterial infection, which is a major proximate cause of morbidity and mortality. We have shown that in mice, prior infection with influenza results in increased inflammation and mortality upon Staphylococcus aureus infection, recapitulating the human disease. Lipidomic profiling of the lungs of superinfected mice revealed an increase in CYP450 metabolites during lethal superinfection. These lipids are endogenous ligands for the nuclear receptor PPARα, and we demonstrate that Ppara -/- mice are less susceptible to superinfection than wild-type mice. PPARα is an inhibitor of NFκB activation, and transcriptional profiling of cells isolated by bronchoalveolar lavage confirmed that influenza infection inhibits NFκB, thereby dampening proinflammatory and prosurvival signals. Furthermore, network analysis indicated an increase in necrotic cell death in the lungs of superinfected mice compared to mice infected with S. aureus alone. Consistent with this, we observed reduced NFκB-mediated inflammation and cell survival signaling in cells isolated from the lungs of superinfected mice. The kinase RIPK3 is required to induce necrotic cell death and is strongly induced in cells isolated from the lungs of superinfected mice compared to mice infected with S. aureus alone. Genetic and pharmacological perturbations demonstrated that PPARα mediates RIPK3-dependent necroptosis and that this pathway plays a central role in mortality following superinfection. Thus, we have identified a molecular circuit in which infection with influenza induces CYP450 metabolites that activate PPARα, leading to increased necrotic cell death in the lung which correlates with the excess mortality observed in superinfection.
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18
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Meilleur CE, Memarnejadian A, Shivji AN, Benoit JM, Tuffs SW, Mele TS, Singh B, Dikeakos JD, Topham DJ, Mu HH, Bennink JR, McCormick JK, Haeryfar SMM. Discordant rearrangement of primary and anamnestic CD8+ T cell responses to influenza A viral epitopes upon exposure to bacterial superantigens: Implications for prophylactic vaccination, heterosubtypic immunity and superinfections. PLoS Pathog 2020; 16:e1008393. [PMID: 32433711 PMCID: PMC7239382 DOI: 10.1371/journal.ppat.1008393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
Infection with (SAg)-producing bacteria may precede or follow infection with or vaccination against influenza A viruses (IAVs). However, how SAgs alter the breadth of IAV-specific CD8+ T cell (TCD8) responses is unknown. Moreover, whether recall responses mediating heterosubtypic immunity to IAVs are manipulated by SAgs remains unexplored. We employed wild-type (WT) and mutant bacterial SAgs, SAg-sufficient/deficient Staphylococcus aureus strains, and WT, mouse-adapted and reassortant IAV strains in multiple in vivo settings to address the above questions. Contrary to the popular view that SAgs delete or anergize T cells, systemic administration of staphylococcal enterotoxin B (SEB) or Mycoplasma arthritidis mitogen before intraperitoneal IAV immunization enlarged the clonal size of ‘select’ IAV-specific TCD8 and reshuffled the hierarchical pattern of primary TCD8 responses. This was mechanistically linked to the TCR Vβ makeup of the impacted clones rather than their immunodominance status. Importantly, SAg-expanded TCD8 retained their IFN-γ production and cognate cytolytic capacities. The enhancing effect of SEB on immunodominant TCD8 was also evident in primary responses to vaccination with heat-inactivated and live attenuated IAV strains administered intramuscularly and intranasally, respectively. Interestingly, in prime-boost immunization settings, the outcome of SEB administration depended strictly upon the time point at which this SAg was introduced. Accordingly, SEB injection before priming raised CD127highKLRG1low memory precursor frequencies and augmented the anamnestic responses of SEB-binding TCD8. By comparison, introducing SEB before boosting diminished recall responses to IAV-derived epitopes drastically and indiscriminately. This was accompanied by lower Ki67 and higher Fas, LAG-3 and PD-1 levels consistent with a pro-apoptotic and/or exhausted phenotype. Therefore, SAgs can have contrasting impacts on anti-IAV immunity depending on the naïve/memory status and the TCR composition of exposed TCD8. Finally, local administration of SEB or infection with SEB-producing S. aureus enhanced pulmonary TCD8 responses to IAV. Our findings have clear implications for superinfections and prophylactic vaccination. Exposure to bacterial superantigens (SAgs) is often a consequence of infection with common Gram-positive bacteria causing septic and toxic shock or food poisoning. How SAgs affect the magnitude, breadth and quality of infection/vaccine-elicited CD8+ T cell (TCD8) responses to respiratory viral pathogens, including influenza A viruses (IAVs), is far from clear. Also importantly, superinfections with IAVs and SAg-producing bacteria are serious clinical occurrences during seasonal and pandemic flu and require urgent attention. We demonstrate that two structurally distinct SAgs, including staphylococcal enterotoxin B (SEB), unexpectedly enhance primary TCD8 responses to ‘select’ IAV-derived epitopes depending on the TCR makeup of the responding clones. Intriguingly, the timing of exposure to SEB dictates the outcome of prime-boost immunization. Seeing a SAg before priming raises memory precursor frequencies and augments anamnestic TCD8 responses. Conversely, a SAg encounter before boosting renders TCD8 prone to death or exhaustion and impedes recall responses, thus likely compromising heterosubtypic immunity to IAVs. Finally, local exposure to SEB increases the pulmonary response of immunodominant IAV-specific TCD8. These findings shed new light on how bacterial infections and SAgs influence the effectiveness of anti-IAV TCD8 responses, and have, as such, wide-ranging implications for preventative vaccination and infection control.
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Affiliation(s)
- Courtney E. Meilleur
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Arash Memarnejadian
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Adil N. Shivji
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Jenna M. Benoit
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Stephen W. Tuffs
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Tina S. Mele
- Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Bhagirath Singh
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
| | - Jimmy D. Dikeakos
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - David J. Topham
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Hong-Hua Mu
- Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Jack R. Bennink
- Viral Immunology Section, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - John K. McCormick
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
| | - S. M. Mansour Haeryfar
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
- Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, Ontario, Canada
- * E-mail:
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19
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Daoud A, Laktineh A, Macrander C, Mushtaq A, Soubani AO. Pulmonary complications of influenza infection: a targeted narrative review. Postgrad Med 2019; 131:299-308. [PMID: 30845866 DOI: 10.1080/00325481.2019.1592400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Severe influenza infection represents a leading cause of global morbidity and mortality. Several clinical syndromes that involve a number of organs may be associated with Influenza infection. However, lower respiratory complications remain the most common and serious sequel of influenza infection. These include influenza pneumonia, superinfection with bacteria and fungi, exacerbation of underlying lung disease and ARDS. This review analyzes the available literature on the epidemiology and clinical considerations of these conditions. It also provides an overview of the effects of type of influenza, antiviral therapy, vaccination and other therapies on the outcome of these complications.
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Affiliation(s)
- Asil Daoud
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Amir Laktineh
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Corey Macrander
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Ammara Mushtaq
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Ayman O Soubani
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
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20
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Rijkers G, Croon S, Nguyen TA. Rocking Pneumonia and the Boogie Woogie Flu. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10311819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The relation between pneumonia and influenza is regularly addressed in modern music. Epidemiological data obtained during influenza pandemics, as well as during seasonal influenza, illustrate and underscore this association. Even though the number of pneumonia cases are generally under-reported and blood tests show a lack of sensitivity, a clear link between influenza and pneumonia can still be observed. In fact, the majority of mortality during influenza pandemics is due to pneumonia caused by a bacterial superinfection, in most cases Streptococcus pneumoniae. Vaccination is a powerful tool to prevent the development of both influenza and pneumonia in children, as well as in the elderly. Cellular and molecular data show that influenza can lead to changes in the integrity of lung epithelial cells, including desialysation of carbohydrate moieties, which favour attachment and invasion of S. pneumoniae. Further elucidation of these mechanisms could lead to targeted intervention strategies, in which universal influenza vaccines could play a role.
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Affiliation(s)
- Ger Rijkers
- Science Department, University College Roosevelt, Middelburg, Netherlands
| | - Sophie Croon
- Science Department, University College Roosevelt, Middelburg, Netherlands
| | - Thuc Anh Nguyen
- Science Department, University College Roosevelt, Middelburg, Netherlands
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21
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Jia L, Zhao J, Yang C, Liang Y, Long P, Liu X, Qiu S, Wang L, Xie J, Li H, Liu H, Guo W, Wang S, Li P, Zhu B, Hao R, Ma H, Jiang Y, Song H. Severe Pneumonia Caused by Coinfection With Influenza Virus Followed by Methicillin-Resistant Staphylococcus aureus Induces Higher Mortality in Mice. Front Immunol 2019; 9:3189. [PMID: 30761162 PMCID: PMC6364753 DOI: 10.3389/fimmu.2018.03189] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/31/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Coinfection with influenza virus and bacteria is a major cause of high mortality during flu pandemics. Understanding the mechanisms behind such coinfections is of utmost importance both for the clinical treatment of influenza and the prevention and control of epidemics. Methods: To investigate the cause of high mortality during flu pandemics, we performed coinfection experiments with H1N1 influenza virus and Staphylococcus aureus in which mice were infected with bacteria at time points ranging from 0 to 7 days after infection with influenza virus. Results: The mortality rates of mice infected with bacteria were highest 0-3 days after infection with influenza virus; lung tissues extracted from these co-infected mice showed higher infiltrating cells and thicker lung parenchyma than lung samples from coinfected mice in which influenza virus was introduced at other times and sequences. The levels of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-8, and IL-6 in the 0-3 day coinfected group were significantly higher than those in the other groups (p < 0.01), as were the mRNA levels of IFN-γ, IL-6, and TNF-α. Coinfection with influenza virus and S. aureus led to high mortality rates that are directly dependent on the sequence and timing of infection by both pathogens. Moreover, coinfection following this particular schedule induced severe pneumonia, leading to increased mortality. Conclusions: Our data suggest that prevention of bacterial co-infection in the early stage of influenza virus infection is critical to reducing the risk of clinical mortality.
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Affiliation(s)
- Leili Jia
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Jiangyun Zhao
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Chaojie Yang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yuan Liang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Pengwei Long
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.,Department of Health Care, Chinese PLA Joint Staff Headquarters Guard Bureau, Beijing, China
| | - Xiao Liu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Shaofu Qiu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Ligui Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Jing Xie
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hao Li
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China
| | - Hongbo Liu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Weiguang Guo
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Shan Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Peng Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | | | - Rongzhang Hao
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hui Ma
- The 6th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yong Jiang
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hongbin Song
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
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22
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Hanada S, Pirzadeh M, Carver KY, Deng JC. Respiratory Viral Infection-Induced Microbiome Alterations and Secondary Bacterial Pneumonia. Front Immunol 2018; 9:2640. [PMID: 30505304 PMCID: PMC6250824 DOI: 10.3389/fimmu.2018.02640] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/26/2018] [Indexed: 12/18/2022] Open
Abstract
Influenza and other respiratory viral infections are the most common type of acute respiratory infection. Viral infections predispose patients to secondary bacterial infections, which often have a more severe clinical course. The mechanisms underlying post-viral bacterial infections are complex, and include multifactorial processes mediated by interactions between viruses, bacteria, and the host immune system. Studies over the past 15 years have demonstrated that unique microbial communities reside on the mucosal surfaces of the gastrointestinal tract and the respiratory tract, which have both direct and indirect effects on host defense against viral infections. In addition, antiviral immune responses induced by acute respiratory infections such as influenza are associated with changes in microbial composition and function (“dysbiosis”) in the respiratory and gastrointestinal tract, which in turn may alter subsequent immune function against secondary bacterial infection or alter the dynamics of inter-microbial interactions, thereby enhancing the proliferation of potentially pathogenic bacterial species. In this review, we summarize the literature on the interactions between host microbial communities and host defense, and how influenza, and other acute respiratory viral infections disrupt these interactions, thereby contributing to the pathogenesis of secondary bacterial infections.
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Affiliation(s)
- Shigeo Hanada
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.,Toranomon Hospital, Tokyo, Japan
| | - Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.,Veterans Affairs Healthcare System, Ann Arbor, MI, United States
| | - Kyle Y Carver
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.,Veterans Affairs Healthcare System, Ann Arbor, MI, United States
| | - Jane C Deng
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.,Veterans Affairs Healthcare System, Ann Arbor, MI, United States
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23
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Gopal R, Lee B, McHugh KJ, Rich HE, Ramanan K, Mandalapu S, Clay ME, Seger PJ, Enelow RI, Manni ML, Robinson KM, Rangel-Moreno J, Alcorn JF. STAT2 Signaling Regulates Macrophage Phenotype During Influenza and Bacterial Super-Infection. Front Immunol 2018; 9:2151. [PMID: 30337919 PMCID: PMC6178135 DOI: 10.3389/fimmu.2018.02151] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/31/2018] [Indexed: 01/14/2023] Open
Abstract
Influenza is a common respiratory virus that infects between 5 and 20% of the US population and results in 30,000 deaths annually. A primary cause of influenza-associated death is secondary bacterial pneumonia. We have previously shown that influenza induces type I interferon (IFN)-mediated inhibition of Type 17 immune responses, resulting in exacerbation of bacterial burden during influenza and Staphylococcus aureus super-infection. In this study, we investigated the role of STAT2 signaling during influenza and influenza-bacterial super-infection in mice. Influenza-infected STAT2−/− mice had increased morbidity, viral burden, and inflammation when compared to wild-type mice. Despite an exaggerated inflammatory response to influenza infection, we found increased bacterial control and survival in STAT2 deficient mice during influenza-MRSA super-infection compared to controls. Further, we found that increased bacterial clearance during influenza-MRSA super-infection is not due to rescue of Type 17 immunity. Absence of STAT2 was associated with increased accumulation of M1, M2 and M1/M2 co-expressing macrophages during influenza-bacterial super-infection. Neutralization of IFNγ (M1) and/or Arginase 1 (M2) impaired bacterial clearance in Stat2−/− mice during super-infection, demonstrating that pulmonary macrophages expressing a mixed M1/M2 phenotype promote bacterial control during influenza-bacterial super-infection. Together, these results suggest that the STAT2 signaling is involved in suppressing macrophage activation and bacterial control during influenza-bacterial super-infection. Further, these studies reveal novel mechanistic insight into the roles of macrophage subpopulations in pulmonary host defense.
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Affiliation(s)
- Radha Gopal
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Benjamin Lee
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, United States
| | - Kevin J McHugh
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Helen E Rich
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Krishnaveni Ramanan
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sivanarayana Mandalapu
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michelle E Clay
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Philip J Seger
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Richard I Enelow
- Department of Medicine, Dartmouth Medical School, Lebanon, PA, United States
| | - Michelle L Manni
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Keven M Robinson
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Javier Rangel-Moreno
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - John F Alcorn
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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24
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Denney L, Ho LP. The role of respiratory epithelium in host defence against influenza virus infection. Biomed J 2018; 41:218-233. [PMID: 30348265 PMCID: PMC6197993 DOI: 10.1016/j.bj.2018.08.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022] Open
Abstract
The respiratory epithelium is the major interface between the environment and the host. Sophisticated barrier, sensing, anti-microbial and immune regulatory mechanisms have evolved to help maintain homeostasis and to defend the lung against foreign substances and pathogens. During influenza virus infection, these specialised structural cells and populations of resident immune cells come together to mount the first response to the virus, one which would play a significant role in the immediate and long term outcome of the infection. In this review, we focus on the immune defence machinery of the respiratory epithelium and briefly explore how it repairs and regenerates after infection.
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Affiliation(s)
- Laura Denney
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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25
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Differential Ability of Pandemic and Seasonal H1N1 Influenza A Viruses To Alter the Function of Human Neutrophils. mSphere 2018; 3:mSphere00567-17. [PMID: 29299535 PMCID: PMC5750393 DOI: 10.1128/mspheredirect.00567-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
A long-standing notion is that IAV inhibits normal neutrophil function and thereby predisposes individuals to secondary bacterial infections. Here we report that seasonal H1N1 IAV primes human neutrophils for enhanced killing of Staphylococcus aureus. Moreover, we provide a comprehensive view of the changes in neutrophil gene expression during interaction with seasonal or pandemic IAV and report how these changes relate to functions such as bactericidal activity. This study expands our knowledge of IAV interactions with human neutrophils. Neutrophils are essential cells of host innate immunity. Although the role of neutrophils in defense against bacterial and fungal infections is well characterized, there is a relative paucity of information about their role against viral infections. Influenza A virus (IAV) infection can be associated with secondary bacterial coinfection, and it has long been posited that the ability of IAV to alter normal neutrophil function predisposes individuals to secondary bacterial infections. To better understand this phenomenon, we evaluated the interaction of pandemic or seasonal H1N1 IAV with human neutrophils isolated from healthy persons. These viruses were ingested by human neutrophils and elicited changes in neutrophil gene expression that are consistent with an interferon-mediated immune response. The viability of neutrophils following coculture with either pandemic or seasonal H1N1 IAV was similar for up to 18 h of culture. Notably, neutrophil exposure to seasonal (but not pandemic) IAV primed these leukocytes for enhanced functions, including production of reactive oxygen species and bactericidal activity. Taken together, our results are at variance with the universal idea that IAV impairs neutrophil function directly to predispose individuals to secondary bacterial infections. Rather, we suggest that some strains of IAV prime neutrophils for enhanced bacterial clearance. IMPORTANCE A long-standing notion is that IAV inhibits normal neutrophil function and thereby predisposes individuals to secondary bacterial infections. Here we report that seasonal H1N1 IAV primes human neutrophils for enhanced killing of Staphylococcus aureus. Moreover, we provide a comprehensive view of the changes in neutrophil gene expression during interaction with seasonal or pandemic IAV and report how these changes relate to functions such as bactericidal activity. This study expands our knowledge of IAV interactions with human neutrophils.
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26
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27
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Siemens N, Oehmcke-Hecht S, Mettenleiter TC, Kreikemeyer B, Valentin-Weigand P, Hammerschmidt S. Port d'Entrée for Respiratory Infections - Does the Influenza A Virus Pave the Way for Bacteria? Front Microbiol 2017; 8:2602. [PMID: 29312268 PMCID: PMC5742597 DOI: 10.3389/fmicb.2017.02602] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/13/2017] [Indexed: 12/12/2022] Open
Abstract
Bacterial and viral co-infections of the respiratory tract are life-threatening and present a global burden to the global community. Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes are frequent colonizers of the upper respiratory tract. Imbalances through acquisition of seasonal viruses, e.g., Influenza A virus, can lead to bacterial dissemination to the lower respiratory tract, which in turn can result in severe pneumonia. In this review, we summarize the current knowledge about bacterial and viral co-infections of the respiratory tract and focus on potential experimental models suitable for mimicking this disease. Transmission of IAV and pneumonia is mainly modeled by mouse infection. Few studies utilizing ferrets, rats, guinea pigs, rabbits, and non-human primates are also available. The knowledge gained from these studies led to important discoveries and advances in understanding these infectious diseases. Nevertheless, mouse and other infection models have limitations, especially in translation of the discoveries to humans. Here, we suggest the use of human engineered lung tissue, human ex vivo lung tissue, and porcine models to study respiratory co-infections, which might contribute to a greater translation of the results to humans and improve both, animal and human health.
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Affiliation(s)
- Nikolai Siemens
- Department of Molecular Genetics and Infection Biology, Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja Oehmcke-Hecht
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Thomas C. Mettenleiter
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institute, Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Peter Valentin-Weigand
- Center for Infection Medicine, Institute for Microbiology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sven Hammerschmidt
- Department of Molecular Genetics and Infection Biology, Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
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28
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Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Front Microbiol 2017; 8:1041. [PMID: 28690590 PMCID: PMC5481322 DOI: 10.3389/fmicb.2017.01041] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/24/2017] [Indexed: 12/16/2022] Open
Abstract
Lower and upper respiratory infections are the fourth highest cause of global mortality (Lozano et al., 2012). Epidemic and pandemic outbreaks of respiratory infection are a major medical concern, often causing considerable disease and a high death toll, typically over a relatively short period of time. Influenza is a major cause of epidemic and pandemic infection. Bacterial co/secondary infection further increases morbidity and mortality of influenza infection, with Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus reported as the most common causes. With increased antibiotic resistance and vaccine evasion it is important to monitor the epidemiology of pathogens in circulation to inform clinical treatment and development, particularly in the setting of an influenza epidemic/pandemic.
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Affiliation(s)
- Denise E. Morris
- Infectious Disease Epidemiology Group, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, Institute for Life Sciences, University of Southampton, University Hospital Southampton Foundation NHS TrustSouthampton, United Kingdom
| | - David W. Cleary
- Infectious Disease Epidemiology Group, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, Institute for Life Sciences, University of Southampton, University Hospital Southampton Foundation NHS TrustSouthampton, United Kingdom
| | - Stuart C. Clarke
- Infectious Disease Epidemiology Group, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, Institute for Life Sciences, University of Southampton, University Hospital Southampton Foundation NHS TrustSouthampton, United Kingdom
- Global Health Research Institute, University of SouthamptonSouthampton, United Kingdom
- NIHR Southampton Respiratory Biomedical Research UnitSouthampton, United Kingdom
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29
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Pociask DA, Robinson KM, Chen K, McHugh KJ, Clay ME, Huang GT, Benos PV, Janssen-Heininger YMW, Kolls JK, Anathy V, Alcorn JF. Epigenetic and Transcriptomic Regulation of Lung Repair during Recovery from Influenza Infection. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:851-863. [PMID: 28193481 DOI: 10.1016/j.ajpath.2016.12.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/07/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
Seasonal and pandemic influenza is a cause of morbidity and mortality worldwide. Most people infected with influenza virus display mild-to-moderate disease phenotypes and recover within a few weeks. Influenza is known to cause persistent alveolitis in animal models; however, little is known about the molecular pathways involved in this phenotype. We challenged C57BL/6 mice with influenza A/PR/8/34 and examined lung pathologic processes and inflammation, as well as transcriptomic and epigenetic changes at 21 to 60 days after infection. Influenza induced persistent parenchymal lung inflammation, alveolar epithelial metaplasia, and epithelial endoplasmic reticulum stress that were evident after the clearance of virus and resolution of morbidity. Influenza infection induced robust changes in the lung transcriptome, including a significant impact on inflammatory and extracellular matrix protein expression. Despite the robust changes in lung gene expression, preceding influenza (21 days) did not exacerbate secondary Staphylococcus aureus infection. Finally, we examined the impact of influenza on miRNA expression in the lung and found an increase in miR-155. miR-155 knockout mice recovered from influenza infection faster than controls and had decreased lung inflammation and endoplasmic reticulum stress. These data illuminate the dynamic molecular changes in the lung in the weeks after influenza infection and characterize the repair process, identifying a novel role for miR-155.
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Affiliation(s)
- Derek A Pociask
- Department of Pulmonary Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana; Richard K. Mellon Foundation Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Keven M Robinson
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kong Chen
- Richard K. Mellon Foundation Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Kevin J McHugh
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Michelle E Clay
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Grace T Huang
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; PhD Program in Computational Biology, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Panayiotis V Benos
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Jay K Kolls
- Richard K. Mellon Foundation Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Vikas Anathy
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - John F Alcorn
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
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30
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Tarabichi Y, Li K, Hu S, Nguyen C, Wang X, Elashoff D, Saira K, Frank B, Bihan M, Ghedin E, Methé BA, Deng JC. The administration of intranasal live attenuated influenza vaccine induces changes in the nasal microbiota and nasal epithelium gene expression profiles. MICROBIOME 2015; 3:74. [PMID: 26667497 PMCID: PMC4678663 DOI: 10.1186/s40168-015-0133-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 11/12/2015] [Indexed: 05/08/2023]
Abstract
BACKGROUND Viral infections such as influenza have been shown to predispose hosts to increased colonization of the respiratory tract by pathogenic bacteria and secondary bacterial pneumonia. To examine how viral infections and host antiviral immune responses alter the upper respiratory microbiota, we analyzed nasal bacterial composition by 16S ribosomal RNA (rRNA) gene sequencing in healthy adults at baseline and at 1 to 2 weeks and 4 to 6 weeks following instillation of live attenuated influenza vaccine or intranasal sterile saline. A subset of these samples was submitted for microarray host gene expression profiling. RESULTS We found that live attenuated influenza vaccination led to significant changes in microbial community structure, diversity, and core taxonomic membership as well as increases in the relative abundances of Staphylococcus and Bacteroides genera (both p < 0.05). Hypergeometric testing for the enrichment of gene ontology terms in the vaccinated group reflected a robust up-regulation of type I and type II interferon-stimulated genes in the vaccinated group relative to controls. Translational murine studies showed that poly I:C administration did in fact permit greater nasal Staphylococcus aureus persistence, a response absent in interferon alpha/beta receptor deficient mice. CONCLUSIONS Collectively, our findings demonstrate that although the human nasal bacterial community is heterogeneous and typically individually robust, activation of a type I interferon (IFN)-mediated antiviral response may foster the disproportionate emergence of potentially pathogenic species such as S. aureus. TRIAL REGISTRATION This study was registered with Clinicaltrials.gov on 11/3/15, NCT02597647 .
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Affiliation(s)
- Y Tarabichi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen SOM at UCLA, 37-131 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
| | - K Li
- Department of Human Genome Medicine, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
- Department of Microbial and Environmental Genomics, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
| | - S Hu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen SOM at UCLA, 37-131 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
| | - C Nguyen
- Department of Medicine, UCLA, Los Angeles, CA, USA.
| | - X Wang
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA.
| | - D Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA.
| | - K Saira
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Present address: Infectious Disease Research, Southern Research Institute, Birmingham, AL, USA.
| | - Bryan Frank
- Department of Human Genome Medicine, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
- Department of Microbial and Environmental Genomics, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Monika Bihan
- Department of Human Genome Medicine, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
- Department of Microbial and Environmental Genomics, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
| | - E Ghedin
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Biology, Center for Genomics and Systems Biology, Global Institute of Public Health, New York University, New York, NY, USA.
| | - Barbara A Methé
- Department of Human Genome Medicine, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
- Department of Microbial and Environmental Genomics, J. Craig Venter Institute, 9704 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Jane C Deng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen SOM at UCLA, 37-131 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
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31
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Wu W, Zhang W, Duggan ES, Booth JL, Zou MH, Metcalf JP. RIG-I and TLR3 are both required for maximum interferon induction by influenza virus in human lung alveolar epithelial cells. Virology 2015; 482:181-8. [PMID: 25880109 PMCID: PMC4461467 DOI: 10.1016/j.virol.2015.03.048] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 02/01/2023]
Abstract
Pattern recognition receptors, such as retinoic acid-inducible protein I (RIG-I), Toll-like receptors 3 and 7 (TLR3 and 7), and nucleotide-binding oligomerization domain containing protein 2 (NOD2), play important roles in the recognition of influenza A virus (IAV), but their role in interferon (IFN) induction is still unclear, particularly in human lung. We investigated IFN induction by IAV in the A549 cell line as well as in primary human alveolar epithelial cells (AEC). TLR3/7, NOD2, RIG-I, and IFN expression levels were measured by qRT-PCR and ELISA in cells infected with IAV PR8. We found that TLR7 and NOD2 were not involved in IFN induction by IAV in these cells. Neither RIG-I nor TLR3 siRNA alone completely blocked IFN induction. However, double knockdown of RIG-I and TLR3 completely inhibited IFN induction by influenza. Thus, signaling through both RIG-I and TLR3 is important for IFN induction by IAV in human lung AEC.
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Affiliation(s)
- Wenxin Wu
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wei Zhang
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elizabeth S Duggan
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Leland Booth
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ming-Hui Zou
- Section of Molecular Medicine, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jordan P Metcalf
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Veterans Affairs Medical Center, Oklahoma City, OK, USA.
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Metzger DW, Furuya Y, Salmon SL, Roberts S, Sun K. Limited Efficacy of Antibacterial Vaccination Against Secondary Serotype 3 Pneumococcal Pneumonia Following Influenza Infection. J Infect Dis 2015; 212:445-52. [PMID: 25649173 DOI: 10.1093/infdis/jiv066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/26/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Secondary bacterial infections following influenza represent a major cause of mortality in the human population, which, in turn, has led to a call for stockpiling of bacterial vaccines for pandemic preparedness. METHODS To investigate the efficacy of bacterial vaccination for protection against secondary pneumococcal infection, mice were immunized with pneumococcal capsular polysaccharide conjugate vaccine, and then sequentially coinfected 5 weeks later with PR8 influenza virus and A66.1 Streptococcus pneumoniae. RESULTS In the absence of influenza virus exposure, vaccination with polysaccharide conjugate vaccine was highly effective, as indicated by 100% survival from lethal pneumococcal pneumonia and 10 000-fold greater efficiency in clearance of bacteria from the lung compared to unvaccinated mice. Enhanced clearance after vaccination was dependent upon Fc receptor (FcR) expression. However, following influenza, <40% of vaccinated mice survived bacterial coinfection and FcR-dependent clearance of antibody-opsonized bacteria reduced bacterial levels in the lungs only 5-10 fold. No differences in lung myeloid cell numbers or in FcR cell surface expression were observed following influenza. CONCLUSIONS The results show that induction of antibacterial humoral immunity is only partially effective in protection against secondary bacterial infections that occur following influenza, and suggest that additional therapeutic strategies to overcome defective antibacterial immunity should be explored.
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Affiliation(s)
- Dennis W Metzger
- Center for Immunology and Microbial Disease, Albany Medical College, New York
| | - Yoichi Furuya
- Center for Immunology and Microbial Disease, Albany Medical College, New York
| | - Sharon L Salmon
- Center for Immunology and Microbial Disease, Albany Medical College, New York
| | - Sean Roberts
- Center for Immunology and Microbial Disease, Albany Medical College, New York
| | - Keer Sun
- Center for Immunology and Microbial Disease, Albany Medical College, New York
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Mina MJ, Klugman KP, Rosch JW, McCullers JA. Live attenuated influenza virus increases pneumococcal translocation and persistence within the middle ear. J Infect Dis 2014; 212:195-201. [PMID: 25505300 DOI: 10.1093/infdis/jiu804] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/05/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Infection with influenza A virus (IAV) increases susceptibility to respiratory bacterial infections, resulting in increased bacterial carriage and complications such acute otitis media, pneumonia, bacteremia, and meningitis. Recently, vaccination with live attenuated influenza virus (LAIV) was reported to enhance subclinical bacterial colonization within the nasopharynx, similar to IAV. Although LAIV does not predispose to bacterial pneumonia, whether it may alter bacterial transmigration toward the middle ear, where it could have clinically relevant implications, has not been investigated. METHODS BALB/c mice received LAIV or phosphate-buffered saline 1 or 7 days before or during pneumococcal colonization with either of 2 clinical isolates, 19F or 7F. Middle ear bacterial titers were monitored daily via in vivo imaging. RESULTS LAIV increased bacterial transmigration to and persistence within the middle ear. When colonization followed LAIV inoculation, a minimum LAIV incubation period of 4 days was required before bacterial transmigration commenced. CONCLUSIONS While LAIV vaccination is safe and effective at reducing IAV and coinfection with influenza virus and bacteria, LAIV may increase bacterial transmigration to the middle ear and could thus increase the risk of clinically relevant acute otitis media. These data warrant further investigations into interactions between live attenuated viruses and naturally colonizing bacterial pathogens.
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Affiliation(s)
- Michael J Mina
- Medical Scientist Training Program, Emory University School of Medicine Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Keith P Klugman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason W Rosch
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jonathan A McCullers
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
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Fujikura Y, Kawano S, Kouzaki Y, Shinoda M, Hara Y, Shinkai M, Kanoh S, Kawana A. The (H1N1) 2009 pandemic influenza pneumonia among adult patients in Japan. Jpn J Infect Dis 2014; 67:100-4. [PMID: 24647251 DOI: 10.7883/yoken.67.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The recent H1N1 influenza pandemic involved several cases of influenza pneumonia. Although influenza pneumonia may have occurred more frequently in fatal cases, the clinical characteristics of influenza pneumonia in Japan remain unclear. We conducted a retrospective cohort study of adult patients with influenza pneumonia, for which questionnaires were sent to respiratory physicians working in 2,491 hospitals across Japan. Questionnaires were returned by 994 physicians (39.9%), providing data on 346 influenza pneumonia cases. The case-fatality ratio was 8.2% (27 cases). Pure influenza viral pneumonia was observed in 94 cases, which were most frequently young adults with chief complaints of non-productive cough and dyspnea. Radiological imaging showed diffuse ground-glass opacity. Corticosteroid therapy and mechanical ventilation were more frequently used for pure influenza viral pneumonia, but these modalities were not correlated with poor treatment outcomes. Anti-influenza antiviral drugs were prescribed in 335 cases (96.8%). In the recent pandemic in Japan, several pure influenza viral pneumonia cases were observed, but we found no variances in mortality between the different types of pneumonia. Almost all cases were treated with anti-influenza antiviral drugs, which may have contributed to its relatively low mortality rate.
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Affiliation(s)
- Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
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Nicholls JM, Tsai PN, Chan RW, Hui KP, Chan MC, Malik Peiris J, Chan K, Yuen K, To KK. Fatal H7N9 pneumonia complicated by viral infection of a prosthetic cardiac valve – An autopsy study. J Clin Virol 2014; 61:466-9. [DOI: 10.1016/j.jcv.2014.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/06/2014] [Indexed: 01/01/2023]
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Brown TI, Collie DS, Shaw DJ, Rzechorzek NM, Sallenave JM. Sheep lung segmental delivery strategy demonstrates adenovirus priming of local lung responses to bacterial LPS and the role of elafin as a response modulator. PLoS One 2014; 9:e107590. [PMID: 25216250 PMCID: PMC4162618 DOI: 10.1371/journal.pone.0107590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/15/2014] [Indexed: 11/18/2022] Open
Abstract
Viral lung infections increase susceptibility to subsequent bacterial infection. We questioned whether local lung administration of recombinant adenoviral vectors in the sheep would alter the susceptibility of the lung to subsequent challenge with bacterial lipopolysaccharide (LPS). We further questioned whether local lung expression of elafin, a locally produced alarm anti-LPS/anti-bacterial molecule, would modulate the challenge response. We established that adenoviral vector treatment primed the lung for an enhanced response to bacterial LPS. Whereas this local effect appeared to be independent of the transgene used (Ad-o-elafin or Ad-GFP), Ad-o-elafin treated sheep demonstrated a more profound lymphopenia in response to local lung administration of LPS. The local influence of elafin in modulating the response to LPS was restricted to maintaining neutrophil myeloperoxidase activity, and levels of alveolar macrophage and neutrophil phagocytosis at higher levels post-LPS. Adenoviral vector-bacterial synergism exists in the ovine lung and elafin expression modulates such synergism both locally and systemically.
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Affiliation(s)
- Thomas I. Brown
- University of Edinburgh, Medical School, Edinburgh, Scotland, United Kingdom
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, United Kingdom
| | - David S. Collie
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, United Kingdom
- * E-mail:
| | - Darren J. Shaw
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, United Kingdom
| | - Nina M. Rzechorzek
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, United Kingdom
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Christopoulou I, Roose K, Ibañez LI, Saelens X. Influenza vaccines to control influenza-associated bacterial infection: where do we stand? Expert Rev Vaccines 2014; 14:55-67. [DOI: 10.1586/14760584.2015.957191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mina MJ, Klugman KP. The role of influenza in the severity and transmission of respiratory bacterial disease. THE LANCET RESPIRATORY MEDICINE 2014; 2:750-63. [PMID: 25131494 DOI: 10.1016/s2213-2600(14)70131-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Infections with influenza viruses and respiratory bacteria each contribute substantially to the global burden of morbidity and mortality. Simultaneous or sequential infection with these pathogens manifests in complex and difficult-to-treat disease processes that need extensive antimicrobial therapy and cause substantial excess mortality, particularly during annual influenza seasons and pandemics. At the host level, influenza viruses prime respiratory mucosal surfaces for excess bacterial acquisition and this supports increased carriage density and dissemination to the lower respiratory tract, while greatly constraining innate and adaptive antibacterial defences. Driven by virus-mediated structural modifications, aberrant immunological responses to sequential infection, and excessive immunopathological responses, co-infections are noted by short-term and long-term departures from immune homoeostasis, inhibition of appropriate pathogen recognition, loss of tolerance to tissue damage, and general increases in susceptibility to severe bacterial disease. At the population level, these effects translate into increased horizontal bacterial transmission and excess use of antimicrobial therapies. With increasing concerns about future possible influenza pandemics, the past decade has seen rapid advances in our understanding of these interactions. In this Review, we discuss the epidemiological and clinical importance of influenza and respiratory bacterial co-infections, including the foundational efforts that laid the groundwork for today's investigations, and detail the most important and current advances in our understanding of the structural and immunological mechanisms underlying the pathogenesis of co-infection. We describe and interpret what is known in sequence, from transmission and phenotypic shifts in bacterial dynamics to the immunological, cellular, and molecular modifications that underlie these processes, and propose avenues of further research that might be most valuable for prevention and treatment strategies to best mitigate excess disease during future influenza pandemics.
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Affiliation(s)
- Michael J Mina
- Rollins School of Public Health, Department of Global Health, Emory University, Atlanta, GA, USA; Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
| | - Keith P Klugman
- Rollins School of Public Health, Department of Global Health, Emory University, Atlanta, GA, USA
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Gotts JE, Abbott J, Matthay MA. Influenza causes prolonged disruption of the alveolar-capillary barrier in mice unresponsive to mesenchymal stem cell therapy. Am J Physiol Lung Cell Mol Physiol 2014; 307:L395-406. [PMID: 25038188 DOI: 10.1152/ajplung.00110.2014] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Viral pneumonia is a major cause of acute respiratory distress syndrome (ARDS). Anti-inflammatory therapies for viral-induced lung injury show promise in preclinical models. Mesenchymal stem/stromal cells (MSCs) are multipotent, self-renewing cells that secrete anti-inflammatory cytokines and epithelial and endothelial growth factors. We inoculated mice intranasally with influenza A (murine-adapted Puerto Rico/8/34) or PBS, and the mice were killed at multiple time points after infection for measures of lung injury and viral load. We report that influenza induces marked, long-lasting dysfunction of the alveolar-capillary barrier peaking at 1 wk but lasting longer than 3 wk postinfection. Weight loss, commonly employed as a criterion for euthanasia (and hence "survival"), was found to be poorly predictive of the severity of lung injury at its peak; rather, persistent weight loss 11 days postinfection identified mice with impaired injury resolution. Murine and human bone marrow-derived MSCs (obtained from the National Institutes of Health repository) were then administered intravenously during the rapid phase of injury progression. Murine MSCs (mMSCs) given two times 24 h apart failed to improve weight loss, lung water, bronchoalveolar lavage inflammation, or histology. However, mMSCs prevented influenza-induced thrombocytosis and caused a modest reduction in lung viral load at day 7. Human MSCs administered intravenously showed a similar lack of efficacy. The results demonstrate that the influenza murine model bears important similarities to the slow resolution of ARDS in patients. Despite their potent therapeutic effects in many models of acute inflammation and lung injury, MSCs do not improve influenza-mediated lung injury in mice.
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Affiliation(s)
- Jeffrey E Gotts
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Jason Abbott
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
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Abstract
Viruses are a common and important cause of severe community-acquired pneumonia, and may lead to severe respiratory disease and admission to the intensive care unit. Influenza is the most common virus associated with severe viral pneumonia, although other important causes include respiratory syncytial virus, adenovirus, metapneumonia virus, and coronaviruses. Viral pneumonias tend to have a seasonal predilection and are often preceded by a typical viral prodrome. This article focuses on severe influenza pneumonia, including the 2009 H1N1 pandemic, and briefly discusses other causes of severe respiratory disease of viral etiology.
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Affiliation(s)
- Clare D Ramsey
- Section of Respiratory Medicine, Department of Medicine, University of Manitoba, RS 314, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada; Section of Critical Care, Department of Medicine, University of Manitoba, GC 425, 820 Sherbrook Street, Winnipeg, Manitoba R3T 2N2, Canada; Department of Community Health Sciences, University of Manitoba, S113, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
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Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses 2014; 7 Suppl 2:105-113. [PMID: 24034494 PMCID: PMC5909385 DOI: 10.1111/irv.12089] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Influenza‐associated bacterial and viral infections are responsible for high levels of morbidity and death during pandemic and seasonal influenza episodes. A review was undertaken to assess and evaluate the incidence, epidemiology, aetiology, clinical importance and impact of bacterial and viral co‐infection and secondary infection associated with influenza. A review was carried out of published articles covering bacterial and viral infections associated with pandemic and seasonal influenza between 1918 and 2009 (and published through December 2011) to include both pulmonary and extra‐pulmonary infections. While pneumococcal infection remains the predominant cause of bacterial pneumonia, the review highlights the importance of other co‐ and secondary bacterial and viral infections associated with influenza, and the emergence of newly identified dual infections associated with the 2009 H1N1 pandemic strain. Severe influenza‐associated pneumonia is often bacterial and will necessitate antibiotic treatment. In addition to the well‐known bacterial causes, less common bacteria such as Legionella pneumophila may also be associated with influenza when new influenza strains emerge. This review should provide clinicians with an overview of the range of bacterial and viral co‐ or secondary infections that could present with influenza illness.
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Affiliation(s)
- Carol Joseph
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
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42
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Live attenuated influenza vaccine enhances colonization of Streptococcus pneumoniae and Staphylococcus aureus in mice. mBio 2014; 5:mBio.01040-13. [PMID: 24549845 PMCID: PMC3944816 DOI: 10.1128/mbio.01040-13] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Community interactions at mucosal surfaces between viruses, like influenza virus, and respiratory bacterial pathogens are important contributors toward pathogenesis of bacterial disease. What has not been considered is the natural extension of these interactions to live attenuated immunizations, and in particular, live attenuated influenza vaccines (LAIVs). Using a mouse-adapted LAIV against influenza A (H3N2) virus carrying the same mutations as the human FluMist vaccine, we find that LAIV vaccination reverses normal bacterial clearance from the nasopharynx and significantly increases bacterial carriage densities of the clinically important bacterial pathogens Streptococcus pneumoniae (serotypes 19F and 7F) and Staphylococcus aureus (strains Newman and Wright) within the upper respiratory tract of mice. Vaccination with LAIV also resulted in 2- to 5-fold increases in mean durations of bacterial carriage. Furthermore, we show that the increases in carriage density and duration were nearly identical in all aspects to changes in bacterial colonizing dynamics following infection with wild-type (WT) influenza virus. Importantly, LAIV, unlike WT influenza viruses, had no effect on severe bacterial disease or mortality within the lower respiratory tract. Our findings are, to the best of our knowledge, the first to demonstrate that vaccination with a live attenuated viral vaccine can directly modulate colonizing dynamics of important and unrelated human bacterial pathogens, and does so in a manner highly analogous to that seen following wild-type virus infection. Following infection with an influenza virus, infected or recently recovered individuals become transiently susceptible to excess bacterial infections, particularly Streptococcus pneumoniae and Staphylococcus aureus. Indeed, in the absence of preexisting comorbidities, bacterial infections are a leading cause of severe disease during influenza epidemics. While this synergy has been known and is well studied, what has not been explored is the natural extension of these interactions to live attenuated influenza vaccines (LAIVs). Here we show, in mice, that vaccination with LAIV primes the upper respiratory tract for increased bacterial growth and persistence of bacterial carriage, in a manner nearly identical to that seen following wild-type influenza virus infections. Importantly, LAIV, unlike wild-type virus, did not increase severe bacterial disease of the lower respiratory tract. These findings may have consequences for individual bacterial disease processes within the upper respiratory tract, as well as bacterial transmission dynamics within LAIV-vaccinated populations
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Abstract
Severe sepsis is traditionally associated with bacterial diseases. While fungi and parasites can also cause sepsis, they are significantly less common than bacterial causes. However, viruses are becoming a growing cause of severe sepsis worldwide. Among these viruses, influenza is crossing all geographic boundaries and is causing larger epidemics and pandemics. As a consequence, more critically ill patients with severe sepsis caused directly by influenza viruses, or indirectly by influenza-induced secondary bacterial infections are being admitted to hospitals worldwide. This manuscript aims to provide a pathophysiological and clinical update on the link between influenza and severe sepsis.
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Affiliation(s)
- Diana F Florescu
- Infectious Diseases Division; Internal Medicine Department; University of Nebraska Medical Center; Omaha, NE USA
| | - Andre C Kalil
- Infectious Diseases Division; Internal Medicine Department; University of Nebraska Medical Center; Omaha, NE USA
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Metzger DW, Sun K. Immune dysfunction and bacterial coinfections following influenza. THE JOURNAL OF IMMUNOLOGY 2013; 191:2047-52. [PMID: 23964104 DOI: 10.4049/jimmunol.1301152] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Secondary pulmonary infections by encapsulated bacteria including Streptococcus pneumoniae and Staphylococcus aureus following influenza represent a common and challenging clinical problem. The reasons for this polymicrobial synergy are still not completely understood, hampering development of effective prophylactic and therapeutic interventions. Although it has been commonly thought that viral-induced epithelial cell damage allows bacterial invasiveness, recent studies by several groups have now implicated dysfunctional innate immune defenses following influenza as the primary culprit for enhanced susceptibility to secondary bacterial infections. Understanding the immunological imbalances that are responsible for virus/bacteria synergy will ultimately allow the design of effective, broad-spectrum therapeutic approaches for prevention of enhanced susceptibility to these pathogens.
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Affiliation(s)
- Dennis W Metzger
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, USA.
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Hayashi Y, Vaska VL, Baba H, Nimmo GR, Davis L, Paterson DL. Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia. Intern Med J 2013; 42:755-60. [PMID: 21981384 DOI: 10.1111/j.1445-5994.2011.02602.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Secondary bacterial pneumonia due to community onset methicillin-resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza-associated death. There is a risk that case reports of fatal outcomes with post-influenza MRSA pneumonia may unduly influence antibiotic prescribing. AIMS The aim of this study was to demonstrate the incidence of community-onset MRSA pneumonia in 2009 H1N1 influenza patients. METHODS The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. RESULTS In 2009, 4491 laboratory-confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. CONCLUSIONS Influenza-associated community-onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community-onset MRSA skin and soft tissue infections being very common. Although post-influenza MRSA pneumonia is of great concern, its influence on empiric-prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.
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Affiliation(s)
- Y Hayashi
- The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia.
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Nicholls JM. The battle between influenza and the innate immune response in the human respiratory tract. Infect Chemother 2013; 45:11-21. [PMID: 24265946 PMCID: PMC3780943 DOI: 10.3947/ic.2013.45.1.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Indexed: 12/23/2022] Open
Abstract
Influenza is a viral infection of the respiratory tract. Infection is normally confined to the upper respiratory tract but certain viral strains have evolved the ability to infect the lower respiratory tract, including the alveoli, leading to inflammation and a disease pattern of diffuse alveolar damage. Factors leading to this sequence of events are novel influenza strains, or strains that have viral proteins, in particular the NS1 protein that allow it to escape the innate immune system. There are three main barriers that prevent infection of pneumocytes - mucin, host defence lectins and cells such as macrophages. Viruses have developed strategies such as neuraminidase and glycosylation patterns that allow this evasion. Though there has been much investment in antiviral drugs, it is proposed that more attention should be directed towards developing or utilizing compounds that enhance the ability of the innate immune system to combat viral infection.
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Affiliation(s)
- John M Nicholls
- Department of Pathology, Hong Kong University, Hong Kong, Hong Kong
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47
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Blanton L, Peacock G, Cox C, Jhung M, Finelli L, Moore C. Neurologic disorders among pediatric deaths associated with the 2009 pandemic influenza. Pediatrics 2012; 130:390-6. [PMID: 22931899 PMCID: PMC11376344 DOI: 10.1542/peds.2011-3343] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to describe reported influenza A (H1N1)pdm09 virus (pH1N1)-associated deaths in children with underlying neurologic disorders. METHODS The study compared demographic characteristics, clinical course, and location of death of pH1N1-associated deaths among children with and without underlying neurologic disorders reported to the Centers for Disease Control and Prevention. RESULTS Of 336 pH1N1-associated pediatric deaths with information on underlying conditions, 227 (68%) children had at least 1 underlying condition that conferred an increased risk of complications of influenza. Neurologic disorders were most frequently reported (146 of 227 [64%]), and, of those disorders, neurodevelopmental disorders such as cerebral palsy and intellectual disability were most common. Children with neurologic disorders were older (P = .02), had a significantly longer duration of illness from onset to death (P < .01), and were more likely to die in the hospital versus at home or in the emergency department (P < .01) compared with children without underlying medical conditions. Many children with neurologic disorders had additional risk factors for influenza-related complications, especially pulmonary disorders (48%). Children without underlying conditions were significantly more likely to have a positive result from a sterile-site bacterial culture than were those with an underlying neurologic disorder (P < .01). CONCLUSIONS Neurologic disorders were reported in nearly two-thirds of pH1N1-associated pediatric deaths with an underlying medical condition. Because of the potential for severe outcomes, children with underlying neurologic disorders should receive influenza vaccine and be treated early and aggressively if they develop influenza-like illness.
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Affiliation(s)
- Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Pneumonia in US hospitalized patients with influenza-like illness: BioSense, 2007–2010. Epidemiol Infect 2012; 141:805-15. [DOI: 10.1017/s0950268812001549] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYWe used data from BioSense, a national electronic surveillance system, to describe pneumonia in hospitalized patients with influenza-like illness (ILI). Ninety-five hospitals from 20 states reported ICD-9-CM-coded inpatient final diagnosis data during the study period of September 2007 to February 2010. We compared the characteristics of persons with and without pneumonia among those with ILI-related hospitalizations. BioSense captured 26 987 ILI-related inpatient hospitalizations; 8979 (33%) had a diagnosis of pneumonia. Analysis of trends showed highest counts of pneumonia during the 2007–2008 season and the second 2009 pandemic wave. Pneumonia was more common with increasing age. Microbiology and pharmacy data were available for a subset of patients; 107 (5%) with pneumonia had a bloodstream infection and 17% of patients were prescribed antiviral treatment. Our findings demonstrate the potential utility of electronic healthcare data to track trends in ILI and pneumonia, identify risk factors for disease, identify bacteraemia in patients with pneumonia, and monitor antiviral use.
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50
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Bal A, Suri V, Mishra B, Bhalla A, Agarwal R, Abrol A, Ratho RK, Joshi K. Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009-2010. Histopathology 2012; 60:326-35. [PMID: 22211291 DOI: 10.1111/j.1365-2559.2011.04081.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To describe the pathological findings, immunohistochemical localization of viral antigen and tissue reverse transcriptase polymerase chain reaction (RT-PCR) findings of different organs in cases of fatal H1N1 influenza virus infection from North India. METHODS AND RESULTS Nine patients positive for H1N1 virus by a throat swab real-time RT-PCR (rRT-PCR) were included. Underlying risk factors included pregnancy, respiratory diseases, rheumatic heart disease, and chronic kidney disease. Pathological evidence of tracheitis, necrotizing bronchiolitis and diffuse alveolar damage was noted in all of the cases. Influenza viral antigen was observed by immunohistochemistry in the epithelium of the tracheobronchial tree, bronchial glands, gland ducts, and, less frequently, the alveolar epithelial cells. Viral particles were confirmed by electron microscopy in three autopsy cases. Tissue rRT-PCR for H1N1 viral RNA was positive in lung samples, but negative in other organs. Secondary bacterial pneumonia, cytomegalovirus infection and angio-invasive zygomycosis were detected. CONCLUSIONS The pulmonary findings are similar to those described in past pandemics. Secondary fungal and viral infections, which have not been reported previously, were noted. Although the number of cases in this study is small, the findings reinforce the notion that changes in extrapulmonary organs are attributable to multiorgan dysfunction syndrome rather than a viral cytopathic effect, and that there is no transplacental transmission of virus.
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Affiliation(s)
- Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Sciences & Research, Sector 12, Chandigarh, India
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