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Sitoe HM, Oswald WE, Zita F, Fall M, Momade T, Adams MW, Flueckiger RM, McPherson S, Eyob S, Doan T, Lietman TM, Arnold BF, Wickens K, Gwyn S, Martin DL, Kasubi M, Boyd S, Bakhtiari A, Jimenez C, Solomon AW, Harding-Esch EM, Mwingira UJ, Ngondi JM. Ongoing transmission of trachoma in low prevalence districts in Mozambique: results from four cross-sectional enhanced impact surveys, 2022. Sci Rep 2024; 14:22842. [PMID: 39406720 PMCID: PMC11480103 DOI: 10.1038/s41598-024-71201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/26/2024] [Indexed: 10/19/2024] Open
Abstract
Mozambique is making progress towards elimination of trachoma as a public health problem, but in some districts trachomatous inflammation-follicular (TF) prevalence remains above the 5% elimination threshold despite years of various interventions, including antibiotic mass drug administration. To characterize transmission in four districts, we incorporated testing of ocular infection and serology into routine trachoma impact surveys (TIS) in August 2022. We examined residents aged ≥ 1 year for trachoma and collected information on household water, sanitation, and hygiene. Among children aged 1-9 years, we tested conjunctival swabs for Chlamydia trachomatis nucleic acid and dried blood spots for C. trachomatis antibodies. We modeled age-dependent seroprevalence to estimate seroconversion rate (SCR). We examined 4841 children aged 1-9 years. TF prevalence ranged between 1.1 and 6.0% with three districts below the 5% threshold. PCR-confirmed infection prevalence ranged between 1.1 and 4.8%, and Pgp3 seroprevalence ranged between 8.8 and 24.3%. Pgp3 SCR was 1.9 per 100 children per year in the district with the lowest TF prevalence. Two other districts with TF < 5% had SCR of 5.0 and 4.7. The district with TF ≥ 5% had a SCR of 6.0. This enhanced TIS furthered understanding of transmission in these districts and provides information on additional indicators for monitoring trachoma programs.
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Affiliation(s)
| | | | | | - Mawo Fall
- RTI International, Maputo, Mozambique
| | | | | | | | | | | | - Thuy Doan
- F.I. Proctor Foundation and University of California San Francisco, San Francisco, USA
| | - Thomas M Lietman
- F.I. Proctor Foundation and University of California San Francisco, San Francisco, USA
| | - Benjamin F Arnold
- F.I. Proctor Foundation and University of California San Francisco, San Francisco, USA
| | - Karana Wickens
- Oak Ridge Institute for Science and Education, Oak Ridge, USA
| | - Sarah Gwyn
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Diana L Martin
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Mabula Kasubi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, USA
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, USA
| | | | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
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Kamau E, Ante-Testard PA, Gwyn S, Blumberg S, Abdalla Z, Aiemjoy K, Amza A, Aragie S, Arzika AM, Awoussi MS, Bailey RL, Butcher R, Callahan EK, Chaima D, Dawed AA, Saboyá Díaz MI, Domingo ABS, Drakeley C, Elshafie BE, Emerson PM, Fornace K, Gass K, Goodhew EB, Hammou J, Harding-Esch EM, Hooper PJ, Kadri B, Kalua K, Kanyi S, Kasubi M, Kello AB, Ko R, Lammie PJ, Lescano AG, Maliki R, Masika MP, Migchelsen SJ, Nassirou B, Nesemann JM, Parameswaran N, Pomat W, Renneker K, Roberts C, Rymil P, Sata E, Senyonjo L, Seife F, Sillah A, Sokana O, Srivathsan A, Tadesse Z, Taleo F, Taylor EM, Tekeraoi R, Togbey K, West SK, Wickens K, William T, Wittberg DM, Yeboah-Manu D, Youbi M, Zeru T, Keenan JD, Lietman TM, Solomon AW, Nash SD, Martin DL, Arnold BF. Characterizing trachoma elimination using serology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.20.24313635. [PMID: 39399026 PMCID: PMC11469394 DOI: 10.1101/2024.09.20.24313635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Trachoma is targeted for global elimination as a public health problem by 2030. Measurement of IgG antibodies in children is being considered for surveillance and programmatic decision-making. There are currently no guidelines for applications of serology, which represents a generalizable problem in seroepidemiology and disease elimination. We collated Chlamydia trachomatis Pgp3 and CT694 IgG measurements (63,911 children ages 1-9 years) from 48 serosurveys, including surveys across Africa, Latin America, and the Pacific Islands to estimate population-level seroconversion rates (SCR) along a gradient of trachoma endemicity. We propose a novel, generalizable approach to estimate the probability that population C. trachomatis transmission is below levels requiring ongoing programmatic action, or conversely is above levels that indicate ongoing interventions are needed. We provide possible thresholds for SCR at a specified level of certainty and illustrate how the approach could be used to inform trachoma program decision-making using serology.
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Sodha D, Patzelt S, Djalilian AR, Jain S, Geerling G, Schmidt E, Amber KT. The Role of Serology in the Diagnosis of Ocular Predominant Mucous Membrane Pemphigoid and the Search for an Ocular-Specific Autoantigen. Ocul Immunol Inflamm 2024:1-14. [PMID: 39241171 DOI: 10.1080/09273948.2024.2397715] [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: 05/23/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/08/2024]
Abstract
Ocular predominant mucous membrane pemphigoid (oMMP) is a severe subtype of MMP that can lead to scarring and blindness. While conjunctival biopsy for direct immunofluorescence (DIF) is considered the gold standard for diagnosis, limited sensitivity results in a false-negative rate upwards of 40%. Likewise, it remains unclear to what extent a negative biopsy, whether false-negative or true-negative, results in a different prognosis, with patients previously termed "pseudopemphigoid" demonstrating comparable disease progression. Serologic testing allows for a less invasive means to demonstrate circulating autoantibodies against known autoantigens in pemphigoid diseases. Patients with MMP, particularly oMMP, however, typically demonstrate low titers of circulating autoantibodies, limiting the diagnostic utility of these tests. The autoantigen integrin β4 has been previously reported to be a specific marker of pure ocular MMP, while in the majority of patients with oMMP, the identified target antigens are BP180 (type XVII collagen) and laminin 332. Recent studies have, however, demonstrated inconsistent reactivity and specificity for integrin β4 as an ocular-specific marker in MMP. Herein, we review the role of serologic testing in the diagnosis and prognosis of oMMP, as well as the current understanding of autoantigens in oMMP.Abbreviations: BMZ - basement membrane zone, DIF - direct immunofluorescence, IIF - indirect immunofluorescence, MMP - mucous membrane pemphigoid, oMMP - ocular predominant mucous membrane pemphigoid.
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Affiliation(s)
- Dharm Sodha
- Medical Student, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Sabrina Patzelt
- Department of Dermatology, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ali R Djalilian
- Department of Ophthalmology, The University of Illinois at Chicago College of Medicine - Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | - Sandeep Jain
- Department of Ophthalmology, The University of Illinois at Chicago College of Medicine - Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | - Gerd Geerling
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
| | - Enno Schmidt
- Department of Dermatology, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Kyle T Amber
- Department of Dermatology, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Martini M, Riccardi N, Simonetti O, Orsini D, Samassa F, Parodi A. "The blinding disease". The history of trachoma in Italians between the 19th and 20th centuries: colonial or national blindness? Pathog Glob Health 2024; 118:499-504. [PMID: 38644632 PMCID: PMC11441016 DOI: 10.1080/20477724.2024.2342623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Trachoma is one of the oldest known causes of blindness in humans and it is caused by the intracellular Gram-negative bacterium Chlamydia trachomatis serovars A, B, Ba and C. Its transmission has historically been related to poorness, overcrowded housing and scarce hygiene. We have traced the history of trachoma in Italy in the 19th and 20th centuries, among people living in Italy, those who immigrated to America and the population in the colonies, with a focus on Libya (1912-1943). Trachoma knowledge and perception in Italy and in its colonies was ambiguous during the 19th and 20th centuries. Trachoma was responsible for a great morbidity on both sides of the Mediterranean, in Italy as well as in Libya. Trachoma is still one of the leading infectious causes of preventable blindness worldwide and it was widespread in Italy and the Italian colonies in the first half of the last century.
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Affiliation(s)
- Mariano Martini
- Department of Health Sciences, University of Genoa, Genova, Italy
- UNESCO Chair “Anthropology of Health – Biosphere and Healing System”, University of Genoa, Genova, Italy
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Omar Simonetti
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Davide Orsini
- University Museum System of Siena (SIMUS), History of Medicine, University of Siena, Siena, Italy
| | - Francesco Samassa
- Department of Ophthalmology, Ospedale dell’Angelo di Mestre – AULSS3 – Serenissima, Mestre, Italy
| | - Alessandra Parodi
- Institut für Geschichte und Ethik der Medizin, Ruprecht-Karls – Universität Heidelberg, Heidelberg, Germany
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Reigada I, Kapp K, Kaudela T, García Soria M, Oksanen T, Hanski L. Tracking Chlamydia - Host interactions and antichlamydial activity in Caenorhabditis elegans. Biomed Pharmacother 2024; 177:116956. [PMID: 38901202 DOI: 10.1016/j.biopha.2024.116956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/02/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024] Open
Abstract
The fading efficacy of antibiotics is a growing global health concern due to its life-threatening consequences and increased healthcare costs. Non-genetic mechanisms of antimicrobial resistance, such as those employed by Chlamydia pneumoniae and Chlamydia trachomatis, complicate treatment as these bacteria can enter a non-replicative, persistent state under stress, evading antibiotics and linking to inflammatory conditions. Understanding chlamydial persistence at the molecular level is challenging, and new models for studying Chlamydia-host interactions in vivo are urgently needed. Caenorhabditis elegans offers an alternative given its immune system and numerous orthologues of human genes. This study established C. elegans as an in vivo model for chlamydial infection. Both Chlamydia species reduced the worm's lifespan, their DNA being detectable at three- and six-days post-infection. Azithromycin at its MIC (25 nM) failed to prevent the infection-induced lifespan reduction, indicating a persister phenotype. In contrast, the methanolic extract of Schisandra chinensis berries showed anti-chlamydial activity both in vitro (in THP-1 macrophages) and in vivo, significantly extending the lifespan of infected C. elegans and reducing the bacterial load. Moreover, S. chinensis increased the transcriptional activity of SKN-1 in the worms, but was unable to impact the bacterial load or lifespan in a sek-1 defective C. elegans strain. In summary, this study validated C. elegans as a chlamydial infection model and showcased S. chinensis berries' in vivo anti-chlamydial potential, possibly through SEK/SKN-1 signaling modulation.
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Affiliation(s)
- Inés Reigada
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
| | - Karmen Kapp
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
| | - Theresa Kaudela
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
| | - María García Soria
- Department of Pharmacy, Faculty of Health Sciences, Universidad San Jorge (San Jorge University), Zaragoza 50830, Spain
| | - Timo Oksanen
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland
| | - Leena Hanski
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki 00014, Finland.
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Greenland K, Collin C, Sinba Etu E, Guye M, Hika D, Macleod D, Schmidt WP, Shafi Abdurahman O, Last A, Burton MJ. Comparison of metrics for assessing face washing behaviour for trachoma control. PLoS Negl Trop Dis 2024; 18:e0012399. [PMID: 39141680 PMCID: PMC11346966 DOI: 10.1371/journal.pntd.0012399] [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: 02/08/2024] [Revised: 08/26/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.
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Affiliation(s)
- Katie Greenland
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Claire Collin
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Edao Sinba Etu
- Berhan Public Health & Eye Care Consultancy, Addis Ababa, Ethiopia
| | - Meseret Guye
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - Demitu Hika
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - David Macleod
- International Statistics and Epidemiology Group, LSHTM, London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Oumer Shafi Abdurahman
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Anna Last
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
- Clinical Research Department, London School of Hygiene & Tropical Medicine (LSHTM)
| | - Matthew J. Burton
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Pollock KM, Borges ÁH, Cheeseman HM, Rosenkrands I, Schmidt KL, Søndergaard RE, Day S, Evans A, McFarlane LR, Joypooranachandran J, Amini F, Skallerup P, Dohn RB, Jensen CG, Olsen AW, Bang P, Cole T, Schronce J, Lemm NM, Kristiansen MP, Andersen PL, Dietrich J, Shattock RJ, Follmann F. An investigation of trachoma vaccine regimens by the chlamydia vaccine CTH522 administered with cationic liposomes in healthy adults (CHLM-02): a phase 1, double-blind trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:829-844. [PMID: 38615673 DOI: 10.1016/s1473-3099(24)00147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND There is no vaccine against the major global pathogen Chlamydia trachomatis; its different serovars cause trachoma in the eye or chlamydia in the genital tract. We did a clinical trial administering CTH522, a recombinant version of the C trachomatis major outer membrane molecule, in different dose concentrations with and without adjuvant, to establish its safety and immunogenicity when administered intramuscularly, intradermally, and topically into the eye, in prime-boost regimens. METHODS CHLM-02 was a phase 1, double-blind, randomised, placebo-controlled trial at the National Institute for Health Research Imperial Clinical Research Facility, London, UK. Participants were healthy men and non-pregnant women aged 18-45 years, without pre-existing C trachomatis genital infection. Participants were assigned into six groups by the electronic database in a pre-prepared randomisation list (A-F). Participants were randomly assigned (1:1:1:1:1) to each of the groups A-E (12 participants each) and 6 were randomly assigned to group F. Investigators were masked to treatment allocation. Groups A-E received investigational medicinal product and group F received placebo only. Two liposomal adjuvants were compared, CAF01 and CAF09b. The groups were intramuscular 85 μg CTH522-CAF01, or placebo on day 0 and two boosters or placebo at day 28 and 112, and a mucosal recall with either placebo or CTH522 topical ocularly at day 140 (A); intramuscular 85 μg CTH522-CAF01, two boosters at day 28 and 112 with additional topical ocular administration of CTH522, and a mucosal recall with either placebo or CTH522 topical ocularly at day 140 (B); intramuscular 85 μg CTH522-CAF01, two boosters at day 28 and 112 with additional intradermal administration of CTH522, and a mucosal recall with either placebo or CTH522 topical ocularly at day 140 (C); intramuscular 15 μg CTH522-CAF01, two boosters at day 28 and 112, and a mucosal recall with either placebo or CTH522 topical ocularly at day 140 (D); intramuscular 85 μg CTH522-CAF09b, two boosters at day 28 and 112, and a mucosal recall with either placebo or CTH522 topical ocularly at day 140 (E); intramuscular placebo (F). The primary outcome was safety; the secondary outcome (humoral immunogenicity) was the percentage of trial participants achieving anti-CTH522 IgG seroconversion, defined as four-fold and ten-fold increase over baseline concentrations. Analyses were done as intention to treat and as per protocol. The trial is registered with ClinicalTrials.gov, NCT03926728, and is complete. FINDINGS Between Feb 17, 2020 and Feb 22, 2022, of 154 participants screened, 65 were randomly assigned, and 60 completed the trial (34 [52%] of 65 women, 46 [71%] of 65 White, mean age 26·8 years). No serious adverse events occurred but one participant in group A2 discontinued dosing after having self-limiting adverse events after both placebo and investigational medicinal product doses. Study procedures were otherwise well tolerated; the majority of adverse events were mild to moderate, with only seven (1%) of 865 reported as grade 3 (severe). There was 100% four-fold seroconversion rate by day 42 in the active groups (A-E) and no seroconversion in the placebo group. Serum IgG anti-CTH522 titres were higher after 85 μg CTH522-CAF01 than 15 μg, although not significantly (intention-to-treat median IgG titre ratio groups A-C:D=5·6; p=0·062), with no difference after three injections of 85 μg CTH522-CAF01 compared with CTH522-CAF09b (group E). Intradermal CTH522 (group C) induced high titres of serum IgG anti-CTH522 neutralising antibodies against serovars B (trachoma) and D (urogenital). Topical ocular CTH522 (group B) at day 28 and 112 induced higher total ocular IgA compared with baseline (p<0·001). Participants in all active vaccine groups, particularly groups B and E, developed cell mediated immune responses against CTH522. INTERPRETATION CTH522, adjuvanted with CAF01 or CAF09b, is safe and immunogenic, with 85 μg CTH522-CAF01 inducing robust serum IgG binding titres. Intradermal vaccination conferred systemic IgG neutralisation breadth, and topical ocular administration increased ocular IgA formation. These findings indicate CTH522 vaccine regimens against ocular trachoma and urogenital chlamydia for testing in phase 2, clinical trials. FUNDING The EU Horizon Program TRACVAC.
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Affiliation(s)
- Katrina M Pollock
- Department of Infectious Disease, Imperial College London, London, UK
| | - Álvaro H Borges
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ida Rosenkrands
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Kirstine L Schmidt
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | | | - Suzanne Day
- Department of Infectious Disease, Imperial College London, London, UK
| | - Abbey Evans
- Department of Infectious Disease, Imperial College London, London, UK
| | - Leon R McFarlane
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Fahimah Amini
- Department of Infectious Disease, Imperial College London, London, UK
| | - Per Skallerup
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | - Rebecca B Dohn
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotte G Jensen
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | - Anja W Olsen
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Bang
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | - Tom Cole
- Department of Infectious Disease, Imperial College London, London, UK
| | - Joanna Schronce
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nana-Marie Lemm
- Department of Infectious Disease, Imperial College London, London, UK
| | - Max P Kristiansen
- Department of Vaccine Development, Statens Serum Institut, Copenhagen, Denmark
| | - Peter L Andersen
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk Foundation, Hellerup, Denmark
| | - Jes Dietrich
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark.
| | - Robin J Shattock
- Department of Infectious Disease, Imperial College London, London, UK
| | - Frank Follmann
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
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Paulet E, Contreras V, Galhaut M, Rosenkrands I, Holland M, Burton M, Dietrich J, Gallouet AS, Bosquet N, Relouzat F, Langlois S, Follmann F, Le Grand R, Labetoulle M, Rousseau A. Multimodal mucosal and systemic immune characterization of a non-human primate trachoma model highlights the critical role of local immunity during acute phase disease. PLoS Negl Trop Dis 2024; 18:e0012388. [PMID: 39093884 PMCID: PMC11333008 DOI: 10.1371/journal.pntd.0012388] [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: 01/31/2024] [Revised: 08/19/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Trachoma is a leading cause of infection-related blindness worldwide. This disease is caused by recurrent Chlamydia trachomatis (Ct) infections of the conjunctiva and develops in two phases: i) active (acute trachoma, characterized by follicular conjunctivitis), then long-term: ii) scarring (chronic trachoma, characterized by conjunctival fibrosis, corneal opacification and eyelid malposition). Scarring trachoma is driven by the number and severity of reinfections. The immune system plays a pivotal role in trachoma including exacerbation of the disease. Hence the immune system may also be key to developing a trachoma vaccine. Therefore, we characterized clinical and local immune response kinetics in a non-human primate model of acute conjunctival Ct infection and disease. METHODOLOGY/PRINCIPAL FINDINGS The conjunctiva of non-human primate (NHP, Cynomolgus monkeys-Macaca fascicularis-) were inoculated with Ct (B/Tunis-864 strain, B serovar). Clinical ocular monitoring was performed using a standardized photographic grading system, and local immune responses were assessed using multi-parameter flow cytometry of conjunctival cells, tear fluid cytokines, immunoglobulins, and Ct quantification. Clinical findings were similar to those observed during acute trachoma in humans, with the development of typical follicular conjunctivitis from the 4th week post-exposure to the 11th week. Immunologic analysis indicated an early phase influx of T cells in the conjunctiva and elevated interleukins 4, 8, and 5, followed by a late phase monocytic influx accompanied with a decrease in other immune cells, and tear fluid cytokines returning to initial levels. CONCLUSION/SIGNIFICANCE Our NHP model accurately reproduces the clinical signs of acute trachoma, allowing for an accurate assessment of the local immune responses in infected eyes. A progressive immune response occurred for weeks after exposure to Ct, which subsided into a persistent innate immune response. An understanding of these local responses is the first step towards using the model to assess new vaccine and therapeutic strategies for disease prevention.
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Affiliation(s)
- Elodie Paulet
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Vanessa Contreras
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Mathilde Galhaut
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Ida Rosenkrands
- Center for Vaccine Research, Statens Serum Institut, Copenhagen, Denmark
| | - Martin Holland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jes Dietrich
- Center for Vaccine Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anne-Sophie Gallouet
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Nathalie Bosquet
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Francis Relouzat
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Sébastien Langlois
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Frank Follmann
- Center for Vaccine Research, Statens Serum Institut, Copenhagen, Denmark
| | - Roger Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
- Service d’Ophtalmologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Service d’Ophtalmologie, Hôpital National de la Vision des 15-20, IHU Foresight, Paris, France
| | - Antoine Rousseau
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
- Service d’Ophtalmologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Service d’Ophtalmologie, Hôpital National de la Vision des 15-20, IHU Foresight, Paris, France
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9
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Toumasis P, Vrioni G, Tsinopoulos IT, Exindari M, Samonis G. Insights into Pathogenesis of Trachoma. Microorganisms 2024; 12:1544. [PMID: 39203386 PMCID: PMC11355952 DOI: 10.3390/microorganisms12081544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/31/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Trachoma is the most common infectious cause of blindness worldwide. This review investigates the pathogenesis of trachoma, focusing on its causative agent, transmission pathways, disease progression, and immune responses. Trachoma is caused by serovars A-C of the bacterium Chlamydia trachomatis (Ct). Transmission occurs through direct or indirect exchanges of ocular and nasal secretions, especially in regions with poor hygiene and overcrowded living conditions. The disease is initiated in early childhood by repeated infection of the ocular surface by Ct. This triggers recurrent chronic inflammatory episodes, leading to the development of conjunctival scarring and potentially to trichiasis, corneal opacity, and visual impairment. Exploring the pathogenesis of trachoma not only unveils the intricate pathways and mechanisms underlying this devastating eye disease but also underscores the multifaceted dimensions that must be considered in its management.
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Affiliation(s)
- Panagiotis Toumasis
- MSc in Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (P.T.); (I.T.T.); (M.E.)
| | - Georgia Vrioni
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 115 25 Athens, Greece;
| | - Ioannis T. Tsinopoulos
- MSc in Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (P.T.); (I.T.T.); (M.E.)
- Second Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 564 29 Thessaloniki, Greece
| | - Maria Exindari
- MSc in Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (P.T.); (I.T.T.); (M.E.)
- Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - George Samonis
- School of Medicine, University of Crete, 715 00 Heraklion, Greece
- Metropolitan Hospital, 185 47 Piraeus, Greece
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10
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West SK, Hazel A, Munoz B, Wolle MA, Mkocha H, Porco TC. Model of yearly transition to severe trachomatous scarring and trichiasis in a cohort of women in Kongwa Tanzania. Sci Rep 2024; 14:16654. [PMID: 39030278 PMCID: PMC11271489 DOI: 10.1038/s41598-024-67245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024] Open
Abstract
One criterion for validation of trachoma elimination is the management of Trachomatous Trichiasis (TT) after Trachoma inflammation-follicular (TF) is eliminated in children ages 1-9 years at district level. No data exist on how long countries must have dedicated TT programs, as the timeline for progression to TT from trachomatous scarring is unknown. We used eight years of longitudinal data in women in Kongwa Tanzania to model progression from no scarring (S0) through grades of scarring severity (S1-S4) to TT. Markov models were used, with age, community prevalence of TF (CPTF), and household characteristics as co-variates. Adjusted for covariates, the incidence of S1 was estimated at 4∙7% per year, and the risk increased by 26% if the CPTF was between 5-10% and by 48% if greater than 10%. The transition from S4 to TT was estimated at 2∙6% per year. Districts, even after elimination of TF, may have some communities with TF ≥ 5% and increased risk of incident scarring. Once scarring progresses to S2, further progression is not dependent on CPTF. These data suggest that, depending on the district level of scarring and degree of heterogeneity in CPTF at the time of elimination, incident TT will still be an issue for decades.
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Affiliation(s)
- Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA.
| | - Ashley Hazel
- Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Beatriz Munoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Meraf A Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Travis C Porco
- Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
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11
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Meewes C, Gupta K, Geisler WM. Role of microRNAs in immune regulation and pathogenesis of Chlamydia trachomatis and Chlamydia muridarum infections: a rapid review. Microbes Infect 2024:105397. [PMID: 39025257 DOI: 10.1016/j.micinf.2024.105397] [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: 02/21/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
MicroRNAs in Chlamydia trachomatis (CT) and Chlamydia muridarum (CM) infections are an emerging topic of research that provide knowledge that could advance vaccine development and strategies for managing infection. This rapid review summarizes human and murine studies on miRNA expression in CT and CM infections in vivo and ex vivo.
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Affiliation(s)
- Chloe Meewes
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kanupriya Gupta
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William M Geisler
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
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12
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Pak C, Hall N, Bekele DT, Kollmann KHM, Tadele T, Tekle-Haimanot R, Taye T, Qureshi B, Yalew W, Gower EW, Kempen JH. Impact of refresher training on the outcomes of trachomatous trichiasis surgery. Br J Ophthalmol 2024; 108:1049-1052. [PMID: 37775258 DOI: 10.1136/bjo-2022-322497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND/AIMS Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia. METHODS Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest. RESULTS A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT. CONCLUSION Our results indicate a significant reduction in the risk of PTT after experienced surgeons' participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.
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Affiliation(s)
- Clara Pak
- University of Rochester School of Medicine and Dentistry, Rochester, Minnesota, USA
| | - Nathan Hall
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Demissie Tadesse Bekele
- MyungSung Christian Medical Center (MCM) Eye Unit of MCM Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
- Christian Blind Mission, Bensheim, Germany
| | | | | | | | - Tarik Taye
- Grarbet Tehadiso Mahber, Addis Ababa, Ethiopia
| | | | | | - Emily W Gower
- Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - John H Kempen
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit of MCM Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
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13
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Ghasemian E, Holland MJ. Genomic profiling and characterization of ocular Chlamydia trachomatis reference strain B/HAR36. Microbiol Resour Announc 2024; 13:e0002924. [PMID: 38700340 PMCID: PMC11237376 DOI: 10.1128/mra.00029-24] [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: 01/10/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024] Open
Abstract
The human pathogen Chlamydia trachomatis has multiple serovariants that have distinct organotropisms. We recently revised genomic sequence data linked to ocular reference strain, B/HAR36. Now linked to its correct genomic data in the European Nucleotide Archive, we describe its genomic features.
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Affiliation(s)
- Ehsan Ghasemian
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin J. Holland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Manchart T, Froussart-Maille F. [Ophthalmic disqualification from the military services: Multicentric cross-sectional study]. J Fr Ophtalmol 2024; 47:104187. [PMID: 38663225 DOI: 10.1016/j.jfo.2024.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 06/12/2024]
Abstract
PURPOSE This article aims to describe the causes of ophthalmological disqualification from the military services detected during specialist consultations conducted at Army Training Hospitals. METHODS This observational, cross-sectional, multicenter study retrospectively included individuals deemed as "unfit for military service" due to eye diseases identified during the specialist consultation conducted at 3 ATHs between January 2020 and December 2021. The data collected included age, medical and surgical history, reasons for ophthalmological disqualification, uncorrected distance visual acuity, best corrected distance visual acuity and cycloplegic refraction. RESULTS Over this period, 133 subjects (98 men and 35 women) were included. Thirty-eight candidates (28.6%) were declared unfit due to a refractive error beyond the required limits, including 30 myopic subjects in excess of -10 diopters (D) and 8 hypermetropic subjects over +8 D. Twenty-five candidates (18.8%) were unfit under the age of 21 years due to corneal refractive surgery performed before the required age. Four subjects (3.0%) were unfit due to phakic intraocular lenses. Degenerative conditions were observed in 23 subjects (17.3%), including 21 patients with severe keratoconus. Other causes of incapacity were linked to oculo-orbital trauma in 11 subjects (8.3%), moderate or severe amblyopia in 7 patients (5.3%), congenital causes in 7 subjects (5.3%), inflammatory or infectious diseases in 7 candidates (5.3%), hereditary causes in 6 subjects (4.5%) and undetermined visual dysfunctions in 4 subjects (3.0%). CONCLUSION The three main causes of ophthalmological disqualification were high ametropia, refractive surgery performed before the required age and keratoconus.
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Affiliation(s)
- T Manchart
- Service d'ophtalmologie et Centre principal d'expertise du personnel navigant, hôpital d'instruction des Armées Percy, 2, rue Lieutenant-Raoul-Batany, 92140 Clamart, France.
| | - F Froussart-Maille
- Service d'ophtalmologie et Centre principal d'expertise du personnel navigant, hôpital d'instruction des Armées Percy, 2, rue Lieutenant-Raoul-Batany, 92140 Clamart, France
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15
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Ekka R, Gutierrez A, Johnson KA, Tan M, Sütterlin C. Chlamydia trachomatis induces disassembly of the primary cilium to promote the intracellular infection. PLoS Pathog 2024; 20:e1012303. [PMID: 38885287 PMCID: PMC11213297 DOI: 10.1371/journal.ppat.1012303] [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: 11/01/2023] [Revised: 06/28/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Chlamydia trachomatis is a clinically important bacterium that infects epithelial cells of the genitourinary and respiratory tracts and the eye. These differentiated cells are in a quiescent growth state and have a surface organelle called a primary cilium, but the standard Chlamydia cell culture infection model uses cycling cells that lack primary cilia. To investigate if these differences are relevant, we performed infections with host cells that have a primary cilium. We found that C. trachomatis caused progressive loss of the primary cilium that was prevented by disrupting Aurora A (AurA), HDAC6 or calmodulin, which are components of the cellular cilia disassembly pathway. Stabilization of the primary cilium by targeting this pathway caused a large reduction in infectious progeny although there were no changes in chlamydial inclusion growth, chlamydial replication or the ultrastructural appearance of dividing and infectious forms (RBs and EBs, respectively). Thus, the presence of a primary cilium interfered with the production of infectious EBs at a late step in the developmental cycle. C. trachomatis infection also induced quiescent cells to re-enter the cell cycle, as detected by EdU incorporation in S-phase, and Chlamydia-induced cilia disassembly was necessary for cell cycle re-entry. This study therefore describes a novel host-pathogen interaction in which the primary cilium limits a productive Chlamydia infection, and the bacterium counteracts this host cell defense by activating the cellular cilia disassembly pathway.
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Affiliation(s)
- Roseleen Ekka
- Department of Developmental and Cell Biology, University of California, Irvine, California, United States of America
| | - Abraham Gutierrez
- Department of Developmental and Cell Biology, University of California, Irvine, California, United States of America
| | - Kirsten A. Johnson
- Department of Developmental and Cell Biology, University of California, Irvine, California, United States of America
| | - Ming Tan
- Department of Microbiology and Molecular Genetics, University of California, Irvine, California, United States of America
- Department of Medicine, University of California, Irvine, California, United States of America
| | - Christine Sütterlin
- Department of Developmental and Cell Biology, University of California, Irvine, California, United States of America
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16
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Harding-Esch EM, Bakhtiari A, Boyd S, Burgert-Brucker C, Butcher R, Dejene M, Harte A, Hooper PJ, Jimenez C, Taylor EM, Millar T, Mpyet C, Ngondi JM, Rotondo LA, Solomon AW. Tropical Data: supporting health ministries worldwide to conduct high-quality trachoma surveys. Int Health 2024:ihae036. [PMID: 38815986 DOI: 10.1093/inthealth/ihae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
| | - A Bakhtiari
- International Trachoma Initiative, Decatur, GA, USA
| | - S Boyd
- International Trachoma Initiative, Decatur, GA, USA
| | | | - R Butcher
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Dejene
- Sightsavers, Addis Ababa, Ethiopia
| | - A Harte
- London School of Hygiene and Tropical Medicine, London, UK
| | - P J Hooper
- International Trachoma Initiative, Decatur, GA, USA
| | | | | | | | - C Mpyet
- Sightsavers, Kaduna, Nigeria
- University of Jos, Jos, Nigeria
| | | | | | - A W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
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17
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Srivathsan A, Abdou A, Al-Khatib T, Apadinuwe SC, Badiane MD, Bucumi V, Chisenga T, Kabona G, Kabore M, Kanyi SK, Bella L, M’po N, Masika M, Minnih A, Sitoe HM, Mishra S, Olobio N, Omar FJ, Phiri I, Sanha S, Seife F, Sharma S, Tekeraoi R, Traore L, Watitu T, Bol YY, Borlase A, Deiner MS, Renneker KK, Hooper PJ, Emerson PM, Vasconcelos A, Arnold BF, Porco TC, Hollingsworth TD, Lietman TM, Blumberg S. District-Level Forecast of Achieving Trachoma Elimination as a Public Health Problem By 2030: An Ensemble Modelling Approach. Clin Infect Dis 2024; 78:S101-S107. [PMID: 38662700 PMCID: PMC11045026 DOI: 10.1093/cid/ciae031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.
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Affiliation(s)
- Ariktha Srivathsan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Amza Abdou
- Programme National de Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Tawfik Al-Khatib
- Prevention of Blindness Program, Ministry of Public Health & Population, Sana'a, Yemen
| | | | - Mouctar D Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L'Action sociale, Dakar, Sénégal
| | - Victor Bucumi
- Département En Charge des Maladies Tropicales Négligées, Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Tina Chisenga
- Ministry of Health Public Health Department, Lusaka, Zambia
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, United Republic of Tanzania
| | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées, Ministère de la santé et de l'hygiène publique, Ouagadougou, Burkina Faso
| | - Sarjo Kebba Kanyi
- The National Eye Health Programme, Ministry of Health and Social Welfare, Banjul, Kanifing, The Gambia
| | - Lucienne Bella
- Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaoundé, Cameroon
| | - Nekoua M’po
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | - Michael Masika
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Abdellahi Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Henis Mior Sitoe
- Direcção Nacional De Saúde Pública Ministerio Da Saude, Maputo, Mozambique
| | | | - Nicholas Olobio
- National Trachoma Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Salimato Sanha
- Programa Nacional De Saúde De Visão, Minsap, Bissau, Guinea-Bissau
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Lamine Traore
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | | | - Yak Yak Bol
- Neglected Tropical Diseases Programme, Ministry of Health, Juba, South Sudan
| | - Anna Borlase
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Michael S Deiner
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Kristen K Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - P J Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
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18
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Du XY, Yang JY. Biomimetic microfluidic chips for toxicity assessment of environmental pollutants. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 919:170745. [PMID: 38340832 DOI: 10.1016/j.scitotenv.2024.170745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Various types of pollutants widely present in environmental media, including synthetic and natural chemicals, physical pollutants such as radioactive substances, ultraviolet rays, and noise, as well as biological organisms, pose a huge threat to public health. Therefore, it is crucial to accurately and effectively explore the human physiological responses and toxicity mechanisms of pollutants to prevent diseases caused by pollutants. The emerging toxicological testing method biomimetic microfluidic chips (BMCs) exhibit great potential in environmental pollutant toxicity assessment due to their superior biomimetic properties. The BMCs are divided into cell-on-chips and organ-on-chips based on the distinctions in bionic simulation levels. Herein, we first summarize the characteristics, emergence and development history, composition and structure, and application fields of BMCs. Then, with a focus on the toxicity mechanisms of pollutants, we review the applications and advances of the BMCs in the toxicity assessment of physical, chemical, and biological pollutants, respectively, highlighting its potential and development prospects in environmental toxicology testing. Finally, the opportunities and challenges for further use of BMCs are discussed.
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Affiliation(s)
- Xin-Yue Du
- College of Architecture and Environment, Sichuan University, Chengdu 610065, China
| | - Jin-Yan Yang
- College of Architecture and Environment, Sichuan University, Chengdu 610065, China..
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19
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Harte AJ, Ghasemian E, Pickering H, Houghton J, Chernet A, Sata E, Yismaw G, Zeru T, Tadesse Z, Callahan EK, Nash SD, Holland MJ. Unravelling Chlamydia trachomatis diversity in Amhara, Ethiopia: MLVA-ompA sequencing as a molecular typing tool for trachoma. PLoS Negl Trop Dis 2024; 18:e0012143. [PMID: 38662795 PMCID: PMC11075894 DOI: 10.1371/journal.pntd.0012143] [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: 01/31/2024] [Revised: 05/07/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Trachoma is the leading infectious cause of blindness worldwide and is now largely confined to around 40 low- and middle-income countries. It is caused by Chlamydia trachomatis (Ct), a contagious intracellular bacterium. The World Health Organization recommends mass drug administration (MDA) with azithromycin for treatment and control of ocular Ct infections, alongside improving facial cleanliness and environmental conditions to reduce transmission. To understand the molecular epidemiology of trachoma, especially in the context of MDA and transmission dynamics, the identification of Ct genotypes could be useful. While many studies have used the Ct major outer membrane protein gene (ompA) for genotyping, it has limitations. Our study applies a typing system novel to trachoma, Multiple Loci Variable Number Tandem Repeat Analysis combined with ompA (MLVA-ompA). Ocular swabs were collected post-MDA from four trachoma-endemic zones in Ethiopia between 2011-2017. DNA from 300 children with high Ct polymerase chain reaction (PCR) loads was typed using MLVA-ompA, utilizing 3 variable number tandem repeat (VNTR) loci within the Ct genome. Results show that MLVA-ompA exhibited high discriminatory power (0.981) surpassing the recommended threshold for epidemiological studies. We identified 87 MLVA-ompA variants across 26 districts. No significant associations were found between variants and clinical signs or chlamydial load. Notably, overall Ct diversity significantly decreased after additional MDA rounds, with a higher proportion of serovar A post-MDA. Despite challenges in sequencing one VNTR locus (CT1299), MLVA-ompA demonstrated cost-effectiveness and efficiency relative to whole genome sequencing, providing valuable information for trachoma control programs on local epidemiology. The findings suggest the potential of MLVA-ompA as a reliable tool for typing ocular Ct and understanding transmission dynamics, aiding in the development of targeted interventions for trachoma control.
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Affiliation(s)
- Anna J. Harte
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ehsan Ghasemian
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harry Pickering
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joanna Houghton
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Taye Zeru
- The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | | | | | - Scott D. Nash
- The Carter Center, Atlanta, Georgia, United States of America
| | - Martin J. Holland
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Ghasemian E, Faal N, Pickering H, Sillah A, Breuer J, Bailey RL, Mabey D, Holland MJ. Genomic insights into local-scale evolution of ocular Chlamydia trachomatis strains within and between individuals in Gambian trachoma-endemic villages. Microb Genom 2024; 10:001210. [PMID: 38445851 PMCID: PMC10999739 DOI: 10.1099/mgen.0.001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
Trachoma, a neglected tropical disease caused by Chlamydia trachomatis (Ct) serovars A-C, is the leading infectious cause of blindness worldwide. Africa bears the highest burden, accounting for over 86 % of global trachoma cases. We investigated Ct serovar A (SvA) and B (SvB) whole genome sequences prior to the induction of mass antibiotic drug administration in The Gambia. Here, we explore the factors contributing to Ct strain diversification and the implications for Ct evolution within the context of ocular infection. A cohort study in 2002-2003 collected ocular swabs across nine Gambian villages during a 6 month follow-up study. To explore the genetic diversity of Ct within and between individuals, we conducted whole-genome sequencing (WGS) on a limited number (n=43) of Ct-positive samples with an omcB load ≥10 from four villages. WGS was performed using target enrichment with SureSelect and Illumina paired-end sequencing. Out of 43 WGS samples, 41 provided sufficient quality for further analysis. ompA analysis revealed that 11 samples had highest identity to ompA from strain A/HAR13 (NC_007429) and 30 had highest identity to ompA from strain B/Jali20 (NC_012686). While SvB genome sequences formed two distinct village-driven subclades, the heterogeneity of SvA sequences led to the formation of many individual branches within the Gambian SvA subclade. Comparing the Gambian SvA and SvB sequences with their reference strains, Ct A/HAR13 and Ct B/Jali20, indicated an single nucleotide polymorphism accumulation rate of 2.4×10-5 per site per year for the Gambian SvA and 1.3×10-5 per site per year for SvB variants (P<0.0001). Variant calling resulted in a total of 1371 single nucleotide variants (SNVs) with a frequency >25 % in SvA sequences, and 438 SNVs in SvB sequences. Of note, in SvA variants, highest evolutionary pressure was recorded on genes responsible for host cell modulation and intracellular survival mechanisms, whereas in SvB variants this pressure was mainly on genes essential for DNA replication/repair mechanisms and protein synthesis. A comparison of the sequences between observed separate infection events (4-20 weeks between infections) suggested that the majority of the variations accumulated in genes responsible for host-pathogen interaction such as CTA_0166 (phospholipase D-like protein), CTA_0498 (TarP) and CTA_0948 (deubiquitinase). This comparison of Ct SvA and SvB variants within a trachoma endemic population focused on their local evolutionary adaptation. We found a different variation accumulation pattern in the Gambian SvA chromosomal genes compared with SvB, hinting at the potential of Ct serovar-specific variation in diversification and evolutionary fitness. These findings may have implications for optimizing trachoma control and prevention strategies.
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Affiliation(s)
- Ehsan Ghasemian
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Nkoyo Faal
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Harry Pickering
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ansumana Sillah
- National Eye Health Programme, Ministry of Health, Kanifing, Gambia
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin J. Holland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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21
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Pitt SJ, Gunn A. The One Health Concept. Br J Biomed Sci 2024; 81:12366. [PMID: 38434675 PMCID: PMC10902059 DOI: 10.3389/bjbs.2024.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
The concept of One Health has been developed as the appreciation that human health is intricately connected to those of other animals and the environment that they inhabit. In recent years, the COVID-19 pandemic and noticeable effects of climate change have encouraged national and international cooperation to apply One Health strategies to address key issues of health and welfare. The United Nations (UN) Sustainable Development Goals have established targets for health and wellbeing, clean water and sanitation, climate action, as well as sustainability in marine and terrestrial ecosystems. The One Health Quadripartite comprises the World Health Organization (WHO), the World Organization for Animal Health (WOAH-formerly OIE), the United Nations Food and Agriculture Organization (FAO) and the United Nations Environment Programme (UNEP). There are six areas of focus which are Laboratory services, Control of zoonotic diseases, Neglected tropical diseases, Antimicrobial resistance, Food safety and Environmental health. This article discusses the concept of One Health by considering examples of infectious diseases and environmental issues under each of those six headings. Biomedical Scientists, Clinical Scientists and their colleagues working in diagnostic and research laboratories have a key role to play in applying the One Health approach to key areas of healthcare in the 21st Century.
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Affiliation(s)
- Sarah J. Pitt
- School of Applied Sciences, University of Brighton, Brighton, United Kingdom
| | - Alan Gunn
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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22
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Rockey DD, Wang X, Debrine A, Grieshaber N, Grieshaber SS. Metabolic dormancy in Chlamydia trachomatis treated with different antibiotics. Infect Immun 2024; 92:e0033923. [PMID: 38214508 PMCID: PMC10863404 DOI: 10.1128/iai.00339-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
Diseases caused by Chlamydia spp. are often associated with persistent infections. Chlamydial persistence is commonly associated with a unique non-infectious intracellular developmental form, termed an aberrant form. Although infectious chlamydiae can be cultured consistently in cells stressed to aberrancy, their role in persistence is not clear. Recovery from antibiotic stress was explored as a model to determine how survival of non-aberrant chlamydiae, in the presence of fully inhibitory drug concentrations, may participate in persistence. Assays included incubation in quinolones, tetracyclines, or chloramphenicol for differing lengths of time, followed by an extended recovery period in antibiotic-free media. Culturable elementary bodies were not detected during treatment with each antibiotic, but viable and culturable Chlamydia trachomatis emerged after the drug was removed. Time-lapse imaging of live, antibiotic-treated infected cells identified metabolically dormant developmental forms within cells that emerged to form typical productive inclusions. The effects of the increasing concentration of most tested antibiotics led to predictable inhibitory activity, in which the survival rate decreased with increasing drug concentration. In contrast, in fluoroquinolone-treated cells, there was a paradoxical increase in productive development that was directly correlated with drug concentration and inversely associated with aberrant form production. This model system uncovers a unique chlamydial persistence pathway that does not involve the chlamydial aberrant form. The association between productive latency and metabolic dormancy is consistent with models for many bacterial species and may lead to a different interpretation of mechanisms of chlamydial persistence in patients.IMPORTANCEThe life history of most pathogens within the genus Chlamydia relies on lengthy persistence in the host. The most generally accepted model for Chlamydia spp. persistence involves an unusual developmental stage, termed the aberrant form, which arises during conditions that mimic a stressful host environment. In this work, we provide an alternate model for chlamydial persistence in the face of antibiotic stress. This model may be relevant to antibiotic treatment failures in patients infected with C. trachomatis.
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Affiliation(s)
- Daniel D. Rockey
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Xisheng Wang
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Abigail Debrine
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Nicole Grieshaber
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA
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Cochrane GM, Mangot M, Houinei W, Susapu M, Cama A, Le Mesurier R, Webster S, Hillgrove T, Barton J, Butcher R, Harding-Esch EM, Mabey D, Bakhtiari A, Müller A, Yajima A, Solomon AW, Kaldor J, Koim SP, Ko R, Garap J. Corneal pannus, Herbert's pits and conjunctival inflammation in older children in Papua New Guinea. Ophthalmic Epidemiol 2024:1-8. [PMID: 38329811 DOI: 10.1080/09286586.2023.2273507] [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] [Indexed: 02/10/2024]
Abstract
PURPOSE The prevalence of trachomatous inflammation-follicular (TF) in Papua New Guinea (PNG) suggests antibiotic mass drug administration (MDA) is needed to eliminate trachoma as a public health problem but the burden of trichiasis is low. As a result, WHO issued bespoke recommendations for the region. If ≥ 20% of 10-14-year-olds have both any conjunctival scarring (C1 or C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. Equally, if ≥ 5% of that group have both moderate/severe conjunctival scarring (C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. METHODS We identified 14 villages where > 20% of 1-9-year-olds had TF during baseline mapping undertaken 4 years and 1 month previously. Every child aged 10-14 years in those villages was eligible to be examined for clinical signs of corneal pannus, Herbert's pits and conjunctival scarring. A grading system that built on existing WHO grading systems was used. RESULTS Of 1,293 resident children, 1,181 (91%) were examined. Of 1,178 with complete examination data, only one (0.08%) individual had concurrent scarring and limbal signs. CONCLUSIONS The WHO-predefined criteria for continuation of MDA were not met. Ongoing behavioural and environmental improvement aspects of the SAFE strategy may contribute to integrated NTD control. Surveillance methods should be strengthened to enable PNG health authorities to identify future changes in disease prevalence.
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Affiliation(s)
| | - Magdelene Mangot
- National Prevention of Blindness Committee, Port Moresby, Papua New Guinea
| | - Wendy Houinei
- National Department of Health, Port Moresby, Papua New Guinea
| | - Melinda Susapu
- National Department of Health, Port Moresby, Papua New Guinea
| | | | | | | | | | | | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Ana Bakhtiari
- International Trachoma Initiative,Task Force for Global Health, Atlanta, USA
| | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Aya Yajima
- Division of Programmes for Disease Control, Western Pacific Regional Office, World Health Organization, Manila, Philippines
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Robert Ko
- National Department of Health, Port Moresby, Papua New Guinea
| | - Jambi Garap
- National Prevention of Blindness Committee, Port Moresby, Papua New Guinea
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24
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Sié A, Ouattara M, Bountogo M, Dah C, Ouedraogo T, Boudo V, Lebas E, Hu H, Arnold BF, O’Brien KS, Lietman TM, Oldenburg CE. Single-dose azithromycin for infant growth in Burkina Faso: Prespecified secondary anthropometric outcomes from a randomized controlled trial. PLoS Med 2024; 21:e1004345. [PMID: 38261579 PMCID: PMC10846702 DOI: 10.1371/journal.pmed.1004345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/06/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Antibiotic use during early infancy has been linked to childhood obesity in high-income countries. We evaluated whether a single oral dose of azithromycin administered during infant-well visits led to changes in infant growth outcomes at 6 months of age in a setting with a high prevalence of undernutrition in rural Burkina Faso. METHODS AND FINDINGS Infants were enrolled from September 25, 2019, until October 22, 2022, in a randomized controlled trial designed to evaluate the efficacy of a single oral dose of azithromycin (20 mg/kg) compared to placebo when administered during well-child visits for prevention of infant mortality. The trial found no evidence of a difference in the primary endpoint. This paper presents prespecified secondary anthropometric endpoints including weight gain (g/day), height change (mm/day), weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), length-for-age Z-score (LAZ), and mid-upper arm circumference (MUAC). Infants were eligible for the trial if they were between 5 and 12 weeks of age, able to orally feed, and their families were planning to remain in the study area for the duration of the study. Anthropometric measurements were collected at enrollment (5 to 12 weeks of age) and 6 months of age. Among 32,877 infants enrolled in the trial, 27,298 (83%) were followed and had valid anthropometric measurements at 6 months of age. We found no evidence of a difference in weight gain (mean difference 0.03 g/day, 95% confidence interval (CI) -0.12 to 0.18), height change (mean difference 0.004 mm/day, 95% CI -0.05 to 0.06), WAZ (mean difference -0.004 SD, 95% CI -0.03 to 0.02), WLZ (mean difference 0.001 SD, 95% CI -0.03 to 0.03), LAZ (mean difference -0.005 SD, 95% CI -0.03 to 0.02), or MUAC (mean difference 0.01 cm, 95% CI -0.01 to 0.04). The primary limitation of the trial was that measurements were only collected at enrollment and 6 months of age, precluding assessment of shorter-term or long-term changes in growth. CONCLUSIONS Single-dose azithromycin does not appear to affect weight and height outcomes when administered during early infancy. TRIAL REGISTRATION ClinicalTrials.gov NCT03676764.
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Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
| | | | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Valentin Boudo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
| | - Huiyu Hu
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
| | - Benjamin F. Arnold
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
- Department of Ophthalmology, University of California, San Francisco, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, United States of America
| | - Kieran S. O’Brien
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
- Department of Ophthalmology, University of California, San Francisco, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, United States of America
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
- Department of Ophthalmology, University of California, San Francisco, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, United States of America
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, United States of America
- Department of Ophthalmology, University of California, San Francisco, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, United States of America
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25
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Caplan N, Sanka BC, Mulat A, Brener DT, Baum S, Seifu A, Kesete NZ, Bruck M, Wohlgemuth LG, Debela MM, Weekes RB, Sabar G, Bentwich Z, Golan R. Motivating school communities towards behavior change and local ownership: a gamification intervention to prevent trachoma at primary schools in southern Ethiopia. Int Health 2023; 15:ii38-ii43. [PMID: 38048382 PMCID: PMC10695423 DOI: 10.1093/inthealth/ihad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Ethiopia alone carries 49% of the global burden of trachoma, associated with a lack of safe water, sanitation and hygiene (WASH) and poor health practices. The aim of this study was to examine whether gamification among schoolchildren and promotion of local ownership of school WASH is associated with healthy behaviors and WASH infrastructure improvements. METHODS Application of the Accelerate gamification intervention for elimination of trachoma, with an emphasis on gamification among schoolchildren and community involvement in motivating face-washing, handwashing and functional use of latrines, was undertaken. RESULTS The study was conducted over 9 mo in 223 rural schools from six districts within the intervention area, reaching 93 518 schoolchildren. At baseline, students were observed washing their hands after using latrines in 23 (10.3%) schools. This increased to 132 (59%) schools (p≤0.001) at follow-up. The number of latrines increased from 585 at baseline to 594 at follow-up (p=0.031). The availability of handwashing stations in schools increased from 31 (13.9%) with water access (8%) and soap (5%) to 155 (69.5%) schools with handwashing stations with water access in 153 (98.7%) (p<0.001) and soap in 121 (78%) (p<0.001). CONCLUSIONS Motivational strategies such as gamification among schoolchildren and promotion of local ownership of school WASH may be associated with healthy behaviors and WASH infrastructure improvements.
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Affiliation(s)
- Naomi Caplan
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Bharat C Sanka
- School of Global Public Health, New York University, New York, NY 10012, USA
| | - Asmro Mulat
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | | | - Sarit Baum
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Azeb Seifu
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | | | - Michal Bruck
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Leah G Wohlgemuth
- Sightsavers International address is 35 Perrymount Road Haywards Heath, RH16 3BW, UK
| | - Melaku M Debela
- Sightsavers International address is 35 Perrymount Road Haywards Heath, RH16 3BW, UK
| | - Reut Barak Weekes
- Glocal, Hebrew University of Jerusalem, Mt. Scopus 91905 Jerusalem, Israel
| | - Galia Sabar
- Department of Middle Eastern and African History, Tel Aviv University, Tel Aviv-Yafo P.O. Box 39040, Israel
| | - Zvi Bentwich
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
| | - Rachel Golan
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
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Baayenda G, Opon R, Waititu T, Kabona G. 'Follow the cattle': a joint cross-border trachoma MDA perspective. Int Health 2023; 15:ii68-ii72. [PMID: 38048373 PMCID: PMC10695424 DOI: 10.1093/inthealth/ihad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/30/2023] [Accepted: 09/12/2023] [Indexed: 12/06/2023] Open
Abstract
Trachoma, a disease caused by Chlamydia trachomatis, is the leading infectious cause of blindness. To fight it, endemic East African countries adopted the World Health Organization's SAFE Strategy, targeting surgery, antibiotics through mass drug administration (MDA), facial cleanliness and environmental improvement. Trachoma persists among nomadic communities along the Kenya-Uganda and Kenya-Tanzania borders. To address this, Kenya, Tanzania and Uganda launched synchronized MDA campaigns, simultaneously treating populations across borders. Successes included joint planning, community involvement and intergovernmental cooperation, although challenges remained in resourcing MDA cross-border focal points and in addressing coverage and funding. Novel strategies like synchronized joint cross-border MDA with community engagement are vital for sustainable trachoma elimination in these nomadic settings.
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27
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Gebreselassie G, Negash K, Tsegaye S, Makonnen M, Deneke B, Desalegn M, Harding-Esch EM, Harte A, Solomon AW, Boyd S, Bakhtiari A, Hassen MA, Hambali A, Dejene M, Beckwith C, Tadesse F, Seifu F, Kiflu G, Kebede F. Prevalence of trachoma in Somali region, Ethiopia: results from trachoma impact surveys in 50 woredas. Int Health 2023; 15:ii30-ii37. [PMID: 38048381 PMCID: PMC10695430 DOI: 10.1093/inthealth/ihad063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Following interventions to eliminate trachoma in Somali region, Ethiopia, we aimed to re-estimate the prevalence of trachomatous trichiasis (TT) and trachomatous inflammation-follicular (TF) at woreda level and identify the factors associated with the disease. METHODS We implemented cross-sectional community-based surveys in 50 trachoma-endemic woredas, using a standardized survey. Households were the secondary sampling unit. Surveys were undertaken through a combination of interviews of household heads and direct inspection of water, sanitation and hygiene (WASH) access, plus clinical evaluation of eligible household members for TT and TF. RESULTS Overall, 41 (82%) of the 50 woredas had met the WHO-recommended active trachoma elimination threshold (prevalence of TF <5% in 1-9-y-olds) and 42 (84%) had met the TT threshold (prevalence of TT unknown to the health system <0.2% in ≥15-y-olds). Only 18% of households had access to an improved drinking water source within a 30-min trip and only 25% had an improved latrine. CONCLUSIONS Additional rounds of antibiotic mass drug administration, plus interventions to enhance facial cleanliness and improve the environment, are required in nine woredas. TT surgical campaigns are needed in eight woredas. Greater access to WASH is required across all the woredas that were surveyed.
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Affiliation(s)
| | | | | | | | | | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Sarah Boyd
- Task Force for Global Health, Decatur GA, USA
| | | | | | | | | | | | | | - Fikre Seifu
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Kiflu
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
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28
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Miecha H, Dejene M, Adugna D, Kebede A, Yadeta D, Alemayehu A, Abateneh A, Dayessa M, Shafi M, Taye E, Balcha L, Negussu N, Mengistu B, Willis R, Jimenez C, Bakhtiari A, Boyd S, Kebede B, Tadesse F, Mamo A, Bekele M, Sinke Z, Solomon AW, Harding-Esch EM. Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018-2020. Ophthalmic Epidemiol 2023; 30:655-662. [PMID: 36519777 PMCID: PMC10581667 DOI: 10.1080/09286586.2022.2119258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation-follicular (TF) prevalence in 1-9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. METHOD We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. RESULT Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1-9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. CONCLUSION Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.
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Affiliation(s)
- Hirpa Miecha
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Dereje Adugna
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Ageru Kebede
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Damtew Yadeta
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Leta Balcha
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | | | - Ayele Mamo
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Zelalem Sinke
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Harding-Esch EM, Burgert-Brucker CR, Jimenez C, Bakhtiari A, Willis R, Dejene Bejiga M, Mpyet C, Ngondi J, Boyd S, Abdala M, Abdou A, Adamu Y, Alemayehu A, Alemayehu W, Al-Khatib T, Apadinuwe SC, Awaca N, Awoussi MS, Baayendag G, Badiane Mouctar D, Bailey RL, Batcho W, Bay Z, Bella A, Beido N, Bol YY, Bougouma C, Brady CJ, Bucumi V, Butcher R, Cakacaka R, Cama A, Camara M, Cassama E, Chaora SG, Chebbi AC, Chisambi AB, Chu B, Conteh A, Coulibaly SM, Courtright P, Dalmar A, Dat TM, Davids T, DJAKER MEA, de Fátima Costa Lopes M, Dézoumbé D, Dodson S, Downs P, Eckman S, Elshafie BE, Elmezoghi M, Elvis AA, Emerson P, Epée EEE, Faktaufon D, Fall M, Fassinou A, Fleming F, Flueckiger R, Gamael KK, Garae M, Garap J, Gass K, Gebru G, Gichangi MM, Giorgi E, Goépogui A, Gómez DVF, Gómez Forero DP, Gower EW, Harte A, Henry R, Honorio-Morales HA, Ilako DR, Issifou AAB, Jones E, Kabona G, Kabore M, Kadri B, Kalua K, Kanyi SK, Kebede S, Kebede F, Keenan JD, Kello AB, Khan AA, KHELIFI H, Kilangalanga J, KIM SH, Ko R, Lewallen S, Lietman T, Logora MSY, Lopez YA, MacArthur C, Macleod C, Makangila F, Mariko B, Martin DL, Masika M, Massae P, Massangaie M, Matendechero HS, Mathewos T, McCullagh S, Meite A, Mendes EP, Abdi HM, Miller H, Minnih A, Mishra SK, Molefi T, Mosher A, M’Po N, Mugume F, Mukwiza R, Mwale C, Mwatha S, Mwingira U, Nash SD, NASSA C, Negussu N, Nieba C, Noah Noah JC, Nwosu CO, Olobio N, Opon R, Pavluck A, Phiri I, Rainima-Qaniuci M, Renneker KK, Saboyá-Díaz MI, Sakho F, Sanha S, Sarah V, Sarr B, Szwarcwald CL, Shah Salam A, Sharma S, Seife F, Serrano Chavez GM, Sissoko M, Sitoe HM, Sokana O, Tadesse F, Taleo F, Talero SL, Tarfani Y, Tefera A, Tekeraoi R, Tesfazion A, Traina A, Traoré L, Trujillo-Trujillo J, Tukahebwa EM, Vashist P, Wanyama EB, WARUSAVITHANA SD, Watitu TK, West S, Win Y, Woods G, YAJIMA A, Yaya G, Zecarias A, Zewengiel S, Zoumanigui A, Hooper PJ, Millar T, Rotondo L, Solomon AW. Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys. Ophthalmic Epidemiol 2023; 30:544-560. [PMID: 38085791 PMCID: PMC10751062 DOI: 10.1080/09286586.2023.2249546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amza Abdou
- Programme National de Santé Oculaire, Niger
| | | | | | | | | | | | - Naomie Awaca
- Ministère de la Santé Publique, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | - Clarisse Bougouma
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Victor Bucumi
- National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Burundi
| | | | | | | | | | | | | | | | | | - Brian Chu
- International Trachoma Initiative, USA
| | | | | | - Paul Courtright
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | - Abdi Dalmar
- Ministry of Human Development and Public Services, Somalia
| | | | | | | | | | | | | | | | | | | | | | - Ange Aba Elvis
- Programme National de la Santé Oculaire et de la lutte contre l’Onchocercose, Côte d’Ivoire
| | | | | | | | | | | | | | | | | | | | - Jambi Garap
- Port Moresby General Hospital, Papua New Guinea
| | | | | | | | | | | | | | | | | | - Anna Harte
- London School of Hygiene & Tropical Medicine, UK
| | - Rob Henry
- U.S. Agency for International Development, USA
| | | | | | | | | | | | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | | | | | | | | | | | | | | | | | - Robert Ko
- Port Moresby General Hospital, Papua New Guinea
| | - Susan Lewallen
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | | | | | - Yuri A Lopez
- SACAICET / MINISTERIO DEL PODER POPULAR PARA LA SALUD, Venezuela
| | | | | | | | | | | | | | | | | | | | | | | | - Aboulaye Meite
- Ministère de la Santé et de l’Hygiène Publique, Cote d’Ivoire
| | | | | | | | | | | | | | - Aryc Mosher
- U.S. Agency for International Development, USA
| | | | | | | | | | | | | | | | | | | | - Cece Nieba
- Ministère de la Santé et de l’Hygiene Publique, Guinea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Solomon Islands
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Alemayehu A, Mekonen A, Mengistu B, Mihret A, Asmare A, Bakhtiari A, Mengistu B, Jimenez C, Kebede D, Bol D, Tadesse F, Kebede F, Gebru G, Frawley H, Ngondi J, Jemal M, Brady M, Negussu N, Butcher R, McPherson S, Backers S, Solomon AW, Bejiga MD, Harding-Esch EM. Prevalence of Trachoma After Three Rounds of Antibiotic Mass Drug Administration in 13 Woredas of Gambella Region, Ethiopia. Ophthalmic Epidemiol 2023:1-9. [PMID: 38032947 DOI: 10.1080/09286586.2023.2248624] [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: 09/27/2022] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required. METHODS Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed. RESULTS The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine. CONCLUSION In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.
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Affiliation(s)
- Addisu Alemayehu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Ademe Mekonen
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Addisalem Mihret
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Bekele Mengistu
- Nekemte Specialized Hospital, Eastern Wollega Zone, Oromia Region, Ethiopia
| | | | - Demis Kebede
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Doul Bol
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Fentahun Tadesse
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Jeremiah Ngondi
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Mohammed Jemal
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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31
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Issifou AAB, Dare A, Badou GA, Harding-Esch EM, Solomon AW, Bakhtiari A, Boyd S, Jimenez C, Harte A, Burgert-Brucker CR, Sintondji FR, Dossa NI, M'Po NTN, Batcho W. Twenty-Three Population-Based Trachoma Prevalence Surveys in the Central and Northern Regions of Benin, 2018-2022. Ophthalmic Epidemiol 2023:1-11. [PMID: 38032921 DOI: 10.1080/09286586.2023.2265796] [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: 11/01/2022] [Accepted: 03/14/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Trachoma is an infectious eye disease caused by Chlamydia trachomatis. Infection causes conjunctival inflammation, which can be manifested by the sign known as trachomatous inflammation-follicular (TF). Repeated inflammation leads to eyelid scarring, which in susceptible individuals can cause in-turning of the eyelashes, referred to as trachomatous trichiasis (TT). This article describes 23 population-based surveys conducted in northern and central Benin to determine TF and/or TT prevalence for trachoma elimination purposes. METHODS A total of 18 surveys estimated the prevalence of both TF and TT: two baseline surveys, eight impact surveys after implementation of interventions against trachoma, and eight surveillance surveys. Five other evaluation units (EUs) were surveyed for TT only. To estimate the TF prevalence, a target sample size of 1701 (baseline) and 1164 1-9-year-olds (impact and surveillance) was required, whereas 2818 ≥ 15-year-olds were required to estimate the less prevalent TT. In each EU, individuals were selected by two-stage cluster sampling and examined by certified graders for TF and/or TT. RESULTS A total of 68,613 people were examined. TF prevalence estimates were under the 5% elimination threshold in all surveys. TT prevalence estimates were above the 0.2% elimination threshold in all five TT-only surveys and in four impact surveys, ranging from 0.2-0.57. CONCLUSION TF prevalence in Benin is low, but TT was above 0.2% in nine districts. Increased case-finding and continuing efforts to improve surgery accessibility will be needed to reduce the burden of TT in Benin.
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Affiliation(s)
| | - Aboudou Dare
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
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32
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Borlase A, Prada JM, Crellen T. Modelling morbidity for neglected tropical diseases: the long and winding road from cumulative exposure to long-term pathology. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220279. [PMID: 37598702 PMCID: PMC10440174 DOI: 10.1098/rstb.2022.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Reducing the morbidities caused by neglected tropical diseases (NTDs) is a central aim of ongoing disease control programmes. The broad spectrum of pathogens under the umbrella of NTDs lead to a range of negative health outcomes, from malnutrition and anaemia to organ failure, blindness and carcinogenesis. For some NTDs, the most severe clinical manifestations develop over many years of chronic or repeated infection. For these diseases, the association between infection and risk of long-term pathology is generally complex, and the impact of multiple interacting factors, such as age, co-morbidities and host immune response, is often poorly quantified. Mathematical modelling has been used for many years to gain insights into the complex processes underlying the transmission dynamics of infectious diseases; however, long-term morbidities associated with chronic or cumulative exposure are generally not incorporated into dynamic models for NTDs. Here we consider the complexities and challenges for determining the relationship between cumulative pathogen exposure and morbidity at the individual and population levels, drawing on case studies for trachoma, schistosomiasis and foodborne trematodiasis. We explore potential frameworks for explicitly incorporating long-term morbidity into NTD transmission models, and consider the insights such frameworks may bring in terms of policy-relevant projections for the elimination era. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Anna Borlase
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
| | - Joaquin M. Prada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Thomas Crellen
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
- School of Biodiversity, One Health & Veterinary Medicine, Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK
- Wellcome Centre for Integrative Parasitology, Sir Graeme Davies Building, University of Glasgow, Glasgow G12 8TA, UK
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33
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Ghasemian E, Harding-Esch E, Mabey D, Holland MJ. When Bacteria and Viruses Collide: A Tale of Chlamydia trachomatis and Sexually Transmitted Viruses. Viruses 2023; 15:1954. [PMID: 37766360 PMCID: PMC10536055 DOI: 10.3390/v15091954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
The global incidence of sexually transmitted infections (STIs) remains high, with the World Health Organization (WHO) estimating that over 1 million people acquire STIs daily. STIs can lead to infertility, pregnancy complications, and cancers. Co-infections with multiple pathogens are prevalent among individuals with an STI and can lead to heightened infectivity and more severe clinical manifestations. Chlamydia trachomatis (CT) is the most reported bacterial STI worldwide in both men and women, and several studies have demonstrated co-infection of CT with viral and other bacterial STIs. CT is a gram-negative bacterium with a unique biphasic developmental cycle including infectious extracellular elementary bodies (EBs) and metabolically active intracellular reticulate bodies (RBs). The intracellular form of this organism, RBs, has evolved mechanisms to persist for long periods within host epithelial cells in a viable but non-cultivable state. The co-infections of CT with the most frequently reported sexually transmitted viruses: human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) have been investigated through in vitro and in vivo studies. These research studies have made significant strides in unraveling the intricate interactions between CT, these viral STIs, and their eukaryotic host. In this review, we present an overview of the epidemiology of these co-infections, while specifically delineating the underlying mechanisms by which CT influences the transmission and infection dynamics of HIV and HSV. Furthermore, we explore the intricate relationship between CT and HPV infection, with a particular emphasis on the heightened risk of cervical cancer. By consolidating the current body of knowledge, we provide valuable insights into the complex dynamics and implications of co-infection involving CT and sexually transmitted viruses.
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Affiliation(s)
- Ehsan Ghasemian
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.H.-E.); (D.M.); (M.J.H.)
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Sun R, Zheng W, Yang S, Zeng J, Tuo Y, Tan L, Zhang H, Bai H. In Silico Identification and Validation of Pyroptosis-Related Genes in Chlamydia Respiratory Infection. Int J Mol Sci 2023; 24:13570. [PMID: 37686375 PMCID: PMC10488104 DOI: 10.3390/ijms241713570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
The incidence of Chlamydia trachomatis respiratory infection is increasing, and its pathogenesis is still unclear. Pyroptosis, as a mode of inflammatory cell death, plays a vital role in the occurrence and development of Chlamydia trachomatis respiratory infection. In this study, the potential pyroptosis-related genes involved in Chlamydia trachomatis respiratory infection were identified by constructing a mouse model of C. muridarum infection combined with bioinformatics analysis. Through in-depth analysis of the RNA sequencing data, 13 differentially expressed pyroptosis-related genes were screened, including 1 downregulated gene and 12 upregulated genes. Gene ontology (GO) analysis showed that these genes mainly regulate inflammatory responses and produce IL-1β. Protein-protein interaction network analysis identified eight hub genes of interest: Tnf, Tlr2, Il1b, Nlrp3, Tlr9, Mefv, Zbp1 and Tnfaip3. Through quantitative real-time PCR (qPCR) analysis, we found that the expression of these genes in the lungs of C. muridarum-infected mice was significantly reduced, consistent with the bioinformatics results. At the same time, we detected elevated levels of caspase-3, gasdermin D and gasdermin E proteins in the lungs of C. muridarum-infected mice, demonstrating that Chlamydia trachomatis infection does induce pyroptosis. We then predicted nine miRNAs targeting these hub genes and constructed a key competitive endogenous RNA (ceRNA) network. In summary, we identified six key pyroptosis-related genes involved in Chlamydia trachomatis respiratory infection and constructed a ceRNA network associated with these genes. These findings will improve understanding of the molecular mechanisms underlying pyroptosis in Chlamydia trachomatis respiratory infections.
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Affiliation(s)
| | | | | | | | | | | | | | - Hong Bai
- Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Department of Immunology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China; (R.S.); (W.Z.); (S.Y.); (J.Z.); (Y.T.); (L.T.); (H.Z.)
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35
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Meier K, Jachmann LH, Türköz G, Babu Sait MR, Pérez L, Kepp O, Valdivia RH, Kroemer G, Sixt BS. The Chlamydia effector CpoS modulates the inclusion microenvironment and restricts the interferon response by acting on Rab35. mBio 2023; 14:e0319022. [PMID: 37530528 PMCID: PMC10470785 DOI: 10.1128/mbio.03190-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
The obligate intracellular bacterium Chlamydia trachomatis inserts a family of inclusion membrane (Inc) proteins into the membrane of its vacuole (the inclusion). The Inc CpoS is a critical suppressor of host cellular immune surveillance, but the underlying mechanism remained elusive. By complementing a cpoS mutant with various natural orthologs and variants of CpoS, we linked distinct molecular interactions of CpoS to distinct functions. Unexpectedly, we found CpoS to be essential for the formation of inclusion membrane microdomains that control the spatial organization of multiple Incs involved in signaling and modulation of the host cellular cytoskeleton. While the function of CpoS in microdomains was uncoupled from its role in the suppression of host cellular defenses, we found the ability of CpoS to interact with Rab GTPases to be required not only for the manipulation of membrane trafficking, such as to mediate transport of ceramide-derived lipids (sphingolipids) to the inclusion, but also for the inhibition of Stimulator of interferon genes (STING)-dependent type I interferon responses. Indeed, depletion of Rab35 phenocopied the exacerbated interferon responses observed during infection with CpoS-deficient mutants. Overall, our findings highlight the role of Inc-Inc interactions in shaping the inclusion microenvironment and the modulation of membrane trafficking as a pathogenic immune evasion strategy. IMPORTANCE Chlamydia trachomatis is a prevalent bacterial pathogen that causes blinding ocular scarring and urogenital infections that can lead to infertility and pregnancy complications. Because Chlamydia can only grow within its host cell, boosting the intrinsic defenses of human cells may represent a novel strategy to fight pathogen replication and survival. Hence, CpoS, a Chlamydia protein known to block host cellular defenses, or processes regulated by CpoS, could provide new opportunities for therapeutic intervention. By revealing CpoS as a multifunctional virulence factor and by linking its ability to block host cellular immune signaling to the modulation of membrane trafficking, the present work may provide a foundation for such rationale targeting and advances our understanding of how intracellular bacteria can shape and protect their growth niche.
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Affiliation(s)
- Karsten Meier
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
| | - Lana H. Jachmann
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
| | - Gözde Türköz
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
| | - Mohammed Rizwan Babu Sait
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
| | - Lucía Pérez
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
| | - Oliver Kepp
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
| | - Raphael H. Valdivia
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Department of Biology, Institut du Cancer Paris CARPEM, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Barbara S. Sixt
- Department of Molecular Biology, Umeå University, Umeå, Sweden
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research (UCMR), Umeå University, Umeå, Sweden
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DeBoer AG, Lei L, Yang C, Martens CA, Anzick SL, Antonioli-Schmit S, Suchland RJ, McClarty G, Caldwell HD, Rockey DD. TargeTron Inactivation of Chlamydia trachomatis gseA Results in a Lipopolysaccharide 3-Deoxy-d-Manno-Oct-2-Ulosonic Acid-Deficient Strain That Is Cytotoxic for Cells. Infect Immun 2023; 91:e0009623. [PMID: 37255490 PMCID: PMC10353364 DOI: 10.1128/iai.00096-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
All members of the family Chlamydiaceae have lipopolysaccharides (LPS) that possess a shared carbohydrate trisaccharide antigen, 3-deoxy-d-manno-oct-2-ulosonic acid (Kdo) that is functionally uncharacterized. A single gene, genus-specific epitope (gseA), is responsible for attaching the tri-Kdo to lipid IVA. To investigate the function of Kdo in chlamydial host cell interactions, we made a gseA-null strain (L2ΔgseA) by using TargeTron mutagenesis. Immunofluorescence microscopy and immunoblotting with a Kdo-specific monoclonal antibody demonstrated that L2ΔgseA lacked Kdo. L2ΔgseA reacted by immunoblotting with a monoclonal antibody specific for a conserved LPS glucosamine-PO4 epitope, indicating that core lipid A was retained by the mutant. The mutant strain produced a similar number of inclusions as the parental strain but yielded lower numbers of infectious elementary bodies. Transmission electron microscopy of L2ΔgseA-infected cells showed atypical developmental forms and a reduction in the number of elementary bodies. Immunoblotting of dithiothreitol-treated L2ΔgseA-infected cells lysates revealed a marked reduction in outer membrane OmcB disulfide cross-linking, suggesting that the elementary body outer membrane structure was affected by the lack of Kdo. Notably, lactic acid dehydrogenase release by infected cells demonstrated that L2ΔgseA was significantly more cytotoxic to host cells than the wild type. The cytotoxic phenotype may result from an altered outer membrane biogenesis structure and/or function or, conversely, from a direct pathobiological effect of Kdo on an unknown host cell target. These findings implicate a previously unrecognized role for Kdo in host cell interactions that facilitates postinfection host cell survival.
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Affiliation(s)
- Addison G. DeBoer
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lei Lei
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Chunfu Yang
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Craig A. Martens
- National Institute of Allergy and Infectious Disease, Rocky Mountain Laboratory, Hamilton, Montana, USA
| | - Sarah L. Anzick
- National Institute of Allergy and Infectious Disease, Rocky Mountain Laboratory, Hamilton, Montana, USA
| | - Sophia Antonioli-Schmit
- National Institute of Allergy and Infectious Disease, Rocky Mountain Laboratory, Hamilton, Montana, USA
| | - Robert J. Suchland
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Grant McClarty
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba Winnipeg, Winnipeg, Manitoba, Canada
| | - Harlan D. Caldwell
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel D. Rockey
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
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Bucumi V, Muhimpundu E, Bio Issifou AA, Akweyu S, Burn N, Willems J, Niyongabo J, Elvis A, Koizan G, Harte A, Boyd S, Willis R, Bakhtiari A, Jimenez C, Burgert-Brucker C, Kollmann KHMM, Solomon AW, Harding-Esch EM, Gashikanyi RM. Baseline, Impact and Surveillance Trachoma Prevalence Surveys in Burundi, 2018-2021. Ophthalmic Epidemiol 2023:1-10. [PMID: 37401094 PMCID: PMC10581665 DOI: 10.1080/09286586.2023.2213776] [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: 11/10/2022] [Revised: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Trachoma is an eye disease caused by the bacterium Chlamydia trachomatis (Ct). It can lead to permanent vision loss. Since 2007, Burundi has included trachoma elimination as part of its fight against neglected tropical diseases and blindness. This study presents the results of trachoma baseline, impact and surveillance surveys conducted in Burundi between 2018 and 2021. METHODS Areas were grouped into evaluation units (EU) with resident populations of between 100,000 and 250,000 people. Baseline surveys were conducted in 15 EUs, impact surveys in 2 EUs and surveillance surveys in 5 EUs; in each survey, 23 clusters of about 30 households were included. Consenting residents of those households were screened for clinical signs of trachoma. Access to water, sanitation and hygiene (WASH) was recorded. RESULTS A total of 63,800 individuals were examined. The prevalence of TF in 1-9-year-olds was above the elimination threshold of 5% in a single EU at baseline, but fell below the threshold in subsequent impact and surveillance surveys. The prevalence of TT was below the 0.2% elimination threshold in ≥15-year-olds in all EUs surveyed. A high proportion (83%) of households had access to safe drinking water, while only a minority (~8%) had access to improved latrines. CONCLUSION Burundi has demonstrated the prevalence levels necessary for trachoma elimination status. With continued effort and the maintenance of existing management plans, trachoma elimination in Burundi is within reach.
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Affiliation(s)
- Victor Bucumi
- Département En Charge des Maladies Tropicales, National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Bujumbura, Burundi
| | - Elvis Muhimpundu
- Département En Charge des Maladies Tropicales, National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Bujumbura, Burundi
| | | | - Stephanie Akweyu
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM international
| | - Nick Burn
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM international
| | - Johan Willems
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM international
| | - Junénal Niyongabo
- Département En Charge des Maladies Tropicales, National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Bujumbura, Burundi
| | - Aba Elvis
- Programme National de la Santé Oculaire et de la lutte contre l’Onchocercose, Côte d’Ivoire
| | - Gamael Koizan
- Ministère de la Santé et de l’Hygiène Publique, Cote d’Ivoire
| | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | | | - KHM Martin Kollmann
- Inclusive Eye Health and Neglected Tropical Diseases Initiative, CBM international
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Rose Marie Gashikanyi
- Département En Charge des Maladies Tropicales, National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Bujumbura, Burundi
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Sasanami M, Amoah B, Diori AN, Amza A, Souley ASY, Bakhtiari A, Kadri B, Szwarcwald CL, Ferreira Gomez DV, Almou I, Lopes MDFC, Masika MP, Beidou N, Boyd S, Harding-Esch EM, Solomon AW, Giorgi E. Using model-based geostatistics for assessing the elimination of trachoma. PLoS Negl Trop Dis 2023; 17:e0011476. [PMID: 37506060 PMCID: PMC10381061 DOI: 10.1371/journal.pntd.0011476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Trachoma is the commonest infectious cause of blindness worldwide. Efforts are being made to eliminate trachoma as a public health problem globally. However, as prevalence decreases, it becomes more challenging to precisely predict prevalence. We demonstrate how model-based geostatistics (MBG) can be used as a reliable, efficient, and widely applicable tool to assess the elimination status of trachoma. METHODS We analysed trachoma surveillance data from Brazil, Malawi, and Niger. We developed geostatistical Binomial models to predict trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) prevalence. We proposed a general framework to incorporate age and gender in the geostatistical models, whilst accounting for residual spatial and non-spatial variation in prevalence through the use of random effects. We also used predictive probabilities generated by the geostatistical models to quantify the likelihood of having achieved the elimination target in each evaluation unit (EU). RESULTS TF and TT prevalence varied considerably by country, with Brazil showing the lowest prevalence and Niger the highest. Brazil and Malawi are highly likely to have met the elimination criteria for TF in each EU, but, for some EUs, there was high uncertainty in relation to the elimination of TT according to the model alone. In Niger, the predicted prevalence varied significantly across EUs, with the probability of having achieved the elimination target ranging from values close to 0% to 100%, for both TF and TT. CONCLUSIONS We demonstrated the wide applicability of MBG for trachoma programmes, using data from different epidemiological settings. Unlike the standard trachoma prevalence survey approach, MBG provides a more statistically rigorous way of quantifying uncertainty around the achievement of elimination prevalence targets, through the use of spatial correlation. In addition to the analysis of existing survey data, MBG also provides an approach to identify areas in which more sampling effort is needed to improve EU classification. We advocate MBG as the new standard method for analysing trachoma survey outputs.
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Affiliation(s)
- Misaki Sasanami
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Benjamin Amoah
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Adam Nouhou Diori
- Ophtalmologie de l’Hôpital Amirou Boubacar Diallo de Niamey, Niamey, Niger
| | - Abdou Amza
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Boubacar Kadri
- Programme National de Sante Oculaire (PNSO), Niamey, Niger
| | - Célia L. Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ibrahim Almou
- Programme National de Sante Oculaire (PNSO), Niamey, Niger
| | | | | | | | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Emma M. Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Wan W, Li D, Li D, Jiao J. Advances in genetic manipulation of Chlamydia trachomatis. Front Immunol 2023; 14:1209879. [PMID: 37449211 PMCID: PMC10337758 DOI: 10.3389/fimmu.2023.1209879] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Chlamydia trachomatis, one species of Chlamydia spp., has the greatest impact on human health and is the main cause of bacterial sexually transmitted diseases and preventable blindness among all Chamydia spp. species. The obligate intracellular parasitism and unique biphasic developmental cycle of C. trachomatis are the main barriers for the development of tools of genetic manipulation. The past decade has witnessed significant gains in genetic manipulation of C. trachomatis, including chemical mutagenesis, group II intron-based targeted gene knockout, fluorescence-reported allelic exchange mutagenesis (FRAEM), CRISPR interference (CRISPRi) and the recently developed transposon mutagenesis. In this review, we discuss the current status of genetic manipulations of C. trachomatis and highlights new challenges in the nascent field of Chlamydia genetics.
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Affiliation(s)
- Weiqiang Wan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Danni Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Dan Li
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, The First Hospital of Jilin University, Changchun, China
| | - Jun Jiao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
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Ul Hassan E, Apadinuwe SC, Bisanzio D, Dejene M, Downs P, Harding-Esch EM, Jimenez C, Kabona G, Kebede BN, Kelly M, Kivumbi P, Millar T, Mosher AW, Mpyet C, Mkocha H, Ngondi JM, Olobio N, Palmer S, Teyil WM, Courtright P. Impact of personal protective equipment on the clarity of vision among trachoma survey graders and trichiasis surgeons in the context of COVID-19. BMJ Open Ophthalmol 2023; 8:e001255. [PMID: 37493675 PMCID: PMC10255175 DOI: 10.1136/bmjophth-2023-001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/20/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND/AIMS The COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness. METHODS There were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation-follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes. RESULTS In phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations. CONCLUSION The face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.
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Affiliation(s)
| | | | - Donal Bisanzio
- Research Triangle Park, Research Triangle Institute, Durham, North Carolina, USA
| | - Michael Dejene
- Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Philip Downs
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
- Neglected Tropical Diseases, Sightsavers, Durham, North Carolina, USA
| | - Emma M Harding-Esch
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - George Kabona
- Union Government of Tanzania Ministry of Health Community Development Gender Elderly Children, Dar es Salaam, Tanzania, United Republic of
| | | | - Michaela Kelly
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | - Peter Kivumbi
- Sightsavers, Dar es Salaam, United Republic of Tanzania
| | - Tom Millar
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | - Aryc W Mosher
- United States Agency for International Development, Washington, DC, USA
| | - Caleb Mpyet
- Neglected Tropical Diseases, Sightsavers, Kaduna, Nigeria
| | - Harran Mkocha
- Microbiology and Immunology, Kongwa Trachoma Project, Kongwa, Tanzania, United Republic of
| | - Jeremiah M Ngondi
- Research Triangle Park, Research Triangle Institute, Durham, North Carolina, USA
| | | | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, University of Cape Town, Observatory, South Africa
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Caven LT, Carabeo RA. The role of infected epithelial cells in Chlamydia-associated fibrosis. Front Cell Infect Microbiol 2023; 13:1208302. [PMID: 37265500 PMCID: PMC10230099 DOI: 10.3389/fcimb.2023.1208302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
Ocular, genital, and anogenital infection by the obligate intracellular pathogen Chlamydia trachomatis have been consistently associated with scar-forming sequelae. In cases of chronic or repeated infection of the female genital tract, infection-associated fibrosis of the fallopian tubes can result in ectopic pregnancy or infertility. In light of this urgent concern to public health, the underlying mechanism of C. trachomatis-associated scarring is a topic of ongoing study. Fibrosis is understood to be an outcome of persistent injury and/or dysregulated wound healing, in which an aberrantly activated myofibroblast population mediates hypertrophic remodeling of the basement membrane via deposition of collagens and other components of the extracellular matrix, as well as induction of epithelial cell proliferation via growth factor signaling. Initial study of infection-associated immune cell recruitment and pro-inflammatory signaling have suggested the cellular paradigm of chlamydial pathogenesis, wherein inflammation-associated tissue damage and fibrosis are the indirect result of an immune response to the pathogen initiated by host epithelial cells. However, recent work has revealed more direct routes by which C. trachomatis may induce scarring, such as infection-associated induction of growth factor signaling and pro-fibrotic remodeling of the extracellular matrix. Additionally, C. trachomatis infection has been shown to induce an epithelial-to-mesenchymal transition in host epithelial cells, prompting transdifferentiation into a myofibroblast-like phenotype. In this review, we summarize the field's current understanding of Chlamydia-associated fibrosis, reviewing key new findings and identifying opportunities for further research.
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Affiliation(s)
- Liam T. Caven
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Rey A. Carabeo
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
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Wilson SE. Topical Losartan: Practical Guidance for Clinical Trials in the Prevention and Treatment of Corneal Scarring Fibrosis and Other Eye Diseases and Disorders. J Ocul Pharmacol Ther 2023; 39:191-206. [PMID: 36877777 PMCID: PMC10079252 DOI: 10.1089/jop.2022.0174] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 03/08/2023] Open
Abstract
Losartan is an angiotensin II receptor blocker (ARB) that impedes transforming growth factor (TGF) beta signaling by inhibiting activation of signal transduction molecule extracellular signal-regulated kinase (ERK). Studies supported the efficacy of topical losartan in decreasing scarring fibrosis after rabbit Descemetorhexis, alkali burn, and photorefractive keratectomy injuries, and in case reports of humans with scarring fibrosis after surgical complications. Clinical studies are needed to explore the efficacy and safety of topical losartan in the prevention and treatment of corneal scarring fibrosis, and other eye diseases and disorders where TGF beta has a role in pathophysiology. These include scarring fibrosis associated with corneal trauma, chemical burns, infections, surgical complications, and persistent epithelial defects, as well as conjunctival fibrotic diseases, such as ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Research is also needed to explore the efficacy and safety of topical losartan for hypothesized treatment of transforming growth factor beta-induced (TGFBI)-related corneal dystrophies (Reis-Bu¨cklers corneal dystrophy, lattice corneal dystrophy type 1, and granular corneal dystrophies type 1 and type 2) where deposited mutant protein expression is modulated by TGF beta. Investigations could also explore the efficacy and safety of topical losartan treatments to reduce conjunctival bleb scarring and shunt encapsulation following glaucoma surgical procedures. Losartan and sustained release drug delivery devices could be efficacious in treating intraocular fibrotic diseases. Dosing suggestions and precautions that should be considered in trials of losartan are detailed. Losartan, as an adjuvant to current treatments, has the potential to augment pharmacological therapeutics for many ocular diseases and disorders where TGF beta plays a central role in pathophysiology.
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Affiliation(s)
- Steven E. Wilson
- The Cole Eye Institute, The Cleveland Clinic, Cleveland, Ohio, USA
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Sokunbi TO, Unnithan V, Unim B, Odhiambo J, Dauda Z, Effiong FB. Trachoma elimination in Togo: lessons and recommendations for African countries. Pathog Glob Health 2023; 117:99-100. [PMID: 36254374 PMCID: PMC9970232 DOI: 10.1080/20477724.2022.2136602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Taiwo Oluwaseun Sokunbi
- Directorate of Research, TORASIF, Calabar, Nigeria
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Vishnu Unnithan
- Directorate of Research, TORASIF, Calabar, Nigeria
- Department of Nuclear Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
- Research Committee (Education Sub-group), Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, Geneva, Switzerland
| | - Brigid Unim
- Department of Cardiovascular, Endocrine – Metabolic Disease and Aging, Istituto Superiore di Sanita, Rome, Italy
| | - Janice Odhiambo
- Directorate of Research, TORASIF, Calabar, Nigeria
- School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zakariya’u Dauda
- Directorate of Research, TORASIF, Calabar, Nigeria
- School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Fortune Benjamin Effiong
- Directorate of Research, TORASIF, Calabar, Nigeria
- Department of Clinical Chemistry and Immunology, Faculty of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
- African Community for Systematic Reviews and Meta-analyses (ACSRM), Lagos, Nigeria
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Bilchut AH, Burroughs HR, Oldenburg CE, Lietman TM. Trachoma Control: A Glass Half Full? Am J Trop Med Hyg 2023; 108:237-238. [PMID: 36623481 PMCID: PMC9896326 DOI: 10.4269/ajtmh.22-0760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Awraris H. Bilchut
- School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Hadley R. Burroughs
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;,Department of Ophthalmology, University of California, San Francisco, San Francisco, California;,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;,Department of Ophthalmology, University of California, San Francisco, San Francisco, California;,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California,Address correspondence to Thomas M. Lietman, Francis I Proctor Foundation, University of California, San Francisco, 490 Illinois St., 2nd Floor, San Francisco, CA 94143-0944. E-mail:
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Chlamydia trachomatis Alters Mitochondrial Protein Composition and Secretes Effector Proteins That Target Mitochondria. mSphere 2022; 7:e0042322. [PMID: 36286535 PMCID: PMC9769516 DOI: 10.1128/msphere.00423-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mitochondria are critical cellular organelles that perform a wide variety of functions, including energy production and immune regulation. To perform these functions, mitochondria contain approximately 1,500 proteins, the majority of which are encoded in the nuclear genome, translated in the cytoplasm, and translocated to the mitochondria using distinct mitochondrial targeting sequences (MTS). Bacterial proteins can also contain MTS and localize to the mitochondria. For the obligate intracellular human pathogen Chlamydia trachomatis, interaction with various host cell organelles promotes intracellular replication. However, the extent and mechanisms through which Chlamydia cells interact directly with mitochondria remain unclear. We investigated the presence of MTS in the C. trachomatis genome and discovered 30 genes encoding proteins with around 70% or greater probability of mitochondrial localization. Five are translocated to the mitochondria upon ectopic expression in HeLa cells. Mass spectrometry of isolated mitochondria from infected cells revealed that two of these proteins localize to the mitochondria during infection. Comparison of mitochondria from infected and uninfected cells suggests that chlamydial infection affects the mitochondrial protein composition. Around 125 host proteins were significantly decreased or absent in mitochondria from infected cells. Among these were proapoptotic factors and those related to mitochondrial fission/fusion dynamics. Conversely, 82 host proteins were increased in or specific to mitochondria of infected cells, many of which act as antiapoptotic factors and upregulators of cellular metabolism. These data support the notion that C. trachomatis specifically targets host mitochondria to manipulate cell fate decisions and metabolic function to support pathogen survival and replication. IMPORTANCE Obligate intracellular bacteria have evolved multiple means to promote their intracellular survival and replication within the otherwise harsh environment of the eukaryotic cell. Nutrient acquisition and avoidance of cellular defense mechanisms are critical to an intracellular lifestyle. Mitochondria are critical organelles that produce energy in the form of ATP and regulate programmed cell death responses to invasive pathogenic microbes. Cell death prior to completion of replication would be detrimental to the pathogen. C. trachomatis produces at least two and possibly more proteins that target the mitochondria. Collectively, C. trachomatis infection modulates the mitochondrial protein composition, favoring a profile suggestive of downregulation of apoptosis.
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Kuwabara S, Landers ER, Fisher DJ. Impact of nutrients on the function of the chlamydial Rsb partner switching mechanism. Pathog Dis 2022; 80:6831632. [PMID: 36385643 DOI: 10.1093/femspd/ftac044] [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: 07/26/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
The obligate intracellular bacterial pathogen Chlamydia trachomatis is a leading cause of sexually transmitted infections and infectious blindness. Chlamydia undergo a biphasic developmental cycle alternating between the infectious elementary body (EB) and the replicative reticulate body (RB). The molecular mechanisms governing RB growth and RB-EB differentiation are unclear. We hypothesize that the bacterium senses host cell and bacterial energy levels and metabolites to ensure that development and growth coincide with nutrient availability. We predict that a partner switching mechanism (PSM) plays a key role in the sensing and response process acting as a molecular throttle sensitive to metabolite levels. Using purified wild type and mutant PSM proteins, we discovered that metal type impacts enzyme activity and the substrate specificity of RsbU and that RsbW prefers ATP over GTP as a phosphate donor. Immunoblotting analysis of RsbV1/V2 demonstrated the presence of both proteins beyond 20 hours post infection and we observed that an RsbV1-null strain has a developmental delay and exhibits differential growth attenuation in response to glucose levels. Collectively, our data support that the PSM regulates growth in response to metabolites and further defines biochemical features governing PSM-component interactions which could help in the development of novel PSM-targeted therapeutics.
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Affiliation(s)
- Shiomi Kuwabara
- Molecular Biology, Microbiology and Biochemistry Graduate Program, Southern Illinois University, Carbondale, IL 62901, United States
| | - Evan R Landers
- Molecular Biology, Microbiology and Biochemistry Graduate Program, Southern Illinois University, Carbondale, IL 62901, United States
| | - Derek J Fisher
- Molecular Biology, Microbiology and Biochemistry Graduate Program, Southern Illinois University, Carbondale, IL 62901, United States.,School of Biological Sciences, Southern Illinois University, Carbondale, IL 62901, United States
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Suchland RJ, Carrell SJ, Ramsey SA, Hybiske K, Debrine AM, Sanchez J, Celum C, Rockey DD. Genomic Analysis of MSM Rectal Chlamydia trachomatis Isolates Identifies Predicted Tissue-Tropic Lineages Generated by Intraspecies Lateral Gene Transfer-Mediated Evolution. Infect Immun 2022; 90:e0026522. [PMID: 36214558 PMCID: PMC9670952 DOI: 10.1128/iai.00265-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Chlamydia trachomatis is an obligate intracellular bacterium that causes serious diseases in humans. Rectal infection and disease caused by this pathogen are important yet understudied aspects of C. trachomatis natural history. The University of Washington Chlamydia Repository has a large collection of male-rectal-sourced strains (MSM rectal strains) isolated in Seattle, USA and Lima, Peru. Initial characterization of strains collected over 30 years in both Seattle and Lima led to an association of serovars G and J with male rectal infections. Serovar D, E, and F strains were also collected from MSM patients. Genome sequence analysis of a subset of MSM rectal strains identified a clade of serovar G and J strains that had high overall genomic identity. A genome-wide association study was then used to identify genomic loci that were correlated with tissue tropism in a collection of serovar-matched male rectal and female cervical strains. The polymorphic membrane protein PmpE had the strongest correlation, and amino acid sequence alignments identified a set of PmpE variable regions (VRs) that were correlated with host or tissue tropism. Examination of the positions of VRs by the protein structure-predicting Alphafold2 algorithm demonstrated that the VRs were often present in predicted surface-exposed loops in both PmpE and PmpH protein structure. Collectively, these studies identify possible tropism-predictive loci for MSM rectal C. trachomatis infections and identify predicted surface-exposed variable regions of Pmp proteins that may function in MSM rectal versus cervical tropism differences.
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Affiliation(s)
- Robert J. Suchland
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Steven J. Carrell
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Stephen A. Ramsey
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Kevin Hybiske
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Abigail M. Debrine
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Universidad Nacional Mayor San Marcos, Lima, Peru
| | - Connie Celum
- Departments of Global Health and Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel D. Rockey
- Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, USA
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Adams J, Kim SH, Solomon AW. Where should we offer mass drug administration for trachoma? Med J Aust 2022; 217:522-523. [DOI: 10.5694/mja2.51752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
| | - Sung Hye Kim
- World Health Organization Regional Office for the Western Pacific Manila Philippines
- Hanyang University Seoul Republic of Korea
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Pickering H, Ramadhani AM, Massae P, Mafuru E, Malisa A, Mbuya K, Makupa W, Mtuy T, Derrick T, Houghton J, Bailey RL, Mabey DCW, Burton MJ, Holland MJ. The conjunctival microbiome before and after azithromycin mass drug administration for trachoma control in a cohort of Tanzanian children. Front Public Health 2022; 10:1015714. [PMID: 36324475 PMCID: PMC9619060 DOI: 10.3389/fpubh.2022.1015714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background Trachoma, caused by ocular infection with Chlamydia trachomatis, is a neglected tropical disease that can lead to blinding pathology. Current trachoma control programmes have successfully used mass drug administration (MDA) with azithromycin to clear C. trachomatis infection and reduce transmission, alongside promoting facial cleanliness for better personal hygiene and environmental improvement. In areas of low-trachoma endemicity, the relationship between C. trachomatis infection and trachomatous disease weakens, and non-chlamydial bacteria have been associated with disease signs. Methods We enrolled a cohort of children aged 6-10 years from three adjacent trachoma endemic villages in Kilimanjaro and Arusha regions, Northern Tanzania. Children were divided into four clinical groups based on the presence or absence of ocular C. trachomatis infection and clinical signs of trachomatous papillary inflammation (TP). To determine the impact of treatment on the ocular microbiome in these clinical groups, we performed V4-16S rRNA sequencing of conjunctival DNA from children 3-9 months pre-MDA (n = 269) and 3 months post-MDA (n = 79). Results Chlamydia trachomatis PCR-negative, no TP children had the highest pre-MDA ocular microbiome alpha diversity, which was reduced in C. trachomatis infected children and further decreased in those with TP. Pre-MDA, Haemophilus and Staphylococcus were associated with C. trachomatis infection with and without concurrent TP, while Helicobacter was increased in those with TP in the absence of current C. trachomatis infection. Post-MDA, none of the studied children had ocular C. trachomatis infection or TP. MDA increased ocular microbiome diversity in all clinical groups, the change was of greater magnitude in children with pre-MDA TP. MDA effectively reduced the prevalence of disease causing pathogenic non-chlamydial bacteria, and promoted restoration of a normal, healthy conjunctival microbiome. Conclusion We identified Helicobacter as a non-chlamydial bacterium associated with the clinical signs of TP. Further investigation to determine its relevance in other low-endemicity communities is required. MDA was shown to be effective at clearing C. trachomatis infection and other non-chlamydial ocular pathogens, without any detrimental longitudinal effects on the ocular microbiome. These findings suggest that azithromycin MDA may be valuable in trachoma control even in populations where the relationship between clinical signs of trachoma and the prevalence of current ocular C. trachomatis infection has become dissociated.
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Affiliation(s)
- Harry Pickering
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Elias Mafuru
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Aiweda Malisa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kelvin Mbuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Tara Mtuy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tamsyn Derrick
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joanna Houghton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Martin J. Holland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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