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Marshall EM, Rashidi AS, van Gent M, Rockx B, Verjans GMGM. Neurovirulence of Usutu virus in human fetal organotypic brain slice cultures partially resembles Zika and West Nile virus. Sci Rep 2024; 14:20095. [PMID: 39209987 PMCID: PMC11362282 DOI: 10.1038/s41598-024-71050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Usutu (USUV), West Nile (WNV), and Zika virus (ZIKV) are neurotropic arthropod-borne viruses (arboviruses) that cause severe neurological disease in humans. However, USUV-associated neurological disease is rare, suggesting a block in entry to or infection of the brain. We determined the replication, cell tropism and neurovirulence of these arboviruses in human brain tissue using a well-characterized human fetal organotypic brain slice culture model. Furthermore, we assessed the efficacy of interferon-β and 2'C-methyl-cytidine, a synthetic nucleoside analogue, in restricting viral replication. All three arboviruses replicated within the brain slices, with WNV reaching the highest titers, and all primarily infected neuronal cells. USUV- and WNV-infected cells exhibited a shrunken morphology, not associated with detectable cell death. Pre-treatment with interferon-β inhibited replication of all arboviruses, while 2'C-methyl-cytidine reduced only USUV and ZIKV titers. Collectively, USUV can infect human brain tissue, showing similarities in tropism and neurovirulence as WNV and ZIKV. These data suggest that a blockade to infection of the human brain may not be the explanation for the low clinical incidence of USUV-associated neurological disease. However, USUV replicated more slowly and to lower titers than WNV, which could help to explain the reduced severity of neurological disease resulting from USUV infection.
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Affiliation(s)
- Eleanor M Marshall
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ahmad S Rashidi
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- HerpeslabNL of the Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michiel van Gent
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- HerpeslabNL of the Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
- HerpeslabNL of the Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
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2
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Wongchitrat P, Chanmee T, Govitrapong P. Molecular Mechanisms Associated with Neurodegeneration of Neurotropic Viral Infection. Mol Neurobiol 2024; 61:2881-2903. [PMID: 37946006 PMCID: PMC11043213 DOI: 10.1007/s12035-023-03761-6] [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: 08/25/2022] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Viral infections of the central nervous system (CNS) cause variable outcomes from acute to severe neurological sequelae with increased morbidity and mortality. Viral neuroinvasion directly or indirectly induces encephalitis via dysregulation of the immune response and contributes to the alteration of neuronal function and the degeneration of neuronal cells. This review provides an overview of the cellular and molecular mechanisms of virus-induced neurodegeneration. Neurotropic viral infections influence many aspects of neuronal dysfunction, including promoting chronic inflammation, inducing cellular oxidative stress, impairing mitophagy, encountering mitochondrial dynamics, enhancing metabolic rewiring, altering neurotransmitter systems, and inducing misfolded and aggregated pathological proteins associated with neurodegenerative diseases. These pathogenetic mechanisms create a multidimensional injury of the brain that leads to specific neuronal and brain dysfunction. The understanding of the molecular mechanisms underlying the neurophathogenesis associated with neurodegeneration of viral infection may emphasize the strategies for prevention, protection, and treatment of virus infection of the CNS.
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Affiliation(s)
- Prapimpun Wongchitrat
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, 999 Phutthamonthon 4 Road, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Theerawut Chanmee
- Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Salaya, Nakhon Pathom, Thailand
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3
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Perera DR, Ranadeva ND, Sirisena K, Wijesinghe KJ. Roles of NS1 Protein in Flavivirus Pathogenesis. ACS Infect Dis 2024; 10:20-56. [PMID: 38110348 DOI: 10.1021/acsinfecdis.3c00566] [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: 12/20/2023]
Abstract
Flaviviruses such as dengue, Zika, and West Nile viruses are highly concerning pathogens that pose significant risks to public health. The NS1 protein is conserved among flaviviruses and is synthesized as a part of the flavivirus polyprotein. It plays a critical role in viral replication, disease progression, and immune evasion. Post-translational modifications influence NS1's stability, secretion, antigenicity, and interactions with host factors. NS1 protein forms extensive interactions with host cellular proteins allowing it to affect vital processes such as RNA processing, gene expression regulation, and cellular homeostasis, which in turn influence viral replication, disease pathogenesis, and immune responses. NS1 acts as an immune evasion factor by delaying complement-dependent lysis of infected cells and contributes to disease pathogenesis by inducing endothelial cell damage and vascular leakage and triggering autoimmune responses. Anti-NS1 antibodies have been shown to cross-react with host endothelial cells and platelets, causing autoimmune destruction that is hypothesized to contribute to disease pathogenesis. However, in contrast, immunization of animal models with the NS1 protein confers protection against lethal challenges from flaviviruses such as dengue and Zika viruses. Understanding the multifaceted roles of NS1 in flavivirus pathogenesis is crucial for effective disease management and control. Therefore, further research into NS1 biology, including its host protein interactions and additional roles in disease pathology, is imperative for the development of strategies and therapeutics to combat flavivirus infections successfully. This Review provides an in-depth exploration of the current available knowledge on the multifaceted roles of the NS1 protein in the pathogenesis of flaviviruses.
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Affiliation(s)
- Dayangi R Perera
- Department of Chemistry, Faculty of Science, University of Colombo, Sri Lanka 00300
| | - Nadeeka D Ranadeva
- Department of Biomedical Science, Faculty of Health Sciences, KIU Campus Sri Lanka 10120
| | - Kavish Sirisena
- Department of Chemistry, Faculty of Science, University of Colombo, Sri Lanka 00300
- Section of Genetics, Institute for Research and Development in Health and Social Care, Sri Lanka 10120
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Venâncio LGA, Muniz LF, Hora LCDD, Silva JDD, Cavalcanti GST, Leal MDC, Caldas Neto SDS. Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika. Braz J Otorhinolaryngol 2024; 90:101342. [PMID: 37879254 PMCID: PMC10598399 DOI: 10.1016/j.bjorl.2023.101342] [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: 02/28/2023] [Revised: 06/30/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. METHODS A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. RESULTS Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. CONCLUSIONS Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.
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Kuhn RJ, Barrett ADT, Desilva AM, Harris E, Kramer LD, Montgomery RR, Pierson TC, Sette A, Diamond MS. A Prototype-Pathogen Approach for the Development of Flavivirus Countermeasures. J Infect Dis 2023; 228:S398-S413. [PMID: 37849402 PMCID: PMC10582523 DOI: 10.1093/infdis/jiad193] [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: 02/22/2023] [Accepted: 05/28/2023] [Indexed: 10/19/2023] Open
Abstract
Flaviviruses are a genus within the Flaviviridae family of positive-strand RNA viruses and are transmitted principally through mosquito and tick vectors. These viruses are responsible for hundreds of millions of human infections worldwide per year that result in a range of illnesses from self-limiting febrile syndromes to severe neurotropic and viscerotropic diseases and, in some cases, death. A vaccine against the prototype flavivirus, yellow fever virus, has been deployed for 85 years and is highly effective. While vaccines against some medically important flaviviruses are available, others have proven challenging to develop. The emergence and spread of flaviviruses, including dengue virus and Zika virus, demonstrate their pandemic potential. This review highlights the gaps in knowledge that need to be addressed to allow for the rapid development of vaccines against emerging flaviviruses in the future.
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Affiliation(s)
- Richard J Kuhn
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
- Purdue Institute of Inflammation, Immunology, and Infectious Disease, Purdue University, West Lafayette, Indiana, USA
| | - Alan D T Barrett
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Aravinda M Desilva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Laura D Kramer
- School of Public Health, State University of New York at Albany, Albany, New York, USA
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Theodore C Pierson
- Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, California, USA
- Department of Medicine, University of California in San Diego, San Diego, California, USA
| | - Michael S Diamond
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Molecular Microbiology and Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
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Nogueira CO, Rocha T, Messor DF, Souza INO, Clarke JR. Fundamental neurochemistry review: Glutamatergic dysfunction as a central mechanism underlying flavivirus-induced neurological damage. J Neurochem 2023; 166:915-927. [PMID: 37603368 DOI: 10.1111/jnc.15935] [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: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
The Flaviviridae family comprises positive-sense single-strand RNA viruses mainly transmitted by arthropods. Many of these pathogens are especially deleterious to the nervous system, and a myriad of neurological symptoms have been associated with infections by Zika virus (ZIKV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) in humans. Studies suggest that viral replication in neural cells and the massive release of pro-inflammatory mediators lead to morphological alterations of synaptic spine structure and changes in the balance of excitatory/inhibitory neurotransmitters and receptors. Glutamate is the predominant excitatory neurotransmitter in the brain, and studies propose that either enhanced release or impaired uptake of this amino acid contributes to brain damage in several conditions. Here, we review existing evidence suggesting that glutamatergic dysfunction-induced by flaviviruses is a central mechanism for neurological damage and clinical outcomes of infection. We also discuss current data suggesting that pharmacological approaches that counteract glutamatergic dysfunction show benefits in animal models of such viral diseases.
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Affiliation(s)
- Clara O Nogueira
- Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tamires Rocha
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel F Messor
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isis N O Souza
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Julia R Clarke
- Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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7
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Kaur G, Pant P, Bhagat R, Seth P. Zika virus E protein modulates functions of human brain microvascular endothelial cells and astrocytes: implications on blood-brain barrier properties. Front Cell Neurosci 2023; 17:1173120. [PMID: 37545876 PMCID: PMC10399241 DOI: 10.3389/fncel.2023.1173120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Neurotropic viruses can cross the otherwise dynamically regulated blood-brain barrier (BBB) and affect the brain cells. Zika virus (ZIKV) is an enveloped neurotropic Flavivirus known to cause severe neurological complications, such as encephalitis and fetal microcephaly. In the present study, we employed human brain microvascular endothelial cells (hBMECs) and astrocytes derived from human progenitors to establish a physiologically relevant BBB model. We used this model to investigate the effects of ZIKV envelope (E) protein on properties of cells comprising the BBB. E protein is the principal viral protein involved in interaction with host cell surface receptors, facilitating the viral entry. Our findings show that the presence of ZIKV E protein leads to activation of both hBMECs and astrocytes. In hBMECs, we observed a decrease in the expression of crucial endothelial junction proteins such as ZO-1, Occludin and VE-Cadherin, which are vital in establishment and maintenance of the BBB. Consequently, the ZIKV E protein induced changes in BBB integrity and permeability. We also found upregulation of genes involved in leukocyte recruitment along with increased proinflammatory chemokines and cytokines upon exposure to E protein. Additionally, the E protein also led to astrogliosis, evident from the elevated expression of GFAP and Vimentin. Both cell types comprising the BBB exhibited inflammatory response upon exposure to E protein which may influence viral access into the central nervous system (CNS) and subsequent infection of other CNS cells. Overall, our study provides valuable insights into the transient changes that occur at the site of BBB upon ZIKV infection.
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8
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Agner SC, Brier LM, Hill J, Liu E, Bice A, Rahn RM, Culver JP, Klein RS. Myeloid cell activation during Zika virus encephalitis predicts recovery of functional cortical connectivity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.06.547991. [PMID: 37461558 PMCID: PMC10350085 DOI: 10.1101/2023.07.06.547991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Neurologic complications of Zika virus (ZIKV) infection across the lifespan have been described during outbreaks in Southeast Asia, South America, and Central America since 2016. In the adult CNS ZIKV tropism for neurons is tightly linked to its effects, with neuronal loss within the hippocampus during acute infection and protracted synapse loss during recovery, which is associated with cognitive deficits. The effects of ZIKV on cortical networks have not been evaluated. Although animal behavior assays have been used previously to model cognitive impairment, in vivo brain imaging can provide orthogonal information regarding the health of brain networks in real time, providing a tool to translate findings in animal models to humans. In this study, we use widefield optical imaging to measure cortical functional connectivity (FC) in mice during acute infection with, and recovery from, intracranial infection with a mouse-adapted strain of ZIKV. Acute ZIKV infection leads to high levels of myeloid cell activation, with loss of neurons and presynaptic termini in the cerebral cortex and associated loss of FC primarily within the somatosensory cortex. During recovery, neuron numbers, synapses and FC recover to levels near those of healthy mice. However, hippocampal injury and impaired spatial cognition persist. The magnitude of activated myeloid cells during acute infection predicted both recovery of synapses and the degree of FC recovery after recovery from ZIKV infection. These findings suggest that a robust inflammatory response may contribute to the health of functional brain networks after recovery from infection.
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Affiliation(s)
- Shannon C. Agner
- Center for Neuroimmunology and Neuroinfectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindsey M. Brier
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeremy Hill
- Center for Neuroimmunology and Neuroinfectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ethan Liu
- Center for Neuroimmunology and Neuroinfectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie Bice
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel M. Rahn
- Departments of Physics, Biomedical Engineering, and Electrical and Systems Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph P. Culver
- Departments of Physics, Biomedical Engineering, and Electrical and Systems Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | - Robyn S. Klein
- Center for Neuroimmunology and Neuroinfectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Medicine, Pathology & Immunology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
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Jeong GU, Lee S, Kim DY, Lyu J, Yoon GY, Kim KD, Ku KB, Ko J, Kwon YC. Zika Virus Infection Induces Interleukin-1β-Mediated Inflammatory Responses by Macrophages in the Brain of an Adult Mouse Model. J Virol 2023; 97:e0055623. [PMID: 37191498 PMCID: PMC10308908 DOI: 10.1128/jvi.00556-23] [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: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
During the 2015-2016 Zika virus (ZIKV) epidemic, ZIKV-associated neurological diseases were reported in adults, including microcephaly, Guillain-Barre syndrome, myelitis, meningoencephalitis, and fatal encephalitis. However, the mechanisms underlying the neuropathogenesis of ZIKV infection are not yet fully understood. In this study, we used an adult ZIKV infection mouse model (Ifnar1-/-) to investigate the mechanisms underlying neuroinflammation and neuropathogenesis. ZIKV infection induced the expression of proinflammatory cytokines, including interleukin-1β (IL-1β), IL-6, gamma interferon, and tumor necrosis factor alpha, in the brains of Ifnar1-/- mice. RNA-seq analysis of the infected mouse brain also revealed that genes involved in innate immune responses and cytokine-mediated signaling pathways were significantly upregulated at 6 days postinfection. Furthermore, ZIKV infection induced macrophage infiltration and activation and augmented IL-1β expression, whereas microgliosis was not observed in the brain. Using human monocyte THP-1 cells, we confirmed that ZIKV infection promotes inflammatory cell death and increases IL-1β secretion. In addition, expression of the complement component C3, which is associated with neurodegenerative diseases and known to be upregulated by proinflammatory cytokines, was induced by ZIKV infection through the IL-1β-mediated pathway. An increase in C5a produced by complement activation in the brains of ZIKV-infected mice was also verified. Taken together, our results suggest that ZIKV infection in the brain of this animal model augments IL-1β expression in infiltrating macrophages and elicits IL-1β-mediated inflammation, which can lead to the destructive consequences of neuroinflammation. IMPORTANCE Zika virus (ZIKV) associated neurological impairments are an important global health problem. Our results suggest that ZIKV infection in the mouse brain can induce IL-1β-mediated inflammation and complement activation, thereby contributing to the development of neurological disorders. Thus, our findings reveal a mechanism by which ZIKV induces neuroinflammation in the mouse brain. Although we used adult type I interferon receptor IFNAR knockout (Ifnar1-/-) mice owing to the limited mouse models of ZIKV pathogenesis, our conclusions contributed to the understanding ZIKV-associated neurological diseases to develop treatment strategies for patients with ZIKV infection based on these findings.
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Affiliation(s)
- Gi Uk Jeong
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sumin Lee
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Do Yeon Kim
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
- Medical Chemistry and Pharmacology, University of Science and Technology, Daejeon, Republic of Korea
| | - Jaemyun Lyu
- Arontier Co., Ltd., Seoul, Republic of Korea
| | - Gun Young Yoon
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Kyun-Do Kim
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Keun Bon Ku
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Junsu Ko
- Arontier Co., Ltd., Seoul, Republic of Korea
| | - Young-Chan Kwon
- Department of Convergent Research for Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
- Medical Chemistry and Pharmacology, University of Science and Technology, Daejeon, Republic of Korea
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10
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Cole J, Choudry S, Kular S, Payne T, Akili S, Callaby H, Gordon NC, Ankcorn M, Martin A, Hobson E, Tunbridge AJ. Monkeypox encephalitis with transverse myelitis in a female patient. THE LANCET. INFECTIOUS DISEASES 2023; 23:e115-e120. [PMID: 36470282 PMCID: PMC9718539 DOI: 10.1016/s1473-3099(22)00741-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 12/05/2022]
Abstract
The 2022 monkeypox outbreak has affected 110 countries worldwide, outside of classic endemic areas (ie, west Africa and central Africa). On July 23, 2022, the outbreak was classified by WHO as a public health emergency of international concern. Clinical presentation varies from mild to life-changing symptoms; neurological complications are relatively uncommon and there are few therapeutic interventions for monkeypox disease. In this Grand Round, we present a case of monkeypox with encephalitis complicated by transverse myelitis in a previously healthy woman aged 35 years who made an almost complete recovery from her neurological symptoms after treatment with tecovirimat, cidofovir, steroids, and plasma exchange. We describe neurological complications associated with orthopoxvirus infections and laboratory diagnosis, the radiological features in this case, and discuss treatment options.
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Affiliation(s)
- Joby Cole
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity, and Cardiovascular Diseases, University of Sheffield, Sheffield, UK.
| | - Saher Choudry
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Saminderjit Kular
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Thomas Payne
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suha Akili
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Callaby
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - N Claire Gordon
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK
| | - Michael Ankcorn
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Martin
- Department of Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Esther Hobson
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Anne J Tunbridge
- Department of Infectious Diseases and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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11
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Yan Q, Zheng W, Jiang Y, Zhou P, Lai Y, Liu C, Wu P, Zhuang H, Huang H, Li G, Zhan S, Lao Z, Liu X. Transcriptomic reveals the ferroptosis features of host response in a mouse model of Zika virus infection. J Med Virol 2023; 95:e28386. [PMID: 36477858 DOI: 10.1002/jmv.28386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Zika virus (ZIKV) is a neurotropic flavivirus. The outbreak of ZIKV in 2016 created a global health emergency. However, the underlying pathogenic mechanisms remain elusive. We investigated the host response features of in vivo replication in a mouse model of ZIKV infection, by performing a series of transcriptomic and bioinformatic analyses of ZIKV and mock-infected brain tissue. Tissue damage, inflammatory cells infiltration and high viral replication were observed in the brain tissue of ZIKV infected mice. RNA-Seq of the brain indicated the activation of ferroptosis pathways. Enrichment analysis of ferroptosis regulators revealed their involvement in pathways such as mineral absorption, fatty acid biosynthesis, fatty acid degradation, PPAR signaling pathway, peroxidase, and adipokinesine signalling pathway. We then identified 12 interacted hub ferroptosis regulators (CYBB, HMOX1, CP, SAT1, TF, SLC39A14, FTL, LPCAT3, FTH1, SLC3A2, TP53, and SLC40A1) that were related to the differential expression of CD8+ T cells, microglia and monocytes. CYBB, HMOX1, SALT, and SLAC40A1 were selected as potential biomarkers of ZIKV infection. Finally, we validated our results using RT-qPCR and outside available datasets. For the first time, we proposed a possible mechanism of ferroptosis in brain tissue infected by ZIKV in mice and identified the four key ferroptosis regulators.
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Affiliation(s)
- Qian Yan
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.,Animal Biosafety Level 2 laboratory (ABSL-2), Animal Laboratory Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjiang Zheng
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.,Animal Biosafety Level 2 laboratory (ABSL-2), Animal Laboratory Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Jiang
- Traditional Chinese Medicine Innovation Research Center and Department of Respiratory Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Peiwen Zhou
- Animal Biosafety Level 3 laboratory (ABSL-3), Foshan Institute of Medical Microbiology, Foshan, China
| | - Yanni Lai
- Department of Diagnostics of Traditional Chinese Medicine (TCM), Basic Medical Sciences School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengxin Liu
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Wu
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongfa Zhuang
- Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huiting Huang
- Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Geng Li
- Animal Biosafety Level 2 laboratory (ABSL-2), Animal Laboratory Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaofeng Zhan
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zizhao Lao
- Animal Biosafety Level 2 laboratory (ABSL-2), Animal Laboratory Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Traditional Chinese Medicine Innovation Research Center and Department of Respiratory Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Xiaohong Liu
- Department of Internal Medicine of Traditional Chinese Medicine (TCM), The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine (PCCM), The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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Davies AJ, Lleixà C, Siles AM, Gourlay DS, Berridge G, Dejnirattisai W, Ramírez-Santana C, Anaya JM, Falconar AK, Romero-Vivas CM, Osorio L, Parra B, Screaton GR, Mongkolsapaya J, Fischer R, Pardo CA, Halstead SK, Willison HJ, Querol L, Rinaldi S. Guillain-Barré Syndrome Following Zika Virus Infection Is Associated With a Diverse Spectrum of Peripheral Nerve Reactive Antibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200047. [PMID: 36411078 PMCID: PMC9679884 DOI: 10.1212/nxi.0000000000200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent outbreaks of Zika virus (ZIKV) in South and Central America have highlighted significant neurologic side effects. Concurrence with the inflammatory neuropathy Guillain-Barré syndrome (GBS) is observed in 1:4,000 ZIKV cases. Whether the neurologic symptoms of ZIKV infection are immune mediated is unclear. We used rodent and human live cellular models to screen for anti-peripheral nerve reactive IgG and IgM autoantibodies in the sera of patients with ZIKV with and without GBS. METHODS In this study, 52 patients with ZIKV-GBS were compared with 134 ZIKV-infected patients without GBS and 91 non-ZIKV controls. Positive sera were taken forward for target identification by immunoprecipitation and mass spectrometry, and candidate antigens were validated by ELISA and cell-based assays. Autoantibody reactions against glycolipid antigens were also screened on an array. RESULTS Overall, IgG antibody reactivities to rat Schwann cells (SCs) (6.5%) and myelinated cocultures (9.6%) were significantly higher, albeit infrequent, in the ZIKV-GBS group compared with all controls. IgM antibody immunoreactivity to dorsal root ganglia neurones (32.3%) and SCs (19.4%) was more frequently observed in the ZIKV-GBS group compared with other controls, whereas IgM reactivity to cocultures was as common in ZIKV and non-ZIKV sera. Strong axonal-binding ZIKV-GBS serum IgG antibodies from 1 patient were confirmed to react with neurofascin 155 and 186. Serum from a ZIKV-infected patient without GBS displayed strong myelin-binding and putative antilipid antigen reaction characteristics. There was, however, no significant association of ZIKV-GBS with any known antiglycolipid antibodies. DISCUSSION Autoantibody responses in ZIKV-GBS target heterogeneous peripheral nerve antigens suggesting heterogeneity of the humoral immune response despite a common prodromal infection.
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Affiliation(s)
- Alexander J Davies
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cinta Lleixà
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ana M Siles
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dawn S Gourlay
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Georgina Berridge
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwisa Dejnirattisai
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carolina Ramírez-Santana
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Juan-Manuel Anaya
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andrew K Falconar
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Claudia M Romero-Vivas
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lyda Osorio
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Beatriz Parra
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gavin R Screaton
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Juthathip Mongkolsapaya
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roman Fischer
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carlos A Pardo
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Susan K Halstead
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hugh J Willison
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Luis Querol
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Simon Rinaldi
- From the Nuffield Department of Clinical Neurosciences (A.J.D., S.R.), University of Oxford, John Radcliffe Hospital, UK; Neuromuscular Diseases Unit (C.L., A.M.S., L.Q.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para la Investigación Biomédica en red en Enfermedades Raras-(CIBERER) Madrid (C.L., A.M.S., L.Q.), Spain; Institute of Infection (D.S.G., S.K.H., H.J.W.), Immunity & Inflammation, University of Glasgow, University Place, UK; Target Discovery Institute (G.B., R.F.), NDM Research Building, University of Oxford, Old Road Campus, UK; Wellcome Centre for Human Genetics (W.D., G.R.S., J.M.), Nuffield Department of Medicine, University of Oxford, UK; Center for Autoimmune Diseases Research (CREA) (C.R.-S., J.-M.A.), Universidad del Rosario, Bogotá, Colombia; Departamento de Medicina (A.K.F., C.M.R.-V.), Universidad del Norte, Barranquilla, Colombia; Grupo de Epidemiología y Salud Poblacional (GESP) (L.O.,), School of Public Health, Universidad del Valle, Cali, Colombia; Department of Microbiology (B.P.), School of Basic Sciences, Universidad del Valle, Cali, Colombia; Dengue Hemorrhagic Fever Research Unit (J.M.), Office for Research and Development, Siriraj Hospital, Faculty of Medicine, Mahidol Univeristy, Bangkok, Thailand; Department of Neurology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; and LifeFactors (J.-M.A.), Rionegro, Colombia; Division of Emerging Infectious Disease (W.D.), Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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13
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Esper NB, Franco AR, Soder RB, Bomfim RC, Nunes ML, Radaelli G, Esper KB, Kotoski A, Pripp W, Neto FK, Azambuja LS, Mathias NA, da Costa DI, Portuguez MW, da Costa JC, Buchweitz A. Zika virus congenital microcephaly severity classification and the association of severity with neuropsychomotor development. Pediatr Radiol 2022; 52:941-950. [PMID: 35229185 DOI: 10.1007/s00247-022-05284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Zika virus infection during pregnancy is linked to birth defects, most notably microcephaly, which is associated with neurodevelopmental delays. OBJECTIVE The goals of the study were to propose a method for severity classification of congenital microcephaly based on neuroradiologic findings of MRI scans, and to investigate the association of severity with neuropsychomotor developmental scores. We also propose a semi-automated method for MRI-based severity classification of microcephaly. MATERIALS AND METHODS We conducted a cross-sectional investigation of 42 infants born with congenital Zika infection. Bayley Scales of Infant and Toddler Development III (Bayley-III) developmental evaluations and MRI scans were carried out at ages 13-39 months (mean: 24.8 months; standard deviation [SD]: 5.8 months). The severity score was generated based on neuroradiologist evaluations of brain malformations. Next, we established a distribution of Zika virus-microcephaly severity score including mild, moderate and severe and investigated the association of severity with neuropsychomotor developmental scores. Finally, we propose a simplified semi-automated procedure for estimating the severity score based only on volumetric measures. RESULTS The results showed a correlation of r=0.89 (P<0.001) between the Zika virus-microcephaly severity score and the semi-automated method. The trimester of infection did not correlate with the semi-automated method. Neuropsychomotor development correlated with the severity classification based on the radiologic readings and semi-automated method; the more severe the imaging scores, the lower the neuropsychomotor developmental scores. CONCLUSION These severity classification methods can be used to evaluate severity of microcephaly and possible association with developmental consequences. The semi-automated methods thus provide an alternative for predicting severity of microcephaly based on only one MRI sequence.
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Affiliation(s)
- Nathalia Bianchini Esper
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Alexandre Rosa Franco
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Magda Lahorgue Nunes
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Graciane Radaelli
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
| | - Katherine Bianchini Esper
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Aline Kotoski
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Willian Pripp
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Felipe Kalil Neto
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
| | - Luciana Schermann Azambuja
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- Graduate Program in Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Nathália Alves Mathias
- Graduate Program in Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Danielle Irigoyen da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Life and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil.
- School of Medicine, Neurosciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
| | - Augusto Buchweitz
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenue Ipiranga, 6690, Building 63, Porto Alegre, 90610-000, Brazil
- School of Life and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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14
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Kung PL, Chou TW, Lindman M, Chang NP, Estevez I, Buckley BD, Atkins C, Daniels BP. Zika virus-induced TNF-α signaling dysregulates expression of neurologic genes associated with psychiatric disorders. J Neuroinflammation 2022; 19:100. [PMID: 35462541 PMCID: PMC9036774 DOI: 10.1186/s12974-022-02460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/07/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) is an emerging flavivirus of global concern. ZIKV infection of the central nervous system has been linked to a variety of clinical syndromes, including microcephaly in fetuses and rare but serious neurologic disease in adults. However, the potential for ZIKV to influence brain physiology and host behavior following apparently mild or subclinical infection is less well understood. Furthermore, though deficits in cognitive function are well-documented after recovery from neuroinvasive viral infection, the potential impact of ZIKV on other host behavioral domains has not been thoroughly explored. METHODS We used transcriptomic profiling, including unbiased gene ontology enrichment analysis, to assess the impact of ZIKV infection on gene expression in primary cortical neuron cultures. These studies were extended with molecular biological analysis of gene expression and inflammatory cytokine signaling. In vitro observations were further confirmed using established in vivo models of ZIKV infection in immunocompetent hosts. RESULTS Transcriptomic profiling of primary neuron cultures following ZIKV infection revealed altered expression of key genes associated with major psychiatric disorders, such as bipolar disorder and schizophrenia. Gene ontology enrichment analysis also revealed significant changes in gene expression associated with fundamental neurobiological processes, including neuronal development, neurotransmission, and others. These alterations to neurologic gene expression were also observed in the brain in vivo using several immunocompetent mouse models of ZIKV infection. Mechanistic studies identified TNF-α signaling via TNFR1 as a major regulatory mechanism controlling ZIKV-induced changes to neurologic gene expression. CONCLUSIONS Our studies reveal that cell-intrinsic innate immune responses to ZIKV infection profoundly shape neuronal transcriptional profiles, highlighting the need to further explore associations between ZIKV infection and disordered host behavioral states.
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Affiliation(s)
- Po-Lun Kung
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Tsui-Wen Chou
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Marissa Lindman
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Nydia P. Chang
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Irving Estevez
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Benjamin D. Buckley
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Colm Atkins
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
| | - Brian P. Daniels
- grid.430387.b0000 0004 1936 8796Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Room B314, Piscataway, NJ 08854 USA
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15
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Feng T, Zhang J, Chen Z, Pan W, Chen Z, Yan Y, Dai J. Glycosylation of viral proteins: Implication in virus-host interaction and virulence. Virulence 2022; 13:670-683. [PMID: 35436420 PMCID: PMC9037552 DOI: 10.1080/21505594.2022.2060464] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Glycans are among the most important cell molecular components. However, given their structural diversity, their functions have not been fully explored. Glycosylation is a vital post-translational modification for various proteins. Many bacteria and viruses rely on N-linked and O-linked glycosylation to perform critical biological functions. The diverse functions of glycosylation on viral proteins during viral infections, including Dengue, Zika, influenza, and human immunodeficiency viruses as well as coronaviruses have been reported. N-linked glycosylation is the most common form of protein modification, and it modulates folding, transportation and receptor binding. Compared to N-linked glycosylation, the functions of O-linked viral protein glycosylation have not been comprehensively evaluated. In this review, we summarize findings on viral protein glycosylation, with particular attention to studies on N-linked glycosylation in viral life cycles. This review informs the development of virus-specific vaccines or inhibitors.
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Affiliation(s)
- Tingting Feng
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Jinyu Zhang
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Zhiqian Chen
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Wen Pan
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yongdong Yan
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Jianfeng Dai
- Jiangsu Key Laboratory of Infection and Immunity, Institute of Biology and Medical Sciences, Soochow University, Suzhou, China
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16
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Kapuganti SK, Bhardwaj A, Kumar P, Bhardwaj T, Nayak N, Uversky VN, Giri R. Role of structural disorder in the multi-functionality of flavivirus proteins. Expert Rev Proteomics 2022; 19:183-196. [PMID: 35655146 DOI: 10.1080/14789450.2022.2085563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The life cycle of a virus involves interacting with the host cell, entry, hijacking host machinery for viral replication, evading the host's immune system, and releasing mature virions. However, viruses, being small in size, can only harbor a genome large enough to code for the minimal number of proteins required for the replication and maturation of the virions. As a result, many viral proteins are multifunctional machines that do not directly obey the classic structure-function paradigm. Often, such multifunctionality is rooted in intrinsic disorder that allows viral proteins to interact with various cellular factors and remain functional in the hostile environment of different cellular compartments. AREAS COVERED This report covers the classification of flaviviruses, their proteome organization, and the prevalence of intrinsic disorder in the proteomes of different flaviviruses. Further, we have summarized the speculations made about the apparent roles of intrinsic disorder in the observed multifunctionality of flaviviral proteins. EXPERT OPINION Small sizes of viral genomes impose multifunctionality on their proteins, which is dependent on the excessive usage of intrinsic disorder. In fact, intrinsic disorder serves as a universal functional tool, weapon, and armor of viruses and clearly plays an important role in their functionality and evolution.
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Affiliation(s)
| | - Aparna Bhardwaj
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, India
| | - Prateek Kumar
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, India
| | - Taniya Bhardwaj
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, India
| | - Namyashree Nayak
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, India
| | - Vladimir N Uversky
- Department of Molecular Medicine and Byrd Alzheimer's Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rajanish Giri
- School of Basic Sciences, Indian Institute of Technology Mandi, Mandi, India
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17
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Caldwell M, Boruah AP, Thakur KT. Acute neurologic emerging flaviviruses. Ther Adv Infect Dis 2022; 9:20499361221102664. [PMID: 35719177 PMCID: PMC9198421 DOI: 10.1177/20499361221102664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic has shed light on the challenges we face as a global society in preventing and containing emerging and re-emerging pathogens. Multiple intersecting factors, including environmental changes, host immunological factors, and pathogen dynamics, are intimately connected to the emergence and re-emergence of communicable diseases. There is a large and expanding list of communicable diseases that can cause neurological damage, either through direct or indirect routes. Novel pathogens of neurotropic potential have been identified through advanced diagnostic techniques, including metagenomic next-generation sequencing, but there are also known pathogens which have expanded their geographic distribution to infect non-immune individuals. Factors including population growth, climate change, the increase in animal and human interface, and an increase in international travel and trade are contributing to the expansion of emerging and re-emerging pathogens. Challenges exist around antimicrobial misuse giving rise to antimicrobial-resistant infectious neurotropic organisms and increased susceptibility to infection related to the expanded use of immunomodulatory treatments. In this article, we will review key concepts around emerging and re-emerging pathogens and discuss factors associated with neurotropism and neuroinvasion. We highlight several neurotropic pathogens of interest, including West Nile virus (WNV), Zika Virus, Japanese Encephalitis Virus (JEV), and Tick-Borne Encephalitis Virus (TBEV). We emphasize neuroinfectious diseases which impact the central nervous system (CNS) and focus on flaviviruses, a group of vector-borne pathogens that have expanded globally in recent years and have proven capable of widespread outbreak.
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Affiliation(s)
- Marissa Caldwell
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Abhilasha P. Boruah
- Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), New York, NY, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kiran T. Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, NY 10032, USA
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18
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Enlow W, Bordeleau M, Piret J, Ibáñez FG, Uyar O, Venable MC, Goyette N, Carbonneau J, Tremblay ME, Boivin G. Microglia are involved in phagocytosis and extracellular digestion during Zika virus encephalitis in young adult immunodeficient mice. J Neuroinflammation 2021; 18:178. [PMID: 34399779 PMCID: PMC8369691 DOI: 10.1186/s12974-021-02221-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) has been associated with several neurological complications in adult patients. METHODS We used a mouse model deficient in TRIF and IPS-1 adaptor proteins, which are involved in type I interferon production, to study the role of microglia during brain infection by ZIKV. Young adult mice were infected intravenously with the contemporary ZIKV strain PRVABC59 (1 × 105 PFUs/100 µL). RESULTS Infected mice did not present overt clinical signs of the disease nor body weight loss compared with noninfected animals. However, mice exhibited a viremia and a brain viral load that were maximal (1.3 × 105 genome copies/mL and 9.8 × 107 genome copies/g of brain) on days 3 and 7 post-infection (p.i.), respectively. Immunohistochemistry analysis showed that ZIKV antigens were distributed in several regions of the brain, especially the dorsal hippocampus. The number of Iba1+/TMEM119+ microglia remained similar in infected versus noninfected mice, but their cell body and arborization areas significantly increased in the stratum radiatum and stratum lacunosum-moleculare layers of the dorsal hippocampus cornu ammoni (CA)1, indicating a reactive state. Ultrastructural analyses also revealed that microglia displayed increased phagocytic activities and extracellular digestion of degraded elements during infection. Mice pharmacologically depleted in microglia with PLX5622 presented a higher brain viral load compared to untreated group (2.8 × 1010 versus 8.5 × 108 genome copies/g of brain on day 10 p.i.) as well as an increased number of ZIKV antigens labeled with immunogold in the cytoplasm and endoplasmic reticulum of neurons and astrocytes indicating an enhanced viral replication. Furthermore, endosomes of astrocytes contained nanogold particles together with digested materials, suggesting a compensatory phagocytic activity upon microglial depletion. CONCLUSIONS These results indicate that microglia are involved in the control of ZIKV replication and/or its elimination in the brain. After depletion of microglia, the removal of ZIKV-infected cells by phagocytosis could be partly compensated by astrocytes.
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Affiliation(s)
- William Enlow
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Maude Bordeleau
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Neurosciences Axis, Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Jocelyne Piret
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Fernando González Ibáñez
- Neurosciences Axis, Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada.,Department of Molecular Medicine, Université Laval, Quebec City, QC, Canada.,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Olus Uyar
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Marie-Christine Venable
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Nathalie Goyette
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Julie Carbonneau
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Marie-Eve Tremblay
- Neurosciences Axis, Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada. .,Department of Molecular Medicine, Université Laval, Quebec City, QC, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada. .,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada. .,Department of Biochemistry and Molecular Biology, The University of British Columbia, Vancouver, BC, Canada.
| | - Guy Boivin
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada.
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19
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Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil. Viruses 2021; 13:v13071370. [PMID: 34372576 PMCID: PMC8310075 DOI: 10.3390/v13071370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Virus-induced infections of the central nervous system (CNS) are among the most serious problems in public health and can be associated with high rates of morbidity and mortality, mainly in low- and middle-income countries, where these manifestations have been neglected. Typically, herpes simplex virus 1 and 2, varicella-zoster, and enterovirus are responsible for a high number of cases in immunocompetent hosts, whereas other herpesviruses (for example, cytomegalovirus) are the most common in immunocompromised individuals. Arboviruses have also been associated with outbreaks with a high burden of neurological disorders, such as the Zika virus epidemic in Brazil. There is a current lack of understanding in Brazil about the most common viruses involved in CNS infections. In this review, we briefly summarize the most recent studies and findings associated with the CNS, in addition to epidemiological data that provide extensive information on the circulation and diversity of the most common neuro-invasive viruses in Brazil. We also highlight important aspects of the prion-associated diseases. This review provides readers with better knowledge of virus-associated CNS infections. A deeper understanding of these infections will support the improvement of the current surveillance strategies to allow the timely monitoring of the emergence/re-emergence of neurotropic viruses.
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20
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Maramattom BV, Rathish B, Meleth HA. Miller Fisher Syndrome and Boomerang Sign: A Rare Presentation of Typhoid Fever. Cureus 2021; 13:e15386. [PMID: 34249538 PMCID: PMC8253474 DOI: 10.7759/cureus.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Miller Fischer syndrome (MFS) is a variant of Guillain-Barré syndrome which is characterized by a triad of ataxia, ophthalmoplegia, and areflexia. It is uncommonly associated with systemic illnesses. We present the case of a young boy who came back after a trip to New Delhi in India, who developed MFS. MRI showed a callosal splenial hyperintensity which is called the boomerang sign. The evaluation revealed typhoid fever. This is probably the first such report of MFS associated with this infection.
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21
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Halani S, Tombindo PE, O'Reilly R, Miranda RN, Erdman LK, Whitehead C, Bielecki JM, Ramsay L, Ximenes R, Boyle J, Krueger C, Willmott S, Morris SK, Murphy KE, Sander B. Clinical manifestations and health outcomes associated with Zika virus infections in adults: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009516. [PMID: 34252102 PMCID: PMC8297931 DOI: 10.1371/journal.pntd.0009516] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/22/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Zika virus (ZIKV) has generated global interest in the last five years mostly due to its resurgence in the Americas between 2015 and 2016. It was previously thought to be a self-limiting infection causing febrile illness in less than one quarter of those infected. However, a rise in birth defects amongst children born to infected pregnant women, as well as increases in neurological manifestations in adults has been demonstrated. We systemically reviewed the literature to understand clinical manifestations and health outcomes in adults globally. Methods This review was registered prospectively with PROPSERO (CRD 42018096558). We systematically searched for studies in six databases from inception to the end of September 2020. There were no language restrictions. Critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Findings We identified 73 studies globally that reported clinical outcomes in ZIKV-infected adults, of which 55 studies were from the Americas. For further analysis, we considered studies that met 70% of critical appraisal criteria and described subjects with confirmed ZIKV. The most common symptoms included: exanthema (5,456/6,129; 89%), arthralgia (3,809/6,093; 63%), fever (3,787/6,124; 62%), conjunctivitis (2,738/3,283; 45%), myalgia (2,498/5,192; 48%), headache (2,165/4,722; 46%), and diarrhea (337/2,622; 13%). 36/14,335 (0.3%) of infected cases developed neurologic sequelae, of which 75% were Guillain-Barré Syndrome (GBS). Several subjects reported recovery from peak of neurological complications, though some endured chronic disability. Mortality was rare (0.1%) and hospitalization (11%) was often associated with co-morbidities or GBS. Conclusions The ZIKV literature in adults was predominantly from the Americas. The most common systemic symptoms were exanthema, fever, arthralgia, and conjunctivitis; GBS was the most prevalent neurological complication. Future ZIKV studies are warranted with standardization of testing and case definitions, consistent co-infection testing, reporting of laboratory abnormalities, separation of adult and pediatric outcomes, and assessing for causation between ZIKV and neurological sequelae. Interest in Zika virus (ZIKV) has increased in the last decade due to its emergence and rapid spread in the Americas. In this review, we examine ZIKV clinical manifestations and sequelae in adults. Among studies reporting subjects with confirmed ZIKV and critical appraisal scores of at least 70%, symptoms reported include exanthema, fever, arthralgia, conjunctivitis, myalgia, headache, and diarrhea. Neurological sequelae in this group occurred in 0.3% of subjects, of which 75% were Guillain-Barré Syndrome (GBS). Recovery from GBS was variable: some patients returned to health and others endured chronic disability. Mortality was rare (0.1%). Hospitalization (11%) was often associated co-morbidities or GBS; this percentage perhaps reflects studies in which all reported subjects were hospitalized. Synthesizing reported data is challenging given the wide range of case definitions and ZIKV testing practices.
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Affiliation(s)
| | | | - Ryan O'Reilly
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Laura K Erdman
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clare Whitehead
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren Ramsay
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Escola de Matemática Aplicada, Fundação Getúlio Vargas, Praia de Botafogo, Rio de Janeiro, Brasil
| | | | - Carsten Krueger
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shannon Willmott
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K Morris
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kellie E Murphy
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Beate Sander
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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22
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Khan F, Sharma P, Pandey S, Sharma D, V V, Kumar N, Shukla S, Dandu H, Jain A, Garg RK, Malhotra HS. COVID-19-associated Guillain-Barre syndrome: Postinfectious alone or neuroinvasive too? J Med Virol 2021; 93:6045-6049. [PMID: 34170552 PMCID: PMC8426929 DOI: 10.1002/jmv.27159] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been shown to be associated with a lot of neurological complications, of whom Guillain-Barre syndrome (GBS) is an important post-infectious consequentiality. More than 220 patients with GBS have been reported thus far. We intend to share our experience with five patients of GBS where one of them had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the cerebrospinal fluid (CSF). This is the first-ever report demonstrating the presence of SARS-CoV-2 in the CSF of an adult patient; a similar occurrence has recently been described in a pediatric patient. We wish to emphasize the fact that commonly GBS occurs as a result of a post-infectious process but in a few cases where the symptoms of COVID-19 and GBS occur concurrently, corresponding to the viremic phase, separate pathogenesis needs to be thought of. This para-infectious nature is exemplified by the presence of virus in the cerebrospinal fluid of one of our patients. We review the neuroinvasive potential of SARS-Cov-2 in this regard and draw parallels with Cytomegalovirus, Zika virus, and Human Immunodeficiency virus-associated occurrences of GBS.
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Affiliation(s)
- Farman Khan
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Praveen Sharma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saurabh Pandey
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepak Sharma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijayavarman V
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Suruchi Shukla
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Himanshu Dandu
- Department of Infectious Diseases, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra K Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Hardeep S Malhotra
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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23
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Abstract
The pandemic of Coronavirus disease 2019 (COVID-19), caused by a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spotlighted the link between viral infection and autoimmunity. In this review, we focus on coronavirus-induced autoimmunity based on evidence from experimental animal models, SARS-CoV infection with in vitro studies of molecular mimicry and COVID-19 with several clinical reports of autoimmune manifestations of this disease. Further studies will be needed to better characterize the role of SARS-CoV-2 in the development of autoimmunity.
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Affiliation(s)
- Valéry Salle
- Department of Internal Medicine, Amiens University Hospital, 1 place Victor Pauchet, Amiens 80054, France.
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24
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Salisch NC, Stephenson KE, Williams K, Cox F, van der Fits L, Heerwegh D, Truyers C, Habets MN, Kanjilal DG, Larocca RA, Abbink P, Liu J, Peter L, Fierro C, De La Barrera RA, Modjarrad K, Zahn RC, Hendriks J, Cahill CP, Leyssen M, Douoguih M, van Hoof J, Schuitemaker H, Barouch DH. A Double-Blind, Randomized, Placebo-Controlled Phase 1 Study of Ad26.ZIKV.001, an Ad26-Vectored Anti-Zika Virus Vaccine. Ann Intern Med 2021; 174:585-594. [PMID: 33587687 DOI: 10.7326/m20-5306] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) may cause severe congenital disease after maternal-fetal transmission. No vaccine is currently available. OBJECTIVE To assess the safety and immunogenicity of Ad26.ZIKV.001, a prophylactic ZIKV vaccine candidate. DESIGN Phase 1 randomized, double-blind, placebo-controlled clinical study. (ClinicalTrials.gov: NCT03356561). SETTING United States. PARTICIPANTS 100 healthy adult volunteers. INTERVENTION Ad26.ZIKV.001, an adenovirus serotype 26 vector encoding ZIKV M-Env, administered in 1- or 2-dose regimens of 5 × 1010 or 1 × 1011 viral particles (vp), or placebo. MEASUREMENTS Local and systemic adverse events; neutralization titers by microneutralization assay (MN50) and T-cell responses by interferon-γ enzyme-linked immunospot and intracellular cytokine staining; and protectivity of vaccine-induced antibodies in a subset of participants through transfer in an exploratory mouse ZIKV challenge model. RESULTS All regimens were well tolerated, with no safety concerns identified. In both 2-dose regimens, ZIKV neutralizing titers peaked 14 days after the second vaccination, with geometric mean MN50 titers (GMTs) of 1065.6 (95% CI, 494.9 to 2294.5) for 5 × 1010 vp and 956.6 (595.8 to 1535.8) for 1 × 1011 vp. Titers persisted for at least 1 year at a GMT of 68.7 (CI, 26.4-178.9) for 5 × 1010 vp and 87.0 (CI, 29.3 to 258.6) for 1 × 1011 vp. A 1-dose regimen of 1 × 1011 vp Ad26.ZIKV.001 induced seroconversion in all participants 56 days after the first vaccination (GMT, 103.4 [CI, 52.7 to 202.9]), with titers persisting for at least 1 year (GMT, 90.2 [CI, 38.4 to 212.2]). Env-specific cellular responses were induced. Protection against ZIKV challenge was observed after antibody transfer from participants into mice, and MN50 titers correlated with protection in this model. LIMITATION The study was conducted in a nonendemic area, so it did not assess safety and immunogenicity in a flavivirus-exposed population. CONCLUSION The safety and immunogenicity profile makes Ad26.ZIKV.001 a promising candidate for further development if the need reemerges. PRIMARY FUNDING SOURCE Janssen Vaccines and Infectious Diseases.
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Affiliation(s)
- Nadine C Salisch
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Kathryn E Stephenson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | - Kristi Williams
- Janssen Research and Development, Spring House, Pennsylvania (K.W.)
| | - Freek Cox
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Leslie van der Fits
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Dirk Heerwegh
- Janssen Research and Development, Beerse, Belgium (D.H., C.T.)
| | - Carla Truyers
- Janssen Research and Development, Beerse, Belgium (D.H., C.T.)
| | - Marrit N Habets
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Diane G Kanjilal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | - Rafael A Larocca
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | - Peter Abbink
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | - Jinyan Liu
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | - Lauren Peter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
| | | | | | - Kayvon Modjarrad
- Walter Reed Army Institute of Research, Silver Spring, Maryland (R.A.D., K.M.)
| | - Roland C Zahn
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Jenny Hendriks
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Conor P Cahill
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Maarten Leyssen
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Macaya Douoguih
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Johan van Hoof
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Hanneke Schuitemaker
- Janssen Vaccines and Prevention, Leiden, the Netherlands (N.C.S., F.C., L.V., M.N.H., R.C.Z., J.H., C.P.C., M.L., M.D., J.V., H.S.)
| | - Dan H Barouch
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.E.S., D.G.K., R.A.L., P.A., J.L., L.P., D.H.B.)
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25
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McEntire CRS, Song KW, McInnis RP, Rhee JY, Young M, Williams E, Wibecan LL, Nolan N, Nagy AM, Gluckstein J, Mukerji SS, Mateen FJ. Neurologic Manifestations of the World Health Organization's List of Pandemic and Epidemic Diseases. Front Neurol 2021; 12:634827. [PMID: 33692745 PMCID: PMC7937722 DOI: 10.3389/fneur.2021.634827] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
The World Health Organization (WHO) monitors the spread of diseases globally and maintains a list of diseases with epidemic or pandemic potential. Currently listed diseases include Chikungunya, cholera, Crimean-Congo hemorrhagic fever, Ebola virus disease, Hendra virus infection, influenza, Lassa fever, Marburg virus disease, Neisseria meningitis, MERS-CoV, monkeypox, Nipah virus infection, novel coronavirus (COVID-19), plague, Rift Valley fever, SARS, smallpox, tularemia, yellow fever, and Zika virus disease. The associated pathogens are increasingly important on the global stage. The majority of these diseases have neurological manifestations. Those with less frequent neurological manifestations may also have important consequences. This is highlighted now in particular through the ongoing COVID-19 pandemic and reinforces that pathogens with the potential to spread rapidly and widely, in spite of concerted global efforts, may affect the nervous system. We searched the scientific literature, dating from 1934 to August 2020, to compile data on the cause, epidemiology, clinical presentation, neuroimaging features, and treatment of each of the diseases of epidemic or pandemic potential as viewed through a neurologist's lens. We included articles with an abstract or full text in English in this topical and scoping review. Diseases with epidemic and pandemic potential can be spread directly from human to human, animal to human, via mosquitoes or other insects, or via environmental contamination. Manifestations include central neurologic conditions (meningitis, encephalitis, intraparenchymal hemorrhage, seizures), peripheral and cranial nerve syndromes (sensory neuropathy, sensorineural hearing loss, ophthalmoplegia), post-infectious syndromes (acute inflammatory polyneuropathy), and congenital syndromes (fetal microcephaly), among others. Some diseases have not been well-characterized from a neurological standpoint, but all have at least scattered case reports of neurological features. Some of the diseases have curative treatments available while in other cases, supportive care remains the only management option. Regardless of the pathogen, prompt, and aggressive measures to control the spread of these agents are the most important factors in lowering the overall morbidity and mortality they can cause.
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Affiliation(s)
- Caleb R. S. McEntire
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Kun-Wei Song
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Robert P. McInnis
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - John Y. Rhee
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Michael Young
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Erika Williams
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Leah L. Wibecan
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Neal Nolan
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Amanda M. Nagy
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Jeffrey Gluckstein
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Shibani S. Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Zika Virus Infection Leads to Demyelination and Axonal Injury in Mature CNS Cultures. Viruses 2021; 13:v13010091. [PMID: 33440758 PMCID: PMC7827345 DOI: 10.3390/v13010091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023] Open
Abstract
Understanding how Zika virus (Flaviviridae; ZIKV) affects neural cells is paramount in comprehending pathologies associated with infection. Whilst the effects of ZIKV in neural development are well documented, impact on the adult nervous system remains obscure. Here, we investigated the effects of ZIKV infection in established mature myelinated central nervous system (CNS) cultures. Infection incurred damage to myelinated fibers, with ZIKV-positive cells appearing when myelin damage was first detected as well as axonal pathology, suggesting the latter was a consequence of oligodendroglia infection. Transcriptome analysis revealed host factors that were upregulated during ZIKV infection. One such factor, CCL5, was validated in vitro as inhibiting myelination. Transferred UV-inactivated media from infected cultures did not damage myelin and axons, suggesting that viral replication is necessary to induce the observed effects. These data show that ZIKV infection affects CNS cells even after myelination-which is critical for saltatory conduction and neuronal function-has taken place. Understanding the targets of this virus across developmental stages including the mature CNS, and the subsequent effects of infection of cell types, is necessary to understand effective time frames for therapeutic intervention.
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Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
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Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Brito Ferreira ML, Militão de Albuquerque MDFP, de Brito CAA, de Oliveira França RF, Porto Moreira ÁJ, de Morais Machado MÍ, da Paz Melo R, Medialdea-Carrera R, Dornelas Mesquita S, Lopes Santos M, Mehta R, Ramos E Silva R, Leonhard SE, Ellul M, Rosala-Hallas A, Burnside G, Turtle L, Griffiths MJ, Jacobs BC, Bhojak M, Willison HJ, Pena LJ, Pardo CA, Ximenes RAA, Martelli CMT, Brown DWG, Cordeiro MT, Lant S, Solomon T. Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study. Lancet Neurol 2020; 19:826-839. [PMID: 32949543 PMCID: PMC7494308 DOI: 10.1016/s1474-4422(20)30232-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity. METHODS We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics. FINDINGS Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34-60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20-30] vs 17 days [10-20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047). INTERPRETATION There is a wide and overlapping spectrum of neurological manifestations caused by Zika or chikungunya mono-infection and by dual infections. The possible increased risk of acute cerebrovascular disease in patients with dual infection merits further investigation. FUNDING Fundação do Amparo a Ciência e Tecnologia de Pernambuco (FACEPE), EU's Horizon 2020 research and innovation programme, National Institute for Health Research. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | | | | | | | | | - Raquel Medialdea-Carrera
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Marcela Lopes Santos
- Department of Collective Health, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
| | - Ravi Mehta
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mark Ellul
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Michael J Griffiths
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Hugh J Willison
- Department of Neurology and Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Lindomar José Pena
- Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
| | - Carlos A Pardo
- Department of Neurology, Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricardo A A Ximenes
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
| | | | - David W G Brown
- Blood Borne Virus Unit, Virus Reference Department, Public Health England, London, England; Flavivirus Reference Laboratory, Evandro Chagas National Infectious Disease Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marli Tenório Cordeiro
- Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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29
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Evolutionary analysis of the Musashi family: What can it tell us about Zika? INFECTION GENETICS AND EVOLUTION 2020; 84:104364. [DOI: 10.1016/j.meegid.2020.104364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
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Beaver JT, Mills LK, Swieboda D, Lelutiu N, Esser ES, Antao OQ, Scountzou E, Williams DT, Papaioannou N, Littauer EQ, Romanyuk A, Compans RW, Prausnitz MR, Skountzou I. Cutaneous vaccination ameliorates Zika virus-induced neuro-ocular pathology via reduction of anti-ganglioside antibodies. Hum Vaccin Immunother 2020; 16:2072-2091. [PMID: 32758106 PMCID: PMC7553697 DOI: 10.1080/21645515.2020.1775460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Zika virus (ZIKV) causes moderate to severe neuro-ocular sequelae, with symptoms ranging from conjunctivitis to Guillain-Barré Syndrome (GBS). Despite the international threat ZIKV poses, no licensed vaccine exists. As ZIKV and DENV are closely related, antibodies against one virus have demonstrated the ability to enhance the other. To examine if vaccination can confer robust, long-term protection against ZIKV, preventing neuro-ocular pathology and long-term inflammation in immune-privileged compartments, BALB/c mice received two doses of unadjuvanted inactivated whole ZIKV vaccine (ZVIP) intramuscularly (IM) or cutaneously with dissolving microneedle patches (MNP). MNP immunization induced significantly higher B and T cell responses compared to IM vaccination, resulting in increased antibody titers with greater avidity for ZPIV as well as increased numbers of IFN-γ, TNF-α, IL- and IL-4 secreting T cells. When compared to IM vaccination, antibodies generated by cutaneous vaccination demonstrated greater neutralization activity, increased cross-reactivity with Asian and African lineage ZIKV strains (PRVABC59, FLR, and MR766) and Dengue virus (DENV) serotypes, limited ADE, and lower reactivity to GBS-associated gangliosides. MNP vaccination effectively controlled viremia and inflammation, preventing neuro-ocular pathology. Conversely, IM vaccination exacerbated ocular pathology, resulting in uncontrolled, long-term inflammation. Importantly, neuro-ocular pathology correlated with anti-ganglioside antibodies implicated in demyelination and GBS. This study highlights the importance of longevity studies in ZIKV immunization, and the need of exploring alternative vaccination platforms to improve the quality of vaccine-induced immune responses.
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Affiliation(s)
- Jacob T Beaver
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Lisa K Mills
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Dominika Swieboda
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Nadia Lelutiu
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Edward S Esser
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Olivia Q Antao
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | | | - Dahnide T Williams
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Nikolaos Papaioannou
- Faculty of Veterinary Medicine, Laboratory of Pathologic Anatomy, Aristotle University of Thessaloniki , Greece
| | - Elizabeth Q Littauer
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Andrey Romanyuk
- Department of Biomedical Engineering, School of Chemical and Biomolecular Engineering, Georgia Institute of Technology , Atlanta, GA, USA
| | - Richard W Compans
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Mark R Prausnitz
- Department of Biomedical Engineering, School of Chemical and Biomolecular Engineering, Georgia Institute of Technology , Atlanta, GA, USA
| | - Ioanna Skountzou
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
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31
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Beaver JT, Mills LK, Swieboda D, Lelutiu N, Esser ES, Antao OQ, Scountzou E, Williams DT, Papaioannou N, Littauer EQ, Skountzou I. Zika virus-induced neuro-ocular pathology in immunocompetent mice correlates with anti-ganglioside autoantibodies. Hum Vaccin Immunother 2020; 16:2092-2108. [PMID: 32758108 PMCID: PMC7553712 DOI: 10.1080/21645515.2020.1775459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A severe consequence of adult Zika virus (ZIKV) infection is Guillain-Barré Syndrome (GBS), where autoreactive antibodies attack peripheral and central nervous systems (CNS) resulting in neuro-ocular pathology and fatal complications. During virally induced GBS, autoimmune brain demyelination and macular degeneration correlate with low virus neutralization and elevated antibody-mediated infection among Fcγ-R bearing cells. The use of interferon-deficient mice for ZIKV studies limits elucidation of antibody-dependent enhancement (ADE) and long-term pathology (≥120 days), due to high lethality post-infection. Here we used immunocompetent BALB/c mice, which generate robust humoral immune responses, to investigate long-term impacts of ZIKV infection. A high infectious dose (1x106 FFU per mouse) of ZIKV was administered intravenously. Control animals received a single dose of anti-IFNAR blocking monoclonal antibody and succumbed to lethal neurological pathology within 13 days. Immunocompetent mice exhibited motor impairment such as arthralgia, as well as ocular inflammation resulting in retinal vascular damage, and corneal edema. This pathology persisted 100 days after infection with evidence of chronic inflammation in immune-privileged tissues, demyelination in the hippocampus and motor cortex regions of the brain, and retinal/corneal hyperplasia. Anti-inflammatory transcriptional responses were tissue-specific, likely contributing to differential pathology in these organs. Pathology in immunocompetent animals coincided with weakly neutralizing antibodies and increased ADE among ZIKV strains (PRVABC59, FLR, and MR766) and all Dengue virus (DENV) serotypes. These antibodies were autoreactive to GBS-associated gangliosides. This study highlights the importance of longevity studies in ZIKV infection and confirms the role of anti-ganglioside antibodies in ZIKV-induced neuro-ocular disease.
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Affiliation(s)
- Jacob T Beaver
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Lisa K Mills
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Dominika Swieboda
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Nadia Lelutiu
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Edward S Esser
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Olivia Q Antao
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | | | - Dahnide T Williams
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Nikolaos Papaioannou
- Faculty of Veterinary Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Elizabeth Q Littauer
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
| | - Ioanna Skountzou
- Department of Microbiology & Immunology, Emory University School of Medicine , Atlanta, GA, USA
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Ku MW, Anna F, Souque P, Petres S, Prot M, Simon-Loriere E, Charneau P, Bourgine M. A Single Dose of NILV-Based Vaccine Provides Rapid and Durable Protection against Zika Virus. Mol Ther 2020; 28:1772-1782. [PMID: 32485138 PMCID: PMC7403329 DOI: 10.1016/j.ymthe.2020.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Zika virus, a member of the Flaviviridae family, is primarily transmitted by infected Aedes species mosquitoes. In 2016, Zika infection emerged as a global health emergency for its explosive spread and the remarkable neurological defects in the developing fetus. Development of a safe and effective Zika vaccine remains a high priority owing to the risk of re-emergence and limited understanding of Zika virus epidemiology. We engineered a non-integrating lentiviralvector(NILV)-based Zika vaccine encoding the consensus pre-membrane and envelope glycoprotein of circulating Zika virus strains. We further evaluated the immunogenicity and protective efficacy of this vaccine in both immunocompromised and immunocompetent mouse models. A single immunization in both mouse models elicited a robust neutralizing antibody titer and afforded full protection against Zika challenge as early as 7 days post-immunization. This NILV-based vaccine also induced a long-lasting immunity when immunized mice were challenged 6 months after immunization. Altogether, our NILV Zika vaccine provides a rapid yet durable protection through a single dose of immunization without extra adjuvant formulation. Our data suggest a promising Zika vaccine candidate for an emergency situation, and demonstrate the capacity of lentiviral vector as an efficient vaccine delivery platform.
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Affiliation(s)
- Min Wen Ku
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75005 Paris, France; Ecole Doctorale Frontières du Vivant (FdV), 26 Rue de l'Étoile, 75017 Paris, France
| | - François Anna
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Philippe Souque
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Stéphane Petres
- Plateforme Technologique Production et Purification de Protéines Recombinantes, Centre de Ressources et Recherches Technologiques, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Matthieu Prot
- Génomique Évolutive des Virus à ARN, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Etienne Simon-Loriere
- Génomique Évolutive des Virus à ARN, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Pierre Charneau
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France; Laboratoire commun Institut Pasteur-Theravectys, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France.
| | - Maryline Bourgine
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France; Laboratoire commun Institut Pasteur-Theravectys, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France.
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Mora-Salamanca AF, Porras-Ramírez A, De la Hoz Restrepo FP. Estimating the burden of arboviral diseases in Colombia between 2013 and 2016. Int J Infect Dis 2020; 97:81-89. [PMID: 32434085 DOI: 10.1016/j.ijid.2020.05.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE During the 2013-2016 period, Dengue, Chikungunya, and Zika affected more than 1 million people in Colombia. These arboviruses and their chronic manifestations pose a public health challenge. Therefore, we estimated the burden of disease by Dengue, Chikungunya, and Zika in Colombia between 2013 and 2016. METHODS An exploratory ecological study was carried out using the disability-adjusted life years (DALYs) as a unit of measure. The mortality databases of the National Administrative Department of Statistics (DANE) and the morbidity databases of the National Public Health Surveillance System (SIVIGILA) were used. Deaths and cases for each arbovirus were grouped and then adjusted to control biases. Subsequently, we performed a sensitivity analysis. RESULTS In the 2013-2016 period, 491,629.2 DALYs were lost due to arboviruses in Colombia. By disease, 26.6% of the total DALYs were caused by Dengue, 71.3% by Chikungunya, and the remaining 2.2%, by Zika. The majority of DALYs (68.2%) were caused by chronic complications. Five out of 32 departments (Valle del Cauca, Tolima, Norte de Santander, Huila, and Bolívar) contributed 50.5% of total DALYs. CONCLUSION The burden of disease by arboviruses in the 2013-2016 period exceeded the burden of other infectious diseases such as HIV/AIDS and tuberculosis in Colombia. Public health efforts must be made to mitigate new epidemics of these arboviruses.
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Affiliation(s)
| | - Alexandra Porras-Ramírez
- Grupo de Epidemiología y Evaluación en Salud pública, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo Medicina Comunitaria y Salud Colectiva, Universidad El Bosque, Bogotá, Colombia; Coordinación de Epidemiología e Investigación, Los Cobos Medical Center. Bogotá, Colombia.
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Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, Guarrera GM, Giometto B. Early Guillain-Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol Sci 2020; 41:1351-1354. [PMID: 32399950 PMCID: PMC7216127 DOI: 10.1007/s10072-020-04449-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy associated with dysimmune processes, often related to a previous infectious exposure. During Italian severe acute respiratory syndrome coronavirus-2 outbreak, a woman presented with a rapidly progressive flaccid paralysis with unilateral facial neuropathy after a few days of mild respiratory symptoms. Coronavirus was detected by nasopharyngeal swab, but there was no evidence of its presence in her cerebrospinal fluid, which confirmed the typical albumin-cytological dissociation of GBS, along with consistent neurophysiological data. Despite immunoglobulin infusions and intensive supportive care, her clinical picture worsened simultaneously both from the respiratory and neurological point of view, as if reflecting different aspects of the same systemic inflammatory response. Similar early complications have already been observed in patients with para-infectious GBS related to Zika virus, but pathological mechanisms have yet to be established.
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Affiliation(s)
- Donatella Ottaviani
- Neurology Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Federica Boso
- Neurology Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy.,Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enzo Tranquillini
- Neurology Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Ilaria Gapeni
- Neurology Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Giovanni Pedrotti
- Intensive Care Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Susanna Cozzio
- Internal Medicine Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Giovanni M Guarrera
- Health Trust, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Bruno Giometto
- Neurology Unit, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy.
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Gobillot TA, Humes D, Sharma A, Kikawa C, Overbaugh J. The Robust Restriction of Zika Virus by Type-I Interferon in A549 Cells Varies by Viral Lineage and Is Not Determined by IFITM3. Viruses 2020; 12:v12050503. [PMID: 32370187 PMCID: PMC7290589 DOI: 10.3390/v12050503] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/18/2022] Open
Abstract
Type-I interferon (IFN-I) is a major antiviral host response but its impact on Zika virus (ZIKV) replication is not well defined, particularly as it relates to different circulating strains. Interferon stimulated genes (ISGs) that inhibit ZIKV, such as IFITM3, have been identified largely using overexpression studies. Here, we tested whether diverse ZIKV strains differed in their susceptibility to IFN-I-mediated restriction and the contribution of IFITM3 to this restriction. We identified a robust IFN-I-mediated antiviral effect on ZIKV replication (>100-fold reduction) in A549 cells, a commonly used cell line to study ZIKV replication. The extent of inhibition depended on the IFN-I type and the virus strain tested. Viruses from the American pathogenic outbreak were more sensitive to IFNα (p = 0.049) and IFNβ (p = 0.09) than African-lineage strains, which have not been linked to severe pathogenesis. Knocking out IFITM3 expression did not dampen the IFN-I antiviral effect and only high overexpression of IFITM3 led to ZIKV inhibition. Moreover, IFITM3 expression levels in different cells were not associated with IFN-mediated ZIKV inhibition. Taken together, our findings indicate that there is a robust IFN-I-mediated antiviral effect on ZIKV infection, particularly for American viruses, that is not due to IFITM3. A549 cells, which are a commonly used cell line to study ZIKV replication, present an opportunity for the discovery of novel antiviral ISGs against ZIKV.
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Affiliation(s)
- Theodore A. Gobillot
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (T.A.G.); (D.H.); (A.S.); (C.K.)
- Medical Scientist Training Program, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Daryl Humes
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (T.A.G.); (D.H.); (A.S.); (C.K.)
| | - Amit Sharma
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (T.A.G.); (D.H.); (A.S.); (C.K.)
| | - Caroline Kikawa
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (T.A.G.); (D.H.); (A.S.); (C.K.)
| | - Julie Overbaugh
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (T.A.G.); (D.H.); (A.S.); (C.K.)
- Correspondence:
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Leonhard SE, Bresani-Salvi CC, Lyra Batista JD, Cunha S, Jacobs BC, Brito Ferreira ML, P. Militão de Albuquerque MDF. Guillain-Barré syndrome related to Zika virus infection: A systematic review and meta-analysis of the clinical and electrophysiological phenotype. PLoS Negl Trop Dis 2020; 14:e0008264. [PMID: 32339199 PMCID: PMC7205322 DOI: 10.1371/journal.pntd.0008264] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/07/2020] [Accepted: 03/31/2020] [Indexed: 12/30/2022] Open
Abstract
Background The Zika virus (ZIKV) has been associated with Guillain-Barré syndrome (GBS) in epidemiological studies. Whether ZIKV-associated GBS is related to a specific clinical or electrophysiological phenotype has not been established. To this end, we performed a systematic review and meta-analysis of all published studies on ZIKV-related GBS. Methods We searched Pubmed, EMBASE and LILACS, and included all papers, reports or bulletins with full text in English, Spanish or Portuguese, reporting original data of patients with GBS and a suspected, probable or confirmed recent ZIKV infection. Data were extracted according to a predefined protocol, and pooled proportions were calculated. Results Thirty-five studies were included (13 single case reports and 22 case series, case-control or cohort studies), reporting on a total of 601 GBS patients with a suspected, probable or confirmed ZIKV infection. Data from 21 studies and 587 cases were available to be summarized. ZIKV infection was confirmed in 21%, probable in 22% and suspected in 57% of cases. ZIKV PCR was positive in 30% (95%CI 15–47) of tested patients. The most common clinical features were: limb weakness 97% (95%CI 93–99), diminished/absent reflexes 96% (95%CI 88–100), sensory symptoms 82% (95%CI 76–88), and facial palsy 51% (95%CI 44–58). Median time between infectious and neurological symptoms was 5–12 days. Most cases had a demyelinating electrophysiological subtype and half of cases were admitted to the Intensive Care Unit (ICU). Heterogeneity between studies was moderate to substantial for most variables. Conclusions The clinical phenotype of GBS associated with ZIKV infection reported in literature is generally a sensorimotor demyelinating GBS with frequent facial palsy and a severe disease course often necessitating ICU admittance. Time between infectious and neurological symptoms and negative PCR in most cases suggests a post-infectious disease mechanism. Heterogeneity between studies was considerable and results may be subject to reporting bias. This study was registered on the international Prospective Register of Systematic Reviews (CRD42018081959). Guillain-Barré syndrome (GBS) is a rare but severe neurological disease, characterized by an acute onset flaccid paralysis. GBS is thought to be caused by an exaggerated immune response to common infections that damages the peripheral nerves. The Zika virus (ZIKV) is the most recent pathogen to be connected to GBS, when large outbreaks of ZIKV infection in French Polynesia and Latin America were followed by an increased incidence of GBS patients. To better understand the clinical features and outcome of ZIKV-related GBS, we have performed a systematic review and meta-analysis of all published studies on GBS related to ZIKV. We identified 35 studies, reporting on a total of 601 patients with GBS and a suspected, probable or confirmed Zika virus infection, and were able to summarize data of 587 patients from 21 studies in a pooled analysis. Our study shows that published cases with ZIKV-related GBS generally have both sensory and motor symptoms, facial palsy, demyelination on electrophysiological examination, and a severe disease course that often necessitates ICU admittance. The relatively long time between infectious and neurologic symptoms and the lack of detection of viral particles in bodily fluids in most patients suggest a post-infectious rather than an infectious pathogenesis. However, these results should be interpreted taking into account the heterogeneity between studies, which was considerable for many variables, and a possible reporting bias of more severe cases. Outbreaks of ZIKV and GBS may appear in the future and our study can help clinicians in diagnosing and managing GBS patients in ZIKV endemic areas, and increases our understanding of the neuropathology of ZIKV.
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Affiliation(s)
- Sonja E. Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Cristiane C. Bresani-Salvi
- Laboratory of Virology and Experimental Therapy, Oswaldo Cruz Foundation, Ministry of Health, Recife, Brazil
| | | | - Sergio Cunha
- Department of Preventive Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Bart C. Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Genetic Diversity of Collaborative Cross Mice Controls Viral Replication, Clinical Severity, and Brain Pathology Induced by Zika Virus Infection, Independently of Oas1b. J Virol 2020; 94:JVI.01034-19. [PMID: 31694939 DOI: 10.1128/jvi.01034-19] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022] Open
Abstract
The explosive spread of Zika virus (ZIKV) has been associated with major variations in severe disease and congenital afflictions among infected populations, suggesting an influence of host genes. We investigated how genome-wide variants could impact susceptibility to ZIKV infection in mice. We first describe that the susceptibility of Ifnar1-knockout mice is largely influenced by their genetic background. We then show that Collaborative Cross (CC) mice, which exhibit a broad genetic diversity, in which the type I interferon receptor (IFNAR) was blocked by an anti-IFNAR antibody expressed phenotypes ranging from complete resistance to severe symptoms and death, with large variations in the peak and the rate of decrease in the plasma viral load, in the brain viral load, in brain histopathology, and in the viral replication rate in infected cells. The differences in susceptibility to ZIKV between CC strains correlated with the differences in susceptibility to dengue and West Nile viruses between the strains. We identified highly susceptible and resistant mouse strains as new models to investigate the mechanisms of human ZIKV disease and other flavivirus infections. Genetic analyses revealed that phenotypic variations are driven by multiple genes with small effects, reflecting the complexity of ZIKV disease susceptibility in the human population. Notably, our results rule out the possibility of a role of the Oas1b gene in the susceptibility to ZIKV. Altogether, the findings of this study emphasize the role of host genes in the pathogeny of ZIKV infection and lay the foundation for further genetic and mechanistic studies.IMPORTANCE In recent outbreaks, ZIKV has infected millions of people and induced rare but potentially severe complications, including Guillain-Barré syndrome and encephalitis in adults. While several viral sequence variants were proposed to enhance the pathogenicity of ZIKV, the influence of host genetic variants in mediating the clinical heterogeneity remains mostly unexplored. We addressed this question using a mouse panel which models the genetic diversity of the human population and a ZIKV strain from a recent clinical isolate. Through a combination of in vitro and in vivo approaches, we demonstrate that multiple host genetic variants determine viral replication in infected cells and the clinical severity, the kinetics of blood viral load, and brain pathology in mice. We describe new mouse models expressing high degrees of susceptibility or resistance to ZIKV and to other flaviviruses. These models will facilitate the identification and mechanistic characterization of host genes that influence ZIKV pathogenesis.
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Sun P, Nie K, Zhu Y, Liu Y, Wu P, Liu Z, Du S, Fan H, Chen CH, Zhang R, Wang P, Cheng G. A mosquito salivary protein promotes flavivirus transmission by activation of autophagy. Nat Commun 2020; 11:260. [PMID: 31937766 PMCID: PMC6959235 DOI: 10.1038/s41467-019-14115-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/07/2019] [Indexed: 01/07/2023] Open
Abstract
Transmission from an infected mosquito to a host is an essential process in the life cycle of mosquito-borne flaviviruses. Numerous studies have demonstrated that mosquito saliva facilitates viral transmission. Here we find that a saliva-specific protein, named Aedes aegypti venom allergen-1 (AaVA-1), promotes dengue and Zika virus transmission by activating autophagy in host immune cells of the monocyte lineage. The AG6 mice (ifnar1–/–ifngr1–/–) bitten by the virus-infected AaVA-1-deficient mosquitoes present a lower viremia and prolonged survival. AaVA-1 intracellularly interacts with a dominant negative binder of Beclin-1, known as leucine-rich pentatricopeptide repeat-containing protein (LRPPRC), and releases Beclin-1 from LRPPRC-mediated sequestration, thereby enabling the initialization of downstream autophagic signaling. A deficiency in Beclin-1 reduces viral infection in mice and abolishes AaVA-1-mediated enhancement of ZIKV transmission by mosquitoes. Our study provides a mechanistic insight into saliva-aided viral transmission and could offer a potential prophylactic target for reducing flavivirus transmission. Mosquito saliva affects transmission of flaviviruses, but underlying mechanisms are incompletely understood. Here, the authors show that Aedes aegypti venom allergen-1 (AaVA-1) promotes dengue and Zika virus transmission by activating autophagy in host immune cells of the monocyte lineage.
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Affiliation(s)
- Peng Sun
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China.,Institute of Pathogenic Organisms, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, 518055, China
| | - Kaixiao Nie
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Yibin Zhu
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China.,Institute of Pathogenic Organisms, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, 518055, China.,School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Yang Liu
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China.,School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Pa Wu
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Ziwen Liu
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Senyan Du
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Huahao Fan
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Chun-Hong Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan, 35053, China
| | - Renli Zhang
- Institute of Pathogenic Organisms, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, 518055, China
| | - Penghua Wang
- Department of Immunology, School of Medicine, The University of Connecticut Health Center, Farmington, Connecticut, 06030, USA
| | - Gong Cheng
- Tsinghua-Peking Center for Life Sciences, School of Medicine, Tsinghua University, Beijing, 100084, China. .,Institute of Pathogenic Organisms, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, 518055, China.
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Abstract
Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.
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Affiliation(s)
- Louis H. Weimer
- Correspondence to: Louis H. Weimer, M.D., Neurological Institute of New York, 710 W. 168th Street, New York, NY 10032, United States. Tel: + 1-212-305-1516, Fax: + 1-212-305-4268
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Affiliation(s)
- Didier Musso
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
| | - Albert I Ko
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
| | - David Baud
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
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Abstract
Zika virus (ZIKV) is an arthropod-borne virus that belongs to the Flaviviridae family. Although most cases are mild or go undetected, rare severe neurologic effects, including congenital ZIKV syndrome (CZS) and Guillain-Barré syndrome, have been identified. The serious neurologic complications associated with ZIKV prompted the declaration of the public health emergency of international concern by the World Health Organization. Overall, transmission occurred throughout South and Central America as well as the Caribbean, affecting 48 countries and territories from March 2015 to March 2017. Long-term management of CZS requires a comprehensive combination of supportive services throughout early development.
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Affiliation(s)
- Savina Reid
- Department of Neurology, Columbia University Medical Center, Milstein Hospital, 177 Fort Washington Avenue, 8GS-300, New York, NY 10032, USA
| | - Kathryn Rimmer
- Department of Neurology, Columbia University Medical Center, Milstein Hospital, 177 Fort Washington Avenue, 8GS-300, New York, NY 10032, USA
| | - Kiran Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital, 177 Fort Washington Avenue, 8GS-300, New York, NY 10032, USA.
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Walteros DM, Soares J, Styczynski AR, Abrams JY, Galindo-Buitrago JI, Acosta-Reyes J, Bravo-Ribero E, Arteta ZE, Solano-Sanchez A, Prieto FE, Gonzalez-Duarte M, Navarro-Lechuga E, Salinas JL, Belay ED, Schonberger LB, Damon IK, Ospina ML, Sejvar JJ. Long-term outcomes of Guillain-Barré syndrome possibly associated with Zika virus infection. PLoS One 2019; 14:e0220049. [PMID: 31369576 PMCID: PMC6675241 DOI: 10.1371/journal.pone.0220049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/08/2019] [Indexed: 01/09/2023] Open
Abstract
Background This prospective cohort investigation analyzed the long-term functional and neurologic outcomes of patients with Zika virus-associated Guillain-Barré syndrome (GBS) in Barranquilla, Colombia. Methods Thirty-four Zika virus-associated GBS cases were assessed a median of 17 months following acute GBS illness. We assessed demographics, results of Overall Disability Sum Scores (ODSS), Hughes Disability Score (HDS), Zung Depression Scale (ZDS), and Health Related Quality of Life (HRQL) questionnaires; and compared outcomes indices with a normative sample of neighborhood-selected control subjects in Barranquilla without GBS. Results Median age at time of acute neurologic onset was 49 years (range, 10–80); 17 (50%) were male. No deaths occurred. At long-term follow-up, 25 (73%) patients had a HDS 0–1, indicating complete / near complete recovery. Among the group, HDS (mean 1.4, range 0–4), ODSS (mean 1.9, range 0–9) and ZDS score (mean 34.4, range 20–56) indicated mild / moderate ongoing disability. Adjusting for age and sex, Zika virus-associated GBS cases were similar to a population comparison group (n = 368) in Barranquilla without GBS in terms of prevalence of physical or mental health complaints, though GBS patients were more likely to have an ODSS of ≥ 1 (OR 8.8, 95% CI 3.2–24.5) and to suffer from moderate / moderate-severe depression (OR 3.89, 95% CI 1.23–11.17) than the comparison group. Conclusions Long-term outcomes of Zika virus-associated GBS are consistent with those associated with other antecedent antigenic stimuli in terms of mortality and ongoing long-term morbidity, as published in the literature. Persons with Zika virus-associated GBS more frequently reported disability and depression after approximately one year compared with those without GBS.
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Affiliation(s)
| | - Jesus Soares
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ashley R. Styczynski
- Stanford University Department of Infectious Diseases, Palo Alto, California, United States of America
| | - Joseph Y. Abrams
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | | | | | | | | | | | - Jorge L. Salinas
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States of America
| | - Ermias D. Belay
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Inger K. Damon
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - James J. Sejvar
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Chesnut M, Muñoz LS, Harris G, Freeman D, Gama L, Pardo CA, Pamies D. In vitro and in silico Models to Study Mosquito-Borne Flavivirus Neuropathogenesis, Prevention, and Treatment. Front Cell Infect Microbiol 2019; 9:223. [PMID: 31338335 PMCID: PMC6629778 DOI: 10.3389/fcimb.2019.00223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/11/2019] [Indexed: 01/07/2023] Open
Abstract
Mosquito-borne flaviviruses can cause disease in the nervous system, resulting in a significant burden of morbidity and mortality. Disease models are necessary to understand neuropathogenesis and identify potential therapeutics and vaccines. Non-human primates have been used extensively but present major challenges. Advances have also been made toward the development of humanized mouse models, but these models still do not fully represent human pathophysiology. Recent developments in stem cell technology and cell culture techniques have allowed the development of more physiologically relevant human cell-based models. In silico modeling has also allowed researchers to identify and predict transmission patterns and discover potential vaccine and therapeutic candidates. This review summarizes the research on in vitro and in silico models used to study three mosquito-borne flaviviruses that cause neurological disease in humans: West Nile, Dengue, and Zika. We also propose a roadmap for 21st century research on mosquito-borne flavivirus neuropathogenesis, prevention, and treatment.
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Affiliation(s)
- Megan Chesnut
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura S. Muñoz
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Neuroviruses Emerging in the Americas Study, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Georgina Harris
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dana Freeman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lucio Gama
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Carlos A. Pardo
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Neuroviruses Emerging in the Americas Study, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Pamies
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Physiology, University of Lausanne, Lausanne, Switzerland
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Central and peripheral nervous system involvement in Zika virus infection in a child. J Neurovirol 2019; 25:893-896. [DOI: 10.1007/s13365-019-00770-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/23/2019] [Accepted: 05/26/2019] [Indexed: 01/07/2023]
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Envelope Protein Glycosylation Mediates Zika Virus Pathogenesis. J Virol 2019; 93:JVI.00113-19. [PMID: 30944176 DOI: 10.1128/jvi.00113-19] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/23/2019] [Indexed: 12/25/2022] Open
Abstract
Zika virus (ZIKV) is an emerging mosquito-borne flavivirus. Recent ZIKV outbreaks have produced serious human disease, including neurodevelopmental malformations (congenital Zika syndrome) and Guillain-Barré syndrome. These outcomes were not associated with ZIKV infection prior to 2013, raising the possibility that viral genetic changes could contribute to new clinical manifestations. All contemporary ZIKV isolates encode an N-linked glycosylation site in the envelope (E) protein (N154), but this glycosylation site is absent in many historical ZIKV isolates. Here, we investigated the role of E protein glycosylation in ZIKV pathogenesis using two contemporary Asian-lineage strains (H/PF/2013 and PRVABC59) and the historical African-lineage strain (MR766). We found that glycosylated viruses were highly pathogenic in Ifnar1-/- mice. In contrast, nonglycosylated viruses were attenuated, producing lower viral loads in the serum and brain when inoculated subcutaneously but remaining neurovirulent when inoculated intracranially. These results suggest that E glycosylation is advantageous in the periphery but not within the brain. Accordingly, we found that glycosylation facilitated infection of cells expressing the lectins dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) or DC-SIGN-related (DC-SIGNR), suggesting that inefficient infection of lectin-expressing leukocytes could contribute to the attenuation of nonglycosylated ZIKV in mice.IMPORTANCE It is unclear why the ability of Zika virus (ZIKV) to cause serious disease, including Guillain-Barré syndrome and birth defects, was not recognized until recent outbreaks. One contributing factor could be genetic differences between contemporary ZIKV strains and historical ZIKV strains. All isolates from recent outbreaks encode a viral envelope protein that is glycosylated, whereas many historical ZIKV strains lack this glycosylation. We generated nonglycosylated ZIKV mutants from contemporary and historical strains and evaluated their virulence in mice. We found that nonglycosylated viruses were attenuated and produced lower viral loads in serum and brains. Our studies suggest that envelope protein glycosylation contributes to ZIKV pathogenesis, possibly by facilitating attachment to and infection of lectin-expressing leukocytes.
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Klein RS, Garber C, Funk KE, Salimi H, Soung A, Kanmogne M, Manivasagam S, Agner S, Cain M. Neuroinflammation During RNA Viral Infections. Annu Rev Immunol 2019; 37:73-95. [PMID: 31026414 PMCID: PMC6731125 DOI: 10.1146/annurev-immunol-042718-041417] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neurotropic RNA viruses continue to emerge and are increasingly linked to diseases of the central nervous system (CNS) despite viral clearance. Indeed, the overall mortality of viral encephalitis in immunocompetent individuals is low, suggesting efficient mechanisms of virologic control within the CNS. Both immune and neural cells participate in this process, which requires extensive innate immune signaling between resident and infiltrating cells, including microglia and monocytes, that regulate the effector functions of antiviral T and B cells as they gain access to CNS compartments. While these interactions promote viral clearance via mainly neuroprotective mechanisms, they may also promote neuropathology and, in some cases, induce persistent alterations in CNS physiology and function that manifest as neurologic and psychiatric diseases. This review discusses mechanisms of RNA virus clearance and neurotoxicity during viral encephalitis with a focus on the cytokines essential for immune and neural cell inflammatory responses and interactions. Understanding neuroimmune communications in the setting of viral infections is essential for the development of treatments that augment neuroprotective processes while limiting ongoing immunopathological processes that cause ongoing CNS disease.
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Affiliation(s)
- Robyn S Klein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri 63110, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Charise Garber
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Kristen E Funk
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Hamid Salimi
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Allison Soung
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Marlene Kanmogne
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Sindhu Manivasagam
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Shannon Agner
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Matthew Cain
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
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Morens DM, Fauci AS. Pandemic Zika: A Formidable Challenge to Medicine and Public Health. J Infect Dis 2019; 216:S857-S859. [PMID: 29267908 PMCID: PMC5853239 DOI: 10.1093/infdis/jix383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- David M Morens
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.,National Institutes of Health, Bethesda, Maryland
| | - Anthony S Fauci
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.,National Institutes of Health, Bethesda, Maryland
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48
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Abstract
There was a dramatic upsurge in research activity after the recognition of Zika virus (ZIKV) transmission in South America in 2015 and its causal relationship to devastating anomalies in newborn infants. Progress in this area required a community of arbovirologists poised to refocus their research efforts and rapidly characterize the features of ZIKV transmission and infection through diverse multidisciplinary collaborations. Significant gaps remain in our knowledge of the natural history of ZIKV infection, its effects on neurodevelopment, modes and risk of transmission, and its interrelationship with other arbovirus infections. Development of effective countermeasures, such as therapeutics and an effective vaccine, are also research priorities. Lessons learned from our research response to ZIKV may help public health officials plan for the next emerging infectious disease threat.The last 18 months have witnessed one of the most rapid and coordinated research responses against an emerging disease to date. Zika virus, a pathogen that has been known since 1947 but poorly studied until recently because it was believed to only cause a mild infection, has rapidly become the object of intense investigation by the international research community since the link between infection and severe congenital disease was announced by Brazilian authorities in November 2015. According to PubMed, the total number of ZIKV-related publications skyrocketed from 117 in 2015 to 3253 in August of 2017. This supplement summarizes the tremendous progress that has been made since 2015 to elucidate the biology of this virus, its various disease manifestations in humans and animals, the diverse routes by which it is transmitted, and the role of various mosquito vectors in the recent outbreaks. In addition, several efforts have been initiated to develop new diagnostics, therapeutics, vaccines, and vector control strategies to better detect, treat, and prevent this important infection. There are 3 factors that contributed to the rapid progress in ZIKV research: (1) the availability of dedicated funding for ZIKV research; (2) the prior existence of both flavivirologists and maternal-child health researchers who were poised to tackle this new public health challenge; and (3) the high level of coordination and collaboration between different research agencies worldwide.Despite the significant progress, many significant questions remain to be addressed to accelerate the development of effective ZIKV countermeasures and increase our preparedness against this significant public health threat. Some of the most pressing scientific gaps that need to be addressed to advance the field are summarized below.
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Affiliation(s)
- Emily Erbelding
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Cristina Cassetti
- Virology Branch, Division of Microbiology and Infectious Diseases, Bethesda, Maryland
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Mancera-Páez O, Román GC, Pardo-Turriago R, Rodríguez Y, Anaya JM. Concurrent Guillain-Barré syndrome, transverse myelitis and encephalitis post-Zika: A case report and review of the pathogenic role of multiple arboviral immunity. J Neurol Sci 2018; 395:47-53. [PMID: 30292020 DOI: 10.1016/j.jns.2018.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022]
Abstract
We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies. With intensive care treatment, respiratory support, steroids, and intravenous immunoglobulin (IVIg), patient survived with residual flaccid paraparesis. She had preexisting immunity against Chikungunya virus (CHIKV) and Dengue virus (DENV) acquired before the arrival of ZIKV in Colombia. From reports in the Caribbean, Central and South America we review 19 cases of ZIKV-associated TM, encephalitis and ADEM occurring after a mean latent period of 10.5 days (range 1-96) post-infection. Although GBS and ADEM are usually considered post-infectious and associated with development of antibodies against peripheral nerve and CNS epitopes, we postulate that our case of ADEM+GBS is para-infectious, induced by acute ZIKV neurotropism boosted by active immunity against other arboviruses. Animal models of ZIKV demonstrated strong viral neurotropism enhanced by passive immunity with antibodies against arboviruses such as West Nile virus, CHIKV, or DENV. These considerations are relevant to prevent potential ZIKV vaccine-induced reactions involving central and peripheral nervous system.
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Affiliation(s)
- Oscar Mancera-Páez
- Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia.; David Cabello International Alzheimer Disease Scholarship Fund, Houston Methodist Hospital, Houston, TX, USA..
| | - Gustavo C Román
- Department of Neurology, Methodist Neurological Institute and the Institute for Academic Medicine Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA; Weill Cornell Medical College, Department of Neurology, Cornell University, NY, New York, USA.
| | - Rodrigo Pardo-Turriago
- Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia..
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
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50
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Dirlikov E, Major CG, Medina NA, Lugo-Robles R, Matos D, Muñoz-Jordan JL, Colon-Sanchez C, Garcia M, Olivero-Segarra M, Malave G, Rodríguez-Vega GM, Thomas DL, Waterman SH, Sejvar JJ, Luciano CA, Sharp TM, Rivera-García B. Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016. JAMA Neurol 2018; 75:1089-1097. [PMID: 29799940 PMCID: PMC6143122 DOI: 10.1001/jamaneurol.2018.1058] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
Importance The pathophysiologic mechanisms of Guillain-Barré syndrome (GBS) associated with Zika virus (ZIKV) infection may be indicated by differences in clinical features. Objective To identify specific clinical features of GBS associated with ZIKV infection. Design, Setting, and Participants During the ZIKV epidemic in Puerto Rico, prospective and retrospective strategies were used to identify patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico. Guillain-Barré syndrome diagnosis was confirmed via medical record review using the Brighton Collaboration criteria. Specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection by real-time reverse transcriptase-polymerase chain reaction; serum and cerebrospinal fluid were also tested by IgM enzyme-linked immunosorbent assay. In this analysis of public health surveillance data, a total of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing; there were 71 patients with and 36 patients without evidence of ZIKV infection. Follow-up telephone interviews with patients were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection participated. Main Outcomes and Measures Acute and long-term clinical characteristics of GBS associated with ZIKV infection. Results Of 123 patients with confirmed GBS, the median age was 54 years (age range, 4-88 years), and 68 patients (55.3%) were male. The following clinical features were more frequent among patients with GBS and evidence of ZIKV infection compared with patients with GBS without evidence of ZIKV infection: facial weakness (44 [62.0%] vs 10 [27.8%]; P < .001), dysphagia (38 [53.5%] vs 9 [25.0%]; P = .005), shortness of breath (33 [46.5%] vs 9 [25.0%]; P = .03), facial paresthesia (13 [18.3%] vs 1 [2.8%]; P = .03), elevated levels of protein in cerebrospinal fluid (49 [94.2%] vs 23 [71.9%]; P = .008), admission to the intensive care unit (47 [66.2%] vs 16 [44.4%]; P = .03), and required mechanical ventilation (22 [31.0%] vs 4 [11.1%]; P = .02). Six months after neurologic illness onset, patients with GBS and evidence of ZIKV infection more frequently reported having excessive or inadequate tearing (30 [53.6%] vs 6 [26.1%]; P = .03), difficulty drinking from a cup (10 [17.9%] vs 0; P = .03), and self-reported substantial pain (15 [27.3%] vs 1 [4.3%]; P = .03). Conclusions and Relevance In this study, GBS associated with ZIKV infection was found to have higher morbidity during the acute phase and more frequent cranial neuropathy during acute neuropathy and 6 months afterward. Results indicate GBS pathophysiologic mechanisms that may be more common after ZIKV infection.
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Affiliation(s)
- Emilio Dirlikov
- Office of Epidemiology and Research, Puerto Rico Department of Health, San Juan
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chelsea G. Major
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Office for State, Tribal, Local, and Territorial Support, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole A. Medina
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roberta Lugo-Robles
- Office of Epidemiology and Research, Puerto Rico Department of Health, San Juan
| | - Desiree Matos
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge L. Muñoz-Jordan
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Candimar Colon-Sanchez
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Myriam Garcia
- Biological and Chemical Emergencies Laboratory, Office of Public Health Preparedness and Response, Puerto Rico Department of Health, San Juan
- Public Health Laboratory, Puerto Rico Department of Health, San Juan
| | - Marangely Olivero-Segarra
- Biological and Chemical Emergencies Laboratory, Office of Public Health Preparedness and Response, Puerto Rico Department of Health, San Juan
- Public Health Laboratory, Puerto Rico Department of Health, San Juan
| | - Graciela Malave
- Biological and Chemical Emergencies Laboratory, Office of Public Health Preparedness and Response, Puerto Rico Department of Health, San Juan
- Public Health Laboratory, Puerto Rico Department of Health, San Juan
| | | | - Dana L. Thomas
- Division of State and Local Readiness, Office of Public Health Preparedness and Response, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Commissioned Corps of the US Public Health Service, Rockville, Maryland
| | - Stephen H. Waterman
- Office of Epidemiology and Research, Puerto Rico Department of Health, San Juan
- Commissioned Corps of the US Public Health Service, Rockville, Maryland
| | - James J. Sejvar
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos A. Luciano
- Neurology Section, University of Puerto Rico School of Medicine, San Juan
| | - Tyler M. Sharp
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Commissioned Corps of the US Public Health Service, Rockville, Maryland
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