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Kesteleyn B, Herschke F, Darville N, Stoops B, Jacobs T, Jacoby E, Shaffer P, Lammens L, Van Rompaey D, Matcha K, Martinez Lamenca C, Coesemans E, Hache G, Pieters S, Lecomte M, Hu L, Demin S, Milligan C, Abeywickrema P, De Bruyn S, Van Den Berg J, Ysebaert N, De Zwart L, Nájera I, Rigaux P, Roymans D, Jonckers THM. Spiro-Azetidine Oxindoles as Long-Acting Injectables for Pre-Exposure Prophylaxis against Respiratory Syncytial Virus Infections. J Med Chem 2024. [PMID: 38932487 DOI: 10.1021/acs.jmedchem.4c00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Respiratory syncytial virus (RSV) is a major cause of hospitalization in infants, the elderly, and immune-compromised patients. While a half-life extended monoclonal antibody and 2 vaccines have recently been approved for infants and the elderly, respectively, options to prevent disease in immune-compromised patients are still needed. Here, we describe spiro-azetidine oxindoles as small molecule RSV entry inhibitors displaying favorable potency, developability attributes, and long-acting PK when injected as an aqueous suspension, suggesting their potential to prevent complications following RSV infection over a period of 3 to 6 months with 1 or 2 long-acting intramuscular (IM) or subcutaneous (SC) injections in these immune-compromised patients.
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Affiliation(s)
- Bart Kesteleyn
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Florence Herschke
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Nicolas Darville
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Bart Stoops
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Tom Jacobs
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Edgar Jacoby
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Paul Shaffer
- Janssen Research & Development, 1400 McKean Rd, Spring House, Pennsylvania 19477, United States
| | - Lieve Lammens
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Dries Van Rompaey
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Kiran Matcha
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | | | - Erwin Coesemans
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Geerwin Hache
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Serge Pieters
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Morgan Lecomte
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Lili Hu
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Samuel Demin
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Cynthia Milligan
- Janssen Research & Development, 1400 McKean Rd, Spring House, Pennsylvania 19477, United States
| | - Pravien Abeywickrema
- Janssen Research & Development, 1400 McKean Rd, Spring House, Pennsylvania 19477, United States
| | - Suzanne De Bruyn
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Joke Van Den Berg
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Nina Ysebaert
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Loeckie De Zwart
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Isabel Nájera
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Peter Rigaux
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Dirk Roymans
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
| | - Tim H M Jonckers
- Janssen Research & Development, Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse 2340, Belgium
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Mankad VS, Leach A, Chang Y, Wählby Hamrén U, Kiazand A, Kubiak RJ, Takas T, Villafana T, Shroff M. Comprehensive Summary of Safety Data on Nirsevimab in Infants and Children from All Pivotal Randomized Clinical Trials. Pathogens 2024; 13:503. [PMID: 38921800 PMCID: PMC11206492 DOI: 10.3390/pathogens13060503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Nirsevimab is approved in the US for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants during their first RSV season and in children aged ≤24 months who remain vulnerable to severe RSV disease through their second RSV season. We summarize a pre-specified analysis of nirsevimab safety data from three randomized controlled trials: Phase 2b (NCT02878330; healthy infants born ≥29 to <35 weeks' gestational age [wGA]); Phase 3 MELODY (NCT03979313; healthy infants born ≥35 wGA); and Phase 2/3 MEDLEY (NCT03959488; infants with congenital heart disease [CHD] and/or chronic lung disease of prematurity [CLD] or born ≤35 wGA). METHODS Participants (randomized 2:1) received a single intramuscular dose of nirsevimab or comparator (placebo, Phase 2b/MELODY; 5× once-monthly palivizumab, MEDLEY) before their first RSV season (recipients < 5 kg, nirsevimab 50 mg; ≥5 kg, nirsevimab 100 mg). In MEDLEY, children with CHD/CLD continued to a second RSV season: first-season nirsevimab recipients received nirsevimab 200 mg; first-season palivizumab recipients were re-randomized 1:1 to receive nirsevimab 200 mg or 5× once-monthly palivizumab. RESULTS The incidence, severity, and nature of AEs were similar across treatments (nirsevimab, n = 3184; placebo, n = 1284; palivizumab, n = 304). Most AEs were mild to moderate in severity, with ≥98% unrelated to treatment. AEs of special interest occurred infrequently (<1%): no anaphylaxis or thrombocytopenia were treatment-related, and no immune complex disease was reported. Deaths (incidence < 1.0%) were all unrelated to treatment. CONCLUSIONS A single dose per season of nirsevimab for the prevention of RSV disease had a favorable safety profile, irrespective of wGA or comorbidities.
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Affiliation(s)
- Vaishali S. Mankad
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Durham, NC 27703, USA;
| | - Amanda Leach
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (A.L.); (Y.C.); (T.T.); (T.V.)
| | - Yue Chang
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (A.L.); (Y.C.); (T.T.); (T.V.)
| | - Ulrika Wählby Hamrén
- Clinical Pharmacology and Quantitative Pharmacology, R&D, AstraZeneca, SE-43183 Gothenburg, Sweden;
| | - Alexandre Kiazand
- Patient Safety, Chief Medical Office, Oncology R&D, AstraZeneca, Gaithersburg, MD 20878, USA;
| | - Robert J. Kubiak
- Clinical Pharmacology and Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA;
| | - Therese Takas
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (A.L.); (Y.C.); (T.T.); (T.V.)
| | - Tonya Villafana
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA; (A.L.); (Y.C.); (T.T.); (T.V.)
| | - Manish Shroff
- Patient Safety, Chief Medical Office, Oncology R&D, AstraZeneca, Waltham, MA 02451, USA
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Ma HY, Lin IF, Liu YC, Yen TY, Huang KYA, Shih WL, Lu CY, Chang LY, Huang LM. Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children. Pediatr Infect Dis J 2024; 43:487-492. [PMID: 38295229 DOI: 10.1097/inf.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a common cause of bronchiolitis and pneumonia in infants and young children. Starting in December 2010, RSV monoclonal antibody (RSV mAb) was endorsed by Taiwan National Health Insurance and given to children with prematurity and/or congenital heart diseases, which are considered high-risk factors for severe RSV diseases. Investigating other important contributing risk factors is warranted. METHODS We conducted a cohort study at National Taiwan University Hospital to determine the rate of severe outcomes among children hospitalized due to RSV infection from 2008 to 2018. Adjusted for age, sex and birth cohorts born before and after RSV mAb endorsement, we identified risk factors for severe RSV infection, defined as the requirement of invasive ventilator support. RESULTS There were 1985 admissions due to RSV infections. Among them, 66 patients (3.3%) had severe RSV infection. The proportion of severe RSV infections decreased significantly after RSV mAb endorsement. Multivariable analysis revealed that age <1.5 months and cardiovascular and congenital/genetic diseases were high-risk underlying conditions. In addition, bacterial coinfections, elevated creatinine levels and initial abnormal chest radiograph findings posed warning signs for severe RSV infection. CONCLUSIONS Children younger than 1.5 months of age with cardiovascular or congenital/genetic diseases were predisposed to severe RSV infection and might benefit from RSV mAb prophylaxis.
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Affiliation(s)
- Hsuan-Yin Ma
- From the Center for Drug Evaluation, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - I-Fan Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Yun-Chung Liu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Kuan-Ying A Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University
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Trusinska D, Zin ST, Sandoval E, Homaira N, Shi T. Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2024; 43:467-476. [PMID: 38285519 PMCID: PMC11003409 DOI: 10.1097/inf.0000000000004258] [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] [Accepted: 12/06/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Acute lower respiratory infection (ALRI) caused by respiratory viruses is among the most common causes of hospitalization and mortality in children. We aimed to identify risk factors for poor outcomes in children <5 years old hospitalized with ALRI caused by respiratory syncytial virus (RSV), influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS We searched Embase, Medline and Global Health databases and included observational studies reporting risk factors for poor outcomes (defined as use of supplemental oxygen, mechanical ventilation, intensive care unit admission, prolonged hospital stay and mortality) published between January 2011 and January 2023. Two authors independently extracted data on study characteristics, outcomes and risk factors. Due to limited data, meta-analyses were only conducted for RSV-ALRI poor outcome risk factors using random effects model when there were at least 3 studies. RESULTS We included 30 studies. For RSV-related ALRI, significant risk factors based on meta-analysis were: neurological disease [odds ratio (OR): 6.14; 95% confidence intervals (CIs): 2.39-15.77], Down's syndrome (5.43; 3.02-9.76), chronic lung disease (3.64; 1.31-10.09), immunocompromised status (3.41; 1.85-6.29), prematurity (2.98; 1.93-4.59), congenital heart disease (2.80; 1.84-4.24), underlying disease (2.45; 1.94-3.09), age <2 months (2.29; 1.78-2.94), age <6 months (2.08; 1.81-2.39), viral coinfection (2.01; 1.27-3.19), low birth weight (1.88; 1.19-2.95) and being underweight (1.80; 1.38-2.35). For influenza-related ALRI, chronic conditions and age 6-24 months were identified as risk factors for poor outcomes. Cardiovascular disease, immunosuppression, chronic kidney disease, diabetes and high blood pressure were reported as risk factors for mortality due to SARS-CoV-2 associated ALRI. CONCLUSIONS These findings might contribute to the development of guidelines for prophylaxis and management of ALRI caused by RSV, influenza and SARS-CoV-2.
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Affiliation(s)
- Daira Trusinska
- From the Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom
| | - Si Thu Zin
- Randwick Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Emmanuel Sandoval
- From the Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom
- Department of Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nusrat Homaira
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Respiratory Department, Sydney Children’s Hospital, Randwick, Sydney, New South Wales, Australia
- James P. Grant School of Public Health, BRAC University, Bangladesh
| | - Ting Shi
- From the Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom
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Lee J, Sabati A, Mirea L, Alaeddine M, Velez DA. Congenital heart surgery outcomes in patients with positive respiratory viral swabs. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00001-1. [PMID: 38191072 DOI: 10.1016/j.jtcvs.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To examine whether or not viral positive patients experienced worse outcomes and assess differences in surgical outcomes between viral-positive patients with and without viral symptoms within 30 days of surgery. METHODS This retrospective study reviewed charts of pediatric patients who underwent congenital heart surgery and routine viral testing at a single institution over a consecutive 3-year period (2017-2019). Patients with a history of heart transplants, pacemaker changes, or implants, and mediastinal washouts were excluded from the study. Surgical outcomes were compared by viral status and viral symptoms, using the Fisher exact and Wilcoxon rank sum tests. RESULTS Among 1041 patients, 374 patients underwent routine preoperative viral testing, with 107 patients testing positive and 267 testing negative for viral swabs before surgery. There were no significant differences observed in surgical outcomes by viral status, including no differences in mortality. Among the 107 patients with positive viral swabs before surgery, comparisons between 24 patients with viral symptoms and 83 without symptoms within 30 days of surgery detected no significant differences in mortality or complication rates. However, symptomatic versus asymptomatic patients had significantly longer postoperative stay (23.4 vs 13.4 days; P = .02) and intubation time (9.8 vs 4.9 hours; P = .004). CONCLUSIONS Patients who test positive before congenital heart surgery and are asymptomatic beyond the incubation period may proceed to surgery with no further delay. Patients who are viral positive and symptomatic have a longer postoperative stay and intubation time. A prospective study is needed to assess the importance of routine viral testing.
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Affiliation(s)
- Joy Lee
- University of Arizona College of Medicine, Phoenix, Ariz
| | - Arash Sabati
- Department of Cardiology, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz
| | - Lucia Mirea
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Ariz
| | - Mohamad Alaeddine
- Department of Cardiothoracic Surgery, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz.
| | - Daniel A Velez
- Department of Cardiothoracic Surgery, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz
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de Souza Luna LK, Cruz JS, Chaves TDSS, Bellei N. Comparative analysis of Respiratory Syncytial Virus frequency rates and viral load in different patient cohorts in a University Hospital in São Paulo, Brazil, over an eight-year period (2005-2013). Braz J Infect Dis 2023; 27:103702. [PMID: 38043582 PMCID: PMC10714327 DOI: 10.1016/j.bjid.2023.103702] [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: 06/29/2023] [Revised: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) poses a global health concern, particularly affecting young children, the elderly, and immunosuppressed individuals. RSV viral load is essential for understanding transmission, disease severity, prevention, and treatment. This retrospective study aimed to analyze the frequency rates and viral loads of RSV infections in different patient cohorts and age groups over an eight-year period in a university hospital in São Paulo, Brazil. This study analyzed 1380 Immunocompetent (IC) and Immunosuppressed (IS) patients with acute respiratory tract infections. IC included patients with chronic Heart Disease (HD), Primary Care service recipients (PC), and a subgroup suspected of having Severe Acute Respiratory Syndrome caused by Influenza A (H1N1)pdm09 virus (SARS H1N1). IS comprised transplant patients and those with HIV infection. Respiratory samples were collected between February 2005 and October 2013, with RSV detection and viral load quantification (Log10 copies of RNA/mL) using RT-qPCR. Overall RSV infection rate was 17.3 %, with higher rates in children (23.9 %) than in adults (12.9 %), particularly in children under two years of age (28.2 %). Children in the SARS H1N1 and PC subgroups had higher infection rates (16.4 % and 34.9 %, respectively), with the highest rate in PC children aged 1 to < 2 years (45.45 %). Adults with HD had a significantly higher frequency rate (27.83 %) than those in the SARS H1N1 (2.65 %) and IS (15.16 %) subgroups and higher hospitalization rate among adults under 65 years. RSV viral load ranged from 2.43 to 10.15 Log10 RNA copies/mL (mean ± SD 5.82 ± 2.19), with hospitalized patients exhibiting significantly higher viral loads (7.34 ± 1.9) than outpatients (4.38 ± 1.89). Elderly bone marrow transplant patients also had significantly higher viral loads (7.57 ± 2.41) than younger adults (5.12 ± 1.87). This study provides insights into the RSV infection patterns in different patient cohorts in Brazil. Further investigations are needed to understand susceptibility and risk factors associated with RSV infection. In conclusion, high RSV viral load among hospitalized patients could serve as a surrogate marker of disease severity. Additionally, patients with chronic heart disease deserve greater attention regarding complications associated with RSV infection.
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Affiliation(s)
- Luciano Kleber de Souza Luna
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Laboratório de Virologia Clínica, São Paulo, SP, Brazil.
| | - Jessica Santiago Cruz
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Laboratório de Virologia Clínica, São Paulo, SP, Brazil
| | - Tânia do Socorro Souza Chaves
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Laboratório de Virologia Clínica, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade Federal do Pará, Belém, PA, Brazil; Instituto Evandro Chagas, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde do Brasil, Brasília, DF, Brazil
| | - Nancy Bellei
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Laboratório de Virologia Clínica, São Paulo, SP, Brazil
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Vartiainen P, Jukarainen S, Rhedin SA, Prinz A, Hartonen T, Vabalas A, Viippola E, Rodosthenous RS, Koskelainen S, Liu A, Lundholm C, Smew AI, Osvald EC, Helle E, Perola M, Almqvist C, Heinonen S, Ganna A. Risk factors for severe respiratory syncytial virus infection during the first year of life: development and validation of a clinical prediction model. Lancet Digit Health 2023; 5:e821-e830. [PMID: 37890904 DOI: 10.1016/s2589-7500(23)00175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/13/2023] [Accepted: 08/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Novel immunisation methods against respiratory syncytial virus (RSV) are emerging, but knowledge of risk factors for severe RSV disease is insufficient for optimal targeting of interventions against them. Our aims were to identify predictors for RSV hospital admission from registry-based data and to develop and validate a clinical prediction model to guide RSV immunoprophylaxis for infants younger than 1 year. METHODS In this model development and validation study, we studied all infants born in Finland between June 1, 1997, and May 31, 2020, and in Sweden between June 1, 2006, and May 31, 2020, along with the data for their parents and siblings. Infants were excluded if they died or were admitted to hospital for RSV within the first 7 days of life. The outcome was hospital admission due to RSV bronchiolitis during the first year of life. The Finnish study population was divided into a development dataset (born between June 1, 1997, and May 31, 2017) and a temporal hold-out validation dataset (born between June 1, 2017, and May 31, 2020). The development dataset was used for predictor discovery and selection in which we screened 1511 candidate predictors from the infants', parents', and siblings' data, and developed a logistic regression model with the 16 most important predictors. This model was then validated using the Finnish hold-out validation dataset and the Swedish dataset. FINDINGS In total, there were 1 124 561 infants in the Finnish development dataset, 130 352 infants in the Finnish hold-out validation dataset, and 1 459 472 infants in the Swedish dataset. In addition to known predictors such as severe congenital heart defects (adjusted odds ratio 2·89, 95% CI 2·28-3·65), we confirmed some less established predictors for RSV hospital admission, most notably oesophageal malformations (3·11, 1·86-5·19) and lower complexity congenital heart defects (1·43, 1·25-1·63). The prediction model's C-statistic was 0·766 (95% CI 0·742-0·789) in Finnish data and 0·737 (0·710-0·762) in Swedish validation data. The infants in the highest decile of predicted RSV hospital admission probability had 4·5 times higher observed risk compared with others. Calibration varied according to epidemic intensity. The model's performance was similar to a machine learning (XGboost) model using all 1511 candidate predictors (C-statistic in Finland 0·771, 95% CI 0·754-0·788). The prediction model showed clinical utility in decision curve analysis and in hypothetical number needed to treat calculations for immunisation, and its C-statistic was similar across different strata of parental income. INTERPRETATION The identified predictors and the prediction model can be used in guiding RSV immunoprophylaxis in infants, or as a basis for further immunoprophylaxis targeting tools. FUNDING Sigrid Jusélius Foundation, European Research Council, Pediatric Research Foundation, and Academy of Finland.
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Affiliation(s)
- Pekka Vartiainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Pediatric Research Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Sakari Jukarainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Samuel Arthur Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Alexandra Prinz
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Tuomo Hartonen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Andrius Vabalas
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Essi Viippola
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Sara Koskelainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Aoxing Liu
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Emmi Helle
- Pediatric Research Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Markus Perola
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Santtu Heinonen
- Pediatric Research Center, Helsinki University Hospital, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Andrea Ganna
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Analytical and Translational Genetic Unit, Massachusetts General Hospital, Cambridge, MA, USA
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8
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Yu X, Abeywickrema P, Bonneux B, Behera I, Anson B, Jacoby E, Fung A, Adhikary S, Bhaumik A, Carbajo RJ, De Bruyn S, Miller R, Patrick A, Pham Q, Piassek M, Verheyen N, Shareef A, Sutto-Ortiz P, Ysebaert N, Van Vlijmen H, Jonckers THM, Herschke F, McLellan JS, Decroly E, Fearns R, Grosse S, Roymans D, Sharma S, Rigaux P, Jin Z. Structural and mechanistic insights into the inhibition of respiratory syncytial virus polymerase by a non-nucleoside inhibitor. Commun Biol 2023; 6:1074. [PMID: 37865687 PMCID: PMC10590419 DOI: 10.1038/s42003-023-05451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
The respiratory syncytial virus polymerase complex, consisting of the polymerase (L) and phosphoprotein (P), catalyzes nucleotide polymerization, cap addition, and cap methylation via the RNA dependent RNA polymerase, capping, and Methyltransferase domains on L. Several nucleoside and non-nucleoside inhibitors have been reported to inhibit this polymerase complex, but the structural details of the exact inhibitor-polymerase interactions have been lacking. Here, we report a non-nucleoside inhibitor JNJ-8003 with sub-nanomolar inhibition potency in both antiviral and polymerase assays. Our 2.9 Å resolution cryo-EM structure revealed that JNJ-8003 binds to an induced-fit pocket on the capping domain, with multiple interactions consistent with its tight binding and resistance mutation profile. The minigenome and gel-based de novo RNA synthesis and primer extension assays demonstrated that JNJ-8003 inhibited nucleotide polymerization at the early stages of RNA transcription and replication. Our results support that JNJ-8003 binding modulates a functional interplay between the capping and RdRp domains, and this molecular insight could accelerate the design of broad-spectrum antiviral drugs.
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Affiliation(s)
- Xiaodi Yu
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA.
| | - Pravien Abeywickrema
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Brecht Bonneux
- Janssen Infectious Diseases and Vaccines, 2340, Beerse, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Ishani Behera
- Johnson & Johnson Innovative Medicine, Brisbane, CA, 94005, USA
| | - Brandon Anson
- Johnson & Johnson Innovative Medicine, Brisbane, CA, 94005, USA
| | - Edgar Jacoby
- Johnson & Johnson Innovative Medicine, Beerse, Belgium
| | - Amy Fung
- Johnson & Johnson Innovative Medicine, Brisbane, CA, 94005, USA
| | - Suraj Adhikary
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Anusarka Bhaumik
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Rodrigo J Carbajo
- Johnson & Johnson Innovative Medicine, Janssen-Cilag, Discovery Chemistry S.A. Río Jarama, 75A, 45007, Toledo, Spain
| | | | - Robyn Miller
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Aaron Patrick
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Quyen Pham
- Johnson & Johnson Innovative Medicine, Brisbane, CA, 94005, USA
| | - Madison Piassek
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Nick Verheyen
- Janssen Infectious Diseases and Vaccines, 2340, Beerse, Belgium
| | - Afzaal Shareef
- Department of Microbiology, National Emerging Infectious Diseases Laboratories, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | | | - Nina Ysebaert
- Janssen Infectious Diseases and Vaccines, 2340, Beerse, Belgium
| | | | | | | | - Jason S McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Etienne Decroly
- Aix Marseille Université, CNRS, AFMB, UMR 7257, Marseille, France
| | - Rachel Fearns
- Department of Microbiology, National Emerging Infectious Diseases Laboratories, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | | | - Dirk Roymans
- Janssen Infectious Diseases and Vaccines, 2340, Beerse, Belgium
| | - Sujata Sharma
- Johnson & Johnson Innovative Medicine, Spring House, Pennsylvania, PA, 19477, USA
| | - Peter Rigaux
- Janssen Infectious Diseases and Vaccines, 2340, Beerse, Belgium
| | - Zhinan Jin
- Johnson & Johnson Innovative Medicine, Brisbane, CA, 94005, USA.
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Chaiut W, Sapbamrer R, Dacha S, Sudjaritruk T, Malasao R. Epidemiology and associated factors for hospitalization related respiratory syncytial virus infection among children less than 5 years of age in Northern Thailand. J Infect Public Health 2023; 16:1659-1665. [PMID: 37633227 DOI: 10.1016/j.jiph.2023.08.004] [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: 04/24/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is often the main problem in young children that require hospitalization. The objective of this study was to identify factors associated with RSV-related hospitalizations in young children less than five years old. METHODOLOGY A retrospective study was conducted for acute respiratory tract infection (ARTI) at a tertiary care hospital from January 2017 to December 2021 by using binary logistic regression analysis to detect the associated factors with RSV-related hospitalizations in children. RESULTS RSV-related hospitalization was detected in 293 of 410 (71.46 %) cases of RSV infection, most of which appeared in the rainy months of August to November. The most common symptoms and signs were 81.5 % rhinorrhea, 70.7 % cough, 68.5 % sore throat, 68.3 % sputum production, and 66.8 % fever. Factors associated with RSV-related hospitalization were age less than or equal to 2 years (aOR = 4.62, 95 % CI = 1.86-11.44), preterm birth (aOR = 2.61, 95 % CI = 1.05-6.10), patients with underlying disease (aOR = 3.06, 95 % CI = 1.21-10.34), and the presenting symptoms with sputum production (aOR = 16.49, 95 % CI = 3.80-71.55). Laboratory blood tests, low levels of hematocrit (aOR = 9.61, 95 % CI = 1.09-84.49) was the associated factor for hospitalization with RSV infection (p < 0.05). CONCLUSIONS Factors associated with RSV-related hospitalizations in children were age less than or equal to two years, preterm birth, underlying disease, symptoms of sputum production. The low level of hematocrit was also associated with RSV-related hospitalizations in these children.
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Affiliation(s)
- Wilawan Chaiut
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ratana Sapbamrer
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sauwaluk Dacha
- Department of Physical Therapy, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tavitiya Sudjaritruk
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rungnapa Malasao
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
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Targeted Literature Review of the Burden of Respiratory Syncytial Infection among High-Risk and Elderly Patients in Asia Pacific Region. Infect Dis Ther 2023; 12:807-828. [PMID: 36869266 PMCID: PMC10017894 DOI: 10.1007/s40121-023-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION The burden of respiratory syncytial virus (RSV), which causes acute respiratory illness, is well recognized among the pediatric population but also imposes a significant risk to the elderly (age ≥ 60) and those with underlying comorbidities. The study aimed to review the most recent data on epidemiology and burden (clinical and economic) of RSV in the elderly/high-risk populations in China, Japan, South Korea, Taiwan, and Australia. METHODS A targeted review was conducted of English, Japanese, Korean, and Chinese language articles published from 1 January 2010 to 7 October 2020 relevant for the purpose. RESULTS A total of 881 studies were identified, and 41 were included. The median proportion of elderly patients with RSV in all adult patients with acute respiratory infection (ARI) or community acquired pneumonia was 79.78% (71.43-88.12%) in Japan, 48.00% (3.64-80.00%) in China, 41.67% (33.33-50.00%) in Taiwan, 38.61% in Australia, and 28.57% (22.76-33.33%) in South Korea. RSV was associated with a high clinical burden on those patients with comorbidities such as asthma and chronic obstructive pulmonary disease. In China, inpatients with ARI showed a significantly higher rate of RSV-related hospitalization than outpatients (13.22% versus 4.08%, p < 0.01). The median length of hospital stay among elderly patients with RSV was longest in Japan (30 days) and shortest in China (7 days). Mortality data varied by region with some studies reporting rates as high as 12.00% (9/75) in hospitalized elderly patients. Finally, data on the economic burden was only available for South Korea, with the median cost of a medical admission for an elderly patient with RSV being US dollar (USD) 2933. CONCLUSION RSV infection is a major source of disease burden among elderly patients, especially in regions with aging populations. It also complicates the management of those with underlying diseases. Appropriate prevention strategies are required to reduce the burden among the adult, especially the elderly, population. Data gaps regarding economic burden of RSV infection in the Asia Pacific region indicates the need for further research to increase our understanding on the burden of this disease in this region.
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Simões EAF, Madhi SA, Muller WJ, Atanasova V, Bosheva M, Cabañas F, Baca Cots M, Domachowske JB, Garcia-Garcia ML, Grantina I, Nguyen KA, Zar HJ, Berglind A, Cummings C, Griffin MP, Takas T, Yuan Y, Wählby Hamrén U, Leach A, Villafana T. Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:180-189. [PMID: 36634694 PMCID: PMC9940918 DOI: 10.1016/s2352-4642(22)00321-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In a phase 2b trial and the phase 3 MELODY trial, nirsevimab, an extended half-life, monoclonal antibody against respiratory syncytial virus (RSV), protected healthy infants born preterm or at full term against medically attended RSV lower respiratory tract infection (LRTI). In the MEDLEY phase 2-3 trial in infants at higher risk for severe RSV infection, nirsevimab showed a similar safety profile to that of palivizumab. The aim of the current analysis was to assess the efficacy of nirsevimab using a weight-banded dosing regimen in infants born between 29 weeks gestational age and full term. METHODS Infants enrolled in the phase 2b and MELODY trials were randomised (2:1) to receive a single intramuscular injection of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) or placebo before the RSV season. Infants in MEDLEY were randomised (2:1) to receive one dose of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) followed by four monthly placebo doses, or five once-a-month intramuscular doses of palivizumab. We report a prespecified pooled efficacy analysis assessing the weight-banded dosing regimen proposed on the basis of the phase 2b and MELODY trials, in addition to extrapolated efficacy in infants with chronic lung disease, congenital heart disease, or extreme preterm birth (<29 weeks' gestational age) based on pharmacokinetic data from the phase 2-3 MEDLEY safety trial. For the pooled efficacy analysis, the primary endpoint was incidence of medically attended RSV LRTI through 150 days post-dose. The secondary efficacy endpoint was number of admissions to hospital for medically attended RSV LRTI. The incidence of very severe RSV LRTI was an exploratory endpoint, defined as cases of hospital admission for medically attended RSV LRTI that required supplemental oxygen or intravenous fluids. We also did a prespecified exploratory analysis of medically attended LRTI of any cause (in the investigator's judgement) and hospital admission for respiratory illness of any cause (defined as any upper respiratory tract infection or LRTI leading to hospital admission). Post hoc exploratory analyses of outpatient visits and antibiotic use were also done. Nirsevimab serum concentrations in MEDLEY were assessed using population pharmacokinetic methods and the pooled data from the phase 2b and MELODY trials. An exposure target was defined on the basis of an exposure-response analysis. To successfully demonstrate extrapolation, more than 80% of infants in MEDLEY had to achieve serum nirsevimab exposures at or above the predicted efficacious target. FINDINGS Overall, 2350 infants (1564 in the nirsevimab group and 786 in the placebo group) in the phase 2b and MELODY trials were included in the pooled analysis. Nirsevimab showed efficacy versus placebo with respect to the primary endpoint of medically attended RSV LRTI (19 [1%] nirsevimab recipients vs 51 [6%] placebo recipients; relative risk reduction [RRR] 79·5% [95% CI 65·9-87·7]). Consistent efficacy was shown for additional endpoints of RSV LRTI hospital admission (nine [1%] nirsevimab recipients vs 21 [3%] placebo recipients; 77·3% [50·3-89·7]) and very severe RSV (five [<1%] vs 18 [2%]; 86·0% [62·5-94·8]). Nirsevimab recipients had fewer hospital admissions for any-cause respiratory illness (RRR 43·8% [18·8-61·1]), any-cause medically attended LRTI (35·4% [21·5-46·9]), LRTI outpatient visits (41·9% [25·7-54·6]), and antibiotic prescriptions (23·6% [3·8-39·3]). Among infants with chronic lung disease, congenital heart disease, or extreme preterm birth in MEDLEY, nirsevimab serum exposures were similar to those found in the pooled data; exposures were above the target in more than 80% of the overall MEDLEY trial population (94%), including infants with chronic lung disease (94%) or congenital heart disease (80%) and those born extremely preterm (94%). INTERPRETATION A single dose of nirsevimab protected healthy infants born at term or preterm from medically attended RSV LRTI, associated hospital admission, and severe RSV. Pharmacokinetic data support efficacy extrapolation to infants with chronic lung disease, congenital heart disease, or extreme prematurity. Together, these data suggest that nirsevimab has the potential to change the landscape of infant RSV disease by reducing a major cause of infant morbidity and the consequent burden on caregivers, clinicians, and health-care providers. FUNDING AstraZeneca and Sanofi.
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Affiliation(s)
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William J Muller
- Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Miroslava Bosheva
- University Multiprofile Hospital for Active Treatment Sv Georgi Medical University, Plovdiv, Bulgaria
| | | | | | | | | | | | - Kim A Nguyen
- Hospices Civils de Lyon, Neonatal Intensive Care Units and CIC 1407, Lyon, France
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anna Berglind
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Celeste Cummings
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Durham, NC, USA
| | - M Pamela Griffin
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Therese Takas
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Yuan Yuan
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Ulrika Wählby Hamrén
- Clinical Pharmacology and Quantitative Pharmacology, R&D, AstraZeneca, Gothenburg, Sweden
| | - Amanda Leach
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tonya Villafana
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
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Raes M, Daelemans S, Cornette L, Moniotte S, Proesmans M, Schaballie H, Frère J, Vanden Driessche K, Van Brusselen D. The burden and surveillance of RSV disease in young children in Belgium-expert opinion. Eur J Pediatr 2023; 182:451-460. [PMID: 36371521 PMCID: PMC9660201 DOI: 10.1007/s00431-022-04698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED Infections with respiratory syncytial virus (RSV) can cause severe disease. In young children, RSV is the most common cause of lower respiratory tract illness and life-threatening infections most commonly occur in the first years of life. In adults, elderly and immunocompromised people are most vulnerable. Recently there has been an acceleration in the development of candidate RSV vaccines, monoclonal antibodies and therapeutics which are expected to become available in Europe within the next 2-10 years. Understanding the true burden of childhood RSV disease will become very important to support public health authorities and policy makers in the assessment of new therapeutic opportunities against RSV disease. A systematic literature search was performed to map local data on the burden of RSV disease and to evaluate available RSV surveillance systems. A group of 9 paediatric infectious diseases specialists participated in an expert panel. The purpose of this meeting was to evaluate and map the burden associated with RSV infection in children, including patient pathways and the epidemiological patterns of virus circulation in Belgium. Sources of information on the burden of RSV disease in Belgium are very limited. For the outpatient setting, it is estimated that 5-10% of young patients seen in primary care are referred to the hospital. Around 3500 children between 0 and 12 months of age are hospitalized for RSV-bronchiolitis every year and represent the majority of all hospitalizations. The current Belgian RSV surveillance system was evaluated and found to be insufficient. Knowledge gaps are highlighted and future perspectives and priorities offered. CONCLUSION The Belgian population-based RSV surveillance should be improved, and a hospital-led reporting system should be put in place to enable the evaluation of the true burden of RSV disease in Belgium and to improve disease management in the future. WHAT IS KNOWN • RSV bronchiolitis is a very important cause of infant hospitalization. • The burden of disease in the community is poorly studied and underestimated. WHAT IS NEW • This expert opinion summarizes knowledge gaps and offers insights that allow improvement of local surveillance systems in order to establish a future-proof RSV surveillance system.
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Affiliation(s)
- Marc Raes
- Department of Paediatrics, Jessa Hospital, Hasselt, Belgium.
| | - Siel Daelemans
- Paediatric Pulmonary and Infectious Diseases, University Hospital Brussel, Brussels, Belgium
| | - Luc Cornette
- Department of Neonatology, AZ Sint-Jan Hospital, Brugge, Belgium
| | - Stéphane Moniotte
- Department of Paediatric Cardiology, University Hospital Saint-Luc, UCLouvain, Brussels, Belgium
| | - Marijke Proesmans
- Paediatric Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Heidi Schaballie
- Department of Paediatric Pulmonology, Infectious Diseases and Immune Disorders, University Hospital, Ghent, Belgium
| | - Julie Frère
- Department of Paediatrics and Infectious Diseases, University Hospital, Liège, Belgium
| | | | - Daan Van Brusselen
- Department of Paediatric Infectious Diseases, GZA Hospitals, Antwerp, Belgium
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Ghosh A, Annigeri S, Hemram SK, Dey PK, Mazumder S. Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective. Indian J Crit Care Med 2022; 26:1210-1217. [PMID: 36873591 PMCID: PMC9983658 DOI: 10.5005/jp-journals-10071-24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The objective was to delineate the clinico-epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRI) during its recent outbreak and to find out the independent predictors of pediatric intensive care unit (PICU) admission. Materials and methods Children aged between 1 month and 12 years who tested positive for RSV were included. Multivariate analysis was performed to identify the independent predictors and predictive scores were developed from the β-coefficients. Receiver operating characteristic curve (ROC) was generated and the area under the curve (AUC) was calculated to assess the overall precision. The performance of sum scores in predicting PICU need, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-) were calculated for each cutoff value. Results The proportion of RSV positivity was 72.58%. A total of 127 children were included with a median [interquartile range (IQR)] age of 6 (2-12) months, of whom 61.42% were males and 33.07% had underlying comorbidity. Tachypnea, cough, rhinorrhea, and fever were predominant clinical presentations while hypoxia and extrapulmonary manifestations were present in 30.71% and 14.96% of children, respectively. About 30% required PICU admission, and 24.41% developed complications. Premature birth, age below 1 year, presence of underlying CHD, and hypoxia were independent predictors. The AUC [95% confidence interval (CI)] was 0.869 (0.843-0.935). Sum score below 4 had 97.3% sensitivity and 97.1% NPV whereas sum score above 6 had 98.9% specificity, 89.7% PPV, 81.3% NPV, 46.2 LR+, and 0.83 LR- to predict PICU needs. Conclusion Awareness of these independent predictors and application of the novel scoring system will be beneficial for busy clinicians in planning the level of care needed, thereby optimizing PICU resource utilization. How to cite this article Ghosh A, Annigeri S, Hemram SK, Dey PK, Mazumder S. Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective. Indian J Crit Care Med 2022;26(11):1210-1217.
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Affiliation(s)
- Arindam Ghosh
- Department of Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Saba Annigeri
- Department of Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Sunil Kumar Hemram
- Department of Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Pranab Kumar Dey
- Department of Paediatrics, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sangita Mazumder
- Department of Community Medicine, Medical College Kolkata, Kolkata, West Bengal, India
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Rodriguez-Martinez CE, Barbosa-Ramirez J, Acuña-Cordero R. Predictors of poor outcomes of respiratory syncytial virus acute lower respiratory infections in children under 5 years of age in a middle-income tropical country based on the National Public Health Surveillance System. Pediatr Pulmonol 2022; 57:1188-1195. [PMID: 35182056 DOI: 10.1002/ppul.25866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of the present study is to gain insight into the identification of region-specific factors associated with poor outcomes in children under 5 years of age with confirmed respiratory syncytial virus acute lower respiratory infection (RSV-ALRI) living in Colombia, a middle-income country, based on the National Public Health Surveillance System of the country. METHODS An analytical cross-sectional study was conducted using epidemiological data from the records of morbidity and mortality of respiratory infections as registered in the surveillance system report of the National Institute of Health of Colombia 2018, including children under 5 years of age with confirmed RSV-ALRI. Predictor variables included demographic and clinical variables, as well as variables measured after hospital attendance. Outcome variables analyzed were respiratory failure, the need for pediatric intensive care unit admission, and mortality. RESULTS Of a total of 8470 patients with a diagnosis of ALRI, we selected 1215 (14.3%) that were under 5 years of age and were positive for RSV. After controlling for potential confounders, it was found that age, gender, socioeconomic stratum, incomplete pneumococcal conjugate vaccine 13 immunization for age, cardiac disease, and malnutrition as comorbidities, chest X-ray findings, and development of sepsis independently predicted poor outcomes among the patients analyzed. CONCLUSIONS The identified predictors for poor outcomes in RSV-affected children may be helpful for guiding efficient and targeted national and/or regional programs and public policies to assist in achieving Goal 3 of the Sustainable Development Goals adopted by the United Nations in 2015.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | | | - Ranniery Acuña-Cordero
- Departamento de Neumologia Pediatrica, Hospital Militar Central, Bogota, Colombia.,Departamento de Pediatria, Facultad de Medicina, Universidad Militar Nueva Granada, Bogota, Colombia
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Hartmann K, Liese JG, Kemmling D, Prifert C, Weißbrich B, Thilakarathne P, Diels J, Weber K, Streng A. Clinical Burden of Respiratory Syncytial Virus in Hospitalized Children Aged ≤5 years (INSPIRE Study). J Infect Dis 2022; 226:386-395. [PMID: 35417015 PMCID: PMC9417125 DOI: 10.1093/infdis/jiac137] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of hospitalizations in children (≤5 years of age); limited data compare burden by age. Methods This single-center retrospective study included children (≤5 years of age) hospitalized for >24 hours with reverse-transcription polymerase chain reaction (RT-PCR)–confirmed RSV infection (2015–2018). Hospital length of stay (LOS), intensive care unit (ICU) admissions, ICU LOS, supplemental oxygen, and medication use were assessed. Multivariate logistic regression analyses identified predictors of hospital LOS >5 days. Results Three hundred twelve patients had RSV infection (ages 0 to <6 months [35%], 6 to <12 months [15%], 1 to <2 years [25%], and 2–5 years [25%]); 16.3% had predefined comorbidities (excludes preterm infants). Median hospital LOS was 5.0 days and similar across age; 5.1% (16/312) were admitted to ICU (ICU LOS, 5.0 days), with those aged 0 to <6 months admitted most frequently (10/108 [9.3%]). Supplemental oxygen was administered in 57.7% of patients, with similar need across ages. Antibiotics were administered frequently during hospitalization (43.6%). Predictors of prolonged LOS included pneumonia (odds ratio [OR], 2.33), supplemental oxygen need (OR, 5.09), and preterm births (OR, 3.37). High viral load (RT-PCR RSV cycle threshold value <25) was associated with greater need for supplemental oxygen. Conclusions RSV causes substantial burden in hospitalized children (≤5 years), particularly preterm infants and those aged <6 months.
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Affiliation(s)
- Katrin Hartmann
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Christiane Prifert
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Benedikt Weißbrich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | | | | | - Karin Weber
- Global Medical Affairs, IDV, Janssen-Cilag, Vienna, Austria
| | - Andrea Streng
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
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Palmer GM, Kooima TR, Van Hove CM, Withrow LL, Gurumoorthy A, Lopez SMC. Disparities in Outcomes During Lower Respiratory Tract Infection in American Indian Children: A 9-Year Retrospective Analysis in a Rural Population in South Dakota. Pediatr Infect Dis J 2022; 41:205-210. [PMID: 34817412 DOI: 10.1097/inf.0000000000003406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND American Indian (AI) children are at increased risk for severe disease during lower respiratory tract infection (LRTI). The reasons for this increased severity are poorly understood. The objective of this study was to define the clinical presentations of LRTI and highlight the differences between AI and non-AI previously healthy patients under the age of 24 months. METHODS We performed a retrospective chart review between October 2010 and December 2019. We reviewed 1245 patient charts and 691 children met inclusion criteria for this study. Data records included demographics, clinical, laboratory data, and illness outcomes. RESULTS Of 691 patients, 120 were AI and 571 were non-AI. There was a significant difference in breast-feeding history (10% of AI vs. 28% of non-AI, P < 0.0001) and in secondhand smoke exposure (37% of AI vs. 21% of non-AI, P < 0.0001). AI children had increased length of hospitalization compared with non-AI children (median of 3 vs. 2 days, P < 0.001). In addition, AI children had higher rates of pediatric intensive unit admission (30%, n = 37) compared with non-AI children (11%; n = 67, P < 0.01). AI children also had higher rates (62.5%, n = 75) and duration of oxygen supplementation (median 3 days) than non-AI children (48%, n = 274, P = 0.004; median 2 days, P = 0.0002). On a multivariate analysis, AI race was an independent predictor of severe disease during LRTI. CONCLUSIONS AI children have increased disease severity during LRTI with longer duration of hospitalization and oxygen supplementation, a higher rate of oxygen requirement and Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation pediatric intensive care unit admissions, and a greater need for mechanical ventilation. These results emphasize the need for improvement in health policies and access to health care in this vulnerable population.
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Affiliation(s)
- Geralyn M Palmer
- From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Travis R Kooima
- From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Christopher M Van Hove
- From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Landon L Withrow
- From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Aarabhi Gurumoorthy
- Research Design and Biostatistics Core, Sanford Research Center, Sioux Falls, SD
| | - Santiago M C Lopez
- From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
- Sanford Research Center, Environmental Influences on Health and Disease Group, Sioux Falls, SD
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Bronchiolitis and Noninvasive Ventilation. Once Again Time to Review…. Crit Care Med 2021; 49:2164-2166. [PMID: 34793386 DOI: 10.1097/ccm.0000000000005321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Forman LS, Macleod W, Mwananyanda L, Kwenda G, Pieciak R, Mupila Z, Murphy C, Thea D, Chikoti C, Yankonde B, Ngoma B, Chimoga C, Gill CJ. Association of Respiratory Syncytial Virus Infection and Underlying Risk Factors for Death Among Young Infants Who Died at University Teaching Hospital, Lusaka Zambia. Clin Infect Dis 2021; 73:S180-S186. [PMID: 34472569 PMCID: PMC8411249 DOI: 10.1093/cid/ciab466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections and child mortality. While RSV disease burden is highest in low- and middle-income countries, most knowledge about risk factors for fatal RSV disease comes from high-income settings. Methods Among infants aged 4 days to <6 months who died at University Teaching Hospital in Lusaka, Zambia, we tested nasopharyngeal swabs obtained postmortem for RSV using reverse transcriptase–quantitative polymerase chain reaction. Through a systematic review of death certificates and hospital records, we identified 10 broad categories of underlying medical conditions associated with infant deaths. We used backward-selection models to calculate adjusted and unadjusted risk ratios (RRs) for the association between each underlying condition and RSV status. Results From 720 infant deaths, 6% (44) were RSV-positive, 70% were <4 weeks old, and 54% were male. At least 1 underlying condition was found in 85% of infants, while 63% had ≥2. Prematurity/low birth weight (53% [384]) and complications of labor and delivery (32% [230]) were the most common conditions. Congenital cardiac conditions were significantly associated with an increased risk of RSV infection (4%, 32; adjusted RR: 3.57; 95% CI: 1.71–7.44). No other underlying conditions were significantly associated with RSV. Conclusions Other than congenital cardiac conditions, we found a lack of association between RSV and underlying risk factors. This differs from high-income settings, where RSV mortality is concentrated among high-risk infants. In this population, birth-related outcomes are the highest mortality risk factors. Improved neonatal care remains crucial in the fight against neonatal mortality.
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Affiliation(s)
- Leah S Forman
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston, Massachusetts, USA
| | - William Macleod
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.,Right to Care-Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- School of Health Sciences, Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | - Rachel Pieciak
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | | | | | - Donald Thea
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | | | | | | | | | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
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Cyclophilin A Inhibits Human Respiratory Syncytial Virus (RSV) Replication by Binding to RSV-N through Its PPIase Activity. J Virol 2021; 95:e0056321. [PMID: 34011546 PMCID: PMC8274602 DOI: 10.1128/jvi.00563-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human respiratory syncytial virus (hRSV) is the most common pathogen which causes acute lower respiratory infection (ALRI) in infants. Recently, virus-host interaction has become a hot spot of virus-related research, and it needs to be further elaborated for RSV infection. In this study, we found that RSV infection significantly increased the expression of cyclophilin A (cypA) in clinical patients, mice, and epithelial cells. Therefore, we evaluated the function of cypA in RSV replication and demonstrated that virus proliferation was accelerated in cypA knockdown host cells but restrained in cypA-overexpressing host cells. Furthermore, we proved that cypA limited RSV replication depending on its PPIase activity. Moreover, we performed liquid chromatography-mass spectrometry, and the results showed that cypA could interact with several viral proteins, such as RSV-N, RSV-P, and RSV-M2-1. Finally, the interaction between cypA and RSV-N was certified by coimmunoprecipitation and immunofluorescence. Those results provided strong evidence that cypA may play an inhibitory role in RSV replication through interaction with RSV-N via its PPIase activity. IMPORTANCE RSV-N, packed in the viral genome to form the ribonucleoprotein (RNP) complex, which is recognized by the RSV RNA-dependent RNA polymerase (RdRp) complex to initiate viral replication and transcription, plays an indispensable role in the viral biosynthesis process. cypA, binding to RSV-N, may impair this function by weakening the interaction between RSV-N and RSV-P, thus leading to decreased viral production. Our research provides novel insight into cypA antiviral function, including binding to viral capsid protein to inhibit viral replication, which may be helpful for new antiviral drug exploration.
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Saragovi A, Abramovich I, Omar I, Arbib E, Toker O, Gottlieb E, Berger M. Systemic hypoxia inhibits T cell response by limiting mitobiogenesis via matrix substrate-level phosphorylation arrest. eLife 2020; 9:56612. [PMID: 33226340 PMCID: PMC7728436 DOI: 10.7554/elife.56612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022] Open
Abstract
Systemic oxygen restriction (SOR) is prevalent in numerous clinical conditions, including chronic obstructive pulmonary disease (COPD), and is associated with increased susceptibility to viral infections. However, the influence of SOR on T cell immunity remains uncharacterized. Here we show the detrimental effect of hypoxia on mitochondrial-biogenesis in activated mouse CD8+ T cells. We find that low oxygen level diminishes CD8+ T cell anti-viral response in vivo. We reveal that respiratory restriction inhibits ATP-dependent matrix processes that are critical for mitochondrial-biogenesis. This respiratory restriction-mediated effect could be rescued by TCA cycle re-stimulation, which yielded increased mitochondrial matrix-localized ATP via substrate-level phosphorylation. Finally, we demonstrate that the hypoxia-arrested CD8+ T cell anti-viral response could be rescued in vivo through brief exposure to atmospheric oxygen pressure. Overall, these findings elucidate the detrimental effect of hypoxia on mitochondrial-biogenesis in activated CD8+ T cells, and suggest a new approach for reducing viral infections in COPD.
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Affiliation(s)
- Amijai Saragovi
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel
| | - Ifat Abramovich
- The Ruth and Bruce Rappaport, Faculty of Medicine, Technion - Israel Institute of Technology, Jerusalem, Israel
| | - Ibrahim Omar
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel
| | - Eliran Arbib
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel
| | - Ori Toker
- Faculty of Medicine, Hebrew University of Jerusalem; The Allergy and Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eyal Gottlieb
- The Ruth and Bruce Rappaport, Faculty of Medicine, Technion - Israel Institute of Technology, Jerusalem, Israel
| | - Michael Berger
- The Lautenberg center for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem, Israel
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