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García M, Carrasco García A, Weigel W, Christ W, Lira-Junior R, Wirth L, Tauriainen J, Maleki K, Vanoni G, Vaheri A, Mäkelä S, Mustonen J, Nordgren J, Smed-Sörensen A, Strandin T, Mjösberg J, Klingström J. Innate lymphoid cells are activated in HFRS, and their function can be modulated by hantavirus-induced type I interferons. PLoS Pathog 2024; 20:e1012390. [PMID: 39038044 DOI: 10.1371/journal.ppat.1012390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024] Open
Abstract
Hantaviruses cause the acute zoonotic diseases hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Infected patients show strong systemic inflammation and immune cell activation. NK cells are highly activated in HFRS, suggesting that also other innate lymphoid cells (ILCs) might be responding to infection. Here, we characterized peripheral ILC responses, and measured plasma levels of soluble factors and plasma viral load, in 17 Puumala virus (PUUV)-infected HFRS patients. This revealed an increased frequency of ILC2 in patients, in particular the ILC2 lineage-committed c-Kitlo ILC2 subset. Patients' ILCs showed an activated profile with increased proliferation and displayed altered expression of several homing markers. How ILCs are activated during viral infection is largely unknown. When analyzing PUUV-mediated activation of ILCs in vitro we observed that this was dependent on type I interferons, suggesting a role for type I interferons-produced in response to virus infection-in the activation of ILCs. Further, stimulation of naïve ILC2s with IFN-β affected ILC2 cytokine responses in vitro, causing decreased IL-5 and IL-13, and increased IL-10, CXCL10, and GM-CSF secretion. These results show that ILCs are activated in HFRS patients and suggest that the classical antiviral type I IFNs are involved in shaping ILC functions.
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Affiliation(s)
- Marina García
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Carrasco García
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Whitney Weigel
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Wanda Christ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ronaldo Lira-Junior
- Section of Oral Diagnostics and Surgery, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lorenz Wirth
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Mechanistic & Structural Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Johanna Tauriainen
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kimia Maleki
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Vanoni
- Institut Curie, PSL University, Inserm, Immunity and Cancer, Paris, France
| | - Antti Vaheri
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johan Nordgren
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna Smed-Sörensen
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Strandin
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Mjösberg
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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2
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Peralta Alvarez MP, Jones H, Redondo Azema H, Davis C, White AD, Sarfas C, Dennis M, Li S, Wright D, Puentes E, Kimuda S, Belij-Rammerstorfer S, Aguilo N, Martin C, Sharpe S, McShane H, Tanner R. Low-dose M.tb infection but not BCG or MTBVAC vaccination enhances heterologous antibody titres in non-human primates. Front Immunol 2024; 15:1387454. [PMID: 38799468 PMCID: PMC11116990 DOI: 10.3389/fimmu.2024.1387454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Mycobacteria are known to exert a range of heterologous effects on the immune system. The mycobacteria-based Freund's Complete Adjuvant is a potent non-specific stimulator of the immune response used in immunization protocols promoting antibody production, and Mycobacterium bovis Bacille Calmette Guérin (BCG) vaccination has been linked with decreased morbidity and mortality beyond the specific protection it provides against tuberculosis (TB) in some populations and age groups. The role of heterologous antibodies in this phenomenon, if any, remains unclear and under-studied. Methods We set out to evaluate antibody responses to a range of unrelated pathogens following infection with Mycobacterium tuberculosis (M.tb) and vaccination with BCG or a candidate TB vaccine, MTBVAC, in non-human primates. Results We demonstrate a significant increase in the titer of antibodies against SARS-CoV-2, cytomegalovirus, Epstein-Barr virus, tetanus toxoid, and respiratory syncytial virus antigens following low-dose aerosol infection with M.tb. The magnitude of some of these responses correlated with TB disease severity. However, vaccination with BCG administered by the intradermal, intravenous or aerosol routes, or intradermal delivery of MTBVAC, did not increase antibody responses against unrelated pathogens. Discussion Our findings suggest that it is unlikely that heterologous antibodies contribute to the non-specific effects of these vaccines. The apparent dysregulation of B cell responses associated with TB disease warrants further investigation, with potential implications for risk of B cell cancers and novel therapeutic strategies.
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Affiliation(s)
| | - Holly Jones
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hugo Redondo Azema
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Chloe Davis
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Andrew D. White
- United Kingdom (UK) Health Security Agency, Salisbury, United Kingdom
| | - Charlotte Sarfas
- United Kingdom (UK) Health Security Agency, Salisbury, United Kingdom
| | - Mike Dennis
- United Kingdom (UK) Health Security Agency, Salisbury, United Kingdom
| | - Shuailin Li
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniel Wright
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Eugenia Puentes
- Clinical Research Department y Research and Development Department, Biofabri, Grupo Zendal, Pontevedra, Spain
| | - Simon Kimuda
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, London, United Kingdom
| | | | - Nacho Aguilo
- University of Zaragoza, Spanish Network for Research on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martin
- University of Zaragoza, Spanish Network for Research on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sally Sharpe
- United Kingdom (UK) Health Security Agency, Salisbury, United Kingdom
| | - Helen McShane
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rachel Tanner
- Department of Biology, University of Oxford, Oxford, United Kingdom
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3
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Quan C, Liu Q, Yu L, Li C, Nie K, Ding G, Zhou H, Wang X, Sun W, Wang H, Yue M, Wei L, Zheng W, Lyu Q, Xing W, Zhang Z, Carr MJ, Zhang H, Shi W. SFTSV infection is associated with transient overproliferation of monoclonal lambda-type plasma cells. iScience 2023; 26:106799. [PMID: 37250798 PMCID: PMC10212991 DOI: 10.1016/j.isci.2023.106799] [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] [Received: 10/08/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
The impairment of antibody-mediated immunity is a major factor associated with fatal cases of severe fever with thrombocytopenia syndrome (SFTS). By collating the clinical diagnosis reports of 30 SFTS cases, we discovered the overproliferation of monoclonal plasma cells (MCP cells, CD38+cLambda+cKappa-) in bone marrow, which has only been reported previously in multiple myeloma. The ratio of CD38+cLambda+ versus CD38+cKappa+ in SFTS cases with MCP cells was significantly higher than that in normal cases. MCP cells presented transient expression in the bone marrow, which was distinctly different from multiple myeloma. Moreover, the SFTS patients with MCP cells had higher clinical severity. Further, the overproliferation of MCP cells was also observed in SFTS virus (SFTSV)-infected mice with lethal infectious doses. Together, SFTSV infection induces transient overproliferation of monoclonal lambda-type plasma cells, which have important implications for the study of SFTSV pathogenesis, prognosis, and the rational development of therapeutics.
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Affiliation(s)
- Chuansong Quan
- Department of Infectious Disease, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qinghua Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Lijuan Yu
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Chunjing Li
- Department of Hematology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Kaixiao Nie
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Guoyong Ding
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji’nan 250117, China
| | - Hong Zhou
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Xinli Wang
- Department of Pathology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Wenwen Sun
- Department of Pathology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Huiliang Wang
- Department of Infectious Disease, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Maokui Yue
- Department of Critical Care Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Li Wei
- Department of Respiratory Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Wenjun Zheng
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qiang Lyu
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji’nan 250117, China
| | - Weijia Xing
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji’nan 250117, China
| | - Zhenjie Zhang
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Michael J. Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin 4, Ireland
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, N20 W10 Kita-ku, Sapporo 001-0020, Japan
| | - Hong Zhang
- Department of Infectious Disease, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
- Department of Hematology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Weifeng Shi
- Key Laboratory of Emerging Infectious Diseases in Universities of Shandong, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji’nan 250117, China
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4
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Nguyen DC, Lamothe PA, Woodruff MC, Saini AS, Faliti CE, Sanz I, Lee FE. COVID-19 and plasma cells: Is there long-lived protection? Immunol Rev 2022; 309:40-63. [PMID: 35801537 PMCID: PMC9350162 DOI: 10.1111/imr.13115] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infection with SARS-CoV-2, the etiology of the ongoing COVID-19 pandemic, has resulted in over 450 million cases with more than 6 million deaths worldwide, causing global disruptions since early 2020. Memory B cells and durable antibody protection from long-lived plasma cells (LLPC) are the mainstay of most effective vaccines. However, ending the pandemic has been hampered by the lack of long-lived immunity after infection or vaccination. Although immunizations offer protection from severe disease and hospitalization, breakthrough infections still occur, most likely due to new mutant viruses and the overall decline of neutralizing antibodies after 6 months. Here, we review the current knowledge of B cells, from extrafollicular to memory populations, with a focus on distinct plasma cell subsets, such as early-minted blood antibody-secreting cells and the bone marrow LLPC, and how these humoral compartments contribute to protection after SARS-CoV-2 infection and immunization.
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Affiliation(s)
- Doan C. Nguyen
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Pedro A. Lamothe
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Matthew C. Woodruff
- Division of Rheumatology, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
- Emory Autoimmunity Center of ExcellenceEmory UniversityAtlantaGeorgiaUSA
- Lowance Center for Human ImmunologyEmory UniversityAtlantaGeorgiaUSA
| | - Ankur S. Saini
- Division of Rheumatology, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
- Emory Autoimmunity Center of ExcellenceEmory UniversityAtlantaGeorgiaUSA
- Lowance Center for Human ImmunologyEmory UniversityAtlantaGeorgiaUSA
| | - Caterina E. Faliti
- Division of Rheumatology, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
- Lowance Center for Human ImmunologyEmory UniversityAtlantaGeorgiaUSA
| | - Ignacio Sanz
- Division of Rheumatology, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
- Emory Autoimmunity Center of ExcellenceEmory UniversityAtlantaGeorgiaUSA
- Lowance Center for Human ImmunologyEmory UniversityAtlantaGeorgiaUSA
| | - Frances Eun‐Hyung Lee
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of MedicineEmory UniversityAtlantaGeorgiaUSA
- Lowance Center for Human ImmunologyEmory UniversityAtlantaGeorgiaUSA
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5
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Silveira CGT, Magnani DM, Costa PR, Avelino-Silva VI, Ricciardi MJ, Timenetsky MDCST, Goulart R, Correia CA, Marmorato MP, Ferrari L, Nakagawa ZB, Tomiyama C, Tomiyama H, Kalil J, Palacios R, Precioso AR, Watkins DI, Kallás EG. Plasmablast Expansion Following the Tetravalent, Live-Attenuated Dengue Vaccine Butantan-DV in DENV-Naïve and DENV-Exposed Individuals in a Brazilian Cohort. Front Immunol 2022; 13:908398. [PMID: 35837409 PMCID: PMC9274664 DOI: 10.3389/fimmu.2022.908398] [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: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
An effective vaccine against the dengue virus (DENV) should induce a balanced, long-lasting antibody (Ab) response against all four viral serotypes. The burst of plasmablasts in the peripheral blood after vaccination may reflect enriched vaccine-specific Ab secreting cells. Here we characterize the acute plasmablast responses from naïve and DENV-exposed individuals following immunization with the live attenuated tetravalent (LAT) Butantan DENV vaccine (Butantan-DV). The frequency of circulating plasmablasts was determined by flow cytometric analysis of fresh whole blood specimens collected from 40 participants enrolled in the Phase II Butantan-DV clinical trial (NCT01696422) before and after (days 6, 12, 15 and 22) vaccination. We observed a peak in the number of circulating plasmablast at day 15 after vaccination in both the DENV naïve and the DENV-exposed vaccinees. DENV-exposed vaccinees experienced a significantly higher plasmablast expansion. In the DENV-naïve vaccinees, plasmablasts persisted for approximately three weeks longer than among DENV-exposed volunteers. Our findings indicate that the Butantan-DV can induce plasmablast responses in both DENV-naïve and DENV-exposed individuals and demonstrate the influence of pre-existing DENV immunity on Butantan DV-induced B-cell responses.
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Affiliation(s)
- Cássia G. T. Silveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diogo M. Magnani
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Priscilla R. Costa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vivian I. Avelino-Silva
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Michael J. Ricciardi
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Raphaella Goulart
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carolina A. Correia
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mariana P. Marmorato
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lilian Ferrari
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Zelinda B. Nakagawa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudia Tomiyama
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Helena Tomiyama
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Palacios
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Alexander R. Precioso
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
- Pediatrics Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - David I. Watkins
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Esper G. Kallás
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
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6
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Liu Z, Li X, Fan N, Wang H, Xia W, Li W, Tang S, Zhou X, Wu Y, Zou L, Li J, Zhang J. Increased Circulating PD-1 hi CXCR5 - Peripheral T Helper Cells are Associated with Disease Activity of ANCA-Associated Vasculitis. Clin Exp Immunol 2022; 207:uxac002. [PMID: 35022684 PMCID: PMC9113185 DOI: 10.1093/cei/uxac002] [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: 07/31/2021] [Revised: 12/22/2021] [Accepted: 01/09/2022] [Indexed: 01/14/2023] Open
Abstract
Newly identified PD-1 hiCXCR5 -CD4 + T cells, termed as peripheral helper T cells (Tph), have been found elevated and playing pathogenic role in some autoimmune diseases like systemic lupus erythematosus (SLE) and rheumatic arthritis (RA). However, the potential role of Tph cells in Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains unclear. Here, we explored the potential clinical significance of circulating Tph cells in the pathogenesis of AAV. Comparing 32 active AAV patients and 18 age- and sex-matched healthy controls (HCs), we found that the frequency of circulating Tph cells was significantly expanded in active AAV patients. Besides, programmed death 1 (PD-1) expression on the surface of Tph cells was significantly up-regulated in active AAV patients. Importantly, the frequency of circulating Tph cells was greatly decreased in AAV patients after receiving treatment. Tph cells frequency was positively correlated with the Birmingham Vasculitis Activity Score (BVAS), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil lymphocyte ratio (NLR) and cellular crescent in active AAV patients, but negatively correlated with fibrosus crescent. Tph cells frequency was also positively correlated with naïve B cells, serum concentration of MPO-ANCAs, serum tumor necrosis factor-α (TNF-α), IL-4, IL-21 and IL-12. However, serum IL-10 exhibited negative correlation with circulating Tph cells in active AAV patients. These results demonstrated that circulating Tph cells are greatly expanded in active AAV patients and are positively associated with serum MPO-ANCAs and disease activity, thus contributing to the pathogenesis of AAV.
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Affiliation(s)
- Zhenyu Liu
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Xueqin Li
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Ningning Fan
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Hong Wang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Wenli Xia
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Wenjie Li
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Sha Tang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Xinyuan Zhou
- Department of Immunology, Third Military Medical University, Chongqing, PR China
| | - Yuzhang Wu
- Department of Immunology, Third Military Medical University, Chongqing, PR China
| | - Liyun Zou
- Department of Immunology, Third Military Medical University, Chongqing, PR China
| | - Jingyi Li
- Department of Rheumatology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
| | - Jingbo Zhang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
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7
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Delayed viral clearance despite high number of activated T cells during the acute phase in Argentinean patients with hantavirus pulmonary syndrome. EBioMedicine 2022; 75:103765. [PMID: 34986457 PMCID: PMC8743200 DOI: 10.1016/j.ebiom.2021.103765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 01/16/2023] Open
Abstract
Background The hallmarks of HPS are increase of vascular permeability and endothelial dysfunction. Although an exacerbated immune response is thought to be implicated in pathogenesis, clear evidence is still elusive. As orthohantaviruses are not cytopathic CD8+ T cells are believed to be the central players involved in pathogenesis. Methods Serum and blood samples from Argentinean HPS patients were collected from 2014 to 2019. Routine white blood cell analyses, quantification and characterization of T-cell phenotypic profile, viral load, neutralizing antibody response and quantification of inflammatory mediators were performed. Findings High numbers of activated CD4+ and CD8+ T cells were found in all HPS cases independently of disease severity. We found increased levels of some proinflammatory mediators during the acute phase of illness. Nonetheless, viral RNA remained high, showing a delay in clearance from blood up to late convalescence, when titers of neutralizing antibodies reached a high level. Interpretation The high activated phenotypic profile of T cells seems to be unable to resolve infection during the acute and early convalescent phases, and it was not associated with the severity of the disease. Thus, at least part of the activated T cells could be induced by the dysregulated inflammatory response in an unspecific manner. Viral clearance seems to have been more related to high titers of neutralizing antibodies than to the T-cell response. Funding This work was supported mainly by the Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos Malbrán”. Further details of fundings sources is included in the appendix.
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8
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Silveira ELV, Hong JJ, Amancha PK, Rogers KA, Ansari AA, Byrareddy SN, Villinger F. Viremia controls Env-specific antibody-secreting cell responses in simian immunodeficiency virus infected macaques pre and post-antiretroviral therapy. AIDS 2021; 35:2085-2094. [PMID: 34148985 PMCID: PMC8490307 DOI: 10.1097/qad.0000000000002998] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the kinetics of Env (gp140)-specific antibody-secreting cells (ASCs) during acute and early chronic simian immunodeficiency virus (SIV) infection, and prior to and postantiretroviral therapy (ART) in rhesus macaques. DESIGN AND METHODS At week 0, rhesus macaques were inoculated intravenously with SIVmac239 and the viral loads were allowed to develop. Daily ART was initiated at week 5 post infection until week 18, though the animals were monitored until week 28 for the following parameters: enumeration of SIV gp140-specific ASCs by ELISPOT; quantification of viremia and SIV gp140-specific IgG titres through qRT-PCR and ELISA, respectively; estimation of monocytes, follicular helper T cells (Tfh) and memory B cell frequencies using polychromatic flow cytometry. RESULTS Direct correlations were consistently found between blood SIV gp140-specific ASC responses and viremia or SIV Env-specific IgG titres. In contrast, SIV gp140-specific ASC responses showed inverse correlations with the percentage of total memory B cells in the blood. In lymph nodes, the magnitude of the SIV gp140-specific ASC responses also followed the viral load kinetics. In contrast, the number of SIV gp140-specific ASCs presented did not correlate with frequencies of circulating activated monocyte (CD14+CD16+) or Tfh cells. CONCLUSION Blood and/or lymph node viral loads may regulate the onset and magnitude of SIV gp140-specific ASCs during SIV infection and following ART in rhesus macaques.
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Affiliation(s)
- Eduardo L. V. Silveira
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
| | - Jung Joo Hong
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
| | - Praveen K. Amancha
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
| | - Kenneth A Rogers
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
| | - Aftab A. Ansari
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322 – USA
| | - Siddappa N. Byrareddy
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322 – USA
| | - Francois Villinger
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329 - USA
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9
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In Vitro Generation of Human Antibody-Secreting Cells Through the Stimulation of PBMCs with Dengue Virus Particles. Methods Mol Biol 2021. [PMID: 34709646 DOI: 10.1007/978-1-0716-1879-0_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
The Dengue pathophysiology has had several aspects determined over the years. However, some points remain elusive, such as the metabolic factors that regulate the massive B cell differentiation into antibody-secreting cells observed in Dengue patients. In this chapter, we describe an in vitro method capable of mimicking this Dengue-induced cell expansion. More specifically, this approach allows dengue virus-stimulated peripheral blood mononuclear cells (PBMCs) from healthy individuals to enhance the frequency of phenotypical and functional antibody-secreting cells (ASCs) after 7 days of culture. A manuscript recently published by Bonezi and colleagues displays results generated through this methodology.
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10
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Hantavirus infection-induced B cell activation elevates free light chains levels in circulation. PLoS Pathog 2021; 17:e1009843. [PMID: 34379707 PMCID: PMC8382192 DOI: 10.1371/journal.ppat.1009843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/23/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
In humans, orthohantaviruses can cause hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). An earlier study reported that acute Andes virus HPS caused a massive and transient elevation in the number of circulating plasmablasts with specificity towards both viral and host antigens suggestive of polyclonal B cell activation. Immunoglobulins (Igs), produced by different B cell populations, comprise heavy and light chains; however, a certain amount of free light chains (FLCs) is constantly present in serum. Upregulation of FLCs, especially clonal species, associates with renal pathogenesis by fibril or deposit formations affecting the glomeruli, induction of epithelial cell disorders, or cast formation in the tubular network. We report that acute orthohantavirus infection increases the level of Ig FLCs in serum of both HFRS and HPS patients, and that the increase correlates with the severity of acute kidney injury in HFRS. The fact that the kappa to lambda FLC ratio in the sera of HFRS and HPS patients remained within the normal range suggests polyclonal B cell activation rather than proliferation of a single B cell clone. HFRS patients demonstrated increased urinary excretion of FLCs, and we found plasma cell infiltration in archival patient kidney biopsies that we speculate to contribute to the observed FLC excreta. Analysis of hospitalized HFRS patients’ peripheral blood mononuclear cells showed elevated plasmablast levels, a fraction of which stained positive for Puumala virus antigen. Furthermore, B cells isolated from healthy donors were susceptible to Puumala virus in vitro, and the virus infection induced increased production of Igs and FLCs. The findings propose that hantaviruses directly activate B cells, and that the ensuing intense production of polyclonal Igs and FLCs may contribute to acute hantavirus infection-associated pathological findings. Orthohantaviruses are globally spread zoonotic pathogens, which can cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) with significant burden to human health. The pathogenesis mechanisms of orthohantavirus-caused diseases are not known in detail; however, excessive immune response towards the virus with concomitant pathological effects against host tissues appears to be a contributing factor. Here we report an increase of free immunoglobulin (Ig) light chains (FLCs), components required to make complete Ig molecules, in blood of acute HFRS and HPS. Samples collected during acute HFRS demonstrated increased FLCs levels in the urine and blood of patients hospitalized due the disease. Furthermore, the FLC levels positively correlated with markers of acute kidney injury. In addition, our results show that orthohantaviruses can infect and activate B cells to produce FLCs as well as whole Igs, which provides a mechanistic explanation of the increased FLC levels in patients. Taken together, our results suggest that aberrant antibody responses might play a role in the pathogenesis of orthohantavirus infections.
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11
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Kerkman PF, Dernstedt A, Tadala L, Mittler E, Dannborg M, Sundling C, Maleki KT, Tauriainen J, Tuiskunen‐Bäck A, Wigren Byström J, Ocaya P, Thunberg T, Jangra RK, Román‐Sosa G, Guardado‐Calvo P, Rey FA, Klingström J, Chandran K, Puhar A, Ahlm C, Forsell MNE. Generation of plasma cells and CD27 -IgD - B cells during hantavirus infection is associated with distinct pathological findings. Clin Transl Immunology 2021; 10:e1313. [PMID: 34277007 PMCID: PMC8275445 DOI: 10.1002/cti2.1313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Human hantavirus infections can cause haemorrhagic fever with renal syndrome (HFRS). The pathogenic mechanisms are not fully understood, nor if they affect the humoral immune system. The objective of this study was to investigate humoral immune responses to hantavirus infection and to correlate them to the typical features of HFRS: thrombocytopenia and transient kidney dysfunction. METHODS We performed a comprehensive characterisation of longitudinal antiviral B-cell responses of 26 hantavirus patients and combined this with paired clinical data. In addition, we measured extracellular adenosine triphosphate (ATP) and its breakdown products in circulation and performed in vitro stimulations to address its effect on B cells. RESULTS We found that thrombocytopenia was correlated to an elevated frequency of plasmablasts in circulation. In contrast, kidney dysfunction was indicative of an accumulation of CD27-IgD- B cells and CD27-/low plasmablasts. Finally, we provide evidence that high levels of extracellular ATP and matrix metalloproteinase 8 can contribute to shedding of CD27 during human hantavirus infection. CONCLUSION Our findings demonstrate that thrombocytopenia and kidney dysfunction associate with distinctly different effects on the humoral immune system. Moreover, hantavirus-infected individuals have significantly elevated levels of extracellular ATP in circulation.
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Affiliation(s)
- Priscilla F Kerkman
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Andy Dernstedt
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Lalitha Tadala
- The Laboratory for Molecular Infection Medicine Sweden (MIMS)Umeå Centre for Microbial Research (UCMR)UmeaSweden
- Department of Molecular BiologyUmeå UniversityUmeaSweden
| | - Eva Mittler
- Department of Microbiology & ImmunologyAlbert Einstein College of MedicineBronxNYUSA
| | - Mirjam Dannborg
- The Laboratory for Molecular Infection Medicine Sweden (MIMS)Umeå Centre for Microbial Research (UCMR)UmeaSweden
- Department of Molecular BiologyUmeå UniversityUmeaSweden
| | - Christopher Sundling
- Department of MedicineKarolinska InstitutetSolnaSweden
- Department of Infectious DiseasesKarolinska University HospitalStockholmSweden
| | - Kimia T Maleki
- Department of MedicineKarolinska InstitutetHuddingeSweden
| | | | - Anne Tuiskunen‐Bäck
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Julia Wigren Byström
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Pauline Ocaya
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Therese Thunberg
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Rohit K Jangra
- Department of Microbiology & ImmunologyAlbert Einstein College of MedicineBronxNYUSA
| | - Gleyder Román‐Sosa
- Structural Virology UnitVirology DepartmentInstitut PasteurCNRS UMR 3569ParisFrance
| | - Pablo Guardado‐Calvo
- Structural Virology UnitVirology DepartmentInstitut PasteurCNRS UMR 3569ParisFrance
| | - Felix A Rey
- Structural Virology UnitVirology DepartmentInstitut PasteurCNRS UMR 3569ParisFrance
| | | | - Kartik Chandran
- Department of Microbiology & ImmunologyAlbert Einstein College of MedicineBronxNYUSA
| | - Andrea Puhar
- The Laboratory for Molecular Infection Medicine Sweden (MIMS)Umeå Centre for Microbial Research (UCMR)UmeaSweden
- Department of Molecular BiologyUmeå UniversityUmeaSweden
| | - Clas Ahlm
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
| | - Mattias NE Forsell
- Department of Clinical MicrobiologyUmeå Centre for Microbial Research (UCMR)UmeaSweden
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12
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Saavedra F, Díaz FE, Retamal‐Díaz A, Covián C, González PA, Kalergis AM. Immune response during hantavirus diseases: implications for immunotherapies and vaccine design. Immunology 2021; 163:262-277. [PMID: 33638192 PMCID: PMC8207335 DOI: 10.1111/imm.13322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Orthohantaviruses, previously named hantaviruses, cause two emerging zoonotic diseases: haemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Overall, over 200 000 cases are registered every year worldwide, with a fatality rate ranging between 0·1% and 15% for HFRS and between 20% and 40% for HCPS. No specific treatment or vaccines have been approved by the U.S. Food and Drug Administration (FDA) to treat or prevent hantavirus-caused syndromes. Currently, little is known about the mechanisms at the basis of hantavirus-induced disease. However, it has been hypothesized that an excessive inflammatory response plays an essential role in the course of the disease. Furthermore, the contributions of the cellular immune response to either viral clearance or pathology have not been fully elucidated. This article discusses recent findings relative to the immune responses elicited to hantaviruses in subjects suffering HFRS or HCPS, highlighting the similarities and differences between these two clinical diseases. Also, we summarize the most recent data about the cellular immune response that could be important for designing new vaccines to prevent this global public health problem.
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Affiliation(s)
- Farides Saavedra
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Fabián E. Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Angello Retamal‐Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Camila Covián
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Pablo A. González
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
- Millennium Institute on Immunology and ImmunotherapyDepartamento de EndocrinologíaFacultad de MedicinaEscuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
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13
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Correlation of CD38 expression with the progression of hemorrhagic fever with renal syndrome. Arch Virol 2021; 166:2399-2406. [PMID: 34114140 DOI: 10.1007/s00705-021-05136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
To assess the relationship between the expression of CD38 and the progression of hemorrhagic fever with renal syndrome (HFRS), we determined the levels of CD38 during different phases of HFRS and evaluated the relationship between changes in CD38 expression and the progression of HFRS. The expression of CD38 in 68 patients with HFRS was analyzed by flow cytometry, and this method was also used to determine the levels of CD4+T, CD8+T, and B lymphocytes and NK cells. Furthermore, creatinine (Cr), uric acid (UA), and urea in serum at each stage of HFRS were measured using commercial kits. The basic clinical reference values for leukocytes, platelets (PLT), and red blood cells were determined by conventional methods. The colloidal gold method was used to measure HFRS antibody levels in the patients. A significant change in CD38 expression was observed from the fever phase to the recovery phase in patients with HFRS. Moreover, the expression of CD38 was proportionally correlated with the levels of Cr, UA, and urea in serum. In contrast, there was an inverse correlation between CD38 and PLT. Interestingly, an increase in CD38 expression correlated with an increase in CD8+T lymphocytes, B cells, and NK cells, but with a decrease in CD4+T lymphocytes. The expression of CD38 is associated with the progression of HFRS, suggesting that it may be a potent indicator of the stages of this disorder.
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14
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Mishra PK, Bruiners N, Ukey R, Datta P, Onyuka A, Handler D, Hussain S, Honnen W, Singh S, Guerrini V, Yin Y, Dewald H, Choudhary A, Horton DB, Barrett ES, Roy J, Weiss SH, Fitzgerald-Bocarsly P, Blaser MJ, Carson JL, Panettieri RA, Lardizabal A, Chang TLY, Pinter A, Gennaro ML. Vaccination boosts protective responses and counters SARS-CoV-2-induced pathogenic memory B cells. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33880486 PMCID: PMC8057254 DOI: 10.1101/2021.04.11.21255153] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Much is to be learned about the interface between immune responses to SARS-CoV-2 infection and vaccination. We monitored immune responses specific to SARS-CoV-2 Spike Receptor-Binding-Domain (RBD) in convalescent individuals for eight months after infection diagnosis and following vaccination. Over time, neutralizing antibody responses, which are predominantly RBD specific, generally decreased, while RBD-specific memory B cells persisted. RBD-specific antibody and B cell responses to vaccination were more vigorous than those elicited by infection in the same subjects or by vaccination in infection-naïve comparators. Notably, the frequencies of double negative B memory cells, which are dysfunctional and potentially pathogenic, increased in the convalescent subjects over time. Unexpectedly, this effect was reversed by vaccination. Our work identifies a novel aspect of immune dysfunction in mild/moderate COVID-19, supports the practice of offering SARS-CoV-2 vaccination regardless of infection history, and provides a potential mechanistic explanation for the vaccination-induced reduction of “Long-COVID” symptoms.
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Affiliation(s)
- Pankaj Kumar Mishra
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Natalie Bruiners
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Rahul Ukey
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Pratik Datta
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Alberta Onyuka
- Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Deborah Handler
- Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Sabiha Hussain
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - William Honnen
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Sukhwinder Singh
- NJMS Flow Cytometry and Immunology Core Laboratory, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Valentina Guerrini
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Yue Yin
- Center for Advanced Biotechnology and Medicine, School of Public Health, Rutgers University, Piscataway, NJ 08854
| | - Hannah Dewald
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Alok Choudhary
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Emily S Barrett
- Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ 08854.,Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ 08854
| | - Jason Roy
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ 08854
| | - Stanley H Weiss
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103
| | | | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, School of Public Health, Rutgers University, Piscataway, NJ 08854
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | | | - Alfred Lardizabal
- Global Tuberculosis Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Theresa Li-Yun Chang
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Abraham Pinter
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
| | - Maria Laura Gennaro
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ 07103
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15
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Maleki KT, Tauriainen J, García M, Kerkman PF, Christ W, Dias J, Wigren Byström J, Leeansyah E, Forsell MN, Ljunggren HG, Ahlm C, Björkström NK, Sandberg JK, Klingström J. MAIT cell activation is associated with disease severity markers in acute hantavirus infection. CELL REPORTS MEDICINE 2021; 2:100220. [PMID: 33763658 PMCID: PMC7974553 DOI: 10.1016/j.xcrm.2021.100220] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Hantaviruses are zoonotic RNA viruses that cause severe acute disease in humans. Infected individuals have strong inflammatory responses that likely cause immunopathology. Here, we studied the response of mucosal-associated invariant T (MAIT) cells in peripheral blood of individuals with hemorrhagic fever with renal syndrome (HFRS) caused by Puumala orthohantavirus, a hantavirus endemic in Europe. We show that MAIT cell levels decrease in the blood during HFRS and that residual MAIT cells are highly activated. This activation correlates with HFRS severity markers. In vitro activation of MAIT cells by hantavirus-exposed antigen-presenting cells is dependent on type I interferons (IFNs) and independent of interleukin-18 (IL-18). These findings highlight the role of type I IFNs in virus-driven MAIT cell activation and suggest a potential role of MAIT cells in the disease pathogenesis of viral infections. MAIT cells are activated in individuals with hemorrhagic fever with renal syndrome (HFRS) MAIT cell activation correlates with HFRS severity markers during hantavirus infection MAIT cell blood levels decline during acute HFRS Hantavirus-mediated MAIT cell activation is type I IFN dependent
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Affiliation(s)
- Kimia T Maleki
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Tauriainen
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marina García
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Priscilla F Kerkman
- Department of Clinical Microbiology, Division of Infection & Immunology, Umeå University, Umeå, Sweden.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wanda Christ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Joana Dias
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Julia Wigren Byström
- Department of Clinical Microbiology, Division of Infection & Immunology, Umeå University, Umeå, Sweden
| | - Edwin Leeansyah
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China.,Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Mattias N Forsell
- Department of Clinical Microbiology, Division of Infection & Immunology, Umeå University, Umeå, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Division of Infection & Immunology, Umeå University, Umeå, Sweden
| | - Niklas K Björkström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan K Sandberg
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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16
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Tu HA, Nivarthi UK, Graham NR, Eisenhauer P, Delacruz MJ, Pierce KK, Whitehead SS, Boyson JE, Botten JW, Kirkpatrick BD, Durbin AP, deSilva AM, Diehl SA. Stimulation of B Cell Immunity in Flavivirus-Naive Individuals by the Tetravalent Live Attenuated Dengue Vaccine TV003. Cell Rep Med 2020; 1:100155. [PMID: 33377126 PMCID: PMC7762770 DOI: 10.1016/j.xcrm.2020.100155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Abstract
The tetravalent live attenuated dengue vaccine candidate TV003 induces neutralizing antibodies against all four dengue virus serotypes (DENV1-DENV4) and protects against experimental challenge with DENV2 in humans. Here, we track vaccine viremia and B and T cell responses to this vaccination/challenge model to understand how vaccine viremia links adaptive immunity and development of protective antibody responses. TV003 viremia triggers an acute plasmablast response that, in combination with DENV-specific CD4+ T cells, correlates with serum neutralizing antibodies. TV003 vaccinees develop DENV2-reactive memory B cells, including serotype-specific and multivalent specificities in line with the composition of serum antibodies. There is no post-challenge plasmablast response in vaccinees, although stronger and earlier post-TV003 plasmablast responses associate with sterile humoral protection from DENV2 challenge. TV003 vaccine triggers plasmablasts and memory B cells, which, with support from CD4+ T cells, functionally link early vaccine viremia and the serum antibody responses.
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Affiliation(s)
- Huy A. Tu
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
- Cellular, Molecular, and Biomedical Sciences Graduate Program, University of Vermont, Burlington, VT 05405, USA
| | - Usha K. Nivarthi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Nancy R. Graham
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Philip Eisenhauer
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Matthew J. Delacruz
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Kristen K. Pierce
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Stephen S. Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jonathan E. Boyson
- Cellular, Molecular, and Biomedical Sciences Graduate Program, University of Vermont, Burlington, VT 05405, USA
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Jason W. Botten
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
- Cellular, Molecular, and Biomedical Sciences Graduate Program, University of Vermont, Burlington, VT 05405, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Beth D. Kirkpatrick
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Anna P. Durbin
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Aravinda M. deSilva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Sean A. Diehl
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
- Cellular, Molecular, and Biomedical Sciences Graduate Program, University of Vermont, Burlington, VT 05405, USA
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17
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Martínez VP, Di Paola N, Alonso DO, Pérez-Sautu U, Bellomo CM, Iglesias AA, Coelho RM, López B, Periolo N, Larson PA, Nagle ER, Chitty JA, Pratt CB, Díaz J, Cisterna D, Campos J, Sharma H, Dighero-Kemp B, Biondo E, Lewis L, Anselmo C, Olivera CP, Pontoriero F, Lavarra E, Kuhn JH, Strella T, Edelstein A, Burgos MI, Kaler M, Rubinstein A, Kugelman JR, Sanchez-Lockhart M, Perandones C, Palacios G. "Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina. N Engl J Med 2020; 383:2230-2241. [PMID: 33264545 DOI: 10.1056/nejmoa2009040] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions. METHODS Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events. RESULTS After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18-19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission. CONCLUSIONS Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.).
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Affiliation(s)
- Valeria P Martínez
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Nicholas Di Paola
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Daniel O Alonso
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Unai Pérez-Sautu
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Carla M Bellomo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Ayelén A Iglesias
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Rocio M Coelho
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Beatriz López
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Natalia Periolo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Peter A Larson
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Elyse R Nagle
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Joseph A Chitty
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Catherine B Pratt
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jorge Díaz
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Daniel Cisterna
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Josefina Campos
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Heema Sharma
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Bonnie Dighero-Kemp
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Emiliano Biondo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Lorena Lewis
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Constanza Anselmo
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Camila P Olivera
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Fernanda Pontoriero
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Enzo Lavarra
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jens H Kuhn
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Teresa Strella
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Alexis Edelstein
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Miriam I Burgos
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Mario Kaler
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Adolfo Rubinstein
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Jeffrey R Kugelman
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Mariano Sanchez-Lockhart
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Claudia Perandones
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
| | - Gustavo Palacios
- From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha
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18
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Varnaitė R, García M, Glans H, Maleki KT, Sandberg JT, Tynell J, Christ W, Lagerqvist N, Asgeirsson H, Ljunggren HG, Ahlén G, Frelin L, Sällberg M, Blom K, Klingström J, Gredmark-Russ S. Expansion of SARS-CoV-2-Specific Antibody-Secreting Cells and Generation of Neutralizing Antibodies in Hospitalized COVID-19 Patients. THE JOURNAL OF IMMUNOLOGY 2020; 205:2437-2446. [PMID: 32878912 DOI: 10.4049/jimmunol.2000717] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/20/2020] [Indexed: 01/16/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in late 2019 and has since become a global pandemic. Pathogen-specific Abs are typically a major predictor of protective immunity, yet human B cell and Ab responses during COVID-19 are not fully understood. In this study, we analyzed Ab-secreting cell and Ab responses in 20 hospitalized COVID-19 patients. The patients exhibited typical symptoms of COVID-19 and presented with reduced lymphocyte numbers and increased T cell and B cell activation. Importantly, we detected an expansion of SARS-CoV-2 nucleocapsid protein-specific Ab-secreting cells in all 20 COVID-19 patients using a multicolor FluoroSpot Assay. Out of the 20 patients, 16 had developed SARS-CoV-2-neutralizing Abs by the time of inclusion in the study. SARS-CoV-2-specific IgA, IgG, and IgM Ab levels positively correlated with SARS-CoV-2-neutralizing Ab titers, suggesting that SARS-CoV-2-specific Ab levels may reflect the titers of neutralizing Abs in COVID-19 patients during the acute phase of infection. Last, we showed that IL-6 and C-reactive protein serum concentrations were higher in patients who were hospitalized for longer, supporting the recent observations that IL-6 and C-reactive protein could be used as markers for COVID-19 severity. Altogether, this study constitutes a detailed description of clinical and immunological parameters in 20 COVID-19 patients, with a focus on B cell and Ab responses, and describes tools to study immune responses to SARS-CoV-2 infection and vaccination.
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Affiliation(s)
- Renata Varnaitė
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Marina García
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Hedvig Glans
- Department of Infectious Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Kimia T Maleki
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - John Tyler Sandberg
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Janne Tynell
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Wanda Christ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | | | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden; and
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden; and
| | - Gustaf Ahlén
- Department of Laboratory Medicine, Division of Clinical Microbiology, ANA Futura, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Lars Frelin
- Department of Laboratory Medicine, Division of Clinical Microbiology, ANA Futura, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Matti Sällberg
- Department of Laboratory Medicine, Division of Clinical Microbiology, ANA Futura, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Kim Blom
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden.,Public Health Agency of Sweden, 171 65 Solna, Sweden
| | - Sara Gredmark-Russ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden; .,Department of Infectious Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
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19
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Kimuda SG, Andia-Biraro I, Sebina I, Egesa M, Nalwoga A, Smith SG, Bagaya BS, Levin J, Elliott AM, Raynes JG, Cose S. Mycobacterium tuberculosis infection is associated with increased B cell responses to unrelated pathogens. Sci Rep 2020; 10:14324. [PMID: 32868810 PMCID: PMC7458924 DOI: 10.1038/s41598-020-71044-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/05/2020] [Indexed: 01/12/2023] Open
Abstract
Antigens from Mycobacterium tuberculosis (M.tb), have been shown to stimulate human B cell responses to unrelated recall antigens in vitro. However, it is not known whether natural M.tb infection or whether vaccination with, Mycobacterium bovis BCG, has a similar effect. This study investigated the effects of M.tb infection and BCG vaccination on B cell responses to heterologous pathogen recall antigens. Antibodies against several bacterial and viral pathogens were quantified by ELISA in 68 uninfected controls, 62 individuals with latent TB infection (LTBI) and 107 active pulmonary TB (APTB) cases, and 24 recently BCG-vaccinated adolescents and naive controls. Antibody avidity was investigated using surface plasmon resonance and B cell ELISPOTs were used to measure plasmablast and memory B cell responses (MBC) in APTB cases and healthy donor controls. APTB was associated with higher levels of antibodies to respiratory syncytial virus and measles virus, compared to uninfected controls. BCG vaccination did not alter levels of antibodies against heterologous pathogens. Tetanus toxoid (TT)-specific antibody avidity was increased in APTB cases in comparison to uninfected individuals and the ratio of TT-specific plasmablasts to MBCs in the APTB cases was 7:1. M.tb infection is associated with increased antibody responses to heterologous pathogens in human subjects.
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Affiliation(s)
- Simon G Kimuda
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ismail Sebina
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Moses Egesa
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Angela Nalwoga
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven G Smith
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernard S Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - John G Raynes
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Cose
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda. .,Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda. .,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
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20
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Rowley AH, Baker SC, Arrollo D, Gruen LJ, Bodnar T, Innocentini N, Hackbart M, Cruz-Pulido YE, Wylie KM, Kim KYA, Shulman ST. A Protein Epitope Targeted by the Antibody Response to Kawasaki Disease. J Infect Dis 2020; 222:158-168. [PMID: 32052021 PMCID: PMC7296860 DOI: 10.1093/infdis/jiaa066] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of childhood acquired heart disease in developed nations and can result in coronary artery aneurysms and death. Clinical and epidemiologic features implicate an infectious cause but specific antigenic targets of the disease are unknown. Peripheral blood plasmablasts are normally highly clonally diverse but the antibodies they encode are approximately 70% antigen-specific 1-2 weeks after infection. METHODS We isolated single peripheral blood plasmablasts from children with KD 1-3 weeks after onset and prepared 60 monoclonal antibodies (mAbs). We used the mAbs to identify their target antigens and assessed serologic response among KD patients and controls to specific antigen. RESULTS Thirty-two mAbs from 9 of 11 patients recognize antigen within intracytoplasmic inclusion bodies in ciliated bronchial epithelial cells of fatal cases. Five of these mAbs, from 3 patients with coronary aneurysms, recognize a specific peptide, which blocks binding to inclusion bodies. Sera from 5/8 KD patients day ≥ 8 after illness onset, compared with 0/17 infant controls (P < .01), recognized the KD peptide antigen. CONCLUSIONS These results identify a protein epitope targeted by the antibody response to KD and provide a means to elucidate the pathogenesis of this important worldwide pediatric problem.
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Affiliation(s)
- Anne H Rowley
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Microbiology/Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Susan C Baker
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - David Arrollo
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Leah J Gruen
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Tetyana Bodnar
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nancy Innocentini
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Matthew Hackbart
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Yazmin E Cruz-Pulido
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Kristine M Wylie
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stanford T Shulman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
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21
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Hicar MD. Antibodies and Immunity During Kawasaki Disease. Front Cardiovasc Med 2020; 7:94. [PMID: 32671098 PMCID: PMC7326051 DOI: 10.3389/fcvm.2020.00094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
The cause of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology studies support that an infectious disease is involved in at least starting the inflammatory cascade set off during KD. Clues from epidemiology support that humoral immunity can have a protective effect. However, the role of the immune system, particularly of B cells and antibodies, in pathogenesis of KD is still unclear. Intravenous immunoglobulin (IVIG) and other therapies targeted at modulating inflammation can prevent development of coronary aneurysms. A number of autoantibody responses have been reported in children with KD and antibodies have been generated from aneurysmal plasma cell infiltrates. Recent reports show that children with KD have similar plasmablast responses as other children with infectious diseases, further supporting an infectious starting point. As ongoing studies are attempting to identify the etiology of KD through study of antibody responses, we sought to review the role of humoral immunity in KD pathogenesis, treatment, and recovery.
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Affiliation(s)
- Mark Daniel Hicar
- University at Buffalo, Buffalo, NY, United States.,John R. Oishei Children's Hospital, Buffalo, NY, United States.,Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
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22
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Kuri-Cervantes L, Pampena MB, Meng W, Rosenfeld AM, Ittner CAG, Weisman AR, Agyekum R, Mathew D, Baxter AE, Vella L, Kuthuru O, Apostolidis S, Bershaw L, Dougherty J, Greenplate AR, Pattekar A, Kim J, Han N, Gouma S, Weirick ME, Arevalo CP, Bolton MJ, Goodwin EC, Anderson EM, Hensley SE, Jones TK, Mangalmurti NS, Luning Prak ET, Wherry EJ, Meyer NJ, Betts MR. Immunologic perturbations in severe COVID-19/SARS-CoV-2 infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.05.18.101717. [PMID: 32511394 PMCID: PMC7263541 DOI: 10.1101/2020.05.18.101717] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although critical illness has been associated with SARS-CoV-2-induced hyperinflammation, the immune correlates of severe COVID-19 remain unclear. Here, we comprehensively analyzed peripheral blood immune perturbations in 42 SARS-CoV-2 infected and recovered individuals. We identified broad changes in neutrophils, NK cells, and monocytes during severe COVID-19, suggesting excessive mobilization of innate lineages. We found marked activation within T and B cells, highly oligoclonal B cell populations, profound plasmablast expansion, and SARS-CoV-2-specific antibodies in many, but not all, severe COVID-19 cases. Despite this heterogeneity, we found selective clustering of severe COVID-19 cases through unbiased analysis of the aggregated immunological phenotypes. Our findings demonstrate broad immune perturbations spanning both innate and adaptive leukocytes that distinguish dysregulated host responses in severe SARS-CoV-2 infection and warrant therapeutic investigation. One Sentence Summary Broad immune perturbations in severe COVID-19.
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23
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Takahashi T, Suzuki T, Hiroshige S, Nouno S, Matsumura T, Tominaga T, Yujiri T, Katano H, Sato Y, Hasegawa H. Transient Appearance of Plasmablasts in the Peripheral Blood of Japanese Patients With Severe Fever With Thrombocytopenia Syndrome. J Infect Dis 2020; 220:23-27. [PMID: 30721983 DOI: 10.1093/infdis/jiz054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
Atypical lymphocytes in the peripheral blood in patients with severe fever with thrombocytopenia syndrome (SFTS) have not been well examined. In this study, we analyzed counts and characteristics of atypical lymphocytes in 7 patients with SFTS. Atypical lymphocytes resembled plasma cells morphologically and appeared in the peripheral blood of all patients 4-8 days after onset of disease. Among these lymphocytes flow cytometry showed a CD19+CD38+CD138-/+ phenotype, and immunohistochemical staining revealed a CD79a+CD38+CD138-/+CD27+ phenotype. From our observations, atypical lymphocytes transiently that appeared in the peripheral blood during the acute phase of SFTS were considered to be plasmablasts.
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Affiliation(s)
- Toru Takahashi
- Department of Hematology, Yamaguchi Grand Medical Center, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shunsuke Hiroshige
- Department of Hematology, Yamaguchi Grand Medical Center, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Shota Nouno
- Department of Hematology, Yamaguchi Grand Medical Center, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Takuro Matsumura
- Department of Hematology, Yamaguchi Grand Medical Center, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Takayuki Tominaga
- Department of Hematology, Yamaguchi Grand Medical Center, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Toshiaki Yujiri
- Department of Clinical Laboratory Science, Yamaguchi University Graduate School of Medicine, Yamaguchi
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuko Sato
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hideki Hasegawa
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
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24
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Maleki KT, García M, Iglesias A, Alonso D, Ciancaglini M, Hammar U, Ljunggren HG, Schierloh P, Martínez VP, Klingström J. Serum Markers Associated with Severity and Outcome of Hantavirus Pulmonary Syndrome. J Infect Dis 2020; 219:1832-1840. [PMID: 30698699 PMCID: PMC6500549 DOI: 10.1093/infdis/jiz005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background Hantavirus pulmonary syndrome (HPS) is caused by Andes virus (ANDV) and related hantaviruses in the Americas. Despite a fatality rate of 40%, the pathogenesis of HPS is poorly understood and factors associated with severity, fatality, and survival remain elusive. Methods Ninety-three ANDV-infected HPS patients, of whom 34 had a fatal outcome, were retrospectively studied. Serum levels of cytokines and other inflammation-associated markers were analyzed using multiplex immunoassay and enzyme-linked immunosorbent assay. Associations with disease severity, fatal outcome, and survival were identified using logistic regression. Results HPS patients exhibited increased serum levels of markers associated with inflammation, intestinal damage, and microbial translocation compared to controls. Patients with fatal outcome displayed higher levels of interleukin (IL) 6, IL-10, interferon-γ, soluble tumor necrosis factor-related apoptosis-inducing ligand, and intestinal fatty acid–binding protein (I-FABP) than survivors. Levels of complement factor 5/5a were higher in survivors compared with fatal cases. IL-6 and I-FABP, the latter a marker for intestinal damage, were by multivariate analyses identified as independent markers associated with disease severity (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.01–5.01) and fatal outcome (OR, 1.64; 95% CI, 1.01–2.64), respectively. Conclusions HPS patients displayed a multifaceted, systemic inflammatory response, with IL-6 and I-FABP as independent markers of disease severity and fatality, respectively.
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Affiliation(s)
- Kimia T Maleki
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marina García
- Laboratorio de Inmunología de Enfermedades Respiratorias, Instituto de Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Academia Nacional de Medicina
| | - Ayelén Iglesias
- Laboratorio Nacional de Referencia para Hantavirus, Servicio de Biología Molecular, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, "Dr Carlos G. Malbrán," Buenos Aires, Argentina
| | - Daniel Alonso
- Laboratorio Nacional de Referencia para Hantavirus, Servicio de Biología Molecular, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, "Dr Carlos G. Malbrán," Buenos Aires, Argentina
| | - Matías Ciancaglini
- Laboratorio Nacional de Referencia para Hantavirus, Servicio de Biología Molecular, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, "Dr Carlos G. Malbrán," Buenos Aires, Argentina
| | - Ulf Hammar
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pablo Schierloh
- Laboratorio de Microscopía Aplicada a Estudios Moleculares y Celulares, Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática, CONICET, Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Argentina
| | - Valeria P Martínez
- Laboratorio Nacional de Referencia para Hantavirus, Servicio de Biología Molecular, Instituto Nacional de Enfermedades Infecciosas, Administración Nacional de Laboratorios e Institutos de Salud, "Dr Carlos G. Malbrán," Buenos Aires, Argentina
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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25
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Meeting report: Eleventh International Conference on Hantaviruses. Antiviral Res 2020; 176:104733. [PMID: 32068071 DOI: 10.1016/j.antiviral.2020.104733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/24/2022]
Abstract
The 2019 11th International Conference on Hantaviruses (ICH 2019) was organized by the International Society for Hantaviruses (ISH), and held on September 1-4, 2019, at the Irish College, in Leuven, Belgium. These ICHs have been held every three years since 1989. ICH 2019 was attended by 158 participants from 33 countries. The current report summarizes research presented on all aspects of hantavirology: ecology; pathogenesis and immune responses; virus phylogeny, replication and morphogenesis; epidemiology; vaccines, therapeutics and prevention; and clinical aspects and diagnosis.
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26
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Bonezi V, Cataneo AHD, Branquinho MSF, Silva MBB, Gonzalez-Dias P, Pereira SS, Ferreira LCDS, Nakaya HI, Campa A, Wowk PF, Silveira ELV. Flavivirus-Mediating B Cell Differentiation Into Antibody-Secreting Cells in Humans Is Associated With the Activation of the Tryptophan Metabolism. Front Immunol 2020; 11:20. [PMID: 32117223 PMCID: PMC7026258 DOI: 10.3389/fimmu.2020.00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Patients infected with the Dengue virus (DENV) often present with a massive generation of DENV-specific antibody-secreting cells (ASCs) in the blood. In some cases, these ASCs represent more than 50% of the circulating B cells, a higher magnitude than those induced by other infections, vaccinations, and plasma cell lymphomas. However, it remains unclear how the DENV infection elicits this colossal response. To address this issue, we utilised an in vitro strategy to induce human PBMCs of healthy individuals incubated with DENV particles (DENV4 TVP/360) to differentiate into ASCs. As controls, PBMCs were incubated with a mitogen cocktail or supernatants of uninfected C6/36 cells (mock). The ASC phenotype and function were increasingly detected in the DENV and mitogen-cultured PBMCs as compared to mock-treated cells. In contrast to the in vivo condition, secreted IgG derived from the PBMC-DENV culture was not DENV-specific. Lower ASC numbers were observed when inactivated viral particles or purified B cells were added to the cultures. The physical contact was essential between B cells and the remaining PBMCs for the DENV-mediated ASC response. Considering the evidence for the activation of the tryptophan metabolism detected in the serum of Dengue patients, we assessed its relevance in the DENV-mediated ASC differentiation. For this, tryptophan and its respective metabolites were quantified in the supernatants of cell cultures through mass spectrophotometry. Tryptophan depletion and kynurenine accumulation were found in the supernatants of PBMC-DENV cultures, which presented enhanced detection of indoleamine 2,3-dioxygenase 1 and 2 transcripts as compared to controls. In PBMC-DENV cultures, tryptophan and kynurenine levels strongly correlated to the respective ASC numbers, while the kynurenine levels were directly proportional to the secreted IgG titers. Contrastingly, PBMCs incubated with Zika or attenuated Yellow Fever viruses showed no correlation between their kynurenine concentrations and ASC numbers. Therefore, our data revealed the existence of distinct pathways for the DENV-mediated ASC differentiation and suggest the involvement of the tryptophan metabolism in this cellular process triggered by flavivirus infections.
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Affiliation(s)
- Vivian Bonezi
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Allan H D Cataneo
- Laboratório de Virologia Molecular, Instituto Carlos Chagas (ICC/Fiocruz Paraná), Curitiba, Brazil
| | - Maryana S F Branquinho
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Maysa B B Silva
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Patricia Gonzalez-Dias
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.,Scientific Platform Pasteur, University of São Paulo, São Paulo, Brazil
| | - Samuel S Pereira
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luís C de Souza Ferreira
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.,Scientific Platform Pasteur, University of São Paulo, São Paulo, Brazil
| | - Ana Campa
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Pryscilla F Wowk
- Laboratório de Virologia Molecular, Instituto Carlos Chagas (ICC/Fiocruz Paraná), Curitiba, Brazil
| | - Eduardo L V Silveira
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
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27
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Yamaoka S, Weisend C, Ebihara H. Identifying target cells for a tick-borne virus that causes fatal hemorrhagic fever. J Clin Invest 2020; 130:598-600. [PMID: 31904585 PMCID: PMC6994110 DOI: 10.1172/jci134512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease in China, South Korea, and Japan caused by the tick-borne SFTS virus (SFTSV). Severe and fatal SFTS presents as a hemorrhagic fever characterized by high viral load, uncontrolled inflammatory response, dysregulated adaptive immunity, coagulation abnormalities, hemorrhage, and multiorgan failure with up to 33% case fatality rates (CFRs). Despite its public health significance in Asia, vaccines and specific therapeutics against SFTS are still unavailable. A better understanding of the pathogenesis of SFTS is crucial to improving medical countermeasures against this devastating disease. In this issue of the JCI, Suzuki and colleagues analyzed histopathological samples from 22 individuals who succumbed to SFTS, and identified antibody-producing B cell-lineage plasmablasts and macrophages as principal target cells for SFTSV infection in fatal SFTS. Their results suggest that SFTSV-infected post-germinal center B cells, plasmablasts, and macrophages affect systemic immunopathology and dysregulation, which likely leads to fatal outcomes.
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28
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Schönrich G, Raftery MJ. Dendritic Cells (DCs) as "Fire Accelerants" of Hantaviral Pathogenesis. Viruses 2019; 11:v11090849. [PMID: 31540199 PMCID: PMC6783833 DOI: 10.3390/v11090849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/20/2023] Open
Abstract
Hantaviruses are widespread zoonotic pathogens found around the globe. Depending on their geographical location, hantaviruses can cause two human syndromes, haemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). HPS and HFRS have many commonalities amongst which excessive activation of immune cells is a prominent feature. Hantaviruses replicate in endothelial cells (ECs), the major battlefield of hantavirus-induced pathogenesis, without causing cytopathic effects. This indicates that a misdirected response of human immune cells to hantaviruses is causing damage. As dendritic cells (DCs) orchestrate antiviral immune responses, they are in the focus of research analysing hantavirus-induced immunopathogenesis. In this review, we discuss the interplay between hantaviruses and DCs and the immunological consequences thereof.
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Affiliation(s)
- Günther Schönrich
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Martin J Raftery
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
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29
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Klingström J, Smed-Sörensen A, Maleki KT, Solà-Riera C, Ahlm C, Björkström NK, Ljunggren HG. Innate and adaptive immune responses against human Puumala virus infection: immunopathogenesis and suggestions for novel treatment strategies for severe hantavirus-associated syndromes. J Intern Med 2019; 285:510-523. [PMID: 30663801 PMCID: PMC6850289 DOI: 10.1111/joim.12876] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two related hyperinflammatory syndromes are distinguished following infection of humans with hantaviruses: haemorrhagic fever with renal syndrome (HFRS) seen in Eurasia and hantavirus pulmonary syndrome (HPS) seen in the Americas. Fatality rates are high, up to 10% for HFRS and around 35%-40% for HPS. Puumala virus (PUUV) is the most common HFRS-causing hantavirus in Europe. Here, we describe recent insights into the generation of innate and adaptive cell-mediated immune responses following clinical infection with PUUV. First described are studies demonstrating a marked redistribution of peripheral blood mononuclear phagocytes (MNP) to the airways, a process that may underlie local immune activation at the site of primary infection. We then describe observations of an excessive natural killer (NK) cell activation and the persistence of highly elevated numbers of NK cells in peripheral blood following PUUV infection. A similar vigorous CD8 Tcell response is also described, though Tcell responses decline with viraemia. Like MNPs, many NK cells and CD8 T cells also localize to the lung upon acute PUUV infection. Following this, findings demonstrating the ability of hantaviruses, including PUUV, to cause apoptosis resistance in infected target cells, are described. These observations, and associated inflammatory cytokine responses, may provide new insights into HFRS and HPS disease pathogenesis. Based on similarities between inflammatory responses in severe hantavirus infections and other hyperinflammatory disease syndromes, we speculate whether some therapeutic interventions that have been successful in the latter conditions may also be applicable in severe hantavirus infections.
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Affiliation(s)
- J Klingström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Smed-Sörensen
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K T Maleki
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Solà-Riera
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - N K Björkström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - H G Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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30
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Lindquist ME, Hicar MD. B Cells and Antibodies in Kawasaki Disease. Int J Mol Sci 2019; 20:ijms20081834. [PMID: 31013925 PMCID: PMC6514959 DOI: 10.3390/ijms20081834] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
The etiology of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology supports a relationship of KD to an infectious disease. Several pathological mechanisms are being considered, including a superantigen response, direct invasion by an infectious etiology or an autoimmune phenomenon. Treating affected patients with intravenous immunoglobulin is effective at reducing the rates of coronary aneurysms. However, the role of B cells and antibodies in KD pathogenesis remains unclear. Murine models are not clear on the role for B cells and antibodies in pathogenesis. Studies on rare aneurysm specimens reveal plasma cell infiltrates. Antibodies generated from these aneurysmal plasma cell infiltrates showed cross-reaction to intracellular inclusions in the bronchial epithelium of a number of pathologic specimens from children with KD. These antibodies have not defined an etiology. Notably, a number of autoantibody responses have been reported in children with KD. Recent studies show acute B cell responses are similar in children with KD compared to children with infections, lending further support of an infectious disease cause of KD. Here, we will review and discuss the inconsistencies in the literature in relation to B cell responses, specific antibodies, and a potential role for humoral immunity in KD pathogenesis or diagnosis.
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Affiliation(s)
- Michael E Lindquist
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA.
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14222, USA.
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31
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Alonso D, Iglesias A, Coelho R, Periolo N, Bruno A, Córdoba M, Filomarino N, Quipildor M, Biondo E, Fortunato E, Bellomo C, Martínez V. Epidemiological description, case‐fatality rate, and trends of Hantavirus Pulmonary Syndrome: 9 years of surveillance in Argentina. J Med Virol 2019; 91:1173-1181. [DOI: 10.1002/jmv.25446] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Oscar Alonso
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
| | - Ayelen Iglesias
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
| | - Rocio Coelho
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
| | - Natalia Periolo
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
| | - Agostina Bruno
- Laboratorio de Enfermedades TropicalesHospital San Vicente de Paúl, OránSalta Oran Argentina
| | - Maria Teresa Córdoba
- Laboratorio de Enfermedades TropicalesHospital San Vicente de Paúl, OránSalta Oran Argentina
| | - Noemi Filomarino
- Laboratorio Provincial de HantavirusHospital Señor Del MilagroSalta Argentina
| | - Marcelo Quipildor
- Laboratorio de Enfermedades TropicalesHospital San Vicente de Paúl, OránSalta Oran Argentina
| | - Emiliano Biondo
- Area Programatica EsquelMinisterio de Salud de la Provincia de ChubutEsquel Chubut Argentina
| | - Eduardo Fortunato
- Region Sanitaria XIMinisterio de Salud de la Provincia de Buenos AiresBuenos Aires Argentina
| | - Carla Bellomo
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
| | - Valeria Paula Martínez
- Laboratorio Nacional de Referencia para HantavirusInstituto Nacional de Enfermedades Infecciosas (INEI) Administración Nacional de Laboratorio e Institutos de Salud (ANLIS) “Dr. C. G. Malbrán”Ciudad Autónoma de Buenos Aires Argentina
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32
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Raftery MJ, Abdelaziz MO, Hofmann J, Schönrich G. Hantavirus-Driven PD-L1/PD-L2 Upregulation: An Imperfect Viral Immune Evasion Mechanism. Front Immunol 2018; 9:2560. [PMID: 30559738 PMCID: PMC6287426 DOI: 10.3389/fimmu.2018.02560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Abstract
Viruses often subvert antiviral immune responses by taking advantage of inhibitory immune signaling. We investigated if hantaviruses use this strategy. Hantaviruses cause viral hemorrhagic fever (VHF) which is associated with strong immune activation resulting in vigorous CD8+ T cell responses. Surprisingly, we observed that hantaviruses strongly upregulate PD-L1 and PD-L2, the ligands of checkpoint inhibitor programmed death-1 (PD-1). We detected high amounts of soluble PD-L1 (sPD-L1) and soluble PD-L2 (sPD-L2) in sera from hantavirus-infected patients. In addition, we observed hantavirus-induced PD-L1 upregulation in mice with a humanized immune system. The two major target cells of hantaviruses, endothelial cells and monocyte-derived dendritic cells, strongly increased PD-L1 and PD-L2 surface expression upon hantavirus infection in vitro. As an underlying mechanism, we found increased transcript levels whereas membrane trafficking of PD-L1 was not affected. Further analysis revealed that hantavirus-associated inflammatory signals and hantaviral nucleocapsid (N) protein enhance PD-L1 and PD-L2 expression. Cell numbers were strongly reduced when hantavirus-infected endothelial cells were mixed with T cells in the presence of an exogenous proliferation signal compared to uninfected cells. This is compatible with the concept that virus-induced PD-L1 and PD-L2 upregulation contributes to viral immune escape. Intriguingly, however, we observed hantavirus-induced CD8+ T cell bystander activation despite strongly upregulated PD-L1 and PD-L2. This result indicates that hantavirus-induced CD8+ T cell bystander activation bypasses checkpoint inhibition allowing an early antiviral immune response upon virus infection.
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Affiliation(s)
- Martin J Raftery
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mohammed O Abdelaziz
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jörg Hofmann
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Günther Schönrich
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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33
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Zijlstra HW, Mulder AHL, Geeraedts F, Visser F. Falsely positive anti-glomerular basement membrane antibodies in a patient with hantavirus induced acute kidney injury - a case report. BMC Nephrol 2018; 19:286. [PMID: 30348108 PMCID: PMC6198376 DOI: 10.1186/s12882-018-1082-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hantavirus infection is an uncommon cause of acute renal failure with massive proteinuria. Serology tests to support a presumptive diagnosis usually take a few days. During the initial work-up, autoimmune causes including anti-glomerular basement membrane (GBM) glomerulonephritis need to be excluded, because these require urgent therapy. In this case the delay in serological testing caused a dilemma in treatment initiation. Case presentation An 18-year-old patient was admitted to the hospital with acute renal failure, erythrocyturia and massive proteinuria. Routine blood analysis showed leucocytosis (40,5 × 109/l) and a serum creatinine of 233 μmol/l. Infectious causes, e.g. leptospirosis or hantavirus infection, or an autoimmune disease, e.g., AAV or anti-GBM glomerulonephritis was the most feasible underlying diagnosis. Before hantavirus serology results were known, anti-GBM antibodies were positive. Treatment for anti-GBM glomerulonephritis was withheld, because of the absence of other signs and symptoms of the disease and slight improvement of renal function. The diagnosis of acute hantavirus infection was later on confirmed, by seroconversion of a follow-up serum sample. Without further intervention renal function recovered and anti-GBM antibodies disappeared. Conclusion Hantavirus infection may induce anti-GBM antibodies, falsely suggestive of anti-GBM glomerulonephritis. Anti-GBM antibodies are supposed to be 100% specific. No earlier reports of false positive anti-GBM titers were reported. Nevertheless, the anti-GBM antibodies in this case were seen as an innocent bystander effect. Considering the need of urgent initiation of plasmapheresis and administration of immunosuppressants it may lead to diagnostic dilemmas with crucial therapeutic consequences. Knowledge of this anomaly when diagnosing acute renal failure, is very important.
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Affiliation(s)
- H W Zijlstra
- Ziekenhuisgroep Twente, Department of Nephrology, Almelo, The Netherlands.
| | - A H L Mulder
- Medlon, Department of Clinical Chemistry, Almelo, The Netherlands
| | - F Geeraedts
- Laboratory for Medical Microbiology and Public Health, Hengelo, The Netherlands
| | - F Visser
- Ziekenhuisgroep Twente, Department of Nephrology, Almelo, The Netherlands
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34
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Martin M, Wrotniak BH, Hicar M. Suppressed plasmablast responses in febrile infants, including children with Kawasaki disease. PLoS One 2018; 13:e0193539. [PMID: 29579044 PMCID: PMC5868766 DOI: 10.1371/journal.pone.0193539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/13/2018] [Indexed: 12/24/2022] Open
Abstract
Background Kawasaki disease (KD), the leading cause of acquired heart disease in children, primarily affects infants and toddlers. Investigations on immune responses during KD are hampered by a limited understanding of normal immune responses in these ages. It’s well known that Infants have poorer vaccine responses and difficulty with maintaining prolonged serum immunity, but there are few studies on human infants detailing immune deficiencies. Limited studies propose an inability to maintain life-long bone marrow plasma cells. Plasmablasts are a transitional cell form of B cells that lead to long-term Plasma cells. Plasmablasts levels rise in the peripheral blood after exposure to a foreign antigen. In adult studies, these responses are both temporally and functionally well characterized. To date, there have been few studies on plasmablasts in the predominant age range of KD. Methods Children presenting to an urban pediatric emergency room undergoing laboratory evaluation, who had concern of KD or had fever and symptoms overlapping those of KD, were recruited. Peripheral blood mononuclear cells were isolated and evaluated utilizing flow cytometry with specific B cell markers from 18 KD subjects and 69 febrile controls. Results Plasmablast numbers and temporal formation are similar between infectious disease controls and KD subjects. In both groups, infants have diminished plasmablast responses compared to older children. Conclusion In this single-time point survey, infants have a blunted peripheral plasmablast response. Overall, similar plasmablast responses in KD and controls support an infectious disease relationship to KD. Future time-course studies of plasmablasts in infants are warranted as this phenomenon may contribute to observed immune responses in this age group.
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Affiliation(s)
- Meghan Martin
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Brian H. Wrotniak
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Mark Hicar
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- * E-mail:
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35
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Scholz S, Baharom F, Rankin G, Maleki KT, Gupta S, Vangeti S, Pourazar J, Discacciati A, Höijer J, Bottai M, Björkström NK, Rasmuson J, Evander M, Blomberg A, Ljunggren HG, Klingström J, Ahlm C, Smed-Sörensen A. Human hantavirus infection elicits pronounced redistribution of mononuclear phagocytes in peripheral blood and airways. PLoS Pathog 2017. [PMID: 28640917 PMCID: PMC5498053 DOI: 10.1371/journal.ppat.1006462] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hantaviruses infect humans via inhalation of virus-contaminated rodent excreta. Infection can cause severe disease with up to 40% mortality depending on the viral strain. The virus primarily targets the vascular endothelium without direct cytopathic effects. Instead, exaggerated immune responses may inadvertently contribute to disease development. Mononuclear phagocytes (MNPs), including monocytes and dendritic cells (DCs), orchestrate the adaptive immune responses. Since hantaviruses are transmitted via inhalation, studying immunological events in the airways is of importance to understand the processes leading to immunopathogenesis. Here, we studied 17 patients infected with Puumala virus that causes a mild form of hemorrhagic fever with renal syndrome (HFRS). Bronchial biopsies as well as longitudinal blood draws were obtained from the patients. During the acute stage of disease, a significant influx of MNPs expressing HLA-DR, CD11c or CD123 was detected in the patients’ bronchial tissue. In parallel, absolute numbers of MNPs were dramatically reduced in peripheral blood, coinciding with viremia. Expression of CCR7 on the remaining MNPs in blood suggested migration to peripheral and/or lymphoid tissues. Numbers of MNPs in blood subsequently normalized during the convalescent phase of the disease when viral RNA was no longer detectable in plasma. Finally, we exposed blood MNPs in vitro to Puumala virus, and demonstrated an induction of CCR7 expression on MNPs. In conclusion, the present study shows a marked redistribution of blood MNPs to the airways during acute hantavirus disease, a process that may underlie the local immune activation and contribute to immunopathogenesis in hantavirus-infected patients. Inhalation of hantavirus-infected rodent droppings can cause a wide range of disease ranging from mild symptoms to deaths in humans. Central to hantavirus disease is vascular leakage that can manifest in different organs, including the lungs. Although the virus can infect endothelial cells lining the blood vessels, it does not cause cell death. Instead, activation of the immune system in response to viral infection has been implicated in causing vascular leakage. In this study, we investigated how monocytes and dendritic cells (DCs) are involved in hantavirus disease, given their capacity to activate other immune cells. We obtained unique clinical material from 17 Puumala virus-infected patients including mucosal biopsies from the airways as well as multiple blood draws over the course of disease. In the airways of these patients, we observed an infiltration of monocytes and DCs. In parallel, there was a dramatic depletion in peripheral blood—more than ten-fold—of monocytes and DCs that was sustained throughout the first two weeks of disease. Taken together, this study provides novel insights into immune mediated processes underlying human hantavirus pathogenesis.
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Affiliation(s)
- Saskia Scholz
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Faezzah Baharom
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gregory Rankin
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Kimia T. Maleki
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Shawon Gupta
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sindhu Vangeti
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jamshid Pourazar
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas K. Björkström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Rasmuson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Anna Smed-Sörensen
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
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