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Zarate-Sanchez E, George SC, Moya ML, Robertson C. Vascular dysfunction in hemorrhagic viral fevers: opportunities for organotypic modeling. Biofabrication 2024; 16:032008. [PMID: 38749416 PMCID: PMC11151171 DOI: 10.1088/1758-5090/ad4c0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
The hemorrhagic fever viruses (HFVs) cause severe or fatal infections in humans. Named after their common symptom hemorrhage, these viruses induce significant vascular dysfunction by affecting endothelial cells, altering immunity, and disrupting the clotting system. Despite advances in treatments, such as cytokine blocking therapies, disease modifying treatment for this class of pathogen remains elusive. Improved understanding of the pathogenesis of these infections could provide new avenues to treatment. While animal models and traditional 2D cell cultures have contributed insight into the mechanisms by which these pathogens affect the vasculature, these models fall short in replicatingin vivohuman vascular dynamics. The emergence of microphysiological systems (MPSs) offers promising avenues for modeling these complex interactions. These MPS or 'organ-on-chip' models present opportunities to better mimic human vascular responses and thus aid in treatment development. In this review, we explore the impact of HFV on the vasculature by causing endothelial dysfunction, blood clotting irregularities, and immune dysregulation. We highlight how existing MPS have elucidated features of HFV pathogenesis as well as discuss existing knowledge gaps and the challenges in modeling these interactions using MPS. Understanding the intricate mechanisms of vascular dysfunction caused by HFV is crucial in developing therapies not only for these infections, but also for other vasculotropic conditions like sepsis.
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Affiliation(s)
- Evelyn Zarate-Sanchez
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States of America
| | - Steven C George
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, United States of America
| | - Monica L Moya
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA, United States of America
| | - Claire Robertson
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA, United States of America
- UC Davis Comprehensive Cancer Center, Davis, CA, United States of America
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2
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Lafoux B, Baillet N, Picard C, Fourcaud G, Borges-Cardoso V, Reynard S, Journeaux A, Germain C, Perthame E, Mateo M, Hortion J, Carnec X, Pietrosemoli N, Moroso M, Lacroix O, Jourjon O, Barron S, Vallve A, Duthey A, Jacquot F, Barrot L, Dirheimer M, Raoul H, Nougier C, Baize S. Hemostasis defects underlying the hemorrhagic syndrome caused by mammarenaviruses in a cynomolgus macaque model. Blood 2023; 142:2092-2104. [PMID: 37699247 DOI: 10.1182/blood.2023020351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Viral hemorrhagic fevers (HF) are a group of acute febrile diseases with high mortality rates. Although hemostatic dysfunction appears to be a major determinant of the severity of the disease, it is still unclear what pathogenic mechanisms lead to it. In clinical studies it is found that arenaviruses, such as Lassa, Machupo, and Guanarito viruses cause HF that vary in symptoms and biological alterations. In this study we aimed to characterize the hemostatic dysfunction induced by arenaviral HF to determine its implication in the severity of the disease and to elucidate the origin of this syndrome. We found that lethal infection with Machupo, Guanarito, and Lassa viruses is associated with cutaneomucosal, cerebral, digestive, and pulmonary hemorrhages. The affected animals developed a severe alteration of the coagulation system, which was concomitant with acute hepatitis, minor deficit of hepatic factor synthesis, presence of a plasmatic inhibitor of coagulation, and dysfunction of the fibrinolytic system. Despite signs of increased vascular permeability, endothelial cell infection was not a determinant factor of the hemorrhagic syndrome. There were also alterations of the primary hemostasis during lethal infection, with moderate to severe thrombocytopenia and platelet dysfunction. Finally, we show that lethal infection is accompanied by a reduced hematopoietic potential of the bone marrow. This study provides an unprecedented characterization of the hemostasis defects induced by several highly pathogenic arenaviruses.
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Affiliation(s)
- Blaise Lafoux
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Nicolas Baillet
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Caroline Picard
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Gustave Fourcaud
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Virginie Borges-Cardoso
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Stéphanie Reynard
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Alexandra Journeaux
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Clara Germain
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Emeline Perthame
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, Paris, France
| | - Mathieu Mateo
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Jimmy Hortion
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Xavier Carnec
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
| | - Natalia Pietrosemoli
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, Paris, France
| | - Marie Moroso
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Orianne Lacroix
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Ophélie Jourjon
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Stéphane Barron
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Audrey Vallve
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Aurélie Duthey
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | | | - Laura Barrot
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Manon Dirheimer
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Hervé Raoul
- Laboratoire P4 INSERM-Jean Mérieux, INSERM US003, Lyon, France
| | - Christophe Nougier
- Service d'hématologie Biologique, Centre de Pathologie et Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Sylvain Baize
- Unité de Biologie des Infections Virales Emergentes, Institut Pasteur, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Lyon, France
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3
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Grant DS, Samuels RJ, Garry RF, Schieffelin JS. Lassa Fever Natural History and Clinical Management. Curr Top Microbiol Immunol 2023. [PMID: 37106159 DOI: 10.1007/82_2023_263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Lassa fever is caused by Lassa virus (LASV), an Old World Mammarenavirus that is carried by Mastomys natalensis and other rodents. It is endemic in Sierra Leone, Nigeria, and other countries in West Africa. The clinical presentation of LASV infection is heterogenous varying from an inapparent or mild illness to a fatal hemorrhagic fever. Exposure to LASV is usually through contact with rodent excreta. After an incubation period of 1-3 weeks, initial symptoms such as fever, headache, and fatigue develop that may progress to sore throat, retrosternal chest pain, conjunctival injection, vomiting, diarrhea, and abdominal pain. Severe illness, including hypotension, shock, and multiorgan failure, develops in a minority of patients. Patient demographics and case fatality rates are distinctly different in Sierra Leone and Nigeria. Laboratory diagnosis relies on the detection of LASV antigens or genomic RNA. LASV-specific immunoglobulin G and M assays can also contribute to clinical management. The mainstay of treatment for Lassa fever is supportive care. The nucleoside analog ribavirin is commonly used to treat acute Lassa fever but is considered useful only if treatment is begun early in the disease course. Drugs in development, including a monoclonal antibody cocktail, have the potential to impact the management of Lassa fever.
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Affiliation(s)
- Donald S Grant
- Lassa Fever Program, Kenema Government Hospital, Ministry of Health, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Robert J Samuels
- Lassa Fever Program, Kenema Government Hospital, Ministry of Health, Kenema, Sierra Leone
| | - Robert F Garry
- School of Medicine, Department of Microbiology and Immunology, Tulane University, New Orleans, LA, 70112, USA
- Zalgen Labs, Frederick, MD, 21703, USA
- Global Virus Network (GVN), Baltimore, MD, 21201, USA
| | - John S Schieffelin
- School of Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, 70112, USA.
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Schrottmaier WC, Schmuckenschlager A, Pirabe A, Assinger A. Platelets in Viral Infections - Brave Soldiers or Trojan Horses. Front Immunol 2022; 13:856713. [PMID: 35419008 PMCID: PMC9001014 DOI: 10.3389/fimmu.2022.856713] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Viral infections are often associated with platelet activation and haemostatic complications. In line, low platelet counts represent a hallmark for poor prognosis in many infectious diseases. The underlying cause of platelet dysfunction in viral infections is multifaceted and complex. While some viruses directly interact with platelets and/or megakaryocytes to modulate their function, also immune and inflammatory responses directly and indirectly favour platelet activation. Platelet activation results in increased platelet consumption and degradation, which contributes to thrombocytopenia in these patients. The role of platelets is often bi-phasic. Initial platelet hyper-activation is followed by a state of platelet exhaustion and/or hypo-responsiveness, which together with low platelet counts promotes bleeding events. Thereby infectious diseases not only increase the thrombotic but also the bleeding risk or both, which represents a most dreaded clinical complication. Treatment options in these patients are limited and new therapeutic strategies are urgently needed to prevent adverse outcome. This review summarizes the current literature on platelet-virus interactions and their impact on viral pathologies and discusses potential intervention strategies. As pandemics and concomitant haemostatic dysregulations will remain a recurrent threat, understanding the role of platelets in viral infections represents a timely and pivotal challenge.
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Affiliation(s)
- Waltraud C Schrottmaier
- Institute of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anna Schmuckenschlager
- Institute of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Anita Pirabe
- Institute of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alice Assinger
- Institute of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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5
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Merson L, Bourner J, Jalloh S, Erber A, Salam AP, Flahault A, Olliaro PL. Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design. PLoS Negl Trop Dis 2021; 15:e0009788. [PMID: 34547033 PMCID: PMC8486098 DOI: 10.1371/journal.pntd.0009788] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature. METHODOLOGY Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics. RESULTS 147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications). CONCLUSION Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.
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Affiliation(s)
- Laura Merson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Josephine Bourner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Astrid Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Piero L. Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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6
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Strampe J, Asogun DA, Speranza E, Pahlmann M, Soucy A, Bockholt S, Pallasch E, Becker-Ziaja B, Duraffour S, Bhadelia N, Ighodalo Y, Oyakhilome J, Omomoh EO, Olokor T, Adomeh DI, Ikponwonsa O, Aire C, Tobin E, Akpede N, Okokhere PO, Okogbenin SA, Akpede GO, Muñoz-Fontela C, Ogbaini-Emovon E, Günther S, Connor JH, Oestereich L. Factors associated with progression to death in patients with Lassa fever in Nigeria: an observational study. THE LANCET. INFECTIOUS DISEASES 2021; 21:876-886. [PMID: 33484646 DOI: 10.1016/s1473-3099(20)30737-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lassa fever is endemic in several west African countries. Case-fatality rates ranging from 21% to 69% have been reported. The pathophysiology of the disease in humans and determinants of mortality remain poorly understood. We aimed to determine host protein biomarkers capable of determining disease outcome. METHODS In this observational study, we analysed left-over blood samples from patients who tested positive for Lassa fever at Irrua Specialist Teaching Hospital, Nigeria, between January, 2014, and April, 2017. We measured viral load, concentrations of clinical chemistry parameters, and levels of 62 circulating proteins involved in inflammation, immune response, and haemostasis. Patients with a known outcome (survival or death) and at least 200 μL of good-quality diagnostic sample were included in logistic regression modelling to assess the correlation of parameters with Lassa fever outcome. Individuals who gave consent could further be enrolled into a longitudinal analysis to assess the association of parameters with Lassa fever outcome over time. Participants were divided into two datasets for the statistical analysis: a primary dataset (samples taken between Jan 1, 2014, and April 1, 2016), and a secondary dataset (samples taken between April 1, 2016, and April 1, 2017). Biomarkers were ranked by area under the receiver operating characteristic curve (AUC) from highest (most predictive) to lowest (least predictive). FINDINGS Of 554 patients who tested positive for Lassa fever during the study period, 201 (131 in the primary dataset and 70 in the secondary dataset) were included in the biomarker analysis, of whom 74 (49 in the primary dataset and 25 in the secondary dataset) had died and 127 (82 in the primary dataset and 45 in the secondary dataset) had survived. Cycle threshold values (indicating viral load) and levels of 18 host proteins at the time of admission to hospital were significantly correlated with fatal outcome. The best predictors of outcome in both datasets were plasminogen activator inhibitor-1 (PAI-1; AUC 0·878 in the primary dataset and 0·876 in the secondary dataset), soluble thrombomodulin (TM; 0·839 in the primary dataset and 0·875 in the secondary dataset), and soluble tumour necrosis factor receptor superfamily member 1A (TNF-R1; 0·807 in the primary dataset and 0·851 in the secondary dataset), all of which had higher prediction accuracy than viral load (0·774 in the primary dataset and 0·837 in the secondary dataset). Longitudinal analysis (150 patients, of whom 36 died) showed that of the biomarkers that were predictive at admission, PAI-1 levels consistently decreased to normal levels in survivors but not in those who died. INTERPRETATION The identification of PAI-1 and soluble TM as markers of fatal Lassa fever at admission, and of PAI-1 as a marker of fatal Lassa fever over time, suggests that dysregulated coagulation and fibrinolysis and endothelial damage have roles in the pathophysiology of Lassa fever, providing a mechanistic explanation for the association of Lassa fever with oedema and bleeding. These novel markers might aid in clinical risk stratification and disease monitoring. FUNDING German Research Foundation, Leibniz Association, and US National Institutes of Health.
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Affiliation(s)
- Jamie Strampe
- Bioinformatics Program, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Danny A Asogun
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Emily Speranza
- Bioinformatics Program, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA; National Institutes of Health, National Institute of Allergy and Infectious disease, Laboratory of Virology, Laboratory of Immune System Biology, Bethesda, MD, USA
| | - Meike Pahlmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Ali Soucy
- Department of Microbiology, School of Medicine, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Sabrina Bockholt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Elisa Pallasch
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Beate Becker-Ziaja
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany; Robert Koch Institute, Berlin, Germany
| | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Nahid Bhadelia
- National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Yemisi Ighodalo
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - Thomas Olokor
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | - Odia Ikponwonsa
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Aire
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekaete Tobin
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Nosa Akpede
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - George O Akpede
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - John H Connor
- Bioinformatics Program, Boston University, Boston, MA, USA; Department of Microbiology, School of Medicine, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA.
| | - Lisa Oestereich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany.
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7
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Gale TV, Schieffelin JS, Branco LM, Garry RF, Grant DS. Elevated L-threonine is a biomarker for Lassa fever and Ebola. Virol J 2020; 17:188. [PMID: 33243278 PMCID: PMC7690152 DOI: 10.1186/s12985-020-01459-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022] Open
Abstract
Background Lassa fever and Ebola are characterized by non-specific initial presentations that can progress to severe multisystem illnesses with high fatality rates. Samples from additional subjects are examined to extend and corroborate biomarkers with prognostic value for these diseases. Methods Liquid Chromatography Mass Spectrometry metabolomics was used to identify and confirm metabolites disrupted in the blood of Lassa fever and Ebola patients. Authenticated standards are used to confirm the identify of key metabolites. Results We confirm prior results by other investigators that the amino acid l-threonine is elevated during Ebola virus infection. l-Threonine is also elevated during Lassa virus infection. We also confirmed that platelet-activating factor (PAF) and molecules with PAF moiety are reduced in the blood of patients with fatal Lassa fever. Similar changes in PAF and PAF-like molecules were not observed in the blood of Ebola patients. Conclusions Metabolomics may provide tools to identify pathways that are differentially affected during viral hemorrhagic fevers and guide development of diagnostics to monitor and predict outcome.
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Affiliation(s)
- Trevor V Gale
- Department of Microbiology and Immunology, Tulane University, 1430 Tulane Avenue, JBJ568, New Orleans, LA, 70112, USA.,Ansun Biopharma, San Diego, CA, 92121, USA
| | - John S Schieffelin
- Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, LA, USA
| | | | - Robert F Garry
- Department of Microbiology and Immunology, Tulane University, 1430 Tulane Avenue, JBJ568, New Orleans, LA, 70112, USA. .,Zalgen Labs, LLC, Germantown, MD, USA.
| | - Donald S Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone. .,Ministry of Health and Sanitation, Freetown, Sierra Leone.
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8
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Horton LE, Cross RW, Hartnett JN, Engel EJ, Sakabe S, Goba A, Momoh M, Sandi JD, Geisbert TW, Garry RF, Schieffelin JS, Grant DS, Sullivan BM. Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever. Emerg Infect Dis 2020; 26:2625-2637. [PMID: 33079033 PMCID: PMC7588510 DOI: 10.3201/eid2611.191694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lassa fever (LF) causes multisystem disease and has a fatality rate <70%. Severe cases exhibit abnormal coagulation, endothelial barrier disruption, and dysfunctional platelet aggregation but the underlying mechanisms remain poorly understood. In Sierra Leone during 2015-2018, we assessed LF patients' day-of-admission plasma samples for levels of proteins necessary for coagulation, fibrinolysis, and platelet function. P-selectin, soluble endothelial protein C receptor, soluble thrombomodulin, plasminogen activator inhibitor 1, ADAMTS-13, von Willebrand factor, tissue factor, soluble intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 were more elevated in LF patients than in controls. Endothelial protein C receptor, thrombomodulin, intercellular adhesion molecule 1, plasminogen activator inhibitor 1, D-dimer, and hepatocyte growth factor were higher in fatal than nonfatal LF cases. Platelet disaggregation occurred only in samples from fatal LF cases. The impaired homeostasis and platelet dysfunction implicate alterations in the protein C pathway, which might contribute to the loss of endothelial barrier function in fatal infections.
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Abstract
Lassa fever was first described as a clinical entity fifty years ago. The causative agent Lassa virus was isolated from these first known cases. This chapter reviews the key publications on Lassa fever research that appeared in the scientific literature at that time and over the ensuing decades.
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Affiliation(s)
- Robert F Garry
- Department of Microbiology and Immunology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70118, USA. .,Zalgen Labs, LLC, 20271 Goldenrod Lane, Suite 2083, Germantown, MD, 20876, USA.
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10
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Garnett LE, Strong JE. Lassa fever: With 50 years of study, hundreds of thousands of patients and an extremely high disease burden, what have we learned? Curr Opin Virol 2019; 37:123-131. [PMID: 31479990 DOI: 10.1016/j.coviro.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Lauren E Garnett
- Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Canada; Departments of Medical Microbiology and Infectious Diseases, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James E Strong
- Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Canada; Departments of Medical Microbiology and Infectious Diseases, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Departments of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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11
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Fletcher TE, Leblebicioglu H, Bozkurt I, Sunbul M, Bilek H, Asik Z, Barut S, Gunes F, Gemici U, Hewson R, Wilson D, O'Shea MK, Woolley T, Faragher B, Parmar K, Lalloo DG, Beeching NJ, Hunt BJ. Rotational thromboelastometry alongside conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2019; 19:862-871. [PMID: 31262565 PMCID: PMC7641897 DOI: 10.1016/s1473-3099(19)30112-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data describing the coagulopathy of Crimean-Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease. METHODS We did a prospective observational cohort study of adults aged 18 years and older and admitted to hospitals with PCR-confirmed Crimean-Congo haemorrhagic fever in Samsun and Tokat, Turkey. Demographic, clinical, and laboratory data were collected and blood samples for ROTEM analysis and coagulation testing were drawn at admission and during hospital admission and convalescence (up to 30 days after onset of illness). For the ROTEM analysis we recorded the following extrinsically activated ROTEM (EXTEM S) variables, with normal ranges indicated: clotting time (38-79 s), clot formation time (34-159 s), amplitude at 10 min after clotting time (43-65 mm), maximum clot firmness (50-72 mm), and maximum lysis (>15% at 1 h). The following fibrin-specific ROTEM (FIBTEM S) variables were also recorded: amplitude at 10 min after clotting time (normal range 7-23 mm) and maximum clot firmness (9-25 mm). Disease severity was assessed by Swanepoel criteria, severity grading score (SGS), and the severity scoring index (SSI), with mild disease defined as meeting no Swanepoel criteria, graded mild by SSI, and graded low risk by SGS. FINDINGS Between May 27, 2015, and Aug 2, 2015, 65 patients with confirmed Crimean-Congo haemorrhagic fever were recruited and had blood taken at 110 time points. Most were male (40 [62%] of 65) with mild disease (49 [75%] of 65). Haemorrhage occurred in 13 (20%; 95% CI 11·1-31·8) of 65 patients and 23 (35%) of 65 received blood products (15 received fresh frozen plasma and eight received red blood cell concentrates), and 21 patients received platelet transfusions. At admission, the following EXTEM S variables differed significantly between mild cases and moderate to severe cases: median clotting time 56 s (range 42-81; IQR 48-64) versus 69 s (range 48-164; IQR 54-75; p=0·01); mean amplitude at 10 min after clotting time 45·1 mm (SD 7·0) versus 33·9 mm (SD 8·6; p<0·0001); median clot formation time 147 s (range 72-255; IQR 101-171) versus 197 s (range 98-418; IQR 156-296; p=0·006); and maximum clot firmness 54·4 mm (SD 7·2) versus 45·1 mm (SD 12·5; p=0·003). The EXTEM S variables were compared at different time points; maximum clot firmness (p=0·024) and amplitude at 10 min after clotting time (p=0·090) were lowest on days 4-6 of illness. We found no significant differences in FIBTEM variables between mild and moderate to severe cases (median amplitude at 10 min, 13 mm [range 8-20; IQR 11-15] vs 12 mm [range 6-25; IQR 10-15; p=0·68]; and median maximum clot firmness, 15 mm [range 9-60; IQR 13-21] vs 17 mm [range 7-39; IQR 13-23; p=0·21]); and no hyperfibrinolysis (maximum lysis >15%). INTERPRETATION Coagulopathy of Crimean-Congo haemorrhagic fever is related to defects in clot development and stabilisation that are more marked in severe disease than in mild disease. The combination of normal and slightly deranged coagulation screens and FIBTEM results with the absence of hyperfibrinolysis suggests that the coagulopathy of Crimean-Congo haemorrhagic fever relates to platelet dysfunction. FUNDING Wellcome Trust, UK Ministry of Defence, and National Institute for Health Research Health Protection Research Unit.
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Affiliation(s)
- Tom E Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK; Ondokuz Mayis University, Samsun, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | | - Tom Woolley
- Royal Centre for Defence Medicine, Birmingham, UK
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kiran Parmar
- Haemostasis Research Unit, Guy's and St Thomas' Foundation Trust, London, UK
| | - David G Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Nick J Beeching
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Beverley J Hunt
- Haemostasis Research Unit, Guy's and St Thomas' Foundation Trust, London, UK
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12
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Scarlatescu E, Lance MD. Crimean–Congo haemorrhagic fever: test early with ROTEM? THE LANCET. INFECTIOUS DISEASES 2019; 19:796-797. [DOI: 10.1016/s1473-3099(19)30298-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
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13
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Sigfrid L, Moore C, Salam AP, Maayan N, Hamel C, Garritty C, Lutje V, Buckley B, Soares-Weiser K, Marshall R, Clarke M, Horby P. A rapid research needs appraisal methodology to identify evidence gaps to inform clinical research priorities in response to outbreaks-results from the Lassa fever pilot. BMC Med 2019; 17:107. [PMID: 31185979 PMCID: PMC6560772 DOI: 10.1186/s12916-019-1338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/01/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Infectious disease epidemics are a constant threat, and while we can strengthen preparedness in advance, inevitably, we will sometimes be caught unaware by novel outbreaks. To address the challenge of rapidly identifying clinical research priorities in those circumstances, we developed and piloted a protocol for carrying out a systematic, rapid research needs appraisal (RRNA) of existing evidence within 5 days in response to outbreaks globally, with the aim to inform clinical research prioritization. METHODS The protocol was derived from rapid review methodologies and optimized through effective use of pre-defined templates and global time zones. It was piloted using a Lassa fever (LF) outbreak scenario. Databases were searched from 1969 to July 2017. Systematic reviewers based in Canada, the UK, and the Philippines screened and extracted data using a systematic review software. The pilot was evaluated through internal analysis and by comparing the research priorities identified from the data, with those identified by an external LF expert panel. RESULTS The RRNA pilot was completed within 5 days. To accommodate the high number of articles identified, data extraction was prioritized by study design and year, and the clinical research prioritization done post-day 5. Of 118 potentially eligible articles, 52 met the data extraction criteria, of which 46 were extracted within the 5-day time frame. The RRNA team identified 19 clinical research priorities; the expert panel independently identified 21, of which 11 priorities overlapped. Each method identified a unique set of priorities, showing that combining both methods for clinical research prioritization is more robust than using either method alone. CONCLUSIONS This pilot study shows that it is feasible to carry out a systematic RRNA within 5 days in response to a (re-) emerging outbreak to identify gaps in existing evidence, as long as sufficient resources are identified, and reviewers are experienced and trained in advance. Use of an online systematic review software and global time zones effectively optimized resources. Another 3 to 5 days are recommended for review of the extracted data and to formulate clinical research priorities. The RRNA can be used for a "Disease X" scenario and should optimally be combined with an expert panel to ensure breadth and depth of coverage of clinical research priorities.
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Affiliation(s)
- Louise Sigfrid
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Catrin Moore
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Alex P Salam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- United Kingdom Public Health Rapid Support Team, London, UK
| | | | - Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vittoria Lutje
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Brian Buckley
- Department of Surgery, Philippine General Hospital, National University of the Philippines, Manila, Philippines
| | - Karla Soares-Weiser
- Editorial & Methods Department, Cochrane Central Executive, Cochrane, London, UK
| | | | - Mike Clarke
- Evidence Aid, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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14
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Zapata JC, Medina-Moreno S, Guzmán-Cardozo C, Salvato MS. Improving the Breadth of the Host's Immune Response to Lassa Virus. Pathogens 2018; 7:E84. [PMID: 30373278 PMCID: PMC6313495 DOI: 10.3390/pathogens7040084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/20/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022] Open
Abstract
In 2017, the global Coalition for Epidemic Preparedness (CEPI) declared Lassa virus disease to be one of the world's foremost biothreats. In January 2018, World Health Organization experts met to address the Lassa biothreat. It was commonly recognized that the diversity of Lassa virus (LASV) isolated from West African patient samples was far greater than that of the Ebola isolates from the West African epidemic of 2013⁻2016. Thus, vaccines produced against Lassa virus disease face the added challenge that they must be broadly-protective against a wide variety of LASV. In this review, we discuss what is known about the immune response to Lassa infection. We also discuss the approaches used to make broadly-protective influenza vaccines and how they could be applied to developing broad vaccine coverage against LASV disease. Recent advances in AIDS research are also potentially applicable to the design of broadly-protective medical countermeasures against LASV disease.
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Affiliation(s)
- Juan Carlos Zapata
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Sandra Medina-Moreno
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Camila Guzmán-Cardozo
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Maria S Salvato
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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15
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Lymphocytic choriomeningitis virus Clone 13 infection causes either persistence or acute death dependent on IFN-1, cytotoxic T lymphocytes (CTLs), and host genetics. Proc Natl Acad Sci U S A 2018; 115:E7814-E7823. [PMID: 30061383 DOI: 10.1073/pnas.1804674115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Understanding of T cell exhaustion and successful therapy to restore T cell function was first described using Clone (Cl) 13 variant selected from the lymphocytic choriomeningitis virus (LCMV) Armstrong (ARM) 53b parental strain. T cell exhaustion plays a pivotal role in both persistent infections and cancers of mice and humans. C57BL/6, BALB, SWR/J, A/J, 129, C3H, and all but one collaborative cross (CC) mouse strain following Cl 13 infection have immunosuppressed T cell responses, high PD-1, and viral titers leading to persistent infection and normal life spans. In contrast, the profile of FVB/N, NZB, PL/J, SL/J, and CC NZO mice challenged with Cl 13 is a robust T cell response, high titers of virus, PD-1, and Lag3 markers on T cells. These mice all die 7 to 9 d after Cl 13 infection. Death is due to enhanced pulmonary endothelial vascular permeability, pulmonary edema, collapse of alveolar air spaces, and respiratory failure. Pathogenesis involves abundant levels of Cl 13 receptor alpha-dystroglycan on endothelial cells, with high viral replication in such cells leading to immunopathologic injury. Death is aborted by blockade of interferon-1 (IFN-1) signaling or deletion of CD8 T cells.
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16
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Gale TV, Horton TM, Grant DS, Garry RF. Metabolomics analyses identify platelet activating factors and heme breakdown products as Lassa fever biomarkers. PLoS Negl Trop Dis 2017; 11:e0005943. [PMID: 28922385 PMCID: PMC5619842 DOI: 10.1371/journal.pntd.0005943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/28/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022] Open
Abstract
Lassa fever afflicts tens of thousands of people in West Africa annually. The rapid progression of patients from febrile illness to fulminant syndrome and death provides incentive for development of clinical prognostic markers that can guide case management. The small molecule profile of serum from febrile patients triaged to the Viral Hemorrhagic Fever Ward at Kenema Government Hospital in Sierra Leone was assessed using untargeted Ultra High Performance Liquid Chromatography Mass Spectrometry. Physiological dysregulation resulting from Lassa virus (LASV) infection occurs at the small molecule level. Effects of LASV infection on pathways mediating blood coagulation, and lipid, amino acid, nucleic acid metabolism are manifest in changes in the levels of numerous metabolites in the circulation. Several compounds, including platelet activating factor (PAF), PAF-like molecules and products of heme breakdown emerged as candidates that may prove useful in diagnostic assays to inform better care of Lassa fever patients. Lassa fever afflicts tens of thousands of people in West Africa each year. The disease progresses rapidly, but there are no tests available to determine which patients are at high risk for dying. We measured the levels of small molecules in the blood of febrile patients with and without infection by LASV that presented to Kenema Government Hospital in Sierra Leone using Ultra High Performance Liquid Chromatography Mass Spectrometry (LCMS), which identifies compounds based on their precise mass. Computational analyses were used to identify compounds that differed in patients with an acute LASV infection, patients with evidence of prior exposure to LASV and patients with fever, but who did not have evidence of exposure to LASV. Several serum metabolites, including factors that are involved in blood clotting and breakdown products of heme, were identified that may prove useful in diagnostic assays that will inform better care of Lassa fever patients or development of therapeutic interventions.
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Affiliation(s)
- Trevor V. Gale
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Timothy M. Horton
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America
- Zalgen Labs, LLC, Germantown, Maryland, United States of America
- Tulane Center of Excellence, Global Viral Network, New Orleans, Louisiana, United States of America
- * E-mail:
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17
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Abstract
Platelets have various roles in vascular biology and homeostasis. They are the first actor in primary haemostasis and play important roles in thrombosis pathogenesis, but they are also part of innate immunity, which initiates and accelerate many inflammatory conditions. In some contexts, their immune functions are protective, while in others they contribute to adverse inflammatory outcomes. Platelets express numerous receptors and contain hundreds of secretory molecules that are crucial for platelet functional responses. The capacity of platelets to produce and secrete cytokines, chemokines and related molecules, under the control of specific intracellular pathways, is intimately related to their key role in inflammation. They are also able to intervene in tissue regeneration and repair because they produce pro-angiogenic mediators. Due to this characteristic platelets are involved in cancer progression and spreading. In this review we discuss the complex role of platelets, which bridges haemostasis, inflammation and immune response both in physiological and pathological conditions.
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Affiliation(s)
- Maria Elisa Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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18
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Thachil J. Platelets and infections in the resource-limited countries with a focus on malaria and viral haemorrhagic fevers. Br J Haematol 2017; 177:960-970. [PMID: 28295179 DOI: 10.1111/bjh.14582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infections continue to cause a high incidence of mortality and morbidity in resource-poor nations. Although antimicrobial therapy has aided mostly in dealing with the pathogenic micro-organisms themselves, the collateral damage caused by the infections continue to cause many deaths. Intensive care support and manipulation of the hosts' abnormal response to the infection have helped to improve mortality in well-resourced countries. But, in those areas with limited resources, this is not yet the case and simpler methods of diagnosis and interventions are required. Thrombocytopenia is one of the most common manifestations in all these infections and may be used as an easily available prognostic indicator and marker for the severity of the infections. In this review, the relevance of platelets in infections in general, and specifically to tropical infections, malaria, and viral haemorrhagic fevers in the emerging countries is discussed. Better understanding of the pathophysiology and the role of platelets in particular in such conditions is likely to translate into better patient care and thus reduce morbidity and mortality.
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Affiliation(s)
- Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
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19
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Abstract
Virus–platelet interplay is complex. Diverse virus types have been shown to associate with numerous distinct platelet receptors. This association can benefit the virus or the host, and thus the platelet is somewhat of a renegade. Evidence is accumulating to suggest that viruses are capable of entering platelets. For at least one type of RNA virus (dengue virus), the platelet has the necessary post-translational and packaging machinery required for production of replicative viral progeny. As a facilitator of immunity, the platelet also participates in eradicating the virus by direct and indirect mechanisms involving presentation of the pathogen to the innate and adaptive immune systems, thus enhancing inflammation by release of cytokines and other agonists. Virus-induced thrombocytopenia is caused by tangential imbalance of thrombopoeisis, autoimmunity, and loss of platelet function and integrity.
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20
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Chabert A, Hamzeh-Cognasse H, Pozzetto B, Cognasse F, Schattner M, Gomez RM, Garraud O. Human platelets and their capacity of binding viruses: meaning and challenges? BMC Immunol 2015; 16:26. [PMID: 25913718 PMCID: PMC4411926 DOI: 10.1186/s12865-015-0092-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/03/2015] [Indexed: 01/16/2023] Open
Abstract
Blood platelets are first aimed at ensuring primary hemostasis. Beyond this role, they have been acknowledged as having functions in the maintenance of the vascular arborescence and, more recently, as being also innate immune cells, devoted notably to the detection of danger signals, of which infectious ones. Platelets express pathogen recognition receptors that can sense bacterial and viral moieties. Besides, several molecules that bind epithelial or sub-endothelial molecules and, so forth, are involved in hemostasis, happen to be able to ligate viral determinants, making platelets capable of either binding viruses or even to be infected by some of them. Further, as platelets express both Fc-receptors for Ig and complement receptors, they also bind occasionally virus-Ig or virus-Ig-complement immune complexes. Interplays of viruses with platelets are very complex and viral infections often interfere with platelet number and functions. Through a few instances of viral infections, the present review aims at presenting some of the most important interactions from pathophysiological and clinical points of view, which are observed between human viruses and platelets.
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Affiliation(s)
- Adrien Chabert
- EA3064-GIMAP, Université de Lyon, 42023, Saint-Etienne, France.
| | | | - Bruno Pozzetto
- EA3064-GIMAP, Université de Lyon, 42023, Saint-Etienne, France. .,Service des Agents infectieux et d'Hygiène, CHU de Saint-Etienne, 42055, Saint-Etienne, France.
| | - Fabrice Cognasse
- EA3064-GIMAP, Université de Lyon, 42023, Saint-Etienne, France. .,EFS Auvergne-Loire, 42023, Saint-Etienne, France.
| | - Mirta Schattner
- Laboratorio de Trombosis Experimental, Instituto de Medicina Experimental, ANM-CONICET, Buenos Aires, Argentina.
| | - Ricardo M Gomez
- Laboratorio de Virus Animales, Instituto de Biotecnología y Biología Molecular, UNLP-CONICET, La Plata, Argentina.
| | - Olivier Garraud
- EA3064-GIMAP, Université de Lyon, 42023, Saint-Etienne, France. .,Institut National de la Transfusion Sanguine, 75015, Paris, France. .,INTS, 6 rue Alexandre-Cabanel, 75015, Paris, France.
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21
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Zapata JC, Salvato MS. Genomic profiling of host responses to Lassa virus: therapeutic potential from primate to man. Future Virol 2015; 10:233-256. [PMID: 25844088 DOI: 10.2217/fvl.15.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lassa virus infection elicits distinctive changes in host gene expression and metabolism. We focus on changes in host gene expression that may be biomarkers that discriminate individual pathogens or may help to provide a prognosis for disease. In addition to assessing mRNA changes, functional studies are also needed to discriminate causes of disease from mechanisms of host resistance. Host responses that drive pathogenesis are likely to be targets for prevention or therapy. Host responses to Lassa or its related arenaviruses have been monitored in cell culture, in animal models of hemorrhagic fever, in Lassa-infected nonhuman primates and, to a limited extent, in infected human beings. Here, we describe results from those studies and discuss potential targets for reducing virus replication and mitigating disease.
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Affiliation(s)
- Juan C Zapata
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Maria S Salvato
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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22
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Assinger A. Platelets and infection - an emerging role of platelets in viral infection. Front Immunol 2014; 5:649. [PMID: 25566260 PMCID: PMC4270245 DOI: 10.3389/fimmu.2014.00649] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/05/2014] [Indexed: 12/23/2022] Open
Abstract
Platelets are anucleate blood cells that play a crucial role in the maintenance of hemostasis. While platelet activation and elevated platelet counts (thrombocytosis) are associated with increased risk of thrombotic complications, low platelet counts (thrombocytopenia) and several platelet function disorders increase the risk of bleeding. Over the last years, more and more evidence has emerged that platelets and their activation state can also modulate innate and adaptive immune responses and low platelet counts have been identified as a surrogate marker for poor prognosis in septic patients. Viral infections often coincide with platelet activation. Host inflammatory responses result in the release of platelet activating mediators and a pro-oxidative and pro-coagulant environment, which favors platelet activation. However, viruses can also directly interact with platelets and megakaryocytes and modulate their function. Furthermore, platelets can be activated by viral antigen-antibody complexes and in response to some viruses B-lymphocytes also generate anti-platelet antibodies. All these processes contributing to platelet activation result in increased platelet consumption and removal and often lead to thrombocytopenia, which is frequently observed during viral infection. However, virus-induced platelet activation does not only modulate platelet count but also shape immune responses. Platelets and their released products have been reported to directly and indirectly suppress infection and to support virus persistence in response to certain viruses, making platelets a double-edged sword during viral infections. This review aims to summarize the current knowledge on platelet interaction with different types of viruses, the viral impact on platelet activation, and platelet-mediated modulations of innate and adaptive immune responses.
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Affiliation(s)
- Alice Assinger
- Department of Physiology and Pharmacology, Medical University of Vienna , Vienna , Austria ; Department of Medicine, Center for Molecular Medicine, Karolinska University Hospital , Stockholm , Sweden
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23
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Abstract
Viral hemorrhagic fevers (VHF) are acute zoonotic diseases that, early on, seem to cause platelet destruction or dysfunction. Here we present the four major ways viruses affect platelet development and function and new evidence of molecular factors that are preferentially induced by the more pathogenic members of the families Flaviviridae, Bunyaviridae, Arenaviridae, and Filoviridae. A systematic search was performed through the main medical electronic databases using as parameters all current findings concerning platelets in VHF. Additionally, the review contains information from conference proceedings.
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Affiliation(s)
- Juan C. Zapata
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Dermot Cox
- Molecular and Cellular Therapeutics School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maria S. Salvato
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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24
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McLay L, Liang Y, Ly H. Comparative analysis of disease pathogenesis and molecular mechanisms of New World and Old World arenavirus infections. J Gen Virol 2014; 95:1-15. [PMID: 24068704 PMCID: PMC4093776 DOI: 10.1099/vir.0.057000-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/19/2013] [Indexed: 12/24/2022] Open
Abstract
Arenaviruses can cause fatal human haemorrhagic fever (HF) diseases for which vaccines and therapies are extremely limited. Both the New World (NW) and Old World (OW) groups of arenaviruses contain HF-causing pathogens. Although these two groups share many similarities, important differences with regard to pathogenicity and molecular mechanisms of virus infection exist. These closely related pathogens share many characteristics, including genome structure, viral assembly, natural host selection and the ability to interfere with innate immune signalling. However, members of the NW and OW viruses appear to use different receptors for cellular entry, as well as different mechanisms of virus internalization. General differences in disease signs and symptoms and pathological lesions in patients infected with either NW or OW arenaviruses are also noted and discussed herein. Whilst both the OW Lassa virus (LASV) and the NW Junin virus (JUNV) can cause disruption of the vascular endothelium, which is an important pathological feature of HF, the immune responses to these related pathogens seem to be quite distinct. Whereas LASV infection results in an overall generalized immune suppression, patients infected with JUNV seem to develop a cytokine storm. Additionally, the type of immune response required for recovery and clearance of the virus is different between NW and OW infections. These differences may be important to allow the viruses to evade host immune detection. Understanding these differences will aid the development of new vaccines and treatment strategies against deadly HF viral infections.
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MESH Headings
- Animals
- Arenaviridae Infections/immunology
- Arenaviridae Infections/pathology
- Arenaviridae Infections/virology
- Arenaviruses, New World/classification
- Arenaviruses, New World/genetics
- Arenaviruses, New World/immunology
- Arenaviruses, New World/pathogenicity
- Arenaviruses, Old World/classification
- Arenaviruses, Old World/genetics
- Arenaviruses, Old World/immunology
- Arenaviruses, Old World/pathogenicity
- Hemorrhagic Fevers, Viral/immunology
- Hemorrhagic Fevers, Viral/pathology
- Hemorrhagic Fevers, Viral/virology
- Humans
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Affiliation(s)
- Lisa McLay
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, MN 55108, USA
| | - Yuying Liang
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, MN 55108, USA
| | - Hinh Ly
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, MN 55108, USA
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25
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Zapata JC, Carrion R, Patterson JL, Crasta O, Zhang Y, Mani S, Jett M, Poonia B, Djavani M, White DM, Lukashevich IS, Salvato MS. Transcriptome analysis of human peripheral blood mononuclear cells exposed to Lassa virus and to the attenuated Mopeia/Lassa reassortant 29 (ML29), a vaccine candidate. PLoS Negl Trop Dis 2013; 7:e2406. [PMID: 24069471 PMCID: PMC3772037 DOI: 10.1371/journal.pntd.0002406] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 07/24/2013] [Indexed: 12/22/2022] Open
Abstract
Lassa virus (LASV) is the causative agent of Lassa Fever and is responsible for several hundred thousand infections and thousands of deaths annually in West Africa. LASV and the non-pathogenic Mopeia virus (MOPV) are both rodent-borne African arenaviruses. A live attenuated reassortant of MOPV and LASV, designated ML29, protects rodents and primates from LASV challenge and appears to be more attenuated than MOPV. To gain better insight into LASV-induced pathology and mechanism of attenuation we performed gene expression profiling in human peripheral blood mononuclear cells (PBMC) exposed to LASV and the vaccine candidate ML29. PBMC from healthy human subjects were exposed to either LASV or ML29. Although most PBMC are non-permissive for virus replication, they remain susceptible to signal transduction by virus particles. Total RNA was extracted and global gene expression was evaluated during the first 24 hours using high-density microarrays. Results were validated using RT-PCR, flow cytometry and ELISA. LASV and ML29 elicited differential expression of interferon-stimulated genes (ISG), as well as genes involved in apoptosis, NF-kB signaling and the coagulation pathways. These genes could eventually serve as biomarkers to predict disease outcomes. The remarkable differential expression of thrombomodulin, a key regulator of inflammation and coagulation, suggests its involvement with vascular abnormalities and mortality in Lassa fever disease. The virulent Lassa fever virus (LASV) and the non-pathogenic Mopeia virus (MOPV) infect rodents and, incidentally, people in West Africa. The mechanism of LASV damage in human beings is unclear. There is no licensed Lassa fever vaccine and therapeutic intervention is usually too late. The ML29 vaccine candidate derived from Lassa and Mopeia viruses protects rodents and primates from Lassa fever disease. Peripheral blood mononuclear cells from healthy human subjects were exposed to either LASV or ML29 in order to identify early cellular responses that could be attributed to the difference in virulence between the two viruses. Differential expression of interferon-stimulated genes as well as coagulation-related genes could lead to an explanation for Lassa fever pathogenesis and indicate protective treatments for Lassa fever disease.
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Affiliation(s)
- Juan Carlos Zapata
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Pathogenic mechanisms involved in the hematological alterations of arenavirus-induced hemorrhagic fevers. Viruses 2013; 5:340-51. [PMID: 23337384 PMCID: PMC3564124 DOI: 10.3390/v5010340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 11/17/2022] Open
Abstract
Viral hemorrhagic fevers (VHFs) caused by arenaviruses are acute diseases characterized by fever, headache, general malaise, impaired cellular immunity, eventual neurologic involvement, and hemostatic alterations that may ultimately lead to shock and death. The causes of the bleeding are still poorly understood. However, it is generally accepted that these causes are associated to some degree with impaired hemostasis, endothelial cell dysfunction and low platelet counts or function. In this article, we present the current knowledge about the hematological alterations present in VHF induced by arenaviruses, including new aspects on the underlying pathogenic mechanisms.
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Goeijenbier M, van Wissen M, van de Weg C, Jong E, Gerdes VEA, Meijers JCM, Brandjes DPM, van Gorp ECM. Review: Viral infections and mechanisms of thrombosis and bleeding. J Med Virol 2013; 84:1680-96. [PMID: 22930518 PMCID: PMC7166625 DOI: 10.1002/jmv.23354] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Viral infections are associated with coagulation disorders. All aspects of the coagulation cascade, primary hemostasis, coagulation, and fibrinolysis, can be affected. As a consequence, thrombosis and disseminated intravascular coagulation, hemorrhage, or both, may occur. Investigation of coagulation disorders as a consequence of different viral infections have not been performed uniformly. Common pathways are therefore not fully elucidated. In many severe viral infections there is no treatment other than supportive measures. A better understanding of the pathophysiology behind the association of viral infections and coagulation disorders is crucial for developing therapeutic strategies. This is of special importance in case of severe complications, such as those seen in hemorrhagic viral infections, the incidence of which is increasing worldwide. To date, only a few promising targets have been discovered, meaning the implementation in a clinical context is still hampered. This review discusses non‐hemorrhagic and hemorrhagic viruses for which sufficient data on the association with hemostasis and related clinical features is available. This will enable clinicians to interpret research data and place them into a perspective. J. Med. Virol. 84:1680–1696, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- M Goeijenbier
- Department of Virology, Erasmus Medical Centre, University of Rotterdam, Rotterdam, The Netherlands.
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Zapata JC, Pauza CD, Djavani MM, Rodas JD, Moshkoff D, Bryant J, Ateh E, Garcia C, Lukashevich IS, Salvato MS. Lymphocytic choriomeningitis virus (LCMV) infection of macaques: a model for Lassa fever. Antiviral Res 2011; 92:125-38. [PMID: 21820469 DOI: 10.1016/j.antiviral.2011.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/07/2011] [Accepted: 07/18/2011] [Indexed: 12/14/2022]
Abstract
Arenaviruses such as Lassa fever virus (LASV) and lymphocytic choriomeningitis virus (LCMV) are benign in their natural reservoir hosts, and can occasionally cause severe viral hemorrhagic fever (VHF) in non-human primates and in human beings. LCMV is considerably more benign for human beings than Lassa virus, however certain strains, like the LCMV-WE strain, can cause severe disease when the virus is delivered as a high-dose inoculum. Here we describe a rhesus macaque model for Lassa fever that employs a virulent strain of LCMV. Since LASV must be studied within Biosafety Level-4 (BSL-4) facilities, the LCMV-infected macaque model has the advantage that it can be used at BSL-3. LCMV-induced disease is rarely as severe as other VHF, but it is similar in cases where vascular leakage leads to lethal systemic failure. The LCMV-infected macaque has been valuable for describing the course of disease with differing viral strains, doses and routes of infection. By monitoring system-wide changes in physiology and gene expression in a controlled experimental setting, it is possible to identify events that are pathognomonic for developing VHF and potential treatment targets.
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Affiliation(s)
- Juan C Zapata
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
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Abstract
Viral hemorrhagic fevers (VHFs) caused by arenaviruses belong to the most devastating emerging human diseases and represent serious public health problems. Arenavirus VHFs in humans are acute diseases characterized by fever and, in severe cases, different degrees of hemorrhages associated with a shock syndrome in the terminal stage. Over the past years, much has been learned about the pathogenesis of arenaviruses at the cellular level, in particular their ability to subvert the host cell's innate antiviral defenses. Clinical studies and novel animal models have provided important new information about the interaction of hemorrhagic arenaviruses with the host's adaptive immune system, in particular virus-induced immunosuppression, and have provided the first hints towards an understanding of the terminal hemorrhagic shock syndrome. The scope of this article is to review our current knowledge on arenavirus VHF pathogenesis with an emphasis on recent developments.
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Affiliation(s)
- Marie-Laurence Moraz
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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Pozner RG, Ure AE, Jaquenod de Giusti C, D'Atri LP, Italiano JE, Torres O, Romanowski V, Schattner M, Gómez RM. Junín virus infection of human hematopoietic progenitors impairs in vitro proplatelet formation and platelet release via a bystander effect involving type I IFN signaling. PLoS Pathog 2010; 6:e1000847. [PMID: 20419155 PMCID: PMC2855331 DOI: 10.1371/journal.ppat.1000847] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 03/05/2010] [Indexed: 12/19/2022] Open
Abstract
Argentine hemorrhagic fever (AHF) is an endemo-epidemic disease caused by Junín virus (JUNV), a member of the arenaviridae family. Although a recently introduced live attenuated vaccine has proven to be effective, AHF remains a potentially lethal infection. Like in other viral hemorrhagic fevers (VHF), AHF patients present with fever and hemorrhagic complications. Although the causes of the bleeding are poorly understood, impaired hemostasis, endothelial cell dysfunction and low platelet counts have been described. Thrombocytopenia is a common feature in VHF syndromes, and it is a major sign for its diagnosis. However, the underlying pathogenic mechanism has not yet been elucidated. We hypothesized that thrombocytopenia results from a viral-triggered alteration of the megakaryo/thrombopoiesis process. Therefore, we evaluated the impact of JUNV on megakaryopoiesis using an in vitro model of human CD34+ cells stimulated with thrombopoietin. Our results showed that CD34+ cells are infected with JUNV in a restricted fashion. Infection was transferrin receptor 1 (TfR1)-dependent and the surface expression of TfR1 was higher in infected cultures, suggesting a novel arenaviral dissemination strategy in hematopoietic progenitor cells. Although proliferation, survival, and commitment in JUNV-infected cultures were normal, viral infection impaired thrombopoiesis by decreasing in vitro proplatelet formation, platelet release, and P-selectin externalization via a bystander effect. The decrease in platelet release was also TfR1-dependent, mimicked by poly(I:C), and type I interferon (IFN α/β) was implicated as a key paracrine mediator. Among the relevant molecules studied, only the transcription factor NF-E2 showed a moderate decrease in expression in megakaryocytes from either infected cultures or after type I IFN treatment. Moreover, type I IFN-treated megakaryocytes presented ultrastructural abnormalities resembling the reported thrombocytopenic NF-E2−/− mouse phenotype. Our study introduces a potential mechanism for thrombocytopenia in VHF and other diseases associated with increased bone marrow type I IFN levels. Argentine hemorrhagic fever (AHF) is an endemo-epidemic disease caused by Junín virus (JUNV). Although a recently introduced live attenuated vaccine has proven to be effective, AHF remains a potentially lethal infection and JUNV is considered to be a potential biological weapon. Like other viral hemorrhagic fevers (VHF), AHF patients present fever with a combination of neurological and bleeding complications. Although the causes of the bleeding are poorly understood, impaired hemostasis and endothelial cell function as well as low platelet counts have been described. In this study, we have examined the impact of JUNV on an in vitro model of platelet production. We found that neither infection of hematopoietic progenitors with JUNV nor poly(I:C) (a double-stranded RNA that mimics viral infection) affected cell survival or megakaryocyte generation. However, these treatments triggered the main anti-viral cytokines produced by host type I IFN (IFN α/β), which acted in a paracrine fashion and led to abnormal platelet formation. Thus, this study identifies type I IFN as a new regulator that selectively affects the last steps of megakaryocyte lifespan, and it suggests a potential mechanism for thrombocytopenia in AHF and other diseases associated with increased bone marrow type I IFN levels.
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Affiliation(s)
- Roberto G. Pozner
- Department of Thrombosis and Hemostasis, Hematological Research Institute “Mariano R Castex”, National Academy of Medicine, CONICET, Buenos Aires, Argentina
| | - Agustín E. Ure
- Biotechnology and Molecular Biology Institute, CONICET-UNLP, La Plata, Argentina
| | | | - Lina P. D'Atri
- Department of Thrombosis and Hemostasis, Hematological Research Institute “Mariano R Castex”, National Academy of Medicine, CONICET, Buenos Aires, Argentina
| | - Joseph E. Italiano
- Division of Translational Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Vascular Biology, Children's Hospital Boston, Boston, Massachusetts, United States of America
| | - Oscar Torres
- Department of Thrombosis and Hemostasis, Hematological Research Institute “Mariano R Castex”, National Academy of Medicine, CONICET, Buenos Aires, Argentina
| | - Victor Romanowski
- Biotechnology and Molecular Biology Institute, CONICET-UNLP, La Plata, Argentina
| | - Mirta Schattner
- Department of Thrombosis and Hemostasis, Hematological Research Institute “Mariano R Castex”, National Academy of Medicine, CONICET, Buenos Aires, Argentina
- * E-mail: (MS); (RMG)
| | - Ricardo M. Gómez
- Biotechnology and Molecular Biology Institute, CONICET-UNLP, La Plata, Argentina
- * E-mail: (MS); (RMG)
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Djavani M, Crasta OR, Zhang Y, Zapata JC, Sobral B, Lechner MG, Bryant J, Davis H, Salvato MS. Gene expression in primate liver during viral hemorrhagic fever. Virol J 2009; 6:20. [PMID: 19216742 PMCID: PMC2657139 DOI: 10.1186/1743-422x-6-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 02/12/2009] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Rhesus macaques infected with lymphocytic choriomeningitis virus (LCMV) provide a model for human Lassa fever. Disease begins with flu-like symptoms and progresses rapidly with fatal consequences. Previously, we profiled the blood transcriptome of LCMV-infected monkeys (M. Djavani et al J. Virol. 2007) showing distinct pre-viremic and viremic stages that discriminated virulent from benign infections. In the present study, changes in liver gene expression from macaques infected with virulent LCMV-WE were compared to gene expression in uninfected monkeys as well as to monkeys that were infected but not diseased. RESULTS Based on a functional pathway analysis of differentially expressed genes, virulent LCMV-WE had a broader effect on liver cell function than did infection with non-virulent LCMV-Armstrong. During the first few days after infection, LCMV altered expression of genes associated with energy production, including fatty acid and glucose metabolism. The transcriptome profile resembled that of an organism in starvation: mRNA for acetyl-CoA carboxylase, a key enzyme of fatty acid synthesis was reduced while genes for enzymes in gluconeogenesis were up-regulated. Expression was also altered for genes associated with complement and coagulation cascades, and with signaling pathways involving STAT1 and TGF-beta. CONCLUSION Most of the 4500 differentially expressed transcripts represented a general response to both virulent and mild infections. However, approximately 250 of these transcripts had significantly different expression in virulent infections as compared to mild infections, with approximately 30 of these being differentially regulated during the pre-viremic stage of infection. The genes that are expressed early and differently in mild and virulent disease are potential biomarkers for prognosis and triage of acute viral disease.
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Affiliation(s)
- Mahmoud Djavani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Khan SH, Goba A, Chu M, Roth C, Healing T, Marx A, Fair J, Guttieri MC, Ferro P, Imes T, Monagin C, Garry RF, Bausch DG. New opportunities for field research on the pathogenesis and treatment of Lassa fever. Antiviral Res 2007; 78:103-15. [PMID: 18241935 DOI: 10.1016/j.antiviral.2007.11.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/26/2007] [Accepted: 11/06/2007] [Indexed: 12/13/2022]
Abstract
Unlike many viral hemorrhagic fevers (VHFs), Lassa fever (LF) is not a rare disease that emerges only as sporadic cases or in outbreak form. Although surveillance is inadequate to determine the true incidence, up to 300,000 infections and 5000 deaths from LF are estimated to occur yearly. The highest incidence is in the "Mano River Union (MRU) countries" of Sierra Leone, Liberia, and Guinea. Although civil unrest in this region over the past two decades has impeded capacity building and research, new-found peace in recent years presents new opportunities. In 2004, the Mano River Union Lassa Fever Network (MRU LFN) was established to assist MRU countries in the development of national and regional surveillance, diagnosis, treatment, control, and prevention of LF. Here, we review the present literature on treatment and pathogenesis of LF and outline priorities for future research in the field made possible by the improved research capacity of the MRU LFN.
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Affiliation(s)
- Sheik Humarr Khan
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
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Djavani MM, Crasta OR, Zapata JC, Fei Z, Folkerts O, Sobral B, Swindells M, Bryant J, Davis H, Pauza CD, Lukashevich IS, Hammamieh R, Jett M, Salvato MS. Early blood profiles of virus infection in a monkey model for Lassa fever. J Virol 2007; 81:7960-73. [PMID: 17522210 PMCID: PMC1951294 DOI: 10.1128/jvi.00536-07] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Acute arenavirus disease in primates, like Lassa hemorrhagic fever in humans, begins with flu-like symptoms and leads to death approximately 2 weeks after infection. Our goal was to identify molecular changes in blood that are related to disease progression. Rhesus macaques (Macaca mulatta) infected intravenously with a lethal dose of lymphocytic choriomeningitis virus (LCMV) provide a model for Lassa virus infection of humans. Blood samples taken before and during the course of infection were used to monitor gene expression changes that paralleled disease onset. Changes in blood showed major disruptions in eicosanoid, immune response, and hormone response pathways. Approximately 12% of host genes alter their expression after LCMV infection, and a subset of these genes can discriminate between virulent and non-virulent LCMV infection. Major transcription changes have been given preliminary confirmation by quantitative PCR and protein studies and will be valuable candidates for future validation as biomarkers for arenavirus disease.
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Affiliation(s)
- Mahmoud M Djavani
- Institute of Human Virology, University of Maryland Biotechnology Institute, 725 West Lombard St., Baltimore, MD 21201, USA
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Abstract
Lassa virus is a RNA virus belonging to the family of Arenaviridae. It was discovered as the causative agent of a hemorrhagic fever--Lassa fever--about 30 years ago. Lassa fever is endemic in West Africa and is estimated to affect some 100,000 people annually. Great progress in the understanding of the life cycle of arenaviruses, including Lassa virus, has been made in recent years. New insights have been gained in the pathogenesis and molecular epidemiology of Lassa fever, and state-of the-art technologies for diagnosing this life-threatening disease have been developed. The intention of this review is to summarize in particular the recent literature on Lassa virus and Lassa fever. Several aspects ranging from basic research up to clinical practice and laboratory diagnosis are discussed and linked together.
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Affiliation(s)
- Stephan Günther
- Department of Virology, Bernhard-Nocht-Institute of Tropical Medicine, Hamburg, Germany.
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Lukashevich IS, Rodas JD, Tikhonov II, Zapata JC, Yang Y, Djavani M, Salvato MS. LCMV-mediated hepatitis in rhesus macaques: WE but not ARM strain activates hepatocytes and induces liver regeneration. Arch Virol 2004; 149:2319-36. [PMID: 15338320 PMCID: PMC1361292 DOI: 10.1007/s00705-004-0385-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Accepted: 06/18/2004] [Indexed: 10/26/2022]
Abstract
Lymphocytic chorimeningitis virus (LCMV), the prototype arenavirus, and Lassa virus (LASV), causative agent of Lassa hemorrhagic fever (LHF), belong to the Old World group of the family Arenaviridae. Both viruses have extensive strain diversity and significant variations in lethality and pathogenicity for man and experimental animals. We have shown that the LHF-like infection of rhesus macaques with the WE strain of LCMV affects liver functions, induces hepatocyte proliferation, and causes a rise in IL-6 and soluble TNF receptors (sTNFR) concomitant with a rise in viremia. The levels of IL-6 and sTNFR can serve as an additional diagnostic tool for liver involvement in pathogenesis of arenavirus infection. Mucosal inoculation of rhesus macaques with LCMV-WE can result in attenuated infection with a transient viremia and liver enzyme abnormalities. The ARM strain of LCMV shares 88% amino acid homology with WE. In contrast to LCMV-WE, ARM strain does not induce manifested disease in monkeys, does not affect liver functions, and does not induce hepatocyte proliferation. Previously we demonstrated that LCMV-ARM infection protected rhesus macaques challenged with LCMV-WE. Here we have shown that the protected animals have no signs of hepatitis and hepatocyte proliferation.
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Affiliation(s)
- I S Lukashevich
- Biotechnology Center, Institute of Human Virology, University of Maryland, Baltimore, Maryland 21201, USA.
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Abstract
Lassa fever is endemic in west Africa, where it probably kills several thousand people each year. With access to the region improving, the opportunity, and the need, to improve our understanding of this disease are increasing
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Affiliation(s)
- J L Whitton
- Department of Neuropharmacology, CVN-9, Scripps Research Institute, 10550 N. Torrey Pines Road, La Jolla, CA 92037, USA
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Affiliation(s)
- J B McCormick
- University of Texas, School of Public Health, Brownsville, TX, USA
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Lukashevich IS, Djavani M, Rodas JD, Zapata JC, Usborne A, Emerson C, Mitchen J, Jahrling PB, Salvato MS. Hemorrhagic fever occurs after intravenous, but not after intragastric, inoculation of rhesus macaques with lymphocytic choriomeningitis virus. J Med Virol 2002; 67:171-86. [PMID: 11992578 PMCID: PMC2398702 DOI: 10.1002/jmv.2206] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arenaviruses can cause hemorrhagic fever and death in primates and guinea pigs, but these viruses are not highly pathogenic for most rodent carriers. In the United States, arenaviruses precipitated outbreaks of hepatitis in captive monkeys, and they present an emerging health threat in the tropical areas of Africa and South America. We describe infection of rhesus macaques with the prototype arenavirus, lymphocytic choriomeningitis virus (LCMV), using the WE strain that has been known to cause both encephalopathy and multifocal hemorrhage. Five macaques were inoculated: two by the intravenous (i.v.) and three by the intragastric (i.g.) route. Whereas the two i.v.-inoculated monkeys developed signs and lesions consistent with fatal hemorrhagic fever, the i.g.-inoculated monkeys had an attenuated infection with no disease. Pathological signs of the primate i.v. infection differ significantly from guinea pig arenavirus infections and make this a superior model for human viral hemorrhagic disease.
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Affiliation(s)
- Igor S. Lukashevich
- Institute of Human Virology, University of Maryland, Biotech Center, Baltimore, Maryland
| | - Mahmoud Djavani
- Institute of Human Virology, University of Maryland, Biotech Center, Baltimore, Maryland
| | - Juan D. Rodas
- Institute of Human Virology, University of Maryland, Biotech Center, Baltimore, Maryland
| | - Juan C. Zapata
- Institute of Human Virology, University of Maryland, Biotech Center, Baltimore, Maryland
| | - Amy Usborne
- Wisconsin Regional Primate Research Center, Madison, Wisconsin
| | - Carol Emerson
- Wisconsin Regional Primate Research Center, Madison, Wisconsin
| | - Jacque Mitchen
- Wisconsin Regional Primate Research Center, Madison, Wisconsin
| | | | - Maria S. Salvato
- Institute of Human Virology, University of Maryland, Biotech Center, Baltimore, Maryland
- Wisconsin Regional Primate Research Center, Madison, Wisconsin
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Abstract
OBJECTIVE To describe endothelial participation in the pathogenesis of viral hemorrhagic fevers and certain other acute infectious diseases. DATA EXTRACTION AND SYNTHESIS Survey of published literature on viral hemorrhagic fevers interpreted in light of observations in patients and research on those diseases. CONCLUSIONS Endothelial involvement is an extremely important factor in the clinical syndrome termed viral hemorrhagic fever. Endothelial dysfunction is important in the genesis of bleeding, which is not universal and is commonly seen only in the presence of thrombocytopenia or severe platelet dysfunction. The pathogenesis of endothelial dysfunction varies in the different diseases. In some situations, direct endothelial infection is important in increased vascular permeability, changes in the procoagulant vs. anticoagulant balance, or cytokine production. In all the viral hemorrhagic fevers studied to date, cytokine induction is an important factor and also acts on the endothelium. Poor myocardial contractility is a very important issue in viral hemorrhagic fever and is not caused by direct viral infection of the heart; it is increasingly being recognized that these patients present with low cardiac output and high peripheral resistance and that they respond poorly to fluid infusion. The clinical findings in viral hemorrhagic fever differ from those in the sepsis syndrome and should be studied and interpreted separately; this approach will sharpen therapeutic approaches and could shed light on the problems of sepsis in general.
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Affiliation(s)
- Clarence J Peters
- John Sealy Distinguished University Chair in Tropical and Emerging Virology, University of Texas Medical Branch, Galveston 77555-0609, USA.
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Abstract
Lassa fever has been estimated to cause 5,000 deaths annually in West Africa. Recently, war in the zone where Lassa fever is hyperendemic has severely impeded control and treatment. Vaccination is the most viable control measure. There is no correlation between antibody levels and outcome in human patients, and inactivated vaccines produce high titers of antibodies to all viral proteins but do not prevent virus replication and death in nonhuman primates. Accordingly, we vaccinated 44 macaques with vaccinia virus-expressed Lassa virus structural proteins separately and in combination, with the object of inducing a predominantly TH1-type immune response. Following Lassa virus challenge, all unvaccinated animals died (0% survival). Nine of 10 animals vaccinated with all proteins survived (90% survival). Although no animals that received full-length glycoprotein alone had a high titer of antibody, 17 of 19 survived challenge (88%). In contrast, all animals vaccinated with nucleoprotein developed high titers of antibody but 12 of 15 died (20% survival). All animals vaccinated with single glycoproteins, G1 or G2, died, but all those that received both single glycoproteins (G1 plus G2) at separate sites survived, showing that both glycoproteins are independently important in protection. Neither group had demonstrable antibody levels prior to challenge. We demonstrate that in primates, immune responses to epitopes on both glycoproteins are required to protect against lethal challenge with Lassa virus without having untoward side effects and that this protection is likely to be primarily cell mediated. We show that an effective, safe vaccine against Lassa virus can and should be made and that its evaluation for human populations is a matter of humanitarian priority.
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Affiliation(s)
- S P Fisher-Hoch
- Special Pathogens Branch, Division of Viral, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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42
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Chen JP, Cosgriff TM. Hemorrhagic fever virus-induced changes in hemostasis and vascular biology. Blood Coagul Fibrinolysis 2000; 11:461-83. [PMID: 10937808 DOI: 10.1097/00001721-200007000-00010] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Viral hemorrhagic fever (VHF) denotes a virus-induced acute febrile, hemorrhagic disease reported from wide areas of the world. Hemorrhagic fever (HF) viruses are encapsulated, single-stranded RNA viruses that are associated with insect or rodent vectors whose interaction with humans defines the mode of disease transmission. There are 14 HF viruses, which belong to four viral families: Arenaviridae, Bunyaviridae, Filoviridae and Flaviviridae. This review presents, in order, the following aspects of VHF: (1) epidemiology, (2) anomalies of platelets and coagulation factors, (3) vasculopathy, (4) animal models of VHFs, (5) pathogenic mechanisms, and (6) treatment and future studies. HF viruses produce the manifestations of VHFs either by direct effects on cellular functions or by activation of immune and inflammatory pathways. In Lassa fever, Rift Valley fever and Crimean-Congo HF, the main feature of fatal illness appears to be impaired/delayed cellular immunity, which leads to unchecked viremia. However, in HF with renal syndrome and dengue HF, the immune response plays an active role in disease pathogenesis. The interplay of hemostasis, immune response, and inflammation is very complex. Molecular biologic techniques and the use of animal models have helped to unravel some of these interactions.
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Affiliation(s)
- J P Chen
- Department of Medical Biology, University of Tennessee Graduate School of Medicine, Knoxville, USA.
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Gómez-Villamandos JC, Bautista MJ, Hervás J, Carrasco L, de Lara FC, Pérez J, Wilkinson PJ, Sierra MA. Subcellular changes in platelets in acute and subacute African swine fever. J Comp Pathol 1996; 115:327-41. [PMID: 9004076 DOI: 10.1016/s0021-9975(96)80069-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The morphological changes in platelets in acute and subacute African swine fever (ASF) and their relationship to pathogenesis were studied. Eight pigs were inoculated with a highly virulent strain of African swine fever (Malawi '83) and 14 with a moderately virulent strain (Dominican Republic '78) for ultrastructural study of platelets, monocyte/macrophages and vascular structures in the liver, spleen, lymph node, bone marrow, lung and kidney. Both viruses produced activation and degranulation of platelets from day 3 after inoculation onwards, coinciding with activation of the mononuclear phagocyte system and virus replication in monocyte/macrophages. Platelet aggregation and viscous metamorphosis of platelets were observed at 5 and 7 days after inoculation with the highly virulent strain, coinciding with endothelial alterations, but platelet aggregation was less prevalent and there was no sign of viscous metamorphosis in animals inoculated with the moderately virulent strain. Virions within platelets were observed at the final stage of acute ASF and at 5-7 days after inoculation in subacute ASF. This suggests that platelets assist in disseminating ASF virus within the body, especially in subacute infections.
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Affiliation(s)
- J C Gómez-Villamandos
- Departmento de Anatomía y Anatomía Patológica, Facultad de Veterinaria, Universidad de Córdoba, Spain
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Schaeffer RC, Bitrick MS, Connolly B, Jenson AB, Gong F. Pichinde virus-induced respiratory failure due to obstruction of the small airways: structure and function. Exp Lung Res 1993; 19:715-29. [PMID: 8281916 DOI: 10.3109/01902149309064367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Respiratory distress that leads to death is seen in patients with Lassa fever. The development of this respiratory problem was studied using a Pichinde virus model (10(4) plaque forming units, IP, survival time 20 +/- 1 days) in strain 13 guinea pigs (n = 35, 229-353 g) of this lethal human contagious infectious disease. Extravascular lung water to bloodless dry lung weight (EVLW/BDLW) ratio showed a modest yet significant increase in animals 13 and 18-21 days postinoculation (PI). In contrast, residual lung blood and lung radioactive 125I-labeled human serum albumin activity index were elevated only in the 18- to 21-day group. These data are consistent with the progressive severity of perivascular edema, lymphocytic pneumonitis, and some alveolar protein between days 13 and 18-21 PI. Lymphocytic pneumonitis appeared to be distributed near most airways and was proportional to the degree of Pichinde virus antigen staining of alveolar macrophages, large mononuclear cells within the pulmonary vascular and extravascular spaces, and alveolar-capillary membranes. These findings suggest that lymphocyte recruitment to the lung reflects the Pichinde virus-induced cell-mediated immune response. Obstructed small bronchi with some lumenal cell debris and hypertrophied epithelial cells were found associated with the areas of marked pneumonitis. The severe hypoxemia and modest anaerobic metabolism in association with marked tachypnea and normocapnia are consistent with small airway obstruction and wasted ventilation, since no change in arterial blood pressure, heart rate, hematocrit, hemoglobin, or blood volume was noted. These data suggest that Pichinde virus-induced respiratory failure was due to obstruction of the small airways with wasted ventilation in association with lymphocytic pneumonitis.
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Affiliation(s)
- R C Schaeffer
- Department of Physiology, University of Arizona Health Sciences Center, Tucson 85724
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Kornblihtt LI, Finocchiaro L, Molinas FC. Inhibitory effect of melatonin on platelet activation induced by collagen and arachidonic acid. J Pineal Res 1993; 14:184-91. [PMID: 8345446 DOI: 10.1111/j.1600-079x.1993.tb00501.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Melatonin, an indolamine synthesized in the pineal gland, is known to have antiprostanoid activity. The inhibition of platelet aggregation induced by melatonin has been proposed to take place through the cyclooxygenase pathway. In the present study, we found that melatonin has a marked inhibitory effect on collagen, arachidonic acid (AA), adenosine diphosphate (ADP), epinephrine, and A23187-induced aggregation in platelet-rich plasma. On the other hand, using metrizamide-filtered platelets resuspended in Tyrode's buffer, melatonin fails to suppress AA-induced platelet aggregation and 14C-5-HT release. Under the same conditions, melatonin inhibits collagen-induced platelet activation; however, the addition of threshold doses of AA (0.3 mM) abrogates this effect. These studies suggest that melatonin also inhibits platelet function at a stage preceding the cyclooxygenase-dependent pathway.
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Affiliation(s)
- L I Kornblihtt
- Instituto de Investigaciones Medicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires, Argentina
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Fisher-Hoch SP. Stringent precautionsare not advisable when caring for patients with viral hemorrhagic fevers. Rev Med Virol 1993. [DOI: 10.1002/rmv.1980030103] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstracts of the State of the Art Symposia Presented at the 24th Congress of the International Society of Haematology, London, 23–27 August 1992. Br J Haematol 1992. [DOI: 10.1111/j.1365-2141.1992.tb04619.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We report a patient with fulminant Lassa fever who responded dramatically to a 2.5-litre exchange transfusion of whole blood. On admission he was semicomatose with facial oedema and oral haemorrhage; his platelets showed markedly depressed aggregation to ADP; and his plasma inhibited the aggregation responses of normal platelets in vitro. Exchange transfusion resulted in rapid clinical improvement, recovery of platelet function, and disappearance of platelet-inhibitory activity in plasma. The patient died 2 weeks later from an acute encephalopathy. His initial response was sufficiently impressive to suggest that further evaluation of this therapeutic approach is justified in selected patients with overwhelming Lassa virus infection.
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Affiliation(s)
- D Cummins
- Department of Haematology, University College and Middlesex School of Medicine, London, UK
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Roberts PJ, Cummins D, Bainton AL, Walshe KJ, Fisher-Hoch SP, McCormick JB, Gribben JG, Machin SJ, Linch DC. Plasma from patients with severe Lassa fever profoundly modulates f-met-leu-phe induced superoxide generation in neutrophils. Br J Haematol 1989; 73:152-7. [PMID: 2554951 DOI: 10.1111/j.1365-2141.1989.tb00245.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A recurrent theme in studies of the pathology of fatal Lassa fever in man is the lack of histological lesions to explain disordered cell function and death. Recently, we demonstrated the existence of a factor in the plasma of patients with Lassa fever which markedly inhibits the aggregation responses of normal platelets in vitro. To assess whether this factor could mediate more global cellular dysfunction, we studied the effects of Lassa plasma on the respiratory burst of neutrophils. Thirteen of 15 samples from patients in the acute phase of Lassa fever profoundly inhibited the amount of superoxide generated by normal neutrophils in response to the chemotactic peptide, f-met-leu-phe (FMLP) (mean superoxide generated = 54.7 +/- 6.1% of control). In contrast, eight of nine samples from patients who had infections other than Lassa fever enhanced the neutrophil response to the peptide. All Lassa samples which inhibited the ADP-induced aggregation responses of normal platelets inhibited the neutrophil response to FMLP. Unlike the effect on platelets, however, the inhibition of neutrophils was only apparent when the cells were stimulated within 5 min of exposure to the plasma. The inhibition of neutrophils is not due to either interference with FMLP-neutrophil binding or an effect on the NADPH-oxidase, suggesting a suppression of signal transduction. Our data suggest the inhibitory factor in Lassa plasma has global effects on cellular function, and may play a central role in the pathogenesis of this often fatal illness.
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Affiliation(s)
- P J Roberts
- Department of Haematology, University College and Middlesex School of Medicine, London
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