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Plocque A, Mitri C, Lefèvre C, Tabary O, Touqui L, Philippart F. Should We Interfere with the Interleukin-6 Receptor During COVID-19: What Do We Know So Far? Drugs 2023; 83:1-36. [PMID: 36508116 PMCID: PMC9743129 DOI: 10.1007/s40265-022-01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Severe manifestations of COVID-19 consist of acute respiratory distress syndrome due to an initially local reaction leading to a systemic inflammatory response that results in hypoxia. Many therapeutic approaches have been attempted to reduce the clinical consequences of an excessive immune response to viral infection. To date, systemic corticosteroid therapy is still the most effective intervention. More recently, new hope has emerged with the use of interleukin (IL)-6 receptor inhibitors (tocilizumab and sarilumab). However, the great heterogeneity of the methodology and results of published studies obfuscate the true value of this treatment, leading to a confusing synthesis in recent meta-analyses, and the persistence of doubts in terms of patient groups and the appropriate time to treat. Moreover, their effects on the anti-infectious or pro-healing response are still poorly studied. This review aims to clarify the potential role of IL-6 receptor inhibitors in the treatment of severe forms of COVID-19.
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Affiliation(s)
- Alexia Plocque
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Christie Mitri
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne Université, Inserm, 75012, Paris, France
| | - Charlène Lefèvre
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Olivier Tabary
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne Université, Inserm, 75012, Paris, France
| | - Lhousseine Touqui
- INSERM U938 Unit, St. Antoine Research Centre, Sorbona University, Paris, France
- Mucoviscidosis and Pulmonary Disease Units, Institute Pasteur, Paris, France
- Cystic fibrosis and Bronchial diseases team-INSERM U938, Institut Pasteur, Paris, France
| | - Francois Philippart
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France.
- Endotoxins, Structures and Host Response, Department of Microbiology, Institute for Integrative Biology of the Cell, UMR 9891 CNRS-CEA-Paris Saclay University, 98190, Gif-sur-Yvette, France.
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Alagarasu K, Kaushal H, Shinde P, Kakade M, Chaudhary U, Padbidri V, Sangle SA, Salvi S, Bavdekar AR, D’costa P, Choudhary ML. TNFA and IL10 Polymorphisms and IL-6 and IL-10 Levels Influence Disease Severity in Influenza A(H1N1)pdm09 Virus Infected Patients. Genes (Basel) 2021; 12:genes12121914. [PMID: 34946862 PMCID: PMC8700762 DOI: 10.3390/genes12121914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 12/05/2022] Open
Abstract
Cytokines are key modulators of immune response, and dysregulated production of proinflammatory and anti-inflammatory cytokines contributes to the pathogenesis of influenza A(H1N1)pdm09 virus infection. Cytokine production is impacted by single nucleotide polymorphisms (SNPs) in the genes coding for them. In the present study, SNPs in the IL6, TNFA, IFNG, IL17A, IL10, and TGFB were investigated for their association with disease severity and fatality in influenza A(H1N1)pdm09-affected patients with mild disease (n = 293) and severe disease (n = 86). Among those with severe disease, 41 patients had fatal outcomes. In a subset of the patients, levels of IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL-17 were assayed in the plasma for their association with severe disease. The frequency of TNFA rs1800629 G/A allele was significantly higher in severe cases and survived severe cases group compared to that of those with mild infection (OR with 95% for mild vs. severe cases 2.95 (1.52–5.73); mild vs. survived severe cases 4.02 (1.84–8.82)). IL10 rs1800896-rs1800872 G-C haplotype was significantly lower (OR with 95% 0.34 (0.12–0.95)), while IL10 rs1800896-rs1800872 G-A haplotype was significantly higher (OR with 95% 12.11 (2.23–76.96)) in fatal cases group compared to that of the mild group. IL-6 and IL-10 levels were significantly higher in fatal cases compared to that of survived severe cases. IL-6 levels had greater discriminatory power than IL-10 to predict progression to fatal outcome in influenza A(H1N1)pdm09 virus-infected patients. To conclude, the present study reports the association of TNFA and IL10 SNPs with severe disease in Influenza A(H1N1)pdm09 virus-infected subjects. Furthermore, IL-6 levels can be a potential biomarker for predicting fatal outcomes in Influenza A(H1N1)pdm09 virus infected subjects.
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Affiliation(s)
- Kalichamy Alagarasu
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Himanshu Kaushal
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Pooja Shinde
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Mahadeo Kakade
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | - Urmila Chaudhary
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
| | | | - Shashikala A. Sangle
- Department of Medicine, BJ Medical College, Pune 411001, India; (S.A.S.); (S.S.)
| | - Sonali Salvi
- Department of Medicine, BJ Medical College, Pune 411001, India; (S.A.S.); (S.S.)
| | | | - Pradeep D’costa
- KEM Hospital Research Center, Pune 411001, India; (A.R.B.); (P.D.)
| | - Manohar Lal Choudhary
- ICMR-National Institute of Virology, Pune 411001, India; (K.A.); (H.K.); (P.S.); (M.K.); (U.C.)
- Correspondence: ; Tel.: +91-020-26006270
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Murdaca G, Paladin F, Tonacci A, Isola S, Allegra A, Gangemi S. The Potential Role of Cytokine Storm Pathway in the Clinical Course of Viral Respiratory Pandemic. Biomedicines 2021; 9:biomedicines9111688. [PMID: 34829918 PMCID: PMC8615478 DOI: 10.3390/biomedicines9111688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/10/2021] [Accepted: 11/13/2021] [Indexed: 01/01/2023] Open
Abstract
The "cytokine storm" (CS) consists of a spectrum of different immune dysregulation disorders characterized by constitutional symptoms, systemic inflammation and multiorgan dysfunction triggered by an uncontrolled immune response. Particularly in respiratory virus infections, the cytokine storm plays a primary role in the pathogenesis of respiratory disease and the clinical outcome of respiratory diseases, leading to complications such as alveolar edema and hypoxia. In this review, we wanted to analyze the different pathogenetic mechanisms involved in the various respiratory viral pandemics (COVID-19; SARS; MERS; H1N1 influenza A and Spanish flu) which have affected humans in this and last century, with particular attention to the phenomenon of the "cytokine storm" which determines the clinical severity of the respiratory disease and consequently its lethality.
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Affiliation(s)
- Giuseppe Murdaca
- Clinical Immunology Unit, Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-0103537924; Fax: +39-0105556950
| | - Francesca Paladin
- Department of Internal Medicine, University of Genoa and Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy;
| | - Stefania Isola
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (S.I.); (S.G.)
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (S.I.); (S.G.)
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Pérez-Rubio G, Ponce-Gallegos MA, Domínguez-Mazzocco BA, Ponce-Gallegos J, García-Ramírez RA, Falfán-Valencia R. Role of the Host Genetic Susceptibility to 2009 Pandemic Influenza A H1N1. Viruses 2021; 13:344. [PMID: 33671828 PMCID: PMC7926867 DOI: 10.3390/v13020344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 01/05/2023] Open
Abstract
Influenza A virus (IAV) is the most common infectious agent in humans, and infects approximately 10-20% of the world's population, resulting in 3-5 million hospitalizations per year. A scientific literature search was performed using the PubMed database and the Medical Subject Headings (MeSH) "Influenza A H1N1" and "Genetic susceptibility". Due to the amount of information and evidence about genetic susceptibility generated from the studies carried out in the last influenza A H1N1 pandemic, studies published between January 2009 to May 2020 were considered; 119 papers were found. Several pathways are involved in the host defense against IAV infection (innate immune response, pro-inflammatory cytokines, chemokines, complement activation, and HLA molecules participating in viral antigen presentation). On the other hand, single nucleotide polymorphisms (SNPs) are a type of variation involving the change of a single base pair that can mean that encoded proteins do not carry out their functions properly, allowing higher viral replication and abnormal host response to infection, such as a cytokine storm. Some of the most studied SNPs associated with IAV infection genetic susceptibility are located in the FCGR2A, C1QBP, CD55, and RPAIN genes, affecting host immune responses through abnormal complement activation. Also, SNPs in IFITM3 (which participates in endosomes and lysosomes fusion) represent some of the most critical polymorphisms associated with IAV infection, suggesting an ineffective virus clearance. Regarding inflammatory response genes, single nucleotide variants in IL1B, TNF, LTA IL17A, IL8, IL6, IRAK2, PIK3CG, and HLA complex are associated with altered phenotype in pro-inflammatory molecules, participating in IAV infection and the severest form of the disease.
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Affiliation(s)
- Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (G.P.-R.); (M.A.P.-G.); (B.A.D.-M.); (R.A.G.-R.)
| | - Marco Antonio Ponce-Gallegos
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (G.P.-R.); (M.A.P.-G.); (B.A.D.-M.); (R.A.G.-R.)
| | - Bruno André Domínguez-Mazzocco
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (G.P.-R.); (M.A.P.-G.); (B.A.D.-M.); (R.A.G.-R.)
| | - Jaime Ponce-Gallegos
- High Speciality Cardiology Unit “Korazón”, Puerta de Hierro Hospital, Tepic 63173, Nayarit, Mexico;
| | - Román Alejandro García-Ramírez
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (G.P.-R.); (M.A.P.-G.); (B.A.D.-M.); (R.A.G.-R.)
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (G.P.-R.); (M.A.P.-G.); (B.A.D.-M.); (R.A.G.-R.)
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5
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Bermejo-Martin JF, González-Rivera M, Almansa R, Micheloud D, Tedim AP, Domínguez-Gil M, Resino S, Martín-Fernández M, Ryan Murua P, Pérez-García F, Tamayo L, Lopez-Izquierdo R, Bustamante E, Aldecoa C, Gómez JM, Rico-Feijoo J, Orduña A, Méndez R, Fernández Natal I, Megías G, González-Estecha M, Carriedo D, Doncel C, Jorge N, Ortega A, de la Fuente A, Del Campo F, Fernández-Ratero JA, Trapiello W, González-Jiménez P, Ruiz G, Kelvin AA, Ostadgavahi AT, Oneizat R, Ruiz LM, Miguéns I, Gargallo E, Muñoz I, Pelegrin S, Martín S, García Olivares P, Cedeño JA, Ruiz Albi T, Puertas C, Berezo JÁ, Renedo G, Herrán R, Bustamante-Munguira J, Enríquez P, Cicuendez R, Blanco J, Abadia J, Gómez Barquero J, Mamolar N, Blanca-López N, Valdivia LJ, Fernández Caso B, Mantecón MÁ, Motos A, Fernandez-Barat L, Ferrer R, Barbé F, Torres A, Menéndez R, Eiros JM, Kelvin DJ. Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19. Crit Care 2020; 24:691. [PMID: 33317616 PMCID: PMC7734467 DOI: 10.1186/s13054-020-03398-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.
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Affiliation(s)
- Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Milagros González-Rivera
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Dariela Micheloud
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ana P Tedim
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Marta Domínguez-Gil
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. de Pozuelo, 28, 28222, Majadahonda, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Ryan Murua
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Carr. de Alcalá, s/n, 28805, Madrid, Spain
| | - Luis Tamayo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Raúl Lopez-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Elena Bustamante
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - César Aldecoa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Av. Ramón y Cajal, 47005, Valladolid, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Manuel Gómez
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jesús Rico-Feijoo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Antonio Orduña
- Microbiology Service, Hospital Clinico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Raúl Méndez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Isabel Fernández Natal
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - Gregoria Megías
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Montserrat González-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Cristina Doncel
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Noelia Jorge
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Alicia Ortega
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Amanda de la Fuente
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Félix Del Campo
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | | | - Wysali Trapiello
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Paula González-Jiménez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Guadalupe Ruiz
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Alyson A Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ali Toloue Ostadgavahi
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ruth Oneizat
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Luz María Ruiz
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Iria Miguéns
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Esther Gargallo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ioana Muñoz
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Sara Pelegrin
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Silvia Martín
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo García Olivares
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jamil Antonio Cedeño
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Tomás Ruiz Albi
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Carolina Puertas
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jose Ángel Berezo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Gloria Renedo
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Rubén Herrán
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiovascular Surgery, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Pedro Enríquez
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Ramón Cicuendez
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Jesús Blanco
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesica Abadia
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Julia Gómez Barquero
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Nuria Mamolar
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Natalia Blanca-López
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Luis Jorge Valdivia
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Belén Fernández Caso
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - María Ángeles Mantecón
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Anna Motos
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Laia Fernandez-Barat
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Ricard Ferrer
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Ferrán Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Respiratory Department, Institut Ricerca Biomedica de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - José María Eiros
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - David J Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China.
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6
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Bermejo-Martin JF, González-Rivera M, Almansa R, Micheloud D, Tedim AP, Domínguez-Gil M, Resino S, Martín-Fernández M, Ryan Murua P, Pérez-García F, Tamayo L, Lopez-Izquierdo R, Bustamante E, Aldecoa C, Gómez JM, Rico-Feijoo J, Orduña A, Méndez R, Fernández Natal I, Megías G, González-Estecha M, Carriedo D, Doncel C, Jorge N, Ortega A, de la Fuente A, Del Campo F, Fernández-Ratero JA, Trapiello W, González-Jiménez P, Ruiz G, Kelvin AA, Ostadgavahi AT, Oneizat R, Ruiz LM, Miguéns I, Gargallo E, Muñoz I, Pelegrin S, Martín S, García Olivares P, Cedeño JA, Ruiz Albi T, Puertas C, Berezo JÁ, Renedo G, Herrán R, Bustamante-Munguira J, Enríquez P, Cicuendez R, Blanco J, Abadia J, Gómez Barquero J, Mamolar N, Blanca-López N, Valdivia LJ, Fernández Caso B, Mantecón MÁ, Motos A, Fernandez-Barat L, Ferrer R, Barbé F, Torres A, Menéndez R, Eiros JM, Kelvin DJ. Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19. Crit Care 2020; 24:691. [PMID: 33317616 DOI: 10.1186/s13054‐020‐03398‐0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.
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Affiliation(s)
- Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Milagros González-Rivera
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Dariela Micheloud
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ana P Tedim
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Marta Domínguez-Gil
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. de Pozuelo, 28, 28222, Majadahonda, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Ryan Murua
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Carr. de Alcalá, s/n, 28805, Madrid, Spain
| | - Luis Tamayo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Raúl Lopez-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Elena Bustamante
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - César Aldecoa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Av. Ramón y Cajal, 47005, Valladolid, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Manuel Gómez
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jesús Rico-Feijoo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Antonio Orduña
- Microbiology Service, Hospital Clinico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Raúl Méndez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Isabel Fernández Natal
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - Gregoria Megías
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Montserrat González-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Cristina Doncel
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Noelia Jorge
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Alicia Ortega
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Amanda de la Fuente
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Félix Del Campo
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | | | - Wysali Trapiello
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Paula González-Jiménez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Guadalupe Ruiz
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Alyson A Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ali Toloue Ostadgavahi
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ruth Oneizat
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Luz María Ruiz
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Iria Miguéns
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Esther Gargallo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ioana Muñoz
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Sara Pelegrin
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Silvia Martín
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo García Olivares
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jamil Antonio Cedeño
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Tomás Ruiz Albi
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Carolina Puertas
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jose Ángel Berezo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Gloria Renedo
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Rubén Herrán
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiovascular Surgery, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Pedro Enríquez
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Ramón Cicuendez
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Jesús Blanco
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesica Abadia
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Julia Gómez Barquero
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Nuria Mamolar
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Natalia Blanca-López
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Luis Jorge Valdivia
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Belén Fernández Caso
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - María Ángeles Mantecón
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Anna Motos
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Laia Fernandez-Barat
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Ricard Ferrer
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Ferrán Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Respiratory Department, Institut Ricerca Biomedica de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - José María Eiros
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - David J Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China.
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Ortiz de Lejarazu Leonardo R, Rojo Rello S, Sanz Muñoz I. Diagnostic challenges in influenza. Enferm Infecc Microbiol Clin 2019; 37 Suppl 1:47-55. [PMID: 31138423 DOI: 10.1016/s0213-005x(19)30182-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2018 there are still microbiology laboratories that do not subtype or detect influenza viruses, one of the main agents of community-acquired pneumonia. A major challenge is to introduce multiplex-type technologies into most clinical virological diagnostic laboratories, increasing the feasibility of timely etiological diagnosis of influenza and other respiratory viruses whenever required and thus limiting antibiotic treatments. Other diagnostic tools such as markers of severity and the detection of resistance are pending challenges to complete and expand. Viral culture, an essential tool in the epidemiological surveillance of viruses, has been relegated by more sensitive and affordable molecular techniques. Sequencing of the influenza virus together with the antigenic characterisation and detection techniques of antibodies against hemagglutinin and neuraminidase will, in future, be used in tandem with other techniques to detect antibodies against other structural proteins, helping to elucidate the complicated epidemiology of these viruses and the production of new vaccines and their evaluation. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A. © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.
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Affiliation(s)
- Raúl Ortiz de Lejarazu Leonardo
- Centro Nacional de Gripe de Valladolid, Universidad de Valladolid, Valladolid, España; Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Silvia Rojo Rello
- Centro Nacional de Gripe de Valladolid, Universidad de Valladolid, Valladolid, España; Servicio de Microbiología e Inmunología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Iván Sanz Muñoz
- Centro Nacional de Gripe de Valladolid, Universidad de Valladolid, Valladolid, España
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8
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Choudhary ML, Alagarasu K, Chaudhary U, Kawale S, Malasane P, Gurav YK, Padbidri V, Kadam D, Sangle SA, Salvi S, Bavdekar AR, D'costa P, Chadha MS. Association of Single Nucleotide Polymorphisms inTNFAandIL10Genes with Disease Severity in Influenza A/H1N1pdm09 Virus Infections: A Study from Western India. Viral Immunol 2018; 31:683-688. [DOI: 10.1089/vim.2018.0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Urmila Chaudhary
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Samruddhi Kawale
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Prachi Malasane
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | - Yogesh K. Gurav
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
| | | | - Deelip Kadam
- Department of Medicine, BJ Medical College, Pune, India
| | | | - Sonali Salvi
- Department of Medicine, BJ Medical College, Pune, India
| | | | | | - Mandeep S. Chadha
- Human Influenza Group, ICMR-National Institute of Virology, Pune, India
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9
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von Mollendorf C, Hellferscee O, Valley-Omar Z, Treurnicht FK, Walaza S, Martinson NA, Lebina L, Mothlaoleng K, Mahlase G, Variava E, Cohen AL, Venter M, Cohen C, Tempia S. Influenza Viral Shedding in a Prospective Cohort of HIV-Infected and Uninfected Children and Adults in 2 Provinces of South Africa, 2012-2014. J Infect Dis 2018; 218:1228-1237. [PMID: 29800425 PMCID: PMC6498143 DOI: 10.1093/infdis/jiy310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Background Prolonged shedding of influenza viruses may be associated with increased transmissibility and resistance mutation acquisition due to therapy. We compared duration and magnitude of influenza shedding between human immunodeficiency virus (HIV)-infected and -uninfected individuals. Methods A prospective cohort study during 3 influenza seasons enrolled patients with influenza-like illness and a positive influenza rapid test. Influenza viruses were detected by real-time reverse transcription polymerase chain reaction. Weibull accelerated failure time regression models were used to describe influenza virus shedding. Mann-Whitney U tests explored initial influenza viral loads (VL). Results Influenza virus shedding duration was similar in 65 HIV-infected (6 days; interquartile range [IQR] 3-10) and 176 HIV-uninfected individuals (7 days; IQR 4-11; P = .97), as was initial influenza VL (HIV-uninfected 5.28 ± 1.33 log10 copies/mL, HIV-infected 4.73 ± 1.68 log10 copies/mL; P = .08). Adjusted for age, HIV-infected individuals with low CD4 counts shed influenza virus for longer than those with higher counts (adjusted hazard ratio 3.55; 95% confidence interval, 1.05-12.08). Discussion A longer duration of influenza virus shedding in HIV-infected individuals with low CD4 counts may suggest a possible increased risk for transmission or viral evolution in severely immunocompromised individuals. HIV-infected individuals should be prioritized for annual influenza immunization.
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Affiliation(s)
- Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Ziyaad Valley-Omar
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
- Department of Pathology, Division of Medical Virology, University of Cape Town
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Neil A Martinson
- Perinatal HIV Research Unit, Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg
| | - Limakatso Lebina
- Perinatal HIV Research Unit, Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg
| | - Katlego Mothlaoleng
- Perinatal HIV Research Unit, Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg
| | | | - Ebrahim Variava
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
- Department of Medicine, Klerksdorp Tshepong Hospital, North West Province
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Pretoria
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Pretoria
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Baicalin Downregulates RLRs Signaling Pathway to Control Influenza A Virus Infection and Improve the Prognosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4923062. [PMID: 29681974 PMCID: PMC5846362 DOI: 10.1155/2018/4923062] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/23/2018] [Indexed: 12/31/2022]
Abstract
The objective of this study is to investigate the effects of baicalin on controlling the pulmonary infection and improving the prognosis in influenza A virus (IAV) infection. PCR and western blot were used to measure the changes of some key factors in RLRs signaling pathway. MSD electrochemiluminescence was used to measure the expression of pulmonary inflammatory cytokines including IFN-γ, TNF-α, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p70, and KC/GRO. Flow cytometry was used to detect the proportion of Th1, Th2, Th17, and Treg. The results showed that IAV infection led to low body weight and high viral load and high expression of RIG-I, IRF3, IRF7, and NF-κB mRNA, as well as RIG-I and NF-κB p65 protein. However, baicalin reduced the rate of body weight loss, inhibited virus replication, and downregulated the key factors of the RLRs signaling pathway. Besides, baicalin reduced the high expression inflammatory cytokines in lung and decreased the ratios of Th1/Th2 and Th17/Treg to arouse a brief but not overviolent inflammatory response. Therefore, baicalin activated a balanced host inflammatory response to limit immunopathologic injury, which was helpful to the improvement of clinical and survival outcomes.
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11
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Huang CG, Lee LA, Wu YC, Hsiao MJ, Horng JT, Kuo RL, Huang CH, Lin YC, Tsao KC, Chen MC, Chen TC, Shih SR. A pilot study on primary cultures of human respiratory tract epithelial cells to predict patients' responses to H7N9 infection. Oncotarget 2018; 9:14492-14508. [PMID: 29581859 PMCID: PMC5865685 DOI: 10.18632/oncotarget.24537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/10/2018] [Indexed: 12/23/2022] Open
Abstract
Avian influenza A(H7N9) virus infections frequently lead to acute respiratory distress syndrome and death in humans. We aimed to investigate whether primary cultures of human respiratory tract epithelial cells are helpful to understand H7N9 virus pathogenesis and tissue tropism, and to evaluate how patient-related characteristics can affect the host's response to infection. Normal human bronchial epithelial cells (isolated from two different donors) and primary epithelial cells (harvested from 27 patients undergoing airway surgery) were experimentally infected with H7N9 and/or H1N1pdm for 72 h. After virus infection, the culture media were collected for viral RNA quantitation and cytokine detection. Both H7N9 and H1N1pdm viruses replicated and induced a cytokine response differently for each donor in the normal human bronchial epithelial model. H7N9 replicated equivalently in epithelial cells harvested from the inferior turbinate and paranasal sinus, and those from the larynx and bronchus, at 72 h post-infection. Viral RNA quantity at 72 h was significantly higher in patients aged 21-64 years than in patients aged ≥ 65 years; however, no effects of sex, medical comorbidities, and obesity were noted. H7N9-infected cultured cells released multiple cytokines within 72 h. Levels of interleukin-1β, interleukin-6, interleukin-8, interferon-γ, and tumor necrosis factor-α were associated differently with patient-related characteristics (such as age, sex, obesity, and medical comorbidities). In the era of precision medicine, these findings illustrate the potential utility of this primary culture approach to predict a host's response to H7N9 infection or to future infection by newly emerging viral infections, and to dissect viral pathogenesis.
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Affiliation(s)
- Chung-Guei Huang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Yi-Cheng Wu
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan, ROC
| | - Mei-Jen Hsiao
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Jim-Tong Horng
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Biochemistry and Molecular Biology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Rei-Lin Kuo
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Chih-Heng Huang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan, ROC
| | - Ya-Chu Lin
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Kuo-Chien Tsao
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
| | - Min-Chi Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan 33302, Taiwan, ROC
| | - Tse-Ching Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33305, Taiwan, ROC
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, ROC.,Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan, ROC
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12
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Almansa R, Martínez-Orellana P, Rico L, Iglesias V, Ortega A, Vidaña B, Martínez J, Expósito A, Montoya M, Bermejo-Martin JF. Pulmonary transcriptomic responses indicate a dual role of inflammation in pneumonia development and viral clearance during 2009 pandemic influenza infection. PeerJ 2017; 5:e3915. [PMID: 29038764 PMCID: PMC5640978 DOI: 10.7717/peerj.3915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022] Open
Abstract
Background The interaction between influenza virus and the host response to infection clearly plays an important role in determining the outcome of infection. While much is known on the participation of inflammation on the pathogenesis of severe A (H1N1) pandemic 09-influenza virus, its role in the course of non-fatal pneumonia has not been fully addressed. Methods A systems biology approach was used to define gene expression profiles, histology and viral dynamics in the lungs of healthy immune-competent mice with pneumonia caused by a human influenza A (H1N1) pdm09 virus, which successfully resolved the infection. Results Viral infection activated a marked pro-inflammatory response at the lung level paralleling the emergence of histological changes. Cellular immune response and cytokine signaling were the two signaling pathway categories more representative of our analysis. This transcriptome response was associated to viral clearance, and its resolution was accompanied by resolution of histopathology. Discussion These findings suggest a dual role of pulmonary inflammation in viral clearance and development of pneumonia during non-fatal infection caused by the 2009 pandemic influenza virus. Understanding the dynamics of the host’s transcriptomic and virological changes over the course of the infection caused by A (H1N1) pdm09 virus may help identifying the immune response profiles associated with an effective response against influenza virus.
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Affiliation(s)
- Raquel Almansa
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
| | - Pamela Martínez-Orellana
- Centre de Recerca en Sanitat Animal (CReSA), Universitat Autónoma de Barcelona, IRTA, Barcelona, Spain
| | - Lucía Rico
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
| | - Verónica Iglesias
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
| | - Alicia Ortega
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
| | - Beatriz Vidaña
- Department of Pathology, Animal and Plant Health Agency (APHA), Surrey, UK
| | - Jorge Martínez
- Centre de Recerca en Sanitat Animal (CReSA), Universitat Autónoma de Barcelona, IRTA, Barcelona, Spain.,Departament de Sanitat i d'Anatomia Animals, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ana Expósito
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
| | - María Montoya
- Centre de Recerca en Sanitat Animal (CReSA), Universitat Autónoma de Barcelona, IRTA, Barcelona, Spain.,African Swine Fever Virus Immunology Group, The Pirbright Institute, Surrey, UK
| | - Jesús F Bermejo-Martin
- Laboratory of Biomedical Research in Sepsis (BIOSEPSIS), Hospital Clínico Universitario de Valladolid, Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Valladolid, Spain
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13
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CD206+ cell number differentiates influenza A (H1N1)pdm09 from seasonal influenza A virus in fatal cases. Mediators Inflamm 2014; 2014:921054. [PMID: 25614715 PMCID: PMC4295401 DOI: 10.1155/2014/921054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022] Open
Abstract
In 2009, a new influenza A (H1N1) virus affected many persons around the world. There is an urgent need for finding biomarkers to distinguish between influenza A (H1N1)pdm09 and seasonal influenza virus. We investigated these possible biomarkers in the lung of fatal cases of confirmed influenza A (H1N1)pdm09. Cytokines (inflammatory and anti-inflammatory) and cellular markers (macrophages and lymphocytes subpopulation markers) were analyzed in lung tissue from both influenza A (H1N1)pdm09 and seasonal influenza virus. High levels of IL-17, IFN-γ, and TNF-α positive cells were identical in lung tissue from the influenza A (H1N1)pdm09 and seasonal cases when compared with healthy lung tissue (P < 0.05). Increased IL-4+ cells, and CD4+ and CD14+ cells were also found in high levels in both influenza A (H1N1)pdm09 and seasonal influenza virus (P < 0.05). Low levels of CD206+ cells (marker of alternatively activated macrophages marker in lung) were found in influenza A (H1N1)pdm09 when compared with seasonal influenza virus (P < 0.05), and the ratio of CD206/CD14+ cells was 2.5-fold higher in seasonal and noninfluenza group compared with influenza A (H1N1)pdm09 (P < 0.05). In conclusion, CD206+ cells differentiate between influenza A (H1N1)pdm09 and seasonal influenza virus in lung tissue of fatal cases.
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14
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Wu W, Shi Y, Gao H, Liang W, Sheng J, Li L. Immune derangement occurs in patients with H7N9 avian influenza. Crit Care 2014; 18:R43. [PMID: 25030090 PMCID: PMC4056113 DOI: 10.1186/cc13788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/20/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Currently, little is known about the immunological characteristics of patients with avian influenza A (H7N9) virus infection. METHODS The numbers and percentages of peripheral blood immune cells were measured in 27 patients with laboratory-confirmed H7N9 virus infection and 30 healthy controls (HCs). The functional phenotypes of T cells and monocytes, as well as serum cytokine levels, were analyzed by flow cytometry. RESULTS There were 19 patients (70.4%) with acute respiratory distress syndrome, 13 (48.1%) with secondary respiratory infection, 20 (74%) with systemic inflammatory response syndrome (SIRS; defined as having at least two concurrent SIRS components), 18 (66.7%) with lymphocytopenia and 11 (40.7%) with reduced numbers of monocytes. In comparison with levels in the HCs, the levels of serum interleukin 6 (IL-6), IL-8 and IL-10 and the percentages of CD38+ or Tim-3+ T cells were significantly increased. However, the percentages of human leukocyte antigen-DR + and Tim-3+ monocytes were significantly decreased in patients compared with HCs. CONCLUSIONS Patients with avian H7N9 virus infection display profound SIRS concomitantly with an anti-inflammatory response, which may be associated with the rapid progression of and high mortality associated with this novel viral disease.
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Affiliation(s)
- Wei Wu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
| | - Yu Shi
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
| | - Hainv Gao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
| | - Weifeng Liang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
| | - Jifang Sheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
| | - Lanjuan Li
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No 79, Hangzhou 310003, China
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15
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Almansa R, Justel M, Socias L, Ramírez P, Andaluz-Ojeda D, Estella A, Loza A, Blanco J, Berezo JÁ, Rosich S, Cillòniz C, Torres A, de Lejarazu RO, Martin-Loeches I, Bermejo-Martin JF. IgA level in plasma as a differential factor for influenza infection in severe viral pneumonia. J Clin Virol 2014; 59:135-6. [PMID: 24380719 PMCID: PMC7128445 DOI: 10.1016/j.jcv.2013.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Raquel Almansa
- Unidad de Investigación Biomédica, Hospital Clínico Universitario de Valladolid (ibC), SACYL/IECSCYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Mar Justel
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, SACYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Lorenzo Socias
- Servicio de Medicina Intensiva, Hospital Son Llatzer, SEMICYUC, Ctra. Manacor, km 4, 07198 Palma de Mallorca, Spain
| | - Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, SEMICYUC, Valencia, Bulevar del Sur, 46026 Valencia, Spain
| | - David Andaluz-Ojeda
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valladolid, SEMICYUC, SACYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Angel Estella
- Servicio de Medicina Intensiva, Hospital de Jérez, SAS, SEMICYUC, Ronda de Circunvalacion, s/n, Jérez, Spain
| | - Ana Loza
- Servicio de Medicina Intensiva. Hospital Nuestra Señora de Valme, SEMICYUC, Carretera Madrid-Cadiz (Pol. Ind. La Palmera), Km 548, 41014 Sevilla, Spain
| | - Jesús Blanco
- Servicio de Medicina Intensiva. Hospital Universitario Rio Hortega, SEMICYUC, SACYL, Centro de investigación en red de enfermedades respiratorias, CIBERES, Valladolid, Dulzaina 2, 47012 Valladolid, Spain
| | - Jose Ángel Berezo
- Servicio de Medicina Intensiva. Hospital Universitario Rio Hortega, SEMICYUC, SACYL, Centro de investigación en red de enfermedades respiratorias, CIBERES, Valladolid, Dulzaina 2, 47012 Valladolid, Spain
| | - Sara Rosich
- Servicio de Medicina Intensiva. Hospital Universitari Joan XXIII, SEMICYUC, Mallafre Guasch 4, 43007 Tarragona, Spain
| | | | | | - Raul Ortiz de Lejarazu
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, SACYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Ignacio Martin-Loeches
- Centro de Críticos, Corporación Sanitaria y Universitaria Parc Taulí - Hospital de Sabadell, CIBER Enfermedades Infecciosas, SEMICYUC, Parc Taulí 1, 08208 Sabadell, Spain
| | - Jesus F Bermejo-Martin
- Unidad de Investigación Biomédica, Hospital Clínico Universitario de Valladolid (ibC), SACYL/IECSCYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain.
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16
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Almansa R, Bermejo-Martín JF, de Lejarazu Leonardo RO. Immunopathogenesis of 2009 pandemic influenza. Enferm Infecc Microbiol Clin 2013; 30 Suppl 4:18-24. [PMID: 23116788 PMCID: PMC7130369 DOI: 10.1016/s0213-005x(12)70100-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Three years after the pandemic, major advances have been made in our understanding of the innate and adaptive immune responses to the influenza A(H1N1)pdm09 virus and those responses' contribution to the immunopathology associated with this infection. Severe disease is characterized by early secretion of proinflammatory and immunomodulatory cytokines. This cytokine secretion persisted in patients with severe viral pneumonia and was directly associated with the degree of viral replication in the respiratory tract. Cytokines play important roles in the antiviral defense, but persistent hypercytokinemia may cause inflammatory tissue damage and participate in the genesis of the respiratory failure observed in these patients. An absence of pre-existing protective antibodies was the rule for both mild and severe cases. A role for pathogenic immunocomplexes has been proposed for this disease. Defective T cell responses characterize severe cases of infection caused by the influenza A(H1N1)pdm09 virus. Immune alterations associated with accompanying conditions such as obesity, pregnancy or chronic obstructive pulmonary disease may interfere with the normal development of the specific response to the virus. The role of host immunogenetic factors associated with disease severity is also discussed in this review. In conclusion, currently available information suggests a complex immunological dysfunction/alteration that characterizes the severe cases of 2009 pandemic influenza. The potential benefits of prophylactic/therapeutic interventions aimed at preventing/correcting such dysfunction warrant investigation.
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Affiliation(s)
- Raquel Almansa
- Unidad de Investigación Médica en Infección e Inmunidad (IMI), Investigación Biomédica del Clínico (ibC), Hospital Clínico Universitario, Valladolid, Spain
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17
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PD-L1 expression induced by the 2009 pandemic influenza A(H1N1) virus impairs the human T cell response. Clin Dev Immunol 2013; 2013:989673. [PMID: 24187568 PMCID: PMC3803123 DOI: 10.1155/2013/989673] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/22/2013] [Indexed: 12/31/2022]
Abstract
PD-L1 expression plays a critical role in the impairment of T cell responses during chronic infections; however, the expression of PD-L1 on T cells during acute viral infections, particularly during the pandemic influenza virus (A(H1N1)pdm09), and its effects on the T cell response have not been widely explored. We found that A(H1N1)pdm09 virus induced PD-L1 expression on human dendritic cells (DCs) and T cells, as well as PD-1 expression on T cells. PD-L1 expression impaired the T cell response against A(H1N1)pdm09 by promoting CD8+ T cell death and reducing cytokine production. Furthermore, we found increased PD-L1 expression on DCs and T cells from influenza-infected patients from the first and second 2009 pandemic waves in Mexico City. PD-L1 expression on CD8+ T cells correlated inversely with T cell proportions in patients infected with A(H1N1)pdm09. Therefore, PD-L1 expression on DCs and T cells could be associated with an impaired T cell response during acute infection with A(H1N1)pdm09 virus.
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Justel M, Socias L, Almansa R, Ramírez P, Gallegos MC, Fernandez V, Gordon M, Andaluz-Ojeda D, Nogales L, Rojo S, Vallés J, Estella A, Loza A, León C, Lopez-Mestanza C, Blanco J, Berezo JÁ, Rosich S, Cillòniz C, Torres A, de Lejarazu RO, Martin-Loeches I, Bermejo-Martin JF. IgM levels in plasma predict outcome in severe pandemic influenza. J Clin Virol 2013; 58:564-7. [PMID: 24076102 DOI: 10.1016/j.jcv.2013.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known on the participation of immunoglobulin isotypes and subclasses in the pathogenesis of the severe disease caused by the pandemic influenza virus (influenza A(H1N1)pdm09). OBJECTIVES (1) To evaluate the association between plasma levels of IgG1, IgG2, IgG3, IgG4, IgA, IgM, IgE and outcome in patients with severe pandemic influenza. (2) To evaluate the association between immunoglobulin and cytokine levels in these patients. STUDY DESIGN 40 critically ill patients with community acquired pneumonia and influenza A(H1N1)pdm09 infection were recruited from November 2010 to February 2011. Plasma samples were collected during the first 24h following admission to the ICU. Immunoglobulins and 17 major cytokines were profiled in plasma. RESULTS 15 patients died (37.5%). When the association between clinical variables and prognosis was assessed, prior immunosuppression, APACHE II score, levels of IgG2 and levels of IgM were associated with outcome in a univariate Cox regression analysis. Kaplan Meier analysis showed that patients with levels of IgG2 and IgM < 59 and<58 mg/dl respectively died earlier. Multivariate Cox regression analysis showed that APACHE II score and levels of IgM were the best predictors of outcome, being levels of IgM a protective factor against mortality. IgM was the immunoglobulin showing the largest number of negative correlations with cytokine levels. CONCLUSIONS Our results support a central role of IgM in preventing uncontrolled inflammatory response and mortality in severe pandemic influenza. Early assessment of IgM could contribute to guide clinical decisions in these patients.
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Affiliation(s)
- Mar Justel
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, SACYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain(2)
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Jartti T, Söderlund-Venermo M, Hedman K, Ruuskanen O, Mäkelä MJ. New molecular virus detection methods and their clinical value in lower respiratory tract infections in children. Paediatr Respir Rev 2013; 14:38-45. [PMID: 23347659 PMCID: PMC7106250 DOI: 10.1016/j.prrv.2012.04.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
During the past decade, several new respiratory viruses and their subgroups have been discovered. All these new viruses, as well as previously known respiratory viruses, can be detected by sensitive PCR methods, which have become popular in the diagnostic workup of respiratory viral infections. Currently, respiratory viruses can be detected in up to 95% of children with lower respiratory tract illness. On the other hand, virus detection rates in asymptomatic children are also high (up to 68%), as are coinfection rates in symptomatic children (up to 43%) and justified concerns of causality have been raised. Imposing progress has been made in developing multiplex quantitative PCR assays; here, several primer sets are run within a single PCR mixture. These PCR assays give a better understanding of the dominant viral infection, of viral infections that may be incipient and of any waning infections than does a single-target PCR. Multiplex PCR assays are also gaining popularity due to their cost-effectiveness and short throughput time compared to multiple single-target PCRs. Our understanding of the indications of virus PCRs and our ability to interpret the results from a clinical point of view have improved. This paper reviews the progress in PCR assays and discusses their role in the diagnosis of lower respiratory tract infections in children.
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Key Words
- dna, deoxyribonucleic acid
- hbov, human bocavirus
- hmpv, human metapneumovirus
- hrv, human rhinovirus
- lrti, lower respiratory tract illness
- n, number of samples
- np, nasophryngeal
- npa, nasopharyngeal aspirate
- pcr, polymerase chain reaction
- piv, parainfluenza virus
- qpcr, quantitative pcr
- rna, ribonucleic acid
- rsv, respiratory syncytial virus
- rt, reverse transcriptase
- rvp, respiratory virus panel
- child
- infection
- lower respiratory tract
- multiplex
- pcr
- quantitative
- respiratory
- virus
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Affiliation(s)
- Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
| | | | - Klaus Hedman
- Department of Virology; University of Helsinki; Helsinki
| | - Olli Ruuskanen
- Department of Pediatrics, Turku University Hospital, Turku
| | - Mika J. Mäkelä
- Pediatric division, Department of Allergy, Skin and Allergy Hospital, University of Helsinki, Helsinki, all in Finland
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Launes C, García-García J, Martínez-Planas A, Moraga F, Soldevila N, Astigarraga I, Arístegui J, Korta J, Quintana J, Torner N, Domínguez A. Clinical features of influenza disease in admitted children during the first postpandemic season and risk factors for hospitalization: a multicentre Spanish experience. Clin Microbiol Infect 2013; 19:E157-62. [DOI: 10.1111/1469-0691.12106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 01/16/2023]
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21
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Rodriguez A, Falcon A, Cuevas MT, Pozo F, Guerra S, García-Barreno B, Martinez-Orellana P, Pérez-Breña P, Montoya M, Melero JA, Pizarro M, Ortin J, Casas I, Nieto A. Characterization in vitro and in vivo of a pandemic H1N1 influenza virus from a fatal case. PLoS One 2013; 8:e53515. [PMID: 23326447 PMCID: PMC3542358 DOI: 10.1371/journal.pone.0053515] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/30/2012] [Indexed: 02/02/2023] Open
Abstract
Pandemic 2009 H1N1 (pH1N1) influenza viruses caused mild symptoms in most infected patients. However, a greater rate of severe disease was observed in healthy young adults and children without co-morbid conditions. Here we tested whether influenza strains displaying differential virulence could be present among circulating pH1N1 viruses. The biological properties and the genotype of viruses isolated from a patient showing mild disease (M) or from a fatal case (F), both without known co-morbid conditions were compared in vitro and in vivo. The F virus presented faster growth kinetics and stronger induction of cytokines than M virus in human alveolar lung epithelial cells. In the murine model in vivo, the F virus showed a stronger morbidity and mortality than M virus. Remarkably, a higher proportion of mice presenting infectious virus in the hearts, was found in F virus-infected animals. Altogether, the data indicate that strains of pH1N1 virus with enhanced pathogenicity circulated during the 2009 pandemic. In addition, examination of chemokine receptor 5 (CCR5) genotype, recently reported as involved in severe influenza virus disease, revealed that the F virus-infected patient was homozygous for the deleted form of CCR5 receptor (CCR5Δ32).
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Affiliation(s)
- Ariel Rodriguez
- Centro Nacional de Biotecnología, C.S.I.C. Darwin 3, Cantoblanco, Madrid, Spain
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
| | - Ana Falcon
- Centro Nacional de Biotecnología, C.S.I.C. Darwin 3, Cantoblanco, Madrid, Spain
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
| | - Maria Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Pozo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Susana Guerra
- Dpto. de Medicina Preventiva, Salud Pública y Microbiología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Blanca García-Barreno
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Pamela Martinez-Orellana
- Centre de Recerca en Sanitat Animal (CReSA), UAB-IRTA, Campus de la Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Pilar Pérez-Breña
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Montoya
- Centre de Recerca en Sanitat Animal (CReSA), UAB-IRTA, Campus de la Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Institut de Recerca i Tecnologia Agroalimentarias (IRTA), Barcelona, Spain
| | - Jose Antonio Melero
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Manuel Pizarro
- Servicio de Anatomia Patologica, Hospital Clínico Veterinario, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Juan Ortin
- Centro Nacional de Biotecnología, C.S.I.C. Darwin 3, Cantoblanco, Madrid, Spain
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
| | - Inmaculada Casas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Amelia Nieto
- Centro Nacional de Biotecnología, C.S.I.C. Darwin 3, Cantoblanco, Madrid, Spain
- Ciber de Enfermedades Respiratorias, Mallorca, Illes Balears, Spain
- * E-mail:
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Influenza A(H1N1)pdm09 virus: viral characteristics and genetic evolution. Enferm Infecc Microbiol Clin 2012; 30 Suppl 4:10-7. [DOI: 10.1016/s0213-005x(12)70099-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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