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Hao Q, Gao Y, Zhao Y, Murad MH, Mustafa R, Ansari MT, Schünemann HJ, Rind DM, Brignardello-Petersen R, Guyatt G. GRADE concept 6: a novel application of external indirect evidence into GRADE ratings of evidence certainty in network meta-analysis. J Clin Epidemiol 2023; 163:95-101. [PMID: 37739191 DOI: 10.1016/j.jclinepi.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES We describe how consideration of external evidence may play an important role in judging certainty in the process of establishing the certainty of the evidence. Our example is a network meta-analysis (NMA) addressing treatment for Ebola virus disease, which informed a World Health Organization guideline. STUDY DESIGN AND SETTING Through Grading of Recommendations Assessment, Development, and Evaluations (GRADE) project group iterative online, in-person and email discussions, we developed this GRADE concept and obtained approval from the GRADE working group. Using the null as a threshold, we rated our certainty for network estimates in mortality, including consideration of evidence external to the NMA (i.e., did not meet eligibility criteria) and formal logical construction. RESULTS Based on the existing GRADE guidance, we rated the network estimate for one indirect comparison as low certainty. The formal logical construction that lead us reevaluate the certainty of the evidence is as follows: if A is superior to B, and B is not inferior to C, then A must be superior to C. After considering the logic and the external indirect evidence, we concluded at least moderate certainty for the comparison. CONCLUSION Systematic review authors and guideline developers should apply the fundamental logical construction for indirect comparisons and consider compelling external evidence in NMA certainty ratings.
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Affiliation(s)
- Qiukui Hao
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Ya Gao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Reem Mustafa
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David M Rind
- Institute for Clinical and Economic Review, 14 Beacon Street, Boston, MA 02108, USA; Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Chatterjee K, Lakdawala S, Quadir SS, Puri D, Mishra DK, Joshi G, Sharma S, Choudhary D. siRNA-Based Novel Therapeutic Strategies to Improve Effectiveness of Antivirals: An Insight. AAPS PharmSciTech 2023; 24:170. [PMID: 37566146 DOI: 10.1208/s12249-023-02629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
Since the ground-breaking discovery of RNA interference (RNAi), scientists have made significant progress in the field of small interfering RNA (siRNA) treatments. Due to severe barriers to the therapeutic application of siRNA, nanoparticle technologies for siRNA delivery have been designed. For pathological circumstances such as viral infection, toxic RNA abnormalities, malignancies, and hereditary diseases, siRNAs are potential therapeutic agents. However, systemic administration of siRNAs in vivo remains a substantial issue due to a lack of "drug-likeness" (siRNA are relatively larger than drugs and have low hydrophobicity), physiological obstacles, and possible toxicities. This write-up covers important accomplishment in the field of clinical trials and patents specially based of siRNAs using targeting viruses. Furthermore, it offers deep insight of nanoparticle applied for siRNA delivery and strategies to improve the effectiveness of antivirals.
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Affiliation(s)
- Krittika Chatterjee
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS (Deemed to be University), Mumbai, 400056, India
| | - Sagheerah Lakdawala
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS (Deemed to be University), Mumbai, 400056, India
| | - Sheikh Shahnawaz Quadir
- Department of Pharmaceutical Sciences, Mohanlal Sukhadia University, Udaipur, Rajasthan, 313001, India
| | - Dinesh Puri
- School of Pharmacy, Graphic Era Hill University, Dehradun, Uttarakhand, 248001, India
| | - Dinesh Kumar Mishra
- Department of Pharmacy, Guru Ghasidas Vishwavidyalaya (A Central University), Koni, Bilaspur (C.G.), 495009, India
| | - Garima Joshi
- Department of Pharmaceutical Sciences, Mohanlal Sukhadia University, Udaipur, Rajasthan, 313001, India
| | - Sanjay Sharma
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS (Deemed to be University), Mumbai, 400056, India.
| | - Deepak Choudhary
- Department of Pharmaceutical Sciences, Mohanlal Sukhadia University, Udaipur, Rajasthan, 313001, India.
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Chavez S, Koyfman A, Gottlieb M, Brady WJ, Carius BM, Liang SY, Long B. Ebola virus disease: A review for the emergency medicine clinician. Am J Emerg Med 2023; 70:30-40. [PMID: 37196593 DOI: 10.1016/j.ajem.2023.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Ebolavirus, the causative agent of Ebola virus disease (EVD) has been responsible for sporadic outbreaks mainly in sub-Saharan Africa since 1976. EVD is associated with high risk of transmission, especially to healthcare workers during patient care. OBJECTIVE The purpose of this review is to provide a concise review of EVD presentation, diagnosis, and management for emergency clinicians. DISCUSSION EVD is spread through direct contact, including blood, bodily fluids or contact with a contaminated object. Patients may present with non-specific symptoms such as fevers, myalgias, vomiting, or diarrhea that overlap with other viral illnesses, but rash, bruising, and bleeding may also occur. Laboratory analysis may reveal transaminitis, coagulopathy, and disseminated intravascular coagulation. The average clinical course is approximately 8-10 days with an average case fatality rate of 50%. The mainstay of treatment is supportive care, with two U.S. Food and Drug Administration-approved monoclonal antibody treatments (Ebanga and Inmazeb). Survivors of the disease may have a complicated recovery, marked by long-term symptoms. CONCLUSION EVD is a potentially deadly condition that can present with a wide range of signs and symptoms. Emergency clinicians must be aware of the presentation, evaluation, and management to optimize the care of these patients.
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Affiliation(s)
- Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, United States of America.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas 75390, TX, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | | | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis 63110, MO, United States of America.
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America
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Smith JA, DeVito N, Lee H, Tiplady C, Abhari RE, Kartsonaki C. Estimating the effect of COVID-19 on trial design characteristics: a registered report. ROYAL SOCIETY OPEN SCIENCE 2023; 10:201543. [PMID: 36686547 PMCID: PMC9832295 DOI: 10.1098/rsos.201543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
There have been reports of poor-quality research during the COVID-19 pandemic. This registered report assessed design characteristics of registered clinical trials for COVID-19 compared to non-COVID-19 trials to empirically explore the design of clinical research during a pandemic and how it compares to research conducted in non-pandemic times. We did a retrospective cohort study with a 1 : 1 ratio of interventional COVID-19 registrations to non-COVID-19 registrations, with four trial design outcomes: use of control arm, randomization, blinding and prospective registration. Logistic regression was used to estimate the odds ratio of investigating COVID-19 versus not COVID-19 and estimate direct and total effects of investigating COVID-19 for each outcome. The primary analysis showed a positive direct and total effect of COVID-19 on the use of control arms and randomization. It showed a negative direct effect of COVID-19 on blinding but no evidence of a total effect. There was no evidence of an effect on prospective registration. Taken together with secondary and sensitivity analyses, our findings are inconclusive but point towards a higher prevalence of key design characteristics in COVID-19 trials versus controls. The findings do not support much existing COVID-19 research quality literature, which generally suggests that COVID-19 led to a reduction in quality. Limitations included some data quality issues, minor deviations from the pre-registered plan and the fact that trial registrations were analysed which may not accurately reflect study design and conduct. Following in-principle acceptance, the approved stage 1 version of this manuscript was pre-registered on the Open Science Framework at https://doi.org/10.17605/OSF.IO/5YAEB. This pre-registration was performed prior to data analysis.
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Affiliation(s)
- James A. Smith
- Botnar Research Centre and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Nicholas DeVito
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Hopin Lee
- Botnar Research Centre and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Catherine Tiplady
- Botnar Research Centre and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Roxanna E. Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
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Bringas M, Luck M, Müller P, Scheidt HA, Di Lella S. Effects of the RNA-Polymerase Inhibitors Remdesivir and Favipiravir on the Structure of Lipid Bilayers-An MD Study. MEMBRANES 2022; 12:941. [PMID: 36295700 PMCID: PMC9608901 DOI: 10.3390/membranes12100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The structure and dynamics of membranes are crucial to ensure the proper functioning of cells. There are some compounds used in therapeutics that show nonspecific interactions with membranes in addition to their specific molecular target. Among them, two compounds recently used in therapeutics against COVID-19, remdesivir and favipiravir, were subjected to molecular dynamics simulation assays. In these, we demonstrated that the compounds can spontaneously bind to model lipid membranes in the presence or absence of cholesterol. These findings correlate with the corresponding experimental results recently reported by our group. In conclusion, insertion of the compounds into the membrane is observed, with a mean position close to the phospholipid head groups.
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Affiliation(s)
- Mauro Bringas
- Instituto de Química Biológica—Ciencias Exactas y Naturales (IQUIBICEN)—CONICET and Departamento de Química Biológica FCEN, Universidad de Buenos Aires, Int. Güiraldes 2160, Buenos Aires C1428EGA, Argentina
| | - Meike Luck
- Department of Biology, Humboldt Universität zu Berlin, Invalidenstr. 42, D-10115 Berlin, Germany
| | - Peter Müller
- Department of Biology, Humboldt Universität zu Berlin, Invalidenstr. 42, D-10115 Berlin, Germany
| | - Holger A. Scheidt
- Institute for Medical Physics and Biophysics, Leipzig University, Härtelstr. 16–18, D-04107 Leipzig, Germany
| | - Santiago Di Lella
- Instituto de Química Biológica—Ciencias Exactas y Naturales (IQUIBICEN)—CONICET and Departamento de Química Biológica FCEN, Universidad de Buenos Aires, Int. Güiraldes 2160, Buenos Aires C1428EGA, Argentina
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Gao Y, Zhao Y, Guyatt G, Fowler R, Kojan R, Ge L, Tian J, Hao Q, Lado M, Youkee D, Ahmad A, Albertson C, Caluwaerts S, Camara M, Crozier I, De Clerck H, Dunachie S, Fischer WA, Jamil B, Kabongo P, Kabuni P, Ngorombi CK, Kakule M, Kolié MC, Lakoh S, Lang HJ, Moses JS, Fiston IM, Mulumba PM, Murthy S, Samura S, Couban R. Effects of therapies for Ebola virus disease: a systematic review and network meta-analysis. THE LANCET. MICROBE 2022; 3:e683-e692. [PMID: 35803293 PMCID: PMC9441701 DOI: 10.1016/s2666-5247(22)00123-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Specific treatments targeting Ebola virus are crucial in managing Ebola virus disease. To support the development of clinical practice guidelines on medications for Ebola virus disease, we aimed to evaluate the efficacy and safety of therapies for patients with Ebola virus disease. METHODS In this systematic review and network meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, Global Health, African Index Medicus, World Health Organization Global Index Medicus, the Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, Epistemonikos, bioRxiv, medRxiv, and SSRN without language restrictions for randomised controlled trials (RCTs) published between database inception and Jan 1, 2022, comparing at least one therapeutic agent for Ebola virus disease against standard care or another therapeutic agent for Ebola virus disease. Two reviewers assessed study eligibility and extracted summary data independently using a standardised form. Our outcomes of interest were mortality, adverse maternal outcomes, risk of onward transmission, duration of admission to a health-care facility, functional status after Ebola virus disease, serious adverse events from medication, adverse perinatal outcomes, time to symptom resolution, and time to viral clearance. We did frequentist network meta-analyses to estimate the effect of all interventions and applied the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of the evidence. We registered the protocol with PROSPERO, CRD42022296539. FINDINGS We identified 7840 records through database searches, of which two RCTs with a total of 753 patients proved eligible. Only data on mortality, the duration of admission, serious adverse events, and time to viral clearance were available for meta-analysis. Compared with standard care, REGN-EB3 (relative risk [RR] 0·40, 95% CI 0·18 to 0·89; moderate certainty) and mAb114 (0·42, 0·19 to 0·93; moderate certainty) probably reduce mortality. Whether ZMapp (0·60, 0·28 to 1·26; very low certainty) and remdesivir (0·64, 0·29 to 1·39; very low certainty) reduce mortality compared with standard care is uncertain. With high certainty, REGN-EB3 reduces mortality compared with ZMapp (0·67, 0·52 to 0·88) and remdesivir (0·63, 0·49 to 0·82). With high certainty, mAb114 also reduces mortality compared with ZMapp (0·71, 0·55 to 0·91) and remdesivir (0·66, 0·52 to 0·84). Compared with standard care, REGN-EB3, mAb114, ZMapp, and remdesivir might have little or no effect on the time to viral clearance (mean difference ranged from -0·25 days to -1·14 days; low certainty). ZMapp might reduce the duration of admission compared with standard care (mean difference -2·02 days, 95% CI -4·05 to 0·01; low certainty). Findings for all comparisons suggested that there might be little or no difference in the prevalence of serious adverse events, but certainty was low or very low in all comparisons but one. INTERPRETATION REGN-EB3 and mAb114 separately reduce mortality compared with ZMapp, remdesivir, or standard care in patients with Ebola virus disease. These findings suggest that health-care workers should prioritise the use of REGN-EB3 and mAb114 for patients with Ebola virus disease during future outbreaks. FUNDING WHO.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard Kojan
- Alliance for International Medical Action, Dakar, Senegal
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | | | - Qiukui Hao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada,Correspondence to: Dr Qiukui Hao, Department of Health Research Methods, Evidence, and Impact and School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 4L8, Canada
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Crozier I, Britson KA, Wolfe DN, Klena JD, Hensley LE, Lee JS, Wolfraim LA, Taylor KL, Higgs ES, Montgomery JM, Martins KA. The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps. Vaccines (Basel) 2022; 10:1213. [PMID: 36016101 PMCID: PMC9415766 DOI: 10.3390/vaccines10081213] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
The Ebola virus disease outbreak that occurred in Western Africa from 2013-2016, and subsequent smaller but increasingly frequent outbreaks of Ebola virus disease in recent years, spurred an unprecedented effort to develop and deploy effective vaccines, therapeutics, and diagnostics. This effort led to the U.S. regulatory approval of a diagnostic test, two vaccines, and two therapeutics for Ebola virus disease indications. Moreover, the establishment of fieldable diagnostic tests improved the speed with which patients can be diagnosed and public health resources mobilized. The United States government has played and continues to play a key role in funding and coordinating these medical countermeasure efforts. Here, we describe the coordinated U.S. government response to develop medical countermeasures for Ebola virus disease and we identify lessons learned that may improve future efforts to develop and deploy effective countermeasures against other filoviruses, such as Sudan virus and Marburg virus.
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Affiliation(s)
- Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA;
| | - Kyla A. Britson
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow, Oak Ridge, TN 37831, USA
| | - Daniel N. Wolfe
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Lisa E. Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD 12116, USA;
| | - John S. Lee
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - Larry A. Wolfraim
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Kimberly L. Taylor
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Elizabeth S. Higgs
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Karen A. Martins
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
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Zeitlin L, Cone RA. Special focus issue: passive immunization. Hum Vaccin Immunother 2022; 18:2028517. [PMID: 35507828 PMCID: PMC9090283 DOI: 10.1080/21645515.2022.2028517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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De Santis GC, Oliveira LC, Garibaldi PMM, Almado CEL, Croda J, Arcanjo GGA, Oliveira ÉAF, Tonacio AC, Langhi DM, Bordin JO, Gilio RN, Palma LC, Santos EV, Haddad SK, Prado BPA, Pontelli MC, Gomes R, Miranda CH, Auxiliadora Martins M, Covas DT, Arruda E, Fonseca BAL, Calado RT. High-Dose Convalescent Plasma for Treatment of Severe COVID-19. Emerg Infect Dis 2022; 28:548-555. [PMID: 35081022 PMCID: PMC8888205 DOI: 10.3201/eid2803.212299] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess whether high-dose coronavirus disease (COVID-19) convalescent plasma (CCP) transfusion may benefit patients with severe COVID-19, we conducted a multicenter randomized trial in Brazil. Patients with severe COVID-19 who were within 10 days of initial symptom onset were eligible. Patients in the CCP group received 3 daily doses of CCP (600 mL/d) in addition to standard treatment; control patients received standard treatment only. Primary outcomes were death rates at days 30 and 60 of study randomization. Secondary outcomes were ventilator-free days and hospital-free days. We enrolled 107 patients: 36 CCP and 71 control. At day 30, death rates were 22% for CCP and 25% for the control group; at day 60, rates were 31% for CCP and 35% for control. Needs for invasive mechanical ventilation and durations of hospital stay were similar between groups. We conclude that high-dose CCP transfused within 10 days of symptom onset provided no benefit for patients with severe COVID-19.
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Kiiza P, Mullin SI, Teo K, Goodman L, Perez A, Pinto R, Thompson K, Piquette D, Hall T, Bah EI, Christian M, Hajek JJ, Kao R, Lamontagne F, Marshall JC, Mishra S, Murthy S, Vanderschuren A, Fowler RA, Adhikari NKJ. Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study. Viruses 2021; 13:v13112205. [PMID: 34835011 PMCID: PMC8622862 DOI: 10.3390/v13112205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (p = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.
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Affiliation(s)
- Peter Kiiza
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Sarah I. Mullin
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON M1C 1A4, Canada;
| | - Koren Teo
- Canadian Forces Health Services Group (CFHS), Toronto, ON M3K 0A1, Canada;
| | - Len Goodman
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada;
| | - Adic Perez
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Kelly Thompson
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia;
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Trevor Hall
- Healthcare Insurance Reciprocal of Canada and Interactive Media Lab., University of Toronto, Toronto, ON M2N 6K8, Canada;
| | - Elhadj I. Bah
- Infectious Diseases Department, Donka National Hospital, Conakry, Guinea;
| | | | - Jan J. Hajek
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Raymond Kao
- Division of Critical Care Medicine, Western University, London, ON N6A 5W9, Canada;
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - John C. Marshall
- Departments of Surgery and Critical Care, St. Michael’s Hospital, Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, Department of Medicine, Division of Infectious Diseases, St. Michael’s Hospital and University of Toronto, Institute of Health Policy, Management and Evaluation and Institute of Medical Science, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
| | - Abel Vanderschuren
- Division of Intensive Care, Université Laval-CHU de Québec, Québec, QC G1J 1Z4, Canada;
| | - Robert A. Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence: (R.A.F.); (N.K.J.A.)
| | - Neill K. J. Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence: (R.A.F.); (N.K.J.A.)
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Rajput A, Kumar M. Anti-Ebola: an initiative to predict Ebola virus inhibitors through machine learning. Mol Divers 2021; 26:1635-1644. [PMID: 34357513 PMCID: PMC8343361 DOI: 10.1007/s11030-021-10291-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023]
Abstract
Ebola virus is a deadly pathogen responsible for a frequent series of outbreaks since 1976. Despite various efforts from researchers worldwide, its mortality and fatality are quite high. For antiviral drug discovery, the computational efforts are considered highly useful. Therefore, we have developed an 'anti-Ebola' web server, through quantitative structure-activity relationship information of available molecules with experimental anti-Ebola activities. Three hundred and five unique anti-Ebola compounds with their respective IC50 values were extracted from the 'DrugRepV' database. Later, the compounds were used to extract the molecular descriptors, which were subjected to regression-based model development. The robust machine learning techniques, namely support vector machine, random forest and artificial neural network, were employed using tenfold cross-validation. After a randomization approach, the best predictive model showed Pearson's correlation coefficient ranges from 0.83 to 0.98 on training/testing (T274) dataset. The robustness of the developed models was cross-evaluated using William's plot. The highly robust computational models are integrated into the web server. The 'anti-Ebola' web server is freely available at https://bioinfo.imtech.res.in/manojk/antiebola . We anticipate this will serve the scientific community for developing effective inhibitors against the Ebola virus.
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Affiliation(s)
- Akanksha Rajput
- Virology Unit and Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research (CSIR), Sector 39A, Chandigarh, 160036, India
| | - Manoj Kumar
- Virology Unit and Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research (CSIR), Sector 39A, Chandigarh, 160036, India. .,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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12
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Dos Santos Nascimento IJ, de Aquino TM, da Silva-Júnior EF. Drug Repurposing: A Strategy for Discovering Inhibitors against Emerging Viral Infections. Curr Med Chem 2021; 28:2887-2942. [PMID: 32787752 DOI: 10.2174/0929867327666200812215852] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Viral diseases are responsible for several deaths around the world. Over the past few years, the world has seen several outbreaks caused by viral diseases that, for a long time, seemed to possess no risk. These are diseases that have been forgotten for a long time and, until nowadays, there are no approved drugs or vaccines, leading the pharmaceutical industry and several research groups to run out of time in the search for new pharmacological treatments or prevention methods. In this context, drug repurposing proves to be a fast and economically viable technique, considering the fact that it uses drugs that have a well-established safety profile. Thus, in this review, we present the main advances in drug repurposing and their benefit for searching new treatments against emerging viral diseases. METHODS We conducted a search in the bibliographic databases (Science Direct, Bentham Science, PubMed, Springer, ACS Publisher, Wiley, and NIH's COVID-19 Portfolio) using the keywords "drug repurposing", "emerging viral infections" and each of the diseases reported here (CoV; ZIKV; DENV; CHIKV; EBOV and MARV) as an inclusion/exclusion criterion. A subjective analysis was performed regarding the quality of the works for inclusion in this manuscript. Thus, the selected works were those that presented drugs repositioned against the emerging viral diseases presented here by means of computational, high-throughput screening or phenotype-based strategies, with no time limit and of relevant scientific value. RESULTS 291 papers were selected, 24 of which were CHIKV; 52 for ZIKV; 43 for DENV; 35 for EBOV; 10 for MARV; and 56 for CoV and the rest (72 papers) related to the drugs repurposing and emerging viral diseases. Among CoV-related articles, most were published in 2020 (31 papers), updating the current topic. Besides, between the years 2003 - 2005, 10 articles were created, and from 2011 - 2015, there were 7 articles, portraying the outbreaks that occurred at that time. For ZIKV, similar to CoV, most publications were during the period of outbreaks between the years 2016 - 2017 (23 articles). Similarly, most CHIKV (13 papers) and DENV (14 papers) publications occur at the same time interval. For EBOV (13 papers) and MARV (4 papers), they were between the years 2015 - 2016. Through this review, several drugs were highlighted that can be evolved in vivo and clinical trials as possible used against these pathogens showed that remdesivir represent potential treatments against CoV. Furthermore, ribavirin may also be a potential treatment against CHIKV; sofosbuvir against ZIKV; celgosivir against DENV, and favipiravir against EBOV and MARV, representing new hopes against these pathogens. CONCLUSION The conclusions of this review manuscript show the potential of the drug repurposing strategy in the discovery of new pharmaceutical products, as from this approach, drugs could be used against emerging viral diseases. Thus, this strategy deserves more attention among research groups and is a promising approach to the discovery of new drugs against emerging viral diseases and also other diseases.
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Manabe T, Kambayashi D, Akatsu H, Kudo K. Favipiravir for the treatment of patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:489. [PMID: 34044777 PMCID: PMC8159019 DOI: 10.1186/s12879-021-06164-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Favipiravir possesses high utility for treating patients with COVID-19. However, research examining the efficacy and safety of favipiravir for patients with COVID-19 is limited. METHODS We conducted a systematic review of published studies reporting the efficacy of favipiravir against COVID-19. Two investigators independently searched PubMed, the Cochrane Database of Systematic Reviews, MedRxiv, and ClinicalTrials.gov (inception to September 2020) to identify eligible studies. A meta-analysis was performed to measure viral clearance and clinical improvement as the primary outcomes. RESULTS Among 11 eligible studies, 5 included a comparator group. Comparing to the comparator group, the favipiravir group exhibited significantly better viral clearance on day 7 after the initiation of treatment (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.19-5.22), whereas no difference was noted on day 14 (OR = 2.19, 95% CI = 0.69-6.95). Although clinical improvement was significantly better in the favipiravir group on both days 7 and 14, the improvement was better on day 14 (OR = 3.03, 95% CI = 1.17-7.80) than on day 7 (OR = 1.60, 95% CI = 1.03-2.49). The estimated proportions of patients with viral clearance in the favipiravir arm on days 7 and 14 were 65.42 and 88.9%, respectively, versus 43.42 and 78.79%, respectively, in the comparator group. The estimated proportions of patients with clinical improvement on days 7 and 14 in the favipiravir group were 54.33 and 84.63%, respectively, compared with 34.40 and 65.77%, respectively, in the comparator group. CONCLUSIONS Favipiravir induces viral clearance by 7 days and contributes to clinical improvement within 14 days. The results indicated that favipiravir has strong possibility for treating COVID-19, especially in patients with mild-to-moderate illness. Additional well-designed studies, including examinations of the dose and duration of treatment, are crucial for reaching definitive conclusions.
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Affiliation(s)
- Toshie Manabe
- Nagoya City University Graduate School of Medicine, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi 467-8601 Japan
- Nagoya City University West Medical Center, Nagoya City, Aichi Japan
| | - Dan Kambayashi
- Nagoya City University Graduate School of Medicine, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi 467-8601 Japan
- Showa Pharmaceutical University, Tokyo, Japan
| | - Hiroyasu Akatsu
- Nagoya City University Graduate School of Medicine, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi 467-8601 Japan
| | - Koichiro Kudo
- Yurin Hospital, Tokyo, Japan
- Waseda University Regional and Inter-Regional Organization, Tokyo, Japan
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Li X, Peng T. Strategy, Progress, and Challenges of Drug Repurposing for Efficient Antiviral Discovery. Front Pharmacol 2021; 12:660710. [PMID: 34017257 PMCID: PMC8129523 DOI: 10.3389/fphar.2021.660710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/16/2021] [Indexed: 12/17/2022] Open
Abstract
Emerging or re-emerging viruses are still major threats to public health. Prophylactic vaccines represent the most effective way to prevent virus infection; however, antivirals are more promising for those viruses against which vaccines are not effective enough or contemporarily unavailable. Because of the slow pace of novel antiviral discovery, the high disuse rates, and the substantial cost, repurposing of the well-characterized therapeutics, either approved or under investigation, is becoming an attractive strategy to identify the new directions to treat virus infections. In this review, we described recent progress in identifying broad-spectrum antivirals through drug repurposing. We defined the two major categories of the repurposed antivirals, direct-acting repurposed antivirals (DARA) and host-targeting repurposed antivirals (HTRA). Under each category, we summarized repurposed antivirals with potential broad-spectrum activity against a variety of viruses and discussed the possible mechanisms of action. Finally, we proposed the potential investigative directions of drug repurposing.
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Affiliation(s)
- Xinlei Li
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Tao Peng
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, College of Basic Medicine, Guangzhou Medical University, Guangzhou, China
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Mahapatra S, Pati S. Constraints and challenges in convalescent plasma collection amidst the Covid 19 pandemic- strategies and recommendations to overcome these. Transfus Clin Biol 2021; 28:175-179. [PMID: 33677086 PMCID: PMC7931723 DOI: 10.1016/j.tracli.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/06/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022]
Abstract
Background COVID 19 is an acute respiratory disease caused by infection by the virus SARS-COV-2 and has been declared as a pandemic whose specific treatment is still not established. One of the options in the treatment is Convalescent plasma (CP) therapy when there is presence of required amount of neutralizing antibodies in the plasma of recovered COVID patients. Our objective was to analyze the challenges and the constraints encountered in motivation of COVID 19 recovered persons to come for the screening procedures and to convince the selected persons to come for Plasma donation voluntarily. Material & methods The present retrospective observational study was conducted for a period of five and half months. Out of 1515 number of persons contacted telephonically for Plasma donation, 1291 persons came for screening of whom 1028 persons were eligible for donation, 263 cases were deferred and 966 persons finally donated. Results Maximum number of acceptance cases were from males-(98.7%). Of the accepted cases, (41.73%) were from the 18-30 years’ age group. 33.94% were from blood group ‘O’ Rh D positive giving maximum contribution from any blood group. 38.3% of the accepted cases had resolution of all COVID symptoms within time period of 28-40 days. Maximum number of accepted individuals (39.75%) had suffered from multiple symptoms followed by 39.02% of asymptomatic persons. Highest number of Plasma donation was contributed by Odisha Government Police personnel (51.56%). Discussion In this global ongoing pandemic, the “Fear Factor of contracting the disease” has acted as a major challenge in motivating and convincing a COVID recovered patient for plasma donation. The challenge before the medical professionals was to motivate, educate and convince the potential donors and the society about the likely benefits of convalescent plasma. This could be finally overcome with the help of positive orientation through social and conventional media as well as mass appeal from government side on the benefits of plasma therapy in saving lives in the present pandemic.
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Affiliation(s)
- S Mahapatra
- C/O- Mr NK Mishra, N-1/256, Nayapalli, IRC Village, 751015 Bhubaneswar, Odisha, India.
| | - S Pati
- Regional Medical research Centre, Chandrasekharpur, 751023 Bhubaneswar, Odisha, India.
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Łagocka R, Dziedziejko V, Kłos P, Pawlik A. Favipiravir in Therapy of Viral Infections. J Clin Med 2021; 10:E273. [PMID: 33451007 PMCID: PMC7828521 DOI: 10.3390/jcm10020273] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 02/07/2023] Open
Abstract
Favipiravir (FPV) is a novel antiviral drug acting as a competitive inhibitor of RNA-dependent RNA polymerase (RdRp), preventing viral transcription and replication. FPV was approved in Japan in 2014 for therapy of influenza unresponsive to standard antiviral therapies. FPV was also used in the therapy of Ebola virus disease (EVD) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, we discuss the mechanisms of action, pharmacokinetic parameters, toxicity, and adverse effects of FPV, as well as clinical studies evaluating the use of FPV in the therapy of influenza virus (IV) infection, EVD, and SARS-CoV-2 infection, along with its effectiveness in treating other human RNA infections.
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Affiliation(s)
- Ryta Łagocka
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Violetta Dziedziejko
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland; (V.D.); (P.K.)
| | - Patrycja Kłos
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland; (V.D.); (P.K.)
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, 70-204 Szczecin, Poland
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Devasenapathy N, Ye Z, Loeb M, Fang F, Najafabadi BT, Xiao Y, Couban R, Bégin P, Guyatt G. Efficacité et innocuité du plasma de convalescent en cas de forme grave de COVID-19, extrapolée de données relatives à d’autres formes graves d’infections respiratoires virales : revue systématique et méta-analyse. CMAJ 2020; 192:E1559-E1570. [PMID: 33229354 PMCID: PMC7721266 DOI: 10.1503/cmaj.200642-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXTE: On ne connaît pas encore avec certitude l’innocuité et l’efficacité du plasma de convalescent comme traitement de la forme grave de la maladie à coronavirus 2019 (COVID-2019). Afin d’appuyer la conception de lignes directrices sur la prise en charge de la COVID-19, nous avons effectué une revue systématique et une méta-analyse sur l’utilisation du plasma de convalescent pour le traitement de cette maladie et d’autres formes graves d’infections respiratoires virales. MÉTHODES: En mars 2020, nous avons effectué des recherches dans des bases de données biomédicales internationales et chinoises, des registres d’essais cliniques et des sources prépubliées afin de recenser des essais randomisés et contrôlés (ERC) et des études non randomisées comparant les issues de patients ayant reçu du plasma de convalescent à celles de patients n’en ayant pas reçu. Ont été inclus les patients ayant une infection aiguë attribuable à un coronavirus, au virus de l’influenza ou au virus Ebola. Nous avons également réalisé une méta-analyse à l’aide d’un modèle à effets aléatoires et évalué la qualité des données probantes au moyen de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation ). RÉSULTATS: Sur les 1099 études uniques initialement repérées, 6 étaient admissibles, et aucune d’entre elles ne portait sur des patients atteints de la COVID-19. Une étude non randomisée (n = 40) sur l’administration de plasma de convalescent à des patients atteints du coronavirus du syndrome respiratoire aigu sévère (SRAS-CoV) a fourni des données peu concluantes sur le taux de mortalité (risque relatif [RR] 0,10; intervalle de confiance [IC] de 95 % 0,01 à 1,70). Des estimations regroupées provenant de 4 ERC sur l’influenza (n = 572) n’ont pas montré d’effet manifeste sur le taux de mortalité (4 ERC; RR 0,94; IC de 95 % 0,49 à 1,81), le rétablissement complet (2 ERC; rapports de cotes [RC] 1,04; IC de 95 % 0,69 à 1,64) et la durée d’hospitalisation (3 ERC; différence moyenne [DM] −1,62; IC de 95 % −3,82 à 0,58 jours). La qualité des données était très faible pour tous les paramètres relatifs à l’efficacité. Dans les ERC sur l’influenza, aucun ou peu d’événements indésirables graves ont été associés au plasma de convalescent (RR 0,85; IC de 95 % 0,56 à 1,29; données de faible qualité). INTERPRÉTATION: Les études portant sur des formes graves d’infections respiratoires virales autres que la COVID-19 ont fourni des données indirectes de très faible qualité semblant indiquer que le plasma de convalescent n’offre aucun bénéfice ou offre des bénéfices minimes pour le traitement de la COVID-19, de même que des données de faible qualité montrant qu’il n’entraîne pas d’événements indésirables graves.
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Affiliation(s)
- Niveditha Devasenapathy
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué.
| | - Zhikang Ye
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Mark Loeb
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Fang Fang
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Borna Tadayon Najafabadi
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Yingqi Xiao
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Rachel Couban
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Philippe Bégin
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
| | - Gordon Guyatt
- Instituts indiens de santé publique de Delhi (N. Devasenapathy), Fondation de santé publique de l'Inde, Gurgaon, Haryana, Inde; Département des méthodes, des données et de l'incidence de la recherche en santé (Z. Ye, M. Loeb, F. Fang, B. Tadayon Najafabadi, Y. Xiao, R. Couban, G. Guyatt), Université McMaster, Hamilton, Ont.; Université de médecine chinoise de Guangzhou (F. Fang), Guangzhou, Guangdong, Chine; École de soins infirmiers de Chine occidentale et Hôpital de Chine occidentale (Y. Xiao), Université du Sichuan, Chengdu, Sichuan, Chine; Département de médecine (p. Bégin), Université de Montréal, Montréal, Qué
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Liu STH, Lin HM, Baine I, Wajnberg A, Gumprecht JP, Rahman F, Rodriguez D, Tandon P, Bassily-Marcus A, Bander J, Sanky C, Dupper A, Zheng A, Nguyen FT, Amanat F, Stadlbauer D, Altman DR, Chen BK, Krammer F, Mendu DR, Firpo-Betancourt A, Levin MA, Bagiella E, Casadevall A, Cordon-Cardo C, Jhang JS, Arinsburg SA, Reich DL, Aberg JA, Bouvier NM. Convalescent plasma treatment of severe COVID-19: a propensity score–matched control study. Nat Med 2020; 26:1708-1713. [DOI: 10.1038/s41591-020-1088-9] [Citation(s) in RCA: 331] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
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19
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Lane TR, Massey C, Comer JE, Freiberg AN, Zhou H, Dyall J, Holbrook MR, Anantpadma M, Davey RA, Madrid PB, Ekins S. Pyronaridine tetraphosphate efficacy against Ebola virus infection in guinea pig. Antiviral Res 2020; 181:104863. [PMID: 32682926 PMCID: PMC8194506 DOI: 10.1016/j.antiviral.2020.104863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Abstract
The recent outbreaks of the Ebola virus (EBOV) in Africa have brought global visibility to the shortage of available therapeutic options to treat patients infected with this or closely related viruses. We have recently computationally identified three molecules which have all demonstrated statistically significant efficacy in the mouse model of infection with mouse adapted Ebola virus (ma-EBOV). One of these molecules is the antimalarial pyronaridine tetraphosphate (IC50 range of 0.82-1.30 μM against three strains of EBOV and IC50 range of 1.01-2.72 μM against two strains of Marburg virus (MARV)) which is an approved drug in the European Union and used in combination with artesunate. To date, no small molecule drugs have shown statistically significant efficacy in the guinea pig model of EBOV infection. Pharmacokinetics and range-finding studies in guinea pigs directed us to a single 300 mg/kg or 600 mg/kg oral dose of pyronaridine 1hr after infection. Pyronaridine resulted in statistically significant survival of 40% at 300 mg/kg and protected from a lethal challenge with EBOV. In comparison, oral favipiravir (300 mg/kg dosed once a day) had 43.5% survival. All animals in the vehicle treatment group succumbed to disease by study day 12 (100% mortality). The in vitro metabolism and metabolite identification of pyronaridine and another of our EBOV active molecules, tilorone, suggested significant species differences which may account for the efficacy or lack thereof, respectively in guinea pig. In summary, our studies with pyronaridine demonstrates its utility for repurposing as an antiviral against EBOV and MARV.
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Affiliation(s)
- Thomas R. Lane
- Collaborations Pharmaceuticals, Inc., 840 Main Campus Drive, Lab 3510, Raleigh, NC 27606, USA
| | - Christopher Massey
- Institutional Office of Regulated Nonclinical Studies, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Jason E. Comer
- Institutional Office of Regulated Nonclinical Studies, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Alexander N. Freiberg
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
- Department of Pathology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Huanying Zhou
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Julie Dyall
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Michael R. Holbrook
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Manu Anantpadma
- Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Robert A. Davey
- Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Peter B. Madrid
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
| | - Sean Ekins
- Collaborations Pharmaceuticals, Inc., 840 Main Campus Drive, Lab 3510, Raleigh, NC 27606, USA
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20
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Devasenapathy N, Ye Z, Loeb M, Fang F, Najafabadi BT, Xiao Y, Couban R, Bégin P, Guyatt G. Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis. CMAJ 2020; 192:E745-E755. [PMID: 32444482 PMCID: PMC7828893 DOI: 10.1503/cmaj.200642] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The safety and efficacy of convalescent plasma in severe coronavirus disease 2019 (COVID-19) remain uncertain. To support a guideline on COVID-19 management, we conducted a systematic review and meta-analysis of convalescent plasma in COVID-19 and other severe respiratory viral infections. METHODS In March 2020, we searched international and Chinese biomedical literature databases, clinical trial registries and prepublication sources for randomized controlled trials (RCTs) and nonrandomized studies comparing patients receiving and not receiving convalescent plasma. We included patients with acute coronavirus, influenza and Ebola virus infections. We conducted a meta-analysis using random-effects models and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS Of 1099 unique records, 6 studies were eligible, and none of these included patients with COVID-19. One nonrandomized study (n = 40) on convalescent plasma in severe acute respiratory syndrome coronavirus (SARS-CoV) provided uninformative results regarding mortality (relative risk [RR] 0.10, 95% confidence interval [CI] CI 0.01 to 1.70). Pooled estimates from 4 RCTs on influenza (n = 572) showed no convincing effects on deaths (4 RCTs, RR 0.94, 95% CI 0.49 to 1.81), complete recovery (2 RCTs, odds ratio 1.04, 95% CI 0.69 to 1.64) or length of stay (3 RCTs, mean difference -1.62, 95% CI -3.82 to 0.58, d). The quality of evidence was very low for all efficacy outcomes. Convalescent plasma caused few or no serious adverse events in influenza RCTs (RR 0.85, 95% CI 0.56 to 1.29, low-quality evidence). INTERPRETATION Studies of non-COVID-19 severe respiratory viral infections provide indirect, very low-quality evidence that raises the possibility that convalescent plasma has minimal or no benefit in the treatment of COVID-19 and low-quality evidence that it does not cause serious adverse events.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
| | - Zhikang Ye
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Mark Loeb
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Fang Fang
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Borna Tadayon Najafabadi
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Yingqi Xiao
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Rachel Couban
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Philippe Bégin
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
| | - Gordon Guyatt
- Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que
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21
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Li Y, Wang L, Si H, Yu Z, Tian S, Xiang R, Deng X, Liang R, Jiang S, Yu F. Influenza virus glycoprotein-reactive human monoclonal antibodies. Microbes Infect 2020; 22:263-271. [PMID: 32569735 PMCID: PMC7303604 DOI: 10.1016/j.micinf.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/08/2020] [Indexed: 11/05/2022]
Abstract
Influenza continues to be a significant public health challenge. Two glycoproteins on the surface of influenza virus, hemagglutinin and neuraminidase, play a prominent role in the process of influenza virus infection and release. Monoclonal antibodies targeting glycoproteins can effectively prevent the spread of the virus. In this review, we summarized currently reported human monoclonal antibodies targeting glycoproteins of influenza A and B viruses.
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Affiliation(s)
- Yanbai Li
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Lili Wang
- Research Center of Chinese Jujube, Hebei Agricultural University, Baoding, China
| | - Helong Si
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Zhengsen Yu
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Shijun Tian
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Rong Xiang
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Xiaoqian Deng
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Ruiying Liang
- College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai, China.
| | - Fei Yu
- College of Life Sciences, Hebei Agricultural University, Baoding, China.
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22
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Yamayoshi S, Kawaoka Y. Uncovering the Anti-Ebola Repertome. Cell Host Microbe 2020; 27:163-165. [PMID: 32053784 DOI: 10.1016/j.chom.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ebolavirus disease is a global threat. In this issue, Khurana et al. reveal the antibody response against all ebolavirus proteins by analyzing longitudinal antibody repertoires of an Ebola survivor from disease onset. Antibodies against VP40 and GP are found to predominate and two protective antigenic sites in GP identified.
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Affiliation(s)
- Seiya Yamayoshi
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
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23
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Kiiza P, Mullin S, Teo K, Adhikari NKJ, Fowler RA. Treatment of Ebola-related critical illness. Intensive Care Med 2020; 46:285-297. [PMID: 32055888 PMCID: PMC7223059 DOI: 10.1007/s00134-020-05949-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore contemporary clincial case management of patients with Ebola virus disease. METHODS A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - S Mullin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Lane, North York, ON, M3K 0A1, Canada
| | - N K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - R A Fowler
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
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24
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Kiiza P, Adhikari NKJ, Mullin S, Teo K, Fowler RA. Principles and Practices of Establishing a Hospital-Based Ebola Treatment Unit. Crit Care Clin 2020; 35:697-710. [PMID: 31445614 DOI: 10.1016/j.ccc.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen treatment units may improve case detection, interrupt transmission, and improve staff safety and patient care.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Neill K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Mullin
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Koren Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Ln, North York, Ontario M3K 0A1, Canada
| | - Robert A Fowler
- Sunnybrook Research Institute, Sunnybrook Hospital, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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25
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D’Alessandro S, Scaccabarozzi D, Signorini L, Perego F, Ilboudo DP, Ferrante P, Delbue S. The Use of Antimalarial Drugs against Viral Infection. Microorganisms 2020; 8:microorganisms8010085. [PMID: 31936284 PMCID: PMC7022795 DOI: 10.3390/microorganisms8010085] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Abstract
In recent decades, drugs used to treat malaria infection have been shown to be beneficial for many other diseases, including viral infections. In particular, they have received special attention due to the lack of effective antiviral drugs against new emerging viruses (i.e., HIV, dengue virus, chikungunya virus, Ebola virus, etc.) or against classic infections due to drug-resistant viral strains (i.e., human cytomegalovirus). Here, we reviewed the in vitro/in vivo and clinical studies conducted to evaluate the antiviral activities of four classes of antimalarial drugs: Artemisinin derivatives, aryl-aminoalcohols, aminoquinolines, and antimicrobial drugs.
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Affiliation(s)
- Sarah D’Alessandro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Diletta Scaccabarozzi
- Department of Pharmacological and Biomolecular Sciences, University of Milano, 20133 Milan, Italy;
| | - Lucia Signorini
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Federica Perego
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Denise P. Ilboudo
- Département des Sciences de la Vie, University of Fada N’Gourma (UFDG), Fada N’Gourma BP 54, Burkina Faso;
| | - Pasquale Ferrante
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
- Correspondence: ; Tel.: +39-02-50315070
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Ozer T, Geiss BJ, Henry CS. Review-Chemical and Biological Sensors for Viral Detection. JOURNAL OF THE ELECTROCHEMICAL SOCIETY 2020; 167:037523. [PMID: 32287357 PMCID: PMC7106559 DOI: 10.1149/2.0232003jes] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/25/2019] [Indexed: 05/19/2023]
Abstract
Infectious diseases commonly occur in contaminated water, food, and bodily fluids and spread rapidly, resulting in death of humans and animals worldwide. Among infectious agents, viruses pose a serious threat to public health and global economy because they are often difficult to detect and their infections are hard to treat. Since it is crucial to develop rapid, accurate, cost-effective, and in-situ methods for early detection viruses, a variety of sensors have been reported so far. This review provides an overview of the recent developments in electrochemical sensors and biosensors for detecting viruses and use of these sensors on environmental, clinical and food monitoring. Electrochemical biosensors for determining viruses are divided into four main groups including nucleic acid-based, antibody-based, aptamer-based and antigen-based electrochemical biosensors. Finally, the drawbacks and advantages of each type of sensors are identified and discussed.
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Affiliation(s)
- Tugba Ozer
- Department of Chemistry, Colorado State University, USA
- Yildiz Technical University, Faculty of Chemistry-Metallurgy, Department of Bioengineering, Istanbul, Turkey
| | - Brian J Geiss
- Department of Microbiology, Immunology & Pathology, Colorado State University, USA
- School of Biomedical Engineering, Colorado State University, USA
| | - Charles S Henry
- Department of Chemistry, Colorado State University, USA
- School of Biomedical Engineering, Colorado State University, USA
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