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Martin MF, Bonaventure B, McCray NE, Peersen OB, Rozen-Gagnon K, Stapleford KA. Distinct chikungunya virus polymerase palm subdomains contribute to virus replication and virion assembly. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.15.575630. [PMID: 38293111 PMCID: PMC10827052 DOI: 10.1101/2024.01.15.575630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Alphaviruses encode an error-prone RNA-dependent RNA polymerase (RdRp), nsP4, required for genome synthesis, yet how the RdRp functions in the complete alphavirus life cycle is not well-defined. Previous work using chikungunya virus (CHIKV) has established the importance of the nsP4 residue cysteine 483 in maintaining viral genetic fidelity. Given the location of residue C483 in the nsP4 palm domain, we hypothesized that other residues within this domain and surrounding subdomains would also contribute to polymerase function. To test this hypothesis, we designed a panel of nsP4 variants via homology modeling based on the Coxsackievirus B3 3 polymerase. We rescued each variant in both mammalian and mosquito cells and discovered that the palm domain and ring finger subdomain contribute to polymerase host-specific replication and genetic stability. Surprisingly, in mosquito cells, these variants in the ring finger and palm domain were replication competent and produced viral structural proteins, but they were unable to produce infectious progeny, indicating a yet uncharacterized role for the polymerase in viral assembly. Finally, we have identified additional residues in the nsP4 palm domain that influence the genetic diversity of the viral progeny, potentially via an alteration in NTP binding and/or discrimination by the polymerase. Taken together, these studies highlight that distinct nsP4 subdomains regulate multiple processes of the alphavirus life cycle, placing nsP4 in a central role during the switch from RNA synthesis to packaging and assembly.
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Affiliation(s)
- Marie-France Martin
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Boris Bonaventure
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nia E. McCray
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Olve B. Peersen
- Department of Biochemistry & Molecular Biology, Colorado State University, Fort Collins, CO, USA
| | | | - Kenneth A. Stapleford
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
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2
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Ren J, Ling F, Liu Y, Sun J. Chikungunya in Zhejiang Province, Southeast China. INFECTIOUS MEDICINE 2023; 2:315-323. [PMID: 38205180 PMCID: PMC10774776 DOI: 10.1016/j.imj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
Background Chikungunya is emerging and reemerging word-widely in the past decades. It is non-endemic in Zhejiang Province, Southeast China. Aedes albopictus, one of major vectors of chikungunya, is widely-distribution in Zhejiang, and autochthonous transmission is possible after introducing chikungunya virus. Methods Retrospectively collected the epidemiological, clinical and genetic data of chikungunya and conducted the descriptive analysis and gene sequence analysis. Results From 2008 to 2022, 29 chikungunya cases, including 26 overseas imported and 3 local cases, were reported and no cases died of chikungunya. More than half of the imported cases (53.85%) were from Southeast Asia. Seasonal peak of the imported cases was noted between August and September, and 42.31% cases onset in those 2 months. Eight prefecture-level cities and 16 counties reported cases during the study period, with Jinghua (27.59%) and Hangzhou (24.14%) reporting the largest number of cases. The 3 local cases were all reported in Qujiang, Quzhou in 2017. For imported cases, the male-female gender ratio was 2.71:1, 20-30 years old cases (46.15%) and commercial service (42.31%) accounted for the highest proportion. Clinically, fever (100%), fatigue (94.44%), arthralgia (79.17%), headache (71.43%) and erythra (65.22%) were the most common reported symptoms. Eight whole-genome sequences were obtained and belonged to East/Central/South African (ECSA) or Asian genotype. Conclusions With the change of immigration policy, the surveillance of chikungunya should be strengthened and the ability of the case discovery and diagnosis should be improved in Zhejiang in the post-COVID-19 era.
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Affiliation(s)
- Jiangping Ren
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
| | - Feng Ling
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
| | - Ying Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou 310051, China
- Zhejiang Provincial Station of Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Hangzhou 310051, China
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Grabenstein JD, Tomar AS. Global geotemporal distribution of chikungunya disease, 2011-2022. Travel Med Infect Dis 2023; 54:102603. [PMID: 37307983 DOI: 10.1016/j.tmaid.2023.102603] [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: 05/20/2022] [Revised: 01/06/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chikungunya virus is a mosquito-borne alphavirus, transmitted by Aedes mosquitoes. Humans serve as the primary reservoir. Chikungunya infections typically appear with an abrupt onset of fever, rash, and severe joint pain. Some 40% of cases develop chronic rheumatologic complications that can persist months to years. OBJECTIVES To improve precision of risk characterization by analyzing cases of chikungunya by year and by country and depicting this geotemporal distribution in map form. METHOD Chikungunya case counts by year were compiled from national or regional health authorities from 2011 to 2022. These data were augmented by published reviews plus the Program for Monitoring Emerging Diseases (ProMED). Country-level distribution was categorized into four groups based on recency and magnitude. Data for India were mapped on a per-state basis. RESULTS The global map depicts distribution of chikungunya disease from 2011 through 2022. Most cases are reported in tropical and subtropical areas, but notable exceptions include the northern coast of the Mediterranean Sea. Countries of high recency and frequency include India, Brazil, Sudan, and Thailand. Countries with high frequency, but few cases reported in 2019-22 include many Latin American and Caribbean countries. Subnational foci are discussed in general and mapped for India. The range of Aedes mosquitoes is broader than the geography where chikungunya infection is typically diagnosed. CONCLUSIONS These maps help identify geographical regions where residents or travelers are at greatest risk of chikungunya. Once vaccines are licensed to help prevent chikungunya, maps like these can help guide future vaccine decision-making.
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Coirada FC, Fernandes ER, Mello LRD, Schuch V, Soares Campos G, Braconi CT, Boscardin SB, Santoro Rosa D. Heterologous DNA Prime- Subunit Protein Boost with Chikungunya Virus E2 Induces Neutralizing Antibodies and Cellular-Mediated Immunity. Int J Mol Sci 2023; 24:10517. [PMID: 37445695 DOI: 10.3390/ijms241310517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Chikungunya virus (CHIKV) has become a significant public health concern due to the increasing number of outbreaks worldwide and the associated comorbidities. Despite substantial efforts, there is no specific treatment or licensed vaccine against CHIKV to date. The E2 glycoprotein of CHIKV is a promising vaccine candidate as it is a major target of neutralizing antibodies during infection. In this study, we evaluated the immunogenicity of two DNA vaccines (a non-targeted and a dendritic cell-targeted vaccine) encoding a consensus sequence of E2CHIKV and a recombinant protein (E2*CHIKV). Mice were immunized with different homologous and heterologous DNAprime-E2* protein boost strategies, and the specific humoral and cellular immune responses were accessed. We found that mice immunized with heterologous non-targeted DNA prime- E2*CHIKV protein boost developed high levels of neutralizing antibodies, as well as specific IFN-γ producing cells and polyfunctional CD4+ and CD8+ T cells. We also identified 14 potential epitopes along the E2CHIKV protein. Furthermore, immunization with recombinant E2*CHIKV combined with the adjuvant AS03 presented the highest humoral response with neutralizing capacity. Finally, we show that the heterologous prime-boost strategy with the non-targeted pVAX-E2 DNA vaccine as the prime followed by E2* protein + AS03 boost is a promising combination to elicit a broad humoral and cellular immune response. Together, our data highlights the importance of E2CHIKV for the development of a CHIKV vaccine.
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Affiliation(s)
- Fernanda Caroline Coirada
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo 04023-062, Brazil
| | - Edgar Ruz Fernandes
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo 04023-062, Brazil
| | - Lucas Rodrigues de Mello
- Departamento de Biofísica, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo 04044-020, Brazil
| | - Viviane Schuch
- Departamento de Análises Clínicas e Toxicológicas, Universidade de São Paulo (USP), São Paulo 05508-000, Brazil
| | - Gúbio Soares Campos
- Laboratório de Virologia, Universidade Federal da Bahia (UFBA), Salvador 40110-909, Brazil
| | - Carla Torres Braconi
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo 04023-062, Brazil
| | - Silvia Beatriz Boscardin
- Departamento de Parasitologia, Universidade de São Paulo (USP), São Paulo 05508-000, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia-INCT (III), São Paulo 05403-900, Brazil
| | - Daniela Santoro Rosa
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo 04023-062, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia-INCT (III), São Paulo 05403-900, Brazil
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Kim AS, Diamond MS. A molecular understanding of alphavirus entry and antibody protection. Nat Rev Microbiol 2023; 21:396-407. [PMID: 36474012 PMCID: PMC9734810 DOI: 10.1038/s41579-022-00825-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
Alphaviruses are arthropod-transmitted RNA viruses that cause epidemics of human infection and disease on a global scale. These viruses are classified as either arthritogenic or encephalitic based on their genetic relatedness and the clinical syndromes they cause. Although there are currently no approved therapeutics or vaccines against alphaviruses, passive transfer of monoclonal antibodies confers protection in animal models. This Review highlights recent advances in our understanding of the host factors required for alphavirus entry, the mechanisms of action by which protective antibodies inhibit different steps in the alphavirus infection cycle and candidate alphavirus vaccines currently under clinical evaluation that focus on humoral immunity. A comprehensive understanding of alphavirus entry and antibody-mediated protection may inform the development of new classes of countermeasures for these emerging viruses.
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Affiliation(s)
- Arthur S Kim
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, USA
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Michael S Diamond
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO, USA.
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, Saint Louis, MO, USA.
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6
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Costa LB, Barreto FKDA, Barreto MCA, Santos THPD, Andrade MDMOD, Farias LABG, Freitas ARRD, Martinez MJ, Cavalcanti LPDG. Epidemiology and Economic Burden of Chikungunya: A Systematic Literature Review. Trop Med Infect Dis 2023; 8:301. [PMID: 37368719 DOI: 10.3390/tropicalmed8060301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Chikungunya (CHIK) is a re-emerging viral infection endemic in tropical and subtropical areas. While the typical clinical presentation is an acute febrile syndrome, long-term articular complications and even death can occur. This review characterizes the global epidemiological and economic burden of chikungunya. The search included studies published from 2007 to 2022 in MEDLINE, Embase, LILACS, and SciELO for a thorough evaluation of the literature. Rayyan software was used for data analysis, and data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-six publications were included. Chikungunya is widely distributed in the tropics, including Africa, Asia, South America, and Oceania/the Pacific Islands, and co-circulates with other simultaneous arboviruses such as DENV, ZIKV, and YFV. Chikungunya infection can lead to chronic articular manifestations with a significant impact on the quality of life in the long term. In addition, it generates absenteeism and economic and social losses and can cause fatal infections in vulnerable populations, mainly in high-risk patients with co-morbidities and at the extremes of age. Reported costs associated with CHIKV diseases are substantial and vary by region, age group, and public/private delivery of healthcare services. The chikungunya disease burden includes chronicity, severe infections, increased hospitalization risks, and associated mortality. The disease can impact the economy in several spheres, significantly affecting the health system and national economies. Understanding and measuring the full impact of this re-emerging disease is essential.
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Affiliation(s)
- Lourrany Borges Costa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Ceara (UFC), Ceara 60020-181, Brazil
- Faculdade de Medicina, Universidade de Fortaleza (UNIFOR), Ceara 60811-905, Brazil
| | | | | | | | | | - Luís Arthur Brasil Gadelha Farias
- Hospital São Jose de Doenças Infecciosas, Ceara 60455-610, Brazil
- Faculdade de Medicina, Centro Universitário Christus (UNICHRISTUS), Ceara 60192-345, Brazil
| | | | - Miguel Julian Martinez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Luciano Pamplona de Góes Cavalcanti
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Ceara (UFC), Ceara 60020-181, Brazil
- Faculdade de Medicina, Centro Universitário Christus (UNICHRISTUS), Ceara 60192-345, Brazil
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Montalvo Zurbia-Flores G, Reyes-Sandoval A, Kim YC. Chikungunya Virus: Priority Pathogen or Passing Trend? Vaccines (Basel) 2023; 11:568. [PMID: 36992153 PMCID: PMC10058558 DOI: 10.3390/vaccines11030568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Chikungunya virus (CHIKV) is considered a priority pathogen and a major threat to global health. While CHIKV infections may be asymptomatic, symptomatic patients can develop chikungunya fever (CHIKF) characterized by severe arthralgia which often transitions into incapacitating arthritis that could last for years and lead to significant loss in health-related quality of life. Yet, Chikungunya fever (CHIKF) remains a neglected tropical disease due to its complex epidemiology and the misrepresentation of its incidence and disease burden worldwide. Transmitted to humans by infected Aedes mosquitoes, CHIKV has dramatically expanded its geographic distribution to over 100 countries, causing large-scale outbreaks around the world and putting more than half of the population of the world at risk of infection. More than 50 years have passed since the first CHIKV vaccine was reported to be in development. Despite this, there is no licensed vaccine or antiviral treatments against CHIKV to date. In this review, we highlight the clinical relevance of developing chikungunya vaccines by discussing the poor understanding of long-term disease burden in CHIKV endemic countries, the complexity of CHIKV epidemiological surveillance, and emphasising the impact of the global emergence of CHIKV infections. Additionally, our review focuses on the recent progress of chikungunya vaccines in development, providing insight into the most advanced vaccine candidates in the pipeline and the potential implications of their roll-out.
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Affiliation(s)
| | - Arturo Reyes-Sandoval
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7DG, UK
- Instituto Politécnico Nacional (IPN), Av. Luis Enrique Erro s/n, Unidad Adolfo López Mateos, Mexico City 07738, Mexico
| | - Young Chan Kim
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford OX3 7DG, UK
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
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8
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Batista RP, Hökerberg YHM, de Oliveira RDVC, Lambert Passos SR. Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area. PLoS One 2023; 18:e0279970. [PMID: 36608030 PMCID: PMC9821784 DOI: 10.1371/journal.pone.0279970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Rio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungunya based on 3,214 suspected cases consecutively treated at primary and secondary health units of the sentinel surveillance system (up to 7 days from onset of symptoms) in Rio de Janeiro, Brazil. Of the total sample, 624 were chikungunya, 88 Zika, 51 dengue, and 2,451 were negative for all these arboviruses according to real-time polymerase chain reaction (RT-qPCR). The derived rule included fever (1 point), exanthema (1 point), myalgia (2 points), arthralgia or arthritis (2 points), and joint edema (2 points), providing an AUC (area under the receiver operator curve) = 0.695 (95% CI: 0.662-0.725). Scores of 4 points or more (validation sample) showed 74.3% sensitivity (69.0% - 79.2%) and 51.5% specificity (48.8% - 54.3%). Adding more symptoms improved the specificity at the expense of a lower sensitivity compared to definitions proposed by government agencies based on fever alone (European Center for Disease Control) or in combination with arthralgia (World Health Organization) or arthritis (Pan American Health Organization, Brazilian Ministry of Health). The proposed clinical rule offers a rapid, low-cost, easy-to-apply strategy to differentiate chikungunya fever from other arbovirus infections during epidemics.
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Affiliation(s)
- Raquel Pereira Batista
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: ,
| | - Yara Hahr Marques Hökerberg
- Laboratório de Epidemiologia Clínica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade de Medicina, Universidade Estácio de Sá (UNESA), Rio de Janeiro, Brazil
| | | | - Sonia Regina Lambert Passos
- Laboratório de Epidemiologia Clínica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Rabelo VWH, de Palmer Paixão ICN, Abreu PA. Structural insights into the inhibition of the nsP2 protease from Chikungunya virus by molecular modeling approaches. J Mol Model 2022; 28:311. [PMID: 36097090 DOI: 10.1007/s00894-022-05316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
Chikungunya virus (CHIKV) is the etiological agent of the Chikungunya fever which has spread worldwide. Clinically, this disease may lead to prolonged incapacitating joint pain that can compromise remarkably the patients' quality of life. However, there are no licensed vaccines or specific drugs to fight this infection yet, making the search for novel therapies an imperative need. In this scenario, the CHIKV nsP2 protease emerged as an attractive therapeutic target once this protein plays a pivotal role in viral replication and pathogenesis. Hence, we investigated the structural basis for the inhibition of this enzyme by using molecular docking and dynamics simulations. Compounds with inhibitory activities against CHIKV nsP2 protease determined experimentally were selected from the literature. Docking studies with a set of stereoisomers showed that trans isomers, but not cis ones, bound close to the catalytic dyad which may explain isomerism requirements to the enzyme's inhibition. Further, binding mode analyses of other known inhibitors revealed highly conserved contacts between inhibitors and enzyme residues like N1011, C1013, A1046, Y1079, N1082, W1084, L1205, and M1242. Molecular dynamics simulations reinforced the importance of some of these interactions and pointed to nonpolar interactions as the main forces for inhibitors' binding. Finally, we observed that true inhibitors exhibited lower structural fluctuation, higher ligand efficiency and did not induce significant changes in protein correlated motions. Collectively, our findings might allow discerning true inhibitors from false ones and can guide drug development efforts targeting the nsP2 protease to fight CHIKV infections in the future.
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Affiliation(s)
- Vitor Won-Held Rabelo
- Instituto de Biologia, Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Niterói, RJ, 24210-201, Brazil
| | - Izabel Christina Nunes de Palmer Paixão
- Instituto de Biologia, Programa de Pós-Graduação em Ciências e Biotecnologia, Universidade Federal Fluminense, Niterói, RJ, 24210-201, Brazil.,Departamento de Biologia Celular e Molecular, Instituto de Biologia, Universidade Federal Fluminense, Niterói, RJ, 24210-201, Brazil
| | - Paula Alvarez Abreu
- Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro, Macaé, RJ, 27965-045, Brazil.
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10
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Vidal ERN, Frutuoso LCV, Duarte EC, Peixoto HM. Epidemiological burden of Chikungunya fever in Brazil, 2016 and 2017. Trop Med Int Health 2021; 27:174-184. [PMID: 34905272 DOI: 10.1111/tmi.13711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To describe Chikungunya fever (CHIKF) cases and estimate the burden of the disease in Brazil between 2016 and 2017. METHODS The first stage of this study consisted of a descriptive epidemiological study with estimations of incidence, mortality and case-fatality rates for each Brazilian state. The second stage provided estimates of the disease burden using DALY, an indicator that aggregates measures of morbidity (years lived with disability - YLD) and mortality (years of life lost - YLL) into a single value. RESULTS In Brazil, the incidence rate in 2016 was 114.70 per 100,000 inhabitants, while the mortality rate was 0.15 per 100,000, for a case-fatality rate of 0.13%. In 2017, these figures were 87.59 and 0.12 per 100,000 inhabitants and 0.14%, respectively. The estimated CHIKF burden for Brazil in 2016 was 77,422.61 DALY or 0.3757 per 1000 inhabitants. In 2016, the YLL share of DALY was 10.04%, with YLD accounting for the remaining 89.96%. In 2017, the estimated burden was 59,307.59 DALY or 0.2856 per 1000 inhabitants, with YLL accounting for 9.65% of the total and YLD for 90.35%. CONCLUSION CHIKF causes a significant disease burden in Brazil. The chronic phase of CHIKF is responsible for the largest portion of DALY. Deaths from CHIKF are a significant component of the disease burden, with YLL accounting for approximately 10% of the total DALY value.
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Affiliation(s)
- Emily Raquel Nunes Vidal
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,Federal District Health Secretariat, Brasília, Brazil
| | - Livia Carla Vinhal Frutuoso
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, Brasil
| | - Elisabeth Carmen Duarte
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil
| | - Henry Maia Peixoto
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
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11
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Varghese FS, Meutiawati F, Teppor M, Jacobs S, de Keyzer C, Taşköprü E, van Woudenbergh E, Overheul GJ, Bouma E, Smit JM, Delang L, Merits A, van Rij RP. Posaconazole inhibits multiple steps of the alphavirus replication cycle. Antiviral Res 2021; 197:105223. [PMID: 34856248 DOI: 10.1016/j.antiviral.2021.105223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Abstract
Repurposing drugs is a promising strategy to identify therapeutic interventions against novel and re-emerging viruses. Posaconazole is an antifungal drug used to treat invasive aspergillosis and candidiasis. Recently, posaconazole and its structural analog, itraconazole were shown to inhibit replication of multiple viruses by modifying intracellular cholesterol homeostasis. Here, we show that posaconazole inhibits replication of the alphaviruses Semliki Forest virus (SFV), Sindbis virus and chikungunya virus with EC50 values ranging from 1.4 μM to 9.5 μM. Posaconazole treatment led to a significant reduction of virus entry in an assay using a temperature-sensitive SFV mutant, but time-of-addition and RNA transfection assays indicated that posaconazole also inhibits post-entry stages of the viral replication cycle. Virus replication in the presence of posaconazole was partially rescued by the addition of exogenous cholesterol. A transferrin uptake assay revealed that posaconazole considerably slowed down cellular endocytosis. A single point mutation in the SFV E2 glycoprotein, H255R, provided partial resistance to posaconazole as well as to methyl-β-cyclodextrin, corroborating the effect of posaconazole on cholesterol and viral entry. Our results indicate that posaconazole inhibits multiple steps of the alphavirus replication cycle and broaden the spectrum of viruses that can be targeted in vitro by posaconazole, which could be further explored as a therapeutic agent against emerging viruses.
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Affiliation(s)
- Finny S Varghese
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Febrina Meutiawati
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mona Teppor
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Sofie Jacobs
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Carolien de Keyzer
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Ezgi Taşköprü
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esther van Woudenbergh
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gijs J Overheul
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ellen Bouma
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jolanda M Smit
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Leen Delang
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Andres Merits
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Ronald P van Rij
- Department of Medical Microbiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
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Pentosan polysulfate sodium prevents functional decline in chikungunya infected mice by modulating growth factor signalling and lymphocyte activation. PLoS One 2021; 16:e0255125. [PMID: 34492036 PMCID: PMC8423248 DOI: 10.1371/journal.pone.0255125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
Chikungunya virus (CHIKV) is an arthropod-borne virus that causes large outbreaks world-wide leaving millions of people with severe and debilitating arthritis. Interestingly, clinical presentation of CHIKV arthritides have many overlapping features with rheumatoid arthritis including cellular and cytokine pathways that lead to disease development and progression. Currently, there are no specific treatments or vaccines available to treat CHIKV infections therefore advocating the need for the development of novel therapeutic strategies to treat CHIKV rheumatic disease. Herein, we provide an in-depth analysis of an efficacious new treatment for CHIKV arthritis with a semi-synthetic sulphated polysaccharide, Pentosan Polysulfate Sodium (PPS). Mice treated with PPS showed significant functional improvement as measured by grip strength and a reduction in hind limb foot swelling. Histological analysis of the affected joint showed local inflammation was reduced as seen by a decreased number of infiltrating immune cells. Additionally, joint cartilage was protected as demonstrated by increased proteoglycan staining. Using a multiplex-immunoassay system, we also showed that at peak disease, PPS treatment led to a systemic reduction of the chemokines CXCL1, CCL2 (MCP-1), CCL7 (MCP-3) and CCL12 (MCP-5) which may be associated with the reduction in cellular infiltrates. Further characterisation of the local effect of PPS in its action to reduce joint and muscle inflammation was performed using NanoString™ technology. Results showed that PPS altered the local expression of key functional genes characterised for their involvement in growth factor signalling and lymphocyte activation. Overall, this study shows that PPS is a promising treatment for alphaviral arthritis by reducing inflammation and protecting joint integrity.
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13
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Hapuarachchi HC, Wong WY, Koo C, Tien WP, Yeo G, Rajarethinam J, Tan E, Chiang S, Chong CS, Tan CH, Tan LK, Ng LC. Transient transmission of Chikungunya virus in Singapore exemplifies successful mitigation of severe epidemics in a vulnerable population. Int J Infect Dis 2021; 110:417-425. [PMID: 34380087 DOI: 10.1016/j.ijid.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Singapore experienced two major outbreaks of chikungunya in 2008-09 and 2013-14. Despite repeated virus introductions, fresh local outbreaks have not emerged after 2014. The present study reviews the success of chikungunya control in Singapore, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population. METHODS Chikungunya virus (CHIKV) sequences (421 envelope 1 genes and 56 polyproteins) were analysed to distinguish the indigenous virus groups from 2008 to 2020. Vector surveillance data was used to incriminate the vector/s associated with local outbreaks. The population exposure to CHIKV was determined by assessing the seroprevalence status in three cohorts of sera collected in 2009 (n=2,008), 2013 (n=2,000) and 2017 (n=3,615). RESULTS Four distinct groups of CHIKV of East, Central and South African genotype have mainly circulated since 2008, transmitted primarily by Aedes albopictus. The age weighted CHIKV IgG prevalence rates were low (1-5%) and showed a non-significant increase from 2009 to 2013, but a significant decrease in 2017. In contrast, the prevalence of CHIKV neutralising antibodies in the population increased significantly from 2009 to 2013, with no significant change in 2017, but the levels remained below 2%. CONCLUSIONS The evidence suggested that surveillance and vector control strategies implemented were robust to avert severe epidemics, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population.
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Affiliation(s)
| | - Wing-Yan Wong
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Carmen Koo
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Wei-Ping Tien
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Gladys Yeo
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Jayanthi Rajarethinam
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Eugene Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Suzanna Chiang
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Chee-Seng Chong
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Cheong-Huat Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Li-Kiang Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667; School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551
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14
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Nano-multilamellar lipid vesicles loaded with a recombinant form of the chikungunya virus E2 protein improve the induction of virus-neutralizing antibodies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 37:102445. [PMID: 34303841 DOI: 10.1016/j.nano.2021.102445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023]
Abstract
Chikungunya virus (CHIKV) is responsible for a self-limited illness that can evolve into long-lasting painful joint inflammation. In this study, we report a novel experimental CHIKV vaccine formulation of lipid nanoparticles loaded with a recombinant protein derived from the E2 structural protein. This antigen fragment, designated ∆E2.1, maintained the antigenicity of the native viral protein and was specifically recognized by antibodies induced in CHIKV-infected patients. The antigen has been formulated into nanoparticles consisting of nano-multilamellar vesicles (NMVs) combined with the adjuvant monophosphoryl lipid A (MPLA). The vaccine formulation demonstrated a depot effect, leading to controlled antigen release, and induced strong antibody responses significantly higher than in mice immunized with the purified protein combined with the adjuvant. More relevantly, E2-specific antibodies raised in mice immunized with ∆E2.1-loaded NMV-MPLA neutralized CHIKV under in vitro conditions. Taken together, the results demonstrated that the new nanoparticle-based vaccine formulation represents a promising approach for the development of effective anti-CHIKV vaccines.
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15
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Silva MMO, Kikuti M, Anjos RO, Portilho MM, Santos VC, Gonçalves TSF, Tauro LB, Moreira PSS, Jacob-Nascimento LC, Santana PM, Campos GS, Siqueira AM, Kitron U, Reis MG, Ribeiro GS. Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil. Int J Infect Dis 2021; 105:608-616. [PMID: 33684559 DOI: 10.1016/j.ijid.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/17/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. METHODS From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. RESULTS Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95-2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01-1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48-1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). CONCLUSIONS These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
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Affiliation(s)
| | - Mariana Kikuti
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane C Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Laura B Tauro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Biologia Subtropical, CONICET-UNAM, Puerto Iguazú, Argentina
| | | | | | - Perla M Santana
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Gúbio S Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Emory University, Atlanta, GA, USA
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
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Abstract
Throughout the last decade, chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have spread globally, causing a spectrum of disease that ranges from self-limited febrile illness to permanent severe disability, congenital anomalies, and early death. Nevertheless, estimates of their aggregate health impact are absent from the literature and are currently omitted from the Global Burden of Disease (GBD) reports. We systematically reviewed published literature and surveillance records to evaluate the global burden caused by CHIKV and ZIKV between 2010 and 2019, to calculate estimates of their disability-adjusted life year (DALY) impact. Extracted data on acute, chronic, and perinatal outcomes were used to create annualized DALY estimates, following techniques outlined in the GBD framework. This study is registered with PROSPERO (CRD42020192502). Of 7,877 studies identified, 916 were screened in detail, and 21 were selected for inclusion. Available data indicate that CHIKV and ZIKV caused the average yearly loss of over 106,000 and 44,000 DALYs, respectively, between 2010 and 2019. Both viruses caused substantially more burden in the Americas than in any other World Health Organization (WHO) region. This unequal distribution is likely due to a combination of limited active surveillance reporting in other regions and the lack of immunity that left the previously unexposed populations of the Americas susceptible to severe outbreaks during the last decade. Long-term rheumatic sequelae provided the largest DALY component for CHIKV, whereas congenital Zika syndrome (CZS) contributed most significantly for ZIKV. Acute symptoms and early mortality accounted for relatively less of the overall burden. Suboptimal reporting and inconsistent diagnostics limit precision when determining arbovirus incidence and frequency of complications. Despite these limitations, it is clear from our assessment that CHIKV and ZIKV represent a significant cause of morbidity that is not included in current disease burden reports. These results suggest that transmission-blocking strategies, including vector control and vaccine development, remain crucial priorities in reducing global disease burden through prevention of potentially devastating arboviral outbreaks. Chikungunya and Zika are 2 mosquito-borne viral diseases that can cause both acute symptoms and long-term, debilitating complications in infected individuals. Chikungunya is best known as a cause of persistent arthritis in otherwise recovered patients and Zika as a cause of cognitive, motor, and sensory anomalies in newborn children. Both diseases emerged in the Americas within the last decade and have since spread rapidly throughout the region. Despite their widespread transmission there and throughout much of the world, chikungunya and Zika remain neglected diseases. One of the most significant obstacles to address their spread is a lack of data involving their burden. We searched the published literature and surveillance reports to collect information about the incidence, mortality, and morbidity associated with each of these diseases to estimate their regional and global burden during the last decade. Our estimates confirm that chikungunya and Zika caused substantial burden throughout this time frame and place them among the most problematic mosquito-borne viral diseases worldwide. We found that the largest proportion of global burden linked to each disease between 2010 and 2019 occurred in the Americas, although this observation is likely due to limited reporting in other regions.
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Prophylactic strategies to control chikungunya virus infection. Virus Genes 2021; 57:133-150. [PMID: 33590406 PMCID: PMC7883954 DOI: 10.1007/s11262-020-01820-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/11/2020] [Indexed: 11/18/2022]
Abstract
Chikungunya virus (CHIKV) is a (re)emerging arbovirus and the causative agent of chikungunya fever. In recent years, CHIKV was responsible for a series of outbreaks, some of which had serious economic and public health impacts in the affected regions. So far, no CHIKV-specific antiviral therapy or vaccine has been approved. This review gives a brief summary on CHIKV epidemiology, spread, infection and diagnosis. It furthermore deals with the strategies against emerging diseases, drug development and the possibilities of testing antivirals against CHIKV in vitro and in vivo. With our review, we hope to provide the latest information on CHIKV, disease manifestation, as well as on the current state of CHIKV vaccine development and post-exposure therapy.
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18
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BEHZADIFAR MASOUD, IMANI-NASAB MOHAMMADHASAN, MARTINI MARIANO, GHANBARI MAHBOUBEHKHATON, BAKHTIARI AHAD, BRAGAZZI NICOLALUIGI. Universal Health Coverage to counteract the economic impact of the COVID-19 infection: current practices and ethical challenges. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E520-E524. [PMID: 33628955 PMCID: PMC7888394 DOI: 10.15167/2421-4248/jpmh2020.61.4.1581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 02/03/2023]
Abstract
In late December 2019, the first case of an emerging coronavirus was identified in the city of Wuhan, Hubei province, in mainland China. The novel virus appears to be highly contagious and is rapidly spreading worldwide, becoming a pandemic. The disease is causing a high toll of deaths. Effective public health responses to a new infectious disease are expected to mitigate and counteract its negative impact on the population. However, time and economic-financial constraints, as well as uncertainty, can jeopardize the answer. The aim of the present paper was to discuss the role of Universal Health Coverage to counteract the economic impact of the COVID-19 infection. Appropriate financing of the health system and ensuring equitable access to health services for all can, indeed, protect individuals against high medical costs, which is one of the most important goals of any health system. Financing profoundly affects the performance of the health system, and any policy that the health system decides to implement or not directly depends on the amount of available funding. Developed countries are injecting new funding to cope with the disease and prevent its further transmission. In addition to psychological support and increased societal engagement for the prevention, control, and treatment of COVID-19, extensive financial support to governments by the community should be considered. Developed and rich countries should support countries that do not have enough financial resources. This disease cannot be controlled and contained without international cooperation. The experience of the COVID-19 should be a lesson for further establishing and achieving universal health coverage in all countries. In addition to promoting equity in health, appropriate infrastructure should be strengthened to address these crises. Governments should make a stronger political commitment to fully implement this crucial set of policies and plans.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - MOHAMMAD-HASAN IMANI-NASAB
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | | | - AHAD BAKHTIARI
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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19
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Dudouet P, Gautret P, Larsen CS, Díaz-Menéndez M, Trigo E, von Sonnenburg F, Gobbi F, Grobusch MP, Malvy D, Field V, Asgeirsson H, Souto IO, Hamer DH, Parola P, Javelle E. Chikungunya resurgence in the Maldives and risk for importation via tourists to Europe in 2019-2020: A GeoSentinel case series. Travel Med Infect Dis 2020; 36:101814. [PMID: 32619732 PMCID: PMC7324928 DOI: 10.1016/j.tmaid.2020.101814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
Background Chikungunya virus (CHIKV) is an arthropod-borne virus mainly transmitted in tropical areas by Aedes spp. mosquitoes. It has been responsible for small-to-large outbreaks in temperate areas including southern Europe and North America. Past outbreaks in 2006 on the islands of Maldives, as well as on other islands in the Indian Ocean and in Southeast Asia, demonstrated for the first time the capacity of CHIKV to disseminate through travel and transcontinental commerce, and revealed the major socio-economic impact of CHIKV epidemics. Recently, CHIKV has been circulating in highly touristic areas including the Maldives, where 1736 cases were notified by the Health Protection Agency during 2019. Case series Among EuroTravNet/GeoSentinel patient records, eight CHIKV-confirmed cases imported the Maldives to France, Germany, Denmark, Italy and Spain were identified between February 2019 and February 2020; exceeding the total number of CHIKV infections travel-acquired in Maldives reported to this surveillance network during the previous 10 years. Conclusions The prevention and control of CHIKV introduction into naïve areas colonised by competent vectors is crucial. CHIKV outbreaks must be detected and reported in a timely manner. This must lead to adapted health information for international travellers and to prompt management of suspected imported cases. Conversely, travellers make for excellent sentinels and increased reports of imported cases might reflect a change in the level of endemicity or even herald an outbreak. Feedback to the local health authorities and matching this with local epidemiological surveillance data may lead to health benefits for the local population.
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Affiliation(s)
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | | | - Marta Díaz-Menéndez
- National Referral Unit for Imported Tropical Diseases, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Elena Trigo
- National Referral Unit for Imported Tropical Diseases, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Frank von Sonnenburg
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Federico Gobbi
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro-Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Denis Malvy
- Department for Infectious and Tropical Diseases, University Hospital Center of Bordeaux, Bordeaux, France
| | - Vanessa Field
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, and Unit of Infectious Diseases, Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Inés Oliveira Souto
- Department of Infectious Diseases, Tropical Medicine Unit Vall d'Hebron-Drassanes, Valld'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS, Barcelona, Spain
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, USA; Department of Medicine, Boston University School of Medicine, and National Emerging Infectious Disease Laboratory, USA
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Emilie Javelle
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; Laveran Military Teaching Hospital, Marseille, France.
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20
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Gong M, Liu L, Sun X, Yang Y, Wang S, Zhu H. Cloud-Based System for Effective Surveillance and Control of COVID-19: Useful Experiences From Hubei, China. J Med Internet Res 2020; 22:e18948. [PMID: 32287040 PMCID: PMC7179239 DOI: 10.2196/18948] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background Coronavirus disease (COVID-19) has been an unprecedented challenge to the global health care system. Tools that can improve the focus of surveillance efforts and clinical decision support are of paramount importance. Objective The aim of this study was to illustrate how new medical informatics technologies may enable effective control of the pandemic through the development and successful 72-hour deployment of the Honghu Hybrid System (HHS) for COVID-19 in the city of Honghu in Hubei, China. Methods The HHS was designed for the collection, integration, standardization, and analysis of COVID-19-related data from multiple sources, which includes a case reporting system, diagnostic labs, electronic medical records, and social media on mobile devices. Results HHS supports four main features: syndromic surveillance on mobile devices, policy-making decision support, clinical decision support and prioritization of resources, and follow-up of discharged patients. The syndromic surveillance component in HHS covered over 95% of the population of over 900,000 people and provided near real time evidence for the control of epidemic emergencies. The clinical decision support component in HHS was also provided to improve patient care and prioritize the limited medical resources. However, the statistical methods still require further evaluations to confirm clinical effectiveness and appropriateness of disposition assigned in this study, which warrants further investigation. Conclusions The facilitating factors and challenges are discussed to provide useful insights to other cities to build suitable solutions based on cloud technologies. The HHS for COVID-19 was shown to be feasible and effective in this real-world field study, and has the potential to be migrated.
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Affiliation(s)
- Mengchun Gong
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Li Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuang Wang
- Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Zhu
- Institute of Health Management, Southern Medical University, Guangzhou, China.,Nanfang Hospital, Southern Medical University, Guangzhou, China
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21
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弓 孟, 刘 莉, 吴 琛, 杨 越, 沈 杨, 李 杰, 林 凯, 郭 怡, 魏 红, 徐 泽, 朱 宏. [Conducting clinical studies during the epidemics of communicable diseases: perspectives of methodology and health economics]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:353-357. [PMID: 32376587 PMCID: PMC7167318 DOI: 10.12122/j.issn.1673-4254.2020.03.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 12/21/2022]
Abstract
In the setting of epidemics of communicable diseases, early initiation of epidemiological and clinical data collection and analysis and conducting relevant researches are essential to the success of epidemic containment. The coronavirus disease 2019 (COVID-19), starting initially as an epidemic in China in late 2019 and now becoming a pandemic globally, poses grave challenges to the global health care systems while also provides an opportunity for studying infectious diseases in the perspective of methodology. The authors propose the evaluation methods for case reports, randomized controlled trials (RCTs), real-world evidence studies and health economics researches during an epidemic. Case reports, which are of important value for health care workers during outbreaks of infectious diseases, should be written in standard format and style and published following a strict peer review process. RCTs provides the gold standard for evaluating the effectiveness of a given treatment for the patients from the outbreaks. We review the potential challenges faced in conducting RCTs during the outbreaks. The real-world data collected from the cases in designated hospitals allow the verification of the safety and effectiveness of the intervention measures. The data from health economics research also provide important support for optimizing communicable disease prevention and control strategies. Herein we summarize the health economics research methods, study design, and technical points during the outbreaks. We recommend that clinical research and health economics research be incorporated into the prevention and control plan and measures be taken to ensure both the standards and feasibility of these studies to improve the response capacity against outbreaks of communicable diseases.
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Affiliation(s)
- 孟春 弓
- 南方医科大学 卫生与健康管理研究院,广东 广州 510515Institute of Health Management, Southern Medical University, Guangzhou 510515, China
| | - 莉 刘
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 琛 吴
- 神州数码医疗科技股份有限公司,北京 100085Digital China Health Technologies Co. Ltd, Beijing 100085, China
| | - 越 杨
- 神州数码医疗科技股份有限公司,北京 100085Digital China Health Technologies Co. Ltd, Beijing 100085, China
| | - 杨 沈
- 神州数码医疗科技股份有限公司,北京 100085Digital China Health Technologies Co. Ltd, Beijing 100085, China
| | - 杰 李
- 神州数码医疗科技股份有限公司,北京 100085Digital China Health Technologies Co. Ltd, Beijing 100085, China
| | - 凯程 林
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 怡 郭
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 红云 魏
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 泽宇 徐
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 宏 朱
- 南方医科大学 卫生与健康管理研究院,广东 广州 510515Institute of Health Management, Southern Medical University, Guangzhou 510515, China
- 南方医科大学 南方医院,广东 广州 510515Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Waltero C, Martins R, Calixto C, da Fonseca RN, Abreu LAD, da Silva Vaz I, Logullo C. The hallmarks of GSK-3 in morphogenesis and embryonic development metabolism in arthropods. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2020; 118:103307. [PMID: 31857215 DOI: 10.1016/j.ibmb.2019.103307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
Several research groups around the world have studied diverse aspects of energy metabolism in arthropod disease vectors, with the aim of discovering potential control targets. As in all oviparous organisms, arthropod embryonic development is characterized by the mobilization of maternally-derived metabolites for the formation of new tissues and organs. Glycogen synthase kinase-3 (GSK-3) is a serine-threonine kinase described as an important regulator of metabolism and development in a wide range of organisms. GSK-3 was first identified based on its action upon glycogen synthase, a central enzyme in glycogen biosynthesis. Currently, it is recognized as a key component of multiple cellular processes such as glucose metabolism, apoptosis, cell proliferation, transcription, cell migration, and immune response. The present review will describe the current knowledge on GSK-3 activation and its role in morphogenesis and embryonic metabolism in arthropods. Altogether, the information discussed here can spark new approaches and strategies for further studies, enhancing our understanding of these important arthropod vectors and strengthening the resources in the search for novel control methods.
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Affiliation(s)
- Camila Waltero
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil
| | - Renato Martins
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil
| | - Christiano Calixto
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil
| | - Rodrigo Nunes da Fonseca
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular (INCT-EM), Brazil
| | - Leonardo Araujo de Abreu
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular (INCT-EM), Brazil
| | - Itabajara da Silva Vaz
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular (INCT-EM), Brazil; Centro de Biotecnologia and Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Brazil
| | - Carlos Logullo
- Instituto de Biodiversidade e Sustentabilidade NUPEM, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular (INCT-EM), Brazil.
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