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Dalvie NC, Tostanoski LH, Rodriguez-Aponte SA, Kaur K, Bajoria S, Kumru OS, Martinot AJ, Chandrashekar A, McMahan K, Mercado NB, Yu J, Chang A, Giffin VM, Nampanya F, Patel S, Bowman L, Naranjo CA, Yun D, Flinchbaugh Z, Pessaint L, Brown R, Velasco J, Teow E, Cook A, Andersen H, Lewis MG, Camp DL, Silverman JM, Kleanthous H, Joshi SB, Volkin DB, Biswas S, Love JC, Barouch DH. A modular protein subunit vaccine candidate produced in yeast confers protection against SARS-CoV-2 in non-human primates. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.07.13.452251. [PMID: 34282417 PMCID: PMC8288147 DOI: 10.1101/2021.07.13.452251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vaccines against SARS-CoV-2 have been distributed at massive scale in developed countries, and have been effective at preventing COVID-19. Access to vaccines is limited, however, in low- and middle-income countries (LMICs) due to insufficient supply, high costs, and cold storage requirements. New vaccines that can be produced in existing manufacturing facilities in LMICs, can be manufactured at low cost, and use widely available, proven, safe adjuvants like alum, would improve global immunity against SARS-CoV-2. One such protein subunit vaccine is produced by the Serum Institute of India Pvt. Ltd. and is currently in clinical testing. Two protein components, the SARS-CoV-2 receptor binding domain (RBD) and hepatitis B surface antigen virus-like particles (VLPs), are each produced in yeast, which would enable a low-cost, high-volume manufacturing process. Here, we describe the design and preclinical testing of the RBD-VLP vaccine in cynomolgus macaques. We observed titers of neutralizing antibodies (>104) above the range of protection for other licensed vaccines in non-human primates. Interestingly, addition of a second adjuvant (CpG1018) appeared to improve the cellular response while reducing the humoral response. We challenged animals with SARS-CoV-2, and observed a ~3.4 and ~2.9 log10 reduction in median viral loads in bronchoalveolar lavage and nasal mucosa, respectively, compared to sham controls. These results inform the design and formulation of current clinical COVID-19 vaccine candidates like the one described here, and future designs of RBD-based vaccines against variants of SARS-CoV-2 or other betacoronaviruses.
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Affiliation(s)
- Neil C Dalvie
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Lisa H Tostanoski
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sergio A Rodriguez-Aponte
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Kawaljit Kaur
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, Kansas, 66047, USA
| | - Sakshi Bajoria
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, Kansas, 66047, USA
| | - Ozan S Kumru
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, Kansas, 66047, USA
| | - Amanda J Martinot
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Departments of Infectious Diseases and Global Health and Comparative Pathobiology, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
| | - Abishek Chandrashekar
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katherine McMahan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noe B Mercado
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aiquan Chang
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Victoria M Giffin
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix Nampanya
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shivani Patel
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lesley Bowman
- SpyBiotech Limited, Oxford Business Park North, Oxford, OX4 2JZ, United Kingdom
| | - Christopher A Naranjo
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Dongsoo Yun
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | | | | | | | | | | | | | | | | | - Danielle L Camp
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | | | | | - Sangeeta B Joshi
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, Kansas, 66047, USA
| | - David B Volkin
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, Kansas, 66047, USA
| | - Sumi Biswas
- Bill&Melinda Gates Foundation, Seattle, WA 98109, USA
| | - J Christopher Love
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- The Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Ragon Institute of MGH, MIT, Harvard, Cambridge, MA 02139, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA 02115, USA
- Ragon Institute of MGH, MIT, Harvard, Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA
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11
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Ramos AP, Leonhard SE, Halstead SK, Cuba MA, Castañeda CC, Dioses JA, Tipismana MA, Abanto JT, Llanos A, Gourlay D, Grogl M, Ramos M, Rojas JD, Meza R, Puiu D, Sherman RM, Salzberg SL, Simner PJ, Willison HJ, Jacobs BC, Cornblath DR, Umeres HF, Pardo CA. Guillain-Barré Syndrome Outbreak in Peru 2019 Associated With Campylobacter jejuni Infection. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e952. [PMID: 33547152 PMCID: PMC8057064 DOI: 10.1212/nxi.0000000000000952] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To identify the clinical phenotypes and infectious triggers in the 2019 Peruvian Guillain-Barré syndrome (GBS) outbreak. METHODS We prospectively collected clinical and neurophysiologic data of patients with GBS admitted to a tertiary hospital in Lima, Peru, between May and August 2019. Molecular, immunologic, and microbiological methods were used to identify causative infectious agents. Sera from 41 controls were compared with cases for antibodies to Campylobacter jejuni and gangliosides. Genomic analysis was performed on 4 C jejuni isolates. RESULTS The 49 included patients had a median age of 44 years (interquartile range [IQR] 30-54 years), and 28 (57%) were male. Thirty-two (65%) had symptoms of a preceding infection: 24 (49%) diarrhea and 13 (27%) upper respiratory tract infection. The median time between infectious to neurologic symptoms was 3 days (IQR 2-9 days). Eighty percent had a pure motor form of GBS, 21 (43%) had the axonal electrophysiologic subtype, and 18% the demyelinating subtype. Evidence of recent C jejuni infection was found in 28/43 (65%). No evidence of recent arbovirus infection was found. Twenty-three cases vs 11 controls (OR 3.3, confidence interval [CI] 95% 1.2-9.2, p < 0.01) had IgM and/or IgA antibodies against C jejuni. Anti-GM1:phosphatidylserine and/or anti-GT1a:GM1 heteromeric complex antibodies were strongly positive in cases (92.9% sensitivity and 68.3% specificity). Genomic analysis showed that the C jejuni strains were closely related and had the Asn51 polymorphism at cstII gene. CONCLUSIONS Our study indicates that the 2019 Peruvian GBS outbreak was associated with C jejuni infection and that the C jejuni strains linked to GBS circulate widely in different parts of the world.
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Affiliation(s)
- Ana P. Ramos
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sonja E. Leonhard
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan K. Halstead
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mireya A. Cuba
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carlos C. Castañeda
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose A. Dioses
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin A. Tipismana
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jesus T. Abanto
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alejandro Llanos
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dawn Gourlay
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Max Grogl
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mariana Ramos
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jesus D. Rojas
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rina Meza
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniela Puiu
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rachel M. Sherman
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven L. Salzberg
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patricia J. Simner
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hugh J. Willison
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bart C. Jacobs
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R. Cornblath
- From the Departamento de Medicina (A.P.R., M.A.C., C.C.C., J.A.D., M.A.T., J.T.A., H.F.U.), Servicio de Neurología y Neuropsiquiatría, Hospital Cayetano Heredia, Lima, Perú; Department of Neurology (S.E.L.) and Department of Neurology and Department of Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, Netherlands; Institute of Infection, Immunity and Inflammation (S.K.H., D.G., H.J.W.), University of Glasgow, United Kingdom; Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas (A.L.), Hospital Cayetano Heredia, Lima, Perú; U.S. Naval Medical Research Unit-6 (M.G., M.R., J.D.R., R.M.), Lima, Peru; Center for Computational Biology (D.P., R.M.S., S.L.S.), Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD; and Department of Pathology (P.J.S.), Department of Neurology (D.R.C.), and Department of Neurology and Department of Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD
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