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Curran EH, Devine MD, Hartley CD, Huang Y, Conrady CD, Debiec MR, Justin GA, Thomas J, Yeh S. Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework. Front Med (Lausanne) 2024; 10:1349571. [PMID: 38293299 PMCID: PMC10824978 DOI: 10.3389/fmed.2023.1349571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.
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Affiliation(s)
- Emma H. Curran
- Creighton University School of Medicine, Omaha, NE, United States
| | - Max D. Devine
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caleb D. Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- Department of Ophthalmology, University of Illinois-Chicago, Chicago, IL, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joanne Thomas
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
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2
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Stoll A, Shenton DP, Green AC, Holley JL. Comparative Aspects of Ricin Toxicity by Inhalation. Toxins (Basel) 2023; 15:toxins15040281. [PMID: 37104219 PMCID: PMC10145923 DOI: 10.3390/toxins15040281] [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: 03/20/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
The pathogenesis of ricin toxicity following inhalation has been investigated in many animal models, including the non-human primate (predominantly the rhesus macaque), pig, rabbit and rodent. The toxicity and associated pathology described in animal models are broadly similar, but variation appears to exist. This paper reviews the published literature and some of our own unpublished data and describes some of the possible reasons for this variation. Methodological variation is evident, including method of exposure, breathing parameters during exposure, aerosol characteristics, sampling protocols, ricin cultivar, purity and challenge dose and study duration. The model species and strain used represent other significant sources of variation, including differences in macro- and microscopic anatomy, cell biology and function, and immunology. Chronic pathology of ricin toxicity by inhalation, associated with sublethal challenge or lethal challenge and treatment with medical countermeasures, has received less attention in the literature. Fibrosis may follow acute lung injury in survivors. There are advantages and disadvantages to the different models of pulmonary fibrosis. To understand their potential clinical significance, these factors need to be considered when choosing a model for chronic ricin toxicity by inhalation, including species and strain susceptibility to fibrosis, time it takes for fibrosis to develop, the nature of the fibrosis (e.g., self-limiting, progressive, persistent or resolving) and ensuring that the analysis truly represents fibrosis. Understanding the variables and comparative aspects of acute and chronic ricin toxicity by inhalation is important to enable meaningful comparison of results from different studies, and for the investigation of medical countermeasures.
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Affiliation(s)
- Alexander Stoll
- Defence Science and Technology Laboratory, Salisbury SP4 0JQ, UK
| | - Daniel P Shenton
- Defence Science and Technology Laboratory, Salisbury SP4 0JQ, UK
| | | | - Jane L Holley
- Defence Science and Technology Laboratory, Salisbury SP4 0JQ, UK
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3
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Rasetti-Escargueil C, Avril A. Medical Countermeasures against Ricin Intoxication. Toxins (Basel) 2023; 15:toxins15020100. [PMID: 36828415 PMCID: PMC9966136 DOI: 10.3390/toxins15020100] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/14/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Ricin toxin is a disulfide-linked glycoprotein (AB toxin) comprising one enzymatic A chain (RTA) and one cell-binding B chain (RTB) contained in the castor bean, a Ricinus species. Ricin inhibits peptide chain elongation via disruption of the binding between elongation factors and ribosomes, resulting in apoptosis, inflammation, oxidative stress, and DNA damage, in addition to the classically known rRNA damage. Ricin has been used in traditional medicine throughout the world since prehistoric times. Because ricin toxin is highly toxic and can be readily extracted from beans, it could be used as a bioweapon (CDC B-list). Due to its extreme lethality and potential use as a biological weapon, ricin toxin remains a global public health concern requiring specific countermeasures. Currently, no specific treatment for ricin intoxication is available. This review focuses on the drugs under development. In particular, some examples are reviewed to demonstrate the proof of concept of antibody-based therapy. Chemical inhibitors, small proteins, and vaccines can serve as alternatives to antibodies or may be used in combination with antibodies.
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Affiliation(s)
- Christine Rasetti-Escargueil
- Unité des Bactéries Anaérobies et Toxines, Institut Pasteur, 25 Avenue du Docteur Roux, 75015 Paris, France
- Correspondence:
| | - Arnaud Avril
- Unité Immunopathologies, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France
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4
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Brunka Z, Ryl J, Brushtulli P, Gromala D, Walczak G, Zięba S, Pieśniak D, Sein Anand J, Wiergowski M. Selected Political Criminal Poisonings in the Years 1978-2020: Detection and Treatment. TOXICS 2022; 10:468. [PMID: 36006147 PMCID: PMC9413450 DOI: 10.3390/toxics10080468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Criminal poisonings are among the least frequently detected crimes in the world. Lack of suspicion of this type of event by police officers and prosecutors, clinical symptoms imitating many somatic diseases and technical difficulties in diagnostics, as well as high research costs make the actual frequency of these events difficult to estimate. The substance used for criminal poisoning is often characterized by: lack of taste, color and smell, delayed action, easy availability and difficulty to detect. The aim of the study was to analyze selected cases of political poisoning that took place in the years 1978-2020, to describe the mechanisms of action of the substances used and to evaluate the diagnosis and treatment. The analyzed cases of criminal poisoning concerned: Georgi Markov (ricin), Khalid Maszal (fentanyl), Wiktor Yushchenko (TCDD dioxin), Jasir Arafat (polonium 210Po isotope), Alexander Litvinenko (polonium 210Po isotope), Kim Jong-Nam (VX), Sergei Skripal (Novichok) and Alexei Navalny (Novichok). Contemporary poisons, to a greater extent than in the past, are based on the use of synthetic substances from the group of organophosphorus compounds and radioactive substances. The possibility of taking appropriate and effective treatment in such cases is the result of many factors, including the possibility of quick and competent rescue intervention, quick and reliable detection of the toxic substance and the possibility of using an antidote.
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Affiliation(s)
- Zuzanna Brunka
- Student Scientific Society of the Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Jan Ryl
- Student Scientific Society of the Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Piotr Brushtulli
- Student Scientific Society of the Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Daria Gromala
- Student Scientific Society of the Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Grzegorz Walczak
- Student Scientific Society of the Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Sonia Zięba
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Dorota Pieśniak
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
| | - Jacek Sein Anand
- Division of Clinical Toxicology, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
- Pomeranian Center of Toxicology, Kartuska 4/6 Str., 80-104 Gdańsk, Poland
| | - Marek Wiergowski
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Str., 80-210 Gdańsk, Poland
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Falach R, Goldvaser M, Halpern P, Rosner A, Sapoznikov A, Gal Y, Goren O, Sabo T, Kronman C, Katalan S. Pathophysiological profile of awake and anesthetized pigs following systemic exposure to the highly lethal ricin toxin. Clin Toxicol (Phila) 2022; 60:76-82. [PMID: 34080504 DOI: 10.1080/15563650.2021.1933513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Ricin, a plant-derived toxin originating from the seeds of Ricinus communis (castor bean plant), is one of the most lethal toxins known. To date, no in-depth study of systemic exposure to ricin in a standardized large animal model has been reported. This study details for the first time the pathophysiological hemodynamic profile following systemic/intramuscular exposure to the ricin toxin in a porcine model by comprehensive cardiorespiratory monitoring of awake and anesthetized pigs. Unlike respiratory exposure to ricin, which is characterized by the development of acute respiratory distress syndrome, following intramuscular exposure to ricin respiratory parameters were grossly unaffected, however the hemodynamics of both awake and anesthetize pigs were unsustainably compromised. We show that in the early phase until approximately 24 h post-exposure, cardiac output is not impaired although one of its components, stroke volume, is relatively low. This is due to compensatory increase in heart rate, which eventually becomes insufficient. Later, distributive shock develops, characterized by severe vasodilatation (decreased systemic vascular resistance), low central venous oxygen saturation and elevation of venous-to-arterial carbon dioxide difference indicating increase in tissue oxygen demand not met by cardiac supply. These findings serve as a basis for further studies to evaluate the ability of supportive treatments such as vasoactive and inotropic drugs, to postpone the hemodynamic deterioration and thus expand the therapeutic window for the anti-ricin treatment. Such studies are of crucial importance for judicious treatment of victims of acts of bioterrorism or of intentional self-poisoning.
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Affiliation(s)
- Reut Falach
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Michael Goldvaser
- Division of Medicinal Chemistry, Israel Institute for Biological Research, Ness Ziona, Israel
| | | | - Amir Rosner
- Veterinary Center for Preclinical Research, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Anita Sapoznikov
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Yoav Gal
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Orr Goren
- Anesthesia, Pain and Intensive Care Division, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Tamar Sabo
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Chanoch Kronman
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Shahaf Katalan
- Division of Medicinal Chemistry, Israel Institute for Biological Research, Ness Ziona, Israel
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6
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Intramuscular Exposure to a Lethal Dose of Ricin Toxin Leads to Endothelial Glycocalyx Shedding and Microvascular Flow Abnormality in Mice and Swine. Int J Mol Sci 2021; 22:ijms222212345. [PMID: 34830227 PMCID: PMC8618821 DOI: 10.3390/ijms222212345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/17/2023] Open
Abstract
Ricin toxin isolated from the castor bean (Ricinus communis) is one of the most potent and lethal molecules known. While the pathophysiology and clinical consequences of ricin poisoning by the parenteral route, i.e., intramuscular penetration, have been described recently in various animal models, the preceding mechanism underlying the clinical manifestations of systemic ricin poisoning has not been completely defined. Here, we show that following intramuscular administration, ricin bound preferentially to the vasculature in both mice and swine, leading to coagulopathy and widespread hemorrhages. Increased levels of circulating VEGF and decreased expression of vascular VE-cadherin caused blood vessel impairment, thereby promoting hyperpermeability in various organs. Elevated levels of soluble heparan sulfate, hyaluronic acid and syndecan-1 were measured in blood samples following ricin intoxication, indicating that the vascular glycocalyx of both mice and swine underwent extensive damage. Finally, by using side-stream dark field intravital microscopy imaging, we determined that ricin poisoning leads to microvasculature malfunctioning, as manifested by aberrant blood flow and a significant decrease in the number of diffused microvessels. These findings, which suggest that glycocalyx shedding and microcirculation dysfunction play a major role in the pathology of systemic ricin poisoning, may serve for the formulation of specifically tailored therapies for treating parenteral ricin intoxication.
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7
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Falach R, Bar-On L, Lazar S, Kadar T, Mazor O, Aftalion M, Gur D, Evgy Y, Shifman O, Aminov T, Israeli O, Cohen-Gihon I, Zaide G, Gutman H, Vagima Y, Makdasi E, Stein D, Rosenfeld R, Alcalay R, Zahavy E, Levy H, Glinert I, Ben-Shmuel A, Israely T, Melamed S, Politi B, Achdout H, Yitzhaki S, Kronman C, Sabo T. Mice with induced pulmonary morbidities display severe lung inflammation and mortality following exposure to SARS-CoV-2. JCI Insight 2021; 6:145916. [PMID: 33974566 PMCID: PMC8262502 DOI: 10.1172/jci.insight.145916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
Mice are normally unaffected by SARS coronavirus 2 (SARS-CoV-2) infection since the virus does not bind effectively to the murine version of the angiotensin-converting enzyme 2 (ACE2) receptor molecule. Here, we report that induced mild pulmonary morbidities rendered SARS-CoV-2–refractive CD-1 mice susceptible to this virus. Specifically, SARS-CoV-2 infection after application of low doses of the acute lung injury stimulants bleomycin or ricin caused severe disease in CD-1 mice, manifested by sustained body weight loss and mortality rates greater than 50%. Further studies revealed markedly higher levels of viral RNA in the lungs, heart, and serum of low-dose ricin–pretreated mice compared with non-pretreated mice. Furthermore, lung extracts prepared 2–3 days after viral infection contained subgenomic mRNA and virus particles capable of replication only when derived from the pretreated mice. The deleterious effects of SARS-CoV-2 infection were effectively alleviated by passive transfer of polyclonal or monoclonal antibodies generated against the SARS-CoV-2 receptor binding domain (RBD). Thus, viral cell entry in the sensitized mice seems to depend on viral RBD binding, albeit by a mechanism other than the canonical ACE2-mediated uptake route. This unique mode of viral entry, observed over a mildly injured tissue background, may contribute to the exacerbation of coronavirus disease 2019 (COVID-19) pathologies in patients with preexisting morbidities.
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Affiliation(s)
- Reut Falach
- Department of Biochemistry and Molecular Genetics
| | - Liat Bar-On
- Department of Biochemistry and Molecular Genetics
| | | | | | - Ohad Mazor
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | | | - David Gur
- Department of Biochemistry and Molecular Genetics
| | - Yentl Evgy
- Department of Biochemistry and Molecular Genetics
| | - Ohad Shifman
- Department of Biochemistry and Molecular Genetics
| | - Tamar Aminov
- Department of Biochemistry and Molecular Genetics
| | - Ofir Israeli
- Department of Biochemistry and Molecular Genetics
| | | | - Galia Zaide
- Department of Biochemistry and Molecular Genetics
| | | | - Yaron Vagima
- Department of Biochemistry and Molecular Genetics
| | - Efi Makdasi
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Dana Stein
- Department of Biochemistry and Molecular Genetics
| | | | - Ron Alcalay
- Department of Biochemistry and Molecular Genetics
| | - Eran Zahavy
- Department of Biochemistry and Molecular Genetics
| | - Haim Levy
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Itai Glinert
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Amir Ben-Shmuel
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Tomer Israely
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Sharon Melamed
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Boaz Politi
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Hagit Achdout
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Shmuel Yitzhaki
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | | | - Tamar Sabo
- Department of Biochemistry and Molecular Genetics
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Whitfield SJ, Padgen DB, Knight S, Gwyther RJ, Holley JL, Clark GC, Green AC. Establishment of a Novel Oral Murine Model of Ricin Intoxication and Efficacy Assessment of Ovine Ricin Antitoxins. Toxins (Basel) 2020; 12:E784. [PMID: 33302573 PMCID: PMC7764460 DOI: 10.3390/toxins12120784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Ricin, produced from the castor beans of Ricinus communis, is a cytotoxin that exerts its action by inactivating ribosomes and causing cell death. Accidental (e.g., ingestion of castor beans) and/or intentional (e.g., suicide) exposure to ricin through the oral route is an area of concern from a public health perspective and no current licensed medical interventions exist to protect from the action of the toxin. Therefore, we examined the oral toxicity of ricin in Balb/C mice and developed a robust food deprivation model of ricin oral intoxication that has enabled the assessment of potential antitoxin treatments. A lethal oral dose was identified and mice were found to succumb to the toxin within 48 h of exposure. We then examined whether a despeciated ovine F(ab')2 antibody fragment, that had previously been demonstrated to protect mice from exposure to aerosolised ricin, could also protect against oral intoxication. Mice were challenged orally with an LD99 of ricin, and 89 and 44% of mice exposed to this otherwise lethal exposure survived after receiving either the parent anti-ricin IgG or F(ab')2, respectively. Combined with our previous work, these results further highlight the benefit of ovine-derived polyclonal antibody antitoxin in providing post-exposure protection against ricin intoxication.
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Affiliation(s)
- Sarah J. Whitfield
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
| | - Debbie B. Padgen
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
| | - Simon Knight
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
| | - Robert J. Gwyther
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
| | - Jane L. Holley
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
| | - Graeme C. Clark
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
- Institute of Infection and Global Health, University of Liverpool, IC2 Building, Liverpool L3 5RF, UK
| | - A. Christopher Green
- CBR Division, Dstl-Porton Down, Salisbury SP4 0JQ, UK; (D.B.P.); (S.K.); (R.J.G.); (J.L.H.); (G.C.C.); (A.C.G.)
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