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Effects of Tenofovir Combined with Recombinant Human Interferon α-2b on Negative Conversion Rate, Liver Function, Immune Status, and Drug Safety in Patients with Chronic Hepatitis B: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1889628. [PMID: 35815265 PMCID: PMC9262527 DOI: 10.1155/2022/1889628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
Abstract
Objective To systematically evaluate the clinical value of tenofovir combined with recombinant human interferon α-2b in the treatment of chronic hepatitis B and to provide evidence-based medicine for its popularization and use. Methods The randomized controlled trials (RCTs) of tenofovir combined with recombinant human interferon α-2b in the online database of PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network (CNKI), China VIP database, Wanfang database, and China Biomedical Literature Database (CBM) were searched. The data included in this study were extracted by two independent researchers. After extracting the data of the study, the Cochrane manual 5.1.0 standard was used to evaluate the bias risk of all the literature included in this study. RevMan5.4 statistical software was used to analyze the collected data by meta. Results Entecavir combined with recombinant human interferon α-2b can inhibit the activity of HBV polymerase and improve the inflammatory response of the liver. Recombinant human interferon α-2b can regulate immune function by inducing T cell differentiation and maturation and enhancing the production of cytokines. The systematic evaluation showed that entecavir combined with recombinant human interferon α-2b had higher serum HBeAg negative conversion rate, higher drug safety compared with entecavir alone, and improved liver function and immune status. Conclusion Tenofovir combined with recombinant human interferon alpha-2b has a high serum HBeAg negative rate and safety profile for the treatment of chronic hepatitis B. The combination treatment can improve liver function and immune status in patients, but more studies with higher methodological quality and longer duration of intervention are needed for further validation.
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Prêle CM, Iosifidis T, McAnulty RJ, Pearce DR, Badrian B, Miles T, Jamieson SE, Ernst M, Thompson PJ, Laurent GJ, Knight DA, Mutsaers SE. Reduced SOCS1 Expression in Lung Fibroblasts from Patients with IPF Is Not Mediated by Promoter Methylation or Mir155. Biomedicines 2021; 9:biomedicines9050498. [PMID: 33946612 PMCID: PMC8147237 DOI: 10.3390/biomedicines9050498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 01/16/2023] Open
Abstract
The interleukin (IL)-6 family of cytokines and exaggerated signal transducer and activator of transcription (STAT)3 signaling is implicated in idiopathic pulmonary fibrosis (IPF) pathogenesis, but the mechanisms regulating STAT3 expression and function are unknown. Suppressor of cytokine signaling (SOCS)1 and SOCS3 block STAT3, and low SOCS1 levels have been reported in IPF fibroblasts and shown to facilitate collagen production. Fibroblasts and lung tissue from IPF patients and controls were used to examine the mechanisms underlying SOCS1 down-regulation in IPF. A significant reduction in basal SOCS1 mRNA in IPF fibroblasts was confirmed. However, there was no difference in the kinetics of activation, and methylation of SOCS1 in control and IPF lung fibroblasts was low and unaffected by 5′-aza-2′-deoxycytidine’ treatment. SOCS1 is a target of microRNA-155 and although microRNA-155 levels were increased in IPF tissue, they were reduced in IPF fibroblasts. Therefore, SOCS1 is not regulated by SOCS1 gene methylation or microRNA155 in these cells. In conclusion, we confirmed that IPF fibroblasts had lower levels of SOCS1 mRNA compared with control fibroblasts, but we were unable to determine the mechanism. Furthermore, although SOCS1 may be important in the fibrotic process, we were unable to find a significant role for SOCS1 in regulating fibroblast function.
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Affiliation(s)
- Cecilia M. Prêle
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
- Centre for Respiratory Health and Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, University of Western Australia, Nedland, WA 6009, Australia
| | - Thomas Iosifidis
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
| | - Robin J. McAnulty
- Centre for Inflammation and Tissue Repair, Rayne Institute, Department of Medicine, University College London, London WC1E 6JJ, UK; (R.J.M.); (D.R.P.)
| | - David R. Pearce
- Centre for Inflammation and Tissue Repair, Rayne Institute, Department of Medicine, University College London, London WC1E 6JJ, UK; (R.J.M.); (D.R.P.)
| | - Bahareh Badrian
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
| | - Tylah Miles
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
| | - Sarra E. Jamieson
- Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Nedlands, WA 6009, Australia;
| | - Matthias Ernst
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia;
| | - Philip J. Thompson
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
| | - Geoffrey J. Laurent
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
- Centre for Respiratory Health and Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, University of Western Australia, Nedland, WA 6009, Australia
| | - Darryl A. Knight
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6Z 1Y5, Canada;
| | - Steven E. Mutsaers
- Institute for Respiratory Health, Nedland, WA 6009, Australia; (C.M.P.); (T.I.); (B.B.); (T.M.); (P.J.T.); (G.J.L.)
- Centre for Respiratory Health and Centre for Cell Therapy and Regenerative Medicine, School of Biomedical Sciences, University of Western Australia, Nedland, WA 6009, Australia
- Correspondence: ; Tel.: +61-(0)8-6151-0891; Fax: +61-(0)8-6151-1027
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Bin Wahid S, Ain QU, Quraishi A, Wahid B. Clinical correlation of liver function tests with suppression of cytokine signaling (SOCS1) gene expression in HCV infected patients: A real-world clinical experience. J Med Virol 2019; 92:257-259. [PMID: 31535716 DOI: 10.1002/jmv.25596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) is the leading cause of chronic liver complications globally and suppressor of cytokine signaling-1 (SOCS-1) is a gene triggered by cytokines that activates transcription of the JAK/STAT signal transduction pathway and negatively regulates Janus kinase-signal transducer. Several studies have shown that the expression of SOCS1 and SOCS3 genes negatively regulate the response of HCV infection to interferon therapy and interferon-free regimens. It has been reported that liver function enzymes elevate in CHC patients but the association of SOCS1 gene expression with LFTs haven't been studied. This study recruited 114 CHC patients and 112 normal healthy participants and analyzed the correlation of SOCS1 gene expression and liver function enzymes (LFEs). Herein, we observed that the expression of SOCS1 gene had a positive correlation with LFEs.
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Affiliation(s)
- Sohaib Bin Wahid
- Department of Biology, Lahore Garrison University, Lahore, Pakistan
| | - Qurat Ul Ain
- Department of Mathematics, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Azra Quraishi
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Braira Wahid
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
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Yu J, Zhang W, Qian H, Tang H, Lin W, Lu B. SOCS1 regulates hepatic regenerative response and provides prognostic makers for acute obstructive cholangitis. Sci Rep 2017; 7:9482. [PMID: 28842621 PMCID: PMC5573403 DOI: 10.1038/s41598-017-09865-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
Acute obstructive cholangitis (AOC) is a common and severe infectious diseases that occurs in an obstructed biliary system. The suppressors of cytokine signaling (SOCS) family include well-known negative regulators of cytokine receptor signaling. However, few studies have been conducted to determine their function in AOC. In this study, we showed that SOCS1 expression aberrantly changed and was associated with AOC prognosis in rat models. Decreased SOCS1 expression enhances regenerative response after biliary drainage (BD) resulting from AOC by upregulating hepatocyte growth factor (HGF) signaling. To detect SOCS1 expression in the liver less invasively and to predict the prognosis for AOC after BD, miR-221 and miR-222 were investigated. Ectopic SOCS1 expression indirectly decreases miR-221/222 expression through Met in vitro. An inverse correlation between SOCS1 expression and miR-221/222 expression in liver tissue or in serum was verified in rats. Serum from AOC patients showed that lower expression of circulating miR-221/222 after endoscopic nasobiliary drainage was associated with delayed restoration of liver function. Our results showed that SOCS1 regulates hepatic regenerative response, and indirectly detecting downstream molecules, such as miR-221/222, may provide prognostic makers for AOC.
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Affiliation(s)
- Jianhua Yu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiguang Zhang
- Department of Molecular Medicine and Clinical Laboratory, Shaoxing Second Hospital, Shaoxing, China
| | - Hongwei Qian
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Haijun Tang
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiguo Lin
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Baochun Lu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China.
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Zhang JJ, Fan YC, Zhang ZH, Han J, Wang LY, Li T, Zhang F, Yin YP, Hu LH, Yang Y, Sun FK, Wang K. Methylation of suppressor of cytokine signalling 1 gene promoter is associated with acute-on-chronic hepatitis B liver failure. J Viral Hepat 2015; 22:307-17. [PMID: 25045829 DOI: 10.1111/jvh.12286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/14/2014] [Indexed: 12/13/2022]
Abstract
Suppressor of cytokine signalling 1 (SOCS1) was demonstrated to play an important negative role in fulminant hepatitis and might be involved in acute-on-chronic hepatitis B liver failure (ACHBLF). This study was therefore to identify the potential role of SOCS1 and its promoter methylation pattern in ACHBLF patients. Sixty ACHBLF patients, 60 chronic hepatitis B (CHB) patients and 30 healthy controls were investigated in this study. We found that expression of SOCS1 mRNA in CHB and ACHBLF patients was significantly higher than that in healthy controls. The serum level of IL-6, IFN-γ and TNF-α was significantly higher in ACHBLF than CHB. Increased serum level of IL-6, IFN-γ and TNF-α was correlated with total bilirubin, ALT, PTA and MELD scores in ACHBLF. The degree of methylation of the SOCS1 in ACHBLF patients (35.0%, 21/60) was significantly higher than that in CHB patients (16.7%, 10/60). Furthermore, methylated group showed lower level of SOCS1, and higher MELD scores and mortality rate when compared with unmethylated group of ACHBLF. These results suggested that SOCS1 might contribute to immune-related liver damage in ACHBLF, and its aberrant methylation may be a key event for the prognosis of ACHBLF.
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Affiliation(s)
- J-J Zhang
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
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Zhang P, Li F, Li N, Zhu Q, Yang C, Han Q, Chen J, Lv Y, Yu L, Wei P, Liu Z. Genetic variations of SOCS1 are associated with chronic hepatitis B virus infection. Hum Immunol 2014; 75:709-14. [PMID: 24768946 DOI: 10.1016/j.humimm.2014.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/19/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
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Zhang JJ, Fan YC, Zhao ZH, Yang Y, Dou CY, Gao S, Wang K. Prognoses of patients with acute-on-chronic hepatitis B liver failure are closely associated with altered SOCS1 mRNA expression and cytokine production following glucocorticoid treatment. Cell Mol Immunol 2014; 11:396-404. [PMID: 24727541 DOI: 10.1038/cmi.2014.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 12/28/2022] Open
Abstract
Suppressor of cytokine signaling (SOCS) 1 plays a crucial role in the immune response and might contribute to the prognoses of liver failure treated with glucocorticoid. We recruited 47 acute-on-chronic hepatitis B liver failure (ACHBLF) patients receiving glucocorticoid treatment and 30 healthy controls to determine the potential effects of glucocorticoid on the transcriptional level of SOCS1 in peripheral blood mononuclear cells. On the third and twenty-eighth days of glucocorticoid treatment, SOCS1 expression was negatively correlated with model for end-stage liver disease (MELD) score. Interleukin-6 (IL-6) and tumor-necrosis factor-α (TNF-α) levels were statistically lower, while the SOCS1 transcription level was higher in survivors than non-survivors both in pre- and post-treatment ACHBLF patients. The methylation rate of the SOCS1 promoter in ACHBLF patients was higher than in healthy control patients as determined by methylation-specific polymerase chain reaction. The mRNA level of SOCS1 in methylated promoters was significantly lower than from patients with unmethylated SOCS1 promoters. interferon (IFN)-γ-responsive and STAT1-dependent gene expression was higher in survivors and was dramatically decreased with rising expression of SOCS1 after glucocorticoid treatment. Mortality rates were significantly higher in methylated patients than for those without methylation at the end of a 90-day follow-up. Furthermore, we found that five in six surviving patients displayed demethylated SOCS1 on the twenty-eighth day after treatment, while that number was 3 in 10 in the non-survivors. These findings suggested that ACHBLF patients without SOCS1 methylation may have a favorable response to corticosteroid treatment.
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Affiliation(s)
- Jian-Jun Zhang
- Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Yu-Chen Fan
- 1] Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China [2] Institute of Hepatology, Shandong University, Ji'nan, China
| | - Ze-Hua Zhao
- Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Yang Yang
- Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Cheng-Yun Dou
- Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Shuai Gao
- Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Kai Wang
- 1] Department of Hepatology, Qilu Hospital of Shandong University, Ji'nan, China [2] Institute of Hepatology, Shandong University, Ji'nan, China
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Wang RQ, Nan YM, Wu WJ, Kong LB, Han F, Zhao SX, Kong L, Yu J. Induction of heme oxygenase-1 protects against nutritional fibrosing steatohepatitis in mice. Lipids Health Dis 2011; 10:31. [PMID: 21314960 PMCID: PMC3048569 DOI: 10.1186/1476-511x-10-31] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 02/12/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heme oxygenase-1 (HO-1), an antioxidant defense enzyme, has been shown to protect against oxidant-induced liver injury. However, its role on liver fibrosis remains unclear. This study aims to elucidate the effect and the mechanism of HO-1 in nutritional fibrosing steatohepatitis in mice. METHODS Male C57BL/6J mice were fed with a methionine-choline deficient (MCD) diet for eight weeks to induce hepatic fibrosis. HO-1 chemical inducer (hemin), HO-1 chemical inhibitor zinc protoporphyrin IX (ZnPP-IX) and/or adenovirus carrying HO-1 gene (Ad-HO-1) were administered to mice, respectively. Liver injury was assessed by serum ALT, AST levels and histological examination; hepatic lipid peroxides levels were determined; the expression levels of several fibrogenic related genes were assayed by real-time quantitative PCR and Western blot. RESULTS MCD feeding mice showed progressive hepatic injury including hepatic steatosis, inflammatory infiltration and fibrosis. Induction of HO-1 by hemin or Ad-HO-1 significantly attenuated the severity of liver injury. This effect was associated with the up-regulation of HO-1, reduction of hepatic lipid peroxides levels, down-regulation of inflammatory factors tumor necrosis factor-alpha, interleukin-6 and suppressor of cytokine signaling-1 as well as the pro-fibrotic genes alpha-smooth muscle actin, transforming growth factor-β1, matrix metallopeptidase-2 and matrix metallopeptidase-9. A contrary effect was observed in mice treated with ZnPP-IX. CONCLUSIONS The present study provided the evidence for the protective role of HO-1 in ameliorating MCD diet-induced fibrosing steatohepatitis. Modulation of HO-1 expression might serve as a therapeutic approach for fibrotic steatohepatitis.
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Affiliation(s)
- Rong Qi Wang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Paeoniflorin ameliorates schistosomiasis liver fibrosis through regulating IL-13 and its signalling molecules in mice. Parasitology 2010; 137:1213-25. [DOI: 10.1017/s003118201000003x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
SUMMARYTreatment of liver fibrosis associated with Schistosoma japonicum ova-induced granulomas remains a challenging proposition. Paeoniflorin (PAE, C23H28O11) has anti-inflammatory, anti-allergic, and immunoregulatory effects and it is commonly used in Chinese Herbal prescriptions to treat hepatic disorders. The present study was carried out to investigate the effects of PAE on hepatic fibrosis of mice infected with S. japonicum and to explore its possible mechanism. Upon pathological examination of PAE-treated mice, the size of egg granuloma, fibrosis scores, the concentration of IL-13 and hydroxyproline in liver were significantly reduced compared with the model mice. In the primary culture of hepatic stellate cells (HSCs), PAE inhibited IL-13-induced collagen synthesis. These results suggested that PAE might alleviate the hepatic granulomas and fibrosis caused by S. japonicum and the inhibitory effect of PAE on hepatic fibrosis might be associated with its ability to decrease the level of IL-13 and to interfere with the IL-13 signalling molecule in HSCs.
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Li J, Chen F, Zheng M, Zhu H, Zhao D, Liu W, Liu W, Chen Z. Inhibition of STAT1 methylation is involved in the resistance of hepatitis B virus to Interferon alpha. Antiviral Res 2009; 85:463-9. [PMID: 19857525 DOI: 10.1016/j.antiviral.2009.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/11/2009] [Accepted: 10/16/2009] [Indexed: 12/24/2022]
Abstract
As a major therapy for hepatitis B virus (HBV) infection, Interferon alpha (IFN-alpha) triggers intracellular signal transduction including JAK-STAT pathway to produce various antiviral effector mechanisms. However, patients with chronic hepatitis B usually show low response to IFN-alpha treatment and the underlying mechanism remains unclear. In the present study, HepG2 and HepG2.2.15 cells were used to examine the Type I IFN receptors expression, phosphorylation and methylation of STAT1. STAT1-PIAS1 interaction in cells was tested by protein co-immunoprecipitation. The potential improvement of S-adenosylmethionine (SAM) in the antiviral effect of IFN-alpha was also investigated. Our data demonstrated that both chains of the Type I IFN receptors were expressed for a much higher extent in HepG2.2.15 cells than in HepG2 cells. HBV inhibited dramatically the methylation rather than the phosphorylation of STAT1, which was consistent with an increased STAT1-PIAS1 interaction. Combined with IFN-alpha, SAM treatment effectively improved STAT1 methylation and attenuated STAT1-PIAS1 binding, followed by increased PKR and 2',5'-OAS mRNA expression, thus significantly reducing the HBsAg, HBeAg protein levels and HBV DNA load in the supernatant of HepG2.2.15 cells. Less STAT1 methylation and subsequent increased STAT1-PIAS1 interaction are involved in the mechanism of the IFN-alpha-antagonistic activity of HBV. By improving STAT1 methylation, SAM can enhance the antiviral effect of IFN-alpha.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Infectious Disease Diagnosis and Treatment, First Affiliated Hospital, Zhejiang University College of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang 310003, China
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Oshansky CM, Krunkosky TM, Barber J, Jones LP, Tripp RA. Respiratory Syncytial Virus Proteins Modulate Suppressors of Cytokine Signaling 1 and 3 and the Type I Interferon Response to Infection by a Toll-Like Receptor Pathway. Viral Immunol 2009; 22:147-61. [DOI: 10.1089/vim.2008.0098] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Christine M. Oshansky
- Department of Infectious Diseases, College of Veterinary Medicine, Center for Disease Intervention, University of Georgia, Athens, Georgia
| | - Thomas M. Krunkosky
- Department of Anatomy and Radiology, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Jamie Barber
- Department of Infectious Diseases, College of Veterinary Medicine, Center for Disease Intervention, University of Georgia, Athens, Georgia
| | - Les P. Jones
- Department of Infectious Diseases, College of Veterinary Medicine, Center for Disease Intervention, University of Georgia, Athens, Georgia
| | - Ralph A. Tripp
- Department of Infectious Diseases, College of Veterinary Medicine, Center for Disease Intervention, University of Georgia, Athens, Georgia
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