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Dick JK, Sangala JA, Krishna VD, Khaimraj A, Hamel L, Erickson SM, Hicks D, Soigner Y, Covill LE, Johnson A, Ehrhardt MJ, Ernste K, Brodin P, Koup RA, Khaitan A, Baehr C, Thielen BK, Henzler CM, Skipper C, Miller JS, Bryceson YT, Wu J, John CC, Panoskaltsis-Mortari A, Orioles A, Steiner ME, Cheeran MCJ, Pravetoni M, Hart GT. Antibody-mediated cellular responses are dysregulated in Multisystem Inflammatory Syndrome in Children (MIS-C). bioRxiv 2024:2024.04.16.589585. [PMID: 38659969 PMCID: PMC11042288 DOI: 10.1101/2024.04.16.589585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of SARS-CoV-2 infection characterized by multi-organ involvement and inflammation. Testing of cellular function ex vivo to understand the aberrant immune response in MIS-C is limited. Despite strong antibody production in MIS-C, SARS-CoV-2 nucleic acid testing can remain positive for 4-6 weeks after infection. Therefore, we hypothesized that dysfunctional cell-mediated antibody responses downstream of antibody production may be responsible for delayed clearance of viral products in MIS-C. In MIS-C, monocytes were hyperfunctional for phagocytosis and cytokine production, while natural killer (NK) cells were hypofunctional for both killing and cytokine production. The decreased NK cell cytotoxicity correlated with an NK exhaustion marker signature and systemic IL-6 levels. Potentially providing a therapeutic option, cellular engagers of CD16 and SARS-CoV-2 proteins were found to rescue NK cell function in vitro. Together, our results reveal dysregulation in antibody-mediated cellular responses unique to MIS-C that likely contribute to the immune pathology of this disease.
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2
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Goren LR, Lehman AC, Luquette M, Howard C, Thielen BK. A Lytic Bone Lesion in a 23-month-old Boy from Kenya. Pediatr Rev 2024; 45:225-229. [PMID: 38556514 DOI: 10.1542/pir.2021-005473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lea R Goren
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN
| | - Alice C Lehman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Mark Luquette
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Cynthia Howard
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Beth K Thielen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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3
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Lehman A, Goren L, Evans MD, Toles O, Drozdov D, Andrews S, McAllister S, Thielen BK. Clinical Performance of Plasma Metagenomic Sequencing in Immunocompromised Pediatric Patients. J Pediatric Infect Dis Soc 2024:piae024. [PMID: 38483068 DOI: 10.1093/jpids/piae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Alice Lehman
- Division of Pediatric Infectious Diseases, University of Minnesota, Minneapolis, USA
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA
| | - Lea Goren
- University of Minnesota Medical School, Minneapolis, USA
| | - Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, USA
| | - Olivia Toles
- Division of Pediatric Infectious Diseases, University of Minnesota, Minneapolis, USA
| | - Daniel Drozdov
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, USA
- Division of Stem Cell Transplantation and Children's Research Center and Pediatric Hematology and Oncology University Children's Hospital Zurich, University of Zürich, Zürich, Switzerland
| | - Shannon Andrews
- Division of Pediatric Infectious Diseases, University of Minnesota, Minneapolis, USA
| | - Shane McAllister
- Division of Pediatric Infectious Diseases, University of Minnesota, Minneapolis, USA
| | - Beth K Thielen
- Division of Pediatric Infectious Diseases, University of Minnesota, Minneapolis, USA
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Thielen BK, Holzbauer S, Templen B, Schafer IJ, Artus A, Galloway R, Ireland M, Femrite T, Schleiss MR. Case Report: Locally Acquired Leptospirosis in a Minnesota Boy and His Dog. Am J Trop Med Hyg 2024; 110:123-126. [PMID: 37983913 DOI: 10.4269/ajtmh.23-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023] Open
Abstract
Leptospirosis affects numerous animal species, including domestic dogs, but documented transmission to humans is rare. Here, we describe epidemiologically linked cases in a 12-year-old Minnesota boy and his pet dog. While human leptospirosis is often thought of as a disease of tropical locations, this case report describes a rare documented example of local transmission in the northern United States, a region historically not perceived to be at high risk of Leptospira species transmission to humans. This case highlights an unusual presentation, with facial nerve palsy, underappreciated epidemiological risks, and diagnostic challenges of this reemerging infection.
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Affiliation(s)
- Beth K Thielen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Stacy Holzbauer
- Minnesota Department of Health, St. Paul, Minnesota
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ilana J Schafer
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aileen Artus
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Mark R Schleiss
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Goren LR, Adeyi O, Thielen BK. Possible Donor-Derived Infection in a Pediatric Liver Transplant Patient With Granulomatous Hepatitis. Cureus 2023; 15:e49136. [PMID: 38130518 PMCID: PMC10733164 DOI: 10.7759/cureus.49136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Pediatric liver transplant recipients are a high-risk group for the development of adenovirus hepatitis and other manifestations of disseminated adenoviral disease. The risk is greatest during periods of increased immunosuppression, including immediately post-transplantation and following treatment for rejection. Manifestations of adenovirus hepatitis are heterogeneous with a wide spectrum of clinical severity, ranging from mild, focal disease to fulminant liver failure. Here we report a case of liver transplantation-associated adenovirus hepatitis presenting with fever and multifocal liver lesions. The diagnosis was not clinically suspected due to atypical imaging findings and pathology. Non-targeted metagenomic sequencing of plasma cell-free DNA facilitated and expedited the diagnosis. Confirmatory conventional testing was obtained, allowing for appropriate initiation of targeted treatment in this patient.
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Affiliation(s)
- Lea R Goren
- Pediatric Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, USA
| | - Oyedele Adeyi
- Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, USA
| | - Beth K Thielen
- Pediatric Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, USA
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Hoover A, Thielen BK, Ebens CL. Fever and neutropenia in pediatric oncology and stem cell transplant patients: an editorial commentary on updated international clinical practice guidelines. Transl Pediatr 2023; 12:1908-1912. [PMID: 37969121 PMCID: PMC10644023 DOI: 10.21037/tp-23-368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Alex Hoover
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Beth K. Thielen
- Division of Infectious Diseases, Department of Pediatrics, Global Pediatrics Program, Minneapolis, MN, USA
| | - Christen L. Ebens
- Division of Blood and Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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7
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Lehman A, Goren L, Toles O, Andrews SL, Thielen BK, Drozdov D, Rubin N. 320. Clinical Impact of Metagenomic Next Generation Sequencing in a Large Pediatric and Adult Cohort. Open Forum Infect Dis 2022. [PMCID: PMC9752281 DOI: 10.1093/ofid/ofac492.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Plasma metagenomic next-generation sequencing (mNGS) is an emerging diagnostic tool. As the clinical use of mNGS increases, efforts to better understand the role of mNGS in diagnosis and management of infectious diseases are essential. Current literature is limited to small retrospective reviewers and a prospective study therefore subject to institutional variability. Here, we aim to describe the use, sensitivity, time to diagnosis, clinical impact, and cost effectiveness of mNGS in the largest patient cohort to date. Methods We included pediatric and adult patients who had plasma mNGS testing as part of care from December 2017 through December 2021 at University of Minnesota (UMN). Patients were identified using the Karius database. Electronic medical records were reviewed for every mNGS test, recording patient demographics, underlying conditions, indications, and results within 30 days of mNGS. All cases were assessed by 2 reviewers including one board-certified infectious diseases doctor. Sensitivity of mNGS was determined relative to conventional tests. The primary end point was change in clinical management. Secondary end points included accuracy, time to diagnosis, and infectious disease consultation. UMN IRB approved this study as non human subjects research. Results 584 mNGS tests were ordered in the study period, with 203 reviews completed to date. Solid organ transplantation (SOT) (32%) was the most common underlying condition, followed by hemopoietic stem cell transplantation (HSCT) (28%). Fever (45.8%), then pulmonary findings (26%) were the most common indications for ordering mNGS. Conventional and mNGS tests identified an infectious cause of the clinical syndrome in 49% of cases, while a contaminant was found in 52% of cases. The sensitivity of mNGS in identification of infectious cause was 47%, approximately 7% more sensitive than conventional testing. Despite this increased sensitivity, mNGS changed clinical management in 20% of cases. Conclusion mNGS demonstrated superiority in accurate detection of infectious causes of clinical syndromes, however, changed clinical management in a minority of cases, suggesting timing of the mNGS test is critical. This study identified SOT and HSCT as high yield patient groups for implementation of a prospective study. Disclosures Beth K. Thielen, MD, PhD, Horizon: Advisor/Consultant|Horizon: Honoraria|Merck: Grant/Research Support.
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Affiliation(s)
| | - Lea Goren
- University of Minnesota, Minneapolis, Minnesota
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8
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Norton LE, Grothe LY, Oliver MB, Thielen BK. 555. Early Outcomes of Penicillin and Cephalosporin Allergy Assessment Tool. Open Forum Infect Dis 2022. [PMCID: PMC9752258 DOI: 10.1093/ofid/ofac492.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Penicillin allergy is reported in approximately 10% of the US population and is one of the most frequent medication allergies in children. Penicillin allergy labels are associated with more expensive care and adverse outcomes, such as MRSA and C. Diff infection. Studies suggest up to 90% of these patients could safely tolerate this class of drugs. Our team at M Health Fairview University of Minnesota Masonic Children’s Hospital (UMMCH) implemented an allergy assessment tool for inpatient use in January of 2020 to create an effective and accessible path for delabeling pediatric patients with penicillin and cephalosporin allergies. Methods Our pharmacists conducted the allergy assessment on inpatient pediatric patients with penicillin/cephalosporin allergies. Those deemed low to moderate risk for having a true IgE-mediated allergy by our assessment were recommended for outpatient allergy testing. Those deemed no risk were recommended for immediate delabeling. We performed manual chart reviews to describe pediatric patient risk stratification, allergy label status after assessment, outpatient allergy follow-up, and status and results of allergy testing. Results From January, 2020 to present, 140 patients received a pharmacist allergy assessment. During the 2020 calendar year, 51 allergy assessments were performed on 49 patients. 58 allergies were recorded, with penicillins as the most common (62%), followed by cephalosporins (24%), and penicillin combination drugs (14%). 1.9% of allergies were high risk, 68.8% moderate, 15.7% low, 9.8% no risk, and 3.8% difficult to determine. Of 42 patients deemed low to moderate risk, 8 (17%) were seen by an outpatient allergist. Of these, 5 proceeded with allergy testing and were found to be not allergic. Out of 58 allergy labels, 9 (15.5%) were removed, 5 after allergy testing, 2 immediately due to no risk, and 2 after further history review. Conclusion Our preliminary data show allergy assessments can inform pediatric allergy risk prior to outpatient allergy testing and assist with imminent delabeling. Next steps include analysis of our 2021 assessments as well as patient caregiver surveys to assess perception of the allergy assessment process and to elucidate on barriers to testing/delabeling. Disclosures Beth K. Thielen, MD, PhD, Horizon: Advisor/Consultant|Horizon: Honoraria|Merck: Grant/Research Support.
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Affiliation(s)
| | | | - Meredith B Oliver
- M Health Fairview Masonic Children’s Hospital, Minneapolis, Minnesota
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9
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Christian VJ, Sarwar R, Resch JC, Lim S, Somani A, Larson-Nath C, McAllister S, Thielen BK, Adeyi O, Chinnakotla S, Bhatt H. Use of Cidofovir for Safe Transplantation in a Toddler with Acute Liver Failure and Adenovirus Viremia. Case Rep Transplant 2022; 2022:9426175. [PMID: 36405892 PMCID: PMC9668457 DOI: 10.1155/2022/9426175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/21/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Since October 2021, there have been more than 500 cases of severe hepatitis of unknown origin in children reported worldwide, including 180 cases in the U.S. The most frequently detected potential pathogen to date has been adenovirus, typically serotype 41. Adenovirus is known to cause a self-limited infection in the immunocompetent host. However, in immunosuppressed individuals, severe or disseminated infections may occur. METHOD We present the case of a two-year-old female who presented with cholestatic hepatitis and acute liver failure (ALF). Work up for etiologies of ALF was significant for adenovirus viremia, but liver biopsy was consistently negative for the virus. The risk for severe adenoviral infection in the setting of anticipated immunosuppression prompted us to initiate cidofovir to decrease viral load prior to undergoing liver transplantation. RESULT Our patient received a successful liver transplant, cleared the viremia after 5 doses of cidofovir, and continues to maintain allograft function without signs of infection at the time of this report, 5 months posttransplant. CONCLUSION Recent reports of pediatric hepatitis cases may be associated with adenoviral infection although the exact relationship is unclear. There is the possibility of the ongoing SARS-CoV-2 environment, or other immunologic modifying factors. All patients presenting with hepatitis or acute liver failure should be screened for adenovirus and reported to state health departments. Cidofovir may be used to decrease viral load prior to liver transplantation, to decrease risk of severe adenoviral infection.
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Affiliation(s)
- Vikram J. Christian
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Raiya Sarwar
- Department of Medicine, Division of Transplant Hepatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph C. Resch
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Arif Somani
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Catherine Larson-Nath
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Shane McAllister
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Beth K. Thielen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Oyedele Adeyi
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Srinath Chinnakotla
- Department of Surgery, Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Heli Bhatt
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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10
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Frosch AE, Thielen BK, Alpern JD, Walz EJ, Volkman HR, Smith M, Wanduragala D, Holder W, Boumi AE, Stauffer WM. Antimalarial chemoprophylaxis and treatment in the USA: limited access and extreme price variability. J Travel Med 2022; 29:6338087. [PMID: 34343310 PMCID: PMC9282095 DOI: 10.1093/jtm/taab117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Anne E Frosch
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.,Department of Medicine, Hennepin Healthcare Research Institute and Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Beth K Thielen
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN 55108, USA
| | - Hannah R Volkman
- School of Public Health, Division of Environmental Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mackenzie Smith
- Infectious Disease Equity and Engagement Unit, Minnesota Department of Health, Saint Paul, MN 55164, USA
| | - Danushka Wanduragala
- Infectious Disease Equity and Engagement Unit, Minnesota Department of Health, Saint Paul, MN 55164, USA
| | - Wilhelmina Holder
- New American Alliance for Development, Saint Paul, MN 55104, USA.,Malaria Community Advisory Board, Minneapolis/Saint Paul, MN 55164, USA
| | - Ama Eli Boumi
- Malaria Community Advisory Board, Minneapolis/Saint Paul, MN 55164, USA
| | - William M Stauffer
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
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Randolph HE, Fiege JK, Thielen BK, Mickelson CK, Shiratori M, Barroso-Batista J, Langlois RA, Barreiro LB. Genetic ancestry effects on the response to viral infection are pervasive but cell type specific. Science 2021; 374:1127-1133. [PMID: 34822289 PMCID: PMC8957271 DOI: 10.1126/science.abg0928] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Humans differ in their susceptibility to infectious disease, partly owing to variation in the immune response after infection. We used single-cell RNA sequencing to quantify variation in the response to influenza infection in peripheral blood mononuclear cells from European- and African-ancestry males. Genetic ancestry effects are common but highly cell type specific. Higher levels of European ancestry are associated with increased type I interferon pathway activity in early infection, which predicts reduced viral titers at later time points. Substantial population-associated variation is explained by cis-expression quantitative trait loci that are differentiated by genetic ancestry. Furthermore, genetic ancestry–associated genes are enriched among genes correlated with COVID-19 disease severity, suggesting that the early immune response contributes to ancestry-associated differences for multiple viral infection outcomes.
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Affiliation(s)
- Haley E Randolph
- Committee on Genetics, Genomics, and Systems Biology, University of Chicago, Chicago, IL, USA
| | - Jessica K Fiege
- Center for Immunology, University of Minnesota, Minneapolis, MN, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Beth K Thielen
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Clayton K Mickelson
- Center for Immunology, University of Minnesota, Minneapolis, MN, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Mari Shiratori
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - João Barroso-Batista
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ryan A Langlois
- Center for Immunology, University of Minnesota, Minneapolis, MN, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Luis B Barreiro
- Committee on Genetics, Genomics, and Systems Biology, University of Chicago, Chicago, IL, USA
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- Committee on Immunology, University of Chicago, Chicago, IL, USA
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12
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Lofgren SM, Okafor EC, Colette AA, Pastick KA, Skipper CP, Pullen MF, Nicol MR, Bold TD, Bangdiwala AS, Engen NW, Collins LB, Williams DA, Axelrod ML, Thielen BK, Hullsiek KH, Boulware DR, Rajasingham R. Feasibility of SARS-CoV-2 Antibody Testing in Remote Outpatient Trials. Open Forum Infect Dis 2021; 8:ofab506. [PMID: 35548171 PMCID: PMC8522439 DOI: 10.1093/ofid/ofab506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, clinical trials necessitated rapid testing to be performed remotely. Dried blood spot (DBS) techniques have enabled remote HIV virologic testing globally, and more recently, antibody testing as well. We evaluated DBS testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing in outpatients to assess seropositivity. Methods In 2020, we conducted 3 internet-based randomized clinical trials and offered serologic testing via self-collected DBS as a voluntary substudy. COVID-19 diagnosis was based on the Centers for Disease Control and Prevention case definition with epidemiological link to cases. A minority reported polymerase chain reaction (PCR) testing at an outside facility. We tested for anti-SARS-CoV-2 immunoglobulin via antibody detection by agglutination-PCR (ADAP) and compared the results with enzyme-linked immunosorbent assay (ELISA). Results Of 2727 participants in the primary studies, 60% (1648/2727) consented for serology testing; 56% (931/1648) returned a usable DBS sample. Of those who were asymptomatic, 5% (33/707) had positive ADAP serology. Of participants with a positive PCR, 67% (36/54) had positive SARS-CoV-2 antibodies. None of those who were PCR-positive and asymptomatic were seropositive (0/7). Of 77 specimens tested for concordance via ELISA, 83% (64/77) were concordant. The challenges of completing a remote testing program during a pandemic included sourcing and assembling collection kits, delivery and return of the kits, and troubleshooting testing. Self-collection was successful for >95% of participants. Delays in US mail with possible sample degradation and timing of DBS collection complicated the analysis. Conclusions We found remote antibody testing during a global pandemic feasible although challenging. We identified an association between symptomatic COVID-19 and positive antibody results at a similar prevalence as other outpatient cohorts.
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Affiliation(s)
- Sarah M Lofgren
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth C Okafor
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alanna A Colette
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katelyn A Pastick
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caleb P Skipper
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew F Pullen
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tyler D Bold
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ananta S Bangdiwala
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicole W Engen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lindsey B Collins
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Darlisha A Williams
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Margaret L Axelrod
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Beth K Thielen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathy H Hullsiek
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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13
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Quadri NS, Thielen BK, Crichlow R, Rheault M, Vraga EK, Cohen EL, Erayil SE, Gulleen EA, Braman JP, Krohn K. 12 Tips for Engaging Medical Students in Health Communications. MedEdPublish (2016) 2021; 10:48. [PMID: 38486528 PMCID: PMC10939613 DOI: 10.15694/mep.2021.000048.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The proliferation of misinformation during the COVID-19 pandemic provides a clear example of the harms that can occur when medical professionals do not engage with the public regarding health topics. To address this need for accessible, accurate medical information, we taught medical students a COVID-19-specific curriculum tailored to sharing this information with the lay public via social media. Through active learning, students developed their understanding of disease-specific pathophysiology, prevention techniques, treatments, and public health interventions while practicing new skills in public communication as health professionals. After two cohorts completed the course, students' high-quality medical information about COVID-19 reached >100,000 viewers. To further broaden the impact, we shared the course curriculum through the Association of American Medical College (AAMC) iCollaborative. This curriculum provides a model for future engagement of medical students in health communication with lay audiences.
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14
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Thielen BK, Bye E, Wang X, Maroushek S, Friedlander H, Bistodeau S, Christensen J, Reisdorf E, Shilts MH, Martin K, Como-Sabetti K, Strain AK, Ferrieri P, Lynfield R. Summer Outbreak of Severe RSV-B Disease, Minnesota, 2017 Associated with Emergence of a Genetically Distinct Viral Lineage. J Infect Dis 2021; 222:288-297. [PMID: 32083677 DOI: 10.1093/infdis/jiaa075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) typically causes winter outbreaks in temperate climates. During summer 2017, the Minnesota Department of Health received a report of increased cases of severe RSV-B infection. METHODS We compared characteristics of summer 2017 cases with those of 2014-2018 summers. To understand the genetic relatedness among viruses, we performed high-throughput sequencing of RSV from patients with a spectrum of illness from sites in Minnesota and Wisconsin. RESULTS From May to September 2017, 58 RSV cases (43 RSV-B) were reported compared to 20-29 cases (3-7 RSV-B) during these months in other years. Median age and frequency of comorbidities were similar, but 55% (24/43) were admitted to the ICU in 2017 compared to 12% in preceding 3 years (odds ratio, 4.84, P < .01). Sequencing was performed on 137 specimens from March 2016 to March 2018. Outbreak cases formed a unique clade sharing a single conserved nonsynonymous change in the SH gene. We observed increased cases during the following winter season, when the new lineage was the predominant strain. CONCLUSIONS We identified an outbreak of severe RSV-B disease associated with a new genetic lineage among urban Minnesota children during a time of expected low RSV circulation.
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Affiliation(s)
- Beth K Thielen
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erica Bye
- Minnesota Department of Health, St Paul, Minnesota, USA
| | - Xiong Wang
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | | | | | | | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Meghan H Shilts
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karen Martin
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Anna K Strain
- Minnesota Department of Health, St Paul, Minnesota, USA
| | - Patricia Ferrieri
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota, USA
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15
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Fiege JK, Thiede JM, Nanda HA, Matchett WE, Moore PJ, Montanari NR, Thielen BK, Daniel J, Stanley E, Hunter RC, Menachery VD, Shen SS, Bold TD, Langlois RA. Single cell resolution of SARS-CoV-2 tropism, antiviral responses, and susceptibility to therapies in primary human airway epithelium. PLoS Pathog 2021; 17:e1009292. [PMID: 33507952 PMCID: PMC7872261 DOI: 10.1371/journal.ppat.1009292] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/09/2021] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
The human airway epithelium is the initial site of SARS-CoV-2 infection. We used flow cytometry and single cell RNA-sequencing to understand how the heterogeneity of this diverse cell population contributes to elements of viral tropism and pathogenesis, antiviral immunity, and treatment response to remdesivir. We found that, while a variety of epithelial cell types are susceptible to infection, ciliated cells are the predominant cell target of SARS-CoV-2. The host protease TMPRSS2 was required for infection of these cells. Importantly, remdesivir treatment effectively inhibited viral replication across cell types, and blunted hyperinflammatory responses. Induction of interferon responses within infected cells was rare and there was significant heterogeneity in the antiviral gene signatures, varying with the burden of infection in each cell. We also found that heavily infected secretory cells expressed abundant IL-6, a potential mediator of COVID-19 pathogenesis.
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Affiliation(s)
- Jessica K. Fiege
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Joshua M. Thiede
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Hezkiel Arya Nanda
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - William E. Matchett
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Patrick J. Moore
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Noe Rico Montanari
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Beth K. Thielen
- Department of Pediatrics, Division of Infectious Diseases, University of Minnesota, United States of America
| | - Jerry Daniel
- University of Minnesota Genomics Center, Minneapolis, Minnesota, United States of America
| | - Emma Stanley
- University of Minnesota Genomics Center, Minneapolis, Minnesota, United States of America
| | - Ryan C. Hunter
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Vineet D. Menachery
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Steven S. Shen
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Tyler D. Bold
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ryan A. Langlois
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
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16
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Fiege JK, Thiede JM, Nanda H, Matchett WE, Moore PJ, Montanari NR, Thielen BK, Daniel J, Stanley E, Hunter RC, Menachery VD, Shen SS, Bold TD, Langlois RA. Single cell resolution of SARS-CoV-2 tropism, antiviral responses, and susceptibility to therapies in primary human airway epithelium. bioRxiv 2020. [PMID: 33106802 PMCID: PMC7587775 DOI: 10.1101/2020.10.19.343954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The human airway epithelium is the initial site of SARS-CoV-2 infection. We used flow cytometry and single cell RNA-sequencing to understand how the heterogeneity of this diverse cell population contributes to elements of viral tropism and pathogenesis, antiviral immunity, and treatment response to remdesivir. We found that, while a variety of epithelial cell types are susceptible to infection, ciliated cells are the predominant cell target of SARS-CoV-2. The host protease TMPRSS2 was required for infection of these cells. Importantly, remdesivir treatment effectively inhibited viral replication across cell types, and blunted hyperinflammatory responses. Induction of interferon responses within infected cells was rare and there was significant heterogeneity in the antiviral gene signatures, varying with the burden of infection in each cell. We also found that heavily infected secretory cells expressed abundant IL-6, a potential mediator of COVID-19 pathogenesis.
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Affiliation(s)
- Jessica K Fiege
- Center for Immunology, University of Minnesota.,Department of Microbiology and Immunology, University of Minnesota
| | - Joshua M Thiede
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota
| | - Hezkiel Nanda
- Institute for Health Informatics, University of Minnesota
| | - William E Matchett
- Center for Immunology, University of Minnesota.,Department of Microbiology and Immunology, University of Minnesota
| | - Patrick J Moore
- Department of Microbiology and Immunology, University of Minnesota
| | | | - Beth K Thielen
- Department of Pediatrics, Division of Infectious Diseases, University of Minnesota
| | | | | | - Ryan C Hunter
- Center for Immunology, University of Minnesota.,Department of Microbiology and Immunology, University of Minnesota
| | - Vineet D Menachery
- Department of Microbiology and Immunology, University of Texas Medical Branch
| | - Steven S Shen
- Institute for Health Informatics, University of Minnesota
| | - Tyler D Bold
- Center for Immunology, University of Minnesota.,Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota
| | - Ryan A Langlois
- Center for Immunology, University of Minnesota.,Department of Microbiology and Immunology, University of Minnesota
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17
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Quadri NS, Thielen BK, Erayil SE, Gulleen EA, Krohn K. Deploying Medical Students to Combat Misinformation During the COVID-19 Pandemic. Acad Pediatr 2020; 20:762-763. [PMID: 32502537 PMCID: PMC7265844 DOI: 10.1016/j.acap.2020.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022]
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18
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Prince BT, Thielen BK, Williams KW, Kellner ES, Arnold DE, Cosme-Blanco W, Redmond MT, Hartog NL, Chong HJ, Holland SM. Geographic Variability and Pathogen-Specific Considerations in the Diagnosis and Management of Chronic Granulomatous Disease. Pediatric Health Med Ther 2020; 11:257-268. [PMID: 32801991 PMCID: PMC7383027 DOI: 10.2147/phmt.s254253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare but serious primary immunodeficiency with varying prevalence and rates of X-linked and autosomal recessive disease worldwide. Functional defects in the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex predispose patients to a relatively narrow spectrum of bacterial and fungal infections that are sometimes fastidious and often difficult to identify. When evaluating and treating patients with CGD, it is important to consider their native country of birth, climate, and living situation, which may predispose them to types of infections that are atypical to your routine practice. In addition to recurrent and often severe infections, patients with CGD and X-linked female carriers are also susceptible to developing many non-infectious complications including tissue granuloma formation and autoimmunity. The DHR-123 oxidation assay is the gold standard for making the diagnosis and it along with genetic testing can help predict the severity and prognosis in patients with CGD. Disease management focuses on prophylaxis with antibacterial, antifungal, and immunomodulatory medications, prompt identification and treatment of acute infections, and prevention of secondary granulomatous complications. While hematopoietic stem-cell transplantation is the only widely available curative treatment for patients with CGD, recent advances in gene therapy may provide a safer, more direct alternative.
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Affiliation(s)
- Benjamin T Prince
- Division of Allergy and Immunology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Beth K Thielen
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Kelli W Williams
- Department of Pediatrics, Division of Pediatric Pulmonology, Allergy & Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Erinn S Kellner
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Danielle E Arnold
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wilfredo Cosme-Blanco
- Department of Allergy and Immunology, Veteran Affairs Caribbean Healthcare System, San Juan, Puerto Rico
| | - Margaret T Redmond
- Division of Allergy and Immunology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nicholas L Hartog
- Department of Allergy and Immunology, Spectrum Health Helen DeVos Children’s Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Hey J Chong
- Division of Allergy and Immunology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Steven M Holland
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland National Institutes of Health, Bethesda, MD, USA
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19
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Ingraham NE, Lotfi-Emran S, Thielen BK, Techar K, Morris RS, Holtan SG, Dudley RA, Tignanelli CJ. Immunomodulation in COVID-19. Lancet Respir Med 2020; 8:544-546. [PMID: 32380023 PMCID: PMC7198187 DOI: 10.1016/s2213-2600(20)30226-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Nicholas E Ingraham
- Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Sahar Lotfi-Emran
- Division of Rheumatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Beth K Thielen
- Division of Infectious Disease and International Medicine, University of Minnesota, Minneapolis, MN 55455, USA; Division of Pediatrics Infectious Disease and Immunology, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristina Techar
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Rachel S Morris
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shernan G Holtan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA
| | - R Adams Dudley
- Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN 55455, USA; Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, USA; School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA; Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Christopher J Tignanelli
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, USA; Division of Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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20
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Thielen BK, Barnes AMT, Sabin AP, Huebner B, Nelson S, Wesenberg E, Hansen GT. Widespread Lichtheimia Infection in a Patient with Extensive Burns: Opportunities for Novel Antifungal Agents. Mycopathologia 2018; 184:121-128. [PMID: 29967971 DOI: 10.1007/s11046-018-0281-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/21/2018] [Indexed: 03/04/2023]
Abstract
The Mucorales fungi-formerly classified as the zygomycetes-are environmentally ubiquitous fungi, but generally rare causes of clinical infections. In the immunocompromised host, however, they can cause invasive, rapidly spreading infections that confer a high risk of morbidity and mortality, often despite surgical and antifungal therapy. Patients with extensive burn injuries are particularly susceptible to skin and soft-tissue infections with these organisms. Here, we present a case of Lichtheimia infection in a patient with extensive full-thickness burns that required significant and repeated surgical debridement successfully treated with isavuconazole and adjunctive topical amphotericin B washes. We also review the available literature on contemporary antifungal treatment for Lichtheimia species and related Mucorales fungi.
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Affiliation(s)
- Beth K Thielen
- Department of Medicine (Division of Infectious Diseases and International Medicine), University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA. .,Department of Pediatrics (Division of Pediatric Infectious Diseases and Immunology), University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.
| | - Aaron M T Barnes
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.,Department of Microbiology & Immunology, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA
| | - Arick P Sabin
- Department of Medicine (Division of Infectious Diseases and International Medicine), University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA
| | - Becky Huebner
- Department of Pathology & Laboratory Medicine, Hennepin County Medical Center, Minneapolis, MN, 55415, USA
| | - Susan Nelson
- Department of Pathology & Laboratory Medicine, Hennepin County Medical Center, Minneapolis, MN, 55415, USA
| | - Elizabeth Wesenberg
- Department of Pathology & Laboratory Medicine, Hennepin County Medical Center, Minneapolis, MN, 55415, USA
| | - Glen T Hansen
- Department of Medicine (Division of Infectious Diseases and International Medicine), University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.,Department of Pathology & Laboratory Medicine, Hennepin County Medical Center, Minneapolis, MN, 55415, USA
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21
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Scott LA, Dunlop SJ, Walz EJ, Wanduragala DM, Thielen BK, Smith ML, Volkman HR, Walker PF, Stauffer WM, Alpern JD. Prescription drug-dispensing limits in the USA-implications for malaria chemoprophylaxis among VFR travellers. J Travel Med 2018; 25:5035015. [PMID: 29893891 PMCID: PMC6676974 DOI: 10.1093/jtm/tay039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/16/2018] [Indexed: 11/13/2022]
Affiliation(s)
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Emily J Walz
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St Paul, MN, USA
| | | | - Beth K Thielen
- Departments of Medicine and Pediatrics, University of Minnesota, St. Paul, Minneapolis, MN, USA
| | | | - Hannah R Volkman
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Patricia F Walker
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Travel and Tropical Medicine, HealthPartners, St. Paul, MN, USA
| | - William M Stauffer
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Travel and Tropical Medicine, HealthPartners, St. Paul, MN, USA.,Department of Medicine, Division of Infectious Diseases, HealthPartners, Minneapolis, MN, USA
| | - Jonathan D Alpern
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Travel and Tropical Medicine, HealthPartners, St. Paul, MN, USA.,Department of Medicine, Division of Infectious Diseases, HealthPartners, Minneapolis, MN, USA
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22
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Thielen BK, Friedlander H, Bistodeau S, Shu B, Lynch B, Martin K, Bye E, Como-Sabetti K, Boxrud D, Strain AK, Chaves SS, Steffens A, Fowlkes AL, Lindstrom S, Lynfield R. Detection of Influenza C Viruses Among Outpatients and Patients Hospitalized for Severe Acute Respiratory Infection, Minnesota, 2013-2016. Clin Infect Dis 2018; 66:1092-1098. [PMID: 29069373 PMCID: PMC5862734 DOI: 10.1093/cid/cix931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background Existing literature suggests that influenza C typically causes mild respiratory tract disease. However, clinical and epidemiological data are limited. Methods Four outpatient clinics and 3 hospitals submitted clinical data and respiratory specimens through a surveillance network for acute respiratory infection (ARI) from May 2013 through December 2016. Specimens were tested using multitarget nucleic acid amplification for 19-22 respiratory pathogens, including influenza C. Results Influenza C virus was detected among 59 of 10 202 (0.58%) hospitalized severe ARI cases and 11 of 2282 (0.48%) outpatients. Most detections occurred from December to March, 73% during the 2014-2015 season. Influenza C detections occurred among patients of all ages, with rates being similar between inpatients and outpatients. The highest rate of detection occurred among children aged 6-24 months (1.2%). Among hospitalized cases, 7 required intensive care. Medical comorbidities were reported in 58% of hospitalized cases and all who required intensive care. At least 1 other respiratory pathogen was detected in 40 (66%) cases, most commonly rhinovirus/enterovirus (25%) and respiratory syncytial virus (20%). The hemagglutinin-esterase-fusion gene was sequenced in 37 specimens, and both C/Kanagawa and C/Sao Paulo lineages were detected in inpatients and outpatients. Conclusions We found seasonal circulation of influenza C with year-to-year variability. Detection was most frequent among young children but occurred in all ages. Some cases that were positive for influenza C, particularly those with comorbid conditions, had severe disease, suggesting a need for further study of the role of influenza C virus in the pathogenesis of respiratory disease.
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Affiliation(s)
- Beth K Thielen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota, Minneapolis
| | | | | | - Bo Shu
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Lynch
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul
| | | | | | | | - Sandra S Chaves
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Steffens
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley L Fowlkes
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Lindstrom
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Thielen BK, McNevin JP, McElrath MJ, Hunt BVS, Klein KC, Lingappa JR. Innate immune signaling induces high levels of TC-specific deaminase activity in primary monocyte-derived cells through expression of APOBEC3A isoforms. J Biol Chem 2010; 285:27753-66. [PMID: 20615867 PMCID: PMC2934643 DOI: 10.1074/jbc.m110.102822] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 07/05/2010] [Indexed: 01/06/2023] Open
Abstract
In HIV-1-infected individuals, G-to-A hypermutation is found in HIV-1 DNA isolated from peripheral blood mononuclear cells (PBMCs). These mutations are thought to result from editing by one or more host enzymes in the APOBEC3 (A3) family of cytidine deaminases, which act on CC (APOBEC3G) and TC (other A3 proteins) dinucleotide motifs in DNA (edited cytidine underlined). Although many A3 proteins display high levels of deaminase activity in model systems, only low levels of A3 deaminase activity have been found in primary cells examined to date. In contrast, here we report high levels of deaminase activity at TC motifs when whole PBMCs or isolated primary monocyte-derived cells were treated with interferon-alpha (IFNalpha) or IFNalpha-inducing toll-like receptor ligands. Induction of TC-specific deaminase activity required new transcription and translation and correlated with the appearance of two APOBEC3A (A3A) isoforms. Knockdown of A3A in monocytes with siRNA abolished TC-specific deaminase activity, confirming that A3A isoforms are responsible for all TC-specific deaminase activity observed. Both A3A isoforms appear to be enzymatically active; moreover, our mutational studies raise the possibility that the smaller isoform results from internal translational initiation. In contrast to the high levels of TC-specific activity observed in IFNalpha-treated monocytes, CC-specific activity remained low in PBMCs, suggesting that A3G deaminase activity is relatively inhibited, unlike that of A3A. Together, these findings suggest that deaminase activity of A3A isoforms in monocytes and macrophages may play an important role in host defense against viruses.
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Affiliation(s)
- Beth K. Thielen
- From the Department of Global Health, University of Washington, Seattle, Washington 98102
| | - John P. McNevin
- the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, and
| | - M. Juliana McElrath
- the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, and
- the Department of Medicine, University of Washington, Seattle, Washington 98195
| | | | - Kevin C. Klein
- From the Department of Global Health, University of Washington, Seattle, Washington 98102
| | - Jaisri R. Lingappa
- From the Department of Global Health, University of Washington, Seattle, Washington 98102
- the Department of Medicine, University of Washington, Seattle, Washington 98195
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24
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Thielen BK, Klein KC, Walker LW, Rieck M, Buckner JH, Tomblingson GW, Lingappa JR. T cells contain an RNase-insensitive inhibitor of APOBEC3G deaminase activity. PLoS Pathog 2007; 3:1320-34. [PMID: 17892323 PMCID: PMC1993843 DOI: 10.1371/journal.ppat.0030135] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 07/27/2007] [Indexed: 12/22/2022] Open
Abstract
The deoxycytidine deaminase APOBEC3G (A3G) is expressed in human T cells and inhibits HIV-1 replication. When transfected into A3G-deficient epithelial cell lines, A3G induces catastrophic hypermutation by deaminating the HIV-1 genome. Interestingly, studies suggest that endogenous A3G in T cells induces less hypermutation than would be expected. However, to date, the specific deaminase activity of endogenous A3G in human CD4+ T cells has not been examined directly. Here, we compared deaminase activity of endogenous and exogenous A3G in various human cell lines using a standard assay and a novel, quantitative, high-throughput assay. Exogenous A3G in epithelial cell lysates displayed deaminase activity only following RNase treatment, as expected given that A3G is known to form an enzymatically inactive RNA-containing complex. Surprisingly, comparable amounts of endogenous A3G from T cell lines or from resting or activated primary CD4+ T cells exhibited minimal deaminase activity, despite RNase treatment. Specific deaminase activity of endogenous A3G in H9, CEM, and other T cell lines was up to 36-fold lower than specific activity of exogenous A3G in epithelial-derived cell lines. Furthermore, RNase-treated T cell lysates conferred a dose-dependent inhibition to epithelial cell lysates expressing enzymatically active A3G. These studies suggest that T cells, unlike epithelial-derived cell lines, express an unidentified RNase-resistant factor that inhibits A3G deaminase activity. This factor could be responsible for reduced levels of hypermutation in T cells, and its identification and blockade could offer a means for increasing antiretroviral intrinsic immunity of T cells. APOBEC3G (A3G) is an antiviral enzyme that is expressed in human T cells and macrophages, which are the cell types infected by HIV. Early in the HIV life cycle, the HIV RNA genome is reverse transcribed into DNA. A3G can modify this DNA enzymatically, leading to high rates of mutation such that the virus can no longer replicate. To date, most studies of A3G's enzymatic activity have utilized cell lines (293T and HeLa) that can be transfected to express A3G but do not express it endogenously. A report of unexpectedly low levels of mutation in viral DNA from HIV-infected human T cells led us to investigate regulation of A3G enzymatic activity in T cells. We developed a high-throughput assay to compare the enzymatic activity of endogenous A3G in T cells versus transfected (exogenous) A3G. Surprisingly, enzymatic activity of A3G from human T cell lines and primary T cells was very low relative to A3G from transfected cells, even when corrected for A3G protein amount. Moreover, T cell lysates inhibited enzymatic activity of exogenously expressed A3G. These data suggest that enzymatic activity of endogenous A3G in human T cells is inhibited by an uncharacterized mechanism that may protect the host from this DNA mutator and could have important implications for A3G antiviral activity in vivo.
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Affiliation(s)
- Beth K Thielen
- Department of Pathobiology, University of Washington, Seattle, Washington, United States of America
| | - Kevin C Klein
- Department of Pathobiology, University of Washington, Seattle, Washington, United States of America
| | - Lorne W Walker
- Department of Pathobiology, University of Washington, Seattle, Washington, United States of America
| | - Mary Rieck
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Garrett W Tomblingson
- Department of Pathobiology, University of Washington, Seattle, Washington, United States of America
| | - Jaisri R Lingappa
- Department of Pathobiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * To whom correspondence should be addressed. E-mail:
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Abstract
X-linked Alport syndrome (XLAS) is a progressive disorder of basement membranes caused by mutations in the COL4A5 gene, encoding the alpha5 chain of type IV collagen. A mouse model of this disorder was generated by targeting a human nonsense mutation, G5X, to the mouse Col4a5 gene. As predicted for a nonsense mutation, hemizygous mutant male mice are null and heterozygous carrier female mice are mosaic for alpha5(IV) chain expression. Mutant male mice and carrier female mice are viable through reproductive age and fertile. Mutant male mice died spontaneously at 6 to 34 wk of age, and carrier female mice died at 8 to 45 wk of age, manifesting proteinuria, azotemia, and progressive and manifold histologic abnormalities of the kidney glomerulus and tubulointerstitium. Ultrastructural abnormalities of the glomerular basement membrane, including lamellation and splitting, were characteristic of human XLAS. The mouse model described here recapitulates essential clinical and pathologic findings of human XLAS. With alpha5(IV) expression reflecting X-inactivation patterns, it will be especially useful in studying determinants of disease variability in the carrier state.
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Affiliation(s)
- Michelle N Rheault
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Thielen BK, Barker DF, Nelson RD, Zhou J, Kren SM, Segal Y. Deletion mapping in Alport syndrome and Alport syndrome-diffuse leiomyomatosis reveals potential mechanisms of visceral smooth muscle overgrowth. Hum Mutat 2003; 22:419. [PMID: 14517961 DOI: 10.1002/humu.9191] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diffuse leiomyomatosis is associated with the inherited kidney disease Alport syndrome, and characterized by visceral smooth muscle overgrowth within the respiratory, gastrointestinal and female reproductive tracts. Although partial deletions of the type IV collagen genes COL4A5 and COL4A6, paired head-to-head on chromosome Xq22, are known to cause diffuse leiomyomatosis, loss of function for type IV collagen does not explain smooth muscle overgrowth. To further clarify pathogenic mechanisms, we have characterized novel deletions in patients with Alport syndrome-diffuse leiomyomatosis or Alport syndrome alone. A 27.6-kb deletion, in a female with Alport syndrome-diffuse leiomyomatosis, is marked by the most proximal, i.e. most 5', COL4A5 breakpoint described to date. By comparing this deletion to others described here and previously, we have defined a minimal overlap region, only 4.2 kb in length and containing the COL4A5-COL4A6 proximal promoters, loss of which contributes to smooth muscle overgrowth. A novel deletion in a male with Alport syndrome alone is>1.4 Mb in length, encompassing COL4A5 and COL4A6 entirely, as well as neighboring genes. We postulate that loss of the 4.2-kb region in diffuse leiomyomatosis causes misregulation of neighboring genes, contributing to smooth muscle overgrowth. Deletion of the neighboring genes themselves may afford protection from this condition.
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Affiliation(s)
- Beth K Thielen
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
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