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Uthappa DM, McClain MT, Nicholson BP, Park LP, Zhbannikov I, Suchindran S, Jimenez M, Constantine FJ, Nichols M, Jones DC, Hudson LL, Jaggers LB, Veldman T, Burke TW, Tsalik EL, Ginsburg GS, Woods CW. Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students. Open Forum Infect Dis 2024; 11:ofae081. [PMID: 38440301 PMCID: PMC10911223 DOI: 10.1093/ofid/ofae081] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024] Open
Abstract
Background Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population. Methods We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group. Results We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group. Conclusions Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.
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Affiliation(s)
- Diya M Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Micah T McClain
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Ilya Zhbannikov
- Bioinformatics and Clinical Analytics Team, Clinical Research Unit, Duke University Department of Medicine, Durham, North Carolina, USA
| | - Sunil Suchindran
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Monica Jimenez
- Institute for Medical Research, Durham, North Carolina, USA
| | - Florica J Constantine
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Marshall Nichols
- Duke Institute for Health Innovation, Durham, North Carolina, USA
| | - Daphne C Jones
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Lori L Hudson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - L Brett Jaggers
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy Veldman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Thomas W Burke
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Ephraim L Tsalik
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Geoffrey S Ginsburg
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher W Woods
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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2
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Krishnan J, Woods CW, Holodniy M, Nicholson BP, Marconi VC, Ammons MCB, Jinadatha C, Pyarajan S, Wang-Rodriguez J, Garcia AP, Battles JK. Nationwide Genomic Surveillance and Response to COVID-19: The VA SeqFORCE and SeqCURE Consortiums. Fed Pract 2023; 40:S44-S47. [PMID: 38577303 PMCID: PMC10988620 DOI: 10.12788/fp.0417] [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: 04/06/2024]
Abstract
Background The US Department of Veterans Affairs (VA) has dedicated significant resources toward countering the COVID-19 pandemic. Sequencing for Research Clinical and Epidemiology (SeqFORCE) and Sequencing Collaborations United for Research and Epidemiology (SeqCURE) were developed as clinical and research consortiums, respectively, focused on the genetic COVID-19 surveillance. Observations Through genetic sequencing, VA SeqFORCE and SeqCURE collaborations contributed to the COVID-19 pandemic response and scientific understanding. Future directions for each program include the assessment of the unique impact of COVID-19 on the veteran population, as well as the adaptation of these programs to future infectious disease threats. We foresee the use of these established platforms beyond infectious diseases. Conclusions VA SeqFORCE and SeqCURE were established as clinical and research programs dedicated to sequencing COVID-19 as part of ongoing clinical and surveillance efforts. In the future, we anticipate that having these programs embedded within the largest integrated health care system in the US will enable the study of pathogens and pandemics beyond COVID-19 and at an unprecedented scale. The investment in these programs will form an integral part of our nation's response to emerging infectious diseases, with future applications to precision medicine and beyond.
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Affiliation(s)
- Jay Krishnan
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, North Carolina
| | - Christopher W. Woods
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, North Carolina
| | - Mark Holodniy
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC
- Stanford University, California
| | - Bradly P. Nicholson
- Durham Veterans Affairs Medical Center, North Carolina
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
| | - Mary Cloud B. Ammons
- Idaho Veterans Research and Education Foundation & Boise Veterans Affairs Medical Center
| | - Chetan Jinadatha
- Central Texas Veterans Health Care System, Temple
- Texas A&M University School of Medicine, Bryan
| | - Saiju Pyarajan
- Center for Data and Computational Sciences, Veterans Affairs Boston Healthcare System, Massachusetts
| | - Jessica Wang-Rodriguez
- National Pathology and Laboratory Medicine Service, Department of Veterans Affairs, Washington, DC
| | - Amanda P. Garcia
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
| | - Jane K. Battles
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
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3
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Giroux NS, Ding S, McClain MT, Burke TW, Petzold E, Chung HA, Rivera GO, Wang E, Xi R, Bose S, Rotstein T, Nicholson BP, Chen T, Henao R, Sempowski GD, Denny TN, De Ussel MI, Satterwhite LL, Ko ER, Ginsburg GS, Kraft BD, Tsalik EL, Shen X, Woods CW. Author Correction: Differential chromatin accessibility in peripheral blood mononuclear cells underlies COVID-19 disease severity prior to seroconversion. Sci Rep 2023; 13:6462. [PMID: 37081034 PMCID: PMC10116442 DOI: 10.1038/s41598-023-33323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Nicholas S Giroux
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Shengli Ding
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
- Durham Veterans Affairs Health Care System, Durham, NC, 27705, USA
- Division of Infectious Diseases, School of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710-4000, USA
| | - Thomas W Burke
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Hong A Chung
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Grecia O Rivera
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Ergang Wang
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Rui Xi
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Shree Bose
- Department of Pharmacology and Cancer Biology, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Tomer Rotstein
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | | | - Tianyi Chen
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Gregory D Sempowski
- Duke Human Vaccine Institute and Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Thomas N Denny
- Duke Human Vaccine Institute and Department of Medicine, School of Medicine, Duke University, Durham, NC, 27710, USA
| | - Maria Iglesias De Ussel
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lisa L Satterwhite
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Emily R Ko
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Bryan D Kraft
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
- Durham Veterans Affairs Health Care System, Durham, NC, 27705, USA
| | - Ephraim L Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
- Durham Veterans Affairs Health Care System, Durham, NC, 27705, USA
- Division of Infectious Diseases, School of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710-4000, USA
| | - Xiling Shen
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, 27708, USA
| | - Christopher W Woods
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27710, USA.
- Durham Veterans Affairs Health Care System, Durham, NC, 27705, USA.
- Division of Infectious Diseases, School of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710-4000, USA.
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Temple DS, Hegarty-Craver M, Furberg RD, Preble EA, Bergstrom E, Gardener Z, Dayananda P, Taylor L, Lemm NM, Papargyris L, McClain MT, Nicholson BP, Bowie A, Miggs M, Petzold E, Woods CW, Chiu C, Gilchrist KH. Wearable sensor-based detection of influenza in presymptomatic and asymptomatic individuals. J Infect Dis 2022; 227:864-872. [PMID: 35759279 PMCID: PMC9384446 DOI: 10.1093/infdis/jiac262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic highlighted the need for early detection of viral infections in symptomatic and asymptomatic individuals to allow for timely clinical management and public health interventions. METHODS Twenty healthy adults were challenged with an influenza A (H3N2) virus and prospectively monitored from 7 days before through 10 days after inoculation, using wearable electrocardiogram and physical activity sensors (Clinical Trial: NCT04204493; https://clinicaltrials.gov/ct2/show/NCT04204993). This framework allowed for responses to be accurately referenced to the infection event. For each participant, we trained a semi-supervised multivariable anomaly detection model on data acquired before inoculation and used it to classify the post-inoculation dataset. RESULTS Inoculation with this challenge virus was well-tolerated with an infection rate of 85%. With the model classification threshold set so that no alarms were recorded in the 170 healthy days recorded, the algorithm correctly identified 16 of 17 (94%) positive presymptomatic and asymptomatic individuals, on average 58 hours post inoculation and 23 hrs before the symptom onset. CONCLUSION The data processing and modeling methodology show promise for the early detection of respiratory illness. The detection algorithm is compatible with data collected from smartwatches using optical techniques but needs to be validated in large heterogeneous cohorts in normal living conditions.
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Affiliation(s)
| | | | | | | | - Emma Bergstrom
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Zoe Gardener
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Peter Dayananda
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Lydia Taylor
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Nana Marie Lemm
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Lukas Papargyris
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, 27710, USA
| | - Bradly P Nicholson
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, 27710, USA.,Institute for Medical Research, Durham, 27710, USA
| | - Aleah Bowie
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, 27710, USA
| | - Maria Miggs
- Institute for Medical Research, Durham, 27710, USA
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, 27710, USA
| | - Christopher W Woods
- Institute for Medical Research, Durham, 27710, USA.,Hubert-Yeargan Center for Global Health, Duke University School of Medicine, Durham, 27710, USA
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, SWT 2AZ, UK
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5
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Weerasinghe NP, Bodinayake CK, Wijayaratne WMDGB, Devasiri IV, Dahanayake NJ, Kurukulasooriya MRP, Premamali M, Sheng T, Nicholson BP, Ubeysekera HA, de Silva AD, Østbye T, Woods CW, Tillekeratne LG, Nagahawatte ADS. Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka. BMC Health Serv Res 2022; 22:657. [PMID: 35578247 PMCID: PMC9112532 DOI: 10.1186/s12913-022-08048-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars. Results A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%. Conclusions Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
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Affiliation(s)
- N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. .,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - C K Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - W M D G B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - I V Devasiri
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - N J Dahanayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M R P Kurukulasooriya
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M Premamali
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - T Sheng
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - B P Nicholson
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Institute for Medical Research, Durham, NC, USA
| | | | - A D de Silva
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - T Østbye
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - C W Woods
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - L G Tillekeratne
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - A De S Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA
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6
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Giroux NS, Ding S, Mcclain MT, Burke TW, Petzold E, Chung HA, Rivera GO, Wang E, Xi R, Bose S, Rotstein T, Nicholson BP, Chen T, Henao R, Sempowski GD, Denny TN, De Ussel MI, Satterwhite LL, Ko ER, Ginsburg GS, Kraft BD, Tsalik EL, Shen X, Woods C. Differential chromatin accessibility in peripheral blood mononuclear cells underlies COVID-19 disease severity prior to seroconversion.. [PMID: 35411343 PMCID: PMC8996625 DOI: 10.21203/rs.3.rs-1479864/v1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
SARS-CoV-2 infection triggers profound and variable immune responses in human hosts. Chromatin remodeling has been observed in individuals severely ill or convalescing with COVID-19, but chromatin remodeling early in disease prior to anti-spike protein IgG seroconversion has not been defined. We performed the Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq) and RNA-seq on peripheral blood mononuclear cells (PBMCs) from outpatients with mild or moderate symptom severity at different stages of clinical illness. Early in the disease course prior to IgG seroconversion, modifications in chromatin accessibility associate with mild or moderate symptoms are already robust and include severity-associated changes in accessibility of genes in interleukin signaling, regulation of cell differentiation and cell morphology. Furthermore, single-cell analyses revealed evolution of the chromatin accessibility landscape and transcription factor motif accessibility for individual PBMC cell types over time. The most extensive remodeling occurred in CD14+ monocytes, where sub-populations with distinct chromatin accessibility profiles were observed prior to seroconversion. Mild symptom severity is marked by upregulation classical antiviral pathways including those regulating IRF1 and IRF7, whereas in moderate disease these classical antiviral signals diminish suggesting dysregulated and less effective responses. Together, these observations offer novel insight into the epigenome of early mild SARS-CoV-2 infection and suggest that detection of chromatin remodeling in early disease may offer promise for a new class of diagnostic tools for COVID-19.
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7
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Tsalik EL, Henao R, Montgomery JL, Nawrocki JW, Aydin M, Lydon EC, Ko ER, Petzold E, Nicholson BP, Cairns CB, Glickman SW, Quackenbush E, Kingsmore SF, Jaehne AK, Rivers EP, Langley RJ, Fowler VG, McClain MT, Crisp RJ, Ginsburg GS, Burke TW, Hemmert AC, Woods CW. Discriminating Bacterial and Viral Infection Using a Rapid Host Gene Expression Test. Crit Care Med 2021; 49:1651-1663. [PMID: 33938716 PMCID: PMC8448917 DOI: 10.1097/ccm.0000000000005085] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 11/25/2022]
Abstract
OBJECTIVES Host gene expression signatures discriminate bacterial and viral infection but have not been translated to a clinical test platform. This study enrolled an independent cohort of patients to describe and validate a first-in-class host response bacterial/viral test. DESIGN Subjects were recruited from 2006 to 2016. Enrollment blood samples were collected in an RNA preservative and banked for later testing. The reference standard was an expert panel clinical adjudication, which was blinded to gene expression and procalcitonin results. SETTING Four U.S. emergency departments. PATIENTS Six-hundred twenty-three subjects with acute respiratory illness or suspected sepsis. INTERVENTIONS Forty-five-transcript signature measured on the BioFire FilmArray System (BioFire Diagnostics, Salt Lake City, UT) in ~45 minutes. MEASUREMENTS AND MAIN RESULTS Host response bacterial/viral test performance characteristics were evaluated in 623 participants (mean age 46 yr; 45% male) with bacterial infection, viral infection, coinfection, or noninfectious illness. Performance of the host response bacterial/viral test was compared with procalcitonin. The test provided independent probabilities of bacterial and viral infection in ~45 minutes. In the 213-subject training cohort, the host response bacterial/viral test had an area under the curve for bacterial infection of 0.90 (95% CI, 0.84-0.94) and 0.92 (95% CI, 0.87-0.95) for viral infection. Independent validation in 209 subjects revealed similar performance with an area under the curve of 0.85 (95% CI, 0.78-0.90) for bacterial infection and 0.91 (95% CI, 0.85-0.94) for viral infection. The test had 80.1% (95% CI, 73.7-85.4%) average weighted accuracy for bacterial infection and 86.8% (95% CI, 81.8-90.8%) for viral infection in this validation cohort. This was significantly better than 68.7% (95% CI, 62.4-75.4%) observed for procalcitonin (p < 0.001). An additional cohort of 201 subjects with indeterminate phenotypes (coinfection or microbiology-negative infections) revealed similar performance. CONCLUSIONS The host response bacterial/viral measured using the BioFire System rapidly and accurately discriminated bacterial and viral infection better than procalcitonin, which can help support more appropriate antibiotic use.
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Affiliation(s)
- Ephraim L. Tsalik
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Informatics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mert Aydin
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily C. Lydon
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily R. Ko
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Regional Hospital, Durham, NC, USA
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Charles B. Cairns
- University of North Carolina Medical Center, Chapel Hill, NC, USA
- Drexel University, Philadelphia, PA, USA
| | - Seth W. Glickman
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | | | | | | | | | - Vance G. Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Micah T. McClain
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Geoffrey S. Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Thomas W. Burke
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Christopher W. Woods
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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8
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Grzesiak E, Bent B, McClain MT, Woods CW, Tsalik EL, Nicholson BP, Veldman T, Burke TW, Gardener Z, Bergstrom E, Turner RB, Chiu C, Doraiswamy PM, Hero A, Henao R, Ginsburg GS, Dunn J. Assessment of the Feasibility of Using Noninvasive Wearable Biometric Monitoring Sensors to Detect Influenza and the Common Cold Before Symptom Onset. JAMA Netw Open 2021; 4:e2128534. [PMID: 34586364 PMCID: PMC8482058 DOI: 10.1001/jamanetworkopen.2021.28534] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Currently, there are no presymptomatic screening methods to identify individuals infected with a respiratory virus to prevent disease spread and to predict their trajectory for resource allocation. OBJECTIVE To evaluate the feasibility of using noninvasive, wrist-worn wearable biometric monitoring sensors to detect presymptomatic viral infection after exposure and predict infection severity in patients exposed to H1N1 influenza or human rhinovirus. DESIGN, SETTING, AND PARTICIPANTS The cohort H1N1 viral challenge study was conducted during 2018; data were collected from September 11, 2017, to May 4, 2018. The cohort rhinovirus challenge study was conducted during 2015; data were collected from September 14 to 21, 2015. A total of 39 adult participants were recruited for the H1N1 challenge study, and 24 adult participants were recruited for the rhinovirus challenge study. Exclusion criteria for both challenges included chronic respiratory illness and high levels of serum antibodies. Participants in the H1N1 challenge study were isolated in a clinic for a minimum of 8 days after inoculation. The rhinovirus challenge took place on a college campus, and participants were not isolated. EXPOSURES Participants in the H1N1 challenge study were inoculated via intranasal drops of diluted influenza A/California/03/09 (H1N1) virus with a mean count of 106 using the median tissue culture infectious dose (TCID50) assay. Participants in the rhinovirus challenge study were inoculated via intranasal drops of diluted human rhinovirus strain type 16 with a count of 100 using the TCID50 assay. MAIN OUTCOMES AND MEASURES The primary outcome measures included cross-validated performance metrics of random forest models to screen for presymptomatic infection and predict infection severity, including accuracy, precision, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). RESULTS A total of 31 participants with H1N1 (24 men [77.4%]; mean [SD] age, 34.7 [12.3] years) and 18 participants with rhinovirus (11 men [61.1%]; mean [SD] age, 21.7 [3.1] years) were included in the analysis after data preprocessing. Separate H1N1 and rhinovirus detection models, using only data on wearble devices as input, were able to distinguish between infection and noninfection with accuracies of up to 92% for H1N1 (90% precision, 90% sensitivity, 93% specificity, and 90% F1 score, 0.85 [95% CI, 0.70-1.00] AUC) and 88% for rhinovirus (100% precision, 78% sensitivity, 100% specificity, 88% F1 score, and 0.96 [95% CI, 0.85-1.00] AUC). The infection severity prediction model was able to distinguish between mild and moderate infection 24 hours prior to symptom onset with an accuracy of 90% for H1N1 (88% precision, 88% sensitivity, 92% specificity, 88% F1 score, and 0.88 [95% CI, 0.72-1.00] AUC) and 89% for rhinovirus (100% precision, 75% sensitivity, 100% specificity, 86% F1 score, and 0.95 [95% CI, 0.79-1.00] AUC). CONCLUSIONS AND RELEVANCE This cohort study suggests that the use of a noninvasive, wrist-worn wearable device to predict an individual's response to viral exposure prior to symptoms is feasible. Harnessing this technology would support early interventions to limit presymptomatic spread of viral respiratory infections, which is timely in the era of COVID-19.
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Affiliation(s)
- Emilia Grzesiak
- Biomedical Engineering Department, Duke University, Durham, North Carolina
| | - Brinnae Bent
- Biomedical Engineering Department, Duke University, Durham, North Carolina
| | - Micah T. McClain
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christopher W. Woods
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke Global Health Institute, Durham, North Carolina
| | - Ephraim L. Tsalik
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | - Timothy Veldman
- Department of Medicine, Duke Global Health Institute, Durham, North Carolina
| | - Thomas W. Burke
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Zoe Gardener
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Emma Bergstrom
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Ronald B. Turner
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - P. Murali Doraiswamy
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Alfred Hero
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor
| | - Ricardo Henao
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Geoffrey S. Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jessilyn Dunn
- Biomedical Engineering Department, Duke University, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
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9
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Paterson S, Kar S, Ung SK, Gardener Z, Bergstrom E, Ascough S, Kalyan M, Zyla J, Maertzdorf J, Mollenkopf HJ, Weiner J, Jozwik A, Jarvis H, Jha A, Nicholson BP, Veldman T, Woods CW, Mallia P, Kon OM, Kaufmann SH, Openshaw PJ, Chiu C. Innate-like Gene Expression of Lung-resident Memory CD8+ T-cells During Experimental Human Influenza: A Clinical Study. Am J Respir Crit Care Med 2021; 204:826-841. [PMID: 34256007 DOI: 10.1164/rccm.202103-0620oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/02/2023] Open
Abstract
RATIONALE Suboptimal vaccine immunogenicity and antigenic mismatch, compounded by poor uptake, means that influenza remains a major global disease. T-cells recognising peptides derived from conserved viral proteins could enhance vaccine-induced cross-strain protection. OBJECTIVES To investigate the kinetics, phenotypes and function of influenza virus-specific CD8+ resident-memory T-cells (Trm) in the lower airway and infer the molecular pathways associated with their response to infection in vivo. METHODS Healthy volunteers, aged 18-55, were inoculated intranasally with influenza A(H1N1)2009. Blood, upper and (in a subgroup) lower airway samples were obtained throughout infection. Symptoms were assessed using self-reported diaries and nasal viral load by qPCR. T-cell responses were analysed by three-colour FluoroSpot, flow cytometry with MHC I-peptide tetramers and RNAseq, with candidate markers confirmed using immunohistochemistry of endobronchial biopsies. MEASUREMENTS AND MAIN RESULTS Following challenge, 57% of participants became infected. Pre-existing influenza-specific CD8+ T-cells in blood correlated strongly with reduced viral load, which peaked at day 3. Influenza-specific CD8+ T-cells in BAL were highly enriched and predominantly expressed the Trm markers CD69 and CD103. Comparison between pre-infection CD8+ T-cells in BAL and blood by RNAseq revealed 3928 differentially expressed genes, including all major Trm cell markers. However, gene-set enrichment analysis of BAL CD8+ T-cells showed primarily innate cell-related pathways and, during infection, included upregulation of innate chemokines (Cxcl1, Cxcl10 and Cxcl16) that were also expressed by CD8+ cells in bronchial tissues. CONCLUSIONS CD8+ Trm cells in the human lung display innate-like gene and protein expression that demonstrates blurred divisions between innate and adaptive immunity. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02755948.
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Affiliation(s)
- Suzanna Paterson
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Satwik Kar
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Seng Kuong Ung
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Zoe Gardener
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Emma Bergstrom
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Stephanie Ascough
- Imperial College London, 4615, Infectious Disease and Immunity, London, United Kingdom of Great Britain and Northern Ireland
| | - Mohini Kalyan
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland
| | - Joanna Zyla
- Max-Planck-Institute for Infection Biology, 28260, Berlin, Germany.,Silesian University of Technology, 49569, Department of Data Science and Engineering, Gliwice, Poland
| | | | | | - January Weiner
- Max-Planck-Institute for Infection Biology, 28260, Berlin, Germany
| | - Agnieszka Jozwik
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, London, United Kingdom of Great Britain and Northern Ireland
| | - Hannah Jarvis
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, London, United Kingdom of Great Britain and Northern Ireland
| | - Akhilesh Jha
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Bradly P Nicholson
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Timothy Veldman
- Duke University, 3065, Department of Medicine, Durham, North Carolina, United States
| | - Chris W Woods
- Duke University, 3065, Medicine, Durham, North Carolina, United States
| | - Patrick Mallia
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, London, United Kingdom of Great Britain and Northern Ireland
| | - Onn Min Kon
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Peter J Openshaw
- National Heart and Lung Institute Section of Allergy and Clinical Immunology, 247223, Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Chiu
- Imperial College London, 4615, Department of Infectious Disease, London, United Kingdom of Great Britain and Northern Ireland;
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10
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Giroux NS, Ding S, McClain MT, Burke TW, Petzold E, Chung HA, Palomino GR, Wang E, Xi R, Bose S, Rotstein T, Nicholson BP, Chen T, Henao R, Sempowski GD, Denny TN, Ko ER, Ginsburg GS, Kraft BD, Tsalik EL, Woods CW, Shen X. Chromatin remodeling in peripheral blood cells reflects COVID-19 symptom severity. bioRxiv 2020:2020.12.04.412155. [PMID: 33300002 PMCID: PMC7724678 DOI: 10.1101/2020.12.04.412155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2 infection triggers highly variable host responses and causes varying degrees of illness in humans. We sought to harness the peripheral blood mononuclear cell (PBMC) response over the course of illness to provide insight into COVID-19 physiology. We analyzed PBMCs from subjects with variable symptom severity at different stages of clinical illness before and after IgG seroconversion to SARS-CoV-2. Prior to seroconversion, PBMC transcriptomes did not distinguish symptom severity. In contrast, changes in chromatin accessibility were associated with symptom severity. Furthermore, single-cell analyses revealed evolution of the chromatin accessibility landscape and transcription factor motif occupancy for individual PBMC cell types. The most extensive remodeling occurred in CD14+ monocytes where sub-populations with distinct chromatin accessibility profiles were associated with disease severity. Our findings indicate that pre-seroconversion chromatin remodeling in certain innate immune populations is associated with divergence in symptom severity, and the identified transcription factors, regulatory elements, and downstream pathways provide potential prognostic markers for COVID-19 subjects.
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Affiliation(s)
- Nicholas S. Giroux
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Shengli Ding
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Micah T. McClain
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Thomas W. Burke
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Hong A. Chung
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Grecia R. Palomino
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Ergang Wang
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Rui Xi
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Shree Bose
- Department of Pharmacology and Cancer Biology, School of Medicine, Duke University, Durham, NC, USA
| | - Tomer Rotstein
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | | - Tianyi Chen
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC, USA
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Gregory D. Sempowski
- Duke Human Vaccine Institute and Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Thomas N. Denny
- Duke Human Vaccine Institute and Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Emily R. Ko
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Geoffrey S. Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Bryan D. Kraft
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Ephraim L. Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Christopher W. Woods
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Xiling Shen
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
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11
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Doshi RH, Hoff NA, Bratcher A, Mukadi P, Gadoth A, Nicholson BP, Williams R, Mukadi D, Mossoko M, Wasiswa J, Mwanza A, Sinai C, Alfonso VH, Shah R, Bramble MS, Ilunga-Kebela B, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Risk factors for Ebola exposure in healthcare workers in Boende, Tshuapa Province, Democratic Republic of the Congo. J Infect Dis 2020; 226:608-615. [PMID: 33269402 PMCID: PMC9441197 DOI: 10.1093/infdis/jiaa747] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Healthcare workers (HCW) are more likely to be exposed to Ebola virus (EBOV) during an outbreak compared to people in the general population due to close physical contact with patients and potential exposure to infectious fluids. However, not all will fall ill. Despite evidence of subclinical and paucisymptomatic Ebola Virus Disease (EVD), the prevalence and associated risk factors remains unknown. We conducted a serosurvey among healthcare workers in the town of Boende in Tshuapa Province, Democratic Republic of Congo (DRC). Human anti-EBOV Glycoprotein (GP) IgG titers were measured using a commercially available ELISA kit. We assessed associations between anti-EBOV IgG seroreactivity, defined as ≥2.5 units/mL and risk factors using univariable and multivariable logistic regression. Sensitivity analyses explored a more conservative cutoff >5 units/mL. Overall, 22.5% of HCWs were seroreactive for EBOV. In multivariable analyses, using any form of personal protective equipment (PPE) when interacting with a confirmed, probable, or suspect EVD case was negatively associated with seroreactivity [0.23 (95% CI: 0.07, 0.73)]. Our results suggest high exposure to EBOV among HCWs and provide additional evidence for asymptomatic or minimally symptomatic EVD. Further studies should be conducted to determine the probability of onward transmission and if seroreactivity is associated with immunity.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Anna Bratcher
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Adva Gadoth
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | | | | | - Daniel Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Matthias Mossoko
- Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | - Joseph Wasiswa
- UCLA-DRC Research Program, Kinshasa, DRC.,Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | | | - Cyrus Sinai
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Vivian H Alfonso
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Rupal Shah
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Matthew S Bramble
- Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, D.C. USA
| | | | | | | | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
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12
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Vanderburg S, Wijayaratne G, Danthanarayana N, Jayamaha J, Piyasiri B, Halloluwa C, Sheng T, Amarasena S, Kurukulasooriya R, Nicholson BP, Peiris JSM, Gray GC, Gunasena S, Nagahawatte A, Bodinayake CK, Woods CW, Devasiri V, Tillekeratne LG. Outbreak of severe acute respiratory infection in Southern Province, Sri Lanka in 2018: a cross-sectional study. BMJ Open 2020; 10:e040612. [PMID: 33158834 PMCID: PMC7651749 DOI: 10.1136/bmjopen-2020-040612] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018. DESIGN Prospective, cross-sectional study. SETTING 1600-bed, public, tertiary care hospital in Southern Province, Sri Lanka. PARTICIPANTS 410 consecutive patients, including 371 children and 39 adults, who were admitted with suspected viral pneumonia (passive surveillance) or who met case definition for acute respiratory illness (active surveillance) in May to June 2018. RESULTS We found that cocirculation of influenza A (22.6% of cases), respiratory syncytial virus (27.8%) and adenovirus (AdV) (30.7%; type B3) was responsible for the outbreak. Mortality was noted in 4.5% of paediatric cases identified during active surveillance. Virus type and viral coinfection were not significantly associated with mortality. CONCLUSIONS This is the first report of intense cocirculation of multiple respiratory viruses as a cause of an outbreak of severe acute respiratory illness in Sri Lanka, and the first time that AdV has been documented as a cause of a respiratory outbreak in the country. Our results emphasise the need for continued vigilance in surveying for known and emerging respiratory viruses in the tropics.
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Affiliation(s)
- Sky Vanderburg
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | | | - Jude Jayamaha
- Medical Research Institute Sri Lanka, Colombo, Sri Lanka
| | | | | | - Tianchen Sheng
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | | | | | - Gregory C Gray
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Ajith Nagahawatte
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Champica K Bodinayake
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Christopher W Woods
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | - L Gayani Tillekeratne
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
- Duke Global Health Institute, Durham, North Carolina, USA
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13
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McClain MT, Constantine FJ, Nicholson BP, Nichols M, Burke TW, Henao R, Jones DC, Hudson LL, Jaggers LB, Veldman T, Mazur A, Park LP, Suchindran S, Tsalik EL, Ginsburg GS, Woods CW. A blood-based host gene expression assay for early detection of respiratory viral infection: an index-cluster prospective cohort study. Lancet Infect Dis 2020; 21:396-404. [PMID: 32979932 PMCID: PMC7515566 DOI: 10.1016/s1473-3099(20)30486-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 01/31/2023]
Abstract
Background Early and accurate identification of individuals with viral infections is crucial for clinical management and public health interventions. We aimed to assess the ability of transcriptomic biomarkers to identify naturally acquired respiratory viral infection before typical symptoms are present. Methods In this index-cluster study, we prospectively recruited a cohort of undergraduate students (aged 18–25 years) at Duke University (Durham, NC, USA) over a period of 5 academic years. To identify index cases, we monitored students for the entire academic year, for the presence and severity of eight symptoms of respiratory tract infection using a daily web-based survey, with symptoms rated on a scale of 0–4. Index cases were defined as individuals who reported a 6-point increase in cumulative daily symptom score. Suspected index cases were visited by study staff to confirm the presence of reported symptoms of illness and to collect biospecimen samples. We then identified clusters of close contacts of index cases (ie, individuals who lived in close proximity to index cases, close friends, and partners) who were presumed to be at increased risk of developing symptomatic respiratory tract infection while under observation. We monitored each close contact for 5 days for symptoms and viral shedding and measured transcriptomic responses at each timepoint each day using a blood-based 36-gene RT-PCR assay. Findings Between Sept 1, 2009, and April 10, 2015, we enrolled 1465 participants. Of 264 index cases with respiratory tract infection symptoms, 150 (57%) had a viral cause confirmed by RT-PCR. Of their 555 close contacts, 106 (19%) developed symptomatic respiratory tract infection with a proven viral cause during the observation window, of whom 60 (57%) had the same virus as their associated index case. Nine viruses were detected in total. The transcriptomic assay accurately predicted viral infection at the time of maximum symptom severity (mean area under the receiver operating characteristic curve [AUROC] 0·94 [95% CI 0·92–0·96]), as well as at 1 day (0·87 [95% CI 0·84–0·90]), 2 days (0·85 [0·82–0·88]), and 3 days (0·74 [0·71–0·77]) before peak illness, when symptoms were minimal or absent and 22 (62%) of 35 individuals, 25 (69%) of 36 individuals, and 24 (82%) of 29 individuals, respectively, had no detectable viral shedding. Interpretation Transcriptional biomarkers accurately predict and diagnose infection across diverse viral causes and stages of disease and thus might prove useful for guiding the administration of early effective therapy, quarantine decisions, and other clinical and public health interventions in the setting of endemic and pandemic infectious diseases. Funding US Defense Advanced Research Projects Agency.
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Affiliation(s)
- Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA; Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.
| | - Florica J Constantine
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Marshall Nichols
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas W Burke
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Lori L Hudson
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - L Brett Jaggers
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Timothy Veldman
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anna Mazur
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lawrence P Park
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
| | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Ephraim L Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA; Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
| | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher W Woods
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA; Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA
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14
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McClain MT, Constantine FJ, Henao R, Liu Y, Tsalik EL, Burke TW, Steinbrink JM, Petzold E, Nicholson BP, Rolfe R, Kraft BD, Kelly MS, Sempowski GD, Denny TN, Ginsburg GS, Woods CW. Dysregulated transcriptional responses to SARS-CoV-2 in the periphery support novel diagnostic approaches. medRxiv 2020:2020.07.20.20155507. [PMID: 32743603 PMCID: PMC7386527 DOI: 10.1101/2020.07.20.20155507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In order to elucidate novel aspects of the host response to SARS-CoV-2 we performed RNA sequencing on peripheral blood samples across 77 timepoints from 46 subjects with COVID-19 and compared them to subjects with seasonal coronavirus, influenza, bacterial pneumonia, and healthy controls. Early SARS-CoV-2 infection triggers a conserved transcriptomic response in peripheral blood that is heavily interferon-driven but also marked by indicators of early B-cell activation and antibody production. Interferon responses during SARS-CoV-2 infection demonstrate unique patterns of dysregulated expression compared to other infectious and healthy states. Heterogeneous activation of coagulation and fibrinolytic pathways are present in early COVID-19, as are IL1 and JAK/STAT signaling pathways, that persist into late disease. Classifiers based on differentially expressed genes accurately distinguished SARS-CoV-2 infection from other acute illnesses (auROC 0.95). The transcriptome in peripheral blood reveals unique aspects of the immune response in COVID-19 and provides for novel biomarker-based approaches to diagnosis.
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Affiliation(s)
- Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | | | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Yiling Liu
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Ephraim L Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Thomas W Burke
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Julie M Steinbrink
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | | | - Robert Rolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University Medical Center
| | | | | | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Christopher W Woods
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
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15
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Tillekeratne LG, Suchindran S, Ko ER, Petzold EA, Bodinayake CK, Nagahawatte A, Devasiri V, Kurukulasooriya R, Nicholson BP, McClain MT, Burke TW, Tsalik EL, Henao R, Ginsburg GS, Reller ME, Woods CW. Previously Derived Host Gene Expression Classifiers Identify Bacterial and Viral Etiologies of Acute Febrile Respiratory Illness in a South Asian Population. Open Forum Infect Dis 2020; 7:ofaa194. [PMID: 32617371 PMCID: PMC7314590 DOI: 10.1093/ofid/ofaa194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort. Methods Patients ≥15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a pan-viral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious). Results Ribonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classification accuracy of 94%, with sensitivity and specificity of 91% and 95%, respectively, for bacterial infection. The sensitivity and specificity of C-reactive protein (>10 mg/L) and procalcitonin (>0.25 ng/mL) for bacterial infection were 100% and 34%, and 100% and 41%, respectively. Conclusions Previously derived gene expression classifiers had high predictive accuracy at distinguishing viral and bacterial infection in South Asian patients with ARI caused by typical and atypical pathogens.
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Affiliation(s)
- L Gayani Tillekeratne
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA.,Infectious Diseases Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Emily R Ko
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA.,Program in Hospital Medicine, Duke Regional Hospital, Durham, North Carolina, USA
| | - Elizabeth A Petzold
- Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Champica K Bodinayake
- Duke Global Health Institute, Durham, North Carolina, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Ajith Nagahawatte
- Duke Global Health Institute, Durham, North Carolina, USA.,Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Vasantha Devasiri
- Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | | | - Micah T McClain
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Infectious Diseases Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Thomas W Burke
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Ephraim L Tsalik
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Infectious Diseases Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Ricardo Henao
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Geoffrey S Ginsburg
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
| | - Megan E Reller
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA.,Infectious Diseases Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Christopher W Woods
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA.,Infectious Diseases Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Center for Applied Genomics and Precision Medicine, Durham, North Carolina, USA
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16
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Lydon EC, Henao R, Burke TW, Aydin M, Nicholson BP, Glickman SW, Fowler VG, Quackenbush EB, Cairns CB, Kingsmore SF, Jaehne AK, Rivers EP, Langley RJ, Petzold E, Ko ER, McClain MT, Ginsburg GS, Woods CW, Tsalik EL. Validation of a host response test to distinguish bacterial and viral respiratory infection. EBioMedicine 2019; 48:453-461. [PMID: 31631046 PMCID: PMC6838360 DOI: 10.1016/j.ebiom.2019.09.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Distinguishing bacterial and viral respiratory infections is challenging. Novel diagnostics based on differential host gene expression patterns are promising but have not been translated to a clinical platform nor extensively tested. Here, we validate a microarray-derived host response signature and explore performance in microbiology-negative and coinfection cases. METHODS Subjects with acute respiratory illness were enrolled in participating emergency departments. Reference standard was an adjudicated diagnosis of bacterial infection, viral infection, both, or neither. An 87-transcript signature for distinguishing bacterial, viral, and noninfectious illness was measured from peripheral blood using RT-PCR. Performance characteristics were evaluated in subjects with confirmed bacterial, viral, or noninfectious illness. Subjects with bacterial-viral coinfection and microbiologically-negative suspected bacterial infection were also evaluated. Performance was compared to procalcitonin. FINDINGS 151 subjects with microbiologically confirmed, single-etiology illness were tested, yielding AUROCs 0•85-0•89 for bacterial, viral, and noninfectious illness. Accuracy was similar to procalcitonin (88% vs 83%, p = 0•23) for bacterial vs. non-bacterial infection. Whereas procalcitonin cannot distinguish viral from non-infectious illness, the RT-PCR test had 81% accuracy in making this determination. Bacterial-viral coinfection was subdivided. Among 19 subjects with bacterial superinfection, the RT-PCR test identified 95% as bacterial, compared to 68% with procalcitonin (p = 0•13). Among 12 subjects with bacterial infection superimposed on chronic viral infection, the RT-PCR test identified 83% as bacterial, identical to procalcitonin. 39 subjects had suspected bacterial infection; the RT-PCR test identified bacterial infection more frequently than procalcitonin (82% vs 64%, p = 0•02). INTERPRETATION The RT-PCR test offered similar diagnostic performance to procalcitonin in some subgroups but offered better discrimination in others such as viral vs. non-infectious illness and bacterial/viral coinfection. Gene expression-based tests could impact decision-making for acute respiratory illness as well as a growing number of other infectious and non-infectious diseases.
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Affiliation(s)
- Emily C Lydon
- Duke University School of Medicine, Durham, NC, USA; Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA
| | - Ricardo Henao
- Duke University Department of Biostatistics and Informatics, Durham, NC, USA
| | - Thomas W Burke
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA
| | - Mert Aydin
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA
| | - Bradly P Nicholson
- Institute of Medical Research, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Seth W Glickman
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Vance G Fowler
- Duke University Department of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | | | - Charles B Cairns
- University of North Carolina Medical Center, Chapel Hill, NC, USA; United Arab Emirates University, Al Ain, UAE
| | | | | | | | - Raymond J Langley
- University of South Alabama Health University Hospital, Mobile, AL, USA
| | - Elizabeth Petzold
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA
| | - Emily R Ko
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA; Department of Hospital Medicine, Duke Regional Hospital, Durham, NC 27705, USA
| | - Micah T McClain
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Geoffrey S Ginsburg
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA
| | - Christopher W Woods
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Ephraim L Tsalik
- Duke University Center for Applied Genomics and Precision Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA.
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17
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Rimoin AW, Lu K, Bramble MS, Steffen I, Doshi RH, Hoff NA, Mukadi P, Nicholson BP, Alfonso VH, Olinger G, Sinai C, Yamamoto LK, Ramirez CM, Okitolonda Wemakoy E, Kebela Illunga B, Pettitt J, Logue J, Bennett RS, Jahrling P, Heymann DL, Piot P, Muyembe-Tamfum JJ, Hensley LE, Simmons G. Ebola Virus Neutralizing Antibodies Detectable in Survivors of theYambuku, Zaire Outbreak 40 Years after Infection. J Infect Dis 2019; 217:223-231. [PMID: 29253164 PMCID: PMC5853670 DOI: 10.1093/infdis/jix584] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022] Open
Abstract
The first reported outbreak of Ebola virus disease occurred in 1976 in Yambuku, Democratic Republic of Congo. Antibody responses in survivors 11 years after infection have been documented. However, this report is the first characterization of anti-Ebola virus antibody persistence and neutralization capacity 40 years after infection. Using ELISAs we measured survivor’s immunological response to Ebola virus Zaire (EBOV) glycoprotein and nucleoprotein, and assessed VP40 reactivity. Neutralization of EBOV was measured using a pseudovirus approach and plaque reduction neutralization test with live EBOV. Some survivors from the original EBOV outbreak still harbor antibodies against all 3 measures. Interestingly, a subset of these survivors’ serum antibodies could still neutralize live virus 40 years postinitial infection. These data provide the longest documentation of both anti-Ebola serological response and neutralization capacity within any survivor cohort, extending the known duration of response from 11 years postinfection to at least 40 years after symptomatic infection.
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Affiliation(s)
- Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Matthew S Bramble
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles.,Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Vivian H Alfonso
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Gerrard Olinger
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Cyrus Sinai
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Lauren K Yamamoto
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | | | | | | | - James Logue
- Integrated Research Facility at Fort Detrick
| | | | | | - David L Heymann
- Chatham House Center on Global Health Security, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lisa E Hensley
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
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18
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Tillekeratne LG, Bodinayake CK, Simmons R, Nagahawatte A, Devasiri V, Kodikara Arachchi W, Nicholson BP, Park LP, Vanderburg S, Kurukulasooriya R, De Silva AD, Østybe T, Reller ME, Woods CW. Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka. Am J Trop Med Hyg 2019; 100:672-680. [PMID: 30594268 PMCID: PMC6402941 DOI: 10.4269/ajtmh.18-0699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/26/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022] Open
Abstract
The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ≥ 1 year of age admitted to a tertiary care hospital in southern Sri Lanka, June 2012-October 2014. We collected epidemiologic/clinical data and a nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). We determined associations between weather data and respiratory viral activity using the Spearman correlation and assessed respiratory virus seasonality using a Program for Appropriate Technology definition. Bivariable and multivariable regression analyses were conducted to identify features associated with respiratory virus detection. Among 964 patients, median age was 26.2 years (interquartile range 14.6-39.9) and 646 (67.0%) were male. One-fifth (203, 21.1%) had respiratory virus detected: 13.9% influenza, 1.4% human enterovirus/rhinovirus, 1.4% parainfluenza virus, 1.1% respiratory syncytial virus, and 1.1% human metapneumovirus. Patients with respiratory virus identified were younger (median 9.8 versus 27.7 years, P < 0.001) and more likely to have respiratory signs and symptoms. Influenza A and respiratory viral activity peaked in February-June each year. Maximum daily temperature was associated with influenza and respiratory viral activity (P = 0.03 each). Patients with respiratory virus were as likely as others to be prescribed antibiotics (55.2% versus 52.6%, P = 0.51), and none reported prior influenza vaccination. Respiratory viral infection was a common cause of AFI. Improved access to vaccines and respiratory diagnostics may help reduce disease burden and inappropriate antibiotic use.
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Affiliation(s)
- L. Gayani Tillekeratne
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Champica K. Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Ryan Simmons
- Duke Global Health Institute, Durham, North Carolina
| | - Ajith Nagahawatte
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Vasantha Devasiri
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Wasantha Kodikara Arachchi
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - Bradly P. Nicholson
- Duke University, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Lawrence P. Park
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
| | - Sky Vanderburg
- Duke University, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | | | - Aruna Dharshan De Silva
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
- General Sir Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Truls Østybe
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Megan E. Reller
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
| | - Christopher W. Woods
- Duke University, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka
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19
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Gayani Tillekeratne L, Suchindran S, Ko E, Petzold E, Bodinayake CK, Nagahawatte A, Devasiri V, Kurukulasooriya R, Reller ME, Nicholson BP, Burke T, Mcclain MT, Tsalik EL, Henao R, Ginsburg GS, Woods CW. 2018. Host Gene Expression Classifiers Distinguish Bacterial and Viral Infections in Sri Lankan Patients with Acute Febrile Respiratory Illness. Open Forum Infect Dis 2018. [PMCID: PMC6253671 DOI: 10.1093/ofid/ofy210.1674] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Acute febrile illness is a frequent cause of hospitalization in the tropics and often presents with respiratory symptoms, even when caused by nonrespiratory pathogens. Previously, host-based gene expression signatures accurately identified acute respiratory infections as being bacterial or viral in a U.S. cohort. We determined signature performance in a Sri Lankan cohort with acute febrile respiratory illness (AFRI). Methods We enrolled patients with AFRI in Sri Lanka from July 2012 to May 2013 and collected nasopharygeal swabs, acute/ convalescent sera, and blood in PAXgene RNA tubes. Bacterial (Orientia tsutsugamushi, Leptospira spp.) and viral (influenza A/B, dengue) infections were confirmed using polymerase chain reaction, virus isolation, enzyme immunoassay, and/or microscopic agglutination testing. We extracted total RNA and performed host RNA sequencing (Illumina). We aligned reads to hg38 reference genome using Bowtie2, quantified at isoform level using Express version 1.5.1, and normalized using trimmed-mean normalization. The original model estimated three classes and separate signatures predicted bacterial infections, viral infections, and non-infectious illnesses. Regularized regression was used to predict bacterial and viral infections based on prior signatures. Accuracy was estimated using leave-one-out cross-validation. Results Among 43 patients with viral infections (14 dengue, 29 influenza) and 16 patients with bacterial infections (six Leptospira spp., 10 O. tsutsumagushi), median age was 37 years (IQR 23–51) and 49% were male. Of five respiratory symptoms (cough, sore throat, rhinitis/ congestion, shortness of breath, and pain with breathing), median (IQR) number of symptoms was 2 (1–2) for influenza, 2 (1–2) for dengue, 2 (2–3) for Leptospira spp., and 1.5 (1–2) for O. tsutsumagushi. We observed high predictive accuracy in discriminating bacterial and viral infections: AUROC 0.91 for the bacterial and AUROC 0.81 for the viral model. At enrollment, 65% of viral and 50% of bacterial AFRI patients received antibiotics. Conclusion Host gene expression classifiers performed well in a Sri Lankan population with AFRI, even with nonrespiratory pathogens that may not be readily identified. Host-based diagnostics may play a critical role in improving diagnostic ability and antibiotic use globally. Disclosures E. L. Tsalik, Host Response, Inc.: Founder, Equity. G. S. Ginsburg, Host Response Inc.: Board Member, Founder, Scientific Advisor and Shareholder, Stock (currently worth <$100). C. W. Woods, Host Response, Inc.: Founder, Equity.
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Affiliation(s)
- L Gayani Tillekeratne
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Veterans Affairs Medical Center, Durham, North Carolina
| | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Emily Ko
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Elizabeth Petzold
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | | | | | | | | | - Megan E Reller
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Veterans Affairs Medical Center, Durham, North Carolina
| | | | - Thomas Burke
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Micah T Mcclain
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Veterans Affairs Medical Center, Durham, North Carolina
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Ephraim L Tsalik
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
- Emergency Department Service, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Christopher W Woods
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
- Veterans Affairs Medical Center, Durham, North Carolina
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
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20
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Bramble MS, Hoff N, Gilchuk P, Mukadi P, Lu K, Doshi RH, Steffen I, Nicholson BP, Lipson A, Vashist N, Sinai C, Spencer D, Olinger G, Wemakoy EO, Illunga BK, Pettitt J, Logue J, Marchand J, Varughese J, Bennett RS, Jahrling P, Cavet G, Serafini T, Ollmann Saphire E, Vilain E, Muyembe-Tamfum JJ, Hensely LE, Simmons G, Crowe JE, Rimoin AW. Pan-Filovirus Serum Neutralizing Antibodies in a Subset of Congolese Ebolavirus Infection Survivors. J Infect Dis 2018; 218:1929-1936. [PMID: 30107445 PMCID: PMC6217721 DOI: 10.1093/infdis/jiy453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/28/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
One year after a Zaire ebolavirus (EBOV) outbreak occurred in the Boende Health Zone of the Democratic Republic of the Congo during 2014, we sought to determine the breadth of immune response against diverse filoviruses including EBOV, Bundibugyo (BDBV), Sudan (SUDV), and Marburg (MARV) viruses. After assessing the 15 survivors, 5 individuals demonstrated some degree of reactivity to multiple ebolavirus species and, in some instances, Marburg virus. All 5 of these survivors had immunoreactivity to EBOV glycoprotein (GP) and EBOV VP40, and 4 had reactivity to EBOV nucleoprotein (NP). Three of these survivors showed serologic responses to the 3 species of ebolavirus GPs tested (EBOV, BDBV, SUDV). All 5 samples also exhibited ability to neutralize EBOV using live virus, in a plaque reduction neutralization test. Remarkably, 3 of these EBOV survivors had plasma antibody responses to MARV GP. In pseudovirus neutralization assays, serum antibodies from a subset of these survivors also neutralized EBOV, BDBV, SUDV, and Taï Forest virus as well as MARV. Collectively, these findings suggest that some survivors of naturally acquired ebolavirus infection mount not only a pan-ebolavirus response, but also in less frequent cases, a pan-filovirus neutralizing response.
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Affiliation(s)
- Matthew S Bramble
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Nicole Hoff
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Pavlo Gilchuk
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Allen Lipson
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Neerja Vashist
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Cyrus Sinai
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - D’andre Spencer
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Garrard Olinger
- Boston University, School of Medicine, Department of Medicine, Massachusetts
| | | | - Benoit Kebela Illunga
- Direction de la Lutte Contre les Maladies, Ministère de la Sante, Kinshasa, Democratic Republic of the Congo
| | - James Pettitt
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Jonathan Marchand
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Justin Varughese
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Richard S Bennett
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Peter Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | | | | | - Erica Ollmann Saphire
- Skaggs Institute for Chemical Biology, La Jolla, California
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, California
| | - Eric Vilain
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | | | - Lisa E Hensely
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
- Emerging Viral Pathogens Section, NIAID, NIH, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - James E Crowe
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Pediatrics and Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
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Burke TW, Henao R, Soderblom E, Tsalik EL, Thompson JW, McClain MT, Nichols M, Nicholson BP, Veldman T, Lucas JE, Moseley MA, Turner RB, Lambkin-Williams R, Hero AO, Woods CW, Ginsburg GS. Nasopharyngeal Protein Biomarkers of Acute Respiratory Virus Infection. EBioMedicine 2017; 17:172-181. [PMID: 28238698 PMCID: PMC5360578 DOI: 10.1016/j.ebiom.2017.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/12/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/09/2022] Open
Abstract
Infection of respiratory mucosa with viral pathogens triggers complex immunologic events in the affected host. We sought to characterize this response through proteomic analysis of nasopharyngeal lavage in human subjects experimentally challenged with influenza A/H3N2 or human rhinovirus, and to develop targeted assays measuring peptides involved in this host response allowing classification of acute respiratory virus infection. Unbiased proteomic discovery analysis identified 3285 peptides corresponding to 438 unique proteins, and revealed that infection with H3N2 induces significant alterations in protein expression. These include proteins involved in acute inflammatory response, innate immune response, and the complement cascade. These data provide insights into the nature of the biological response to viral infection of the upper respiratory tract, and the proteins that are dysregulated by viral infection form the basis of signature that accurately classifies the infected state. Verification of this signature using targeted mass spectrometry in independent cohorts of subjects challenged with influenza or rhinovirus demonstrates that it performs with high accuracy (0.8623 AUROC, 75% TPR, 97.46% TNR). With further development as a clinical diagnostic, this signature may have utility in rapid screening for emerging infections, avoidance of inappropriate antibacterial therapy, and more rapid implementation of appropriate therapeutic and public health strategies.
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Affiliation(s)
- Thomas W Burke
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA
| | - Ricardo Henao
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
| | - Erik Soderblom
- Proteomics and Metabolomics Shared Resource, Duke University Medical Center, Durham, NC 27708, USA
| | - Ephraim L Tsalik
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Durham Veteran's Affairs Medical Center, Durham, NC 27705, USA; Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC 27710, USA
| | - J Will Thompson
- Proteomics and Metabolomics Shared Resource, Duke University Medical Center, Durham, NC 27708, USA
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC 27710, USA; Section for Infectious Diseases, Medicine Service, Durham Veteran's Affairs Medical Center, Durham, NC 27705, USA
| | - Marshall Nichols
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA
| | | | - Timothy Veldman
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA
| | - Joseph E Lucas
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
| | - M Arthur Moseley
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Proteomics and Metabolomics Shared Resource, Duke University Medical Center, Durham, NC 27708, USA
| | - Ronald B Turner
- School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | | | - Alfred O Hero
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christopher W Woods
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA; Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC 27710, USA; Section for Infectious Diseases, Medicine Service, Durham Veteran's Affairs Medical Center, Durham, NC 27705, USA.
| | - Geoffrey S Ginsburg
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC 27708, USA.
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22
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McClain MT, Woods CW, Tsalik EL, Ginsburg GS, Nicholson BP, Burke T, Hudson L, Veldman T, Better O, Dobos S, Suchindran S, Nichols M, Valente A, Park L, Henao R. Host Transcriptomic Signatures for Early Diagnosis of Acute Respiratory Viral Infection in a University-Based Index-Cluster Cohort. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Micah T. McClain
- Internal Medicine/Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | - Ephraim L. Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Geoffrey S. Ginsburg
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | | | - Thomas Burke
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Lori Hudson
- Duke Center for Applied Genomics and Precision Medicine, Durham, North Carolina
| | | | - Olga Better
- Durham VA Medical Center, Durham, North Carolina
| | | | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - Marshall Nichols
- Duke Center for Applied Genomics and Precision Medicine, Durham, North Carolina
| | - Ashlee Valente
- Duke Center for Applied Genomics and Precision Medicine, Durham, North Carolina
| | - Lawrence Park
- Infectious Diseases, Durham VA Medical Center, Durham, North Carolina
| | - Ricardo Henao
- Duke Center for Applied Genomics and Precision Medicine, Durham, North Carolina
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McClain MT, Nicholson BP, Park LP, Liu TY, Hero AO, Tsalik EL, Zaas AK, Veldman T, Hudson LL, Lambkin-Williams R, Gilbert A, Burke T, Nichols M, Ginsburg GS, Woods CW. A Genomic Signature of Influenza Infection Shows Potential for Presymptomatic Detection, Guiding Early Therapy, and Monitoring Clinical Responses. Open Forum Infect Dis 2016; 3:ofw007. [PMID: 26933666 PMCID: PMC4771939 DOI: 10.1093/ofid/ofw007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/14/2016] [Indexed: 11/25/2022] Open
Abstract
Early, presymptomatic intervention with oseltamivir (corresponding to the onset of a published host-based genomic signature of influenza infection) resulted in decreased overall influenza symptoms (aggregate symptom scores of 23.5 vs 46.3), more rapid resolution of clinical disease (20 hours earlier), reduced viral shedding (total median tissue culture infectious dose [TCID50] 7.4 vs 9.7), and significantly reduced expression of several inflammatory cytokines (interferon-γ, tumor necrosis factor-α, interleukin-6, and others). The host genomic response to influenza infection is robust and may provide the means for early detection, more timely therapeutic interventions, a meaningful reduction in clinical disease, and an effective molecular means to track response to therapy.
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Affiliation(s)
- Micah T McClain
- Center for Applied Genomics and Precision Medicine, Duke University; Durham Veterans Affairs Medical Center; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Lawrence P Park
- Durham Veterans Affairs Medical Center; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Tzu-Yu Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley; National Center for Genome Resources, Santa Fe, New Mexico
| | - Alfred O Hero
- Center for Computational Biology and Bioinformatics , University of Michigan , Ann Arbor
| | - Ephraim L Tsalik
- Center for Applied Genomics and Precision Medicine, Duke University; Durham Veterans Affairs Medical Center; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Aimee K Zaas
- Center for Applied Genomics and Precision Medicine, Duke University; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Timothy Veldman
- Center for Applied Genomics and Precision Medicine , Duke University
| | - Lori L Hudson
- Center for Applied Genomics and Precision Medicine , Duke University
| | | | | | - Thomas Burke
- Center for Applied Genomics and Precision Medicine , Duke University
| | - Marshall Nichols
- Center for Applied Genomics and Precision Medicine , Duke University
| | | | - Christopher W Woods
- Center for Applied Genomics and Precision Medicine, Duke University; Durham Veterans Affairs Medical Center; Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Yang WE, Suchindran S, Nicholson BP, McClain MT, Burke T, Ginsburg GS, Harro CD, Chakraborty S, Sack DA, Woods CW, Tsalik EL. Transcriptomic Analysis of the Host Response and Innate Resilience to Enterotoxigenic Escherichia coli Infection in Humans. J Infect Dis 2016; 213:1495-504. [PMID: 26787651 DOI: 10.1093/infdis/jiv593] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/27/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Enterotoxigenic Escherichia coli (ETEC) is a globally prevalent cause of diarrhea. Though usually self-limited, it can be severe and debilitating. Little is known about the host transcriptional response to infection. We report the first gene expression analysis of the human host response to experimental challenge with ETEC. METHODS We challenged 30 healthy adults with an unattenuated ETEC strain, and collected serial blood samples shortly after inoculation and daily for 8 days. We performed gene expression analysis on whole peripheral blood RNA samples from subjects in whom severe symptoms developed (n = 6) and a subset of those who remained asymptomatic (n = 6) despite shedding. RESULTS Compared with baseline, symptomatic subjects demonstrated significantly different expression of 406 genes highlighting increased immune response and decreased protein synthesis. Compared with asymptomatic subjects, symptomatic subjects differentially expressed 254 genes primarily associated with immune response. This comparison also revealed 29 genes differentially expressed between groups at baseline, suggesting innate resilience to infection. Drug repositioning analysis identified several drug classes with potential utility in augmenting immune response or mitigating symptoms. CONCLUSIONS There are statistically significant and biologically plausible differences in host gene expression induced by ETEC infection. Differential baseline expression of some genes may indicate resilience to infection.
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Affiliation(s)
- William E Yang
- Duke University School of Medicine, Department of Medicine, Duke University Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University
| | - Sunil Suchindran
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University
| | - Bradly P Nicholson
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University Internal Medicine Service, Durham VA Medical Center, Duke University Medical Center, North Carolina
| | - Micah T McClain
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University Internal Medicine Service, Durham VA Medical Center, Duke University Medical Center, North Carolina Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, North Carolina
| | - Thomas Burke
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University
| | - Geoffrey S Ginsburg
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University
| | - Clayton D Harro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christopher W Woods
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University Internal Medicine Service, Durham VA Medical Center, Duke University Medical Center, North Carolina Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, North Carolina
| | - Ephraim L Tsalik
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, North Carolina Emergency Medicine Service, Durham VA Medical Center, North Carolina
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25
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Tillekeratne LG, Vidanagama D, Tippalagama R, Lewkebandara R, Joyce M, Nicholson BP, Nagahawatte A, Bodinayake CK, De Silva AD, Woods CW. Extended-spectrum ß-Lactamase-producing Enterobacteriaceae as a Common Cause of Urinary Tract Infections in Sri Lanka. Infect Chemother 2016; 48:160-165. [PMID: 27704730 PMCID: PMC5047996 DOI: 10.3947/ic.2016.48.3.160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not been well described. Materials and Methods We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital in southern Sri Lanka and enrolled patients ≥1 year of age with clinically relevant UTIs due to ESBL-PE. Isolate identity, antimicrobial drug susceptibility, and ESBL production were determined. Presence of ß-lactamase genes, blaSHV, blaTEM, and blaCTX-M, was identified by polymerase chain reaction. Results During the study period, Enterobacteriaceae were detected in 184 urine samples, with 74 (40.2%) being ESBL producers. Among 47 patients with ESBL-PE who had medical records available, 38 (80.9%) had clinically significant UTIs. Most UTIs (63.2%) were community acquired and 34.2% were in patients with diabetes. Among 36 cultured ESBL-PE isolates, significant susceptibility (>80%) was only retained to amikacin and the carbapenems. The group 1 blaCTX-M gene was present in 90.0% of Escherichia coli isolates and all Klebsiella pneumoniae and Enterobacter cloacae isolates. The blaSHV and blaTEM genes were more common in K. pneumoniae (75% and 50%) and E. cloacae (50% and 50%) isolates than in E. coli (10% and 20%) isolates, respectively. Conclusion The majority of UTIs caused by ESBL-PE were acquired in the community and due to organisms carrying the group 1 CTX-M ß-lactamase. Further epidemiologic studies of infections due to ESBL-PE are urgently needed to better prevent and treat these infections in South Asia.
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Affiliation(s)
| | | | | | | | - Maria Joyce
- Durham Veteran Affairs Medical Center, Durham, NC, USA
| | | | - Ajith Nagahawatte
- Department of Microbiology, Ruhuna University Faculty of Medicine, Galle, Sri Lanka
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Yang WE, Suchindran S, Nicholson BP, McClain MT, Burke T, Ginsburg GS, Harro CD, Chakraborty S, Sack DA, Woods CW, Tsalik EL. Transcriptomic Analysis of the Host Response to Enterotoxigenic E. coli (ETEC) Infection in Humans. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Becker-Dreps S, Kistler CE, Ward K, Killeya-Jones LA, Better OM, Weber DJ, Zimmerman S, Nicholson BP, Woods CW, Sloane P. Pneumococcal Carriage and Vaccine Coverage in Retirement Community Residents. J Am Geriatr Soc 2015; 63:2094-8. [PMID: 26456473 DOI: 10.1111/jgs.13651] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/29/2022]
Abstract
OBJECTIVES To evaluate pneumococcal immunization in older adults living in retirement communities and to measure nasopharyngeal carriage of Streptococcus pneumoniae to better assess the potential for herd protection from the 13-valent pneumococcal conjugate vaccine (PCV-13) in these settings. DESIGN Cross-sectional observational study of adults aged 65 and older living in retirement communities to determine coverage with 23-valent pneumococcal vaccine (PPSV-23), coverage with PCV-13 in immuncompromised individuals according to 2012 Advisory Committee on Immunization Practices (ACIP) guidelines, and nasopharyngeal carriage of S. pneumoniae. SETTING Two retirement communities in North Carolina. PARTICIPANTS Older adults recruited between December 2013 and April 2014 (N = 21, 64.8% female, mean age 81.4). MEASUREMENTS A survey was used to assess chronic illnesses, immunization history, and potential risk factors for pneumococcal carriage; a chart review was used to confirm immunization history and abstract chronic conditions; and a nasopharyngeal swab was collected and cultured for S. pneumoniae. RESULTS Eighty-seven percent of participants reported receiving PPSV-23 since age 65. Of the 16.2% of participants with an immunocompromising condition, only one had received PCV-13. Nasopharyngeal carriage with S. pneumoniae was detected in 1.9% (95% confidence interval = 0.0-3.8%) of participants. CONCLUSION In this select sample, PPSV-23 coverage was high, but adherence to the ACIP recommendation for PCV-13 in immunocompromised groups was low. Nasopharyngeal carriage of S. pneumoniae was present, although infrequent, suggesting that immunization with PCV-13 could provide an individual benefit and a small degree of herd protection.
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Affiliation(s)
- Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine E Kistler
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly Ward
- Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ley A Killeya-Jones
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Olga Maria Better
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina
| | - David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Chris W Woods
- Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Philip Sloane
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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28
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O'Meara WP, Mott JA, Laktabai J, Wamburu K, Fields B, Armstrong J, Taylor SM, MacIntyre C, Sen R, Menya D, Pan W, Nicholson BP, Woods CW, Holland TL. Etiology of pediatric fever in western Kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis. Am J Trop Med Hyg 2015; 92:1030-7. [PMID: 25758648 DOI: 10.4269/ajtmh.14-0560] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/31/2014] [Indexed: 02/03/2023] Open
Abstract
In Kenya, more than 10 million episodes of acute febrile illness are treated annually among children under 5 years. Most are clinically managed as malaria without parasitological confirmation. There is an unmet need to describe pathogen-specific etiologies of fever. We enrolled 370 febrile children and 184 healthy controls. We report demographic and clinical characteristics of patients with Plasmodium falciparum, group A streptococcal (GAS) pharyngitis, and respiratory viruses (influenza A and B, respiratory syncytial virus [RSV], parainfluenza [PIV] types 1-3, adenovirus, human metapneumovirus [hMPV]), as well as those with undifferentiated fever. Of febrile children, 79.7% were treated for malaria. However, P. falciparum was detected infrequently in both cases and controls (14/268 [5.2%] versus 3/133 [2.3%], P = 0.165), whereas 41% (117/282) of febrile children had a respiratory viral infection, compared with 24.8% (29/117) of controls (P = 0.002). Only 9/515 (1.7%) children had streptococcal infection. Of febrile children, 22/269 (8.2%) were infected with > 1 pathogen, and 102/275 (37.1%) had fevers of unknown etiology. Respiratory viruses were common in both groups, but only influenza or parainfluenza was more likely to be associated with symptomatic disease (attributable fraction [AF] 67.5% and 59%, respectively). Malaria was overdiagnosed and overtreated. Few children presented to the hospital with GAS pharyngitis. An enhanced understanding of carriage of common pathogens, improved diagnostic capacity, and better-informed clinical algorithms for febrile illness are needed.
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Affiliation(s)
- Wendy P O'Meara
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Joshua A Mott
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Jeremiah Laktabai
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Kabura Wamburu
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Barry Fields
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Janice Armstrong
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Steve M Taylor
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Charles MacIntyre
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Reeshi Sen
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Diana Menya
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - William Pan
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Bradly P Nicholson
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Christopher W Woods
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Thomas L Holland
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina
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Alagna L, Park LP, Nicholson BP, Keiger AJ, Strahilevitz J, Morris A, Wray D, Gordon D, Delahaye F, Edathodu J, Miró JM, Fernández-Hidalgo N, Nacinovich FM, Shahid R, Woods CW, Joyce MJ, Sexton DJ, Chu VH. Repeat endocarditis: analysis of risk factors based on the International Collaboration on Endocarditis - Prospective Cohort Study. Clin Microbiol Infect 2014; 20:566-75. [PMID: 24102907 DOI: 10.1111/1469-0691.12395] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [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: 04/25/2013] [Revised: 08/14/2013] [Accepted: 09/12/2013] [Indexed: 12/01/2022]
Abstract
Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. We considered 1874 patients enrolled in the International Collaboration on Endocarditis - Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single-episode IE and 91 (4.8%) had repeat IE: 74/91 (81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p 0.002), HIV (p 0.009), injection drug use (IDU) (p < 0.001), Staphylococcus aureus IE (p 0.003), healthcare acquisition (p 0.006) and previous IE before ICE enrolment (p 0.001). On adjusted analysis, independent risk factors were haemodialysis (OR, 2.5; 95% CI, 1.2-5.3), IDU (OR, 2.9; 95% CI, 1.6-5.4), previous IE (OR, 2.8; 95% CI, 1.5-5.1) and living in the North American region (OR, 1.9; 95% CI, 1.1-3.4). Patients with repeat IE had higher 1-year mortality than those with single-episode IE (p 0.003). Repeat IE is associated with IDU, previous IE and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk of repeat IE.
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Affiliation(s)
- L Alagna
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
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Abstract
A signal-on DNA bioassay-on-chip using SERS detection and a single incubation step without any washing was developed for dengue diagnosis.
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Affiliation(s)
- Hoan T. Ngo
- Department of Biomedical Engineering
- Duke University
- Durham, USA
- Fitzpatrick Institute for Photonics
- Duke University
| | - Hsin-Neng Wang
- Department of Biomedical Engineering
- Duke University
- Durham, USA
- Fitzpatrick Institute for Photonics
- Duke University
| | - Andrew M. Fales
- Department of Biomedical Engineering
- Duke University
- Durham, USA
- Fitzpatrick Institute for Photonics
- Duke University
| | | | - Christopher W. Woods
- Fitzpatrick Institute for Photonics
- Duke University
- Durham, USA
- Veterans Affairs Medical Center
- Durham, USA
| | - Tuan Vo-Dinh
- Department of Biomedical Engineering
- Duke University
- Durham, USA
- Fitzpatrick Institute for Photonics
- Duke University
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Woods CW, McClain MT, Chen M, Zaas AK, Nicholson BP, Varkey J, Veldman T, Kingsmore SF, Huang Y, Lambkin-Williams R, Gilbert AG, Hero AO, Ramsburg E, Glickman S, Lucas JE, Carin L, Ginsburg GS. A host transcriptional signature for presymptomatic detection of infection in humans exposed to influenza H1N1 or H3N2. PLoS One 2013; 8:e52198. [PMID: 23326326 PMCID: PMC3541408 DOI: 10.1371/journal.pone.0052198] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [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: 06/25/2012] [Accepted: 11/15/2012] [Indexed: 11/18/2022] Open
Abstract
There is great potential for host-based gene expression analysis to impact the early diagnosis of infectious diseases. In particular, the influenza pandemic of 2009 highlighted the challenges and limitations of traditional pathogen-based testing for suspected upper respiratory viral infection. We inoculated human volunteers with either influenza A (A/Brisbane/59/2007 (H1N1) or A/Wisconsin/67/2005 (H3N2)), and assayed the peripheral blood transcriptome every 8 hours for 7 days. Of 41 inoculated volunteers, 18 (44%) developed symptomatic infection. Using unbiased sparse latent factor regression analysis, we generated a gene signature (or factor) for symptomatic influenza capable of detecting 94% of infected cases. This gene signature is detectable as early as 29 hours post-exposure and achieves maximal accuracy on average 43 hours (p = 0.003, H1N1) and 38 hours (p-value = 0.005, H3N2) before peak clinical symptoms. In order to test the relevance of these findings in naturally acquired disease, a composite influenza A signature built from these challenge studies was applied to Emergency Department patients where it discriminates between swine-origin influenza A/H1N1 (2009) infected and non-infected individuals with 92% accuracy. The host genomic response to Influenza infection is robust and may provide the means for detection before typical clinical symptoms are apparent.
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Affiliation(s)
- Christopher W. Woods
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
- * E-mail: (CW); (GG)
| | - Micah T. McClain
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
| | - Minhua Chen
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Aimee K. Zaas
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Bradly P. Nicholson
- Durham Veteran’s Affairs Medical Center, Durham, North Carolina, United States of America
| | - Jay Varkey
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Timothy Veldman
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Stephen F. Kingsmore
- National Center for Genome Resources, Santa Fe, New Mexico, United States of America
| | - Yongsheng Huang
- Center for Computational Biology and Bioinformatics, University of Michigan, Ann Arobor, Michigan, United States of America
| | | | | | - Alfred O. Hero
- Center for Computational Biology and Bioinformatics, University of Michigan, Ann Arobor, Michigan, United States of America
| | - Elizabeth Ramsburg
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Seth Glickman
- Department of Emergency Medicine, University of North Carolina-Chapel-Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph E. Lucas
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Geoffrey S. Ginsburg
- Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail: (CW); (GG)
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Naggie S, Miller BA, Zuzak KB, Pence BW, Mayo AJ, Nicholson BP, Kutty PK, McDonald LC, Woods CW. A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am J Med 2011. [PMID: 21396512 DOI: 10.1016/j.amjmed.2010.10.013s0002-9343(10)00925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The epidemiology of community-associated Clostridium difficile infection is not well known. We performed a multicenter, case-control study to further describe community-associated C. difficile infection and assess novel risk factors. METHODS We conducted this study at 5 sites from October 2006 through November 2007. Community-associated C. difficile infection included individuals with diarrhea, a positive C. difficile toxin, and no recent (12 weeks) discharge from a health care facility. We selected controls from the same clinics attended by cases. We collected clinical and exposure data at the time of illness and cultured residual stool samples and performed ribotyping. RESULTS Of 1041 adult C. difficile infections, 162 (15.5%) met criteria for community-associated: 66 case and 114 control patients were enrolled. Case patients were relatively young (median 64 years), female (56%), and frequently required hospitalization (38%). Antimicrobials, malignancy, exposure to high-risk persons, and remote health care exposure were independently associated with community-associated C. difficile infection. In 40% of cases, we could not confirm recent antibiotic exposure. Stomach-acid suppressants were not associated with community-associated infection, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors appeared protective. Prevalence of the hypervirulent NAP-1/027 strain was infrequent (17%). CONCLUSIONS Community-associated C. difficile infection resulted in a substantial health care burden. Antimicrobials are a significant risk factor for community-associated infection. However, other unique factors also may contribute, including person-to-person transmission, remote health care exposures, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors. A role for stomach-acid suppressants in community-associated C. difficile infection is not supported.
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Affiliation(s)
- Susanna Naggie
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA.
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33
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Naggie S, Miller BA, Zuzak KB, Pence BW, Mayo AJ, Nicholson BP, Kutty PK, McDonald LC, Woods CW. A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am J Med 2011; 124:276.e1-7. [PMID: 21396512 DOI: 10.1016/j.amjmed.2010.10.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND The epidemiology of community-associated Clostridium difficile infection is not well known. We performed a multicenter, case-control study to further describe community-associated C. difficile infection and assess novel risk factors. METHODS We conducted this study at 5 sites from October 2006 through November 2007. Community-associated C. difficile infection included individuals with diarrhea, a positive C. difficile toxin, and no recent (12 weeks) discharge from a health care facility. We selected controls from the same clinics attended by cases. We collected clinical and exposure data at the time of illness and cultured residual stool samples and performed ribotyping. RESULTS Of 1041 adult C. difficile infections, 162 (15.5%) met criteria for community-associated: 66 case and 114 control patients were enrolled. Case patients were relatively young (median 64 years), female (56%), and frequently required hospitalization (38%). Antimicrobials, malignancy, exposure to high-risk persons, and remote health care exposure were independently associated with community-associated C. difficile infection. In 40% of cases, we could not confirm recent antibiotic exposure. Stomach-acid suppressants were not associated with community-associated infection, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors appeared protective. Prevalence of the hypervirulent NAP-1/027 strain was infrequent (17%). CONCLUSIONS Community-associated C. difficile infection resulted in a substantial health care burden. Antimicrobials are a significant risk factor for community-associated infection. However, other unique factors also may contribute, including person-to-person transmission, remote health care exposures, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors. A role for stomach-acid suppressants in community-associated C. difficile infection is not supported.
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Affiliation(s)
- Susanna Naggie
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA.
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Affiliation(s)
- B P Nicholson
- ole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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35
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Abstract
Whether in natural populations or between two unrelated members of a species, most phenotypic variation is quantitative. To analyze such quantitative traits, one must first map the underlying quantitative trait loci. Next, and far more difficult, one must identify the quantitative trait genes (QTGs), characterize QTG interactions, and identify the phenotypically relevant polymorphisms to determine how QTGs contribute to phenotype. In this work, we analyzed three Saccharomyces cerevisiae high-temperature growth (Htg) QTGs (MKT1, END3, and RHO2). We observed a high level of genetic interactions among QTGs and strain background. Interestingly, while the MKT1 and END3 coding polymorphisms contribute to phenotype, it is the RHO2 3′UTR polymorphisms that are phenotypically relevant. Reciprocal hemizygosity analysis of the Htg QTGs in hybrids between S288c and ten unrelated S. cerevisiae strains reveals that the contributions of the Htg QTGs are not conserved in nine other hybrids, which has implications for QTG identification by marker-trait association. Our findings demonstrate the variety and complexity of QTG contributions to phenotype, the impact of genetic background, and the value of quantitative genetic studies in S. cerevisiae. Most of the differences in phenotype between unrelated members of a species are polygenic in nature. Because of their ubiquity and importance, these polygenic (or quantitative) traits have been intensively studied, and a variety of techniques have been proposed to identify and characterize quantitative trait genes (QTGs). Indeed, the main application of the recently published human HapMap project is to identify the genes responsible for diseases that are quantitative in nature. Using a well-defined Saccharomyces cerevisiae quantitative trait locus containing three QTGs (MKT1, END3, and RHO2), the authors used deletions to analyze the contributions of each gene to phenotype, singly and in combination, and found a variety of interactions. Expression analysis showed no difference in steady-state mRNA levels between alleles of the three genes. Homologous allele replacement identified the phenotypically relevant differences between alleles of each gene, which were single coding polymorphisms for two genes (MKT1 and END3) and the 3′ untranslated region of one gene (RHO2). Finally, analysis of multiple genetic backgrounds showed that the phenotypes conferred by these genetic variants were not conserved. The results show that the techniques proposed to identify QTGs, such as expression analysis and marker-trait association, have profound limitations, and that unbiased genome-wide approaches are needed to dissect quantitative traits. The results also demonstrate the complexity of the genetic interactions that affect quantitative traits and the value of the S. cerevisiae system in studying these traits.
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Affiliation(s)
- Himanshu Sinha
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
- European Molecular Biology Laboratory, Heidelberg, Germany
| | - Bradly P Nicholson
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - John H McCusker
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
- * To whom correspondence should be addressed. E-mail:
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Abstract
We describe positive/negative selectable cytosine deaminase MX cassettes for use in Saccharomyces cerevisiae. The basis of positive selection for cytosine deaminase (Fcy1) activity is that (a) fcy1 strains are unable to grow on medium containing cytosine as a sole nitrogen source and (b) fcy1 ura3 strains are unable to grow on medium containing cytosine as the sole pyrimidine source. Conversely, as 5-fluorocytosine (5FC) is toxic to cytosine deaminase-producing cells, fcy1 strains are resistant to 5FC. FCY1MX and FCA1MX cassettes, containing open reading frames (ORFs) of S. cerevisiae FCY1 and Candida albicans FCA1, respectively, were constructed and used to disrupt targeted genes in S. cerevisiae fcy1 strains. In addition, new direct repeat cassettes, kanPR, FCA1PR, FCY1PR and CaURA3PR, were developed to allow efficient deletion of target genes in cells containing MX3 repeats. Finally, the FCY1- and FCA1MX3 or PR direct repeat cassettes can be readily recycled after 5FC counter-selection on both synthetic and rich media.
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Affiliation(s)
- Phillip E Hartzog
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC 27710, USA
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37
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Tedesco KL, Thor AD, Johnson DH, Shyr Y, Blum KA, Goldstein LJ, Gradishar WJ, Nicholson BP, Merkel DE, Murrey D, Edgerton S, Sledge GW. Docetaxel Combined With Trastuzumab Is an Active Regimen in HER-2 3+ Overexpressing and Fluorescent In Situ Hybridization–Positive Metastatic Breast Cancer: A Multi-Institutional Phase II Trial. J Clin Oncol 2004; 22:1071-7. [PMID: 15020608 DOI: 10.1200/jco.2004.10.046] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [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: 11/20/2022] Open
Abstract
Purpose To determine the efficacy and safety of weekly docetaxel and trastuzumab as first- or second-line therapy in women with HER-2–overexpressing metastatic breast cancer and to correlate the efficacy of trastuzumab with HER-2 status as determined by immunohistochemistry assay and fluorescent in situ hybridization (FISH). Patients and Methods Twenty-six women with HER-2–positive (HercepTest [Dako Corp, Carpenteria, CA]2 to 3+) metastatic breast cancer were enrolled onto this study of trastuzumab (4 mg/kg load; 2 mg/kg/wk administered intravenously) and docetaxel (35 mg/m2/wk for 6 weeks). Results Using an intent-to-treat analysis, the overall response rate was 50% (13 of 26 patients). Eight patients (31%) had a period of stable disease posttherapy. Among HER-2 3+ patients, the overall response rate was 63% (12 of 19 patients) compared with a 14% response rate (one of seven patients) for HER-2 2+ patients (P = .07). Patients with FISH-positive tumors experienced an overall response rate of 64%. Median time to progression was 12.4 months for the entire cohort (HER-2 3+ tumors, 12.3 months; HER-2 2+ lesions, 9.5 months) and median survival was 22.1 months. All HER-2 3+ patients were FISH-positive; the only HER-2 2+ patient responding to treatment was also FISH-positive. Grade 4 toxicities occurred in four patients; most toxicities were mild. Conclusion Trastuzumab plus docetaxel is an active and well-tolerated regimen in women with HER-2 3+ overexpressing or FISH-positive metastatic breast cancer.
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Affiliation(s)
- K L Tedesco
- Vanderbilt Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
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Nicholson BP. Ongoing and planned trials of hormonal therapy and trastuzumab. Semin Oncol 2000; 27:33-7; discussion 92-100. [PMID: 11236026] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Studies with human breast cancer cell lines have shown a causal association between overexpression of the HER-2/neu proto-oncogene receptor and the acquisition of resistance to tamoxifen. Some clinical studies also indicate that patients with tumors showing high HER-2 levels or high levels of the circulating ectodomain of HER-2 may have a lower response to tamoxifen compared with tumors with low HER-2 levels or low circulating ectodomain. Treatment with anti-HER-2 antibodies seems to restore tamoxifen activity in some experimental systems. However, whether anti-HER-2 therapies will increase tamoxifen action and/or reverse this putative oncogene-mediated resistance in patients with estrogen receptor-positive, hormone-dependent tumors, is unclear. We are conducting a phase II trial of a humanized anti-HER-2 monoclonal antibody, trastuzumab (Herceptin; Genentech, Inc, South San Francisco, CA) in combination with tamoxifen in patients with estrogen receptor-positive metastatic breast cancer. Other prospective randomized clinical trials are needed to directly evaluate the contribution of HER-2 signaling to antiestrogen resistance in vivo.
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Affiliation(s)
- B P Nicholson
- Vanderbilt Ingram Cancer Center, Nashville, TN 37232, USA
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Nicholson BP, Paul DM, Hande KR, Shyr Y, Meshad M, Cohen A, Johnson DH. Paclitaxel, 5-fluorouracil, and leucovorin (TFL) in the treatment of metastatic breast cancer. Clin Breast Cancer 2000; 1:136-43; discussion 144. [PMID: 11899652 DOI: 10.3816/cbc.2000.n.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To assess the activity of paclitaxel in combination with 5-fluorouracil (5-FU) and leucovorin in breast cancer, a phase II trial was conducted in women with metastatic disease. Toxicity, response rate, median survival, median duration of response, and median time to disease progression were measured. Between January 1994 and May 1996, 47 patients with metastatic breast cancer and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) < or = 2 who had previously been treated with chemotherapy received 175 mg/m2 paclitaxel over 3 hours on day 1. After paclitaxel administration, 300 mg intravenous (i.v.) leucovorin over 30 minutes was administered followed by 350 mg/m2 i.v. push 5-FU. Both 5-FU and leucovorin were given on days 1-3. Treatment was repeated every 28 days for a minimum of 6 cycles per patient. Two (4%) patients had a complete response and 21 (45%) patients had a partial response for an overall response rate of 49% (95% confidence interval: 35%-63%). The median survival was 17.7 months, median duration of response was 8.6 months, and median time to disease progression was 6.3 months. There was no statistical difference in survival or time to progression between anthracycline-naive, anthracycline-sensitive, and anthracycline-resistant patients. Nine (19%) patients had grade 3 or 4 neutropenia, and no patient required blood or platelet transfusion. The most frequently observed nonhematologic toxicities were arthralgia and myalgia. Pharmacokinetic data were obtained on 19 patients. Responders had higher peak plasma concentrations of paclitaxel than nonresponders (4.46 vs. 2.9 micrograms/mL; P = 0.02). Paclitaxel/5-fluorouracil/leucovorin is an active, well-tolerated regimen for patients with metastatic breast cancer.
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Affiliation(s)
- B P Nicholson
- Vanderbilt University Cancer Center, Vanderbilt Cancer Center Affiliate Network, Nashville, TN, USA.
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40
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Dickson NR, Nicholson BP, Hande K, Blanke C, Johnson D, Cohen A. Paclitaxel, UFT, and calcium folinate in metastatic breast cancer. Oncology (Williston Park) 1999; 13:69-70. [PMID: 10442366] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
This is a phase I dose-escalation study of uracil and tegafur (in a molar ratio of 4:1 [UFT]) administered in combination with calcium folinate and paclitaxel in metastatic breast cancer. This trial was initiated to 1) determine the maximum tolerated dose and dose-limiting toxicities of UFT plus calcium folinate (Orzel) administered three times per day for 21 days in combination with paclitaxel; and 2) define the appropriate dose for phase II testing. Thus far, 14 patients have been accrued to three dose levels. Two patients developed dose-limiting toxicities at dose level 3. One patient experienced grade 3 hypotension. A second patient experienced grade 3 vomiting, grade 4 diarrhea, and severe hand-foot syndrome. Two partial responses and one complete response have been observed. Early trends suggest that this regimen is active in metastatic breast cancer and is well tolerated. Completion of this study is anticipated in 1999.
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Affiliation(s)
- N R Dickson
- Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee, USA
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