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Striker R, Siraj DS, Duke ER. Idiopathic CD4 Lymphocytopenia at 30 Years. N Engl J Med 2023; 389:674-675. [PMID: 37585646 DOI: 10.1056/nejmc2307362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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2
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Radtke S, Enstrom M, Pande D, Duke ER, Cardozo-Ojeda EF, Madhu R, Owen S, Kanestrom G, Cui M, Perez AM, Schiffer JT, Kiem HP. Stochastic fate decisions of HSCs after transplantation: early contribution, symmetric expansion, and pool formation. Blood 2023; 142:33-43. [PMID: 36821766 PMCID: PMC10935507 DOI: 10.1182/blood.2022018564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Hematopoietic stem cells (HSCs) are assumed to be rare, infrequently dividing, long-lived cells not involved in immediate recovery after transplantation. Here, we performed unprecedented high-density clonal tracking in nonhuman primates and found long-term persisting HSC clones to actively contribute during early neutrophil recovery, and to be the main source of blood production as early as 50 days after transplantation. Most surprisingly, we observed a rapid decline in the number of unique HSC clones, while persisting HSCs expanded, undergoing symmetric divisions to create identical siblings and formed clonal pools ex vivo as well as in vivo. In contrast to the currently assumed model of hematopoietic reconstitution, we provide evidence for contribution of HSCs in short-term recovery as well as symmetric expansion of individual clones into pools. These findings provide novel insights into HSC biology, informing the design of HSC transplantation and gene therapy studies.
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Affiliation(s)
- Stefan Radtke
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Mark Enstrom
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Dnyanada Pande
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Elizabeth R. Duke
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Ravishankar Madhu
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Staci Owen
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Greta Kanestrom
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Margaret Cui
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anai M. Perez
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Joshua T. Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Hans-Peter Kiem
- Stem Cell and Gene Therapy Program, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
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Goswami H, Alsumali A, Jiang Y, Schindler M, Duke ER, Cohen J, Briggs A, Puenpatom A. Correction to: Cost-Effectiveness Analysis of Molnupiravir Versus Best Supportive Care for the Treatment of Outpatient COVID-19 in Adults in the US. Pharmacoeconomics 2023; 41:605. [PMID: 36928836 PMCID: PMC10019393 DOI: 10.1007/s40273-023-01263-w] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Hardik Goswami
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA.
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA.
| | - Adnan Alsumali
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA
| | - Yiling Jiang
- BARDS-Health Economics and Decision Science MSD (UK) Ltd, London, UK
| | | | | | - Joshua Cohen
- Center for the Evaluation of Value and Risk in Health, Boston, MA, USA
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Puenpatom
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA
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Tettamanti Boshier FA, Reeves DB, Duke ER, Swan DA, Prlic M, Cardozo-Ojeda EF, Schiffer JT. Substantial uneven proliferation of CD4 + T cells during recovery from acute HIV infection is sufficient to explain the observed expanded clones in the HIV reservoir. J Virus Erad 2022; 8:100091. [PMID: 36582473 PMCID: PMC9792356 DOI: 10.1016/j.jve.2022.100091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 09/08/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022] Open
Abstract
The HIV reservoir is a population of 1-10 million anatomically dispersed, latently infected memory CD4+ T cells in which HIV DNA is quiescently integrated into human chromosomal DNA. When antiretroviral therapy (ART) is stopped and HIV replication initiates in one of these cells, systemic viral spread resumes, rekindling progression to AIDS. Therefore, HIV latency prevents cure. The detection of many populations of identical HIV sequences at unique integration sites implicates CD4+ T cell proliferation as the critical driver of reservoir sustainment after a prolonged period of effective ART. Initial reservoir formation occurs during the first week of primary infection usually before ART is started. While empirical data indicates that both de novo infection and cellular proliferation generate latently infected cells during early untreated infection, it is not known which of these mechanisms is predominant. We developed a mathematical model that recapitulates the profound depletion and brisk recovery of CD4+ T cells, reservoir creation, and viral load trajectory during primary HIV infection. We extended the model to stochastically simulate individual HIV reservoir clones. This model predicts the first detection of HIV infected clones approximately 5 weeks after infection as has recently been shown in vivo and suggests that substantial, uneven proliferation among clones during the recovery from CD4+ lymphopenia is the most plausible explanation for the observed clonal reservoir distribution during the first year of infection.
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Affiliation(s)
- Florencia A. Tettamanti Boshier
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
| | - Daniel B. Reeves
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
| | - Elizabeth R. Duke
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
- Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - David A. Swan
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
| | - Martin Prlic
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
- Department of Global Health, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - E. Fabian Cardozo-Ojeda
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
| | - Joshua T. Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA, 98122, USA
- Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Clinical Research Division, University of Washington, 1959 NE Pacific St., Seattle, WA, USA
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5
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Johnson MG, Puenpatom A, Moncada PA, Burgess L, Duke ER, Ohmagari N, Wolf T, Bassetti M, Bhagani S, Ghosn J, Zhang Y, Wan H, Williams-Diaz A, Brown ML, Paschke A, De Anda C. Effect of Molnupiravir on Biomarkers, Respiratory Interventions, and Medical Services in COVID-19 : A Randomized, Placebo-Controlled Trial. Ann Intern Med 2022; 175:1126-1134. [PMID: 35667065 PMCID: PMC9186515 DOI: 10.7326/m22-0729] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the MOVe-OUT trial, molnupiravir showed a clinically meaningful reduction in the risk for hospitalization or death in adults with mild to moderate COVID-19 and risk factors for progression to severe disease. OBJECTIVE To identify other potential clinical benefits of molnupiravir versus placebo. DESIGN Secondary analysis of the randomized, double-blind, placebo-controlled phase 3 component of MOVe-OUT. (ClinicalTrials.gov: NCT04575597). SETTING 107 sites globally. PARTICIPANTS 1433 nonhospitalized adults aged 18 years or older with mild to moderate COVID-19. INTERVENTION Molnupiravir, 800 mg, or placebo every 12 hours for 5 days. MEASUREMENTS Changes from baseline in C-reactive protein (CRP) concentration and oxygen saturation (Spo 2), need for respiratory interventions (including invasive mechanical ventilation), and need for medical services in all randomly assigned participants through day 29, and need for respiratory interventions and time to discharge in the subgroup of participants who were hospitalized after randomization. RESULTS Participants receiving molnupiravir showed faster normalization of CRP and Spo 2, with improvements observed on day 3 of therapy, compared with placebo. Molnupiravir-treated participants had a decreased need for respiratory interventions versus placebo-treated participants (relative risk reduction [RRR], 34.3% [95% CI, 4.3% to 54.9%]), with similar findings in participants who were hospitalized after randomization (RRR, 21.3% [CI, 0.2% to 38.0%]). Hospitalized participants who received molnupiravir were discharged a median of 3 days before those who received placebo. Acute care visits (7.2% vs. 10.6%; RRR, 32.1% [CI, 4.4% to 51.7%]) and COVID-19-related acute care visits (6.6% vs. 10.0%; RRR, 33.8% [CI, 5.6% to 53.6%]) were less frequent in molnupiravir- versus placebo-treated participants. LIMITATIONS Some analyses were performed post hoc. Longer-term benefits of molnupiravir therapy were not evaluated. Participants were not immunized against SARS-CoV-2. CONCLUSION The findings suggest there are additional important clinical benefits of molnupiravir beyond reduction in hospitalization or death. PRIMARY FUNDING SOURCE Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.
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Affiliation(s)
- Matthew G Johnson
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Amy Puenpatom
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | | | - Lesley Burgess
- TREAD Research, Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa (L.B.)
| | - Elizabeth R Duke
- Fred Hutchinson Cancer Research Center, Seattle, Washington (E.R.D.)
| | - Norio Ohmagari
- National Center for Global Health and Medicine, Tokyo, Japan (N.O.)
| | - Timo Wolf
- Universitätsklinikum Frankfurt, Frankfurt am Main, Germany (T.W.)
| | - Matteo Bassetti
- IRCCS Ospedale Policlinico San Martino, and Department of Health Sciences, University of Genoa, Genova, Italy (M.B.)
| | - Sanjay Bhagani
- Royal Free London NHS Foundation Trust, London, United Kingdom (S.B.)
| | - Jade Ghosn
- AP-HP. Nord, Hôpital Bichat - Claude Bernard, and Université Paris Cité, INSERM UMR 1137 IAME, Paris, France (J.G.)
| | - Ying Zhang
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Hong Wan
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Angela Williams-Diaz
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Michelle L Brown
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Amanda Paschke
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
| | - Carisa De Anda
- Merck & Co., Inc., Rahway, New Jersey (M.G.J., A.P., Y.Z., H.W., A.W., M.L.B., A.P., C.D.)
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Goswami H, Alsumali A, Jiang Y, Schindler M, Duke ER, Cohen J, Briggs A, Puenpatom A. Cost-Effectiveness Analysis of Molnupiravir Versus Best Supportive Care for the Treatment of Outpatient COVID-19 in Adults in the US. Pharmacoeconomics 2022; 40:699-714. [PMID: 35779197 PMCID: PMC9270266 DOI: 10.1007/s40273-022-01168-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) imposes a substantial and ongoing burden on the US healthcare system and society. Molnupiravir is a new oral antiviral for treating COVID-19 in outpatient settings. This study evaluated the cost-effectiveness profile of molnupiravir versus best supportive care in the treatment of adult patients with mild-to-moderate COVID-19 at risk of progression to severe disease, from a US payer's perspective. METHODS The model was developed using a decision tree for the short-term acute phase of COVID-19 and a Markov state transition model for the long-term post-acute phase. This model compared molnupiravir with best supportive care as consistent with the MOVe-OUT trial. Costs were reported in 2021 US dollars. Transition probabilities were derived from the phase III MOVe-OUT trial and the TriNetX real-world electronic health records database. Costs were derived from the TriNetX database and utility values from a de novo, vignette-based utility study. Deterministic and probabilistic sensitivity analyses (DSA/PSA) were conducted. Primary outcomes included proportion hospitalized, proportion who died overall and by highest healthcare setting at the end of the acute phase, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a lifetime (100 years) horizon, discounted at 3% annually and assessed at a willingness-to-pay (WTP) threshold of $100,000 per QALY. RESULTS In this model, the use of molnupiravir led to an increase in QALYs (0.210) and decrease in direct total medical costs (-$895) per patient across a lifetime horizon, compared with best supportive care in COVID-19 outpatients. Molnupiravir was the dominant intervention when compared with best supportive care. Patients treated with molnupiravir were less likely to be hospitalized (6.38% vs. 9.20%) and more likely to remain alive (99.88% vs. 98.71%) during the acute phase. Through DSA, molnupiravir treatment effect of hospitalization reduction was identified to be the most influential parameter, and through PSA, molnupiravir remained dominant in 84% of the total simulations and, overall, 100% cost effective. CONCLUSION This analysis suggests that molnupiravir is cost effective compared with best supportive care for the treatment of adult outpatients with COVID-19. However, our study was limited by the unavailability of the most recent information on the rapidly evolving pandemic, including new viral variants, patient populations affected, and changes in standards of care. Further research should explore the impact of vaccination on the cost effectiveness of molnupiravir and other therapies, based on real-world data, to account for these changes, including the impact of vaccination and immunity.
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Affiliation(s)
- Hardik Goswami
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA.
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., 770 Sumneytown Pike, West Point, PA, 19486, USA.
| | - Adnan Alsumali
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA
| | - Yiling Jiang
- BARDS-Health Economics and Decision Science MSD (UK) Ltd, London, UK
| | | | | | - Joshua Cohen
- Center for the Evaluation of Value and Risk in Health, Boston, MA, USA
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Puenpatom
- BARDS-Health Economics and Decision Science, Merck & Co, Inc., Kenilworth, NJ, USA
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Goyal A, Duke ER, Cardozo-Ojeda EF, Schiffer JT. Modeling explains prolonged SARS-CoV-2 nasal shedding relative to lung shedding in remdesivir treated rhesus macaques. iScience 2022; 25:104448. [PMID: 35634576 PMCID: PMC9130309 DOI: 10.1016/j.isci.2022.104448] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/19/2022] [Accepted: 05/16/2022] [Indexed: 12/12/2022] Open
Abstract
In clinical trials, remdesivir decreased recovery time in hospitalized patients with SARS- CoV-2 and prevented hospitalization when given early during infection, despite not reducing nasal viral loads. In rhesus macaques, early remdesivir prevented pneumonia and lowered lung viral loads, but viral loads increased in nasal passages after five days. We developed mathematical models to explain these results. Our model raises the hypotheses that: 1) in contrast to nasal passages viral load monotonically decreases in lungs during therapy because of infection-dependent generation of refractory cells, 2) slight reduction in lung viral loads with an imperfect agent may result in a substantial decrease in lung damage, and 3) increases in nasal viral load may occur due to a blunting of peak viral load which decreases the intensity of the innate immune response. We demonstrate that a higher potency drug could lower viral loads in nasal passages and lung.
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Affiliation(s)
- Ashish Goyal
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Elizabeth R Duke
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington, Seattle
| | | | - Joshua T Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington, Seattle.,Clinical Research Division, Fred Hutchinson Cancer Research Center
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8
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Fischer WA, Eron JJ, Holman W, Cohen MS, Fang L, Szewczyk LJ, Sheahan TP, Baric R, Mollan KR, Wolfe CR, Duke ER, Azizad MM, Borroto-Esoda K, Wohl DA, Coombs RW, James Loftis A, Alabanza P, Lipansky F, Painter WP. A phase 2a clinical trial of molnupiravir in patients with COVID-19 shows accelerated SARS-CoV-2 RNA clearance and elimination of infectious virus. Sci Transl Med 2022; 14:eabl7430. [PMID: 34941423 PMCID: PMC10763622 DOI: 10.1126/scitranslmed.abl7430] [Citation(s) in RCA: 196] [Impact Index Per Article: 98.0] [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: 08/21/2021] [Revised: 10/01/2021] [Accepted: 12/21/2021] [Indexed: 12/19/2022]
Abstract
There is an urgent need for an effective, oral, direct-acting therapeutic to block transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent progression to severe coronavirus disease 2019 (COVID-19). In a phase 2a double-blind, placebo-controlled, randomized, multicenter clinical trial, we evaluated the safety, tolerability, and antiviral efficacy of the nucleoside analog molnupiravir in 202 unvaccinated participants with confirmed SARS-CoV-2 infection and symptom duration <7 days. Participants were randomized 1:1 to receive molnupiravir (200 mg) or placebo and then 3:1 to receive molnupiravir (400 or 800 mg) or placebo, orally twice daily for 5 days. Antiviral activity was assessed by reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA in nasopharyngeal swabs. Infectious virus was assessed by inoculation of cultured Vero cells with samples from nasopharyngeal swabs and was detected by RT-PCR. Time to viral RNA clearance (primary endpoint) was decreased in the 800-mg molnupiravir group (median 14 days) compared to the placebo group (median 15 days) (log rank P value = 0.013). Of participants receiving 800 mg of molnupiravir, 92.5% achieved viral RNA clearance compared with 80.3% of placebo recipients by study end (4 weeks). Infectious virus (secondary endpoint) was detected in swabs from 1.9% of the 800-mg molnupiravir group compared with 16.7% of the placebo group at day 3 of treatment (P = 0.016). At day 5 of treatment, infectious virus was not isolated from any participants receiving 400 or 800 mg of molnupiravir compared with 11.1% of placebo recipients (P = 0.034 and 0.027, respectively). Molnupiravir was well tolerated across all doses.
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Affiliation(s)
- William A. Fischer
- Institute for Global Health and Infectious Diseases, Division of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph J. Eron
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Myron S. Cohen
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Timothy P. Sheahan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ralph Baric
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie R. Mollan
- Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cameron R. Wolfe
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R. Duke
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | | | | | - David A. Wohl
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert W. Coombs
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Amy James Loftis
- Institute for Global Health and Infectious Diseases, Division of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Alabanza
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Mollan KR, Eron JJ, Krajewski TJ, Painter W, Duke ER, Morse CG, Goecker EA, Premkumar L, Wolfe CR, Szewczyk LJ, Alabanza PL, Loftis AJ, Degli-Angeli EJ, Brown AJ, Dragavon JA, Won JJ, Keys J, Hudgens MG, Fang L, Wohl DA, Cohen MS, Baric RS, Coombs RW, Sheahan TP, Fischer WA. Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Virus in Symptomatic Coronavirus Disease 2019 (COVID-19) Outpatients: Host, Disease, and Viral Correlates. Clin Infect Dis 2021; 75:e1028-e1036. [PMID: 35022711 PMCID: PMC9402664 DOI: 10.1093/cid/ciab968] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectious virus isolation in outpatients with coronavirus disease 2019 (COVID-19) has been associated with viral RNA levels and symptom duration, little is known about the host, disease, and viral determinants of infectious virus detection. METHODS COVID-19 adult outpatients were enrolled within 7 days of symptom onset. Clinical symptoms were recorded via patient diary. Nasopharyngeal swabs were collected to quantitate SARS-CoV-2 RNA by reverse transcriptase polymerase chain reaction and for infectious virus isolation in Vero E6-cells. SARS-CoV-2 antibodies were measured in serum using a validated ELISA assay. RESULTS Among 204 participants with mild-to-moderate symptomatic COVID-19, the median nasopharyngeal viral RNA was 6.5 (interquartile range [IQR] 4.7-7.6 log10 copies/mL), and 26% had detectable SARS-CoV-2 antibodies (immunoglobulin (Ig)A, IgM, IgG, and/or total Ig) at baseline. Infectious virus was recovered in 7% of participants with SARS-CoV-2 antibodies compared to 58% of participants without antibodies (prevalence ratio [PR] = 0.12, 95% confidence interval [CI]: .04, .36; P = .00016). Infectious virus isolation was also associated with higher levels of viral RNA (mean RNA difference +2.6 log10, 95% CI: 2.2, 3.0; P < .0001) and fewer days since symptom onset (PR = 0.79, 95% CI: .71, .88 per day; P < .0001). CONCLUSIONS The presence of SARS-CoV-2 antibodies is strongly associated with clearance of infectious virus. Seropositivity and viral RNA levels are likely more reliable markers of infectious virus clearance than subjective measure of COVID-19 symptom duration. Virus-targeted treatment and prevention strategies should be administered as early as possible and ideally before seroconversion. CLINICAL TRIALS REGISTRATION NCT04405570.
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Affiliation(s)
- Katie R Mollan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Taylor J Krajewski
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | | | - Elizabeth R Duke
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin A Goecker
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Lakshmanane Premkumar
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | | | | | - Paul L Alabanza
- Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Amy James Loftis
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Emily J Degli-Angeli
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ariane J Brown
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joan A Dragavon
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - John J Won
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Jessica Keys
- Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Michael G Hudgens
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Lei Fang
- Pharstat Inc., Raleigh, North Carolina, USA
| | - David A Wohl
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Myron S Cohen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States,School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States,Center for AIDS Research, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ralph S Baric
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Robert W Coombs
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | | | - William A Fischer
- Correspondence: W. A. Fischer II: 130 Mason Farm Rd, CB#7020, Chapel Hill, NC 27599 ()
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10
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Heldman MR, Ma J, Gauthier J, O’Hara RA, Cowan AJ, Yoke LM, So L, Gulleen E, Duke ER, Liu C, Turtle CJ, Hill JA. CMV and HSV Pneumonia After Immunosuppressive Agents for Treatment of Cytokine Release Syndrome Due to Chimeric Antigen Receptor-modified T (CAR-T)-Cell Immunotherapy. J Immunother 2021; 44:351-354. [PMID: 34369454 PMCID: PMC8497421 DOI: 10.1097/cji.0000000000000388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Pneumonia due to cytomegalovirus and herpes simplex virus-1 caused substantial morbidity after hematopoietic cell transplantation before the institution of preventative approaches. End-organ disease from herpesviruses is poorly described after chimeric antigen receptor-modified T-cell immunotherapy. We report 2 cases of cytomegalovirus pneumonia and 1 case of herpes simplex virus-1 gingivostomatitis, esophagitis, and pneumonia after chimeric antigen receptor-modified T-cell immunotherapy for the treatment of hematologic malignancies.
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Affiliation(s)
- Madeleine R. Heldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jimmy Ma
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Riley A. O’Hara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Leah M. Yoke
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa So
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth Gulleen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth R. Duke
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Liu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cameron J. Turtle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Joshua A. Hill
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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11
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Duke ER, Williamson BD, Borate B, Golob JL, Wychera C, Stevens-Ayers T, Huang ML, Cossrow N, Wan H, Mast TC, Marks MA, Flowers ME, Jerome KR, Corey L, Gilbert PB, Schiffer JT, Boeckh M. CMV viral load kinetics as surrogate endpoints after allogeneic transplantation. J Clin Invest 2021; 131:133960. [PMID: 32970635 DOI: 10.1172/jci133960] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/05/2019] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDViral load (VL) surrogate endpoints transformed development of HIV and hepatitis C therapeutics. Surrogate endpoints for CMV-related morbidity and mortality could advance development of antiviral treatments. Although observational data support using CMV VL as a trial endpoint, randomized controlled trials (RCTs) demonstrating direct associations between virological markers and clinical endpoints are lacking.METHODSWe performed CMV DNA PCR on frozen serum samples from the only placebo-controlled RCT of ganciclovir for early treatment of CMV after hematopoietic cell transplantation (HCT). We used established criteria to assess VL kinetics as surrogates for CMV disease or death by weeks 8, 24, and 48 after randomization and quantified antiviral effects captured by each marker. We used ensemble-based machine learning to assess the predictive ability of VL kinetics and performed this analysis on a ganciclovir prophylaxis RCT for validation.RESULTSVL suppression with ganciclovir reduced cumulative incidence of CMV disease and death for 20 years after HCT. Mean VL, peak VL, and change in VL during the first 5 weeks of treatment fulfilled the Prentice definition for surrogacy, capturing more than 95% of ganciclovir's effect, and yielded highly sensitive and specific predictions by week 48. In the prophylaxis trial, the viral shedding rate satisfied the Prentice definition for CMV disease by week 24.CONCLUSIONSOur results support using CMV VL kinetics as surrogates for CMV disease, provide a framework for developing CMV preventative and therapeutic agents, and support reductions in VL as the mechanism through which antivirals reduce CMV disease.FUNDINGMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
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Affiliation(s)
- Elizabeth R Duke
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | | | - Bhavesh Borate
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jonathan L Golob
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Chiara Wychera
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | | | - Hong Wan
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | - Mary E Flowers
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Keith R Jerome
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Peter B Gilbert
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Joshua T Schiffer
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
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12
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Zamora D, Duke ER, Xie H, Edmison BC, Akoto B, Kiener R, Stevens-Ayers T, Wagner R, Mielcarek M, Leisenring WM, Jerome KR, Schiffer JT, Finak G, De Rosa SC, Boeckh M. Cytomegalovirus-specific T-cell reconstitution following letermovir prophylaxis after hematopoietic cell transplantation. Blood 2021; 138:34-43. [PMID: 33657225 PMCID: PMC8493975 DOI: 10.1182/blood.2020009396] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [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: 10/05/2020] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
Decreased cytomegalovirus (CMV)-specific immunity after hematopoietic cell transplantation (HCT) is associated with late CMV reactivation and increased mortality. Whether letermovir prophylaxis-associated reduction in viral exposure influences CMV-specific immune reconstitution is unknown. In a prospective cohort of allogeneic HCT recipients who received letermovir, we compared polyfunctional CMV-specific T-cell responses to those of controls who received PCR-guided preemptive therapy before the introduction of letermovir. Thirteen-color flow cytometry was used to assess T-cell responses at 3 months after HCT following stimulation with CMV immediate early-1 (IE-1) antigen and phosphoprotein 65 (pp65) antigens. Polyfunctionality was characterized by combinatorial polyfunctionality analysis of antigen-specific T-cell subsets. Use of letermovir and reduction of viral exposure were assessed for their association with CMV-specific T-cell immunity. Polyfunctional T-cell responses to IE-1 and pp65 were decreased in letermovir recipients and remained diminished after adjustment for donor CMV serostatus, absolute lymphocyte count, and steroid use. Among letermovir recipients, greater peak CMV DNAemia and increased viral shedding were associated with stronger CD8+ responses to pp65, whereas the CMV shedding rate was associated with greater CD4+ responses to IE-1. In summary, our study provided initial evidence that letermovir may delay CMV-specific cellular reconstitution, possibly related to decreased CMV antigen exposure. Evaluating T-cell polyfunctionality may identify patients at risk for late CMV infection after HCT.
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Affiliation(s)
- Danniel Zamora
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Elizabeth R Duke
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Bradley C Edmison
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brenda Akoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Richard Kiener
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Terry Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany; and
| | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, and
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Greg Finak
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen C De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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13
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Mollan KR, Eron JJ, Krajewski TJ, Painter W, Duke ER, Morse CG, Goecker EA, Premkumar L, Wolfe CR, Szewczyk LJ, Alabanza PL, Loftis AJ, Degli-Angeli EJ, Brown AJ, Dragavon JA, Won JJ, Keys J, Hudgens MG, Fang L, Wohl DA, Cohen MS, Baric RS, Coombs RW, Sheahan TP, Fischer WA. Infectious SARS-CoV-2 Virus in Symptomatic COVID-19 Outpatients: Host, Disease, and Viral Correlates. medRxiv 2021:2021.05.28.21258011. [PMID: 34100024 PMCID: PMC8183023 DOI: 10.1101/2021.05.28.21258011] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND While SARS-CoV-2 infectious virus isolation in outpatients with COVID-19 has been associated with viral RNA levels and symptom duration, little is known about the host, disease and viral determinants of infectious virus detection. METHODS COVID-19 adult outpatients were enrolled within 7 days of symptom onset. Clinical symptoms were recorded via patient diary. Nasopharyngeal swabs were collected to quantitate SARS-CoV-2 RNA by reverse transcriptase polymerase chain reaction and for infectious virus isolation in Vero E6-cells. SARS-CoV-2 antibodies were measured in serum using a validated ELISA assay. RESULTS Among 204 participants with mild-to-moderate symptomatic COVID19, the median nasopharyngeal viral RNA was 6.5 (IQR 4.7-7.6 log10 copies/mL), and 26% had detectable SARS-CoV-2 antibodies (IgA, IgM, IgG, and/or total Ig) at baseline. Infectious virus was recovered in 7% of participants with SARS-CoV-2 antibodies compared to 58% of participants without antibodies (probability ratio (PR)=0.12, 95% CI: 0.04, 0.36; p=0.00016). Infectious virus isolation was also associated with higher levels of viral RNA (mean RNA difference +2.6 log10, 95% CI: 2.2, 3.0; p<0.0001) and fewer days since symptom onset (PR=0.79, 95% CI: 0.71, 0.88 per day; p<0.0001). CONCLUSIONS The presence of SARS-CoV-2 antibodies is strongly associated with clearance of infectious virus isolation. Seropositivity and viral RNA levels are likely more reliable markers of infectious virus clearance than subjective measure of COVID-19 symptom duration. Virus-targeted treatment and prevention strategies should be administered as early as possible and ideally before seroconversion. CLINICALTRIALSGOV IDENTIFIER NCT04405570.
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Affiliation(s)
- Katie R Mollan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Taylor J Krajewski
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Wendy Painter
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Elizabeth R Duke
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Caryn G Morse
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Erin A Goecker
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Lakshmanane Premkumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Cameron R Wolfe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Laura J Szewczyk
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Paul L Alabanza
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Amy James Loftis
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Emily J Degli-Angeli
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Ariane J Brown
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Joan A Dragavon
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - John J Won
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Jessica Keys
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Michael G Hudgens
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Lei Fang
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - David A Wohl
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Myron S Cohen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Ralph S Baric
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Robert W Coombs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - Timothy P Sheahan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
| | - William A Fischer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, AJB, JJW, MGH, RSB, TPS); School of Medicine, University of North Carolina at Chapel Hill, NC (KRM, JJE, LP, AJL, DAW, WAF); Center for AIDS Research, University of North Carolina at Chapel Hill, NC (KRM, JJE, TJK, PLA, JK, MGH); Ridgeback Biotherapeutics LP, Miami, Florida (WP, LJS); Fred Hutchinson Cancer Research Center, Seattle, WA (ERD); Wake Forest School of Medicine, Winston-Salem, NC (CGM); Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (EAG, EJDA, JAD, RWC); Duke University Medical Center, Durham, NC (CRW); Pharstat Inc., Raleigh, NC (LF); Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, NC (WAF)
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Fischer W, Eron JJ, Holman W, Cohen MS, Fang L, Szewczyk LJ, Sheahan TP, Baric R, Mollan KR, Wolfe CR, Duke ER, Azizad MM, Borroto-Esoda K, Wohl DA, Loftis AJ, Alabanza P, Lipansky F, Painter WP. Molnupiravir, an Oral Antiviral Treatment for COVID-19. medRxiv 2021. [PMID: 34159342 DOI: 10.1101/2021.06.17.21258639] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Easily distributed oral antivirals are urgently needed to treat coronavirus disease-2019 (COVID-19), prevent progression to severe illness, and block transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the results of a Phase 2a trial evaluating the safety, tolerability, and antiviral efficacy of molnupiravir in the treatment of COVID-19 ( ClinicalTrials.gov NCT04405570 ). Methods Eligible participants included outpatients with confirmed SARS-CoV-2 infection and symptom onset within 7 days. Participants were randomized 1:1 to 200 mg molnupiravir or placebo, or 3:1 to molnupiravir (400 or 800 mg) or placebo, twice-daily for 5 days. Antiviral activity was assessed as time to undetectable levels of viral RNA by reverse transcriptase polymerase chain reaction and time to elimination of infectious virus isolation from nasopharyngeal swabs. Results Among 202 treated participants, virus isolation was significantly lower in participants receiving 800 mg molnupiravir (1.9%) versus placebo (16.7%) at Day 3 (p = 0.02). At Day 5, virus was not isolated from any participants receiving 400 or 800 mg molnupiravir, versus 11.1% of those receiving placebo (p = 0.03). Time to viral RNA clearance was decreased and a greater proportion overall achieved clearance in participants administered 800 mg molnupiravir versus placebo (p = 0.01). Molnupiravir was generally well tolerated, with similar numbers of adverse events across all groups. Conclusions Molnupiravir is the first oral, direct-acting antiviral shown to be highly effective at reducing nasopharyngeal SARS-CoV-2 infectious virus and viral RNA and has a favorable safety and tolerability profile.
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15
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Ford ES, Duke ER, Cheng GS, Yoke LM, Liu C, Hill JA, Pergam SA, Pipavath SNJ, Walter RB, Mielcarek M, Schiffer JT, Boeckh M. Outcomes of Hematopoietic Cell Transplantation in Patients with Mixed Response to Pretransplantation Treatment of Confirmed or Suspected Invasive Fungal Infection. Transplant Cell Ther 2021; 27:684.e1-684.e9. [PMID: 33964516 DOI: 10.1016/j.jtct.2021.04.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 03/26/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Patients with hematologic malignancy or bone marrow failure are typically required to achieve radiographic improvement or stabilization of invasive fungal infection (IFI) before hematopoietic cell transplantation (HCT) owing to a concern for progression before engraftment. Refractory IFI with a mixture of improvement and progression on serial imaging (ie, mixed response) poses a clinical dilemma, because a delay in HCT may allow for a hematologic relapse or other complications. Furthermore, HCT itself may yield the immune reconstitution necessary for clearance of infection. We sought to describe the characteristics and outcomes of patients who underwent HCT with mixed response IFI. We performed a chart review of all patients who underwent HCT between 2014 and 2020 in whom imaging within 6 weeks before HCT indicated a mixed response to treatment of a diagnosed IFI. Fourteen patients had evidence of a mixed response in low-to-moderate burden of diagnosed IFI by imaging before HCT, including 9 with pulmonary aspergillosis, 2 with hepatosplenic candidiasis (1 also with aspergillosis), and 4 with pulmonary nodules of presumed fungal etiology. Five had refractory severe neutropenia at evaluation for HCT (median, 95 days). All 14 patients showed radiographic stability or improvement in imaging following engraftment; no IFI-related surgeries were required, and no IFI-related deaths occurred. For patients without relapse who underwent HCT more than 1 year earlier, 7 of 8 (88%) were alive at 1 year. Our findings suggest that low-to-moderate burden IFI with mixed response is unlikely to progress on appropriate therapy before engraftment during allogeneic HCT.
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Affiliation(s)
- Emily S Ford
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Elizabeth R Duke
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Guang-Shing Cheng
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Leah M Yoke
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Catherine Liu
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven A Pergam
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Roland B Walter
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Marco Mielcarek
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joshua T Schiffer
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michael Boeckh
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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16
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Cardozo-Ojeda EF, Duke ER, Peterson CW, Reeves DB, Mayer BT, Kiem HP, Schiffer JT. Thresholds for post-rebound SHIV control after CCR5 gene-edited autologous hematopoietic cell transplantation. eLife 2021; 10:57646. [PMID: 33432929 PMCID: PMC7803377 DOI: 10.7554/elife.57646] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/07/2020] [Accepted: 12/27/2020] [Indexed: 01/10/2023] Open
Abstract
Autologous, CCR5 gene-edited hematopoietic stem and progenitor cell (HSPC) transplantation is a promising strategy for achieving HIV remission. However, only a fraction of HSPCs can be edited ex vivo to provide protection against infection. To project the thresholds of CCR5-edition necessary for HIV remission, we developed a mathematical model that recapitulates blood T cell reconstitution and plasma simian-HIV (SHIV) dynamics from SHIV-1157ipd3N4-infected pig-tailed macaques that underwent autologous transplantation with CCR5 gene editing. The model predicts that viral control can be obtained following analytical treatment interruption (ATI) when: (1) transplanted HSPCs are at least fivefold higher than residual endogenous HSPCs after total body irradiation and (2) the fraction of protected HSPCs in the transplant achieves a threshold (76–94%) sufficient to overcome transplantation-dependent loss of SHIV immunity. Under these conditions, if ATI is withheld until transplanted gene-modified cells engraft and reconstitute to a steady state, spontaneous viral control is projected to occur.
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Affiliation(s)
- E Fabian Cardozo-Ojeda
- Vaccine and Infectious Disease Division, University of Washington, Seattle, United States
| | - Elizabeth R Duke
- Vaccine and Infectious Disease Division, University of Washington, Seattle, United States.,Department of Medicine, University of Washington, Seattle, United States
| | - Christopher W Peterson
- Department of Medicine, University of Washington, Seattle, United States.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Stem Cell and Gene Therapy Program, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Daniel B Reeves
- Vaccine and Infectious Disease Division, University of Washington, Seattle, United States
| | - Bryan T Mayer
- Vaccine and Infectious Disease Division, University of Washington, Seattle, United States
| | - Hans-Peter Kiem
- Department of Medicine, University of Washington, Seattle, United States.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, United States.,Stem Cell and Gene Therapy Program, Fred Hutchinson Cancer Research Center, Seattle, United States.,Department of Pathology, University of Washington, Seattle, United States
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, University of Washington, Seattle, United States.,Department of Medicine, University of Washington, Seattle, United States.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, United States
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17
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Waghmare A, Krantz EM, Baral S, Vasquez E, Loeffelholz T, Chung EL, Pandey U, Kuypers J, Duke ER, Jerome KR, Greninger AL, Reeves DB, Hladik F, Cardozo-Ojeda EF, Boeckh M, Schiffer JT. Reliability of self-sampling for accurate assessment of respiratory virus viral and immunologic kinetics. J Infect Dis 2020; 226:278-286. [PMID: 32710762 PMCID: PMC7454707 DOI: 10.1093/infdis/jiaa451] [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: 06/02/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic demonstrates the need for accurate and convenient approaches to diagnose and therapeutically monitor respiratory viral infections. We demonstrated that self-sampling with mid-nasal foam swabs is well-tolerated and provides quantitative viral output concordant with flocked swabs. Using longitudinal home-based self-sampling, we demonstrate that nasal cytokine levels correlate and cluster according to immune cell of origin. Periods of stable viral loads are followed by rapid elimination, which could be coupled with cytokine expansion and contraction. Nasal foam swab self-sampling at home provides a precise, mechanistic readout of respiratory virus shedding and local immune responses.
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Affiliation(s)
- Alpana Waghmare
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Pediatrics, University of Washington.,Center for Clinical and Translational Research, Seattle Children's Research Institute
| | - Elizabeth M Krantz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Subhasish Baral
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Emma Vasquez
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Tillie Loeffelholz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - E Lisa Chung
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Urvashi Pandey
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Obstetrics and Gynecology, University of Washington
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington
| | - Elizabeth R Duke
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington
| | - Keith R Jerome
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Laboratory Medicine, University of Washington
| | | | - Daniel B Reeves
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Florian Hladik
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Obstetrics and Gynecology, University of Washington.,Department of Medicine, University of Washington
| | | | - Michael Boeckh
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Joshua T Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center
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18
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Waghmare A, Krantz EM, Baral S, Vasquez E, Loeffelholz T, Chung EL, Pandey U, Kuypers J, Duke ER, Jerome KR, Greninger AL, Reeves DB, Hladik F, Cardozo-Ojeda EF, Boeckh M, Schiffer JT. Reliability of self-sampling for accurate assessment of respiratory virus viral and immunologic kinetics. medRxiv 2020:2020.04.03.20051706. [PMID: 32511581 PMCID: PMC7276008 DOI: 10.1101/2020.04.03.20051706] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The SARS-CoV-2 pandemic demonstrates the need for accurate and convenient approaches to diagnose and therapeutically monitor respiratory viral infections. We demonstrated that self-sampling with foam swabs at home is well-tolerated and provides quantitative viral output concordant with flocked swabs. Nasal cytokine levels correlate and cluster according to immune cell of origin. Periods of stable viral loads are followed by rapid elimination, which could be coupled with cytokine expansion and contraction using mathematical models. Nasal foam swab self-sampling at home provides a precise, mechanistic readout of respiratory virus shedding and local immune responses.
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Affiliation(s)
- Alpana Waghmare
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Pediatrics, University of Washington
- Center for Clinical and Translational Research, Seattle Children’s Research Institute
| | - Elizabeth M. Krantz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Subhasish Baral
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Emma Vasquez
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Tillie Loeffelholz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - E. Lisa Chung
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Urvashi Pandey
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Obstetrics and Gynecology, University of Washington
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington
| | - Elizabeth R Duke
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Medicine, University of Washington
| | - Keith R. Jerome
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Laboratory Medicine, University of Washington
| | | | - Daniel B. Reeves
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
| | - Florian Hladik
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Obstetrics and Gynecology, University of Washington
- Department of Medicine, University of Washington
| | | | - Michael Boeckh
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Joshua T. Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center
- Department of Medicine, University of Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center
- Corresponding author: Joshua T. Schiffer, MD, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109,
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19
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Wychera C, Duke ER, Imlay H, Xie H, Leisenring WM, Nichols G, Boeckh M, Englund JA, Hill J, Hingorani S. BK Viremia Was Not Associated with Acute Kidney Injury in Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.347] [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: 11/15/2022]
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20
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Reeves DB, Huang Y, Duke ER, Mayer BT, Cardozo-Ojeda EF, Boshier FA, Swan DA, Rolland M, Robb ML, Mascola JR, Cohen MS, Corey L, Gilbert PB, Schiffer JT. Mathematical modeling to reveal breakthrough mechanisms in the HIV Antibody Mediated Prevention (AMP) trials. PLoS Comput Biol 2020; 16:e1007626. [PMID: 32084132 PMCID: PMC7055956 DOI: 10.1371/journal.pcbi.1007626] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/04/2020] [Accepted: 12/22/2019] [Indexed: 12/19/2022] Open
Abstract
The ongoing Antibody Mediated Prevention (AMP) trials will uncover whether passive infusion of the broadly neutralizing antibody (bNAb) VRC01 can protect against HIV acquisition. Previous statistical simulations indicate these trials may be partially protective. In that case, it will be crucial to identify the mechanism of breakthrough infections. To that end, we developed a mathematical modeling framework to simulate the AMP trials and infer the breakthrough mechanisms using measurable trial outcomes. This framework combines viral dynamics with antibody pharmacokinetics and pharmacodynamics, and will be generally applicable to forthcoming bNAb prevention trials. We fit our model to human viral load data (RV217). Then, we incorporated VRC01 neutralization using serum pharmacokinetics (HVTN 104) and in vitro pharmacodynamics (LANL CATNAP database). We systematically explored trial outcomes by reducing in vivo potency and varying the distribution of sensitivity to VRC01 in circulating strains. We found trial outcomes could be used in a clinical trial regression model (CTRM) to reveal whether partially protective trials were caused by large fractions of VRC01-resistant (IC50>50 μg/mL) circulating strains or rather a global reduction in VRC01 potency against all strains. The former mechanism suggests the need to enhance neutralizing antibody breadth; the latter suggests the need to enhance VRC01 delivery and/or in vivo binding. We will apply the clinical trial regression model to data from the completed trials to help optimize future approaches for passive delivery of anti-HIV neutralizing antibodies. Infusions of broadly neutralizing antibodies are currently being tested as a novel HIV prevention modality. To help interpret the results of these antibody mediated prevention (AMP) studies we developed a mathematical modeling framework. The approach combines antibody potency and drug levels with models of HIV viral dynamics, which will be generally applicable to future studies. Through simulating these clinical trials, we found trial outcomes can be used in combination to infer whether breakthrough infections are caused by large fractions of antibody-resistant circulating strains or some reduction in potency against all strains. This distinction helps to focus future trials on enhancing neutralizing antibody breadth or antibody delivery and/or in vivo binding.
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Affiliation(s)
- Daniel B. Reeves
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - Yunda Huang
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth R. Duke
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Bryan T. Mayer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - E. Fabian Cardozo-Ojeda
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Florencia A. Boshier
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - David A. Swan
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Morgane Rolland
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Myron S. Cohen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lawrence Corey
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Peter B. Gilbert
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Joshua T. Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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Murphy SC, Duke ER, Shipman KJ, Jensen RL, Fong Y, Ferguson S, Janes HE, Gillespie K, Seilie AM, Hanron AE, Rinn L, Fishbaugher M, VonGoedert T, Fritzen E, Kappe SH, Chang M, Sousa JC, Marcsisin SR, Chalon S, Duparc S, Kerr N, Möhrle JJ, Andenmatten N, Rueckle T, Kublin JG. A Randomized Trial Evaluating the Prophylactic Activity of DSM265 Against Preerythrocytic Plasmodium falciparum Infection During Controlled Human Malarial Infection by Mosquito Bites and Direct Venous Inoculation. J Infect Dis 2019; 217:693-702. [PMID: 29216395 DOI: 10.1093/infdis/jix613] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background DSM265 is a selective inhibitor of Plasmodium dihydroorotate dehydrogenase that fully protected against controlled human malarial infection (CHMI) by direct venous inoculation of Plasmodium falciparum sporozoites when administered 1 day before challenge and provided partial protection when administered 7 days before challenge. Methods A double-blinded, randomized, placebo-controlled trial was performed to assess safety, tolerability, pharmacokinetics, and efficacy of 1 oral dose of 400 mg of DSM265 before CHMI. Three cohorts were studied, with DSM265 administered 3 or 7 days before direct venous inoculation of sporozoites or 7 days before 5 bites from infected mosquitoes. Results DSM265-related adverse events consisted of mild-to-moderate headache and gastrointestinal symptoms. DSM265 concentrations were consistent with pharmacokinetic models (mean area under the curve extrapolated to infinity, 1707 µg*h/mL). Placebo-treated participants became positive by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and were treated 7-10 days after CHMI. Among DSM265-treated subjects, 2 of 6 in each cohort were sterilely protected. DSM265-treated recipients had longer times to development of parasitemia than placebo-treated participants (P < .004). Conclusions This was the first CHMI study of a novel antimalarial compound to compare direct venous inoculation of sporozoites and mosquito bites. Times to qRT-PCR positivity and treatment were comparable for both routes. DSM265 given 3 or 7 days before CHMI was safe and well tolerated but sterilely protected only one third of participants.
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Affiliation(s)
- Sean C Murphy
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.,Department of Microbiology, University of Washington, Seattle, Washington.,Center for Emerging and Re-emerging Infectious Diseases, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Elizabeth R Duke
- Department of Medicine, University of Washington, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kelly J Shipman
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan L Jensen
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Youyi Fong
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sue Ferguson
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly E Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin Gillespie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Annette M Seilie
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Amelia E Hanron
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Laurie Rinn
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew Fishbaugher
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Tracie VonGoedert
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Emma Fritzen
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Stefan H Kappe
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Ming Chang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jason C Sousa
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | | | | | - Nicola Kerr
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - James G Kublin
- Department of Global Health, University of Washington, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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22
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Duke ER, Williamson BD, Stevens-Ayers TL, Cossrow N, Marks MA, Wan H, Mast TC, Huang MLW, Gilbert PB, Schiffer JT, Boeckh MJ. Determination of Optimal Viral Kinetic Markers for Predicting Antiviral Treatment Effect for the Prevention of Cytomegalovirus (CMV) Disease after Hematopoietic Cell Transplant (HCT) Using Machine Learning and a Novel Non-Parametric Estimation Method. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.559] [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: 11/26/2022]
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23
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McGuffin SA, Bharadwaj R, Gonzalez-Cuyar LF, Schiffer JT, Stacey AW, Walter RB, Duke ER. In the Eye of the Beholder: A Conjunctival Lesion in a Woman With Acute Myelogenous Leukemia. Clin Infect Dis 2019; 68:525-529. [PMID: 30657904 PMCID: PMC6594456 DOI: 10.1093/cid/ciy394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah A McGuffin
- Division of Allergy and Infectious Diseases, University of Washington
| | - Rajnish Bharadwaj
- Department of Pathology, Division of Neuropathology, University of Washington
| | | | - Joshua T Schiffer
- Division of Allergy and Infectious Diseases, University of Washington
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center
- Division of Hematology/Department of Medicine, University of Washington, Seattle
| | - Elizabeth R Duke
- Division of Allergy and Infectious Diseases, University of Washington
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
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24
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Duke ER, Gilbert PB, Stevens-Ayers TL, Golob JL, Cossrow N, Marks MA, Wan H, Mast TC, Huang MLW, Jerome KR, Corey L, Schiffer JT, Boeckh MJ. Viral Kinetic Correlates of Cytomegalovirus Disease and Death after Hematopoietic Cell Transplant. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Ford ES, Duke ER, Schiffer JT, Pergam SA, Cheng GS, Liu C, Hill JA, Golob JL, Mattson D, Yoke LM, Bhattacharyya P, Corey L, Boeckh MJ. Outcome of Hematopoietic Cell Transplantation (HCT) in Patients with Invasive Fungal Infection before HCT Without Regression or Stabilization of Radiographic Signs. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.489] [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: 10/18/2022]
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Abstract
In the era of antiretroviral therapy (ART), HIV-1 infection is no longer tantamount to early death. Yet the benefits of treatment are available only to those who can access, afford, and tolerate taking daily pills. True cure is challenged by HIV latency, the ability of chromosomally integrated virus to persist within memory CD4+ T cells in a non-replicative state and activate when ART is discontinued. Using a mathematical model of HIV dynamics, we demonstrate that treatment strategies offering modest but continual enhancement of reservoir clearance rates result in faster cure than abrupt, one-time reductions in reservoir size. We frame this concept in terms of compounding interest: small changes in interest rate drastically improve returns over time. On ART, latent cell proliferation rates are orders of magnitude larger than activation and new infection rates. Contingent on subtypes of cells that may make up the reservoir and their respective proliferation rates, our model predicts that coupling clinically available, anti-proliferative therapies with ART could result in functional cure within 2–10 years rather than several decades on ART alone.
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Affiliation(s)
- Daniel B Reeves
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA, 98109, USA
| | - Elizabeth R Duke
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA, 98109, USA.,University of Washington, Department of Medicine, Seattle, WA, 98195, USA
| | - Sean M Hughes
- University of Washington, Departments of Obstetrics and Gynecology, Seattle, WA, 98195, USA
| | - Martin Prlic
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA, 98109, USA.,University of Washington, Department of Global Health, Seattle, WA, 98105, USA
| | - Florian Hladik
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA, 98109, USA. .,University of Washington, Departments of Obstetrics and Gynecology, Seattle, WA, 98195, USA.
| | - Joshua T Schiffer
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Diseases Division, Seattle, WA, 98109, USA. .,University of Washington, Department of Medicine, Seattle, WA, 98195, USA. .,Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, 98109, USA.
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27
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Zill SN, Keller BR, Chaudhry S, Duke ER, Neff D, Quinn R, Flannigan C. Detecting substrate engagement: responses of tarsal campaniform sensilla in cockroaches. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2010; 196:407-20. [PMID: 20396892 DOI: 10.1007/s00359-010-0526-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 11/26/2022]
Abstract
Sensory signals of contact and engagement with the substrate are important in the control and adaptation of posture and locomotion. We characterized responses of campaniform sensilla, receptors that encode forces as cuticular strains, in the tarsi (feet) of cockroaches using neurophysiological techniques and digital imaging. A campaniform sensillum on the fourth tarsal segment was readily identified by its large action potential in nerve recordings. The receptor discharged to contractions of the retractor unguis muscle, which engages the pretarsus (claws and arolium) with the substrate. We mimicked the effects of muscle contractions by applying displacements to the retractor apodeme (tendon). Sensillum firing did not occur to unopposed movements, but followed engagement of the claws with an object. Vector analysis of forces suggested that resisted muscle contractions produce counterforces that axially compress the tarsal segments. Close joint packing of tarsal segments was clearly observed following claw engagement. Physiological experiments showed that the sensillum responded vigorously to axial forces applied directly to the distal tarsus. Discharges of tarsal campaniform sensilla could effectively signal active substrate engagement when the pretarsal claws and arolium are used to grip the substrate in climbing, traversing irregular terrains or walking on inverted surfaces.
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Affiliation(s)
- Sasha N Zill
- Department of Anatomy and Pathology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25704, USA.
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28
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Zill SN, Keller BR, Duke ER. Sensory Signals of Unloading in One Leg Follow Stance Onset in Another Leg: Transfer of Load and Emergent Coordination in Cockroach Walking. J Neurophysiol 2009; 101:2297-304. [DOI: 10.1152/jn.00056.2009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The transfer of load from one leg to another is an essential component in walking, but sense organs that signal this process have rarely been identified. We used high-speed digital imaging and neurophysiological recordings to characterize activities of tibial campaniform sensilla, receptors that detect forces via cuticular strains, in the middle legs of cockroaches during walking. Previous studies demonstrated that the distal tibial sensilla discharge when body load is suddenly decreased in freely standing animals. Sensory recordings during walking showed that distal receptors in the middle leg fired an intense burst near the end of the stance phase. We tested the hypothesis that initiation of distal firing resulted from the action of other legs entering stance. Analysis of leg movements in slow walking showed that sensory bursts in the middle leg closely followed stance onset of the ipsilateral hind leg while the ipsilateral front leg entered stance earlier in phase. Similar phases of leg movement were found in slow walking in experiments in which animals had no implanted recording wires. Those studies also demonstrated that the opposite middle leg entered stance earlier in phase. Measurements of leg positions in walking showed that the hind leg tarsus was placed closest to the middle leg, in keeping with a “targeting” strategy. Triggering of distal bursts in the middle leg by mechanical action of the hind leg could facilitate the onset of swing in the middle leg through local reflex effects and contribute to emergent coordination of leg movements in metachronal gaits.
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29
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Keller BR, Duke ER, Amer AS, Zill SN. Tuning posture to body load: decreases in load produce discrete sensory signals in the legs of freely standing cockroaches. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2007; 193:881-91. [PMID: 17541783 DOI: 10.1007/s00359-007-0241-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 05/06/2007] [Accepted: 05/11/2007] [Indexed: 11/26/2022]
Abstract
Decreases in load are important cues in the control of posture and walking. We recorded activities of the tibial campaniform sensilla, receptors that monitor forces as strains in the exoskeleton, in the middle legs of freely moving cockroaches. Small magnets were attached to the thorax and body load was changed by applying currents to a coil below the substrate. Body position was monitored by video recording. The tibial sensilla are organized into proximal and distal subgroups that have different response properties and reflex effects: proximal sensilla excite extensor motoneurons while distal receptors inhibit extensor firing. Sudden load decreases elicited bursts from distal sensilla, while increased load excited proximal receptors. The onset of sensory discharges closely approximated the time of peak velocity of body movement in both load decreases and increases. Firing of distal sensilla rapidly adapted to sustained unloading, while proximal sensilla discharged tonically to load increases. Load decreases of small amplitude or at low rates produced only inhibition of proximal activity while decrements of larger size or rate elicited distal firing. These response properties may provide discrete signals that either modulate excitatory extensor drive during small load variations or inhibit support prior to compensatory stepping or initiation of swing.
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Affiliation(s)
- Bridget R Keller
- Department of Anatomy and Pathology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25704, USA
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30
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Abstract
Vascular bundles were isolated from grapefruit (Citrus paradisi Macf.) during periods of rapid sucrose translocation into fruit. Invertase and sucrose synthase activities were assayed in these strands and compared with immediately adjacent tissues (inner most peel and segment epidermis) and phloem-free juice sacs during four growing seasons. Although sucrose synthase was present in sink cells, the significantly greater activity in vascular strands (per unit fresh weight and protein) indicated that the role of this enzyme in translocation may include a vascular function in addition to its proposed involvement in metabolism of importing cells.
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Affiliation(s)
- P T Tomlinson
- Fruit Crops Department, Fifield Hall, University of Florida, Gainesville, Florida 32611
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31
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Duke ER, McCarty DR, Koch KE. Organ-specific invertase deficiency in the primary root of an inbred maize line. Plant Physiol 1991; 97:523-7. [PMID: 16668430 PMCID: PMC1081038 DOI: 10.1104/pp.97.2.523] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
An organ-specific invertase deficiency affecting only the primary root system is described in the Oh 43 inbred maize (Zea mays). Invertases (acid and neutral/soluble and insoluble) were assayed in various tissues of hybrid (NK 508) and inbred (Oh 43, W 22) maize lines to determine the basis for an early report that Oh 43 root tips were unable to grow on sucrose agar (27). Substantial acid invertase activity (7.3 to 16.1 micromoles of glucose per milligram of protein per hour) was evident in extracts of all tissues tested except the primary root system of Oh 43. This deficiency was also evident in lateral roots arising from the primary root. In contrast, morphologically identical lateral roots from the adventitious root system had normal invertase levels. These results suggest that ontogenetic origin of root tissues is an important determinant of invertase expression in maize. Adventitious roots (including the seminals) arise above the scutellar node and are, therefore, of shoot origin. The Oh 43 deficiency also demonstrated that invertase activity was not essential for maize root growth. Sucrose synthase was active in extracts from all root apices and theoretically provided the only available avenue for sucrose degradation in primary root tips of Oh 43. The deficiency described here will provide a useful avenue of investigation into the expression and significance of root invertase.
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Affiliation(s)
- E R Duke
- Fruit Crops Department, University of Florida, Gainesville, Florida 32611
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32
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Duke ER, Johnson CR, Koch KE. ACCUMULATION OF PHOSPHORUS, DRY MATTER AND BETAINE DURING NaCl STRESS OF SPLIT-ROOT CITRUS SEEDLINGS COLONIZED WITH VESICULAR-ARBUSCULAR MYCORRHIZAL FUNGI ON ZERO, ONE OR TWO HALVES. New Phytol 1986; 104:583-590. [PMID: 33873868 DOI: 10.1111/j.1469-8137.1986.tb00658.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sodium chloride tolerance and phosphorus content were examined in split-root Carrizo citrange seedlings [Poncirus trifoliata (L.) Raf. ×Citrus sinensis (L.) Osbeck] colonized with a vesicular-arbuscular mycorrhizal fungus (Glomus intraradices Schenck & Smith) on zero, one or two root halves. Plants were treated with NaCl at 0, 25, 50 or 100 mM, and the degree of stress was measured as reduction of dry matter accumulation and rise in level of leaf proline-betaine (stachydrine). Shoot and root dry weight production during this period decreased with increasing levels of salt. Absolute reductions were similar for plants inoculated on one vs two half-root systems, but percentage decreases were less in the latter due to greater overall growth in all treatments. Betaine levels in leaf tissues were positively related to soil salt levels for each mycorrhizal treatment. Significant differences in betaine levels were also detected in plants with and without mycorrhizal fungi, and mean levels tended to be higher for those colonized on one vs two halves of their root system. In contrast, a half-root system and its fungal symbiont supplied enough phosphorus to allow concentrations of leaf P to equal those of fully infected root systems, yet the two groups did not show equal growth under control conditions or percentage reductions with NaCl stress.
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Affiliation(s)
- E R Duke
- Department of Ornamental Horticulture, University of Florida, Gainesville, FL 32611, USA
| | - C R Johnson
- Department of Ornamental Horticulture, University of Florida, Gainesville, FL 32611, USA
| | - K E Koch
- Department of Fruit Crops, University of Florida, Gainesville, FL 32611, USA
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