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Zhou JJ, Jin C, Leang ZX, Chatelier J, Godsell J, Tsang S, Douglass JA, Yong MK, Slavin M, Bryant VL, Slade CA, Chan S. A single-center experience of COVID-19 infection in patients with primary immunodeficiency. J Allergy Clin Immunol Glob 2024; 3:100241. [PMID: 38585448 PMCID: PMC10997894 DOI: 10.1016/j.jacig.2024.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 04/09/2024]
Abstract
Background Reported outcomes in patients with primary immunodeficiency (PID) infected by coronavirus disease 2019 (COVID-19) have been variable owing to a combination of viral strain heterogeneity, differences in patient populations and health systems, and local availability of vaccination and specific COVID-19 therapies. There are few reports on the experience of Australian patients with PID during the pandemic. Objectives In this retrospective study, we describe the baseline characteristics and short-term outcomes of patients with PID who were infected by COVID-19 and known to the Royal Melbourne Hospital, a major tertiary center in Victoria, Australia. Methods Between April 2021 and April 2022, a total of 31 of 138 patients with PID were affected by COVID-19. More than half of them had 3 vaccine doses at the time of infection (which at the time was considered being fully vaccinated) and received COVID-19-targeted treatment. Results All of the infected patients had ambulatory disease, with no cases of morbidity or mortality. In line with the current literature, the PID subtypes described did not appear to independently predict worse outcomes. Conclusions Some protective factors include this cohort's relatively younger average age and its high uptake of vaccination and COVID-19 therapies.
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Affiliation(s)
- Jessie J. Zhou
- Department of Clinical Immunology and Allergy, Melbourne, Australia
| | - Celina Jin
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute, Melbourne, Australia
| | - Zhi Xiang Leang
- Department of Clinical Immunology and Allergy, Melbourne, Australia
| | - Josh Chatelier
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jack Godsell
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Department of Infectious Diseases and Immunology, Austin Health, Melbourne, Australia
| | - Sylvia Tsang
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia
| | - Jo A. Douglass
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Michelle K. Yong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Monica Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Vanessa L. Bryant
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Charlotte A. Slade
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Samantha Chan
- Department of Clinical Immunology and Allergy, Melbourne, Australia
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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2
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Copaescu AM, Vogrin S, James F, Chua KYL, Rose MT, De Luca J, Waldron J, Awad A, Godsell J, Mitri E, Lambros B, Douglas A, Youcef Khoudja R, Isabwe GAC, Genest G, Fein M, Radojicic C, Collier A, Lugar P, Stone C, Ben-Shoshan M, Turner NA, Holmes NE, Phillips EJ, Trubiano JA. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med 2023; 183:944-952. [PMID: 37459086 PMCID: PMC10352926 DOI: 10.1001/jamainternmed.2023.2986] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 07/20/2023]
Abstract
Importance Fewer than 5% of patients labeled with a penicillin allergy are truly allergic. The standard of care to remove the penicillin allergy label in adults is specialized testing involving prick and intradermal skin testing followed by an oral challenge with penicillin. Skin testing is resource intensive, limits practice to specialist-trained physicians, and restricts the global population who could undergo penicillin allergy delabeling. Objective To determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk penicillin allergy. Design, Setting, and Participants This parallel, 2-arm, noninferiority, open-label, multicenter, international randomized clinical trial occurred in 6 specialized centers, 3 in North America (US and Canada) and 3 in Australia, from June 18, 2021, to December 2, 2022. Eligible adults had a PEN-FAST score lower than 3. PEN-FAST is a prospectively derived and internationally validated clinical decision rule that enables point-of-care risk assessment for adults reporting penicillin allergies. Interventions Patients were randomly assigned to either direct oral challenge with penicillin (intervention arm) or a standard-of-care arm of penicillin skin testing followed by oral challenge with penicillin (control arm). Main Outcome and Measure The primary outcome was a physician-verified positive immune-mediated oral penicillin challenge within 1 hour postintervention in the intention-to-treat population. Noninferiority was achieved if a 1-sided 95% CI of the risk difference (RD) did not exceed 5 percentage points (pp). Results A total of 382 adults were randomized, with 377 patients (median [IQR] age, 51 [35-65] years; 247 [65.5%] female) included in the analysis: 187 in the intervention group and 190 in the control group. Most patients had a PEN-FAST score of 0 or 1. The primary outcome occurred in 1 patient (0.5%) in the intervention group and 1 patient (0.5%) in the control group, with an RD of 0.0084 pp (90% CI, -1.22 to 1.24 pp). The 1-sided 95% CI was below the noninferiority margin of 5 pp. In the 5 days following the oral penicillin challenge, 9 immune-mediated adverse events were recorded in the intervention group and 10 in the control group (RD, -0.45 pp; 95% CI, -4.87 to 3.96 pp). No serious adverse events occurred. Conclusions and Relevance In this randomized clinical trial, direct oral penicillin challenge in patients with a low-risk penicillin allergy was noninferior compared with standard-of-care skin testing followed by oral challenge. In patients with a low-risk history, direct oral penicillin challenge is a safe procedure to facilitate the removal of a penicillin allergy label. Trial Registration ClinicalTrials.gov Identifier: NCT04454229.
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Affiliation(s)
- Ana Maria Copaescu
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona James
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kyra Y. L. Chua
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Morgan T. Rose
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph De Luca
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie Waldron
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew Awad
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jack Godsell
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elise Mitri
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Belinda Lambros
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Abby Douglas
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rabea Youcef Khoudja
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ghislaine A. C. Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Genevieve Genest
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael Fein
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Cristine Radojicic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ann Collier
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patricia Lugar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cosby Stone
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Division of Allergy, Immunology and Dermatology, Montreal Children’s Hospital, McGill University Health Centre McGill University, Montreal, Quebec, Canada
| | - Nicholas A. Turner
- Department of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Natasha E. Holmes
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth J. Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Jason A. Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
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3
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McComish JS, Slade CA, Buizen L, Paul SK, Chatelier JW, Unglik G, Nicholls KA, Spriggs K, Chan SS, Godsell J, Auyeung P, Tan ZH, DeLuca J, Patel M, Kuek LE, Tran Y, Kern JS, Scardamaglia L, Varigos GA, Juneja S, Grabek JA, Christie M, Mackay GA, Douglass JA. Randomized controlled trial of omalizumab in treatment-resistant systemic and cutaneous mastocytosis (ROAM). J Allergy Clin Immunol Pract 2023; 11:2248-2250.e3. [PMID: 37088371 DOI: 10.1016/j.jaip.2023.04.008] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Charlotte A Slade
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Luke Buizen
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Sanjoy K Paul
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Josh W Chatelier
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Unglik
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Kymble Spriggs
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha S Chan
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jack Godsell
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Priscilla Auyeung
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Zi Hao Tan
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joseph DeLuca
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mittal Patel
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lin Eon Kuek
- Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Tran
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Johannes S Kern
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | | | - Graham A Mackay
- Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jo A Douglass
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Walter and Eliza Hall Institute, Melbourne, Victoria, Australia; Melbourne EpiCentre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
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4
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Chan S, Godsell J, Horton M, Farchione A, Howson LJ, Margetts M, Jin C, Chatelier J, Yong M, Sasadeusz J, Douglass JA, Slade CA, Bryant VL. Case Report: Cytomegalovirus Disease Is an Under-Recognized Contributor to Morbidity and Mortality in Common Variable Immunodeficiency. Front Immunol 2022; 13:815193. [PMID: 35242131 PMCID: PMC8885594 DOI: 10.3389/fimmu.2022.815193] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Common Variable Immunodeficiency (CVID) is classified as a ‘Predominantly Antibody Deficiency’ (PAD), but there is emerging evidence of cellular immunodeficiency in a subset of patients. This evidence includes CVID patients diagnosed with cytomegalovirus (CMV) infection, a hallmark of ‘combined immunodeficiency’. CMV infection also has the potential to drive immune dysregulation contributing to significant morbidity and mortality in CVID. We aim to determine the extent of cellular immune dysfunction in CVID patients, and whether this correlates with CMV infection status. Methods We conducted a single-center retrospective cohort study of individuals with CVID at the Royal Melbourne Hospital, and identified patients with and without CMV disease or viraemia. We then isolated T-cells from patient and healthy donor blood samples and examined T-cell proliferation and function. Results Six patients (7.6%, 6/79) had either CMV disease (pneumonitis or gastrointestinal disease), or symptomatic CMV viraemia. A high mortality rate in the cohort of patients with CVID and CMV disease was observed, with 4 deaths in the period of analysis (66.6%, 4/6). Individuals with CMV infection showed reduced T-cell division in response to T-cell receptor (TCR) stimulation when compared with CMV-negative patients. Discussion This study demonstrates the morbidity and mortality associated with CMV in CVID, and highlights the need for focused interventions for patients with CVID at risk of CMV disease.
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Affiliation(s)
- Samantha Chan
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jack Godsell
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Miles Horton
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Farchione
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Lauren J Howson
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Mai Margetts
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Celina Jin
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Josh Chatelier
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Yong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jo A Douglass
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Charlotte A Slade
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Vanessa L Bryant
- Immunology Division, Walter & Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
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5
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De Luca JF, Mackay GA, Chatelier JW, Chan SSY, Zhang SS, Godsell J, Spriggs K, Slade C, Douglass JA. Goat milk skin products may cause the development of goat milk allergy. Clin Exp Allergy 2022; 52:706-710. [PMID: 35384104 DOI: 10.1111/cea.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph Francis De Luca
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Graham Angus Mackay
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, Victoria, Australia
| | - Josh William Chatelier
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Samantha Sing-Yi Chan
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Stephanie Sihan Zhang
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jack Godsell
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kymble Spriggs
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Charlotte Slade
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jo Anne Douglass
- Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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6
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Abstract
PURPOSE OF REVIEW Cytomegalovirus (CMV) infection and disease are well described in the setting of secondary immunodeficiency. Less is known about CMV in the context of primary immunodeficiencies (PIDs), where inborn errors in one or more arms of the immune system result in variable degrees of CMV susceptibility. RECENT FINDINGS PID presents unique challenges in the diagnosis and management of CMV disease. The clinical presentation of CMV in PID is often severe, accelerated by underlying immune dysregulation and iatrogenic immunosuppression. Here we describe the clinical significance of CMV infection in PID, the key components of immune defence against CMV and how these are affected in specific PIDs. CMV disease is under-recognized as a complication of common variable immunodeficiency (CVID). High rates of CMV end-organ disease, mortality, development of CMV resistance and prolonged antiviral use have been observed in individuals with CVID. SUMMARY We recommend that clinicians tailor their approach to the individual based on their underlying immune deficit and maintain a high index of suspicion and low threshold for treatment. More research is required to improve stratification of CMV risk in PID, develop new diagnostic tools and manage end-organ disease in this cohort.
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Affiliation(s)
- Jack Godsell
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
| | - Samantha Chan
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
- Department of Medicine, University of Melbourne
| | - Charlotte Slade
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
| | - Vanessa Bryant
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Immunology Division, Walter & Eliza Hall Institute of Medical Research
| | - Jo Anne Douglass
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital
- Department of Medicine, University of Melbourne
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne
| | - Michelle K Yong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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7
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Longhitano A, Godsell J, Hume S. Disseminated Pasteurella multocida pleuropulmonary disease in a patient using short duration oral glucocorticoids and absence of bite. Intern Med J 2021; 51:1977-1978. [PMID: 34796629 DOI: 10.1111/imj.15576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Anthony Longhitano
- Department of Infectious Diseases, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Jack Godsell
- Department of Immunology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Samuel Hume
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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8
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Ibn-Mohammed T, Mustapha KB, Godsell J, Adamu Z, Babatunde KA, Akintade DD, Acquaye A, Fujii H, Ndiaye MM, Yamoah FA, Koh SCL. A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies. Resour Conserv Recycl 2021; 164:105169. [PMID: 32982059 PMCID: PMC7505605 DOI: 10.1016/j.resconrec.2020.105169] [Citation(s) in RCA: 196] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/01/2020] [Accepted: 09/18/2020] [Indexed: 05/05/2023]
Abstract
The World Health Organization declared COVID-19 a global pandemic on the 11th of March 2020, but the world is still reeling from its aftermath. Originating from China, cases quickly spread across the globe, prompting the implementation of stringent measures by world governments in efforts to isolate cases and limit the transmission rate of the virus. These measures have however shattered the core sustaining pillars of the modern world economies as global trade and cooperation succumbed to nationalist focus and competition for scarce supplies. Against this backdrop, this paper presents a critical review of the catalogue of negative and positive impacts of the pandemic and proffers perspectives on how it can be leveraged to steer towards a better, more resilient low-carbon economy. The paper diagnosed the danger of relying on pandemic-driven benefits to achieving sustainable development goals and emphasizes a need for a decisive, fundamental structural change to the dynamics of how we live. It argues for a rethink of the present global economic growth model, shaped by a linear economy system and sustained by profiteering and energy-gulping manufacturing processes, in favour of a more sustainable model recalibrated on circular economy (CE) framework. Building on evidence in support of CE as a vehicle for balancing the complex equation of accomplishing profit with minimal environmental harms, the paper outlines concrete sector-specific recommendations on CE-related solutions as a catalyst for the global economic growth and development in a resilient post-COVID-19 world.
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Affiliation(s)
- T Ibn-Mohammed
- Warwick Manufacturing Group (WMG), The University of Warwick, Coventry CV4 7AL, United Kingdom
| | - K B Mustapha
- Faculty of Engineering and Science, University of Nottingham (Malaysia Campus), Semenyih, Selangor43500, Malaysia
| | - J Godsell
- Warwick Manufacturing Group (WMG), The University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Z Adamu
- School of The Built Environment and Architecture, London South Bank University, London SE1 0AA, United Kingdom
| | - K A Babatunde
- Faculty of Economics and Management, Universiti Kebangsaan Malaysia, Bangi, Selangor43600, Malaysia
- Department of Economics, Faculty of Management Sciences, Al-Hikmah University, Ilorin, Nigeria
| | - D D Akintade
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH United Kingdom
| | - A Acquaye
- Kent Business School, University of Kent, Canterbury CT2 7PE, United Kingdom
| | - H Fujii
- Faculty of Economics, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
| | - M M Ndiaye
- Department of Industrial Engineering, College of Engineering, American University of Sharjah, Sharjah, UAE
| | - F A Yamoah
- Department of Management, Birkbeck University of London, London WC1E 7JL United Kingdom
| | - S C L Koh
- Sheffield University Management School (SUMS), The University of Sheffield, Sheffield S10 1FL, United Kingdom
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9
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Godsell J, Rudloff I, Kandane-Rathnayake R, Hoi A, Nold MF, Morand EF, Harris J. Clinical associations of IL-10 and IL-37 in systemic lupus erythematosus. Sci Rep 2016; 6:34604. [PMID: 27708376 PMCID: PMC5052569 DOI: 10.1038/srep34604] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 04/28/2016] [Accepted: 09/15/2016] [Indexed: 12/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the development of autoantibodies to nuclear antigens and inflammatory responses mediated by multiple cytokines. Although previous studies have determined clinical associations between SLE and the anti-inflammatory cytokines IL-10 and IL-37, their role in the disease, or their potential as biomarkers, remains unclear. We examined serum levels of IL-10 and IL-37 in a large cohort of SLE patients, with detailed longitudinal clinical data. We demonstrate a statistically significant association of serum IL-10 with disease activity, with higher levels in active compared to inactive disease. High first visit IL-10 was predictive of high subsequent disease activity; patients with IL-10 in highest quartile at first visit were 3.6 times more likely to have active disease in subsequent visits. Serum IL-37 was also higher in SLE patients compared to control, and was strongly associated with Asian ethnicity. However, IL-37 was not statistically significantly associated with disease activity. IL-37 was significantly reduced in patients with organ damage but this association was attenuated in multivariable analysis. The data suggest that IL-10, but not IL-37, may have potential as a biomarker predictive for disease activity in SLE.
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Affiliation(s)
- Jack Godsell
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ina Rudloff
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Alberta Hoi
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Marcel F Nold
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
| | - James Harris
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing &Health Sciences, Monash University, Clayton, Victoria, Australia
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Rudloff I, Godsell J, Nold-Petry CA, Harris J, Hoi A, Morand EF, Nold MF. Brief Report: Interleukin-38 Exerts Antiinflammatory Functions and Is Associated With Disease Activity in Systemic Lupus Erythematosus. Arthritis Rheumatol 2016; 67:3219-25. [PMID: 26314375 DOI: 10.1002/art.39328] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/11/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Knowledge of interleukin-38 (IL-38), formerly IL-1 family member 10, is sparse, but Il1f10 polymorphisms are associated with inflammatory diseases, and recombinant IL-38 inhibits inflammatory responses similar to those reported in the context of systemic lupus erythematosus (SLE). We undertook this study to explore the function of endogenous IL-38 in human peripheral blood mononuclear cells (PBMCs) as well as its abundance in serum in a well-characterized cohort of SLE patients. METHODS Serum IL-38 and IL-10 levels were quantified by enzyme-linked immunosorbent assay in 142 SLE patients at ≤3 consecutive visits and in 28 healthy volunteers. To assess IL-38 function, we silenced IL-38 in PBMCs from healthy donors using IL-38 small interfering RNA (siRNA). RESULTS IL-38 (63-5,928 pg/ml) was detectable in 16% of 372 serum samples. IL-38 abundance was significantly higher in samples from SLE patients than in samples from healthy controls (P = 0.004) and 11-fold higher in patients with active disease (SLE Disease Activity Index 2000 [SLEDAI-2K] score of ≥4) than in those with inactive disease (SLEDAI-2K score of <4) (P = 0.044). Importantly, IL-38 detection was associated with increased risk of renal lupus (relative risk [RR] 1.6, P = 0.027) and central nervous system lupus (RR 2.3, P = 0.034), and detectable baseline IL-38 entailed a 1.6-fold increased risk of subsequently meeting criteria for persistently active disease (P = 0.0097). Longitudinal time-adjusted mean IL-38 concentration was also 6-fold higher in patients with persistently active disease than in those without (P = 0.023). Remarkably, PBMCs treated with IL-38 siRNA produced up to 28-fold more of the proinflammatory mediators IL-6, CCL2, and APRIL than did control siRNA-transfected cells upon stimulation with Toll-like receptor agonists. Similarly, in SLE patients, the antiinflammatory cytokine IL-10 was 5-fold more abundant when IL-38 was detectable. CONCLUSION This is the first study of the function of endogenous IL-38, and the data suggest that IL-38 may be protective in SLE. A strong association between IL-38 and SLE severity suggests that IL-38 expression is driven by processes linked to SLE pathogenesis. Exploitation of the regulatory effects of IL-38 may represent a promising therapeutic strategy in SLE.
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Affiliation(s)
- Ina Rudloff
- Hudson Institute of Medical Research and Monash University, Melbourne, Victoria, Australia
| | - Jack Godsell
- Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
| | - Claudia A Nold-Petry
- Hudson Institute of Medical Research and Monash University, Melbourne, Victoria, Australia
| | - James Harris
- Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alberta Hoi
- Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
| | - Eric F Morand
- Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
| | - Marcel F Nold
- Hudson Institute of Medical Research and Monash University, Melbourne, Victoria, Australia
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Godsell J, Rudloff I, Hoi A, Nold M, Morand E. OP0101 First Report of IL-38 in Systemic Lupus Erythematosus (SLE). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3594] [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: 11/03/2022]
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