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Mann T, Gupta RK, Reeve BWP, Ndlangalavu G, Chandran A, Krishna AP, Calderwood CJ, Tshivhula H, Palmer Z, Naidoo S, Mbu DL, Theron G, Noursadeghi M. Blood RNA biomarkers for tuberculosis screening in people living with HIV before antiretroviral therapy initiation: a diagnostic accuracy study. Lancet Glob Health 2024; 12:e783-e792. [PMID: 38583459 DOI: 10.1016/s2214-109x(24)00029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/23/2023] [Revised: 12/06/2023] [Accepted: 01/11/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Undiagnosed tuberculosis remains a major threat for people living with HIV. Multiple blood transcriptomic biomarkers have shown promise for tuberculosis diagnosis. We sought to evaluate their diagnostic accuracy and clinical utility for systematic pre-antiretroviral therapy (ART) tuberculosis screening. METHODS We enrolled consecutive adults (age ≥18 years) referred to start ART at a community health centre in Cape Town, South Africa, irrespective of symptoms. Sputa were obtained (using induction if required) for two liquid cultures. Whole-blood RNA samples underwent transcriptional profiling using a custom Nanostring gene panel. We measured the diagnostic accuracy of seven candidate RNA signatures (one single gene biomarker [BATF2] and six multigene biomarkers) for the reference standard of Mycobacterium tuberculosis culture status, using area under the receiver-operating characteristic curve (AUROC) analysis, and sensitivity and specificity at prespecified thresholds (two standard scores above the mean of healthy controls; Z2). Clinical utility was assessed by calculating net benefit in decision curve analysis. We compared performance with C-reactive protein (CRP; threshold ≥5 mg/L), WHO four-symptom screen (W4SS), and the WHO target product profile for tuberculosis triage tests. FINDINGS A total of 707 people living with HIV (407 [58%] female and 300 [42%] male) were included, with median CD4 count 306 cells per mm3 (IQR 184-486). Of 676 participants with available sputum culture results, 89 (13%) had culture-confirmed tuberculosis. The seven RNA signatures were moderately to highly correlated (Spearman rank coefficients 0·42-0·93) and discriminated tuberculosis culture positivity with similar AUROCs (0·73-0·80), but none statistically better than CRP (AUROC 0·78, 95% CI 0·72-0·83). Diagnostic accuracy was similar across CD4 count strata, but lower among participants with negative W4SS (AUROCs 0·56-0·65) compared with positive (AUROCs 0·75-0·84). The RNA biomarker with the highest AUROC point estimate was a four-gene signature (Suliman4; AUROC 0·80, 95% CI 0·75-0·86), with sensitivity 83% (95% CI 74-90) and specificity 59% (55-63) at the Z2 threshold. In decision curve analysis, Suliman4 and CRP had similar clinical utility to guide confirmatory tuberculosis testing, but both had higher net benefit than W4SS. In exploratory analyses, an approach combining CRP (≥5 mg/L) and Suliman4 (≥Z2) had sensitivity of 80% (70-87), specificity of 70% (66-74), and higher net benefit than either biomarker alone. INTERPRETATION RNA biomarkers showed better clinical utility to guide confirmatory tuberculosis testing for people living with HIV before ART initiation than symptom-based screening, but their performance did not exceed that of CRP and fell short of WHO recommended targets. Interferon-independent approaches might be required to improve accuracy of host-response biomarkers to support tuberculosis screening before ART initiation. FUNDING South African Medical Research Council, European and Developing Countries Clinical Trials Partnership 2, National Institutes of Health National Institute of Allergy and Infectious Diseases, The Wellcome Trust, National Institute for Health and Care Research, Royal College of Physicians London.
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Affiliation(s)
- Tiffeney Mann
- Division of Infection and Immunity, University College London, London, UK
| | - Rishi K Gupta
- Institute of Health Informatics, University College London, London, UK
| | - Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London, UK
| | - Amirtha P Krishna
- Division of Infection and Immunity, University College London, London, UK
| | - Claire J Calderwood
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Happy Tshivhula
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Selisha Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Desiree L Mbu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK.
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2
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Reeve BWP, Ndlangalavu G, Mishra H, Palmer Z, Tshivhula H, Rockman L, Naidoo S, Mbu DL, Naidoo CC, Derendinger B, Walzl G, Malherbe ST, van Helden PD, Semitala FC, Yoon C, Gupta RK, Noursadeghi M, Warren RM, Theron G. Point-of-care C-reactive protein and Xpert MTB/RIF Ultra for tuberculosis screening and diagnosis in unselected antiretroviral therapy initiators: a prospective, cross-sectional, diagnostic accuracy study. Lancet Glob Health 2024; 12:e793-e803. [PMID: 38583458 PMCID: PMC11035478 DOI: 10.1016/s2214-109x(24)00052-4] [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: 10/23/2023] [Revised: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Tuberculosis, a major cause of death in people living with HIV, remains challenging to diagnose. Diagnostic accuracy data are scarce for promising triage and confirmatory tests such as C-reactive protein (CRP), sputum and urine Xpert MTB/RIF Ultra (Xpert Ultra), and urine Determine TB LAM Ag (a lateral flow lipoarabinomannan [LF-LAM] test), without symptom selection. We evaluated novel triage and confirmatory tests in ambulatory people with HIV initiating antiretroviral therapy (ART). METHODS 897 ART-initiators were recruited irrespective of symptoms and sputum induction offered. For triage (n=800), we evaluated point-of-care blood-based CRP testing, compared with the WHO-recommended four-symptom screen (W4SS). For sputum-based confirmatory testing (n=787), we evaluated Xpert Ultra versus Xpert MTB/RIF (Xpert). For urine-based confirmatory testing (n=732), we evaluated Xpert Ultra and LF-LAM. We used a sputum culture reference standard. FINDINGS 463 (52%) of 897 participants were female. The areas under the receiver operator characteristic curves for CRP was 0·78 (95% CI 0·73-0·83) and for number of W4SS symptoms was 0·70 (0·64-0·75). CRP (≥10 mg/L) had similar sensitivity to W4SS (77% [95% CI 68-85; 80/104] vs 77% [68-85; 80/104]; p>0·99] but higher specificity (64% [61-68; 445/696] vs 48% [45-52; 334/696]; p<0·0001]; reducing unnecessary confirmatory testing by 138 (95% CI 117-160) per 1000 people and number-needed-to-test from 6·91 (95% CI 6·25-7·81) to 4·87 (4·41-5·51). Sputum samples with Xpert Ultra, which required induction in 49 (31%) of 158 of people (95% CI 24-39), had higher sensitivity than Xpert (71% [95% CI 61-80; 74/104] vs 56% [46-66; 58/104]; p<0·0001). Of the people with one or more confirmatory sputum or urine test results that were positive, the proportion detected by Xpert Ultra increased from 45% (26-64) to 66% (46-82) with induction. Programmatically done haemoglobin, triage test combinations, and urine tests showed comparatively worse results. INTERPRETATION CRP is a more specific triage test than W4SS in those initiating ART. Sputum induction improves diagnostic yield. Sputum samples with Xpert Ultra is a more accurate confirmatory test than with Xpert. FUNDING South African Medical Research Council, EDCTP2, US National Institutes of Health-National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hridesh Mishra
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Happy Tshivhula
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Loren Rockman
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Selisha Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Desiree L Mbu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charissa C Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brigitta Derendinger
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Walzl
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanus T Malherbe
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Paul D van Helden
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fred C Semitala
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda; Department of Internal Medicine, Makerere University College of Health Sciences, Makerere, Kampala, Uganda
| | - Christina Yoon
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Rishi K Gupta
- Division of Infection and Immunity, University College London, London, UK
| | | | - Robin M Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Altmann DM, Reynolds CJ, Joy G, Otter AD, Gibbons JM, Pade C, Swadling L, Maini MK, Brooks T, Semper A, McKnight Á, Noursadeghi M, Manisty C, Treibel TA, Moon JC, Boyton RJ. Persistent symptoms after COVID-19 are not associated with differential SARS-CoV-2 antibody or T cell immunity. Nat Commun 2023; 14:5139. [PMID: 37612310 PMCID: PMC10447583 DOI: 10.1038/s41467-023-40460-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Among the unknowns in decoding the pathogenesis of SARS-CoV-2 persistent symptoms in Long Covid is whether there is a contributory role of abnormal immunity during acute infection. It has been proposed that Long Covid is a consequence of either an excessive or inadequate initial immune response. Here, we analyze SARS-CoV-2 humoral and cellular immunity in 86 healthcare workers with laboratory confirmed mild or asymptomatic SARS-CoV-2 infection during the first wave. Symptom questionnaires allow stratification into those with persistent symptoms and those without for comparison. During the period up to 18-weeks post-infection, we observe no difference in antibody responses to spike RBD or nucleoprotein, virus neutralization, or T cell responses. Also, there is no difference in the profile of antibody waning. Analysis at 1-year, after two vaccine doses, comparing those with persistent symptoms to those without, again shows similar SARS-CoV-2 immunity. Thus, quantitative differences in these measured parameters of SARS-CoV-2 adaptive immunity following mild or asymptomatic acute infection are unlikely to have contributed to Long Covid causality. ClinicalTrials.gov (NCT04318314).
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Affiliation(s)
- Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK.
| | | | - George Joy
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Leo Swadling
- Division of Infection and Immunity, University College London, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.
- Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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4
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Dhana A, Gupta RK, Hamada Y, Kengne AP, Kerkhoff AD, Yoon C, Cattamanchi A, Reeve BWP, Theron G, Ndlangalavu G, Wood R, Drain PK, Calderwood CJ, Noursadeghi M, Boyles T, Meintjes G, Maartens G, Barr DA. Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis. Eur Respir Rev 2023; 32:230021. [PMID: 37286216 PMCID: PMC10245131 DOI: 10.1183/16000617.0021-2023] [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: 01/24/2023] [Accepted: 03/15/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that outpatient people living with HIV (PLHIV) undergo tuberculosis screening with the WHO four-symptom screen (W4SS) or C-reactive protein (CRP) (5 mg·L-1 cut-off) followed by confirmatory testing if screen positive. We conducted an individual participant data meta-analysis to determine the performance of WHO-recommended screening tools and two newly developed clinical prediction models (CPMs). METHODS Following a systematic review, we identified studies that recruited adult outpatient PLHIV irrespective of tuberculosis signs and symptoms or with a positive W4SS, evaluated CRP and collected sputum for culture. We used logistic regression to develop an extended CPM (which included CRP and other predictors) and a CRP-only CPM. We used internal-external cross-validation to evaluate performance. RESULTS We pooled data from eight cohorts (n=4315 participants). The extended CPM had excellent discrimination (C-statistic 0.81); the CRP-only CPM had similar discrimination. The C-statistics for WHO-recommended tools were lower. Both CPMs had equivalent or higher net benefit compared with the WHO-recommended tools. Compared with both CPMs, CRP (5 mg·L-1 cut-off) had equivalent net benefit across a clinically useful range of threshold probabilities, while the W4SS had a lower net benefit. The W4SS would capture 91% of tuberculosis cases and require confirmatory testing for 78% of participants. CRP (5 mg·L-1 cut-off), the extended CPM (4.2% threshold) and the CRP-only CPM (3.6% threshold) would capture similar percentages of cases but reduce confirmatory tests required by 24, 27 and 36%, respectively. CONCLUSIONS CRP sets the standard for tuberculosis screening among outpatient PLHIV. The choice between using CRP at 5 mg·L-1 cut-off or in a CPM depends on available resources.
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Affiliation(s)
- Ashar Dhana
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
- Centre for International Cooperation and Global TB Information, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Andre P Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew D Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, USA
| | - Christina Yoon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Adithya Cattamanchi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robin Wood
- Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Paul K Drain
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Claire J Calderwood
- Institute for Global Health, University College London, London, UK
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- The Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Tom Boyles
- Helen Joseph Hospital, Johannesburg, South Africa
| | - Graeme Meintjes
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David A Barr
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Milighetti M, Peng Y, Tan C, Mark M, Nageswaran G, Byrne S, Ronel T, Peacock T, Mayer A, Chandran A, Rosenheim J, Whelan M, Yao X, Liu G, Felce SL, Dong T, Mentzer AJ, Knight JC, Balloux F, Greenstein E, Reich-Zeliger S, Pade C, Gibbons JM, Semper A, Brooks T, Otter A, Altmann DM, Boyton RJ, Maini MK, McKnight A, Manisty C, Treibel TA, Moon JC, Noursadeghi M, Chain B. Large clones of pre-existing T cells drive early immunity against SARS-COV-2 and LCMV infection. iScience 2023; 26:106937. [PMID: 37275518 PMCID: PMC10201888 DOI: 10.1016/j.isci.2023.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Abstract
T cell responses precede antibody and may provide early control of infection. We analyzed the clonal basis of this rapid response following SARS-COV-2 infection. We applied T cell receptor (TCR) sequencing to define the trajectories of individual T cell clones immediately. In SARS-COV-2 PCR+ individuals, a wave of TCRs strongly but transiently expand, frequently peaking the same week as the first positive PCR test. These expanding TCR CDR3s were enriched for sequences functionally annotated as SARS-COV-2 specific. Epitopes recognized by the expanding TCRs were highly conserved between SARS-COV-2 strains but not with circulating human coronaviruses. Many expanding CDR3s were present at high frequency in pre-pandemic repertoires. Early response TCRs specific for lymphocytic choriomeningitis virus epitopes were also found at high frequency in the preinfection naive repertoire. High-frequency naive precursors may allow the T cell response to respond rapidly during the crucial early phases of acute viral infection.
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Affiliation(s)
- Martina Milighetti
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Yanchun Peng
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Cedric Tan
- UCL Genetics Institute, University College London, London WC1E 6BT, UK
| | - Michal Mark
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Gayathri Nageswaran
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Suzanne Byrne
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Tahel Ronel
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Tom Peacock
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Andreas Mayer
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Joshua Rosenheim
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Matthew Whelan
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Xuan Yao
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Guihai Liu
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Suet Ling Felce
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Tao Dong
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | | | - Julian C Knight
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Francois Balloux
- UCL Genetics Institute, University College London, London WC1E 6BT, UK
| | - Erez Greenstein
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shlomit Reich-Zeliger
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Amanda Semper
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Ashley Otter
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London SW7 2BX, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Lung Division, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Benny Chain
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
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Reeve BW, Ndlangalavu G, Mishra H, Palmer Z, Tshivhula H, Rockman L, Naidoo S, Mbu DL, Naidoo CC, Derendinger B, Walzl G, Malherbe ST, van Helden PD, Semitala FC, Yoon C, Gupta RK, Noursadeghi M, Warren RM, Theron G. Point-of-care C-reactive protein and Xpert MTB/RIF Ultra for tuberculosis screening and diagnosis in unselected antiretroviral therapy initiators: a prospective diagnostic accuracy study. medRxiv 2023:2023.05.30.23290716. [PMID: 37333303 PMCID: PMC10274965 DOI: 10.1101/2023.05.30.23290716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Tuberculosis (TB), a major cause of death in people living with HIV (PLHIV), remains challenging to diagnose. Diagnostic accuracy data are lacking for promising triage tests, such as C-reactive protein (CRP), and confirmatory tests, such as sputum and urine Xpert MTB/RIF Ultra (Ultra), and urine LAM, without prior symptom selection. Methods 897 PLHIV initiating antiretroviral therapy were consecutively recruited in settings with high TB incidence, irrespective of symptoms. Participants were offered sputum induction, with a liquid culture reference standard. First, we evaluated point-of-care CRP testing on blood, compared to the World Health Organization (WHO)-recommended four-symptom screen (W4SS) for triage (n=800). Second, we evaluated Xpert MTB/RIF Ultra (Ultra) versus Xpert MTB/RIF (Xpert) for sputum-based confirmatory testing (n=787), with or without sputum induction. Third, we evaluated Ultra and Determine LF-LAM for urine-based confirmatory testing (n=732). Findings CRP and number of W4SS symptoms had areas under the receiver operator characteristic curve of 0.78 (95% confidence interval 0.73, 0.83) and 0.70 (0.64, 0.75), respectively. For triage, CRP (≥10 mg/l) has similar sensitivity to W4SS [77% (68, 85) vs. 77% (68, 85); p>0.999] but higher specificity [64% (61, 68) vs. 48% (45, 52); p<0.001]; reducing unnecessary confirmatory testing by 138 per 1000 people and the number-needed-to-test from 6.91 (6.25, 7.81) to 4.87 (4.41, 5.51). Using sputum, which required induction in 31% (24, 39) of people, Ultra had higher sensitivity than Xpert [71% (61, 80) vs. 56% (46, 66); p<0.001] but lower specificity [98% (96, 100) vs. 99% (98, 100); p<0.001]. The proportion of people with ≥1 positive confirmatory result detected by Ultra increased from 45% (26, 64) to 66% (46, 82) when induction was done. Programmatically-done haemoglobin, triage test combinations, and urine tests showed comparatively worse performance. Interpretation Among ART-initiators in a high burden setting, CRP is a more specific triage test than W4SS. Sputum induction improves yield. Sputum Ultra is a more accurate confirmatory test than Xpert. Funding SAMRC (MRC-RFA-IFSP-01-2013), EDCTP2 (SF1401, OPTIMAL DIAGNOSIS), NIH/NIAD (U01AI152087). Research in context Evidence before this study: Novel triage and confirmatory tests are urgently needed for TB, especially in key risk groups like PLHIV. Many TB cases do not meet World Health Organization (WHO)-recommended four-symptom screen (W4SS) criteria despite accounting for significant transmission and morbidity. W4SS also lacks specificity, which makes onward referral of triage-positive people for expensive confirmatory testing inefficient and hampers diagnostic scale-up. Alternative triage approaches like CRP have promise, but have comparatively little data in ART-initiators, especially when done without syndromic preselection and using point-of-care (POC) tools. After triage, confirmatory testing can be challenging due to sputum scarcity and paucibacillary early-stage disease. Next generation WHO-endorsed rapid molecular tests (including Xpert MTB/RIF Ultra; Ultra) are a standard-of-care for confirmatory testing. However, there are no supporting data in ART-initiators, among whom Ultra may offer large sensitivity gains over predecessors like Xpert MTB/RIF (Xpert). The added value of sputum induction to augment diagnostic sampling for confirmatory testing is also unclear. Lastly, the performance of urine tests (Ultra, Determine LF-LAM) in this population requires more data.Added value of this study: We evaluated repurposed and new tests for triage and confirmatory testing using a rigorous microbiological reference standard in a highly vulnerable high-priority patient population (ART-initiators) regardless of symptoms and ability to naturally expectorate sputum. We showed POC CRP triage is feasible, performs better than W4SS, and that combinations of different triage approaches offer no advantages over CRP alone. Sputum Ultra has superior sensitivity to Xpert; often detecting W4SS-negative TB. Furthermore, without induction, confirmatory sputum-based testing would not be possible in a third of people. Urine tests had poor performance. This study contributed unpublished data to systematic reviews and meta-analyses used by the WHO to inform global policy supporting use of CRP triage and Ultra in PLHIV.Implication of all the available evidence: POC CRP triage testing is feasible and superior to W4SS and, together with sputum induction in people who triage CRP-positive should, after appropriate cost and implementation research, be considered for roll-out in ART-initiators in high burden settings. Such people should be offered Ultra, which outperforms Xpert.
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7
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Mann T, Gupta RK, Reeve BWP, Ndlangalavu G, Chandran A, Krishna AP, Calderwood CJ, Tshivhula H, Palmer Z, Naidoo S, Mbu DL, Theron G, Noursadeghi M. Blood RNA biomarkers for tuberculosis screening in people living with HIV prior to anti-retroviral therapy initiation: A diagnostic accuracy study. medRxiv 2023:2023.06.01.23290783. [PMID: 37397982 PMCID: PMC10312886 DOI: 10.1101/2023.06.01.23290783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Undiagnosed tuberculosis (TB) remains a major threat for people living with HIV (PLHIV). Multiple blood transcriptomic biomarkers have shown promise for TB diagnosis. We sought to evaluate their diagnostic accuracy and clinical utility for systematic pre-antiretroviral therapy (ART) TB screening. Methods We enrolled consecutive adults referred to start ART at a community health centre in Cape Town, South Africa, irrespective of symptoms. Sputa were obtained (using induction if required) for two liquid cultures. Whole-blood RNA samples underwent transcriptional profiling using a custom Nanostring gene-panel. We measured the diagnostic accuracy of seven candidate RNA biomarkers for the reference standard of Mycobacterium tuberculosis culture status, using area under the receiver-operating characteristic curve (AUROC) analysis, and sensitivity/specificity at pre-specified thresholds (two standard scores above the mean of healthy controls; Z2). Clinical utility was assessed using decision curve analysis. We compared performance to CRP (threshold ≥5mg/L), World Health Organisation (WHO) four-symptom screen (W4SS) and the WHO target product profile for TB triage tests. Results A total of 707 PLHIV were included, with median CD4 count 306 cells/mm3. Of 676 with available sputum culture results, 89 (13%) had culture-confirmed TB. The seven RNA biomarkers were moderately to highly correlated (Spearman rank coefficients 0.42-0.93) and discriminated TB culture-positivity with similar AUROCs (0.73-0.80), but none statistically better than CRP (AUROC 0.78; 95% CI 0.72-0.83). Diagnostic accuracy was similar across CD4 count strata, but lower among W4SS-negative (AUROCs 0.56-0.65) compared to W4SS-positive participants (AUROCs 0.75-0.84). The RNA biomarker with highest AUROC point estimate was a 4-gene signature (Suliman4; AUROC 0.80; 95% CI 0.75-0.86), with sensitivity 0.83 (0.74-0.90) and specificity 0.59 (0.55-0.63) at Z2 threshold. In decision curve analysis, Suliman4 and CRP had similar clinical utility to guide confirmatory TB testing, but both had higher net benefit than W4SS. In exploratory analyses, an approach combining CRP (≥5mg/L) and Suliman4 (≥Z2) had sensitivity of 0.80 (0.70-0.87), specificity of 0.70 (0.66-0.74) and higher net benefit than either biomarker alone. Interpretation RNA biomarkers showed better clinical utility to guide confirmatory TB testing for PLHIV prior to ART initiation than symptom-based screening, but their performance did not exceed that of CRP, and fell short of WHO recommended targets. Interferon-independent approaches may be required to improve accuracy of host-response biomarkers to support TB screening pre-ART initiation. Funding South African MRC, EDCTP2, NIH/NIAID, Wellcome Trust, NIHR, Royal College of Physicians London.
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Affiliation(s)
- Tiffeney Mann
- Division of Infection and Immunity, University College London, London, UK
| | - Rishi K Gupta
- Institute of Health Informatics, University College London, London, UK
| | - Byron WP Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London, UK
| | - Amirtha P Krishna
- Division of Infection and Immunity, University College London, London, UK
| | - Claire J Calderwood
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Happy Tshivhula
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Selisha Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Desiree L Mbu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | | | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
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8
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Morfopoulou S, Buddle S, Torres Montaguth OE, Atkinson L, Guerra-Assunção JA, Moradi Marjaneh M, Zennezini Chiozzi R, Storey N, Campos L, Hutchinson JC, Counsell JR, Pollara G, Roy S, Venturini C, Antinao Diaz JF, Siam A, Tappouni LJ, Asgarian Z, Ng J, Hanlon KS, Lennon A, McArdle A, Czap A, Rosenheim J, Andrade C, Anderson G, Lee JCD, Williams R, Williams CA, Tutill H, Bayzid N, Martin Bernal LM, Macpherson H, Montgomery KA, Moore C, Templeton K, Neill C, Holden M, Gunson R, Shepherd SJ, Shah P, Cooray S, Voice M, Steele M, Fink C, Whittaker TE, Santilli G, Gissen P, Kaufer BB, Reich J, Andreani J, Simmonds P, Alrabiah DK, Castellano S, Chikowore P, Odam M, Rampling T, Houlihan C, Hoschler K, Talts T, Celma C, Gonzalez S, Gallagher E, Simmons R, Watson C, Mandal S, Zambon M, Chand M, Hatcher J, De S, Baillie K, Semple MG, Martin J, Ushiro-Lumb I, Noursadeghi M, Deheragoda M, Hadzic N, Grammatikopoulos T, Brown R, Kelgeri C, Thalassinos K, Waddington SN, Jacques TS, Thomson E, Levin M, Brown JR, Breuer J. Genomic investigations of unexplained acute hepatitis in children. Nature 2023; 617:564-573. [PMID: 36996872 PMCID: PMC10170458 DOI: 10.1038/s41586-023-06003-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.
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Affiliation(s)
- Sofia Morfopoulou
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Sarah Buddle
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Enrique Torres Montaguth
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Laura Atkinson
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - José Afonso Guerra-Assunção
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mahdi Moradi Marjaneh
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
- Section of Virology, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Riccardo Zennezini Chiozzi
- University College London Mass Spectrometry Science Technology Platform, Division of Biosciences, University College London, London, UK
| | - Nathaniel Storey
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Luis Campos
- Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Ciaran Hutchinson
- Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John R Counsell
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London, UK
| | - Sunando Roy
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Cristina Venturini
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Juan F Antinao Diaz
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - Ala'a Siam
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
- Gene Transfer Technology Group, EGA-Institute for Women's Health, University College London, London, UK
| | - Luke J Tappouni
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - Zeinab Asgarian
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - Joanne Ng
- Gene Transfer Technology Group, EGA-Institute for Women's Health, University College London, London, UK
| | - Killian S Hanlon
- Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Lennon
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew McArdle
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Agata Czap
- Division of Infection and Immunity, University College London, London, UK
| | - Joshua Rosenheim
- Division of Infection and Immunity, University College London, London, UK
| | - Catarina Andrade
- Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Glenn Anderson
- Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jack C D Lee
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rachel Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Charlotte A Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helena Tutill
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Nadua Bayzid
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Luz Marina Martin Bernal
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah Macpherson
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - Kylie-Ann Montgomery
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - Catherine Moore
- Wales Specialist Virology Centre, Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, UK
| | - Kate Templeton
- Department of Medical Microbiology, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Claire Neill
- Public Health Agency Northern Ireland, Belfast, UK
| | - Matt Holden
- School of Medicine, University of St. Andrews, St. Andrews, UK
- Public Health Scotland, Edinburgh, UK
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | | | - Priyen Shah
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Samantha Cooray
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marie Voice
- Micropathology Ltd, University of Warwick Science Park, Coventry, UK
| | - Michael Steele
- Micropathology Ltd, University of Warwick Science Park, Coventry, UK
| | - Colin Fink
- Micropathology Ltd, University of Warwick Science Park, Coventry, UK
| | - Thomas E Whittaker
- Molecular and Cellular Immunology, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Giorgia Santilli
- Molecular and Cellular Immunology, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paul Gissen
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Jana Reich
- Institute of Virology, Freie Universität Berlin, Berlin, Germany
| | - Julien Andreani
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Centre Hospitalier Universitaire (CHU) Grenoble-Alpes, Grenoble, France
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dimah K Alrabiah
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
- National Centre for Biotechnology, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Sergi Castellano
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
- University College London Genomics, University College London, London, UK
| | | | - Miranda Odam
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Tommy Rampling
- Division of Infection and Immunity, University College London, London, UK
- UK Health Security Agency, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catherine Houlihan
- Division of Infection and Immunity, University College London, London, UK
- UK Health Security Agency, London, UK
- Department of Clinical Virology, University College London Hospitals, London, UK
| | | | | | | | | | | | | | | | | | | | | | - James Hatcher
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Surjo De
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Malcolm Gracie Semple
- Pandemic Institute, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Joanne Martin
- Centre for Genomics and Child Health, The Blizard Institute, Queen Mary University of London, London, UK
| | | | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | | | | | | | - Rachel Brown
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Chayarani Kelgeri
- Liver Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Konstantinos Thalassinos
- University College London Mass Spectrometry Science Technology Platform, Division of Biosciences, University College London, London, UK
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, UK
- Institute of Structural and Molecular Biology, Birkbeck College, University of London, London, UK
| | - Simon N Waddington
- Gene Transfer Technology Group, EGA-Institute for Women's Health, University College London, London, UK
- Medical Research Council Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Thomas S Jacques
- Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emma Thomson
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Michael Levin
- Section for Paediatrics, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Julianne R Brown
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Judith Breuer
- Infection, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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9
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Pallett LJ, Swadling L, Diniz M, Maini AA, Schwabenland M, Gasull AD, Davies J, Kucykowicz S, Skelton JK, Thomas N, Schmidt NM, Amin OE, Gill US, Stegmann KA, Burton AR, Stephenson E, Reynolds G, Whelan M, Sanchez J, de Maeyer R, Thakker C, Suveizdyte K, Uddin I, Ortega-Prieto AM, Grant C, Froghi F, Fusai G, Lens S, Pérez-Del-Pulgar S, Al-Akkad W, Mazza G, Noursadeghi M, Akbar A, Kennedy PTF, Davidson BR, Prinz M, Chain BM, Haniffa M, Gilroy DW, Dorner M, Bengsch B, Schurich A, Maini MK. Tissue CD14 +CD8 + T cells reprogrammed by myeloid cells and modulated by LPS. Nature 2023; 614:334-342. [PMID: 36697826 DOI: 10.1038/s41586-022-05645-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 10/31/2018] [Accepted: 12/12/2022] [Indexed: 01/26/2023]
Abstract
The liver is bathed in bacterial products, including lipopolysaccharide transported from the intestinal portal vasculature, but maintains a state of tolerance that is exploited by persistent pathogens and tumours1-4. The cellular basis mediating this tolerance, yet allowing a switch to immunity or immunopathology, needs to be better understood for successful immunotherapy of liver diseases. Here we show that a variable proportion of CD8+ T cells compartmentalized in the human liver co-stain for CD14 and other prototypic myeloid membrane proteins and are enriched in close proximity to CD14high myeloid cells in hepatic zone 2. CD14+CD8+ T cells preferentially accumulate within the donor pool in liver allografts, among hepatic virus-specific and tumour-infiltrating responses, and in cirrhotic ascites. CD14+CD8+ T cells exhibit increased turnover, activation and constitutive immunomodulatory features with high homeostatic IL-10 and IL-2 production ex vivo, and enhanced antiviral/anti-tumour effector function after TCR engagement. This CD14+CD8+ T cell profile can be recapitulated by the acquisition of membrane proteins-including the lipopolysaccharide receptor complex-from mononuclear phagocytes, resulting in augmented tumour killing by TCR-redirected T cells in vitro. CD14+CD8+ T cells express integrins and chemokine receptors that favour interactions with the local stroma, which can promote their induction through CXCL12. Lipopolysaccharide can also increase the frequency of CD14+CD8+ T cells in vitro and in vivo, and skew their function towards the production of chemotactic and regenerative cytokines. Thus, bacterial products in the gut-liver axis and tissue stromal factors can tune liver immunity by driving myeloid instruction of CD8+ T cells with immunomodulatory ability.
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Affiliation(s)
- Laura J Pallett
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK.
| | - Leo Swadling
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Mariana Diniz
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | | | | | - Jessica Davies
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Stephanie Kucykowicz
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | - Niclas Thomas
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Nathalie M Schmidt
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Oliver E Amin
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Upkar S Gill
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kerstin A Stegmann
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Alice R Burton
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Emily Stephenson
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gary Reynolds
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matt Whelan
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Jenifer Sanchez
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Roel de Maeyer
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Clare Thakker
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Kornelija Suveizdyte
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Imran Uddin
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | | | - Farid Froghi
- Division of Surgery, University College London, London, UK
| | - Giuseppe Fusai
- Division of Surgery, University College London, London, UK
| | - Sabela Lens
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sofia Pérez-Del-Pulgar
- Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Walid Al-Akkad
- Institute for Liver & Digestive Health, University College London, London, UK
| | - Giuseppe Mazza
- Institute for Liver & Digestive Health, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Arne Akbar
- Division of Medicine, University College London, London, UK
| | - Patrick T F Kennedy
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Marco Prinz
- Institute of Neuropathology, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Benjamin M Chain
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | - Muzlifah Haniffa
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Derek W Gilroy
- Division of Medicine, University College London, London, UK
| | - Marcus Dorner
- Department of Medicine, Imperial College London, London, UK
| | - Bertram Bengsch
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
| | - Anna Schurich
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Mala K Maini
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK.
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10
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Gil E, Wall E, Noursadeghi M, Brown JS. Streptococcus pneumoniae meningitis and the CNS barriers. Front Cell Infect Microbiol 2023; 12:1106596. [PMID: 36683708 PMCID: PMC9845635 DOI: 10.3389/fcimb.2022.1106596] [Citation(s) in RCA: 1] [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: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Streptococcus pneumoniae (SPN) is a globally significant cause of meningitis, the pathophysiology of which involves damage to the brain by both bacterial virulence factors and the host inflammatory response. In most cases of SPN meningitis bacteria translocate from the blood into the central nervous system (CNS). The principal site of SPN translocation into the CNS is not known, with possible portals of entry proposed to be the cerebral or meningeal blood vessels or the choroid plexus. All require SPN to bind to and translocate across the vascular endothelial barrier, and subsequently the basement membrane and perivascular structures, including an additional epithelial barrier in the case of the blood-CSF barrier. The presence of SPN in the CNS is highly inflammatory resulting in marked neutrophilic infiltration. The secretion of toxic inflammatory mediators by activated neutrophils within the CNS damages pathogen and host alike, including the non-replicative neurons which drives morbidity and mortality. As with the translocation of SPN, the recruitment of neutrophils into the CNS in SPN meningitis necessitates the translocation of neutrophils from the circulation across the vascular barrier, a process that is tightly regulated under basal conditions - a feature of the 'immune specialization' of the CNS. The brain barriers are therefore central to SPN meningitis, both through a failure to exclude bacteria and maintain CNS sterility, and subsequently through the active recruitment and/or failure to exclude circulating leukocytes. The interactions of SPN with these barriers, barrier inflammatory responses, along with their therapeutic implications, are explored in this review.
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Affiliation(s)
- Eliza Gil
- Division of Infection and Immunity, University College London, London, United Kingdom,*Correspondence: Eliza Gil,
| | - Emma Wall
- Francis Crick Institute, London, United Kingdom,UCLH Biomedical Research Centre, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Jeremy S. Brown
- Division of Medicine, University College London, London, United Kingdom
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11
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Calderwood CJ, Reeve BW, Mann T, Palmer Z, Nyawo G, Mishra H, Ndlangalavu G, Abubakar I, Noursadeghi M, Theron G, Gupta RK. Clinical utility of C-reactive protein-based triage for presumptive pulmonary tuberculosis in South African adults. J Infect 2023; 86:24-32. [PMID: 36375640 PMCID: PMC10567578 DOI: 10.1016/j.jinf.2022.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Identification of an accurate, low-cost triage test for pulmonary TB among people presenting to healthcare facilities is an urgent global research priority. We assessed the diagnostic accuracy and clinical utility of C-reactive protein (CRP) for TB triage among symptomatic adult outpatients, irrespective of HIV status. METHODS We prospectively enrolled adults reporting at least one (for people with HIV) or two (for people without HIV) symptoms of cough, fever, night sweats, or weight loss at two TB clinics in Cape Town, South Africa. Participants provided sputum for culture and Xpert MTB/RIF Ultra. We evaluated the diagnostic accuracy of CRP (measured using a laboratory-based assay) against a TB-culture reference standard as the area under the receiver operating characteristic curve (AUROC), and sensitivity and specificity at pre-specified thresholds. We assessed clinical utility using decision curve analysis and benchmarked against WHO recommendations. RESULTS Of 932 included individuals, 255 (27%) had culture-confirmed pulmonary TB and 389 (42%) were living with HIV. CRP demonstrated an AUROC of 0·80 (95% confidence interval 0·77-0·83), with sensitivity 93% (89-95%) and specificity 54% (50-58%) using a primary cut-off of ≥10 mg/L. Performance was similar among people with HIV to those without. In decision curve analysis, CRP-based triage offered greater clinical utility than confirmatory testing for all up to a number willing to test threshold of 20 confirmatory tests per true positive pulmonary TB case diagnosed (threshold probability 5%). If it is possible to perform more confirmatory tests than this, a 'confirmatory test for all' strategy performed better. CONCLUSIONS CRP achieved the WHO-defined sensitivity, but not specificity, targets for a triage test for pulmonary TB and showed evidence of clinical utility among symptomatic outpatients, irrespective of HIV status. FUNDING South African Medical Research Council, EDCTP2, Royal Society Newton Advanced Fellowship, Wellcome Trust, National Institute of Health Research, Royal College of Physicians.
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Affiliation(s)
| | - Byron Wp Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tiffeney Mann
- Division of Infection and Immunity, University College London, London, UK
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Nyawo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hridesh Mishra
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gcobisa Ndlangalavu
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rishi K Gupta
- Institute for Global Health, University College London, London, UK.
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12
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Gupta RK, Noursadeghi M. Toward a more generalizable blood RNA signature for bacterial and viral infections. Cell Rep Med 2022; 3:100866. [PMID: 36543100 PMCID: PMC9798014 DOI: 10.1016/j.xcrm.2022.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Host-response profiles can discriminate different infections. A new 8-gene blood RNA signature to discriminate bacterial and viral infections extends our focus hitherto on the case mix from the US and Europe to include that of low- and middle-income countries.1 Challenges remain.
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Affiliation(s)
- Rishi K. Gupta
- Institute of Health Informatics, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK,Corresponding author
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13
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Periselneris J, Turner CT, Ercoli G, Szylar G, Weight CM, Thurston T, Whelan M, Tomlinson G, Noursadeghi M, Brown J. Pneumolysin suppresses the initial macrophage pro-inflammatory response to Streptococcus pneumoniae. Immunology 2022; 167:413-427. [PMID: 35835695 PMCID: PMC10497322 DOI: 10.1111/imm.13546] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
Published data for the Streptococcus pneumoniae virulence factor Pneumolysin (Ply) show contradictory effects on the host inflammatory response to infection. Ply has been shown to activate the inflammasome, but also can bind to MRC-1 resulting in suppression of dendritic cell inflammatory responses. We have used an in vitro infection model of human monocyte-derived macrophages (MDM), and a mouse model of pneumonia to clarify whether pro- or anti-inflammatory effects dominate the effects of Ply on the initial macrophage inflammatory response to S. pneumoniae, and the consequences during early lung infection. We found that infection with S. pneumoniae expressing Ply suppressed tumour necrosis factor (TNF) and interleukin-6 production by MDMs compared to cells infected with ply-deficient S. pneumoniae. This effect was independent of bacterial effects on cell death. Transcriptional analysis demonstrated S. pneumoniae expressing Ply caused a qualitatively similar but quantitatively lower MDM transcriptional response to S. pneumoniae compared to ply-deficient S. pneumoniae, with reduced expression of TNF and type I IFN inducible genes. Reduction of the MDM inflammatory response was prevented by inhibition of SOCS1. In the early lung infection mouse model, the TNF response to ply-deficient S. pneumoniae was enhanced and bacterial clearance increased compared to infection with wild-type S. pneumoniae. Overall, these data show Ply inhibits the initial macrophage inflammatory response to S. pneumoniae, probably mediated through SOCS1, and this was associated with improved immune evasion during early lung infection.
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Affiliation(s)
- Jimstan Periselneris
- Centre for Inflammation and Tissue Repair, Division of MedicineUniversity College Medical SchoolLondonUK
| | | | - Giuseppe Ercoli
- Centre for Inflammation and Tissue Repair, Division of MedicineUniversity College Medical SchoolLondonUK
| | - Gabriella Szylar
- Centre for Inflammation and Tissue Repair, Division of MedicineUniversity College Medical SchoolLondonUK
| | | | - Teresa Thurston
- MRC Centre for Molecular Bacteriology and InfectionImperial College LondonLondonUK
| | - Matthew Whelan
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | | | | | - Jeremy Brown
- Centre for Inflammation and Tissue Repair, Division of MedicineUniversity College Medical SchoolLondonUK
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14
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Captur G, Moon JC, Topriceanu CC, Joy G, Swadling L, Hallqvist J, Doykov I, Patel N, Spiewak J, Baldwin T, Hamblin M, Menacho K, Fontana M, Treibel TA, Manisty C, O'Brien B, Gibbons JM, Pade C, Brooks T, Altmann DM, Boyton RJ, McKnight Á, Maini MK, Noursadeghi M, Mills K, Heywood WE. Plasma proteomic signature predicts who will get persistent symptoms following SARS-CoV-2 infection. EBioMedicine 2022; 85:104293. [PMID: 36182629 PMCID: PMC9515404 DOI: 10.1016/j.ebiom.2022.104293] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The majority of those infected by ancestral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the UK first wave (starting March 2020) did not require hospitalisation. Most had a short-lived mild or asymptomatic infection, while others had symptoms that persisted for weeks or months. We hypothesized that the plasma proteome at the time of first infection would reflect differences in the inflammatory response that linked to symptom severity and duration. METHODS We performed a nested longitudinal case-control study and targeted analysis of the plasma proteome of 156 healthcare workers (HCW) with and without lab confirmed SARS-CoV-2 infection. Targeted proteomic multiple-reaction monitoring analysis of 91 pre-selected proteins was undertaken in uninfected healthcare workers at baseline, and in infected healthcare workers serially, from 1 week prior to 6 weeks after their first confirmed SARS-CoV-2 infection. Symptom severity and antibody responses were also tracked. Questionnaires at 6 and 12 months collected data on persistent symptoms. FINDINGS Within this cohort (median age 39 years, interquartile range 30-47 years), 54 healthcare workers (44% male) had PCR or antibody confirmed infection, with the remaining 102 (38% male) serving as uninfected controls. Following the first confirmed SARS-CoV-2 infection, perturbation of the plasma proteome persisted for up to 6 weeks, tracking symptom severity and antibody responses. Differentially abundant proteins were mostly coordinated around lipid, atherosclerosis and cholesterol metabolism pathways, complement and coagulation cascades, autophagy, and lysosomal function. The proteomic profile at the time of seroconversion associated with persistent symptoms out to 12 months. Data are available via ProteomeXchange with identifier PXD036590. INTERPRETATION Our findings show that non-severe SARS-CoV-2 infection perturbs the plasma proteome for at least 6 weeks. The plasma proteomic signature at the time of seroconversion has the potential to identify which individuals are more likely to suffer from persistent symptoms related to SARS-CoV-2 infection. FUNDING INFORMATION The COVIDsortium is supported by funding donated by individuals, charitable Trusts, and corporations including Goldman Sachs, Citadel and Citadel Securities, The Guy Foundation, GW Pharmaceuticals, Kusuma Trust, and Jagclif Charitable Trust, and enabled by Barts Charity with support from University College London Hospitals (UCLH) Charity. This work was additionally supported by the Translational Mass Spectrometry Research Group and the Biomedical Research Center (BRC) at Great Ormond Street Hospital.
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Affiliation(s)
- Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London WC1B 5JU, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; The Royal Free Hospital, Center for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London NW3 2QG, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Constantin-Cristian Topriceanu
- UCL MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London WC1B 5JU, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - George Joy
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Leo Swadling
- Division of Infection and Immunity, University College London, London WC1E 6JF, UK
| | - Jenny Hallqvist
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Ivan Doykov
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Nina Patel
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Justyna Spiewak
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Tomas Baldwin
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Matt Hamblin
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; The Royal Free Hospital, Cardiac MRI Unit, Pond Street, Hampstead, London NW3 2QG, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Ben O'Brien
- Department of Perioperative Medicine, St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Outcomes Research Consortium, Department of Outcomes Research, The Cleveland Clinic, 9500 Euclid Ave P77, Cleveland, OH 44195, USA
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Corrina Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London W12 0NN, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK; Lung Division, Royal Brompton Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 6NP, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London WC1E 6JF, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6JF, UK
| | - Kevin Mills
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Wendy E Heywood
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK.
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15
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Doykov I, Baldwin T, Spiewak J, Gilmour KC, Gibbons JM, Pade C, Reynolds CJ, Áine McKnight, Noursadeghi M, Maini MK, Manisty C, Treibel T, Captur G, Fontana M, Boyton RJ, Altmann DM, Brooks T, Semper A, Moon JC, Kevin Mills, Heywood WE, Abiodun A, Alfarih M, Alldis Z, Altmann DM, Amin OE, Andiapen M, Artico J, Augusto JB, Baca GL, Bailey SN, Bhuva AN, Boulter A, Bowles R, Boyton RJ, Bracken OV, O’Brien B, Brooks T, Bullock N, Butler DK, Captur G, Carr O, Champion N, Chan C, Chandran A, Coleman T, Couto de Sousa J, Couto-Parada X, Cross E, Cutino-Moguel T, D’Arcangelo S, Davies RH, Douglas B, Di Genova C, Dieobi-Anene K, Diniz MO, Ellis A, Feehan K, Finlay M, Fontana M, Forooghi N, Francis S, Gibbons JM, Gillespie D, Gilroy D, Hamblin M, Harker G, Hemingway G, Hewson J, Heywood W, Hickling LM, Hicks B, Hingorani AD, Howes L, Itua I, Jardim V, Lee WYJ, Jensen M, Jones J, Jones M, Joy G, Kapil V, Kelly C, Kurdi H, Lambourne J, Lin KM, Liu S, Lloyd A, Louth S, Maini MK, Mandadapu V, Manisty C, McKnight Á, Menacho K, Mfuko C, Mills K, Millward S, Mitchelmore O, Moon C, Moon J, Sandoval DM, Murray SM, Noursadeghi M, Otter A, Pade C, Palma S, Parker R, Patel K, Pawarova M, Petersen SE, Piniera B, Pieper FP, Rannigan L, Rapala A, Reynolds CJ, Richards A, Robathan M, Rosenheim J, Rowe C, Royds M, West JS, Sambile G, Schmidt NM, Selman H, Semper A, Seraphim A, Simion M, Smit A, Sugimoto M, Swadling L, Taylor S, Temperton N, Thomas S, Thornton GD, Treibel TA, Tucker A, Varghese A, Veerapen J, Vijayakumar M, Warner T, Welch S, White H, Wodehouse T, Wynne L, Zahedi D. Quantitative, multiplexed, targeted proteomics for ascertaining variant specific SARS-CoV-2 antibody response. Cell Rep Methods 2022; 2:100279. [PMID: 35975199 PMCID: PMC9372021 DOI: 10.1016/j.crmeth.2022.100279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 02/09/2023]
Abstract
Determining the protection an individual has to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VoCs) is crucial for future immune surveillance, vaccine development, and understanding of the changing immune response. We devised an informative assay to current ELISA-based serology using multiplexed, baited, targeted proteomics for direct detection of multiple proteins in the SARS-CoV-2 anti-spike antibody immunocomplex. Serum from individuals collected after infection or first- and second-dose vaccination demonstrates this approach and shows concordance with existing serology and neutralization. Our assays show altered responses of both immunoglobulins and complement to the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.1) VoCs and a reduced response to Omicron (B1.1.1529). We were able to identify individuals who had prior infection, and observed that C1q is closely associated with IgG1 (r > 0.82) and may better reflect neutralization to VoCs. Analyzing additional immunoproteins beyond immunoglobulin (Ig) G, provides important information about our understanding of the response to infection and vaccination.
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Affiliation(s)
- Ivan Doykov
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
| | - Tomas Baldwin
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK
| | - Justyna Spiewak
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK
| | - Kimberly C Gilmour
- Great Ormond Street Children's Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas Treibel
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK.,Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK.,Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.,Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | | | - James C Moon
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Kevin Mills
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
| | - Wendy E Heywood
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
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Abstract
Host innate and adaptive immunity to infection with Streptococcus pneumoniae is critically dependent on the complement system, demonstrated by the high incidence of invasive S. pneumoniae infection in people with inherited deficiency of complement components. The complement system is activated by S. pneumoniae through multiple mechanisms. The classical complement pathway is activated by recognition of S. pneumoniae by C-reactive protein, serum amyloid P, C1q, SIGN-R1, or natural or acquired antibody. Some S. pneumoniae strains are also recognised by ficolins to activate the mannose binding lectin (MBL) activation pathway. Complement activation is then amplified by the alternative complement pathway, which can also be activated by S. pneumoniae directly. Complement activation results in covalent linkage of the opsonic complement factors C3b and iC3b to the S. pneumoniae surface which promote phagocytic clearance, along with complement-mediated immune adherence to erythrocytes, thereby protecting against septicaemia. The role of complement for mucosal immunity to S. pneumoniae is less clear. Given the major role of complement in controlling infection with S. pneumoniae, it is perhaps unsurprising that S. pneumoniae has evolved multiple mechanisms of complement evasion, including the capsule, multiple surface proteins, and the toxin pneumolysin. There is considerable variation between S. pneumoniae capsular serotypes and genotypes with regards to sensitivity to complement which correlates with ability to cause invasive infections. However, at present we only have a limited understanding of the main mechanisms causing variations in complement sensitivity between S. pneumoniae strains and to non-pathogenic streptococci.
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Affiliation(s)
- Eliza Gil
- Division of Infection and Immunity, University College London, London, United Kingdom
- *Correspondence: Eliza Gil,
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Jeremy S. Brown
- Division of Medicine, University College London, London, United Kingdom
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17
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Gil E, Venturini C, Stirling D, Turner C, Tezera LB, Ercoli G, Baker T, Best K, Brown JS, Noursadeghi M. Pericyte derived chemokines amplify neutrophil recruitment across the cerebrovascular endothelial barrier. Front Immunol 2022; 13:935798. [PMID: 35967327 PMCID: PMC9371542 DOI: 10.3389/fimmu.2022.935798] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/04/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Excessive neutrophil extravasation can drive immunopathology, exemplified in pyogenic meningitis caused by Streptococcus pneumoniae infection. Insufficient knowledge of the mechanisms that amplify neutrophil extravasation has limited innovation in therapeutic targeting of neutrophil mediated pathology. Attention has focussed on neutrophil interactions with endothelia, but data from mouse models also point to a role for the underlying pericyte layer, as well as perivascular macrophages, the only other cell type found within the perivascular space in the cerebral microvasculature. We tested the hypothesis that human brain vascular pericytes (HBVP) contribute to neutrophil extravasation in a transwell model of the cerebral post-capillary venule. We show that pericytes augment endothelial barrier formation. In response to inflammatory cues, they significantly enhance neutrophil transmigration across the endothelial barrier, without increasing the permeability to small molecules. In our model, neither pericytes nor endothelia responded directly to bacterial stimulation. Instead, we show that paracrine signalling by multiple cytokines from monocyte derived macrophages drives transcriptional upregulation of multiple neutrophil chemokines by pericytes. Pericyte mediated amplification of neutrophil transmigration was independent of transcriptional responses by endothelia, but could be mediated by direct chemokine translocation across the endothelial barrier. Our data support a model in which microbial sensing by perivascular macrophages generates an inflammatory cascade where pericytes serve to amplify production of neutrophil chemokines that are translocated across the endothelial barrier to act directly on circulating neutrophils. In view of the striking redundancy in inflammatory cytokines that stimulate pericytes and in the neutrophil chemokines they produce, we propose that the mechanism of chemokine translocation may offer the most effective therapeutic target to reduce neutrophil mediated pathology in pyogenic meningitis.
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Affiliation(s)
- Eliza Gil
- Division of Infection and Immunity, University College London, London, United Kingdom
- *Correspondence: Eliza Gil, ; Mahdad Noursadeghi,
| | - Cristina Venturini
- Infection, Immunity and Inflammation Department, Institute for Child Health, University College London, London, United Kingdom
| | - David Stirling
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Carolin Turner
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Liku B. Tezera
- Division of Infection and Immunity, University College London, London, United Kingdom
- NIHR Biomedical Research Center, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Giuseppe Ercoli
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Tina Baker
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Katharine Best
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Jeremy S. Brown
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
- *Correspondence: Eliza Gil, ; Mahdad Noursadeghi,
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18
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Reynolds CJ, Pade C, Gibbons JM, Otter AD, Lin KM, Muñoz Sandoval D, Pieper FP, Butler DK, Liu S, Joy G, Forooghi N, Treibel TA, Manisty C, Moon JC, Semper A, Brooks T, McKnight Á, Altmann DM, Boyton RJ, Abbass H, Abiodun A, Alfarih M, Alldis Z, Altmann DM, Amin OE, Andiapen M, Artico J, Augusto JB, Baca GL, Bailey SNL, Bhuva AN, Boulter A, Bowles R, Boyton RJ, Bracken OV, O'Brien B, Brooks T, Bullock N, Butler DK, Captur G, Carr O, Champion N, Chan C, Chandran A, Coleman T, Couto de Sousa J, Couto-Parada X, Cross E, Cutino-Moguel T, D'Arcangelo S, Davies RH, Douglas B, Di Genova C, Dieobi-Anene K, Diniz MO, Ellis A, Feehan K, Finlay M, Fontana M, Forooghi N, Francis S, Gibbons JM, Gillespie D, Gilroy D, Hamblin M, Harker G, Hemingway G, Hewson J, Heywood W, Hickling LM, Hicks B, Hingorani AD, Howes L, Itua I, Jardim V, Lee WYJ, Jensen M, Jones J, Jones M, Joy G, Kapil V, Kelly C, Kurdi H, Lambourne J, Lin KM, Liu S, Lloyd A, Louth S, Maini MK, Mandadapu V, Manisty C, McKnight Á, Menacho K, Mfuko C, Mills K, Millward S, Mitchelmore O, Moon C, Moon J, Muñoz Sandoval D, Murray SM, Noursadeghi M, Otter A, Pade C, Palma S, Parker R, Patel K, Pawarova M, Petersen SE, Piniera B, Pieper FP, Rannigan L, Rapala A, Reynolds CJ, Richards A, Robathan M, Rosenheim J, Rowe C, Royds M, Sackville West J, Sambile G, Schmidt NM, Selman H, Semper A, Seraphim A, Simion M, Smit A, Sugimoto M, Swadling L, Taylor S, Temperton N, Thomas S, Thornton GD, Treibel TA, Tucker A, Varghese A, Veerapen J, Vijayakumar M, Warner T, Welch S, White H, Wodehouse T, Wynne L, Zahedi D, Chain B, Moon JC. Immune boosting by B.1.1.529 (Omicron) depends on previous SARS-CoV-2 exposure. Science 2022; 377:eabq1841. [PMID: 35699621 PMCID: PMC9210451 DOI: 10.1126/science.abq1841] [Citation(s) in RCA: 187] [Impact Index Per Article: 93.5] [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: 03/23/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
The Omicron, or Pango lineage B.1.1.529, variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carries multiple spike mutations with high transmissibility and partial neutralizing antibody (nAb) escape. Vaccinated individuals show protection against severe disease, often attributed to primed cellular immunity. We investigated T and B cell immunity against B.1.1.529 in triple BioNTech BNT162b2 messenger RNA-vaccinated health care workers (HCWs) with different SARS-CoV-2 infection histories. B and T cell immunity against previous variants of concern was enhanced in triple-vaccinated individuals, but the magnitude of T and B cell responses against B.1.1.529 spike protein was reduced. Immune imprinting by infection with the earlier B.1.1.7 (Alpha) variant resulted in less durable binding antibody against B.1.1.529. Previously infection-naïve HCWs who became infected during the B.1.1.529 wave showed enhanced immunity against earlier variants but reduced nAb potency and T cell responses against B.1.1.529 itself. Previous Wuhan Hu-1 infection abrogated T cell recognition and any enhanced cross-reactive neutralizing immunity on infection with B.1.1.529.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | - George Joy
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nasim Forooghi
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | | | | | | | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.,Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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19
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de Jong VMT, Rousset RZ, Antonio-Villa NE, Buenen AG, Van Calster B, Bello-Chavolla OY, Brunskill NJ, Curcin V, Damen JAA, Fermín-Martínez CA, Fernández-Chirino L, Ferrari D, Free RC, Gupta RK, Haldar P, Hedberg P, Korang SK, Kurstjens S, Kusters R, Major RW, Maxwell L, Nair R, Naucler P, Nguyen TL, Noursadeghi M, Rosa R, Soares F, Takada T, van Royen FS, van Smeden M, Wynants L, Modrák M, Asselbergs FW, Linschoten M, Moons KGM, Debray TPA. Clinical prediction models for mortality in patients with covid-19: external validation and individual participant data meta-analysis. BMJ 2022; 378:e069881. [PMID: 35820692 PMCID: PMC9273913 DOI: 10.1136/bmj-2021-069881] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To externally validate various prognostic models and scoring rules for predicting short term mortality in patients admitted to hospital for covid-19. DESIGN Two stage individual participant data meta-analysis. SETTING Secondary and tertiary care. PARTICIPANTS 46 914 patients across 18 countries, admitted to a hospital with polymerase chain reaction confirmed covid-19 from November 2019 to April 2021. DATA SOURCES Multiple (clustered) cohorts in Brazil, Belgium, China, Czech Republic, Egypt, France, Iran, Israel, Italy, Mexico, Netherlands, Portugal, Russia, Saudi Arabia, Spain, Sweden, United Kingdom, and United States previously identified by a living systematic review of covid-19 prediction models published in The BMJ, and through PROSPERO, reference checking, and expert knowledge. MODEL SELECTION AND ELIGIBILITY CRITERIA Prognostic models identified by the living systematic review and through contacting experts. A priori models were excluded that had a high risk of bias in the participant domain of PROBAST (prediction model study risk of bias assessment tool) or for which the applicability was deemed poor. METHODS Eight prognostic models with diverse predictors were identified and validated. A two stage individual participant data meta-analysis was performed of the estimated model concordance (C) statistic, calibration slope, calibration-in-the-large, and observed to expected ratio (O:E) across the included clusters. MAIN OUTCOME MEASURES 30 day mortality or in-hospital mortality. RESULTS Datasets included 27 clusters from 18 different countries and contained data on 46 914patients. The pooled estimates ranged from 0.67 to 0.80 (C statistic), 0.22 to 1.22 (calibration slope), and 0.18 to 2.59 (O:E ratio) and were prone to substantial between study heterogeneity. The 4C Mortality Score by Knight et al (pooled C statistic 0.80, 95% confidence interval 0.75 to 0.84, 95% prediction interval 0.72 to 0.86) and clinical model by Wang et al (0.77, 0.73 to 0.80, 0.63 to 0.87) had the highest discriminative ability. On average, 29% fewer deaths were observed than predicted by the 4C Mortality Score (pooled O:E 0.71, 95% confidence interval 0.45 to 1.11, 95% prediction interval 0.21 to 2.39), 35% fewer than predicted by the Wang clinical model (0.65, 0.52 to 0.82, 0.23 to 1.89), and 4% fewer than predicted by Xie et al's model (0.96, 0.59 to 1.55, 0.21 to 4.28). CONCLUSION The prognostic value of the included models varied greatly between the data sources. Although the Knight 4C Mortality Score and Wang clinical model appeared most promising, recalibration (intercept and slope updates) is needed before implementation in routine care.
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Affiliation(s)
- Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Rebecca Z Rousset
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Neftalí Eduardo Antonio-Villa
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
- EPI-centre, KU Leuven, Leuven, Belgium
| | | | - Nigel J Brunskill
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Carlos A Fermín-Martínez
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Faculty of Chemistry, Universidad Nacional Autónoma de México, México City, Mexico
| | - Davide Ferrari
- School of Population Health and Environmental Sciences, King's College London, London, UK
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Robert C Free
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Pranabashis Haldar
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pontus Hedberg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Steef Kurstjens
- Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Ron Kusters
- Laboratory of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Den Bosch, Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Rupert W Major
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Lauren Maxwell
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Germany
| | - Rajeshwari Nair
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Centre for Access and Delivery Research Evaluation Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Tri-Long Nguyen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Pharmacy, University Hospital Centre of Nîmes, Nîmes, France
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Rossana Rosa
- Infectious Diseases Service, UnityPoint Health-Des Moines, Des Moines, IA, USA
| | - Felipe Soares
- Industrial Engineering Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Florien S van Royen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Laure Wynants
- Bernhoven, Uden, Netherlands
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Martin Modrák
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Netherlands
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20
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Knight SR, Gupta RK, Ho A, Pius R, Buchan I, Carson G, Drake TM, Dunning J, Fairfield CJ, Gamble C, Green CA, Halpin S, Hardwick HE, Holden KA, Horby PW, Jackson C, Mclean KA, Merson L, Nguyen-Van-Tam JS, Norman L, Olliaro PL, Pritchard MG, Russell CD, Shaw CA, Sheikh A, Solomon T, Sudlow C, Swann OV, Turtle LCW, Openshaw PJM, Baillie JK, Docherty A, Semple MG, Noursadeghi M, Harrison EM. Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. Thorax 2022; 77:606-615. [PMID: 34810237 PMCID: PMC8610617 DOI: 10.1136/thoraxjnl-2021-217629] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19. METHODS Prospective observational cohort study of adults (age ≥18 years) with confirmed or highly suspected COVID-19 recruited into the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study in 306 hospitals across England, Scotland and Wales. Patients were recruited between 27 August 2020 and 17 February 2021, with at least 4 weeks follow-up before final data extraction. The main outcome measures were discrimination and calibration of models for in-hospital deterioration (defined as any requirement of ventilatory support or critical care, or death) and mortality, incorporating predefined subgroups. RESULTS 76 588 participants were included, of whom 27 352 (37.4%) deteriorated and 12 581 (17.4%) died. Both the 4C Mortality (0.78 (0.77 to 0.78)) and 4C Deterioration scores (pooled C-statistic 0.76 (95% CI 0.75 to 0.77)) demonstrated consistent discrimination across all nine National Health Service regions, with similar performance metrics to the original validation cohorts. Calibration remained stable (4C Mortality: pooled slope 1.09, pooled calibration-in-the-large 0.12; 4C Deterioration: 1.00, -0.04), with no need for temporal recalibration during the second UK pandemic wave of hospital admissions. CONCLUSION Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making. TRIAL REGISTRATION NUMBER ISRCTN66726260.
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Affiliation(s)
- Stephen R Knight
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Rishi K Gupta
- University College London Institute for Global Health, London, UK
| | - Antonia Ho
- Medical Research Council University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Riinu Pius
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Iain Buchan
- Manchester Academic Health Science Centre, Manchester, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Gail Carson
- Nuffield Department of Clinical Medicine, ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Thomas M Drake
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Jake Dunning
- Public Health England National Infection Service, Salisbury, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Christopher A Green
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Sophie Halpin
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hayley E Hardwick
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Karl A Holden
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Peter W Horby
- Nuffield Department of Clinical Medicine, ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Clare Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Kenneth A Mclean
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Laura Merson
- Nuffield Department of Clinical Medicine, ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Lisa Norman
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Piero L Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Mark G Pritchard
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Clark D Russell
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Catherine A Shaw
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tom Solomon
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Olivia V Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Lance C W Turtle
- Clinical Infection, Microbiology and Immunology, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | | | - J Kenneth Baillie
- Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, University of Liverpool, Liverpool, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
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21
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Astbury S, Reynolds CJ, Butler DK, Muñoz‐Sandoval DC, Lin K, Pieper FP, Otter A, Kouraki A, Cusin L, Nightingale J, Vijay A, Craxford S, Aithal GP, Tighe PJ, Gibbons JM, Pade C, Joy G, Maini M, Chain B, Semper A, Brooks T, Ollivere BJ, McKnight Á, Noursadeghi M, Treibel TA, Manisty C, Moon JC, Valdes AM, Boyton RJ, Altmann DM. HLA-DR polymorphism in SARS-CoV-2 infection and susceptibility to symptomatic COVID-19. Immunology 2022; 166:68-77. [PMID: 35156709 PMCID: PMC9111350 DOI: 10.1111/imm.13450] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 infection results in different outcomes ranging from asymptomatic infection to mild or severe disease and death. Reasons for this diversity of outcome include differences in challenge dose, age, gender, comorbidity and host genomic variation. Human leukocyte antigen (HLA) polymorphisms may influence immune response and disease outcome. We investigated the association of HLAII alleles with case definition symptomatic COVID-19, virus-specific antibody and T-cell immunity. A total of 1364 UK healthcare workers (HCWs) were recruited during the first UK SARS-CoV-2 wave and analysed longitudinally, encompassing regular PCR screening for infection, symptom reporting, imputation of HLAII genotype and analysis for antibody and T-cell responses to nucleoprotein (N) and spike (S). Of 272 (20%) HCW who seroconverted, the presence of HLA-DRB1*13:02 was associated with a 6·7-fold increased risk of case definition symptomatic COVID-19. In terms of immune responsiveness, HLA-DRB1*15:02 was associated with lower nucleocapsid T-cell responses. There was no association between DRB1 alleles and anti-spike antibody titres after two COVID vaccine doses. However, HLA DRB1*15:01 was associated with increased spike T-cell responses following both first and second dose vaccination. Trial registration: NCT04318314 and ISRCTN15677965.
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Affiliation(s)
- Stuart Astbury
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | | | - David K. Butler
- Department of Infectious DiseaseImperial College LondonLondonUK
| | | | - Kai‐Min Lin
- Department of Infectious DiseaseImperial College LondonLondonUK
| | | | - Ashley Otter
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Afroditi Kouraki
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Lola Cusin
- School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | | | - Joseph M. Gibbons
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | - Corinna Pade
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | - George Joy
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
| | - Mala Maini
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Benny Chain
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Amanda Semper
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Timothy Brooks
- National Infection ServicePublic Health EnglandPorton DownUK
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Áine McKnight
- Barts and the London School of Medicine and DentistryBlizard InstituteQueen Mary University of LondonLondonUK
| | | | - Thomas A. Treibel
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Charlotte Manisty
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - James C. Moon
- Barts Heart CentreSt. Bartholomew's HospitalLondonUK
- Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Ana M. Valdes
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Division of Rheumatology, Orthopaedics and DermatologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - Rosemary J. Boyton
- Department of Infectious DiseaseImperial College LondonLondonUK
- Lung DivisionRoyal Brompton and Harefield HospitalsGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Daniel M. Altmann
- Department of Immunology and InflammationImperial College LondonLondonUK
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22
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Reuschl AK, Mesner D, Shivkumar M, Whelan MVX, Pallett LJ, Guerra-Assunção JA, Madansein R, Dullabh KJ, Sigal A, Thornhill JP, Herrera C, Fidler S, Noursadeghi M, Maini MK, Jolly C. HIV-1 Vpr drives a tissue residency-like phenotype during selective infection of resting memory T cells. Cell Rep 2022; 39:110650. [PMID: 35417711 PMCID: PMC9350556 DOI: 10.1016/j.celrep.2022.110650] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
HIV-1 replicates in CD4+ T cells, leading to AIDS. Determining how HIV-1 shapes its niche to create a permissive environment is central to informing efforts to limit pathogenesis, disturb reservoirs, and achieve a cure. A key roadblock in understanding HIV-T cell interactions is the requirement to activate T cells in vitro to make them permissive to infection. This dramatically alters T cell biology and virus-host interactions. Here we show that HIV-1 cell-to-cell spread permits efficient, productive infection of resting memory T cells without prior activation. Strikingly, we find that HIV-1 infection primes resting T cells to gain characteristics of tissue-resident memory T cells (TRM), including upregulating key surface markers and the transcription factor Blimp-1 and inducing a transcriptional program overlapping the core TRM transcriptional signature. This reprogramming is driven by Vpr and requires Vpr packaging into virions and manipulation of STAT5. Thus, HIV-1 reprograms resting T cells, with implications for viral replication and persistence.
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Affiliation(s)
- Ann-Kathrin Reuschl
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK.
| | - Dejan Mesner
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Maitreyi Shivkumar
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Matthew V X Whelan
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Laura J Pallett
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | | | - Rajhmun Madansein
- Department of Cardiothoracic Surgery, University of KwaZulu-Natal, Durban 4091, South Africa; Centre for the AIDS Programme of Research in South Africa, Durban 4091, South Africa
| | - Kaylesh J Dullabh
- Department of Cardiothoracic Surgery, University of KwaZulu-Natal, Durban 4091, South Africa
| | - Alex Sigal
- Africa Health Research Institute, Durban 4001, South Africa; School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4091, South Africa; Max Planck Institute for Infection Biology, 10117 Berlin, Germany
| | - John P Thornhill
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford OX1 3XY, UK; Department of Infectious Disease, Faculty of Medicine, Imperial College, London W2 1NY, UK
| | - Carolina Herrera
- Department of Infectious Disease, Faculty of Medicine, Imperial College, London W2 1NY, UK
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College, London W2 1NY, UK; Imperial College NIHR Biomedical Research Centre, London W2 1NY, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK.
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23
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Thorne LG, Bouhaddou M, Reuschl AK, Zuliani-Alvarez L, Polacco B, Pelin A, Batra J, Whelan MVX, Hosmillo M, Fossati A, Ragazzini R, Jungreis I, Ummadi M, Rojc A, Turner J, Bischof ML, Obernier K, Braberg H, Soucheray M, Richards A, Chen KH, Harjai B, Memon D, Hiatt J, Rosales R, McGovern BL, Jahun A, Fabius JM, White K, Goodfellow IG, Takeuchi Y, Bonfanti P, Shokat K, Jura N, Verba K, Noursadeghi M, Beltrao P, Kellis M, Swaney DL, García-Sastre A, Jolly C, Towers GJ, Krogan NJ. Publisher Correction: Evolution of enhanced innate immune evasion by SARS-CoV-2. Nature 2022; 604:E14. [PMID: 35332335 PMCID: PMC8944406 DOI: 10.1038/s41586-022-04653-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Lucy G Thorne
- Division of Infection and Immunity, University College London, London, UK
| | - Mehdi Bouhaddou
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lorena Zuliani-Alvarez
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Ben Polacco
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Adrian Pelin
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Jyoti Batra
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Matthew V X Whelan
- Division of Infection and Immunity, University College London, London, UK
| | - Myra Hosmillo
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Andrea Fossati
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta Ragazzini
- Epithelial Stem Cell Biology and Regenerative Medicine Laboratory, The Francis Crick Institute, London, UK
| | - Irwin Jungreis
- MIT Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Manisha Ummadi
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Ajda Rojc
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Jane Turner
- Division of Infection and Immunity, University College London, London, UK
| | - Marie L Bischof
- Division of Infection and Immunity, University College London, London, UK
| | - Kirsten Obernier
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Hannes Braberg
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Soucheray
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Alicia Richards
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Kuei-Ho Chen
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Bhavya Harjai
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Danish Memon
- European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Joseph Hiatt
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Romel Rosales
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Briana L McGovern
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aminu Jahun
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Jacqueline M Fabius
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Kris White
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ian G Goodfellow
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Yasu Takeuchi
- Division of Infection and Immunity, University College London, London, UK
| | - Paola Bonfanti
- Epithelial Stem Cell Biology and Regenerative Medicine Laboratory, The Francis Crick Institute, London, UK
| | - Kevan Shokat
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA.,Howard Hughes Medical Institute, San Francisco, CA, USA
| | - Natalia Jura
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA.,Division of Advanced Therapies, National Institute for Biological Standards and Control, South Mimms, UK.,Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Klim Verba
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Pedro Beltrao
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Manolis Kellis
- MIT Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Danielle L Swaney
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.,J. David Gladstone Institutes, San Francisco, CA, USA.,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London, UK.
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK.
| | - Nevan J Krogan
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA. .,Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA. .,J. David Gladstone Institutes, San Francisco, CA, USA. .,Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA.
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24
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Chandran A, Rosenheim J, Nageswaran G, Swadling L, Pollara G, Gupta RK, Burton AR, Guerra-Assunção JA, Woolston A, Ronel T, Pade C, Gibbons JM, Sanz-Magallon Duque De Estrada B, Robert de Massy M, Whelan M, Semper A, Brooks T, Altmann DM, Boyton RJ, McKnight Á, Captur G, Manisty C, Treibel TA, Moon JC, Tomlinson GS, Maini MK, Chain BM, Noursadeghi M. Rapid synchronous type 1 IFN and virus-specific T cell responses characterize first wave non-severe SARS-CoV-2 infections. Cell Rep Med 2022; 3:100557. [PMID: 35474751 PMCID: PMC8895494 DOI: 10.1016/j.xcrm.2022.100557] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Effective control of SARS-CoV-2 infection on primary exposure may reveal correlates of protective immunity to future variants, but we lack insights into immune responses before or at the time virus is first detected. We use blood transcriptomics, multiparameter flow cytometry, and T cell receptor (TCR) sequencing spanning the time of incident non-severe infection in unvaccinated virus-naive individuals to identify rapid type 1 interferon (IFN) responses common to other acute respiratory viruses and cell proliferation responses that discriminate SARS-CoV-2 from other viruses. These peak by the time the virus is first detected and sometimes precede virus detection. Cell proliferation is most evident in CD8 T cells and associated with specific expansion of SARS-CoV-2-reactive TCRs, in contrast to virus-specific antibodies, which lag by 1-2 weeks. Our data support a protective role for early type 1 IFN and CD8 T cell responses, with implications for development of universal T cell vaccines.
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Affiliation(s)
- Aneesh Chandran
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Joshua Rosenheim
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Gayathri Nageswaran
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Leo Swadling
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Rishi K. Gupta
- Institute for Global Health, University College London, London WC1E 6BT, UK
| | - Alice R. Burton
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | | | - Annemarie Woolston
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Tahel Ronel
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Joseph M. Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | | | - Marc Robert de Massy
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Matthew Whelan
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, Salisbury SP4 0JQ, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, Salisbury SP4 0JQ, UK
| | - Daniel M. Altmann
- Department of Immunology and Inflammation, Imperial College London, London SW7 2BX, UK
| | - Rosemary J. Boyton
- Department of Infectious Disease, Imperial College London, London SW7 2BX, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Gabriella Captur
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London WC1E 6BT, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | | | - James C. Moon
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Gillian S. Tomlinson
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Mala K. Maini
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Benjamin M. Chain
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | - COVIDsortium Investigators
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
- Institute for Global Health, University College London, London WC1E 6BT, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- National Infection Service, Public Health England, Porton Down, Salisbury SP4 0JQ, UK
- Department of Immunology and Inflammation, Imperial College London, London SW7 2BX, UK
- Department of Infectious Disease, Imperial College London, London SW7 2BX, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas' NHS Foundation Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London WC1E 6BT, UK
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25
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Mehta R, Chekmeneva E, Jackson H, Sands C, Mills E, Arancon D, Li HK, Arkell P, Rawson TM, Hammond R, Amran M, Haber A, Cooke GS, Noursadeghi M, Kaforou M, Lewis MR, Takats Z, Sriskandan S. Antiviral metabolite 3'-deoxy-3',4'-didehydro-cytidine is detectable in serum and identifies acute viral infections including COVID-19. Med 2022; 3:204-215.e6. [PMID: 35128501 PMCID: PMC8801973 DOI: 10.1016/j.medj.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/14/2021] [Accepted: 01/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a critical need for rapid viral infection diagnostics to enable prompt case identification in pandemic settings and support targeted antimicrobial prescribing. METHODS Using untargeted high-resolution liquid chromatography coupled with mass spectrometry, we compared the admission serum metabolome of emergency department patients with viral infections (including COVID-19), bacterial infections, inflammatory conditions, and healthy controls. Sera from an independent cohort of emergency department patients admitted with viral or bacterial infections underwent profiling to validate findings. Associations between whole-blood gene expression and the identified metabolite of interest were examined. FINDINGS 3'-Deoxy-3',4'-didehydro-cytidine (ddhC), a free base of the only known human antiviral small molecule ddhC-triphosphate (ddhCTP), was detected for the first time in serum. When comparing 60 viral with 101 non-viral cases in the discovery cohort, ddhC was the most significantly differentially abundant metabolite, generating an area under the receiver operating characteristic curve (AUC) of 0.954 (95% CI: 0.923-0.986). In the validation cohort, ddhC was again the most significantly differentially abundant metabolite when comparing 40 viral with 40 bacterial cases, generating an AUC of 0.81 (95% CI 0.708-0.915). Transcripts of viperin and CMPK2, enzymes responsible for ddhCTP synthesis, were among the five genes most highly correlated with ddhC abundance. CONCLUSIONS The antiviral precursor molecule ddhC is detectable in serum and an accurate marker for acute viral infection. Interferon-inducible genes viperin and CMPK2 are implicated in ddhC production in vivo. These findings highlight a future diagnostic role for ddhC in viral diagnosis, pandemic preparedness, and acute infection management. FUNDING NIHR Imperial BRC; UKRI.
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Affiliation(s)
- Ravi Mehta
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Elena Chekmeneva
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Heather Jackson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Caroline Sands
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Ewurabena Mills
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | | | - Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
| | - Paul Arkell
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Timothy M. Rawson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Robert Hammond
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Maisarah Amran
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Anna Haber
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Matthew R. Lewis
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Zoltan Takats
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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26
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Thorne LG, Bouhaddou M, Reuschl AK, Zuliani-Alvarez L, Polacco B, Pelin A, Batra J, Whelan MVX, Hosmillo M, Fossati A, Ragazzini R, Jungreis I, Ummadi M, Rojc A, Turner J, Bischof ML, Obernier K, Braberg H, Soucheray M, Richards A, Chen KH, Harjai B, Memon D, Hiatt J, Rosales R, McGovern BL, Jahun A, Fabius JM, White K, Goodfellow IG, Takeuchi Y, Bonfanti P, Shokat K, Jura N, Verba K, Noursadeghi M, Beltrao P, Kellis M, Swaney DL, García-Sastre A, Jolly C, Towers GJ, Krogan NJ. Evolution of enhanced innate immune evasion by SARS-CoV-2. Nature 2022; 602:487-495. [PMID: 34942634 PMCID: PMC8850198 DOI: 10.1038/s41586-021-04352-y] [Citation(s) in RCA: 175] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
The emergence of SARS-CoV-2 variants of concern suggests viral adaptation to enhance human-to-human transmission1,2. Although much effort has focused on the characterization of changes in the spike protein in variants of concern, mutations outside of spike are likely to contribute to adaptation. Here, using unbiased abundance proteomics, phosphoproteomics, RNA sequencing and viral replication assays, we show that isolates of the Alpha (B.1.1.7) variant3 suppress innate immune responses in airway epithelial cells more effectively than first-wave isolates. We found that the Alpha variant has markedly increased subgenomic RNA and protein levels of the nucleocapsid protein (N), Orf9b and Orf6-all known innate immune antagonists. Expression of Orf9b alone suppressed the innate immune response through interaction with TOM70, a mitochondrial protein that is required for activation of the RNA-sensing adaptor MAVS. Moreover, the activity of Orf9b and its association with TOM70 was regulated by phosphorylation. We propose that more effective innate immune suppression, through enhanced expression of specific viral antagonist proteins, increases the likelihood of successful transmission of the Alpha variant, and may increase in vivo replication and duration of infection4. The importance of mutations outside the spike coding region in the adaptation of SARS-CoV-2 to humans is underscored by the observation that similar mutations exist in the N and Orf9b regulatory regions of the Delta and Omicron variants.
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Affiliation(s)
- Lucy G Thorne
- Division of Infection and Immunity, University College London, London, UK
| | - Mehdi Bouhaddou
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lorena Zuliani-Alvarez
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Ben Polacco
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Adrian Pelin
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Jyoti Batra
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Matthew V X Whelan
- Division of Infection and Immunity, University College London, London, UK
| | - Myra Hosmillo
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Andrea Fossati
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta Ragazzini
- Epithelial Stem Cell Biology and Regenerative Medicine Laboratory, The Francis Crick Institute, London, UK
| | - Irwin Jungreis
- MIT Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Manisha Ummadi
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Ajda Rojc
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Jane Turner
- Division of Infection and Immunity, University College London, London, UK
| | - Marie L Bischof
- Division of Infection and Immunity, University College London, London, UK
| | - Kirsten Obernier
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Hannes Braberg
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Soucheray
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Alicia Richards
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Kuei-Ho Chen
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Bhavya Harjai
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Danish Memon
- European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Joseph Hiatt
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Romel Rosales
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Briana L McGovern
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aminu Jahun
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Jacqueline M Fabius
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Kris White
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ian G Goodfellow
- Division of Virology, Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Yasu Takeuchi
- Division of Infection and Immunity, University College London, London, UK
| | - Paola Bonfanti
- Epithelial Stem Cell Biology and Regenerative Medicine Laboratory, The Francis Crick Institute, London, UK
| | - Kevan Shokat
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, San Francisco, CA, USA
| | - Natalia Jura
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
- Division of Advanced Therapies, National Institute for Biological Standards and Control, South Mimms, UK
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Klim Verba
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Pedro Beltrao
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Manolis Kellis
- MIT Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Danielle L Swaney
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London, UK.
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK.
| | - Nevan J Krogan
- QBI Coronavirus Research Group (QCRG), University of California San Francisco, San Francisco, CA, USA.
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA.
- J. David Gladstone Institutes, San Francisco, CA, USA.
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA, USA.
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27
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Reynolds CJ, Gibbons JM, Pade C, Lin KM, Sandoval DM, Pieper F, Butler DK, Liu S, Otter AD, Joy G, Menacho K, Fontana M, Smit A, Kele B, Cutino-Moguel T, Maini MK, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, McKnight Á, Altmann DM, Boyton RJ. Heterologous infection and vaccination shapes immunity against SARS-CoV-2 variants. Science 2022; 375:183-192. [PMID: 34855510 PMCID: PMC10186585 DOI: 10.1126/science.abm0811] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [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: 08/25/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022]
Abstract
The impact of the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecting strain on downstream immunity to heterologous variants of concern (VOCs) is unknown. Studying a longitudinal healthcare worker cohort, we found that after three antigen exposures (infection plus two vaccine doses), S1 antibody, memory B cells, and heterologous neutralization of B.1.351, P.1, and B.1.617.2 plateaued, whereas B.1.1.7 neutralization and spike T cell responses increased. Serology using the Wuhan Hu-1 spike receptor binding domain poorly predicted neutralizing immunity against VOCs. Neutralization potency against VOCs changed with heterologous virus encounter and number of antigen exposures. Neutralization potency fell differentially depending on targeted VOCs over the 5 months from the second vaccine dose. Heterologous combinations of spike encountered during infection and vaccination shape subsequent cross-protection against VOC, with implications for future-proof next-generation vaccines.
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Affiliation(s)
| | - Joseph M. Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Franziska Pieper
- Department of Infectious Disease, Imperial College London, London, UK
| | - David K. Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - George Joy
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Katia Menacho
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Beatrix Kele
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Mala K. Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - COVIDsortium Immune Correlates Network‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | - Charlotte Manisty
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A. Treibel
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C. Moon
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - COVIDsortium Investigators‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M. Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J. Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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28
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Swadling L, Diniz MO, Schmidt NM, Amin OE, Chandran A, Shaw E, Pade C, Gibbons JM, Le Bert N, Tan AT, Jeffery-Smith A, Tan CCS, Tham CYL, Kucykowicz S, Aidoo-Micah G, Rosenheim J, Davies J, Johnson M, Jensen MP, Joy G, McCoy LE, Valdes AM, Chain BM, Goldblatt D, Altmann DM, Boyton RJ, Manisty C, Treibel TA, Moon JC, van Dorp L, Balloux F, McKnight Á, Noursadeghi M, Bertoletti A, Maini MK. Pre-existing polymerase-specific T cells expand in abortive seronegative SARS-CoV-2. Nature 2022; 601:110-117. [PMID: 34758478 PMCID: PMC8732273 DOI: 10.1038/s41586-021-04186-8] [Citation(s) in RCA: 229] [Impact Index Per Article: 114.5] [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: 06/17/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Individuals with potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) do not necessarily develop PCR or antibody positivity, suggesting that some individuals may clear subclinical infection before seroconversion. T cells can contribute to the rapid clearance of SARS-CoV-2 and other coronavirus infections1-3. Here we hypothesize that pre-existing memory T cell responses, with cross-protective potential against SARS-CoV-2 (refs. 4-11), would expand in vivo to support rapid viral control, aborting infection. We measured SARS-CoV-2-reactive T cells, including those against the early transcribed replication-transcription complex (RTC)12,13, in intensively monitored healthcare workers (HCWs) who tested repeatedly negative according to PCR, antibody binding and neutralization assays (seronegative HCWs (SN-HCWs)). SN-HCWs had stronger, more multispecific memory T cells compared with a cohort of unexposed individuals from before the pandemic (prepandemic cohort), and these cells were more frequently directed against the RTC than the structural-protein-dominated responses observed after detectable infection (matched concurrent cohort). SN-HCWs with the strongest RTC-specific T cells had an increase in IFI27, a robust early innate signature of SARS-CoV-2 (ref. 14), suggesting abortive infection. RNA polymerase within RTC was the largest region of high sequence conservation across human seasonal coronaviruses (HCoV) and SARS-CoV-2 clades. RNA polymerase was preferentially targeted (among the regions tested) by T cells from prepandemic cohorts and SN-HCWs. RTC-epitope-specific T cells that cross-recognized HCoV variants were identified in SN-HCWs. Enriched pre-existing RNA-polymerase-specific T cells expanded in vivo to preferentially accumulate in the memory response after putative abortive compared to overt SARS-CoV-2 infection. Our data highlight RTC-specific T cells as targets for vaccines against endemic and emerging Coronaviridae.
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Affiliation(s)
- Leo Swadling
- Division of Infection and Immunity, University College London, London, UK.
| | - Mariana O Diniz
- Division of Infection and Immunity, University College London, London, UK
| | - Nathalie M Schmidt
- Division of Infection and Immunity, University College London, London, UK
| | - Oliver E Amin
- Division of Infection and Immunity, University College London, London, UK
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London, UK
| | - Emily Shaw
- Division of Infection and Immunity, University College London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nina Le Bert
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
| | - Anthony T Tan
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
| | - Anna Jeffery-Smith
- Division of Infection and Immunity, University College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Cedric C S Tan
- UCL Genetics Institute, University College London, London, UK
| | - Christine Y L Tham
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Joshua Rosenheim
- Division of Infection and Immunity, University College London, London, UK
| | - Jessica Davies
- Division of Infection and Immunity, University College London, London, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health NIHR Biomedical Research Centre, University College London, London, UK
| | - Melanie P Jensen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Laura E McCoy
- Division of Infection and Immunity, University College London, London, UK
| | - Ana M Valdes
- Academic Rheumatology, Clinical Sciences, Nottingham City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Benjamin M Chain
- Division of Infection and Immunity, University College London, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health NIHR Biomedical Research Centre, University College London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Lung Division, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charlotte Manisty
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Lucy van Dorp
- UCL Genetics Institute, University College London, London, UK
| | | | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Antonio Bertoletti
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
- Singapore Immunology Network, A*STAR, Singapore, Singapore
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK.
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29
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Rodel HE, Ferreira IATM, Ziegler CGK, Ganga Y, Bernstein M, Hwa SH, Nargan K, Lustig G, Kaplan G, Noursadeghi M, Shalek AK, Steyn AJC, Sigal A. Aggregated Mycobacterium tuberculosis Enhances the Inflammatory Response. Front Microbiol 2021; 12:757134. [PMID: 34925266 PMCID: PMC8674758 DOI: 10.3389/fmicb.2021.757134] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Mycobacterium tuberculosis (Mtb) bacilli readily aggregate. We previously reported that Mtb aggregates lead to phagocyte death and subsequent efficient replication in the dead infected cells. Here, we examined the transcriptional response of human monocyte derived macrophages to phagocytosis of aggregated Mtb relative to phagocytosis of non-aggregated single or multiple bacilli. Infection with aggregated Mtb led to an early upregulation of pro-inflammatory associated genes and enhanced TNFα signaling via the NFκB pathway. These pathways were significantly more upregulated relative to infection with single or multiple non-aggregated bacilli per cell. Phagocytosis of aggregates led to a decreased phagosome acidification on a per bacillus basis and increased phagocyte cell death, which was not observed when Mtb aggregates were heat killed prior to phagocytosis. Mtb aggregates, observed in a granuloma from a patient, were found surrounding a lesion cavity. These observations suggest that TB aggregation may be a mechanism for pathogenesis. They raise the possibility that aggregated Mtb, if spread from individual to individual, could facilitate increased inflammation, Mtb growth, and macrophage cell death, potentially leading to active disease, cell necrosis, and additional cycles of transmission.
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Affiliation(s)
- Hylton E Rodel
- Africa Health Research Institute, Durban, South Africa.,Division of Infection and Immunity, University College London, London, United Kingdom
| | | | - Carly G K Ziegler
- Ragon Institute of MGH, Harvard, and MIT, Cambridge, MA, United States.,Department of Chemistry, Institute for Medical Engineering and Sciences, MIT, Cambridge, MA, United States.,Broad Institute of MIT and Harvard, Cambridge, MA, United States.,Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA, United States
| | - Yashica Ganga
- Africa Health Research Institute, Durban, South Africa
| | | | - Shi-Hsia Hwa
- Africa Health Research Institute, Durban, South Africa.,Division of Infection and Immunity, University College London, London, United Kingdom
| | | | - Gila Lustig
- Africa Health Research Institute, Durban, South Africa
| | - Gilla Kaplan
- University of Cape Town, Cape Town, South Africa
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Alex K Shalek
- Ragon Institute of MGH, Harvard, and MIT, Cambridge, MA, United States.,Department of Chemistry, Institute for Medical Engineering and Sciences, MIT, Cambridge, MA, United States.,Broad Institute of MIT and Harvard, Cambridge, MA, United States.,Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA, United States
| | - Adrie J C Steyn
- Africa Health Research Institute, Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Microbiology, Centres for AIDS Research and Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alex Sigal
- Africa Health Research Institute, Durban, South Africa.,Division of Infection and Immunity, University College London, London, United Kingdom.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Max Planck Institute for Infection Biology, Berlin, Germany
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30
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Banerjee A, Chen S, Pasea L, Lai AG, Katsoulis M, Denaxas S, Nafilyan V, Williams B, Wong WK, Bakhai A, Khunti K, Pillay D, Noursadeghi M, Wu H, Pareek N, Bromage D, McDonagh TA, Byrne J, Teo JTH, Shah AM, Humberstone B, Tang LV, Shah ASV, Rubboli A, Guo Y, Hu Y, Sudlow CLM, Lip GYH, Hemingway H. Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic. Eur J Prev Cardiol 2021; 28:1599-1609. [PMID: 33611594 PMCID: PMC7928969 DOI: 10.1093/eurjpc/zwaa155] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
AIMS Cardiovascular diseases (CVDs) increase mortality risk from coronavirus infection (COVID-19). There are also concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both 'direct', through infection, and 'indirect', through changes in healthcare. METHODS AND RESULTS We used (i) national mortality data for England and Wales to investigate trends in non-COVID-19 and CVD excess deaths; (ii) routine data from hospitals in England (n = 2), Italy (n = 1), and China (n = 5) to assess indirect pandemic effects on referral, diagnosis, and treatment services for CVD; and (iii) population-based electronic health records from 3 862 012 individuals in England to investigate pre- and post-COVID-19 mortality for people with incident and prevalent CVD. We incorporated pre-COVID-19 risk (by age, sex, and comorbidities), estimated population COVID-19 prevalence, and estimated relative risk (RR) of mortality in those with CVD and COVID-19 compared with CVD and non-infected (RR: 1.2, 1.5, 2.0, and 3.0).Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous (peak RR 1.14). CVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy, and England. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown and is still reduced in Italy and England. For total CVD (incident and prevalent), at 10% COVID-19 prevalence, we estimated direct impact of 31 205 and 62 410 excess deaths in England (RR 1.5 and 2.0, respectively), and indirect effect of 49 932 to 99 865 deaths. CONCLUSION Supply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the pandemic.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
- Department of Cardiology, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, UK, E1 1BB
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU
| | - Suliang Chen
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
| | - Laura Pasea
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
| | - Alvina G Lai
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
| | - Michail Katsoulis
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
| | - Vahe Nafilyan
- Office for National Statistics. 1 Drummond Gate, Pimlico, London, UK, SW1V 2QQ
| | - Bryan Williams
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU
- Institute of Cardiovascular Science, University College London, London, UK, WC1E 6BT
- University College London Hospitals NIHR Biomedical Research Centre, Maple House, 1st Floor, 149 Tottenham Court Road, London, UK, W1T 7DN
| | - Wai Keong Wong
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU
| | - Ameet Bakhai
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK, NW3 2QG
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, UK, LE5 4PW
| | - Deenan Pillay
- Division of Infection and Immunity, UCL Cruciform Building, University College London, Gower Street, London, UK, WC1E 6BT
| | - Mahdad Noursadeghi
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK, NW1 2BU
- Division of Infection and Immunity, UCL Cruciform Building, University College London, Gower Street, London, UK, WC1E 6BT
| | - Honghan Wu
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
- School of Computer and Software, Najing University of Information Science and Technology, Ningliu Road, Nanjing, Jiangsu Province, P.R.C. 210044, China
| | - Nilesh Pareek
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
| | - Daniel Bromage
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
- Kings College London British Heart Foundation Centre, School of Cardiovascular Medicine & Sciences, London, Strand, London WC2R 2LS. UK
| | - Theresa A McDonagh
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
- Kings College London British Heart Foundation Centre, School of Cardiovascular Medicine & Sciences, London, Strand, London WC2R 2LS. UK
| | - Jonathan Byrne
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
| | - James T H Teo
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
| | - Ajay M Shah
- Kings College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, UK, SE5 9RS
- Kings College London British Heart Foundation Centre, School of Cardiovascular Medicine & Sciences, London, Strand, London WC2R 2LS. UK
| | - Ben Humberstone
- Office for National Statistics. 1 Drummond Gate, Pimlico, London, UK, SW1V 2QQ
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Anoop S V Shah
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent Edinburgh, UK. EH16 4TJ
| | - Andrea Rubboli
- Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna. Italy
| | - Yutao Guo
- PLA General Hospital, 28 Fuxing Road, Beijing, Haidian District, Beijing, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Cathie L M Sudlow
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, 9 Little France Road, Edinburgh BioQuarter City, Edinburgh, UK, EH16 4UX
- BHF Data Science Centre, Health Data Research, 215 Euston Road, London, UK, NW1 2BE
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool,William Henry Duncan Building, 6 W Derby Street, Liverpool, UK, L7 8TX
- Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, UK, L14 3PE
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus 9000, Aalborg, Denmark
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK, NW1 1DA
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, UK, NW1 2BE
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31
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Noursadeghi M, Gupta RK. New Insights into the Limitations of Host Transcriptional Biomarkers of Tuberculosis. Am J Respir Crit Care Med 2021; 204:1363-1365. [PMID: 34705613 PMCID: PMC8865719 DOI: 10.1164/rccm.202109-2146ed] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mahdad Noursadeghi
- Division of Infection and Immunity University College London London, United Kingdom
| | - Rishi K Gupta
- Institute for Global Health University College London London, United Kingdom
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, Ivulich D, Jaafar D, Jaafoura S, Jabot J, Jackson C, Jamieson N, Jaquet P, Jassat W, Jaud-Fischer C, Jaureguiberry S, Javidfar J, Jawad I, Jaworsky D, Jayakumar D, Jego F, Jelani AM, Jenum S, Jimbo-Sotomayor R, Job VDP, Joe OY, Jorge García RN, Joseph C, Joseph M, Joshi S, Jourdain M, Jouvet P, June J, Jung A, Jung H, Juzar D, Kafif O, Kaguelidou F, Kaisbain N, Kaleesvran T, Kali S, Kalicinska A, Kalomoiri S, Kamal S, Kamaluddin MAA, Kamaruddin ZAC, Kamarudin N, Kandamby DH, Kandel C, Kang KY, Kant R, Kanwal D, Kanyawati D, Karki B, Karpayah P, Karsies T, Kartsonaki C, Kasugai D, Kataria A, Katz K, Kaur A, Kaur Johal S, Kawasaki T, Kay C, Keane H, Keating S, Kellam P, Kelly A, Kelly A, Kelly C, Kelly N, Kelly S, Kelly Y, Kelsey M, Kennedy R, Kennon K, Kernan M, Kerroumi Y, Keshav S, Kestelyn E, Khalid I, Khalid O, Khalil A, Khan C, Khan I, Khanal S, Kho ME, Khoo D, Khoo R, Khoo S, Khoso N, Kiat KH, Kida Y, Kiiza P, Kildal AB, Kim JB, Kimmoun A, Kindgen-Milles D, King A, Kitamura N, Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Keeton R, Richardson SI, Moyo-Gwete T, Hermanus T, Tincho MB, Benede N, Manamela NP, Baguma R, Makhado Z, Ngomti A, Motlou T, Mennen M, Chinhoyi L, Skelem S, Maboreke H, Doolabh D, Iranzadeh A, Otter AD, Brooks T, Noursadeghi M, Moon JC, Grifoni A, Weiskopf D, Sette A, Blackburn J, Hsiao NY, Williamson C, Riou C, Goga A, Garrett N, Bekker LG, Gray G, Ntusi NAB, Moore PL, Burgers WA. Prior infection with SARS-CoV-2 boosts and broadens Ad26.COV2.S immunogenicity in a variant-dependent manner. Cell Host Microbe 2021; 29:1611-1619.e5. [PMID: 34688376 PMCID: PMC8511649 DOI: 10.1016/j.chom.2021.10.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 10/07/2021] [Indexed: 01/02/2023]
Abstract
The Johnson and Johnson Ad26.COV2.S single-dose vaccine represents an attractive option for coronavirus disease 2019 (COVID-19) vaccination in countries with limited resources. We examined the effect of prior infection with different SARS-CoV-2 variants on Ad26.COV2.S immunogenicity. We compared participants who were SARS-CoV-2 naive with those either infected with the ancestral D614G virus or infected in the second wave when Beta predominated. Prior infection significantly boosts spike-binding antibodies, antibody-dependent cellular cytotoxicity, and neutralizing antibodies against D614G, Beta, and Delta; however, neutralization cross-reactivity varied by wave. Robust CD4 and CD8 T cell responses are induced after vaccination, regardless of prior infection. T cell recognition of variants is largely preserved, apart from some reduction in CD8 recognition of Delta. Thus, Ad26.COV2.S vaccination after infection could result in enhanced protection against COVID-19. The impact of the infecting variant on neutralization breadth after vaccination has implications for the design of second-generation vaccines based on variants of concern.
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Affiliation(s)
- Roanne Keeton
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Simone I Richardson
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tandile Hermanus
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Marius B Tincho
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ntombi Benede
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Nelia P Manamela
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Baguma
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zanele Makhado
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Amkele Ngomti
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Thopisang Motlou
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Mathilda Mennen
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Lionel Chinhoyi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Sango Skelem
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Hazel Maboreke
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Deelan Doolabh
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Arash Iranzadeh
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Jonathan Blackburn
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; NHLS Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Carolyn Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Catherine Riou
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Ameena Goga
- South African Medical Research Council, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Centre, Cape Town, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town and Groote Schuur Hospital, South Africa; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa; MRC Antibody Immunity Research Unit, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Wendy A Burgers
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa.
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Joy G, Artico J, Kurdi H, Seraphim A, Lau C, Thornton GD, Oliveira MF, Adam RD, Aziminia N, Menacho K, Chacko L, Brown JT, Patel RK, Shiwani H, Bhuva A, Augusto JB, Andiapen M, McKnight A, Noursadeghi M, Pierce I, Evain T, Captur G, Davies RH, Greenwood JP, Fontana M, Kellman P, Schelbert EB, Treibel TA, Manisty C, Moon JC. Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers. JACC Cardiovasc Imaging 2021; 14:2155-2166. [PMID: 33975819 PMCID: PMC8105493 DOI: 10.1016/j.jcmg.2021.04.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection. BACKGROUND Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease. METHODS Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available. RESULTS A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction <54%, septal T1 >1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro-B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals. CONCLUSIONS Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post-mild severe acute respiratory syndrome-coronavirus-2 infection.
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Affiliation(s)
- George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jessica Artico
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hibba Kurdi
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andreas Seraphim
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Clement Lau
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - George D Thornton
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Marta Fontes Oliveira
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Cardiology Department, University Hospital Centre of Porto, Porto, Portugal
| | - Robert Daniel Adam
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nikoo Aziminia
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Katia Menacho
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Liza Chacko
- Institute of Cardiovascular Science, University College London, London, United Kingdom; National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom
| | - James T Brown
- Institute of Cardiovascular Science, University College London, London, United Kingdom; National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom
| | - Rishi K Patel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Joao B Augusto
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Cardiology Department, Hospital Prof Doutor Fernando Fonseca Amadora, Portugal
| | - Mervyn Andiapen
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Aine McKnight
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | | | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, United Kingdom; National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, Maryland, USA
| | | | - Thomas A Treibel
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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35
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Gupta RK, Rosenheim J, Bell LC, Chandran A, Guerra-Assuncao JA, Pollara G, Whelan M, Artico J, Joy G, Kurdi H, Altmann DM, Boyton RJ, Maini MK, McKnight A, Lambourne J, Cutino-Moguel T, Manisty C, Treibel TA, Moon JC, Chain BM, Noursadeghi M. Blood transcriptional biomarkers of acute viral infection for detection of pre-symptomatic SARS-CoV-2 infection: a nested, case-control diagnostic accuracy study. Lancet Microbe 2021; 2:e508-e517. [PMID: 34250515 PMCID: PMC8260104 DOI: 10.1016/s2666-5247(21)00146-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We hypothesised that host-response biomarkers of viral infections might contribute to early identification of individuals infected with SARS-CoV-2, which is critical to breaking the chains of transmission. We aimed to evaluate the diagnostic accuracy of existing candidate whole-blood transcriptomic signatures for viral infection to predict positivity of nasopharyngeal SARS-CoV-2 PCR testing. METHODS We did a nested case-control diagnostic accuracy study among a prospective cohort of health-care workers (aged ≥18 years) at St Bartholomew's Hospital (London, UK) undergoing weekly blood and nasopharyngeal swab sampling for whole-blood RNA sequencing and SARS-CoV-2 PCR testing, when fit to attend work. We identified candidate blood transcriptomic signatures for viral infection through a systematic literature search. We searched MEDLINE for articles published between database inception and Oct 12, 2020, using comprehensive MeSH and keyword terms for "viral infection", "transcriptome", "biomarker", and "blood". We reconstructed signature scores in blood RNA sequencing data and evaluated their diagnostic accuracy for contemporaneous SARS-CoV-2 infection, compared with the gold standard of SARS-CoV-2 PCR testing, by quantifying the area under the receiver operating characteristic curve (AUROC), sensitivities, and specificities at a standardised Z score of at least 2 based on the distribution of signature scores in test-negative controls. We used pairwise DeLong tests compared with the most discriminating signature to identify the subset of best performing biomarkers. We evaluated associations between signature expression, viral load (using PCR cycle thresholds), and symptom status visually and using Spearman rank correlation. The primary outcome was the AUROC for discriminating between samples from participants who tested negative throughout the study (test-negative controls) and samples from participants with PCR-confirmed SARS-CoV-2 infection (test-positive participants) during their first week of PCR positivity. FINDINGS We identified 20 candidate blood transcriptomic signatures of viral infection from 18 studies and evaluated their accuracy among 169 blood RNA samples from 96 participants over 24 weeks. Participants were recruited between March 23 and March 31, 2020. 114 samples were from 41 participants with SARS-CoV-2 infection, and 55 samples were from 55 test-negative controls. The median age of participants was 36 years (IQR 27-47) and 69 (72%) of 96 were women. Signatures had little overlap of component genes, but were mostly correlated as components of type I interferon responses. A single blood transcript for IFI27 provided the highest accuracy for discriminating between test-negative controls and test-positive individuals at the time of their first positive SARS-CoV-2 PCR result, with AUROC of 0·95 (95% CI 0·91-0·99), sensitivity 0·84 (0·70-0·93), and specificity 0·95 (0·85-0·98) at a predefined threshold (Z score >2). The transcript performed equally well in individuals with and without symptoms. Three other candidate signatures (including two to 48 transcripts) had statistically equivalent discrimination to IFI27 (AUROCs 0·91-0·95). INTERPRETATION Our findings support further urgent evaluation and development of blood IFI27 transcripts as a biomarker for early phase SARS-CoV-2 infection for screening individuals at high risk of infection, such as contacts of index cases, to facilitate early case isolation and early use of antiviral treatments as they emerge. FUNDING Barts Charity, Wellcome Trust, and National Institute of Health Research.
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Affiliation(s)
- Rishi K Gupta
- Institute of Global Health, University College London, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Joshua Rosenheim
- Division of Infection and Immunity, University College London, London, UK
| | - Lucy C Bell
- Division of Infection and Immunity, University College London, London, UK
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London, UK
| | | | - Gabriele Pollara
- Division of Infection and Immunity, University College London, London, UK
| | - Matthew Whelan
- Division of Infection and Immunity, University College London, London, UK
| | - Jessica Artico
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Hibba Kurdi
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Lung Division, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan Lambourne
- Department of Infection, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Teresa Cutino-Moguel
- Department of Virology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Benjamin M Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
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36
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Fox TA, Kirkwood AA, Enfield L, O'Reilly M, Arulogun S, D'Sa S, O'Nions J, Kavi J, Vitsaras E, Townsend W, Burns SO, Gohil SH, Cwynarski K, Thomson KJ, Noursadeghi M, Heyderman RS, Rampling T, Ardeshna KM, McCoy LE, Morris EC. Low seropositivity and suboptimal neutralisation rates in patients fully vaccinated against COVID-19 with B-cell malignancies. Br J Haematol 2021; 195:706-709. [PMID: 34545952 DOI: 10.1111/bjh.17836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Thomas A Fox
- UCL Institute of Immunity and Transplantation, University College London, London, UK.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- CR UK and UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - Louise Enfield
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maeve O'Reilly
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Suzanne Arulogun
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shirley D'Sa
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jenny O'Nions
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Janki Kavi
- Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | | | - William Townsend
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Siobhan O Burns
- UCL Institute of Immunity and Transplantation, University College London, London, UK.,Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | - Satyen H Gohil
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kate Cwynarski
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirsty J Thomson
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mahdad Noursadeghi
- Research Department of Infection, University College London, London, UK.,Department of Infectious Disease, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert S Heyderman
- Research Department of Infection, University College London, London, UK.,Department of Infectious Disease, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tommy Rampling
- Department of Infectious Disease, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirit M Ardeshna
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura E McCoy
- UCL Institute of Immunity and Transplantation, University College London, London, UK.,Research Department of Infection, University College London, London, UK
| | - Emma C Morris
- UCL Institute of Immunity and Transplantation, University College London, London, UK.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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37
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Li HK, Kaforou M, Rodriguez-Manzano J, Channon-Wells S, Moniri A, Habgood-Coote D, Gupta RK, Mills EA, Arancon D, Lin J, Chiu YH, Pennisi I, Miglietta L, Mehta R, Obaray N, Herberg JA, Wright VJ, Georgiou P, Shallcross LJ, Mentzer AJ, Levin M, Cooke GS, Noursadeghi M, Sriskandan S. Discovery and validation of a three-gene signature to distinguish COVID-19 and other viral infections in emergency infectious disease presentations: a case-control and observational cohort study. Lancet Microbe 2021; 2:e594-e603. [PMID: 34423323 PMCID: PMC8367196 DOI: 10.1016/s2666-5247(21)00145-2] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Emergency admissions for infection often lack initial diagnostic certainty. COVID-19 has highlighted a need for novel diagnostic approaches to indicate likelihood of viral infection in a pandemic setting. We aimed to derive and validate a blood transcriptional signature to detect viral infections, including COVID-19, among adults with suspected infection who presented to the emergency department. Methods Individuals (aged ≥18 years) presenting with suspected infection to an emergency department at a major teaching hospital in the UK were prospectively recruited as part of the Bioresource in Adult Infectious Diseases (BioAID) discovery cohort. Whole-blood RNA sequencing was done on samples from participants with subsequently confirmed viral, bacterial, or no infection diagnoses. Differentially expressed host genes that met additional filtering criteria were subjected to feature selection to derive the most parsimonious discriminating signature. We validated the signature via RT-qPCR in a prospective validation cohort of participants who presented to an emergency department with undifferentiated fever, and a second case-control validation cohort of emergency department participants with PCR-positive COVID-19 or bacterial infection. We assessed signature performance by calculating the area under receiver operating characteristic curves (AUROCs), sensitivities, and specificities. Findings A three-gene transcript signature, comprising HERC6, IGF1R, and NAGK, was derived from the discovery cohort of 56 participants with bacterial infections and 27 with viral infections. In the validation cohort of 200 participants, the signature differentiated bacterial from viral infections with an AUROC of 0·976 (95% CI 0·919−1·000), sensitivity of 97·3% (85·8−99·9), and specificity of 100% (63·1−100). The AUROC for C-reactive protein (CRP) was 0·833 (0·694−0·944) and for leukocyte count was 0·938 (0·840−0·986). The signature achieved higher net benefit in decision curve analysis than either CRP or leukocyte count for discriminating viral infections from all other infections. In the second validation analysis, which included SARS-CoV-2-positive participants, the signature discriminated 35 bacterial infections from 34 SARS-CoV-2-positive COVID-19 infections with AUROC of 0·953 (0·893−0·992), sensitivity 88·6%, and specificity of 94·1%. Interpretation This novel three-gene signature discriminates viral infections, including COVID-19, from other emergency infection presentations in adults, outperforming both leukocyte count and CRP, thus potentially providing substantial clinical utility in managing acute presentations with infection. Funding National Institute for Health Research, Medical Research Council, Wellcome Trust, and EU-FP7.
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Affiliation(s)
- Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London, UK
- Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | | | - Ahmad Moniri
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
| | | | - Rishi K Gupta
- Institute of Global Health, University College London, London, UK
| | - Ewurabena A Mills
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Jessica Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | - Yueh-Ho Chiu
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ivana Pennisi
- Department of Infectious Disease, Imperial College London, London, UK
| | - Luca Miglietta
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
| | - Ravi Mehta
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nelofar Obaray
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jethro A Herberg
- Department of Infectious Disease, Imperial College London, London, UK
| | - Victoria J Wright
- Department of Infectious Disease, Imperial College London, London, UK
| | - Pantelis Georgiou
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
- Centre for Bio-Inspired Technology, Imperial College London, London, UK
| | | | | | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK
- Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
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38
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Thorne LG, Reuschl A, Zuliani‐Alvarez L, Whelan MVX, Turner J, Noursadeghi M, Jolly C, Towers GJ. SARS-CoV-2 sensing by RIG-I and MDA5 links epithelial infection to macrophage inflammation. EMBO J 2021; 40:e107826. [PMID: 34101213 PMCID: PMC8209947 DOI: 10.15252/embj.2021107826] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022] Open
Abstract
SARS-CoV-2 infection causes broad-spectrum immunopathological disease, exacerbated by inflammatory co-morbidities. A better understanding of mechanisms underpinning virus-associated inflammation is required to develop effective therapeutics. Here, we discover that SARS-CoV-2 replicates rapidly in lung epithelial cells despite triggering a robust innate immune response through the activation of cytoplasmic RNA sensors RIG-I and MDA5. The inflammatory mediators produced during epithelial cell infection can stimulate primary human macrophages to enhance cytokine production and drive cellular activation. Critically, this can be limited by abrogating RNA sensing or by inhibiting downstream signalling pathways. SARS-CoV-2 further exacerbates the local inflammatory environment when macrophages or epithelial cells are primed with exogenous inflammatory stimuli. We propose that RNA sensing of SARS-CoV-2 in lung epithelium is a key driver of inflammation, the extent of which is influenced by the inflammatory state of the local environment, and that specific inhibition of innate immune pathways may beneficially mitigate inflammation-associated COVID-19.
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Affiliation(s)
- Lucy G Thorne
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | | | | | | | - Jane Turner
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | | | - Clare Jolly
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Greg J Towers
- Division of Infection and ImmunityUniversity College LondonLondonUK
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39
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Thorne LG, Reuschl AK, Zuliani-Alvarez L, Whelan MVX, Turner J, Noursadeghi M, Jolly C, Towers GJ. SARS-CoV-2 sensing by RIG-I and MDA5 links epithelial infection to macrophage inflammation. EMBO J 2021; 40:e107826. [PMID: 34101213 DOI: 10.1101/2020.12.23.424169] [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: 01/26/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 05/18/2023] Open
Abstract
SARS-CoV-2 infection causes broad-spectrum immunopathological disease, exacerbated by inflammatory co-morbidities. A better understanding of mechanisms underpinning virus-associated inflammation is required to develop effective therapeutics. Here, we discover that SARS-CoV-2 replicates rapidly in lung epithelial cells despite triggering a robust innate immune response through the activation of cytoplasmic RNA sensors RIG-I and MDA5. The inflammatory mediators produced during epithelial cell infection can stimulate primary human macrophages to enhance cytokine production and drive cellular activation. Critically, this can be limited by abrogating RNA sensing or by inhibiting downstream signalling pathways. SARS-CoV-2 further exacerbates the local inflammatory environment when macrophages or epithelial cells are primed with exogenous inflammatory stimuli. We propose that RNA sensing of SARS-CoV-2 in lung epithelium is a key driver of inflammation, the extent of which is influenced by the inflammatory state of the local environment, and that specific inhibition of innate immune pathways may beneficially mitigate inflammation-associated COVID-19.
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Affiliation(s)
- Lucy G Thorne
- Division of Infection and Immunity, University College London, London, UK
| | | | | | - Matthew V X Whelan
- Division of Infection and Immunity, University College London, London, UK
| | - Jane Turner
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London, UK
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK
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40
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Pollara G, Turner CT, Rosenheim J, Chandran A, Bell LCK, Khan A, Patel A, Peralta LF, Folino A, Akarca A, Venturini C, Baker T, Ecker S, Ricciardolo FLM, Marafioti T, Ugarte-Gil C, Moore DAJ, Chain BM, Tomlinson GS, Noursadeghi M. Exaggerated IL-17A activity in human in vivo recall responses discriminates active tuberculosis from latent infection and cured disease. Sci Transl Med 2021; 13:13/592/eabg7673. [PMID: 33952677 PMCID: PMC7610803 DOI: 10.1126/scitranslmed.abg7673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/27/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
Host immune responses at the site of Mycobacterium tuberculosis (Mtb) infection can mediate pathogenesis of tuberculosis (TB) and onward transmission of infection. We hypothesized that pathological immune responses would be enriched at the site of host-pathogen interactions modelled by a standardized tuberculin skin test (TST) challenge in patients with active TB compared to those without disease, and interrogated immune responses by genome-wide transcriptional profiling. We show exaggerated interleukin (IL)-17A and Th17 responses among 48 individuals with active TB compared to 191 with latent TB infection, associated with increased neutrophil recruitment and matrix metalloproteinase-1 expression, both involved in TB pathogenesis. Curative antimicrobial treatment reversed these observed changes. Increased IL-1β and IL-6 responses to mycobacterial stimulation were evident in both circulating monocytes and in molecular changes at the site of TST in individuals with active TB, supporting a model in which monocyte-derived IL-1β and IL-6 promote Th17 differentiation within tissues. Modulation of these cytokine pathways may provide a rational strategy for host-directed therapy in active TB.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Folino
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | | | | | | | | | | | - Cesar Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.,TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - David A J Moore
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
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Kloprogge F, Abubakar I, Esmail H, Hack V, Kunst H, McHugh TD, Noursadeghi M, Surey J, Tiberi S, Lipman M. Exploring a combined biomarker for tuberculosis treatment response: protocol for a prospective observational cohort study. BMJ Open 2021; 11:e052885. [PMID: 34244287 PMCID: PMC8268918 DOI: 10.1136/bmjopen-2021-052885] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An improved understanding of factors explaining tuberculosis (TB) treatment response is urgently needed to help clinicians optimise and personalise treatment and assist scientists undertaking novel treatment regimen trials. Promising outcome proxy measures, including sputum bacillary load and host immune response, are widely reported with variable results. However, they have not been studied together in combination with antibiotic exposure. The aim of this observational cohort study is to investigate which antibiotic exposures correlate with sputum bacillary load and which with the host immune response. Subsequently, we will explore if these correlations can be used to inform a candidate combined biomarker predicting cure. METHODS AND ANALYSIS All patients aged ≥ 18, diagnosed with drug-sensitive pulmonary TB (culture or molecular test), eligible for standard anti-TB treatment, at selected London, UK TB Services, will be invited to participate in this observational cohort study (target sample size=210). Patients will be asked to give blood for host transcriptomics and antibiotic plasma exposure, in addition to standard of care sputum samples for bacillary load. Antibiotic plasma concentrations will be quantified using a validated liquid chromatograph triple quadrupole mass spectrometer (LC-MS/MS) assay and sputum bacillary load by mycobacterial growth incubator tube time to positivity. Expression from a total of 35 prespecified host blood genes will be quantified using NanoString®. Antibiotic exposure, sputum bacillary load and host blood transcriptomic time series data will be analysed using nonlinear mixed-effects models. Correlations between combinations of longitudinal biomarkers and microbiological cure at the end of treatment and remaining relapse free for 1 year thereafter will be analysed using logistic regression and Cox proportional hazard models. ETHICS AND DISSEMINATION The observational cohort study has been approved by the UK's HRA REC (20/SW/0007). Written informed consent will be obtained. Results will be disseminated via publication, presentation and through engagement with institutes/companies developing novel anti-TB treatment combinations.
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Affiliation(s)
- Frank Kloprogge
- Institute for Global Health, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Hanif Esmail
- Institute for Global Health, University College London, London, UK
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Marc Lipman
- Respiratory medicine, Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, Division of Medicine, University College London, London, UK
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42
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Thorne LG, Bouhaddou M, Reuschl AK, Zuliani-Alvarez L, Polacco B, Pelin A, Batra J, Whelan MV, Ummadi M, Rojc A, Turner J, Obernier K, Braberg H, Soucheray M, Richards A, Chen KH, Harjai B, Memon D, Hosmillo M, Hiatt J, Jahun A, Goodfellow IG, Fabius JM, Shokat K, Jura N, Verba K, Noursadeghi M, Beltrao P, Swaney DL, Garcia-Sastre A, Jolly C, Towers GJ, Krogan NJ. Evolution of enhanced innate immune evasion by the SARS-CoV-2 B.1.1.7 UK variant. bioRxiv 2021:2021.06.06.446826. [PMID: 34127972 PMCID: PMC8202424 DOI: 10.1101/2021.06.06.446826] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Emergence of SARS-CoV-2 variants, including the globally successful B.1.1.7 lineage, suggests viral adaptations to host selective pressures resulting in more efficient transmission. Although much effort has focused on Spike adaptation for viral entry and adaptive immune escape, B.1.1.7 mutations outside Spike likely contribute to enhance transmission. Here we used unbiased abundance proteomics, phosphoproteomics, mRNA sequencing and viral replication assays to show that B.1.1.7 isolates more effectively suppress host innate immune responses in airway epithelial cells. We found that B.1.1.7 isolates have dramatically increased subgenomic RNA and protein levels of Orf9b and Orf6, both known innate immune antagonists. Expression of Orf9b alone suppressed the innate immune response through interaction with TOM70, a mitochondrial protein required for RNA sensing adaptor MAVS activation, and Orf9b binding and activity was regulated via phosphorylation. We conclude that B.1.1.7 has evolved beyond the Spike coding region to more effectively antagonise host innate immune responses through upregulation of specific subgenomic RNA synthesis and increased protein expression of key innate immune antagonists. We propose that more effective innate immune antagonism increases the likelihood of successful B.1.1.7 transmission, and may increase in vivo replication and duration of infection.
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Affiliation(s)
- Lucy G Thorne
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Mehdi Bouhaddou
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ann-Kathrin Reuschl
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Lorena Zuliani-Alvarez
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ben Polacco
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Adrian Pelin
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jyoti Batra
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Matthew V.X. Whelan
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Manisha Ummadi
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ajda Rojc
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jane Turner
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Kirsten Obernier
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Hannes Braberg
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Margaret Soucheray
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Alicia Richards
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Kuei-Ho Chen
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Bhavya Harjai
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Danish Memon
- European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Myra Hosmillo
- Division of Virology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK
| | - Joseph Hiatt
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Aminu Jahun
- Division of Virology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK
| | - Ian G. Goodfellow
- Division of Virology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK
| | - Jacqueline M. Fabius
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Kevan Shokat
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
- Howard Hughes Medical Institute, San Francisco, CA 94158, USA
| | - Natalia Jura
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
- Cardiovascular Research Institute, University of California - San Francisco, San Francisco, CA 94158, U.S.A
| | - Klim Verba
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Pedro Beltrao
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- European Molecular Biology Laboratory (EMBL), European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Danielle L. Swaney
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Adolfo Garcia-Sastre
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Greg J. Towers
- Division of Infection and Immunity, University College London, London, WC1E 6BT, United Kingdom
| | - Nevan J. Krogan
- Quantitative Biosciences Institute (QBI) Coronavirus Research Group (QCRG), San Francisco, CA 94158, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, 94158, USA
- J. David Gladstone Institutes, San Francisco, CA 94158, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94158, USA
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Belay M, Tulu B, Younis S, Jolliffe DA, Tayachew D, Manwandu H, Abozen T, Tirfie EA, Tegegn M, Zewude A, Forrest S, Mayito J, Huggett JF, Jones GM, O'Sullivan DM, Martineau HM, Noursadeghi M, Chandran A, Harris KA, Nikolayevskyy V, Demaret J, Berg S, Vordermeier M, Balcha TT, Aseffa A, Ameni G, Abebe M, Reece ST, Martineau AR. Detection of Mycobacterium tuberculosis complex DNA in CD34-positive peripheral blood mononuclear cells of asymptomatic tuberculosis contacts: an observational study. Lancet Microbe 2021; 2:e267-e275. [PMID: 34100007 PMCID: PMC8172384 DOI: 10.1016/s2666-5247(21)00043-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Haematopoietic stem cells expressing the CD34 surface marker have been posited as a niche for Mycobacterium tuberculosis complex bacilli during latent tuberculosis infection. Our aim was to determine whether M tuberculosis complex DNA is detectable in CD34-positive peripheral blood mononuclear cells (PBMCs) isolated from asymptomatic adults living in a setting with a high tuberculosis burden. METHODS We did a cross-sectional study in Ethiopia between Nov 22, 2017, and Jan 10, 2019. Digital PCR (dPCR) was used to determine whether M tuberculosis complex DNA was detectable in PBMCs isolated from 100 mL blood taken from asymptomatic adults with HIV infection or a history of recent household or occupational exposure to an index case of human or bovine tuberculosis. Participants were recruited from HIV clinics, tuberculosis clinics, and cattle farms in and around Addis Ababa. A nested prospective study was done in a subset of HIV-infected individuals to evaluate whether administration of isoniazid preventive therapy was effective in clearing M tuberculosis complex DNA from PBMCs. Follow-up was done between July 20, 2018, and Feb 13, 2019. QuantiFERON-TB Gold assays were also done on all baseline and follow-up samples. FINDINGS Valid dPCR data (ie, droplet counts >10 000 per well) were available for paired CD34-positive and CD34-negative PBMC fractions from 197 (70%) of 284 participants who contributed data to cross-sectional analyses. M tuberculosis complex DNA was detected in PBMCs of 156 of 197 participants with valid dPCR data (79%, 95% CI 74-85). It was more commonly present in CD34-positive than in CD34-negative fractions (154 [73%] of 197 vs 46 [23%] of 197; p<0·0001). Prevalence of dPCR-detected M tuberculosis complex DNA did not differ between QuantiFERON-negative and QuantiFERON-positive participants (77 [78%] of 99 vs 79 [81%] of 98; p=0·73), but it was higher in HIV-infected than in HIV-uninfected participants (67 [89%] of 75 vs 89 [73%] of 122, p=0·0065). By contrast, the proportion of QuantiFERON-positive participants was lower in HIV-infected than in HIV-uninfected participants (25 [33%] of 75 vs 73 [60%] of 122; p<0·0001). Administration of isoniazid preventive therapy reduced the prevalence of dPCR-detected M tuberculosis complex DNA from 41 (95%) of 43 HIV-infected individuals at baseline to 23 (53%) of 43 after treatment (p<0·0001), but it did not affect the prevalence of QuantiFERON positivity (17 [40%] of 43 at baseline vs 13 [30%] of 43 after treatment; p=0·13). INTERPRETATION We report a novel molecular microbiological biomarker of latent tuberculosis infection with properties that are distinct from those of a commercial interferon-γ release assay. Our findings implicate the bone marrow as a niche for M tuberculosis in latently infected individuals. Detection of M tuberculosis complex DNA in PBMCs has potential applications in the diagnosis of latent tuberculosis infection, in monitoring response to preventive therapy, and as an outcome measure in clinical trials of interventions to prevent or treat latent tuberculosis infection. FUNDING UK Medical Research Council.
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Affiliation(s)
- Mulugeta Belay
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Begna Tulu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sidra Younis
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - David A Jolliffe
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawit Tayachew
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Hana Manwandu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | | | - Aboma Zewude
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sally Forrest
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mayito
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jim F Huggett
- National Measurement Laboratory, LGC, Teddington, Middlesex, UK
- School of Biosciences & Medicine, Faculty of Health & Medical Science, University of Surrey, Guildford, UK
| | - Gerwyn M Jones
- National Measurement Laboratory, LGC, Teddington, Middlesex, UK
| | | | | | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Aneesh Chandran
- Division of Infection and Immunity, University College London, London, UK
| | - Kathryn A Harris
- Camelia Botnar Laboratories, Great Ormond Street Hospital for Children, London, UK
| | - Vlad Nikolayevskyy
- National Mycobacterium Reference Service—South, National Infection Service, London, UK
| | - Julie Demaret
- Institut d'Immunologie, Centre de Biologie-Pathologie-Génétique du CHRU de Lille, Lille, France
| | | | | | - Taye T Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen T Reece
- Department of Medicine, University of Cambridge, Cambridge, UK
- Kymab, Babraham Research Campus, Cambridge, UK
| | - Adrian R Martineau
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Kumar Gupta R, Noursadeghi M. Blood transcriptomic biomarkers for tuberculosis screening: time to redefine our target populations? Lancet Glob Health 2021; 9:e736-e737. [PMID: 33862011 DOI: 10.1016/s2214-109x(21)00088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Rishi Kumar Gupta
- Institute for Global Health, University College London, London WC1E 6JB, UK.
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London WC1E 6JB, UK
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45
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Naidoo CC, Nyawo GR, Sulaiman I, Wu BG, Turner CT, Bu K, Palmer Z, Li Y, Reeve BWP, Moodley S, Jackson JG, Limberis J, Diacon AH, van Helden PD, Clemente JC, Warren RM, Noursadeghi M, Segal LN, Theron G. Anaerobe-enriched gut microbiota predicts pro-inflammatory responses in pulmonary tuberculosis. EBioMedicine 2021; 67:103374. [PMID: 33975252 PMCID: PMC8122180 DOI: 10.1016/j.ebiom.2021.103374] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between tuberculosis (TB), one of the leading infectious causes of death worldwide, and the microbiome, which is critical for health, is poorly understood. METHODS To identify potential microbiome-host interactions, profiling of the oral, sputum and stool microbiota [n = 58 cases, n = 47 culture-negative symptomatic controls (SCs)] and whole blood transcriptome were done in pre-treatment presumptive pulmonary TB patients. This was a cross-sectional study. Microbiota were also characterised in close contacts of cases (CCCs, n = 73) and close contacts of SCs (CCSCs, n = 82) without active TB. FINDINGS Cases and SCs each had similar α- and β-diversities in oral washes and sputum, however, β-diversity differed in stool (PERMANOVA p = 0•035). Cases were enriched with anaerobes in oral washes, sputum (Paludibacter, Lautropia in both) and stool (Erysipelotrichaceae, Blautia, Anaerostipes) and their stools enriched in microbial genes annotated as amino acid and carbohydrate metabolic pathways. In pairwise comparisons with their CCCs, cases had Megasphaera-enriched oral and sputum microbiota and Bifidobacterium-, Roseburia-, and Dorea-depleted stools. Compared to their CCSCs, SCs had reduced α-diversities and many differential taxa per specimen type. Cases differed transcriptionally from SCs in peripheral blood (PERMANOVA p = 0•001). A co-occurrence network analysis showed stool taxa, Erysipelotrichaceae and Blautia, to negatively co-correlate with enriched "death receptor" and "EIF2 signalling" pathways whereas Anaerostipes positively correlated with enriched "interferon signalling", "Nur77 signalling" and "inflammasome" pathways; all of which are host pathways associated with disease severity. In contrast, none of the taxa enriched in SCs correlated with host pathways. INTERPRETATION TB-specific microbial relationships were identified in oral washes, induced sputum, and stool from cases before the confounding effects of antibiotics. Specific anaerobes in cases' stool predict upregulation of pro-inflammatory immunological pathways, supporting the gut microbiota's role in TB. FUNDING European & Developing Countries Clinical Trials Partnership, South African-Medical Research Council, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Charissa C Naidoo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Georgina R Nyawo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Imran Sulaiman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Carolin T Turner
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Kevin Bu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zaida Palmer
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Yonghua Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Byron W P Reeve
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Suventha Moodley
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jennifer G Jackson
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jason Limberis
- Division of Experimental Medicine, University of California, San Francisco, United States
| | - Andreas H Diacon
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Paul D van Helden
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robin M Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, United States
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.
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Reynolds CJ, Pade C, Gibbons JM, Butler DK, Otter AD, Menacho K, Fontana M, Smit A, Sackville-West JE, Cutino-Moguel T, Maini MK, Chain B, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, Valdes AM, McKnight Á, Altmann DM, Boyton R. Prior SARS-CoV-2 infection rescues B and T cell responses to variants after first vaccine dose. Science 2021; 372:eabh1282. [PMID: 33931567 PMCID: PMC8168614 DOI: 10.1126/science.abh1282] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [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: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
SARS-CoV-2 vaccine rollout has coincided with the spread of variants of concern. We investigated if single dose vaccination, with or without prior infection, confers cross protective immunity to variants. We analyzed T and B cell responses after first dose vaccination with the Pfizer/BioNTech mRNA vaccine BNT162b2 in healthcare workers (HCW) followed longitudinally, with or without prior Wuhan-Hu-1 SARS-CoV-2 infection. After one dose, individuals with prior infection showed enhanced T cell immunity, antibody secreting memory B cell response to spike and neutralizing antibodies effective against B.1.1.7 and B.1.351. By comparison, HCW receiving one vaccine dose without prior infection showed reduced immunity against variants. B.1.1.7 and B.1.351 spike mutations resulted in increased, abrogated or unchanged T cell responses depending on human leukocyte antigen (HLA) polymorphisms. Single dose vaccination with BNT162b2 in the context of prior infection with a heterologous variant substantially enhances neutralizing antibody responses against variants.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Katia Menacho
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | | | | | | | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Benjamin Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana M Valdes
- Academic Rheumatology, Clinical Sciences, Nottingham City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary Boyton
- Department of Infectious Disease, Imperial College London, London, UK.
- Lung Division, Royal Brompton and Harefield Hospitals, London, UK
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Valdes AM, Moon JC, Vijay A, Chaturvedi N, Norrish A, Ikram A, Craxford S, Cusin LM, Nightingale J, Semper A, Brooks T, McKnight A, Kurdi H, Menni C, Tighe P, Noursadeghi M, Aithal G, Treibel TA, Ollivere BJ, Manisty C. Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine 2021; 34:100835. [PMID: 33880438 PMCID: PMC8049191 DOI: 10.1016/j.eclinm.2021.100835] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND : Healthcare workers (HCWs) have increased rates of SARS-CoV-2 infection compared with the general population. We aimed to understand ethnic differences in SARS-CoV-2 seropositivity among hospital healthcare workers depending on their hospital role, socioeconomic status, Covid-19 symptoms and basic demographics. METHODS A prospective longitudinal observational cohort study. 1364 HCWs at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals between March 20 and July 10 2020. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms. Registration number: NCT04318314. FINDINGS 272 of 1364 HCWs (mean age 40.7 years, 72% female, 74% White, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in Intensive Therapy Unit (ITU) workers (OR=0.44 95%CI 0.24, 0.77; p=0.0035). Seropositivity was higher in Black (compared to White) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen between White HCWs and other minority ethnic groups. INTERPRETATION In the UK first wave, Black ethnicity (but not other ethnicities) more than doubled HCWs likelihood of seropositivity, independent of age, sex, measured socio-economic factors and hospital role.
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Affiliation(s)
- Ana M. Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Corresponding Author: Professor Ana Valdes, University of Nottingham School of Medicine, Nottingham, United Kingdom, Tel: (+44)0115 823 1954
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Alan Norrish
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Adeel Ikram
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | | | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hibba Kurdi
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, NG7 2RB
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Guruprasad Aithal
- Nottingham Digestive Disease Centre, University of Nottingham School of Medicine, Nottingham, UK
| | - Thomas A. Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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Gupta RK, Harrison EM, Ho A, Docherty AB, Knight SR, van Smeden M, Abubakar I, Lipman M, Quartagno M, Pius R, Buchan I, Carson G, Drake TM, Dunning J, Fairfield CJ, Gamble C, Green CA, Halpin S, Hardwick HE, Holden KA, Horby PW, Jackson C, Mclean KA, Merson L, Nguyen-Van-Tam JS, Norman L, Olliaro PL, Pritchard MG, Russell CD, Scott-Brown J, Shaw CA, Sheikh A, Solomon T, Sudlow C, Swann OV, Turtle L, Openshaw PJM, Baillie JK, Semple MG, Noursadeghi M. Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study. Lancet Respir Med 2021; 9:349-359. [PMID: 33444539 PMCID: PMC7832571 DOI: 10.1016/s2213-2600(20)30559-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prognostic models to predict the risk of clinical deterioration in acute COVID-19 cases are urgently required to inform clinical management decisions. METHODS We developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requirement of ventilatory support or critical care, or death) among consecutively hospitalised adults with highly suspected or confirmed COVID-19 who were prospectively recruited to the International Severe Acute Respiratory and Emerging Infections Consortium Coronavirus Clinical Characterisation Consortium (ISARIC4C) study across 260 hospitals in England, Scotland, and Wales. Candidate predictors that were specified a priori were considered for inclusion in the model on the basis of previous prognostic scores and emerging literature describing routinely measured biomarkers associated with COVID-19 prognosis. We used internal-external cross-validation to evaluate discrimination, calibration, and clinical utility across eight National Health Service (NHS) regions in the development cohort. We further validated the final model in held-out data from an additional NHS region (London). FINDINGS 74 944 participants (recruited between Feb 6 and Aug 26, 2020) were included, of whom 31 924 (43·2%) of 73 948 with available outcomes met the composite clinical deterioration outcome. In internal-external cross-validation in the development cohort of 66 705 participants, the selected model (comprising 11 predictors routinely measured at the point of hospital admission) showed consistent discrimination, calibration, and clinical utility across all eight NHS regions. In held-out data from London (n=8239), the model showed a similarly consistent performance (C-statistic 0·77 [95% CI 0·76 to 0·78]; calibration-in-the-large 0·00 [-0·05 to 0·05]); calibration slope 0·96 [0·91 to 1·01]), and greater net benefit than any other reproducible prognostic model. INTERPRETATION The 4C Deterioration model has strong potential for clinical utility and generalisability to predict clinical deterioration and inform decision making among adults hospitalised with COVID-19. FUNDING National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, NIHR HPRU in Respiratory Infections at Imperial College London.
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Affiliation(s)
- Rishi K Gupta
- Institute for Global Health, University College London, London, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Antonia Ho
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, UK; Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK; Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK; Royal Free Hospitals NHS Trust, London, UK
| | - Matteo Quartagno
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Riinu Pius
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Iain Buchan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Gail Carson
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas M Drake
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jake Dunning
- National Infection Service, Public Health England, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Christopher A Green
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Sophie Halpin
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hayley E Hardwick
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary, and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Karl A Holden
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary, and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Peter W Horby
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Clare Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Kenneth A Mclean
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Laura Merson
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Lisa Norman
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Piero L Olliaro
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mark G Pritchard
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Clark D Russell
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Catherine A Shaw
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tom Solomon
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary, and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Olivia V Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary, and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit, Institute of Infection, Veterinary, and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, University of Liverpool, Liverpool, UK.
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK.
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49
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Manisty C, Otter AD, Treibel TA, McKnight Á, Altmann DM, Brooks T, Noursadeghi M, Boyton RJ, Semper A, Moon JC. Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals. Lancet 2021; 397:1057-1058. [PMID: 33640038 PMCID: PMC7972310 DOI: 10.1016/s0140-6736(21)00501-8] [Citation(s) in RCA: 277] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Áine McKnight
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London W12 0NN, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK; Lung Division, Royal Brompton and Harefield Hospitals, London, UK.
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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50
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Manisty C, Treibel TA, Jensen M, Semper A, Joy G, Gupta RK, Cutino-Moguel T, Andiapen M, Jones J, Taylor S, Otter A, Pade C, Gibbons J, Lee J, Bacon J, Thomas S, Moon C, Jones M, Williams D, Lambourne J, Fontana M, Altmann DM, Boyton R, Maini M, McKnight A, Chain B, Noursadeghi M, Moon JC. Time series analysis and mechanistic modelling of heterogeneity and sero-reversion in antibody responses to mild SARS‑CoV-2 infection. EBioMedicine 2021; 65:103259. [PMID: 33662833 PMCID: PMC7920816 DOI: 10.1016/j.ebiom.2021.103259] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND SARS-CoV-2 serology is used to identify prior infection at individual and at population level. Extended longitudinal studies with multi-timepoint sampling to evaluate dynamic changes in antibody levels are required to identify the time horizon in which these applications of serology are valid, and to explore the longevity of protective humoral immunity. METHODS Healthcare workers were recruited to a prospective cohort study from the first SARS-CoV-2 epidemic peak in London, undergoing weekly symptom screen, viral PCR and blood sampling over 16-21 weeks. Serological analysis (n =12,990) was performed using semi-quantitative Euroimmun IgG to viral spike S1 domain and Roche total antibody to viral nucleocapsid protein (NP) assays. Comparisons were made to pseudovirus neutralizing antibody measurements. FINDINGS A total of 157/729 (21.5%) participants developed positive SARS-CoV-2 serology by one or other assay, of whom 31.0% were asymptomatic and there were no deaths. Peak Euroimmun anti-S1 and Roche anti-NP measurements correlated (r = 0.57, p<0.0001) but only anti-S1 measurements correlated with near-contemporary pseudovirus neutralising antibody titres (measured at 16-18 weeks, r = 0.57, p<0.0001). By 21 weeks' follow-up, 31/143 (21.7%) anti-S1 and 6/150 (4.0%) anti-NP measurements reverted to negative. Mathematical modelling revealed faster clearance of anti-S1 compared to anti-NP (median half-life of 2.5 weeks versus 4.0 weeks), earlier transition to lower levels of antibody production (median of 8 versus 13 weeks), and greater reductions in relative antibody production rate after the transition (median of 35% versus 50%). INTERPRETATION Mild SARS-CoV-2 infection is associated with heterogeneous serological responses in Euroimmun anti-S1 and Roche anti-NP assays. Anti-S1 responses showed faster rates of clearance, more rapid transition from high to low level production rate and greater reduction in production rate after this transition. In mild infection, anti-S1 serology alone may underestimate incident infections. The mechanisms that underpin faster clearance and lower rates of sustained anti-S1 production may impact on the longevity of humoral immunity. FUNDING Charitable donations via Barts Charity, Wellcome Trust, NIHR.
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Affiliation(s)
- Charlotte Manisty
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas Alexander Treibel
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Melanie Jensen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rishi K Gupta
- Division of Infection and Immunity, University College London, London, UK
| | | | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jessica Jones
- National Infection Service, Public Health England, Porton Down, UK
| | - Stephen Taylor
- National Infection Service, Public Health England, Porton Down, UK
| | - Ashley Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Corrina Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jason Lee
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joanna Bacon
- National Infection Service, Public Health England, Porton Down, UK
| | - Steve Thomas
- National Infection Service, Public Health England, Porton Down, UK
| | - Chris Moon
- National Infection Service, Public Health England, Porton Down, UK
| | - Meleri Jones
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dylan Williams
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Marianna Fontana
- Royal Free London NHS Foundation Trust, London, UK; Division of Medicine, University College London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary Boyton
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mala Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Aine McKnight
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Benjamin Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK.
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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