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Funnell SGP, Dowling WE, Muñoz-Fontela C, Gsell PS, Ingber DE, Hamilton GA, Delang L, Rocha-Pereira J, Kaptein S, Dallmeier KH, Neyts J, Rosenke K, de Wit E, Feldmann H, Maisonnasse P, Le Grand R, Frieman MB, Coleman CM. Emerging preclinical evidence does not support broad use of hydroxychloroquine in COVID-19 patients. Nat Commun 2020; 11:4253. [PMID: 32848158 PMCID: PMC7450055 DOI: 10.1038/s41467-020-17907-w] [Citation(s) in RCA: 36] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022] Open
Abstract
There is an urgent need for drugs, therapies and vaccines to be available to protect the human population against COVID-19. One of the first approaches taken in the COVID-19 global response was to consider repurposing licensed drugs. This commentary highlights an extraordinary international collaborative effort of independent researchers who have recently all come to the same conclusion—that chloroquine or hydroxchloroquine are unlikely to provide clinical benefit against COVID-19.
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Affiliation(s)
- S G P Funnell
- National Infection Service, Public Health England, Porton Down, Manor Farm Road, Salisbury, Wiltshire, SP40JG, UK.
| | - W E Dowling
- Coalition for Epidemic Preparedness Innovations, 1901 Pennsylvania Avenue, NW, Suite 1003, Washington, DC, 20006, USA
| | - C Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse. 74, 20359, Hamburg, Germany
| | - P-S Gsell
- World Health Organisation, Avenue Appia, 1211, Geneva, Switzerland
| | - D E Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, CLSB5, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - G A Hamilton
- Emulate Inc., 27 Drydock Avenue, 5th Floor, Boston, MA, 02210, USA
| | - L Delang
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute, Global Virus Network, KU Leuven, 3000, Leuven, Belgium
| | - J Rocha-Pereira
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute, Global Virus Network, KU Leuven, 3000, Leuven, Belgium
| | - S Kaptein
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute, Global Virus Network, KU Leuven, 3000, Leuven, Belgium
| | - K H Dallmeier
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute, Global Virus Network, KU Leuven, 3000, Leuven, Belgium
| | - J Neyts
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute, Global Virus Network, KU Leuven, 3000, Leuven, Belgium
| | - K Rosenke
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, Hamilton, 59840, MT, USA
| | - E de Wit
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, Hamilton, 59840, MT, USA
| | - H Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, Hamilton, 59840, MT, USA
| | - P Maisonnasse
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases » (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, 92265, France
| | - R Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases » (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, 92265, France
| | - M B Frieman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - C M Coleman
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Funnell SGP, Tree JA, Hatch GJ, Bate SR, Hall G, Pearson G, Rayner EL, Roberts ADG, Vipond J. Dose-dependant acute or subacute disease caused by Burkholderia pseudomallei strain NCTC 13392 in a BALB/c aerosol model of infection. J Appl Microbiol 2019; 127:1224-1235. [PMID: 31330088 PMCID: PMC6747009 DOI: 10.1111/jam.14396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 01/26/2023]
Abstract
AIMS The goal of this study was to examine, for the first time, the virulence and pathogenicity of aerosolized Burkholderia pseudomallei, strain NCTC 13392, in BALB/c mice in order to develop an animal model for testing novel medical countermeasures (MCMs) for the treatment of human acute and subacute (a disease state between acute and chronic) melioidosis. METHODS AND RESULTS BALB/c mice were exposed to varying doses of aerosolized bacteria. Acute disease was seen in animals exposed to a very-high dose (≥103 CFU per animal) and death occurred 3-4 days postchallenge (pc). Bacteria were detected in the lungs, liver, kidney and spleen. In contrast, animals exposed to a low dose (<10 CFU per animal) survived to the end of the study (day 30 pc) but developed weight loss, a bacterial tissue burden and increasing clinical signs of infection from day 20 pc onwards, mimicking a subacute form of the disease. Pathological changes in the tissues mirrored these findings. CONCLUSIONS This proof of concept study has shown that B. pseudomallei strain NCTC 13392 is virulent and pathogenic in BALB/c mice, when delivered by aerosol. By varying the doses of aerosolized bacteria it was possible to mimic characteristics of both human acute and subacute melioidosis, at the same time, within the same study. SIGNIFICANCE AND IMPACT OF THE STUDY Burkholderia pseudomallei, the aetiological agent of melioidosis, causes a serious and often fatal disease in humans and animals. Novel MCMs are urgently needed for both public health and biodefense purposes. The present model provides a useful tool for the assessment and evaluation of new MCMs (e.g. therapeutics and vaccines) and offers the potential for testing new treatments for both subacute to chronic and acute melioidosis prior to human clinical trials.
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Affiliation(s)
- S G P Funnell
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - J A Tree
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - G J Hatch
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - S R Bate
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - G Hall
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - G Pearson
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - E L Rayner
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - A D G Roberts
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
| | - J Vipond
- National Infection Service, Public Health England (PHE), Salisbury, Wiltshire, UK
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Carvalho AL, Miquel-Clopés A, Wegmann U, Jones E, Stentz R, Telatin A, Walker NJ, Butcher WA, Brown PJ, Holmes S, Dennis MJ, Williamson ED, Funnell SGP, Stock M, Carding SR. Use of bioengineered human commensal gut bacteria-derived microvesicles for mucosal plague vaccine delivery and immunization. Clin Exp Immunol 2019; 196:287-304. [PMID: 30985006 PMCID: PMC6514708 DOI: 10.1111/cei.13301] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Accepted: 03/25/2019] [Indexed: 12/19/2022] Open
Abstract
Plague caused by the Gram‐negative bacterium, Yersinia pestis, is still endemic in parts of the world today. Protection against pneumonic plague is essential to prevent the development and spread of epidemics. Despite this, there are currently no licensed plague vaccines in the western world. Here we describe the means of delivering biologically active plague vaccine antigens directly to mucosal sites of plague infection using highly stable microvesicles (outer membrane vesicles; OMVs) that are naturally produced by the abundant and harmless human commensal gut bacterium Bacteroides thetaiotaomicron (Bt). Bt was engineered to express major plague protective antigens in its OMVs, specifically Fraction 1 (F1) in the outer membrane and LcrV (V antigen) in the lumen, for targeted delivery to the gastrointestinal (GI) and respiratory tracts in a non‐human primate (NHP) host. Our key findings were that Bt OMVs stably expresses F1 and V plague antigens, particularly the V antigen, in the correct, immunogenic form. When delivered intranasally V‐OMVs elicited substantive and specific immune and antibody responses, both in the serum [immunoglobulin (Ig)G] and in the upper and lower respiratory tract (IgA); this included the generation of serum antibodies able to kill plague bacteria. Our results also showed that Bt OMV‐based vaccines had many desirable characteristics, including: biosafety and an absence of any adverse effects, pathology or gross alteration of resident microbial communities (microbiotas); high stability and thermo‐tolerance; needle‐free delivery; intrinsic adjuvanticity; the ability to stimulate both humoral and cell‐mediated immune responses; and targeting of primary sites of plague infection.
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Affiliation(s)
- A L Carvalho
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - A Miquel-Clopés
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - U Wegmann
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - E Jones
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - R Stentz
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - A Telatin
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK
| | - N J Walker
- Defence Science and Technology Laboratory, Porton, Salisbury, UK
| | - W A Butcher
- Defence Science and Technology Laboratory, Porton, Salisbury, UK
| | - P J Brown
- Public Health England, Porton, Porton, Salisbury, UK
| | - S Holmes
- Public Health England, Porton, Porton, Salisbury, UK
| | - M J Dennis
- Public Health England, Porton, Porton, Salisbury, UK
| | - E D Williamson
- Defence Science and Technology Laboratory, Porton, Salisbury, UK
| | - S G P Funnell
- Public Health England, Porton, Porton, Salisbury, UK
| | - M Stock
- Plant Biotechnology Ltd, Norwich, UK
| | - S R Carding
- Gut Microbes and Health Research Programme, Quadram Institute Bioscience, Norwich, UK.,Norwich Medical School, University East Anglia, Norwich, UK
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Tree JA, Hall G, Pearson G, Rayner E, Graham VA, Steeds K, Bewley KR, Hatch GJ, Dennis M, Taylor I, Roberts AD, Funnell SGP, Vipond J. Sequence of pathogenic events in cynomolgus macaques infected with aerosolized monkeypox virus. J Virol 2015; 89:4335-44. [PMID: 25653439 PMCID: PMC4442344 DOI: 10.1128/jvi.03029-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 10/15/2014] [Accepted: 01/26/2015] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED To evaluate new vaccines when human efficacy studies are not possible, the FDA's "Animal Rule" requires well-characterized models of infection. Thus, in the present study, the early pathogenic events of monkeypox infection in nonhuman primates, a surrogate for variola virus infection, were characterized. Cynomolgus macaques were exposed to aerosolized monkeypox virus (10(5) PFU). Clinical observations, viral loads, immune responses, and pathological changes were examined on days 2, 4, 6, 8, 10, and 12 postchallenge. Viral DNA (vDNA) was detected in the lungs on day 2 postchallenge, and viral antigen was detected, by immunostaining, in the epithelium of bronchi, bronchioles, and alveolar walls. Lesions comprised rare foci of dysplastic and sloughed cells in respiratory bronchioles. By day 4, vDNA was detected in the throat, tonsil, and spleen, and monkeypox antigen was detected in the lung, hilar and submandibular lymph nodes, spleen, and colon. Lung lesions comprised focal epithelial necrosis and inflammation. Body temperature peaked on day 6, pox lesions appeared on the skin, and lesions, with positive immunostaining, were present in the lung, tonsil, spleen, lymph nodes, and colon. By day 8, vDNA was present in 9/13 tissues. Blood concentrations of interleukin 1ra (IL-1ra), IL-6, and gamma interferon (IFN-γ) increased markedly. By day 10, circulating IgG antibody concentrations increased, and on day 12, animals showed early signs of recovery. These results define early events occurring in an inhalational macaque monkeypox infection model, supporting its use as a surrogate model for human smallpox. IMPORTANCE Bioterrorism poses a major threat to public health, as the deliberate release of infectious agents, such smallpox or a related virus, monkeypox, would have catastrophic consequences. The development and testing of new medical countermeasures, e.g., vaccines, are thus priorities; however, tests for efficacy in humans cannot be performed because it would be unethical and field trials are not feasible. To overcome this, the FDA may grant marketing approval of a new product based upon the "Animal Rule," in which interventions are tested for efficacy in well-characterized animal models. Monkeypox virus infection of nonhuman primates (NHPs) presents a potential surrogate disease model for smallpox. Previously, the later stages of monkeypox infection were defined, but the early course of infection remains unstudied. Here, the early pathogenic events of inhalational monkeypox infection in NHPs were characterized, and the results support the use of this surrogate model for testing human smallpox interventions.
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Affiliation(s)
- J A Tree
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - G Hall
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - G Pearson
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - E Rayner
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - V A Graham
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - K Steeds
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - K R Bewley
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - G J Hatch
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - M Dennis
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - I Taylor
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - A D Roberts
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - S G P Funnell
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - J Vipond
- Microbiological Services, Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
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Newcombe J, Eales-Reynolds LJ, Wootton L, Gorringe AR, Funnell SGP, Taylor SC, McFadden JJ. Infection with an avirulent phoP mutant of Neisseria meningitidis confers broad cross-reactive immunity. Infect Immun 2004; 72:338-44. [PMID: 14688113 PMCID: PMC343971 DOI: 10.1128/iai.72.1.338-344.2004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [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: 06/11/2003] [Revised: 09/03/2003] [Accepted: 09/29/2003] [Indexed: 11/20/2022] Open
Abstract
Successful vaccines against serogroup A and C meningococcal strains have been developed, but current serogroup B vaccines provide protection against only a limited range of strains. The ideal meningococcal vaccine would provide cross-reactive immunity against the variety of strains that may be encountered in any community, but it is unclear whether the meningococcus possesses immune targets that have the necessary level of cross-reactivity. We have generated a phoP mutant of the meningococcus by allele exchange. PhoP is a component of a two-component regulatory system which in other bacteria is an important regulator of virulence gene expression. Inactivation of the PhoP-PhoQ system in Salmonella leads to avirulence, and phoP mutants have been shown to confer protection against virulent challenge. These mutants have been examined as potential live attenuated vaccines. We here show that a phoP mutant of the meningococcus is avirulent in a mouse model of infection. Moreover, infection of mice with the phoP mutant stimulated a bactericidal immune response that not only killed the infecting strain but also showed cross-reactive bactericidal activity against a range of strains with different serogroup, serotype, and serosubtyping antigens. Sera from the mutant-infected mice contained immunoglobulin G that bound to the surface of a range of meningococcal strains and mediated opsonophagocytosis of meningococci by human phagocytic cells. The meningococcal phoP mutant is thus a candidate live, attenuated vaccine strain and may also be used to identify cross-reactive protective antigens in the meningococcus.
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Affiliation(s)
- J Newcombe
- School of Biomedical and Molecular Sciences, University of Surrey, Guildford, Surrey, United Kingdom
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