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Mende K, Akers KS, Tyner SD, Bennett JW, Simons MP, Blyth DM, Li P, Stewart L, Tribble DR. Multidrug-Resistant and Virulent Organisms Trauma Infections: Trauma Infectious Disease Outcomes Study Initiative. Mil Med 2022; 187:42-51. [PMID: 35512375 DOI: 10.1093/milmed/usab131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION During the wars in Iraq and Afghanistan, increased incidence of multidrug-resistant (MDR) organisms, as well as polymicrobial wounds and infections, complicated the management of combat trauma-related infections. Multidrug resistance and wound microbiology are a research focus of the Trauma Infectious Disease Outcomes Study (TIDOS), an Infectious Disease Clinical Research Program, Uniformed Services University, research protocol. To conduct comprehensive microbiological research with the goal of improving the understanding of the complicated etiology of wound infections, the TIDOS MDR and Virulent Organisms Trauma Infections Initiative (MDR/VO Initiative) was established as a collaborative effort with the Brooke Army Medical Center, Naval Medical Research Center, U.S. Army Institute of Surgical Research, and Walter Reed Army Institute of Research. We provide a review of the TIDOS MDR/VO Initiative and summarize published findings. METHODS Antagonism and biofilm formation of commonly isolated wound bacteria (e.g., ESKAPE pathogens-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.), antimicrobial susceptibility patterns, and clinical outcomes are being examined. Isolates collected from admission surveillance swabs, as part of infection control policy, and clinical infection workups were retained in the TIDOS Microbiological Repository and associated clinical data in the TIDOS database. RESULTS Over the TIDOS study period (June 2009 to December 2014), more than 8,300 colonizing and infecting isolates were collected from military personnel injured with nearly one-third of isolates classified as MDR. At admission to participating U.S. military hospitals, 12% of wounded warriors were colonized with MDR Gram-negative bacilli. Furthermore, 27% of 913 combat casualties with ≥1 infection during their trauma hospitalization had MDR Gram-negative bacterial infections. Among 335 confirmed combat-related extremity wound infections (2009-2012), 61% were polymicrobial and comprised various combinations of Gram-negative and Gram-positive bacteria, yeast, fungi, and anaerobes. Escherichia coli was the most common Gram-negative bacilli isolated from clinical workups, as well as the most common colonizing MDR secondary to extended-spectrum β-lactamase resistance. Assessment of 479 E. coli isolates collected from wounded warriors found 188 pulsed-field types (PFTs) from colonizing isolates and 54 PFTs from infecting isolates without significant overlap across combat theaters, military hospitals, and study years. A minority of patients with colonizing E. coli isolates developed subsequent infections with the same E. coli strain. Enterococcus spp. were most commonly isolated from polymicrobial wound infections (53% of 204 polymicrobial cultures). Patients with Enterococcus infections were severely injured with a high proportion of lower extremity amputations and genitourinary injuries. Approximately 65% of polymicrobial Enterococcus infections had other ESKAPE organisms isolated. As biofilms have been suggested as a cause of delayed wound healing, wound infections with persistent recovery of bacteria (isolates of same organism collected ≥14 days apart) and nonrecurrent bacterial isolates were assessed. Biofilm production was significantly associated with recurrent bacteria isolation (97% vs. 59% with nonrecurrent isolates; P < 0.001); however, further analysis is needed to confirm biofilm formation as a predictor of persistent wound infections. CONCLUSIONS The TIDOS MDR/VO Initiative provides comprehensive and detailed data of major microbial threats associated with combat-related wound infections to further the understanding of wound etiology and potentially identify infectious disease countermeasures, which may lead to improvements in combat casualty care.
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Affiliation(s)
- Katrin Mende
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.,Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Kevin S Akers
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Stuart D Tyner
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Jason W Bennett
- Multidrug-Resistant Organisms Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Mark P Simons
- Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Dana M Blyth
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Ping Li
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Selig DJ, Chin GC, Bobrov AG, DeLuca JP, Getnet D, Livezey JR, Long JB, Sajja VS, Swierczewski BE, Tyner SD, Antonic V. Semimechanistic Modeling of the Effects of Blast Overpressure Exposure on Cefazolin Pharmacokinetics in Mice. J Pharmacol Exp Ther 2021; 379:175-181. [PMID: 34433578 DOI: 10.1124/jpet.121.000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
Cefazolin is a first-line antibiotic to treat infection related to deployment-associated blast injuries. Prior literature demonstrated a 331% increase cefazolin liver area under the curve (AUC) in mice exposed to a survivable blast compared with controls. We repeated the experiment, validated the findings, and established a semimechanistic two-compartment pharmacokinetic (PK) model with effect compartments representing the liver and skin. We found that blast statistically significantly increased the pseudo-partition coefficient to the liver by 326% (95% confidence interval: 76-737%), which corresponds to the observed 331% increase in cefazolin liver AUC described previously. To a lesser extent, plasma AUC in blasted mice increased 14-45% compared with controls. Nevertheless, the effects of blast on cefazolin PK were transient, normalizing by 10 hours after the dose. It is unclear as to how this blast effect t emporally translates to humans; however, given the short-lived effect on PK, there is insufficient evidence to recommend cefazolin dosing changes based on blast overpressure injury alone. Clinicians should be aware that cefazolin may cause drug-induced liver injury with a single dose and the risk may be higher in patients with blast overpressure injury based on our findings. SIGNIFICANCE STATEMENT: Blast exposure significantly, but transiently, alters cefazolin pharmacokinetics in mice. The questions of whether other medications or potential long-term consequences in humans need further exploration.
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Affiliation(s)
- Daniel J Selig
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Geoffrey C Chin
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Alexander G Bobrov
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Jesse P DeLuca
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Derese Getnet
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Jeffrey R Livezey
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Joseph B Long
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Venkatasivasai S Sajja
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Brett E Swierczewski
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Stuart D Tyner
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
| | - Vlado Antonic
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA (D.J.S., G.C.C., A.G.B., J.P.D., D.G., J.B.L., V.S.S., B.E.S., S.D.T., V.A.); Uniformed Services University, Bethesda, Maryland, USA (J.R.L.)
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Engeman E, Freyberger HR, Corey BW, Ward AM, He Y, Nikolich MP, Filippov AA, Tyner SD, Jacobs AC. Synergistic Killing and Re-Sensitization of Pseudomonas aeruginosa to Antibiotics by Phage-Antibiotic Combination Treatment. Pharmaceuticals (Basel) 2021; 14:ph14030184. [PMID: 33668899 PMCID: PMC7996583 DOI: 10.3390/ph14030184] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 01/23/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
Multidrug-resistant (MDR) Pseudomonas aeruginosa infections pose a serious health threat. Bacteriophage-antibiotic combination therapy is a promising candidate for combating these infections. A 5-phage P. aeruginosa cocktail, PAM2H, was tested in combination with antibiotics (ceftazidime, ciprofloxacin, gentamicin, meropenem) to determine if PAM2H enhances antibiotic activity. Combination treatment in vitro resulted in a significant increase in susceptibility of MDR strains to antibiotics. Treatment with ceftazidime (CAZ), meropenem, gentamicin, or ciprofloxacin in the presence of the phage increased the number of P. aeruginosa strains susceptible to these antibiotics by 63%, 56%, 31%, and 81%, respectively. Additionally, in a mouse dorsal wound model, seven of eight mice treated with a combination of CAZ and PAM2H for three days had no detectable bacteria remaining in their wounds on day 4, while all mice treated with CAZ or PAM2H alone had ~107 colony forming units (CFU) remaining in their wounds. P. aeruginosa recovered from mouse wounds post-treatment showed decreased virulence in a wax worm model, and DNA sequencing indicated that the combination treatment prevented mutations in genes encoding known phage receptors. Treatment with PAM2H in combination with antibiotics resulted in the re-sensitization of P. aeruginosa to antibiotics in vitro and a synergistic reduction in bacterial burden in vivo.
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Affiliation(s)
- Emily Engeman
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN 37831, USA
| | - Helen R. Freyberger
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- ICON plc, Ellicott City, MD 21043, USA
| | - Brendan W. Corey
- Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA;
| | - Amanda M. Ward
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- ICON plc, Ellicott City, MD 21043, USA
| | - Yunxiu He
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- ICON plc, Ellicott City, MD 21043, USA
| | - Mikeljon P. Nikolich
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
| | - Andrey A. Filippov
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- ICON plc, Ellicott City, MD 21043, USA
- Correspondence:
| | - Stuart D. Tyner
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
| | - Anna C. Jacobs
- Center for Infectious Diseases Research, Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (E.E.); (H.R.F.); (A.M.W.); (Y.H.); (M.P.N.); (S.D.T.); (A.C.J.)
- ICON plc, Ellicott City, MD 21043, USA
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Shrestha B, Shah Z, Morgan AP, Saingam P, Chaisatit C, Chaorattanakawee S, Praditpol C, Boonyalai N, Lertsethtakarn P, Wojnarski M, Deutsch-Feldman M, Adams M, Sea D, Chann S, Tyner SD, Lanteri CA, Spring MD, Saunders DL, Smith PL, Lon C, Gosi P, Sok S, Satharath P, Rekol H, Lek D, Vesely BA, Lin JT, Waters NC, Takala-Harrison S. Distribution and temporal dynamics of P. falciparum chloroquine resistance transporter mutations associated with piperaquine resistance in Northern Cambodia. J Infect Dis 2021; 224:1077-1085. [PMID: 33528566 DOI: 10.1093/infdis/jiab055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia from 2009-2017. METHODS The sequence of pfcrt was determined for 410 P. falciparum isolates using PacBio amplicon sequencing or whole genome sequencing. Quantitative PCR was used to estimate pfpm2 and pfmdr1 copy number. RESULTS Newly emerged PfCRT mutations increased in prevalence after the change to dihydroartemisinin-piperaquine in 2010, with >98% of parasites harboring these mutations by 2017. After 2014, the prevalence of PfCRT F145I declined, being out-competed by parasites with less resistant, but more fit PfCRT alleles. After the change to artesunate-mefloquine, the prevalence of parasites with amplified pfpm2 decreased, with nearly half of piperaquine-resistant PfCRT mutants having single copy pfpm2. CONCLUSIONS The large proportion of PfCRT mutants that lack pfpm2 amplification emphasizes the importance of including PfCRT mutations as part of molecular surveillance for piperaquine resistance in this region. Likewise, it is critical to monitor for amplified pfmdr1 in these PfCRT mutants, as increased mefloquine pressure could lead to mutants resistant to both drugs.
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Affiliation(s)
- Biraj Shrestha
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zalak Shah
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew P Morgan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Piyaporn Saingam
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Suwanna Chaorattanakawee
- Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | | | - Mariusz Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Matthew Adams
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Soklyda Chann
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stuart D Tyner
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Michele D Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - David L Saunders
- US Army Research Institute of Infectious Diseases, Ft. Detrick, MD, USA
| | - Philip L Smith
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | | | - Huy Rekol
- National Center for Parasitology Entomology and Malaria Control, Village Trapangsvay, Sanakat Phnom Penh, Cambodia
| | - Dysoley Lek
- National Center for Parasitology Entomology and Malaria Control, Village Trapangsvay, Sanakat Phnom Penh, Cambodia
| | - Brian A Vesely
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jessica T Lin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Norman C Waters
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Shannon Takala-Harrison
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Medina-Rojas M, Stribling W, Snesrud E, Garry BI, Li Y, Gann PM, Demons ST, Tyner SD, Zurawski DV, Antonic V. Comparison of Pseudomonas aeruginosa strains reveals that Exolysin A toxin plays an additive role in virulence. Pathog Dis 2020; 78:5804881. [PMID: 32167551 DOI: 10.1093/femspd/ftaa010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa possesses an array of virulence genes ensuring successful infection development. A two-partner secretion system Exolysin BA (ExlBA) is expressed in the PA7-like genetic outliers consisting of ExlA, a pore-forming toxin and ExlB transporter protein. Presence of exlBA in multidrug-resistant (MDR) strains has not been investigated, particularly in the strains isolated from wounded soldiers. METHODS We screened whole genome sequences of 2439 MDR- P. aeruginosa strains for the presence of exlBA. We compiled all exlBA positive strains and compared them with a diversity set for demographics, antimicrobial profiles and phenotypic characteristics: surface motility, biofilm formation, pyocyanin production and hemolysis. We compared the virulence of strains with comparable phenotypic characteristics in Galleria mellonella. RESULTS We identified 33 exlBA-positive strains (1.5%). These strains have increased antibiotic resistance, they are more motile, produce more robust biofilms and have comparable pyocianin production with the diversity set despite the phenotypic differences within the group. In in vivo infection models, these strains were less virulent than Type III Secretion System (T3SS) positive counterparts. CONCLUSIONS exlBA-positive strains are wide spread among the PA7-like outliers. While not as virulent as strains possessing T3SS, these strains exhibit phenotypic features associated with virulence and are still lethal in vivo.
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Affiliation(s)
- Maria Medina-Rojas
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - William Stribling
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Erik Snesrud
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Brittany I Garry
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Yuanzhang Li
- Walter Reed Army Institute of Research, Preventive Medicine, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Patrick Mc Gann
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Samandra T Demons
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Stuart D Tyner
- Walter Reed Army Institute of Research, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Daniel V Zurawski
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Vlado Antonic
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
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Zurawski DV, Black CC, Alamneh YA, Biggemann L, Banerjee J, Thompson MG, Wise MC, Honnold CL, Kim RK, Paranavitana C, Shearer JP, Tyner SD, Demons ST. A Porcine Wound Model of Acinetobacter baumannii Infection. Adv Wound Care (New Rochelle) 2019; 8:14-27. [PMID: 30705786 PMCID: PMC6350066 DOI: 10.1089/wound.2018.0786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/24/2018] [Indexed: 01/25/2023] Open
Abstract
Objective: To better understand Acinetobacter baumannii pathogenesis and to advance drug discovery against this pathogen, we developed a porcine, full-thickness, excisional, monospecies infection wound model. Approach: The research was facilitated with AB5075, a previously characterized, extensively drug-resistant A. baumannii isolate. The model requires cyclophosphamide-induced neutropenia to establish a skin and soft tissue infection (SSTI) that persists beyond 7 days. Multiple, 12-mm-diameter full-thickness wounds were created in the skin overlying the cervical and thoracic dorsum. Wound beds were inoculated with 5.0 × 104 colony-forming units (CFU) and covered with dressing. Results:A. baumannii was observed in the wound bed and on the dressing in what appeared to be biofilm. When bacterial burdens were measured, proliferation to at least 106 CFU/g (log106) wound tissue was observed. Infection was further characterized by scanning electron microscopy (SEM) and peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) staining. To validate as a treatment model, polymyxin B was applied topically to a subset of infected wounds every 2 days. Then, the treated and untreated wounds were compared using multiple quantitative and qualitative techniques to include gross pathology, CFU burden, histopathology, PNA-FISH, and SEM. Innovation: This is the first study to use A. baumannii in a porcine model as the sole infectious agent. Conclusion: The porcine model allows for an additional preclinical assessment of antibacterial candidates that show promise against A. baumannii in rodent models, further evaluating safety and efficacy, and serve as a large animal in preclinical assessment for the treatment of SSTI.
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Affiliation(s)
- Daniel V. Zurawski
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Chad C. Black
- Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Yonas A. Alamneh
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Lionel Biggemann
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jaideep Banerjee
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Mitchell G. Thompson
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Matthew C. Wise
- Veterinary Services Program, Department of Pathology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Cary L. Honnold
- Veterinary Services Program, Department of Pathology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Robert K. Kim
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Chrysanthi Paranavitana
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jonathan P. Shearer
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Stuart D. Tyner
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Samandra T. Demons
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Heitkamp RA, Li P, Mende K, Demons ST, Tribble DR, Tyner SD. Association of Enterococcus spp. with Severe Combat Extremity Injury, Intensive Care, and Polymicrobial Wound Infection. Surg Infect (Larchmt) 2017; 19:95-103. [PMID: 29261091 DOI: 10.1089/sur.2017.157] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Combat-related extremity wound infections can complicate the recovery of injured military personnel. The Enterococcus genus contains both commensal and pathogenic bacteria found in many combat wounds. We describe the patient population susceptible to Enterococcus infection, the characteristics of Enterococcus spp. isolated from combat-related wounds, and the microbiological profile of Enterococcus-positive wounds. METHODS Patient and culture data were obtained from the Trauma Infectious Disease Outcomes Study. Subjects were divided into a case group with enterococcal extremity wound infections and a comparator group with wound infections caused by other micro-organisms. RESULTS Case and comparator subjects had similar patterns of injury and infection. Case subjects had higher Injury Severity Scores (33 vs. 30; p < 0.001), longer hospitalization at U.S. facilities (55 vs. 40 days; p = 0.004), and required more large-volume blood transfusions (>20 units) within 24 h post-injury (53% vs. 30%; p < 0.001). Approximately 60% of case subjects had three or more infections, and 91% had one or more polymicrobial infections, compared with 43% and 50%, respectively, in the comparator group. The thigh was the most common site of Enterococcus spp. isolation, contributing 50% of isolates. Enterococcus faecium was the predominant species isolated from case-group infections overall (66%), as well as in polymicrobial infections (74%). Frequent co-colonizing microbes in polymicrobial wound infections with Enterococcus were other ESKAPE pathogens (64%) (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae [and Escherichia coli], Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) and fungi (35%). CONCLUSIONS The specific pathogenicity of Enterococcus relative to other pathogens in polymicrobial wounds is unknown. Identifying strain-specific outcomes and investigating the interactions of Enterococcus strains with other wound pathogens could provide additional tools and strategies for infection mitigation in combat-related wounds.
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Affiliation(s)
- Rae A Heitkamp
- 1 Bacterial Diseases Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Ping Li
- 2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,3 Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, Maryland
| | - Katrin Mende
- 2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,3 Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, Maryland.,4 San Antonio Military Medical Center , Joint Base San Antonio, Fort Sam Houston, Texas
| | - Samandra T Demons
- 1 Bacterial Diseases Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - David R Tribble
- 2 Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Stuart D Tyner
- 1 Bacterial Diseases Branch, Walter Reed Army Institute of Research , Silver Spring, Maryland
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8
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Wallum TE, Yun HC, Rini EA, Carter K, Guymon CH, Akers KS, Tyner SD, White CE, Murray CK. Pathogens present in acute mangled extremities from Afghanistan and subsequent pathogen recovery. Mil Med 2016; 180:97-103. [PMID: 25562864 DOI: 10.7205/milmed-d-14-00301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Given the changing epidemiology of infecting pathogens in combat casualties, we evaluated bacteria and fungi in acute traumatic wounds from Afghanistan. From January 2013 to February 2014, 14 mangled lower extremities from 10 explosive-device injured casualties were swabbed for culture at Role 3 facilities. Bacteria were recovered from all patients on the date of injury. Pathogens recovered during routine patient care were recorded. The median injury severity score was 29, median initial Role 3/4 blood product support was 32 units, and median evacuation time was 42 minutes to first surgical care. Gram-positive bacteria were found in some wounds but not methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. Most wounds were colonized with low-virulence, environmental gram-negative bacteria, and not recovered again during therapy, reflecting wound contamination. Only one wound had the same bacteria (E. cloacae) throughout care at the Role 3, 4, and 5 facilities. Three cultures from two patients had multidrug-resistant bacteria (E. cloacae, E. coli), all detected at Role 5 facilities. Molds were not detected at Role 3, whereas one patient had a mold at Role 4 and 5. Mangled lower extremity injuries have a high contamination rate with environmental organisms, which are not typically associated with infections during the course of the patient's care.
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Affiliation(s)
- Timothy E Wallum
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Heather C Yun
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
| | - Elizabeth A Rini
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Kristina Carter
- Naval Environmental Preventive Medicine Unit 5 San Diego, 3235 Albacore Alley, San Diego, CA 92136
| | - Charles H Guymon
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Kevin S Akers
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Stuart D Tyner
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Christopher E White
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Clinton K Murray
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
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9
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Timmermans A, Melendrez MC, Se Y, Chuang I, Samon N, Uthaimongkol N, Klungthong C, Manasatienkij W, Thaisomboonsuk B, Tyner SD, Rith S, Horm VS, Jarman RG, Bethell D, Chanarat N, Pavlin J, Wongstitwilairoong T, Saingam P, El BS, Fukuda MM, Touch S, Sovann L, Fernandez S, Buchy P, Chanthap L, Saunders D. Human Sentinel Surveillance of Influenza and Other Respiratory Viral Pathogens in Border Areas of Western Cambodia. PLoS One 2016; 11:e0152529. [PMID: 27028323 PMCID: PMC4814059 DOI: 10.1371/journal.pone.0152529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/15/2016] [Indexed: 01/16/2023] Open
Abstract
Little is known about circulation of influenza and other respiratory viruses in remote populations along the Thai-Cambodia border in western Cambodia. We screened 586 outpatients (median age 5, range 1–77) presenting with influenza-like-illness (ILI) at 4 sentinel sites in western Cambodia between May 2010 and December 2012. Real-time reverse transcriptase (rRT) PCR for influenza was performed on combined nasal and throat specimens followed by viral culture, antigenic analysis, antiviral susceptibility testing and full genome sequencing for phylogenetic analysis. ILI-specimens negative for influenza were cultured, followed by rRT-PCR for enterovirus and rhinovirus (EV/RV) and EV71. Influenza was found in 168 cases (29%) and occurred almost exclusively in the rainy season from June to November. Isolated influenza strains had close antigenic and phylogenetic relationships, matching vaccine and circulating strains found elsewhere in Cambodia. Influenza vaccination coverage was low (<20%). Western Cambodian H1N1(2009) isolate genomes were more closely related to 10 earlier Cambodia isolates (94.4% genome conservation) than to 13 Thai isolates (75.9% genome conservation), despite sharing the majority of the amino acid changes with the Thai references. Most genes showed signatures of purifying selection. Viral culture detected only adenovirus (5.7%) and parainfluenza virus (3.8%), while non-polio enteroviruses (10.3%) were detected among 164 culture-negative samples including coxsackievirus A4, A6, A8, A9, A12, B3, B4 and echovirus E6 and E9 using nested RT-PCR methods. A single specimen of EV71 was found. Despite proximity to Thailand, influenza epidemiology of these western Cambodian isolates followed patterns observed elsewhere in Cambodia, continuing to support current vaccine and treatment recommendations from the Cambodian National Influenza Center. Amino acid mutations at non-epitope sites, particularly hemagglutinin genes, require further investigation in light of an increasingly important role of permissive mutations in influenza virus evolution. Further research about the burden of adenovirus and non-polio enteroviruses as etiologic agents in acute respiratory infections in Cambodia is also needed.
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Affiliation(s)
- Ans Timmermans
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Melanie C. Melendrez
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Youry Se
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Ilin Chuang
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nou Samon
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Nichapat Uthaimongkol
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Wudtichai Manasatienkij
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stuart D. Tyner
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sareth Rith
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Viseth Srey Horm
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Delia Bethell
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nitima Chanarat
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Julie Pavlin
- Deputy Director, Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
| | | | - Piyaporn Saingam
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - But Sam El
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Mark M. Fukuda
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sok Touch
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Ly Sovann
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Stefan Fernandez
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Philippe Buchy
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Lon Chanthap
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - David Saunders
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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10
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Chaorattanakawee S, Lanteri CA, Sundrakes S, Yingyuen K, Gosi P, Chanarat N, Wongarunkochakorn S, Buathong N, Chann S, Kuntawunginn W, Arsanok M, Lin JT, Juliano JJ, Tyner SD, Char M, Lon C, Saunders DL. Attenuation of Plasmodium falciparum in vitro drug resistance phenotype following culture adaptation compared to fresh clinical isolates in Cambodia. Malar J 2015; 14:486. [PMID: 26626127 PMCID: PMC4667454 DOI: 10.1186/s12936-015-1021-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/26/2015] [Indexed: 01/03/2023] Open
Abstract
Background There is currently no standardized approach for assessing in vitro anti-malarial drug susceptibility. Potential alterations in drug susceptibility results between fresh immediate ex vivo (IEV) and cryopreserved culture-adapted (CCA) Plasmodium falciparum isolates, as well as changes in parasite genotype during culture adaptation were investigated. Methods The 50 % inhibitory concentration (IC50) of 12 P. falciparum isolates from Cambodia against a panel of commonly used drugs were compared using both IEV and CCA. Results were compared using both histidine-rich protein-2 ELISA (HRP-2) and SYBR-Green I fluorescence methods. Molecular genotyping and amplicon deep sequencing were also used to compare multiplicity of infection and genetic polymophisms in fresh versus culture-adapted isolates. Results IC50 for culture-adapted specimens were significantly lower compared to the original fresh isolates for both HRP-2 and SYBR-Green I assays, with greater than a 50 % decline for the majority of drug-assay combinations. There were correlations between IC50s from IEV and CCA for most drugs assays. Infections were nearly all monoclonal, with little or no change in merozoite surface protein 1 (MSP1), MSP2, glutamate-rich protein (GLURP) or apical membrane antigen 1 (AMA1) polymorphisms, nor differences in P. falciparum multidrug resistance 1 gene (PfMDR1) copy number or single nucleotide polymorphisms following culture adaptation. Conclusions The overall IC50 reduction combined with the correlation between fresh isolates and culture-adapted drug susceptibility assays suggests the utility of both approaches, as long as there is consistency of method, and remaining mindful of possible attenuation of resistance phenotype occurring in culture. Further study should be done in higher transmission settings where polyclonal infections are prevalent. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-1021-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suwanna Chaorattanakawee
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Charlotte A Lanteri
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand. .,Microbiology Section, Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, San Antonio, TX, USA.
| | - Siratchana Sundrakes
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Kritsanai Yingyuen
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Panita Gosi
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Nitima Chanarat
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Saowaluk Wongarunkochakorn
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Nillawan Buathong
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Soklyda Chann
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Worachet Kuntawunginn
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Montri Arsanok
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - Jessica T Lin
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Jonathan J Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Stuart D Tyner
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand. .,US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, USA.
| | - Mengchuor Char
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
| | - Chanthap Lon
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
| | - David L Saunders
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science, Bangkok, Thailand.
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11
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Spooner SP, Tyner SD, Sowers C, Tsao J, Stuessi K. Utility of a Sports Medicine Model in Military Combat Concussion and Musculoskeletal Restoration Care. Mil Med 2014; 179:1319-24. [DOI: 10.7205/milmed-d-14-00191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Takala-Harrison S, Jacob CG, Arze C, Cummings MP, Silva JC, Dondorp AM, Fukuda MM, Hien TT, Mayxay M, Noedl H, Nosten F, Kyaw MP, Nhien NTT, Imwong M, Bethell D, Se Y, Lon C, Tyner SD, Saunders DL, Ariey F, Mercereau-Puijalon O, Menard D, Newton PN, Khanthavong M, Hongvanthong B, Starzengruber P, Fuehrer HP, Swoboda P, Khan WA, Phyo AP, Nyunt MM, Nyunt MH, Brown TS, Adams M, Pepin CS, Bailey J, Tan JC, Ferdig MT, Clark TG, Miotto O, MacInnis B, Kwiatkowski DP, White NJ, Ringwald P, Plowe CV. Independent emergence of artemisinin resistance mutations among Plasmodium falciparum in Southeast Asia. J Infect Dis 2014; 211:670-9. [PMID: 25180241 DOI: 10.1093/infdis/jiu491] [Citation(s) in RCA: 325] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The emergence of artemisinin-resistant Plasmodium falciparum in Southeast Asia threatens malaria treatment efficacy. Mutations in a kelch protein encoded on P. falciparum chromosome 13 (K13) have been associated with resistance in vitro and in field samples from Cambodia. METHODS P. falciparum infections from artesunate efficacy trials in Bangladesh, Cambodia, Laos, Myanmar, and Vietnam were genotyped at 33 716 genome-wide single-nucleotide polymorphisms (SNPs). Linear mixed models were used to test associations between parasite genotypes and parasite clearance half-lives following artesunate treatment. K13 mutations were tested for association with artemisinin resistance, and extended haplotypes on chromosome 13 were examined to determine whether mutations arose focally and spread or whether they emerged independently. RESULTS The presence of nonreference K13 alleles was associated with prolonged parasite clearance half-life (P = 1.97 × 10(-12)). Parasites with a mutation in any of the K13 kelch domains displayed longer parasite clearance half-lives than parasites with wild-type alleles. Haplotype analysis revealed both population-specific emergence of mutations and independent emergence of the same mutation in different geographic areas. CONCLUSIONS K13 appears to be a major determinant of artemisinin resistance throughout Southeast Asia. While we found some evidence of spreading resistance, there was no evidence of resistance moving westward from Cambodia into Myanmar.
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Affiliation(s)
| | | | - Cesar Arze
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | - Michael P Cummings
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park
| | - Joana C Silva
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore
| | | | - Mark M Fukuda
- Armed Forces Research Institute of Medical Sciences, Bangkok
| | - Tran Tinh Hien
- Center for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital Faculty of Postgraduate Studies, University of Health Sciences Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford
| | - Harald Noedl
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Francois Nosten
- Mahidol-Oxford Tropical Medicine Research Unit Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford
| | - Myat P Kyaw
- Department of Medical Research (Lower Myanmar), Yangon
| | - Nguyen Thanh Thuy Nhien
- Center for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University
| | - Delia Bethell
- Armed Forces Research Institute of Medical Sciences, Bangkok
| | - Youry Se
- Armed Forces Research Institute of Medical Sciences
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences
| | - Stuart D Tyner
- Armed Forces Research Institute of Medical Sciences, Bangkok
| | | | | | | | - Didier Menard
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford
| | | | | | - Peter Starzengruber
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Hans-Peter Fuehrer
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Paul Swoboda
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Aung Pyae Phyo
- Mahidol-Oxford Tropical Medicine Research Unit Shoklo Malaria Research Unit Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Myaing M Nyunt
- Howard Hughes Medical Institute/Center for Vaccine Development
| | - Myat H Nyunt
- Department of Medical Research (Lower Myanmar), Yangon
| | - Tyler S Brown
- Howard Hughes Medical Institute/Center for Vaccine Development
| | - Matthew Adams
- Howard Hughes Medical Institute/Center for Vaccine Development
| | | | - Jason Bailey
- Howard Hughes Medical Institute/Center for Vaccine Development
| | - John C Tan
- Research and Development, Roche NimbleGen, Madison, Wisconsin
| | - Michael T Ferdig
- Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Indiana
| | - Taane G Clark
- Faculty of Epidemiology and Population Health Faculty Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Olivo Miotto
- Mahidol-Oxford Tropical Medicine Research Unit MRC Centre for Genomics and Global Health, Oxford University and Wellcome Trust Sanger Institute Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Bronwyn MacInnis
- Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Dominic P Kwiatkowski
- MRC Centre for Genomics and Global Health, Oxford University and Wellcome Trust Sanger Institute Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | | | - Pascal Ringwald
- Drug Resistance and Containment Unit, Global Malaria Programme, World Health Organization, Geneva, Switzerland
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13
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Lon C, Manning JE, Vanachayangkul P, So M, Sea D, Se Y, Gosi P, Lanteri C, Chaorattanakawee S, Sriwichai S, Chann S, Kuntawunginn W, Buathong N, Nou S, Walsh DS, Tyner SD, Juliano JJ, Lin J, Spring M, Bethell D, Kaewkungwal J, Tang D, Chuor CM, Satharath P, Saunders D. Efficacy of two versus three-day regimens of dihydroartemisinin-piperaquine for uncomplicated malaria in military personnel in northern Cambodia: an open-label randomized trial. PLoS One 2014; 9:e93138. [PMID: 24667662 PMCID: PMC3965521 DOI: 10.1371/journal.pone.0093138] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/27/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Emerging antimalarial drug resistance in mobile populations remains a significant public health concern. We compared two regimens of dihydroartemisinin-piperaquine in military and civilians on the Thai-Cambodian border to evaluate national treatment policy. METHODS Efficacy and safety of two and three-day regimens of dihydroartemisinin-piperaquine were compared as a nested open-label evaluation within a malaria cohort study in 222 otherwise healthy volunteers (18% malaria-infected at baseline). The first 80 volunteers with slide-confirmed Plasmodium falciparum or vivax malaria were randomized 1:1 to receive either regimen (total dose 360 mg dihydroartemisinin and 2880 mg piperaquine) and followed weekly for up to 6 months. The primary endpoint was malaria recurrence by day 42. Volunteers with vivax infection received primaquine at study discharge with six months follow-up. RESULTS Eighty patients (60 vivax, 15 falciparum, and 5 mixed) were randomized to dihydroartemisinin-piperaquine. Intention-to-treat all-species efficacy at Day 42 was 85% for the two-day regimen (95% CI 69-94) and 90% for the three-day regimen (95% CI 75-97). PCR-adjusted falciparum efficacy was 75% in both groups with nearly half (45%) still parasitemic at Day 3. Plasma piperaquine levels were comparable to prior published reports, but on the day of recrudescence were below measurable in vitro piperaquine IC50 levels in all falciparum treatment failures. CONCLUSIONS In the brief period since introduction of dihydroartemisinin-piperaquine, there is early evidence suggesting declining efficacy relative to previous reports. Parasite IC50 levels in excess of plasma piperaquine levels seen only in treatment failures raises concern for clinically significant piperaquine resistance in Cambodia. These findings warrant improved monitoring of clinical outcomes and follow-up, given few available alternative drugs. TRIAL REGISTRATION ClinicalTrials.gov NCT01280162.
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Affiliation(s)
- Chanthap Lon
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Jessica E. Manning
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Pattaraporn Vanachayangkul
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Mary So
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | - Darapiseth Sea
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Youry Se
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Panita Gosi
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Charlotte Lanteri
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Suwanna Chaorattanakawee
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Sabaithip Sriwichai
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Soklyda Chann
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Worachet Kuntawunginn
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Nillawan Buathong
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Samon Nou
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Douglas S. Walsh
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Stuart D. Tyner
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Jonathan J. Juliano
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessica Lin
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Michele Spring
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Delia Bethell
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Mahidol University, Bangkok, Thailand
| | - Douglas Tang
- Fast Track Biologics, Potomac, Maryland, United States of America
| | - Char Meng Chuor
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - David Saunders
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand
- * E-mail:
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Gosi P, Lanteri CA, Tyner SD, Se Y, Lon C, Spring M, Char M, Sea D, Sriwichai S, Surasri S, Wongarunkochakorn S, Pidtana K, Walsh DS, Fukuda MM, Manning J, Saunders DL, Bethell D. Evaluation of parasite subpopulations and genetic diversity of the msp1, msp2 and glurp genes during and following artesunate monotherapy treatment of Plasmodium falciparum malaria in Western Cambodia. Malar J 2013; 12:403. [PMID: 24206588 PMCID: PMC3830508 DOI: 10.1186/1475-2875-12-403] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 07/25/2013] [Accepted: 11/04/2013] [Indexed: 11/14/2022] Open
Abstract
Background Despite widespread coverage of the emergence of artemisinin resistance, relatively little is known about the parasite populations responsible. The use of PCR genotyping around the highly polymorphic Plasmodium falciparum msp1, msp2 and glurp genes has become well established both to describe variability in alleles within a population of parasites, as well as classify treatment outcome in cases of recurrent disease. The primary objective was to assess the emergence of minority parasite clones during seven days of artesunate (AS) treatment in a location with established artemisinin resistance. An additional objective was to investigate whether the classification of clinical outcomes remained valid when additional genotyping was performed. Methods Blood for parasite genotyping was collected from 143 adult patients presenting with uncomplicated falciparum malaria during a clinical trial of AS monotherapy in Western Cambodia. Nested allelic type-specific amplification of the genes encoding the merozoite surface proteins 1 and 2 (msp1 and msp2) and the glutamate-rich protein (glurp) was performed at baseline, daily during seven days of treatment, and again at failure. Allelic variants were analysed with respect to the size of polymorphisms using Quantity One software to enable identification of polyclonal infections. Results Considerable variation of msp2 alleles but well-conserved msp1 and glurp were identified. At baseline, 31% of infections were polyclonal for one or more genes. Patients with recurrent malaria were significantly more likely to have polyclonal infections than patients without recurrence (seven of nine versus 36 of 127, p = 0.004). Emergence of minority alleles during treatment was detected in only one of twenty-three cases defined as being artemisinin resistant. Moreover, daily genotyping did not alter the final outcome classification in any recurrent cases. Conclusions The parasites responsible for artemisinin-resistant malaria in a clinical trial in Western Cambodia comprise the dominant clones of acute malaria infections rather than minority clones emerging during treatment. Additional genotyping during therapy was not beneficial. Disproportionately high rates of polyclonal infections in cases of recurrence suggest complex infections lead to poor treatment outcomes. Current research objectives should be broadened to include identification and follow-up of recurrent polyclonal infections so as to define their role as potential agents of emerging resistance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Delia Bethell
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Science (AFRIMS), Bangkok, Thailand.
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15
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Chaorattanakawee S, Tyner SD, Lon C, Yingyuen K, Ruttvisutinunt W, Sundrakes S, Sai-gnam P, Johnson JD, Walsh DS, Saunders DL, Lanteri CA. Direct comparison of the histidine-rich protein-2 enzyme-linked immunosorbent assay (HRP-2 ELISA) and malaria SYBR green I fluorescence (MSF) drug sensitivity tests in Plasmodium falciparum reference clones and fresh ex vivo field isolates from Cambodia. Malar J 2013; 12:239. [PMID: 23849006 PMCID: PMC3716935 DOI: 10.1186/1475-2875-12-239] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 04/02/2013] [Accepted: 07/03/2013] [Indexed: 12/23/2022] Open
Abstract
Background Performance of the histidine-rich protein-2 enzyme-linked immunosorbent assay (HRP-2 ELISA) and malaria SYBR Green I fluorescence (MSF) drug sensitivity tests were directly compared using Plasmodium falciparum reference strains and fresh ex vivo isolates from Cambodia against a panel of standard anti-malarials. The objective was to determine which of these two common assays is more appropriate for studying drug susceptibility of “immediate ex vivo” (IEV) isolates, analysed without culture adaption, in a region of relatively low malaria transmission. Methods Using the HRP-2 and MSF methods, the 50% inhibitory concentration (IC50) values against a panel of malaria drugs were determined for P. falciparum reference clones (W2, D6, 3D7 and K1) and 41 IEV clinical isolates from an area of multidrug resistance in Cambodia. Comparison of the IC50 values from the two methods was made using Wilcoxon matched pair tests and Pearson’s correlation. The lower limit of parasitaemia detection for both methods was determined for reference clones and IEV isolates. Since human white blood cell (WBC) DNA in clinical samples is known to reduce MSF assay sensitivity, SYBR Green I fluorescence linearity of P. falciparum samples spiked with WBCs was evaluated to assess the relative degree to which MSF sensitivity is reduced in clinical samples. Results IC50 values correlated well between the HRP-2 and MSF methods when testing either P. falciparum reference clones or IEV isolates against 4-aminoquinolines (chloroquine, piperaquine and quinine) and the quinoline methanol mefloquine (Pearson r = 0.85-0.99 for reference clones and 0.56-0.84 for IEV isolates), whereas a weaker IC50 value correlation between methods was noted when testing artemisinins against reference clones and lack of correlation when testing IEV isolates. The HRP-2 ELISA produced a higher overall success rate (90% for producing IC50 best-fit sigmoidal curves), relative to only a 40% success rate for the MSF assay, when evaluating ex vivo Cambodian isolates. Reduced sensitivity of the MSF assay is likely due to an interference of WBCs in clinical samples. Conclusions For clinical samples not depleted of WBCs, HRP-2 ELISA is superior to the MSF assay at evaluating fresh P. falciparum field isolates with low parasitaemia (<0.2%) generally observed in Southeast Asia.
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Affiliation(s)
- Suwanna Chaorattanakawee
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Bethell D, Saunders D, Jongkaewwattana A, Kramyu J, Thitithayanont A, Wiboon-ut S, Yongvanitchit K, Limsalakpetch A, Kum-Arb U, Uthaimongkol N, Garcia JM, Timmermans AE, Peiris M, Thomas S, Engering A, Jarman RG, Mongkolsirichaikul D, Mason C, Khemnu N, Tyner SD, Fukuda MM, Walsh DS, Pichyangkul S. Evaluation of in vitro cross-reactivity to avian H5N1 and pandemic H1N1 2009 influenza following prime boost regimens of seasonal influenza vaccination in healthy human subjects: a randomised trial. PLoS One 2013; 8:e59674. [PMID: 23555741 PMCID: PMC3608534 DOI: 10.1371/journal.pone.0059674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/16/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Recent studies have demonstrated that inactivated seasonal influenza vaccines (IIV) may elicit production of heterosubtypic antibodies, which can neutralize avian H5N1 virus in a small proportion of subjects. We hypothesized that prime boost regimens of live and inactivated trivalent seasonal influenza vaccines (LAIV and IIV) would enhance production of heterosubtypic immunity and provide evidence of cross-protection against other influenza viruses. Methods In an open-label study, 26 adult volunteers were randomized to receive one of four vaccine regimens containing two doses of 2009-10 seasonal influenza vaccines administered 8 (±1) weeks apart: 2 doses of LAIV; 2 doses of IIV; LAIV then IIV; IIV then LAIV. Humoral immunity assays for avian H5N1, 2009 pandemic H1N1 (pH1N1), and seasonal vaccine strains were performed on blood collected pre-vaccine and 2 and 4 weeks later. The percentage of cytokine-producing T-cells was compared with baseline 14 days after each dose. Results Subjects receiving IIV had prompt serological responses to vaccine strains. Two subjects receiving heterologous prime boost regimens had enhanced haemagglutination inhibition (HI) and neutralization (NT) titres against pH1N1, and one subject against avian H5N1; all three had pre-existing cross-reactive antibodies detected at baseline. Significantly elevated titres to H5N1 and pH1N1 by neuraminidase inhibition (NI) assay were observed following LAIV-IIV administration. Both vaccines elicited cross-reactive CD4+ T-cell responses to nucleoprotein of avian H5N1 and pH1N1. All regimens were safe and well tolerated. Conclusion Neither homologous nor heterologous prime boost immunization enhanced serum HI and NT titres to 2009 pH1N1 or avian H5N1 compared to single dose vaccine. However heterologous prime-boost vaccination did lead to in vitro evidence of cross-reactivity by NI; the significance of this finding is unclear. These data support the strategy of administering single dose trivalent seasonal influenza vaccine at the outset of an influenza pandemic while a specific vaccine is being developed. Trial Registration ClinicalTrials.gov NCT01044095
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MESH Headings
- Adolescent
- Adult
- Animals
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Birds
- Cross Reactions
- Feasibility Studies
- Female
- Health
- Humans
- Immunization, Secondary/adverse effects
- Immunization, Secondary/methods
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/physiology
- Influenza A Virus, H5N1 Subtype/immunology
- Influenza A Virus, H5N1 Subtype/physiology
- Influenza in Birds/immunology
- Influenza in Birds/prevention & control
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Male
- Middle Aged
- Orthomyxoviridae/immunology
- Orthomyxoviridae/physiology
- Pandemics/prevention & control
- Pilot Projects
- Safety
- Seasons
- T-Lymphocytes/immunology
- T-Lymphocytes/virology
- Vaccination/adverse effects
- Vaccination/methods
- Viral Vaccines/adverse effects
- Viral Vaccines/immunology
- Young Adult
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Affiliation(s)
- Delia Bethell
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
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17
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Rutvisuttinunt W, Chaorattanakawee S, Tyner SD, Teja-Isavadharm P, Se Y, Yingyuen K, Chaichana P, Bethell D, Walsh DS, Lon C, Fukuda M, Socheat D, Noedl H, Schaecher K, Saunders DL. Optimizing the HRP-2 in vitro malaria drug susceptibility assay using a reference clone to improve comparisons of Plasmodium falciparum field isolates. Malar J 2012; 11:325. [PMID: 22974086 PMCID: PMC3489509 DOI: 10.1186/1475-2875-11-325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 06/21/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Apparent emerging artemisinin-resistant Plasmodium falciparum malaria in Southeast Asia requires development of practical tools to monitor for resistant parasites. Although in vitro anti-malarial susceptibility tests are widely used, uncertainties remain regarding interpretation of P. falciparum field isolate values. Methods Performance parameters of the W2 P. falciparum clone (considered artemisinin “sensitive”) were evaluated as a reference for the HRP-2 immediate ex vivo assay. Variability in W2 IC50s was assessed, including intra- and inter-assay variability among and between technicians in multiple experiments, over five freeze-thaw cycles, over five months of continuous culture, and before and after transport of drug-coated plates to remote field sites. Nominal drug plate concentrations of artesunate (AS) and dihydroartemisinin (DHA) were verified by LC-MS analysis. Plasmodium falciparum field isolate IC50s for DHA from subjects in an artemisinin-resistant area in Cambodia were compared with W2 susceptibility. Results Plate drug concentrations and day-to-day technical assay performance among technicians were important sources of variability for W2 IC50s within and between assays. Freeze-thaw cycles, long-term continuous culture, and transport to and from remote sites had less influence. Despite variability in W2 susceptibility, the median IC50s for DHA for Cambodian field isolates were higher (p <0.0001) than the W2 clone (3.9 nM), both for subjects with expected (less than 72 hours; 6.3 nM) and prolonged (greater or equal to 72 hours; 9.6 nM) parasite clearance times during treatment with artesunate monotherapy. Conclusion The W2 reference clone improved the interpretability of field isolate susceptibility from the immediate ex vivo HRP-2 assay from areas of artemisinin resistance. Methods to increase the reproducibility of plate coating may improve overall assay interpretability and utility.
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Affiliation(s)
- Wiriya Rutvisuttinunt
- Department of Immunology and Medicine, US Army Medical Corps, Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), Bangkok, Thailand
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18
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Tyner SD, Lon C, Se Y, Bethell D, Socheat D, Noedl H, Sea D, Satimai W, Schaecher K, Rutvisuttinunt W, Fukuda MM, Chaorattanakawee S, Yingyuen K, Sundrakes S, Chaichana P, Saingam P, Buathong N, Sriwichai S, Chann S, Timmermans A, Saunders DL, Walsh DS. Ex vivo drug sensitivity profiles of Plasmodium falciparum field isolates from Cambodia and Thailand, 2005 to 2010, determined by a histidine-rich protein-2 assay. Malar J 2012; 11:198. [PMID: 22694953 PMCID: PMC3403988 DOI: 10.1186/1475-2875-11-198] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/13/2012] [Indexed: 11/21/2022] Open
Abstract
Background In vitro drug susceptibility assay of Plasmodium falciparum field isolates processed “immediate ex vivo” (IEV), without culture adaption, and tested using histidine-rich protein-2 (HRP-2) detection as an assay, is an expedient way to track drug resistance. Methods From 2005 to 2010, a HRP-2 in vitro assay assessed 451 P. falciparum field isolates obtained from subjects with malaria in western and northern Cambodia, and eastern Thailand, processed IEV, for 50% inhibitory concentrations (IC50) against seven anti-malarial drugs, including artesunate (AS), dihydroartemisinin (DHA), and piperaquine. Results In western Cambodia, from 2006 to 2010, geometric mean (GM) IC50 values for chloroquine, mefloquine, quinine, AS, DHA, and lumefantrine increased. In northern Cambodia, from 2009–2010, GM IC50 values for most drugs approximated the highest western Cambodia GM IC50 values in 2009 or 2010. Conclusions Western Cambodia is associated with sustained reductions in anti-malarial drug susceptibility, including the artemisinins, with possible emergence, or spread, to northern Cambodia. This potential public health crisis supports continued in vitro drug IC50 monitoring of P. falciparum isolates at key locations in the region.
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Affiliation(s)
- Stuart D Tyner
- Department of Immunology and Medicine, US Army Medical Corps, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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19
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Lin JT, Bethell D, Tyner SD, Lon C, Shah NK, Saunders DL, Sriwichai S, Khemawoot P, Kuntawunggin W, Smith BL, Noedl H, Schaecher K, Socheat D, Se Y, Meshnick SR, Fukuda MM. Plasmodium falciparum gametocyte carriage is associated with subsequent Plasmodium vivax relapse after treatment. PLoS One 2011; 6:e18716. [PMID: 21533092 PMCID: PMC3080384 DOI: 10.1371/journal.pone.0018716] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 09/21/2010] [Accepted: 03/16/2011] [Indexed: 11/19/2022] Open
Abstract
Mixed P. falciparum/P. vivax infections are common in southeast Asia. When patients with P. falciparum malaria are treated and followed for several weeks, a significant proportion will develop P. vivax malaria. In a combined analysis of 243 patients recruited to two malaria treatment trials in western Cambodia, 20/43 (47%) of those with P. falciparum gametocytes on admission developed P. vivax malaria by Day 28 of follow-up. The presence of Pf gametocytes on an initial blood smear was associated with a 3.5-fold greater rate of vivax parasitemia post-treatment (IRR = 3.5, 95% CI 2.0-6.0, p<0.001). The increased rate of post-treatment P. vivax infection persisted when correlates of exposure and immunity such as a history of malaria, male gender, and age were controlled for (IRR = 3.0, 95% CI 1.9-4.7, p<0.001). Polymerase chain reaction (PCR) confirmed that only a low proportion of subjects (5/55 or 9.1%) who developed vivax during follow-up had detectable Pv parasites in the peripheral blood at baseline. Molecular detection of falciparum gametocytes by reverse transcriptase PCR in a subset of patients strengthened the observed association, while PCR detection of Pv parasitemia at follow-up was similar to microscopy results. These findings suggest that the majority of vivax infections arising after treatment of falciparum malaria originate from relapsing liver-stage parasites. In settings such as western Cambodia, the presence of both sexual and asexual forms of P. falciparum on blood smear at presentation with acute falciparum malaria serves as a marker for possible occult P. vivax coinfection and subsequent relapse. These patients may benefit from empiric treatment with an 8-aminoquinolone such as primaquine.
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Affiliation(s)
- Jessica T Lin
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
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Hildesheim J, Belova GI, Tyner SD, Zhou X, Vardanian L, Fornace AJ. Gadd45a regulates matrix metalloproteinases by suppressing DeltaNp63alpha and beta-catenin via p38 MAP kinase and APC complex activation. Oncogene 2004; 23:1829-37. [PMID: 14647429 DOI: 10.1038/sj.onc.1207301] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The p53-regulated growth arrest and DNA damage-inducible gene product Gadd45a has been recently identified as a key factor protecting the epidermis against ultraviolet radiation (UVR)-induced skin tumors by activating p53 via the stress mitogen-activated protein kinase (MAPK) signaling pathway. Herein we identify Gadd45a as an important negative regulator of two oncogenes commonly over-expressed in epithelial tumors: the p53 homologue DeltaNp63alpha and beta-catenin. DeltaNp63alpha is one of the several p63 isoforms and is the predominant species expressed in basal epidermal keratinocytes. DeltaNp63alpha lacks the N-terminal transactivation domain and behaves as a dominant-negative factor blocking expression of several p53-effector genes. DeltaNp63alpha also associates with and blocks activation of the adenomatous polyposis coli (APC) destruction complex that targets free cytoplasmic beta-catenin for degradation. While most beta-catenin protein is localized to the cell membrane and is involved in cell-cell adhesion, accumulation of free cytoplasmic beta-catenin will translocate into the nucleus where it functions in a bipartite transcription factor complex, whose targets include invasion and metastasis promoting endopeptidases, matrix metalloproteinases (MMP). We show that Gadd45a not only directly associates with two components of the APC complex, namely protein phosphatase 2A (PP2A) and glycogen synthase kinase 3beta (GSK3beta) but also promotes GSK3beta dephosphorylation at Ser9, which is essential for GSK3beta activation, and resultant activation of the APC destruction complex. We demonstrate that lack of Gadd45a not only prevents DeltaNp63alpha suppression and GSK3beta dephosphorylation but also prevents free cytoplasmic beta-catenin degradation after UV irradiation. The inability of Gadd45a-null keratinocytes to suppress beta-catenin may contribute to the resulting observation of increased MMP expression and activity along with significantly faster keratinocyte migration in Matrigel in vitro and accelerated wound closure in vivo. Furthermore, epidermal keratinocytes treated with p38 MAPK inhibitors, both in vivo and in vitro, behave very similarly to Gadd45a-null keratinocytes after UVR. Similarly, Trp53-null mice are unable to attenuate DeltaNp63alpha expression in epidermal keratinocytes after such stress. These findings demonstrate a dependence on Gadd45a-mediated p38 MAPK and p53 activation for proper modulation of DeltaNp63alpha, GSK3beta, and beta-catenin after irradiation. Taken together, our results indicate that Gadd45a is able to repress DeltaNp63alpha, beta-catenin, and consequently MMP expression by two means: by maintaining UVR-induced p38 MAPK and p53 activation and also by associating with the APC complex. This implicates Gadd45a in the negative regulation of cell migration, and invasion.
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Affiliation(s)
- Jeffrey Hildesheim
- Gene Response Section, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892-4255, USA
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21
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Venkatachalam S, Tyner SD, Pickering CR, Boley S, Recio L, French JE, Donehower LA. Is p53 haploinsufficient for tumor suppression? Implications for the p53+/- mouse model in carcinogenicity testing. Toxicol Pathol 2002; 29 Suppl:147-54. [PMID: 11695551 DOI: 10.1080/019262301753178555] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The p53 tumor suppressor gene has been shown to be critical in preventing cancer in humans and mice. We have generated and extensively characterized p53-deficient mice lacking one (p53+/-) or both (p53-/-) p53 alleles. The p53-deficient mice are much more susceptible to an array of different tumor types than their wild-type (p53+/+) littermates. The enhanced tumor susceptibility of the p53+/- mice has made them one of several transgenic mouse models that are being considered as substitutes for standard 2-year rodent carcinogenicity assays. In order to fully exploit this model, it will be important to understand some of the basic biological and molecular mechanisms that underlie its enhanced tumor susceptibility. With this in mind, we have explored the fate of the remaining wild-type p53 allele in spontaneously arising p53+/- tumors and have shown that over half of these tumors retain an intact, functional wild-type p53 allele. This suggests that p53 is haploinsufficient for tumor suppression and that mere reduction in p53 dosage is sufficient to promote cancer formation. To support the idea that p53 is indeed a haploinsufficient tumor suppressor, we show here that normal p53+/- cells exhibit reduced parameters of growth control and stress response compared to their p53+/- counterparts. We hypothesize that the reduced p53 dosage in the p53+/- cells provides an environment more conducive to the development of further oncogenic lesions and the initiation of a tumor. Finally, we have assessed p53 loss of heterozygosity (LOH) in carcinogen-induced p53+/- tumors and have found that some agents induce tumors that almost invariably exhibit p53 LOH, whereas other agents induce tumors that often retain the wild-type p53 allele. Our preliminary data suggest that LOH is dependent on both the mechanism of genotoxicity of the agent utilized and the tissue type targeted.
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Affiliation(s)
- S Venkatachalam
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
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Tyner SD, Venkatachalam S, Choi J, Jones S, Ghebranious N, Igelmann H, Lu X, Soron G, Cooper B, Brayton C, Park SH, Thompson T, Karsenty G, Bradley A, Donehower LA. p53 mutant mice that display early ageing-associated phenotypes. Nature 2002; 415:45-53. [PMID: 11780111 DOI: 10.1038/415045a] [Citation(s) in RCA: 1015] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The p53 tumour suppressor is activated by numerous stressors to induce apoptosis, cell cycle arrest, or senescence. To study the biological effects of altered p53 function, we generated mice with a deletion mutation in the first six exons of the p53 gene that express a truncated RNA capable of encoding a carboxy-terminal p53 fragment. This mutation confers phenotypes consistent with activated p53 rather than inactivated p53. Mutant (p53+/m) mice exhibit enhanced resistance to spontaneous tumours compared with wild-type (p53+/+) littermates. As p53+/m mice age, they display an early onset of phenotypes associated with ageing. These include reduced longevity, osteoporosis, generalized organ atrophy and a diminished stress tolerance. A second line of transgenic mice containing a temperature-sensitive mutant allele of p53 also exhibits early ageing phenotypes. These data suggest that p53 has a role in regulating organismal ageing.
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Affiliation(s)
- Stuart D Tyner
- Cell and Molecular Biology Program, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
A number of transgenic animal model systems have addressed the mechanistic role of p53 loss in tumor progression. However, many of these tumor models have analyzed p53 function in the context of other transgenes expressing activated oncogenes or defective tumor suppressor genes generated by gene targeting. To examine the role of p53 loss independent of other exogenous oncogenic influences, we analyzed some of the biological aspects of tumor formation and progression in p53-knockout mice containing a null germline p53 allele. We analyzed tumors from p53-/-, p53+/-, and p53+/+ littermates. Some of the p53+/- tumors had lost the remaining p53 allele (p53+/- loss of heterozygosity), whereas others retained the allele (p53+/-). In this report, we show that loss or absence of p53 conferred a tumor growth advantage by increasing the rate of cellular proliferation in a p53 dosage-dependent manner. The apoptotic levels in tumor tissue were found to be modest and not significantly dependent on p53 status. These results contrast with those from some other p53-deficient tumor models, in which p53 loss was associated with more rapid tumor progression through abrogated apoptosis. Finally, as p53 has been shown to regulate certain angiogenic factors, we examined the levels of angiogenesis in p53-containing and p53-deficient tumors. We found no p53-dependent differences in the levels of tumor angiogenesis measured by intratumoral microvessel density.
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Affiliation(s)
- S D Tyner
- Division of Molecular Virology, Baylor College of Medicine, Houston, Texas 77030, USA
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