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Macêdo JVL, Júnior AGS, Oliveira MDL, Andrade CAS. Systematic review and meta-analysis: assessing the accuracy of rapid immunochromatographic tests in dengue diagnosis. Diagn Microbiol Infect Dis 2024; 109:116227. [PMID: 38503028 DOI: 10.1016/j.diagmicrobio.2024.116227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
The objective of this systematic review is to analyze the diagnostic accuracy of rapid dengue diagnostic tests. The search was conducted in the following databases: LILACS, Medline (Pubmed), CRD, The Cochrane Library, Trip Medical Database and Google Scholar. ELISA and PCR assays were adopted as reference methods. Thirty-four articles were included in this systematic review. Receiver operating characteristic (ROC) and Forest Plot were performed to evaluate sensitivity and specificity for each parameter analyzed (NS1, IgM and IgG). The results revealed that the combined analysis of the IgM antibody with the NS1 antigen resulted in greater sensitivity than the isolated analysis of IgM. The three analytes together showed the best performance, with a combined sensitivity of 90 % (95 % CI: 89-92 %) using ELISA as a comparator. Thus, the present review provides relevant knowledge for decision-making between the available rapid diagnostic tests.
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Affiliation(s)
- Jéssica V L Macêdo
- Programa de Pós-Graduação em Inovação Terapêutica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Núcleo de Pesquisa em Avaliação de Tecnologias em Saúde - NUPIATS, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil
| | - Alberto G S Júnior
- Programa de Pós-Graduação em Inovação Terapêutica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Departamento de Bioquímica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil
| | - Maria D L Oliveira
- Programa de Pós-Graduação em Inovação Terapêutica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Departamento de Bioquímica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Núcleo de Pesquisa em Avaliação de Tecnologias em Saúde - NUPIATS, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil
| | - César A S Andrade
- Programa de Pós-Graduação em Inovação Terapêutica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Departamento de Bioquímica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil; Núcleo de Pesquisa em Avaliação de Tecnologias em Saúde - NUPIATS, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil.
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Medigeshi GR, Islam F, Lodha R. Quadrivalent dengue-virus vaccines: challenges and opportunities for India. Lancet Infect Dis 2024; 24:e270-e271. [PMID: 38408459 DOI: 10.1016/s1473-3099(24)00137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Guruprasad R Medigeshi
- Translational Health Science and Technology Institute, Faridabad, India; Indian Institute of Science, Education and Research, Tirupati, India.
| | - Farzana Islam
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Caucheteux SM, Piguet V. Contribution of Langerhans Cells to Early Dengue Infection. J Invest Dermatol 2024; 144:927-929. [PMID: 38206271 DOI: 10.1016/j.jid.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Stephan M Caucheteux
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada.
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Wang L, Huang AT, Katzelnick LC, Lefrancq N, Escoto AC, Duret L, Chowdhury N, Jarman R, Conte MA, Berry IM, Fernandez S, Klungthong C, Thaisomboonsuk B, Suntarattiwong P, Vandepitte W, Whitehead SS, Cauchemez S, Cummings DAT, Salje H. Antigenic distance between primary and secondary dengue infections correlates with disease risk. Sci Transl Med 2024; 16:eadk3259. [PMID: 38657027 DOI: 10.1126/scitranslmed.adk3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
Many pathogens continuously change their protein structure in response to immune-driven selection, resulting in weakened protection even in previously exposed individuals. In addition, for some pathogens, such as dengue virus, poorly targeted immunity is associated with increased risk of severe disease through a mechanism known as antibody-dependent enhancement. However, it remains unclear whether the antigenic distances between an individual's first infection and subsequent exposures dictate disease risk, explaining the observed large-scale differences in dengue hospitalizations across years. Here, we develop a framework that combines detailed antigenic and genetic characterization of viruses with details on hospitalized cases from 21 years of dengue surveillance in Bangkok, Thailand, to identify the role of the antigenic profile of circulating viruses in determining disease risk. We found that the risk of hospitalization depended on both the specific order of infecting serotypes and the antigenic distance between an individual's primary and secondary infections, with risk maximized at intermediate antigenic distances. These findings suggest that immune imprinting helps determine dengue disease risk and provide a pathway to monitor the changing risk profile of populations and to quantifying risk profiles of candidate vaccines.
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Affiliation(s)
- Lin Wang
- Department of Genetics, University of Cambridge, Cambridge CB2 1TN, UK
| | - Angkana T Huang
- Department of Genetics, University of Cambridge, Cambridge CB2 1TN, UK
| | - Leah C Katzelnick
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Noémie Lefrancq
- Department of Genetics, University of Cambridge, Cambridge CB2 1TN, UK
| | - Ana Coello Escoto
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Loréna Duret
- Department of Genetics, University of Cambridge, Cambridge CB2 1TN, UK
| | - Nayeem Chowdhury
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard Jarman
- Coalition for Epidemic Preparedness Initiative, Washington, DC 20006, USA
| | - Matthew A Conte
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand
| | | | - Warunee Vandepitte
- Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand
| | - Stephen S Whitehead
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris 75015, France
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611, USA
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge CB2 1TN, UK
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611, USA
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Lenharo M. Brazil's record dengue surge: why a vaccine campaign is unlikely to stop it. Nature 2024; 627:250-251. [PMID: 38429511 DOI: 10.1038/d41586-024-00626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
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Kallás EG, Cintra MAT, Moreira JA, Patiño EG, Braga PE, Tenório JCV, Infante V, Palacios R, de Lacerda MVG, Batista Pereira D, da Fonseca AJ, Gurgel RQ, Coelho ICB, Fontes CJF, Marques ETA, Romero GAS, Teixeira MM, Siqueira AM, Barral AMP, Boaventura VS, Ramos F, Elias Júnior E, Cassio de Moraes J, Covas DT, Kalil J, Precioso AR, Whitehead SS, Esteves-Jaramillo A, Shekar T, Lee JJ, Macey J, Kelner SG, Coller BAG, Boulos FC, Nogueira ML. Live, Attenuated, Tetravalent Butantan-Dengue Vaccine in Children and Adults. N Engl J Med 2024; 390:397-408. [PMID: 38294972 DOI: 10.1056/nejmoa2301790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Butantan-Dengue Vaccine (Butantan-DV) is an investigational, single-dose, live, attenuated, tetravalent vaccine against dengue disease, but data on its overall efficacy are needed. METHODS In an ongoing phase 3, double-blind trial in Brazil, we randomly assigned participants to receive Butantan-DV or placebo, with stratification according to age (2 to 6 years, 7 to 17 years, and 18 to 59 years); 5 years of follow-up is planned. The objectives of the trial were to evaluate overall vaccine efficacy against symptomatic, virologically confirmed dengue of any serotype occurring more than 28 days after vaccination (the primary efficacy end point), regardless of serostatus at baseline, and to describe safety up to day 21 (the primary safety end point). Here, vaccine efficacy was assessed on the basis of 2 years of follow-up for each participant, and safety as solicited vaccine-related adverse events reported up to day 21 after injection. Key secondary objectives were to assess vaccine efficacy among participants according to dengue serostatus at baseline and according to the dengue viral serotype; efficacy according to age was also assessed. RESULTS Over a 3-year enrollment period, 16,235 participants received either Butantan-DV (10,259 participants) or placebo (5976 participants). The overall 2-year vaccine efficacy was 79.6% (95% confidence interval [CI], 70.0 to 86.3) - 73.6% (95% CI, 57.6 to 83.7) among participants with no evidence of previous dengue exposure and 89.2% (95% CI, 77.6 to 95.6) among those with a history of exposure. Vaccine efficacy was 80.1% (95% CI, 66.0 to 88.4) among participants 2 to 6 years of age, 77.8% (95% CI, 55.6 to 89.6) among those 7 to 17 years of age, and 90.0% (95% CI, 68.2 to 97.5) among those 18 to 59 years of age. Efficacy against DENV-1 was 89.5% (95% CI, 78.7 to 95.0) and against DENV-2 was 69.6% (95% CI, 50.8 to 81.5). DENV-3 and DENV-4 were not detected during the follow-up period. Solicited systemic vaccine- or placebo-related adverse events within 21 days after injection were more common with Butantan-DV than with placebo (58.3% of participants, vs. 45.6%). CONCLUSIONS A single dose of Butantan-DV prevented symptomatic DENV-1 and DENV-2, regardless of dengue serostatus at baseline, through 2 years of follow-up. (Funded by Instituto Butantan and others; DEN-03-IB ClinicalTrials.gov number, NCT02406729, and WHO ICTRP number, U1111-1168-8679.).
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Affiliation(s)
- Esper G Kallás
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Monica A T Cintra
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José A Moreira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Elizabeth G Patiño
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Patricia Emilia Braga
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Juliana C V Tenório
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Vanessa Infante
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Palacios
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Marcus Vínicius Guimarães de Lacerda
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dhelio Batista Pereira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Allex Jardim da Fonseca
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Queiroz Gurgel
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ivo Castelo-Branco Coelho
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Cor Jesus Fernandes Fontes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ernesto T A Marques
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Gustavo Adolfo Sierra Romero
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauro Martins Teixeira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - André M Siqueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Aldina Maria Prado Barral
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Viviane Sampaio Boaventura
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fabiano Ramos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Erivaldo Elias Júnior
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José Cassio de Moraes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dimas T Covas
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jorge Kalil
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alexander Roberto Precioso
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Stephen S Whitehead
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alejandra Esteves-Jaramillo
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Tulin Shekar
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jung-Jin Lee
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Julieta Macey
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Sabrina Gozlan Kelner
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Beth-Ann G Coller
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fernanda Castro Boulos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauricio L Nogueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
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7
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Munoz-Jordan J, Cardona J, Beltrán M, Colón C, Schiffer J, Stewart-Clark E, Zellner B, Semenova V, Li Y, Jia LT, Maniatis P, Pawloski L, Adams L, Paz-Bailey G, Rivera-Amill V, Medina F. Evaluation of Serologic Cross-Reactivity Between Dengue Virus and SARS-CoV-2 in Patients with Acute Febrile Illness — United States and Puerto Rico, April 2020–March 2021. MMWR Morb Mortal Wkly Rep 2022; 71:375-377. [PMID: 35271558 PMCID: PMC8912001 DOI: 10.15585/mmwr.mm7110a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Russell TL, Horwood PF, Harrington H, Apairamo A, Kama NJ, Bobogare A, MacLaren D, Burkot TR. Seroprevalence of dengue, Zika, chikungunya and Ross River viruses across the Solomon Islands. PLoS Negl Trop Dis 2022; 16:e0009848. [PMID: 35143495 PMCID: PMC8865700 DOI: 10.1371/journal.pntd.0009848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/23/2022] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
Across the Pacific, and including in the Solomon Islands, outbreaks of arboviruses such as dengue, chikungunya, and Zika are increasing in frequency, scale and impact. Outbreaks of mosquito-borne disease have the potential to overwhelm the health systems of small island nations. This study mapped the seroprevalence of dengue, Zika, chikungunya and Ross River viruses in 5 study sites in the Solomon Islands. Serum samples from 1,021 participants were analysed by ELISA. Overall, 56% of participants were flavivirus-seropositive for dengue (28%), Zika (1%) or both flaviviruses (27%); and 53% of participants were alphavirus-seropositive for chikungunya (3%), Ross River virus (31%) or both alphaviruses (18%). Seroprevalence for both flaviviruses and alphaviruses varied by village and age of the participant. The most prevalent arboviruses in the Solomon Islands were dengue and Ross River virus. The high seroprevalence of dengue suggests that herd immunity may be a driver of dengue outbreak dynamics in the Solomon Islands. Despite being undetected prior to this survey, serology results suggest that Ross River virus transmission is endemic. There is a real need to increase the diagnostic capacities for each of the arboviruses to support effective case management and to provide timely information to inform vector control efforts and other outbreak mitigation interventions. The occurrence of arboviruses is increasing and causing significant impacts on human health. This is of high concern in small Pacific island nations where fragile health systems are regularly overwhelmed by disease outbreaks. To effectively prevent and control disease transmission there is a need to understand which viruses have been in circulation. Therefore, we conducted a cross-sectional survey of residents from 5 study sites distributed across the Solomon Islands. The serum samples were tested for antibodies that indicate prior infection for four arboviruses. We found evidence that the residents of the Solomon Islands have been exposed to substantial transmission of dengue and Ross River viruses, with lower levels of Zika and chikungunya transmission. Two large dengue outbreaks have been recently experienced and the outbreak pattern suggests that natural herd immunity may still be a driver of dengue outbreak dynamics in the Solomon Islands. Regarding Ross River virus, transmission is endemic despite being undetected prior to this survey. There is a real need to increase the capacity to accurately diagnose each of these arboviruses to support effective case management and to provide timely information to inform vector control efforts.
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Affiliation(s)
- Tanya L. Russell
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
- * E-mail:
| | - Paul F. Horwood
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Humpress Harrington
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Atoifi College of Nursing, Atoifi Adventist Hospital, Atoifi, Malaita, Solomon Islands
| | - Allan Apairamo
- National Vector Borne Disease Control Program, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Nathan J. Kama
- National Vector Borne Disease Control Program, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Albino Bobogare
- National Vector Borne Disease Control Program, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Thomas R. Burkot
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
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9
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Mapalagamage M, Weiskopf D, Sette A, De Silva AD. Current Understanding of the Role of T Cells in Chikungunya, Dengue and Zika Infections. Viruses 2022; 14:v14020242. [PMID: 35215836 PMCID: PMC8878350 DOI: 10.3390/v14020242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023] Open
Abstract
Arboviral infections such as Chikungunya (CHIKV), Dengue (DENV) and Zika (ZIKV) are a major disease burden in tropical and sub-tropical countries, and there are no effective vaccinations or therapeutic drugs available at this time. Understanding the role of the T cell response is very important when designing effective vaccines. Currently, comprehensive identification of T cell epitopes during a DENV infection shows that CD8 and CD4 T cells and their specific phenotypes play protective and pathogenic roles. The protective role of CD8 T cells in DENV is carried out through the killing of infected cells and the production of proinflammatory cytokines, as CD4 T cells enhance B cell and CD8 T cell activities. A limited number of studies attempted to identify the involvement of T cells in CHIKV and ZIKV infection. The identification of human immunodominant ZIKV viral epitopes responsive to specific T cells is scarce, and none have been identified for CHIKV. In CHIKV infection, CD8 T cells are activated during the acute phase in the lymph nodes/blood, and CD4 T cells are activated during the chronic phase in the joints/muscles. Studies on the role of T cells in ZIKV-neuropathogenesis are limited and need to be explored. Many studies have shown the modulating actions of T cells due to cross-reactivity between DENV-ZIKV co-infections and have repeated heterologous/homologous DENV infection, which is an important factor to consider when developing an effective vaccine.
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Affiliation(s)
- Maheshi Mapalagamage
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo 00700, Sri Lanka;
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - Aruna Dharshan De Silva
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo 10390, Sri Lanka
- Correspondence:
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10
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Pollett S, Kuklis CH, Barvir DA, Jarman RG, Romaine RM, Forshey BM, Gromowski GD. The seroepidemiology of dengue in a US military population based in Puerto Rico during the early phase of the Zika pandemic. PLoS Negl Trop Dis 2022; 16:e0009986. [PMID: 35061659 PMCID: PMC8846501 DOI: 10.1371/journal.pntd.0009986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 02/15/2022] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Understanding the burden and risk factors of dengue virus (DENV) infection in Puerto Rico is important for the prevention of dengue in local, traveler and military populations. Using sera from the Department of Defense Serum Repository, we estimated the prevalence and predictors of DENV seropositivity in those who had served in Puerto Rico, stratified by birth or prior residence (“birth/residence”) in dengue-endemic versus non-endemic regions. We selected sera collected in early 2015 from 500 U.S. military members, a time-point also permitting detection of early cryptic Zika virus (ZIKV) circulation. 87.2% were born or resided in a DENV-endemic area before their military service in Puerto Rico. A high-throughput, flow-cytometry-based neutralization assay was employed to screen sera for ZIKV and DENV neutralizing antibodies, and confirmatory testing was done by plaque-reduction neutralization test (PRNT). We identified one Puerto Rico resident who seroconverted to ZIKV by June 2015, suggesting cryptic ZIKV circulation in Puerto Rico at least 4 months before the first reported cases. A further six PRNT-positive presumptive ZIKV infections which were resolved as DENV infections only by the use of paired sera. We noted 66.8% of the total study sample was DENV seropositive by early 2015. Logistic regression analysis indicated that birth/residence in a dengue non-endemic region (before military service in Puerto Rico) was associated with a lower odds of DENV exposure by January—June 2015 (aOR = 0.28, p = 0.001). Among those with birth/residence in a non-endemic country, we noted moderate evidence to support increase in odds of DENV exposure for each year of military service in Puerto Rico (aOR = 1.58, p = 0.06), but no association with age. In those with birth/residence in dengue-endemic regions (before military service in Puerto Rico), we noted that age (aOR = 1.04, p = 0.02), rather than duration of Puerto Rico service, was associated with dengue seropositivity, suggesting earlier lifetime DENV exposure. Our findings provide insights into the burden and predictors of DENV infection in local, traveler and military populations in Puerto Rico. Our study also highlights substantial PRNT ZIKV false-positivity when paired sera are not available, even during periods of very low ZIKV prevalence.
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Affiliation(s)
- Simon Pollett
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Caitlin H. Kuklis
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - David A. Barvir
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Rachel M. Romaine
- Armed Forces Health Surveillance Division, Silver Spring, Maryland, United States of America
| | - Brett M. Forshey
- Armed Forces Health Surveillance Division, Silver Spring, Maryland, United States of America
| | - Gregory D. Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
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11
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Lima MRQ, Nunes PCG, Dos Santos FB. Serological Diagnosis of Dengue. Methods Mol Biol 2022; 2409:173-196. [PMID: 34709642 DOI: 10.1007/978-1-0716-1879-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A reliable and specific diagnosis is imperative in viral diagnosis, both for clinical management and surveillance, and to ensure that early treatment and control measures are carried out. The number of days of illness is important to choose the most appropriate method to be used and for the correct interpretation of the results obtained. Specific IgM is elicited after that period, indicating an active infection and usually lasts up to 3 months. However, in DENV secondary infections, IgM levels may be significantly lower or undetectable. After 10-12 days, a lifetime specific IgG is produced. Routinely, the laboratory diagnosis of DENV infections can be performed by viral isolation and/or detection of viral nucleic acid, serological assays for the detection of specific antibodies (IgM/IgG), antigen (NS1) and the detection of viral antigens in tissues, which are suitable during certain phases of the disease. For serological diagnosis, serum, plasma, or cerebrospinal fluid (CSF) samples may be investigated. If the test is carried out a few days after collection, the specimens can be stored at 4 °C, since the immunoglobulins are stable in serum or plasma. If the storage period is extended, the material must be kept at -20 °C or -70 °C. In serology, several methods can be used to detect specific viral antigens and/or antibodies, produced by the host in response to DENV infection. Routinely, serological tests include the hemagglutination inhibition (HI) assay, the plaque reduction neutralizing test (PRNT), the gold standard assay for dengue immune response characterization, and ELISAs to detect IgM (MAC-ELISA) and IgG (IgG-ELISA).
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Affiliation(s)
- Monique R Q Lima
- Laboratório Estratégico de Diagnóstico (LED), Centro de Desenvolvimento Científico, Instituto Butantan, São Paulo, Brazil
| | - Priscila C G Nunes
- Laboratório Municipal de Saúde Pública (LASP), Laboratório de Virologia e Biotério, Subsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonoses, Rio de Janeiro, Brazil
- Superintendência de Informações Estratégicas de Vigilância em Saúde (SIEVS/RJ), Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Flávia B Dos Santos
- Laboratório de Imunologia Viral (LIV), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
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12
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Hsieh SC, Tsai WY, Wang WK. Obtention of Dengue Virus Membrane Proteins and Role for Virus Assembly. Methods Mol Biol 2022; 2409:63-76. [PMID: 34709636 DOI: 10.1007/978-1-0716-1879-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
The four serotypes of dengue virus (DENV), belonging to the genus Flavivirus in the family Flaviviridae, are the leading cause of arboviral diseases in humans. The clinical presentations range from dengue fever to dengue hemorrhagic fever and dengue shock syndrome. Despite decades of efforts on developing intervention strategies against DENV, there is no licensed antiviral, and safe and effective vaccines remain challenging. Similar to other flaviviruses, the assembly of DENV particles occurs in the membranes derived from endoplasmic reticulum; immature virions bud into the lumen followed by maturation in the trans-Golgi and transport through the secretary pathway. A unique feature of flavivirus replication is the production of small and slowly sedimenting subviral particles, known as virus-like particles (VLPs). Co-expression of premembrane (prM) and envelope (E) proteins can generate recombinant VLPs, which are biophysically and antigenically similar to infectious virions and have been employed to study the function of prM and E proteins, assembly, serodiagnostic antigens, and vaccine candidates. Previously, we have developed several assays including sucrose cushion ultracentrifugation, sucrose gradient ultracentrifugation, membrane flotation, subcellular fractionation, and glycosidase digestion assay to exploit the interaction between DENV prM and E proteins, membrane association, subcellular localization, glycosylation pattern, and assembly of VLPs and replicon particles. The information derived from these assays have implications to further our understanding of DENV assembly, replication cycle, intervention strategies, and pathogenesis.
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Affiliation(s)
- Szu-Chia Hsieh
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
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13
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Khor CS, Tsuji R, Lee HY, Nor’e SS, Sahimin N, Azman AS, Tiong V, Hasandarvish P, Teoh BT, Soh YH, Chai JH, Kokubo T, Kanauchi O, Yamamoto N, AbuBakar S. Lactococcus lactis Strain Plasma Intake Suppresses the Incidence of Dengue Fever-like Symptoms in Healthy Malaysians: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2021; 13:nu13124507. [PMID: 34960061 PMCID: PMC8707015 DOI: 10.3390/nu13124507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/31/2022] Open
Abstract
Dengue fever (DF) is a mosquito-borne disease still with no effective treatment or vaccine available. A randomized, placebo-controlled, double-blinded, parallel-group trial was undertaken to evaluate the efficacy of oral intake of Lactococcus lactis strain plasma (LC-Plasma) on the presentation and severity of DF-like symptoms among healthy volunteers. Study participants (320) were assigned into two groups, and consumed either placebo or LC-Plasma tablets (approximately 100 billion cells/day) for 8 weeks. The clinical symptoms of DF were self-recorded through questionnaires, and exposure to DENV was determined by serum antibody and/or DENV antigen tests. No significant differences between groups were observed for exposure to DENV, or the symptomatic ratio. Results obtained showed that participants from the LC-Plasma group reported a significant reduction in the cumulative incidence days of DF-like symptoms, which include fever (p < 0.001), muscle pain (p < 0.005), joint pain (p < 0.001), and pain behind the eyes (p < 0.001), compared to that of the placebo group. Subgroup analysis revealed a significantly (p < 0.05) reduced severity score in the LC-Plasma group when study sites were separately analyzed. Overall, our findings suggest that LC-Plasma supplementation reduces the cumulative days with DF-like symptoms, and the severity of the symptoms. Daily oral intake of LC-Plasma, hence, is shown to mitigate the DF-like symptoms.
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Affiliation(s)
- Chee-Sieng Khor
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Ryohei Tsuji
- Kirin Central Research Institute, Kirin Holdings Co., Ltd., Yokohama 236-0004, Japan; (R.T.); (T.K.)
| | - Hai-Yen Lee
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Siti-Sarah Nor’e
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Norhidayu Sahimin
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Adzzie-Shazleen Azman
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Vunjia Tiong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Pouya Hasandarvish
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Boon-Teong Teoh
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Yih-Harng Soh
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Jian-Hai Chai
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
| | - Takeshi Kokubo
- Kirin Central Research Institute, Kirin Holdings Co., Ltd., Yokohama 236-0004, Japan; (R.T.); (T.K.)
| | - Osamu Kanauchi
- Research and Development Strategy Department, Kirin Holdings Co., Ltd., Tokyo 164-0001, Japan;
| | - Naoki Yamamoto
- Genome Medical Sciences Project, National Center for Global Health and Medicine, Chiba 272-8516, Japan;
- Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia; (C.-S.K.); (H.-Y.L.); (S.-S.N.); (N.S.); (A.-S.A.); (V.T.); (P.H.); (B.-T.T.); (Y.-H.S.); (J.-H.C.)
- Correspondence:
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14
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Lim XX, Shu B, Zhang S, Tan AWK, Ng TS, Lim XN, Chew VSY, Shi J, Screaton GR, Lok SM, Anand GS. Human antibody C10 neutralizes by diminishing Zika but enhancing dengue virus dynamics. Cell 2021; 184:6067-6080.e13. [PMID: 34852238 DOI: 10.1016/j.cell.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 02/04/2023]
Abstract
The human monoclonal antibody (HmAb) C10 potently cross-neutralizes Zika virus (ZIKV) and dengue virus. Analysis of antibody fragment (Fab) C10 interactions with ZIKV and dengue virus serotype 2 (DENV2) particles by cryoelectron microscopy (cryo-EM) and amide hydrogen/deuterium exchange mass spectrometry (HDXMS) shows that Fab C10 binding decreases overall ZIKV particle dynamics, whereas with DENV2, the same Fab causes increased dynamics. Testing of different Fab C10:DENV2 E protein molar ratios revealed that, at higher Fab ratios, especially at saturated concentrations, the Fab enhanced viral dynamics (detected by HDXMS), and observation under cryo-EM showed increased numbers of distorted particles. Our results suggest that Fab C10 stabilizes ZIKV but that with DENV2 particles, high Fab C10 occupancy promotes E protein dimer conformational changes leading to overall increased particle dynamics and distortion of the viral surface. This is the first instance of a broadly neutralizing antibody eliciting virus-specific increases in whole virus particle dynamics.
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Affiliation(s)
- Xin-Xiang Lim
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Singapore
| | - Bo Shu
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Shuijun Zhang
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Aaron W K Tan
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Thiam-Seng Ng
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Xin-Ni Lim
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Valerie S-Y Chew
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Jian Shi
- Centre for Bioimaging Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117557, Singapore
| | - Gavin R Screaton
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Shee-Mei Lok
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Singapore; Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore; Centre for Bioimaging Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117557, Singapore.
| | - Ganesh S Anand
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Singapore; Department of Chemistry, Huck Institutes of the Life Sciences, The Pennsylvania State University, 104 Chemistry Building, University Park, PA 16802, USA.
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15
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Sharma A, Zhang X, Dejnirattisai W, Dai X, Gong D, Wongwiwat W, Duquerroy S, Rouvinski A, Vaney MC, Guardado-Calvo P, Haouz A, England P, Sun R, Zhou ZH, Mongkolsapaya J, Screaton GR, Rey FA. The epitope arrangement on flavivirus particles contributes to Mab C10's extraordinary neutralization breadth across Zika and dengue viruses. Cell 2021; 184:6052-6066.e18. [PMID: 34852239 PMCID: PMC8724787 DOI: 10.1016/j.cell.2021.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 10/26/2022]
Abstract
The human monoclonal antibody C10 exhibits extraordinary cross-reactivity, potently neutralizing Zika virus (ZIKV) and the four serotypes of dengue virus (DENV1-DENV4). Here we describe a comparative structure-function analysis of C10 bound to the envelope (E) protein dimers of the five viruses it neutralizes. We demonstrate that the C10 Fab has high affinity for ZIKV and DENV1 but not for DENV2, DENV3, and DENV4. We further show that the C10 interaction with the latter viruses requires an E protein conformational landscape that limits binding to only one of the three independent epitopes per virion. This limited affinity is nevertheless counterbalanced by the particle's icosahedral organization, which allows two different dimers to be reached by both Fab arms of a C10 immunoglobulin. The epitopes' geometric distribution thus confers C10 its exceptional neutralization breadth. Our results highlight the importance not only of paratope/epitope complementarity but also the topological distribution for epitope-focused vaccine design.
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Affiliation(s)
- Arvind Sharma
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France
| | - Xiaokang Zhang
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France; Interdisciplinary Center for Brain Information, the Brain Cognition and Brain Disease Institute, Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong 518055, China
| | - Wanwisa Dejnirattisai
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Xinghong Dai
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Danyang Gong
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Wiyada Wongwiwat
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Stéphane Duquerroy
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France; Université Paris-Saclay, Faculté des Sciences, F-91405 Orsay, France
| | - Alexander Rouvinski
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France
| | - Marie-Christine Vaney
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France
| | - Pablo Guardado-Calvo
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France
| | - Ahmed Haouz
- Institut Pasteur, Université de Paris, CNRS UMR 3528, Center for Technological Resources and Research, 75015 Paris, France
| | - Patrick England
- Institut Pasteur, Université de Paris, CNRS UMR 3528, Center for Technological Resources and Research, 75015 Paris, France
| | - Ren Sun
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA 90095, USA; California NanoSystems Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Z Hong Zhou
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; California NanoSystems Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Juthathip Mongkolsapaya
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Dengue Hemorrhagic Fever Research Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Felix A Rey
- Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France.
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16
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Inizan C, Minier M, Prot M, O’Connor O, Forfait C, Laumond S, Marois I, Biron A, Gourinat AC, Goujart MA, Descloux E, Sakuntabhai A, Tarantola A, Simon-Lorière E, Dupont-Rouzeyrol M. Viral evolution sustains a dengue outbreak of enhanced severity. Emerg Microbes Infect 2021; 10:536-544. [PMID: 33686914 PMCID: PMC8011692 DOI: 10.1080/22221751.2021.1899057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 01/21/2023]
Abstract
Compared to the previous 2013-2014 outbreak, dengue 2016-2017 outbreak in New Caledonia was characterized by an increased number of severe forms associated with hepatic presentations. In this study, we assessed the virological factors associated with this enhanced severity. Whole-genome sequences were retrieved from dengue virus (DENV)-1 strains collected in 2013-2014 and from severe and non-severe patients in 2016-2017. Fitness, hepatic tropism and cytopathogenicity of DENV 2016-2017 strains were compared to those of 2013-2014 strains using replication kinetics in the human hepatic cell line HuH7. Whole-genome sequencing identified four amino acid substitutions specific to 2016-2017 strains and absent from 2013-2014 strains. Three of these mutations occurred in predicted T cell epitopes, among which one was also a B cell epitope. Strains retrieved from severe forms did not exhibit specific genetic features. DENV strains from 2016-2017 exhibited a trend towards reduced replicative fitness and cytopathogenicity in vitro compared to strains from 2013-2014. Overall, the 2016-2017 dengue outbreak in New Caledonia was associated with a viral genetic evolution which had limited impact on DENV hepatic tropism and cytopathogenicity. These mutations, however, may have modified DENV strains antigenicity, altering the anti-DENV immune response in some patients, in turn favoring the development of severe forms.Trial registration: ClinicalTrials.gov identifier: NCT04615364.
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Affiliation(s)
- Catherine Inizan
- URE Dengue and Arboviruses, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
| | - Marine Minier
- URE Dengue and Arboviruses, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
| | - Matthieu Prot
- Evolutionary genomics of RNA viruses, Institut Pasteur, Paris, France
| | - Olivia O’Connor
- URE Dengue and Arboviruses, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
| | | | | | - Ingrid Marois
- Internal medicine and infectious diseases department, Territorial Hospital Center (CHT), Dumbéa, New Caledonia
| | - Antoine Biron
- Microbiology laboratory, Territorial Hospital Center (CHT), Dumbéa, New Caledonia
| | - Ann-Claire Gourinat
- Microbiology laboratory, Territorial Hospital Center (CHT), Dumbéa, New Caledonia
| | - Marie-Amélie Goujart
- Microbiology laboratory, Territorial Hospital Center (CHT), Dumbéa, New Caledonia
| | - Elodie Descloux
- Internal medicine and infectious diseases department, Territorial Hospital Center (CHT), Dumbéa, New Caledonia
| | - Anavaj Sakuntabhai
- Functional genetics of infectious diseases Unit, Institut Pasteur, Paris, France
- CNRS UMR2000: Génomique évolutive, modélisation et santé (GEMS), Paris, France
| | - Arnaud Tarantola
- URE Epidemiology, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
| | | | - Myrielle Dupont-Rouzeyrol
- URE Dengue and Arboviruses, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
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17
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Katzelnick LC, Escoto AC, Huang AT, Garcia-Carreras B, Chowdhury N, Berry IM, Chavez C, Buchy P, Duong V, Dussart P, Gromowski G, Macareo L, Thaisomboonsuk B, Fernandez S, Smith DJ, Jarman R, Whitehead SS, Salje H, Cummings DA. Antigenic evolution of dengue viruses over 20 years. Science 2021; 374:999-1004. [PMID: 34793238 PMCID: PMC8693836 DOI: 10.1126/science.abk0058] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infection with one of dengue viruses 1 to 4 (DENV1-4) induces protective antibodies against homotypic infection. However, a notable feature of dengue viruses is the ability to use preexisting heterotypic antibodies to infect Fcγ receptor–bearing immune cells, leading to higher viral load and immunopathological events that augment disease. We tracked the antigenic dynamics of each DENV serotype by using 1944 sequenced isolates from Bangkok, Thailand, between 1994 and 2014 (348 strains), in comparison with regional and global DENV antigenic diversity (64 strains). Over the course of 20 years, the Thailand DENV serotypes gradually evolved away from one another. However, for brief periods, the serotypes increased in similarity, with corresponding changes in epidemic magnitude. Antigenic evolution within a genotype involved a trade-off between two types of antigenic change (within-serotype and between-serotype), whereas genotype replacement resulted in antigenic change away from all serotypes. These findings provide insights into theorized dynamics in antigenic evolution.
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Affiliation(s)
- Leah C. Katzelnick
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, United States
| | - Ana Coello Escoto
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, United States
| | - Angkana T. Huang
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Bernardo Garcia-Carreras
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
| | - Nayeem Chowdhury
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, United States
| | - Chris Chavez
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
| | - Philippe Buchy
- GlaxoSmithKline (GSK) Vaccines, 637421 Singapore, Singapore
| | - Veasna Duong
- Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh 12201, Cambodia
| | - Philippe Dussart
- Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh 12201, Cambodia
| | - Gregory Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, United States
| | - Louis Macareo
- 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
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Derek J. Smith
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, United Kingdom
| | - Richard Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, United States
| | - Stephen S. Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, United States
| | - Henrik Salje
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
- Department of Genetics, University of Cambridge, Cambridge, CB2 3EJ, United Kingdom
| | - Derek A.T. Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32611, United States
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18
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Chen RE, Smith BK, Errico JM, Gordon DN, Winkler ES, VanBlargan LA, Desai C, Handley SA, Dowd KA, Amaro-Carambot E, Cardosa MJ, Sariol CA, Kallas EG, Sékaly RP, Vasilakis N, Fremont DH, Whitehead SS, Pierson TC, Diamond MS. Implications of a highly divergent dengue virus strain for cross-neutralization, protection, and vaccine immunity. Cell Host Microbe 2021; 29:1634-1648.e5. [PMID: 34610295 PMCID: PMC8595868 DOI: 10.1016/j.chom.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/15/2021] [Accepted: 09/10/2021] [Indexed: 01/29/2023]
Abstract
Although divergent dengue viruses (DENVs) have been isolated in insects, nonhuman primates, and humans, their relationships to the four canonical serotypes (DENV 1-4) are poorly understood. One virus isolated from a dengue patient, DKE-121, falls between genotype and serotype levels of sequence divergence to DENV-4. To examine its antigenic relationship to DENV-4, we assessed serum neutralizing and protective activity. Whereas DENV-4-immune mouse sera neutralize DKE-121 infection, DKE-121-immune sera inhibit DENV-4 less efficiently. Passive transfer of DENV-4 or DKE-121-immune sera protects mice against homologous, but not heterologous, DENV-4 or DKE-121 challenge. Antigenic cartography suggests that DENV-4 and DKE-121 are related but antigenically distinct. However, DENV-4 vaccination confers protection against DKE-121 in nonhuman primates, and serum from humans immunized with a tetravalent vaccine neutralize DENV-4 and DKE-121 infection equivalently. As divergent DENV strains, such as DKE-121, may meet criteria for serotype distinction, monitoring their capacity to impact dengue disease and vaccine efficacy appears warranted.
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Affiliation(s)
- Rita E Chen
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Brittany K Smith
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - John M Errico
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - David N Gordon
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-9806, USA
| | - Emma S Winkler
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Laura A VanBlargan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Chandni Desai
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Scott A Handley
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Kimberly A Dowd
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-9806, USA
| | - Emerito Amaro-Carambot
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-9806, USA
| | - M Jane Cardosa
- Institute of Health and Community Medicine, Universiti Sarawak Malaysia (UNIMAS), Kota Samarahan, Sarawak 94300, Malaysia; Integrated Research Associates, San Rafael, CA 94903, USA
| | - Carlos A Sariol
- Unit of Comparative Medicine, Caribbean Primate Research Center, University of Puerto Rico-Medical Sciences Campus, San Juan, PR 00936-5067, USA
| | - Esper G Kallas
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Rafick-Pierre Sékaly
- Department of Microbiology and Immunology, Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nikos Vasilakis
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555, USA; Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA; Sealy Center for Vector-Borne and Zoonotic Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Daved H Fremont
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; The Andrew M. Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Stephen S Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-9806, USA
| | - Theodore C Pierson
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-9806, USA
| | - Michael S Diamond
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; The Andrew M. Jane M. Bursky Center for Human Immunology & Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, Saint Louis, MO 63110-1010, USA.
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19
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Nascimento EJM, Norwood B, Parker A, Braun R, Kpamegan E, Dean HJ. Development and Characterization of a Multiplex Assay to Quantify Complement-Fixing Antibodies against Dengue Virus. Int J Mol Sci 2021; 22:ijms222112004. [PMID: 34769432 PMCID: PMC8584793 DOI: 10.3390/ijms222112004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022] Open
Abstract
Antibodies capable of activating the complement system (CS) when bound with antigen are referred to as "complement-fixing antibodies" and are involved in protection against Flaviviruses. A complement-fixing antibody test has been used in the past to measure the ability of dengue virus (DENV)-specific serum antibodies to activate the CS. As originally developed, the test is time-consuming, cumbersome, and has limited sensitivity for DENV diagnosis. Here, we developed and characterized a novel multiplex anti-DENV complement-fixing assay based on the Luminex platform to quantitate serum antibodies against all four serotypes (DENV1-4) that activate the CS based on their ability to fix the complement component 1q (C1q). The assay demonstrated good reproducibility and showed equivalent performance to a DENV microneutralization assay that has been used to determine DENV serostatus. In non-human primates, antibodies produced in response to primary DENV1-4 infection induced C1q fixation on homologous and heterologous serotypes. Inter-serotype cross-reactivity was associated with homology of the envelope protein. Interestingly, the antibodies produced following vaccination against Zika virus fixed C1q on DENV. The anti-DENV complement fixing antibody assay represents an alternative approach to determine the quality of functional antibodies produced following DENV natural infection or vaccination and a biomarker for dengue serostatus, while providing insights about immunological cross-reactivity among different Flaviviruses.
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20
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Cui X, Sun J, Minkove SJ, Li Y, Cooper D, Couse Z, Eichacker PQ, Torabi‐Parizi P. Effects of chloroquine or hydroxychloroquine treatment on non-SARS-CoV2 viral infections: A systematic review of clinical studies. Rev Med Virol 2021; 31:e2228. [PMID: 33694220 PMCID: PMC8209942 DOI: 10.1002/rmv.2228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/15/2022]
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have been used as antiviral agents for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. We performed a systematic review to examine whether prior clinical studies that compared the effects of CQ and HCQ to a control for the treatment of non-SARS-CoV2 infection supported the use of these agents in the present SARS-CoV2 outbreak. PubMed, EMBASE, Scopus and Web of Science (PROSPERO CRD42020183429) were searched from inception through 2 April 2020 without language restrictions. Of 1766 retrieved reports, 18 studies met our inclusion criteria, including 17 prospective controlled studies and one retrospective study. CQ or HCQ were compared to control for the treatment of infectious mononucleosis (EBV, n = 4), warts (human papillomavirus, n = 2), chronic HIV infection (n = 6), acute chikungunya infection (n = 1), acute dengue virus infection (n = 2), chronic HCV (n = 2), and as preventive measures for influenza infection (n = 1). Survival was not evaluated in any study. For HIV, the virus that was most investigated, while two early studies suggested HCQ reduced viral levels, four subsequent ones did not, and in two of these CQ or HCQ increased viral levels and reduced CD4 counts. Overall, three studies concluded CQ or HCQ were effective; four concluded further research was needed to assess the treatments' effectiveness; and 11 concluded that treatment was ineffective or potentially harmful. Prior controlled clinical trials with CQ and HCQ for non-SARS-CoV2 viral infections do not support these agents' use for the SARS-CoV2 outbreak.
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Affiliation(s)
- Xizhong Cui
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
| | - Junfeng Sun
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
| | - Samuel J. Minkove
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
| | - Yan Li
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
| | - Diane Cooper
- NIH LibraryClinical CenterNational Institutes of HealthBethesdaMarylandUSA
| | - Zoe Couse
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
| | - Peter Q. Eichacker
- Critical Care Medicine DepartmentNational Institutes of HealthBethesdaMarylandUSA
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21
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Nanda JD, Jung CJ, Satria RD, Jhan MK, Shen TJ, Tseng PC, Wang YT, Ho TS, Lin CF. Serum IL-18 Is a Potential Biomarker for Predicting Severe Dengue Disease Progression. J Immunol Res 2021; 2021:7652569. [PMID: 34734091 PMCID: PMC8560270 DOI: 10.1155/2021/7652569] [Citation(s) in RCA: 2] [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: 09/06/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background. Dengue virus (DENV) infection is the most common arboviral disease that affects tropical and subtropical regions. Based on the clinical hallmarks, the different severities of patients range from mild dengue fever (MDF) to severe dengue diseases (SDDs) and include dengue hemorrhagic fever or dengue shock syndrome. These are commonly associated with cytokine release syndrome (CRS). The types and levels of cytokines/chemokines, which are suppressed or enhanced, are varied, indicating CRS's pathogenic and host defensive effects. Principal Finding. In this study, we created an integrated and precise multiplex panel of cytokine/chemokine assays based on our literature analysis to monitor dengue CRS. A 24-plex panel of cytokines/chemokines was evaluated to measure the plasma levels of targeting factors in dengue patients with an MDF and SDD diagnosis without or with comorbidities. As identified in sixteen kinds of cytokines/chemokines, ten were significantly (P < 0.05) (10/16) increased, one was significantly (P < 0.01) (1/16) decreased, and five were potentially (5/16) altered in all dengue patients (n = 30) in the acute phase of disease onset. Compared to MDF, the levels of IL-8 (CXCL-8) and IL-18 in SDD were markedly (P < 0.05) increased, accompanied by positively increased IL-6 and TNF-α and decreased IFN-γ and RANTES. With comorbidities, SDD significantly (P < 0.01) portrayed elevated IL-18 accompanied by increased IL-6 and decreased IFN-α2 and IL-12. In addition, decreased platelets were significantly (P < 0.05) associated with increased IL-18. Significance. These results demonstrate an efficient panel of dengue cytokine/chemokine assays used to explore the possible level of CRS during the acute phase of disease onset; also, we are the first to report the increase of IL-18 in severe dengue with comorbidity compared to severe dengue without comorbidity and mild dengue.
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Affiliation(s)
- Josephine Diony Nanda
- International Ph.D. Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chiau-Jing Jung
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Rahmat Dani Satria
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Clinical Laboratory Installation, Dr. Sardjito Central General Hospital, Yogyakarta 55281, Indonesia
| | - Ming-Kai Jhan
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ting-Jing Shen
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Po-Chun Tseng
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Core Laboratory of Immune Monitoring, Office of Research & Development, Taipei Medical University, Taipei 110, Taiwan
| | - Yung-Ting Wang
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Tzong-Shiann Ho
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan 700, Taiwan
| | - Chiou-Feng Lin
- International Ph.D. Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Core Laboratory of Immune Monitoring, Office of Research & Development, Taipei Medical University, Taipei 110, Taiwan
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22
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Fadaka AO, Sibuyi NRS, Martin DR, Goboza M, Klein A, Madiehe AM, Meyer M. Immunoinformatics design of a novel epitope-based vaccine candidate against dengue virus. Sci Rep 2021; 11:19707. [PMID: 34611250 PMCID: PMC8492693 DOI: 10.1038/s41598-021-99227-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/22/2021] [Indexed: 02/08/2023] Open
Abstract
Dengue poses a global health threat, which will persist without therapeutic intervention. Immunity induced by exposure to one serotype does not confer long-term protection against secondary infection with other serotypes and is potentially capable of enhancing this infection. Although vaccination is believed to induce durable and protective responses against all the dengue virus (DENV) serotypes in order to reduce the burden posed by this virus, the development of a safe and efficacious vaccine remains a challenge. Immunoinformatics and computational vaccinology have been utilized in studies of infectious diseases to provide insight into the host-pathogen interactions thus justifying their use in vaccine development. Since vaccination is the best bet to reduce the burden posed by DENV, this study is aimed at developing a multi-epitope based vaccines for dengue control. Combined approaches of reverse vaccinology and immunoinformatics were utilized to design multi-epitope based vaccine from the sequence of DENV. Specifically, BCPreds and IEDB servers were used to predict the B-cell and T-cell epitopes, respectively. Molecular docking was carried out using Schrödinger, PATCHDOCK and FIREDOCK. Codon optimization and in silico cloning were done using JCAT and SnapGene respectively. Finally, the efficiency and stability of the designed vaccines were assessed by an in silico immune simulation and molecular dynamic simulation, respectively. The predicted epitopes were prioritized using in-house criteria. Four candidate vaccines (DV-1-4) were designed using suitable adjuvant and linkers in addition to the shortlisted epitopes. The binding interactions of these vaccines against the receptors TLR-2, TLR-4, MHC-1 and MHC-2 show that these candidate vaccines perfectly fit into the binding domains of the receptors. In addition, DV-1 has a better binding energies of - 60.07, - 63.40, - 69.89 kcal/mol against MHC-1, TLR-2, and TLR-4, with respect to the other vaccines. All the designed vaccines were highly antigenic, soluble, non-allergenic, non-toxic, flexible, and topologically assessable. The immune simulation analysis showed that DV-1 may elicit specific immune response against dengue virus. Moreover, codon optimization and in silico cloning validated the expressions of all the designed vaccines in E. coli. Finally, the molecular dynamic study shows that DV-1 is stable with minimum RMSF against TLR4. Immunoinformatics tools are now applied to screen genomes of interest for possible vaccine target. The designed vaccine candidates may be further experimentally investigated as potential vaccines capable of providing definitive preventive measure against dengue virus infection.
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Affiliation(s)
- Adewale Oluwaseun Fadaka
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa.
| | - Nicole Remaliah Samantha Sibuyi
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Darius Riziki Martin
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Mediline Goboza
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Ashwil Klein
- Plant Omics Laboratory, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa
| | - Abram Madimabe Madiehe
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
- Nanobiotechnology Research Group, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - Mervin Meyer
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa.
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23
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Auerswald H, Kann S, Klepsch L, Hülsemann J, Rudnik I, Schreiber S, Buchy P, Schreiber M. Neutralization of Dengue Virus Serotypes by Sera from Dengue-Infected Individuals Is Preferentially Directed to Heterologous Serotypes and Not against the Autologous Serotype Present in Acute Infection. Viruses 2021; 13:v13101957. [PMID: 34696387 PMCID: PMC8541627 DOI: 10.3390/v13101957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Sequential infections of humans by the four different dengue serotypes (DENV-1–4) lead to neutralizing antibodies with group, cross, and type specificity. Virus neutralization of serotypes showed monotypic but mostly multitypic neutralization profiles due to multiple virus exposures. We have studied neutralization to heterologous, reference DENV serotypes using paired sera collected between days 6 and 37 after onset of fever. The DENV-primed neutralization profile of the first serum sample, which was monitored by a foci reduction neutralization test (FRNT), was boosted but the neutralization profile stayed unchanged in the second serum sample. In 45 of 47 paired serum samples, the predominant neutralization was directed against DENV serotypes distinct from the infecting serotype. Homologous neutralization studies using sera and viruses from the same area, 33 secondary sera from DENV-1 infected Cambodian patients and eight virus isolates from Cambodia, showed that the FRNT assay accurately predicted the lack of a predominant antibody response against the infecting DENV-1 serotype in contrast to FRNT results using the WHO set of DENV viruses. This report provides evidence that DENV-primed multitypic neutralizing antibody profiles were mainly boosted and stayed unchanged after secondary infection and that DENV neutralization was predominantly directed to heterologous DENV but not against the infecting homologous serotype.
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Affiliation(s)
- Heidi Auerswald
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh 12201, Cambodia;
| | - Simone Kann
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
| | - Leonard Klepsch
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
| | - Janne Hülsemann
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
| | - Ines Rudnik
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
| | - Sebastian Schreiber
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
| | - Philippe Buchy
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh 12201, Cambodia;
- GlaxoSmithKline, Vaccines R&D, Singapore 139234, Singapore
| | - Michael Schreiber
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany; (H.A.); (S.K.); (L.K.); (J.H.); (I.R.); (S.S.)
- Correspondence:
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24
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Wessel AW, Dowd KA, Biering SB, Zhang P, Edeling MA, Nelson CA, Funk KE, DeMaso CR, Klein RS, Smith JL, Cao TM, Kuhn RJ, Fremont DH, Harris E, Pierson TC, Diamond MS. Levels of Circulating NS1 Impact West Nile Virus Spread to the Brain. J Virol 2021; 95:e0084421. [PMID: 34346770 PMCID: PMC8475509 DOI: 10.1128/jvi.00844-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
Dengue virus (DENV) and West Nile virus (WNV) are arthropod-transmitted flaviviruses that cause systemic vascular leakage and encephalitis syndromes, respectively, in humans. However, the viral factors contributing to these specific clinical disorders are not completely understood. Flavivirus nonstructural protein 1 (NS1) is required for replication, expressed on the cell surface, and secreted as a soluble glycoprotein, reaching high levels in the blood of infected individuals. Extracellular DENV NS1 and WNV NS1 interact with host proteins and cells, have immune evasion functions, and promote endothelial dysfunction in a tissue-specific manner. To characterize how differences in DENV NS1 and WNV NS1 might function in pathogenesis, we generated WNV NS1 variants with substitutions corresponding to residues found in DENV NS1. We discovered that the substitution NS1-P101K led to reduced WNV infectivity in the brain and attenuated lethality in infected mice, although the virus replicated efficiently in cell culture and peripheral organs and bound at wild-type levels to brain endothelial cells and complement components. The P101K substitution resulted in reduced NS1 antigenemia in mice, and this was associated with reduced WNV spread to the brain. Because exogenous administration of NS1 protein rescued WNV brain infectivity in mice, we conclude that circulating WNV NS1 facilitates viral dissemination into the central nervous system and impacts disease outcomes. IMPORTANCE Flavivirus NS1 serves as an essential scaffolding molecule during virus replication but also is expressed on the cell surface and is secreted as a soluble glycoprotein that circulates in the blood of infected individuals. Although extracellular forms of NS1 are implicated in immune modulation and in promoting endothelial dysfunction at blood-tissue barriers, it has been challenging to study specific effects of NS1 on pathogenesis without disrupting its key role in virus replication. Here, we assessed WNV NS1 variants that do not affect virus replication and evaluated their effects on pathogenesis in mice. Our characterization of WNV NS1-P101K suggests that the levels of NS1 in the circulation facilitate WNV dissemination to the brain and affect disease outcomes. Our findings facilitate understanding of the role of NS1 during flavivirus infection and support antiviral strategies for targeting circulating forms of NS1.
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Affiliation(s)
- Alex W. Wessel
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kimberly A. Dowd
- Viral Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Scott B. Biering
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Ping Zhang
- Department of Immunology, Key Laboratory of Tropical Diseases Control, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Melissa A. Edeling
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher A. Nelson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kristen E. Funk
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christina R. DeMaso
- Viral Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Robyn S. Klein
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
- Center for Neuroimmunology and Neuroinfectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janet L. Smith
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biological Chemistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Thu Minh Cao
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
- Purdue Institute of Inflammation, Immunology, and Infectious Disease, Purdue University, West Lafayette, Indiana, USA
| | - Richard J. Kuhn
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
- Purdue Institute of Inflammation, Immunology, and Infectious Disease, Purdue University, West Lafayette, Indiana, USA
| | - Daved H. Fremont
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Theodore C. Pierson
- Viral Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael S. Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri, USA
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25
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Scott CAP, Amarilla AA, Bibby S, Newton ND, Hall RA, Hobson-Peters J, Muller DA, Chappell KJ, Young PR, Modhiran N, Watterson D. Implications of Dengue Virus Maturation on Vaccine Induced Humoral Immunity in Mice. Viruses 2021; 13:v13091843. [PMID: 34578424 PMCID: PMC8473161 DOI: 10.3390/v13091843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
The use of dengue virus (DENV) vaccines has been hindered by the complexities of antibody dependent enhancement (ADE). Current late-stage vaccine candidates utilize attenuated and chimeric DENVs that produce particles of varying maturities. Antibodies that are elicited by preferentially exposed epitopes on immature virions have been linked to increased ADE. We aimed to further understand the humoral immunity promoted by DENV particles of varying maturities in an AG129 mouse model using a chimeric insect specific vaccine candidate, bDENV-2. We immunized mice with mature, partially mature, and immature bDENV-2 and found that immunization with partially mature bDENV-2 produced more robust and cross-neutralizing immune responses than immunization with immature or mature bDENV-2. Upon challenge with mouse adapted DENV-2 (D220), we observed 80% protection for mature bDENV-2 vaccinated mice and 100% for immature and partially mature vaccinated mice, suggesting that protection to homotypic challenge is not dependent on maturation. Finally, we found reduced in vitro ADE at subneutralising serum concentrations for mice immunized with mature bDENV-2. These results suggest that both immature and mature DENV particles play a role in homotypic protection; however, the increased risk of in vitro ADE from immature particles indicates potential safety benefits from mature DENV-based vaccines.
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Affiliation(s)
- Connor A. P. Scott
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
| | - Alberto A. Amarilla
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
| | - Summa Bibby
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
| | - Natalee D. Newton
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
| | - Roy A. Hall
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Jody Hobson-Peters
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - David A. Muller
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
| | - Keith J. Chappell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Paul R. Young
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Naphak Modhiran
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Correspondence: (N.M.); (D.W.)
| | - Daniel Watterson
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (C.A.P.S.); (A.A.A.); (S.B.); (N.D.N.); (R.A.H.); (J.H.-P.); (D.A.M.); (K.J.C.); (P.R.Y.)
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD 4072, Australia
- Correspondence: (N.M.); (D.W.)
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Phatihattakorn C, Wongsa A, Pongpan K, Anuwuthinawin S, Mungmanthong S, Wongprasert M, Tassaneetrithep B. Seroprevalence of Zika virus in pregnant women from central Thailand. PLoS One 2021; 16:e0257205. [PMID: 34516583 PMCID: PMC8437263 DOI: 10.1371/journal.pone.0257205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Zika virus (ZKV) infection in a pregnant woman, especially during the first trimester, often results in congenital anomalies. However, the pathogenic mechanism is unknown and one-third of ZKV infected pregnancies are asymptomatic. Neutralizing antibodies against ZKV has been reported in 70% of Thai adults, but the prevalence among pregnant women is unknown. Currently, vaccines and specific treatments for ZKV are under development. A better understanding of the immune status of pregnant women will increase the success of effective prevention guidelines. The prevalence of ZKV infection in pregnant women in antenatal care clinics was investigated during the rainy season from May to October 2019 at Siriraj Hospital, Bangkok, Thailand. We recruited 650 pregnant women (39.42% first, 52.26% second and 7.36% third trimester) and found that 30.77% had ZKV-specific IgG, and 39.81% had neutralizing antibodies (nAb) against ZKV (titer ≥10). Specific and neutralizing antibody levels varied by maternal age, trimester, and month. We further characterized the cross-reaction between ZKV and the four Dengue virus (DENV) serotypes by focused reduction neutralization test (FRNT) and found that cross-reactions were common. In conclusion, about 60% of pregnant women who living in central Thailand may be at risk of ZKV infection due to the absence of neutralizing antibodies against ZKV. The functions of cross-reactive antibodies between related viral genotypes require further study. These findings have implications for health care monitoring in pregnant women including determining the risk of ZKV infection, assisting the development of a flavivirus vaccine, and informing the development of preventative health policies.
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Affiliation(s)
- Chayawat Phatihattakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellence in Immunoregulation, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Artit Wongsa
- Center of Research Excellence in Immunoregulation, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kirakorn Pongpan
- Center of Research Excellence in Immunoregulation, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanitra Anuwuthinawin
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sakita Mungmanthong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manthana Wongprasert
- Division of Obstetrics and Gynecology Nursing, Department of Nursing, Siriraj Hospital, Bangkok, Thailand
| | - Boonrat Tassaneetrithep
- Center of Research Excellence in Immunoregulation, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
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27
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Beddingfield BJ, Hartnett JN, Wilson RB, Kulakosky PC, Andersen KG, Robles-Sikisaka R, Grubaugh ND, Aybar A, Nunez MZ, Fermin CD, Garry RF. Zika Virus Non-Structural Protein 1 Antigen-Capture Immunoassay. Viruses 2021; 13:v13091771. [PMID: 34578352 PMCID: PMC8473068 DOI: 10.3390/v13091771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023] Open
Abstract
Infection with Zika virus (ZIKV), a member of the Flavivirus genus of the Flaviviridae family, typically results in mild self-limited illness, but severe neurological disease occurs in a limited subset of patients. In contrast, serious outcomes commonly occur in pregnancy that affect the developing fetus, including microcephaly and other major birth defects. The genetic similarity of ZIKV to other widespread flaviviruses, such as dengue virus (DENV), presents a challenge to the development of specific ZIKV diagnostic assays. Nonstructural protein 1 (NS1) is established for use in immunodiagnostic assays for flaviviruses. To address the cross-reactivity of ZIKV NS1 with proteins from other flaviviruses we used site-directed mutagenesis to modify putative epitopes. Goat polyclonal antibodies to variant ZIKV NS1 were affinity-purified to remove antibodies binding to the closely related NS1 protein of DENV. An antigen-capture ELISA configured with the affinity-purified polyclonal antibody showed a linear dynamic range between approximately 500 and 30 ng/mL, with a limit of detection of between 1.95 and 7.8 ng/mL. NS1 proteins from DENV, yellow fever virus, St. Louis encephalitis virus and West Nile virus showed significantly reduced reactivity in the ZIKV antigen-capture ELISA. Refinement of approaches similar to those employed here could lead to development of ZIKV-specific immunoassays suitable for use in areas where infections with related flaviviruses are common.
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Affiliation(s)
- Brandon J. Beddingfield
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (B.J.B.); (J.N.H.)
| | - Jessica N. Hartnett
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (B.J.B.); (J.N.H.)
| | - Russell B. Wilson
- Autoimmune Technologies, Limited Liability Company, New Orleans, LA 70112, USA; (R.B.W.); (P.C.K.)
| | - Peter C. Kulakosky
- Autoimmune Technologies, Limited Liability Company, New Orleans, LA 70112, USA; (R.B.W.); (P.C.K.)
| | - Kristian G. Andersen
- Department of Immunology and Microbial Science, Scripps Research, La Jolla, CA 92037, USA; (K.G.A.); (R.R.-S.); (N.D.G.)
- Scripps Translational Science Institute, La Jolla, CA 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA 92037, USA
| | - Refugio Robles-Sikisaka
- Department of Immunology and Microbial Science, Scripps Research, La Jolla, CA 92037, USA; (K.G.A.); (R.R.-S.); (N.D.G.)
- Scripps Translational Science Institute, La Jolla, CA 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA 92037, USA
| | - Nathan D. Grubaugh
- Department of Immunology and Microbial Science, Scripps Research, La Jolla, CA 92037, USA; (K.G.A.); (R.R.-S.); (N.D.G.)
- Scripps Translational Science Institute, La Jolla, CA 92037, USA
- Department of Integrative Structural and Computational Biology, Scripps Research, La Jolla, CA 92037, USA
| | - Argelia Aybar
- MediPath Instituto de Patologia Molecular, Universidad Tecnológica de Santiago (UTESA), Santiago 51000, Dominican Republic;
| | - Maria-Zunilla Nunez
- Centro de Investigaciones Biomédicas y Clínicas (CINBIOCLI), Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago 51034, Dominican Republic;
| | - Cesar D. Fermin
- Instituto de Innovacion Biotecnologia e Industria (IIBI), Santo Domingo 10135, Dominican Republic;
- Ministerio de Salud Publica (MSP), Santo Domingo 10514, Dominican Republic
| | - Robert F. Garry
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (B.J.B.); (J.N.H.)
- Zalgen Labs, Limited Liability Company, Germantown, MD 20876, USA
- Correspondence: ; Tel.: +1-504-988-2027
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Angleró-Rodríguez YI, Tikhe CV, Kang S, Dimopoulos G. Aedes aegypti Toll pathway is induced through dsRNA sensing in endosomes. Dev Comp Immunol 2021; 122:104138. [PMID: 34022257 DOI: 10.1016/j.dci.2021.104138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
Mosquito anti-pathogen immune responses, including those controlling infection with arboviruses are regulated by multiple signal transduction pathways. While the Toll pathway is critical in the defense against arboviruses such as dengue and Zika viruses, the factors and mechanisms involved in virus recognition leading to the activation of the Toll pathway are not fully understood. In this study we evaluated the role of virus-produced double-stranded RNA (dsRNA) intermediates in mosquito immune activation by utilizing the synthetic dsRNA analog polyinosinic-polycytidylic acid (poly I:C). Poly I:C treatment of Aedes aegypti mosquitoes and Aag2 cells reduced DENV infection. Transcriptomic analyses of Aag2 cell responses to poly I:C indicated putative activation of the Toll pathway. We found that poly I:C is translocated to the endosomal compartment of Aag2 cells, and that the A. aegypti Toll 6 receptor is a putative dsRNA recognition receptor. This study elucidates the role of dsRNAs in the immune activation of non-RNAi pathways in mosquitoes.
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Affiliation(s)
| | - Chinmay V Tikhe
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Seokyoung Kang
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, United States
| | - George Dimopoulos
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, United States.
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29
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Pinheiro JR, Camilo dos Reis E, Souza RDSO, Rocha ALS, Suesdek L, Azevedo V, Tiwari S, Rocha BGS, Birbrair A, Méndez EC, Luiz WB, Amorim JH. Comparison of Neutralizing Dengue Virus B Cell Epitopes and Protective T Cell Epitopes With Those in Three Main Dengue Virus Vaccines. Front Immunol 2021; 12:715136. [PMID: 34489965 PMCID: PMC8417696 DOI: 10.3389/fimmu.2021.715136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
The four serotypes of Dengue virus (DENV1-4) are arboviruses (arthropod-borne viruses) that belong to the Flavivirus genus, Flaviviridae family. They are the causative agents of an infectious disease called dengue, an important global public health problem with significant social-economic impact. Thus, the development of safe and effective dengue vaccines is a priority according to the World Health Organization. Only one anti-dengue vaccine has already been licensed in endemic countries and two formulations are under phase III clinical trials. In this study, we aimed to compare the main anti-dengue virus vaccines, DENGVAXIA®, LAV-TDV, and TAK-003, regarding their antigens and potential to protect. We studied the conservation of both, B and T cell epitopes involved in immunological control of DENV infection along with vaccine viruses and viral isolates. In addition, we assessed the population coverage of epitope sets contained in each vaccine formulation with regard to different human populations. As main results, we found that all three vaccines contain the main B cell epitopes involved in viral neutralization. Similarly, LAV-TDV and TAK-003 contain most of T cell epitopes involved in immunological protection, a finding not observed in DENGVAXIA®, which explains main limitations of the only licensed dengue vaccine. In summary, the levels of presence and absence of epitopes that are target for protective immune response in the three main anti-dengue virus vaccines are shown in this study. Our results suggest that investing in vaccines that contain the majority of epitopes involved in protective immunity (cellular and humoral arms) is an important issue to be considered.
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MESH Headings
- Amino Acid Sequence
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/immunology
- Conserved Sequence
- Dengue/prevention & control
- Dengue Vaccines/genetics
- Dengue Vaccines/immunology
- Dengue Virus/immunology
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Epitopes, T-Lymphocyte/chemistry
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Humans
- Immunization Programs
- Models, Molecular
- Structure-Activity Relationship
- Vaccination
- Vaccines, Synthetic
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Affiliation(s)
- Josilene Ramos Pinheiro
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Bahia, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Bahia, Brazil
| | - Esther Camilo dos Reis
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Bahia, Brazil
| | - Rayane da Silva Oliveira Souza
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Bahia, Brazil
| | - Ana Luíza Silva Rocha
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Bahia, Brazil
| | - Lincoln Suesdek
- Laboratório de Parasitologia, Instituto, Butantan, São Paulo, Brazil
| | - Vasco Azevedo
- Departamento de Genética, Ecologia e Evolução, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandeep Tiwari
- Departamento de Genética, Ecologia e Evolução, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Alexander Birbrair
- Departamento de Patologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Erick Carvalho Méndez
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Bahia, Brazil
| | - Wilson Barros Luiz
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Bahia, Brazil
| | - Jaime Henrique Amorim
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Bahia, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Bahia, Brazil
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30
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Peroni LA, Toscaro JM, Canateli C, Tonoli CCC, de Olivera RR, Benedetti CE, Coimbra LD, Pereira AB, Marques RE, Proença-Modena JL, Lima GC, Viana R, Borges JB, Lin-Wang HT, Abboud CS, Gun C, Franchini KG, Bajgelman MC. Serological Testing for COVID-19, Immunological Surveillance, and Exploration of Protective Antibodies. Front Immunol 2021; 12:635701. [PMID: 34489923 PMCID: PMC8417107 DOI: 10.3389/fimmu.2021.635701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/28/2021] [Indexed: 01/11/2023] Open
Abstract
Serological testing is a powerful tool in epidemiological studies for understanding viral circulation and assessing the effectiveness of virus control measures, as is the case of SARS-CoV-2, the pathogenic agent of COVID-19. Immunoassays can quantitatively reveal the concentration of antiviral antibodies. The assessment of antiviral antibody titers may provide information on virus exposure, and changes in IgG levels are also indicative of a reduction in viral circulation. In this work, we describe a serological study for the evaluation of antiviral IgG and IgM antibodies and their correlation with antiviral activity. The serological assay for IgG detection used two SARS-CoV-2 proteins as antigens, the nucleocapsid N protein and the 3CL protease. Cross-reactivity tests in animals have shown high selectivity for detection of antiviral antibodies, using both the N and 3CL antigens. Using samples of human serum from individuals previously diagnosed by PCR for COVID-19, we observed high sensitivity of the ELISA assay. Serological results with human samples also suggest that the combination of higher titers of antiviral IgG antibodies to different antigen targets may be associated with greater neutralization activity, which can be enhanced in the presence of antiviral IgM antibodies.
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Affiliation(s)
- Luis A. Peroni
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Jessica M. Toscaro
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
- Medical School, University of Campinas, Campinas, Brazil
| | - Camila Canateli
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Celisa C. C. Tonoli
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Renata R. de Olivera
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Celso E. Benedetti
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Lais D. Coimbra
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Alexandre Borin Pereira
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - Rafael E. Marques
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
| | - José L. Proença-Modena
- Laboratory of Emerging Viruses (LEVE), Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
- Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, Brazil
| | - Gabriel C. Lima
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
- Molecular Sciences Undergrad Program, University of São Paulo, São Paulo, Brazil
| | - Renata Viana
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo, Brazil
| | - Jessica B. Borges
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo, Brazil
| | - Cely S. Abboud
- Infectious Diseases Section and Hospital Infection Control Committee, Dante Pazzanese Cardiology Institute, São Paulo, Brazil
| | - Carlos Gun
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo, Brazil
| | - Kleber G. Franchini
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
- Medical School, University of Campinas, Campinas, Brazil
| | - Marcio C. Bajgelman
- Brazilian Biosciences National Laboratory, Center for Research in Energy and Materials, Campinas, Brazil
- Medical School, University of Campinas, Campinas, Brazil
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
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31
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Sirikajornpan K, Suntarattiwong P, Suwanpakdee D, Tabprasit S, Buddhari D, Thaisomboonsuk B, Klungthong C, Poolpanichupatam Y, Buathong R, Srikiatkhachorn A, Jones A, Fernandez S, Hunsawong T. Standardization and Evaluation of an Anti-ZIKV IgM ELISA Assay for the Serological Diagnosis of Zika Virus Infection. Am J Trop Med Hyg 2021; 105:936-941. [PMID: 34339380 PMCID: PMC8592169 DOI: 10.4269/ajtmh.21-0163] [Citation(s) in RCA: 2] [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: 02/09/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022] Open
Abstract
Here, we describe the development of the in-house anti-Zika virus (ZIKV) IgM antibody capture ELISA (in-house ZIKV IgM ELISA) for the detection and diagnosis of acute ZIKV infections. We compared the in-house ZIKV IgM ELISA assay performance against two commercial kits, Euroimmun ZIKV IgM and InBios 2.0 ZIKV IgM ELISA. We tested the assays' ability to detect anti-ZIKV IgM using a well-defined serum sample panel. This panel included 80 ZIKV negative samples (20 negative, 20 found to be primary dengue virus [DENV][ infections, 20 secondary DENV infections, and 20 Japanese encephalitis virus [JEV] infections) and 67 ZIKV reverse transcriptase-polymerase chain reaction-positive acute serum samples. The OD values were calculated to enzyme immunoassay (EIA) unts by comparing them to weak positive controls. The results demonstrated the high sensitivity (88.06%) and specificity (90.00%) of our in-house ZIKV IgM ELISA and its 89.12% overall percentage agreement. The kappa values were deemed to be within excellent range and comparable to the InBios ZIKV IgM ELISA. Some cross-reactivity was observed among secondary DENV and JEV samples, and to a much lower extent, among primary DENV samples. These data indicate that our in-house ZIKV IgM ELISA is a reliable assay for the detection of anti-ZIKV IgM antibodies in serum.
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Affiliation(s)
- Kanittha Sirikajornpan
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Piyarat Suntarattiwong
- Pediatrician, Infectious Diseases Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - Sutchana Tabprasit
- Research Division, Royal Thai Army-Armed Forces Research Institute of Medical Sciences (RTA-AFRIMS), Bangkok, Thailand
| | - Darunee Buddhari
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Yongyuth Poolpanichupatam
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Rome Buathong
- Department of Disease Control, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand
| | - Anon Srikiatkhachorn
- Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Anthony Jones
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Taweewun Hunsawong
- Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
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32
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Fibriansah G, Lim XN, Lok SM. Morphological Diversity and Dynamics of Dengue Virus Affecting Antigenicity. Viruses 2021; 13:v13081446. [PMID: 34452312 PMCID: PMC8402850 DOI: 10.3390/v13081446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 01/30/2023] Open
Abstract
The four serotypes of the mature dengue virus can display different morphologies, including the compact spherical, the bumpy spherical and the non-spherical clubshape morphologies. In addition, the maturation process of dengue virus is inefficient and therefore some partially immature dengue virus particles have been observed and they are infectious. All these viral particles have different antigenicity profiles and thus may affect the type of the elicited antibodies during an immune response. Understanding the molecular determinants and environmental conditions (e.g., temperature) in inducing morphological changes in the virus and how potent antibodies interact with these particles is important for designing effective therapeutics or vaccines. Several techniques, including cryoEM, site-directed mutagenesis, hydrogen-deuterium exchange mass spectrometry, time-resolve fluorescence resonance energy transfer, and molecular dynamic simulation, have been performed to investigate the structural changes. This review describes all known morphological variants of DENV discovered thus far, their surface protein dynamics and the key residues or interactions that play important roles in the structural changes.
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Affiliation(s)
- Guntur Fibriansah
- Programme in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.F.); (X.-N.L.)
- Centre for BioImaging Sciences, Department of Biological Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Xin-Ni Lim
- Programme in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.F.); (X.-N.L.)
- Centre for BioImaging Sciences, Department of Biological Sciences, National University of Singapore, Singapore 117557, Singapore
| | - Shee-Mei Lok
- Programme in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.F.); (X.-N.L.)
- Centre for BioImaging Sciences, Department of Biological Sciences, National University of Singapore, Singapore 117557, Singapore
- Correspondence:
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33
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Biggs JR, Sy AK, Brady OJ, Kucharski AJ, Funk S, Tu YH, Reyes MAJ, Quinones MA, Jones-Warner W, Ashall J, Avelino FL, Sucaldito NL, Tandoc AO, Cutiongco-de la Paz E, Capeding MRZ, Padilla CD, Hibberd ML, Hafalla JCR. Serological Evidence of Widespread Zika Transmission across the Philippines. Viruses 2021; 13:1441. [PMID: 34452307 PMCID: PMC8402696 DOI: 10.3390/v13081441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
Zika virus (ZIKV) exposure across flavivirus-endemic countries, including the Philippines, remains largely unknown despite sporadic case reporting and environmental suitability for transmission. Using laboratory surveillance data from 2016, 997 serum samples were randomly selected from suspected dengue (DENV) case reports across the Philippines and assayed for serological markers of short-term (IgM) and long-term (IgG) ZIKV exposure. Using mixture models, we re-evaluated ZIKV IgM/G seroprevalence thresholds and used catalytic models to quantify the force of infection (attack rate, AR) from age-accumulated ZIKV exposure. While we observed extensive ZIKV/DENV IgG cross-reactivity, not all individuals with active DENV presented with elevated ZIKV IgG, and a proportion of dengue-negative cases (DENV IgG-) were ZIKV IgG-positive (14.3%, 9/63). We identified evidence of long-term, yet not short-term, ZIKV exposure across Philippine regions (ZIKV IgG+: 31.5%, 314/997) which was geographically uncorrelated with DENV exposure. In contrast to the DENV AR (12.7% (95%CI: 9.1-17.4%)), the ZIKV AR was lower (5.7% (95%CI: 3-11%)) across the country. Our results provide evidence of widespread ZIKV exposure across the Philippines and suggest the need for studies to identify ZIKV infection risk factors over time to better prepare for potential future outbreaks.
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Affiliation(s)
- Joseph R. Biggs
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.J.-W.); (J.A.); (M.L.H.); (J.C.R.H.)
| | - Ava Kristy Sy
- Department of Virology, Research Institute for Tropical Medicine, Manila 1781, Philippines; (A.K.S.); (M.A.J.R.); (M.A.Q.); (A.O.T.)
- Dengue Study Group, Research Institute for Tropical Medicine, Manila 1781, Philippines;
| | - Oliver J. Brady
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (O.J.B.); (A.J.K.); (S.F.)
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Adam J. Kucharski
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (O.J.B.); (A.J.K.); (S.F.)
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (O.J.B.); (A.J.K.); (S.F.)
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yun-Hung Tu
- Department of Molecular Parasitology and Tropical Diseases, Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 11031, Taiwan;
| | - Mary Anne Joy Reyes
- Department of Virology, Research Institute for Tropical Medicine, Manila 1781, Philippines; (A.K.S.); (M.A.J.R.); (M.A.Q.); (A.O.T.)
- Dengue Study Group, Research Institute for Tropical Medicine, Manila 1781, Philippines;
| | - Mary Ann Quinones
- Department of Virology, Research Institute for Tropical Medicine, Manila 1781, Philippines; (A.K.S.); (M.A.J.R.); (M.A.Q.); (A.O.T.)
- Dengue Study Group, Research Institute for Tropical Medicine, Manila 1781, Philippines;
| | - William Jones-Warner
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.J.-W.); (J.A.); (M.L.H.); (J.C.R.H.)
| | - James Ashall
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.J.-W.); (J.A.); (M.L.H.); (J.C.R.H.)
| | - Ferchito L. Avelino
- Department of Health, Philippine Epidemiology Bureau, Manila 1003, Philippines; (F.L.A.); (N.L.S.)
| | - Nemia L. Sucaldito
- Department of Health, Philippine Epidemiology Bureau, Manila 1003, Philippines; (F.L.A.); (N.L.S.)
| | - Amado O. Tandoc
- Department of Virology, Research Institute for Tropical Medicine, Manila 1781, Philippines; (A.K.S.); (M.A.J.R.); (M.A.Q.); (A.O.T.)
| | - Eva Cutiongco-de la Paz
- Institute of Human Genetics, University of the Philippines, Manila 1000, Philippines; (E.C.-d.l.P.); (C.D.P.)
- Philippine Genome Centre, University of the Philippines, Manila 1101, Philippines
| | - Maria Rosario Z. Capeding
- Dengue Study Group, Research Institute for Tropical Medicine, Manila 1781, Philippines;
- Institute of Human Genetics, University of the Philippines, Manila 1000, Philippines; (E.C.-d.l.P.); (C.D.P.)
| | - Carmencita D. Padilla
- Institute of Human Genetics, University of the Philippines, Manila 1000, Philippines; (E.C.-d.l.P.); (C.D.P.)
- Philippine Genome Centre, University of the Philippines, Manila 1101, Philippines
| | - Martin L. Hibberd
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.J.-W.); (J.A.); (M.L.H.); (J.C.R.H.)
- Institute of Human Genetics, University of the Philippines, Manila 1000, Philippines; (E.C.-d.l.P.); (C.D.P.)
- Philippine Genome Centre, University of the Philippines, Manila 1101, Philippines
| | - Julius Clemence R. Hafalla
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.J.-W.); (J.A.); (M.L.H.); (J.C.R.H.)
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Ngo-Giang-Huong N, Leroi C, Fusco D, Cressey TR, Wangsaeng N, Salvadori N, Kongyai N, Sirirungsi W, Lallemant M, Auewarakul P, Khamduang W, Jourdain G. Lack of Association between Adverse Pregnancy Outcomes and Zika Antibodies among Pregnant Women in Thailand between 1997 and 2015. Viruses 2021; 13:1423. [PMID: 34452289 PMCID: PMC8402824 DOI: 10.3390/v13081423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 01/28/2023] Open
Abstract
Data about Zika virus infection and adverse pregnancy outcomes in Southeast Asia are scarce. We conducted an unmatched case-control study of Zika virus (ZIKV) serology in pregnant women enrolled in human immunodeficiency virus (HIV) or hepatitis B virus (HBV) perinatal prevention trials between 1997 and 2015 in Thailand. Case and control groups included women with and without adverse pregnancy outcomes. Plasma samples collected during the last trimester of pregnancy were tested for ZIKV IgG/IgM and Dengue IgG/IgM (Euroimmun, AG, Germany). Case newborn plasma samples were tested for ZIKV IgM and ZIKV RNA (Viasure, Spain). The case group included women with stillbirth (n = 22) or whose infants had microcephaly (n = 4), a head circumference below the first percentile (n = 14), neurological disorders (n = 36), or had died within 10 days after birth (n = 11). No women in the case group were positive for ZIKV IgM, and none of their live-born neonates were positive for ZIKV IgM or ZIKV RNA. The overall ZIKV IgG prevalence was 29%, 24% in the case and 34% in the control groups (Fisher's exact test; p = 0.13), while the dengue IgG seroprevalence was 90%. Neither neonatal ZIKV infections nor ZIKV-related adverse pregnancy outcomes were observed in these women with HIV and/or HBV during the 18-year study period.
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Affiliation(s)
- Nicole Ngo-Giang-Huong
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Charline Leroi
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Dahlene Fusco
- Department of Medicine, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112, USA;
| | - Tim R. Cressey
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Nantawan Wangsaeng
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Nicolas Salvadori
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Natedao Kongyai
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Wasna Sirirungsi
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Marc Lallemant
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Prasert Auewarakul
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand;
| | - Woottichai Khamduang
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Gonzague Jourdain
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
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Falconi-Agapito F, Kerkhof K, Merino X, Michiels J, Van Esbroeck M, Bartholomeeusen K, Talledo M, Ariën KK. Dynamics of the Magnitude, Breadth and Depth of the Antibody Response at Epitope Level Following Dengue Infection. Front Immunol 2021; 12:686691. [PMID: 34290707 PMCID: PMC8289389 DOI: 10.3389/fimmu.2021.686691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
Dengue is a major public health problem in tropical and sub-tropical regions worldwide. Since the Zika epidemic and the increased co-circulation of other arboviruses, the serology-based diagnosis of dengue has become more problematic due to the high antigenic resemblance, especially among the flavivirus family. Therefore, a more comprehensive understanding of the diversity, specificity and temporal evolution of the antibody response following dengue infection is needed. In order to close this knowledge gap, we used a high-density peptide microarray of 9,072 linear peptides covering the entire proteome diversity of dengue, Zika, yellow fever and chikungunya viruses. The IgM and IgG antibody responses were measured against the designed microarray in symptomatic dengue infected individuals from an arbovirus endemic area in Peru and in overseas travelers returning to Belgium, as representatives of multiple-exposed and primary infections, respectively. Serum samples were collected longitudinally across four time points over the period of six months in Peru and over two time points in travelers. We show that epitopes eliciting the strongest flavivirus cross-reactive antibodies, in both primary and secondary infections were concentrated in the capsid, E, NS1, NS3 and NS5 proteins. The IgG antibody responses against NS1 and NS3 followed a rise-and-fall pattern, with peak titers between two to four weeks after onset of illness. The response to the E and NS5 proteins increased rapidly in the acute phase and was maintained at stable levels until at least 6 months after illness. A more scattered IgM antibody reactivity across the viral proteome was observed in the acute phase of the disease and that persisted through the 6-month window. The magnitude, breadth (i.e. number of unique epitopes targeted) and depth (i.e. number of epitope variants recognized) of the IgG response was higher in secondary infections compared to primary infections. For IgM antibodies, the magnitude of the response was higher in primary infected individuals whereas the breadth and depth of the response was lower in this group compared with the endemic subjects. Finally, through this arboviral proteome-wide epitope mapping, we were able to identify IgM and IgG dengue-specific epitopes which can be useful serological markers for dengue diagnosis and serostatus determination.
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Affiliation(s)
- Francesca Falconi-Agapito
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Karen Kerkhof
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Xiomara Merino
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Johan Michiels
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, National Reference Center for Arboviruses, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Bartholomeeusen
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
| | - Michael Talledo
- Virology Unit, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kevin K. Ariën
- Department of Biomedical Sciences, Unit of Virology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Slavov SN, Santos EV, Hespanhol MR, Rodrigues ES, Haddad R, Ubiali EMA, Covas DT, Kashima S. Dengue RNA detection and seroprevalence in blood donors during an outbreak in the São Paulo State, Brazil, 2016. J Med Virol 2021; 93:3344-3349. [PMID: 33090520 DOI: 10.1002/jmv.26619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
Most dengue virus (DENV) infections remain asymptomatic. This increases the risk of DENV transfusion transmission (TT-DENV) during outbreaks. We evaluated DENV viremia in 8475 blood donations assembled in minipools for the presence of DENV RNA. The tested samples were obtained between February and May, 2016, during a large DENV outbreak in Ribeirão Preto city, northeast region of the São Paulo State, Brazil. The DENV RNA + samples were serotyped and screened for DENV NS1. We also tested a significant number of plasma samples (n = 372) to estimate the DENV seroprevalence among blood donors in the region. We detected three DENV RNA + samples in the tested blood donations (n = 3/8475, 0.04%). From these, two samples were further serotyped as DENV-1 and one sample as DENV-2. All DENV RNA positive samples were negative for anti-DENV IgG, indicating the presence of primary acute infection. Moreover, two of the DENV RNA + samples were also NS1 antigen positive (antigenemia). The anti-DENV IgG seroprevalence among blood donor population was 50.8% (n = 189/372). Our results are in accordance with the presence of DENV primary infection in blood donors which can lead to transfusion transmission of the infection to recipients. Measures to exclude such donors should be adopted to prevent TT-DENV.
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Affiliation(s)
- Svetoslav N Slavov
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Elaine V Santos
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marta R Hespanhol
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Evandra S Rodrigues
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Haddad
- Laboratory of Clinical Analyses, Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
- Center for Tropical Medicine, Faculty of Medicine, University of Brasilia, Brasilia, Federal District, Brazil
| | - Eugênia M A Ubiali
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Dimas T Covas
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Simone Kashima
- Blood Center of Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Kalita JM, Aggarwal A, Yedale K, Gadepalli R, Nag VL. A 5-year study of dengue seropositivity among suspected cases attending a teaching hospital of North-Western region of India. J Med Virol 2021; 93:3338-3343. [PMID: 33038014 DOI: 10.1002/jmv.26592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/08/2022]
Abstract
Dengue virus infection is estimated to cause infection in approximately 390 million people globally each year, of which 96 million develop clinical disease. Dengue serotype 2 (DEN-2) is the most prevalent serotype over the past 50 years in India, but serotypes 3 and 4 have appeared in some epidemics as well. A retrospective study was conducted in a teaching hospital, western India, between January 2014 and December 2018. The records of dengue serological test were analyzed. In total, 40 randomly selected nonstructural protein 1 (NS1) antigen-positive samples were analyzed by a reverse transcription-polymerase chain reaction. The demographic data, that is, age and sex, along with geographic location and platelet count level, were recorded from the Serology laboratory register and Hospital Information System. In total, 14.85% (735/4948) samples tested positive for dengue serology. Most of the laboratory-confirmed dengue cases, 34.97% (257/735), were observed in the 21-30 years of age group. The most common serotype detected in the tested samples was DEN-3 in 55% cases (22/40, 13 monoinfection and 9 coinfection with DEN-1 and DEN-2). The present study gives an insight into the trend of dengue seropositivity among suspected cases in the western part of Rajasthan, India. This study showed a higher seroprevalence of dengue infection as well as a gradual increase in the seroprevalence in this part of India.
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Affiliation(s)
- Jitu M Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alisha Aggarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kavita Yedale
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya L Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Gandikota C, Gandhi L, Maisnam D, Kesavulu MM, Billoria A, Prasad VSV, Venkataramana M. A novel anti-NS2BNS3pro antibody-based indirect ELISA test for the diagnosis of dengue virus infections. J Med Virol 2021; 93:3312-3321. [PMID: 32418268 DOI: 10.1002/jmv.26024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/13/2020] [Indexed: 11/06/2022]
Abstract
Dengue virus reportedly circulates as four genetically distinct serotypes for which there is no widely accepted vaccine or drug at present. Morbidity and mortality caused by this virus are alarming for the possible increased threat to human health. A suitable diagnostic test is the prerequisite for designing and developing control measures. But, the tests being employed at present possess one or the other drawback for this disease diagnosis. During the dengue virus infections, NS2B is essential for the stability and catalytic activity of the NS3 protease. N-terminal 185 amino acids of NS3 protease domain along with hydrophilic portion of NS2B (NS2BNS3pro) is being used to screen dengue inhibitors but not for diagnosis until now. In the present study, we have used purified NS2BNS3pro as an antigen to trap anti-NS2BNS3pro antibodies of the clinical samples. Antibodies were detected successfully in both Western blot analysis and enzyme-linked immunosorbent assay (ELISA) tests. In ELISA, antibodies were detected in both primary and secondary infections of all serotypes. Interestingly, 17 samples declared as other febrile infections by NS1 and IgM/IgG tests were found to be positive in present test, which were further confirmed by reverse-transcription polymerase chain reaction. In silico studies suggested the absence of conserved epitopes between NS2BNS3pro and the counterpart in JEV, Zika, and CHIKV, indicating less possibility of crossreaction, which was in turn confirmed by using synthetic peptides representing the above epitopes. Statistical analysis with 76% specificity, 87% sensitivity, and 95% concordance also supported the present test as a suitable test for large scale diagnosis of dengue virus infections.
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Affiliation(s)
- Chaitanya Gandikota
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Lekha Gandhi
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Deepti Maisnam
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Muppuru Muni Kesavulu
- Department of Biotechnology, SreeVidyanikethan Engineering College, Tirupati, Andhra Pradesh, India
| | - Arcy Billoria
- Department of Microbiology, Lotus Hospitals for Women and Children, Hyderabad, Telangana State, India
| | | | - Musturi Venkataramana
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana, India
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Wollner CJ, Richner M, Hassert MA, Pinto AK, Brien JD, Richner JM. A Dengue Virus Serotype 1 mRNA-LNP Vaccine Elicits Protective Immune Responses. J Virol 2021; 95:e02482-20. [PMID: 33762420 PMCID: PMC8315947 DOI: 10.1128/jvi.02482-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
Dengue virus (DENV) is the most common vector-borne viral disease, with nearly 400 million worldwide infections each year concentrated in the tropical and subtropical regions of the world. Severe dengue complications are often associated with a secondary heterotypic infection of one of the four circulating serotypes. In this scenario, humoral immune responses targeting cross-reactive, poorly neutralizing epitopes can lead to increased infectivity of susceptible cells via antibody-dependent enhancement (ADE). In this way, antibodies produced in response to infection or vaccination are capable of contributing to enhanced disease in subsequent infections. Currently, there are no available therapeutics to combat DENV disease, and there is an urgent need for a safe and efficacious vaccine. Here, we developed a nucleotide-modified mRNA vaccine encoding the membrane and envelope structural proteins from DENV serotype 1 encapsulated in lipid nanoparticles (prM/E mRNA-LNP). Vaccination of mice elicited robust antiviral immune responses comparable to viral infection, with high levels of neutralizing antibody titers and antiviral CD4+ and CD8+ T cells. Immunocompromised AG129 mice vaccinated with the prM/E mRNA-LNP vaccine were protected from a lethal DENV challenge. Vaccination with either a wild-type vaccine or a vaccine with mutations in the immunodominant fusion loop epitope elicited equivalent humoral and cell-mediated immune responses. Neutralizing antibodies elicited by the vaccine were sufficient to protect against a lethal challenge. Both vaccine constructs demonstrated serotype-specific immunity with minimal serum cross-reactivity and reduced ADE in comparison to a live DENV1 viral infection.IMPORTANCE With 400 million worldwide infections each year, dengue is the most common vector-borne viral disease. Forty percent of the world's population is at risk, with dengue experiencing consistent geographic spread over the years. With no therapeutics available and vaccines performing suboptimally, the need for an effective dengue vaccine is urgent. Here, we develop and characterize a novel mRNA vaccine encoding the dengue serotype 1 envelope and premembrane structural proteins that is delivered via a lipid nanoparticle. Our DENV1 prM/E mRNA-LNP vaccine induces neutralizing antibody and cellular immune responses in immunocompetent mice and protects an immunocompromised mouse from a lethal DENV challenge. Existing antibodies against dengue can enhance subsequent infections via antibody-dependent enhancement (ADE). Importantly our vaccine induced only serotype-specific immune responses and did not induce ADE.
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MESH Headings
- Adaptive Immunity
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody-Dependent Enhancement
- Cell Line
- Cross Reactions
- Dengue/immunology
- Dengue/prevention & control
- Dengue Vaccines/administration & dosage
- Dengue Vaccines/immunology
- Dengue Virus/classification
- Dengue Virus/genetics
- Dengue Virus/immunology
- Immunity, Humoral
- Immunization Schedule
- Liposomes
- Mice
- Mice, Inbred C57BL
- Nanoparticles
- RNA, Messenger/genetics
- RNA, Viral/genetics
- Serogroup
- T-Lymphocytes/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/immunology
- Viral Envelope Proteins/genetics
- Viral Envelope Proteins/immunology
- Viral Proteins/genetics
- Viral Proteins/immunology
- mRNA Vaccines
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Affiliation(s)
- Clayton J Wollner
- Department of Microbiology and Immunology, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Michelle Richner
- Department of Microbiology and Immunology, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Mariah A Hassert
- Department of Molecular Microbiology and Immunology, St. Louis University College of Medicine, St. Louis, Missouri, USA
| | - Amelia K Pinto
- Department of Molecular Microbiology and Immunology, St. Louis University College of Medicine, St. Louis, Missouri, USA
| | - James D Brien
- Department of Molecular Microbiology and Immunology, St. Louis University College of Medicine, St. Louis, Missouri, USA
| | - Justin M Richner
- Department of Microbiology and Immunology, University of Illinois College of Medicine, Chicago, Illinois, USA
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Choy MM, Ng DHL, Siriphanitchakorn T, Ng WC, Sundstrom KB, Tan HC, Zhang SL, Chan KWK, Manuel M, Kini RM, Chan KR, Vasudevan SG, Ooi EE. A Non-structural 1 Protein G53D Substitution Attenuates a Clinically Tested Live Dengue Vaccine. Cell Rep 2021; 31:107617. [PMID: 32402284 DOI: 10.1016/j.celrep.2020.107617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
Abstract
The molecular basis of dengue virus (DENV) attenuation remains ambiguous and hampers a targeted approach to derive safe but nonetheless immunogenic live vaccine candidates. Here, we take advantage of DENV serotype 2 PDK53 vaccine strain, which recently and successfully completed a phase-3 clinical trial, to identify how this virus is attenuated compared to its wild-type parent, DENV2 16681. Site-directed mutagenesis on a 16681 infectious clone identifies a single G53D substitution in the non-structural 1 (NS1) protein that reduces 16681 infection and dissemination in both Aedes aegypti, as well as in mammalian cells to produce the characteristic phenotypes of PDK53. Mechanistically, NS1 G53D impairs the function of a known host factor, the endoplasmic reticulum (ER)-resident ribophorin 1 protein, to properly glycosylate NS1 and thus induce a host antiviral gene through ER stress responses. Our findings provide molecular insights on DENV attenuation on a clinically tested strain.
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Affiliation(s)
- Milly M Choy
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Dorothy H L Ng
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore 169108, Singapore
| | - Tanamas Siriphanitchakorn
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Biological Sciences, National University of Singapore, Singapore 117558, Singapore
| | - Wy Ching Ng
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Karin B Sundstrom
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Hwee Cheng Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Summer L Zhang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Kitti W K Chan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Menchie Manuel
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - R Manjunatha Kini
- Department of Biological Sciences, National University of Singapore, Singapore 117558, Singapore
| | - Kuan Rong Chan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Subhash G Vasudevan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Eng Eong Ooi
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
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41
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Ngim CF, Husain SMT, Hassan SS, Dhanoa A, Ahmad SAA, Mariapun J, Wan Ismail WF, Botross Henien NP, Jahan NK, Pong LY, Elshahawi H, Hontz RD, Warkentein T, Yunos NM. Rapid testing requires clinical evaluation for accurate diagnosis of dengue disease: A passive surveillance study in Southern Malaysia. PLoS Negl Trop Dis 2021; 15:e0009445. [PMID: 34014983 PMCID: PMC8171949 DOI: 10.1371/journal.pntd.0009445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 06/02/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Dengue fever is the most common mosquito-borne infection worldwide where an expanding surveillance and characterization of this infection are needed to better inform the healthcare system. In this surveillance-based study, we explored the prevalence and distinguishing features of dengue fever amongst febrile patients in a large community-based health facility in southern peninsular Malaysia. Methods Over six months in 2018, we recruited 368 adults who met the WHO 2009 criteria for probable dengue infection. They underwent the following blood tests: full blood count, dengue virus (DENV) rapid diagnostic test (RDT), ELISA (dengue IgM and IgG), nested RT-PCR for dengue, multiplex qRT-PCR for Zika, Chikungunya and dengue as well as PCR tests for Leptopspira spp., Japanese encephalitis and West Nile virus. Results Laboratory-confirmed dengue infections (defined by positive tests in NS1, IgM, high-titre IgG or nested RT-PCR) were found in 167 (45.4%) patients. Of these 167 dengue patients, only 104 (62.3%) were positive on rapid diagnostic testing. Dengue infection was significantly associated with the following features: family or neighbours with dengue in the past week (AOR: 3.59, 95% CI:2.14–6.00, p<0.001), cutaneous rash (AOR: 3.58, 95% CI:1.77–7.23, p<0.001), increased temperature (AOR: 1.33, 95% CI:1.04–1.70, p = 0.021), leucopenia (white cell count < 4,000/μL) (AOR: 3.44, 95% CI:1.72–6.89, p<0.001) and thrombocytopenia (platelet count <150,000/μL)(AOR: 4.63, 95% CI:2.33–9.21, p<0.001). Dengue infection was negatively associated with runny nose (AOR: 0.47, 95% CI:0.29–0.78, p = 0.003) and arthralgia (AOR: 0.42, 95% CI:0.24–0.75, p = 0.004). Serotyping by nested RT-PCR revealed mostly mono-infections with DENV-2 (n = 64), DENV-1 (n = 32) and DENV-3 (n = 17); 14 co-infections occurred with DENV-1/DENV-2 (n = 13) and DENV-1/DENV-4 (n = 1). Besides dengue, none of the pathogens above were found in patients’ serum. Conclusions Acute undifferentiated febrile infections are a diagnostic challenge for community-based clinicians. Rapid diagnostic tests are increasingly used to diagnose dengue infection but negative tests should be interpreted with caution as they fail to detect a considerable proportion of dengue infection. Certain clinical features and haematological parameters are important in the clinical diagnosis of dengue infection. With the rise in dengue infection worldwide, dengue fever remains an important diagnosis among patients presenting with fever in the community. We conducted a passive surveillance study in a large community clinic in southern Malaysia. Adults with fever who met the WHO 2009 criteria for probable dengue infection underwent blood tests that were able to detect dengue fever accurately, including rapid diagnostics tests, serology, and molecular tests. Nearly half (45.4%) of the patients were confirmed to suffer from dengue infection in which the widely-used rapid tests were negative in a considerable proportion of dengue-infected patients. This underlines the importance of recognizing clinical and laboratory features suggestive of dengue fever. We found that a history of family or neighbours with dengue infection in the past week, skin rash, a higher temperature, leucopenia (white cell count < 4,000/μL) and thrombocytopenia (platelet count <150,000/μL) were significantly associated with dengue fever whereas runny nose and arthralgia were features that suggest non-dengue conditions. These features in addition to rapid diagnostic kits are useful to guide community based health care workers in the diagnosis of patients presenting with undifferentiated fever.
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Affiliation(s)
- Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
- * E-mail:
| | | | - Sharifah Syed Hassan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Amreeta Dhanoa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | | | - Jeevitha Mariapun
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | | | | | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Lian Yih Pong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Hesham Elshahawi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | | | | | - Nor’azim Mohd Yunos
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
- Faculty of Medicine, University of Malaya, Malaysia
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42
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Rouers A, Chng MHY, Lee B, Rajapakse MP, Kaur K, Toh YX, Sathiakumar D, Loy T, Thein TL, Lim VW, Singhal A, Yeo TW, Leo YS, Vora KA, Casimiro D, Lim B, Tucker-Kellogg L, Rivino L, Newell EW, Fink K. Immune cell phenotypes associated with disease severity and long-term neutralizing antibody titers after natural dengue virus infection. Cell Rep Med 2021; 2:100278. [PMID: 34095880 PMCID: PMC8149372 DOI: 10.1016/j.xcrm.2021.100278] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
Prior immunological exposure to dengue virus can be both protective and disease-enhancing during subsequent infections with different dengue virus serotypes. We provide here a systematic, longitudinal analysis of B cell, T cell, and antibody responses in the same patients. Antibody responses as well as T and B cell activation differentiate primary from secondary responses. Hospitalization is associated with lower frequencies of activated, terminally differentiated T cells and higher percentages of effector memory CD4 T cells. Patients with more severe disease tend to have higher percentages of plasmablasts. This does not translate into long-term antibody titers, since neutralizing titers after 6 months correlate with percentages of specific memory B cells, but not with acute plasmablast activation. Overall, our unbiased analysis reveals associations between cellular profiles and disease severity, opening opportunities to study immunopathology in dengue disease and the potential predictive value of these parameters.
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Affiliation(s)
- Angeline Rouers
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
| | - Melissa Hui Yen Chng
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Menaka P. Rajapakse
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Kaval Kaur
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Ying Xiu Toh
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Durgalakshmi Sathiakumar
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
| | - Thomas Loy
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
| | - Tun-Linn Thein
- National Centre for Infectious Diseases, Singapore 308442, Singapore
| | - Vanessa W.X. Lim
- National Centre for Infectious Diseases, Singapore 308442, Singapore
| | - Amit Singhal
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- A∗STAR ID Labs, Agency for Science, Technology and Research, Singapore 138468, Singapore
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
- Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore 308442, Singapore
- Lee Kong Chian School of Medicine, Singapore 308232, Singapore
- Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, Singapore 117549, Singapore
| | - Kalpit A. Vora
- Department of Infectious Diseases and Vaccines Research, Merck, Kenilworth, NJ, USA
| | - Danilo Casimiro
- Department of Infectious Diseases and Vaccines Research, Merck, Kenilworth, NJ, USA
| | - Bing Lim
- Merck Sharp & Dohme Translational Medicine Research Centre, 8A Biomedical Grove, Singapore 138648, Singapore
| | - Lisa Tucker-Kellogg
- Cancer and Stem Cell Biology, and Centre for Computational Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Laura Rivino
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- School of Cellular and Molecular Medicine, University of Bristol, Bristol BS8 1TD, UK
| | - Evan W. Newell
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Katja Fink
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore 138648, Singapore
- Corresponding author
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43
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Mantri CK, Soundarajan G, Saron WAA, Rathore APS, Alonso S, St. John AL. Maternal Immunity and Vaccination Influence Disease Severity in Progeny in a Novel Mast Cell-Deficient Mouse Model of Severe Dengue. Viruses 2021; 13:v13050900. [PMID: 34066286 PMCID: PMC8152039 DOI: 10.3390/v13050900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
Abstract
Sub-neutralizing concentrations of antibodies in dengue infected patients is a major risk factor for the development of dengue hemorrhagic fever and dengue shock syndrome. Here, we describe a mouse model with a deficiency in mast cells (MCs) in addition to a deficiency in Type-I and II IFN receptors for studying dengue virus (DENV) infection. We used this model to understand the influence of MCs in a maternal antibody-dependent model of severe dengue, where offspring born to DENV-immune mothers are challenged with a heterologous DENV serotype. Mice lacking both MCs and IFN receptors were found susceptible to primary DENV infection and showed morbidity and mortality. When these mice were immunized, pups born to DENV-immune mothers were found to be protected for a longer duration from a heterologous DENV challenge. In the absence of MCs and type-I interferon signaling, IFN-γ was found to protect pups born to naïve mothers but had the opposite effect on pups born to DENV-immune mothers. Our results highlight the complex interactions between MCs and IFN-signaling in influencing the role of maternal antibodies in DENV-induced disease severity.
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Affiliation(s)
- Chinmay Kumar Mantri
- Program in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.S.); (W.A.A.S.)
- Correspondence: (C.K.M.); (A.L.S.J.)
| | - Gayathri Soundarajan
- Program in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.S.); (W.A.A.S.)
| | - Wilfried A. A. Saron
- Program in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.S.); (W.A.A.S.)
| | - Abhay P. S. Rathore
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Sylvie Alonso
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore;
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore 119077, Singapore
| | - Ashley L. St. John
- Program in Emerging Infectious Diseases, Duke–National University of Singapore Medical School, Singapore 169857, Singapore; (G.S.); (W.A.A.S.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
- Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore 119077, Singapore
- SingHealth Duke-National University of Singapore Global Health Institute, Singapore 168753, Singapore
- Correspondence: (C.K.M.); (A.L.S.J.)
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Alexander LW, Ben-Shachar R, Katzelnick LC, Kuan G, Balmaseda A, Harris E, Boots M. Boosting can explain patterns of fluctuations of ratios of inapparent to symptomatic dengue virus infections. Proc Natl Acad Sci U S A 2021; 118:e2013941118. [PMID: 33811138 PMCID: PMC8040803 DOI: 10.1073/pnas.2013941118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dengue is the most prevalent arboviral disease worldwide, and the four dengue virus (DENV) serotypes circulate endemically in many tropical and subtropical regions. Numerous studies have shown that the majority of DENV infections are inapparent, and that the ratio of inapparent to symptomatic infections (I/S) fluctuates substantially year-to-year. For example, in the ongoing Pediatric Dengue Cohort Study (PDCS) in Nicaragua, which was established in 2004, the I/S ratio has varied from 16.5:1 in 2006-2007 to 1.2:1 in 2009-2010. However, the mechanisms explaining these large fluctuations are not well understood. We hypothesized that in dengue-endemic areas, frequent boosting (i.e., exposures to DENV that do not lead to extensive viremia and result in a less than fourfold rise in antibody titers) of the immune response can be protective against symptomatic disease, and this can explain fluctuating I/S ratios. We formulate mechanistic epidemiologic models to examine the epidemiologic effects of protective homologous and heterologous boosting of the antibody response in preventing subsequent symptomatic DENV infection. We show that models that include frequent boosts that protect against symptomatic disease can recover the fluctuations in the I/S ratio that we observe, whereas a classic model without boosting cannot. Furthermore, we show that a boosting model can recover the inverse relationship between the number of symptomatic cases and the I/S ratio observed in the PDCS. These results highlight the importance of robust dengue control efforts, as intermediate dengue control may have the potential to decrease the protective effects of boosting.
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Affiliation(s)
| | - Rotem Ben-Shachar
- Integrative Biology, University of California, Berkeley, CA 94720
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, 12014 Managua, Nicaragua
- Sustainable Sciences Institute, 14007 Managua, Nicaragua
| | - Angel Balmaseda
- Sustainable Sciences Institute, 14007 Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, 16064 Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720
| | - Mike Boots
- Integrative Biology, University of California, Berkeley, CA 94720;
- Biosciences, University of Exeter, Penryn TR10 9EZ, United Kingdom
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45
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Sánchez-González G, Belak ZR, Lozano L, Condé R. Probability of consolidation constrains novel serotype emergence in dengue fever virus. PLoS One 2021; 16:e0248765. [PMID: 33819302 PMCID: PMC8021166 DOI: 10.1371/journal.pone.0248765] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Since their first sequencing 40 years ago, Dengue virus (DENV) genotypes have shown extreme coherence regarding the serotype class they encode. Considering that DENV is a ribonucleic acid (RNA) virus with a high mutation rate, this behavior is intriguing. Here, we explore the effect of various parameters on likelihood of new serotype emergence. In order to determine the time scales of such an event, we used a Timed Markov Transmission Model to explore the influences of sylvatic versus peri-urban transmission, viral mutation rate, and vertical transmission on the probabilities of novel serotype emergence. We found that around 1 000 years are required for a new serotype to emerge, consistent with phylogenetic analysis of extant dengue serotypes. Furthermore, we show that likelihood of establishing chains of mosquito-human-mosquito infection, known as consolidation, is the primary factor which constrains novel serotype emergence. Our work illustrates the restrictions on and provides a mechanistic explanation for the low probability of novel dengue virus serotype emergence and the low number of observed DENV serotypes.
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Affiliation(s)
- Gilberto Sánchez-González
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | | | - Luis Lozano
- Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Renaud Condé
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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46
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Pan YH, Liao MY, Chien YW, Ho TS, Ko HY, Yang CR, Chang SF, Yu CY, Lin SY, Shih PW, Shu PY, Chao DY, Pan CY, Chen HM, Perng GC, Ku CC, King CC. Use of seroprevalence to guide dengue vaccination plans for older adults in a dengue non-endemic country. PLoS Negl Trop Dis 2021; 15:e0009312. [PMID: 33793562 PMCID: PMC8075253 DOI: 10.1371/journal.pntd.0009312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/24/2020] [Revised: 04/26/2021] [Accepted: 03/17/2021] [Indexed: 01/05/2023] Open
Abstract
A shift in dengue cases toward the adult population, accompanied by an increased risk of severe cases of dengue in the elderly, has created an important emerging issue in the past decade. To understand the level of past DENV infection among older adults after a large dengue outbreak occurred in southern Taiwan in 2015, we screened 1498 and 2603 serum samples from healthy residents aged ≥ 40 years in Kaohsiung City and Tainan City, respectively, to assess the seroprevalence of anti-DENV IgG in 2016. Seropositive samples were verified to exclude cross-reaction from Japanese encephalitis virus (JEV), using DENV/JEV-NS1 indirect IgG ELISA. We further identified viral serotypes and secondary DENV infections among positive samples in the two cities. The overall age-standardized seroprevalence of DENV-IgG among participants was 25.77% in Kaohsiung and 11.40% in Tainan, and the seroprevalence was significantly higher in older age groups of both cities. Although the percentages of secondary DENV infection in Kaohsiung and Tainan were very similar (43.09% and 44.76%, respectively), DENV-1 and DENV-2 spanned a wider age range in Kaohsiung, whereas DENV-2 was dominant in Tainan. As very few studies have obtained the serostatus of DENV infection in older adults and the elderly, this study highlights the need for further investigation into antibody status, as well as the safety and efficacy of dengue vaccination in these older populations.
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Affiliation(s)
- Yi-Hua Pan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
| | - Mei-Ying Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University (NCKU), Tainan, Taiwan, Republic of China
| | - Tzong-Shiann Ho
- Department of Pediatrics, National Cheng-Kung University Hospital (NCKUH), College of Medicine, NCKU, Tainan, Taiwan, Republic of China
| | - Hui-Ying Ko
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
| | - Chin-Rur Yang
- Institute of Immunology, College of Medicine, NTU, Taipei, Taiwan, Republic of China
| | - Shu-Fen Chang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan, Republic of China
| | - Chia-Yi Yu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes (NHRI), Tainan, Taiwan, Republic of China
| | - Shu-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
| | - Pin-Wei Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan, Republic of China
| | - Day-Yu Chao
- Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, Republic of China
| | - Chao-Ying Pan
- Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan, Republic of China
| | - Hong-Ming Chen
- Public Health Bureau, Tainan City Government, Tainan, Taiwan, Republic of China
| | - Guey-Chuen Perng
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University (NCKU), Tainan, Taiwan, Republic of China
| | - Chia-Chi Ku
- Institute of Immunology, College of Medicine, NTU, Taipei, Taiwan, Republic of China
| | - Chwan-Chuen King
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan, Republic of China
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Yow KS, Aik J, Tan EYM, Ng LC, Lai YL. Rapid diagnostic tests for the detection of recent dengue infections: An evaluation of six kits on clinical specimens. PLoS One 2021; 16:e0249602. [PMID: 33793682 PMCID: PMC8016316 DOI: 10.1371/journal.pone.0249602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Early and rapid confirmation of dengue infections strengthens disease surveillance program and are critical to the success of vector control measures. Rapid diagnostics tests (RDTs) are increasingly used to confirm recent dengue infections due to their ease of use and short turnaround time for results. Several studies undertaken in dengue-endemic Southeast Asia have reported the performance of RDTs against enzyme-linked immunosorbent assay (ELISA), reverse transcriptase polymerase chain reaction (RT-PCR) and virus isolation methods. However, few studies have compared multiple RDTs for the detection of dengue NS1 antigen and IgM antibody in a single combo cassette. We evaluated six RDTs in Singapore for their utility in routine clinical testing to detect recent dengue infections. Methods The evaluation comprised two phases. The first phase sought to determine each RDT’s specificity to dengue NS1 and IgM using zika and chikungunya virus supernatant and zika convalescent samples. RDTs that cross-reacted with zika or chikungunya were not further tested in phase 2. The second phase sought to determine the sensitivity and specificity of the remaining RDTs to dengue NS1 and IgM using pre-characterised dengue specimens and non-dengue/chikungunya febrile clinical specimens. Results None of the RDTs cross-reacted with zika IgM in Phase 1. Truquick and Quickprofile cross reacted with zika and chikungunya viruses and were not evaluated thereafter. Standard Q had the highest dengue NS1 and IgM sensitivity at 87.0% and 84.3% respectively whereas Bioline (68.5%) and Multisure (58.3%) had the lowest dengue NS1 and IgM sensitivity respectively. Combining dengue NS1/IgM detection results greatly improved the RDT ability to detect recent dengue infection; Standard Q had the highest sensitivity at 99.1% while Multisure had the lowest at 92.6%. All the RDTs were highly specific for dengue NS1 and IgM (96.7% to 100%). All the RDTs had high positive predictive values (98.4% to 100%) for NS1, IgM and combined NS1/IgM parameters whereas Standard Q had the highest negative predictive values at 68.2% (NS1), 63.8% (IgM) and 96.8% (NS1/IgM). For the RDTs, detection of NS1 declined from acute to convalescent phase of illness whereas IgM detection rate gradually increased over time. Conclusion In our study, several RDTs were evaluated for their diagnostic accuracy and capability in detecting recent dengue infection. Standard Q demonstrated a high degree of diagnostic accuracy and capability in the detection of NS1 and IgM biomarkers. RDTs can provide rapid and accurate confirmation of recent dengue infections and augment dengue surveillance and control programmes. Further studies are required to assess the usefulness of these RDTs in other epidemiology settings.
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Affiliation(s)
- Kok-Siang Yow
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
- * E-mail:
| | - Joel Aik
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Eugene Yong-Meng Tan
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Yee-Ling Lai
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
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Stiasny K, Malafa S, Aberle SW, Medits I, Tsouchnikas G, Aberle JH, Holzmann H, Heinz FX. Different Cross-Reactivities of IgM Responses in Dengue, Zika and Tick-Borne Encephalitis Virus Infections. Viruses 2021; 13:v13040596. [PMID: 33807442 PMCID: PMC8066087 DOI: 10.3390/v13040596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/30/2022] Open
Abstract
Flaviviruses circulate worldwide and cause a number of medically relevant human diseases, such as dengue, Zika, yellow fever, and tick-borne encephalitis (TBE). Serology plays an important role in the diagnosis of flavivirus infections, but can be impeded by antigenic cross-reactivities among flaviviruses. Therefore, serological diagnosis of a recent infection can be insufficiently specific, especially in areas where flaviviruses co-circulate and/or vaccination coverage against certain flaviviruses is high. In this study, we developed a new IgM assay format, which is well suited for the specific diagnosis of TBE, Zika and dengue virus infections. In the case of TBE and Zika, the IgM response proved to be highly specific for the infecting virus. In contrast, primary dengue virus infections induced substantial amounts of cross-reactive IgM antibodies, which is most likely explained by structural peculiarities of dengue virus particles. Despite the presence of cross-reactive IgM, the standardized nature and the quantitative read-out of the assay even allowed the serotype-specific diagnosis of recent dengue virus infections in most instances.
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49
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Lien TS, Sun DS, Hung SC, Wu WS, Chang HH. Dengue Virus Envelope Protein Domain III Induces Nlrp3 Inflammasome-Dependent NETosis-Mediated Inflammation in Mice. Front Immunol 2021; 12:618577. [PMID: 33815373 PMCID: PMC8009969 DOI: 10.3389/fimmu.2021.618577] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
Abnormal immune responses and cytokine storm are involved in the development of severe dengue, a life-threatening disease with high mortality. Dengue virus-induced neutrophil NETosis response is associated with cytokine storm; while the role of viral factors on the elicitation of excessive inflammation mains unclear. Here we found that treatments of dengue virus envelope protein domain III (EIII), cellular binding moiety of virion, is sufficient to induce neutrophil NETosis processes in vitro and in vivo. Challenges of EIII in inflammasome Nlrp3-/- and Casp1-/- mutant mice resulted in less inflammation and NETosis responses, as compared to the wild type controls. Blockages of EIII-neutrophil interaction using cell-binding competitive inhibitor or selective Nlrp3 inflammasome inhibitors OLT1177 and Z-WHED-FMK can suppress EIII-induced NETosis response. These results collectively suggest that Nlrp3 inflammsome is a molecular target for treating dengue-elicited inflammatory pathogenesis.
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Affiliation(s)
- Te-Sheng Lien
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien, Taiwan
| | - Der-Shan Sun
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu-Chi University, Hualien, Taiwan
| | - Shih-Che Hung
- Institute of Medical Sciences, Tzu-Chi University, Hualien, Taiwan
| | - Wen-Sheng Wu
- Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsin-Hou Chang
- Department of Molecular Biology and Human Genetics, Tzu-Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu-Chi University, Hualien, Taiwan
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50
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Cabezas-Falcon S, Norbury AJ, Hulme-Jones J, Klebe S, Adamson P, Rudd PA, Mahalingam S, Ong LC, Alonso S, Gordon DL, Carr JM. Changes in complement alternative pathway components, factor B and factor H during dengue virus infection in the AG129 mouse. J Gen Virol 2021; 102:001547. [PMID: 33410734 PMCID: PMC8515863 DOI: 10.1099/jgv.0.001547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
The complement alternative pathway (AP) is tightly regulated and changes in two important AP components, factor B (FB) and factor H (FH) are linked to severe dengue in humans. Here, a mouse model of dengue was investigated to define the changes in FB and FH and assess the utility of this model to study the role of the AP in severe dengue. Throughout the period of viremia in the AG129 IFN signalling-deficient mouse, an increase in FB and a decrease in FH was observed following dengue virus (DENV) infection, with the former only seen in a model of more severe disease associated with antibody-dependent enhancement (ADE). Terminal disease was associated with a decrease in FB and FH, with greater changes during ADE, and accompanied by increased C3 degradation consistent with complement activation. In silico analysis of NFκΒ, signal transducer and activator of transcription (STAT) and IFN-driven FB and FH promoter elements to reflect the likely impact of the lack of IFN-responses in AG129 mice, demonstrated that these elements differed markedly between human and mouse, notably with mouse FH lacking NFκΒ and key IFN-stimulated response elements (ISRE), and FB with many more NFκΒ and STAT-responsive elements than human FB. Thus, the AG129 mouse offers utility in demonstrating changes in FB and FH that, similar to humans, are associated with severe disease, but lack predicted important human-specific and IFN-dependent responses of FB and FH to DENV-infection that are likely to regulate the subtleties of the overall AP response during dengue disease in humans.
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Affiliation(s)
- Sheila Cabezas-Falcon
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
| | - Aidan J. Norbury
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
| | - Jarrod Hulme-Jones
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
| | - Sonja Klebe
- Anatomy and Pathology, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide 5042, South Australia
- SA Pathology, Adelaide 5000, South Australia
| | - Penelope Adamson
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
| | - Penny A. Rudd
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4215, Australia
| | - Suresh Mahalingam
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4215, Australia
| | - Li-Ching Ong
- Infectious Disease Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, and Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore
| | - Sylvie Alonso
- Infectious Disease Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, and Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore
| | - David L. Gordon
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
- SA Pathology, Adelaide 5000, South Australia
| | - Jillian M. Carr
- Microbiology and Infectious Diseases, Flinders University, Bedford Park, Adelaide 5042, South Australia
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