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McNaughton AL, Paton RS, Edmans M, Youngs J, Wellens J, Phalora P, Fyfe A, Belij-Rammerstorfer S, Bolton JS, Ball J, Carnell GW, Dejnirattisai W, Dold C, Eyre DW, Hopkins P, Howarth A, Kooblall K, Klim H, Leaver S, Lee LN, López-Camacho C, Lumley SF, Macallan DC, Mentzer AJ, Provine NM, Ratcliff J, Slon-Compos J, Skelly D, Stolle L, Supasa P, Temperton N, Walker C, Wang B, Wyncoll D, Simmonds P, Lambe T, Baillie JK, Semple MG, Openshaw PJ, Obolski U, Turner M, Carroll M, Mongkolsapaya J, Screaton G, Kennedy SH, Jarvis L, Barnes E, Dunachie S, Lourenço J, Matthews PC, Bicanic T, Klenerman P, Gupta S, Thompson CP. Fatal COVID-19 outcomes are associated with an antibody response targeting epitopes shared with endemic coronaviruses. JCI Insight 2022; 7:156372. [PMID: 35608920 PMCID: PMC9310533 DOI: 10.1172/jci.insight.156372] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
The role of immune responses to previously seen endemic coronavirus epitopes in severe acute respiratory coronavirus 2 (SARS-CoV-2) infection and disease progression has not yet been determined. Here, we show that a key characteristic of fatal outcomes with coronavirus disease 2019 (COVID-19) is that the immune response to the SARS-CoV-2 spike protein is enriched for antibodies directed against epitopes shared with endemic beta-coronaviruses and has a lower proportion of antibodies targeting the more protective variable regions of the spike. The magnitude of antibody responses to the SARS-CoV-2 full-length spike protein, its domains and subunits, and the SARS-CoV-2 nucleocapsid also correlated strongly with responses to the endemic beta-coronavirus spike proteins in individuals admitted to an intensive care unit (ICU) with fatal COVID-19 outcomes, but not in individuals with nonfatal outcomes. This correlation was found to be due to the antibody response directed at the S2 subunit of the SARS-CoV-2 spike protein, which has the highest degree of conservation between the beta-coronavirus spike proteins. Intriguingly, antibody responses to the less cross-reactive SARS-CoV-2 nucleocapsid were not significantly different in individuals who were admitted to an ICU with fatal and nonfatal outcomes, suggesting an antibody profile in individuals with fatal outcomes consistent with an "original antigenic sin" type response.
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Affiliation(s)
- Anna L. McNaughton
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Robert S. Paton
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Matthew Edmans
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Jonathan Youngs
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Judith Wellens
- Peter Medawar Building for Pathogen Research
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
- Translational Research for Gastrointestinal Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Prabhjeet Phalora
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Alex Fyfe
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Jai S. Bolton
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Jonathan Ball
- General Intensive Care service, St George’s University Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - George W. Carnell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | | | - David W. Eyre
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Philip Hopkins
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College, London, United Kingdom
| | - Alison Howarth
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kreepa Kooblall
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, and
| | - Hannah Klim
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Future of Humanity Institute, Department of Philosophy, and
| | - Susannah Leaver
- General Intensive Care service, St George’s University Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - Lian Ni Lee
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | | | - Sheila F. Lumley
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Derek C. Macallan
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | | | - Nicholas M. Provine
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy Ratcliff
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Jose Slon-Compos
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Donal Skelly
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lucas Stolle
- Department of Biochemistry, University of Oxford, Oxford, United Kingdom
| | - Piyada Supasa
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, United Kingdom
| | - Chris Walker
- Meso Scale Diagnostics, Rockville, Maryland, USA
| | - Beibei Wang
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
| | - Duncan Wyncoll
- Intensive Care Medicine, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Peter Simmonds
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
| | - Teresa Lambe
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | | | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Uri Obolski
- School of Public Health, Faculty of Medicine, and
- Porter School of the Environment and Earth Sciences, Faculty of Exact Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Marc Turner
- National Microbiology Reference Unit, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Miles Carroll
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- National Infection Service, Public Health England (PHE), Salisbury, United Kingdom
| | - Juthathip Mongkolsapaya
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- Siriraj Center of Research for Excellence in Dengue & Emerging Pathogens, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
| | - Gavin Screaton
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, United Kingdom
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Lisa Jarvis
- National Microbiology Reference Unit, Scottish National Blood Transfusion Service, Edinburgh, United Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susanna Dunachie
- Peter Medawar Building for Pathogen Research
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - José Lourenço
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Philippa C. Matthews
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tihana Bicanic
- Institute of Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research
- Nuffield Department of Medicine, and
- Translational Research for Gastrointestinal Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sunetra Gupta
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Craig P. Thompson
- Peter Medawar Building for Pathogen Research
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Stolle L, Nalamasu R, Rodenbeck R, Davidson K, Smarelli C, Rosko S, Wales J, LeQuang JAK, Pergolizzi J. Ozone: A Novel Sterilizer for Personal Protective Equipment. Cureus 2021; 13:e18228. [PMID: 34722033 PMCID: PMC8544639 DOI: 10.7759/cureus.18228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Personal protective equipment (PPE) is urgently sought during public health crises. It is necessary for the safety of both the patient and the healthcare professional. Yet during the recent COVID-19 pandemic, PPE scarcity in many countries, including the United States, has impacted the level of care for patients and the safety of healthcare personnel. Additionally, the implementation of mandatory mask mandates for the general public in many countries forced individuals to either reuse PPE, which can contribute to poor hygiene, or buy PPE in bulk and thereby contribute to the scarcity of PPE. In this study, we investigate the possibility of using a cost-effective ozone sterilization unit on contaminated N95 masks as an alternative to current sterilization methods. Method: This protocol examined ozone’s ability to decontaminate N95 mask fabric that was exposed to a surrogate virus (Escherichia coli bacteriophage MS2). Once the sterilization unit achieves an ozone concentration of ~30 ppm, a 60-minute or 120-minute sterilization cycle commences. Following the sterilization cycle, we investigated the amount of viable virus on the slide using a viral plaque assay and compared it to a non-sterilized, control slide. Furthermore, we carried out trials to investigate the safety of an ozone sterilization device, by measuring the levels of ozone exposure that individuals may experience when operating the sterilization unit post-cycle. Results: We showed that a 120-minute sterilization cycle at ~30 ppm achieves a 3-log reduction in viral activity, thereby complying with industry and U.S. Food and Drug Administration (FDA) standards. Further, we demonstrated that when following our protocol, the ozone exposure levels for a simple sterilization unit to be used at home complied with federal and industry standards. Conclusion: Ozone may have the potential to decontaminate masks and other PPE.
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Affiliation(s)
- Lucas Stolle
- Molecular and Cellular Biochemistry, Oxford University, Oxford, GBR
| | - Rohit Nalamasu
- Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, USA
| | | | - Kyle Davidson
- Research, Delta Faucet Company, Indianapolis, Indiana, USA
| | | | - Scot Rosko
- Research, Delta Faucet Company, Indianapolis, Indiana, USA
| | - Josh Wales
- Research, Delta Faucet Company, Indianapolis, Indiana, USA
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Schwenk ES, Pradhan B, Nalamasu R, Stolle L, Wainer IW, Cirullo M, Olson A, Pergolizzi JV, Torjman MC, Viscusi ER. Correction to: Ketamine in the Past, Present, and Future: Mechanisms, Metabolites, and Toxicity. Curr Pain Headache Rep 2021; 25:62. [PMID: 34537869 DOI: 10.1007/s11916-021-00985-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA.
| | - Basant Pradhan
- Psychiatry & Pediatrics, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Rohit Nalamasu
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Michael Cirullo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander Olson
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
| | | | - Marc C Torjman
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
| | - Eugene R Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
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Schwenk ES, Pradhan B, Nalamasu R, Stolle L, Wainer IW, Cirullo M, Olsen A, Pergolizzi JV, Torjman MC, Viscusi ER. Ketamine in the Past, Present, and Future: Mechanisms, Metabolites, and Toxicity. Curr Pain Headache Rep 2021; 25:57. [PMID: 34269883 DOI: 10.1007/s11916-021-00977-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW While ketamine's analgesia has mostly been attributed to antagonism of N-methyl-D-aspartate receptors, evidence suggests multiple other pathways are involved in its antidepressant and possibly analgesic activity. These mechanisms and ketamine's role in the nociplastic pain paradigm are discussed. Animal studies demonstrating ketamine's neurotoxicity have unclear human translatability and findings from key rodent and human studies are presented. RECENT FINDINGS Ketamine's metabolites, and (2R,6R)-hydroxynorketamine in particular, may play a greater role in its clinical activity than previously believed. The activation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and the mammalian target of rapamycin by ketamine are mechanisms that are still being elucidated. Ketamine might work best in nociplastic pain, which involves altered pain processing. While much is known about ketamine, new studies will continue to define its role in clinical medicine. Evidence supporting ketamine's neurotoxicity in humans is lacking and should not impede future ketamine clinical trials.
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Affiliation(s)
- Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA.
| | - Basant Pradhan
- Psychiatry & Pediatrics, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Rohit Nalamasu
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Michael Cirullo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander Olsen
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
| | | | - Marc C Torjman
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
| | - Eugene R Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, 8290, Philadelphia, PA, 19107, USA
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