1
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Hartmann JA, Cardoso MR, Talarico MCR, Kenney DJ, Leone MR, Reese DC, Turcinovic J, O'Connell AK, Gertje HP, Marino C, Ojeda PE, De Paula EV, Orsi FA, Velloso LA, Cafiero TR, Connor JH, Ploss A, Hoelzemer A, Carrington M, Barczak AK, Crossland NA, Douam F, Boucau J, Garcia-Beltran WF. Evasion of NKG2D-mediated cytotoxic immunity by sarbecoviruses. Cell 2024; 187:2393-2410.e14. [PMID: 38653235 PMCID: PMC11088510 DOI: 10.1016/j.cell.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
SARS-CoV-2 and other sarbecoviruses continue to threaten humanity, highlighting the need to characterize common mechanisms of viral immune evasion for pandemic preparedness. Cytotoxic lymphocytes are vital for antiviral immunity and express NKG2D, an activating receptor conserved among mammals that recognizes infection-induced stress ligands (e.g., MIC-A/B). We found that SARS-CoV-2 evades NKG2D recognition by surface downregulation of MIC-A/B via shedding, observed in human lung tissue and COVID-19 patient serum. Systematic testing of SARS-CoV-2 proteins revealed that ORF6, an accessory protein uniquely conserved among sarbecoviruses, was responsible for MIC-A/B downregulation via shedding. Further investigation demonstrated that natural killer (NK) cells efficiently killed SARS-CoV-2-infected cells and limited viral spread. However, inhibition of MIC-A/B shedding with a monoclonal antibody, 7C6, further enhanced NK-cell activity toward SARS-CoV-2-infected cells. Our findings unveil a strategy employed by SARS-CoV-2 to evade cytotoxic immunity, identify the culprit immunevasin shared among sarbecoviruses, and suggest a potential novel antiviral immunotherapy.
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Affiliation(s)
- Jordan A Hartmann
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Devin J Kenney
- Department of Virology, Immunology, and Microbiology, Chobanian and Avedisian Boston University School of Medicine, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Madison R Leone
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
| | - Dagny C Reese
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jacquelyn Turcinovic
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Aoife K O'Connell
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Hans P Gertje
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Caitlin Marino
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
| | - Pedro E Ojeda
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
| | - Erich V De Paula
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil
| | - Fernanda A Orsi
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil
| | - Licio Augusto Velloso
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
| | - Thomas R Cafiero
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - John H Connor
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Angelique Hoelzemer
- First Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Institute for Infection and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Research Department Virus Immunology, Leibniz Institute for Virology, Hamburg, Germany
| | - Mary Carrington
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA; Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Amy K Barczak
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas A Crossland
- Department of Virology, Immunology, and Microbiology, Chobanian and Avedisian Boston University School of Medicine, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Florian Douam
- Department of Virology, Immunology, and Microbiology, Chobanian and Avedisian Boston University School of Medicine, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Julie Boucau
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA.
| | - Wilfredo F Garcia-Beltran
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
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2
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Hauser BM, Feldman J, Sangesland M, Ronsard L, St Denis KJ, Sheehan ML, Cao Y, Boucau J, Windsor IW, Cheng AH, Vu ML, Cardoso MR, Kannegieter T, Balazs AB, Lingwood D, Garcia-Beltran WF, Schmidt AG. Cross-reactive SARS-CoV-2 epitope targeted across donors informs immunogen design. Cell Rep Med 2022; 3:100834. [PMID: 36423634 PMCID: PMC9663748 DOI: 10.1016/j.xcrm.2022.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
The emergence of the antigenically distinct and highly transmissible Omicron variant highlights the possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune escape due to viral evolution. This continued evolution, along with the possible introduction of new sarbecoviruses from zoonotic reservoirs, may evade host immunity elicited by current SARS-CoV-2 vaccines. Identifying cross-reactive antibodies and defining their epitope(s) can provide templates for rational immunogen design strategies for next-generation vaccines. Here, we characterize the receptor-binding-domain-directed, cross-reactive humoral repertoire across 10 human vaccinated donors. We identify cross-reactive antibodies from diverse gene rearrangements targeting two conserved receptor-binding domain epitopes. An engineered immunogen enriches antibody responses to one of these conserved epitopes in mice with pre-existing SARS-CoV-2 immunity; elicited responses neutralize SARS-CoV-2, variants, and related sarbecoviruses. These data show how immune focusing to a conserved epitope targeted by human cross-reactive antibodies may guide pan-sarbecovirus vaccine development, providing a template for identifying such epitopes and translating to immunogen design.
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Affiliation(s)
- Blake M Hauser
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Maya Sangesland
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Larance Ronsard
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Kerri J St Denis
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Maegan L Sheehan
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Yi Cao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Julie Boucau
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Ian W Windsor
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA; Laboratory of Molecular Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Agnes H Cheng
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Mya L Vu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | | | - Ty Kannegieter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | | | - Daniel Lingwood
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA
| | - Wilfredo F Garcia-Beltran
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA.
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3
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Schult TA, Lauer MJ, Berker Y, Cardoso MR, Vandergrift LA, Habbel P, Nowak J, Taupitz M, Aryee M, Mino-Kenudson MA, Christiani DC, Cheng LL. Screening human lung cancer with predictive models of serum magnetic resonance spectroscopy metabolomics. Proc Natl Acad Sci U S A 2021; 118:e2110633118. [PMID: 34903652 PMCID: PMC8713787 DOI: 10.1073/pnas.2110633118] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
The current high mortality of human lung cancer stems largely from the lack of feasible, early disease detection tools. An effective test with serum metabolomics predictive models able to suggest patients harboring disease could expedite triage patient to specialized imaging assessment. Here, using a training-validation-testing-cohort design, we establish our high-resolution magic angle spinning (HRMAS) magnetic resonance spectroscopy (MRS)-based metabolomics predictive models to indicate lung cancer presence and patient survival using serum samples collected prior to their disease diagnoses. Studied serum samples were collected from 79 patients before (within 5.0 y) and at lung cancer diagnosis. Disease predictive models were established by comparing serum metabolomic patterns between our training cohorts: patients with lung cancer at time of diagnosis, and matched healthy controls. These predictive models were then applied to evaluate serum samples of our validation and testing cohorts, all collected from patients before their lung cancer diagnosis. Our study found that the predictive model yielded values for prior-to-detection serum samples to be intermediate between values for patients at time of diagnosis and for healthy controls; these intermediate values significantly differed from both groups, with an F1 score = 0.628 for cancer prediction. Furthermore, values from metabolomics predictive model measured from prior-to-diagnosis sera could significantly predict 5-y survival for patients with localized disease.
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Affiliation(s)
- Tjada A Schult
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, 12203 Berlin, Germany
| | - Mara J Lauer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
- Graduate School of Life Sciences, University of Würzburg, 97074 Würzburg, Germany
| | - Yannick Berker
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, DKFZ and DKTK, 69120 Heidelberg, Germany
| | - Marcella R Cardoso
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | | | - Piet Habbel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, 12203 Berlin, Germany
| | - Johannes Nowak
- Radiological Practice Gotha, SRH Poliklinik Gera GmbH, 99867 Gotha, Germany
| | - Matthias Taupitz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, 12203 Berlin, Germany
| | - Martin Aryee
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | | | - David C Christiani
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114;
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Leo L Cheng
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114;
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Silva AAR, Cardoso MR, Rezende LM, Lin JQ, Guimaraes F, Silva GRP, Murgu M, Priolli DG, Eberlin MN, Tata A, Eberlin LS, Derchain SFM, Porcari AM. Multiplatform Investigation of Plasma and Tissue Lipid Signatures of Breast Cancer Using Mass Spectrometry Tools. Int J Mol Sci 2020; 21:E3611. [PMID: 32443844 PMCID: PMC7279467 DOI: 10.3390/ijms21103611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/02/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023] Open
Abstract
Plasma and tissue from breast cancer patients are valuable for diagnostic/prognostic purposes and are accessible by multiple mass spectrometry (MS) tools. Liquid chromatography-mass spectrometry (LC-MS) and ambient mass spectrometry imaging (MSI) were shown to be robust and reproducible technologies for breast cancer diagnosis. Here, we investigated whether there is a correspondence between lipid cancer features observed by desorption electrospray ionization (DESI)-MSI in tissue and those detected by LC-MS in plasma samples. The study included 28 tissues and 20 plasma samples from 24 women with ductal breast carcinomas of both special and no special type (NST) along with 22 plasma samples from healthy women. The comparison of plasma and tissue lipid signatures revealed that each one of the studied matrices (i.e., blood or tumor) has its own specific molecular signature and the full interposition of their discriminant ions is not possible. This comparison also revealed that the molecular indicators of tissue injury, characteristic of the breast cancer tissue profile obtained by DESI-MSI, do not persist as cancer discriminators in peripheral blood even though some of them could be found in plasma samples.
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Affiliation(s)
- Alex Ap. Rosini Silva
- Postgraduate Program of Health Sciences, São Francisco University, Bragança Paulista SP 12916-900, Brazil; (A.A.R.S.); (D.G.P.)
| | - Marcella R. Cardoso
- Department of Gynecological and Breast Oncology, Women’s Hospital (CAISM), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas SP 13083-881, Brazil; (M.R.C.); (L.M.R.); (F.G.); (S.F.M.D.)
| | - Luciana Montes Rezende
- Department of Gynecological and Breast Oncology, Women’s Hospital (CAISM), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas SP 13083-881, Brazil; (M.R.C.); (L.M.R.); (F.G.); (S.F.M.D.)
| | - John Q. Lin
- Department of Chemistry, The University of Texas at Austin, Austin, TX 78712, USA; (J.Q.L.); (L.S.E.)
| | - Fernando Guimaraes
- Department of Gynecological and Breast Oncology, Women’s Hospital (CAISM), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas SP 13083-881, Brazil; (M.R.C.); (L.M.R.); (F.G.); (S.F.M.D.)
| | - Geisilene R. Paiva Silva
- Laboratory of Molecular and Investigative Pathology—LAPE, Women’s Hospital (CAISM), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas SP 13083-881, Brazil;
| | - Michael Murgu
- Waters Corporation, São Paulo, SP 13083-970, Brazil;
| | - Denise Gonçalves Priolli
- Postgraduate Program of Health Sciences, São Francisco University, Bragança Paulista SP 12916-900, Brazil; (A.A.R.S.); (D.G.P.)
| | - Marcos N. Eberlin
- School of Engineering, Mackenzie Presbyterian University, São Paulo SP 01302-907, Brazil;
| | - Alessandra Tata
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico Sperimentale delle Venezie, Viale Fiume 78, 36100 Vicenza, Italy;
| | - Livia S. Eberlin
- Department of Chemistry, The University of Texas at Austin, Austin, TX 78712, USA; (J.Q.L.); (L.S.E.)
| | - Sophie F. M. Derchain
- Department of Gynecological and Breast Oncology, Women’s Hospital (CAISM), Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas SP 13083-881, Brazil; (M.R.C.); (L.M.R.); (F.G.); (S.F.M.D.)
| | - Andreia M. Porcari
- Postgraduate Program of Health Sciences, São Francisco University, Bragança Paulista SP 12916-900, Brazil; (A.A.R.S.); (D.G.P.)
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Almeida GFB, Cardoso MR, Aoki PHB, Lima JJD, Costa LDF, Rodrigues CA, Constantino CJL, Mendoncal CR. Surface Morphology and Structural Modification Induced by Femtosecond Pulses in Hydrogenated Amorphous Silicon Films. J Nanosci Nanotechnol 2015; 15:2495-2500. [PMID: 26413695 DOI: 10.1166/jnn.2015.9820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This work investigates the modification, resulting from fs-laser irradiation (150 fs, 775 nm and 1 kHz), on the structure and surface morphology of hydrogenated amorphous silicon (a-Si:H) thin films. The sample morphology was studied by performing a statistical analyzes of atomic force microscopy images, using a specially developed software that identifies and characterizes the domains (spikes) produced by the laser irradiation. For a fluence of 3.1 MJ/m2, we observed formation of spikes with smaller average height distribution, centered at around 15 nm, while for fluencies higher than 3.7 MJ/m2 aggregation of the produced spikes dominates the sample morphology. On the other hand, Raman spectroscopy revealed that a higher crystalline fraction (73%) is obtained for higher fluences (> 3.1 MJ/m2), which is accompanied by a decrease in the size of the produced crystals. Therefore, such results indicate that there is a trade-off between the spike distribution, crystallization fraction and size of the nanocrystals attained by laser irradiation, which has to be taken into account when using such approach for the development of devices.
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Taha MO, Miranda-Ferreira R, Chang ACR, Rodrigues AM, Fonseca IS, Toral LB, Cardoso MR, Simões MJ, Oliveira-Junior IS, Monteiro HP, Fagundes DJ, Taha NSA, Caricati-Neto A. Effect of ischemic preconditioning on injuries caused by ischemia and reperfusion in rat intestine. Transplant Proc 2013; 44:2304-8. [PMID: 23026580 DOI: 10.1016/j.transproceed.2012.07.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To study whether ischemic preconditioning (IPC) attenuated intestinal dysfunction caused by ischemia (I) and reperfusion (R), rats were underwent 60 minutes of I which was produced by occlusion of the superior mesenteric artery, and/or 120 minutes R. The IPC group had the I procedure previously stimulated for 5 minutes and the R for 10 minutes. IPC and sham groups were injected with saline solution (SS) via the femoral vein 5 minutes before the I and R, and for R. After I or I/R, 2-cm jejunal segments were mounted in an organ bath to study neurogenic contractions stimulated by electrical pulses or KCl using a digital recording system. Thin jejunal slices were stained with hematoxylin and eosin for optical microscopy. Compared with the sham group, jejunal contractions were similar in the IPC + I and the IPC + I/R groups, but reduced in the I + SS and the I/R + SS groups. The jejunal enteric nerves were damaged in the I + SS and the I/R + SS groups, but not in the IPC groups. These results suggested that ischemic preconditioning attenuated intestinal dysfunction caused by I and I/R.
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Affiliation(s)
- M O Taha
- Department of Pharmacology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
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Michaluart P, Abdallah KA, Lima FD, Smith R, Moysés RA, Coelho V, Victora GD, Socorro-Silva A, Volsi EC, Zárate-Bladés CR, Ferraz AR, Barreto AK, Chammas MC, Gomes R, Gebrim E, Arakawa-Sugueno L, Fernandes KP, Lotufo PA, Cardoso MR, Kalil J, Silva CL. Phase I trial of DNA-hsp65 immunotherapy for advanced squamous cell carcinoma of the head and neck. Cancer Gene Ther 2008; 15:676-84. [PMID: 18535616 DOI: 10.1038/cgt.2008.35] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Considering that mycobacterial heat-shock protein 65 (hsp65) gene transfer can elicit a profound antitumoral effect, this study aimed to establish the safety, maximum-tolerated dose (MTD) and preliminary efficacy of DNA-hsp65 immunotherapy in patients with advanced head and neck squamous cell carcinoma (HNSCC). For this purpose, 21 patients with unresectable and recurrent HNSCC were studied. Each patient received three ultrasound-guided injections at 21-day intervals of: 150, 600 or 400 microg of DNA-hsp65. Toxicity was graded according to CTCAE directions. Tumor volume was measured before and after treatment using computed tomography scan. The evaluation included tumor mass variation, delayed-type hypersensitivity response and spontaneous peripheral blood mononuclear cell proliferation before and after treatment. The MTD was 400 microg per dose. DNA-hsp65 immunotherapy was well tolerated with moderate pain, edema and infections as the most frequent adverse effects. None of the patients showed clinical or laboratory alterations compatible with autoimmune reactions. Partial response was observed in 4 out of 14 patients who completed treatment, 2 of which are still alive more than 3 years after the completion of the trial. Therefore, DNA-hsp65 immunotherapy is a feasible and safe approach at the dose of 400 microg per injection in patients with HNSCC refractory to standard treatment. Further studies in a larger number of patients are needed to confirm the efficacy of this novel strategy.
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Affiliation(s)
- P Michaluart
- HSP65 Clinical Trial Group, University of São Paulo, São Paulo, Brazil
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Benicio MH, Cardoso MR, Gouveia NC, Monteiro CA. [Secular trends in respiratory diseases of childhood in the city of São Paulo, Brazil (1984-1996)]. Rev Saude Publica 2000; 34:91-101. [PMID: 11434324] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE Data from two consecutive household surveys undertaken in mid-80s and mid-90s allow to characterize and analyse secular trends in infant and child respiratory diseases in the city of S. Paulo, Brazil. METHODS The two surveys included random population samples aged from zero to 59 months (1,016 in the period of 1984-85 and 1,280 in 1995-96). In both surveys the instant prevalence of high respiratory diseases (above the epiglottis) and low respiratory diseases with or without wheezing were calculated. All sampled children were examined in their household at a random day by trained pediatricians using standardized procedures. The examinations included medical history, past respiratory diseases and a complete physical examination. In both surveys the examinations were distributed throughout a period of almost 12 months to assure a uniform coverage of the various areas of the city along the four seasons of the year. For each survey, the study of the social distribution of the diseases took into account tertiles of the per capita family income. For the study of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS In the time span from the first to the second survey, there was a substantial increase in the prevalence of both low (from 22.2% to 38.8%) and high respiratory diseases (from 6.0% to 10.0% and from 0.8% to 2.8%, without and with wheezing, respectively). In the case of high respiratory disease and low respiratory disease without wheezing, an increase in prevalence was observed among all social strata, which did not interfere with the slightly less favourable situation of the lower income groups. In the case of low respiratory disease with wheezing, the increase was only observed among middle and low-income groups, being particularly high among the lower income group, yielding a significant inverse gradient between income and respiratory disease. Positive changes in distal (family income and maternal schooling) and in intermediate determinants related to housing characteristics would have resulted in a decline, not an increase, in the prevalence of respiratory diseases in the city. The duplication in the attendance rate to day care nurseries seen in the period could have counterbalanced the positive effect due to socioeconomic and housing variables but would not be enough to explain an increase in the disease.
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Affiliation(s)
- M H Benicio
- Departamento de Nutrição da Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil.
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9
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Cardoso MR, Cousens SN, Alves FM, Ribeiro MM, Abreu Neto BP. Diagnosis and prognosis of wheezing disorders in young children in the city of São Paulo, Southeast Brazil. Acta Paediatr 2000; 89:1484-9. [PMID: 11195241 DOI: 10.1080/080352500456697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED Three-hundred-and-ninety-seven children aged 2-59 mo presenting to the paediatric emergency departments of five public hospitals in São Paulo, Brazil, with an acute episode of lower respiratory disease were examined. The children were classified into the following diagnostic categories: acute bronchitis, acute bronchiolitis, pneumonia, asthma, post-bronchiolitis wheezing and wheezing of uncertain aetiology. Three years after the initial study, the homes of the children diagnosed as asthmatic or as having wheezing of uncertain aetiology were visited to collect information on subsequent episodes of lower respiratory disease. This paper reports the proportional incidence of different categories of lower respiratory disease and the results of an analysis to investigate clinical features that might distinguish wheezing children between those with asthma and those with an infectious disease. The predictions made for children with wheezing of uncertain aetiology were then compared with the follow-up data. Recurrent wheezing disorders (asthma, post-bronchiolitis wheezing) were common in the study sample (47% of children). Thirty-six percent of children with an initial diagnosis of wheezing of uncertain aetiology were diagnosed as asthmatic by another doctor over the next 3 y. We were unable to identify any clinical features that were useful in identifying those children likely to be diagnosed subsequently as asthmatic. CONCLUSIONS The use of a diagnostic category similar to that which we have called "wheezing of uncertain aetiology" might help to alert physicians early to the possibility of asthma without interfering in the management of the illness. Such a classification might also be useful in epidemiological investigations of the aetiology of lower respiratory diseases.
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Affiliation(s)
- M R Cardoso
- Faculdade de Saúde Pública, Departamento de Epidemiologia, Universidade de São Paulo, Brazil.
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10
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Cesar CL, Figueiredo GM, Westphal MF, Cardoso MR, Costa MZ, Gattás VL. [Referred morbidity and the utilization of health services in Brazilian urban areas: methodology]. Rev Saude Publica 1996; 30:153-60. [PMID: 9077014 DOI: 10.1590/s0034-89101996000200007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The reorganization of the Brazilian health system in the last few years has been based on the decentralization of the services and the integration of preventive and curative medicine, then creating new needs in term of the health information needed for health planning. The planning and administration of a regionalized and integrated health system calls for information about the population's morbidity profile, and the description of the pattern of the utilization of the health services, which can be obtained by means of household health surveys. The methodology utilized in a household health survey carried out in the Metropolitan Area of S. Paulo, Brazil, from July 1989 to June 1990, is described. This survey has some distinct methodological characteristics, such as the sampling process that defined the domains by age and sex, allowing an analysis of populational groups less well represented in the general population, as that of less than one year of age and that of aged people, as well as the use of the results of the latest Brazilian Census in 1991 for adjusting the sample.
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Affiliation(s)
- C L Cesar
- Departamento de Epidemiologia da Faculdadae de Saúde Pública da Universidadae São Paulo, Brasil
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De Azevedo Neto RS, Silveira AS, Nokes DJ, Yang HM, Passos SD, Cardoso MR, Massad E. Rubella seroepidemiology in a non-immunized population of São Paulo State, Brazil. Epidemiol Infect 1994; 113:161-73. [PMID: 8062873 PMCID: PMC2271213 DOI: 10.1017/s095026880005158x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A rubella serological survey of 476 individuals selected by cluster sampling technique from Caieiras, a small town located in the outskirts of São Paulo city, southeastern Brazil, was carried out over the period November 1990-January 1991. The aim of the study was to characterize rubella epidemiology in a representative non-immunized community in south east Brazil. The survey comprised a seroprevalence study, stratified by age (0-40 years) and a seroconversion study of rubella vaccine in non-infected children below 2 years of age. Mathematical techniques were applied to resultant data sets to determine the age dependent rates of decay in the proportion of individuals with maternally derived antibodies, vaccine seroconversion, and infection of susceptibles, termed the force of infection, and to estimate the average age at first infection.
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