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Wunderlich W, Sidebottom AC, Schulte AK, Taghon J, Dollard S, Hernandez-Alvarado N. The Use of Saliva Samples to Test for Congenital Cytomegalovirus Infection in Newborns: Examination of False-Positive Samples Associated with Donor Milk Use. Int J Neonatal Screen 2023; 9:46. [PMID: 37606483 PMCID: PMC10443263 DOI: 10.3390/ijns9030046] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
A universal screening research study was conducted in six hospitals to identify the clinical sensitivity of polymerase chain reaction (PCR) testing on newborn dried blood spots (DBSs) versus saliva specimens for the diagnosis of congenital cytomegalovirus (cCMV). CMV DNA positive results from DBSs or saliva were confirmed with urine testing. Findings of several false-positive (FP) saliva PCR results prompted an examination of a possible association with donor milk. Documentation of the frequency of positive saliva results, including both true-positive (TP) and FP status from clinical confirmation, occurred. The frequency of donor milk use was compared for TP and FP cases. Of 22,079 participants tested between 2016 and 2022, 96 had positive saliva results, 15 were determined to be FP, 79 TP, and 2 were excluded for incomplete clinical evaluation. Newborn donor milk use was identified for 18 (19.14%) of all the positive saliva screens. Among the 15 FPs, 11 (73.33%) consumed donor milk compared to 7 of the 79 TPs (8.8%) (OR 28.29, 95% CI 7.10-112.73, p < 0.001). While milk bank Holder pasteurization inactivates CMV infectivity, CMV DNA may still be detectable. Due to this possible association, screening programs that undertake testing saliva for CMV DNA may benefit from documenting donor milk use as a potential increased risk for FP results.
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Affiliation(s)
- Whitney Wunderlich
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Abbey C. Sidebottom
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Anna K. Schulte
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Jessica Taghon
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA;
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Dollard S, Chen MH, Lindstrom S, Marin M, Rota PA. Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem. J Infect Dis 2022; 226:S450-S455. [PMID: 36265850 DOI: 10.1093/infdis/jiac363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The clinical presentation of varicella in unvaccinated persons, with skin vesicles and scabs, has facilitated the use of rapid diagnostic methods for confirming disease. Polymerase chain reaction (PCR) assays are the diagnostic method of choice. The sharp decline in unmodified cases of varicella due to the US varicella vaccination program has led to fewer healthcare providers being familiar with varicella presentation and an increased reliance on laboratory diagnosis to confirm suspected cases. The mild, atypical presentation of the disease in vaccinated persons (fewer skin lesions, mostly maculopapular) has made it more challenging for providers to recognize and also to collect samples to detect the virus. Nonetheless, PCR is highly sensitive and specific in confirming modified disease if adequate samples are provided. While a positive PCR result is confirmatory, interpreting a negative result can prove to be more challenging in determining whether suspected varicella is falsely negative or attributable to other causes. Enhanced education of healthcare providers is critical for adequate specimen collection from modified varicella cases. In addition, more sensitive commercial serologic assays are needed in the United States for varicella immunity testing in the vaccine era.
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Affiliation(s)
- Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-Hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Yassine BB, Hulkower R, Dollard S, Cahill E, Lanzieri T. A Legal Mapping Assessment of Cytomegalovirus-Related Laws in the United States. J Public Health Manag Pract 2022; 28:E624-E629. [PMID: 34225306 DOI: 10.1097/phh.0000000000001401] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Congenital cytomegalovirus (CMV) infection is the leading infectious cause of birth defects in the United States, affecting approximately 1 out of 200 newborns. Increasing awareness of congenital CMV infection among policy makers and the public is critical for advancing the evidence base for prevention and intervention strategies, including behavioral interventions for pregnant women, newborn screening to enable timely interventions, and garnering support for vaccine development. OBJECTIVE To understand the current landscape of CMV-related statutes and regulations, we conducted a 50-state legal epidemiology study of laws expressly referencing "cytomegalovirus." EVIDENCE REVIEW Our search yielded 101 statutes and regulations from 35 jurisdictions (34 states and District of Columbia). We systematically reviewed and coded the texts for themes. FINDINGS Laws addressed 3 main themes: (1) CMV awareness and education; (2) testing and reporting; and (3) the provision of services. CONCLUSIONS AND RELEVANCE State-level CMV laws have been enacted to increase CMV awareness and to implement CMV testing for infants at a higher risk for infection, such as those who do not pass newborn hearing screening. This study provides a complete legal assessment of existing ways law is used to address CMV infection in the United States.
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Affiliation(s)
- Brianne B Yassine
- Center for State, Tribal, Local, and Territorial Support (Drs Yassine and Hulkower), Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (Drs Dollard and Lanzieri), and Division of Human Development and Disability, National Center for Birth Defects and Developmental Disabilities (Mr Cahill), Centers for Disease Control and Prevention, Atlanta, Georgia
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Wang C, Liu X, Wang S, Zhang W, Wang H, Ma W, Meng X, Xu X, Li Z, Pan QS, Wang P, Lin Q, Wang X, Amin M, Dollard S, Xu A, Chung W. Late-onset Hearing Loss From Congenital Cytomegalovirus Infection After Newborn Period in a Highly Immune Population in China. Pediatr Infect Dis J 2021; 40:70-73. [PMID: 33284252 PMCID: PMC8383185 DOI: 10.1097/inf.0000000000002922] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
After following 141 children with likely asymptomatic congenital cytomegalovirus infection in a highly immune population in China, four children (2.8%) were found to have late-onset hearing loss. No maternal or childhood factors, except higher saliva cytomegalovirus viral load at birth (P = 0.03), were associated with increased risk of developing a hearing loss.
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Affiliation(s)
- Chengbin Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaolin Liu
- Academy of Preventive Medicine, Shandong University
- Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong
| | - Shiwen Wang
- Chinese Center for Disease Control and Prevention, Beijing
| | - Wenqiang Zhang
- Academy of Preventive Medicine, Shandong University
- Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong
| | - Haiyan Wang
- Academy of Preventive Medicine, Shandong University
- Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong
| | - Wei Ma
- School of Public Health, Shandong University, Jinan
| | - Xiangxin Meng
- Pingyin County Center for Disease Control and Prevention, Pingyin
| | - Xingqu Xu
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zhan Li
- Academy of Preventive Medicine, Shandong University
| | - Qiang Shuxia Pan
- Linyi Municipal Center for Disease Control and Prevention, Linyi
- Pingyin County Maternal and Children Healthcare and Family Planning Service Center, Pingyin
| | - Ping Wang
- Yinan County Maternal and Children Healthcare Center, Yinan
| | - Qian Lin
- Jinan Municipal Maternal and Children Healthcare Center, Jinan, Shandong, China
| | - Xiaofang Wang
- Chinese Center for Disease Control and Prevention, Beijing
| | - Minal Amin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sheila Dollard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aiqiang Xu
- Academy of Preventive Medicine, Shandong University
- Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong
| | - Winnie Chung
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Tong V, Corchuelo S, Cates J, Laiton-Donato K, Dollard S, Rico A, Lanzieri T, Acosta J, Ailes E, Rodríguez H, Ricaldi J, González M, Pelaez D, Valencia D, Mercado M, Honein M, Ospina M. Prevalence of congenital CMV infection in Colombia. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Koontz D, Dollard S, Cordovado S. Evaluation of rapid and sensitive DNA extraction methods for detection of cytomegalovirus in dried blood spots. J Virol Methods 2019; 265:117-120. [PMID: 30639422 DOI: 10.1016/j.jviromet.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dried blood spots (DBS), collected universally from newborns in the U.S., could be used as a matrix for the detection of cytomegalovirus (CMV) infection in infants. However, sensitivity to detect CMV in DBS as compared to saliva and urine is variable across studies largely due to the DNA extraction method. Thermal shock, a widely used DNA extraction method, is highly sensitive for the detection of CMV in DBS, however, the processing time required is not practical for high-throughput testing. OBJECTIVE To determine if rapid and cost-effective DNA extraction methods amenable to newborn screening (NBS) could achieve the same sensitivity as the thermal shock method. STUDY DESIGN DBS were prepared from CMV positive blood samples from 20 organ transplant recipients. Three DNA extraction methods were compared for relative yield and sensitivity of detection of CMV DNA: thermal shock, KOH Tris buffer, and DNA Extract All. CMV DNA was detected by real-time quantitative polymerase chain reaction (qPCR). RESULTS The KOH Tris and DNA Extract All methods gave higher yields and sensitivity of CMV detection in DBS than thermal shock, which were significantly greater when viral loads were ≤ 10,000 copies/ml blood. Both methods gave faster turnaround times than thermal shock and would be better suited for NBS. CONCLUSIONS The choice of DNA extraction method greatly influences the ability to detect low levels of CMV DNA in DBS. Moreover, development of highly sensitive yet rapid methods for CMV detection could help facilitate future newborn screening of CMV in DBS.
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Affiliation(s)
- D Koontz
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA.
| | - S Dollard
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - S Cordovado
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
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Xu A, Wang S, Zhang W, Wang X, Wang T, Liu X, Wang H, Ma W, Amin M, Dollard S, Wang C. Viral Loads in Congenital Cytomegalovirus Infection From a Highly Immune Population. J Pediatric Infect Dis Soc 2018; 7:e160-e162. [PMID: 29860410 PMCID: PMC6107419 DOI: 10.1093/jpids/piy048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/02/2018] [Indexed: 11/12/2022]
Abstract
Among newborns with congenital cytomegalovirus (CMV) infection from China, there was no difference in CMV viral load in saliva specimens dried and stored at room temperature compared with those kept wet and stored cold, even after longer storage time for the former than the later (74 vs 58 days, P = .02).
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Affiliation(s)
- Aiqiang Xu
- Shandong Provincial Key Laboratory for Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, China,Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Shiwen Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenqiang Zhang
- Shandong Provincial Key Laboratory for Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, China,Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaofang Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tongzhan Wang
- Shandong Provincial Key Laboratory for Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, China,Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Xialin Liu
- Shandong Provincial Key Laboratory for Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, China,Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Haiyan Wang
- Shandong Provincial Key Laboratory for Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, China,Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, Shandong, China
| | - Minal Amin
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sheila Dollard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chengbin Wang
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Koontz D, Baecher K, Amin M, Nikolova S, Gallagher M, Dollard S. Evaluation of DNA extraction methods for the detection of Cytomegalovirus in dried blood spots. J Clin Virol 2015; 66:95-9. [PMID: 25866346 DOI: 10.1016/j.jcv.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/24/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dried blood spots (DBS) are collected universally from newborns and may be valuable for the diagnosis of congenital Cytomegalovirus (CMV) infection. The reported analytical sensitivity for DBS testing compared to urine or saliva varies greatly across CMV studies. The purpose of this study was to directly compare the performance of various DNA extraction methods for identification of CMV in DBS including those used most often in CMV studies. STUDY DESIGN Whatman(®) Grade 903 filter paper cards were spotted with blood samples from 25 organ transplant recipients who had confirmed CMV viremia. Six DNA extraction methods were compared for relative yield of viral and cellular DNA: 2 manual solution-based methods (Gentra Puregene, thermal shock), 2 manual silica column-based methods (QIAamp DNA Mini, QIAamp DNA Investigator), and 2 automated methods (M48 MagAttract Mini, QIAcube Investigator). DBS extractions were performed in triplicate followed by real-time quantitative PCR (qPCR). RESULTS For extraction of both viral and cellular DNA, two methods (QIAamp DNA Investigator and thermal shock) consistently gave the highest yields, and two methods (M48 MagAttract Mini and QIAamp DNA Mini) consistently gave the lowest yields. There was an average 3-fold difference in DNA yield between the highest and lowest yield methods. CONCLUSION The choice of DNA extraction method is a major factor in the ability to detect low levels of CMV in DBS and can largely account for the wide range of DBS sensitivities reported in studies to date.
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Affiliation(s)
- D Koontz
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA.
| | - K Baecher
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - M Amin
- Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - S Nikolova
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - M Gallagher
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - S Dollard
- Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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Chang T, Wiener J, Dollard S, Amin M, Ellington S, Kayira D, Tegha G, Jamieson D, Horst CVD, Kourtis A. 1000Effect of Cytomegalovirus Infection on Breastfeeding Transmission of HIV and on the Health of Infants Born to HIV-infected Mothers. Open Forum Infect Dis 2014. [PMCID: PMC5781518 DOI: 10.1093/ofid/ofu052.708] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Minal Amin
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Dumbani Kayira
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Gerald Tegha
- University of North Carolina Project, Lilongwe, Malawi
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Butler LM, Were WA, Balinandi S, Downing R, Dollard S, Neilands TB, Gupta S, Rutherford GW, Mermin J. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. J Infect Dis 2011; 203:625-34. [PMID: 21273188 DOI: 10.1093/infdis/jiq092] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human herpesvirus 8 (HHV-8) infection is endemic in sub-Saharan Africa. We examined sociodemographic, behavioral, and biological factors associated with HHV-8 infection in children and adults to determine HHV-8 seroprevalence and potential routes of transmission. METHODS Participants were 1383 children and 1477 adults from a population-based sample in a rural community in Uganda. Serum samples were tested for HHV-8 antibodies with use of an enzyme immunoassay against K8.1. RESULTS HHV-8 seroprevalence increased from 16% among children aged 1.5-2 years to 32% among children aged 10-13 years (P <.001) and from 37% among participants aged 14-19 years to 49% among adults aged ≥ 50 years (P <.05). HHV-8 seropositivity in children was independently associated with residing with a seropositive parent (P < .001) and residing with ≥ 1 other seropositive child aged <14 years (P < .001). History of sharing food and/or sauce plates was marginally associated with HHV-8 infection in children (P = .05). Among 1404 participants aged ≥ 15 years , there was no association between correlates of sexual behavior (eg, number of lifetime sex partners and HIV infection) and HHV-8 seropositivity (P > .10). CONCLUSIONS Our data suggest that HHV-8 is acquired primarily through horizontal transmission in childhood from intrafamilial contacts and that transmission continues into adulthood potentially through nonsexual routes.
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Affiliation(s)
- Lisa M Butler
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, CA 94105, USA.
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Butler L, Dollard S, Amin M, Mosam A, Martin J. Relationship between salivary shedding and seropositivity for Kaposi’s sarcoma-associated herpesvirus (KSHV) and Epstein-Barr virus (EBV) among South African children and adults: insights on why EBV infection is ubiquitous and KSHV is not. Infect Agent Cancer 2010. [PMCID: PMC3002731 DOI: 10.1186/1750-9378-5-s1-a69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pozharskaya V, Torres-González E, Rojas M, Gal A, Amin M, Dollard S, Roman J, Stecenko AA, Mora AL. Twist: a regulator of epithelial-mesenchymal transition in lung fibrosis. PLoS One 2009; 4:e7559. [PMID: 19851501 PMCID: PMC2761603 DOI: 10.1371/journal.pone.0007559] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [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: 03/03/2009] [Accepted: 10/05/2009] [Indexed: 02/06/2023] Open
Abstract
Background Several studies have implicated viral infection as an important factor in the pathogenesis of IPF and related fibrotic lung disorders. Viruses are thought to cause epithelial cell injury and promote epithelial-mesenchymal transition (EMT), a process whereby differentiated epithelial cells undergo transition to a mesenchymal phenotype, and considered a source of fibroblasts in the setting of lung injury. We have demonstrated an association between the epithelial injury caused by chronic herpes virus infection with the murine γ-herpes virus, MHV68, and lung fibrosis. We hypothesize that EMT in this model of virus-induced pulmonary fibrosis is driven by the expression of the transcription factor Twist. Methods/Findings In vitro MHV68 infection of murine lung epithelial cells induced expression of Twist, and mesenchymal markers. Stable overexpression of Twist promoted EMT in MLE15 lung epithelial cells. Transient knockdown expression of Twist resulted in preservation of epithelial phenotype after in vitro MHV68 infection. In concordance, high expression of Twist was found in lung epithelial cells of MHV68 infected mice, but not in mock infected mice. Alveolar epithelial cells from lung tissue of idiopathic pulmonary fibrosis (IPF) patients were strongly positive for Twist. These cells demonstrated features of EMT with low expression of E-cadherin and upregulation of the mesenchymal marker N-cadherin. Finally, IPF tissue with high Twist protein levels was also positive for the herpesvirus, EBV. Conclusions/Significance We conclude that Twist contributes to EMT in the model of virus-induced pulmonary fibrosis. We speculate that in some IPF cases, γ-herpes virus infection with EBV might be a source of injury precipitating EMT through the expression of Twist.
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Affiliation(s)
- Veronika Pozharskaya
- Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
| | - Edilson Torres-González
- CTRL, Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Mauricio Rojas
- CTRL, Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- McKelvey Lung Transplantation Center, Emory University, Atlanta, Georgia, United States of America
| | - Anthony Gal
- Department of Pathology, Emory University, Atlanta, Georgia, United States of America
| | - Minal Amin
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Sheila Dollard
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Jesse Roman
- Department of Medicine, University of Louisville School of Medicine and Louisville VA Medical Center, Louisville, Kentucky, United States of America
| | - Arlene A. Stecenko
- Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
- McKelvey Lung Transplantation Center, Emory University, Atlanta, Georgia, United States of America
| | - Ana L. Mora
- CTRL, Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- McKelvey Lung Transplantation Center, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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13
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Grosse SD, Dollard S, Ross DS, Cannon M. Newborn screening for congenital cytomegalovirus: Options for hospital-based and public health programs. J Clin Virol 2009; 46 Suppl 4:S32-6. [PMID: 19783205 DOI: 10.1016/j.jcv.2009.08.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/18/2009] [Accepted: 08/22/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss (SNHL) and developmental disability in children. Early identification of infected children through screening could allow for early intervention and improvement in functional outcomes among the subset who develop sequelae. OBJECTIVES To outline potential options and strategies for screening newborns for congenital CMV infection and to discuss barriers to screening and data needs to inform future policy decisions. STUDY DESIGN Commentary based on the literature and expert opinion on newborn dried blood spot screening, newborn hearing screening/Early Hearing Detection and Intervention (EHDI) programs, and congenital CMV. RESULTS Although no population-based screening for congenital CMV is underway, pilot newborn screening studies using a variety of assays with urine or dried blood spot specimens are underway. Challenges to screening are both practical-uncertain sensitivity of blood spot assays suitable for large-scale screening and lack of infrastructure for collection of urine specimens; and evidentiary-the need to demonstrate improved outcomes and value of screening to offset the expense and potential adverse psychosocial consequences for children and families whose children require periodic monitoring but never develop sequelae. CONCLUSIONS Screening for congenital CMV infection is a potentially important intervention that merits additional research, including the logistical feasibility of different screening options and psychosocial consequences for families.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, USA.
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Bihl F, Mosam A, Henry LN, Chisholm JV, Dollard S, Gumbi P, Cassol E, Page T, Mueller N, Kiepiela P, Martin JN, Coovadia HM, Scadden DT, Brander C. Kaposi's sarcoma-associated herpesvirus-specific immune reconstitution and antiviral effect of combined HAART/chemotherapy in HIV clade C-infected individuals with Kaposi's sarcoma. AIDS 2007; 21:1245-52. [PMID: 17545700 DOI: 10.1097/qad.0b013e328182df03] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kaposi's sarcoma-associated herpesvirus (KSHV) is endemic in South Africa and the clinical manifestation of AIDS-associated Kaposi's sarcoma (KS) represents a significant clinical problem. Whereas the positive effects of HAART on the regression of KS have been well established, less is known about the role of herpesvirus-specific cellular immunity in disease improvement. DESIGN Thirty-three treatment-naive HIV clade C-infected individuals with KS were randomly assigned into two treatment arms (HAART plus systemic chemotherapy versus HAART alone). KSHV-specific cellular immune responses, viral loads and clinical outcome were evaluated. METHODS KSHV, Epstein-Barr virus and HIV-specific cellular immunity was measured using an IFN-gamma enzyme-linked immunospot assay in samples obtained at baseline and up to 11 months after treatment initiation. Cell-associated KSHV viremia was determined by real-time polymerase chain reaction. RESULTS Robust increases in CD4 cell counts and suppressed HIV viral loads were seen in parallel with significant increases in the KSHV-specific cellular immune responses over time. Although slowly increasing after 5 months, KSHV-specific T-cell responses were significantly elevated only after 11 months, with both lytic and latent antigens being more frequently targeted. A trend towards better clinical outcome with HAART plus chemotherapy treatment was observed compared with HAART alone, and was accompanied by a significant reduction in cellular KSHV viral load in the HAART plus chemotherapy-treated subjects but not those treated with HAART alone after 11 months of treatment. CONCLUSION The data show a temporal association between the clinical improvement of KS and the re-appearance of KSHV-specific cellular immunity, and demonstrate an effective suppression of KSHV viral replication using combination therapy.
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Affiliation(s)
- Florian Bihl
- Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, 13th Street, Charlestown, MA 02129, USA
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Bihl F, Narayan M, Chisholm JV, Henry LM, Suscovich TJ, Brown EE, Welzel TM, Kaufmann DE, Zaman TM, Dollard S, Martin JN, Wang F, Scadden DT, Kaye KM, Brander C. Lytic and latent antigens of the human gammaherpesviruses Kaposi's sarcoma-associated herpesvirus and Epstein-Barr virus induce T-cell responses with similar functional properties and memory phenotypes. J Virol 2007; 81:4904-8. [PMID: 17329344 PMCID: PMC1900166 DOI: 10.1128/jvi.02509-06] [Citation(s) in RCA: 29] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The cellular immunity against Kaposi's sarcoma-associated herpesvirus (KSHV) is poorly characterized and has not been compared to T-cell responses against other human herpesviruses. Here, novel and dominant targets of KSHV-specific cellular immunity are identified and compared to T cells specific for lytic and latent antigens in a second human gammaherpesvirus, Epstein-Barr virus. The data identify a novel HLA-B57- and HLA-B58-restricted epitope in the Orf57 protein and show consistently close parallels in immune phenotypes and functional response patterns between cells targeting lytic or latent KSHV- and EBV-encoded antigens, suggesting common mechanisms in the induction of these responses.
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Affiliation(s)
- Florian Bihl
- Partners AIDS Research Center, Massachusetts General Hospital East, 149 13th Street, Charlestown, MA 02129-2000, USA
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Schoenfisch A, Dollard S, Gardner L, Klein R, Mayer K, Rompalo A, Sobel J, Cannon M. Determinants of Cytomegalovirus (Cmv) Dna Presence and the Host Immune Response. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s197-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Woodberry T, Suscovich TJ, Henry LM, Martin JN, Dollard S, O'Connor PG, Davis JK, Osmond D, Lee TH, Kedes DH, Khatri A, Lee J, Walker BD, Scadden DT, Brander C. Impact of Kaposi Sarcoma–Associated Herpesvirus (KSHV) Burden and HIV Coinfection on the Detection of T Cell Responses to KSHV ORF73 and ORF65 Proteins. J Infect Dis 2005; 192:622-9. [PMID: 16028131 DOI: 10.1086/432103] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 03/24/2005] [Indexed: 11/03/2022] Open
Abstract
Cellular immune responses to Kaposi sarcoma-associated herpesvirus (KSHV), the etiological agent of KS and several other malignancies, are incompletely characterized. We assessed KSHV-specific interferon- gamma enzyme-linked immunospot responses in a cohort of 154 individuals, using overlapping peptide sets spanning the KSHV-encoded latency-associated nuclear antigen (ORF73) and the minor capsid glycoprotein (ORF65). Among KSHV-seropositive subjects, ORF73-specific responses dominated over responses to ORF65 and were preferentially detected in human immunodeficiency virus-coinfected individuals who had elevated levels of cell-associated KSHV DNA, indicating that the viral antigen burden may have been driving these responses. Responses to both ORF73 and ORF65 were also detected in several KSHV-seronegative subjects who were at increased risk for KSHV infection, which demonstrates that cellular immunity can be found in the absence of detectable humoral responses. These data have implications for the reliable identification of KSHV infection and may help guide the design of immune-based therapeutic and prophylactic interventions.
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Affiliation(s)
- Tonia Woodberry
- Partners AIDS Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA
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