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Zhang S, Jiang J, Wang R, Zhang Y, Sun J, Hong W, Qi L, Zang J, Liu Z, Xia Y, Yang H, Chen L. Immune Response and Serum Biomarker Screening in Pregnant Women with Influenza A Virus Infection: Insight into Susceptibility and Disease Severity. Diseases 2025; 13:182. [PMID: 40558593 PMCID: PMC12192047 DOI: 10.3390/diseases13060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2025] [Revised: 06/01/2025] [Accepted: 06/06/2025] [Indexed: 06/29/2025] Open
Abstract
BACKGROUND Seasonal influenza infection poses substantial risks to pregnant women, yet the immunological mechanisms underlying their heightened disease susceptibility remain incompletely characterized. METHODS This study employed multiparametric immunophenotyping and metabolic profiling to investigate cellular immunity, cytokine dynamics, and serum biomarkers in pregnant women infected with H3N2 across gestational stages. Through integrated flow cytometric analysis of peripheral blood mononuclear cells (PBMCs), multiple cytokine quantification, and LC-MS-based serum metabolomics, we compared immunological parameters, serum cytokines, and metabolites across trimesters in pregnant women infected and not infected with H3N2. RESULTS The results revealed reduced CD4+/CD8+ T cell ratios, a diminished CD27+ memory B cell population in pregnant women infected with H3N2, and elevated NK cells and Th2-skewed cytokines (IL-4, IL-6, IL-10) in severe influenza cases. Metabolomic profiling identified the dysregulation of the tryptophan-kynurenine (Trp-Kyn) pathway, with a 15-fold increase in the Kyn/Trp ratio in severe influenza compared to a normal pregnancy as a potential biomarker. CONCLUSIONS These results elucidate synergistic pathophysiological axes-immune dysregulation and tryptophan metabolism alteration that potentially drive adverse outcomes. The identified biomarker panel (CD4/CD8 ratio, IL-6, Kyn/Trp ratio) shows potential clinical promise for early risk stratification in high-risk pregnancies with influenza infection.
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Affiliation(s)
- Suping Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, China;
| | - Jiarun Jiang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, China;
| | - Rui Wang
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, China;
| | - Yuanyuan Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
| | - Jinghui Sun
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Wanting Hong
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Likai Qi
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
| | - Jia Zang
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
| | - Zeyi Liu
- Institue of Respiratory Diseases, Soochow University, Suzhou 215006, China;
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yu Xia
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
| | - Haibing Yang
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
| | - Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou 215131, China; (S.Z.); (R.W.); (Y.Z.); (J.S.); (W.H.); (L.Q.); (J.Z.); (Y.X.); (H.Y.)
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, China;
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Mei C, Cai X, Li P, Chen J, Lu W, Pi P, Shi J, Li W, Cai X. Preparation and comprehensive preclinical study of Peramivir inhalation solution: Achieving accurate drug delivery. Biomed Pharmacother 2025; 186:118029. [PMID: 40174540 DOI: 10.1016/j.biopha.2025.118029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/21/2025] [Accepted: 03/28/2025] [Indexed: 04/04/2025] Open
Abstract
Peramivir, a Neuraminidase inhibitor used for influenza A or B treatment, is currently marketed in the form of injections globally. However, Peramivir injections result in widespread systemic distribution, with only 3-9 % of the drug reaching the nasal cavity and pharyngeal mucus (key sites of action). In contrast, inhaled formulations can directly reach the site of absorption or action, leading to rapid onset of effect. This approach circumvents the first-pass hepatic metabolism, reduces the dosage required, minimizes systemic exposure, and may mitigate or avoid certain adverse drug reactions. It is noteworthy that no Peramivir inhalation solution (PIS) products are currently available globally. In this study, we focused on the reformulation of Peramivir from intravenous to inhalation administration, conducting comprehensive research on its toxicity, tissue distribution, pharmacokinetics, and pharmacodynamics. We demonstrated that PIS, compared to intravenous administration, exhibited heightened local drug exposure in lung tissues, longer exposure duration, slower elimination, and exhibited good tolerability without specific safety concerns.
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Affiliation(s)
- Chao Mei
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Xinyi Cai
- Shenzhen Maternity & Child healthcare hospital, Shenzhen 518000, China
| | - Pian Li
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Jingli Chen
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Wenting Lu
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Peipei Pi
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Jianfang Shi
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Wenlong Li
- Tianjin University of Traditional Chinese Medicine, Tianjin 300000, China
| | - Xiang Cai
- Langtian Pharmaceutical (Hubei) Co.,Ltd., Huangshi 435000, China; Department of Pharmacy, Hubei University of Science and Technology, Xianning 437100, China.
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Zhao M, Zhang B, Yan M, Zhao Z. Development and validation of a nomogram to predict severe influenza. Immun Inflamm Dis 2024; 12:e70026. [PMID: 39340342 PMCID: PMC11437489 DOI: 10.1002/iid3.70026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 09/09/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Influenza is an acute respiratory disease posing significant harm to human health. Early prediction and intervention in patients at risk of developing severe influenza can significantly decrease mortality. METHOD A comprehensive analysis of 146 patients with influenza was conducted using the Gene Expression Omnibus (GEO) database. We assessed the relationship between severe influenza and patients' clinical information and molecular characteristics. First, the variables of differentially expressed genes were selected using R software. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were performed to investigate the association between clinical information and molecular characteristics and severe influenza. A nomogram was developed to predict the presence of severe influenza. At the same time, the concordance index (C-index) is adopted area under the receiver operating characteristic (ROC), area under the curve (AUC), decision curve analysis (DCA), and calibration curve to evaluate the predictive ability of the model and its clinical application. RESULTS Severe influenza was identified in 47 of 146 patients (32.20%) and was significantly related to age and duration of illness. Multivariate logistic regression demonstrated significant correlations between severe influenza and myloperoxidase (MPO) level, haptoglobin (HP) level, and duration of illness. A nomogram was formulated based on MPO level, HP level, and duration of illness. This model produced a C-index of 0.904 and AUC of 0.904. CONCLUSIONS A nomogram based on the expression levels of MPO, HP, and duration of illness is an efficient model for the early identification of patients with severe influenza. These results will be useful in guiding prevention and treatment for severe influenza disease.
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Affiliation(s)
- Mingzhen Zhao
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Bo Zhang
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Mingjun Yan
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Zhiwei Zhao
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
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Wang Y, Liu Y, Liu G, Sun X, Zhang Z, Shen J. Analysis of data from two influenza surveillance hospitals in Zhejiang province, China, for the period 2018-2022. PLoS One 2024; 19:e0299488. [PMID: 38416761 PMCID: PMC10901301 DOI: 10.1371/journal.pone.0299488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE To assess the epidemiology of seasonal influenza in Huzhou City, Zhejiang Province, China, during 2018-2022 and provide insights for influenza prevention. METHODS Following the National Influenza Surveillance Program, we conducted pathogen surveillance by randomly sampling throat swabs from cases with influenza-like illness (ILI) at two sentinel hospitals. RESULTS From 2018 to 2022, a total of 3,813,471 cases were treated at two hospitals in Huzhou, China. Among them, there were 112,385 cases of Influenza-Like Illness (ILI), accounting for 2.95% of the total number of cases. A total of 11,686 ILI throat swab samples were tested for influenza viruses, with 1,602 cases testing positive for influenza virus nucleic acid, resulting in a positivity rate of 13.71%. Among the positive strains, there were 677 strains of A(H3N2) virus, 301 strains of A(H1N1) virus, 570 strains of B/Victoria virus, and 54 strains of B/Yamagata virus. The ILI percentage (ILI%) and influenza nucleic acid positivity rate showed winter-spring peaks in the years 2018, 2019, 2021, and 2022, with the peaks concentrated in January and February. Additionally, a small peak was observed in August 2022 during the summer season. No peak was observed during the winter-spring season of 2020. The highest proportion of ILI cases was observed in children aged 0-4 years, followed by school-age children aged 5-14 years. There was a positive correlation between ILI% and influenza virus nucleic acid positivity rate (r = 0.60, p < 0.05). CONCLUSIONS The influenza outbreak in Huzhou from 2020 to 2022 was to some extent influenced by the COVID-19 pandemic and public health measures. After the conclusion of the COVID-19 pandemic, the influenza outbreak in Huzhou may become more severe. Therefore, it is crucial to promptly assess the influenza outbreak trends based on the ILI% and the positivity rate of influenza virus nucleic acid tests.
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Affiliation(s)
- Yuda Wang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Yan Liu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Guangtao Liu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Xiuxiu Sun
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Zizhe Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
| | - Jianyong Shen
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang, China
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Yuan C, Guan Y. Efficacy and safety of Lianhua Qingwen as an adjuvant treatment for influenza in Chinese patients: A meta-analysis. Medicine (Baltimore) 2024; 103:e36986. [PMID: 38241551 PMCID: PMC10798757 DOI: 10.1097/md.0000000000036986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Lianhua Qingwen (LHQW) is a proprietary traditional Chinese medicine for the treatment of influenza (FLu). It is composed of 2 prescriptions, Maxing Shigan and Yinqiao, which has antiviral, antibacterial, and immunomodulatory effects. However its clinical suitability has not yet been investigated. OBJECTIVE This study aimed to evaluate the efficacy and safety of LHQW in the treatment of FLu. METHODS We searched several databases, including PubMed and China Biomedical Database for literature research, from inception to July 1, 2023. This meta-analysis included RCTs that compared the safety and efficacy of the combination of LHQW and conventional drugs (CD) with CD alone for IFU. The extracted data were analyzed using Revman5.4 software with risk ratio (RR), 95% confidence intervals (CI), and standardized mean difference. RESULTS Our meta-analysis included 32 articles with 3592 patients. The results showed that the effects of LHQW adjuvant therapy were superior to those of CD (clinical effective rate: RR = 1.22, 95% CI: 1.18-1.26, P < .00001; cure rate: RR = 1.54, 95% CI: 1.35-1.75, P < .00001), and adverse reactions after treatment were significantly lower than those before treatment (RR = 0.70, 95% CI: 0.50-0.98, P = .04). CONCLUSION This meta-analysis indicates that LHQW combined with CD may be more effective than CD alone for the treatment of FLu.
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Affiliation(s)
- Chao Yuan
- Department of Pharmacy, Weifang People’s Hospital, Weifang, China
| | - Ying Guan
- Department of Medical Insurance Office, Weifang People’s Hospital, Weifang, China
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