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Martin DR, Mutombwera AT, Madiehe AM, Onani MO, Meyer M, Cloete R. Molecular modeling and simulation studies of SELEX-derived high-affinity DNA aptamers to the Ebola virus nucleoprotein. J Biomol Struct Dyn 2024:1-18. [PMID: 38217874 DOI: 10.1080/07391102.2024.2302922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
Ebola viral disease (EVD) is a highly infectious and potentially fatal illness with a case fatality rate ranging from 25% to 90%. To effectively control its spread, there is a need for rapid, reliable and lowcost point-of-care (P OC) diagnostic tests. While various EVD diagnostic tests exist, few are P OC tests, and many are not cost-effective. The use of antibodies in these tests has limitations, prompting the exploration of aptamers as potential alternatives. Various proteins from the Ebola virus (EBOV) proteome, including EBOV nucleoprotein (NP), are considered viable targets for diagnostic assays. A previous study identified three aptamers (Apt1. Apt2 and Apt3) with high affinity for EBOV NP using systemic evolution of ligands by exponential enrichment (SELEX). This study aimed to employ in silico methods, such as Phyre2, RNAfold, RNAComposer, HADDOCK and GROMACS, to model the structures of EBOV NP and the aptamers, and to investigate their binding. The in silico analysis revealed successful binding of all the three aptamers to EBOV NP, with a suggested ranking of Apt1 > Apt2 > Apt3 based on binding affinity. Microscale thermophoresis (MST) analysis confirmed the binding, providing dissociation constants of 25 ± 2.84, 56 ± 2.76 and 140 ±3.69 nM for Apt1, Apt2 and Apt3, respectively. The study shows that the findings of the in silico analysis was in agreement with the MST analysis. Inclusion of these in silico approaches in diagnostic assay development can expedite the selection of candidate aptamers, potentially overcoming challenges associated with aptamer application in diagnostics.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- D R Martin
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute (SANBI), University of the Western Cape, Bellville, South Africa Cape Town, South Africa
| | - A T Mutombwera
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - A M Madiehe
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
- Nanobiotechnology Research Group, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - M O Onani
- Department of Chemistry, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - M Meyer
- Department of Science and Innovation/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Bellville, South Africa
| | - R Cloete
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute (SANBI), University of the Western Cape, Bellville, South Africa Cape Town, South Africa
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Changula K, Kajihara M, Muramatsu S, Hiraoka K, Yamaguchi T, Yago Y, Kato D, Miyamoto H, Mori-Kajihara A, Shigeno A, Yoshida R, Henderson CW, Marzi A, Takada A. Development of an Immunochromatography Assay to Detect Marburg Virus and Ravn Virus. Viruses 2023; 15:2349. [PMID: 38140590 PMCID: PMC10747695 DOI: 10.3390/v15122349] [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: 10/12/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
The recent outbreaks of Marburg virus disease (MVD) in Guinea, Ghana, Equatorial Guinea, and Tanzania, none of which had reported previous outbreaks, imply increasing risks of spillover of the causative viruses, Marburg virus (MARV) and Ravn virus (RAVV), from their natural host animals. These outbreaks have emphasized the need for the development of rapid diagnostic tests for this disease. Using monoclonal antibodies specific to the viral nucleoprotein, we developed an immunochromatography (IC) assay for the rapid diagnosis of MVD. The IC assay was found to be capable of detecting approximately 102-4 50% tissue culture infectious dose (TCID50)/test of MARV and RAVV in the infected culture supernatants. We further confirmed that the IC assay could detect the MARV and RAVV antigens in the serum samples from experimentally infected nonhuman primates. These results indicate that the IC assay to detect MARV can be a useful tool for the rapid point-of-care diagnosis of MVD.
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Affiliation(s)
- Katendi Changula
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia;
| | - Masahiro Kajihara
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
| | - Shino Muramatsu
- DENKA Co., Ltd., Tokyo 103-8338, Japan; (S.M.); (K.H.); (T.Y.); (Y.Y.); (D.K.)
| | - Koji Hiraoka
- DENKA Co., Ltd., Tokyo 103-8338, Japan; (S.M.); (K.H.); (T.Y.); (Y.Y.); (D.K.)
| | - Toru Yamaguchi
- DENKA Co., Ltd., Tokyo 103-8338, Japan; (S.M.); (K.H.); (T.Y.); (Y.Y.); (D.K.)
| | - Yoko Yago
- DENKA Co., Ltd., Tokyo 103-8338, Japan; (S.M.); (K.H.); (T.Y.); (Y.Y.); (D.K.)
| | - Daisuke Kato
- DENKA Co., Ltd., Tokyo 103-8338, Japan; (S.M.); (K.H.); (T.Y.); (Y.Y.); (D.K.)
| | - Hiroko Miyamoto
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
| | - Akina Mori-Kajihara
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
| | - Asako Shigeno
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
| | - Reiko Yoshida
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
| | - Corey W. Henderson
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA
| | - Andrea Marzi
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA
| | - Ayato Takada
- Division of Global Epidemiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.K.); (H.M.); (A.M.-K.); (A.S.); (R.Y.)
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan
- One Health Research Center, Hokkaido University, Sapporo 001-0020, Japan
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia
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Tshomba AO, Mukadi-Bamuleka D, De Weggheleire A, Tshiani OM, Kayembe CT, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Chenge FM, Jacobs BKM, Mumba DN, Tshala-Katumbay DD, Mulangu S. Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model. PLoS One 2023; 18:e0293077. [PMID: 37847703 PMCID: PMC10581462 DOI: 10.1371/journal.pone.0293077] [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: 04/26/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists. OBJECTIVE To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak. METHODS We collected data on rapid diagnostic tests (RDTs) and prediction scores' accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi™-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi™-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi™-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi™-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings. RESULTS Our analysis found dual ECPS as a conditional test with the QuickNavi™-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi™-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi™-Ebola RDT. CONCLUSIONS Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi™-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.
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Affiliation(s)
- Antoine Oloma Tshomba
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- National Institute for Biomedical Research, Kinshasa, DRC
| | - Daniel Mukadi-Bamuleka
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | | | - Olivier M. Tshiani
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Charles T. Kayembe
- Department of Internal Medicine, University of Kisangani, Kisangani, DRC
| | - Placide Mbala-Kingebeni
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Faustin M. Chenge
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- School of Public Health, University of Lubumbashi, Lubumbashi, RDC
| | - Bart Karl M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dieudonné N. Mumba
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, DRC
| | - Désiré D. Tshala-Katumbay
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Neurology, University of Kinshasa, Kinshasa, DRC
| | - Sabue Mulangu
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
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Mukadi-Bamuleka D, Bulabula-Penge J, Jacobs BKM, De Weggheleire A, Edidi-Atani F, Mambu-Mbika F, Legand A, Klena JD, Fonjungo PN, Mbala-Kingebeni P, Makiala-Mandanda S, Kajihara M, Takada A, Montgomery JM, Formenty P, Muyembe-Tamfum JJ, Ariën KK, van Griensven J, Ahuka-Mundeke S. Head-to-head comparison of diagnostic accuracy of four Ebola virus disease rapid diagnostic tests versus GeneXpert® in eastern Democratic Republic of the Congo outbreaks: a prospective observational study. EBioMedicine 2023; 91:104568. [PMID: 37084479 PMCID: PMC10148093 DOI: 10.1016/j.ebiom.2023.104568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Ebola virus disease (EVD) outbreaks have emerged in Central and West Africa. EVD diagnosis relies principally on RT-PCR testing with GeneXpert®, which has logistical and cost restrictions at the peripheral level of the health system. Rapid diagnostic tests (RDTs) would offer a valuable alternative at the point-of-care to reduce the turn-around time, if they show good performance characteristics. We evaluated the performance of four EVD RDTs against the reference standard GeneXpert® on stored EVD positive and negative blood samples collected between 2018 and 2021 from outbreaks in eastern Democratic Republic of the Congo (DRC). METHODS We conducted a prospective and observational study in the laboratory on QuickNavi-Ebola™, OraQuick® Ebola Rapid Antigen, Coris® EBOLA Ag K-SeT, and Standard® Q Ebola Zaïre Ag RDTs using left-over archived frozen EDTA whole blood samples. We randomly selected 450 positive and 450 negative samples from the EVD biorepositories in DRC, across a range of GeneXpert® cycle threshold values (Ct-values). RDT results were read by three persons and we considered an RDT result as "positive", when it was flagged as positive by at least two out of the three readers. We estimated the sensitivity and specificity through two independent generalized (logistic) linear mixed models (GLMM). FINDINGS 476 (53%) of 900 samples had a positive GeneXpert Ebola result when retested. The QuickNavi-Ebola™ showed a sensitivity of 56.8% (95% CI 53.6-60.0) and a specificity of 97.5% (95% CI 96.2-98.4), the OraQuick® Ebola Rapid Antigen test displayed 61.6% (95% CI 57.0-65.9) sensitivity and 98.1% (95% CI 96.2-99.1) specificity, the Coris® EBOLA Ag K-SeT showed 25.0% (95% CI 22.3-27.9) sensitivity and 95.9% (95% CI 94.2-97.1) specificity, and the Standard® Q Ebola Zaïre Ag displayed 21.6% (95% CI 18.1-25.7) sensitivity and 99.1% (95% CI 97.4-99.7) specificity. INTERPRETATION None of the RDTs evaluated approached the "desired or acceptable levels" for sensitivity set out in the WHO target product profile, while all of the tests met the "desired level" for specificity. Nevertheless, the QuickNavi-Ebola™ and OraQuick® Ebola Rapid Antigen Test demonstrated the most favorable profiles, and may be used as frontline tests for triage of suspected-cases while waiting for RT-qPCR confirmatory testing. FUNDING Institute of Tropical Medicine Antwerp/EDCTP PEAU-EBOV-RDC project.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | | | | | - François Edidi-Atani
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Rodolphe Mérieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Anaïs Legand
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - John D Klena
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Pierre Formenty
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
| | - Kevin K Ariën
- Institute of Tropical Medicine, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Departement de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Democratic Republic of the Congo
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Bettini A, Lapa D, Garbuglia AR. Diagnostics of Ebola virus. Front Public Health 2023; 11:1123024. [PMID: 36908455 PMCID: PMC9995846 DOI: 10.3389/fpubh.2023.1123024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Ebola is a highly pathogenic virus, which in humans reaches a mortality rate above 50%. Due to a lack of laboratories in territories where Ebola viruses are endemic and the limited number of surveillance programmes, tests for the confirmation of suspected cases of Ebola are often performed in Reference Laboratories. While this provides guarantees regarding the accuracy of results, the shipment of samples to a centralized facility where the diagnostic test can be performed and the time required to achieve the results takes several days, which increases costs and entails delays in the isolation of positive subjects and therapeutic intervention with negative consequences both for patients and the community. Molecular tests have been the most frequently used tool in Ebola diagnosis in recent outbreaks. One of the most commonly used molecular tests is the Real-Star Altona, which targets a conserved area of the L gene. This assay showed different sensitivities depending on the Ebola virus: 471 copies/mL (EBOV) and 2871 copies/ml (SUDAN virus). The Cepheid system also showed good sensitivity (232 copies/mL). The LAMP platform is very promising because, being an isothermal reaction, it does not require high-precision instrumentation and can be considered a Point of Care (PoC) tool. Its analytical sensitivity is 1 copy/reaction. However, since data from real life studies are not yet available, it is premature to give any indications on its feasibility. Moreover, in November 2014, the WHO recommended the development of rapid diagnostic tests (RDT) according to ASSURED criteria. Several RDT assays have since been produced, most of which are rapid tests based on the search for antibody anti-Ebola viral proteins with immunochromatographic methods. Several viral antigens are used for this purpose: VP40, NP and GP. These assays show different sensitivities according to the protein used: VP40 57.4-93.1%, GP 53-88.9% and 85% for NP compared to reference molecular assays. From these results, it can be deduced that no RDT reaches the 99% sensitivity recommended by the WHO and therefore any RDT negative results in suspected cases should be confirmed with a molecular test.
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Affiliation(s)
- Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani (IRCCS), Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani (IRCCS), Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani (IRCCS), Rome, Italy
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Muzembo BA, Kitahara K, Ohno A, Ntontolo NP, Ngatu NR, Okamoto K, Miyoshi SI. Rapid diagnostic tests versus RT-PCR for Ebola virus infections: a systematic review and meta-analysis. Bull World Health Organ 2022; 100:447-458. [PMID: 35813519 PMCID: PMC9243686 DOI: 10.2471/blt.21.287496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the clinical accuracy of rapid diagnostic tests for the detection of Ebola virus. Methods We searched MEDLINE®, Embase® and Web of Science for articles published between 1976 and October 2021 reporting on clinical studies assessing the performance of Ebola virus rapid diagnostic tests compared with reverse transcription polymerase chain reaction (RT-PCR). We assessed study quality using the QUADAS-2 criteria. To estimate the pooled sensitivity and specificity of these rapid diagnostic tests, we used a bivariate random-effects meta-analysis. Findings Our search identified 113 unique studies, of which nine met the inclusion criteria. The studies were conducted in the Democratic Republic of the Congo, Guinea, Liberia and Sierra Leone and they evaluated 12 rapid diagnostic tests. We included eight studies in the meta-analysis. The pooled sensitivity and specificity of the rapid tests were 86% (95% confidence interval, CI: 80-91) and 95% (95% CI: 91-97), respectively. However, pooled sensitivity decreased to 83% (95% CI: 77-88) after removing outliers. Pooled sensitivity increased to 90% (95% CI: 82-94) when analysis was restricted to studies using the RT-PCR from altona Diagnostics as gold standard. Pooled sensitivity increased to 99% (95% CI: 67-100) when the analysis was restricted to studies using whole or capillary blood specimens. Conclusion The included rapid diagnostic tests did not detect all the Ebola virus disease cases. While the sensitivity and specificity of these tests are moderate, they are still valuable tools, especially useful for triage and detecting Ebola virus in remote areas.
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Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530, Japan
| | - Kei Kitahara
- Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata, India
| | - Ayumu Ohno
- Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata, India
| | | | - Nlandu Roger Ngatu
- Department of Public Health, Kagawa University Faculty of Medicine, Miki, Japan
| | - Keinosuke Okamoto
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530, Japan
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530, Japan
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7
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Mukadi-Bamuleka D, Bulabula-Penge J, De Weggheleire A, Jacobs BKM, Edidi-Atani F, Mambu-Mbika F, Mbala-Kingebeni P, Makiala-Mandanda S, Faye M, Diagne CT, Diagne MM, Faye O, Kajihara M, Faye O, Takada A, Sall AA, Muyembe-Tamfum JJ, van Griensven J, Ariën KK, Ahuka-Mundeke S. Field performance of three Ebola rapid diagnostic tests used during the 2018-20 outbreak in the eastern Democratic Republic of the Congo: a retrospective, multicentre observational study. THE LANCET. INFECTIOUS DISEASES 2022; 22:891-900. [PMID: 35298901 DOI: 10.1016/s1473-3099(21)00675-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Democratic Republic of the Congo has confronted 13 outbreaks of Ebola virus disease since 1976. Rapid diagnostic tests (RDTs) detecting viral antigens have been developed to circumvent difficulties encountered with RT-PCR for diagnosis in remote low-resource settings, but there is still uncertainty about their performance characteristics and usability during outbreaks. We aimed to assess the field performance of three antigen detection RDTs compared with the gold-standard Cepheid GeneXpert Ebola assay results. METHODS We conducted a retrospective, multicentre observational study using complete and de-identified databases of five mobile laboratories (managed by the Institut National de Recherche Biomédicale) to assess the performance of three Ebola virus disease RDTs (QuickNavi-Ebola, OraQuick Ebola Rapid Antigen Test, and Coris EBOLA Ag K-SeT rapid test) run on blood samples of patients with suspected Ebola virus disease in direct comparison with the Cepheid GeneXpert Ebola assay reference test during the 2018-20 outbreak in the eastern Democratic Republic of the Congo. We estimated the sensitivity and specificity of each test through generalised linear mixed models against the GeneXpert Ebola assay reference test and corrected for cycle threshold value and random site effects. FINDINGS 719 (7·9%) of 9157 samples had a positive GeneXpert Ebola assay result. The QuickNavi-Ebola RDT had a sensitivity of 87·4% (95% CI 63·6-96·8) around the mean cycle threshold value and a specificity of 99·6% (99·3-99·8). The OraQuick Ebola Rapid Antigen Test had a sensitivity of 57·4% (95% CI 38·8-75·8) and specificity of 98·3% (97·5-99·0), and the Coris EBOLA Ag K-SeT rapid test had a sensitivity of 38·9% (23·0-63·6) against the GeneXpert Ebola assay reference and specificity of 97·4% (85·3-99·6). The QuickNavi-Ebola RDT showed a robust performance with good sensitivity, particularly with increasing viral loads (ie, low cycle threshold values), and specificity. INTERPRETATION The three RDTs evaluated did not achieve the desired sensitivity and specificity of the WHO target product profile. Although the RDTs cannot triage and rule out Ebola virus infection among clinical suspects, they can still help to sort people with suspected Ebola virus disease into high-risk and low-risk groups while waiting for GeneXpert Ebola assay reference testing. FUNDING None. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel Mukadi-Bamuleka
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Junior Bulabula-Penge
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anja De Weggheleire
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Edidi-Atani
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fabrice Mambu-Mbika
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sheila Makiala-Mandanda
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Oumar Faye
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Masahiro Kajihara
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Ayato Takada
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | | | - Jean-Jacques Muyembe-Tamfum
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Steve Ahuka-Mundeke
- Department of Virology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
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8
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Fontes CM, Lipes BD, Liu J, Agans KN, Yan A, Shi P, Cruz DF, Kelly G, Luginbuhl KM, Joh DY, Foster SL, Heggestad J, Hucknall A, Mikkelsen MH, Pieper CF, Horstmeyer RW, Geisbert TW, Gunn MD, Chilkoti A. Ultrasensitive point-of-care immunoassay for secreted glycoprotein detects Ebola infection earlier than PCR. Sci Transl Med 2021; 13:13/588/eabd9696. [PMID: 33827978 DOI: 10.1126/scitranslmed.abd9696] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/12/2021] [Indexed: 12/23/2022]
Abstract
Ebola virus (EBOV) hemorrhagic fever outbreaks have been challenging to deter due to the lack of health care infrastructure in disease-endemic countries and a corresponding inability to diagnose and contain the disease at an early stage. EBOV vaccines and therapies have improved disease outcomes, but the advent of an affordable, easily accessed, mass-produced rapid diagnostic test (RDT) that matches the performance of more resource-intensive polymerase chain reaction (PCR) assays would be invaluable in containing future outbreaks. Here, we developed and demonstrated the performance of a new ultrasensitive point-of-care immunoassay, the EBOV D4 assay, which targets the secreted glycoprotein of EBOV. The EBOV D4 assay is 1000-fold more sensitive than the U.S. Food and Drug Administration-approved RDTs and detected EBOV infection earlier than PCR in a standard nonhuman primate model. The EBOV D4 assay is suitable for low-resource settings and may facilitate earlier detection, containment, and treatment during outbreaks of the disease.
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Affiliation(s)
- Cassio M Fontes
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Barbara D Lipes
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Jason Liu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Krystle N Agans
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Aiwei Yan
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Patricia Shi
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Daniela F Cruz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Garrett Kelly
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Kelli M Luginbuhl
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Daniel Y Joh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Stephanie L Foster
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Jacob Heggestad
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Angus Hucknall
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Maiken H Mikkelsen
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
| | - Carl F Pieper
- Departments of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Roarke W Horstmeyer
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA.,Galveston National Laboratory, University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Michael D Gunn
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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9
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Noda H. Progress of public health policy regarding global infectious diseases over the past decade in Japan. J Infect Chemother 2021; 27:555-561. [PMID: 33472748 PMCID: PMC7833483 DOI: 10.1016/j.jiac.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
This article aims to examine progress of public health policy regarding global infectious diseases over the past decade in Japan. A narrative review was conducted, overviewing items of the Infectious Disease Committee and the Tuberculosis Committee of the Ministry of Health, Labour and Welfare between 2010 and 2019. The mean value of items discussed in each meeting were 9.7 items. Among these items, these committees have discussed about countermeasures in terms of reduced burden of indigenous infectious diseases such as measles, rubella and pertussis, and increased risk of imported infectious diseases such as Ebola virus disease, Middle East Respiratory Syndrome, plague, avian influenza, pandemic influenza and tuberculosis. These changes regarding infectious diseases lead to loss of target population, difficulty of early detection, and market failure in old and new antibiotics and others, which requires challenge to scattered at-risk targets, effort to training and awareness, and creation of novel public health policy for research and development as well as production and supply. Over the past decade, public health policy regarding global infectious diseases have been one of the key targets under the triangle of global infectious disease, and recent experience of Coronavirus disease 2019 will further prioritize it in Japan. However, the principles of public health policy are globally vulnerable in the Post-Corona era, which can lead to the collapse of democratic way. To combat global infectious diseases without going off the road, we need to learn about the past history of public health policy.
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Affiliation(s)
- Hiroyuki Noda
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan; Cabinet Secretariat, Tokyo, Japan.
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10
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Kumar S, Nehra M, Khurana S, Dilbaghi N, Kumar V, Kaushik A, Kim KH. Aspects of Point-of-Care Diagnostics for Personalized Health Wellness. Int J Nanomedicine 2021; 16:383-402. [PMID: 33488077 PMCID: PMC7814661 DOI: 10.2147/ijn.s267212] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Advancements in analytical diagnostic systems for point-of-care (POC) application have gained considerable attention because of their rapid operation at the site required to manage severe diseases, even in a personalized manner. The POC diagnostic devices offer easy operation, fast analytical outcome, and affordable cost, which promote their advanced research and versatile adoptability. Keeping advantages in view, considerable efforts are being made to design and develop smart sensing components such as miniaturized transduction, interdigitated electrodes-based sensing chips, selective detection at low level, portable packaging, and sustainable durability to promote POC diagnostics according to the needs of patient care. Such effective diagnostics systems are in demand, which creates the challenge to make them more efficient in every aspect to generate a desired bio-informatic needed for better health access and management. Keeping advantages and scope in view, this mini review focuses on practical scenarios associated with miniaturized analytical diagnostic devices at POC application for targeted disease diagnostics smartly and efficiently. Moreover, advancements in technologies, such as smartphone-based operation, paper-based sensing assays, and lab-on-a-chip (LOC) which made POC more sensitive, informative, and suitable for major infectious disease diagnosis, are the main focus here. Besides, POC diagnostics based on automated patient sample integration with a sensing platform is continuously improving therapeutics interventions against specific infectious disease. This review also discussed challenges associated with state-of-the-art technology along with future research opportunities to design and develop next generation POC diagnostic systems needed to manage infectious diseases in a personalized manner.
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Affiliation(s)
- Sandeep Kumar
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana 125001, India
| | - Monika Nehra
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana 125001, India
| | - Sakina Khurana
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana 125001, India
| | - Neeraj Dilbaghi
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, Haryana 125001, India
| | - Vanish Kumar
- National Agri-Food Biotechnology Institute (NABI), Mohali, Punjab, India
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Natural Sciences, Division of Sciences, Art, & Mathematics, Florida Polytechnic University, Lakeland, FL, 33805-8531, USA
| | - Ki-Hyun Kim
- Department of Civil & Environmental Engineering, Hanyang University, Seoul 04763, Republic of Korea
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11
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Kiiza P, Mullin S, Teo K, Adhikari NKJ, Fowler RA. Treatment of Ebola-related critical illness. Intensive Care Med 2020; 46:285-297. [PMID: 32055888 PMCID: PMC7223059 DOI: 10.1007/s00134-020-05949-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore contemporary clincial case management of patients with Ebola virus disease. METHODS A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - S Mullin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Lane, North York, ON, M3K 0A1, Canada
| | - N K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - R A Fowler
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
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12
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Affiliation(s)
- Myron M Levine
- From the University of Maryland School of Medicine, Baltimore
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