1
|
Palav HC, Bhonde G, Padwal V, Velhal S, Pereira J, Singh AK, Ghosh S, Karandikar K, Satoskar P, Bhor V, Patel V. Integrated immune monitoring of HCMV infection in pregnant women with complications and its association with adverse pregnancy outcomes. Microb Pathog 2023; 179:106109. [PMID: 37040845 PMCID: PMC7615074 DOI: 10.1016/j.micpath.2023.106109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
Human Cytomegalovirus (HCMV) infection is associated with bad obstetric history (BOH) and adverse pregnancy outcomes (APO). Here, we characterized antiviral humoral profiles, systemic and virus specific cellular immune responses concurrently in pregnant women (n = 67) with complications including BOH and associated these signatures with pregnancy outcomes. Infection status was determined using nested blood PCR, seropositivity and IgG avidity by ELISA. Systemic and HCMV specific (pp65) cellular immune responses were evaluated by flow cytometry. Seropositivity was determined for other TORCH pathogens (n = 33) on samples with recorded pregnancy outcomes. This approach was more sensitive in detecting HCMV infection. Blood PCR positive participants, irrespective of their IgG avidity status, had higher cytotoxic potential in circulating CD8+ T cells (p < 0.05) suggesting that infection associated cellular dysfunction was uncoupled with avidity maturation of antiviral humoral responses. Also, impaired anamnestic degranulation of HCMV-pp65-specific T cells compared to HCMV blood PCR negative participants (p < 0.05) was observed. APO correlated with HCMV blood PCR positivity but not serostatus (p = 0.0039). Most HCMV IgM positive participants (5/6) were HCMV blood PCR positive with APO. None were found to be IgM positive for other TORCH pathogens. Multiple TORCH seropositivity however was significantly enriched in the APO group (p = 0.024). Generation of HCMV specific high avidity IgG antibodies had no bearing on APO (p = 0.9999). Our study highlights the utility of an integrated screening approach for antenatal HCMV infection in the context of BOH, where infection is associated with systemic and virus specific cellular immune dysfunction as well as APO.
Collapse
Affiliation(s)
- Harsha Chandrashekhar Palav
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Gauri Bhonde
- Department of Molecular Immunology and Microbiology, ICMR- National Institute for Research in Reproductive and Child Health Mumbai, Maharashtra, India
| | - Varsha Padwal
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Shilpa Velhal
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Jacintha Pereira
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Amit Kumar Singh
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Sayantani Ghosh
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Kalyani Karandikar
- Department of Molecular Immunology and Microbiology, ICMR- National Institute for Research in Reproductive and Child Health Mumbai, Maharashtra, India
| | | | - Vikrant Bhor
- Department of Molecular Immunology and Microbiology, ICMR- National Institute for Research in Reproductive and Child Health Mumbai, Maharashtra, India.
| | - Vainav Patel
- Viral Immunopathogenesis Lab, ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India.
| |
Collapse
|
2
|
Kudryashova AM, Manuylov VA, Murzina AA, Kaira AN, Borisova OV. DYNAMICS IN MATURATION OF SARS-COV-2 RBD-SPECIFIC IGG ANTIBODY AVIDITY DEPENDING ON IMMUNIZATION TIMEFRAME AND TYPE. Russian Journal of Infection and Immunity 2023. [DOI: 10.15789/2220-7619-dim-2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The aim is to study the dynamics of avidity maturation of IgG antibodies to RBD SARS-CoV-2 depending on the type of immunization (vaccination or infection), as well as on the duration and frequency of immunization.
Materials and methods. The study was performed on two cohort collected at two time of the COVID-19 pandemic. We established a cohort of 87 convalescents from COVID-19 of the pandemic in spring- winter 2020. The second cohort collected in September 2021 from 204 individuals and are represented by two groups.
The first group (n=64) vaccinations with Gam-Covid-Vac and did not report a COVID-19 disease. Hybrid immunity (second group) was achieved after a SARS-CoV-2 breakthrough infection in naive individuals, who had received a two-dose COVID-19 vaccination Gam-Covid-Vac during the spring-summer of 2021.
Results and conclusions. This study allowed to determine the dynamics of avidity maturation IgG antibodies to RBD SARS-CoV-2 associated with the type and order of antigen exposure in the form of vaccination or infection.
In this article, we showed that the most effective immunity is formed in COVID-19 convalescents and then two steps vaccination Sputnik V.
Comparison of "hybrid" immunity individuals with vaccinated and COVID-19 convalescents was shown significantly higher (p0.001) and median level was 228 BAU/ml versus 75 or 119 BAU/ml, and higher level of avidity index (IA 90.5% vs. 54.5 and 76.6, respectively, p0.001).
Comparison immunization COVID-19 convalescents with vaccination a of two Sputnik V vaccination was shown that vaccination leads to higher IgG levels (median values in groups 119 and 75 BAU/ml, p0.001) and to a higher avidity index (76.6% vs. 54.5%).
It should be noted, in patients with "hybrid" immunity, the median level of avidity index was 25% versus 14.8% and 16% in COVID-19 convalescents and vaccinated (p0.001) and in 8 individuals it was higher than 50% in the test with 8M urea as a denaturing agent.
Thus, the more rapid induction of high-avidity antibodies was in vaccination individuals the early stages of immunization (up to 4 months), during the period when IgG maturation has not yet been completed.
Our results showed what during this period vaccination leads to the production of antibodies with avidity index a median level of 82% versus 36% in COVID-19 convalescents the same period.
Collapse
|
3
|
Cordray H, Liu-Lam O, Tey CS, Alfonso K. Congenital Cytomegalovirus Infection and Hearing Outcomes in Twins: A Systematic Review of Reported Cases. Otol Neurotol 2023; 44:e53-62. [PMID: 36538753 DOI: 10.1097/MAO.0000000000003776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus infection is the leading nonhereditary cause of pediatric sensorineural hearing loss. This systematic review evaluated infection concordance and comparative hearing abilities in twins/multiple births to model infection patterns. DATABASES REVIEWED PubMed, Embase, Web of Science, and Google Scholar. METHODS Studies that reported hearing outcomes of congenital cytomegalovirus infection in at least one multiple birth were eligible. Concordant infections (both twins) and discordant infections (single twin) were included. Multiple reviewers performed data extraction and quality assessment. Analyses involved relative risk of infection concordance by zygosity and chorionicity and odds of hearing loss by infection concordance. Hearing outcomes were compared between siblings. RESULTS Of 247 studies screened, 31 were included (74.2% high quality). The review captured 40 eligible multiple births. Among infected patients, 42.9% (95% confidence interval, 31.2-55.2%) demonstrated hearing loss. All uninfected twins had normal hearing. Most infections were concordant, and infected patients experienced 4.11 (1.18-14.36) times greater odds of hearing loss if their twin was also infected ( p = .02). Yet siblings' hearing outcomes diverged in over 40% of concordant cases. If either twin is infected, infection risk in the second twin is 3.25 (1.83-5.79) times greater in monozygotic than dizygotic twins and 2.50 (1.61-3.88) times greater in monochorionic than dichorionic twins (both p < .001). We describe a case from our practice. CONCLUSION Congenital cytomegalovirus infection patterns and hearing outcomes can vary widely even within a shared fetal and postnatal environment. Suspected infection in a twin indicates that both should receive testing and continued monitoring for late-onset sequelae.
Collapse
|
4
|
Kaneko M, Yang L, Tanabe A, Fujii Y, Nakao H, Minematsu T. Prevalence of congenital cytomegalovirus infection according to the type of maternal infection in Japan. J Infect Chemother 2023:S1341-321X(23)00032-6. [PMID: 36716861 DOI: 10.1016/j.jiac.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Variable rates of cytomegalovirus (CMV) seropositivity in mothers from different individual's background may translate to distinct epidemiological patterns of congenital CMV infection. METHODS The prospective cohort study was conducted in Japan to evaluate the prevalence of vertical transmission rate according to the type of maternal infection. Post hoc power as a follow-up analysis was evaluated to compare the statistical power with other studies from France, Finland and Brazil. One thousand one hundred sixty-three pregnant women were measured IgG, IgM and IgG avidity index. The urine samples of neonates of these women were evaluated using polymerase chain reaction to diagnose the vertical transmission. RESULTS The prevalence of congenital CMV infection in the study population was 0.4%. The proportions of patients with primary and nonprimary infections were 60% and 40%, respectively, with a maternal seroprevalence of 82.5%. The rate of vertical transmission among the seronegative pregnant women before pregnancy was statistically higher than that among the seropositive pregnant women before pregnancy (p < 0.05), with a study power of 52.7%. The same difference was observed in France and Finland for maternal seroprevalence of 61% and 72% and statistical power of 56.9% and 66.7%, respectively. CONCLUSION The maternal seroprevalence of the present study conducted in Japan was much higher than that of studies in France and Finland. Nevertheless, seronegative pregnant women had a higher risk of vertical transmission before pregnancy.
Collapse
|
5
|
Raynor EM, Martin HL, Poehlein E, Lee H, Lantos P. Impact of maternal cytomegalovirus seroconversion on newborn and childhood hearing loss triological thesis 2022–2023. Laryngoscope Investig Otolaryngol 2022; 7:1626-1633. [PMID: 36258861 PMCID: PMC9575047 DOI: 10.1002/lio2.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives/hypothesis The objective of this study is to describe long‐term hearing outcomes in infants born to mothers with a known cytomegalovirus (CMV) positivity who were not tested for congenital CMV. Study type Clinical research study. Design Retrospective cohort study. Methods Retrospective chart review was performed for mothers seropositive to CMV. Mother–infant dyads (130) were identified between January 1, 2013 and January 1, 2017. Outcomes data was collected through June 1, 2020. Demographics, risk factors for hearing loss, evidence of CMV infection, other causes of hearing loss, need for speech therapy services, and results of all hearing tests were collected. Results All 130 infants were asymptomatic and 5 were tested for congenital CMV. Five were negative for CMV and excluded from analyses. Of the remaining 125, only 1 had low‐viral avidity IgG antibodies. None had IgM antibodies. Four children (3.2%) had hearing loss at last audiogram and one child had delayed onset SNHL due to an enlarged vestibular aqueduct. Speech therapy for communication was required for 33 children (26.4%). Conclusions Knowledge of maternal perinatal CMV status can allow for education about possible sequelae of cCMV, as well as trigger an alert for testing babies born to mothers with low‐viral avidity IgG during the first trimester, when the risk of vertical transmission is highest. Also, babies born to CMV positive mothers may be more at risk for communication delays necessitating intervention. Studies focusing on the impact of maternal CMV related to childhood communication deficits could elucidate any direct relationships.
Collapse
Affiliation(s)
- Eileen M. Raynor
- Department of Head and Neck Surgery and Communication Sciences Duke University Durham North Carolina USA
| | - Hannah L. Martin
- Department of Head and Neck Surgery and Communication Sciences Duke University Durham North Carolina USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Hui‐Jie Lee
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Paul Lantos
- Department of Pediatric Infectious Disease Duke University Durham North Carolina USA
| |
Collapse
|
6
|
Iijima S. Pitfalls in the Serological Evaluation of Maternal Cytomegalovirus Infection as a Potential Cause of Fetal and Neonatal Involvements: A Narrative Literature Review. J Clin Med 2022; 11:jcm11175006. [PMID: 36078936 PMCID: PMC9457027 DOI: 10.3390/jcm11175006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of intrauterine infection and serological assays are the primary tools for assessing CMV infections during pregnancy. CMV-specific immunoglobulin M (IgM) antibodies have been used as a diagnostic marker for primary CMV infection in pregnant women, although CMV-IgM has been detected in non-primary CMV infections. IgG avidity testing may aid the distinguishing of primary from non-primary CMV infection; however, there is no standardized assay for detecting this difference. Moreover, when maternal serology shows positive CMV-IgG with negative CMV-IgM findings, vertical transmission probability following primary CMV infection is often excluded. However, symptomatic congenital CMV infections in the context of negative findings for maternal CMV-IgM have been reported recently. The absence of CMV-IgM is recognized in both primary and non-primary CMV infections. Furthermore, maternal non-primary CMV infections during pregnancy may yield a greater proportion of symptomatic congenital CMV infections than previously thought. If universal prenatal screening is performed, ultrasonography for abnormal fetal findings should be conducted regardless of CMV-IgM antibody status. If not universally screened, CMV antibody screening should be performed whenever routine fetal ultrasound reveals abnormal findings. For suspected fetal CMV infection, amniotic fluid or postnatal infant urine CMV-DNA testing is required.
Collapse
Affiliation(s)
- Shigeo Iijima
- Department of Regional Neonatal-Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan
| |
Collapse
|
7
|
Tanimura K, Uchida A, Imafuku H, Tairaku S, Fujioka K, Morioka I, Yamada H. The Current Challenges in Developing Biological and Clinical Predictors of Congenital Cytomegalovirus Infection. Int J Mol Sci 2021; 22:13487. [PMID: 34948284 DOI: 10.3390/ijms222413487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/15/2023] Open
Abstract
Congenital cytomegalovirus (CMV) infection may cause severe long-term sequelae. Recent studies have demonstrated that early antiviral therapy for infants with symptomatic congenital CMV (cCMV) infection may improve neurological outcomes; thus, accurate identification of newborns at high risk of cCMV infection may contribute to improved outcomes in affected children. However, maternal serological screening for cCMV infection by diagnosing primary infection during pregnancy, which is a popular screening strategy, is inefficient, because the number of cCMV infections with nonprimary causes, including reactivation of or reinfection with CMV, is larger than that of cCMV infections with primary causes. Low levels of neutralizing antibodies against pentameric complex and potent CMV-specific T cell-mediated immune responses are associated with an increased risk of cCMV infection. Conversely, our prospective cohort studies revealed that the presence of maternal fever/flu-like symptoms, threatened miscarriage/premature delivery, or actual premature delivery are risk factors for cCMV infection among both women with normal pregnancies and those with high-risk ones, regardless of whether the infection is primary or nonprimary. This review focused on host immune responses to human CMV and current knowledge of potential biological and clinical factors that are predictive of cCMV infection.
Collapse
|
8
|
Hassan SS, Lundstrom K, Barh D, Silva RJS, Andrade BS, Azevedo V, Choudhury PP, Palu G, Uhal BD, Kandimalla R, Seyran M, Lal A, Sherchan SP, Azad GK, Aljabali AAA, Brufsky AM, Serrano-Aroca Á, Adadi P, Abd El-Aziz TM, Redwan EM, Takayama K, Rezaei N, Tambuwala M, Uversky VN. Implications derived from S-protein variants of SARS-CoV-2 from six continents. Int J Biol Macromol 2021; 191:934-955. [PMID: 34571123 PMCID: PMC8462006 DOI: 10.1016/j.ijbiomac.2021.09.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023]
Abstract
The spike (S) protein is a critical determinant of the infectivity and antigenicity of SARS-CoV-2. Several mutations in the S protein of SARS-CoV-2 have already been detected, and their effect in immune system evasion and enhanced transmission as a cause of increased morbidity and mortality are being investigated. From pathogenic and epidemiological perspectives, S proteins are of prime interest to researchers. This study focused on the unique variants of S proteins from six continents: Asia, Africa, Europe, Oceania, South America, and North America. In comparison to the other five continents, Africa had the highest percentage of unique S proteins (29.1%). The phylogenetic relationship implies that unique S proteins from North America are significantly different from those of the other five continents. They are most likely to spread to the other geographic locations through international travel or naturally by emerging mutations. It is suggested that restriction of international travel should be considered, and massive vaccination as an utmost measure to combat the spread of the COVID-19 pandemic. It is also further suggested that the efficacy of existing vaccines and future vaccine development must be reviewed with careful scrutiny, and if needed, further re-engineered based on requirements dictated by new emerging S protein variants.
Collapse
Affiliation(s)
- Sk Sarif Hassan
- Department of Mathematics, Pingla Thana Mahavidyalaya, Maligram, Paschim Medinipur 721140, West Bengal, India.
| | | | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, WB, India; Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Raner Jośe Santana Silva
- Department of Biological Sciences (DCB), Graduate Program in Genetics and Molecular Biology (PPGGBM), State University of Santa Cruz (UESC), Rodovia Ilheus-Itabuna, km 16, 45662-900 Ilheus, BA, Brazil
| | - Bruno Silva Andrade
- Laboratory of Bioinformatics and Computational Chemistry, Department of Biological Sciences, State University of Southwest Bahia (UESB), Jequié 45206-190, Brazil.
| | - Vasco Azevedo
- Laborat'orio de Geńetica Celular e Molecular, Departamento de Genetica, Ecologia e Evolucao, Instituto de Ciˆencias Biol'ogicas, Universidade Federal de Minas Gerais, Belo Horizonte CEP 31270-901, Brazil.
| | - Pabitra Pal Choudhury
- Applied Statistics Unit, Indian Statistical Institute, 203 B T Road, Kolkata 700108, India
| | - Giorgio Palu
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35121 Padova, Italy.
| | - Bruce D Uhal
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad 500007, India; Department of Biochemistry, Kakatiya Medical College, Warangal, Telangana, India
| | - Murat Seyran
- Doctoral Studies in Natural and Technical Sciences (SPL 44), University of Vienna, W¨ahringer Straße, A-1090 Vienna, Austria
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samendra P Sherchan
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA 70112, USA.
| | | | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Faculty of Pharmacy, Irbid 566, Jordan.
| | - Adam M Brufsky
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigaci'on Traslacional San Alberto Magno, Universidad Cat́olica de Valencia San Vicente Ḿartir, c/Guillem de Castro, 94, 46001 Valencia, Spain.
| | - Parise Adadi
- Department of Food Science, University of Otago, Dunedin 9054, New Zealand
| | - Tarek Mohamed Abd El-Aziz
- Zoology Department, Faculty of Science, Minia University, El-Minia 61519, Egypt; Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
| | - Elrashdy M Redwan
- Faculty of Science, Department of Biological Science, King Abdulazizi University, Jeddah 21589, Saudi Arabia; Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg El-Arab, Alexandria 21934, Egypt.
| | - Kazuo Takayama
- Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto 606-8507, Japan.
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden.
| | - Murtaza Tambuwala
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK.
| | - Vladimir N Uversky
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology, Institutskiy pereulok, 9, Dolgoprudny, 141700, Russia.
| |
Collapse
|
9
|
Moura AD, da Costa HHM, Correa VA, de S Lima AK, Lindoso JAL, De Gaspari E, Hong MA, Cunha-Junior JP, Prudencio CR. Assessment of avidity related to IgG subclasses in SARS-CoV-2 Brazilian infected patients. Sci Rep 2021; 11:17642. [PMID: 34480056 PMCID: PMC8417219 DOI: 10.1038/s41598-021-95045-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/05/2021] [Indexed: 01/07/2023] Open
Abstract
SARS-CoV-2 is considered a global emergency, resulting in an exacerbated crisis in the health public in the world. Although there are advances in vaccine development, it is still limited for many countries. On the other hand, an immunological response that mediates protective immunity or indicates that predict disease outcome in SARS-CoV-2 infection remains undefined. This work aimed to assess the antibody levels, avidity, and subclasses of IgG to RBD protein, in symptomatic patients with severe and mild forms of COVID-19 in Brazil using an adapted in-house RBD-IgG ELISA. The RBD IgG-ELISA showed 100% of specificity and 94.3% of sensibility on detecting antibodies in the sera of hospitalized patients. Patients who presented severe COVID-19 had higher anti-RBD IgG levels compared to patients with mild disease. Additionally, most patients analyzed displayed low antibody avidity, with 64.4% of the samples of patients who recovered from the disease and 84.6% of those who died in this avidity range. Our data also reveals an increase of IgG1 and IgG3 levels since the 8th day after symptoms onset, while IgG4 levels maintained less detectable during the study period. Surprisingly, patients who died during 8–14 and 15–21 days also showed higher anti-RBD IgG4 levels in comparison with the recovered (P < 0.05), suggesting that some life-threatening patients can elicit IgG4 to RBD antibody response in the first weeks of symptoms onset. Our findings constitute the effort to clarify IgG antibodies' kinetics, avidity, and subclasses against SARS-CoV-2 RBD in symptomatic patients with COVID-19 in Brazil, highlighting the importance of IgG antibody avidity in association with IgG4 detection as tool laboratory in the follow-up of hospitalized patients with more significant potential for life-threatening.
Collapse
Affiliation(s)
- Andrew D Moura
- Center of Immunology, Institute Adolfo Lutz, São Paulo, Brazil
| | | | - Victor A Correa
- Center of Immunology, Institute Adolfo Lutz, São Paulo, Brazil
| | | | - José A L Lindoso
- Institute of Infectology Emilio Ribas, São Paulo, Brazil.,Department of Infectious Disease, School of Medicine, São Paulo University, São Paulo, Brazil.,Laboratory of Protozoology, Institute of Tropical Medicine, São Paulo, Brazil
| | | | - Marisa A Hong
- Center of Immunology, Institute Adolfo Lutz, São Paulo, Brazil
| | - Jair P Cunha-Junior
- Laboratory of Immunochemistry and Immunotechnology, Department of Immunology, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | | |
Collapse
|
10
|
Kaneko M, Muraoka J, Kusumoto K, Minematsu T. Low Maternal Immunoglobulin G Avidity and Single Parity as Adverse Implications of Human Cytomegalovirus Vertical Transmission in Pregnant Women with Immunoglobulin M Positivity. Viruses 2021; 13:v13050866. [PMID: 34065047 PMCID: PMC8151860 DOI: 10.3390/v13050866] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/31/2022] Open
Abstract
Human cytomegalovirus (CMV) is the leading cause of neurological sequelae in infants. Understanding the risk factors of primary CMV infection is crucial in establishing preventive strategies. Thus, we conducted a retrospective cohort study to identify risk factors of vertical transmission among pregnant women with immunoglobulin (Ig) M positivity. The study included 456 pregnant women with IgM positivity. Information on age, parity, occupation, clinical signs, IgM levels, and IgG avidity index (AI) was collected. The women were divided into infected and non-infected groups. The two groups showed significant differences in IgM level, IgG AI, number of women with low IgG AI, clinical signs, and number of pregnant women with single parity. In the multiple logistic regression analysis, pregnant women with single parity and low IgG AI were independent predictors. Among 40 women who tested negative for IgG antibody in their previous pregnancy, 20 showed low IgG AI in their current pregnancy. Among the 20 women, 4 had vertical transmission. These results provide better understanding of the risk factors of vertical transmission in pregnant women with IgM positivity.
Collapse
Affiliation(s)
- Masatoki Kaneko
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; (J.M.); (K.K.)
- Graduate School of Nursing Science, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
- Correspondence: ; Tel.: +81-985-85-0988, Fax.: +81-985-85-6149
| | - Junsuke Muraoka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; (J.M.); (K.K.)
| | - Kazumi Kusumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; (J.M.); (K.K.)
| | - Toshio Minematsu
- Research Institute for Disease Control, Aisenkai Nichinan Hospital, 3649-2 Kazeda, Nichinan, Miyazaki 887-0034, Japan;
| |
Collapse
|
11
|
Bauer G. The potential significance of high avidity immunoglobulin G (IgG) for protective immunity towards SARS-CoV-2. Int J Infect Dis 2021; 106:61-64. [PMID: 33713819 PMCID: PMC7944804 DOI: 10.1016/j.ijid.2021.01.061] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background Avidity is defined as the strength of binding between immunoglobulin G (IgG) and its specific target epitope. IgG of high avidity is established during affinity maturation. Failure to achieve high avidity IgG may result in a lack of protective immunity towards infection and disease. It is known that the interaction between SARS-CoV-2 spike protein and its cellular receptor is driven by high affinity. Therefore, it is predictable that protective antibodies towards SARS-CoV-2 should show high affinity/avidity. Avidity after SARS-CoV-2 infection Recent findings by several groups demonstrate that the serological response towards infection with SARS-CoV-2 and seasonal coronaviruses is characterized by incomplete avidity maturation, followed by a decline of the serological response. This response might facilitate reinfection, prevent herd immunity and potentially allow repeated cycles of infection. Consequences for vaccination towards SARS-CoV-2 Therefore, the sole focus on antibody titers reached after vaccination towards SARS-CoV-2 might not be sufficient to evaluate the degree of achieved protection. Rather, it is suggested to include avidity determination to optimize vaccination protocols and achieve high avidity IgG directed towards SARS-CoV-2 through vaccination. Avidity determination might also be useful to control for truly protective immunity towards SARS-CoV-2 in individual cases.
Collapse
Affiliation(s)
- Georg Bauer
- Institute of Virology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
12
|
Bauer G, Struck F, Schreiner P, Staschik E, Soutschek E, Motz M. The challenge of avidity determination in SARS-CoV-2 serology. J Med Virol 2021; 93:3092-3104. [PMID: 33565617 PMCID: PMC8013859 DOI: 10.1002/jmv.26863] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
The serological responses towards severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) nucleoprotein, receptor‐binding domain (RBD), and spike protein S1 are characterized by incomplete avidity maturation. Analysis with varying concentrations of urea allows to determine distinct differences in avidity maturation, though the total process remains at an unusually low level. Despite incomplete avidity maturation, this approach allows to define early and late stages of infection. It therefore can compensate for the recently described irregular kinetic patterns of immunoglobulin M and immunoglobulin G (IgG) directed towards SARS‐CoV‐2 antigens. The serological responses towards seasonal coronaviruses neither have a negative nor positive impact on SARS‐CoV‐2 serology in general. Avidity determination in combination with measurement of antibody titers and complexity of the immune response allows to clearly differentiate between IgG responses towards seasonal coronaviruses and SARS‐CoV‐2. Cross‐reactions seem to occur with very low probability. They can be recognized by their pattern of response and through differential treatment with urea. As high avidity has been shown to be essential in several virus systems for the protective effect of neutralizing antibodies, it should be clarified whether high avidity of IgG directed towards RBD indicates protective immunity. If this is the case, monitoring of avidity should be part of the optimization of vaccination programs. Avidity maturation of immunoglobulin G (IgG) towards severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antigens is distinct, but incomplete in most cases
Nevertheless, avidity determination allows to differentiate between acute and past SARS CoV‐infection
Avidity maturation is instrumental for differentiation between IgG responses towards SARS‐CoV‐2 and seasonal coronaviruses
It is suggested to clarify whether high avidity is required for and indicative of protective immunity.
Collapse
Affiliation(s)
- Georg Bauer
- Institute of VirologyMedical Center, University of FreiburgFreiburgGermany
- Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | | | | | | | | |
Collapse
|
13
|
Kaneko M, Ohhashi M, Fujii Y, Minematsu T, Kusumoto K. A multiple regression model for predicting a high cytomegalovirus immunoglobulin G avidity level in pregnant women with IgM positivity. Int J Infect Dis 2020; 100:1-6. [PMID: 32798662 DOI: 10.1016/j.ijid.2020.08.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To establish a model to predict high cytomegalovirus (CMV) immunoglobulin (Ig)G avidity index (AI) using clinical information, to contribute to the mental health of CMV-IgM positive pregnant women. METHODS We studied 371 women with IgM positivity at ≤14 w of gestation. Information on the age, parity, occupation, clinical signs, IgM and G values, and IgG AI was collected. The IgG AI cut-off value for diagnosing congenital infection was calculated based on a receiver operating characteristic curve analysis. Between-group differences were assessed using the Mann-Whitney U-test or χ2 analysis. The factors predicting a high IgG AI were determined using multiple logistic regression. RESULTS The women were divided into high or low IgG AI groups based on an IgG AI cut-off value of 31.75. There were significant differences in the IgG and IgM levels, age, clinical signs, and the number of women with one parity between the two groups. In a multiple logistic regression analysis, IgM and the number of women with one parity were independent predictors. This result helped us establish a mathematical model that correctly classified the IgG AI level for 84.6% of women. CONCLUSION We established a highly effective model for predicting a high IgG AI immediately after demonstrating IgM positivity.
Collapse
Affiliation(s)
- Masatoki Kaneko
- Department of Obstetrics and Gynecology,Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Graduate School of Nursing Science, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Masanao Ohhashi
- Department of Obstetrics and Gynecology,Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Yoshinori Fujii
- Department of Mathematics Education, Faculty of Education, University of Miyazaki,1-1 Gakuenkibanadai-nishi, Miyazaki, 889-2192, Japan.
| | - Toshio Minematsu
- Aisenkai Nichinan Hospital,3649-2, Kazeda, Nichinan, Miyazaki, 887-0034, Japan.
| | - Kazumi Kusumoto
- Department of Obstetrics and Gynecology,Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| |
Collapse
|
14
|
Voordouw B, Rockx B, Jaenisch T, Fraaij P, Mayaud P, Vossen A, Koopmans M. Performance of Zika Assays in the Context of Toxoplasma gondii, Parvovirus B19, Rubella Virus, and Cytomegalovirus (TORCH) Diagnostic Assays. Clin Microbiol Rev 2019; 33:e00130-18. [PMID: 31826871 DOI: 10.1128/CMR.00130-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infections during pregnancy that may cause congenital abnormalities have been recognized for decades, but their diagnosis is challenging. This was again illustrated with the emergence of Zika virus (ZIKV), highlighting the inherent difficulties in estimating the extent of pre- and postnatal ZIKV complications because of the difficulties in establishing definitive diagnoses. We reviewed the epidemiology, infection kinetics, and diagnostic methods used for Toxoplasma gondii, parvovirus B19, rubella virus, and cytomegalovirus (TORCH) infections and compared the results with current knowledge of ZIKV diagnostic assays to provide a basis for the inclusion of ZIKV in the TORCH complex evaluations. Similarities between TORCH pathogens and ZIKV support inclusion of ZIKV as an emerging TORCH infection. Our review evaluates the diagnostic performance of various TORCH diagnostic assays for maternal screening, fetal screening, and neonatal screening. We show that the sensitivity, specificity, and positive and negative predictive value of TORCH complex pathogens are widely variable, stressing the importance of confirmatory testing and the need for novel techniques for earlier and accurate diagnosis of maternal and congenital infections. In this context it is also important to acknowledge different needs and access to care for different geographic and resource settings.
Collapse
|
15
|
Ikuta K, Koshizuka T, Kanno R, Inoue N, Kubo T, Koyano S, Suzutani T. Evaluation of the indirect and IgM-capture anti-human cytomegalovirus IgM ELISA methods as confirmed by cytomegalovirus IgG avidity. Microbiol Immunol 2019; 63:172-178. [PMID: 31012489 DOI: 10.1111/1348-0421.12683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/21/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
Primary cytomegalovirus (CMV) infection during pregnancy often results in congenital CMV infection with severe clinical complications. IgM antibodies are one of the indices of primary infection. The IgG avidity index (AI) is also known to remain low for 3 months after primary infection. Here, we evaluated and compared the performance of CMV IgM and IgG avidity assays. Because sensitivity and specificity reportedly differ between CMV IgM kits, CMV IgM detection was compared between the two commercially available ELISA kits that are most commonly used in Japan. Sera for CMV IgM were first screened using a traditional indirect ELISA kit. Selected samples were then tested for CMV IgM and CMV AI using a CMV IgM-capture ELISA kit and a CMV IgG avidity assay, respectively. The rate of concordance between the IgM kits was 89% (42/47), indicating the absence of any significant difference. Most of the CMV IgM-positive plasma samples showed high CMV IgG AI; however, 18 commercially available plasma samples with low CMV IgG AI were all CMV IgM-positive. One plausible explanation for this discrepancy is that the duration of low IgG AI is shorter than that of IgM positivity. Alternatively, CMV IgM tests may generate pseudo-positive readouts in cases of congenital infection. Nevertheless, our study confirms that CMV IgG AI can be a reliable indicator of CMV primary infection.
Collapse
Affiliation(s)
- Kazufumi Ikuta
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Division of Microbiology, Tohoku Medical and Pharmaceutical University School of Medicine, Miyagi, Japan
| | - Tetsuo Koshizuka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Laboratory of Microbiology and Immunology, Gifu Pharmaceutical University, Gifu, Japan
| | - Ryoko Kanno
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Inoue
- Laboratory of Microbiology and Immunology, Gifu Pharmaceutical University, Gifu, Japan
| | - Takahiko Kubo
- Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo, Japan.,Shirota Obstetrical and Gynecological Hospital, Kanagawa, Japan
| | - Shin Koyano
- Ujiie Memorial Clinic for Children, Hokkaido, Japan
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
16
|
Tsuge M, Hida AI, Minematsu T, Honda N, Oshiro Y, Yokoyama M, Kondo Y. Prospective Cohort Study of Congenital Cytomegalovirus Infection during Pregnancy with Fetal Growth Restriction: Serologic Analysis and Placental Pathology. J Pediatr 2019; 206:42-48.e2. [PMID: 30413316 DOI: 10.1016/j.jpeds.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/08/2018] [Revised: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate prospectively the prevalence of congenital cytomegalovirus (CMV) infection and the pathologic features of the placenta in cases of fetal growth restriction (FGR). STUDY DESIGN Forty-eight pregnant women who were diagnosed with FGR during pregnancy were enrolled for 15 months. Maternal CMV serologic tests, pathologic examinations of the placenta, and newborn urinary CMV-DNA polymerase chain reaction tests were performed in all the cases. The clinical characteristics and laboratory findings of the pregnant women and their newborns were collected. Biomarkers for inflammation, angiogenesis, and placental hormones were measured in the maternal serum at FGR diagnosis or in the neonatal urine at birth. RESULTS One of the 48 cases with FGR was a congenital CMV infection. CMV antigen was detected in the placenta of 7 cases with FGR. The change rate of the estimated fetal body weight was significantly lower in FGR cases with placental CMV detection. Placental villitis was observed more frequently in FGR cases with placental CMV detection. Human placental lactogen was significantly decreased in FGR cases with placental CMV detection. Increased C-reactive protein and serum amyloid A levels in the maternal serum were observed more frequently in FGR cases with placental CMV detection. Newborn urine β-2 microglobulin levels were significantly higher in FGR cases with placental CMV detection. CONCLUSIONS Serologic tests for maternal CMV, the change rate of the estimated fetal body weight, analysis of several biomarkers, and placental pathologic examinations might be helpful in comprehensively predicting the possibility of congenital CMV infection.
Collapse
Affiliation(s)
- Mitsuru Tsuge
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akira I Hida
- Department of Pathology, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan.
| | - Toshio Minematsu
- Research Center for Disease Control, Aisenkai Nichinan Hospital, Nichinan, Japan
| | - Naotoshi Honda
- Department of Obstetrics and Gynecology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Mikifumi Yokoyama
- Department of Obstetrics and Gynecology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yoichi Kondo
- Department of Pediatrics, Matsuyama Red Cross Hospital, Matsuyama, Japan
| |
Collapse
|
17
|
Tanimura K, Yamada H. Potential Biomarkers for Predicting Congenital Cytomegalovirus Infection. Int J Mol Sci 2018; 19:ijms19123760. [PMID: 30486359 PMCID: PMC6321102 DOI: 10.3390/ijms19123760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022] Open
Abstract
Early diagnosis and treatment of infants with symptomatic congenital cytomegalovirus (CMV) infection may improve neurological outcomes. For this reason, prenatal detection of newborns at high risk for congenital CMV infection is important. A polymerase chain reaction (PCR) assay for CMV DNA in the amniotic fluid is the gold standard for the diagnosis of intrauterine CMV infection; however, amniocentesis is an invasive procedure. Recently, we have found that the presence of CMV DNA in the maternal uterine cervical secretion is predictive of the occurrence of congenital CMV infection in CMV immunoglobulin M (IgM)-positive pregnant women. In contrast, we have suggested that maternal serological screening for primary CMV infection using CMV-specific immunoglobulin G (IgG), the IgG avidity index, or CMV-specific IgM overlooks a number of newborns with congenital CMV infection. We will review current knowledge of the potential biomarkers for predicting congenital CMV infection.
Collapse
Affiliation(s)
- Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
| |
Collapse
|
18
|
Abstract
A vaccine against congenital human cytomegalovirus (CMV) infection is a major public health priority. Congenital CMV causes substantial long-term morbidity, particularly sensorineural hearing loss (SNHL), in newborns, and the public health impact of this infection on maternal and child health is underrecognized. Although progress toward development of a vaccine has been limited by an incomplete understanding of the correlates of protective immunity for the fetus, knowledge about some of the key components of the maternal immune response necessary for preventing transplacental transmission is accumulating. Moreover, although there have been concerns raised about observations indicating that maternal seropositivity does not fully prevent recurrent maternal CMV infections during pregnancy, it is becoming increasing clear that preconception immunity does confer some measure of protection against both CMV transmission and CMV disease (if transmission occurs) in the newborn infant. Although the immunity to CMV conferred by both infection and vaccination is imperfect, there are encouraging data emerging from clinical trials demonstrating the immunogenicity and potential efficacy of candidate CMV vaccines. In the face of the knowledge that between 20,000 and 30,000 infants are born with congenital CMV in the United States every year, there is an urgent and compelling need to accelerate the pace of vaccine trials. In this minireview, we summarize the status of CMV vaccines in clinical trials and provide a perspective on what would be required for a CMV immunization program to become incorporated into clinical practice.
Collapse
Affiliation(s)
- Mark R Schleiss
- Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota Medical School, Department of Pediatrics, Minneapolis, Minnesota, USA
| | - Sallie R Permar
- Duke University Medical School, Human Vaccine Institute, Department of Pediatrics, Durham, North Carolina, USA
| | - Stanley A Plotkin
- University of Pennsylvania, Vaxconsult, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Schleiss MR. Congenital Cytomegalovirus Infection: Improved Understanding of Maternal Immune Responses That Reduce the Risk of Transplacental Transmission. Clin Infect Dis 2017; 65:1666-1669. [PMID: 29020147 DOI: 10.1093/cid/cix626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/18/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- Mark R Schleiss
- Department of Pediatrics, University of Minnesota Medical School, Division of Pediatric Infectious Diseases and Immunology, Center for Infectious Diseases and Microbiology Translational Research, Minneapolis
| |
Collapse
|
20
|
Affiliation(s)
| | - Russell W Steele
- 1 University of Queensland, Herston, Queensland, Australia.,2 Tulane University, New Orleans, LA, USA
| |
Collapse
|