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Durstenfeld MS, Weiman S, Holtzman M, Blish C, Pretorius R, Deeks SG. Long COVID and post-acute sequelae of SARS-CoV-2 pathogenesis and treatment: A Keystone Symposia report. Ann N Y Acad Sci 2024. [PMID: 38593220 DOI: 10.1111/nyas.15132] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
In 2023, the Keystone Symposia held the first international scientific conference convening research leaders investigating the pathology of post-acute sequelae of COVID-19 (PASC) or Long COVID, a growing and urgent public health priority. In this report, we present insights from the talks and workshops presented during this meeting and highlight key themes regarding what researchers have discovered regarding the underlying biology of PASC and directions toward future treatment. Several themes have emerged in the biology, with inflammation and other immune alterations being the most common focus, potentially related to viral persistence, latent virus reactivation, and/or tissue damage and dysfunction, especially of the endothelium, nervous system, and mitochondria. In order to develop safe and effective treatments for people with PASC, critical next steps should focus on the replication of major findings regarding potential mechanisms, disentangling pathogenic mechanisms from downstream effects, development of cellular and animal models, mechanism-focused randomized, placebo-controlled trials, and closer collaboration between people with lived experience, scientists, and other stakeholders. Ultimately, by learning from other post-infectious syndromes, the knowledge gained may help not only those with PASC/Long COVID, but also those with other post-infectious syndromes.
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Affiliation(s)
| | | | - Michael Holtzman
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Catherine Blish
- Stanford Immunology Program and Department of Medicine, Stanford University, Stanford, California, USA
| | - Resia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Steven G Deeks
- Department of Medicine, University of California, San Francisco, California, USA
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2
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Zhou X, Yu W, Dunham D, Schuetz J, Blish C, Dekruyff R, Nadeau K. A cytometric survey of immune cell populations reveals an association between allergen-responsive natural killer (NK) cells and human peanut allergy. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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3
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Ty M, Sun S, Callaway PC, Rek J, Press KD, van der Ploeg K, Nideffer J, Hu Z, Klemm S, Greenleaf W, Donato M, Tukwasibwe S, Arinaitwe E, Nankya F, Musinguzi K, Andrew D, de la Parte L, Mori DM, Lewis SN, Takahashi S, Rodriguez-Barraquer I, Greenhouse B, Blish C, Utz PJ, Khatri P, Dorsey G, Kamya M, Boyle M, Feeney M, Ssewanyana I, Jagannathan P. Malaria-driven expansion of adaptive-like functional CD56-negative NK cells correlates with clinical immunity to malaria. Sci Transl Med 2023; 15:eadd9012. [PMID: 36696483 PMCID: PMC9976268 DOI: 10.1126/scitranslmed.add9012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Natural killer (NK) cells likely play an important role in immunity to malaria, but the effect of repeated malaria on NK cell responses remains unclear. Here, we comprehensively profiled the NK cell response in a cohort of 264 Ugandan children. Repeated malaria exposure was associated with expansion of an atypical, CD56neg population of NK cells that differed transcriptionally, epigenetically, and phenotypically from CD56dim NK cells, including decreased expression of PLZF and the Fc receptor γ-chain, increased histone methylation, and increased protein expression of LAG-3, KIR, and LILRB1. CD56neg NK cells were highly functional and displayed greater antibody-dependent cellular cytotoxicity than CD56dim NK cells. Higher frequencies of CD56neg NK cells were associated with protection against symptomatic malaria and high parasite densities. After marked reductions in malaria transmission, frequencies of these cells rapidly declined, suggesting that continuous exposure to Plasmodium falciparum is required to maintain this modified, adaptive-like NK cell subset.
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Affiliation(s)
- Maureen Ty
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Shenghuan Sun
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Perri C Callaway
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Jason Nideffer
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Zicheng Hu
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sandy Klemm
- Department of Genetics, Stanford University, Stanford, CA, USA
| | | | - Michele Donato
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | | | | | | | | | - Dean Andrew
- Queensland Institute for Medical Research, Queensland, Australia
| | | | | | | | - Saki Takahashi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Blish
- Department of Medicine, Stanford University, Stanford, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - P J Utz
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University, Kampala, Uganda
| | - Michelle Boyle
- Queensland Institute for Medical Research, Queensland, Australia
| | - Margaret Feeney
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
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4
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Hu Z, van der Ploeg K, Chakraborty S, Arunachalam PS, Mori DAM, Jacobson KB, Bonilla H, Parsonnet J, Andrews JR, Holubar M, Subramanian A, Khosla C, Maldonado Y, Hedlin H, de la Parte L, Press K, Ty M, Tan GS, Blish C, Takahashi S, Rodriguez-Barraquer I, Greenhouse B, Butte AJ, Singh U, Pulendran B, Wang TT, Jagannathan P. Early immune markers of clinical, virological, and immunological outcomes in patients with COVID-19: a multi-omics study. eLife 2022; 11:77943. [PMID: 36239699 PMCID: PMC9566856 DOI: 10.7554/elife.77943] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/22/2022] [Indexed: 01/29/2023] Open
Abstract
Background The great majority of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infections are mild and uncomplicated, but some individuals with initially mild COVID-19 progressively develop more severe symptoms. Furthermore, there is substantial heterogeneity in SARS-CoV-2-specific memory immune responses following infection. There remains a critical need to identify host immune biomarkers predictive of clinical and immunological outcomes in SARS-CoV-2-infected patients. Methods Leveraging longitudinal samples and data from a clinical trial (N=108) in SARS-CoV-2-infected outpatients, we used host proteomics and transcriptomics to characterize the trajectory of the immune response in COVID-19 patients. We characterized the association between early immune markers and subsequent disease progression, control of viral shedding, and SARS-CoV-2-specific T cell and antibody responses measured up to 7 months after enrollment. We further compared associations between early immune markers and subsequent T cell and antibody responses following natural infection with those following mRNA vaccination. We developed machine-learning models to predict patient outcomes and validated the predictive model using data from 54 individuals enrolled in an independent clinical trial. Results We identify early immune signatures, including plasma RIG-I levels, early IFN signaling, and related cytokines (CXCL10, MCP1, MCP-2, and MCP-3) associated with subsequent disease progression, control of viral shedding, and the SARS-CoV-2-specific T cell and antibody response measured up to 7 months after enrollment. We found that several biomarkers for immunological outcomes are shared between individuals receiving BNT162b2 (Pfizer-BioNTech) vaccine and COVID-19 patients. Finally, we demonstrate that machine-learning models using 2-7 plasma protein markers measured early within the course of infection are able to accurately predict disease progression, T cell memory, and the antibody response post-infection in a second, independent dataset. Conclusions Early immune signatures following infection can accurately predict clinical and immunological outcomes in outpatients with COVID-19 using validated machine-learning models. Funding Support for the study was provided from National Institute of Health/National Institute of Allergy and Infectious Diseases (NIH/NIAID) (U01 AI150741-01S1 and T32-AI052073), the Stanford's Innovative Medicines Accelerator, National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) DP1DA046089, and anonymous donors to Stanford University. Peginterferon lambda provided by Eiger BioPharmaceuticals.
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Affiliation(s)
- Zicheng Hu
- Bakar Computational Health Sciences Institute, University of CaliforniaSan FranciscoUnited States
- Department of Microbiology and Immunology, University of CaliforniaSan FranciscoUnited States
| | | | | | - Prabhu S Arunachalam
- Institute for Immunity, Transplantation, and Infection, Stanford UniversityStanfordUnited States
| | - Diego AM Mori
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Karen B Jacobson
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Hector Bonilla
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Julie Parsonnet
- Department of Medicine, Stanford UniversityStanfordUnited States
- Department of Epidemiology and Population Health, Stanford UniversityStanfordUnited States
| | - Jason R Andrews
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Marisa Holubar
- Department of Medicine, Stanford UniversityStanfordUnited States
| | | | | | - Yvonne Maldonado
- Department of Pediatrics, Stanford UniversityStanfordUnited States
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford UniversityStanfordUnited States
| | | | - Kathleen Press
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Maureen Ty
- Department of Medicine, Stanford UniversityStanfordUnited States
| | - Gene S Tan
- J. Craig Venter InstituteSan DiegoUnited States
- Division of Infectious Diseases, Department of Medicine, University of CaliforniaSan DiegoUnited States
| | - Catherine Blish
- Department of Medicine, Stanford UniversityStanfordUnited States
- Chan Zuckerberg BiohubSan FranciscoUnited States
| | - Saki Takahashi
- Department of Medicine, University of CaliforniaSan FranciscoUnited States
| | | | - Bryan Greenhouse
- Chan Zuckerberg BiohubSan FranciscoUnited States
- Department of Medicine, University of CaliforniaSan FranciscoUnited States
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of CaliforniaSan FranciscoUnited States
| | - Upinder Singh
- Department of Medicine, Stanford UniversityStanfordUnited States
- Department of Microbiology and Immunology, Stanford UniversityStanfordUnited States
| | - Bali Pulendran
- Institute for Immunity, Transplantation, and Infection, Stanford UniversityStanfordUnited States
- Department of Microbiology and Immunology, Stanford UniversityStanfordUnited States
- Department of Pathology, Stanford UniversityStanfordUnited States
| | - Taia T Wang
- Department of Medicine, Stanford UniversityStanfordUnited States
- Chan Zuckerberg BiohubSan FranciscoUnited States
- Department of Microbiology and Immunology, Stanford UniversityStanfordUnited States
| | - Prasanna Jagannathan
- Department of Medicine, Stanford UniversityStanfordUnited States
- Chan Zuckerberg BiohubSan FranciscoUnited States
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5
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Castellano E, Samba C, Esteso G, Simpson L, Vendrame E, García‐Cuesta EM, López‐Cobo S, Álvarez-Maestro M, Linares A, Leibar A, Ranganath T, Reyburn HT, Martínez‐Piñeiro L, Blish C, Valés‐Gómez M. CyTOF analysis identifies unusual immune cells in urine of BCG-treated bladder cancer patients. Front Immunol 2022; 13:970931. [PMID: 36189320 PMCID: PMC9520259 DOI: 10.3389/fimmu.2022.970931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
High grade non-muscle-invasive bladder tumours are treated with transurethral resection followed by recurrent intravesical instillations of Bacillus Calmette Guérin (BCG). Although most bladder cancer patients respond well to BCG, there is no clinical parameter predictive of treatment response, and when treatment fails, the prognosis is very poor. Further, a high percentage of NMIBC patients treated with BCG suffer unwanted effects that force them to stop treatment. Thus, early identification of patients in which BCG treatment will fail is really important. Here, to identify early stage non-invasive biomarkers of non-responder patients and patients at risk of abandoning the treatment, we longitudinally analysed the phenotype of cells released into the urine of bladder cancer patients 3-7 days after BCG instillations. Mass cytometry (CyTOF) analyses revealed a large proportion of granulocytes and monocytes, mostly expressing activation markers. A novel population of CD15+CD66b+CD14+CD16+ cells was highly abundant in several samples; expression of these markers was confirmed using flow cytometry and qPCR. A stronger inflammatory response was associated with increased cell numbers in the urine; this was not due to hematuria because the cell proportions were distinct from those in the blood. This pilot study represents the first CyTOF analysis of cells recruited to urine during BCG treatment, allowing identification of informative markers associated with treatment response for sub-selection of markers to confirm using conventional techniques. Further studies should jointly evaluate cells and soluble factors in urine in larger cohorts of patients to characterise the arms of the immune response activated in responders and to identify patients at risk of complications from BCG treatment.
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Affiliation(s)
- Eva Castellano
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Célia Samba
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Gloria Esteso
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Laura Simpson
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Elena Vendrame
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Eva M. García‐Cuesta
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Sheila López‐Cobo
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Mario Álvarez-Maestro
- Urology Department, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Ana Linares
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Asier Leibar
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Thanmayi Ranganath
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Hugh T. Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
| | - Luis Martínez‐Piñeiro
- Urology Department, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Urology Unit, Infanta Sofia Hospital, Madrid, Spain
| | - Catherine Blish
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Mar Valés‐Gómez
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB) Spanish National Research Council (CSIC), Madrid, Spain
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Mar Valés‐Gómez,
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6
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Hu Z, van der Ploeg K, Chakraborty S, Arunachalam P, Mori D, Jacobson K, Bonilla H, Parsonnet J, Andrews J, Hedlin H, de la Parte L, Dantzler K, Ty M, Tan G, Blish C, Takahashi S, Rodriguez-Barraquer I, Greenhouse B, Butte A, Singh U, Pulendran B, Wang T, Jagannathan P. Early immune responses have long-term associations with clinical, virologic, and immunologic outcomes in patients with COVID-19. Res Sq 2022:rs.3.rs-847082. [PMID: 35132407 PMCID: PMC8820672 DOI: 10.21203/rs.3.rs-847082/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The great majority of SARS-CoV-2 infections are mild and uncomplicated, but some individuals with initially mild COVID-19 progressively develop more severe symptoms. Furthermore, there is substantial heterogeneity in SARS-CoV-2-specific memory immune responses following infection. There remains a critical need to identify host immune biomarkers predictive of clinical and immunologic outcomes in SARS-CoV-2-infected patients. Leveraging longitudinal samples and data from a clinical trial in SARS-CoV-2 infected outpatients, we used host proteomics and transcriptomics to characterize the trajectory of the immune response in COVID-19 patients within the first 2 weeks of symptom onset. We identify early immune signatures, including plasma RIG-I levels, early interferon signaling, and related cytokines (CXCL10, MCP1, MCP-2 and MCP-3) associated with subsequent disease progression, control of viral shedding, and the SARS-CoV-2 specific T cell and antibody response measured up to 7 months after enrollment. We found that several biomarkers for immunological outcomes are shared between individuals receiving BNT162b2 (Pfizer-BioNTech) vaccine and COVID-19 patients. Finally, we demonstrate that machine learning models using 7-10 plasma protein markers measured early within the course of infection are able to accurately predict disease progression, T cell memory, and the antibody response post-infection in a second, independent dataset.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Atul Butte
- Bakar Institute for Computational Health Sciences, University of California, San Francisco
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7
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Feng A, Yang E, Moore A, Dhingra S, Chang S, Yin X, Pi R, Mack E, Völkel S, Geßner R, Gundisch M, Neubauer A, Renz H, Tsiodras S, Fragkou P, Asuni A, Levitt J, Wilson J, Leong M, Lumb J, Mao R, Pinedo K, Roque J, Richards C, Stabile M, Swaminathan G, Salagianni M, Triantafyllia V, Bertrams W, Blish C, Carette J, Frankovich J, Meffre E, Nadeau KC, Singh U, Wang T, Prak EL, Herold S, Andreakos E, Schmeck B, Skevaki C, Rogers A, Utz P. Autoantibodies targeting cytokines and connective tissue disease autoantigens are common in acute non-SARS-CoV-2 infections. Res Sq 2022:rs.3.rs-1233038. [PMID: 35075455 PMCID: PMC8786233 DOI: 10.21203/rs.3.rs-1233038/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The widespread presence of autoantibodies in acute infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is increasingly recognized, but the prevalence of autoantibodies in infections with organisms other than SARS-CoV-2 has not yet been reported. We used protein arrays to profile IgG autoantibodies from 317 samples from 268 patients across a spectrum of non-SARS-CoV-2 infections, many of whom were critically ill with pneumonia. Anti-cytokine antibodies (ACA) were identified in > 50% of patients infected with non-SARS-CoV-2 viruses and other pathogens, including patients with pneumonia attributed to bacterial causes. In cell-based functional assays, some ACA blocked binding to surface receptors for type I interferons (Type I IFN), granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin-6 (IL-6). Autoantibodies against traditional autoantigens associated with connective tissue diseases (CTDs) were also commonly observed in these cohorts, including newly-detected antibodies that emerged in longitudinal samples from patients infected with influenza. We conclude that autoantibodies, some of which are functionally active, may be much more prevalent than previously appreciated in patients who are symptomatically infected with diverse pathogens.
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Affiliation(s)
| | | | | | | | | | - Xihui Yin
- Stanford University School of Medicine
| | - Ruoxi Pi
- Stanford University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Utz
- Stanford University School of Medicine
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8
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Jagannathan P, Andrews JR, Bonilla H, Hedlin H, Jacobson KB, Balasubramanian V, Purington N, Kamble S, de Vries CR, Quintero O, Feng K, Ley C, Winslow D, Newberry J, Edwards K, Hislop C, Choong I, Maldonado Y, Glenn J, Bhatt A, Blish C, Wang T, Khosla C, Pinsky BA, Desai M, Parsonnet J, Singh U. Peginterferon Lambda-1a for treatment of outpatients with uncomplicated COVID-19: a randomized placebo-controlled trial. Nat Commun 2021; 12:1967. [PMID: 33785743 PMCID: PMC8009873 DOI: 10.1038/s41467-021-22177-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [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: 12/22/2020] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
Type III interferons have been touted as promising therapeutics in outpatients with coronavirus disease 2019 (COVID-19). We conducted a randomized, single-blind, placebo-controlled trial (NCT04331899) in 120 outpatients with mild to moderate COVID-19 to determine whether a single, 180 mcg subcutaneous dose of Peginterferon Lambda-1a (Lambda) within 72 hours of diagnosis could shorten the duration of viral shedding (primary endpoint) or symptoms (secondary endpoint). In both the 60 patients receiving Lambda and 60 receiving placebo, the median time to cessation of viral shedding was 7 days (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.56 to 1.19). Symptoms resolved in 8 and 9 days in Lambda and placebo, respectively, and symptom duration did not differ significantly between groups (HR 0.94; 95% CI 0.64 to 1.39). Both Lambda and placebo were well-tolerated, though liver transaminase elevations were more common in the Lambda vs. placebo arm (15/60 vs 5/60; p = 0.027). In this study, a single dose of subcutaneous Peginterferon Lambda-1a neither shortened the duration of SARS-CoV-2 viral shedding nor improved symptoms in outpatients with uncomplicated COVID-19.
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Affiliation(s)
- Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, CA, USA. .,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.
| | - Jason R Andrews
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Hector Bonilla
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | | | | | | | - Savita Kamble
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | | | | | - Kent Feng
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | - Catherine Ley
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Dean Winslow
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jennifer Newberry
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Karlie Edwards
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Colin Hislop
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Ingrid Choong
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Jeffrey Glenn
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Ami Bhatt
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Genetics, Stanford University, Stanford, CA, USA
| | - Catherine Blish
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Taia Wang
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | | | - Benjamin A Pinsky
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Pathology, Stanford University, Stanford, CA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Julie Parsonnet
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Upinder Singh
- Department of Medicine, Stanford University, Stanford, CA, USA. .,Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.
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9
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Krummel M, Blish C, Kuhns M, Cadwell K, Oberst A, Goldrath A, Ansel KM, Chi H, O'Connell R, Wherry EJ, Pepper M. Universal Principled Review: A Community-Driven Method to Improve Peer Review. Cell 2020; 179:1441-1445. [PMID: 31835023 DOI: 10.1016/j.cell.2019.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite being a staple of our science, the process of pre-publication peer review has few agreed-upon standards defining its goals or ideal execution. As a community of reviewers and authors, we assembled an evaluation format and associated specific standards for the process as we think it should be practiced. We propose that we apply, debate, and ultimately extend these to improve the transparency of our criticism and the speed with which quality data and ideas become public.
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Affiliation(s)
- Matthew Krummel
- Department of Pathology, ImmunoX Initiative, and Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Catherine Blish
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Kuhns
- Department of Immunobiology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Ken Cadwell
- Kimmel Center for Biology and Medicine at the Skirball Institute and Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - Andrew Oberst
- Department of Immunology, University of Washington, Seattle, WA 98109, USA
| | - Ananda Goldrath
- Division of Biological Sciences, Section of Molecular Biology, University of California San Diego, La Jolla, CA 92037, USA
| | - K Mark Ansel
- Sandler Asthma Basic Research Center and Department of Microbiology & Immunology, and ImmunoX Initiative, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hongbo Chi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ryan O'Connell
- Huntsman Cancer Institute and the Division of Microbiology and Immunology, Department of Pathology at the University of Utah, 15 N. Medical Dr. East, Salt Lake City, UT, 84112, USA
| | - E John Wherry
- Department of Systems Pharmacology and Translational Therapeutics and Institute for Immunology, Perelman School of Medicine, and Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marion Pepper
- Department of Immunology, University of Washington, Seattle, WA 98109, USA
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10
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Crotty S, Blish C, Cadwell K, Chi H, Goldrath A, Green D, Kaech SM, Krummel M, Pepper M, Rothlin CV, Wherry EJ. Reinvigorating NIH Grant Peer Review. Immunity 2020; 52:1-3. [PMID: 31940266 DOI: 10.1016/j.immuni.2019.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shane Crotty
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92037, USA.
| | - Catherine Blish
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ken Cadwell
- Kimmel Center for Biology and Medicine at the Skirball Institute and Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - Hongbo Chi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ananda Goldrath
- Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Douglas Green
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Matthew Krummel
- Department of Pathology, ImmunoX Initiative, and Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Marion Pepper
- Department of Immunology, University of Washington, Seattle, WA 98109, USA
| | - Carla V Rothlin
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - E John Wherry
- Department of Systems Pharmacology and Translational Therapeutics and Institute for Immunology, Perelman School of Medicine and Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA 19104, USA
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11
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Bayless N, Kay A, Fukuayama J, Aziz N, Dekker C, Mackey S, Swan G, Davis M, Holmes S, Blish C. Pregnancy does not attenuate the antibody or plasmablast response to inactivated influenza vaccine (HUM6P.247). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.190.6] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Background. Inactivated influenza vaccine (IIV) is recommended during pregnancy to prevent influenza infection and its complications in pregnant women and their infants. However, the extent to which pregnancy modifies the antibody response to vaccination remains unclear, and prior studies have focused primarily on hemagglutinin inhibition (HI) titers. A more comprehensive understanding of how pregnancy modifies the humoral immune response to influenza vaccination will aid in maximizing vaccine efficacy. Methods. Healthy pregnant women and control women were studied prior to, 7 days after and 28 days after vaccination with IIV. HI titers, microneutralization (MN) titers and the frequency of circulating plasmablasts were evaluated in pregnant vs. control women. Results. Pregnant women and control women mount similarly robust serologic immune responses to IIV, with no significant differences for any influenza strain in post-vaccination geometric mean HI or MN titers. HI and MN titers correlate, though MN titers demonstrate more robust changes pre- vs. post-vaccination. The induction of circulating plasmablasts is increased in pregnant women vs. controls (median fold-change 2.60 vs. 1.49 [Interquartile Range 0.94-7.53 vs. 0.63-2.67]; p = 0.03). Conclusion. Pregnant women do not have impaired humoral immune responses to IIV, and may have increased circulating plasmablast production compared to control women.
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Affiliation(s)
| | - Alexander Kay
- 2Department of Pediatrics, Stanford Univ. Sch. of Med., Stanford, CA
| | - Julia Fukuayama
- 3Department of Statistics, Stanford Univ. Sch. of Med., Stanford, CA
| | - Natali Aziz
- 4Department of Obstetrics & Gynecology, Stanford Univ. Sch. of Med., Stanford, CA
| | - Cornelia Dekker
- 2Department of Pediatrics, Stanford Univ. Sch. of Med., Stanford, CA
| | - Sally Mackey
- 2Department of Pediatrics, Stanford Univ. Sch. of Med., Stanford, CA
| | - Gary Swan
- 5Stanford Prevention Research Center, Department of Medicine, Stanford Univ. Sch. of Med., Stanford, CA
| | - Mark Davis
- 1Stanford Immunology, Stanford Univ. Sch. of Med., Stanford, CA
- 6Department of Microbiology and Immunology, Stanford Univ. Sch. of Med., Stanford, CA
| | - Susan Holmes
- 3Department of Statistics, Stanford Univ. Sch. of Med., Stanford, CA
| | - Catherine Blish
- 1Stanford Immunology, Stanford Univ. Sch. of Med., Stanford, CA
- 7Department of Medicine, Stanford Univ. Sch. of Med., Stanford, CA
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12
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Forthal DN, Landucci G, Chohan B, Richardson BA, McClelland RS, Jaoko W, Blish C, Overbaugh J. Antibody-dependent cell-mediated virus inhibition antibody activity does not correlate with risk of HIV-1 superinfection. J Acquir Immune Defic Syndr 2013; 63:31-3. [PMID: 23344546 DOI: 10.1097/qai.0b013e3182874d41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous studies of HIV-infected women with high-risk behavior have indicated that neither neutralizing antibody nor cellular immunity elicited by an initial HIV-1 infection is associated with protection against superinfection with a different HIV-1 strain. Here, we measured antibody-dependent cell-mediated virus inhibition (ADCVI) antibody activity in the plasma of 12 superinfected cases and 36 singly infected matched controls against 2 heterologous viruses. We found no association between plasma ADCVI activity and superinfection status. ADCVI antibody activity against heterologous virus elicited by the original infection may not contribute to preventing a superinfecting HIV-1.
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Affiliation(s)
- Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA 92967, USA.
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13
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Horowitz A, Strauss-Albee D, Nemat-Gorgani N, Dogan O, Dekker C, Mackey S, Swan G, Davis M, Norman P, Guethlein L, Parham P, Blish C. Discovering the determinants of diversity in the human NK cell repertoire by mass cytometry (P3018). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.114.10] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
NK cells respond to infected and transformed cells using germline-encoded NK receptors (NKRs). Collectively, these NKRs combine to form distinct repertoires that tune the NK cell response. To provide a framework for understanding how perturbations in expression of NKRs influence disease pathogenesis, we defined the phenotypic heterogeneity of NK cells in 22 healthy individuals (ages 21-62; M=10, F=12), including 5 sets of monozygotic twins. Using mass cytometry, surface expression of 38 markers specific for NKRs and lineage markers to identify B cells, T cells and myeloid cells were examined. KIR and HLA class I genotypes were determined by Luminex, and KIR gene content was further assessed using pyrosequencing. NK cell populations, as defined by inhibitory NKRs, were highly concordant between twins (R2 = 0.90) in comparison to unrelated individuals (R2 = 0.66), indicating that the inhibitory repertoire is highly genetically determined. However, when analyzing all twenty-five NKRs, including activating receptors, the concordance in twins (R2=0.34) and in unrelated individuals (R2=0.11) was greatly decreased, indicating significant environmental influence in determining the overall NK cell repertoire. Overall, these analyses reveal tremendous diversity within the NK repertoire that is both genetically and environmentally determined, and offer the ability to examine the functional capacity of NK cells with far greater resolution.
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Affiliation(s)
- Amir Horowitz
- 1Structural Biology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 2Microbiology&Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 3Stanford Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Dara Strauss-Albee
- 3Stanford Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 4Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Neda Nemat-Gorgani
- 1Structural Biology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Ozge Dogan
- 4Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Cornelia Dekker
- 5Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford University, Stanford, CA
- 6Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Sally Mackey
- 5Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford University, Stanford, CA
- 6Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Gary Swan
- 7Center for Health Sciences, SRI International, Menlo park, CA
| | - Mark Davis
- 2Microbiology&Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 3Stanford Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 5Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Paul Norman
- 1Structural Biology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Lisbeth Guethlein
- 1Structural Biology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Peter Parham
- 1Structural Biology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 2Microbiology&Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 3Stanford Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Catherine Blish
- 3Stanford Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA
- 4Medicine, Stanford University School of Medicine, Stanford University, Stanford, CA
- 5Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford University, Stanford, CA
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14
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Strauss-Albee D, Horowitz A, Dogan O, Mackey S, Swan G, Dekker C, Davis M, Parham P, Blish C. Quantifying the unanticipated diversity of the human NK cell repertoire (P1456). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.60.11] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Like their T and B lymphocyte counterparts, natural killer (NK) cells exist in small and specialized subpopulations. However, while T and B cell repertoire diversity is generated primarily through DNA rearrangement to produce a single antigen-specific receptor, the diversity of the NK cell repertoire is determined by the expression of a spectrum of activating and inhibitory receptors. To evaluate the human NK cell repertoire on a single-cell basis, we simultaneously measured more than 25 NK cell receptors in the peripheral blood of 22 healthy individuals via mass cytometry. We used Boolean gating to classify cellular phenotypes. Based on the Simpson index, an ecological measure designed to quantify population diversity, we found that total NK cell repertoire diversity was approximately normally distributed across individuals. Using rarefaction curves and non-parametric species estimators, we calculate the expansiveness of the NK cell repertoire at a minimum of 100,000 unique phenotypes. Furthermore, within an individual, the ex vivo addition of the homeostatic cytokine IL-15 biased the repertoire toward highly common and uncommon phenotypes, increasing the total population richness but decreasing the overall diversity. These data show, for the first time, that the receptor-based NK cell repertoire is exquisitely diverse. They further suggest an optimal baseline diversity that is highly sensitive to optimization by exogenous factors.
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Affiliation(s)
- Dara Strauss-Albee
- 1Stanford Immunology, Stanford University, Stanford, CA
- 2Department of Medicine, Stanford University, Stanford, CA
| | - Amir Horowitz
- 1Stanford Immunology, Stanford University, Stanford, CA
- 3Department of Structural Biology, Stanford University, Stanford, CA
- 4Department of Microbiology & Immunology, Stanford University, Stanford, CA
| | - Ozge Dogan
- 2Department of Medicine, Stanford University, Stanford, CA
| | - Sally Mackey
- 5Department of Pediatrics, Stanford University, Stanford, CA
- 6Institute for Immunity Transplantation and Infection, Stanford University, Stanford, CA
| | - Gary Swan
- 7Center for Health Sciences, SRI International, Menlo Park, CA
| | - Cornelia Dekker
- 5Department of Pediatrics, Stanford University, Stanford, CA
- 6Institute for Immunity Transplantation and Infection, Stanford University, Stanford, CA
| | - Mark Davis
- 1Stanford Immunology, Stanford University, Stanford, CA
- 4Department of Microbiology & Immunology, Stanford University, Stanford, CA
- 7Center for Health Sciences, SRI International, Menlo Park, CA
| | - Peter Parham
- 1Stanford Immunology, Stanford University, Stanford, CA
- 3Department of Structural Biology, Stanford University, Stanford, CA
- 4Department of Microbiology & Immunology, Stanford University, Stanford, CA
| | - Catherine Blish
- 1Stanford Immunology, Stanford University, Stanford, CA
- 2Department of Medicine, Stanford University, Stanford, CA
- 6Institute for Immunity Transplantation and Infection, Stanford University, Stanford, CA
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15
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Burgers WA, Manrique A, Masopust D, McKinnon LR, Reynolds MR, Rolland M, Blish C, Chege GK, Curran R, Fischer W, Herrera C, Sather DN. Measurements of immune responses for establishing correlates of vaccine protection against HIV. AIDS Res Hum Retroviruses 2012; 28:641-8. [PMID: 21861777 DOI: 10.1089/aid.2011.0239] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Well-defined correlates of protective immunity are an essential component of rational vaccine development. Despite years of basic science and three HIV vaccine efficacy trials, correlates of immunological protection from HIV infection remain undefined. In December 2010, a meeting of scientists engaged in basic and translational work toward developing HIV-1 vaccines was convened. The goal of this meeting was to discuss current opportunities and optimal approaches for defining correlates of protection, both for ongoing and future HIV-1 vaccine candidates; specific efforts were made to engage young scientists. We discuss here the highlights from the meeting regarding the progress made and the way forward for a protective HIV-1 vaccine.
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Affiliation(s)
- Wendy A. Burgers
- Institute of Infectious Diseases and Molecular Medicine and Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | | | - David Masopust
- Department of Microbiology, Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lyle R. McKinnon
- Department of Medicine, University of Toronto, Toronto, Canada and Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Matthew R. Reynolds
- AIDS Vaccine Research Laboratory, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Catherine Blish
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Gerald K. Chege
- Institute of Infectious Diseases and Molecular Medicine and Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Rhonda Curran
- Institute of Nursing Research/School of Nursing, University of Ulster, Ulster, United Kingdom
| | - William Fischer
- Group T-6, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - Carolina Herrera
- Section of Infectious Diseases, Faculty of Medicine, St Mary's Campus, Imperial College, London, United Kingdom
| | - D. Noah Sather
- Seattle Biomedical Research Institute, Seattle, Washington
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16
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17
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Abstract
Lymphoblasts of the normal embryonic follicles of the chicken bursa of Fabricius undergo rapid apoptosis when exposed to gamma-radiation or when cell-cell contacts are disrupted by mechanical dispersion in short term culture. We have observed previously that overexpression of v-myc sensitizes preneoplastic bursal lymphoblasts to induction of cell death, whereas resistance to induced cell death is acquired during progression to neoplasia. In this study we observed extensive DNA degradation in the large majority of the lymphoblast population within the first hour after dispersion-induced apoptosis. Paradoxically these cells continued to progress into S-phase with the bulk of DNA cleavage and death occurring in S-phase cells (i.e., in cells with more than 2C and less than 4C DNA content). We confirmed the S phase status of apoptotic cells by determining that detection of nuclear cyclin A in individual cells also corresponded with detection of DNA breakage. Levels of cyclin E, cyclin E-dependent H1 histone kinase, and p53 proteins were maintained during dispersion-induced DNA cleavage. gamma-radiation failed either to inhibit cell cycle progression or to raise p53 levels in dispersed bursal lymphoblasts. In intact bursal follicles low doses of gamma-radiation induced p53 whereas higher, apoptosis-inducing doses failed to induce p53 or prevent G1 to S-phase progression. These results suggest that normal DNA damage-induced cell cycle checkpoint controls are lost or overridden when apoptosis is induced in bursal lymphoblasts.
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Affiliation(s)
- P E Neiman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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18
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Carey TS, Thomas D, Woolsey A, Proctor R, Philbeck M, Bowen G, Blish C, Fletcher S. Half a loaf is better than waiting for the bread truck. A computerized mini-medical record for outpatient care. Arch Intern Med 1992; 152:1845-9. [PMID: 1520051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a locally developed system for partial computer storage of medical data, called the mini-medical record system. The system produces a typed face sheet prior to each patient visit. The face sheet, which also serves as a progress note, contains patient demographic data, medical problem lists, previous vital signs, allergies, medication profile, and health maintenance reminders. Between regularly scheduled visits, all computerized data are available by computer printout for unscheduled visits to walk-in clinics and the emergency department. Structured reports are generated by the system that describes each resident and faculty members' practice. Quality assurance reports are also available. Since the system draws from several already existing databases, new data entry requirements are modest and cost to the institution is low. Partially computerized systems can be developed inexpensively and are well received in multispecialty practices, where interphysician communication is vital.
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Affiliation(s)
- T S Carey
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill 27599-7110
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19
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Abstract
When internal medicine residents leave teaching programs, continuity of care for outpatients is affected. The authors had departing residents send their patients computer-generated letters identifying another physician to provide continuing care. The letters were randomly withheld from 20% of the patients (NL), and they were compared with patients who received letters (RL). A telephone survey was administered and visits and no-show rates were determined. The RL patients more often knew of the change in provider (84% vs 54%, p less than 0.01) and identified the resident as the source of the information (77% vs 43%, p less than 0.01) than NL patients. There were no significant differences between RL and NL patients in mean numbers of appointments (1.0 vs 0.8) or no-show rates (24% vs 21%) following housestaff turnover. Both groups wanted to be told by the physician about future changes and were willing to be informed by letter. A computer-generated letter appears to be an effective way of notifying patients about transfer of care during the annual housestaff turnover in teaching programs.
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20
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Blish C, Retchin SM. Why a teaching hospital needs a department of medical informatics. Med Inform (Lond) 1984; 9:308-10. [PMID: 6503467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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