Prevalence of abnormalities on cardiac MRI in unselected patients after recovery from acute SARS-CoV-2 infection and correlation with markers of immunity and coagulation: the SETANTA study

Background

Previous studies have reported ongoing cardiac inflammation as assessed by cardiac magnetic resonance imaging (CMR) in a significant proportion of patients several months after recovery from SARS-CoV-2 infection, many of whom had no or minimal symptoms at the time of infection.

Purpose

The aim of SETANTA was to investigate the prevalence of cardiac abnormalities by CMR in unselected patients in Ireland after acute SARS-CoV-2 infection and the correlation with immunological response and biomarkers of coagulation.

Methods

This was a prospective, observational, community-based study (clinicaltrials.gov identifier NCT04823182). Consecutive patients recovered from recent SARS-CoV-2 infection at 3 primary care sites were invited to participate. Key inclusion/exclusion criteria and outcomes of interest are shown in Figure 1.

Results

100 participants were enrolled (Feb-Sept 2021) at a median of 188 (IQR, 125, 246) days after positive SARS-CoV-2 swab. At index infection, 18% and 35% reported severe and moderate symptoms, respectively; 14% were hospitalized; 3% were admitted to intensive care for ventilatory support. At enrolment, 83% had ongoing symptoms. 85% had detectable SARS-CoV-2 antigens. CMR and laboratory findings are shown in Figure 1.

Conclusion

Among an unselected cohort of patients recovered from acute SARS-CoV2 infection, we report a low prevalence of cardiac abnormalities by CMR, despite a high prevalence of moderate/severe symptoms at presentation and a high prevalence of persistent symptoms. Correlation with biomarkers of immunity and coagulation will be available at ESC 2022.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): WomenAsOne

A mutation in the voltage-gated sodium channel gene associated with pyrethroid resistance in Latin American Aedes aegypti

Pyrethroids are commonly used as mosquito adulticides and evolution of resistance to these compounds is a major threat to public health. 'Knockdown resistance' to pyrethroids (kdr) is frequently caused by nonsynonymous mutations in the voltage-gated sodium channel transmembrane protein (para) that reduce pyrethroid binding. Early detection of kdr is critical to the development of resistance management strategies in mosquitoes including Aedes aegypti, the most prevalent vector of dengue and yellow fever viruses. Brengues et al. described seven novel mutations in hydrophobic segment 6 of domain II of para in Ae. aegypti. Assays on larvae from strains bearing these mutations indicated reduced nerve sensitivity to permethrin inhibition. Two of these occurred in codons Iso1011 and Val1016 in exons 20 and 21 respectively. A transition in the third position of Iso1011 encoded a Met1011 replacement and a transversion in the second position of Val1016 encoded a Gly1016 replacement. We have screened this same region in 1318 mosquitoes in 32 additional strains; 30 from throughout Latin America. While the Gly1016 allele was never detected in Latin America, we found two new mutations in these same codons. A transition in the first position of codon 1011 encodes a Val replacement while a transition in the first position of codon 1016 encodes an Iso replacement. We developed PCR assays for these four mutations that can be read either on an agarose gel or as a melting curve. Selection experiments, one with deltamethrin on a field strain from Santiago de Cuba and another with permethrin on a strain from Isla Mujeres, Mexico rapidly increased the frequency of the Iso1016 allele. Bioassays of F(3) offspring arising from permethrin susceptible Val1016 homozygous parents and permethrin resistant Iso1016 homozygous parents show that Iso1016 segregates as a recessive allele in conferring kdr. Analysis of segregation between alleles at the 1011 and 1016 codons in the F(3) showed a high rate of recombination even though the two codons are only separated by a ~250 bp intron. The tools and information presented provide a means for early detection and characterization of kdr that is critical to the development of strategies for resistance management.

Detection of insecticide resistance in Aedes aegypti (Diptera: Culicidae) from Cuba and Venezuela

Four strains of Aedes aegypti (L.), one from Cuba and three from Venezuela, were bioassayed for susceptibility to eight insecticides, including the organophosphates, temephos, malathion, fenthion, pirimiphos methyl, and chlorpyrifos, and the pyrethroids, deltamethrin, lambda cyhalothrin and cypermethrin, S, S, S,-tributyl phosphorotrithioate and piperonyl butoxide were used as synergists to assess the involvement of esterases and monooxygenases in organophosphate resistance. Venezuelan strains had low levels of resistance to fenthion and malathion, and moderate to high resistance to temephos, pyrimphos methyl, and chlorpiriphos. All strains were susceptible to the pyrethroids, except the Cuban strain, which had moderate levels of resistance to cypermethrin. Organophosphate resistance in Ae. aegypti is a serious threat to control operations. Integrated strategies for Ae. aegypti control to prevent or delay pyrethroid resistance in Venezuela and Cuba are discussed.

[The selection of a strain of Culex quinquefasciatus resistant to lambdacyhalothrin and its spectrum of cross-resistance to other insecticides]

A field strain of Culex quinquefasciatus resistant to pyrethroid lambda-cyhalothrin insecticide was selected to be used as a reference strain in the laboratory for conducting studies of biochemistry and genetics of resistance, to evaluate the utility of this insecticide for the control of mosquitoes in Cuba, and to determine the cross resistance to organophosphate insecticides, pyrethroids and a carbamate. A high resistance to lambdacyhalothrin was obtained after 6 generations of selective pressure. Lowe or no cross resistance to other pyrethroids (deltamethrin and cypermethrin), to a carbamate (propoxur) and to the organophosphate insecticides (clorpirifos and methyl-pyrimifos) was observed. A high cross resistance to malathion (organophosphate) was detected.

[Resistance in a strain of Culex quinquefasciatus coming from Medellín, Colombia]

The levels of susceptibility and/or resistance to 5 organophosphate insecticides (malathion, methyl-pyrimifos, clorpirifos, temephos and fenthion), 4 pyrethroids (cypermethrin, deltamethrin, permethrin and lambda-cyhalothrin), and a carbamate (propoxur) were determined in order to know the state of resistance in a strain of Culex quinquefasciatus from a locality of the city of Medellín, Colombia. Resistance to all organophosphate insecticides, though with relatively lower values for methyloirimifos and fenthion, was observed. No resistance to lambda-cyhalothrin and cypermethrin or to propoxur was found. These insecticides may be useful for the control of mosquitoes in Colombia. It was demonstrated by using the piperonil butoxide synergist that the oxidases of multiple function played an important role in the resistance to organophosphate insecticides and pyrethroids. The utilization of S.S.S. tributyl phosphotritiate revealed that the superproduction of unspecific esterases was a mechanism of resistance to organophosphate insecticides, except methyl-pirimifos and for perythroids, except lambda-cyhalothrin. This result should be taken into consideration for the strategies to be used to control Culex quinquefasciatus in Colombia. These two mechanism of resistance are not responsible for the resistance to propoxur. The electrophoretic analysis showed the presence of esterases B1, A6 and B6, which seem to have an important function in resistance.

[Determination of insecticide resistance and its biochemical mechanisms in 2 strains of Culex quinquefasciatus from Santiago de Cuba]

It was analyzed the behavior of the resistance of 3 organophosphated insecticides (malathion, clorpirifos and methyl-pyrimifos), 3 pyrethroids (deltamethrin, lambda-cyhalothrin and cypermethrin), and 1 carbamate (propuxur) in populations of Culex quinquefasciatus from 2 municipalities of the province of Santiago de Cuba. The values of the resistance factor proved that there is resistance to malathion and clorpirifos. However, in spite of the existence of a high frequency of the mechanisms of elevated esterases and altered acetylcholinesterase no resistance to methylpymirifos, was observed which demonstrated that this insecticide is not affected by these mechanisms selected in our populations of Culex quinquefasciatus. There was resistence to deltamethrin, and lambda-cyhalothrin in Santiago de Cuba, whereas it was moderate to cypermethrin in Santiago and San Luis. Resistance to deltamethrin was also found in San Luis, but it was mild to lambda-cyhalothrin. The results obtained from the use of the synergists S,S,S tributyl phosphotritiade (DBF) and piperonyl butoxide (PB) indicated that the mechanisms of resistance of unspecific esterases and oxidases of multiple function are involved in the resistance to pyrethroids in both strains from Santiago de Cuba and San Luis. It was determined by the biochemical tests that there existed a high frequency of the mechanisms of esterases and altered acetylcholinesterase. The results of the polyacrylamide gel electrophoresis (PAGE) showed that esterase B1 appears more frequently associated with esterases A6 and B6. It was inferred that this association could be connected with the resistance to pyrethroids.

Cross-resistance to pyrethroid and organophosphorus insecticides in the southern house mosquito (Diptera:Culicidae) from Cuba

A sample of the southern house mosquito, Culex pipiens quinquefasciatus Say, from Cuba was subjected to lambda-cyhalothrin selection to evaluate the usefulness of this pyrethroid insecticide for mosquito control. High resistance developed after 6 generations of selection. Little or no cross-resistance was observed to other pyrethroids (deltamethrin and cypermethrin), to a carbamate (propoxur) and to some organophosphates (chlorpyrifos and pirimiphos-methyl), but high cross-resistance was found to malathion (organophosphate). Possible resistance mechanisms responsible for this phenomenon are discussed.

Duplication of the Ace.1 locus in Culex pipiens mosquitoes from the Caribbean

In Culex pipiens mosquitoes, AChE1 encoded by the locus Ace.1 is the target of organophosphorus and carbamate insecticides. In several resistant strains homozygous for Ace.1RR, insensitive AChE1 is exclusively found. An unusual situation occurs in two Caribbean resistant strains where each mosquito, at each generation, displays a mixture of sensitive and insensitive AChE1. These mosquitoes are not heterozygotes, Ace.1RS, as preimaginal mortalities cannot account for the lethality of both homozygous classes. This situation is best explained by the existence of two Ace.1 loci, coding, respectively, a sensitive and an insensitive AChE1. Thus, we suggest that in the Caribbean a duplication of the Ace.1 locus occurred before the appearance of insecticide resistance at one of the two copies.

Determination of Ace.1 Genotypes in Single Mosquitoes: Toward an Ecumenical Biochemical Test

The occurrence of two acetylcholinesterases, AChE1 and AChE2, in the mosquito Culex pipiens has been recently documented. Resistance to organophosphates and carbamates due to target insensitivity is the result of a qualitative change of only AChE1, encoded by the Ace.1 gene. Because AChE1 and AChE2 differ in their sensitivity to inhibitors, Ace.1 genotypes can be misclassified by previous tests. We describe a new rapid microplate test that allows unambiguous identification of Ace.1 genotypes. This test involves comparing AChE activities in the absence of insecticide and in the presence of two propoxur concentrations: a low concentration that inhibits only the sensitive AChE1 and a higher concentration that inhibits also AChE2 but not the insensitive AChE1 responsible of insecticide resistance. This comparison allows the identification of the three Ace.1 genotypes: resistant (Ace.1RR), susceptible (Ace.1SS) homozygotes, and heterozygotes (Ace.1RS). The similarity of propoxur sensitivity of modified AChE1s found in various resistant strains from the United States, Europe, and Africa indicates that this test is probably suitable for all the Ace.1 alleles described so far in C. pipiens.

Detoxifying esterases in Culex pipiens quinquefasciatus from the Caribbean countries

Several over-produced esterases confer resistance to organophosphorus insecticides in the Culex pipiens complex. We describe their distribution in islands and countries of the Caribbean region based on new collections and previous studies, and discuss the need to: 1) undertake DNA studies to correctly identify the esterase B alleles that are amplified in different regions, and 2) investigate the variability among gene copies within each amplification system in order to fully understand their origin and their evolution through time.

Effects of three organophosphorus insecticides in the reproductive potential of Culex quinquefasciatus

A Culex quinquefasciatus Say 1823 strain with resistant genes to organophosphates was tested in the laboratory to know the reproductive potential after exposure, as larvae, at the LC30 and LC70 (mg/l) of three organophosphorus insecticides: malathion, chlorpyrifos and methyl-pirimiphos. Data showed that fecundity was decreased significantly by malathion at LC30 = 0.0025 and LC70 = 0.0075, whereas fertility has a no significant decrement by chlorpyrifos and methyl-pirimiphos at the LC70 (0.000016, 0.00043). The sexual index was affected by chlorpyrifos and methyl-pirimiphos showing a greater number of adult females.

Use of antibiotic resistance mutations to track strains of obligately anaerobic bacteria introduced into the rumen of sheep

Selective plating procedures were used to follow the fate of rifampicin-resistant mutant strains of the obligately anaerobic species Bacteroides multiacidus and Selenomonas ruminantium after their introduction at numbers around 10(7)/ml into the rumen of sheep. Bacteroides multiacidus strain F100 showed an initially rapid rate of loss (49%/h) but subsequently numbers declined more gradually approaching the limits of detection (less than 10(3)/ml) after 100 h. Viable cell numbers also decreased in vitro upon addition of F100 cells to whole rumen contents, but remained stable upon addition to cell-free rumen fluid, suggesting protozoal predation. F100 cells were able to grow in vitro in whole rumen contents in the presence of an added utilizable substrate such as sorbitol, but addition of sorbitol to the rumen failed to enhance survival in vivo. In the case of S. ruminantium, introduced rifR strains persisted in the rumen at levels around 10(6) ml for at least 30 days.

Molecular cloning of genes from Ruminococcus flavefaciens encoding xylanase and beta(1-3,1-4)glucanase activities

Clones expressing activity against xylan or beta(1-3,1-4)glucan (lichenan) were isolated from a library of Ruminococcus flavefaciens 17 DNA made in bacteriophage lambda EMBL3. Hybridization analyses indicated the recovery of four separate genes encoding xylanases that showed no detectable associated carboxylmethylcellulase activity. One of these genes was associated with clones that also expressed beta(1-3,1-4)glucanase and beta-xylosidase activities.

[Larval density of Anopheles (N) albimanus Wiedemann, 1821 in relation to phenology of Oryza sativa (Linnaeus) rice]

The larval density of Anopheles (N) albimanus Wiedemann, 1821, is linked with rice phenology in the two crops of the year (summer and winter). It was determined that a higher density agrees with the second stage of the vegetative cycle of the culture named beginning of shooting processes and the formation of the panicular primordium. The number of anopheline larvae was higher in the summer.

Plasmid-associated transfer of tetracycline resistance in Bacteroides ruminicola

Tetracycline resistance was transferred at frequencies between 10(-7) and 10(-6) per recipient cell in anaerobic matings between two strains of the strictly anaerobic rumen bacterium Bacteroides ruminicola. The donor strain, 223/M2/7, was a multiple-plasmid-bearing tetracycline-resistant strain from the ovine rumen, and the recipient, F101, was a rifampin-resistant mutant of B14, a bovine strain belonging to B. ruminicola subsp. brevis. Resistance transfer could occur in the presence of DNase, but not in dummy mating mixtures in which filtrate from a donor culture replaced donor cells. Acquisition of tetracycline resistance by the recipient was accompanied by the appearance of a 19.5-kilobase pair plasmid (designated pRRI4) which was homologous with a plasmid of similar size and restriction pattern present in the donor strain. A transconjugant (F115) carrying pRRI4 was also able to act as a donor of tetracycline resistance and plasmid DNA in matings with another recipient. Derivatives of F115 that had spontaneously lost tetracycline resistance lacked detectable plasmid DNA. It is concluded that pRRI4 mediated the transfer of tetracycline resistance. Transfer of resistance was not detectably enhanced by pregrowth of the donor in medium containing tetracycline. Transfer of tetracycline resistance was not detected from 223/M2/7 to a strain, 23 belonging to B. ruminicola subsp. ruminicola.

An intra-corpus luteum site for the luteolytic action of prostaglandin F2 alpha in the rhesus monkey

It has not been possible to demonstrate prostaglandin F2 alpha (PGF2 alpha) participation in primate luteolysis under conditions of systemic administration or of acute intraluteal injection. These study designs were hampered by the short biological half-life in the first instance and brevity of administration in the latter. In this study, luteolysis has resulted from chronic, intraluteal delivery of PGF2 alpha. Using the Alzet osmotic pump-cannula system, normally cycling rhesus monkeys were continuously infused, until menses occurred, with PGF2 alpha (10 ng/1/hr) directly into the corpus luteum (CL, n = 6), into the stroma of the ovary not bearing the corpus luteum (NCL, n = 3), or subcutaneously (SC, n = 5). An additional 5 monkeys received vehicle (V) into the corpus luteum. All experiments commenced 5-7 days after the preovulatory estradiol surge. Luteal function was assessed by the daily measurements of plasma progesterone, estradiol, and LH. Intraluteal PGF2 alpha caused premature functional luteolysis in all monkeys, as reflected by a highly significant decline in circulating progesterone and estradiol and the early onset of menstruation, when compared to the other groups. V, NCL, and SC infusions had no effect on either circulating steroid levels or luteal phase lengths. None of the experimental groups showed any change in plasma LH concentrations. These are the first data to indicate that PGF2 alpha can induce functional luteolysis in the primate, and the site of action appears to be the corpus luteum.

[Metabolism of fibrinogen in the cirrhotic patient. Dynamic study by isotope method]

The authors studied the metabolism of fibrinogen labelled with iodine 125 in 57 cirrhotic patients and 25 controls. Their results show that if the 82 subjects are grouped according to biological period values (T) and plasma pool (N.I.) of each of them, 4 distinct populations emerge. In each of these 4 groups a physiopathological interpretation of fibrinogen metabolism may be proposed. In the context of consumption coagulopathies in cirrhosis, the examination is of real value and offers an objective criterion of therapeutic effectiveness.