1
|
Yoon H, Li Y, Goldfeld KS, Cobb GF, Sturm-Reganato CL, Ostrosky-Zeichner L, Jayaweera DT, Philley JV, Desruisseaux MS, Keller MJ, Hochman JS, Pirofski LA, Ortigoza MB. COVID-19 Convalescent Plasma Therapy: Long-term Implications. Open Forum Infect Dis 2024; 11:ofad686. [PMID: 38269049 PMCID: PMC10807994 DOI: 10.1093/ofid/ofad686] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Background The long-term effect of coronavirus disease 2019 (COVID-19) acute treatments on postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is unknown. The CONTAIN-Extend study explores the long-term impact of COVID-19 convalescent plasma (CCP) therapy on postacute sequelae of SARS-CoV-2 infection (PASC) symptoms and general health 18 months following hospitalization. Methods The CONTAIN-Extend study examined 281 participants from the original CONTAIN COVID-19 trial (CONTAIN-RCT, NCT04364737) at 18 months post-hospitalization for acute COVID-19. Symptom surveys, global health assessments, and biospecimen collection were performed from November 2021 to October 2022. Multivariable logistic and linear regression estimated associations between the randomization arms and self-reported symptoms and Patient-Reported Outcomes Measurement Information System (PROMIS) scores and adjusted for covariables, including age, sex, race/ethnicity, disease severity, and CONTAIN enrollment quarter and sites. Results There were no differences in symptoms or PROMIS scores between CCP and placebo (adjusted odds ratio [aOR] of general symptoms, 0.95; 95% CI, 0.54-1.67). However, females (aOR, 3.01; 95% CI, 1.73-5.34), those 45-64 years (aOR, 2.55; 95% CI, 1.14-6.23), and April-June 2020 enrollees (aOR, 2.39; 95% CI, 1.10-5.19) were more likely to report general symptoms and have poorer PROMIS physical health scores than their respective reference groups. Hispanic participants (difference, -3.05; 95% CI, -5.82 to -0.27) and Black participants (-4.48; 95% CI, -7.94 to -1.02) had poorer PROMIS physical health than White participants. Conclusions CCP demonstrated no lasting effect on PASC symptoms or overall health in comparison to the placebo. This study underscores the significance of demographic factors, including sex, age, and timing of acute infection, in influencing symptom reporting 18 months after acute hypoxic COVID-19 hospitalization.
Collapse
Affiliation(s)
- Hyunah Yoon
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Yi Li
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Keith S Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Gia F Cobb
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Dushyantha T Jayaweera
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Clinical and Translational Science Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Tyler, UTHealth East Texas, Tyler, Texas, USA
| | - Mahalia S Desruisseaux
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marla J Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Judith S Hochman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mila B Ortigoza
- Division of Infectious Diseases, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NYU Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
2
|
Ndunge OBA, Shikani HJ, Dai M, Freeman BD, Desruisseaux MS. Effects of anti-tau immunotherapy on reactive microgliosis, cerebral endotheliopathy, and cognitive function in an experimental model of cerebral malaria. J Neurochem 2023; 167:441-460. [PMID: 37814468 PMCID: PMC10596299 DOI: 10.1111/jnc.15972] [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: 08/08/2022] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Cerebral malaria (CM), a potentially fatal encephalopathy caused primarily by infection with Plasmodium falciparum, results in long-term adverse neuro-psychiatric sequelae. Neural cell injury contributes to the neurological deficits observed in CM. Abnormal regulation of tau, an axonal protein pathologically associated with the formation of neurofibrillary lesions in neurodegenerative diseases, has been linked to inflammation and cerebral microvascular compromise and has been reported in human and experimental CM (ECM). Immunotherapy with a monoclonal antibody to pathological tau (PHF-1 mAB) in experimental models of neurodegenerative diseases has been reported to mitigate cognitive decline. We investigated whether immunotherapy with PHF-1 mAB prevented cerebral endotheliopathy, neural cell injury, and neuroinflammation during ECM. Using C57BL/6 mice infected with either Plasmodium berghei ANKA (PbA), which causes ECM, Plasmodium berghei NK65 (PbN), which causes severe malaria, but not ECM, or uninfected mice (Un), we demonstrated that when compared to PbN infection or uninfected mice, PbA infection resulted in significant memory impairment at 6 days post-infection, in association with abnormal tau phosphorylation at Ser202 /Thr205 (pSer202 /Thr205 ) and Ser396-404 (pSer396-404 ) in mouse brains. ECM also resulted in significantly higher expression of inflammatory markers, in microvascular congestion, and glial cell activation. Treatment with PHF-1 mAB prevented PbA-induced cognitive impairment and was associated with significantly less vascular congestion, neuroinflammation, and neural cell activation in mice with ECM. These findings suggest that abnormal regulation of tau protein contributes to cerebral vasculopathy and is critical in the pathogenesis of neural cell injury during CM. Tau-targeted therapies may ameliorate the neural cell damage and subsequent neurocognitive impairment that occur during disease.
Collapse
Affiliation(s)
| | - Henry J. Shikani
- Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Minxian Dai
- Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Brandi D. Freeman
- Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Mahalia S. Desruisseaux
- Correspondence and reprint requests: Mahalia S. Desruisseaux, MD, Associate Professor of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, PO Box 208022, TAC S169B, New Haven, CT 06520-8022,
| |
Collapse
|
3
|
Hill K, Kuo I, Shenoi SV, Desruisseaux MS, Springer SA. Integrated Care Models: HIV and Substance Use. Curr HIV/AIDS Rep 2023; 20:286-295. [PMID: 37698755 PMCID: PMC11034717 DOI: 10.1007/s11904-023-00667-9] [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] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Behaviors and practices associated with substance use contribute to lack of HIV virologic suppression and onward transmission. In the USA, many recent HIV outbreaks have been connected with substance use. Evidence-based strategies for integrating care of those at risk for and living with HIV and who use substances continue to evolve. This review, based on scientific and medical literature through March 2023, provides an overview and evaluation of initiatives for integrated care aimed to serve patients at risk for and with HIV and a substance use disorder. RECENT FINDINGS Integrated care services can improve health outcomes for patients at risk for and with HIV and a substance use disorder; for instance, treatment for an opioid use disorder can help improve HIV viral suppression. Brick-and-mortar facilities can provide successful care integration with appropriate clinic leadership to support multidisciplinary care teams, up-to-date provider training, and sufficient pharmacy stock for substance use treatment. Delivering healthcare services to communities (e.g., mobile healthcare clinics and pharmacies, telehealth) may prove to be an effective way to provide integrated services for those with or at risk of HIV and substance use disorders. Incorporating technology (e.g., mobile phone applications) may facilitate integrated care. Other venues, including harm reduction programs and carceral settings, should be targets for integrated services. Venues providing healthcare should invest in integrated care and support legislation that increases access to services related to HIV and substance use.
Collapse
Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA
| | - Sheela V Shenoi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA
- Yale Institute of Global Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
- The Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Mahalia S Desruisseaux
- Yale Institute of Global Health, New Haven, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
- The Veterans Administration Connecticut Healthcare System, West Haven, CT, USA.
| |
Collapse
|
4
|
Gleeson SE, Zapata H, Bathgate ME, Emu B, Frederick J, Friedland G, Golden MP, Meyer JP, Radin J, Sideleau R, Shaw A, Shenoi SV, Trubin PA, Virata M, Barakat LA, Desruisseaux MS. Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections. Clin Infect Dis 2023; 77:703-710. [PMID: 37078888 DOI: 10.1093/cid/ciad236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.
Collapse
Affiliation(s)
- Shana E Gleeson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Heidi Zapata
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meghan E Bathgate
- The Poorvu Center for Teaching and Learning, Yale University, New Haven, Connecticut, USA
| | - Brinda Emu
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Frederick
- The Poorvu Center for Teaching and Learning, Yale University, New Haven, Connecticut, USA
| | - Gerald Friedland
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Marjorie P Golden
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaimie P Meyer
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joanna Radin
- Department of History, Yale University, New Haven, Connecticut, USA
| | - Robert Sideleau
- New England AIDS Education and Training Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Albert Shaw
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sheela V Shenoi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul A Trubin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Virata
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lydia A Barakat
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | |
Collapse
|
5
|
Ortigoza MB, Yoon H, Goldfeld KS, Troxel AB, Daily JP, Wu Y, Li Y, Wu D, Cobb GF, Baptiste G, O'Keeffe M, Corpuz MO, Ostrosky-Zeichner L, Amin A, Zacharioudakis IM, Jayaweera DT, Wu Y, Philley JV, Devine MS, Desruisseaux MS, Santin AD, Anjan S, Mathew R, Patel B, Nigo M, Upadhyay R, Kupferman T, Dentino AN, Nanchal R, Merlo CA, Hager DN, Chandran K, Lai JR, Rivera J, Bikash CR, Lasso G, Hilbert TP, Paroder M, Asencio AA, Liu M, Petkova E, Bragat A, Shaker R, McPherson DD, Sacco RL, Keller MJ, Grudzen CR, Hochman JS, Pirofski LA, Parameswaran L, Corcoran AT, Rohatgi A, Wronska MW, Wu X, Srinivasan R, Deng FM, Filardo TD, Pendse J, Blaser SB, Whyte O, Gallagher JM, Thomas OE, Ramos D, Sturm-Reganato CL, Fong CC, Daus IM, Payoen AG, Chiofolo JT, Friedman MT, Wu DW, Jacobson JL, Schneider JG, Sarwar UN, Wang HE, Huebinger RM, Dronavalli G, Bai Y, Grimes CZ, Eldin KW, Umana VE, Martin JG, Heath TR, Bello FO, Ransford DL, Laurent-Rolle M, Shenoi SV, Akide-Ndunge OB, Thapa B, Peterson JL, Knauf K, Patel SU, Cheney LL, Tormey CA, Hendrickson JE. Efficacy and Safety of COVID-19 Convalescent Plasma in Hospitalized Patients: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:115-126. [PMID: 34901997 PMCID: PMC8669605 DOI: 10.1001/jamainternmed.2021.6850] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19. OBJECTIVE To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen. DESIGN, SETTING, AND PARTICIPANTS CONTAIN COVID-19, a randomized, double-blind, placebo-controlled trial of CCP in hospitalized adults with COVID-19, was conducted at 21 US hospitals from April 17, 2020, to March 15, 2021. The trial enrolled 941 participants who were hospitalized for 3 or less days or presented 7 or less days after symptom onset and required noninvasive oxygen supplementation. INTERVENTIONS A unit of approximately 250 mL of CCP or equivalent volume of placebo (normal saline). MAIN OUTCOMES AND MEASURES The primary outcome was participant scores on the 11-point World Health Organization (WHO) Ordinal Scale for Clinical Improvement on day 14 after randomization; the secondary outcome was WHO scores determined on day 28. Subgroups were analyzed with respect to age, baseline WHO score, concomitant medications, symptom duration, CCP SARS-CoV-2 titer, baseline SARS-CoV-2 serostatus, and enrollment quarter. Outcomes were analyzed using a bayesian proportional cumulative odds model. Efficacy of CCP was defined as a cumulative adjusted odds ratio (cOR) less than 1 and a clinically meaningful effect as cOR less than 0.8. RESULTS Of 941 participants randomized (473 to placebo and 468 to CCP), 556 were men (59.1%); median age was 63 years (IQR, 52-73); 373 (39.6%) were Hispanic and 132 (14.0%) were non-Hispanic Black. The cOR for the primary outcome adjusted for site, baseline risk, WHO score, age, sex, and symptom duration was 0.94 (95% credible interval [CrI], 0.75-1.18) with posterior probability (P[cOR<1] = 72%); the cOR for the secondary adjusted outcome was 0.92 (95% CrI, 0.74-1.16; P[cOR<1] = 76%). Exploratory subgroup analyses suggested heterogeneity of treatment effect: at day 28, cORs were 0.72 (95% CrI, 0.46-1.13; P[cOR<1] = 93%) for participants enrolled in April-June 2020 and 0.65 (95% CrI, 0.41 to 1.02; P[cOR<1] = 97%) for those not receiving remdesivir and not receiving corticosteroids at randomization. Median CCP SARS-CoV-2 neutralizing titer used in April to June 2020 was 1:175 (IQR, 76-379). Any adverse events (excluding transfusion reactions) were reported for 39 (8.2%) placebo recipients and 44 (9.4%) CCP recipients (P = .57). Transfusion reactions occurred in 2 (0.4) placebo recipients and 8 (1.7) CCP recipients (P = .06). CONCLUSIONS AND RELEVANCE In this trial, CCP did not meet the prespecified primary and secondary outcomes for CCP efficacy. However, high-titer CCP may have benefited participants early in the pandemic when remdesivir and corticosteroids were not in use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04364737.
Collapse
Affiliation(s)
- Mila B Ortigoza
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York.,Department of Microbiology, NYU Grossman School of Medicine, New York, New York
| | - Hyunah Yoon
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Johanna P Daily
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Yinxiang Wu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Yi Li
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Danni Wu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Gia F Cobb
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Gillian Baptiste
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Mary O'Keeffe
- Department of Medicine, NYU Long Island School of Medicine, Mineola, New York
| | - Marilou O Corpuz
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Luis Ostrosky-Zeichner
- Division of Infectious Disease, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Amee Amin
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Ioannis M Zacharioudakis
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Dushyantha T Jayaweera
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.,Miami Clinical and Translational Science Institute, University of Miami Miller School of Medicine Miami, Florida
| | - Yanyun Wu
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Tyler, UTHealth East Texas, Tyler
| | - Megan S Devine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Tyler, UTHealth East Texas, Tyler
| | - Mahalia S Desruisseaux
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Shweta Anjan
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Reeba Mathew
- Division of Critical Care, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Bela Patel
- Division of Critical Care, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Masayuki Nigo
- Division of Infectious Disease, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Rabi Upadhyay
- Department of Medicine, NYU Grossman School of Medicine, New York, New York.,Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York
| | - Tania Kupferman
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Andrew N Dentino
- Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg
| | - Rahul Nanchal
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David N Hager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kartik Chandran
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan R Lai
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York
| | - Johanna Rivera
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Chowdhury R Bikash
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York
| | - Gorka Lasso
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Timothy P Hilbert
- Department of Pathology, NYU Grossman School of Medicine, New York, New York
| | - Monika Paroder
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea A Asencio
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York.,Department of Environmental Health, NYU Grossman School of Medicine, New York, New York
| | - Eva Petkova
- Department of Population Health, NYU Grossman School of Medicine, New York, New York.,Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Alexander Bragat
- Clinical Research Information Technology and Informatics, NYU Grossman School of Medicine, New York, New York
| | - Reza Shaker
- Clinical and Translational Science Institute of Southern Wisconsin, Medical College of Wisconsin Milwaukee
| | - David D McPherson
- Center for Clinical and Translational Sciences, Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Ralph L Sacco
- Miami Clinical and Translational Science Institute, University of Miami Miller School of Medicine Miami, Florida
| | - Marla J Keller
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine and Montefiore Medical Center Bronx, New York
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York.,NYC Health and Hospitals Corporation Clinical and Translational Science Institute, NYU Grossman School of Medicine, New York, New York
| | - Judith S Hochman
- NYC Health and Hospitals Corporation Clinical and Translational Science Institute, NYU Grossman School of Medicine, New York, New York.,Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Liise-Anne Pirofski
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Lalitha Parameswaran
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Anthony T Corcoran
- Department of Urology, NYU Long Island School of Medicine, Mineola, New York
| | - Abhinav Rohatgi
- Department of Medicine, NYU Long Island School of Medicine, Mineola, New York
| | - Marta W Wronska
- Department of Medicine, NYU Long Island School of Medicine, Mineola, New York
| | - Xinyuan Wu
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Ranjini Srinivasan
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Fang-Ming Deng
- Department of Pathology, NYU Grossman School of Medicine, New York, New York
| | - Thomas D Filardo
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Jay Pendse
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Simone B Blaser
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Olga Whyte
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | | | - Ololade E Thomas
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Danibel Ramos
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | | | - Charlotte C Fong
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Ivy M Daus
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | | | - Joseph T Chiofolo
- Department of Pathology, NYU Long Island School of Medicine, Mineola, New York
| | - Mark T Friedman
- Department of Pathology, NYU Long Island School of Medicine, Mineola, New York
| | - Ding Wen Wu
- Department of Pathology, NYU Grossman School of Medicine, New York, New York
| | - Jessica L Jacobson
- Department of Pathology, NYU Grossman School of Medicine, New York, New York
| | - Jeffrey G Schneider
- Department of Medicine, NYU Long Island School of Medicine, Mineola, New York
| | - Uzma N Sarwar
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Pfizer Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York
| | - Henry E Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston.,Department of Emergency Medicine, The Ohio State University, Ohio
| | - Ryan M Huebinger
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Goutham Dronavalli
- Division of Critical Care, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Carolyn Z Grimes
- Division of Infectious Disease, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Karen W Eldin
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Virginia E Umana
- Division of Infectious Disease, Department of Internal Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Jessica G Martin
- Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg
| | - Timothy R Heath
- Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg
| | - Fatimah O Bello
- Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg
| | - Daru Lane Ransford
- Miami Clinical and Translational Science Institute, University of Miami Miller School of Medicine Miami, Florida
| | - Maudry Laurent-Rolle
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sheela V Shenoi
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Oscar Bate Akide-Ndunge
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Bipin Thapa
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Jennifer L Peterson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Kelly Knauf
- Clinical and Translational Science Institute of Southern Wisconsin, Medical College of Wisconsin Milwaukee
| | - Shivani U Patel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Laura L Cheney
- Division of Infectious Disease, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
6
|
Gleeson S, Bathgate M, Frederick J, Desruisseaux MS, Meyer J, Virata MD, Zapata H, Shenoi S, Radin J, Golden M, Trubin P, Shaw A, Friedland G, Aoun-Barakat LA. 87. Infectious Disease Diversity, Equity, and Antiracism (ID2EA): A Dedicated Curriculum for Infectious Disease Professionals. Open Forum Infect Dis 2021. [PMCID: PMC8644171 DOI: 10.1093/ofid/ofab466.087] [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] [Indexed: 11/13/2022] Open
Abstract
Background Systemic bias in the health care system has adverse effects on health outcomes. Educational programs examining the relationship between structural racism and health inequities are needed to translate knowledge into equitable care. The Yale School of Medicine Infectious Disease (ID) Section designed and piloted an innovative Infectious Disease Diversity, Equity, and Anti-Racism (ID2EA) curriculum to better understand and confront these issues. Methods The ID Section collaborated with pedagogical experts to create a curriculum. A baseline survey of ID faculty and trainees was used to gauge relevant knowledge, attitudes, skills, and topics of interest to participants. The curriculum was designed as a “roadmap” of interactive sessions (“roadmap stops”) focused on topics identified by respondents. Evaluations were performed after events to guide curriculum development and monitor its acceptance and effectiveness. Results All respondents (n=28) to the baseline survey agreed that discussion of race and ethnicity should be integrated into medical training. Most respondents (96%) had experience or knowledge of racial microaggressions in the workplace. Fewer (75%) felt comfortable talking to patients about race and only 68% felt confident teaching learners how to decrease bias in care. The survey identified topics of highest priority to participants, including building trust with patients (75%), providing racially sensitive care (68%) and establishing dialogue with community members (57%). Roadmap stops were constructed based on these priorities, with sessions on race-based medical experimentation and inequities, racial segregation and its impact on health, medical mistrust, and a skill building session on improving patient-centered communication. On follow-up surveys (n=18-28), most participants (93%) saw the sessions as a valuable way to spend time and the majority (91%) reported an impact on their understanding of racism in healthcare; specific changes in thinking were qualitatively coded. ![]()
![]()
![]()
Conclusion Our findings demonstrate the positive impact of a curriculum to help understand racism and inequities in medicine. Building and implementing a diversity, inclusion, and anti-racism curriculum in ID sections is feasible, beneficial, and valued. Disclosures Jaimie Meyer, MD, Gilead Sciences (Scientific Research Study Investigator) Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.) Marjorie Golden, MD, Iterum Pharmaceuticals (Consultant)
Collapse
Affiliation(s)
| | - Meghan Bathgate
- Yale Poorvu Center for Teaching and Learning, New Haven, Connecticut
| | | | | | | | | | | | | | | | | | - Paul Trubin
- Yale School of Medicine, Branford, Connecticut
| | - Albert Shaw
- Yale School of Medicine, Branford, Connecticut
| | | | | |
Collapse
|
7
|
Briggs N, Gormally MV, Li F, Browning SL, Treggiari MM, Morrison A, Laurent-Rolle M, Deng Y, Hendrickson JE, Tormey CA, Desruisseaux MS. Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19. PLoS One 2021; 16:e0254453. [PMID: 34320004 PMCID: PMC8318280 DOI: 10.1371/journal.pone.0254453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/26/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. RESEARCH QUESTION What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? STUDY DESIGN AND METHODS We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. RESULTS Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. INTERPRETATION Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.
Collapse
Affiliation(s)
- Neima Briggs
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Michael V. Gormally
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, United States of America
| | - Sabrina L. Browning
- Section of Hematology, Department of Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Miriam M. Treggiari
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Alyssa Morrison
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Maudry Laurent-Rolle
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, United States of America
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Christopher A. Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Mahalia S. Desruisseaux
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| |
Collapse
|
8
|
Desruisseaux MS, Tan TQ. Inclusion, Diversity, Access, and Equity (IDA&E) Roadmap: Infectious Diseases Society of America's Commitment to the Future. J Infect Dis 2021; 222:S523-S527. [PMID: 32926738 DOI: 10.1093/infdis/jiaa153] [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] [Indexed: 11/13/2022] Open
Abstract
This article identifies the major elements of the strategic road map for the Infectious Diseases Society of America's (IDSA) Inclusion, Diversity, Access, and Equity (IDA&E) initiative and discusses the long-term goals and the proposed steps needed to achieve these goals.
Collapse
Affiliation(s)
- Mahalia S Desruisseaux
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tina Q Tan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| |
Collapse
|
9
|
Freeman BD, Martins YC, Akide-Ndunge OB, Bruno FP, Wang H, Tanowitz HB, Spray DC, Desruisseaux MS. Endothelin-1 Mediates Brain Microvascular Dysfunction Leading to Long-Term Cognitive Impairment in a Model of Experimental Cerebral Malaria. PLoS Pathog 2016; 12:e1005477. [PMID: 27031954 PMCID: PMC4816336 DOI: 10.1371/journal.ppat.1005477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/14/2015] [Accepted: 02/08/2016] [Indexed: 01/29/2023] Open
Abstract
Plasmodium falciparum infection causes a wide spectrum of diseases, including cerebral malaria, a potentially life-threatening encephalopathy. Vasculopathy is thought to contribute to cerebral malaria pathogenesis. The vasoactive compound endothelin-1, a key participant in many inflammatory processes, likely mediates vascular and cognitive dysfunctions in cerebral malaria. We previously demonstrated that C57BL6 mice infected with P. berghei ANKA, our fatal experimental cerebral malaria model, sustained memory loss. Herein, we demonstrate that an endothelin type A receptor (ETA) antagonist prevented experimental cerebral malaria-induced neurocognitive impairments and improved survival. ETA antagonism prevented blood-brain barrier disruption and cerebral vasoconstriction during experimental cerebral malaria, and reduced brain endothelial activation, diminishing brain microvascular congestion. Furthermore, exogenous endothelin-1 administration to P. berghei NK65-infected mice, a model generally regarded as a non-cerebral malaria negative control for P. berghei ANKA infection, led to experimental cerebral malaria-like memory deficits. Our data indicate that endothelin-1 is critical in the development of cerebrovascular and cognitive impairments with experimental cerebral malaria. This vasoactive peptide may thus serve as a potential target for adjunctive therapy in the management of cerebral malaria. The parasite Plasmodium falciparum is the primary cause of cerebral malaria, a neurological manifestation of severe malaria. Cerebral malaria results in disturbances to the blood vessels of the brain, eventually leading to damage to the blood-brain barrier. This damage can lead to adverse, debilitating neurological complications, particularly in children and individuals with compromised immune systems. Yet there is still a considerable gap in understanding the causes of the detrimental neurological effects of P. falciparum infection. We employed a multidisciplinary approach to delineate the mechanisms by which Plasmodium infection causes these abnormalities. The vasoactive peptide endothelin-1 is implicated in a variety of neurological and inflammatory diseases. Using mouse experimental models of cerebral malaria, we demonstrated that targeting this protein resulted in stabilization of the blood vessels in the brain, decreased the influx of inflammatory cells to the brain vessels, and preserved the integrity of the blood-brain barrier, eventually leading to improved cognitive function and improved survival rates in mice with infection. It is our hope that our work will help extend understanding of the causes of cerebral malaria in humans, and may eventually lead to therapies for preservation or salvaging of neurological function in the management of this disease.
Collapse
Affiliation(s)
- Brandi D. Freeman
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Yuri C. Martins
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Oscar B. Akide-Ndunge
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Fernando P. Bruno
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Hua Wang
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - David C. Spray
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mahalia S. Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
| |
Collapse
|
10
|
Martins YC, Tanowitz HB, Weiss LM, Desruisseaux MS. Endothelin-1 treatment induces experimental cerebral malaria during Plasmodium berghei NK65 infection. Life Sci 2013. [DOI: 10.1016/j.lfs.2013.12.107] [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: 10/25/2022]
|
11
|
Nagajyothi F, Kuliawat R, Kusminski CM, Machado FS, Desruisseaux MS, Zhao D, Schwartz GJ, Huang H, Albanese C, Lisanti MP, Singh R, Li F, Weiss LM, Factor SM, Pessin JE, Scherer PE, Tanowitz HB. Alterations in glucose homeostasis in a murine model of Chagas disease. Am J Pathol 2013; 182:886-94. [PMID: 23321322 DOI: 10.1016/j.ajpath.2012.11.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/16/2012] [Accepted: 11/30/2012] [Indexed: 11/30/2022]
Abstract
Chagas disease, caused by Trypanosoma cruzi, is an important cause of morbidity and mortality primarily resulting from cardiac dysfunction, although T. cruzi infection results in inflammation and cell destruction in many organs. We found that T. cruzi (Brazil strain) infection of mice results in pancreatic inflammation and parasitism within pancreatic β-cells with apparent sparing of α cells and leads to the disruption of pancreatic islet architecture, β-cell dysfunction, and surprisingly, hypoglycemia. Blood glucose and insulin levels were reduced in infected mice during acute infection and insulin levels remained low into the chronic phase. In response to the hypoglycemia, glucagon levels 30 days postinfection were elevated, indicating normal α-cell function. Administration of L-arginine and a β-adrenergic receptor agonist (CL316, 243, respectively) resulted in a diminished insulin response during the acute and chronic phases. Insulin granules were docked, but the lack of insulin secretion suggested an inability of granules to fuse at the plasma membrane of pancreatic β-cells. In the liver, there was a concomitant reduced expression of glucose-6-phosphatase mRNA and glucose production from pyruvate (pyruvate tolerance test), demonstrating defective hepatic gluconeogenesis as a cause for the T. cruzi-induced hypoglycemia, despite reduced insulin, but elevated glucagon levels. The data establishes a complex, multi-tissue relationship between T. cruzi infection, Chagas disease, and host glucose homeostasis.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Division of Parasitology and Tropical Medicine, Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Infectious diseases are the second leading cause of death worldwide. Noninvasive small-animal imaging has become an important research tool for preclinical studies of infectious diseases. Imaging studies permit enhanced information through longitudinal studies of the same animal during the infection. Herein, we briefly review recent studies of animal models of infectious disease that have used imaging modalities.
Collapse
Affiliation(s)
- Linda A Jelicks
- Department of Physiology and Biophysics and the Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Shikani HJ, Freeman BD, Lisanti MP, Weiss LM, Tanowitz HB, Desruisseaux MS. Cerebral malaria: we have come a long way. Am J Pathol 2012; 181:1484-92. [PMID: 23021981 DOI: 10.1016/j.ajpath.2012.08.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/30/2012] [Accepted: 08/13/2012] [Indexed: 01/21/2023]
Abstract
Despite decades of research, cerebral malaria remains one of the most serious complications of Plasmodium infection and is a significant burden in Sub-Saharan Africa, where, despite effective antiparasitic treatment, survivors develop long-term neurological sequelae. Although much remains to be discovered about the pathogenesis of cerebral malaria, The American Journal of Pathology has been seminal in presenting original research from both human and experimental models. These studies have afforded significant insight into the mechanism of cerebral damage in this devastating disease. The present review highlights information gleaned from these studies, especially in terms of their contributions to the understanding of cerebral malaria.
Collapse
Affiliation(s)
- Henry J Shikani
- Division of Parasitology and Tropical Medicine, Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | |
Collapse
|
14
|
Dai M, Freeman B, Bruno FP, Shikani HJ, Tanowitz HB, Weiss LM, Reznik SE, Stephani RA, Desruisseaux MS. The novel ETA receptor antagonist HJP-272 prevents cerebral microvascular hemorrhage in cerebral malaria and synergistically improves survival in combination with an artemisinin derivative. Life Sci 2012; 91:687-92. [PMID: 22820174 DOI: 10.1016/j.lfs.2012.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/28/2012] [Accepted: 07/06/2012] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association between vasculopathy and survival during experimental cerebral malaria (ECM), and to determine whether targeting the endothelin-1 (ET-1) pathway alone or in combination with the anti-malaria drug artemether (a semi-synthetic derivative of artemisinin) will improve microvascular hemorrhage and survival. MAIN METHODS C57BL/6 mice infected with Plasmodium berghei ANKA (PbA) were randomly assigned to four groups: no treatment, artemether treated, ET(A) receptor antagonist (HJP-272) treated, or HJP-272 and artemether treated. The uninfected control mice were treated with HJP-272 and artemether. We analyzed survival, cerebral hemorrhage, weight change, blood glucose levels and parasitemia. KEY FINDINGS Our studies demonstrated decreased brain hemorrhage in PbA-infected (ECM) mice treated when HJP-272, a 1,3,6-trisubstituted-2-carboxy-quinol-4-one novel ET(A) receptor antagonist synthesized by our group, is used in conjunction with artemether, an anti-malarial agent. In addition, despite adversely affecting parasitemia and weight in non-artemether treated infected mice, HJP-272, seemed to confer some survival benefit when used as adjunctive therapy, though this did not reach significance. SIGNIFICANCE Previous studies demonstrate that the endothelin pathway is associated with vasculopathy, neuronal injury and inflammation in ECM. As demonstrated here, components of the ET-1 pathway may be important targets for adjunctive therapy in ECM, and may help in preventing hemorrhage and in improving survival when used as adjunctive therapy during malaria infection. The data presented suggest that our novel agent, HJP-272, may ameliorate alterations in the vasculature which can potentially lead to inflammation, neurological dysfunction, and subsequent death in mice with ECM.
Collapse
Affiliation(s)
- Minxian Dai
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Nagajyothi F, Desruisseaux MS, Machado FS, Upadhya R, Zhao D, Schwartz GJ, Teixeira MM, Albanese C, Lisanti MP, Chua SC, Weiss LM, Scherer PE, Tanowitz HB. Response of adipose tissue to early infection with Trypanosoma cruzi (Brazil strain). J Infect Dis 2012; 205:830-40. [PMID: 22293433 DOI: 10.1093/infdis/jir840] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Brown adipose tissue (BAT) and white adipose tissue (WAT) and adipocytes are targets of Trypanosoma cruzi infection. Adipose tissue obtained from CD-1 mice 15 days after infection, an early stage of infection revealed a high parasite load. There was a significant increase in macrophages in infected adipose tissue and a reduction in lipid accumulation, adipocyte size, and fat mass and increased expression of lipolytic enzymes. Infection increased levels of Toll-like receptor (TLR) 4 and TLR9 and in the expression of components of the mitogen-activated protein kinase pathway. Protein and messenger RNA (mRNA) levels of peroxisome proliferator-activated receptor γ were increased in WAT, whereas protein and mRNA levels of adiponectin were significantly reduced in BAT and WAT. The mRNA levels of cytokines, chemokines, and their receptors were increased. Nuclear Factor Kappa B levels were increased in BAT, whereas Iκκ-γ levels increased in WAT. Adipose tissue is an early target of T. cruzi infection.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Department of Pathology, Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Tanowitz HB, Jelicks LA, Machado FS, Esper L, Qi X, Desruisseaux MS, Chua SC, Scherer PE, Nagajyothi F. Adipose tissue, diabetes and Chagas disease. Adv Parasitol 2011; 76:235-50. [PMID: 21884894 DOI: 10.1016/b978-0-12-385895-5.00010-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adipose tissue is the largest endocrine organ in the body and is composed primarily of adipocytes (fat cells) but also contains fibroblasts, endothelial cells, smooth muscle cells, macrophages and lymphocytes. Adipose tissue and the adipocyte are important in the regulation of energy metabolism and of the immune response. Adipocytes also synthesize adipokines such as adiponectin which is important in the regulation of insulin sensitivity and inflammation. Infection of mice with Trypanosoma cruzi results in an upregulation of inflammation in adipose tissue that begins during the acute phase of infection and persists into the chronic phase. The adipocyte is both a target of infection and a reservoir for the parasite during the chronic phase from which recrudescence of the infection may occur during periods of immunosuppression.
Collapse
Affiliation(s)
- Herbert B Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Nagajyothi F, Weiss LM, Silver DL, Desruisseaux MS, Scherer PE, Herz J, Tanowitz HB. Trypanosoma cruzi utilizes the host low density lipoprotein receptor in invasion. PLoS Negl Trop Dis 2011; 5:e953. [PMID: 21408103 PMCID: PMC3051337 DOI: 10.1371/journal.pntd.0000953] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [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: 07/08/2010] [Accepted: 01/05/2011] [Indexed: 11/23/2022] Open
Abstract
Background Trypanosoma cruzi, an intracellular protozoan parasite that infects humans and other mammalian hosts, is the etiologic agent in Chagas disease. This parasite can invade a wide variety of mammalian cells. The mechanism(s) by which T. cruzi invades its host cell is not completely understood. The activation of many signaling receptors during invasion has been reported; however, the exact mechanism by which parasites cross the host cell membrane barrier and trigger fusion of the parasitophorous vacuole with lysosomes is not understood. Methodology/Principal Findings In order to explore the role of the Low Density Lipoprotein receptor (LDLr) in T. cruzi invasion, we evaluated LDLr parasite interactions using immunoblot and immunofluorescence (IFA) techniques. These experiments demonstrated that T. cruzi infection increases LDLr levels in infected host cells, inhibition or disruption of LDLr reduces parasite load in infected cells, T. cruzi directly binds recombinant LDLr, and LDLr-dependent T. cruzi invasion requires PIP2/3. qPCR analysis demonstrated a massive increase in LDLr mRNA (8000 fold) in the heart of T. cruzi infected mice, which is observed as early as 15 days after infection. IFA shows a co-localization of both LDL and LDLr with parasites in infected heart. Conclusions/Significance These data highlight, for the first time, that LDLr is involved in host cell invasion by this parasite and the subsequent fusion of the parasitophorous vacuole with the host cell lysosomal compartment. The model suggested by this study unifies previous models of host cell invasion for this pathogenic protozoon. Overall, these data indicate that T. cruzi targets LDLr and its family members during invasion. Binding to LDL likely facilitates parasite entry into host cells. The observations in this report suggest that therapeutic strategies based on the interaction of T. cruzi and the LDLr pathway should be pursued as possible targets to modify the pathogenesis of disease following infection. Trypanosoma cruzi, an intracellular protozoan parasite that causes Chagas disease in humans and results in the development of cardiomyopathy, is a major health problem in endemic areas. This parasite can invade a wide variety of mammalian cells. The mechanisms by which these parasites invade their host cells are not completely understood. Our study highlights, for the first time, that the Low Density Lipoprotein receptor (LDLr) is important in the invasion and the subsequent fusion of the parasitophorous vacuole with host lysosomes. We demonstrate that T. cruzi directly binds to LDLr, and inhibition or disruption of LDLr significantly decreases parasite entry. Additionally, we have determined that this cross-linking triggers the accumulation of LDLr and phosphotidylinositol phosphates in coated pits, which initiates a signaling cascade that results in the recruitment of lysosomes, possibly via the sorting motif in the cytoplasmic tail of LDLr, to the site of adhesion/invasion. Studies of infected CD1 mice demonstrate that LDLs accumulate in infected heart and that LDLr co-localize with internalized parasites. Overall, this study demonstrates that LDLr and its family members, engaged mainly in lipoprotein transportation, are also involved in T. cruzi entry into host cells and this interaction likely contributes to the progression of chronic cardiomyopathy.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Desruisseaux MS, Iacobas DA, Iacobas S, Mukherjee S, Weiss LM, Tanowitz HB, Spray DC. Alterations in the Brain Transcriptome in Plasmodium Berghei ANKA Infected Mice. J Neuroparasitology 2010; 1:N100803. [PMID: 23467761 PMCID: PMC3587055] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We have used cDNA microarrays to compare gene expression profiles in brains from normal mice to those infected with the ANKA strain of Plasmodium berghei, a model of cerebral malaria. For each of three brains in each group, we computed ratios of all quantifiable genes with a composite reference sample and then computed ratios of gene expression in infected brains compared to untreated controls. Of the almost 12,000 unigenes adequately quantified in all arrays, approximately 3% were significantly downregulated (P < 0.05, ≥ 50% fold change) and about 7% were upregulated. Upon inspection of the lists of regulated genes, we identified a high number encoding proteins of importance to normal brain function or associated with neuropathology, including genes that encode for synaptic proteins or genes involved in cerebellar function as well as genes important in certain neurological diseases such as Alzheimer's disease or autism. These results emphasize the important impact of malarial infection on gene expression in the brain and provide potential biomarkers that may provide novel therapeutic targets to ameliorate the neurological sequelae of this infection.
Collapse
Affiliation(s)
- Mahalia S. Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Dumitru A. Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanda Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David C. Spray
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
19
|
Nagajyothi F, Zhao D, Machado FS, Weiss LM, Schwartz GJ, Desruisseaux MS, Zhao Y, Factor SM, Huang H, Albanese C, Teixeira MM, Scherer PE, Chua SC, Tanowitz HB. Crucial role of the central leptin receptor in murine Trypanosoma cruzi (Brazil strain) infection. J Infect Dis 2010; 202:1104-13. [PMID: 20726767 DOI: 10.1086/656189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Mice carrying a defective leptin receptor gene (db/db mice) are metabolically challenged and upon infection with Trypanosoma cruzi (Brazil strain) suffer high mortality. In genetically modified db/db mice, (NSE-Rb db/db mice), central leptin signaling is reconstituted only in the brain, which is sufficient to correct the metabolic defects. NSE-Rb db/db mice were infected with T. cruzi to determine the impact of the lack of leptin signaling on infection in the absence of metabolic dysregulation. Parasitemia levels, mortality rates, and tissue parasitism were statistically significantly increased in infected db/db mice compared with those in infected NSE-Rb db/db and FVB wild-type mice. There was a reduction in fat mass and blood glucose level in infected db/db mice. Plasma levels of several cytokines and chemokines were statistically significantly increased in infected db/db mice compared with those in infected FVB and NSE-Rb db/db mice. These findings suggest that leptin resistance in individuals with obesity and diabetes mellitus may have adverse consequences in T. cruzi infection.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Dai M, Reznik SE, Spray DC, Weiss LM, Tanowitz HB, Gulinello M, Desruisseaux MS. Persistent cognitive and motor deficits after successful antimalarial treatment in murine cerebral malaria. Microbes Infect 2010; 12:1198-207. [PMID: 20800692 DOI: 10.1016/j.micinf.2010.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 11/29/2022]
Abstract
Human cerebral malaria causes neurological and behavioral deficits which persist long after resolution of infection and clearance of parasites with antimalarial drugs. Previously, we demonstrated that during active infection, mice with cerebral malaria demonstrated negative behavioral outcomes. Here we used a chloroquine treatment model of cerebral malaria to determine whether these abnormal outcomes would be persistent in the mouse model. C57BL/6 mice were infected with Plasmodium berghei ANKA, and treated for ten days. After cessation of chloroquine, a comprehensive assessment of cognitive and motor function demonstrated persistence of abnormal behavioral outcomes, 10 days after successful eradication of parasites. Furthermore, these deficits were still evident forty days after cessation of chloroquine, indicating persistence long after successful treatment, a hallmark feature of human cerebral malaria. Thus, cognitive tests similar to those used in these mouse studies could facilitate the development of adjunctive therapies that can ameliorate adverse neurological outcomes in human cerebral malaria.
Collapse
Affiliation(s)
- Minxian Dai
- Department of Pharmaceutical Sciences, College of Pharmacy and Allied Health Professions, St Johns University, Queens, NY 11439, USA
| | | | | | | | | | | | | |
Collapse
|
21
|
Nagajyothi F, Desruisseaux MS, Weiss LM, Chua S, Albanese C, Machado FS, Esper L, Lisanti MP, Teixeira MM, Scherer PE, Tanowitz HB. Chagas disease, adipose tissue and the metabolic syndrome. Mem Inst Oswaldo Cruz 2010; 104 Suppl 1:219-25. [PMID: 19753477 DOI: 10.1590/s0074-02762009000900028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 05/22/2009] [Indexed: 01/28/2023] Open
Abstract
Trypanosoma cruzi infection of the adipose tissue of mice triggers the local expression of inflammatory mediators and a reduction in the expression of the adipokine adiponectin. T. cruzi can be detected in adipose tissue by PCR 300 days post-infection. Infection of cultured adipocytes results in increased expression of cytokines and chemokines and a reduction in the expression of adiponectin and the peroxisome proliferator-activated receptor gamma, both of which are negative regulators of inflammation. Infection also results in the upregulation of cyclin D1, the Notch pathway, and extracellular signal-regulated kinase and a reduction in the expression of caveolin-1. Thus, T. cruzi infection of cultured adipocytes leads to an upregulation of the inflammatory process. Since adiponectin null mice have a cardiomyopathic phenotype, it is possible that the reduction in adiponectin contributes to the pathogenesis of chagasic cardiomyopathy. Adipose tissue may serve as a reservoir for T. cruzi from which parasites can become reactivated during periods of immunosuppression. T. cruzi infection of mice often results in hypoglycemia. In contrast, hyperglycemia as observed in diabetes results in increased parasitemia and mortality. Adipose tissue is an important target tissue of T. cruzi and the infection of this tissue is associated with a profound impact on systemic metabolism, increasing the risk of metabolic syndrome.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- Mahalia S Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | | | | | | | | |
Collapse
|
23
|
Desruisseaux MS, Iacobas DA, Iacobas S, Mukherjee S, Weiss LM, Tanowitz HB, Spray DC. Alterations in the Brain Transcriptome inPlasmodium BergheiANKA Infected Mice. ACTA ACUST UNITED AC 2010. [DOI: 10.4303/jnp/n100803] [Citation(s) in RCA: 14] [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: 11/17/2022]
Affiliation(s)
- Mahalia S. Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Dumitru A. Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanda Iacobas
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shankar Mukherjee
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David C. Spray
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
24
|
Desruisseaux MS, Gulinello M, Smith DN, Lee SC, Tsuji M, Weiss LM, Spray DC, Tanowitz HB. Cognitive dysfunction in mice infected with Plasmodium berghei strain ANKA. J Infect Dis 2008; 197:1621-7. [PMID: 18419550 DOI: 10.1086/587908] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cerebral malaria complicated by cognitive sequelae is a major cause of morbidity in humans infected with Plasmodium falciparum. To model cognitive function after malaria, we created a rodent model of cerebral malaria by infecting C57BL/6 mice with Plasmodium berghei strain ANKA. After 7 days, an object-recognition test of working memory revealed a significant impairment in the visual memory of infected mice. This impairment was observed in the absence of confounding effects of infection. The cognitive dysfunction correlated with hemorrhage and inflammation. Furthermore, microglial activity and morphological changes detected throughout the brains of infected mice were absent from the brains of control mice, and this correlated with the measured cognitive defects. Similar testing methods in human studies could help identify subjects at risk for an adverse cognitive outcome. This murine model should facilitate the study of adjunctive methods to ameliorate adverse neurological outcomes in cerebral malaria.
Collapse
Affiliation(s)
- Mahalia S Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Nagajyothi F, Desruisseaux MS, Thiruvur N, Weiss LM, Braunstein VL, Albanese C, Teixeira MM, de Almeida CJ, Lisanti MP, Scherer PE, Tanowitz HB. Trypanosoma cruzi infection of cultured adipocytes results in an inflammatory phenotype. Obesity (Silver Spring) 2008; 16:1992-7. [PMID: 19186325 PMCID: PMC2771879 DOI: 10.1038/oby.2008.331] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infection with Trypanosoma cruzi, the etiologic agent of Chagas disease is accompanied by an intense inflammatory reaction. Our laboratory group has identified adipose tissue as one of the major sites of inflammation during disease progression. Because adipose tissue is composed of many cell types, we were interested in investigating whether the adipocyte per se was a source of inflammatory mediators in this infection. Cultured adipocytes were infected with the Tulahuen strain of T. cruzi for 48-96 h. Immunoblot and quantitative PCR (qPCR) analyses demonstrated an increase in the expression of proinflammatory cytokines and chemokines, including interleukin (IL)-1 beta, interferon-gamma, tumor necrosis factor-alpha, CCL2, CCL5, and CXCL10 as well as an increase in the expression of Toll-like receptors-2 and 9 and activation of the notch pathway. Interestingly, caveolin-1 expression was reduced while cyclin D1 and extracellular signal-regulated kinase (ERK) expression was increased. The expression of PI3kinase and the activation of AKT (phosphorylated AKT) were increased suggesting that infection may induce components of the insulin/IGF-1 receptor cascade. There was an infection-associated decrease in adiponectin and peroxisome proliferator-activated receptor-gamma (PPAR-gamma). These data provide a mechanism for the increase in the inflammatory phenotype that occurs in T. cruzi-infected adipocytes. Overall, these data implicate the adipocyte as an important target of T. cruzi, and one which contributes significantly to the inflammatory response observed in Chagas disease.
Collapse
Affiliation(s)
- Fnu Nagajyothi
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mahalia S. Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Niranjan Thiruvur
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Louis M. Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vicki L. Braunstein
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chris Albanese
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mauro M. Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cecilia J. de Almeida
- Department of Cancer Biology and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Muscular and Neurodegenerative Disease Unit, University of Genoa, Gaslini Pediatric Institute, Genoa, Italy
| | - Michael P. Lisanti
- Department of Cancer Biology and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Muscular and Neurodegenerative Disease Unit, University of Genoa, Gaslini Pediatric Institute, Genoa, Italy
| | - Philipp E. Scherer
- Department of Internal Medicine, Touchstone Diabetes Center, University of Texas Southwestern School of Medicine, Dallas, Texas, USA
| | - Herbert B. Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
26
|
Ashton AW, Mukherjee S, Nagajyothi FNU, Huang H, Braunstein VL, Desruisseaux MS, Factor SM, Lopez L, Berman JW, Wittner M, Scherer PE, Capra V, Coffman TM, Serhan CN, Gotlinger K, Wu KK, Weiss LM, Tanowitz HB. Thromboxane A 2is a key regulator of pathogenesis during Trypanosoma cruziinfection. J Biophys Biochem Cytol 2007. [DOI: 10.1083/jcb1772oia4] [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: 11/22/2022] Open
|
27
|
Ashton AW, Mukherjee S, Nagajyothi FNU, Huang H, Braunstein VL, Desruisseaux MS, Factor SM, Lopez L, Berman JW, Wittner M, Scherer PE, Capra V, Coffman TM, Serhan CN, Gotlinger K, Wu KK, Weiss LM, Tanowitz HB. Thromboxane A2 is a key regulator of pathogenesis during Trypanosoma cruzi infection. ACTA ACUST UNITED AC 2007; 204:929-40. [PMID: 17420269 PMCID: PMC2118547 DOI: 10.1084/jem.20062432] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [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] [Indexed: 01/16/2023]
Abstract
Chagas' disease is caused by infection with the parasite Trypanosoma cruzi. We report that infected, but not uninfected, human endothelial cells (ECs) released thromboxane A(2) (TXA(2)). Physical chromatography and liquid chromatography-tandem mass spectrometry revealed that TXA(2) is the predominant eicosanoid present in all life stages of T. cruzi. Parasite-derived TXA(2) accounts for up to 90% of the circulating levels of TXA(2) in infected wild-type mice, and perturbs host physiology. Mice in which the gene for the TXA(2) receptor (TP) has been deleted, exhibited higher mortality and more severe cardiac pathology and parasitism (fourfold) than WT mice after infection. Conversely, deletion of the TXA(2) synthase gene had no effect on survival or disease severity. TP expression on somatic cells, but not cells involved in either acquired or innate immunity, was the primary determinant of disease progression. The higher intracellular parasitism observed in TP-null ECs was ablated upon restoration of TP expression. We conclude that the host response to parasite-derived TXA(2) in T. cruzi infection is possibly an important determinant of mortality and parasitism. A deeper understanding of the role of TXA(2) may result in novel therapeutic targets for a disease with limited treatment options.
Collapse
Affiliation(s)
- Anthony W Ashton
- Department of Medicine, Divisions of Cardiology and Infectious Disease, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- Mahalia S Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | | | | | | |
Collapse
|
29
|
Bouzahzah B, Nagajyothi F, Desruisseaux MS, Krishnamachary M, Factor SM, Cohen AW, Lisanti MP, Petkova SB, Pestell RG, Wittner M, Mukherjee S, Weiss LM, Jelicks LA, Albanese C, Tanowitz HB. Cell cycle regulatory proteins in the liver in murine Trypanosoma cruzi infection. Cell Cycle 2006; 5:2396-400. [PMID: 17102609 DOI: 10.4161/cc.5.20.3380] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The liver is an important target of Trypanosoma cruzi infection. Infection of CD-1 mice with T. cruzi (Brazil strain) resulted in parasitism of the liver, primarily in sinusoidal and Kupffer cells. Immunoblot analysis revealed activation of extra cellular signal-regulated kinase (ERK) during the acute and subacute period of infection, but p38 mitogen activated kinase (MAPK) and JNK were not activated. The activity of important cell cycle regulatory genes was also examined in the liver following infection. There was increased expression of cyclin D1, cyclin E and cyclin A as well as proliferating cell nuclear antigen (PCNA) at 45, 60 and 215 days post infection. In addition, the levels of the cyclin-dependent kinase inhibitors p27(KIP1), p21(WAF1) and the tumor suppressor p53 were increased in the livers obtained from infected mice. Quantitative PCR revealed increased abundance of mRNA for cyclins A, D1 and E. Interestingly, cyclin A and E are ordinarily not found in the adult liver. Thus infection caused a reversion to a fetal/neonatal phenotype. These data provide a molecular basis for cell proliferation in the liver following T. cruzi infection.
Collapse
Affiliation(s)
- Boumediene Bouzahzah
- Department of Pathology at Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Machado FS, Desruisseaux MS, Kennan RP, Hetherington HP, Wittner M, Weiss LM, Lee SC, Scherer PE, Tsuji M, Tanowitz HB. Endothelin in a murine model of cerebral malaria. Exp Biol Med (Maywood) 2006; 231:1176-81. [PMID: 16741072] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Cerebral malaria (CM) remains a deadly complication of Plasmodium falciparum infection, and children are at high risk of developing encephalopathy as a result of CM. This is probably a consequence of the activation of many of the inflammatory cytokines as well as the glial cells and the vascular endothelium in the brain. We have previously demonstrated that there is a striking reduction in cerebral blood flow by magnetic resonance imaging when mice are infected with Plasmodium berghei ANKA (PbA), and we now demonstrate a possible role for endothelin (ET-1) in the pathogenesis of CM. The brains of female C57BL/6 mice with PbA infection were examined at Day 5 for the expression of ET-1, endothelin converting enzyme (ECE), and the endothelin receptors A and B (ET(A) and ET(B)) by both reverse transcription-polymerase chain reaction (RT-PCR) and quantitative real-time PCR. ET-1 and ECE mRNA expression was markedly increased by RT-PCR in PbA-infected mice. Real-time quantitative PCR demonstrated a 3-fold increase in ET-1 (P < 0.05) and a significant increase in ET(A) and ET(B) expression (P < 0.05) in PbA-infected mice. Histopathology bof PbA-infected mice demonstrated a transformation in the morphology of microglial cells and clustering of these cells consistent with activation. Though the full impact of ET-1 on CM remains to be elucidated, these findings demonstrate that in the murine model, there is a significant increase in ET-1 and its components, which is associated with the vasculopathy and immunopathology of CM.
Collapse
Affiliation(s)
- Fabiana S Machado
- Department of Medical and Molecular Parasitology, New York University School of Medicine, New York, New York 10016, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Hassan GS, Mukherjee S, Nagajyothi F, Weiss LM, Petkova SB, de Almeida CJ, Huang H, Desruisseaux MS, Bouzahzah B, Pestell RG, Albanese C, Christ GJ, Lisanti MP, Tanowitz HB. Trypanosoma cruzi infection induces proliferation of vascular smooth muscle cells. Infect Immun 2006; 74:152-9. [PMID: 16368968 PMCID: PMC1346667 DOI: 10.1128/iai.74.1.152-159.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trypanosoma cruzi infection causes cardiomyopathy and vasculopathy. Previous studies have demonstrated that infection of human umbilical vein endothelial and smooth muscle cells resulted in activation of extracellular signal-regulated kinase (ERK). In the present study, smooth muscle cells were infected with trypomastigotes, and immunoblot analysis revealed an increase in the expression of cyclin D1 and proliferating cell nuclear antigen (PCNA), important mediators of smooth muscle cell proliferation. Interestingly, after infection, the expression of caveolin-1 was reduced in both human umbilical vein endothelial cells and smooth muscle cells. Immunoblot and immunohistochemical analyses of lysates of carotid arteries obtained from infected mice revealed increased expression of PCNA, cyclin D1, its substrate, phospho-Rb (Ser780), and phospho-ERK1/2. The expression of the cyclin-dependent kinase inhibitor p21(Cip1/Waf1), caveolin-1, and caveolin-3 was reduced in carotid arteries obtained from infected mice. There was an increase in the abundance of pre-pro-endothelin-1 mRNA in the carotid artery and aorta from infected mice. The ET(A) receptor was also elevated in infected arteries. ERK activates endothelin-1, which in turn exerts positive feedback activating ERK, and cyclin D1 is a downstream target of both endothelin-1 and ERK. There was significant incorporation of bromodeoxyuridine into smooth muscle cell DNA when treatment was with conditioned medium obtained from infected endothelial cells. Taken together, these data suggest that T. cruzi infection stimulates smooth muscle cell proliferation and is likely a result of the upregulation of the ERK-cyclin D1-endothelin-1 pathway.
Collapse
MESH Headings
- Animals
- Bromodeoxyuridine/metabolism
- Carotid Arteries/enzymology
- Caveolins/biosynthesis
- Caveolins/genetics
- Cell Cycle/physiology
- Cell Proliferation
- Cells, Cultured
- Chagas Disease/metabolism
- Chagas Disease/pathology
- Cyclin D1/physiology
- Endothelial Cells/metabolism
- Endothelial Cells/parasitology
- Endothelin-1/genetics
- Extracellular Signal-Regulated MAP Kinases/physiology
- Humans
- Male
- Mice
- Mice, Inbred A
- Mice, Inbred C3H
- Muscle, Smooth, Vascular/parasitology
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/parasitology
- Myocytes, Smooth Muscle/pathology
- Proliferating Cell Nuclear Antigen/physiology
- RNA Precursors/metabolism
- Receptor, Endothelin A/metabolism
- Trypanosoma cruzi/physiology
Collapse
Affiliation(s)
- Ghada S Hassan
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kennan RP, Machado FS, Lee SC, Desruisseaux MS, Wittner M, Tsuji M, Tanowitz HB. Reduced cerebral blood flow and N-acetyl aspartate in a murine model of cerebral malaria. Parasitol Res 2005; 96:302-7. [PMID: 15918069 DOI: 10.1007/s00436-005-1349-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 03/10/2005] [Indexed: 01/08/2023]
Abstract
Cerebral malaria is an important cause of morbidity and mortality in many parts of the world. It has been suggested that cerebral malaria is associated with reduced perfusion due to the blockage of blood vessels by parasitized erythrocytes; although, no quantitative validation of this has been done. We infected C57BL/6 mice with the ANKA strain of Plasmodium berghei and on day 6 of infection we investigated alterations in brain function using arterial spin labeling MRI and proton MRS. MR images did not demonstrate signs of damage. However, there was a significant reduction in cerebral blood flow (P<0.012) and the ratio of N-acetyl-aspartate (NAA) to creatine (Cr) (P<0.01) relative to non-infected mice. The NAA/Cr ratios were significantly correlated with cerebral perfusion (r=0.87) suggesting a relationship between impaired oxygen delivery and neuronal dysfunction. Pathological examination revealed accumulations of damaged axons providing a correlate for the decreased NAA/Cr ratio in infected mice. This murine model will permit non-invasive studies of neurologic function during malarial infection.
Collapse
Affiliation(s)
- Richard P Kennan
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | | | | | | | | | | | | |
Collapse
|