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Korde A, Haslip M, Pednekar P, Khan A, Chioccioli M, Mehta S, Lopez-Giraldez F, Bermejo S, Rojas M, Dela Cruz C, Matthay MA, Pober JS, Pierce RW, Takyar SS. MicroRNA-1 protects the endothelium in acute lung injury. JCI Insight 2023; 8:e164816. [PMID: 37737266 PMCID: PMC10561733 DOI: 10.1172/jci.insight.164816] [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: 08/31/2022] [Accepted: 08/10/2023] [Indexed: 09/23/2023] Open
Abstract
Acute lung injury (ALI) and its most severe form, acute respiratory distress syndrome (ARDS), cause severe endothelial dysfunction in the lung, and vascular endothelial growth factor (VEGF) is elevated in ARDS. We found that the levels of a VEGF-regulated microRNA, microRNA-1 (miR-1), were reduced in the lung endothelium after acute injury. Pulmonary endothelial cell-specific (EC-specific) overexpression of miR-1 protected the lung against cell death and barrier dysfunction in both murine and human models and increased the survival of mice after pneumonia-induced ALI. miR-1 had an intrinsic protective effect in pulmonary and other types of ECs; it inhibited apoptosis and necroptosis pathways and decreased capillary leak by protecting adherens and tight junctions. Comparative gene expression analysis and RISC recruitment assays identified miR-1 targets in the context of injury, including phosphodiesterase 5A (PDE5A), angiopoietin-2 (ANGPT2), CNKSR family member 3 (CNKSR3), and TNF-α-induced protein 2 (TNFAIP2). We validated miR-1-mediated regulation of ANGPT2 in both mouse and human ECs and found that in a 119-patient pneumonia cohort, miR-1 correlated inversely with ANGPT2. These findings illustrate a previously unknown role of miR-1 as a cytoprotective orchestrator of endothelial responses to acute injury with prognostic and therapeutic potential.
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Affiliation(s)
- Asawari Korde
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Haslip
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Prachi Pednekar
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Maurizio Chioccioli
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sameet Mehta
- Department of Genetics, Yale University School Medicine, New Haven, Connecticut, USA
| | | | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mauricio Rojas
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Charles Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael A. Matthay
- Cardiovascular Research Institute, Department of Medicine and Anesthesiology, UCSF, San Francisco, California, USA
| | | | | | - Shervin S. Takyar
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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2
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Cox CE, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, Olsen MK, Parish A, Casarett D, Al-Hegelan MS, Naglee C, Katz JN, O'Keefe YA, Harrison RW, Riley IL, Bermejo S, Dempsey K, Johnson KS, Docherty SL. Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms. Crit Care Med 2023; 51:13-24. [PMID: 36326263 PMCID: PMC10191149 DOI: 10.1097/ccm.0000000000005701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine if changes in needs over 1 week was associated with similar changes in psychological distress symptoms at 3 months. DESIGN Prospective cohort study. SETTING Six adult medical and surgical ICUs. PARTICIPANTS Patients receiving mechanical ventilation for greater than or equal to 2 days and their family members. MEASUREMENTS AND MAIN RESULTS The primary outcome was the 13-item Needs at the End-of-Life Screening Tool (NEST; total score range 0-130) completed by family members at baseline, 3, and 7 days. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Post-Traumatic Stress Scale (PTSS) were completed at baseline and 3 months. General linear models were used to estimate differences in distress symptoms by change in need (NEST improvement ≥ 10 points or not). One-hundred fifty-nine family members participated (median age, 54.0 yr [interquartile range (IQR), 44.0-63.0 yr], 125 [78.6%] female, 54 [34.0%] African American). At 7 days, 53 (33%) a serious level of overall need and 35 (22%) ranked greater than or equal to 1 individual need at the highest severity level. NEST scores improved greater than or equal to 10 points in only 47 (30%). Median NEST scores were 22 (IQR, 12-40) at baseline and 19 (IQR, 9-37) at 7 days (change, -2.0; IQR, -11.0 to 5.0; p = 0.12). There were no differences in PHQ-9, GAD-7, or PTSS change scores by change in NEST score (all p > 0.15). CONCLUSIONS Serious palliative care needs were common and persistent among families during ICU care. Improvement in needs was not associated with less psychological distress at 3 months. Serious needs may be commonly underrecognized in current practice.
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Affiliation(s)
- Christopher E Cox
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Jessie Gu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Deepshikha Charan Ashana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Elias H Pratt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Krista Haines
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
- Department of Surgery, Division of Trauma and Critical Care and Acute Care Surgery, Duke University, Durham, NC
| | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, Durham, NC
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - David Casarett
- Department of Medicine, Section of Palliative Care and Hospice Medicine, Duke University, Durham, NC
| | - Mashael S Al-Hegelan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Colleen Naglee
- Department of Anesthesiology, Duke University, Durham, NC
- Department of Neurology, Division of Neurocritical Care, Duke University, Durham, NC
| | - Jason N Katz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yasmin Ali O'Keefe
- Department of Neurology, Division of Neurocritical Care, Duke University, Durham, NC
| | - Robert W Harrison
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Isaretta L Riley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Santos Bermejo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Katelyn Dempsey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Kimberly S Johnson
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, Durham, NC
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
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3
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Cox CE, Olsen MK, Parish A, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, Casarett DJ, Al-Hegelan MS, Naglee C, Katz JN, O'Keefe YA, Harrison RW, Riley IL, Bermejo S, Dempsey K, Wolery S, Jaggers J, Johnson KS, Docherty SL. Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study. BMJ Support Palliat Care 2022:bmjspcare-2022-003622. [PMID: 36167642 PMCID: PMC10085460 DOI: 10.1136/spcare-2022-003622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Because the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care needs exist. METHODS Prospective cohort study conducted among family members of adult patients undergoing mechanical ventilation in six medical and surgical ICUs. The primary outcome was palliative care need measured by the Needs at the End-of-Life Screening Tool (NEST, range from 0 (no need) to 130 (highest need)) completed 3 days after ICU admission. We also assessed quality of communication, clinician-family relationship and patient centredness of care. Latent class analysis of the NEST's 13 items was used to identify groups with similar patterns of serious palliative care needs. RESULTS Among 257 family members, latent class analysis yielded a four-class model including complex communication needs (n=26, 10%; median NEST score 68.0), family spiritual and cultural needs (n=21, 8%; 40.0) and patient and family stress needs (n=43, 31%; 31.0), as well as a fourth group with fewer serious needs (n=167, 65%; 14.0). Interclass differences existed in quality of communication (median range 4.0-10.0, p<0.001), favourable clinician-family relationship (range 34.6%-98.2%, p<0.001) and both the patient centredness of care Eliciting Concerns (median range 4.0-5.0, p<0.001) and Decision-Making (median range 2.3-4.5, p<0.001) scales. CONCLUSIONS Four novel phenotypes of palliative care need were identified among ICU family members with distinct differences in the severity of needs and perceived quality of the clinician-family interaction. Knowledge of need class may help to inform the development of more person-centred models of ICU-based palliative care.
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Affiliation(s)
- Christopher E Cox
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Maren K Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jessie Gu
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Deepshikha Charan Ashana
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Elias H Pratt
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Krista Haines
- Department of Surgery, Division of Trauma and Critical Care and Acute Care Surgery, Duke University, Durham, NC, USA
| | - Jessica Ma
- Section of Palliative Care and Hospice Medicine, Duke University, Durham, NC, USA
| | - David J Casarett
- Section of Palliative Care and Hospice Medicine, Duke University, Durham, NC, USA
| | - Mashael S Al-Hegelan
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Colleen Naglee
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Neurology, Division of Neurocritical Care, Durham, North Carolina, USA
| | - Jason N Katz
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | - Yasmin Ali O'Keefe
- Department of Neurology, Division of Neurocritical Care, Durham, North Carolina, USA
| | - Robert W Harrison
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | - Isaretta L Riley
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Santos Bermejo
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Katelyn Dempsey
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Shayna Wolery
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Jennie Jaggers
- Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina, USA
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, USA
| | - Kimberly S Johnson
- Division of Geriatrics, Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
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Anson C, Jornet N, Ventosa N, Bermejo S, Pérez-Alija J, Gallego P, Latorre-Musoll A, García N, Vivancos H, Barceló M, Ruiz A, Leo F, Carrasco P. PO-1479 SGRT setup patient accuracy in breast cancer patients compared to two different IGRT workflows. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03443-0] [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: 11/29/2022]
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5
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Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:266-301. [PMID: 35610172 DOI: 10.1016/j.redare.2021.03.015] [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] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/19/2021] [Indexed: 06/15/2023]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, Spain
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, Spain.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, Spain
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, Spain
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - M Real
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor, Hospital Sant Pau de Barcelona, Barcelona, Spain
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, Spain
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, Spain
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, Spain
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, Spain
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, Spain
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6
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Unterman A, Sumida TS, Nouri N, Yan X, Zhao AY, Gasque V, Schupp JC, Asashima H, Liu Y, Cosme C, Deng W, Chen M, Raredon MSB, Hoehn KB, Wang G, Wang Z, DeIuliis G, Ravindra NG, Li N, Castaldi C, Wong P, Fournier J, Bermejo S, Sharma L, Casanovas-Massana A, Vogels CBF, Wyllie AL, Grubaugh ND, Melillo A, Meng H, Stein Y, Minasyan M, Mohanty S, Ruff WE, Cohen I, Raddassi K, Niklason LE, Ko AI, Montgomery RR, Farhadian SF, Iwasaki A, Shaw AC, van Dijk D, Zhao H, Kleinstein SH, Hafler DA, Kaminski N, Dela Cruz CS. Single-cell multi-omics reveals dyssynchrony of the innate and adaptive immune system in progressive COVID-19. Nat Commun 2022; 13:440. [PMID: 35064122 PMCID: PMC8782894 DOI: 10.1038/s41467-021-27716-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
Dysregulated immune responses against the SARS-CoV-2 virus are instrumental in severe COVID-19. However, the immune signatures associated with immunopathology are poorly understood. Here we use multi-omics single-cell analysis to probe the dynamic immune responses in hospitalized patients with stable or progressive course of COVID-19, explore V(D)J repertoires, and assess the cellular effects of tocilizumab. Coordinated profiling of gene expression and cell lineage protein markers shows that S100Ahi/HLA-DRlo classical monocytes and activated LAG-3hi T cells are hallmarks of progressive disease and highlights the abnormal MHC-II/LAG-3 interaction on myeloid and T cells, respectively. We also find skewed T cell receptor repertories in expanded effector CD8+ clones, unmutated IGHG+ B cell clones, and mutated B cell clones with stable somatic hypermutation frequency over time. In conclusion, our in-depth immune profiling reveals dyssynchrony of the innate and adaptive immune interaction in progressive COVID-19.
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MESH Headings
- Adaptive Immunity/drug effects
- Adaptive Immunity/genetics
- Adaptive Immunity/immunology
- Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- COVID-19/genetics
- COVID-19/immunology
- Cells, Cultured
- Female
- Gene Expression Profiling/methods
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/immunology
- Humans
- Immunity, Innate/drug effects
- Immunity, Innate/genetics
- Immunity, Innate/immunology
- Male
- RNA-Seq/methods
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/immunology
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- SARS-CoV-2/drug effects
- SARS-CoV-2/immunology
- SARS-CoV-2/physiology
- Single-Cell Analysis/methods
- COVID-19 Drug Treatment
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Affiliation(s)
- Avraham Unterman
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA.
- Pulmonary Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Tomokazu S Sumida
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA.
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA.
| | - Nima Nouri
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Xiting Yan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Amy Y Zhao
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Victor Gasque
- Department of Computer Science, Yale University, New Haven, CT, USA
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jonas C Schupp
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Department of Respiratory Medicine, Hannover Medical School and Biomedical Research in End-stage and Obstructive Lung Disease Hannover, German Lung Research Center (DZL), Hannover, Germany
| | - Hiromitsu Asashima
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Yunqing Liu
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Carlos Cosme
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Wenxuan Deng
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Ming Chen
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Micha Sam Brickman Raredon
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA
| | - Kenneth B Hoehn
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Guilin Wang
- Yale Center for Genome Analysis/Keck Biotechnology Resource Laboratory, Department of Molecular Biophysics and Biochemistry, Yale School of Medicine, New Haven, CT, USA
| | - Zuoheng Wang
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Giuseppe DeIuliis
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Neal G Ravindra
- Department of Computer Science, Yale University, New Haven, CT, USA
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ningshan Li
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
- SJTU-Yale Joint Center for Biostatistics and Data Science, Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | | | - Patrick Wong
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - John Fournier
- School of Medicine, Yale University, New Haven, CT, USA
| | - Santos Bermejo
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Anthony Melillo
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Hailong Meng
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Yan Stein
- Pulmonary Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Maksym Minasyan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Subhasis Mohanty
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - William E Ruff
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Inessa Cohen
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Khadir Raddassi
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Laura E Niklason
- Departments of Anesthesiology & Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shelli F Farhadian
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Albert C Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - David van Dijk
- Department of Computer Science, Yale University, New Haven, CT, USA
- Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- SJTU-Yale Joint Center for Biostatistics and Data Science, Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- Inter-Departmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Steven H Kleinstein
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Inter-Departmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - David A Hafler
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, School of Medicine, Yale University, New Haven, CT, USA
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
- West Haven Veterans Affair Medical Center, West Haven, CT, USA
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7
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Jornet N, Perez Alija J, Bermejo S, Ventosa N, Pedro A, Gomez de Segura G, Guerra P, Sancho G. PO-1707 Near misses reporting: effective tool for safety culture shift in a Radiation Oncology Department. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08158-5] [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: 12/01/2022]
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8
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Huang HR, Cho SJ, Harris RM, Yang J, Bermejo S, Sharma L, Dela Cruz CS, Xu JF, Stout-Delgado HW. RIPK3 Activates MLKL-mediated Necroptosis and Inflammasome Signaling during Streptococcus Infection. Am J Respir Cell Mol Biol 2021; 64:579-591. [PMID: 33625952 DOI: 10.1165/rcmb.2020-0312oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Community-acquired pneumonia is the most common type of pneumonia and remains a leading cause of morbidity and mortality worldwide. Although many different pathogens can contribute to pneumonia, Streptococcus pneumoniae is one of the common bacterial pathogens that underlie community-acquired pneumonia. RIPK3 (receptor-interacting protein kinase 3) is widely recognized as a key modulator of inflammation and cell death. To elucidate a potential role of RIPK3 in pneumonia, we examined plasma from healthy control subjects and patients positive for streptococcal pneumonia. In human studies, RIPK3 protein concentrations were significantly elevated and were identified as a potential plasma marker of pneumococcal pneumonia. To expand these findings, we used an in vivo murine model of pneumococcal pneumonia to demonstrate that RIPK3 deficiency leads to reduced bacterial clearance, severe pathological damage, and high mortality. Our results illustrated that RIPK3 forms a complex with RIPK1, MLKL (mixed-lineage kinase domain-like protein), and MCU (mitochondrial calcium uniporter) to induce mitochondrial calcium uptake and mitochondrial reactive oxygen species(mROS) production during S. pneumoniae infection. In macrophages, RIPK3 initiated necroptosis via the mROS-mediated mitochondrial permeability transition pore opening and NLRP3 inflammasome activation via the mROS-AKT pathway to protect against S. pneumoniae. In conclusion, our study demonstrated a mechanism by which RIPK3-initiated necroptosis is essential for host defense against S. pneumoniae.
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Affiliation(s)
- Hua-Rong Huang
- Department of Medicine, Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York.,Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; and
| | - Soo Jung Cho
- Department of Medicine, Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - Rebecca M Harris
- Department of Medicine, Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - Jianjun Yang
- Department of Medicine, Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - Santos Bermejo
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; and
| | - Heather W Stout-Delgado
- Department of Medicine, Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
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9
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Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00129-8. [PMID: 34330548 DOI: 10.1016/j.redar.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 10/20/2022]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, España
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, España.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, España
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, España
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia, San Sebastián, España
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, España
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - M Real
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor. Hospital Sant Pau de Barcelona, Barcelona, España
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor. Hospital Clínic Universitari de Barcelona, Barcelona, España
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, España
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, España
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, España
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, España
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, España
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor. Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, España
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10
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Lu-Culligan A, Chavan AR, Vijayakumar P, Irshaid L, Courchaine EM, Milano KM, Tang Z, Pope SD, Song E, Vogels CBF, Lu-Culligan WJ, Campbell KH, Casanovas-Massana A, Bermejo S, Toothaker JM, Lee HJ, Liu F, Schulz W, Fournier J, Muenker MC, Moore AJ, Konnikova L, Neugebauer KM, Ring A, Grubaugh ND, Ko AI, Morotti R, Guller S, Kliman HJ, Iwasaki A, Farhadian SF. Maternal respiratory SARS-CoV-2 infection in pregnancy is associated with a robust inflammatory response at the maternal-fetal interface. Med 2021; 2:591-610.e10. [PMID: 33969332 PMCID: PMC8084634 DOI: 10.1016/j.medj.2021.04.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/01/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pregnant women are at increased risk for severe outcomes from coronavirus disease 2019 (COVID-19), but the pathophysiology underlying this increased morbidity and its potential effect on the developing fetus is not well understood. METHODS We assessed placental histology, ACE2 expression, and viral and immune dynamics at the term placenta in pregnant women with and without respiratory severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. FINDINGS The majority (13 of 15) of placentas analyzed had no detectable viral RNA. ACE2 was detected by immunohistochemistry in syncytiotrophoblast cells of the normal placenta during early pregnancy but was rarely seen in healthy placentas at full term, suggesting that low ACE2 expression may protect the term placenta from viral infection. Using immortalized cell lines and primary isolated placental cells, we found that cytotrophoblasts, the trophoblast stem cells and precursors to syncytiotrophoblasts, rather than syncytiotrophoblasts or Hofbauer cells, are most vulnerable to SARS-CoV-2 infection in vitro. To better understand potential immune mechanisms shielding placental cells from infection in vivo, we performed bulk and single-cell transcriptomics analyses and found that the maternal-fetal interface of SARS-CoV-2-infected women exhibited robust immune responses, including increased activation of natural killer (NK) and T cells, increased expression of interferon-related genes, as well as markers associated with pregnancy complications such as preeclampsia. CONCLUSIONS SARS-CoV-2 infection in late pregnancy is associated with immune activation at the maternal-fetal interface even in the absence of detectable local viral invasion. FUNDING NIH (T32GM007205, F30HD093350, K23MH118999, R01AI157488, U01DA040588) and Fast Grant funding support from Emergent Ventures at the Mercatus Center.
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Affiliation(s)
- Alice Lu-Culligan
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Arun R Chavan
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Pavithra Vijayakumar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Lina Irshaid
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Edward M Courchaine
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
- Department of Cell Biology, Yale School of Medicine, New Haven, CT, USA
| | - Kristin M Milano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Zhonghua Tang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Scott D Pope
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Eric Song
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - William J Lu-Culligan
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
- Department of Cell Biology, Yale School of Medicine, New Haven, CT, USA
| | - Katherine H Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Santos Bermejo
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica M Toothaker
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah J Lee
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Wade Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John Fournier
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - M Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Adam J Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Liza Konnikova
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Karla M Neugebauer
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Aaron Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Raffaella Morotti
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Seth Guller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Harvey J Kliman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
- Department of Molecular, Cellular and Developmental Biology, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Shelli F Farhadian
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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11
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Minasyan M, Sharma L, Pivarnik T, Liu W, Adams T, Bermejo S, Peng X, Liu A, Ishikawa G, Perry C, Kaminski N, Gulati M, Herzog EL, Dela Cruz CS, Ryu C. Elevated IL-15 concentrations in the sarcoidosis lung are independent of granuloma burden and disease phenotypes. Am J Physiol Lung Cell Mol Physiol 2021; 320:L1137-L1146. [PMID: 33851886 DOI: 10.1152/ajplung.00575.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease predominantly affecting the lungs. The mechanisms promoting disease pathogenesis and progression are unknown, although interleukin-15 (IL-15) has been associated with the immune-mediated inflammation of sarcoidosis. Because the identification of a mechanistically based, clinically relevant biomarker for sarcoidosis remains elusive, we hypothesized this role for IL-15. Pulmonary sarcoidosis granuloma formation was modeled using trehalose 6,6'-dimicolate (TDM), which was administered into wild-type and three lineages of mice: those overexpressing IL-15, deficient in IL-15, and deficient in IL-15 receptor α. The number of granulomas per lung was counted and normalized to the wild type. IL-15 concentrations were measured in the bronchoalveolar lavage (BAL) from healthy controls and subjects with sarcoidosis in our cohort, where associations between IL-15 levels and clinical manifestations were sought. Findings were validated in another independent sarcoidosis cohort. TDM administration resulted in similar granuloma numbers across all lineages of mice. IL-15 concentrations were elevated in the BAL of both human cohorts, irrespective of disease phenotypes. In exploratory analysis, an association with obesity was observed, and various other soluble mediators were identified in the BAL of both cohorts. Although IL-15 is enriched in the sarcoidosis lung, it was independent of disease pathogenesis or clinical manifestations in our mouse model and human cohorts of sarcoidosis. An association with obesity perhaps reflects the ongoing inflammatory processes of these comorbid conditions. Our findings showed that IL-15 is redundant for disease pathogenesis and clinical progression of sarcoidosis.
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Affiliation(s)
- Maksym Minasyan
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Taylor Pivarnik
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Wei Liu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Taylor Adams
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Santos Bermejo
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Xiaohua Peng
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Angela Liu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Genta Ishikawa
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Carrighan Perry
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Erica L Herzog
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Changwan Ryu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
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12
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Watkins AE, Fenichel EP, Weinberger DM, Vogels CB, Brackney DE, Casanovas-Massana A, Campbell M, Fournier J, Bermejo S, Datta R, Dela Cruz CS, Farhadian SF, Iwasaki A, Ko AI, Grubaugh ND, Wyllie AL. Increased SARS-CoV-2 Testing Capacity with Pooled Saliva Samples. Emerg Infect Dis 2021; 27. [PMID: 33755009 PMCID: PMC8007323 DOI: 10.3201/eid2704.204200] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 testing and found that sensitivity decreased according to pool size: 5 samples/pool, 7.4% reduction; 10 samples/pool, 11.1%; and 20 samples/pool, 14.8%. When virus prevalence is >2.6%, pools of 5 require fewer tests; when <0.6%, pools of 20 support screening strategies.
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13
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Ott IM, Strine MS, Watkins AE, Boot M, Kalinich CC, Harden CA, Vogels CBF, Casanovas-Massana A, Moore AJ, Muenker MC, Nakahata M, Tokuyama M, Nelson A, Fournier J, Bermejo S, Campbell M, Datta R, Dela Cruz CS, Farhadian SF, Ko AI, Iwasaki A, Grubaugh ND, Wilen CB, Wyllie AL. Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva. Emerg Infect Dis 2021; 27:1146-1150. [PMID: 33754989 PMCID: PMC8007305 DOI: 10.3201/eid2704.204199] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The expense of saliva collection devices designed to stabilize severe acute respiratory syndrome coronavirus 2 RNA is prohibitive to mass testing. However, virus RNA in nonsupplemented saliva is stable for extended periods and at elevated temperatures. Simple plastic tubes for saliva collection will make large-scale testing and continued surveillance easier.
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14
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Chiorazzi M, Silva E, Brower K, Wong P, Lucas C, Klein J, Liu F, Nakahata M, Zhao J, Rahman NT, Odio C, Bermejo S, Farhadian SF, Dela Cruz C, Casanovas-Massana A, Fournier J, Muenker C, Wyllie AL, Vogels CB, Kalinich CC, Petrone ME, Ott IM, Watkins AE, Moore AJ, Alpert T, Kluger Y, Ring A, Grubaugh ND, Iwasaki A, Ko AI, Herbst RS. Abstract S03-03: Cancer patients display diminished viral RNA clearance and altered T cell responses during SARS-CoV-2 infection. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s03-03] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer patients display immunomodulation related to malignancy and anti-cancer therapies, but how these factors impact COVID-19 remains unknown. To investigate immune responses in cancer patients with COVID-19, we undertook a prospective case-control study, enrolling hospitalized solid tumor patients with acute COVID-19, as well as age-, gender-, and comorbidity-matched COVID-19 patients without cancer as controls. Using biospecimens collected during hospitalization, we performed virologic measurements as well as in-depth immunophenotyping of cellular, antibody and cytokine responses. We enrolled 17 cancer patients (cases) admitted to Yale-New Haven Hospital between March 15 and June 30, 2020 with COVID-19, as well as 17 matched non-cancer patients (controls) admitted with COVID-19. No significant differences were observed between cases and controls based on patient characteristics (age, gender, race, co-morbidities, smoking history, days from symptom onset to COVID-19 diagnosis) or outcomes (COVID-19 severity, length of hospital stay, rate of intubation or mortality). The most common primary tumor sites were lung (4/17) and gastrointestinal (4/17); all cases had received cancer-directed therapy within 6 months of COVID-19 diagnosis, with 13/17 receiving treatment less than 1 month prior to hospitalization. Three of 17 cases had received immune checkpoint inhibitor therapies. Despite having similar SARS-CoV-2 viral RNA loads at the time of COVID-19 diagnosis when compared with controls, cancer cases had increased viral RNA abundance during hospitalization, suggesting slower clearance. Antibody responses against SARS-CoV-2 were preserved in cancer cases, with cases displaying similar levels of IgM and IgG antibodies directed against SARS-CoV-2 epitopes compared to controls. Cytokine profiling revealed higher plasma levels of CCL3, IL1A and CXCL12 in cancer cases compared to controls. Using flow cytometric immunophenotyping, we found that innate immune and non-T cell adaptive immune parameters were similar between cases and controls hospitalized with COVID-19. However, among cancer cases on conventional therapies, T cell lymphopenia was more profound, and these cases demonstrated higher levels of CD8+ exhausted (CD8+CD45RA−PD1+TIM3+), CD8+GranzymeB+ and CD4+CD38+HLA-DR+ and CD8+CD38+HLA-DR+ activated T cells when compared with controls; interestingly, these differences were not observed in patients who had received immune checkpoint inhibition. Thus, we found reduced viral RNA clearance and specific alterations in T cell and cytokine responses in cancer patients hospitalized with COVID-19 compared with matched controls with COVID-19. This dysregulated T cell response in cancer patients, which may reflect immune modulation due to chronic antigen stimulation as well as cancer therapies, may lead to altered virologic and clinical outcomes in this population.
Citation Format: Michael Chiorazzi, Erin Silva, Kristina Brower, Patrick Wong, Carolina Lucas, Jon Klein, Feimei Liu, Maura Nakahata, Jun Zhao, Nur-Taz Rahman, Camila Odio, Santos Bermejo, Shelli F. Farhadian, Charles Dela Cruz, Arnau Casanovas-Massana, John Fournier, Catherine Muenker, Anne L. Wyllie, Chantal B.F. Vogels, Chaney C. Kalinich, Mary E. Petrone, Isabel M. Ott, Anne E. Watkins, Adam J. Moore, Tara Alpert, Yuval Kluger, Aaron Ring, Nathan D. Grubaugh, Akiko Iwasaki, Albert I. Ko, Roy S. Herbst. Cancer patients display diminished viral RNA clearance and altered T cell responses during SARS-CoV-2 infection [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S03-03.
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Affiliation(s)
| | - Erin Silva
- 1Yale School of Medicine, New Haven, CT,
| | | | | | | | - Jon Klein
- 1Yale School of Medicine, New Haven, CT,
| | - Feimei Liu
- 1Yale School of Medicine, New Haven, CT,
| | | | - Jun Zhao
- 1Yale School of Medicine, New Haven, CT,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tara Alpert
- 2Yale School of Public Health, New Haven, CT
| | | | - Aaron Ring
- 1Yale School of Medicine, New Haven, CT,
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15
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Lu-Culligan A, Chavan AR, Vijayakumar P, Irshaid L, Courchaine EM, Milano KM, Tang Z, Pope SD, Song E, Vogels CB, Lu-Culligan WJ, Campbell KH, Casanovas-Massana A, Bermejo S, Toothaker JM, Lee HJ, Liu F, Schulz W, Fournier J, Muenker MC, Moore AJ, Konnikova L, Neugebauer KM, Ring A, Grubaugh ND, Ko AI, Morotti R, Guller S, Kliman HJ, Iwasaki A, Farhadian SF. SARS-CoV-2 infection in pregnancy is associated with robust inflammatory response at the maternal-fetal interface. medRxiv 2021:2021.01.25.21250452. [PMID: 33532791 PMCID: PMC7852242 DOI: 10.1101/2021.01.25.21250452] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pregnant women appear to be at increased risk for severe outcomes associated with COVID-19, but the pathophysiology underlying this increased morbidity and its potential impact on the developing fetus is not well understood. In this study of pregnant women with and without COVID-19, we assessed viral and immune dynamics at the placenta during maternal SARS-CoV-2 infection. Amongst uninfected women, ACE2 was detected by immunohistochemistry in syncytiotrophoblast cells of the normal placenta during early pregnancy but was rarely seen in healthy placentas at full term. Term placentas from women infected with SARS-CoV-2, however, displayed a significant increase in ACE2 levels. Using immortalized cell lines and primary isolated placental cells, we determined the vulnerability of various placental cell types to direct infection by SARS-CoV-2 in vitro. Yet, despite the susceptibility of placental cells to SARS-CoV-2 infection, viral RNA was detected in the placentas of only a subset (~13%) of women in this cohort. Through single cell transcriptomic analyses, we found that the maternal-fetal interface of SARS-CoV-2-infected women exhibited markers associated with pregnancy complications, such as preeclampsia, and robust immune responses, including increased activation of placental NK and T cells and increased expression of interferon-related genes. Overall, this study suggests that SARS-CoV-2 is associated with immune activation at the maternal-fetal interface even in the absence of detectable local viral invasion. While this likely represents a protective mechanism shielding the placenta from infection, inflammatory changes in the placenta may also contribute to poor pregnancy outcomes and thus warrant further investigation.
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Affiliation(s)
- Alice Lu-Culligan
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Arun R. Chavan
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Pavithra Vijayakumar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Lina Irshaid
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Edward M. Courchaine
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
- Department of Cell Biology, Yale School of Medicine, New Haven, CT, USA
| | - Kristin M. Milano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Zhonghua Tang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Scott D. Pope
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Eric Song
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Chantal B.F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - William J. Lu-Culligan
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
- Department of Cell Biology, Yale School of Medicine, New Haven, CT, USA
| | - Katherine H. Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Santos Bermejo
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jessica M. Toothaker
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah J. Lee
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Wade Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John Fournier
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - M. Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Adam J. Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Liza Konnikova
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Karla M. Neugebauer
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Aaron Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Raffaella Morotti
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Seth Guller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Harvey J. Kliman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
- Department of Molecular, Cellular and Developmental Biology, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Shelli F. Farhadian
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Schwarz B, Sharma L, Roberts L, Peng X, Bermejo S, Leighton I, Casanovas-Massana A, Minasyan M, Farhadian S, Ko AI, Dela Cruz CS, Bosio CM. Cutting Edge: Severe SARS-CoV-2 Infection in Humans Is Defined by a Shift in the Serum Lipidome, Resulting in Dysregulation of Eicosanoid Immune Mediators. J Immunol 2021; 206:329-334. [PMID: 33277388 PMCID: PMC7962598 DOI: 10.4049/jimmunol.2001025] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/11/2020] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic has affected more than 20 million people worldwide, with mortality exceeding 800,000 patients. Risk factors associated with severe disease and mortality include advanced age, hypertension, diabetes, and obesity. Each of these risk factors pathologically disrupts the lipidome, including immunomodulatory eicosanoid and docosanoid lipid mediators (LMs). We hypothesized that dysregulation of LMs may be a defining feature of the severity of COVID-19. By examining LMs and polyunsaturated fatty acid precursor lipids in serum from hospitalized COVID-19 patients, we demonstrate that moderate and severe disease are separated by specific differences in abundance of immune-regulatory and proinflammatory LMs. This difference in LM balance corresponded with decreased LM products of ALOX12 and COX2 and an increase LMs products of ALOX5 and cytochrome p450. Given the important immune-regulatory role of LMs, these data provide mechanistic insight into an immuno-lipidomic imbalance in severe COVID-19.
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Affiliation(s)
- Benjamin Schwarz
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Lydia Roberts
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840
| | - Xiaohua Peng
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Santos Bermejo
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Ian Leighton
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520; and
| | - Maksym Minasyan
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Shelli Farhadian
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520; and
| | - Charles S Dela Cruz
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520;
| | - Catharine M Bosio
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840;
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Vogels CBF, Watkins AE, Harden CA, Brackney DE, Shafer J, Wang J, Caraballo C, Kalinich CC, Ott IM, Fauver JR, Kudo E, Lu P, Venkataraman A, Tokuyama M, Moore AJ, Muenker MC, Casanovas-Massana A, Fournier J, Bermejo S, Campbell M, Datta R, Nelson A, Dela Cruz CS, Ko AI, Iwasaki A, Krumholz HM, Matheus JD, Hui P, Liu C, Farhadian SF, Sikka R, Wyllie AL, Grubaugh ND. SalivaDirect: A simplified and flexible platform to enhance SARS-CoV-2 testing capacity. Med (N Y) 2020; 2:263-280.e6. [PMID: 33521748 PMCID: PMC7836249 DOI: 10.1016/j.medj.2020.12.010] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/15/2023]
Abstract
Background Scaling SARS-CoV-2 testing to meet demands of safe reopenings continues to be plagued by assay costs and supply chain shortages. In response, we developed SalivaDirect, which received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). Methods We simplified our saliva-based diagnostic test by (1) not requiring collection tubes with preservatives, (2) replacing nucleic acid extraction with a simple enzymatic and heating step, and (3) testing specimens with a dualplex qRT-PCR assay. Moreover, we validated SalivaDirect with reagents and instruments from multiple vendors to minimize supply chain issues. Findings From our hospital cohort, we show a high positive agreement (94%) between saliva tested with SalivaDirect and nasopharyngeal swabs tested with a commercial qRT-PCR kit. In partnership with the National Basketball Association (NBA) and National Basketball Players Association (NBPA), we tested 3,779 saliva specimens from healthy individuals and detected low rates of invalid (0.3%) and false-positive (<0.05%) results. Conclusions We demonstrate that saliva is a valid alternative to swabs for SARS-CoV-2 screening and that SalivaDirect can make large-scale testing more accessible and affordable. Uniquely, we can designate other laboratories to use our sensitive, flexible, and simplified platform under our EUA (https://publichealth.yale.edu/salivadirect/). Funding This study was funded by the NBA and NBPA (N.D.G.), the Huffman Family Donor Advised Fund (N.D.G.), a Fast Grant from Emergent Ventures at the Mercatus Center at George Mason University (N.D.G.), the Yale Institute for Global Health (N.D.G.), and the Beatrice Kleinberg Neuwirth Fund (A.I.K.). C.B.F.V. is supported by NWO Rubicon 019.181EN.004. Frequent testing is critical to limit SARS-CoV-2 transmission. In response to this need, we developed SalivaDirect, a sensitive, simplified, and flexible testing framework, which received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). We tested saliva collected from a hospital cohort and showed a high positive agreement (94%) as compared to paired nasopharyngeal swabs tested with a commercial diagnostic kit. Then, we partnered with the National Basketball Association (NBA) to test a large cohort of mostly healthy individuals, and we detected low rates of invalid (0.3%) and false-positive (0.03%–0.05%) results. Our study shows that SalivaDirect can help to increase testing capacity by providing access to an affordable framework that is less prone to supply chain shortages.
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Affiliation(s)
- Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Anne E Watkins
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Christina A Harden
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Doug E Brackney
- Connecticut Agricultural Experimental Station, State of Connecticut, New Haven, CT 06511, USA
| | - Jared Shafer
- Drug Free Sport International, Kansas City, MO 64108, USA
| | - Jianhui Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Chaney C Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Isabel M Ott
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Joseph R Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Eriko Kudo
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Peiwen Lu
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Arvind Venkataraman
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Maria Tokuyama
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adam J Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - M Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - John Fournier
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Santos Bermejo
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Melissa Campbell
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Rupak Datta
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Allison Nelson
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | | | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - J D Matheus
- Drug Free Sport International, Kansas City, MO 64108, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Chen Liu
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Shelli F Farhadian
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Robby Sikka
- Minnesota Timberwolves, Minneapolis, MN 55403, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
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Azar MM, Schlaberg R, Malinis MF, Bermejo S, Schwarz T, Xie H, Dela Cruz CS. Added Diagnostic Utility of Clinical Metagenomics for the Diagnosis of Pneumonia in Immunocompromised Adults. Chest 2020; 159:1356-1371. [PMID: 33217418 DOI: 10.1016/j.chest.2020.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/10/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In the evaluation of community-acquired pneumonia, 30% to 60% of cases remain undiagnosed, despite extensive conventional microbiologic testing (CMT). Clinical metagenomics (CM) is an unbiased pathogen detection method that can increase diagnostic yield. RESEARCH QUESTION Does adding clinical metagenomics to conventional microbiologic testing improve the diagnostic yield for pneumonia in immunocompromised adults? STUDY DESIGN AND METHODS We performed a noninterventional prospective study of immunocompromised adults with pneumonia who underwent bronchoscopy and BAL over 2 years. CMT was performed per standard of care. A commercial CM test was performed on residual BAL fluid. Final microbiologic diagnoses were based on CMT vs CMT + CM. Final clinical diagnoses for CMT and CMT + CM were made based on laboratory results in conjunction with clinical and radiologic findings. Hypothetical impact of CMT + CM on management and antimicrobial stewardship was also assessed. RESULTS A total of 30 immunocompromised adult patients (31 episodes of pneumonia) were included. Final microbiologic diagnoses were made in 11 cases (35%) with the use of CMT and in 18 cases (58%) with the use of CMT + CM. Bacterial pneumonia was diagnosed in five cases (16%) by CMT and in 13 cases (42%) by CMT + CM; fungal pneumonia was diagnosed in six cases (19%) by CMT and in seven cases (23%) by CMT + CM, and viral pneumonia was diagnosed in two cases (6%) by CMT and in five cases (16%) by CMT + CM. The hypothetical impact of CMT + CM on management was deemed probable in one case, possible in eight cases, and unlikely in two cases, whereas the impact on antimicrobial stewardship was possible in 13 cases and unlikely in seven cases. Final clinical diagnoses were made in 20 of 31 cases (65%) based on CMT and in 23 of 31 cases (74%) based on CMT + CM. INTERPRETATION CMT + CM increased diagnostic yield in immunocompromised adults with pneumonia from 35% to 58%, mostly by the detection of additional bacterial causes but was less useful for fungal pneumonia.
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Affiliation(s)
- Marwan M Azar
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT.
| | - Robert Schlaberg
- IDbyDNA Inc, University of Utah School of Medicine, Salt Lake City, UT; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Maricar F Malinis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Toni Schwarz
- IDbyDNA Inc, University of Utah School of Medicine, Salt Lake City, UT
| | - Heng Xie
- IDbyDNA Inc, University of Utah School of Medicine, Salt Lake City, UT
| | - Charles S Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT
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19
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Vogels CBF, Brito AF, Wyllie AL, Fauver JR, Ott IM, Kalinich CC, Petrone ME, Casanovas-Massana A, Catherine Muenker M, Moore AJ, Klein J, Lu P, Lu-Culligan A, Jiang X, Kim DJ, Kudo E, Mao T, Moriyama M, Oh JE, Park A, Silva J, Song E, Takahashi T, Taura M, Tokuyama M, Venkataraman A, Weizman OE, Wong P, Yang Y, Cheemarla NR, White EB, Lapidus S, Earnest R, Geng B, Vijayakumar P, Odio C, Fournier J, Bermejo S, Farhadian S, Dela Cruz CS, Iwasaki A, Ko AI, Landry ML, Foxman EF, Grubaugh ND. Analytical sensitivity and efficiency comparisons of SARS-CoV-2 RT-qPCR primer-probe sets. Nat Microbiol 2020. [PMID: 32651556 DOI: 10.1101/2020.03.30.20048108] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 05/03/2023]
Abstract
The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exemplifies the critical need for accurate and rapid diagnostic assays to prompt clinical and public health interventions. Currently, several quantitative reverse transcription-PCR (RT-qPCR) assays are being used by clinical, research and public health laboratories. However, it is currently unclear whether results from different tests are comparable. Our goal was to make independent evaluations of primer-probe sets used in four common SARS-CoV-2 diagnostic assays. From our comparisons of RT-qPCR analytical efficiency and sensitivity, we show that all primer-probe sets can be used to detect SARS-CoV-2 at 500 viral RNA copies per reaction. The exception for this is the RdRp-SARSr (Charité) confirmatory primer-probe set which has low sensitivity, probably due to a mismatch to circulating SARS-CoV-2 in the reverse primer. We did not find evidence for background amplification with pre-COVID-19 samples or recent SARS-CoV-2 evolution decreasing sensitivity. Our recommendation for SARS-CoV-2 diagnostic testing is to select an assay with high sensitivity and that is regionally used, to ease comparability between outcomes.
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Affiliation(s)
- Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Anderson F Brito
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Joseph R Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Isabel M Ott
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA
| | - Chaney C Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Mary E Petrone
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - M Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Adam J Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Jonathan Klein
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Peiwen Lu
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Alice Lu-Culligan
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaodong Jiang
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel J Kim
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Eriko Kudo
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Tianyang Mao
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Miyu Moriyama
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ji Eun Oh
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Annsea Park
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Julio Silva
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Eric Song
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Takehiro Takahashi
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Manabu Taura
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Tokuyama
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Arvind Venkataraman
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Orr-El Weizman
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick Wong
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Yexin Yang
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Nagarjuna R Cheemarla
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth B White
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Sarah Lapidus
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Earnest
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Bertie Geng
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Pavithra Vijayakumar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Camila Odio
- Department of Medicine, Northeast Medical Group, Yale-New Haven Health, New Haven, CT, USA
| | - John Fournier
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shelli Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Charles S Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Marie L Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
- Clinical Virology Laboratory, Yale-New Haven Hospital, New Haven, CT, USA
| | - Ellen F Foxman
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
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20
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Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, Warren JL, Geng B, Muenker MC, Moore AJ, Vogels CBF, Petrone ME, Ott IM, Lu P, Venkataraman A, Lu-Culligan A, Klein J, Earnest R, Simonov M, Datta R, Handoko R, Naushad N, Sewanan LR, Valdez J, White EB, Lapidus S, Kalinich CC, Jiang X, Kim DJ, Kudo E, Linehan M, Mao T, Moriyama M, Oh JE, Park A, Silva J, Song E, Takahashi T, Taura M, Weizman OE, Wong P, Yang Y, Bermejo S, Odio CD, Omer SB, Dela Cruz CS, Farhadian S, Martinello RA, Iwasaki A, Grubaugh ND, Ko AI. Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2. N Engl J Med 2020; 383:1283-1286. [PMID: 32857487 PMCID: PMC7484747 DOI: 10.1056/nejmc2016359] [Citation(s) in RCA: 684] [Impact Index Per Article: 171.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peiwen Lu
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji E Oh
- Yale School of Medicine, New Haven, CT
| | | | | | - Eric Song
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT
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21
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Watkins AE, Fenichel EP, Weinberger DM, Vogels CB, Brackney DE, Casanovas-Massana A, Campbell M, Fournier J, Bermejo S, Datta R, Dela Cruz CS, Farhadian SF, Iwasaki A, Ko AI, Grubaugh ND, Wyllie AL. Pooling saliva to increase SARS-CoV-2 testing capacity. medRxiv 2020:2020.09.02.20183830. [PMID: 32909003 PMCID: PMC7480055 DOI: 10.1101/2020.09.02.20183830] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Expanding testing capabilities is integral to managing the further spread of SARS-CoV-2 and developing reopening strategies, particularly in regards to identifying and isolating asymptomatic and pre-symptomatic individuals. Central to meeting testing demands are specimens that can be easily and reliably collected and laboratory capacity to rapidly ramp up to scale. We and others have demonstrated that high and consistent levels of SARS-CoV-2 RNA can be detected in saliva from COVID-19 inpatients, outpatients, and asymptomatic individuals. As saliva collection is non-invasive, extending this strategy to test pooled saliva samples from multiple individuals could thus provide a simple method to expand testing capacity. However, hesitation towards pooled sample testing arises due to the dilution of positive samples, potentially shifting weakly positive samples below the detection limit for SARS-CoV-2 and thereby decreasing the sensitivity. Here, we investigated the potential of pooling saliva samples by 5, 10, and 20 samples prior to RNA extraction and RT-qPCR detection of SARS-CoV-2. Based on samples tested, we conservatively estimated a reduction of 7.41%, 11.11%, and 14.81% sensitivity, for each of the pool sizes, respectively. Using these estimates we modeled anticipated changes in RT-qPCR cycle threshold to show the practical impact of pooling on results of SARS-CoV-2 testing. In tested populations with greater than 3% prevalence, testing samples in pools of 5 requires the least overall number of tests. Below 1% however, pools of 10 or 20 are more beneficial and likely more supportive of ongoing surveillance strategies.
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Affiliation(s)
- Anne E. Watkins
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Eli P. Fenichel
- Yale School of the Environment, Yale University, New Haven, CT 06510, USA
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Chantal B.F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Doug E. Brackney
- Center for Vector-Borne and Zoonotic Diseases, Department of Environmental Sciences, The Connecticut Agricultural Experiment Station, New Haven, Connecticut 06504, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Melissa Campbell
- Department of Pediatrics, Division of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - John Fournier
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Rupak Datta
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Charles S. Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Shelli F. Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
- Howard Hughes Medical Institute, New Haven, CT 06510, USA
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
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22
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Young G, Peng X, Rebeza A, Bermejo S, De C, Sharma L, Dela Cruz CS. Rapid decline of seasonal influenza during the outbreak of COVID-19. ERJ Open Res 2020; 6:00296-2020. [PMID: 32832527 PMCID: PMC7430143 DOI: 10.1183/23120541.00296-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Abstract
Seasonal influenza is a leading cause of disease worldwide, resulting in as many as 650 000 deaths on a yearly basis [1]. Vaccination is the cornerstone of influenza prevention, but its efficacy is limited by the accuracy in predicting circulating strains. Epidemiological methods such as social distancing, the use of protective face masks and frequent hand washing are not routinely practiced in influenza prevention. In contrast, these methods have been widely applied during the COVID-19 outbreak. In this study, we investigated how this year's influenza season has been impacted during the COVID-19 pandemic. The implementation of public health measures during the #COVID19 pandemic may also help to reduce transmission of respiratory illnesses such as influenzahttps://bit.ly/2BmysRJ
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Affiliation(s)
- Grant Young
- Yale School of Medicine, Dept of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.,Joint first authors
| | - Xiaohua Peng
- Yale School of Medicine, Dept of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.,Joint first authors
| | - Andre Rebeza
- Yale School of Medicine, Dept of Internal Medicine, Section of Pediatrics, New Haven, CT, USA
| | - Santos Bermejo
- Yale School of Medicine, Dept of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| | - Chang De
- College of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Lokesh Sharma
- Yale School of Medicine, Dept of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.,Joint senior authors
| | - Charles S Dela Cruz
- Yale School of Medicine, Dept of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.,Joint senior authors
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23
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Ott IM, Strine MS, Watkins AE, Boot M, Kalinich CC, Harden CA, Vogels CB, Casanovas-Massana A, Moore AJ, Muenker MC, Nakahata M, Tokuyama M, Nelson A, Fournier J, Bermejo S, Campbell M, Datta R, Dela Cruz CS, Farhadian SF, Ko AI, Iwasaki A, Grubaugh ND, Wilen CB, Wyllie AL. Simply saliva: stability of SARS-CoV-2 detection negates the need for expensive collection devices. medRxiv 2020:2020.08.03.20165233. [PMID: 32793924 PMCID: PMC7418742 DOI: 10.1101/2020.08.03.20165233] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Most currently approved strategies for the collection of saliva for COVID-19 diagnostics require specialized tubes containing buffers promoted for the stabilization of SARS-CoV-2 RNA and virus inactivation. Yet many of these are expensive, in limited supply, and not necessarily validated specifically for viral RNA. While saliva is a promising sample type as it can be reliably self-collected for the sensitive detection of SARS-CoV-2, the expense and availability of these collection tubes are prohibitive to mass testing efforts. Therefore, we investigated the stability of SARS-CoV-2 RNA and infectious virus detection from saliva without supplementation. We tested RNA stability over extended periods of time (2-25 days) and at temperatures representing at-home storage and elevated temperatures which might be experienced when cold chain transport may be unavailable. We found SARS-CoV-2 RNA in saliva from infected individuals is stable at 4°C, room temperature (~19°C), and 30°C for prolonged periods and found limited evidence for viral replication in saliva. This work demonstrates that expensive saliva collection options involving RNA stabilization and virus inactivation buffers are not always needed, permitting the use of cheaper collection options. Affordable testing methods are urgently needed to meet current testing demands and for continued surveillance in reopening strategies.
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Affiliation(s)
- Isabel M. Ott
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Madison S. Strine
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Anne E. Watkins
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Maikel Boot
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Chaney C. Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Christina A. Harden
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Chantal B.F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Adam J. Moore
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - M. Catherine Muenker
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Maura Nakahata
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Maria Tokuyama
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Allison Nelson
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - John Fournier
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Melissa Campbell
- Department of Pediatrics, Division of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Rupak Datta
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Charles S. Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Shelli F. Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, 06510, USA
- Howard Hughes Medical Institute, New Haven, CT 06510, USA
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Craig B. Wilen
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
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24
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Schwarz B, Sharma L, Roberts L, Peng X, Bermejo S, Leighton I, Massana AC, Farhadian S, Ko AI, Cruz CSD, Bosio CM. Severe SARS-CoV-2 infection in humans is defined by a shift in the serum lipidome resulting in dysregulation of eicosanoid immune mediators. Res Sq 2020:rs.3.rs-42999. [PMID: 32743565 PMCID: PMC7386513 DOI: 10.21203/rs.3.rs-42999/v1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has affected more than 10 million people worldwide with mortality exceeding half a million patients. Risk factors associated with severe disease and mortality include advanced age, hypertension, diabetes, and obesity.1 Clear mechanistic understanding of how these comorbidities converge to enable severe infection is lacking. Notably each of these risk factors pathologically disrupts the lipidome and this disruption may be a unifying feature of severe COVID-19.1-7 Here we provide the first in depth interrogation of lipidomic changes, including structural-lipids as well as the eicosanoids and docosanoids lipid mediators (LMs), that mark COVID-19 disease severity. Our data reveal that progression from moderate to severe disease is marked by a loss of specific immune regulatory LMs and increased pro-inflammatory species. Given the important immune regulatory role of LMs, these data provide mechanistic insight into the immune balance in COVID-19 and potential targets for therapy with currently approved pharmaceuticals.8.
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Affiliation(s)
- Benjamin Schwarz
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lydia Roberts
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Xiaohua Peng
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Santos Bermejo
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ian Leighton
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Arnau Casanovas Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520
| | - Shelli Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, 06520
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520
| | | | - Charles S. Dela Cruz
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Catharine M. Bosio
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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25
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Schwarz B, Sharma L, Roberts L, Peng X, Bermejo S, Leighton I, Massana AC, Farhadian S, Ko AI, Cruz CSD, Bosio CM. Severe SARS-CoV-2 infection in humans is defined by a shift in the serum lipidome resulting in dysregulation of eicosanoid immune mediators. medRxiv 2020:2020.07.09.20149849. [PMID: 32676616 PMCID: PMC7359541 DOI: 10.1101/2020.07.09.20149849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has affected more than 10 million people worldwide with mortality exceeding half a million patients. Risk factors associated with severe disease and mortality include advanced age,hypertension, diabetes, and obesity. Clear mechanistic understanding of how these comorbidities converge to enable severe infection is lacking. Notably each of these risk factors pathologically disrupts the lipidome and this disruption may be a unifying feature of severe COVID-19. Here we provide the first in depth interrogation of lipidomic changes, including structural-lipids as well as the eicosanoids and docosanoids lipid mediators (LMs), that mark COVID-19 disease severity. Our data reveal that progression from moderate to severe disease is marked by a loss of specific immune regulatory LMs and increased pro-inflammatory species. Given the important immune regulatory role of LMs, these data provide mechanistic insight into the immune balance in COVID-19 and potential targets for therapy with currently approved pharmaceuticals.
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Affiliation(s)
- Benjamin Schwarz
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lydia Roberts
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Xiaohua Peng
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Santos Bermejo
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ian Leighton
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Arnau Casanovas Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520
| | - Shelli Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, 06520
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520
| | | | - Charles S. Dela Cruz
- Section of Pulmonary and Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Catharine M. Bosio
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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26
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Farhadian S, Glick LR, Vogels CBF, Thomas J, Chiarella J, Casanovas-Massana A, Zhou J, Odio C, Vijayakumar P, Geng B, Fournier J, Bermejo S, Fauver JR, Alpert T, Wyllie AL, Turcotte C, Steinle M, Paczkowski P, Dela Cruz C, Wilen C, Ko AI, MacKay S, Grubaugh ND, Spudich S, Barakat LA. Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19. BMC Neurol 2020; 20:248. [PMID: 32552792 PMCID: PMC7301053 DOI: 10.1186/s12883-020-01812-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients. CASE PRESENTATION We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion. CONCLUSION Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.
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Affiliation(s)
- Shelli Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA.
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Laura R Glick
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Jared Thomas
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jennifer Chiarella
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Camila Odio
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Pavithra Vijayakumar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Bertie Geng
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - John Fournier
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Joseph R Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Tara Alpert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | | | | | - Charles Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Craig Wilen
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Albert I Ko
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Lydia Aoun Barakat
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
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27
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López AM, Belda I, Bermejo S, Parra L, Áñez C, Borràs R, Sabaté S, Carbonell N, Marco G, Pérez J, Massó E, Soto JM, Boza E, Gil JM, Serra M, Tejedor V, Tejedor A, Roza J, Plaza A, Tena B, Valero R. Recommendations for the evaluation and management of the anticipated and non-anticipated difficult airway of the Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor, based on the adaptation of clinical practice guidelines and expert consensus. ACTA ACUST UNITED AC 2020; 67:325-342. [PMID: 32471791 DOI: 10.1016/j.redar.2019.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.
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Affiliation(s)
- A M López
- Hospital Clínic de Barcelona, Barcelona, España
| | - I Belda
- Hospital Clínic de Barcelona, Barcelona, España
| | - S Bermejo
- Consorci Mar Parc de Salut de Barcelona, Barcelona, España
| | - L Parra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - C Áñez
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - R Borràs
- Hospital Universitari Dexeus, Barcelona, España
| | - S Sabaté
- Fundació Puigvert (IUNA), Barcelona, España
| | - N Carbonell
- Hospital Universitari Dexeus, Barcelona, España
| | - G Marco
- Hospital Universitari Santa Maria de Lleida, Lleida, España
| | - J Pérez
- Hospital Universitari Parc Taulí, Sabadell, España
| | - E Massó
- Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - J Mª Soto
- Hospital d' Igualada, SEM, Igualada, España
| | - E Boza
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España
| | - J M Gil
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Serra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - V Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - A Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - J Roza
- Hospital Universitari de Vic, Vic, España
| | - A Plaza
- Hospital Clínic de Barcelona, Barcelona, España
| | - B Tena
- Hospital Clínic de Barcelona, Barcelona, España
| | - R Valero
- Hospital Clínic de Barcelona, Barcelona, España.
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Farhadian S, Glick LR, Vogels CBF, Thomas J, Chiarella J, Casanovas-Massana A, Zhou J, Odio C, Vijayakumar P, Geng B, Fournier J, Bermejo S, Fauver JR, Alpert T, Wyllie AL, Turcotte C, Steinle M, Paczkowski P, Cruz CD, Wilen C, Ko AI, MacKay S, Grubaugh ND, Spudich S, Aoun Barakat L. Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19. Res Sq 2020:rs.3.rs-28583. [PMID: 32702723 PMCID: PMC7336693 DOI: 10.21203/rs.3.rs-28583/v1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients. CASE PRESENTATION We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion. CONCLUSION Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.
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Fustà-Novell X, Bermejo S, Creus-Vila L. Neutrophilic dermatosis of the dorsal hands. Rev Clin Esp 2020; 221:S0014-2565(20)30056-4. [PMID: 32223993 DOI: 10.1016/j.rce.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/21/2019] [Indexed: 10/24/2022]
Affiliation(s)
- X Fustà-Novell
- Servicio de Dermatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España.
| | - S Bermejo
- Servicio de Nefrología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - L Creus-Vila
- Servicio de Dermatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
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Lee SW, Sharma L, Kang YA, Kim SH, Chandrasekharan S, Losier A, Brady V, Bermejo S, Andrews N, Yoon CM, Liu W, Lee JY, Kang MJ, Dela Cruz CS. Impact of Cigarette Smoke Exposure on the Lung Fibroblastic Response after Influenza Pneumonia. Am J Respir Cell Mol Biol 2019; 59:770-781. [PMID: 30110182 DOI: 10.1165/rcmb.2018-0004oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/14/2022] Open
Abstract
Influenza viruses can result in significant lung injury with significant morbidity and mortality. In this study, we evaluated the impact of cigarette smoke (CS) exposure on the pulmonary fibroblastic response after influenza infection. We used a murine model in which animals were exposed to CS or room air and subsequently infected with H1N1 influenza virus. Inflammatory and fibrotic responses were measured at different time points after influenza infection. Primary fibroblasts were isolated from the lungs of mice and their characteristics were evaluated. Exposure to CS significantly increased the amount of collagen in the lungs of mice infected with influenza virus compared with the nonsmoking group at 30 days after infection. Furthermore, the presence of fibroblast-specific protein-positive cells increased in the lungs of influenza-infected mice that were exposed to CS compared with the infection-alone group. The smoking group also showed delays in weight recovery and higher cell counts in BAL fluid after infection. Active transforming growth factor β1 levels in BAL fluid increased in both groups; however, CS-exposed mice had a later surge in active transforming growth factor β1 (Day 24). Ex vivo cultures of lung-derived fibroblasts from CS-exposed mice with influenza infection showed rapid proliferation, increased expression of α-smooth muscle actin-stained stress fibers, and higher expression of growth factors compared with fibroblasts from room air-exposed lungs after infection. These results suggest that CS exposure changes the fibroblastic potential, leading to increased fibrosis after influenza infection.
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Affiliation(s)
- Sei Won Lee
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,2 Department of Pulmonary and Critical Care Medicine, and.,3 Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lokesh Sharma
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Young Ae Kang
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,4 Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea; and
| | - Sang-Hun Kim
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sreelakshmi Chandrasekharan
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ashley Losier
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Virginia Brady
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Santos Bermejo
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nathaniel Andrews
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Chang-Min Yoon
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Wei Liu
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jung-Yeon Lee
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,5 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Chungju Hospital, Chungju, Korea
| | - Min-Jong Kang
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Charles S Dela Cruz
- 1 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Coral A, Espinosa N, Latorre A, Bermejo S, Nolla X, De Segura G, Diaz C, Mancera M. EP-2176 Analysis of inter-fraction tumor position variability in lung SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32596-4] [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: 10/26/2022]
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Gómez de Segura Melcón G, Nolla X, Bermejo S, Ventosa N, Isern J, Carrasco P. PO-1106 Dosimetric impact to organs at risk when the internal mammary node chain is included in irradiation of left breast. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41098-9] [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: 11/16/2022]
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Bermejo S, Ventosa N, Domenech X, Flores R, Gómez de Segura G, Jimenez J, Nolla X, San Martín L, Carrasco P, Latorre A. EP-1640 Comparison of time-benefit ratio between in vivo dosimetry and pre-treatment verification in IMRT breast treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41632-9] [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: 11/24/2022]
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Neves FMDO, Leite TT, Meneses GC, Araujo De Souza NH, Martins AMC, Parahyba MC, Queiroz REB, Liborio A, Liu Y, Li Y, Li X, Chen L, Zulkarnaev A, Vatazin A, Nikolaj S, Stadler T, Raddatz A, Hubner W, Poppleton A, Fliser D, Klingele M, Castellano G, Intini A, Stasi A, Divella C, Pontrelli P, Gigante M, Zito A, Pertosa GB, Gesualdo L, Grandaliano G, Powell TC, Donnelly JP, Wang HE, Warnock DG, De Loor J, Hoste E, Herck I, Francois K, Decrop L, Clauwaert C, Bracke S, Vermeiren D, Demeyere K, Meyer E, Mitra P, Rahim MA, Gupta RD, Samdani TS, Rahman SA, Enam SF, Mursalin G, E-Khoda MM, Haque WMM, Iqbal S, Mansur MA, Guglielmetti G, Cena T, Musetti C, Quaglia M, Battista M, Radin E, Airoldi A, Izzo C, Stratta P, Haase-Fielitz A, Albert C, Westphal S, Hoffmann J, Mertens PR, Plass M, Westerman M, Bellomo R, Maisel A, Ronco C, Haase M, Wu PC, Wu VC, Prasad B, Wong B, St.Onge JR, Rungta R, Das P, Ray DS, Gupta S, De Gracia MDC, Osuna A, Quesada A, Manzano F, Montoro S, Jimenez MDM, Wangensteen R, Strunk AK, Schmidt J, Schmidt B, Bode-Boger S, Martens-Lobenhoffer J, Welte T, Kielstein JT, Wang AY, Bellomo R, Cass A, Myburgh J, Finfer S, Gatta D, Chadban S, Jardine M, Lo S, Barzi F, Gallagher M, Marn-Pernat A, Benedik M, Bren A, Buturovic-Ponikvar J, Gubensek J, Knap B, Premru V, Ponikvar R, Koba L, Teixeira M, Macedo E, Altunoren O, Balli M, Tasolar H, Eren N, Arpaci A, Caglayan CE, Yavuz YC, Sahin M, Gliga ML, Gliga PM, Frigy A, Bandea A, Magdas AM, Dogaru G, Mergulhao C, Pinheiro H, Vidal E, Sette L, Amorim G, Fernandes G, Valente L, Hornum M, Penninga L, Rasmussen A, Plagborg UB, Oturai P, Feldt-Rasmussen B, Hillingso JG, Klimenko A, Villevalde S, Kobalava Z, Arias Cabrales C, Rodriguez E, Bermejo S, Sierra A, Pascual J, Huang TM, Wu VC, Oh WC, Rigby M, Mafrici B, Sharman A, Harvey D, Welham S, Mahajan R, Gardner D, Devonald M, Wu VC, Lin MC, Wu PC, Wu CH, Nagaraja P, Clark A, Brisk R, Jennings V, Jones H, Hashmi M, Parker C, Mikhail A, Schraut J, Keller F, Mertens T, Duprel JB, Quercia AD, Cantaluppi V, Dellepiane S, Pacitti A, Biancone L, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Quercia AD, Cantaluppi V, Dellepiane S, Medica D, Besso L, Gai M, Leonardi G, Guarena C, Biancone L, Obrencevic K, Jovanovic D, Petrovic M, Ignjatovic L, Tadic J, Mijuskovic M, Maksic D, Vavic N, Pilcevic D, Mistry HD, Bramham K, Seed PT, Lynham S, Ward MA, Poston L, Chappell LC. CLINICAL ACUTE KIDNEY INJURY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu144] [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: 11/14/2022] Open
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Bermejo S, Segura GGD, Fez PCD. EP-1628 DETERMINATION OF CTV-PTV SETUP MARGINGS FOR DIFERENT SITES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71961-8] [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: 11/25/2022]
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Alted López E, Bermejo S, Chico M. Carta de réplica. Med Intensiva 2009. [DOI: 10.1016/j.medin.2009.05.009] [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: 10/20/2022]
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Valero R, Mayoral V, Massó E, López A, Sabaté S, Villalonga R, Villalonga A, Casals P, Vila P, Borràs R, Añez C, Bermejo S, Canet J. [Evaluation and management of expected or unexpected difficult airways: adopting practice guidelines]. Rev Esp Anestesiol Reanim 2008; 55:563-570. [PMID: 19086724 DOI: 10.1016/s0034-9356(08)70653-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- R Valero
- Secció Via Aèria (SEVA) de la Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor.
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Williams MM, Armand-Ugon R, González I, Bermejo S. [Retrospective analysis of fluid balance and complications after liberal intravascular fluid replacement during elective vascular surgery]. Rev Esp Anestesiol Reanim 2008; 55:375-376. [PMID: 18693665 DOI: 10.1016/s0034-9356(08)70595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Gallart L, Bermejo S. Interpleural block and respiratory side effects. Anaesthesia 2008; 63:551; author reply 551-2. [PMID: 18412659 DOI: 10.1111/j.1365-2044.2008.05526_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fernandez-Galinski S, Bermejo S, Mansilla R, Pol O, Puig MM. Comparative assessment of the effects of alfentanil, esmolol or clonidine when used as adjuvants during induction of general anaesthesia. Eur J Anaesthesiol 2004; 21:476-82. [PMID: 15248628 DOI: 10.1017/s0265021504006106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE This randomized, double-blinded, prospective study compared the effects of clonidine, esmolol or alfentanil on the level of hypnosis and haemodynamic responses to intravenous induction of anaesthesia and endotracheal intubation. METHODS Forty-five patients scheduled for elective surgery were allotted to one of three groups. They were given either alfentanil 3 microg kg(-1) min(-1) (n = 15); esmolol 1 mg kg(-1) min(-1) (n = 16) or clonidine 3 microg kg(-1) (n = 14) as a 10 min infusion. The infusions of alfentanil and esmolol, but not of clonidine, were maintained during endotracheal intubation. Anaesthesia was induced with midazolam (2 mg) and thiopental as required to suppress the eyelash reflex. Atracurium (0.5 mg kg(-1)) was given to produce neuromuscular block. Mean arterial pressure, heart rate, and bispectral index were recorded on arrival (baseline), after study drug infusion, after injecting midazolam and thiopental, as well as after endotracheal intubation. ANOVA and chi2-test were used for analysis. RESULTS Blood pressure, heart rate and the bispectral index were unaltered by the study drugs, but thiopental requirements were reduced by alfentanil and clonidine (P < 0.014). Mean arterial pressure values (mean +/- standard error of mean) in the alfentanil, esmolol and clonidine groups were: baseline: 107.8 +/- 3.8; 106.6 +/- 3.9; 103.4 +/- 3.7 mmHg; after thiopental: 74.0 +/- 4.2; 85.6 +/- 4.3; 94.2 +/- 4.1 mmHg and after endotracheal intubation: 91.7 +/- 5.3; 114.1 +/- 6.9; 123.6 +/- 5.6 mmHg, respectively (two-way ANOVA, P < 0.001). Mean arterial pressure changed significantly after intubation from baseline (P < 0.001) after alfentanil (-15%) and clonidine (+20%) but not after esmolol (+7%), while the changes between pre- and postintubation values were similar in all groups (24-33% increase). The bispectral index indicated that all patients had an adequate level of hypnosis, but the variability was higher in the esmolol group (P < 0.002). CONCLUSIONS None of the study drugs blocked the increase in mean arterial pressure induced by endotracheal intubation, but esmolol provided better overall haemodynamic stability. All groups had an adequate level of hypnosis.
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Affiliation(s)
- S Fernandez-Galinski
- Hospital Universitario del Mar, Department of Anaesthesiology, Universidad Autonoma de Barcelona, IMIM, Barcelona, Spain
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Fernandez-Galinski S, Bermejo S, Mansilla R, Pol O, Puig MM. Comparative assessment of the effects of alfentanil, esmolol or clonidine when used as adjuvants during induction of general anaesthesia. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200406000-00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Silva Costa-Gomes T, Montes A, Sánchez JC, Bermejo S, Escolano F. [Cardiorespiratory arrest: a rare complication of subdural block]. Rev Esp Anestesiol Reanim 2002; 49:108-11. [PMID: 12025240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We report a case of accidental subdural block after epidural anesthesia that manifested as cardiac arrest due to extensive spinal blockade 20 minutes after administration of 50 mg of 0.5% bupivacaine. The event resolved without sequelae. Subdural placement of the catheter was verified by computed axial tomography contrast medium. Clinical signs of subdural block are highly variable, extensive neural block being among the possible rare presentations, with latency ranging from a few minutes to as long as 30. Recent electron microscope observations with new methods for fixing and preparing tissues suggest that the dubdural space does not exist naturally, but rather forms artificially within a low-resistance cell plane composed of neurothelial cells, as a result of trauma or the injection of a local anesthetic. The characteristics of the space depend, therefore, on factors that come together at the site. These data explain the great variability in the clinical manifestations of a subdural block. The case of cardiopulmonary arrest we report is rare in the literature.
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Affiliation(s)
- T Silva Costa-Gomes
- Servicio de Anestesiología y Reanimación Hospital Universitario del Mar Paseo Marítimo, 25-29 08003 Barcelona
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Abstract
Large margin classifiers (such as MLPs) are designed to assign training samples with high confidence (or margin) to one of the classes. Recent theoretical results of these systems show why the use of regularisation terms and feature extractor techniques can enhance their generalisation properties. Since the optimal subset of features selected depends on the classification problem, but also on the particular classifier with which they are used, global learning algorithms for large margin classifiers that use feature extractor techniques are desired. A direct approach is to optimise a cost function based on the margin error, which also incorporates regularisation terms for controlling capacity. These terms must penalise a classifier with the largest margin for the problem at hand. Our work shows that the inclusion of a PCA term can be employed for this purpose. Since PCA only achieves an optimal discriminatory projection for some particular distribution of data, the margin of the classifier can then be effectively controlled. We also propose a simple constrained search for the global algorithm in which the feature extractor and the classifier are trained separately. This allows a degree of flexibility for including heuristics that can enhance the search and the performance of the computed solution. Experimental results demonstrate the potential of the proposed method.
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Affiliation(s)
- S Bermejo
- Department of Electronic Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain.
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Bermejo S, Trillo L, Mansilla R, Sitges A, Escolano F. [Is preoperative electrophysiological assessment advisable for patients with bifascicular block?]. Rev Esp Anestesiol Reanim 2001; 48:442-3. [PMID: 11792293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Bermejo S, Castillo J, Sánchez J, Soler E, Castaño J. [Incidence of transient neurologic symptoms after subarachnoid anesthesia with mepivacaine in ambulatory major surgery]. Rev Esp Anestesiol Reanim 2001; 48:345-6. [PMID: 11591285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S Bermejo
- Médico residente.Servicio de Anestesiología y Reanimación, Hospital del Mar y de L'EsperanCa. Institut Municipal d'Assistència Sanitaria, Barcelona, Spain
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