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Focus on Dysregulated Adaptive Immunity in Chronic Hepatitis B: A Promising Direction for Immunotherapy 关注慢性乙型肝炎适应性免疫失调:免疫治疗的一个有希望的方向
Q3 INFECTIOUS DISEASES Pub Date : 2022-01-25 DOI: 10.1097/IM9.0000000000000082
Jiaming Zhou, Chunhong Huang, Haihong Zhu, Zhi Chen
Abstract Hepatitis B virus (HBV) infection is a public health problem that endangers global health and is the leading cause for the occurrence and death due to hepatocellular carcinoma. Although nucleotide analogs are excellent in controlling virus replication, they have little effect on the production, stability, and transcription of covalently closed circular DNA (cccDNA) in infected hepatocytes. Moreover, only a small fraction of patients with chronic hepatitis B are cured by interferon therapy. During HBV infection, HBV-specific B cells and T cells are produced. HBV-specific T cells exert antiviral effects through cell lysis and non-cytolytic effector functions, reducing viral intermediates and cccDNA. In addition, HBV-specific B cells produce antibodies that eliminate HBV-infected liver cells through antibody-dependent cell-mediated cytotoxicity of natural killer cells. They can also bind to the hepatitis B surface antigen on the surface of the virus particle, inducing antibody-dependent phagocytosis by Kupffer cells. These responses could be combined with immunotherapy based on antiviral therapy, which may achieve a complete cure for hepatitis B. However, patients with chronic hepatitis B have immune dysfunctions, which challenges immunotherapy implementation. This review focuses on advances in adaptive immunotherapy for chronic viral hepatitis B.
摘要乙型肝炎病毒(HBV)感染是危害全球健康的公共卫生问题,是肝细胞癌发生和死亡的主要原因。尽管核苷酸类似物在控制病毒复制方面非常出色,但它们对感染肝细胞中共价闭合环状DNA(cccDNA)的产生、稳定性和转录几乎没有影响。此外,只有一小部分慢性乙型肝炎患者通过干扰素治疗得以治愈。在HBV感染期间,会产生HBV特异性的B细胞和T细胞。HBV特异性T细胞通过细胞裂解和非细胞裂解效应器功能发挥抗病毒作用,减少病毒中间体和cccDNA。此外,HBV特异性B细胞产生抗体,通过抗体依赖性细胞介导的自然杀伤细胞的细胞毒性消除HBV感染的肝细胞。它们还可以与病毒颗粒表面的乙型肝炎表面抗原结合,诱导库普弗细胞的抗体依赖性吞噬作用。这些反应可以与基于抗病毒治疗的免疫疗法相结合,从而可能完全治愈乙型肝炎。然而,慢性乙型肝炎患者存在免疫功能障碍,这对免疫疗法的实施提出了挑战。本文综述了慢性病毒性乙型肝炎的适应性免疫治疗进展。
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引用次数: 2
Clinical Efficacy of Inhaled Nitric Oxide in Preventing the Progression of Moderate to Severe COVID-19 and Its Correlation to Viral Clearance: Results of a Pilot Study 吸入一氧化氮预防中重度COVID-19进展的临床疗效及其与病毒清除的相关性:一项初步研究结果
Q3 INFECTIOUS DISEASES Pub Date : 2021-12-28 DOI: 10.1097/IM9.0000000000000079
M. Moni, T. Madathil, D. Sathyapalan, Veena Menon, G. Gutjahr, F. Edathadathil, Deepthi Sureshkumar, P. Prasanna, S. Jose, Roshni Jerome, Ajai Krishnan, Indulekha C. L. Pillai, G. Kumar, Bipin Nair, V. Nizet, A. Jayant
Abstract Hypoxic patients with coronavirus disease 2019 (COVID-19) are at high risk of adverse outcomes. Inhaled nitric oxide (iNO) has shown anti-viral and immunomodulatory effects in vitro. However, in vivo evidence of efficacy in hypoxic COVID-19 is sparse. This open label feasibility study was conducted at a single referral center in South India and evaluated the effectiveness of repurposed iNO in improving clinical outcomes in COVID-19 and its correlation with viral clearance. We recruited hypoxemic COVID-19 patients and allocated them into treatment (iNO) and control groups (1:1). Viral clearance on day 5 favored the treatment group (100% vs 72%, P < 0.01). The speed of viral clearance as adjudged by normalized longitudinal cycle threshold (Ct) values was positively impacted in the treatment group. The proportion of patients who attained clinical improvement, defined as a ≥2-point change on the World Health Organization ordinal scale, was higher in the iNO cohort (n = 11, 79%) as compared to the control group (n = 4, 36%) (odds ratio 6.42, 95% confidence interval 1.09-37.73, P = 0.032). The proportion of patients progressing to mechanical ventilation in the control group (4/11) was significantly higher than in the treatment group (0/14). The all-cause 28-day mortality was significantly different among the study arms, with 36% (4/11) of the patients dying in the control group while none died in the treatment group. The numbers needed to treat to prevent an additional poor outcome of death was estimated to be 2.8. Our study demonstrates the putative role of repurposed iNO in hypoxemic COVID-19 patients and calls for extended validation.
新冠肺炎(COVID-19)缺氧患者不良结局风险高。吸入型一氧化氮(iNO)在体外显示出抗病毒和免疫调节作用。然而,对缺氧COVID-19有效的体内证据很少。这项开放标签可行性研究是在印度南部的一个转诊中心进行的,评估了重新用途的iNO在改善COVID-19临床结果方面的有效性及其与病毒清除的相关性。我们招募低氧血症的COVID-19患者,将其分为治疗组(iNO)和对照组(1:1)。第5天的病毒清除率对治疗组有利(100% vs 72%, P < 0.01)。通过标准化纵向周期阈值(Ct)判断,治疗组的病毒清除速度受到积极影响。获得临床改善的患者比例(定义为世界卫生组织顺序量表上≥2点的变化)在iNO队列中(n = 11,79%)高于对照组(n = 4,36%)(优势比6.42,95%置信区间1.09-37.73,P = 0.032)。对照组患者进展到机械通气的比例(4/11)显著高于治疗组(0/14)。各研究组的全因28天死亡率有显著差异,对照组有36%(4/11)的患者死亡,而治疗组无患者死亡。为防止额外不良死亡结果而需要治疗的人数估计为2.8人。我们的研究证明了重新定位的iNO在低氧血症COVID-19患者中的假定作用,并需要进一步验证。
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引用次数: 1
Detection of Plasmid-Mediated Tigecycline Resistance Gene tet(X4) in a Salmonella enterica Serovar Llandoff Isolate 质粒介导的肠沙门氏菌血清型Llandoff分离株替加环素耐药基因tet(X4)的检测
Q3 INFECTIOUS DISEASES Pub Date : 2021-11-11 DOI: 10.1097/IM9.0000000000000077
Yanan Wang, Fei Liu, Xuebin Xu, Hua Huang, Na Lyu, Sufang Ma, Luping Chen, Mengyu Mao, Yongfei Hu, Xiaofeng Song, Jing Li, Yuanlong Pan, Aiping Wang, Gaiping Zhang, B. Zhu, G. Gao
Supplemental Digital Content is available in the text Abstract The emergence and spread of plasmid-mediated tigecycline resistance genes have attracted extensive attention worldwide. We investigated the distribution of mobile tigecycline resistance genes in Salmonella genomes generated by both our laboratory and public bacterial genomes downloaded from the NCBI GenBank. The tet(X4)-positive strains were subjected to susceptibility testing and conjugation assays. The genetic features of the tet(X4)-bearing plasmid sequence were analyzed. Here, we report the identification of the plasmid-mediated tigecycline resistance gene tet(X4) in a conjugative plasmid of the Salmonella enterica serovar Llandoff strain SH16G3606, isolated from a man in China in 2016, the first reported serovar Llandoff in China as a novel sequence type ST8300. The tet(X4)-mediated resistance phenotype was successfully transferred from the Salmonella Llandoff strain into Escherichia coli J53, resulting in a 32-fold increase in the minimal inhibitory concentration of tigecycline. The tet(X4) gene was located between two copies of ISCR2 in the plasmid pSal21GXH-tetX4. To our knowledge, this is the first report of the plasmid-mediated tigecycline resistance gene tet(X4) in a Salmonella Llandoff strain isolated from a human stool sample in China. In addition, our findings demonstrated that a total of 171 isolates are carrying tet(X)-like genes distributed in 21 countries or areas across 6 continents, posing a serious threat to humans and public health. Overall, our timely discovery of the recent emergence of the tet(X4) gene in Salmonella isolates and other Enterobacteriaceae bacteria species supports the need for rapid surveillance to prevent the tet(X)-like gene from spreading.
质粒介导的替加环素耐药基因的出现和传播引起了世界范围内的广泛关注。我们调查了沙门氏菌基因组中移动替加环素耐药基因的分布,这些基因由我们的实验室和从NCBI GenBank下载的公共细菌基因组生成。对tet(X4)阳性菌株进行药敏试验和偶联试验。分析了携带tet(X4)的质粒序列的遗传特征。在此,我们报告了在2016年从中国一名男子中分离的肠沙门氏菌血清型Llandoff菌株SH16G3606的共轭质粒中鉴定出质粒介导的替加环素耐药基因tet(X4),这是中国首次报道的新型序列型ST8300的血清型Llandoff菌株。将tet(X4)介导的耐药表型成功地从沙门氏菌Llandoff菌株转移到大肠杆菌J53中,使替加环素的最小抑制浓度增加32倍。tet(X4)基因位于质粒pSal21GXH-tetX4的两个ISCR2拷贝之间。据我们所知,这是在中国首次报道从人粪便样本中分离到一株兰多夫沙门氏菌质粒介导的替加环素耐药基因tet(X4)。此外,我们的研究结果表明,共有171株分离株携带tet(X)样基因,分布在6大洲的21个国家或地区,对人类和公共卫生构成严重威胁。总之,我们及时发现沙门氏菌分离株和其他肠杆菌科细菌中最近出现的tet(X4)基因,支持了快速监测以防止tet(X)样基因传播的必要性。
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引用次数: 5
Prevalence and Severity of HBV-Associated Acute-on-Chronic Liver Failure Due to Irregular Medication of Nucleos(t)ide Analogs 因不规律服用核苷类似物导致慢性肝衰竭的HBV相关急性流行率和严重程度
Q3 INFECTIOUS DISEASES Pub Date : 2021-11-09 DOI: 10.1097/IM9.0000000000000076
Ying Zheng, Shu Chen, Yanxin Huang, Lisheng Jiang, Yongguo Li, Y. Lan, Shuchen Li, Yuqin Xu, Xiaodong Li, Hongwei Zhao, Yanbo Wang, Yingyun Shen, Chao Wei, Honglin Zhou, Rongshan Fan, Xiqiu Zeng, M. Jiang, Shupeng Song, Mingyan Xu
Abstract Hepatitis B virus (HBV) represents the commonest etiologic agent of acute-on-chronic liver failure (ACLF) in most Asian countries. Nucleos(t)ide analogs (NAs) are effective in the treatment of chronic HBV infections, but may also exacerbate the disease and stimulate its development into HBV-associated ACLF if not used appropriately. The current study aimed to assess the prevalence and severity of HBV-associated ACLF as a result from irregular medication of NAs (IMNA). A total of 1134 individuals with HBV-associated ACLF in nine hospitals in Heilongjiang Province were enrolled in this study between 2005 and 2015. Among these, 777 chronic hepatitis B (CHB) and 357 HBV-associated liver cirrhosis cases were classified based on various predisposing factors, including IMNA, HBV reactivation (HBVR), infections, treatment drugs, alcohol use and others (hepatitis C virus, hepatitis E virus, gastrointestinal bleeding and unknown reasons). The percentage and improvement rate were examined. Among individuals with HBV-associated ACLF and CHB, IMNA was found in 9.01%, HBVR in 46.20%, infections in 9.52%, treatment drugs in 14.67%, alcohol in 11.71%, and others in 24.58% as predisposing factors. Improvement rates in cases with IMNA, HBVR, infections, treatment drugs, alcohol and others were 41.43%, 58.50%, 58.11%, 56.14%, 53.85%, and 65.97%, respectively. Multivariable analysis showed that IMNA, others, infections, hepatic encephalopathy and hepatorenal syndrome were associated with prognosis. Only IMNA independently predicted HBV-associated ACLF prognosis. Overall, our study demonstrated that the percentage of IMNA-induced HBV-associated ACLF was 12.61%, and worse disease conditions resulted from IMNA compared with other factors. Thus, the suitability of treatment with NAs should be thoroughly evaluated.
摘要在大多数亚洲国家,乙型肝炎病毒(HBV)是急慢性肝功能衰竭(ACLF)最常见的病因。核苷类似物(NAs)对治疗慢性HBV感染有效,但如果使用不当,也可能加剧疾病并刺激其发展为HBV相关的ACLF。目前的研究旨在评估由于不定期服用NAs(IMNA)导致的HBV相关ACLF的患病率和严重程度。2005年至2015年间,黑龙江省9家医院共有1134名HBV相关ACLF患者参与了这项研究。其中,777例慢性乙型肝炎(CHB)和357例HBV相关肝硬化病例根据各种易感因素进行分类,包括IMNA、HBV再激活(HBVR)、感染、治疗药物、饮酒和其他因素(丙型肝炎病毒、戊型肝炎病毒、胃肠道出血和未知原因)。检查百分比和改善率。在HBV相关ACLF和CHB患者中,IMNA为9.01%,HBVR为46.20%,感染为9.52%,治疗药物为14.67%,酒精为11.71%,其他因素为24.58%。IMNA、HBVR、感染、治疗药物、酒精和其他疾病的改善率分别为41.43%、58.50%、58.11%、56.14%、53.85%和65.97%。多因素分析显示IMNA、其他、感染、肝性脑病和肝肾综合征与预后相关。只有IMNA独立预测HBV相关ACLF的预后。总体而言,我们的研究表明,IMNA诱导的HBV相关ACLF的百分比为12.61%,与其他因素相比,IMNA导致的疾病状况更糟。因此,应彻底评估NAs治疗的适宜性。
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引用次数: 1
Recent SARS-CoV-2 Outlook and Implications in a COVID-19 Vaccination Era. 新冠肺炎疫苗接种时代的最新SARS-CoV-2展望和意义
Q3 INFECTIOUS DISEASES Pub Date : 2021-08-13 eCollection Date: 2021-09-01 DOI: 10.1097/IM9.0000000000000072
Teddy Ehianeta, Said Abdulrahman Salim Mzee, Muslimat Kehinde Adebisi, Oluwayemisi Ehianeta

While repurposed drugs came in handy earlier in the wake of the coronavirus disease 2019 (COVID-19) pandemic, vaccination has been considered a more sustainable approach. The recent spikes have been linked to "double," "triple," and even multi-mutant variants, thus renewing calls for deeper structural and functional insights of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a lead to rationale design of therapeutics, vaccines, and point-of-care diagnostics. There is a repertoire of findings from the earliest SARS-CoV-2 molecular mimicry to evade host immunity cum host immune responses to the role of the viral glycocalyx in modulating the susceptibility and severity of infection through attraction and repulsive interactions. Recently, molecular studies of some viral components that aid infection in the face of vaccination seem unending. In addition, the wave of infections and the attendant case fatality ratios have necessitated the need for emergency use authorizations for COVID-19 vaccines and in vitro diagnostics. This review provides key updates of SARS-CoV-2, current antigenic and formulation strategies, with emergency use authorizations considerations for future vaccine candidates and diagnostics. We also premise that despite the difficulty in modeling and analyzing glycans, understanding and exploiting their roles in the SARS-CoV-2 architecture is fundamental to glycan-based COVID-19 vaccines devoid of inconsistent clinical outcomes.

摘要尽管在2019冠状病毒病(新冠肺炎)大流行后,重新调整用途的药物早些时候派上了用场,但疫苗接种被认为是一种更可持续的方法。最近的峰值与“双重”、“三重”甚至多突变变体有关,因此再次呼吁对严重急性呼吸综合征冠状病毒2型(严重急性呼吸系统综合征冠状病毒冠状病毒2型)进行更深入的结构和功能研究,以指导治疗、疫苗和护理点诊断的基本原理设计。从最早的严重急性呼吸系统综合征冠状病毒2型分子模拟到病毒糖盏通过吸引和排斥相互作用调节感染易感性和严重程度的作用,有一系列发现可以逃避宿主免疫和宿主免疫反应。最近,对一些在接种疫苗时有助于感染的病毒成分的分子研究似乎永无止境。此外,感染浪潮和随之而来的病死率使得新冠肺炎疫苗和体外诊断需要紧急使用授权。这篇综述提供了严重急性呼吸系统综合征冠状病毒2型、当前抗原和制剂策略的关键更新,以及未来候选疫苗和诊断的紧急使用授权考虑因素。我们还假设,尽管在建模和分析聚糖方面存在困难,但理解和利用其在SARS-CoV-2结构中的作用对于缺乏不一致临床结果的基于聚糖的新冠肺炎疫苗至关重要。
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引用次数: 0
Mass Spectrometry Analysis of SARS-CoV-2 Nucleocapsid Protein Reveals Camouflaging Glycans and Unique Post-Translational Modifications. SARS-CoV-2核衣壳蛋白的质谱分析揭示了伪装聚糖和独特的翻译后修饰
Q3 INFECTIOUS DISEASES Pub Date : 2021-08-03 eCollection Date: 2021-09-01 DOI: 10.1097/IM9.0000000000000071
Zeyu Sun, Xiaoqin Zheng, Feiyang Ji, Menghao Zhou, Xiaoling Su, Keyi Ren, Lanjuan Li

The devastating coronavirus disease 2019 (COVID-19) pandemic has prompted worldwide efforts to study structural biological traits of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its viral components. Compared to the Spike protein, which is the primary target for currently available vaccines or antibodies, knowledge about other virion structural components is incomplete. Using high-resolution mass spectrometry, we report a comprehensive post-translational modification (PTM) analysis of nucleocapsid phosphoprotein (NCP), the most abundant structural component of the SARS-CoV-2 virion. In addition to phosphoryl groups, we show that the SARS-CoV-2 NCP is decorated with a variety of PTMs, including N-glycans and ubiquitin. Based on newly identified PTMs, refined protein structural models of SARS-CoV-2 NCP were proposed and potential immune recognition epitopes of NCP were aligned with PTMs. These data can facilitate the design of novel vaccines or therapeutics targeting NCP, as valuable alternatives to the current vaccination and treatment paradigm that is under threat of the ever-mutating SARS-CoV-2 Spike protein.

摘要毁灭性的冠状病毒病2019 (COVID-19)大流行促使全球努力研究严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)及其病毒成分的结构生物学特性。与目前可用疫苗或抗体的主要靶点Spike蛋白相比,对其他病毒粒子结构成分的了解尚不完整。利用高分辨率质谱技术,我们报道了对SARS-CoV-2病毒粒子中最丰富的结构成分核衣壳磷酸化蛋白(NCP)的全面翻译后修饰(PTM)分析。除了磷酸化基团外,我们还发现SARS-CoV-2 NCP被多种ptm修饰,包括n -聚糖和泛素。基于新鉴定的ptm,提出了SARS-CoV-2新冠病毒的精细蛋白结构模型,并与ptm进行了比对。这些数据可以促进针对新冠病毒的新型疫苗或治疗方法的设计,作为当前疫苗接种和治疗模式的宝贵替代方案,该模式受到不断突变的SARS-CoV-2刺突蛋白的威胁。
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引用次数: 0
The Effect of FOXP3+ Regulatory T Cells on Infectious and Inflammatory Diseases FOXP3+调节性T细胞在感染性和炎性疾病中的作用
Q3 INFECTIOUS DISEASES Pub Date : 2021-07-29 DOI: 10.1097/IM9.0000000000000070
Yakun Bai, Fang Gao, Dan Li, Suyuan Ji, Shuijun Zhang, Wenzhi Guo, Bin Li
Abstract CD4+CD25+FOXP3+ regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.
摘要CD4+CD25+FOXP3+调节性T细胞(Tregs)有助于维持体内免疫稳态和耐受性。FOXP3的表达水平和功能稳定性控制Tregs的功能和可塑性。Tregs严重影响传染病,尤其是通过调节对病原微生物的免疫反应阈值。对Tregs在不同组织和炎症微环境中的功能调节机制和细胞特异性表面标志物进行了深入研究,为针对传染病的免疫治疗提供了新的思路和策略。
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引用次数: 4
Site-Specific Conjugation of Cell Wall Polyrhamnose to Protein SpyAD Envisioning a Safe Universal Group A Streptococcal Vaccine. 细胞壁多鼠李糖与SpyAD蛋白的位点特异性偶联——一种安全的通用a群链球菌疫苗
IF 2 Q3 INFECTIOUS DISEASES Pub Date : 2021-06-01 Epub Date: 2020-12-29 DOI: 10.1097/im9.0000000000000044
Nina J Gao, Satoshi Uchiyama, Lucy Pill, Samira Dahesh, Joshua Olson, Leslie Bautista, Shilpa Maroju, Aym Berges, Janet Z Liu, Raymond H Zurich, Nina van Sorge, Jeff Fairman, Neeraj Kapoor, Victor Nizet

Development of an effective vaccine against the leading human bacterial pathogen group A Streptococcus (GAS) is a public health priority. The species defining group A cell wall carbohydrate (GAC, Lancefield antigen) can be engineered to remove its immunodominant N-acetylglucosamine (GlcNAc) side chain, implicated in provoking autoimmune cross-reactivity in rheumatic heart disease, leaving its polyrhamnose core (GACPR). Here we generate a novel protein conjugate of the GACPR and test the utility of this conjugate antigen in active immunization. Instead of conjugation to a standard carrier protein, we selected SpyAD, a highly conserved GAS surface protein containing both B-cell and T-cell epitopes relevant to the bacterium that itself shows promise as a vaccine antigen. SpyAD was synthesized using the XpressTM cell-free protein expression system, incorporating a non-natural amino acid to which GACPR was conjugated by site-specific click chemistry to yield high molecular mass SpyAD-GACPR conjugates and avoid disruption of important T-cell and B-cell immunological epitopes. The conjugated SpyAD-GACPR elicited antibodies that bound the surface of multiple GAS strains of diverse M types and promoted opsonophagocytic killing by human neutrophils. Active immunization of mice with a multivalent vaccine consisting of SpyAD-GACPR, together with candidate vaccine antigens streptolysin O and C5a peptidase, protected against GAS challenge in a systemic infection model and localized skin infection model, without evidence of cross reactivity to human heart or brain tissue epitopes. This general approach may allow GAC to be safely and effectively included in future GAS subunit vaccine formulations with the goal of broad protection without autoreactivity.

摘要开发针对主要人类细菌病原体A群链球菌(GAS)的有效疫苗是公共卫生的优先事项。定义A组细胞壁碳水化合物(GAC,Lancefield抗原)的物种可以被改造以去除其免疫优势的N-乙酰葡糖胺(GlcNAc)侧链,该侧链与引发风湿性心脏病中的自身免疫交叉反应有关,留下其多鼠李糖核心(GACPR)。在这里,我们产生了一种新的GACPR蛋白缀合物,并测试了这种缀合物抗原在主动免疫中的效用。我们没有与标准载体蛋白结合,而是选择了SpyAD,这是一种高度保守的GAS表面蛋白,含有与细菌相关的B细胞和T细胞表位,其本身有望成为疫苗抗原。SpyAD是使用XpressTM无细胞蛋白质表达系统合成的,结合了一种非天然氨基酸,通过位点特异性点击化学将GACPR偶联到该氨基酸上,以产生高分子量SpyAD-GACPR缀合物,并避免破坏重要的T细胞和B细胞免疫表位。缀合的SpyAD-GACPR引发的抗体结合了多种不同M型GAS菌株的表面,并促进了人类中性粒细胞对视蛋白单吞噬细胞的杀伤。用由SpyAD GACPR组成的多价疫苗以及候选疫苗抗原链球菌溶血素O和C5a肽酶对小鼠进行主动免疫,在全身感染模型和局部皮肤感染模型中保护小鼠免受GAS攻击,没有对人类心脏或脑组织表位的交叉反应的证据。这种通用方法可以使GAC安全有效地包含在未来的GAS亚单位疫苗配方中,目的是在没有自身反应的情况下提供广泛的保护。
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引用次数: 0
Bacterial Infections in Cirrhosis 肝硬化的细菌感染
Q3 INFECTIOUS DISEASES Pub Date : 2021-05-17 DOI: 10.1097/IM9.0000000000000065
M. Tonon, P. Angeli, S. Piano
Abstract Bacterial infections are the most common trigger of acute decompensation of cirrhosis. The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions, failures, and acute on chronic liver failure. The combination of infections and organ dysfunction/acute on chronic liver failure dramatically increases the mortality risk in these patients. Infections in cirrhosis are a big challenge for clinicians, since the mortality from sepsis is increasing in these patients worldwide. The rapid and progressive spread of multiresistant bacteria has been blamed for the increased mortality rate. Several studies have shown that early diagnosis and appropriate administration of antibiotic treatment are crucial for improving prognosis in these patients. Moreover, the prevention and treatment of acute kidney injury and organ failures are fundamental parts of management of infections in cirrhosis. Herein we provided a concise and updated review of the literature on bacterial infections in patients with cirrhosis.
摘要细菌感染是肝硬化急性失代偿期最常见的诱因。肝硬化中感染的发生与器官功能障碍、衰竭和急性或慢性肝衰竭的发展有关。感染和器官功能障碍/急性或慢性肝功能衰竭的组合显著增加了这些患者的死亡风险。肝硬化感染对临床医生来说是一个巨大的挑战,因为败血症导致的死亡率在全球范围内都在增加。多种耐药细菌的快速和渐进传播被认为是死亡率上升的原因。几项研究表明,早期诊断和适当的抗生素治疗对改善这些患者的预后至关重要。此外,预防和治疗急性肾损伤和器官衰竭是肝硬化感染管理的基本组成部分。在此,我们对肝硬化患者细菌感染的文献进行了简要和更新的综述。
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引用次数: 0
Is Hyperbaric Oxygen an Effective Treatment for the Prevention of Complications in SARS-CoV-2 Asymptomatic Patients? 高压氧是预防SARS-CoV-2无症状患者并发症的有效治疗方法吗?
Q3 INFECTIOUS DISEASES Pub Date : 2021-05-05 DOI: 10.1097/IM9.0000000000000064
P. Longobardi, Klarida Hoxha, Fabiana Perreca
Abstract Is hyperbaric oxygen therapy (HBO2T) useful to counteract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in positive asymptomatic patients? Asymptomatic persons seem to account for approximately 45% of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days. In patients dying from SARS-CoV-2 infection, the mean number of concomitant diseases was 3.6 (median 3, standard deviation 2.1). Many of these diseases are correlated with the nitric oxide synthase genetic polymorphism and reduced nitric oxide synthesis [risk for coronary heart disease: odds ratio (95% confidence interval) = 2.74 (1.78–3.85)]. HBO2T significantly increases the production of nitric oxide and free radicals which, in laboratory tests, inhibit the replication of the SARS-CoV. HBO2T upregulates hypoxia inducible factor, which promotes the expression of human antiviral peptides: defensins and cathelicidins, both effective to block the virus. Thus, HBO2T regulates the inflammatory response. We share our pilot study conclusions as a basis for clinical trials.
高压氧治疗(HBO2T)对无症状阳性患者对抗SARS-CoV-2是否有效?无症状者似乎约占SARS-CoV-2感染者的45%,他们可以将病毒传播给他人很长一段时间,可能超过14天。在死于SARS-CoV-2感染的患者中,平均伴随疾病数为3.6例(中位数为3,标准差为2.1)。其中许多疾病与一氧化氮合酶基因多态性和一氧化氮合成减少有关[冠心病风险:优势比(95%置信区间)= 2.74(1.78-3.85)]。HBO2T显著增加一氧化氮和自由基的产生,在实验室测试中,它们抑制了sars冠状病毒的复制。HBO2T上调缺氧诱导因子,促进人抗病毒肽:防御素和抗菌肽的表达,均能有效阻断病毒。因此,HBO2T调节炎症反应。我们分享我们的初步研究结论作为临床试验的基础。
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引用次数: 2
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Infectious microbes & diseases
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