Chronic Viral Infections Research Articles

Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Viral Hepatitis: The Interlink.

Metabolic dysfunction-associated fatty liver disease (MAFLD) has now affected nearly one-third of the global population and has become the number one cause of chronic liver disease in the world because of the obesity pandemic. Chronic hepatitis resulting from hepatitis B virus (HBV) and hepatitis C virus (HCV) remain significant challenges to liver health even in the 21st century. The co-existence of MAFLD and chronic viral hepatitis can markedly alter the disease course of individual diseases and can complicate the management of each of these disorders. A thorough understanding of the pathobiological interactions between MAFLD and these two chronic viral infections is crucial for appropriately managing these patients. In this comprehensive clinical review, we discuss the various mechanisms of chronic viral hepatitis-mediated metabolic dysfunction and the impact of MAFLD on the progression of liver disease.

Immunosenescence and Cytomegalovirus: Exploring Their Connection in the Context of Aging, Health, and Disease.

Aging induces numerous physiological alterations, with immunosenescence emerging as a pivotal factor. This phenomenon has attracted both researchers and clinicians, prompting profound questions about its implications for health and disease. Among the contributing factors, one intriguing actor in this complex interplay is human cytomegalovirus (CMV), a member of the herpesvirus family. Latent CMV infection exerts a profound influence on the aging immune system, potentially contributing to age-related diseases. This review delves into the intricate relationship between immunosenescence and CMV, revealing how chronic viral infection impacts the aging immune landscape. We explore the mechanisms through which CMV can impact both the composition and functionality of immune cell populations and induce shifts in inflammatory profiles with aging. Moreover, we examine the potential role of CMV in pathologies such as cardiovascular diseases, cancer, neurodegenerative disorders, COVID-19, and Long COVID. This review underlines the importance of understanding the complex interplay between immunosenescence and CMV. It offers insights into the pathophysiology of aging and age-associated diseases, as well as COVID-19 outcomes among the elderly. By unraveling the connections between immunosenescence and CMV, we gain a deeper understanding of aging's remarkable journey and the profound role that viral infections play in transforming the human immune system.

Ten-eleven translocation (Tet) methylcytosine dioxygenase-dependent viral DNA demethylation mediates in vivo hepatitis B virus (HBV) biosynthesis.

Liver-specific ten-eleven translocation (Tet) methylcytosine dioxygenases 2 and 3 (Tet2 plus Tet3)-deficient hepatitis B virus (HBV) transgenic mice fail to support viral biosynthesis. The levels of viral transcription and replication intermediates are dramatically reduced. Hepatitis B core antigen is only observed in a very limited number of pericentral hepatocytes in a pattern that is similar to glutamate-ammonia ligase (Glul), a β-catenin target gene. HBV transcript abundance in adult Tet-deficient mice resembles that observed in wild-type neonatal mice. Furthermore, the RNA levels of several β-catenin target genes including Glul, Lhpp, Notun, Oat, Slc1a2, and Tbx3 in Tet-deficient mice were also similar to that observed in wild-type neonatal mice. As HBV transcription is regulated by β-catenin, these findings support the suggestion that neonatal Tet deficiency might limit β-catenin target gene expression, limiting viral biosynthesis. Additionally, HBV transgene DNA displays increased 5-methylcytosine (5mC) frequency at CpG sequences consistent with neonatal Tet deficiency being responsible for decreased developmental viral DNA demethylation mediated by 5mC oxidation to 5-hydroxymethylcytosine, a process that might be responsible for the reduction in cellular β-catenin target gene expression and viral transcription and replication.IMPORTANCEChronic hepatitis B virus (HBV) infection causes significant worldwide morbidity and mortality. There are no curative therapies available to resolve chronic HBV infections, and the small viral genome limits molecular targets for drug development. An alternative approach to drug development is to target cellular genes essential for HBV biosynthesis. In the liver, ten-eleven translocation (Tet) genes encode cellular enzymes that are not essential for postnatal mouse development but represent essential activities for viral DNA demethylation and transcription. Consequently, Tet inhibitors may potentially be developed into therapeutic agents capable of inducing and/or maintaining HBV covalently closed circular DNA methylation, resulting in transcriptional silencing and the resolution of chronic viral infection.

Association between chronic viral infection-related hospitalization and risk of cardiovascular disease: Apopulation-based cohort study.

Chronic viral infection induces immunosenescence and systemic low-grade inflammation, leading to worsened long-term outcomes. We sought to explore the short- and long-term effects of chronic viral infection on cardiovascular disease (CVD). Based on UK Biobank data, exposed group was identified as individuals who had chronic virus infection-related hospitalization (IRH). Unexposed group was randomly selected, matched by 5-year age interval, sex, and Charlson comorbidity index at a ratio up to 1:10. Restricted cubic splines were used to model time-varying effects of IRH in nonproportional Cox models. A cut-off value of 5 years was recorded and used in piecewise Cox proportional hazards models as we estimated short- and long-term effects of IRH on CVD. A total of 2826 exposed participants and 28 212 matched unexposed participants were included. Chronic viral IRH was associated with increased risk of CVD (0-5 years: hazard ratio, 1.57 [95% confidence interval: 1.32, 1.87] and 5+ years: 1.31 [1.06, 1.61]). Elevated risk of stroke was only observed within the initial 5-year follow-up (0-5 years: 1.91 [1.30, 2.81]). The short- and long-term associations were observed in herpes or hepatitis virus IRH with risk of CVD (all p < 0.05). Subgroup analysis revealed long-term association between chronic viral IRH and CVD among female (5+ years: 1.68 [1.27, 2.22]) but not among male. The association between chronic viral infection and elevated CVD risk appeared to be stronger among individuals who did not take cholesterol-lowering medication, antithrombotic medication, or certain antihypertensive medications (all p for interaction < 0.05). The risk of CVD event remained persistently higher within and over 5 years following chronic viral IRH, especially in individuals infected with herpes and hepatitis virus.

Single-cell RNA sequencing reveals the dynamics and heterogeneity of lymph node immune cells during acute and chronic viral infections.

The host immune response determines the differential outcome of acute or chronic viral infections. The comprehensive comparison of lymphoid tissue immune cells at the single-cell level between acute and chronic viral infections is largely insufficient. To explore the landscape of immune responses to acute and chronic viral infections, single-cell RNA sequencing(scRNA-seq), scTCR-seq and scBCR-seq were utilized to evaluate the longitudinal dynamics and heterogeneity of lymph node CD45+ immune cells in mouse models of acute (LCMV Armstrong) and chronic (LCMV clone 13) viral infections. In contrast with acute viral infection, chronic viral infection distinctly induced more robust NK cells and plasma cells at the early stage (Day 4 post-infection) and acute stage (Day 8 post-infection), respectively. Moreover, chronic viral infection exerted decreased but aberrantly activated plasmacytoid dendritic cells (pDCs) at the acute phase. Simultaneously, there were significantly increased IgA+ plasma cells (MALT B cells) but differential usage of B-cell receptors in chronic infection. In terms of T-cell responses, Gzma-high effector-like CD8+ T cells were significantly induced at the early stage in chronic infection, which showed temporally reversed gene expression throughout viral infection and the differential usage of the most dominant TCR clonotype. Chronic infection also induced more robust CD4+ T cell responses, including follicular helper T cells (Tfh) and regulatory T cells (Treg). In addition, chronic infection compromised the TCR diversity in both CD8+ and CD4+ T cells. In conclusion, gene expression and TCR/BCR immune repertoire profiling at the single-cell level in this study provide new insights into the dynamic and differential immune responses to acute and chronic viral infections.

Generation of Anti-HIV CAR-T Cells for Preclinical Research.

The inability of people living with HIV (PLWH) to eradicate human immunodeficiency virus (HIV) infection is due in part to the inadequate HIV-specific cellular immune response. The antiviral function of cytotoxic CD8+ T cells, which are crucial for HIV control, is impaired during chronic viral infection because of viral escape mutations, immune exhaustion, HIV antigen downregulation, inflammation, and apoptosis. In addition, some HIV-infected cells either localize to tissue sanctuaries inaccessible to CD8+ T cells or are intrinsically resistant to CD8+ T cell killing. The novel design of synthetic chimeric antigen receptors (CARs) that enable T cells to target specific antigens has led to the development of potent and effective CAR-T cell therapies. While initial clinical trials using anti-HIV CAR-T cells performed over 20years ago showed limited anti-HIV effects, the improved CAR-T cell design, which enabled its success in treating cancer, has reinstated CAR-T cell therapy as a strategy for HIV cure with notable progress being made in the recent decade.Effective CAR-T cell therapy against HIV infection requires the generation of anti-HIV CAR-T cells with potent in vivo activity against HIV-infected cells. Preclinical evaluation of anti-HIV efficacy of CAR-T cells and their safety is fundamental for supporting the initiation of subsequent clinical trials in PLWH. For these preclinical studies, we developed a novel humanized mouse model supporting in vivo HIV infection, the development of viremia, and the evaluation of novel HIV therapeutics. Preclinical assessment of anti-HIV CAR-T cells using this mouse model involves a multistep process including peripheral blood mononuclear cells (PBMCs) harvested from human donors, T cell purification, ex vivo T cell activation, transduction with lentiviral vectors encoding ananti-HIV CAR, CAR-T cell expansion and infusion in mice intrasplenically injected with autologous PBMCs followed by the determination of CAR-T cell capacity for HIV suppression. Each of the steps described in the following protocol were optimized in the lab to maximize the quantity and quality of the final anti-HIV CAR-T cell products.

The Role of Dysbiosis and Chronic Viral Infection in Autoimmune Rheumatic Diseases

Autoimmune diseases are a diverse group of approximately 100 disorders that are characterized by abnormal reactivity of B and T cells against self-antigens.1 Clinical manifestations can vary greatly, from organ-specific to systemic, and from life-threatening to subclinical. Autoimmune conditions affect about 5-9% of the world’s population,2 and occur more frequently in women than men.3,4 A 2020 study of the prevalence of antinuclear antibodies (ANAs) found a 50% overall increase in this biomarker of autoimmunity over the course of 25 years, suggesting that autoimmunity is on the rise in the United States.5 Interestingly, the increase in ANA prevalence was notable among adolescents (ages 12-19), lending some credence to the hygiene hypothesis, which posits that improved hygiene practices and cleaner environments in childhood reduce exposure to immune challenges, and may result in aberrant immune responses when exposed to infections later in life.

Detection of musculoskeletal inflammatory lesions in patients with chronic chikungunya infection using 3T whole-body magnetic resonance imaging.

Musculoskeletal inflammatory lesions in chronic Chikungunya virus (CHIKV) infection have not been thoroughly assessed using whole-body magnetic resonance imaging (WBMRI). This study aimed to determine the prevalence of these lesions in such patients. From September 2018 to February 2019, patients with positive Chikungunya-specific serology (Immunoglobulin M/Immunoglobulin G anti-CHIKV), with a history of polyarthralgia for > 6 months prior to MRI with no pre-existing rheumatic disorders, underwent 3T WBMRI and localized MRI. The evaluation focused on musculoskeletal inflammatory lesions correlated with chronic CHIKV infection. Pain levels were assessed using a visual analogue scale on the same day as WBMRI. The study included 86 patients of whom 26 met the inclusion criteria. All patients reported pain and most (92.3%) categorized it as moderate or severe. The most common finding across joints was effusion, particularly in the tibiotalar joint (57.7%) and bursitis, with the retrocalcaneal bursa most affected (48.0%). Tenosynovitis was prevalent in the flexor compartment of the hands (44.2%), while Kager fat pad and soleus edema were also observed. Bone marrow edema-like signals were frequently seen in the sacroiliac joints (19.2%). Most WBMRI findings were classified as mild. This study represents the first utilization of 3T WBMRI to assess musculoskeletal inflammatory disorders in chronic CHIKV infection. The aim was to identify the most affected joints and prevalent lesions, providing valuable insights for future research and clinical management of this condition regarding understanding disease pathophysiology, developing targeted treatment strategies, and using advanced imaging techniques in the assessment of musculoskeletal manifestations.

Uncloaking the viral glycocalyx: How do viruses exploit glycoimmune checkpoints?

The surfaces of cells and enveloped viruses alike are coated in carbohydrates that play multifarious roles in infection and immunity. Organisms across all kingdoms of life make use of a diverse set of monosaccharide subunits, glycosidic linkages, and branching patterns to encode information within glycans. Accordingly, sugar-patterning enzymes and glycan binding proteins play integral roles in cell and organismal biology, ranging from glycoprotein quality control within the endoplasmic reticulum to lymphocyte migration, coagulation, inflammation, and tissue homeostasis. Unsurprisingly, genes involved in generating and recognizing oligosaccharide patterns are playgrounds for evolutionary conflicts that abound in cross-species interactions, exemplified by the myriad plant lectins that function as toxins. In vertebrates, glycans bearing acidic nine-carbon sugars called sialic acids are key regulators of immune responses. Various bacterial and fungal pathogens adorn their cells in sialic acids that either mimic their hosts' or are stolen from them. Yet, how viruses commandeer host sugar-patterning enzymes to thwart immune responses remains poorly studied. Here, we review examples of viruses that interact with sialic acid-binding immunoglobulin-like lectins (Siglecs), a family of immune cell receptors that regulate toll-like receptor signaling and govern glycoimmune checkpoints, while highlighting knowledge gaps that merit investigation. Efforts to illuminate how viruses leverage glycan-dependent checkpoints may translate into new clinical treatments that uncloak viral antigens and infected cell surfaces by removing or masking immunosuppressive sialoglycans, or by inhibiting viral gene products that induce their biosynthesis. Such approaches may hold the potential to unleash the immune system to clear long intractable chronic viral infections.

DIAGNOSTIC BIOMARKERS IN ORAL CANCER: CURRENT APPROACHES

Oral cancer is due to over expression of growth of abnormal cells which rapidly multiply and divide. oral cancer is the sixth most common tumour in the world and the highest mortality and morbidity rate amongst all the human malignancies. Betal nut, chewing pan and smokeless tobacco, intake of alcohol and chronic viral infections like human papilloma virus are some of the etiological factors of oral cancer. The pathogenies of oral cancers depend upon the interaction between the genetic, epigenetic and carcinogenetic factors and their association with tumour growth and the progression of cancer. Genetic alteration changes give rise to a multiplex of oral mucosal changes like cellular and architectural and dysplastic changes which help in grading of tumour (well-differentiated, moderately differentiated and poorly differentiated) oral cancer. K-67 and cyclin D1 are strong genetic changes taking place in oral malignancies. Diagnostic biomarkers are an essential tool for the early detection and better prognosis of oral cancer. There are invasive and non-invasive procedures for the diagnosis of oral cancer which include invasive procedures like biopsy and the non-invasive or minimally invasive procedures are blood, plasma, serum and saliva. The oral cancer biomarkers can be detected by taking the samples from cancer patients and running the molecular laboratory techniques like real time PCR for liquid biopsy, DNA sequencing, hybridization technique, single nucleotide polymorphism analysis and immunofluorescence for FFPS.&#x0D; Methylation includes hypermethylation and hypomethylation in which there is a defect in the promotor region of CPG island. The methylation process takes place in the early phase of the initiation of cancer so it is an important biomarker for the early detection of oral cancer. HOXA9, NID2, P16 AND PTEN are the genes of interest for hypermethylation in early cancer detection.&#x0D; Viral infection load like Epstein bar virus (EBV)and human papilloma virus (HPV) DNA load have specific biomarkers which can help in the early detection of oral cancer when combines with hypermethylation. Interferon and microRNA related gene are also upregulated in tumour and a biomarker for early detection of oral cancer.

Antibody and Cell-Based Therapies against Virus-Induced Cancers in the Context of HIV/AIDS.

Infectious agents, notably viruses, can cause or increase the risk of cancer occurrences. These agents often disrupt normal cellular functions, promote uncontrolled proliferation and growth, and trigger chronic inflammation, leading to cancer. Approximately 20% of all cancer cases in humans are associated with an infectious pathogen. The International Agency for Research on Cancer (IARC) recognizes seven viruses as direct oncogenic agents, including Epstein-Barr Virus (EBV), Kaposi's Sarcoma-associated herpesvirus (KSHV), human T-cell leukemia virus type-1 (HTLV-1), human papilloma virus (HPV), hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus type 1 (HIV-1). Most viruses linked to increased cancer risk are typically transmitted through contact with contaminated body fluids and high-risk behaviors. The risk of infection can be reduced through vaccinations and routine testing, as well as recognizing and addressing risky behaviors and staying informed about public health concerns. Numerous strategies are currently in pre-clinical phases or undergoing clinical trials for targeting cancers driven by viral infections. Herein, we provide an overview of risk factors associated with increased cancer incidence in people living with HIV (PLWH) as well as other chronic viral infections, and contributing factors such as aging, toxicity from ART, coinfections, and comorbidities. Furthermore, we highlight both antibody- and cell-based strategies directed against virus-induced cancers while also emphasizing approaches aimed at discovering cures or achieving complete remission for affected individuals.

Differential kinetics of splenic CD169+ macrophage death is one underlying cause of virus infection fate regulation

Acute infection and chronic infection are the two most common fates of pathogenic virus infections. While several factors that contribute to these fates are described, the critical control points and the mechanisms that underlie infection fate regulation are incompletely understood. Using the acute and chronic lymphocytic choriomeningitis virus (LCMV) infection model of mice, we find that the early dynamic pattern of the IFN-I response is a differentiating trait between both infection fates. Acute-infected mice generate a 2-wave IFN-I response while chronic-infected mice generate only a 1-wave response. The underlying cause is a temporal difference in CD8 T cell-mediated killing of splenic marginal zone CD169+ macrophages. It occurs later in acute infection and thus enables CD169+ marginal zone macrophages to produce the 2nd IFN-I wave. This is required for subsequent immune events including induction of inflammatory macrophages, generation of effector CD8+ T cells and virus clearance. Importantly, these benefits come at a cost for the host in the form of spleen fibrosis. Due to an earlier marginal zone destruction, these ordered immune events are deregulated in chronic infection. Our findings demonstrate the critical importance of kinetically well-coordinated sequential immune events for acute infection control and highlights that it may come at a cost for the host organism.

HSV‐1 reactivation in AD mouse model reveals longitudinal reduction in synaptic gene expression in the brain

AbstractBackgroundMounting evidence supports the contribution of neurotrophic herpesvirus family infections to Alzheimer’s Disease (AD) etiology on the molecular, physiologic, and epidemiologic levels. As chronic viral infections have substantial variability in reactivations, and AD pathology is known to begin over a decade prior to symptoms, understanding the longitudinal impact of herpesviruses on AD pathogenesis is a challenging and complex problem.MethodWe developed a mouse model of herpes‐simplex virus type 1 (HSV‐1) infection in C57B6/J mice containing humanized APP and APOE4. Using 10 mice per group (5 male, 5 female), and after initial infection at 2 months of age via corneal scarification with 106 PFU HSV‐1 strain 17, we reactivated the virus with the bromo‐domain compound JQ1 at 4, 6 and 10 months, with 1x, 3x and 6x reactivations respectively. We included both mock transfected and JQ1‐only treated mice as controls.ResultWe found reactivation by JQ1 resulted in increased HSV‐1 detection by qPCR in a progressive manner, emanating outward from the trigeminal ganglion, towards more distal brain regions. One month post reactivation, we harvested multiple brain regions (brainstem, hippocampus, entorhinal cortex, and dural sinus) for RNAseq expression profiling one month after the last reactivation (i.e. latent HSV‐1 infection) to allow for the immune system to clear the active reactivation and observe long‐term changes in gene expression. We found many synaptic genes down regulated in the entorhinal cortex at 10 months, with 6 reactivations, compared to mock infected. We additionally saw decreases in gene expression in lipid metabolism, myelination, and the endolysosomal pathways. In the brain stem, where HSV‐1 viral levels were found at higher levels, gene expression patterns showed increase immune‐cell related activity.ConclusionOur HSV‐1 reactivation mouse model enables characterization of the impacts of HSV‐1 infections on neuronal gene expression. These changes are consistent with observed changes in gene expression in humans, and help contextualize the putative mechanisms by which HSV‐1 contribute to Alzheimer’s disease etiology.

Deviations in the content of neurotransmitters amino acids in patients with chronic hepatopathies

Introduction. Some amino acids are neurotransmitters. These include glycine (Gly), gamma-aminobutyric acid (GABA), glutamate (Glu), and aspartate (Asp). The liver is an important organ for the metabolism of amino acids. Materials and methods. It was examined 24 patients with chronic hepatopathy: 12 patients with chronic HBV infection (group I) and 12 patients with hepatic steatosis (group II), the control group (CG) consisted of 12 practically healthy individuals. Quantitative determination of Asp, Glu, Gly and GABA in blood serum was carried out using liquid chromatography. Results. In most patients with chronic hepatopathy Gly and Asp levels were within the regional norms, GABA levels were higher, and Glu levels were below the reference values. In I-st group of patients the level of Gly was 18.76±1.45, GABA - 0.83±0.06, Asp - 5.56±0.97, and Glu - 6.34±0.70 mcM/ dL. In II-nd group: the level of Gly was 22.37±0.91, GABA 0.77±0.03, Asp - 5.16±0.74, and Glu - 7.87±1.47 mcM/dL. In CG: the level of Gly was 22.93±2.21, GABA - 0.55±0.06, Asp - 2.69±0.45, and Glu - 12.46±1.92 mcM/dL. Conclusion. A violation of neurotransmitter amino acids metabolism is found in chronic hepatopathy. A decrease in glycine and glutamate was observed in patients’ blood serum, with an increase in GABA and aspartate. These disorders are most profound in individuals with chronic viral infection B.

Abstract A041: Rejuvenation: Innovative technology to improve T-cell antitumor properties through partial reprogramming

Abstract The T-cell identity and age determine function and fitness over a T-cell’s lifespan. This is particularly relevant when T cells are derived from patients with chronic viral infection or cancer. It is well known that increased T-cell age and differentiation and increased effector and exhausted phenotypes are associated with reduced anti-tumor efficacy and the need for higher infusion T-cell numbers for the treatment of hematological or solid tumors during adoptive cell therapies (ACT) (Kishton 2022). In an effort to overcome these barriers, methods to de-differentiate T cells into induced pluripotent stem cells (iPSCs) that return to embryonic immaturity, but lose their functional identity, have been extensively explored in the past years. Early work revealed several challenges to re-differentiate iPSCs into T cells with the desired functional phenotype, requiring a complex and time-consuming process. Here, we bring our novel strategy that counters the impact of aging on T-cell function through cellular rejuvenation without de-differentiating to iPSCs. We achieved T-cell rejuvenation via partial reprogramming of aged T cells by transiently expressing transcription factors associated with iPSC reprogramming. This proprietary partial reprogramming methodology reduces epigenetic age and rejuvenates T cells while maintaining the phenotype and function of conventional T cells. We were the first to illustrate the ability to reduce the epigenetic age of T cells without fully de-differentiating to iPSCs. Our initial studies with PBMCs showed a significant reduction in epigenetic age. On subsequent RNAseq analyses, we observed that rejuvenated and conventional T cells have equivalent transcriptomes, suggesting the maintenance of identity. Functionally, the TRJ cells are characterized by greatly improved cell-expansion capacity, together with increased expression of markers associated with T-cell stemness, including CCR7 and CD62L. In vitro studies of NY-ESO-1-targeted T-cell receptor (TCR) or a CD19-targeted chimeric antigen receptor (CAR) TRJ cells exhibited improved antitumor properties compared with non-rejuvenated T-cell control (TCT) cells in sequential cell-killing assays. We also confirmed the enhanced in vivo antitumor efficiency of NY-ESO-1 TCR TRJ cells in a murine xenograft tumor model. When tumor-infiltrating lymphocytes (TILs) are rejuvenated with the same rejuvenation technology the TILs showed enhanced cell-expansion capacity, and improvements in T-cell stemness phenotype. These results suggest the potential application of T-cell rejuvenation across multiple adoptive T-cell therapeutic modalities and may potentially improve outcomes for patients with solid tumors. Citation Format: Jessica Fioravanti, Yasuhiro Yamazaki, Takuya Maeda, Yin Huang, Naritaka Tamaoki, Kriti Bahl, Burak Kutlu, Shobha Potluri, Gary Lee, Nicholas P Restifo, Raul Vizcardo. Rejuvenation: Innovative technology to improve T-cell antitumor properties through partial reprogramming [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A041.

GROWTH HORMONE, IMMUNOSENESCENCE AND VACCINATION FAILURE IN THE ELDERLY

In the aging population, the longitudinal decrease in the secretion of steroidal and polypeptides growth hormones is directly associated with accumulation of senescent cells in tissues and organs. The cellular hypo-replicative senescence state is caused by metabolic stress and persistent DNA damage, which lead to the activation of the p16INK4a cell-cycle inhibitor, retinoblastoma and p53 pathways. Aging increases the susceptibility to physical frailty, sarcopenia, diabetes, atherosclerosis, infectious disease and cancer in the older adults. As a consequence of immunosenescence and reduced immunoreactivity of the innate and adaptive systems, seniors have a weak response to vaccination. The high doses of vaccines have been recommended to boost growth and activation of memory T and B cells in non-responsive older individuals, but it is not sufficient for long-term protection. The treatment with recombinant human growth hormone has been shown to regenerate thymus and increase the repertoire of naive T cells CD4+ and CD8+ T cell and B cell subsets in people with age-related diseases, chronic viral infection and immunodeficiencies. This review presents an update on senescence biology and their clinical immunological manifestations in the elderly. We describe possible immune mechanisms by which personalized recombinant growth hormone therapy could act to prolong the effectiveness of the vaccines recommended to older adults.

Interferon system in typical chronic and atypically occurring chronic active herpes virus infections

Objective: to study the characteristics of the functioning of the IFN system, the presence of autoantibodies to INFα in patients suffering from atypical chronic active herpesvirus infections (ACA-HVI) in comparison with patients with a typical course of chronic herpesvirus infections (CHVI).Materials and methods: under our supervision were 485 patients of both sexes aged 23 to 70 years, suffering from chronic herpes virus infections, of which 335 patients suffered from AHA-HVI and 150 people suffered from CHVI. The comparison group was 250 conditionally healthy individuals (CG). The complex of the study included methods for detecting herpesviruses: serodiagnostics, PCR-RT. The IFN system (spontaneous and induced production, serum concentration) was tested by ELISA. The study was approved by the ethics board and informed consent was obtained from all patients.Results: the incidence of various mono-mixed herpesvirus infections in patients with ACA-HVI (mono – 26,6% and mixed – 73.4%) and CHVI (mono – 23.1% and mixed – 76.9%) was determined, with EBV dominance in patients of both groups. Serum IFNα deficiency was detected in 100% of cases in both groups, and IFNα in 67% in ACA-HVI and 57% in CHVI. At the same time, significant differences were found between the ACA-HVI and HGVI groups in the level of IFNα reduction: 10 and 5 times, respectively, and for IFNγ – 2.0 and 2.6 times, respectively. The induced IFNα production decreased by 89.1% in ACA-HVI and 47.2% in CHVI. A decrease in induced IFNγ production is characteristic of 50% of patients in both groups. At the same time, the level of induced production of IFN α in patients with ACA-HVI was 9 times lower than in the control group and 4.75 times lower than in the group of patients with CHVI. And the level of induced IFNγ production was 2 times lower compared to CHVI and the control group.Conclusions: when assessing the state of the IFN system in patients with various chronic herpes virus infections, significant differences were revealed. Thus, the most pronounced manifestations of interferonopathy, consisting in a significant decrease in serum IFNα and IFNγ and defects in induced IFN production of both types, are observed statistically significantly more often in the group of patients with an atypical course of the disease than in the group of patients with a typical course of CHVI. The most pronounced disorders in the IFN system and the lack of recovery of IFNα and IFNγ levels in the interrelational period cause atypicity of the course and active viral replication in patients with ACA-HVI.

ABO Incompatibility Haploidentical Peripheral Blood Stem Cell Transplantation Combined with a Single Cord Blood Unit for Severe Aplastic Anemia Patients

Background: For young severe aplastic anemia (SAA) patients without HLA matched donors, haploidentical hematopoietic stem cell transplantation can be used as an alternative selection. The grafts of classic Beijing protocol in China is a combination of bone marrow and peripheral blood stem cell. For patients with major or minor blood type incompatibility, bone marrow stem cells need to undergo red blood cell or plasma removal treatment. There was rare reports about haploidentical peripheral blood stem cell combined with a single unrelated cord blood unit for ABO incompatibility haploidentical stem cell transplantation in SAA patients. Objective: To observe the efficacy of ABO incompatibility haploidentcial peripheral blood hematopoietic stem cell transplantation combined with a single unrelated cord blood unit for SAA patients. Method s : Fifty-five SAA patients underwent stem cell transplantation from August 2018 to February 2022 in the First Affiliated Hospital of Xi'an Jiaotong Univeristy were divided into two groups based on donor-recipient ABO compatibility, the donor-recipient ABO matched group（BM+PB group）using haploidentical bone marrow and peripheral blood stem cell as grafts, and donor-recipient ABO mismatched group（CB+PB group）, using unrelated cord blood and haploidentical peripheral blood stem cell as grafts. The differences of hematopoietic reconstitution, acute and chronic GVHD, CMV and EB virus infection, PFS, and OS between the two groups were compared. Result s : There were 30 cases in CB+PB group and 27 cases in the BM+PB group. Except for differences in donor-recipient ABO compatibility, the other characteristics of the two groups of patients were comparable((P&amp;gt;0.05). One patient in the BM+PB group had primary graft failure, while the rest of the patients were successfully implanted. There were no significant statistical differences in neutrophil,platelet and red blood cells recovery rates, the incidence of acute and chronic GVHD, CMV, EB virus infection, and PTLD between the two groups of patients(P&amp;gt;0.05). There was no significant statistical difference in OS between the two groups of patients(P&amp;gt;0.05)(Figure 1). Conclusion: For SAA patients with donor-recipient ABO incompatibility could use haploidentical peripheral blood cell combined with unrelated cord blood for transplantation which had compared outcome with haploidentcal bone marrow and peripheral blood cell transplantation.

Characteristics of Patients with Cirrhosis and Impact on Outcomes Following Heparin-Induced Thrombocytopenia; A Retrospective National Population-Based Study between 2016 and 2019

Introduction: Heparin-induced thrombocytopenia (HIT) is characterized by thrombocytopenia and a prothrombotic state. It can occur following the use of heparin products of any form or dosage. Various factors predispose cirrhosis patients to thrombocytopenia, such as splenic platelet sequestration, lower levels and activity of thrombopoietin (TPO), bone marrow suppression secondary to chronic viral infections(e.g., Hepatitis C), and use of antiviral therapies such as interferons. As there is a paucity of data on the impact that cirrhosis confers on the outcomes following HIT, we conducted a retrospective nationwide analysis. Methods: A retrospective study of adult patients with HIT was performed using the2016-2019 National Inpatient Sample(NIS), a set of annual hospitalization databases produced by HCUP, AHRQ, and multiple partners. Patients with HIT were identified via the ICD-10 code “D7582”. We studied the differences in patient characteristics and multiple comorbidities among patients with and without cirrhosis, along with the impact on outcomes. Results: Our study included a total of 60800 cases of HIT, which included 3020(5.0%) cases with a diagnosis of cirrhosis (Table 1). The majority of cases involved patients classified as White, were Medicare-insured and underwent treatment in Urban-teaching centers. While patients with cirrhosis were younger (mean age 61.71 years vs. 64.39 years, p&amp;lt;0.01), they also reported disparities in patient characteristics and comorbidities. Cirrhosis cohort had fewer females (43.9% vs. 46.9%, p&amp;lt;0.01), lower prevalence of hypertension (22.2% vs. 29.4%, p&amp;lt;0.01), peripheral vascular disease (7.0% vs. 10.6%, p&amp;lt;0.01), lipid disorders (24.2% vs. 42.1%, p&amp;lt;0.01), and were overall younger (mean age 61.71 vs. 64.39 years, p&amp;lt;0.01). However, cirrhosis patients showed a higher prevalence of smoking (39.4% vs. 35.1%, p&amp;lt;0.01), chronic kidney disease (39.4% vs. 36.4%, p&amp;lt;0.01), and alcohol abuse ( 24.2% vs. 4.8%, p&amp;lt;0.01). Moreover, 4.1% of cirrhosis patients had a diagnosis of hepatocellular carcinoma (vs. 0.4% of non-cirrhosis patients, p&amp;lt;0.01). No differences in the two groups were observed for diabetes and obesity. Overall, cirrhosis patients reported a higher mean Charlson Comorbidity Index (CCI) score (6.21 vs. 4.58, p&amp;lt;0.01) but had a shorter stay (13.84 days vs. 14.64 days, p&amp;lt;0.01), with a lower mean hospital charge ($167196 vs. $225959, p&amp;lt;0.01). After careful adjustment of confounders, lower odds of Major adverse cardiovascular events (MACEs) were seen among cirrhosis patients (14.2% vs. 19.3%,aOR 0.531, 95% CI 0.474-0.595, p&amp;lt;0.01). Moreover, cirrhosis patients also had lower odds of in-hospital death following events of HIT (11.4% vs. 10.9%, aOR 0.875, 95% CI 0.770-0.994, p=0.040). Conclusion: Our study found lower odds of MACEs and mortality among cirrhosis patients in cases of HIT. However, as the NIS has multiple limitations, such as the unavailability of medication codes and the inability to evaluate post-discharge outcomes, we highly encourage more in-depth studies to improve our understanding of the impact of cirrhosis in patients with HIT.

Platinum-Based Chemotherapy Attenuates the Effector Response of CD8 T Cells to Concomitant PD-1 Blockade.

Combination of chemotherapy with programmed cell death 1 (PD-1) blockade is a front-line treatment for lung cancer. However, it remains unknown whether and how chemotherapy affects the response of exhausted CD8 T cells to PD-1 blockade. We used the well-established mouse model of T-cell exhaustion with chronic lymphocytic choriomeningitis virus (LCMV) infection to assess the effect of chemotherapy (cisplatin+pemetrexed) on T-cell response to PD-1 blockade, in the absence of the impact of chemotherapy on antigen release and presentation observed in tumor models. When concomitantly administered with PD-1 blockade, chemotherapy affected the differentiation path of LCMV-specific CD8 T cells from stem-like to transitory effector cells, thereby reducing their expansion and production of IFNγ. After combination treatment, these restrained effector responses resulted in impaired viral control, compared with PD-1 blockade alone. The sequential combination strategy, where PD-1 blockade followed chemotherapy, proved to be superior to the concomitant combination, preserving the proliferative response of exhausted CD8 T cells to PD-1 blockade. Our findings suggest that the stem-like CD8 T cells themselves are relatively unaffected by chemotherapy partly because they are quiescent and maintained by slow self-renewal at the steady state. However, upon the proliferative burst mediated by PD-1 blockade, the accelerated differentiation and self-renewal of stem-like cells may be curbed by concomitant chemotherapy, ultimately resulting in impaired overall CD8 T-cell effector functions. In a translational context, we provide a proof-of-concept to consider optimizing the timing of chemo-immunotherapy strategies for improved CD8 T-cell functions. See related commentary by Vignali and Luke, p. 1705.