Background. Treatment for hepatitis C virus (HCV) can lead to sustained virological response (SVR) in over 90% of people. Subsequent recurrence of HCV, either from late relapse or reinfection, ...reverses the beneficial effects of SVR. Methods. A search identified studies analysing HCV recurrence post-SVR. The recurrence rate for each study was calculated using events/person years of follow-up (PYFU). Results were pooled using a random-effects model and used to calculate 5-year recurrence risk. Three patient groups were analysed: (1) Mono-HCV infected "low-risk" patients; (2) Mono-HCV infected "high-risk" patients (injecting drug users or prisoners); (3) human immunodeficiency virus (HIV)/HCV coinfected patients. Recurrence was defined as confirmed HCV RNA detectability post-SVR. Results. In the 43 studies of HCV mono-infected "low-risk" patients (n = 7969) the pooled recurrence rate was 1.85/1000 PYFU (95% confidence interval CI, .71–3.35; I2 = 73%) leading to a summary 5-year recurrence risk of 0.95% (95% CI, .35%–1.69%). For the 14 studies of HCV monoinfected "high-risk" patients (n = 771) the pooled recurrence rate was 22.32/1000 PYFU (95% CI, 13.07–33.46; I2 = 27%) leading to a summary 5-year risk of 10.67% (95% CI, 6.38%–15.66%). For the 4 studies of HIV/HCV coinfected patients the pooled recurrence rate was 32.02/1000 PYFU (95% CI, .00–123.49; I2 – 96%) leading to a summary 5-year risk of 15.02% (95% CI, .00%–48.26%). The higher pooled estimates of recurrence in the high-risk and coinfected cohorts were driven by an increase in reinfection rather than late relapse. Conclusions. SVR appears durable in the majority of patients at 5 years post-treatment. The large difference in 5 year event rate by risk group is driven mainly by an increased reinfection risk.
Systemic lupus erythematosus (SLE) is a complex trait characterised by the production of a range of auto-antibodies and a diverse set of clinical phenotypes. Currently, ~8% of the genetic ...contribution to SLE in Europeans is known, following publication of several moderate-sized genome-wide (GW) association studies, which identified loci with a strong effect (OR>1.3). In order to identify additional genes contributing to SLE susceptibility, we conducted a replication study in a UK dataset (870 cases, 5,551 controls) of 23 variants that showed moderate-risk for lupus in previous studies. Association analysis in the UK dataset and subsequent meta-analysis with the published data identified five SLE susceptibility genes reaching genome-wide levels of significance (P(comb)<5×10(-8)): NCF2 (P(comb) = 2.87×10(-11)), IKZF1 (P(comb) = 2.33×10(-9)), IRF8 (P(comb) = 1.24×10(-8)), IFIH1 (P(comb) = 1.63×10(-8)), and TYK2 (P(comb) = 3.88×10(-8)). Each of the five new loci identified here can be mapped into interferon signalling pathways, which are known to play a key role in the pathogenesis of SLE. These results increase the number of established susceptibility genes for lupus to ~30 and validate the importance of using large datasets to confirm associations of loci which moderately increase the risk for disease.
Identifying functionally relevant variants against the background of ubiquitous genetic variation is a major challenge in human genetics. For variants in protein-coding regions, our understanding of ...the genetic code and splicing allows us to identify likely candidates, but interpreting variants outside genic regions is more difficult. Here we present genome-wide annotation of variants (GWAVA), a tool that supports prioritization of noncoding variants by integrating various genomic and epigenomic annotations.
Epstein-Barr virus (EBV) is usually acquired silently early in life and carried thereafter as an asymptomatic infection of the B lymphoid system. However, many circumstances disturb the delicate ...EBV-host balance and cause the virus to display its pathogenic potential. Thus, primary infection in adolescence can manifest as infectious mononucleosis (IM), as a fatal illness that magnifies the immunopathology of IM in boys with the X-linked lymphoproliferative disease trait, and as a chronic active disease leading to life-threatening hemophagocytosis in rare cases of T or natural killer (NK) cell infection. Patients with primary immunodeficiencies affecting the NK and or T cell systems, as well as immunosuppressed transplant recipients, handle EBV infections poorly, and many are at increased risk of virus-driven B-lymphoproliferative disease. By contrast, a range of other EBV-positive malignancies of lymphoid or epithelial origin arise in individuals with seemingly intact immune systems through mechanisms that remain to be understood.
Dengue is the most rapidly emerging climate-sensitive infection, and there has been a 10-fold rise in cases over the past 20 years.Severe illness is characterized by vascular leakage, organ ...dysfunction, and severe bleeding which occur due to the direct effects of the viral non-structural protein NS1 and an aberrant host immune response.Dengue NS1 antigen, cytokines such as IL-1β, TNF-α, and IL-6, lipid mediators such as platelet-activating factor (PAF), leukotrienes and prostaglandins, VEGF, chymase, tryptase, and MMP-9 are thought to contribute to endothelial dysfunction.Many mechanisms contribute to liver dysfunction, including prolonged shock that causes hypoxic damage, direct liver cell death due to infection with the virus, and immune-mediated effects.Bleeding following dengue virus infection occurs due to multiple mechanisms including platelet activation by NS1, serotonin, and PAF, accompanied by a wide range of other coagulation abnormalities.
Dengue is the most rapidly emerging climate-sensitive infection, and morbidity/mortality and disease incidence are rising markedly, leading to healthcare systems being overwhelmed. There are currently no specific treatments for dengue or prognostic markers to identify those who will progress to severe disease. Owing to an increase in the burden of illness and a change in epidemiology, many patients experience severe disease. Our limited understanding of the complex mechanisms of disease pathogenesis has significantly hampered the development of safe and effective treatments, vaccines, and biomarkers. We discuss the molecular mechanisms of dengue pathogenesis, the gaps in our knowledge, and recent advances, as well as the most crucial questions to be answered to enable the development of therapeutics, biomarkers, and vaccines.
Dengue is the most rapidly emerging climate-sensitive infection, and morbidity/mortality and disease incidence are rising markedly, leading to healthcare systems being overwhelmed. There are currently no specific treatments for dengue or prognostic markers to identify those who will progress to severe disease. Owing to an increase in the burden of illness and a change in epidemiology, many patients experience severe disease. Our limited understanding of the complex mechanisms of disease pathogenesis has significantly hampered the development of safe and effective treatments, vaccines, and biomarkers. We discuss the molecular mechanisms of dengue pathogenesis, the gaps in our knowledge, and recent advances, as well as the most crucial questions to be answered to enable the development of therapeutics, biomarkers, and vaccines.
ABSTRACT We use radiation hydrodynamic simulations to examine two models of solar flare chromospheric heating: Alfvén wave dissipation and electron beam collisional losses. Both mechanisms are ...capable of strong chromospheric heating, and we show that the distinctive atmospheric evolution in the mid-to-upper chromosphere results in Mg ii k-line emission that should be observably different between wave-heated and beam-heated simulations. We also present Ca ii 8542 profiles that are formed slightly deeper in the chromosphere. The Mg ii k-line profiles from our wave-heated simulation are quite different from those from a beam-heated model and are more consistent with Interface Region Imaging Spectrograph observations. The predicted differences between the Ca ii 8542 in the two models are small. We conclude that careful observational and theoretical study of lines formed in the mid-to-upper chromosphere holds genuine promise for distinguishing between competing models for chromospheric heating in flares.
The Interface Region Imaging Spectrograph has routinely observed the flaring Mg ii near-ultraviolet (NUV) spectrum, offering excellent diagnostic potential and a window into the location of energy ...deposition. A number of studies have forward-modeled both the general properties of these lines and specific flare observations. Generally these have forward-modeled radiation via post-processing of snapshots from hydrodynamic flare simulations through radiation transfer codes. There has, however, not been a study of how the physics included in these radiation transport codes affects the solution. A baseline setup for forward-modeling Mg ii in flares is presented and contrasted with approaches that add or remove complexity. It is shown for Mg ii that (1) partial frequency distribution (PRD) is still required during flare simulations despite the increased densities; (2) using full angle-dependent PRD affects the solution but takes significantly longer to process a snapshot; (3) including Mg i in non-LTE (NLTE) results in negligible differences to the Mg ii lines but does affect the NUV quasi-continuum; (4) only hydrogen and Mg ii need to be included in NLTE; (5) ideally the nonequilibrium hydrogen populations, with nonthermal collisional rates, should be used rather than the statistical equilibrium populations; (6) an atom consisting of only the ground state, h and k upper levels, and continuum level is insufficient to model the resonance lines; and (7) irradiation from a hot, dense flaring transition region can affect the formation of Mg ii. We discuss modifications to the RH code allowing straightforward inclusion of the transition region and coronal irradiation in flares.
The Interface Region Imaging Spectrograph routinely observes the Si iv resonance lines. When analyzing quiescent observations of these lines, it has typically been assumed that they form under ...optically thin conditions. This is likely valid for the quiescent Sun, but this assumption has also been applied to the more extreme flaring scenario. We used 36 electron-beam-driven radiation hydrodynamic solar flare simulations, computed using the RADYN code, to probe the validity of this assumption. Using these simulated atmospheres, we solved the radiation transfer equations to obtain the non-LTE, nonequilibrium populations, line profiles, and opacities for a model silicon atom, including charge exchange processes. This was achieved using the "minority species" version of RADYN. The inclusion of charge exchange resulted in a substantial fraction of Si iv at cooler temperatures than those predicted by ionization equilibrium. All simulations with an injected energy flux erg cm−2 s−1 resulted in optical depth effects on the Si iv emission, with differences in both intensity and line shape compared to the optically thin calculation. Weaker flares (down to F 5 × 109 erg cm−2 s−1) also resulted in Si iv emission forming under optically thick conditions, depending on the other beam parameters. When opacity was significant, the atmospheres generally had column masses in excess of 5 × 10−6 g cm−2 over the temperature range 40-100 kK, and the Si iv formation temperatures were between 30 and 60 kK. We urge caution when analyzing Si iv flare observations, or when computing synthetic emission without performing a full radiation transfer calculation.
Vaccines are needed to prevent coronavirus disease 2019 (Covid-19) and to protect persons who are at high risk for complications. The mRNA-1273 vaccine is a lipid nanoparticle-encapsulated mRNA-based ...vaccine that encodes the prefusion stabilized full-length spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19.
This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. Persons at high risk for SARS-CoV-2 infection or its complications were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo 28 days apart. The primary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with SARS-CoV-2.
The trial enrolled 30,420 volunteers who were randomly assigned in a 1:1 ratio to receive either vaccine or placebo (15,210 participants in each group). More than 96% of participants received both injections, and 2.2% had evidence (serologic, virologic, or both) of SARS-CoV-2 infection at baseline. Symptomatic Covid-19 illness was confirmed in 185 participants in the placebo group (56.5 per 1000 person-years; 95% confidence interval CI, 48.7 to 65.3) and in 11 participants in the mRNA-1273 group (3.3 per 1000 person-years; 95% CI, 1.7 to 6.0); vaccine efficacy was 94.1% (95% CI, 89.3 to 96.8%; P<0.001). Efficacy was similar across key secondary analyses, including assessment 14 days after the first dose, analyses that included participants who had evidence of SARS-CoV-2 infection at baseline, and analyses in participants 65 years of age or older. Severe Covid-19 occurred in 30 participants, with one fatality; all 30 were in the placebo group. Moderate, transient reactogenicity after vaccination occurred more frequently in the mRNA-1273 group. Serious adverse events were rare, and the incidence was similar in the two groups.
The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. Aside from transient local and systemic reactions, no safety concerns were identified. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE ClinicalTrials.gov number, NCT04470427.).
The COVID-19 pandemic has had widespread effects across the globe, and its causative agent, SARS-CoV-2, continues to spread. Effective interventions need to be developed to end this pandemic. Single ...and combination therapies with monoclonal antibodies have received emergency use authorization
, and more treatments are under development
. Furthermore, multiple vaccine constructs have shown promise
, including two that have an approximately 95% protective efficacy against COVID-19
. However, these interventions were directed against the initial SARS-CoV-2 virus that emerged in 2019. The recent detection of SARS-CoV-2 variants B.1.1.7 in the UK
and B.1.351 in South Africa
is of concern because of their purported ease of transmission and extensive mutations in the spike protein. Here we show that B.1.1.7 is refractory to neutralization by most monoclonal antibodies against the N-terminal domain of the spike protein and is relatively resistant to a few monoclonal antibodies against the receptor-binding domain. It is not more resistant to plasma from individuals who have recovered from COVID-19 or sera from individuals who have been vaccinated against SARS-CoV-2. The B.1.351 variant is not only refractory to neutralization by most monoclonal antibodies against the N-terminal domain but also by multiple individual monoclonal antibodies against the receptor-binding motif of the receptor-binding domain, which is mostly due to a mutation causing an E484K substitution. Moreover, compared to wild-type SARS-CoV-2, B.1.351 is markedly more resistant to neutralization by convalescent plasma (9.4-fold) and sera from individuals who have been vaccinated (10.3-12.4-fold). B.1.351 and emergent variants
with similar mutations in the spike protein present new challenges for monoclonal antibody therapies and threaten the protective efficacy of current vaccines.
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