Drugs for the Treatment of Zika Virus Infection.

Zika virus is an emerging flavivirus that causes the neurodevelopmental congenital Zika syndrome and that has been linked to the neuroinflammatory Guillain-Barré syndrome. The absence of a vaccine or a clinically approved drug to treat the disease combined with the likelihood that another outbreak will occur in the future defines an unmet medical need. Several promising drug candidate molecules have been reported via repurposing studies, high-throughput compound library screening, and de novo design in the short span of a few years. Intense research activity in this area has occurred in response to the World Health Organization declaration of a Public Health Emergency of International Concern on February 1, 2016. In this Perspective, the authors review the emergence of Zika virus, the biology of its replication, targets for therapeutic intervention, target product profile, and current drug development initiatives.

Implementation of a Pharmacist-Led Diabetes Management Protocol.

BACKGROUND: Little data exist regarding how pharmacist-led collaborative drug therapy management protocols are implemented in health systems. Barriers to collaborative drug therapy management protocol implementation exist, but they can be overcome by effective protocol education and communication, allowing pharmacists to manage more patients with chronic disease states, thereby enhancing quality health outcomes for patients and reducing health resource utilization. OBJECTIVE: To determine the preferred method of provider education regarding the implementation of a pharmacist-led type 2 diabetes collaborative drug therapy management protocol, and to assess pharmacist and provider satisfaction with the protocol implementation. METHODS: This single-center, prospective cohort study included pharmacists practicing within a pharmacist-led type 2 diabetes collaborative drug therapy management protocol, as well as providers practicing at 4 primary care clinics within a health system. All providers received an e-mail regarding education about the protocol. In addition, providers at 2 of the clinics received education about the protocol at a provider meeting, and providers at the other 2 clinics received a personalized provider report card. The personalized provider report card identified patients within the provider's panel who met criteria for referral to a pharmacist under the new protocol. The referred patients were tracked for 2 months, and provider and pharmacist satisfaction with the protocol were assessed. RESULTS: A total of 54 patients were referred for pharmacist management per the protocol. The majority (89%) of patients were referred by providers who received a personalized provider report card. Nearly all (96%) of the providers were satisfied with the protocol-driven services, and most (67%) pharmacists were satisfied with their role in managing patients with type 2 diabetes under the collaborative drug therapy management protocol. CONCLUSION: The majority of patients with type 2 diabetes who were referred for pharmacist management per the protocol were referred by providers who received personalized provider report cards. Provider and pharmacist satisfaction with the new pharmacist-led protocol was high.

Unraveling the associations of osteoprotegerin gene with production traits in a paternal broiler line.

Improvements on growth and carcass traits in the poultry industry have been achieved by intense selection for heavier chickens at early ages. This faster growth has caused serious problems due to insufficient skeletal structure development needed to support the musculature of modern broilers. The osteoprotegerin gene (OPG), located on GGA2, is an important regulator of bone metabolism and reabsorption, being suggestive as a possible functional candidate gene associated with bone integrity in chickens. This study reports associations of a single nucleotide polymorphism (SNP) in the OPG gene with production traits in a parental broiler line. Different phenotypic groups were evaluated: performance, carcass and skeletal traits. SNPs were identified within the OPG gene and the most informative SNP g.9144C > G was chosen for association analyses. Chickens (n = 1230) were genotyped using PCR-RFLP. The association was carried out with QxPaK v4.0 software using a mixed model including sex, hatch and SNP as fixed effects, and the infinitesimal and residual as random effects. The OPG SNP was associated with important traits as body weight at 21 days, weights of tibia and drumstick skin, leg muscle yield, and tibia breaking strength (P < 0.05). Associations were explained by the additive effect of the SNP and the additive effect within sex. This SNP could be considered a potential marker to improve bone resistance in chickens; however, caution should be taken because of its negative effect in other important traits evaluated in this study. Furthermore, these findings suggest a possible involvement of the OPG gene in fat deposition in poultry.

Quantitative proteomics by 2-DE, 16O/18O labelling and linear ion trap mass spectrometry analysis of lymph nodes from piglets inoculated by porcine circovirus type 2.

Porcine circovirus type 2 (PCV2) has been identified as the essential causal agent of postweaning multisystemic wasting syndrome. However, little is known regarding the mechanism(s) underlying the pathogenesis of PCV2-induced disease and the interaction of the virus with the host immune system. Here, we present a proteomics study on inguinal lymph nodes of piglets inoculated with PCV2, in order to better understand the pathogenesis of postweaning multisystemic wasting syndrome and the pathways might be affected after infection. We used two proteomics strategies, 2-DE and 1-DE followed by (16)O/(18)O peptide labelling and peptide identification and quantification by MS. More than 100 proteins were found to be differentially regulated and the results obtained by the two strategies were fairly concordant but also complementary, the (18)O labelling approach being a more robust alternative. Analysis of these proteins by systems biology tools revealed the implication of acute phase response and NrF2-mediated oxidative stress, suggesting a putative role for these pathways in the pig immune response. Besides, CD81 was found to be up-regulated, suggesting a possible role in the internalization of the virus. The use of proteomics technologies together with biology analysis systems opens up the way to gain more exhaustive and systematic knowledge of virus-pathogen interactions.

Endophytic and pathogenic isolates of the cacao fungal pathogen Moniliophthora perniciosa (Tricholomataceae) are indistinguishable based on genetic and physiological analysis.

We evaluated the genetic and physiological variability of Moniliophthora perniciosa obtained from healthy and diseased branches of cacao (Theobroma cacao) plants. The diversity of the isolates was evaluated by RAPD technique and by studies of virulence and exoenzyme production. The genetic variability of endophytic and pathogenic M. perniciosa was evaluated in association with pathogenicity assays. RAPD analysis showed eight genetic groups, which were not related to plant disease status (healthy versus diseased branches). Isolates from cacao were included in three groups, excluding isolates from other host plants. Pathogenicity and enzyme analysis showed that the virulence of the isolates is not related to exoenzyme production. This is the first evidence that M. perniciosa colonizes healthy parenchymatic tissues, showing that endophytic behavior may occur in this species.

The 'head-to-head' comparison of etanercept and infliximab in treating children with juvenile idiopathic arthritis.

OBJECTIVES: Our aim was to assess long-term efficacy and tolerability of etanercept and infliximab in patients with JIA. METHODS: This was an observational, retrospective study of 41 patients treated with anti-TNF therapy. We assessed clinical remission, flare, ACR improvement, improvement of DAS28, and JADAS. Some patients with polyarticular JIA were scored according to the modified SHARP criteria. RESULTS: Twenty-four weeks after beginning of therapy 35 patients (92.1%) achieved ACR 20, 33 patients (86.8%) ACR 30, 31 patients (81.6%) ACR 50, 28 patients (73.7%) ACR 70 and 20 patients (52.6%) ACR 90. In the same period 19 patients (50%) had good DAS28 response, 12 patients (31.6%) had moderate response, and 5 patients (13.2%) did not respond to therapy. Statistically significant difference was shown in the average value of JADAS-71 before the beginning and 24 weeks after introduction of anti-TNF therapy. Eleven patients had a flare in the study period (28.9%); five on etanercept (13.1%), three on infliximab (7.9%), and three flared on both of the medications (7.9%). After 12 months, fifteen patients fulfilled criteria for clinical remission on medications. Seven of them were on infliximab and eight on etanercept. Eleven patients have fulfilled criteria for clinical remission off of medications: three were taking etanercept, seven infliximab, and one was switched from etanercept to infliximab. CONCLUSIONS: In our patient cohort, both etanercept and infliximab performed well, since we found no significant difference in the duration, response, flare, resistance or adverse effects between both drugs, however long term remissions are rare.

Time course differential gene expression in response to porcine circovirus type 2 subclinical infection.

This study was aimed at characterizing the potential differences in gene expression in piglets inoculated with Porcine circovirus type 2 (PCV2), the essential causative agent of postweaning multisystemic wasting syndrome. Seven-day-old caesarean-derived, colostrum-deprived piglets were distributed into two groups: control (n = 8) and pigs inoculated with 10(5.2) TCID(50) of the Burgos PCV2 isolate (n = 16). One control and three inoculated pigs were necropsied on days 1, 2, 5, and 8 post-infection (p.i.). The remaining pigs (four of each group) were sequentially bled on days 0, 7, 14, 21, and 29 p.i. (necropsy). Total RNA from the mediastinal lymph node (MLN) and lysed whole blood (LWB) samples were hybridized to Affymetrix Porcine GeneChip. Forty-three probes were differentially expressed (DE) in MLN samples (FDR < 0.1, fold change > 2) and were distributed into three clusters: globally down-regulated genes, and up-regulated genes at early (first week p.i.) and late (day 29 p.i.) stages of infection. In LWB samples,maximal differences were observed at day 7 p.i., with 54 probes DE between control and inoculated pigs. Main Gene Ontology biological processes assigned to upregulated genes were related to the immune response. Six common genes were found in both types of samples, all of which belonged to the interferon signaling antiviral effector pathway. Down-regulated genes were mainly related to cell adhesion and migration in MLN, and cellular organization and biogenesis in LWB. Microarray results were validated by quantitative real-time PCR. This study provides, for the first time, the characterization of the early and late molecular events taking place in response to a subclinical PCV2 infection.

Development of cell-mediated immunity to porcine circovirus type 2 (PCV2) in caesarean-derived, colostrum-deprived piglets.

The interaction between porcine circovirus type 2 (PCV2) and the pig immune system has been suggested to be a determinant event for the pathogenesis of postweaning multisystemic wasting syndrome (PMWS). To gain insight into the host immune mechanisms developed upon PCV2 infection, early innate and adaptive immune responses were examined in 1-week-old, caesarean-derived, colostrum-deprived piglets using a subclinical infection model of PCV2 in combination with lipopolysaccharide (LPS) as a potential immunostimulation factor. The use of LPS did not show any significant effect on the course of PCV2 infection, nor did in the evolution of the immunological parameters evaluated. Ex vivo responses were detected as early as 1 day post-infection (PI) and consisted of an elevation of the plasmatic levels of interleukin (IL)-8 in PCV2-inoculated pigs followed by an increase on plasmatic IFN-alpha at day 5 PI. Regarding IL-10, only one PCV2-inoculated pig was positive (day 7 PI); this pig was the only one in which viremia persisted until the end of the study. In vitro cytokine determination showed that, regardless of the treatment administrated to the pigs, an IL-10 release was observed when peripheral blood mononuclear cells (PBMC) cultures were stimulated with PCV2. Seroconvertion to PCV2 measured by an immunoperoxidase monolayer assay (IPMA) occurred between 7 and 14 days PI, whereas neutralizing antibodies (NA) did not appear until day 29 PI. PCV2 DNA was first detected in serum at day 7 PI, reaching the peak of viremia between days 14 and 21 PI, followed by a drop in viral load that was found coincident with the appearance of PCV2-specific IFN-gamma-secreting cells (PCV2-IFN-gamma-SC) and NA. Results from the present work suggest that viral clearance might be mediated by the development of PCV2-IFN-gamma-SC in contribution to the PCV2-specific NA.

A meta-analysis on experimental infections with porcine circovirus type 2 (PCV2).

A meta-analysis was performed with the aim to identify factors with a relevant influence on the expression of clinical postweaning multisystemic wasting syndrome (PMWS) under experimental conditions. Data from 44 studies were included in the analysis. Several variables were studied: number of pigs in the experiment, intake of colostrum, serological status against porcine circovirus type 2 (PCV2), strain of PCV2 used for inoculation, the route and dose of inoculation, and use of potential triggering factors (such as co-infections, vaccinations, or immunomodulator products). Multiple correspondence analysis and log-linear regression methods were used to establish the relationships between the studied variables and the number of PCV2 infected pigs that developed PMWS. Based on the results of the meta-analysis, the most successful animal experiment aimed to develop PMWS should include: (1) colostrum-deprived pigs, (2) age of inoculation below 3 weeks, (3) high doses of PCV2 inoculum, (4) PCV2 strain from genotype 1, and (5) co-infection with another swine pathogen as a triggering factor.

Transcriptome architecture across tissues in the pig.

BACKGROUND: Artificial selection has resulted in animal breeds with extreme phenotypes. As an organism is made up of many different tissues and organs, each with its own genetic programme, it is pertinent to ask: How relevant is tissue in terms of total transcriptome variability? Which are the genes most distinctly expressed between tissues? Does breed or sex equally affect the transcriptome across tissues? RESULTS: In order to gain insight on these issues, we conducted microarray expression profiling of 16 different tissues from four animals of two extreme pig breeds, Large White and Iberian, two males and two females. Mixed model analysis and neighbor - joining trees showed that tissues with similar developmental origin clustered closer than those with different embryonic origins. Often a sound biological interpretation was possible for overrepresented gene ontology categories within differentially expressed genes between groups of tissues. For instance, an excess of nervous system or muscle development genes were found among tissues of ectoderm or mesoderm origins, respectively. Tissue accounted for ~11 times more variability than sex or breed. Nevertheless, we were able to confidently identify genes with differential expression across tissues between breeds (33 genes) and between sexes (19 genes). The genes primarily affected by sex were overall different than those affected by breed or tissue. Interaction with tissue can be important for differentially expressed genes between breeds but not so much for genes whose expression differ between sexes. CONCLUSION: Embryonic development leaves an enduring footprint on the transcriptome. The interaction in gene x tissue for differentially expressed genes between breeds suggests that animal breeding has targeted differentially each tissue's transcriptome.

Lack of in vitro and in vivo effects of lipopolysaccharide on porcine circovirus type 2 infection.

Porcine circovirus type 2 (PCV2) is the causative agent of postweaning multisystemic wasting syndrome (PMWS). The presence of immunostimulating factors or concurrent infections seems to be crucial for PMWS development. Lipopolysaccharide (LPS) is a potent immunological activator and has recently been suggested to enhance PCV2 replication in vitro. This study was designed to evaluate the effects of different LPS products on PCV2 in vitro replication of pulmonary macrophages (PMs), and on the potential ability to trigger PMWS in cesarean-derived, colostrum-deprived (CDCD) PCV2-inoculated piglets. In vitro studies using two different PCV2 isolates (Stoon-1010 and 1452/3) showed the presence of PCV2 antigen within the cytoplasm to a variable degree; PCV2 Stoon-1010 was barely detectable (<1% of stained cells), and PCV2 1452/3 was seen in the cytoplasm of more than 85% of PMs. However, no differences were found in intracytoplasmic PCV2 signals among different LPS treatments, or between the LPS-treated and non-treated PMs. Moreover, almost no intranuclear signals for PCV2 antigen were detected in PMs. The in vivo experiment included twenty 7-day-old CDCD piglets divided into four groups: control (n = 4), control/LPS (n = 4), PCV2 (n = 6), and PCV2/LPS (n = 6). The control and control/LPS groups were inoculated intranasally with a cell culture medium (MEM), and the PCV2 and PCV2/LPS groups were inoculated with a Spanish isolate of PCV2 (Burgos). The control/LPS and PCV2/LPS groups were inoculated intraperitoneally with LPS on PCV2 inoculation day. All pigs remained clinically healthy during the entire experimental period (29 days). Animals inoculated with LPS had significant hyperthermia within the first 24 hours post-inoculation. No differences in gross or histological findings were observed among the PCV2 and PCV2/LPS inoculated pigs. All PCV2-infected piglets developed a subclinical infection with the virus. Our results showed that LPS did not increase in vitro viral replication and did not trigger PMWS in PCV2-inoculated pigs.

Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial.

OBJECTIVE: To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome. DESIGN: Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis. SETTING: Two tertiary hospitals in Sydney. INTERVENTION: 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor. PARTICIPANTS: 113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded. MAIN OUTCOME MEASURES: Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility. RESULTS: The estimated incremental cost per QALY saved for rehabilitation relative to standard care was 42,535 US dollars when modelling included the reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective. CONCLUSIONS: The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.

Attitudes and psychosocial adjustment of unaffected siblings of patients with phenylketonuria.

Sibling illness may contribute to an increased risk of adjustment problems in healthy siblings. Previous studies have reported a variety of effects on healthy individuals who have an ill sibling, but the psychosocial effects of treatable inherited disease on healthy siblings have not yet been investigated. We report the results of a survey study conducted in families with both unaffected and affected children with classic phenylketonuria (PKU), an inherited inborn error of metabolism. The survey included a knowledge test about PKU, and four previously validated instruments designed to assess psychosocial adjustment of unaffected siblings compared to age and sex matched norms. The responses revealed that unaffected adolescent and adult siblings had gaps in their knowledge about the genetic basis of PKU, and had evidence for the presence of adverse psychosocial sequelae. These findings suggest a role for genetic services providers, including genetic counselors, in assisting all members of a family adjust, when the diagnosis of an inborn error of metabolism has been made.