Comprehensive Genomic Profiling Alters Clinical Diagnoses in a Significant Fraction of Tumors Suspicious of Sarcoma.

PURPOSE: Tumor classification is a key component in personalized cancer care. For soft tissue and bone tumors, this classification is currently based primarily on morphology assessment and immunohistochemical staining. However, these standard-of-care methods can pose challenges for pathologists. We therefore assessed how whole-genome and whole-transcriptome sequencing (WGTS) impacted tumor classification and clinical management when interpreted together with histomorphology. EXPERIMENTAL DESIGN: We prospectively evaluated WGTS in routine diagnostics of 200 soft tissue and bone tumors suspicious for malignancy, including DNA and RNA isolation from the tumor, and DNA isolation from a peripheral blood sample or any non-tumor tissue. RESULTS: Based on specific genomic alterations or absence of presumed findings, WGTS resulted in reclassification of 7% (13/197) of the histopathological diagnoses. Four cases were downgraded from low-grade sarcomas to benign lesions, and two cases were reclassified as metastatic malignant melanomas. Fusion genes associated with specific tumor entities were found in 30 samples. For malignant soft tissue and bone tumors, we identified treatment relevant variants in 15% of cases. Germline pathogenic variants associated to a hereditary cancer syndrome were found in 22 participants (11%). CONCLUSION: We conclude that WGTS provides an important dimension of data which aids in the classification of soft tissue and bone tumors, correcting a significant fraction of clinical diagnoses, and identifies molecular targets relevant for precision medicine. However, genetic findings need to be evaluated in their morphopathological context, just as germline findings need to be evaluated in the context of patient phenotype and family history.

Virus persistence after recovery from acute Lassa fever in Nigeria: a 2-year interim analysis of a prospective longitudinal cohort study.

BACKGROUND: There is anecdotal evidence for Lassa virus persistence in body fluids. We aimed to investigate various body fluids after recovery from acute Lassa fever, describe the dynamics of Lassa virus RNA load in seminal fluid, and assess the infectivity of seminal fluid. METHODS: In this prospective, longitudinal, cohort study we collected plasma, urine, saliva, lacrimal fluid, vaginal fluid, and seminal fluid from Lassa fever survivors from Irrua Specialist Teaching Hospital in Edo State, Nigeria. Inclusion criteria for participants were RT-PCR-confirmed Lassa fever diagnosis and age 18 years or older. Samples were taken at discharge from hospital (month 0) and at months 0·5, 1, 3, 6, 9, 12, 18, and 24 after discharge. The primary objective of this study was to quantitatively describe virus persistence and clearance and assess the infectivity of seminal fluid. Lassa virus RNA was detected using real-time RT-PCR. Infectivity was tested in cell culture and immunosuppressed mice. We used a linear mixed-effect model to analyse the dynamics of virus persistence in seminal fluid over time. FINDINGS: Between Jan 31, 2018, and Dec 11, 2019, 165 participants were enrolled in the study, of whom 159 were eligible for analysis (49 women and 110 men). Low amounts of Lassa virus RNA were detected at month 0 in plasma (49 [45%] of 110 participants), urine (37 [34%]), saliva (five [5%]), lacrimal fluid (ten [9%]), and vaginal fluid (seven [21%] of 33 female participants). Virus RNA was cleared from these body fluids by month 3. However, 35 (80%) of 44 male participants had viral RNA in seminal fluid at month 0 with a median cycle threshold of 26·5. Lassa virus RNA remained detectable up to month 12 in seminal fluid. Biostatistical modelling estimated a clearance rate of 1·19 log10 viral RNA copies per month and predicted that 50% of male survivors remain Lassa virus RNA-positive in seminal fluid for 83 days after hospital discharge and 10% remain positive in seminal fluid for 193 days after discharge. Viral RNA persistence in seminal fluid for 3 months or more was associated with higher viraemia (p=0·006), more severe disease (p=0·0075), and longer hospitalisation during the acute phase of Lassa fever (p=0·0014). Infectious virus was isolated from 48 (52%) of 93 virus RNA-positive seminal fluid samples collected between month 0 and 12. INTERPRETATION: Lassa virus RNA is shed in various body fluids after recovery from acute disease. The persistence of infectious virus in seminal fluid implies a risk of sexual transmission of Lassa fever. FUNDING: German Federal Ministry of Health, German Research Foundation, Leibniz Association.

Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks.

Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization.

Benchmarking Hybrid Atomistic/Coarse-Grained Schemes for Proteins with an Atomistic Water Layer.

An approach to overcome the limited time and spatial scales in molecular dynamics (MD) simulations is to reduce the number of degrees of freedom in the system through coarse-graining. In hybrid atomistic/coarse-grained (AT/CG) simulations, the region of interest (e.g., the solute) is simulated at a higher level of resolution than the surrounding solvent. Recently, we have reparametrized the interactions between the GROMOS 54A7 force field and the GROMOS CG water model to correctly reproduce solvation free energies of side-chain analogues. In this study, a benchmarking of the AT-CG parametrization using a broad set of 22 proteins is conducted. On the basis of the results, the idea of introducing a thin AT water layer around the solute (protein) is revisited to provide a detailed first solvation shell. Different layer schemes were investigated: (a) the water molecules in the AT water layer around the whole protein were restrained to their respective closest protein atom, and (b) the AT water layer was present only around the charged side chains. Results show that the second scheme is more robust in practice and reduces artifacts from the hybrid model with only a small additional computational cost. In general, this layer scheme was found to preserve the structural properties of the proteins better compared to direct solvation in CG water.

Improved accuracy of hybrid atomistic/coarse-grained simulations using reparametrised interactions.

Reducing the number of degrees of freedom in molecular models-so-called coarse-graining-is a popular approach to increase the accessible time scales and system sizes in molecular dynamics simulations. It involves, however, per se a loss of information. In order to retain a high accuracy in the region of interest, hybrid methods that combine two levels of resolution in a single system are an attractive trade-off. Hybrid atomistic (AT)/coarse-grained (CG) simulations have previously been shown to preserve the secondary structure elements of AT proteins in CG water but to cause an artificial increase in intramolecular hydrogen bonds, resulting in a reduced flexibility of the proteins. Recently, it was found that the AT-CG interactions employed in these simulations were too favourable for apolar solutes and not favourable enough for polar solutes. Here, the AT-CG interactions are reparametrised to reproduce the solvation free energy of a series of AT alkanes and side-chain analogues in CG water, while retaining the good mixing behaviour of AT water with CG water. The new AT-CG parameters are tested in hybrid simulations of four proteins in CG water. Structural and dynamic properties are compared to those obtained in fully AT simulations and, if applicable, to experimental data. The results show that the artificial increase of intramolecular hydrogen bonds is drastically reduced, leading to a better reproduction of the structural properties and flexibility of the proteins in atomistic water, without the need for an atomistic solvent layer.

The importance of N-methylations for the stability of the ß6·³-helical conformation of polytheonamide B.

Polytheonamide B (pTB), a highly cytotoxic peptide produced by a symbiotic bacterium of the marine sponge Theonella swinhoei, forms a transmembrane pore consisting of 49 residues. More than half of its residues are posttranslationally modified. Epimerizations result in alternating L- and D-amino acids that allow the peptide to adopt a [Formula: see text]-helical conformation. Unusually, the wide [Formula: see text]-helix of pTB is stable in a polar environment, which is in contrast to gramicidin A, an antibiotic with similar function and structure. The role of the other posttranslational modifications (PTMs) such as side chain hydroxylations, C- and N-methylations is not well understood. In this study, the importance of these PTMs for the stability of [Formula: see text]-helix is investigated using computational tools. By reverting the modified residues to their precursors and monitoring the effect on the dominant structure, we show that the N-methylations are crucial for the stability of the [Formula: see text]-helix in a polar environment. They are the driving force for the formation of stable side chain hydrogen-bond chains that act as an "exoskeleton." Such exoskeletons could present a general design strategy for helical peptides.