Correction to "Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study" [The Lancet Regional Health - Americas 2022; 16: 100366] https://doi.org/10.1016/j.lana.2022.100366.

[This corrects the article DOI: 10.1016/j.lana.2022.100366.].

Green-based methods to obtain bioactive compounds from Ilex guayusa Loes. using polar solvent.

Many biological activities have been reported for the Ilex genus. However, few studies in the literature have reported on guayusa. To address this gap in our knowledge, chemical analysis of guayusa leaves was made. Extracts were obtained by applying Soxhlet, maceration, supercritical CO2 and pressurised liquid extraction techniques, using water and ethanol as solvent/cosolvent. Extracts were evaluated for their phenolic content and antioxidant capacity. The chemical profile was obtained from HPLC. In raw guayusa leaves were identified caffeine (2.27 ± 0.05%), protein (15.31 ± 0.07%) and lipids (11.81 ± 0.14%). Extracts presented the highest phenolic content (156.56 ± 1.32 mg GAE g-1) and the best antioxidant activity (EC50= 61.85 ± 0.21 µg mL-1) when water was used as solvent/cosolvent. Through HPLC, three main substances were determined and quantified in the extracts: caffeine, theobromine and 5-caffeoylquinic acid. Based on these results, guayusa may be considered a natural source of compounds with potential application in the food and pharmaceutical industries.

Cuban Abdala vaccine: Effectiveness in preventing severe disease and death from COVID-19 in Havana, Cuba; A cohort study.

Background: COVID-19 vaccines have proven safe and efficacious in reducing severe illness and death. Cuban protein subunit vaccine Abdala has shown safety, tolerability and efficacy (92·3% [95% CI: 85·7‒95·8]) against SARS-CoV-2 in clinical trials. This study aimed to estimate Abdala's real-world vaccine effectiveness (VE). Methods: This retrospective cohort study in Havana analyzed Cuban Ministry of Public Health databases (May 12-August 31, 2021) to assess VE in preventing severe illness and death from COVID-19 (primary outcomes). Cox models accounting for time-varying vaccination status and adjusting by demographics were used to estimate hazard ratios. A subgroup analysis by age group and a sensitivity analysis including a subgroup of tested persons (qRT-PCR) were conducted. Daily cases and deaths were modelled accounting for different VE. Findings: The study included 1 355 638 persons (Mean age: 49·5 years [SD: 18·2]; 704 932 female [52·0%]; ethnicity data unavailable): 1 324 vaccinated (partially/fully) and 31 433 unvaccinated. Estimated VE against severe illness was 93·3% (95% CI: 92·1-94·3) in partially- vaccinated and 98·2% (95% CI: 97·9-98·5) in fully-vaccinated and against death was 94·1% (95% CI: 92·5-95·4) in partially-vaccinated and 98·7% (95% CI: 98·3-99·0) in fully-vaccinated. VE exceeded 92·0% in all age groups. Daily cases and deaths during the study period corresponded to a VE above 90%, as predicted by models. Interpretation: The Cuban Abdala protein subunit vaccine was highly effective in preventing severe illness and death from COVID-19 under real-life conditions. Funding: Cuban Ministry of Public Health. Genetic Engineering and Biotechnology Centre.

Response surface methodology (RSM) to evaluate both the extraction of triterpenes and sterols from jackfruit seed with supercritical CO2 and the biological activity of the extracts.

Jackfruit seeds are an underestimate residue having important biological activity such as anti-inflammatory, cytotoxicity and antimicrobial effects. However few researches have been done for this material using alternative extraction technologies, so this study aimed to evaluate the extraction of triterpenes and sterols from jackfruit seed by applying high- and low-pressure techniques. Response surface methodology (RSM) was used to determine the best conditions of pressure, temperature and CO2 flow rate for extraction with supercritical CO2. The yield and profile of these compounds were compared with the low pressure technique, which was considered as a reference. In vitro biological tests of anti-inflammatory activity and cytotoxicity in L929 and RAW 264.7 cells were also performed. The best extraction conditions in SFE for sterols were 40 °C/20 MPa/4 mL min-1 (0.832 ± 0.007 mgSR g-1 sample) and 40 °C/20 MPa/3 mL min-1 (0.800 ± 0.009 mgSR g-1 sample), for triterpenes were 50 °C/12 MPa/4 mL min-1 (1.501 ± 0.004 mgTT g-1 sample) and 45 °C/9.3 MPa/3.5 mL min-1 (1.485 ± 0.004 mgTT g-1 sample). No cytotoxic activity was detected in L929 cells in the extracts obtained from ethanol up to concentration of 100 µg mL-1 of extract. The Pearson's coefficient indicated that the reduction in cell viability was related to the concentration of triterpenes. Anti-inflammatory assays showed that some extracts could inhibit the inflammatory action induced in RAW 264.7 cells at concentration of 30 µg mL-1 of extract. Our results justify the further exploration of these characteristics to obtain natural products for the pharmaceutical and food industries.

Biología molecular del virus de la hepatitis C / Molecular biology of hepatitis C virus

Resumen La infección por el virus de la hepatitis C (VHC) se distribuye en todo el mundo, frecuentemente se convierte en hepatitis crónica, cirrosis y hepatocarcinoma. El genoma del VHC es una molécula de ARN monocatenario, de polaridad positiva, de aproximadamente 9.6 kb de longitud. Esta revisión resume el conocimiento actual y los avances recientes en la investigación de la biología molecular del VHC.

Abstract Infection with hepatitis C virus (HCV), which is distributed worldwide, often becomes in chronic hepatitis, cirrhosis and hepatocellular carcinoma. The HCV genome is a single-stranded RNA molecule of positive polarity approximately 9.6 kb in length. This review summarizes the current knowledge of recent advances in the investigation of the molecular biology of HCV.

Ultrastructural and biochemical basis for hepatitis C virus morphogenesis.

Chronic infection with HCV is a leading cause of cirrhosis, hepatocellular carcinoma and liver failure. One of the least understood steps in the HCV life cycle is the morphogenesis of new viral particles. HCV infection alters the lipid metabolism and generates a variety of microenvironments in the cell cytoplasm that protect viral proteins and RNA promoting viral replication and assembly. Lipid droplets (LDs) have been proposed to link viral RNA synthesis and virion assembly by physically associating these viral processes. HCV assembly, envelopment, and maturation have been shown to take place at specialized detergent-resistant membranes in the ER, rich in cholesterol and sphingolipids, supporting the synthesis of luminal LDs-containing ApoE. HCV assembly involves a regulated allocation of viral and host factors to viral assembly sites. Then, virus budding takes place through encapsidation of the HCV genome and viral envelopment in the ER. Interaction of ApoE with envelope proteins supports the viral particle acquisition of lipids and maturation. HCV secretion has been suggested to entail the ion channel activity of viral p7, several components of the classical trafficking and autophagy pathways, ESCRT, and exosome-mediated export of viral RNA. Here, we review the most recent advances in virus morphogenesis and the interplay between viral and host factors required for the formation of HCV virions.

Modificación ultraestructural de las membranas derivadas del retículo endoplasmático y morfogénesis del virus de la hepatitis C en muestras de hígado humano / Ultrastructural remodelling of e ndoplasmic reticulum-derived membranes and hepatitis C virus morphogenesis in human liver samples

Introducción: la infección por el virus de la hepatitis C es una de las causas principales de la enfermedad del hígado a nivel mundial. La utilización de la cepa del virus de la hepatitis C, JFH1 en cultivo de células de hepatoma ha permitido el avance de la comprensión del ciclo de vida viral. No obstante, se conoce poco sobre la morfogénesis del virus de la hepatitis C. Las dificultades para detectar el ensamblaje viral en este modelo de cultivo celular, así como los bajos niveles y complejidad de las partículas del virus de la hepatitis C en pacientes y chimpancés infectados limitan el estudio de la morfogénesis viral.Objetivo: estudiar las características ultraestructurales y los eventos de ensamblaje viral en hepatocitos de pacientes infectados con el virus de la hepatitis C.Métodos: se utilizaron muestras de biopsias de hígado de pacientes infectados, anticuerpos específicos para el virus de la hepatitis C y técnicas de microscopía e inmunomicroscopía electrónica.Resultados: la infección por el virus de la hepatitis C se relacionó con una modificación de las membranas derivadas del retículo endoplasmático y con diferentes microambientes citoplasmáticos en los hepatocitos de individuos infectados. La dilatación del retículo endoplasmático y la formación de diferentes vesículas de membrana son características que se asocian con los complejos de replicación viral. Resulta interesante destacar la detección del ensamblaje de partículas semejantes a la cápsida y al virus de la hepatitis C cerca de complejos de membrana con alta densidad electrónica y estructuras tubulares. Las proteínas estructurales del virus de la hepatitis C se detectaron en el retículo endoplasmático .Conclusiones: estos eventos sugieren que el proceso temprano de ensamblaje de las nucleocápsidas y del virión ocurre en las membranas del retículoendoplasmático que se asocian con estos microambientes citoplasmáticos en los hepatocitos humanos(AU)

Introduction: hepatitis C virus infection is considered as a leading cause of liver disease worldwide. Despite recent advances in understanding the hepatitis C virus life cycle using the highly replicative JFH1 strain in human hepatoma cells, little is known about hepatitis C virus morphogenesis. Low levels of hepatitis C virus assembly in this cell culture model as well as low levels and complexity of hepatitis C virus particles in infected humans and chimpanzees have hampered the study of hepatitis C virus morphogenesis in vivo.Objetivo: to study the ultrastructural features and viral assembly events in hepatocytes from HCV hepatitis C virus-infected patients.Methods: liver needle biopsies samples of patients with hepatitis C virus infection, specific antibodies against hepatitis C virus and transmission electron microscopy and immunoelectron microscopy analyses were used in this study.Results: ultrastructural studies in liver biopsies from hepatitis C virus-infected patients revealed that hepatitis C virus infection was related with remodelling of endoplasmic reticulum-derived membranes and with a variety of cytoplasmic microenvironments in hepatocytes. Dilated endoplasmic reticulum and formation of various membrane vesicles are features that have been associated with the viral replication complex. Interestingly, hepatitis C virus-like particles and core-like particles budding and assembly were observed near convoluted electron-dense membranes and tubular structures. Particularly, hepatitis C virus structural proteins localize to the endoplasmic reticulum.Conclusions: these events indicate that hepatitis C virus nucleocapsids and early virion assembly take place atendoplasmic reticulum membranes that are associated with these cytoplasmic microenvironments in human hepatocytes(AU)

A chimeric protein encompassing hepatitis C virus epitopes is able to elicit both humoral and cell-mediated immune responses in mice.

Hepatitis C virus (HCV) infection is a worldwide health problem. Vaccines against this pathogen are not available and advances in this field are limited because of the high genetic variability of the virus, inaccessibility of animal models, and incomplete definition of immunological correlates of protection. In the present work, a chimeric protein, Eq1, encompassing HCV amino acid regions from structural antigens, was generated. Eq1 was expressed in GC-366 bacterial cells. After cell disruption, Eq1 was purified from the insoluble fraction by sequential steps of differential solubilization and metal chelating affinity chromatography. Eq1 was specifically recognized by anti-HCV positive human sera. Moreover, immunization of BALB/c mice with different doses of Eq1 formulated either in Alum or Freund's incomplete adjuvant elicited both humoral- and cellular-specific immune responses. Doses of 20 µg of Eq1 induced the strongest cell-mediated immune responses and only the formulation of this dose in Alum elicited a neutralizing antibody response against heterologous cell culture HCV. All these data together indicate that Eq1 is immunogenic in mice and might be an interesting component of vaccine candidates against HCV infection.

Percutaneous transluminal angioplasty with drug-eluting balloons for salvage of infrainguinal bypass grafts.

PURPOSE: To evaluate the safety and feasibility of using drug-eluting balloons (DEBs) in the treatment of infrainguinal bypass graft stenoses. METHODS: A nonrandomized prospective study evaluated the feasibility of DEB treatment for intragraft/anastomotic stenoses arising >1 month after infrainguinal bypass grafting; stenoses due to graft/technical problems (e.g., vein torsion) were excluded, as were failed grafts that could not be successfully recanalized with catheter-directed thrombolysis. Between February 2010 and February 2012, 41 patients (35 men; mean age 71 years, range 46-87) were treated with DEBs for 63 anastomotic/intragraft stenoses in vein or prosthetic grafts. Follow-up was performed with duplex ultrasonography. The primary endpoint at 12 months was graft occlusion or >50% restenosis at the DEB treatment site. RESULTS: DEB treatment was technically successful in 61 (96.8%) of the 63 lesions with no complications other than one instance of vasospasm; one totally occluded segment and one restenosis were treated surgically. The mean follow-up was 16.7 months (range 3-24). The estimated cumulative target site primary and secondary patency rates at 6 months were 91% and 96%, respectively, and 70% and 90%, respectively, at both 12 and 18 months (no restenoses after 12 months). The estimated mean durations of primary and secondary treatment site patency were 20.3 and 22.7 months, respectively (p=0.033). At 6 and 12/18 months, the cumulative rates were 96% and 90%, respectively, for graft patency and 98% and 93% for freedom from amputation. CONCLUSION: DEBs proved to be a feasible, safe, and effective treatment for vein and prosthetic bypass graft stenoses, with excellent technical success and acceptable short and midterm patency.

Neutralizing antibodies and broad, functional T cell immune response following immunization with hepatitis C virus proteins-based vaccine formulation.

HCV is a worldwide health problem despite the recent advances in the development of more effective therapies. No preventive vaccine is available against this pathogen. However, non-sterilizing immunity has been demonstrated and supports the potential success of HCV vaccines. Induction of cross-neutralizing antibodies and T cell responses targeting several conserved epitopes, have been related to hepatitis C virus (HCV) clearance. Therefore, in this work, the immunogenicity of a preparation (MixprotHC) based on protein variants of HCV Core, E1, E2 and NS3 was evaluated in mice and monkeys. IgG from MixprotHC immunized mice and monkeys neutralized the infectivity of heterologous HCVcc. Moreover, strong CD4+ and CD8+ T cells proliferative and IFN-γ secretion responses were elicited against HCV proteins. Remarkably, immunization with MixprotHC induced control of viremia in a surrogate challenge model in mice. These results suggest that MixprotHC might constitute an effective immunogen against HCV in humans with potential for reducing the likelihood of immune escape and viral persistence.

HCV-specific immune responses induced by CIGB-230 in combination with IFN-α plus ribavirin.

AIM: To analyze hepatitis C virus (HCV)-specific immune responses in chronically infected patients under triple therapy with interferon-α (IFN-α) plus ribavirin and CIGB-230. METHODS: CIGB-230 was administered in different schedules with respect to IFN-α plus ribavirin therapy. Paired serum and peripheral blood mononuclear cells (PBMC) samples from baseline and end of treatment were analyzed. The HCV-specific humoral response was tested by enzyme-linked immunosorbent assay, neutralizing antibodies were evaluated by cell culture HCV neutralization assays, PBMC proliferation was assayed by carboxyfluorescein succinimidyl ester staining and IFN-γ secretion was assessed by enzyme-linked immunospot. Data on virological and histological response and their association with immune variables are also provided. RESULTS: From week 12 to week 48, all groups of patients showed a significant reduction in mean leukocyte counts. Statistically significant reductions in antibody titers were frequent, but only individuals immunized with CIGB-230 as early add-on treatment sustained the core-IgG response, and the neutralizing antibody response was enhanced only in patients receiving CIGB-230. Cell-mediated immune responses also tended to decline, but significant reductions in IFN-γ secretion and total absence of core-specific lymphoproliferation were exclusive of the control group. Only CIGB-230-immunized individuals showed de novo induced lymphoproliferative responses against the structural antigens. Importantly, it was demonstrated that the quality of the CIGB-230-induced immune response depended on the number of doses and timing of administration in relation to the antiviral therapy. Specifically, the administration of 6 doses of CIGB-230 as late add-on to therapy increased the neutralizing antibody activity and the de novo core-specific IFN-γ secretion, both of which were associated with the sustained virological response. CONCLUSION: CIGB-230, combined with IFN-α-based therapy, modifies the immune response in chronic patients. The study provides evidence for the design of more effective therapeutic vaccine interventions against HCV.

Fístula aortoesofágica secundaria a endoprótesis torácica: a propósito de 3 casos y revisión de la literatura / Aortoesophageal fistula secondary to a thoracic endoprosthesis: A presentation of 3 cases and a review of the literature

La reparación endovascular de aorta torácica (TEVAR) es una modalidad mínimamente invasiva y generalmente excelente de tratar aneurismas torácicos, disecciones o roturas aórticas postraumáticas. La fístula aortoesofágica (FAE) es una causa altamente letal de sangrado masivo y constituye una complicación catastrófica tras una TEVAR. La incidencia de FAE tras TEVAR ha sido situada entre el 5 y el 10,53%. En este artículo aportamos 3 casos de de FAE tras TEVAR y nuestra experiencia en el tratamiento de las mismas. Se incluye además una revisión de la literatura disponible. Estos hallazgos enfatizan la importancia de la infección mediastínica, el tratamiento quirúrgico del esófago y el reemplazamiento de la aorta. El tratamiento debe ser quirúrgico, puesto que las estrategias conservadoras han demostrado un desenlace casi invariablemente fatal. Futuros desarrollos en el diseño de las endoprótesis y los materiales, así como el evitar un sobredimensionamiento excesivo, pueden reducir la aparición de esta desastrosa complicación (AU)

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive, and generally excellent, technique to treat thoracic aortic aneurysms, dissections, or traumatic aortic transections. Aortoesophageal fistula (AEF) is a highly lethal cause of massive bleeding and a catastrophic complication after TEVAR. The incidence of AEF after TEVAR has been reported as between 5% and 10.53%. We present 3 cases of AEF after TEVAR, and our experience with management and outcome of these patients. A review of the recent literature has been included. These findings emphasize the importance of mediastinal infection, esophageal surgical management, and aorta replacement. Management should be surgical, since the outcome under conservative management seems almost invariably fatal. Future developments in endoprosthesis design and material, and avoidance of over sizing will hopefully reduce the occurrence of this disastrous complication (AU)

Intraoperative embolization with poloxamer 407 during surgical resection of a carotid body tumor.

Surgical excision is the preferred definitive treatment for carotid body tumors, although postoperative morbidity rate as quoted in the literature is rather high. Morbidity includes cranial nerve dysfunction, stroke, and the majority severe blood loss. Embolization of the feeding branches of the external carotid artery can be performed a few days prior to surgery with the intention to decrease blood loss during operation, facilitate surgical resection, and reduce operating time and morbidity. The special risk of embolization is migration into the intracranial circulation. Poloxamer 407, a reverse-thermal polymer, is a nontoxic compound that is a viscous liquid at room temperatures but instantly changes to a firm water-soluble gel when warmed to body temperature. It dissolves spontaneously or can be dissolved at will by cooling. We describe an intraoperative technique for complete devascularization of carotid body tumor by using an intraarterial temporary occlusion technique with a poloxamer 407.

HCV genotype determination in monoinfected and HIV co-infected patients in Cuba.

With the aim to characterize the HCV genotype distribution in Cuba, sera were collected from two subgroups: HCV-monoinfected and HCV/HIV co-infected patients. A combination of reverse transcription-PCR using genotype-specific primers, restriction fragment length polymorphism and sequencing was used to determine the genotype of 84 samples. Seventy-nine (94%) showed single infections (10 [12%] were genotype 1a and 69 [82%] genotype 1b) and 5 (6%) samples corresponded to mixed infections (2 [2%] with genotypes 1a/3a and 1 sample [1%] each with 1b/3a, 1b/4a and 1a/1b/3a). HCV/HIV co-infected subjects had a higher frequency of mixed infections (p=0.08), infection with genotype 3a (p=0.18) and for the first time genotype 4a was found. There was no association of any demographic characteristics with any specific genotype although HCV/HIV co-infected patients showed a tendency to have mixed genotypes in those older than 45 years of age (p=0.11). Phylogenetic analysis showed that HCV isolates clustered with subtypes 1b (n=15, maximal genetic distance 2.51%) and 1a (n=2, maximal genetic distance 0.35%). This report presents the prevalence of HCV genotypes in monoinfected and HIV co-infected patients, mixed HCV infections in HCV/HIV co-infected men who have sex with men with high-risk sexual practices and for the first time identifies that the uncommon genotype 4a can be present in a patient co-infected with HIV.

Complete definition of immunological correlates of protection and clearance of hepatitis C virus infection: a relevant pending task for vaccine development.

Hepatitis C virus (HCV) infects approximately 3% of global population. This pathogen is one of the main causes of chronic viral hepatitis, cirrhosis, and liver cancer, as well as the principal reason for liver transplant in Western countries. Therapy against HCV infection is effective in only half of treated patients. There is no vaccine available against HCV. Some vaccine candidates have reached the clinical trials but several factors, including the incomplete definition of immunological correlates of protection and treatment-related clearance have slowed down vaccine development. Precisely, the present review discusses the state of the art in the establishment of parameters related with immunity against HCV. Validity and limitations of the information accumulated from chimpanzees and other animal models, analysis of studies in humans infected with HCV, and relevance of aspects like type, strength, duration, and specificity of immune response related to successful outcome are evaluated in detail. Moreover, the immune responses induced in some clinical trials with vaccine candidates resemble the theoretical immunological correlates, raising questions about the validity of those correlates. When all facts are taken together, complete definition of immunological correlates for protection or treatment-related clearance is an urgent priority. A limited or wrong criterion with respect to this relevant matter might cause incorrect vaccine design and selection of immunization strategies or erroneous clinical evaluation.

Generation of HIV-1 and Internal Control Transcripts as Standards for an In-House Quantitative Competitive RT-PCR Assay to Determine HIV-1 Viral Load.

Human immunodeficiency virus type-1 (HIV-1) viral load is useful for monitoring disease progression in HIV-infected individuals. We generated RNA standards of HIV-1 and internal control (IC) by in vitro transcription and evaluated its performance in a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay. HIV-1 and IC standards were obtained at high RNA concentrations, without DNA contamination. When these transcripts were included as standards in a qRT-PCR assay, it was obtained a good accuracy (±0.5 log(10) unit of the expected results) in the quantification of the HIV-1 RNA international standard and controls. The lower limit detection achieved using these standards was 511.0 IU/mL. A high correlation (r = 0.925) was obtained between the in-house qRT-PCR assay and the NucliSens easyQ HIV-1 test (bioMerieux) for HIV-1 RNA quantitation with clinical samples (N = 14). HIV-1 and IC RNA transcripts, generated in this study, proved to be useful as standards in an in-house qRT-PCR assay for determination of HIV-1 viral load.

Early interferon-based treatment after detection of persistent hepatitis C virus infection: a critical decision.

Approximately 170 million people are infected with the hepatitis C virus (HCV) worldwide. Infection with this pathogen is persistent in more than 80% of cases, frequently developing severe forms of liver damage such as cirrhosis and hepatocellular carcinoma. No preventive vaccine is available against HCV, and current treatment based on the combination of pegylated interferon and ribavirin is effective in ∼55% of patients infected with genotype 1, the most prevalent genotype. This review analyzes several factors influencing the achievement of a sustained virological response, namely undetectable HCV RNA at 6 months after conclusion of therapy. Particularly, the relevant issue of age and duration of infection is discussed in detail. Indeed, the final decision for starting treatment should be a case-by-case point. However, the cost-benefit analysis seems to indicate that in patients who are motivated and without contraindications, starting the treatment as early as possible is probably the best choice for success.