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1.
Viruses ; 13(5)2021 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-33946875

RESUMO

Lentiviral vectors (LVs) are a powerful tool for gene and cell therapy and human embryonic kidney cells (HEK293) have been extensively used as a platform for production of these vectors. Like most cells and cellular tissues, HEK293 cells release extracellular vesicles (EVs). EVs released by cells share similar size, biophysical characteristics and even a biogenesis pathway with cell-produced enveloped viruses, making it a challenge to efficiently separate EVs from LVs. Thus, EVs co-purified with LVs during downstream processing, are considered "impurities" in the context of gene and cell therapy. A greater understanding of EVs co-purifying with LVs is needed to enable improved downstream processing. To that end, EVs from an inducible lentivirus producing cell line were studied under two conditions: non-induced and induced. EVs were identified in both conditions, with their presence confirmed by transmission electron microscopy and Western blot. EV cargos from each condition were then further characterized by a multi-omic approach. Nineteen proteins were identified by mass spectrometry as potential EV markers to differentiate EVs in LV preparations. Lipid composition of EV preparations before and after LV induction showed similar enrichment in phosphatidylserine. RNA cargos in EVs showed enrichment in transcripts involved in viral processes and binding functions. These findings provide insights on the product profile of lentiviral preparations and could support the development of improved separation strategies aimed at removing co-produced EVs.


Assuntos
Vesículas Extracelulares/metabolismo , Vetores Genéticos/biossíntese , Vetores Genéticos/genética , Células HEK293/metabolismo , Lentivirus/genética , Transporte Biológico , Técnicas de Cultura de Células , Cromatografia Líquida , Biologia Computacional/métodos , Meios de Cultivo Condicionados , Exossomos , Vesículas Extracelulares/ultraestrutura , Humanos , Lipidômica , Espectrometria de Massas , Proteômica/métodos
2.
Vaccine ; 38(50): 7949-7955, 2020 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-33139138

RESUMO

Acquired Immune Deficiency Syndrome (AIDS) in humans is a result of the destruction of the immune system caused by Human Immunodeficiency Virus (HIV) infection. This serious epidemic is still progressing world-wide. Despite advances in treatment, a safe and effective preventive HIV vaccine is desired to combat this disease, and to save millions of lives. However, such a vaccine is not available yet although extensive amounts of resources in research and development have been invested over three decades. In light of the recently approved Ebola virus disease vaccine based on a recombinant vesicular stomatitis virus (rVSV-ZEBOV), we present the results of our work on three novel VSV-vectored HIV vaccine candidates. We describe the design, rescue, production and purification method and evaluate their immunogenicity in mice prior to preclinical studies that will be performed in non-human primates. The production of each of the three candidate vaccines (rVSV-B6-NL4.3Env/SIVtm, rVSV-B6-NL4.3Env/Ebtm and rVSV-B6-A74Env(PN6)/SIVtm) was evaluated in small scale in Vero cells and it was found that production kinetics on Vero cells vary depending on the HIV gp surface protein used. Purified virus preparations complied with the WHO restrictions for the residual DNA and host cell protein contents. Finally, when administered to mice, all three rVSV-HIV vaccine candidates induced an HIV gp140-specific antibody response.


Assuntos
Vacinas contra a AIDS , Vacinas contra Ebola , Ebolavirus , Doença pelo Vírus Ebola , Estomatite Vesicular , Animais , Técnicas de Cultura de Células , Chlorocebus aethiops , Vetores Genéticos , Camundongos , Vacinas Sintéticas/genética , Células Vero
3.
Sci Rep ; 10(1): 12166, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699298

RESUMO

Cell-derived influenza vaccines provide better protection and a host of other advantages compared to the egg-derived vaccines that currently dominate the market, but their widespread use is hampered by a lack of high yield, low cost production platforms. Identification and knockout of innate immune and metabolic restriction factors within relevant host cell lines used to grow the virus could offer a means to substantially increase vaccine yield. In this paper, we describe and validate a novel genome-wide pooled CRISPR/Cas9 screening strategy that incorporates a reporter virus and a FACS selection step to identify and rank restriction factors in a given vaccine production cell line. Using the HEK-293SF cell line and A/PuertoRico/8/1934 H1N1 influenza as a model, we identify 64 putative influenza restriction factors to direct the creation of high yield knockout cell lines. In addition, gene ontology and protein complex enrichment analysis of this list of putative restriction factors offers broader insights into the primary host cell determinants of viral yield in cell-based vaccine production systems. Overall, this work will advance efforts to address the public health burden posed by influenza.


Assuntos
Genoma Viral , Vírus da Influenza A Subtipo H1N1/genética , Vacinas contra Influenza/metabolismo , Sistemas CRISPR-Cas/genética , Sobrevivência Celular , Edição de Genes , Ontologia Genética , Genes Reporter , Vetores Genéticos/genética , Vetores Genéticos/metabolismo , Células HEK293 , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H1N1/fisiologia , Vacinas contra Influenza/genética , Vacinas contra Influenza/imunologia , Influenza Humana/patologia , Influenza Humana/prevenção & controle , Influenza Humana/virologia , RNA Guia de Cinetoplastídeos/metabolismo , Replicação Viral
4.
MethodsX ; 7: 100806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32195130

RESUMO

The recombinant Vesicular Stomatitis Virus (rVSV) is an emerging platform for viral vector-based vaccines. Promising results have been reported in clinical trials for the rVSV-ZEBOV vaccine for Ebola virus disease prevention. In this study, we describe the titration tools elaborated to assess the titre of rVSV-ZEBOV productions. • A streamlined Median Tissue Culture Infectious Dose (TCID50) assay to determine the infectious titer of this vaccine was established. • A digital polymerase chain reaction (dPCR) assay to assess the total number of viral particles present in cell-free culture supernatants of rVSV productions was developed. • These assays are used to titre rVSV-ZEBOV samples and characterize the ratio of total particles to infectious units for monitoring process robustness and product quality attributes and can be used to titre samples generated in the production of further rVSV vectors.

5.
J Biotechnol ; 310: 32-39, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32006630

RESUMO

Ebola virus disease outbreaks have repeatedly occurred on the African continent over the last decades, with more serious outbreaks in recent years. Being highly transmissible and associated to high fatality rates, it constitutes a serious threat to public health. Vaccination, however, may allow for efficient control of its propagation. The most promising Ebola vaccine candidate to date, rVSV-ZEBOV, relies on a recombinant vesicular stomatitis virus construct, in which the native viral glycoprotein is replaced by the glycoprotein of Ebola virus (Zaire). However, its cell-based manufacturing process is still lengthy and cumbersome, thus urging the implementation of a new and more efficient bioprocess. To address these issues, serum-free production of rVSV-ZEBOV in Vero cells has been studied with the aim to test an alternative upstream process. Until viable options of suspension cell culture are available, Vero cell cultures still rely on adherent bioprocesses and have thus been developed in this work. Particularly, a bioprocess developed with standard microcarrier bioreactor technology was successfully transferred to the novel single-use scale-X™ hydro fixed-bed.


Assuntos
Reatores Biológicos , Vacinas contra Ebola/biossíntese , Vesiculovirus , Animais , Chlorocebus aethiops , Meios de Cultura Livres de Soro/farmacologia , Vacinas contra Ebola/genética , Vacinas Sintéticas/biossíntese , Vacinas Sintéticas/genética , Células Vero
6.
Vaccine ; 37(44): 6624-6632, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31548015

RESUMO

Ebola virus disease is an urgent international priority. Promising results for several vaccine candidates have been reported in non-human primate studies and clinical trials with the most promising being the rVSV-ZEBOV vaccine. In this study, we sought to produce rVSV-ZEBOV in HEK 293SF cells in suspension and serum-free media. The purpose of this study was to establish a process using the HEK 293SF production platform, optimise the production titre, demonstrate scalability and the efficiency of the generated material to elicit an immune reaction in an animal model. Critical process parameters were evaluated to maximize production yield and process robustness and the following operating conditions: 1-2 × 106 cells/mL grown in HyClone HyCell TransFx-H media infected at an MOI of 0.001 with a temperature shift to 34 °C during the production phase and a harvest of the product after 48 h. Using these conditions, scalability in a 3.5 L controlled bioreactor was shown reaching a titre of 1.19 × 108 TCID50/mL at the peak of production, the equivalent of 4165 doses of vaccine per litre. The produced virus was shown to be thermostable in the culture media and, when concentrated, purified and administered to mice, demonstrated the ability to induce a ZEBOV-specific immune response.


Assuntos
Técnicas de Cultura Celular por Lotes , Vacinas contra Ebola/biossíntese , Vacinas contra Ebola/imunologia , Ebolavirus/imunologia , Vacinas de DNA/biossíntese , Vacinas de DNA/imunologia , Vesiculovirus , Animais , Anticorpos Antivirais/imunologia , Reatores Biológicos , Modelos Animais de Doenças , Vacinas contra Ebola/administração & dosagem , Vacinas contra Ebola/genética , Ebolavirus/genética , Feminino , Células HEK293 , Doença pelo Vírus Ebola/imunologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Imunização , Camundongos , Vacinas de DNA/administração & dosagem , Vacinas de DNA/genética , Vesiculovirus/genética
7.
Gene Ther ; 25(5): 345-358, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30022127

RESUMO

We have shown that a lentiviral vector (rSIV.F/HN) pseudotyped with the F and HN proteins from Sendai virus generates high levels of intracellular proteins after lung transduction. Here, we evaluate the use of rSIV.F/HN for production of secreted proteins. We assessed whether rSIV.F/HN transduction of the lung generates therapeutically relevant levels of secreted proteins in the lung and systemic circulation using human α1-anti-trypsin (hAAT) and factor VIII (hFVIII) as exemplars. Sedated mice were transduced with rSIV.F/HN carrying either the secreted reporter gene Gaussia luciferase or the hAAT or hFVIII cDNAs by nasal sniffing. rSIV.F/HN-hAAT transduction lead to therapeutically relevant hAAT levels (70 µg/ml) in epithelial lining fluid, with stable expression persisting for at least 19 months from a single application. Secreted proteins produced in the lung were released into the circulation and stable expression was detectable in blood. The levels of hFVIII in murine blood approached therapeutically relevant targets. rSIV.F/HN was also able to produce secreted hAAT and hFVIII in transduced human primary airway cells. rSIV.F/HN transduction of the murine lungs leads to long-lasting and therapeutically relevant levels of secreted proteins in the lung and systemic circulation. These data broaden the use of this vector platform for a large range of disease indications.


Assuntos
Proteína HN/metabolismo , Transfecção/métodos , Proteínas Virais de Fusão/metabolismo , Animais , DNA Complementar/metabolismo , Fator VIII , Técnicas de Transferência de Genes , Genes Reporter , Terapia Genética , Vetores Genéticos , Humanos , Infecções por Lentivirus , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/fisiologia , Camundongos , Sistemas de Translocação de Proteínas/genética , Vírus Sendai/metabolismo , Transdução Genética/métodos
8.
Sci Rep ; 8(1): 6774, 2018 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-29691424

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

9.
Microbiol Mol Biol Rev ; 82(1)2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29321222

RESUMO

The use of lentiviral vectors for therapeutic purposes has shown promising results in clinical trials. The ability to produce a clinical-grade vector at high yields remains a critical issue. One possible obstacle could be cellular factors known to inhibit human immunodeficiency virus (HIV). To date, five HIV restriction factors have been identified, although it is likely that more factors are involved in the complex HIV-cell interaction. Inhibitory factors that have an adverse effect but do not abolish virus production are much less well described. Therefore, a gap exists in the knowledge of inhibitory factors acting late in the HIV life cycle (from transcription to infection of a new cell), which are relevant to the lentiviral vector production process. The objective was to review the HIV literature to identify cellular factors previously implicated as inhibitors of the late stages of lentivirus production. A search for publications was conducted on MEDLINE via the PubMed interface, using the keyword sequence "HIV restriction factor" or "HIV restriction" or "inhibit HIV" or "repress HIV" or "restrict HIV" or "suppress HIV" or "block HIV," with a publication date up to 31 December 2016. Cited papers from the identified records were investigated, and additional database searches were performed. A total of 260 candidate inhibitory factors were identified. These factors have been identified in the literature as having a negative impact on HIV replication. This study identified hundreds of candidate inhibitory factors for which the impact of modulating their expression in lentiviral vector production could be beneficial.


Assuntos
Vetores Genéticos/uso terapêutico , Infecções por HIV/virologia , HIV-1/fisiologia , Interações Hospedeiro-Patógeno , Replicação Viral , Ensaios Clínicos como Assunto , Replicação do DNA , Regulação da Expressão Gênica/imunologia , Técnicas de Transferência de Genes , HIV-1/genética , HIV-1/imunologia , Humanos , Imunidade Celular , Lentivirus/genética
10.
Sci Rep ; 7(1): 10198, 2017 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-28860488

RESUMO

The development of lentiviral-based therapeutics is challenged by the high cost of current Good Manufacturing Practices (cGMP) production. Lentiviruses are enveloped viruses that capture a portion of the host cell membrane during budding, which then constitutes part of the virus particle. This process might lead to lipid and protein depletion in the cell membrane and affect cell viability. Furthermore, growth in suspension also causes stresses that can affect virus production yields. To assess the impact of these issues, selected supplements (Cholesterol Lipid Concentrate, Chemically Defined Lipid Concentrate, Lipid Mixture 1, Gelatin Peptone N3, N-Acetyl-L-Cysteine and Pluronic F-68) were assayed in order to improve production yields in a transient transfection production of a Sendai virus F/HN-pseudotyped HIV-1-based third generation lentiviral vector in FreeStyle 293 (serum-free media) in suspension. None of the supplements tested had a significant positive impact on lentiviral vector yields, but small non-significant improvements could be combined to increase vector production in a cell line where other conditions have been optimised.


Assuntos
Meios de Cultura/química , Proteína HN/metabolismo , Lentivirus/crescimento & desenvolvimento , Proteínas Virais de Fusão/metabolismo , Técnicas de Cultura de Células , Células HEK293 , Proteína HN/genética , Humanos , Lentivirus/genética , Vírus Sendai/genética , Vírus Sendai/metabolismo , Transfecção , Proteínas Virais de Fusão/genética , Carga Viral
12.
Retrovirology ; 10: 96, 2013 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-24020926

RESUMO

BACKGROUND: HIV-1 translation is modulated by the activation of the interferon (IFN)-inducible Protein Kinase RNA-activated (PKR). PKR phosphorylates its downstream targets, including the alpha subunit of the eukaryotic translation Initiation Factor 2 (eIF2α), which decreases viral replication. The PKR Activator (PACT) is known to activate PKR after a cellular stress. In lymphocytic cell lines, HIV-1 activates PKR only transiently and not when cells replicate the virus at high levels. The regulation of this activation is due to a combination of viral and cellular factors that have been only partially identified. RESULTS: PKR is transiently induced and activated in peripheral blood mononuclear cells after HIV-1 infection. The addition of IFN reduces viral replication, and induces both the production and phosphorylation of PKR. In lymphocytic Jurkat cells infected by HIV-1, a multiprotein complex around PKR contains the double-stranded RNA binding proteins (dsRBPs), adenosine deaminase acting on RNA (ADAR)1 and PACT. In HEK 293T cells transfected with an HIV-1 molecular clone, PACT unexpectedly inhibited PKR and eIF2α phosphorylation and increased HIV-1 protein expression and virion production in the presence of either endogenous PKR alone or overexpressed PKR. The comparison between different dsRBPs showed that ADAR1, TAR RNA Binding Protein (TRBP) and PACT inhibit PKR and eIF2α phosphorylation in HIV-infected cells, whereas Staufen1 did not. Individual or a combination of short hairpin RNAs against PACT or ADAR1 decreased HIV-1 protein expression. In the astrocytic cell line U251MG, which weakly expresses TRBP, PACT mediated an increased HIV-1 protein expression and a decreased PKR phosphorylation. In these cells, a truncated PACT, which constitutively activates PKR in non-infected cells showed no activity on either PKR or HIV-1 protein expression. Finally, PACT and ADAR1 interact with each other in the absence of RNAs. CONCLUSION: In contrast to its previously described activity, PACT contributes to PKR dephosphorylation during HIV-1 replication. This activity is in addition to its heterodimer formation with TRBP and could be due to its binding to ADAR1. HIV-1 has evolved to replicate in cells with high levels of TRBP, to induce the expression of ADAR1 and to change the function of PACT for PKR inhibition and increased replication.


Assuntos
HIV-1/fisiologia , Interações Hospedeiro-Patógeno , Proteínas de Ligação a RNA/metabolismo , Replicação Viral , eIF-2 Quinase/antagonistas & inibidores , Adenosina Desaminase/metabolismo , Linhagem Celular , Humanos , Fosforilação , Ligação Proteica , Multimerização Proteica , Processamento de Proteína Pós-Traducional
13.
Immunogenetics ; 65(6): 397-403, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23455512

RESUMO

Single nucleotide polymorphisms (SNPs) in the proximity of the interleukin-28B (IL28B) gene can predict spontaneous resolution of hepatitis C virus (HCV) infection and response to interferon therapy. Screening for this polymorphism has become part of the standard criteria for the management of HCV-infected patients, hence the need for a rapid, cost-effective screening method. Here, we describe a rapid PCR-based test to screen for two IL28B SNPs (rs12979860 and rs8099917). We used this test to investigate IL28B polymorphism and prevalence in a cohort of French Canadian injection drug users who are part of a unique population known to have a strong genetic founder effect. This population had lower linkage disequilibrium between the two tested SNPs as compared to other cohorts (|d'| = 0.68, r = 0.59). The special genetic makeup should be considered in the management of HCV-infected patients within that population.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/genética , Interleucinas/genética , Reação em Cadeia da Polimerase/métodos , Adulto , Canadá/epidemiologia , Estudos de Coortes , Feminino , Genótipo , Hepatite C Crônica/epidemiologia , Humanos , Interferons , Desequilíbrio de Ligação , Masculino , Polimorfismo de Nucleotídeo Único , Prevalência
14.
J Virol ; 85(17): 8460-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21490091

RESUMO

Adenosine deaminase acting on RNA 1 (ADAR1) is a double-stranded RNA binding protein and RNA-editing enzyme that modifies cellular and viral RNAs, including coding and noncoding RNAs. This interferon (IFN)-induced protein was expected to have an antiviral role, but recent studies have demonstrated that it promotes the replication of many RNA viruses. The data from these experiments show that ADAR1 directly enhances replication of hepatitis delta virus, human immunodeficiency virus type 1, vesicular stomatitis virus, and measles virus. The proviral activity of ADAR1 occurs through two mechanisms: RNA editing and inhibition of RNA-activated protein kinase (PKR). While these pathways have been found independently, the two mechanisms can act in concert to increase viral replication and contribute to viral pathogenesis. This novel type of proviral regulation by an IFN-induced protein, combined with some antiviral effects of hyperediting, sheds new light on the importance of ADAR1 during viral infection and transforms our overall understanding of the innate immune response.


Assuntos
Adenosina Desaminase/metabolismo , Edição de RNA , Vírus de RNA/fisiologia , RNA Viral/metabolismo , Replicação Viral , eIF-2 Quinase/antagonistas & inibidores , Humanos , Modelos Biológicos , Proteínas de Ligação a RNA
15.
Rev Med Virol ; 21(1): 42-53, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21294215

RESUMO

Recent therapeutic approaches against HIV-1 include IFN in combination therapy for patients with coinfections or as an alternative strategy against the virus. These treatment options require a better understanding of the weak efficacy of the IFN-stimulated genes, such as the protein kinase RNA-activated (PKR), which results in viral progression. Activated PKR has a strong antiviral activity on HIV-1 expression and production in cell culture. However, PKR is not activated upon HIV-1 infection when the virus reaches high levels of replication, due to viral and cellular controls. PKR is activated by low levels of the HIV-1 trans-activation response (TAR) RNA element, but is inhibited by high levels of this double-stranded RNA. The viral Tat protein also counteracts PKR activation by several mechanisms. In addition, HIV-1 replicates only in cells that have a high level of the TAR RNA binding protein (TRBP), a strong inhibitor of PKR activation. Furthermore, increased levels of adenosine deaminase acting on RNA (ADAR1) are observed when HIV-1 replicates at high levels and the protein binds to PKR and inhibits its activation. Finally, the PKR activator (PACT) also binds to PKR during HIV-1 replication with no subsequent kinase activation. The combination of all the inhibiting pathways that prevent PKR phosphorylation contributes to a high HIV-1 production in permissive cells. Enhancing PKR activation by counteracting its inhibitory partners could establish an increased innate immune antiviral pathway against HIV-1 and could enhance the efficacy of the IFN treatment.


Assuntos
Regulação para Baixo , Infecções por HIV/enzimologia , HIV-1/fisiologia , Replicação Viral , eIF-2 Quinase/antagonistas & inibidores , Animais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Inibidores de Proteínas Quinases/farmacologia , Replicação Viral/efeitos dos fármacos , eIF-2 Quinase/genética , eIF-2 Quinase/metabolismo
16.
J Virol ; 83(19): 10119-28, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19605474

RESUMO

The interferon-induced protein kinase RNA activated (PKR) is activated after virus infection. This activation is transient during the human immunodeficiency virus type 1 (HIV-1) infection of lymphocytes, and the protein is not activated at the peak of infection. We observed that interferon-induced adenosine deaminase acting on RNA 1-p150 (ADAR1-p150) and ADAR1-p110 expression increases while the virus replicates actively. Furthermore, both forms of ADAR1 show enhanced interactions with PKR at the peak of HIV infection, suggesting a role for this protein in the regulation of PKR activation. We observed that ADAR1-p150, as previously shown for the TAR RNA binding protein (TRBP), reverses the PKR inhibition of HIV expression and production in HEK 293T cells. This activity requires the Z-DNA binding motif and the three double-stranded RNA binding domains but not the catalytic domain. In astrocytic cells, ADAR1-p150 increased HIV expression and production to an extent similar to that of TRBP. Small interfering RNAs against ADAR1-p150 moderately decreased HIV production. These results indicate that two interferon-induced proteins, ADAR1 and PKR, have antagonistic functions on HIV production. They suggest that ADAR1 and TRBP belong to a multiprotein complex that inhibits PKR during the HIV infection of lymphocytes.


Assuntos
Adenosina Desaminase/genética , Adenosina Desaminase/fisiologia , Regulação Viral da Expressão Gênica , Infecções por HIV/metabolismo , Infecções por HIV/virologia , Linfócitos/virologia , Replicação Viral , eIF-2 Quinase/metabolismo , Motivos de Aminoácidos , Linhagem Celular , Fator de Iniciação 2 em Eucariotos/metabolismo , HIV-1/metabolismo , Humanos , Células Jurkat , Modelos Biológicos , Fosforilação , Proteínas de Ligação a RNA , Transfecção
17.
J Pediatr ; 154(3): 332-7, 337.e1-2, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18950797

RESUMO

OBJECTIVE: To determine whether known risk factors for cardiorespiratory illnesses will help identify infants who could experience extreme events during an admission for an apparent life-threatening event (ALTE) or later at home. STUDY DESIGN: Retrospective cohort study of all patients admitted for ALTE between 1996 and 2006. Extreme events included central apnea >30 seconds, bradycardia >10 seconds, and desaturation >10 seconds at hemoglobin-oxygen saturation value with pulse oximetry <80%. RESULTS: Of the 625 patients included in the study, 46 (7.4%) had extreme cardiorespiratory events recorded, usually within 24 hours of hospital admission. The most frequent diagnosis was upper respiratory tract infection (URTI, 30 infants). These factors increased the likelihood of having extreme events (P < .0001): post-conceptional age <43 weeks (5.2-fold increase), premature birth (6.3-fold), and URTI symptoms (11.2-fold). The most frequent events were extreme desaturations (43/46 infants), preceded by a central apnea. Seven infants had extreme events recorded later during home monitoring (4 with URTI); all 7 infants had sustained extreme events in the hospital. CONCLUSION: Extreme events were identified mostly in association with symptoms of URTIs, in infants born prematurely, and in infants <43 weeks post-conceptional age. Monitoring with a pulse oximeter should identify infants who sustain these events.


Assuntos
Obstrução das Vias Respiratórias/epidemiologia , Apneia/epidemiologia , Cianose/epidemiologia , Obstrução das Vias Respiratórias/diagnóstico , Apneia/diagnóstico , Canadá/epidemiologia , Estudos de Coortes , Comorbidade , Cianose/diagnóstico , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro , Pacientes Internados/estatística & dados numéricos , Masculino , Monitorização Fisiológica , Oximetria , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
18.
Int J Pediatr Otorhinolaryngol ; 72(4): 433-52, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18281102

RESUMO

OBJECTIVES: Determine the exact incidence of pulmonary involvement in recurrent respiratory papillomatosis (RRP); explore available treatments and their effectiveness; determine the characteristics of cases that progress to lung cancer. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Library databases between 1966 and 2007; reference lists of retrieved publication. STUDY SELECTION: Studies investigating recurrent respiratory papillomatosis with lung involvement. Age limited to 20 years of age to qualify for the diagnosis of juvenile-onset RRP. DATA EXTRACTION: Data pertaining to study design, population demographics, risk factors, site of involvement, investigation including the determination of the human papillomavirus type, treatment, and outcomes including the development of cancer. DATA SYNTHESIS: No randomized control trials were retrieved. Hundred and one studies met our inclusion criteria (23 cohorts, 4 case series, 72 case reports, 2 open trials) with 161 cases of lung involvement identified. From the cohort studies we could estimate the incidence of lung involvement in RRP at 3.3%. The incidence of cancer in cases with lung involvement was 16%. We could not draw conclusions regarding treatment effectiveness in lung involvement, as that was not evaluated except in case studies. It would nevertheless appear that Interferon is not effective and the use of intravenous Cidofovir needs to be better evaluated. CONCLUSION: Well-designed, hypothesis-driven randomized control trials and prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the development of lung involvement in RRP, the risks associated with different HPV types, the efficacy of potential therapeutic options as well as the risk of progression to cancer.


Assuntos
Neoplasias Pulmonares/patologia , Papiloma/patologia , Adolescente , Adulto , Idade de Início , Progressão da Doença , Humanos , Neoplasias Pulmonares/epidemiologia , Recidiva Local de Neoplasia , Papiloma/epidemiologia
19.
Pediatr Pulmonol ; 43(3): 288-96, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18219691

RESUMO

RATIONALE: Although home cardiorespiratory monitors have been used for a few decades, they do not give information on oxygenation status during events. Pulse oximeters with low false-alarm rates are now available but with no standards for alarm adjustment. OBJECTIVE: To determine, in a population of children monitored at home with a pulse oximeter, whether the chosen alarm levels could safely identify potentially significant events early on but also limit the number of alarms for non-significant events. METHODS: Retrospective cohort study of all children monitored at home with a pulse oximeter (n = 37) between 2002 and 2007. Clinical information and Hb-O(2) saturation (SpO(2)) recordings were reviewed. Audible alarm was set-up when SpO(2) reached 85% with a delay of 5 or 10 sec. RESULTS: A total of 24,127 hr of valid data were available for analysis. There were 13,228 events >4 sec of which 9177 (69%) were events lasting <10 sec. We determine that, with an audible alarm being triggered when SpO(2) reached 85% with no delay or a delay of 5 or 10 sec, audible alarms would have occurred at a rate of 3.6, 0.9, and 0.2 alarm/night (median), respectively. Thirteen patients needed intervention following alarms. Ten patients were readmitted to the hospital on the basis of increased frequency of alarms confirmed as true events on the recordings, but in the absence of clinical deterioration. CONCLUSION: The monitor was able to alert parents as to potentially dangerous events while the alarm adjustment limited the number of alarms for non-significant events.


Assuntos
Hipóxia/diagnóstico , Monitorização Ambulatorial , Oximetria/métodos , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Apneia Obstrutiva do Sono
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