Monocyte migration profiles define disease severity in acute COVID-19 and unique features of long COVID.

BACKGROUND: COVID-19 is associated with a dysregulated immune response but it is unclear how immune dysfunction contributes to the chronic morbidity persisting in many COVID-19 patients during convalescence (long COVID). METHODS: We assessed phenotypical and functional changes of monocytes in COVID-19 patients during hospitalisation and up to 9 months of convalescence following COVID-19, respiratory syncytial virus or influenza A. Patients with progressive fibrosing interstitial lung disease were included as a positive control for severe, ongoing lung injury. RESULTS: Monocyte alterations in acute COVID-19 patients included aberrant expression of leukocyte migration molecules, continuing into convalescence (n=142) and corresponding with specific symptoms of long COVID. Long COVID patients with unresolved lung injury, indicated by sustained shortness of breath and abnormal chest radiology, were defined by high monocyte expression of C-X-C motif chemokine receptor 6 (CXCR6) (p<0.0001) and adhesion molecule P-selectin glycoprotein ligand 1 (p<0.01), alongside preferential migration of monocytes towards the CXCR6 ligand C-X-C motif chemokine ligand 16 (CXCL16) (p<0.05), which is abundantly expressed in the lung. Monocyte CXCR6 and lung CXCL16 were heightened in patients with progressive fibrosing interstitial lung disease (p<0.001), confirming a role for the CXCR6-CXCL16 axis in ongoing lung injury. Conversely, monocytes from long COVID patients with ongoing fatigue exhibited a sustained reduction of the prostaglandin-generating enzyme cyclooxygenase 2 (p<0.01) and CXCR2 expression (p<0.05). These monocyte changes were not present in respiratory syncytial virus or influenza A convalescence. CONCLUSIONS: Our data define unique monocyte signatures that define subgroups of long COVID patients, indicating a key role for monocyte migration in COVID-19 pathophysiology. Targeting these pathways may provide novel therapeutic opportunities in COVID-19 patients with persistent morbidity.

Infected erythrocytes expressing DC13 PfEMP1 differ from recombinant proteins in EPCR-binding function.

Recent advances have identified a new paradigm for cerebral malaria pathogenesis in which endothelial protein C receptor (EPCR) is a major host receptor for sequestration of Plasmodium falciparum-infected erythrocytes (IEs) in the brain and other vital organs. The parasite adhesins that bind EPCR are members of the IE variant surface antigen family Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) containing specific adhesion domains called domain cassette (DC) 8 and DC13. The binding interaction site between PfEMP1 and EPCR has been mapped by biophysical and crystallography studies using recombinant proteins. However, studies examining the interaction of native PfEMP1 on the IE surface with EPCR are few. We aimed to study binding to EPCR by IEs expressing DC8 and DC13 PfEMP1 variants whose recombinant proteins have been used in key prior functional and structural studies. IE binding to EPCR immobilized on plastic and on human brain endothelial cells was examined in static and flow adhesion assays. Unexpectedly, we found that IEs expressing the DC13 PfEMP1 variant HB3var03 or IT4var07 did not bind to EPCR on plastic and the binding of these variants to brain endothelial cells was not dependent on EPCR. IEs expressing the DC8 variant IT4var19 did bind to EPCR, but this interaction was inhibited if normal human serum or plasma was present, raising the possibility that IE-EPCR interaction may be prevented by plasma components under physiological conditions. These data highlight a discrepancy in EPCR-binding activity between PfEMP1 recombinant proteins and IEs, and indicate the critical need for further research to understand the pathophysiological significance of the PfEMP1-EPCR interaction.

A method for positive and negative selection of Plasmodium falciparum platelet-mediated clumping parasites and investigation of the role of CD36.

Platelet-mediated clumping of Plasmodium falciparum infected erythrocytes (IEs) is a frequently observed parasite adhesion phenotype. The importance of clumping in severe malaria and the molecular mechanisms behind this phenomenon are incompletely understood. Three platelet surface molecules have previously been identified as clumping receptors: CD36, globular C1q receptor (gC1qR/HABP1/p32), and P-selectin (CD62P), but the parasite ligands mediating this phenotype are unknown. The aim of this work was to develop a selection method to facilitate investigations of the molecular mechanisms of clumping in selected P. falciparum lines. Magnetic beads coated with anti-platelet antibodies were used to positively and negatively select clumping IEs from P. falciparum strains IT, HB3, 3D7 and Dd2. Clumping in all four positively selected parasite lines was abolished by antibodies to CD36, but was not affected by antibodies to gC1qR or P-selectin. Clumping positive lines showed significantly higher binding to CD36 than clumping negative lines in flow adhesion assays (strains IT, HB3 and 3D7, p<0.05 for all strains, paired t test) and static assays (strain Dd2, p<0.0001 paired t test). However, clumping negative lines IT, HB3 and 3D7 did show some binding to CD36 under flow conditions, indicating that CD36-binding is not sufficient for clumping. These data show that CD36-dependent clumping positive and negative lines can easily be selected from P. falciparum laboratory strains. CD36-binding is necessary but not sufficient for clumping, and the molecular differences between clumping positive and negative parasite lines responsible for the phenotype require further investigation.

A subset of group A-like var genes encodes the malaria parasite ligands for binding to human brain endothelial cells.

Cerebral malaria is the most deadly manifestation of infection with Plasmodium falciparum. The pathology of cerebral malaria is characterized by the accumulation of infected erythrocytes (IEs) in the microvasculature of the brain caused by parasite adhesins on the surface of IEs binding to human receptors on microvascular endothelial cells. The parasite and host molecules involved in this interaction are unknown. We selected three P. falciparum strains (HB3, 3D7, and IT/FCR3) for binding to a human brain endothelial cell line (HBEC-5i). The whole transcriptome of isogenic pairs of selected and unselected parasites was analyzed using a variant surface antigen-supplemented microarray chip. After selection, the most highly and consistently up-regulated genes were a subset of group A-like var genes (HB3var3, 3D7_PFD0020c, ITvar7, and ITvar19) that showed 11- to >100-fold increased transcription levels. These var genes encode P. falciparum erythrocyte membrane protein (PfEMP)1 variants with distinct N-terminal domain types (domain cassette 8 or domain cassette 13). Antibodies to HB3var3 and PFD0020c recognized the surface of live IEs and blocked binding to HBEC-5i, thereby confirming the adhesive function of these variants. The clinical in vivo relevance of the HBEC-selected parasites was supported by significantly higher surface recognition of HBEC-selected parasites compared with unselected parasites by antibodies from young African children suffering cerebral malaria (Mann-Whitney test, P = 0.029) but not by antibodies from controls with uncomplicated malaria (Mann-Whitney test, P = 0.58). This work describes a binding phenotype for virulence-associated group A P. falciparum erythrocyte membrane protein 1 variants and identifies targets for interventions to treat or prevent cerebral malaria.

Evaluation of polymerase chain reaction diagnosis of Cryptosporidium spp in dairy cattle and wildlife.

This study investigated the utility of the polymerase chain reaction (PCR) protocol as a screening test for Cryptosporidium spp in 125 fecal samples from dairy cattle and wild rodents. Samples initially examined by fecal flotation and ELISA were evaluated using four PCR protocols (18S SSU rRNA, TRAP-C2, HSP70, and COWP), and the relative accuracy and agreement of PCR protocols was assessed. Although PCR can be both highly sensitive and accurate, the ability of these protocols to accurately detect DNA in samples can vary. A combination of techniques may be the best choice for to screen samples for this parasite.

Identification and typing of Cameroonian isolates of P. malariae using monoclonal antibodies against P. brasilianum.

In the present study, monoclonal antibodies raised against Plasmodium brasilianum were used to demonstrate, for the first time, antigenic diversity in natural populations of Plasmodium malariae isolates and as diagnostic tool to detect low parasitaemia P. malariae infection. Seventeen McAbs reacting by indirect immunoflorescence antibody (IFA) assay with no other Plasmodium species than P. brasilianum, were shown to react with P. malariae and were used for typing 29 P. malariae isolates from hyperendemic areas in Yaounde and in three villages of South Cameroon with parasitaemia ranging from 0.01% to 1.8%. All 29 isolates were distinguished by their ability to react with certain antibodies and considered as representing different isolates of P. malariae. One of these McAbs (No. 14) recognized P. malariae isolates to both in Yaounde and from Mengang but not in Edou or in Nkol Mvae, which may recognize a specific epitope that is less common in strains found in these villages and provide evidence of regional variation within the P. malariae parasites. The McAbs Nos. 16 and 17 were used to determine their usefulness as diagnostic tools for 30 suspected blood samples that were collected from patients with fever and it became clear that they could detect sub-microscopical infections of P. malariae. This study supports the concept of using of P. brasilianum as a substitute for P. malariae during immuno-diagnosis of malaria in endemic areas where PCR assay cannot be used for identification of the P. malariae parasites. In addition our results for the first time provide evidence of considerable antigenic diversity of clinical P. malariae isolates in Cameroon.

A novel multiplex polymerase chain reaction approach for detection of four human infective Cryptosporidium isolates: Cryptosporidium parvum, types H and C, Cryptosporidium canis, and Cryptosporidium felis in fecal and soil samples.

A nested multiplex polymerase chain reaction (PCR) approach was adopted for the simultaneous detection of 4 human infective genotypes of the protozoan parasite Cryptosporidium. Specific PCR primers were designed for the heat shock protein 70 gene of 2 genotypes of Cryptosporidium parvum (human and bovine types), Cryptosporidium canis, and Cryptosporidium felis. These 4 genotypes have all been found in human fecal samples. The primers amplified DNA fragments of specific sizes, each representing a unique genotype. The limit of detection of the method was found to vary between 10 and 100 oocysts per 1 ml fecal material. There appeared to be no cross-reactivity with other organisms commonly present in feces and soil, and the approach has a high specificity. The rapid identification of various human infective Cryptosporidium isolates is a part of the authors' long-term aim of determining the routes of infection with oocysts and thereby increase their epidemiological understanding of Cryptosporidium infection in humans and animals.

Utility of the Cryptosporidium oocyst wall protein (COWP) gene in a nested PCR approach for detection infection in cattle.

A preliminary molecular epidemiological study was carried out to investigate the utility of the Cryptosporidium oocyst wall protein (COWP) gene in the detection of Cryptosporidium oocysts in fecal samples. A nested polymerase chain reaction (PCR) approach using COWP gene primers was adopted for this purpose. Fecal samples were spiked with each of 1, 10, and 100 oocysts of C. parvum, four samples for each number, and the DNA was extracted from each sample using a glassbead method. The presence of oocysts was determined using the nested PCR with COWP gene primers, and the limit of detection of oocysts by the PCR was determined. The limit of detection was 100 oocysts spiked in 1 ml of fecal material (50% sold material) (four positives/four samples tested). Seventy-five percent of DNA extracted samples spiked with 1 and 10 oocysts was positive by the PCR (three positives/four samples tested). Based on this, small sample size using the COWP gene primers with a nested PCR analysis could reliably identify infected animals rather conveniently and accurately.

The sensitivity of PCR detection of Cryptosporidium oocysts in fecal samples using two DNA extraction methods.

BACKGROUND: The implementation of cost-effective intervention strategies for zoonotic protozoa relies on the development of sensitive and accurate diagnostic methods. We carried out a study to evaluate the accuracy of a PCR method for the detection of Cryptosporidium spp. oocysts in fecal samples from cattle. METHODS: Fecal samples were spiked with different numbers of oocysts and the limit of detection of the method was determined. Two methods of DNA extraction were assessed: glass beads and freeze-thawing using liquid nitrogen. A nested PCR approach was developed targeting the Cryptosporidium SSU rRNA and TRAP-C2 genes. Agreement between the diagnosis of Cryptosporidium spp. at the SSU rRNA and TRAP-C2 loci was quantified using the kappa-coefficient. RESULTS: Compared with the freeze-thawing method, the glass beads method was found to be a better way of extracting DNA from Cryptosporidium oocysts (sensitivities were 83 and 100%, respectively). The limits of detection for glass beads and freeze-thaw were low, 1 and 10 oocyst/g fecal samples, respectively. Forty-six percent of the field samples previously classified as negative for Cryptosporidium parvum by the flotation-concentration and enzyme-linked immunosorbent assay methods showed DNA with the PCR protocol. CONCLUSION: Primers for SSU rRNA are more successful in producing an amplification than primers for the TRAP-C2 gene which makes the former PCR protocol the approach of choice for detecting Cryptosporidium parvum oocysts in field samples.

Serological detection of exposure to Cryptosporidium parvum in cattle by ELISA and its evaluation in relation to coprological tests.

We evaluated serum examination as an alternative to fecal analysis for the diagnosis of exposure to Cryptosporidium parvum in cattle. The accuracy of the serum ELISA was compared to the combined results of concentration flotation microscopy and fecal enzyme immunoassay. The expected performance of the serum ELISA at different levels of infection with C. parvum was evaluated using the predicative values positive and negative. Optimal conditions for the serum ELISA can be achieved by diluting the serum samples 1:20 and the conjugate 1:8,000. The serum ELISA had a relatively high sensitivity of 97.5% (95% CI=87-100%) and poor specificity, 4% (95% CI=1-20%). There was a poor agreement between the serum ELISA and the fecal tests (kappa=0) on samples collected from adult cows in a high-risk and a low-risk population. Examination of some of these fecal samples using a PCR detection method demonstrated the presence of C. parvum DNA in 10% of the samples.