Predictive Value Alteration of Laboratory Routine and Ferritin/Transferrin Ratio in Monitoring of COVID-19 Patients.

BACKGROUND: Inflammatory processes activated by rapid viral replication of SARS-CoV-2 can play a key role in the pathogenesis of multiple organ damage and be responsible for the COVID-19 patients' dramatic outcomes and common abnormal laboratory findings. The aim of this study was to assess the correlation between various laboratory biomarkers, ferritin/transferrin ratio (FTR) and receiver operating characteristic (ROC) analysis in monitoring COVID-19 patients. METHODS: This observational study was conducted in three groups: healthy participants, non COVID-19 patients with COVID-19-like clinical signs, and COVID-19 patients (severe and non-severe). Biochemical (CRP, ferritin, transferrin and albumin) and hematological (WBC, lymphocytes) parameters were assessed by automated methods. Moreover, FTR and NLR markers were calculated in the three groups mentioned. Statistical analyses were done using R (version 4.1.0). ROC curve was used to validate the predictive value of parameters. RESULTS: The COVID-19 positive group had significantly higher NEU, CRP, ferritin, FTR values, while it's WBC, absolute counts of lymphocytes and albumin were significantly lower compared to the non-COVID-19 patients (p < 0.001). Serum ferritin and FTR level of the severe group was significantly higher than that of the non-severe group (p = 0.006 and (p = 0.011, respectively). The strongest correlation in all subjects showed between lymphocytopenia and increased NEU (r = -0.99, p < 0.001). The AUC values of WBC (0.95), lymphocytes (0.89), NEU (0.88), and NLR (0.88) were higher than CRP (0.64) or Ferritin (0.81). CONCLUSIONS: We recommend using FTR, WBC, and NLR changes as simple, useful, and inexpensive indicators in early detection of COVID-19 patients.

Full-length Sequencing and Genotyping of Hepatitis A Virus among Acute Hepatic Patients in Iran.

BACKGROUND: Given the lack of access to a full-length sequence of hepatitis A virus (HAV) and scarce information about its circulating genotype, sub-type and strain in Iran, two specimens were isolated from two patients with clinical symptoms of acute HAV to determine the full-length sequence of HAV. Following the phylogenetic and molecular study, we determined HAV genotype, sub-genotype, and strain of circulating virus in Iran. METHODS: According to real-time PCR results, 16 pairs of overlapped specific primers were used to determine the full-length sequence of HAV by whole-genome amplification (WGA) and using the Sanger method. Moreover, the results were assessed using Chromas, CLC Genomics Workbench, Mega 6, and RDP software. RESULTS: The full-length genome of HAV was amplified and sequenced with a length of 7,182 nucleotides. According to the obtained sequences, the phylogenetic tree of the mentioned viruses was drawn using MEGA 6 software and 44 full-genome viruses registered in the GenBank worldwide. Afterwards, the same process was repeated based on the protein sequence of VP1-P2A fragment in Iranian samples along with the other 22 registered protein sequences of GenBank to confirm the results of the full-genome phylogenetic tree. CONCLUSIONS: In this study, complete sequencing of two HAV specimens was carried out using the overlapping amplification and Sanger methods. According to the results of the phylogenetic tree, the circulating HAV in Iran had Genotype I and sub-genotype B and strain HM-175. In the present study, the full sequences of HAV of the two specimens were registered with accession numbers of BankIt 2277890/MN746031 and BankIt 2287607/MN746032.

Changes in the Distribution Pattern of Hepatitis C Virus Genotypes Among Chronic Hepatitis Patients: a Cross-Sectional Study.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of liver diseases. It has been determined that HCV genotypes have a distinct geographical distribution, clinical outcome, and response to antiviral therapy. Over the past years, many studies have reported that HCV genotype 1a is the dominant genotype in Ahvaz city. In recent years, changes in the distribution pattern of HCV genotypes of different geographical regions have attracted a great deal of attention; hence, the aim of this study was to accurately evaluate such probable changes in Ahvaz in southwestern Iran. METHODS: This is a cross-sectional study conducted from September 2017 to August 2020, including 262 patients suffering from chronic hepatitis C. HCV-RNA was extracted, and HCV genotyping was performed by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) method. To evaluate the association between HCV genotype, age, gender, and viral load, statistical analyses were done by SPSS software. RESULTS: HCV genotyping was done on 260 patients where genotype 3a had the highest prevalence over the period of 4 years with an average of 48.1%, followed by genotype 1a (46.5%). HCV genotype of two patients was not typeable. Although the difference between the two genotypes is currently small, the main result was finding an increasing trend in the prevalence of genotype 3a in recent years. CONCLUSIONS: The present study showed that the distribution pattern of HCV genotypes is gradually changing among chronic hepatitis C patients in Ahvaz city. The most important cause of such changes could be the alteration in HCV transmission routes and the increase in migration from areas where genotype 3 is dominant.

Listeriolysin O immunogenetic adjuvant enhanced potency of hepatitis C virus NS3 DNA vaccine.

Hepatitis C virus (HCV) is a major health problem all over the world. Among HCV proteins, nonstructural protein 3 (NS3) is one of the most promising target for anti-HCV therapy and a candidate for vaccine design. DNA vaccine is an efficient approach to stimulate antigen-specific immunity but the main problem with that is less immunogenic efficiency in comparison with traditional vaccines. Several approaches have been applied to enhance the immunogenicity of DNA. Recently, bacteria-derived substances are considered as one of the most attractive adjuvants for vaccines, which among them, Listeriolysin O (LLO) of Listeria monocytogenes is a toxin with an extremely immunogenic feature. We investigated detoxified form of LLO gene as genetic adjuvant to modulate NS3 DNA vaccine potency. Immunogenic truncated NS3 gene sequence of HCV (1095-1380aa) and detoxified LLO gene region (5-441aa) were amplified by PCR and cloned into the pcDNA3.1 plasmid separately. The expression of recombinant proteins (pc-NS3, pLLO) was confirmed in HEK293T cell line by western blotting. BALB/c mice models received three doses of different formula of plasmids in two-week intervals and two weeks after the final immunization, the immune responses were evaluated by specific total antibody level, lymphocyte proliferation, cytotoxicity, and cytokine levels assays. To evaluate in vivo cytotoxic activity, tumor challenge was performed. The recombinant plasmids were successfully expressed in mammalian cell line, and coadministration of pc-NS3 with pLLO induced the highest titer of total IgG against NS3 antigen compared with other controls. Determination of IgG subclasses confirmed the efficient increase in mixed responses with Th1 dominancy. Furthermore, significant levels of cytokines (p < .05) and lymphocyte proliferation responses (p < .05) indicated the superiority of this regimen. The findings may have important implication for LLO gene application as genetic adjuvant in immune response against HCV.

Rabies Prophylaxis Strategy in Iran, a Need for an Alternative Strategy: Would the Essen Regimen be Replaced by Zagreb Protocol?

BACKGROUND: Rabies is a fatal zoonotic infectious disease, which can be prevented by prompt post-exposure prophylaxis that could be expensive in countries with a large population. The Essen protocol with injection of 5 single doses of human rabies vaccine on separate days is a well-known rabies prophylaxis schedule. Decreasing the number of vaccine doses and the number of clinical visits due to an effective alternative schedule is strongly needed. The 2-1-1 regimen, known as Zagreb, is one of the best candidates to succeed Essen. METHODS: To evaluate the effectiveness of Zagreb regimen in the Iranian population by using the Purified Vero cell Rabies Vaccine (PVRV), anti-rabies antibody titer was measured in volunteers with second and third exposure through Rapid Fluorescent Focus Inhibition Test (RFFIT) and Enzyme Linked Immunosorbent Assay (ELISA) test and compared with patients, who were treated according to the Essen protocol. RESULTS: In all participants, anti-rabies antibody titer reached the protective level with no suppressive effect of rabies immunoglobulin in patients with third exposure in Zagreb regimen. CONCLUSIONS: Zagreb regimen could be considered a suitable alternative for the Essen protocol.

Design, Synthesis, and Anti-HIV-1 Evaluation of a Novel Series of 1,2,3,4-Tetrahydropyrimidine-5-Carboxylic Acid Derivatives.

A series of tetrahydropyrimidine derivatives (2a - 2l) were designed, synthesized, and screened for anti-HIV-1 properties based on the structures of HIV-1 gp41 binding site inhibitors, NB-2 and NB-64. A computational study was performed to predict the pharmacodynamics, pharmacokinetics, and drug-likeness features of the studied molecules. Docking studies revealed that the carboxylic acid group in the molecules forms salt bridges with either Lys574 or Arg579. Physiochemical properties (e.g., molecular weight, number of hydrogen bond donors, number of hydrogen bond acceptors, and number of rotatable bonds) of the synthesized compounds confirmed and exhibited that these compounds were within the range set by Lipinski's rule of five. Compounds 2e and 2k with 4-chlorophenyl substituent and 4-methylphenyl group at C(4) position of the tetrahydropyrimidine ring was the most potent one among the tested compounds. This suggests that these compounds may serve as leads for development of novel small-molecule HIV-1 inhibitors.

Synthesis, Biological Evaluation, and Molecular Docking Studies of Novel 4-[4-Arylpyridin-1(4H)-yl]benzoic Acid Derivatives as Anti-HIV-1 Agents.

The structural similarities between N1 substituted 1,4-dihydropyridines and the known gp41 inhibitors, NB-2 and NB-64, were considered in the current research for the design of some novel anti-HIV-1 agents. A series of novel 4-[4-arylpyridin-1(4H)-yl]benzoic acid derivatives were synthesized and after a comprehensive structural elucidation were screened for in vitro anti-HIV-1 activity. Most of the tested compounds displayed moderate to good inhibitory activity against HIV-1 growth and were evaluated for in vitro cytotoxic activity using XTT assay at the concentration of 100 µm. Among the tested compounds, 1c, 1d and 1e showed potent anti-HIV-1 activity against P24 expression at 100 µm with inhibition percentage of 84.00%, 76.42% and 80.50%, respectively. All the studied compounds possessed no significant cytotoxicity on MT-2 cell line. The binding modes of these compounds to gp41 binding site were determined through molecular docking study. Docking studies proved 1a as the most potent compound and binding maps exhibited that the activities might be attributed to the electrostatic and hydrophobic interactions and additional H-bonds with the gp41 binding site. The Lipinski's 'rule of five' and drug-likeness criteria were also calculated for the studied compounds. All derivatives obeyed the Lipinski's 'rule of five' and had drug-like features. The findings of this study suggest that novel 4-[4-arylpyridin-1(4H)-yl]benzoic acid might be a promising scaffold for the discovery and development of novel anti-HIV-1 agents.

Antiretroviral drug resistance mutations in naïve and experienced patients in Shiraz, Iran, 2014.

Resistance to antiretroviral agents is a significant concern in the clinical management of HIV-infected individuals, particularly in areas of the world where treatment options are limited. In this study, we aimed to identify HIV drug-resistance-associated mutations in 40 drug-naïve patients and 62 patients under antiretroviral therapy (ART) referred to the Shiraz HIV/AIDS Research Center - the first such data available for the south of Iran. HIV reverse transcriptase and protease genes were amplified and sequenced to determine subtypes and antiretroviral- resistance-associated mutations (RAMs). Subtype CRF35-AD recombinant was the most prevalent in all patients (98 of 102, 96 %), followed by subtype A1, and subtype B (one each, 2 %). Among the 40 ART-naïve patients, two mutations associated with nucleoside reverse transcriptase inhibitor (NRTI) resistance (two with Y115F and T215I) and three associated with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance (two with G190S and Y181C, four with V179T) were found. Among ART-experienced patients, four mutations associated with resistance to NRTI, four with NNRTI, and five with protease inhibitors (PI) were found. Twenty patients with high levels of resistance were already on second-line therapy. We document for the first time in this region of Iran high levels of ART resistance to multiple drugs. Our findings call for more vigilant systematic ART resistance surveillance, increased resistance testing, careful management of patients with existing regimens, and strong advocacy for expansion of available drugs in Iran.

Design, Synthesis, Molecular Modeling and Anti-HIV Assay of Novel Quinazolinone Incorporated Coumarin Derivatives.

BACKGROUND: The emergence of drug-resistant viral strains has created the need for the development of novel anti-HIV agents with a diverse structure that targets key enzymes in the HIV lifecycle. OBJECTIVE: Considering the pharmacophore of integrase inhibitors, one of the validated targets for anti-HIV therapy, we designed a quinazolinone incorporated coumarin scaffold to affect HIV. METHODS: Coumarin is a beta enol ester and also a well-known drug scaffold. Designed structures were prepared using a one-pot three-component reaction from 3-amino-4-hydroxycoumarin, isatoic anhydride and benzaldehyde derivatives. RESULTS: In vitro anti-HIV and cytotoxicity assay indicated that more than half of the compounds had EC50 values lower than 50 µM. Unsubstituted phenyl derivative showed the highest activity and selectivity with an EC50 value of 5 µM and a therapeutic index of 7. Compounds were docked into the integrase active site to investigate the probable mechanism of action. Accordingly, the hydroxyl moiety of coumarin along with the carbonyl of the quinazolinone ring could function as the metal chelating group. Quinazolinone and phenyl groups interact with side chains of IN residues, as well. CONCLUSION: Here, a novel anti-HIV scaffold is represented for further modification and in-vivo studies.

Synthesis, Molecular Modelling and Biological Studies of 3-hydroxypyrane- 4-one and 3-hydroxy-pyridine-4-one Derivatives as HIV-1 Integrase Inhibitors.

BACKGROUND: Despite the progress in the discovery of antiretroviral compounds for treating HIV-1 infection by targeting HIV integrase (IN), a promising and well-known drug target against HIV-1, there is a growing need to increase the armamentarium against HIV, for avoiding the drug resistance issue. OBJECTIVE: To develop novel HIV-1 IN inhibitors, a series of 3-hydroxy-pyrane-4-one (HP) and 3- hydroxy-pyridine-4-one (HPO) derivatives have been rationally designed and synthesized. METHODS: To provide a significant characterization of the novel compounds, in-depth computational analysis was performed using a novel HIV-1 IN/DNA binary 3D-model for investigating the binding mode of the newly conceived molecules in complex with IN. The 3D-model was generated using the proto-type foamy virus (PFV) DNA as a structural template, positioning the viral polydesoxyribonucleic chain into the HIV-1 IN homology model. Moreover, a series of in vitro tests were performed including HIV-1 activity inhibition, HIV-1 IN activity inhibition, HIV-1 IN strand transfer activity inhibition and cellular toxicity. RESULTS: Bioassay results indicated that most of HP analogues including HPa, HPb, HPc, HPd, HPe and HPg, showed favorable inhibitory activities against HIV-1-IN in the low micromolar range. Particularly halogenated derivatives (HPb and HPd) offered the best biological activities in terms of reduced toxicity and optimum inhibitory activities against HIV-1 IN and HIV-1 in cell culture. CONCLUSION: Halogenated derivatives, HPb and HPd, displayed the most promising anti-HIV profile, paving the way to the optimization of the presented scaffolds for developing new effective antiviral agents.

Preparation and Evaluation of a New Lipopolysaccharide-based Conjugate as a Vaccine Candidate for Brucellosis.

OBJECTIVES: Development of an efficacious vaccine against brucellosis has been a challenge for scientists for many years. At present, there is no licensed vaccine against human brucellosis. To overcome this problem, currently, antigenic determinants of Brucella cell wall such as Lipopolysaccharide (LPS) are considered as potential candidates to develop subunit vaccines. METHODS: In this study, Brucella abortus LPS was used for conjugation to Neisseria meningitidis serogroup B outer membrane vesicle (OMV) as carrier protein using carbodiimide and adipic acid-mediated coupling and linking, respectively. Groups of eight BALB/c mice were injected subcutaneously with 10 µg LPS alone, combined LPS + OMV and conjugated LPS-OMV on 0 days, 14 days, 28 days and 42 days. Anti-LPS IgG was measured in serum. RESULTS: The yield of LPS to OMV in LPS-OMV conjugate was 46.55%, on the basis of carbohydrate content. The ratio for LPS to OMV was 4.07. The LPS-OMV conjugate was the most immunogenic compound that stimulated following the first injection with increased IgG titer of ∼5-fold and ∼1.3-fold higher than that produced against LPS and LPS in noncovalent complex to OMV (LPS + OMV), respectively. The highest anti-LPS IgG titer was detected 2 weeks after the third injection (Day 42) of LPS-OMV conjugate. The conjugated compound elicited higher titers of IgG than LPS + OMV, that showed a 100-120-fold rise of anti-LPS IgG in mice. CONCLUSION: These results indicate that our conjugated LPS-OMV can be used as a brucellosis vaccine, but further investigation is required.

Methanobrevibacter smithii archaeosomes-entrapped mzNL4-3 virus-like particles induce specific T helper 1-oriented cellular and humoral responses against HIV-1.

Despite numerous and tremendous achievements in the development and standardization of HIV vaccines, there are still lots of vague concepts in HIV vaccinology. Various approaches have been applied to design an efficient HIV vaccine. Due to their lack of replication ability and expression of native antigens at the same time virus-like particles, such as previously introduced mzNL4-3 HIV-1 VLPs are among the highlighted candidates in this field. On the other part, application of adjuvants is an inseparable strategy in the vaccine development researches. Archaeosomes are liposomal adjuvants with intensifiying features of T helper 1 and cytotoxic T-cells responses. Archaeosomes derived from Methanobrevibacter smithii has been shown to enhance MHC class I-dependent antigen presentation and hence, are to be advantageous in the development of vaccines against viral infections. Herein, we have studied efficiency of mzNL4-3 VLPs entrapped in M. smithii archaeosomes as an HIV-1 vaccine candidate to induce humoral and cellular responses in BALB/c mice. Analysis of total and subtype-specific anti-Env IgG antibody, as well as, cytokine secretion pattern revealed an efficient promotion of anti-HIV specific T helper 1 responses in immunized animals. This finding was evidenced by the significant dominance of IgG2a subtype in the sera and considerable secretion of IFN-γ by specifically induced splenocytes of mice immunized with VLP-containing archaeosomes (VLP+ Archaeosome). In addition, ELISpot assay verified these results and indicated the significantly higher frequency of IFN-γ secreting splenocytes in immunized models. The ratio of IFN-γ to IL-4 spot forming cells (SFCs) in the VLP+ Archaeosome immunized mice was also higher than that of the other groups immunized with either VLP-free archaeosomes or VLPs formulated with complete/incomplete Freund's adjuvants. These results propound M. smithii archaeosomes-entrapped mzNL4-3 VLPs as a promising immunogen which specifically induces and augments T-helper 1 oriented responses against HIV antigens.

Prevalence of transmitted HIV drug resistance in Iran between 2010 and 2011.

OBJECTIVE: Drug-resistant (DR) HIV emerges during combined antiretroviral treatment (cART), creating concern about widespread transmission of DR-HIV as cART is expanded in resource-limited countries. The aim of this study was to determine the predominant HIV-1 subtypes and prevalence of transmitted DR mutations among antiretroviral-naïve patients in Iran. DESIGN: To monitor transmission of DR HIV, a threshold surveillance based on the world health organization (WHO) guidelines was implemented in Iran. METHODS: For this HIVDR threshold surveillance study, blood samples were collected from 50 antiretroviral-naïve HIV-1-infected patients. Antiretroviral-resistant mutations were determined by sequencing HIV-1 protease, reverse transcriptase and integrase regions. The HIV-1 subtype was determined by sequencing the p17 and C2-V5 regions of the gag and env genes, respectively. RESULTS: Phylogenetic analyses of the sequenced regions revealed that 45 (95.7%) of 47 samples that were successfully obtained were CRF35_AD. The remaining two cases were subtype B (2.1%) and CRF01_AE (2.1%). Consistent results were obtained also from Env and Gag sequences. Regarding prevalence of transmitted DR viruses, two cases were found to harbor reverse transcriptase-inhibitor-resistant mutations (4.3%). In addition, although not in the WHO list for surveillance of transmitted mutations, 13 minor protease-inhibitor-resistant mutations listed in the International AIDS Society-USA panel of drug resistance mutations were found. No DR mutations were detected in the integrase region. CONCLUSIONS: Our study clarified that CRF35_AD is the major subtype among HIV-1-infected patients in Iran. According to the WHO categorization method of HIVDR threshold survey, the prevalence of transmitted drug resistant HIV in Iran was estimated as moderate (5-15%).

Lamivudine-PEGylated chitosan: a novel effective nanosized antiretroviral agent.

Due to the fact that a definite treatment for AIDS disease has not been discovered so far, antiretroviral drugs are relatively significant in controlling the disease. In this study, Lamivudine- which is an old and effective anti-AIDS drug- was connected to PEGylated chitosan nanoparticle in order to produce a new and greater version of Lamivudine. First, physicochemical studies such as HNMR, FTIR spectroscopy and CHN analysis were performed to ensure the proper synthesis. Following that, Lamivudine-PEGylated Chitosan (LPC) drug was evaluated in terms of its inhibitory capability in producing HIV virions and its cytotoxicity in different doses. HIV virions were created by transfection of psPAX2, PmzNL4-3 and pMD2.G plasmids into HEK293T cell line. Also, assessment of the P24 amounts of cell supernatant was performed using ELISA method. Among the different doses of LPC drug (0.1, 1, 10 and 100µM), it was found that 0.1µM was the most effective and least toxic dose compared to Lamivudine in the same dose. Results of this study indicate that LPC drug has the ability to inhibit HIV virus replication in a more significant way in comparison to the old drug. Besides, the drug has a low cytotoxicity and is effective with a lower dose.