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Archive for the ‘Infectious Disease & New Antibiotic Targets’ Category

New Treatment for Melanoma Uses a Form of the Herpes Virus

Reporter: Aviva Lev-Ari, PhD, RN

 

 

 

The American Cancer Society estimates that about 74,000 Americans will be diagnosed with melanoma this year and almost 10,000 will die from this deadliest form of skin cancer. Over the past several years, treatment of advanced cases of melanoma has been transformed as new FDA-approved therapies developed by several different companies have come onto the market. An FDA advisory committee recently approved a therapy that takes a totally novel approach that involves injecting a live attenuated virus directly into regionally or distant metastatic melanoma tumors.

 

HSV-1 infections cause cold sores and sometimes genital herpes, although infection with human simplex virus 2 is more often the cause of genital herpes. Researchers have characterized the virulence genes of the virus. Talimogene laherparepvec, sometimes shortened to T-VEC, is made by depleting those virulence genes and inserting sequences that generate GM-CSF. It’s believed that removal of the virulence genes decreases the chances that the virus will infect nerve cells and will instead home in on tumor cells. By delivering GM-CSF, the genetically engineered virus enhances tumor antigen presentation to the immune system and induction of immune system attack on the malignancy.

Encouraging durable response results

 

Talimogene laherparepvec was studied in a randomized, open label phase 3 study to compare the new therapy with GM-CSF injections in subjects with unresectable stage IIIB, IIIC, and IV melanoma. A total of 437 subjects were randomized into the study at 64 study sites. The study was designed to demonstrate an improvement in durable response rate, which was defined as a complete response or partial response maintained for at least six months. Subjects were to receive therapy until Week 24, even if their melanoma was progressing. GM-CSF was used for comparison purposes because at the time that this study was designed, it was also in clinical studies as a treatment for melanoma. It is unclear, though, if GM-CSF by itself has any therapeutic value.

 

To be enrolled in the study, people had to be age 18 or older, have a histologically confirmed malignant melanoma of the stages listed in the previous paragraph, measurable disease of at least 1 cm, injectable disease (either on the surface of the skin or through the use of ultrasound guidance), ECOG performance of 0 or 1, and a life expectancy greater than four months from date of randomization. The study exclusions included active cerebral disease, any bone metastases, history of secondary cancer unless disease-free for at least five years, open herpetic skin lesions, and primary ocular or mucosal melanoma.

Sourced through Scoop.it from: managedcaremag.com

See on Scoop.itCardiovascular Disease: PHARMACO-THERAPY

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Nanotechnology Used for Prevention of Bone Infection

Larry H Bernstein, MD, FCAP, Reporter

http://pharmaceuticalintelligence.com/2013/06/03/lhbern/Nanotechnology_Used_for_Prevention_of_Bone_Infection

source:

Functionalised nanoscale coatings using layer-by-layer assembly for imparting antibacterial properties to polylactide-co-glycolide surfaces

Piergiorgio GentileMaria E. FrongiaMar CardellachCheryl A. Mille

In order to achieve high local biological activity and reduce the risk of side effects of antibiotics in the treatment of periodontal and bone infections, a localised and temporally controlled delivery system is desirable. The aim of this research was to develop a functionalised and resorbable surface to contact soft tissues to improve the antibacterial behaviour during the first week after its implantation in the treatment of periodontal and bone infections. Solvent-cast poly(d,l-lactide-co-glycolide acid) (PLGA) films were aminolysed and then modified by Layer-by-Layer technique to obtain a nano-layered coating using poly(sodium4-styrenesulfonate) (PSS) and poly(allylamine hydrochloride) (PAH) as polyelectrolytes. The water-soluble antibiotic, metronidazole (MET), was incorporated from the ninth layer. Infrared spectroscopy showed that the PSS and PAH absorption bands increased with the layer number. The contact angle values had a regular alternate behaviour from the ninth layer. X-ray Photoelectron Spectroscopy evidenced two distinct peaks, N1s and S2p, indicating PAH and PSS had been introduced. Atomic Force Microscopy showed the presence of polyelectrolytes on the surface with a measured roughness about 10 nm after 20 layers’ deposition. The drug release was monitored by Ultraviolet–visible spectroscopy showing 80% loaded-drug delivery in 14 days. Finally, the biocompatibility was evaluated in vitro with L929 mouse fibroblasts and the antibacterial properties were demonstrated successfully against the keystone periodontal bacteria Porphyromonas gingivalis, which has an influence on implant failure, without compromising in vitro biocompatibility. In this study, PLGA was successfully modified to obtain a localised and temporally controlled drug delivery system, demonstrating the potential value of LbL as a coating technology for the manufacture of medical devices with advanced functional properties.
functionalized coating at nanoscale dimension

functionalized coating at nanoscale dimension

 

 

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Antibody shows promise as treatment for HIV

Aviva Lev-Ari, PhD, RN

 

 

 

 

Treating HIV with an antibody can reduce the levels of the virus in people’s bodies — at least temporarily, scientists report on 8 April in Nature1. The approach, called passive immunization, involves infusing antibodies into a person’s blood. Several trials are under way in humans, and researchers hope that the approach could help to prevent, treat or even cure HIV. The work is a milestone towards those goals, says Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. “This is an early study, but it’s a study with some impressive results,” he says.

 

Researchers tested four different doses of an HIV antibody called 3BNC117 in 29 people in the United States and Germany. Seventeen of the participants had HIV, and 15 of those were not taking antiretroviral (ARV) drugs at the time of the study. One infusion of the highest dose of antibody, given to 8 participants, cut the amount of virus in their blood by between 8 and 250 times for 28 days.

 

But much work remains to determine whether the approach can produce longer-lasting effects and whether it is practical for clinical use. Previous studies have shown that passive immunization can reduce levels of HIV in the blood of monkeys and mice, although the approach has not worked as well in humans2.

 

But the antibodies used in those earlier clinical tests were of an older generation that could not neutralize many different strains of HIV. Researchers have spent much of the past decade trying to find ‘broadly neutralizing’ antibodies that are more widely effective against the virus, and the 3BNC117 antibody belongs to this class.

 

The price of treatment with this approach is also a concern. Antibodies can cost thousands of dollars for each course of treatment, and the majority of people with HIV are in low- and middle-income countries, some of which are already fighting drug companies over the high cost of antibody medicines. “The practicality, utility and efficacy of this approach are hugely open questions,” says Mitchell Warren, executive director of AVAC, a global organization that advocates HIV prevention and is headquartered in New York City.

Source: www.nature.com

See on Scoop.itCardiovascular and vascular imaging

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Imaging the 3D structure of a single virus using the world’s most powerful x-ray free-electron laser

Reporter: Aviva Lev-Ari, PhD, RN

 

 

By measuring a series of diffraction pattern from a virus injected into an XFEL beam, researchers at Stanford’s Linac Coherent Light Source (LCLS) have determined the first three-dimensional structure of a virus, using a mimivirus.

 

X-ray crystallography has solved the vast majority of the structures of proteins and other biomolecules. The success of the method relies on growing large crystals of the molecules, which isn’t possible for all molecules.

 

“Free-electron lasers provide femtosecond X-ray pulses with a peak brilliance ten billion times higher than any previously available X-ray source,” the researchers note in a paper inPhysical Review Letters. “Such a large jump in one physical quantity is very rare, and can have far reaching implications for several areas of science. It has been suggested that such pulses could outrun key damage processes and allow structure determination without the need for crystallization.”

 

The current resolution of the technique (about 100 nanometers) would be sufficient to image important pathogenic viruses like HIV, influenza and herpes, and further improvements may soon allow researchers to tackle the study of single proteins, the scientists say.

 

Mimivirus is one of the largest known viruses. The viral capsid is about 450 nanometers in diameter and is covered by a layer of thin fibres. A 3D structure of the viral capsid exists, but the 3D structure of the inside was previously unknown.

Source: www.kurzweilai.net

See on Scoop.itCardiovascular Disease: PHARMACO-THERAPY

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Bacteria jump between species more easily than previously thought

Reporter: Aviva Lev-Ari, PhD, RN

 

 

A new study suggests that bacteria may be able to jump between host species far easier than was previously thought. Researchers discovered that a single genetic mutation in a strain of bacteria infectious to humans enables it jump species to also become infectious to rabbits. The discovery has major implications for how we assess the risk of bacterial diseases that can pass between humans and animals. It is well known that relatively few mutations are required to support the transmission of viruses — such as influenza — from one species to another. Until now it was thought that the process was likely to be far more complicated for bacteria.

 

Scientists at the universities of CEU Cardenal Herrera (Spain) and Glasgow and Edinburgh (UK) studied a strain of bacteria called Staphylococcus aureus ST121, which is responsible for widespread epidemics of disease in the global rabbit farming industry. The team looked at the genetic make-up of ST121 to work out where the strain originated and the changes that occurred that enabled it to infect rabbits. They found that ST121 most likely evolved through a host jump from humans to rabbits around 40 years ago with a genetic mutation at a single site in the bacterial DNA code the cause for this.

 

The discovery transforms our understanding of the minimal genetic changes that are required for bacteria to infect different species. ST121 is found in the respiratory tract and on the skin of some people. While it is usually harmless, the bacteria can cause a variety of conditions from minor skin infections to meningitis and sepsis. In rabbits, the bacteria can cause serious skin infections.

Source: www.sciencedaily.com

See on Scoop.itCardiovascular Disease: PHARMACO-THERAPY

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Researchers discover RNA viral “Enigma machine”

Reporter: Aviva Lev-Ari, PhD, RN

 

 

Researchers discover RNA viral “Enigma machine”Researchers discover RNA viral “Enigma machine”Researchers discover RNA viral “Enigma machine”

Researchers have cracked a code that governs infections by a major group of viruses including the common cold and polio. Until now, scientists had not noticed the code, which had been hidden in plain sight in the sequence of the ribonucleic acid (RNA) that makes up this type of viral genome. But a paper published in the Proceedings of the National Academy of Sciences (PNAS) Early Edition by a group from the University of Leeds and University of York unlocks its meaning and demonstrates that jamming the code can disrupt virus assembly. Stopping a virus assembling can stop it functioning and therefore prevent disease.

 

Single-stranded RNA viruses are the simplest type of virus and were probably one of the earliest to evolve. However, they are still among the most potent and damaging of infectious pathogens. Rhinovirus (which causes the common cold) accounts for more infections every year than all other infectious agents put together (about 1 billion cases), while emergent infections such as chikungunya and tick-borne encephalitis are from the same ancient family. Other single-stranded RNA viruses include the hepatitis C virus, HIV and the winter vomiting bug norovirus.

 

This breakthrough was the result of three stages of research:

In 2012, researchers at the University of Leeds published the first observations at a single-molecule level of how the core of a single-stranded RNA virus packs itself into its outer shell—a remarkable process because the core must first be correctly folded to fit into the protective viral protein coat. The viruses solve this fiendish problem in milliseconds. The next challenge for researchers was to find out how the viruses did this.University of York mathematicians Dr Eric Dykeman and Professor Reidun Twarock, working with the Leeds group, then devised mathematical algorithms to crack the code governing the process and built computer-based models of the coding system.In this latest study, the two groups have unlocked the code. The group used single-molecule fluorescence spectroscopy to watch the codes being used by the satellite tobacco necrosis virus, a single stranded RNA plant virus.

 

Dr Roman Tuma, Reader in Biophysics at the University of Leeds, said: “We have understood for decades that the RNA carries the genetic messages that create viral proteins, but we didn’t know that, hidden within the stream of letters we use to denote the genetic information, is a second code governing virus assembly. It is like finding a secret message within an ordinary news report and then being able to crack the whole coding system behind it.

 

“This paper goes further: it also demonstrates that we could design molecules to interfere with the code, making it uninterpretable and effectively stopping the virus in its tracks.”

 

Reference: N. Patel et al. ‘Revealing the density of encoded functions in a viral RNA,’ PNAS (2014) is available to download (www.pnas.org/cgi/doi/10.1073/pnas.1420812112; DOI 10.1073/ pnas.1420812112).

Source: www.leeds.ac.uk

See on Scoop.itCardiovascular Disease: PHARMACO-THERAPY

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Viruses, Vaccines and Immunotherapy

Writer and Curator: Larry H. Bernstein, MD, FCAP

This discussion is exclusively concerned with viruses, the infectious particles of coated DNA or RNA, that have been a major cause of epidemics.  There will be a presentation of mechanisms of disease and disease resistance, and of diagnosis and treatment.  The preventive treatment of viral disease has a long history that began with the discovery by Edward Jenner (1772) that the milkmaids did not get “smallpox”, but were protected by a history of “cowpox”, which led to the vaccine (1796). Jenner’s work is widely regarded as the foundation of immunology.  Rabies may be the oldest infectious disease known to man.  Louis Pasteur created the first vaccine in 1885.
Today we appreciate the advances in vaccination as a matter of public health with – measles, mumps, rubella, and the astounding work on polio. The making of a vaccine for influenza has been an evolutionary struggle.

Edward Jenner

Edward Jenner

For many centuries, smallpox devastated mankind.  It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 BC, survivors of smallpox were called upon to nurse the afflicted. Interestingly, reminiscent of Florence Nightingale, Dr. Sydenham (1624–1689) treated his patients by allowing no fire in the room, leaving the windows permanently open.  Prior to vaccination, innoculation or variolation was used by subcutaneous insertion by a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox. This method was introduced by Circassian traders (to immunize the Sultan’s Harem as children)  in the Ottoman Turkish Empire in 1670 .

The earliest evidence of skin lesions resembling those of smallpox is found on faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570–1085 bc). The first stages of the decline of the Roman Empire (ad 108) coincided with a large-scale epidemic: the plague of Antonine, which accounted for the deaths of almost 7 million people. The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the disease. With the rapid pace of vaccine development in recent decades, the historic origins of immunization are often forgotten.

Unknown in the New World, smallpox was introduced by the Spanish and Portuguese conquistadors. The disease decimated the local population and was instrumental in the fall of the empires of the Aztecs and the Incas. Similarly, on the eastern coast of North America, the disease was introduced by the early settlers and led to a decline in the native population. The devastating effects of smallpox also gave rise to one of the first examples of biological warfare. During the French-Indian War (1754–1767), Sir Jeffrey Amherst, the commander of the British forces in North America, suggested the deliberate use of smallpox to diminish the American Indian population hostile to the British. Another factor contributing to smallpox in the Americas was the slave trade because many slaves came from regions in Africa where smallpox was endemic. Since the attack on the World Trade Center on September 11, 2001, the threat of biological warfare and bioterrorism has reemerged. Smallpox has been identified as a possible agent of bioterrorism.
(Google sources)

Hepatitis C/B

Virus-host interactomics: new insights and opportunities for antiviral
drug discovery
B de Chassey, L Meyniel-Schicklin, J Vonderscher1, P André and V Lotteau
de Chassey et al. Genome Medicine 2014, 6:115
http://genomemedicine.com/content/6/11/115

The current therapeutic arsenal against viral infections remains limited,
with often poor efficacy and incomplete coverage, and appears inadequate
to face the emergence of drug resistance. Our understanding of viral biology
and pathophysiology and our ability to develop a more effective antiviral
arsenal would greatly benefit from a more comprehensive picture of the
events that lead to viral replication and associated symptoms. Towards this
goal, the construction of virus-host interactomes is instrumental, mainly
relying on the assumption that a viral infection at the cellular level can be
viewed as a number of perturbations introduced into the host protein network
when viral proteins make new connections and disrupt existing ones. Here,
we review advances in interactomic approaches for viral infections, focusing
on high-throughput screening (HTS) technologies and on the generation of
high-quality datasets. We show how these are already beginning to offer
intriguing perspectives in terms of virus-host cell biology and the control of
cellular functions, and we conclude by offering a summary of the current
situation regarding the potential development of host-oriented antiviral
therapeutics.

Innate and adaptive immune responses in HCV infections
Markus H. Heim, Robert Thimme
Journal of Hepatology Update: Hepatitis C
J Hepatol 2014; 61: j S14–S25.

Hepatitis C virus has been identified a quarter of a decade ago as a
leading cause of chronic viral hepatitis that can lead to cirrhosis
and hepatocellular carcinoma. Only a minority of patients can
clear the virus spontaneously during acute infection. Elimination
of HCV during acute infection correlates with a rapid induction of
innate, especially interferon (IFN) induced genes, and a delayed
induction of adaptive immune responses. However, the majority
of patients is unable to clear the virus and develops viral persistence
in face of an ongoing innate and adaptive immune
response. The virus has developed several strategies to escape
these immune responses. For example, to escape innate
immunity, the HCV NS3/4A protease can efficiently cleave and
inactivate two important signalling molecules in the sensory
pathways that react to HCV pathogen-associated molecular patterns
(PAMPs) to induce IFNs, i.e., the mitochondrial anti-viral
signalling protein (MAVS) and the Toll-IL-1 receptor-domaincontaining
adaptor-inducing IFN-b (TRIF). Despite these escape
mechanisms, IFN-stimulated genes (ISGs) are induced in a large
proportion of patients with chronic infection. Of note, chronically
HCV infected patients with constitutive IFN-stimulated gene
(ISG) expression have a poor response to treatment with pegylated
IFN-a (PegIFN-a) and ribavirin. The mechanisms that protect
HCV from IFN-mediated innate immune reactions are not entirely
understood, but might involve blockade of ISG protein translation
at the ribosome, localization of viral replication to cell compartments
that are not accessible to anti-viral IFN-stimulated effector
systems, or direct antagonism of effector systems by viral
proteins. Escape from adaptive immune responses can be
achieved by emergence of viral escape mutations that avoid recognition
by antibodies and T cells. In addition, chronic infection is
characterized by the presence of functionally and phenotypically
altered NK and T cell responses that are unable to clear the virus
but most likely contribute to the ongoing liver disease. In this
review, we will summarize current knowledge about the role of
innate and adaptive immune responses in determining the outcome
of HCV infection.

Host-virus interactions in acute hepatitis C
Key Points
• Hepatitis C virus (HCV) has a very high replicative
capacity. Within days after infection, viral titres of
>106 IU/ml can be measured in the serum
• The innate immune system reacts to HCV infections
with the induction of interferon (IFN)-stimulated genes
in the liver. This initial type I and/or type III IFN driven
response controls viral replication to some extent, but
can not eliminate HCV completely
• 4-8 weeks after infection, HCV specific T cells are
recruited to the liver. HCV replication is inhibited by
noncytolytic (IFN-γ mediated) and cytolytic mechanisms.
In about 30% of patients, the immune reaction during
acute hepatitis C is strong enough to eliminate HCV
infection.
• In the acute phase of the infection, HCV is highly
vulnerable to therapy with recombinant IFN-α. Over
90% of patients can be cured with IFN-α monotherapy

Severity of Hepatitis C Virus (Genotype-3) Infection Positively
Correlates with Circulating MicroRNA-122 in Patients Sera
S Kumar, YK Chawla, S Ghosh, and A Chakraborti
Disease Markers 2014; Article ID 435476, 6 pages
http://dx.doi.org/10.1155/2014/435476

Introduction. Hepatitis C virus (genotype-3) causes acute and
chronic hepatitis infection predomination in India. The infectious
phase of the virus requires various host factors for its survival
and subsequent viral particle production. Small RNA molecules like
microRNA-122 (miR-122) are one such factormostly present in the
liver and play a supportive role in viral replication. Objective. In
this study, diagnostic potential of miR-122 is evaluated in the sera
of chronic hepatitis C patients. Methods. miRNAs were isolated
fromthe sera samples of patients as well as controls and miR-122
expression was quantified by real-time PCR. Results. A significant
augmentation was observed in the level of circulating miR-122
(median level, 0.66 versus 0.29, p = 0.001) in patients compared to
controls with ROC value of 0.929 ± 0.034 (p < 0.001). Interestingly,
miR-122 level also depicted a significant positive correlation
with serum ALT (p = 0.53), AST (p = 0.44), and viral load
(p = 0.52). Conclusion. The study thus unveiled the role of miR-122 as a
plausible diagnostic biomarker during HCV genotype-3 infection in India.

MicroRNA Expression Profiling in PBMCs: A Potential Diagnostic
Biomarker of Chronic Hepatitis C
Chiu-Chun Chang, Chun-Che Lin, Wan-Ling Hsieh, Hsin-Wu Lai, et al.
Disease Markers 2014; Article ID 367157, 9 pages
http://dx.doi.org/10.1155/2014/367157

The expression levels of miR-16, miR-193b, miR-199a, miR-222, and
miR-324 in PBMCs were significantly higher in CHC patients
compared with healthy controls and significantly different between
CHC patients withHCV genotype 1 (GT-1) and non-genotype-1
(non-GT-1).Multivariate logistic regression analysis also showed
that patients with high expression levels of the six target miRNAs
had an approximately 7.202-fold risk of CHC compared with those
with low expression levels of the target miRNAs.We concluded
that the expression levels of miR-16, miR-193b, miR-199a, miR-222,
and miR-324 target miRNAs in PBMCs of CHC may act as
significant risk biomarkers for the development of CHC.

Neutrophil-to-Lymphocyte Ratio as a Predictor of Response to
Peginterferon plus Ribavirin Therapy for Chronic Hepatitis C
Ming-Te Kuo, Tsung-Hui Hu, Sheng-Nan Lu, CH Hung, Jing-Houng Wang, et al.
Disease Markers 2014; Article ID 462958, 6 pages
http://dx.doi.org/10.1155/2014/462958

We aimed to determine whether neutrophil-to-lymphocyte ratio (NLR)
could be a predictor of antiviral response in chronic hepatitis C patients.
A total of 602 consecutive patients (genotype 1, n = 263; genotype 2,
n = 297; others/unknown, n = 42) receiving response-guided
therapy with peginterferon plus ribavirin were recruited. NLR was
related to clinical and virological features and to treatment outcome.
Rapid virological response (RVR) and sustained virological response
(SVR) were achieved in 436 (73%) and 458 (76%) of the patients,
respectively. Higher NLR ( ≥1.42) was found to be associated with
higher prevalence of DM (p = 0.039) and higher hepatitis C viral
load (p = 0.002) and white cell count (p < 0.001). NLR was
significantly lower in patients with RVR and SVR compared
to those without (𝑃 = 0.032 and 0.034, resp.). However, NLR
was not an independent factor by multivariate analysis. In the
subgroup analysis, higher NLR (≥1.42) (odds ratio, 0.494,
p = 0.038) was an independent poor predictor of SVR in
genotype 2 patients but was not in genotype 1 patients. In
conclusion, NLR is a simple and easily accessible marker to
predict response to peginterferon plus ribavirin therapy
for chronic hepatitis C genotype 2.

Therapy of Hepatitis C — Back to the Future
T. Jake Liang and Marc G. Ghany
N Engl J Med  http://nejm.org

The results of several phase 3 studies of interferon-free combination
regimens of DAAs reported in the Journal now2-4 and recently5-9
unequivocally show the superiority of two regimens over the standard-
of-care treatment (a combination of peginterferon, ribavirin, and
a protease inhibitor) for HCV genotype 1 infection. A previous editorial
in the Journal highlighted the significantly improved response rates
(rates of sustained virologic response of 93% to 99%) with a
coformulated regimen of sofosbuvir (a nucleotide NS5B inhibitor)
and ledipasvir (an NS5A inhibitor) among patients with HCV genotype
1 infection, as compared with the rates with the previously approved
interferon-based single-DAA combination therapy.

Sofosbuvir and Ribavirin in HCV Genotypes 2 and 3
S Zeuzem, GM Dusheiko, R Salupere, et al.
N Eng J Med May 2014  http://dx.doi.org:/10.1056/NEJMoa1316145

Background
In clinical trials, treatment with a combination of the nucleotide
polymerase inhibitor sofosbuvir and the antiviral drug ribavirin was
associated with high response rates among patients with hepatitis C
virus (HCV) genotype 2 infection, with lower response rates among
patients with HCV genotype 3 infection.
Methods
We conducted a study involving patients with HCV genotype 2 or 3
infection, some of whom had undergone previous treatment with
an interferon-based regimen. We randomly assigned 91 patients with
HCV genotype 2 infection and 328 with HCV genotype 3 infection, in
a 4:1 ratio, to receive sofosbuvir–ribavirin or placebo for 12 weeks.
On the basis of emerging data from phase 3 trials indicating that
patients with HCV genotype 3 infection had higher response rates
when they were treated for 16 weeks, as compared with 12 weeks,
the study was unblinded, treatment for all patients with genotype 3
infection was extended to 24 weeks, the placebo group was terminated,
and the goals of the study were redefined to be descriptive and not
include hypothesis testing. The primary end point was a sustained
virologic response at 12 weeks after the end of therapy.
Results
Of the 419 patients who were enrolled and treated, 21% had cirrhosis
and 58% had received previous interferon-based treatment. The criterion
for a sustained virologic response was met in 68 of 73 patients (93%; 95%
confidence interval [CI], 85 to 98) with HCV genotype 2 infection who
were treated for 12 weeks and in 213 of 250 patients (85%; 95% CI, 80 to 89)
with HCV genotype 3 infection who were treated for 24 weeks. Among
patients with HCV genotype 3 infection, response rates were 91%
and 68% among those without and those with cirrhosis, respectively.
The most common adverse events were headache, fatigue, and pruritus.
Conclusions
Therapy with sofosbuvir–ribavirin for 12 weeks in patients with HCV
genotype 2 infection and for 24 weeks in patients with HCV genotype 3
infection resulted in high rates of sustained virologic response. (Funded
by Gilead Sciences; VALENCE ClinicalTrials.gov number, NCT01682720.)

New developments in the management of hepatitis C virus infection:
focus on boceprevir
Marina Berenguer, F Xavier López-Labrador
Biologics: Targets and Therapy 2012:6 249–256
http://dx.doi.org/10.2147/BTT.S24413

Chronic hepatitis C virus infection is an important public health problem,
and the standard treatment (combination of pegylated interferon-α and
ribavirin) has an effectiveness rate of only 40%–50%. Novel virus-specific
drugs have recently been designed, and multiple compounds are under
development. The approval for the clinical use of direct-acting antivirals
in 2011 (boceprevir [BOC] and telaprevir, viral NS3 protease inhibitors)
has increased recovery rates by up to 70%. Therefore, a highly effective
treatment has been envisioned for the first time. This paper focuses on
BOC and the implementation of new BOC-based treatment regimes.

ABT-450/r–Ombitasvir and Dasabuvir with or without Ribavirin for HCV
P Ferenci, D Bernstein, J Lalezari, D Cohen, Y Luo, C Cooper, et al.
N Engl J Med May 4, 2014. http://dx.doi.org:/10.1056/NEJMoa1402338

Background
The interferon-free regimen of ABT-450 with ritonavir (ABT-450/r),
ombitasvir, and dasabuvir with or without ribavirin has shown efficacy
in inducing a sustained virologic response in a phase 2 study involving
patients with hepatitis C virus (HCV) genotype 1 infection. We conducted
two phase 3 trials to examine the efficacy and safety of this regimen in
previously untreated patients with HCV genotype 1 infection and no cirrhosis.
Methods
We randomly assigned 419 patients with HCV genotype 1b infection
(PEARL-III study) and 305 patients with genotype 1a infection (PEARL-IV
study) to 12 weeks of ABT-450/r–ombitasvir (at a once-daily dose of
150 mg of ABT-450, 100 mg of ritonavir, and 25 mg of ombitasvir), dasabuvir
(250 mg twice daily), and ribavirin administered according to body weight
or to matching placebo for ribavirin. The primary efficacy end point was a
sustained virologic response (an HCV RNA level of <25 IU per milliliter)
12 weeks after the end of treatment.
Results
The study regimen resulted in high rates of sustained virologic response
among patients with HCV genotype 1b infection (99.5% with ribavirin
and 99.0% without ribavirin) and among those with genotype 1a infection
(97.0% and 90.2%, respectively). Of patients with genotype 1b infection,
1 had virologic failure, and 2 did not have data available at post-treatment
week 12. Among patients with genotype 1a infection, the rate of virologic
failure was higher in the ribavirin-free group than in the ribavirin
group (7.8% vs. 2.0%). In both studies, decreases in the hemoglobin
level were significantly more common in patients receiving ribavirin.
Two patients (0.3%) discontinued the study drugs owing to adverse events.
The most common adverse events were fatigue, headache, and nausea.
Conclusions
Twelve weeks of treatment with ABT-450/r–ombitasvir and dasabuvir
without ribavirin was associated with high rates of sustained virologic
response among previously untreated patients with HCV genotype 1
infection. Rates of virologic failure were higher without ribavirin than
with ribavirin among patients with genotype 1a infection but not among
those with genotype 1b infection. (Funded by AbbVie; PEARL-III and
PEARL-IV ClinicalTrials.gov numbers, NCT01767116 and NCT01833533.)

Individualized treatment of chronic hepatitis C with pegylated interferon
and ribavirin
Roberto J Carvalho-Filho and Olav Dalgard
Pharmacogenomics and Personalized Medicine 2010:3 1–13

Chronic infection with hepatitis C virus (HCV) is a major public health
problem, with perhaps 180 million people infected worldwide. A significant
proportion of these will eventually develop clinical complications, such as
cirrhosis, liver decompensation and hepatocellular carcinoma. Sustained
virological response (SVR) to antiviral therapy is associated with
improvement in liver histology and survival free of liver-related complications.
Great effort has been made to improve SVR rate by adapting the duration
of therapy according to HCV genotype and to on-treatment response. Rapid
virological response (RVR, undetectable HCV RNA at week 4) usually has
a high positive predictive value for achieving SVR and early virological
response (EVR, > 2 log reduction or undetectable HCV RNA at week 12)
exhibits a high negative predictive value for non-response. Individualized
approach can improve cost-effectiveness of HCV antiviral therapy by
reducing side effects and the costs of therapy associated with unnecessary
exposure to treatment and through extending therapy for those with
unfavorable features. This article summarizes recent data on strategies
of individualized treatment in naïve patients with mono-infection by
the different HCV genotypes. The management of common side effects,
the impact of HCV infection on health-related quality of life and the
potential applications of host genomics in HCV therapy are briefly discussed.

Simeprevir for the treatment of hepatitis C virus infection
L Izquierdo, F Helle, C François, S Castelain, G Duverlie, E Brochot
Pharmacogenomics and Personalized Medicine 2014:7 241–249
http://dx.doi.org/10.2147/PGPM.S52715

Simeprevir (TMC435, Olysio™), a second-generation hepatitis C virus
(HCV) protease inhibitor, has been recently approved for the treatment
of genotype 1 chronic hepatitis C in combination with pegylated interferon
and ribavirin. This molecule has very different characteristics from first-
generation protease inhibitors. Results from trials show that simeprevir
is highly effective and safe, with few adverse events. We discuss the
specific features of this new treatment option for HCV infection, in terms
of in vitro data, pharmacological data, and clinical trials. We also discuss
the impact of Q80K polymorphism at baseline. Studies evaluating interferon-
free regimens with simeprevir are ongoing. Future combinations of two or
more direct-acting antiviral agents, targeting different viral enzymes and
with synergistic antiviral effects, will be approved, allowing treatment of
pan-genotypic HCV with optimized sustained virologic responses. Simeprevir
will undoubtedly be part of future treatment strategies.

Boceprevir and personalized medicine in hepatitis C virus infection
F Habersetzer, C Leboeuf, M Doffoël, TF Baumert
Pharmacogenomics and Personalized Medicine 2012:5 125–137
http://dx.doi.org/10.2147/PGPM.S24259

Boceprevir was the first agent, along with telaprevir, of a novel class of
direct-acting antivirals that entered clinical practice for the treatment
of chronic hepatitis C. Boceprevir is an antiprotease that directly blocks
hepatitis C virus (HCV) replication. Two studies in patients with HCV
genotype 1 infection have shown that addition of boceprevir to the
standard of care, ie, pegylated interferon-alfa (PEG-IFN-α) and ribavirin,
markedly increased the rate of sustained virological response. A sustained
virological response was obtained in about 70% of patients who had never
been treated, as well as in 69%–75% and 40% of previous relapsers and
nonresponders to PEG-IFN-α-ribavirin, respectively. Side effects were
observed in almost all treated patients. Anemia, the most frequent adverse
event related to administration of boceprevir, occurred in about 50% of
patients. The decision to add boceprevir to the standard of care is made
on an individual basis, and takes into account the prognosis of the liver
disease, the efficacy of therapy, as it could be at best predicted, and the
side effects that may arise, taking into account the comorbidities of the
patient. Ultimately, the treatment must be accepted by the patient, who
should fully understand the benefits and risks. Boceprevir trials were
designed with the concept of individualized and response-guided therapy
which establishes treatment decisions on how rapidly patients respond
to treatment. Individualized therapy for chronic hepatitis C is based on
patient and viral characteristics to make the best choice about whether a
person will benefit from therapy and to evaluate on-treatment predictors
of response to shorten therapy in patients with a rapid response as well as
in patients who did not respond sufficiently to expect HCV eradication.
This review focuses on the main results obtained so far, their impact on
the treatment of patients with chronic hepatitis C, and potential
therapeutic perspectives.

Ribavirin at the Era of Novel Direct Antiviral Agents for the Treatment
of Hepatitis C Virus Infection: Relevance of Pharmacological Monitoring
P Pradat, V Virlogeux, Marie-Claude Gagnieu, F Zoulim, and F Bailly
Adv Hepatol 2014, Article ID 493087, 13 pages
http://dx.doi.org/10.1155/2014/493087

Ribavirin is often used for the treatment of hepatitis C virus (HCV)
infection. Although its mechanisms of action remain to be clearly
elucidated, ribavirin plays a beneficial role for achieving virological
response and decreasing the rate of virological relapse after
treatment cessation. However, ribavirin may induce side effects
leading to early treatment discontinuation. Among them,
hemolytic anemia is the most frequent and results from
intraerythrocyte accumulation. Pharmacological studies have
shown that early ribavirin exposure assessed by the area under
the curve (AUC) at day 0 and ribavirin trough concentration
during the first three months of therapy were correlated with
sustained virological response (SVR). These studies highlighted
the relevance of ribavirin pharmacologic monitoring and early
dose adaptation during therapy. Although the role of ribavirin
within new direct acting antiviral (DAA) combinations will
probably decrease in the future, its potential benefit in difficult-
to-treat patients such as patients with severe hepatopathy or
patients who failed triple therapy including patients with
multiresistance will need to be further investigated.

Clinical utility of pharmacogenomics in the management
of hepatitis C
J Trinks, ML Hulaniuk, MA Redal, D Flichman
Pharmacogenomics and Personalized Medicine 2014:7 339–347
http://dx.doi.org/10.2147/PGPM.S52624

Hepatitis C virus (HCV) was identified for the first time more than
20 years ago. Since then, several studies have highlighted the
complicated aspects of this viral infection in relation to its worldwide
prevalence, its clinical presentation, and its therapeutic response.
Recently, two landmark scientific breakthroughs have moved us
closer to the successful eradication of chronic HCV infection. First,
response rates in treatment-naïve patients and in prior non-responders
to pegylated-interferon-α and ribavirin therapy are increasing as a direct
consequence of the development of direct-acting antiviral drugs. Secondly,
the discovery of single-nucleotide polymorphisms near the interleukin
28B gene significantly related to spontaneous and treatment-induced
HCV clearance represents a milestone in the HCV therapeutic landscape.
The implementation of this pharmacogenomics finding as a routine test
for HCV-infected patients has enhanced our understanding of viral
pathogenesis, has encouraged the design of ground-breaking antiviral
treatment regimens, and has become useful for pretreatment decision
making. Nowadays, interleukin 28B genotyping is considered to be a
key diagnostic tool for the management of HCV-infected patients and
will maintain its significance for new combination treatment schemes
using direct-acting antiviral agents and even in interferon-free regimens.
Such pharmacogenomics insights represent a challenge to clinicians,
researchers, and health administrators to transform this information
into knowledge with the aim of elaborating safer and more effective
therapeutic strategies specifically designed for each patient. In conclusion,
the individualization of treatment regimens for patients with hepatitis C,
that may lead to a universal cure in future years, is becoming a reality
due to recent developments in biomarker and genomic medicine.
In light of these advances, we review the scientific evidence and clinical
implications of recent findings related to host genetic factors in the
management of HCV infection.

Hepatitis B virus and Homo sapiens proteome-wide analysis: A
profusion of viral peptide overlaps in neuron-specific human proteins
Rosalia Ricco and Darja Kanduc
Biologics: Targets & Therapy 2010:4 75–81

The primary amino acid sequence of the hepatitis B virus (HBV)
proteome was searched for identity spots in the human proteome
by using the Protein Information Resource database. We find that
the HBV polyprotein shares sixty-five heptapeptides, one octapeptide,
and one nonapeptide with the human proteins. The viral matches
are disseminated among fundamental human proteins such as
adhesion molecules, leukocyte differentiation antigens, enzymes,
proteins associated with spermatogenesis, and transcription factors.
As a datum of special interest, a number of peptide motifs are shared
between the virus- and brain-specific antigens involved in neuronal
protection. This study may help to evaluate the potential cross
reactions and side effects of HBV antigen-based vaccines.

Dual effects of interleukin-18: inhibiting hepatitis B virus replication
in HepG2.2.15 cells and promoting hepatoma cells metastasis
Y Zhang, Y Li, Y Ma, S Liu, Y She, P Zhao, M Jing, et al.
Am J Physiol Gastrointest Liver Physiol 301: G565–G573, 2011
http://dx.doi.org:/10.1152/ajpglp.00058.2011

Interleukin-18 (IL-18) has been reported to inhibit hepatitis B
virus (HBV) replication in the liver of HBV transgenic mice;
however, the molecular mechanism of its antiviral effect has not
been fully understood. In the present study, it was shown that
IL-18 and its receptors (IL-18R) were constitutively expressed
in hepatoma cell lines HepG2 and HepG2.2.15 as well as
normal liver cell line HL-7702. We demonstrated that IL-18
directly inhibited HBV replication in HepG2.2.15 cells via
downregulating the activities of HBV core and X gene promoters.
The suppressed HBV replication by IL-18 could be rescued by
the administration of BAY11-7082, an inhibitor of transcription
factor NF-B. On the other hand, it was of interest that IL-18
promoted HepG2 cell metastasis and migration dose dependently
in both wound-healing assays and Transwell assays. The underlying
mechanism could be partially attributable to the increased activities
of extracellular matrix metalloproteinase (MMP)-9, MMP-3, and
MMP-2 by IL-18, which upregulated the mRNA levels of MMP-3
and MMP-9 in a NF-B-dependent manner. Furthermore, it was
confirmed that expression of IL-18/IL-18R and most MMPs were
remarkably upregulated in hepatocellular carcinoma (HCC) liver
cancer tissue specimens, suggesting that IL-18/IL-18R-triggered
signaling pathway was closely related to HCC metastasis
in vivo. Therefore, we revealed the dual effects of IL-18 in
human hepatocytes: it not only inhibited HBV replication but
also promoted hepatoma cells metastasis and migration. NF-B
played a critical role in both effects. Our work contributed to a
deeper understanding of the biological function of IL-18 in
human hepatocytes.

HIV

The export receptor Crm1 forms a dimer to promote nuclear
export of HIV RNA
David S Booth, Yifan Cheng, Alan D Frankel
eLife 2014;3:e04121 http://dx.doi.org:/10.7554/eLife.04121

The HIV Rev protein routes viral RNAs containing the Rev Response
Element (RRE) through the Crm1 nuclear export pathway to the
cytoplasm where viral proteins are expressed and genomic RNA is
delivered to assembling virions. The RRE assembles a Rev oligomer
that displays nuclear export sequences (NESs) for recognition by
the Crm1-RanGTP nuclear receptor complex. Here we provide the
first view of an assembled HIV-host nuclear export complex using
single particle electron microscopy. Unexpectedly, Crm1 forms a
dimer with an extensive interface that enhances association with
Rev-RRE and poises NES binding sites to interact with a Rev oligomer.
The interface between Crm1 monomers explains differences between
Crm1 orthologs that alter nuclear export and determine cellular tropism
for viral replication. The arrangement of the export complex identifies
a novel binding surface to possibly target an HIV inhibitor and may point
to a broader role for Crm1 dimerization in regulating host gene expression.

RNA-directed remodeling of the HIV-1 Rev protein orchestrates assembly
of the Rev-Rev response element complex
B Jayaraman, DC Crosby, C Homer, I Ribeiro, D Mavor, AD Frankel
eLife 2014; http://dx.doi.org/10.7554/eLife.04120

The HIV-1 protein Rev controls a critical step in viral replication by
mediating the nuclear export of unspliced and singly-spliced viral
mRNAs. Multiple Rev subunits assemble on the Rev Response Element
(RRE), a structured region present in these RNAs, and direct their
export through the Crm1 pathway. Rev-RRE assembly occurs via
several Rev oligomerization and RNA-binding steps, but how these
steps are coordinated to form an export-competent complex is unclear.
Here, we report the first crystal structure of a Rev dimer-RRE complex,
revealing a dramatic rearrangement of the Rev-dimer upon RRE binding
through re-packing of its hydrophobic protein-protein interface. Rev-RNA
recognition relies on sequence-specific contacts at the well-characterized
IIB site and local RNA architecture at the second site. The structure
supports a model in which the RRE utilizes the inherent plasticity of
Rev subunit interfaces to guide the formation of a functional complex.

HIV-1 envelope glycoprotein structure
Alan Merk and Sriram Subramaniam
Curr Opin Struct Biol. 2013 April ; 23(2): 268–276.
http://dx.doi.org:/10.1016/j.sbi.2013.03.007

The trimeric envelope glycoprotein of HIV-1, composed of gp120 and
gp41 subunits, remains a major target for vaccine development. The
structures of the core regions of monomeric gp120 and gp41 have
been determined previously by X-ray crystallography. New insights
into the structure of trimeric HIV-1 envelope glycoproteins are now
coming from cryo-electron tomographic studies of the gp120/gp41
trimer as displayed on intact viruses and from cryo-electron microscopic
studies of purified, soluble versions of the ectodomain of the trimer.
Here, we review recent developments in these fields as they relate to
our understanding of the structure and function of HIV-1 envelope
glycoproteins.

The QSAR and docking calculations of fullerene derivatives as HIV-1
protease inhibitors
Noha A. Saleh
Spectrochim Acta Part A: Molec and Biomol Spectrosc 2015; 136: 1523–1529
http://dx.doi.org/10.1016/j.saa.2014.10.045

The inhibition of HIV-1 protease is considered as one of the most
important targets for drug design and the deactivation of HIV-1.
In the present work, the fullerene surface (C60) is modified by
adding oxygen atoms as well as hydroxymethylcarbonyl (HMC)
groups to form 6 investigated fullerene derivative compounds.
These compounds have one, two, three, four or five O atoms +
HMC groups at different positions on phenyl ring. The effect of
the repeating of these groups on the ability of suggested compounds
to inhibit the HIV protease is studied by calculating both Quantitative
Structure Activity Relationship (QSAR) properties and docking simulation.
Based on the QSAR descriptors, the solubility and the hydrophilicity
of studied fullerene derivatives increased with increasing the number
of oxygen atoms + HMC groups in the compound. While docking
calculations indicate that, the compound with two oxygen atoms +
HMC groups could interact and binds with HIV-1 protease active site.
This is could be attributed to the active site residues of HIV-1 protease
are hydrophobic except the two aspartic acids. So that, the increase in the
hydrophilicity and polarity of the compound is preventing and/or
decreasing the hydrophobic interaction between the compound and
HIV-1 protease active site.

In silico identification of Novel HIVProtease inhibitors (PIs) using
ZINC drug Database
KK Srivastava, S Srivastava, T Alam, Rituraj
Int J Pharma Sci and Res (IJPSR) Dec 2014; 5(12):947-952.

The Human immunodeficiency virus type-1 protease is one of the
most important target of highly active anti-retrovirus therapy
(HAART) for the treatment of all acquired immune deficiency
syndrome (AIDS). Protease inhibitor Darunavir is most recent
included as a PI in the list of HARRT, more effective against mutant
type and wild type of Protease with increased no. of H-bonding then
precursors approved by FDA, So herein we taken Darunavir as a base
structure for virtually identification of more/similar efficient drug
like leads then Darunavir using PDB structure (3BGR) of Protease
from PDB database ‘RCSB’ versus chemical compounds database
‘ZINC’ using Schrodinger and Discovery Studio software. Using
molecular constraint search with similarity coefficient ‘Tanimoto’,
1,65,000 ligands were extracted and docking analysis resulted in
some efficient in docking and in other computational medicinal
parameters, we are reporting such leads, and, they may further
undergo through high end extensive virtual investigation and beyond.

DARUNAVIR DOCKED IN PDB 3BGR

DARUNAVIR DOCKED IN PDB 3BGR

In this work, we have tried to recognized some more/similar
potent drug like leads instead ‘Darunavir’ may be more effective,
we used five different RT crystallographic structures for better
identification/verification for our results, ZINC78487241,
ZINC09060710, ZINC72320180, ZINC78487244 & ZINC78487242
are showing very fine computed properties therefore, this study
verifies the importance of small drug like molecules libraries as
like ‘ZINC.docking.org’and their use certainly help scientific groups
to enhance their capabilities in drug discovery with reducing time,
including drug discovery process prior synthesis. Meanwhile all
herein identified molecules may further investigate instead “in silico”.

Development and Customization of a Color-Coded Microbeads-Based
Assay for Drug Resistance in HIV-1 Reverse Transcriptase
L Gu, Ai Kawana-Tachikawa, T Shiino, H Nakamura, M Koga, et al.
PLoS ONE 9(10): e109823. http://dx.doi.org:/10.1371/journal.pone.0109823

Other Virus Diseases

A global phylogenetic analysis in order to determine the host species
and geography dependent features present in the evolution of avian
H9N2 influenza hemagglutinin
Andrew R. Dalby and Munir Iqbal
PeerJ 2014. http://dx.doi.org:/10.7717/peerj.655

A complete phylogenetic analysis of all of the H9N2 hemagglutinin
sequences that were collected between 1966 and 2012 was carried out
in order to build a picture of the geographical and host specific evolution
of the hemagglutinin protein. To improve the quality and applicability
of the output data the sequences were divided into subsets based upon
location and host species. The phylogenetic analysis of hemagglutinin
reveals that the protein has distinct lineages between China and the
Middle East, and that wild birds in both regions retain a distinct form
of the H9 molecule, from the same lineage as the ancestral hemagglutinin.
The results add further evidence to the hypothesis that the current
predominant H9N2 hemagglutinin lineage might have originated in
Southern China. The study also shows that there are sampling problems
that affect the reliability of this and any similar analysis. This raises
questions about the surveillance of H9N2 and the need for wider
sampling of the virus in the environment. The results of this analysis
are also consistent with a model where hemagglutinin has predominantly
evolved by neutral drift punctuated by occasional selection events. These
selective events have produced the current pattern of distinct lineages in
the Middle East, Korea and China.

Describing the hexapeptide identity platform between the influenza A
H5N1 and Homo sapiens proteomes
Darja Kanduc
Biologics: Targets & Therapy 2010:4 245–261
http://dx.doi.org:/10.2147/BTT.S12097

We searched the primary sequence of influenza A H5N1 polyprotein
for hexamer amino acid sequences shared with human proteins using
the Protein International Resource database and the exact peptide
matching analysis program. We find that the viral polyprotein shares
numerous hexapeptides with the human proteome. The human
proteins involved in the viral overlap are represented by antigens
associated with basic cell functions such as proliferation, development,
and differentiation. Of special importance, many human proteins
that share peptide sequences with influenza A polyprotein are
antigens such as reelin, neurexin I-α, myosin-IXa, Bardet–Biedl
syndrome 10 protein, Williams syndrome transcription factor,
disrupted in schizophrenia 1 protein, amyotrophic lateral sclerosis 2
chromosomal region candidate gene 17 protein, fragile X mental
retardation 2 protein, and jouberin. That is, the viral-vs-human
overlap involves human proteins that, when altered, have been
reported to be potentially associated with multiple neurological
disorders that can include autism, epilepsy, obesity, dystonia,
ataxia–telangiectasia, amyotrophic lateral sclerosis, sensorineural
deafness, sudden infant death syndrome, Charcot-Marie-Tooth
disease, and myelination. The present data are discussed as a
possible molecular basis for understanding influenza A viral
escape from immunosurveillance and for defining anti-influenza
immune-therapeutic approaches devoid of collateral adverse events.

Middle East respiratory syndrome coronavirus neutralising serum
antibodies in dromedary camels: a comparative serological study

CBEM Reusken, BL Haagmans, MA Müller, C Gutierrez,
Gert-Jan Godeke, et al.
Lancet Infectious Diseases Oct 2013; 13(10): 859 – 866
http://dx.doi.org:/10.1016/S1473-3099(13)70164-6

A new betacoronavirus—Middle East respiratory syndrome coronavirus
(MERS-CoV)—has been identified in patients with severe acute
respiratory infection. Although related viruses infect bats, molecular
clock analyses have been unable to identify direct ancestors of MERS-CoV. Anecdotal exposure histories suggest that patients had been in
contact with dromedary camels or goats. We investigated possible
animal reservoirs of MERS-CoV by assessing specific serum antibodies
in livestock.
We took sera from animals in the Middle East (Oman) and from
elsewhere (Spain, Netherlands, Chile). Cattle (n=80), sheep (n=40),
goats (n=40), dromedary camels (n=155), and various other camelid
species (n=34) were tested for specific serum IgG by protein microarray
using the receptor-binding S1 subunits of spike proteins of MERS-CoV,
severe acute respiratory syndrome coronavirus, and human coronavirus
OC43. Results were confirmed by virus neutralization tests for MERS-CoV
and bovine coronavirus.  50 of 50 (100%) sera from Omani camels and 15
of 105 (14%) from Spanish camels had protein-specific antibodies against
MERS-CoV spike. Sera from European sheep, goats, cattle, and other
camelids had no such antibodies. MERS-CoV neutralising antibody titers
varied between 1/320 and 1/2560 for the Omani camel sera and between
1/20 and 1/320 for the Spanish camel sera. There was no evidence for cross-
neutralization by bovine coronavirus antibodies. MERS-CoV or a related
virus has infected camel populations. Both titres and seroprevalences in
sera from different locations in Oman suggest widespread infection.

Cosic’s Resonance Recognition Model for Protein Sequences and
Photon Emission Differentiates Lethal and Non-Lethal Ebola
Strains: Implications for Treatment
Nirosha J. Murugan, Lukasz M. Karbowski, Michael A. Persinger
Open Journal of Biophysics, 2015, 5, 35-43
http://dx.doi.org/10.4236/ojbiophy.2015.51003

The Cosic Resonance Recognition Model (RRM) for amino acid
sequences was applied to the classes of proteins displayed by four
strains (Sudan, Zaire, Reston, Ivory Coast) of Ebola virus that
produced either high or minimal numbers of human fatalities.
The results clearly differentiated highly lethal and non-lethal strains.
Solutions for the two lethal strains exhibited near ultraviolet (~230 nm)
photon values while the two asymptomatic forms displayed near i
nfrared (~1000 nm) values. Cross-correlations of spectral densities of
the RRM values of the different classes of proteins associated with the
genome of the viruses supported this dichotomy. The strongest coefficient
occurred only between Sudan-Zaire strains but not for any of the other
pairs of strains for sGP, the small glycoprotein that intercalated with
the plasma cell membrane to promote insertion of viral contents into
cellular space. A surprising, statistically significant cross-spectral
correlation occurred between the “spike” glycoprotein component (GP1)
of the virus that associated the anchoring of the virus to the mammalian
cell plasma membrane and the Schumann resonance of the earth whose
intensities were determined by the incidence of equatorial thunderstorms.
Previous applications of the RRM to shifting photon wavelengths emitted
by melanoma cells adapting to reduced ambient temperature have validated
Cosic’s model and have demonstrated very narrow wave-length (about 10 nm)
specificity. One possible ancillary and non-invasive treatment of people
within which the fatal Ebola strains are residing would be whole body
application of narrow band near-infrared light pulsed as specific
physiologically-patterned sequences with sufficient radiant flux density
to perfuse the entire body volume.

Nov 23rd, 2014
Replication of Ebola Virus

Ebola Virus do not replicate through any kind of cell division; rather,
they use a combination of host and virally encoded enzymes, alongside
host cell structures, to produce multiple copies of viruses. These then self-assemble into viral macromolecular structures in the host cell. The
virus completes a set of steps when infecting each individual cell.

Replication of Ebola Virus

Following are the steps during the replication of Ebola Virus:

Attachment

First of all, there is attachment of virus to host receptors through
GP glycoprotein which is endocytosed into vesicles in the host cell.
Host DC-SIGN and DC-SIGNR play a role in virion attachment.

Viral Entry (Penetration)

The virion enters early endosomes by Macropinocytosis or
clathrin-mediated endocytosis.

Macropinocytosis

In this process, ruffled segments of the host’s plasma membrane
protrude outward from the cell and form invaginations where
the virus utilizes glycoproteins in order to attach to the surface
of the plasma membrane. Macropinocytosis is a process in which
the Eukaryotic host cells form macropinosomes, segments of plasma
membranes that extend out from the cell approximately 0.2-10 µm, in
order to incorporate the virus into the cell. The formation of macro-
pinosomes occurs spontaneously, as a result of the activation of various
growth factors, or simultaneously with the intake of cellular molecules
or extracellular fluid.

Clathrin-mediated endocytosis

Clathrin-mediated endocytosis is the other means by which Ebolavirus
enters the host cell. This process is very similar to macropinocytosis
in that the plasma membrane forms invaginations that engulf the cell.
However, clathrin-mediated endocytosis is different in that proteins on
the surface of the host’s surface, and in particular clathrin, facilitate
the attachment of the virus to the host’s cell surface. Glycoproteins
are still used to attach the virus to the cell surface, and the NP-C1
cholesterol transporter still facilitates the fusion of the virus with
endosomes and lysosomes and still allows the virus to escape into
the cytoplasm. Without the NPC1 cholesterol transporter, Ebolavirus
cannot leave the vesicle in order to replicate and cause infection in other cells.

To penetrate the cell, the viral membrane fuses with vesicle membrane,
and the nucleocapsid is released into the cytoplasm.

In some culture cells, GP glycoprotein can be processed by host
Cathepsin L andCathepsin B into 19kDa GP1. But this processing is
not happening in all cells or for all ebolavirus. 19kDA GP1 interacts
with host NPC1, which is highly expressed in dendritic cells.

Fusion of virus membrane with the vesicle membrane is triggered
by either low pH orNPC1 binding.

Sequential Transcription

During transcription, the RNA genome is transcribed into seven
monocistronic mRNAs whose length is determined by highly
conserved start and stop signals.

The transcription process begins with the binding of the polymerase
complex to a single binding site located within the leader region of
the genome. The complex then slides along the RNA template and
sequentially transcribes the individual genes in their 3’ to 5’ order.
Encapsidated, negative-sense genomic ssRNA is used as a template
for the synthesis (3′-5′) of polyadenylated, monocistronic mRNAs
and, using the host cell’s ribosomes, tRNA molecules, etc.,
the mRNA is translated into individual viral proteins.

Replication

As viral protein levels rise, a switch occurs from translation to replication.
Using the negative-sense genomic RNA as a template, a complementary
+ssRNA is synthesized; this is then used as a template for the synthesis
of new genomic (-)ssRNA, which is rapidly encapsidated. Replication
presumably starts when enough nucleoprotein is present to encapsidate
neo-synthetized antigenomes and genomes.

Budding

The newly formed nucleocapsids and envelope proteins associate at the
host cell’s plasma membrane; budding occurs, destroying the cell.

These viruses recruit components of the cellular ESCRT (endosomal
sorting complex required for transport) system to mediate host-assisted
viral budding. SCRT complexes are normally used by the cell for
biological functions involving membrane remodeling, such as intra-luminal vesicle formation, autophagy or terminal stages of cytokinesis.
The ESCRT family consists of ESCRT-0, ESCRT-I, ESCRT-II which are
primarily involved in cargo sorting and membrane deformation, and
ESCRT-III which cleaves the bud neck from its cytosolic face.  In the
last step, vps4 disassembles the complex. The budding reaction
catalyzed by the ESCRT machinery has reversed topology when
compared with most other budding processes in the cell, such as
endocytosis and formation of transport vesicles.

Release –   Finally, the virion is released.

Favipiravir elicits antiviral mutagenesis during virus replication in vivo

Armando Arias, Lucy Thorne, Ian Goodfellow
eLife 2014;3:e03679. http://dx.doi.org:/10.7554/eLife.03679

Lethal mutagenesis has emerged as a novel potential therapeutic
approach to treat viral infections. Several studies have demonstrated
that increases in the high mutation rates inherent to RNA viruses lead
to viral extinction in cell culture, but evidence during infections in vivo
is limited. In this study, we show that the broad-range antiviral nucleoside
favipiravir reduces viral load in vivo by exerting antiviral mutagenesis
in a mouse model for norovirus infection. Increased mutation frequencies
were observed in samples from treated mice and were accompanied with
lower or in some cases undetectable levels of infectious virus in faeces
and tissues. Viral RNA isolated from treated animals showed reduced
infectivity, a feature of populations approaching extinction during antiviral
mutagenesis. These results suggest that favipiravir can induce norovirus
mutagenesis in vivo, which in some cases leads to virus extinction,
providing a proof-of-principle for the use of favipiravir derivatives or
mutagenic nucleosides in the clinical treatment of noroviruses.

Individualization of antiretroviral therapy
Rebecca Pavlos, Elizabeth J Phillips
Pharmacogenomics and Personalized Medicine 2012:5 1–17
http://dx.doi.org/10.2147/PGPM.S15303

Antiretroviral therapy (ART) has evolved considerably over the last
three decades. From the early days of monotherapy with high toxicities
and pill burdens, through to larger pill burdens and more potent
combination therapies, and finally, from 2005 and beyond where we
now have the choice of low pill burdens and once-daily therapies.
More convenient and less toxic regimens are also becoming available,
even in resource-poor settings. An understanding of the individual
variation in response to ART, both efficacy and toxicity, has evolved
over this time. The strong association of the major histocompatibility
class I allele HLA-B*5701 and abacavir hypersensitivity, and its
translation and use in routine HIV clinical practice as a predictive
marker with 100% negative predictive value, has been a success story
and a notable example of the challenges and triumphs in bringing
pharmacogenetics to the clinic. In real clinical practice, however, it is
going to be the exception rather than the rule that individual
biomarkers will definitively guide patient therapy. The need for
individualized approaches to ART has been further increased by the
importance of non-AIDS comorbidities in HIV clinical practice. In the
future, the ideal utilization of the individualized approach to ART will
likely consist of a combined approach using a combination of knowledge
of drug, virus, and host (pharmacogenetic and pharmacoecologic [factors
in the individual’s environment that may be dynamic over time])
information to guide the truly personalized prescription. This review
will focus on our knowledge of the pharmacogenetics of the efficacy
and toxicity of currently available antiretroviral agents and the current
and potential utility of such information and approaches in present
and future HIV clinical care.

Additional Considerations

PLOS Biology Paper Wins Omenn Prize for Viral Evasion Story
By Roli Roberts  Posted: June 19, 2014

We talk to the authors of a PLOS Biology research article published in
May 2013 that won the Omenn Prize for the best article published in 2013.
The Omenn Prize is awarded annually by the Evolution, Medicine, & Public
Health Foundation to authors of articles related to “evolution in the context
of medicine and public health,” and the winner was picked from a tough
long-list of 47 papers. Four other papers, including two from our sister
journal PLOS Pathogens, were cited for “honorable mention”
(Graves et al. Huijben et al.).

The PLOS Biology paper looks at how an essential mammalian protein –
the transferrin receptor, TfR1 – evolves in the face of contrasting selective
pressures. TfR1 is a protein that sits on the membrane of our cells and
mediates the regulated uptake of iron. TfR1 is stuck in the horns of a
dilemma. On the one hand, it has to be able to bind its functional partners –
the iron-loaded plasma protein transferrin, and a negative regulator protein
called HFE; this requirement constrains the sequence and structure of TfR1
through evolutionary time. On the other hand, it has to evade viruses that
exploit its handy cell-surface location, such as arenaviruses and the rodent
retrovirus MMTV.

TfR1 can carry on binding transferrin and HFE while dodging viruses

TfR1 can carry on binding transferrin and HFE while dodging viruses

TfR1 can carry on binding transferrin and HFE while dodging viruses.
http://dx.doi.org:/10.1371/journal.pbio.1001571

The authors compared sequences of TfR1 from various mammalian hosts
and then expressed them on the surface of cells to check a) their ability
to confer vulnerability or resistance to MMTV and arenaviruses such as
Machupo, Junin and Guanarito virus and b) their ability to bind to
transferrin. This image from the paper summarises the central finding –
how TfR1 (green) manages to square this circle by evolving rapidly (red)
to change the outer surfaces that are hijacked by viruses while keeping
constant the central surfaces that it uses to bind transferrin and HFE
(purple, blue).

First author Ann Demogines and lead author Sara Sawyer – both from
the University of Texas at Austin – told us how the study first arose and
then evolved into the paper that you can now read on our website.

Sawyer recalls the exact point at which the project started: “In the first year
of my faculty position, Welkin Johnson invited me to give a talk at the New
England Primate Research Center.  While I was there, I had a 45 minute
meeting with his colleague, Mike Farzan [also a co-author]. Mike had just
discovered TfR1 as the cellular receptor for arenaviruses, and suggested to
me that this might be a molecule that is engaged in an evolutionary arms race.
While ideas like this often arise out of conversations between scientists, I
remember having a gut reaction that this was something worth pursuing.”

Positively selected amino acids (red) hit the virus binding sites on TfR1 (blue, grey).

Positively selected amino acids (red) hit the virus binding sites on TfR1 (blue, grey).

Positively selected amino acids (red) hit the virus binding sites on
TfR1 (blue, grey)   http://dx.doi.org:/10.1371/journal.pbio.1001571

Demogines, who received $5000 from the Foundation, describes
how the spectacular arrangement of the evolutionarily selected sites
emerged: “I am still amazed to this day by the results of the evolutionary
analysis.  We were able to take DNA sequence from just 7 species and
computationally predict six sites under selection.  These sites were
scattered on the linear diagram of the protein, and didn’t make much
sense to us. But, when we placed them onto the 3D crystal structure
they formed a beautiful ridge going straight down the outer surface of
the receptor.  That was a great day in the lab.  We knew this had to
mean something!”

Demogines goes on to think about the implications of her paper and
related studies: “This work really gets me excited about the future of
evolutionary analysis applied in biomedical research.  As we collect the
genome sequences from more and more species, especially rodents and
bats which are major reservoirs for zoonotic and potentially zoonotic
viruses, we should be able to do this type of analysis more and more.
This type of analysis has many applications: allowing us to identify
critical cofactors involved in the viral lifecycle, viral binding sites, and
potentially novel drug targets. It can also be used to study interactions
with bacterial pathogens, although this has not yet been extensively explored.”

If you’d like to find out more about this elegant study, why not read the
article itself, or the accompanying Primer written by John Coffin:

“Dual Host-Virus Arms Races Shape an Essential Housekeeping Protein”
by Ann Demogines, Jonathan Abraham, Hyeryun Choe, Michael Farzan and
Sara L. Sawyer. http://dx.doi.org:/10.1371/journal.pbio.1001571

“Virions at the Gates: Receptors and the Host–Virus Arms Race” by
John M. Coffin. http://dx.doi.org:/10.1371/journal.pbio.1001574
Angiomotin Functions in HIV-1 Assembly and Budding
G Mercenne, SL Alam, J Arii, MS Lalonde and WI Sundquist
eLife 2015; http://dx.doi.org:/10.7554/eLife.03778

Many retroviral Gag proteins contain PPXY late assembly domain motifs that recruit proteins of the NEDD4 ubiquitin E3 ligase family to facilitate virus release. Overexpression of NEDD4L can also stimulate HIV-1 release but in this case the Gag protein lacks a PPXY motif, suggesting that NEDD4L may function through an adaptor protein. Here, we demonstrate that the cellular protein Angiomotin (AMOT) can bind both NEDD4L and HIV-1 Gag. HIV-1 release and infectivity are stimulated by AMOT overexpression and inhibited by AMOT,depletion, whereas AMOT mutants that cannot bind NEDD4L cannot function in virus release. Electron microscopic
analyses revealed that in the absence of AMOT assembling Gag molecules fail to form a fully spherical enveloped particle. Our experiments indicate that AMOT and other motin family members function together with NEDD4L to help complete immature virion assembly prior to ESCRT-mediated virus budding.

The DEAH-Box RNA Helicase DHX15 Activates NF-B and MAPK Signaling Downstream of MAVS During Antiviral Responses

K Mosallanejad, Y Sekine, S Ishikura-Kinoshita, K Kumagai, T Nagano, et al.
Sci. Signal., 29 Apr 2014;  7(323), p. ra40
http://dx.doi.org/10.1126/scisignal.2004841]

During infection with an RNA virus, the DExD/H-box RNA helicases RIG-I (retinoic acid–inducible gene I) and MDA5 (melanoma differentiation–associated gene 5) activate the interferon regulatory factor 3 (IRF3), nuclear factor B (NF-B), c-Jun amino-terminal kinase (JNK), and p38 mitogen-activated protein kinase (MAPK) signaling pathways through an unknown mechanism involving the adaptor protein MAVS (mitochondrial antiviral signaling). We used a Drosophila misexpression screen to identify DEAH-box polypeptide 15 (DHX15) as an activator of the p38 MAPK pathway. Human DHX15 contributed to the activation of the NF-B, JNK, and p38 MAPK pathways, but not the IRF3 pathway, in response to the synthetic double-stranded RNA analog poly(I:C) (polyinosinic-polycytidylic acid), and DHX15 was required for optimal cytokine production in response to poly(I:C) and infection with RNA virus. DHX15 physically interacted with MAVS and mediated the MAVS-dependent activation of the NF-B and MAPK pathways. Furthermore, DHX15 was required for poly(I:C)- and RNA virus–dependent, MAVS-mediated apoptosis. Thus, our findings indicate that, in RIG-I–like receptor signaling, DHX15 specifically stimulates the NF-B and MAPK pathways downstream of MAVS and contributes to MAVS-mediated cytokine production and apoptosis.

Mitochondrial Membrane Potential Is Required for MAVS-Mediated Antiviral Signaling
T Koshiba, Kai Yasukawa, Y Yanagi, and Shun-ichiro Kawabata
Sci. Signal., 1 Feb 2011; 4(158), p. ra7
http://dx.doi.org:/10.1126/scisignal.2001147]

Mitochondria, dynamic organelles that undergo cycles of fusion and fission, are the powerhouses of eukaryotic cells and are also involved in cellular innate antiviral immunity in mammals. Mitochondrial antiviral immunity depends on activation of the cytoplasmic retinoic acid–inducible gene I (RIG-I)–like receptor (RLR) signaling pathway and the participation of a mitochondrial outer membrane adaptor protein called MAVS (mitochondrial antiviral signaling). We found that cells that lack the ability to undergo mitochondrial fusion as a result of targeted deletion of both mitofusin 1 (Mfn1) and mitofusin 2 (Mfn2) exhibited impaired induction of interferons and proinflammatory cytokines in response to viral infection, resulting in increased viral replication. In contrast, cells with null mutations in either Mfn1 or Mfn2 retained their RLR-induced antiviral responses. We also found that a reduced mitochondrial membrane potential (m) correlated with the reduced antiviral response. The dissipation in m did not affect the activation of the transcription factor interferon regulatory factor 3 downstream of MAVS, which suggests that m and MAVS are coupled at the same stage in the RLR signaling pathway. Our results provide evidence that the physiological function of mitochondria plays a key role in innate antiviral immunity.

The Ubiquitin-Specific Protease USP15 Promotes RIG-I–Mediated Antiviral Signaling by Deubiquitylating TRIM25
Eva-Katharina Pauli, YK Chan, ME Davis, S Gableske, MK Wang, KF F, et al.
Sci. Signal., 7 Jan 2014; 7(307), p. ra3
http://dx.doi.org:/10.1126/scisignal.2004577

Ubiquitylation is an important mechanism for regulating innate immune responses to viral infections. Attachment of lysine 63 (Lys63)–linked ubiquitin chains to the RNA sensor retinoic acid–inducible gene-I (RIG-I) by the ubiquitin E3 ligase tripartite motif protein 25 (TRIM25) leads to the activation of RIG-I and stimulates production of the antiviral cytokines interferon-α (IFN-α) and IFN-β. Conversely, Lys48-linked ubiquitylation of TRIM25 by the linear ubiquitin assembly complex (LUBAC) stimulates the proteasomal degradation of TRIM25, thereby inhibiting the RIG-I signaling pathway. Here, we report that ubiquitin-specific protease 15 (USP15) deubiquitylates TRIM25, preventing the LUBAC-dependent degradation of TRIM25. Through protein purification and mass spectrometry analysis, we identified USP15 as an interaction partner of TRIM25 in human cells. Knockdown of endogenous USP15 by specific small interfering RNA markedly enhanced the ubiquitylation of TRIM25. In contrast, expression of wild-type USP15, but not its catalytically inactive mutant, reduced the Lys48-linked ubiquitylation of TRIM25, leading to its stabilization. Furthermore, ectopic expression of USP15 enhanced the TRIM25- and RIG-I–dependent production of type I IFN and suppressed RNA virus replication. In contrast, depletion of USP15 resulted in decreased IFN production and markedly enhanced viral replication. Together, these data identify USP15 as a critical regulator of the TRIM25- and RIG-I–mediated antiviral immune response, thereby highlighting the intricate regulation of innate immune signaling.

Antiviral Mitochondrial Action
Editor’s Summary
Sci. Signal., 1 Feb 2011;  4(158), p. ra7
http://dx.doi.org:/10.1126/scisignal.2001147

Mitochondria are the energy generators of the cell, but they also act as platforms upon which complexes of proteins respond to RNA-containing viruses within the cytosol. Through genetic and pharmacological means, Koshiba et al. present evidence that suggests that the contribution of mitochondria to these antiviral responses is not as passive as originally thought. Indeed, their data suggest that successful resistance to viral infections depends on maintenance of the internal physiological functions of mitochondria coupled with the functions of the external protein complexes.

Prolonging Antiviral Signaling
Editor’s Summary
Sci. Signal., 7 Jan 2014; 7(307), p. ra3
http://dx.doi.org:/10.1126/scisignal.2004577

As part of the innate immune response to infection by RNA viruses, signaling by the cytosolic RNA sensor retinoic acid–inducible gene-I (RIG-I) stimulates the production of type I interferons (IFNs). RIG-I activity depends on its Lys63-linked polyubiquitylation by the ubiquitin E3 ligase TRIM25. As part of a negative feedback mechanism, the linear ubiquitin assembly complex (LUBAC) mediates the Lys48-linked polyubiquitylation and degradation of TRIM25, leading to inhibition of RIG-I signaling. Pauli et al. found that the deubiquitylase USP15 (ubiquitin-specific protease 15) counteracted the function of LUBAC by removing polyubiquitin from TRIM25, thus promoting its stabilization and enhancing the RIG-I–dependent antiviral response. Loss of USP15 resulted in decreased type I IFN production and enhanced viral replication in infected cells. Together, these data suggest that USP15 fine-tunes the antiviral response by sustaining the production of IFNs.

NIH-funded study uncovers range of molecular alterations in head and neck cancers, new potential drug targets

TCGA tumor genome sequencing analyses offer new insights into the effects of HPV and smoking, and find genomic similarities with other cancers

human papillomavirus (HPV) in head and neck cancer

human papillomavirus (HPV) in head and neck cancer

TCGA researchers have uncovered new details about the potential role of the human papillomavirus (HPV) in head and neck cancer. HPV-related head and neck cancers have been growing in number

Bethesda, Md., Wed., Jan. 28, 2015 – Investigators with The Cancer Genome Atlas (TCGA) Research Network have discovered genomic differences – with potentially important clinical implications – in head and neck cancers caused by infection with the human papillomavirus (HPV). HPV is the most common sexually transmitted virus in the United States, and the number of HPV-related head and neck cancers has been growing. Almost every sexually active person will acquire HPV at some point in their lives, according to the Centers for Disease Control and Prevention.

The researchers also uncovered new smoking-related cancer subtypes and potential new drug targets, and found numerous genomic similarities with other cancer types. Taken together, this study’s findings may provide more detailed explanations of how HPV infection and smoking play roles in head and neck cancer risk and disease development, and offer potential novel diagnostic and treatment directions.

The study is the most comprehensive examination to date of genomic alterations in head and neck cancers. The results were published online Jan. 28, 2015 in the journal Nature. TCGA is jointly supported and managed by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both parts of the National Institutes of Health.

The U.S. Food and Drug Administration-approved HPV vaccines should be able to prevent the cancers caused by HPV infection in head and neck cancers and elsewhere, including anal cancer, whose incidence has also been increasing.
However, these vaccines work by preventing new infections, and the long interval between infection and cancer development make it important to understand the molecular changes that bring about these HPV-positive head and neck cancers – as well as those that lead to the HPV-negative cancers – and to develop new approaches for treating them.

“The rapid increase in HPV-related head and neck cancers, noticeably in oropharyngeal tumors, has created an even greater sense of urgency in the field,” said D. Neil Hayes, M.D., M.P.H, senior author of the study report and associate professor of medicine at the University of North Carolina (UNC) and the UNC Lineberger Comprehensive Cancer Center at Chapel Hill. Oropharyngeal cancer starts in the oropharynx, which is the part of the throat just behind the mouth. “We’re uncovering differences between tumors with and without HPV infection, and these new data are allowing us to rethink how we approach head and neck cancers.”

In the study, researchers performed genomic analyses on 279 tumors – head and neck squamous cell carcinomas (HNSCC) – from untreated patients. Approximately 80 percent of tumor samples were from individuals who smoked. The majority of samples were oral cavity cancers (61 percent) and larynx cancers (26 percent).

While only about 25 percent of head and neck cancers are linked to HPV infection, TCGA researchers confirmed that many patients with HPV-associated tumors have specific alterations of the gene FGFR3 and mutations in the PIK3CA gene, which are also found in a much broader set of mutations in smoking-related tumors. In contrast, while the EGFR (epidermal growth factor receptor) gene is frequently altered in HPV-negative tumors in smokers, it is rarely abnormal in HPV-positive tumors. Such insights may help in developing potential therapies and biomarkers, noted Dr. Hayes.

Head and neck cancers comprise a constellation of tumors of the mouth, throat, larynx, nasal cavity, salivary gland and elsewhere that have frequently been attributed to tobacco and alcohol use in most patients. Some 90 percent are squamous cell carcinomas, which occur in the surface layers of cells in the body. An estimated 55,000 people developed head and neck cancer in the United States in 2014. Approximately 12,000 Americans die from the diseases each year. Head and neck cancers are common worldwide, with more than 600,000 cases diagnosed each year.

“The rising worldwide incidence of head and neck cancers makes these types of large integrated genomic analyses by TCGA vital to establish a more detailed understanding of disease causes and behavior, and for the development of new treatment approaches,” said NIH Director Francis S. Collins, M.D., Ph.D.

Scientists found that more than 70 percent of head and neck cancers had alterations in genes for growth factor receptors (EGFR, FGFR, IGFR, MET, ERBB2, DDR2), signaling molecules (PIK3CA, HRAS) and cell division regulation (CCND1). These genes may play roles in pathways that control cell growth and proliferation, and for which therapies are either available or in development.

The investigators also discovered new clues about drug resistance in head and neck cancers. They found that genes affecting about 40 percent of such cancers form key parts of a pathway that helps determine cell survival and drug resistance. They showed that extra copies of the genes FADD and BIRC2, or mutations in or the absence of the CASP8 gene in smoking-related cancers – all which affect the process of programmed cell death – may underlie the resistance of cancer cells to current treatments. Similarly, the absence of the TRAF3 gene, or extra copies of a gene for the growth-promoting E2F1 protein in HPV-related cancers, may also increase resistance.

The findings showed similarities between head and neck cancer genomes and other cancers, including squamous cell lung and cervical, indicating possible common paths of cancer development, and potential treatment opportunities. “It is surprising to see that head and neck tumor genomes are remarkably similar to cervical and squamous lung cancer genomes. They are from very different organs, but they show similar losses and gains of genetic material across tumors,” Dr. Hayes noted. These common genetic abnormalities belong to a pathway that protects cells from damage and stress.

“These novel findings help establish a genomic map of various head and neck cancers, provide new insights into other similar cancers and  may further our understanding of how viruses can impact disease,” said NHGRI Director Eric D. Green, M.D., Ph.D.

“While many head and neck cancers are preventable, they are increasingly common throughout the world, and often challenging to effectively treat over the long term,” said NCI Director Harold Varmus, M.D. “This type of broad analysis provides important new clues for future research and treatment directions.”

The TCGA Research Network has generated data and published analyses on a number of cancers, all of which can be found on the TCGA website, www.cancergenome.nih.gov

The TCGA Research Network consists of more than 150 researchers at dozens of institutions across the nation.  A list of participants is available at http://cancergenome.nih.gov/abouttcga/overview. More details about The Cancer Genome Atlas, including Quick Facts, Q&A, graphics, glossary, a brief guide to genomics and a media library of available images can be found at http://cancergenome.nih.gov.

NHGRI is one of the 27 institutes and centers at the National Institutes of Health. The NHGRI Extramural Research Program supports grants for research and training and career development at sites nationwide. Additional information about NHGRI can be found at http://www.genome.gov.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at http://www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs, see the NIDCD website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

INNATE IMMUNITY
Phosphorylation of innate immune adaptor proteins MAVS, STING, and TRIF induces IRF3 activation
Siqi Liu1, Xin Cai1, Jiaxi Wu1, Qian Cong2, Xiang Chen1,3, Tuo Li1, Fenghe Du1,3, Junyao Ren1, Youtong Wu1, Nick Grishin2,3, Zhijian J. Chen1,3,*
Science http://dx.doi.org:/10.1126/science.aaa2630

1Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9148, USA.
2Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9148, USA.
3Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390-9148, USA.

During virus infection, the adaptor proteins MAVS and STING transduce signals from the cytosolic nucleic acid sensors RIG-I and cyclic guanosine monophosphate–adenosine monophosphate synthase, respectively, to induce type I interferons (IFNs) and other antiviral molecules. Here, we show that MAVS and STING harbor two conserved serine and threonine clusters that are phosphorylated by the kinases inhibitor of nuclear factor κB subunit IKK and/or TBK1 in response to stimulation. Phosphorylated MAVS and STING then bind to a positively charged surface of interferon regulatory factor 3 (IRF3) and thereby recruit IRF3 for its phosphorylation and activation by TBK1. We further show that TRIF, an adaptor protein in Toll-like receptor signaling, activates IRF3 through a similar phosphorylation-dependent mechanism. These results reveal that phosphorylation of innate adaptor proteins is an essential and conserved mechanism that selectively recruits IRF3 to activate the type I IFN pathway.

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The Challenge of Antimicrobial Resistance

Writer and Curator: Larry H. Bernstein, MD, FCAP

 

Antibiotic resistance has become a major challenge of our time.  Common microorganisms that inhabit the skin, mouth and nares, and fecal organisms are transmitted in the hospital setting. Handwashing procedures have had limited benefit. Operating rooms are ventilated and environmentally engineered to minimize transmission intraoperatively. The patient may be immune-compromized. The organisms that are encountered have genetically adapted to the most effective antibiotics at our disposal. even with some risk of secondary toxicity in some cases.

What is Drug Resistance?

Antimicrobial resistance is the ability of microbes, such as bacteria, viruses,
parasites, or fungi, to grow in the presence of a chemical (drug) that would
normally kill it or limit its growth.

Diagram showing the difference between non-resistant bacteria and drug
resistant bacteria.

Drug Resistance difference between non-resistant bacteria and drug resistant bacteria

Drug Resistance difference between non-resistant bacteria and drug resistant bacteria

Credit: NIAID

http://www.niaid.nih.gov/SiteCollectionImages/topics/
antimicrobialresistance/1whatIsDrugResistance.gif

Diagram showing the difference between non-resistant bacteria and drug
resistant bacteria. Non-resistant bacteria multiply, and upon drug treatment,
the bacteria die. Drug resistant bacteria multiply as well, but upon drug
treatment, the bacteria continue to spread.

Many infectious diseases are increasingly difficult to treat because of
antimicrobial-resistant organisms, including HIV infection, staphylococcal
infection, tuberculosis, influenza, gonorrhea, candida infection, and malaria.

Between 5 and 10 percent of all hospital patients develop an infection. About
90,000 of these patients die each year as a result of their infection, up from
13,300 patient deaths in 1992.

According to the Centers for Disease Control and Prevention (April 2011),
antibiotic resistance in the United States costs an estimated $20 billion a year
in excess health care costs, $35 million in other societal costs and more than 8
million additional days that people spend in the hospital.

World Health Organization – 2014 Report
WHO/HSE/PED/AIP/2014.2
http://www.who.int.org/

Antimicrobial resistance (AMR) is an increasingly serious threat to
global public health. AMR develops when a microorganism (bacteria,
fungus, virus or parasite) no longer responds to a drug to which it
was originally sensitive. This means that standard treatments no
longer work; infections are harder or impossible to control; the risk
of the spread of infection to others is increased; illness and hospital
stays are prolonged, with added economic and social costs; and the
risk of death is greater—in some cases, twice that of patients who
have infections caused by non-resistant bacteria. The problem is so
serious that it threatens the achievements of modern medicine. A
post-antibiotic era—in which common infections and minor
injuries can kill—is a very real possibility for the 21st century.

WHO is developing a global action plan for AMR that
will include:
• development of tools and standards for harmonized
surveillance of ABR in humans, and for integrated
surveillance in food-producing animals and the
food chain;
• elaboration of strategies for population-based
surveillance of AMR and its health and economic
impact; and
• collaboration between AMR surveillance networks
and centres to create or strengthen coordinated
regional and global surveillance.
AMR is a global health security threat that requires
action across government sectors and society as a
whole. Surveillance that generates reliable data is the
essential foundation of global strategies and public
health actions to contain AMR.

Resistance to Antibiotics: Are We in the Post-Antibiotic Era?
Alfonso J. Alanis
Archives of Medical Research 36 (2005) 697–705
http://dx.doi.org:/10.1016/j.arcmed.2005.06.009

Serious infections caused by bacteria that have become resistant
to commonly used antibiotics have become a major global healthcare
problem in the 21st century. They not only are more severe and
require longer and more complex treatments, but they are also
significantly more expensive to diagnose and to treat. Antibiotic
resistance, initially a problem of the hospital setting associated
with an increased number of hospital acquired infections usually
in critically ill and immunosuppressed patients, has now extended
into the community causing severe infections difficult to diagnose
and treat. The molecular mechanisms by which bacteria have
become resistant to antibiotics are diverse and complex. Bacteria
have developed resistance to all different classes of antibiotics
discovered to date. The most frequent type of resistance is
acquired and transmitted horizontally via the conjugation
of a plasmid. In recent times new mechanisms of resistance
have resulted in the simultaneous development of resistance
to several antibiotic classes creating very dangerous multidrug
-resistant (MDR) bacterial strains, some also known as
‘‘superbugs’’. The indiscriminate and inappropriate use of
antibiotics in outpatient clinics, hospitalized patients and
in the food industry is the single largest factor leading to
antibiotic resistance. In recent years, the number of new
antibiotics licensed for human use in different parts of the
world has been lower than in the recent past. In addition,
there has been less innovation in the field of antimicrobial
discovery research and development. The pharmaceutical
industry, large academic institutions or the government are
not investing the necessary resources to produce the next
generation of newer safe and effective antimicrobial drugs.
In many cases, large pharmaceutical companies have terminated
their anti-infective research programs altogether due to economic
reasons. The potential negative consequences of all these events
are relevant because they put society at risk for the spread of
potentially serious MDR bacterial infections.

Structural and biological studies on bacterial nitric oxide synthase
inhibitors
JK Holden,  H Li, Q Jing, S Kang, J Richo, RB Silverman, TL Poulos

Significance: Nitric oxide (NO) produced by bacterial nitric oxide
synthase has recently been shown to protect the Gram-positive
pathogens Bacillus anthracis and Staphylococcus aureus from
antibiotics and oxidative stress. Using Bacillus subtilis as a model
system, we identified two NOS inhibitors that work in conjunction
with an antibiotic to kill B. subtilis. Moreover, comparison of inhibitor-bound crystal structures between the bacterial NOS and mammalian
NOS revealed an unprecedented mode of binding to the bacterial NOS
that can be further exploited for future structure-based drug design.
Overall, this work is an important advance in developing inhibitors
against gram-positive pathogens.

Summary: Nitric oxide (NO) produced by bacterial NOS functions as a
cytoprotective agent against oxidative stress in Staphylococcus aureus,
Bacillus anthracis, and Bacillus subtilis. The screening of several NOS-selective inhibitors uncovered two inhibitors with potential antimicrobial
properties. These two compounds impede the growth of B. subtilis under
oxidative stress, and crystal structures show that each compound exhibits
a unique binding mode. Both compounds serve as excellent leads for the
future development of antimicrobials against bacterial NOS-containing
bacteria.  http://dx.doi.org/10.1073/pnas.1314080110

Speciation of clinically significant coagulase negative Staphylococci
and their antibiotic resistant patterns in a tertiary care hospital
PR Vysakh, S Kandasamy and RM Prabhavathi
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 704-709
http://www.ijcmas.com

Human skin and mucus membrane has Coagulase Negative Staphylococci
(CoNS) as the indigenous flora. CoNS had become an important agent for
nosocomial infections accounting for about 9%. These infections are
difficult to treat because of the risk factors and the multiple drug resistance
nature of these organisms. The study was undertaken to identify the
prevalence of clinical isolates of CoNS, their speciation and to determine
the antibiotic sensitivity/resistant patterns of CoNS. A total of 490 isolates
were collected from different samples and subjected to biochemical
characterization and antimicrobial screening using conventional
microbiological methods. 165 isolates were identified as CoNS. 23% of
CoNS were isolated from blood, 30% from post-operative wound infections,
23% from pus, 18% from urine, 3% from body fluids (CSF, ascitic fluid etc)
and 3% from CVP tips. The antibiotic sensitivity revealed 81% resistance
to Penicillin,32% resistance to Cefoxitin, 27% resistance to Cefazolin,
55% resistance to Erythromycin, 22% to Clindamycin and 35% to
Cotrimoxazole and with no resistance to Vancomycin, Linezolid and
Ciprofloxacin. The increased recognition of CoNS and emergence of
drug resistance among them demonstrates the need to consider them
as a potent pathogen and to devise laboratory procedure to identify
and to determine the prevalence and antibiotic resistant patterns of CoNS.

Resistance to rifampicin: a review
Beth P Goldstein
The Journal of Antibiotics (2014) 67, 625–630
http:://dx.doi.org:/10.1038/ja.2014.107

Resistance to rifampicin (RIF) is a broad subject covering not just the
mechanism of clinical resistance, nearly always due to a genetic change
in the b subunit of bacterial RNA polymerase (RNAP), but also how
studies of resistant polymerases have helped us understand the structure
of the enzyme, the intricacies of the transcription process and its role
in complex physiological pathways. This review can only scratch the
surface of these phenomena. The identification, in strains of
Escherichia coli, of the positions within b of the mutations determining
resistance is discussed in some detail, as are mutations in organisms
that are therapeutic targets of RIF, in particular Mycobacterium
tuberculosis. Interestingly, changes in the same three codons of
the consensus sequence occur repeatedly in unrelated RIF-resistant
(RIFr) clinical isolates of several different single mutation
predominates in mycobacteria. The utilization of our knowledge of
these mutations to develop rapid screening tests for detecting resistance
is briefly discussed. Cross-resistance among rifamycins has been a topic
of controversy; current thinking is that there is no difference in the
susceptibility of RNAP mutants to RIF, rifapentine and rifabutin.
Also summarized are intrinsic RIF resistance and other resistance
mechanisms.

Multi-drug resistance, inappropriate initial antibiotic therapy and
mortality in Gram negative severe sepsis and septic shock: A
retrospective cohort study
MD Zilberberg, AF Shorr, ST Micek, C Vazquez-Guillamet, MH Kollef
Critical Care 2014, 18:596 http://dx.doi.org:/10.1186/s13054-014-0596-8
http://ccforum.com/content/18/6/596

Introduction
The impact of in vitro resistance on initially appropriate antibiotic therapy
(IAAT) remains unclear. We elucidated the relationship between non-IAAT
and mortality, and between IAAT and multi-drug resistance (MDR) in
sepsis due to Gram-negative bacteremia (GNS).
Methods
We conducted a single-center retrospective cohort study of adult intensive
care unit patients with bacteremia and severe sepsis/septic shock caused by
a gram-negative (GN) organism. We identified the following MDR pathogens:
MDR P. aeruginosa, extended spectrum beta lactamase and carbapenemase-
producing organisms. IAAT was defined as exposure within 24 hours of
infection onset to antibiotics active against identified pathogens based on
in vitro susceptibility testing. We derived logistic regression models to
examine a) predictors of hospital mortality and b) impact of MDR on
non-IAAT. Proportions are presented for categorical variables, and
median values with interquartile ranges (IQR) for continuous
variables.

Results
Out of 1,064 patients with GNS, 351 (29.2%) did not survive
hospitalization. Non-survivors were older (66.5 (55, 73.5)
versus 63 (53, 72) years, P =0.036), sicker (Acute Physiology and
Chronic Health Evaluation II (19 (15, 25) versus 16 (12, 19),
P <0.001), and more likely to be on pressors (odds ratio (OR) 2.79,
95% confidence interval (CI) 2.12 to 3.68), mechanically ventilated
(OR 3.06, 95% CI 2.29 to 4.10) have MDR (10.0% versus 4.0%,
P <0.001) and receive non-IAAT (43.4% versus 14.6%, P <0.001).
In a logistic regression model, non-IAAT was an independent
predictor of hospital mortality (adjusted OR 3.87, 95% CI 2.77 to
5.41). In a separate model, MDR was strongly associated with
the receipt of non-IAAT (adjusted OR 13.05, 95% CI 7.00 to 24.31).
Conclusions
MDR, an important determinant of non-IAAT, is associated with
a three-fold increase in the risk of hospital mortality. Given the
paucity of therapies to cover GN MDRs, prevention and
development of new agents are critical.

Phenotypic and molecular characteristics of methicillin-resistant
Staphylococcus aureus isolates from Ekiti State, Nigeria
OA Olowe, OO Kukoyi, SS Taiwo, O Ojurongbe, OO Opaleye, et al.
Infection and Drug Resistance 2013:6 87–92
http://dx.doi.org/10.2147/IDR.S48809

Introduction: The characteristics and antimicrobial resistance profiles
of Staphylococcus aureus differs according to geographical regions and
in relation to antibiotic usage. The aim of this study was to determine
the biochemical characteristics of the prevalent S. aureus from Ekiti State,
Nigeria, and to evaluate three commonly used disk diffusion methods
(cefoxitin, oxacillin, and methicillin) for the detection of methicillin
resistance in comparison with mecA gene detection by polymerase chain
reaction.
Materials and methods: A total of 208 isolates of S. aureus recovered
from clinical specimens were included in this study. Standard
microbiological procedures were employed in isolating the strains.
Susceptibility of each isolate to methicillin (5 μg), oxacillin (1 μg),
and cefoxitin (30 μg) was carried out using the modified Kirby–Bauer/
Clinical and Laboratory Standard Institute disk diffusion technique.
They were also tested against panels of antibiotics including vancomycin.
The conventional polymerase chain reaction method was used to detect
the presence of the mecA gene.
Results: Phenotypic resistance to methicillin, oxacillin, and cefoxitin
were 32.7%, 40.3%, and 46.5%, respectively. The mecA gene was detected
in 40 isolates, giving a methicillin-resistant S. aureus (MRSA) prevalence
of 19.2%. The S. aureus isolates were resistant to penicillin (82.7%) and
tetracycline (65.4%), but largely susceptible to erythromycin (78.8%
sensitive), pefloxacin (82.7%), and gentamicin (88.5%). When compared
to the mecA gene as the gold standard for MRSA detection, methicillin,
oxacillin, and cefoxitin gave sensitivity rates of 70%, 80%, and 100%,
and specificity rates of 76.2%, 69.1%, and 78.5% respectively.
Conclusion: When compared with previous studies employing mecA
polymerase chain reaction for MRSA detection, the prevalence of 19.2%
reported in Ekiti State, Nigeria in this study is an indication of gradual rise
in the prevalence of MRSA in Nigeria. A cefoxitin (30 μg) disk diffusion test
is recommended above methicillin and oxacillin for the phenotypic detection
of MRSA in clinical laboratories.

Direct sequencing for rapid detection of multidrug resistant Mycobacterium
tuberculosis strains in Morocco
F Zakham, I Chaoui, AH Echchaoui, F Chetioui, M Driss Elmessaoudi, et al.
Infection and Drug Resistance 2013:6 207–213
http://dx.doi.org/10.2147/IDR.S47724

Background: Tuberculosis (TB) is a major public health problem with high
mortality and morbidity rates, especially in low-income countries.
Disturbingly, the emergence of multidrug resistant (MDR) and extensively
drug resistant (XDR) TB cases has worsened the situation, raising concerns
of a future epidemic of virtually untreatable TB. Indeed, the rapid diagnosis
of MDR TB is a critical issue for TB management. This study is an attempt to
establish a rapid diagnosis of MDR TB by sequencing the target fragments of
the rpoB gene which linked to resistance against rifampicin and the katG gene
and inhA promoter region, which are associated with resistance to isoniazid.
Methods: For this purpose, 133 sputum samples of TB patients from Morocco
were enrolled in this study. One hundred samples were collected from new
cases, and the remaining 33 were from previously treated patients (drug
relapse or failure, chronic cases) and did not respond to anti-TB drugs after
a sufficient duration of treatment. All samples were subjected to rpoB, katG
and pinhA mutation analysis by polymerase chain reaction and DNA sequencing.
Results: Molecular analysis showed that seven strains were isoniazid-
monoresistant and 17 were rifampicin-monoresistant. MDR TB strains were
identified in nine cases (6.8%). Among them, eight were traditionally
diagnosed as critical cases, comprising four chronic and four drug-relapse
cases. The last strain was isolated from a new case. The most recorded
mutation in the rpoB gene was the substitution TCG . TTG at codon 531
(Ser531 Leu), accounting for 46.15%. Significantly, the only mutation found
in the katG gene was at codon 315 (AGC to ACC) with a Ser315Thr amino acid
change. Only one sample harbored mutation in the inhA promoter region
and was a point mutation at the −15p position (C . T). Conclusion: The
polymerase chain reaction sequencing approach is an accurate and rapid
method for detection of drug-resistant TB in clinical specimens, and could
be of great interest in the management of TB in critical cases to adjust the
treatment regimen and limit the emergence of MDR and XDR strains.

Limiting and controlling carbapenem-resistant Klebsiella pneumoniae
L Saidel-Odes, A Borer.
Infection and Drug Resistance 2014:7 9–14
http://dx.doi.org/10.2147/IDR.S44358

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to
almost all antimicrobial agents, is associated with substantial morbidity
and mortality, and poses a serious threat to public health. The ongoing
worldwide spread of this pathogen emphasizes the need for immediate
intervention. This article reviews the global spread and risk factors for
CRKP colonization/infection, and provides an overview of the strategy
to combat CRKP dissemination.

Staphylococcus aureus – antimicrobial resistance and the immuno-
compromised child
J Chase McNeil
Infection and Drug Resistance 2014:7 117–127
http://dx.doi.org/10.2147/IDR.S39639

Children with immunocompromising conditions represent a unique
group for the acquisition of antimicrobial resistant infections due to
their frequent encounters with the health care system, need for empiric
antimicrobials, and immune dysfunction. These infections are further
complicated in that there is a relative paucity of literature on the clinical
features and management of Staphylococcus aureus infections in
immunocompromised children. The available literature on the clinical
features, antimicrobial susceptibility, and management of S. aureus
infections in immunocompromised children is reviewed. S. aureus
infections in children with human immunodeficiency virus (HIV) are
associated with higher HIV viral loads and a greater degree of CD4 T-cell
suppression. In addition, staphylococcal infections in children with HIV
often exhibit a multidrug resistant phenotype. Children with cancer have
a high rate of S. aureus bacteremia and associated complications. Increased
tolerance to antiseptics among staphylococcal isolates from pediatric
oncology patients is an emerging area of research. The incidence of S. aureus
infections among pediatric solid organ transplant recipients varies
considerably by the organ transplanted; in general however, staphylococci
figure prominently among infections in the early post-transplant period.
Staphylococcal infections are also prominent pathogens among children
with a number of immunodeficiencies, notably chronic granulomatous
disease. Significant gaps in knowledge exist regarding the epidemiology
and management of S. aureus infection in these vulnerable children.

selected Staphylococcus aureus mechanisms for immune evasion.

selected Staphylococcus aureus mechanisms for immune evasion.

Figure 1 A schematic depiction of selected Staphylococcus aureus
mechanisms for immune evasion.
Notes: Cna interacts with C1q preventing formation of the C1qrs complex.
ClfA and SdrE each promote Factor I mediated conversion of C3b to iC3b.
Protein A is depicted binding to the Fc region of IgG preventing immunoglobulin
opsonization.
Abbreviations: ClfA, staphylococcal clumping factor A; Cna, collagen adhesin;
IgG, immunoglobulin G; PVL, Panton–Valentine leukocidin; SdrE, S. aureus
surface protein.

The Future of Antibiotics and Resistance
B Spellberg, JG Bartlett, and DN Gilbert
N Engl J Med Jan 24, 2013; 368(4): 299-302
http://dx.doi.org:/ 10.1056/NEJMp1215093

In its recent annual report on global risks, the World Economic
Forum (WEF) concluded that “arguably the greatest
risk . . . to human health comes in the form of antibiotic-resistant
bacteria. We live in a bacterial world where we will never be able
to stay ahead of the mutation curve. A test of our resilience is
how far behind the curve we allow ourselves to fall.”

The WEF report underscores the facts that antibiotic resistance
and the collapse of the antibiotic research and-development
pipeline continue to worsen despite our ongoing efforts on
current fronts. If we’re to develop countermeasures that
have lasting effects, new ideas that complement traditional
approaches will be needed.

Resistance is primarily the result of bacterial adaptation to eons
of antibiotic exposure. What are the fundamental implications of
this reality? First, in addition to antibiotics’ curative power, their
use naturally selects for preexisting resistant populations of bacteria
in nature. Second, it is not just “inappropriate” antibiotic use
that selects for resistance. Rather, the speed with which resistance
spreads is driven by microbial exposure to all antibiotics, whether
appropriately prescribed or not. Thus, even if all inappropriate
antibiotic use were eliminated, antibiotic-resistant infections
would still occur (albeit at lower frequency). Third, after billions
of years of evolution, microbes have most likely invented
antibiotics against every biochemical target that can be attacked
— and, of necessity, developed resistance mechanisms
to protect all those biochemical targets.

Remarkably, resistance was found even to synthetic antibiotics
that did not exist on earth until the 20th century. These results
underscore a critical reality: antibiotic resistance already exists,
widely disseminated in nature, to drugs we have not yet invented.

Table **

Interventions to Address the Antibiotic-Resistance Crisis.*

Intervention Status                                                   Preventing infection
and resistance

“Self-cleaning” hospital rooms;                                Some commercially available
automated disinfectant application                         but require clinical validation;
through misting, vapor, radiation, etc.                    more needed

Novel drug-delivery systems to replace                  Basic science and
IV catheters; regenerative-tissue technology        conceptual stages
to replace prosthetics; superior, noninvasive
ventilation strategies

Improvement of population health and                 Implementation
health care systems to reduce admissions             research stage
to hospitals and skilled nursing facilities

Niche vaccines to prevent resistant                        Basic and clinical
bacterial infections                                                    development stage

Refilling antibiotic pipeline by aligning
economic and regulatory approaches

Models in place, expansion needed in number    Government or nonprofit grants
and scope; new nonprofit corporations                 and contracts to defray R&D costs
needed                                                                          and establish nonprofits
to develop antibiotics

Institution of novel approval pathways                 Proposed, legislative
(e.g., Limited Population Antibiotic                        and regulatory
Drug proposal)                                                            action needed

Preserving available antibiotics,
slowing resistance

Public reporting of antibiotic-use data as a         Policy action needed to
basis for benchmarking and reimbursement      develop and implement

Development of and reimbursement for            Basic and applied research
rapid diagnostic and biomarker tests to              and policy action and
enable appropriate use of antibiotics                   policy action needed

Elimination of use of antibiotics to                       Legislation proposed
promote livestock growth

New waste-treatment strategies;                       One strategy approaching
targeted chemical or biologic                              clinical trials
degradation of antibiotics in waste

Studies to define shortest effective                    Some trials completed
courses of antibiotics for infections

Developing microbe-attacking                            Preclinical, proof-of-
treatments with diminished                                principle stage
potential to drive resistance

Immune-based therapies, such
as infusion of monoclonal antibodies
and white cells that kill microbes

Antibiotics or biologic agents that
don’t kill bacteria but alter their ability
to trigger inflammation or cause disease

Developing treatments attacking host             Preclinical, proof-of-principle stage
targets rather than microbial targets to
avoid selective pressure driving resistance

Direct moderation of host inflammation
in response to infection (e.g., cytokine
agonists or antagonists, PAMP receptor
agonists)

Sequestration of host nutrients to
prevent microbial access to nutrients

Probiotics that compete with microbial
growth

* IV denotes intravenous, PAMP pathogen-associated molecular
pattern, and R&D research and development

Antibiotic-Resistant Bugs Appear to Use Universal Ribosome-Stalling Mechanism

GEN News  Jan 26, 2015
http://www.genengnews.com/gen-news-highlights/antibiotic-resistant-bugs-
appear-to-use-universal-ribosome-stalling-mechanism/81250847/

Researchers at St. Louis University say they have discovered new information
about how antibiotics like azithromycin stop staph infections, and why staph
sometimes becomes resistant to drugs. The team, led by Mee-Ngan F. Yap, Ph.D.,
believe their evidence suggests a universal, evolutionary mechanism by which
the bacteria elude this kind of drug, offering scientists a way to improve the
effectiveness of antibiotics to which bacteria have become resistant.  Their
study (“Sequence selectivity of macrolide-induced translational attenuation”)
was published in PNAS.

Staphylococcus aureus  is a strain of bacteria that frequently has become
resistant to antibiotics, a development that has been challenging for doctors
and dangerous for patients with severe infections. Dr. Yap and her research
team studied staph that had been treated with the antibiotic azithromycin and
learned two things: One, it turns out that the antibiotic isn’t as effective as was
previously thought. And two, the process that the bacteria use to evade the
antibiotic appears to be an evolutionary mechanism that the bacteria developed
in order to delay genetic replication when beneficial.

Genomic epidemiology of a protracted hospital outbreak caused by multidrug-
resistant Acinetobacter baumannii in Birmingham, England
MR Halachev, J Z-M Chan, CI Constantinidou, N Cumley, C Bradley, et al.
Genome Medicine 2014, 6:70 http://genomemedicine.com/content/6/11/70

Background: Multidrug-resistant Acinetobacter baumannii commonly causes
hospital outbreaks. However, within an outbreak, it can be difficult to identify
the routes of cross-infection rapidly and accurately enough to inform infection
control. Here, we describe a protracted hospital outbreak of multidrug-resistant
A. baumannii, in which whole-genome sequencing (WGS) was used to obtain
a high-resolution view of the relationships between isolates.
Methods: To delineate and investigate the outbreak, we attempted to genome-
sequence 114 isolates that had been assigned to the A. baumannii complex
by the Vitek2 system and obtained informative draft genome sequences from
102 of them. Genomes were mapped against an outbreak reference sequence
to identify single nucleotide variants (SNVs).
Results: We found that the pulsotype 27 outbreak strain was distinct from all
other genome-sequenced strains. Seventy-four isolates from 49 patients
could be assigned to the pulsotype 27 outbreak on the basis of genomic
similarity, while WGS allowed 18 isolates to be ruled out of the outbreak.
Among the pulsotype 27 outbreak isolates, we identified 31 SNVs and seven
major genotypic clusters. In two patients, we documented within-host diversity,
including mixtures of unrelated strains and within-strain clouds of SNV diversity.
By combining WGS and epidemiological data, we reconstructed potential
transmission events that linked all but 10 of the patients and confirmed links
between clinical and environmental isolates. Identification of a contaminated
bed and a burns theatre as sources of transmission led to enhanced
environmental decontamination procedures.
Conclusions: WGS is now poised to make an impact on hospital infection
prevention and control, delivering cost-effective identification of routes of
infection within a clinically relevant timeframe and allowing infection control
teams to track, and even prevent, the spread of drug-resistant hospital pathogens.

Discovery of β-lactam-resistant variants in diverse pneumococcal populations
Regine Hakenbeck
Genome Medicine 2014, 6:72  http://genomemedicine.com/content/6/9/72

Understanding of antibiotic resistance in Streptococcus pneumoniae has been
hindered by the low frequency of recombination events in bacteria and thus the
presence of large linked haplotype blocks, which preclude identification of
causative variants. A recent study combining a large number of genomes of
resistant phenotypes has given an insight into the evolving resistance to
β-lactams, providing the first large-scale identification of candidate variants
underlying resistance.

Additional sources:

A Simple Method for Assessment of MDR Bacteria for Over-Expressed
Efflux Pumps
M Martins, MP McCusker, M Viveiros, I Couto, S Fanning, .., L Amaral
The Open Microbiology Journal, 2013, 7, 1-5

Identification of Efflux Pump-mediated Multidrug-resistant
Bacteria by the Ethidium Bromide-agar Cartwheel Method
M MARTINS, M VIVEIROS, I COUTO,, SS COSTA, .., L AMARAL
in vivo 25: 171-178 (2011)

Efflux Pumps that Bestow Multi-Drug Resistance of Pathogenic
Gram negative Bacteria
Amaral L, Spengler G, Martins A and Molnar J
Biochem Pharmacol 2013; 2(3):119
http://dx.doi.org/10.4172/2167-0501.1000119

graphical abstract

graphical abstract

An Instrument-free Method for the Demonstration
of Efflux Pump Activity of Bacteria
M MARTINS, B SANTOS, A MARTINS, M VIVEIROS, I COUTO,
A CRUZ, THE MANAGEMENT COMMITTEE MEMBERS
OF COST B16 OF THE EUROPEAN COMMISSION/
EUROPEAN SCIENCE FOUNDATION,…, J MOLNAR, S FANNING
and LEONARD AMARAL
in vivo 20: 657-664 (2006)

Potential Therapy of Multidrug-resistant and Extremely
Drug-resistant Tuberculosis with Thioridazine
LEONARD AMARAL and JOSEPH MOLNAR
in vivo 26: 231-236 (2012)

Inhibitors of efflux pumps of Gram-negative bacteria
inhibit Quorum Sensing
Leonard Amaral, Joseph Molnar
Open Journal of Pharmacology, 2012, 2-2

An Overview of Clinical Microbiology, Classification,
and Antimicrobial Resistance
Larry H. Bernstein
http://pharmaceuticalintelligence.com/2015/01/17/an-overview-
of-clinical-microbiology-classification-and-antimicrobial-resistance/

New protein detonates bacteria from within

By Tim Sandle     in Science

Tel Aviv – By sequencing the DNA of bacteria resistant to viral toxins, scientists have identified novel proteins capable of stymieing growth in pathogenic, antibiotic-resistant bacteria.

Today’s arsenal of antibiotics is ineffective against some emerging strains of antibiotic-resistant pathogens. Novel inhibitors of bacterial growth therefore need to be found. One way is looking into the viruses that infect bacteria.

Key to the new initiative is the concept of fighting bacteria from within, rather than using an external chemical to batter through the bacterial cell wall. the basis of the new weapon is viral. In order to select an appropriate viral protein, researchers undertook a comprehensive screening exercise in order to identify proteins in viruses that are known to infect bacteria (bacteriophages). Bacteriophages occur abundantly in the biosphere, with different virions, genomes and lifestyles. The review was so comprehensive that it took almost three years to complete.

The screening was achieved through the use of high-throughput DNA sequencing. This is the process of determining the precise order of nucleotides within a DNA molecule. By using this advanced genetic method, the scientists identified mutations in bacterial genes that resisted the toxicity of growth inhibitors produced by bacterial viruses. Through this, a new, tiny protein was found. The protein is termed “growth inhibitor gene product (Gp) 0.6”.

Later testing found that the protein specifically targets and inhibits the activity of a protein essential to bacterial cells. The bacterial protein affected has the function of holding the microbe’s cell wall together. Without this protein functioning correctly, the cell bursts open from within and the bacterium dies.

For the next wave of research, the Israeli science group are looking further at bacterial viruses with the aim of finding compounds that facilitate improved treatment of antibiotic-resistant bacteria.
Read more: http://www.digitaljournal.com/science/new-protein-detonates-bacteria-from-within/article/424747#ixzz3QJN0uo1d

Revealing bacterial targets of growth inhibitors encoded by bacteriophage T7

Shahar Molshanski-Mora, Ido Yosefa, Ruth Kiroa, Rotem Edgara, Miriam Manora, Michael Gershovitsb, Mia Lasersonb, Tal Pupkob, and Udi Qimrona,1

Author Affiliations

Edited* by Sankar Adhya, National Institutes of Health, National Cancer Institute, Bethesda, MD, and approved November 24, 2014 (received for review July 13, 2014)

Significance

Antibiotic resistance of pathogens is a growing threat to human health, requiring immediate action. Identifying new gene products of bacterial viruses and their bacterial targets may provide potent tools for fighting antibiotic-resistant strains. We show that a significant number of phage proteins are inhibitory to their bacterial host. DNA sequencing was used to map the targets of these proteins. One particular target was a key cytoskeleton protein whose function is impaired following the phage protein’s expression, resulting in bacterial death. Strikingly, in over 70 y of extensive research into the tested bacteriophage, this inhibition had never been characterized. We believe that the presented approach may be broadened to identify novel, clinically relevant bacteriophage growth inhibitors and to characterize their targets.

Abstract

Today’s arsenal of antibiotics is ineffective against some emerging strains of antibiotic-resistant pathogens. Novel inhibitors of bacterial growth therefore need to be found. The target of such bacterial-growth inhibitors must be identified, and one way to achieve this is by locating mutations that suppress their inhibitory effect. Here, we identified five growth inhibitors encoded by T7 bacteriophage. High-throughput sequencing of genomic DNA of resistant bacterial mutants evolving against three of these inhibitors revealed unique mutations in three specific genes. We found that a nonessential host gene, ppiB, is required for growth inhibition by one bacteriophage inhibitor and another nonessential gene, pcnB, is required for growth inhibition by a different inhibitor. Notably, we found a previously unidentified growth inhibitor, gene product (Gp) 0.6, that interacts with the essential cytoskeleton protein MreB and inhibits its function. We further identified mutations in two distinct regions in the mreB gene that overcome this inhibition. Bacterial two-hybrid assay and accumulation of Gp0.6 only in MreB-expressing bacteria confirmed interaction of MreB and Gp0.6. Expression of Gp0.6 resulted in lemon-shaped bacteria followed by cell lysis, as previously reported for MreB inhibitors. The described approach may be extended for the identification of new growth inhibitors and their targets across bacterial species and in higher organisms.

New funding to fight antibiotic resistance SPECIAL

By Tim Sandle

This week the White House stated that it will double the amount of federal funding put aside to combat and preventing antibiotic resistance. The sum stands at greater than $1.2 billion.

Read more: http://www.digitaljournal.com/life/health/new-funding-to-fight-antibiotic-resistance/article/424745#ixzz3QJSBRxLU

U.S. Senator Sherrod Brown has been campaigning across the U.S. about the risks related to antibiotic-resistant infections for several years. Such infections affect more than two million U.S. citizens each year. The issue is not only of importance in one country for the growing menace of antibiotic resistance is, arguably, the single biggest threat faced by the world’s population. Moreover, emerging antimicrobial resistance and the growing shortage of effective antibiotic drugs is widely regarded as a crisis that jeopardizes patient safety and public health.

Senator Brown has welcomed the increased spending, although he also feels that more action is required. “To combat antibiotic resistance, it’s important that we leverage the best in medical expertise, stewardship, and technological innovation,” Brown has told Digital Journal.

He went on to add: “This unprecedented proposal underscores the importance of taking a comprehensive, wide-ranging approach to tackle this issue. I look forward to continuing to work with federal agencies, research institutions, and health care providers to combat this threat to America’s health.”

In 2014, Brown proposed the Strategies to Address Antimicrobial Resistance (STAAR) Act. The aim of this legislation was to boost the federal response to antibiotic resistance through promoting prevention and control. Other measures included: tracking drug-resistant bacteria; supporting enhanced research efforts; and improving the development, use, and stewardship of antibiotics. The Act would have provided an opportunity to bring multiple federal and non-governmental partners together to protect the public health from these drug-resistant bugs.

The Act, reported by Digital Journal, did not get through, despite the recent announcement of increased federal spending. Senator Brown argues that more preventative measures are needed. For this reason he plans to reintroduce similar legislation this year.

The STAAR Act would:

Promote prevention through public health partnerships at the U.S. Centers for Disease Control and Prevention (CDC) and local health departments;

Track resistant bacteria by making data collection better and requiring better reporting;

Improve the use of antibiotics by educating health care facilities on appropriate antibiotic use;

Enhance leadership and accountability in antibiotic resistance by reauthorizing a task force and coordinating agency efforts;

Support research by directing the National Institutes of Health (NIH) to work with other agencies and experts to create a strategic plan to address the problem.

Read more: http://www.digitaljournal.com/life/health/new-funding-to-fight-antibiotic-resistance/article/424745#ixzz3QJSliTXy

Senator takes on antibiotic resistant organisms SPECIAL

By Tim Sandle     Apr 16, 2014 in Science

Washington – With so-called “super bugs” on the rise, U.S. Sen. Sherrod Brown (D-OH) has introduced a bill aimed at slowing down the rate of antibiotic resistant microorganisms.

Read more: http://www.digitaljournal.com/science/senator-takes-on-antibiotic-resistant-organisms/article/381328#ixzz3QJT1jbOk

Senator Brown has introduced the Strategies to Address Antimicrobial Resistance (STAAR) Act. This is legislation aimed at combating antimicrobial resistance. In presenting the Act, Brown called for greater Federal attention to the growth of antibiotic-resistant infections, which affect more than two million Americans each year.

Brown is aiming for the STAAR Act to provide an opportunity to bring multiple federal and non-governmental partners together to protect the public health from these drug-resistant bugs.

Senator Brown contacted Digital Journal to explain more. In explaining the basis to the Act, Brown said: “Each year more than 23,000 Americans die from bacterial infections that are resistant to antibiotics.”

Antimicrobial resistance describes the ability of a microorganism to resist the action of antimicrobial drugs. In some instances some microorganisms are naturally resistant to particular antimicrobial agents; in other instances, the genes of non-disease-causing bacteria can be transferred to pathogenic bacteria, leading to patterns of clinically significant antibiotic resistance. Since the 1990s antibiotic resistance has been of concern for scientists and health policy makers.

Looking at the reasons for this, Brown explained that: “Antibiotics and other antimicrobial drugs have been a victim of their own success. We have used these drugs so widely and for so long that the microbes they are designed to kill have adapted to them, making the drugs less effective.”

Considering this in the context of his Act, Brown added: “We need a comprehensive strategy to address antimicrobial resistance. That is why I am introducing the STAAR Act, which would revitalize efforts to combat super bugs.”

Emerging antimicrobial resistance and the growing shortage of effective antibiotic drugs is widely regarded as a crisis that jeopardizes patient safety and public health. Once confined to hospitals, drug-resistant microbes, such as multi-drug-resistant Staphylococcus aureus (MRSA), are now striking down healthy, non-hospitalized citizens. This includes both the young and old, adults and children. These infections are painful, difficult to treat, and have become a silent epidemic in communities and hospitals across the U.S. (according to CDC).

Brown hopes that the STAAR Act will help strengthen the federal response to antimicrobial resistance by placing more of an emphasis on federal antimicrobial resistance surveillance, prevention and control, and research efforts.

In addition the Senator hopes that the Act will strengthen coordination within both Department of Health and Human Services (HHS) agencies as well as across other federal departments that are important to addressing antimicrobial resistance and enable opportunities to address this issue globally.

By providing for a more comprehensive and coordinated approach to the antimicrobial resistance crisis, it would seem that the STAAR Act represents a critical first step toward resolving what has become a major public health crisis.

Read more: http://www.digitaljournal.com/science/senator-takes-on-antibiotic-resistant-organisms/article/381328#ixzz3QJTWUxTB

H.R. 2285 (113th): Strategies to Address Antimicrobial Resistance Act

Introduced:
Jun 6, 2013 (113th Congress, 2013–2015)

Status:
Died (Referred to Committee) in a previous session of Congress

See Instead:
S. 2236 (same title)

Referred to Committee — Apr 10, 2014

  • Vaccination -how is vaccination important in preventing resistance?
  • Bioterrorism – what are the risks of resistance associated with bioterrorism
  • Antibacterials – do they cause resistance?
  • Food & Farming – why are antimicrobials used in farming?

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Evolution and Medicine

Reporter and Curator: Larry H. Bernstein, MD, FCAP 

 

http://paleoaerie.org/2015/01/21/what-has-evolution-done-for-me-lately/

Excerpt of article

Cancer is an inescapable fact of life. All of us with either die from it or know someone who will. Cancer is so prevalent because it isn’t a disease in the way a flu or a cold is. No outside force or germ is needed to cause cancer (although it can). It arises from the very way we are put together.  Most of the genes that are needed for multicellular life have been found to be associated with cancer. Cancer is a result of our natural genetic machinery that has been built up over billions of years breaking down over time.

CLONAL EVOLUTION OF CANCER. MEL GREAVES.HTTP://WWW.SCIENCE-CONNECTIONS.COM/TRENDS/SCIENCE_CONTENT/EVOLUTION_6.HTM

Cancer is not only a result of evolutionary processes, cancer itself follows evolutionary theory as it grows. The immune system places a selective pressure on cancer cells, keeping it in check until the cancer evolves a way to avoid it and surpass it in a process known as immunoediting. Cancers face selective pressures in the microenvironments in which they grow. Due to the fast growth of cancer cells, they suck up oxygen in the tissues, causing wildly fluctuating oxygen levels as the body tries to get oxygen to the tissues. This sort of situation is bad for normal tissues and so it is for cancer, at least until they evolve and adapt. At some point, some cancer cells will develop the ability to use what is called aerobic glycolysis to make the ATP we use for energy. Ordinarily, our cells only use glycolysis when they run out of oxygen because aerobic respiration (aka oxidative phosphorylation) is far more efficient. Cancer cells, on the other hand, learn to use glycolysis all the time, even in the presence of abundant oxygen. They may not grow as quickly when there is plenty of oxygen, but they are far better than normal cells at hypoxic, or low oxygen, conditions, which they create by virtue of their metabolism. Moreover, they are better at taking up nutrients because many of the metabolic pathways for aerobic respiration also influence nutrient uptake, so shifting those pathways to nutrient uptake rather than metabolism ensures cancer cells get first pick of any nutrients in the area. The Warburg Effect, as this is called, works by selective pressures hindering those cells that can’t do so and favoring those that can. Because cancer cells have loose genetic controls and they are constantly dividing, the cancer population can evolve, whereas the normal cells cannot.

Evolutionary theory can also be used to track cancer as it metastasizes. If a person has several tumors, it is possible to take biopsies of each one and use standard cladistic programs that are normally used to determine evolutionary relationships between organisms to find which tumor is the original tumor. If the original tumor is not one of those biopsied, it will tell you where the cancer originated within the body. You can thus track the progression of cancer throughout a person’s body. Expanding on this, one can even track the effect of cancer through its effects on how organisms interact within ecosystems, creating its own evolutionary stamp on the environment as its effects radiate throughout the ecosystem.

I’ve talked about cancer at decent length (although I could easily go one for many more pages) because it is less well publicly known than some of the other ways that evolutionary theory helps us out in medicine. The increasing resistance of bacteria and viruses to antibiotics is well known. Antibiotic resistance follows standard evolutionary processes, with the result that antibiotic resistant bacteria are expected to kill 10 million people a year by 2050.  People have to get a new flu shot every year because the flu viruses are legion and they evolve rapidly to bypass old vaccinations.  If we are to accurately predict how the viruses may adapt and properly prepare vaccines for the coming year, evolutionary theory must be taken into account. Without it, the vaccines are much less likely to be effective. Evolutionary studies have pointed out important changes in the Ebola virus and how those changes areaffecting its lethality, which will need to be taken into account for effective treatments. Tracking the origins of viruses, like the avian flu or swine flu, gives us information that will be useful in combating them or even stopping them at their source before they become a problem.

HTTP://WWW.MEDSCAPE.COM/VIEWARTICLE/756378

 

 

Read Full Post »

Highlights in the History of Physiology

Larry H. Bernstein, MD, FCAP, Curator

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Milestones in the Evolution of Diagnostics in the US HealthCare System: 1920s to Pre-Genomics

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Diagnostics Industry and Drug Development in the Genomics Era: Mid 80s to Present

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The History of Infectious Diseases and Epidemiology in the late 19th and 20th Century

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The History of Hematology and Related Sciences: A Historical Review of Hematological Diagnosis from 1880 -1980
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Outline of Medical Discoveries between 1880 and 1980

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William Harvey can be credited with founding modern physiology, then Claude Bernard, and then the great anatomist John Hunter, all before the twentieth century.

In the 19th century, curiosity, medical necessity, and economic interest stimulated research concerning the physiology of all living organisms. Discoveries of unity of structure and functions common to all living things resulted in the development of the concept of general physiology, in which general principles and concepts applicable to all living things are sought. Since the mid-19th century, therefore, the word physiology has implied the utilization of experimental methods, as well as techniques and concepts of the physical sciences, to investigate causes and mechanisms of the activities of all living things.
One view of the history of physiology is that it was shortened from a macro-
to a microstructural view with the developments of biochemistry and then molecular biology.  Though that view is attractive, it is not really compliant with a holistic view
of human and mammalian development.  But form and function are the concern of anatomy and physiology, even with the emergence of a subcellular domain.

William Harvey

William Harvey, discoverer of blood circulation and heart function, was born in 1578 in England. He graduated in Padua in 1602, returned to England, and practiced medicine for a long time. Among his patients were two kings of England (James I and Charles I), and Francis Bacon. He published the work “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (An Anatomical Dissertation Upon the Movement of the Heart and Blood in Animals)  in 1682. It is identified as the beginning of modern experimental physiology. Harvey’s study was based only on anatomical experiments; despite increased knowledge in physics and chemistry during the 17th century, physiology remained closely tied to anatomy and medicine.

The seminal work  lays a basic foundation accurately explaining the circulation. In 1609 Harvey was appointed to the staff of St. Bartholomew’s Hospital. He was elected a fellow of the Royal College of Physicians in 1607. His ideas about circulation of the blood were first publicly expressed in lectures he gave in 1616. The work of Aristotle was the basis for Galen’s De usu partium (“On the Use of Parts”) and a source for many early misconceptions in physiology. Galen, the leading physician in ancient times, never thought that the blood circulates.

Harvey first formulated an opinion about the blood circulation by making a simple calculation. Harvey first studied the heartbeat, establishing the existence of the pulmonary (heart-lung-heart) circulation process and noting the one-way flow of blood. When he also realized how much blood was pumped by the heart, he realized there must be a constant amount of blood flowing through the arteries and returning through the veins of the heart, a continuing circular flow. He estimated that the amount of blood that is emitted by each heartbeat about 2 ounces. Because the heart beats 72 times per minute, the sum is about 540 pounds per hour of emitted blood into the aorta. After formulating this hypothesis, he performed experiments and conducted thorough investigation to determine the details of the circulation of the blood.

Harvey stated that arteries carry blood away from the heart while veins carry blood back to the heart. Although Harvey could not visualize the capillaries, the smallest blood vessels that connect the arterioles to small veins, he concluded that there must be capillaries. Harvey pointed out that the function of the heart is to pump blood into the arteries. His theory of the circulation was not readily accepted, Harvey’s work got recognition at the end of his life. The discovery of capillaries by Marcello Malpighi in 1661 provided factual evidence to confirm Harvey’s theory of blood circulation.

Harvey was also involved in the field of Embryology, although less important than the investigation in terms of the circulation of the blood, not something that should be underestimated. He was a careful observer, and his book On the Generation of Animals (On-generation animal world), published in 1651 showed the beginning of the actual field of Embryology. Harvey rejected the theory that the overall structure of the animal body are the same as young and adult animals, the only difference being size. He rightly declared that an embryo grows to its final structure step by step.

http://www.discoveriesinmedicine.com/General-Information-and-Biographies/Harvey-William.html

Herman Boerhaave is sometimes referred to as the father of physiology due to his exemplary teaching in Leiden and his textbook Institutiones medicae (1708).

In the United States, the first physiology professorship was founded in 1789 at the College of Philadelphia, and in 1832, Robert Dunglison published the first comprehensive work on the subject, Human Physiology (Encyclopedia of American History, 2007). In 1833, William Beaumont published a classic work on digestive function.

In the 19th century, physiological knowledge began to accumulate at a rapid rate, in particular with the 1838 appearance of the Cell theory of Matthias Schleiden and Theodor Schwann. It radically stated that organisms are made up of units called cells. Claude Bernard’s (1813–1878) further discoveries ultimately led to his concept of milieu interieur (internal environment), which would later be taken up and championed as “homeostasis” by American physiologist Walter Cannon.

Claude Bernard

Claude Bernard’s first important work was on the functions of the exocrine pancreas; this achievement won him the prize for experimental physiology from the French Academy of Sciences. His most famous work was on the glycogenic function of the liver; in the course of his study he was led to the conclusion that the liver is the seat of an internal secretion, by which it prepares sugar from the elements of the blood passing through it.

In 1851, while examining the effects produced in the temperature of various parts of the body by section of the nerve or nerves belonging to them, he noticed that division of the cervical sympathetic nerve gave rise to more active circulation and more forcible pulsation of the arteries in certain parts of the head, and a few months afterwards he observed that electrical excitation of the upper portion of the divided nerve had the contrary effect. In this way he established the existence of vasomotor nerves, both
vasodilator and vasoconstrictor.

Milieu intérieur is the key process with which Bernard is associated. He wrote, “The stability of the internal environment [the milieu intérieur] is the condition for the free and independent life.”

The living body, though it has need of the surrounding environment, is nevertheless relatively independent of it. This independence which the organism has of its external environment, derives from the fact that in the living being, the tissues are withdrawn from external influences and are protected by a veritable internal environment. The constancy of the internal environment is the condition for free and independent life: the mechanism that makes it possible is that which assures the maintenance, within the internal environment, of all the conditions necessary for the life of the elements.

The constancy of the environment presupposes a perfection of the organism such that external variations are at every instant compensated and brought into balance. In consequence, the higher animal is in a close relation with its environment so that its equilibrium results from a continuous and delicate compensation established as if the most sensitive of balances.

In his major discourse on the scientific method, An Introduction to the Study of Experimental Medicine (1865), Bernard described what makes a scientific theory good and what makes a scientist important, a true discoverer. Unlike many scientific writers of his time, Bernard wrote about his own experiments and thoughts, and used the first person.
http://en.wikipedia.org/wiki/Claude_Bernard

Physiology as a distinct discipline utilizing chemical, physical, and anatomical methods began to develop in the 19th century. Claude Bernard in France; Johannes Müller, Justus von Liebig, and Carl Ludwig in Germany; and Sir Michael Foster in England may be numbered among the founders of physiology as it now is known. At the beginning of the 19th century, German physiology was under the influence of the romantic school of Naturphilosophie. In France, on the other hand, romantic elements were opposed by rational and skeptical viewpoints. Bernard’s teacher, François Magendie, the pioneer of experimental physiology, was one of the first men to perform experiments on living animals. Both Müller and Bernard, however, recognized that the results of observations and experiments must be incorporated into a body of scientific knowledge, and that the theories of natural philosophers must be tested by experimentation. Many important ideas in physiology were investigated experimentally by Bernard, who also wrote books on the subject. He recognized cells as functional units of life and developed the concept of blood and body fluids as the internal environment (milieu intérieur) in which cells carry out their activities. This concept of physiological regulation of the internal environment occupies an important position in physiology and medicine; Bernard’s work had a profound influence on succeeding generations of physiologists in France, Russia, Italy, England, and the United States.

Müller’s interests were anatomical and zoological, whereas Bernard’s were chemical and medical, but both men sought a broad biological viewpoint in physiology rather than one limited to human functions. Although Müller did not perform many experiments, his textbook Handbuch der Physiologie des Menschen für Vorlesungen and his personal influence determined the course of animal biology in Germany during the 19th century.

It has been said that, if Müller provided the enthusiasm and Bernard the ideas for modern physiology, Carl Ludwig provided the methods. During his medical studies at the University of Marburg in Germany, Ludwig applied new ideas and methods of the physical sciences to physiology. In 1847 he invented the kymograph, a cylindrical drum that still is used to record muscular motion, changes in blood pressure, and other physiological phenomena. He also made significant contributions to the physiology of circulation and urine secretion. His textbook of physiology, published in two volumes in 1852 and 1856, was the first to stress physical instead of anatomical orientation in physiology. In 1869 at Leipzig, Ludwig founded the Physiological Institute (neue physiologische Anstalt), which served as a model for research institutes in medical schools all over the world. The chemical approach to physiological problems, developed first in France by Lavoisier, was expanded in Germany by Justus von Liebig, whose books on Organic Chemistry and its Applications to Agriculture and Physiology (1840) and Animal Chemistry (1842) created new areas of study both in medical physiology and agriculture. German schools devoted to the study of physiological chemistry evolved from Liebig’s laboratory at Giessen.

The British tradition of physiology is distinct from that of the continental schools. In 1869 Sir Michael Foster became Professor of Practical Physiology at University College in London, where he taught the first laboratory course ever offered as a regular part of instruction in medicine. The pattern Foster established still is followed in medical schools in Great Britain and the United States. In 1870 Foster transferred his activities to Trinity College at Cambridge, England, and a postgraduate medical school emerged from his physiology laboratory there. Although Foster did not distinguish himself in research, his laboratory produced many of the leading physiologists of the late 19th century in Great Britain and the United States. In 1877 Foster wrote a major book (Textbook of Physiology), which passed through seven editions and was translated into German, Italian, and Russian. He also published Lectures on the History of Physiology (1901). In 1876, partly in response to increased opposition in England to experimentation with animals, Foster was instrumental in founding the Physiological Society, the first organization of professional physiologists. In 1878, again due largely to Foster’s activities, the Journal of Physiology, which was the first journal devoted exclusively to the publication of research results in physiology, was initiated.

Foster’s teaching methods in physiology and a new evolutionary approach to zoology were transferred to the United States. in 1876 by Henry Newell Martin, a professor of biology at Johns Hopkins University in Baltimore, Md. The American tradition drew also on the continental schools. S. Weir Mitchell, who studied under Claude Bernard, and Henry P. Bowditch, who worked with Carl Ludwig, joined Martin to organize the American Physiological Society in 1887, and in 1898 the society sponsored publication of the American Journal of Physiology. In 1868 Eduard Pflüger, professor at the Institute of Physiology at Bonn, founded the Archiv für die gesammte Physiologie, which became the most important journal of physiology in Germany.

Physiological chemistry followed a course partly independent of physiology. Müller and Liebig provided a stronger relationship between physical and chemical approaches to physiology in Germany than prevailed elsewhere. Felix Hoppe-Seyler, who founded his Zeitschrift für physiologische Chemie in 1877, gave identity to the chemical approach to physiology. The American tradition in physiological chemistry initially followed that in Germany; in England, however, it developed from a Cambridge laboratory founded in 1898 to complement the physical approach started earlier by Foster.

Physiology in the 20th century is a mature science; during a century of growth, physiology became the parent of a number of related disciplines, of which of comparative physiology and ecophysiology, biochemistry, biophysics, and molecular biology are examples. Major figures in these fields include Knut Schmidt-Nielsen and George Bartholomew. Most recently, evolutionary physiology has become a distinct subdiscipline.

Physiology, however, retains an important position among the functional sciences that are closely related to the field of medicine. Although many research areas, especially in mammalian physiology, have been fully exploited from a classical-organ and organ-system point of view, comparative studies in physiology may be expected to continue. The solution of the major unsolved problems of physiology will require technical and expensive research by teams of specialized investigators. Unsolved problems include the unravelling of the ultimate bases of the phenomena of life. Research in physiology also is aimed at the integration of the varied activities of cells, tissues, and organs at the level of the intact organism. Both analytical and integrative approaches uncover new problems that also must be solved. In many instances, the solution is of practical value in medicine or helps to improve the understanding of both human beings and other animals.

Among areas that have shown significant growth in the twentieth century are endocrinology (study of function of hormones) and neurobiology (study of function of nerve cells and the nervous system).

Fye, B. W. 1987. The Development of American Physiology: Scientific Medicine in the Nineteenth Century. Baltimore: Johns Hopkins University Press.

Rothschuh, K. E. 1973. History of Physiology. Huntington, N.Y.: Krieger.

The Nobel Prize in Physiology or Medicine

Year Laureate[A] Country[B] Rationale[C]
1901 Emil Adolf von Behring Germany “for his work on serum therapy, especially its application against diphtheria, by which he has opened a new road in the domain of medical science and thereby placed in the hands of the physician a victorious weapon against illness and deaths”[10]
1902 Sir Ronald Ross United Kingdom “for his work on malaria, by which he has shown how it enters the organism and thereby has laid the foundation for successful research on this disease and methods of combating it”[11]
1903 Niels Ryberg Finsen Denmark
(Faroe Islands)
“[for] his contribution to the treatment of diseases, especially lupus vulgaris, with concentrated light radiation, whereby he has opened a new avenue for medical science”[12]
1904 Ivan Petrovich Pavlov Russia “in recognition of his work on the physiology of digestion, through which knowledge on vital aspects of the subject has been transformed and enlarged”[13]
1905 Robert Koch Germany “for his investigations and discoveries in relation to tuberculosis[14]
1906 Camillo Golgi Italy “in recognition of their work on the structure of the nervous system[15]
Santiago Ramón y Cajal Spain
1907 Charles Louis Alphonse Laveran France “in recognition of his work on the role played by protozoa in causing diseases”[16]
1908 Ilya Ilyich Mechnikov Russia “in recognition of their work on immunity[17]
Paul Ehrlich Germany
1909 Emil Theodor Kocher Switzerland “for his work on the physiology, pathology and surgery of the thyroid gland[18]
1910 Albrecht Kossel Germany “in recognition of the contributions to our knowledge of cell chemistry made through his work on proteins, including the nucleic substances[19]
1911 Allvar Gullstrand Sweden “for his work on the dioptrics of the eye[20]
1912 Alexis Carrel France “[for] his work on vascular suture and the transplantation of blood vessels and organs[21]
1913 Charles Richet France “[for] his work on anaphylaxis[22]
1914 Robert Bárány Austria “for his work on the physiology and pathology of the vestibular apparatus[23]
1919 Jules Bordet Belgium “for his discoveries relating to immunity[24]
1920 Schack August Steenberg Krogh Denmark “for his discovery of the capillary motor regulating mechanism”[25]
1921 Not awarded
1922 Archibald Vivian Hill United Kingdom “for his discovery relating to the production of heat in the muscle[26]
Otto Fritz Meyerhof Germany “for his discovery of the fixed relationship between the consumption of oxygen and the metabolism of lactic acid in the muscle”[26]
1923 Sir Frederick Grant Banting Canada “for the discovery of insulin[27]
John James Rickard Macleod Canada
1924 Willem Einthoven The Netherlands “for the discovery of the mechanism of the electrocardiogram[28]
1925 Not awarded
1926 Johannes Andreas Grib Fibiger Denmark “for his discovery of the Spiroptera carcinoma[29]
1927 Julius Wagner-Jauregg Austria “for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica[30]
1928 Charles Jules Henri Nicolle France “for his work on typhus[31]
1929 Christiaan Eijkman The Netherlands “for his discovery of the antineuritic vitamin[32]
Sir Frederick Gowland Hopkins United Kingdom “for his discovery of the growth-stimulating vitamins[32]
1930 Karl Landsteiner Austria “for his discovery of human blood groups[33]
1931 Otto Heinrich Warburg Germany “for his discovery of the nature and mode of action of the respiratory enzyme[34]
1932 Sir Charles Scott Sherrington United Kingdom “for their discoveries regarding the functions of neurons[35]
Edgar Douglas Adrian United Kingdom
1933 Thomas Hunt Morgan United States “for his discoveries concerning the role played by the chromosome in heredity[36]
1934 George Hoyt Whipple United States “for their discoveries concerning liver therapy in cases of anaemia[37]
George Richards Minot United States
William Parry Murphy United States
1935 Hans Spemann Germany “for his discovery of the organizer effect in embryonic development[38]
1936 Sir Henry Hallett Dale United Kingdom “for their discoveries relating to chemical transmission of nerve impulses[39]
Otto Loewi Austria
1937 Albert Szent-Györgyi von Nagyrapolt Hungary “for his discoveries in connection with the biological combustion processes, with special reference to vitamin C and the catalysis of fumaric acid[40]
1938 Corneille Jean François Heymans Belgium “for the discovery of the role played by the sinus and aortic mechanisms in the regulation of respiration[41]
1939 Gerhard Domagk Germany “for the discovery of the antibacterial effects of prontosil[42]
1943 Carl Peter Henrik Dam Denmark “for his discovery of vitamin K[43]
Edward Adelbert Doisy United States “for his discovery of the chemical nature of vitamin K[43]
1944 Joseph Erlanger United States “for their discoveries relating to the highly differentiated functions of single nerve fibres[44]
Herbert Spencer Gasser United States
1945 Sir Alexander Fleming United Kingdom “for the discovery of penicillin and its curative effect in various infectious diseases[45]
Sir Ernst Boris Chain United Kingdom
Howard Walter Florey Australia
1946 Hermann Joseph Muller United States “for the discovery of the production of mutations by means of X-ray irradiation[46]
1947 Carl Ferdinand Cori United States “for their discovery of the course of the catalytic conversion of glycogen[47]
Gerty Theresa Cori, née Radnitz United States
Bernardo Alberto Houssay Argentina “for his discovery of the part played by the hormone of the anterior pituitary lobe in the metabolism of sugar[47]
1948 Paul Hermann Müller Switzerland “for his discovery of the high efficiency of DDT as a contact poison against several arthropods[48]
1949 Walter Rudolf Hess Switzerland “for his discovery of the functional organization of the interbrain as a coordinator of the activities of the internal organs”[49]
António Caetano Egas Moniz Portugal “for his discovery of the therapeutic value of leucotomy (lobotomy) in certain psychoses”[49]
1950 Philip Showalter Hench United States “for their discoveries relating to the hormones of the adrenal cortex, their structure and biological effects”[50]
Edward Calvin Kendall United States
Tadeusz Reichstein Switzerland
Poland
Year Laureate[A] Country[B] Rationale[C]
1951 Max Theiler South Africa “for his discoveries concerning yellow fever and how to combat it”[51]
1952 Selman Abraham Waksman United States “for his discovery of streptomycin, the first antibiotic effective against tuberculosis[52]
1953 Sir Hans Adolf Krebs United Kingdom “for his discovery of the citric acid cycle[53]
Fritz Albert Lipmann United States “for his discovery of co-enzyme A and its importance for intermediary metabolism”[53]
1954 John Franklin Enders United States “for their discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue”[54]
Frederick Chapman Robbins United States
Thomas Huckle Weller United States
1955 Axel Hugo Theodor Theorell Sweden “for his discoveries concerning the nature and mode of action of oxidation enzymes”[55]
1956 André Frédéric Cournand United States “for their discoveries concerning heart catheterization and pathological changes in the circulatory system[56]
Werner Forssmann Federal Republic of Germany
Dickinson W. Richards United States
1957 Daniel Bovet Italy “for his discoveries relating to synthetic compounds that inhibit the action of certain body substances, and especially their action on the vascular system and the skeletal muscles”[57]
1958 George Wells Beadle United States “for their discovery that genes act by regulating definite chemical events”[58]
Edward Lawrie Tatum United States
Joshua Lederberg United States “for his discoveries concerning genetic recombination and the organization of the genetic material of bacteria[58]
1959 Arthur Kornberg United States “for their discovery of the mechanisms in the biological synthesis of ribonucleic acid and deoxyribonucleic acid[59]
Severo Ochoa Spain
United States
1960 Sir Frank Macfarlane Burnet Australia “for discovery of acquired immunological tolerance[60]
Sir Peter Brian Medawar Brazil
United Kingdom
1961 Georg von Békésy United States “for his discoveries of the physical mechanism of stimulation within the cochlea[61]
1962 Francis Harry Compton Crick United Kingdom “for their discoveries concerning the molecular structure of nucleic acids and its significance for information transfer in living material”[62]
James Dewey Watson United States
Maurice Hugh Frederick Wilkins New Zealand
United Kingdom
1963 Sir John Carew Eccles Australia “for their discoveries concerning the ionic mechanisms involved in excitation and inhibition in the peripheral and central portions of the nerve cell membrane[63]
Sir Alan Lloyd Hodgkin United Kingdom
Sir Andrew Fielding Huxley United Kingdom
1964 Konrad Bloch United States “for their discoveries concerning the mechanism and regulation of the cholesterol and fatty acid metabolism[64]
Feodor Lynen Federal Republic of Germany
1965 François Jacob France “for their discoveries concerning genetic control of enzyme and virus synthesis[65]
André Lwoff France
Jacques Monod France
1966 Peyton Rous United States “for his discovery of tumour-inducing viruses[66]
Charles Brenton Huggins United States “for his discoveries concerning hormonal treatment of prostatic cancer[66]
1967 Ragnar Granit Finland/Sweden “for their discoveries concerning the primary physiological and chemical visual processes in the eye[67]
Haldan Keffer Hartline United States
George Wald United States
1968 Robert W. Holley United States “for their interpretation of the genetic code and its function in protein synthesis[68]
Har Gobind Khorana India
Marshall W. Nirenberg United States
1969 Max Delbrück United States “for their discoveries concerning the replication mechanism and the genetic structure of viruses[69]
Alfred D. Hershey United States
Salvador E. Luria Italy
United States
1970 Julius Axelrod United States “for their discoveries concerning the humoral transmittors in the nerve terminals and the mechanism for their storage, release and inactivation”[70]
Ulf von Euler Sweden
Sir Bernard Katz United Kingdom
1971 Earl W. Sutherland, Jr. United States “for his discoveries concerning the mechanisms of the action of hormones[71]
1972 Gerald M. Edelman United States “for their discoveries concerning the chemical structure of antibodies[72]
Rodney R. Porter United Kingdom
1973 Karl von Frisch Federal Republic of Germany “for their discoveries concerning organization and elicitation of individual and social behaviour patterns”[73]
Konrad Lorenz Austria
Nikolaas Tinbergen United Kingdom
1974 Albert Claude Belgium “for their discoveries concerning the structural and functional organization of the cell[74]
Christian de Duve Belgium
George E. Palade Romania
1975 David Baltimore United States “for their discoveries concerning the interaction between tumour viruses and the genetic material of the cell”[75]
Renato Dulbecco Italy
United States
Howard Martin Temin United States
1976 Baruch S. Blumberg United States “for their discoveries concerning new mechanisms for the origin and dissemination of infectious diseases[76]
D. Carleton Gajdusek United States
1977 Roger Guillemin United States “for their discoveries concerning the peptide hormone production of the brain[77]
Andrew V. Schally United States
Rosalyn Yalow United States “for the development of radioimmunoassays of peptide hormones[77]
1978 Werner Arber Switzerland “for the discovery of restriction enzymes and their application to problems of molecular genetics[78]
Daniel Nathans United States
Hamilton O. Smith United States
1979 Allan M. Cormack South Africa “for the development of computer assisted tomography[79]
Sir Godfrey N. Hounsfield United Kingdom
1980 Baruj Benacerraf Venezuela “for their discoveries concerning genetically determined structures on the cell surface that regulate immunological reactions[80]
Jean Dausset France
George D. Snell United States
1981 Roger W. Sperry United States “for his discoveries concerning the functional specialization of the cerebral hemispheres[81]
David H. Hubel Canada “for their discoveries concerning information processing in the visual system[81]
Torsten N. Wiesel Sweden
1982 Sune K. Bergström Sweden “for their discoveries concerning prostaglandins and related biologically active substances”[82]
Bengt I. Samuelsson Sweden
Sir John R. Vane United Kingdom
1983 Barbara McClintock United States “for her discovery of mobile genetic elements[83]
1984 Niels K. Jerne Denmark “for theories concerning the specificity in development and control of the immune system and the discovery of the principle for production of monoclonal antibodies[84]
Georges J.F. Köhler Federal Republic of Germany
César Milstein Argentina
United Kingdom
1985 Michael S. Brown United States “for their discoveries concerning the regulation of cholesterol metabolism[85]
Joseph L. Goldstein United States
1986 Stanley Cohen United States “for their discoveries of growth factors[86]
Rita Levi-Montalcini Italy
1987 Susumu Tonegawa Japan “for his discovery of the genetic principle for generation of antibody diversity”[87]
1988 Sir James W. Black United Kingdom “for their discoveries of important principles for drug treatment[88]
Gertrude B. Elion United States
George H. Hitchings United States
1989 J. Michael Bishop United States “for their discovery of the cellular origin of retroviral oncogenes[89]
Harold E. Varmus United States
1990 Joseph E. Murray United States “for their discoveries concerning organ and cell transplantation in the treatment of human disease”[90]
E. Donnall Thomas United States
1991 Erwin Neher Federal Republic of Germany “for their discoveries concerning the function of single ion channels in cells”[91]
Bert Sakmann Federal Republic of Germany
1992 Edmond H. Fischer Switzerland
United States
“for their discoveries concerning reversible protein phosphorylation as a biological regulatory mechanism”[92]
Edwin G. Krebs United States
1993 Sir Richard J. Roberts United Kingdom “for their discoveries of split genes[93]
Phillip A. Sharp United States
1994 Alfred G. Gilman United States “for their discovery of G-proteins and the role of these proteins in signal transduction in cells”[94]
Martin Rodbell United States
1995 Edward B. Lewis United States “for their discoveries concerning the genetic control of early embryonic development[95]
Christiane Nüsslein-Volhard Federal Republic of Germany
Eric F. Wieschaus United States
1996 Peter C. Doherty Australia “for their discoveries concerning the specificity of the cell mediated immune defence[96]
Rolf M. Zinkernagel Switzerland
1997 Stanley B. Prusiner United States “for his discovery of Prions – a new biological principle of infection”[97]
1998 Robert F. Furchgott United States “for their discoveries concerning nitric oxide as a signalling molecule in the cardiovascular system”[98]
Louis J. Ignarro United States
Ferid Murad United States
1999 Günter Blobel Germany/United States “for the discovery that proteins have intrinsic signals that govern their transport and localization in the cell”[99]
2000 Arvid Carlsson Sweden “for their discoveries concerning signal transduction in the nervous system[100]
Paul Greengard United States
Eric R. Kandel United States
Year Laureate[A] Country[B] Rationale[C]
2001 Leland H. Hartwell United States “for their discoveries of key regulators of the cell cycle[101]
Sir Tim Hunt United Kingdom
Sir Paul M. Nurse United Kingdom
2002 Sydney Brenner South Africa “for their discoveries concerning ‘genetic regulation of organ development and programmed cell death‘”[102]
H. Robert Horvitz United States
Sir John E. Sulston United Kingdom
2003 Paul Lauterbur United States “for their discoveries concerning magnetic resonance imaging[103]
Sir Peter Mansfield United Kingdom
2004 Richard Axel United States “for their discoveries of odorant receptors and the organization of the olfactory system[104]
Linda B. Buck United States
2005 Barry J. Marshall Australia “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease[105]
J. Robin Warren Australia
2006 Andrew Z. Fire United States “for their discovery of RNA interference – gene silencing by double-stranded RNA”[106]
Craig C. Mello United States
2007 Mario R. Capecchi United States “for their discoveries of principles for introducing specific gene modifications in mice by the use of embryonic stem cells.”[107]
Sir Martin J. Evans United Kingdom
Oliver Smithies United States
2008 Harald zur Hausen Germany “for his discovery of human papilloma viruses causing cervical cancer[108]
Françoise Barré-Sinoussi France “for their discovery of human immunodeficiency virus[108]
Luc Montagnier France
2009 Elizabeth H. Blackburn United States
Australia
“for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase[109]
Carol W. Greider United States
Jack W. Szostak United States
2010 Sir Robert G. Edwards United Kingdom “for the development of in vitro fertilization[110]
2011
Bruce A. Beutler United States “for their discoveries concerning the activation of innate immunity[111]
Jules A. Hoffmann France
Ralph M. Steinman United States
Canada
“for his discovery of the dendritic cell and its role in adaptive immunity[111]
(awarded posthumously)[112][113]
2012 Sir John B. Gurdon United Kingdom “for the discovery that mature cells can be reprogrammed to become pluripotent[114]
Shinya Yamanaka Japan
2013 James E. Rothman United States “for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells[5]
Randy W. Schekman United States
Thomas C. Südhof United States
2014 John O’Keefe United States
United Kingdom
“for their discoveries of cells that constitute a positioning system in the brain”
May-Britt Moser Norway
Edvard I. Moser Norway

Footnotes:

  1. In chronological order with prizes not given during war years.
  2. There are distinct categories to observe: infectious disease; vitamins; neurophysiology; biochemistry and molecular biology; immunology and pharmacology; cancer; endocrinology.
  3. There were deserving scientists who did not receive the Nobel Prize:  Most notable – were…
    Rosalind Franklin, Britton Chance, Bernard Horacker, Allan Wilson, perhaps others..

Excerpt from “Sound and Hearing”, Stevens, S. S., & Warshofsky, Fred,eds., Time-Life Books, NY, 1965. p54  “The molder of the modern theory of basilar-membrane “resonance” is Georg von Bekesy. In 1928 Bekesy was a communications engineer in Budapest, studying the mechanical and electrical adaptation of telephone equipment to the demands of the human hearing mechanism. One day, in the course of a casual conversation, an acquantance asked him whether a major improvement would soon be forthcoming in the quality of telephone systems. The idle remark strarted a chain of thought that eventually posed to Bekesy a more fundamental question: “How much better is the quality of the human ear than that of any telephone system?” His search for the answer has added volumes to our present-day knowledge of hearing.”

a sound impulse sends a wave sweeping along the basilar membrane. As the wave moves along the membrane, its amplitude increases until it reaches a maximum, then falls off sharply until the wave dies out. That point at which the wave reaches its greatest amplitude is the point at which the frequency of the sound is detected by the ear. And as Helmholtz had postulated, Bekesy found that the high-frequency tones were perceived near the base of the cochlea and the lower frequencies toward the apex.”
For his studines of the traveling wave, Georg von Bekesy received the Nobel Prize in 1961. His incredible delicate and elegant experiments had traced sound to the very threshold of sensation. …”
http://hyperphysics.phy-astr.gsu.edu/hbase/sound/bekesy.html

In the 1950s, Wald and his colleagues used chemical methods to extract pigments from the retina. Then, using a spectrophotometer, they were able to measure the light absorbance of the pigments. Since the absorbance of light by retina pigments corresponds to thewavelengths that best activate photoreceptor cells, this experiment showed the wavelengths that the eye could best detect. However, since rod cells make up most of the retina, what Wald and his colleagues were specifically measuring was the absorbance of rhodopsin, the main photopigment in rods. Later, with a technique called microspectrophotometry, he was able to measure the absorbance directly from cells, rather than from an extract of the pigments. This allowed Wald to determine the absorbance of pigments in the cone cells (Goldstein, 2001).

Schack August Steenberg Krogh ForMemRS (November 15, 1874 – September 13, 1949) was a Danish professor at the department of zoophysiology at the University of Copenhagen from 1916-1945.[3][4][5] He contributed a number of fundamental discoveries within several fields of physiology, and is famous for developing the Krogh Principle. In 1920 August Krogh was awarded the Nobel Prize in Physiology or Medicine for the discovery of the mechanism of regulation of the capillaries in skeletal muscle. Krogh was first to describe the adaptation of blood perfusion in muscle and other organs according to demands through opening and closing the arterioles and capillaries.

Although neurobiology (as it is now called) has always been subsumed under physiology, its rapid growth in the twentieth century, along with its institutionalization in separate university departments and separate funding programs, has made it an almost completely autonomous discipline. Neurobiology can be divided into two major areas: neurophysiology, or the study of the process by which nerve cells transmit a message; and neurology, the study of the structure and organization of the nervous system. A general work is The Neurosciences: Paths of Discovery, edited by Frederic G. Worden, Judith P. Swazey, and George Adelman (Cambridge, Mass.: MIT Press, 1975). Two articles in this collection stand out as particularly interesting: Richard Jung’s “Some European Neuroscientists: A Personal Tribute” (pp. 477-511), and Judith P. Swazey and Frederic G. Worden’s “On the Nature of Research in Neuroscience” (pp. 569-587). Swazey and Worden look at the development of twentieth-century neurobiology in terms of Thomas Kuhn’s concept of scientific revolution.

Two major questions confronted neurologists at the end of the nineteenth and beginning of the twentieth centuries: What was the basic anatomical element of the nervous system (individual cells, or a continuous nerve network)? How were parts of the nervous system (e.g., peripheral nerves and spinal cord) integrated to produce an overall functioning system? The first question involved considerable debate in the period of the 1870s through the 1890s, though it was resolved ultimately in favor of the neuron theory (individual nerve cells as the basic structural and functional unit of the nervous system) by the early 1909.

Central to that debate was the work of the Spanish cytologist Santiago Ramón y Cajal (1852-1934), whose autobiography Recollections of My Life, translated by E. Horne Craigie with the assistance of Juan Cano (Philadelphia: American Philosophical Society, 1937), contains considerable information about the debate, the clash of paradigms, and Ramón y Cajal’s exquisite techniques for bringing about the resolution. A more recent and historically oriented account is Susan Billings’s “Concepts of Nerve Fiber Development 1839- 1930,” Journal of the History of Biology, 1971, 4:275-306, which shows how study of the embryological development of the nervous system (which Ramón y Cajal wisely exploited) helped to demonstrate that the nervous system arises from many discrete individual cells.

The structural and functional organization of the nervous system has been an area of great advancement during the twentieth century. Much work on the mode of action of the reflex response (as well as on how reflexes are learned) and on the relation between inhibition and excitation of nerve tracks was done by Russian neurologists in the latter part of the nineteenth and especially the early part of the twentieth century. The chief figures there were Ivan Michailovich Sechenov (1829-1905) and Ivan P. Pavlov (1849-1936). Pavlov’s inerest in digestion led him, under Sechenov’s infuence, to study the now-classic conditioned reflex involved in salivation. Pavlov’s life and work is the subject of one English-language volume: B.P. Babkin’s Pavlov, A Biography (Chicago: Univ. Chicago Press, 1949). This source provides valuable insight into a whole school of neurological work that has had as much influence on psychology as on neurobiology in this century.

While the general features and functions of the reflex were understood by the turn of the century, its manner of organization (especially in terms of connections with the brain) was not. A towering figure in elucidating the relationship between central and peripheral nervous systems, and especially the integrative function of the spinal cord, was the British physiologist Charles Scott Sherrington (1857-1952). Regnar Granit’s biography, Charles Scott Sherrington, An Appraisal (London: Nelson, 1967), and  Judith Swayze’s Reflexes and Motor Integration: Sharington’s Concept of Integrative Action (Cambridge, Mass.: Harvard Univ. Press, 1969) are significant sources. Swayze concentrates on a detailed but clear and insightful analysis of Sherrington’s scientific background, his experimental methods, and the development of his hypotheses about integrative action.

Concerning the development of the neurotransmitter hypothesis (conduction across the synapse between adjacent neurons occurs by a chemical process), its antagonists and protagonists, see Michael V. L. Bennett’s “Nicked by Occam’s Razor: Unitarianism in the Investigation of Synaptic Transmission,” Biological Bulletin, Suppl., June 1985, 168:159-167.

http://depts.washington.edu/hssexec/newsletter/1997/allen.html

Sir John Carew Eccles (27 January 1903 – 2 May 1997) was an Australian neurophysiologist who won the 1963 Nobel Prize in Physiology or Medicine for his work on the synapse. He shared the prize with Andrew Huxley and Alan Lloyd Hodgkin. Eccles and colleagues used the stretch reflex as a model. When Eccles passed a current into the sensory neuron in the quadriceps, the motor neuron innervating the quadriceps produced a small excitatory postsynaptic potential (EPSP). When he passed the same current through the hamstring, the opposing muscle to the quadriceps, he saw an inhibitory postsynaptic potential (IPSP) in the quadriceps motor neuron. Although a single EPSP was not enough to fire an action potential in the motor neuron, the sum of several EPSPs from multiple sensory neurons synapsing onto the motor neuron could cause the motor neuron to fire, thus contracting the quadriceps. On the other hand, IPSPs could subtract from this sum of EPSPs, preventing the motor neuron from firing.

However, neuroscience has been repositioned in the 21st century. Arvid Carlsson, 77, of the University of Gothenburg in Sweden, as well as Paul Greengard of Rockefeller University in New York City, and Eric Kandel of New York’s Columbia University, shared the 2000 Nobel Prize in Physiology or Medicine.

Carlsson overturned conventional wisdom in 1950 by proving that dopamine–once thought to be a mere building block in the synthesis of the neurotransmitter norepinephrine–was an important nervous system messenger in its own right. He and others later discovered that Parkinson’s disease, which causes rigidity and tremors, results from a lack of dopamine in the brain.

Greengard, 74, took Carlsson’s insights several steps further in the 1960s by exploring how dopamine, norepinephrine, and serotonin control transmission of nerve signals at the synapse, the junction between communicating nerve cells. Greengard showed that the three neurotransmitters trigger the addition or removal of phosphate groups to proteins involved in nerve signaling, prompting them to interact with other proteins in a cascade of phosphorylation in and around the synapse.

The discovery that protein phosphorylation is key to nerve cell signaling helped inspire the research of Kandel, 70, who found that the ease with which ions such as calcium pass through a cell membrane– depends on whether the proteins forming the membrane’s pore are phosphorylated. Based on these findings, Kandel showed that short-term and long-term memory are related to the strength and duration of nerve impulses, and that new proteins are synthesized to maintain long-term memory.

Neuroscientist Thomas Südhof, MD, professor of molecular and cellular physiology at the Stanford University School of Medicine, shared the 2013 Nobel Prize in Physiology or Medicine with James Rothman, PhD, a former Stanford professor of biochemistry, and Randy Schekman, PhD, who earned his doctorate at Stanford under the late Arthur Kornberg, MD, another winner of the Nobel Prize in Physiology or Medicine. They were awarded the prize “for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells.” Rothman is now a professor at Yale University, and Schekman is a professor at UC-Berkeley.

“Tom Südhof has done brilliant work that lays a molecular basis for neuroscience and brain chemistry,” said Roger Kornberg, PhD, Stanford’s Mrs. George A. Winzer Professor in Medicine. Kornberg was awarded the Nobel Prize in Chemistry in 2006. He is the son of Arthur Kornberg, in whose lab Schekman received his doctorate.

“The brain works by neurons communicating via synapses,” Südhof said in a phone conversation this morning shortly after the announcement. “We’d like to understand how synapse communication leads to learning on a larger scale. How are the specific connections established? How do they form? And what happens in schizophrenia and autism when these connections are compromised?” In 2009, he published research describing how a gene implicated in autism and schizophrenia alters mice’s synapses and produces behavioral changes in the mice, such as excessive grooming and impaired nest building, that are reminiscent of these human neuropsychiatric disorders.

Südhof, along with other researchers worldwide, has identified integral protein components critical to the membrane fusion process. Südhof purified key protein constituents sticking out of the surfaces of neurotransmitter-containing vesicles, protruding from nearby presynaptic-terminal membranes, or bridging them. Then, using biochemical, genetic and physiological techniques, he elucidated the ways in which the interactions among these proteins contribute to carefully orchestrated membrane fusion.

The Nobel Prize in Physiology or Medicine 2014 was divided, one half awarded to John O’Keefe, the other half jointly to May-Britt Moser and Edvard I. Moser “for their discoveries of cells that constitute a positioning system in the brain.”

In 1971, John O’Keefe discovered the first component of this positioning system. He found that a type of nerve cell in an area of the brain called the hippocampus that was always activated when a rat was at a certain place in a room. Other nerve cells were activated when the rat was at other places. O’Keefe concluded that these “place cells” formed a map of the room.

More than three decades later, in 2005, May-Britt and Edvard Moser discovered another key component of the brain’s positioning system. They identified another type of nerve cell, which they called “grid cells”, that generate a coordinate system and allow for precise positioning and pathfinding. Their subsequent research showed how place and grid cells make it possible to determine position and to navigate.

http://www.nobelprize.org/nobel_prizes/medicine/laureates/

History of Physiology
Lois N Magner,
Purdue University, West Lafayette, USA
Published online: April 2001
http://dx.doi.org:/10.1038/npg.els.0003083

Major developments in the history of physiology include William Harvey’s demonstration of the circulation of the blood in the seventeenth century and Claude Bernard’s discovery of internal secretions in the nineteenth century.

For a neglected side of the story, see Seymour S. Cohen’s “The Biochemical Origins of Molecular Biology (Introduction),” Trends in Biochemical Sciences, 1984, 9:334-336, which argues that many of the histories of molecular biology have ignored the contributions of biochemistry to molecular genetics in general and to the discovery of DNA in particular.

Rather than covering the vast array of subjects that rightfully fall under the history of physiology (such as plant physiology and pathology, etc.), I focus on three areas that have been major concerns in the twentieth century: general physiology, neurobiology and endocrinology. For a brief introduction and overview of twentieth-century physiology, it is worthwhile to consult Karl E. Rothschuh’s History of Physiology (Huntington, N.Y.: Krieger, 1973). Chapter 7 (pp. 264-361) deals with the twentieth century; while it does not provide in-depth coverage, the broad outline establishes the framework within which more specialized topics can be placed.

The Prussian-born American physiologist Jacques Loeb (1859-1924), a long-time investigator at the Rockefeller Institute and a close professional friend of such figures as T. H. Morgan, Boss Harrison, J. McKeen Cattell, and W.J. V. Osterhout, set the style of experimental and quantitative biology that influenced a whole generation of biologists, especially in the United States. Loeb championed what he called “the mechanistic conception of life”–the title of a major address he gave in 1911 and of a book of essays collected in 1912 (Cambridge, Mass.: Harvard Univ. Press, 1964). The reprint edition benefits from a superb introduction by Donald Fleming. The Mechanistic Conception of Life was a celebration of the mechanistic materialist viewpoint in twentieth-century biology. A new biography of Loeb is Philip J. Pauly’s Controlling Life: Jacques Loeb and the Engineering Ideal in Biology (New York: Oxford Univ. Press, 1987). As the title suggests, Pauly emphasizes that Loeb’s guiding ideal was the scientific control of life.

Opposition to the “mechanistic conception of life” came from a number of sources–principally embryology and areas of general physiology–from the 1920s onward. Prominent among those who advanced a more holistic approach were the physiologist Walter Bradford Cannon (1871-1942) and the physiological chemist Lawrence J. Henderson (1878-1942). Cannon’s work, is summarized in his popular book The Wisdom of the Body (1932; New York: Norton, 1960). Henderson’s work is summarized, along with a number of other chemical topics, in his “The Fitness of the Environment” (1913; Boston: Beacon Press, 1958). The development of the idea of homeostasis is the subject of a superb essay by Donald Fleming, “Walter B. Cannon and homeostasis,” Social Research, 1984, 51:609-640.

Henderson’s work has been the subject of several studies. John Parascandola’s “Organismic and Holistic Concepts in the Thought of L. J. Henderson,” Journal of the Histoty of Biology, 1971, 4:63-113, relates Henderson’s scientific to his philosophical work. Henderson and Cannon were strongly interested in social regulation and equilibrium, as was fitting for products of the “Progressive Era,” and sought in physiological processes analogies for the notion of social and economic balance. A specific discussion of Henderson’s view of the interrelationship between social and physiological equilibrium theory can be found in Cynthia Eagle Russett’s The Concept of Equilibrium in American Social Thought (New Haven, Conn.: Yale Univ. Press, 1968). See also Stephen J. Cross and William R. Albury, “Walter B. Cannon, L.J. Henderson, and the Organic Analogy,” Osiris, 1987, N.S. 3:165-192.

Endocrinology (the study of the nature and effect of hormones, or “chemical messengers,” produced by the endocrine glands) is an area of general physiology that has shown enormous growth in the twentieth century. It has also been the subject of numerous historical studies. Arthur F. Hughes has prepared a brief but useful introduction titled “A History of Endocrinology,” Journal of the History of Medcine and Allied Sciences, 1977, 32(3): 292-313. While it is largely descriptive and chronological, Hughes’s study demonstrates the close link between clinical pathology and the gradual discovery of the role of hormones in maintaining physiological balance.

The history of endocrinology is the subject of a special issue of the Journal of the History of Biology, 1976, 9. A general introduction to the historiography of endocrinology is provided for the volume by Diana Long Hall and Thomas F. Click (pp. 229-233). Hall has explored some social and technical aspects of the history of sex-hormone research in “Biology, Sex Hormones, and Sexism in the 1920s,” Philosophical Forum 1974, 5:81-96. She suggests that sexist biases about the importance of male over female hormones proved to be a barrier to the technical solution of problems associated with extracting, isolating, and characterizing the chemical nature of sex hormones (principally testosterone and estrogen) in the 1920s.

On a somewhat more specific aspect of endocrinology, Michael Bliss’s The Discovery of Insulin (Chicago: Univ. Chicago Press, 1982) provides a close picture of the technical problems that investigators in any field of endocrinology had to surmount in order to identify, isolate, and purify a given hormone. The insulin story also provides a fascinating picture of the role of drug companies in encouraging and financing hormone research in the period (1920s) before government subsidy of basic scientific research.

http://depts.washington.edu/hssexec/newsletter/1997/allen.html
Cardiovascular Physiology
The Frank–Starling law of the heart (also known as Starling’s law or the Frank–Starling mechanism or Maestrini heart’s law) states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant.  It is based on the late19th century studies by Otto Frank, who found using isolated frog hearts that the strength of ventricular contraction was increased when the ventricle was stretched prior to contraction. This observation was extended by the elegant studies of Ernest Starling and colleagues in the early 20th century who found that increasing venous return, and therefore the filling pressure of the ventricle, led to increased stroke volume in dogs.

The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully. The stroke volume – contractile force model of  Ernest Starling was also based on the earlier observations of Maestrini in 1914.  The hypothesis states that “the mechanical energy set free in the passage from the resting to the active state is a function of the length of the fiber.”  This allows the cardiac output to be synchronized with the venous return without depending upon external regulation to make alterations. Initial length of myocardial fibers determines the initial work done during the cardiac cycle.

The stroke volume may also increase as a result of greater contractility of the cardiac muscle during exercise, independent of the end-diastolic volume. The Frank–Starling mechanism appears to make its greatest contribution to increasing stroke volume at lower work rates, and contractility has its greatest influence at higher work rates.

The first formulation of the law was theorized by the Italian physiologist Dario Maestrini, who on December 13, 1914, started the first of 19 experiments that led him to formulate the “legge del cuore”. Starling, the holder of the Physiology chair at London University, traced Maestrini’s work in 1918. While Starling was identified for the proposed award of the Nobel Prize, Maestrini never received his recognition, and today the “law of the heart” is known worldwide as “Starling’s Law,” though, among the Italian doctors, it is known by the nickname “Legge di Maestrini”.

One mechanism to explain how preload influences contractile force is that increasing the sarcomere length increases troponin C calcium sensitivity, which increases the rate of cross-bridge attachment and detachment, and the amount of tension developed by the muscle fiber (see Excitation-Contraction Coupling).  The effect of increased sarcomere length on the contractile proteins is termed length-dependent activation

It has traditionally been taught that the Frank-Starling mechanism is due to changes in the number of overlapping actin and myosin units within the sarcomere as in skeletal muscle. According to this view, changes in the force of contraction do not result from a change in inotropy. Because we now know that changes in preload are associated with altered calcium handling and troponin C affinity for calcium, a sharp distinction cannot be made mechanistically between length-dependent (Frank-Starling mechanism) and length-independent changes (inotropic mechanisms) in contractile function.

There is no single Frank-Starling curve on which the ventricle operates. There is actually a family of curves, each of which is defined by the afterload and inotropic state of the heart (Figure 2). For example, increasing afterload or decreasing inotropy shifts the curve down and to the right. Decreasing afterload and increasing inotropy shifts the curve up and to the left. To summarize, changes in venous return cause the ventricle to move along a single Frank-Starling curve that is defined by the existing conditions of afterload and inotropy.

Frank-Starling curves show how changes in ventricular preload lead to changes in stroke volume. This graphical representation, however, does not show how changes in venous return affect end-diastolic and end-systolic volume. In order to do this, it is necessary to describe ventricular function in terms of pressure-volume diagrams. When venous return is increased, there is increased filling of the ventricle along its passive pressure curve leading to an increase in end-diastolic volume (Figure 3). If the ventricle now contracts at this increased preload, and the afterload is held constant, the ventricle will empty to the same end-systolic volume, thereby increasing its stroke volume. The increased stroke volume is manifested by an increase in the width of the pressure-volume loop. The normal ventricle, therefore, is capable of increasing its stroke volume to match physiological increases in venous return.

Starling_

Starling_

Starling's Law of the heart

Starling’s Law of the heart

Starling's Law of the heart

Starling’s Law of the heart

Skeletal Muscle Contraction

Muscle Contraction and Relaxation

Step 1

A nerve impulse travels down and axon and causes the release of acetylcholine.

Step 2

Acetylecholine causes the impulse to spread across the surface of the sarcolemma.

Step 3

The nerve impulse enters the T Tubules and Sarcoplasmic Reticulum, stimulating the release of calcium ions.

Step 4

Calcium ions combine with Troponin, shifting troponin and exposing the myosin binding sites on the actin.

Step 5

ATP breaks down ADP + P. The released energy activates the myosin cross bridges and results in the sliding of thin actin myofilament past the thick myosin myofilaments.

Step 6

The sliding of the myofilaments draws the Z lines towards each other, the sarcomere shortens, the muscle fibers contract and therefore muscle contracts.

Step 7

ACh is inactivated by Acetylcholinesterase, inhibiting the nerve impulse conduction across the sarcolemma.

Step 8

Nerve impulse is inhibited, calcium ions are actively transported back into the Sarcoplasmic Reticulum, using the energy from the earlier ATP breakdown.

Step 9

The low calcium concentration causes the myosin cross bridges to separate from the think actin myofilaments and the actin myofilaments return to their relaxed position.

Step 10

Sarcomeres return to their resting lengths, muscle fibers relax and the muscle relaxes.

muscle contraction

muscle contraction

sarcomere structure

sarcomere structure

Contraction

Contraction

Pulmonary Gas Exchange

Inhalation (breathing in) is usually an active movement. The contraction of the diaphragm muscles causes the thoracic cavity to increase in volume, thus decreasing the pressures within the lung (Intrapleural and Alveolar Pressures). This negative pressure within the lungs acts as a Pressure Gradient, thus pulling air into the lungs. As air fills the lungs, the negative alveolar pressure moves back towards atmospheric pressure, and air flow into the lungs slows down. In contrast, expiration (breathing out) is usually a passive process.

Where Pel equals the product of elastance E (inverse of compliance) and volume of the system V, Pre equals the product of flow resistance R and time derivate of volume V (which is equivalent to the flow), Pin equals the product of inertance I and second time derivate of V. R and I are sometimes referred to as Rohrer’s constants.

Alveoli.

Alveoli.

Alveoli_diagram

Alveoli_diagram

Pulmonary circulation

Gas exchange/transport (primarily oxygen and carbon dioxide)

 

Oxyhaemoglobin_dissociation_curve

Oxyhaemoglobin_dissociation_curve

Oxygen-hemoglobin dissociation curve
(Bohr effect, Haldane effect)

The Young–Laplace equation (/ˈjʌŋ ləˈplɑːs/) is a nonlinear partial differential equation that describes the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of surface tension or wall tension, although usage on the latter is only applicable if assuming that the wall is very thin. The Young–Laplace equation relates the pressure difference to the shape of the surface or wall and it is fundamentally important in the study of static capillary surfaces. It is a statement of normal stress balance for static fluids meeting at an interface, where the interface is treated as a surface (zero thickness).

The equation is named after Thomas Young, who developed the qualitative theory of surface tension in 1805, and Pierre-Simon Laplace who completed the mathematical description in the following year. It is sometimes also called the Young–Laplace–Gauss equation, as Gauss unified the work of Young and Laplace in 1830, deriving both the differential equation and boundary conditions using Johann Bernoulli‘s virtual work principles.

Dalton’s law (also called Dalton’s law of partial pressures) states that in a mixture of non-reacting gases, the total pressure exerted is equal to the sum of the partial pressures of the individual gases. This empirical law was observed by John Dalton in 1801 and is related to the ideal gas laws. Dalton’s law is not strictly followed by real gases with deviations being considerably large at high pressures.
http://en.wikipedia.org/wiki/

Histidine residues in hemoglobin can accept protons and act as buffers. Deoxygenated hemoglobin is a better proton acceptor than the oxygenated form.

In red blood cells, the enzyme carbonic anhydrase catalyzes the conversion of dissolved carbon dioxide to carbonic acid, which rapidly dissociates to bicarbonate and a free proton:
CO2 + H2O → H2CO3 → H+ + HCO3
By Le Chatelier’s principle, anything that stabilizes the proton produced will cause the reaction to shift to the right, thus the enhanced affinity of deoxyhemoglobin for protons enhances synthesis of bicarbonate and accordingly increases capacity of deoxygenated blood for carbon dioxide. The majority of carbon dioxide in the blood is in the form of bicarbonate. Only a very small amount is actually dissolved as carbon dioxide, and the remaining amount of carbon dioxide is bound to hemoglobin.

In addition to enhancing removal of carbon dioxide from oxygen-consuming tissues, the Haldane effect promotes dissociation of carbon dioxide from hemoglobin in the presence of oxygen. In the oxygen-rich capillaries of the lung, this property causes the displacement of carbon dioxide to plasma as low-oxygen blood enters the alveolus and is vital for alveolar gas exchange.

The general equation for the Haldane Effect is: H+ + HbO2 ←→ H+Hb + O2; however, this equation is confusing as it reflects primarily the Bohr effect. The significance of this equation lies in realizing that oxygenation of Hb promotes dissociation of H+ from Hb, which shifts the bicarbonate buffer equilibrium towards CO2 formation; therefore, CO2 is released from RBCs, so it can diffuse out into the lungs (vs the Bohr effect being most relevant at non high O2 environment tissues; useful comparison to not confuse the 2 concepts of Haldane vs Bohr- Haldane@lung and Bohr@tissues for their physiological relevance).

http://en.wikipedia.org/wiki/Haldane_effect

Liver

In 1957, the french surgeon Claude Couinaud described 8 liver segments. Since then, radiographic studies describe an average of twenty segments based on distribution of blood supply. Each segment has its own independent vascular and biliary branches. Surgeons utilize these independent segments when performing liver resection for tumor or transplantation.

There are at least three reasons why segmental resection is superior to simple wedge resection. First, segmental resection minimizes blood loss because vascular density is reduced at the borders between segments. Second, it results in improved tumor removal for those cancers which are disseminated via intrasegmental branches of the portal vein. Third, segmental resection spares normal liver allowing for repeat partial hepatectomy.

liver triad

liver triad

Each segment of the liver is further divided into lobules. Lobules are usually represented as discrete hexagonal aggregations of hepatocytes. The hepatocytes assemble as plates which radiate from a central vein. Lobules are served by arterial, venous and biliary vessels at their periphery. Human lobules have little connective tissue separating one lobule from another. The paucity of connective tissue makes it more difficult to identify the portal triads and the boundaries of individual lobules. Central veins are easier to identify due to their large lumen and because they lack connective tissue that invests the portal triad vessels.

Lobules consist of hepatocytes and the spaces between them. Sinusoids are the spaces between the plates of hepatocytes. Sinusoids receive blood from the portal triads. About 25% of total cardiac output enters the sinusoids via terminal portal and arterial vessels. Seventy-five percent of the blood flowing into the liver comes through the portal vein; the remaining 25% is oxygenated blood that is carried by the hepatic artery. The blood mixes, passes through the sinusoids, bathes the hepatocytes and drains into the central vein. About 1.5 liters of blood exit the liver every minute.

The liver is central to a multitude of physiologic functions, including:

Clearance of damaged red blood cells & bacteria by phagocytosis

Nutrient management

Synthesis of plasma proteins such as albumin, globulin, protein C, insulin-like growth factor, clotting factors etc.

Biotransformation of toxins, hormones, and drugs

Vitamin & mineral storage

Kidney

Renal physiology (Latin rēnēs, “kidneys”) is the study of the physiology of the kidney. This encompasses all functions of the kidney, including reabsorption of glucose, amino acids, and other small molecules; regulation of sodium, potassium, and other electrolytes; regulation of fluid balance and blood pressure; maintenance of acid-base balance; the production of various hormones including erythropoietin, and the activation of vitamin D.

Much of renal physiology is studied at the level of the nephron, the smallest functional unit of the kidney. Each nephron begins with a filtration component that filters blood entering the kidney. This filtrate then flows along the length of the nephron, which is a tubular structure lined by a single layer of specialized cells and surrounded by capillaries. The major functions of these lining cells are the reabsorption of water and small molecules from the filtrate into the blood, and the secretion of wastes from the blood into the urine.

Proper function of the kidney requires that it receives and adequately filters blood. This is performed at the microscopic level by many hundreds of thousands of filtration units called renal corpuscles, each of which is composed of a glomerulus and a Bowman’s capsule. A global assessment of renal function is often ascertained by estimating the rate of filtration, called the glomerular filtration rate (GFR).

Renal

Renal

vit D and receptor complex

vit D and receptor complex

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