高致病性冠状病毒感染时的固有免疫应答:精准治疗的潜在靶点

21世纪初,包括严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）在内的高致病性冠状病毒对人类健康构成了巨大威胁。随着新型冠状病毒肺炎（COVID-19）在全球的暴发,冠状病毒尤其是能够引起严重下呼吸道感染的高致病性冠状病毒（HPCoVs）再次引起了人们的关注。在HPCoVs不断出现的大背景下,阐明其致病机制并控制感染过程中的宿主免疫对抵抗病毒感染,避免过度反应至关重要。在病毒感染过程中,多种天然免疫信号在冠状病毒感染过程发挥关键作用。本文就近年来出现的HPCoVs特征及其感染过程中天然免疫的应答情况作一综述,借此探寻重症感染患者炎症反应旺盛的原因并解释其临床表现,为进一步探寻精准治疗的潜在靶点。     

生物标记物与精准医疗研究进展

自2015年精准医疗理念提出后,生物标记物与精准医疗愈加被人们重视。并被广泛应用于病毒、癌症等重大疾病的筛查与治疗研究中。新兴循环生物标记物的应用与开发,在HBV、HPV的检测和肿瘤的靶向药物治疗、细胞治疗、免疫抑制剂、癌症疫苗开发方向上都取得了重大成果。与传统的医疗方法相比,生物标记物为辅助精准医疗的检测治疗模式,无论是在研发还是治疗上都有着显著的优势。因此,综述了生物标记物与精准医疗的应用,并就最近的研究报告重点综述了生物标记物与精准医疗的最新研究进展。     

关于HCMV潜伏感染与激活感染研究的新进展

人巨细胞病毒（HCMV）是疱疹病毒科中最大的病毒,结构复杂,其感染在人群中非常普遍,近年来免疫妥协（immunocompmmised）群体尤其是移植群体中的HCMV潜伏感染和激活感染越来越受到临床重视。本文就HCMV的感染与免疫、HCMV的致病机制、宿主的抗感染与免疫、HCMV的免疫逃逸、HCMV的潜伏与激活及HcMV相关研究的困境与展望近年来此方面研究新进辰作一简要综述。     

关于HCMV 潜伏感染与激活感染研究的新进展

人巨细胞病毒(HCMV)是疱疹病毒科中最大的病毒,结构复杂,其感染在人群中非常普遍,近年来免疫妥协(immunocompromised)群体尤其是移植群体中的HCMV潜伏感染和激活感染越来越受到临床重视。本文就HCMV的感染与免疫、HCMV的致病机制、宿主的抗感染与免疫、HCMV的免疫逃逸、HCMV的潜伏与激活及HCMV相关研究的困境与展望近年来此方面研究新进展作一简要综述。     

精准医学基础研究与临床实践的回顾与展望

精准医学是健康卫生和医学科学的发展方向,是发展了一个多世纪的现代医学实践的升级版。本文研究了医学科研和医疗实践的发展趋势,从分子遗传、环境变迁及医疗信息管理等领域,分析和总结了影响精准医学发展的一些因素,提出了精准医学基础研究和临床实践的一些新思路,希望对精准医学的发展、医学科研实践及医疗卫生政策的制定产生积极的影响。     

精准医疗与结核病

精准医疗概念的提出开启了一个医学新时代,且在世界范围内引起了一场科技竞争。精准医疗的实质包括精准诊断和精准治疗,其具体内容,结合各国实际情况各不相同。对中国而言,慢性传染病特别是结核病造成了严重疾病负担,应作为重点研究对象,实际上该领域中各种形式的精准医疗已然展开。精准医疗作为一种新的理念,贯穿于结核病的研究和治疗中,势必对人类结束结核病的肆虐和消除结核病作出重大贡献。     

意识障碍诊断评估及无创精准治疗

由于意识障碍的病因复杂，个体差异较大，对这类患者的诊断和治疗仍存在较多问题。近年来电生理技术、影像学和精准治疗技术的不断发展使得意识障碍的相关研究取得了诸多实质性进展，包括识别患者残余意识、解释意识恢复的生物学机制以及精准治疗技术对受损神经通路的重建等。本文回顾了意识障碍的诊断评估及无创精准治疗的研究进展，并讨论了新兴技术手段在检测意识水平和预测意识恢复方面的重要作用，提出了该领域目前研究存在的不足之处。期望对相关的研究人员具有一定的指导意义。     

2022年精准医学发展态势

精准医学的形成是科技自身发展的客观必然,也是公众对健康需求的推动,体现了医学科学发展趋势,也代表了临床实践发展的方向。经过几年的快速发展,精准医学研究理念和范式已广泛推广,精准医学体系逐渐成熟走向应用。该文在系统梳理2022年精准医学领域的发展布局与举措,前瞻领域发展新趋势、研究新进展、产业新突破的基础上,展望了领域未来发展前景。当前,精准医学的科学价值与健康维护作用进一步凸显,各国系统布局、长期规划、持续加码支持精准医学发展;大型人群队列平台建设广泛开展、疾病研究与疾病精准防诊治方案开始成熟,诊断方案与治疗药物的开发思路及审批标准也开始发生转变,精准医学发展进入新阶段。未来,随高质量大型队列的建设、生命组学技术的发展,以及相关政策体系的完善,精准医学将呈现巨大发展前景。     

轮状病毒的动物感染模型

本文综述了以小鼠和兔为主的动物研究模型对轮状病毒（ＲＶ）感染与免疫的研究。根据感染动物排出病毒、血清学免疫反应等指标,可以间接评价ＲＶ口服疫苗、亚单位疫苗肠道外免疫、粘膜－肠道外联合免疫等对肠道的保护作用以及确定保护作用的相关因素和添加佐剂等新方法的效果。     

丙型肝炎病毒性传播感染研究进展

随着性传播疾病（ＳＴＤ）的流行,丙型肝炎病毒（ＨＣＶ）性传播感染日益受到重视。本文综合分析ＨＣＶ性传播感染流行病学调查研究的不同观点,旨在提醒人们对ＨＣＶ性传播感染的警惕。     

Metabolomic profiling reveals bacterial metabolic adaptation strategies and new metabolites

How has metabolomics helped our understanding of infectious diseases? With the threat of antimicrobial resistance to human health around the world, metabolomics has emerged as a powerful tool to comprehensively characterize metabolic pathways to identify new drug targets. However, its output is constrained to known metabolites and their metabolic pathways. Recent advances in instrumentation, methodologies, and computational mass spectrometry have accelerated the use of metabolomics to understand pathogen–host metabolic interactions. This short review discusses a selection of recent publications using metabolomics in infectious/bacterial diseases. These studies unravel the links between metabolic adaptations to environments and host metabolic responses. Moreover, they highlight the importance of enzyme function and metabolite characterization in identifying new drug targets and biomarkers, as well as precision medicine in monitoring therapeutics and diagnosing diseases.     

Evolution of airborne infectious diseases according to changes in characteristics of the host population

The authors predicted evolutionary changes in airborne infectious diseases according to changes in the characteristics of the host population. The predictions were based upon a mathematical model of infectious diseases and the validity of the predictions was verified against the history of man and pathogens. The feature of this model is that it involves a density of pathogens in the environment as an additional variable which can be regarded as more suitable to airborne infectious diseases. In spite of this modification, this study reached a similar conclusion to the threshold density theory: that is, susceptible host density in the absence of the pathogen must be larger than that in the presence of the pathogen, for the pathogen to be persistent. Moreover the authors concluded that one type of pathogen cannot be replaced by another type of pathogen as long as the susceptible host density of the former type is the mininum one. The predictions were considered to be valid for a wide range of infectous diseases. Making use of these principles, the authors predicted that the variety of infectious diseases should increase as host density increases and that pathogens should evolve to be less virulent as the host life-span increases. The finalidea discussed is whether or nor the history of man and pathogen can be verified by the predictions.     

Genome-wide association studies and susceptibility to infectious diseases

Progress in genomics and the associated technological, statistical and bioinformatics advances have facilitated the successful implementation of genome-wide association studies (GWAS) towards understanding the genetic basis of common diseases. Infectious diseases contribute significantly to the global burden of disease and there is robust epidemiological evidence that host genetic factors are important determinants of the outcome of interactions between host and pathogen. Indeed, infectious diseases have exerted profound selective pressure on human evolution. However, the application of GWAS to infectious diseases has been relatively limited compared with non-communicable diseases. Here we review GWAS findings for important infectious diseases, including malaria, tuberculosis and HIV. We highlight some of the pitfalls recognized more generally for GWAS, as well as issues specific to infection, including the role of the pathogen which also has a genome. We also discuss the challenges encountered when studying African populations which are genetically more ancient and more diverse that other populations and disproportionately bear the main global burden of serious infectious diseases.     

Immunity to intracellular pathogens as a complex genetic trait

Although the role of host heredity in susceptibility to infectious diseases is significant, the genetic control of immunity to infection remains poorly understood. Advances in experimental and epidemiological analyses of complex genetic traits have led to the discoveries of novel genetic determinants of host resistance. New loci that control susceptibility to a number of intracellular pathogens have been identified using mouse models of infectious diseases. The contributions of individual loci, however, vary in quantitative and qualitative manner, depending on mechanisms of pathogen virulence and genetic background of the host. In this review, we discuss how genetic analysis of host resistance contributes to further understanding of host immunity and pathogenesis of intracellular infections.     

Host shift and cospeciation rate estimation from co‐phylogenies

Host shifts can cause novel infectious diseases, and is a key process in diversification. Disentangling the effects of host shift vs. those of cospeciation is non‐trivial as both can result in phylogenic congruence. We develop a new framework based on network analysis and Approximate Bayesian Computation to quantify host shift and cospeciation rates in host‐parasite systems. Our method enables estimation of the expected time to the next host shift or cospeciation event. We then apply it to avian haemosporidian parasite systems and to the pocket gophers‐chewing lice system, and demonstrate that both host shift and cospeciation can be reliably estimated by our method. We confirm that host shifts have shaped the evolutionary history of avian haemosporidian parasites and have played a minor role in the gopher–chewing lice system. Our method is promising for predicting the rate of potential host shifts and thus the emergence of novel infectious diseases.     

The future impact of societal and cultural factors on parasitic disease -- some emerging issues

A variety of societal and cultural factors will increase host exposure or susceptibility to infectious agents, particularly parasites. Such factors have already had a major impact on the emergence of infectious diseases and the situation is likely to worsen further as we enter the new millennium. The changes that are enhancing the spread and transmission of parasitic diseases, as well as those which are adversely affecting host responsiveness, are examined with reference to specific parasites.     

Stochastic two-group models with transmission dependent on host infectivity or susceptibility

ABSTRACT

Stochastic epidemic models with two groups are formulated and applied to emerging and re-emerging infectious diseases. In recent emerging diseases, disease spread has been attributed to superspreaders, highly infectious individuals that infect a large number of susceptible individuals. In some re-emerging infectious diseases, disease spread is attributed to waning immunity in susceptible hosts. We apply a continuous-time Markov chain (CTMC) model to study disease emergence or re-emergence from different groups, where the transmission rates depend on either the infectious host or the susceptible host. Multitype branching processes approximate the dynamics of the CTMC model near the disease-free equilibrium and are used to estimate the probability of a minor or a major epidemic. It is shown that the probability of a major epidemic is greater if initiated by an individual from the superspreader group or by an individual from the highly susceptible group. The models are applied to Severe Acute Respiratory Syndrome and measles.     

Disease and the dynamics of extinction

Invading infectious diseases can, in theory, lead to the extinction of host populations, particularly if reservoir species are present or if disease transmission is frequency-dependent. The number of historic or prehistoric extinctions that can unequivocally be attributed to infectious disease is relatively small, but gathering firm evidence in retrospect is extremely difficult. Amphibian chytridiomycosis and Tasmanian devil facial tumour disease (DFTD) are two very different infectious diseases that are currently threatening to cause extinctions in Australia. These provide an unusual opportunity to investigate the processes of disease-induced extinction and possible management strategies. Both diseases are apparently recent in origin. Tasmanian DFTD is entirely host-specific but potentially able to cause extinction because transmission depends weakly, if at all, on host density. Amphibian chytridiomycosis has a broad host range but is highly pathogenic only to some populations of some species. At present, both diseases can only be managed by attempting to isolate individuals or populations from disease. Management options to accelerate the process of evolution of host resistance or tolerance are being investigated in both cases. Anthropogenic changes including movement of diseases and hosts, habitat destruction and fragmentation and climate change are likely to increase emerging disease threats to biodiversity and it is critical to further develop strategies to manage these threats.     

Microbial (co)infections: Powerful immune influencers

It is well established that by modulating various immune functions, host infection may alter the course of concomitant inflammatory diseases, of both infectious and autoimmune etiologies. Beyond the major impact of commensal microbiota on the immune status, host exposure to viral, bacterial, and/or parasitic microorganisms also dramatically influences inflammatory diseases in the host, in a beneficial or harmful manner. Moreover, by modifying pathogen control and host tolerance to tissue damage, a coinfection can profoundly affect the development of a concomitant infectious disease. Here, we review the diverse mechanisms that underlie the impact of (co)infections on inflammatory disorders. We discuss epidemiological studies in the context of the hygiene hypothesis and shed light on the sometimes dual impact of germ exposure on human susceptibility to inflammatory disease. We then summarize the immunomodulatory mechanisms at play, which can involve pleiotropic effects of immune players and discuss the possibility to harness pathogen-derived compounds to the host benefit.