Recomendaciones sobre el manejo clínico de la infección por el «nuevo coronavirus» SARS-CoV2. Grupo de trabajo de la Asociación Española de Pediatría (AEP)

On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19).The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.     

Epitope mapping and biological function analysis of antibodies produced by immunization of mice with an inactivated Chinese isolate of severe acute respiratory syndrome-associated coronavirus (SARS-CoV)

Inactivated severe acute respiratory syndrome-associated coronavirus (SARS-CoV) has been tested as a candidate vaccine against the re-emergence of SARS. In order to understand the efficacy and safety of this approach, it is important to know the antibody specificities generated with inactivated SARS-CoV. In the current study, a panel of twelve monoclonal antibodies (mAbs) was established by immunizing Balb/c mice with the inactivated BJ01 strain of SARS-CoV isolated from the lung tissue of a SARS-infected Chinese patient. These mAbs could recognize SARS-CoV-infected cells by immunofluorescence analysis (IFA). Seven of them were mapped to the specific segments of recombinant spike (S) protein: six on S1 subunit (aa 12-798) and one on S2 subunit (aa 797-1192). High neutralizing titers against SARS-CoV were detected with two mAbs (1A5 and 2C5) targeting at a subdomain of S protein (aa 310-535), consistent with the previous report that this segment of S protein contains the major neutralizing domain. Some of these S-specific mAbs were able to recognize cleaved products of S protein in SARS-CoV-infected Vero E6 cells. None of the remaining five mAbs could recognize either of the recombinant S, N, M, or E antigens by ELISA. This study demonstrated that the inactivated SARS-CoV was able to preserve the immunogenicity of S protein including its major neutralizing domain. The relative ease with which these mAbs were generated against SARS-CoV virions further supports that subunit vaccination with S constructs may also be able to protect animals and perhaps humans. It is somewhat unexpected that no N-specific mAbs were identified albeit anti-N IgG was easily identified in SARS-CoV-infected patients. The availability of this panel of mAbs also provided potentially useful agents with applications in therapy, diagnosis, and basic research of SARS-CoV.     

抗SARS-CoV病毒N蛋白的单链抗体(scFv)筛选

目的筛选出抗SARS-CoV病毒N蛋白的单链抗体。方法利用原核表达所获得的SARS病毒N蛋白,筛选人源单链抗体噬菌体展示库,经特异性的检测,以期得到抗SARS-CoV病毒N蛋白的特异单链抗体。结果获得了8个抗SARS病毒N蛋白的候选克隆。经测序,获得了编码抗体可变区的基因序列,并进行了原核表达。结论筛选得到的抗SARS-CoV病毒N蛋白单链抗体具有高度的特异性,可以用作临床实验或研究SARS病毒过程中快速检测SARSN蛋白或SARS病毒粒子的候选抗体。     

Serum neopterin for early assessment of severity of severe acute respiratory syndrome

Neopterin and C-reactive protein (CRP) concentrations were determined in serum samples from 129 severe acute respiratory syndrome (SARS) patients and 156 healthy blood donors. In the patients with confirmed SARS, an early neopterin elevation was detected already at the day of onset of symptoms and rose to a maximum level of 45.0 nmol/L 3 days after the onset. All SARS patients had elevated neopterin concentrations (>10 nmol/L) within 9 days after the onset. The mean neopterin concentrations were 34.2 nmol/L in acute sera of SARS patients, 5.1 nmol/L in convalescent sera, and 6.7 nmol/L in healthy controls. In contrast, the mean CRP concentrations in both acute and convalescent sera of SARS patients were in the normal range (<10 mg/L). Serum neopterin level in SARS patients was associated with fever period and thus the clinical progression of the disease, while there was no significant correlation between the CRP level and the fever period. Serum neopterin may allow early assessment of the severity of SARS. The decrease of neopterin level was found after steroid treatment, which indicates that blood samples should be collected before steroid treatment for the neopterin measurement.     

SARS冠状病毒棘突蛋白的S1蛋白诱导小鼠产生中和抗体的研究

目的 研究SARS冠状病毒棘突蛋白受体结合部位S1的免疫原性，为SARS的实验诊断和新型疫苗的研究提供依据。方法 用克隆有哺乳动物细胞密码子优化的SARS-CoV S1基因的质粒pcDNA3．1／S1或P-S1Ig转染293T细胞，用细胞的上清液纯化S1蛋白。以pcDNA3．1／S1质粒对BALB／c小鼠进行2次基因免疫，以纯化的S1蛋白进行加强免疫。用ELISA法检测小鼠抗SARS-CoV的特异性IgG抗体，并在Vero E6细胞上做体外中和实验，检测中和抗体。结果 S1蛋白诱导小鼠产生抗SARS-CoV的特异性抗体；1：1499．68稀释的S1蛋白免疫的小鼠血清可保护50％的细胞对1000TCID50的病毒攻击，而阴性对照血清不能保护细胞对病毒的感染。结论 SAPS冠状病毒棘突蛋白受体结合部位S1能有效诱导机体产生具有高效保护作用的中和抗体免疫反应，可望发展成为理想的SARS棘突蛋白亚单位疫苗。     

人冠状病毒229E、OC43与SARS-CoV血清学相关性的研究

目的 检测正常人和SARS患者血清中3种人冠状病毒（229E、OCA3和SARS-CoV）特异性抗体．分析3种冠状病毒血清学相关性。方法 采用免疫印迹、免疫荧光和ELISA方法检测100例健康献血员、34例SARS患者恢复期以及11例SARS患者双份血清中229E、OCA3和SARS-CoV3种冠状病毒核衣壳（N）蛋白抗体。结果 用免疫荧光方法检测100例健康献血员血清中229E、OCA3和SARS-CoV IgG阳性率分别为98％、100％和1％，34例SARS患者恢复期血清中3种冠状病毒IgG的阳性率均为100％；免疫印迹检测100例健康献血员血清中229E、OCA3和SARS-CoVN蛋白IgG阳性率分别9r7％、99％和2％，34例SARS患者恢复期血清中229E、OCA3和SARS-CoVN蛋白IgG阳性率分别97％、100％和100％；11例SARS患者的急性期和恢复期双份血清中，免疫荧光检测有5例出现229E IgG滴度4倍或以上升高，10例出现OC43 IgG滴度4倍或以上升高，ELISA检测2例出现229EN蛋白IgG滴度4倍以上升高，没有一例出现OCA3N蛋白抗体滴度升高。结论 正常人群中普遍存在229E和OCA3两种人冠状病毒抗体，SARS-CoV感染者存在对人冠状病毒229E和OCA3血清学交叉反应，提示核衣壳蛋白不是引起血清学交叉反应的主要抗原，结果对研究SARS溯源有重要意义。     

SARS-CoV、MERS-CoV、SARS-CoV-2的基因结构特点与致病机制

高致病性冠状病毒具有高发病率、高病死率以及全球大流行等特点,严重威胁人类健康,给社会经济带来巨大挑战。目前关于高致病冠状病毒的致病机制,主要从直接细胞病变效应和间接免疫病理损伤两方面进行讨论,但具体作用基因的研究尚需进一步深入。本文从高致病性冠状病毒的基因结构特点与致病机制的相关性进行综述,为预防和治疗高致病性冠状病毒感染提供参考。     

妊娠期冠状病毒感染与母婴健康研究进展

目前全球范围内正流行新型冠状病毒肺炎（COVID-19）,而其强烈的传播性已引发重大公共卫生危机。新型冠状病毒与严重急性呼吸综合征（SARS）冠状病毒、中东呼吸综合征（MERS）冠状病毒存在高度病原同源性,同为β属冠状病毒。由于孕妇群体在生理和心理上存在一定脆弱性,为疫情流行期间的易感人群和高危人群,本文将对目前所报道的孕产妇罹患SARS、MERS、COVID-19对母婴健康影响进行文献综述,旨在为COVID-19流行中孕妇健康管理与防控提供依据。     

从噬菌体随机肽库中筛选SARS病毒N蛋白表位模拟肽的研究

目的获得具有生物学活性的SARSN蛋白的模拟肽。方法以抗SARS病毒N蛋白的单克隆抗体作为固相筛选分子,免疫筛选噬菌体随机十二肽库,并采用夹心ELISA、竞争抑制试验鉴定阳性克隆。结果经噬菌体富集后,从随机筛选的各46个克隆中得到N蛋白的2个不同表位,即由ELISA鉴定出单克隆抗体C00835个阳性克隆,确定氨基酸序列GXLXTPXXXXGT为SARSN蛋白的一个表位;单克隆抗体C03941个阳性克隆,确定氨基酸序列TTLPXXXXAXXX为SARS病毒N蛋白的另一个表位。结论用噬菌体随机12肽库成功筛选得到SARSN蛋白的2个不同模拟表位,为用SARS表位去探索其病毒的结构及疫苗的研制创造了条件。