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Pathogenesis and Immunity

Analysis of Human Peripheral Blood Samples from Fatal and Nonfatal Cases of Ebola (Sudan) Hemorrhagic Fever: Cellular Responses, Virus Load, and Nitric Oxide Levels

Anthony Sanchez, Matthew Lukwiya, Daniel Bausch, Siddhartha Mahanty, Angela J. Sanchez, Kent D. Wagoner, Pierre E. Rollin
Anthony Sanchez
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • For correspondence: ASanchez1@cdc.gov
Matthew Lukwiya
2Saint Mary's Hospital, Gulu, Uganda
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Daniel Bausch
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Siddhartha Mahanty
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Angela J. Sanchez
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kent D. Wagoner
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pierre E. Rollin
1Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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DOI: 10.1128/JVI.78.19.10370-10377.2004
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  • FIG. 1.
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    FIG. 1.

    Differential staining of peripheral blood smears (Wright's stain). Shown on the top row of images are low-magnification pictures of blood cells from an uninfected patient (A), and Ebola-S virus-infected patients with nonfatal (B) and fatal (C) disease outcomes (samples taken during the acute phase). The arrows in A point to platelets (dramatically reduced or absent in B and C). The bottom row shows higher-magnification images of differentiating and abnormal cells seen in acute-phase blood smears from Ebola-S patients: (D) plasmacytoid lymphocytes, (E) plasma cell, (F) normal neutrophil (top) and lymphoblast (bottom), (G) pseudo-Pelger cells, and (H) neutrophil with fragmented nucleus.

  • FIG. 2.
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    FIG. 2.

    Flow cytometry (lymphocyte phenotyping) of PBMC samples obtained from fatal (A) and nonfatal (B) cases of Ebola-S disease. Average values were plotted as a percentage of gated cells (side scatter × CD24+ for B, T, and CD8+ T cells; side scatter × CD3+ for CD8+ HLA-DR+ and CD8+ CD38+). The numbers of specimens for each group are shown in parentheses in the legend. Arrows indicate the average values derived from four samples taken from healthy volunteers (Special Pathogens Branch workers). ND, not done. Asterisks indicate statistically significant differences between fatal and nonfatal cases (t < 0.05). The bars on the graph indicate standard errors.

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    FIG. 3.

    Relative expression of cytokines, Fas antigen, FasL, and Ebola-S virus GP. Average values were determined from quantitative PCR (TaqMan) assays performed on samples from 48 patients with fatal disease (A) and 70 patients with nonfatal disease (B). Asterisks indicate statistically significant differences between fatal and nonfatal cases (t < 0.05). Black arrows indicate levels for 25 uninfected patients, and white arrow indicate levels for five healthy volunteers (Special Pathogens Branch workers). The bars on the graph indicate standard errors.

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    FIG. 4.

    Relative expression of cytokines, Fas, FasL, and Ebola-S virus GP determined for three patients with severe Ebola-S disease (fatal and nonfatal) (A, B, and C) and one with mild disease (D). Black arrows indicate levels for 25 uninfected patients, and white arrows indicate levels for five healthy volunteers (Special Pathogens Branch workers).

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    FIG. 5.

    Ebola-S virus antigen levels in blood compared with levels of relative Ebola-S virus GP gene expression in PBMC samples. Comparisons were made only on the basis of antigen levels (antigen sum optical density) regardless of time after disease onset. The bars on the graph indicate standard errors. Differences between fatal and nonfatal cases were found not to be statistically significant (t > 0.05).

  • FIG. 6.
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    FIG. 6.

    NO levels in peripheral blood of Ebola-S virus-infected patients. A comparison of average NO concentrations determined for fatal and nonfatal cases is shown. The dashed line indicates a “normal” level, determined from the serum of five healthy volunteers (Special Pathogens Branch workers). Asterisks indicate statistically significant difference between fatal and nonfatal cases (t < 0.05). The bars on the graph indicate standard errors.

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  • TABLE 1.

    Synthetic deoxyoligonucleotide primers used in quantitative PCR assaysa

    Target sequence (GenBank no.)Primers (forward, reverse, and probe)
    Ebola-S virus GPb (AY316199)5′ GGCACTAACGGCAACCATATG
    5′ ACTCGGGATTTGGCTGGAG
    5′ (FAM)-AGATCTCCACCATCGGGATAAGACCGA-(QSY7)
    TNF-α (Z15026)5′ GCCCAGGCAGTCAGATCATCT
    5′ TTGAGGGTTTGCTACAACATGG
    5′ (FAM)-TCG AAC CCC GAG TGA CAA GCC TGT-(QSY7)
    IFN-γ (XM_006883)5′ CAAGGAAGACATGAATGTCAAGTT
    5′ ATTCAAGTCAGTTACCGAATAATTAG
    5′ (FAM)-ATAGCAACAAAAAGAAACGAGATGACTTCGAAAAGC-(QSY7)
    IL-6 (Y00081)5′ GCAACACCAGGAGCAGCC
    5′ AACTCCTTCTCCACAAGCGC
    5′ (FAM)-CAGGGAGAAGGCAACTGGACCGAA-(QSY7)
    IL-8 (M28130)5′ AGCTCTGTCTGGACCCCAAG
    5′ GAATTCTCAGCCCTCTTCAAAAAC
    5′ (FAM)-AAAACTGGGTGCAGAGGGTTGTGGAGA-(QSY7)
    IL-10 (U16720)5′ CGGCGCTGTCATCGATTT
    5′ GGCATTCTTCACCTGCTCCA
    5′ (FAM)-TTCCCTGTGAAAACAAGAGCAAGGCCG-(QSY7)
    MCP-1 (Y18933)5′ GCAGAGGCTCGCGAGCT
    5′ ACAATGGTCTTGAAGATCACAGC
    5′ (FAM)-TAGAAGAATCACCAGCAGCAAGTGTCCCA-(QSY7)
    Fas (X63717)5′ TCCACTAATTGTTTGGGTGAAGAG
    5′ GATTCATGAGAACCTTGGTTTTCC
    5′ (FAM)-AAGGAAGTACAGAAAACATGCAGAAAGCACAGAA-(QSY7)
    FasL (Z96050)5′ TGGCCCATTTAACAGGCAA
    5′ AATTCCATAGGTGTCTTCCCATTC
    5′ (FAM)-TCCAACTCAAGGTCCATGCCTCTGG-(QSY7)
    GAPDH (J04038)5′ CTCAAGATCATCAGCAATGCCT
    5′ AAGTTGTCATGGATGACCTTGG
    5′ (FAM)-CTGCACCACCAACTGCTTAGCACCC-(QSY7)
    • ↵ a All probes were synthesized with a 5′ FAM (6-carboxyfluorescein) and a 3′ dark quencher (QSY7).

    • ↵ b Gulu (2000) strain of Ebola-S virus; primer sequences are specific for this strain.

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Analysis of Human Peripheral Blood Samples from Fatal and Nonfatal Cases of Ebola (Sudan) Hemorrhagic Fever: Cellular Responses, Virus Load, and Nitric Oxide Levels
Anthony Sanchez, Matthew Lukwiya, Daniel Bausch, Siddhartha Mahanty, Angela J. Sanchez, Kent D. Wagoner, Pierre E. Rollin
Journal of Virology Sep 2004, 78 (19) 10370-10377; DOI: 10.1128/JVI.78.19.10370-10377.2004

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Analysis of Human Peripheral Blood Samples from Fatal and Nonfatal Cases of Ebola (Sudan) Hemorrhagic Fever: Cellular Responses, Virus Load, and Nitric Oxide Levels
Anthony Sanchez, Matthew Lukwiya, Daniel Bausch, Siddhartha Mahanty, Angela J. Sanchez, Kent D. Wagoner, Pierre E. Rollin
Journal of Virology Sep 2004, 78 (19) 10370-10377; DOI: 10.1128/JVI.78.19.10370-10377.2004
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KEYWORDS

ebolavirus
Hemorrhagic Fever, Ebola
Leukocytes, Mononuclear
nitric oxide

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