The long-term objective of this study is to develop and apply to the clinical setting a model of clinical and immunologic parameters of early dengue virus infection which predict the progression from dengue fever (D) to the serious complications of hemorrhage and shock (DHF/DSS). This project will involve a prospective cohort study of children with suspected dengue in Thailand. The study will be conducted in four phases; I. Pilot Study - The phase, conducted in year 1 and continuing into year 2, will analyze potential virologic and immunologic markers of risk for plasma developing DHF/DSS. The levels of T cell and monocyte activation, cytokines, and virus infection of PBMC will be determined by the clinical research core and Project 2. Clinical and laboratory observations will be compared in patients with DHF/DSS, D, and nondengue febrile illness to identify promising prognostic markes for further study. Dengue virus isolates from patients with DHF/DSS and D will be obtained for sequencing and animal studies (Projects 3). II. Validation Study - This phase, conducted in years 2 & 3, will analyze in detail the association of selected early immunologic, virologic, and clinical markers, determined in phase I, with the development of DHF/DSS. These results characterizing beneficial and immunopathological aspects of immune responses to dengue virus will be important in developing safe, effective vaccines. III. Intervention Study - We will design, and plan to initiate in year 4, a study that will use the predictive model developed in phase II to select patients who are at high risk for DHF/DSS. We will test the efficacy of early initiation of therapy in reducing the severity of illness in a controlled trial. The therapy proposed will be based on the hypotheses of pathogenesis of DHF/DSS generated in phases I and II in conjunction with projects 2 and 3 IV. Long-term Follow-up Study - Patients with confirmed DHF/DSS or D in the pilot study will be seen 6, 12, and 24 months infection. Class I and claws II HLA typing will be performed to assess whether specific HLA haplotypes are associated with the development of DHF/DSS. The levels of dengue-specific CTL activity, neutralizing and enhancing antibodies will be measured at these time points to assess the influence of initial presentation (e.g. DHF/DSS vs D) on the persistence of these immune responses.
| Salje, Henrik; Cummings, Derek A T; Rodriguez-Barraquer, Isabel et al. (2018) Reconstruction of antibody dynamics and infection histories to evaluate dengue risk. Nature 557:719-723 |
| Park, Sangshin; Srikiatkhachorn, Anon; Kalayanarooj, Siripen et al. (2018) Use of structural equation models to predict dengue illness phenotype. PLoS Negl Trop Dis 12:e0006799 |
| Kang, Jeon-Young; Aldstadt, Jared (2017) The Influence of Spatial Configuration of Residential Area and Vector Populations on Dengue Incidence Patterns in an Individual-Level Transmission Model. Int J Environ Res Public Health 14: |
| Srikiatkhachorn, Anon; Mathew, Anuja; Rothman, Alan L (2017) Immune-mediated cytokine storm and its role in severe dengue. Semin Immunopathol 39:563-574 |
| Rattanamahaphoom, Jittraporn; Leaungwutiwong, Pornsawan; Limkittikul, Kriengsak et al. (2017) Activation of dengue virus-specific T cells modulates vascular endothelial growth factor receptor 2 expression. Asian Pac J Allergy Immunol 35:171-178 |
| Kalayanarooj, Siripen; Rothman, Alan L; Srikiatkhachorn, Anon (2017) Case Management of Dengue: Lessons Learned. J Infect Dis 215:S79-S88 |
| Moulton, Steven L; Mulligan, Jane; Srikiatkhachorn, Anon et al. (2016) State-of-the-art monitoring in treatment of dengue shock syndrome: a case series. J Med Case Rep 10:233 |
| Srikiatkhachorn, Anon; Yoon, In-Kyu (2016) Immune correlates for dengue vaccine development. Expert Rev Vaccines 15:455-65 |
| Rothman, Alan L; Ennis, Francis A (2016) Dengue Vaccine: The Need, the Challenges, and Progress. J Infect Dis 214:825-7 |
| Townsley, E; O'Connor, G; Cosgrove, C et al. (2016) Interaction of a dengue virus NS1-derived peptide with the inhibitory receptor KIR3DL1 on natural killer cells. Clin Exp Immunol 183:419-30 |
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