<p>Human rhinovirus (HRV) is a single-stranded RNA virus responsible for causing the common cold and exacerbating chronic respiratory diseases. HRV is the most common cause of acute respiratory illness. Unfortunately, difficult culturing conditions and perceived mild symptoms have limited our understanding of HRV. This thesis characterizes fundamental aspects of HRV such as viral load in different patient populations, prevalence and diversity of HRV, and severity and duration of infection.</p> <p>We developed an HRV qPCR assay to quantitate HRV in clinical isolates. We used this assay to measure viral loads in hospitalized and community members. We found that HRV viral loads were similar regardless of age and need for hospitalization. Viral loads were significantly lower amongst individuals with asymptomatic HRV infection than symptomatic HRV infection. Next, we determined the prevalence and diversity of HRV in children and adults. We found that HRV is the most common respiratory pathogen in September-October in both children and adults. A broad range of HRV genotypes can be found circulating amongst children and adults; however HRV C is more prevalent in children. Furthermore, we investigated the association of HRV C duration and severity of illness. Among otherwise healthy individuals, HRV C did not persist longer than HRV A/B, nor was the viral load significantly different. In hospitalized children, HRV C was not more associated with an asthma or wheeze diagnosis. Overall, our data suggest that viral loads do not predict the severity of illness, HRV C commonly occurs in children, and behaves like other HRV species.</p> / Master of Science (MSc)

<p>Upper respiratory tract infection (URTI), which presents clinically as the common cold, is the most common form of respiratory illness experienced by humans and is a major cause of morbidity and hospitalizations. Currently, URTI prevention focuses on hand hygiene with some consideration given to other lifestyle factors such as sleep, nutrition, and exercise. Identifying additional interventions for the prevention of URTI could reduce the burden of this disease.</p> <p>In this thesis, I examine the role of vitamin D3 supplementation and tap water gargling for the prevention of URTI. I employ experimental and observational study designs to assess the effect of these interventions on the risk of URTI in the context of a randomized controlled trial of 600 participants, and a longitudinal cohort of 416 participants. Further, I investigate the association between modifiable lifestyle factors and risk of URTI using data from the longitudinal cohort. Data from this study is also used to explore statistical methods for the analysis of repeated events.</p> <p>When evaluating self-reported, clinical URTI, all analyses supported the use of vitamin D3 supplementation to reduce the risk of URTI. However, this finding was only statistically significant in the analysis of the longitudinal cohort study; results from the RCT indicated that vitamin D3 supplementation statistically significantly reduced the risk of laboratory confirmed infections but had a non-significant benefit for clinical infections. Gargling did not reduce the risk of clinical or laboratory confirmed infections.</p> / Doctor of Philosophy (PhD)

Rhinoviruses (RVs) constitute a substantial public health burden. To evaluate their abundance and genetic diversity in adult patients, RV RNA in respiratory samples was assessed using real-time RT-PCR and the partial nucleic acid sequencing of viral genomes. Additionally, clinical data were retrieved from patient charts to determine the clinical significance of adult RV infections. In total, the respiratory specimens of 284 adult patients (18–90 years), collected from 2013 to 2017, were analyzed. Infections occurred throughout the entire year, with peaks occurring in fall and winter, and showed a remarkably high intra- and interseasonal diversity of RV genotypes. RV species were detected in the following ratios: 60.9% RV-A 173, 12.7% RV-B, and 26.4% RV-C. No correlations between RV species and underlying comorbidities such as asthma (p = 0.167), COPD (p = 0.312) or immunosuppression (p = 0.824) were found. However, 21.1% of the patients had co-infections with other pathogens, which were associated with a longer hospital stay (p = 0.024), LRTI (p < 0.001), and pneumonia (p = 0.01). Taken together, this study shows a pronounced genetic diversity of RV in adults and underlines the important role of co-infections. No correlation of specific RV species with a particular clinical presentation could be deduced.

Rhinoviruses (RVs) constitute a substantial public health burden. To evaluate their abundance and genetic diversity in pediatric patients, RV RNA in respiratory samples was assessed using real-time RT-PCR and partial nucleic acid sequencing of viral genomes. Additionally, clinical data were retrieved from patient charts to determine the clinical significance of pediatric RV infections. In total, the respiratory specimens of 776 patients (<18 years), collected from 2013 to 2017, were analyzed. Infections occurred throughout the entire year, with peaks occurring in fall and winter, and showed remarkably high intra- and interseasonal diversity for RV genotypes. RV species were detected in the following frequencies: 49.1% RV-A, 5.9% RV-B, and 43.6% RV-C. RV-C was found to be more frequently associated with asthma (p = 0.04) and bronchiolitis (p < 0.001), while RV-A was more frequently associated with fever (p = 0.001) and pneumonia (p = 0.002). Additionally, 35.3% of the patients had co-infections with other pathogens, which were associated with a longer hospital stay (p < 0.001), need for ventilation (p < 0.001), and pneumonia (p < 0.001). Taken together, this study shows pronounced RV genetic diversity in pediatric patients and indicates differences in RV-associated pathologies, as well as an important role for co-infections.

O objetivo deste estudo foi avaliar o impacto clínico, funcional e bacteriológico das infecções respiratórias virais nos pacientes com fibrose cística durante um ano. A identificação viral foi feita por métodos de biologia molecular para os seguintes virus: Vírus sincicial respiratório, Influenza A e B, Parainfluenza 1, 2 e 3, Adenovírus, Rinovírus, Metapneumovírus humano, Coronavírus, Enterovírus e Bocavírus. Foram 408 amostras com identificação viral em 199 amostras (48,7%). O Rinovírus foi o mais prevalente sendo identificado em 140 amostras (34,31%), mas contrastando com outros estudos em fibrose cística e em outras doenças pulmonares crônicas, o Rinovírus não mostrou ter impacto clínico, funcional ou bacteriológico significativo nos pacientes com fibrose cística / The objective of this study was to evaluate the clinical, functional and bacteriological impact of the viral respiratory tract infections in cystic fibrosis patients over one year. Viral identification was done through molecular biology methods for the following virus: Respiratory syncytial virus, Influenza A and B, Parainfluenza viruses type 1 to 3, Adenovirus, Rhinovirus, Human metapneumovirus, Coronavirus, Enterovirus and Human bocavirus. 199 (48,7%) samplings among 408 were positive for at least one virus. Rhinovirus was the virus with a higher prevalence, which was identified in 140 samplings (34,31%), but without clinical, functional or bacteriological impact contrasting with other studies in patients with cystic fibrosis and other chronic lung diseases

O objetivo deste estudo foi avaliar o impacto clínico, funcional e bacteriológico das infecções respiratórias virais nos pacientes com fibrose cística durante um ano. A identificação viral foi feita por métodos de biologia molecular para os seguintes virus: Vírus sincicial respiratório, Influenza A e B, Parainfluenza 1, 2 e 3, Adenovírus, Rinovírus, Metapneumovírus humano, Coronavírus, Enterovírus e Bocavírus. Foram 408 amostras com identificação viral em 199 amostras (48,7%). O Rinovírus foi o mais prevalente sendo identificado em 140 amostras (34,31%), mas contrastando com outros estudos em fibrose cística e em outras doenças pulmonares crônicas, o Rinovírus não mostrou ter impacto clínico, funcional ou bacteriológico significativo nos pacientes com fibrose cística / The objective of this study was to evaluate the clinical, functional and bacteriological impact of the viral respiratory tract infections in cystic fibrosis patients over one year. Viral identification was done through molecular biology methods for the following virus: Respiratory syncytial virus, Influenza A and B, Parainfluenza viruses type 1 to 3, Adenovirus, Rhinovirus, Human metapneumovirus, Coronavirus, Enterovirus and Human bocavirus. 199 (48,7%) samplings among 408 were positive for at least one virus. Rhinovirus was the virus with a higher prevalence, which was identified in 140 samplings (34,31%), but without clinical, functional or bacteriological impact contrasting with other studies in patients with cystic fibrosis and other chronic lung diseases

Le rhinovirus (RV) est connu pour être l'étiologie de plus de la moitié des rhumes bénins. Ces virus ont également été associés à des pathologies respiratoires beaucoup plus graves (asthme, bronchopneumopathie chronique obstructive (BPCO) et mucoviscidose). Le développement d'inhibiteurs de décapsidation du virus, appelés agents « capsid-binders », est ainsi devenu une priorité pour de nombreux laboratoires de recherche. Dans ce contexte, une classe d’inhibiteurs se liant au sein de la poche hydrophobe de la protéine capsidaire VP1 a été développée par notre équipe au travers d’une stratégie radicalaire médiée par le TDAE (Tétrakis(DiméthylAmino)Ethylène). Dans le but de poursuivre les investigations sur le hit LPCRW_0005, un travail de pharmacochimie a été entrepris selon deux approches. Dans un premier temps, une optimisation de la taille du LPCRW_0005 a été envisagée par un allongement du squelette chimique. La conception de ces molécules a été guidée par l’utilisation de modélisation moléculaire via la réalisation de docking rigide ligand/protéine. La synthèse de nombreux composés et leur évaluation in vitro, ont permis de mieux apprécier le potentiel biologique de ce type de dérivés. L’identification de la configuration active du centre stéréogène porté par le linker alcool a été rendue possible par la séparation énantiosélective de certains inhibiteurs suivie d’une caractérisation basée sur un protocole de Mosher. Dans un second temps, une étude comparative des séquences primaires protéiques, nous ont conduits à concevoir de nouveaux composés afin de développer des « capsid-binders » à plus large spectre d'action. / Rhinovirus (RV), virus of Picornaviridae family, is known to be the aetiology of more than half of the common cold. Through advances in molecular biology, the rhinoviruses have been associated with much more serious respiratory pathologies (asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis). So, the development of viral attachment and/or uncoating inhibitors named « capsid-binders » molecules has become a priority for many research laboratories. In this context, a class of inhibitors binding into a hydrophobic pocket of the VP1 capsid protein has been identified by our team through a TDAE strategy. In order to follow the investigations on the LPCRW_0005 hit, a pharmacochemistry work was begun according to two approaches. Initially, an optimisation of the LPCRW_0005 size was envisaged by an extension of the scaffold via various pallado-catalyzed cross-coupling reactions. The design of these molecules was guided by the use of molecular modeling via a rigid ligand/protein docking. The synthesis of many compounds and their in vitro biological evaluation on HeLa cells infected with the rhinovirus 14 (RV-B14), refined our knowledge about the biological potential of such a scaffold. The enantioselective separation of some inhibitors followed by a Mosher’s protocol allowed us to identify the active configuration of the alcohol linker. Finally, a comparative study of protein primary sequences as well as drug design, led us to design and develop more potent broad-spectrum capsid-binders.

Introducción: Las infecciones agudas del tracto respiratorio (IRA) son muy prevalentes, las IRAs bajas constituyen la cuarta causa de muerte a nivel mundial. Los agentes causales más comunes en niños son el Rinovirus (RV) y el Virus sincitial respiratorio (VSR). Existen tres especies de RV (A, B, C), estudios recientes han demostrado que la sintomatología y severidad de la enfermedad varía dependiendo de la especie de RV por la que hayan sido infectados los pacientes. Objetivo: Evaluar la prevalencia de Rinovirus en muestras de hisopado nasofaríngeo de niños con diagnóstico clínico de IRA en Lima, Perú durante el periodo 2009-2010. Materiales y métodos: Estudio retrospectivo de muestras de hisopado nasofaríngeo en niños, procesadas por la técnica RT-PCR para identificación de RV y sus especies. La población está compuesta por pacientes pediátricos en el Hospital Nacional Cayetano Heredia. Se analizó las variables por medio de la prueba de Chi cuadrado y Fischer. Resultados: RVA se detectó en 10.26%, RVB en 16.67%, RVC 73.9%. Grupo etario más prevalente fue de 0-5 meses. Signos y síntomas más comunes fueron tos, fiebre, rinorrea y dificultad respiratoria. Se encontró asociación entre sibilancias y RVA; tos, sibilancias e inyección conjuntival con RVC. Se halló pico de casos por RVC durante marzo, junio y noviembre. Conclusión: Se encontró alta prevalencia de infección por RVC en pacientes pediátricos, principalmente en pacientes de 0-5 meses. Distribución mensual muestra aumento de casos en marzo y junio. Se sugiere realizar vigilancia epidemiológica y estudios longitudinales para el estudio de este patógeno. / Introduction: Acute respiratory tract infections (ARTI) are a very prevalent group of diseases, lower ARTI represent the fourth cause of death worldwide. In children, the two most usual agents are Rhinovirus (RV) and Syncytial respiratory virus (SRV). RV is responsible for most is related with lower respiratory tract infections. Scientists have identified three RV species (A, B, C), recent studies have reported that symptomatology and severity vary within RV species. Objective: Asses the prevalence of Rhinovirus on nasopharyngeal swab samples of children with clinical diagnosis of ARTI in Lima, Peru during 2009-2010. Materials and method: Retrospective study about nasopharyngeal swab on children, which were processed through RT-PCR technique to identify RV and its species. The study population was pediatric patients, with clinical diagnosis of ARTI, at Hospital Nacional Cayetano Heredia. This investigation project will be revised by the ethics committee from Universidad Peruana de Ciencias Aplicadas. Results: RVA was detected in 10.26% of cases, RVB 16-67% and RVC in 73.9%. The most prevalent age group was the 0-5 months old. The most common signs and symptoms were cough, fever, rhinorrhea, and respiratory distress. The study found association between wheezing and RVA infection, cough, wheezing and conjunctival injection and RVC infection. There was a peak in RVC cases during the March, June, and November. Conclusion: We found a high prevalence for RVC infection, mainly in children between 0-5 months old. Monthly distribution showed an increase of RVC cases during March and June; epidemiological surveillance and longitudinal studies should be encouraged. / Tesis

Ce travail de pharmacochimie est consacré à la synthèse de nouvelles molécules benzéniques en vue d’étudier leurs propriétés pharmacologiques in vitro sur le Rhinovirus humain 14 mais également d’en déduire des relations de structure activité. En effet, le fil conducteur du projet de thèse est un travail de pharmacomodulation en collaboration avec le Rega Institute for Medical Research de Louvain. La méthode principale de synthèse de ces structures est basée sur la méthodologie TDAE ou Tétrakis(DiméthylAmino)Ethylène, appliquée sur des substrats dérivés du chlorure de nitrobenzyle. La synthèse et l’évaluation biologique de plus de 100 molécules a permis de décrire 5 hits dérivés du 4,5-diméthoxybenzène présentant des activités biologiques intéressantes in vitro (Concentration Effective Médiane de 1,5 à 4,3 μM ; index de sélectivité de 6 à 92). Les différentes stratégies adoptées lors de ce travail de pharmacochimie ont permis d’étendre l’étude des réactions par transfert monoélectronique sur de nouveaux substrats. Ainsi, le 1-(3-chloroprop-1-ynyl)-4-nitrobenzène a fait l’objet d’une étude en méthodologie LD-SRN1 avec des nitroalcanes, nitrocycloalcanes ainsi qu’avec des anions sulfinates ; ces travaux ont permis de décrire de nouveaux substrats insaturés originaux avec de bons rendements. De plus, la réactivité de ce substrat original a été évaluée en méthodologie TDAE avec des aldéhydes aromatiques. Ces travaux ont été valorisés par la synthèse de diarylbutynols originaux et ouvrent de nombreuses perspectives de recherche sur ce même noyau. / This pharmacochemistry work aims at synthesizing of new benzenic derivatives molecules with the scope to study both the chemical and antirhinoviruses 14 pharmacological properties in vitro. In fact, this work was focused on the pharmacomodulation of benzonitrile derivatives in collaboration with Rega Institute for Medical Research group. One hundred structural analogues were synthesized and a structure-activity-relationship was established. Biological assays showed five molecules with interesting anti-hRV 14 activities (EC50 from 1.5 to 4.3 and selectivity index from 6 to 92).These products derived from the TDAE-initiated reaction of various nitrobenzyl chloride analogues. Different strategies directed toward this pharmacochemistry project permitted to study single electron transfer (SET) reaction on original substrates. In this way, we explored the concept of LD-SRN1 on a propargylic chloride derivative such as 1-(3-chloroprop-1-ynyl)-4-nitrobenzene with nitronate and sulfinate anions. This latter compound also constitutes a potential substrate for the preparation of a propargylic anion using the TDAE strategy. So, we examined the use of TDAE methodology in alkyne series with various aromatic aldehydes in the presence of TDAE. These last works opened the scope of single electron transfer (SET) reactions.

Introduction: Epidemiological studies have indicated that 5-38% of influenza like illnesses (ILI) develop into severe disease due to, among others, factors such as; underlying chronic diseases, age, pregnancy, and viral mutations. There are suggestions that dual or multiple virus infections may affect disease severity. This study investigated the association between co-infection between influenza A viruses and other respiratory viruses and disease severity. Methodology: Datum for samples from North West England tested between January 2007 and June 2012 was analysed for patterns of co-infection between influenza A viruses and ten respiratory viruses. Risk of hospitalization to a general ward ICU or death in single versus mixed infections was assessed using multiple logistic regression models. Results: One or more viruses were identified in 37.8% (11,715/30,975) of samples, of which 10.4% (1,214) were mixed infections and 89.6% (10,501) were single infections. Among patients with influenza A(H1N1)pdm09, co-infections occurred in 4.7% (137⁄2,879) vs. 6.5% (59⁄902) in those with seasonal influenza A virus infection. In general, patients with mixed respiratory virus infections had a higher risk of admission to a general ward (OR: 1.43, 95% CI: 1.2 – 1.7, p = <0.0001) than those with a single infection. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/ death (OR: 22.0, 95% CI: 2.21 – 219.8 p = 0.008). RSV/seasonal influenza A viruses co-infection also associated with increased risk but this was not statistically significant. For the pandemic influenza A(H1N1)pdm09 virus, RSV and AdV co-infection increased risk of hospitalization to a general ward, whereas Flu B increased risk of admission to ICU/ death, but none of these were statistically significant. Considering only single infections, RSV and hPIV1-3 increased risk of admission to a general ward (OR: 1.49, 95% CI: 1.28 – 1.73, p = <0.0001 and OR: 1.34, 95% CI: 1.003 – 1.8, p = 0.05) and admission to ICU/ death (OR: 1.5, 95% CI: 1.20 – 2.0, p = <0.0001 and OR: 1.60, 95% CI: 1.02 – 2.40, p = 0.04). Conclusion: Co-infection is a significant predictor of disease outcome; there is insufficient public health data on this subject as not all samples sent for investigation of respiratory virus infection are tested for all respiratory viruses. Integration of testing for respiratory viruses’ co-infections into routine clinical practice and R&D on integrated drugs and vaccines for influenza A&B, RSV, and AdV, and development of multi-target diagnostic tests is encouraged.