Die neuartige Infektionskrankheit Covid-19 breitet sich seit Dezember 2019 von Wuhan, China, in zahlreiche Länder aller Kontinente aus. Durch die rasche Verbreitung der Viruserkrankung und die schnell steigende Zahl an infizierten Personen, rief die WHO im Januar 2020 die „Gesundheitliche Notlage internationaler Tragweite“ aus. Im März desselben Jahres wurde die Situation als Pandemie deklariert. Die Infektionskrankheit wird durch das SARS-CoV-2 hervorgerufen, ein Vertreter aus der Gattung der Betacoronaviren, dessen Genom durch einzelsträngige RNA positiver Polarität (ssRNA) gekennzeichnet ist. Ein zoonotischer Ursprung des Virus aus Fledermäusen wird derzeit aufgrund hoher genetischer Übereinstimmungen als wahrscheinlichste initiale Quelle betrachtet. Die Transmission des SARS-CoV-2 erfolgt über die respiratorische Aufnahme von virushaltigem Aerosol und ruft Symptome wie Husten, Fieber, Geschmacks- und Geruchsstörungen sowie bei schwerem Verlauf auch Pneumonien mit beatmungspflichtigem ARDS (Acute Respiratory Distress Syndrome) hervor. Eine spezifische Therapie für Covid-19 ist bisher nicht etabliert, jedoch sind supportive Maßnahmen sinnvoll, der Einsatz von Remdesivir von der Europäischen Arzneimittel-Agentur zugelassen und die Verwendung von systemischen Kortikosteroiden von der WHO empfohlen. Um die Basisreproduktionszahl für das SARS-CoV-2 gering zu halten, sind infektionspräventive Maßnahmen wie Mund-Nase-Bedeckung, Mindestabstand, regelmäßiger Luftaustausch und das strenge Einhalten von Hygieneregeln wirksam. Die ersten Impfstoffe für die Viruserkrankung Covid-19 stehen seit Dezember 2020 bereit. Da die Vakzine bislang begrenzt zur Verfügung stehen, ist eine frühzeitige Diagnostik und die Nachverfolgung des Infektionsgeschehens weiterhin von großer Bedeutung. Der direkte Erregernachweis des SARS-CoV-2 erfolgt durch einen Nasen-Rachen-Abstrich, der mittels RT-PCR auf replizierendes Virusgenom untersucht wird. Für die Erfassung der asymptomatisch bzw. subklinisch infizierten Personen sind neben dem Antigen-Schnelltest auch serologische Nachweisverfahren notwendig, um die reale Ausbreitung des SARS-CoV-2 nachvollziehen zu können. Ziel dieser Arbeit war es, durch zahlreiche Optimierungen ein valides Protokoll für einen SARS-CoV-2-N IgG Antikörper ELISA zu etablieren. Der Test sollte einen qualitativen Nachweis zur Detektion der SARS-CoV-2-Immunantwort gegen das Nukleokapsidprotein des Virus möglich machen. Die in das Protokoll aufgenommenen Optimierungen umfassen u. a. die Konzentration des verwendeten Antigens N-MBP, die Zusammensetzung der Beschichtungs- und Blocklösung, die Probenvolumina, die Verdünnung des Sekundärantikörpers und die Zeit der Substratinkubation für die Farbentwicklung. Für das Protokoll des SARS-CoV-2-N IgG Antikörper ELISA wurde ein Kalibrator entwickelt, um einen normierten Grenzwert für Seropositivität festlegen zu können und ein Antikörper-Konzentrationsstandard etabliert, um die Ergebnisse des Immunassays auch quantitativ interpretieren zu können. Zur Validierung des SARS-CoV-2-N IgG Antikörper ELISA wurden 73 Covid-19-Seren von Probanden mit zuvor positivem RT-PCR Testergebnis und 180 Negativkontrollseren bzw. -plasmen verwendet. Die Covid-19-Patienten zeigten eine milde bis moderate Erkrankung oder einen asymptomatischen Infektionsverlauf. Die Covid-19-Seren wurden 2 - 3 Wochen (n = 25) oder über 4 Wochen (n = 48) nach Symptombeginn bzw. positivem RNA-Test gewonnen. Die Spezifität des SARS-CoV-2-N IgG Antikörpertests betrug 99,44 % und die Sensitivität wurde mit 80,82 % ermittelt. Nach 2 - 3 Wochen entnommene Covid-19-Seren wurden dabei mit einer Sensitivität von 80,0 % und mehr als 4 Wochen nach Diagnosestellung gewonnene Seren mit einer Positivrate von 81,3 % erkannt. Weiterhin wurde die Empfindlichkeit des In-house ELISA in einer prospektiven diagnostischen Studie mit der Sensitivität von sieben kommerziellen Nukleokapsid- oder S-Glykoprotein-basierten Antikörpertests verglichen, um den Nutzen der Tests für den klinischen Einsatz bewerten zu können. Die Sensitivitäten der Antikörperassays lagen bei 64,4 - 93,2 %. Die empfindlichsten Tests erkannten 95,8 - 100 % der über 4 Wochen nach Symptombeginn gewonnenen Covid-19-Seren als positiv. Seren, die 2 - 3 Wochen nach positivem RNA-Test entnommen wurden, wurden mit einer geringeren Sensitivität erkannt, was darauf hindeutet, dass der optimale Zeitpunkt für serologische Testungen später als 3 Wochen nach Ausbruch der Infektionskrankheit liegen sollte. Antikörpertests, die das Nukleokapsid- bzw. das S-Glykoprotein als Antigen verwendeten, zeigten vergleichbare Sensitivitätswerte auf. Dies bedeutet, dass sowohl N- als auch S-basierte Antiköpertests für die serologische Diagnostik geeignet sind. Nukleokapsidprotein und S-Glykoprotein-basierte Antikörperassays zeigten außerdem Unterschiede in der Detektion einer positiven oder negativen Immunreaktion bei den untersuchten Covid-19-Seren. Eine kombinierte Auswertung von seriellen Tests unter separater Verwendung beider Antigene könnte somit die Positivrate bei der Untersuchung von Covid-19-Seren steigern.:INHALTSVERZEICHNIS ABKÜRZUNGSVERZEICHNIS III 1 EINFÜHRUNG 1 1.1 SARS-CoV-2: Virale Struktur und Replikation 1 1.2 Covid-19: Pathogenese und Krankheitsbild 3 1.3 Epidemiologie und Herkunft 6 1.4 Diagnostik 8 1.5 Therapie 11 1.6 Prävention 12 1.7 Impfung 12 2 AUFGABENSTELLUNG 15 3 MATERIALIEN UND METHODEN 16 3.1 Materialien 16 3.1.1 Geräte 16 3.1.2 Chemikalien 16 3.1.3 Proteine 17 3.1.4 Seren 17 3.1.5 Immunoreagenzien 18 3.1.6 Sonstige Materialien 18 3.2 Methoden 18 3.2.1 Allgemein verwendete Lösungen 18 3.2.2 Ethikantrag 19 3.2.3 Probanden 19 3.2.4 Probenentnahme 20 3.2.5 Probenaufarbeitung 20 3.2.6 Nukleokapsidprotein (N) und Maltose-bindendes Protein (MBP) 20 3.2.7 Enzyme-Linked Immunosorbent Assay (ELISA) 22 3.2.8 Kommerzielle Antikörpertests 23 3.2.9 Auswertung und Statistik 24 4 ERGEBNISSE 28 4.1 Optimierung des SARS-CoV-2-N IgG Antikörper ELISA 28 4.1.1 Beschichtung mit Nukleokapsid-Fusionsprotein 28 4.1.2 Einfluss der Antigenkonzentration in der Beschichtungslösung 29 4.1.3 Einfluss der Auftauhäufigkeit des N-MBP-Antigens 31 4.1.4 Variation der Beschichtungslösung 33 4.1.5 Beschichtungs- und Probenvolumina 34 4.1.6 Blocklösung 35 4.1.7 Substratinkubationszeit 36 4.1.8 Sekundärantikörperverdünnung 38 4.1.9 Stabilisierung des Protokolls mit CANDOR®-Reagenzien 40 4.2 Validierung des SARS-CoV-2-N IgG Antikörper ELISA 42 4.2.1 Herstellung eines Kalibrators 42 4.2.2 Bestimmung der Sensitivität 44 4.2.3 Bestimmung der Spezifität 46 4.2.4 Herstellung eines Antikörper-Konzentrationsstandards 47 4.2.5 Intra-Assay und Inter-Assay-Variabilität 49 4.3 Protokoll des SARS-CoV-2-N IgG Antikörper ELISA 50 4.4 Vergleich der diagnostischen Sensitivität von SARS-CoV-2-Nukleoprotein- und Glykoprotein-basierten Antikörpertests 53 5 DISKUSSION 58 5.1 Ergebnisse der diagnostischen Validierungsstudie 58 5.2 Eignung und Verwendung des Nukleokapsidproteins als Antigen für den SARS-CoV-2 IgG Antikörper ELISA 61 5.3 Validität und Limitationen 62 5.4 Ausblick und Bedeutung des SARS-CoV-2-N IgG Antikörpertests 64 6 ZUSAMMENFASSUNG 67 LITERATURVERZEICHNIS 70 ANLAGEN 89 ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT 92 LEBENSLAUF 93 PUBLIKATIONSVERZEICHNIS 95 DANKSAGUNG 96

ACKNOWLEDGEMENTS I would like to take this moment to extend my utmost appreciation for all the support provided by my supervisor, Dr. Russell de Souza. He assisted me along the way and ensured that I was always on the right path to achieve all my goals and checkpoints in every circumstance. I would also like to thank my committee for providing me with fantastic support: Ms. Laura Banfield for always being there to help solve any problem in this process, and Dr. Zain Chagla for providing a plethora of knowledge from the technical perspective of infectious disease and being so patient. Special thanks to Dr. Alexandra Mayhew for her support in our prevalence meta-analysis. Finally, I would like to thank my family, my wife, Dr. Sanjida Rowshan Anannya, for whom I am here today, and my parents, siblings, and in-laws; you are always there for me in every walk of life. You are why I have gotten to where I am today and are my daily inspiration. / Background: Bacteria is a major cause of many infectious diseases, and the treatment for these diseases is antibiotics designed to kill or subdue the growth of the bacteria. However, bacteria evolve, and if an antibiotic prescription is not the right antibiotic for the right patient at the right time with the correct dose and the right route, Antimicrobial Resistance (AMR) may result. During this pandemic, the use of antibiotics to treat hospitalized COVID-19 patients without any bacterial coinfection threatens the effectiveness of antibiotic treatment for current and future bacterial infections. Methods: A systematic search was conducted of the Embase, Medline, Web of Science, and Cochrane Library databases by generating search terms using the concepts of “COVID-19,” “Bacterial Coinfection,” “Secondary bacterial infection,” and “Antimicrobial resistance” to identify studies that reported the prevalence of antibiotic prescription for the treatment of COVID-19 in hospitalized patients with and without bacterial coinfection. The pooled estimate of the percentage of the total and confirmed appropriate antibiotic prescriptions provided to hospitalized COVID-19 patients was generated using a random effect meta-analysis with inverse variance weighting. Result: Of 157,623 participants from 29 studies included in our review, 67% (CI 64% to 71%, P<0.00001) were prescribed antibiotics, among which 80% (CI 76% to 83%, P<0.00001) prescriptions were given for the COVID-19 patients without any bacterial coinfections. The use of antibiotics varied during the pre-immunosuppressive period (before 16 June 2020) and post-immunosuppressive period of the pandemic and between the High-Income Countries and Upper and Lower Middle-Income Countries. Conclusion: This Systematic Review and Meta-analysis finds greater than expected use of antibiotics to treat hospitalized COVID-19 patients without bacterial coinfections, which can worsen AMR globally. Clear and concrete guidelines for the use of antibiotic prescriptions to treat COVID-19 patients, strict monitoring, and compliance with Antimicrobial Stewardship are needed to prevent over-prescription. / Thesis / Master in Advanced Studies (MAS) / Bacteria is a major cause of many infectious diseases. Before the discovery of Antibiotics in 1928, hundreds of thousands of people used to die due to infectious diseases caused by bacteria. While Antibiotics are essential to treat bacterial infectious diseases, overuse or misuse can accelerate Antibiotic Resistance, a phenomenon when bacteria change and/or develop the ability to escape the drugs designed to kill them. Self-medication, availability of antibiotics without a prescription, and inappropriate dosing of antibiotics can worsen the situation. During the COVID-19 pandemic, antibiotics were commonly prescribed as part of the treatment regime for COVID-19, even when a clear bacterial infection was not identified. In our Systematic Review and Meta-analysis, we aimed to see the frequency of antibiotic prescriptions to treat hospitalized COVID-19 patients without any bacterial coinfections.

No description available.

The world is grappling with an escalating risk of viral outbreaks of pandemic proportion, with zoonotic RNA viruses such as chikungunya virus (CHIKV) and SARS-CoV-2 posing significant threats to global health. Several environmental and evolutionary factors have fueled the emergence and spread of infection, creating a constant arms race against emerging pathogens. Current prevention and mitigation strategies are inadequate, necessitating tools to prevent and control viral infections; innovative strategies are needed in the pipeline to address significant challenges. CHIKV is a mosquito-borne virus that has caused millions of disease cases worldwide and is a reemerging threat with increasing potential to become endemic in the US. Currently, there are no licensed treatments available to protect against CHIK disease, making the development of a vaccine crucial. Live-attenuated vaccines (LAVs) have traditionally been a promising strategy due to their high immunogenicity and cost-effectiveness. However, concerns regarding adverse side effects and the potential for viral replication leading to pathogenic reversions or transmission into mosquitoes have limited their use. To that end, we have developed a new generation of safer vaccines by modifying the standard LAV platform through innovative attenuating strategies. Our dual-attenuated platform utilizes a previously developed chimera of CHIKV and the closely related Semliki Forest virus (SFV) as a vaccine backbone which expresses antiviral mouse cytokines IFN-γ or IL-21, as an additional mechanism to control infection. In several mouse models, both cytokine-expressing candidates showed reduced footpad swelling and minimal to no systemic replication or dissemination capacity compared to the parental vaccine post-vaccination. Importantly, these candidates conferred full protection from wildtype CHIK disease. Our IFNγ-expressing vaccine showed the most significant attenuation of viral replication. To understand the underlying mechanism, we identified three IFNγ-regulated antiviral genes (Gbp1/2 and Ido1) that were highly upregulated in 3T3 mouse fibroblasts post-infection with the IFN-γ-expressing candidate but not the parental backbone. To further investigate the role of these genes in restricting viral replication and enhance the clinical relevance of our vaccine platform, we redesigned our vaccine to express human IFNγ (hIFNγ) and performed viral growth kinetics in MRC5 human lung fibroblasts. Our vaccine showed reduced viral replication compared to controls and high expression of human GBP1/2/3 was observed post-infection. Overexpression of these genes demonstrated a direct impact on viral replication against wildtype CHIKV. These findings shed light on the mechanism of action of our vaccine and highlight the potential of targeting IFNγ-regulated antiviral genes for developing effective vaccines against CHIKV. Our results provided a foundation for investigating the broad-use application of IFN-γ against other alphaviruses for vaccine or therapeutic design. We evaluated the effects of increasing levels of exogenous hIFNγ on Mayaro virus (MAYV), Ross River virus (RRV), and Venezuelan Equine Encephalitis virus (VEEV). We observed a positive dose-dependent relationship between hIFNγ and decreasing viral titers for all three viruses. Interestingly, we also observed similar patterns of GBP upregulation with MAYV and RRV, both Old World alphaviruses, but not with VEEV, a New World alphavirus. This finding may indicate an alternative IFNγ-stimulated pathway responsible for controlling different alphaviruses. Overall, these studies establish a fundamental role of IFNγ in controlling viral infection and highlight its potential use in both vaccine and therapeutic intervention. While LAVs are a gold standard for developing immunity against a virus, the urgency of responding to an active and deadly pandemic has promoted the use of faster strategies such as mRNA vaccines. Once the viral sequence was known, these vaccines were comparatively quick to produce for SARS-CoV-2 and prevented millions of disease cases at the height of their introduction. However, the emergence of variants of concerns bypassing previous immunization efforts has demonstrated the need for complementary treatments such as antivirals to control disease. To that end, we evaluated several rhodium organometallic complexes as potential antivirals against SARS-CoV-2. We show that two pentamethylcyclopentadienyl (Cp*) rhodium piano stool complexes, Cp*Rh(ICy)Cl2 and Cp*Rh(dpvm)Cl are non-toxic in Vero E6 and Calu3 cells and reduce SARS-CoV-2 plaque formation up to 99%. These complexes have previously demonstrated high antimicrobial activity against multiple antibiotic-resistance bacteria and with our results, support their potential application as pharmaceuticals, warranting further investigation into their activity. / Doctor of Philosophy / The global response to the COVID-19 pandemic, and its far-reaching impact, revealed significant shortcomings in public health preparedness for emerging viruses. Despite efforts to develop vaccines and antivirals to prevent and treat disease, current mitigation strategies have proven insufficient to eradicate the pathogen. The emergence of viral outbreaks caused by viruses such as chikungunya (CHIKV) and SARS-CoV-2 underscores the ongoing threat posed by emerging infectious diseases. Improved countermeasures are urgently needed to address gaps in vaccine and antiviral development. CHIKV is a mosquito-borne virus that has caused millions of infections across hundreds of countries with the emergent potential to become endemic in the US. Currently, there are no vaccines available to the public; therefore, it is important to generate and administer an effective vaccine before further spread of the virus. To this end, we developed innovative live-attenuated vaccines (LAVs) against CHIKV using a weakened chimeric backbone of CHIKV and its close relative, Semliki Forest virus (SFV), along with vaccine-driven expression of antiviral cytokines to control viral replication. Vaccination of highly susceptible mice with these cytokine-expressing vaccines produced significantly decreased side-effects compared to the parental virus not expressing the cytokines. Additionally, these viruses had significantly restricted viral replication capabilities while robustly protecting mice from a semi-lethal CHIKV infection. Our interferon-gamma (IFNγ) expressing vaccine had the greatest impact on viral replication, and we investigated the mechanism leading to this attenuation. To assess the clinical relevance of our vaccine platform, we redesigned the virus to express human IFNγ and identified a specific pattern of IFNγ-stimulated genes that are potentially responsible for limiting CHIKV replication. Furthermore, we demonstrated the broad therapeutic use of IFNγ against other medically relevant alphaviruses. Overall, these studies establish an improved mechanism to create safer vaccines without compromising efficacy and highlight the therapeutic potential of IFNγ against alphaviruses. Lastly, in a collaborative effort to respond to the COVID-19 pandemic, we also explored and characterized the use of a new class of antiviral drugs. With the advent of increasing drug resistance, it is essential to develop novel and resilient therapeutics. We demonstrated the first antiviral potential of rhodium organometallics, which was previously shown to be effective against multiple antibiotic-resistant bacteria. Two complexes demonstrated high virucidal activity against SARS-CoV-2 and low toxicity in mammalian cell lines. Moreover, these complexes can be further derivatized to improve efficacy, making them a promising new antiviral strategy.

Yes / Introduction. Coronavirus disease 2019 (COVID-19) was first detected in China in December, 2019, and declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. The current management of COVID-19 is based generally on supportive therapy and treatment to prevent respiratory failure. The effective option of antiviral therapy and vaccination are currently under evaluation and development. Areas covered. A literature search was performed using PubMed between December 1, 2019–June 23, 2020. This review highlights the current state of knowledge on the viral replication and pathogenicity, diagnostic and therapeutic strategies, and management of COVID-19. This review will be of interest to scientists and clinicians and make a significant contribution toward development of vaccines and targeted therapies to contain the pandemic. Expert Opinion. The exit strategy for a path back to normal life is required, which should involve a multi-prong effort toward development of new treatment and a successful vaccine to protect public health worldwide and prevent future COVID-19 outbreaks. Therefore, the bench to bedside translational research as well as reverse translational works focusing bedside to bench is very important and would provide the foundation for the development of targeted drugs and vaccines for COVID-19 infections. / Research carried out at TN laboratories are funded by the GrowMedtech, The Royal Society and University of Bradford. KH is supported by a project grant by the GrowMedtech awarded to TN. CW is funded by a Ph.D studentship.

Depuis l'émergence de la pandémie de SARS-CoV-2 en décembre 2019, plus de 675 millions de cas confirmés ont été signalés dans le monde, dont 4,6 millions de cas au Canada uniquement. Bien que la plupart des individus récupèrent sans séquelles, 10 à 20 % des survivants signalent des symptômes persistants au-delà de quatre semaines après une infection par le SARS-CoV-2, tels que la fatigue, les altérations cognitives, la toux, l'anxiété, la dépression, la douleur thoracique et autres, connus sous le nom de COVID longue ou de condition post-SARS-CoV-2 (PCC). Par conséquent, la physiopathologie, le diagnostic et la prise en charge de la PCC sont devenus un axe de recherche majeur. Pour contribuer à la compréhension de la PCC, nous avons mené le projet IPCO (Institut de Recherches cliniques de Montréal (IRCM) Post-COVID-19 Research Clinic), en posant comme hypothèses 1 que les personnes infectés par le SARS-CoV-2 au Québec présenteraient des signes et symptômes fréquents et variés post-phase aiguë, affectant différents systèmes d'organes, et 2 Les niveaux élevés de D-dimères dans PCC ne sont pas pertinents pour les événements thromboemboliques 3 que Chez les individus atteints de la PCC, la vaccination contre la COVID-19 réduirait les symptômes de la PCC en diminuant l'inflammation. Pour évaluer ces hypothèses, nous avons recruté des participants âgés de plus de 18 ans, un à 18 mois après l'infection aiguë, présentant au moins un symptôme persistant, et programmé des visites de base et de suivi à 3-6 mois, 1 an et 2 ans post-infection aiguë. Chaque visite comprenait des évaluations cliniques, des prélèvements, des évaluations en laboratoire, des questionnaires sur l'alimentation et le bien-être, ainsi que des évaluations de la physiologie pulmonaire et cardiaque. Sur la base d'une étude allemande qui a catégorisé les symptômes du PCC et les individuals en trois groupes de sévérité, nous avons classé nos participants en trois niveaux de sévérité : non/légère (score du PCC <10,75), modérée (10,75 < score du PCC < 26,25) et sévère (score du PCC > 26,25). Cette thèse présente les résultats de trois sous-études IPCO. Dans l'étude descriptive, nous avons observé que la fatigue, les problèmes de mémoire et les maux de tête étaient les symptômes de PCC les plus courants, la majorité de nos participants étant des femmes et ayant été traités en ambulatoire pendant la phase aiguë. Dans l'étude transversale, nous avons constaté des différences significatives dans les mesures de santé et de bien-être à tous les moments, mais aucune différence significative dans les résultats des tests physiologiques entre les groupes PCC non/léger, modéré et sévère. Dans l'étude longitudinale, les marqueurs de l'inflammation se sont améliorés au fil du temps, mais le taux métabolique basal et la masse grasse ont augmenté. Dans la deuxième étude, nous avons observé une forte prévalence de participants ayant des niveaux de D-dimères, qui n'étaient pas associés à des événements thromboemboliques, et aucune corrélation entre le niveau de D-dimères et les niveaux de cytokines et de chimiokines. Dans la troisième étude, nous avons observé que les participants vaccinés présentaient significativement moins de symptômes de PCC. Notre étude fournit une meilleure compréhension de la physiopathologie du PCC et de l'effet de la vaccination sur le profil clinique et inflammatoire du PCC, ce qui pourrait aider à la conception d'outils de gestion clinique et de recherche futurs. / Since the emergence of the SARS-CoV-2 pandemic in December 2019, over 675 million confirmed cases have been reported globally, with 4.6 million cases in Canada alone. Although most individuals recover without residual disease, 10-20% of survivors report symptoms persisting beyond four weeks after SARS-CoV-2 infection, such as fatigue, cognitive impairments, cough, anxiety, depression, chest pain, and others known as long-COVID or post SARS-CoV-2 condition (PCC). Consequently, the pathophysiology, diagnosis, and management of PCC have become a significant focus of research. To contribute to the understanding of PCC, we conducted the IPCO (Institut de Recherches cliniques de Montréal (IRCM) Post-COVID-19 Research Clinic) project, hypothesizing that 1 SARS-CoV-2 infected individuals in Quebec would present frequent and varied signs and symptoms post-acute phase, affecting different organ systems, and that 2 high D-dimer level in PCC is irrelevant to thromboembolic events , and 3 in individuals with PCC, COVID-19 vaccination would decrease PCC symptoms by reducing inflammation. To evaluate these hypotheses, we enrolled participants aged >18 years, one to 18 months post-acute infection, with at least one persistent symptom, and scheduled baseline and follow-up visits at 3-6 months, 1 year, and 2 years post-acute infection. Each visit involved clinical evaluations, sampling, laboratory evaluations, diet and well-being questionnaires, and pulmonary and cardiac physiology evaluations. Based on a German study that categorized PCC symptoms and individuals into three severity groups, we classified our participants into three severity levels: non/mild (PCC score < 10.75), moderate (10.75 < PCC score < 26.25), and severe (PCC score > 26.25). This thesis reports the results of three IPCO studies. In the descriptive study, we observed that fatigue, memory problems, and headaches were the most common PCC symptoms, with the majority of our participants being female and managed as outpatients during the acute phase. In the cross-sectional study, we noted significant differences in health and well-being measurements at all time points, but no significant difference in physiological tests' results between different severity groups. In the longitudinal study, markers of inflammation improved over time, but the basal metabolic rate and body fat increased. In the second study, we observed a high prevalence of participants having D-dimer levels in blood, which were not associated with thromboembolic events, and no correlation between D-dimer levels and blood cytokine/ chemokine levels. In the third study, we observed that vaccinated participants had significantly fewer PCC symptoms, fewer organ systems affected, higher well-being scores, and lower blood cytokine/chemokine levels than the non-vaccinated group. We also observed correlations between certain cytokines/chemokines, as well as between clinical parameters and certain cytokines/chemokines. Our study provides a better understanding of the pathophysiology of PCC and effect of vaccination on the clinical and inflammatory profile of PCC, which could assist future research and clinical management tool design.

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2003SARS在兩岸 ------以生物政治學的研究途徑 摘要 生物政治利用SARS事件對人類主體的政治學做出反思，把人類重新放置於「生物」本體的立基點來思考，描繪人類政治學中的權力機制的根源及其作用。生物政治學在研究方法上以系譜學為主，將傳統的權力研究更進一步至確定主體的研究，能重新思考人的本體論，從而開展另一層次的知識論及方法論。2003年春夏所爆發的SARS疫情在海峽兩岸及全世界都造成巨大的影響，而兩岸的經貿、文教交流和外交關係都達到谷底。本文試圖以系譜學方式整合流行病學與政治學研究，觀察海峽兩岸SARS事件始末並推論出其中權力行使的細緻意涵，研究將以社論新聞及實地參與觀察為主。 SARS在國內層面上關注於對身體的控制，國家無法管理病毒，所以以管理身體的方式來管理病毒，對身體監視（量體溫）、對身體限制（隔離）和對身體作用（醫治），而在國際方面國家的能力被簡化成控制身體的能力，於是也有身體的禁止（疫區）、身體能否得到醫治的許可（WHO出席）等等。研究顯示：一方面SARS是一種新型疾病，人們對於SARS的認識都充滿不確定性，但是人們在心理上要對SARS有所認識，因此SARS的流行病學的論述充滿了知識/權力的辯證關係；另一方面，依照SARS的流行病學對於SARS病毒/病人的管制：從SARS的名稱開始，到帶原者的分類，處理傳染與隔離的設施到疫區的判斷方式，也存在身體政治的意涵。證明了疾病的系譜是隨著主體的建構而有多重面向。 關鍵詞： SARS、中國、生物政治、全球化、系譜學、傅科、尼采 / 2003SARS in the Cross-Strait ----On the Bio-Political Perspective Abstract The epidemic, SARS, erupted on two sides of the Taiwan Strait in spring and summer of 2003. Cross-Strait exchanges fell to close to none. It brought great influence to not only East Asia, but also the whole world. This essay attempts to employ the methodology of Genealogy to explore the SARS incident and to understand how power maneuvers in this context. The research materials will primarily be editorials and news. The research reveals that: SARS is a new disease. People are uncertain about the SARS symptom and desired to know more as possible. Therefore, the discourse of SARS is dialectic of knowledge/power. One the other hand, the signification of body politics can be seen in the control of virus/patients: from the name of SARS, to the categorization of virus carriers, and the way to handle the disease and quarantine. The final discuss is on the implication of disease in the context of globalization and international politics. Western philosophical thinking the human being is the greatest of the living thing, and the other organism of the nature is object being. The assumption that human beings have the power to decide and discover their Subjects dictates the interactions between human beings and other creatures/ objects. The existence of “others” thus serves as a background and secondary meaning to human. Bio-politics aims to discuss a different kind of thinking which puts “others” in the position of Subjects. This is to deconstruct the opposite relations between human and nature, and to describe the source of power in humankind’s political science. Genealogy’s research on power traces back to the research on Subjects; while Bio-politics can employ Genealogy’s methodology to discover another level of research on power. Keywords: Bio-politics、Epidemiology、Foucault、Genealogy、SARS、WHO

人類社會中有許多社會現象是隱而不顯的，或者刻意被視而不見、被忽略。當SARS疫情在台灣社會蔓延時，所有與「SARS」相連結的人、事、物，都被投以異樣的眼光，被貼上他者身份的標籤而受到歧視、排拒與指責。同樣，SARS他者的建構也並非自然地存在，而是透過許多語言、行動與機制所形塑出來的。本研究透過分析新聞媒體的語言及所對應的情境脈絡，來理解SARS他者建構之由隱微到顯見的過程，期冀經由逐步揭露SARS他者的風貌，褪去覆蓋在疾病之上的外衣，以回歸到「人」的本質。 　　本研究主要運用Fairclough（1995）的互文性分析策略來分析SARS新聞中他者的再現，將SARS他者分為「新興的他者」—感染者與居家隔離者、「變異的他者」— 醫護人員、以及「恆久的他者」—社會邊緣地位者等三種類別。本對了 所以所謂的七月底前畢業就是七月底前把那張單子交給註冊組就好了 印論文慢慢來 這樣妳應該輕鬆一點了吧是研究發現新聞論述中建構出「恐怖他者」、「罪犯他者」與「自私他者」的想像，劃分著健康我群與染病他者的界限，形塑了感染者與居家隔離者的他者風貌。另外，本研究以Davies & Harré（1990）的定位（positioning）理論來分析醫護人員身份認同的變動也發現，醫護人員、政府、媒體、民眾透過相互定位與定位的回應，隨著指標性新聞事件的發生，而改變著彼此間的身份位置。處於社會邊緣地位者如街友，及醫院看護與清潔人員，長久以來被社會刻意忽視，當SARS風暴席捲台灣時，成了代罪的羔羊而受到矚目，疫情落幕之後依舊回歸到邊緣地位。 　　我們以Fairclough（1995） 分析他者再現之「存在/缺席」原則來檢視三種類別他者，也發現了三種他者在媒體中的「存在/缺席」呈現光譜狀的分配：醫護人員在媒體中的發聲機會與存在多於感染者及居家隔離者，感染者及居家隔離者又多於社會邊緣地位者。本研究亦發現媒體在報導他者的身份的多重角色上可以是污名的製造者；或者是強化者；然而也可能僅是烙印的傳遞者；甚或扮演著有正面意涵之烙印減輕者角色。影響媒體角色的變動因素，與媒體內部既有的框架（frame）有關，面對不同的對象，媒體論述有不同的再現方式。此外，我們也發現，台灣社會在SARS疫情間的他者塑造，有些現象是過去的文獻所無法提供解釋的，特別是在政治層面的考量，展現了台灣社會的特殊性。 　　SARS他者在社會中受到的排斥，來自於社會大眾與媒體只見「病」而不見「人」的思維，而這個「病」又包覆著種種的負面的想像。本研究以SARS為個案，嘗試為疾病去污名化，並且提醒社會要重視「人」的本質，從「人」的角度出發來面對未來的疫病，能夠盡可能的拋開疾病負面意義的包袱，理解人類乃是健康與疾病共存的個體，以正面的態度面對疫病，在未來面對疫疾時，同時看見「病」也看見「人」。

L’identification de molécules organiques capables de moduler des interactions protéine-protéine (PPIs) est longtemps restée un domaine peu exploité par la recherche pharmaceutique privée comme académique. Cependant, le développement de méthodologies innovantes pour l’étude des PPIs et la validation récente de ce type d’inhibiteurs dans des essais précliniques, démontrent que les PPIs constituent une nouvelle source de cibles importantes. Les composés capables de moduler ces interactions représentent une nouvelle classe d’outils prometteurs, tant en recherche fondamentale qu’en thérapeutique. Elles peuvent aider à différencier les multiples fonctions portées par une même protéine, à replacer la protéine dans une cascade de réactions, ainsi qu’à disséquer et reconstituer des réseaux de signalisations protéiques. Ces molécules permettront également de faire émerger de nouvelles familles d’agents pharmacologiques actifs dans diverses pathologies.Mon travail de thèse s'est projeté dans l'avenir de la recherche biomédicale, en ciblant les interactions protéine-protéine. J’ai pu durant mon doctorat mettre en œuvre plusieurs méthodologies pour étudier et caractériser des interactions protéiques afin de développer des inhibiteurs de ces interactions. J’ai ainsi pu travailler sur l’optimisation d’un composé inhibiteur de l’interaction de la protéine virale Nef VIH-1 avec les domaines SH3 des Src kinases, le composé DLC27. J’ai également pu mettre en évidence la pertinence biologique de ce composé, qui cible un mode d’interaction unique, ou très rare, au niveau cellulaire en étudiant l’interaction avec les domaines SH3 de deux protéines, ALIX (ALG2-Interacting Protein X) et la sous-unité p85 de la PI3K (phosphatidylinositol 3-kinase).J’ai également pu caractériser la surface et le mode d’interaction de protéines virales impliquées dans le complexe de réplication du virus du SRAS (Syndrome Respiratoire Aigu Sévère). Cette étude tend à montrer que la protéine virale nsp10 agit comme une plateforme de reconnaissance pour ses partenaires, les protéines virales nsp14 et nsp16. Ces interactions permettent l’activation ou l’augmentation des activités respectives de nsp16 et nsp14 et jouent un rôle au niveau de la réplication virale. Suite à l’identification d’un ‘point chaud’ d’interaction, le résidu Tyr96 à la surface de nsp10, nous avons mis en évidence la première famille de molécules inhibitrices du complexe nsp10-nsp14 en couplant des méthodes informatiques (in silico) à des criblages expérimentaux. Ces molécules pourraient être utilisées comme antiviraux ou servir d’outils pour la recherche, en permettant par exemple de mieux comprendre et d’élucider les mécanismes moléculaires impliqués dans la réplication du virus du SRAS et des coronavirus en général. / Protein-protein interactions (PPIs) participate in and regulate almost all essential cellular functions. As a consequence, they are frequently involved in various pathologies (going from cancer development to viral replication and host cell infection) but their study remains a challenge.Thus understanding those interactions as well as finding small drug candidates able to modulate them, a field of research not currently fully developed, appear as the future of the healthcare industry.In this context, I chose to learn different techniques to study PPIs that are usually employed in academic (IMR laboratory, CNRS, France) or corporate environments (Genentech, USA). Moreover, I also worked on the development of small organic inhibitors of PPIs coupling in silico methodologies (chemo-informatics, Drug Design) to biological and structural validations.During my PhD, I could manage and work on different projects involving the study of PPIs involved in cancer signaling pathways as well as the development of potent antiviral drugs targeting the HIV and SARS viruses.My organizational, personal and scientific skills as well as the practical experience I developed on various techniques (from cell biology to biophysics, structural biochemistry and Drug Design), make me feel confident on the management of PPIs drug discovery projects.I am thus able to efficiently work on, and manage, the study of protein-protein interactions in various pathologies as well as the development of potent PPIs inhibitors, that will be a major breakthrough for Biotech/Pharma companies in the coming years.