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Recombinomics Commentary 21:53, November 18, 2009, Dr Henry Niman
RBD Change D225G in Ukraine Lungs Raises Concerns
Mill Hill, a WHO regional center in London has placed sequences from 10 isolates from Ukraine on deposit at GISAID (see list below). They are to be commended for the prompt deposit of these important sequences. The availability of the sequences should put an end to wild speculation on the origins of the Ukraine outbreak.
All H and N sequences are typical for H1N1, as indicated in early WHO announcements. There are no large changes. Additional gene segments have been deposited from a subset of these isolates (but not analyzed below). There are silent changes that are in all or most Ukraine sequences, but the only HA polymorphism was the receptor binding domain change, D225G. This polymorphism was in the three lung, as well as the one throat sample. It was not in the nasopharyngeal washes or the isolate grown in MDCK cells suggesting the D225G may have a tissue tropism component and may allow for high levels of virus in the lung.
D225G was also found in necropsy lung tissue from fatal cases in Sao Paulo, further supporting tissue tropism associated with this polymorphism. The polymorphism has recently appeared on a series of different genetic backgrounds, supporting acquisition by recombination. The genetic backgrounds were geographically diverse. It was appended onto a genetic background specific for China as well as another distinct background found in Singapore and Japan. It has also recently appeared on backgrounds from Spain and Brazil. In addition, it was in isolates from last spring collected in the United States and Mexico.
The appearance of D225G on multiple recent genetic backgrounds raises concerns that the polymorphism is offering a selective advantage in association with multiple genetic backgrounds, and the selective detection of the polymorphism in lung and throat samples may indicate it is more widespread because of its absence from nasopharyngeal washes. Lung and throat sampling may be required for detection and determination of the true geograpohical reach of this change..
More information on outcomes for these patients, as well as results for lung and nasopharyngeal samples from the same patient, would be useful.
The prompt release of these sequences should help guide further analysis of the evolving swine H1N1.
A/Khmelnitsky/1/2009 EPI_ISL_62017
A/Ternopil/19/2009 EPI_ISL_62016
A/Ternopil/11/2009* EPI_ISL_62015
A/Ternopil/6/2009 EPI_ISL_62014
A/Ternopil/5/2009 EPI_ISL_62013
A/Lviv/N6/2009* EPI_ISL_62012
A/Ternopil/N11/2009 EPI_ISL_62011
A/Ternopil/N10/2009 EPI_ISL_62010
A/Lviv/N2/2009* EPI_ISL_62009
A/Kyiv/N1/2009 EPI_ISL_62008
* D225G
Originally posted by LAUTERMILCH
Another good report on the Ukraine situation.
www.zerohedge.com...
Regardless, there has been almost zero (NOTHING. NADA. SILENCE.) mention of the Ukraine epidemic in the mainstream media, a fact which I find both astonishing and profoundly disturbing. There is apparently collusion at the highest levels of government and media to suppress this information. There are now 1.3 million infected in Ukraine, and over 75,000 hospitalized -- IN FOURTEEN DAYS. This is very serious! Based on previous clinical data we can expect over 8,000 to be dead or soon to be dead. Forward projection of the epidemic is difficult because the clinical attack rate is unknown -- but myself and my associates remain concerned it may be quite high. Deaths globally may be in the millions. Let's hope this is not the case.
Originally posted by windwaker
reply to post by ecoparity
I'm missing work today because of a horrible phlem-filled cough. This morning I saw a speck of blood. I am going to the doctor soon, but if he tries to give me the H1N1 Vaccine, I will refuse it.
I don't know what to do.
If the swab is collected properly but still generating a negative, the involvement of D225G could be a ratio issue. If the ratio is swinging in favor of D225G which drives the virus to the lungs, then the virus may get cleared more quickly from the upper respiratory tract and register a negative becasue the virus has moved to the lungs.
This happened with H5N1 in Turkey, which involved another receptor domain change S227N. As a result the throat swabs of the patients were negative, but lung samples were positive. It is likely that mixtures were in play then also.
Thus, the frequency of negatives in upper respiratory tract increases as RBD changes drive the virus deep into lungs.
Originally posted by windwaker
reply to post by ecoparity
I'm missing work today because of a horrible phlem-filled cough. This morning I saw a speck of blood. I am going to the doctor soon, but if he tries to give me the H1N1 Vaccine, I will refuse it.
I don't know what to do.
Originally posted by tarifa37
I recently had the exact same thing happen to me with noticeable spots of blood in the phlegm that came up seemingly out of nowhere just a light cough and there it was.This happened on two occasions both times first thing when I had got up.I think it is where you have trouble breathing during the night and it forms then.Anyway I didn't go to the docs and was fine after a few days.