Sustained Drug-related Reaction With Eosinophilia and Systemic Symptoms (DRESS) Triggered by Low Molecular Weight Heparins in COVID-19: Management and Precision Diagnosis.

Background. Low molecular weight heparins (LMWHs) are administered routinely to COVID-19 patients. Systemic reactions to LMWHs (both IgE-mediated and non IgE-mediated) are considered rare. Particularly, a single case of drug-related reaction with eosinophilia and systemic symptoms (DRESS) due to enoxaparin has been described in the literature. Here, we report on the first case of DRESS related to administration of fondaparinux.Case presentation. An elderly woman was diagnosed with COVID-19, during the “first wave” of the pandemics in Italy, and treated with enoxaparin (for anti-coagulation). A DRESS syndrome developed after two weeks (RegiSCAR score = 7). Enoxaparin was considered the culprit drug and replaced with the fully synthetic LMWH fondaparinux. At the same time, high-dosage prednisone was added to the therapy. The DRESS slowly subsided and the patient survived. Upon recovery and corticosteroid washout, a lymphocyte proliferation test for both LMWHs was performed, yielding a positive response not only for enoxaparin but also for fondaparinux. Conclusions. By lymphocyte proliferation test we demonstrated that both enoxaparin and fondaparinux were implicated in this case of DRESS, occurring in an elderly COVID-19 patient. In retrospect, the choice of using a sustained high-dose corticosteroid treatment while maintaining anti-coagulation by fondaparinux proved to be right. Ultimately, the patient recovered from both DRESS and COVID-19.

Immunogenicity evaluation of MS2 phage-mediated chimeric nanoparticle displaying an immunodominant B cell epitope of foot-and-mouth disease virus

Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals that has caused tremendous economic losses worldwide. In this study, we designed a chimeric nanoparticles vaccine with the predominant epitope of FMDV (VP1 131–160) displayed on the top of the coat protein (CP) of MS2 phage. The recombinant protein was expressed in E. coli and can self-assembled into chimeric nanoparticles (CNPs) with diameter 20-25nm. A tandem repeat peptide epitopes (VP1 131–160) (TRE) was prepared as control. Mice immunized with CNPs and TRE respectively and immunogenicity evaluated show that CNPs stimulated equivalent specific antibody levels to commercialized synthetic peptide vaccines (PepVac), but was significantly higher than TRE groups. Moreover, results from specific IFN-γ responses and lymphocyte proliferation test indicated that CNPs immunized mice exhibited significantly enhanced cellular immune response. These studies suggested that the CNPs constructed in current study could be a potential alternative vaccine in future FMDV control.

Immunogenicity evaluation of MS2 phage-mediated chimeric nanoparticle displaying an immunodominant B cell epitope of foot-and-mouth disease virus

Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals that has caused tremendous economic losses worldwide. In this study, we designed a chimeric nanoparticles vaccine with the predominant epitope of FMDV (VP1 131–160) displayed on the top of the coat protein (CP) of MS2 phage. The recombinant protein was expressed in E. coli and can self-assembled into chimeric nanoparticles (CNPs) with diameter 20-25nm. A tandem repeat peptide epitopes (VP1 131–160) (TRE) was prepared as control. Mice immunized with CNPs and TRE respectively and immunogenicity evaluated show that CNPs stimulated equivalent specific antibody levels to commercialized synthetic peptide vaccines (PepVac), but was significantly higher than TRE groups. Moreover, results from specific IFN-γ responses and lymphocyte proliferation test indicated that CNPs immunized mice exhibited significantly enhanced cellular immune response. These studies suggested that the CNPs constructed in current study could be a potential alternative vaccine in future FMDV control.