'SPIICA' - the Sao Paulo-Imperial College Immune Correlates in Arbovirus Infection Network

埃及伊蚊可以传播多种不同的病毒。在巴西的一些地区，这些病毒包括不同类型的登革热病毒，以及寨卡病毒、黄热病病毒和基孔肯雅病毒。其中，对基孔肯雅人的了解可能是最少的。据信，它被相当低估的诊断。症状可能包括头痛、发烧和皮疹。然而，关键的担忧是，一部分患者将继续发展为一种毁灭性的关节炎样慢性病，这种疾病可能会持续数年。在某些情况下，疾病是致命的。因此，这是一种给感染者带来巨大痛苦的疾病，也是照顾慢性病的巨大经济保健负担。人们迫切需要弄清楚，为什么有些人会患上轻微的疾病，而另一些人会患上严重的慢性病。人们认为，这种慢性关节疾病不是由病毒本身传播的，而是通过对它的免疫反应而传播的。因此，迫切需要了解保护性宿主免疫的细节，从而降低未来任何疫苗可能无意中诱发而不是预防关节疾病的风险。为了解决这个问题，我们建议在英格兰和巴西建立一个由领先免疫学家组成的联合中心。我们把这个联合中心称为‘SPIICA’，这是一个天文典故，指的是两颗看起来像一颗恒星的独立恒星。我们将密切合作，包括联合研讨会和工作人员培训。该计划的核心是在巴西的6个临床中心招募一名基孔肯雅病患者队列，每组90名患者，分三个季节进行。每个患者都将接受仔细的临床评估，以确定是否有基孔肯雅症状，并进行纵向跟踪，定期采集血样。这些血液样本将使用大量最先进的技术进行评估，允许在免疫反应和疾病特征之间建立关联。这些方法包括对病毒的抗体反应、包括T淋巴细胞和自然杀伤细胞在内的白细胞亚群的反应以及血液中称为细胞因子的免疫介质的表征。我们的目标是，在这项研究结束时，我们将有一个更好的理由来解释感染后的不同结果。这应该有助于解释如何制造能够在不造成伤害的情况下促进保护的疫苗，以及如何预测谁可能会患上这种慢性病，并在症状出现之前对他们进行治疗。

The Aedes egypti mosquito can spread a number of different viruses. In regions of Brazil, these include the different types of Dengue virus, as well as Zika virus, Yellow fever virus and Chikungunya virus. Of these, perhaps the least is understood about Chikungunya. It is believed to be rather underdiagnosed. The symptoms can include headache, fever and rash. However, the key concern is that a proportion of patients will go on to develop a devastating arthritis-like, chronic disease which can continue for years. In some cases, disease is fatal. This is thus a disease which causes great misery to those infected and also, a great financial healthcare burden in caring for chronic disease. There is an urgent need to unravel why it is that some people experience mild disease, while others develop severe, chronic disease. It is believed that the chronic, joint disease is mediated not by the virus itself, but by the immune response to it. For this reason, there is an urgent need to understand the detailed aspects of protective host immunity, so reducing the risk that any future vaccines may inadvertently induce rather than prevent joint disease. To address this question, we here propose to build a joint centre of leading immunologists in England and Brazil. We have called the joint centre 'SPIICA', an astronomical allusion to two separate stars that appear as one. We will work closely together, including joint workshops and staff training. Central to the plan is to recruit a Chikungunya patient cohort, 90 patients in each of four groups, across three seasons at 6 clinical centres in Brazil. Each patient will be carefully evaluated clinically for Chikungunya symptoms and followed longitudinally, giving periodic blood samples. These blood samples will be evaluated using a large array of state-of-the art technologies, allowing correlations to be drawn between the immune response and the disease features. The approaches include characterisation of the antibody response to the virus, of the response by subsets of white blood cells including T lymphocytes and natural killer cells, and of immune mediators in the blood termed cytokines. Our aim is that, by the end of this study, we will have a much-improved rationale to explain the different outcomes following infection. This should help explain how to build vaccines that can promote protection without causing harm and also, how to predict who might be the patients who will develop the chronic disease, treating them before symptoms develop.