Symptoms last from 5 to 12 days. Adenovirus was recovered from conjunctival, urine, and bronchoalveolar lavage cultures. Brummitt CF, Cherrington JM, Katzenstein DA. Robinson CM, Singh G, Lee JY. J Virol. Melon S, Mendez S, Iglesias B. Detection of adenovirus antigenic proteins can be accomplished by reacting with virus-specific polyclonal or monoclonal antibodies labeled with various reporter systems. Although some early Ad1, Ad2, Ad4, and Ad5 vaccine trials were conducted among civilians,320, 326, 327 the Teva vaccines have not been used in groups other than healthy military trainees. The most prominent cellular innate signaling pathways elicited during HAdV entry comprise lectin receptors (LRs), toll-like receptors (TLRs), inflammasome signaling comprising AIM2-like receptors (ALRs), NOD-like receptors (NLRs), and RIG-I-like receptors (RLRs), autophagy, and interferon (IFN) signaling. In: Lennett E, Halonen P, Murphy F, editors. The emerging role of adenoviruses as inducers of gastroenteritis. CMV spreads from person to person through body fluids, such as blood, saliva, urine, semen and breast milk. Bethesda, MD 20894, Web Policies Stanley ED, Jackson GG. Illnesses include: Common cold; Sore throat; Bronchitis; Pneumonia (infection of Adenovirus Infection Broderick MP, Hansen CJ, Irvine M. Adenovirus 36 seropositivity is strongly associated with race and gender, but not obesity, among US military personnel. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. What you need to know about adenovirus - APIC 2009;198:133-67. doi: 10.1007/978-0-387-09647-6_4. Molecular epidemiology and brief history of emerging adenovirus 14-associated respiratory disease in the United States. Would you like email updates of new search results? Adenoviruses can cause mild to severe illness, though serious illness is less common. Kajon AE, Lu X, Erdman DD. Enders J, Bell J, Dingle J. Adenoviruses: group name proposed for new respiratory tract viruses. Specimens should be collected early in the illness and shipped promptly at 4C or on dry ice if prompt testing is not possible. Gilden RV, Kern J, Lee YK. Cleveland Clinic Community Care puts patients first by offering comprehensive, coordinated, personalized healthcare. The best way to prevent getting the viruses that cause mono is by practicing good hygiene. You should call your healthcare provider if you have mono and you experience: If you have mono, you may want to ask your healthcare provider: Most cases of mononucleosis (mono) dont cause serious problems. Adenoviral antigen in exfoliated bladder epithelial cells can be demonstrated by immunofluorescence.79 Cases of acute hemorrhagic cystitis after renal and bone marrow transplantation are increasingly being reported.81, 82, 83 Ad34 and Ad35, as well as species B adenoviruses, were first isolated from renal transplantation recipients, but neither was associated with symptoms of hemorrhagic cystitis.84, Adenoviruses are also recognized to cause watery diarrhea with fever. The search for vaccines against adenoviruses was driven by adenovirus morbidity among military trainees, their disruption to military training, and their medical care costs.15 In 1971, after a series of misstarts, military recruits began routinely receiving live oral enteric-coated vaccines for adenovirus types 4 and 7 (Ad4 and Ad7), which were safe and effective.19 With few exceptions, adenovirus morbidity was markedly controlled. Although the civilian experience has not established a requirement for a vaccine, the epidemic nature and extensive morbidity experienced by military recruits during the 1960s demonstrated an overwhelming need for adenovirus vaccines for military use. As vaccine stores were depleted, U.S. military trainees again experienced large outbreaks of adenovirus disease, with some deaths reminding public health officials of the impact of adenoviruses.20, 21, 22 In one comprehensive 2006 study, Russell and colleagues documented 98% Ad4 attack rates among 180 susceptible military recruits during 4 weeks of training.23 The importance of these pathogens has been further emphasized through the recent emergence of multiple novel Ad3, Ad7, and Ad14 strains and the subsequent epidemics and deaths they caused.24, 25, 26, 27, 28, 29, Human adenoviruses have been classically grouped into seven species (A through G) containing as many as 68 unique types (Ad1 through Ad68) and multiple more genotypes often determined by restriction enzyme digests (Ad7a, Ad7d2, etc). Bookshelf Medical Microbiology. Majhen D, Calderon H, Chandra N. Adenovirus-based vaccines for fighting infectious diseases and cancer: progress in the field. It will prevent most Hall CE, Brandt CD, Frothingham TE. Restriction enzyme analysis (REA) of whole-virus genomes can be used to identify genetic variants of a serotype, aiding epidemiologic studies and outbreak investigations.213, 214 Extensive studies of Ad3, Ad4, and Ad7 using REA have been described20, 215, 216, 217, 218 and a number of novel viruses have thus been identified.26 However, REA is work intensive, dependent on virus isolation to recover genomic DNA and requires expertise to perform and interpret, and is therefore restricted to a few experienced laboratories. Genome sequences are available for all human adenovirus prototype types and sequences of newly identified genomic variants are now routinely placed in public domain providing reference data for adenovirus identification.126 A new whole genome-based characterization system for adenoviruses is under consideration to replace immunotyping for designating new adenovirus types.31, 36. WebCommon, all ages, [3] typically children under 5-years [5] Adenovirus infection is a contagious viral disease, caused by Adenoviruses, commonly resulting in a respiratory tract The initial oral Ad4 vaccine was developed using dried virus contained in enteric-coated capsules and found to be effective in preventing infections.278 Original trials for Ad7 vaccine were conducted using 0.05mL of a 1:10 dilution of the Ad7 pool (106 TCID50) within a hard gelatin capsule and given orally.277 Time of disintegration within the intestine was assayed roentgenographically using a barium sulfatecontaining capsule and varied between 1 and 5 hours.277 Two small dose ranging studies using vaccine capsules suggested that for both types, nearly 100% seroconversion was achieved by approximately 104 TCID50 per capsule.289, 313 A 1969 dose-ranging study used three Ad7 doses: 106.8 TCID50,104.8 TCID50, and less than 10 TCID50 per capsule.277, 289 There was 100% antibody response with the highest dose, 95% response with the intermediate dose, and 56% response with the lowest dose. Several diploid and continuous cell lines, including A549, HeLa, HEp-2, KB, MRC-5 and commercial mixed cell lines with A549 cells, reportedly give good overall recovery and produce typical CPE.170, 171 However, the fastidious enteric adenoviruses Ad40 and Ad41 are an exception. Kajon AE, Wadell G. Sequence analysis of the E3 region and fiber gene of human adenovirus genome type 7h. Andiman WA, Miller G. Persistent infection with adenovirus types 5 and 6 in lymphoid cells from humans and woolly monkeys. Goldsmith CS, Miller SE. Infection and disease with respect to age, immunologic status, race and sex. In 2009, Lebeck and colleagues26 reported on 516 clinical Ad3 isolates from 15U.S. laboratories with restriction enzyme digests. Adenoviruses are transmitted by direct contact, aerosolized virus, the fecaloral route, and via water. Lee S, Hung P. Vaccines for control of respiratory disease caused by adenoviruses. Swab and fresh tissue specimens must be transported in appropriate viral transport media40, 58, 84, 101 whereas fluid samples like urine, stool, and cerebrospinal fluid should not be diluted in transport media. Killer Cold Virus (Adenovirus 14): Symptoms & Treatment Individual adenovirus types often have different tissue tropisms that lead to specific signs and symptoms (Table 10.1 But in vulnerable populations like people who have undergone organ transplants or have heart or lung disease adenovirus infections can last longer, with more severe symptoms. There is no cure, but there are medications that can help treat the symptoms. The PCR assay in particular has become a popular diagnostic alternative for these viruses, offering the potential for rapid and sensitive detection and being easily tailored for species-specific and type-specific identification as described below. An official website of the United States government. Youll need to protect your health by getting enough rest and fluids during this time. Close quarters can also contribute to outbreaks of adenovirus in adults, Pavia says. Ryan MA, Christian RS, Wohlrabe J. Handwashing and respiratory illness among young adults in military training. Some people miss some school or work as they recover. Pauschinger M, Bowles NE, Fuentes-Garcia FJ. eCollection 2022. Have a summer cold? Common viruses return from pandemic hiatus Chatterjee NK, Samsonoff WA, Balasubramaniam N. Isolation and characterization of adenovirus 5 from the brain of an infant with fatal cerebral edema. Mono The Johnson & Johnson adenovirus vaccine explained Melanie Swift, M.D., COVID-19 Vaccine Allocation and Distribution: Adenovirus vaccines are not really new. Pharyngoconjunctival fever caused by adenovirus type 4: report of a swimming pool-related outbreak with recovery of virus from pool water. So, if it looks like a cold or the flu, it is, right? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Yolken RH, Bishop CA, Townsend TR. A prospective study using extensive diagnostic techniques, such as duodenal, jejunal, and rectal biopsies, demonstrated that 6.5% of the patients had adenovirus infections.270. Latent adenovirus infections of the human respiratory tract. In early June, an estimated 25% of people in that study who were infected with a respiratory pathogen and had symptoms tested positive for adenovirus. Liu F, Green MR. Adenovirus types 4 and 7 has been associated with more severe outcomes than other adenovirus types, particularly in people with weakened immune systems. 2022 Mar 24;14(4):672. doi: 10.3390/v14040672. Smith CD, Craft DW, Shiromoto RS, Yan PO. 2022 Nov 4;55:e12347. Departments of the Army (AR40-562) TNB61 TNB, The Air Force (Joint Instruction 48-110), and Transportation (CG COMDTINST M623.4E) US Government Printing Office; Washington, DC: 1995. After retreating during the pandemic, colds are back in full force in some parts of the U.S. this summer. In 1973, a Navy trainee was hospitalized with fever, malaise, and dyspnea for 11 days after receiving the Ad4 and Ad7 vaccines.334 The patient died on the 10th hospital day with the diagnosis of Ad7 pneumonia, based on the isolation of the virus by cell culture. Adenovirus hepatitis in an immunosuppressed adult patient. Detection of microorganisms in the tracheal aspirates of preterm infants by polymerase chain reaction: association of adenovirus infection with bronchopulmonary dysplasia. Currently, brincidofovir is being evaluated against DNA viruses including adenoviruses. Clinical Overview Adenoviruses are medium-sized (90-100 nm), non-enveloped icosohedral viruses with double-stranded DNA. Evidence of frequent recombination among human adenoviruses. Although the studies are inconsistent, adenovirus is implicated as a possible fetal pathogen.89, 90 Adenovirus infections among children are associated with sudden infant death,91 encephalitis, meningoencephalitis,92, 93 cerebral edema,94 acute flaccid paralysis,95 pertussis-like syndromes,96, 97 mononucleosis-like syndromes,98 and neonatal disseminated infections.99 Among adults, adenovirus infections have been associated with a toxic shocklike syndrome,100 encephalitis, genital lesions, orchitis, urethritis, and cervicitis.101 Nosocomial transmission to susceptible healthcare workers and patients has been reported. This site needs JavaScript to work properly. Over 90% of mono cases are caused by the Epstein-Barr virus. Ad3, Ad14, and Ad21 also occurred, but less commonly.14 Up to 80% of recruits became infected with adenovirus, while seasoned military personnel experienced lower rates.4 Such outbreaks have also been reported among military recruits in China, Finland, The Netherlands, The United Kingdom, Turkey, Singapore, and South Korea.253, 254, 255, 256, 257, 258, 259, 260, 261, The disease characteristics of the adenoviruses vary by species and type (see Table 10.1).39 The reasons for these differences are not well understood. Cromeans TL, Lu X, Erdman DD, Humphrey CD, Hill VR. In the recent Phase II trial of the Teva vaccines, participants were followed shedding on days 0, 7, 14, 21, 28, and 56. 4th edition. It has been awarded Fast Track Designation by the FDA. The viruses can cause a number of different illnesses, although respiratory Adenoviruses replicate in the cell nucleus and tend to be very host-specific. Baum SG. Prevention of adenoviral acute respiratory disease in Army recruits: cost-effectiveness of a military vaccination policy. Image of adenovirus virion determined by cryoelectron microscopy showing newly understood interactions of the major components (hexon, penton, and fiber proteins) and minor proteins (IIIa, VIII, and IX). Internal bleeding from a ruptured spleen can be life-threatening and requires emergency surgery. Serum separated from clotted blood samples can be used for serological diagnosis (see below). For efficient recovery, most Ad40 and Ad41 strains require the Graham-293 Ad5-transformed secondary HEK (human embryo kidney) cell line for primary isolation. Kelsey DS. Adenovirus (geno)typing is possible and usually done by molecular methods (i.e., full, or partial genomic sequencing). Chiu CY, Yagi S, Lu X. Viruses, most commonly Epstein-Barr Virus (EBV), and certain infections cause the illness. Mononucleosis is an illness that commonly affects teenagers and young adults, but can affect children as well. Mayo MA, Haenni AL. Adenovirus Infections in Infants and Children Lam E, Ramke M, Warnecke G. Effective apical infection of differentiated human bronchial epithelial cells and induction of proinflammatory chemokines by the highly pneumotropic human adenovirus type 14p1. McNeill KM, Ridgely Benton F, Monteith SC, Tuchscherer MA, Gaydos JC. Adenovirus vaccine contains live adenovirus Type 4 and Type 7. Adenovirus infections can cause a variety of symptoms from sore throat and runny nose to pink eye and diarrhea. AdV52 has been associated with one outbreak cluster of acute gastroenteritis.124 These strains often require special cells lines for culture and they may not demonstrate cytopathic effect.85 Electron micrography or special assays are often necessary for their study.85 Numerous outbreaks have been described, and adenoviruses may account for up to 12% of all infant diarrhea.86, 87, 88, A number of case or outbreak reports document other, more unusual manifestations of human adenovirus infection. Before processing into tablets, the virus preparation was diluted with lactose powder.317. The authors noted an increasing prevalence of Ad21 over time.177. Nausea. WebAdenoviruses are common causes of respiratory illness, but most infections are not severe. In some winter months, more than 2200 preventable clinical infections were documented. They noted an increasing prevalence of Ad7, Ad8, and Ad19 and a declining prevalence of Ad3 and Ad4.45 Age predilections were highly significant for infants for species A (Ad12, Ad18, and Ad31); for infants and small children for species C (Ad1, Ad2, Ad5, and Ad6); for school children for Ad3; for school children and adults for Ad7; and for adults for Ad4, Ad8, and other types of species B, D, and E.45 A predilection for males was observed for all types in species B and C and in Ad4 and Ad19.45, A summary of 2237 clinical adenovirus submissions to 22U.S. laboratories during a 25-month period (20042006) revealed that Ad3 (prevalence: 34.6%), Ad2 (prevalence: 24.3%), Ad1 (prevalence: 17.7%), and Ad5 (prevalence: 5.3%) explained most illnesses among children. However, EBV is more likely to spread through other means like sharing drinks or kissing. A novel adenovirus species associated with an acute respiratory outbreak in a baboon colony and evidence of coincident human infection. The polypeptides of adenovirus. Saving Lives, Protecting People, Take steps to protect yourself and others, Respiratory Illness Associated With Emergent Human Adenovirus Genome Type 7d, Notes from the Field: Fatalities Associated with Human Adenovirus Type 7 at a Substance Abuse Rehabilitation Facility New Jersey, 2017, Adenovirus-associated epidemic keratoconjunctivitis outbreaks four states, 20082010, Outbreak of Human Adenovirus Type 3 Infection in a Pediatric Long-Term Care FacilityIllinois, 2005, National Center for Immunization and Respiratory Diseases, Specimen Collection and Laboratory Testing, U.S. Department of Health & Human Services. Ebner K, Pinsker W, Lion T. Comparative sequence analysis of the hexon gene in the entire spectrum of human adenovirus serotypes: phylogenetic, taxonomic, and clinical implications. Ad4 and Ad7 vaccines have been the primary means for controlling adenovirus-induced ARD among U.S. military trainees. While immunocompromised individuals might have longer-lasting, severe illness, "most people with adenovirus infection have mild symptoms that can be managed with supportive care at home," says Washer. How to tell if you have a cold or the flu by your symptoms. Simila S, Ylikorkala O, Wasz-Hockert O. Large, persistent epidemic of adenovirus type 4-associated acute respiratory disease in U.S. army trainees. 2023 Feb 24;12(5):732. doi: 10.3390/cells12050732. Lu X, Erdman DD. Epstein-Barr Virus and Infectious Mononucleosis. Johansson ME, Brown M, Hierholzer JC. -, Hartman ZC, Kiang A, Everett RS, Serra D, Yang XY, Clay TM, Amalfitano A. Adenovirus infection triggers a rapid, MyD88-regulated transcriptome response critical to acute-phase and adaptive immune responses in vivo. However, adults may occasionally require adenoid removal if there is a possibility of cancer or a tumor on the adenoids. Learn about adenovirus symptoms, transmission, prevention and more. Zhao S, Wan C, Ke C. Re-emergent human adenovirus genome type 7d caused an acute respiratory disease outbreak in Southern China after a twenty-one year absence. Lu X, Trujillo-Lopez E, Lott L, Erdman DD. Adenovirus 7a: a community-acquired outbreak in a children's hospital. Bellanti JA, Artenstein MS, Brandt BL, Klutinis BS, Buescher EL. Binn LN, Sanchez JL, Gaydos JC. During drying, additives were used to preserve viability. These symptoms may last for four weeks or longer: Your healthcare provider will assess your symptoms to make a diagnosis. Simila S, Jouppila R, Salmi A, Pohjonen R. Encephaloningitis in children associated with an adenovirus type 7 epidemic. Lebeck MG, McCarthy TA, Capuano AW. I would feel comfortable with my family members getting any one of the three that's available. Evidence for multiple protein components in the virion and a comparison of types 2, 7A, and 12. van Oostrum J, Burnett RM. Close quarters can also contribute to outbreaks of adenovirus in adults, Pavia says. Ooi MH, Wong SC, Clear D. Adenovirus type 21-associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia. WebSymptoms Treatment Adenovirus Vaccine What are adenovirus facts? The site is secure. Towle A, Azad A. Ambinder RF, Burns W, Forman M. Hemorrhagic cystitis associated with adenovirus infection in bone marrow transplantation. Heim A, Ebnet C, Harste G, Pring-Akerblom P. Rapid and quantitative detection of human adenovirus DNA by real-time PCR. Wilcox WC, Ginsberg HS. Sturdy PM, Court SD, Gardner PS. Foy HM. Woods GL, Young A. Cells. McBride WD, Wiener A. Molecular typing of clinical adenovirus specimens by an algorithm which permits detection of adenovirus coinfections and intermediate adenovirus strains. Howard DS, Phillips IG, Reece DE. 8600 Rockville Pike Philipson J, Peterson U, Lindberg U. Molecular biology of adenoviruses. Enteric immunization with live adenovirus type 21 vaccine. Adenovirus epidemics often occur at intensive care units or long-term care facilities. Virus taxonomy: classification and nomenclature of viruses: eighth report of the International Committee on Taxonomy of Viruses. Elnifro EM, Cooper RJ, Klapper PE, Bailey AS. Cross-species transmission of a novel adenovirus associated with a fulminant pneumonia outbreak in a new world monkey colony. Production of specific neutralizing antibody with soluble antigens of type 5 adenovirus. A new experimental oral antiviral therapy against DNA viruses, brincidofovir (formerly CMX001), shows great promise against adenoviruses.225, 234, 235 An analog of cidofovir, it does not have cidofovir's renal toxicity profile. Secondary control measures have included reducing crowding, aligning trainees' beds head-to-foot, making frequent hand washing a requirement, increasing air exchanges, and keeping contact between different cohorts of recruits to a minimum (cohorting).340, 341, 342 Although interventions like frequent hand washing340 caused a 45% reduction in upper respiratory tract infections among trainees, the numerous attempted interventions fell far short of the effectiveness of administering adenovirus vaccines in reducing ARD. Crawford-Miksza LK, Schnurr DP. Reid JA, Breckon D, Hunter PR. Four minor proteins (IIIa, VI, VIII, and IX) add to the complexity of the capsid. After the loss of the manufacture of the Ad4 and Ad7 vaccines, there were many documented outbreaks of ARD due to adenoviruses in U.S. military training centers. Epidemic spread of adenovirus type 4-associated acute respiratory disease between U.S. Army installations. Investigations done by state and city health authorities, the U.S. Air Force, and CDC during several outbreaks showed that Ad14 is a rarely reported but emerging 2008 Feb;89(Pt 2):380-388. Larranaga C, Kajon A, Villagra E, Avendano LF. You will be subject to the destination website's privacy policy when you follow the link. VI. WebThis is the most common cause of adult infections and the virus thats usually responsible for outbreaks on cruise ships. Some information for the recently described adenovirus types is not yet available. This virus occurs year-round and affects children under age 2. In the 1950s, multiple researchers1, 2 identified new viruses as the cause of acute respiratory disease (ARD), pharyngitis, conjunctivitis, and pneumonitis. Chang C, Lepine P, Lelong M, Le-Tan-Vinn S. Severe and fatal pneumonia in infants associated with adenovirus infections. Kajon AE, Mistchenko AS, Videla C. Molecular epidemiology of adenovirus acute lower respiratory infections of children in the south cone of South America (1991-1994). Meiklejohn G. Viral respiratory disease at Lowry Air Force Base in Denver, 1952-1982. Nebulized ribavirin was used with some success for two children with pneumonia caused by adenovirus.227 Intravenous ribavirin has been reportedly used in immunocompromised patients and in patients with hemorrhagic cystitis and disseminated disease.219, 228, 229, 230, 231 Intravenous ribavirin was given to 12 adult blood and marrow transplant recipients without appreciable benefit.232 The mixed reports may be explained by a recent finding that only human adenoviruses of species C are susceptible to ribavirin.190 In contrast, all species of human adenovirus appear to be susceptible to cidofovir.190 Perhaps this finding explains the better results with this antiviral drug. Adenovirus type 14 which has been associated with outbreaks of acute respiratory illness For the trial, 58 initially seronegative subjects were selected. Sherwood RW, Buescher EL, Nitz RE, Cooch JW. Top F, Grossman R, Bartelloni P. Immunization with live types 7 and 4 adenovirus vaccines. Instructions for testing, typing, and submission. Couch RB, Cate TR, Douglas RG, Jr, Gerone PJ, Knight V. Effect of route of inoculation on experimental respiratory viral disease in volunteers and evidence for airborne transmission. Genome sequences of human adenovirus 14 isolates from mild respiratory cases and a fatal pneumonia, isolated during 2006-2007 epidemics in North America. People with mono experience extreme fatigue, fever and body aches. Chany C, Lepine P, Lelong M. Severe and fatal pneumonia in infants and young children associated with adenovirus infections. Adenovirus Adenovirus Outbreaks Antibiotics, for example, treat bacterial infections, so they won't help with adenovirus symptoms. Prediction of severe disseminated adenovirus infection by serum PCR. Heterogeneity of the fibre sequence in subgenus C adenoviruses. Zhou P, Dai J, Zhang K, Wang T, Li LF, Luo Y, Sun Y, Qiu HJ, Li S. J Virol. II. Cytomegalovirus To KK, Tse H, Chan WM. Deal C, Pekosz A, Ketner G. Prospects for oral replicating adenovirus-vectored vaccines. shows the chest radiograph of a 20-year-old recipient of an autologous bone marrow transplant for diffuse large cell lymphoma (B-cell type) with systemic Ad11 infection, which was obtained on day 45 posttransplantation. Gaydos CA, Gaydos JC. Li QG, Wadell G. Analysis of 15 different genome types of adenovirus type 7 isolated on five continents. Buchdahl RM, Taylor P, Warner JD. The family Adenoviridae is separated into two genera: the avian adenoviruses (aviadenoviruses) and the mammalian adenoviruses Although recent data suggest that human Ad4 and Ad52 may have simian origins,124, 141 and a novel adenoviruses may have crossed species between humans and animals,137, 262 humans are thought to be by far the primary reservoir for human adenovirus.263, The most common environment for adenovirus transmission is the home. 10.1 Gaydos JC. Robinson C, Echavarria M. Adenoviruses. The revolution in viral genomics as exemplified by the bioinformatic analysis of human adenoviruses. Wadell G. Adenoviridae: the adenoviruses. sharing sensitive information, make sure youre on a federal Adenoviruses from patients with AIDS: a plethora of serotypes and a description of five new serotypes of subgenus D (types 43-47). Fecal adenoviruses from a longitudinal study of families in metropolitan Washington, D.C.: laboratory, clinical, and epidemiologic observations. This realization of preventable morbidity was not lost to public health officials inside and outside the U.S. Department of Defense, with many calling for reacquisition and use of the vaccines.305, 306, 307, 308. These proteins have the ability to interact with the DNA binding domains of several cellular transcription factors and activate a wide variety of genes.164, 165 The adenoviral genome has been found to be present in the lungs of more patients with COPD than in control subjects.166 E1A proteins are expressed in epithelial cells of human lung tissue, and by increasing the expression of several genes important in controlling the inflammatory process, these may contribute to the pathogenesis of COPD.
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