BIOCHEMISTRY & BIOMEDICAL SCIENCES

Influenza Virus Type A, B, & C
Multiple Choice Questions

1) Which of the following statement is NOT true about the influenza viruses A, B, and C?
a) Influenza type A can be found in chickens, pigs, and horses
b) Antigenic shifts or viral genome reassortment occurs in Influenza A virus, the common cause for worldwide epidemics
c) All three types of viruses are found in humans as well as animals
d) Influenza virus infects mainly the upper respiratory tract

2)The properties of Orthomyxoviruses include all of the following statement, EXCEPT?
a) The virus consists of single-stranded RNA
b) The outer envelope of the virus is made up of lipid bilayer
c) The size of the virus (150nm) is larger than the Paramyxoviruses >
d) The hemagglutinin and neuraminidase of the influenza virus helps it to attach to the host cells

3) Which of the following is NOT the common symptoms of flu caused by influenza virus in adults?
a) Fever
b) Cough
c) Rashes
d) Headache

4) Which of the following viruses gives lifelong immunity to disease............?
a) Rhinovirus
b) Influenza A virus
c) Influenza C virus
d) Measles virus

5) Which of the following immunologic types of influenza causes most of the epidemics?
a) Type A
b) Type B
c) Type C
d) None of the above

6) Which of the following are at risk of getting influenza flu? Choose the correct answer
a) A 70-year-old woman
b) A healthy 4-year-old boy
c) A 35-year-old man with diabetes
d) All of the above

7) The most common route of the pathogenesis of influenza virus is airborne droplets, which of the following virus is most likely to cause a pandemic?
a) Influenza A
b) Rhinovirus
c) Influenza B
d) All of the above

8) Which of the following microorganism is commonly associated with pneumonia caused by the influenza virus?
a) Rhinovirus
b) Staphylococcus aureus
c) Rubella virus
d) Chlamydia pneumoniae

9) All of the following statements are correct about the Neuraminidase (NA) and Hemagglutinin (HA) of influenza virus, EXCEPT?
a) Helps the virus to bind to host cell surface
b) Both of the antigens are embedded in the outer surface of the viral envelope
c) Neuraminidase is present as a spike and is composed of dimers
d) Frequent antigenic changes occur in NA and HA

10) A 16-year-old girl comes to the clinic with a sore throat, fever, and headache, the symptoms resembled the flu-like syndrome. Which of the following could be the primary sample/specimen for the laboratory diagnosis of influenza virus?
a) Blood
b) Sputum
c) Urine
d) Nasopharyngeal washing

11) Which of the following statements about isolation and identification of influenza is NOT correct?
a) The specimen should be kept at 4 degree Celsius
b) Culture of the virus is usually done by using embryonated eggs
c) The specimens should be taken within 1 to 3 days after the onset of symptoms
d) Rapid antigen detection tests cannot be done

12) Major antigenic changes in HA or NA is known as an antigenic shift which results in a new influenza virus subtype, True or False?
a) True
b) False

13)Which of the following is a reservoir for the antigenic shift variants of influenza virus?

Title: Volanesorsen and Triglyceride Levels in Familial Chylomicronemia Syndrome.
Abstract
BACKGROUND:
Familial chylomicronemia syndrome is a rare genetic disorder that is caused by loss of lipoprotein lipase activity and characterized by chylomicronemia and recurrent episodes of pancreatitis. There are no effective therapies. In an open-label study of three patients with this syndrome, antisense-mediated inhibition of hepatic APOC3 mRNA with volanesorsen led to decreased plasma apolipoprotein C-III and triglyceride levels.
METHODS:
We conducted a phase 3, double-blind, randomized 52-week trial to evaluate the safety and effectiveness of volanesorsen in 66 patients with familial chylomicronemia syndrome. Patients were randomly assigned, in a 1:1 ratio, to receive volanesorsen or placebo. The primary end point was the percentage change in fasting triglyceride levels from baseline to 3 months.
RESULTS:
Patients receiving volanesorsen had a decrease in mean plasma apolipoprotein C-III levels from baseline of 25.7 mg per deciliter, corresponding to an 84% decrease at 3 months, whereas patients receiving placebo had an increase in mean plasma apolipoprotein C-III levels from baseline of 1.9 mg per deciliter, corresponding to a 6.1% increase (P<0.001). Patients receiving volanesorsen had a 77% decrease in mean triglyceride levels, corresponding to a mean decrease of 1712 mg per deciliter (19.3 mmol per liter) (95% confidence interval [CI], 1330 to 2094 mg per deciliter [15.0 to 23.6 mmol per liter]), whereas patients receiving placebo had an 18% increase in mean triglyceride levels, corresponding to an increase of 92.0 mg per deciliter (1.0 mmol per liter) (95% CI, -301.0 to 486 mg per deciliter [-3.4 to 5.5 mmol per liter]) (P<0.001). At 3 months, 77% of the patients in the volanesorsen group, as compared with 10% of patients in the placebo group, had triglyceride levels of less than 750 mg per deciliter (8.5 mmol per liter). A total of 20 of 33 patients who received volanesorsen had injection-site reactions, whereas none of the patients who received placebo had such reactions. No patients in the placebo group had platelet counts below 100,000 per microliter, whereas 15 of 33 patients in the volanesorsen group had such levels, including 2 who had levels below 25,000 per microliter. No patient had platelet counts below 50,000 per microliter after enhanced platelet-monitoring began.
CONCLUSIONS:
Volanesorsen lowered triglyceride levels to less than 750 mg per deciliter in 77% of patients with familial chylomicronemia syndrome. Thrombocytopenia and injection-site reactions were common adverse events.

Meadows et al. recently published papers (Mol Ther Methods Clin Dev, 2019) that investigated the threshold of antibody titer levels that would limit the transduction efficiency of systematic rAAV9 gene delivery.  The early clinical trials have revealed a potential impact of preexisting antibodies against adeno associated virus in the efficacy of transgene expressions. This study attempts to characterize the correlation of transgene expression (NAGLU)  with preexisting antibody titers against AAV9.  The nonclinical nonhuman primate studies were conducted to evaluate the transduction efficiency after systemic delivery of rAAV9 at varying level of preexisting antibodies and define efficacy threshold if any. The following are the excerpts and the result summary from the study:
Journal Title: Molecular Therapy: Methods & Clinical Development
Title:

Long et al. & Majowicz et al. recently published papers (Mol Ther Methods Clin Dev, 2019) that reported potential impact of preexisting antibodies against adeno associated virus serotype 5 ( AAV5) in the efficacy of transgene expressions. These nonclinical nonhuman primate studies were conducted to evaluate the efficacy of the gene therapy at varying level of preexisting antibodies. Factor VIII and factor IX activity as measured as a pharmacodynamic marker of efficacy.  The Following are the excerpts and the result summary from the study:

Journal: Molecular Therapy Methods & Clinical Development
Title: The Impact of Pre-existing Immunity on the Non-clinical Pharmacodynamics of AAV5-Based Gene Therapy

Kruzik et al. recently published a paper (Human Gene Therapy Methods, 2019) that provides the rationale for use of in vitro assay for the detection of low titer neutralizing antibody against adeno associated virus. The study showed superior sensitivity of in vitro NAb assay compared to the in vivo assay. Following are the excerpts from the study.

Journal: Human Gene Therapy Methods
Title: Detection of Biologically Relevant Low-Titer Neutralizing Antibodies Against Adeno-Associated Virus Require Sensitive In Vitro Assays

Multiple Choice Question of Hepatitis viruses, types, infection and transmission

1) Which of the following organ is primarily infected by Hepatitis viruses?
a) Intestines
b) Gall bladder
c) Stomach
d) Liver

2) All of the following are the type RNA virus, EXCEPT?
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D

3) Which of the following virus is NOT transmitted through the parenteral route?
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D

4) Hepatitis A virus (HAV) belongs to which of the following family of viruses?
a) Hepadnaviridae
b) Hepeviridae
c) Picornaviridae
d) Flaviviridae

5) All of the following are the important structural characteristics of the Hepatitis B virus (HBV) EXCEPT?
a) The size of the virus is 42 nm in diameter
b) The envelope consists of surface antigen (HBsAg) and lipid
c) Consists of the single-stranded RNA genome
d) The mode of transmission is parenteral

6) All of the following statements regarding HBV infection is true, EXCEPT?
a) Acute liver infection is subclinical in about 70 percent
b) Chronic hepatitis B can lead to cirrhosis and liver cancer
c) Infants born to infected mothers can have this virus
d) Medications are not available for the treatment of the chronic hepatitis B infection

7) Which of the following is the major risk factor for the Hepatitis C virus (HCV)infection in the United States of America?
a) Sexual activity
b) Use of drugs
c) Blood transfusion
d) Tattoos

8) Hepatitis D virus is also known as the delta virus requires HBV to cause infection in people
a) TRUE
b) FALSE

9) Hepatitis E virus (HEV) infection is more commonly found in developing countries which is transmitted mostly through contaminated water, all of the following are the signs and symptoms of HEV, EXCEPT?
a) Blood in the stool
b) Nausea and vomiting
c) Yellowing of the skin
d) Low-grade fever

10) Which of the following statement is true for hepatitis causing viruses HAV, HCV, HDV, and HEV?
a) Transmitted via the fecal-oral route
b) Transmitted via the parenteral route
c) Contain a single-stranded RNA genome
d) Can lead to liver cancer

11) Which of the following group of people are NOT considered in the increased risk of acquiring HAV infections?
a) People traveling to developed countries to developing countries
b) Men having a sexual relationship with other men
c) People working with primates
d) From infectious pregnant women to their babies >

12) A 32-year-old man comes to the clinic with abdominal discomfort and vomiting, low grade and fever, the diagnosis was done and is found to be infected with HAV. In a blood sample, IgM antibodies detection confirms the HAV infection, how long after the initial infection these antibodies are found in the blood?
a) 24 hours
b) 3 to 4 days
c) 1 to 2 weeks
d) 12 hours

13) All of the following statements are true for the diagnosis of HBV infection, EXCEPT?
a) Tests for the detection of elevated liver enzymes should be done
b) Serological tests to detect
c) Liver function test- bilirubin
d) Glucose challenge test       

14) Which of the following statements about HDV is NOT correct?
a) RNA virus
b) Transmitted by parenteral route
c) Can replicate only when in a cell that is also infected by HBV
d) None of the above

15) According to the World Health Organization's recent survey, about what percentage of people know they are living with Hepatitis infection?
a) 75 %
b) >5 %
c) 25 %
d) 50 %

16) What are the other risk factors that can cause hepatitis infection apart from virus, Select all the correct answers?
a) Abuse of drugs
b) High alcohol consumption
c) Fatty liver
d) Autoimmune infection

17) Which of the following statements is NOT correct about the vaccination of HAV, HBV, and HCV?
a) Hepatitis A vaccination should be started when kids are 1 year old
b) Newborns from infected mothers are only required to get the HBV vaccine
c) There is no vaccine available for HCV
d) All of the above

18) HEV can cause epidemics of jaundice, more commonly seen in developing countries. All of the following are the most common sources of HEV, EXCEPT?
a) Contaminated water
b) Raw or undercooked pork
c) Contaminated blood products
d) A sexual relationship with an infected individual

19) All of the following statements about the HEV is true, EXCEPT?
a) Transmitted by the fecal-oral route
b) It is a non-enveloped virus
c) The major cause of hepatitis liver cancer
d) Found in rodents and pigs

20) Hepatitis C infection in the USA is increasing among young adults in the USA, there is more than 100 % increase since 2005 particularly seen among young adults. Which of the following is the most common cause of this infection?
a) Injecting drug use
b) Sexual relation
c) Baby born to an infectious mother
d) Sharing razors and toothbrushes


Answers
1) d) Liver
2) b) Hepatitis B
3) a) Hepatitis A
4) c) Picornaviridae
5) c) Consists of the single-stranded RNA genome
6) d) Medications are not available for the treatment of the chronic hepatitis B infection
7) c) Blood transfusion
8) a) TRUE
9) a) Blood in the stool
10) c) Contain a single-stranded RNA genome
11) d) From infectious pregnant women to their babies
12) c)1 to 2 weeks
13) d) Glucose challenge test           
14) d) None of the above
15) b) >5 %
16) All options above
17) b) Newborns from infected mothers are only required to get the HBV vaccine
18) d) A sexual relationship with the infected individual
19) c) The major cause of hepatitis liver cancer
20) a) Injecting drug use