In conversation with Dr. Richard Mollenkamp, ​​Department of Viroscience, Erasmus MC

The Erasmus Medical Center (Erasmus MC) in Rotterdam, the Netherlands, has a long and proud history as a teaching hospital and research facility, with a world-renowned virology department dedicated to better understanding viruses and molecular diseases, patients and the infections they cause. working for Population level.

It is thanks to the work of them and similar centers around the world that threats of serious illness can be rapidly detected and controlled. In fact, their work includes studying and monitoring a whole range of viruses, from Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) to Ebola, HIV, influenza, herpes and measles.

In addition to known viruses, his work also helps identify new and emerging pathogens that may pose a threat to humans, which are appearing more and more frequently due to a number of factors, including globalization, land use, and climate change. Huh. The ongoing COVID-19 pandemic, now entering its fourth year, and the recent Public Health Emergency of International Concern, are just 2 examples showing the significant impact of zoonotic diseases (those originating in animals). Huh. Our interconnected world.

To better understand the work of the Department of Virology, especially in the context of the COVID-19 pandemic, we spoke to Dr. Richard Mollenkamp, ​​a clinical molecular virologist who works there.

How long have you worked at Erasmus MC and what is your specific role here?

I’ve been working here for 4½ years, and my role is focused on molecular diagnostics – in other words, analyzing markers in the genome of viruses to diagnose and monitor disease, and to help clinicians decide whether that which treatments will work best for their patients.

In addition, I also play a role in reference centers for many viruses. Erasmus MC is the WHO Collaborating Center for Arbovirus and Hemorrhagic Fever Reference and Research. Arboviruses are transmitted by mosquitoes, ticks, and other arthropods. The Collaborating Center’s work also includes dealing with novel and emerging infectious diseases, such as those caused by coronaviruses. Additionally, the Department of Virology is recognized as one of the reference laboratories of the WHO European Region for measles and rubella, and is the National Reference Center for Influenza and Emerging Viral Infections in the Netherlands.

Can you give us a brief description of the purpose and work of the Department of Viroscience?

We do basic research and diagnosis, plus everything in between! As with all of our activities, we aim to use what we know to benefit human health. We are a large department, consisting of about 200 or 300 people, from clinical doctors working directly with patients to scientists and technicians of all levels who actually do the diagnosis and study.

How do you go about identifying, characterizing and diagnosing viruses?

Depending on the specific diagnostic question, we sequence the genomic material of the virus using polymerase chain reaction (PCR) to copy, amplify, and detect the ribonucleic acid (RNA) strands that make up the genomic code of the virus. Let’s try to find out.

Additionally, we can perform sequencing to understand the exact sequence of genetic information contained in the RNA strands, which helps us to identify and characterize viruses, for example, to determine whether viruses have The mutation may affect antiviral therapy.

Alternatively, we can determine whether a patient has been previously infected with a virus by looking at antibodies in the patients’ serum (serology). Finally, we use virus culture in some cases to answer some specific diagnostic questions that we may have.

Can you tell us what role Erasmus MC laboratories have played in testing for SARS-CoV-2, the virus that causes the disease COVID-19?

From the early start of the pandemic in January 2020, we collaborated with other WHO Collaborating Centers to validate the PCR test developed by the Charite laboratory in Berlin, Germany, for the clinical detection of SARS-CoV-2. Had to be a standard method. 2 around the world.

Thereafter, we started testing for SARS-CoV-2 in the third week of January 2020. Since that time, and essentially still, we have advised and collaborated with WHO and other WHO Collaborating Centers around the world to share information on the virus and Laboratory Methods.

In the Netherlands, we were initially only testing suspected cases who had a travel history to China or later Italy, but in late February, we had our first positive COVID-19 case here. From that point on, we began doing regular testing, working with the RIVM (National Institute for Public Health and the Environment) to confirm each other’s test results.

As the pandemic spread and more hospital laboratories became involved in testing, we became the sole testing laboratory for the Rotterdam region, which lasted until August 2020, when it was realized that there was more testing capacity than we could provide was needed.

Currently, we are primarily involved in routine testing of newly admitted patients to our hospital, while continuing to regularly test our health care workers to prevent the spread of COVID-19 infection and ensure adequate personnel availability Huh. To provide health care.

As the pandemic has progressed, we have seen new forms emerge. Are you surprised how viruses have changed and evolved over time?

Not necessary. From our experience and previous studies of coronaviruses and other genetically engineered viruses of RNA, I think it is no surprise that there has been a certain level of variation and evolution in the makeup of SARS-CoV-2. What is new in this pandemic, however, compared to other outbreaks, is that we have been able to closely follow how viruses have evolved through populations, thanks to the powerful techniques that have been developed for real-time sequencing. are capable of. The amount of genetic data we have for SARS-CoV-2 is unprecedented. This means we have been able to better detect new variants and track in real time how they are spreading.

Has your testing regime changed as a result of the number of people affected by COVID-19?

definitely. At the start of the pandemic, we were splitting our samples with the RIVM lab for joint testing and confirmation using a manual PCR system to take a joint decision on the results. This was all great when we were only dealing with a small number of cases, but it took more than 24 hours to get a definitive result, making the process unstable as the numbers grew exponentially.

Thanks to the development and introduction of more automated systems, we can now do community testing in about 12 hours and have laboratories working round the clock to process samples. If really quick answers are needed – for example, if a hospital’s emergency department is full of patients and a negative test is needed to admit someone to a general ward – we can use rapid molecular testing. Which can give results within an hour. These tests are expensive and only suitable for testing very small quantities, so we only do this for particularly urgent cases.

How is your work contributing to controlling and ending the pandemic?

During the pandemic, we have provided community testing for people with mild symptoms as a means of controlling infection and ensuring that the virus does not spread further through the population. Since vaccines have become available, we have also conducted tests on their effectiveness, especially looking at newer forms, and have conducted diagnostics to see how well they perform.

In addition, we also study the effectiveness of antiviral compounds on emerging variants, all of which are helpful for the development of new, more targeted vaccines and antiviral therapies.

Do you think that the role of laboratories in disease research, surveillance and testing is fully appreciated by governments, health authorities and the wider public? What needs to happen to better communicate what you do?

Laboratories often play a role behind the scenes, which can be too easily taken for granted. Indeed, I often think that the public, policy-makers and even some clinicians treat them as some sort of machine where you push a button and the results pop up immediately!

In reality, it is much more sophisticated than that. It is only through continuous manufacturing expertise that laboratories work properly. Without specialist laboratories and the funding needed to maintain and develop them, we would have a very limited understanding of diseases, infection dynamics and the best ways to prevent and treat emerging health threats. This has been particularly evident during the COVID-19 pandemic, as many measures of response were developed for data from specialist laboratories like ours.

In general, laboratories try – and we certainly do – to communicate their work in a number of ways, including publishing results, talking with the press, and informing stakeholders. However, science communication is a specialization in its own right and, in my opinion, needs to be more integrated into the skill set of the next generation of laboratory scientists in order to improve effectiveness.

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