Emerging Laboratory Safety I have no financial conflicts. Off label - - PDF document

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Emerging Laboratory Safety I have no financial conflicts. Off label - - PDF document

3/8/18 Disclosure Emerging Laboratory Safety I have no financial conflicts. Off label use of medications will be discussed and Health Issues Diane Liu, MD, MPH Chief, Occupational Health (formerly) UC Berkeley UC System Occupational


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Emerging Laboratory Safety and Health Issues

Diane Liu, MD, MPH Chief, Occupational Health (formerly) UC Berkeley

Disclosure

  • I have no financial conflicts.
  • Off label use of medications will be discussed

UC System Occupational Health

  • 10 campuses – Includes medical centers and campuses
  • Office of the President
  • UC Agriculture and Natural Resources
  • http://ucanr.edu/About_ANR/We_are_UC_ANR/
  • 7 on-site Occupational Health Clinics
  • Campus workers compensation treatment
  • Laboratory occupational health
  • Institutional Biosafety Committee
  • Animal Care and Use Committee
  • Campus/MC Occupational Health and Wellness
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University of California - Berkeley

FTE Academic 5484.7 Non-Academic 8592.7 Total 14077.3 Title FTE Faculty- Ladder-rank and Equivalent 1367.7 Faculty – Clinical/In-Residence/Adjunct 141.7 Faculty - Lecturers 406.5 Other Academic Employees 962.2 Post-doctoral Scholars 877.1 Student Teaching/Research Assistants 1792.4 Senior Management 10.5 MSP - Managers 517.8 MSP – Senior Professionals 790.2 PSS – Non Students 6314.3 Student Staff 959.9

University of California - Berkeley

Headcount Academic 9802 Non-Academic 13755 Total 23557 Title Headcount Faculty- Ladder-rank and Equivalent 1513 Faculty – Clinical/In-Residence/Adjunct 214 Faculty - Lecturers 797 Other Academic Employees 1348 Post-doctoral Scholars 1208 Student Teaching/Research Assistants 4722 Senior Management 13 MSP - Managers 518 MSP – Senior Professionals 863 PSS – Non Students 7104 Student Staff 5257

Reporting of Laboratory Accidents

  • National Institutes of Health
  • Office of Science Policy
  • Office of Laboratory Animal Welfare
  • OSHA
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Laboratory Accidents

UCB 2016-17 Lab Accidents identified: 16 Total injuries: 500-600/yr

Injury Cut 3 Needlestick 2 Skin exp, with PPE 2 Skin exp, no PPE 1 Splash with PPE 2 Splash no PPE 5 Resp irritant 1

In the news

  • Boston College Student Hurt in Lab Accident – Boston Globe 2011
  • Colorado College Lab Accident Hospitalizes 13 – The Denver Post 2013
  • Death in the Lab – Discover 2015
  • Dartmouth Faces Fine of $13,000 – Valley News 1997

Research at Berkeley

  • World Class Research
  • 8 current Nobel Laureates
  • 144 members of National Academy of Sciences
  • 235 Fellow of the American Academy of Arts and Sciences
  • Innovative and Entrepreneurial
  • Currently there are ~450 operating laboratories

UC Berkeley Faculty Health Programs

  • Occupational Health Clinic
  • Campus Employee Health
  • Resource for Health in Research

Laboratories

  • MD 2.2 FTE
  • NP 1.0 FTE
  • AA 2.0 FTE
  • MA 3.0 FTE
  • Wellness Coordinator 1.0 FTE
  • Registered Dietician 0.2 FTE
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Rabies

An Anci cient t Disease – Modern times

  • A condition known for 4000 years
  • Democritis in 4th Century BC, gave a clear description of rabies
  • Aristotle (300 BC) notes that rabies as disease of dogs and any animal the

dog bites

  • Rabies: Latin “to rage” (rabere)
  • 16th century, Girolamo Fracastoro discovered that rabies was a

fatal disease affecting humans as well as animals, calling it "an incurable wound”.

  • Louis Pasteur a French biologist that created the first vaccine in 1885.

Etymologia: Rabies. Emerg Infect Dis. 2012;18(7):1169. https://dx.doi.org/10.3201/eid1807.ET1807

Ancient Disease – Mo Modern times

  • Canines – new WHO initiative (Jan 2018) to eradicate rabies (a

neglected zoonotic disease) in developing countries

  • Wild animals: carnivores, raccoons, skunks, foxes
  • No rabies seen in Antarctica
  • Current incidence in the U.S. is less than 2 per year ( 100 per year in

the late 1800s to early 1900s)

  • Canine vaccination very successful in the reduction of rabies in

developing countries.

By Wei-Chung Allen Lee, Hayden Huang, Guoping Feng, Joshua R. Sanes, Emery N. Brown, Peter T. So, Elly Nedivi

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Neuroscience

  • Imagine being able to choose one neuron and identify all of the

neurons connected to that single neuron.

  • This is felt to be key to fully understand the functioning of the brain
  • Scientists at the Salk Institute reported successfully turning the deadly

rabies virus into a tool for neuroscience.

  • Monosynaptic Restriction of Transsynaptic Tracing from Single,

Genetically Targeted Neurons Wickersham, Ian R. et al. Neuron , Volume 53 , Issue 5 , 639 – 647. March 2007.

Modified Rabies Virus (RV)

  • Single gene deletion – rabies Glycoprotein (G)
  • This glycoprotein allows RV to move transynaptically from neuron to

neuron from bite to the brain and then anterograde to the salivary

  • glands. It is not involved in replication of the virus.
  • If one deletes this gene, the rabies virus is marooned in the cell that

has been infected.

  • If you add the gene (G) via plasmid into the same cell, it will replicate

and be able to transfect any synaptically connected neurons

  • However, the modified virus cannot spread further: monosynaptic

Pseudo-typing - A second modification

  • In order to further customize the virus, the investigators pseudotyped the

virus with an avian envelope protein (EnvA) to only recognize a specific receptor, (TLV)

  • Changes the tropism of the virus. No longer recognized mammalian cells,

but recognize avian cells

  • Can transfect specific neurons with plasmids with TLV gene, G gene and a

fluorophore such as Green Fluorescent Protein (EGF), mCherry or DsRed2.

  • SADdG-EGFP/EnvA is an example of a modified rabies virus. This modified

version of the rabies virus forces neurons it infects to produce a green fluorescent protein.

Occupational Health Issues

  • 2008 – First researcher at UCB requested to use this modified rabies

virus.

  • Only one gene different than wild-type RV
  • Presented to Institutional Biosafety Committee, determined with

input from the NIH that all researchers and persons potentially exposed to virus have pre-exposure prophylaxis for rabies infection.

  • Mortality of RV infection approaches 100% in unvaccinated
  • individuals. Vaccination offers close to 100% protection
  • Latency: an eclipse phase for days to months
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Occupational Health Issues – G-deleted RV

  • Current recommendations are to have pre-exposure counselling for

possibility of vaccination.

  • Post-exposure: follow current guidelines appropriate for pre-

vaccinated vs. unvaccinated individuals

Sample SOP for G-deleted rabies

  • BL-2 containment: disposable gloves, gown and faceshield. Work to

be done in dedicated BL-2 room

  • All persons to be trained.
  • Signage on doors
  • Reduce level of sharps use. Proper sharps disposal
  • Red biohazard bags for waste
  • 10% bleach for decontamination of surfaces
  • Animals injected with g-deleted RV remain housed in BL-2 cages but

can be moved to BL-1 rooms for housing.

"Stanek E, Cheng S, Takatoh J, Han B, Wang F (2014).Monosynaptic premotor circuit tracing reveals neural substrates for oro-motor coordination". eLife. DOI:10.7554/eLife.02511. PMID 24843003. PMC: 4041139

Bats and Rabies

Photos by Christie Ferrecchia, DVM

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Research at UCB

  • Field researchers
  • Museum of Vertebrate Zoology – specimen collection
  • Live trapping
  • Specimens from local health department
  • Teaching classes in basic field technique
  • Studying bat viruses and spillover events in Madagascar – new!

Rabies Vaccination – pre-exposure

  • Recommended for:
  • Veterinarians
  • Persons who work with rabies

virus

  • Frequent contact with animals

known to be infected with rabies

  • Study bats, work in caves
  • Travel to countries with canine rabies
  • Pre-exposure prophylaxis
  • IM vaccine at 0, 7, 21 –28 days
  • No need for post-vx titer
  • Titer check every 1 or 2 years
  • Avoid vx in immune compromised

Rabies Post-Exposure Vaccine

  • Decontamination of wound: thorough gentle cleansing with soap and H2O.

Povidone-Iodine if available.

  • If pre-vaccinated
  • Dose 1 – as soon as possible after decontamination of wound
  • Dose 2 – 3 days after first dose
  • If not pre-vaccinated
  • Dose 1 – as soon as possible after decontamination of wound. HRIG, infiltrated

around wound and the rest IM distant from vx site

  • Dose 2 – 3 days after first dose
  • Dose 3 – 7 days after first dose
  • Dose 4 – 14 days after first dose
  • Dose 5 (for immune compromised host) – 4 weeks after first dose

Viral Vectors

Biosafety Considerations for Research with Lentiviral Vectors

https://osp.od.nih.gov/wp-content/uploads/2014/01/Lenti_Containment_Guidance_0.pdf

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Viral Vectors

  • Engineered viruses that take

advantage of the infective and replicative qualities of the virus

  • Introduce genetic material into

the genome of cells, either in vitro or in vivo

  • Risks include accidental

exposure to laboratory workers to infectious viruses

By biology pop (biology pop) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Non-retroviral vectors

  • Some vectors used to introduce genes into host cells, such as

adenovirus or adeno-associated virus.

  • Gene expression is typically transient because genes are not

integrated into host genome, remain as plasmid

  • Risks: may induce an immune response to viral proteins
  • Risk seen in clinical trials
  • Risk in research is theoretical. Adverse events have been documented

in clinical trials of gene therapy

  • No risk if bitten by an animal transfected with viral vector

Lentiviral Vectors

  • HIV is a lentivirus in the genus Retroviridae
  • HIV, as a viral vector inserts genetic material into host genome
  • Can infect dividing and non-dividing cells
  • Wild-type HIV is a safety issue for workers, so the virus has been

engineered to achieve safe gene transfer

  • HIV typically recognizes CD4 receptors, so has affinity for T-cells,

macrophages, microglial cells. This is limiting in research.

  • To increase tropism, the envelope protein is often replaced with

vesicular stomatitis virus glycoprotein (VSV-G).

L L pol env vif vpr nef tat vpu

gag

tat rev LTR rev LTR

Human Immunodeficiency Virus

Ψ Wild-type gag – core proteins and matrix proteins pol – reverse transcriptase, integrase, protease rev – regulator of viral expression tat – regulation of transciption env – transmembrane viral proteins (recognize CD4) Accessory genes: vif, vpr, vpu, nef LTR – Long Terminal Repeats Ψ – packaging signal

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L pol vif vpr nef tat vpu

gag

tat rev rev LTR env promotor First generation lentiviral vector promotor L L pol env tat

gag

tat rev rev LTR Second generation lentivirus promotor promotor promotor LTR Transfer plasmid pol env

gag

rev promotor Third generation – genes necessary for expression on three plasmids LTR L LTR promotor LTF promotor Transfer plasmid

Packaging a 3rd gen lentivirus

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Safety of Lentivirus – 3rd gen

  • Non-replicative
  • Requires several recombination events to revert to wild type HIV in

the presence of HIV

  • 4th generation
  • Creation of Self-Inactivating (SIN) LVV

Risks of Lentivirus and Transgene exposure

  • Recombination and reversion to wild-type HIV
  • Oncogenic potential when using LVV
  • Activation of oncogenes or inactivation of tumor suppressor genes
  • Insertional mutagenesis
  • Gene-transduction of an oncogenic transgene
  • LVVs might target multiple genes which could silence or inactivate tumor

suppressor activity

  • Unknown functions of some transgenes may promote oncogenesis or other

toxic effects

  • Transduction of a toxin gene

Clinical gene therapy

  • Howe SJ, Mansour MR, Schwarzwaelder K, et al. Insertional

mutagenesis combined with acquired somatic mutations causes leukemogenesis following gene therapy of SCID-X1 patients. The Journal of Clinical Investigation. 2008;118(9):3143-3150. doi:10.1172/JCI35798.

  • Hacein-Bey-Abina S, Garrigue A, Wang GP, et al. Insertional
  • ncogenesis in 4 patients after retrovirus-mediated gene therapy of

SCID-X1. The Journal of Clinical Investigation. 2008;118(9):3132-3142. doi:10.1172/JCI35700.

Proposed Post-exposure protocol

  • Discussed at recent professional conferences: OBA, Eagleson Institute
  • Journal of Occupational and Environmental Medicine
  • Schlimgen R, Howard J, Wooley D, et al. Risks Associated With Lentiviral

Vector Exposures and Prevention Strategies. Journal of Occupational and Environmental Medicine. 2016;58(12):1159-1166.

  • Off label use of FDA approved medications
  • Re-framing treatment for researchers who have been convinced that

use of late generation LVVs are “safer”

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Pre-Exposure preparations

  • Proposed recommendations
  • Review biological hazard protocols for lentiviral exposure
  • Consider nature of transgene
  • Does it silence a tumor-suppressor gene?
  • Does it express an oncogene? A toxin?
  • Expanded host range (pseudotyped?)
  • Large volume?
  • Create a post-exposure protocol for each lab
  • Train each lab member on the procedures for decontamination, notification

and the need for immediate care.

  • Use of medical cards for providers

Post-exposure first aid

  • Call 911 if needed for injury requiring emergency treatment
  • Begin decontamination:
  • Intact Skin Exposure: immediately wash area with copious amounts of

running water to dilute, cleanse and flush

  • Nonintact Skin Exposure: immediately wash area with generous amounts

soap and water to dilute, cleanse and flush

  • Mucous Membrane Exposure: immediately flush the area with running water

for at least 15 minutes

  • Droplet exposure: see above depending on area of exposed
  • Contact the institution’s Biosafety Officer

Post-exposure prophylaxis

  • Integrase inhibitor plus nucleoside reverse transcriptase inhibitor
  • Initiate ASAP, within 2 hours, but no later than 72 hours (optimally)
  • 7 day course
  • Non-FDA approved
  • A suggested regimen
  • Raltegravir (Isentress) 400 mg po BID
  • tenofovir (Truvada)– 300 mg po once daily (Descovy may be used instead)
  • Follow-up for medication side effects
  • Any sequelae from exposure may have long latency, and truly

unknown effects.

NRTI Integrase Inhibitor

By Dan Cojocari · · [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) via Wikimedia Commons (adapted)

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PEP Considerations for LVV exposure

  • Off label use of medications
  • However safety profile of meds fairly well known
  • Recommendations based on HIV PEP
  • Risk of insertional mutagenesis or oncogene promotion is not

quantifiable

  • Integration thought to occur in 1-2 hours. PEP in time?
  • Exposure registry?

Other antiviral PEP protocols

  • HIV exposure – PEP
  • Isentress and Descovy for 28 days
  • B virus (macacine herpes B virus 1)
  • Valacyclovir or Acyclovir for 28 days

CRISPR/Cas9

CRISPR= Clustered Repeating Interspaced Short Palindromic Repeats

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What is CRISPR/Cas9

  • First identified in E. coli
  • An “immune system” for bacteria against viruses
  • Palindromic DNA interspaced with:
  • Spacer DNA
  • Match up with viral DNA
  • When a virus attempts to infect the bacteria, a copy of the spacer DNA is

created

  • Cas proteins are also made and form into a complex
  • Function is to unwind DNA( helicase) and cut DNA (nuclease) using the spacer

genes to identify the viral genes

What is CRISPR/Cas9

  • The modification done by researchers at UCB and the Broad Institute

used the function of this bacterial system to create a tool to cut dsDNA in very precise places

  • Cells naturally detect and repair cuts in dsDNA
  • Can be used to either delete a gene (correct a mutation or knockout

the gene) or insert new DNA (gene therapy)

  • Cells are transfected with Cas9 genes and gRNA
  • Can be done with many methods including using lentiviral vectors

By David Goodsell - RCSB PDB Molecule of the Month, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=37916906 DBCLS TV [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

CRISPR technology and Ethics

  • Can edit any cell
  • Use in gene therapy
  • Inexpensive compared to previous methods of creating transgenes or

genetically modified animals.

  • Will Cas9 stop cutting? AKA “brake failure”
  • Gene drives – controversial
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By Mariuswalter - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=62766590

Other biosafety issues

Vaccinations

  • Diphtheria toxin (0.1 µ/kg body weight) – used to transport large

proteins across cell membranes

  • Pertussis toxin – interrupt cell signaling.
  • Seasonal influenza
  • Work with Swine
  • Work with influenza virus (not-mouse adapted)
  • Association of Dengue virus pathogenicity and H1N1
  • Anthrax
  • Field research with elephants, vultures and zebras in Namibia

Question 1. G-deleted rabies has all of the following qualities except:

  • A. Has a single gene deletion
  • B. Can move from cell to cell transynaptically until it reaches the brain
  • C. Can transfect any synaptically connected neuron if one adds the

gene for G protein on a plasmid

  • D. Can be used as a tracer gene by adding jelly fish genes
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Question 2. PEP for LVV exposure includes

  • A. Acyclovir
  • B. Valacylovir
  • C. Integrase inhibitor
  • D. Protease inhibitor

Question 3. The risk of LVV exposure includes all but which answer?

  • A. Insertional mutagenesis
  • B. Insertion of an oncogene
  • C. Recombination to wild-type HIV1
  • D. Dengue Fever