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Safety assessment includes knowledge of the precise function and genetic location of the genes to be mutated, their genetic stability, potential reversion mechanisms, possible recombination events with dormant genes, gene transfer to other organisms as well as gene acquisition from other organisms by phage transduction, transposition or plasmid transfer and cis- or trans-complementation.
Although these vaccines are efficacious, there are lingering concerns regarding potential reversion to virulence, overall safety in immunocompromised populations [3], [8], [9], and the possible inclusion of toxic cell components such as endotoxins [10].
However, concerns still exist over their use, particularly in those countries where the disease is not endemic because of potential gene segment reassortment between field and vaccine strains, potential reversion to virulence and inability to distinguish vaccinated from infected animals [1], [14] [17].
Interestingly, when passage 18 cultures were subjected to stress in the form of serum/growth factor starvation, E/M-cells regain features of stem cells, particularly the expression of nuclear Nanog, indicating a potential reversion of E/M-E to E/M-MP cells (Figure S8).
The concern over potential reversion of live-attenuated vaccine to virulence, has made chemically-inactivated virion-based vaccines a more attractive choice for EV71 vaccine development.
However, LVS vaccine has not been licensed for general use in the United States because of concerns about potential reversion to virulence and variable efficacy.
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Rewiring occurs because new mutations act as 'epistatic ratchets' (Bridgham et al., 2009) for potential reversions, restricting their fixation and thus leading to the incompatible new enzyme neoPTE.
Although vaccine candidates based on infectious virus have shown the greatest progress amongst different dengue vaccine approaches, there are safety concerns associated with their use based on potential reactogenicity, interference amongst the viruses, possible reversion to native virus, and possible increase of virus infectivity and/or virulence via antibody dependent enhancement [ 223].
Compensatory mutations have a higher probability to appear because there are several potential compensatory mutations for the same initial mutation whereas there is only one possible reversion.
The lack of productive viral replication further improves the safety profile of MVA as a vector, minimizing the potential for reversion to virulent forms particularly if used in immunocompromised individuals.
At the same time, care was taken to achieve this with a minimum number of passages (maximum 3) to minimize the potential for reversion to replication at non-permissive temperatures.
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