A discussion with Dr. Richard Mollenkamp from the Virology Department of Erasmus MC

Erasmus Medical Center (Erasmus MC) in Rotterdam, the Netherlands, has a long and proud history as a teaching hospital and research institution, with a world-renowned Department of Virology working to better understand viruses and the molecular, molecular, and pathogenic aspects of infections. Population.

Thanks to their work, serious disease threats to similar centers around the world can be quickly identified and contained. Indeed, their work includes studying and monitoring viruses ranging from those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) to Ebola, HIV, influenza, herpes and measles.

In addition to known viruses, their work helps identify pathogens that may pose a threat to humans, which are becoming more frequent for many reasons – including globalization, land use and climate change. The ongoing covid-19 pandemic, now in its fourth year, and the recent outbreak of empox (monkey disease), a public health emergency of global concern, are just 2 recent examples that demonstrate the enormous impact that zoonotic diseases (of animal origin) can have. An interconnected world.

To better understand the work of the Virology Department, 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 4 and a half years, and my role is focused on molecular diagnostics – in other words, analyzing signals in the genomes of viruses to diagnose and manage disease and help clinicians decide which treatments work. The best for their patients.

In addition, I play a role in the reference centers for many viruses. Erasmus MC is the World Health Organization’s Arbovirus and Hemorrhagic Fever Reference and Research Centre. Arboviruses are transmitted by mosquitoes, ticks and other arthropods. The collaborative center’s work also includes dealing with new and emerging infectious diseases such as the coronavirus. In addition, the Department of Virology is recognized as one of the reference laboratories for measles and mumps in the WHO European Region, 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 Virology Department?

We do basic research and investigations, and everything in between! The purpose of all our activities is to bring benefits to human health. We are a large department of 200 or 300 people, from clinical doctors who work directly with patients to scientists and technicians at all levels who are actually doing the testing and research.

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

Based on a specific diagnostic question, we try to identify the viral genomic material by using polymerase chain reaction (PCR) to transcribe, amplify and isolate the ribonucleic acid (RNA) that makes up the viral genomic code.

In addition, we can sequence the genetic information contained in the RNA strands to understand the exact sequence, which can help us identify and isolate the virus, for example to determine whether mutations in the virus may affect antiviral treatment.

Alternatively, we can determine whether a patient has been infected with the virus in the past by looking at antibodies in the patient’s serum (serology). Finally, we use viral cultures in some cases to answer some very specific diagnostic questions.

Can you tell us what role the Erasmus MC laboratories played in researching SARS-CoV-2, the virus that causes Covid-19?

Since the beginning of the epidemic in January 2020, in collaboration with other WHO Collaborating Centers, the PCR test developed by the Charte Laboratory in Berlin, Germany was to be approved as a standard method for diagnosing SARS-CoV. 2 worldwide.

We then started testing for SARS-CoV-2 in the third week of January 2020. Since then and basically still with the WHO and other World Health Organization collaboration centers on viruses and laboratory methods.

Initially in the Netherlands we were only testing cases with a history of travel to China or later suspected to Italy, but at the end of February we found our first case of COVID-19 here. Since then, we have started regular inspections with the RIVM (National Institute of Public Health and Environment) to confirm each other’s test results.

We were the only testing laboratory for the Rotterdam area until August 2020, when the outbreak started and many hospital laboratories became involved in testing, which required more testing capacity than we could provide.

Currently, we are mainly involved in the routine screening of newly admitted patients in our hospital, and we are working to prevent the spread of covid-19 and ensure that there is an adequate supply of human resources by regularly testing our healthcare workforce. To provide health care.

As the epidemic continues, we have seen new variants emerge. Ever wondered how the virus has changed and evolved over time?

not really. From past experience and previous research on coronaviruses and other RNA-genetically engineered viruses, I think it is not surprising that there is some variation and degree of evolution in the makeup of SARS-CoV-2. What is new in this epidemic, but compared to other epidemics, is that we can closely monitor how the virus has changed in the population, thanks to the powerful methods developed for accurate sequencing. The amount of genetic data we have for SARS-CoV-2 is unprecedented. This means we’re able to better identify new variants and track how they’re spreading right away.

Has your testing regime changed due to the number of people infected with Covid-19?

for sure. At the beginning of the epidemic, we bring our samples together with the RIVM laboratory for joint testing and verification, with manual PCR systems and combined decisions on the results. This was all very well when we only had a handful of cases, but it took more than 24 hours to get a confirmed result, and the number was increasing rapidly and the process was not sustainable.

Thanks to the development and introduction of more automated systems, we can now carry out community tests around 12 hours a day and there are laboratories working around the clock to process samples. If a very quick answer is needed – for example, if a hospital emergency room is full of patients and a negative test is needed to admit someone to the general ward, we can use rapid molecular tests that can produce results within an hour. These tests are expensive and only suitable for very small test sizes, so we only do them in particularly urgent cases.

How is your work contributing to control and stop the epidemic?

Throughout the outbreak, we have offered community testing for people with mild symptoms to control infection and ensure the virus does not spread further in the population. As vaccines are becoming available, we have conducted tests on their effectiveness, especially against new variants, and set up tests to see how well they perform.

Furthermore, we study the efficacy of antiviral compounds against emerging variants, all of which are helpful for the development of new, more targeted vaccines and antiviral therapies.

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

Laboratories often play a behind-the-scenes role, which can be easily taken for granted. Of course, I often see the public, policy makers and some clinicians as some kind of machine, where you press a button and the result just comes out!

In fact, it is more sophisticated than that. Laboratories can only function well by continuously developing knowledge. Without professional laboratories and the financial support needed to maintain and grow them, we would have far better understanding of diseases, the dynamics of infection, and ways to prevent and treat emerging health threats. This was particularly evident during the Covid-19 pandemic, as many of the response measures were developed with data from expert laboratories such as ours.

In general, laboratories try to – and indeed do – communicate their work in a variety of ways, including publishing results, talking to the press and informing stakeholders. However, science communication is knowledge in itself, and in my opinion, it should be integrated more into the skill set of the next generation of laboratory scientists to improve effectiveness.

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