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Content with Investigacion Susceptibilidad del huésped a las infecciones fúngicas invasoras .

Susceptibilidad del huésped a las infecciones fúngicas invasoras


Se estima que más de un millón y medio de personas mueren al año en el mundo debido a una enfermedad fúngica invasora (EFI). Los tratamientos con inmunosupresores, terapias con corticoides, trasplantes de células hematopoyéticas y órgano sólido así como tratamientos quimioterapéuticos contra el cáncer han favorecido el aumento de estas infecciones fúngicas. El género Aspergillus es la principal causa de EFI por hongos filamentosos, siendo A. fumigatus la especie principalmente aislada en la mayoría de los casos y más frecuentemente asociada a Aspergilosis Invasora. 
Muchas de estas infecciones están infra-diagnosticadas debido, tanto a la falta de sospecha clínica como a las limitaciones diagnósticas. Esta línea de investigación tiene como principal objetivo mejorar el pronóstico de la infecciones en pacientes con riesgo de desarrollar infecciones invasoras por hongos. Para ello se estudian marcadores del individuo (denominados biomarcadores del hospedador) que puedan ser detectados de forme temprana en muestras de pacientes en riesgo y que nos permita estratificar a los mismos en función de la susceptibilidad a desarrollar una infección invasora por hongos. Además, estudios realizados en los últimos años muestran que el fondo genético del hospedador está asociado con la predisposición al desarrollo de este tipo de enfermedades. En concreto se han identificado polimorfismos genéticos de nucleótido simple (“Single Nucleotide Polymorphism”- SNP) en genes que codifican para componentes celulares que interaccionan con estructuras  fúngicas y/o que están involucradas en la respuesta inmune del huésped frente a agentes infecciosos como Aspergillus. En este sentido se han estandarizado y aplicado herramientas para la detección de SNPs en humanos de genes diana asociados concretamente con la susceptibilidad a la Aspergilosis Invasora.

Estudio de los mecanismos de virulencia en Aspergillus fumigatus


En paralelo al estudio de la respuesta del hospedador se sigue una línea cuyo objetivo es caracterizar mecanismos de virulencia en A. fumigatus. Uno de los principales mecanismos por los que A. fumigatus es capaz de causar enfermedad en humanos es su capacidad de adaptarse a las condiciones ambientales del hospedador. Entre las moléculas y los genes que se han relacionado con la virulencia de este hongo se encuentran componentes de la pared celular, genes y moléculas relacionadas con la evasión de la respuesta inmune, sistemas de detoxificación de los compuestos derivados del oxígeno, la producción de toxinas, la obtención de nutrientes como hierro, fósforo, nitrógeno y la adaptación a pH y temperatura del hospedador.  Estos estudios permiten profundizar en el conocimiento sobre la patogenicidad de este hongo e identificar nuevas dianas terapéuticas

Research projects

Content with Investigacion Susceptibilidad del huésped a las infecciones fúngicas invasoras .

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Emergence of cfr-Mediated Linezolid Resistance in a Methicillin-Resistant Staphylococcus aureus Epidemic Clone Isolated from Patients with Cystic Fibrosis.

4. Emergence of cfr-Mediated Linezolid Resistance in a Methicillin-Resistant Staphylococcus aureus Epidemic Clone Isolated from Patients with Cystic Fibrosis. de Dios Caballero J, Pastor MD, Vindel A, Máiz L, Yagüe G, Salvador C, Cobo M, Morosini MI, del Campo R, Cantón R; GEIFQ Study Group. Antimicrob Agents Chemother. 2015 Dec 14;60(3):1878-82.

PUBMED DOI

The dynamic changes of dominant clones of Staphylococcus aureus causing bloodstream infections in the European region: results of a second structured survey.

5. The dynamic changes of dominant clones of Staphylococcus aureus causing bloodstream infections in the European region: results of a second structured survey. Grundmann H, Schouls LM, Aanensen DM, Pluister GN, Tami A, Chlebowicz M, Glasner C, Sabat AJ, Weist K, Heuer O, Friedrich AW; ESCMID Study Group on Molecular Epidemiological Markers; European Staphylococcal Reference Laboratory Working Group. Euro Surveill. 2014 Dec 11;19(49).

PUBMED DOI

Peptidoglycan recycling contributes to intrinsic resistance to fosfomycin in Acinetobacter baumannii.

6. Gil-Marqués ML, Moreno-Martínez P, Costas C, Pachón J, Blázquez J, McConnell M.J.* Peptidoglycan recycling contributes to intrinsic resistance to fosfomycin in Acinetobacter baumannii. Journal of Antimicrobial Chemotherapy. 2018 Nov 1;73(11):2960-2968.

PUBMED DOI

Immunization with lipopolysaccharide-free outer membrane complexes protects against Acinetobacter baumannii infection.

7. Pulido MR, García-Quintanilla M, Pachón J, McConnell M.J.* Immunization with lipopolysaccharide-free outer membrane complexes protects against Acinetobacter baumannii infection. Vaccine. 2018 Jul 5;36(29):4153-4156.

PUBMED DOI

Inhibition of LpxC increases antibiotic susceptibility in Acinetobacter baumannii.

8. García-Quintanilla M, Caro-Vega JM, Pulido MR, Moreno-Martínez P, Pachón J, McConnell M.J.* Inhibition of LpxC increases antibiotic susceptibility in Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy. 2016 Jul 22;60(8):5076-9.

PUBMED DOI

Immunization with lipopolysaccharide-deficient whole cells provides protective immunity in an experimental mouse model of Acinetobacter baumannii infection.

9. García-Quintanilla M., Pulido M.R., Pachón J. and McConnell, M.J.* Immunization with lipopolysaccharide-deficient whole cells provides protective immunity in an experimental mouse model of Acinetobacter baumannii infection. PLOS One. 2014 Dec 8;9(12).

PUBMED DOI

Varicella-zoster virus clades circulating in Spain over two decades.

I. González; A. Molina-Ortega; P. Pérez-Romero; J.E. Echevarría; L. He; D. Tarragó. Varicella-zoster virus clades circulating in Spain over two decades. Journal of Clinical Virology. 110, pp. 17- 21. 2019.

PUBMED DOI

Human herpesvirus 8-associated inflammatory cytokine syndrome.

M. Prieto-Barrios; R. Aragón-Miguel; D. Tarragó-Asensio; A. Lalueza; C. Zarco-Olivo. Human herpesvirus 8-associated inflammatory cytokine syndrome. JAMA Dermatology. 154 - 2, pp. 228 - 230. 2018.

PUBMED DOI

Encephalitis associated with human herpesvirus-7 infection in an immunocompetent adult.

M. Parra; A. Alcala; C. Amoros; A. Baeza; A. Galiana; D. Tarragó; M.Á. García-Quesada; V. Sánchez-Hellín. Encephalitis associated with human herpesvirus-7 infection in an immunocompetent adult. Virology Journal. 14 - 1, 2017.

PUBMED DOI

Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain.

M. Cabrerizo; M. Díaz-Cerio; C. Muñoz-Almagro; N. Rabella; D. Tarragó; M.P. Romero; M.J. Pena; C. Calvo; S. Rey-Cao; A. Moreno-Docón; I. Martínez-Rienda; A. Otero; G. Trallero. Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain. J Med Virol. 2017 Mar;89(3):435-442.

PUBMED DOI

Viral epidemic outbreaks and public health alerts studied at the National Centre of Microbiology during a two-year period (2012-2013).

J.M. Echevarría Mayo; A.A. Avellón Calvo; M. Cabrerizo Sanz; I. Casas Flecha; J.E. Echevarría Mayo; Fd.eO. de Ory Manchón; A. Negredo Antón; F. Pozo Sánchez; M.P. Sánchez-Seco Fariñas; D. Tarragó Asensio; G. Trallero Masó. Viral epidemic outbreaks and public health alerts studied at the National Centre of Microbiology during a two-year period (2012-2013). Revista española de salud pública. 90, pp. E16 - E16. 2016

PUBMED

Application of a commercial immunoblot to define EBV IgG seroprofiles.

F. de Ory; E. Guisasola; D. Tarragó; J.C. Sanz. Application of a commercial immunoblot to define EBV IgG seroprofiles. Journal of Clinical Laboratory Analysis. 29 - 1, pp. 47 - 51. 2015.

PUBMED DOI

Molecular epidemiology of enterovirus 71, coxsackievirus A16 and A6 associated with hand, foot and mouth disease in Spain.

M. Cabrerizo; D. Tarragó; C. Muñoz-Almagro; E. del Amo; M. Domínguez-Gil; J.M.-S. Eiros; I. López-Miragaya; C. Pérez; J. Reina; A. Otero; I. González; J.E. Echevarría; G. Trallero. Molecular epidemiology of enterovirus 71, coxsackievirus A16 and A6 associated with hand, foot and mouth disease in Spain. Clinical Microbiology and Infection. 20 - 3, pp. O150 - O156. 2014.

PUBMED DOI

Molecular epidemiology of the first Spanish enterovirus A71 outbreak associated with severe neurological diseases, 2016.

R Gonzalez-Sanz*, D Casas-Alba, C Launes, C Muñoz-Almagro, M Ruiz-García, MJ Gonzalez-Abad, M Alonso, G Megias, N Rabella, M del Cuerpo, M Gozalo-Margüello, A González-Praetorius, A Martínez-Sapiña, MJ Goyanes-Galán, MP Romero, C Calvo, A Antón, M Imaz, M Aranzamendi, Á Hernandez, A Moreno-Docón, S Rey Cao, A Navascuences, A Otero, M Cabrerizo. Molecular epidemiology of the first Spanish enterovirus A71 outbreak associated with severe neurological diseases, 2016. Euro Surveill. 2019 Feb;24(7).

PUBMED DOI

Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015.

J Masa-Calles, N Torner, N López-Perea, MV Torres de Mier, B Fernández-Martínez, M Cabrerizo, V Gallardo-García, C Malo, M Margolles, M Portell, N Abadía, A Blasco, S García-Hernández, H Marcos, N Rabella, C Marín, A Fuentes, I Losada, A Nieto, V García Ortúzar, M García Cenoz, JM Arteagoitia, Á Blanco Martínez, A Rivas, D Castrillejo, Spanish AFP Surveillance Working Group. Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015. EuroSurveill 2018 23(47):pii=1700423.

PUBMED DOI

Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.

H Harvala, E Broberg, K Benschop, N Berginc, S Ladhani, P Susi, C Christiansen, J McKenna, D Allen, P Makiello, G McAllister, M Carmen, M Sveinsdottir, K Zakikhany, T Gunnarsdottir, R Dyrdak, X Nielsen, T Madsen, J Paul, C Moore, K von Eije, A Piralla , M Strutt, M Carileir, L Vanoverschelde, R Poelman, A Anton, X López-Labrador, C Galli, K Keeren, M Maier, H Cassidy, S Derdas, C Savolainen-Kopra, S Diedrich, S Nordbø, P Minor, J Buesa, H Yu, Q Liao, JL Bailly, F Baldanti, A MacAdam, N Grossly, A Mirand, S Dudman, I Schuffenecker, S Kadamba, n Neyts, M Griffiths, J Richter, C Margaretto, S Govind, U Morley, S Krokstad, J Dean, M Salort, B Prochazka, H-R Honkanen, M Cabrerizo, M Majumdar, L Pellegrinelli, G Nebbia, M Wiewel, S Cottrell, P Coyle, O Adams, J Martin, S Midgley, P Horby, K Wolthers, B Hubert Niesters, P Simmonds and TK Fischer. Recommendations for enterovirus diagnostics and characterisation within and beyond Europe. J Clin Virol 101: 11-17 (2018).

PUBMED DOI

Molecular surveillance of norovirus, 2005-16: an epidemiological analysis of data collected from the NoroNet network.

4. J van Beek, M de Graaf, H Al-Hhello, DJ Allen, K Ambert-Balay, N Botteldoorn, M Brytting, J Buesa, M Cabrerizo, M Chan, F Cloak, I Di Bartolo, S Guix, J Hewitt, N Iritani, M Jin, R Johne, I Lederer, J Mans, V Martella, L Maunula, G McAllister, S Niendorf, HG Niesters, AT Podkolzin, M Poljsak-Prijatelj, L Dam Rasmussen, G Reuter, G Tuite, A Kroneman, H Vennema, MPG Koopmans, on behalf of NoroNet. Molecular surveillance of norovirus, 2005-16: an epidemiological analysis of data collected from the NoroNet network. Lancet Infect Dis 18:545-553 (2018)

PUBMED DOI

First Cases of Severe Flaccid Paralysis Associated with Enterovirus D68 Infection in Spain, 2015-2016.

M Cabrerizo*, JP García-Iñiguez, F Munell, A Amado, P Madurga-Revilla, C Rodrigo, S Pérez, A Martínez-Sapiña, A Antón, G Suárez, N Rabella, V Del Campo, A Otero, J Masa-Calles. First Cases of Severe Flaccid Paralysis Associated with Enterovirus D68 Infection in Spain, 2015-2016. Pediatric Infect Dis J; 36: 1214-1216 (2017).

PUBMED DOI

Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children’s reference centre in Catalonia

6. D Casas-Alba, M de Sevilla, A Valero-Rello, C Fortuny, JJ Garcia, C Ortez, J Muchart, T Armangue, I Jordan, C Luaces-Cubells, I Barrabeig, R González-Sanz, M Cabrerizo, C Munoz-Almagro, C Launes. Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children’s reference centre in Catalonia. Clin Microbiol Infect 23: 874-881 (2017)

PUBMED DOI

Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain.

7. M Cabrerizo*, M Díaz-Cerio, C Muñoz-Almagro, N Rabella, D Tarragó, MP Romero, MJ Pena, C Calvo, S Rey-Cao, A Moreno-Docón, I Martínez-Rienda, A Otero, G Trallero. Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4-year period in Spain. J Med Virol 89: 435-442 (2017).

PUBMED DOI

Content with Investigacion Biología y Variabilidad del VIH .

List of staff

Additional Information

Contact Information

María Teresa Coiras

918223782
mcoiras@isciii.es

generic email: pirv.isciii@gmail.com

 

Scientific Societies

 

•    Spanis Society for Infectious Diseases and Clinical Microbiology (SEIMC).
•    AIDS Study Group (GeSIDA) of SEIMC.
•    PIRV is member of the Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC, group CB21/13/00015).

 

Other links

 

You can follow the activity of our group in Twitter (X), Instagram and Linkedin.

 

Collaboration in other projects

Project Title: Rectal microbiota as a factor associated with vulnerability to repeated sexually transmitted infections.  Microsex Studio
Principal investigators: Vicente Estrada Pérez (San Carlos Clinical Hospital)
Financing agency: Strategic Action in Health (AES) 2023
Participating entities: San Carlos Clinical Hospital, ISCIII
Duration: 01/01/2024-12/31/2026. Contract/project file: PI23/01545

Project title: Prospective, observational, longitudinal, multicenter study to evaluate clinical efficacy, safety and immunogenicity developed in individuals with Philadelphia-negative Chronic Myeloproliferative Neoplasms treated with JAK inhibitors after receiving full vaccination with Adjuvanted Herpes Zoster Subunit vaccine (Shingrix)
Principal investigators: Valentín García Gutiérrez (Hospital Univ Ramón y Cajal)
Funding agency: GSK Glaxo Smithkline
Participating entities: IRYCIS, ISCIII
Duration: 01/01/2024 – 12/31/2024

Project title: Infection in Solid Organ Transplant recipients: correlation with immune function. Identification of predictive biomarkers and feasibility evaluation with CD45RAneg cell therapy
Principal investigators: Alejandro Luna de Abia, Jesús Fortún (Univ Ramón y Cajal Hospital)
Financing agency: Strategic Health Action (AES) 2023
Participating entities: IRYCIS, ISCIII
Duration: 01/01/2024-12/31/2026
Contract/project file: PI23/01924

Project title: Evaluation of the levels of the System associated with BLyS in patients with post-infectious syndromes and dysautonomic alterations of the heart rhythm
Principal researcher: Pablo Guisado
Funding agency: Spanish Society of Internal Medicine SEMI.
Participating entities: ISCIII, Quironsalud Research Institute for Research and Innovation
Duration 2023-2025

Project title: HIV Open Science (dissemination project)
Principal researcher: Eva Poveda
Financing agency: Spanish Foundation for Science and Technology (FECYT), Call for aid for the Promotion of Scientific, Technological and Innovation Culture.
Participating entities: ISCIII, Fundación Biomédica Galicia Sur, IrsiCaixa, Hospital Vall d’Hebron, Hospital de la Princesa, Fundación Imagina Más, Institute of Biomedicine of Seville (IBIS), Case Western Reserve University (Cleveland, Ohio)
Duration 2023-2024
Contract/project file: 17715

Project title: Identification of immunological biomarkers associated with the cellular and humoral immune response related to vaccination against SARS-CoV-2 in patients with HIV (Annual renewal).
Principal investigator: Rafael Rodríguez Rosado
Funding agency: Alfonso X El Sabio University-Santander Universities. XIII Call for Research Projects.
Participating entities: ISCIII, Severo Ochoa University Hospital
Duration 04/01/2023 – 04/01/2024
Contract/project file: 1,013,006

Project title: Clinical and microbiological impact of the monkeypox virus outbreak in patients in Spain (2022): multicenter project MONKPOX-ESP22, Work package 4, virological research.
Principal researcher: Anabel Negredo (WP4 coordinator); Maria Paz Sánchez Seco (general coordinator)
Financing agency: CIBERINFEC/CIBERESP ISCIII Strategic Action.
Participating entities: ISCIII
Duration July 2022 - May 2023
Contract/project file: MONKPOX-ESP22

Project title: Biomarkers and underlying immunopathological mechanisms of post COVID-19 condition.
Principal investigator: Gemma Moncunill Piñas (IP); Marta Massanella (coIP); María Teresa Coiras López (co-PI)
Financing agency: CIBERINFEC Strategic Action.
Participating entities: ISCIII, IS-Global, IrsiCaixa
Duration 07/28/2022-07/29/2024
Contract/project file: IM22/INF/5

Project title: Identification of immunological biomarkers associated with the cellular and humoral immune response related to vaccination against SARS-CoV-2 in patients with HIV.
Principal investigator: Rafael Rodríguez Rosado
Funding agency: Alfonso X El Sabio University-Santander Universities. XIII Call for Research Projects.
Participating entities: ISCIII, Severo Ochoa University Hospital
Duration 04/01/2022 – 04/01/2023
Contract/project file: 1,013,006

Project title: Characterization of the immune response developed after vaccination with COVID-19 in patients with hematological malignancies.
Principal researcher: Valentín García Gutiérrez
Funding agency: Ministry of Science and Innovation, PI21 - Health research projects (AES 2021). Health research project modality.
Participating entities: ISCIII, Ramón y Cajal University Hospital
Duration 01/01/2022 – 12/31/2024
Contract/project file: PI21_00877

Contact Information

María Teresa Coiras

918223782
mcoiras@isciii.es

generic email: pirv.isciii@gmail.com

 

Scientific Societies

 

•    Spanis Society for Infectious Diseases and Clinical Microbiology (SEIMC).
•    AIDS Study Group (GeSIDA) of SEIMC.
•    PIRV is member of the Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC, group CB21/13/00015).

 

Other links

 

You can follow the activity of our group in Twitter (X), Instagram and Linkedin.

 

Collaboration in other projects

Project Title: Rectal microbiota as a factor associated with vulnerability to repeated sexually transmitted infections.  Microsex Studio
Principal investigators: Vicente Estrada Pérez (San Carlos Clinical Hospital)
Financing agency: Strategic Action in Health (AES) 2023
Participating entities: San Carlos Clinical Hospital, ISCIII
Duration: 01/01/2024-12/31/2026. Contract/project file: PI23/01545

Project title: Prospective, observational, longitudinal, multicenter study to evaluate clinical efficacy, safety and immunogenicity developed in individuals with Philadelphia-negative Chronic Myeloproliferative Neoplasms treated with JAK inhibitors after receiving full vaccination with Adjuvanted Herpes Zoster Subunit vaccine (Shingrix)
Principal investigators: Valentín García Gutiérrez (Hospital Univ Ramón y Cajal)
Funding agency: GSK Glaxo Smithkline
Participating entities: IRYCIS, ISCIII
Duration: 01/01/2024 – 12/31/2024

Project title: Infection in Solid Organ Transplant recipients: correlation with immune function. Identification of predictive biomarkers and feasibility evaluation with CD45RAneg cell therapy
Principal investigators: Alejandro Luna de Abia, Jesús Fortún (Univ Ramón y Cajal Hospital)
Financing agency: Strategic Health Action (AES) 2023
Participating entities: IRYCIS, ISCIII
Duration: 01/01/2024-12/31/2026
Contract/project file: PI23/01924

Project title: Evaluation of the levels of the System associated with BLyS in patients with post-infectious syndromes and dysautonomic alterations of the heart rhythm
Principal researcher: Pablo Guisado
Funding agency: Spanish Society of Internal Medicine SEMI.
Participating entities: ISCIII, Quironsalud Research Institute for Research and Innovation
Duration 2023-2025

Project title: HIV Open Science (dissemination project)
Principal researcher: Eva Poveda
Financing agency: Spanish Foundation for Science and Technology (FECYT), Call for aid for the Promotion of Scientific, Technological and Innovation Culture.
Participating entities: ISCIII, Fundación Biomédica Galicia Sur, IrsiCaixa, Hospital Vall d’Hebron, Hospital de la Princesa, Fundación Imagina Más, Institute of Biomedicine of Seville (IBIS), Case Western Reserve University (Cleveland, Ohio)
Duration 2023-2024
Contract/project file: 17715

Project title: Identification of immunological biomarkers associated with the cellular and humoral immune response related to vaccination against SARS-CoV-2 in patients with HIV (Annual renewal).
Principal investigator: Rafael Rodríguez Rosado
Funding agency: Alfonso X El Sabio University-Santander Universities. XIII Call for Research Projects.
Participating entities: ISCIII, Severo Ochoa University Hospital
Duration 04/01/2023 – 04/01/2024
Contract/project file: 1,013,006

Project title: Clinical and microbiological impact of the monkeypox virus outbreak in patients in Spain (2022): multicenter project MONKPOX-ESP22, Work package 4, virological research.
Principal researcher: Anabel Negredo (WP4 coordinator); Maria Paz Sánchez Seco (general coordinator)
Financing agency: CIBERINFEC/CIBERESP ISCIII Strategic Action.
Participating entities: ISCIII
Duration July 2022 - May 2023
Contract/project file: MONKPOX-ESP22

Project title: Biomarkers and underlying immunopathological mechanisms of post COVID-19 condition.
Principal investigator: Gemma Moncunill Piñas (IP); Marta Massanella (coIP); María Teresa Coiras López (co-PI)
Financing agency: CIBERINFEC Strategic Action.
Participating entities: ISCIII, IS-Global, IrsiCaixa
Duration 07/28/2022-07/29/2024
Contract/project file: IM22/INF/5

Project title: Identification of immunological biomarkers associated with the cellular and humoral immune response related to vaccination against SARS-CoV-2 in patients with HIV.
Principal investigator: Rafael Rodríguez Rosado
Funding agency: Alfonso X El Sabio University-Santander Universities. XIII Call for Research Projects.
Participating entities: ISCIII, Severo Ochoa University Hospital
Duration 04/01/2022 – 04/01/2023
Contract/project file: 1,013,006

Project title: Characterization of the immune response developed after vaccination with COVID-19 in patients with hematological malignancies.
Principal researcher: Valentín García Gutiérrez
Funding agency: Ministry of Science and Innovation, PI21 - Health research projects (AES 2021). Health research project modality.
Participating entities: ISCIII, Ramón y Cajal University Hospital
Duration 01/01/2022 – 12/31/2024
Contract/project file: PI21_00877

Content with Investigacion Biología y Variabilidad del VIH .