Modulatory effects of Epstein-Barr, herpes simplex, and human herpes-6 viral infections and coinfections on cytokine synthesis. A comparative study

Herpesviruses such as EBV, HSV, and human herpes virus-6 (HHV-6) have a marked tropism for cells of the immune system and therefore infection by these viruses may result in alterations of immune functions, leading at times to a state of immunosuppression. We report the results of a comparative study in which we found that EBV, HSV-1, and HHV-6 act differentially on the immune system with regard to their effect on the synthesis of IL-1 beta, IL-6, and TNF-alpha, i.e., three immunoregulatory cytokines mainly secreted by activated monocytes/macrophages. Using the polymerase chain reaction technique, analyses of the mRNA levels for each of the three monokines after viral infection indicated that the effect exerted by each of these herpesviruses on cytokine synthesis by human PBMC was detectable at the transcriptional level. Different amounts of IL-1 beta protein were detected in infected PBMC cultures, HHV-6 being the strongest IL-1 beta up-regulatory among these three herpesviruses. Spontaneous releases of IL-6 and TNF-alpha were found reduced after infection by HHV-6 and EBV, respectively. In comparison to EBV and HHV-6, HSV-1 proved to be a weak monokine enhancer. Results of coinfection studies indicated that virus-induced suppressive effects on cytokine synthesis are dominant. In fact, EBV inhibited TNF-alpha synthesis even in the presence of HHV-6, a strong up-regulator of TNF-alpha synthesis. Similarly, EBV was unable to stimulate IL-6 production in the presence of HHV-6. Viral structural component(s) appeared to be responsible for the up-regulation of IL-6 by both EBV and HSV-1, and of TNF-alpha by HSV-1. Taken together, our observations illustrate that herpesviruses can selectively regulate cytokine synthesis thereby disturbing immune homeostasis; this effect may favor pathogenic events, including the reactivation and/or spread of other infectious agents within the host.

Infection of peripheral blood mononuclear cells by herpes simplex and Epstein-Barr viruses. Differential induction of interleukin 6 and tumor necrosis factor-alpha

Infection by herpesviruses can result in profound immunosuppressive or immunomodulatory effects. However, no significant information is available on the effect of such infections on the production of immunoregulatory cytokines. We studied the kinetics of production of two monocyte-derived cytokines, interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF alpha), induced by Epstein-Barr virus (EBV) and herpes simplex virus type 1 (HSV-1) in peripheral blood mononuclear cell cultures and in fractionated cell populations. We observed that, when compared to HSV-1, EBV is a stronger inducer of IL-6. In EBV-infected cultures, IL-6 protein was detected at day 1 postinfection and gradually increased with time. In contrast, lower amounts of IL-6 were detected 5 d postinfection in HSV-1-infected cultures. HSV-1-infected cultures secreted significant amounts of TNF alpha protein after 5 d of culture and reached a maximal level of production at day 7, whereas EBV inhibited TNF alpha production. In fractionated cell populations, monocytic cells were found to be the main source of IL-6 synthesis after EBV or HSV-1 infection. However, TNF alpha synthesis in HSV-1-infected cultures was from both B and monocytic cells. By using the polymerase chain reaction technique we show that, after infection by these two herpesviruses, differences in cytokine gene products are also observed at the transcriptional level. These observations demonstrate that EBV and HSV-1 exert differential effects on IL-6 and TNF alpha gene transcription and on the resulting protein secretion in human mononuclear blood cells.

[Return to work after surgical treatment of varicosities of the lower limb]

Factors which the duration of time off work after surgical treatment of venous insufficiency of the legs were studied in 3000 patients undergoing surgery in our institution between 1985 and 1990. Three variables significantly influenced return to work at 2 weeks (RW2w). The first was socio-professional group. All patients in the first was socio-professional group. All patients in the professions and 95 per cent of tradesmen or freelance workers had returned to work after 2 weeks, while 40 per cent of civil servants and 35 per cent of employees in private organisations were still off work. Time spent of work was 23 +/- 10 days in civil servants, 4 +/- 3 days in the professions and 5 +/- 2 days in tradesmen of freelance workers. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work, the RW2w was 72 par cent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work. The RW2w was 72 percent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. It is concluded that the rapidity of return to work was not as good as could legitimately be expected following an operation with nil mortality and extremely limited morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Human herpesvirus 6 induces interleukin-1 beta and tumor necrosis factor alpha, but not interleukin-6, in peripheral blood mononuclear cell cultures

The human herpesvirus 6 (HHV-6) is known to interact intimately with cells of the immune system. Here we report that HHV-6 is a potent inducer of interleukin-1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF-alpha) in cultures of peripheral blood mononuclear cells. In contradistinction, HHV-6 has no effect on IL-6 synthesis. Maximal IL-1 beta and TNF-alpha gene transcription, as detected by polymerase chain reaction amplification analysis, is observed at 12 and 6 h postinfection, respectively. Release of IL-1 beta and TNF-alpha into the culture supernatants peaked at 24 h and gradually decreased with time. Heat-inactivated virus was unable to stimulate IL-1 beta and TNF-alpha syntheses, whereas UV-irradiated virus retained the full monokine-inducing potential of the native particle. Preincubation of viral preparation with neutralizing anti-HHV-6 antibody resulted in the abrogation of this cytokine-inducing effect, whereas treatment of cells with phosphonoacetic acid (an inhibitor of viral DNA polymerase activity) had no effect on the ability of the virus to stimulate monokine release. These results indicate that HHV-6 can exert a strong immunomodulatory effect by stimulating the cells of myeloid lineage to produce these cytokines.

Inhibition of tumor necrosis factor-alpha transcription by Epstein-Barr virus

Tumor necrosis factor-alpha (TNF-alpha), which is produced mainly by monocyte/macrophage cells, has diverse physiological functions on lymphoid cells. Moreover, it has been shown that TNF-alpha exhibits antiviral activities. Here we report that Epstein-Barr virus (EBV), a B lymphotropic human herpes virus that interacts intimately with the immune system, exerts a strong inhibitory effect on TNF-alpha production by lipopolysaccharide-treated peripheral blood leukocytes as well as by monocytic cell lines, HL-60 and U-937. Flow cytometric analysis following staining with OKB7 monoclonal antibody showed that about 20% of cells from these monocytic lines express the CR2 antigen. Direct binding of fluorescein isothiocyanate-labeled EBV indicated that the virus binds to approximately 22% of cells of both monocytic lines. However, no virus-specific antigens were detected in the infected cells by immunofluorescence, suggesting that the infection was of the abortive type. The use of UV- or heat-inactivated EBV and inhibitory effect on TNF-alpha synthesis. These results suggest that infectious virus is necessary to obtain such an inhibitory effect. Analysis of TNF-alpha mRNA by polymerase chain reaction amplification indicated that the EBV suppressive effect is manifested at the transcriptional level. In contrast, EBV did not inhibit interleukin 1 mRNA production by these cells. These results indicate that EBV interacts directly with monocytes/macrophages to exert its immunomodulatory effect.

[The value of velocimetric investigation of the uterine arteries in retro-placental hematoma. 3 cases]

Retro-placental hematoma is a sudden event with a serious prognosis which is aggravated by the very frequent absence of premonitory clinical, biological or ultrasonic signs. Does a velocimetric investigation of the uterine arteries have any predictive value in this disorder? The apparatus used was a continuous Doppler with spectral analysis and a 4 MHz probe no ultrasonic location. Each examination involved the exploration of 2 uterine arteries and of the umbilical flow. The method of recording the uterine arteries is described. Three cases of retro-placental hematoma are reported. In these three cases, an increase in the resistance index of one of the uterine arteries (the right artery in 2 cases and the left in 1 case) was detected with the presence of a protodiastolic notch on the trace, whereas the umbilical index itself was normal and no other sign was present which could predict the placental event. The value of the Doppler recording is already established in many obstetric indications, and these should be extended yet further, particularly if this preliminary study is confirmed on a larger scale.

Peripheral blood lymphocytes resistant to Epstein-Barr virus immortalization manifest high natural killer (NK) type activity against NK-resistant target cells

Epstein-Barr virus (EBV) readily immortalizes human peripheral blood lymphocytes (PBL) in vitro. We found recently that PBL from two EBV-seropositive healthy adults were exceptionally resistant to immortalization by EBV. In contrast to PBL from other EBV-seropositive donors sensitive to immortalization by EBV (S-PBL), the "resistant" PBL (R-PBL) respond to EBV infection with an early interleukin-2 (IL-2) synthesis and high interferon gamma (IFN gamma) production. In order to determine whether these differences in cytokine responses between R-PBL and S-PBL could be associated with a detectable difference in lymphocyte cytotoxicity, we compared the natural killer (NK) activity of R-PBL and S-PBL effectors by using both NK-sensitive (i.e. K562) and NK-resistant (i.e. Raji) targets. We found that, while effectors from EBV-infected R-PBL and S-PBL cultures exhibited comparable NK activity against the K562 targets, they differed remarkably in their cytolytic activity against Raji cells. At days 3 and 5 of culture, effectors from EBV-infected R-PBL showed a significantly higher lytic activity against Raji targets, whereas S-PBL did not. Culture of EBV-infected R-PBL and S-PBL effectors in the presence of recombinant IL-2 (rIL-2) for 5 days resulted in increases of their lytic activity against Raji cells, whereas pretreatment of these effectors with recombinant IFN gamma (rIFN gamma) was found to increase only R-PBL cytotoxicity. These results suggest that the resistance of R-PBL to EBV immortalization could be associated with a lymphokine-mediated early cellular cytotoxic response of the NK/LAK (lymphokine-activated killer cell) type against EBV-infected cells.

Differential interleukin-2 and interferon-gamma production by human lymphocyte cultures exceptionally resistant to Epstein-Barr virus immortalization

Epstein-Barr virus (EBV) readily immortalizes human peripheral blood lymphocytes (PBL) in vitro. However, during the past several years, we found that PBL from two exceptional EBV-seropositive healthy adult individuals were refractory to immortalization by EBV. We report here a study aimed at learning about the immunobiological features which differentiate these EBV-resistant (R) PBL from others which are susceptible (S) to EBV immortalization. Results of this investigation indicate that: (a) Following EBV infection, R-PBL produced significantly higher amounts of interferon gamma (IFN-gamma) than S-PBL. There were however no differences in regard to interferon alpha production between these two types (R and S) of EBV-infected cultures. (b) R-PBL had a maximal interleukin-2 (IL-2) production by S-PBL occurred at least 48 hr later, i.e., at Day 7. (c) The percentage of non-B cells expressing the IL-2 receptor was also higher in EBV-infected R-PBL than S-PBL. (d) In contrast, expression of IL-2 receptors after EBV infection was higher on B cells from S-PBL than on B cells from R-PBL. Interestingly, no differences were noted in regard to IL-2 receptor expression between R-PBL and S-PBL treated with mitogens (i.e., phytohemagglutinin and pokeweed mitogen). (e) Finally, using anti-IL-2 and anti-IFN-gamma antibodies in EBV-infected R-PBL cultures, we were able to obtain EBV-induced immortalization of these cultures. Taken together, these results suggest that an early IL-2 synthesis and high IFN-gamma production by EBV-infected PBL play an important role against lymphocyte immortalization by EBV.

Stimulation of T cells and induction of interferon by toxic shock syndrome toxin 1

Toxic shock syndrome toxin 1 (TSST-1) is a potent immunomodulating substance isolated from Staphylococcus aureus strains associated with toxic shock syndrome (TSS). Flow cytometric analysis was used to compare scatter changes in several cell-surface phenotype markers on human mononuclear cells exposed in vitro to TSST-1 or to phytohemagglutinin, a lectin with similar effects on the immune response. The results showed differences between PHA and TSST-1 in the appearance of the tested T cell subset markers and of interleukin 2 receptors. In general, the stimulation of mononuclear cells by TSST-1 was slower than that by phytohemagglutinin. TSST-1 induced the production of interferon in cultures of murine spleen cells. By means of inhibition studies with specific antibodies to interferon, the interferon produced was characterized as the gamma type. Human mononuclear cells exposed to the toxin also produced gamma interferon, with levels similar to those induced by staphylococcal enterotoxin A, a known potent interferon inducer. The induction of gamma interferon by TSST-1 may play a role in the immunosuppression caused by TSST-1.

Tac expression induced by Epstein-Barr virus is restricted on non-transformable B lymphocytes

During the course of a comparative study dealing with the immortalization of lymphocytes from a large number of normal healthy donors, we found that B cells of two of these individuals could not be immortalized by Epstein-Barr virus (EBV) under the standard conditions. The expression of the Tac antigen on the membrane of EBV-infected B cells from these two donors was compared with that of B cells from EBV immortalization-susceptible ones. The method used was two-colour immunofluorescence cytofluorometer analysis. We found that the Tac antigen expression was significantly and repeatedly reduced in the case of the two immortalization-resistant donors. This difference might be related to a genetic control of the resistance to EBV-immortalization.

[A case of complex angiodysplasia of the lower limb. Attempted treatment by embolization]

The authors report a case of complex angiodysplasia of the right lower limb, complicated by an ulcer of the ankle, and associated with a venous dysplasia, arteriovenous fistulae, and malformations in the distal arterial system. A deliberately partial embolization of the arteriovenous communications of the right foot helped to achieve scarring of the trophic disturbance.

[A case of an aneurysm of the popliteal vein with repeated pulmonary embolisms]

The authors report on a case of a patient having several unexplained pulmonary embolisms. A phlebologic and phlebographic exam make it possible to diagnose an aneurysmal dilatation of the popliteal vein as the cause of the thrombo-embolic problems. Cure was obtained through the resection of this venous ectasia.

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