Coxsackievirus B3 persistence and myocarditis in NFR nu/nu and +/nu mice

Innate and adaptive immune responses against picornaviruses and their counteractions: An overview

Picornaviruses, small positive-stranded RNA viruses, cause a wide range of diseases which is based on their differential tissue and cell type tropisms. This diversity is reflected by the immune responses, both innate and adaptive, induced after infection, and the subsequent interactions of the viruses with the immune system. The defense mechanisms of the host and the countermeasures of the virus significantly contribute to the pathogenesis of the infections. Important human pathogens are poliovirus, coxsackievirus, human rhinovirus and hepatitis A virus. These viruses are the best-studied members of the family, and in this review we want to present the major aspects of the reciprocal effects between the immune system and these viruses.

Type B coxsackieviruses and their interactions with the innate and adaptive immune systems

Coxsackieviruses are important human pathogens, and their interactions with the innate and adaptive immune systems are of particular interest. Many viruses evade some aspects of the innate response, but coxsackieviruses go a step further by actively inducing, and then exploiting, some features of the host cell response. Furthermore, while most viruses encode proteins that hinder the effector functions of adaptive immunity, coxsackieviruses and their cousins demonstrate a unique capacity to almost completely evade the attention of naive CD8(+) T cells. In this artcle, we discuss the above phenomena, describe the current status of research in the field, and present several testable hypotheses regarding possible links between virus infection, innate immune sensing and disease.

Coxsackievirus myocarditis: interplay between virus and host in the pathogenesis of heart disease

Coxsackievirus (CVB) infection is a significant cause of myocarditis and dilated cardiomyopathy (DCM). Heart disease may be caused by direct cytopathic effects of the virus, a pathologic immune response to persistent virus, or autoimmunity triggered by the viral infection. CVB interacts with its host at multiple stages during disease development. Signaling through viral receptors may alter the intracellular environment in addition to facilitating virus entry. Viral genetic determinants that encode cardiovirulence have been mapped and may change depending on the nutritional status of the host. Virus persistence is directly associated with pathology, and recent work demonstrates that CVB evolves into a slowly replicating form capable of establishing a low-grade infection in the heart. The innate immune response to CVB has taken on increasing importance because of its role in shaping the development of the adaptive immune response that is responsible for cardiac pathology. Studies of T cell responsiveness and the development of autoimmunity at the molecular level are beginning to clarify the mechanisms through which CVB infection causes inflammatory heart disease.

Extracellular matrix remodeling in coxsackievirus B3 myocarditis

The connective tissue abnormality in relation to T lymphocytes was investigated in murine myocarditis. Inbred BALB/c-nu/+ (euthymic and normal T cell function) and BALB/c-nu/nu (athymic and T cell deficient) mice were inoculated with coxsackievirus B3 (CB3). Hearts were stained with hematoxylin-eosin, Malloryazan, and silver impregnation, for reticulin fiber abnormalities, and T lymphocyte subsets. In BALB/c-nu/+ mice, active myocardial necrosis appeared parallel with T lymphocyte infiltrates, that is, it was absent on day 0, increased until 14 days, and then decreased with time. In contrast, the abnormal reticulin fiber architecture and interstitial fibrosis increased with time until 60 days, when ventricular remodeling was noted. In the hearts of BALB/c-nu/nu mice, although minimal myocardial necrosis associated with infiltrating immature T lymphocytes was noted earlier, subsequent interstitial fibrosis and reticulin fiber abnormalities were not documented later. The abnormal reticulin fiber architecture seen in BALB/c-nu/+ mice may contribute to the extracellular matrix remodeling in murine CB3 myocarditis in which dilated cardiomyopathy develops later.

Viral persistence during the developmental phase of Coxsackievirus B1-induced murine polymyositis

Mice infected with coxsackievirus B1 (CVB1) develop a chronic hindquarter muscle weakness which resembles human polymyositis. In this study, we used in situ hybridization to screen for persistent viral RNA in hamstring and quadriceps muscles from mice that displayed various degrees of clinical weakness. At 28 to 31 days postinfection, when chronic myositis is well developed but infectious virus can no longer be recovered, persistent CVB1 RNA was found in hindquarter skeletal muscle of all 12 infected animals examined. Persistent CVB1 showed a multifocal distribution within muscle and was associated with three different histopathology patterns (HPPs). These three HPPs (HPP-1, HPP-2, and HPP-3) represent potentially different stages in the mechanism of persistence. They are based on the pattern of grains, the location of hybridization signal within the muscle, and the accompanying histopathology. In HPP-1, virus persisted in nonnecrotic muscle fibers and was not directly associated with foci of inflammatory cells. HPP-2 consisted of virus contained within necrotic myocytes that were surrounded by inflammatory cells. HPP-3 was rare and showed virus inside infiltrating mononuclear cells in a region where muscle tissue had been extensively destroyed. Persistent CVB1 occurred more frequently in severely diseased animals and in tissue sections displaying intense inflammation. Moreover, HPP-2 showed a stronger association with tissue inflammation and hindquarter weakness than did HPP-1. These data demonstrate that CVB1 persists in skeletal muscle for at least 28 to 31 days postinfection and support the concept that this persistence plays a role in the development of murine polymyositis.

Enteroviral infection in end stage dilated cardiomyopathy

In order to evaluate the role of enteroviral infections in end stage dilated cardiomyopathy, RNA was isolated from left ventricular myocardium of patients with dilated cardiomyopathy explanted during heart transplantation (n = 6) and from control hearts (n = 8), then probed using a dot blot procedure with two well-defined enteroviral cloned cDNA probes. One of the cardiomyopathic heart samples hybridized with the enteroviral probes, while RNA samples from the other diseased heart and the control heart demonstrated no hybridization. To verify further the enteroviral infection, a cDNA prepared from the positive heart RNA hybridized with Southern blotted coxsackievirus B3 and poliovirus 1 nucleotide sequences, while a control sample, which gave negative results in the dot blot, showed no hybridization to the enteroviral sequence. These results provide evidence for an enteroviral infection in certain patients with end stage dilated cardiomyopathy.

Derivation and characterization of an efficiently myocarditic reovirus variant

A reovirus variant, 8B, was isolated from a neonatal mouse which had been inoculated with a mixture of two reovirus strains: type 1 Lang (T1L) and type 3 Dearing (T3D) (E. A. Wenske, S.J. Chanock, L. Krata, and B. N. Fields, J. Virol. 56:613-616, 1985). 8B is a reassortant containing eight gene segments derived from the T1L parent and two gene segments derived from the T3D parent. Upon infection of neonatal mice, 8B produced a generalized infection characteristic of many reoviruses, but it also efficiently induced numerous macroscopic external cardiac lesions, unlike either of its parents. Microscopic examination of hearts from infected mice revealed myocarditis with necrotic myocytes and both polymorphonuclear and mononuclear cellular infiltration. Electron microscopy revealed viral arrays in necrotic myocytes and dystrophic calcification accompanying late lesions. Determination of viral titers in hearts from T1L-, T3D-, or 8B-infected mice indicated that growth was not the primary determinant of myocardial necrosis. Results from inoculations of athymic mice demonstrated that T cells were not a requirement for the 8B-induced myocarditis. Finally, 8B was more cytopathic than either of the parent viruses in cultured mouse L cells. Together, the data suggest that 8B-induced myocardial necrosis is due to a direct effect of reovirus on myocytes. Reovirus thus provides a useful model for the study of viral myocarditis.

Coxsackievirus B-3 selection of virus resistant Buffalo green monkey kidney cells and chromosome analysis of parental and resistant cells

Following coxsackievirus B-3 (CBV-3) infection and lysis of highly susceptible Buffalo green monkey kidney (BGMK) cells, there was a regrowth of cells. Cultures of regrown cells were established and they continued to release infectious CBV-3 for up to 20 weeks. The parental BGMK cells were susceptible to CBV-3, CBV-4 and poliovirus type 2 induced cytopathic effect (CPE), while the cured cells were resistant to CBV-3 and CBV-4 but not to poliovirus type 2. Attachment of CBV-3 was restricted on cured BGMK cells but not on parental cells. Chromosome analysis showed that the cured cells originated from the BGMK cell line and that they were missing two marker chromosomes present in the parental cells.

Pathogenesis of acute myocardial necrosis in inbred mice infected with coxsackievirus B3

The pathogenesis of myocardial necrosis due to CB3W infection was studied in BALB/c and C3H/HeJ mice. BALB/c mice infected with 5 x 10(4) pfu were found to die of massive hepatic coagulative necrosis before myocardial changes occurred. Reducing the inoculum size to 5 x 10(2) pfu resulted in sublethal hepatic involvement and multifocal myocardial coagulative necrosis by day 7 p.i. In contrast, C3H/HeJ mice survived infection and developed multifocal myocardial coagulative necrosis, but not liver disease following inoculation with as much as 5 x 10(6) pfu of CB3W. As with BALB/c mice infected with 5 x 10(2) pfu, myocardial lesions became apparent in C3H/HeJ mice a few days after peak cardiac virus titer was attained. Minimal inflammatory infiltrate was seen following development of cellular necrosis and was restricted to the areas of virus-induced pathologic change. However, no evidence was found for virus-specific cytotoxic T cell activity or for delayed type hypersensitivity responses. Furthermore, myocardial necrosis in CB3W-infected, T cell-depleted C3H/HeJ mice was as severe as in CB3W-infected, immunocompetent mice. These data have led us to conclude that cardiac lesions were due to virus-induced cytopathology rather than immunopathogenic mechanisms.