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Influence of Immune System Abnormalities Caused by Maternal Immune Activation in the Postnatal Period. Cells 2023; 12:cells12050741. [PMID: 36899877 PMCID: PMC10001371 DOI: 10.3390/cells12050741] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
The developmental origins of health and disease (DOHaD) indicate that fetal tissues and organs in critical and sensitive periods of development are susceptible to structural and functional changes due to the adverse environment in utero. Maternal immune activation (MIA) is one of the phenomena in DOHaD. Exposure to maternal immune activation is a risk factor for neurodevelopmental disorders, psychosis, cardiovascular diseases, metabolic diseases, and human immune disorders. It has been associated with increased levels of proinflammatory cytokines transferred from mother to fetus in the prenatal period. Abnormal immunity induced by MIA includes immune overreaction or immune response failure in offspring. Immune overreaction is a hypersensitivity response of the immune system to pathogens or allergic factor. Immune response failure could not properly fight off various pathogens. The clinical features in offspring depend on the gestation period, inflammatory magnitude, inflammatory type of MIA in the prenatal period, and exposure to prenatal inflammatory stimulation, which might induce epigenetic modifications in the immune system. An analysis of epigenetic modifications caused by adverse intrauterine environments might allow clinicians to predict the onset of diseases and disorders before or after birth.
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2
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Shimizu Y, Tsukada T, Sakata-Haga H, Sakai D, Shoji H, Saikawa Y, Hatta T. Exposure to Maternal Immune Activation Causes Congenital Unfolded Protein Response Defects and Increases the Susceptibility to Postnatal Inflammatory Stimulation in Offspring. J Inflamm Res 2021; 14:355-365. [PMID: 33603435 PMCID: PMC7886242 DOI: 10.2147/jir.s294238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background A number of childhood diseases have been identified, such as severe infection or autoinflammatory disease, in which immune overreaction against inflammation is a possible underlying mechanism. Previous reports have demonstrated that fetal cells exposed to maternal immune activation (MIA) induced by polyriboinosinic-polyribocytidylic acid [poly(I:C)] exhibited hypersensitivity to inflammation in vitro. However, the details of this mechanism remain unclear. Therefore, this study aimed to reveal the reaction to inflammation in offspring exposed to MIA in the prenatal period, as well as its molecular mechanism, using a viral infection mouse model. Materials and Methods Pregnant mice at 12.5, 14.5, and 16.5 days post coitum were injected intraperitoneally with poly(I:C) 20 mg/kg body weight (BW) or saline. Offspring aged 3-4 weeks received the second injection of 20 mg/kg BW or 4 mg/kg BW poly(I:C) or saline. Serum and tissues were collected at 2, 24, 48, and 72 h after the postnatal injection. The cytokine profile, histopathology of organs, and unfolded protein response (UPR) in offspring were examined. Results The serum levels of interleukin (IL)-6, IL-17, and interferon-γ were significantly higher in the MIA group, and acute liver necrosis was detected. Moreover, failure in UPR was observed in the MIA group compared with that in the control group. Conclusion Overall, MIA exposure in utero caused failure in UPR as well as immune overreaction to the second attack of inflammation in offspring. Our results suggested that prenatal exposure to MIA might contribute to the congenital inflammatory constitution after birth.
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Affiliation(s)
- Yo Shimizu
- Department of Pediatrics, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Tsuyoshi Tsukada
- Department of Anatomy, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hiromi Sakata-Haga
- Department of Anatomy, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Daisuke Sakai
- Department of Biology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hiroki Shoji
- Department of Biology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Yutaka Saikawa
- Department of Pediatrics, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Toshihisa Hatta
- Department of Anatomy, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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3
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Rao S, Martin J, Ahearn MA, Osborne C, Moss A, Dempsey A, Dominguez SR, Weinberg A, Messacar KB. Neurologic Manifestations of Influenza A(H3N2) Infection in Children During the 2016-2017 Season. J Pediatric Infect Dis Soc 2018; 9:71-74. [PMID: 30590598 PMCID: PMC7317155 DOI: 10.1093/jpids/piy130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022]
Abstract
Among 182 children with influenza infection in 2016-2017, 18% had neurologic manifestations of influenza (NMI), including seizures and encephalopathy; 85% of these children were infected with the H3N2 strain. Children with NMI had 3.5-times-higher odds of having a neurologic comorbidity than those without NMI and a 10-fold increased odds of hospitalization.
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Affiliation(s)
- Suchitra Rao
- Division of Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Hospital Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Epidemiology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Correspondence: S. Rao, MBBS, University of Colorado School of Medicine and Children’s Hospital Colorado, Divisions of Infectious Diseases, Hospital Medicine, Epidemiology, Department of Pediatrics, Box 055, 13123 E 16th Ave, Aurora, CO 80045 ()
| | - Jan Martin
- Division of Neurology, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - M Alex Ahearn
- Division of Hospital Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Christina Osborne
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Angela Moss
- Division of Hospital Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado
| | - Amanda Dempsey
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado
| | - Samuel R Dominguez
- Division of Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Epidemiology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Pathology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Laboratory, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Adriana Weinberg
- Division of Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Department of Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Department of Pathology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Kevin B Messacar
- Division of Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora,Division of Hospital Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
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4
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Martin BE, Jia K, Sun H, Ye J, Hall C, Ware D, Wan XF. Detection of influenza antigenic variants directly from clinical samples using polyclonal antibody based proximity ligation assays. Virology 2015; 476:151-158. [PMID: 25546251 PMCID: PMC4902327 DOI: 10.1016/j.virol.2014.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/20/2014] [Accepted: 11/28/2014] [Indexed: 11/30/2022]
Abstract
Identification of antigenic variants is the key to a successful influenza vaccination program. The empirical serological methods to determine influenza antigenic properties require viral propagation. Here a novel quantitative PCR-based antigenic characterization method using polyclonal antibody and proximity ligation assays, or so-called polyPLA, was developed and validated. This method can detect a viral titer that is less than 1000 TCID50/mL. Not only can this method differentiate between different HA subtypes of influenza viruses but also effectively identify antigenic drift events within the same HA subtype of influenza viruses. Applications in H3N2 seasonal influenza data showed that the results from this novel method are consistent with those from the conventional serological assays. This method is not limited to the detection of antigenic variants in influenza but also other pathogens. It has the potential to be applied through a large-scale platform in disease surveillance requiring minimal biosafety and directly using clinical samples.
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MESH Headings
- Antibodies/analysis
- Antibodies, Viral/analysis
- Antigenic Variation
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- China
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- High-Throughput Screening Assays/instrumentation
- High-Throughput Screening Assays/methods
- Humans
- Influenza A Virus, H3N2 Subtype/classification
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza, Human/virology
- Polymerase Chain Reaction/instrumentation
- Polymerase Chain Reaction/methods
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Affiliation(s)
- Brigitte E Martin
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA
| | - Kun Jia
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA
| | - Hailiang Sun
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA
| | - Jianqiang Ye
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA
| | - Crystal Hall
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA
| | - Daphne Ware
- Mississippi Public Health Laboratory, Jackson, MS 39216, USA
| | - Xiu-Feng Wan
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA.
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5
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Sawada T, Fedorov DG, Kitaura K. Role of the Key Mutation in the Selective Binding of Avian and Human Influenza Hemagglutinin to Sialosides Revealed by Quantum-Mechanical Calculations. J Am Chem Soc 2010; 132:16862-72. [DOI: 10.1021/ja105051e] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Toshihiko Sawada
- Nanosystem Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan, and Graduate School of Pharmaceutical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Dmitri G. Fedorov
- Nanosystem Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan, and Graduate School of Pharmaceutical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Kazuo Kitaura
- Nanosystem Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan, Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan, and Graduate School of Pharmaceutical Sciences, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
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6
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Cissé Y, Wang S, Inoue I, Kido H. Rat model of influenza-associated encephalopathy (IAE): studies of electroencephalogram (EEG) in vivo. Neuroscience 2010; 165:1127-37. [DOI: 10.1016/j.neuroscience.2009.10.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 10/24/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
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7
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Fislová T, Gocník M, Sládková T, Durmanová V, Rajcáni J, Varecková E, Mucha V, Kostolanský F. Multiorgan distribution of human influenza A virus strains observed in a mouse model. Arch Virol 2009; 154:409-19. [PMID: 19189197 DOI: 10.1007/s00705-009-0318-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
Multiorgan spread and pathogenesis of influenza infection with three human influenza A viruses was studied in mice. Mouse-adapted viruses A/Dunedin/4/73(H3N2), A/Mississippi/1/85(H3N2), and A/PR/8/34(H1N1) differed considerably in virulence (p.f.u./LD(50)): 79,000 p.f.u. for Dunedin, 5,000 p.f.u. for Mississippi, and 65 p.f.u. for PR/8, which qualified Dunedin as low virulent, Mississippi as intermediate, and PR/8 as highly virulent. All three viruses were detected in lungs, heart, and thymus by cultivation and RT-PCR. Moreover, vRNA of all viruses was found in liver and spleen, of Dunedin and PR/8 also in kidneys and that of Dunedin and Mississippi in blood. Only vRNA of Dunedin was demonstrated in brain. Lung damage accompanied by histopathological changes and thymus reduction were most extensive after infection with the highly virulent virus PR/8. We assume that the ability to spread to multiple organs may be a more common property of influenza viruses in mammalian hosts than previously believed.
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Affiliation(s)
- T Fislová
- Institute of Virology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05, Bratislava, Slovak Republic
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8
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Neilson DE, Adams MD, Orr CMD, Schelling DK, Eiben RM, Kerr DS, Anderson J, Bassuk AG, Bye AM, Childs AM, Clarke A, Crow YJ, Di Rocco M, Dohna-Schwake C, Dueckers G, Fasano AE, Gika AD, Gionnis D, Gorman MP, Grattan-Smith PJ, Hackenberg A, Kuster A, Lentschig MG, Lopez-Laso E, Marco EJ, Mastroyianni S, Perrier J, Schmitt-Mechelke T, Servidei S, Skardoutsou A, Uldall P, van der Knaap MS, Goglin KC, Tefft DL, Aubin C, de Jager P, Hafler D, Warman ML. Infection-triggered familial or recurrent cases of acute necrotizing encephalopathy caused by mutations in a component of the nuclear pore, RANBP2. Am J Hum Genet 2009; 84:44-51. [PMID: 19118815 DOI: 10.1016/j.ajhg.2008.12.009] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 12/09/2008] [Accepted: 12/12/2008] [Indexed: 01/05/2023] Open
Abstract
Acute necrotizing encephalopathy (ANE) is a rapidly progressive encephalopathy that can occur in otherwise healthy children after common viral infections such as influenza and parainfluenza. Most ANE is sporadic and nonrecurrent (isolated ANE). However, we identified a 7 Mb interval containing a susceptibility locus (ANE1) in a family segregating recurrent ANE as an incompletely penetrant, autosomal-dominant trait. We now report that all affected individuals and obligate carriers in this family are heterozygous for a missense mutation (c.1880C-->T, p.Thr585Met) in the gene encoding the nuclear pore protein Ran Binding Protein 2 (RANBP2). To determine whether this mutation is the susceptibility allele, we screened controls and other patients with ANE who are unrelated to the index family. Patients from 9 of 15 additional kindreds with familial or recurrent ANE had the identical mutation. It arose de novo in two families and independently in several other families. Two other patients with familial ANE had different RANBP2 missense mutations that altered conserved residues. None of the three RANBP2 missense mutations were found in 19 patients with isolated ANE or in unaffected controls. We conclude that missense mutations in RANBP2 are susceptibility alleles for familial and recurrent cases of ANE.
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Affiliation(s)
- Derek E Neilson
- Department of Genetics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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9
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Qi L, Carbone KM, Ye Z, Liu T, Ovanesov M, Pletnikov M, Sauder C, Rubin SA. Genetic contributions to influenza virus attenuation in the rat brain. J Neurovirol 2008; 14:136-42. [PMID: 18444085 DOI: 10.1080/13550280701885563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Influenza is generally regarded as an infection of the respiratory tract; however, neurological involvement is a well-recognized, although uncommon, complication of influenza A virus infection. The authors previously described the development of a rat model for studying influenza virus infection of the central nervous system (CNS). This model was used here to study the role of virus genes in virus replication and spread in brain. In the present work, an infectious cDNA clone of the neurotoxic WSN strain of influenza virus (rWSN) was altered by site-directed mutagenesis at five loci that corresponded to changes previously shown to confer temperature sensitivity and attenuation of the A/Ann Arbor/6/60 strain (PB1Delta 391, PB1Delta 581, and PB1Delta 661; PB2Delta 265, and NPDelta 34). Whereas rWSN and its mutated derivative (mu-rWSN) replicated equally well in MDCK cells at 37 degrees C (the body temperature of rats), rWSN grew to higher titers and infection was more widespread compared to mu-rWSN in rat brain. These results demonstrate that the five mutations that confer attenuation of the A/Ann Arbor/6/60 influenza virus strain for the respiratory system also confer attenuation for the central nervous system. Further in vivo and in vitro examination of these five mutations, both individually and in combination, will likely provide important information on the role of specific virus genes in virulence and pathogenesis.
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Affiliation(s)
- Li Qi
- CBER, Food and Drug Administration, Bethesda, Maryland 20892, USA
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10
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Lau SKP, Woo PCY, Yip CCY, Tse H, Tsoi HW, Cheng VCC, Lee P, Tang BSF, Cheung CHY, Lee RA, So LY, Lau YL, Chan KH, Yuen KY. Coronavirus HKU1 and other coronavirus infections in Hong Kong. J Clin Microbiol 2006; 44:2063-71. [PMID: 16757599 PMCID: PMC1489438 DOI: 10.1128/jcm.02614-05] [Citation(s) in RCA: 305] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We have recently described the discovery of a novel coronavirus, coronavirus HKU1 (CoV-HKU1), associated with community-acquired pneumonia. However, the clinical spectrum of disease and the epidemiology of CoV-HKU1 infections in relation to infections with other respiratory viruses are unknown. In this 12-month prospective study, 4,181 nasopharyngeal aspirates from patients with acute respiratory tract infections were subjected to reverse transcription-PCRs specific for CoV-HKU1 and human coronaviruses NL63 (HCoV-NL63), OC43 (HCoV-OC43), and 229E (HCoV-229E). Coronaviruses were detected in 87 (2.1%) patients, with 13 (0.3%) positive for CoV-HKU1, 17 (0.4%) positive for HCoV-NL63, 53 (1.3%) positive for HCoV-OC43, and 4 (0.1%) positive for HCoV-229E. Of the 13 patients with CoV-HKU1 infections, 11 were children and 8 had underlying diseases. Similar to the case for other coronaviruses, upper respiratory infection was the most common presentation of CoV-HKU1 infections, although pneumonia, acute bronchiolitis, and asthmatic exacerbation also occurred. Despite a shorter duration of fever (mean, 1.7 days) and no difference in maximum temperature in children with CoV-HKU1 infections compared to patients with most other respiratory virus infections, a high incidence of febrile seizures (50%) was noted, which was significantly higher than those for HCoV-OC43 (14%), adenovirus (9%), human parainfluenza virus 1 (0%), and respiratory syncytial virus (8%) infections. CoV-HKU1 and HCoV-OC43 infections peaked in winter, although cases of the former also occurred in spring to early summer. This is in contrast to HCoV-NL63 infections, which mainly occurred in early summer and autumn but were absent in winter. Two genotypes of CoV-HKU1 cocirculated during the study period. Continuous studies over a longer period are warranted to ascertain the seasonal variation and relative importance of the different coronaviruses. Similar studies in other countries are required to better determine the epidemiology and genetic diversity of CoV-HKU1.
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MESH Headings
- Acute Disease
- Aged, 80 and over
- Child
- Child, Preschool
- Coronavirus/classification
- Coronavirus/genetics
- Coronavirus/isolation & purification
- Coronavirus 229E, Human/classification
- Coronavirus 229E, Human/genetics
- Coronavirus 229E, Human/isolation & purification
- Coronavirus Infections/epidemiology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/virology
- Coronavirus OC43, Human/classification
- Coronavirus OC43, Human/genetics
- Coronavirus OC43, Human/isolation & purification
- Female
- Hong Kong/epidemiology
- Hospitalization
- Humans
- Incidence
- Infant
- Male
- Molecular Sequence Data
- Nasopharynx/virology
- Phylogeny
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/physiopathology
- Respiratory Tract Infections/virology
- Reverse Transcriptase Polymerase Chain Reaction
- Seizures, Febrile/epidemiology
- Sequence Analysis, DNA
- Severity of Illness Index
- Viral Proteins/genetics
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Affiliation(s)
- Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong
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11
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Rubin S, Liu D, Pletnikov M, McCullers J, Ye Z, Levandowski R, Johannessen J, Carbone K. Wild-type and attenuated influenza virus infection of the neonatal rat brain. J Neurovirol 2004; 10:305-14. [PMID: 15385253 DOI: 10.1080/13550280490499579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although influenza virus infection of humans has been associated with a wide spectrum of clinical neurological syndromes, the pathogenesis of influenza virus associated central nervous system (CNS) disease in humans remains controversial. To better study influenza virus neuropathogenesis, an animal model of influenza-associated CNS disease using human virus isolates without adaptation to an animal host was developed. This neonatal rat model of influenza virus CNS infection was developed using low-passage human isolates and shows outcomes in specific brain regions, cell types infected, and neuropathological outcomes that parallel the available literature on cases of human CNS infection. The degree of virus replication and spread in the rat brain correlated with the strains' neurotoxicity potential for humans. In addition, using sensitive neurobehavioral test paradigms, changes in brain function were found to be associated with areas of virus replication in neurons. These data suggest that further evaluation of this pathogenesis model may provide important information regarding influenza virus neuropathogenesis, and that this model may have possible utility as a preclinical assay for evaluating the neurological safety of new live attenuated influenza virus vaccine strains.
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Affiliation(s)
- Steven Rubin
- DVP/OVRR/CBER/FDA, Bethesda, Maryland 20892, USA.
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12
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Grose C. The puzzling picture of acute necrotizing encephalopathy after influenza A and B virus infection in young children. Pediatr Infect Dis J 2004; 23:253-4. [PMID: 15014302 DOI: 10.1097/01.inf.0000114901.70040.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute necrotizing encephalopathy is a complication of influenza A and B virus infection in young children, especially in Japan. The disease is characterized by high fever, convulsions and coma. A prominent feature of this central nervous system disease is bilateral thalamic necrosis, documented by magnetic resonance imaging. The pathogenesis of the virus-associated brain pathology has not yet been elucidated. There is considerable circumstantial evidence that influenza immunization may decrease the likelihood of children developing acute necrotizing encephalopathy.
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Affiliation(s)
- Charles Grose
- Virology Laboratory, Childrens Hospital of Iowa, Iowa City, IA, USA
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13
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Ono S, Kudo M, Aoki K, Ezaki F, Misumi J. Effect of mass immunization against influenza encephalopathy on mortality rates in children. Pediatr Int 2003; 45:680-7. [PMID: 14651541 DOI: 10.1111/j.1442-200x.2003.01813.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since the Japanese influenza vaccination program for school children was terminated in 1994, a steep rise has been noted in the number of young children reported with fulminant influenza and influenza associated with acute encephalopathy/encephalitis. The purpose of the present study was to interpret and clarify the effect of mass influenza vaccination on mortality of Japanese children, aged <19 years, with influenza and influenza-associated acute encephalopathy/encephalitis. METHODS The authors examined the distribution of mortality rates of children in Japan aged <19 years with influenza during 1950-2000, influenza associated with central nervous system (CNS) signs in the period 1950-1978, and the estimated cases of influenza associated with acute encephalopathy/encephalitis in the period 1987-2000. RESULTS Total influenza mortality among children aged <19 years has increased since 1990, with children aged <4 years after 1994 being the worst affected. The mean values of mortality rates of influenza associated with central nervous system signs during 1963-1978 and the estimated mortality of children aged <9 years during 1979-1994 were significantly lower than in some years before 1962, and after 1995 (P < 0.05). The annual mortality rates of influenza-associated acute encephalopathy/encephalitis during 1995-2000 were significantly higher than the expected mortality of influenza associated with central nervous system signs in children aged <14 years (P < 0.05). CONCLUSION The results of the present study suggest that mass immunization of school-aged children reduced the mortality rate from influenza-associated acute encephalopathy/encephalitis in children less than 9 years of age.
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Affiliation(s)
- Shigetoo Ono
- Division of Preventive Medicine Department of Human Environmental and Social Medicine, Faculty of Medicine, Oita University, Hasama, Oita, Japan
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14
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Kawada JI, Kimura H, Hara S, Ito Y, Kawashima H, Okuno T, Morishima T. Absence of associations between influenza-associated encephalopathy and human herpesvirus 6 or human herpesvirus 7. Pediatr Infect Dis J 2003; 22:115-9. [PMID: 12586973 DOI: 10.1097/01.inf.0000050364.08131.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Influenza-associated encephalopathy is a severe complication of influenza virus infection, but its pathogenesis is unknown. It was recently suggested that the neurologic complications of influenza, including encephalopathy, are associated with human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7). AIM To confirm or refute the association between influenza-associated encephalopathy and HHV-6 or HHV-7. METHODS Cerebrospinal fluid and serum from 25 patients with central nervous system complications of influenza (18 patients with encephalopathy and 7 patients with febrile convulsions) were investigated. The specimens were examined by real time polymerase chain reaction (PCR) and nested PCR for HHV-6 and HHV-7 DNA. RESULTS In the cerebrospinal fluid samples neither HHV-6 DNA nor HHV-7 DNA was detected by real time PCR or nested PCR. HHV-6 DNA was detected in a single serum sample from a patient with febrile convulsions. CONCLUSION In our study there was no association with HHV-6 or HHV-7 in most patients with central nervous system complications of influenza.
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MESH Headings
- Age Distribution
- Case-Control Studies
- Child
- Child, Preschool
- DNA, Viral/analysis
- Encephalitis, Viral/complications
- Encephalitis, Viral/virology
- Female
- Herpesviridae Infections/complications
- Herpesviridae Infections/virology
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 7, Human/isolation & purification
- Humans
- Incidence
- Influenza, Human/complications
- Influenza, Human/diagnosis
- Japan/epidemiology
- Male
- Polymerase Chain Reaction
- Risk Factors
- Seizures, Febrile/complications
- Seizures, Febrile/virology
- Sex Distribution
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Affiliation(s)
- Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University School of Medicine, Japan
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15
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Morishima T, Togashi T, Yokota S, Okuno Y, Miyazaki C, Tashiro M, Okabe N. Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis 2002; 35:512-7. [PMID: 12173123 DOI: 10.1086/341407] [Citation(s) in RCA: 346] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2001] [Revised: 03/05/2002] [Indexed: 11/03/2022] Open
Abstract
During the winter of 1998-1999, there was an outbreak of encephalitis/encephalopathy in Japan that appeared to be associated with influenza. We conducted a national survey of the prevalence and clinical features of disease and the associated outcomes and prognostic factors related to this outbreak. A total of 202 cases were analyzed, of which 148 were diagnosed as influenza-associated encephalitis/encephalopathy on the basis of virologic analysis. Of the 148 cases studied, 130 (87.8%) were type A influenza and 17 were type B. Encephalitis/encephalopathy developed mainly in children age <5 years, either on the day that influenza signs appeared or on the next day. The major signs included altered consciousness or loss of consciousness, convulsions, cough, and vomiting. In many patients, multiple-organ failure developed, and rates of mortality (31.8%) and disability (27.7%) were high. Thrombocytopenia and severely elevated transaminase levels were factors associated with a poor prognosis. Thus, influenza-associated encephalitis/encephalopathy progressed rapidly and was associated with poor outcomes.
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Affiliation(s)
- Tsuneo Morishima
- Department of Health Science, Nagoya University, Nagoya, Nagoya 461-0047, Japan.
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Sugaya N. Influenza-associated encephalopathy in Japan. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2002; 13:79-84. [PMID: 12122956 DOI: 10.1053/spid.2002.122993] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the clinical entity of influenza-associated encephalopathy (influenza encephalopathy) has not gained universal recognition, it has been reported frequently as a complication of influenza in Japanese children. The influenza type A (H3N2) virus was detected in most cases. Most of the patients have been young children. Influenza encephalopathy typically is associated with a sudden onset of high fever, severe convulsions, rapidly progressive coma, and death within 2 or 3 days. Influenza encephalopathy reported in Japan is distinct from Reye syndrome, and one-fourth of patients exhibit bilateral thalamic necrosis on neuroimaging. Similar encephalopathic symptoms probably occur in North America and European countries.
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Affiliation(s)
- Norio Sugaya
- Department of Pediatrics, Nippon Kokan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa 210-0852, Japan.
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Sugaya N, Yoshikawa T, Miura M, Ishizuka T, Kawakami C, Asano Y. Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7. Clin Infect Dis 2002; 34:461-6. [PMID: 11797172 DOI: 10.1086/338468] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2001] [Revised: 09/10/2001] [Indexed: 11/03/2022] Open
Abstract
Influenza-associated encephalopathy is often reported in young Japanese children, but its pathogenesis is unknown. Although influenza virus can be demonstrated by throat culture for patients with encephalopathy, cultures of samples of cerebrospinal fluids (CSF) do not yield the virus. Eight patients with encephalopathy or complicated febrile convulsions had influenza virus infection diagnosed by means of culture, polymerase chain reaction (PCR), or rapid diagnosis using throat swabs. In all 8 cases, the results of PCR testing of CSF specimens for influenza virus were negative. On the other hand, human herpesvirus 6 (HHV-6) DNA was demonstrated in CSF specimens obtained from 2 of 8 patients. In 3 of 8 patients, the presence of human herpesvirus 7 (HHV-7) DNA was demonstrated in CSF specimens. Some cases of influenza-associated encephalopathy reported in Japan may be attributable to a dual infection with influenza virus and HHV-6, -7, or both. Another possibility is that latent HHV-6 or HHV-7 in the brain is reactivated by influenza, causing encephalopathy or febrile convulsions.
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Affiliation(s)
- Norio Sugaya
- Department of Pediatrics, Nippon Kokan Hospital, Kawasaki, Kanagawa 210-0852, Japan.
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18
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Medeiros R, Escriou N, Naffakh N, Manuguerra JC, van der Werf S. Hemagglutinin residues of recent human A(H3N2) influenza viruses that contribute to the inability to agglutinate chicken erythrocytes. Virology 2001; 289:74-85. [PMID: 11601919 DOI: 10.1006/viro.2001.1121] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To identify the molecular determinants contributing to the inability of recent human influenza A(H3N2) viruses to agglutinate chicken erythrocytes, phenotypic revertants were selected upon passage in eggs or MDCK cells. The Leu194Ile or Val226Ile substitutions were detected in their hemagglutinin (HA) sequence concomitantly with the phenotypic reversion. Remarkably, as little as 3.5% of variants bearing a Val226Ile substitution was found to confer the ability to agglutinate chicken erythrocytes to the virus population. Hemadsorption assays following transient expression of mutated HA proteins showed that the successive Gln226 --> Leu --> Ile --> Val changes observed on natural isolates resulted in a progressive loss of the ability of the HA to bind chicken erythrocytes. The Val226Ile change maintained the preference of the HA for SAalpha2,6Gal over SAalpha2,3Gal and enhanced binding of the HA to alpha2,6Gal receptors present on chicken erythrocytes. In contrast, simultaneous Ser193Arg and Leu194Ile substitutions that were found to confer the ability to agglutinate sheep erythrocytes increased the affinity of the HA for SAalpha2,3Gal.
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Affiliation(s)
- R Medeiros
- Unité de Génétique Moléculaire des Virus Respiratoires, URA 1966 CNRS, Institut Pasteur, 75724 Paris Cedex 15, France
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19
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Abstract
OBJECTIVES To compare the incidence of febrile seizures in children hospitalized for influenza A infection with parainfluenza and adenovirus infection and to examine the hypothesis that children hospitalized for influenza A (variant Sydney/H3N2) during the 1998 season in Hong Kong had more frequent and refractory seizures when compared with other respiratory viruses, including the A/Wuhan H3N2 variant that was present in the previous year. METHODS Medical records of children between 6 months and 5 years of age admitted for influenza A infection in 1998 were reviewed. For comparison, records of children of the same age group with influenza A infection in 1997, and with parainfluenza and adenovirus infections between 1996 and 1998 were reviewed. Children who were afebrile or who had an underlying neurologic disorder were excluded. RESULTS Of children hospitalized for influenza A in 1998 and 1997, 54/272 (19.9%) and 27/144 (18.8%) had febrile seizures, respectively. The overall incidence of febrile seizures associated with influenza A (19.5%) was higher than that in children hospitalized for parainfluenza (18/148; 12.2%) and adenovirus (18/199; 9%) infection, respectively. In children who had febrile seizures, repeated seizures were more commonly associated with influenza A infection than with parainfluenza or adenovirus infection (23/81 [28%] vs 3/36 [8.3%], odds ratio [OR] 4.3, 95% confidence interval: 1.2 to 15.4). Alternatively, children with influenza A infection had a higher incidence (23/416, 5.5%) of multiple seizures during the same illness than those with adenovirus or parainfluenza infection (3/347, 0.86%; OR 6.7, 95% confidence interval: 2.0-22.5.) The increased incidence of febrile seizures associated with influenza A was not attributable to differences in age, gender, or family history of febrile seizure. Multivariate analysis, adjusted for peak temperature and duration of fever, showed that hospitalized children infected with infection A had a higher risk of febrile seizures than those who were infected with parainfluenza or adenovirus (OR 1.97). Influenza A infection was a significant cause of febrile seizure admissions. Of 250 and 249 children admitted to Queen Mary Hospital for febrile seizures in 1997 and 1998, respectively, influenza A infection accounted for 27 (10.8%) admissions in 1997 and 54 (21.7%) in 1998. During months of peak influenza activity, it accounted for up to 35% to 44% of febrile seizure admissions. In contrast, parainfluenza, adenovirus, respiratory syncytial virus, and influenza B had a smaller contribution to hospitalizations for febrile seizures, together accounting for only 25/250 (10%) admissions in 1997 and 16/249 (6.4%) in 1998. CONCLUSION The influenza A Sydney variant (H3N2) was not associated with an increased risk of febrile seizures when compared with the previous influenza A Wuhan variant (H3N2) or H1N1 viruses. However, in hospitalized children, influenza A is associated with a higher incidence of febrile seizures and of repeated seizures in the same febrile episode than are adenovirus or parainfluenza infections. The pathogenesis of these observations warrants additional studies. Complex febrile seizures, particularly multiple febrile seizures at the time of presentation, have been thought to carry an adverse long-term prognosis because of its association with a higher incidence of epilepsy. Repeated febrile seizures alone, particularly if associated with influenza A infection, may not be as worrisome as children with complex febrile seizures because of other causes, which requires additional investigation. This may subsequently have an impact on reducing the burden of evaluation in a subset of children with complex febrile seizures.
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Affiliation(s)
- S S Chiu
- Department of Pediatrics, University of Hong Kong, Hong Kong SAR, China.
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Shiraishi K, Lindstrom SE, Saito T, Shinjoh M, Nerome R, Funatsumaru S, Nerome K. Genetic analysis of an influenza B virus isolated from a patient with encephalopathy in Japan. J Med Virol 2001. [DOI: 10.1002/jmv.2077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shinjoh M, Bamba M, Jozaki K, Takahashi E, Koinuma G, Sugaya N. Influenza A-associated encephalopathy with bilateral thalamic necrosis in Japan. Clin Infect Dis 2000; 31:611-3. [PMID: 10987732 DOI: 10.1086/313978] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Two cases of acute encephalopathy in young children clearly showed evidence of influenza A virus infection and bilateral thalamic lesions. Influenza-associated encephalopathy with bilateral thalamic lesions has mostly been reported in Japan; it differs from Reye's syndrome in several respects. Other factors in addition to influenza virus infection may have contributed to the etiology of encephalopathy in our case patients.
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Affiliation(s)
- M Shinjoh
- Department of Pediatrics, Hiratsuka Kyosai Hospital, Hiratsuka, Japan.
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22
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Abstract
It is estimated that more than 100 children die of influenza-associated encephalopathy (influenza encephalopathy) every year in Japan. Influenza encephalopathy is distinct from Reye's syndrome. Specifically, 20% of influenza encephalopathy patients exhibit bilateral thalamic necrosis on neuroimaging, a lesion referred to as acute necrotizing encephalopathy (ANE). Influenza encephalopathy may develop by the same pathogenetic mechanisms as ANE, possibly via vasoactive substances or a process leading to vasoconstriction in the central nervous system (CNS). A novel substitution at the receptor-binding site (Tyr 137 to Phe) was reported to be found exclusively in influenza type A (H3N2) viruses isolated from patients with influenza encephalopathy, suggesting that encephalopathy may be caused by a variant influenza type A (H3N2) virus. Recently, it has been reported that cytokines may mediate the disease and that a high plasma concentration of interleukin-6 could be an indicator of progression to encephalopathy. Although it is unknown whether influenza virus invades the CNS, amantadine therapy for influenza encephalopathy has been tried in Japan, in patients in whom influenza type A infection has been demonstrated by rapid antigen detection tests.
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Affiliation(s)
- N Sugaya
- Department of Pediatrics, Nippon Kokan Hospital, Kanagawa, Japan.
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