1
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Ma H, Yang Y, Nie T, Yan R, Si Y, Wei J, Li M, Liu H, Ye W, Zhang H, Cheng L, Zhang L, Lv X, Luo L, Xu Z, Zhang X, Lei Y, Zhang F. Disparate macrophage responses are linked to infection outcome of Hantan virus in humans or rodents. Nat Commun 2024; 15:438. [PMID: 38200007 PMCID: PMC10781751 DOI: 10.1038/s41467-024-44687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Hantaan virus (HTNV) is asymptomatically carried by rodents, yet causes lethal hemorrhagic fever with renal syndrome in humans, the underlying mechanisms of which remain to be elucidated. Here, we show that differential macrophage responses may determine disparate infection outcomes. In mice, late-phase inactivation of inflammatory macrophage prevents cytokine storm syndrome that usually occurs in HTNV-infected patients. This is attained by elaborate crosstalk between Notch and NF-κB pathways. Mechanistically, Notch receptors activated by HTNV enhance NF-κB signaling by recruiting IKKβ and p65, promoting inflammatory macrophage polarization in both species. However, in mice rather than humans, Notch-mediated inflammation is timely restrained by a series of murine-specific long noncoding RNAs transcribed by the Notch pathway in a negative feedback manner. Among them, the lnc-ip65 detaches p65 from the Notch receptor and inhibits p65 phosphorylation, rewiring macrophages from the pro-inflammation to the pro-resolution phenotype. Genetic ablation of lnc-ip65 leads to destructive HTNV infection in mice. Thus, our findings reveal an immune-braking function of murine noncoding RNAs, offering a special therapeutic strategy for HTNV infection.
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Affiliation(s)
- Hongwei Ma
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
- Department of Anaesthesiology & Critical Care Medicine, Xijing Hospital, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Yongheng Yang
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Tiejian Nie
- Department of Experimental Surgery, Tangdu Hospital, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710038, China
| | - Rong Yan
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Yue Si
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Jing Wei
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
- Shaanxi Provincial Centre for Disease Control and Prevention, Xi'an, Shaanxi, 710054, China
| | - Mengyun Li
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - He Liu
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Wei Ye
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Hui Zhang
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Linfeng Cheng
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Liang Zhang
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Xin Lv
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China
| | - Limin Luo
- Department of Infectious Disease, Air Force Hospital of Southern Theatre Command, Guangzhou, Guangdong, 510602, China
| | - Zhikai Xu
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China.
| | - Xijing Zhang
- Department of Anaesthesiology & Critical Care Medicine, Xijing Hospital, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China.
| | - Yingfeng Lei
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China.
| | - Fanglin Zhang
- Department of Microbiology & Pathogen Biology, School of Basic Medical Sciences, Air Force Medical University (the Fourth Military Medical University), Xi'an, Shaanxi, 710032, China.
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2
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Vaheri A, Henttonen H, Mustonen J. Hantavirus Research in Finland: Highlights and Perspectives. Viruses 2021; 13:v13081452. [PMID: 34452318 PMCID: PMC8402838 DOI: 10.3390/v13081452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/24/2023] Open
Abstract
Finland has the highest incidence of hantavirus infections globally, with a significant impact on public health. The large coverage of boreal forests and the cyclic dynamics of the dominant forest rodent species, the bank vole Myodes glareolus, explain most of this. We review the relationships between Puumala hantavirus (PUUV), its host rodent, and the hantavirus disease, nephropathia epidemica (NE), in Finland. We describe the history of NE and its diagnostic research in Finland, the seasonal and multiannual cyclic dynamics of PUUV in bank voles impacting human epidemiology, and we compare our northern epidemiological patterns with those in temperate Europe. The long survival of PUUV outside the host and the life-long shedding of PUUV by the bank voles are highlighted. In humans, the infection has unique features in pathobiology but rarely long-term consequences. NE is affected by specific host genetics and risk behavior (smoking), and certain biomarkers can predict the outcome. Unlike many other hantaviruses, PUUV causes a relatively mild disease and is rarely fatal. Reinfections do not exist. Antiviral therapy is complicated by the fact that when symptoms appear, the patient already has a generalized infection. Blocking vascular leakage measures counteracting pathobiology, offer a real therapeutic approach.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-505552884
| | - Heikki Henttonen
- Wildlife Ecology, Natural Resources Institute Finland, 00790 Helsinki, Finland;
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
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3
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Saavedra F, Díaz FE, Retamal‐Díaz A, Covián C, González PA, Kalergis AM. Immune response during hantavirus diseases: implications for immunotherapies and vaccine design. Immunology 2021; 163:262-277. [PMID: 33638192 PMCID: PMC8207335 DOI: 10.1111/imm.13322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Orthohantaviruses, previously named hantaviruses, cause two emerging zoonotic diseases: haemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Overall, over 200 000 cases are registered every year worldwide, with a fatality rate ranging between 0·1% and 15% for HFRS and between 20% and 40% for HCPS. No specific treatment or vaccines have been approved by the U.S. Food and Drug Administration (FDA) to treat or prevent hantavirus-caused syndromes. Currently, little is known about the mechanisms at the basis of hantavirus-induced disease. However, it has been hypothesized that an excessive inflammatory response plays an essential role in the course of the disease. Furthermore, the contributions of the cellular immune response to either viral clearance or pathology have not been fully elucidated. This article discusses recent findings relative to the immune responses elicited to hantaviruses in subjects suffering HFRS or HCPS, highlighting the similarities and differences between these two clinical diseases. Also, we summarize the most recent data about the cellular immune response that could be important for designing new vaccines to prevent this global public health problem.
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Affiliation(s)
- Farides Saavedra
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Fabián E. Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Angello Retamal‐Díaz
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Camila Covián
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Pablo A. González
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and ImmunotherapyDepartamento de Genética Molecular y MicrobiologíaFacultad de Ciencias BiológicasPontificia Universidad Católica de ChileSantiagoChile
- Millennium Institute on Immunology and ImmunotherapyDepartamento de EndocrinologíaFacultad de MedicinaEscuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
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4
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Li Y, Quan C, Xing W, Wang P, Gao J, Zhang Z, Jiang X, Ma C, Carr MJ, He Q, Gao L, Bi Y, Tang H, Shi W. Rapid humoral immune responses are required for recovery from haemorrhagic fever with renal syndrome patients. Emerg Microbes Infect 2021; 9:2303-2314. [PMID: 32990499 PMCID: PMC8284976 DOI: 10.1080/22221751.2020.1830717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Haemorrhagic fever with renal syndrome (HFRS) following Hantaan virus (HTNV) infection displays variable clinical signs. Humoral responses elicited during HTNV infections are considered important, however, this process remains poorly understood. Herein, we have investigated the phenotype, temporal dynamics, and characteristics of B-cell receptor (BCR) repertoire in an HFRS cohort. The serological profiles were characterized by a lowered expression level of nucleoprotein (NP)-specific antibody in severe cases. Importantly, B-cell subsets were activated and proliferated within the first two weeks of symptom onset and moderate cases reacted more rapidly. BCR analysis in the recovery phase revealed a dramatic increase in the immunoglobulin gene diversity which was more significantly progressed in moderate infections. In severe cases, B-cell-related transcription was lower with inflammatory sets overactivated. Taken together, these data suggest the clinical signs and disease recovery in HFRS patients were positively impacted by rapid and efficacious humoral responses.
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Affiliation(s)
- Yaoni Li
- Baoji Center Hospital, Baoji, People's Republic of China
| | - Chuansong Quan
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Weijia Xing
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Peihan Wang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Jiming Gao
- Institute of Immunology, Shandong First Medical University& Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Zhenjie Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Xiaolin Jiang
- Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China
| | - Chuanmin Ma
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Michael J Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin, Ireland.,Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Kita-ku, Japan
| | - Qian He
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Lei Gao
- School of Life Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Yuhai Bi
- Key Laboratory of Pathogenic Microbiology and Immunology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Institute of Microbiology, Center for Influenza Research and Early Warning, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Hua Tang
- Institute of Immunology, Shandong First Medical University& Shandong Academy of Medical Sciences, Taian, People's Republic of China
| | - Weifeng Shi
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, People's Republic of China
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5
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Heterologous boosting of nonrelated toxoid immunity during acute Puumala hantavirus infection. Vaccine 2021; 39:1818-1825. [PMID: 33678453 DOI: 10.1016/j.vaccine.2021.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/01/2021] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
Persistence of immune memory in humans is a crucial yet poorly understood aspect of immunology. Here we have studied the effect of Puumala hantavirus infection on unrelated, pre-existing immune memory by studying T cell- and antibody responses against toxoid vaccine antigens of diphtheria, tetanus and pertussis in a cohort of 45 patients. We found that tetanus- and pertussis -specific IgG concentrations elevate during acute Puumala virus infection. Increase in vaccine IgG was associated with proliferation of heterologous T cells. Interestingly, increases in tetanus-specific IgG persisted a year after the infection while pertussis-specific IgG declined rapidly; a difference in IgG kinetics resembling the difference seen after vaccination against tetanus and pertussis. These results suggest that persistence of immune memory is facilitated by heterologous boosting of old memory during memory formation against newly encountered antigens. They also show that different toxoid antigens may be treated differently. Our study gives new insight into how immune memory formation may alter pre-existing immune memory, and also shows that heterologous immunity may have an impact on vaccination outcomes.
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6
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Resman Rus K, Kopitar AN, Korva M, Ihan A, Petrovec M, Avšič-Županc T. Comparison of Lymphocyte Populations in Patients With Dobrava or Puumala orthohantavirus Infection. Front Cell Infect Microbiol 2020; 10:566149. [PMID: 33178625 PMCID: PMC7596256 DOI: 10.3389/fcimb.2020.566149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS), caused by Dobrava (DOBV) and Puumala (PUUV) orthohantaviruses, is an endemic disease in Slovenia. DOBV is mainly responsible for a more severe disease, whereas PUUV usually causes a milder form. Therefore, the aim of our study was to determine whether any differences in lymphocyte population in patients infected with these two viruses exist. Mononuclear cells from peripheral blood (PBMCs) were isolated from DOBV or PUUV infected patients and different lymphocyte subpopulations were analyzed with flow cytometry. Decreased concentrations of lymphocyte subpopulation were observed in DOBV and in PUUV infected patients compared with a healthy control, which was especially evident in DOBV infected patients. The lower values of T cells are likely due to the extravasation of the activated cells from the circulation to the infected tissue. Higher percentage of NK cells were detected in DOBV infected patients in comparison to PUUV infected patients, which could be associated with a more severe HFRS caused by DOBV. PUUV infected patients had a significantly higher concentration of activated T cell subsets, expressing markers CD25, CD69, and HLA-DR in comparison to DOBV infected patients. Higher activation of T cell subsets in PUUV infected patients could be a contributor to a milder HFRS. Further studies are necessary to elucidate the relation between the protective and the harmful role of activated lymphocytes subsets in HFRS pathogenesis.
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Affiliation(s)
- Katarina Resman Rus
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Andreja Nataša Kopitar
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Korva
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Alojz Ihan
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Miroslav Petrovec
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
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7
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Klingström J, Smed-Sörensen A, Maleki KT, Solà-Riera C, Ahlm C, Björkström NK, Ljunggren HG. Innate and adaptive immune responses against human Puumala virus infection: immunopathogenesis and suggestions for novel treatment strategies for severe hantavirus-associated syndromes. J Intern Med 2019; 285:510-523. [PMID: 30663801 PMCID: PMC6850289 DOI: 10.1111/joim.12876] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two related hyperinflammatory syndromes are distinguished following infection of humans with hantaviruses: haemorrhagic fever with renal syndrome (HFRS) seen in Eurasia and hantavirus pulmonary syndrome (HPS) seen in the Americas. Fatality rates are high, up to 10% for HFRS and around 35%-40% for HPS. Puumala virus (PUUV) is the most common HFRS-causing hantavirus in Europe. Here, we describe recent insights into the generation of innate and adaptive cell-mediated immune responses following clinical infection with PUUV. First described are studies demonstrating a marked redistribution of peripheral blood mononuclear phagocytes (MNP) to the airways, a process that may underlie local immune activation at the site of primary infection. We then describe observations of an excessive natural killer (NK) cell activation and the persistence of highly elevated numbers of NK cells in peripheral blood following PUUV infection. A similar vigorous CD8 Tcell response is also described, though Tcell responses decline with viraemia. Like MNPs, many NK cells and CD8 T cells also localize to the lung upon acute PUUV infection. Following this, findings demonstrating the ability of hantaviruses, including PUUV, to cause apoptosis resistance in infected target cells, are described. These observations, and associated inflammatory cytokine responses, may provide new insights into HFRS and HPS disease pathogenesis. Based on similarities between inflammatory responses in severe hantavirus infections and other hyperinflammatory disease syndromes, we speculate whether some therapeutic interventions that have been successful in the latter conditions may also be applicable in severe hantavirus infections.
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Affiliation(s)
- J Klingström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Smed-Sörensen
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K T Maleki
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Solà-Riera
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - N K Björkström
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - H G Ljunggren
- Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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8
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Raftery MJ, Abdelaziz MO, Hofmann J, Schönrich G. Hantavirus-Driven PD-L1/PD-L2 Upregulation: An Imperfect Viral Immune Evasion Mechanism. Front Immunol 2018; 9:2560. [PMID: 30559738 PMCID: PMC6287426 DOI: 10.3389/fimmu.2018.02560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Abstract
Viruses often subvert antiviral immune responses by taking advantage of inhibitory immune signaling. We investigated if hantaviruses use this strategy. Hantaviruses cause viral hemorrhagic fever (VHF) which is associated with strong immune activation resulting in vigorous CD8+ T cell responses. Surprisingly, we observed that hantaviruses strongly upregulate PD-L1 and PD-L2, the ligands of checkpoint inhibitor programmed death-1 (PD-1). We detected high amounts of soluble PD-L1 (sPD-L1) and soluble PD-L2 (sPD-L2) in sera from hantavirus-infected patients. In addition, we observed hantavirus-induced PD-L1 upregulation in mice with a humanized immune system. The two major target cells of hantaviruses, endothelial cells and monocyte-derived dendritic cells, strongly increased PD-L1 and PD-L2 surface expression upon hantavirus infection in vitro. As an underlying mechanism, we found increased transcript levels whereas membrane trafficking of PD-L1 was not affected. Further analysis revealed that hantavirus-associated inflammatory signals and hantaviral nucleocapsid (N) protein enhance PD-L1 and PD-L2 expression. Cell numbers were strongly reduced when hantavirus-infected endothelial cells were mixed with T cells in the presence of an exogenous proliferation signal compared to uninfected cells. This is compatible with the concept that virus-induced PD-L1 and PD-L2 upregulation contributes to viral immune escape. Intriguingly, however, we observed hantavirus-induced CD8+ T cell bystander activation despite strongly upregulated PD-L1 and PD-L2. This result indicates that hantavirus-induced CD8+ T cell bystander activation bypasses checkpoint inhibition allowing an early antiviral immune response upon virus infection.
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Affiliation(s)
- Martin J Raftery
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mohammed O Abdelaziz
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jörg Hofmann
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Günther Schönrich
- Berlin Institute of Health, Institute of Virology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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9
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Khaiboullina SF, Levis S, Morzunov SP, Martynova EV, Anokhin VA, Gusev OA, St Jeor SC, Lombardi VC, Rizvanov AA. Serum Cytokine Profiles Differentiating Hemorrhagic Fever with Renal Syndrome and Hantavirus Pulmonary Syndrome. Front Immunol 2017; 8:567. [PMID: 28572804 PMCID: PMC5435745 DOI: 10.3389/fimmu.2017.00567] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/27/2017] [Indexed: 12/16/2022] Open
Abstract
Hantavirus infection is an acute zoonosis that clinically manifests in two primary forms, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). HFRS is endemic in Europe and Russia, where the mild form of the disease is prevalent in the Tatarstan region. HPS is endemic in Argentina, as well as other countries of North and South American. HFRS and HPS are usually acquired via the upper respiratory tract by inhalation of virus-contaminated aerosol. Although the pathogenesis of HFRS and HPS remains largely unknown, postmortem tissue studies have identified endothelial cells as the primary target of infection. Importantly, cell damage due to virus replication, or subsequent tissue repair, has not been documented. Since no single factor has been identified that explains the complexity of HFRS or HPS pathogenesis, it has been suggested that a cytokine storm may play a crucial role in the manifestation of both diseases. In order to identify potential serological markers that distinguish HFRS and HPS, serum samples collected during early and late phases of the disease were analyzed for 48 analytes using multiplex magnetic bead-based assays. Overall, serum cytokine profiles associated with HPS revealed a more pro-inflammatory milieu as compared to HFRS. Furthermore, HPS was strictly characterized by the upregulation of cytokine levels, in contrast to HFRS where cases were distinguished by a dichotomy in serum cytokine levels. The severe form of hantavirus zoonosis, HPS, was characterized by the upregulation of a higher number of cytokines than HFRS (40 vs 21). In general, our analysis indicates that, although HPS and HFRS share many characteristic features, there are distinct cytokine profiles for these diseases. These profiles suggest a strong activation of an innate immune and inflammatory responses are associated with HPS, relative to HFRS, as well as a robust activation of Th1-type immune responses. Finally, the results of our analysis suggest that serum cytokines profiles of HPS and HFRS cases are consistent with the presence of extracellular matrix degradation, increased mononuclear leukocyte proliferation, and transendothelial migration.
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Affiliation(s)
- Svetlana F Khaiboullina
- Nevada Center for Biomedical Research, Reno, NV, USA.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.,Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, NV, USA
| | - Silvana Levis
- Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio I. Maiztegui", Pergamino, Argentina
| | - Sergey P Morzunov
- Department of Pathology, University of Nevada School of Medicine, Reno, NV, USA
| | - Ekaterina V Martynova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | | | - Oleg A Gusev
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.,Preventive Medicine and Diagnosis Innovation Program, Center for Life Science Technologies, Yokohama, Japan
| | - Stephen C St Jeor
- Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, NV, USA
| | - Vincent C Lombardi
- Nevada Center for Biomedical Research, Reno, NV, USA.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert A Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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10
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Koivula TT, Tuulasvaara A, Hetemäki I, Hurme M, Mäkelä S, Mustonen J, Vaheri A, Arstila TP. Indoleamine 2,3-dioxygenase activity is associated with regulatory T cell response in acute Puumala hantavirus infection. Pathog Dis 2017; 75:ftw114. [PMID: 28057727 DOI: 10.1093/femspd/ftw114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/29/2016] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
Abstract
High indoleamine 2,3-dioxygenase (IDO) activity is associated with clinically severe acute infection caused by Puumala hantavirus. The immunoregulatory effects of IDO can be mediated either through metabolic control of effector T cells, caused by depletion of the essential amino acid tryptophan, or intercellular signaling and activation of regulatory T cell responses. Here, we have studied 24 patients with acute Puumala hantavirus infection to distinguish between these possibilities. Maximum IDO activity showed a significant positive correlation with FOXP3 expression levels in regulatory T cells, a quantitative surrogate marker for suppressive capability. In contrast, IDO activity did not correlate with the frequency of CD8+ effector cells in cell cycle. The data suggest that in Puumala infection, the mechanism responsible for the suppressive effect of IDO is not metabolic control of effector cells but rather the signaling mediated by tryptophan breakdown products, such as kynurenine.
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Affiliation(s)
- Tuisku-Tuulia Koivula
- Department of Immunology, Medicum, University of Helsinki, 00290 Helsinki, Finland.,Research Programs Unit, Immunobiology, University of Helsinki, 00290 Helsinki, Finland
| | - Anni Tuulasvaara
- Department of Immunology, Medicum, University of Helsinki, 00290 Helsinki, Finland.,Research Programs Unit, Immunobiology, University of Helsinki, 00290 Helsinki, Finland
| | - Iivo Hetemäki
- Department of Immunology, Medicum, University of Helsinki, 00290 Helsinki, Finland.,Research Programs Unit, Immunobiology, University of Helsinki, 00290 Helsinki, Finland
| | - Mikko Hurme
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, 33014 Tampere, Finland
| | - Satu Mäkelä
- Department of Medicine, School of Medicine, University of Tampere, 33014 Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, 33014, Tampere, Finland
| | - Jukka Mustonen
- Department of Medicine, School of Medicine, University of Tampere, 33014 Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, 33014, Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - T Petteri Arstila
- Department of Immunology, Medicum, University of Helsinki, 00290 Helsinki, Finland .,Research Programs Unit, Immunobiology, University of Helsinki, 00290 Helsinki, Finland
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11
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Mustonen J, Outinen T, Laine O, Pörsti I, Vaheri A, Mäkelä S. Kidney disease in Puumala hantavirus infection. Infect Dis (Lond) 2017; 49:321-332. [PMID: 28049381 DOI: 10.1080/23744235.2016.1274421] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Acute kidney injury (AKI) remains a predominant clinical expression of nephropathia epidemica (NE). Its pathogenesis is not yet fully understood. Here, we describe the tissue injury comprehensively and present new data aimed to characterize the injury and explain its pathophysiology. When compared to tubulointerstitial nephritis of a wide variety of other aetiologies, a high degree of proteinuria is a distinguished trait of NE, a finding that is also helpful in the clinical suspicion of the disease. Recently, novel biomarkers for the prediction of severe AKI, including neutrophil gelatinase-associated lipocalin (NGAL), have been identified and ultrastructural tissue changes have been more accurately described. A role for soluble urokinase-type plasminogen activator (suPAR) in the pathogenesis of NE has been suggested, and data on gene polymorphisms, in relation to the severity of AKI have been presented. Smoking is a risk factor for NE and smoking is also associated with aggravated AKI in NE. Although no specific treatment is in sight, recent case reports concerning therapy directed against vascular permeability and vasodilation are of interest. In fact, future work trying to explain the pathophysiology of AKI might need concentrated efforts towards the mechanisms of increased vascular permeability and vasodilatation, which irrespective of organ manifestation, are two major determinants of NE.
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Affiliation(s)
- Jukka Mustonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Tuula Outinen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Outi Laine
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Antti Vaheri
- c Department of Virology, Medicum , University of Helsinki , Helsinki , Finland
| | - Satu Mäkelä
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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12
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Papa A, Vaheri A, LeDuc JW, Krüger DH, Avšič-Županc T, Arikawa J, Song JW, Markotić A, Clement J, Liang M, Li D, Yashina LN, Jonsson CB, Schmaljohn CS. Meeting report: Tenth International Conference on Hantaviruses. Antiviral Res 2016; 133:234-41. [PMID: 27544703 DOI: 10.1016/j.antiviral.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/14/2016] [Indexed: 12/17/2022]
Abstract
The 10th International Conference on Hantaviruses, organized by the International Society on Hantaviruses, was held from May 31-June 3, 2016 at Colorado State University, Fort Collins, CO, USA. These conferences have been held every three years since 1980. The current report summarizes research presented on all aspects of hantavirology: ecology and epidemiology, virus replication, phylogeny, pathogenesis, immune response, clinical studies, vaccines and therapeutics.
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Affiliation(s)
- Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antti Vaheri
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - James W LeDuc
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Detlev H Krüger
- Institute of Medical Virology, University Hospital Charité, Berlin, Germany
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jiro Arikawa
- Department of Microbiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jin-Won Song
- Department of Microbiology, College of Medicine, Korea University, Seoul, South Korea
| | - Alemka Markotić
- Research Department, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb, Croatia
| | - Jan Clement
- Laboratory of Clinical and Epidemiological Virology and Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Mifang Liang
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Dexin Li
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Liudmila N Yashina
- State Research Center of Virology and Biotechnology "Vector", Koltsovo, Russia
| | - Colleen B Jonsson
- Department of Microbiology, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Connie S Schmaljohn
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA
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13
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Ermonval M, Baychelier F, Tordo N. What Do We Know about How Hantaviruses Interact with Their Different Hosts? Viruses 2016; 8:v8080223. [PMID: 27529272 PMCID: PMC4997585 DOI: 10.3390/v8080223] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/27/2016] [Accepted: 08/05/2016] [Indexed: 11/26/2022] Open
Abstract
Hantaviruses, like other members of the Bunyaviridae family, are emerging viruses that are able to cause hemorrhagic fevers. Occasional transmission to humans is due to inhalation of contaminated aerosolized excreta from infected rodents. Hantaviruses are asymptomatic in their rodent or insectivore natural hosts with which they have co-evolved for millions of years. In contrast, hantaviruses cause different pathologies in humans with varying mortality rates, depending on the hantavirus species and its geographic origin. Cases of hemorrhagic fever with renal syndrome (HFRS) have been reported in Europe and Asia, while hantavirus cardiopulmonary syndromes (HCPS) are observed in the Americas. In some cases, diseases caused by Old World hantaviruses exhibit HCPS-like symptoms. Although the etiologic agents of HFRS were identified in the early 1980s, the way hantaviruses interact with their different hosts still remains elusive. What are the entry receptors? How do hantaviruses propagate in the organism and how do they cope with the immune system? This review summarizes recent data documenting interactions established by pathogenic and nonpathogenic hantaviruses with their natural or human hosts that could highlight their different outcomes.
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Affiliation(s)
- Myriam Ermonval
- Unité des Stratégies Antivirales, Département de Virologie, Institut Pasteur, 25 Rue du Docteur Roux, 75015 Paris, France.
| | - Florence Baychelier
- Unité des Stratégies Antivirales, Département de Virologie, Institut Pasteur, 25 Rue du Docteur Roux, 75015 Paris, France.
| | - Noël Tordo
- Unité des Stratégies Antivirales, Département de Virologie, Institut Pasteur, 25 Rue du Docteur Roux, 75015 Paris, France.
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14
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Rasmuson J, Pourazar J, Mohamed N, Lejon K, Evander M, Blomberg A, Ahlm C. Cytotoxic immune responses in the lungs correlate to disease severity in patients with hantavirus infection. Eur J Clin Microbiol Infect Dis 2016; 35:713-21. [PMID: 26873376 PMCID: PMC4819462 DOI: 10.1007/s10096-016-2592-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022]
Abstract
Hantavirus infections may cause severe and sometime life-threatening lung failure. The pathogenesis is not fully known and there is an urgent need for effective treatment. We aimed to investigate the association between pulmonary viral load and immune responses, and their relation to disease severity. Bronchoscopy with sampling of bronchoalveolar lavage (BAL) fluid was performed in 17 patients with acute Puumala hantavirus infection and 16 healthy volunteers acting as controls. Lymphocyte subsets, granzyme concentrations, and viral load were determined by flow cytometry, enzyme-linked immunosorbent assay (ELISA), and quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Analyses of BAL fluid revealed significantly higher numbers of activated CD8+ T cells and natural killer (NK) cells, as well as higher concentrations of the cytotoxins granzymes A and B in hantavirus-infected patients, compared to controls. In patients, Puumala hantavirus RNA was detected in 88 % of BAL cell samples and correlated inversely to the T cell response. The magnitude of the pulmonary cytotoxic lymphocyte response correlated to the severity of disease and systemic organ dysfunction, in terms of need for supplemental oxygen treatment, hypotension, and laboratory data indicating renal failure, cardiac dysfunction, vascular leakage, and cell damage. Regulatory T cell numbers were significantly lower in patients compared to controls, and may reflect inadequate immune regulation during hantavirus infection. Hantavirus infection elicits a pronounced cytotoxic lymphocyte response in the lungs. The magnitude of the immune response was associated with disease severity. These results give insights into the pathogenesis and possibilities for new treatments.
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Affiliation(s)
- J Rasmuson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, 90185, Umeå, Sweden.
| | - J Pourazar
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - N Mohamed
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - K Lejon
- Department of Clinical Microbiology, Immunology, Umeå University, Umeå, Sweden
| | - M Evander
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
| | - A Blomberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - C Ahlm
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, 90185, Umeå, Sweden
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15
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Jiang H, Du H, Wang LM, Wang PZ, Bai XF. Hemorrhagic Fever with Renal Syndrome: Pathogenesis and Clinical Picture. Front Cell Infect Microbiol 2016; 6:1. [PMID: 26870699 PMCID: PMC4737898 DOI: 10.3389/fcimb.2016.00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/05/2016] [Indexed: 01/08/2023] Open
Abstract
Hantaan virus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS), which is a zoonosis endemic in eastern Asia, especially in China. The reservoir host of HTNV is field mouse (Apodemus agraricus). The main manifestation of HFRS, including acute kidney injury, increases vascular permeability, and coagulation abnormalities. In this paper, we review the current knowledge of the pathogenesis of HFRS including virus factor, immunity factor and host genetic factors. Furthermore, the treatment and prevention will be discussed.
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Affiliation(s)
- Hong Jiang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Hong Du
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Li M Wang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University Xi'an, China
| | - Ping Z Wang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
| | - Xue F Bai
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University Xi'an, China
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16
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Strandin T, Hepojoki J, Laine O, Mäkelä S, Klingström J, Lundkvist Å, Julkunen I, Mustonen J, Vaheri A. Interferons Induce STAT1–Dependent Expression of Tissue Plasminogen Activator, a Pathogenicity Factor in Puumala Hantavirus Disease. J Infect Dis 2015; 213:1632-41. [DOI: 10.1093/infdis/jiv764] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022] Open
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17
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Yi X, Li W, Li H, Jie S. Circulating regulatory T cells in patients with severe fever with thrombocytopenia syndrome. Infect Dis (Lond) 2015; 47:294-301. [PMID: 25712790 DOI: 10.3109/00365548.2014.987812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease caused by SFTS virus (SFTSV). Immunologic factors have been proved to be related to the occurrence and development of SFTS; however, their role still remains to be further elucidated. METHODS Samples from 30 patients with laboratory-confirmed SFTS and 15 healthy controls were subjected to flow cytometry to detect the proportion of CD4+/total lymphocytes, CD4 + CD25+/CD4 + cells and CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in circulating blood and to evaluate their potential function in the development of SFTS. RESULTS The data showed that a reduced proportion of CD4+/total lymphocytes and CD4 + CD25+/CD4 + cells was observed in patients with SFTS compared with healthy controls. In contrast, the percentage of CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in the patients in the SFTS group was significantly elevated. Furthermore, we investigated the dynamic changes of the circulating regulatory T cells (Tregs) in patients with SFTS at different stages. The results showed that the proportion of CD4+/total lymphocytes and CD4 + CD25+/CD4 + cells in the non-severe group was prominently higher than that in patients with severe SFTS. Conversely, the proportion of CD4 + CD25+ Foxp3+/CD4 + CD25+ cells was lower in the non-severe group than in the severe group. Additionally, the circulating Tregs reverted to normal ranges during the convalescent phase of SFTSV infection. Moreover, the Tregs level correlated with various clinical parameters. CONCLUSION We demonstrated that SFTSV infection resulted in a robust circulating Treg response in patients with SFTS. Our investigation suggested that the proportions of CD4+/total lymphocytes and CD4 + CD25+ Foxp3+/CD4 + CD25+ cells in circulating blood could serve as sensitive indices to evaluate the changes in Tregs in SFTS and predict the progression of SFTS.
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18
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Latus J, Kitterer D, Segerer S, Artunc F, Alscher MD, Braun N. Determination of procalcitonin levels in patients with nephropathia epidemica - a useful tool or an unnecessary diagnostic procedure? Kidney Blood Press Res 2015; 40:22-30. [PMID: 25662000 DOI: 10.1159/000368479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Puumala virus causes nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome that occurs in Central and Northern Europe. Several studies have sought to identify risk factors for severe NE. However, elevated procalcitonin (PCT) levels have not previously been investigated as a predictive marker for a severe course of NE. METHODS A cross-sectional prospective survey of 456 adults with serologically confirmed NE was performed. RESULTS PCT levels at the time of diagnosis were available for 43 out of 456 patients, and in 24 of these patients (56%) PCT levels were elevated ("PCT positive"). C-reactive protein (CRP) levels at admission to hospital and peak CRP levels during the acute course of the disease were higher in the PCT-positive compared with the PCT-negative group (p<0.05). Severe acute kidney injury (AKI) (RIFLE I and F) was present in similar numbers of PCT-positive and -negative patients (p=0.7), but antibiotics were more frequently used in the PCT-positive than the PCT-negative group (p<0.05). Within the PCT-positive group, PCT levels were similar among those receiving and not receiving antibiotics (p=0.13), and neither the duration of hospital stay nor CRP peak levels were lower in those treated with antibiotics (p=0.12 and p=0.13, respectively). CONCLUSIONS Elevated PCT levels are common in patients with acute NE. There was no association between PCT levels and severity of disease, including AKI or thrombocytopenia. It is important to distinguish Puumala virus infection from other causes of AKI with thrombocytopenia. However, PCT might not be useful in differentiating hantavirus infection from bacterial infection.
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Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
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19
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Laine O, Leppänen I, Koskela S, Antonen J, Mäkelä S, Sinisalo M, Vaheri A, Mustonen J. Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant. Infect Dis (Lond) 2014; 47:107-11. [PMID: 25496418 DOI: 10.3109/00365548.2014.969304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early identification of patients at risk of a severe course of hantaviral disease and lack of effective medication represent a global challenge in the treatment of this emerging infection. We describe a 67-year-old female patient with a history of chronic lymphoproliferative disease involving the spleen and an extremely severe acute Puumala hantavirus infection. She was treated with the bradykinin receptor antagonist icatibant and recovered. She is the second patient with a spleen abnormality and severe Puumala infection treated with icatibant in our hospital. We suggest that patients with spleen abnormalities may be more susceptible to severe hantavirus disease. The activation of the kinin-kallikrein system and the formation of bradykinin in hantavirus-infected endothelial cells indicate that the role of bradykinin receptor antagonist icatibant in the treatment of hantavirus disease is worth studying.
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Affiliation(s)
- Outi Laine
- From the Department of Internal Medicine, Tampere University Hospital , Tampere , Finland
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