Lymphocyte viraemia in congenital rubella

Elevated rubella antibodies in patients with chronic liver disease

Patients with autoimmune chronic active hepatitis (AICAH) and certain other chronic liver disorders often have very high titres of haemagglutination-inhibition (HI) antibodies to rubella virus. In this study it is shown, using floatation centrifugation, that the high rubella HI reactivity is not caused by nonspecific lipoprotein inhibitors but rather by antibodies specific for the rubella haemagglutinin (E1 glycoprotein). After sucrose density gradient ultracentrifugation of sera the major HI reactivity was recovered in the IgG containing fractions. The IgG antibody fraction was strongly reactive by an indirect enzyme-linked immunosorbent assay (ELISA). Higher prevalence and titres of rubella antibodies were also demonstrated by the complement fixation (CF) test using a haemagglutinin-free antigen, and by an indirect haemagglutination (IHA) test (Rubacell) using a cell-associated antigen which is distinct from the antigens used in the HI and CF tests. This high rubella antibody response is therefore demonstrated using three distinct antigen-antibody systems. By means of absorption experiments and radioimmunoprecipitation assays the coating antigen used in the IHA test was shown to reside in the E2 glycoprotein. The cause of this enhanced antibody response to rubella virus structural proteins remains elusive.

Radioimmunoprecipitation and immunoblot studies of antibodies to rubella virus in patients with chronic liver disease

Patients with autoimmune chronic active hepatitis (AICAH) and some other chronic liver disorders often have very high titres of rubella HI antibodies. In the present study sera from 46 patients with chronic liver disease and controls were examined for rubella antibodies using radioimmunoprecipitation assay (RIPA) and Western blot. RIPA appeared to be more suitable than Western blot for the study of the individual antibody specificities provided that proteins (possibly actin) interfering with the resolution of the E2 glycoprotein band are identified. It was shown that patients with high rubella HI titres reacted strongly against the E1 glycoprotein and in general also against the core protein (C). Reactivity to the E2 glycoprotein was detected with all sera from patients with chronic liver disease but varied more in strength. Three patients with post-acute rubella showed very faint E2 reactivity, but strong E1 and C reactivities. Patients with primary biliary cirrhosis had normal HI titres and showed no increase in reactivity in RIPA. The present findings show that patients with chronic liver disease and high rubella HI antibody titres exhibit an enhanced specific antibody response to rubella virus structural proteins.

In situ detection of rubella RNA and antigens in cultured cells

We developed in situ hybridization and immunofluorescent procedures to detect rubella RNA and antigens in tissue-cultured cells infected with rubella virus. cDNA fragments of the rubella virus E1 structural gene were used as probes for in situ hybridization to detect rubella RNA sequences in Vero cells infected with rubella virus. Using antibodies against rubella proteins, indirect immunofluorescence detected rubella virus structural proteins in Vero cells infected with rubella virus. The immunofluorescence method has also been applied to study the expression of rubella polypeptide E1 in transfected COS cells and may be applied to the detection and study of persistent rubella virus infection in human tissues.

In vivo expression of rubella antigens on human leucocytes: detection by flow cytometry

Flow cytometry has been used to detect in vivo expression of rubella antigens on human leucocytes. Sequential samples of peripheral blood were obtained from four volunteers with naturally acquired rubella and five persons immunised with RA27/3 rubella vaccine. Leucocytes were stained for rubella antigens using a pool of rubella monoclonal antibodies. Rubella antigens were detected on the leucocytes of all four volunteers with naturally acquired rubella between 1 and 13 days after onset of illness. Viral antigens were expressed more frequently on the monocyte (9-51%) than the lymphocyte (less than 1-4%) and granulocyte (less than 1-3%) populations. Among the vaccines, rubella antigens were detected on the leucocytes of four of the five volunteers between 5 and 12 days after immunisation. The expression of viral antigens was more transient and the proportion of cells exhibiting rubella-specific fluorescence considerably lower following vaccination (1-12%) than natural infection (9-51%). Our results demonstrate that flow cytometry provides a rapid and sensitive analytical technique for detecting viral antigens on leucocytes from infected persons. Leucocytes may play an important role in the pathogenesis of rubella infection.

Congenital infections with nonarbo togaviruses

The present review deals with the similarities and differences of selected aspects of prenatal pestivirus infections of domestic animals and congenital rubella of man. Hog cholera virus, bovine virus diarrhoea virus and border disease virus are antigenically closely related, but unrelated to rubella virus. The nonarbo togaviruses are capable of producing congenital infections resulting in a wide spectrum of abnormalities. The infected foetus can die in utero, in the neonatal period, or it may be born with teratogenic defects. In addition, apparently healthy progeny can be delivered that develop a late onset disease, months, or years after birth, or remain clinically normal for life. The ultimate outcome of a congenital infection is mainly determined by the stage of foetal development, at which infection occurs. Foetuses exposed to rubella virus raise an antibody response to the virus, whereas domestic animals frequently fail to respond immunologically to a congenital pestivirus infection. In congenital rubella the virus usually disappears from the host's body 1-2 years after birth. However, congenital pestivirus infections may be characterized by a lifelong and widespread persistence of virus in clinically healthy animals. Such animals are of significance in the epizootiology of bovine virus diarrhoea, border disease or hog cholera.

Rubella-associated arthritis: rescue of rubella virus from peripheral blood lymphocytes two years postvaccination

Rubella virus was isolated from the peripheral lymphocytes of a patient with rubella-associated arthritis 2 years after rubella vaccination. The rescue of the virus was carried out by stimulating the lymphocytes with mitogens for several days in cultures and then cocultivating them with RK13 cells at 35 degrees C. Rubella virus was detected by a variety of techniques, including electron microscopy, indirect immunofluorescence, polyacrylamide gel analysis of labeled viral proteins, and microfocus assay for infectious virus particles. Assessment of the immune status of the patient did not indicate any impairment of immune function associated with long-term persistence of the virus.

Replication of rubella virus in human mononuclear blood cells

Rubella virus was capable of replicating in both unstimulated and phytohemagglutinin-stimulated cultures of human mononuclear blood cells. Monocyte-derived macrophages were the main cell type responsible for viral replication. The susceptibility of macrophages increased during cultivation. Phytohemagglutinin-stimulated lymphocytes were able to support replication to a limited degree. No viral replication was detected in unstimulated lymphocytes. Both stimulation and viral replication in phytohemagglutinin-treated lymphocyte cultures were enhanced by the addition of murine macrophages. Human leukocyte interferon depressed the production of virus in these combined cultures. The finding that rubella virus is able to replicate in human lymphocytes as well as in macrophages may contribute to understanding the mechanisms of the suppressive effect of the virus on in vitro lymphocyte phytohemagglutinin responsiveness and in vivo immune functions.

[Angioimmunoblastic lymphadenopathy and persistent virus infection? Discussion of immunohistological findings on two cases (author's trsnsl)]

The presence of rubella virus antigen was demonstrated by means of immunohistological methods in two cases of angioimmunoblastic lymphadenopathy. One patient had elevated serum anti rubella titer and myocarditis. These findings support the idea that angioimmunoblastic lymphadenopathy develops as a combined effect of persistent virus infection and partial immune deficiency.

Possible initiation of viral encephalomyelitis in dogs by migrating lymphocytes infected with distemper virus

The principal pathways by which viruses spread to the central nervous system (C.N.S.) are considered to be direct invasion along peripheral nerves or the haematogenous route. The latter is thought to involve passive transfer or active replication of virus in C.N.S. endothelial cells. In this study histological evidence of mild perivascular encephalomyelitis was found 8-10 days after infection of dogs with canine distemper virus (C.D.V.). C.D.V. antigen and viral nucleocapsids were detectable in the mononuclear cells infiltrating nervous tissue and C.D.V. was isolated from lymphoid tissue and buffy-coat cells. C.N.S. infection may thus be initiated by migrating virus-infected lymphocytes and this pathway may operate in other viral disorders of the C.N.S.

Mitogen stimulation and distribution of T- and B-lymphocytes during natural rubella infection

The phytohaemagglutinin (PHA) response of lymphocytes from seven patients with natural rubella infection was investigated during the acute, early and late convalescence stages of disease. When the lymphocytes were cultured in autologous serum, a moderate depression of the response, following stimulation with PHA in both optimal and suboptimal concentrations was obtained two weeks after the onset of exanthema (early convalescence). Two months later (late convalescence), the lymphocyte stimulation response had returned to almost normal values. On the other hand, lymphocytes incubated in pooled homologous serum reacted normally to PHA in optimal concentrations at all three stages. Determination of T- and B-lymphocytes did not reveal any change in the relative proportion of T-lymphocytes during the course of the disease. However, in late convalescence, a significant decrease in the relative number of B-lymphocytes was recorded.

Cell mediated immunity in experimental rubella infections

Antibody and cell-bound immune response were assessed in rabbits inoculated by the intravenous route with Cenedehill or with wild rubella virus. Our results suggest that wild or attenuated live rubella virus induce a transient unresponsiveness of the lymphocytes to PHA stimulation in vitro and suggest also that this immunosuppression was due to the persistence of rubella virus in the lymphocytes.

Impaired cellular immunity to rubella virus in congenital rubella

Specific cell-mediated immunity (CMI) responses to rubella virus were studied in 12 children with documented congenital rubella syndrome employing a (51)Cr lymphocytotoxicity microassay. Hemagglutination inhibition antibody was detected in 11 of the 12 children, with titers ranging from 1:4 to 1:128. CMI to rubella virus was demonstrated in only 3 of the 11 antibody-positive children. The 12th child was negative for both hemagglutination inhibition and CMI. Of the three children with a positive CMI response, two had histories of reinfection with rubella virus. These data suggest that congenital rubella infection produces an impaired CMI response which subsequently may be altered by reinfection with rubella virus. The lack of CMI in the presence of antibody and concurrent excretion of live virus in the child with documented congenital rubella infection suggest a factor to be explored in the pathogenesis of this disease.

Cellular viraemia in babies infected with rubella virus before birth

Chronic viraemia has been detected in 10 out of 12 rubella syndrome babies at periods ranging from 1 to 196 days. The virus was found to be associated with leucocytes, and it is assumed that removal of neutralizing antibody is the most likely explanation for the high success rate in detecting viraemia. The findings are discussed in relation to diagnosis by virus isolation, to pathogenesis, and to the possible significance in explaining the failure of the foetus to develop a tolerance to rubella virus. Several published reports of viraemia in the acute exanthematous disease are contrasted with the less frequent reports of viraemia in the chronic disease of early postnatal life.