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Yang J, Sun JF, Wang TT, Guo XH, Wei JX, Jia LT, Yang AG. Targeted inhibition of hantavirus replication and intracranial pathogenesis by a chimeric protein-delivered siRNA. Antiviral Res 2017; 147:107-115. [DOI: 10.1016/j.antiviral.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022]
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Angulo J, Martínez-Valdebenito C, Marco C, Galeno H, Villagra E, Vera L, Lagos N, Becerra N, Mora J, Bermúdez A, Díaz J, Ferrés M, López-Lastra M. Serum levels of interleukin-6 are linked to the severity of the disease caused by Andes Virus. PLoS Negl Trop Dis 2017; 11:e0005757. [PMID: 28708900 PMCID: PMC5529019 DOI: 10.1371/journal.pntd.0005757] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/26/2017] [Accepted: 06/29/2017] [Indexed: 12/16/2022] Open
Abstract
Andes virus (ANDV) is the etiological agent of hantavirus cardiopulmonary syndrome in Chile. In this study, we evaluated the profile of the pro-inflammatory cytokines IL-1β, IL-12p70, IL-21, TNF-α, IFN-γ, IL-10 and IL-6 in serum samples of ANDV-infected patients at the time of hospitalization. The mean levels of circulating cytokines were determined by a Bead-Based Multiplex assay coupled with Luminex detection technology, in order to compare 43 serum samples of healthy controls and 43 samples of ANDV-infected patients that had been categorized according to the severity of disease. When compared to the controls, no significant differences in IL-1β concentration were observed in ANDV-infected patients (p = 0.9672), whereas levels of IL-12p70 and IL-21 were significantly lower in infected cases (p = <0.0001). Significantly elevated levels of TNF-α, IFN-γ, IL-10, and IL-6 were detected in ANDV-infected individuals (p = <0.0001, 0.0036, <0.0001, <0.0001, respectively). Notably, IL-6 levels were significantly higher (40-fold) in the 22 patients with severe symptoms compared to the 21 individuals with mild symptoms (p = <0.0001). Using multivariate regression models, we show that IL-6 levels has a crude OR of 14.4 (CI: 3.3–63.1). In conclusion, the serum level of IL-6 is a significant predictor of the severity of the clinical outcome of ANDV-induced disease. Andes virus (ANDV) causes hantavirus cardiopulmonary syndrome (HCPS) that is characterized by the development of vascular leakage syndrome, eventually leading to massive pulmonary edema, shock and, in many cases, death. To date, no FDA-approved immunotherapeutics, specific antivirals, or vaccines are available for use against HCPS. Patient survival rates hinge largely on early virus diagnosis, hospital admission and aggressive pulmonary and hemodynamic support in an intensive care unit. Individual host factors associated with the outcome of an ANDV infection are poorly known, and such knowledge could allow the disease progression of hospitalized patients to be predicted, resulting in individualized treatment. In this study, we show that serum levels of IL-6 at the time of hospitalization in ANDV-infected patients are associated with the severity of the clinical outcome of ANDV-induced disease. Therefore, these finding suggest that determining IL-6 levels at the time of admission to the hospital could be useful to predict the progression of ANDV-induced disease.
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Affiliation(s)
- Jenniffer Angulo
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia (IMII), Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Martínez-Valdebenito
- Laboratorio de Infectología, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Marco
- Laboratorio de Infectología, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Héctor Galeno
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Eliecer Villagra
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Lilian Vera
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Natalia Lagos
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Natalia Becerra
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Judith Mora
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Andrea Bermúdez
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Janepsy Díaz
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Marcela Ferrés
- Laboratorio de Infectología, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo López-Lastra
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia (IMII), Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
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Angulo J, Pino K, Echeverría-Chagas N, Marco C, Martínez-Valdebenito C, Galeno H, Villagra E, Vera L, Lagos N, Becerra N, Mora J, Bermúdez A, Cárcamo M, Díaz J, Miquel JF, Ferrés M, López-Lastra M. Association of Single-Nucleotide Polymorphisms in IL28B, but Not TNF-α, With Severity of Disease Caused by Andes Virus. Clin Infect Dis 2015; 61:e62-9. [PMID: 26394672 PMCID: PMC4657541 DOI: 10.1093/cid/civ830] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/04/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Andes virus (ANDV) is the sole etiologic agent of hantavirus cardiopulmonary syndrome (HCPS) in Chile, with a fatality rate of about 35%. Individual host factors affecting ANDV infection outcome are poorly understood. In this case-control genetic association analysis, we explored the link between single-nucleotide polymorphisms (SNPs) rs12979860, rs8099917 and rs1800629 and the clinical outcome of ANDV-induced disease. The SNPs rs12979860 and rs8099917 are known to play a role in the differential expression of the interleukin 28B gene (IL28B), whereas SNP rs1800629 is implicated in the expression of tumor necrosis factor α gene (TNF-α). METHODS A total of 238 samples from confirmed ANDV-infected patients collected between 2006 and 2014, and categorized according to the severity of the disease, were genotyped for SNPs rs12979860, rs8099917, and rs1800629. RESULTS Analysis of IL28B SNPs rs12979860 and rs8099917 revealed a link between homozygosity of the minor alleles (TT and GG, respectively), displaying a mild disease progression, whereas heterozygosity or homozygosity for the major alleles (CT/CC and TG/TT, respectively) in both IL28B SNPs is associated with severe disease. No association with the clinical outcome of HCPS was observed for TNF-α SNP rs1800629 (TNF -308G>A). CONCLUSIONS The IL28B SNPs rs12979860 and rs8099917, but not TNF-α SNP rs1800629, are associated with the clinical outcome of ANDV-induced disease, suggesting a possible link between IL28B expression and ANDV pathogenesis.
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Affiliation(s)
- Jenniffer Angulo
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia
| | - Karla Pino
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia
| | - Natalia Echeverría-Chagas
- Laboratorio de Virología Molecular, Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Claudia Marco
- Laboratorio de Infectología, Centro de Investigaciones Médicas, Escuela de Medicina, División de Pediatría
| | | | - Héctor Galeno
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Eliecer Villagra
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Lilian Vera
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Natalia Lagos
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Natalia Becerra
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Judith Mora
- Subdepartamento de Virología Clínica, Departamento Laboratorio Biomédico Nacional y de Referencia
| | - Andrea Bermúdez
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago
| | - Marcela Cárcamo
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago
| | - Janepsy Díaz
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago
| | - Juan Francisco Miquel
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile
| | - Marcela Ferrés
- Laboratorio de Infectología, Centro de Investigaciones Médicas, Escuela de Medicina, División de Pediatría
| | - Marcelo López-Lastra
- Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia
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Srikiatkhachorn A, Spiropoulou CF. Vascular events in viral hemorrhagic fevers: a comparative study of dengue and hantaviruses. Cell Tissue Res 2014; 355:621-33. [PMID: 24623445 PMCID: PMC3972431 DOI: 10.1007/s00441-014-1841-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
Viral hemorrhagic diseases are a group of systemic viral infections with worldwide distribution and are significant causes of global mortality and morbidity. The hallmarks of viral hemorrhagic fevers are plasma leakage, thrombocytopenia, coagulopathy and hemorrhagic manifestations. The molecular mechanisms leading to plasma leakage in viral hemorrhagic fevers are not well understood. A common theme has emerged in which a complex interplay between pathogens, host immune response, and endothelial cells leads to the activation of endothelial cells and perturbation of barrier integrity. In this article, two clinically distinct viral hemorrhagic fevers caused by dengue viruses and hantaviruses are discussed to highlight their similarities and differences that may provide insights into the pathogenesis and therapeutic approach.
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Affiliation(s)
- Anon Srikiatkhachorn
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA,
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Spiropoulou CF, Srikiatkhachorn A. The role of endothelial activation in dengue hemorrhagic fever and hantavirus pulmonary syndrome. Virulence 2013; 4:525-36. [PMID: 23841977 PMCID: PMC5359750 DOI: 10.4161/viru.25569] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The loss of the endothelium barrier and vascular leakage play a central role in the pathogenesis of hemorrhagic fever viruses. This can be caused either directly by the viral infection and damage of the vascular endothelium, or indirectly by a dysregulated immune response resulting in an excessive activation of the endothelium. This article briefly reviews our knowledge of the importance of the disruption of the vascular endothelial barrier in two severe disease syndromes, dengue hemorrhagic fever and hantavirus pulmonary syndrome. Both viruses cause changes in vascular permeability without damaging the endothelium. Here we focus on our understanding of the virus interaction with the endothelium, the role of the endothelium in the induced pathogenesis, and the possible mechanisms by which each virus causes vascular leakage. Understanding the dynamics between viral infection and the dysregulation of the endothelial cell barrier will help us to define potential therapeutic targets for reducing disease severity.
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Pettersson L, Thunberg T, Rocklöv J, Klingström J, Evander M, Ahlm C. Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients--implications for treatment. Clin Microbiol Infect 2013; 20:235-41. [PMID: 23742660 PMCID: PMC4286007 DOI: 10.1111/1469-0691.12259] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 01/11/2023]
Abstract
Hantaviruses are the causative agents of haemorrhagic fever with renal syndrome (HFRS) in Eurasia and of hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The case fatality rate varies between different hantaviruses and can be up to 40%. At present, there is no specific treatment available. The hantavirus pathogenesis is not well understood, but most likely, both virus-mediated and host-mediated mechanisms are involved. The aim of the present study was to investigate the association among Puumala hantavirus (PUUV) viral RNA load, humoral immune response and disease severity in patients with HFRS. We performed a study of 105 PUUV-infected patients that were followed during the acute phase of disease and for up to 1–3 months later. Fifteen of the 105 patients (14%) were classified as having moderate/severe disease. A low PUUV-specific IgG response (p <0.05) and also a higher white blood cell count (p <0.001) were significantly associated with more severe disease. The PUUV RNA was detected in a majority of patient plasma samples up to 9 days after disease onset; however, PUUV RNA load or longevity of viraemia were not significantly associated with disease severity. We conclude that a low specific IgG response was associated with disease severity in patients with HFRS, whereas PUUV RNA load did not seem to affect the severity of HFRS. Our results raise the possibility of passive immunotherapy as a useful treatment for hantavirus-infected patients.
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Affiliation(s)
- L Pettersson
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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Hantavirus infection in North America: a clinical review. Am J Emerg Med 2013; 31:978-82. [PMID: 23680331 DOI: 10.1016/j.ajem.2013.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 02/01/2023] Open
Abstract
The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion. Hantavirus cardiopulmonary syndrome presents as a vague prodrome of fever, cough, myalgias, chills, and nausea followed by a rapidly worsening respiratory phase. Presumptive diagnosis can be made based on pulmonary interstitial edema on chest radiographs in association with leukocytosis, thrombocytopenia, and hemoconcentration. Suspected cases should be confirmed with a reference laboratory and reported to the appropriate public health authorities. Although treatment is primarily supportive, aggressive fluid administration should be avoided due to the risk of pulmonary edema. The cardiopulmonary phase of the disease can progress rapidly with catastrophic decompensation in as little as a few hours. Patients require rapid intensive care unit admission for monitoring, mechanical ventilation, vasoactive agents, and possibly extracorporeal mechanical ventilation. Emergency physicians should be aware of outbreaks and vigilant for hantavirus exposures, especially during the summer and early fall months.
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