1
|
Nusshag C, Gruber G, Zeier M, Krautkrämer E. Neutrophil-to-lymphocyte ratio is elevated in acute hantavirus infection and correlates with markers of disease severity. J Med Virol 2024; 96:e29759. [PMID: 38899399 DOI: 10.1002/jmv.29759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Pathogenic Eurasian hantaviruses cause hemorrhagic fever with renal syndrome (HFRS), which is characterized by acute kidney injury. The clinical course shows a broad range of severity and is influenced by direct and immune-mediated effects. The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and predicts severity and outcome in various diseases. Therefore, we examined the role of NLR in HFRS caused by hantavirus Puumala (PUUV) and its association with disease severity and kidney injury. We detected elevated NLR levels on admission (NLRadm: median 3.82, range 1.75-7.59), which increased during acute HFRS. Maximum NLR levels (NLRmax: median 4.19, range 1.75-13.16) were 2.38-fold higher compared to the reference NLR level of 1.76 in the general population. NLR levels on admission correlate with markers of severity (length of hospital stay, serum creatinine) but not with other markers of severity (leukocytes, platelets, C-reactive protein, lactate dehydrogenase, serum albumin, proteinuria). Interestingly, levels of nephrin, which is a specific marker of podocyte damage in kidney injury, are highest on admission and correlate with NLRmax, but not with NLRadm. Together, we observed a correlation between systemic inflammation and the severity of HFRS, but our results also revealed that podocyte damage precedes these inflammatory processes.
Collapse
Affiliation(s)
- Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Gefion Gruber
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
2
|
Nusshag C, Schreiber P, Uhrig J, Zeier M, Krautkrämer E. In-cell Western assay to quantify infection with pathogenic orthohantavirus Puumala virus in replication kinetics and antiviral drug testing. Virus Res 2023; 337:199230. [PMID: 37777116 PMCID: PMC10590686 DOI: 10.1016/j.virusres.2023.199230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
Hemorrhagic fever with renal syndrome (HFRS) represents a serious zoonotic disease caused by orthohantaviruses in Eurasia. A specific antiviral therapy is not available. HFRS is characterized by acute kidney injury (AKI) with often massive proteinuria. Infection of kidney cells may contribute to the clinical picture. However, orthohantaviral replication in kidney cells is not well characterized. Therefore, we aimed to perform a reliable high-throughput assay that allows the quantification of infection rates and testing of antiviral compounds in different cell types. We quantified relative infection rates of Eurasian pathogenic Puumala virus (PUUV) by staining of nucleocapsid protein (N protein) in an in-cell Western (ICW) assay. Vero E6 cells, derived from the African green monkey and commonly used in viral cell culture studies, and the human podocyte cell line CIHP (conditionally immortalized human podocytes) were used to test the ICW assay for replication kinetics and antiviral drug testing. Quantification of infection by ICW revealed reliable results for both cell types, as shown by their correlation with immunofluorescence quantification results by counting infected cells. Evaluation of antiviral efficacy of ribavirin by ICW assay revealed differences in the toxicity (TC) and inhibitory concentrations (IC) between Vero E6 cells and podocytes. IC5O of ribavirin in podocytes is about 12-fold lower than in Vero E6 cells. In summary, ICW assay together with relevant human target cells represents an important tool for the study of hantaviral replication and drug testing.
Collapse
Affiliation(s)
- Christian Nusshag
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg 69120, Germany
| | - Pamela Schreiber
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg 69120, Germany
| | - Josephine Uhrig
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg 69120, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg 69120, Germany
| | - Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, Im Neuenheimer Feld 162, Heidelberg 69120, Germany.
| |
Collapse
|
3
|
Schreiber P, Friedrich AK, Gruber G, Nusshag C, Boegelein L, Essbauer S, Uhrig J, Zeier M, Krautkrämer E. Differences in the Susceptibility of Human Tubular Epithelial Cells for Infection with Orthohantaviruses. Viruses 2023; 15:1670. [PMID: 37632012 PMCID: PMC10459294 DOI: 10.3390/v15081670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Diseases induced by infection with pathogenic orthohantaviruses are characterized by a pronounced organ-specific manifestation. Pathogenic Eurasian orthohantaviruses cause hemorrhagic fever with renal syndrome (HFRS) with often massive proteinuria. Therefore, the use of a relevant kidney cell culture would be favorable to analyze the underlying cellular mechanisms of orthohantavirus-induced acute kidney injury (AKI). We tested different human tubular epithelial cell lines for their suitability as an in vitro infection model. Permissiveness and replication kinetics of highly pathogenic Hantaan virus (HTNV) and non-/low-pathogenic Tula virus (TULV) were analyzed in tubular epithelial cell lines and compared to human primary tubular epithelial cells. Ana-lysis of the cell line HK-2 revealed the same results for viral replication, morphological and functional effects as observed for HTNV in primary cells. In contrast, the cell lines RPTEC/TERT1 and TH1 demonstrated only poor infection rates after inoculation with HTNV and are unusable as an infection model. While pathogenic HNTV infects primary tubular and HK-2 cells, non-/low-pathogenic TULV infects neither primary tubular cells nor the cell line HK-2. Our results show that permissiveness of renal cells varies between orthohantaviruses with differences in pathogenicity and that HK-2 cells demonstrate a suitable in vitro model to study viral tropism and pathogenesis of orthohantavirus-induced AKI.
Collapse
Affiliation(s)
- Pamela Schreiber
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | | | - Gefion Gruber
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Lukas Boegelein
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Sandra Essbauer
- Bundeswehr Institute of Microbiology, Department Virology and Intracellular Agents, German Centre for Infection Research, Munich Partner Site, D-80937 Munich, Germany
| | - Josephine Uhrig
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany
| |
Collapse
|
4
|
Wei C, Datta PK, Siegerist F, Li J, Yashwanth S, Koh KH, Kriho NW, Ismail A, Luo S, Fischer T, Amber KT, Cimbaluk D, Landay A, Endlich N, Rappaport J, Hayek SS, Reiser J. SuPAR mediates viral response proteinuria by rapidly changing podocyte function. Nat Commun 2023; 14:4414. [PMID: 37479685 PMCID: PMC10362037 DOI: 10.1038/s41467-023-40165-5] [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: 03/08/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023] Open
Abstract
Elevation in soluble urokinase receptor (suPAR) and proteinuria are common signs in patients with moderate to severe coronavirus disease 2019 (COVID-19). Here we characterize a new type of proteinuria originating as part of a viral response. Inoculation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes increased suPAR levels and glomerulopathy in African green monkeys. Using an engineered mouse model with high suPAR expression, inhaled variants of SARS-CoV-2 spike S1 protein elicite proteinuria that could be blocked by either suPAR antibody or SARS-CoV-2 vaccination. In a cohort of 1991 COVID-19 patients, suPAR levels exhibit a stepwise association with proteinuria in non-Omicron, but not in Omicron infections, supporting our findings of biophysical and functional differences between variants of SARS-CoV-2 spike S1 protein and their binding to podocyte integrins. These insights are not limited to SARS-CoV-2 and define viral response proteinuria (VRP) as an innate immune mechanism and co-activation of podocyte integrins.
Collapse
Affiliation(s)
- Changli Wei
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Prasun K Datta
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Florian Siegerist
- Department of Anatomy and Cell Biology, University Medicine Greifswald, 17487, Greifswald, Germany
- NIPOKA GmbH, 17489, Greifswald, Germany
| | - Jing Li
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sudhini Yashwanth
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kwi Hye Koh
- Morphic Therapeutic, Waltham, MA, 02451, USA
| | - Nicholas W Kriho
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Anis Ismail
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shengyuan Luo
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tracy Fischer
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Kyle T Amber
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
- Department of Dermatology, Rush University Medical Center, Chicago, IL, USA
| | - David Cimbaluk
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Alan Landay
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, 17487, Greifswald, Germany
- NIPOKA GmbH, 17489, Greifswald, Germany
| | - Jay Rappaport
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
5
|
Martynova E, Stott-Marshall RJ, Shakirova V, Saubanova A, Bulatova A, Davidyuk YN, Kabwe E, Markelova M, Khaertynova I, Foster TL, Khaiboullina S. Differential Cytokine Responses and the Clinical Severity of Adult and Pediatric Nephropathia Epidemica. Int J Mol Sci 2023; 24:ijms24087016. [PMID: 37108178 PMCID: PMC10139191 DOI: 10.3390/ijms24087016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
Nephropathia epidemica (NE), caused by the hantavirus infection, is endemic in Tatarstan Russia. The majority of patients are adults, with infection rarely diagnosed in children. This limited number of pediatric NE cases means there is an inadequate understanding of disease pathogenesis in this age category. Here, we have analyzed clinical and laboratory data in adults and children with NE to establish whether and how the disease severity differs between the two age groups. Serum cytokines were analyzed in samples collected from 11 children and 129 adult NE patients during an outbreak in 2019. A kidney toxicity panel was also used to analyze urine samples from these patients. Additionally, serum and urine samples were analyzed from 11 control children and 26 control adults. Analysis of clinical and laboratory data revealed that NE was milder in children than in adults. A variation in serum cytokine activation could explain the differences in clinical presentation. Cytokines associated with activation of Th1 lymphocytes were prominent in adults, while they were obscured in sera from pediatric NE patients. In addition, a prolonged activation of kidney injury markers was found in adults with NE, whilst only a short-lasting activation of these markers was observed in children with NE. These findings support previous observations of age differences in NE severity, which should be considered when diagnosing the disease in children.
Collapse
Affiliation(s)
- Ekaterina Martynova
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Robert J Stott-Marshall
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | | | | | | | - Yuriy N Davidyuk
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Emmanuel Kabwe
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | - Maria Markelova
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| | | | - Toshana L Foster
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | - Svetlana Khaiboullina
- "Gene and Cell Technologies" Institute of Fundamental Medicine and Biology, Kazan Federal University, OpenLab, 420008 Kazan, Russia
| |
Collapse
|
6
|
Tervo L, Outinen T, Kiekara T, Tietäväinen J, Paakkala A, Pörsti I, Huhtala H, Mäkelä S, Mustonen J. The presence of intraperitoneal, retroperitoneal and pleural fluid in acute Puumala hantavirus infection. Infect Dis (Lond) 2023; 55:207-215. [PMID: 36562294 DOI: 10.1080/23744235.2022.2160010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes most cases of haemorrhagic fever with renal syndrome (HFRS) in Europe. PUUV infection is characterised by acute kidney injury, thrombocytopenia and increased capillary leakage. Typical symptoms are fever, headache, nausea, abdominal and back pain. This study aimed to evaluate the amount and distribution of intraperitoneal, retroperitoneal and pleural fluid and the association of fluid collections to the symptoms and clinical findings in patients with acute PUUV infection. METHODS Abdominal magnetic resonance imaging (MRI) was performed on 27 hospitalised patients with acute PUUV infection. The clinical and laboratory findings and patients' symptoms were analysed in relation to the imaging findings. The thickness of the fluid collections was measured in millimetres (mm) from axial images. RESULTS Fluid collections were found in all patients. The amount of intraperitoneal fluid correlated positively with plasma C-reactive protein (CRP) level (r = 0.586, p = .001), while it had an inverse correlation with serum creatinine concentration (r = -0.418, p = .030). Retroperitoneal fluid also correlated inversely with serum creatinine and cystatin C concentrations (r = -0.501, p = .008 and r = -0.383, p = .048, respectively). The amount of fluid was not greater in patients with abdominal or back pain. Patients with back pain had higher serum creatinine compared with patients without back pain, 452 µmol/L (range 88-1071) vs. 83 µmol/L (range 60-679), p = .004. CONCLUSIONS Fluid collections were found in all patients. A greater amount of intraperitoneal fluid associates with higher CRP concentrations but not with higher serum creatinine levels. Back pain associates with higher creatinine level but not with the presence of fluids.
Collapse
Affiliation(s)
- L Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - T Kiekara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - J Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Paakkala
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - S Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
7
|
Noack D, Travar M, Mrdjen V, Voermans JJC, van de Vijver D, Molenkamp R, Koopmans MPG, Goeijenbier M, Rockx B. Serum Markers Associated with Disease Severity in a Bosnian Hemorrhagic Fever with Renal Syndrome Cohort. Viruses 2022; 14:v14071377. [PMID: 35891358 PMCID: PMC9316913 DOI: 10.3390/v14071377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022] Open
Abstract
Puumala orthohantavirus (PUUV) is endemic in Europe and can cause hemorrhagic fever with renal syndrome (nephropathia epidemica). Disease features include fever, thrombocytopenia, and acute kidney injury (AKI). This retrospective cohort study of forty PUUV patients aims to characterize associations of serum immunological, hemostatic or kidney injury markers to disease severity. While interleukin-18 (IL-18) was significantly increased in severely thrombocytopenic patients (<100 × 109 platelets/L) compared to patients with higher platelet counts, RANTES was significantly decreased in these patients. These data suggest that patients with significant thrombocytopenia might have experienced pronounced Th1 immune responses. When kidney dysfunction was used as the primary disease outcome, recently identified AKI biomarkers (Cystatin C, insulin-like growth factor-binding protein 7, Nephrin, and trefoil factor 3) were significantly upregulated in patients with severe PUUV infection, defined as the estimated glomerular filtration rate (eGFR) below 30 m/min/1.73 m2. The increased expression of these markers specifically indicates pathology in glomeruli and proximal tubuli. Furthermore, E-selectin was significantly higher while interferon gamma-induced protein 10 (IP-10) was significantly lower in PUUV patients with more severe kidney dysfunction compared to patients with higher eGFR-values. Increased E-selectin illustrates the central role of endothelial cell activation, whereas decreased IP-10 could indicate a less important role of this cytokine in the pathogenesis of kidney dysfunction.
Collapse
Affiliation(s)
- Danny Noack
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Maja Travar
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Visnja Mrdjen
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Jolanda J. C. Voermans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - David van de Vijver
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Richard Molenkamp
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Correspondence:
| |
Collapse
|
8
|
Nusshag C, Boegelein L, Schreiber P, Essbauer S, Osberghaus A, Zeier M, Krautkrämer E. Expression Profile of Human Renal Mesangial Cells Is Altered by Infection with Pathogenic Puumala Orthohantavirus. Viruses 2022; 14:v14040823. [PMID: 35458553 PMCID: PMC9025590 DOI: 10.3390/v14040823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Acute kidney injury (AKI) with proteinuria is a hallmark of infections with Eurasian orthohantaviruses. Different kidney cells are identified as target cells of hantaviruses. Mesangial cells may play a central role in the pathogenesis of AKI by regulation of inflammatory mediators and signaling cascades. Therefore, we examined the characteristics of hantavirus infection on human renal mesangial cells (HRMCs). Receptor expression and infection with pathogenic Puumala virus (PUUV) and low-pathogenic Tula virus (TULV) were explored. To analyze changes in protein expression in infected mesangial cells, we performed a proteome profiler assay analyzing 38 markers of kidney damage. We compared the proteome profile of in vitro-infected HRMCs with the profile detected in urine samples of 11 patients with acute hantavirus infection. We observed effective productive infection of HRMCs with pathogenic PUUV, but only poor abortive infection for low-pathogenic TULV. PUUV infection resulted in the deregulation of proteases, adhesion proteins, and cytokines associated with renal damage. The urinary proteome profile of hantavirus patients demonstrated also massive changes, which in part correspond to the alterations observed in the in vitro infection of HRMCs. The direct infection of mesangial cells may induce a local environment of signal mediators that contributes to AKI in hantavirus infection.
Collapse
Affiliation(s)
- Christian Nusshag
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
| | - Lukas Boegelein
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
| | - Pamela Schreiber
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
| | - Sandra Essbauer
- Bundeswehr Institute of Microbiology, Department Virology and Intracellular Agents, German Centre for Infection Research, Munich Partner Site, D-80937 Munich, Germany;
| | - Anja Osberghaus
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
| | - Ellen Krautkrämer
- Department of Nephrology, University of Heidelberg, D-69120 Heidelberg, Germany; (C.N.); (L.B.); (P.S.); (A.O.); (M.Z.)
- Correspondence:
| |
Collapse
|
9
|
Increased Heparanase Levels in Urine during Acute Puumala Orthohantavirus Infection Are Associated with Disease Severity. Viruses 2022; 14:v14030450. [PMID: 35336857 PMCID: PMC8954369 DOI: 10.3390/v14030450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/06/2023] Open
Abstract
Old–world orthohantaviruses cause hemorrhagic fever with renal syndrome (HFRS), characterized by acute kidney injury (AKI) with transient proteinuria. It seems plausible that proteinuria during acute HFRS is mediated by the disruption of the glomerular filtration barrier (GFB) due to vascular leakage, a hallmark of orthohantavirus–caused diseases. However, direct infection of endothelial cells by orthohantaviruses does not result in increased endothelial permeability, and alternative explanations for vascular leakage and diminished GFB function are necessary. Vascular integrity is partly dependent on an intact endothelial glycocalyx, which is susceptible to cleavage by heparanase (HPSE). To understand the role of glycocalyx degradation in HFRS–associated proteinuria, we investigated the levels of HPSE in urine and plasma during acute, convalescent and recovery stages of HFRS caused by Puumala orthohantavirus. HPSE levels in urine during acute HFRS were significantly increased and strongly associated with the severity of AKI and other markers of disease severity. Furthermore, increased expression of HPSE was detected in vitro in orthohantavirus–infected podocytes, which line the outer surfaces of glomerular capillaries. Taken together, these findings suggest the local activation of HPSE in the kidneys of orthohantavirus–infected patients with the potential to disrupt the endothelial glycocalyx, leading to increased protein leakage through the GFB, resulting in high amounts of proteinuria.
Collapse
|
10
|
An evaluation of kidney dysfunction as a common symptom of typhoid infection in an endemic country: A rare case study. IDCases 2022; 29:e01580. [PMID: 35942255 PMCID: PMC9356191 DOI: 10.1016/j.idcr.2022.e01580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Nephrotic syndrome and encephalopathy are uncommon complications that occurred in typhoid fever. The diagnosis is based on proteinuria finding with nephrotic range value, edema, and hypoalbuminemia. In this study, a 10-year-old boy was diagnosed with encephalopathy typhoid and nephrotic syndrome. The physical examination and urinalysis were conducted with methylprednisolone 60 mg/body surface area and captopril to reduce proteinuria.
Collapse
|
11
|
Severity Biomarkers in Puumala Hantavirus Infection. Viruses 2021; 14:v14010045. [PMID: 35062248 PMCID: PMC8778356 DOI: 10.3390/v14010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Annually, over 10,000 cases of hemorrhagic fever with renal syndrome (HFRS) are diagnosed in Europe. Puumala hantavirus (PUUV) causes most of the European HFRS cases. PUUV causes usually a relatively mild disease, which is rarely fatal. However, the severity of the infection varies greatly, and factors affecting the severity are mostly unrevealed. Host genes are known to have an effect. The typical clinical features in PUUV infection include acute kidney injury, thrombocytopenia, and increased vascular permeability. The primary target of hantavirus is the endothelium of the vessels of different organs. Although PUUV does not cause direct cytopathology of the endothelial cells, remarkable changes in both the barrier function of the endothelium and the function of the infected endothelial cells occur. Host immune or inflammatory mechanisms are probably important in the development of the capillary leakage. Several immunoinflammatory biomarkers have been studied in the context of assessing the severity of HFRS caused by PUUV. Most of them are not used in clinical practice, but the increasing knowledge about the biomarkers has elucidated the pathogenesis of PUUV infection.
Collapse
|