1
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Zhao HD, Sun JJ, Liu HL. Potential clinical biomarkers in monitoring the severity of Hantaan virus infection. Cytokine 2023; 170:156340. [PMID: 37607412 DOI: 10.1016/j.cyto.2023.156340] [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: 07/10/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Hantavirus, which causes hemorrhagic fever with renal syndrome (HFRS) is almost prevalent worldwide. While Hantaan virus (HTNV) causes the most severe form of HFRS with typical clinical manifestations of thrombocytopenia, increased vascular permeability, and acute kidney injury. Although the knowledge of the pathogenesis of HFRS is still limited, immune dysfunction and pathological damage caused by disorders of immune regulation are proposed to play a vital role in the development of the disorder, and the endothelium is considered to be the primary target of hantaviruses. Here, we reviewed the production and function of multiple molecules, mainly focusing on their role in immune response, endothelium, vascular permeability regulation, and platelet and coagulation activation which are closely related to the pathogenesis of HTNV infection. meanwhile, the relationship between these molecules and characteristics of HTNV infection including the hospital duration, immune dysfunction, thrombocytopenia, leukocytosis, and acute kidney injury are also presented, to provide a novel insight into the potential role of these molecules as monitoring markers for HTNV infection.
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Affiliation(s)
- Han-Dong Zhao
- Central Laboratory of Virology, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ju-Jun Sun
- Clinical Laboratory Center, XD Group Hospital, Xi'an 710077, China
| | - Hong-Li Liu
- Clinical Laboratory Center, Xi'an People's Hospital (Xi'an Fourth Hospital) Guang-Ren Hospital Affiliated to Xi'an Jiaotong University Health Science Center, Xi'an 710004, China.
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2
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Mocanu A, Cajvan AM, Lazaruc TI, Lupu VV, Florescu L, Lupu A, Bogos RA, Ioniuc I, Scurtu G, Dragan F, Starcea IM. Hantavirus Infection in Children-A Pilot Study of Single Regional Center. Viruses 2023; 15:v15040872. [PMID: 37112856 PMCID: PMC10143646 DOI: 10.3390/v15040872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hantaviruses are infectious etiological agents of a group of rodent-borne hemorrhagic fevers, with two types of clinical manifestations in humans: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). According to available statistics, the disease occurs mainly in adults, but the lower incidence in the pediatric population might also be related to a lack of diagnosis possibilities or even unsatisfactory knowledge about the disease. MATERIALS AND METHODS The purpose of this study was to evaluate the cases of hemorrhagic fever with renal syndrome diagnosed and treated in the Department of Nephrology at St. Mary's Emergency Hospital for Children in Iasi, Romania, representative of the North-East of Romania. We also reviewed the specialized literature on the topic. RESULTS Between January 2017 and January 2022, eight cases of HFRS, all men, and seven from rural areas, aged 11-18 years old, were referred to our clinic because of an acute kidney injury (AKI). Seven cases were identified as Dobrava serotype while one case was determined by Haantan serotype. CONCLUSIONS HFRS should always be considered as a differential diagnosis when faced with a patient with AKI and thrombocytopenia. Dobrava serotype is the most common hantavirus subtype in the Balkans. For the specific prevention of human infections, mainly in high-risk groups, vaccines are needed. As far as we know, this is the first study on HFRS in Romanian children.
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Affiliation(s)
- Adriana Mocanu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Ana-Maria Cajvan
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Tudor Ilie Lazaruc
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Florescu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Roxana Alexandra Bogos
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
| | - Ileana Ioniuc
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Georgiana Scurtu
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Iuliana Magdalena Starcea
- Pediatrics "Grigore T. Popa", University of Medicine and Pharmacy, 700115 Iasi, Romania
- Nephrology Division, St. Mary's Emergency Hospital for Children, 700309 Iasi, Romania
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3
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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.
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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:
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4
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Koehler FC, Di Cristanziano V, Späth MR, Hoyer-Allo KJR, Wanken M, Müller RU, Burst V. OUP accepted manuscript. Clin Kidney J 2022; 15:1231-1252. [PMID: 35756741 PMCID: PMC9217627 DOI: 10.1093/ckj/sfac008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 01/18/2023] Open
Abstract
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - K Johanna R Hoyer-Allo
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Manuel Wanken
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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5
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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.
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6
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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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7
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Lupuşoru G, Lupuşoru M, Ailincăi I, Bernea L, Berechet A, Spătaru R, Ismail G. Hanta hemorrhagic fever with renal syndrome: A pathology in whose diagnosis kidney biopsy plays a major role (Review). Exp Ther Med 2021; 22:984. [PMID: 34345266 PMCID: PMC8311249 DOI: 10.3892/etm.2021.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022] Open
Abstract
Hantavirus infection belongs to a group of zoonoses rare in the Balkan Peninsula, causing two major syndromes, depending on the viral serotype involved: Hemorrhagic fever with renal syndrome (HFRS) also known as endemic nephropathy and cardiopulmonary syndrome (CPS). Because there is no specific treatment or vaccine for this condition approved in the USA or Europe, the key to minimizing the risk of adverse progression to chronic kidney disease, secondary hypertension or even death is primarily the recognition and early diagnosis of this condition with prompt therapeutic intervention. The aim of this study was to review the literature data on the epidemiology, pathogenesis and management of this disease and to identify several aspects related to the difficulties encountered in diagnosing this pathology, taking into consideration that the disease is not endemic in this geographical area.
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Affiliation(s)
- Gabriela Lupuşoru
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Lupuşoru
- Department of Physiology I, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Lavinia Bernea
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Berechet
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Radu Spătaru
- Department of Pediatric Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Uronephrology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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8
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Tietäväinen J, Mäkelä S, Huhtala H, Pörsti IH, Strandin T, Vaheri A, Mustonen J. The Clinical Presentation of Puumala Hantavirus Induced Hemorrhagic Fever with Renal Syndrome Is Related to Plasma Glucose Concentration. Viruses 2021; 13:v13061177. [PMID: 34202952 PMCID: PMC8235586 DOI: 10.3390/v13061177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome characterized by thrombocytopenia, increased capillary leakage, and acute kidney injury (AKI). As glucosuria at hospital admission predicts the severity of PUUV infection, we explored how plasma glucose concentration associates with disease severity. Plasma glucose values were measured during hospital care in 185 patients with PUUV infection. They were divided into two groups according to maximum plasma glucose concentration: P-Gluc < 7.8 mmol/L (n = 134) and P-Gluc ≥ 7.8 mmol/L (n = 51). The determinants of disease severity were analyzed across groups. Patients with P-Gluc ≥7.8 mmol/L had higher hematocrit (0.46 vs. 0.43; p < 0.001) and lower plasma albumin concentration (24 vs. 29 g/L; p < 0.001) than patients with P-Gluc < 7.8 mmol/L. They presented with higher prevalence of pulmonary infiltrations and pleural effusion in chest radiograph, higher prevalence of shock and greater weight change during hospitalization. Patients with P-Gluc ≥ 7.8 mmol/L were characterized by lower platelet count (50 vs. 66 × 109/L; p = 0.001), more severe AKI (plasma creatinine 272 vs. 151 µmol/L; p = 0.001), and longer hospital treatment (8 vs. 6 days; p < 0.001) than patients with P-Gluc < 7.8 mmol/L. Plasma glucose level is associated with the severity of capillary leakage, thrombocytopenia, inflammation, and AKI in patients with acute PUUV infection.
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Affiliation(s)
- Johanna Tietäväinen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (S.M.); (I.H.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
- Correspondence:
| | - Satu Mäkelä
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (S.M.); (I.H.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland;
| | - Ilkka H. Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (S.M.); (I.H.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Tomas Strandin
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland; (T.S.); (A.V.)
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland; (T.S.); (A.V.)
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (S.M.); (I.H.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
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9
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Ouahmi H, Courjon J, Morand L, François J, Bruckert V, Lombardi R, Esnault V, Seitz-Polski B, Demonchy E, Dellamonica J, Boyer-Suavet S. Proteinuria as a Biomarker for COVID-19 Severity. Front Physiol 2021; 12:611772. [PMID: 33767630 PMCID: PMC7985082 DOI: 10.3389/fphys.2021.611772] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Renal involvement in syndrome coronavirus 2 (SARS-CoV-2) infection has been retrospectively described, especially acute kidney injury (AKI). However, quantitative proteinuria assessment and its implication in coronavirus disease 2019 (COVID-19) remain unknown. Methods In this prospective, multicenter study in France, we collected clinical and biological data including urinary protein to creatine ratio (UPCR) in patients presenting with moderate to severe COVID-19. Clinical outcome was analyzed according to the level of UPCR. Results 42/45 patients (93.3%) had renal involvement (abnormal urinary sediment and/or AKI). Significant proteinuria occurred in 60% of patients. Urine protein electrophoresis showed tubular protein excretion in 83.8% of patients with proteinuria. Inflammatory parametersand D-dimer concentrations correlated with proteinuria level. Patients who required intensive care unit (ICU) admission had higher proteinuria (p = 0.008). On multivariate analysis, proteinuria greater than 0.3 g/g was related to a higher prevalence of ICU admission [OR = 4.72, IC95 (1.16–23.21), p = 0.03], acute respiratory distress syndrome (ARDS) [OR = 6.89, IC95 (1.41–53.01, p = 0.02)], nosocomial infections [OR = 3.75, IC95 (1.11–13.55), p = 0.03], longer inpatient hospital stay (p = 0.003). Conclusion Renal involvement is common in moderate to severe SARS-CoV-2 infection. Proteinuria at baseline is an independent risk factor for increased hospitalization duration and ICU admission in patients with COVID-19.
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Affiliation(s)
- Hajar Ouahmi
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France.,Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Johan Courjon
- Service d'Infectiologie, CHU de Nice, Université Côte d'Azur, Nice, France.,Université Côte d'Azur, Centre Méditerranéen de Médecine Moléculaire (C3M), CHU de Nice, INSERM U1065, Nice, France
| | - Lucas Morand
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France
| | | | - Vincent Bruckert
- Département de réanimation médico-chirugicale et transplantation d'organe, hôpital L'Archet 2, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Romain Lombardi
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Vincent Esnault
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Barbara Seitz-Polski
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France.,Laboratoire d'Immunologie, CHU de Nice, Université Côte d'Azur, Nice, France.,Centre de référence Maladies rares Syndrome néphrotique idiopathique, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Elisa Demonchy
- Service d'Infectiologie, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Sonia Boyer-Suavet
- Centre de référence Maladies rares Syndrome néphrotique idiopathique, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
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10
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Hansson M, Gustafsson R, Jacquet C, Chebaane N, Satchell S, Thunberg T, Ahlm C, Fors Connolly AM. Cystatin C and α-1-Microglobulin Predict Severe Acute Kidney Injury in Patients with Hemorrhagic Fever with Renal Syndrome. Pathogens 2020; 9:pathogens9080666. [PMID: 32824680 PMCID: PMC7460112 DOI: 10.3390/pathogens9080666] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022] Open
Abstract
Puumala orthohantavirus causes hemorrhagic fever with renal syndrome (HFRS) characterized by acute kidney injury (AKI), an abrupt decrease in renal function. Creatinine is routinely used to detect and quantify AKI; however, early AKI may not be reflected in increased creatinine levels. Therefore, kidney injury markers that can predict AKI are needed. The potential of the kidney injury markers urea, cystatin C, α1-microglobulin (A1M) and neutrophil gelatinase-associated lipocalin (NGAL) to detect early AKI during HFRS was studied by quantifying the levels of these markers in consecutively obtained plasma (P) and urine samples (U) for 44 HFRS patients. P-cystatin C and U-A1M levels were significantly increased during early HFRS compared to follow-up. In a receiver operating characteristic (ROC) curve analysis, P-cystatin C, U-A1M and P-urea predicted severe AKI with area under the curve 0.72, 0.73 and 0.71, respectively, whereas the traditional kidney injury biomarkers creatinine and U-albumin did not predict AKI. Nearly half of the HFRS patients (41%) fulfilled the criteria for shrunken pore syndrome, which was associated with the level of inflammation as measured by P-CRP. P-cystatin C and U-A1M are more sensitive and earlier markers compared to creatinine in predicting kidney injury during HFRS.
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Affiliation(s)
- Magnus Hansson
- Clinical Chemistry, Karolinska University Hospital, 17176 Stockholm, Sweden;
- Department of Laboratory Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Rasmus Gustafsson
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Chloé Jacquet
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
- Molecular Infection Medicine Sweden (MIMS), Umeå University, 90187 Umeå, Sweden
| | - Nedia Chebaane
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Simon Satchell
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol BS1 3NY, UK;
| | - Therese Thunberg
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
| | - Anne-Marie Fors Connolly
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden; (C.J.); (N.C.); (T.T.); (C.A.)
- Molecular Infection Medicine Sweden (MIMS), Umeå University, 90187 Umeå, Sweden
- Correspondence:
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11
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Mantula P, Tietäväinen J, Clement J, Niemelä O, Pörsti I, Vaheri A, Mustonen J, Mäkelä S, Outinen T. Flash-Like Albuminuria in Acute Kidney Injury Caused by Puumala Hantavirus Infection. Pathogens 2020; 9:E615. [PMID: 32731475 PMCID: PMC7459820 DOI: 10.3390/pathogens9080615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
Transient proteinuria and acute kidney injury (AKI) are characteristics of Puumala virus (PUUV) infection. Albuminuria peaks around the fifth day and associates with AKI severity. To evaluate albuminuria disappearance rate, we quantified albumin excretion at different time points after the fever onset. The study included 141 consecutive patients hospitalized due to acute PUUV infection in Tampere University Hospital, Finland. Timed overnight albumin excretion (cU-Alb) was measured during the acute phase in 133 patients, once or twice during the convalescent phase within three months in 94 patients, and at six months in 36 patients. During hospitalization, 30% of the patients had moderately increased albuminuria (cU-Alb 20-200 μg/min), while 57% presented with severely increased albuminuria (cU-Alb >200 μg/min). Median cU-Alb was 311 μg/min (range 2.2-6460) ≤7 days after fever onset, 235 μg/min (range 6.8-5479) at 8-13 days and 2.8 μg/min (range 0.5-18.2) at 14-20 days. After that, only one of the measurements showed albuminuria (35.4 μg/min at day 44). At six months, the median cU-Alb was 2.0 μg/min (range 0.6-14.5). Albuminuria makes a flash-like appearance in PUUV infection and returns rapidly to normal levels within 2-3 weeks after fever onset. In the case of AKI, this is a unique phenomenon.
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Affiliation(s)
- Paula Mantula
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
| | - Johanna Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Jan Clement
- Department of Microbiology, Immunology and Transplantation, Rega Institute, National Reference Center for Hantaviruses, Laboratory of Clinical and Epidemiological Virology, KU Leuven, 3000 Leuven, Belgium;
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
- Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00100 Helsinki, Finland;
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Tuula Outinen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
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12
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Outinen TK, Mantula P, Jaatinen P, Hämäläinen M, Moilanen E, Vaheri A, Huhtala H, Mäkelä S, Mustonen J. Glycoprotein YKL-40 Is Elevated and Predicts Disease Severity in Puumala Hantavirus Infection. Viruses 2019; 11:v11090767. [PMID: 31438470 PMCID: PMC6784349 DOI: 10.3390/v11090767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 12/17/2022] Open
Abstract
Most cases of hemorrhagic fever with renal syndrome (HFRS) in Europe are caused by the Puumala hantavirus (PUUV). Typical features of the disease are increased vascular permeability, acute kidney injury (AKI), and thrombocytopenia. YKL-40 is an inflammatory glycoprotein involved in various forms of acute and chronic inflammation. In the present study, we examined plasma YKL-40 levels and the associations of YKL-40 with disease severity in acute PUUV infection. A total of 79 patients treated in Tampere University Hospital during 2005–2014 were studied. Plasma YKL-40 was measured in the acute phase, the recovery phase, and one year after hospitalization. Plasma YKL-40 levels were higher during the acute phase compared to the recovery phase and one year after hospitalization (median YKL-40 142 ng/mL, range 11–3320, vs. 45 ng/mL, range 15–529, vs. 32 ng/mL, range 3–213, p < 0.001). YKL-40 level was correlated with the length of hospital stay (r = 0.229, p = 0.042), the levels of inflammatory markers—that is, blood leukocytes (r = 0.234, p = 0.040), plasma C-reactive protein (r = 0.332, p = 0.003), and interleukin-6 (r = 0.544, p < 0.001), and maximum plasma creatinine level (r = 0.370, p = 0.001). In conclusion, plasma YKL-40 levels were found to be elevated during acute PUUV infection and correlated with the overall severity of the disease, as well as with the degree of inflammation and the severity of AKI.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland.
| | - Paula Mantula
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
| | - Pia Jaatinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33100 & FI-33521 Tampere, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33100 & FI-33521 Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00100 Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
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13
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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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14
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Mantula PS, Outinen TK, Jaatinen P, Hämäläinen M, Huhtala H, Pörsti IH, Vaheri A, Mustonen JT, Mäkelä SM. High plasma resistin associates with severe acute kidney injury in Puumala hantavirus infection. PLoS One 2018; 13:e0208017. [PMID: 30517161 PMCID: PMC6281250 DOI: 10.1371/journal.pone.0208017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022] Open
Abstract
Background Puumala hantavirus (PUUV) infected patients typically suffer from acute kidney injury (AKI). Adipokines have inflammation modulating functions in acute diseases including AKI. We examined plasma levels of three adipokines (resistin, leptin, and adiponectin) in acute PUUV infection and their associations with disease severity. Methods This study included 79 patients hospitalized due to acute PUUV infection. Plasma resistin, leptin, adiponectin, as well as IL-6 and CRP, were measured at the acute phase, recovery phase and one year after hospitalization. Results Plasma resistin levels were significantly higher in the acute phase compared to the recovery phase and one year after (median resistin 28 pg/mL (11–107) vs. 17 pg/mL (7–36) vs. 14 pg/mL (7–31), p<0.001). Maximum resistin concentration correlated with maximum plasma creatinine levels (r = 0.63; p<0.001). The higher the amount of albuminuria in the urine dipstick test (0–1+, 2+ or 3+) at admission, the higher the median of maximum resistin (24.7 pg/mL, 25.4 pg/mL and 39.6 pg/mL, respectively, p = 0.002). High resistin was also an independent risk factor for severe AKI (creatinine ≥353.6μmol/L) (OR 1.08, 95% CI 1.02–1.14). Neither plasma leptin nor adiponectin level had any correlation with creatinine concentration or the amount of albuminuria. Conclusions Plasma resistin independently associates with the severity of AKI in acute PUUV infection. The association of resistin with the amount of albuminuria suggests that the level of plasma resistin is not only influenced by renal clearance but could have some role in the pathogenesis of AKI during PUUV infection.
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Affiliation(s)
- Paula S. Mantula
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- * E-mail:
| | - Tuula K. Outinen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Pia Jaatinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Division of Intermal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ilkka H. Pörsti
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
| | - Jukka T. Mustonen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Satu M. Mäkelä
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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15
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Ying Q, Ma T, Cheng L, Zhang X, Truax AD, Ma R, Liu Z, Lei Y, Zhang L, Ye W, Zhang F, Xu Z, Shang L, Liu R, Wang F, Wu X. Construction and immunological characterization of CD40L or GM-CSF incorporated Hantaan virus like particle. Oncotarget 2018; 7:63488-63503. [PMID: 27542281 PMCID: PMC5325379 DOI: 10.18632/oncotarget.11329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022] Open
Abstract
Infection of Hantaan virus (HTNV) usually causes hemorrhagic fever with renal syndrome (HFRS). China has the worst epidemic incidence of HFRS as well as high fatality. Inactivated whole virus has been used for HFRS vaccination, however there are still problems such as safety concerns. CD40 ligand (CD40L) and granulocyte macrophage colony-stimulating factor (GM-CSF) are well-known immune stimulating molecules that can enhance antigen presenting, lymphocytes activation and maturation, incorporation of CD40L and GM-CSF to the surface of virus like particles (VLPs) can greatly improve the vaccination effect. We constructed eukaryotic vectors expressing HTNV M segment and S segment, as well as vectors expressing HTNV M segment with CD40L or GM-CSF, our results showed successful production of CD40L or GM-CSF incorporated HTNV VLPs. In vitro stimulation with CD40L or GM-CSF anchored HTNV VLP showed enhanced activation of macrophages and DCs. CD40L/GM-CSF incorporated VLP can induce higher level of HTNV specific antibody and neutralizing antibody in mice. Immunized mice splenocytes showed higher ability of secreting IFN-γ and IL-2, as well as enhancing CTL activity. These results suggest CD40L/GM-CSF incorporated VLP can serve as prospective vaccine candidate.
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Affiliation(s)
- Qikang Ying
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Tiejun Ma
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Linfeng Cheng
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiaoxiao Zhang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Agnieszka D Truax
- The Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7295, USA
| | - Ruixue Ma
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Ziyu Liu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Yingfeng Lei
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Liang Zhang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Wei Ye
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Fanglin Zhang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Zhikai Xu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Lei Shang
- Department of Statistics, Fourth Military Medical University, Xi'an, 710032, China
| | - Rongrong Liu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Fang Wang
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Xingan Wu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
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16
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Outinen TK, Mantula P, Laine OK, Pörsti I, Vaheri A, Mäkelä SM, Mustonen J. Haematuria is a marker for the severity of acute kidney injury but does not associate with thrombocytopenia in acute Puumala hantavirus infection. Infect Dis (Lond) 2017; 49:840-846. [PMID: 28762841 DOI: 10.1080/23744235.2017.1358461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome characterized by thrombocytopenia, capillary leakage and acute kidney injury (AKI) with proteinuria and haematuria. Although the typical histologic lesion is acute tubulointerstitial nephritis, the amount of glomerular proteinuria predicts the severity of upcoming AKI. Here, we studied the associations of haematuria and proteinuria with the severity of emerging AKI, thrombocytopenia and markers of coagulation and fibrinolysis in PUUV infection. METHODS We examined 205 consecutive patients treated for serologically confirmed acute PUUV infection at Tampere University Hospital during 1997-2014. The patients were divided into three groups according to the combined positive result in urine haemoglobin and albumin dipstick tests: 0-2 + (n = 58), 3-4 + (n = 100) and 5-6 + (n = 47). RESULTS The medians of maximum creatinine concentrations in the three groups were: 0-2 + 100 μmol/L (range 52-1499), 3-4 + 204 μmol/L (range 65-1071) and 5-6 + 361 μmol/l (range 51-1285) (p < .001). The number of blood platelets (p = .069), and the levels of fibrinogen, prothrombin fragments F1 + 2 and d-dimer (p = .602, p = .113, p = .289, respectively) were not significantly different between the groups. When the amount of haematuria in the dipstick test was examined separately, no association with thrombocytopenia was detected (p = .307 between groups 0, 1+ and 2-3+). CONCLUSIONS Combined positive result of haematuria and proteinuria in the dipstick test at hospital admission predicted the severity of upcoming AKI in acute PUUV infection. As haematuria was not associated with the severity of thrombocytopenia, it did not indicate increased bleeding tendency, but was rather a marker of acute kidney injury.
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Affiliation(s)
- Tuula K Outinen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Paula Mantula
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Outi K Laine
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Ilkka Pörsti
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Antti Vaheri
- c Department of Virology , Medicum, University of Helsinki , Helsinki , Finland
| | - Satu M Mäkelä
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Jukka Mustonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
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17
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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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18
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Chen D, Peng W, Jiang H, Yang H, Wu J, Wang H, Chen J. Noninvasive detection of acute renal allograft rejection by measurement of soluble Tim-3 in urine. Mol Med Rep 2017; 16:915-921. [PMID: 28586044 DOI: 10.3892/mmr.2017.6670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/09/2017] [Indexed: 11/06/2022] Open
Abstract
The purpose of the present study was to assess whether urinary soluble T-cell immunoglobulin and mucin domain-containing protein 3 (sTim-3) could be adopted as a novel non‑invasive biomarker for acute rejection (AR) following renal transplantation. A total of 156 patients were enrolled between January 2006 and December 2009, comprising 49 patients with biopsy‑proven AR, 58 patients with stable grafts and no abnormal histological findings (NO‑AR), 10 patients with subclinical rejection (SCR) in protocol biopsies, 10 patients with acute tubular necrosis (ATN) and 29 patients with chronic allograft nephropathy (CAN). Additionally, urine samples from 40 healthy individuals were also collected as controls. The urinary concentration of sTim‑3 was determined by ELISA in the 156 renal allograft recipients and 40 healthy controls. Compared with NO‑AR and healthy controls, patients with AR excreted urinary sTim‑3 at a significantly higher level (4,356±440.4, 95% CI: 3,473‑5,242 ng/mmol creatinine). Likewise, patients with ATN exhibited a significantly lower level of urinary sTim‑3 (2,060±217, 95% CI: 1,679‑2,680 ng/mmol creatinine) than patients with AR. The discriminatory value was measured by the area under the receiver operating characteristic curve (ROC), which had a value of 0.88 (95% CI: 0.809‑0.951), demonstrating that sTim‑3 was a suitable marker for the diagnosis of AR. At a cut-off point of 1,836 ng/mmol creatinine, the sensitivity was 89.8% and the specificity was 82.8% (P<0.001). Amongst the patients with AR, patients with steroid‑resistant acute rejection (n=31) had significantly higher urinary sTim‑3 concentrations than patients with steroid‑sensitive acute rejection (n=18; 5,548±613.5, 95%CI: 4,287‑6,809 ng/mmol creatinine vs. 2,653±391.7, 95% CI: 1,830‑3,476 ng/mmol creatinine; P=0.0002). No significant difference in urinary sTim‑3 was found between patients with AR and CAN (3,920±543.5, 95% CI: 3,473‑5,242 ng/mmol creatinine), and a significantly higher level of Tim‑3 was excreted by patients with CAN compared with patients with NO‑AR and healthy controls (P<0.001). The present study, therefore, suggests that urinary sTim‑3 may be used as a valuable non‑invasive biomarker for the detection of AR. In addition, urinary sTim‑3 levels were demonstrated to be associated with the response to anti‑rejection therapy. The results of the present study may provide support future research into the screening of novel immune suppressants.
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Affiliation(s)
- Dajin Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Wenhan Peng
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hong Jiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hao Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianyong Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Huiping Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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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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20
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Koskela S, Laine O, Mäkelä S, Pessi T, Tuomisto S, Huhtala H, Karhunen PJ, Pörsti I, Mustonen J. Endothelial Nitric Oxide Synthase G894T Polymorphism Associates with Disease Severity in Puumala Hantavirus Infection. PLoS One 2015; 10:e0142872. [PMID: 26561052 PMCID: PMC4641644 DOI: 10.1371/journal.pone.0142872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Hantavirus infections are characterized by both activation and dysfunction of the endothelial cells. The underlying mechanisms of the disease pathogenesis are not fully understood. Here we tested the hypothesis whether the polymorphisms of endothelial nitric oxide synthase, eNOS G894T, and inducible nitric oxide synthase, iNOS G2087A, are associated with the severity of acute Puumala hantavirus (PUUV) infection. Patients and Methods Hospitalized patients (n = 172) with serologically verified PUUV infection were examined. Clinical and laboratory variables reflecting disease severity were determined. The polymorphisms of eNOS G894T (Glu298Asp, rs1799983) and iNOS G2087A (Ser608Leu, rs2297518) were genotyped. Results The rare eNOS G894T genotype was associated with the severity of acute kidney injury (AKI). The non-carriers of G-allele (TT-homozygotes) had higher maximum level of serum creatinine than the carriers of G-allele (GT-heterozygotes and GG-homozygotes; median 326, range 102–1041 vs. median 175, range 51–1499 μmol/l; p = 0.018, respectively). The length of hospital stay was longer in the non-carriers of G-allele than in G-allele carriers (median 8, range 3–14 vs. median 6, range 2–15 days; p = 0.032). The rare A-allele carriers (i.e. AA-homozygotes and GA-heterozygotes) of iNOS G2087A had lower minimum systolic and diastolic blood pressure than the non-carriers of A-allele (median 110, range 74–170 vs.116, range 86–162 mmHg, p = 0.019, and median 68, range 40–90 vs. 72, range 48–100 mmHg; p = 0.003, respectively). Conclusions Patients with the TT-homozygous genotype of eNOS G894T had more severe PUUV-induced AKI than the other genotypes. The eNOS G894T polymorphism may play role in the endothelial dysfunction observed during acute PUUV infection.
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Affiliation(s)
- Sirpa Koskela
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- * E-mail:
| | - Outi Laine
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tanja Pessi
- School of Medicine, University of Tampere, Tampere, Finland
- Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Sari Tuomisto
- School of Medicine, University of Tampere, Tampere, Finland
- Fimlab Laboratories Ltd, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka J. Karhunen
- School of Medicine, University of Tampere, Tampere, Finland
- Fimlab Laboratories Ltd, Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
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Outinen TK, Mäkelä S, Clement J, Paakkala A, Pörsti I, Mustonen J. Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome. Nephron Clin Pract 2015; 130:182-90. [PMID: 26139246 DOI: 10.1159/000433563] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection. METHODS We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection. RESULTS Plasma creatinine concentration was elevated (>100 μmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 μmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels. CONCLUSIONS In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Gnemmi V, Verine J, Vrigneaud L, Glowacki F, Ratsimbazafy A, Copin MC, Dewilde A, Buob D. Microvascular inflammation and acute tubular necrosis are major histologic features of hantavirus nephropathy. Hum Pathol 2015; 46:827-35. [PMID: 25791582 DOI: 10.1016/j.humpath.2015.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/31/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
Hantavirus nephropathy (HVN) is an uncommon etiology of acute renal failure due to hantavirus infection. Pathological features suggestive of HVN historically reported are medullary interstitial hemorrhages in a background of acute interstitial nephritis (AIN). However, interstitial hemorrhages may be lacking because of medullary sampling error. This emphasizes that other pathological criteria may be of interest. We performed a retrospective clinicopathological study of 17 serologically proven HVN cases with renal biopsy from 2 nephrology centers in northern France. Histologic analysis was completed by immunohistochemistry with anti-CD3, anti-CD68, and anti-CD34 antibodies. Three control groups were not related to hantavirus infection: acute tubular necrosis (ATN) of ischemic or toxic etiology and AIN were used for comparison. Renal biopsy analysis showed that almost all HVN cases with medullary sampling (9/10) displayed interstitial hemorrhages, whereas focal hemorrhages were detected in 2 of the 7 "cortex-only" specimens. ATN was common, as it was present in 15 (88.2%) of 17 HVN cases. By contrast, interstitial inflammation was scarce with no inflammation or only slight inflammation, representing 15 (88.2%) of 17 cases. Moreover, HVN showed inflammation of renal microvessels with cortical peritubular capillaritis and medullary vasa recta inflammation; peritubular capillaritis was significantly higher in HVN after comparison with ischemic and toxic ATN controls (P = .0001 and P = .003, respectively), but not with AIN controls. Immunohistochemical studies highlighted the involvement of T cells and macrophages in renal microvascular inflammation related to HVN. Our study showed that microvascular inflammation, especially cortical peritubular capillaritis, and ATN are important histologic features of HVN.
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Affiliation(s)
- Viviane Gnemmi
- Department of Pathology, CHRU Lille, 59037 Lille, France; Université Lille Nord de France, 59000 Lille, France.
| | - Jérôme Verine
- Department of Pathology, Hopital Saint-Louis, 75475 Paris Cedex 10, France
| | - Laurence Vrigneaud
- Department of Nephrology, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France
| | - François Glowacki
- Université Lille Nord de France, 59000 Lille, France; Department of Nephrology, Hôpital Huriez, CHRU Lille, rue Michel Polonovski, 59037 Lille, France
| | - Anderson Ratsimbazafy
- Department of Nephrology, Centre Hospitalier de Bethune, Rue Delbecque, 62660 Beuvry Bethune, France
| | - Marie-Christine Copin
- Department of Pathology, CHRU Lille, 59037 Lille, France; Université Lille Nord de France, 59000 Lille, France
| | - Anny Dewilde
- Université Lille Nord de France, 59000 Lille, France; Department of Virology, CHRU Lille, 59037 Lille, France
| | - David Buob
- Department of Pathology, Hôpital Tenon, 75020 Paris, France
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Baigildina AA, Khaiboullina SF, Martynova EV, Anokhin VA, Lombardi VC, Rizvanov AA. Inflammatory cytokines kinetics define the severity and phase of nephropathia epidemica. Biomark Med 2014; 9:99-107. [PMID: 25313675 DOI: 10.2217/bmm.14.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS Nephropathia epidemica (NE) is a form of hemorrhagic fever with renal syndrome associated with the Puumala virus species of Hantavirus. The pathogenesis of NE is not well understood; therefore, investigating the inflammatory cytokine response to infection may provide useful knowledge in deciphering the pathophysiology of NE. MATERIALS & METHODS Using Luminex and ELISA, we analyzed the serum of 137 NE cases and 44 controls to investigate if serum cytokines associate with different clinical presentations. RESULTS Serum levels of TNF-α and IL-1β are associated with disease severity while upregulation of IL-6, CXCL10, CCL2 and CCL3 are associated with clinical presentation. CONCLUSION Inflammatory cytokine kinetics associate with the severity and phase of NE. Our data support a role for inflammatory cytokines in the pathophysiology of NE.
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Affiliation(s)
- Asia A Baigildina
- Bashkir State Medical University, Ufa, Republic of Bashkortostan, Russian Federation
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24
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Outinen TK, Mäkelä S, Huttunen R, Mäenpää N, Libraty D, Vaheri A, Mustonen J, Aittoniemi J. Urine soluble urokinase-type plasminogen activator receptor levels correlate with proteinuria in Puumala hantavirus infection. J Intern Med 2014; 276:387-95. [PMID: 24717117 PMCID: PMC4172514 DOI: 10.1111/joim.12257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Urokinase-type plasminogen activator receptor (uPAR) is upregulated during inflammation and known to bind to β3 -integrins, receptors used by pathogenic hantaviruses to enter endothelial cells. It has been proposed that soluble uPAR (suPAR) is a circulating factor that causes focal segmental glomerulosclerosis and proteinuria by activating β3 -integrin in kidney podocytes. Proteinuria is also a characteristic feature of hantavirus infections. The aim of this study was to evaluate the relation between urine suPAR levels and disease severity in acute Puumala hantavirus (PUUV) infection. DESIGN A single-centre, prospective cohort study. SUBJECTS AND METHODS Urinary suPAR levels were measured twice during the acute phase and once during convalescence in 36 patients with serologically confirmed PUUV infection. Fractional excretion of suPAR (FE suPAR) and of albumin (FE alb) was calculated. RESULTS The FE suPAR was significantly elevated during the acute phase of PUUV infection compared to the convalescent phase (median 3.2%, range 0.8-52.0%, vs. median 1.9%, range 1.0-5.8%, P = 0.005). Maximum FE suPAR was correlated markedly with maximum FE alb (r = 0.812, P < 0.001) and with several other variables that reflect disease severity. There was a positive correlation with the length of hospitalization (r = 0.455, P = 0.009) and maximum plasma creatinine level (r = 0.780, P < 0.001) and an inverse correlation with minimum urinary output (r = -0.411, P = 0.030). There was no correlation between FE suPAR and plasma suPAR (r = 0.180, P = 0.324). CONCLUSION Urinary suPAR is markedly increased during acute PUUV infection and is correlated with proteinuria. High urine suPAR level may reflect local production of suPAR in the kidney during the acute infection.
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Affiliation(s)
- T K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Boehlke C, Hartleben B, Huber TB, Hopfer H, Walz G, Neumann-Haefelin E. Hantavirus Infection With Severe Proteinuria and Podocyte Foot-Process Effacement. Am J Kidney Dis 2014; 64:452-6. [DOI: 10.1053/j.ajkd.2014.04.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/14/2014] [Indexed: 11/11/2022]
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26
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Koskela SM, Laine OK, Paakkala AS, Mäkelä SM, Mustonen JT. Spleen enlargement is a common finding in acute Puumala hantavirus infection and it does not associate with thrombocytopenia. ACTA ACUST UNITED AC 2014; 46:723-6. [DOI: 10.3109/00365548.2014.930967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Khaiboullina SF, Martynova EV, Khamidullina ZL, Lapteva EV, Nikolaeva IV, Anokhin VV, Lombardi VC, Rizvanov AA. Upregulation of IFN-γ and IL-12 is associated with a milder form of hantavirus hemorrhagic fever with renal syndrome. Eur J Clin Microbiol Infect Dis 2014; 33:2149-56. [PMID: 24942310 DOI: 10.1007/s10096-014-2176-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/29/2014] [Indexed: 01/19/2023]
Abstract
Hantavirus hemorrhagic fever with renal syndrome (HFRS) is a zoonotic disease characterized by acute onset, fever, malaise, and back pain. As the disease progresses, hemorrhagic disturbances and kidney dysfunctions predominate. The examination of tissue collected postmortem supports the premise that virus replication is not responsible for this pathology; therefore, it is widely believed that virus-induced immune responses lead to the clinical manifestations associated with HFRS. The overproduction of inflammatory cytokines is commonly reported in subjects with HFRS and has given rise to the hypothesis that a so-called "cytokine storm" may play a pivotal role in the pathogenesis of this disease. Currently, supportive care remains the only effective treatment for HFRS. Our data show that serum levels of interferon (IFN)-γ, interleukin (IL)-10, CCL2, and IL-12 are upregulated in HFRS cases when compared to healthy controls and the level of upregulation is dependent on the phase and severity of the disease. Furthermore, we observed an association between the mild form of the disease and elevated serum levels of IFN-γ and IL-12. Collectively, these observations suggest that the administration of exogenous IFN-γ and IL-12 may provide antiviral benefits for the treatment of HFRS and, thus, warrants further investigations.
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Affiliation(s)
- S F Khaiboullina
- Department of Biochemistry and Molecular Biology, University of Nevada School of Medicine, WPI, 1664 N. Virginia St., MS 0552, Reno, NV, 89557, USA
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Immunogenetic factors affecting susceptibility of humans and rodents to hantaviruses and the clinical course of hantaviral disease in humans. Viruses 2014; 6:2214-41. [PMID: 24859344 PMCID: PMC4036553 DOI: 10.3390/v6052214] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/17/2014] [Accepted: 05/16/2014] [Indexed: 12/11/2022] Open
Abstract
We reviewed the associations of immunity-related genes with susceptibility of humans and rodents to hantaviruses, and with severity of hantaviral diseases in humans. Several class I and class II HLA haplotypes were linked with severe or benign hantavirus infections, and these haplotypes varied among localities and hantaviruses. The polymorphism of other immunity-related genes including the C4A gene and a high-producing genotype of TNF gene associated with severe PUUV infection. Additional genes that may contribute to disease or to PUUV infection severity include non-carriage of the interleukin-1 receptor antagonist (IL-1RA) allele 2 and IL-1β (-511) allele 2, polymorphisms of plasminogen activator inhibitor (PAI-1) and platelet GP1a. In addition, immunogenetic studies have been conducted to identify mechanisms that could be linked with the persistence/clearance of hantaviruses in reservoirs. Persistence was associated during experimental infections with an upregulation of anti-inflammatory responses. Using natural rodent population samples, polymorphisms and/or expression levels of several genes have been analyzed. These genes were selected based on the literature of rodent or human/hantavirus interactions (some Mhc class II genes, Tnf promoter, and genes encoding the proteins TLR4, TLR7, Mx2 and β3 integrin). The comparison of genetic differentiation estimated between bank vole populations sampled over Europe, at neutral and candidate genes, has allowed to evidence signatures of selection for Tnf, Mx2 and the Drb Mhc class II genes. Altogether, these results corroborated the hypothesis of an evolution of tolerance strategies in rodents. We finally discuss the importance of these results from the medical and epidemiological perspectives.
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Neutrophil depletion suppresses pulmonary vascular hyperpermeability and occurrence of pulmonary edema caused by hantavirus infection in C.B-17 SCID mice. J Virol 2014; 88:7178-88. [PMID: 24719427 DOI: 10.1128/jvi.00254-14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Hantavirus infections are characterized by vascular hyperpermeability and neutrophilia. However, the pathogenesis of this disease is poorly understood. Here, we demonstrate for the first time that pulmonary vascular permeability is increased by Hantaan virus infection and results in the development of pulmonary edema in C.B-17 severe combined immunodeficiency (SCID) mice lacking functional T cells and B cells. Increases in neutrophils in the lung and blood were observed when pulmonary edema began to be observed in the infected SCID mice. The occurrence of pulmonary edema was inhibited by neutrophil depletion. Moreover, the pulmonary vascular permeability was also significantly suppressed by neutrophil depletion in the infected mice. Taken together, the results suggest that neutrophils play an important role in pulmonary vascular hyperpermeability and the occurrence of pulmonary edema after hantavirus infection in SCID mice. IMPORTANCE Although hantavirus infections are characterized by the occurrence of pulmonary edema, the pathogenic mechanism remains largely unknown. In this study, we demonstrated for the first time in vivo that hantavirus infection increases pulmonary vascular permeability and results in the development of pulmonary edema in SCID mice. This novel mouse model for human hantavirus infection will be a valuable tool and will contribute to elucidation of the pathogenetic mechanisms. Although the involvement of neutrophils in the pathogenesis of hantavirus infection has largely been ignored, the results of this study using the mouse model suggest that neutrophils are involved in the vascular hyperpermeability and development of pulmonary edema in hantavirus infection. Further study of the mechanisms could lead to the development of specific treatment for hantavirus infection.
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Mustonen J, Mäkelä S, Outinen T, Laine O, Jylhävä J, Arstila PT, Hurme M, Vaheri A. The pathogenesis of nephropathia epidemica: new knowledge and unanswered questions. Antiviral Res 2013; 100:589-604. [PMID: 24126075 DOI: 10.1016/j.antiviral.2013.10.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 01/20/2023]
Abstract
Puumala virus (PUUV) causes an acute hemorrhagic fever with renal syndrome (HFRS), a zoonosis also called nephropathia epidemica (NE). The reservoir host of PUUV is the bank vole (Myodes glareolus). Herein we review the main clinical manifestations of NE, acute kidney injury, increased vascular permeability, coagulation abnormalities as well as pulmonary, cardiac, central nervous system and ocular manifestations of the disease. Several biomarkers of disease severity have recently been discovered: interleukin-6, pentraxin-3, C-reactive protein, indoleamine 2,3-dioxygenase, cell-free DNA, soluble urokinase-type plasminogen activator, GATA-3 and Mac-2 binding protein. The role of cytokines, vascular endothelial growth hormone, complement, bradykinin, cellular immune response and other mechanisms in the pathogenesis of NE as well as host genetic factors will be discussed. Finally therapeutic aspects and directions for further research will be handled.
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Affiliation(s)
- Jukka Mustonen
- School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Abstract
Hantaviruses are negative-sense single-stranded RNA viruses that infect many species of rodents, shrews, moles and bats. Infection in these reservoir hosts is almost asymptomatic, but some rodent-borne hantaviruses also infect humans, causing either haemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS). In this Review, we discuss the basic molecular properties and cell biology of hantaviruses and offer an overview of virus-induced pathology, in particular vascular leakage and immunopathology.
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Outinen TK, Tervo L, Mäkelä S, Huttunen R, Mäenpää N, Huhtala H, Vaheri A, Mustonen J, Aittoniemi J. Plasma levels of soluble urokinase-type plasminogen activator receptor associate with the clinical severity of acute Puumala hantavirus infection. PLoS One 2013; 8:e71335. [PMID: 23990945 PMCID: PMC3749226 DOI: 10.1371/journal.pone.0071335] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Urokinase-type plasminogen activator receptor is a multifunctional glycoprotein, the expression of which is increased during inflammation. It is known to bind to β3-integrins, which are elementary for the cellular entry of hantaviruses. Plasma soluble form of the receptor (suPAR) levels were evaluated as a predictor of severe Puumala hantavirus (PUUV) infection and as a possible factor involved in the pathogenesis of the disease. Design A single-centre prospective cohort study. Subjects and Methods Plasma suPAR levels were measured twice during the acute phase and once during the convalescence in 97 patients with serologically confirmed acute PUUV infection using a commercial enzyme-linked immunosorbent assay (ELISA). Results The plasma suPAR levels were significantly higher during the acute phase compared to the control values after the hospitalization (median 8.7 ng/ml, range 4.0–18.2 ng/ml vs. median 4.7 ng/ml, range 2.4–12.2 ng/ml, P<0.001). The maximum suPAR levels correlated with several variables reflecting the severity of the disease. There was a positive correlation with maximum leukocyte count (r = 0.475, p<0.001), maximum plasma creatinine concentration (r = 0.378, p<0.001), change in weight during the hospitalization (r = 0.406, p<0.001) and the length of hospitalization (r = 0.325, p = 0.001), and an inverse correlation with minimum platelet count (r = −0.325, p = 0.001) and minimum hematocrit (r = −0.369, p<0.001). Conclusion Plasma suPAR values are markedly increased during acute PUUV infection and associate with the severity of the disease. The overexpression of suPAR possibly activates β3-integrin in PUUV infection, and thus might be involved in the pathogenesis of the disease.
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Affiliation(s)
- Tuula K. Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- * E-mail:
| | - Laura Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Niina Mäenpää
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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Elevated cerebrospinal fluid neopterin concentration is associated with disease severity in acute Puumala hantavirus infection. Clin Dev Immunol 2013; 2013:634632. [PMID: 23983770 PMCID: PMC3747491 DOI: 10.1155/2013/634632] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/19/2013] [Indexed: 11/18/2022]
Abstract
Nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) is the most common hemorrhagic fever with renal syndrome (HFRS) in Europe. The infection activates immunological mechanisms that contribute to the pathogenesis and characteristics of the illness. In this study we measured cerebrospinal fluid (CSF) neopterin concentration from 23 acute-phase NE patients. We collected data on kidney function, markers of tissue permeability, haemodynamic properties, blood cell count, length of hospitalisation, inflammatory parameters, and ophthalmological properties. The neopterin levels were elevated (>5.8 nmol/L) in 22 (96%) NE-patients (mean 45.8 nmol/L); these were especially high in patients with intrathecal PUUV-IgM production (mean 58.2 nmol/L, P = 0.01) and those with elevated CSF protein concentrations (mean 63.6 nmol/L, P < 0.05). We also observed a correlation between the neopterin and high plasma creatinine value (r = 0.66, P = 0.001), low blood thrombocyte count (r = −0.42, P < 0.05), and markedly disturbed refractory properties of an eye (r = 0.47, P < 0.05). Length of hospitalisation correlated with the neopterin (r = 0.42, P < 0.05; male patients r = 0.69, P < 0.01). Patients with signs of tissue oedema and increased permeability also had high neopterin concentrations. These results reinforce the view that PUUV-HFRS is a general infection that affects the central nervous system and the blood-brain barrier.
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Antonen J, Leppänen I, Tenhunen J, Arvola P, Mäkelä S, Vaheri A, Mustonen J. A severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant. ACTA ACUST UNITED AC 2013; 45:494-6. [PMID: 23294035 DOI: 10.3109/00365548.2012.755268] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A patient with severe capillary leakage syndrome caused by a Puumala hantavirus infection was treated with a single dose of icatibant, a bradykinin receptor antagonist, with a dramatic positive response. We suggest that this drug should be tested in a larger number of patients with severe hantavirus infection.
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Affiliation(s)
- Jaakko Antonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Sane J, Laine O, Mäkelä S, Paakkala A, Jarva H, Mustonen J, Vapalahti O, Meri S, Vaheri A. Complement activation in Puumala hantavirus infection correlates with disease severity. Ann Med 2012; 44:468-75. [PMID: 21495786 DOI: 10.3109/07853890.2011.573500] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hantaviruses are important human pathogens that cause clinical diseases characterized by renal and cardiopulmonary manifestations. Their pathogenesis is currently poorly understood. We have studied the role of the complement system in the pathogenesis of Puumala (PUUV) hantavirus infection. MATERIAL AND METHODS We studied the activation of complement by measuring the terminal complement complex SC5b-9 and complement component C3 and C4 levels in patients with acute PUUV infection. Several laboratory parameters and clinical findings reflecting the severity of PUUV-HFRS were evaluated with regard to complement activation. RESULTS The levels of SC5b-9 were significantly increased and C3 decreased in the acute stage as compared to the levels at full recovery (P < 0.001). We found that SC5b-9 levels were higher in patients with chest X-ray abnormalities than in patients with a normal X-ray during the acute stage (P = 0.028). Furthermore, SC5b-9 and C3 levels showed significant correlation with several clinical and laboratory parameters that reflect the severity of the acute PUUV infection. CONCLUSIONS We showed that the complement system becomes activated via the alternative pathway in the acute stage of PUUV infection and the level of activation correlates with disease severity. The results further suggest that complement activation may contribute to the pathogenesis of acute PUUV infection.
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Affiliation(s)
- Jussi Sane
- Infection Biology Research Program, Department of Virology, Haartman Institute, University of Helsinki, Finland.
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Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O. Hantavirus infections in Europe and their impact on public health. Rev Med Virol 2012; 23:35-49. [PMID: 22761056 DOI: 10.1002/rmv.1722] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/04/2012] [Accepted: 05/08/2012] [Indexed: 11/09/2022]
Abstract
Hantaviruses (genus Hantavirus, family Bunyaviridae) are enveloped tri-segmented negative-stranded RNA viruses each carried by a specific rodent or insectivore host species. Several different hantaviruses known to infect humans circulate in Europe. The most common is Puumala (PUUV) carried by the bank vole; another two important, genetically closely related ones are Dobrava-Belgrade (DOBV) and Saaremaa viruses (SAAV) carried by Apodemus mice (species names follow the International Committee on Taxonomy of Viruses nomenclature). Of the two hantaviral diseases, hemorrhagic fever with renal syndrome (HFRS) and hantaviral cardiopulmonary syndrome, the European viruses cause only HFRS: DOBV with often severe symptoms and a high case fatality rate, and PUUV and SAAV more often mild disease. More than 10,000 HFRS cases are diagnosed annually in Europe and in increasing numbers. Whether this is because of increasing recognition by the medical community or due to environmental factors such as climate change, or both, is not known. Nevertheless, in large areas of Europe, the population has a considerable seroprevalence but only relatively few HFRS cases are reported. Moreover, no epidemiological data are available from many countries. We know now that cardiac, pulmonary, ocular and hormonal disorders are, besides renal changes, common during the acute stage of PUUV and DOBV infection. About 5% of hospitalized PUUV and 16%-48% of DOBV patients require dialysis and some prolonged intensive-care treatment. Although PUUV-HFRS has a low case fatality rate, complications and long-term hormonal, renal, and cardiovascular consequences commonly occur. No vaccine or specific therapy is in general use in Europe. We conclude that hantaviruses have a significant impact on public health in Europe.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Haartman Institute, and Research Programs Unit, Infection Biology, University of Helsinki, Helsinki, Finland.
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Libraty DH, Mäkelä S, Vlk J, Hurme M, Vaheri A, Ennis FA, Mustonen J. The degree of leukocytosis and urine GATA-3 mRNA levels are risk factors for severe acute kidney injury in Puumala virus nephropathia epidemica. PLoS One 2012; 7:e35402. [PMID: 22523590 PMCID: PMC3327672 DOI: 10.1371/journal.pone.0035402] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/16/2012] [Indexed: 11/29/2022] Open
Abstract
Puumala hantavirus (PUUV) infection, also known as nephropathia epidemica, is the most common cause of hemorrhagic fever with renal syndrome (HFRS) in Europe. The pathogenesis of PUUV nephropathia epidemica is complex and multifactorial, and the risk factors for severe acute kidney injury (AKI) during acute PUUV infection are not well defined. We conducted a prospective study of hospitalized patients with PUUV infection in Tampere, Finland to identify acute illness risk factors for HFRS severity. Serial daily blood and urine samples were collected throughout acute illness and at 2 week and 6 month convalescent visits. By univariate analyses, the maximum white blood cell count during acute illness was a risk factor for severe AKI. There were no significant associations between PUUV-induced AKI severity and platelet counts, C-reactive protein, or alanine aminotransferase levels. Maximum plasma interleukin (IL)-6, urine IL-6, and urine IL-8 concentrations were positively associated with PUUV-induced AKI. Finally, the maximum urinary sediment GATA-3 mRNA level was positively correlated with the peak fold-change in serum creatinine, regardless of AKI severity classification. By multivariate analyses, we found that the maximum levels of leukocytes and urinary sediment GATA-3 mRNA during acute illness were independent risk factors for severe PUUV-induced AKI. We have identified novel acute illness risk factors for severe PUUV-induced AKI.
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Affiliation(s)
- Daniel H Libraty
- Department of Medicine, Medical School, University of Massachusetts, Worcester, Massachusetts, United States of America.
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Outinen TK, Kuparinen T, Jylhävä J, Leppänen S, Mustonen J, Mäkelä S, Pörsti I, Syrjänen J, Vaheri A, Hurme M. Plasma cell-free DNA levels are elevated in acute Puumala hantavirus infection. PLoS One 2012; 7:e31455. [PMID: 22347483 PMCID: PMC3274523 DOI: 10.1371/journal.pone.0031455] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 01/09/2012] [Indexed: 12/27/2022] Open
Abstract
Introduction Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome called nephropathia epidemica (NE). The aim of the present study was to evaluate plasma cell-free DNA (cf-DNA) levels and urinary cf-DNA excretion in acute NE as well as their associations with the severity of the disease. Methods Total plasma cf-DNA was quantified directly in plasma of 61 patients and urine of 20 patients with acute NE. We also carried out a qualitative high-sensitivity lab-on-a-chip DNA assay in 20 patients to elucidate the appearance of cf-DNA in plasma and urine. Results The maximum plasma cf-DNA values taken during acute NE were significantly higher than the control values taken after the hospitalization period (median 1.33 µg/ml, range 0.94–3.29 µg/ml vs. median 0.77 µg/ml, range 0.55–0.99 µg/ml, P<0.001). The maximum plasma cf-DNA levels correlated positively with maximum blood leukocyte count (r = 0.388, P = 0.002) and the length of hospital stay (r = 0.376, P = 0.003), and inversely with minimum blood platelet count (r = −0.297, P = 0.020). Qualitative analysis of plasma cf-DNA revealed that in most of the patients cf-DNA displayed a low-molecular weight appearance, corresponding to the size of apoptotic DNA (150–200 bp). The visually graded maximum cf-DNA band intensity correlated positively with the maximum quantity of total plasma cf-DNA (r = 0.513, P = 0.021). Maximum urinary excretion of cf-DNA in turn was not markedly increased during the acute phase of NE and did not correlate with any of the variables reflecting severity of the disease or with the maximum plasma cf-DNA level. Conclusions The plasma levels of cf-DNA are elevated during acute PUUV infection and correlate with the apoptotic cf-DNA-band intensity. The plasma cf-DNA concentration correlates with some variables reflecting the severity of the disease. The urinary excretion of cf-DNA does not reflect the degree of inflammation in the kidney.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Cytokine expression during early and late phase of acute Puumala hantavirus infection. BMC Immunol 2011; 12:65. [PMID: 22085404 PMCID: PMC3259039 DOI: 10.1186/1471-2172-12-65] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/16/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hantaviruses of the family Bunyaviridae are emerging zoonotic pathogens which cause hemorrhagic fever with renal syndrome (HFRS) in the Old World and hantavirus pulmonary syndrome (HPS) in the New World. An immune-mediated pathogenesis is discussed for both syndromes. The aim of our study was to investigate cytokine expression during the course of acute Puumala hantavirus infection. RESULTS We retrospectively studied 64 patients hospitalised with acute Puumala hantavirus infection in 2010 during a hantavirus epidemic in Germany. Hantavirus infection was confirmed by positive anti-hantavirus IgG/IgM. Cytokine expression of IL-2, IL-5, IL-6, IL-8, IL-10, IFN-γ, TNF-α and TGF-β1 was analysed by ELISA during the early and late phase of acute hantavirus infection (average 6 and 12 days after onset of symptoms, respectively). A detailed description of the demographic and clinical presentation of severe hantavirus infection requiring hospitalization during the 2010 hantavirus epidemic in Germany is given. Acute hantavirus infection was characterized by significantly elevated levels of IL-2, IL-6, IL-8, TGF-β1 and TNF-α in both early and late phase compared to healthy controls. From early to late phase of disease, IL-6, IL-10 and TNF-α significantly decreased whereas TGF-β1 levels increased. Disease severity characterized by elevated creatinine and low platelet counts was correlated with high pro-inflammatory IL-6 and TNF-α but low immunosuppressive TGF-β1 levels and vice versa . CONCLUSION High expression of cytokines activating T-lymphocytes, monocytes and macrophages in the early phase of disease supports the hypothesis of an immune-mediated pathogenesis. In the late phase of disease, immunosuppressive TGF-β1 level increase significantly. We suggest that delayed induction of a protective immune mechanism to downregulate a massive early pro-inflammatory immune response might contribute to the pathologies characteristic of human hantavirus infection.
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Outinen TK, Mäkelä S, Huhtala H, Hurme M, Meri S, Pörsti I, Sane J, Vaheri A, Syrjänen J, Mustonen J. High pentraxin-3 plasma levels associate with thrombocytopenia in acute Puumala hantavirus-induced nephropathia epidemica. Eur J Clin Microbiol Infect Dis 2011; 31:957-63. [PMID: 21901638 DOI: 10.1007/s10096-011-1392-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 08/18/2011] [Indexed: 12/18/2022]
Abstract
Our aim was to investigate whether plasma levels of the long pentraxin-3 (PTX3) associate with the severity of Puumala hantavirus-induced nephropathia epidemica (NE). Sixty-one prospectively identified consecutively hospitalized NE patients were examined. Plasma PTX3, interleukin (IL)-6, terminal complement complex SC5b-9, complement component C3, C-reactive protein (CRP), creatinine, sodium, kynurenine, and tryptophan levels, as well as the blood cell count, were determined for up to five consecutive days after hospitalization. Receiver operating characteristic (ROC) analysis revealed that the maximum PTX3 level >101.6 ng/ml (high PTX3) showed a sensitivity of 71% and a specificity of 89% for detecting platelet level <50 × 10(9)/l, with an area under the curve (AUC) value of 0.78 (95% confidence interval [CI] 0.63-0.94). High PTX3 level was also associated with several other variables reflecting the severity of the disease: patients with high PTX3 level had higher maximum blood leukocyte (16.1 vs. 9.7 × 10(9)/l, p < 0.001), plasma IL-6 (16.9 vs. 9.0 pg/ml, p = 0.007), and creatinine (282 vs. 124 μmol/l, p = 0.007) levels than patients with low maximum PTX3 level. They also had longer hospital stays (8 vs. 5 days, p = 0.015) compared to patients with low PTX3 level. High plasma PTX3 levels are associated with thrombocytopenia and the overall severity of NE.
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Affiliation(s)
- T K Outinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.
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Pathogenic old world hantaviruses infect renal glomerular and tubular cells and induce disassembling of cell-to-cell contacts. J Virol 2011; 85:9811-23. [PMID: 21775443 DOI: 10.1128/jvi.00568-11] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Viral hemorrhagic fevers are characterized by enhanced permeability. One of the most affected target organs of hantavirus-induced hemorrhagic fever with renal syndrome is the kidney, and an infection often results in acute renal failure. To study the underlying cellular effects leading to kidney dysfunction, we infected human renal cell types in vitro that are critical for the barrier functions of the kidney, and we examined kidney biopsy specimens obtained from hantavirus-infected patients. We analyzed the infection and pathogenic effects in tubular epithelial and glomerular endothelial renal cells and in podocytes. Both epithelial and endothelial cells and podocytes were susceptible to hantavirus infection in vitro. The infection disturbed the structure and integrity of cell-to-cell contacts, as demonstrated by redistribution and reduction of the tight junction protein ZO-1 and the decrease in the transepithelial resistance in infected epithelial monolayers. An analysis of renal biopsy specimens from hantavirus-infected patients revealed that the expression and the localization of the tight junction protein ZO-1 were altered compared to renal biopsy specimens from noninfected individuals. Both tubular and glomerular cells were affected by the infection. Furthermore, the decrease in glomerular ZO-1 correlates with disease severity induced by glomerular dysfunction. The finding that different renal cell types are susceptible to hantaviral infection and the fact that infection results in the breakdown of cell-to-cell contacts provide useful insights in hantaviral pathogenesis.
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Hantavirus infection—Hemorrhagic fever with renal syndrome: the first case series reported in Romania and review of the literature. Int Urol Nephrol 2011; 44:1185-91. [DOI: 10.1007/s11255-011-0013-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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Klingström J, Ahlm C. Hantavirus protein interactions regulate cellular functions and signaling responses. Expert Rev Anti Infect Ther 2011; 9:33-47. [PMID: 21171876 DOI: 10.1586/eri.10.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Rodent-borne pathogenic hantaviruses cause two severe and often lethal zoonotic diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Currently, no US FDA-approved therapeutics or vaccines are available for HFRS/HCPS. Infections with hantaviruses are not lytic, and it is currently not known exactly why infections in humans cause disease. A better understanding of how hantaviruses interfere with normal cell functions and activation of innate and adaptive immune responses might provide clues to future development of specific treatment and/or vaccines against hantavirus infection. In this article, the current knowledge regarding immune responses observed in patients, hantavirus interference with cellular proteins and signaling pathways, and possible approaches in the development of therapeutics are discussed.
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Affiliation(s)
- Jonas Klingström
- Centre for Microbiological Preparedness, Swedish Institute for Infectious Disease Control, Solna, Sweden.
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De La Torre M, Arboleya L, Pozo S, Pinto J, Velasco J. Rapid and sustained response to tocilizumab, anti-interleukin-6 receptor antibody, in a patient with nephrotic syndrome secondary to systemic juvenile idiopathic arthritis-related amyloidosis. NDT Plus 2011; 4:178-80. [PMID: 25984151 PMCID: PMC4421601 DOI: 10.1093/ndtplus/sfr004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 01/10/2011] [Indexed: 01/17/2023] Open
Abstract
AA amyloidosis, or secondary amyloidosis, is a rare but serious complication of chronic inflammatory diseases. Chronic inflammatory arthritis is the commonest cause of AA amyloidosis and, when the latter appears, treatment can be frustrating. Deposition of fibrils, derived from circulating acute-phase reactant serum amyloid A protein (SAA), in the kidneys can lead to proteinuria and progressive loss of renal function. We describe the case of a 14-year-old female with systemic juvenile idiopathic arthritis who developed nephrotic syndrome secondary to AA amyloidosis; while she was unresponsive to all measures, including anti-tumour necrosis factor therapy, treatment with tocilizumab, an anti-human interleukin-6 receptor antibody, immediately normalized the SAA and reversed the nephrotic syndrome. We discuss this new therapeutic approach.
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Affiliation(s)
| | - Luis Arboleya
- Rheumatology Services, Hospital San Agustin, Avilés, Asturias, Spain
| | - Sergio Pozo
- Nephrology Services, Hospital San Agustin, Avilés, Asturias, Spain
| | - Jesús Pinto
- Pathology Services, Hospital San Agustin, Avilés, Asturias, Spain
| | - Julio Velasco
- Pathology Services, Hospital San Agustin, Avilés, Asturias, Spain
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Huttunen NP, Mäkelä S, Pokka T, Mustonen J, Uhari M. Systematic literature review of symptoms, signs and severity of serologically confirmed nephropathia epidemica in paediatric and adult patients. ACTA ACUST UNITED AC 2011; 43:405-10. [DOI: 10.3109/00365548.2011.559666] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Outinen TK, Mäkelä SM, Ala-Houhala IO, Huhtala HS, Hurme M, Paakkala AS, Pörsti IH, Syrjänen JT, Mustonen JT. The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations. BMC Infect Dis 2010; 10:132. [PMID: 20500875 PMCID: PMC2885391 DOI: 10.1186/1471-2334-10-132] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/25/2010] [Indexed: 12/16/2022] Open
Abstract
Background Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE. Methods A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high. Results We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 vs 9.0 × 109/l, P = 0.001) and urinary protein excretion (2.51 vs 1.68 g/day, P = 0.017), as well as a lower minimum blood platelet count (55 vs 80 × 109/l, P < 0.001), hematocrit (0.34 vs 0.38, P = 0.001), and urinary output (1040 vs 2180 ml/day, P < 0.001). They also stayed longer in hospital than patients with low IL-6 (8 vs 6 days, P < 0.001). In contrast, high CRP did not associate with severe disease. Conclusions High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, POBox 2000, Tampere, FI-33521, Finland.
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Jiang H, Wang PZ, Zhang Y, Xu Z, Sun L, Wang LM, Huang CX, Lian JQ, Jia ZS, Li ZD, Bai XF. Hantaan virus induces toll-like receptor 4 expression, leading to enhanced production of beta interferon, interleukin-6 and tumor necrosis factor-alpha. Virology 2008; 380:52-9. [DOI: 10.1016/j.virol.2008.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 06/13/2008] [Accepted: 07/01/2008] [Indexed: 11/17/2022]
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Abstract
Hantaviruses are globally important human pathogens that cause hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. Capillary leakage is central to hantaviral diseases, but how it develops, has remained unknown. It has been hypothesized that the pathogenesis of hantavirus infection would be a complex interplay between direct viral effects and immunopathological mechanisms. Both of these were studied in the so far best model of mild hemorrhagic fever with renal syndrome, i.e. cynomolgus macaques infected with wild-type Puumala hantavirus. Viral RNA detected by in situ hybridization and nucleocapsid protein detected by immunohistochemical staining were observed in kidney, spleen and liver tissues. Inflammatory cell infiltrations and tubular damage were found in the kidneys, and these infiltrations contained mainly CD8-type T-cells. Importantly, these results are consistent with those obtained from patients with hantaviral disease, thus showing that the macaque model of hantavirus infection mimics human infection also on the tissue level. Furthermore, both the markers of viral replication and the T-cells appeared to co-localize in the kidneys to the sites of tissue damage, suggesting that these two together might be responsible for the pathogenesis of hantavirus infection.
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Krautkrämer E, Zeier M. [Emerging zoonoses: Hantavirus infections]. DER NEPHROLOGE 2007; 3:8-13. [PMID: 32288846 PMCID: PMC7104139 DOI: 10.1007/s11560-007-0125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among the emerging viruses, hantaviruses are being focused on more and more due to their increasing number and worldwide distribution. Transmission occurs via inhalation of aerosolized infected rodent excreta. The symptoms and course of disease vary with the infecting hantavirus species. The distribution of the different hantavirus species correlates with the geographical distribution of the virus-type-specific rodent host. Hantaviruses in Europe and Asia cause hemorrhagic fever with renal syndrome (HFRS). Infection with Puumala, the prevalent virus type in Germany, results in a more moderate form of HFRS, nephropathia epidemica. Infections with virus species on the American continents lead to a clinical picture with predominantly pulmonary pathology (hantaviral pulmonary syndrome). No specific antiviral therapy or approved vaccines are available for any hantavirus species. Controlling the rodent populations and avoiding contact with rodent excrement are the only measures that can be undertaken to contain and prevent infection.
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Affiliation(s)
- E. Krautkrämer
- Nephrologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Deutschland
| | - M. Zeier
- Nephrologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Deutschland
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