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Taglauer E, Benarroch Y, Rop K, Barnett E, Sabharwal V, Yarrington C, Wachman EM. Consistent localization of SARS-CoV-2 spike glycoprotein and ACE2 over TMPRSS2 predominance in placental villi of 15 COVID-19 positive maternal-fetal dyads. Placenta 2020; 100:69-74. [PMID: 32862058 PMCID: PMC7445146 DOI: 10.1016/j.placenta.2020.08.015] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION While the COVID-19 pandemic continues to have a significant global health impact, rates of maternal to infant vertical transmission remain low (<5%). Parenchymal changes of placentas from COVID-19 infected mothers have been reported by several groups, but the localization and relative abundance of SARS-CoV-2 viral proteins and cellular entry machinery has not been fully characterized within larger placental tissue cohorts. METHODS An extended placental tissue cohort including samples from 15 COVID-19 positive maternal-fetal dyads (with n = 5 cases with evidence of fetal transmission) in comparison with 10 contemporary COVID-19 negative controls. Using comparative immunofluorescence, we examined the localization and relative tissue abundance of SARS-CoV2 spike glycoprotein (CoV2 SP) along with the co-localization of two SARS-CoV2 viral entry proteins angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). RESULTS/CONCLUSIONS CoV2 SP was present within the villous placenta in COVID-19 positive pregnancies with and without evidence of fetal transmission. We further identified the predominance of ACE2 expression in comparison with TMPRSS2. Importantly, both CoV2 SP and ACE2 expression consistently localized primarily within the outer syncytiotrophoblast layer placental villi, a key physiologic interface between mother and fetus. Overall this study provides an important basis for the ongoing evaluation of SARS-CoV-2 physiology in pregnancy and highlights the importance of the placenta as a key source of primary human tissue for ongoing diagnostic and therapeutic research efforts to reduce the global burden of COVID-19.
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Affiliation(s)
- Elizabeth Taglauer
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Yoel Benarroch
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Kevin Rop
- Department of Pathology, Boston University School of Medicine, 670 Albany Street, Boston, MA, 02119, USA
| | - Elizabeth Barnett
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA, 02119, USA.
| | - Vishakha Sabharwal
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA, 02119, USA.
| | - Christina Yarrington
- Departmentof Obstetrics and Gynecology, Boston Medical Center, 720 Harrison Avenue, Boston, MA, 02118, USA.
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA, 02119, USA.
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Roulet V, Satie AP, Ruffault A, Le Tortorec A, Denis H, Guist'hau O, Patard JJ, Rioux-Leclerq N, Gicquel J, Jégou B, Dejucq-Rainsford N. Susceptibility of human testis to human immunodeficiency virus-1 infection in situ and in vitro. THE AMERICAN JOURNAL OF PATHOLOGY 2007; 169:2094-103. [PMID: 17148672 PMCID: PMC1762481 DOI: 10.2353/ajpath.2006.060191] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Semen represents the main vector for human immunodeficiency virus (HIV) dissemination worldwide and has been shown to harbor replication-competent virus despite otherwise effective highly active anti-retroviral therapy, which achieves undetectable viral load in plasma. Despite this, the origin of seminal HIV particles remains unclear, as does the question of whether the male genital tract organs contribute virus to semen. Here we investigated the presence of HIV receptors within the human testis using immunohistochemistry and quantitative real-time polymerase chain reaction. We also analyzed the infectivity of a dual tropic HIV-1 strain in an organotypic culture, as well as the impact of viral exposure on testosterone production. Our study establishes that CXCR4+, CCR5+, CD4+, and DC-SIGN+ cells are present within the interstitial tissue of human testis and that these molecules persist throughout our organotypic culture. Our data also reveal that the human testis is permissive to HIV-1 and supports productive infection, leaving testosterone production apparently unaffected. Infected cells appeared to be testicular macrophages located within the interstitial tissue. That the testis itself represents a potential source of virus in semen could play a role in preventing viral eradication from semen because this organ constitutes a pharmacological sanctuary for many current antiretrovirals.
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Affiliation(s)
- Vanessa Roulet
- INSERM U625-GERHM, Campus Scientifique de Beaulieu, Avenue du Général Leclerc, 35 042 Rennes Cedex, France
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3
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Arias RA, Muñoz LD, Muñoz-Fernández MA. Transmission of HIV-1 infection between trophoblast placental cells and T-cells take place via an LFA-1-mediated cell to cell contact. Virology 2003; 307:266-77. [PMID: 12667796 DOI: 10.1016/s0042-6822(02)00040-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-1 vertical transmission is thought to mainly take place by virus crossing the placental barrier. However, the mechanism by which HIV-1-infects placental cells remains to be elucidated. We have found that purified cytotrophoblasts as well as trophoblastic cell lines are susceptible to infection by different HIV-1 isolates as detected by DNA-PCR and release of infectious virus, although with very low efficiency. Purified trophoblast or trophoblastic cell lines express low levels of chemokine receptors CCR-5 and CXCR-4 but not CD4 on the cell surface. To test if those molecules were used as receptors for HIV-1 infection, placental cells were pretreated with antibodies to CD4, CC-chemokines, C-X-C chemokines. None of those treatments inhibited HIV-1 infection. In contrast, we have found that HIV-1 infection of placental cells was increased in cocultures of infected T-cell blasts and placental cells. More interestingly, antibodies to beta(2) integrins and to LFA-1 were able to significantly block infection of placental cells. Cell surface expression of ICAM-1, an adhesion molecule involved in attachment of leukocytes to placenta, was upregulated in HIV-1-infected placental cells. Placental cells were able to transfer HIV-1 infection to T-cell blasts. This transmission required cell to cell contact and was also inhibited by anti-LFA-1 antibodies. In summary our results suggest that placental trophoblast could be infected by HIV-1 by a mechanism involving T cell to placental contact. Moreover, placental infection enhanced ICAM-1 expression and leukocyte adherence, an event which was required to transfer HIV-1 infection to T cells. This provides an explanation of the virus passing through the placental barrier during in utero HIV-1 vertical transmission.
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Affiliation(s)
- Rebeca Alonso Arias
- Department of Immunology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tóth FD, Bácsi A, Beck Z, Szabó J. Vertical transmission of human immunodeficiency virus. Acta Microbiol Immunol Hung 2002; 48:413-27. [PMID: 11791341 DOI: 10.1556/amicr.48.2001.3-4.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sensitive detection methods, such as DNA PCR and RNA PCR suggest that vertical transmission of human immunodeficiency virus (HIV) occurs at three major time periods; in utero, around the time of birth, and postpartum as a result of breastfeeding (Fig. 1). Detection of proviral DNA in infant's blood at birth suggests that transmission occurred prior to delivery. A working definition for time of infection is that HIV detection by DNA PCR in the first 48 h of life indicates in utero transmission, while peripartum transmission is considered if DNA PCR is negative the first 48 h, but then it is positive 7 or more days later [1]. Generally, in the breastfeeding population, breast milk transmission is thought to occur if virus is not detected by PCR at 3-5 months of life but is detected thereafter within the breastfeeding period [2]. Using these definitions and guidelines, studies has suggested that in developed countries the majority, or two thirds of vertical transmission occur peripartum, and one-third in utero [3-6]. The low rate of breastfeeding transmission is due to the practice of advising known HIV-positive mothers not to feed breast milk. However, since the implementation of antiretroviral treatment in prophylaxis of HIV-positive mothers, some studies have suggested that in utero infection accounts for a larger percentage of vertical transmissions [7]. In developing countries, although the majority of infections occurs also peripartum, a significant percentage, 10-17%, is thought to be due to breastfeeding [2, 8, 9].
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Affiliation(s)
- F D Tóth
- Institute of Microbiology, Medical and Health Science Center, University of Debrecen, Nagyerdei krt. 98, H-4012 Debrecen, Hungary
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5
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Al-Harthi L, Guilbert LJ, Hoxie JA, Landay A. Trophoblasts are productively infected by CD4-independent isolate of HIV type 1. AIDS Res Hum Retroviruses 2002; 18:13-7. [PMID: 11804552 DOI: 10.1089/088922202753394673] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evidence for HIV-1 infection of trophoblasts is discordant. Utilizing highly purified full-term trophoblasts, we demonstrate that full-term trophoblasts express CXCR4 but are negative for CCR5 and CD4 cell surface proteins. Full-term trophoblasts were refractory to infection by HIV-1 IIIB and primary isolates of HIV-1. However, full-term trophoblasts could be infected by a CD4-independent, CXCR4-utilizing HIV-1 strain, as demonstrated by substantial p24 (5.5 ng/ml) levels and HIV-1 gag/pol DNA content (3050 copies/microg) 7 days postinfection. These data illustrate that trophoblasts express the essential host factors for productive HIV-1 infection and that the block to HIV-1 infection may be at the level of entry. In additional, our data suggest that CD4-independent mechanisms of infection may play a role in promoting in utero HIV-1 transmission.
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Affiliation(s)
- Lena Al-Harthi
- Department of Immunology/Microbiology, Rush-Presbyterian-St. Luke's Medical Center, Rush University, Chicago, Illinois 60612, USA.
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Bácsi A, Ebbesen P, Szabó J, Beck Z, Andirkó I, Csoma E, Tóth FD. Pseudotypes of vesicular stomatitis virus-bearing envelope antigens of certain HIV-1 strains permissively infect human syncytiotrophoblasts cultured in vitro: implications for in vivo infection of syncytiotrophoblasts by cell-free HIV-1. J Med Virol 2001; 64:387-97. [PMID: 11468721 DOI: 10.1002/jmv.1063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrauterine infection of the fetus is clearly an important mode of vertical transmission of human immunodeficiency virus type 1 (HIV-1). The syncytiotrophoblast layer of the human placenta must be traversed by HIV-1 in order to reach underlying cells and fetal capillaries. Although HIV-1 has been detected in the syncytiotrophoblast layer in situ, there is conflicting evidence regarding infection of syncytiotrophoblast cells with cell-free virus. The phenotypic mixing between HIV-1 and vesicular stomatitis virus (VSV) has been exploited to assay the susceptibility of human term syncytiotrophoblast cells to penetration by various strains of HIV-1. VSV(HIV-1(IIIB)) and VSV(HIV-1(Ba-L)) pseudotypes were found to enter syncytiotrophoblast cells. In contrast, VSV pseudotyped with envelope glycoproteins of RF, MN, or Ada-M strains of HIV-1 did not infect syncytiotrophoblasts. Plating efficiency of VSV(HIV-1(IIIB)) and VSV(HIV-1(Ba-L)) was 10-fold lower on syncytiotrophoblasts than on T-cells and macrophages, respectively. Incubation of VSV(HIV-1(IIIB)) and VSV(HIV-1(Ba-L)) viruses with appropriate HIV-1 neutralizing sera before infection strongly inhibited entry of pseudotyped VSV into syncytiotrophoblast cells. These findings demonstrated that infection of syncytiotrophoblasts with VSV(HIV-1) pseudotypes was mediated by Env from IIIB and Ba-L strains of HIV-1. Monoclonal antibodies (MAb) to CD4, CXCR4, CCR5, and CCR3 were tested for their ability to block VSV(HIV-1) infection of syncytiotrophoblast cells. Neither the anti-CD4 nor the anti-CXCR4, anti-CCR5, and anti-CCR3 MAb had any inhibitory effect on infection of syncytiotrophoblast cells with VSV(HIV-1) pseudotypes. Results from this study suggest that cell-free HIV-1 can enter syncytiotrophoblasts and the susceptibility of these cells to penetration by the virus is strain dependent. Pseudotype infection merely demonstrates that the first steps in HIV-1 replication are possible in syncytiotrophoblast cells.
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Affiliation(s)
- A Bácsi
- Institute of Microbiology, University Medical School, Debrecen, Hungary
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7
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Douglas GC, Thirkill TL, LaSalle J. Automated quantitation of cell-mediated HIV type 1 infection of human syncytiotrophoblast cells by fluorescence in situ hybridization and laser scanning cytometry. AIDS Res Hum Retroviruses 2001; 17:507-16. [PMID: 11350664 DOI: 10.1089/08892220151126562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Infection of human placental syncytiotrophoblast cells with HIV requires direct contact with infected leukocytes. In vitro investigations into mechanisms regulating placental HIV transmission and into the development of therapeutic interventions have been hampered by difficulties inherent in quantitating HIV levels in cocultures of infected lymphocytes and adherent multinucleated syncytiotrophoblast cells. Here, we have used fluorescence in situ hybridization (FISH) for the direct detection of HIV-1 RNA within syncytiotrophoblast cells combined with laser scanning cytometry (LSC) to quantitate HIV levels exclusively in the syncytiotrophoblast cells. HIV-1-infected lymphocytic MOLT-4 cells were cocultured with primary human syncytiotrophoblast cells. Lymphocytic cells were identified with an anti-vimentin antibody and Cy5. HIV RNA was localized by in situ hybridization, using a digoxigenin-labeled riboprobe detected by Oregon Green, and nuclei were stained with 7-aminoactinomycin D. The three-color cocultures were analyzed by LSC to remove unwanted cell populations and quantitate HIV expression levels. The total HIV RNA level (green fluorescence integral) in each colony was normalized for cell size by dividing by the total DNA content (red fluorescence integral). The nuclear-normalized fluorescence integral was 2.3 times higher in infected cocultures than in uninfected cultures. When cocultures were incubated with 10 microM AZT, the green/red fluorescence integral value was significantly lower than that of cocultures incubated in the absence of AZT, corresponding to a 78% reduction in fluorescence. Laser scanning cytometry can be used to quantitate cell-mediated HIV infection in syncytiotrophoblast cells and should allow drug assessment studies and studies aimed at understanding the mechanism of virus entry into trophoblast cells to be carried out.
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Affiliation(s)
- G C Douglas
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, California 95616, USA.
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Anderson V, Carneiro M, Bulterys M, Douglas G, Polliotti B, Slikker W. Perinatal infections: HIV and co-infections in the placenta and therapeutic interventions-a workshop report. Placenta 2001; 22 Suppl A:S34-7. [PMID: 11312626 DOI: 10.1053/plac.2001.0641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- V Anderson
- Department of Pathology, SUNY-HSC at Brooklyn, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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9
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Abstract
Knowledge of chemokine receptor expression by human syncytiotrophoblast has important implications for our understanding of maternal-fetal HIV transmission as well as for understanding the regulation of placental growth and development. This review discusses what is known about chemokine receptor expression by trophoblast and other placental cells. In addition, new data are presented showing that CXCR4 is expressed on the syncytiotrophoblast surface. In other new studies, leukocyte-mediated HIV-1Lai(an X4 strain) infection of syncytiotrophoblast cultures was reduced when stromal derived factor-1alpha was added to the cocultures, consistent with a role for CXCR4. The available information on chemokine receptor expression by trophoblast is discussed in terms of the apparent selective transmission of R5 strains. Studies in other systems indicate that caution must be used in predicting chemokine receptor usage by different HIV isolates, particularly when the route of infection is cellmediated.
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Affiliation(s)
- G C Douglas
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA 95616-8643, USA.
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10
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Douglas GC, Thirkill TL, Sideris V, Rabieh M, Trollinger D, Nuccitelli R. Chemokine receptor expression by human syncytiotrophoblast. J Reprod Immunol 2001; 49:97-114. [PMID: 11164896 DOI: 10.1016/s0165-0378(00)00083-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite their potential importance in placental HIV infection and placental immune function, nothing is known about the expression of chemokine receptors by human syncytiotrophoblast cells. Immunocytochemical analysis revealed that primary cultures of term syncytiotrophoblast cells express CCR1, CCR3, CXCR4, and CCR6. Immunohistochemical examination of cryosections of term placental villous tissue confirmed the expression of CCR3, CXCR4, and CCR6 by trophoblast cells. The primary syncytiotrophoblast cultures showed no reactivity with antibodies against CCR5. In the villous tissue sections, CCR5 was detected in stromal cells and blood vessel walls but was not found in trophoblast cells. RT-PCR analysis of RNA extracted from cultured syncytiotrophoblast cells confirmed that the cells express message for CCR1, CCR3, CXCR4, CCR6 and CCR10. No transcripts corresponding to CCR2b, CCR5, or CCR8 were detected. Other experiments showed that exposure of syncytiotrophoblast cells to soluble SDF-1alpha elicited a calcium mobilization response, consistent with the expression of functional CXCR4. Thus, human syncytiotrophoblast cells express CXCR4, a known co-receptor for TCL-tropic HIV-1 isolates but do not express CCR5, the major co-receptor for M-tropic isolates. In addition to implications for the maternal-fetal transmission of HIV, the expression of chemokine receptors by syncytiotrophoblast cells could be important in other aspects of placental immune function.
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Affiliation(s)
- G C Douglas
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Tupper Hall, Davis, CA 95616-8643, USA.
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Mognetti B, Moussa M, Croitoru J, Menu E, Dormont D, Roques P, Chaouat G. HIV-1 co-receptor expression on trophoblastic cells from early placentas and permissivity to infection by several HIV-1 primary isolates. Clin Exp Immunol 2000; 119:486-92. [PMID: 10691921 PMCID: PMC1905586 DOI: 10.1046/j.1365-2249.2000.01149.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/1999] [Indexed: 02/01/2023] Open
Abstract
We examined CD4 and major HIV-1 co-receptor expression by trophoblast cells (TC) from early placentas, and the permissiveness of TC for infection by several natural HIV-1 isolates in vitro. Ten early placentas (4-6 weeks of gestation) from HIV- women were obtained after elective abortion. CD4 and HIV-1 co-receptor expression by TC was examined in terms of both mRNA and protein. The same TC were then challenged with three clinical HIV isolates of known phenotype, two originating from mothers who transmitted the virus to their child and one from a vertically infected newborn. TC infection was detected by polymerase chain reaction. CD4 expression was detected in five of the 10 placentas, while membrane protein expression of CCR3, CXCR4 and CCR5 was detected in every case, despite quantitative differences among individuals. Bonzo, GPR1 and ChemR23 mRNAs were detected in all TC preparations. TC from seven out of eight placentas were permissive to HIV entry, but no productive viral replication was detected (reverse transcriptase activity in culture supernatants). Interestingly, the addition of chemokine(s) or a CD4-blocking antibody to the cultures failed to inhibit TC virus entry. These data point to marked interindividual variability in HIV co-receptor expression by trophoblast cells and show that TC from early placentas can be infected in vitro by clinical HIV-1 isolates. They also suggest that viral entry in vitro might occur through a mechanism independent of both CD4 and chemokine receptors.
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Affiliation(s)
- B Mognetti
- Laboratoire de Biologie de la Relation Materno-foetale, Inserm U131, Hôpital A. Béclère, Clamart, France
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Zachar V, Zacharova V, Fink T, Thomas RA, King BR, Ebbesen P, Jones TB, Goustin AS. Genetic analysis reveals ongoing HIV type 1 evolution in infected human placental trophoblast. AIDS Res Hum Retroviruses 1999; 15:1673-83. [PMID: 10606090 DOI: 10.1089/088922299309711] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To provide a better understanding of the role of placenta in vertical human immunodeficiency virus (HIV) transmission, we have studied the infection of placental trophoblast in a group of 15 mother-neonate pairs. By nested PCR amplification of the C2V3 env gene region, HIV-1 has been found to infect the placenta in five cases (33%). Phylogenetic analysis of the cloned sequences showed that all recovered maternal variants were of the B subtype. Further investigation into the ancestral relationships at the nucleotide level revealed that the trophoblast sequences evolved into a quasispecies population clearly distant from that observed in the mother. As expected, the populations transmitted to the trophoblast were also found to be more homogeneous than those in the mothers when characterized on the basis of pairwise nucleotide sequence distances. With regard to the predicted biological properties, the primary amino acid structure of the V3 loop domain was consistent, with a macrophage-tropic, non-syncytium-inducing phenotype in all patients. We also attempted to determine if any of a number of selected maternal or viral factors was associated with trophoblast infection. However, none of the followed parameters, including maternal age, disease stage, antiretroviral therapy, CCR5delta32 deletion status of the infant, and viral genotype, could be associated with viral transmission. Moreover, in one pair with proven trophoblast infection, HIV was also detected in the cord blood. Taken together, our data suggest that the productive trophoblast infection by HIV-1 in vivo is a relatively frequent event that may bear direct implications for a further transplacental propagation of the virus.
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Affiliation(s)
- V Zachar
- Department of Virus and Cancer, Danish Cancer Society, Aarhus.
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Douglas GC, Fazely F, Hu JJ. Transmission of HIV to the placenta, fetus and mother and implications of gametic infection. J Reprod Immunol 1998; 41:321-9. [PMID: 10213320 DOI: 10.1016/s0165-0378(98)00068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Therapeutic interventions and public education are reducing pediatric AIDS cases in developed countries, but the number of HIV-infected women and children is still a major global concern. The finding that human sperm-associated HIV can be transmitted to oocytes following in vitro fertilization provides a novel viewpoint from which to consider not only the problem of HIV transmission to children but also transmission to women. In the present paper we will first discuss some recent findings that offer new perspectives on the role of the placenta, and particularly the trophoblast, in maternal-fetal transmission of HIV. Results will be presented showing that cell-mediated infection of syncytiotrophoblast cells requires direct contact between infected lymphocytes and trophoblast. We will also discuss possible routes of transmission of HIV to both mothers and their offspring in the light of data providing evidence of gametic infection. These hypothetical routes include trophoblast-mediated infection of maternal uterine cells during implantation and trophoblast-mediated infection of maternal blood cells during pregnancy. Clearly, more studies are needed in order to assess the significance and relative contribution of these routes in the transmission of HIV.
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Affiliation(s)
- G C Douglas
- Department of Cell Biology, School of Medicine, University of California, Davis 95616-8643, USA.
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Ladner J, Leroy V, Hoffman P, Nyiraziraje M, De Clercq A, Van de Perre P, Dabis F. Chorioamnionitis and pregnancy outcome in HIV-infected African women. Pregnancy and HIV Study Group. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1998; 18:293-8. [PMID: 9665509 DOI: 10.1097/00042560-199807010-00015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the role of chorioamnionitis (CAM) on pregnancy outcome in HIV-1-infected (HIV-positive) pregnant women, treated for sexually transmitted diseases (STDs), during the last trimester of pregnancy in Kigali, Rwanda. METHODS At inclusion in a prospective cohort, from July 1992 to August 1993, 561 pregnant women between 24 and 28 weeks were systematically screened for HIV infection, STDs, anemia, malaria, and hepatitis B infection; a CD4 lymphocyte count was performed. Until delivery, each woman enrolled had a monthly clinical follow-up with STD treatment when needed. The pregnancy outcome was recorded. Diagnosis of CAM was based on histologic examination of the placenta. RESULTS Among the 275 placentas of HIV-negative women and 286 placentas of HIV-positive women examined, CAM was diagnosed (CAM-positive) in 27 HIV-positive women (9.8%) and in 28 HIV-negative women (9.8%). No statistical association was found between CAM and the following variables, independent of the HIV serostatus: age, parity, hepatitis B, anemia, STDs, and immune deficiency. Among HIV-negative women, CAM was significantly associated with prematurity (relative risk [RR] = 3.0; 95% confidence interval [CI] = 1.5-6.3), stillbirth (RR = 4.2; 95% CI = 1.6-11.0) and premature rupture of membranes (RR = 2.9; 95% CI = 1.4-6.1). Among HIV-positive women, early neonatal mortality was the only adverse outcome associated with CAM (RR = 2.0; 95% CI = 1.6-11.0). CONCLUSIONS In our study, the prevalence of CAM was low and no risk factor of CAM was identified, a probable consequence of the control factor of STDs. CAM was strongly associated with adverse pregnancy outcomes in HIV-infected women, reflecting a possible deleterious effect of HIV.
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Affiliation(s)
- J Ladner
- Medical Information Unit, Centre Hospitalier de Kigali, Rwanda.
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15
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Hemmings DG, Kilani R, Nykiforuk C, Preiksaitis J, Guilbert LJ. Permissive cytomegalovirus infection of primary villous term and first trimester trophoblasts. J Virol 1998; 72:4970-9. [PMID: 9573266 PMCID: PMC110059 DOI: 10.1128/jvi.72.6.4970-4979.1998] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Forty percent of women with primary cytomegalovirus (CMV) infections during pregnancy infect their fetuses with complications for the baby varying from mild to severe. How CMV crosses the syncytiotrophoblast, the barrier between maternal blood and fetal tissue in the villous placenta, is unknown. Virus may cross by infection of maternal cells that pass through physical breaches in the syncytiotrophoblast or by direct infection of the syncytiotrophoblast, with subsequent transmission to underlying fetal placental cells. In this study, we show that pure (>99.99%), long-term and healthy (>3 weeks) cultures of syncytiotrophoblasts are permissively infected with CMV. Greater than 99% of infectious progeny virus remained cell associated throughout culture periods up to 3 weeks. Infection of term trophoblasts required a higher virus inoculum, was less efficient, and progressed more slowly than parallel infections of placental and human embryonic lung fibroblasts. Three laboratory strains (AD169, Towne, and Davis) and a clinical isolate from a congenitally infected infant all permissively infected trophoblasts, although infection efficiencies varied. The infection of first trimester syncytiotrophoblasts with strain AD169 occurred at higher frequency and progressed more rapidly than infection of term cells but less efficiently and rapidly than infection of fibroblasts. These results show that villous syncytiotrophoblasts can be permissively infected by CMV but that the infection requires high virus titers and proceeds slowly and that progeny virus remains predominantly cell associated.
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Affiliation(s)
- D G Hemmings
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada T6G 2H7
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Burton GJ, Watson AL. The Structure of the Human Placenta: Implications for Initiating and Defending Against Virus Infections. Rev Med Virol 1997; 7:219-228. [PMID: 10398486 DOI: 10.1002/(sici)1099-1654(199712)7:4<219::aid-rmv205>3.0.co;2-e] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The architecture of the human placenta permits an extensive and intimate association between the maternal and fetal circulations. The fetal component consists of the elaborately branched villous tree, and this is bathed directly by maternal blood circulating within the intervillous space. Whilst this arrangement may favour metabolic exchange, it poses considerable risks for the vertical transmission of pathogens. Some features of placental structure can be considered potential impediments to transmission, such as the syncytial nature of the outer villous covering, the syncytiotrophoblast, and the ability of this tissue to secrete both nitric oxide and interferons. Other features may facilitate vertical transmission, including the lack of expression of MHC Class 1 antigens by the syncytiotrophoblast, and its vesicular and immunoglobulin transport pathways. More importantly, it is known that physical defects occur in the trophoblast layers at all stages in gestation. Whilst repair processes have been identified it must be assumed that pathogens or infected maternal white cells have access to the trophoblastic basement membrane, albeit transiently. The universal nature of these defects suggests that the trophoblast cannot be of paramount importance in the prevention of transmission. Rather, the defence mechanisms must lie either at the level of the basement membrane or within the villous core. There they may be represented by the resident macrophage population or the capillary endothelial cells and their junctional complexes. Consequently, the placenta should be viewed as an active rather than a passive barrier. Copyright 1997 by John Wiley & Sons, Ltd.
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Affiliation(s)
- GJ Burton
- Department of Anatomy, Downing Street, University of Cambridge, CB2 3DY, UK
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Kilani RT, Chang LJ, Garcia-Lloret MI, Hemmings D, Winkler-Lowen B, Guilbert LJ. Placental trophoblasts resist infection by multiple human immunodeficiency virus (HIV) type 1 variants even with cytomegalovirus coinfection but support HIV replication after provirus transfection. J Virol 1997; 71:6359-72. [PMID: 9261353 PMCID: PMC191909 DOI: 10.1128/jvi.71.9.6359-6372.1997] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Whether cell-free human immunodeficiency virus type 1 (HIV-1) can productively infect placental trophoblasts (which in turn could transmit the virus into the fetal circulation) is controversial but essential to know for the evaluation of alternative routes (such as cell-mediated infection or trophoblast damage). We have addressed infection factors such as cell purity, source, culture methods, and activation states as well as virus variant and detection methods to conclusively determine the outcome of trophoblast challenge by free virus. Pure (> 99.98%) populations of trophoblasts from 11 different placentas were challenged at a multiplicity of infection (MOI) as high as 6 with five different HIV-1 variants, three of which are non-syncytium-forming, macrophage-tropic isolates from infected infants, with and without coinfection with cytomegalovirus; these preparations were monitored for productive infection for up to 3 weeks after challenge by five different criteria, the most sensitive of which were cocultivation with target cells that can detect virus at an MOI of 10(-7) and HIV DNA PCR that detects 30 virus copies per 10(5) cells. Infection was never detected. However, molecularly cloned T-cell (pNL4-3)- and macrophage (pNLAD8)-tropic provirus plasmids, when transfected into primary trophoblasts, yielded productive infections, indicating that trophoblasts do not suppress late-stage virus replication and assembly. Because of the purity of the trophoblast preparations, the extended length of the infection culture period, the number of trophoblast preparations and virus types examined, the sensitivity of the bioassays and molecular detection assays, and the observations that trophoblasts can support virus replication from provirus, the results of this study strongly argue that free virus cannot infect primary villous trophoblasts.
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Affiliation(s)
- R T Kilani
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada
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Pathogenesis of HIV infection in children. PROGRESS IN PEDIATRIC CARDIOLOGY 1997. [DOI: 10.1016/s1058-9813(97)00198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dolei A, Serra C, Biolchini A, Curreli S, Marongiu P, Gomes E, Ameglio F. HIV-permissive cells from solid tissues: Cytokine induction and effects. ACTA ACUST UNITED AC 1996. [DOI: 10.1007/bf02174005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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