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Essex K, Mullen J, Lauria MJ, Braude DA. Management of Hantavirus Cardiopulmonary Syndrome in Critical Care Transport: A Review. Air Med J 2023; 42:483-487. [PMID: 37996187 DOI: 10.1016/j.amj.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 11/25/2023]
Abstract
In 1993, the Southwest found itself staring down a disease then known as "unexplained adult respiratory syndrome." During the outbreak, 12 of 23 known patients died. What we now recognize as hantavirus cardiopulmonary syndrome still remains a rare and deadly disease. Although no cure exists, modern supportive techniques such as extracorporeal membrane oxygenation have increased survival among these patients. Early diagnosis has become the primary factor in patient survival. The initial presentation of hantavirus is similar to acute respiratory distress syndrome, necessitating a high index of suspicion to afford the patient the best chance of survival. Diagnosis is further complicated by prolonged and nonspecific incubation periods making it difficult to pinpoint an exposure. Familiarizing oneself with common clinical presentations, diagnostic strategies, and testing is the best way to increase patient survival. Because hantavirus has a predilection for rural areas, transport to a tertiary facility is paramount to provide the resources necessary to care for these complex patients. Rapid sequence intubation, although common in airway-compromised patients, could prove fatal in the setting of the severe hemodynamic instability found in hantavirus cardiopulmonary syndrome. Anticipation of significant pressor use and fluid administration could likely mean the difference in patient mortality during transport.
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Affiliation(s)
- Kyle Essex
- AIT Airmed, Albuquerque, New Mexico; American Medical Response, Las Cruces, New Mexico.
| | | | - Michael J Lauria
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Lifeguard Air Emergency Services, Albuquerque, NM
| | - Darren A Braude
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Lifeguard Air Emergency Services, Albuquerque, NM
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2
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Meza-Fuentes G, López R, Vial C, Cortes LJ, Retamal MA, Delgado I, Vial P. Assessing Pulmonary Epithelial Damage in Hantavirus Cardiopulmonary Syndrome: Challenging the Predominant Role of Vascular Endothelium through sRAGE as a Potential Biomarker. Viruses 2023; 15:1995. [PMID: 37896774 PMCID: PMC10611316 DOI: 10.3390/v15101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium's role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.
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Affiliation(s)
- Gabriela Meza-Fuentes
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile; (G.M.-F.); (C.V.); (L.J.C.); (P.V.)
| | - René López
- Grupo Intensivo, ICIM, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile
- Departamento de Paciente Crítico Clínica Alemana de Santiago, Santiago 7610658, Chile
| | - Cecilia Vial
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile; (G.M.-F.); (C.V.); (L.J.C.); (P.V.)
| | - Lina Jimena Cortes
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile; (G.M.-F.); (C.V.); (L.J.C.); (P.V.)
| | - Mauricio A. Retamal
- Centro de Fisiología Celular e Integrativa, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile;
| | - Iris Delgado
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610658, Chile;
| | - Pablo Vial
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Plaza #680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile; (G.M.-F.); (C.V.); (L.J.C.); (P.V.)
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3
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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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4
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Kallel H, Matheus S, Mayence C, Houcke S, Mathien C, Lavergne A, Hommel D. Capillary leak-syndrome triggered by Maripa virus in French Guiana: case report and implication for pathogenesis. BMC Infect Dis 2019; 19:260. [PMID: 30876401 PMCID: PMC6420753 DOI: 10.1186/s12879-019-3887-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report hereby a severe case of Hantavirus Pulmonary Syndrome" (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. CASE PRESENTATION A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). CONCLUSIONS The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.
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Affiliation(s)
- Hatem Kallel
- Service de Réanimation Polyvalente, Centre Hospitalier Andrée Rosemon de Cayenne, Avenue des Flamboyants, 6006 97306, Cayenne, BP, French Guiana.
| | - Séverine Matheus
- Centre National de Référence des Hantavirus, Laboratoire associé, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Claire Mayence
- Service de Réanimation Polyvalente, Centre Hospitalier Andrée Rosemon de Cayenne, Avenue des Flamboyants, 6006 97306, Cayenne, BP, French Guiana
| | - Stéphanie Houcke
- Service de Réanimation Polyvalente, Centre Hospitalier Andrée Rosemon de Cayenne, Avenue des Flamboyants, 6006 97306, Cayenne, BP, French Guiana
| | - Cyrille Mathien
- Service de Réanimation Polyvalente, Centre Hospitalier Andrée Rosemon de Cayenne, Avenue des Flamboyants, 6006 97306, Cayenne, BP, French Guiana
| | - Anne Lavergne
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Didier Hommel
- Service de Réanimation Polyvalente, Centre Hospitalier Andrée Rosemon de Cayenne, Avenue des Flamboyants, 6006 97306, Cayenne, BP, French Guiana
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5
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Llah ST, Mir S, Sharif S, Khan S, Mir MA. Hantavirus induced cardiopulmonary syndrome: A public health concern. J Med Virol 2018; 90:1003-1009. [PMID: 29446472 DOI: 10.1002/jmv.25054] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022]
Abstract
Hantavirus cardiopulmonary syndrome is characterized by pulmonary capillary leakage and alveolar flooding, resulting in 50% mortality due to fulminant hypoxic respiratory failure. In addition, depression of cardiac function ensues, which complicates the picture with cardiogenic shock. Early diagnosis and appropriate use of extracorporeal membrane oxygenation (ECMO) are amongst the lifesaving interventions in this fatal illness. However, a recent case report demonstrates that implementation of high volume continuous hemofilteration along with protective ventilation reverses the cardiogenic shock within few hours in hantavirus infected patients. This review article is focused on the recent advances in clinical features, diagnosis, management, epidemiology, and pathogenesis of hantavirus induced cardiopulmonary syndrome. It provides information for clinicians to help in correct diagnosis during the early stages of viral infection that could improve the prognosis of this viral illness.
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Affiliation(s)
- Sibghat T Llah
- Saint Joseph's Hospital Medical Center, Phoenix, Arizona
| | - Sheema Mir
- Applied BioCode, Santa Fe Springs, Calofornia
| | | | - Salman Khan
- University of Arkansas For Medical Sciences, Little Rock, Arizona
| | - Mohammed A Mir
- Saint Joseph's Hospital Medical Center, Phoenix, Arizona
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7
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Hepojoki J, Vaheri A, Strandin T. The fundamental role of endothelial cells in hantavirus pathogenesis. Front Microbiol 2014; 5:727. [PMID: 25566236 PMCID: PMC4273638 DOI: 10.3389/fmicb.2014.00727] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/03/2014] [Indexed: 01/17/2023] Open
Abstract
Hantavirus, a genus of rodent- and insectivore-borne viruses in the family Bunyaviridae, is a group of emerging zoonotic pathogens. Hantaviruses cause hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome in man, often with severe consequences. Vascular leakage is evident in severe hantavirus infections, and increased permeability contributes to the pathogenesis. This review summarizes the current knowledge on hantavirus interactions with hematopoietic and endothelial cells, and their effects on the increased vascular permeability.
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Affiliation(s)
- Jussi Hepojoki
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
| | - Antti Vaheri
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
| | - Tomas Strandin
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
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8
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Borges AA, Donadi EA, Campos GM, de Figueiredo GG, Saggioro FP, Badra SJ, Deghaide NHS, Figueiredo LTM. Polymorphisms in human leukocyte antigens, human platelet antigens, and cytokine genes in hantavirus cardiopulmonary syndrome patients from Ribeirão Preto, Brazil. J Med Virol 2013; 86:1962-70. [DOI: 10.1002/jmv.23836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandra Abel Borges
- Virology Research Center; School of Medicine of Ribeirão Preto, University of São Paulo; Ribeirão Preto Brazil
| | - Eduardo Antonio Donadi
- Molecular Immunology Laboratory, Hospital das Clínicas; School of Medicine of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Gelse Mazzoni Campos
- Virology Research Center; School of Medicine of Ribeirão Preto, University of São Paulo; Ribeirão Preto Brazil
| | | | - Fabiano Pinto Saggioro
- Death Verification Service (CEMEL) and Department of Pathology; School of Medicine of Ribeirão Preto, University of São Paulo; Ribeirão Preto Brazil
| | - Soraya Jabur Badra
- Virology Research Center; School of Medicine of Ribeirão Preto, University of São Paulo; Ribeirão Preto Brazil
| | - Neifi Hassan Saloum Deghaide
- Molecular Immunology Laboratory, Hospital das Clínicas; School of Medicine of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
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9
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Hantavirus infection in North America: a clinical review. Am J Emerg Med 2013; 31:978-82. [PMID: 23680331 DOI: 10.1016/j.ajem.2013.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 02/01/2023] Open
Abstract
The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion. Hantavirus cardiopulmonary syndrome presents as a vague prodrome of fever, cough, myalgias, chills, and nausea followed by a rapidly worsening respiratory phase. Presumptive diagnosis can be made based on pulmonary interstitial edema on chest radiographs in association with leukocytosis, thrombocytopenia, and hemoconcentration. Suspected cases should be confirmed with a reference laboratory and reported to the appropriate public health authorities. Although treatment is primarily supportive, aggressive fluid administration should be avoided due to the risk of pulmonary edema. The cardiopulmonary phase of the disease can progress rapidly with catastrophic decompensation in as little as a few hours. Patients require rapid intensive care unit admission for monitoring, mechanical ventilation, vasoactive agents, and possibly extracorporeal mechanical ventilation. Emergency physicians should be aware of outbreaks and vigilant for hantavirus exposures, especially during the summer and early fall months.
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10
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Sargianou M, Watson DC, Chra P, Papa A, Starakis I, Gogos C, Panos G. Hantavirus infections for the clinician: From case presentation to diagnosis and treatment. Crit Rev Microbiol 2012; 38:317-29. [DOI: 10.3109/1040841x.2012.673553] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Macneil A, Nichol ST, Spiropoulou CF. Hantavirus pulmonary syndrome. Virus Res 2011; 162:138-47. [PMID: 21945215 DOI: 10.1016/j.virusres.2011.09.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 09/10/2011] [Accepted: 09/10/2011] [Indexed: 12/27/2022]
Abstract
Hantavirus pulmonary syndrome (HPS) is a severe disease characterized by a rapid onset of pulmonary edema followed by respiratory failure and cardiogenic shock. The HPS associated viruses are members of the genus Hantavirus, family Bunyaviridae. Hantaviruses have a worldwide distribution and are broadly split into the New World hantaviruses, which includes those causing HPS, and the Old World hantaviruses [including the prototype Hantaan virus (HTNV)], which are associated with a different disease, hemorrhagic fever with renal syndrome (HFRS). Sin Nombre virus (SNV) and Andes virus (ANDV) are the most common causes of HPS in North and South America, respectively. Case fatality of HPS is approximately 40%. Pathogenic New World hantaviruses infect the lung microvascular endothelium without causing any virus induced cytopathic effect. However, virus infection results in microvascular leakage, which is the hallmark of HPS. This article briefly reviews the knowledge on HPS-associated hantaviruses accumulated since their discovery, less than 20 years ago.
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Affiliation(s)
- Adam Macneil
- Viral Special Pathogens Branch, Division of High-consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., Atlanta, GA 30333, USA
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12
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Terajima M, Ennis FA. T cells and pathogenesis of hantavirus cardiopulmonary syndrome and hemorrhagic fever with renal syndrome. Viruses 2011; 3:1059-73. [PMID: 21994770 PMCID: PMC3185782 DOI: 10.3390/v3071059] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/30/2011] [Accepted: 07/01/2011] [Indexed: 12/17/2022] Open
Abstract
We previously hypothesized that increased capillary permeability observed in both hantavirus cardiopulmonary syndrome (HCPS) and hemorrhagic fever with renal syndrome (HFRS) may be caused by hantavirus-specific cytotoxic T cells attacking endothelial cells presenting viral antigens on their surface based on clinical observations and in vitro experiments. In HCPS, hantavirus-specific T cell responses positively correlated with disease severity. In HFRS, in one report, contrary to HCPS, T cell responses negatively correlated with disease severity, but in another report the number of regulatory T cells, which are thought to suppress T cell responses, negatively correlated with disease severity. In rat experiments, in which hantavirus causes persistent infection, depletion of regulatory T cells helped infected rats clear virus without inducing immunopathology. These seemingly contradictory findings may suggest delicate balance in T cell responses between protection and immunopathogenesis. Both too strong and too weak T cell responses may lead to severe disease. It is important to clarify the role of T cells in these diseases for better treatment (whether to suppress T cell functions) and protection (vaccine design) which may need to take into account viral factors and the influence of HLA on T cell responses.
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Affiliation(s)
- Masanori Terajima
- Center for Infectious Disease and Vaccine Research, Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; E-Mail:
| | - Francis A. Ennis
- Center for Infectious Disease and Vaccine Research, Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; E-Mail:
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Andes virus disrupts the endothelial cell barrier by induction of vascular endothelial growth factor and downregulation of VE-cadherin. J Virol 2010; 84:11227-34. [PMID: 20810734 DOI: 10.1128/jvi.01405-10] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS) are severe diseases associated with hantavirus infection. High levels of virus replication occur in microvascular endothelial cells but without a virus-induced cytopathic effect. However, virus infection results in microvascular leakage, which is the hallmark of these diseases. VE-cadherin is a major component of adherens junctions, and its interaction with the vascular endothelial growth factor (VEGF) receptor, VEGF-R2, is important for maintaining the integrity of the endothelial barrier. Here we report that increased secreted VEGF and concomitant decreased VE-cadherin are seen at early times postinfection of human primary lung endothelial cells with an HPS-associated hantavirus, Andes virus. Furthermore, active virus replication results in increased permeability and loss of the integrity of the endothelial cell barrier. VEGF binding to VEGF-R2 is known to result in dissociation of VEGF-R2 from VE-cadherin and in VE-cadherin activation, internalization, and degradation. Consistent with this, we showed that an antibody which blocks VEGF-R2 activation resulted in inhibition of the Andes virus-induced VE-cadherin reduction. These data implicate virus induction of VEGF and reduction in VE-cadherin in the endothelial cell permeability seen in HPS and suggest potential immunotherapeutic targets for the treatment of the disease.
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Borges AA, Donadi EA, Campos GM, Moreli ML, de Sousa RLM, Saggioro FP, de Figueiredo GG, Badra SJ, Deghaide NHS, Figueiredo LTM. Association of -308G/A polymorphism in the tumor necrosis factor-alpha gene promoter with susceptibility to development of hantavirus cardiopulmonary syndrome in the Ribeirão Preto region, Brazil. Arch Virol 2010; 155:971-5. [PMID: 20372945 DOI: 10.1007/s00705-010-0655-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 03/02/2010] [Indexed: 11/24/2022]
Abstract
Activation of the immune response in hantavirus cardiopulmonary syndrome (HCPS) leads to a high TNF production, probably contributing to the disease. The polymorphic TNF2 allele (TNF -308G/A) has been associated with increased cytokine production. We investigated the association of the TNF2 allele with the outcome of hantavirus infection in Brazilian patients. A total of 122 hantavirus-exposed individuals (26 presenting HCPS and 96 only hantavirus seroconversion) were studied. The TNF2 allele was more frequently found in HCPS patients than in individuals with positive serology for hantavirus but without a history of HCPS illness, suggesting that the TNF2 allele could represent a risk factor for developing HCPS.
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Affiliation(s)
- Alessandra Abel Borges
- Virology Research Center, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Brazil
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