Possible genetic determinants in epidemic polyarthritis caused by Ross River virus infection

Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016-2017

Two outbreaks of epidemic polyarthritis occurred among Australian Defence Force personnel during and following short military exercises in the Shoalwater Bay Training Area, northeastern Australia, in 2016 and 2017. Ross River virus (RRV) IgM was detected in acute-phase serum samples from most patients (28/28 in 2016 and 25/31 in 2017), and RRV was recovered from 4/38 serum samples assayed (1/21 in 2016 and 3/17 in 2017). Phylogenetic analyses of RRV envelope glycoprotein E2 and nonstructural protein nsP3 nucleotide sequences segregated the RRV isolates obtained in 2016 and 2017 outbreaks into 2 distinct sublineages, suggesting that each outbreak was caused by a different strain of RRV. The spatiotemporal characteristics of the 2016 outbreak suggested that some of the infections involved human-mosquito-human transmission without any intermediate host. These outbreaks highlight the importance of personal protective measures in preventing vectorborne diseases for which no vaccine or specific prophylaxis exists.

Molecular mechanisms involved in the pathogenesis of alphavirus-induced arthritis

Arthritogenic alphaviruses, including Ross River virus (RRV), Chikungunya virus (CHIKV), Sindbis virus (SINV), Mayaro virus (MAYV), O'nyong-nyong virus (ONNV), and Barmah Forest virus (BFV), cause incapacitating and long lasting articular disease/myalgia. Outbreaks of viral arthritis and the global distribution of these diseases point to the emergence of arthritogenic alphaviruses as an important public health problem. This review discusses the molecular mechanisms involved in alphavirus-induced arthritis, exploring the recent data obtained with in vitro systems and in vivo studies using animal models and samples from patients. The factors associated to the extension and persistence of symptoms are highlighted, focusing on (a) virus replication in target cells, and tissues, including macrophages and muscle cells; (b) the inflammatory and immune responses with recruitment and activation of macrophage, NK cells and T lymphocytes to the lesion focus and the increase of inflammatory mediators levels; and (c) the persistence of virus or viral products in joint and muscle tissues. We also discuss the importance of the establishment of novel animal models to test new molecular targets and to develop more efficient and selective drugs to treat these diseases.

The immunobiology of viral arthritides

A large range of human viruses are associated with the development of arthritis or arthralgia. Although there are many parallels with autoimmune arthritides, there is little evidence that viral arthritides lead to autoimmune disease. In humans viral arthritides usually last from weeks to months, can be debilitating, and are usually treated with non-steroidal anti-inflammatory drugs, but with variable success. Viral arthritides likely arise from immunopathological inflammatory responses directed at viruses and/or their products residing and/or replicating within joint tissues. Macrophages recruited by monocyte chemoattractant protein-1 (MCP-1/CCL2) and activated by interferon, and proinflammatory mediators like tumour necrosis factor alpha, interferon gamma, interleukin-6 and interleukin-1beta appear to be common elements in this group of diseases. The challenge for new treatments is to target excessive inflammation without compromising anti-viral immunity. Recent evidence from mouse models suggests targeting MCP-1 or complement may emerge as viable new treatment options for viral arthritides.

Ross River virus transmission, infection, and disease: a cross-disciplinary review

Ross River virus (RRV) is a fascinating, important arbovirus that is endemic and enzootic in Australia and Papua New Guinea and was epidemic in the South Pacific in 1979 and 1980. Infection with RRV may cause disease in humans, typically presenting as peripheral polyarthralgia or arthritis, sometimes with fever and rash. RRV disease notifications in Australia average 5,000 per year. The first well-described outbreak occurred in 1928. During World War II there were more outbreaks, and the name epidemic polyarthritis was applied. During a 1956 outbreak, epidemic polyarthritis was linked serologically to a group A arbovirus (Alphavirus). The virus was subsequently isolated from Aedes vigilax mosquitoes in 1963 and then from epidemic polyarthritis patients. We review the literature on the evolutionary biology of RRV, immune response to infection, pathogenesis, serologic diagnosis, disease manifestations, the extraordinary variety of vertebrate hosts, mosquito vectors, and transmission cycles, antibody prevalence, epidemiology of asymptomatic and symptomatic human infection, infection risks, and public health impact. RRV arthritis is due to joint infection, and treatment is currently based on empirical anti-inflammatory regimens. Further research on pathogenesis may improve understanding of the natural history of this disease and lead to new treatment strategies. The burden of morbidity is considerable, and the virus could spread to other countries. To justify and design preventive programs, we need accurate data on economic costs and better understanding of transmission and behavioral and environmental risks.

Arboviruses associated with human disease in Australia

Mosquito-borne arboviruses are an important public health issue in Australia. The alphaviruses Ross River and Barmah Forest virus are widespread and active annually, and cause debilitating polyarthritis. The flaviviruses Murray Valley encephalitis, Kunjin and Japanese encephalitis virus are restricted in distribution and activity but may cause life-threatening illness, and dengue viruses are active in some areas.

A candidate Ross River virus vaccine: preclinical evaluation

A killed Ross River virus vaccine is being developed in an effort to prevent the, ca 5000 cases of epidemic polyarthritis which occur in Australia each year. The symptoms of epidemic polyarthritis commonly last 30-40 weeks and 25% of patients have symptoms for a year or more. There is no cure. Although there was some strain to strain variation, particularly after a single injection, outbred and inbred strains of mice all produced significant levels of anti-Ross River virus antibody after intramuscular (i.m.) injection with 24 h BEI inactivated, sucrose gradient purified, Ross River virus vaccine. Mice immunized i.m. with two 20 micrograms doses of vaccine or live virus produced similar levels of neutralizing antibody but the reaction of IgG 2a and IgG 2b antibody from these two groups of mice to Ross River virus proteins in western blots differed. Antibody from BALB/c mice immunized with this vaccine neutralized all strains of Ross River virus tested, in vitro, albeit to different degrees.

Immune complexes and Ross River virus disease (epidemic polyarthritis)

Immune complexes were sought in serum and synovial fluid in Ross River virus disease (epidemic polyarthritis). Multiple samples from 15 patients showing varied degrees of disease activity over a 3 month period were analysed for their content of complement components C3 and C4, and for C1q solid-phase and Raji cell binding activity. Levels of C3 and C1q binding activity were normal. C4 and Raji cell binding activity were normal except for three high levels of Raji cell binding, of which two were accompanied by low levels of C4, with normal C3 and C1q binding. Synovial fluid showed anomalous Raji cell reactivity of uncertain significance. Conglutinin solid-phase binding activity and IgG rheumatoid factor were compared in the serum of 20 patients during active disease and after recovery. The results were identical and within the normal range in both phases. One patient developed IgM rheumatoid factor in a low titre late in his illness. Although these findings do not entirely exclude a role for immune complexes formed at the onset in the circulation or tissues, it is concluded from this and other evidence that circulating complexes are not commonly responsible for the persistence of syndromes in this disease.

Collagen antibodies in Ross River virus disease (epidemic polyarthritis)

Antibody activity against collagen was measured in 53 samples of serum from 48 patients with active signs of epidemic polyarthritis (EPA) following infection with Ross River virus. Activity was higher against denatured collagen than against native collagen, but was within the normal range for each. Determination of HLA phenotypes permitted a search for any relationship between HLA type and differences in collagen antibody levels within the normal range. No relationship was detected with HLA antigens predominating in EPA or with HLA antigens that are associated with high collagen-antibody levels in rheumatoid arthritis (RA), which suggests that the latter associations may represent failure to control collagen antibody levels after the onset of RA. The findings also provide evidence against a role for nonspecific enhancement of humoral immune responses in the pathogenesis of EPA, and constitute a further point of distinction between EPA and RA.

Natural killer cell activity in inflammatory joint disease

The natural killer (NK) cell activity of unfractionated peripheral blood and synovial fluid mononuclear cells from patients with inflammatory joint disease was measured in a short-term assay using the human tumour cell line, K562, as the target. The mean values for peripheral blood NK activity of the various groups (controls, rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA] were similar although the rheumatoid group showed the widest range. However, the NK activity of PsA patients (23.74 +/- 10.14) was significantly lower than that of the controls (31.63 +/- 10.8, 0.05 greater than P greater than 0.01). Almost without exception, NK activity was found to be considerably lower in synovial fluid than in paired blood samples (p less than 0.01).

Cytology of synovial effusions in epidemic polyarthritis

Examination of synovial fluid in eight patients with epidemic polyarthritis following Ross River virus infection showed cell counts ranging from 1,500 to 13,800 per mm3. Stained smears were notable for a paucity of neutrophils and high proportions of monocytes and vacuolated macrophages, which were further characterised by light and electron microscopy. Ross River virus antigen was detected by specific immunofluorescence in monocytes and macrophages of four cases early in the course of the illness, but intact virus was not identified by electron microscopy or cell culture. No cell-associated C3 component of complement or immunoglobulin of IgM or IgG class was detected in any cell-type. These findings indicate that cell counts and simple smears may be useful in the early diagnosis of suspected epidemic polyarthritis, and provide further information pertinent to the pathogenesis of this disease.