Enhancive and suppressive effects of cytomegalovirus on human lymphocyte responses in vitro

Does cytomegalovirus play a causative role in the development of various inflammatory diseases and cancer?

Human cytomegalovirus (HCMV) is a herpes virus that infects and is carried by 70-100% of the world's population. During its evolution, this virus has developed mechanisms that allow it to survive in an immunocompetent host. For many years, HCMV was not considered to be a major human pathogen, as it appeared to cause only rare cases of HCMV inclusion disease in neonates. However, HCMV is poorly adapted for survival in the immunosuppressed host and has emerged as an important human pathogen in AIDS patients and in patients undergoing immunosuppressive therapy following organ or bone marrow transplantation. HCMV-mediated disease in such patients has highlighted the possible role of this virus in the development of other diseases, in particular inflammatory diseases such as vascular diseases, autoimmune diseases and, more recently, with certain forms of cancers. Current research is focused on determining whether HCMV plays a causative role in these diseases or is merely an epiphenomenon of inflammation. Inflammation plays a central role in the pathogenesis of HCMV. This virus has developed a number of mechanisms that enable it to hide from the cells of the immune system and, at the same time, reactivation of a latent infection requires immune activation. Numerous products of the HCMV genome are devoted to control central functions of the innate and adaptive immune responses. By influencing the regulation of various cellular processes including the cell cycle, apoptosis and migration as well as tumour invasiveness and angiogenesis, HCMV may participate in disease development. Thus, the various drugs now available for treatment of HCMV disease (e.g. ganciclovir, acyclovir and foscarnet), may also prove to be useful in the treatment of other, more widespread diseases.

Human Cytomegalovirus Binding to Human Monocytes Induces Immunoregulatory Gene Expression

To continue our investigation of the cellular events that occur following human CMV (HCMV) infection, we focused on the regulation of cellular activation following viral binding to human monocytes. First, we showed that viral binding induced a number of immunoregulatory genes (IL-1β, A20, NF-κB-p105/p50, and IκBα) in unactivated monocytes and that neutralizing Abs to the major HCMV glycoproteins, gB (UL55) and gH (UL75), inhibited the induction of these genes. Next, we demonstrated that these viral ligands directly up-regulated monocyte gene expression upon their binding to their appropriate cellular receptors. We then investigated if HCMV binding also resulted in the translation and secretion of cytokines. Our results showed that HCMV binding to monocytes resulted in the production and release of IL-1β protein. Because these induced gene products have NF-κB sites in their promoter regions, we next examined whether there was an up-regulation of nuclear NF-κB levels. These experiments showed that, in fact, NF-κB was translocated to the nucleus following viral binding or purified viral ligand binding. Changes in IκBα levels correlated with the changes in NF-κB translocation. Lastly, we demonstrated that p38 kinase activity played a central role in IL-1β production and that it was rapidly up-regulated following infection. These results support our hypothesis that HCMV initiates a signal transduction pathway that leads to monocyte activation and pinpoints a potential mechanism whereby HCMV infection of monocytes can result in profound pathogenesis, especially in chronic inflammatory-type conditions.

The effect of human cytomegalovirus on selected functions of peripheral blood monocytes

The effect of in vitro infection of human cytomegalovirus (HCMV) on various monocyte functions relevant to antimicrobial defence mechanisms has been investigated: the phagocytic activity of monocytes, the release of lysozyme and intracellular concentration of acid phosphatase, and the release of the cytokines interleukin-1 (IL-1), IL-6, and tumour necrosis factor-alpha (TNF-alpha). HCMV significantly inhibited the release of lysozyme and intracellular concentration of acid phosphatase. Regarding the phagocytic activity and the release of cytokines, there was considerable variation in the HCMV effect among the different blood donors tested. There was no clear tendency in the observed results; both stimulation and inhibition were seen. The HCMV-specific pp65 was detected in the nucleus of about 1% of the monocytes 3 h after infection and HCMV-specific IE antigens were found in about 0.1% of the monocytes 2 days postinfection. No E- or L-gene expression was observed and no infectious virus was produced in the monocytes. Our results indicate that HCMV infection may influence monocyte functions in spite of no productive infection of these cells.

Infection with human cytomegalovirus enhances bacterial adhesiveness and invasiveness in permissive and semipermissive cells

The effect of human cytomegalovirus (HCMV) infection on adhesiveness and invasiveness of Salmonella typhimurium was examined in cells permissive (human embryo fibroblasts (HE)), semipermissive (A549) and nonpermissive (HEp-2) for the virus. Preinfection of the cells with HCMV induced enhanced adhesiveness and invasiveness of bacteria in the permissive HE cells. In the semipermissive A549 cells, where HCMV immediate-early (IE) mRNA transcripts and IE proteins were detected, a significant effect on the initial phase of invasiveness, the adherence phase, was demonstrated. HCMV had no effect on invasiveness of S. typhimurium in nonpermissive HEp-2 cells. Neither HCMV IE transcripts nor IE proteins could be detected in these cells.

Human cytomegalovirus productively infects primary differentiated macrophages

Monocytes are one of the predominant cell types in the peripheral blood that are infected by human cytomegalovirus (HCMV). Although virus can be detected in these cells in vivo, HCMV replication in cultured monocytes has been unsuccessful. In this study, we demonstrate efficient HCMV replication in cultured monocytes. HCMV permissiveness in these cells was dependent on nonadherent cell-induced stimulation of the monocyte, with subsequent morphological differentiation into macrophages. Approximately 40% of the cells infected by virus were detected by immunofluorescent staining with both immediate-early and late antibodies. In addition, viral plaque assays demonstrated significant productive infection of macrophages. These observations are consistent with the suggestion that the monocyte/macrophage serves as a source of viral amplification and dissemination.

Suppression of monocyte functions by human cytomegalovirus

The role of the monocyte in human cytomegalovirus (HCMV)-induced immunosuppression was examined by assessing the ability of the virus to directly suppress various monocyte accessory cell functions. Both patient-derived and laboratory-adapted strains of HCMV were capable of impairing antigen-presenting functions of purified human monocytes. In seven of 12 virus-infected samples, there was a significant decrease (P less than 0.05) in the ability of HCMV-infected monocytes to present tetanus toxoid to autologous lymphocytes compared with mock-infected controls; similar results were obtained with Candida albicans and mumps. In contrast, the response to PHA was impaired in only one of eight HCMV-infected samples. The increased expression of MHC class II Ia antigens (HLA-DQ and HLA-DR) by monocytes after stimulation by interferon-gamma was impaired in approximately one-third of the 43 virus-infected samples tested. Interleukin-1 (IL-1) production after incubation with the stimulating antigens, however, was unaffected. Attempts to augment immuno-suppression by co-stimulation of monocytes with lipopolysaccharide (LPS), heat-killed Escherichia coli or Listeria monocytogenes were not successful; however, dramatically increased levels of immunosuppression was obtained with HCMV preparations containing mycoplasma. Thus, although HCMV is capable of directly perturbing monocyte accessory cell functions, the variability and partial suppression observed suggests that infection of monocytes by HCMV alone is not sufficient to produce the levels of immune hyporesponsiveness observed in HCMV-infected patients.

The cellular immune response to cell-associated and cell-free cytomegalovirus (CMV) antigens after primary CMV-infection in non-immunocompromised hosts: development and maintenance of CMV-latency and its influence on immunocompetence

Development and maintenance of cellular immunity to cell-associated CMV-antigens (CMVFF) was investigated in non-immunocompromised hosts during the first year (group I, n = 11) and 1 to 5 years (group II, n = 9) after a symptomatic primary CMV infection, as well as in healthy CMV-seropositive controls without a history of CMV disease (group III, n = 28). During the acute phase (0-2 months) of a primary CMV-infection CMVFF-induced lymphocyte proliferation was severely decreased compared to that in the post-illness phase (5-12 months), and to that in groups II and III. After the reconvalescent period (3-4 months) it gradually increased to levels seen in group III. In group II higher responses to CMVFF were found than in group III or during the post-illness phase of a primary infection. In general CMV-virion induced lymphocyte proliferation showed the same pattern of development as the CMVFF-induced lymphocyte response, but during the acute phase (0-2 months) a lack of correlation was observed between lymphocyte proliferation to CMVFF and CMV-virions. Lymphocyte proliferation to PHA, Con A, allogeneic lymphocytes and recall antigens were severely depressed in the acute phase of a primary CMV-infection and restored gradually to levels seen in groups II and III, with the exception of Con A-reactivity. The latter response remained depressed when compared to healthy seropositive controls, not only during the post-illness period, but also later on (group II).

Cytomegalovirus infection of peripheral blood mononuclear cells: effects on interleukin-1 and -2 production and responsiveness

Cytomegalovirus suppresses the proliferative response of peripheral blood mononuclear cells to phytohemagglutinin. In these experiments, we identified which mononuclear cell subpopulation might be responsible for the suppression. We found that prior infection of either lymphocytes or monocytes followed by reconstitution with monocytes or lymphocytes, respectively, would abrogate the proliferative response in a subsequent culture with phytohemagglutinin. Infection of either cell type also reduced both the production of interleukin-1 (IL-1) and IL-2 and the proliferative response to exogenously supplied IL-1 or IL-2. We did not find evidence for an IL-2 antagonist. These experiments suggest that cytomegalovirus causes a metabolic derangement in lymphocytes and monocytes and impairs their ability both to produce and to respond to physiological mediators of the immune response.

Cytomegalovirus-infected adherent cells interact synergistically and antagonistically with Staphylococcus aureus protein A in vitro

Cytomegalovirus (CMV) has been shown to exert suppressive effects on the immune response but also to have mitogenic properties. A bacterial product, protein A from Staphylococcus aureus (SpA) was chosen to study possible interactions in vitro between bacterial products and adherent cells incubated with infectious CMV and ultraviolet light (UV)-inactivated CMV. Small amounts of infectious CMV potentiated SpA-induced DNA synthesis and Ig secretion measured by induction of plaque-forming cells (PFC). The reason for this may be that CMV in small amounts may act in synergism with the non-specific mitogen SpA. UV-inactivated CMV did not influence these responses except for a markedly enhanced PFC induction with SpA in lymphocytes from seronegative individuals. This remarkable synergism with SpA was also seen in enriched B cells. No synergism was seen in lymphocytes from seropositive donors. Large amounts of infectious CMV markedly reduced SpA-induced immune responses. Preliminary data suggest that the immunosuppressive effects are mediated by an interleukin 1 inhibitory factor. CMV was not shown to be a polyclonal B-cell activator but may, possibly in small amounts, act as such together with bacterial products, which would explain certain autoimmune phenomena. To conclude, CMV could in interaction with a bacterial product generate both synergistic and suppressive effects on immune response.

B and T cell reactivities after immunization of macaques with HIV subcomponents

A model system was established for studies of humoral and cellular immunity to human immunodeficiency virus (HIV) antigens after vaccination. Macaques (Macaca fascicularis) were immunized with purified HIV, an infected cell extract rich in gp120 or polypeptides of cloned genes representing parts of p24, gp41, and gp120. Western blot analysis best showed the appearance of antibodies to nucleocapsid proteins, and antibodies to higher molecular weight envelope glycoproteins were better demonstrated by radioimmunoprecipitation. With whole HIV, antibodies to p24 appeared first, and sometimes were the only ones to be demonstrable. Several immunizations with HIV or recombinant polypeptides were required to obtain antibodies to gp120, and the responses were weak. Although the envelope-specific response was weak, this was the only component that mediated neutralizing capacity. Escherichia coli-derived viral transmembrane polypeptide (g)p41 also had a poor immunizing effect. IgG synthesis from B cells in vitro was demonstrable to antigens and generally paralleled the antibody titers of sera after multiple immunizations. The HIV-specific lymphocyte proliferation response as measured by DNA synthesis was best seen with polypeptide p24-15, followed by the other antigens.

Interactions of human cytomegalovirus with leukocytes in vivo: analysis by in situ hybridization

Reactivation of human cytomegalovirus (HCMV) from latency occurs in immunosuppressed individuals and infection is itself immunosuppressive. To better understand the basis for this virally induced impairment of immune function, we have analyzed virus-leukocyte interactions by in situ hybridization. We detected viral DNA in 12 viremic patients in the mononuclear cell population, predominantly in cells identified as monocytes by their morphology and by labelling the cells with a monocyte specific monoclonal antibody prior to in situ hybridization. We detected immediate early RNA in infected cells at frequencies comparable to DNA (10(-3) to 10(-5)). By contrast, no viral transcripts were detected in polymorphonuclear cells and viral DNA was inclusively cytoplasmic in accord with the interpretation that this cell type harbors HCMV in phagosomes. These findings in vivo continue to suggest that infection of monocytes plays an important part in the immunosuppressive effects of HCMV infections.

Characteristics of the specific cell-mediated immune response in human immunodeficiency virus infection

The human immunodeficiency virus (HIV)-specific lymphocyte proliferation response was determined for 40 persons at different stages of HIV infection. The specific response to purified HIV virion antigens from strain HTLV-IIIB was poor, occurred in only 9 of the 40 subjects, was not improved with the addition of interleukin-2, and was more frequent in symptom-free individuals (46%) than in patients with lymphadenopathy syndrome (10%). Reactivity to subcomponent p24 was better than that to whole HIV; reactivity was present in five of six infected persons and increased with the addition of exogenous interleukin-2. Reactivities to subcomponents (g)p41 and gp120 were also measured. This is the first evidence of a specific cell-mediated immune response to HIV antigen in HIV-infected persons. Monkeys immunized with purified HIV or with purified p24 displayed cellular immunoreactivity both to whole HIV and to subcomponents. In contrast to the poor reactivity to HIV antigen, the lymphocytes of the patients had good specific cell proliferation responses to cytomegalovirus and herpes simplex virus challenge and a normal response to the addition of phytohemagglutinin. The results suggest a functional defect in peripheral lymphocytes of some HIV-infected individuals on the basis of their response to whole HIV antigen and a better response to gag protein.

Molecular biology and immunology of cytomegalovirus

The application of modern biochemical techniques has led to a rapid improvement in our knowledge of the molecular biology of CMV. Several coding regions of the DNA genome have been identified with certainty and major virus-coded proteins have been given provisional names. The cascade expression of the CMV genome has been shown to be controlled by mechanisms similar to those found in other herpes viruses, together with novel post-transcriptional controls which remain to be defined. The control of CMV replication by the host involves both non-specific and specific defence mechanisms. The induction of natural killer cells and interferon early after CMV infection appears to be the most important aspects of the non-specific host defence against the virus. The cell-mediated immune response, in particular the generation of Tc cells against CMV early antigens, is probably the most important facet of the specific immune defence against CMV. When intact these defence mechanisms appear to be efficient in restricting viral replication; however, when such immunity is compromised, the balance rapidly swings in favour of the virus. As our understanding of the interaction between the host and the virus increases, it may be possible to redress the balance in such cases in favour of the host.

Monocyte and iscom enhancement of cell-mediated response to cytomegalovirus

Cell-mediated and humoral responses to cytomegalovirus were studied in a monkey model. Repeated low doses of virus antigen gave poor reactivities in both respects. High antigen doses gave a good humoral IgG response. When autologous monocytes were incubated with the CMV antigen as the immunizing injection, the specific cellular response to CMV antigen increased. The monocytes themselves did not contribute to the in vitro specific proliferation response. When iscoms were the carrier particles for CMV antigens, cellular response was even more strongly enhanced. In immunization schedules where specific cellular responses are important, we suggest that autologous monocytes or iscoms may be employed as antigen carriers.