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Raftery MJ, Lalwani P, Krautkrӓmer E, Peters T, Scharffetter-Kochanek K, Krüger R, Hofmann J, Seeger K, Krüger DH, Schönrich G. β2 integrin mediates hantavirus-induced release of neutrophil extracellular traps. ACTA ACUST UNITED AC 2014; 211:1485-97. [PMID: 24889201 PMCID: PMC4076588 DOI: 10.1084/jem.20131092] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
β2 Integrin–mediated systemic release of neutrophil extracellular traps is a novel mechanism of immunopathology associated with hantavirus infection. Rodent-borne hantaviruses are emerging human pathogens that cause severe human disease. The underlying mechanisms are not well understood, as hantaviruses replicate in endothelial and epithelial cells without causing any cytopathic effect. We demonstrate that hantaviruses strongly stimulated neutrophils to release neutrophil extracellular traps (NETs). Hantavirus infection induced high systemic levels of circulating NETs in patients and this systemic NET overflow was accompanied by production of autoantibodies to nuclear antigens. Analysis of the responsible mechanism using neutrophils from β2 null mice identified β2 integrin receptors as a master switch for NET induction. Further experiments suggested that β2 integrin receptors such as complement receptor 3 (CR3) and 4 (CR4) may act as novel hantavirus entry receptors. Using adenoviruses, we confirmed that viral interaction with β2 integrin induced strong NET formation. Collectively, β2 integrin–mediated systemic NET overflow is a novel viral mechanism of immunopathology that may be responsible for characteristic aspects of hantavirus-associated disease such as kidney and lung damage.
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Affiliation(s)
- Martin J Raftery
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Pritesh Lalwani
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ellen Krautkrӓmer
- Department of Nephrology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Thorsten Peters
- Department of Dermatology and Allergic Diseases, University Hospital Ulm, 89081 Ulm, Germany
| | | | - Renate Krüger
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jörg Hofmann
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany Division of Virology, Labor Berlin Charité-Vivantes GmbH, 13353 Berlin, Germany
| | - Karl Seeger
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Detlev H Krüger
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Günther Schönrich
- Institute of Medical Virology, Helmut-Ruska-Haus, Department of Pediatric Pneumology and Immunology, and Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
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Sundberg E, Hultdin J, Nilsson S, Ahlm C. Evidence of disseminated intravascular coagulation in a hemorrhagic fever with renal syndrome-scoring models and severe illness. PLoS One 2011; 6:e21134. [PMID: 21731657 PMCID: PMC3121717 DOI: 10.1371/journal.pone.0021134] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Viral hemorrhagic fevers (VHF) are considered to be a serious threat to public health worldwide with up to 100 million cases annually. The general hypothesis is that disseminated intravascular coagulation (DIC) is an important part of the pathogenesis. The study objectives were to study the variability of DIC in consecutive patients with acute hemorrhagic fever with renal syndrome (HFRS), and to evaluate if different established DIC-scores can be used as a prognostic marker for a more severe illness. METHOD AND FINDINGS In a prospective study 2006-2008, data from 106 patients with confirmed HFRS were analyzed and scored for the presence of DIC according to six different templates based on criteria from the International Society on Thrombosis and Haemostasis (ISTH). The DIC-scoring templates with a fibrinogen/CRP-ratio were most predictive, with predictions for moderate/severe illness (p<0.01) and bleeding of moderate/major importance (p<0.05). With these templates, 18.9-28.3% of the patients were diagnosed with DIC. CONCLUSIONS DIC was found in about one fourth of the patients and correlated with a more severe disease. This supports that DIC is an important part of the pathogenesis in HFRS. ISTH-scores including fibrinogen/CRP-ratio outperform models without. The high negative predictive value could be a valuable tool for the clinician. We also believe that our findings could be relevant for other VHFs.
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Affiliation(s)
- Erik Sundberg
- Department of Clinical Microbiology/Infectious Diseases, Umeå University, Umeå, Sweden.
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