Virus-specific, early appearing neutralizing activity and interferon in tears of patients with acute hemorrhagic conjunctivitis

Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear

Purpose

The purpose of this paper is to present the clinical course of a laboratory-acquired case of acute hemorrhagic conjunctivitis (AHC) caused by coxsackievirus A24 variant (CA24v). Also, the anti-CA24v neutralizing activity and anti-CA24v immunoglobulin (Ig) G and secretory IgA (sIgA) in acute and convalescent tears and/or sera are presented.

Case

A 60-year-old male presented with acute-onset left eyelid edema, tearing, conjunctival erythema, pain, foreign body sensation, and subconjunctival hemorrhage 24 hours after suspected laboratory exposure. Bilateral conjunctivitis presented 24 hours later and resolved in 10 days.

Methods

Tear and blood samples were collected for virus isolation and neutralizing assays. CA24v-reactive IgG and sIgA in tear and/or serum samples were detected by immunofluorescent antibody analysis of ethanol-fixed virus-infected cells.

Results

Peak tear neutralization titers (1,000–1,500 U/mL) against the isolated virus occurred 1 day post-onset (po) of AHC. Tear neutralization titers became undetectable by the sixth day as serum neutralization titers became detectable on the ninth day po (60 U/mL), peaked by 21 days (3,000 U/mL), declined by 1 year to 200 U/mL, and remained at 30 U/mL 5 years po. Antibody to human IgG, IgA, and secretory component (sIgA) reacted with CA24v-infected cells treated with pooled acute tears collected 1–4 days po. Predominantly, sIgA was detected in CA24v-infected cells treated with tears collected 4 years and 5 years post-AHC, while convalescent serum contained predominantly anti-CA24v IgG.

Conclusion

AHC was confirmed by CA24v isolation, tear anti-CA24v neutralizing activity, and seroconversion. The detection of CA24v-reactive IgG, sIgA, and neutralizing activity in tears collected 1–4 days po of AHC supports plasma extravasation of IgG and suggests a defensive role for tear anti-CA24v sIgA. The results suggest that immunofluorescent antibody analysis of tears for persistent anti-CA24v sIgA may be useful in epidemiological monitoring of AHC.

Treatment of picornavirus infections

The picornaviruses are a diverse group of viral pathogens that together comprise the most common causes of infections of humans in the developed world. Within the picornavirus family are three well-known groups of human pathogens-the enteroviruses (including polioviruses, coxsackieviruses, and echoviruses), the rhinoviruses, and the hepatoviruses (including hepatitis A). Recently, the parechoviruses (formerly, echoviruses 22 and 23) have been classified as a fourth genus of human picornaviruses. This article will focus on the enteroviruses and rhinoviruses agents, for which substantial effort has been expended and recent successes reported towards the development of safe and effective antiviral therapy.

Antiviral therapy for enteroviruses and rhinoviruses

The picornaviruses are a diverse group of viral pathogens that together comprise the most common causes of infection of humans in the developed world. Within the picornavirus family are three well-known groups of human pathogens--the rhinoviruses, the enteroviruses (including polioviruses, coxsackieviruses and echoviruses) and the hepatoviruses (including hepatitis A virus). This article will focus on the rhinoviruses and enteroviruses, agents for which substantial effort has been expended, and recent successes reported, toward the development of safe and effective antiviral therapy.

Antibodies may act synergistically or additively with interferon to inhibit poliovirus

We investigated the protective effects of combinations of interferon-alpha (IFN-alpha) and neutralizing monoclonal antibodies (mAbs) and serum antibodies against poliovirus type 1 (PV-1) in vitro. Our results indicate that the antiviral effects of IFN-alpha and most neutralizing mAbs to PV-1 act synergistically to inhibit PV-1. However, the antiviral effects of IFN-alpha and one type specific mAb to PV-1 were additive. Further, the protective effects observed with combinations of IFN-alpha and rabbit, monkey or human serum containing effects observed with combinations strains Mahoney (Mah) and Sabin (Sab) were similar to those observed with combinations of IFN-alpha and mixtures of mAbs with synergistic and additive activities. Our studies suggest that the antiviral activity of neutralizing antibody acts with the antiviral activity of IFN to inhibit virus infection synergistically or additively and that the different antibody activities are associated with the mechanism of neutralization.

An assay for the detection of interferon dependent and interferon independent antibody activities

A spectrophotometric assay is described for the detection of interferon (IFN) dependent antibody (IDA) activity (i.e., antibodies that act with IFN to synergistically inhibit virus infection) and IFN independent antibody (IIA) activity (i.e., antibodies that act additively with IFN to inhibit virus infection). Four neutralizing monoclonal antibodies (mAb) against poliovirus type 1 (PV-1) were tested. Three mAb exhibited IDA activity and one mAb exhibited IIA activity against PV-1 strain Sabin. Concomitantly, the respective IDA and IIA activities were confirmed by a yield reduction assay. Also, the spectrophotometric assay detected IIA activity against PV-1 and IDA activity against PV-2 and PV-3 in human serum. Interestingly, antibody to a synthetic peptide of PV-1 capsid protein VP2 exhibited IIA activity against PV-2 strain MEF. Thus, this assay can facilitate the identification and investigation of IDA and IIA activities. Further, the assay adds economic feasibility to studying the natural occurrence of these antibody activities in the general population and can be useful in assessing the therapeutic potential of vaccine induced and hyperimmune antibodies.

Viral specificity of multiple sclerosis tear immunoglobulins

The mucosal immune system plays an important role in determining how an individual handles infection by most of the common viruses. Tears form part of this system and participate in mucosal immunity. We examined tears from multiple sclerosis (MS) and control subjects for antibodies to seven common neurotropic viruses. Antibodies to multiple viruses were detected in MS tears, especially when tears were obtained from chronic progressive active patients. In particular, MS patients showed a significantly greater prevalence of tear antibodies to measles, herpes simplex type I, and rubella virus. The tear anti-viral response included IgA as well as IgG antibody and appeared to be independent of serum. Mucosal fluid in MS patients, in addition to cerebrospinal fluid, also shows heightened humoral immune responses to multiple neurotropic viruses.

Activity of arildone with or without interferon against acute hemorrhagic conjunctivitis viruses in cell culture

Arildone (WIN 38020; 4-[6-(2-chloro-4-methoxyphenoxy)hexyl]-3,5-heptanedione) inhibited the infectivity of acute hemorrhagic conjunctivitis viruses in tissue culture. Arildone did not inhibit interferon (IFN) production or IFN activity. Treatment of cultures with combinations of arildone and IFN resulted in an additive inhibition of acute hemorrhagic conjunctivitis virus production.