mAb therapy controls CNS-resident lyssavirus infection via a CD4 T cell-dependent mechanism

Infections with rabies virus (RABV) and related lyssaviruses are uniformly fatal once virus accesses the central nervous system (CNS) and causes disease signs. Current immunotherapies are thus focused on the early, pre-symptomatic stage of disease, with the goal of peripheral neutralization of virus to prevent CNS infection. Here, we evaluated the therapeutic efficacy of F11, an anti-lyssavirus human monoclonal antibody (mAb), on established lyssavirus infections. We show that a single dose of F11 limits viral load in the brain and reverses disease signs following infection with a lethal dose of lyssavirus, even when administered after initiation of robust virus replication in the CNS. Importantly, we found that F11-dependent neutralization is not sufficient to protect animals from mortality, and a CD4 T cell-dependent adaptive immune response is required for successful control of infection. F11 significantly changes the spectrum of leukocyte populations in the brain, and the FcRγ-binding function of F11 contributes to therapeutic efficacy. Thus, mAb therapy can drive potent neutralization-independent T cell-mediated effects, even against an established CNS infection by a lethal neurotropic virus.

Control of established, CNS-resident lyssavirus infection by an adaptive immune response stimulated by single-dose monoclonal antibody therapy

Rabies virus and related lyssaviruses cause uniformly fatal disease, once the infection progresses to the central nervous system. Current lyssavirus immunotherapies are directed toward peripheral neutralization of virus to prevent CNS infection during the pre-symptomatic stage of disease. In this study, using an anti-lyssavirus human monoclonal antibody (mAb), F11, we evaluated the efficacy of immunotherapy on established lyssavirus infections in mice. Remarkably, using luminescence-based longitudinal tracing of virus infection in a mouse model of lethal disease, we found that a single dose of F11 reverses clinical signs of disease and protects animals from lethality following lyssavirus infection, even when administered after initiation of virus replication in the CNS. Investigation of the mechanisms of F11 efficacy revealed that F11-dependent neutralization is insufficient to protect animals from mortality. Control of infection requires an intact adaptive immune response, particularly CD4 T cells. Additionally, in vivo analysis of the F11-N297G mutant, which has defective FcRγ binding, showed a transiently increased viral load and increased morbidity when compared to F11 treated mice. Despite long-term survival and absence of clinical signs of disease in F11-treated animals, we found that lyssavirus infection persists chronically, concomitant with elevated expression of cellular immune response genes. These findings demonstrate that single-dose mAb therapy can stimulate an adaptive, T cell-dependent response that is durable and highly effective against an established CNS infection by a lethal neurotropic virus.

Supported by grants from the National Institute of Health (U01GM109887, R01AI125552), and a USU Program Project Grant (MIC-732515) and a USU Center for Global Health Engagement grant (HU00011920118)

Longitudinal Tracing of Lyssavirus Infection in Mice via In Vivo Bioluminescence Imaging

Bioluminescence imaging (BLI) is a technique that can be employed to quantify biological processes in living cells. When used in small animal models such as mice, BLI can provide both longitudinal and positional information regarding the biological process under investigation. Although perhaps best known for its utility in non-invasively quantifying tumor burden over time in experimental animals, BLI has also been applied in many pathogenesis models to track pathogen burden and responses to therapeutic interventions. In this chapter, we present a BLI-based method for tracing anatomical progression of lyssavirus infection in a mouse model. We also include validation methods to ensure that semiquantitative BLI data correlate well with viral load. Due to the longitudinal nature of this approach, lyssavirus pathogenesis and therapeutic intervention studies can be performed with far fewer animals than more traditional approaches, which typically require euthanasia of large animal groups at every data collection time point.

Establishment of a longitudinal pre-clinical model of lyssavirus infection

Traditional mouse models of lyssavirus pathogenesis rely on euthanizing large groups of animals at various time points post-infection, processing infected tissues, and performing histological and molecular analyses to determine anatomical sites of infection. While powerful by some measures, this approach is limited by the inability to monitor disease progression in the same mice over time. In this study, we established a novel non-invasive mouse model of lyssavirus pathogenesis, which consists of longitudinal imaging of a luciferase-expressing Australian bat lyssavirus (ABLV) reporter virus. In vivo bioluminescence imaging (BLI) in mice revealed viral spread from a peripheral site of inoculation into the central nervous system (CNS), with kinetically and spatially distinct foci of replication in the footpad, spinal cord, and hindbrain. Detection of virus within the CNS was associated with onset of clinical disease. Quantification of virus-derived luminescent signal in the brain was found to be a reliable measure of viral replication, when compared to traditional molecular methods. Furthermore, we demonstrate that in vivo imaging of ABLV infection is not restricted to the use of albino strains of mice, but rather strong BLI signal output can be achieved by shaving the hair from the heads and spines of pigmented strains, such as C57BL/6. Overall, our data show that in vivo BLI can be used to rapidly and non-invasively identify sites of lyssavirus replication and to semi-quantitatively determine viral load without the need to sacrifice mice at multiple time points.