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Kimura-Ohba S, Kitamura M, Tsukamoto Y, Kogaki S, Sakai S, Fushimi H, Matsuoka K, Takeuchi M, Itoh K, Ueda K, Kimura T. Viral entry and translation in brain endothelia provoke influenza-associated encephalopathy. Acta Neuropathol 2024; 147:77. [PMID: 38687393 PMCID: PMC11061015 DOI: 10.1007/s00401-024-02723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Influenza-associated encephalopathy (IAE) is extremely acute in onset, with high lethality and morbidity within a few days, while the direct pathogenesis by influenza virus in this acute phase in the brain is largely unknown. Here we show that influenza virus enters into the cerebral endothelium and thereby induces IAE. Three-weeks-old young mice were inoculated with influenza A virus (IAV). Physical and neurological scores were recorded and temporal-spatial analyses of histopathology and viral studies were performed up to 72 h post inoculation. Histopathological examinations were also performed using IAE human autopsy brains. Viral infection, proliferation and pathogenesis were analyzed in cell lines of endothelium and astrocyte. The effects of anti-influenza viral drugs were tested in the cell lines and animal models. Upon intravenous inoculation of IAV in mice, the mice developed encephalopathy with brain edema and pathological lesions represented by micro bleeding and injured astrocytic process (clasmatodendrosis) within 72 h. Histologically, massive deposits of viral nucleoprotein were observed as early as 24 h post infection in the brain endothelial cells of mouse models and the IAE patients. IAV inoculated endothelial cell lines showed deposition of viral proteins and provoked cell death, while IAV scarcely amplified. Inhibition of viral transcription and translation suppressed the endothelial cell death and the lethality of mouse models. These data suggest that the onset of encephalopathy should be induced by cerebral endothelial infection with IAV. Thus, IAV entry into the endothelium, and transcription and/or translation of viral RNA, but not viral proliferation, should be the key pathogenesis of IAE.
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Affiliation(s)
- Shihoko Kimura-Ohba
- Division of Virology, Department of Microbiology and Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
- Reverse Translational Research Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan.
- KAGAMI Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan.
- Department of Pediatrics and Neonatology, Osaka General Medical Center, Osaka, Japan.
| | - Mieko Kitamura
- KAGAMI Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
| | - Yusuke Tsukamoto
- Reverse Translational Research Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
- KAGAMI Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
| | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center, Osaka, Japan
| | - Shinsuke Sakai
- Reverse Translational Research Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
- KAGAMI Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Fushimi
- Department of Pathology, Osaka General Medical Center, Osaka, Japan
| | - Keiko Matsuoka
- Department of Pathology, Osaka General Medical Center, Osaka, Japan
- Department of Pathology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Makoto Takeuchi
- Department of Pathology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiji Ueda
- Division of Virology, Department of Microbiology and Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Tomonori Kimura
- Reverse Translational Research Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
- KAGAMI Project, Health and Nutrition (NIBIOHN), National Institutes of Biomedical Innovation, Osaka, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
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Kurane K, Wakae K, Yamagishi H, Kawahara Y, Ono M, Tamura D, Furuya K, Taga N, Matsuki M, Yamagata T, Muramatsu K. The first case of hemorrhagic shock and encephalopathy syndrome with fulminant hypercytokinemia associated with pediatric COVID-19. Brain Dev 2024; 46:44-48. [PMID: 37730452 DOI: 10.1016/j.braindev.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead not only to respiratory symptoms but also to neurologic symptoms with various levels of severity. After the worldwide prevalence of Omicron variant, severe neurological manifestations of coronavirus disease 2019 (COVID-19) such as febrile seizure, demyelinating disease, and cerebrovascular disease, have been reported. However, reports of acute encephalopathy in patients with COVID-19 are quite limited. Especially in terms of cytokine storm-inducing hemorrhagic shock and encephalopathy syndrome (HSES), there is no case reported related to COVID-19. CASE PRESENTATION We describe the case of an 8-year-old girl who presented with fatal HSES associated with pediatric SARS-CoV-2 infection. Status epilepticus occurs after the onset of fever and diarrhea and lasted for at least an hour. Unconsciousness was followed by circulatory failure and ultimately leading to death within 2 days after the fever onset. Analysis of forty-eight cytokines and chemokines measured in three consecutive serum samples revealed that interferon (IFN)-γ, interleukin (IL)-6, IL-10, IL-17A, tumor necrosis factor (TNF)-a, IL-8, Interferon gamma inducible protein (IP)-10, and Monocyte chemoattractant protein (MCP)-1, were increased within an hour after the onset of impaired consciousness. CONCLUSION Here, we describe a case of fatal fulminant encephalopathy with rapid progression because of HSES associated with COVID-19. High levels of cytokines and chemokines observed in this case may be because of the SARS-CoV-2-associated cytokine storm. This study is the first COVID-19-associated case of HSES.
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Affiliation(s)
- Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Keizo Wakae
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Hirokazu Yamagishi
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Marika Ono
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Daisuke Tamura
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Kaito Furuya
- Department of Pediatrics, Haga Red Cross Hospital, Tochigi, Japan
| | - Naoyuki Taga
- Department of Pediatric Intensive Care and Anesthesia, Jichi Children's Medical Center Tochigi, Tochigi, Japan
| | - Mitsuru Matsuki
- Department of Radiology, Jichi Children's Medical Center Tochigi, Tochigi, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan
| | - Kazuhiro Muramatsu
- Department of Pediatrics, Jichi Medical University, Tochigi, Tochigi, Japan.
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Inoue T, Kuki I, Uda T, Kunihiro N, Umaba R, Koh S, Nukui M, Okazaki S, Otsubo H. Comparing late-onset epileptic spasm outcomes after corpus callosotomy and subsequent disconnection surgery between post-encephalitis/encephalopathy and non-encephalitis/encephalopathy. Epilepsia Open 2023; 8:346-359. [PMID: 36692212 PMCID: PMC10235586 DOI: 10.1002/epi4.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE We aimed to analyze the efficiency of corpus callosotomy (CC) and subsequent disconnection surgeries in patients with late-onset epileptic spasms (LOES) by comparing post-encephalitis/encephalopathy (PE) and non-encephalitis/encephalopathy (NE). We hypothesized these surgeries can control potential focal onset epileptic spasms (ES) in the NE group but not in the PE group. METHODS We retrospectively included 23 patients (12 with PE and 11 with NE) who initially underwent CC and subsequent disconnection surgeries (five NE). We compared the clinical courses, seizure types, MRI, video-EEG, epilepsy surgery, and seizure outcomes between the two groups. RESULTS The median age of LOES onset in the PE group was 2.8 (range 1.0-10.1 years) and 2.9 years (range 1.1-12.6) in the NE group. Bilateral MRI abnormalities were observed in both groups (PE, n = 12; NE, n = 3; P < 0.05). The PE group presented ES alone (n = 2), ES + focal seizures (FS) (n = 3), ES + generalized seizures (GS) (n = 3), and ES + FS + GS (n = 4) in addition to stimulus-induced startle seizures (SS) (n = 8) (mean 3.1 seizure types/patient). The NE group presented ES alone (n = 1), ES + FS (n = 2), and ES + FS + GS (n = 8) (mean 2.7 seizure types/patient). In the PE group, CC stopped ES (n = 1) and SS (n = 1) and achieved <50% SS (n = 3). In the NE group, CC achieved immediate ES-free status (n = 2) and < 50% ES (n = 1), and additional disconnection surgeries subsided all seizure types (n = 3) based on lateralized interictal/ictal EEG findings. LOES was significantly remitted by surgery in the NE group (6/11 [55%]) compared with the PE group (1/12 [8%]) (P < 0.05). SIGNIFICANCE LOES is a drug-resistant, focal/generalized/unknown onset ES. Lateralization of ES in NE could be achieved after CC and eliminated by further disconnection surgeries because of potential focal onset ES. LOES in PE had little benefit from CC for generalized onset ES. However, CC might reduce SS in patients in the PE group with multiple seizure types.
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Affiliation(s)
- Takeshi Inoue
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Ichiro Kuki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Takehiro Uda
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Noritsugu Kunihiro
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Ryoko Umaba
- Department of Pediatric NeurosurgeryOsaka City General HospitalOsakaJapan
| | - Saya Koh
- Department of NeurosurgeryOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Megumi Nukui
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Shin Okazaki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
- Department of Pediatric LogopedicsOsaka City General HospitalOsakaJapan
| | - Hiroshi Otsubo
- Division of NeurologyThe Hospital for Sick ChildrenTorontoOntarioCanada
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Effect of higher body temperature and acute brain edema on mortality in hemorrhagic shock and encephalopathy syndrome. J Neurol Sci 2022; 439:120321. [PMID: 35728335 DOI: 10.1016/j.jns.2022.120321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hemorrhagic shock and encephalopathy syndrome (HSES) is a severe subtype of acute encephalopathy with a poor prognosis. The factors associated with acute neurological outcomes in patients with HSES remain unclear. This study aimed to determine the clinical features, laboratory and radiological findings, and treatments that determine the acute outcomes of HSES. METHODS Forty children with HSES registered in a database of Osaka City General Hospital between 1995 and 2020 were included in this observational study. We retrospectively collected data on clinical features, laboratory and radiological items, and treatments. We divided acute neurological outcomes into two groups: the non-death and death groups in 1 week. Correlations were assessed between these items and acute neurological outcomes. RESULTS Twenty-seven and 13 patients comprised the non-death and death groups, respectively. Univariate logistic regression analysis showed that higher body temperature, presence of hemorrhagic episode, elevated lactate level, high glucose level in the cerebrospinal fluid, and brain edema at initial computed tomography (CT) were correlated with the death group. Regarding treatments, barbiturate therapy, intravenous immunoglobulin, and intravenous methylprednisolone were significantly initiated in the non-death group. The multivariate logistic regression model showed higher body temperature (odds ratio [OR], 4.210 [1.409-12.584]; p = 0.010) and brain edema on initial head CT (OR, 46.917 [3.995-550.976]; p = 0.002) were independent factors. CONCLUSIONS Higher body temperature and brain edema at the onset of HSES were associated with acute outcomes. The results of this study may be useful for treatment planning and acute outcomes in patients with HSES.
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