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Yamin R, Kao KS, MacDonald MR, Cantaert T, Rice CM, Ravetch JV, Bournazos S. Human FcγRIIIa activation on splenic macrophages drives dengue pathogenesis in mice. Nat Microbiol 2023; 8:1468-1479. [PMID: 37429907 PMCID: PMC10753935 DOI: 10.1038/s41564-023-01421-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/01/2023] [Indexed: 07/12/2023]
Abstract
Although dengue virus (DENV) infection typically causes asymptomatic disease, DENV-infected patients can experience severe complications. A risk factor for symptomatic disease is pre-existing anti-DENV IgG antibodies. Cellular assays suggested that these antibodies can enhance viral infection of Fcγ receptor (FcγR)-expressing myeloid cells. Recent studies, however, revealed more complex interactions between anti-DENV antibodies and specific FcγRs by demonstrating that modulation of the IgG Fc glycan correlates with disease severity. To investigate the in vivo mechanisms of antibody-mediated dengue pathogenesis, we developed a mouse model for dengue disease that recapitulates the unique complexity of human FcγRs. In in vivo mouse models of dengue disease, we discovered that the pathogenic activity of anti-DENV antibodies is exclusively mediated through engagement of FcγRIIIa on splenic macrophages, resulting in inflammatory sequelae and mortality. These findings highlight the importance of IgG-FcγRIIIa interactions in dengue, with important implications for the design of safer vaccination approaches and effective therapeutic strategies.
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Affiliation(s)
- Rachel Yamin
- Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY, USA
| | - Kevin S Kao
- Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY, USA
| | - Margaret R MacDonald
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY, USA
| | - Tineke Cantaert
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY, USA
| | - Jeffrey V Ravetch
- Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY, USA.
| | - Stylianos Bournazos
- Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, NY, USA.
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2
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Ribeiro YP, Falcão LFM, Smith VC, de Sousa JR, Pagliari C, Franco ECS, Cruz ACR, Chiang JO, Martins LC, Nunes JAL, Vilacoert FSDS, Santos LCD, Furlaneto MP, Fuzii HT, Bertonsin Filho MV, da Costa LD, Duarte MIS, Furlaneto IP, Martins Filho AJ, Aarão TLDS, Vasconcelos PFDC, Quaresma JAS. Comparative Analysis of Human Hepatic Lesions in Dengue, Yellow Fever, and Chikungunya: Revisiting Histopathological Changes in the Light of Modern Knowledge of Cell Pathology. Pathogens 2023; 12:pathogens12050680. [PMID: 37242350 DOI: 10.3390/pathogens12050680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Arboviruses, such as yellow fever virus (YFV), dengue virus (DENV), and chikungunya virus (CHIKV), present wide global dissemination and a pathogenic profile developed in infected individuals, from non-specific clinical conditions to severe forms, characterised by the promotion of significant lesions in different organs of the harbourer, culminating in multiple organ dysfunction. An analytical cross-sectional study was carried out via the histopathological analysis of 70 samples of liver patients, collected between 2000 and 2017, with confirmed laboratory diagnoses, who died due to infection and complications due to yellow fever (YF), dengue fever (DF), and chikungunya fever (CF), to characterise, quantify, and compare the patterns of histopathological alterations in the liver between the samples. Of the histopathological findings in the human liver samples, there was a significant difference between the control and infection groups, with a predominance of alterations in the midzonal area of the three cases analysed. Hepatic involvement in cases of YF showed a greater intensity of histopathological changes. Among the alterations evaluated, cell swelling, microvesicular steatosis, and apoptosis were classified according to the degree of tissue damage from severe to very severe. Pathological abnormalities associated with YFV, DENV, and CHIKV infections showed a predominance of changes in the midzonal area. We also noted that, among the arboviruses studied, liver involvement in cases of YFV infection was more intense.
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Affiliation(s)
- Yasmin Pacheco Ribeiro
- Center for Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil
| | - Luiz Fabio Magno Falcão
- Center for Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil
| | - Vanessa Cavaleiro Smith
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Jorge Rodrigues de Sousa
- Center for Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil
| | - Carla Pagliari
- School of Medicine, São Paulo University, São Paulo 01246-903, SP, Brazil
| | | | - Ana Cecília Ribeiro Cruz
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Janniffer Oliveira Chiang
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Livia Carício Martins
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Juliana Abreu Lima Nunes
- Section of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | | | - Lais Carneiro Dos Santos
- Section of Pathology, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | | | - Hellen Thais Fuzii
- Tropical Medicine Center, Federal University of Pará, Belém 66055-240, PA, Brazil
| | | | - Luccas Delgado da Costa
- Section of Pathology, Evandro Chagas Institute, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | | | - Ismari Perini Furlaneto
- Center for Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil
| | | | | | | | - Juarez Antônio Simões Quaresma
- Center for Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil
- School of Medicine, São Paulo University, São Paulo 01246-903, SP, Brazil
- Tropical Medicine Center, Federal University of Pará, Belém 66055-240, PA, Brazil
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3
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Subsets of Cytokines and Chemokines from DENV-4-Infected Patients Could Regulate the Endothelial Integrity of Cultured Microvascular Endothelial Cells. Pathogens 2022; 11:pathogens11050509. [PMID: 35631030 PMCID: PMC9144803 DOI: 10.3390/pathogens11050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is a consensus that inflammatory mediators produced by immune cells contribute to changes in endothelial permeability in dengue. We propose to relate inflammatory mediators seen in dengue patients with the in vitro alteration of endothelial cells (ECs) cultured with serum from these patients. Methods: Patients with mild (DF) to moderate and severe dengue (DFWS/Sev) were selected. ELISA quantified inflammatory mediators. Expression of adhesion molecules and CD147 were evaluated in the ECs cultured with the patient’s serum by flow cytometry. We assessed endothelial permeability by measuring transendothelial electrical resistance in cocultures of ECs with patient serum. Results: Dengue infection led to an increase in inflammatory mediators—the IL-10 distinguished DF from DFWS/Sev. There were no changes in CD31, CD54, and CD106 but decreased CD147 expression in ECs. DFWS/Sev sera induced a greater difference in endothelial permeability than DF sera. Correlation statistical test indicated that low IL-10 and IFN-γ and high CCL5 maintain the integrity of ECs in DF patients. In contrast, increased TNF, IFN-γ, CXCL8, and CCL2 maintain EC integrity in DFWS/Sev patients. Conclusions: Our preliminary data suggest that a subset of inflammatory mediators may be related to the maintenance or loss of endothelial integrity, reflecting the clinical prognosis.
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Evaluating Dengue Virus Pathogenesis in Mice and Humans by Histological and Immunohistochemistry Approaches. Methods Mol Biol 2022; 2409:259-269. [PMID: 34709648 DOI: 10.1007/978-1-0716-1879-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The analysis of dengue virus (DENV) infected tissues in mice experimental model and in human biopsies/autopsies may support the pathogenesis studies. Through such models, it is possible to investigate possible histopathological changes caused by the infection and detections of different targets of interest, such as viral antigens, immune cells, and cytokines. In this chapter, we showed a brief review of how histological and immunohistochemistry approaches may improve the knowledge in this field.
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Misra U, Kalita J. Changing spectrum of acute encephalitis syndrome in India and a syndromic approach. Ann Indian Acad Neurol 2022; 25:354-366. [PMID: 35936627 PMCID: PMC9350753 DOI: 10.4103/aian.aian_1117_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022] Open
Abstract
Acute encephalitis syndrome (AES) refers to an acute onset of fever and clinical neurological manifestation that includes mental confusion, disorientation, delirium, or coma, which may occur because of infectious or non-infectious causes. Cerebrospinal fluid (CSF) pleocytosis generally favors infectious etiology, and a normal CSF favors an encephalopathy or non-infectious AES. Among the infectious AES, viral, bacterial, rickettsial, fungal, and parasitic causes are the commonest. Geographical and seasonal clustering and other epidemiological characteristics are important in clinical decision making. Clinical markers like eschar, skin rash, myalgia, hepatosplenomegaly, thrombocytopenia, liver and kidney dysfunction, elevated serum CK, fronto-temporal or thalamic involvement on MRI, and anterior horn cell involvement are invaluable clues for the etiological diagnosis. Categorizing the AES cases into neurologic [Herpes simplex encephalitis (HSE), Japanese encephalitis (JE), and West Nile encephalitis (WNE)] and systemic (scrub typhus, malaria, dengue, and Chikungunya) helps in rational utilization of diagnostic and management resources. In neurological AES, cranial CT/MRI revealing frontotemporal lesion is consistent with HSE, and thalamic and basal ganglia lesions are consistent with JE. Cerebrospinal fluid nucleic acid detection test or IgM antibody for JE and HSE are confirmatory. Presence of frontotemporal involvement on MRI indicates acyclovir treatment pending virological confirmation. In systemic AES, CT/MRI, PCR for HSE and JE, and acyclovir therapy may not be useful, rather treatable etiologies such as malaria, scrub typhus, and leptospirosis should be looked for. If smear or antigen for malaria is positive, should receive antimalarial, if negative doxycycline and ceftriaxone should be started pending serological confirmation of scrub typhus, leptospira, or dengue. A syndromic approach of AES based on the prevalent infection in a geographical region may be developed, which may be cost-effective.
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Leowattana W, Leowattana T. Dengue hemorrhagic fever and cardiac involvement. World J Meta-Anal 2021; 9:286-296. [DOI: 10.13105/wjma.v9.i3.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/30/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Dengue viral infection (DVI) is one of the world’s most significant viral infections spreading. Most of the patients have been asymptomatic, with relatively benign clinical manifestations and outcomes. However, a small number of patients have progressed to severe dengue diseases, including hemorrhage, multi-organ impairment, and increased vascular leakage causing hypovolemic shock, which can cause cardiovascular collapse and death. Numerous lines of evidence have demonstrated that DVI could also cause cardiac dysfunction, arrhythmias, and severe myocarditis. The treatment for dengue hemorrhagic fever (DHF) patients remains symptomatic and supportive, with close monitoring of hemodynamic status. The contributory role of cardiac dysfunction in DHF patients has potentially critical implications on the management. This review will address the current knowledge of cardiac involvement in DHF patients and the management strategy to reduce the fatality outcome.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
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Calderón A, Guzmán C, Oviedo-Socarras T, Mattar S, Rodríguez V, Castañeda V, Moraes Figueiredo LT. Two Cases of Natural Infection of Dengue-2 Virus in Bats in the Colombian Caribbean. Trop Med Infect Dis 2021; 6:tropicalmed6010035. [PMID: 33809400 PMCID: PMC8005977 DOI: 10.3390/tropicalmed6010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
Dengue, a mosquito-borne zoonotic disease, is the most common vector-borne disease in tropical and subtropical areas. In this study, we aim to demonstrate biological evidence of dengue virus infection in bats. A cross-sectional study was carried out in the departments of Cordoba and Sucre, Colombia. A total of 286 bats were captured following the ethical protocols of animal experimentation. The specimens were identified and euthanized using a pharmacological treatment with atropine, acepromazine and sodium pentobarbital. Duplicate samples of brain, heart, lung, spleen, liver, and kidney were collected with one set stored in Trizol and the other stored in 10% buffered formalin for histopathological and immunohistochemical analysis using polyclonal antibodies. Brain samples from lactating mice with an intracranial inoculation of DENV-2 were used as a positive control. As a negative control, lactating mouse brains without inoculation and bats brains negative for RT-PCR were included. Tissue sections from each specimen of bat without conjugate were used as staining control. In a specimen of Carollia perspicillata captured in Ayapel (Cordoba) and Phylostomus discolor captured in San Carlos (Cordoba), dengue virus was detected, and sequences were matched to DENV serotype 2. In bats RT-PCR positive for dengue, lesions compatible with viral infections, and the presence of antigens in tissues were observed. Molecular findings, pathological lesions, and detection of antigens in tissues could demonstrate viral DENV-2 replication and may correspond to natural infection in bats. Additional studies are needed to elucidate the exact role of these species in dengue epidemics.
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Affiliation(s)
- Alfonso Calderón
- Faculty of Veterinary Medicine and Animal Production Husbandry, Institute for Biological Research in the Tropics (IIBT), University of Cordoba, Monteria 230002, Cordoba, Colombia;
| | - Camilo Guzmán
- Department of Pharmacy, Faculty of Health Sciences, Institute for Biological Research in the Tropics (IIBT), University of Cordoba, Monteria 230002, Cordoba, Colombia;
| | - Teresa Oviedo-Socarras
- Research Group on Tropical Animal Production (GIPAT), Faculty of Veterinary Medicine and Animal Production Husbandry, University of Cordoba, Monteria 230002, Cordoba, Colombia;
| | - Salim Mattar
- Faculty of Veterinary Medicine and Animal Production Husbandry, Institute for Biological Research in the Tropics (IIBT), University of Cordoba, Monteria 230002, Cordoba, Colombia;
- Correspondence: or
| | - Virginia Rodríguez
- Bacteriological Program, Microbiological and Biomedical Research Group of Cordoba (GIMBIC), Faculty of Health Sciences, University of Cordoba, Monteria 230002, Cordoba, Colombia;
| | - Víctor Castañeda
- Veterinary Diagnostic Laboratories Network, Colombian Agricultural Institute, Cerete 230550, Cordoba, Colombia;
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8
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Kalimuddin S, Xie W, Watanabe S, Tham JY, Sam H, Chan KWK, Yap TS, Totman JJ, Chacko AM, Vasudevan SG, Low JG. 18F-fluorodeoxyglucose positron emission tomography as a window into human dengue pathophysiology. Antiviral Res 2020; 185:104991. [PMID: 33279522 DOI: 10.1016/j.antiviral.2020.104991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
In mouse models of dengue virus (DENV) infection, 18F-FDG PET is able to sensitively detect tissue-specific sites of inflammation and disease activity, as well as track therapeutic response to anti- DENV agents. However, the use of 18F-FDG PET to study the pathogenesis of inflammation and disease activity in DENV infection in humans, has not been clinically validated. Here we report the 18F-FDG PET imaging results of two patients during the febrile phase of acute DENV infection, paired with serial serum viral load, NS1 and proinflammatory cytokine measurements. Our findings demonstrate that 18F-FDG PET is able to sensitively detect and quantify organ-specific inflammation in the lymph nodes and spleen, in classic acute dengue fever. This raises the potential for 18F-FDG PET to be used as a research tool that may provide further insights into disease pathogenesis.
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Affiliation(s)
- Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Programme in Emerging Infectious Diseases, Duke-National University of Singapore (NUS), Medical School, Singapore
| | - Wanying Xie
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Satoru Watanabe
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore (NUS), Medical School, Singapore
| | - Jing Yang Tham
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
| | - Huizhen Sam
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Kitti Wing Ki Chan
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore (NUS), Medical School, Singapore
| | - Tiang Siew Yap
- Clinical Imaging Research Centre, NUS Yong Loo Lin School of Medicine, Singapore
| | - John J Totman
- Clinical Imaging Research Centre, NUS Yong Loo Lin School of Medicine, Singapore
| | - Ann-Marie Chacko
- Laboratory for Translational and Molecular Imaging, Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore
| | - Subhash G Vasudevan
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore (NUS), Medical School, Singapore; Department of Microbiology and Immunology, National University of Singapore, Singapore; Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Jenny G Low
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Programme in Emerging Infectious Diseases, Duke-National University of Singapore (NUS), Medical School, Singapore.
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Salomão N, Rabelo K, Basílio-de-Oliveira C, Basílio-de-Oliveira R, Geraldo L, Lima F, dos Santos F, Nuovo G, Oliveira ERA, Paes M. Fatal Dengue Cases Reveal Brain Injury and Viral Replication in Brain-Resident Cells Associated with the Local Production of Pro-Inflammatory Mediators. Viruses 2020; 12:E603. [PMID: 32486462 PMCID: PMC7354550 DOI: 10.3390/v12060603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
Dengue is an arboviral disease caused by dengue virus (DENV), which is transmitted to humans by Aedes aegypti mosquitoes. Infection by DENV most commonly results in a mild flu-like illness; however, the disease has been increasingly associated with neurological symptomatology. This association draws attention to further investigations on the impact of DENV infection in the host's central nervous system. Here, we analyzed brain samples of three fatal dengue cases that occurred in 2002 during an outbreak in Rio de Janeiro, Brazil. Brain tissues of these cases were marked by histopathological alterations, such as degenerated neurons, demyelination, hemorrhage, edema, and increased numbers of astrocytes and microglial cells. Samples were also characterized by lymphocytic infiltrates mainly composed of CD8 T cells. DENV replication was evidenced in neurons, microglia and endothelial cells through immunohistochemistry and in situ hybridization techniques. Pro-inflammatory cytokines, such as TNF-α and IFN-γ were detected in microglia, while endothelial cells were marked by the expression of RANTES/CCL5. Cytoplasmic HMGB1 and the production of nitric oxide were also found in neurons and microglial cells. This work highlights the possible participation of several local pro-inflammatory mediators in the establishment of dengue neuropathogenesis.
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Affiliation(s)
- Natália Salomão
- Interdisciplinary Medical Research Laboratory Rio de Janeiro, Oswaldo Cruz Foundation, 21040-900 Rio de Janeiro, Brazil;
| | - Kíssila Rabelo
- Ultrastructure and Tissue Biology Laboratory Rio de Janeiro, Rio de Janeiro State University, 20551-030 Rio de Janeiro, Brazil;
| | - Carlos Basílio-de-Oliveira
- Pathological Anatomy, Gaffrée Guinle University Hospital Rio de Janeiro, Federal University of the State of Rio de Janeiro, 20270-004 Rio de Janeiro, Brazil; (C.B.-d.-O.); (R.B.-d.-O.)
| | - Rodrigo Basílio-de-Oliveira
- Pathological Anatomy, Gaffrée Guinle University Hospital Rio de Janeiro, Federal University of the State of Rio de Janeiro, 20270-004 Rio de Janeiro, Brazil; (C.B.-d.-O.); (R.B.-d.-O.)
| | - Luiz Geraldo
- Glial Cell Biology Laboratory, Institute of Biomedical Sciences Rio de Janeiro, Federal University of Rio de Janeiro, 21941-590 Rio de Janeiro, Brazil; (L.G.); (F.L.)
| | - Flávia Lima
- Glial Cell Biology Laboratory, Institute of Biomedical Sciences Rio de Janeiro, Federal University of Rio de Janeiro, 21941-590 Rio de Janeiro, Brazil; (L.G.); (F.L.)
| | - Flávia dos Santos
- Viral Immunology Laboratory, Oswaldo Cruz Institute Rio de Janeiro, Oswaldo Cruz Foundation, 21040-900 Rio de Janeiro, Brazil;
| | - Gerard Nuovo
- Ohio State University Comprehensive Cancer Center, Ohio State University Foundation, Columbus, OH 43210, USA;
- Phylogeny Medical Laboratory Columbus, Ohio State University Foundation, Columbus, OH 43214, USA
| | - Edson R. A. Oliveira
- Department of Microbiology and Immunology Chicago, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marciano Paes
- Interdisciplinary Medical Research Laboratory Rio de Janeiro, Oswaldo Cruz Foundation, 21040-900 Rio de Janeiro, Brazil;
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Cipitelli MDC, Amâncio Paiva I, Badolato-Corrêa J, de-Oliveira-Pinto LM. Influence of chemokines on the endothelial permeability and cellular transmigration during dengue. Immunol Lett 2019; 212:88-97. [PMID: 31181280 DOI: 10.1016/j.imlet.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/24/2019] [Accepted: 06/06/2019] [Indexed: 01/31/2023]
Abstract
During a pathogenic infection, an inflammatory process is triggered in which several inflammatory mediators, such as cytokines, chemokines, growth factors, complement system components, nitric oxide, and others induce integrity alteration on the endothelial barrier. Chemokines are responsible for regulating leukocyte trafficking under homeostatic conditions as well as activating immune system cells under inflammatory conditions. They are crucial molecules in the early stages of infection, leading to the recruitment of immune cells, namely neutrophils, monocytes, natural killer (NK) cells, natural killer T cells (NKT), dendritic cells (DC), T lymphocytes and all cells expressing chemokine receptors for inflammatory sites. Other functions, such as collagen production, tissue repair, a proliferation of hematopoietic precursors and angiogenesis, are also performed by these molecules. Chemokines, amongst inflammatory mediators, play a key role in dengue immunopathogenesis. Dengue fever is a disease caused by the dengue virus (DENV). It is characterized by a broad spectrum of clinical manifestations ranging from asymptomatic cases to mild and severe symptomatic ones. As for the latter, the appearance of hemorrhagic manifestations and changes in vascular permeability may lead the patient to develop cavitary effusions, organ involvement, and even death. As chemokines exert an influence on various homeostatic and inflammatory processes, acting vigorously on vascular endothelial activation and cell migration, the main purpose of this chapter is to discuss the influence of chemokines on the alteration of endothelial permeability and migration of T lymphocytes in DENV infection.
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Affiliation(s)
- Márcio da Costa Cipitelli
- Laboratory of Viral Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Fundation, Rio de Janeiro, Brazil
| | - Iury Amâncio Paiva
- Laboratory of Viral Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Fundation, Rio de Janeiro, Brazil
| | - Jéssica Badolato-Corrêa
- Laboratory of Viral Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Fundation, Rio de Janeiro, Brazil
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Kularatne SAM, Rajapakse MM, Ralapanawa U, Waduge R, Pathirage LPMMK, Rajapakse RPVJ. Heart and liver are infected in fatal cases of dengue: three PCR based case studies. BMC Infect Dis 2018; 18:681. [PMID: 30567553 PMCID: PMC6299998 DOI: 10.1186/s12879-018-3603-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/10/2018] [Indexed: 01/13/2023] Open
Abstract
Background Dengue is a global problem mainly in the tropics. Meticulous clinical management of cases has reduced the death rate significantly, but large numbers of people still succumb to severe complications of the infection. Presence of myocarditis is often overlooked leading to a poor outcome. Clinical management guidelines of dengue do not stress the importance of myocarditis as a manifestation in dengue infection. Severe hepatic dysfunction also needs emphasis. Case presentation We present three patients who had come to hospital on the 3rd day of fever. Two of them (case 1 and 3) were in shock on admission and case 2, who was stable on the3rd day, went into the critical phase and developed shock while in the hospital on the 4thday. All three had tachycardia on admission that got worse with time. The clinical course was unstable with fluctuations in urine output and deterioration of organ function. Despite frequent monitoring and life support they survived only 2–3 days in hospital. All three patients had myocarditis during the critical phase. In the first case, myocarditis was confirmed by troponin estimation and echocardiogram. In the second and third cases, histopathology confirmed myocarditis. Haemorrhagic necrosis of the liver was found in case 2 and 3 with exponential rise of transaminases. In all three cases, viral RNA was detected in both heart and liver tissues by PCR amplification. Conclusions We stress that detection of myocarditis and liver involvement in any dengue patient is important from the onset of the illness where treatment should be tailored to prevent development of hypotension. Our findings are novel as PCR and histology are rarely done on tissues of deceased dengue patients in the world. Studies are needed to find therapeutic interventions to reverse cardiac and hepatic dysfunction in dengue infection.
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Affiliation(s)
- S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M M Rajapakse
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Udaya Ralapanawa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - R Waduge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - L P M M K Pathirage
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - R P V J Rajapakse
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
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12
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Watterson D, Modhiran N, Muller DA, Stacey KJ, Young PR. Plugging the Leak in Dengue Shock. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1062:89-106. [PMID: 29845527 DOI: 10.1007/978-981-10-8727-1_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recent structural and functional advances provide fresh insight into the biology of the dengue virus non-structural protein, NS1 and suggest new avenues of research. The work of our lab and others have shown that the secreted, hexameric form of NS1 has a systemic toxic effect, inducing inflammatory cytokines and acting directly on endothelial cells to produce the hallmark of dengue disease, vascular leak. We also demonstrated that NS1 exerts its toxic activity through recognition by the innate immune receptor TLR4, mimicking the bacterial endotoxin LPS. This monograph covers the background underpinning these new findings and discusses new avenues for antiviral and vaccine intervention.
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Affiliation(s)
- Daniel Watterson
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.
| | - Naphak Modhiran
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - David A Muller
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Katryn J Stacey
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Paul R Young
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.
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Malavige GN, Ogg GS. Pathogenesis of vascular leak in dengue virus infection. Immunology 2017; 151:261-269. [PMID: 28437586 DOI: 10.1111/imm.12748] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/26/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022] Open
Abstract
Endothelial dysfunction leading to vascular leak is the hallmark of severe dengue. Vascular leak typically becomes clinically evident 3-6 days after the onset of illness, which is known as the critical phase. This critical phase follows the period of peak viraemia, and lasts for 24-48 hr and usually shows rapid and complete reversal, suggesting that it is likely to occur as a result of inflammatory mediators, rather than infection of the endothelium. Cytokines such as tumour necrosis factor-α, which are known to be elevated in the critical phase of dengue, are likely to be contributing factors. Dengue NS1, a soluble viral protein, has also been shown to disrupt the endothelial glycocalyx and thus contribute to vascular leak, although there appears to be a discordance between the timing of NS1 antigenaemia and occurrence of vascular leak. In addition, many inflammatory lipid mediators are elevated in acute dengue viral infection such as platelet activating factor (PAF) and leukotrienes. Furthermore, many other inflammatory mediators such as vascular endothelial growth factor and angiopoietin-2 have been shown to be elevated in patients with dengue haemorrhagic fever, exerting their action in part by inducing the activity of phospholipases, which have diverse inflammatory effects including generation of PAF. Platelets have also been shown to significantly contribute to endothelial dysfunction by production of interleukin-1β through activation of the NLRP3 inflammasome and also by inducing production of inflammatory cytokines by monocytes. Drugs that block down-stream immunological mediator pathways such as PAF may also be beneficial in the treatment of severe disease.
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Affiliation(s)
- Gathsaurie Neelika Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.,MRC Human Immunology Unit, Radcliffe Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Graham S Ogg
- MRC Human Immunology Unit, Radcliffe Department of Medicine, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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Lethal Dengue Virus Infection. Am J Forensic Med Pathol 2016; 37:221. [DOI: 10.1097/paf.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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