Virus del dengue: estructura y ciclo viral

A tangled threesome: understanding arbovirus infection in Aedes spp. and the effect of the mosquito microbiota

Arboviral infections transmitted by Aedes spp. mosquitoes are a major threat to human health, particularly in tropical regions but are expanding to temperate regions. The ability of Aedes aegypti and Aedes albopictus to transmit multiple arboviruses involves a complex relationship between mosquitoes and the virus, with recent discoveries shedding light on it. Furthermore, this relationship is not solely between mosquitoes and arboviruses, but also involves the mosquito microbiome. Here, we aimed to construct a comprehensive review of the latest information about the arbovirus infection process in A. aegypti and A. albopictus, the source of mosquito microbiota, and its interaction with the arbovirus infection process, in terms of its implications for vectorial competence. First, we summarized studies showing a new mechanism for arbovirus infection at the cellular level, recently described innate immunological pathways, and the mechanism of adaptive response in mosquitoes. Second, we addressed the general sources of the Aedes mosquito microbiota (bacteria, fungi, and viruses) during their life cycle, and the geographical reports of the most common microbiota in adults mosquitoes. How the microbiota interacts directly or indirectly with arbovirus transmission, thereby modifying vectorial competence. We highlight the complexity of this tripartite relationship, influenced by intrinsic and extrinsic conditions at different geographical scales, with many gaps to fill and promising directions for developing strategies to control arbovirus transmission and to gain a better understanding of vectorial competence. The interactions between mosquitoes, arboviruses and their associated microbiota are yet to be investigated in depth.

Endothelial Dysfunction, HMGB1, and Dengue: An Enigma to Solve

Dengue is a viral infection caused by dengue virus (DENV), which has a significant impact on public health worldwide. Although most infections are asymptomatic, a series of severe clinical manifestations such as hemorrhage and plasma leakage can occur during the severe presentation of the disease. This suggests that the virus or host immune response may affect the protective function of endothelial barriers, ultimately being considered the most relevant event in severe and fatal dengue pathogenesis. The mechanisms that induce these alterations are diverse. It has been suggested that the high mobility group box 1 protein (HMGB1) may be involved in endothelial dysfunction. This non-histone nuclear protein has different immunomodulatory activities and belongs to the alarmin group. High concentrations of HMGB1 have been detected in patients with several infectious diseases, including dengue, and it could be considered as a biomarker for the early diagnosis of dengue and a predictor of complications of the disease. This review summarizes the main features of dengue infection and describes the known causes associated with endothelial dysfunction, highlighting the involvement and possible relationship between HMGB1 and DENV.

Nuclear localization of non-structural protein 3 (NS3) during dengue virus infection

Although dengue virus (DENV) replication occurs in the cytoplasm, the nucleus plays an essential role during infection. Both the capsid protein (C) and non-structural protein 5 (NS5) are translocated into the infected cell nucleus to favor viral replication. Previously, our group reported the nuclear localization of the NS3 protein during DENV infection of mosquito cells; however, the nuclear localization of the DENV NS3 protein in human host cells has not been described. Here, we demonstrated that NS3 is present in the nucleus of Huh7 cells at early infection times, and later, it is mainly located in the cytoplasm.

Extracellular vesicles of U937 macrophage cell line infected with DENV-2 induce activation in endothelial cells EA.hy926

Endothelial activation and alteration during dengue virus (DENV) infection are multifactorial events; however, the role of extracellular vesicles (EVs) in these phenomena is not known. In the present study, we characterized the EVs released by DENV-2 infected U937 macrophage cell line and evaluated the changes in the physiology and integrity of the EA.hy926 endothelial cells exposed to them. U937 macrophages were infected, supernatants were collected, and EVs were purified and characterized. Then, polarized endothelial EA.hy926 cells were exposed to the EVs for 24 h, and the transendothelial electrical resistance (TEER), monolayer permeability, and the expression of tight junction and adhesion proteins and cytokines were evaluated. The isolated EVs from infected macrophages corresponded to exosomes and apoptotic bodies, which contained the viral NS3 protein and different miRs, among other products. Exposure of EA.hy926 cells to EVs induced an increase in TEER, as well as changes in the expression of VE-cadherin and ICAM in addition leads to an increase in TNF-α, IP-10, IL-10, RANTES, and MCP-1 secretion. These results suggest that the EVs of infected macrophages transport proteins and miR that induce early changes in the physiology of the endothelium, leading to its activation and eliciting a defense program against damage during first stages of the disease, even in the absence of the virus.

Amplificación de la infección dependiente de anticuerpos en la inmunopatogénesis del dengue grave, implicaciones para el desarrollo y uso de las vacunas

Actualmente, la infección por el virus de dengue (DENV) es uno de los problemas más importantes de salud pública en países tropicales y endémicos como Colombia, pues en tanto puede ser producida por cuatro diferentes serotipos virales, durante las infecciones secundarias se presentan frecuentemente cuadros más severos que incluso pueden llevar a desenlaces fatales. El centro de la fisiopatología del dengue grave es el daño producido al endotelio, que se traduce en un aumento en la permeabilidad vascular que se evidencia como fuga plasmática, descontrol en la coagulación y daño de órganos. Aunque hay varias teorías que explican la enfermedad severa, el fenómeno denominado amplificación de la infección dependiente de anticuerpos (antibody dependent enhancement, ADE) es el más conocido. En este, se postula que el virus causante de una infección secundaria es reconocido, pero no neutralizado, por anticuerpos generados en la infección previa e internalizado en las células susceptibles usando receptores Fc-gamma, lo cual aumenta la replicación viral e induce modificaciones en la respuesta inmune celular que contribuyen al desarrollo de dengue grave. En este escrito, se realiza una revisión de los hallazgos sobre los mecanismos involucrados en el fenómeno de ADE y cómo pueden contribuir a la progresión hacia dengue grave, describiendo los conceptos de ADE extrínseco e intrínseco, además de como este fenómeno debe ser tenido en cuenta para el diseño, desarrollo e implementación de una vacuna para dengue, en tanto es capaz de afectar su eficacia y seguridad.

Barriers that limit the implementation of thermal fogging for the control of dengue in Colombia: a study of mixed methods

BACKGROUND

Thermal fogging of Insecticides is a vector control strategy used by the Medellin Secretary of Health to combat dengue. This method is employed during outbreaks to curb populations of potentially infectious adult mosquitoes and interrupt transmission cycles. While this strategy has been used in Medellin since 2007, in some years it has not reduced dengue cases as expected. Difficulties in the implementation of fumigation strategies, such as lack of opportunity for treatment and public perception may be factors that limit its utility. The objective of this study was to identify barriers that hinder the implementation of thermal fogging, as well as attitudes and beliefs that prevent its acceptance.

METHODS

We used a cross-sectional observational study of mixed methods carried out in neighborhoods prioritized for fumigation treatment in Medellin, Colombia. First, we assessed the timeliness of treatment by determining the latency period between reported dengue cases and the implementation of fumigation in response to those cases. Next, we administered structured questionnaires to residents in the area of fumigation treatments (n = 4455 homes) to quantify acceptance and rejection, as well as factors associated with rejection.

RESULTS

The median time between notification and treatment was 25 days (IQR 20.0-36.5). Fumigators were only able to treat 53.7% of total households scheduled for treatment; 9.6% rejected treatment, and treatment teams were unable to fumigate the remaining 36.7% of homes due to absent residents, no adults being present, and other reasons. The most frequent causes for rejection were residents being busy at the time of treatment (33.1%) and no interest in the treatment (24.5%). Other reasons for rejection include the perceptions that fumigation does not control pests other than mosquitoes (4.3%), that no mosquitoes were present in the home (3.3%), and that fumigation affects human health (3.1%).

CONCLUSIONS

The high percentage of houses where it was not possible to perform fumigation limits control of the vector. Future strategies should consider more flexible treatment schedules and incorporate informational messages to educate residents about the safety and importance of treatment.

Virological surveillance of Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus as support for decision making for dengue control in Medellín

INTRODUCTION

Dengue represents an important public health problem in Colombia. No treatment is available and the vaccine has not been approved in all countries, hence, actions should be strengthened to mitigate its impact through the control of Aedes aegypti, the vector mosquito. In Colombia, surveillance is done using entomological indexes and case notification, which is usually informed late, leading to untimely interventions. Viral detection in urban mosquitoes using molecular techniques provides more accurate entomological information for decision-making.

OBJECTIVE

To report results of virological surveillance in Aedes specimens collected during routine entomological activities of the Secretaría de Salud de Medellín.

MATERIALS AND METHODS

Specimens were collected during two periods in each of which we selected 18 dwellings around each one of the 250 larva traps arranged for mosquitoe surveillance, as well as 70 educational institutions and 30 health centers. Specimens were identified morphologically, and divided in pools for viral detection using reverse transcription polymerase chain reaction (RT-PCR). We calculated the minimum infection rate and the adult infestation index for each group.

RESULTS

We collected 1,507 adult mosquitoes, 10 of which were identified as A. albopictus. Out of the 407 pools, 132 (one of them Ae. albopictus) were positive, and 14.39% were A. aegypti males. The minimum infection rates for Ae. aegypti were 120.07 and 69,50 for the first and second periods, respectively, and the adult infestation index was higher in educational institutions (23.57%).

CONCLUSIONS

Using RT-PCR we identified natural infectivity and vertical transmission of dengue virus in A. aegypti and A. albopictus. We suggest the use of molecular techniques in arbovirosis surveillance and control programs in Colombia.

[Polyclonal antibodies against recombinant dengue virus NS3 protein]

INTRODUCTION

Dengue is a disease caused by one of four serotypes of the dengue virus (DENV) and is endemic in approximately 130 countries. The incidence of dengue has increased dramatically in recent decades, as well as the frequency and magnitude of outbreaks. Despite all efforts, there are no prophylactic or therapeutic treatments for the disease. Accordingly, research on the processes governing the DENV infection cycle is essential to develop vaccines or antiviral therapies. One of themost attractive DENV molecules to investigate is nonstructural protein 3 (NS3), which is essential for viral replication and a major immune target for infection.

OBJECTIVE

To produce antibodies to support future studies on NS3 and its cellular interactions with other proteins.

MATERIALS AND METHODS

Two recombinant proteins of the helicase domain of DENV NS3 serotype 2 were expressed, and used to immunize mice and produce polyclonal antibodies.

RESULTS

The antibodies produced were useful in Western blot and immunofluorescence tests. We report an NS3 antibody that immunoprecipitates the viral protein and detects it in Western blot with no need to over-express it or use cell extracts with metabolic radiolabeling.

CONCLUSION

The recombinant proteins expressed and the antibodies produced constitute valuable tools for studying DENV infectious processes involving NS3 and for evaluating tests designed to interfere with its functions.

Prevalence and clinical course of dengue infection in elderly patients with acute febrile illness in a tertiary care hospital in Cali, Colombia

INTRODUCTION

Little is known about the prevalence and clinical course of dengue infection in elderly patients living in endemic areas; it is presumed that there is a lower prevalence but higher severity, complications and mortality. 

OBJECTIVE

To describe the prevalence and clinical course of dengue infection in elderly patients who were admitted to a referral care center for infectious diseases in an endemic region. 

MATERIALS AND METHODS

We conducted an observational and descriptive study between 2011 and 2014, using a cohort of elderly patients with serological diagnosis of dengue. 

RESULTS

A total of 235 febrile elderly patients were assessed, of which 43 patients (18.3%) were found to have dengue. The median age was 71 years; 48.7% were female, and 89% of patients had at least one comorbid condition. According to the serological tests, 51.4% of cases were positive for NS1 Ag, 27% for IgM and 54.1% for IgG, while 64.8% were secondary infections. Dengue was diagnosed in 13 patients (35%), dengue with warning signs in 16 cases (43%), and severe dengue in 8 cases (22%). Nearly 56.7% of patients were admitted to hospital and 21.6%, to the intensive care unit. None died. 

CONCLUSION

We found dengue infection to be more frequent than expected in this sample of elderly patients, due to acute febrile syndrome. Elderly patients also required higher rate of hospitalization and had more complications, however there were no deaths due to good management.

Dengue virus induces apoptosis in SH-SY5Y human neuroblastoma cells

INTRODUCTION

Dengue is a human disease caused by a virus with the same name, which is transmitted by the bite of Aedes mosquitoes. The infection has a wide range of clinical presentations ranging from asymptomatic to fatal cases, with the pediatric population being the most susceptible. According to the new classification of the disease, the neurological manifestations are considered a criterion for the diagnosis of severe dengue. 

OBJECTIVE

To evaluate the possible mechanisms involved in the onset of neurological signs in a cell line of human neurons as a model of infection with dengue virus type 2 (DENV-2). 

MATERIALS AND METHODS

Susceptibility and permissiveness of the SH-SY5Y line to infection by DENV-2 was analyzed, showing that the proportions of viral infection and production are similar to those of primate cells used as positive control for infection. 

RESULTS

Infection induced a cytopathic effect on the neuroblastoma line characterized by apoptotic cell death process, increasing the proportion of annexin V and TUNEL positive cells and an upregulation of TNF-α. Treatment with anti-TNF-α antibody increased slightly cell survival of infected cells. The addition of exogenous TNF-α to the infected cultures enhanced cell death. 

CONCLUSION

These results as a whole suggest that the upregulation of TNF-α could be part of the process that induces cell damage and death in cases of dengue encephalitis.

Methodology to develop endemic channels and notification trends for dengue in Valle del Cauca, Colombia, 2009-2013

INTRODUCTION

Dengue is the fastest spreading disease in the world and a permanent threat to global public health. It is a viral illness for which approximately 2.5 million people are at high risk of infection. Given the severity of the disease at national and global levels, new predictive methodologies need to be generated to facilitate decision-making in public health. 

OBJECTIVE

To characterize cases of dengue reported from 2009 to 2013 in Valle del Cauca department, Colombia, and to establish a methodology to develop endemic channels that can be applied to this event. 

MATERIALS AND METHODS

This was a retrospective descriptive study. Notification forms were used as a secondary database to characterize dengue cases from 2009 to 2013. Two endemic channels were developed, one using running means and the other through exponential smoothing. 

RESULTS

Dengue in the department of Valle del Cauca showed a positive tendency, indicating that the number of cases had increased in the last five years. An important variation was observed that could be explained by a three-year cycle beginning in the first epidemiological period of the year. 

CONCLUSION

The development of the dengue endemic channel for Valle del Cauca illustrates the importance of applying these monitoring methodologies to events of public health interest. As can be seen from the results, there were some years in which the number of cases was very low and others in which the epidemic reached very high levels.