Subacute sclerosing panencephalitis: isolation of a virus encephalitogenic for ferrets

Measles Encephalitis: Towards New Therapeutics

Measles remains a major cause of morbidity and mortality worldwide among vaccine preventable diseases. Recent decline in vaccination coverage resulted in re-emergence of measles outbreaks. Measles virus (MeV) infection causes an acute systemic disease, associated in certain cases with central nervous system (CNS) infection leading to lethal neurological disease. Early following MeV infection some patients develop acute post-infectious measles encephalitis (APME), which is not associated with direct infection of the brain. MeV can also infect the CNS and cause sub-acute sclerosing panencephalitis (SSPE) in immunocompetent people or measles inclusion-body encephalitis (MIBE) in immunocompromised patients. To date, cellular and molecular mechanisms governing CNS invasion are still poorly understood. Moreover, the known MeV entry receptors are not expressed in the CNS and how MeV enters and spreads in the brain is not fully understood. Different antiviral treatments have been tested and validated in vitro, ex vivo and in vivo, mainly in small animal models. Most treatments have high efficacy at preventing infection but their effectiveness after CNS manifestations remains to be evaluated. This review describes MeV neural infection and current most advanced therapeutic approaches potentially applicable to treat MeV CNS infection.

Use of Ferrets in Toxicity Testing

A selective review of the literature is presented in order to introduce the reader to the extensive studies conducted in the ferret ( Mustela putorius furo) in such diverse fields as virology, gastroenterology, and teratology. Husbandry, anatomical variations, and the modeling of specific human disorders are discussed to indicate the increasing recognition of this species as a valuable asset in toxicity testing.

Amino acid substitutions in the heptad repeat A and C regions of the F protein responsible for neurovirulence of measles virus Osaka-1 strain from a patient with subacute sclerosing panencephalitis

Measles virus (MV) is the causative agent of subacute sclerosing panencephalitis (SSPE). We previously reported that the F gene of the SSPE Osaka-2 strain is the major determinant of MV neurovirulence. Because the sites and extents of mutations differ among SSPE strains, it is necessary to determine the mutations responsible for the SSPE-specific phenotypes of individual viral strain. In this study, recombinant viruses containing the envelope-associated genes from the SSPE Osaka-1 strain were generated in the IC323 wild-type MV background. Hamsters inoculated with MV containing the H gene of the Osaka-1 strain displayed hyperactivity and seizures, but usually recovered and survived. Hamsters inoculated with MV containing the F gene of the Osaka-1 strain displayed severe neurologic signs and died. Amino acid substitutions in the heptad repeat A and C regions of the F protein, including a methionine-to-valine substitution at amino acid 94, play major roles in neurovirulence.

Biased hypermutation occurred frequently in a gene inserted into the IC323 recombinant measles virus during its persistence in the brains of nude mice

Measles virus (MV) is the causative agent of measles and its neurological complications, subacute sclerosing panencephalitis (SSPE) and measles inclusion body encephalitis (MIBE). Biased hypermutation in the M gene is a characteristic feature of SSPE and MIBE. To determine whether the M gene is the preferred target of hypermutation, an additional transcriptional unit containing a humanized Renilla reniformis green fluorescent protein (hrGFP) gene was introduced into the IC323 MV genome, and nude mice were inoculated intracerebrally with the virus. Biased hypermutation occurred in the M gene and also in the hrGFP gene when it was inserted between the leader and the N gene, but not between the H and L gene. These results indicate that biased hypermutation is usually found in a gene whose function is not essential for viral proliferation in the brain and that the location of a gene in the MV genome can affect its mutational frequency.

The F gene of the Osaka-2 strain of measles virus derived from a case of subacute sclerosing panencephalitis is a major determinant of neurovirulence

Measles virus (MV) is the causative agent for acute measles and subacute sclerosing panencephalitis (SSPE). Although numerous mutations have been found in the MV genome of SSPE strains, the mutations responsible for the neurovirulence have not been determined. We previously reported that the SSPE Osaka-2 strain but not the wild-type strains of MV induced acute encephalopathy when they were inoculated intracerebrally into 3-week-old hamsters. The recombinant MV system was adapted for the current study to identify the gene(s) responsible for neurovirulence in our hamster model. Recombinant viruses that contained envelope-associated genes from the Osaka-2 strain were generated on the IC323 wild-type MV background. The recombinant virus containing the M gene alone did not induce neurological disease, whereas the H gene partially contributed to neurovirulence. In sharp contrast, the recombinant virus containing the F gene alone induced lethal encephalopathy. This phenotype was related to the ability of the F protein to induce syncytium formation in Vero cells. Further study indicated that a single T461I substitution in the F protein was sufficient to transform the nonneuropathogenic wild-type MV into a lethal virus for hamsters.

Measles virus-specific T-cell immunity in rodent models

Measles virus (MV) infection still belongs to the most important infectious diseases world wide. To identify the components of the immune system that combat MV infection, infection models in rodents have been established. In rats and mice, the immune response to experimental MV infection is governed by the major histocombatibility complex (MHC). According to the MHC haplotype, the functional composition of the T-cell subsets determines the degree of susceptibility to experimental measles virus infection. CD4+ T-cells are the most important T-cell subset in combating experimental MV infection in rodents. However, the mechanism of action still remains to be elucidated.

Comparison of the neuropathogenicity of two SSPE sibling viruses of the Osaka-2 strain isolated with Vero and B95a cells

Two sibling viruses, Fr/V and Fr/B, of the subacute sclerosing panencephalitis (SSPE) virus Osaka-2 strain were isolated from a small biopsy specimen of the brain of an SSPE patient by cocultivation with two different cell lines, Vero and B95a cells, respectively. These two sibling viruses differ from each other in their molecular mechanisms of defective M protein expression. In this study, we found that the Fr/B virus could scarcely form syncytium foci on Vero cells, although the Fr/V virus could do so on both Vero and B95a cells, showing a similar relation of cell tropism between recent field isolates and laboratory strains of the measles virus. Severe neurovirulence of both Fr/V and Fr/B viruses was observed in hamsters inoculated intracerebrally with less than 100 PFU, in contrast to the negative neurological and pathological findings in hamsters inoculated even with more than 10(5) PFU of their possible progenitor measles virus. Comparative sequence analysis of inoculated viruses and reisolated viruses from diseased hamster brains showed few variations at a region containing the P-M gene junction, indicating that the inoculated viruses propagated in the brains and induced neurovirulence. All these results suggest that SSPE virus isolated with a lymphoid cell line is similar in neuropathogenicity to that isolated with a nonlymphoid cell lines, irrespective of differences in the molecular mechanism of M protein defectiveness.

Presence of oligoclonal immunoglobulin G bands and lack of matrix protein antibodies in cerebrospinal fluids and sera of ferrets with measles virus encephalitis

Young adult ferrets were immunized with measles vaccine and 5 to 6 weeks later inoculated intracerebrally with Vero cells persistently infected with cell-associated strain D.R. of measles virus isolated from a patient with subacute sclerosing panencephalitis. Of nine ferrets which survived the infection for 3 weeks or longer, five showed neurological signs. At the time of death they had widespread inflammation in their brains, and cell-associated virus was isolated from three ferrets sacrificed from 5 weeks to 7 months after inoculation. Four ferrets did not develop clinical signs, but two of these had mild inflammation in the brain 7 months and 2 1/2 years after inoculation, respectively. Cerebrospinal fluids drawn by cisternal puncture from infected ferrets at the time of sacrifice had neutralizing titers against measles virus similar to the titers found in sera, but antibody against the measles virus matrix protein was not detectable. Cerebrospinal fluid showed increased immunoglobulin G (IgG) and had distinct measles virus-specific oligoclonal IgG bands. The intensity of the bands correlated with the neutralizing titers of the fluids. These results confirm and extend earlier findings and indicate that persistent measles virus infection in ferrets is similar to human subacute sclerosing panencephalitis and can be used to study certain aspects of persistent brain infections leading to subacute encephalitis.

Persistence of visna virus in cultured ferret brain cortex and fibroblasts

Cerebral cortex tissue fragments from newborn ferrets have been cultured in vitro and, when exposed to visna virus, failed to exhibit a cytopathic effect but retained the genome of the virus in a quiescent state for 46 d before synthesizing plaque-forming virus for the subsequent 26 d. In contrast, infection of an established line of cells derived from a ferret's brain with visna virus resulted in the formation of the polykaryocytes typically produced by this virus and a limited synthesis of plaque-forming virus. Ferret cerebral cortex cultures may be suitable in vitro hosts for studies to define the virus-host interactions that result in virus-induced demyelination.

Immunoperoxidase study of astrocytic reaction in Junín virus encephalomyelitis of mice

Intracerebral inoculation of strain XJ Clon 3 of Junín virus into 1-2-day-old mice resulted in the appearance of viral antigen, detectable by means of the peroxidase antiperoxidase (PAP) technique, within the cytoplasm of the neurons of the cerebral cortex, the basal nuclei, cerebellum, pons, medulla, spinal cord, and spinal ganglia; Junín antigen was likewise observed, although to a lesser extent, in the cytoplasm of astrocytes. The viral antigen was found in highest concentration at the cytoplasmic periphery, near the cell membrane, where complete virions are formed by budding. In some cells a "tigroid" distribution of the antigen was observed, suggestive of its production and concentration within the granular endoplasmic reticulum. In spite of the heavy infection of the neural structures, the neurons did not always show major alterations. By immunolabeling of the glial fibrillary acidic protein (GFAP) by the PAP method, a severe glial response could be seen in infected mice, featuring hyperplasia, hypertrophy, and shape distortion of the astrocytes. This easy labeling was not observed in normal mice of the same age, and suggests the accelerated maturation of the astrocytes and the increased GFAP synthesis by direct action of the virus upon such cells. In view of its specificity, use of the PAP technique for GFAP immunolabeling will most likely replace the traditional metal impregnation methods in the study of the astrocytes. Its utilization would be indicated whenever astroglial changes are suspected in any CNS pathologic condition.

Comparison of wild-type and subacute sclerosing panencephalitis strains of measles virus. Neurovirulence in ferrets and biological properties in cell cultures

The neurovirulence of two wild type (wt) and seven Subacute Sclerosing Panencephalitis (SSPE) measles virus strains was tested in young adult ferrets by intracerebral (IC) inoculation of infected Vero cell suspensions. Wt strains Edmonston and Woodfolk and SSPE strains Mantooth, Halle, and LEC-S did not produce a detectable encephalitis in the ferrets, but caused a significant formation of serum antibodies against measles virus. SSPE strains LEC, IP-3, Biken, and D.R., on the other hand, were all neurovirulent in ferrets, particularly strain D.R. which caused an acute encephalitis in all inoculated animals. Strain Biken was of particular interest since it caused a subacute encephalitis in four of seven ferrets. The subacute encephalitis was characterized by a long incubation time, persistence of virus in the brain for at least 8 mo, widespread inflammatory lesions, and production of measles virus specific IgG in the brain. A study of the biological properties of the various measles virus strains showed that wt strains Edmonston and Woodfolk and SSPE strains Mantooth, Halle, and LEC-S produced free virus particles in significant titers both in Vero and ferret brain (FB) cultures. Cytopathic effect (CPE) with cell-fusion was marked in Vero cultures, whereas only minimal CPE and no cell-fusion were observed in the FB cultures. SSPE strains LEC, IP-3, Biken, and D.R., on the other hand, were mostly cell-associated in Vero and FB cultures, although atypical cell-free particles were produced by strains Biken and IP-3. All four strains showed cell-fusing activity in FB cultures, particularly strain D.R., which was the only strain that spread more actively by fusion in FB than in Vero cultures. The results are discussed in relation to the neurovirulence of the various measles virus strains in adult ferrets. Pronounced cell-fusing activity in FB cells and cell-association with minimal or no production of cell-free virus seem to be essential to establish a brain infection in the animals.

CNS disease following dissemination of SSPE measles virus from intraperitoneal inoculation of suckling hamsters

Acute encephalitis was observed in suckling Golden Syrian hamsters following intraperitoneal (ip) inoculation of a hamster brain adapted strain of subacute sclerosing panencephalitis (SSPE) measles virus (HBS). Virus was isolated from the brains of all encephalitic animals by cocultivation of tissue with Vero cells. The histopathology of the encephalitis was characterized by perivascular mononuclear infiltrates, necrosis, eosinophilic inclusion bodies, and rare giant cells. Association of encephalitis with systemic viral infection was observed with virus present in lung and a kidney-spleen pool in addition to brain. Viral dissemination in asymptomatic animals was documented with virus being isolated from multiple non-neural tissues (spleen, lung, liver) of animals having no recoverable virus in their brains and no signs of encephalitis. Treatment of animals with cyclophosphamide prior to ip virus inoculation did not increase dissemination to brain. Absence of encephalitis in asymptomatic animals with proven viral dissemination to parenchymal organs indicates that neither viremia alone, nor viremia in conjunction with dissemination are sufficient conditions to establish central nervous system disease. The association of encephalitis with systemic viral infection and the dissemination to brain establish this model's potential value for the study of the pathogenesis of measles encephalitis.

Encephalomyelitis induced by canine distemper virus in non-human primates

A strain of canine distemper virus was shown to be highly neuro-virulent in non-human primates. Intracerebral inoculation induced in monkeys histological lesions of encephalomyelitis, i.e., degenerative changes consisting mainly of neuronal damage and inflammatory changes such as perivascular cuffings and glial proliferation, in wide areas in the brain and spinal cord. In one monkey observed for 70 days, lesions with a tendency of subacute sclerosing were also noticed. Immunosuppression with cyclophosphamide or antithymocyte serum was found to aggravate the clinical course and to modify the histological lesions in the central nervous system as well as the level of antibody response to the virus in cerebrospinal fluid. Possible application of distemper encephalomyelitis in monkeys as a primate model for analysis of the immune mechanism involved in paramyxovirus-induced encephalomyelitis was discussed.

Specific inhibitory factors of cellular immunity in children with subacute sclerosing panencephalitis

Employing a 51Cr release cytotoxicity microassay, and using both measles-and SSPE-infected target cells, four patients with documented SSPE were evaluated for specific cellular and humoral immunity. Mononuclear leukocytes from SSPE patients and control subjects exhibited comparable cytotoxicity. Serum and CSF from these SSPE patients inhibited the cellular response to SSPE-infected cells but not to measles-infected cells. Moreover, fresh whole serum alone from control donors produced significant 51Cr release from both cell lines, whereas SSPE whole serum was effective only against measles-infected cells. CSF from an additional ten patients with SSPE was examined for inhibitory activity: seven of these completely blocked and one partially blocked cell-mediated cytotoxicity to SSPE-infected cells. Preliminary characterization of the serum inhibitory factor suggested that it is IgM or antigen-antibody complexes. These data also suggest antigenic differences between the SSPE and measles viruses.

Growth of measles virus in nervous tissues. III. Neurovirulence of SSPE virus in ferrets

The Niigata-1 strain isolated from a patient with subacute sclerosing panencephalitis (SSPE) was inoculated intracerebrally into ferrets. Neurological signs developed in about 1 week in most of the animals. Histopathological examinations of the central nervous tissues revealed degenerative lesions in the parenchyma of the brains and inflammatory reactions predominantly in the meninges and choroid plexus. Virus antigen was demonstrated mainly in the nerve cells by immunofluorescent staining. The results indicated high affinity of the Niigata-1 strain to the nerve cells. In contrast, the Mantooth strain of SSPE virus in cell-free state did not exhibit neurovirulence in ferrets.

[Subacute sclerosing panencephalitis: transmission of a human encephalitogenic agent to Macacus rhesus]

Material proveniente do cérebro de um paciente com "panencefalite subaguda esclerosante" foi inoculado, por via intracerebral, em dois Macacus rhesus. Os animais permaneceram assintomáticos, aparentemente bem, por mais de um ano. Entretanto, 21 e 22 meses após as inoculações começaram a apresentar sinais de comprometimento neurológico, traduzido por paralisia dos membros posteriores, com apatia e caquexia progressivas. Os animais foram sacrificados. O exame histopatológico do sistema nervoso central mostrou gliose marginal e gliose da substância branca, com os neurônios exibindo sinais de "lesão celular crônica". Foram vistos discretos manguitos inflamatórios perivasculares. Em um animal foi encontrada inclusão acidófila intra- nuclear. Havia também proliferação da glia satélite perineuronal, com satelitose, notadamente no tronco cerebral. No exame das vísceras foi encontrado discreto processo de miocardite crônica. Foram retirados fragmentos dos encéfalos destes animais e inoculados em 4 outros, também por via intracerebral. Estes animais de 2.ª passagem após 2 meses de inoculação, em média, apresentaram sinais de comprometimento do sistema nervoso central semelhante ao dos animais doadores, de 1ª passagem. Houve, portanto, um encurtamento do período de inoculação da moléstia. Estes animais também foram sacrificados, sendo encontradas gliose marginal, gliose da substância branca, "lesão celular crônica" neuronal e proliferação da glia satélite, notadamente no tronco cerebral; vasos sangüíneos congestos; espongiose cortical. Os animais testemunhas, do mesmo lote, permaneceram normais. Acreditamos que as lesões observadas nos animais de 1.ª passagem, e que se repetiram com maior intensidade e com menor tempo de incubação nos de 2.ª passagem somente podem ser explicadas admitindo-se a existência de um agente virai que, pela natureza do quadro histopatológico (gliose, "lesão celular crônica" neuronal e espongiose cortical) bem como pelo período longo de incubação, deva pertencer ao grupo dos chamados vírus lentos.

Intracerebral inoculation of rhesus monkeys with a strain of measles virus isolated from a case of subacute sclerosing panencephalitis

Measles virus isolated from the brain of a patient with subacute sclerosing panencephalitis was injected intracerebrally (ic) into 34 rhesus monkeys. Groups of these animals were injected with measles antigen in Freund's complete adjuvant or treated by schedules used for suppression of the general or cell-mediated immune responsiveness. In another group of animals, experimental allergic encephalitis was induced parallel with measles infection. Measles virus was isolated from the brains of monkeys up to 13 days after ic inoculation. No virus was detected in the central nervous system after 3 to 4 weeks, the longest postinoculation period examined. It was concluded that the subacute sclerosing panencephalitis-derived virus either lost its neurotropic properties at the passage level at which it was used or that it submerged into a silent stage and escaped detection. Neither immunosuppression nor concomitant autoimmune encephalitis had an effect on the survival of measles virus in the central nervous system. The histology of the nervous tissue was basically normal except for characteristic lesions of experimental allergic encephalitis in animals receiving the respective treatment.

Immunosuppression and experimental virus infection of the nervous system

This chapter describes the current views of the pathogenesis of virus infections of the nervous system, with particular attention to certain aspects of virus-host interactions. Following invasion of the central nervous system, infection can follow a variety of patterns, as to number and distribution of neuronal and non-neuronal cells involved. There is a corresponding diversity in the pathological lesions of the central nervous system (CNS) produced by acute virus infection. Infection can be pictured as a race between virus and host defenses, where many factors, acting through different mechanisms, can influence the outcome. Outcome is always determined by multiple virus and host variables, although single variables can be independently studied under experimentally controlled conditions in the laboratory. The chapter demonstrates that in many virus-host combinations, the immune response plays an important role in recovery from primary infections. It mentions that an immunopathological process mediates the disease which follows certain CNS virus infections.