The Neurobiology of Zika Virus: New Models, New Challenges

Growth and Survival of a Cohort of Congenital Zika Virus Syndrome Children Born With Microcephaly and Children Who Developed With Microcephaly After Birth

BACKGROUND AND OBJECTIVES

Little is known about the clinical course of children born with congenital Zika virus syndrome (CZS). This article aimed to analyze the growth and survival of children with CZS born with microcephaly and children who developed with microcephaly after birth in the 36-month period.

METHODS

This is a cohort of children diagnosed with CZS who were monitored in a series of outpatient appointments, with clinical and demographic information and anthropometric measurements collected. The Mann-Kendall test evaluated the trend of the mean Z-score of head circumference (HC) for age and the Kaplan-Meier model described the time to low weight and short length according to the classification of HC at birth.

RESULTS

Children born without microcephaly had a reduction in HC growth velocity ( P = 0.019) and took longer to reach low weight ( P = 0.036) and short length ( P = 0.034) when compared with those born with microcephaly. Seven (10%) deaths were reported, and the probability of survival after 36 months of age was 88%. In children with arthrogryposis, the risk of death was 7 times as high as in those without this condition (adjusted hazard ratio: 6.49; 95% confidence interval: 1.31-32.20; P = 0.022).

CONCLUSIONS

In this cohort of children with CZS, 20% were born without microcephaly and all of them presented a reduction in HC growth velocity, which led to microcephaly. Progression to low weight and short length occurred in the first years of life, and that was faster in those born with microcephaly. Healthcare providers should be aware of these conditions that pose a risk of unfavorable anthropometric measurements and death.

Evolution of Zika virus in Rag1-deficient mice selects for unique envelope glycosylation motif mutants that show enhanced replication fitness

N-linked glycosylation of flavivirus envelope proteins is widely viewed as being required for optimal folding, processing and/or transit of envelope proteins, and the assembling virons, through the endoplasmic reticulum (ER) and the Golgi. Zika virus (ZIKV) has a single N-linked envelope glycan located adjacent to the fusion loop. Herein we show that independent serial passage of ZIKVNatal in Rag1 -/- mice for 223 or 386 days generated two unique envelope glycan-deficient mutants, ZIKV-V153D and ZIKV-N154D, respectively. Surprisingly, these mutants grew to titres ∼1 to 2.6 logs higher than the glycosylated parental ZIKVNatal in Vero E6 cells and human brain organoids. RNA-Seq of infected organoids suggested that this increased replication fitness was associated with upregulation of the unfolded protein response (UPR). Cell death, cellular viral RNA, and viral protein levels were not significantly affected, arguing that these glycan mutants enjoyed faster ER/Golgi folding, processing, assembly, transit, and virion egress, assisted by an upregulated UPR. Thus, ZIKV envelope N-linked glycosylation is not essential for promoting envelope folding, assembly, and transit through the ER/Golgi, since aspartic acid (D) substitutions in the glycosylation motif can achieve this with significantly greater efficiency. Instead, the evolution of glycan mutants in Rag1 -/- mice indicates that such envelope glycosylation can have a fitness cost in an environment devoid of virus-specific antibody responses. The V153D and N154D mutations, generated by natural selection in Rag1 -/- mice, have to date not been employed in orthoflavivirus envelope glycosylation studies. Instead, genetic engineering has been used to generate mutant viruses that, for instance, contain a N154A substitution. The latter may impart confounding unfavourable properties, such as envelope protein insolubility, that have a detrimental impact on virus replication. The V153D and N154D substitutions may avoid imparting unfavourable properties by preserving the surface negative charge provided by the glycan moiety in the parental ZIKVNatal envelope protein. In Ifnar1 -/- mice ZIKV-V153D and -N154D showed faster viremia onsets, but reduced viremic periods, than the parental ZIKVNatal, consistent with an established contention that such glycans have evolved to delay neutralizing antibody activity.

Disruption of functional network development in children with prenatal Zika virus exposure revealed by resting-state EEG

Children born to mothers infected by Zika virus (ZIKV) during pregnancy are at increased risk of adverse neurodevelopmental outcomes including microcephaly, epilepsy, and neurocognitive deficits, collectively known as Congenital Zika Virus Syndrome. To study the impact of ZIKV on infant brain development, we collected resting-state electroencephalography (EEG) recordings from 28 normocephalic ZIKV-exposed children and 16 socio-demographically similar but unexposed children at 23-27 months of age. We assessed group differences in frequency band power and brain synchrony, as well as the relationship between these metrics and age. A significant difference (p < 0.05, Bonferroni corrected) in Inter-Site Phase Coherence was observed: median Pearson correlation coefficients were 0.15 in unexposed children and 0.07 in ZIKV-exposed children. Results showed that functional brain networks in the unexposed group were developing rapidly, in part by strengthening distal high-frequency and weakening proximal lower frequency connectivity, presumably reflecting normal synaptic growth, myelination and pruning. These maturation patterns were attenuated in the ZIKV-exposed group, suggesting that ZIKV exposure may contribute to neurodevelopmental vulnerabilities that can be detected and quantified by resting-state EEG.

Pilot deployment of a cloud-based universal medical image repository in a large public health system: A protocol study

This paper outlines the protocol for the deployment of a cloud-based universal medical image repository system. The proposal aims not only at the deployment but also at the automatic expansion of the platform, incorporating Artificial Intelligence (AI) for the analysis of medical image examinations. The methodology encompasses efficient data management through a universal database, along with the deployment of various AI models designed to assist in diagnostic decision-making. By presenting this protocol, the goal is to overcome technical challenges and issues that impact all phases of the workflow, from data management to the deployment of AI models in the healthcare sector. These challenges include ethical considerations, compliance with legal regulations, establishing user trust, and ensuring data security. The system has been deployed, with a tested and validated proof of concept, possessing the capability to receive thousands of images daily and to sustain the ongoing deployment of new AI models to expedite the analysis process in medical image exams.

Zika virus induced microcephaly and aberrant hematopoietic cell differentiation modeled in novel neonatal humanized mice

Introduction

Immunocompetent and immunocompromised murine models have been instrumental in answering important questions regarding ZIKV pathogenesis and vertical transmission. However, mimicking human congenital zika syndrome (CZS) characteristics in these murine models has been less than optimal and does not address the potential viral effects on the human immune system.

Methods

Here, we utilized neonatal humanized Rag2-/-γc-/- mice to model CZS and evaluate the potential viral effects on the differentiation of human hematopoietic stem cells in vivo. Newborn Rag2-/-γc-/- mice were engrafted with ZIKV-infected hematopoietic stem cells (HSC) and monitored for symptoms and lesions.

Results

Within 13 days, mice displayed outward clinical symptoms that encompassed stunted growth, hunched posture, ruffled fur, and ocular defects. Striking gross pathologies in the brain and visceral organs were noted. Our results also confirmed that ZIKV actively infected human CD34+ hematopoietic stem cells and restricted the development of terminally differentiated B cells. Histologically, there was multifocal mineralization in several different regions of the brain together with ZIKV antigen co-localization. Diffuse necrosis of pyramidal neurons was seen with collapse of the hippocampal formation.

Discussion

Overall, this model recapitulated ZIKV microcephaly and CZS together with viral adverse effects on the human immune cell ontogeny thus providing a unique in vivo model to assess the efficacy of novel therapeutics and immune interventions.

Zika Virus: A New Therapeutic Candidate for Glioblastoma Treatment

Glioblastoma (GBM) is the most aggressive among the neurological tumors. At present, no chemotherapy or radiotherapy regimen is associated with a positive long-term outcome. In the majority of cases, the tumor recurs within 32-36 weeks of initial treatment. The recent discovery that Zika virus (ZIKV) has an oncolytic action against GBM has brought hope for the development of new therapeutic approaches. ZIKV is an arbovirus of the Flaviviridae family, and its infection during development has been associated with central nervous system (CNS) malformations, including microcephaly, through the targeting of neural stem/progenitor cells (NSCs/NPCs). This finding has led various groups to evaluate ZIKV's effects against glioblastoma stem cells (GSCs), supposedly responsible for GBM onset, progression, and therapy resistance. While preliminary data support ZIKV tropism toward GSCs, a more accurate study of ZIKV mechanisms of action is fundamental in order to launch ZIKV-based clinical trials for GBM patients.