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Filgueiras-Rama D, Vasilijevic J, Jalife J, Noujaim SF, Alfonso JM, Nicolas-Avila JA, Gutierrez C, Zamarreño N, Hidalgo A, Bernabé A, Cop CP, Ponce-Balbuena D, Guerrero-Serna G, Calle D, Desco M, Ruiz-Cabello J, Nieto A, Falcon A. Human influenza A virus causes myocardial and cardiac-specific conduction system infections associated with early inflammation and premature death. Cardiovasc Res 2021; 117:876-889. [PMID: 32346730 PMCID: PMC7898948 DOI: 10.1093/cvr/cvaa117] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS Human influenza A virus (hIAV) infection is associated with important cardiovascular complications, although cardiac infection pathophysiology is poorly understood. We aimed to study the ability of hIAV of different pathogenicity to infect the mouse heart, and establish the relationship between the infective capacity and the associated in vivo, cellular and molecular alterations. METHODS AND RESULTS We evaluated lung and heart viral titres in mice infected with either one of several hIAV strains inoculated intranasally. 3D reconstructions of infected cardiac tissue were used to identify viral proteins inside mouse cardiomyocytes, Purkinje cells, and cardiac vessels. Viral replication was measured in mouse cultured cardiomyocytes. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used to confirm infection and study underlying molecular alterations associated with the in vivo electrophysiological phenotype. Pathogenic and attenuated hIAV strains infected and replicated in cardiomyocytes, Purkinje cells, and hiPSC-CMs. The infection was also present in cardiac endothelial cells. Remarkably, lung viral titres did not statistically correlate with viral titres in the mouse heart. The highly pathogenic human recombinant virus PAmut showed faster replication, higher level of inflammatory cytokines in cardiac tissue and higher viral titres in cardiac HL-1 mouse cells and hiPSC-CMs compared with PB2mut-attenuated virus. Correspondingly, cardiac conduction alterations were especially pronounced in PAmut-infected mice, associated with high mortality rates, compared with PB2mut-infected animals. Consistently, connexin43 and NaV1.5 expression decreased acutely in hiPSC-CMs infected with PAmut virus. YEM1L protease also decreased more rapidly and to lower levels in PAmut-infected hiPSC-CMs compared with PB2mut-infected cells, consistent with mitochondrial dysfunction. Human IAV infection did not increase myocardial fibrosis at 4-day post-infection, although PAmut-infected mice showed an early increase in mRNAs expression of lysyl oxidase. CONCLUSION Human IAV can infect the heart and cardiac-specific conduction system, which may contribute to cardiac complications and premature death.
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Affiliation(s)
- David Filgueiras-Rama
- Cardiac Electrophysiology Unit, Hospital Clínico San Carlos,
Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
- Consortium CIBER of Cardiovascular Diseases (CIBERCV), Spain
| | - Jasmina Vasilijevic
- Department of Molecular and Cellular Biology, National Center for
Biotechnology, Spanish National Research Council, Madrid, Spain
- Consortium CIBER of Respiratory Diseases, Spain
| | - Jose Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
- Consortium CIBER of Cardiovascular Diseases (CIBERCV), Spain
- Center for Arrhythmia Research, Health System, University of
Michigan, MI, USA
| | - Sami F Noujaim
- Morsani College of Medicine Molecular Pharmacology & Physiology, University
of South Florida, Tampa, FL, USA
| | - Jose M Alfonso
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
| | | | - Celia Gutierrez
- Department of Molecular and Cellular Biology, National Center for
Biotechnology, Spanish National Research Council, Madrid, Spain
| | - Noelia Zamarreño
- Department of Molecular and Cellular Biology, National Center for
Biotechnology, Spanish National Research Council, Madrid, Spain
| | - Andres Hidalgo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
| | - Alejandro Bernabé
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
| | | | | | | | - Daniel Calle
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid,
Spain
| | - Manuel Desco
- Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid,
Spain
- Department of Bioengineering and Aerospace Engineering, University Carlos III
of Madrid, Madrid, Spain
- Consortium CIBER of Mental Health (CIBERSAM), Spain
| | - Jesus Ruiz-Cabello
- Consortium CIBER of Respiratory Diseases, Spain
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque
Research and Technology Alliance (BRTA), San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Spain
- Universidad Complutense Madrid, Madrid, Spain
| | - Amelia Nieto
- Department of Molecular and Cellular Biology, National Center for
Biotechnology, Spanish National Research Council, Madrid, Spain
- Consortium CIBER of Respiratory Diseases, Spain
| | - Ana Falcon
- Department of Molecular and Cellular Biology, National Center for
Biotechnology, Spanish National Research Council, Madrid, Spain
- Consortium CIBER of Respiratory Diseases, Spain
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