Suwimon Wiboon-ut

High Susceptibility of Human Dendritic Cells to Avian Influenza H5N1 Virus Infection and Protection by IFN-α and TLR Ligands

There is worldwide concern that the avian influenza H5N1 virus, with a mortality rate of >50%, might cause the next influenza pandemic. Unlike most other influenza infections, H5N1 infection causes a systemic disease. The underlying mechanisms for this effect are still unclear. In this study, we investigate the interplay between avian influenza H5N1 and human dendritic cells (DC). We showed that H5N1 virus can infect and replicate in monocyte-derived and blood myeloid DC, leading to cell death. These results suggest that H5N1 escapes viral-specific immunity, and could disseminate via DC. In contrast, blood pDC were resistant to infection and produced high amounts of IFN-α. Addition of this cytokine to monocyte-derived DC or pretreatment with TLR ligands protected against infection and the cytopathic effects of H5N1 virus.

Antiviral immune responses in H5N1-infected human lung tissue and possible mechanisms underlying the hyperproduction of interferon-inducible protein IP-10.

Information on the immune response against H5N1 within the lung is lacking. Here we describe the sustained antiviral immune responses, as indicated by the expression of MxA protein and IFN-alpha mRNA, in autopsy lung tissue from an H5N1-infected patient. H5N1 infection of primary bronchial/tracheal epithelial cells and lung microvascular endothelial cells induced IP-10, and also up-regulated the retinoic acid-inducible gene-I (RIG-I). Down-regulation of RIG-I gene expression decreased IP-10 response. Co-culturing of H5N1-infected pulmonary cells with TNF-alpha led to synergistically enhanced production of IP-10. In the absence of viral infection, TNF-alpha and IFN-alpha also synergistically enhanced IP-10 response. Methylprednisolone showed only a partial inhibitory effect on this chemokine response. Our findings strongly suggest that both the H5N1 virus and the locally produced antiviral cytokines; IFN-alpha and TNF-alpha may have an important role in inducing IP-10 hyperresponse, leading to inflammatory damage in infected lung.

Tissue Distribution of Memory T and B Cells in Rhesus Monkeys following Influenza A Infection

Studies of influenza-specific immune responses in humans have largely assessed systemic responses involving serum Ab and peripheral blood T cell responses. However, recent evidence indicates that tissue-resident memory T (TRM) cells play an important role in local murine intrapulmonary immunity. Rhesus monkeys were pulmonary exposed to 2009 pandemic H1N1 virus at days 0 and 28 and immune responses in different tissue compartments were measured. All animals were asymptomatic postinfection. Although only minimal memory immune responses were detected in peripheral blood, a high frequency of influenza nucleoprotein–specific memory T cells was detected in the lung at the “contraction phase,” 49–58 d after second virus inoculation. A substantial proportion of lung nucleoprotein-specific memory CD8+ T cells expressed CD103 and CD69, phenotypic markers of TRM cells. Lung CD103+ and CD103- memory CD8+ T cells expressed similar levels of IFN-γ and IL-2. Unlike memory T cells, spontaneous Ab secreting cells and memory B cells specific to influenza hemagglutinin were primarily observed in the mediastinal lymph nodes. Little difference in systemic and local immune responses against influenza was observed between young adult (6–8 y) and old animals (18–28 y). Using a nonhuman primate model, we revealed substantial induction of local T and B cell responses following 2009 pandemic H1N1 infection. Our study identified a subset of influenza-specific lung memory T cells characterized as TRM cells in rhesus monkeys. The rhesus monkey model may be useful to explore the role of TRM cells in local tissue protective immunity after rechallenge and vaccination.

Cross-reactive Antibodies against Avian Influenza Virus A (H5N1)

To the Editor: Intravenous immunoglobulin (IVIg) is used to treat bacterial and viral infections in patients with primary immunodeficiency disease and those with autoimmune and inflammatory disorders (1). IVIg contains pooled IgG from >1,000 blood donors and antibodies against various common human pathogens, including influenza virus A. We tested the efficacy of commercial preparations of IVIg (50 mg/mL of highly purified immunoglobulin) against homosubtypic influenza viruses A (H1N1 and H3N2) and their cross-reactivity against avian influenza virus A (H5N1). IVIg preparations (Octagam; Octapharma, Vienna, Austria and Flebogamma; Instituto Grifols, Barcelona, Spain) had hemagglutination inhibition (HI) titers against subtypes H1N1 and H3N2 ranging from 20 to 40. Human Immunoglobulin, pH 4.0, (Harbin Sequel Bio-Engineering Pharmaceutical, Harbin, People’s Republic of China) had lower HI titers against homosubtypic avian influenza viruses (10 for subtype H3N2 and <10 for subtype H1N1). As expected, we did not detect antibodies against hemagglutinin (HA) of subtype H5N1 (A/open-billed/stork/Nahkonsawan/BBD0104F/2004) in any of the IVIg preparations (HI titer <10). Human influenza subtype H1N1 shares the same neuraminidase (NA) subtype (human N1) as subtype H5N1 (avian N1). We therefore tested whether IVIg preparations would react and inhibit NA activity of human and avian influenza viruses by using a neuraminidase inhibition (NI) assay (2). NI titer was defined as the reciprocal of the highest dilution that gave 50% reduction compared with that of the virus control. All 3 IVIg preparations inhibited NA activity of human N1 (NI titer against subtype H1N1 range 258–986) and human N2 (NI titer against subtype H3N2 range 1,309–3,274). Enzyme activity of avian N1 (7:1 reassortant; PR8 + NA [A/Vietnam/DT-0361/2005 H5N1]) was inhibited by all IVIg preparations (NI titer range 143–231). These findings support the recent observation of neutralizing antibodies against human N1 in human serum, which could inhibit enzyme activity of avian N1 from subtype H5N1 (3,4). We also tested IVIg preparations against reverse genetics subtype H5N3 virus in which the N3 NA was derived from H2N3 virus (6:1:1 reassortant; 6 internal genes from PR8 + HA (A/Vietnam/DT-0361/05 H5N1) + NA (A/duck/Germany 1207 H2N3) and observed no effect (NI titer <10). The N3 subtype belongs to avian influenza NA. Thus, antibodies against NA in IVIg appear to be specific for those circulating human influenza viruses (human N1 and human N2). Unlike HA and NA, virus matrix 2 ectodomain (M2e) is highly conserved. Its presence on the surface of the viral particle makes it a potential target of antibody response similar to that for HA and NA (5,6). We assessed reactivity of IVIg preparations against a consensus M2e peptide derived from human influenza viruses of H1, H2, and H3 subtypes (MSLLTEVETPIRNEWGCRCNDSSD) and those derived from A/Hong Kong/156/97 H5N1 (MSLLTEVETLTRNGWGCRCSDSSD and A/Thailand/ SP-83/2004 H5N1 (MSLLTEVETPTRNEWECRCSDSSD) by using ELISA (7). Antibody titer was defined as the reciprocal of the highest dilution that had an optical density of 0.5 at 414 nm in our assay. Results showed considerable variation among IVIg preparations, caused by M2e peptides derived from different influenza viruses (titer range 88–23,614). Among the 3 preparations, Human Immunoglobulin, pH 4.0, IVIg showed the highest titers against all M2e peptides (consensus, 9,639; H5N1 Hong Kong, 3,519; and H5N1 Thailand, 23,614). Variation of antibody titers against M2e in IVIGs may be geographically dependent. Unlike Octagam and Flebogamma, Human Immunoglobulin, pH 4.0, IVIg was likely derived from blood donors in China. Octagam and Immunoglobulin, pH 4.0, IVIg were more reactive with M2e of avian influenza virus (H5N1) (A/Thailand/SP-83/2004) than with other M2e peptides. We measured the ability of IVIg preparations to inhibit influenza subtype H5N1 replication by using a plaque-reduction assay. Subtype H5N1 (A/open-billed stork/ Nakhonsawan/BBD0104F/2004) was maintained as described (8). MDCK cells were infected with virus and agar containing various concentrations of IVIg was layered on top of these cells and incubated for 2 days. Results are shown in the Figure. IVIG inhibited plaque formation in a dose-dependent manner. Although plaques of heterogeneous size were observed in infected plates without IVIg, larger plaques were preferentially neutralized with increasing concentrations of IVIg in the agar (Figure). Figure Neutralization of avian influenza virus A (H5N1) by intravenous immunoglobulin (IVIg) preparations measured by percentage reduction in plaque number (A) and plaque size (B). Monolayers of MDCK cells were infected with virus and overlaid with agar containing ... Premixing excess M2e peptide with IVIg to absorb M2e-specific antibodies had no effect on plaque formation, indicating that antibodies against M2e in IVIg preparations were not responsible for neutralization of influenza subtype H5N1. Antibodies against M2e may have a role in protection against subtype H5N1 by another mechanism. Our data suggest that the neutralizing activity against influenza subtype H5N1 in all 3 IVIg preparations was likely contributed by cross-reactive antibodies against avian N1. IVIg has been reported to have antiinflammatory activity (9,10). The immune suppressive effect of IVIg may benefit patients by reducing the cytokine storm. These data suggest use of IVIg, especially preparations containing high neutralizing activity against subtype H5N1, as adjunctive treatment for infection with highly pathogenic avian influenza virus (H5N1).

Evaluation of In Vitro Cross-Reactivity to Avian H5N1 and Pandemic H1N1 2009 Influenza Following Prime Boost Regimens of Seasonal Influenza Vaccination in Healthy Human Subjects: A Randomised Trial

Introduction Recent studies have demonstrated that inactivated seasonal influenza vaccines (IIV) may elicit production of heterosubtypic antibodies, which can neutralize avian H5N1 virus in a small proportion of subjects. We hypothesized that prime boost regimens of live and inactivated trivalent seasonal influenza vaccines (LAIV and IIV) would enhance production of heterosubtypic immunity and provide evidence of cross-protection against other influenza viruses. Methods In an open-label study, 26 adult volunteers were randomized to receive one of four vaccine regimens containing two doses of 2009-10 seasonal influenza vaccines administered 8 (±1) weeks apart: 2 doses of LAIV; 2 doses of IIV; LAIV then IIV; IIV then LAIV. Humoral immunity assays for avian H5N1, 2009 pandemic H1N1 (pH1N1), and seasonal vaccine strains were performed on blood collected pre-vaccine and 2 and 4 weeks later. The percentage of cytokine-producing T-cells was compared with baseline 14 days after each dose. Results Subjects receiving IIV had prompt serological responses to vaccine strains. Two subjects receiving heterologous prime boost regimens had enhanced haemagglutination inhibition (HI) and neutralization (NT) titres against pH1N1, and one subject against avian H5N1; all three had pre-existing cross-reactive antibodies detected at baseline. Significantly elevated titres to H5N1 and pH1N1 by neuraminidase inhibition (NI) assay were observed following LAIV-IIV administration. Both vaccines elicited cross-reactive CD4+ T-cell responses to nucleoprotein of avian H5N1 and pH1N1. All regimens were safe and well tolerated. Conclusion Neither homologous nor heterologous prime boost immunization enhanced serum HI and NT titres to 2009 pH1N1 or avian H5N1 compared to single dose vaccine. However heterologous prime-boost vaccination did lead to in vitro evidence of cross-reactivity by NI; the significance of this finding is unclear. These data support the strategy of administering single dose trivalent seasonal influenza vaccine at the outset of an influenza pandemic while a specific vaccine is being developed. Trial Registration ClinicalTrials.gov NCT01044095

Tropism of Avian Influenza A (H5N1) Virus to Mesenchymal Stem Cells and CD34+ Hematopoietic Stem Cells

The presence of abnormal hematologic findings such as lymphopenia, thrombocytopenia, and pancytopenia were diagnosed in severe cases of avian influenza A H5N1. Whether direct viral dissemination to bone marrow (BM) cells causes this phenomenon remains elusive. We explore the susceptibility of the two stem cell types; hematopoietic stem cells (HSCs) and mesenchymal stromal cells (MSCs) isolated from human BM cells or cord blood, to infection with avian H5N1 viruses. For the first time, we demonstrated that the H5N1 virus could productively infect and induce cell death in both human stem cell types. In contrast, these activities were not observed upon human influenza virus infection. We also determined whether infection affects the immunomodulatory function of MSCs. We noted a consequent dysregulation of MSC-mediated immune modulation as observed by high cytokine and chemokine production in H5N1 infected MSCs and monocytes cocultures. These findings provide a better understanding of H5N1 pathogenesis in terms of broad tissue tropism and systemic spread.

Pre-Existing Cross-Reactive Antibodies to Avian Influenza H5N1 and 2009 Pandemic H1N1 in US Military Personnel

We studied cross-reactive antibodies against avian influenza H5N1 and 2009 pandemic (p) H1N1 in 200 serum samples from US military personnel collected before the H1N1 pandemic. Assays used to measure antibodies against viral proteins involved in protection included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay. Viral neutralization by antibodies against avian influenza H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based and H1N1 microneutralization assays. Some US military personnel had cross-neutralizing antibodies against H5N1 (14%) and 2009 pH1N1 (16.5%). The odds of having cross-neutralizing antibodies against 2009 pH1N1 were 4.4 times higher in subjects receiving more than five inactivated whole influenza virus vaccinations than those subjects with no record of vaccination. Although unclear if the result of prior vaccination or disease exposure, these pre-existing antibodies may prevent or reduce disease severity.

P2Y6 receptors are involved in mediating the effect of inactivated avian influenza virus H5N1 on IL-6 & CXCL8 mRNA expression in respiratory epithelium

One of the key pathophysiologies of H5N1 infection is excessive proinflammatory cytokine response (cytokine storm) characterized by increases in IFN-β, TNF-α, IL-6, CXCL10, CCL4, CCL2 and CCL5 in the respiratory tract. H5N1-induced cytokine release can occur via an infection-independent mechanism, however, detail of the cellular signaling involved is poorly understood. To elucidate this mechanism, the effect of inactivated (β-propiolactone-treated) H5N1 on the cytokine and chemokine mRNA expression in 16HBE14o- human respiratory epithelial cells was investigated. We found that the inactivated-H5N1 increased mRNA for IL-6 and CXCL8 but not TNF-α, CCL5 or CXCL10. This effect of the inactivated-H5N1 was inhibited by sialic acid receptor inhibitor (α-2,3 sialidase), adenosine diphosphatase (apyrase), P2Y receptor (P2YR) inhibitor (suramin), P2Y6R antagonist (MRS2578), phospholipase C inhibitor (U73122), protein kinase C inhibitors (BIM and Gö6976) and cell-permeant Ca2+ chelator (BAPTA-AM). Inhibitors of MAPK signaling, including of ERK1/2 (PD98059), p38 MAPK (SB203580) and JNK (SP600125) significantly suppressed the inactivated-H5N1-induced mRNA expression of CXCL8. On the other hand, the inactivated-H5N1-induced mRNA expression of IL-6 was inhibited by SB203580, but not PD98059 or SP600125, whereas SN-50, an inhibitor of NF-κB, inhibited the effect of virus on mRNA expression of both of IL-6 and CXCL8. Taken together, our data suggest that, without infection, inactivated-H5N1 induces mRNA expression of IL-6 and CXCL8 by a mechanism, or mechanisms, requiring interaction between viral hemagglutinin and α-2,3 sialic acid receptors at the cell membrane of host cells, and involves activation of P2Y6 purinergic receptors.

An influenza A virus agglutination test using antibody-like polymers

Abstract Antibodies are commonly used in diagnostic routines to identify pathogens. The testing protocols are relatively simple, requiring a certain amount of a specific antibody to detect its corresponding pathogen. Antibody functionality can be mimicked by synthesizing molecularly imprinted polymers (MIPs), i.e. polymers that can selectively recognize a given template structure. Thus, MIPs are sometimes termed ‘plastic antibody (PA)’. In this study, we have synthesized new granular MIPs using influenza A virus templates by precipitation polymerization. The selective binding of influenza A to the MIP particles was assessed and subsequently contrasted with other viruses. The affinities of influenza A virus towards the MIP was estimated based on an agglutination test by measuring the amount of influenza subtypes absorbed onto the MIPs. The MIPs produced using the H1N1 template showed specific reactivity to H1N1 while those produced using H5N1 and H3N2 templates showed cross-reactivity.

The activation of B cells enhances DC-SIGN expression and promotes susceptibility of B cells to HPAI H5N1 infection

The interplay between highly pathogenic avian influenza (HPAI) H5N1 virus and immune cells has been extensively studied for years, as host immune components are thought to play significant roles in promoting the systemic spread of the virus and responsible for cytokine storm. Previous studies suggested that the interaction of B cells and monocytes could promote HPAI H5N1 infection by enhancing avian influenza virus receptor expression. In this study, we further investigate the relationship between the HPAI H5N1 virus, activated B cells, and DC-SIGN expression. DC-SIGN has been described as an important factor for mediating various types of viral infection. Here, we first demonstrate that HPAI H5N1 infection could induce an activation of B cells, which was associated with DC-SIGN expression. Using CD40L and recombinant IL-4 for B cell stimulation, we determined that DC-SIGN expressed on activated B cells was able to enhance its susceptibility to HPAI H5N1 infection. Our findings uncover the interplay between this H5N1 virus and B cells and provide important information in understanding how the virus overcomes our immune system, contributing to its unusual immunopathogenesis.