Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2013-03-20T19:12:45Z No. of bitstreams: 1 Tiago_Póvoa.pdf: 6904413 bytes, checksum: 89b7d7a97e24eb2dfd28a1d63fbce130 (MD5) / Made available in DSpace on 2013-03-20T19:12:45Z (GMT). No. of bitstreams: 1 Tiago_Póvoa.pdf: 6904413 bytes, checksum: 89b7d7a97e24eb2dfd28a1d63fbce130 (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / A dengue representa um sério problema de saúde pública mundial entre as doenças causadas por arbovírus. Seu agente etiológico, o vírus da dengue, compreende 4 sorotipos antigenicamente distintos (DENV1-4). Os sintomas da dengue variam desde a febre da dengue (FD) até a febre hemorrágica da dengue (FHD) e a síndrome do choque da dengue (SCD). No presente trabalho, iniciamos um estudo com o material obtido de diferentes órgãos (fígado, baço, pulmão, coração e rim) de quatro casos fatais de dengue. Análises histopatológicas revelaram, em todos os casos, áreas com edema e hemorragia; presença de esteatose (micro e macrovesicular) e necrose no fígado; degeneração de fibras cardíacas; necrose tubular aguda dos túbulos contorcidos proximais renais; destruição dos centros germinativos e atrofia de folículos linfóides do baço; espessamento dos septos alveolares e hipertrofia de macrófagos alveolares nos pulmões dos quatro pacientes e também a formação de membrana hialina nos casos 1 e 2. Detectamos antígenos virais em todos os órgãos e também um aumento de infiltrado inflamatório mononuclear, com aumento da população de macrófagos ativados e linfócitos B no rim; predomínio somente de linfócitos B no coração; aumento do número de macrófagos ativados e linfócitos T CD4+ no fígado e pulmão, e de linfócitos T CD8+ no pulmão. No baço, observamos uma diminuição das populações de linfócitos T CD4+, T CD8+ e B. A quantificação de células expressando citocinas mostrou: aumento da expressão de RANTES em todos os órgãos; um equilíbrio entre a produção das citocinas pró-inflamatórias (TNF-α e IFN-γ) e anti-inflamatórias (IL-10 e TGF-β) no fígado, rim e pulmão; aumento das citocinas pró-inflamatórias e diminuição das anti-inflamatórias no baço e o perfil oposto no tecido cardíaco, com predomínio da detecção de TGF-β. Além disso, avaliamos o efeito da infecção com DENV-2 em camundongos BALB/c inoculados pelas vias intraperitoneal (i.p.) e intravenosa (i.v.). A análise histopatológica do fígado e baço destes animais revelou alterações semelhantes às observadas nos casos de dengue (áreas de edema e hemorragia, esteatose, necrose e tumefação no fígado, e desorganização da arquitetura dos folículos no baço). De um modo geral, a inoculação pela via i.p. induziu danos em áreas focais, enquanto a via i.v. provocou lesões mais difusas em ambos os tecidos. Entretanto, essas diferenças entre as vias de inoculação não se refletiram em diferenças nas subpopulações de linfócitos. Verificamos que, em ambos os casos, as alterações das subpopulações linfocitárias ocorreram já no segundo dia de infecção. A quantificação dessas subpopulações revelou uma diminuição de linfócitos B totais e um aumento de linfócitos T CD4+ totais no fígado dos camundongos infectados, enquanto que no sangue, observamos um comportamento inverso dessas subpopulações. Já no baço, verificamos uma diminuição da subpopulação de linfócitos T CD8+ totais e um aumento de linfócitos T CD8+ ativados nos animais com 2 dias de infecção. De um modo geral, tais resultados poderão contribuir para um melhor entendimento da doença e para a validação do modelo experimental murino em novas abordagens vacinais ou terapêuticas. / Dengue is a serious worldwide public health problem among the diseases caused by arboviruses. Its etiologic agent, the dengue virus, comprises four antigenically distinct serotypes (DENV1-4). Dengue symptoms range from the dengue fever (DF) to the dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). In the present work, we initiated a study with materials obtained from different organs (liver, spleen, lung, heart and kidney) of four dengue fatal cases. Histopathological analysis revealed, in all cases, areas with edema and hemorrhage; the presence of steatosis (micro and macrovesicular) and necrosis in the liver; degeneration of cardiac fibers; acute tubular necrosis of renal proximal convoluted tubules; destruction of the germinal centers and atrophy of lymphoid follicles in the spleen; thickened alveolar septa and hypertrophy of alveolar macrophages in the lungs of the four patients and also the presence of hyaline membrane in cases 1 and 2. Virus antigens were detected in all organs as well as an increase of mononuclear cell infiltration, with the increase of activated macrophages population and B lymphocytes in the kidney; predominance of only B lymphocytes in the heart; increased number of activated macrophages and CD4+ T cells in the liver and the lung, and of CD8+ T cells in the lung. In the spleen, we observed a decrease of CD4+ T, CD8+ T and B populations. The quantification of cells expressing cytokines showed: increase of RANTES expression in all organs, a balance between production of proinflammatory (TNF-α e IFN-γ) and anti-inflammatory (IL-10 and TGF-β) cytokines in the liver, kidney and lung; increase of proinflammatory and decrease of anti-inflammatory cytokines in the spleen, while the opposite profile was observed in the cardiac tissue, with the predominance of TGF-β. In addition, we evaluated the effect of DENV-2 infection in BALB/c mice inoculated by the intraperitoneal (i.p.) and intravenous (i.v.) routes. Histopathological analysis in the liver and the spleen of these animals showed alterations similar to those observed in the dengue cases (areas of edema and hemorrhage, steatosis, necrosis and swelling hepatocytes in the liver, as well as disorganization of splenic follicle architectures). In general, results indicated that the i.p. inoculation induced damages in focal areas, whereas the lesions caused by the i.v. route were more diffused in both tissues. However, these differences between the two inoculation routes were not reflected in differences in the lymphocyte subsets. We observed that changes in lymphocyte subpopulations occurred by the second day after infection in both cases. The quantification of these subpopulations revealed a decrease of total B lymphocytes and an increase of total CD4+ T cells in the liver of infected mice, whereas in the blood we were observed an inverse behavior of such subpopulations. In the spleen, we verified a decrease of the total CD8+ T lymphocyte subpopulation and an increased of activated CD8+ T cells, two days after infection. Overall, these results may contribute to a better understanding of the disease and to the validation of this murine experimental model for novel vaccine or therapeutic approaches.

Geographically, Pakistan is in the western part of south Asia at about 24-37 °N latitudes and62-75 °E longitudes. Livestock and agriculture are two major sectors in Pakistan and play animportant role in the country economy.The tick infestation in livestock is not only devastating for animals and their products but alsobecome the cause of transmission of pathogens into humans. Crimean Congo fever (CCHF) isa viral tick-borne fatal disease. The dissemination of ticks and amplification of Crimean Congofever (CCHF) pathogen throughout the tick-animals-tick cycle, increases risk of transmissionto humans many times. In Pakistan, cases are reported in all areas, particularly those areaswhich lie on the border to CCHF endemic countries. There is a high prevalence of CCHF inboth Baluchistan and Khyber Pakhtunkhwa regions. Baluchistan is bordering with Afghanistanand Iran and Khyber Pakhtunkhwa with Afghanistan. Linear regression analysis revealed apositive significant association of high level of CCHF cases in livestock, with camels, goatsand sheep. The literacy rate is negatively significantly corelated with the numbers of cases.Statistical analysis of border effect revealed a high positive significant correlation of CCHFprevalence in areas near to borders. Both Baluchistan and Khyber Pakhtunkhwa (KPK) haslow literacy rate than other regions of Pakistan. Islamabad (capital city) has a higher literacyrate than all other regions but there is still a high CCHF prevalence. This is not only becauseof high population density but people from other regions, particularly from Baluchistan andKPK come here for animals selling or to seeking medical facilities in the large city hospitals.The study gives a proof that illiteracy and borders are the major respondent factors in theCCHF incidences and prevalence in an area. There is a need to raise awareness about ticksand tick-borne disease in the public and establishment of monitoring system across the bordersto prevent the spread of CCHF virus.

The four serotypes of dengue virus (DENV 1-4) have a significant and growing impact on global health. Dengue disease encompasses a wide range of clinical symptoms, usually presenting as an uncomplicated febrile illness lasting 5-7 days; however, a small percentage of infections are associated with plasma leakage and bleeding tendency (called dengue hemorrhagic fever, DHF), which can result in shock. Epidemiological studies indicate that severe dengue disease most often occurs during secondary heterotypic DENV infection. Additionally, plasma leakage (the hallmark of DHF) coincides with defervescence and viral clearance, suggesting that severe disease arises from the immune response to infection rather than a direct effect of the virus. A number of studies have found increased levels of markers of immune cell activation in patients with DHF compared to patients with the less severe form of disease (DF). These markers include IFNγ, TNFα, soluble CD8, soluble IL-2 receptor, soluble TNF receptor, and CD69, which support a role for T cells in mediating immunopathology. Because of the high homology of DENV 1-4, some degree of serotype-cross-reactivity is seen for most T cell epitopes. A high percentage of DENV-specific T cells recognize multiple DENV serotypes, as demonstrated by peptide-MHC (pMHC) tetramer binding and in vitro functional assays performed on PBMC from subjects vaccinated with an experimental DENV vaccine or naturally-infected subjects with secondary (>1) DENV infection. This thesis sought to address several gaps in the literature, specifically whether T cell responses differ in primary versus secondary (natural) infection. We studied the frequency, phenotype, and function of DENV-specific T cells. We demonstrated substantial serotype-cross-reactivity of antigen-specific T cells generated in response to naturally-acquired primary as well as secondary DENV infection. The frequency of A11-NS3133 epitope-specific T cells during acute infection did not correlate with disease severity. However, the peak frequency occurred earlier in primary infection while the frequency of CD45RA+ T cells declined quicker in secondary infection, suggesting the expansion of DENV-specific memory T cells. DENV-immune T cells exhibited different functional capabilities that were dependent on the particular serotype of infection. Specifically, DENV-1 or -3 stimulation of A11-NS3133 epitope-specific T cell lines resulted in robust function that included IFNγ production, whereas DENV-2 stimulation resulted in limited function that often included MIP-1β but not IFNγ production. These data support a role for T cells in DENV infection and offer new insights into their potential contribution to dengue pathology.

Dengue viruses (DV) are re-emerging mosquito-borne pathogens for which four distinct lineages, grouped based on serology and referred to as serotypes 1-4 (DIV-D4V), have been described. Epidemiological data imply that re-infection with a "heterologous" serotype, i.e, one other than that to which the individual was originally exposed, enhances the risk for development of severe disease, dengue hemorrhagic fever (DHF). The hallmark of DHF is a transient capillary leakage syndrome of rapid onset, temporally associated with the resolution of fever and viremia. In its most grave form, the vascular permeability phenomenon in DHF may progress to dengue shock syndrome (DSS), which is often fatal in the absence of appropriate medical care. Despite the fulminant nature of vascular leakage during DHF/DSS, this phenomenon does not appear to be due to direct cytopathic effects of DV. Rather, inappropriate reactivation and/or regulation of dengue-specific memory are the prevailing theorized (immunopathological) etiologies. Traditional vaccine development techniques have proven insufficient for DV, since any vaccine must offer complete protection against all four serotypes to avoid enhanced pathology on natural viral challenge. Understanding the underlying mechanisms that contribute to dengue disease, particularly the development of dengue-specific memory, is therefore of critical importance. Dengue immunopathology and the specific aspects of immunological memory that determine disease severity are heatedly debated. Previous research in our lab has suggested that T cell responses contribute to the severity of dengue illness. Clinical data indicate enhanced immune activation in more grave cases of DV infection, and serotype cross-reactive T cells from multiple individuals are present after both primary and secondary dengue infections. However, little is known about the conditions under which T cells are primed and dengue-specific memory is generated. Dendritic cells (DCs) are bone marrow-derived cells that play a central role in directing activity within the immune system. DCs shape quantitative and qualitative aspects of adaptive immunity, and therefore the intrinsic characteristics of host memory to a pathogen. DCs are essential in generating primary immune responses, due to their particular effectiveness in stimulating naïve T cells. DCs also play important roles in the reactivation of memory to an infectious agent, and as reservoirs for the dissemination of invading microorganisms. Exposure to pathogens or their products initiates a series of phenotypic and functional changes in DCs, termed maturation. DC maturation involves a coordinated response of immunomodulatory surface molecule elaboration and cytokine production, culminating in antigen presentation to, and co-stimulation of, T cells specific for the invading agent. The DC response is ostensibly tailored to facilitate effective elimination by regulating effective downstream interactions of the DC with T cells. A number of viruses have evolved to infect DCs and alter their functional behavior, facilitating their own survival within the host, and the herd. DV readily infects DCs both in primary cell cultures and in vivo. However, reports on the effects of DV infection on DC maturation vary both with regard to some of the cytokines produced, and the phenotypes of infected versus bystander cells. Although DCs appear to be activated following DV exposure, responses on the single-cell level appear to depend on the infection state of the cell, hypothetically driven by intracellular virus-mediated effects. Therefore, downstream responses to these divergent populations - i.e., actively infected cells versus uninfected bystander cells - are likely to be the consequence of at least two modes of DC behavior. Because DCs play a pivotal role in adaptive immune development, and because the resulting memory response appears to be critical in affecting disease pathology after heterologous DV re-infection, I sought to explore the phenomena of DC maturation in response to dengue exposure, and to begin to answer the question of how active infection alters the functional capabilities of DCs. Notably, primary dengue infection is generally well-controlled with minimal pathology. Therefore, this thesis addresses the hypothesis that DV infection of DCs results in cellular activation and stimulation of antiviral immunity, despite virus-mediated alteration of DC maturation. In order to address this hypothesis, I examined both DV infection-dependent and independent effects on DC functional responses including surface molecule regulation secretory activity, and CD4 T cell allostimulatory priming. DCs derived from human peripheral blood monocytes were readily infected with multiple strains of DV. DV infection of DCs derived from separate donors was dose-dependent, with substantial variability in DC susceptibility to infection. Exposure to live DV activated surface molecule expression in DCs, similar to the effects of defined maturation stimuli including a combination of TNF-α and IFN-α, or LPS. In addition, UV-inactivated DV induced expression of cell surface molecules, albeit to a lesser extent than did live virus demonstrating inherent stimulatory properties of DV particles. Using intracellular staining for DV envelope (E) protein, I detected increased surface molecule expression on both infected DCs and uninfected bystander DCs from the same culture, as compared to mock-infected DCs. These data indicate that activation was not prevented in cells undergoing active viral replication. However, the degree of surface molecule induction depended on the infection state of the cell. Infected DCs had enhanced PD-L2 and MHC II expression relative to uninfected bystander cells, while PD-L1, CD80, CD86, and MHC I expression were suppressed with active infection. Therefore, intracellular DV replication altered the process of cell surface molecule regulation within these cells. DV infection of DCs also resulted in the secretion of a broad array of cytokines and chernokines. These included the antiviral cytokine IFN-α, inflammatory cytokines TNF-α, IL-6, and IL-1α, and inflammatory chemokines IP10, MCP-1, MIP-1α, and RANTES. DV infection did not induce DC production of the IL-12 p70 heterodimer, and secretion of the immunosuppressive cytokine IL-10 was low in most experiments. Similar to the results seen with surface molecule induction, UV inactivation of DV reduced, but did not eliminate, cytokine and chemokine responses. At the single-cell level, TNF-α and IP10 production profiles of infected DCs and uninfected bystander DCs were distinct. DV infection in DCs reduced production of IP10, but stimulated TNF-α as compared to uninfected bystander cells in the same culture. Blocking experiments demonstrated that IFN-α/β produced by DCs in response to infection actively inhibited viral protein expression and drove IP10, but not TNF-α, production. DV infection of DCs did not consistently suppress DC stimulation of allogeneic CD4 T cell proliferation. In cases where infection enhanced DC stimulatory function, T cell proliferation was less pronounced than that induced by DCs activated with exogenous TNF-α plus IFN-α. Increasing multiplicity of infection (MOI) of DCs with DV resulted in increasing DC infection rates, but a statistically significant trend at the highest MOIs for decreased T cell alloproliferation, suggesting that direct infection of DCs reduces their CD4 T cell priming function. MOI-dependent reduction in DC stimulatory function depended on replication-competent virus. Increased MOIs during DV infection of DCs did not cause an elevation in detectable IL-10 in supernatants derived from T-DC co-cultures. In addition, increased DV MOI of DCs was not associated with increased levels of either IL-13 or IFN-γ in supernatants from T-DC co-culture, suggesting that actively infected DC do not skew CD4 T cells towards a specific Th phenotype. These data demonstrate that DV infection induces functional maturation of DCs that is modified by the presence of virus through both IFN-dependent and independent mechanisms. However, the allostimulatory phenotype of DCs was not universally enhanced, nor was it skewed towards antiviral (Th1)-type responses. These data suggest a model whereby dengue infection during primary illness results in controlled immune stimulation through activation of bystander DCs, and the generation of mixed Th-type responses. Direct DV infection of DCs appears to attenuate activation of, and potentially clearance by, antiviral mechanisms. During secondary infection, reduced IP10 production and enhanced TNF-α secretion by infected cells coupled with MHC I downregulation and enhanced PD-L2 expression, would subvert both Th1 CD4 T cell recruitment and result in CD8 T cell suppression and death. Furthermore, DV-specific effects on DCs would allow for continued viral replication in the absence of effective clearance. These DV-mediated effects would modify T cell memory responses to infected DC, and potentially facilitate the expansion of pathologic T cell subsets. Contributing to this pathological cascade, antibody-dependent enhancement of infection in monocytic cells and macrophages would shift antigen presentation and cytokine production paradigms, increasing the risk of DHF.

Ο ιός του αιμορραγικού πυρετού Κριμαίας-Κογκό (Crimean-Congo Hemorrhagic Fever Virus, CCHFV), καθώς και οι χανταϊοί (hantaviruses) προκαλούν στον άνθρωπο αιμορραγικό πυρετό. Αυτοί παρουσιάζουν ευρεία γεωγραφική κατανομή και αποτελούν απειλή για τη δημόσια υγεία, λόγω του υψηλού ποσοστού θνητότητας που σημειώνουν και της απουσίας αποτελεσματικής θεραπευτικής αγωγής. Παρότι επιδημιολογικές μελέτες δείχνουν την παρουσία αντισωμάτων στον ελληνικό πληθυσμό, περιορισμένες είναι οι αναφορές κλινικών περιστατικών CCHF και HFRS στην Ελλάδα. Σκοπός της παρούσας μελέτης είναι να προσδιορίσει τον επιπολασμό της μόλυνσης με τον CCHFV και τους χανταϊούς στον Ν. Αχαΐας, που αν και παρουσιάζει ευνοϊκές συνθήκες για την κυκλοφορία των δύο ιών, δεν έχει μελετηθεί στο παρελθόν. Σχεδιάσθηκε διατμηματική μελέτη και συγκεντρώθηκαν προοπτικά 207 δείγματα ορού φαινομενικά υγιών ατόμων-κατοίκων της περιοχής, τα οποία εξετάστηκαν με τη μέθοδο ELISA και έμμεσου ανοσοφθορισμού για την ύπαρξη αντισωμάτων έναντι του CCHFV και των χανταϊών. Ο επιπολασμός για τη μόλυνση με CCHFV βρέθηκε 3,4% και 9,7% για τη μόλυνση με χανταϊούς, ενώ κανένα από τα οροθετικά άτομα δεν ανακαλούσε συμπτώματα παρόμοια με αυτά του CCHF ή του HFRS. Για τον CCHFV, βρέθηκε ότι η ηλικία, η αγροτοκτηνοτροφική ενασχόληση, η κατοχή/εκτροφή αιγοπροβάτων, το ιστορικό νύγματος κρότωνα, η μόνιμη διαμονή σε υψόμετρο ≥400μ., η μόνιμη διαμονή σε μη αρδευόμενες αρόσιμες εκτάσεις ή σε αγροτικές εκτάσεις με σημαντικό ποσοστό φυσικής βλάστησης, καθώς και η μόνιμη διαμονή σε αγροτική περιοχή είναι σημαντικοί παράγοντες κινδύνου. Από αυτούς, το νύγμα κρότωνα, η αγροτοκτηνοτροφική ενασχόληση και η μόνιμη διαμονή σε υψόμετρο ≥400μ. βρέθηκαν να προβλέπουν καλύτερα την οροθετικότητα ενός ατόμου. Επίσης, βρέθηκε ότι παράγοντες που σχετίζονται με τη μόλυνση με χανταϊούς είναι: η ηλικία, η θέαση τρωκτικών σε ακτίνα <200μ. γύρω από την οικία και η ιδιοκτησία υπόγειας αποθήκης. Από αυτούς, μόνο η ηλικία βρέθηκε να προβλέπει καλύτερα την οροθετικότητα ενός ατόμου. Επιπλέον, παρατηρήθηκε ότι σχεδόν το 75% των θετικών ατόμων για αντισώματα έναντι των χανταϊών παρουσίαζαν ήπια επηρεασμένη νεφρική λειτουργία. Εντοπίστηκαν, επίσης, ενδημικές εστίες των ιών στον νομό: ο Δ. Ερυμάνθου για τον CCHFV και ο Δ. Δυτικής Αχαΐας για του χανταϊούς. Λαμβάνοντας υπόψη τα παραπάνω αποτελέσματα, θα πρέπει οι κλινικοί γιατροί της περιοχής να συμπεριλαμβάνουν τον CCHF και τον HFRS στη διαφορική διάγνωση εμπύρετων νοσημάτων, ιδίως όταν αυτά συνοδεύονται από θρομβοπενία ή επηρεασμένη νεφρική λειτουργία. / Crimean-Congo hemorrhagic fever virus (CCHFV) and hantaviruses cause to humans fever with hemorrhagic manifestations. These viruses present wide geographic distribution and represent major threats for public health, because of the high fatality rate that they present and the lack of appropriate treatment. Although seroprevalence studies show the presence of antibodies against CCHFV and hantaviruses in the greek population, only some reports of human cases have been reported to date in Greece. The aim of the present study is to estimate seroprevalence for CCHFV and hantaviruses in humans in the prefecture of Achaia, where the local conditions potentially favor the circulation of these viruses and which has not been previously studied. A cross-sectional study was designed and 207 human sera were collected from apparently healthy individuals living in Achaia, which were tested for CCHFV and hantaviruses IgG antibodies by ELISA and by indirect immunofluorescence assay (IFA). Seroprevalence for CCHFV infection was estimated at 3.4%, whereas for hantaviruses at 9.7%; none recalled any illness resembling CCHF or HFRS. For CCHFV, it was found that age, agro-pastoral occupation, tending sheep and/or goats, tick bite, living in areas at an altitude of ≥400m., living at rural areas, living on non-irrigated arable land or on land principally occupied by agriculture, with significant areas of natural vegetation are significantly related to seropositivity. Among them, tick bite, agro-pastoral occupation and living in areas at an altitude of ≥400m. better predict seropositivity of an individual. For hantaviruses, it was found that age, rodent sighting around home and the ownership of an underground shed are significantly related to seropositivity. Among them, it seems that only age can predict seropositivity of an individual. Moreover, it was observed that almost 75% of the seropositive for hantaviruses individuals presented mild renal dysfunction. In this study, endemic foci were also detected: the municipality of Erimanthos for CCHFV and the municipality of Western Achaia for hantaviruses. Clinicians should include CCHF and HFRS in the differential diagnosis of an acute febrile case, especially when thrombocytopenia or impaired renal function is encountered.

Les fièvres hémorragiques à virus Lassa (LASV) et Ebola (EBOV) représentent un important problème de santé publique en Afrique. Les réponses immunes et la pathogenèse associées à ces maladies sont peu connues. Les cellules NK ont un rôle important dans la réponse immune innée par leurs propriétés cytotoxiques, mais également dans l’induction des réponses adaptatives par leur production de cytokines et leurs interactions avec les cellules dendritiques (DC) et les macrophages. Ce projet s’attache à comprendre le rôle des cellules NK dans le contrôle de la réplication virale et dans l’induction des réponses immunitaires au cours de ces infections. Un modèle in vitro de coculture de cellules NK humaines avec des DC et macrophages autologues a été développé. L’activation des cellules NK et leurs fonctions ont été analysées après l’infection par LASV et EBOV. Par ailleurs, les réponses des cellules NK en réponse à LASV ont été comparées avec celles induites lors de l’infection par le virus Mopeia (MOPV), très proche de LASV mais non pathogène pour l’homme. Les macrophages, mais pas les DC, infectés par LASV ou MOPV induisent l’activation et l’augmentation des capacités cytotoxiques des cellules NK. Toutefois, les cellules NK ne sont pas capables de lyser les cellules infectées et ne produisent pas d’IFN-γ. Les cellules NK s’activent et sont capables de lyser les cellules infectées en présence de macrophages mais également de DC infectés par des LASV mutants. Cependant, les IFN de type I sécrétés en grande quantité en réponse à ces virus ne sont pas impliqués dans l’activation des cellules NK. L’infection par EBOV n’induit qu’une très faible activation des cellules NK en présence de DC ou macrophages et ne conduit pas à la sécrétion de cytokines, ni à la modification du potentiel cytotoxique.Ces résultats permettent d’améliorer la compréhension des réponses immunes et des mécanismes de pathogenèse mis en place lors des fièvres hémorragiques Lassa et Ebola. / The hemorrhagic fevers caused by Lassa (LASV) and Ebola (EBOV) viruses are important problems of public health in Africa. The immune responses and the pathogenesis associated with these diseases are unknown. NK cells are at the crossroads between the innate and adaptive immune responses through their abilities to secrete cytokines and kill the infected cells. The interactions between NK cells and dendritic cells (DC) or macrophages potentiate the immune responses. This project aims to understand the role of NK cells in the control of viral replication and in the induction of immune responses during LASV and EBOV infection.An in vitro model of coculture of human NK cells with autologous DC or macrophages has been set up. Cell activation, cytokine production, proliferation and NK cell-mediated killing were analyzed after the infection with LASV or EBOV. In addition, NK cell functions in response to LASV were compared with those induced during Mopeia virus (MOPV) infection, closely related to LASV but not pathogenic for humans.Here, we show that LASV- or MOPV-infected macrophages, but not DC, induce the activation of NK cells and the increase of their cytotoxic capacity. This process involves cell contact and type I IFN. However, these cells are neither able to kill the infected cells nor produce IFN-γ. NK cells are activated and are able to kill the infected cells when stimulated by mutated LASV-infected macrophages and DC. Surprisingly, the type I IFN which are secreted in high amounts in response to these viruses are not involved in NK cell activation. EBOV infection does not lead to NK cell activation in the presence of DC. EBOV-infected macrophages induce low NK cell activation without cytokine production or cytotoxicity.These results allow to better understand the immune responses and the mechanisms of pathogenesis associated with Lassa and Ebola hemorrhagic fevers.

Hantaviren (Familie Bunyaviridae) sind Erreger, die von Nagetieren auf den Menschen übertragen werden und Hämorrhagische Fieber mit Renalem Syndrom (HFRS) auslösen. Die vorgelegte Arbeit beinhaltet derartige Ergebnisse zu zwei europäischen Hantaviren, dem Dobravavirus (DOBV) und dem Tulavirus (TULV). DOBV ist ein wichtiger HFRS-Erreger in Europa. DOBV Stämme kommen in mindestens zwei Nagerspecies, der Gelbhalsmaus (Apodemus flavicollis) und der Brandmaus (A. agrarius) vor. In Übereinstimmung mit diesen natürlichen Wirten bilden die Virusstämme zwei genetische Linien: DOBV-Af und DOBV-Aa. Die phylogenetischen Analysen von den Nukleotidsequenzen der S-, M- und L-Segmente von sympatrisch vorkommenden DOBV-Af und DOBV-Aa Stämmen aus Mitteleuropa zeigten das Vorkommen von Reassortmentprozessen der Genomsegmente während der Evolution der Virusspecies. Ausserdem, wurde die virale Nukleotidsequenz aus einem DOBV-seropositiven HFRS-Patienten aus Detschland amplifiziert. Damit wurde erstmalig der molekulare Beweis erbracht, dass DOBV in Mitteleuropa HFRS auslöst und dass die DOBV-Aa Linie humanpathogen ist. Aus einer in der Slowakei gefangenen A. agrarius Maus haben wir ein neues Virusisolat gewonnen, welches "Slovakia (SK/Aa)" genannt wurde. SK/Aa ist das bisher einzige Virusisolat, das die DOBV-Aa Linie repräsentiert. Es wurde gemeinsam mit einem Isolat der DOBV-Af Linie zur vergleichenden Typisierung der Antikörper von mitteleuropäischen HFRS-Patienten mittels Fokusreduktionsneutralisationstest eingesetzt. Die Seren der meisten Patienten zeigten die höchsten neutralisierenden Antikörpertiter gegenüber SK/Aa, was die Schlussfolgerung zulässt, dass DOBV-Aa Stämme für die meisten DOBV-Infektionen in Mitteleuropa verantwortlich sind. TULV wird durch die Feldmaus (Microtus arvalis) beherbergt. Die Fähigkeit zur Auslösung von HFRS war bisher wenig bekannt. Wir haben den ersten Fall von HFRS gefunden, der mit einer TULV Infektion assoziiert ist. Aus demselben geographischen Gebiet in Nordostdeutschland konnten aus Feldmäusen TULV Nukleotidsequenzen amplifiziert werden. In phylogenetischen Analysen clustern sie mit Stämmen aus Polen und bilden mit diesen gemeinsam eine eigene, neue genetische Linie. Ausser dem hier untersuchten DOBV und dem länger bekannten Puumalavirus ist TULV offenbar das dritte Hantavirus, das in Mitteleuropa HFRS hervorruft. / Hantaviruses (Bunyaviridae family) are rodent-borne bunyaviruses that cause hemorrhagic fever with renal syndrome (HFRS) in Eurasia. This thesis presents novel data about two European hantaviruses, Dobrava virus (DOBV) and Tula virus (TULV). DOBV is an important etiologic agent of HFRS in Europe. DOBV strains were found to be hosted by at least two different rodent species, yellow-necked mouse (Apodemus flavicollis) and striped field mouse (A. agrarius). According to their natural hosts they form the distinct genetic lineages DOBV-Af and DOBV-Aa, respectively. We have determined and analysed the complete S and M, and partial L segment nucleotide sequences of sympatrically occurring DOBV-Af and DOBV-Aa strains from Central Europe. Molecular phylogenetic analyses gave evidence for genetic reassortment in the evolution of the virus species. Moreover, we amplified a DOBV-Aa nucleotide sequence from a DOBV-seropositive HFRS patient from Germany. This is the first molecular identification of human infection by DOBV in Central Europe and the first direct proof that a virus strain related to the DOBV-Aa lineage, carried by A. agrarius rodents, is able to cause HFRS. Under biosafety level 3 conditions, we have established a DOBV isolate named Slovakia (SK/Aa) from an A. agrarius animal captured in Slovakia. SK/Aa, as the only isolate clearly belonging to the DOBV-Aa lineage, can be taken as the representative of this virus lineage. The new virus isolate, in comparison to a DOBV-Af strain, was used for serotyping neutralising antibodies of HFRS patients in Central Europe by the use of a focus reduction neutralisation assay. Most patients'' sera exhibited a higher end-point titer towards SK/Aa suggesting that DOBV-Aa strains are responsible for most of the DOBV HFRS cases in this region. TULV is carried by European common voles (Microtus sp.). Its pathogenic potential for humans was rather unknown. We have described the first case of HFRS which can be associated with TULV infection. Moreover, TULV strains detected in M. arvalis near the home village of the patient in North-East Germany clustered with strains from Poland and represent a new, well-supported genetic lineage within the TULV species. In addition to DOBV and longer known Puumala virus, TULV is most likely an additional causative agent of HFRS in Central Europe.

Le virus Lassa (LASV) induit une fièvre hémorragique chez l’homme et est responsable de 3 000 à 5 000 décès par an. Aucun vaccin ou traitement efficace contre LASV n’est disponible, et les mécanismes de pathogenèse de la fièvre de Lassa sont encore mal compris. Des études chez l’homme et le primate suggèrent que la réponse interféron de type I (IFN-I) et de la réponse T sont critiques pour la survie de l’hôte. Nous nous sommes intéressés à la réponse des cellules dendritiques (DC) à LASV, car elles peuvent à la fois produire des IFN-I et induire la réponse T. Nous avons étudié les DC plasmacytoïdes (pDC), spécialisées dans la réponse IFN-I, et les DC myéloïdes (mDC), présentatrices d’antigènes. Nous avons montré que les pDC et les mDC ne sont pas productivement infectées par MOPV et LASV. Les pDC produisent des quantités importantes d’IFN-I en réponse à MOPV, mais pas à LASV. Les mDC sont activées et produisent des IFN-I en réponse à MOPV mais aussi à LASV. Cependant, seules les mDC infectées par MOPV sont capables d’activer des lymphocytes T. De plus, la présence de lymphocytes T inhibe complètement l’activation des mDC infectées par LASV. Ces différences entre les mDC infectées par MOPV et LASV dépendent de la nucléoprotéine de LASV, qui est connue pour ses propriétés immunosuppressives, mais aussi de la glycoprotéine. En résumé, nous avons obtenu des différences de réponse à l’infection par MOPV ou LASV chez les pDC et les mDC. Ces cellules pourraient avoir un rôle essentiel in vivo dans la réponse globale à LASV, et donc dans l’issue de la fièvre de Lassa / Lassa virus (LASV) is responsible for a viral haemorrhagic fever in humans and the death of 3,000 to 5,000 people every year. There is currently no vaccine or treatmentavailable against LASV, and its pathogenesis is not completely understood yet. According to studies on humans and primates, type I interferon (IFN-I) and T cell responses appear to be critical for the host. We studied the response of dendritic cells (DC) to LASV, as DC are involved in both IFN-I production and T cell activation. We compared the response of primary human DC to LASV and Mopeia virus (MOPV), which is similar to LASV, but non-pathogenic.We focused on plasmacytoid DC (pDC), specialized in IFN-I production, and myeloid DC (mDC), specialized in antigen presentation. We showed that neither pDC nor mDC were productively infected by LASV and MOPV. pDC infected with MOPV produced large amounts of IFN-I, whereas pDC infected with LASV did not. mDC produced substantial amounts of IFN-I in response to both LASV and MOPV. However, only MOPV-infected mDC were able to activate T cells. More surprisingly, coculture with T cells completely inhibited the activation of LASV-infected mDC. These differences between LASV- and MOPV-infected mDC were mostly due to LASV nucleoprotein, which has major immunosuppressive properties, but the glycoprotein was also involved. Overall, these results showed differences in pDC and mDC response to MOPV and LASV. Therefore, both pDC and mDC may be important for the global response to LASV in vivo, and play a role in the outcome of Lassa fever

Hantaviruses are members of the virus family Bunyaviridaethat cause two potentially life-threatening diseases in humans: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (BPS). HFRS is caused by Old World hantaviruses that are endemic in many Asian and European countries. Infections with Old World hantaviruses can range in severity from asymptomatic to moderate or severe, depending primarily on the infecting serotype of virus. HPS is caused by New World hantaviruses in North and South America. New World hantaviruses are rarely asymptomatic and are severe in the majority of cases. These syndromes are distinct from one another in the primary target organ of virus infection (kidney vs. lung), but have important clinical features in common, including fever, thrombocytopenia, and a capillary leak syndrome. These common clinical manifestations suggest that the underlying mechanisms of disease may be similar in the two syndromes. The precise mechanisms of pathogenesis of HFRS and HPS are poorly characterized, but may be mediated in part by immunopathology. Hantaviruses are able to establish infections in many human cell types, including primary human endothelial cells, without having any cytopathic effect on these cells. Human infections with hantavirus result in a robust activation of the humoral and cellular immune response, and we hypothesize that these immune responses contribute to the pathology of disease. Evidence for the activation of T lymphocytes, and their potential involvement in immunopathology, includes increases in the number of circulating, activated CD8+ T cells during HFRS, the presence of lymphocytic infiltrates (predominantly CD8+T cells) in kidney biopsies from patients with acute HFRS, and associations between certain HLA haplotype and disease severity following hantavirus infection. This thesis is the first examination of human T lymphocyte responses that are generated during HFRS. Initially, we studied memory T cell responses in scientists who were sub-clinically infected with Hantaan virus (HTNV), the prototype hantavirus. We later investigated memory T cell responses in healthy Finnish adults who had HFRS caused by Puumala virus (PUUV), a hantavirus endemic primarily in Scandinavia. At the onset of these studies, there was no available information on human T lymphocyte responses to Old World hantaviruses. Virus-specific CD8+ and CD4+human T cell lines had been isolated from patients with acute HPS caused by Sin Nombre virus (SNV) infection. In that study, conducted in our laboratory, several human T cell epitopes on the nucleocapsid (N) protein and G2 envelope glycoprotein of SNV were identified and characterized. We decided to perform similar analyses on PBMC from donors who had been infected with HTNV and PUUV, in order to determine the specificity and diversity of the T cell response to Old World hantaviruses. The initial study of three donors who had sub-clinical infections with HTNV demonstrated that virus-specific T cell responses could be detected in all the donors following in vitro stimulation of PBMC with inactivated virus. In two of the donors, the virus-specific cytolytic T cells (CTL) recognized the HTNV N protein, and in the third donor the virus-specific CTLs recognized the HTNV G1 glycoprotein. Isolation and characterization of virus-specific T cells from two donors resulted in the identification of two CD8+ T cell epitopes on the HTNV N protein, which were restricted by either HLA A1 or B51. These CTL lines included both HTNV-specific (HLA B51-restricted) and serotype-cross reactive (HLA A1 restricted) lines. In one subject, these virus-specific T cell responses were detectable in IFN-γ ELISPOT assays following peptide stimulation, and in bulk cultures after short-term stimulation with inactivated HTNV. These results indicated that the CD8+CTL responses of humans after sub-clinical infection with HTNV were readily detectable and were directed against a limited number of viral proteins and epitopes. In addition, sub-clinical infection resulted in the generation of both virus-specific and cross-reactive CTL responses. We reasoned that hantavirus infections that lead to clinical illness may result in the generation of more robust and/or diverse virus-specific T cell responses than in sub-clinical infections. To address this question, we studied the memory CD8+ T cell responses in a group of healthy adults from Finland who had HFRS caused by PUUV infection between the years 1984 and 1995. We detected virus-specific CTL in the bulk cultures of seven of eleven immune individuals tested following stimulation with infectious virus. The PUUV proteins N, G1 and G2 were recognized by CTLs in six, five, and two donors respectively. Extensive cloning of T cells from two donors resulted in the isolation of sixty-three virus-specific CTL lines, the majority of which (61/63) were specific for the PUUV N protein. Six novel CD8+ CTL epitopes and one CD4+ CTL epitope were identified on the N protein, all of which clustered in the center of the protein between amino acids 173 and 251. The CTL lines specific for these epitopes were restricted by a variety of HLA alleles including A2, A28, B7 and B8, and were primarily serotype specific when tested against target cells expressing HTNV or SNV N protein. IFN-γ ELISPOT analysis using the defined epitopes to stimulated PBMC, revealed high frequencies of circulating N-specific CD8+ T cells in eight of thirteen individuals tested. Finally, T cell receptor (TCR) Vβ analysis of CTL clones specific for one epitope (N204-12) demonstrated that cells in this population expressed up to five different Vβ chains. These results demonstrated that the PUUV N protein may be the dominant target of the CTL response, that the N-specific CD8+ CTL responses are diverse, heterogeneous, and primarily serotype specific, and that virus-specific memory CD8+T cells can persist at high levels for up to 15 years after the primary infection. In order to understand the pathology of HFRS and HPS, we must be able to assess the contribution of various factors that could potentially contribute to disease. The virus burden in the infected individual is likely to be an important factor in the severity of the resulting disease. Quantitative RT-PCR analysis of plasma samples from acute HPS patients demonstrated that a higher virus burden (as reflected by viral RNA copy number) is associated with more severe HPS. In order to perform similar analyses in patients with HFRS caused by PUUV, we established a quantitative RT-PCR assay for the detection of PUUV S segment RNA in patient plasma. The design and optimization of the PUUV-specific RT-PCR is described in this report. This assay will allow us to measure the virus burden in patients and compare these data with levels of T cell activation and with parameters of disease severity. In this way, we hope to gain an understanding of the kinetics and magnitude of both the virus burden and virus-specific T cell response during the acute illness. This thesis provides the first description of human virus-specific T cell responses to HTNV and PUUV. These data shed light on the nature of the CD8+ T cell responses that are generated following natural infections with PUUV and sub-clinical infections with HTNV. The studies of memory CD8+ T cell responses to PUUV, and the development of a PUUV-specific quantitative RT-PCR assay, establish the framework for future studies of the immunopathology of acute HFRS. Quantitative analysis of both virus burden and T cell responses during acute illness will provide insight into their relative contributions to the pathology of disease.

This study proposes to directly test the hypothesis that antibody-dependent enhancement (ADE) is the critical factor in the development of dengue hemorrhagic fever (DHF) in infants. DHF occurs in two distinct clinical settings: a) in children and adults with secondary DENV infection, and b) in infants with primary DENV infection born to mothers with prior DENV infection. The ADE hypothesis proposes that pre-existing serotype-cross-reactive non-neutralizing anti-DENV antibodies bind the heterotypic DENV during secondary infection and enhance its uptake into immune cells, leading to increased viral load and DHF. This model suggests that DHF in DENV-infected infants is caused by the enhancing effect of waning maternal anti-DENV antibodies, thus causing a “physiologic secondary infection” during an infant’s primary infection and thereby increasing the infant’s risk for DHF. The effect of maternal immunity on DHF in infants has been studied exclusively in Southeast Asia. However, the maternal DENV seroprevalence approaches 100% in this part of the world. As a consequence, the ADE model of infant DHF cannot truly be tested in Southeast Asia, because all infants possess anti-DENV antibody at birth. In the Western Hemisphere, by contrast, women may have experienced either a single DENV infection, more than one DENV infection, or no DENV infection at all. The ability to include DENV-seronegative mothers as controls allows for the ADE hypothesis to be directly tested in a clinical study. To our knowledge, no such study has been previously conducted. This thesis presents a case-control study designed to evaluate the influence of positive maternal dengue seroprevalence on the risk of DHF in infants. As the MSCI program provides instruction in study design, this thesis does not present findings. The clinical trial described herein began in May 2010 and enrollment is expected to continue through May 2012 (see Table 4).