In recent years, dengue viral infection has become one of the most widely-spread mosquito-borne diseases in the world, with an estimated 50-100 million cases annually, resulting in 500,000 hospitalizations. Due to the nature of the immune response to each of the four serotypes of dengue virus, secondary infections of dengue put patients at higher risk for more severe infection as opposed to primary infections. The current hypothesis for this phenomenon is antibody-dependent enhancement, where strain-specific antibodies from the primary infection enhance infection by a heterologous serotype. To determine the mechanisms responsible for the increase in disease severity, we develop mathematical models of within-host virus-cell interaction, epidemiological models of virus transmission, and a combination of the within-host and between-host models. The main results of this thesis focus on the within-host model. We model the effects of antibody responses against primary and secondary virus strains. We find that secondary infections lead to a reduction of virus removal. This is slightly different than the current antibody-dependent enhancement hypothesis, which suggests that the rate of virus infectivity is higher during secondary infections due to antibody failure to neutralize the virus. We use the results from the within-host model in an epidemiological multi-scale model. We start by constructing a two-strain SIR model and vary the parameters to account for the effect of antibody-dependent enhancement. / Master of Science

This literature review will discuss Zika virus and the salient research on antibody dependent enhancement and how this mechanism may lead to congenital defects. Specific objectives include: the mechanism of antibody dependent enhancement, Zika and dengue virus pathogenesis, placenta pathophysiology, and how changes in viral virulence may play a role the pathogenesis of neurologic congenital defects seen in infants infected with Zika virus in utero. While some cohort studies have examined the relationship between prior dengue immunity, Zika virus infection in pregnancy, and effects on neonatal outcomes further prospective studies using large cohorts and more detailed lab testing and imaging is essential to better understand this relationship. A proposed study enrolling a large cohort of women in the 6th- 8th week of pregnancy from Northeastern Brazil will seek to further describe what additional risk dengue immunity may pose in the context of Zika virus. This risk is essential to understand, as Zika and Dengue viruses co-circulate in many regions of the world. Furthermore, participants in the proposed study will undergo bi-weekly screening for Zika virus through laboratory and ultrasound testing until their delivery. Infants will then have full neurologic testing and MRI scanning for the following year after birth to characterize any congenital defects. Neonates born to mothers with prior dengue immunity who contract Zika virus during pregnancy will be compared to neonates not exposed to Zika virus in utero. This experiment will illuminate the associated risk and evidence of ADE occurring with prior dengue immunity and Zika virus infection during pregnancy. Results from this study will not only help define risks of congenital defects with Zika virus, it will inform vaccine research and elucidate challenges in the administration of the current tetravalent dengue vaccine.

abstract: Antibodies are naturally occurring proteins that protect a host during infection through direct neutralization and/or recruitment of the innate immune system. Unfortunately, in some infections, antibodies present unique hurdles that must be overcome for a safer and more efficacious antibody-based therapeutic (e.g., antibody dependent viral enhancement (ADE) and inflammatory pathology). This dissertation describes the utilization of plant expression systems to produce N-glycan specific antibody-based therapeutics for Dengue Virus (DENV) and Chikungunya Virus (CHIKV). The Fc region of an antibody interacts with Fcγ Receptors (FcγRs) on immune cells and components of the innate immune system. Each class of immune cells has a distinct action of neutralization (e.g., antibody dependent cell-mediated cytotoxicity (ADCC) and antibody dependent cell-mediated phagocytosis (ADCP)). Therefore, structural alteration of the Fc region results in novel immune pathways of protection. One approach is to modulate the N-glycosylation in the Fc region of the antibody. Of scientific significance, is the plant’s capacity to express human antibodies with homogenous plant and humanized N-glycosylation (WT and GnGn, respectively). This allows to study how specific glycovariants interact with other components of the immune system to clear an infection, producing a tailor-made antibody for distinct diseases. In the first section, plant-produced glycovariants were explored for reduced interactions with specific FcγRs for the overall reduction in ADE for DENV infections. The results demonstrate a reduction in ADE of our plant-produced monoclonal antibodies in in vitro experiments, which led to a greater survival in vivo of immunodeficient mice challenged with lethal doses of DENV and a sub-lethal dose of DENV in ADE conditions. In the second section, plant-produced glycovariants were explored for increased interaction with specific FcγRs to improve ADCC in the treatment of the highly inflammatory CHIKV. The results demonstrate an increase ADCC activity in in vitro experiments and a reduction in CHIKV-associated inflammation in in vivo mouse models. Overall, the significance of this dissertation is that it can provide a treatment for DENV and CHIKV; but equally importantly, give insight to the role of N-glycosylation in antibody effector functions, which has a broader implication for therapeutic development for other viral infections. / Dissertation/Thesis / Doctoral Dissertation Molecular and Cellular Biology 2019

Dengue fever is endemic in tropical and sub-tropical countries, and some of the important features of Dengue fever spread continue posing challenges for mathematical modelling. We propose a model, namely a system of integro-differential equations, to study a multi-serotype infectious disease. The main purpose is to include and analyse the effect of a general time delay on the model describing the length of the cross immunity protection and the effect of Antibody Dependent Enhancement (ADE), both characteristics of Dengue fever. Analysing the system, we could find the equilibriums in the invariant region. A coexistence endemic equilibrium within the region was proved, even for the asymmetric case. The local stability for the disease free equilibrium and for the boundary endemic equilibriums were proved. We have also results about the stability of the solutions of the system, that is completely determined by the Basic Reproduction Number and by the Invasion Reproduction Number, defined mathematically, as a threshold value for stability. The global dynamics is investigated by constructing suitable Lyapunov functions. Bifurcations structure and the solutions of the system were shown through numerical analysis indicating oscillatory dynamics for specific value of the parameter representing the ADE. The analytical results prove the instability of the coexistence endemic equilibrium, showing complex dynamics. Finally, mortality due to the disease is added to the original system. Analysis and discussions are made for this model as perturbation of the original non-linear system. / A Dengue é endêmica em países tropicais e subtropicais e, algumas das importantes características da dengue continua sendo um desafio para a modelagem da propagação da doença. Assim, propomos um modelo, um sistema de equações integro-diferenciais, com o objetivo de estudar uma doença infecciosa identificada por vários sorotipos. O principal objetivo é incluir e analisar o efeito de um tempo geral de retardo no modelo descrevendo o tempo de imunidade cruzada para a doença e o efeito do Antibody Dependent Enhancement (ADE). Analisando o sistema, encontramos os equilíbrios, onde a existência do equilíbrio de coexistência foi provado, mesmo para o caso assimétrico. A estabilidade local para o equilíbrio livre de doença e para os equilíbrios específicos de cada sorotipo foi provada. Também mostramos resultados para a estabilidade das soluções do sistema que é completamente determinada pelo Número Básico de Reprodução e pelo Número Básico de Invasão, definido matematicamente como um valor limiar para a estabilidade. A dinâmica global é investigada construindo funções de Lyapunov. Adicionalmente, bifurcações e as soluções do sistema foram mostrados via análise numérica indicando dinâmica oscilatória para específicos valores do parâmetro que representa o efeito ADE. Resultados analíticos obtidos pela teoria da perturbação provam a instabilidade do equilíbrio endêmico de coexistência e apontam para um complexo comportamento do sistema. Por fim, a mortalidade causada pela doença é adicionada ao sistema original. Análises e discussões são feitas para este modelo como uma perturbação do sistema não linear original.

abstract: Flaviviruses (FVs) are among the most medically important arboviruses of the world with the Dengue virus (DENV) accounting for a large percentage of infections observed in tropical and subtropical regions of the world. Globalization, travel, and the expanding range of mosquito vectors, such as Aedes aegypti, have increased the potential of infection rates and illnesses associated with FVs. The DENV and the Zika (ZIKV) FVs frequently co-circulate and generally cause mild self-liming febrile illnesses. However, a secondary infection with a heterologous DENV serotype may lead to life threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). DHF/DSS have been linked to antibody dependent enhancement of infection (ADE), a phenomenon that occurs when antibodies (Abs) formed against an initial infection with one serotype of DENV cross-reacts but does not neutralize a heterologous DENV serotype in a secondary infection. Furthermore, Abs raised against the ZIKV have been observed to cross-react with the DENV and vice versa, which can potentially cause ADE and lead to severe DENV disease. The ZIKV can be transmitted vertically and has been linked to devastating congenital defects such as microcephaly in newborns. FDA approved treatments do not exist for DENV and ZIKV illnesses. Thus, there is a need for safe and effective treatments for these co-circulating viruses. Here, a tetravalent bispecific antibody (bsAb) targeting the ZIKV and all four serotypes of the DENV was expressed in the Nicotiana benthamiana (N. benthamiana) plant. Functional assays of the DENV/ZIKV bsAb demonstrated binding, neutralization, and a significant reduction in ADE activity against both the DENV and the ZIKV. A single chain variable fragment (scFv) and a diabody based on an antibody directed against the immune checkpoint inhibitor PD-L1, were also expressed in N. benthamiana leaves. The smaller sizes of the scFv and diabody confers them with the ability to penetrate deeper tissues making them beneficial in diagnostics, imaging, and possibly cancer therapy. The past few decades has seen long strives in recombinant protein production in plants with significant improvements in production, safety, and efficacy. These characteristics make plants an attractive platform for the production of recombinant proteins, biologics, and therapeutics. / Dissertation/Thesis / Doctoral Dissertation Molecular and Cellular Biology 2019

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