Zika Virus (ZIKV) is an
emerging flavivirus that was first isolated in 1947 from a sentinel monkey in
Uganda as part of study that aimed to identify novel pathogens and despite
sporadic local outbreaks in countries such as Gabon, Nigeria, Cambodia, Malaysia
and Indonesia followed by the first major outbreak in Yap/Federal States of
Micronesia 2007 only caused mild disease
in humans with up to 80% of asymptomatic cases.
The emergence of ZIKV
combined with severe pathogenicity following the outbreak in French Polynesia
2013/2014 with an excess of 30000 patients and particular the introduction of
ZIKV to Brazil as early as 2013 as
suggested by molecular clock analysis however raised questions about the
molecular evolution of ZIKV since ZIKV was previously only associated with
arthralgia and a mild febrile illness but not neuropathological disorders
including abnormal foetal brain development and Guillain-Barre Syndrome (GBS)
that were first identified in Pernambuco/Brazil and in a retroactive study of
the 2013 outbreak in French Polynesia.
ZIKV is a flavivirus
closely related to Dengue Virus (DENV), Japanese Encephalitis Virus (JEV) and
Yellow Fever Virus (YFV) with a single stranded positive stranded RNA genome of
approximately 10800 bp. Similar to DENV, JEV and YFV, the ZIKV RNA encodes for
a single polyprotein that it is cleaved into the structural (Capsid (C),
pre-membrane (prM), and envelope (E)) and non-structural (NS1, NS2A, NS2B, NS3,
NS4A, 2K, NS4B, and NS5) proteins with the replication taking place in the
cytoplasm of infected although at least the C and NS5 proteins localise to the
nucleolus and to nuclear speckles respectively, suggesting that the nuclear
localisation of these proteins might be required for efficient replication of
JEV probably due to the interaction of the JEV core protein with B23, thus
relocalising B23 to the nuclear periphery. In contrast to JEV core protein
however, the DENV core protein does not co-localize with B23. In the case of
NS5, the expression of DENV NS5 interacts with components of the cellular
spliceosome –in particular with components of the U5 small nuclear
ribonucleoprotein particle- and thus disrupts the maturation of cellular pre-mRNA
by decreasing the efficiency of pre-mRNA processing, thus contributing to the
downregulation of cellular gene expression. Presently it is not known to which
extent ZIKV derived proteins interfere with these processes.
Both DENV and ZIKV NS5 have
been shown to inhibit the nuclear translocation of STAT2 and thus antiviral
signaling, suggesting that ZIKV and DENV NS5 exhibit similar if not identical
properties and similar to DENV, so called “viral factories” or viral
replication centers are formed in the cytoplasm of ZIKV infected cells which
contain both viral (progeny) RNA as well as viral proteins. Since ZIKV RC are similar
to the viral replication centers of other positive strand RNA viruses and are
positive for LC3, it has been proposed that these are formed by utilizing the
autophagic machinery although in A549 cells infected with the South Pacific
ZIKV PF-25013-18 no LC3-B positive structures have been identified (in contrast
with ZIKV 766 infected human keratinocytes or ZIKV SPH 2015 infected human astrocytes)
and chloroquine inhibits ZIKV replication in infected U87 glioblstoma cells.
In any case, as mentioned
above, both the ZIKV outbreak in French Polynesia and the current outbreak in
the Americas are are associated with neurological abnormalities, namely foetal
microcephaly/micrencephaly, lissencephaly, hydrocephaly,
cortical/periventricular calcifications, hypoplasia of the brain stem and
spinal cord, necrosis and other
congenital abnormalities such as focal pigment mottling of the retina, optic
nerve abnormalities and chorioretinal atrophy in foetuses and newborns of
previously infected women as well as uveitis, conjunctivitis and GBS in adults.
These observations suggest that ZIKV is neurotrophic, a finding which was first
reported in mice following the isolation of ZIKV from the sentinel monkey (for
further details see previous discussion here). Subsequent studies demonstrated
that ZIKV enters neuronal and non-neuronal cells via different receptors, the
phosphatidylserine TAM receptor Axl that is enriched on the surface of human glial
cells and the main receptor, and with DC-SIGN, TIM-1 and Tyro-3 as minor
receptors.
Consequently, recently published studies which have been discussed in extensio before, suggest that ZIKV can infect human neural
progenitor cells (hNPC) derived from induced pluripotent stem cells, brain
organoids and neurospheres that are derived from embryonic stem cells or
induced pluripotent stem cells as well
as two foetal cell lines. These studies showed that ZIKV induces caspase-3
dependent apoptosis which may be preceded by mitochondrial depolarization and
subsequent activation of caspase-3 via the release of cytochrome-c although the
mechanism leading to mitochondrial depolarisation has not been elucidated (see previous post for discussion). ZIKV infected foetal neural tissue samples derived 13-16
weeks post conception exhibits high levels of infection in the ventricular and
subventricular zone which are positive for radial glial cells with only a small number of mature neurons
being infected and later (18 weeks pcw), suggesting that postmitotic neurons
are not susceptible to ZIKV which is confirmed by the absence of Axl in mature
neurons.
More recent studies also
identified the vaginal mucosa and lacrimal glands of mice as being susceptible
for ZIKV thus providing a model of sexual transmission and viral persistence
respectively. Interestingly, ZIKV infection of the adult neurosensory retina
induces apoptosis as measured by TUNEL staining yet does not induce significant
pan-retinal abnormalities.
Antiviral
drugs: targeting caspase-3
Recently,
a drug repurposing screen identified several small molecule inhibitors that
inhibit ZIKV induced caspase-3 dependent apoptosis in ZIKV FSS 13025 (Cambodia
2010) or ZIKV MR766 (Uganda 1947) infected SNB-19 glioblastoma, human astrocytes
and hNPC. In this assay, 194 compounds were tested using two high-throughput
assays with one measuring both cell viability at 72 hrs p.i. and caspase-3/-7
activity at 6 hrs p.i. and the other measuring the caspase-3/-7 activity in a
primary screen followed secondary screen measuring both cell viability and
caspase-3/-7 activity which is then followed by tertiary screen that involves a
ZIKV replication assay, 2D & 3D neural cell models (such as hNPC and brain organoids)
and in addition measuring the effect of drug combinations on ZIKV replication
and cell viability. Despite causing apoptosis in all cell types tested, ZIKV
MR766 induced apoptosis can only be prevented by 35 compounds tested in all
cell types, with 54 inhibiting apoptosis in human astrocytes, 57 in SNB-19
glioblastoma cells and 48 in hNPC, whereas only 1 compound –a pan-caspase
inhibitor (Emericasan)- inhibiting both caspase-3/-7 activity and increasing the
viability of ZIKV MR766, ZIKV FSS 13025 and ZIKV PRVABC59 infected hNPC/SNB-19 cells
and brain organoids. In contrast to Emericasan, the vast majority of screened
not only inhibited apoptosis but also had a negative impact on cell
proliferation even in the absence of viral infection.
Figure: Effect of tested compounds on cell viability of ZIKV infected cells (Astrocytes, SNB-19 glioblastoma cells and hNPC) Negative cell viablity=toxic effect even in absence of ZIKV |
Besides
preventing ZIKV induced apoptosis, Emericasan also reduced viral replication as
measured by determining viral titres and measuring the expression levels of the
viral NS1 protein, suggesting that the inhibition of cellular caspases also
inhibits viral replication. One possibility is that ZIKV induced activation of
caspase-3/-7 and/or other caspases inactivates Beclin-1 induced autophagy by
cleaving Beclin-1 at AA 133 and AA149 (TDVD133 and DQLD149 respectively) thus
not only preventing autophagy but also localising the resulting Beclin-1 C
terminal fragment to the mitochondria, inducing the release of Cytochrome-c in
addition to cleaving Phosphatidylinositol-3-Kinase (PI3KC3)/vacuolar protein
sorting complex-34 (Vps-34). Restoring Beclin-1 dependent autophagy in
Emericasan treated and ZIKV infected cells therefore might contribute to the
inhibition of viral replication.
Additionally,
the replication of ZIKV FSS13025 and ZIKV PRVABC59 in SNB-19 cells and human
astrocytes can be efficiently inhibited by Cyclin dependent kinase inhibitors
(Cdki) such as PHA-690509, Niclosamide and Seliciclib that inhibit the progression of the cell cycle,
indicating that cellular Cdk might phosphorylate the viral NS5 and/or NS5a
protein similar to the DENV-2, TBE and
YFV NS5 or BVDV NS5a or that the progression in particular from the G1 phase of
the cell cycle to S phase might be required for efficient ZIKV replication similar
to Mouse Hepatitis Virus (MHV), Infectious Bronchitis Virus (IBV), SARS-CoV and
Coxsackievirus B1. Further experiments are however needed to determine the role
of Cdk’s in ZIKV replication which might involve using Cdk -/- MEF and/or
siRNA targeting specific Cdk. The disadvantage of using Cdki however is that
the proliferation of ZIKV PRVABC59 infected/Cdki treated cells as measured by
EdU incorporation is significantly decreased compared to non-infected hNPC at
72 hrs p.i. thus limiting the use in
utero. Cdki however might be useful in treating adults, preventing sexual
transmission and/or prolonged shedding of ZIKV in urine, saliva and tears.
ZIKV
and the cell cycle: G2 and mitotic arrest
As
discussed in a previous post, the in
utero infection of (mouse) foetal brains with ZIKV SZ01 decreases the
expression of proteins that previously have been linked to the development of
microcephaly, in particular those that are involved in the separation of
chromosomes during metaphase and anaphase, suggesting that ZIKV infected
embryonic and/or foetal cells might exhibit incomplete cytokinesis and
subsequent apoptosis, a notion that is supported by previous observations
that hNPC infected with ZIKV MR766 also
exhibit a decrease in the expression of the very same genes confirming that the
downregulation of genes regulating mitotic progression might arrest infected cells
in G2/M phase of the cell cycle which is confirmed by flow cytometry analysis
of infected hNPC. In addition to hNPC, more recent data indicate that the
infection of neuroepithelial cells derived from the Neocortex (NCX-NES) derived
from human specimens ranging from 5 to 8 weeks postconception with ZIKV FSS
13025 not only support viral replication as evidenced by the expression of the
viral NS1 protein but also undergo caspase-3 dependent apoptosis including
nuclear fragmentation and pyknosis as well exhibiting decreased cell
proliferation as indicated by the absence of the proliferation marker Ki-67
starting at day 3.5 p.i. and continuing until day 6.5 p.i. . In contrast to
NCX-NES cells, mature neurons do not support viral replication as measured by
the presence of NS1 probably due to the absence of the entry receptor, Axl, and
do not show a significant increase in apoptosis. Similar to the ZIKV SZ01
isolate, ZIKV FSS13025 and the ZIKV BR 243 strain (derived from the current
outbreak in Brazil) also infect radial glial cells (RGC) of the ventricular
zone (VZ), subventricular zone (SVZ) and the intermediate zone (IZ/SP), all of which
contain PCNA positive proliferating cells and VIM positive RGC cells, of ex vivo foetal brain slices with viral
replication being detected as early as day 3.5 p.i. , similar to NCX-NES cells.
Most interestingly however, only ZIKV infected and ZIKV NS1 positive cells exhibit
an aberrant cell morphology which indicates that primary proliferating neuronal
cells infected with an ZIKV replication competent strain (but not with an UV
inactivated strain) induce a cell cycle arrest.
In addition to
downregulating the expression of genes related to mitotic progression such as
Aurora Kinase-B, activation of the innate immune response can induce apoptosis,
i.e. via IRF-3 mediated activation of Bax by Sendai Virus (SeV). In this case,
the dsRNA intermediate activates IPS-1 which in turn recruits TANK-binding
Kinase-1 (TBK-1) which in turn phosphorylates and activates IRF-3, the latter
binding Bax and translocating to the mitochondrion.
In the case of ZIKV
infected NCX-NES cells or foetal brain slices neither ZIKV FSS13025 nor ZIKV
PE243 increases the expression of TBK-1 but rather relocalises TBK-1 from the
centrosome to mitochondria thus potentially preventing the phosphorylation of the centrosomal protein CEP170 and the mitotic
apparatus protein NuMA as well as g-tubulin,
leading to mitotic defects such as aberrant cytokinesis characterised by the
presence of a cleavage furrow in G1 phase of the cell cycle and/or subsequent
apoptosis due to mitotic catastrophe. The presence of cells with a cleavage
furrow might also explain the presence of a small percentage of ZIKV positive
(postmitotic) neurons.
In
addition, inhibiting the progress of mitosis, TBK-1 also might recruit IRF-3
and Bax to the mitochondria thus providing an alternative pathway culminating
in apoptosis independent of mitotic arrest. Further experiments are needed to
distinguish both pathways. Paradoxically the inhibition of TBK-1 with
inhibitors such as BX795 or Amlexanox exacerbates ZIKV induced apoptosis. One
reason might be that the relocalisation of TBK-1 in ZIKV infected cells also
induces mitophagy by recruiting p62/SQSTM-1 and/or optineurin so that treating
infected cells with TBK-1 also decreases mitophagy and thus the clearance of
damaged mitochondria.
Besides
the induction of apoptosis, mitochondrial localisation of TBK-1 may also
interfere with immune signalling by disrupting STING mediated phosphorylation
of TBK-1 at perinuclear granulae and thus the translocation of IRF-3 to the
nucleus, thus subsequently inhibiting the Interferon response. In this context,
results from both WNV and DENV-1, -2 and -4 infected primary endothelial cells
and HEK 293T cells indicate that the viral encoded NS2A and NS4B inhibit the
phosphorylation of both TBK-1 and IRF-3 and subsequent induction of Interferon-beta, with DENV-1/-2/-4 NS4A uniquely inhibiting
TBK-1 and IKKε-directed signalling. In a similar way, PEDV has been shown to
inhibit TBK-1 signalling as well. Additionally, the expression of ZIKV NS4B
protein might –similar to to DENV NS4B- induce the elongation of mitochondria
in infected cells and disrupting the ER-Mitochondiria contact (MAM) which is
critical for immune signalling and thus abrogating the celluar RIG-1 dependent
interferon response.
Figure: ZIKV and DENV-1/-2/-4 NS4A and TBK-1 mediated signalling: targeting phosphorylation of IRF-3 |
Apart
from inhibiting mitotic progression, interfering with TBK-1 dependent immune
signalling and inducing apoptosis,
mitochondrial TBK-1 might also induce lipophagy and thus promote viral
replication by inducing mitophagy via recruitment of p62/SQSTM-1, NDP52 and/or
Optineurin. Again further studies are warranted.
Table: Genes related to mitotic progression that are up- or downregulated in ZIKV MR766 infected hNPC |
The inhibition of viral
replication by Cdki indicates that Cdk’s are essential for viral replication
and further studies using siRNA and/or specific inhibitors should clarify the
contribution of individual Cdk such as Cdk-4/-6, Cdk-2, Cdk-3, Cdk-1 and -since ZIKV infects neuronal cells- also Cdk-5. The latter is of particular interest
since the inhibition of Cdk-5 has been shown to confer protection against
neuronal apoptosis of cerebral granule neurons and prevent aberrant S-phase entry
of postmitotic neurons.
In addition to (potentially) phosphorylating viral
proteins, Cdk might facilitate ZIKV replication indirectly by creating
favourable conditions for viral entry. In the case of DENV-2 and DENV-3, HepG2
cells have been demonstrated to be more permissive for both infection and viral
replication in G2 phase of the cell cycle compared to G1 or S phase which might
explain why the combination of Niclosamide and a Cdki increases the cell
viability of ZIKV infected human astrocytes and hNPC as well as decreasing viral
replication.
Inhibiting caspase-3 dependent apoptosis also might
prevent the cleavage of Beclin-1 and thus promote autophagy and increase cell
viability in addition in preventing mitotic entry. It is crucial therefore to
determine if caspase-3 inhibition has a negative effect on cell proliferation.
Based on the results obtained from treating ZIKV infected astrocytes with Cdki,
it may be possible that despite limiting ZIKV replication and increasing cell
viability pan-caspase inhibitors might not allow the proliferation of primary
neuronal cells infected with ZIKV.
Finally,
similar to Porcine Respiratory Syndrome Virus (PRRSV) induced apoptosis,
following the initial activation of caspase-3, the cleavage of Beclin-1 in ZIKV
infected cells might enhance mitochondrial depolarisation by releasing the
pro-apoptotic BH3 only protein Bad, followed by the localisation of Bad to the
mitochondria where it forms a dimer with the anti-apoptotic Bcl-XL thus
inactivating Bcl-XL. Since so far
cleavage of Beclin-1 in ZIKV infected cells has not been demonstrated, it
remains to be seen if this is the case or not.
Further reading
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