Virology tidbits

Virology tidbits

Friday, 7 October 2016

ZIKV and ocular infections

Although being first isolated in 1947 from a sentinel rhesus monkey in forests of Uganda, until 2007 Zika Virus (ZIKV) outbreaks have been sporadic, being limited to tropical regions in Africa as well as Southeast Asia and only been associated with relative mild symptoms in about 20% of infected people. Autochthonous transmission of ZIKV outside these areas was only reported in 2007 in the Federal States of Micronesia (FSM), 2013 in French Polynesia, and in 2015 in South America, spreading to the Caribbean and North Americas within a few months. Concomitant with the advent of ZIKV in the Americas, ZIKV was implicated in the onset of neurological diseases in foetuses, neonates and adults, namely microcephaly and Guillan-Barre Syndrome (GBS); subsequently, studies in animal models (both mice and monkeys), brain organoids, neural stem cells (NSC) and human neural progenitor cells (hNPC) confirmed that ZIKV can induce abnormal brain development probably by inducing apoptosis of neural progenitor -but not mature neurons- in a Caspase dependent pathway either in ZIKV infected cells or via bystander apoptosis of uninfected neural crest cells via inducing the secretion of cytokines. As discussed before, the infection of the vaginal mucosa might promote the transmission of ZIKV to the placenta and/or of Hofbauer cells that might cross the placenta and thus infect the embryo during the early stages of neural development, thus explaining data retroactively obtained from the 2013 ZIKV outbreak that indicated an increased risk for microcephaly of infants born to mothers that were infected with ZIKV in the first two trimesters. 

In addition to microcephaly however, several case reports from Brazil indicate that neonates born to ZIKV positive mothers display an array of eye malformations including blindness, intraretinal haemorrhages, chorioretinal atrophy, optic neuritis, lens sublaxation and bilateral iris colobomas, indicating that ZIKV might also affect eye development. Furthermore, in adults, ZIKV infection has been associated with conjunctivitis as well as uveitis in 10-15% of infected adults presenting themselves with  ZIKV infection.  Similar to EBOV, viral RNA can be detected in fluid samples taken from the anterior chamber of the eye, suggesting that ZIKV can either replicate in the eye or that ZIKV is at least present (but not necessarily replicating). ZIKV therefore joins other viruses that (potentially) can cause inflammation of the eye or blindness in neonates such as Human Cytomegalovirus (HCMV) which can be acquired both antenatal and intrapartum in addition to other viruses such as Adenovirus', Picornavirus', Herpes Simplex Virus 2 or Varicella Zoster Virus/Human Herpesvirus 3. So far however, an active eye infection as a result of ZIKV infection has not been reported to transmit to household contacts. More importantly however, the presence of viral RNA in the aqueous humor might indicate that following immunosuppression, ZIKV replication might resurface and thus might be horizontally transmitted via sexual contact or via mosquitoes and thus either sustain or restart a local. ZIKV  outbreak.

In order to characterize the potential of ZIKV to cause uveitis, animal models were being used. As discussed before, ZIKV does not replicate well wt C57BL/6 mice partially because the viral NS5 protein does not block mouse derived STAT2 and thus antiviral signalling. Consequently, in mice, ZIKV pathogenesis in mice is studied either in immunocompromised mice such as AG129 or Ifnar-1 -/- mice; in theory however it might also be possible to use recombinant ZIKV generated using the recently published reverse genetic systems that contain the NS5 gene of the mouse adapted ZIKV MR766 (providing that the ZIKV MR766 NS5 inhibits mouse STAT2) . In accordance with previous results which also have been discussed in previous postings, wt mice treated with Ifnar-1 -/- antibody and infected with either ZIKV H/PF/2013 or ZIKV Paraiba 2015 (isolate from Brazil) do not develop any signs of disease although high viral titres can be detected in multiple organs, including the testes of male mice, which is in contrast with Ifnar-1 -/- mice that develop severe neuroinvasive infection with decreased survival. Viral RNA in both ZIKV H/PF/2013 and ZIKV Paraiba 2015 infected mice can be detected as early as 48 hrs p.i., increasing at day 6 p.i. (H/PF/2013) and day 7 p.i. (Paraiba 2015). Also, viral RNA could be detected in tears and in lacrimal glands of ZIKV Paraiba 2015 infected mice, suggesting the presence of either infectious viral particles and/or cell debris of ZIKV infected cells due to virus induced apoptosis of infected cells.  The presence of infectious ZIKV in eyes at day 7 p.i. was confirmed by infecting immunocompromised AG129 mice eye homogenates of ZIKV Paraiba 2015 infected Ifnar-1 -/- mice, whereas both tears from day 7 p.i. nor eye homogenates from day 28 p.i. contained infectious virus, indicating that tears are not infectious and that infetious virus is not present in the eye after the acute phase of the infection. In general, eye homogenates derived from mice at day 7 p.i. , caused more severe symptoms in AG129 mice compared to ZIKV Paraiba 2015 infection, especially ocular pathology and conjunctivitis, despite similar viral titres in spleen, brain and eyes, suggesting that viral particles derived from the eye might be adapted (which at this point is speculative). One possibility to investigate if ZIKV derived from eye homogenates is adapted to cells in visual system might be to infect Ifnar-1 -/- or AG129 mice with virus grown in human retinal pigment cells (ARPE-19), retinal ganglion cells or adult retinal stem cells. Nonetheless, so far sequencing eye derived virus did not reveal substitutions except an increase single mutation in the viral NS2A gene (C to T at position 3895 or A to V), but the significance of this mutation has not been evaluated.   
As discussed in a previous post, the in utero infection of foetal mice at E4.5 via the vaginal mucosa increases the severity of foetal and neonatal brain abnormalities compared to mice infected at E8.5, confirming previous observations during the ZIKV outbreak in French Polynesia that infants born to women who got infected with ZIKV during the first trimester display a higher percentage of microcephaly. Accordingly, the offspring of Ifnar-1 -/- crossbred with Ifnar-1 +/+ mice and infected in utero  with ZIKV Paraiba 2015 at E6.5 but not E12.5 present themselves with intrauterine growth restriction (IUGR) with foetal demise and viral RNA in the brain without any (detectable) ocular defects. Viral RNA was only detected in 2 out 41 mice infected with either ZIKV H/PF/2013 or ZIKV Paraiba 2015 at day 8 post natal (or 1 week of age), indicating that ocular defects and persistence of viral RNA in the eye is indeed a rare occurrence following infection with ZIKV in utero, which is supported by epidemiological findings. In contrast, the infection of 1 week old wt mice with ZIKV Paraiba 2015 not only is lethal (in accordance with findings from the early 1950s using wt mice and the primary ZIKV MR766 isolate) but also leads to high viral RNA levels in the spleen, brain and the eye concomitant with prominent Caspase-3 dependent apoptosis of cells of the optic tract, the visual cortex and the lateral geniculate nucleus as well as other components of the visual cortex, although based on the data available it is not clear if apoptosis is also induced by "bystander apoptosis" of non-infected cells in addition to ZIKV virus infected cells. Immunodeficient AG129 infected postnatally also exhibit high viral titres at day 8 p.i. in the spleen, brain and eye irrespective if the parental or a mouse-adapted ZIKV Paraiba 2015 strain is used, suggesting that the IFN response in 1 week old wt mice is unable to inhibit viral replication irrespective of the ability of ZIKV to inhibit STAT2 signalling, which might be attributed to an immature immune system. 
In contrast to 1 week old wt/AG129 mice, adult Ifnar-1 -/- mice infected with ZIKV Paraiba 2015 present themselves with extensive apoptosis of retinal cells in the neurosensory retina as measured using TUNEL staining that detects fragmented DNA and uveitis at day 6 p.i., accompanied by infiltration of inflammatory cells into both the anterior and posterior chambers of the eye in the absence of pan-retinal damage to the fundus. Although it is not clear how ZIKV Paraiba 2015 causes uveitis, it might be possible that the viral RNA triggers an inflammatory response that not causes localised apoptosis but also triggers the inflammation of the eye via Toll-like and/or RIG-1/MDA-5 mediated signalling pathways. In any case, viral infection is cleared by day 28 p.i.. Viral RNA can be detected in all regions of the eye between 6 and 8 days p.i. with the highest levels of viral RNA in the retinal epithelium/choroid complex, in particular bipolar and ganglion cell neurons as well as the optic nerve and cornea of ZIKV infected mice as detected by FISH and qRT-PCR, indicating that ZIKV can not infect the eye but also replicates in the eye. 

In conclusion, similar to other viruses such as West Nile Virus, Hepatitis C Virus or EBOV, ZIKV can infect retinal tissue, causing ocular defects in adult as well as foetal/neonate mice. So far however further studies are needed to determine if ZIKV also replicates in retinal cells, which can be done using retinal cell lines. Also, it needs to be determined if ZIKV infection of the foetal brain downregulates the expression of genes that are required for the development of the visual system; experiments can be performed either by using foetal brain of in utero infected mice or alternatively brain organoids and/or neural stem cells. Data previously published suggest that genes encoding for proteins that are involved in the development of the visual system are differently expressed during brain development, which might explain the greater susceptibility of foetal mice infected at E6.5. Congenital ZIKV infection therefore might therefore not only target ocular tissue but also interfere with the development of the visual system which has been suggested by recent findings using SJL mice infected with ZIKV Brazil; it should be noted however that in congenital Ifnar-1 +/- foetuses derived from C57BL/6 Ifnar-1 -/- mice, no histological abnormalities are present unless they are rare and thus were not detected due to the sample size. Bystander apoptosis in non ZIKV infected cells can be induced by the secretion of cytokines by ZIKV cranial neural crest cells (CNCC). In contrast to other cell types, these cells undergo only limited apoptosis upon infection with ZIKV H/PF/2013 and secrete LIF, IL-60, PAI-1, VEGF, MCSF, TNF-α and IL-17 inducing apoptosis of co-cultured neurospheres whilst preventing viral induced apoptosis of infected CNCC in a paracrine manner. Further experiments however are needed to determine if bystander apoptosis is also affecting ocular precursor cells. In a sideline, 4 week old cerebral organoids express higher levels of VEGF compared to hNPC at week 0, so that it might be possible that ZIKV infection of 4 week old cerebral organoids even further increases the expression of VEGF in CNCC and thus prevents apoptosis of CNCC via a paracrine effect. Finally, if ZIKV replicates in retinal epithelial cells, then it might inhibit STAT3 signalling and thus lead to the degeneration of retinal epithelial cells.
Figure: Gene groups that are upregualted in 8 week old cerebral organoids compared to 4 week old
cerebral organiods

Further reading

Basu, R., & Tumban, E. (2016). Zika Virus on a Spreading Spree: what we now know that was unknown in the 1950’s Virology Journal, 13 (1) DOI: 10.1186/s12985-016-0623-2

Ventura CV, Maia M, Travassos SB, Martins TT, Patriota F, Nunes ME, Agra C, Torres VL, van der Linden V, Ramos RC, Rocha MÂ, Silva PS, Ventura LO, & Belfort R Jr (2016). Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection. JAMA ophthalmology, 134 (8), 912-8 PMID: 27228275 

Furtado JM, Espósito DL, Klein TM, Teixeira-Pinto T, & da Fonseca BA (2016). Uveitis Associated with Zika Virus Infection. The New England journal of medicine, 375 (4), 394-6 PMID: 27332784

Grant A, Ponia SS, Tripathi S, Balasubramaniam V, Miorin L, Sourisseau M, Schwarz MC, Sánchez-Seco MP, Evans MJ, Best SM, & García-Sastre A (2016). Zika Virus Targets Human STAT2 to Inhibit Type I Interferon Signaling. Cell host & microbe, 19 (6), 882-90 PMID: 27212660 

Khairallah M, Chee SP, Rathinam SR, Attia S, & Nadella V (2010). Novel infectious agents causing uveitis. International ophthalmology, 30 (5), 465-83 PMID: 19711015 

Teitelbaum BA, Newman TL, & Tresley DJ (2007). Occlusive retinal vasculitis in a patient with West Nile virus. Clinical & experimental optometry, 90 (6), 463-7 PMID: 17958570 

Goodfellow F, Tesla B, Simchick G, Hodge T, Zhao Q, Brindley MA, & Stice SL (2016). Zika Virus Induced Mortality and Microcephaly in Chicken Embryos. Stem cells and development PMID: 27627457 

Miner JJ, Sene A, Richner JM, Smith AM, Santeford A, Ban N, Weger-Lucarelli J, Manzella F, Rückert C, Govero J, Noguchi KK, Ebel GD, Diamond MS, & Apte RS (2016). Zika Virus Infection in Mice Causes Panuveitis with Shedding of Virus in Tears. Cell reports, 16 (12), 3208-18 PMID: 27612415 

Kim K, & Shresta S (2016). Neuroteratogenic Viruses and Lessons for Zika Virus Models. Trends in microbiology, 24 (8), 622-36 PMID: 27387029 

Lazear HM, Govero J, Smith AM, Platt DJ, Fernandez E, Miner JJ, & Diamond MS (2016). A Mouse Model of Zika Virus Pathogenesis. Cell host & microbe, 19 (5), 720-30 PMID: 27066744 Rossi SL, Tesh RB, Azar SR, Muruato AE, Hanley KA, Auguste AJ, Langsjoen RM, Paessler S, Vasilakis N, & Weaver SC (2016). Characterization of a Novel Murine Model to Study Zika Virus. The American journal of tropical medicine and hygiene, 94 (6), 1362-9 PMID: 27022155 

Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK, Kumar G, Smith JR, Kainulainen MH, Whitmer S, Ströher U, Uyeki TM, Ribner BS, & Yeh S (2015). Persistence of Ebola Virus in Ocular Fluid during Convalescence. The New England journal of medicine, 372 (25), 2423-7 PMID: 25950269 

Bayless NL, Greenberg RS, Swigut T, Wysocka J, & Blish CA (2016). Zika Virus Infection Induces Cranial Neural Crest Cells to Produce Cytokines at Levels Detrimental for Neurogenesis. Cell host & microbe PMID: 27693308 

Dang J, Tiwari SK, Lichinchi G, Qin Y, Patil VS, Eroshkin AM, & Rana TM (2016). Zika Virus Depletes Neural Progenitors in Human Cerebral Organoids through Activation of the Innate Immune Receptor TLR3. Cell stem cell, 19 (2), 258-65 PMID: 27162029 

Brault JB, Khou C, Basset J, Coquand L, Fraisier V, Frenkiel MP, Goud B, Manuguerra JC, Pardigon N, & Baffet AD (2016). Comparative Analysis Between Flaviviruses Reveals Specific Neural Stem Cell Tropism for Zika Virus in the Mouse Developing Neocortex. EBioMedicine, 10, 71-6 PMID: 27453325 Patel AK, Syeda S, & Hackam AS (2013). Signal transducer and activator of transcription 3 (STAT3) signaling in retinal pigment epithelium cells. JAK-STAT, 2 (4) PMID: 24416648

No comments:

Post a Comment