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Progressive liver calcifications in neonatal coxsackievirus infection.

Coxsackievirus group B can cause a severe systemic disease in the perinatal period. Severe manifestations like meningitis, encephalitis, hepatitis, and myocarditis have been previously reported. A case of a twin neonate infected by coxsackievirus group B is described, who developed progressive extensive hepatic calcifications demonstrated by ultrasound and computed tomography with follow-up. Hepatic calcifications in coxsackievirus infection have not been previously reported.

Calcinosis↗

Induction of cytokine release from human monocytes by coxsackievirus infection.

Coxsackievirus B3 (CVB3) infections produce an inflammatory and immune response that suggests the involvement of cytokines. In this in vitro study, we exposed purified human monocytes to CVB3 and determined the release of interferon (IFN), interleukin 1 beta (IL-1 beta) and tumour necrosis factor-alpha (TNF-alpha). Exposure to CVB3 did not alter the viability of monocytes, however, it induced an increased adherence. After 12 and 24 h of CVB3 exposure, monocytes released large amounts of IFN, IL-1 beta and TNF-alpha. These data show that CVB3 strongly affects human monocytes and activates them to production of biologically active cytokines, particularly IL-1 beta and TNF-alpha. It is suggested that both cytokines, when released in large amounts and for a prolonged period, may contribute to a strong inflammatory response and eventual tissue damage in afflicted organs such as the myocardium.

Coxsackievirus Infections↗

RNase L and double-stranded RNA-dependent protein kinase exert complementary roles in islet cell defense during coxsackievirus infection.

Coxsackievirus (CV) is an important human pathogen that has been linked to the development of autoimmunity. An intact pancreatic beta cell IFN response is critical for islet cell survival and protection from type 1 diabetes following CV infection. In this study, we show that IFNs trigger an antiviral state in beta cells by inducing the expression of proteins involved in intracellular antiviral defense. Specifically, we demonstrate that 2',5'-oligoadenylate synthetases (2-5AS), RNase L, and dsRNA-dependent protein kinase (PKR) are expressed by pancreatic islet cells and that IFNs (IFN-alpha and IFN-gamma) increase the expression of 2-5AS and PKR, but not RNase L. Moreover, our in vitro studies uncovered that these pathways play important roles in providing unique and complementary antiviral activities that critically regulate the outcome of CV infection. The 2-5AS/RNase L pathway was critical for IFN-alpha-mediated islet cell resistance from CV serotype B4 (CVB4) infection and replication, whereas an intact PKR pathway was required for efficient IFN-gamma-mediated repression of CVB4 infection and replication. Finally, we show that the 2-5AS/RNase L and the PKR pathways play important roles for host survival during a challenge with CVB4. In conclusion, this study has dissected the pathways used by distinct antiviral signals and linked their expression to defense against CVB4.

2',5'-Oligoadenylate Synthetase↗

Coxsackievirus infection of mice. I. Viral kinetics and histopathological changes in mice experimentally infected with coxsackieviruses B3 and B4 by oral route.

We followed the viral kinetics and histopathological changes in different organs of immunocompetent mice infected orally with coxsackieviruses B3 (CVB3) Nancy strain and B4 (CVB4) JVB strain separately. The viruses used were not adapted to mouse organs. In the acute phase of infection, the viral kinetics indicated virus replication in the heart, spleen, thymus, pancreas, and small and large intestines. This was accompanied by histopathological changes, mild infiltration of mononuclear cells and fibrosis in the heart. The necrotic changes with mononuclear infiltration and fibrosis in the myocard was observed on days 56 and 71 p.i. in the CVB4-infected animals only. In the mice infected with CVB3 and CVB4 a prolonged presence of infectious virus was shown in the spleen and small intestine; in the latter viral antigen was localized in smooth muscles of the muscular wall immunohistochemically. This is the first report on prolonged replication of coxsackieviruses (CV) in the spleen and small intestine in orally infected mice.

Administration, Oral↗

Coxsackievirus infection of mice. II. Viral kinetics and histopathological changes in mice experimentally infected with coxsackievirus B3 by intraperitoneal route.

The study was focused on kinetics of Coxsackievirus B3 serotype (CVB3) in different organs of Swiss albino mice following intraperitoneal (i.p.) infection. The results indicated that the virus replicated in the heart, spleen, thymus, pancreas, small and large intestines in the acute stage of the infection. Infectious virus was present in the spleen till day 35 post infection (p.i.). Histopathology of the hearts showed mild foci of infiltration of mononuclear cells in the acute stage of infection and massive inflammation of exocrine pancreas on day 5 p.i. These results, when compared to those of our previous study (Bopegamage et al., 2003), suggest that the pathogenesis of the disease may be influenced by the route of virus administration into the host.

Animals↗

Elution of autoantibodies from the hearts of coxsackievirus-infected mice.

Circulating heart-reactive antibodies are commonly reported in myocarditis and cardiomyopathy patients. While these observations support the hypothesis that autoimmune mechanisms may be involved in pathogenesis, such evidence is largely circumstantial. The current studies demonstrate that heart-reactive antibodies can be eluted from the hearts of infected Coxsackievirus B3-infected A/J mice with post-infectious autoimmune myocarditis, but not from the hearts of infected B10.A mice which are resistant to autoimmune myocarditis. The eluted antibodies recognize fewer cardiac antigens than are recognized by circulating antibodies. These results provide an opportunity to examine the role of autoantibodies in the pathogenesis of chronic myocarditis.

Animals↗

Acceleration of type 1 diabetes by a coxsackievirus infection requires a preexisting critical mass of autoreactive T-cells in pancreatic islets.

Coxsackievirus infections have been proposed as an environmental trigger for the development of T-cell-mediated autoimmune (type 1) diabetes by either providing a molecular mimic of the candidate pancreatic beta-cell autoantigen GAD or inducing bystander inflammation in the pancreas. In this study in the NOD mouse model, we found that infection with a pancreatrophic coxsackievirus isolate can accelerate type 1 diabetes development through the induction of a bystander activation effect, but only after a critical threshold level of insulitic beta-cell-autoreactive T-cells has accumulated. Thus, coxsackievirus infections do not appear to initiate beta-cell autoreactive immunity but can accelerate the process once it is underway. These findings indicate that the timing of a coxsackievirus infection, rather than its simple presence or absence, may have important etiological implications for the development of T-cell-mediated autoimmune type 1 diabetes in humans.

Animals↗

Complications following coxsackievirus B infection.

Coxsackievirus B infection is common in children and young adults, usually causing mild symptoms in the gastrointestinal or upper respiratory tract. However, some patients develop pleurodynia, carditis or aseptic meningitis. This viral infection can be serious in the fetus and fatal in the newborn. Coxsackievirus B infection may cause a postviral fatigue syndrome, juvenile-onset insulin-dependent diabetes mellitus and other chronic diseases.

Child↗

The role of B lymphocytes in coxsackievirus B3 infection.

Coxsackieviruses are important human pathogens, frequently causing myocarditis, pancreatitis, and a variety of less severe diseases. B lymphocytes appear central to the interaction between these viruses and their mammalian hosts, because agammaglobulinemic humans, genetically incapable of antibody production, are susceptible to chronic infections by coxsackieviruses and related enteroviruses, such as poliovirus and echovirus. However, recent studies show that Type B coxsackievirus (CVB) infects B lymphocytes soon after infection, suggesting the possibility that these cells may play some role in virus dissemination and/or that the virus may be able to modulate the host immune response. We analyzed the role of B lymphocytes in CVB infection and confirmed that CVB infects B lymphocytes, and extended these findings to show that this is a productive infection involving approximately 1 to 10% of the cells; however, infectious center assays show that other splenocytes are infected at approximately the same frequency. Virus is readily detectable by in situ hybridization in the spleen of immunocompetent mice but is difficult to detect in mice deficient in B cells (BcKO mice), consistent with much of the splenic signal being the result of B cell infection. Surprisingly, given the extent of their infection, B cells express barely detectable levels of the murine coxsackievirus-adenovirus receptor (mCAR), suggesting that another means of cell entry may be used. We found no evidence of B cell depletion following CVB infection, indicating that this is not the explanation for the transient immunosuppression previously reported. Virus replication and dissemination are slightly delayed in BcKO mice, consistent with B cells' playing a role as an important early target of infection and/or a means to distribute the virus to many tissues. In addition, we show that BcKO mice recapitulate a central feature of human agammaglobulinemia: CVB establishes chronic infection in a variety of organs (heart, liver, brain, kidney, lung, pancreas, spleen). In most of these tissues the viral titers remain high (10(5)-10(8) plaque forming units (pfu) per gram of tissue) for the life of the mouse, and in several there is severe pathology, particularly severe myocardial fibrosis with ventricular dilation, reminiscent of the dilated cardiomyopathy seen in humans with chronic enteroviral myocarditis. Transfer of B and/or T cells from non-immune mice had no discernible effect, whereas equivalent transfers from immune mice often resulted in transient or permanent disappearance of detectable CVB.

Adoptive Transfer↗

Evaluation of coxsackievirus infection in children with human immunodeficiency virus type 1-associated cardiomyopathy.

In a matched case-control study of the association between coxsackieviruses and cardiac impairment, 24 human immunodeficiency virus (HIV) type 1-infected children with cardiac impairment were compared with 24 HIV-1-infected control subjects. Serologic evidence of coxsackievirus infection was present in all children, with no significant difference in geometric mean antibody titers between case patients and control subjects. Conditional logistic regression to test for an association between coxsackievirus antibody titer and the presence or absence of cardiac impairment, by any indicator, showed an odds ratio of 1.11 (95% confidence interval, 0.58-2.10; P=.75), indicating no association between coxsackievirus infection and cardiac impairment. Coxsackievirus antibody titers correlated positively with total IgG levels in nonrapid progressors but not in rapid progressors. Paired serum samples taken before and after diagnosis of cardiac impairment in 5 patients showed no evidence of intervening coxsackievirus infection. These results do not identify a causal role for coxsackieviruses for cardiomyopathy in HIV-1-infected children.

Cardiomyopathies↗

Iron and copper accumulation in the brain of coxsackievirus-infected mice exposed to cadmium.

Cadmium (Cd) is a potentially toxic metal widely distributed in the environment and known to cause adverse health effects in humans. During coxsackievirus infection, the concentrations of essential and nonessential trace elements (e.g., iron (Fe), copper (Cu), and Cd) change in different target organs of the infection. Fe and Cu are recognized cofactors in host defence reactions, and Fe is known to be associated with certain pathological conditions of the brain. However, whether nonessential trace elements could influence the balance of essential trace elements in the brain is unknown. In this study the brain Fe, Cu, and Cd contents were measured through inductively coupled plasma mass spectrometry and their distributions determined by nuclear microscopy in the early phase (day 3) of coxsackievirus B3 (CB3) infection in nonexposed and in Cd-exposed female Balb/c mice. In CB3 infection the brain is a well-known target that has not been studied with regard to trace element balance. The brain concentration of Cu compared with that of noninfected control mice was increased by 9% (P < 0.05) in infected mice not exposed to Cd and by 10% (not significant) in infected Cd-exposed mice. A similar response was seen for Fe, which in infected Cd-exposed mice, compared to noninfected control mice, tended to increase by 16%. Cu showed an even tissue distribution, whereas Fe was distributed in focal deposits. Changes in Cd concentration in the brain of infected mice were less consistent but evenly distributed. Further studies are needed to define whether the accumulation and distribution of trace elements in the brain have an impact on brain function.

Animals↗

Variable susceptibility of mice to group B coxsackievirus infections.

Laboratory strains of group B coxsackievirus serotypes 1 to 6 were inoculated intraperitoneally into newborn mice of differing genetic backgrouns. Of the four genetic strains investigated, C3H mice appeared to be resistant to all six serotypes, whereas BALB/c mice were most susceptible. Swiss mice and a random-bred Swiss strain (COH) were intermediate in susceptibility. The findings underscore the fact that clinical isolation attempts and experimental studies involving group B coxsackieviruses must take into account both the virus strain used and the genetic background of the host. For clinical isolation of these viruses, the BALB/c mouse may be the most suitable of th strains tested.

Animals↗

[Release of chromium 51 by coxsackievirus-infected FL cells].

The time course of chromium-51 (51Cr) release was investigated on FL monolayer cells infected with different serotypes of coxsackievirus. 51Cr release was determined by means of the increase in 51Cr radioactivity in supernatants of cells saturated with 51Cr. Ten hours p.i. the 51Cr release of virus-infected cells was largely increased compared with the control cells. The greatest differences in 51Cr release between normal and virus-infected cells were observed from 10 to 30 hours p.i. The quantitative correlation between virus concentration and 51Cr release as well as the type-specific inhibition of virus-accelerated 51Cr release by virus-neutralizing antisera demonstrate the relationship between 51Cr release and coxsackievirus infection of FL cells. By the use of 51Cr labeled FL cells as an indicator system, the 51Cr release proved to be well suited for objective and quantitative evaluation of coxsackievirus-cell-interactions connected with the cytopathogenic effect (CPE).

Animals↗

Effects of B4 Coxsackievirus infection on cell-mediated immunity, natural cytotoxicity and interleukin-1 production by spleen cells, in mice.

By using CBA inbred mice as responders, the influence of in vivo B4 Coxsackievirus infection (in two separate experimental procedures) on anti-virus cell-mediated immunity (CMI), natural killer (NK) cell activity and lipopolysaccharide (LPS) induced interleukin-1 (IL-1) production in spleen cells were studied. Both experimental infection schedules were able to induce a "positive" CMI response. NK cell activity was also significantly stimulated, especially by the administration of high virus amounts/inoculum, with frequent injections. On the contrary, LPS-dependent IL-1 synthesis increased particularly following application of the other experimental schedule (low virus amounts, few injections). Some aspects concerning CMI, NK and IL-1 relationships, during several enteroviral diseases, are discussed.

Animals↗

Peroxynitrite inhibition of Coxsackievirus infection by prevention of viral RNA entry.

Although peroxynitrite is harmful to the host, the beneficial effects of peroxynitrite are less well understood. We explored the role of peroxynitrite in the host immune response to Coxsackievirus infection. Peroxynitrite inhibits viral replication in vitro, in part by inhibiting viral RNA entry into the host cell. Nitrotyrosine, a marker for peroxynitrite production, is colocalized with viral antigens in the hearts of infected mice but not control mice. Nitrotyrosine coprecipitates with the viral polypeptide VP1 as well. Guanidinoethyl disulfide, a scavenger of peroxynitrite, blocks peroxynitrite inhibition of viral replication in vitro and permits an increase in viral replication in vivo. These data suggest that peroxynitrite is an endogenous effector of the immune response to viruses.

Animals↗

dsRNA formed as an intermediate during Coxsackievirus infection does not induce NO production in a beta-cell line with or without addition of IFN-gamma.

Virus infection is one environmental factor that has been implicated as a precipitating event initiating beta-cell damage during the development of type 1 diabetes. One aim of this study was to investigate how permissive an insulin-producing beta-cell line, RINm5F, is to enterovirus (EV) infections. A second aim was to study if the viral replicative intermediate, double-stranded RNA (dsRNA), together with IFN-gamma results in nitric oxide (NO) production. Monolayer cultures of RINm5F cells were not permissive to infection with seven different strains of EV. However, when the growth pattern of the beta-cell line changed and the cells started to grow as free-floating RIN cell clusters (RCC), all EV strains replicated. Immunostaining for the Coxsackie-adenovirus-receptor (CAR) detected the protein on the free-floating RIN cell clusters, but not on the RINm5F cells cultured as a monolayer of beta-cells. This shows that the CAR expression can change and/or the CAR protein can be redistributed on the cell surface as a consequence of altered growth pattern thus allowing viral replication in a previously non-permissive beta-cell line. As expected, NO production was significantly increased (p<0.05) by addition of synthetic dsRNA and IFN-gamma to the RCC. In contrast, the dsRNA formed during virus infection with a Coxsackievirus B4 strain (E2) with or without addition of IFN-gamma did not induce NO production in these cells. This indicates that synthetic dsRNA does not mimic a real viral infection in that respect, and suggests an NO-independent mechanism for virus-induced beta-cell damage.

Animals↗

Evidence for coxsackievirus infection in primary Sjögren's syndrome.

OBJECTIVE: Primary Sjögren's syndrome (SS) is an autoimmune disease characterized by activation of minor salivary gland (MSG) epithelial cells and B and T lymphocytic infiltrates. These findings have long encouraged the hypothesis that a persistent viral infection of the MSG epithelial cells may drive the autoimmune response; however, the identity of that virus has remained elusive. The aim of this study was to test this hypothesis. METHODS: We applied the differential display protocol to MSG RNA samples from patients with primary SS and healthy controls. We then used seminested reverse transcriptase-polymerase chain reaction to amplify the 5'-noncoding region (5'-NCR) of the enteroviral genome in 8 patients with primary SS, 9 patients with secondary SS, and 8 control subjects. Immunohistochemistry was performed to study the expression of the VP1 enteroviral capsid protein in MSG biopsy samples from 12 patients with primary SS, 8 patients with secondary SS, and 16 controls. RESULTS: Differential display analysis yielded a 94-bp fragment of coxsackievirus B4 (CVB4) P2A gene in the primary SS samples. The 5'-NCR was amplified in 7 samples from patients with primary SS and in no samples from patients with secondary SS or controls. The 7 amplified products were sequenced; 4 of the sequences were found to be 98-99% identical to the 5'- NCR of CVB4, and 3 were found to be 97-98% identical to the 5'-NCR of CVA13. Immunohistochemistry for the enteroviral capsid protein VP1 revealed positive staining in epithelial cells and lymphocytic infiltrates in 11 primary SS samples, 1 secondary SS sample, and no control samples. CONCLUSION: We provide evidence that primary SS may be associated with coxsackievirus infection of the MSG epithelial cells and focal lymphocytic infiltrates. Our findings are formulated in a hypothesis concerning the possible role of coxsackieviruses in the induction and maintenance of autoimmunity in primary SS.

Coxsackievirus Infections↗

Autoimmunity and coxsackievirus infection in primary Sjogren's syndrome.

Exocrine gland epithelial cells are the target of autoimmune pathology in primary Sjögren's syndrome (pSS). Their activated phenotype has incited the notion that they are infected by a virus. We recently presented evidence that coxsackieviruses may persistently infect the salivary glands of pSS patients. We hypothesize that coxsackieviruses may play a permissive role for the perpetuation and possibly the induction of autoimmune disease in pSS.

Animals↗