Metabolic Reprogramming of Host Cells in Response to Enteroviral Infection.

Enterovirus 71 (EV71) infection is an endemic disease in Southeast Asia and China. We have previously shown that EV71 virus causes functional changes in mitochondria. It is speculative whether EV71 virus alters the host cell metabolism to its own benefit. Using a metabolomics approach, we demonstrate that EV71-infected Vero cells had significant changes in metabolism. Glutathione and its related metabolites, and several amino acids, such as glutamate and aspartate, changed significantly with the infectious dose of virus. Other pathways, including glycolysis and tricarboxylic acid cycle, were also altered. A change in glutamine/glutamate metabolism is critical to the viral infection. The presence of glutamine in culture medium was associated with an increase in viral replication. Dimethyl α-ketoglutarate treatment partially mimicked the effect of glutamine supplementation. In addition, the immunoblot analysis revealed that the expression of glutamate dehydrogenase (GDH) and trifunctional carbamoyl-phosphate synthetase 2, aspartate transcarbamylase, and dihydroorotase (CAD) increased during infection. Knockdown of expression of glutaminase (GLS), GDH and CAD drastically reduced the cytopathic effect (CPE) and viral replication. Furthermore, we found that CAD bound VP1 to promote the de novo pyrimidine synthesis. Our findings suggest that virus may induce metabolic reprogramming of host cells to promote its replication through interactions between viral and host cell proteins.

Expression Profile Analysis of Selenium-Related Genes in Peripheral Blood Mononuclear Cells of Patients with Keshan Disease.

Keshan disease (KD) is an endemic cardiomyopathy, which mainly occurs in China. Selenium deficiency is believed to play an important role in the pathogenesis of KD, but the molecular mechanism of selenium-induced damage remains unclear. To identify the key genes involved in selenium-induced damage, we compared the expression profiles of selenium-related genes between patients with KD and normal controls. Total RNA was isolated, amplified, labeled, and hybridized to Agilent human 4 × 44 K whole genome microarrays. Selenium-related genes were screened using the Comparative Toxicogenomics Database. The microarray data were subjected to single-gene and gene ontology (GO) expression analysis using R Studio and Gene Set Enrichment Analysis (GSEA) software. Quantitative real-time PCR was conducted to validate the microarray results. We identified 16 upregulated and 11 downregulated selenium-related genes in patients. These genes are involved in apoptosis, metabolism, transcription regulation, ion transport, and growth and development. Of the significantly enriched GO categories in KD patients, we identified four apoptosis-related, two metabolism-related, four growth and development-related, and four ion transport-related GOs. Based on our results, we suggest that selenium might contribute to the development of KD through dysfunction of selenium-related genes involved in apoptosis, metabolism, ion transport, and growth and development in the myocardium.

The Functional Analysis of Selenium-Related Genes and Magnesium-Related Genes in the Gene Expression Profile Microarray in the Peripheral Blood Mononuclear Cells of Keshan Disease.

Keshan disease (KD) is an endemic cardiomyopathy with high mortality. Selenium (Se) deficiency is closely related to KD, while magnesium (Mg) plays many critical roles in the cardiovascular function. The molecular mechanism of KD pathogenesis is still unclear. Until now, we have not found any studies investigating the association between Se- or Mg-related genes and KD. In this study, oligonucleotide microarray analysis was used to identify the differentially expressed genes in the peripheral blood mononuclear cells between KD patients and normal controls. Next, human metabolome database (HMDB) was used to screen Se- and Mg-related genes. Function classification, gene pathway, and interaction network of Se- and Mg-related genes in KD peripheral blood mononuclear cells were defined by FunRich (functional enrichment analysis tool). Among 83 differentially expressed genes, five Se-related (DIO2, GPX1, GPX2, GPX4, and GPX7) and five Mg-related (ACSL6, EYA4, IDH2, PPM1A, and STK11) genes were recognized from HMDB. Two significant biological processes (energy pathways and metabolism), one molecular function (peroxidase activity), one biological pathway (glutathione redox reactions I), and one gene interaction network were constituted from Se-related and Mg-related genes. Se-related gene DIO2 and Mg-related genes STK11 and IDH2 may have key roles in the myocardial dysfunction of KD. However, we still have not obtained any interaction between Se-related gene and Mg-related gene. The interactions between RPS6KB1, PTEN, ATM, HSP90AA1, SNRK, PRKAA2, SMARCA4, HSPA1A, and STK11 may play important roles in the abnormal cardiac function of KD.

Hsp27 Responds to and Facilitates Enterovirus A71 Replication by Enhancing Viral Internal Ribosome Entry Site-Mediated Translation.

Enterovirus 71 (EV-A71) is a human pathogen that causes hand, foot, and mouth disease (HFMD) and fatal neurological diseases, and no effective treatment is available. Characterization of key host factors is important for understanding its pathogenesis and developing antiviral drugs. Here we report that Hsp27 is one of the most upregulated proteins in response to EV-A71 infection, as revealed by two-dimensional gel electrophoresis-based proteomics studies. Depletion of Hsp27 by small interfering RNA or CRISPR/Cas9-mediated knockout significantly inhibited viral replication, protein expression, and reproduction, while restoration of Hsp27 restored such virus activities. Furthermore, we show that Hsp27 plays a crucial role in regulating viral internal ribosome entry site (IRES) activities by two different mechanisms. Hsp27 markedly promoted 2Apro-mediated eukaryotic initiation factor 4G cleavage, an important process for selecting and initiating IRES-mediated translation. hnRNP A1 is a key IRES trans-acting factor (ITAF) for enhancing IRES-mediated translation. Surprisingly, knockout of Hsp27 differentially blocked hnRNP A1 but not FBP1 translocation from the nucleus to the cytoplasm and therefore abolished the hnRNP A1 interaction with IRES. Most importantly, the Hsp27 inhibitor 1,3,5-trihydroxy-13,13-dimethyl-2H-pyran [7,6-b] xanthone (TDP), a compound isolated from a traditional Chinese herb, significantly protected against cytopathic effects and inhibited EV-A71 infection. Collectively, our results demonstrate new functions of Hsp27 in facilitating virus infection and provide novel options for combating EV-A71 infection by targeting Hsp27.IMPORTANCE Outbreaks of infections with EV-A71, which causes hand, foot, and mouth disease, severe neurological disorders, and even death, have been repeatedly reported worldwide in recent decades and are a great public health problem for which no approved treatments are available. We show that Hsp27, a heat shock protein, supports EV-A71 infection in two distinct ways to promote viral IRES-dependent translation. A small-molecule Hsp27 inhibitor isolated from a traditional Chinese medicinal herb effectively reduces virus yields. Together, our findings demonstrate that Hsp27 plays an important role in EV-A71 infection and may serve as an antiviral target.

A Spatial Ecology Study of Keshan Disease and Hair Selenium.

Few spatial ecological studies on hair selenium (Se) and Keshan disease (KD) have been reported. To investigate the relationships of hair Se with KD and economic indicators and to visualize the evidence for KD precise prevention. An ecological study design was employed. The levels of hair Se of 636 adult men (≥ 18 years old) living in rural, general cities and developed cities in 15 KD endemic provinces and 11 KD non-endemic provinces in mainland China were measured using hydride generation atomic fluorescence spectrometry. Spatial description and spatial analysis of hair Se were conducted. The subjects were adults aged. The hair Se level of the residents of KD endemic areas was 0.30 mg/kg, statistically significantly lower than that of non-endemic areas 0.34 mg/kg (Mann-Whitney U test, p = 0.007). The hair Se level of the 636 people was 0.33 mg/kg. The hair Se levels of the residents of the developed cities, general cities, and rural were 0.35 mg/kg, 0.33 mg/kg, and 0.32 mg/kg, respectively, with statistical significance (Kruskal-Wallis H test, P = 0.032). Spatial regression analysis showed that the spatial distribution of hair Se was positively correlated with per capita GDP. Selenium deficiency may still exist among residents living in the KD endemic areas. The results of spatial description and analysis of hair Se provided visualized evidence for targeting key provinces for precise prevention of Keshan disease, including assessment of KD elimination. The hair Se level of the mainland Chinese males was probably between 0.31 and 0.33 µg/g in 2015.

Harmine, a small molecule derived from natural sources, inhibits enterovirus 71 replication by targeting NF-κB pathway.

Enterovirus 71 (EV71) infection of young children can cause neurological manifestations, which is mainly responsible for the fatality. Although a vaccine is recently available for preventing enterovirus 71 infection, its efficacy remains to be seen. Therefore, there is a pressing need for anti-viral agents for the treatment of EV71 infection. By screening a natural compound library for inhibitory activity of EV71 replication, we identified a small molecule, harmine, that inhibited EV71 replication by targeting NF-κB signaling pathway. Harmine is a ß-carboline alkaloid found in the medicinal plant Peganum harmala, which is used as a folk antitumor medicine in China and other parts of the Asia. The estimated EC50 value for harmine to block EV71 infection was 20 µM, while the CC50 was estimated at 500 µM in vitro. Harmine inhibited replication of EV71, as evidenced by its ability to diminish plague formation induced by EV71 and to reduce the level of viral RNA and protein. Mechanistic studies indicated that harmine suppressed EV71 replication through inhibition of NF-κB signaling pathway. Harmine treatment also reduced EV71-induced reactive oxygen species (ROS) formation, which was associated with a decline in EV71-associated NF-κB activation. In addition, the harmine treatment could protect AG129 mice against EV71 replication in vivo. These findings suggest that harmine may present as a candidate antiviral drug for the treatment of EV71 infection.

An approach to assessment of Keshan disease elimination at the township level.

BACKGROUND: The aim of this study was to pilot a method of a small-scale survey for the assessment of Keshan disease (KD) elimination at township level. METHODS: The prevalence of chronic KD was obtained by case-searching the whole population. The endemic village with the highest prevalence of chronic KD was selected as the key village for the survey of latent KD prevalence rate among permanent residents. The selenium levels in the head hair of individuals in the key village was measured. The professionals of the department of endemic disease control, the township and village doctors were surveyed by pre-designed questionnaire survey for KD interventions. RESULTS: We conducted this study in 2013. Yuanbao township had a population of 16 487 people and 14 862 permanent residents. There were no acute or subacute KD cases in the previous 5 years. The prevalence rate of chronic KD and natural chronic KD were 6.7/10 000 and 3.4/10 000 respectively. The prevalence rate of latent KD was 250.6/10 000, higher than the elimination criterion. The head hair selenium levels were 0.23±0.18 mg/kg. CONCLUSIONS: The small-scale survey methodology for assessing KD elimination at township level was feasible. KD among the people living in Yuanbao township has not been eliminated.

Oblongifolin M, an active compound isolated from a Chinese medical herb Garcinia oblongifolia, potently inhibits enterovirus 71 reproduction through downregulation of ERp57.

There is no effective drug to treat EV71 infection yet. Traditional Chinese herbs are great resources for novel antiviral compounds. Here we showed that Oblongifolin M (OM), an active compound isolated from Garcinia oblongifolia, potently inhibited EV71 infection in a dose dependent manner. To identify its potential effectors in the host cells, we successfully identified 18 proteins from 52 differentially expressed spots by comparative proteomics studies. Further studies showed that knockdown of ERp57 inhibited viral replication through downregulating viral IRES (internal ribosome entry site) activities, whereas ectopic expression of ERp57 increased IRES activity and partly rescued the inhibitory effects of OM on viral replication. We demonstrated that OM is an effective antiviral agent; and that ERp57 is one of its cellular effectors against EV71 infection.

Antiviral effects of Reduning injection against Enterovirus 71 and possible mechanisms of action.

The present study was designed to evaluate the protective effects of Reduning injection against Enterovirus 71 (EV71) in Vero cells and in mice. The Vero cells were infected with 100 and 50 TCID50 (50% tissue culture infective dose) of EV71, respectively. The inhibition of Reduning injection on cytopathic effect (CPE) was detected. Meanwhile, a mouse model produced by intraperitoneal EV71-infection (10(6) TCID50), was used to investigate the protective effects of Reduning injection. The total survival rate, living time, daily survival rate, weight ratio, and score for symptoms were examined. The viral loads in Vero cells and muscle tissues were detected using real-time PCR. Finally, the content of cytokines was analyzed by ELISA. In the Vero cells, 2.5 mg crude drug·mL(-1) of Reduning injection inhibited CPE induced by EV71 infection. In the mice, 1.3 g crude drug·kg(-1) of Reduning injection rescued death triggered by infection, in comparison with model group. Moreover, the survival rate, weight ratio, and clinical scores were also improved. The viral RNA copies in the Vero cells and the mice muscle tissues were reduced. Besides, the steep EV71-induced accumulations of TNF-α and MCP-1 were decreased by Reduning injection. In conclusion, Reduning injection showed promising protective effects against EV71 in Vero cells and in mice.

Human induced pluripotent stem cell-derived cardiomyocytes as an in vitro model for coxsackievirus B3-induced myocarditis and antiviral drug screening platform.

RATIONALE: Viral myocarditis is a life-threatening illness that may lead to heart failure or cardiac arrhythmias. A major causative agent for viral myocarditis is the B3 strain of coxsackievirus, a positive-sense RNA enterovirus. However, human cardiac tissues are difficult to procure in sufficient enough quantities for studying the mechanisms of cardiac-specific viral infection. OBJECTIVE: This study examined whether human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) could be used to model the pathogenic processes of coxsackievirus-induced viral myocarditis and to screen antiviral therapeutics for efficacy. METHODS AND RESULTS: hiPSC-CMs were infected with a luciferase-expressing coxsackievirus B3 strain (CVB3-Luc). Brightfield microscopy, immunofluorescence, and calcium imaging were used to characterize virally infected hiPSC-CMs for alterations in cellular morphology and calcium handling. Viral proliferation in hiPSC-CMs was quantified using bioluminescence imaging. Antiviral compounds including interferonß1, ribavirin, pyrrolidine dithiocarbamate, and fluoxetine were tested for their capacity to abrogate CVB3-Luc proliferation in hiPSC-CMs in vitro. The ability of these compounds to reduce CVB3-Luc proliferation in hiPSC-CMs was consistent with reported drug effects in previous studies. Mechanistic analyses via gene expression profiling of hiPSC-CMs infected with CVB3-Luc revealed an activation of viral RNA and protein clearance pathways after interferonß1 treatment. CONCLUSIONS: This study demonstrates that hiPSC-CMs express the coxsackievirus and adenovirus receptor, are susceptible to coxsackievirus infection, and can be used to predict antiviral drug efficacy. Our results suggest that the hiPSC-CM/CVB3-Luc assay is a sensitive platform that can screen novel antiviral therapeutics for their effectiveness in a high-throughput fashion.

TLR2-ICAM1-Gadd45α axis mediates the epigenetic effect of selenium on DNA methylation and gene expression in Keshan disease.

Keshan disease (KD) is a fatal dilated cardiomyopathy with unknown etiology, and selenium deficiency is considered the main cause of KD. Several observations implicate a role for altered DNA methylation in selenium deficiency-related diseases. The aim of the present study was to investigate the epigenetic effects of selenium (Se) on DNA methylation and gene expression in Keshan disease. Using methylated DNA immunoprecipitation chip (MeDIP-Chip) and quantitative RT-PCR, we identified two inflammatory-related genes (TLR2 and ICAM1) that were differentially methylated and expressed between normal individuals and KD patients. Results from DNA methylation profile between KD patients and normal individuals showed that selenium deficiency decreased methylation of CpG islands in promoter regions of TLR2 and ICAM1 and upregulated messenger RNA (mRNA) and protein levels of TLR2 and ICAM1. In rat animal model of Keshan disease, selenite treatment could increase TLR2 and ICAM1 promoter methylation, suppress these genes expression, and reduce infiltration of myocardial inflammatory cells. In cell culture model of Keshan disease, we found 5-Aza-dC (DNMT1 inhibitor) treatment in the presence of selenium-reduced mRNA and protein levels of DNMT1 regardless of TLR2 and ICAM1 promoter methylation status and expression levels of these genes. Selenite treatment suppressed the expression of the Gadd45α, TLR2, and ICAM1 in a concentration-dependent manner, while selenium deficiency increased the expression of the Gadd45α, TLR2, and ICAM1 and decreased TLR2 and ICAM1 promoter methylation level in a time-dependent manner. Our results revealed that TLR2-ICAM1-Gadd45α axis might play an important role in gene-specific active DNA demethylation during inflammatory response in myocardium.

An original discovery: selenium deficiency and Keshan disease (an endemic heart disease).

This is a review article telling a 50-years old story about the studies on selenium deficiency and Keshan disease in China, an endemic heart disease with high case-fatality, as an example of translational research. Extensive cross-sectional epidemiological studies showed that low selenium concentrations in cereal grains and low selenium status of local residents were associated with the occurrence of Keshan disease. Several large population based intervention trials using oral administration of sodium selenite tablets showed significant reduction of Keshan disease incidence. Based on the above evidence, it was concluded that selenium deficiency is the major cause of Keshan disease, although other etiological factors could not be ruled out. The implications of the findings include: provided critical scientific evidence for selenium being an essential trace element for humans; as scientific basis for identifying minimum requirement and RDA/RNI for selenium; and as solid reference for the formulation of effective preventive measures for Keshan disease in China.

Suboptimal selenium supply--a continuing problem in Keshan disease areas in Heilongjiang province.

This study explores whether the declining prevalence of Keshan disease is associated with increasing selenium levels in Keshan disease areas in Heilongjiang province. Six counties endemic with Keshan disease and three non-endemic counties were selected as study areas. In each county, two townships and in each township one village were chosen in which to survey ten families about head hair, grain, and soil samples and to obtain demographic information. Selenium was measured with hydride generation-atomic fluorescence spectrometry. In each county endemic with Keshan disease, one of the villages was chosen to investigate the prevalence of the disease. We collected 534 head hair samples, 446 staple food samples, and 180 soil samples. The selenium levels of head hair and corn in the endemic counties were significantly lower than those in non-endemic counties. Family demographic information was homologous except for the composition of staple food. More residents in Keshan disease areas preferred flour and corn. The detection rate for latent Keshan disease had a significantly negative correlation with the corn selenium level in six counties endemic with Keshan disease. As the population in this region is still at risk for Keshan disease, selenium surveillance measures should be intensified.

Selenium in human health and disease.

This review covers current knowledge of selenium in the environment, dietary intakes, metabolism and status, functions in the body, thyroid hormone metabolism, antioxidant defense systems and oxidative metabolism, and the immune system. Selenium toxicity and links between deficiency and Keshan disease and Kashin-Beck disease are described. The relationships between selenium intake/status and various health outcomes, in particular gastrointestinal and prostate cancer, cardiovascular disease, diabetes, and male fertility, are reviewed, and recent developments in genetics of selenoproteins are outlined. The rationale behind current dietary reference intakes of selenium is explained, and examples of differences between countries and/or expert bodies are given. Throughout the review, gaps in knowledge and research requirements are identified. More research is needed to improve our understanding of selenium metabolism and requirements for optimal health. Functions of the majority of the selenoproteins await characterization, the mechanism of absorption has yet to be identified, measures of status need to be developed, and effects of genotype on metabolism require further investigation. The relationships between selenium intake/status and health, or risk of disease, are complex but require elucidation to inform clinical practice, to refine dietary recommendations, and to develop effective public health policies.

Is selenium deficiency really the cause of Keshan disease?

Keshan disease (KD) is a dilated cardiomyopathy closely related with a diet deficient in the mineral selenium. It is named for the northeastern Chinese county Keshan, where the disease prevalence is high because of selenium-deficient soil. KD is a gene-environment interaction disease. Here, we used stepwise multiple regression analysis to analyze the risk factors of the disease and the main clinical features in 71 KD patients and 290 controls. The variables analyzed included age, sex, family history of KD, blood selenium level, glutathione peroxidase-1 (GPx-1) activity, variance at codon198 in GPx-1 gene, residence in an endemic area, abnormal electrocardiography (ECG) findings, and cardiothoracic (CT) ratio. The main risk factors found were low GPx-1 activity, family history of KD and living in an endemic area. The main clinical features were increased cardiac load on ECG and increased CT ratio and Tei index. Public health and clinical prevention efforts could focus on increasing GPx-1 activity to address KD. Is selenium deficiency really the certain cause of KD? This is not at all a settled question. And further study is promptly required to investigate the etiology of KD.

[Surveys on the conditions of Keshan disease and selenium levels of 15 counties in Shandong Province in 2008].

OBJECTIVE: To investigate the conditions of Keshan disease and the selenium nutritional status of residents in Keshan disease endemic area in Shandong Province. METHODS: One site from each of 15 Keshan disease endemic counties in Shandong Province was selected for the survey and 700 subjects in each site were randomly selected for the investigation. Physical examination, electrocardiogram and X-ray radiography of the subjects and the selenium contents of hair, wheat, corn and dried sweet potato were surveyed. RESULTS: A total of 10679 people were investigated in 15 counties and 315 patients were found, including 287 cases of latent type and 28 cases of chronic type, but no acute or subacute type patients were found. There were 1776 cases of abnormal electrocardiogram. Among the 461 cases checked up by radiography, the heart of 195 cases was enlarged. The selenium content of hair, wheat, corn and dried sweet potato were (0.5191 +/- 0.5538), (0.0268 +/- 0.0045), (0.0194 +/- 0.0052) and (0.0193 +/- 0.0039) mg/kg respectively. CONCLUSION: The occurrence of Keshan disease is in a stable status in Shandong Province at present. Hair selenium of residents in Keshan disease endemic area has reached an appropriate level. The selenium nutritional status of residents has improved, and the prevalence of Keshan disease is expected to be decreased in these areas.

Selenium level surveillance for the year 2007 of Keshan disease in endemic areas and analysis on surveillance results between 2003 and 2007.

Selenium deficiency is widely accepted as a fundamental cause of Keshan disease (KD). In the present study, the selenium levels of hair and food samples of KD in some endemic areas were measured; the prevalence and incidence of KD for the year 2007 in these areas were surveyed. The results for KD surveillance from 2003 to 2007 were analyzed. The selenium level was measured fluorometrically. In 2007, a total of 19,280 residents were surveyed in 15 provinces. The prevalence and incidence of KD were 3.0% and 4.9‰, respectively. In KD and control subjects, the mean levels of hair selenium were respectively 0.3223 mg/kg and 0.4466 mg/kg. The mean level of staple food selenium was 0.0227 ± 0.0144 mg/kg. During the 5 years, the selenium content in hair was always kept at a normal level within inhabitants of KD-endemic areas, but that in staple food was always kept at a lower level. These results indicate that the pathogenic factor has not been drastically eliminated even with the increasing selenium level of internal environment and is still continually damaging public health of KD in endemic areas. Since KD is still a serious threat to public health in its endemic areas, it is of great importance to pay attention to the prevention and control of this disease.

Coxsackievirus B3-resistant mice become susceptible in Se/vitamin E deficiency.

The severity of the heart damage caused by a coxsackievirus infection in mice is determined by several factors, including the genotype of the infecting virus as well as the genetic background of the infected host. Earlier work by us showed that the cardiovirulence of a given coxsackievirus genotype could be increased substantially by feeding the host a diet nutritionally deficient in either selenium or vitamin E. Here we report that host genetic background as a determinant of viral infection outcome is superseded by feeding the host a diet nutritionally deficient in both selenium and vitamin E. Mice of the C57Bl/6 strain, normally resistant to coxsackievirus B3-induced myocarditis, become susceptible when fed such a doubly deficient diet. Our results demonstrate the powerful influence of host nutritional status on the course of viral infection compared to other variables traditionally considered to play major roles in determining the extent of virally induced inflammatory heart disease.