Novel strategies for targeting innate immune responses to influenza.

We previously reported that TLR4(-/-) mice are refractory to mouse-adapted A/PR/8/34 (PR8) influenza-induced lethality and that therapeutic administration of the TLR4 antagonist Eritoran blocked PR8-induced lethality and acute lung injury (ALI) when given starting 2 days post infection. Herein we extend these findings: anti-TLR4- or -TLR2-specific IgG therapy also conferred significant protection of wild-type (WT) mice from lethal PR8 infection. If treatment is initiated 3 h before PR8 infection and continued daily for 4 days, Eritoran failed to protect WT and TLR4(-/-) mice, implying that Eritoran must block a virus-induced, non-TLR4 signal that is required for protection. Mechanistically, we determined that (i) Eritoran blocks high-mobility group B1 (HMGB1)-mediated, TLR4-dependent signaling in vitro and circulating HMGB1 in vivo, and an HMGB1 inhibitor protects against PR8; (ii) Eritoran inhibits pulmonary lung edema associated with ALI; (iii) interleukin (IL)-1ß contributes significantly to PR8-induced lethality, as evidenced by partial protection by IL-1 receptor antagonist (IL-1Ra) therapy. Synergistic protection against PR8-induced lethality was achieved when Eritoran and the antiviral drug oseltamivir were administered starting 4 days post infection. Eritoran treatment does not prevent development of an adaptive immune response to subsequent PR8 challenge. Overall, our data support the potential of a host-targeted therapeutic approach to influenza infection.

Role of the lipoxygenase pathway in RSV-induced alternatively activated macrophages leading to resolution of lung pathology.

Resolution of severe Respiratory Syncytial Virus (RSV)-induced bronchiolitis is mediated by alternatively activated macrophages (AA-Mφ) that counteract cyclooxygenase (COX)-2-induced lung pathology. Herein, we report that RSV infection of 5-lipoxygenase (LO)(-/-) and 15-LO(-/-) macrophages or mice failed to elicit AA-Mφ differentiation and concomitantly exhibited increased COX-2 expression. Further, RSV infection of 5-LO(-/-) mice resulted in enhanced lung pathology. Pharmacologic inhibition of 5-LO or 15-LO also blocked differentiation of RSV-induced AA-Mφ in vitro and, conversely, treatment of 5-LO(-/-) macrophages with downstream products, lipoxin A4 and resolvin E1, but not leukotriene B4 or leukotriene D4, partially restored expression of AA-Mφ markers. Indomethacin blockade of COX activity in RSV-infected macrophages increased 5-LO and 15-LO, as well as arginase-1 mRNA expression. Treatment of RSV-infected mice with indomethacin also resulted not only in enhanced lung arginase-1 mRNA expression and decreased COX-2, but also decreased lung pathology in RSV-infected 5-LO(-/-) mice. Treatment of RSV-infected cotton rats with a COX-2-specific inhibitor resulted in enhanced lung 5-LO mRNA and AA-Mφ marker expression. Together, these data suggest a novel therapeutic approach for RSV that promotes AA-Mφ differentiation by activating the 5-LO pathway.

Control of RSV-induced lung injury by alternatively activated macrophages is IL-4R alpha-, TLR4-, and IFN-beta-dependent.

Severe respiratory syncytial virus (RSV)-induced bronchiolitis has been associated with a mixed "Th1" and "Th2" cytokine storm. We hypothesized that differentiation of "alternatively activated" macrophages (AA-M phi) would mediate the resolution of RSV-induced lung injury. RSV induced interleukin (IL)-4 and IL-13 by murine lung and peritoneal macrophages, IL-4R alpha/STAT6-dependent AA-M phi differentiation, and significantly enhanced inflammation in the lungs of IL-4R alpha(-/-) mice. Adoptive transfer of wildtype macrophages to IL-4R alpha(-/-) mice restored RSV-inducible AA-M phi phenotype and diminished lung pathology. RSV-infected Toll-like receptor (TLR)4(-/-) and interferon (IFN)-beta(-/-) macrophages and mice also failed to express AA-M phi markers, but exhibited sustained proinflammatory cytokine production (e.g., IL-12) in vitro and in vivo and epithelial damage in vivo. TLR4 signaling is required for peroxisome proliferator-activated receptor gamma expression, a DNA-binding protein that induces AA-M phi genes, whereas IFN-beta regulates IL-4, IL-13, IL-4R alpha, and IL-10 expression in response to RSV. RSV-infected cotton rats treated with a cyclooxygenase-2 inhibitor increased expression of lung AA-M phi. These data suggest new treatment strategies for RSV that promote AA-M phi differentiation.

Comparative efficacy of recombinant modified vaccinia virus Ankara expressing simian immunodeficiency virus (SIV) Gag-Pol and/or Env in macaques challenged with pathogenic SIV.

Prior studies demonstrated that immunization of macaques with simian immunodeficiency virus (SIV) Gag-Pol and Env recombinants of the attenuated poxvirus modified vaccinia virus Ankara (MVA) provided protection from high levels of viremia and AIDS following challenge with a pathogenic strain of SIV (V. M. Hirsch et al., J. Virol. 70:3741-3752, 1996). This MVA-SIV recombinant expressed relatively low levels of the Gag-Pol portion of the vaccine. To optimize protection, second-generation recombinant MVAs that expressed high levels of either Gag-Pol (MVA-gag-pol) or Env (MVA-env), alone or in combination (MVA-gag-pol-env), were generated. A cohort of 24 macaques was immunized with recombinant or nonrecombinant MVA (four groups of six animals) and was challenged with 50 times the dose at which 50% of macaques are infected with uncloned pathogenic SIVsmE660. Although all animals became infected postchallenge, plasma viremia was significantly reduced in animals that received the MVA-SIV recombinant vaccines as compared with animals that received nonrecombinant MVA (P = 0.0011 by repeated-measures analysis of variance). The differences in the degree of virus suppression achieved by the three MVA-SIV vaccines were not significant. Most importantly, the reduction in levels of viremia resulted in a significant increase in median (P < 0.05 by Student's t test) and cumulative (P = 0.010 by log rank test) survival. These results suggest that recombinant MVA has considerable potential as a vaccine vector for human AIDS.

[Value of the de Kleyn symptom in diagnosing vertebro-basilar insufficiency]. / Znachenie simptoma De Kleina v diagnostike vertebro-baziliarnoi nedostatochnosti.

A total of 540 cases with cerebral vascular disorders examined otoneurologically were analyzed. The observed patients were treated in the Research Institute of Neurology. In 62 patients (11,5%) the De Klein symptom was detected. A comparison of the otoneurological rheoencephalographic and neurological symptomatology gives grounds to evaluate the De Klein symptom, encountered in different degrees of circulatory insufficiency in the vertebro-basillar system, as one of the early signs of vascular decompensation in initial forms of cerebro-vascular insufficiency, marking its diagnostic significance.

[Clinical manifestations and vascular reactivity in patients with dyscirculatory encephalopathy]. / Klinicheskie proiavleniia i sosudistaia reaktivnost' u bol'nykh distsirkuliatornoi éntsefalopatiei.

Using a neurological, psychiatric, experimental neuropsychological and REG study with the use of functional tests, the authors studied 66 patients with different stages of dyscirculatory encephalopathy and 20 normals of the same age (a control group). These patients demonstrated different degrees of disturbed intellectual and mnestic activities, a drop of attention and general activity, the speed of reactions, as well as different forms of expressed psychoorganic symptoms developing on the background of diffuse and eventually of microfocal neurological symptomatology. The REG data revealed relation between the stage of the disease on the one hand and the state of the vascular tone, elasticity of the vascular wall, level of arterial pessure and pulse blood repletion, the state of the venous outflow on the other. Changes of such parameters indicate to a prevalently functional character of these changes in the I stage and partly in the II stages of dyscirculatory encephalopathy and mainly organic in its III stage.

[State of the mucus membrane of the small intestine in upper intestinal fistulas]. / Sostoianie slizistoi obolochki tonkoi kishki pri vysokikh kishechnykh svishchakh

In modeled experiments of 23 polyfistulous dogs with a reproduced high complete small-intestine fistula it was established that enteral compensation of water-electrolyte losses by means of a saline solution, isotonic and isoionic to the chyme, contributed to the maintenance of the water-salt balance for a prolonged period of time, kept up the animals' life and ensured the return to normalcy following the closure of the fistula. Preservation of the function of absorption by the small intestine was confirmed by the data of morphological investigations of 403 bioptic specimens of the mucosa from various parts of the small intestine repitedly taken in the course of the experiments. The data obtained testify to the absence of atrophy of villi and nakedness of their stroma, despite the intravital detachment of the epithelium into the lumen of the intestine, as well as to hyperproduction of the mucus, dilatation of the vessels of the circulatory and lymphatic systems, to retention of the mitotic activity.