肠道病毒71型感染动物模型的应用与局限

肠道病毒71型(enterovirus 71,EV71)是一种被忽视的热带传染病——手足口病的主要病原体之一,过去15年在亚太地区引起了多次手足口病暴发。由于脊髓灰质炎病毒的有效控制,EV71已成为最重要的嗜神经肠道病毒,其严重的神经系统并发症威胁着儿童健康。合适的动物模型可帮助更好地了解EV71神经致病机制,并有利于开发有效的疫苗和治疗药物。本文就EV71已建立的3类主要动物模型(非人灵长类动物模型、小鼠适应性模型及转基因小鼠模型)的特征、应用与局限进行综述。     

肠道病毒71型疫苗的研究进展

近年来,手足口病(Hand foot mouth disease,HFMD)在中国多次爆发流行,严重威胁公众健康,尤其是5岁以下的婴幼儿。而肠道病毒71型(Enterovirus 71,EV71)是引起手足口病的主要病原体之一,由于目前还无针对该疾病有效的抗病毒药物,研制疫苗是控制EV71流行最为有效的措施。目前EV71疫苗及相关研究均取得重大突破,本文就近年来关于EV71疫苗研发、动物模型等的研究进展作一综述。     

人肠道病毒71型与手足口病的分子流行病学及其分子进化

人肠道病毒71血清型(Enterovirus 71, EV71)是手足口病(Hand, foot and mouth disease, HFMD)的主要病原体之一,除了引起手、足和口腔等部位出现疱疹的手足口病典型症状,还能引起无菌性脑膜炎和急性迟缓性麻痹等神经系统并发症并致死亡。EV71在历史上曾经造成多起手足口病疫情,尤其是1997年之后,在亚太地区发生了大规模的手足口病疫情,造成了大量的手足口病病例和死亡病例。手足口病尚无上市疫苗和抗病毒药物,主要依赖对症治疗,因此对EV71的分子流行病学和分子进化研究对手足口病的监测和防控具有重要意义。文章对EV71基因型的分类、时空分布、进化特征和模式以及所造成的代表性疫情进行了综述,为EV71致病机制、抗病毒药物和疫苗的研究以及对手足口病疫情的监测和防控提供启发。     

肠道病毒71型及其疫苗的研究进展

肠道病毒71型(Enterovirus71,EV71)是手足口病的主要病原体,是一种具有较强传染性和致病性的病毒,其流行范围波及全世界,近年来在亚太地区尤其是在中国的流行日趋频繁。目前EV71病原学、流行病学以及动物模型的研究均取得了一定进展,为疫苗的研发奠定了相应的基础,中国三家公司的EV71灭活疫苗现已率先获得临床批件,有望成为预防手足口病的有效手段。     

肠道病毒71型2A蛋白的研究进展

肠道病毒71(enterovirus 71,EV71)是手足口病(hand,foot and mouth disease,HFMD)主要致病原之一。手足口病临床上常表现为发热,手掌、脚掌及口腔黏膜皮疹或疱疹。然而,EV71感染导致的手足口病易伴随神经系统并发症,甚至死亡。EV71非结构蛋白2A作为蛋白酶和转录激活因子,在EV71生命周期中发挥重要作用。本文对2A的结构与功能研究进展进行综述,揭示2A的双重功能如何促进病毒复制和调控靶细胞,为进一步研究靶向2A的抗病毒疫苗和药物提供理论基础。     

C4亚型人肠道病毒71型的小鼠肌肉适应株对小鼠具有致死毒力

目的人肠道病毒71型（EV71）感染婴幼儿可导致手足口病,偶尔伴随有严重的并发症。建立EV71的小鼠模型是深入研究病毒感染的致病机制、进行疫苗和药物评价的基础。方法将EV71的临床分离株在小鼠骨骼肌中进行系列传代,得到了小鼠的肌肉适应株MP10。使用MP10经腹腔注射感染10日龄ICR小鼠,对感染小鼠的症状、病毒复制和病理进行了监测。结果与临床分离株相比,MP10对人横纹肌瘤细胞（rhabdomyosarcoma cell,RD细胞）的感染力提高,并且对小鼠的毒力增强,MP10感染10日龄小鼠可导致其瘫痪和死亡。病毒主要在骨骼肌中复制,并引发大面积的坏死性肌炎,同时神经组织未观察到病变。病理分析发现：感染小鼠体内与呼吸运动相关的肌肉均发生严重的坏死性肌炎,推测此类肌肉的坏死会影响小鼠的呼吸功能,从而成为导致小鼠死亡的因素之一。结论建立了C4亚型EV71毒株感染10日龄ICR小鼠的模型,该模型可作为研究EV71感染的致病机制、以及疫苗和药物评价的工具。     

人肠道病毒71型亚单位疫苗的研制

目的利用原核表达技术制备人肠道病毒71型（EV71）的亚单位融合疫苗,并通过小鼠模型对其保护效果进行评价。方法在大肠杆菌中融合表达EV71的亚单位肽段,随后将肽段免疫雌鼠,对其交配后产下的幼鼠进行病毒感染,通过检测其组织内的病毒拷贝数和病理变化,对疫苗的保护效果进行评价。结果通过肽段融合的方法,得到五种备选疫苗,分别为VacA,VacB,VacC,VacD和VacE,这五种疫苗均具有一定的体外保护能力,并且VacB和VacC与正常人大脑组织无明显交叉反应。动物模型评价结果显示,VacB和VacE能赋予幼鼠抗病毒感染的保护效果。结论利用EV71的小鼠感染模型评价了针对EV71的亚单位联合疫苗,VacB和VacE的保护效果较好,此外,VacB与人脑组织间无明显交叉反应,可以作为潜在的无神经毒性的临床使用疫苗。     

肠道病毒71型研究进展

肠道病毒71型是一种具有较强致病性的肠道病毒,主要引起患者手足口病(Hand,foot and mouth disease,HFMD)。已在世界多个地区爆发和流行,主要症状是手、足、口、臀等部位皮疹或疱疹,少数患儿可以并发无菌性脑膜炎、脑炎、急性弛缓性麻痹等严重神经系统并发症,呼吸道感染和心肌炎等,可致残、致死。2007—2008年中国多个地区均有较大规模流行,危害十分严重。近四十年的多次流行中,EV71病毒的基因不断进化,研究其基因变化特点对早期诊断、分型以及了解基因与流行、致病的关系等有着重要的意义。对EV71感染尚缺乏有效的抗病毒药物,研制有效的预防性疫苗迫在眉睫,目前有灭活疫苗、减毒疫苗、多肽或蛋白疫苗、DNA疫苗等多种尝试,但至今尚无EV71疫苗上市。本文对EV71基因、实验室诊断和疫苗方面的研究进展进行了综述。     

EV71小鼠适应株制备及体内外感染特点

目的用1日龄ICR小鼠传代制备EV71小鼠适应株,研究EV71亲代株与小鼠适应株的体内外感染特点,建立EV71感染ICR小鼠动物模型,为病毒疫苗和抗病毒药物的研究提供实用的动物评价工具。方法用1日龄ICR小鼠进行EV71病毒(Fuyang-0805)的传代,得到小鼠传代株。以一定浓度亲代株和传代株病毒分别接种RD、Vero、SY5Y、Caco-2四种细胞,定量方法检测各时间点不同毒株在四种细胞上的复制数量,CCK8方法测定各时间点细胞的存活率;同时,两毒株分别腹腔注射感染1日龄小鼠,定期安乐死动物,采集肺、小肠、骨骼肌、大脑四种器官组织,进行动物体内病毒半定量和定量分析,同时进行各器官组织病理学观察、免疫组织化学鉴定。结果与亲代毒株相比较,小鼠传代株(EV71-MMP4)表现出更强的肌肉来源细胞嗜性与毒性;同时,两毒株腹腔注射感染1日龄小鼠后,EV71-MMP4感染的小鼠体重增长较正常小鼠体重增长缓慢;半定量和定量RT-PCR显示,在小鼠肌肉中的病毒载量于感染后1d和5d达到高峰。EV71-MMP4感染组感染率较高、病毒组织分布较广、感染持续性较好、病毒载量较高,高剂量病毒感染后小鼠小肠、心肌和骨骼肌可观察到细胞空泡变性、淋巴细胞浸润等病理变化。免疫组织化学显示感染后小鼠骨骼肌有EV71病毒特异分布。结论阜阳EV71小鼠适应株表现出较亲代毒株更好的小鼠易感性、细胞毒性,所建立的动物模型可用于EV71病毒致病机制、感染特点的研究和病毒疫苗及药物的评价。     

肠道病毒71型疫苗质量控制研究进展

手足口病(Hand foot and mouth disease,HFMD)已成为西太平洋区严重的公共卫生问题之一,肠道病毒71型(Enterovirus 71,EV71)是引起HFMD的主要病原体,研发疫苗是控制HFMD流行的有效手段。目前世界范围已有5个EV71全病毒灭活疫苗进入临床试验,其中中国研制的3种EV71疫苗已分别完成III期临床试验,结果表明3种疫苗都具有良好的安全性和保护效果。在EV71疫苗研发中,抗原质控的方法和标准是研发的瓶颈,其中抗原活性测定是工序工艺优化、免疫原性评价和剂量确定的关键指标。综述了EV71疫苗抗原质控的研究进展。     

Immunization with recombinant enterovirus 71 viral capsid protein 1 fragment stimulated antibody responses in hamsters

ABSTRACT: Enterovirus 71 (EV71) causes severe neurological diseases resulting in high mortality in young children worldwide. Development of an effective vaccine against EV71 infection is hampered by the lack of appropriate animal models for efficacy testing of candidate vaccines. Previously, we have successfully tested the immunogenicity and protectiveness of a candidate EV71 vaccine, containing recombinant Newcastle disease virus capsids that display an EV71 VP1 fragment (NPt-VP11-100) protein, in a mouse model of EV71 infection. A drawback of this system is its limited window of EV71 susceptibility period, 2 weeks after birth, leading to restricted options in the evaluation of optimal dosing regimens. To address this issue, we have assessed the NPt-VP11-100 candidate vaccine in a hamster system, which offers a 4-week susceptibility period to EV71 infection. Results obtained showed that the NPt-VP11-100 candidate vaccine stimulated excellent humoral immune response in the hamsters. Despite the high level of antibody production, they failed to neutralize EV71 viruses or protect vaccinated hamsters in viral challenge studies. Nevertheless, these findings have contributed towards a better understanding of the NPt-VP11-100 recombinant protein as a candidate vaccine in an alternative animal model system.     

A non-mouse-adapted enterovirus 71 (EV71) strain exhibits neurotropism, causing neurological manifestations in a novel mouse model of EV71 infection

Enterovirus 71 (EV71) is a neurotropic pathogen that has been consistently associated with the severe neurological forms of hand, foot, and mouth disease. The lack of a relevant animal model has hampered our understanding of EV71 pathogenesis, in particular the route and mode of viral dissemination. It has also hindered the development of effective prophylactic and therapeutic approaches, making EV71 one of the most pressing public health concerns in Southeast Asia. Here we report a novel mouse model of EV71 infection. We demonstrate that 2-week-old and younger immunodeficient AG129 mice, which lack type I and II interferon receptors, are susceptible to infection with a non-mouse-adapted EV71 strain via both the intraperitoneal (i.p.) and oral routes of inoculation. The infected mice displayed progressive limb paralysis prior to death. The dissemination of the virus was dependent on the route of inoculation but eventually resulted in virus accumulation in the central nervous systems of both animal groups, indicating a clear neurotropism of the virus. Histopathological examination revealed massive damage in the limb muscles, brainstem, and anterior horn areas. However, the minute amount of infectious viral particles in the limbs from orally infected animals argues against a direct viral cytopathic effect in this tissue and suggests that limb paralysis is a consequence of EV71 neuroinvasion. Together, our observations support that young AG129 mice display polio-like neuropathogenesis upon infection with a non-mouse-adapted EV71 strain, making this mouse model relevant for EV71 pathogenesis studies and an attractive platform for EV71 vaccine and drug testing.     

Recombinant VP1 protein expressed in Pichia pastoris induces protective immune responses against EV71 in mice

Human enterovirus 71 (EV71) is one of the major causative agents of hand, foot and mouth disease and is also associated with serious neurological diseases in children. Currently, there are no effective antiviral drugs or vaccines against EV71 infection. VP1, one of the major immunogenic capsid proteins of EV71, is widely considered to be the candidate antigen for an EV71 vaccine. In this study, VP1 of EV71 was expressed as a secretory protein with an N-terminal histidine tag in the methylotrophic yeast Pichia pastoris, and purified by Ni–NTA affinity chromatography. Immunogenicity and vaccine efficacy of the recombinant VP1 were assessed in mouse models. The results showed that the recombinant VP1 could efficiently induce anti-VP1 antibodies in BALB/c mice, which were able to neutralize EV71 viruses in an in vitro neutralization assay. Passive protection of neonatal mice further confirmed the prophylactic efficacy of the antisera from VP1 vaccinated mice. Furthermore, VP1 vaccination induced strong lymphoproliferative and Th1 cytokine responses. Taken together, our study demonstrated that the yeast-expressed VP1 protein retained good immunogenicity and was a potent EV71 vaccine candidate.     

Enterovirus 71-Induced Neurological Disorders in Young Gerbils,Meriones unguiculatus: Development and Application of a Neurological Disease Model

A reliable disease model mimicking Enterovirus 71 (EV71) infection in humans is essential for understanding pathogenesis and for developing a safe and effective vaccine. Commonly used rodent models including mouse or rat models are not suitable for vaccine evaluation because the rodents are resistant to EV71 infection after they reach the age of 6 days. In this study, 21-day-old gerbils inoculated intraperitoneally (IP) with a non mouse-adapted EV71 strain developed neurological lesion-related signs including hind limb paralysis, slowness, ataxia and lethargy similar to those of central nervous system (CNS) infection of EV71 in humans. The infected gerbils eventually died of the neurological lesions and EV71 could be isolated from lung, liver, spleen, kidney, heart, spinal cord, brain cortex, brainstem and skeletal muscle. Significantly high virus replication was detected in spinal cord, brainstem and skeletal muscle by cellular analysis, real-time quantitative PCR (RT-PCR) and immunohistochemical staining. Histopathologic changes such as neuronal degeneration, neuronal loss and neuronophagia were observed in spinal cord, brain cortex, brainstem, and skeletal muscle along with necrotizing myositis and splenic atrophy. Gerbils that received two doses of inactive whole-virus vaccine showed no EV71-specific symptoms after challenged with EV71. In contrast, gerbils that received mock vaccination died of EV71-induced neuropathology after challenged with EV71. The result indicates that gerbils can serve as a reliable disease model for evaluating safety and efficacy of EV71 vaccine.     

EV71感染抗病毒药物及疫苗研究进展

手足口病在世界多个地区,尤其是亚洲爆发并流行,且其感染率和死亡率逐年增高,危害十分严重。肠道病毒71(Enterovirus 71,EV71)是手足口病(Hand,foot,andmouth disease,HFMD)的主要病原体,以感染婴幼儿为主,其感染常伴随神经系统并发症,严重可导致儿童死亡。近年来,分子生物学和抗病毒研究方面取得的进展为EV71感染的预防及治疗提供了新的途径。本文对EV71病毒学特点及抗EV71药物的筛选、疫苗开发、RNA干扰等进行了综述,以期为相关研究提供参考。     

Monitoring Antigenic Variations of Enterovirus 71: Implications for Virus Surveillance and Vaccine Development

Enterovirus 71 (EV71) causes life-threatening epidemics in Asia and can be phylogenetically classified into three major genogroups (A∼C) including 11 genotypes (A, B1∼B5, and C1∼C5). Recently, EV71 epidemics occurred cyclically in Taiwan with different genotypes. In recent years, human studies using post-infection sera obtained from children have detected antigenic variations among different EV71 strains. Therefore, surveillance of enterovirus 71 should include phylogenetic and antigenic analysis. Due to limitation of sera available from children with EV71 primary infection, suitable animal models should be developed to generate a panel of antisera for monitoring EV71 antigenic variations. Twelve reference strains representing the 11 EV71 genotypes were grown in rhabdomyosarcoma cells. Infectious EV71 particles were purified and collected to immunize rabbits. The rabbit antisera were then employed to measure neutralizing antibody titers against the 12 reference strains and 5 recent strains. Rabbits immunized with genogroup B and C viruses consistently have a lower neutralizing antibody titers against genogroup A (≧8-fold difference) and antigenic variations between genogroup B and C viruses can be detected but did not have a clear pattern, which are consistent with previous human studies. Comparison between human and rabbit neutralizing antibody profiles, the results showed that ≧8-fold difference in rabbit cross-reactive antibody ratios could be used to screen EV71 isolates for identifying potential antigenic variants. In conclusion, a rabbit model was developed to monitor antigenic variations of EV71, which are critical to select vaccine strains and predict epidemics.     

肠道病毒71型（EV71）对ICR小鼠的感染

目的研究肠道病毒71型经不同途径感染不同日龄ICR小鼠后的感染状况,了解肠道病毒71型的感染特点,为了解EV71小鼠感染机制和模型制备提供实验信息和技术支撑。方法分别通过口腔途径、颅腔途径、肌肉途径及腹腔途径感染1日龄、7日龄及3~4周龄SPF级ICR小鼠,定期安乐动物,采集各器官组织进行病原学诊断,确定EV71病毒感染情况;同时建立一步RT-PCR、病毒分离、IFA及IEA等方法。结果经腹腔途径感染成年鼠出现竖毛、弓背、消瘦症状,其他各途径感染小鼠感染后未见竖毛、弓背、觅食减少、体重减轻、精神呆滞及神经系统症状。颅腔注射3~4周龄ICR小鼠能在脑组织检测到病毒RNA,腹腔注射和肌肉注射1日龄乳鼠能在肌肉组织和肠道检测到病毒RNA,其中,肌肉组织病毒分离可检测到活病毒。本研究同时建立了分子生物学、血清学方法,为今后研究其它适合EV71的动物模型奠定了基础。结论临床分离的EV71毒株通过口腔接种、颅腔、肌肉、腹腔注射途径感染1日龄、7日龄及3~4周龄SPF级ICR小鼠的疾病程度和病毒检出不同,ICR乳鼠及成年鼠可作为该病毒感染机制、病毒体内分布等基础研究,但用作EV71动物模型应用,感染程度尚不十分理想。     

Adaptation of Enterovirus 71 to Adult Interferon Deficient Mice

Non-polio enteroviruses, including enterovirus 71 (EV71), have caused severe and fatal cases of hand, foot and mouth disease (HFMD) in the Asia-Pacific region. The development of a vaccine or antiviral against these pathogens has been hampered by the lack of a reliable small animal model. In this study, a mouse adapted EV71 strain was produced by conducting serial passages through A129 (α/β interferon (IFN) receptor deficient) and AG129 (α/β, γ IFN receptor deficient) mice. A B2 sub genotype of EV71 was inoculated intraperitoneally (i.p.) into neonatal AG129 mice and brain-harvested virus was subsequently passaged through 12 and 15 day-old A129 mice. When tested in 10 week-old AG129 mice, this adapted strain produced 100% lethality with clinical signs including limb paralysis, eye irritation, loss of balance, and death. This virus caused only 17% mortality in same age A129 mice, confirming that in the absence of a functional IFN response, adult AG129 mice are susceptible to infection by adapted EV71 isolates. Subsequent studies in adult AG129 and young A129 mice with the adapted EV71 virus examined the efficacy of an inactivated EV71 candidate vaccine and determined the role of humoral immunity in protection. Passive transfer of rabbit immune sera raised against the EV71 vaccine provided protection in a dose dependent manner in 15 day-old A129 mice. Intramuscular injections (i.m.) in five week-old AG129 mice with the alum adjuvanted vaccine also provided protection against the mouse adapted homologous strain. No clinical signs of disease or mortality were observed in vaccinated animals, which received a prime-and-boost, whereas 71% of control animals were euthanized after exhibiting systemic clinical signs (P<0.05). The development of this animal model will facilitate studies on EV71 pathogenesis, antiviral testing, the evaluation of immunogenicity and efficacy of vaccine candidates, and has the potential to establish correlates of protection studies.     

Exhaled breath condensate sampling is not a new method for detection of respiratory viruses

Background

Human enterovirus 71 (EV71) has emerged as a significant cause of acute encephalitis and deaths in young children. The clinical manifestations caused by EV71 varied from mild hand, foot and mouth disease to severe neurological complications and deaths, but its pathogenesis remains elusive. Antibody dependent enhancement (ADE) infection has been reported in various viruses and has been shown to contribute to disease severity.

Results

In this study, the presence of sub-neutralizing antibody was demonstrated to enhance EV71 infection in THP-1 cells and increase the mortality of EV71 infection in a suckling mouse model. Further, a secondary infection model was established to characterize the correlation between ADE and disease severity, and primary asymptomatic EV71 infection was shown to increase the mortality of the secondary EV71 infection in suckling mice.

Conclusions

Together, these in vitro and in vivo experiments strongly supported the hypothesis of ADE infection of EV71. The present findings indicate ADE might contribute to the pathogenesis of severe EV71 infection, and raise practical issues of vaccine development and antibody-based therapy.