Coxsackieviruses are significant human pathogens, and the neonatal central nervous system (CNS) is a major target for infection. Despite the extreme susceptibility of newborn infants to coxsackievirus infection and viral tropism for the CNS, few studies have been aimed at determining the long-term consequences of infection on the developing CNS. We previously described a neonatal mouse model of coxsackievirus B3 (CVB3) infection and determined that proliferating stem cells in the CNS were preferentially targeted. Here, we describe later stages of infection, the ensuing inflammatory response, and subsequent lesions which remain in the adult CNS of surviving animals. High levels of type I interferons and chemokines (in particular MCP-5, IP10, and RANTES) were upregulated following infection and remained at high levels up to day 10 postinfection (p.i). Chronic inflammation and lesions were observed in the hippocampus and cortex of surviving mice for up to 9 months p.i. CVB3 RNA was detected in the CNS up to 3 months p.i at high abundance (∼10
6 genomes/mouse brain), and viral genomic material remained detectable in culture after two rounds of in vitro passage. These data suggest that CVB3 may persist in the CNS as a low-level, noncytolytic infection, causing ongoing inflammatory lesions. Thus, the effects of a relatively common infection during the neonatal period may be long lasting, and the prognosis for newborn infants recovering from acute infection should be reexplored.Early damaging events on the central nervous system (CNS) by infection can result not only in severe physical and intellectual disability but also in less obvious neurological deficits. For example, children who were thought to have fully recovered from neonatal CNS virus infections exhibited some deficiency in scholastic performance (
12). Thus, the enduring harmful effects of childhood infections on the CNS may be greatly underappreciated. Picornaviruses including polioviruses, coxsackieviruses, and other unclassified enteroviruses frequently infect the CNS (
60). Although these infections often are considered acute and self-limiting, evidence is emerging that these viruses—or at least the viral RNAs—may persist for months or years after the initial infection. For example, ∼50 years after the primary infection, a large percentage (∼30%) of polio victims are now experiencing new symptoms (postpolio syndrome), which some investigators have correlated with the presence of viral RNA in the CNS (
43). Worldwide distribution of enterovirus infection is revealed by the detection of enterovirus-specific antibodies in the serum of approximately 75% of individuals within developed countries. For example, in 1996, approximately 10 to 15 million diagnosed cases of enterovirus infection occurred in the United States alone (
49). Few studies have been done to determine if enteroviruses, or their close relatives, have the ability to persist and cause long-term damage in the CNS (
10,
56) or whether previous infection of neurons may indirectly lead to the degeneration of aging motor neurons.Coxsackievirus, a member of the enterovirus genus, is a fairly frequent childhood infection and may cause severe morbidity and mortality in humans, predominantly in the very young. Infants infected with coxsackievirus have been shown to be extremely susceptible to meningitis and encephalitis. Severe demyelinating diseases may occur following infection, including acute disseminated encephalomyelitis (
18) and acute transverse myelitis (
27). Also, a number of delayed neuropathologies have been associated with previous coxsackievirus infection, including schizophrenia (
47,
52), encephalitis lethargica (
16), and amyotrophic lateral sclerosis (
62,
63). If human neurotropic viruses persist, they could provide a chronic inflammatory stimulus, leading to regional cytokine induction and activation of autoreactive T cells through molecular mimicry and bystander activation (
32,
45). This may be especially true for viruses, such as coxsackievirus, which have the ability to infect stem cells (
24) and neurons (
1). Recently, we have shown that coxsackievirus B3 (CVB3) targets proliferating cells in regions of the neonatal CNS supporting neurogenesis (
24). Nonetheless, infected migratory neuronal progenitor cells were able to differentiate into mature neurons. Many neurons eventually underwent caspase-3-mediated apoptosis at later stages of disease (
22).Intriguingly, viral RNA was detected in the CNS of surviving pups in the absence of infectious virus for up to 30 days postinfection (p.i.). The detection of CVB3 RNA in target tissues may have great significance for CVB3-mediated disease, given that the long-term presence of replication-restricted CVB3 RNA in the heart (generated using transgenic techniques) has been directly associated with dilated cardiomyopathy in a previous study by Wessely et al. (
59). We were therefore interested in expanding this notable observation in the CNS by significantly increasing the number of animals examined, more precisely quantifying the amounts of viral RNA, and determining how long viral RNA might persist in the CNS. In addition, we thoroughly assessed the nature and degree of neuropathology in surviving animals harboring CVB3 RNA. These studies may help predict the lasting neurological sequelae of a previous viral infection on the developing host.
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