Internalization of Coxsackievirus A9 Is Mediated by β2-Microglobulin,Dynamin, and Arf6 but Not by Caveolin-1 or Clathrin

Coxsackievirus A9 (CAV9) is a member of the human enterovirus B species within the Enterovirus genus of the family Picornaviridae. It has been shown to utilize αV integrins, particularly αVβ6, as its receptors. The endocytic pathway by which CAV9 enters human cells after the initial attachment to the cell surface has so far been unknown. Here, we present a systematic study concerning the internalization mechanism of CAV9 to A549 human lung carcinoma cells. The small interfering RNA (siRNA) silencing of integrin β6 subunit inhibited virus proliferation, confirming that αVβ6 mediates the CAV9 infection. However, siRNAs against integrin-linked signaling molecules, such as Src, Fyn, RhoA, phosphatidylinositol 3-kinase, and Akt1, did not reduce CAV9 proliferation, suggesting that the internalization of the virus does not involve integrin-linked signaling events. CAV9 endocytosis was independent of clathrin or caveolin-1 but was restrained by dynasore, an inhibitor of dynamin. The RNA interference silencing of β2-microglobulin efficiently inhibited virus infection and caused CAV9 to accumulate on the cell surface. Furthermore, CAV9 infection was found to depend on Arf6 as both silencing of this molecule by siRNA and the expression of a dominant negative construct resulted in decreased virus infection. In conclusion, the internalization of CAV9 to A549 cells follows an endocytic pathway that is dependent on integrin αVβ6, β2-microglobulin, dynamin, and Arf6 but independent of clathrin and caveolin-1.Coxsackievirus A9 (CAV9), a member of the human enterovirus B species in the family Picornaviridae, is a significant human pathogen. It causes infections of the central nervous system, myocarditis, and respiratory diseases and may occasionally cause fatal generalized infections in newborns (6, 22, 26). The CAV9 particle is about 30 nm in diameter and consists of a naked capsid with an icosahedral symmetry, surrounding a positive-sense RNA genome of approximately 7,400 nucleotides (30). The capsid is made up of 60 copies of each of the four proteins VP1 to VP4 and interacts with cell surface integrins during the early stages of infection via arginine-glycine-aspartic acid (RGD) motif that resides in the C terminus of the VP1 protein (11). While CAV9 binds to both integrin αVβ3 and αVβ6 in vitro (53, 61), our recent data show that integrin αVβ6 is the primary receptor of the virus (29).Viruses can utilize several endocytic pathways to enter mammalian cells: macropinocytosis and clathrin-mediated, caveolin-mediated, and clathrin- and caveolin-independent routes (14, 40-41, 50). Recent studies have shown that some of these pathways differ only slightly from each other, and certain endocytic components can participate in more than just one pathway (35, 41, 55). Most of the research carried out on enterovirus endocytosis has been done with echovirus 1 (EV1), coxsackievirus B3 (CBV3), and poliovirus (PV). Recently, Karjalainen et al. showed that EV1 enters SAOS cells via tubulovesicular structures in a dynamin-independent manner that resembles fluid-phase endocytosis and macropinocytosis and that at later stages of infection is targeted to caveosomes (33). EV1 entry to CV-1 cells, on the other hand, was shown to be strictly dynamin dependent (49). PV is endocytosed to HeLa cells by a rapid clathrin- and caveolin-independent pathway, whereas in brain microvascular endothelial cells it uses slower, caveolin- and dynamin-dependent endocytosis (4, 7, 17). CBV3 enters HeLa cells by clathrin-mediated endocytosis (13) and polarized epithelial CaCo-2 cells by a process that combines features of caveolar endocytosis and macropinocytosis (16, 18). Foot-and-mouth-disease virus (FMDV), a member of the Aphthovirus genus of the family Picornaviridae, binds to several αV-integrins, including αVβ6, and is internalized through the clathrin-mediated pathway (5, 19, 31). In the light of these examples, it is evident that enterovirus internalization to human cells is a complex phenomenon wherein a virus may use different mechanisms to enter different cell types.In the CAV9 infection cycle, the steps that follow the initial attachment of the virus to the cell surface integrins are still poorly characterized. An early electron microscopic work by Hecker et al. has shown that single CAV9 particles enter monkey kidney cells in vesicles, which then occasionally fuse and form larger structures (28). Interestingly, they found that most internalized virus particles became eventually trapped in large vacuoles, presumably lysosomes, where they were confined without proceeding to capsid uncoating and RNA release. More recently, a number of cell surface molecules have been proposed to contribute to CAV9 internalization. A subunit of major histocompatibility complex class I (MHC-I) complex, β2-microglobulin (β2M), has been shown to be essential for the infection of several picornaviruses, including CAV9, and it is supposed to have a postattachment role (12, 59, 61). In addition, heat shock 70-kDa protein 5 (HSPA5 protein, also known as glucose-regulated protein 78-kDa, or GRP78) has been suggested to function as a coreceptor for the virus and to mediate CAV9 infection by its interaction with β2M on the cell surface (57). CAV9 entry has been proposed to occur through lipid microdomains, where a number of signaling events takes place (58).The aim of this study was to elucidate the internalization mechanism of CAV9 in A549 human lung carcinoma cells. We used chemical inhibitors, RNA interference (RNAi) silencing, and the expression of dominant negative constructs combined to virus infectivity assays and confocal imaging to examine which cellular molecules are involved in the entry process. The results indicate that CAV9 internalization is dependent on integrin αVβ6, β2M, dynamin 2, and Arf6 (ADP-ribosylation factor 6) but not clathrin or caveolin-1.     

Evolutionary Dynamics and Temporal/Geographical Correlates of Recombination in the Human Enterovirus Echovirus Types 9, 11, and 30

The relationship between virus evolution and recombination in species B human enteroviruses was investigated through large-scale genetic analysis of echovirus type 9 (E9) and E11 isolates (n = 85 and 116) from 16 European, African, and Asian countries between 1995 and 2008. Cluster 1 E9 isolates and genotype D5 and A E11 isolates showed evidence of frequent recombination between the VP1 and 3Dpol regions, the latter falling into 23 (E9) and 43 (E11) clades interspersed phylogenetically with 46 3Dpol clades of E30 and with those of other species B serotypes. Remarkably, only 2 of the 112 3Dpol clades were shared by more than one serotype (E11 and E30), demonstrating an extremely large and genetically heterogeneous recombination pool of species B nonstructural-region variants. The likelihood of recombination increased with geographical separation and time, and both were correlated with VP1 divergence, whose substitution rates allowed recombination half-lives of 1.3, 9.8, and 3.1 years, respectively, for E9, E11, and E30 to be calculated. These marked differences in recombination dynamics matched epidemiological patterns of periodic epidemic cycles of 2 to 3 (E9) and 5 to 6 (E30) years and the longer-term endemic pattern of E11 infections. Phylotemporal analysis using a Bayesian Markov chain Monte Carlo method, which placed recombination events within the evolutionary reconstruction of VP1, showed a close relationship with VP1 lineage expansion, with defined recombination events that correlated with their epidemiological periodicity. Whether recombination events contribute directly to changes in transmissibility that drive epidemic behavior or occur stochastically during periodic population bottlenecks is an unresolved issue vital to future understanding of enterovirus molecular epidemiology and pathogenesis.Human enteroviruses (HEV) are single-stranded, positive-sense RNA viruses in the virus family Picornaviridae. Infections with these viruses are enterically transmitted and normally cause subclinical or mild symptoms, but they are also capable of causing a wide array of often severe disease presentations, including aseptic meningitis, encephalitis, and acute flaccid paralysis. Echovirus type 9 (E9) and E11 are serotypes of species B enteroviruses and are among the most common etiological agents of aseptic meningitis (14). The first epidemiological study of E9 investigated isolates obtained from sick children in 1995 (24). E9 is chiefly associated with mild infections affecting children over the age of 5 years and teenagers, although it can cause more severe syndromes in neonates and immunosuppressed patients (14). E11 infections, which predominantly affect infants less than 1 year old, have been associated with large outbreaks of uveitis in infants (15, 21), sepsis, and other neonatal systemic illnesses with high mortality rates (14, 23).Circulating strains and genotypes of E9 (2, 8, 11, 14) and E11 (4, 7, 21) have been characterized in many different countries through analysis of the structural genome regions, principally VP1. In common with other mammalian RNA viruses, both E9 and E11 show rapid accumulation of nucleotide substitutions over time, but their epidemiologies are distinct. E9 is associated with widespread, large-scale seasonal outbreaks and displays a regular epidemic pattern of outbreaks occurring approximately every 3 years (8, 14). Outbreaks of E11 are less common, occur irregularly, and often last for several years (14, 25).In contrast to time-related diversification observed in the capsid-encoding regions of the HEV genome, nonstructural region genes are subject to frequent recombination (7, 18, 19, 26, 30), leading to the concept of separate, modular evolution of the structural and nonstructural regions of the HEV genome (20). Recombination in the nonstructural gene region of HEV is limited to members of the same species (27). In a recent large-scale investigation of echovirus type 30 (E30) molecular epidemiology, phylogenetic analysis of the 3Dpol region revealed the existence of a number of discrete, bootstrap-supported clades, allowing circulating E30 variants to be classified into a series of distinct recombinant forms (RFs) (22). Individual RFs became very rapidly disseminated over large geographical distances through repeated cycles of emergence, dominance, and disappearance in a 3- to 5-year cycle.In the current study, we carried out parallel investigations of the molecular epidemiology and evolution of clinically presenting isolates of E9 and E11 collected in 16 countries in Europe, central Asia, Southeast Asia, and West Africa over a 14-year period. By comprehensive sequencing of these isolates in the structural (VP1) and nonstructural (3Dpol) genome regions, it was possible to explore the dynamics of sequence diversification and recombination. The turnover of individual recombinant groups and the phylogeographical correlates of recombination were determined and compared to those of E30, providing new insights into the nature of the global spread of these important viral pathogens and the role of recombination in enteroviral evolution.     

Microbial dextran-hydrolyzing enzymes: fundamentals and applications.

Dextran is a chemically and physically complex polymer, breakdown of which is carried out by a variety of endo- and exodextranases. Enzymes in many groups can be classified as dextranases according to function: such enzymes include dextranhydrolases, glucodextranases, exoisomaltohydrolases, exoisomaltotriohydrases, and branched-dextran exo-1,2-alpha-glucosidases. Cycloisomalto-oligosaccharide glucanotransferase does not formally belong to the dextranases even though its side reaction produces hydrolyzed dextrans. A new classification system for glycosylhydrolases and glycosyltransferases, which is based on amino acid sequence similarities, divides the dextranases into five families. However, this classification is still incomplete since sequence information is missing for many of the enzymes that have been biochemically characterized as dextranases. Dextran-degrading enzymes have been isolated from a wide range of microorganisms. The major characteristics of these enzymes, the methods for analyzing their activities and biological roles, analysis of primary sequence data, and three-dimensional structures of dextranases have been dealt with in this review. Dextranases are promising for future use in various scientific and biotechnological applications.     

Effect of Deworming on Physical Fitness of School-Aged Children in Yunnan,China: A Double-Blind,Randomized, Placebo-Controlled Trial

Background

There is considerable debate on the health impacts of soil-transmitted helminth infections. We assessed effects of deworming on physical fitness and strength of children in an area in Yunnan, People''s Republic of China, where soil-transmitted helminthiasis is highly endemic.

Methodology

The double-blind, randomized, placebo-controlled trial was conducted between October 2011 and May 2012. Children, aged 9–12 years, were treated with either triple-dose albendazole or placebo, and monitored for 6 months post-treatment. The Kato-Katz and Baermann techniques were used for the diagnosis of soil-transmitted helminth infections. Physical fitness was assessed with a 20-m shuttle run test, where the maximum aerobic capacity within 1 min of exhaustive exercise (VO₂ max estimate) and the number of 20-m laps completed were recorded. Physical strength was determined with grip strength and standing broad jump tests. Body height and weight, the sum of skinfolds, and hemoglobin levels were recorded as secondary outcomes.

Principal Findings

Children receiving triple-dose albendazole scored slightly higher in the primary and secondary outcomes than placebo recipients, but the difference lacked statistical significance. Trichuris trichiura-infected children had 1.6 ml kg⁻¹ min⁻¹ (P = 0.02) less increase in their VO₂ max estimate and completed 4.6 (P = 0.04) fewer 20-m laps than at baseline compared to non-infected peers. Similar trends were detected in the VO₂ max estimate and grip strength of children infected with hookworm and Ascaris lumbricoides, respectively. In addition, the increase in the VO₂ max estimate from baseline was consistently higher in children with low-intensity T. trichiura and hookworm infections than in their peers with high-intensity infections of all soil-transmitted helminths (range: 1.9–2.1 ml kg⁻¹ min⁻¹; all P<0.05).

Conclusions/Significance

We found no strong evidence for significant improvements in physical fitness and anthropometric indicators due to deworming over a 6-month follow-up period. However, the negative effect of T. trichiura infections on physical fitness warrants further investigation.     

PATHOGEN LIFE‐HISTORY TRADE‐OFFS REVEALED IN ALLOPATRY

Trade‐offs in life‐history traits is a central tenet in evolutionary biology, yet their ubiquity and relevance to realized fitness in natural populations remains questioned. Trade‐offs in pathogens are of particular interest because they may constrain the evolution and epidemiology of diseases. Here, we studied life‐history traits determining transmission in the obligate fungal pathogen, Podosphaera plantaginis, infecting Plantago lanceolata. We find that although traits are positively associated on sympatric host genotypes, on allopatric host genotypes relationships between infectivity and subsequent transmission traits change shape, becoming even negative. The epidemiological prediction of this change in life‐history relationships in allopatry is lower disease prevalence in newly established pathogen populations. An analysis of the natural pathogen metapopulation confirms that disease prevalence is lower in newly established pathogen populations and they are more prone to go extinct during winter than older pathogen populations. Hence, life‐history trade‐offs mediated by pathogen local adaptation may influence epidemiological dynamics at both population and metapopulation levels.     

Synergistic antitumour activity of RAF265 and ZSTK474 on human TT medullary thyroid cancer cells

Medullary thyroid cancer (MTC) is an aggressive malignancy responsible for up to 14% of all thyroid cancer‐related deaths. It is characterized by point mutations in the rearranged during transfection (RET) proto‐oncogene. The activated RET kinase is known to signal via extracellular signal regulated kinase (ERK) and phosphoinositide 3‐kinase (PI3K), leading to enhanced proliferation and resistance to apoptosis. In the present work, we have investigated the effect of two serine/threonine‐protein kinase B‐Raf (BRAF) inhibitors (RAF265 and SB590885), and a PI3K inhibitor (ZSTK474), on RET‐mediated signalling and proliferation in a MTC cell line (TT cells) harbouring the RETC634W activating mutation. The effects of the inhibitors on VEGFR2, PI3K/Akt and mitogen‐activated protein kinases signalling pathways, cell cycle, apoptosis and calcitonin production were also investigated. Only the RAF265+ ZSTK474 combination synergistically reduced the viability of treated cells. We observed a strong decrease in phosphorylated VEGFR2 for RAF265+ ZSTK474 and a signal reduction in activated Akt for ZSTK474. The activated ERK signal also decreased after RAF265 and RAF265+ ZSTK474 treatments. Alone and in combination with ZSTK474, RAF265 induced a sustained increase in necrosis. Only RAF265, alone and combined with ZSTK474, prompted a significant drop in calcitonin production. Combination therapy using RAF265 and ZSTK47 proved effective in MTC, demonstrating a cytotoxic effect. As the two inhibitors have been successfully tested individually in clinical trials on other human cancers, our preclinical data support the feasibility of their combined use in aggressive MTC.     

Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

ContextAdvance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.ObjectiveTo investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.DesignAn explanatory systematic review of qualitative implementation studies.MethodsDirect content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.Results13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.ConclusionsThis review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows.     

Effects of DPP-4 inhibitors on the heart in a rat model of uremic cardiomyopathy

Background

Uremic cardiomyopathy contributes substantially to mortality in chronic kidney disease (CKD) patients. Glucagon-like peptide-1 (GLP-1) may improve cardiac function, but is mainly degraded by dipeptidyl peptidase-4 (DPP-4).

Methodology/Principal Findings

In a rat model of chronic renal failure, 5/6-nephrectomized [5/6N] rats were treated orally with DPP-4 inhibitors (linagliptin, sitagliptin, alogliptin) or placebo once daily for 4 days from 8 weeks after surgery, to identify the most appropriate treatment for cardiac dysfunction associated with CKD. Linagliptin showed no significant change in blood level AUC(0-∞) in 5/6N rats, but sitagliptin and alogliptin had significantly higher AUC(0-∞) values; 41% and 28% (p = 0.0001 and p = 0.0324), respectively. No correlation of markers of renal tubular and glomerular function with AUC was observed for linagliptin, which required no dose adjustment in uremic rats. Linagliptin 7 µmol/kg caused a 2-fold increase in GLP-1 (AUC 201.0 ng/l*h) in 5/6N rats compared with sham-treated rats (AUC 108.6 ng/l*h) (p = 0.01). The mRNA levels of heart tissue fibrosis markers were all significantly increased in 5/6N vs control rats and reduced/normalized by linagliptin.

Conclusions/Significance

DPP-4 inhibition increases plasma GLP-1 levels, particularly in uremia, and reduces expression of cardiac mRNA levels of matrix proteins and B-type natriuretic peptides (BNP). Linagliptin may offer a unique approach for treating uremic cardiomyopathy in CKD patients, with no need for dose-adjustment.     

Highly pathogenic avian influenza virus H5N1 infection in a long-distance migrant shorebird under migratory and non-migratory states

Corticosterone regulates physiological changes preparing wild birds for migration. It also modulates the immune system and may lead to increased susceptibility to infection, with implications for the spread of pathogens, including highly pathogenic avian influenza virus (HPAIV) H5N1. The red knot (Calidris canutus islandica) displays migratory changes in captivity and was used as a model to assess the effect of high plasma concentration of corticosterone on HPAIV H5N1 infection. We inoculated knots during pre-migration (N = 6), fueling (N = 5), migration (N = 9) and post-migration periods (N = 6). Knots from all groups shed similar viral titers for up to 5 days post-inoculation (dpi), peaking at 1 to 3 dpi. Lesions of acute encephalitis, associated with virus replication in neurons, were seen in 1 to 2 knots per group, leading to neurological disease and death at 5 to 11 dpi. Therefore, the risk of HPAIV H5N1 infection in wild birds and of potential transmission between wild birds and poultry may be similar at different times of the year, irrespective of wild birds'' migratory status. However, in knots inoculated during the migration period, viral shedding levels positively correlated with pre-inoculation plasma concentration of corticosterone. Of these, knots that did not become productively infected had lower plasma concentration of corticosterone. Conversely, elevated plasma concentration of corticosterone did not result in an increased probability to develop clinical disease. These results suggest that birds with elevated plasma concentration of corticosterone at the time of migration (ready to migrate) may be more susceptible to acquisition of infection and shed higher viral titers—before the onset of clinical disease—than birds with low concentration of corticosterone (not ready for take-off). Yet, they may not be more prone to the development of clinical disease. Therefore, assuming no effect of sub-clinical infection on the likelihood of migratory take-off, this may favor the spread of HPAIV H5N1 by migratory birds over long distances.