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* Institute of Clinical and Molecular Virology, German National Reference Centre for Retroviruses,
Department of Ophthalmology, and
Department of Internal Medicine III with Institute for Clinical Immunology, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
Plasmacytoid dendritic cells (PDC), the main producers of type I IFNs in the blood, are important for the recognition and control of viral and bacterial infections. Because several viruses induce IFN-
production, severe courses of herpes virus infections in nonimmunocompromised patients may be related to numerical or functional PDC deficits. To evaluate this hypothesis, PBMC and PDC were repeatedly isolated from nine patients with acute retinal necrosis (ARN), caused by herpes simplex or varicella zoster virus. The patients experienced meningitis/encephalitis and frequent infections in childhood (n = 2), recurrent herpes virus infections at unusual localizations (n = 2), ocular surgery (n = 1), infections (n = 4), and stress around ARN (n = 6). The median percentage of isolated PDC was significantly lower in patients compared with 18 age-matched healthy controls (p < 0.001), confirmed by FACS analysis using peripheral blood, and was extremely low during acute disease. PDC counts dropped in five controls suffering from respiratory infections or diarrhea. IFN- production in PDC and PBMC exposed to different stimuli was significantly lower in patients than in controls (p < 0.05). Anergy to these stimuli was observed on four occasions, in particular during acute disease. PDC of patients showed up-regulated IFN regulatory factor-7 mRNA levels and evidence of in vivo activation (CD80) and maturation (CD83) (p < 0.05). CD8+ cell responses were significantly lower in patients vs controls (p = 0.04). These data support a risk factor model in which numerical and functional deficits in PDC-mediated innate immune responses contribute to an impaired control of latent herpes virus infections and subsequent development of ARN.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
1 This work was supported by the German Research Foundation (Grant SCHM 1702/1-1; SFB466, Project A12; Grant SCHM1702/2-1) (to B.S.), the Graduate College GRK1071 ("Viruses of the Immune System") (to N.A.K. and S.H.), and the "Akademie der Wissenschaften und Literatur zu Mainz."
2 N.A.K. and A.B. contributed equally to the work.
3 Address correspondence and reprint requests to Dr. Barbara Schmidt, Institute of Clinical and Molecular Virology, German National Reference Centre for Retroviruses, Schlossgarten 4, D-91054 Erlangen, Germany. E-mail address: baschmid{at}viro.med.uni-erlangen.de
4 Abbreviations used in this paper: ARN, acute retinal necrosis; VZV, varicella zoster virus; PDC, plasmacytoid dendritic cell; MDC, myeloid dendritic cell; lin, lineage; IRF, IFN regulatory factor; IQR, interquartile range.
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