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CXCL5 Into the Upper Airways of Children with Influenza a Virus

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CXCL5 Into the Upper Airways of Children with Influenza a Virus APORTACIONES ORIGINALES Annett Duemmler,1 Aurea Rosalía Montes-Vizuet,2 Julio Santiago Cruz,2 CXCL5 into the upper airways of children Luis Manuel Terán2 with influenza A virus infection 1University of Bremen, RESUMEN SUMMARY Germany Introducción: la infiltración por neutrófilos es una Background: neutrophil infiltration is a major fea- 2Instituto Nacional característica importante en la patogenia de la in- ture in the pathogenesis of influenza infection. The de Enfermedades fección por influenza. Los factores que regulan la factors regulating the neutrophil influx are not fully Respiratorias, afluencia de neutrófilos no están completamente understood. The chemokine CXCL5/ENA-78 is a Secretaría de Salud, establecidos. Nuestro objetivo fue estudiar la li- potent neutrophil chemoattractant, that has been Distrito Federal, México beración de CXCL5 , potente quimioatrayente de implicated in several inflammatory diseases. Our neutrófilos, en niños con influenza naturalmente objectives was to study the release of CXCL5 in adquirida. children with natural acquired influenza. Comunicación con: Luis Manuel Terán. Métodos: la concentración de CXCL5 fue investi- Methods: CXCL5 concentration was investigated by Tel/fax: (55) 5487 1740. gada mediante ensayo inmunoenzimático en as- immunoenzyme assay in nasal aspirates of children Correo electrónico: pirados nasales de niños (n = 18) con síntomas (n = 18) in whom respiratory symptoms were pre- [email protected] respiratorios desencadenados predominantemen- cipitated predominantly by influenza A virus. te por el virus de la influenza A. Results: there were increased CXCL5 levels in na- Resultados: se encontró incremento en los niveles de sal aspirates when children were symptomatic as CXCL5 en aspirados nasales obtenidos cuando los compared with samples from the same children niños presentaban síntomas respiratorios, compara- when they had been asymptomatic for four weeks dos con muestras de los mismos niños obtenidas des- (medians 1850 pg/mL vs. 30 pg/mL, p < 0.005). We pués de cuatro semanas sin síntomas (medianas purified CXCL5 from these samples, and demon- 1850 pg/mL adversus 30 pg/mL, p < 0.005). CXCL5 strated biological neutrophil chemotactic activity. fue purificada de las muestras y se demostró activi- Conclusions: it is the first in vivo data that sug- dad biológica quimiotáctica para neutrófilos. gest an important role for CXCL5 in neutrophil Conclusiones: se sugiere un papel importante para influx in proven upper respiratory influenza infec- CXCL5 en la atracción de neutrófilos a las vías tion. We suggest that CXCL5 might provide a tar- aéreas superiores en infección respiratoria desen- get for therapeutic intervention in influenza cadenada por virus de la influenza, y podría ser un induced respiratory diseases. blanco para la intervención terapéutica. Palabras clave influenza humana subtipo H1N1 del virus Introduction climates between late fall and spring. The average de la influenza A “flu season“ in the United States is marked by 30,000- neutrófilos Influenza viruses (IV) are major cause of respiratory 40,000 deaths per year primarily in elderly patients quimiocinas infection in humans and result in substantial illness, with significant comorbidity and in the very young. It death and economic burden throughout the world.1 is now well established that neutrophils play an Key words There are two major types of human influenza viruses, important role in influenza respiratory infections.2 To influenza, human A and B; the influenza A strains are responsible for date, the 2009 Influenza A virus (IAV) (H1N1) has influenza A virus, H1N1 seasonal or pandemic influenza. Influenza illness is killed over 7820 people worldwide.3 Increased num- subtype characterized by fever, lower and upper respiratory ber of neutrophils count in blood has been found, but neutrophils symptoms, myalgia, malaise and occurs in temperate also in nasal secretions, bronchoalveolar lavage and chemokines Rev Med Inst Mex Seguro Soc 2010; 48 (4): 393-398 393 Duemmler A et al. sputum of patients suffering IAV infection.3-5 Animal the release of CXCL5 in nasal aspirate of children CXCL5 in influenza A studies have shown an induced neutrophil influx into with natural acquired influenza infection. virus infection the lung of IAV infected mice.6,7 H5N1 infection cau- ses excessive infiltration of neutrophils into the res- piratory tract of mice.8 The year 1918 pandemic IAV Methods strain increased the influx compared to infection with other human strains of IAV.9 In this model, depletion Nasal aspirates of 18 children (aged 6-12 years) with of neutrophils before infection reduced survival. upper respiratory symptoms caused by IV (n = 18) Although the role of neutrophils is not well defi- were analyzed. These 18 children were selected from ned, it is known that they act as effectors cells in a longitudinal study on virus respiratory infection defense and eliminate viruses from sites of infec- conducted at the Instituto Nacional de Enfermeda- tion.10,11 Electron microscopy studies have shown that, des Respiratorias. Nasal control samples were obtai- neutrophils incorporate IAV particles into phagosoms ned from 12 children when they were symptom free. and lyse them.7 Similarly, a specific binding of neu- The hospital’s ethic committee approved the study. trophils to IAV infected cells was found.12 Hence neu- We obtained written and verbal consent from parents trophils may play a direct role in viral clearance. and children. Neutrophils are derived from primitive precursor Subjective respiratory symptoms’ children were cells in the bone marrow. Once mature, they circle in recorded in a diary and the peak flow rates measured the peripheral blood. The recruitment of neutrophils daily. Assessments of respiratory symptoms were as to the site of infection is regulated by chemokines follows-0: absent; 1: mild; 2: moderate; 3: severe. which lead to adhesion of neutrophils to endothelial Upper respiratory tract symptoms included: runny/ cells, transendothelial migration, chemotactic move- blocked nose, sneezing, sore throat, hoarse voice, ment, degranulation and stimulation of respiratory headaches, pains elsewhere, shivers, chills or fever. burst.13 CXCL5, also known as ENA-78 (Epithelial Lower respiratory tract symptoms were: cough, neutrophil activating protein 78), member of CXC wheeze and/or breathlessness during day or night. chemokine family, is a neutrophil chemoattractant14,15 Scores were added to give daily upper and lower whose role in virus influenza infection has not been respiratory tract scores. investigated in detail. Our objective was to investigate When upper respiratory tract score was 1, nasal aspirates were collected with a suction pump and homogenized in virus transport medium [L-15 (Gibco- BRL) (9 volumes) supplemented with 1000 IU/mL penicillin (PISA), 1000 μg/mL streptomycin (PISA), Table I Differential and total cell counts (x 105/mL) in 0.5 % bovine serum albumin (BSA) (Sigma)], and nasal aspirate (NA)* immediately transported in ice bath to the laboratory where it was centrifuged (2500xg, 10 min, 10 ºC). Influenza Without virus infection Supernatant was recovered and used for cytokine (n = 18) (n = 12) detection; cell pellet was used to study nasal recruited cells. Controls were obtained from the same chil- Lym 12.0* 0.2 dren (n = 12) when they were free of symptoms. (3 -53) (0-4) Macro 8.2* 0.3 Viral detection (0-19) (0-2) Epi 10.5* 2.0 It was identified IAV infection by viral isolation (2.8 - 45) (0-10) technique and immunofluorescence assay as previo- Neut 220* 1.3 usly described.15 Briefly, cell suspension (0.5 mL) (190.3) (0.5-5) Total 242* 2.8 and respective sample supernatant (0.5 mL) were (26-126) (0-6) added to Madin-Darby Canine Kidney cell mono la- yers, incubated (60 min, 37 °C, 5 % CO2), washed *p < 0.001 compared to asymptomatic (Kruskal-Wallis test); with phosphate buffered saline (PBS) and incubated asymptomatic, for ≥ 10 days with minimum essential medium Lym = lymphocytes, Macro = macrophages, Epi = epithelial (GibcoBRL) containing 1000 IU/mL penicillin cells, Neut = neutrophils (PISA), 1000 mg/mL streptomycin (PISA) and Number of cells in NA is expressed as medians with ranges 250 mg/mL amphotericin B (Squibb). When cyto- shown in parentheses pathic effect (CPE) was extensive, 5 mL of detached 394 Rev Med Inst Mex Seguro Soc 2010; 48 (4): 393-398 cell suspension was centrifuged (200xg, 10 min), Neutrophils chemotaxis assay Duemmler A et al. pellet resuspended in 5 mL PBS, spread onto immu- CXCL5 in influenza A nofluorescence slides (15 μL) and airdried. Uninfec- Chemotaxis assays were performed in modified Bo- virus infection ted and infected cell controls were included. From yden chambers (Neuroprobe). Neutrophils were CPE negative cultures a second successive culture purified from blood of healthy volunteers, by centri- was made. Cell smears were processed using immu- fugation onto Polymorphprep (Axis-Shield POC) nofluorescence kit (Chemicon) according to pro- and adjusted to 105 cells/mL in RPMI-1640 medium. vider’s description. Samples, positive and negative controls (90 µl each) were added separately into lower compartments of Differential cell counts chemotaxis chamber. A polycarbonate filter (Nucleo- pore 3 µm) separated upper and lower compartment. Cells obtained from nasal aspirates were resuspended The chamber was firmly clamped. Upper compart- in PBS (106 cells/mL). An aliquot of cells (50 μl) ments were filled with neutrophils suspension was subjected to cytocentrifugation
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