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JEMI-PEARLS Disease Management for Adenovirus 36-Induced Obesity Vol 2:40-46 JEMI-PEARLS Disease Management for Adenovirus 36-Induced Obesity Betty Zhou Department of Microbiology and Immunology, University of British Columbia BACKGROUND INFORMATION………………………………………………………………………………………....…..40 RESEARCH QUESTIONS…………………………………………………………………………………………….…...….41 PROJECT NARRATIVE What biomarkers could be indicative of susceptibility or protection to adenovirus 36-induced obesity?.......42 What is the reservoir for adenovirus 36-induced obesity?.............................................................................43 What treatment or prevention strategies would be most effective against adenovirus 36-induced obesity?..........................................................................................................................................................43 SUMMARY & CONCLUSION…………………………………………………………………………………………………45 ACKNOWLEDGEMENTS……………………………………………………………………………………………………..46 REFERENCES……………………………………………………………………………………………………………….....46 BACKGROUND INFORMATION address the economic burden associated with the The World Health Organization (WHO) defines obesity exponentially increasing rates of obesity worldwide. as having a Body Mass Index (BMI) of 30 or greater [1]. The Centers for Disease Control and Prevention (CDC) In 1997, the WHO declared obesity as a global epidemic released a series of adult obesity prevalence maps from in developed and developing countries, with obesity 1985 to 2007 showing the rapid increase in obesity rates continuing to increase exponentially [1]. In 1995, prevalence in the US [5]. These map show obesity 200 million adults worldwide were obese and this predominantly spreading from neighbouring states, number rapidly increased to 600 million in 2014 [1]. suggesting that obesity may have an infectious origin. From 2011 to 2012, Statistics Canada estimated that 6.3 The trend from these maps also align with the term million adult Canadians are living with obesity, which “Infectobesity”, meaning obesity of infectious origin, suggest that approximately one in four Canadians are introduced by Dr. Nikhil Dhurandhar [6, 7]. obese [1]. In addition to negatively impacting the Dhurandhar et al. first reported the association between mental and physiological health of individuals, obesity adenovirus and obesity, with adenovirus 36 (Ad36) leads to large economic burdens approximating to an being the first human adipogenic virus reported. annual cost of 4.6 billion in Canada [2, 3]. The causes of Adenovirus serotypes 5 and 37 were also later reported obesity are multifactorial, with behavior factors such as to be associated with obesity in humans [4]. Previously, overeating and low physical activity traditionally Other non-human viruses such as Canine distemper thought to be the main contributing factors [4]. virus (CDV), Rous-associated virus (RAV-7), borna Therefore, conventional treatment and prevention disease virus (BDV) and SMAM-1 were also reported to strategies for obesity often include restriction on diet be associated with obesity [7]. and management of physical activity, which provide Adenoviruses are members of the Adenoviridae family minimal effect on sustainable improvements for obesity and are non-enveloped, icosahedral, doubled stranded [4]. These behavioural interventions are ineffective because such interventions are often irrespective of the Received: Feb./17 Accepted: Feb./17 Published: July/17 cause of obesity. Therefore, cause-specific treatments Citation Zhou, B. 2017. Disease Management for Adenovirus 36- and prevention strategies are urgently needed to Induced Obesity. JEMI-PEARLS. 2:40-46. July 2017 Volume 2 JEMI-PEARLS Undergraduate Review Article 40 DNA viruses with greater than 50 serotypes known to Multiple correlational studies on different populations cause disease in humans [8]. Adenoviruses commonly have been investigated in attempt to establish an infect the upper respiratory tract, gastrointestinal tract association between Ad36-infection and obesity. and conjunctiva and are transmitted through airborne Atkinson et al. released the first correlational study spread, direct contact or fecal-oral route [8]. Adenovirus between Ad36 infection and obesity in humans. The infections are prevalent worldwide with majority of study was performed in the US, showing that 30% of infections occurring in obese individuals young children and rarely compared to 11% of non- causing serious disease in In 1997, the WHO declared obese individuals were immunocompetent seropositive for Ad36 [4]. individuals [8]. obesity as a global Furthermore, the study Ad36 is the most epidemic in developed and showed that Ad36 researched human “ ” seropositive individuals, adipogenic virus because developing countries, with whether obese or non- of its low cross-reactivity obese, had a significantly with other serotypes [4]. obesity rates continuing to higher BMI than Ad36 was first isolated in increase exponentially seronegative individuals Germany from the feces of [4]. The most convincing girl with enteritis and human study showing the diabetes [4, 9]. Animal models of chickens, mice, rats correlation between Ad36 and human obesity involved and marmosets showed causality between Ad36 26 pairs of twins, 20 monozygotic and 6 dizygotic; the infection and adiposity, along with a nine year study showed Ad36-seropositive twins to have a longitudinal study in rhesus monkeys showing that significantly higher BMI and body fat than their naturally Ad36-infected monkeys had a 15% increase in seronegative twin [4]. Additionally, further studies bodyweight [4]. Moreover, transfusion of blood from shown in Table 1 performed in the US, Italy and Turkey Ad36-infected animals to an uninfected recipient showed strong correlation between Ad36-seropositivity caused the recipient to become Ad36-infected and obese and obesity in adults and children [10, 11, 12, 13]. [4, 9]. Numerous studies have suggested that Ad36 Although strong correlations between Ad36 infection promotes obesity by increasing adipogenesis and and obesity in children and adults have been maintaining low grade chronic inflammation [9]. In vitro established in certain populations such as the US, and in vivo studies both suggest that Ad36 promotes the Turkey and Italy, one study performed in the proliferation and differentiation of adipose-tissue Netherlands showed low Ad36 prevalence and no derived stem cells towards adipogenic lineage, correlation between Ad36 and obesity (Table 1) [10, 11, increasing the number of adipocytes [4, 9]. The 12, 13, 14]. Therefore, the following article uses mechanisms leading to obesity from Ad36 infection is longitudinal studies to determine the pathological not well understood, but adiposity and low-grade interplay between Ad36 infection and obesity in chronic inflammation are speculated to have an humans in order to provide cause-specific treatment important role in maintaining obesity. In Ad36-infected and prevention strategies for improving the global animal models, adiposity has been associated with the obesity epidemic. upregulation of PPAR-γ and C/EBP, which are key RESEARCH QUESTIONS transcription factors for adipogenesis [8]. In addition, Discovering effective, sustainable treatment and Ad36 viral E4 orf-1 gene has been shown to stimulate prevention strategies for obesity is currently and will proadipogenic differentiation in 3T3-L1 and human continue to be a pressing issue as obesity rates continue adipose stem cells [8]. Adipokines, such as monocyte to increase exponentially while conventional treatments chemotactic protein (MCP-1), and the phagocytic role of provide unsustainable benefits [4]. Studies have shown adipose tissue contribute to maintaining low-grade adenovirus vaccines to be safe and efficacious, chronic inflammation [4]. Therefore, literature suggest suggesting that Ad36 vaccine development may be an that Ad36 appear to promote chronic obesity in animal attractive avenue against Ad36-induced obesity [15]. In models by sustaining inflammation and expanding addition, the gut microbiota has been shown to be a adipose tissue. major player in obesity and should be researched July 2017 Volume 2 JEMI-PEARLS Undergraduate Review Article 41 further to determine the relations between Ad36- provide constructive solutions to address the infection, the gut microbiota and obesity [4, 8, 16, 17, 18]. worldwide obesity epidemic. This review will address three essential questions to aid the development of personalized therapies for PROJECT NARRATIVE Ad36-induced obesity with the ultimate goal of What biomarkers could be indicative of susceptibility improving the global obesity epidemic. Numerous or protection to adenovirus 36-induced obesity? studies in humans have shown a strong correlation As shown in Table 1, the percentage of Ad36- between Ad36-seropositivity and obesity while a few seropositivity is significantly higher in obese than non- studies have shown low Ad36 prevalence with no obese individuals in the US, Italy and Turkey [10, 11, 12, correlation between Ad36-seropositivity and obesity 13]. On the contrary, the Netherland population shows [10, 11, 12, 13, 14]. This discrepancy could be an no significant correlation between Ad36-seropositivity indication of susceptibility or protection against Ad36- and obesity [14]. Obesity is a metabolic disease and induced obesity, which prompts further investigations substantial numbers of studies have reported the into such populations to detect for biomarkers, hence contribution of the gut microbiota in obesity [4, 8, 16, 17,
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