Hall Olivia J, Nachbagauer Raffael, Vermillion Meghan S, Fink Ashley L, Phuong Vanessa, Krammer Florian, Klein Sabra L
W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Virol. 2017 Mar 29;91(8). doi: 10.1128/JVI.02160-16. Print 2017 Apr 15.
In addition to their intended use, progesterone (P4)-based contraceptives promote anti-inflammatory immune responses, yet their effects on the outcome of infectious diseases, including influenza A virus (IAV) infection, are rarely evaluated. To evaluate their impact on immune responses to sequential IAV infections, adult female mice were treated with placebo or one of two progestins, P4 or levonorgestrel (LNG), and infected with a mouse-adapted H1N1 (maH1N1) virus. Treatment with P4 or LNG reduced morbidity but had no effect on pulmonary virus titers during primary H1N1 infection compared to placebo treatment. In serum and bronchoalveolar lavage fluid, total anti-IAV IgG and IgA titers and virus-neutralizing antibody titers but not hemagglutinin stalk antibody titers were lower in progestin-treated mice than placebo-treated mice. Females were challenged 6 weeks later with either an maH1N1 drift variant (maH1N1dv) or maH3N2 IAV. The level of protection following infection with the maH1N1dv was similar among all groups. In contrast, following challenge with maH3N2, progestin treatment reduced survival as well as the numbers and activity of H1N1- and H3N2-specific memory CD8 T cells, including tissue-resident cells, compared with placebo treatment. In contrast to primary IAV infection, progestin treatment increased the titers of neutralizing and IgG antibodies against both challenge viruses compared with those achieved with placebo treatment. While the immunomodulatory properties of progestins protected immunologically naive female mice from the severe outcomes from IAV infection, it made them more susceptible to secondary challenge with a heterologous IAV, despite improving their antibody responses against a secondary IAV infection. Taken together, the immunomodulatory effects of progestins differentially regulate the outcome of infection depending on exposure history. The impact of hormone-based contraceptives on the outcome of infectious diseases outside the reproductive tract is rarely considered. Using a mouse model, we have made the novel observation that treatment with either progesterone or a synthetic analog found in hormonal contraceptives, levonorgestrel, impacts sequential influenza A virus infection by modulating antibody responses and decreasing the numbers and activity of memory CD8 T cells. Progestins reduced the antibody responses during primary H1N1 virus infection but increased antibody titers following a sequential infection with either an H1N1 drift variant or an H3N2 virus. Following challenge with an H3N2 virus, female mice treated with progestins experienced greater mortality with increased pulmonary inflammation and reduced numbers and activity of CD8 T cells. This study suggests that progestins significantly affect adaptive immune responses to influenza A virus infection, with their effect on the outcome of infection depending on exposure history.
除了其预期用途外,基于孕酮(P4)的避孕药还能促进抗炎免疫反应,然而它们对包括甲型流感病毒(IAV)感染在内的传染病结局的影响却很少被评估。为了评估它们对连续IAV感染免疫反应的影响,成年雌性小鼠接受安慰剂或两种孕激素之一(P4或左炔诺孕酮(LNG))治疗,并感染适应小鼠的H1N1(maH1N1)病毒。与安慰剂治疗相比,P4或LNG治疗可降低发病率,但对初次H1N1感染期间的肺部病毒滴度没有影响。在血清和支气管肺泡灌洗液中,孕激素治疗的小鼠中总的抗IAV IgG和IgA滴度以及病毒中和抗体滴度低于安慰剂治疗的小鼠,但血凝素茎抗体滴度没有差异。6周后,雌性小鼠用maH1N1漂移变体(maH1N1dv)或maH3N2 IAV进行攻击。所有组中感染maH1N1dv后的保护水平相似。相比之下,用maH3N2攻击后,与安慰剂治疗相比,孕激素治疗降低了生存率以及H1N1和H3N2特异性记忆CD8 T细胞(包括组织驻留细胞)的数量和活性。与初次IAV感染不同,与安慰剂治疗相比,孕激素治疗增加了针对两种攻击病毒的中和抗体和IgG抗体滴度。虽然孕激素的免疫调节特性保护了免疫未成熟的雌性小鼠免受IAV感染的严重后果,但尽管改善了它们针对继发性IAV感染的抗体反应,却使它们更容易受到异源IAV的二次攻击。综上所述,孕激素的免疫调节作用根据暴露史差异调节感染结局。基于激素的避孕药对生殖道外传染病结局的影响很少被考虑。使用小鼠模型,我们有了一个新的发现,即使用孕激素或激素避孕药中发现的合成类似物左炔诺孕酮进行治疗,通过调节抗体反应和减少记忆CD8 T细胞的数量和活性来影响连续的甲型流感病毒感染。孕激素在初次H1N1病毒感染期间降低了抗体反应,但在随后用H1N1漂移变体或H3N2病毒进行连续感染后增加了抗体滴度。在用H3N2病毒攻击后,接受孕激素治疗的雌性小鼠死亡率更高,肺部炎症增加,CD8 T细胞数量和活性降低。这项研究表明,孕激素显著影响对甲型流感病毒感染的适应性免疫反应,其对感染结局的影响取决于暴露史。