Lower respiratory tract infections caused by influenza A continue to exact unacceptable worldwide mortality, and recent epidemics have emphasized the importance of preventative and containment strategies. We have previously reported that induction of the lungs' intrinsic defenses by aerosolized treatments can protect mice against otherwise lethal challenges with influenza A virus. More recently, we identified a combination of Toll like receptor (TLR) agonists that can be aerosolized to protect mice against bacterial pneumonia. Here, we tested whether this combination of synthetic TLR agonists could enhance the survival of mice infected with influenza A/HK/8/68 (H3N2) or A/California/04/2009 (H1N1) influenza A viruses. We report that the TLR treatment enhanced survival whether given before or after the infectious challenge, and that protection tended to correlate with reductions in viral titer 4 d after infection. Surprisingly, protection was not associated with induction of interferon gene expression. Together, these studies suggest that synergistic TLR interactions can protect against influenza virus infections by mechanisms that may provide the basis for novel therapeutics.
References
[1]
Mizgerd JP (2006) Lung infection–a public health priority. PLoS Med 3: e76.
[2]
Mizgerd JP (2008) Acute lower respiratory tract infection. N Engl J Med 358: 716–727.
[3]
WHO (2004) The World Health Report 2004 – Changing History. Geneva: World Health Organization.
[4]
Dushoff J, Plotkin JB, Viboud C, Earn DJ, Simonsen L (2006) Mortality due to influenza in the United States–an annualized regression approach using multiple-cause mortality data. Am J Epidemiol 163: 181–187.
[5]
Rothberg MB, Haessler SD, Brown RB (2008) Complications of viral influenza. Am J Med 121: 258–264.
[6]
Johnson NP, Mueller J (2002) Updating the accounts: global mortality of the 1918–1920 “Spanish” influenza pandemic. Bull Hist Med 76: 105–115.
[7]
Fidler DP, Gostin LO (2011) The WHO pandemic influenza preparedness framework: a milestone in global governance for health. Jama 306: 200–201.
[8]
Friede M, Palkonyay L, Alfonso C, Pervikov Y, Torelli G, et al. (2011) WHO initiative to increase global and equitable access to influenza vaccine in the event of a pandemic: supporting developing country production capacity through technology transfer. Vaccine 29: Suppl 1A2–7.
[9]
Abdel-Ghafar AN, Chotpitayasunondh T, Gao Z, Hayden FG, Nguyen DH, et al. (2008) Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med 358: 261–273.
[10]
Fang LQ, de Vlas SJ, Liang S, Looman CW, Gong P, et al. (2008) Environmental factors contributing to the spread of H5N1 avian influenza in mainland China. PLoS ONE 3: e2268.
[11]
Hilleman MR (2002) Overview: cause and prevention in biowarfare and bioterrorism. Vaccine 20: 3055–3067.
[12]
Hamad M (2011) Universal vaccines: shifting to one for many or shooting too high too soon! APMIS 119: 565–573.
[13]
Rage A, Hassan T (2011) Improving Influenza Vaccination Rates by Targeting Individuals not Seeking Early Seasonal Vaccination. Am J Med 124: e9.
[14]
(2011) Influenza vaccination coverage among pregnant women — United States, 2010–11 influenza season. MMWR Morb Mortal Wkly Rep 60: 1078–1082.
[15]
(2011) Influenza vaccination coverage among health-care personnel — United States, 2010–11 influenza season. MMWR Morb Mortal Wkly Rep 60: 1073–1077.
[16]
(2011) Place of influenza vaccination among adults — United States, 2010–11 influenza season. MMWR Morb Mortal Wkly Rep 60: 781–785.
[17]
Ambrose CS, Levin MJ, Belshe RB (2011) The relative efficacy of trivalent live attenuated and inactivated influenza vaccines in children and adults. Influenza Other Respi Viruses 5: 67–75.
[18]
Belshe RB (2010) The need for quadrivalent vaccine against seasonal influenza. Vaccine 28: Suppl 4D45–53.
[19]
Mohty B, Bel M, Vukicevic M, Nagy M, Levrat E, et al. (2011) Graft-versus-host disease is the major determinant of humoral responses to the AS03-adjuvanted influenza A/09/H1N1 vaccine in allogeneic hematopoietic stem cell transplant recipients. Haematologica 96: 896–904.
[20]
Meier S, Bel M, L'Huillier A, Crisinel PA, Combescure C, et al. (2011) Antibody responses to natural influenza A/H1N1/09 disease or following immunization with adjuvanted vaccines, in immunocompetent and immunocompromised children. Vaccine 29: 3548–3557.
[21]
Crawford NW, Bines JE, Royle J, Buttery JP (2011) Optimizing immunization in pediatric special risk groups. Expert Rev Vaccines 10: 175–186.
[22]
Clement CG, Evans SE, Evans CM, Hawke D, Kobayashi R, et al. (2008) Stimulation of lung innate immunity protects against lethal pneumococcal pneumonia in mice. Am J Respir Crit Care Med 177: 1322–1330.
[23]
Clement CG, Tuvim MJ, Evans CM, Tuvin DM, Dickey BF, et al. (2009) Allergic lung inflammation alters neither susceptibility to Streptococcus pneumoniae infection nor inducibility of innate resistance in mice. Respir Res 10: 70.
[24]
Evans SE, Scott BL, Clement CG, Larson DT, Kontoyiannis D, et al. (2010) Stimulated innate resistance of lung epithelium protects mice broadly against bacteria and fungi. Am J Respir Cell Mol Biol 42: 40–50.
[25]
Evans SE, Tuvim MJ, Fox CJ, Sachdev N, Gibiansky L, et al. (2011) Inhaled Innate Immune Ligands To Prevent Pneumonia. Br J Pharmacol.
[26]
Evans SE, Xu Y, Tuvim MJ, Dickey BF (2010) Inducible innate resistance of lung epithelium to infection. Annu Rev Physiol 72: 413–435.
[27]
Tuvim MJ, Evans SE, Clement CG, Dickey BF, Gilbert BE (2009) Augmented lung inflammation protects against influenza A pneumonia. PLoS ONE 4: e4176.
[28]
Duggan JM, You D, Cleaver JO, Larson DT, Garza RJ, et al. (2011) Synergistic Interactions of TLR2/6 and TLR9 Induce a High Level of Resistance to Lung Infection in Mice. J Immunol 186: 5916–5926.
[29]
Wong JP, Christopher ME, Viswanathan S, Karpoff N, Dai X, et al. (2009) Activation of toll-like receptor signaling pathway for protection against influenza virus infection. Vaccine 27: 3481–3483.
[30]
Lau YF, Tang LH, Ooi EE, Subbarao K (2010) Activation of the innate immune system provides broad-spectrum protection against influenza A viruses with pandemic potential in mice. Virology 406: 80–87.
[31]
Lau YF, Tang LH, Ooi EE (2009) A TLR3 ligand that exhibits potent inhibition of influenza virus replication and has strong adjuvant activity has the potential for dual applications in an influenza pandemic. Vaccine 27: 1354–1364.
[32]
Ichinohe T, Watanabe I, Tao E, Ito S, Kawaguchi A, et al. (2006) Protection against influenza virus infection by intranasal vaccine with surf clam microparticles (SMP) as an adjuvant. J Med Virol 78: 954–963.
[33]
Ichinohe T, Watanabe I, Ito S, Fujii H, Moriyama M, et al. (2005) Synthetic double-stranded RNA poly(I:C) combined with mucosal vaccine protects against influenza virus infection. J Virol 79: 2910–2919.
[34]
Sanders CJ, Doherty PC, Thomas PG (2011) Respiratory epithelial cells in innate immunity to influenza virus infection. Cell Tissue Res 343: 13–21.
[35]
Clark NM, Lynch JP (2011) Influenza: epidemiology, clinical features, therapy, and prevention. Semin Respir Crit Care Med 32: 373–392.
[36]
Pizzorno A, Abed Y, Boivin G (2011) Influenza drug resistance. Semin Respir Crit Care Med 32: 409–422.
[37]
Pizzorno A, Bouhy X, Abed Y, Boivin G (2011) Generation and characterization of recombinant pandemic influenza A(H1N1) viruses resistant to neuraminidase inhibitors. J Infect Dis 203: 25–31.
[38]
Garcia-Sastre A (2006) Antiviral response in pandemic influenza viruses. Emerg Infect Dis 12: 44–47.
[39]
Wang JP, Kurt-Jones EA, Finberg RW (2007) Innate immunity to respiratory viruses. Cell Microbiol 9: 1641–1646.
[40]
Dolowschiak T, Chassin C, Ben Mkaddem S, Fuchs TM, Weiss S, et al. (2010) Potentiation of epithelial innate host responses by intercellular communication. PLoS Pathog 6: e1001194.
[41]
Jurk M, Kritzler A, Debelak H, Vollmer J, Krieg AM, et al. (2006) Structure-activity relationship studies on the immune stimulatory effects of base-modified CpG toll-like receptor 9 agonists. ChemMedChem 1: 1007–1014.
[42]
Vollmer J, Jurk M, Samulowitz U, Lipford G, Forsbach A, et al. (2004) CpG oligodeoxynucleotides stimulate IFN-gamma-inducible protein-10 production in human B cells. J Endotoxin Res 10: 431–438.
[43]
Vollmer J, Krieg AM (2009) Immunotherapeutic applications of CpG oligodeoxynucleotide TLR9 agonists. Adv Drug Deliv Rev 61: 195–204.
[44]
Vollmer J, Weeratna R, Payette P, Jurk M, Schetter C, et al. (2004) Characterization of three CpG oligodeoxynucleotide classes with distinct immunostimulatory activities. Eur J Immunol 34: 251–262.
[45]
Krieg AM (2006) Therapeutic potential of Toll-like receptor 9 activation. Nat Rev Drug Discov 5: 471–484.
[46]
Evans CM, Williams OW, Tuvim MJ, Nigam R, Mixides GP, et al. (2004) Mucin is produced by clara cells in the proximal airways of antigen-challenged mice. Am J Respir Cell Mol Biol 31: 382–394.
[47]
Wyde PR, Couch RB, Mackler BF, Cate TR, Levy BM (1977) Effects of low- and high-passage influenza virus infection in normal and nude mice. Infect Immun 15: 221–229.
[48]
Gilbert BE, Wyde PR, Ambrose MW, Wilson SZ, Knight V (1992) Further studies with short duration ribavirin aerosol for the treatment of influenza virus infection in mice and respiratory syncytial virus infection in cotton rats. Antiviral Res 17: 33–42.
[49]
Wikenheiser KA, Vorbroker DK, Rice WR, Clark JC, Bachurski CJ, et al. (1993) Production of immortalized distal respiratory epithelial cell lines from surfactant protein C/simian virus 40 large tumor antigen transgenic mice. Proc Natl Acad Sci U S A 90: 11029–11033.