Genomic and molecular determinants of EV-D68 neuroinvasive disease

中枢神经系统（CNS）的病毒感染是发病和死亡的重要原因 国际吧抗病毒治疗仅限于少数几种病毒，即使存在治疗方法（如阿昔洛韦）， 单纯疱疹病毒性脑炎）的残疾和死亡率仍然很高。我们对病毒性中枢神经系统感染的了解， 特别是涉及脊髓的那些，是有限的，并作为一个障碍，对新的发展， 这些毁灭性疾病的治疗方法。肠道病毒是引起病毒性中枢神经系统疾病的重要原因 感染.脊髓灰质炎病毒是神经营养性肠道病毒中最臭名昭著的成员。然而，一些非- 脊髓灰质炎人肠道病毒（NPEV），包括EV-D 68，也靶向CNS。NPEV很常见， 据估计，仅在美国，每年就有1000万至1500万有症状的感染。虽然这些感染中的大多数 这些病毒不会导致中枢神经系统疾病，但可以获得神经毒性的能力。最近， NPEV已经在世界范围内发生，与神经系统疾病相关，这些病毒是 被称为“重新出现的病原体”。例如，2014年，美国发生了急性 在全国范围内爆发的先前罕见的肠道病毒D 68（EV-1）期间， D 68）呼吸系统疾病。大约50%的AFM患者呼吸道分泌物中有EV-D 68。然而，在这方面， 在任何患者的脑脊液中均未检测到EV-D 68，从而阻止了致病性的建立。 EV-D 68和AFM之间的连接。我们最近表明，许多（包括IL/52和MO/47），但不是全部， (such作为CA 4231），来自2014年爆发的EV-D 68临床分离株在新生小鼠中引起神经系统疾病 并建议使用这种病毒诱导的CNS疾病的新模型来定义EV-1的模式和机制。 D 68引起的瘫痪使用嵌合病毒，我们已经证明，5'非翻译区（UTR）， 病毒结构蛋白VP 3和VP 1是瘫痪的决定因素。在拟议的研究中，我们将使用 类似的方法来确定哪些病毒序列参与瘫痪的特定机制，包括 神经元感染和凋亡。增加了对EV相关致病机制的认识， D 68诱导的CNS疾病将为EV-D 68诱导的AFM的抗病毒药物的开发提供信息。另外通过 将我们的努力集中在宿主对EV-D 68感染的反应上，我们的实验可以确定治疗性的 这些策略对其他电动汽车具有广泛的适用性。我们的研究也可能与 CNS疾病的其他病毒和非病毒原因。

Virus infections of the central nervous system (CNS) are a significant cause of morbidity and mortality worldwide. Proven treatments are limited to only a few viruses and even when treatments exist (e.g. acyclovir for herpes simplex encephalitis) disability and death remain significant. Our knowledge of viral CNS infections, particularly those involving the spinal cord, is limited and serves as a barrier against the development of novel treatments for these devastating diseases. Enteroviruses are an important cause of virus-induced CNS infections. Poliovirus is the most infamous member of the neurotrophic enteroviruses. However, several non- polio human enteroviruses (NPEVs), including EV-D68, also target the CNS. NPEVs are common, causing an estimated 10–15 million symptomatic annual infections in the US alone. Although most of these infections do not result in CNS disease, these viruses can acquire the ability to be neuro-virulent. Recently, large outbreaks of NPEVs have occurred worldwide that have been associated with neurologic disease and these viruses are designated “re-emerging pathogens”. For example, in 2014, the United States experienced an epidemic of acute flaccid myelitis (AFM) cases in children during a nationwide outbreak of previously rare enterovirus D68 (EV- D68) respiratory disease. Approximately 50% of AFM patients had EV-D68 in respiratory secretions. However, EV-D68 was not detected in the cerebrospinal fluid of any patient, preventing the establishment of a causative link between EV-D68 and AFM. We have recently shown that many (including IL/52 and MO/47), but not all (such as CA4231), clinical isolates of EV-D68 from the 2014 outbreak cause neurologic disease in neonatal mice and propose to use this novel model of virus-induced CNS disease to define patterns and mechanisms of EV- D68-induced paralysis. Using chimeric viruses we have demonstrated that the 5’ untranslated region (UTR) and the viral structural proteins VP3 and VP1 are determinants of paralysis. In the proposed studies we will use similar methods to determine which viral sequences are involved in specific mechanisms of paralysis, including neuronal infectivity and apoptosis. An increased knowledge of pathogenic mechanisms that are involved in EV- D68-induced CNS disease will inform the development of antivirals for EV-D68-induced AFM. In addition, by focusing our efforts on host responses to EV-D68 infections our experiments may identify therapeutic strategies that have broad spectrum applicability to additional EVs. Our studies may also have relevance for other viral and non-viral causes of CNS disease.