www.fisiokinesiterapia.biz Retrovirus e cancerogenesi HTLV-1 e HTLV-2 I retrovirus • 1911: Virus del Sarcoma di Rous Francis Peyton Rous (1879-1970) • 1970: trascrittasi inversa Fonti: La Placa, Principi di Microbiologia Medica, X Edizione. Esculapio Ed. Rapporto virus-cellula •Il rapporto virus-cellula infetta può sfociare in: •una infezione citocida (malattia acuta) •latente (malattia recidivante) •persistente (malattia cronica) Infezione citocida Infezione latente Infezione latente In vitro Il virus realizza Il virus realizza un rapporto un rapporto di parassitismo di parassitismo controllato controllato, con continua produzione che consente alle cellule di antigeni virali. non solo di sopravvivere, Le lesioni cellulari ma anche di duplicarsi sono dovute Il genoma virale può ad azioni lesive essere integrato esercitate in tempi con quello della cellula ospite. più o meno lunghi Inclusioni cellulari Il virus permane nella dalle risposte immunitarie degenerazione spongiforme cellula in forma criptica dell’ospite Degenerazione cellulare In vivo La produzione di malattia è un evento raro Risposta cellulare Risposta ospite Lisi cellulare Decesso Formazione inclusi virali Malattia Trasformazione cellulare Disfunzioni cellulari Moltiplicazione virale in assenza di lesioni Ciclo abortivo Infezione asintomatica Esposizione senza infezione Esposizione senza penetrazione Concetto iceberg Rapporto virus-cellula •Il rapporto virus-cellula infetta può sfociare in: •una infezione citocida (malattia acuta) •latente (malattia recidivante) •persistente (malattia cronica) •trasformazione neoplastica I virus oncogeni hanno la capacità di trasformare (immortalizzare) cellule normali in colture in vitro, bloccandone la differenziazione e conferendo loro numerose proprietà della cellula neoplastica. I virus oncogeni •Virus in grado di indurre o di concorrere alla comparsa di alterazioni del ciclo cellulare. L’oncogenesi è un processo graduale: non sempre la formazione del tumore rappresenta una inevitabile conseguenza dell’infezione virale. L’oncogenesi prevede una serie di cambi indipendenti ma irreversibili che insieme contribuiscono alla dis-regolazione della crescita tumorale. L’infezione virale rappresenta uno di questi step. E solo se succedono altri eventi nella stessa cellula, assisteremo allo sviluppo del cancro. Oncogenesi virale: quali meccanismi? I meccanismi con cui un virus provoca un tumore sono molto divergenti, ma hanno tutti alcune caratteristiche in comune… a) una singola particella virale è sufficiente per la trasformazione. Non è necessaria una infezione multipla della stessa cellula. b) tutto o parte del genoma persiste nella cellula trasformata. Comunque, spesso non c’è produzione di progenie infettante. c) in tutti i casi di trasformazione indotta del virus, almeno una parte del genoma viene espresso nelle cellule trasformate d) la trasformazione è il risultato della rottura dei segnali normali di crescita cellulare. Caratteristiche delle cellule neoplastiche • Immortalizzazione • Aumento dell'attività telomerasica: nella cellula normale la telomerasi è repressa. La lunghezza del telomero è un orologio biologico, che ci dice quanto la cellula può arrivare a vivere. Quando i telomeri sono troppo corti, la cellula non è più in grado di replicarsi. La telomerasi è attiva nelle cellule staminali • • • • • • Mancanza della inibizione da contatto Glicolisi aerobia aumentata (la produzione di ATP è aumentata) Presentazione di nuovi antigeni (presenti solo nella vita fetale) Genoma virale totalmente o parzialmente integrato Produzione di proteine precoci Corredo cromosomico alterato Meccanismo dell’azione patogena Oncogene (v-onc) Protooncogeni (c-onc) Sono pressoché identici ai geni cellulari Attivi durante il processo di moltiplicazione e differenziazione cellulare e cessano di funzionare nei tessuti differenziati I prodotti (proteine) intervengono nelle varie fasi della mitosi cellulare Sono sotto il controllo di antioncogeni o geni oncosoppressori Meccanismo dell’azione patogena Presenza di v-onc Assenza di v-onc Mancanza di controllo da parte di anti-oncogeni o geni onco-soppressori Il virus si integra vicino ad un oncogene cellulare e ne induce la trascrizione oppure influenzano negativamente la funzione degli onco-soppressori Aumentata proliferazione cellulare Human pathogenic retroviruses Lentivirinae Human immunodeficiency virus type 1 Human immunodeficiency virus type 2 Oncovirinae Human T-lymphotropic virus type 1 (HTLV-1) Human T-lymphotropic virus type 2 (HTLV-2) Human T-lymphotropic virus type 3 (HTLV-3) simian origin Human T-lymphotropic virus type 4 (HTLV-4) no known primate counterpart T-lymphotropic viruses Human T-lymphotropic virus type 1 (HTLV-1) 1980 Human T-lymphotropic virus type 2 (HTLV-2) 1982 The long history of HTLV in human populations Genetic heterogeneity and stability of the HTLV genome Virus biology The Associated diseases Diagnosis The long history of HTLV in human populations The endemicity of HTLV-1 and HTLV-2 in some populations living in remote areas of the globe, suggests the possibility that these viruses have been infecting human since several thousands of years oldest proto-Africans Efe Mbuti Pygmies The long history of HTLV in human populations HTLV-1 and HTLV-2 infections among Pygmies are ancient origin result of more recent interspecies transmission of STLVs: jumping from primates to humans STLV-1 infects most primate species in Africa and Asia and has been associated with lymphoma and leukemia PTLV-I: HTLV-1 and STLV-I PTLV-II : HTLV-2/STLV-II Stability of the HTLV genome RNA viruses evolve at the rate of 10-3 to 10-5 nucleotide substitution per site per year but HTLV-1 and HTLV-2 have a very stable genome Why? • • • HTLVs are slowly replicating viruses HTLV mutation rates are unusually low, due to a high fidelity reverse transcriptase After the integration in the host genome, HTLVs predominantly propagate as proviral DNA during cellular mitosis using the host cell machinery. HTLV-1 and 2 subtypes • • • • HTLV-1a, the Cosmopolitan subtype, joins strains from different geographic regions HTLV-1b, also known as Central African subtype, joins strains isolated from Central Africa populations HTLV-1c is the Melanesian subtype to which belong the divergent strains isolated in Papua New Guinea and from Australian aboriginals HTLV-1d has been recently described as a new distinct molecular subtype isolated from Cameroonian pygmies and from an infected Gabonese individual • • • HTLV-2 isolates: prevalent in Southeastern Europe HTLV-2a subtypes: prevalent in Northern European IDUs, such as in UK, Ireland and Sweden HTLV-2b subtypes: isolated in Florida, Panama, Colombia, Argentina, Paraguay, Chile Map of distribution of HTLV/STLV viral isolates of known geographic origin HTLV-1 STLV-1 Slattery et al., 1999 HTLV-2 STLV-2 HTLVs Biology HTLVs have a central icosahedral nucleocapsid surrounded by a round shaped envelope and the virions are seen as spherical particles of about 100 nm in diameter HTLV 1 and 2: same genomic organization and up to 65-70% of nucleotide similarity The novel HTLV receptor Endothelial cells GLUT1 glucose transporter erythrocytes Pericyte Neuronal cells Infection Skeletal muscle cells First step is the attachment of the virus to the cell surface through a specific interaction between its envelope glycoproteins and a specific cell surface receptor (GLUT1 glucose transporter) Manel et al., Cell 2003 Glucose Transporter GLUT-1 and the paradox The apparently restricted tropism of HTLV to T lymphocytes in infected patients contrasts with the ability of the viral-encoded envelope glycoprotein (Env) to bind to and direct entry into all vertebrate cell types tested in vitro In vitro Several different cell types can be infected In vivo HTLV-1 and 2 can infect CD4+ and CD8+ T-cells HTLV-1 primarily has a CD4+ tropism HTLV-2 primarily has CD8+ tropism. …….what happened during the first phase of infection? Glucose Transporter GLUT-1 Envelope virus/GLUT interaction inhibited glucose uptake and consumption decreased lactate production and a drop in the acidification of the extracellular milieu GLUT-1 is not expressed on resting T lymphocytes whereas the GLUT 2-4 isoforms are present and GLUT-1 is induced upon immunological or pharmacological activation. 1 2 Early after infection Rapid and dramatic metabolic alterations associated with decreased glucose consumption. HTLV initially spreads with a large tropism……….. 3 In contrast, T lymphocytes that have a low metabolic rate and as such are much less dependent on glucose uptake, are more likely to tolerate this effect and survive infection. the vast majority of cells that are dependent on GLUT-1 activity and concomitantly express the HTLV envelope are rapidly eliminated tax inhibition of tumor suppressor proteins CREB, NF-KB, AP-1 Up-regulation of several cytokines, cytokine receptor, and induction of gene expression (such as c-jun, API-1, c-Fra, BCL-2) Promotes viral transcription Critical factors for cancerogenesis p53 repression TGF-β inhibition Cellular proliferation cytopenia HTLV-1 Tax tumor Haematopoietic precursors TGF-β stimulation TGF-β proliferation TGF-β inhibition HIV-Tat The proliferation of infected cells is promoted by Tax expression CTLs attack the Tax-expressing cells since Tax is their major target Rex, p30 and HBZ suppress Tax expression. Expansion of infected CD4+ cells Suppression of Tax by Rex, p30 and HBZ ATL Alterations of HTLV-1 infected cells Tax genome expression Cell-to cell transmission Suppression of Tax by CTL On the other hand, loss of Tax expression is frequently observed in leukemic cells. Three mechanisms have been identified for inactivation of Tax expression: 1) genetic changes of the tax gene (nonsense mutations, deletions or insertions) 2) DNA methylation of the 5'-LTR and 3) deletion of the 5'-LTR Loss of Tax expression gives ATL cells advantage for their survival since they can escape from CTLs. Matsuoka et al. 2005 HTLV-1 and associated diseases • • • Adult T-cell Leukemia (ATL) The lifetime risk of developing ALT in HTLV-1 seropositive individuals in about 0.1% to 5% The latency period is usually more than 20 years ATL is classified in four clinical stages Lymphoma Smouldering Chronic Acute type HTLV-1 and associated diseases Tropical spastic paraparesis/HTLV associated myelopathy (TSP/HAM) • • • • A slowly progressive myelopathy with spastic paraparesis of lower extremities Moreover…. variable peripheral sensory abnormalities, hyperreflexia, bladder and bowel dysfunction, male impotence. The lifetime risk of developing the disease in HTLV-1 seropositive patients is less than 1%, with a mean age of onset of about 40 years The incubation time can greatly vary and it can be as short as a few weeks in patients who get the infection from blood transfusions. HTLV-2 associated diseases Firstly isolated from a patient with hairy-cell leukaemia …………………. Most of the HTLV-2 infected individuals are asymptomatic during their entire life. Recently there have been increasing evidences that the infection may be associated with neurological disorders HTLV-2 RNA is found in HAM-like lesions of the central nervous system Moreover, an increased prevalence of infectious diseases, such as pneumonia, minor fungal infection or kidney infection, has been associated with the presence of HTLV-2 HTLV-2 is present at significant rate among injecting drug users (IDUs) co-infected by HIV-1 HTLV-2 and human progenitor cells No infection! HTLV-2 Mo viral strain T cell derived CD34 T cell Apoptosis protection CD34 CD34 CD34 by enhancement of telomerase activity and the induction of bcl-2 expression Casoli et al 1999; Re at al. 2000 HTLV-2 and HIV-1. Does an interaction exist? • HTLV-II can interfere with the replicative potential of HIV-1 by upregulating viral suppressive CC-chemokines and, in particular, MIP1alpha. • HTLV-II can influence HIV replication, at least in vitro, via upregulation of HIV-suppressive chemokines HTLV-2 and HIV-1. Does an interaction exist? CD4 HIV-1 CTL HTLV-2 CD8 CC-Chemokines (Mip1α, Mip1β, Rantes) Spontaneous proliferation of T cell •HTLV-II can interfere with the replicative potential of HIV-1 by up-regulating viral suppressive CC-chemokines and, in particular, MIP-1alpha. …… HTLV-II can influence HIV replication, at least in vitro, via up-regulation of HIV-suppressive chemokines HTLV-1 and 2: diagnosis of infection • • • Immunoenzymatic assay Immunoblotting Provirus detection (qualitative and/or quantitative PCR) HTLV-1 and 2: diagnosis of infection • Immunoblotting: The first antibodies, which appeared within 2 months after exposure, were directed against rgp21 and were followed by antibodies to p24 and p19. • the Public Health Service Working Group has recommended that a serum should be considered as HTLV-antibody positive when reactive to p24 and to gp46 or gp61/68 HTLV-1 and 2: diagnosis of infection Blood donor screening for HTLV was introduced in: • • • 1980s: first in Japan 1988 - 1989 in the United States and Canada 1991 in France HTLV-1 and 2: diagnosis of infection The prevalence of confirmed positive tests among tissue donors was 0.093 % for anti-HIV 0.229 % for HBsAg 1.091 % for anti-HCV 0.068 % for anti-HTLV The estimated probability of viremia at the time of donation was 1 in 55,000 for anti-HIV 1 in 34,000 for HBsAg 1 in 42,000 for anti-HCV 1 in 128,000 for anti-HTLV …………..the probability of collecting blood products from a viremic donor is extremely low, it is not negligible.…………… An imported case of adult T cell leukemia in a HTLV-Iinfected patient, in Italy •From an epidemiological point of view, it is important to report a case of imported ATL in a non-endemic area, as it may explain the otherwise untraceable origin of some rare and apparently autochthonous cases of ATL in non-endemic areas ………………… Re et al. 2003 and 2004