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Journal of Virology, April 2004, p. 3455-3461, Vol. 78, No. 7
0022-538X/04/$08.00+0 DOI: 10.1128/JVI.78.7.3455-3461.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
John J. MacKey,2 Vuong Nguyen,1 Jaap M. Middeldorp,3 Jon C. Aster,1 and Fred Wang4*
Departments of Pathology,1 Medicine, BrighamWomen's Hospital, Harvard Medical School, Boston, Massachusetts 02115,4 Department of Pathology, New England Primate Research Center, Harvard Medical School, Southborough, Massachusetts 01772,2 Department of Pathology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands3
Received 10 October 2003/ Accepted 2 December 2003
| ABSTRACT |
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| INTRODUCTION |
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The traditional paradigm for primary EBV infection places virus infection and replication in oral epithelial cells as a critical step between oral inoculation of virus and invasion of the peripheral blood B-cell compartment (22). However, this model has been challenged by the inability to detect EBV infection in the tonsillar epithelium of infectious mononucleosis patients (10, 13). This has led some to speculate that EBV infection of epithelial cells is not an important step for primary EBV infection and that orally inoculated virus may bypass epithelial cells and directly infect B cells. The apparent lack of persistent EBV infection and virus in oral secretions of patients with X-linked agammaglobulinemia who lack B cells is also consistent with the possibility that epithelial cell infection is not important and that the principal source of infectious EBV in oral secretions is from EBV-infected B cells in tonsillar tissue rather than infected epithelial cells (4).
Other explanations may contribute to the apparent inability to detect EBV infection in epithelial cells of immunocompetent hosts. The tonsil may not be the optimal site for EBV infection of oral epithelium, and patients presenting with clinically advanced infectious mononucleosis requiring tonsillectomy may be beyond the optimal time points for peak epithelial cell infection. Persistent EBV infection in epithelial cells may be cryptic in immunocompetent hosts, with only occasional latently infected cells dispersed in various anatomical locations. Patterns of viral gene expression may be different in epithelial cells than in B cells. For example, in situ hybridization (ISH) for the abundant small EBV-encoded RNAs (EBERs) is frequently used as a sensitive assay for EBV infection in B cells, but EBERs are not commonly expressed in the EBV-infected epithelial cells of oral hairy leukoplakia (6). Reactivation of lytic EBV infection in epithelial cells should result in easily detectable viral gene expression, but reactivation may be occurring in sites that are difficult to access and biopsy in otherwise healthy individuals. Thus, it remains uncertain whether epithelial cell infection with EBV is a normal component of the acute and persistent EBV life cycle.
Studies of nonhuman primate herpesviruses closely related to and in the same lymphocryptovirus (LCV) genus as EBV can provide an animal model system to study EBV pathogenesis (12). The rhesus LCV genome has been completely sequenced, and the viral gene repertoire is identical to that of EBV (18). Like EBV, the rhesus LCV efficiently immortalizes B cells in tissue culture (15). As is the case for humans, nearly all rhesus monkeys raised in conventional domestic colonies have a persistent, asymptomatic rhesus LCV infection that can be detected in the peripheral blood lymphocytes of healthy, seropositive animals (16). Rhesus LCV is also associated with the development of B-cell lymphomas in immunosuppressed monkeys (9, 15). Thus, there is considerable genetic and biologic evidence that rhesus LCV infection of B cells is very similar to EBV infection. Viral DNA can be detected in the oral secretions of persistently infected monkeys, and naive rhesus macaques can be successfully infected by experimental oral virus inoculation, suggesting that the mode of transmission is also similar to that of EBV infection in humans (12). However, to date there has been no definitive evidence that the rhesus LCV can infect epithelial cells. In the present study, we describe naturally occurring rhesus LCV-infected epithelial cell lesions in immunosuppressed macaques that resemble oral hairy leukoplakia. These studies demonstrate that like EBV, rhesus LCV has tropism for both B cells and epithelial cells in vivo and that this animal model system should be useful for exploring the role of epithelial cells in EBV infection.
| MATERIALS AND METHODS |
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Electron microscopy. A 5.0-µm section of formalin-fixed esophagus (A02-303) immunostained with anti-BZLF1 was processed for transmission electron microscopy as previously described (2). In brief, toluene was used to remove the coverslip and in the preparation of the fixative and resin. The fixed tissue was postfixed in 1% osmium tetroxide (Stevens Metallurgical Corp., New York, N.Y.), dehydrated, and embedded in eponate 12 resin (Ted Pella, Redding, Calif.). Ultrathin sections were cut on a Leica Ultracut R ultramicrotome and stained with uranyl acetate and Sato's lead stain (19). The sections were examined on a JEOL 1010 transmission electron microscope.
Rhesus LCV serology. Serum antibodies to the rhesus LCV small viral capsid antigen (sVCA) were detected by using an sVCA peptide enzyme immunoassay as previously described (16).
EBER ISH. RNA ISH for EBER expression was performed as previously described (20).
CISH. Chromogenic ISH (CISH) for the presence of LCV DNA was performed on formalin-fixed, paraffin-embedded tissue after pretreatment with methanol-0.5% peroxide for 20 min followed by proteinase K (1:5 dilution; Dako, Carpinteria, Calif.) at room temperature for 10 min. Rhesus LCV cosmids CC1, QA15, and LV28 (18) were mixed in equal portions, and the rhesus LCV DNA was labeled with digoxigenin (Roche). Hybridization with the digoxigenin-labeled rhesus LCV DNA probe was carried out for 10 min at 75°C followed by 4 h at 37°C. Slides were washed three times and incubated with 10% goat serum in 50 mM Tris-Cl (pH 7.4) for 20 min to block nonspecific binding sites. Next, rabbit antidigoxigenin (1:150 dilution; Dako) was applied in 50 mM Tris-HCl (pH 7.4) with 3% goat serum at room temperature for 1 h. Slides were washed in 50 mM Tris-HCl (pH 7.4), and goat anti-rabbit horseradish peroxidase-conjugated antibody (Envision+ detection kit; Dako) was applied for 30 min. After further washing, immunoperoxidase staining was developed by using a diaminobenzidine (DAB) chromogen kit (Dako) according to the instructions of the manufacturer and counterstained with methyl green counterstain.
Anti-BZLF1 and anti-EBNA-2 immunohistochemistry. Immunohistochemistry for LCV immediate-early viral lytic protein (BZLF1, clone BZ.1; Dako) and EBV-encoded nuclear antigen 2 (EBNA-2, clone PE2; Dako) was performed on 5.0-µm sections from formalin-fixed, paraffin-embedded tissues. Both antibodies are known to cross-react with the respective rhesus LCV homologues based on the detection of an appropriately sized protein by Western blot analysis of cells transfected with recombinant expression plasmids and expression of the respective recombinant rhesus LCV genes. The sections were deparaffinized and rehydrated. Endogenous peroxidase activity was quenched with a hydrogen peroxide block for 5 min. Antigen retrieval was achieved by microwaving for 20 min. The sections were treated with Dako Protein Block for 10 min and incubated at 4°C overnight with the primary antibody (BZLF1 diluted 1:80 or EBNA-2 diluted 1:6400). The secondary antibody, biotinylated horse anti-mouse immunoglobulin G (Vector Laboratories, Burlingame, Calif.) diluted 1:200, was applied for 30 min, followed by a 30-min incubation with Vectastain ABC Elite. The reaction was visualized by using DAB chromogen (Dako), and the slides were counterstained with Mayer's hematoxylin.
Anti-sVCA immunohistochemistry. Immunohistochemistry for LCV sVCA (anti-sVCA-p18; BFRF3) was performed with 5.0-µm-thick formalin-fixed, paraffin-embedded tissue sections. Briefly, slides were deparaffinized and pretreated with 10 mM sodium citrate buffer (pH 6.0) (Zymed, South San Francisco, Calif.) in a steam pressure cooker (Decloaking Chamber; BioCare Medical, Walnut Creek, Calif.) according to the manufacturer's instructions, followed by washing in distilled water. All further steps were performed at room temperature in a hydrated chamber. Slides were pretreated with Peroxidase Block (Dako) for 5 min to quench endogenous peroxidase activity followed by a 1:5 dilution of goat serum in 50 mM Tris-HCl (pH 7.4) for 20 min to block nonspecific binding sites. Primary rat anti-sVCA antibody (OT15E, anti-sVCA-p18) (BFRF3; Cyto-Barr BV, Bergen, The Netherlands) was applied at a 1:250 dilution in 50-mM Tris-HCl (pH 7.4) with 3% goat serum for 1 h. After washing in 50 mM Tris-HCl (pH 7.4), secondary rabbit anti-rat antibody (Dako) was applied at a 1:7,500 dilution in 50 mM Tris-HCl (pH 7.4) with 3% goat serum for 30 min. Slides were washed again in 50 mM Tris-HCl (pH 7.4), and goat anti-rabbit horseradish peroxidase-conjugated antibody (Envision+ detection kit; DAKO) was applied for 30 min. After further washing, immunoperoxidase staining was developed by using a DAB chromogen kit (Dako) according to the instructions of the manufacturer and counterstained with Harris hematoxylin.
| RESULTS |
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Since the hyperplastic mucosal epithelium and evidence for active herpesvirus infection were reminiscent of oral hairy leukoplakia, additional studies were focused on definitively identifying whether infection with an EBV-related herpesvirus was associated with the macaque epithelial lesions. Testing of available serum samples showed that all animals had serologic evidence of infection with the EBV-related LCV that naturally infects rhesus macaques (Table 1). Histologic sections were stained with an EBV BZLF1 monoclonal antibody that was known to cross-react with the rhesus LCV BZLF1 homologue. All lesions were positive for the immediate-early viral lytic protein, BZLF1 (Fig. 1E and Table 1). To provide confirmation and further characterization of lytic infection in these lesions, a second monoclonal antibody, OT15E, which is specific for the EBV sVCA, was identified based on its ability to cross-react with an 18-kDa protein in rhesus LCV-infected cells induced for lytic viral replication (data not shown). Immunohistochemistry with the OT15E antibody showed strong expression of sVCA in all lesions examined, demonstrating active lytic infection throughout the histologically abnormal areas of all lesions (Fig. 1F and 2B, D, F, and H; Table 1). Both BZLF1 and sVCA antibodies detected viral gene expression in virtually all cells with intranuclear inclusions and were restricted to cells in the upper stratified epithelium. There was a sharp demarcation with no staining of adjacent normal epithelium, and control sections from animals without epithelial cell lesions did not stain with the BZLF1 and sVCA antibodies, demonstrating the specificity of the immunohistochemical staining (Fig. 2J).
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Five of seven lesions were also positive for EBNA-2 expression by using a monoclonal antibody that is known to detect a conserved epitope in the carboxy-terminal acidic transactivating domain of the EBV, baboon, and rhesus LCV EBNA-2 homologues (Table 1). EBNA-2 is an EBV latent infection protein and is not typically associated with lytic replication. However, aberrant EBNA-2 expression has also been described in association with active viral replication in oral hairy leukoplakia (24). ISH for the rhesus LCV EBER homologues was negative in five of six cases, and in one case epithelial cells were positive for EBER expression (Table 1). These small, nonpolyadenylated RNAs are typically expressed at very high copy numbers in latently infected cells, and EBER ISH is commonly used to detect EBV infection in tissue sections. However, the frequent lack of EBER expression in the rhesus epithelial cell lesions is similar to the lack of EBER expression reported in EBV-associated oral hairy leukoplakia from AIDS patients (6). In addition, EBER ISH, EBNA-2 immunohistochemistry, and DNA CISH failed to detect LCV-positive lymphocytes infiltrating the subepithelial cell layers associated with these lesions.
| DISCUSSION |
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The histologic appearance of these proliferative, hyperkeratotic, and parakeratotic epithelial cell lesions is very similar to that of oral hairy leukoplakia in AIDS patients. The electron microscopic appearance, immunohistochemical staining for an immediate-early protein and a viral capsid protein, and strong DNA ISH clearly demonstrate the association of these epithelial cell lesions with rhesus LCV infection in multiple cases. Furthermore, they characterize the rhesus LCV infection as an active lytic process in the lesions, similar to that of EBV infection in oral hairy leukoplakia. Baskin et al. had previously observed squamous epithelial lesions with intranuclear inclusions in eight SIV-infected macaques (1). Hyperkeratosis and acanthosis were present in lesions on external epithelial cell surfaces (e.g., penis, chest skin, and hand), and lesions on internal epithelial surfaces (e.g., tongue and esophagus) were characterized by intranuclear inclusions and ballooning degeneration but without hyperkeratosis. Bacterial and fungal infections with inflammation were also frequently found associated with these lesions. The data implicating infection with an EBV-related herpesvirus were limited to one of four tissue samples that stained with a monoclonal antibody against the EBV LMP1 protein and positive DNA ISH with a 3.1-kb EBV DNA probe in one of three cases. In our hands, the EBV LMP1 monoclonal antibodies do not cross-react with the rhesus LCV LMP1 homologue. In addition, the rhesus LCV genome sequence reveals that the LMP1 gene is one of the least well-conserved genes between EBV and rhesus LCV, with no significant amino acid homology in the carboxy terminus targeted by various EBV LMP1 monoclonal antibodies (5). Overall, the virologic data linking an EBV-related herpesvirus to these lesions were limited. We did not find any characteristic epithelial cell lesions that failed to test positive for rhesus LCV DNA, but we cannot rule out the possibility that other viruses or pathogens may be associated with similar lesions in immunosuppressed hosts.
The presence of lesions on external epithelial cell surfaces suggests that infection may have occurred as a result of biting and secondary infection from oral secretions containing virus. In six of seven of our cases, the rhesus LCV-positive lesions occurred on internal sites, i.e., in the esophagus and/or tongue, eliminating self-induced trauma as a potential portal of infection. The frequent involvement of the esophagus in SIV-infected macaques raises the question of whether this might also be a common site for EBV-induced epithelial cell abnormalities in AIDS patients. At these internal sites, epithelial cell infection most likely originated from viremia and infection through the basal epithelial cell surfaces, but one cannot rule out the possibility of infection from virus in oral secretions bathing and infecting the apical epithelial cell surface. The DNA ISH technique used here has the sensitivity to detect single-copy episomes in paraffin-embedded tissue (J. L. Kutok et al., unpublished data). Thus, it is interesting that no low-copy viral infection was noted in the basal epithelial cell layers, suggesting that these lesions are not associated with persistent, latent rhesus LCV infection in the basal epithelium.
Multiple questions regarding EBV infection of epithelial cells in immunocompetent, healthy hosts remain unresolved. Are oral epithelial cells the first cells infected with incoming virus in primary EBV infection? Is viral replication in oral epithelial cells required for entry into the peripheral blood compartment during primary EBV infection? Does EBV persist and latently infect oral epithelial cells in convalescent, seropositive hosts? Is viral replication in oral epithelial cells the source of virus shed in the oral secretions of persistently infected hosts? The rhesus LCV model can be helpful for investigating these questions by allowing for more thorough dissection of the oral and upper digestive tracts of naturally and experimentally infected animals to search for reservoirs of virus infection. In addition, the experimental rhesus LCV model is conducive for kinetic studies immediately after viral infection, whereas studies with humans are limited to clinical presentation with infectious mononucleosis as the earliest time point for potential study. The development of genetic systems for rhesus LCV will provide an experimental system for studying alterations in viral genes that may affect epithelial cell infection or for using markers to more easily identify isolated foci of viral infection. The development of reagents and probes to detect rhesus LCV infection will be particularly important for detecting reservoirs of LCV infection in the oral cavity, as these sites are likely to be subtle in immunocompetent hosts. The complete rhesus LCV genome sequence is useful for identifying well-conserved targets where existing EBV-specific monoclonal antibodies, e.g., the EBV BZLF1 and sVCA monoclonal antibodies used in the present studies, might cross-react. In addition, the development of a sensitive rhesus LCV DNA ISH assay for paraffin-embedded tissue provides an important assay for detection of low-copy rhesus LCV infection independent of viral gene expression. These are important new tools for demonstrating epithelial cell tropism in rhesus LCV infection and will aid in the use of this model system to investigate the role of epithelial cell infection in EBV pathogenesis.
| ACKNOWLEDGMENTS |
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We thank Kristen Toohey for photographic assistance and Janice Williams for histologic work.
| FOOTNOTES |
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Present address: Charles River Laboratories, Wilmington, Mass. ![]()
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