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Journal of Virology, November 2007, p. 11722-11729, Vol. 81, No. 21
0022-538X/07/$08.00+0 doi:10.1128/JVI.00874-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Department of Biochemistry and Molecular Biology, 2000 9th Ave. South, Southern Research Institute, Birmingham, Alabama 35205,1 Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico 88003,2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama 352943
Received 24 April 2007/ Accepted 6 August 2007
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At present, there are no vaccines or antivirals approved by the U.S. Food and Drug Administration for treatment of any of the hemorrhagic fever viruses or HPS. A limited number of antivirals have been tested, and few have been effective against viruses within the family Bunyaviridae. Ribavirin (1-ß-D-ribofuranosyl-1,2,4-triazole-3-carboamide) (RBV), a broad-spectrum antiviral agent, and related C-nucleoside analogues ribamidine, selenazofurin (SEL), and tiazofurin (TIA) show potent antiviral activity in vitro against HTNV (17, 19). RBV was proven effective in the treatment of lethal encephalitic suckling mice infected with HTNV (16). Moreover, studies performed in China with HFRS patients suggest that RBV provides an improved prognosis when given early in the course of disease (15). As no other antiviral drugs with this level of activity for the hantaviruses have been reported, RBV remains an important lead for the development of new and better drugs for HTNV and perhaps other members of the Bunyaviridae. However, RBV's mechanism of action has remained elusive; therefore, efforts toward understanding its mechanism should bring new insights into the design of new drugs. For example, one could use the mechanistic information to explore chemical modifications that would increase its selectivity toward RdRps and decrease selectivity for IMP dehydrogenase (IMPDH).
A cursory review of the literature may suggest that RBV's mechanism of action is understood, but an intensive review of the literature reveals a complex profile of activity and perhaps a pleiotropic mechanism for this compound. These seemingly diverse mechanisms of action may derive from RBV's unique interaction with the polymerase machinery for each virus family and the dependence or requirements of that virus family on the nucleotide pool levels, specifically those of GTP. RBV decreases cellular GTP pools by competitive inhibition with IMP for the active site of IMPDH (2, 35). This has been reported to be the mechanism of action for RBV for several viruses (22, 24). However, viral enzymatic activities are also targeted, as suggested by several reports that show RBV's effect on capping (11), translation efficiency of viral mRNA (41), and viral polymerase activity (9). These activities may be due to direct incorporation of RBV 5'-monophosphate into mRNA or viral genomic RNAs since it resembles GMP, although it can pseudo-base pair with C and U. Recently, error-prone replication mediated by RBV has been reported for several RNA viruses (reviewed in reference 42), which would also require direct incorporation of RBV. We have also reported that RBV induced error-prone replication in HTNV (31). RBV can act as a potent RNA virus mutagen in poliovirus-infected cells, and it has been proposed that its incorporation into viral RNAs (vRNAs) causes the virus to enter error catastrophe (5). It is apparent that RBV acts as a mutagen for several viruses, including hantaviruses, but from the studies reported to date, it is not clear for most viruses how or if GTP repression via IMPDH contributes to the observed antiviral effect. Recently we have reported that, at least for HTNV, RBV's activity did not correlate with inhibition of IMPDH but rather with production of RBV triphosphate (RTP) (38). This suggests the interaction of RTP with the hantaviral RdRp, and while consistent with the observed increase in mutation frequency reported earlier for HTNV (31), it does not provide additional insight into the operational mechanism of RBV.
Recently, alternative theoretical models to error catastrophe have been developed for drug-induced mutation frequency in viruses (3, 37). One of the most recent theoretical models, lethal mutagenesis, differs from error catastrophe conceptually. In essence, the theory of lethal mutagenesis is based on a demographic process reflected by an apparent decline in the absolute abundance of the quasispecies population rather than an evolutionary shift in genotype space (3). Furthermore, lethal mutagenesis mandates the extinction of a population, while error catastrophe theory can shift the population toward higher fitness as well as driving what is often referred to as the mutational meltdown of the genome. Clearly, the design of effective antivirals and treatment strategies should be guided by these theoretical considerations. With that in mind, we have designed experiments to reveal which model, if any, was operational for RBV's inhibitory activity against HTNV. We undertook a comprehensive analysis of the mutation frequency over a wide range of RBV concentrations. We also examined the antiviral effects of several additional IMPDH inhibitors, including mycophenolic acid (MPA), selenazofurin (SEL), and tiazofurin (TIA), of which SEL and TIA are C-nucleoside analogues of RBV. This enhanced mutation frequency was observed only with RBV and not with other IMPDH inhibitors. Importantly, we observed that a relatively narrow lethal threshold was sufficient for extinction of HTNV. In essence, this threshold reflects a point in the drug concentration at which additional mutations are not tolerated and hence the virus is unable to replicate. However, this point did not lead to a complete loss of the genomic information, as predicted by the alternative hypothesis of error catastrophe.
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Quantitative real-time RT PCR.
Quantification of HTNV S-segment vRNA within virus-infected cells was carried out with a real-time reverse transcription (RT)-PCR assay using the comparative cycle threshold method 2–
CT as described elsewhere (38). Real-time RT-PCRs were performed in triplicate for each sample and prepared with TaqMan universal PCR master mix (Applied Biosystems).
Nucleotide sequencing. cDNA prepared as described above was amplified by PCR with Phusion high-fidelity DNA polymerase (Finnzyme Oy, Finland) according to the manufacturer's protocols. HS24 (forward, 5'-TACTAGAACAACGATGGCAACTATG-3') and HS1336 (reverse, 5'-GTGCAAATATGATTGATAATGATTCAGTAG-3') primers were used to amplify the open reading frame of N within the S-segment gene. The amplified product was cloned into plasmid pCR-4 (TOPO cloning kits for sequencing; Invitrogen) after A tailing by using Taq polymerase (Promega). Ninety-six colonies per group were picked, and each colony was subjected to colony PCR by using M13 forward and M13 reverse primers. PCR products were used as the template for BigDye 3.1 automated cycle sequencing (Applied Biosystems) with either M13 forward or M13 reverse primers. The background mutation frequency was measured using the same enzymes with plasmid DNA which encodes the HTNV S-segment cDNA. Sequence analysis included positions 91 to 1329 of the HTNV S-segment cDNA and was done with the Seqscape program (Applied Biosystems) by comparison with the published sequence (GenBank accession number M14626) (30).
vRNA size profiling. HTNV S-segment cDNAs were synthesized with one of the four different primers which were complementary to the regions 441 to 461, 963 to 985, 1441 to 1465, and 1673 to 1696 in viral sense RNA. The copy number of the transcribed cDNA was measured by use of a SYBR green real-time PCR method (DyNAmo HS SYBR green quantitative PCR kit; NEB) employing a 160-bp amplicon covering a 302- to 461-bp region in the viral sense RNA. The copy number was calculated from a regression of standard DNA samples.
Extraction and analysis of drug metabolism. Vero cells were incubated at 37°C with RBV or MPA for the indicated times. Cells were washed twice with sterile phosphate-buffered saline and extracted with perchloric acid as described previously (23). The samples were centrifuged at 12,000 x g for 10 min, and the supernatant was neutralized with 4 M of KOH buffered with 1 M of potassium phosphate (pH 7.4). KClO4 was removed by centrifugation. Separation and detection of nucleotides were performed using a high-pressure liquid chromatograph equipped with a Partisil-10 strong anion-exchange column (10 µM, 250 by 4.6 mm; Keystone Scientific, Inc., Bellefonte, PA). Elution of the nucleotides was accomplished with a 50-min linear gradient from 5 mM of NH4H2PO4 (pH 2.8) to 750 mM of H4H2PO4 (pH 3.7) buffer, with a flow rate of 2 ml/min. Purine standards were detected by their absorbance at 260 nm as they eluted from the column.
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FIG. 1. Structures of RBV, SEL, TIA, and MPA.
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FIG. 2. Dose-response curves showing PFU and relative [GTP]/[ATP] following treatment of HTNV-infected cells. Following infection with HTNV, Vero E6 cells were treated with RBV, SEL, or TIA (A) and MPA (B) at several concentrations over a period of 3 days. Vero cells and supernatants were measured for PFU and GTP/ATP content, respectively.
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FIG. 3. Antiviral effects of RBV and MPA on cellular concentrations of HTNV vRNA (vRNAc). HTNV vRNA levels were measured at various combinations of RBV in the absence or presence of MPA.
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View this table: [in a new window] |
TABLE 1. Summary of mutation frequencies of HTNV vRNA in the absence or presence of various chemical treatments
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In up to five separate experiments, we cloned and analyzed cDNA sequences derived from approximately 90 independent clones per group depending on the treatment (Table 1 and data not shown). For each treatment group, we made a detailed mutational analysis, and we show these data for one representative experiment (Table 1 and data not shown). The overall mutation frequency and the C
U and G
A mutation frequency showed a linear increase to 82 µM (20 µg/ml), after which neither the overall relative mutation frequency nor the C
U and G
A mutation frequency showed a linear dose response (Fig. 4A). Rather, in this representative experiment and others, we observed three distinct slopes, which suggest a zone corresponding to a threshold in treatment groups from 82 to 246 µM (20 to 60 µg/ml). This is further demonstrated when one plots the percentages of cDNAs with mutation increases (with respect to the mutation frequency of the wild type) over the concentrations of RBV (Fig. 4B).
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FIG. 4. Analyses of mutation spectrum as a function of [RBV]. (A) Mutation frequency was plotted as a function of [RBV] for one representative experiment. [RTP]/[GTP] was assessed and is also presented. Standard deviations are shown for [RTP]/[GTP]. (B) The percentage of cDNAs as a function of the number of mutations relative to that for the wild-type virus is plotted against [RBV].
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View this table: [in a new window] |
TABLE 2. Average distribution of mutations in cDNAs as a function of drug treatment
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We made a statistical evaluation of total mutation (TM) frequency as a function of RBV concentration presented in Fig. 4. The mutation frequency per 10,000 nt was regressed for all RBV concentrations via simple linear, bivariate, and quadratic regressions. The R2 value for the simple regression relationship of TM versus concentration was 0.82. For the bivariate analyses, concentrations were analyzed by the two apparent groups, 0 to 41 µM and 82 to 246 µM. The R2 value for the simple regression relationship of TM versus concentration was 0.98 for 0 to 41 µM or 0.76 for 82 to 246 µM. The R2 value for the quadratic regression relationship of TM versus concentration was 0.98. These statistical analyses support a significant change in mutation response as the RBV concentration increased past a lethal threshold. Finally, we subjected the data to a second-degree polynomial, which confirms that a linear fit of the data is not appropriate (data not shown). The polynomial fit confirmed the suggestion that the relationship of mutation frequency and drug concentration was asymptotic at this point.
Second, our studies shown in Table 1 relied on the cloning of the entire S-segment open reading frame. Hence, it is possible that our data reflect our sampling strategy in that we were not accounting for truncated vRNA products. To address this, we designed primer sets that measured the numbers of copies of four vRNA lengths (Fig. 5). We found that the copy number ratios of cDNAs primed from the position of nt 446 and from the very end position of nt 1,670 remained constant regardless of RBV treatments (13-fold difference at 0 µM and 16-fold difference at 82 µM) (Fig. 5). This suggests that our sampling method accurately reflected the population spectrum within the cell. This strongly supports that the vRNA populations within these thresholds were undergoing extinction; however, these experiments do not address how.
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FIG. 5. HTNV S vRNA length profile in the absence or presence of various concentrations of RBV. The copy numbers of cDNA primed with the primers described in the text were measured by using a SYBR green quantitative real-time PCR method.
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Two independent mechanisms of action for RBV's antiviral activity are suggested for HTNV. Three lines of evidence support two independent targets of RBV's anti-HTNV activity: IMPDH and the hantaviral polymerase. First, MPA, SEL, and TIA levels correlated with GTP repression and antiviral activity, measured as infectious HTNV particles released by plaque assay. In contrast, RBV did not. Importantly, RBV treatments of HTNV-infected cells caused an additional 100-fold decrease in vRNA levels at a time when levels of GTP had already reached a plateau. Second, Guo rescue experiments are consistent with two targets for RBV (38). Unlike MPA, the antiviral effect of RBV was not fully recovered by the addition of exogenous Guo. Finally, we observed an increase in antiviral activity and mutation frequency when both RBV and MPA were added to HTNV-infected Vero E6 cells. It is plausible to suggest that RTP is incorporated more efficiently when GTP levels are further reduced by MPA. This suggests that while RBV's overall mechanism is targeted at RdRp, an additional drop in GTP levels could enhance its mutagenic potential. Future exploration of drug combinations in HTNV animal models would be very insightful and perhaps suggest alternative approaches to treatment of HFRS.
RBV increased the mutation frequency of HTNV and showed a threshold response.
For several viruses, including HTNV, RBV can act as an RNA mutagen, which would be expected to reduce the specific infectivity of HTNV. We have explored the kinetics of the loss of specific infectivity of HTNV with an increase in RBV concentration. Our results showed that RBV reduced specific infectivity in a dose-response manner, which did not correlate with the decrease in GTP levels promoted by RBV. To further explore the mechanism for the loss of specific infectivity for HTNV, we exhaustively analyzed the mutation frequency and type as a function of RBV concentration. The mutation frequency of the wild-type population of HTNV was 1.0 mutation per 10,000, which is comparable to that of poliovirus or lymphocytic choriomeningitis virus (4, 13). RBV at 41 to 61 µM increased the overall mutation frequency twofold (1.0 versus 2.0 mutations per 10,000) (Table 1). A detailed sequence analysis showed that frequencies of G
A and C
U mutations, which are predicted to be mediated by RBV incorporation (5), increased similarly. Further analysis revealed that the G
A mutation frequency was much higher than the C
U mutation frequency, as has been reported for West Nile virus (7). The previous study and ours suggest that RBV incorporates more readily into antigenomic than into genomic RNA. Remarkably, the percentage of cDNAs with mutations did not show a dose response after treatment with 82 µM RBV in four separate experiments. The kinetics of the response suggested a threshold had been reached. Our analysis fit the data to a second-degree polynomial, which confirmed that a linear fit of the data is not appropriate. The polynomial fit confirmed the suggestion that the relationship of mutation frequency and drug concentration was asymptotic at this point and confirmed the presence of a threshold.
An obvious question that arises from these studies is why the overall mutation frequency reached a threshold. This value is derived from extraction of total cellular RNA from which a large portion of the S segment is subsequently amplified and cloned. One of the simpler explanations could be that the vRNAs can tolerate only a certain level of mutations before they become unstable, which would result in a conformation that is not recognized by the N protein or the polymerase. Alternatively, the drug could affect the processivity of the L protein, which would result in truncated vRNA products. We observed a dose response of infectious virus produced by the cell and the level of vRNA in the cell. We also showed the absence of truncated vRNA products. A model in which RBV causes extinction of the vRNA is suggested by these data. We can simplify the data as two populations, A1 (wild-type population) and A2 (mutant population). In the absence of RBV, we obtained a ratio of 83:17 for A1:A2 for the wild-type population, which basically means that we observed an increase in mutation frequency in only 20% of the population (5:1) over the baseline mutation frequency established at 80%. Upon the addition of drug, a threshold was reached, in which we observed a ratio of
66:
34 (or 3:1) for A1:A2. This ratio was maintained with increasing concentrations of RBV while viral numbers (PFU and vRNA levels) showed a dose-dependent decrease. Hence, the data argue for the presence of a third population, A3, an inferior genotype, which is unable to replicate. The drug is then promoting the extinction of the virus.
Lethal mutagenesis induced by nucleoside analogs has been suggested as a novel strategy for antiviral drug development for RNA viruses which may exist as a quasispecies (23; see reviews in references 1, 6, 10, and 34). Our data support the hypothesis that lethal mutagenesis of HTNV infection by RBV occurs by an extinction catastrophe rather than an error catastrophe mechanism (3). Challenges facing this approach include the need for intracellular transport of derivatives by active or passive processes, efficient phosphorylation by host or viral enzymes, and high levels of incorporation into the viral genome, thereby increasing error frequency during viral replication and transcription. The combination of antiviral compounds and mutagenic agents to increase the error rate while reducing viral replication provides an additional strategy to promote viral extinction (8). Treatment with 5-fluorouracil and guanidine hydrochloride produces high-frequency extinctions of foot-and-mouth disease virus, but treatment with either drug alone does not (12, 25). Systematic extinction of human immunodeficiency virus type 1 was achieved by combining the reverse transcriptase inhibitor zidovudine with 5-hydroxydeoxycytidine (40). Herein, we show an additive antiviral and mutagenic effect on HTNV with combinations of RBV and MPA. Future efforts in this area call for new molecular probes that will illuminate these mechanisms and provide new insights in the discovery of effective antiviral drugs that can promote lethal mutagenesis.
We thank Jim J. Bull, Lauren A. Meyers, Jesse Summers, and Aaron Shatkin for discussions regarding the content of the manuscript and/or comments on the manuscript.
Published ahead of print on 15 August 2007. ![]()
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