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Journal of Virology, April 2008, p. 4164-4168, Vol. 82, No. 8
0022-538X/08/$08.00+0 doi:10.1128/JVI.02621-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
ICAM-1 Participates in the Entry of West Nile Virus into the Central Nervous System
Jianfeng Dai,1
Penghua Wang,1
Fengwei Bai,1
Terrence Town,2,3 and
Erol Fikrig1*
Section of Infectious Diseases, Department of Internal Medicine,1
Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut 06520,2
Department of Biomedical Sciences and Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 900483
Received 10 December 2007/
Accepted 18 January 2008

ABSTRACT
Determining how West Nile virus crosses the blood-brain barrier
is critical to understanding the pathogenesis of encephalitis.
Here, we show that ICAM-1
–/– mice are more resistant
than control animals to lethal West Nile encephalitis. ICAM-1
–/– mice have a lower viral load, reduced leukocyte infiltration,
and diminished neuronal damage in the brain compared to control
animals. This is associated with decreased blood-brain barrier
leakage after viral infection. These data suggest that ICAM-1
plays an important role in West Nile virus neuroinvasion and
that targeting ICAM-1 signaling may help control viral encephalitis.

TEXT
West Nile virus (WNV) is the major cause of mosquito-borne encephalitis
in North America (
22). WNV enters the central nervous system
(CNS) and may use several strategies to cross the blood-brain
barrier (BBB). It is hypothesized that WNV may directly infect
microvascular endothelial cells, cross endothelial cell junctions,
or migrate within infected leukocytes that enter the CNS (
6,
20,
21,
27). The leukocytic infiltration may also aggravate
CNS inflammation, thereby contributing to encephalitis (
20,
27). Viral entry by retrograde axonal transport via the peripheral
nervous system may also occur (
28).
Adhesion molecules on vascular endothelial cells and leukocytes play important roles in leukocyte traffic into the brain. Intercellular adhesion molecule 1 (ICAM-1, or CD54) is one of the most important molecules in this process (7, 8, 15). Up-regulation of ICAM-1 on CNS vascular endothelium and leukocyte-mediated breakdown of the BBB followed by leukocyte recruitment into the CNS are characteristics of brain inflammation (8, 24). Blocking ICAM-1 significantly inhibits the binding of lymphocytes to endothelial cells, as well as migration across the activated monolayer (8, 25, 30). ICAM-1 is also the receptor for human rhinovirus (2) and can incorporate into human immunodeficiency virus type 1 virions to enhance viral infectivity (16, 26). In addition, ICAM-1 knockout mice have decreased susceptibility to high doses of bacterial infection due to reduced T-cell activation and neutrophilic infiltration (33). These findings suggest that blocking ICAM-1 signaling may benefit the host, either by altering pathogen transmission or by controlling excessive immune responses. In this study, we examined the role of ICAM-1 in the pathogenesis of murine WNV encephalitis.
ICAM-1–/– mice are more resistant to lethal WNV infection.
To determine whether WNV influences ICAM-1 expression, a murine brain endothelial cell line (bEnd.3; ATCC) was incubated with WNV isolate 2741 (multiplicity of infection, 0.1) for 24 h, and C57BL/6 mice were challenged intraperitoneally with 2 x 103 PFU of virus. The expression of ICAM-1 in the endothelial cell line or brain tissue was examined by quantitative PCR (Q-PCR). ICAM-1 was up-regulated both in vitro (Fig. 1a) and in vivo (Fig. 1b) after WNV infection, suggesting that it may be important in the course of disease. To examine the role of ICAM-1 in pathogenesis, ICAM-1–/– mice (no. 002867; Jackson Laboratory) and control animals were challenged with virus. Groups of 5 to 10 mice were inoculated with 2 x 103 PFU of WNV and monitored daily for mortality. As shown in Fig. 1c, ICAM-1–/– mice had an increased survival rate compared with control animals (P < 0.01).
ICAM-1–/– mice have a reduced viral load and immune pathology in the brain.
To determine the reason for the resistance of ICAM-1
–/– mice to WNV, the viral load and selected inflammatory/antiviral
cytokines, such as tumor necrosis factor alpha (TNF-

), interleukin-6,
gamma interferon (IFN-

), and IFN-β1, were examined peripherally
and in the CNS. The viral burden was measured by Q-PCR using
the WNV envelope (WNVE) gene and normalized with the murine
β-actin gene. The cytokine levels were measured by enzyme-linked
immunosorbent assay or Q-PCR as described previously (
32). The
peripheral viral load and cytokine levels were similar in wild-type
and ICAM-1
–/– mice (Fig.
2). In contrast, the virus
burden (Fig.
3a and b) and TNF-

, interleukin-6, and IFN-β1
levels (Fig.
3c and d) in brains from ICAM-1
–/– mice were significantly lower than in those from wild-type animals.
To further characterize CNS infection, immunostaining of WNVE,
CD45 (leukocyte common antigen), and CD11b (a macrophage marker)
in frozen sections of murine brains was performed. Specimens
were probed with anti-CD45 (clone YW 62.3; Serotec), anti-CD11b
(clone M1/70.15; Serotec), and biotinylated WNVE antibody (
32).
After reaction with the proper fluorophore-labeled secondary
antibodies, sections were examined with an Olympus BX-61 microscope.
As shown in Fig.
3e and f, leukocyte and macrophage infiltrates
were decreased in the brains of ICAM-1
–/– mice compared
with wild-type samples, and this was most evident in the olfactory
bulb. The results also revealed a subset of CD45-positive leukocytes
(especially CD11b-positive macrophages) that stained positively
for WNV, suggesting an indirect mechanism whereby infected peripheral
leukocytes can act as carriers of virus to the brain (
9). Hematoxylin
and eosin staining also showed that wild-type mice have more
cellular infiltration and neuronal damage in the cerebral cortex
after WNV infection than ICAM-1
–/– mice (Fig.
3g).
ICAM-1 signaling contributes to WNV entry into the brain by enhancing permeability of the BBB.
Since ICAM-1–/– and control mice had similar levels of virus in the blood and peripheral tissues but the ICAM-1–/– mice had less virus in the CNS, we hypothesized that BBB permeabilities are different in wild-type and ICAM-1–/– mice after WNV infection. We administered Evans blue, a dye normally excluded from the CNS, into WNV-infected wild-type and ICAM-1–/– mice through an intraperitoneal injection at day 3, when the viral load is high in the periphery, and at day 5, when the virus is detected in the brain (13, 18). An increased amount of Evans blue dye was found in brains from wild-type compared with ICAM-1–/– mice (Fig. 4a). In addition, the immunoglobulin G (IgG) level, another marker for BBB leakage, was much higher in brains from wild-type mice than in those from ICAM-1–/– mice (Fig. 4b).
Previous work showed that WNV infection can rapidly up-regulate
the expression of adhesion molecules, but the functions of these
molecules in WNV pathogenesis remained largely unknown (
20,
29). In this study, we showed that ICAM-1 plays an important
role in WNV neuroinvasion. ICAM-1 is crucial for leukocyte infiltration
into the brain, and the process of leukocyte migration across
the brain endothelial layer can accelerate the BBB breakdown
(
3,
8). Recent studies alsosuggest that ICAM-1 not only acts
as a ligand for leukocyte receptors, but also can serve as a
signal transducer that influences BBB permeability and the progression
of neuroinflammation (
10,
15,
17). Blocking ICAM-1 can reduce
the relative numbers of infiltrating leukocytes, as well as
attenuating the BBB leakage caused by its downstream signaling.
Our experiments showed that ICAM-1
–/– mice had a
more intact BBB than wild-type mice after WNV infection. Our
data suggest that this results in reduced virion influx across
a compromised BBB, decreasing leukocyte infiltration and virus
entry into the brain carried by infected immune cells and attenuating
the pathological effect caused by immune cell infiltration.
The outcome of WNV infection is clearly a balance between eradication
of virus and virus- or immune-mediated tissue damage (
14,
20,
27). A similar study was done in β2-integrin- and ICAM-1-deficient
mice using lymphocytic choriomeningitis virus infection. The
results also showed decreased mortality in the knockout mice
after infection, and at the same time, the T-cell response was
almost intact (
5).
Targeting ICAM-1 has been shown to be promising in controlling multiple inflammatory and infectious diseases. For example, ICAM-1 neutralizing antibody blocks cell-associated human immunodeficiency virus type 1 transmission across a cervical epithelial monolayer (4). Modulating ICAM-1 signaling may also alleviate the outcomes of many diseases, such as colonic inflammation, asthma, and polymicrobial sepsis (1, 11, 12, 19, 23, 31). Our current findings support an important role of ICAM-1 in WNV neuroinvasion and also suggest the potential application of modulating ICAM-1 signaling in controlling the pathogenesis of West Nile encephalitis and other neuroinvasive flaviviral infections.

ACKNOWLEDGMENTS
This work was supported by the NIH (AI 055749 and AI-50031).
F. Bai was supported by the Northeast Biodefense Center (U54-AI057158-
Lipkin). T. Town was supported by an Alzheimer's Association
grant and an NIH/National Institute on Aging "Pathway to Independence"
award (1K99AG029726).
We thank Deborah Beck for technical assistance.

FOOTNOTES
* Corresponding author. Mailing address: Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208031, New Haven, CT 06520-8031. Phone: (203) 785-2453. Fax: (203) 785-7053. E-mail:
erol.fikrig{at}yale.edu 
Published ahead of print on 6 February 2008. 

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Journal of Virology, April 2008, p. 4164-4168, Vol. 82, No. 8
0022-538X/08/$08.00+0 doi:10.1128/JVI.02621-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
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