The current H5N1 influenza outbreak in Asia is associated with 32 human infections and approximately a 70% mortality rate. Human infections may continue to increase given the uncontrolled outbreak in poultry throughout Asia. The first documented instance of human H5N1 infection by a purely avian H5N1 strain occurred in Hong Kong in 1997. The use of these viruses increased our understanding of the viral genetics underlying influenza virulence. However, the cellular, immunological, and pathological basis for the unusual severity remains unexplored. Limited studies in animal models demonstrated that the virulent 1997 H5N1 viruses resulted in severe respiratory lesions and depression of lymphocytes. Further studies are required to determine the cellular/host mechanism of increased virulence. We demonstrated that an important difference amongst the 1997 H5N 1 viruses is the ability to activate transforming growth factor-beta (TGF-beta). TGF-beta is a potent immunomodulatory factor that influences the host response to numerous infectious diseases, including influenza. The H5N1 viruses associated with human lethality do not activate TGF-beta. Further, neutralization of TGF-beta during non-lethal H5N1 infection resulted in lethal disease characterized by decreased apoptosis in the lung, delayed viral clearance, and leukopenia. When considered together, these results suggested that TGF-beta induction might be a critical factor in influenza pathogenesis. Thus, the long-term goal of these studies is to define the mechanism of H5N1 virulence and the role of TGF-beta in protection.
The specific aims are: 1. Isolate the region of influenza neuraminidase required for TGF-beta activation and determine the mechanism of activation. 2. Evaluate the requirement for TGF-beta in protection from lethal infection. 3. Examine the innate and adaptive immune responses to H5N1 influenza infection to define the mechanism of enhanced virulence. These studies provide a unique opportunity to understand the cellular and immunological basis of H5N1 influenza virus virulence in mammals: currently, an unexplored area of investigation.
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