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ABSTRACT: BACKGROUND: Subspecies B1 human adenoviruses (HAdV-B1) are prevalent respiratory pathogens. Compared to their species C (HAdV-C) counterparts, relatively little work has been devoted to the characterization of their unique molecular biology. The early region 3 (E3) transcription unit is an interesting target for future efforts because of its species-specific diversity in genetic content among adenoviruses. This diversity is particularly significant for the subset of E3-encoded products that are membrane glycoproteins and may account for the distinct pathobiology of the different human adenovirus species. In order to understand the role of HAdV-B-specific genes in viral pathogenesis, we initiated the characterization of unique E3 genes. As a continuation of our efforts to define the function encoded in the highly polymorphic ORF E3-10.9K and testing the hypothesis that the E3-10.9K protein orthologs with a hydrophobic domain contribute to the efficient release of viral progeny, we generated HAdV-3 mutant viruses unable to express E3-10.9K ortholog E3-9K and examined their ability to grow, disseminate, and egress in cell culture. RESULTS: No differences were observed in the kinetics of infected cell death, and virus progeny release or in the plaque size and dissemination phenotypes between cells infected with HAdV-3 E3-9K mutants or the parental virus. The ectopic expression of E3-10.9K orthologs with a hydrophobic domain did not compromise cell viability. CONCLUSIONS: Our data show that despite the remarkable similarities with HAdV-C E3-11.6K, HAdV-B1 ORF E3-10.9K does not encode a product with a "death-like" biological activity.
BMC Research Notes 08/2012; 5(1):429.
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Shoaleh Dehghan,
Elizabeth B Liu,
Jason Seto,
Sarah F Torres,
Nolan R Hudson, Adriana E Kajon,
David Metzgar,
David W Dyer,
James Chodosh,
Morris S Jones,
Donald Seto
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ABSTRACT: Five genomes of human subspecies B1 adenoviruses isolated from cases of acute respiratory disease have been sequenced and archived for reference. These include representatives of two prevalent genomic variants of HAdV-7, i.e., HAdV-7h and HAdV-7d2. The other three are HAdV-3/16, HAdV-16 strain E26, and HAdV-3+7 strain Takeuchi. All are recombinant genomes. Genomics and bioinformatics provide detailed views into the genetic makeup of these pathogens and insight into their molecular evolution. Retrospective characterization of particularly problematic older pathogens such as HAdV-7h (1987) and intriguing isolates such as HAdV-3+7 strain Takeuchi (1958) may provide clues to their phenotypes and serology and may suggest protocols for prevention and treatment.
Journal of Virology 01/2012; 86(1):635-6. · 5.40 Impact Factor
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Michael J Carr, Adriana E Kajon,
Xiaoyan Lu,
Linda Dunford,
Paul O'Reilly,
Paul Holder,
Cillian F De Gascun,
Suzie Coughlan,
Jeff Connell,
Dean D Erdman,
William W Hall
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ABSTRACT: Human adenovirus (HAdV) serotype 14 is rarely identified. However, an emerging variant, termed HAdV-14p1, recently has been described in the United States in association with outbreaks of acute respiratory disease with high rates of illness and death. We retrospectively analyzed specimens confirmed positive for HAdV by immunofluorescence, virus culture, or real-time PCR during July 1, 2009-July 31, 2010, and describe 9 cases of HAdV-14p1 infection with characteristic mutations in the fiber and E1A genes that are phylogenetically indistinguishable from the viruses previously detected in the United States. Three patients died; 2 were immunocompromised, and 1 was an immunocompetent adult. We propose that surveillance should be increased for HAdV-14p1 and recommend that this virus be considered in the differential diagnosis of sudden-onset acute respiratory disease, particularly fatal infections, for which an etiology is not clear.
Emerging Infectious Diseases 08/2011; 17(8):1402-8. · 6.79 Impact Factor
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ABSTRACT: A significant increase in adenovirus detection among patients at the Children's Mercy Hospital, Kansas City was observed between June 2007 and January 2008.
To molecularly characterize the human adenoviruses and describe their association with clinical illness in children.
One hundred adenovirus-positive specimens from 79 children were typed by hexon gene sequence typing method. Restriction enzyme analysis (REA) was performed on isolates of HAdV-3, -7 and -14 to identify genomic variants. Medical records were reviewed to understand the clinical illnesses associated with adenovirus serotypes and genome types.
The most prevalent HAdV serotypes were HAdV-3 (37%), HAdV-7 (25%), HAdV-1 (16%), HAdV-2 (8%). HAdV infection was common in children ≤3 years of age (71%) versus children >3 years (29%). Majority of the HAdV-infected children were hospitalized (78%); 22/79 (28%) stayed >3 days and 8/79 (10%) required intensive care unit stay. Hospitalization rates for HAdV-3 (36%) and HAdV-7 (25%) were comparable. REA data indicated that HAdV-3a2 was the predominant HAdV-3 genome type. Two novel genomic variants of HAdV-3 exhibiting unique BglII or BstEII profiles were identified in isolates from patients with bronchiolitis. All HAdV-7 and -14 isolates were identified as corresponding to genome types 7d2 and 14p1, respectively.
In Kansas City, we noticed an increase in the incidence of HAdV-7 (25%; n=24/98) infections compared to the previous two years (6%; n=6/107). Two new genomic variants of HAdV-3 appear to have emerged in our area and seem to be associated with lower respiratory tract infections in children.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 03/2011; 51(2):126-31. · 3.12 Impact Factor
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ABSTRACT: The following proposals contribute towards elaborating a robust system for designating human adenovirus (HAdV) types....
Journal of Virology 03/2011; 85(11):5703-4. · 5.40 Impact Factor
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ABSTRACT: Subspecies B1 human adenoviruses (HAdV-B1s) are important causative agents of acute respiratory disease, but the molecular bases of their distinct pathobiology are still poorly understood. Marked differences in genetic content between HAdV-B1s and the well-characterized HAdV-Cs that may contribute to distinct pathogenic properties map to the E3 region. Between the highly conserved E3-19K and E3-10.4K/RIDα open reading frames (ORFs), and in the same location as the HAdV-C ADP/E3-11.6K ORF, HAdV-B1s carry ORFs E3-20.1K and E3-20.5K and a polymorphic third ORF, designated E3-10.9K, that varies in the size of its predicted product among HAdV-B1 serotypes and genomic variants. As an initial effort to define the function of the E3-10.9K ORF, we carried out a biochemical characterization of E3-10.9K-encoded orthologous proteins and investigated their expression in infected cells. Sequence-based predictions suggested that E3-10.9K orthologs with a hydrophobic domain are integral membrane proteins. Ectopically expressed, C-terminally tagged (with enhanced green fluorescent protein [EGFP]) E3-10.9K and E3-9K localized primarily to the plasma membrane, while E3-7.7K localized primarily to a juxtanuclear compartment that could not be identified. EGFP fusion proteins with a hydrophobic domain were N and O glycosylated. EGFP-tagged E3-4.8K, which lacked the hydrophobic domain, displayed diffuse cellular localization similar to that of the EGFP control. E3-10.9K transcripts from the major late promoter were detected at late time points postinfection. A C-terminally hemagglutinin-tagged version of E3-9K was detected by immunoprecipitation at late times postinfection in the membrane fraction of mutant virus-infected cells. These data suggest a role for ORF E3-10.9K-encoded proteins at late stages of HAdV-B1 replication, with potentially important functional implications for the documented ORF polymorphism.
Journal of Virology 11/2010; 84(21):11310-22. · 5.40 Impact Factor
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ABSTRACT: The use of corticosteroids and other immunosuppressive agents increases the risk of infection in patients with systemic lupus erythematosus (SLE). The role of human adenoviruses (HAdV) in the etiology of acute viral diseases in these patients is not known.
Describe a case of acute fatal disseminated adenovirus infection in an SLE patient receiving immunosuppressive therapy.
Case report and detailed viral diagnosis by real time PCR and molecular typing of virus isolates by sequencing of hexon and fiber genes and restriction enzyme analysis of viral DNA.
HAdV was detected by real time PCR in multiple clinical specimens including respiratory, urine, plasma, synovial fluid, and cerebrospinal fluid. Amplification and sequence analysis of the hexon and fiber genes identified the virus as HAdV-7-like for both coding regions. Adenoviruses isolated from respiratory and urine specimens were identical and corresponded to genome type 7d2 by restriction enzyme analysis of viral DNA. The isolated strain encodes a unique fiber gene with a 6-nucleotide deletion corresponding to amino acid positions 250 and 251 in the knob region and not previously described for closely related genomic variants of HAdV-7.
Adenovirus detection should be included in the diagnostic testing to determine the infectious etiology of fever and/or respiratory symptoms in SLE patients.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 11/2010; 50(1):80-3. · 3.12 Impact Factor
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ABSTRACT: First isolated in the Netherlands in 1955 during an outbreak of acute respiratory disease (ARD) among military recruits, human adenovirus 14 (HAdV-14) has historically been considered rare. With no precedent of circulation in North America, HAdV-14 has been isolated from military and civilian cases of ARD of variable severity since 2003 in the United States.
Ninety-nine isolates from military and civilian cases from different geographic locations and circulation periods were characterized by restriction enzyme analysis of viral DNA and select gene sequencing.
All examined viruses were found to be identical and to belong to a new genome type designated "HAdV-14p1" (formerly known as "14a"). Comparative alignments of E1A, hexon, and fiber gene sequences with other subspecies B2 HAdVs suggest that HAdV-14p1, like the closely related HAdV-11a, arose from recombination among similar HAdV-11 and HAdV-14 ancestral strains. A deletion of 2 amino acids in the knob region of the fiber protein is the only identified unique characteristic of HAdV-14p1.
The current geographic distribution of HAdV-14p1 involves at least 15 states in the Unites States. The role of the fiber mutations in the recent emergence of HAdV-14p1 ARD in North America warrants further study.
The Journal of Infectious Diseases 07/2010; 202(1):93-103. · 6.41 Impact Factor
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ABSTRACT: Increased levels of serum antibody titers against human adenovirus 36 (HAdV-D36) are associated with human obesity and experimental obesity in laboratory animals. While HAdV-D36 has been studied as an infectious agent implicated in obesity for over a decade, the complete genome sequence and its analysis have yet to be reported. A detailed analysis of the genome sequence of HAdV-D36 may be important to understand its role in obesity. Genomic and bioinformatic comparisons with other HAdVs identified differences that suggested unique functions. Global pairwise genome alignment with all sequenced human adenovirus D (HAdV-D) genomes revealed areas of nonconserved sequences in the hexon, E3 CR1 beta, E3 CR1 gamma, and fiber genes. Phylogenetic analysis of all HAdV-D36 proteins confirmed that this virus belongs to species Human adenovirus D. This genomic analysis of HAdV-D36 provides an important tool for comprehending the role that this unique adenovirus may play in human obesity. Low amino acid sequence identity in the E3 CR1 beta and CR1 gamma genes may suggest distinctive roles for these proteins. Furthermore, the predicted molecular models of the HAdV-D36 fiber protein seem to implicate a unique tissue tropism for HAdV-D36.
Virus Research 05/2010; 149(2):152-61. · 2.94 Impact Factor
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ABSTRACT: Outbreak cases of acute respiratory disease (ARD) associated with subspecies B2 human adenovirus 11a (HAdV-11a) infection were detected during 2005 in a military basic training camp in Singapore. The Singapore HAdV-11a strain is highly similar to other Asian strains of HAdV-11, including strain QS-DLL, which is responsible for the recently described 2006 outbreak of ARD in China.
Journal of clinical microbiology 04/2010; 48(4):1438-41. · 4.16 Impact Factor
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ABSTRACT: An intertypic recombinant adenovirus with a serotype 3-like hexon gene and a serotype 16-like fiber (99% identical to that of the prototype strain of human adenovirus 16 [HAdV-16], Ch79) was isolated in Argentina from an infant admitted to the hospital with acute respiratory disease. Consistent with the results of molecular characterization, strain Arg827/04 was designated H3-F16.
Journal of clinical microbiology 04/2010; 48(4):1494-6. · 4.16 Impact Factor
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ABSTRACT: Human adenovirus 14 (HAdV-14) is a recognized causative agent of epidemic febrile respiratory illness (FRI). Last reported in Eurasia in 1963, this virus has since been conspicuously absent in broad surveys, and was never isolated in North America despite inclusion of specific tests for this serotype in surveillance methods. In 2006 and 2007, this virus suddenly emerged in North America, causing high attack rate epidemics of FRI and, in some cases, severe pneumonias and occasional fatalities. Some outbreaks have been relatively mild, with low rates of progression beyond uncomplicated FRI, while other outbreaks have involved high rates of more serious outcomes.
In this paper we present the complete genomic sequence of this emerging pathogen, and compare genomic sequences of isolates from both mild and severe outbreaks. We also compare the genome sequences of the recent isolates with those of the prototype HAdV-14 that circulated in Eurasia 30 years ago and the closely related sequence of HAdV-11a, which has been circulating in southeast Asia.
The data suggest that the currently circulating strain of HAdV-14 is closely related to the historically recognized prototype throughout its genome, though it does display a couple of potentially functional mutations in the fiber knob and E1A genes. There are no polymorphisms that suggest an obvious explanation for the divergence in severity between outbreak events, suggesting that differences in outcome are more likely environmental or host determined rather than viral genetics.
Respiratory research 01/2010; 11:116. · 3.36 Impact Factor
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ABSTRACT: Adenoviruses are associated with sporadic infection and community and institutional outbreaks; they can cause especially severe disease in infants, young children, immunocompromised persons, and transplant recipients. Fifty-two adenovirus serotypes have been recognized and classified within 7 subgroups or species (A-G), with limited data available on associated clinical syndromes and disease severity in more than one-half of the known serotypes.
We describe the clinical presentation and virologic characterization of 1 adult and 2 pediatric patients admitted to 2 separate hospitals during April-May 2006 with severe acute respiratory tract infection. All patients had underlying chronic pulmonary disease; none were severely immunocompromised. All 3 experienced serious chronic sequelae or died.
Adenovirus was isolated from all 3 case patients. Adenovirus serotype 14, a subspecies B2 serotype not previously associated with severe clinical illness, was confirmed by neutralization assay and sequencing of the hexon gene. Restriction enzyme analysis with BamHI, BglII, HindIII, and SmaI showed all 3 viruses to be identical and to belong to a new genome type that we have designated "Ad14a."
Our identification of severe respiratory illness due to a previously rarely reported adenovirus serotype may signify the emergence in the United States of a new genomic variant that has the potential to spread globally and cause epidemics. These case reports highlight the need for rapid diagnosis and improved surveillance, with serotyping and molecular characterization, to identify emerging variants of adenovirus, which may assist with targeted development of antiviral agents or type-specific vaccines.
Clinical Infectious Diseases 03/2008; 46(3):421-5. · 9.15 Impact Factor
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ABSTRACT: Adenoviruses (Ads) cause continuous outbreaks of acute respiratory disease (ARD) in US military training facilities. In 1996, the loss of vaccines targeting the dominant recruit-associated serotypes precipitated the reemergence of Ads in these populations. Between 1999 and 2002, serotype 4 accounted for >95% of Ads isolated from recruits and for >50% of ARD cases in training facilities (15,000 cases/year).
Ads (n=1867) collected between 2002 and 2006 from recruits with ARD at 8 military training facilities in the United States were serotyped by serum neutralization and polymerase chain reaction.
The dominance of Ad4 continued through 2005, followed by a simultaneous emergence of diverse species B serotypes at the majority of sites. This included the subspecies B1 serotypes 3, 7, and 21 and the subspecies B2 serotype 14. Ad14 was the most prevalent species B serotype, appearing in high numbers at 3 sites and becoming dominant at 1.
Subspecies B2 Ads have rarely been associated with ARD, and only in Eurasia. This survey represents the first report of AdB2-associated ARD in the Western Hemisphere. The simultaneous emergence of several species B Ads suggests a common external source (the civilian population) and a decrease in preexisting immunity to species B Ads.
The Journal of Infectious Diseases 11/2007; 196(10):1465-73. · 6.41 Impact Factor
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Gregory C Gray,
Troy McCarthy,
Mark G Lebeck,
David P Schnurr,
Kevin L Russell, Adriana E Kajon,
Marie L Landry,
Diane S Leland,
Gregory A Storch,
Christine C Ginocchio, [......],
Melissa B Miller,
James D Chappell,
Danielle M Zerr,
Deanna L Kiska,
Diane C Halstead,
Ana W Capuano,
Sharon F Setterquist,
Margaret L Chorazy,
Jeffrey D Dawson,
Dean D Erdman
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ABSTRACT: Recently, epidemiological and clinical data have revealed important changes with regard to clinical adenovirus infection, including alterations in antigenic presentation, geographical distribution, and virulence of the virus.
In an effort to better understand the epidemiology of clinical adenovirus infection in the United States, we adopted a new molecular adenovirus typing technique to study clinical adenovirus isolates collected from 22 medical facilities over a 25-month period during 2004-2006. A hexon gene sequence typing method was used to characterize 2237 clinical adenovirus-positive specimens, comparing their sequences with those of the 51 currently recognized prototype human adenovirus strains. In a blinded comparison, this method performed well and was much faster than the classic serologic typing method.
Among civilians, the most prevalent adenovirus types were types 3 (prevalence, 34.6%), 2 (24.3%), 1 (17.7%), and 5 (5.3%). Among military trainees, the most prevalent types were types 4 (prevalence, 92.8%), 3 (2.6%), and 21 (2.4%).
For both populations, we observed a statistically significant increasing trend of adenovirus type 21 detection over time. Among adenovirus isolates recovered from specimens from civilians, 50% were associated with hospitalization, 19.6% with a chronic disease condition, 11% with a bone marrow or solid organ transplantation, 7.4% with intensive care unit stay, and 4.2% with a cancer diagnosis. Multivariable risk factor modeling for adenovirus disease severity found that age <7 years (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4-7.4), chronic disease (OR, 3.6; 95% CI, 2.6-5.1), recent transplantation (OR, 2.7; 95% CI, 1.3-5.2), and adenovirus type 5 (OR, 2.7; 95% CI, 1.5-4.7) or type 21 infection (OR, 7.6; 95% CI, 2.6-22.3) increased the risk of severe disease.
Clinical Infectious Diseases 11/2007; 45(9):1120-31. · 9.15 Impact Factor
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ABSTRACT: Military recruits are at a higher risk of respiratory infection than their civilian counterparts. Continuous outbreaks of adenovirus (Ad)-associated acute respiratory disease were documented among US trainees before the implementation of serotype 4 (Ad4) and serotype 7 vaccines in 1971. The discontinuation of Ad vaccination programs in 1999 precipitated the reemergence of Ad in training sites, with Ad4 accounting for 98% of all diagnosed cases.
A total of 724 Ad4 strains isolated from recruits presenting with febrile respiratory illness at 8 training sites nationwide between 1997 and 2003 were genome typed by restriction enzyme analysis.
Seven genome types were identified, all of which were distinct from the prototype Ad4p and the vaccine type 4p1. Results showed very different, and often stable, genome type distributions at different geographic sites, despite the homogeneity of the recruit source population.
The data support the hypothesis that reservoirs for Ad outbreaks are within recruit training sites or in their immediate environments, not in the incoming recruit population. Molecular characterization beyond serotype is critical to understanding the transmission dynamics of Ad infection in these unique susceptible populations and to the implementation of effective prevention approaches.
The Journal of Infectious Diseases 08/2007; 196(1):67-75. · 6.41 Impact Factor
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ABSTRACT: Adenoviruses exhibit considerable intraserotypic genetic variability. Restriction enzyme analysis of the adenoviral genome is currently the most widely used procedure for the characterization of adenovirus isolates and has been extensively used for molecular epidemiological studies of subspecies B1 adenovirus infections. Comparison of restriction site maps between viral genomes is qualitatively consistent with DNA sequence homology providing that a sufficient number of sites are known. This technique is simple, sensitive, and can be adapted for screening numerous isolates and is therefore particularly useful for analysis of closely related genomes. Restriction enzyme analysis is still the only molecular approach that, at a reasonable cost, can give a "genome-wide" characterization of an adenovirus strain. Polymerase chain reaction (PCR) amplification followed by sequencing of the generated amplicon is the approach of choice for the detailed analysis of specific regions of the viral genome. Several laboratories have recently adopted PCR amplification of the hexon and/or fiber genes for the determination of adenovirus serotype identity, replacing identification by seroneutralization and hemmaglutination-inhibition. This approach permits rapid and objective type-specific identification of human adenoviruses and is especially useful for the characterization of serologically intermediate strains frequently identified among field strains of subspecies B1 adenoviruses.
Methods in molecular medicine 02/2007; 131:335-55.
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Kevin L Russell,
Michael P Broderick,
Suzanne E Franklin,
Lawrence B Blyn,
Nikki E Freed,
Emily Moradi,
David J Ecker,
Peter E Kammerer,
Miguel A Osuna, Adriana E Kajon,
Cassandra B Morn,
Margaret A K Ryan
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ABSTRACT: High levels of morbidity caused by adenovirus among US military recruits have returned since the loss of adenovirus vaccines in 1999. The transmission dynamics of adenovirus have never been well understood, which complicates prevention efforts.
Enrollment and end-of-study samples were obtained and active surveillance for febrile respiratory illnesses (FRIs) was performed for 341 recruits and support personnel. Environmental samples were collected simultaneously. Classic and advanced diagnostic techniques were used.
Seventy-nine percent (213/271) of new recruits were seronegative for either adenovirus serotype 4 (Ad-4) or adenovirus serotype 7 (Ad-7). FRI caused by Ad-4 was observed in 25% (67/271) of enrolled recruits, with 100% of them occurring in individuals with enrollment titers <1 : 4. The percentage of recruits seropositive for Ad-4 increased from 34% at enrollment to 97% by the end of the study. Adenovirus was most commonly detected in the environment on pillows, lockers, and rifles.
Potential sources of adenovirus transmission among US military recruits included the presence of adenovirus on surfaces in living quarters and extended pharyngeal viral shedding over the course of several days. The introduction of new recruits, who were still shedding adenovirus, into new training groups was documented. Serological screening could identify susceptible recruits for the optimal use of available vaccines. New high-throughput technologies show promise in providing valuable data for clinical and research applications.
The Journal of Infectious Diseases 10/2006; 194(7):877-85. · 6.41 Impact Factor
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ABSTRACT: Despite the well-recognized role of adenoviruses of species B in the etiology of severe respiratory disease, the lack of an experimental in vivo model system has limited the understanding of the molecular pathogenesis of species B adenovirus-induced pneumonia. Intratracheal instillation of 5 x 10(8) plaque-forming units (pfu) of adenoviruses 3p and 7h resulted in a robust inflammatory response in the lungs of infected mice. A marked infiltration of neutrophils into the lung air spaces was observed at 1 and 2 days postinfection (dpi), with a concomitant increase in the levels of neutrophil chemokines MIP-2 and KC. The overall histological severity scores were significantly higher for Ad3p-infected mice at 2 dpi, but similar between the two viruses at other time points. Remodeling of the airway epithelia and mucous cell metaplasia were noted in the proximal airways of infected mice, indicating marked epithelial differentiation and/or injury. The proinflammatory cytokines interleukin-beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma [see symbol in text]), and interleukin-12 (IL-12) were induced by viral infection. Expression of the early viral immunomodulatory genes E3-15.3K and E3gp19K mRNA was readily detectable in the lungs of infected mice by reverse transcription-polymerase chain reaction (RT-PCR) at 1 and 2 dpi, coinciding with the peak levels of TNF-alpha. While the detection of gp19K mRNA declined thereafter, 15.3K mRNA was detectable up to 6 dpi. Our results indicate that human Ad3 and Ad7 cause marked pulmonary pathology, inducing similar host responses in the respiratory tract, thus validating the use of the mouse model for the study of early virus-host interactions during lung infection by adenoviruses of subspecies B1.
Journal of Medical Virology 11/2003; 71(2):233-44. · 2.82 Impact Factor
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ABSTRACT: Genetic variation among 166 isolates of human adenovirus 7 (Ad7) obtained from 1966 to 2000 from the United States and Eastern Ontario, Canada, was determined by genome restriction analysis. Most (65%) isolates were identified as Ad7b. Two genome types previously undocumented in North America were also identified: Ad7d2 (28%), which first appeared in 1993 and was later identified throughout the Midwest and Northeast of the United States and in Canada; and Ad7h (2%), which was identified only in the U.S. Southwest in 1998 and 2000. Since 1996, Ad7d2 has been responsible for several civilian outbreaks of Ad7 disease and was the primary cause of a large outbreak of respiratory illness at a military recruit training center. The appearance of Ad7d2 and Ad7h in North America represents recent introduction of these viruses from previously geographically restricted areas and may herald a shift in predominant genome type circulating in the United States.
Emerging infectious diseases 04/2002; 8(3):269-77. · 6.17 Impact Factor
