Theodore C Pierson

National Institute of Allergy and Infectious Diseases, 베서스다, Maryland, United States

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Publications (84)686.53 Total impact

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    ABSTRACT: The four genetically divergent dengue virus (DENV) types are traditionally classified as serotypes. Antigenic and genetic differences among the DENV types influence disease outcome, vaccine-induced protection, epidemic magnitude, and viral evolution. We characterized antigenic diversity in the DENV types by antigenic maps constructed from neutralizing antibody titers obtained from African green monkeys and after human vaccination and natural infections. Genetically, geographically, and temporally, diverse DENV isolates clustered loosely by type, but we found that many are as similar antigenically to a virus of a different type as to some viruses of the same type. Primary infection antisera did not neutralize all viruses of the same DENV type any better than other types did up to 2 years after infection and did not show improved neutralization to homologous type isolates. That the canonical DENV types are not antigenically homogeneous has implications for vaccination and research on the dynamics of immunity, disease, and the evolution of DENV.
    Science 09/2015; 349(6254):1338-1343. DOI:10.1126/science.aac5017 · 33.61 Impact Factor
  • Leslie Goo · Theodore C Pierson
    Nature 08/2015; 524(7565):295-6. DOI:10.1038/524295a · 41.46 Impact Factor
  • Michael S Diamond · Theodore C Pierson
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    ABSTRACT: Dengue virus (DENV) is a mosquito-transmitted RNA virus that infects an estimated 390 million humans each year. Here, we review recent advances in our understanding of the biology of DENV and describe knowledge gaps that have impacted the development of effective vaccines and therapeutics. Copyright © 2015 Elsevier Inc. All rights reserved.
    Cell 07/2015; 162(3):488-492. DOI:10.1016/j.cell.2015.07.005 · 32.24 Impact Factor
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    ABSTRACT: The molecular mechanisms that define the specificity of flavivirus RNA encapsulation are poorly understood. Virions composed of the structural proteins of one flavivirus and the genomic RNA of a heterologous strain can be assembled and have been developed as live attenuated vaccine candidates for several flaviviruses. In this study, we discovered that not all combinations of flavivirus components are possible. While a West Nile virus (WNV) subgenomic RNA could readily be packaged by structural proteins of the DENV2 strain 16681, production of infectious virions with DENV2 strain New Guinea C (NGC) structural proteins was not possible, despite the very high amino acid identity between these viruses. Mutagenesis studies identified a single residue (position 101) of the DENV capsid (C) protein as the determinant for heterologous virus production. C101 is located at the P1' position of the NS2B/3 protease cleavage site at the carboxy terminus of the C protein. WNV NS2B/3 cleavage of the DENV structural polyprotein was possible when a threonine (Thr101 in strain 16681) but not a serine (Ser101 in strain NGC) occupied the P1' position, a finding not predicted by in vitro protease specificity studies. Critically, both serine and threonine were tolerated at the P1' position of WNV capsid. More extensive mutagenesis revealed the importance of flanking residues within the polyprotein in defining the cleavage specificity of the WNV protease. A more detailed understanding of the context dependence of viral protease specificity may aid the development of new protease inhibitors and provide insight into associated patterns of drug resistance.
    Journal of Virology 06/2015; 89(16). DOI:10.1128/JVI.01253-15 · 4.44 Impact Factor
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    Richard J Kuhn · Kimberly A Dowd · Carol Beth Post · Theodore C Pierson
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    ABSTRACT: Remarkable progress in structural biology has equipped virologists with insight into structures of viral proteins and virions at increasingly high resolution. Structural information has been used extensively to address fundamental questions about virtually all aspects of how viruses replicate in cells, interact with the host, and in the design of antiviral compounds. However, many critical aspects of virology exist outside the snapshots captured by traditional methods used to generate high-resolution structures. Like all proteins, viral proteins are not static structures. The conformational flexibility and dynamics of proteins play a significant role in protein-protein interactions, and in the structure and biology of virus particles. This review will discuss the implications of the dynamics of viral proteins on the biology, antigenicity, and immunogenicity of flaviviruses. Copyright © 2015. Published by Elsevier Inc.
    Virology 03/2015; 479-480. DOI:10.1016/j.virol.2015.03.025 · 3.32 Impact Factor
  • Theodore C Pierson · Michael S Diamond
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    ABSTRACT: The humoral response contributes to the protection against viral pathogens. Although antibodies have the potential to inhibit viral infections via several mechanisms, an ability to neutralize viruses directly may be particularly important. Neutralizing antibody titers are commonly used as predictors of protection from infection, especially in the context of vaccine responses and immunity. Despite the simplicity of the concept, how antibody binding results in virus inactivation is incompletely understood despite decades of research. Flaviviruses have been an attractive system in which to seek a structural and quantitative understanding of how antibody interactions with virions modulate infection because of the contribution of antibodies to both protection and pathogenesis. This review will present a stoichiometric model of antibody-mediated neutralization of flaviviruses and discuss how these concepts can inform the development of vaccines and antibody-based therapeutics. © 2015 Elsevier Inc. All rights reserved.
    Progress in molecular biology and translational science 01/2015; 129C:141-166. DOI:10.1016/bs.pmbts.2014.10.005 · 3.49 Impact Factor
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    ABSTRACT: Background Chikungunya virus—a mosquito-borne alphavirus—is endemic in Africa and south and southeast Asia and has recently emerged in the Caribbean. No drugs or vaccines are available for treatment or prevention. We aimed to assess the safety, tolerability, and immunogenicity of a new candidate vaccine. Methods VRC 311 was a phase 1, dose-escalation, open-label clinical trial of a virus-like particle (VLP) chikungunya virus vaccine, VRC-CHKVLP059-00-VP, in healthy adults aged 18–50 years who were enrolled at the National Institutes of Health Clinical Center (Bethesda, MD, USA). Participants were assigned to sequential dose level groups to receive vaccinations at 10 μg, 20 μg, or 40 μg on weeks 0, 4, and 20, with follow-up for 44 weeks after enrolment. The primary endpoints were safety and tolerability of the vaccine. Secondary endpoints were chikungunya virus-specific immune responses assessed by ELISA and neutralising antibody assays. This trial is registered with, NCT01489358. Findings 25 participants were enrolled from Dec 12, 2011, to March 22, 2012, into the three dosage groups: 10 μg (n=5), 20 μg (n=10), and 40 μg (n=10). The protocol was completed by all five participants at the 10 μg dose, all ten participants at the 20 μg dose, and eight of ten participants at the 40 μg dose; non-completions were for personal circumstances unrelated to adverse events. 73 vaccinations were administered. All injections were well tolerated, with no serious adverse events reported. Neutralising antibodies were detected in all dose groups after the second vaccination (geometric mean titres of the half maximum inhibitory concentration: 2688 in the 10 μg group, 1775 in the 20 μg group, and 7246 in the 40 μg group), and a significant boost occurred after the third vaccination in all dose groups (10 μg group p=0·0197, 20 μg group p<0·0001, and 40 μg group p<0·0001). 4 weeks after the third vaccination, the geometric mean titres of the half maximum inhibitory concentration were 8745 for the 10 μg group, 4525 for the 20 μg group, and 5390 for the 40 μg group. Interpretation The chikungunya VLP vaccine was immunogenic, safe, and well tolerated. This study represents an important step in vaccine development to combat this rapidly emerging pathogen. Further studies should be done in a larger number of participants and in more diverse populations. Funding Intramural Research Program of the Vaccine Research Center, National Institute of Allergy and Infectious Diseases, and National Institutes of Health.
    The Lancet 12/2014; 384(9959). DOI:10.1016/S0140-6736(14)61185-5 · 45.22 Impact Factor
  • Theodore C. Pierson · Michael S. Diamond
    11/2014; 1(1):375-398. DOI:10.1146/annurev-virology-031413-085453
  • Kimberly A Dowd · Swati Mukherjee · Richard J Kuhn · Theodore C Pierson
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    ABSTRACT: Flaviviruses are thought to sample an ensemble of structures at equilibrium. One consequence of a structurally dynamic virion is the observed time-dependent increases in neutralization sensitivity that can occur after prolonged incubation with antibody. Differences in how virus strains "breathe" may affect epitope exposure and contribute to the underlying mechanisms of strain-dependent neutralization sensitivity. Beyond the contribution of structural dynamics, flaviviruses exist as a structurally heterogeneous population due to an inefficient virion maturation process. Herein we investigate the interplay between virion maturation and structural dynamics that contribute to antibody-mediated neutralization. Using West Nile (WNV) and dengue (DENV) viruses produced under conditions that modify the extent of virion maturation, we investigated time-dependent changes in neutralization sensitivity associated with structural dynamics. Our results identify distinct patterns of neutralization against viruses that vary markedly with respect to the extent of virion maturation. Reducing the efficiency of virion maturation resulted in greater time-dependent changes in neutralization potency and a marked reduction in the stability of the particle at 37°C as compared to more mature virus. That neutralization sensitivity of WNV and DENV did not increase after prolonged incubation in the absence of antibody, regardless of virion maturation, suggests that the dynamic processes that govern epitope accessibility on infectious viruses are reversible. Against the backdrop of heterogeneous flavivirus structures, differences in the pathways by which viruses "breathe" represent an additional layer of complexity towards understanding maturation state-dependent patterns of antibody recognition.
    Journal of Virology 07/2014; 88(20). DOI:10.1128/JVI.01140-14 · 4.44 Impact Factor
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    ABSTRACT: Unlabelled: The production of neutralizing antibodies (NAbs) is a correlate of protection for many human vaccines, including currently licensed vaccines against flaviviruses. NAbs are typically measured using a plaque reduction neutralization test (PRNT). Despite its extensive use, parameters that impact the performance of the PRNT have not been investigated from a mechanistic perspective. The results of a recent phase IIb clinical trial of a tetravalent dengue virus (DENV) vaccine suggest that NAbs, as measured using a PRNT performed with Vero cells, do not correlate with protection. This surprising finding highlights the importance of understanding how well the PRNT captures the complexity of the NAb response to DENV. In this study, we demonstrated that the structural heterogeneity of flaviviruses arising from inefficient virion maturation impacts the results of neutralization assays in a cell type-dependent manner. Neutralization titers of several monoclonal antibodies were significantly reduced when assayed on Vero cells compared to Raji cells expressing DC-SIGNR. This pattern can be explained by differences in the efficiency with which partially mature flaviviruses attach to each cell type, rather than a differential capacity of antibody to block infection. Vero cells are poorly permissive to the fraction of virions that are most sensitive to neutralization. Analysis of sera from recipients of live-attenuated monovalent DENV vaccine candidates revealed a strong correlation between the sensitivity of serum antibodies to the maturation state of DENV and cell type-dependent patterns of neutralization. Cross-reactive patterns of neutralization may be underrepresented by the "gold-standard" PRNT that employs Vero cells. Importance: Cell type-dependent patterns of neutralization describe a differential capacity of antibodies to inhibit virus infection when assayed on multiple cellular substrates. In this study, we established a link between antibodies that neutralize infection in a cell type-dependent fashion and those sensitive to the maturation state of the flavivirus virion. We demonstrated that cell type-dependent neutralization reflects a differential capacity to measure neutralization of viruses that are incompletely mature. Partially mature virions that most efficiently bind maturation state-sensitive antibodies are poorly represented by assays typically used in support of flavivirus vaccine development. The selection of cellular substrate for neutralization assays may significantly impact evaluation of the neutralization potency of the polyclonal response. These data suggest that current assays do not adequately capture the full complexity of the neutralizing antibody response and may hinder the identification of correlates of protection following flavivirus vaccination.
    Journal of Virology 04/2014; 88(13). DOI:10.1128/JVI.03690-13 · 4.44 Impact Factor
  • Swati Mukherjee · Theodore C Pierson · Kimberly A Dowd
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    ABSTRACT: This chapter outlines methods for the production of dengue virus (DENV) reporter virus particles (RVPs) and their use in assays that measure antibody-mediated neutralization and enhancement of DENV infection. RVPs are pseudo-infectious virions produced by complementation of a self-replicating flavivirus replicon with the DENV structural genes in trans. RVPs harvested from transfected cells are capable of only a single round of infection and encapsidate replicon RNA that encodes a reporter gene used to enumerate infected cells. RVPs may be produced using the structural genes of different DENV serotypes, genotypes, and mutants by changing plasmids used for complementation. Further modifications are possible including generating RVPs with varying levels of uncleaved prM protein, which resemble either the immature or mature form of the virus. Neutralization potency is measured by incubating RVPs with serial dilutions of antibody, followed by infection of target cells that express DENV attachment factors. Enhancement of infection is measured similarly using Fc receptor-expressing cells capable of internalizing antibody-virus complexes.
    Methods in molecular biology (Clifton, N.J.) 04/2014; 1138:75-97. DOI:10.1007/978-1-4939-0348-1_6 · 1.29 Impact Factor
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    ABSTRACT: Author Summary Dengue virus (DENV) is a globally important mosquito-transmitted human pathogen for which there is no approved vaccine or antiviral therapy. In recent years, the number and severity of DENV human infections have increased due to the expanded geographic range of the virus. Neutralizing antibodies are a key component of a protective natural and vaccine-induced immune response against human DENV infections. One recently described monoclonal antibody (E106) protects mice against infection of DENV-1 when administered before or several days after virus infection. Because of these results, we investigated the mechanism of action of E106 using a combination of structural and functional approaches. E106 engaged an epitope on domain III of the viral envelope protein that is a composite of two previously described epitopes. Unexpectedly, and in contrast to the intact IgG, Fab fragments of E106 were ineffective at neutralizing virus; this was explained by their weak micromolar affinity for virus particles. Our results suggest that neutralization by E106, our most potently inhibitory and protective anti-DENV MAb, requires bivalent binding of adjacent DIII subunits on a single virion. Immunization strategies with intact virions that skew the selection of neutralizing antibodies to those with bivalently binding properties could augment the potency of antiviral humoral responses against DENV and other flaviviruses.
    PLoS Pathogens 04/2014; 10(4):e1004072. DOI:10.1371/journal.ppat.1004072 · 7.56 Impact Factor
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    ABSTRACT: Dengue viruses are mosquito-borne flaviviruses that circulate in nature as four distinct serotypes (DENV1-4). These emerging pathogens are responsible for more than 100 million human infections annually. Severe clinical manifestations of disease are predominantly associated with a secondary infection by a heterotypic DENV serotype. The increased risk of severe disease in DENV-sensitized populations significantly complicates vaccine development, as a vaccine must simultaneously confer protection against all four DENV serotypes. Eliciting a protective tetravalent neutralizing antibody response is a major goal of ongoing vaccine development efforts. However, a recent large clinical trial of a candidate live-attenuated DENV vaccine revealed low protective efficacy despite eliciting a neutralizing antibody response, highlighting the need for a better understanding of the humoral immune response against dengue infection. In this study, we sought to identify epitopes recognized by serotype-specific neutralizing antibodies elicited by monovalent DENV1 vaccination. We constructed a panel of over 50 DENV1 structural gene variants containing substitutions at surface-accessible residues of the envelope (E) protein to match the corresponding DENV2 sequence. Amino acids that contribute to recognition by serotype-specific neutralizing antibodies were identified as DENV mutants with reduced sensitivity to neutralization by DENV1 immune sera, but not cross-reactive neutralizing antibodies elicited by DENV2 vaccination. We identified two mutations (E126K and E157K) that contribute significantly to type-specific recognition by polyclonal DENV1 immune sera. Longitudinal and cross-sectional analysis of sera from 24 participants of a phase I clinical study revealed a markedly reduced capacity to neutralize a E126K/E157K DENV1 variant. Sera from 77% of subjects recognized the E126K/E157K DENV1 variant and DENV2 equivalently (<3-fold difference). These data indicate the type-specific component of the DENV1 neutralizing antibody response to vaccination is strikingly focused on just two amino acids of the E protein. This study provides an important step towards deconvoluting the functional complexity of DENV serology following vaccination.
    PLoS Pathogens 12/2013; 9(12):e1003761. DOI:10.1371/journal.ppat.1003761 · 7.56 Impact Factor
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    ABSTRACT: Flavivirus-infected cells secrete a structurally heterogeneous population of viruses because of an inefficient virion maturation process. Flaviviruses assemble as non-infectious, immature virions composed of trimers of envelope (E) and precursor-membrane (prM) protein heterodimers. Cleavage of prM is a required process during virion maturation, although this often remains incomplete on infectious virus particles. Previous work demonstrated that the efficiency of virion maturation could impact antibody neutralization through changes in the accessibility of otherwise cryptic epitopes on the virion. In this study, we show that the neutralization potency of monoclonal antibody (mAb) E33 is sensitive to the maturation state of West Nile virus (WNV) despite recognizing an accessible epitope, the domain III lateral ridge (DIII-LR). Comprehensive epitope mapping studies using 166 E protein DIII-LR variants revealed that the functional footprint of mAb E33 on the E protein differs subtly from that of the well characterized DIII-LR mAb E16. Remarkably, aromatic substitutions at E protein residue 306 ablated the maturation-state sensitivity of E33 IgG, and the neutralization efficacy of E33 Fab fragments was not affected by changes in the virion maturation state. We propose that E33 IgG binding on mature virions orients the Fc region in a manner that impacts subsequent antibody binding to nearby sites. This Fc-mediated steric constraint is a novel mechanism by which the maturation state of a virion modulates the efficacy of the humoral immune response to flavivirus infection.
    Journal of Virology 10/2013; 24(24). DOI:10.1128/JVI.02340-13 · 4.44 Impact Factor
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    ABSTRACT: Dengue virus (DENV) is a mosquito-transmitted flavivirus that can cause severe disease in humans and is considered a reemerging pathogen of significant importance to public health. The DENV capsid (C) protein functions as a structural component of the infectious virion; however, it may have additional functions in the virus replicative cycle. Here, we show that the DENV C protein interacts and colocalizes with the multifunctional host protein nucleolin (NCL). Furthermore, we demonstrate that this interaction can be disrupted by the addition of an NCL binding aptamer (AS1411). Knockdown of NCL with small interfering RNA (siRNA) or treatment of cells with AS1411 results in a significant reduction of viral titers after DENV infection. Western blotting and quantitative RT-PCR (qRT-PCR) analysis revealed no differences in viral RNA or protein levels at early time points postinfection, suggesting a role for NCL in viral morphogenesis. We support this hypothesis by showing that treatment with AS1411 alters the migration characteristics of the viral capsid, as visualized by native electrophoresis. Here, we identify a critical interaction between DENV C protein and NCL that represents a potential new target for the development of antiviral therapeutics.
    Journal of Virology 09/2013; 87(24). DOI:10.1128/JVI.00704-13 · 4.44 Impact Factor
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    ABSTRACT: Although prior studies have characterized the neutralizing activity of monoclonal antibodies (MAbs) against DENV serotypes 1, 2, and 3 (DENV-1, DENV-2, and DENV-3), few reports have assessed the activity of MAbs against DENV-4. Here, we evaluated the inhibitory activity of 81 new mouse anti-DENV-4 MAbs. We observed strain and genotype-dependent differences in neutralization of DENV-4 by MAbs mapping to epitopes on domains II (DII) and III (DIII) of the envelope (E) protein. Several anti-DENV-4 MAbs inefficiently inhibited at least one strain and/or genotype, suggesting that the exposure or sequence of neutralizing epitopes varies within isolates of this serotype. Remarkably, flavivirus cross-reactive MAbs, which bound to the highly conserved fusion loop in DII and inhibited infection of DENV-1, DENV-2, and DENV-3, more weakly neutralized five different DENV-4 strains encompassing the genetic diversity of the serotype after pre-incubation at 37°C. However, increasing the time of pre-incubation at 37°C or raising the temperature to 40°C enhanced the potency of DII fusion loop-specific MAbs and some DIII-specific MAbs against DENV-4 strains. Prophylaxis studies in two new DENV-4 mouse models showed that neutralization titers of MAbs after pre-incubation at 37°C correlated with activity in vivo. Our studies establish the complexity of MAb recognition against DENV-4, and suggest that differences in epitope exposure relative to other DENV serotypes affects antibody neutralization and protective activity.
    Journal of Virology 06/2013; DOI:10.1128/JVI.01314-13 · 4.44 Impact Factor
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    ABSTRACT: Author Summary Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes outbreaks of polyarthritis in humans, and is currently a threat to spread to the United States due to the presence of its mosquito vector, Aedes albopictus. At present, there is no licensed human vaccine or therapeutic available to protect against CHIKV infection. The primary goal of this study was to develop an antibody-based therapeutic agent against CHIKV. To do this, we developed a panel of 230 new mouse anti-CHIKV MAbs and tested them for their ability to neutralize infection of different CHIKV strains in cell culture. We identified 36 MAbs with broad neutralizing activity, and then tested several of these for their ability to protect immunocompromised Ifnar−/− mice against lethal CHIKV infection. In post-exposure therapeutic trials, administration of a single dose of a combination of two neutralizing MAbs limited the development of resistance and protected Ifnar−/− mice against disease even when given just 24 to 36 hours before CHIKV-induced death. Analogous protection against CHIKV-induced arthritis was seen in a disease model in wild type mice. Our data suggest that pairs of highly neutralizing MAbs may be a therapeutic option against CHIKV infection.
    PLoS Pathogens 04/2013; 9(4):e1003312. DOI:10.1371/journal.ppat.1003312 · 7.56 Impact Factor
  • Theodore C Pierson · Margaret Kielian
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    ABSTRACT: Flaviviruses are small spherical virus particles covered by a dense icosahedral array of envelope (E) proteins that mediate virus attachment to cells and the fusion of viral and cellular membranes. Our understanding of the mechanism by which flavivirus E proteins orchestrate entry into cells has been advanced by studies of E structure and arrangement on the virion at different steps of the virus entry/membrane fusion process. When combined with an increasingly clear (albeit still incomplete) view of the cell biology of virus entry, these advances suggest new antiviral strategies. Indeed, inhibitors that target cellular and viral processes involved in entry show promise as powerful tools to study this critical step of the viral lifecycle, and with luck, may ultimately lead to therapeutic advances.
    01/2013; 3(1). DOI:10.1016/j.coviro.2012.12.001
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    ABSTRACT: Neutralization of flaviviruses requires engagement of the virion by antibodies with a stoichiometry that exceeds a required threshold. Factors that modulate the number of antibodies bound to an individual virion when it contacts target cells impact neutralization potency. However, the contribution of cellular factors to the potency of neutralizing antibodies has not been explored systematically. Here we investigate the relationship between expression level of a viral attachment factor on cells and the neutralizing potency of antibodies. Analysis of the attachment factor DC-SIGNR on cells in neutralization studies failed to identify a correlation between DC-SIGNR expression and antibody-mediated protection. Furthermore, neutralization potency was equivalent on a novel Jurkat cell line induced to express DC-SIGNR at varying levels. Finally, blocking virus-attachment factor interactions had no impact on neutralization activity. Altogether, our studies suggest that cellular attachment factor expression is not a significant contributor to the potency of neutralizing antibodies to flaviviruses.
    Virology 01/2013; 437(1). DOI:10.1016/j.virol.2012.11.016 · 3.32 Impact Factor
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    ABSTRACT: Author Summary Within each Dengue virus (DENV) serotype, viruses are subdivided into genotypes based upon the protein sequence variation. Infection with a given serotype is believed to induce neutralizing antibodies that provide long-term immunity against secondary infection by a strain of the same serotype. However, recent studies suggest that some classes of neutralizing antibodies fail to inhibit infection equivalently for all genotypes within a DENV serotype. DENV1-E111 is an example of an antibody that differentially neutralizes infection of DENV-1 strains. We used structural and molecular approaches to determine that DENV1-E111 binds to an epitope in domain III of the envelope protein. Although the epitope sequence varied between DENV-1 genotypes, inhibitory activity of the antibody remained unequal when we exchanged the amino acids within the epitope among genotypes. Docking of our structures onto DENV virion models revealed that the DENV1-E111 epitope was inaccessible, suggesting that the antibody recognizes an uncharacterized virus conformation. Our studies suggest that DENV virion structures differ in a genotype-dependent manner, which can impact the inhibitory activity of antibodies that recognize cryptic epitopes.
    PLoS Pathogens 10/2012; 8(10):e1002930. DOI:10.1371/journal.ppat.1002930 · 7.56 Impact Factor

Publication Stats

7k Citations
686.53 Total Impact Points


  • 2010–2015
    • National Institute of Allergy and Infectious Diseases
      • Laboratory of Immunoregulation
      베서스다, Maryland, United States
    • University of California, Berkeley
      • Department of Infectious Diseases and Vaccinology
      Berkeley, California, United States
  • 2007–2013
    • National Institutes of Health
      • • Laboratory of Viral Diseases
      • • Laboratory of Infectious Diseases
      Maryland, United States
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 2008–2011
    • National Institute of Allergy and Infectious Disease
      베서스다, Maryland, United States
  • 2003–2007
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2000–2006
    • University of Pennsylvania
      • • Department of Microbiology (Medicine)
      • • Department of Pathology and Laboratory Medicine
      Philadelphia, Pennsylvania, United States
  • 2005
    • University of Missouri - St. Louis
      Сент-Луис, Michigan, United States
  • 2002
    • Johns Hopkins Medicine
      • Department of Medicine
      Baltimore, Maryland, United States
  • 2000–2002
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, MD, United States