Objective. Influenza virus poses a major threat to human health and has serious morbidity and mortality which commonly occurs in high-risk populations. Pharynx and larynx of the upper respiratory tract mucosa is the first defense line against influenza virus infection. However, the ability of the pharynx and larynx organ to eliminate the influenza pathogen is still not clear under different host conditions. Methods. In this study, a mouse model of kidney yang deficiency syndrome (KYDS) was used to mimic high-risk peoples. Two different methods of influenza A (H1N1) virus infection by nasal dropping or tracheal intubation were applied to these mice, which were divided into four groups: normal intubation (NI) group, normal nasal dropping (ND) group, model intubation (MI) group, and model nasal dropping (MD) group. The normal control (NC) group was used as a negative control. Body weight, rectal temperature, and survival rate were observed every day. Histopathologic changes, visceral index, gene expressions of H1N1, cytokine expressions, secretory IgA (SIgA) antibodies of tracheal lavage fluids in the upper respiratory tract, and bronchoalveolar lavage fluids were analyzed by ELISA. Results. The MD group had an earlier serious morbidity and mortality than the others. MI and NI groups became severe only in the 6th to 7th day after infection. The index of the lung increased significantly in NI, MI, and MD groups. Conversely, indices of the thymus and spleen increased significantly in NC and ND groups. H&E staining showed severe tissue lesions in MD, MI, and NI groups. H1N1 gene expressions were higher in the MD group compared with the MI group on the 3rd day; however, the MD group decreased significantly on the 7th day. IL-6 levels increased remarkably, and SIgA expressions decreased significantly in the MD group compared with the NC group. Conclusions. SIgA secretions are influenced directly by different conditions of the host in the pharynx and larynx in the upper respiratory tract mucosa. In the KYDS virus disease mode, SIgA expressions could be inhibited severely, which leads to serious morbidity and mortality after influenza A virus infection. The SIgA expressions of the pharynx and larynx would be an important target in high-risk populations against the influenza A virus for vaccine or antiviral drugs research.
1. Introduction
Influenza is a highly infectious disease that causes a worldwide public health problem in millions of peoples per year. The most common influenza A (H1N1) virus can cause seasonal infections with significant morbidity and mortality in elderly and high-risk adults all around the world [1–5]. It remains unclear why these high-risk populations have serious difficulties in the resolution of influenza virus infection and what factors affect the infectious outcome.
Kidney yang deficiency syndrome (KYDS) is one of the classical syndrome patterns in traditional Chinese medicine (TCM), and it reflects a constitutional tendency of elder peoples with weakness in the knees and lumbar regions, fatigue, difficulty in urination, enuresis, female sterility, reduction of ear functions, and tooth impairment [6–8]. It is the most popular syndrome that occurs in more than sixty-year-olds [6, 9–11]. The influenza virus could cause up to 90% mortality in this age group [12–15], and these susceptible individuals belong to high-risk peoples with influenza infection, which is mostly similar to the KYDS according to the principles of TCM [10, 16]. When an epidemiological investigation was conducted in 2137 healthy elderly above 60-year-old residents, the results showed that the incidence rate of kidney deficiency was 78.80% [16], and the kidney deficiency syndrome prevalence in participants showed an increasing trend with increasing age and deteriorating health status [17]. Another epidemiological study on 2,067 adults aged >60 years revealed that 45.33% suffered from KYDS, showing that KYDS is the predominant TCM syndrome in high-risk populations [18] and these elderly groups are at increased risk for serious flu complications. Therefore, a key challenge is how to reduce the high mortality in susceptible population infected with the influenza virus.
The mucous layer in the upper respiratory tract (pharynx and larynx) is the first innate barrier of defense against influenza virus infection. The virus replication is restricted by the first innate immune line [19, 20]. The defensive functional differences in the mucosal immunity of the pharynx and larynx between normal population and high-risk population are still unknown. As the influenza viral infections mostly have upper respiratory symptoms with sore throat or discomfort, we speculated that the mucosal immunity of the pharynx and larynx may play an important role against influenza virus infection in the initial stage. In order to test this hypothesis, we designed a special experiment by separate infection normal control mice and KYDS mice (by injecting estradiol benzoate intraperitoneally [21, 22]) combined with influenza A (H1N1) virus through nose dropping and tracheal injection, respectively. This experiment would be conductive to reveal the primary mechanism to combat viral infections in the mucosal immunity of the pharynx and larynx in the KYDS mice model.
2. Materials and Methods
2.1. Experimental Design
This study was approved by the Ethic Committee of Shandong University of Traditional Chinese Medicine, and all animals received humane care in compliance with the Chinese Animal Protection Act and the National Research Council Criteria. SPF Male BALB/c mice (16–18 g) were purchased from the Jinan Pengyue Experimental Animal Breeding Company Limited. After three days acclimation, all mice were randomly assigned to two groups: KYDS mice (model group) were established by intraperitoneal injection of estradiol benzoate (8 mg/kg, Ningbo Second Hormone Factory, China) for 7 d as previously described [21, 23] and normal control mice (normal group) were intraperitoneally injected with normal saline. The physical signs in mice were observed, and spontaneous activity, swimming time, rectal temperature, and body weight were monitored. All the animals were housed at 21–23°C in a 12 h light/12 h dark cycle, and environmental humidity was controlled between 60 and 70%.
After the KYDS mice model was finished, these model animals were randomly divided into two groups: model intubation (MI) group and model nasal dropping (MD) group. Normal group animals were divided into three groups: normal control (NC) group, normal intubation (NI) group, and normal nasal dropping (ND) group.
2.2. Virus
Mouse-adapted influenza A virus (A/FM/1/47, H1N1) was kindly donated by the Institute of Basic Medicine, Shandong Academy of Medical Sciences. The virus was amplified in the allantoic cavity of embryonated eggs at 36°C for 48 h with a hemagglutination titer of 1 : 320 and then stored at −80°C. All tests were performed in class II biosafety cabinets [21].
2.3. Visualized Method for Tracheal Intubation
We used mouse-sized speculum, a plastic incisor loop, and a rodent work stand (Hallowell Engineering and Manufacturing Corporation, USA) for the visualization procedure of tracheal intubation. The mouse-sized speculum is attached with an otoscope and has a side cut-away portion that is conducive to the ET tube and a mouse ET tube introducer passing through the trachea [24].
2.4. Tracheal Infection with Influenza A Virus (H1N1)
The intubation method was adapted from the operation guidelines by Hallowell EMC and previous literature [25–27]. Mice were anesthetized intraperitoneally (i.p.) with 500 mg·kg⁻¹ tribromoethanol solution in the biosafety cabinet. Mice were placed on the work stand, and a clear view of the trachea was obtained with the otoscope and attached mouse speculum. The NI group and the MI group mice were injected with 5 μL of viral suspension containing a hemagglutination titer of 1 : 320 of the influenza A/FM/1/47 (H1N1) virus per mouse through the ET tube (1.22 mm OD; 23.5 mm length). We have tested that the ET tube length position was just located in the upper respiratory tract below the oropharyngeal structure. The NC group mice were injected with the same volume normal saline.
2.5. Nasal Dropping Infection with Influenza A Virus (H1N1)
As a common nasal dropping infection method, the ND group and the MD group were anaesthetized intraperitoneally (i.p.) with 500 mg·kg⁻¹ tribromoethanol solution and intranasally inoculated with 5 μL and the same titer of the influenza A/FM/1/47 (H1N1) virus, and then they ate food and drank water freely.
2.6. Serum and Tissue Preparation
On the 14th day, the whole blood was collected from the mice orbit and serum was later separated by centrifugalization, and then mice were sacrificed by cervical dislocation. The thymus, lung, and spleen were isolated and weighed for the organ index calculation. After harvesting, little amount of the right part of the lung samples was immediately submerged in RNAstore Reagent (Tiangen, China) at a dilution ratio of 1 : 10 (w/v) and then stored at 4°C. The left part of the lung tissue was taken, fixed in 10% formalin solution as histological specimens, and observed under the microscope to distinguish the pathological changes.
2.7. Cytometric Bead Array for Cytokine Measurements
Cytokine serum levels were determined using commercially available kits, including the mouse inflammation kit cytometric bead array (CBA; BD Biosciences Pharmingen, USA), to quantify IL-6, MCP-1, IL-12p70, and TNF-alpha. The CBA immunoassay uses 7.5 μm polystyrene microbeads assembled in distinct fluorescent sets, unique on their type-4 fluorescence intensity (FL-4). Each microbead is coupled to the monoclonal antibody (MAb) against a given cytokine. Following incubation with the test sample, the bead-captured cytokines were detected by the direct immunoassay using a “detection cocktail” of distinct MAbs labeled with type-2 fluorescence, phycoerythrin-PE (FL-2). Data acquisition and analysis was performed in a dual-laser C6™ flow cytometer (BD Biosciences Pharmingen, San Jose, CA, USA), using the BD Bioscience CBA software. The fluorescently labeled particles in the BD CBA immunoassay are designed to be excited by the 488 nm and 532 nm lasers on the BD flow cytometer [28].
2.8. Total RNA Extraction
Total RNA was isolated from 10 to 20 mg tissues using RNAprep Pure Tissue Kit (Tiangen, China) following the manufacturer’s instructions. Yield and purity of RNA were determined by the Quawell 5000 spectrophotometer (Quawell Technology, USA). RNA samples with an absorbance ratio OD 260/280 between 1.8 and 2.0 were used for further analysis. RNA integrity was assessed using agarose gel electrophoresis.
2.9. Reverse Transcription cDNA Synthesis
The first-strand cDNA was synthesized from 2 μg of total RNA with random hexamer oligonucleotide primers using a 20 μl reverse transcription system (FastQuant RT kit with gDNase, Tiangen, China) by incubation at 42°C for 3 min to protect the total RNA from genomic DNA interference. FastQuant RT Enzyme was used for reverse transcription at 42°C for 15 min. Then, cDNA was stored at −20°C for future use. For qPCR analysis, each cDNA sample was diluted 10 times with nuclease-free water.
2.10. Real-Time PCR
Real-time PCRs were conducted in Bio-Rad CFX Connect Real-Time System. For each reaction, the 20 μL mixture contained 2 μL of cDNA, 6 pmol each of the forward and reverse primers, and 10 μL of 2 × SuperReal PreMix Plus with SYBR Green I (Tiangen, China). The amplification program was as follows: 95°C for 15 min, 40 cycles at 95°C for 10 s, and 60°C for 32 s. After amplification, a thermal denaturing cycle was added to derive the dissociation curve of the PCR product to verify amplification specificity. Half-quantification of the genes of interest were normalized to Grcc10 and expressed as fold increases over the negative control for each treatment at each time point, as previously described. The primers are as follows: Grcc10 primers: forward 5′- GCGGAGGTGATTCAAGCG -3′ and reverse 5′- TGACCAGGCGGGCAA ACT -3′; influenza A (H1N1) virus M gene Primers: forward 5′-CTGAGAAGCAGATACTGGGC-3′ and reverse 5′-CTGCATTGTCTCCGAAGAAAT-3′.
2.11. Measurement of Secretory IgA Levels
In order to collect bronchoalveolar lavage fluids (BALF) and tracheal lavage fluids (TLF), these animals were divided into six groups: normal control group-intubation (NC-I), normal control group-nasal drop (NC-D), normal intubation (NI) group, normal nasal drop (ND) group, model intubation (MI) group, and model nasal drop (MD) group. On the 14th day, tracheal lavage fluids and bronchoalveolar fluids of 5–7 animals in each group were collected and subjected to the enzyme-linked immunosorbent assay (ELISA) to determine secretory IgA [29, 30].
2.12. Data Analysis
Data are expressed as mean ± SEM. The statistical analysis of two groups data is calculated by Student’s t-test. For multiple groups, one-way ANOVA analysis with the LSD test is used to compare means. Analysis involved the use of SPSS 22; statistical significance is considered at and . For survival studies, a log-rank (Mantel–Cox) test involved the use of GraphPad Prism (GraphPad 5.0 Software).
3. Results
3.1. Establishment of KYDS Mice Model
In order to mimic the high-risk population, we established a KYDS mice model by injecting estradiol benzoate for seven days as previously described; the body weight of the KYDS group was significantly lower than normal control mice from the 3rd day to the 7th day () (Figure 1(a)). The rectal temperature of the KYDS group decreased significantly compared with the normal group for six days () (Figure 1(b)). The spontaneous activity and swimming time of KYDS mice were also obviously lower than the control group (; ) (Figures 1(c) and 1(d)). These results showed that the KYDS mice model was established successfully [21, 22].
(a)