Abstract
Patients following infection by chikungunya virus (CHIKV) can suffer for months to years from arthralgia and arthritis. Interestingly, methotrexate (MTX) a major immune-regulatory drug has proved to be of clinical benefit. We have previously shown that CHIKV can persist in the joint of one patient 18 months post-infection and plausibly driving chronic joint inflammation but through ill-characterized mechanisms. We have pursued our investigations and report novel histological and in vitro data arguing for a plausible role of a COX-2-mediated inflammatory response post-CHIKV. In the joint, we found a robust COX-2 staining on endothelial cells, synovial fibroblasts and more prominently on multinucleated giant cells identified as CD11c+ osteoclasts known to be involved in bone destruction. The joint tissue was also strongly stained for CD3, CD8, CD45, CD14, CD68, CD31, CD34, MMP2, and VEGF (but not for NO synthase and two B cell markers). Dendritic cells were rarely detected. Primary human synovial fibroblasts were infected with CHIKV or stimulated either by the synthetic molecule polyriboinosinic:polyribocytidylic acid (PIC) to mimic chronic viral infection or cytokines. First, we found that PIC and CHIKV enhanced mRNA expression of COX-2. We further found that PIC but not CHIKV increased the mRNA levels of cPLA2α and of mPGES-1, two other central enzymes in PGE2 production. IFNβ upregulated cPLA2α and COX-2 transcription levels but failed to modulated mPGES-1 mRNA expression. Moreover, PIC, CHIKV and IFNβ decreased mRNA expression of the PGE2 degrading enzyme 15-PGDH. Interestingly, MTX failed to control the expression of all these enzymes. In sharp contrast, dexamethasone was able to control the capacity of pro-inflammatory cytokines, IL-1β as well as TNFα, to stimulate mRNA levels of cPLA2α, COX-2 and mPGES-1. These original data argue for a concerted action of CHIKV (including viral RNA) and cytokines plausibly released from recruited leukocytes to drive a major COX-2-mediated PGE2 proinflammatory responses to induce viral arthritis.
Highlights
In the recent years, chikungunya virus (CHIKV) has re-emerged as one of the many arthropod-borne viruses that can cause significant public health threats with high social and economic impact [1,2]
It is important to have a better understanding of the immuno-pathogenesis of Chikungunya virus (CHIKV) and focusing on the chronic phase associated to arthralgia and arthritis
Benefiting from our prospective cohort studies, we provide novel in vivo data identifying for the first time the implication of COX-2 and several other enzymes involved in prostaglandin biosynthesis and the persistence of the virus on the joint
Summary
Chikungunya virus (CHIKV) has re-emerged as one of the many arthropod-borne viruses that can cause significant public health threats with high social and economic impact [1,2]. CHIKV, which causes chikungunya fever (CHIKF), is an alphavirus belonging to the Togaviridae family. CHIKF is an acute illness with abrupt fever, rash, myalgia, and severe incapacitating arthralgia [3,4]. These acute symptoms usually resolve within two weeks, some patients go on to develop persistent and/or recurrent joint pains that may last for months or years after contracting CHIKV [5,6,7]. The precise mechanisms of the progression of the CHIKV disease (CHIKVD) from acute Chikungunya fever to the chronic phase associated with arthralgia remain poorly understood. Possible viral persistence in the joints with local inflammatory responses mediated by recruited macrophages and T cells may play a role in the chronic manifestations of CHIKVD [8,9]
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