Abstract Infection of dengue virus (DENV), an arthropod-borne flavivirus, threatens global public health due to its high prevalence and the lack of effective treatment. Multiple risk factors are believed to be involved, including virus virulence, antibody-dependent enhancement, T cell response, complement activation, autoimmune response, host factors, cytokine storm, and vascular leakage. Regarding host factors may contribute to DENV infection, replication, and pathogenesis, here we investigate the role for nuclear factor (erythroid-derived 2)-like 2 (Nrf2), which is activated by DENV in mononuclear phagocytes. DENV infection selectively activates Nrf2 through a mechanism involving endoplasmic reticulum stress and protein kinase R-like ER kinase activation. After DENV infection, activation of Nrf2 facilitates an increase in C-type lectin domain family 5, member A (CLEC5A) expression through the binding of activated Nrf2 to the CLEC5A promoter. The downstream signaling of the Nrf2-CLEC5A interaction enhances TLR3-independent TNF-α production following DENV infection. Forced expressing the viral protein NS2B3 induces Nrf2 activation and CLEC5A expression to increase DENV-induced TNF-α production. Further animal studies confirm Nrf2-induced CLEC5A and TNF-α in brains from DENV-infected mice. These results demonstrate that, in addition to TLR3, DENV infection also causes Nrf2-facilitated TNF-α production by increasing levels of CLEC5A.
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