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Lethal Disease Following H5N1 Avian Influenza Virus Clade 2.3.4.4b Infection in Macaques

ABSTRACT: The H5N1 avian influenza virus clade 2.3.4.4b outbreak represents a major pandemic threat for humans. Although most human cases to date have been mild, several severe cases of respiratory illness have been reported. A key unanswered question is the pathogenesis of H5N1 infection in primates following respiratory infection. In this study, we observed severe clinical disease in cynomolgus and rhesus macaques following respiratory infection with the H5N1 isolate A/Texas/37/2024 (hu-TX37-H5N1). Cynomolgus macaques inoculated with a high dose of hu-TX37-H5N1 developed severe consolidative necrotizing pneumonia with extrapulmonary spread. Clinical disease was rapidly progressive and lethal in 100% (9 of 9) of macaques by day 5-9 following challenge. Rhesus macaques inoculated with varying doses of hu-TX37-H5N1 demonstrated dose-dependent mortality, and surviving animals showed robust natural protective immunity against high dose re-challenge. H5N1 infection in both cynomolgus and rhesus macaques was characterized by upregulation of proinflammatory cytokine, innate immune cell, complement and coagulation, apoptosis, and immune exhaustion pathways and downregulation of NK, T, and B cell activation and differentiation pathways. Taken together, our data demonstrate severe respiratory disease with H5N1 clade 2.3.4.4b in nonhuman primates and suggest that acute inflammation and immune dysregulation are key contributors to disease pathogenesis.

ORGANISM(S): Macaca fascicularis Macaca mulatta

PROVIDER: GSE287709 | GEO | 2025/08/01

REPOSITORIES: GEO

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Project description:Occasional transmission of highly pathogenic avian H5N1 influenza viruses to humans causes severe pneumonia with high mortality. To better understand the mechanisms via which H5N1 viruses induce severe disease in humans, we infected cynomolgus macaques with six different H5N1 strains isolated from human patients and compared their pathogenicity and the global host responses to the virus infection. Although all H5N1 viruses replicated in the respiratory tract, there was substantial heterogeneity in their replicative ability and in the disease severity induced, which ranged from asymptomatic to fatal. A comparison of global gene expression between severe and mild disease cases indicated that interferon-induced up-regulation of genes related to innate immunity, apoptosis, and antigen processing/presentation in the early phase of infection was limited in severe disease cases, although interferon expression was up-regulated in both severe and mild cases. Furthermore, co-expression analysis of microarray data, which reveals the dynamics of host responses during the infection, demonstrated that the limited expression of these genes early in infection led to a failure to suppress virus replication and to the hyperinduction of genes related to immunity, inflammation, coagulation, and homeostasis in the late phase of infection, resulting in a more severe disease. Our data suggest that the attenuated interferon-induced activation of innate immunity, apoptosis, and antigen presentation in the early phase of H5N1 virus infection leads to subsequent severe disease outcome. Bronchial brushes for microarray studies were obtained from female cynomolgus macaques infected with influenza viruses. Three animals per group were inoculated with one of three H5N1 influenza viruses (VN3028II, VN30259 or VN3040). The early phase of infection refers to timepoints Pre (prior to infection), 1, and 3 days post-infection. The late phase of infection refers to days 5 and 7 post-infection. Samples collected prior to infection (labeled as Pre) served as control data for each infection group.

Project description:Non-human primates are the animals closest to humans for use in influenza A virus challenge studies, in terms of their phylogenetic relatedness, physiology and immune systems. Previous studies have shown that cynomolgus macaques (Macaca fascicularis) are permissive for infection with H1N1pdm influenza virus. These studies have typically used combined challenge routes, with the majority being intra-tracheal delivery, and high doses of virus (> 107 infectious units). This paper describes the outcome of novel challenge routes (inhaled aerosol, intra-nasal instillation) and low to moderate doses (103 to 106 plaque forming units) of H1N1pdm virus in cynomolgus macaques. All 4 challenge groups showed sero-conversion and evidence of virus replication, although the disease was sub-clinical. Intra-nasal challenge led to an infection confined to the nasal cavity. A low dose (103 plaque forming units) did not lead to detectable infectious virus shedding, but a 1000-fold higher dose led to virus shedding in all intra-nasal challenged animals. In contrast, aerosol and intra-tracheal challenge routes led to infections throughout the respiratory tract, although shedding from the nasal cavity was less reproducible between animals compared to the high-dose intra-nasal challenge group. Intra-tracheal and aerosol challenges induced a transient lymphopaenia, similar to that observed in influenza-infected humans, and greater virus-specific cellular immune responses in the blood were observed in these groups in comparison to the intra-nasal challenge groups. Activation of lung macrophages and innate immune response genes were detected at days 5 to 7 post-challenge. The kinetics of infection, both virological and immunological, were broadly in line with human influenza A virus infections. These more authentic infection models should be valuable in the determination of anti-influenza efficacy of novel entities against less severe (and thus more common) influenza infections.

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Lethal Disease Following H5N1 Avian Influenza Virus Clade 2.3.4.4b Infection in Macaques

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