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Measles: Need for Continued Vaccination and Novel Vaccines Post Virus Eradication S. Louise Cosby Professor of Microbiology – Queen’s University Belfast, UK and Head of Virology Branch, Agri-Food and Biosciences Institute (AFBI), Veterinary Division, Stormont, Belfast , UK Queen’s University Belfast AFBI Veterinary Science Division Measles Clinical Presentation and General Complications Measles rash Koplik spots General Complications: giant cell pneumonia; otitis media Highly infectious disease Spread by aerosol 462,186 cases in 2014 (World Health Organisation) CNS Complications Subacute Sclerosing Panencephalitis • Slowly progressing degenerative disease of the brain • Occurs in children and young adults • Clinical Symptoms - 4 main stages (i) Mental and behavioural changes (ii) Disturbances of Motor functionsmonoclonic jerks, epileptic fits (iii) progressive cerebral degeneration with symptoms and signs of decortication. • Progresses to death 1 to 10 years CNS Complications Measles Inclusion Body Encephalitis (MIBE) • Occurs in immunosuppressed patients • Clinically similar to SSPE • However, much more rapid and proceeds to death within months. • Common in children with leukaemia undergoing axial radiation therapy • Also-HIV positive children Cell Types Infected in Subacute Sclerosing Panencephalitis Brain neuron Perivascular cuff astrocyte oligodendrocyte endothelial cell Measles Eradication • In May 2010, the World Health Assembly agreed to interim targets as milestones towards measles eradication, including reducing measles mortality by 95% by 2015. • Measles virus (MV) is mem.ber of morbillivirus genus within the Paramyxoviridae • Morbilliviruses induces cross neutralising antibody to other members of the genus. • After eradication, if measles vaccination is discontinued, are humans at risk of infection with veterinary morbilliviruses? Morbillivirus Genus (Family Paramyxoviradae) Phylogeny Cetaceans Dolphin Porpoise morbillivirus Primates Ancestral virus Measles virus Canine distemper virus Rinderpest virus Phocine distemper virus Ruminants Peste des petits ruminants virus Carnivores CDV and PDV are More Highly Neurovirulent in the Natural Host than MV PDV in the Seal CNS Subacute sclerosing panencephalitis- rare complications of measles infection CDV Jump into None Canine Species- Large Cats and Hyenas Transmission hyenas feed on ? dog carcases ? ? Transmission lions steal kills ? from hyenas and prey on wild dogs CDV Samples Collected in 1993/1994 from the Serengeti National Park Major Threat - CDV infection now in Non Human Primates • 1989- case of encephalitis in a Japanese monkey (Macaca fuscata) - CDV inclusions in the CNS were found to be CDV. -Serologically, 22 monkeys in same group as diseased monkey had relatively high titres of neutralizing antibody to CDV, but not to MV. Yoshikawa et al. (1989) Vet. Microbiol.20,193-205 • 2006 and 2008- outbreak of CDV in hand-feeding Rhesus monkeys in Beijing. - 20 monkeys –12 animals died. - Gross pathological examination showed lesions in the lungs consistent with pneumonia and diffuse haemorrhage in the CNS. Sun et al. (2010). Microbiol. 141, 374-378 ; QIU et al. (2011) Emerg. Infect. Dis. 17, 1541–1543 • 2008 in Japan, a CDV outbreak in cynomolgus monkeys imported from China. In that outbreak - 46 monkeys died from severe pneumonia Sakai et al. J. Virol. 87(2):1105-14. doi: 10.1128/JVI.02419-12 Morbillivirus Structure N Genus in the the Paramyxoviridae ssRNA enveloped virus The ss RNA is encased in a helix of nucleocapsid protein Cell-derived lipid envelope P L M H F Envelope glycoproteins Ribonucleocapsid H – Haemagglutinin cell receptor attachement protein- may need to mutate to allow infection in new species Virus Cell Entry Receptors – A Major Determinant of Cross Species Infection • Viruses hijack receptors on the cell surface to enter cells or to modulate the host immune system. • Use of common cell receptors by morbilliviruses- facilitation of cross species transmission. • Does mutation in morbillivirus virus receptor attachment protein (H) occur to adapt to new species • Consequence for human population lacking cross immunity to veterinary morbilliviruses when MV eradicated. • Could zoonosis occur?? Known Cell Entry Receptors for WT MV, CDV and PDV 1 MV binding Signalling lymphocyte activation Molecule O-linked (SLAM or sugars CDw150) membrane SC R1 SLAM Staining in perivascular cuff in SSPE brain tissue 2 3 C3b/C4b 4 binding region cytoplasm Ser/Thr/P ro rich domain C-terminus Cytoplasmic tails PVRL-4 (nectin-4) • basal receptor polarised epithelial cells • is up-regulated by MV infection in human brain endothelial cells (McQuaid and Cosby, Laboratory Investigation, 2002). Mühlebahc et al., 2011, Nature. 480:530-533 Noyce et al.,2011, PLoS Pathog. 7:e1002240 Abdullah et al. 2013. J. Neuropath. Exp. Neurol Wild Type Measles Virus Infection of Human Neuronal Cells in Culture SHS5Y5 cells hNT2 cells Virus green MAP-2 green Virus red CDV and PDV Infect SHS5Y5 Human Neuroblastoma Cells WT CDV Use of Receptor X? WT PDV Receptor X Expression is Down-Regulated in Infected Areas in SSPE Brain MV Negative Receptor X MV Positive MV WT MV infects and Binds to Vero Cells Expressing Neuronal Receptor X Vero VeroHumanSLAM Vero X *** *** Flow cytometry Virus binding to receptors Three Approaches- Mucosal Vaccination for Paramyxoviruses • Vaccines for Bovine respiratory syncytial virus and bovine parainfluenza 3 • Inactivated Nanoparticle vaccines • Live recombinant vaccine • Infectious recombinant particles The SiSafe® Technology Platform • Patented elemental nano-silicon with a porous structure and massive surface area. These particles, each 100 times smaller than a human hair, contain microscopic reservoirs that can hold and • Molecules incorporated within nanopores which it cannot b SiSafe® is fully patented but also requires specific trade-secret know-how to the produce. And because stabilizes unstable molecules and provides very significant increases in the bioavailability of even the most hydrophobic compounds. • SiSafe® biodegradable and kinetics of drug release depend on the rate of biodegradation of the matrix. SiSafe® has very high Rate of onset and release can be customized by altering drug-loading capacity physical factors of the carrier including particle size, (requiring low ratio of porosity, linkage method and pore width. carrier) compared with • SiSafe® has very high drug-loading capacity (requiring low other drug carriers. ratio of carrier) compared with other drug carriers. • Biocompatible SiSafe® fully dissolves to orthosilicic acid, the natural form of silicon absorbed from food. Orthosilicic acid has a positive safety and toxicological profile – edible. Recovery of Infectious virus from Negative Strand RNA viruses using plasmid cDNAs Both live and infectious particles vaccines –use of animal paramyxovirus vectors which are nonpathogenic in humans and cattle Mutation of virus glycoproteins to more highly immunogenic forms. Proc Natl Acad Sci U S A. 1996 December 24; 93(26): 14998–15000. Summary • MV Receptors shared with other morbilliviruses • WT CDV and PDV cross species barriers • Only 3 mutations required in virus H protein to allow infection of human leucocytes using SLAM receptor . • Epithelial receptor Nectin-4 (PVRL-4) shared by morbilliviruses. • CDV and PDV infect human neuronal cells- likely to share same receptor. • Need to continue vaccination for measles/ veterinary morbillivirus / MV–veterinary morbillivirus recombinant. • Production and testing or novel inactivated (nanoparticle) and recombinant veterinary paramyxovirus vaccines in cattle. • Prototypes for measles and other human paramyxovirus vaccines. Acknowledgements Cosby QUB Cosby AFBI Dr Ultan Power QUB Dr Haniah Abdullah Dr Michael McMenamy Dr Bia He ( University of Georgia, USA) Adam Jeffers Dr Kate Duffy Dr Barney Graham NIH, USA Michael Cooper SiSaf Department of Agriculture, Environment and Rural Affairs (DAERA)