Prompted by an increase of oseltamivir-resistant influenza A virus isolates, this study was initiated to determine the effect of NS1 on IFN signaling, and to explore the therapeutic potential of IFN to override any NS1-mediated inhibitory effects. Any IFN response is augmented by a positive feedback loop; specifically, IFN produced in response to virus infection binds to and activates IFNAR, leading to gene induction, which includes IFN. Thus IFN exerts both direct and paracrine effects on producer and adjacent cells. Previous studies indicate that H5N1 is able to overcome this feedback loop and the NS1 of H5N1 has been implicated in the development of this resistance
[22].
Herein we report novel strategies by which the H5N1 influenza virus NS1 alters IFN-α/β signaling, mediated by the inhibition of IFNAR and SOCS protein expression. The inhibitory effects of NS1 on IFNs-α/β have largely been attributed to its ability to inhibit IFN induction. A number of viruses have evolved to target STAT proteins and block the antiviral activity of IFNs: Paramyxoviruses such as SV5 and type II human parainfluenza viruses (HPIV2) block IFN signaling through their V proteins, which induce proteasomal degradation of STAT1 and STAT2 by polyubiquitation
[23]. HCV core proteins block STAT1 activation and subsequent function, mediated by STAT1-core protein interactions and suppression of STAT1 gene expression
[24]. We provide evidence that expression of the H5N1 influenza virus NS1 in HeLa cells leads to a reduction of IFN-inducible STAT phosphorylation ().
The phosphorylation-dependent activation of STAT1 and STAT2 is critical for mediating IFN-inducible antiviral responses
[25]. Activated STAT proteins form various complexes that subsequently translocate into the nucleus to initiate gene expression via binding to specific elements in the promoter regions of ISGs. In the absence of these transcriptional effector proteins, cells are unresponsive to IFNs and are highly susceptible to viral infection
[26],
[27]. The inhibition of IFN-inducible phosphorylation of STATs in the presence of H5N1 NS1 resulted in a reduction in the formation of the characteristic STAT1:1:SIE, STAT1:3:SIE and STAT3:3:SIE complexes ().
These results prompted us to evaluate whether NS1 might affect upstream effectors of the STATs, thereby limiting their IFN-inducible phosphorylation and activation. FACS and confocal microscopy analysis of surface IFNAR1 and IFNAR2 expression revealed a reduction in cell surface IFNAR1 in the presence of H5N1 NS1, yet IFNAR2 surface expression remained unaltered (). Based on the ability of NS1 to inhibit host mRNA generation, we examined NS1 effects on
ifnar1 and
ifnar2 gene expression, and showed that after an initial, early increase in
ifnar1 and
ifnar2 expression, likely reflective of an innate cellular response, there was a reduction in both
ifnar1 and
ifnar2 expression in monocyte-derived macrophages by 24 hours, but a more selective reduction in expression of
ifnar1 in
ex vivo lung tissues by 16 hours, once viral replication became fully established (). This NS1-dependent reduction in
ifnar1 gene expression is likely responsible for the decrease in IFN-inducible STAT phosphorylation and DNA binding. The basal level of expression of distinct signaling effectors, including IFNAR1, JAK1, TYK2, IRF9 and STAT2, has been shown to correlate directly with the intensity of an IFN response
[28]. IFNAR1 null cells are completely non-responsive to IFN treatment and mice null for IFNAR1 are, likewise, unresponsive to IFNs-α/β and highly susceptible to microbial infections
[29]. Clinical studies of HCV patients whom are either non-responders or exhibit a reduced sensitivity to IFN therapy, identified a reduction in either
ifnar1 or
ifnar2 gene expression when compared to IFN responders
[30]. Polymorphisms in the promoter region of
ifnar1 and
ifnar2 have been closely linked with susceptibility to a number of diseases including malaria, multiple sclerosis, trypanosomaiasis, HCV and HIV
[31],
[32],
[33],
[34]. In contrast, over-expression of IFNAR1 and IFNAR2, as is the case in Down's Syndrome patients, where chromosome 21 is trisomic, results in an enhanced sensitivity to IFN
[35].
While the specific mechanism by which H5N1 NS1 downregulates IFNAR1 expression requires further investigation, NS1 will inhibit pre-mRNA splicing, polyadenylation and nuclear export. NS1 interacts with components of the splicing machinery, U6 snRNA, which complex with other constituents of the spliceosome to mediate pre-mRNA splicing
[11]. An association between NS1 and U6 snRNA hinders its ability to complex with other catalytic subunits of the spliceosome, thereby leading to the accumulation of pre-mRNAs in the nucleus of the host cell. Additionally, NS1 affects polyadenylation of host mRNA through targeting of CPSF30 and PABII
[36],
[37]. 3′ cleavage and polyadenylation of mRNAs promotes their export into the cytoplasm, whereas mRNAs that have undergone 3′ cleavage alone are retained in the nucleus
[38]. Viewed together, the inhibitory effect of influenza virus H5N1 NS1 on
ifnar1 gene expression is an effective mechanism to render target cells insensitive to IFN and overrides the initial non-specific antiviral effect of IFNAR upregulation seen in the monocyte derived macrophages.
IFNs-α/β are not only critical components of the innate immune response, but also play a prominent role in modulating an adaptive immune response. IFNs-α promote the differentiation and maturation of dendritic cells (DCs), which subsequently present viral peptide in the context of the major histocompatibility complex (MHC) to activate T cells. Additionally, IFNs-α/β can modulate co-stimulatory molecule expression, to further stimulate or prime virus-specific CD4
+ and CD8
+ T cells. During influenza A virus infection, expression of NS1 in DCs blocks their maturation and subsequently results in ineffective T cell activation
[39]. NS1 expression in DCs alters the expression of numerous genes that are required for both maturation and migration, including
ifnar1 [39].
Notably, infection with the H5N1 influenza A strain led to a greater reduction in
ifnar1 gene expression compared to infection with H1N1 virus () in the
ex vivo lung tissue model. X-ray crystallographic studies suggest that NS1 from highly pathogenic H5N1 influenza A virus exhibits structural differences in both the RNA-binding and effector domains when compared to NS1 from other influenza strains. H5N1 NS1 can associate with itself to form a novel tubular oligomeric structure, whereas NS1 from other strains adopt a dimeric conformation
[40],
[41]. These conformational differences may contribute to the different degrees of inhibition of
ifnar1 gene expression observed between H5N1 and H1N1.
SOCS proteins are potent inhibitors of JAK/STAT signaling. There is accumulating evidence that influenza virus infection will also inhibit an IFN response in part through up-regulation of SOCS1 and/or SOCS3 expression
[42],
[43]. SOCS1 inhibits IFN signaling through direct physical interactions with JAK1, whereas SOC3 and CIS interact with the phosphorylated receptor to hinder the recruitment and phosphorylation of downstream effectors such as STATs
[44],
[45]. Over-expression of SOCS1 and/or SOCS3 will effectively reduce IFN responses through the inhibition of STAT phosphorylation and induction of ISGs
[46]. Many viruses, including respiratory syncytial virus, herpesviruses and hepatitis C virus, modulate SOCS1 expression to inhibit STAT activation as a way to suppress an IFN response
[47],
[48],
[49]. Our data revealed that both
socs1 and
socs3 gene expression increased in HeLa cells expressing H5N1 NS1, yet we were only able to detect an increase in SOCS1 protein expression (). SOCS1 expression can be induced by various cytokines in a tissue-specific manner
[50],
[51]. STAT proteins including STAT1 and STAT5 have been suggested to play a role in mediating the transcriptional activation of
socs gene expression upon cytokine stimulation
[50],
[51]. Studies in breast cancer cells suggest that MAP kinase (MAPK) p38 activation, an intermediate effector in MAPK signaling, may also play a role in upregulating SOCS1 expression. The hyperinduction of proinflammatory cytokines in H5N1 but not H1N1 influenza A-infected primary human macrophages was strongly associated with p38 activation, suggesting a possible mechanism for the induction of SOCS1 expression
[52],
[53],
[54]. Notably, SOCS1 expression is regulated at the translational level in a cap-dependent manner by the eukaryotic initiation factor 4E-binding proteins
[55]. NS1 affects cellular translation by interacting with eIF4G and activating the PI3K pathway
[12],
[13],
[56],
[57]. Activation of PI3K can lead to translational activation through mTOR and subsequent phosphorylation of 4E-BP1, ultimately leading to an increase in cap-dependent mRNA translation
[58].
The adamantine derivatives, amantadine and rimantadine, as M2 ion channel-blockers were the first antivirals licensed for use against influenza A viruses
[59], yet all isolates of the pandemic H1N1 2009 are resistant to both amantadine and rimantadine
[60]. There are two other drugs licensed globally for specific treatment and prevention of influenza. Relenza (zanamavir) was developed based on knowledge of the 3-dimensional structure of the influenza virus NA complexed with its substrate, sialic acid
[61]. Tamiflu (oseltamivir) was subsequently developed, based on the structure of Relenza
[62]. Relenza has poor bioavailability, it must be delivered topically and is administered by means of an inhaler, which delivers drug to the upper respiratory tract, the primary site of virus replication. Substitution of the glycerol side chain with a hydrophobic side chain enables Tamiflu to be orally available. Tamiflu is taken in an encapsulated form as a prodrug, which is activated by liver esterases to form the active drug
[63]. Although the pandemic H1N1 2009 virus is sensitive to oseltamivir, resistance has been detected in isolated clinical cases in Hong Kong, Denmark, Japan and Canada
[64]. For H5N1 virus, reports of drug resistance in approximately 2% of adult patients and 18% of pediatric patients infected, raises concerns
[65].
In both guinea pig and ferret models, IFN-α treatment effectively inhibits both H1N1 and H5N1 viral replication
[22],
[66], though multiple doses appear necessary in the guinea pig model. Viewed together with the evidence we provide for the antiviral effects of IFN against H1N1 and H5N1 in the human lung explant tissue model, we infer that despite the inhibitory mechanisms employed by NS1 to target an IFN response, IFN treatment can override these effects (). Notably, IFN treatment was inhibitory against both H5N1 and H1N1 influenza A strains, including the pandemic H1N1 influenza 2009. Moreover, we provide evidence that IFN treatment
post-challenge with virus is effective at limiting viral replication: human lung explants when infected with H1N1pdm exhibited IFN-inducible reduction in viral titer, M gene and influenza nucleoprotein expression. Given the broad spectrum antiviral activities of IFNs, that are not pathogen-specific, development of resistance is avoided. Accordingly, in ongoing studies we are evaluating the safety profile and therapeutic potential of IFN alfacon-1 treatment in individuals infected with influenza-like illness, specifically pandemic H1N1pdm.