Differential gene expression changes in children with severe dengue virus infections.
BACKGROUND
The host response to dengue virus infection is characterized by the production of numerous cytokines, but the overall picture appears to be complex. It has been suggested that a balance may be involved between protective and pathologic immune responses. This study aimed to define differential immune responses in association with clinical outcomes by gene expression profiling of a selected panel of inflammatory genes in whole blood samples from children with severe dengue infections.


RESULTS
Whole blood mRNA from 56 Indonesian children with severe dengue virus infections was analyzed during early admission and at day -1, 0, 1, and 5-8 after defervescence. Levels were related to baseline levels collected at a 1-month follow-up visit. Processing of mRNA was performed in a single reaction by multiplex ligation-dependent probe amplification, measuring mRNA levels from genes encoding 36 inflammatory proteins and 14 Toll-like receptor (TLR)-associated molecules. The inflammatory gene profiles showed up-regulation during infection of eight genes, including IFNG and IL12A, which indicated an antiviral response. On the contrary, genes associated with the nuclear factor (NF)-kappaB pathway were down-regulated, including NFKB1, NFKB2, TNFR1, IL1B, IL8, and TNFA. Many of these NF-kappaB pathway-related genes, but not IFNG or IL12A, correlated with adverse clinical events such as development of pleural effusion and hemorrhagic manifestations. The TLR profile showed that TLRs were differentially activated during severe dengue infections: increased expression of TLR7 and TLR4R3 was found together with a decreased expression of TLR1, TLR2, TLR4R4, and TLR4 co-factor CD14.


CONCLUSIONS
These data show that different immunological pathways are differently expressed and associated with different clinical outcomes in children with severe dengue infections.
de Kruif
Martijn D
MD
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. m.d.dekruif@amc.uva.nl
Setiati
Tatty E
TE
Mairuhu
Albertus T A
AT
Koraka
Penelopie
P
Aberson
Hella A
HA
Spek
C Arnold
CA
Osterhaus
Albert D M E
AD
Reitsma
Pieter H
PH
Brandjes
Dees P M
DP
Soemantri
Augustinus
A
van Gorp
Eric C M
EC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000276:immunology* / Q000821:virology; D003716:Dengue Virus / Q000276:immunology; D005260:Female; D020869:Gene Expression Profiling; D005786:Gene Expression Regulation; D006801:Humans; D007113:Immunity, Innate / Q000235:genetics / Q000276:immunology; D053765:Interleukin-12 Subunit p35 / Q000235:genetics / Q000276:immunology; D016209:Interleukin-8 / Q000235:genetics / Q000276:immunology; D008297:Male; D016328:NF-kappa B / Q000235:genetics / Q000276:immunology; D012333:RNA, Messenger / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019595:Severe Dengue / Q000235:genetics* / Q000276:immunology* / Q000821:virology; D015398:Signal Transduction / Q000235:genetics; D051193:Toll-Like Receptors / Q000235:genetics / Q000276:immunology
C508858:IL12A protein, human; D053765:Interleukin-12 Subunit p35; D016209:Interleukin-8; D016328:NF-kappa B; D012333:RNA, Messenger; D051193:Toll-Like Receptors