Picture of cell art Picture of cell under a microscope Daniel L. Peterson, MD Whittemore Peterson Institute

Size: px

Start display at page:

Download "Picture of cell art Picture of cell under a microscope Daniel L. Peterson, MD Whittemore Peterson Institute"

Samson Cook
5 years ago
Views:

1 XMRV, A New Human Pathogenic Retrovirus: Detection In Chronic Diseases Picture of cell art Picture of cell under a microscope Daniel L. Peterson, MD Whittemore Peterson Institute Daniel L. Peterson, MD Whittemore Peterson Institute October 29th, 2009

2 Chronic Fatigue Syndrome (CFS) A debilitating disorder of unknown etiology that is estimated A debilitating disorder of unknown etiology that is estimated to affect 17 million people worldwide to affect 17 million people worldwide CDC Criteria (Fakuda, 1994) Persistent CDC or relapsing Criteria fatigue (Fukuda, of 6 mo or longer 1994) in duration,generally with a distinct onset Other Persistent known medical or relapsing conditions fatigue of excluded 6 mo or longer by clinical in duration, diagnosis generally with a distinct onset Patients have at least 4 of the following symptoms: Impaired Other memory known or medical concentration conditions excluded by clinical diagnosis Sore throat Tender Patients cervical have or axillary at least lymph 4 of the nodes following symptoms: Muscle pain Multi-joint Impaired pain memory or Multi-joint pain New headaches concentration New headaches Un-refreshing Sore sleep throat Un-refreshing sleep Post exertional Tender malaise cervical or axillary lymph lasting > 24 nodes Postexertional malaise hrs Muscle pain lasting > 24 hrs

3 CFS Clinical Research Findings CFS is a heterogeneous, multi-system disorder manifested by inflammatory sequelae including: CFS is a heterogeneous, multi-system disorder manifested by inflammatory sequelae including: antiviral enzyme (RNase L) dysfunction low natural killer (NK) cell numbers and function innate immune activation increased numbers of activated T cells antiviral enzyme (RNase L) dysfunction low natural increased killer production (NK) of inflammatory cell numbers and functioncytokines/chemokines innate immune activation Could these patients immune increased cells numbers infected of activated with XMRV? T cells increased production of inflammatory Could these patients immune cells be infected with XMRV?

Picture of Envelope proteins and core p30 proteins Core proteins p15 p12 p10 Core proteins Gamma (Type-C) retrovirus XMRV Envelope proteins p15e gp70 Envelope proteins XMRV is a simple retrovirus it

4 Picture of Envelope proteins and core p30 proteins Core proteins p15 p12 p10 Core proteins Gamma (Type-C) retrovirus XMRV Envelope proteins p15e gp70 Envelope proteins XMRV is a simple retrovirus it encodes only for structural proteins Retroviruses are NOT ubiquitous and NOT benign They are all associated with disease such as cancer and neurological disease There are three known human exogenous cell retroviruses: Budding XMRV from a XMRV is a simple retrovirus it encodes only for structural proteins Retroviruses are NOT ubiquitous and NOT benign HIV, HTLV-1 (both complex They are all associated with disease such as cancer and retroviruses) neurological and disease XMRV There are three known human exogenous retroviruses: Budding XMRV from a cell 4 HIV, HTLV-1 (both complex retroviruses) and XMRV

5 Presence of XMRV Sequences in These results are representative of the 101 patients tested. They reflect the presence of virus (DNA PCR). Human DNA 68/101 (67%) 12 /320 (3.75%) These results are representative of the 101 patients tested. They reflect the presence of virus (DNA PCR). The importance of this slide- in the normals 3.75% is 10 million Americans! This gel is representative gel- 11 of the 101 are shown Joy Das Gupta in the Silverman lab obtained full length sequence from 3 patient samples To explore the relationship between XMRV in prostate cancer and the on in CFS

Retroviral Life Cycle: Latent vs. Active infection In latent infection- retroviral genome is present but is not transcribing viral genome or mrna for structural proteins.

6 Retroviral Life Cycle: Latent vs. Active infection In latent infection- retroviral genome is present but is not transcribing viral genome or mrna for structural proteins. Distinguished by qpcr (DNA) and qrt- PCR (RNA) In latent infection- retroviral genome is present but is not transcribing viral genome or mrna for structural proteins. Distinguished by qpcr (DNA) and qrt-pcr (RNA)

7 Phylogenetic analysis revealed that XMRV isolates from prostate cancer and CFS form a distinct branch within non ecotronic MLVs Not a mouse contaminant XMRV is a new human retrovirus Not prostate cancer XMRV Not a mouse contaminant XMRV is a new human retrovirus Not prostate cancer XMRV

Detection of Infectious Xenotropic MuLV-Related Virus (XMRV) in Blood Cells From Patients With University Of Nevada, Reno Cleveland Clinic Bob Silverman and Javdip Das Gupta Vincent Lombardi Judy

8 Detection of Infectious Xenotropic MuLV-Related Virus (XMRV) in Blood Cells From Patients With University Of Nevada, Reno Cleveland Clinic Bob Silverman and Javdip Das Gupta Vincent Lombardi Judy Mikovits Daniel Peterson Kathryn Hagen Max Pfost National Cancer Institute Sandra Ruscetti Frank Ruscetti Sandra Ruscetti Rachel Bagni Frank Ruscetti Cari Petrow-Sadowski Rachel Bagni Bert Gold Cari Petrow-Sadowski Michael Dean Bert Gold Michael Dean Chronic Fatigue Syndrome University of Nevada, Reno Vincent Lombardi Judy Mikovits Daniel Peterson Kathryn Hagen Max Pfost Bob Silverman Jaydip Das Gupta

9 CFS Study Cohort Reported in Science: Study cohort from the WPI national repository. Repository samples include samples from NV, CA, OR, FL, NC and NY as well as international CFS patients. Repository inclusion criteria: CFS diagnosis, regardless of severity years of age Study characteristic: 67% women, reflecting gender incidence of CFS Mean age: control samples from same geographic locations

10 Questions What cell types are infected? How is XMRV transmitted? Do infected individuals make an immune response? What are the interactions between XMRV and the innate immune system? Does XMRV infection alter the risk of cancer development in CFS? Can we develop immune based therapies for CFS based on XMRV?

11 XMRV Protein Expression in Purified Activated T and B Lymphocytes from CFS Patients See using a flow cytometry assay expression of 3 goat poly clonal antibodies to purified viral proteins in both T and B cells but not in T cells from a normal donor.. We have shown expression of XMRV proteins but next wanted to ask if that reflected the presence of infectious and transmissable virus 3 goat polyclonal Rat α-mulv antibodies p30 Gag mabto purified viral proteins

12 Transmission of XMRV from Activated PBMCs of CFS Patients to the Human Prostate Cancer Cell Line LNCaP Prostate cancer cell line

spinoculation we transmitted virus from plasma and

13 Cell Free Transmission of XMRV from CFS Patients Plasma to LNCap Using a technique known as spinoculation we transmitted virus from plasma and confirmed infectious particles by TEM next slide 21 positive of 25 (84%)

Transmission Electron Micrograph of C-type Retrovirus Particles Transmitted from CFS patient Early and late buds T-Cells type to LNCaP C morphology Mature extracellular viral particles with condensed

14 Transmission Electron Micrograph of C-type Retrovirus Particles Transmitted from CFS patient Early and late buds T-Cells type to LNCaP C morphology Mature extracellular viral particles with condensed centrally located nucleoid surrounded by an outer membrane separated by an electron lucent area Having detected the presence of XMRV viral proteins and particles in the PBMC of CFS patients, we next asked if we could detect an immune response to XMRV in CFS patients Infectious whole virus budding from the cell membrane Infectious whole virus budding from the cell membrane

15 Antibodies in CFS Patients Plasma to XMRV Env BaF3-ER BaF3-ER-SFFV Env BaF3-ER BaF3-ER-SFFV Env WB: αsffv Env mab SFFV Env BaF3-ER BaF3-ER-SFFV Env

16 Evidence for the presence of XMRV in 33 PCR Negative US CFS Patients 19/33 Antibodies in the plasma 30/33 Transmissable virus in the plasma 10/33 Protein expression in Decitibine (5Aza2DC) treated PBMC Thus, since the submission to Science we determined 99 of 101 US patients show evidence of XMRV infection

17 XMRV Expression in NC/FL Cohort Since the submission to Science, we have +- replicated at the NCI/CC our findings in other cohorts not in the WPI repository. 9/15 (60%) positive for XMRV gag DNA from fresh PBMC 9/15 (60%) positive for XMRV gag DNA from fresh PBMC 13/15 (86.7%) (86.7%) positive by western positive for XMRV by Env western for XMRV and Gag upon co-culture of plasma or PBMC with LNCaP Env and Gag upon co-culture of plasma or PBMC 8/15 (53%) plasma samples contain antibody to XMRV Env with LNCaP 8/15 (53%) plasma samples contain antibody to XMRV Env Since the submission to Science, we have replicated at the NCI/CC our findings in other cohorts not in the WPI repository.

18 Familial Transmission of XMRV From Plasma from patients with Childhood Alzheimer s Acute flulike infection in the family Mother/Father XMRV Env/Antibody positive (no active virus detected) XMRV envelope protein in LNCaP from children s plasma

19 XMRV Associated Neuroimmune Diseases (XAND): Potential Candidates: Atypical MS: 3/3 positive for XMRV ENV protein and gag DNA Fibromyalgia: 12/20 (60%) positive for XMRV gag DNA Autism: 6/15 (40%) positive for XMRV gag DNA 4/7 ( 57%) positive for serum Antibody to XMRV Env Gulf War Illness : Not Tested Samples were taken from family members of XMRV positive CFS subjects with these neuroimmune diseases.

resolution of pathogen induced immune responses.

20 TCR Clonality in Nevada CFS Cohort ~ 77 of the Nevada cohort have a clonal TCRg rearrangement More than 100 of these patients have clonal populations of gamma delta T cells Gamma delta T cells play an active role in the regulation and resolution of pathogen induced immune responses. They accumulate at sites of inflammation associated with viral, bacterial and parasitic infections and in auto immune diseases Interestingly, Gamma Delta T cells up-regulate MIP1lalpha and Beta, TNF alpha,

21 WPI Repository CFS Subjects with Cancer ID# XMRV status Clonal TCR Lymphoma/cancer 1103 positive positive MCL XMRV 1109 status positive determined negative Thymoma by the WPI since 1118 positive negative myelodysplasia the submission 1125 positive to Positive Science. + IGH MCL 1186 positive positive Lymphoma 1199 positive positive Previous Lymphoma 1150 positive positive Lymphoma 1320 Not tested Not tested Thymoma 1321 Not tested Not tested MCL 1174 positive positive Thymoma 1205 positive Not tested lymphoma 1172 positive positive MCL 1135 positive positive suspicious 1204 positive Positive + IGH suspicious 1113 positive positive CLL 1322 Not tested Not tested MCL 1181 positive Not tested CLL 1188 positive positive CLL 1189 positive positive MCL 1190 positive positive suspicious XMRV status determined by the WPI since the submission to Science.

WPI-1125 CFS Diagnosis One Decade Prior to MCL 1988--- ---Seen seen at NIH at for CFS NIH for CFS 1998--- ---Splenectomy to

Given Rituxan and Velcade 1998- Splenectomy to decrease 2000--- aggressiveness.

22 WPI-1125 CFS Diagnosis One Decade Prior to MCL Seen seen at NIH at for CFS NIH for CFS Splenectomy to decrease aggressiveness. ---Seen at NIH for mantle cell lymphoma. Given Rituxan and Velcade Splenectomy to decrease aggressiveness BMT seen with adult at stem NIH cells for mantle cell Blast crisis MCL death lymphoma. Given Rituxan and Velcade BMT with adult stem cells Blast crisis MCL. death MCL cell line developed 2008

23 Neither XMRV infection nor a diagnosis of CFS correlate to RNase L genetic variation R462Q Relationship between RNaseL variant genotype and XMRV expression in CFS patients

24 Dysfunction of Natural Killer Activity in a Family with Chronic Fatigue Syndrome

25 Hypothesis of XMRV disease progression: NK dysregulation Relative time-scale of the virological and immunological events during XMRV CFS develops infection Env antigen Relative time-scale of the virological and immunological events during XMRV infection

26 NK cells kill targets that do not express HLA class I

27 Methods for addressing the NK cell dysregulation PBMCs from XMRV infected patients with low NK cell function were activated with the mitogen PHA and treated with Ampligen The effects on NK cell (CD56+) phenotype were determined by flow cytometry Signaling changes due to the treatment were detected via cytokine analysis The change in XMRV copy number was detected with qrt-pcr

28 Preliminary results from 8 study subjects Ampligen significantly amplifies the degranulation of NK cells Ampligen significantly amplifies the degranulation of NK cells Ampligen may increase the ability of CD56+ cells to degranulate when encountering a target Ampligen may increase the ability of CD56+ cells to degranulate when encountering a target Ampligen significantly increases the production of Perforin and GranzymeB Ampligen significantly increases the production of Perforin and Granzyme B Ampligen may promote synthesis of cytotoxic proteins- perforin and Granzyme Ampligen B may promote synthesis of cytotoxic proteins- perforin and GranzymeB Ampligen may regulate NK and inflammatory signaling molecules Ampligen may regulate NK and inflammatory signaling molecules Anti-viral as well as immune-stimulating cytokines are upregulated Anti-viral as well as immune-stimulating cytokines are upregulated

29 Preliminary Results Cont. XMRV copy number is modulated by Ampligen When treated with Ampligen, qrt-pcr indicates a decrease in some patients and an increase in others. This may suggest why Ampligen worsens some CFS patients and not others. Stratification for Ampligen treatment must consider XMRV status.

30 There is a highly significant Infectious association XMRV was detected between in the lymphocytes and plasma from >75% of CFS patients XMRV retrovirus and Chronic Fatigue Syndrome CFS-XMRV can be transmitted cell-free from patient plasma to human prostate and T cell Infectious XMRV was detected in lymphocytes and plasma from >75% lines of CFS patients and to primary T cells An immune response to the virus was prostate and T cell lines and to primary T cells detected in a majority of CFS subjects CFS-XMRV can be transmitted cell-free from patient plasma to human An immune response to the virus was detected in a majority XMRV of CFS subjects in CFS and prostate cancer are closely XMRV in CFS and prostate cancer are closely related and form related form a distinct phylogenetic a distinct phylogenetic branch branch

Acknowledgements: Cancer and Inflammation Program: Mike Frank Dean Ruscetti Bert Gold Mike Dean Dan Bertolette Ying Bert Huang Gold Dan Bertolette Laboratory Ying of Huang Cancer

Cari Petrow-Sadowski Rachel Bagni Kunio Nagashima Cari Petrow-Sadowski Rachel Bagni Kunio Nagashima From Judy A Mikovits WPI Judy Vincent A Lombardi Mikovits Vincent Lombardi Max Pfost

31 Acknowledgements: Cancer and Inflammation Program: Mike Frank Dean Ruscetti Bert Gold Mike Dean Dan Bertolette Ying Bert Huang Gold Dan Bertolette Laboratory Ying of Huang Cancer Prevention: Laboratory of Cancer Prevention: Jami Troxler Sandra Ruscetti Charlotte Hanson Jami Troxler Cancer and Inflammation Program: Frank Ruscetti Sandra Ruscetti Charlotte Hanson Cari Petrow-Sadowski Rachel Bagni Kunio Nagashima Cari Petrow-Sadowski Rachel Bagni Kunio Nagashima From Judy A Mikovits WPI Judy Vincent A Lombardi Mikovits Vincent Lombardi Max Pfost Pfost Kathryn Hagen From Cleveland Clinic Robert Silverman Jaydip Robert Das Silverman Gupta Robert Jaydip Silverman Das Gupta Robert Silverman Jaydip Das Gupta Jaydip Das Gupta The CFS patients in the US

*To whom correspondence should be addressed. This PDF file includes:

*To whom correspondence should be addressed. This PDF file includes: www.sciencemag.org/cgi/content/full/science.1212182/dc1 Supporting Online Material for Partial Retraction to Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue