
{"id":1358,"date":"2019-03-06T00:00:47","date_gmt":"2019-03-06T05:00:47","guid":{"rendered":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/?p=1358"},"modified":"2025-11-18T13:27:36","modified_gmt":"2025-11-18T18:27:36","slug":"does-prior-dengue-exposure-help-or-hurt-a-zika-infection","status":"publish","type":"post","link":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/2019\/03\/06\/does-prior-dengue-exposure-help-or-hurt-a-zika-infection\/","title":{"rendered":"The-Scientist: Does Prior Dengue Exposure Help or Hurt a Zika Infection?"},"content":{"rendered":"<p>https:\/\/www.the-scientist.com\/does-prior-dengue-exposure-help-or-hurt-a-zika-infection&#8212;65570<\/p>\n<p>Animal and cell culture studies show evidence that dengue antibodies can both neutralize and enhance Zika, but human investigations have only found protective effects.<\/p>\n<div class=\"flex flex-col gap-x-2 @2xl:flex-row @2xl:flex-wrap\">\n<div class=\"@2xl:after:ml-2 @2xl:after:content-['|'] @2xl:last:after:hidden\">\n<p><span class=\"pr-space\">Written by<\/span><span class=\"link peer cursor-pointer pr-0 underline\">Diana Kwon<\/span><\/p>\n<div class=\"author-tooltip peer text-body invisible absolute z-10 w-[70vw] rounded-sm border bg-white p-4 opacity-0 shadow-lg transition-all peer-hover:visible peer-hover:opacity-100 hover:visible hover:opacity-100 sm:max-w-[500px]\">\n<div class=\"flex flex-wrap items-center gap-4\">\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aspect-square rounded-full object-cover\" title=\"\" src=\"https:\/\/cdn.the-scientist.com\/assets\/authorNo\/43\/iImg\/37085\/diana-kwon-t.webp\" alt=\"\" width=\"80\" height=\"80\" \/><\/p>\n<div class=\"flex items-center gap-3 \"><\/div>\n<\/div>\n<div class=\"my-4 line-clamp-4 font-serif leading-6 font-normal\">\n<p><span class=\"dropcap\">T<\/span>he mosquito-borne Zika virus that recently spread <a href=\"https:\/\/www.who.int\/bulletin\/online_first\/16-171082\/en\/\" target=\"_blank\" rel=\"noopener noreferrer\">rapidly<\/a> throughout the Americas shares many characteristics with another virus: dengue. Both are flaviviruses, which are enveloped, sphere-shape virions that are typically transmitted by mosquitos and ticks. Due to their structural similarities and because the latest Zika outbreak appeared in dengue-endemic regions, scientists have been investigating whether antibodies against one might be able to react to the other\u2014and whether these interactions could either worsen or buffer against infections.<\/p>\n<p>Researchers had previously demonstrated a phenomenon known as <a href=\"https:\/\/www.the-scientist.com\/infographics\/antibody-dependent-enhanced-ade-immunity-39674\" target=\"_blank\" rel=\"noopener noreferrer\">antibody-dependent enhancement<\/a> (ADE)\u2014where, at certain concentrations, antibodies against one virus can heighten the effects of another\u2014between <a href=\"http:\/\/science.sciencemag.org\/content\/358\/6365\/929.abstract\" target=\"_blank\" rel=\"noopener noreferrer\">different types of dengue<\/a> viruses. This suggested that antibodies against other flaviviruses might possess similar features. \u201cWhen the recent Zika outbreak occurred, one of the major questions scientists had was whether or not the enhancement effect could also impact Zika infections,\u201d says <a href=\"https:\/\/icahn.mssm.edu\/profiles\/jean-k-lim\" target=\"_blank\" rel=\"noopener noreferrer\">Jean Lim<\/a>, a virologist at the Icahn School of Medicine at Mount Sinai in New York. \u201cBecause of the potential for Zika to cause damage during pregnancy, this was\u2014and still is\u2014an important question.\u201d<\/p>\n<p>Early <a href=\"https:\/\/www.the-scientist.com\/daily-news\/zika-and-dengue-immunity-a-complex-relationship-33298\" target=\"_blank\" rel=\"noopener noreferrer\">in vitro<\/a> studies confirmed that dengue antibodies extracted from human blood cross-reacted with Zika, and some suggested that they could strength infection. \u201cThere were a lot of people who hypothesized that, perhaps the reason that Zika is causing microcephaly was because you were getting enhancement,\u201d <a href=\"https:\/\/news.umich.edu\/for-journalists\/find-experts\/aubree-gordon-ph-d\/\" target=\"_blank\" rel=\"noopener noreferrer\">Aubree Gordon<\/a>, an epidemiologist at the University of Michigan, tells <em>The Scientist<\/em>. \u201cSo there was a lot of interest within the entire field to look at if you see protection or enhancement.\u201d<\/p>\n<p>In animal models, scientists have reported that dengue antibodies can both neutralize and enhance Zika. While the latter observation has raised concerns about heightened Zika infections in regions where dengue is common, the epidemiologic data have been more reassuring. To date, large, human cohort investigations have only found protective effects against Zika. Still, some scientists say that it is possible that augmentation may occur\u2014and recent experimental studies in human tissues and mice suggest that this may happen in pregnant females.<\/p>\n<h2>Dengue antibodies: friend or foe?<\/h2>\n<p>Earlier this year, two long-term assessments of populations in Central and South America reported that dengue immunity was protective against subsequent Zika infections. One <a href=\"http:\/\/science.sciencemag.org\/content\/363\/6427\/607\" target=\"_blank\" rel=\"noopener noreferrer\">study<\/a>, published in <em>Science,<\/em> examined a cohort of 1,453 residents in Brazil and found that having dengue antibodies prior to the Zika outbreak was tied to a decreased risk for Zika infection and fewer symptoms in those who contracted the disease. The other, published in <a href=\"https:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1002726\" target=\"_blank\" rel=\"noopener noreferrer\"><em>PLOS Medicine<\/em><\/a>, followed a group of approximately 3,700 children in Nicaragua, and also discovered that dengue immunity protected against symptoms of Zika, although this study did not find a reduction in total infections.<\/p>\n<p>\u201cWe expected that we would see protection,\u201d says Gordon, who is a coauthor of the Nicaragua study. \u201cWe thought we might see enhancement at well\u2014but at this point we don\u2019t have any evidence for it.\u201d<\/p>\n<p>Gordon\u2019s anticipation that dengue antibodies might both hurt and help Zika infections came from prior <a href=\"https:\/\/www.cell.com\/cell-host-microbe\/fulltext\/S1931-3128(10)00030-2\" target=\"_blank\" rel=\"noopener noreferrer\">laboratory experiments<\/a> and epidemiological investigations that found the effects of cross-reactivity are concentration-dependent, at least when it comes to multiple dengue infections. In humans, Gordon and her colleagues <a href=\"http:\/\/science.sciencemag.org\/content\/358\/6365\/929\" target=\"_blank\" rel=\"noopener noreferrer\">have observed<\/a> that high levels of antibodies against one type of dengue buffers against another, but lower levels actually enhance disease in subsequent exposures.<\/p>\n<p>According to Lim, the same may apply for dengue-Zika interactions. The fact that high concentrations of dengue antibodies offer protection in humans suggests that at the other end of the spectrum, at lower concentrations, you might see enhancement, she explains. \u201cIf you saw no protection, then there\u2019s no potential for enhancement.\u201d<\/p>\n<p>Lim\u2019s group has found evidence that dengue antibodies could <a href=\"http:\/\/science.sciencemag.org\/content\/356\/6334\/175\" target=\"_blank\" rel=\"noopener noreferrer\">enhance<\/a> Zika infection in mice. But other groups\u2014who have used various different animal models and experimental protocols\u2014have turned up mixed results. \u201cIt\u2019s still a very contentious field. Some groups see enhancement effects and other groups do not,\u201d Lim says. \u201cI think everybody is open to the idea that it could happen, but the data is not clear at this point.\u201d<\/p>\n<p>Gordon agrees that it is too early to rule out the possibly that enhancement is happening. \u201cThe fact that we do see protection does make me a bit more concerned, in fact, that enhancement could occur as well, because it verifies that there certainly is an interaction.\u201d<\/p>\n<p>Identifying whether ADE occurs is particularly important for current efforts to develop Zika vaccines, notes <a href=\"https:\/\/publichealth.yale.edu\/people\/albert_ko.profile\" target=\"_blank\" rel=\"noopener noreferrer\">Albert Ko<\/a>, a physician and epidemiologist at the Yale School of Public Health and an author of the Brazil cohort study. \u201cThe question is, are the antibodies made by a dengue or Zika vaccine friend or foe\u201d to subsequent infections, he tells <em>The Scientist<\/em>. \u201cObviously we have to be cautious, because there are these studies in mice and in vitro that find enhancement, but in humans we don\u2019t see enhancement signals as of yet.\u201d<\/p>\n<h2>Pregnancy-specific effects<\/h2>\n<p>One of the biggest concerns about Zika is the virus\u2019s ability to cause <a href=\"https:\/\/www.the-scientist.com\/the-nutshell\/cdc-zika-causes-microcephaly-33708\" target=\"_blank\" rel=\"noopener noreferrer\">microcephaly and other severe birth defects<\/a>. \u201cZika is a mild disease, but the big public health impact is when pregnant women get affected,\u201d says Ko. \u201cHow the prior dengue antibodies influence Zika when a pregnant woman is infected\u2014and how that would influence vertical transmission from the mother to the fetus is an open question.\u201d<\/p>\n<p>Although researchers have yet to find an answer in cohorts of people, recent work in human tissues and animal models provides hints that ADE may indeed influence the spread of Zika from a pregnant mother to her developing fetus. This work may still be preliminary, but \u201cthe big picture that\u2019s emerging is that these cross-reactive antibodies look like they\u2019re facilitating Zika virus [transmission] across the placenta,\u201d says <a href=\"http:\/\/vaccines.emory.edu\/faculty-evc\/primary-faculty\/suthar_mehul.html\" target=\"_blank\" rel=\"noopener noreferrer\">Mehul Suthar<\/a>, an immunologist at Emory University.<\/p>\n<p>Several groups, including <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1931312816302116\" target=\"_blank\" rel=\"noopener noreferrer\">Suthar\u2019s<\/a>, have found the Zika virus can <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5007065\/\" target=\"_blank\" rel=\"noopener noreferrer\">infect<\/a> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1931312816303006\" target=\"_blank\" rel=\"noopener noreferrer\">cells<\/a> in the placenta, an organ that serves many functions during pregnancy, including providing an immunologic barrier between the mother and her developing fetus. Last year, Suthar and his colleagues reported in <a href=\"https:\/\/doi.org\/10.1016\/j.chom.2018.10.008\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Cell Host &amp; Microbe<\/em><\/a> that dengue antibodies could enhance Zika in human placental tissue and macrophages, the primary cell type infected by the virus. They also found that this process was dependent on Fc receptors, proteins that are involved in transcytosis, the process of trafficking molecules across the placenta.<\/p>\n<p>Two recently published rodent studies also support this theory. One, which appeared in <a href=\"https:\/\/www.cell.com\/immunity\/fulltext\/S1074-7613(19)30028-7\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Immunity<\/em><\/a> and was conducted by Lim and her colleagues, found that in pregnant mice, pre-existing dengue antibodies enhanced Zika virus replication in the placenta and caused inflammation and injury to the organ. \u201cWe think that Zika, in the presence of dengue antibodies, is really causing damage to the placenta,\u201d Lim says. \u201cAnd that this is indirectly causing damage to the developing fetus.\u201d<\/p>\n<p>In the other study, published last month in <a href=\"http:\/\/advances.sciencemag.org\/content\/5\/2\/eaav3208\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Science Advances<\/em><\/a>, immunologist <a href=\"http:\/\/www.stjohn-lab.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ashley St. John<\/a> and her team at the Duke-NUS Medical School in Singapore reported that the presence of dengue antibodies in pregnant mice led to enhanced transmission of Zika viruses to their fetuses.<\/p>\n<p>Although both rodent studies found enhanced Zika infection in the placenta of dengue-immune mice\u2014and that enhancement effect was dependent on Fc receptors\u2014the Singapore team observed microcephaly-like effects on fetuses while the other group did not. According to St. John, this is likely because her study used mice that had their immune systems intact and Lim\u2019s used immunocompromised mice (the later model is a common practice when experimenting with Zika and dengue infections because rodents are more resistant to the viruses than humans). However, \u201cfetuses don\u2019t survive Zika infection in the immunocompromised system, so our system allows us to actually study fetal development,\u201d she adds.<\/p>\n<p>Future studies in humans and nonhuman primates will be necessary to verify that this process really occurs. \u201cI do think there is potential for dengue to enhance Zika virus infection,\u201d Lim says. \u201cThe real test will be to see whether or not this happens in humans.\u201d<\/p>\n<\/div>\n<hr class=\"border-body\" \/>\n<p class=\"mt-2 font-serif font-normal\">\n<\/div>\n<\/div>\n<\/div>\n<div class=\"text-muted flex \">Mar 6, 2019<\/div>\n","protected":false},"excerpt":{"rendered":"<p>https:\/\/www.the-scientist.com\/does-prior-dengue-exposure-help-or-hurt-a-zika-infection&#8212;65570 Animal and cell culture studies show evidence that dengue antibodies can both neutralize and enhance Zika, but human investigations have only found protective effects. Written byDiana Kwon The mosquito-borne Zika virus that recently spread rapidly throughout the Americas shares many characteristics with another virus: dengue. Both are flaviviruses, which are enveloped, sphere-shape virions that [&hellip;]<\/p>\n","protected":false},"author":121,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-1358","post","type-post","status-publish","format-standard","hentry","category-press-2"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/posts\/1358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/users\/121"}],"replies":[{"embeddable":true,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/comments?post=1358"}],"version-history":[{"count":3,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/posts\/1358\/revisions"}],"predecessor-version":[{"id":1394,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/posts\/1358\/revisions\/1394"}],"wp:attachment":[{"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/media?parent=1358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/categories?post=1358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/labs.icahn.mssm.edu\/lim-lab\/wp-json\/wp\/v2\/tags?post=1358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}