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      Differentiated human airway organoids to assess infectivity of emerging influenza virus

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          Influenza virus infection represents a major threat to public health worldwide. There is no biologically relevant, reproducible, and readily available in vitro model for predicting the infectivity of influenza viruses in humans. Based on the long-term expanding 3D human airway organoids, we developed proximal differentiation and further established a 2D monolayer culture of airway organoids. The resultant 3D and 2D proximal differentiated airway organoids can morphologically and functionally simulate human airway epithelium and as a proof of concept can discriminate human-infective influenza viruses from poorly human-infective viruses. Thus, the proximal differentiated airway organoids can be utilized to predict the infectivity of influenza viruses and, more broadly, provide a universal platform for studying the biology and pathology of the human airway.

          Abstract

          Novel reassortant avian influenza H7N9 virus and pandemic 2009 H1N1 (H1N1pdm) virus cause human infections, while avian H7N2 and swine H1N1 virus mainly infect birds and pigs, respectively. There is no robust in vitro model for assessing the infectivity of emerging viruses in humans. Based on a recently established method, we generated long-term expanding 3D human airway organoids which accommodate four types of airway epithelial cells: ciliated, goblet, club, and basal cells. We report differentiation conditions which increase ciliated cell numbers to a nearly physiological level with synchronously beating cilia readily discernible in every organoid. In addition, the differentiation conditions induce elevated levels of serine proteases, which are essential for productive infection of human influenza viruses and low-pathogenic avian influenza viruses. We also established improved 2D monolayer culture conditions for the differentiated airway organoids. To demonstrate the ability of differentiated airway organoids to identify human-infective virus, 3D and 2D differentiated airway organoids are applied to evaluate two pairs of viruses with known distinct infectivity in humans, H7N9/Ah versus H7N2 and H1N1pdm versus an H1N1 strain isolated from swine (H1N1sw). The human-infective H7N9/Ah virus replicated more robustly than the poorly human-infective H7N2 virus; the highly human-infective H1N1pdm virus replicated to a higher titer than the counterpart H1N1sw. Collectively, we developed differentiated human airway organoids which can morphologically and functionally simulate human airway epithelium. These differentiated airway organoids can be applied for rapid assessment of the infectivity of emerging respiratory viruses to human.

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          Most cited references19

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          Human and avian influenza viruses target different cell types in cultures of human airway epithelium.

          The recent human infections caused by H5N1, H9N2, and H7N7 avian influenza viruses highlighted the continuous threat of new pathogenic influenza viruses emerging from a natural reservoir in birds. It is generally believed that replication of avian influenza viruses in humans is restricted by a poor fit of these viruses to cellular receptors and extracellular inhibitors in the human respiratory tract. However, detailed mechanisms of this restriction remain obscure. Here, using cultures of differentiated human airway epithelial cells, we demonstrated that influenza viruses enter the airway epithelium through specific target cells and that there were striking differences in this respect between human and avian viruses. During the course of a single-cycle infection, human viruses preferentially infected nonciliated cells, whereas avian viruses as well as the egg-adapted human virus variant with an avian virus-like receptor specificity mainly infected ciliated cells. This pattern correlated with the predominant localization of receptors for human viruses (2-6-linked sialic acids) on nonciliated cells and of receptors for avian viruses (2-3-linked sialic acids) on ciliated cells. These findings suggest that although avian influenza viruses can infect human airway epithelium, their replication may be limited by a nonoptimal cellular tropism. Our data throw light on the mechanisms of generation of pandemic viruses from their avian progenitors and open avenues for cell level-oriented studies on the replication and pathogenicity of influenza virus in humans.
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            A three-dimensional model of human lung development and disease from pluripotent stem cells

            Recapitulation of lung development from human pluripotent stem cells (hPSCs) in three dimensions (3D) would allow deeper insight into human development, as well as the development of innovative strategies for disease modeling, drug discovery and regenerative medicine 1 . We report here the generation from hPSCs of lung bud organoids (LBOs) that contain mesoderm and pulmonary endoderm and develop into branching airway and early alveolar structures after xenotransplantation and in Matrigel 3D culture. Expression analysis and structural features indicated that the branching structures reached the second trimester of human gestation. Infection in vitro with respiratory syncytial virus, which causes small airway obstruction and bronchiolitis in infants 2 , led to swelling, detachment and shedding of infected cells into the organoid lumens, similar to what has been observed in human lungs 3 . Introduction of mutation in HPS1, which causes an early-onset form of intractable pulmonary fibrosis 4,5 , led to accumulation of extracellular matrix and mesenchymal cells, suggesting the potential use of this model to recapitulate fibrotic lung disease in vitro. LBOs therefore recapitulate lung development and may provide a useful tool to model lung disease.
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              Delayed antiviral plus immunomodulator treatment still reduces mortality in mice infected by high inoculum of influenza A/H5N1 virus.

              The mortality of human infection by influenza A/H5N1 virus can exceed 80%. The high mortality and its poor response to the neuraminidase inhibitor oseltamivir have been attributed to uncontrolled virus-induced cytokine storm. We challenged BALB/c mice with 1,000 LD50 of influenza A/Vietnam/1194/04. Survival, body weight, histopathology, inflammatory markers, viral loads, T lymphocyte counts, and neutralizing antibody response were documented in infected mice treated individually or in combination with zanamvir, celecoxib, gemfibrozil, and mesalazine. To imitate the real-life scenario, treatment was initiated at 48 h after viral challenge. There were significant improvements in survival rate (P = 0.02), survival time (P < 0.02), and inflammatory markers (P < 0.01) in the group treated with a triple combination of zanamivir, celecoxib, and mesalazine when compared with zanamivir alone. Zanamivir with or without immunomodulators reduced viral load to a similar extent. Insignificant prolongation of survival was observed when individual agents were used alone. Significantly higher levels of CD4+ and CD8+ T lymphocytes and less pulmonary inflammation were also found in the group receiving triple therapy. Zanamivir alone reduced viral load but not inflammation and mortality. The survival benefits of adding celecoxib and mesalazine to zanamivir could be caused by their synergistic effects in reducing cytokine dysfunction and preventing apoptosis. Combinations of a neuraminidase inhibitor with these immunomodulators should be considered in randomized controlled treatment trials of patients suffering from H5N1 infection.
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                Author and article information

                Journal
                Proc Natl Acad Sci U S A
                Proc. Natl. Acad. Sci. U.S.A
                pnas
                pnas
                PNAS
                Proceedings of the National Academy of Sciences of the United States of America
                National Academy of Sciences
                0027-8424
                1091-6490
                26 June 2018
                11 June 2018
                11 June 2018
                : 115
                : 26
                : 6822-6827
                Affiliations
                [1] aState Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong;
                [2] bDepartment of Microbiology, The University of Hong Kong , Pokfulam, Hong Kong;
                [3] cResearch Centre of Infection and Immunology, The University of Hong Kong , Hong Kong;
                [4] dHubrecht Institute, Royal Netherlands Academy of Arts and Sciences, 3584 CT Utrecht, The Netherlands;
                [5] eInstitute of Integration of Traditional and Western Medicine, Guangzhou Medical University , Guangzhou 510180, China;
                [6] fDepartment of Surgery, Queen Mary Hospital , Hong Kong;
                [7] gCarol Yu Centre for Infection, The University of Hong Kong , Hong Kong;
                [8] hThe Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong , Hong Kong;
                [9] iPrincess Maxima Center for Pediatric Oncology , 3584 CT Utrecht, The Netherlands
                Author notes
                3To whom correspondence may be addressed. Email: h.clevers@ 123456hubrecht.eu or kyyuen@ 123456hku.hk .

                Contributed by Hans Clevers, May 15, 2018 (sent for review April 13, 2018; reviewed by Pei-Jer Chen and Bernard Roizman)

                Author contributions: J.Z., H. Chen, H. Clevers, and K.-Y.Y. designed research; J.Z., C.L., M.C.C., B.H.-Y.W., H. Chu, V.K.-M.P., D.W., X.Z., L.W., W.S., S.Y., and K.K.-Y.W. performed research; N.S. and H. Clevers contributed new reagents/analytic tools; J.Z., C.L., M.C.C., B.H.-Y.W., H. Chu, J.F.-W.C., K.K.-W.T., H. Chen, and K.-Y.Y. analyzed data; and J.Z., H. Chen, H. Clevers, and K.-Y.Y. wrote the paper.

                Reviewers: P.-J.C., Graduate Institute of Clinical Medicine; and B.R., The University of Chicago and Shenzhen International Institute for Biomedical Research.

                1J.Z., C.L., and N.S. contributed equally to this work.

                2H. Clevers and K.-Y.Y. contributed equally to this work.

                Author information
                http://orcid.org/0000-0001-5108-8338
                Article
                201806308
                10.1073/pnas.1806308115
                6042130
                29891677
                5e7724d3-6463-4b52-b639-f598d4ed97e9
                Copyright © 2018 the Author(s). Published by PNAS.

                This open access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND).

                History
                Page count
                Pages: 6
                Funding
                Funded by: Food and Health Bureau (FHB) 501100005407
                Award ID: HMRF RRG-05
                Award Recipient : Jie Zhou
                Funded by: Food and Health Bureau (FHB) 501100005407
                Award ID: HMRF 17161272
                Award Recipient : Jie Zhou
                Funded by: Research Grants Council, University Grants Committee (RGC, UGC) 501100002920
                Award ID: C7011-15R
                Award Recipient : Jie Zhou
                Funded by: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, China
                Award ID: NA
                Award Recipient : Kwok-Yung Yuen
                Funded by: National Project of Infectious Disease, China
                Award ID: 2014ZX10004001004
                Award Recipient : Kwok-Yung Yuen
                Categories
                Biological Sciences
                Microbiology

                airway organoid,proximal differentiation,influenza virus,infectivity

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