Zika from sex, the byway but not the highway

FlavivirusCan Zika virus be sexually transmitted? Perhaps in very rare cases, but the main mode of transmission is certainly via mosquitoes. That’s why I’ve shamelessly stolen a quote on this topic from Dr. William Schaffner of Vanderbilt University:

Mosquito transmission is the highway, whereas sexual transmission is the byway. Sexual transmission cannot account for this sudden and widespread transmission of this virus.

If you just read the news headlines, which many people do, you will think that Zika virus spreads like HIV. But it does not.

Let’s make a clear distinction between sexually transmitted viruses (like HIV – sex is the main mode of transmission, along with contaminated blood), versus sexually transmissible viruses. The latter includes viruses that now and then might be sexually transmitted under certain circumstances, but which normally are transmitted by another route. Zika virus is transmitted among humans by mosquitoes. If sexual transmission occurs, it is very, very rare, given the large number of Zika virus infections that have been documented.

Is Zika virus sexually transmissible?

The first hint of sexual transmission of Zika virus came from the story of two American scientists working in Senegal in 2008, where they were sampling mosquitoes. Between 6-9 days after returning to their homes in Colorado, they developed a variety of symptoms of infection including fatigue, headache, chills, arthralgia, and a maculopapular rash. The wife of one patient had not traveled to Africa, yet she developed similar symptoms three days after her husband. Analysis of paired acute and convalescent sera from all three patients revealed antibodies against Zika virus. The authors of the study do not conclude that transmission from husband to wife was via sexual activity – they suggest it as a possiblity. Their data could not prove sexual transmission.

More recently infectious Zika virus was detected in semen of a French Polynesian male who had recovered from infection. The presence of virus in semen is compatible with sexual transmission, but the patient was not known to have transmitted infection to anyone.

The CDC has concluded that Zika virus was transmitted to an individual in Texas who had sex with a traveler returning from Venezuela. As of this writing I do not know exactly how the CDC came to this conclusion.

What would be needed to prove that Zika virus is sexually transmissible?

Polymerase chain reaction (PCR) is used to diagnose many viral diseases. This assay detects small fragments of viral nucleic acid and can be very specific. However as we are trying to establish for the first time that Zika virus can be transmitted sexually, more than PCR must be done – infectious virus should be recovered from the donor and recipient. A positive PCR result does not mean that infectious virus is present in the sample, only fragments of the genome, which of course would not be infectious. It is important to correlate the presence of infectious virus with sexual transmission.

Not only should infectious virus be recovered from both donor and recipient, but the viral genome sequences should be nearly identical, providing strong evidence for sexual transmission. If the viral genome sequences were substantially different, this result could imply that the infection was acquired from someone else.

Looking for anti-viral antibodies in serum is a good way to confirm virus infection when virus is no longer present. However it is not as specific as PCR or virus isolation, and does not provide information about the genome of the donor and recipient virus.

Sexual transmission of Ebolavirus still remains speculative. There are several suspected cases, and many examples of PCR positive semen samples from men who have recovered from the disease. It’s not easy to prove that a virus can be transmitted sexually, especially when it is a rare event.

Just as we are not sure that Zika virus causes microencephaly, we are not sure if it can be sexually transmitted.

HeLa RNA is everywhere

Immortal LifeThe first immortal human cell line ever produced, HeLa, originated from a cervical adenocarcinoma taken from Henrietta Lacks. The cell line grew so well that it was used in many laboratories and soon was found to contaminate other cell lines. Now HeLa RNA has made its way into human sequence databases.

Although the cause of Henrietta Lacks’ cervical tumor was not known in her lifetime, we now understand that it was triggered by infection with human papillomavirus (HPV) type 18. When this virus infects the cervical epithelium, the viral DNA may integrate into the host genome, causing the cells to become transformed and eventually malignant. HeLa cells are known to contain integrated HPV18 DNA.

There are many different types of cancer, each caused by errors in DNA. The Cancer Genome Atlas (TCGA) is a database for collecting the DNA sequences of diverse cancers from many different individuals. It was established to help understand what mutations cause various types of cancer. As viruses are known to be responsible for about 20% of human cancers, searching this database for viral sequences can advance our understanding of their role in this disease. For example, almost every genome from patients with cervical cancer contains HPV DNA.

A recent search of the TCGA for viral sequences revealed that, in addition to cervical cancer, HPV18 sequences were found in many other cancers, including colon, head and neck, kidney, liver, lung, ovary, rectum, and stomach. The HPV18 sequences in non-cervical cancers resembled the viral sequence found in HeLa cells, both in integration site and single nucleotide variations. In other words, the HPV18 in these cancers closely matches that of the viral genome integrated into HeLa cells, and their presence is likely due to contamination.

Further analysis revealed that the contaminated samples originated from only two genome sequencing centers, the University of North Carolina Lineberger Comprehensive Cancer Center, and the Michael Smith Genome Sciences Centre of the British Columbia Cancer Agency. All the contamination took place in 2011 and 2012, and was limited to 18 (6%) of the sequencing machines.

The contamination with HeLa nucleic acid was observed only in datasets derived from sequencing of RNA, not DNA. I asked the senior author Jim Pipas how he thought this contamination might have taken place:

I can think of two possibilities. One is that the RNA isolated from the tumor was somehow contaminated with HeLa sequences. The other is that HeLa cell RNA was sequenced on the same machine as the tumors and the contamination is from the sequencing machine itself.

It is well known that nucleic acids can become contaminated during their manipulation in the laboratory. The use of sensitive techniques such as PCR and deep sequencing reveal such contamination when it previously went unnoticed. High profile examples of nucleic acid contamination include the retrovirus XMRV associated with chronic fatigue syndrome, and a virus believed to cause hepatitis (a contaminant from laboratory plasticware).

As virus discoverer Eric Delwart noted on TWiV 86, ‘DNA is a real problem. It’s everywhere’. Apparently so is HeLa cell RNA.

TWiV 309: Ebola email

On episode #309 of the science show This Week in Virology, the TWiVocytes answer questions about Ebola virus, including mode of transmission, quarantine, incubation period, immunity, and much more.

You can find TWiV #309 at www.microbe.tv/twiv.

TWiM 90: Think globally, act locally

I usually don’t post TWiM episodes here, but #90 has a lot of virology. In this episode, recorded in La Jolla, CA at the annual meeting of the Southern California Branch of the American Society for Microbiology, I first speak with Laurene Mascola, Chief of Acute Communicable Diseases at the Los Angeles County Department of Public Health. Dr. Mascola talks about how Los Angeles county has prepared for an outbreak of Ebola virus. Next up is David Persing, Executive Vice President and Chief Medical and Technology Officer at Cepheid. His company has developed an amazing, modular PCR machine that is brining rapid diagnosis everywhere, including the United States Post Office. And it might even be available on your refrigerator one day.

Watch TWiM #90 below, or listen at microbeworld.org/twim or iTunes.


MERS-CoV genome found in dromedary camels

coronavirusMiddle Eastern respiratory syndrome coronavirus (MERS-CoV), first identified in the fall of 2012 in a Saudi Arabian patient, has since infected over 160 individuals, causing 71 deaths. Identifying the source of infection is important for efforts to prevent further infections. Recently two studies revealed the presence of antibodies to the virus in dromedary camels in Jordan and Saudi Arabia, two countries where large clusters of infections have occurred. Detection of the viral RNA genome in clinical specimens by polymerase chain reaction (PCR) now provides additional evidence that MERS-CoV can infect camels.

Samples were obtained from all camels (n=14) on a farm where two individuals with laboratory confirmed MERS-CoV infection had been in contact with animals. Nasal swab specimens from three camels were positive when assayed by PCR using MERS-CoV specific primers. Nucleotide sequence analysis revealed that the virus from one camel clustered with sequences obtained from the two farm-associated MERS-CoV infections. Sera from all camels on the farm reacted with MERS-CoV in immunofluorescence and neutralizing assays.

These observations provide strong evidence that MERS-CoV can replicate in camels. However, the authors were not able to isolate infectious virus from camel specimens. MERS-CoV has been previously cultured from human clinical specimens, and it is known what types of cells should be used for virus isolation. Levels of virus in the camel specimens might be too low to detect by culturing, or alternatively only fragments of viral genomes might be present, especially if the infection is over.

Proof that infectious MERS-CoV virus is present in camels will require isolation of infectious virus in cultured cells. If PCR is routinely used to diagnose viral infections such as influenza, why is it not sufficient to conclude that MERS—CoV is present in camels? The answer is that this is not a routine case – the investigators are attempting to determine the origin of MERS-CoV and therefore demonstrating infectious virus is essential. You can bet that the investigators are hard at work attempting to isolate infectious virus from the camels.

The authors note that because of the nucleotide sequence similarity between the camel and human viruses, is not possible to determine if the camels were infected by humans, or if humans infected the camels. It is also possible that camels and humans were infected by a third source. Analysis of outbreaks in which the viruses have undergone more extensive sequence divergence should permit establishment of the chain of transmission. If I had to speculate, I would say the virus is going from camels to humans. So far there has been little evidence of seropositivity in humans outside of the known cases, while many camels have antibodies that react with the virus.

How many viruses on Earth?

EarthHow many different viruses are there on planet Earth? Twenty years ago Stephen Morse suggested that there were about one million viruses of vertebrates (he arrived at this calculation by assuming ~20 different viruses in each of the 50,000 vertebrates on the planet). The results of a new study suggest that at least 320,000 different viruses infect mammals.

To estimate unknown viral diversity in mammals, 1,897 samples (urine, throat swabs, feces, roost urine) were collected from the Indian flying fox, Pteropus giganteus, and analyzed for viral sequences by consensus polymerase chain reaction. This bat species was selected for the study because it is known to harbor zoonotic pathogens such as Nipah virus. PCR assays were designed to detect viruses from nine viral families. A total of 985 viral sequences from members of 7 viral families were obtained. These included 11 paramyxoviruses (including Nipah virus and 10 new viruses), 14 adenoviruses (13 novel), 8 novel astroviruses, 4 distinct coronaviruses, 3 novel polyomaviruses, 2 bocaviruses, and many new herpesviruses.

Statistical methods were then used to estimate that P. giganteus likely harbor 58 different viruses, of which 55 were identified in this study. If the 5,486 known mammalian species each harbor 58 viruses, there would be ~320,000 unknown viruses that infect mammals. This is likely to be un under-estimate as only 9 viral families were targeted by the study. In addition, the PCR approach only detects viruses similar to those that we already know. Unbiased approaches, such as deep DNA sequencing, would likely detect more.

Let’s extend this analysis to additional species, even though it might not be correct to do so. If we assume that the 62,305 known vertebrate species each harbor 58 viruses, the number of unknown viruses rises to 3,613,690 – over three times more than Dr. Morse’s estimate. The number rises to 100,939,140 viruses if we include the 1,740,330 known species of vertebrates, invertebrates, plants, lichens, mushrooms, and brown algae. This number does not include viruses of bacteria, archaea, and other single-celled organisms. Considering that there are 1031 virus particles in the oceans – mostly bacteriophages – the number is likely to be substantially higher.

Based on the cost to study viruses in P. giganteus ($1.2 million), it would require $6.4 billion to discover all mammalian viruses, or $1.4 billion to discover 85% of them. I believe this would be money well spent, as the information would allow unprecedented study on the diversity and origins of viruses and their evolution. The authors justify this expenditure solely in terms of human health; they note that the cost “would represent a small fraction of the cost of many pandemic zoonoses”. However it is not at all clear that knowing all the viruses that could potentially infect humans would have an impact on our ability to prevent disease. Even the authors note that “these programs will not themselves prevent the emergence of new zoonotic viruses”. We have known for some time that P. giganteus harbors Nipah virus, yet outbreaks of infection continue to occur each year. While it is not inconceivable that such information could be useful in responding to zoonotic outbreaks, the knowledge of all the viruses on Earth would likely impact human health in ways that cannot be currently imagined.

Update 1: I neglected to point out an assumption made in this study, that detection of a PCR product in a bat indicates that the virus is replicating in that animal. As discussed for MERS-CoV, conclusive evidence that a virus is present in a given host requires isolation of infectious virus, or if that is not possible, isolation of full length viral genomes from multiple hosts, together with detection of anti-viral antibodies. Obviously these measures cannot be taken for a study such as the one described above whose aim is to estimate the number of unknown viruses.

Update 2: We discussed this estimate of mammalian viruses on TWiV #249.

XMRV not detected in UK chronic fatigue syndrome patients

xmrv_pcrA new retrovirus, xenotropic murine leukaemia virus-related virus (XMRV), first identified in tumor tissue of individuals with prostate cancer, was subsequently found in 68 of 101 US patients with chronic fatigue syndrome (CFS). This observation raised the possibility that XMRV is the etiologic agent of CFS. An important question is whether XMRV is associated with CFS in other parts of the world. For some CFS patients in the UK the answer appears to be no.

The subjects of this study were 186 confirmed CFS patients who had been referred to the CFS clinic at King’s College Hospital, London. DNA was prepared from blood samples and subjected to polymerase chain reaction using primers that anneal to an XMRV-specific sequence, and to a sequence conserved among murine leukemia viruses. To demonstrate that the amplification worked, a positive control reaction was done using XMRV DNA. The reaction products were fractionated by electrophoresis on an agarose gel, and the DNAs were visualized by staining with a dye. As shown in the figure, positive control samples containing XMRV DNA produced DNAs of the expected sizes (lanes 10, 11). None of the 186 test DNAs from CFS patients produced a PCR product with either the XMRV or murine leukemia virus primers. Some of these negative samples are shown in lanes 1-8 of the figure.

The authors of this study suggest that they were more careful at avoiding contamination than the group which previously identified XMRV in American CFS patients:

…the PCR operator was blinded to the provenance of the DNA samples. In fact, with the exception of the PCR controls, all 186 DNA test samples originated from CFS patients. Care was taken to grow the XMRV plasmid in a laboratory in which no MLV had been cultured and no MLV vectors used and the PCR was carried out in a CPA-accredited Molecular Diagnostics Unit which processes only human tissue. Multiple (six) water (negative) controls were included in every run to detect low level contamination and a PCR to amplify a sequence that is conserved in most murine leukaemia viruses was included in order to expose any circulating MLV contamination and to detect any variant of XMRV that might be circulating in the UK CFS population.

But they also acknowledge that there might be population differences in XMRV distribution:

Based on our molecular data, we do not share the conviction that XMRV may be a contributory factor in the pathogenesis of CFS, at least in the U.K.

These results are surely a disappointment to CFS sufferers who believe that XMRV is the etiologic agent of the disease. But they reveal the dangers of making conclusions about disease etiology based on the findings of limited studies. As I wrote previously, while the presence of XMRV in 67% of CFS samples seems impressive, it could be misleading. For example, the samples could be from regions where XMRV infection is common.

In light of these new findings, it is informative to recall that the nucleic acid of another retrovirus, human T-lymphotropic virus type ll, was previously amplified from blood cells of 23 of 30 CFS patients, but not from healthy patients. However this observation was not confirmed in subsequent studies of CFS patients. In addition, there is no evidence for the presence of other retroviruses in CFS patients, including HIV-1, bovine and feline leukemia viruses, simian T lymphotropic virus type l, foamy virus, and simian retrovirus.

It is possible that XMRV is involved in CFS but only in certain parts of the world. More extensive studies such as the one reported here must be done worldwide to clarify the role of XMRV in CFS, and to determine whether other infectious agents are involved.

Erlwein O, Kaye S, McClure MO, Weber J, Wills G, Collier D, Wessely S, & Cleare A (2010). Failure to detect the novel retrovirus XMRV in chronic fatigue syndrome. PloS one, 5 (1) PMID: 20066031

Influenza virus reassortment, then and now

influenza-rna-gelIn a recent study of influenza virus reassortment in ferrets, the authors used polymerase chain reaction (PCR) to search for viruses with RNA segments from the 2009 pandemic H1N1 strain and seasonal H1N1 and H3N2 strains. I thought you might like to see how I did a similar experiment in 1979 – a very different era for laboratory techniques.

For my Ph.D. thesis project, I wanted to isolate reassortants of two influenza B virus strains, B/Lee and B/Maryland. The goal was to obtain viruses with a genome consisting of one RNA segment from one parent, and 7 RNA segments from the other parent. These viruses would then be used to identify the protein product of each viral RNA.

To isolate these reassortants, I co-infected cells in culture with both viruses, allowed them to replicate, and then harvested the newly synthesized viruses. I then did a plaque assay with the viruses produced by the co-infected cells, and isolated individual clones by plaque purification. I prepared virus stocks from each plaque-purified clone, and then asked if any of these viruses were reassortants.

In 1979, we identified viral reassortants by a tedious method. Each virus to be examined was used to infect cultured cells in the presence of radioactive phosphate. The viruses were purified by centrifugation, and the viral RNA was extracted, concentrated, and fractionated by gel electrophoresis. The gel was dried and exposed to X-ray film. Because the viruses were propagated in the presence of radioactive phosphate, which was incorporated into the viral RNAs, it was possible to visualize each viral segment as a band on the film. The X-ray is shown above.

The RNAs of three different viruses are included: B/Lee on the left, B/Maryland in the middle, and a plaque-purified virus called R3. You can see that each lane contains 8 RNAs, as expected. It is also evident that the migration pattern of the RNAs is different for B/Lee and B/Maryland. This property allowed us to determine that the plaque purified virus R3 is a reassortant that inherits RNA 2 from B/Lee, and the remaining 7 RNAs from B/Maryland. Just what I wanted!

In fact, in just one infection, I isolated all the different reassortant viruses that I needed. I remember showing the gel to my thesis advisor: he told me I didn’t deserve such luck.

The whole procedure – from infecting cells in the presence of radioactive phosphate, to producing the X-ray, took about a week. And to get all the right viral reassortants required a great deal of luck.

Today, the process of identifying influenza viral reassortants is far simpler and faster. The process begins in a similar way – co-infect cells (or animals) with two different viruses. Once the infection is complete, a small sample of the cell culture medium is taken, heated to disrupt the virions, and the viral RNA is converted to DNA using reverse transcriptase. The DNA is amplified by PCR, in eight separate reactions, using primer pairs specific for the individuals segments. The products are then fractionated by gel electrophoresis, as shown here.

Total time to identify reassortants by PCR – less than a day. That’s progress.

In a few years, we’ll skip the gel electrophoresis and simply determine the sequence of the RNAs using a small, inexpensive machine that will be on most laboratory benches. And who knows what will be next? That’s one of the beauties of science: it is driven forward by technological innovation.

Racaniello VR, & Palese P (1979). Influenza B virus genome: assignment of viral polypeptides to RNA segments. Journal of virology, 29 (1), 361-73 PMID: 430594