Role of Virus-Specific CD8+ T Cells in the Severity of Hantavirus Pulmonary Syndrome: A Dissertation

The focus of this dissertation is the role of specific CD8+ T cells in the pathogenesis of a highly lethal human viral disease, hantavirus pulmonary syndrome (HPS). HPS is a zoonotic disease caused by transmission of Sin Nombre virus (SNV) from chronically infected deer mice. In humans, this fulminant infection is characterized by lung capillary leakage, respiratory failure and cardiogenic shock. Individuals with HLA-B*3501 have an increased risk of developing severe HPS, and the majority of defined CD8+ T cell epitopes in SNV are presented by this HLA allele, suggesting that CD8+ T cell responses to SNV contribute to pathogenesis. We speculate that CD8+ T cell mediated immune responses to SNV antigens in pulmonary endothelial cells contribute to the pathology of HPS. Specifically, we hypothesize that there are quantitative and/or qualitative differences in SNV-specific CD8+ T cell responses in HPS patients with moderate vs. severe disease. In this dissertation I measured the frequencies of SNV-specific CD8+ T cells during acute HPS. Using HLA/peptide tetramers, I quantitated circulating SNV-specific CD8+ T cells of all the available HLA-B35+ patients with HPS caused by SNV. This is the first time hantavirus-specific T cells have been quantitated during acute infection. I report that between 2.9% and 44.2% of the CD8+ T cells were specific for the three SNV epitopes in combination during acute disease in the patients analyzed in this study. These levels are very high in comparison to the frequencies reported in the literature for other acute human viral infections. Furthermore, I report significantly higher frequencies of SNV-specific T cells in patients with severe HPS requiring mechanical ventilation (up to 44.2% of CD8+ T cells) than in moderately ill HPS patients hospitalized but not requiring mechanical ventilation (up to 9.8% of CD8+ T cells). These results imply that virus-specific CD8+ T cells contribute to HPS disease outcome. In this dissertation I also provide preliminary data on qualitative aspects of SNV-specific T cells. Analysis of the TCR repertoire of SNV-specific T cell lines isolated from the PBMC of acute HPS patients raises the possibility that SNV-specific T cells express a limited number of TCR Vβ alleles; however, this is quite speculative because it is based on the analysis of only seven CTL lines. Analysis of cytokine expression by the CTL lines in response to in vitro antigen-specific stimulation indicate that SNV-specific T cells are capable of secreting IFN-γ, TNF-α, and IL-13 upon stimulation. The data presented in this dissertation extend previous studies, which suggested a role for virus-specific T cells in HPS pathogenesis and support our hypothesis that virus-specific CD8+ T cells contribute to HPS disease outcome. The results of this study will be useful in the design of future therapeutic strategies for this emerging human pathogen. The conclusions of this study may also benefit the study of other human viral hemorrhagic fevers. Improved understanding of the mechanism of pathogenesis of severe viral zoonoses will result in better treatment and prevention strategies