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From the Department of Pathology,*
College of Physicians
and Surgeons, Columbia University, New York, New York; the
Department of Pathology,
Lugio
Sacco Hospital, Milan, Italy; the Department of Microbiology, Molecular
Genetics and Immunology,
The University of
Kansas Medical Center, Kansas City, Kansas; the Institute of Infectious
Disease and Tropical Medicine,§
University of
Milan, Luigi Sacco Hospital, Milan, Italy; the Department of
Pathology,¶
IRCCS Ospedale San Matteo, University
of Pavia, Pravia, Italy; and the Division of
Epidemiology,||
Columbia University, New York,
New York
| Abstract |
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| Introduction |
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-herpesvirus involved in the
pathogenesis of KS, primary effusion lymphoma (PEL), and a subset of
multicentric Castlemans disease (MCD).1-3
KSHV can be
stably propagated in vitro in B-cell lines derived from
PELs, but currently it is not readily transmissible at high
titer.4-8
Similar to other herpesviruses, KSHV infection
can be characterized as lytic or latent. During lytic replication,
virions are packaged and released from the cell. This process requires
DNA synthesis together with expression of virion structural protein
genes and is believed to result in cell death. Latent infection,
however, is characterized by the persistence of the viral genome as a
covalently closed circular episome with limited viral gene
expression.9,10
Latent KSHV in cells derived from PEL can
be induced into lytic replication by chemical treatment with
tetradecanoyl phorbol acetate (TPA) or
butyrate.10,11 PEL-derived cell lines stimulated with phorbol esters or butyrate reveal three distinct classes of KSHV messenger RNAs (mRNAs) corresponding to constitutive (type I), constitutive/inducible (type II), and lytic/inducible (type III) transcripts.12 The expression of selected genes can be further modulated by treatment with cycloheximide, phosphonoacetic acid, or both.13 Most of the viral cytokines and signal transduction genes that are unique to KSHV are type II or III, inducible genes.12 These genes encode proteins that have been postulated to play a central role in the pathogenesis of KSHV-related diseases.
A major drawback to studies on viral gene expression in tissue culture cell lines is that expression patterns in such systems may not reflect viral gene expression in infected tissues in situ. For example, Epstein-Barr virus (EBV) demonstrates different programs of virus latency in different cell types.14 It is currently unknown whether the pattern of gene transcription observed in vitro in PEL cell lines is present in different types of KSHV-infected cells in vivo. Recent immunohistochemistry studies have shown that KS spindle cell, mantle zone B cells in MCD lymph nodes and PEL cells express KSHV LANA,15-17 whereas vIL-6 is detectable in only a subpopulation of KSHV-infected hematopoietic cells.18,19 In this study we used a panel of antibodies directed against KSHV LANA (ORF73),20 vIL6 (K2),18 vIRF1 (ORFK9),21 and processivity factor-8 (PF-8) (ORF59).22 These proteins represent type I-constitutive (ORF73/LANA), type II-constitutive/inducible (ORFK9/vIRF1 and ORF K2/vIL6), and type III-lytic/inducible (ORF59/PF-8) genes of KSHV.12 Our results demonstrate that some KSHV genes can become dysregulated in tissue culture and that tissue-specific patterns of expression are not represented by tissue culture studies. Furthermore, different KSHV-associated diseases show distinct patterns of viral gene expression. Therefore KSHV, like EBV, exhibits multiple programs for viral gene expression.
| Materials and Methods |
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BC-1,4 BCP-1,5 and BCBL-18 KSHV-infected cells were maintained at 37°C and 5% CO2 in 1640 RPMI (GIBCO/BRL, Grand Island, NY) supplemented with 10% to 20% fetal calf serum (GIBCO/BRL). Induction of viral gene expression was performed by treatment of cells with 20 ng/ml of TPA (Sigma Chemical Co., St. Louis, MO). Ramos (EBV-/KSHV-) and P3HRI (EBV+/KSHV-) cells (ATCC, Gaithersburg, MD) were used as KSHV-negative control cell lines. Cytospins, cell pellets, or both were harvested after 48 hours. Cytospins were air dried overnight, fixed in acetone for 4 minutes at room temperature, air dried for 30 minutes, and then either processed for immunohistochemistry or stored at -80°C until use. Cell pellets were fixed overnight in 4% paraformaldehyde in 0.1 mol/L phosphate-buffered saline (PBS; pH7.4) and embedded in paraffin.
Tissue Cases and Controls
Fifteen KS skin lesions, 10 lymph nodes from patients with MCD, and biopsies from four cases of PEL were investigated. KS biopsies included both classical (n = 7) and human immunodeficiency virus (HIV)-associated (n = 8) cases and were representative of patch (n = 5), plaque (n = 7), and nodular (n = 3) stages of the disease. All 10 MCD cases were of the plasma cell variant, six from HIV-seronegative and four from HIV-seropositive individuals. In contrast, all four PEL cases were acquired immune deficiency syndrome (AIDS)-related. Frozen material (required for PF-8 immunostaining) was available for 8 of 15 KS lesions and 7 of 10 MCD cases. Frozen material was available from one of the four PEL cases. Frozen and paraffin-embedded sections from normal tonsils (n = 5) and skin biopsies (n = 5) were used as controls.
Antibodies
The panel of antibodies against KSHV used in this study
specifically recognizes viral proteins representative of different
classes of transcripts involved in virus replication (see Table 1
). When applied to KSHV-infected cells,
monoclonal antibodies and sera directed against different portions of
the same KSHV protein and/or raised in different species showed the
same staining pattern and labeled the same percentage of cells, with a
range of variability of less than 5% (data not shown).
Immunohistochemical procedures to reveal KSHV expression on
paraffin-embedded biopsies were optimized by using sections from
formalin-fixed/paraffin-embedded pellets of KSHV-infected PEL-derived
(BC-1, BCP-1, BCBL-1) cell lines and uninfected control cells (RAMOS).
The results on paraffin-embedded sections were compared with the
results obtained on acetone-fixed cytospins of the same cell lines
(data not shown). For a given antibody, the conditions were considered
satisfactory when, in repeated experiments, the number of immunostained
cells was the same on paraffin-embedded sections and cytospins, with a
range of variability of less than 5% (data not shown). To obtain the
same percentage of stained cells on the paraffin-embedded sections and
on the cytospins, antibodies against LANA and vIRF1 required a
microwave-ethylenediaminetetraacetic acid (EDTA) pretreatment of
paraffin sections,23
whereas the reactivity of antibodies
against vIL6 did not require this treatment. The monoclonal antibody
M11D1 against KSHV PF-8 was the only reagent that was nonreactive on
paraffin sections and required frozen materials (see Table 1
).
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Immunohistochemistry
Antibody binding was revealed using peroxidase-labeled goat anti-mouse or goat anti-rabbit antisera (DAKO) followed by tyramide amplification (DuPont/NEN, Boston, MA). Reactions were developed using diaminobenzidine (DAB; Sigma) or amino ethyl carbazole (AEC; DAKO) as chromogenic substrates, and sections were counterstained with hematoxylin. For double immunostaining, the second primary antibody was revealed using alkaline phosphatase-conjugated rabbit anti-mouse or swine anti-rabbit antisera and Fast Blue (Sigma) as chromogen. For immunofluorescence, fluorescein-isothiocyanate (FITC)-conjugated goat anti-mouse or goat anti-rabbit antisera (Southern Biotechnology, Birmingham, AL) were used alone or, for double staining, in combination with biotinylated horse anti-mouse (Vector Laboratories, Burlingame, CA) or goat anti-rabbit antisera (Southern Biotechnology) followed by Avidin Texas Red (Vector).
| Results |
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Protein expression patterns were examined in three cell lines
(BC-1, BCP-1, and BCBL-1) before and after TPA treatment (summarized in
Table 2
). Although LANA was expressed in
all cells (Figure 1A)
regardless of TPA
treatment and appears to be a marker for KSHV infection, examination of
the immunohistochemical profile for the remaining proteins reveals a
tightly regulated expression pattern. The BC-1 cell line had
constitutive low-level expression of vIRF1 and vIL6 (class II genes)
but lacked expression of PF-8 (class III). In contrast, low-level PF-8
protein expression was present in BCBL-1 and BCP-1 cells without TPA
treatment, which is consistent with these cell lines being producer
cell lines with a low percentage of cells spontaneously entering into
full lytic replication. The percentages of cells expressing vIRF1 and
PF-8 increased approximately 20-fold after TPA treatment for all three
cell lines, whereas vIL6, which was expressed at higher constitutive
levels, increased only 3- to 5-fold (Table 3)
. We found that the vIL6 staining
pattern in KSHV-infected cell lines was less than initially
reported,18
probably due to technical artifacts in the
earlier study that were related to antibody dilution and development.
In TPA-stimulated BCBL-1 cells, double-staining studies demonstrated
that more than 80% of cells expressing vIRF1 coexpressed PF-8, as
compared with 10% of PF-8-positive cells expressing vIL6 (Table 4)
. All antibodies against KSHV proteins
were nonreactive by immunohistochemistry to RAMOS and P3HRI cells, as
well as KSHV-negative tissue controls.
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Kaposis Sarcoma
KSHV protein expression is highly restricted in KS lesions. LANA
is the only protein examined that was expressed in most KS tumor cells.
In KS lesions, regardless of histological stage, the nuclei of spindle
and endothelial KS cells were positive for LANA in a typical speckled
immunoreactivity pattern (Figure 2B)
.
Intratumoral arterioles and extralesional normal tissues, including
epidermis and skin adnexa, were LANA negative (Figure 2C)
. All clinical
stages of KS, including patch, plaque, and nodular lesions, were
positive for LANA expression. In all KS lesions, most CD45+
infiltrating leukocytes were CD68+ monocytic cells, with only a few and
irregularly distributed CD3+ T or CD20+ B lymphocytes. Of these
CD45+/CD68+ monocytes, less than 1% were LANA positive (Figure 2E)
,
and none expressed PF-8 or other KSHV proteins. No expression of vIRF1
or vIL6 was seen in any of the KS lesions. In four of five nodular
lesions for which frozen material was available, the nuclei of rare
(less than 1%) tumor spindle and endothelial cells were positive for
PF-8 (Figure 2F)
.
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Comparison of tumor biopsies to unstimulated cell lines shows
several important differences between PEL cells growing in
vivo and in vitro. As in KS lesions and PEL cell lines,
LANA has a speckled nuclear pattern in virtually all PEL biopsy cells
(Figure 1E)
. In contrast, less than 5% of the cells were positive for
vIL6 (Figure 1F)
, and no immunostaining for vIRF1 protein was detected.
Because vIRF1 can be detected at low levels in resting (ie,
unstimulated) PEL cell lines, these data suggest that gene
dysregulation has occurred in adaptation of the cells to culture.
MCD
In contrast to KS and PEL lesions, a broad pattern of KSHV protein
expression is present in MCD tissues. Expression of KSHV proteins is
confined to the follicular mantle zone, in which 10% to 30% of cells
are positive for LANA (Figure 1H)
. Double staining demonstrates that a
subpopulation of these cells expresses vIL6 and vIRF1. The number of
cells expressing these latter viral proteins, however, was highly
variable among different follicles of the same lymph node, ranging from
5% to 25% of the LANA-positive cells (Figure 1, J and K)
. In four
cases for which frozen material was available, rare LANA-positive cells
of the mantle zone were also positive for PF-8 (Figure 1L)
. Outside the
follicles, cells expressing KSHV proteins were an inconspicuous and
occasional finding. When present, they were within poorly defined
aggregates of B-lymphocytes in the paracortical areas or as single
isolated cells in the marginal sinus. In all MCD cases, cells
expressing KSHV proteins had large, irregular or round nuclei with
marginated chromatin and medium-sized nucleoli (Figure 1J
, inset).
Cells expressing LANA were only occasionally positive for CD20 or CD79
(Figure 1I)
but always negative for CD23 or CD5 or for the T-cell
antigen CD3. In all but one MCD case, in which a single double-stained
cell was observed, CD68+ monocytes were also negative.
Immunohistochemical results on KS, PEL, and CD biopsies are
summarized in Table 2
. Extralesional normal tissues in the biopsies
used in this study were consistently negative with all antibodies
against KSHV proteins tested.
| Discussion |
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Of the proteins assayed in this study, we found that expression is restricted to vIL6 alone in PEL tissue biopsies. In all 4 cases studied, vIL6 was detectable in less than 5% of the LANA-positive neoplastic cells, whereas vIRF1 and PF-8 proteins were not expressed. A difference in viral gene expression patterns between tissue culture cells and the parental tumor has been documented in EBV infection, in which cell lines derived from Burkitts lymphomas expressing type 1 latency in vivo acquire type 2 or type 3 latency in vitro (see14 for review). Our findings suggest that KSHV protein expression may be different in vitro and in vivo. Therefore caution is needed in extending cell culture gene expression studies to patient tissues. Our findings also suggest that in vivo and in vitro expression of vIL6 can occur independently from the activation of the lytic replicative cascade.
In KS lesions, only LANA is expressed by spindle and endothelial KS cells,16,24 with a small minority of the KS cell population expressing PF-8. This is consistent with in situ hybridization studies using T0.7 and T1.1 riboprobes as surrogate markers for latent and lytic virus replication, respectively.25-27 However, in PEL tissue culture, both T0.7 and T1.1 are expressed constitutively, are inducible with TPA treatment, and are therefore defined as class II, constitutive/inducible.12 Neither vIL6 nor vIRF1 was found to be expressed in endothelial or spindle KS cells, including the rare PF-8-positive cells. It has been suggested that primary KSHV infection of spindle cells does not play a central role in the initiation of the KS tumor; instead, infiltrating KSHV-infected mononuclear cells may be secondarily recruited to nascent uninfected KS tumors.28 Our findings suggest otherwise, because infiltrating monocytes and lymphocytes in KS lesions were consistently negative for the KSHV proteins for which we assayed.
Immunohistochemical techniques address critical aspects of virus behavior in infected tissue culture cells and pathological lesions that cannot be explored by mRNA expression studies. Although extensive mRNA mapping of viral gene expression has been performed in KSHV-infected cell lines, this is the first report to compare the protein expression of a panel of constitutive and inducible genes in KSHV-associated disorders. Our study shows that KS, PEL, and MCD are characterized by differing patterns of KSHV protein expression. Currently, it is unclear whether these differences reflect the in vivo establishment of alternative types of latency, which enable KSHV to escape immunological surveillance, or whether these differences in patterns of expression are due to a cell/tissue-specific control of KSHV gene expression. These differences are disease specific and are likely to be relevant to understanding the pathogenesis of KSHV-infected diseases.
| Acknowledgements |
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| Footnotes |
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Supported by National Institutes of Health grants CA67391, CA75911, and CA82056; II Programma Nazionale di Ricerca sullAIDS1998-ISS Project Number 30.A.0.50; and the Lucy Pang Yoa Chang Foundation.
Accepted for publication November 14, 1999.
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