Just Accepted by Free Radical Research
Reactive oxygen and nitrogen species during viral infections Claudio Giuseppe Molteni, Nicola Principi, Susanna Esposito 10.3109/10715762.2014.945443
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Abstract Oxygen and nitrogen radicals are frequently produced during viral infections. These radicals are not only a physiological mechanism for pathogen clearance but also result in many pathological consequences. Low concentrations of radicals can promote viral replication; however high concentrations of radicals can also inhibit viral replication and are detrimental to the cell due to their mitogenic activity. We reviewed the detailed mechanisms behind oxygen and nitrogen radical production and focused on how viruses induce radical production. In addition, we examined the effects of oxygen and nitrogen radicals on both the virus and host. We also reviewed enzymatic and chemical detoxification mechanisms and recent advances in therapeutic antioxidant applications. Many molecules that modulate the redox balance have yielded promising results in cell and animal models of infection. This encourages their use in clinical practice either alone or with existing therapies. However, since the redox balance also plays an important role in host defence against pathogens, carefully designed clinical trials are needed to assess the therapeutic benefits and secondary effects of these molecules and whether these effects differ between different types of viral infections.
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Reactive oxygen and nitrogen species during viral infections
Claudio Giuseppe Molteni1, Nicola Principi1, Susanna Esposito1 1
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and
Correspondence: Susanna Esposito, Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122 Milano, Italy. Tel: +390255032498. Fax: +390250320206. Email:
[email protected] Short title: Reactive oxygen and nitrogen species due to viruses Abstract
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Oxygen and nitrogen radicals are frequently produced during viral infections. These radicals are not only a physiological mechanism for pathogen clearance but also result in many pathological consequences. Low concentrations of radicals can promote viral replication; however high concentrations of radicals can also inhibit viral replication and are detrimental to the cell due to their mitogenic activity. We reviewed the detailed mechanisms behind oxygen and nitrogen radical production and focused on how viruses induce radical production. In addition, we examined the effects of oxygen and nitrogen radicals on both the virus and host. We also reviewed enzymatic and chemical detoxification mechanisms and recent advances in therapeutic antioxidant applications. Many molecules that modulate the redox balance have yielded promising results in cell and animal models of infection. This encourages their use in clinical practice either alone or with existing therapies. However, since the redox balance also plays an important role in host defence against pathogens, carefully designed clinical trials are needed to assess the therapeutic benefits and secondary effects of these molecules and whether these effects differ between different types of viral infections.
Keywords: antioxidant, inducible nitric oxide synthase, nitric oxide, oxidation, reactive oxygen species
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Ospedale Maggiore Policlinico, Milan, Italy
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Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda
Introduction Oxygen and nitric oxide (NO•) radicals are generated at different anatomic sites and under different cellular contexts. Viral infections enhance the production of oxygen and NO• radicals, which can lead to both favourable and unfavourable effects for the host or pathogen. Low concentrations of radicals can promote viral replication;
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however, high concentrations of radicals can also inhibit viral activity [1]. Many human viruses, including human
immunodeficiency virus (HIV), herpes simplex type 1 (HSV-1), hepatitis B virus (HBV), hepatitis C virus (HCV), respiratory
syncytial virus (RSV), and influenza viruses, produce reactive
oxygen species (ROS) [2,3]. ROS are highly diffusible molecules
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that are produced by the reduction of oxygen molecules; ROS
include superoxide anions (O2-), hydrogen peroxide (H2O2), and hydroxyls (OH•) [1]. OH•, which is the most reactive ROS, is generated from O2- and H2O2 in the presence of Fe3+ or Cu2+ ions,
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which catalyse Fenton’s reaction. NO• is generated during viral infections via inducible nitric oxide synthase (iNOS) with tetrahydrobiopterin as a cofactor [1-3]. iNOS is present as a dimer in macrophages and synthesizes NO• via a two-step oxidation of the
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terminal guanidine nitrogen of L-arginine. NO• gives rise to reactive nitric oxide species (RNOS) and reacts with O2- to form peroxynitrite (ONOO-). ONOO- and OH• are potent oxidizers that can alter the structure and function of different macromolecules.
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replication and be detrimental to the cell due to their mitogenic
Here, we review ROS production and metabolism in the context of viral infections and focus on the effects of ROS on viral pathogens as well as the host. PHYSIOPATHOLOGICAL MECHANISMS OF ROS/RNOS PRODUCTION
O2- is produced by physical ROS inducers, such as UV irradiation, and during metabolic processes via different mechanisms [1]. Mitochondria are important sites of ROS production since the electrons flowing through the respiratory chain can be transferred to O2 via oxidative phosphorylation. O2- can also be produced by the degradation of purine nucleotides, mainly AMP, to xanthine and
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hypoxanthine and subsequently to uric acid via xanthine oxidase
translational modifications of xanthine dehydrogenase (XD). These modifications include changes in the oxidation state of thiolic
groups, proteolytic cleavage, and the use of O2 instead of NAD as a cofactor and lead to the release of large amounts of O2- and H2O2 by XO. Granulocytes and macrophages can also produce O2- via the
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membrane-associated NADPH-dependent respiratory burst oxidase. Pathogen recognition triggers the translocation of respiratory burst oxidase to the plasma membrane of the cell. This complex regulates the release of O2- outside the cell and inside phagosomes, which
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form other radicals (e.g., ONOO- and HOCl) that serve as pathogen defence mechanisms. O2- is then converted into the more damaging OH• by reacting with H2O2 via Fenton’s reaction [4]. Fenton’s reaction is catalysed by metals found in ferritin, the Fe-S clusters of
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mitochondrial proteins, heme-like protein domains, and lactoferrin. The H2O2 in the reaction is generated several ways; most notably, H2O2 is generated by the direct addition of an electron to hydrogen ions and O2- or by the enzymatic production of various oxidases and
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(XO) [1]. XO is activated under hypoxic conditions through post-
superoxide dismutase [4]. During viral infections, ROS production can be triggered by cytokines that are secreted in response to the pathogen or by viral components. Table 1 summarizes the main viruses associated with ROS production. The Th1 cytokine tumor necrosis factor (TNF)-α is
produced by phagocytes in response to HIV or influenza and controls O2- production by inhibiting complex III in the mitochondrial respiratory chain [5]. TNF-α is also produced in hepatic cell lines that are transfected with HBV [6], and changes in detoxification have been observed in HBV and HCV-infected patients [7]. Viruses also trigger other proteins to stimulate ROS
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production. The core protein of HCV activates Nox4, which initiates NS5A proteins are also known to induce oxidative [10-12]. During liver diseases (such as hepatocellular or cholestatic problems), the
produced ROS are involved in transcriptional activation of a large
number of cytokines and growth factors, and continued production of ROS feed into the vicious cycle that not only causes hepatic
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damage but also stimulates the processes to reduce treatment of
damage [13]. Epstein-Barr virus (EBV) induces ROS production in B lymphocytes via NADPH oxidase by upregulating EBNA1 and Nox2 [14,15]. HSV-1 J protein and the matrix protein (MP) of the
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vesicular stomatitis virus (VSV) can also induce ROS production [16,17], and the nucleoprotein (N) of the measles and rubella viruses can induce ROS production by increasing the activity of the mitochondria respiratory chain [18,19]. RSV has also been shown to
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induce ROS production in different cell types, including respiratory epithelia [20-22]. The HIV gp120 and TAT proteins, which are known to activate iNOS, may also play a role in superoxidemediated HIV-related neurotoxicity [23,24], while the HIV RT
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mitochondrial ROS production [8,9]; the E1, E2, NS3/4A, and
protein has been shown to induce ROS production [25]. Moreover, Nef and Vpr proteins have also been described to induce superoxide production in different cell types and tissues in HIV infection [26]. Human T cell leukaemia virus type 1 (HTLV-1) has also been found to affect mitochondrial ROS production via the p13 protein during
glucose deprivation [27], while its Tax protein promotes ROS formation by attenuating ubiquitin-specific protease 10 (USP-10), which regulates ROS in T cells [28]. While ROS and RNOS production is generally part of host defences in phagocytic cells, other cell types (such as fibroblasts, endothelial cells, osteoclasts, and chondrocytes) can also produce ROS, which can participate in
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cell signalling, apoptosis, and gene expression [29].
of NF-kB and IRF1 to distinct sites in the iNOS promoter. This calcium-independent enzyme produces large amounts of NO•,
around 10 to 100 times that produced by endothelial and neuronal nitric oxide synthase (eNOS and nNOS), which are calcium
dependent. These three enzymes share 50% amino acid homology
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and are significantly homologous to cytochrome p450 reductase [30]. iNOS can be indirectly activated by Th1 cells and their subsequent cytokine production. In the majority of human cells,
iNOS can be induced by a cytokine cocktail containing interferon
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(IFN)-γ, interleukin (IL)-1β, and TNF-α [30]. Many viruses can directly induce iNOS production. HIV-1, HCV, and RSV are all able to upregulate iNOS expression [31-37]. iNOS is also inhibited by many other factors either directly or indirectly. For example, IL-4
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directly inhibits iNOS by inhibiting IRF1 translation [38], while other factors (IL-4, IL-10, IL13, tumor growing factor [TGF-β]) indirectly inhibit iNOS by inducing arginase, which reduces the availability of L-arginine, the substrate of iNOS substrate [39]. Viral
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During viral infections, iNOS expression is enhanced by the binding
proteins, such as the E1A protein of adenovirus, can also inhibit
iNOS expression [40]. NO• homeostasis is maintained by NO dioxygenase and oxyhemoglobin, which oxidize NO• [1]. NO• can react with oxygen to produce N2O3, which can irreversibly react with halogen ions to
produce nitrosyl halides and NO2-. NO• can also react with O2- to produce ONOO-; this reaction can occur in the intracellular compartments of immune cells (e.g., macrophages and neutrophils) or when NO• diffuses into O2- producing cells. ONOO- decays via proton- or CO2-mediated lysis to produce nitrate (NO3-), and nitrite (NO2-); NO2•, CO3•-, and OH• are secondary (weaker) products. In
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vivo, ONOO- exists in a “solvent-caged” form and is surrounded by nitrative stress and is produced by peroxidases (myeloperoxidase and eosinophilic peroxidase in neutrophils and eosinophils,
respectively) that oxidize nitrite. NO• can also play a role in
signalling by binding the heme iron of guanylate cyclase, thereby
activating it and stimulating the production of cyclic guanosine 3’ 5’
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monophosphate (cGMP). cGMP participates in many processes, including vasodilation, cytokine regulation, cell migration, and apoptosis.
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THE EFFECTS OF ROS AND RNOS ON VIRUSES AND THEIR HOSTS
Table 2 summarizes the main effects of ROS and RNOS on viruses and their hosts. In pathological conditions, ROS typically promotes cell death by stimulating cytochrome c release from the
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mitochondria and by damaging macromolecules [1]. Unsaturated fatty acids, particularly polyunsaturated ones (two to four double bonds) are the main lipid target of ROS. Reactions with ROS produce aldehydes (malondialdehyde and 2- or 4-
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OH• and nitrogen dioxide (NO2) [41-43]. NO2 can also generate
hydroxynonenaldehyde), which target nucleic acid bases or protein amino groups, as well as hydrocarbons like penthane or hexane. When ROS react with esterified fatty acids, cell membrane function, including receptor signalling, is impaired; membrane permeability is also altered, which can lead to cell damage and lysis [1].
ROS can also react with proteins and modify protein backbones and side chains. This frequently results in amino acid chain fragmentation and aldehyde and ketone production. Oxidative damage diminishes or impairs enzymatic protein activities, decreases protein solubility, and can trigger proteasome degradation [44]. High ROS levels have also been correlated with higher tRNA
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misacylation, thereby lowering the fidelity of protein translation
immunoproteasome can be presented by major histocompatibility complex class I proteins [46].
Nucleic acids, particularly DNA, are also prone to ROS damage.
ROS can modify the sugar backbone and nucleobases, leading to strand crosslinking, breakages, and base loss. In addition,
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malondialdehyde and/or reactive nucleobase derivatives, such as the highly mutagenic 8-oxoguanine, are released [1]. Since OH• is extremely reactive, oxidative DNA damage is generally mediated by H2O2 that diffuses across the nuclear membrane or OH• produced by
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Fe2+-catalysed Fenton reactions close to the DNA backbone. Proliferating cells are more sensitive to nuclear DNA damage because they are in an active transcription state where the DNA is dissociated from the histones that can protect it against ROS.
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Mitochondrial DNA is also very prone to ROS damage since mitochondria are the major site of OH• production; furthermore, mitochondrial enzymes are sensitive to ROS damage, and mitochondria have ineffective DNA repair mechanisms [47].
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[45]. The peptides of oxidized proteins that are degraded by the
Nitrative stress occurs in many diseases with viral origins, such as
viral pneumonia and encephalitis [48-50]. NROS can react with thiols, iron-sulfur centers, proteins, unsaturated membrane lipids, and nucleic acids. NROS reactions with cysteine thiol groups results in S-nitrosylation, which activates several proteins with important
roles in cell signalling in apoptosis; these proteins include matrix metalloproteinases (MMPs), albumin, various transcription factors, and caspases [51]. NO• commonly reacts with the iron-sulfur centre of metalloproteins, which typically inactivates the protein (e.g., haemoglobin, the main NO• sink in humans) [52].
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Tyrosine nitration is mediated by ONOO- and NO2 and is catalysed 3-nitrotyrosine, a widely used marker of nitrative stress [53]. 3nitrotyrosine can be incorporated in α-tubulin, which alters microtubule structure and causes structural and functional
aberrations in cells. As previously mentioned, ONOO- activates MMPs, which are involved in tissue remodelling; MMP
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hyperactivation has pathological consequences following infection. ONOO- also inactivates tissue inhibitors of MMP and plasma inhibitors of α-1 proteinase, thereby amplifying tissue damage during host responses to viral pathogens. ONOO- also promotes
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prostaglandin production by triggering cyclooxygenase, enhancing the host inflammatory response. NROS play conflicting roles in apoptosis. ONOO- has pro-apoptotic effects by inducing mitochondrial damage and cytochrome c release. In contrast, NO•
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and nitrosothiols formed via S- or transnitrosylation inhibit apoptosis by modifying the caspases involved [54]. Nitrosylating membrane lipids generates peroxide adducts and aldehydes, such as malonyldialdehyde (MDA) and ketones. These
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by heavy metals, such as iron and copper. Tyrosine nitration forms
molecules impair cell membrane function, alter membrane permeability, and further diffuse throughout the cell to affect
additional targets [54]. RNOS also form DNA and RNA adducts [53]. ONOO- and NO2 react with guanine nucleobases to form 8-nitroguanosine, 8-
nitrodeoxyguanosine, and 8-oxodeoxyguanine, the major nitrated nucleotide/nucleoside derivatives. 8-nitroguanosine is widely used as a nitrative stress marker; it uncouples NADPH electron transport through the cytochrome-NOS complex, thereby promoting the production of ONOO- [55], which also induces P53 inactivation [56]. Furthermore, 8-nitrodeoxyguanosine (8-nitroguanosine for
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RNA) can be incorporated into DNA by mispairing with thymine or consequently, cell metabolism dysregulation. RNA viruses are
particularly prone to ROS/RNOS-induced mutations due to their
lack of proofreading activity, integration into the host cell genome, and the relative instability of RNA (when compared to DNA) [57]. Viral mutations caused by ROS and RNOS contribute to the
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selection for more virulent strains that can escape the immune
response [58,59]. The immunosuppressive effects of ROS may also favour the selection of more virulent strains [60]. ROS production induced by viral infections are often more detrimental than helpful to
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the host. This is due to different factors such as the relative inability of the innate immune system to physically contain viral infections (compared to bacterial infections) [61]. In addition, NO• does not affect some virus families, such as paramyxoviridae, despite having
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antimicrobial effects against others, including influenza viruses, Coxsackievirus B3, HSV-1, severe acute respiratory syndrome coronavirus, and hantaviruses [62-70]. Several studies have shown cytokine biases in response to RNOS
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adenine. This results in mutations, protein alterations, and
production. These are typically thought to reflect the selective impairment of Th1 responses compared to Th2 as well as the possibility of a higher sensitivity to apoptosis in activated Th1 cells [71-77]. This likely affects the clearance of cytopathic viruses, such as influenza or HSV-1, where Th1 responses play a major role.
Macrophages are also affected by RNOS-induced apoptosis [72,73]. Some recent studies have shown that Th1 is not selectively impaired compared to Th2, however [74,75]. ROS AND RNOS DETOXIFICATION ROS and RNOS tissue concentrations are tightly regulated. ROS and RNOS decomposition is mediated by several detoxifying enzymes.
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The importance of these enzymes has been clearly demonstrated in play a key role in this process; these enzymes catalyse the
conversion of O2- to H2O2 and O2, thereby inhibiting ROS
production at an early step. There are three major SODs: cytosolic SOD1 (a homodimeric enzyme that uses Cu/Zn ions as cofactors),
mitochondrial SOD2 (a homotetrameric Mn-requiring enzyme), and
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extracellular SOD3 (which is Cu/Zn dependent) [78,79]. Catalase, a tetrameric hemoprotein, eliminates low concentrations of H2O2 and produces H2O and O2. High concentrations of H2O2 are eliminated by glutathione peroxidase (GPX) enzymes, particularly GPX1,
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which use selenium as cofactor; GPX enzymes convert H2O2 to H2O by oxidating monomeric glutathione (GSH) to glutathione disulfide (GS-SG) [79]. In addition, GPX4 transforms lipid peroxides to their corresponding alcohols. Glutathione homeostasis is maintained by
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glutathione reductase, which uses nicotinammide adenine dinucleotide phosphate (NADP)(H) and H+ to convert glutathione disulfide into its monomeric form. NADP(H) is produced via the pentose phosphate pathway.
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knockout mouse models [78,79]. Superoxide dismutases (SODs)
OH• is detoxified via non-enzymatic systems, such as dietary antioxidants (vitamins A, C, and E). Antioxidants interact with OH• and are converted into harmless secondary molecules, thereby limiting the damaging effects of OH• [80,81]. Other OH• scavenging
molecules are alpha-lipoic acid, glutathione, and homocysteine [80,81]. Peroxiredoxins (Prx) are an additional family of detoxifying enzymes with cytosolic (PrxI and II), mitochondrial (PrxIII), and extracellular (PrxIV) locations. Although the main function of Prx enzymes are to detoxify H2O2, Prx enzymes, particularly PrxV and
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PrxII, have also been shown to have peroxynitrite-clearing activity Most genes that encode for antioxidant proteins are controlled by
antioxidant response elements (ARE). These elements are located in the promoter region upstream of the genes and their expression and activity significantly decrease in response to RSV infection [84,85]. Moreover, ARE are bound by nuclear factor E2-related factor 2
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(Nrf2), the main transcription factor for the oxidant response [86]. Nrf2 is bound in the cytoplasm by Kelch-like ECH-associated protein 1 (Keap1), which promotes its degradation by the
proteasome. Oxidative stress causes Nrf2 to dissociate from Keap1.
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Consequently, Nrf2 is phosphorylated phosphorylation by multiple kinases and translocated to the nucleus where it heterodimerization with other transcription factors [86]. Phosphorylating Nrf2 at additional sites translocates it back to the cytosol where it is then
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degraded. Caveolin-1 has recently been reported to inhibit Nrf2 in both the cytoplasm and nucleus. Nrf2 has been shown to regulate influenza virus entry and replication in airway epithelial cells, possibly by upregulating antiviral genes such as IFN-beta [87]. In
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[82,83].
addition, Nrf2 is affected by HIV transgenes and modulates the expression of adhesion molecules in rat pulmonary epithelia cells; this may explain why HIV-infected patients often experience pulmonary dysfunction [88]. RSV infection has been shown to downregulate Nrf2 expression in both cell models and in children
with RSV-induced bronchiolitis [20-22]; in addition, RSV promotes ROS production and downregulates key antioxidant enzymes such as SOD1, SOD3, catalase, and glutathione peroxidase. It has been shown that antioxidant treatment significantly improves RSV-induced oxidative stress, clinical disease and pulmonary inflammation in a mouse model of infection, thus suggesting a
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casual relationship between increased ROS production and lung antioxidant capacity can have a significant impact on viral-
associated oxidative cell damage, and may be a new therapeutic
approach to modulating virus-induced lung disease. However, as
most of the data are in vitro data and regard only RSV and not other important respiratory viruses, human studies are required before any
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attempt is made to use antioxidising drugs to treat viral infections.
ANTIOXIDANTS AS TREATMENTS FOR VIRAL DISEASES The literature reviewed here indicates that ROS and RNOS production is strongly associated with pathogenesis of viral diseases.
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Therefore, the use of antioxidant molecules to ameliorate the symptoms and prognosis of viral infections is an active area of research. Current findings have been primarily confined to cell and animal models but remain promising. Reviews of specific pathogens
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and pathogen-related complications can be found elsewhere [89-92]. Vitamin and micronutrient supplementation have been shown to improve outcomes in HIV-infected patients either alone or with antiretroviral treatment [93,94]; vitamins and micronutrients work as
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disease [84,85]. These results highlight that increasing cellular
cofactors for enzymatic detoxification systems or by directly quenching ROS. However, optimal dosing must be taken into account since high doses have been shown to increase mortality and
toxicity [95]. Natural (epigallocatechin 3-gallate) and synthetic (dimethyl fumarate) antioxidants have also been shown to affect
gene transcription, act in pathways linked to host responses to viral pathogens, and have direct antiviral effects. This makes it difficult to isolate effects only associated with their antioxidant activity. A pilot study in human subjects showed that fermented papaya extract upregulated the expression of metabolism phase II enzymes and of SOD, which is promising for its use as a dietary supplement [96].
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Recent studies have also suggested that the use of NOS inhibitors and tissue damage [63,64]. CONCLUSION
ROS and RNOS production is common during viral infections and often results in pathological consequences. Many molecules that
regulate the cellular redox balance have proven promising in cell and
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animal models of infection. This encourages their use for clinical practice either alone or with existing therapies. However, well-
designed clinical trials are needed since the redox balance also has important roles in the host defence against pathogens. These trials
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Table Legends Table 1. Main viruses associated with reactive oxygen species (ROS) production. Virus Human immunodeficiency virus (HIV) Epstein-Barr virus (EBV)
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Hepatitis B virus (HBV) and hepatitis C virus (HCV)
(VSV)
Respiratory syncytial virus (RSV) Influenza viruses
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Human T cell leukaemia virus type 1 (HTLV-1)
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Herpes simplex type 1 (HSV-1) and vescicular stomatitis virus
Table 2. Main effects of reactive oxygen species (ROS) and reactive nitric oxide species (RNOS) on viruses and their hosts. Effect Cell damage, lysis and death Impairment in enzymatic protein activities Damage in nucleic acids (mainly DNA)
Mutations, protein alterations and cell metabolism dysregulation Immunosuppressive effects
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Impairment of Th1 responses
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of tissue damage
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Enhancement in the host inflammatory response with amplification