Herpetic and CMV infections are the leading causes of corneal endotheliitis, and they can lead to severe visually depressing bullous keratopathy. These pathogens persist in the cornea and are often reactivated to cause recurrences. To determine how corneal endothelial cells cope with this assault, we have analyzed the transcriptional landscape of HSV-1 infected corneal endothelial cells. We have investigated how corneal endothelial cells activate the innate and acquired immune systems.
Earlier, IRF7 was considered to be a plasmacytoid DC specific transcription factor that mediated the production of IFN. Our findings showed that IRF7 is significantly induced in the corneal endothelial cells after HSV-1 infection, and they induce a strong type 1 IFN response as an innate immune system.
Importantly, our results showed IRF7 specially mediates infection-induced MHC class I upregulation which was not recognized previously. Furthermore, IRF7 was required for the anti-viral cytotoxic CD8+ T cell response that is the most effective strategy to suppress viral infections.
To protect the cornea from HSV-1 infection, the first line defense is the immediate induction of type 1 IFN response. When endothelial cells are exposed to HSV-1, a type I IFN response induces ISGs to eradicate the viral pathogens. This IFN response and ISG induction are part of the innate immunity and are immediately activated by pathogen-associated molecular patterns using pattern recognition receptors including the TLRs- and NOD-like receptors. This is an immediate and effective strategy to protect the cells from viral pathogens.
Nevertheless, the IFN response is often breached by HSV-1. This necessitates an alternate and more robust strategy which can eradicate the viral pathogens in a precise and specific manner. This can be typically achieved by the CD8 T lymphocyte arm of the acquired immune system. This direct and precise killing of infected cells or pathogens is mediated by a CD8 cytotoxic T lymphocyte reaction. To initiate this, processed viral epitopes need to be bound to MHC class I for presentation. In corneal endothelial cells, the antigen processing machinery include the MHC class I, LMP2, TAP1, and β2 microglobulin that are upregulated after a viral infection.
To understand how IRF7 promotes the expression of MHC class I, we examined the promoter regulation of MHC class I A*2402. This allele is shared by a high percentage of the general population, and it possesses a conserved ISRE motif on its promoter. ISRE is conserved among promotors in the HLA class IA, 1B, and 1C, and they serve as putative binding sites for the IRF proteins.5 Using the class I promoter reporter assay, we showed that IRF7 is required for the transcriptional regulation of MHC class I upregulation.
Thus, corneal endothelial cells have this APC capability and prime CTL reactions.3 Importantly, IRF7 was required for MHC class I induction and priming of the CTL cells.
This mode of protection has two advantages as an anti-viral strategy. First, reactivated viral pathogens are immediately responded to by the activation of the innate immune system and CD8 because the reactivation occurs in the same latently infected cells. Second, no new recruitment of professional APC is required. The endothelial cell-lined anterior chamber is a well-known immune privileged site and is devoid of vasculature with only a few antigen presenting cells. Moreover, strong inflammatory responses to recruit antigen presenting cells is undesirable to maintain corneal clarity.
IRF transcriptional factors exert their roles by binding to consensus ISRE region by their DNA binding domain. CIITA also possesses ISRE on its promotor. Its induction was reduced in IRF7 ∆DBD HCEn cells. (Sup Fig. 1) However, the utilization of MHC class II induction is typically characteristics of professional antigen presenting cells, not of non-professional cells including endothelial cells. In addition, the CD4 arm of protection is known to be less effective and can become pathogenic such as in herpetic stromal keratitis. Thus, the roles of IRF7 appear to focus on type I IFN induction and priming of the CD8 arm.
The IRFs that contribute to anti-viral protection are IRF1, IRF3, IRF5, and IRF7.6,7 Of these, IRF3 and IRF7 play pivotal roles for early and late IFN responses.8 For example, upon viral infection, viral DNA or RNA are recognized by the cytosolic and endosomal sensing systems which require IRF3 and IRF7 for type I IFN induction.9
However, the use or expression of IRFs is highly cell dependent. IRF3 and IRF7 have distinct expression profiles depending on the cell type. IRF3 is ubiquitously expressed in a number of cell types, while IRF7 expression is characteristic for pDC.10 IRF7 regulates the innate immune arm of pDC and APCs by stimulating IFN responses. Secreted IFN conditions and stimulates the acquired arm of immunity.
We have reported that corneal endothelial cells have IFN-mediated anti-viral responses and antigen presenting functions as a major transcriptional network after viral infections including HSV and CMV. Based on the transcriptional network analysis, we found that IRF7 is positioned in the hub of the IFN response. Moreover, IRF7 is induced by type I IFN. This can form a positive feedback loop leading to sustained expression of IFNs.11–13
Many in vivo studies have shown that IRF7 can restrict viral replication.14 For infections by HSV-1, dengue virus, and lymphocytic choriomeningitis virus, IRF7 plays a critical role in viral protection as was shown in IRF7-deficient mice.15–17
In an acute HSV-encephalitis model, the IRF7 deficiency was associated with high mortality, reduced IFN response, and increased viral titer in the brain.15 In lymphocytic choriomeningitis virus infections, IRF7 deficient mice had impaired control of viral replication in the brain and reduced serum IFN-α levels. Interestingly, the generation of a viral epitope specific CD8 T cell was not affected. This indicated that IRF7 is dispensable or not required for major antigen presenting cells in the brain.
In humans, homozygous IRF7 deficiency was been shown to be associated with severe influenza A virus infection and acute respiratory distress syndrome. The IRF7 deficient pDC was severely impaired for type I or type III IFN production in response to influenza A virus infection.18 Moreover, an increased viral replication and reduced type I IFN production was observed for IRF7-deficient fibroblast or pulmonary epithelial cells in culture. In marked contrast to earlier observations, our data showed that IRF7 did not play pivotal roles in reducing the viral load in corneal endothelial cells. This suggests that IRF7 has a corneal endothelium specific role, and other IRF can compensate depending on the tissue.14
IFN responses are generally beneficial especially for the earlier phases of viral infections. However, prolonged or delayed IFN responses can become harmful and cause significant damage to the host. Early IFN administration protects mice against the Middle East respiratory syndrome–coronavirus (MERS-CoV) infection, however a late administration results in fatal pneumonia and depressed viral clearance.19 In addition, IFN may promote viral infections. For example, SARS-Cov-2 infection, a viral entry receptor, ACE2, is upregulated by type I IFN and allows effective viral entry.20
There are some limitations in our study. HCEn cells are very similar in cytokine and IFN responses to primary cultured corneal endothelial cells.3,21,22 Although the HCEn cells may not exactly mirror the physiological responses of primary cultured cells, the difficulty in subculturing primary corneal endothelial cells allow only low passage cells for experimentation. Because of this, gene-editing experiments of primary cells are difficult to execute which affects the reproducibility of the infection experiments or may even cause unexpected experimental biases.
In conclusion, our results showed that HSV-1 infection induces IFN responses, and the corneal endothelial cells use IRF7 as a canonical upstream mediator. The roles played by IRF7 is the viral infection-induced MHC class I upregulation and priming of the CD8 arm of acquired immunity, not simply limited to the type I IFN response. Because of the difficulty of completely removing the pathogens from the cornea, this information may help to develop efficacious immune therapy to cope with refractory viral keratitis.