Although the HMGB1 canonical pathway was found to be activated in both in vitro 16 and ZIKV presymptomatic or asymptomatic patient plasma 17, there is still no experimental evidence to support these suggestions. The findings of the present study demonstrated that the ZIKV infection induced translocation of HMGB1 from the nucleus to the cytoplasm and release from the infected Huh7 cells. Treatment with dexamethasone, a well-known anti-inflammatory drug, significantly reduced ZIKV infection and the extracellular HMGB1 levels. In the HMGB1 knockdown Huh7 cells, however, the treatment with dexamethasone did not cause significant inhibition of ZIKV replication, suggesting the involvement of HMGB1 in regulating the antiviral mechanisms of dexamethasone (Fig. 8).
HMGB1 is a nuclear transcription factor which acts as a pro-inflammatory cytokine when released from the cells in response to infection, cell injury and inflammation 6,26. In normal circumstances, the HMGB1 accumulates in the nucleus, giving a nuclear-to-cytoplasmic HMGB1 ratio of approximately 30:1 27. During infection or cell injury, HMGB1 undergoes post-translational modifications, including acetylation, methylation and phosphorylation, causing its translocation from the nucleus to cytoplasm before being released into the extracellular environment 28,29. For instance, the host cell p300/CBP-associated factor (PCAF) acetylase complex, triggered by dengue virus capsid protein, has been demonstrated to enhance the HMGB1 release 30. Moreover, excessive production of reactive oxygen species (ROS) induced by respiratory syncytial virus and porcine circovirus-2 have been found to promote the release of HMGB1 31,32. Similarly, our study showed that ZIKV infection could induce HMGB1 nuclear-to-cytoplasmic translocation and release in a time-dependent manner, most likely through the similar mechanisms described.
In the previous study, augmented serum levels of HMGB1 was observed in secondary dengue virus infection 15, which has been associated with higher viral load and prolonged viremia, most probably due to the delayed virus clearance as reported earlier 33. Meanwhile, our study also revealed that the secreted HMGB1 was elevated in MOI- dependent manner. Because virus-induced cell death is mainly infectious dose-dependent, ZIKV infection may result in necrosis- or apoptosis-dependent HMGB1 passive release, which requires further confirmation in the future.
Extracellular HMGB1 induces innate immune response via interaction with the receptor for advanced glycation end products (RAGE) or toll-like receptor (TLR-2 and − 4), activating MyD88 and NF-κB signaling pathways, which then leads to the production of pro-inflammatory cytokines for virus clearance 34. However, excessive extracellular HMGB1 during virus infection has been associated with the pathogenesis of diseases 35–37. For instance, extracellular HMGB1 was related to the pathogenesis of dengue hemorrhagic fever-dengue shock syndrome (DHF/DSS), presumably through the vascular barrier disruption 30. Besides, extracellular HMGB1 has been correlated to neuroinvasion of ZIKV and Japanese encephalitis virus (JEV), possibly via disruption of the blood-brain barrier 38,39. Therefore, preventing the overproduction of extracellular HMGB1 could be a therapeutic approach against the pathogenesis of viral infection.
Many studies have demonstrated that intracellular and extracellular HMGB1 play different roles in virus replication. For example, intracellular HMGB1 facilitates influenza virus and hepatitis C virus replication by directly interacting with viral RNA or nucleoprotein 40,41. Vice versa, intracellular HMGB1 limits HIV replication by downregulating the long terminal repeat (LTR)-mediated transcription 42. Extracellular HMGB1 has also been reported to promote HIV replication in monocytic cells but decreases viral replication in primary macrophages 43. Moreover, the antiviral effect of extracellular HMGB1 against hepatitis C virus has been established by the activation of the interferon signaling in virus-infected human hepatoma cell line 44. Although HMGB1 has been found to have significant effects on various virus replication, the role of HMGB1 in ZIKV infection remains largely unknown.
This study revealed that dexamethasone treatment decreased both extracellular HMGB1 release and ZIKV replication. Dexamethasone has been shown to inhibit HMGB1 nuclear-to-cytoplasmic translocation via acetyltransferase attenuation, hence reducing the HMGB1-TLR4 inflammatory pathway 21. Moreover, dexamethasone's anti-inflammatory action, which reduces TNF-a, IFN-a, and IL-10 production, has also been demonstrated to reduce dengue virus replication 24. Therefore, the inhibition of ZIKV replication by dexamethasone treatment was likely through the prevention of HMGB1 extracellular release.
To further investigate the role of intracellular HMGB1 in the antiviral mechanism of dexamethasone against ZIKV infection, HMGB1-depleted cells were used. This study showed no antiviral effects in dexamethasone-treated HMGB1-knockdown cells, signifying that the presence of intracellular HMGB1 is critical for the dexamethasone's antiviral activity. This finding is consistent with several earlier studies which demonstrated that HMGB1 retained in the nucleus plays a role in the antiviral response against dengue virus 45, duck reovirus, duck Tembusu, duck plague virus 46 and human immunodeficiency virus 42. In addition, the role of nuclear HMBG1 retention in upregulating interferon-stimulated genes (ISGs) expression to antagonise virus replication has been reported 45,47. Thus, the anti-ZIKV mechanism of dexamethasone is most likely through preventing HMGB1 translocation, which results in HMGB1 retention in the cells. In conclusion, current findings suggest that ZIKV infection triggers HMGB1 translocation from the nucleus to cytoplasm and extracellular release in a time- and MOI-dependent manner. The findings of this study provide a better insight into the underlying anti-ZIKV mechanisms by dexamethasone, particularly through the regulation of HMGB1. Further in vivo investigation could provide better understanding of HMGB1’s role in ZIKV infection.