Defining New Therapeutics Using a More Immunocompetent Mouse Model of Antibody-Enhanced Dengue Virus Infection

<jats:title>ABSTRACT</jats:title><jats:p>With over 3.5 billion people at risk and approximately 390 million human infections per year, dengue virus (DENV) disease strains health care resources worldwide. Previously, we and others established models for DENV pathogenesis in mice that completely lack subunits of the receptors (<jats:italic>Ifnar</jats:italic>and<jats:italic>Ifngr</jats:italic>) for type I and type II interferon (IFN) signaling; however, the utility of these models is limited by the pleotropic effect of these cytokines on innate and adaptive immune system development and function. Here, we demonstrate that the specific deletion of<jats:italic>Ifnar</jats:italic>expression on subsets of murine myeloid cells (LysM Cre<jats:sup>+</jats:sup><jats:italic>Ifnar</jats:italic><jats:sup>flox/flox</jats:sup>[denoted as<jats:italic>Ifnar</jats:italic><jats:sup>f/f</jats:sup>herein]) resulted in enhanced DENV replication<jats:italic>in vivo</jats:italic>. The administration of subneutralizing amounts of cross-reactive anti-DENV monoclonal antibodies to LysM Cre<jats:sup>+</jats:sup><jats:italic>Ifnar</jats:italic><jats:sup>f/f</jats:sup>mice prior to infection with DENV serotype 2 or 3 resulted in antibody-dependent enhancement (ADE) of infection with many of the characteristics associated with severe DENV disease in humans, including plasma leakage, hypercytokinemia, liver injury, hemoconcentration, and thrombocytopenia. Notably, the pathogenesis of severe DENV-2 or DENV-3 infection in LysM Cre<jats:sup>+</jats:sup><jats:italic>Ifnar</jats:italic><jats:sup>f/f</jats:sup>mice was blocked by pre- or postexposure administration of a bispecific dual-affinity retargeting molecule (DART) or an optimized RIG-I receptor agonist that stimulates innate immune responses. Our findings establish a more immunocompetent animal model of ADE of infection with multiple DENV serotypes in which disease is inhibited by treatment with broad-spectrum antibody derivatives or innate immune stimulatory agents.</jats:p><jats:p><jats:bold>IMPORTANCE</jats:bold>Although dengue virus (DENV) infects hundreds of millions of people annually and results in morbidity and mortality on a global scale, there are no approved antiviral treatments or vaccines. Part of the difficulty in evaluating therapeutic candidates is the lack of small animal models that are permissive to DENV and recapitulate the clinical features of severe human disease. Using animals lacking the type I interferon receptor only on myeloid cell subsets, we developed a more immunocompetent mouse model of severe DENV infection with characteristics of the human disease, including vascular leakage, hemoconcentration, thrombocytopenia, and liver injury. Using this model, we demonstrate that pathogenesis by two different DENV serotypes is inhibited by therapeutic administration of a genetically modified antibody or a RIG-I receptor agonist that stimulates innate immunity.</jats:p>