Synergism for cytokine-mediated disease during concurrent endotoxin and viral challenges: roles for NK and T cell IFN-gamma production.

Viral infections in humans or mice can result in increased sensitivity to challenges with bacteria, bacterial products, or cytokine administration. During lymphocytic choriomeningitis virus infections, mice are more sensitive to the lethal effects of bacterial endotoxin LPS, and in the experiments reported here, were observed at up to 10-fold lower doses in infected than in uninfected mice. The mechanisms responsible for heightened susceptibility under these conditions were evaluated. Kinetic studies demonstrated that virus-infected mice had 3- to 50-fold increases over uninfected mice in peak serum TNF, IL-12, and IFN-gamma levels after LPS administration. All three cytokines contributed to lethality during dual challenge, because neutralization of any one of the factors protected from death. Production of TNF was not dependent on either NK or T cells. In contrast, these populations were the predominant sources of IFN-gamma, as determined by lack of detectable IFN-gamma production in NK and T cell-deficient mice and by intracellular cytokine expression in the cell subsets. Concordant with the demonstrations that both cell populations produced IFN-gamma and that this factor was critical for lethality, removal of either subset alone was not sufficient to protect mice from death resulting from dual challenges. Increased resistance required absence of both cell subsets. Taken together, the data show that during viral infections, the normally protective immune responses can profoundly modify reactions to secondary heterologous challenges, to result in dysregulated cytokine expression and consequent heightened detrimental effects.