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Enhanced replication of human cytomegalovirus in human fibroblasts treated with

dexamethasone

著者 Tanaka Junji, Ogura Tsutomu, Kamiya Shigeru, Sato Hiroshi, Yoshie Tadamasa, Ogura Hisashi, Hatano Motoichi

journal or

publication title

Journal of General Virology

volume 65

number 10

page range 1759‑1767

year 1984‑01‑01

URL http://hdl.handle.net/2297/29183

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J. gen. Virol. (1984), 65, 1759-1767. Printed in Great Britain Key words: H C M V DNA/dexamethasone/immediate early proteins

1759

Enhanced Replication of Human Cytomegalovirus in Human Fibroblasts Treated with Dexamethasone

By J U N J I T A N A K A , * T S U T O M U O G U R A , S H I G E R U K A M I Y A , H I R O S H I S A T O , T A D A M A S A Y O S H I E , H I S A S H I O G U R A AND

M O T O I C H I H A T A N O

Department o f Virology, Cancer Research Institute, Kanazawa University, Kanazawa 920, Japan (Accepted 6 June 1984)

SUMMARY

The effect of glucocorticoid hormones on the replication of human cytomegalovirus (HCMV) was studied in human embryonic lung (HEL) cells. Treatment of cells with pharmacological concentrations of adrenal glucocorticoids such as dexamethasone enhanced HCMV replication; treatment with oestrogenic or androgenic hormones did not do so. In dexamethasone-treated HEL cells there was an approximately tenfold increase in virus yield, with the virus eclipse period shortened by 1 day compared to control cultures. Treatment of cells with the hormone also enhanced plaquing efficiency of the virus by approximately tenfold. As the synthesis of virus-specific immediate early proteins and antigens was notably enhanced together with an increase of HCMV DNA synthesis, it appeared that the early stages of the HCMV replication cycle might be under hormonal control. Moreover, the data presented suggest that the hormonal enhancement of HCMV replication involves specific receptor proteins and requires the synthesis of a specific cellular mRNA(s).

I N T R O D U C T I O N

Herpes simplex virus (HSV) has a broad spectrum of pathogenicity and productive cytolytic activity in vivo and in vitro. In contrast, human cytomegalovirus (HCMV) infection is restricted to man and its replication in vitro is supported only in human diploid fibroblasts (Smith, 1959).

On a molecular level, early after virus infection, HSV inhibits the synthesis of host cellular macromolecules (Ben-Porat & Kaplan, 1973). Conversely, HCMV stimulates the synthesis of cellular macromolecules and of cellular enzymes (Furukawa et al., 1975a, 1976; St. Jeor et aL, 1974; Tanaka et al., 1975; Hirai et aL, 1976; Estes & Huang, 1977). When this stimulation is inhibited chemically, by serum starvation or by u.v. light irradiation of host cells, HCMV replication is markedly reduced or eliminated (DeMarchi & Kaplan, 1977; Furukawa et al., 1975b). These observations suggest that the replication of HCMV is dependent on stimulated host cell functions.

Adrenal glucocorticoid hormones such as dexamethasone are known to play a role in the modulation of transcription of host cell DNA. The hormones first bind to a specific receptor protein present in cytoplasm (Yamamoto & Alberts, 1976) and then these hormone receptor complexes bind to cellular DNA (Jensen et al., 1968; Gorski et al., 1968). This interaction has significant effects on synthesis and translation of host cell mRNA (Higgins & Gehring, 1978).

Therefore, it is of interest to study whether these hormones affect the replication of HCMV in the permissive system.

In this report we describe the effect of glucocorticoid hormones on the replication of HCMV.

The results clearly show that treatment of human embryonic lung fibroblasts with pharmaco- logical concentrations of dexamethasone significantly enhances HCMV replication.

0022-1317/84/0000-6052 $02.00 © 1984 SGM

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1760

J. T A N A K A A N D O T H E R S M E T H O D S

Cells and virus. H u m a n embryonic lung (HEL) cells, prepared from 4-month-old foetal lung by explanting minced tissue, were cultured in Dulbecco's modified Eagle's m e d i u m ( D M E M ) supplemented with 10°,o calf serum. HCMV-infected H E L cells were m a i n t a i n e d with D M E M containing 5 ~ calf s e r u m The Towne strain of H C M V was used in these studies. Stocks of virus were prepared by infecting confluent monolayers of H E L cells with H C M V at a multiplicity of infection (m,o.i.) of 0.01 p.f.u./cell, Three to 5 days after cytopathic effect (c.p.e.) had developed in 100% of the cells, culture m e d i a were harvested and clarified by centrifugation (1500g for 15 min). T h e s u p e r n a t a n t s were collected and stored at - 8 5 °C. Cells and virus were found to be free o f myco- plasma contamination by inoculation into P P L O broth (Difco) as described previously (Stinski, 1976).

Treatment o f HEL cells with corticosteroid hormones. Stock solutions of hormones were prepared in 99.5%

ethanol. The hormones, when present, were given 24 h before virus infection, The cells were washed three times with Hanks" balanced salt solution (HBSS), virus was inoculated and m a i n t e n a n c e m e d i u m or agarose overlay m e d i u m (for plaque assay) containing hormones was added. Control cultures were similarly treated with D M E M containing a m o u n t s of ethanol equivalent to those in the hormone-treated cultures. All h o r m o n e s used in these experiments were obtained from Sigma.

Titration o f inJectious virus. Semi-confluent monolayers of H E L cells grown in 1 oz prescription bottles were infected with H C M V . After a 90 m i n adsorption period, the cells were washed twice with HBSS and m a i n t e n a n c e m e d i u m was added. At various intervals post-infection, the total a m o u n t of infectious virus was measured after the cells had been disrupted by freezing and thawing once, and by sonication (Branson sonifier) for 30 s. The infectious virus titre was determined on H E L cells using the plaque assay described by W e n t w o r t h & French (1970).

DNA labelling and analysis. The method used for D N A analysis was, in general, that described by Crouch &

R a p p (1972). H E L cells grown in 4 oz prescription bottles were infected with H C M V at an m.o.i, of 1. After 90 min a d s o r p t i o n , t h e cells were washed with HBSS and m a i n t e n a n c e m e d i u m was added. The cultures were labelled with [Me-3H]thymidine (5 ~tCi/ml, sp. act. 101 C i / m m o l ; New England Nuclear) at 24 h post-infection and incubated for an additional 24 h. T h e cells were rinsed three times with ice-cold TES buffer (10 mM-Tris-HC1 pH 7,4, I0 mM-EDTA, 50 mM-NaCt), lysed in i~o Sarkosyl NL97 for 15 m i n at 60°C~ and then digested by Pronase (final concentration 5 mg/ml) for 2 h at 37 "C. A 0.5 ml aliquot of the sample was mixed with 9-5 ml of CsCI (initial density 1.700g/ml), prepared in TES buffer, and centrifuged at 28000 r.p.m, for 64 h at 18 °C in the 50Ti rotor. Fractions were collected from the top of the gradient by m e a n s of a density gradient fractionator (Gilson), and radioactivity incorporated into 10°o trichloroacetic acid-insoluble material was counted in a B e c k m a n scintillation counter.

Polyaco'lamidegela?lectrophoresis (PAGE). H E L cells grown in 60 m m Petri dishes were infected with H C M V at an m.o.i, of 1 or 5, or mock-infected. After 1 h adsorption, the cells were washed twice with HBSS and then labelled with 30 gCi [3sS]methionine (sp. act. 1110 Ci/mmol, A m e r s h a m ) per ml for 2 h in methionine-free m a i n t e n a n c e medium. The cultures were washed three times with ice-cold phosphate-buffered saline. I m m e d i a t e early polypeptides were extracted, precleared of extraneous protein by incubation with H C M V - n e g a t i v e h u m a n serum and then immunoprecipitated by immediate early antigen (IEA)-positive h u m a n serum according to a method described previously (Michelson et al., 1979: Blanton & Tevethia, 1981). I m m u n o p r e c i p i t a t e d polypeptides were separated by electrophoresis on 10 % slab gels (Laemmli, 1970). After electrophoresis, gels were fixed, soaked in En3Hance (New England Nuclear) and dried. The autofluorogram was recorded on K o d a k X- O m a t film. [35S]Methionine-labelled Sendal virus structural polypeptides were co-electrophoresed on each gel as molecular weight standards.

R E S U L T S

Effect of dexamethasone on plaquing eJficiency and production of HCM V

To study the effect of adrenal corticosteroids on the multiplication of H C M V , we first

d e t e r m i n e d plaquing efficiency and production o f H C M V in H E L cells treated with various

concentrations of dexamethasone, a synthetic glucocorticoid. As shown in Table 1, plaque

numbers found of H E L cells treated with 10 s to 10 - s M-dexamethasone were five- to 11-fold

higher than those on untreated control cultures. In addition, individual plaques a p p e a r e d earlier

and were larger on the hormone-treated H E L cells as c o m p a r e d with untreated cultures; plaques

first a p p e a r e d after 4 days on 10-5 M-dexamethasone-treated H E L cells in contrast to the first

a p p e a r a n c e at 7 days post-infection on control cultures; plaque size on the h o r m o n e - t r e a t e d

cultures was 1-5- to 2-fold larger than that on the control when measured at 14 days. The yield o f

H C M V in the hormone-treated H E L cells was also e n h a n c e d 2.5- to 14.3-fold over production in

untreated cultures (Table 1).

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H C M V replication in hormone-treated cells

I i i i i i

107 i

10 b

10 -~

10 ,

103

>

102

1 0 j

I | I I I I

0 2 4 6

Time after virus infection (days)

Fig. 1. Growth kinetics of HCMV in untreated or dexamethasone-treated HEL cells. The cells either untreated or pretreated for 24 h with the hormone (10- s M) were infected with HCMV at an m.o.i, of 1.

After 90 min adsorption the cells were washed with HBSS and maintenance medium with or without the hormone was added to the respective cells. At the indicated times after virus infection, the total amount of infectious virus was determined by plaque assay. Medium was changed at 3 days. O , Untreated control cultures; O, dexamethasone-treated cultures.

1761

T a b l e 1.

Effect o f various concentrations of dexamethasone on plaquing efficiency and production of H C M V

Dexamethasone No. of plaques Virus yieldt (M) per plate* (p.f.u./ml x 1 0 - ' )

0 6 2.2

10 -8 30 5"5

10 -7 42 12"5

10 6 51 30"5

10 -s 66 31"5

* Confluent monolayers of HEL ceils, grown in 60 mm Petri dishes, were pretreated for 24 h with the indicated concentration of dexamethasone. The cells were infected with HCMV at an m.o.i, of approx. 10 p.f.u./plate. After 90 min adsorption the plates were overlaid with maintenance medium containing 0.4% agarose and the indicated concentration of the hormone. Seven days later a second overlay was added to the plates. The plaques were scored at 14 days; average plaque numbers in each of two samples are shown.

t HEL cells pretreated for 24 h with the indicated concentration of dexamethasone were infected with HCMV at an m.o.i, of 1. After 90 min adsorption, maintenance medium containing the indicated concentration of the hormone was added. At 72 h post-infection the total amount of infectious virus was determined.

Growth kinetics o f H C M V in untreated or dexamethasone-treated H E L cells

G r o w t h o f H C M V i n e i t h e r u n t r e a t e d o r t h e h o r m o n e - t r e a t e d c u l t u r e s w a s a s s e s s e d b y i n f e c t i n g m o n o l a y e r s a t a n m . o . i , o f 1. A t y p i c a l e x p e r i m e n t is s h o w n i n Fig. 1. T h e s y n t h e s i s o f i n f e c t i o u s H C M V w a s first o b s e r v e d a t 3 d a y s i n u n t r e a t e d c o n t r o l c u l t u r e s . I n c o n t r a s t , i n t h e h o r m o n e - t r e a t e d c u l t u r e s i n f e c t i o u s p r o g e n y v i r u s a p p e a r e d 2 d a y s a f t e r i n f e c t i o n a n d t h e a m o u n t o f i n f e c t i o u s v i r u s p r o d u c e d d u r i n g 3 to 6 d a y s p o s t - i n f e c t i o n w a s c o n s i s t e n t l y a b o u t 10- fold h i g h e r t h a n t h a t in t h e c o n t r o l .

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1762

J . T A N A K A A N D O T H E R S

Table 2. Effect of various steroid hormones on replication of H C M V in HEL cells*

Virus yield:~

Expt. no.

1

Hormonet (p.f.u./ml

X 10 3)

None 3.7

Dexamethasone 127.5

Hydrocortisone 24.5

Prednisolone 22.5

Progesterone 7.0

fl-Oestradiol 6.5

Dexamethasone + 62.5 progesterone

None 7.5

Hydrocortisone 51.7

Progesterone 7-7

Testosterone 7-0

Hydrocortisone + 24.5 progesterone

* HEL cells either untreated or pretreated for 24 h with the indicated steroid hormone were infected with HCMV at an m.o.i, of 0.1. After 90 min adsorption, maintenance medium containing the indicated hormone was added.

t The concentration of each hormone

w a s 10 - 6

M.

:~ Titrated 72 h after virus infection.

Effect of other steroid hormones on production of H C M V

To determine whether this enhancing activity by dexamethasone is due to glucocorticoid activity, experiments using other steroid hormones were carried out (Table 2). Dexamethasone enhanced the production of HCMV 34.4-fold over that in untreated cultures. Two natural glucocorticoid hormones enhanced the production of HCMV by levels ranging from 6.0-fold (prednisolone) to 6-8-fold (hydrocortisone). However, oestrogenic (progesterone and /%

oestradiol) and androgenic (testosterone) hormones did not enhance HCMV multiplication.

Because progesterone has been shown to act as a glucocorticoid hormone antagonist by competing for cytoplasmic receptor protein (Samuels & Tomkins, 1970), we tested the effect of progesterone on the enhancement of HCMV production by dexamethasone or hydrocortisone.

The enhancing activity by dexamethasone or hydrocortisone was reduced by 50 ~o when infected cells were treated simultaneously with these hormones and progesterone (Table 2). These results indicate that the mechanism resulting in enhanced production of HCMV is specific for adrenal glucocorticoid hormones and suggest that the hormonal enhancement of HCMV production involves specific receptor proteins in target cells.

Virus adsorption and cell growth

A possible mechanism involved in the enhanced production of HCMV by dexamethasone is hormone enhancement of virus adsorption or stimulation of cell growth. It is known that HCMV replication in growing cells is faster and greater than that in resting cells (DeMarchi & Kaplan, 1977). To test this possibility, the rate of cell growth and virus adsorption were examined. No significant difference was observed in the cell growth in either untreated or hormone-treated cells. To determine the adsorption rate of HCMV, monolayers of HEL cells, either untreated or pretreated with dexamethasone, were exposed to partially purified HCMV that had been labelled with [3H]thymidine. The cultures were incubated at 37 °C. At 30 rain intervals the inoculum was removed from each of two samples and residual acid-insoluble radioactivity in the supernatant was counted. Pretreatment of HEL cells with the hormone did not affect the rate of virus adsorption during the 90 min adsorption period (data not shown).

Analysis of H C M V DNA synthesis in dexamethasone-treated cells

The rate of HCMV D N A synthesis in dexamethasone-treated HEL cells was compared to

that in untreated control cultures. HEL cells untreated or pretreated with dexamethasone were

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5

x

'~3

.o

1

H C M V replication in hormone-treated cells

w i i i v i i

10 2O 30 4O

i i i i i i

[b)

0 10 20 30 40

Fraction number

1-76 1-74 .~.

1.72 ~.~

l. 70 ~ 1.68 1.66

1763

Fig. 2. Analysis of DNA isolated from untreated or dexamethasone-treated HEL cells infected with HCMV. HEL cells either untreated or pretreated for 24 h with the hormone (10- 5 M) were infected with HCMV at an m.o.i, ef 1. The cells were pulse-labelled with [3H]thymidine from 24 to 48 h after infection in the presence or absence of the hormone.

DNA

was extracted and virus DNA was separated from cellular DNA by isopycnic centrifugation in CsC1 as described in Methods. The amount of [3H]- thymidine incorporated into acid-insoluble material was determined. (a) DNA extracted from untreated control cultures; (b) DNA extracted from dexamethasone-treated cultures.

Table 3.

Production o f H C M V in H E L cells treated with dexamethasone at various times before and after virus infection*

Period of dexamethasone Virus yield~

treatment (h)t (p.f.u./ml × 10 -5)

Untreated 3.0

-244) 13.2

1.5-96 28-5

24-96 18.7

48 96 7.7

72 96 5.5

-24-0, 1.5-96 37.0

* HEL cells were treated with dexamethasone (10- 5 M) for the indicated period before and after virus infection at an m.o.i, of 1.

t The time of virus infection is taken as 0 time.

:~ Titrated at 96 h post-infection.

infected with H C M V at an m.o.i, of l, a n d pulsed with [3H]thymidine from 24 to 48 h post- infection in the presence or absence of the hormone. Virus D N A a n d host cell D N A in cellular extracts were separated by equilibrium centrifugation in CsC1 as described in Methods. Fig. 2 illustrates the sedimentation profiles. I n the hormone-treated cultures (Fig. 2 b) the peak (density 1.717 g/ml) that corresponds to the density of standard H C M V D N A (Plummer

et al.,

1969; St.

Jeor & Rapp, 1973) was about three times larger than that in control cultures (Fig. 2a). However, the peak at the density of m a m m a l i a n cell D N A (Crouch & Rapp, 1972) was not significantly different between the two cases. These results indicate that the synthesis of virus D N A is enhanced in the dexamethasone-treated H E L cells.

To determine the stages in the H C M V replication cycle that are under hormonal control, H E L cell monolayers were treated with dexamethasone at various times before a n d after virus infection and virus yield was determined at 96 h (Table 3). The yield of virus was significantly enhanced in cultures treated with the hormone prior to virus infection ( - 24 to 0 h) or during the 48 h latent period of virus replication (1.5 to 96 h and 24 to 96 h). However, a little e n h a n c e m e n t

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1764 J. TANAKA AND OTHERS

(a) (b) (c) (d) (e) (f)

w m

w

m D

m t

76000 72000

Fig. 3. Analysis of immediate early proteins synthesized in untreated or dexamethasone-treated HEL cells by SDS-PAGE. HEL cells were either untreated or pretreated for 24 h with the hormone (10- s M).

These cells were infected with HCMV at an m.o.i, of 1 (e,J) or 5 (c, d), or mock-infected (a, b). After a 1 h adsorption period the cells were washed and pulse-labelled with [3~S]methionine for 2 h in methionine-free maintenance medium with or without the hormone. (b, d, J) Untreated control cultures;

(a, c, e)

dexamethasone-treated cultures.

was observed in cultures treated with the h o r m o n e after virus synthesis b e g a n (48 to 96 h a n d 72 to 96 h).

Effect o f dexamethasone on the synthesis o f immediate early proteins and antigens

D u r i n g the course of these e x p e r i m e n t s , we n o t i c e d that in the h o r m o n e - t r e a t e d H E L cells early c.p.e., resulting from the synthesis o f early p r o t e i n s ( M i c h e l s o n - F i s k e

et al.,

1977: Stinski, 1978), a p p e a r e d earlier a n d in m o r e cells t h a n in u n t r e a t e d control cultures. T h e r e f o r e , we e x a m i n e d the synthesis of i m m e d i a t e early proteins in the h o r m o n e - t r e a t e d cells by S D S - P A G E analysis. T h e results, illustrated in Fig. 3, show t h a t I E A - p o s i t i v e h u m a n s e r u m m a i n l y p r e c i p i t a t e d a b a n d with a n a p p a r e n t m o l e c u l a r weight of 72 000 in all virus-infected cells (lanes c to f ) , b u t n o t in either u n t r e a t e d or d e x a m e t h a s o n e - t r e a t e d m o c k - i n f e c t e d cells (lanes a a n d b).

T h e relative a m o u n t of synthesis of the p r o t e i n was e n h a n c e d in the h o r m o n e - t r e a t e d cultures infected with H C M V at a n m.o.i, o f 5 (lane c) or 1 (lane e) c o m p a r e d to the respective control cultures (lanes d a n d J). Moreover, in the h o r m o n e - t r e a t e d cultures infected w i t h virus at a n

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H C M V replication in hormone-treated cells

Table 4. Effect of cordycepin on enhancing activity by dexamethasone*

D e x a m e t h a s o n e Cordycepin Virus yieldt (M) (~tg/ml) (p.f.u./ml × 10 -3)

0 0 1"2

0 20 2-2

0 30 1.4

10 - s 0 8-7

10 5 20 3-5

10 -5 30 1.8

1765

* H E L cells were pretreated with the indicated concentration of dexamethasone, cordycepin or both for 24 h before virus infection at an m.o.i, of 0.1.

t Titrated at 72 h post-infection.

m.o.i, of 5, another polypeptide (apparent tool. wt. 76000) was also found in addition to a 72000 polypeptide (lane c).

The synthesis of IEA was also stimulated in the hormone-treated cells. H E L cells infected with virus at an m.o.i, of 0.1 were fixed with methanol at 3 h and stained by standard indirect immunofluorescence techniques (Tanaka et al., 1981) using the same serum as used in the immunoprecipitation. In untreated control cultures, IEA was found in 1 to 3 ~ of the cells. In contrast, in the hormone-treated cells 8 to 10~ of the cells contained IEA.

Effect of cordycepin on the enhancement of H C M V production by dexamethasone To determine whether the enhancement of H C M V production by dexamethasone is dependent on the synthesis of a cellular mRNA(s) as a result of hormonal action, like hormonal enzyme induction (Scott et al., 1972), the effect of cordycepin on the enhanced production of H C M V in the hormone-treated cultures was studied. This experiment is based on the fact that cordycepin inhibits the maturation of m R N A by blocking poly(A) synthesis (Penman et al., 1970; Darnell et al., 1971, Abelson & Penman, 1972). The results are shown in Table 4. When cells were pretreated with dexamethasone, the yield of H C M V was enhanced by approximately sevenfold. Pretreatment with cordycepin alone did not affect the virus yield. In the cultures pre- treated simultaneously with the hormone and cordycepin at concentrations of 20 or 30 ~g/ml, there was about 60 or 80~o reduction in virus yield when compared to the yield in the cells treated with dexamethasone alone.

D I S C U S S I O N

The data presented in this paper indicate that treatment of cells with pharmacological concentrations of dexamethasone enhances H C M V replication in H E L cells. This enhanced replication of H C M V is demonstrated by several biological and biochemical parameters, i.e.

enhanced plaquing efficiency, earlier appearance of c.p.e., shortened virus eclipse period, increased synthesis of immediate early proteins and antigens, and enhanced virus D N A synthesis.

In these studies we have found that the hormonal enhancement of H C M V replication probably involves specific receptor proteins in target cells and requires the synthesis of a cellular mRNA(s). Because androgenic and oestrogenic hormones do not significantly enhance HCMV replication, this involvement of transcription in enhancement may be specifically induced by glucogenic hormones. This may be because androgenic and oestrogenic hormones have different modes of action or because fibroblast cells are not targets for these two hormones.

In our system, the early stages in H C M V replication cycle seem to be under hormonal control.

It is likely that the enhancing effect of the hormone is expressed through host cellular functions.

Evidence that this may be the case comes from the fact that when cultures are pretreated with

the hormone, which is then removed before infection, the yield of progeny virus is significantly

higher than that in untreated control cultures (Tables 3 and 4). However, the possibility that

dexamethasone may stimulate HCMV transcription directly can not be ruled out, because the

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1766

J, T A N A K A A N D O T H E R S

yield of HCMV is further enhanced when the hormone is allowed to remain in the cultures throughout the experiment (Table 3). This problem is now under investigation.

The same hormone has been found to enhance production of murine leukaemia virus (Paran

et al.,

1973), murine mammary tumour virus (Parks & Scolnick, 1974), polyoma virus (Morhenn

et al.,

1973) and a certain strain of HSV type 2 (Costa

et al.,

1974). However, whether these phenomena have similar molecular mechanisms is unknown.

Under natural conditions, HCMV causes many diseases after primary or reactivation infection. Chiba

et al.

(1972) have suggested that corticosteroid hormones are one risk factor for HCMV infection in children. Another cytomegalovirus, murine cytomegalovirus, has been shown to be reactivated from latent virus infection by treatment of the animals with cortisone and anti-lymphocyte serum (Jordan

et al.,

1977). Moreover, recently we have found that dexa- methasone also enhances H C M V replication in human epithelial cells in which H C M V replication occurs most frequently

in L'it,o

(Tanaka

et al.,

1984). These observations, coupled with the findings described here, suggest that glucogenic steroid hormones could play a biologically significant role in HCMV-cell interactions m t,i~,o.

R E F E R E N C E S

ABELSON, H. T. & PENMAN, S. (19723. Messenger R N A formation: resistance to inhibition by 3'-deoxycytidine.

Biochimica et biophysica acta 277, 129-133.

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CHIBA, S., IKEDA, S., CHIBA, Y., AGATSUMA, Y., OHSAKI, M. & NAKAO, T. (1972). Epidemic of subclinical infection with cytomegalovirus in an infant home. Tohoku Journal of Experimental Medicine 106, 387 389.

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ESTES, J. E. & HUANG, E. S. (19773. Stimulation of cellular thymidine kinases by h u m a n cytomegalovirus. Journal of Virology 24, 13 21.

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FURUKAWA, T., TANAKA, S. & PLOTKXN, S. A. (1975 b). Restricted growth of h u m a n cytomegalovirus in uv-irradiated WI-38 human fibroblasts. Proceedings oJ the Society.lot Experimental Biology and Medicine 148, 1249-1251.

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