Rabbit Cardiomyopathy Associated l'ith a V'irus Antigenically Related to Human Coronavirus Strain 229E James D. Small, DVM, MPH, Laure Aurelian, PhD, Robert A. Squire, DVM, PhD, John D. Strandberg, DVM, PhD, Edward C. Melby, Jr., DVM, Thomas B. Turner, MD, and Burlina Newman, BS
A new disease of rabbits is described. Following an acute febrile course, animals die or recover by the 11th day postinoculation. The characteristic pathologic finding is multifocal myocardial degeneration and necrosis. The disease can be transmitted bv various routes with tissue filtrates or with infectious sera diluted to 10 and passed through 0.1 gm filters. Virus particles with morphologic features characteristic of a coronavirus are present in infectious but not in normal rabbit serums. The antigen(s) in the infectious serums cross-reacts with the 229E and the OC43 strains of human coronavirus. Antigen cross-reacting with the 229E virus is detectable by immunofluorescent staining in frozen sections of heart tissue from sick but not from healthy animals. Animals surviving infection seroconvert to coronavirus specificity, as demonstrated by the presence in convalescent serums of antibody capable of reacting with the 229E virus. Susceptibility to infection has not been demonstrated in mice, hamsters, or guinea pigs, and the virus was not adapted for growth in tissue culture. It is uncertain whether the agent is a natural pathogen of rabbits or a coronavirus contaminant from another species, possibly human. The name rabbit infectious cardiomyopathy is suggested for this disease. (Am J Pathol 95:709-730, 1979)
IN 1968, Scandinavian workers reported an acute febrile disease of rabbits following intratesticular inoculation of the Nichols strain of Treponema pallidum. 1.2 This strain was maintained in Scandinavia since 1953 by passage in rabbit testes. In 1961 sporadic deaths began in the inoculated animals. Mortality rates reached 30% by 1968 and 75% by 1970.3 Rabbits died within a week of inoculation with an acute, febrile illness characterized bv rectal temperatures in excess of 40 C, severe pulmonary edema, and congestion of the superficial lymph nodes. HeatFrom the Veterinan Resources Branch. Div ision of Research Sers-ices. National Institutes of Health. Bethesda. Mlarland. and The Johns Hopkins University School of Medicine. Disision of Comparative Medicine and Department of Microbiology. Baltimore. Maryland Presented in part at the 26th Annual Session of the American Association for Laboratory Animal Science, Boston, Nos ember 16, 1973. Supported in part by Grant RROO1:30 from the Aknimal Resources Branch. Disision of Research Resources. National Institutes of Health, and a grant from the WN'hitehall Foundation, Nesw York \Mr M1elby's present address is Nesw York State College of Veterinars- Medicine. Cornell Universitv. Ithaca,.NY Mr. Turner's present address is The Johns Hopkins Unisersitv School of Medicine. Baltimore. MID 21205 MIs Neswman's present address is Department of Environmental Health. Div.ision of Radiation Health Sciences. The Johns Hopkins School of Hy giene and Public Health, Baltimore, MD 21205. Address reprint requests to J. D. Small, DV\M., V'eterinary Resources Branch, Building 14A, Room 102. National Institutes of Health. Bethesda. MD 20205. 709 0002-9440/79/0607-0709$01.00 ( 1979 American Association of Pathologists
710
SMALL ET AL
American Journal of Pathology
ing the testicular emulsions to a temperature that killed the treponemes failed to inactivate infectivity, thereby excluding treponomes from the etiology of the disease.3 In 1970, the late Dr. H. Gudj6nsson, a dermatologist at the Karolinska Hospital, Stockholm, Sweden, brought samples of testicular emulsion containing contaminated Nichols strain of T pallidum to the Johns Hopkins University School of Medicine in Baltimore. In this communication we report the results of our studies on the etiology and pathologic manifestations of this apparently new disease of rabbits. Evidence is provided that the agent designated "Stockholm Agent" by Gudj6nsson et al 4 may be a coronavirus. Materials and Methods Animals
Randomly bred New Zealand white rabbits, of both sexes, weighing 1.2 to 4.9 kg, were purchased from commercial suppliers or obtained from the Veterinary Resources Branch, National Institutes of Health. They were housed individually and fed antibiotic-free rabbit pellets (Purina or NIH Animal Feed A) and water ad libitum. Depending on the laboratory, the room temperature was maintained at 15 to 18 or 21 to 24 C. Passage of Infectious Material
Testicular emulsions (5 to 10%) in 0.2 M phosphate-buffered saline (PBS), pH 7.2, were centrifuged at 30Og for 5 minutes of 4 C. The supernatant fluid was removed, frozen, thawed eight times, and filtered through a 1.2-,um Millipore filter to remove large particulate matter, followed by successive filtrations through filters to decreasing porosity. Before final filtration (0. 1-,im pore size), coliform bacteria were added and the filtrates were cultured to determine the efficacy of filtration. Infectious serums were centrifuged at 3000g for 5 minutes at 4 C and filtered through 0.45-,um filters. In some cases, serums were filtered through filters of a smaller pore size (0.22 to 0.1 jIm). Bacteria were added before final filtration as described above. Rabbits were inoculated with either 0.5 to 2.0 ml infectious serums intravenously (IV), 0.3 to 0.5 ml filtrates of testicular emulsions intratesticularly (IT), or 0.5 to 2.0 ml testicular emulsions (IV). Temperature Measurements Rectal temperatures were recorded every 24 hours using a glass mercury thermometer inserted 30 mm. Prior to inoculation the temperatures were lower than 39.5 C.
Pathology
Complete necropsies were done on all controls and on 31 inoculated animals that died or that were euthanatized with CO2, IV sodium pentobarbital, or IV ketamine HCI and exsanguinated 48 hours to 10 months after infection. Tissues routinely taken included brain, cervical spinal cord, eye, trachea, lung, tongue, stomach, duodenum, jejunum, ileum, pancreas, cecum, colon, liver, gallbladder, kidney, urinary bladder, heart, diaphragm, gluteal muscle, adrenal gland, gonad, salivary glands, cervical, axillary, popliteal and mesenteric lymph nodes, spleen, and thymus. Spinal cords and ganglia were removed intact from three animals showing paralysis, and several sections were taken at the cervical, thoracic, and lumbar levels. Tissues, except eyes, were fixed in 10% formalin
Vol. 95, No. 3 June 1979
RABBIT CARDIOMYOPATHY
711
buffered with 2% sodium acetate or Bouin's solution. Selected tissues were fixed with formol-Zenker's. Eyes were fixed in Bouin's solution. Lungs were distended with fixative. Paraffin-imbedded sections were cut at 6 Am and stained with hematoxylin-eosin. Selected tissues were stained with periodic acid-Schiff stain (PAS), Lendrum's inclusion stain, Taylor's gram stain, Gomori's methenamine silver stain, Masson's trichrome stain, azureeosin, alizarin red, phosphotungstic acid-hematoxylin (PTAH), and cresyl echt violetluxol blue.5 Selected kidney sections were cut at 3 gm and stained with PAS-methenamine silver. Blood, pleural exudate, lung, spleen, liver, and testicular emulsions were cultured for bacteria using fluid thioglycolate without indicator and brain-heart infusion broth with 0.1% agar. Cultures were incubated at 37 C for at least 14 days before being discarded as negative. Beef heart infusion agar supplemented with 1% peptone, 0.5% NaCl, 215% baker's yeast, and 20% horse serum was used for the isolation of mycoplasma' Yolk sac inoculation of 6-day-old chick embryos was used for growth of rickettsiae.7
AnUtrsm Hyperimmune serums were prepared in rabbits surviving inoculation with infectious material by giving four or more IV challenges with 0.5 to 1.0 ml of infectious serums (stocks 73-015, 73-022, and 34) at biweekly intervals. Animals were bled 10 to 14 days following the last injection. Pooled guinea pig antiserum to the 229E strain of human coronavirus and mouse ascitic fluid containing antibody to the OC43 strain of human coronavirus were supplied through the courtesy of Dr. A. Kapikian, NIAID, NIH. They titered .1:64 in the microquantitative complement fixation (CF) assay6 using homologous antigens. Neutalzaon Equal volumes of hyperimmune serums and infectious rabbit serums were incubated at 37 C for 2 hours and inoculated IV (2 ml) into each of 3 normal rabbits. Control rabbits received 2 ml of similarly treated mixtures of virus and PBS, virus and preimmune rabbit serum, of hyperimmune rabbit serum and PBS. Morbidity and/or mortality were monitored. Iunomcere Frozen sections of heart tissue obtained from moribund or normal animals were stained by indirect immunofluorescence ' with fluorescein-conjugated goat antirabbit (Cappel Laboratories) or fluorescein-conjugated rabbit antiguinea pig (Miles Laboratories) r -globulin (y -chain-specific). They were read blindly by two investigators on a Zeiss UV photomicroscope.
Comlment Fixation The microquantitative assay of Wassennan and Levine5 was used. Its sensitivity and specificity are well established.1'1' Infectious serums served as antigens. Dr. A. Kapikian supplied 229E virus grown in WI-38 cells and OC43 virus grown in suckling mouse brain. The reaction was considered positive if more than 20% of the complement was consumed.
rTssue CUR" The following cell lines were used: HEp-2, Vero, BSC-1, L, BHK, WI-38, and J-111. Primary rabbit kidney and MA-Ill derived from testicular tissues of newborn rabbits were obtained from Microbiological Associates (Bethesda, MD) and MA-177 cells derived from
712
SMALL ET AL
American Journal of Pathology
newborn human intestine were obtained through the courtesy of Dr. A. Kapikian. All were maintained in minimum essential medium with 10% fetal calf serum. Electron Microscopy.
Virus was concentrated 60-fold from 3 ml of infectious serums by centrifugation at 100,000g for 2 hours. The pellets were resuspended in 50 jul of distilled water, mixed with equal volumes of 1.2% aqueous solution of sodium phosphotungstate (pH 5.8), and transferred to a lightly carbonized Formvar coated grid. Controls consisted of pellets obtained in identical fashion from normal rabbit serums. Air-dried grids were examined in an AEI-801 electron microscope at instrument magnifications of X 10-100,000. In addition, 1-mm cubes of cardiac muscle from infected rabbits were fixed in 3% glutaraldehyde in phosphate buffer (pH 7.2) and subsequently treated with 1% osmium tetroxide for 1 hour. Following dehydration the blocks were embedded in Spurr low-viscosity embedding medium. One micrometer sections were cut with glass knives and stained with toluidine blue. Selected blocks were sectioned at 60 to 90 nm thickness, stained with lead citrate and uranyl acetate, and examined at instrument magnification of 4000 to 25,000 X.
Results Clinical Course
Rabbits were inoculated with infectious material as summarized in Table 1. The clinical course was characterized by a fever spike of 40 to 41.5 C at 24 to 48 hours after inoculation. Animals receiving filtrates of testicular emulsions IT had a single initial fever spike followed by a gradual return to normal with recovery or, alternatively, the rectal temperatures became subnormal (
A new disease of rabbits is described. Following an acute febrile course, animals die or recover by the 11th day postinoculation. The characteristic pathologic finding is multifocal myocardial degeneration and necrosis. The disease can be transmitted bv various routes with tissue filtrates or with infectious sera diluted to 10 and passed through 0.1 gm filters. Virus particles with morphologic features characteristic of a coronavirus are present in infectious but not in normal rabbit serums. The antigen(s) in the infectious serums cross-reacts with the 229E and the OC43 strains of human coronavirus. Antigen cross-reacting with the 229E virus is detectable by immunofluorescent staining in frozen sections of heart tissue from sick but not from healthy animals. Animals surviving infection seroconvert to coronavirus specificity, as demonstrated by the presence in convalescent serums of antibody capable of reacting with the 229E virus. Susceptibility to infection has not been demonstrated in mice, hamsters, or guinea pigs, and the virus was not adapted for growth in tissue culture. It is uncertain whether the agent is a natural pathogen of rabbits or a coronavirus contaminant from another species, possibly human. The name rabbit infectious cardiomyopathy is suggested for this disease. (Am J Pathol 95:709-730, 1979)
IN 1968, Scandinavian workers reported an acute febrile disease of rabbits following intratesticular inoculation of the Nichols strain of Treponema pallidum. 1.2 This strain was maintained in Scandinavia since 1953 by passage in rabbit testes. In 1961 sporadic deaths began in the inoculated animals. Mortality rates reached 30% by 1968 and 75% by 1970.3 Rabbits died within a week of inoculation with an acute, febrile illness characterized bv rectal temperatures in excess of 40 C, severe pulmonary edema, and congestion of the superficial lymph nodes. HeatFrom the Veterinan Resources Branch. Div ision of Research Sers-ices. National Institutes of Health. Bethesda. Mlarland. and The Johns Hopkins University School of Medicine. Disision of Comparative Medicine and Department of Microbiology. Baltimore. Maryland Presented in part at the 26th Annual Session of the American Association for Laboratory Animal Science, Boston, Nos ember 16, 1973. Supported in part by Grant RROO1:30 from the Aknimal Resources Branch. Disision of Research Resources. National Institutes of Health, and a grant from the WN'hitehall Foundation, Nesw York \Mr M1elby's present address is Nesw York State College of Veterinars- Medicine. Cornell Universitv. Ithaca,.NY Mr. Turner's present address is The Johns Hopkins Unisersitv School of Medicine. Baltimore. MID 21205 MIs Neswman's present address is Department of Environmental Health. Div.ision of Radiation Health Sciences. The Johns Hopkins School of Hy giene and Public Health, Baltimore, MD 21205. Address reprint requests to J. D. Small, DV\M., V'eterinary Resources Branch, Building 14A, Room 102. National Institutes of Health. Bethesda. MD 20205. 709 0002-9440/79/0607-0709$01.00 ( 1979 American Association of Pathologists
710
SMALL ET AL
American Journal of Pathology
ing the testicular emulsions to a temperature that killed the treponemes failed to inactivate infectivity, thereby excluding treponomes from the etiology of the disease.3 In 1970, the late Dr. H. Gudj6nsson, a dermatologist at the Karolinska Hospital, Stockholm, Sweden, brought samples of testicular emulsion containing contaminated Nichols strain of T pallidum to the Johns Hopkins University School of Medicine in Baltimore. In this communication we report the results of our studies on the etiology and pathologic manifestations of this apparently new disease of rabbits. Evidence is provided that the agent designated "Stockholm Agent" by Gudj6nsson et al 4 may be a coronavirus. Materials and Methods Animals
Randomly bred New Zealand white rabbits, of both sexes, weighing 1.2 to 4.9 kg, were purchased from commercial suppliers or obtained from the Veterinary Resources Branch, National Institutes of Health. They were housed individually and fed antibiotic-free rabbit pellets (Purina or NIH Animal Feed A) and water ad libitum. Depending on the laboratory, the room temperature was maintained at 15 to 18 or 21 to 24 C. Passage of Infectious Material
Testicular emulsions (5 to 10%) in 0.2 M phosphate-buffered saline (PBS), pH 7.2, were centrifuged at 30Og for 5 minutes of 4 C. The supernatant fluid was removed, frozen, thawed eight times, and filtered through a 1.2-,um Millipore filter to remove large particulate matter, followed by successive filtrations through filters to decreasing porosity. Before final filtration (0. 1-,im pore size), coliform bacteria were added and the filtrates were cultured to determine the efficacy of filtration. Infectious serums were centrifuged at 3000g for 5 minutes at 4 C and filtered through 0.45-,um filters. In some cases, serums were filtered through filters of a smaller pore size (0.22 to 0.1 jIm). Bacteria were added before final filtration as described above. Rabbits were inoculated with either 0.5 to 2.0 ml infectious serums intravenously (IV), 0.3 to 0.5 ml filtrates of testicular emulsions intratesticularly (IT), or 0.5 to 2.0 ml testicular emulsions (IV). Temperature Measurements Rectal temperatures were recorded every 24 hours using a glass mercury thermometer inserted 30 mm. Prior to inoculation the temperatures were lower than 39.5 C.
Pathology
Complete necropsies were done on all controls and on 31 inoculated animals that died or that were euthanatized with CO2, IV sodium pentobarbital, or IV ketamine HCI and exsanguinated 48 hours to 10 months after infection. Tissues routinely taken included brain, cervical spinal cord, eye, trachea, lung, tongue, stomach, duodenum, jejunum, ileum, pancreas, cecum, colon, liver, gallbladder, kidney, urinary bladder, heart, diaphragm, gluteal muscle, adrenal gland, gonad, salivary glands, cervical, axillary, popliteal and mesenteric lymph nodes, spleen, and thymus. Spinal cords and ganglia were removed intact from three animals showing paralysis, and several sections were taken at the cervical, thoracic, and lumbar levels. Tissues, except eyes, were fixed in 10% formalin
Vol. 95, No. 3 June 1979
RABBIT CARDIOMYOPATHY
711
buffered with 2% sodium acetate or Bouin's solution. Selected tissues were fixed with formol-Zenker's. Eyes were fixed in Bouin's solution. Lungs were distended with fixative. Paraffin-imbedded sections were cut at 6 Am and stained with hematoxylin-eosin. Selected tissues were stained with periodic acid-Schiff stain (PAS), Lendrum's inclusion stain, Taylor's gram stain, Gomori's methenamine silver stain, Masson's trichrome stain, azureeosin, alizarin red, phosphotungstic acid-hematoxylin (PTAH), and cresyl echt violetluxol blue.5 Selected kidney sections were cut at 3 gm and stained with PAS-methenamine silver. Blood, pleural exudate, lung, spleen, liver, and testicular emulsions were cultured for bacteria using fluid thioglycolate without indicator and brain-heart infusion broth with 0.1% agar. Cultures were incubated at 37 C for at least 14 days before being discarded as negative. Beef heart infusion agar supplemented with 1% peptone, 0.5% NaCl, 215% baker's yeast, and 20% horse serum was used for the isolation of mycoplasma' Yolk sac inoculation of 6-day-old chick embryos was used for growth of rickettsiae.7
AnUtrsm Hyperimmune serums were prepared in rabbits surviving inoculation with infectious material by giving four or more IV challenges with 0.5 to 1.0 ml of infectious serums (stocks 73-015, 73-022, and 34) at biweekly intervals. Animals were bled 10 to 14 days following the last injection. Pooled guinea pig antiserum to the 229E strain of human coronavirus and mouse ascitic fluid containing antibody to the OC43 strain of human coronavirus were supplied through the courtesy of Dr. A. Kapikian, NIAID, NIH. They titered .1:64 in the microquantitative complement fixation (CF) assay6 using homologous antigens. Neutalzaon Equal volumes of hyperimmune serums and infectious rabbit serums were incubated at 37 C for 2 hours and inoculated IV (2 ml) into each of 3 normal rabbits. Control rabbits received 2 ml of similarly treated mixtures of virus and PBS, virus and preimmune rabbit serum, of hyperimmune rabbit serum and PBS. Morbidity and/or mortality were monitored. Iunomcere Frozen sections of heart tissue obtained from moribund or normal animals were stained by indirect immunofluorescence ' with fluorescein-conjugated goat antirabbit (Cappel Laboratories) or fluorescein-conjugated rabbit antiguinea pig (Miles Laboratories) r -globulin (y -chain-specific). They were read blindly by two investigators on a Zeiss UV photomicroscope.
Comlment Fixation The microquantitative assay of Wassennan and Levine5 was used. Its sensitivity and specificity are well established.1'1' Infectious serums served as antigens. Dr. A. Kapikian supplied 229E virus grown in WI-38 cells and OC43 virus grown in suckling mouse brain. The reaction was considered positive if more than 20% of the complement was consumed.
rTssue CUR" The following cell lines were used: HEp-2, Vero, BSC-1, L, BHK, WI-38, and J-111. Primary rabbit kidney and MA-Ill derived from testicular tissues of newborn rabbits were obtained from Microbiological Associates (Bethesda, MD) and MA-177 cells derived from
712
SMALL ET AL
American Journal of Pathology
newborn human intestine were obtained through the courtesy of Dr. A. Kapikian. All were maintained in minimum essential medium with 10% fetal calf serum. Electron Microscopy.
Virus was concentrated 60-fold from 3 ml of infectious serums by centrifugation at 100,000g for 2 hours. The pellets were resuspended in 50 jul of distilled water, mixed with equal volumes of 1.2% aqueous solution of sodium phosphotungstate (pH 5.8), and transferred to a lightly carbonized Formvar coated grid. Controls consisted of pellets obtained in identical fashion from normal rabbit serums. Air-dried grids were examined in an AEI-801 electron microscope at instrument magnifications of X 10-100,000. In addition, 1-mm cubes of cardiac muscle from infected rabbits were fixed in 3% glutaraldehyde in phosphate buffer (pH 7.2) and subsequently treated with 1% osmium tetroxide for 1 hour. Following dehydration the blocks were embedded in Spurr low-viscosity embedding medium. One micrometer sections were cut with glass knives and stained with toluidine blue. Selected blocks were sectioned at 60 to 90 nm thickness, stained with lead citrate and uranyl acetate, and examined at instrument magnification of 4000 to 25,000 X.
Results Clinical Course
Rabbits were inoculated with infectious material as summarized in Table 1. The clinical course was characterized by a fever spike of 40 to 41.5 C at 24 to 48 hours after inoculation. Animals receiving filtrates of testicular emulsions IT had a single initial fever spike followed by a gradual return to normal with recovery or, alternatively, the rectal temperatures became subnormal (
