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The area of the lesions depends on Keywords cell-to-cell spread; endocytosis; entry; filopodia; glycoproteins; herpes simplex virus; herpes viruses; phagocytosis; viral surfing Correspon

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Viral entry mechanisms: cellular and viral mediators of

herpes simplex virus entry

Jihan Akhtar1and Deepak Shukla1,2

1 Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, IL, USA

2 Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, IL, USA

Introduction

The herpesvirus family consists of over 100

double-stranded DNA viruses divided into a, b and

c subgroups [1] Only eight herpesviruses are known to

commonly infect humans and the remainder are

animal herpesviruses infecting a wide variety of animal

species All members of the herpesvirus family cause

lifelong latent infections and, structurally, all have a

linear, double-stranded DNA genome packaged into

an icosahedral capsid (Fig 1) [1] This capsid, in turn,

is enclosed by the tegument, a layer of proteins The

tegument is then covered by a bilayer lipid membrane

with embedded proteins and glycoproteins The

pro-tected DNA genome is essential for viral infectivity

Closely-related herpes simplex type-1 (HSV-1) and

type-2 (HSV-2) viruses are members of the

alphaher-pesvirus subfamily and are responsible for highly pre-valent infections among humans [2], although a number of common experimental animals also demon-strate susceptibility to HSV infections Symptomatic disease caused by HSV-1 is typically limited to cold sores of the mouth and keratitis in the eyes HSV-2, in contrast, is mostly responsible for genital lesions However, both viruses are capable of causing lesions

on identical body sites and both can cause life-threat-ening diseases in immunocompromised individuals, including newborns, patients with HIV or patients undergoing immunosuppressive treatment [1,2] Trans-mission among humans requires physical contact and often occurs during kissing (HSV-1) or sexual inter-course (HSV-2) The area of the lesions depends on

Keywords

cell-to-cell spread; endocytosis; entry;

filopodia; glycoproteins; herpes simplex virus;

herpes viruses; phagocytosis; viral surfing

Correspondence

D Shukla, 1855 W Taylor Street

(M ⁄ C 648), Chicago, IL 60612, USA

Fax: +1 312 996 7773

Tel: +1 312 355 0908

E-mail: dshukla@uic.edu

(Received 18 June 2009, revised 9

September 2009, accepted 18 September

2009)

doi:10.1111/j.1742-4658.2009.07402.x

Herpes simplex virus type-1 and type-2 are highly prevalent human patho-gens causing life-long infections The process of infection begins when the virions bind heparan sulfate moieties present on host cell surfaces This ini-tial attachment then triggers a cascade of molecular interactions involving multiple viral and host cell proteins and receptors, leading to penetration

of the viral nucleocapsid and tegument proteins into the cytoplasm The nucleocapsid is then transported to the nuclear membrane and the viral DNA is released for replication in the nucleus Recent studies have revealed that herpes simplex virus entry or penetration into cells may be a highly complex process and the mechanism of entry may demonstrate unique cell-type specificities Although specificities clearly exist, past and ongoing studies demonstrate that herpes simplex virus may share certain common receptors and pathways that are also used by many other human viruses This minireview helps to shed light on recent revelations on the herpes simplex virus entry process

Abbreviations

HS, heparan sulfate; HSPG, heparan sulfate proteoglycan; HSV-1, herpes simplex virus type-1; HSV-2, herpes simplex virus type-2; HVEM, herpesvirus entry mediator; 3-OST, 3-O sulfotransferase; PILR, paired immunoglobulin-like receptor.

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the inoculation site; therefore, sores are most

com-monly found on the mouth or genital areas Medical

professionals and others not wearing surgical gloves

could also acquire lesions on their fingers from the

virions shed from their patients’ vaginal mucosa

and⁄ or mouth This is commonly known as finger

herpes or herpetic whitlow

After initial infection, the virus remains latent in

neurons, a key feature of alphaherpesviruses [1]

Dur-ing this period, hosts are still capable of spreadDur-ing

infection to other humans via asymptomatic shedding

of the virions Reactivation of the virus can be a result

of a variety of environmental triggers, including

emo-tional or physical stress, which subsequently leads to

virus replication in epithelial cells and a lifetime of

intermittent mucocutaneous lesions [2] The ability

of the virus to avoid immune detection and establish

latency in a significant patient population (up to 80%

human adults for HSV-1 and approximately 40% for

HSV-2) is facilitated by its unique ability to

produc-tively enter cells of the epithelia for viral gene

expres-sion, replication and eventual spread from cell-to-cell

to innervating nerves and, ultimately, to trigeminal

(HSV-1) or sacral (HSV-2) ganglia for the

estab-lishment of latency Thus, HSV entry into host cells

marks the first and possibly most critical step in viral

pathogenesis

Five viral glycoproteins have been implicated in the

viral entry process: gB, gC, gD, gH and gL [3,4] All

but gC are essential for entry The initial interaction,

or binding to cells, is mediated via interactions of gC and⁄ or gB with heparan sulfate proteoglycans (HSPGs) F-actin-rich membrane protrusions called filopodia may facilitate attachment by providing HSPG-rich sites for the initial binding (Fig 1) Although gC is not essential for viral entry, its absence decreases the overall viral binding to cell surfaces [1] After the initial attachment to cells, the process of pen-etration begins The latter, depending on the host cell type and the mode of entry [4,5], may require fusion

of the virion envelope with the plasma membrane or with the membrane of an intracellular vesicle (Fig 1) [5] In either case, the membrane fusion requires essen-tial participation from viral glycoproteins gB, gD,

gH and gL Although gD is not considered to be a fusogen, other essential glycoproteins, more impor-tantly, gB and gH, demonstrate many characteristics

of viral fusion proteins [4,6] Similar to attachment, membrane fusion also requires participation from cellular receptors A number of unrelated receptors for

gD have been discovered These include nectin-1 and -2, herpesvirus entry mediator (HVEM) and 3-O sul-fated heparan sulfate (3-O HS) [3,7] The current, widely accepted model for membrane fusion suggests that binding of gD to one of its cognate receptors induces conformational changes in gD that mobilize a fusion active multi-glycoprotein complex involving gB,

gD, gH and gL (Fig 2) [8] Fusion of viral envelope

HSV surfing

Glycoproteins Tegument DNA

Envelope

HSPG

gD receptor

Cytoplasm

Nucleus

Fig 1 HSV virion and its two major modes of entry into cells Structural components of a typical HSV virion are shown (box) HSV virions can enter into cells via a pH-independent fusion of viral envelope with the plasma membrane (I) or, alternatively, via an endocytic pathway that may be phagocytosis-like (II) in terms of the viral uptake In both pathways, HSV particles may initially associate with filopodia-like mem-brane protrusions via HSPG Unidirectional transport of extracellular particles bound to filopodia (HSV surfing) then brings the particles closer

to the cell body for entry via interactions with the cellular receptors, including gD receptor and possibly gB receptor Fusion at the plasma membrane results in the release of the naked viral nucleocapsid in the cytoplasm for transport to the nucleus Similarly, endocytosis also requires fusion of the enveloped particles with the vesicular membrane for the release of the viral nucleocapsid proximal to the nucleus.

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with a cellular membrane results in content mixing and

the eventual release of the viral nucleocapsid and

tegu-ment proteins into the host cytoplasm (Figs 1 and 2)

Subsequently, symbolizing post-entry steps, HSV

nucleocapsids dissociate with tegument proteins and

bind a microtubule-dependent, minus end-directed

motor, dynein [9] Although most of the tegument

proteins are required for activation and modulation of

viral gene expression and shut-off of host protein

syn-thesis, some may participate in dynein-propelled

trans-port of the nucleocapsids along microtubules toward

the nuclear membrane for uncoating and the release of

viral DNA into the nucleus Transcription, replication

of viral DNA and assembly of progeny capsids take

place within the host nucleus The intricate details of

the steps required for entry are discussed below

Viral binding to filopodia

Although the virus binding to cells results from the

interaction of gC and⁄ or gB with heparan sulfate (HS),

the location on the cell where this binding can occur

the earliest has only recently been elucidated In human

conjunctival epithelial cells, virions were observed attaching to filopodia-like membrane protrusions [10]

It was also observed that virus attachment to filopodia was followed by unilateral movement of the virions towards the cell body Staining of many natural target cells with anti-HSV receptor antibodies indicated the expression of HS but not other entry receptors

Nectin-1 expression, for example, was limited to cell bodies with no detectable expression on filopodia (M J Oh &

D Shukla, unpublished results) The phenomenon of extracellular HSV-1 moving unilaterally towards the cell body on filopodia has also been observed in retinal pigment epithelial (RPE) and P19N neural cells [11,12]

A similar phenomenon for the transport of extracellular virus particles, termed ‘viral surfing’, has been observed with other viruses, such as retroviruses and human pap-illomavirus type-16 [13,14] Surfing is also shared by many additional herpesviruses, including cytomegalo-virus and human herpescytomegalo-virus-8 (V Tiwari & D Shukla, unpublished results)

Exposure of HSV-1 to cells can induce the forma-tion of filopodia [5] This presumably enhances the effi-cacy of viral infection by targeted delivery (via surfing)

of virus particles to cell bodies for subsequent fusion with plasma membrane or endocytosis [11] Based on functional analogy with retroviral surfing, it is quite likely that myosin-dependent F-actin retrograde flow is responsible for the HSV movements along filopodia [13] Ongoing studies demonstrate that filopodial bridges formed between two cells can help transfer extracellular HSV-1 virions from an infected to an uninfected cell (V Tiwari & D Shukla, unpublished results) Although viral trafficking on filopodia has not yet been observed or studied in HSV-2, because of strong similarities between HSV-1 and HSV-2 viral entry mechanisms, including the use of HS as an attachment receptor, it is quite possible that this phe-nomenon also plays a role in HSV-2 entry It is also worth noting that filopodia are not essential for virus attachment, with the latter occuring at virtually any place on the plasma membrane as long as receptors such as HS are present However, because of the pres-ence of filopodia at the leading edges of tissue layers (e.g in vivo during wound healing), they may provide easy ‘roadways’ for HSV to reach cell bodies for infection

Fusion at cell and vesicular membranes Fusion at the plasma membrane is a pH-independent process that requires gB, gD, gH and gL (Fig 2) [3] Cellular receptors such as nectin-1, HVEM or 3-OS

HS are also required The process is triggered by

gC

Attachment

HSV

gD

gD receptor

HS PG

Fusion

complex

Lipid mixing Content mixing

+

gD receptor

Fig 2 Molecular interactions that facilitate HSV entry Initial

attachment to cells is mediated by interaction between HSPGs

with HSV glycoproteins gC and ⁄ or gB Membrane fusion is

required for penetration of the viral nucleocapsid and tegument into

the cytoplasm Interaction between gD, gH-gL and a gD receptor

may be sufficient to bring conformational changes within gD to

trig-ger merging of viral and cellular membranes or lipid mixing

How-ever, a fourth glycoprotein, gB, is also required for complete fusion

and content mixing, which essentially results in the release of the

tegument and nucleocapsid into the cytoplasm A receptor for gB,

PILR-a, is also expected to play a role during the fusion process.

Its precise role is still emerging and therefore it is not shown here.

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conformational changes in gD that occur upon

recep-tor binding [15] Alteration in gD conformation then

mobilizes gH and gL, a heterodimer, and gB to initiate

the fusion process at the cell surface Multiprotein

complexes involving gD⁄ gB and gD ⁄ gH ⁄ gL have been

detected previously [9,16] and the entire complex

colo-calizes at the membrane during fusion [9] Although it

is expected that members of fusion active complex

undergo additional changes in conformation, no clear

information is available because of the lack of 3D

structures of any fusion active glycoprotein complex It

is, however, known that gD bound to its receptor

dem-onstrates significant changes in its conformation [15]

The HSV-induced membrane fusion is accomplished

by initially bringing the membranes of both the host

cell and virus into close contact by receptor⁄

glycopro-tein interactions followed by mixing of the membranes

or lipids to create an intermediary state, sometimes

referred as ‘hemifusion intermediate’ [17]

Subse-quently, a fusion pore is formed that allows mixing of

the cytoplasmic contents with viral contents, which, in

the case of HSV entry, essnetially implies the delivery

of viral tegument proteins and the nucleocapsid into

the cytoplasm Although gD and the gH⁄ gL

hetero-dimer may be sufficient to initiate the lipid mixing, a

full-scale fusion resulting in the mixing of the contents

requires the presence of gB as well (Fig 2) [17] It has

been suggested that fusion may require a sequential

action by the glycoproteins [17], although a recent

study did not find any pressing evidence for this [16]

Recent studies have implicated gB and gH as having

multiple fusogenic domains [4,6,18] gB is highly

con-served among herpesviruses; however, this glycoprotein

demonstrates a unique characteristic in HSV-1 and

HSV-2 because it remains uncleaved, whereas many

other herpesvirus gBs are post-translationally cleaved

Interestingly, both uncleaved and cleaved forms of gBs

share mixed features of class I and class II viral fusion

proteins, and thereby define a new, hybrid class of viral

fusogens [6] Class I proteins contain hairpin trimers

with N-terminal hydrophobic membrane-penetrating

peptides and centrally located a-helical coiled-coils By

contrast, class II proteins contain b-structures with

internally located fusion domains Similar to class I,

the gB trimer also contains a central a-helical core but

the fusion loops, similar to class II, are part of the

elongated b-hairpins The gB trimer shows strong

resemblance to fusogenic glycoprotein G of vesicular

stomatitis virus [6] Similar to gB, gH was also reported

to contain two heptad repeat regions that were found

to be necessary for fusion induction [4] Peptides that

corresponded to these regions effectively prevented

HSV-1 infection, suggesting the importance of these

regions The exact significance of gL is still unclear, although it is likely to play an important role by stabi-lizing or regulating gH conformations

The role of gD and its receptor in the fusion process

is likely that of a catalyst [3,15] Although gD does not contain any fusion peptides or domains, binding

to its receptor is required for the initiation of fusion, unless a poorly understood dependent but gD-receptor-independent pathway is initiated [19] It is worth noting that gD homologs are rare and, among human herpesviruses, only HSV-1 and HSV-2 appear

to express gD [1] It is unclear why HSV virions have evolved with a gD-based fusion trigger mechanism, whereas many other herpesviruses can do without it It

is conceivable that a gD-based mechanism may pro-vide some explanation for the differences in tissue tro-pism demonstrated by HSV-1 and HSV-2 It is also possible that the involvement of gD, which is capable

of interacting with at least three distinct classes of entry receptors, may enhance the host range for HSV because a vast majority of cultured cells of human or animal origin are susceptible to HSV entry Other human herpesviruses demonstrate more restrictive host ranges in terms of the cell lines that they infect [1] Although fusion at the plasma membrane was origi-nally considered to be the only route of viral entry for HSV, recent studies have supported the existence of an alternate entry mechanism utilizing endocytosis [4,5] This atypical endocytosis resembles phagocytosis in the virus uptake mechanism (Fig 1) [5] Under this pro-cess, the endocytosed enveloped particles subsequently fuse with a vesicular membrane Similar interactions between viral gB, gD, gH, gL and host cell receptors are expectedly mirrored within an intracellular vesicle such as an endosome to facilitate the fusion The gD receptor has been colocalized with endosomal markers and electron micrographs show the fusion and exit of nuclecapsids from the endosomes [5] Interestingly, unlike other bacterial and viral entry mechanisms, HSV-1 endocytosis does not appear to be mediated

by clathrin-coated pits or caveolae Furthermore, although endosomes provide an acidic background that may augment viral infectivity in certain cell types, this

pH dependency is not required in all cell lines [20–22] The choice between endocytosis and fusion at the plasma membrane appears to depend on individual cell types In Vero and Hep2 cells, fusion at the plasma membrane is the mechanism of choice; however, in cell types such as CHO, HeLa, RPE, human epidermal keratinocytes and human conjunctival epithelial cells, evidence of endocytosis of virions has been observed [11,21,22] Interestingly, gD was shown to down-regu-late nectin-1 in cells utilizing endocytosis in HSV-1

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entry, such as HeLa cells [23] By contrast, this

down-regulation was not seen in cells where HSV fuses at the

plasma membrane, such as in Vero cells This suggests

that the gD⁄ nectin-1 interaction is a possible factor in

the cell-type specific mode of HSV-1 internalization

Cellular receptors for gD

The main receptors that gD utilizes for cell entry are

nectin-1, nectin-2, HVEM and 3-O HS HSV-1 and

HSV-2 differ in their preference of gD receptor types

HVEM and nectin-1 are utilized by both virus types;

however, 3-O HS can only be used by HSV-1

Simi-larly, nectin-2 has not been shown to allow substantial

wild-type HSV-1 entry and it may have a greater effect

on HSV-2 entry [3]

Various cell types rely on different gD receptors for

HSV-1 entry: T lymphocytes and trabecular meshwork

cells utilize HVEM, whereas neuronal and epithelial

cells require nectin-1 [3,24] The dependence of HSV-2

on nectin-1 and HVEM for entry and spread in vivo

has been successfully demonstrated using single and

double knockout mice [25] 3-O HS, which is not a

receptor for HSV-2, appears to play a major role in

HSV-1 entry into primary cultures of corneal

fibro-blasts [26] Because 3-O HS is the most recently

dis-covered and perhaps least understood gD receptor, a

relatively detailed analysis of 3-O HS is presented

below

HS essentially represents a structurally diverse

family of polysaccharides sharing a common backbone

structure with varying degrees of additional modifica-tions and funcmodifica-tions [27] Demonstrating its structural complexity, HS, which is essentially a polymer of repeating disaccharide units containing a glucosamine and a glucuronic acid residue (Fig 3), is expressed in a variety of chain lengths with varying degrees of addi-tional modifications on the cell surfaces and extracellu-lar matrices of almost all cell types [27] It is an important attachment receptor shared by many patho-genic viruses, including all human herpesviruses except Epstein–Barr virus [1] The significance of HS is partic-ularly higher for HSV-1 because, in addition to attach-ment, it can also mediate membrane penetration by HSV-1 virions [7] Although a relatively less modified backbone HS chain can facilitate HSV attachment, a highly modified version, 3-OS HS, is required for interaction with gD and for independently triggering membrane fusion during entry and cell-to-cell spread processes [7,28,29] This fusion triggering 3-OS HS is generated after numerous modifications, including 2-O-, 6-O- and 3-O sulfations and epimerization (Fig 3) [7,27] The final step of parent chain sulfation to create 3-O HS is performed by a number of 3-O sulfotrans-ferase (3-OST) isoforms: 3-OST-1, -2, -3A, -3B, -4, -5 and -6 [1,30] Each isoform may demonstrate cell-type specific expression patterns and may produce a unique 3-OS HS chain with uniquely different functions 3-OST-1 creates 3-O HS with anti-thrombin binding sites and no gD binding activity, whereas other iso-forms such as 3-OST-2, -3, -4 and -6, create iso-forms of 3-O HS that can act as gD receptors [1,7,30] Their

6-O

S

6-O

S

6-O

S

6-O

S

6-O

S

6-O

S

6-O

3-O sulfotransferase 6-O sulfotransferase 2-O sulfotransferase

N-deacetylase, N-sulfotransferase, epimerase

S

6-O

S

3-O S

S N

S N S

N

2-O

S 2-O

S

N

S

2-O

S

N

S

N S

2-O

S

N

S

2-O

S

N

S

N multiple copies

= Glucose

= Galactose

= Xylose

= Serine

= α-linkage

= β-linkage

= Glucuronic acid

= Iduronic acid

S

2-O

S

N

S

2-O

S

2-O N

S

N

Fig 3 Outline of HS maturation A number

of listed enzymes participate in the modifi-cation of the parent chain HS, which is a polymer of repeating disaccharide units containing a glucosamine and a glucuronic acid residue All possible modifications and their preferred sequences (arrows) are shown.

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individual physiological functions are yet not well

known

A 3D structure for 3-O HS interaction with gD has

been suggested [15] The crystal structure of gD contains

a positively-charged deep pocket and a flat region with

clusters of basic amino acid residues Mutagenesis

stud-ies indicate that the pocket proximal to N-terminus may

have a role in 3-OS HS binding because mutations in

this region affect 3-OS HS usage by HSV-1 [31]

Inter-estingly, the same mutations also affect HVEM usage

but not nectin-1 Thus, it is quite possible that at least

one 3-OS HS binding region of gD may overlap with

HVEM binding sites [15,31] Efforts have also been

made to identify the structural specificity within HS that

is required for gD binding Apart from a 3-O sulfated

glucosamine, an upstream 2-O sulfated iduronic acid

appears to be required as well [7] To define the

mini-mum size requirement for this interaction, a 3-O sulfated

octasaccharide was generated [32] This octasaccharide

binds gD and demonstrates an inherent ability to block

gD-triggered cell-to-cell fusion Because the fusion was

blocked in cells that may or may not use 3-OS HS as the

major receptor for entry, it again suggests that 3-OS HS

binding sites may overlap with other receptor (HVEM

and possibly nectin-1) binding sites on gD Another

interesting property of 3-OS HS is that HSV-2 gD

fails to use it as a receptor for entry [7] Indeed, even for

the attachment process, HSV-2 demonstrates many

dif-ferences in the HS structure recognition than HSV-1

[33] It remains to be determined whether the inability to

use 3-OS HS and additional differences in HS binding

may have a role in the tissue tropism shown by the two

HSV serotypes

Paired immunoglobulin-like receptor

(PILR)-a: a new receptor for HSV-1 gB

Although viral attachment to cells shows strong

depen-dence on the interactions of gB and gC with HS,

stud-ies have also shown that cells without HS are still

susceptible to low-efficiency HSV-1 infection and

retain the ability to bind soluble gB [34,35] The

sug-gestion that there may be other receptors interacting

with gB was upheld by a recent finding regarding the

ability of gB to act as a ligand for PILR-a, one of the

paired inhibitory receptors found on monocytes,

mac-rophages and dendritic cells [19] CHO-K1 cells,

natu-rally resistant to HSV-1 infection, demonstrate

susceptibility to infection after transfection with

PILR-a plPILR-asmid HumPILR-an cell lines expressing both HVEM

and PILR-a experienced decreased viral entry when

antibodies to either PILR-a or HVEM were used,

supporting a separate need for both receptors

Additionally, PILR-a contains a tyrosine-based motif in its cytoplasmic domain that delivers inhibitory signals to the host cell Thus, by interacting with this inhibitory receptor, gB may allow HSV-1 to escape host immune system recognition via suppression at the same time exploiting the receptor for viral entry The most current notion with respect to HSV-induced membrane fusion may include PILR-a as an important and a balancing component of the fusion machinery [36] Interestingly, HSV-2 entry may not be so strongly dependent on PILR-a as a co-receptor, as shown for RPE cells [37] and further confirmed by additional findings [38]

HSV-1 binding mediated by PILR-a also appears to mediate cell–virus fusion at the plasma membrane Susceptible CHO cells utilize only endocytosis as an HSV entry mechanism However, after inhibiting endo-cytosis and transfecting CHO cells with PILR-a, HSV-1 entry was still possible, presumably at the plasma membrane [38] Therefore, PILR-a may be responsible for an alternate, but poorly understood, plasma membrane fusion mechanism of entry (Fig 2)

It is likely that PILR-a mediated fusion is a gD-depen-dent process that may not require a gD receptor as an essential component Most recent studies appear to indicate that PILR-a plays a role both in binding and fusion; however, additional studies are needed to better elucidate the importance of this receptor

Additional receptors for HSV entry

A few cell surface molecules have been implicated as putative HSV-1 gH receptors These include B5 and avb3 integrins [39,40] Expression cloning in porcine kidney cells resistant for HSV-1 entry has led to the discovery of B5, a type-2 membrane protein containing

an extracellular heptad repeat potentially capable of forming an a-helix for coiled-coils [39] Such structures may facilitate membrane fusion by interacting with viral proteins containing a-helices A synthetic peptide identical to the heptad repeat region blocks HSV infec-tion of B5-expressing porcine cells and human HEp-2 cells, suggesting a possible role for B5 in HSV-1 entry Because gH also contains an a-helix, it is speculated that it may be a ligand for B5 [39] No direct interac-tion between B5 and gH has been demonstrated to date By contrast, in a separate study, a soluble form

of gH-gL heterodimer was found to specifically bind cells expressing avb3 integrins, although the effect of this interaction on HSV-1 entry remains elusive [40] The binding appears to be highly specific because it can be prevented by mutating a potential integrin-binding motif, Arg-Gly-Asp (RGD), in gH Again,

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additional studies are needed to determine and

estab-lish the significance of potential gH receptors

Cell-to-cell viral spread

HSV-1 virus is also unique in that the spread of

infec-tion is not dependent on a hematogenous or lymphatic

route Cell-to-cell contact is essential in HSV-1 and

HSV-2 infection and elucidating the mechanism of

cell-to-cell spread is important for fully understanding

the overall viral infectious process Viral spread from

cell-to-cell depends on the same gD interaction with its

receptor(s) as that observed when free virions initially

infect a host cell [41] Interestingly, gE and gI are

glycoproteins that form a heterodimer required for

cell-to-cell spread but are not required for the initial

entry of free virus particles [42] During HSV infection,

the gE⁄ gI heterodimers move from the trans-Golgi

network to epithelial cell junctions along with other

viral glycoproteins and virion particles Removing the

gene responsible for the early sorting through the

TGN prevents subsequent cell-to-cell spread and

viri-ons are observed to travel towards the apical surface

instead of toward cell–cell junctions Assortment

through the TGN early in infection was found to be

necessary for efficient cell-to-cell spread of HSV-1 In

addition, gK has also been shown to play an essential

role in cell-to-cell spread in corneal and trigeminal

ganglia cells, comprising two cell lines that lead to the

more devastating consequences of diseases such as

blindness and meningitis [43] Mice infected with

mutated virus with the gene for gK deleted were

dem-onstrated a significantly decreased corneal spread and

also had decreased clinical signs of infection

Nectin-1 helps induce HSV-1 cell-to-cell spread

AF6, a multidomain protein that interacts with

nectin-1, leads to decreased cell-to-cell HSV-1 spread when

knocked down [44] Similar to nectin-1, this protein is

also involved in cell–cell adhesion and is found at cell

junctions Interestingly, AF6 knockdown does not

affect the nectin-1 clustering that occurs at junctions

for cell-to-cell transmission Therefore, nectin-1

recep-tor clustering appears to take place independently of

expression of the gene for AF6 and the clustering is

insufficient for cell-to-cell spread

Although 3-O HS has been shown to act as an gD

entry receptor for free virions fusing at the plasma

membrane, 3-O HS has also been shown to play a role

in cell-to-cell fusion and spread [28] Previously,

HVEM and nectin-1 expression were considered to be

required for cell-to-cell spread [41] However, more

recent studies imply that 3-O HS can also mediate

cell-to-cell fusion, which is required during spread Cells

expressing gB, gD, gH and gL, and therefore mimick-ing the essential viral machinery for membrane fusion, were able to fuse with 3-O HS-expressing cells [28] Importantly, these cells expressed neither nectin-1 nor HVEM When heparinase was used to eliminate the total HS, cell-to-cell fusion was dramatically decreased

In separate studies, it was found that 3-OS HS is cru-cial for the HSV-1-induced cell-to-cell fusion observed with primary cultures of corneal fibroblasts [45] Therefore, the role of 3-O HS may be more extensive with respect to the process of viral entry and spread than previously thought

Conclusions HSV-1 and HSV-2 both utilize similar mechanisms of binding, fusion and subsequent cell-to-cell spread Although fewer studies have been performed on HSV-2, the two viruses share 82% of their amino acid sequence and demonstrate high structural similarities [1] Therefore, many of the concepts developed for HSV-1 are likely to be applicable for HSV-2, although further confirmation is needed Different glycoproteins play unique key roles in the infectious cycle Binding can be initiated on filopodia with the interaction of gC and gB; however, subsequent fusion and penetration utilize gB, gD, gH and gL Entry can directly occur at the plasma membrane or via an intracellular vesicle Fusion appears to be mediated by fusogenic regions of

gB and gH triggered by the interaction of gD with its receptor Finally, cell-to-cell spread utilizes gD recep-tors, all fusion essential glycoproteins, the gE⁄ gI heterodimer and gK Clearly, significant advances have been made in our quest to understand the mechanism

of HSV entry, although many areas still remain poorly understood For example, the role of cellular signaling pathways is poorly defined Activation of Rho signaling has been demonstrated [5,46], as has the involvement

of focal adhesion kinases [47], although a complete picture is yet to emerge It is also unclear why the virus undergoes endocytosis when identical receptors can promote fusion at the plasma membrane A better understanding of how the virus fuses with a vesicular membrane is also needed For commonly spreading viruses such as HSV, such studies would have a high impact In lieu of a protective vaccine [2], efficient microbicides or prophylactics can be designed by devel-oping a better understanding of virus entry mecha-nisms Spread of the virus within a host can be contained by antiviral agents that target membrane fusion required for the spread Similarly, targeting shared entry phenomena, such as surfing, can lead to the production of broad-spectrum antiviral agents In

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summary, viral entry is an important area of research

with strong potential for identifying new strategies

aim-ing to prevent epidemic and pandemic viral diseases

caused by HSV, HIV, papilloma, influenza and many

additional viruses Continuing research in this area can

lead to a greater understanding of the disease process

and new treatments for viral diseases

Acknowledgements

The authors thank Dr Beatrice Yue (UIC) for critically

reading the manuscript The work described here that

was performed in the laboratory of D Shukla was

supported by a NIH RO1 grant AI057860 and a NIH

core grant EY01792 D.S is a recipient of Lew

Wasserman Merit award from Research to Prevent

Blindness, New York, NY, USA

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