bDengue viruses (DENV) are transmitted to humans by the bite of Aedes aegypti or Aedes albopictus mosquitoes, with millions of infections annually in over 100 countries. The diseases they produce, which occur exclusively in humans, are dengue fever (DF) and dengue hemorrhagic fever (DHF). We previously developed a humanized mouse model of DF in which mice transplanted with human hematopoietic stem cells produced signs of DENV disease after injection with low-passage, wild-type isolates. Using these mice, but now allowing infected A. aegypti to transmit dengue virus during feeding, we observed signs of more severe disease (higher and more sustained viremia, erythema, and thrombocytopenia).
Dengue fever (DF) in humans is characterized by fever, myalgia, arthralgia, abdominal pain, rash, low platelet counts (thrombocytopenia), and a viremia that begins 3 to 4 days after infection by mosquito bite. The more severe form of dengue, dengue hemorrhagic fever (DHF), usually presents as a second phase of disease, at the end of the fever stage, but with a sudden onset of plasma leakage that can result in hemoconcentration, pleural effusion, ascites, shock, hepatic failure, and encephalopathy. While this hemodynamic syndrome can resolve in 2 days, complete convalescence can take weeks to months (reviewed in reference 53). Moreover, ϳ5% of DHF patients die, usually from hypotensive shock, due to a delay in the recognition and treatment of the plasma leakage. Dengue virus (DENV)-induced disease has increased markedly due to the global spread of the virus and expansion of its mosquito vectors, and it is now the most important viral illness transmitted by insects (61). However, a clear understanding of the mechanisms leading to DF and DHF has been limited by several factors: (i) inadequate animal models of disease, with most knowledge being derived from clinical studies and in vitro experiments; (ii) the genetic diversity of DENV, with four different antigenic groups or serotypes and with humans potentially infected multiple times; and (iii) the relative risk of severe DENV disease, which is enhanced greatly by secondary infection with a heterologous serotype. The last factor has prompted the development of several models of immunopathogenesis (reviewed in reference 47) that have been difficult to evaluate experimentally, given the absence of reliable immunocompetent-animal models of human disease presenting with clinical signs of DHF after serial infection with wild-type viruses.We sought to produce an animal model of disease that could mimic the natural cycle of mosquito-human transmission with low-passage-number viruses from clinical samples, using human cells as targets of infection within a neutral background of nonsusceptible tissues (mouse) and using the appropriate species of mosquito vector, to evaluate the influence of biting/probing, virus delivery, and saliva proteins on DENV pathogenesis. Using humanized NOD/SCID/interleukin 2 receptor gamma (IL-2R␥)-null (hu-NSG) mice that had previously defined differences in th...