2Zika virus (ZIKV), a recently emerged flaviviral pathogen, has been linked to 3 microcephaly in neonates 1 . Yet, it is not understood why some fetuses develop severe 4 microcephaly due to maternal ZIKV infection while others do not. The risk for ZIKV-5 induced microcephaly is greatest during the first trimester of pregnancy in humans 2,3 , yet 6 this alone cannot account for the varied presentation of microcephaly observed. Given 7 the antigenic similarity between ZIKV and closely related dengue virus (DENV) 4 , 8 combined with the substantial immunity to DENV in ZIKV target populations in recent 9 outbreaks, we hypothesized that maternal antibodies against DENV could promote ZIKV-10 induced microcephaly. Here, using immune-competent mice, we show that maternal to 11 fetal transmission of ZIKV occurs, leading to fetal infection and disproportionate 12 microcephaly. DENV-specific antibodies in pregnant female mice enhance vertical 13 transmission of infection and result in a severe microcephaly like-syndrome during ZIKV 14 infection. Furthermore, fetal infection was promoted by the neonatal Fc receptor (FcRN).15 Our results identify a novel immune-mediated mechanism of vertical transmission of 16 viral infection and raise caution since ZIKV epidemic regions are also endemic to DENV. 17 18 19 Zika virus (ZIKV) belongs to the family of Flaviviridae, which includes other arboviruses, 21 such as dengue virus (DENV), Japanese encephalitis virus (JEV) and West Nile virus 4 . ZIKV
22unexpectedly surfaced recently as a major public health concern due to the ongoing and 23 spreading epidemic in South and Central America and the realization that it could cause birth 24 defects and neurological complications 3,5 . In a recent study the rate of neurologic and ocular 25 defects in fetuses born to ZIKV infected mothers were calculated to be ~7% 6 . Rarely, adults 26 experience ZIKV-induced Guillain Barré syndrome 7 , but the congenital ZIka syndrome in infants 27 that includes a spectrum of neurological defects, including microcephaly, is the most 28 devastating and pressing aspect of ZIKV infection 8 . It is suggested that the risk of microcephaly 29 is higher in the fetus when mothers are exposed to ZIKV during first trimester of pregnancy 3,6 .
30Some studies have reported the direct effects of ZIKV infection on neuronal tissue damage 9,10 .
31However, not all ZIKV infections during pregnancy appear to result in brain abnormality during 32 embryonic development and the mechanisms that lead to microcephaly in some fetuses but not 33 others are not yet understood.Interestingly, ZIKV epidemic regions are often endemic for other Flavivirus infections, 1 particularly DENV. Due to the structural similarities between ZIKV and DENV 11,12 , antibodies 2 raised against one of the viruses are able to cross react with the others 12,13 . It is thought that 3 DENV antibodies can potentially lead to antibody-dependent enhanced replication (ADE) of 4 ZIKV in infected patients 14 , which has been shown through in vitro assays 13 . The res...