Pathogenesis and immune response: Edited by Dennis L. StevensMechanisms of shock in hantavirus pulmonary syndromeAbel Borges, Alessandraa; Figueiredo, Luiz Tadeu MbAuthor Information aVirology Research Unit, University of South of Santa Catarina (UNISUL), Tubarão, Santa Catarina State, Brazil bVirology Research Center, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo State, Brazil Correspondence to Dr Alessandra Abel Borges, School of Medicine, University of South of Santa Catarina (UNISUL), Av José Acácio Moreira, 787, Tubarão, SC 88704-900, Brazil Tel: +55 48 3621 3253; fax: +55 48 3621 3319; e-mail: [email protected] Current Opinion in Infectious Diseases: June 2008 - Volume 21 - Issue 3 - p 293-297 doi: 10.1097/QCO.0b013e3282f88b6f Buy Metrics Abstract Purpose of review Despite abundant literature on hantavirus, few reports have focused on the shock in hantavirus pulmonary syndrome. This review approaches recent advances that allow us to better understand the pathogenesis of hantavirus pulmonary syndrome shock. Recent findings Hantavirus pulmonary syndrome has been studied in a hamster model that mimics human shock and respiratory failure. In-vitro experiments show that pathogenic hantaviruses are able to inhibit antiviral responses, and that cytotoxicity of hantavirus-specific T cells enhances the permeability of infected endothelial cells. The idea that the primary cardiac lesion of shock is mostly functional has been shaken by the report of a typical myocarditis in hearts from human hantavirus pulmonary syndrome fatal cases. The involvement of regulatory T cells on hantavirus persistence in its rodent reservoir suggests that these cells could protect from severe hantavirus pulmonary syndrome and shock. Summary Hantavirus pulmonary syndrome shock is probably related to an exacerbated immune response of CD8+ T cells producing cytotoxicity on infected endothelial cells, presence of myocarditis and myocardial depression induced by nitric oxide. The virulence elements in G1 glycoprotein could also contribute to shock. Active suppression of immune T regulatory cells is probably involved in hantavirus pulmonary syndrome pathogenesis. These are all new aspects of hantavirus pulmonary syndrome pathogenesis that stimulate further studies to elucidate mechanisms of shock and to develop effective treatment strategies. © 2008 Lippincott Williams & Wilkins, Inc.