Oxidative Stress and Interferon Signaling Drive Differential Pathogenesis of Ancestral and Contemporary Zika Viruses in Human Cerebral Organoids

Neurotropic Zika viruses (ZIKV) cause serious human disease with pandemic potential. Pathogenesis severities resulting from Asian/American versus African ZIKV lineage infections range from mild to severe, respectively; however, mechanisms underlying differential ZIKV pathogenesis remain unclear, as do effective therapeutic strategies. The limitations of mechanistic understanding are due in part to the challenges of comparing data generated in disparate experimental models, as well as approaches that did not test both ancestral and contemporary ZIKV infections. The goal of this work was to define differential pathogenesis mechanisms among ancestral and contemporary ZIKVs by direct infection comparisons using a relevant human stem cell-derived cerebral organoid experimental model. While Asian/American ZIKV lineage infections enhanced antiviral and interferon gene expression responses that correlated with viral RNA clearance from organoid ventricles, ancestral African lineage ZIKV infections enhanced apoptotic and stress response signaling that correlated with diminished STAT2 signaling protein levels, ongoing ZIKV replication, and production of damaging reactive oxygen species (ROS). We discovered that, surprisingly, severe ancestral Zika virus pathogenesis was dramatically reduced by Trolox, a hydroxyl radical scavenger antioxidant, thereby confirming ROS imbalance as a major pathogenesis driver. These results demonstrate that ZIKV lineage infections and pathogenesis are differentiated by their signaling responses and suggest that preventing or controlling hydroxyl radical imbalance may offer therapeutic benefits to address microcephaly and Congenital Zika Virus Syndrome.