Primary microcephaly is a severe brain malformation characterized by the reduction of the head circumference. Patients display a heterogeneous range of brain impairments that compromise motor, visual, hearing, and cognitive functions (
1).
Microcephaly is associated with decreased neuronal production as a consequence of proliferative defects and death of cortical progenitor cells (
2). During pregnancy, the primary etiology of microcephaly varies from genetic mutations to external insults. The so-called TORCHS factors (toxoplasmosis, rubella, cytomegalovirus, herpes virus, and syphilis) are the main congenital infections that compromise brain development in utero (
3).
An increase in the rate of microcephaly in Brazil has been associated with the recent outbreak of Zika virus (ZIKV) (
4,
5), a flavivirus that is transmitted by mosquitoes (
6) and sexually (
7–
9). So far, ZIKV has been described in the placenta and amniotic fluid of microcephalic fetuses (
10–
13) and in the blood of microcephalic newborns (
11,
14). ZIKV had also been detected within the brain of a microcephalic fetus (
13,
14), and recently, direct evidence has emerged that ZIKV is able to infect and cause the death of neural stem cells (
15).
We used human induced pluripotent stem (iPS) cells cultured as neural stem cells (NSCs), neurospheres, and brain organoids to explore the consequences of ZIKV infection during neurogenesis and growth with three-dimensional culture models. Human iPS-derived NSCs were exposed to ZIKV [multiplicity of infection (MOI), 0.25 to 0.0025]. After 24 hours, ZIKV was detected in NSCs (
Fig. 1, A to D); viral envelope protein was evident in 10.10% (MOI, 0.025) and 21.7% (MOI, 0.25) of cells exposed to ZIKV (
Fig. 1E). Viral RNA was also detected in the supernatant of infected NSCs (MOI, 0.0025) by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) (
Fig. 1F), providing evidence of productive infection.
To investigate the effects of ZIKV during neural differentiation, mock- and ZIKV-infected NSCs were cultured as neurospheres. After 3 days in vitro (DIV), mock-infected NSCs generated round neurospheres. However, ZIKV-infected NSCs generated neurospheres with morphological abnormalities and cell detachment (
Fig. 2B). After 6 DIV, hundreds of neurospheres grew under mock conditions (
Fig. 2, C and E). In ZIKV-infected NSCs (MOI, 2.5 to 0.025), only a few neurospheres survived (
Fig. 2, D and E).
Mock-infected neurospheres presented the expected ultrastructural morphology of the nucleus and mitochondria (
Fig. 3A). Viral particles were present in ZIKV-infected neurospheres, similar to those observed in murine glial and neuronal cells (
16). ZIKV was bound to the membranes and observed in mitochondria and vesicles of cells within infected neurospheres (arrows in
Fig. 3, B and F). Apoptotic nuclei, a hallmark of cell death, were observed in all ZIKV-infected neurospheres that we analyzed (
Fig. 3B). ZIKV-infected cells in neurospheres presented smooth membrane structures (
Fig. 3, B and F), similar to other cell types infected with dengue virus (
17). These results suggest that ZIKV induces cell death in human neural stem cells and thus impairs the formation of neurospheres.
To further investigate the impact of ZIKV infection during neurogenesis, human iPS-derived brain organoids (
18) were exposed to ZIKV and observed for 11 DIV (
Fig. 4). The growth rates of 12 individual organoids (six mock- and six ZIKV-infected) were measured during this period (
Fig. 4, A to D). As a result of ZIKV infection, the average growth area of ZIKV-exposed organoids was reduced by 40% compared with brain organoids under mock conditions [0.624 ± 0.064 mm
2 for ZIKV-exposed organoids versus 1.051 ± 0.1084 mm
2 for mock-infected organoids (normalized);
Fig. 4E].
We used cells infected with dengue virus 2 (DENV2), a flavivirus with genetic similarities to ZIKV (
11,
19), as a second control group in addition to the mock infection group. One day after viral exposure, DENV2 infected human NSCs at a similar rate as that of ZIKV (fig. S1, A and B). However, after 3 DIV, there was no increase in caspase 3/7–mediated cell death induced by DENV2 at the same MOI of 0.025 that was used for ZIKV infection (fig. S1, C and D). In contrast, ZIKV induced caspase 3/7–mediated cell death in NSCs, consistent with the results described by Tang and colleagues (
15). After 6 DIV, cell viability significantly differed between ZIKV-exposed NSCs and DENV2-exposed NSCs (fig. S1, E and F). In addition, neurospheres exposed to DENV2 displayed a round morphology similar to that of uninfected neurospheres after 6 DIV (fig. S1G). Last, there was no reduction of growth in brain organoids that were exposed to DENV2 for 11 days, relative to those grown under mock conditions [1.023 ± 0.1308 mm
2 for DENV2-infected organoids versus 1.011 ± 0.2471 mm
2 for mock-infected organoids (normalized); fig. S1, H and I]. These results suggest that the deleterious consequences of ZIKV infection in human NSCs, neurospheres, and brain organoids are not a general feature of the flavivirus family. Neurospheres and brain organoids are complementary models for studying embryonic brain development in vitro (
20,
21). Whereas neurospheres present the very early characteristics of neurogenesis, brain organoids recapitulate the orchestrated cellular and molecular early events comparably to the first-trimester fetal neocortex, including gene expression and cortical layering (
18,
22). Our results demonstrate that ZIKV induces cell death in human iPS-derived NSCs, disrupts the formation of neurospheres, and reduces the growth of organoids (fig. S2). These models mimic the first trimester of brain development, indicating that ZIKV infection during this developmental time window may result in severe damage. Other studies are necessary to further characterize the consequences of ZIKV infection during different stages of fetal development.
Cell death that impairs brain enlargement, calcification, and microcephaly are well described in congenital infections with TORCHS factors (
3,
23,
24). Our results, together with recent studies showing brain calcification in microcephalic fetuses and newborns infected with ZIKV (
10,
14), reinforce the growing body of evidence connecting the ZIKV outbreak to the increased reports of congenital brain malformations in Brazil.
Acknowledgments
The authors thank the laboratory crew members M. Costa, I. Gomes, G. Vitória, J. Sochacki, R. Maciel, and M. Alloati for providing technical support and cultures of human iPS cells and brain organoids. We acknowledge O. M. Barth for comments on the electron micrographs. We also thank F. Pamplona for assistance with the Mind the Graph science infographic maker and Centro Nacional de Biologia Estrutural e Bioimagem for the use of their electron microscopy facility. Funds (not specifically for Zika virus studies) were provided by the Brazilian Development Bank; the Funding Authority for Studies and Projects; the National Council of Scientific and Technological Development; the Foundation for Research Support in the State of Rio de Janeiro; and fellowships from the São Paulo Research Foundation (grant 2014/21035-0) and Coordination for the Improvement of Higher Education Personnel. All protocols and procedures were approved by the institutional research ethics committee of Hospital Copa D'Or under approved protocol no. 727.269. The authors declare no competing financial interests.