Reactivation from HSV-1 latent sensory ganglionic neurons such as the TG can lead to peripheral shedding of infectious virus that could manifest in the eye as debilitating recurrent, epithelial, ulcerative, and/or stromal keratitis causing corneal scarring, thinning, and neovascularization.
9 HSV-1 encephalitis is the most common cause of sporadic fatality and an estimated two thirds of such cases are most likely the result of viral reactivation from latency.
10,11 Therapies for HSK are not entirely successful, because many patients either do not respond to intensive combination therapy or have rapid recurrence.
12 Therapeutic application of HD inhibitors for central nervous system disorders has also been studied.
13 Recently, we have shown that HSV-1 infection of human brain cells induces microRNA, miRNA-146a, and AD-type inflammatory signaling.
14 The HSV-1 lifecycle after initial infection alternates between a productive phase of approximately 2 weeks
15 and a distinguishable latency phase,
11,16 –20 in the latter of which the only abundant viral transcript is the non–protein-encoding LAT.
21 –23 LAT is not crucial for the establishment or maintenance of latency.
24 –26 It has been reported to enhance latency in rabbits.
27 However, it is essential for efficient spontaneous reactivation of HSV-1 from latency.
28,29 Reactivation of the latent HSV-1 genome has been linked to a reactivation critical region (RCR) including the LAT core promoter through the LAT 5′ exon/enhancer, because recombinants deficient in this region show greatly reduced reactivation phenotypes.
23,30 –33 LAT overlaps the infected cell protein 0 (
ICP0), an immediate-early (IE) regulatory gene, and is transcribed off the opposite DNA strand. LAT is required for efficient HSV reactivation in animal models. A proposed function of LAT is the suppression of the nearby lytic phase transcripts,
ICP0, g34.5 virulence gene, and infected cell protein 4 (
ICP4), through unidentified mechanisms, thus promoting the establishment and maintenance of latency.
23,34 ICP0 is essential for productive HSV-1 replication
35 and is thought to have a role in reactivation from latency.
36 LAT could act to suppress IE genes. Apart from putative LAT-mediated suppression of lytic transcripts during latency, host molecular/immune mechanisms could contribute to the establishment of latency.
37