Rsity School of Medicine and infected with dengue virus in vitro. To our surprise, not only were human BM cells easier to infect with the virus, but, in addition, the levels of virus in the supernatant fluid could reach as high as 109 viral RNA copies per ml, which is similar to the level of viral load in the peripheral blood of dengue patients (Figure 5A). Similar results were also noted in the levels of NS1 in the same supernatants (Figure 5B). Importantly, the pattern of the average focus forming unit (FFU) viral titer was similar but lower than that of the viral RNA titer determined by qRT-PCR assays, peaking on day 3 after infection (Figure S4). The higher viral titers and the detection of NS-1 documented in human BM cultures was statistically significant (Figure 6). BM smears prepared from the human BM cell cultures at different times post-infection were similarly order P7C3 stained withmonoclonal antibodies specific to dengue viral antigen and cell surface markers as described above. Results revealed that cells with the megakaryocytic characteristic/marker were positive for dengue viral antigen (Figure 7A and 7B). Viral antigen containing vesicles shedding from a megakaryocyte with a multi-lobulated nucleus were routinely observed (Figure 7A).Electron Microscopy StudiesElectron microscopy (EM) studies were performed on aliquots of bone marrow cell cultures collected on different days after infection. As seen in Figure 8, viral particles appear primarily within multi-lobulated cells (Figure 8), with viral replication complexes visible on day one (Figure 8B) and large numbers of virions present within the cytoplasm by day 3 post-infection (Figure 8C and 8D). As seen, viral particle-containing vesiclesDengue Virus Infection in Bone MarrowFigure 8. Viral particles are present in megakaryocytes from the human bone marrow. Sample preparations for EM studies were performed as described in the Methods. (A) Uninfected control. (B) Cellular vesicle containing viral particles (single particle, red arrow; cluster of viral particles, blue arrow) inside a diploid megakaryocyte on day one post-infection. (C) Large numbers of viral particles inside the cytoplasm of a multilobulated megakaryocyte on day three post-infection. (D) Cytoplasm containing many virus 24195657 particles shedding off in a vesicle (red arrow). (E) A virioncontaining vesicle (dash circle) at the vicinity of an activated mononuclear cell. (F) Virion containing vesicle (V) fusing with a monocyte (M). A zipper junction (blue arrow) is indicated. No viral particles were observed in the monocytes. A scale bar is 0.2 mM. doi:10.1371/journal.pone.0052902.gappear to be shedding from the cytoplasm (Figure 8D and 8E). We infer that these virus-containing vesicles become engulfed by phagocytic cells at later times post-infection (Figure 8F). EM studies also suggest that phagocytic cells, such as MC-LR chemical information monocytes, are highly activated, featuring numerous vacuoles as early as day one post infection (Figure S5A and S5B). However, virus-like particles were not detectable at this time point in these mononuclear cells (Figure S5C and S5D). In contrast, at later time points post infection, these cells appear to engulf vesicles containing viralparticles (Figure S6A and S6B), which seemed to infiltrate the phagocytic cell cytoplasm upon plasma membrane fusion (Figure S6C). The morphology of the viral particles is unclear in these phagocytic cells and are likely degenerated (Figure S6D).Colony Forming Unit (CFU) AssaysNu.Rsity School of Medicine and infected with dengue virus in vitro. To our surprise, not only were human BM cells easier to infect with the virus, but, in addition, the levels of virus in the supernatant fluid could reach as high as 109 viral RNA copies per ml, which is similar to the level of viral load in the peripheral blood of dengue patients (Figure 5A). Similar results were also noted in the levels of NS1 in the same supernatants (Figure 5B). Importantly, the pattern of the average focus forming unit (FFU) viral titer was similar but lower than that of the viral RNA titer determined by qRT-PCR assays, peaking on day 3 after infection (Figure S4). The higher viral titers and the detection of NS-1 documented in human BM cultures was statistically significant (Figure 6). BM smears prepared from the human BM cell cultures at different times post-infection were similarly stained withmonoclonal antibodies specific to dengue viral antigen and cell surface markers as described above. Results revealed that cells with the megakaryocytic characteristic/marker were positive for dengue viral antigen (Figure 7A and 7B). Viral antigen containing vesicles shedding from a megakaryocyte with a multi-lobulated nucleus were routinely observed (Figure 7A).Electron Microscopy StudiesElectron microscopy (EM) studies were performed on aliquots of bone marrow cell cultures collected on different days after infection. As seen in Figure 8, viral particles appear primarily within multi-lobulated cells (Figure 8), with viral replication complexes visible on day one (Figure 8B) and large numbers of virions present within the cytoplasm by day 3 post-infection (Figure 8C and 8D). As seen, viral particle-containing vesiclesDengue Virus Infection in Bone MarrowFigure 8. Viral particles are present in megakaryocytes from the human bone marrow. Sample preparations for EM studies were performed as described in the Methods. (A) Uninfected control. (B) Cellular vesicle containing viral particles (single particle, red arrow; cluster of viral particles, blue arrow) inside a diploid megakaryocyte on day one post-infection. (C) Large numbers of viral particles inside the cytoplasm of a multilobulated megakaryocyte on day three post-infection. (D) Cytoplasm containing many virus 24195657 particles shedding off in a vesicle (red arrow). (E) A virioncontaining vesicle (dash circle) at the vicinity of an activated mononuclear cell. (F) Virion containing vesicle (V) fusing with a monocyte (M). A zipper junction (blue arrow) is indicated. No viral particles were observed in the monocytes. A scale bar is 0.2 mM. doi:10.1371/journal.pone.0052902.gappear to be shedding from the cytoplasm (Figure 8D and 8E). We infer that these virus-containing vesicles become engulfed by phagocytic cells at later times post-infection (Figure 8F). EM studies also suggest that phagocytic cells, such as monocytes, are highly activated, featuring numerous vacuoles as early as day one post infection (Figure S5A and S5B). However, virus-like particles were not detectable at this time point in these mononuclear cells (Figure S5C and S5D). In contrast, at later time points post infection, these cells appear to engulf vesicles containing viralparticles (Figure S6A and S6B), which seemed to infiltrate the phagocytic cell cytoplasm upon plasma membrane fusion (Figure S6C). The morphology of the viral particles is unclear in these phagocytic cells and are likely degenerated (Figure S6D).Colony Forming Unit (CFU) AssaysNu.