During the 20th century, humans experienced three influenza pandemics, each resulting in significant global mortality: 20 to 40 million deaths in 1918 (Spanish influenza), 1 to 4 million deaths in 1957 (Asian influenza), and 1 to 4 million deaths in 1968 (Hong Kong influenza) . In addition, the pandemic (H1N1) 2009 virus has spread rapidly around the world since spring of 2009; and HPAI viruses have been circulating worldwide since late 2003. Although HPAI viruses are not yet efficiently transmitted to or among humans, their sustained proliferation and continued genetic evolution in avian species, combined with parallel infections in humans, makes this an eventual possibility.
Some patients infected with either 2009 pandemic H1N1 or HPAI viruses develop acute respiratory distress syndrome and severe alveolar damage [2–5]. This pathologic condition is associated with a strong upregulation of cytokines and chemokines: in particular, interferon-induced protein 10 (IP-10; CXCL10), monokine induced by interferon gamma (MIG; CXCL9), monocyte chemotactic protein 1 (MCP-1; CCL2), interleukin (IL)-8, IL-10, IL-6, interferon γ (IFN-γ), and tumor necrosis factor α (TNF-α) [6–10]. In the macaque model, infection with the 1918 Spanish influenza virus markedly increased serum levels of IL-6, IL-8, MCP-1, and RANTES (RANTES; CCL5) . Thus, it has been suggested that the severity of influenza is associated with the aberrant induction of innate immunity.
Pre-stimulation of innate immunity has been shown to confer resistance against lethal influenza infection. Specifically, influenza A virus titers decreased in cells pre-treated with TNF-α, and inoculation of mice with bacterial lysates before viral infection protects against lethal influenza pneumonia [12–15]. Moreover, the general stimulation of innate immunity with interferon α, as well as the stimulation of specific Toll-like receptors (TLRs), promotes survival in mouse models of lethal influenza pneumonia [16–19]. However, the ability of innate immunity pre-stimulation to attenuate disease associated with HPAI viruses has not been explored. In the present study, we aimed to determine the protective effects of TLR pre-stimulation in mice inoculated with influenza A viruses.