The role of anti‐dengue antibodies in the pathogenesis of Dengue disease

Dengue disease includes from mild dengue fever to severe dengue hemorrhagic fever (DHF), which is an important health problem in tropical or sub‐tropical areas. The immunopathogenesis of DHF is initiated by aberrant immune activation and autoantibody production caused by virus infection. There is a molecular mimicry between dengue antigens and self‐proteins. The anti‐dengue antibody cross‐react with platelet and endothelial cell, and would trigger the subsequent dysfunction of endothelial cells and hemorrhage during the acute infection. The antibody‐dependent enhancement theory plays a central role in the dengue disease. The enhancing antibody is dependent on the types of the target cells and the specificity of the enhancing antibody. The enhancing antibody can be either anti‐prM or anti‐E antibody. For anti‐E Ab‐mediated enhancement on monocytic cells, it can be concentration‐dependent: enhancing at sub‐neutralization level or enhance regardless of concentration by Fc and FcR interaction. For anti‐prM Ab‐mediated enhancement, it enhanced the dengue virion binding on both FcR or non‐FcR bearing cells with dual specificity. The anti‐dengue antibodies seem to be either enhancing antibody or the pathogenic antibody, and play a major role in the DHF pathogenesis.