Prospective study of the human polyomaviruses BK and JC and cytomegalovirus in renal transplant recipients

Forty eight renal transplant recipients were investigated prospectively for evidence of infection with the polyomaviruses BK and JC and cytomegalovirus. An active polyomavirus infection was shown in 31 patients (65%) and cytomegalovirus in 30 (62.5%). Half of the BK and JC virus infections occurred within the first three months after transplantation compared with 93% of the cytomegalovirus infections. Very late polyomavirus infections two or more years after the transplant were also shown. Cytology was useful in identifying polyomavirus but not cytomegalovirus infections, and 21 (68%) of the 31 polyomavirus infected patients excreted inclusion-bearing cells. Only three patients had symptoms possibly associated with the polyomavirus infection. One patient with BK virus infection developed ureteric stenosis and a second patient had malaise and vomiting. One patient with JC virus infection developed pericarditis and effusion. Renal function became impaired at the time of the polyomavius infection in eight patients (26%) and ureteric obstruction and pericarditis developed in two patients treated with methyl prednisolone for possible rejection. At the end of the study 25 of the 31 polyomavirus infected patients (81%) had functioning renal grafts. The detection of polyomavirus infection is important as increased immunosuppression needs to be avoided to prevent possible complications such as ureteric stenosis in transplant recipients.

Measurement of BK papovavirus IgG and IgM by radioimmunoassay (RIA)

Current techniques for the measurement of BK papovavirus (BKV) specific IgM include sucrose density gradient centrifugation followed by hemagglutination inhibition (HAI) or indirect immunofluorescent (IF) staining of BKV infected cells using a fluorescein conjugated anti-human IgM antibody. These techniques are cumbersome and labor intensive and do not lend themselves to testing large numbers of sera. A solid phase radioimmunoassay (RIA) was developed to facilitate the measurement of BKV IgG and IgM in large numbers of sera. Solid phase antigen was prepared by adsorbing CsCl purified BKV antigen to polyvinyl chloride microtiter plates. Following reaction with serum, bound immunoglobulin was detected with iodinated goat anti-human IgG or IgM. RIA for the measurement of BKV IgG was sensitive with titers approaching 10(-6). Determination of IgG titers by RIA and HAI showed good agreement (P less than 0.01, correlation coefficient = 0.74). Measurement of BKV IgM was not affected by the presence of BKV IgG as evidenced by sucrose density gradient fractionation of IgM positive sera, removal of IgG by treatment with S. aureus protein A, and addition of BKV IgG to BKV IgM. Rheumatoid factor (RF) gave false positive IgM titers in the presence of BKV IgG when RF titers were greater than or equal to 1:640 by latex agglutination testing and BKV IgG levels exceed 1:256 by HAI. False positives due to RF could be eliminated by treatment of sera with sheep anti-human IgG antisera. RIA for BKV IgM was specific as sera containing JCV-, cytomegalovirus (CMV)-, rubella-, or hepatitis B core antibody (anti HBc)-IgM were negative by RIA. RIA detected BKV IgM in several sera from renal dialysis or allograft patients with titers ranging from 1:400 to 1:128,000 and demonstrated that BKV IgM persisted in sera of renal allograft patients for as long as 343 days post transplantation.

Serologic studies of papovavirus infections in pregnant women and renal transplant recipients

Serologic studies were performed to determine if BKV and JCV are transmitted congenitally and to assess if the virus present in donor kidney contributes to virus activity in renal transplant recipients. Fourteen of 100 normal women showed antibody rise to BKV or JCV during pregnancy; in all instances, these were reactivation infections occurring in initially seropositive women. BKV-and JCV-specific antibodies of the IgM class were not detected in over 300 umbilical cord sera. Thus, there was no evidence of congenital transmission of BKV or JCV. BKV-seronegative renal transplant recipients who received kidneys from BKV-seropositive donors had a frequency of BKV infection which was about four times greater than that in BKV-seronegative recipients receiving kidneys from BKV-seronegative donors. These data suggest that BKV in donor kidney contributes to primary BKV infections in renal transplant recipients.

Genomic structure of human polyoma virus JC: nucleotide sequence of the region containing replication origin and small-T-antigen gene

The nucleotide sequence of the region of human polyoma virus JC DNA between 0.5 and 0.7 map units from a unique EcoRI cleavage site was determined and compared with those of the corresponding regions of another human polyoma virus, BK, and simian virus 40 DNAs. Within this region consisting of 945 base pairs, we located the origin of DNA replication near 0.7 map units, the entire coding region for small T antigen, and the splice junctions for large-T-antigen mRNA. The deduced amino acid sequences for small T antigen and the part of large T antigen markedly resembled those of polyoma virus BK and simian virus 40. The results strongly suggest that polyoma virus JC has the same organization of early genome as polyoma virus BK and simian virus 40 on the physical map, with the EcoRI site as a reference point.

Prevalence rate and age of acquisition of antibodies against JC virus and BK virus in human sera

A total of 480 serum samples from donors including 384 children up to 10 years of age were examined by the hemagglutination-inhibition (HI) test for the rates of prevalence and age of acquisition of HI antibodies against JC virus and BK virus. Among 136 serum samples from various age groups, there were five (4%) with no detectable antibodies against BK or JC virus, 75 (55%) with antibodies against both viruses, 41 (30.1%) with antibodies against only BK virus and 26 (19%) with antibodies against only JC virus. The prevalence of antibodies against JC and BK viruses was 70.5% and 80.8%, respectively, and the mean HI titers (4 x 2n,n greater than or equal to 1) were 4.90 and 4.30. About 50% of the children had acquired antibodies against BK virus by 3 years of age and against JC virus by 6 years of age. These results indicate that dual latent infections with both viruses are common, although independent infections with either virus are predominant in the human population.

Seroepidemiology of human papovaviruses. Discovery of virgin populations and some unusual patterns of antibody prevalence among remote peoples of the world

A total of 1544 sera from 28 diverse and mainly isolated populations were examined for HI antibody to BK virus. A few extremely isolated populations were found with negligible or absent exposure to the virus, but in most populations, remote or cosmopolitan, antibody appeared in increasing prevalence during early childhood and remained stable throughout adult life. Antibody acquisition and prevalence rates in individual families reflected that of the general population. Examined for HI antibody to JC virus were 393 sera from 9 of the 28 populations. Age acquisition and prevalence rates of antibody were similar to those of BK virus, but experience with the 2 viruses was found to occur independently in several population groups, i.e., high exposure to BK with low exposure to JC, or vice-versa. Examined for neurtralizing antibody to SV40 were 151 sera with and without BK HI antibody in individuals from several primitive populations. SV40 antibody, mainly in low titer, occurred in 35% of the BK-positive group, but only 5% of the BK-negative group, suggesting that infection with BK or a closely related virus is responsible for antibody directed against SV40 in most humans unexposed to known vaccine or monkey sources of SV40 infection.