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Mannonen L, Jokela P, Kragh Thomsen M, Yerly S, Cilla G, Jarem D, Canchola JA, Hopkins M. Performance of the cobas EBV and cobas BKV assays: multi-site comparison of standardized quantitation. J Clin Microbiol 2024:e0026724. [PMID: 39046255 DOI: 10.1128/jcm.00267-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024] Open
Abstract
Guidelines recommend monitoring of Epstein-Barr virus (EBV) and BK virus (BKV) in solid organ and hematopoietic stem cell transplant patients. The majority of quantitative DNA testing for EBV and BKV employs unstandardized individual laboratory-developed testing solutions (LDTs), with implications for accuracy, reproducibility, and comparability between laboratories. The performance of the cobas EBV and cobas BKV assays was assessed across five laboratories, using the World Health Organization International Standards (WHO IS) for EBV and BKV, and the National Institute of Standards and Technology Quantitative Standard for BKV, and results were compared with the LDTs in use at the time. Methods were also compared using locally sourced clinical specimens. Variation was high when laboratories reported EBV or BKV DNA values using LDTs, where quantitative values were observed to differ by up to 1.5 log10 unit/mL between sites. Conversely, results from the cobas EBV and cobas BKV assays were accurate and reproducible across sites and on different testing days. Adjustment of LDTs using the international standards led to closer alignment between the assays; however, day-to-day reproducibility of LDTs remained high. In addition, BKV continued to show bias, indicating challenges with the commutability of the BKV International Standard. The cobas EBV and cobas BKV assays are automated, aligned to the WHO IS, and have the potential to reduce the variability in viral load testing introduced by differences in LDTs. Standardization of reporting values may eventually allow different centers to compare data to allow clinical decision thresholds to be established supporting improvements in patient management.IMPORTANCEThe application of center-specific cut-offs for clinical decisions and the variability of LDTs often hinder interpretation; thus, the findings reported here support the need for standardization in the field of post-transplant monitoring of EBV and BKV to improve patient management. Alongside the choice of assay, it is also important to consider which standard to use when deciding upon a testing methodology. This is a call to action for standardization, as treatment for EBV and BKV is driven by viral load test results, and the more accurate and comparable the test results are across institutions, the more informed and better the treatment decisions can be.
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Affiliation(s)
- Laura Mannonen
- Department of Clinical Microbiology, HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Jokela
- Department of Clinical Microbiology, HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Sabine Yerly
- Laboratory of Virology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Gustavo Cilla
- Department of Microbiology, Donostia University Hospital and Biodonostia Health Research Institute, San Sebastián, Spain
| | - Daniel Jarem
- Clinical Development and Medical Affairs, Roche Molecular Systems, Inc., Pleasanton, California, USA
| | - Jesse A Canchola
- CDMA Biometrics, Biostatistics Group, Roche Molecular Systems, Inc., Pleasanton, California, USA
| | - Mark Hopkins
- Department of Virology, Barts Health NHS Trust, London, United Kingdom
- Department of Infection and Immunity, Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
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2
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Cinti L, Roberto P, Rossi M, Napoli A, Russo G, Iori AP, Gentile G, Augurusa M, Girmenia C, Antonelli G, Gaeta A. Molecular monitoring of viral infections in immunocompromised patients in a large university hospital in Italy: reflections after thirteen years of real-life activity. Eur J Clin Microbiol Infect Dis 2024; 43:979-989. [PMID: 38517571 PMCID: PMC11108949 DOI: 10.1007/s10096-024-04812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE This study aimed to investigate the prevalence and viral reactivations of clinical interest in the immunocompromised patient with particular focus on hematologic and solid organ transplant recipients. METHODS Molecular screening data of CMV, EBV, JCV and BKV from 2011 to 2023 were analyzed. This extensive time span allowed the access to more than 100,000 samples from over 20,000 patients treated at Policlinico Umberto I. It was possible to temporally investigate patient attendance patterns, average age distribution, seasonality of infections, and positivity rates of the analyzed viruses. RESULTS Between 2019 and 2022 a significant reduction in organ transplants performed and in the positive molecular detection of EBV, JCV and BKV was observed. Additionally, there has been a noteworthy decrease in CMV reactivations, with a reduction of up to 50% starting in 2019. A remarkable reduction of 39% in the rate of CMV viral reactivation has been also achieved in SOT between 2016 and 2023. CONCLUSION The years following 2019 were profoundly impacted by the COVID-19 pandemic era. This period resulted in a substantial reduction in healthcare services and hospital visits. Furthermore, the introduction of the drug Letermovir in Italy in 2019 demonstrated remarkable efficacy, evidenced by a reduction in CMV reactivations. Additionally, the adoption of a novel clinical approach centered on personalized therapy facilitated improved management of immunocompromised patients.
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Affiliation(s)
- Lilia Cinti
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena, Roma, 324-00161, Italy
| | - Piergiorgio Roberto
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena, Roma, 324-00161, Italy.
| | - Matteo Rossi
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena, Roma, 324-00161, Italy
| | - Anna Napoli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena, Roma, 324-00161, Italy
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Anna Paola Iori
- Hematology, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Giuseppe Gentile
- Department of Translational and Precision Medicine, Sapienza University Rome, Roma, Italy
- University Hospital "Policlinico Umberto I", Rome, Italy
| | - Maria Augurusa
- University Hospital "Policlinico Umberto I", Rome, Italy
| | - Corrado Girmenia
- Hematology, Department of Hematology, Oncology and Dermatology, AOU Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Guido Antonelli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena, Roma, 324-00161, Italy
- University Hospital "Policlinico Umberto I", Rome, Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- University Hospital "Policlinico Umberto I", Rome, Italy
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3
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Zhong C, Chen J, Yan Z, Xia R, Zeng W, Deng W, Xu J, Wang Y, Miao Y. Therapeutic strategies against BK polyomavirus infection in kidney transplant recipients: Systematic review and meta-analysis. Transpl Immunol 2023; 81:101953. [PMID: 37931665 DOI: 10.1016/j.trim.2023.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The selection of antiviral therapy for BK polyomavirus (BKPyV) infection has been extensively debated. Our study aimed to assess the efficacy and safety of various treatments for BKPyV infection. METHODS We searched PubMed, EMBASE, and Web of Science databases for relevant studies regarding drug treatments for BKPyV viremia/DNAemia published between January 1, 1970 and September 30, 2022. Two independent authors screened the published studies, extracted pertinent data, and evaluated their methodological quality. A meta-analysis was performed using the RevMan software version 4.2.2. RESULTS A total of 33 published studies involving 986 patients were included in the meta-analysis. Overall, therapeutic interventions comprised immunosuppression reduction alone or in combination with leflunomide, intravenous immunoglobulin (IVIG), cidofovir, or mTOR inhibitor (mTORi) therapy. The meta-analysis revealed that the efficacy of immunosuppression reduction alone for serum BKPyV clearance was 68% (95% confidence interval [CI]: 0.58-0.77; I2 = 78%). Moreover, the efficacy of immunosuppression reduction in combination with leflunomide, cidofovir, IVIG, or mTORi therapy for serum BKPyV clearance was 61% (95% CI: 0.47-0.74; I2 = 83%), 71% (95% CI: 0.63-0.78; I2 = 0), 87% (95% CI: 0.82-0.93; I2 = 45%), and 80% (95% CI: 0.59-1.00; I2 = 58%), respectively. Compared to immunosuppression reduction alone, immunosuppression reduction combined with IVIG therapy offered a statistically significant benefit in serum BKPyV clearance (P < 0.01) with minimal adverse reactions, whereas other adjunctive drug treatments did not demonstrate considerable effects. CONCLUSIONS Reducing immunosuppression remains the primary approach for treating BKPyV infection. Although the combination treatment with IVIG proved to be most effective, other agents might offer varied antiviral advantages of high heterogeneity, which should be substantiated in future long-term randomized controlled trials.
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Affiliation(s)
- Cuiyu Zhong
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jiayi Chen
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou 510515, China
| | - Ziyan Yan
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Renfei Xia
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenli Zeng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenfeng Deng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jian Xu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yuchen Wang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Yun Miao
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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4
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Parra-Ortega I, Nájera-Martínez N, Gaytán-Morales F, Castorena-Villa I, López-Martínez B, Ortiz-Navarrete V, Olvera-Gómez I. Enrichment of effector memory T cells in the CD4 and CD8 T cell compartment during chronic graft versus host disease in children. Transpl Immunol 2023; 81:101951. [PMID: 37939887 DOI: 10.1016/j.trim.2023.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND During allogeneic Hematopoietic stem cell transplantation (HSCT), frequent pathological scenarios include graft versus host disease (GVHD) and viral infections. We hypothesized if exogenous stimulus as alloantigen and viral antigens might impact on central and effector memory T cells in pediatric recipients. PATIENTS AND METHODS Subjects included 21 pediatric recipients and 20 healthy children (control group). Peripheral blood samples of patients were collected along the first 712 days post-HSCT. T cell phenotyping of naïve, central, and effector memory T cells (TCMs and TEMs, respectively) was conducted using flow cytometry. Viral nucleic acids were detected using real-time PCR. RESULTS T cell reconstitution was not reached after 1 year post-HSCT. Chronic GVHD was associated with increased numbers of naïve CD4 T cells (p < 0.05) as well as an increase in TEM and TCM cells of the CD4 (p < 0.0001 and p < 0.05, respectively) and CD8 T cell TEM (p < 0.0001). and TCM (p < 0.001) populations too. Moreover, BK and Epstein-Barr viruses were the main viral pathogens detected (<104 copies), which were associated with a decrease in all T cell compartments. CONCLUSION During chronic GVHD, alloantigen persistence generates TEM cell enrichment among CD4 and CD8 T cells, and viral infections are associated with deficient recovery of T cells after HSCT.
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Affiliation(s)
- Israel Parra-Ortega
- Hospital Infantil de México Federico Gómez, Clinical Laboratory Department, Mexico City, Mexico
| | - Noemí Nájera-Martínez
- Hospital Infantil de México Federico Gómez, Clinical Laboratory Department, Mexico City, Mexico
| | - Félix Gaytán-Morales
- Hospital Infantil de México Federico Gómez, Hematopoietic Stem Cell Transplantation Unit, Mexico City, Mexico
| | - Iván Castorena-Villa
- Hospital Infantil de México Federico Gómez, Hematopoietic Stem Cell Transplantation Unit, Mexico City, Mexico
| | - Briceida López-Martínez
- Hospital Infantil de México Federico Gómez, Sub-directorate of Auxilliary Services and Diagnosis, Mexico City, Mexico
| | | | - Irlanda Olvera-Gómez
- CICSA, Universidad Anáhuac, State of Mexico, Mexico; Immunology Laboratory, Hospital Nacional Homeopático, Mexico City, Mexico.
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5
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Wang Y, Fang Y, Yan Z, Xia R, Zeng W, Deng W, Xu J, Feng X, Peng J, Miao Y. Fatal BK polyomavirus-associated pneumonia: report of two cases with literature review. BMC Infect Dis 2023; 23:592. [PMID: 37697264 PMCID: PMC10494412 DOI: 10.1186/s12879-023-08577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND In immunocompromised populations, such as patients with AIDS and recipients of solid organ and hematopoietic stem cell transplants, BK polyomavirus (BKPyV) can reactivate and cause several diseases, which can lead to death in their severe forms. Unlike hemorrhagic cystitis and BKPyV-associated nephropathy, BKPyV-associated pneumonia is rare, with only seven known cases worldwide. However, the disease can rapidly progress with extremely high mortality. CASE PRESENTATION Herein, we report two cases of BKPyV-associated pneumonia following hematopoietic stem cell transplantation. Both patients had consistent infectious pneumonia and graft-versus-host disease after stem cell transplantation. The diagnosis of BKPyV-associated pneumonia was confirmed by metagenomic next-generation sequencing and polymerase chain reaction after the sudden worsening of the pulmonary infection signs and symptoms concomitant with renal dysfunction and systemic immune weakening. Both patients eventually died of systemic multi-organ failure caused by severe pneumonia. CONCLUSIONS Currently, BKPyV reactivation cannot be effectively prevented. Immunocompromised patients must actively manage their primary lung infections, pay close attention to pulmonary signs and imaging changes. Especially during and after steroid pulse therapy or immunosuppressive therapy for graft versus host diseases, BKPyV load in blood/urine needs to be regularly measured, and the immunosuppressive intensity should be adjusted properly after the BKPyV reactivation diagnosis. Clinical trials of new antiviral drugs and therapies for BKPyV are urgently needed.
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Affiliation(s)
- Yuchen Wang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Yiling Fang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Ziyan Yan
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Renfei Xia
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Wenli Zeng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Wenfeng Deng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Jian Xu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiaoqin Feng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Yun Miao
- Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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6
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Liu N, Gu C, Yang Y, Gao Z, Kang N, Liu J, Xie Y. Establishment and characterization of a novel reverse genetic system of BK polyomavirus. J Med Virol 2023; 95:e28995. [PMID: 37522259 DOI: 10.1002/jmv.28995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
BK polyomavirus (BKV) is a small non-enveloped DNA virus. BKV infection or reactivation may cause BKV-associated nephropathy and hemorrhagic cystitis in immunosuppressed transplant recipients. No effective antivirals or prevention strategies are available against BKV infections. The current BKV reverse system employs the transfection of purified full-length linear viral genomes released by enzyme digestion from BKV genomic plasmids. The method is laborious and often results in variable DNA yield and quality, which can affect the efficiency of transfection and subsequent formation of circular viral genomes in cells. In this study, we report the generation of circular viral genomes by Cre-mediated DNA recombination in cells directly transfected with BKV precursor genomic plasmids. The novel system supported efficient viral expression and replication, and produced a higher level of infectious virions compared with the transfection with linear BKV genomes. Furthermore, we successfully constructed recombinant BKV capable of reporter gene expression. In conclusion, the novel BKV reverse genetic system allows for simpler manipulation of BKV genome with better virus yield, providing a tool for the study of BKV life cycle and antiviral screening.
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Affiliation(s)
- Nannan Liu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chenjian Gu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Yang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zixiang Gao
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ning Kang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Liu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Epigenetics, Institutes of Biomedical Sciences, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Youhua Xie
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Diseases and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Clinical Laboratory, Children's Hospital, Fudan University, Shanghai, China
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7
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Hsu YH, Chao CN, Huang HY, Zhao PW, Hsu PH, Shen CH, Chen SY, Fang CY. Histone deacetylase III interactions with BK polyomavirus large tumor antigen may affect protein stability. Virol J 2023; 20:155. [PMID: 37464367 DOI: 10.1186/s12985-023-02128-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Human polyomavirus BK (BKPyV) causes associated nephropathy and contributes to urinary tract cancer development in renal transplant recipients. Large tumor antigen (LT) is an early protein essential in the polyomavirus life cycle. Protein acetylation plays a critical role in regulating protein stability, so this study investigated the acetylation of the BKPyV LT protein. METHODS The BKPyV LT nucleotide was synthesized, and the protein was expressed by transfection into permissive cells. The BKPyV LT protein was immunoprecipitated and subjected to LC-MS/MS analysis to determine the acetylation residues. The relative lysine was then mutated to arginine in the LT nucleotide and BKPyV genome to analyze the role of LT lysine acetylation in the BKPyV life cycle. RESULTS BKPyV LT acetylation sites were identified at Lys3 and Lys230 by mass spectrometry. HDAC3 and HDAC8 and their deacetylation activity are required for BKPyV LT expression. In addition, mutations of Lys3 and Lys230 to arginine increased LT expression, and the interaction of HDAC3 and LT was confirmed by coimmunoprecipitation. CONCLUSIONS HDAC3 is a newly identified protein that interacts with BKPyV LT, and LT acetylation plays a vital role in the BKPyV life cycle.
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Affiliation(s)
- Yueh-Han Hsu
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chun-Nun Chao
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Hsin-Yi Huang
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Pei-Wen Zhao
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Pang-Hung Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan
| | - Cheng-Huang Shen
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi, Taiwan
| | - San-Yuan Chen
- Department of Chinese Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
- Department of Sports Management, Chia Nan University of Pharmacy & Science, Tainan City, Taiwan.
| | - Chiung-Yao Fang
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
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8
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Gras J, Nere ML, Peraldi MN, Bonnet-Madin L, Salmona M, Taupin JL, Desgrandchamps F, Verine J, Brochot E, Amara A, Molina JM, Delaugerre C. BK virus genotypes and humoral response in kidney transplant recipients with BKV associated nephropathy. Transpl Infect Dis 2023; 25:e14012. [PMID: 36748721 DOI: 10.1111/tid.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Among kidney transplant recipients (KTR) with BK virus associated nephropathy (BKVN), BKV genotypes' evolution and anti-BKV humoral response are not well established. We aim to analyze BKV replication and genetic evolution following transplantation, and characterize concomitant anti-BKV-VP1 humoral response. METHODS We retrospectively analyzed 32 cases of biopsy-proven BKVN. Stored plasma and kidney biopsies were tested for BKV viral load, and VP1 sequencing performed on positive samples. BKV-VP1 genotype-specific neutralizing antibodies (NAbs) titers were determined at transplantation and BKVN. RESULTS At the time of BKVN diagnosis, BKV viral load was 8.2 log10 IU/106 cells and 5.4 log10 IU/mL in kidney and plasma, respectively. VP1 sequencing identified the same BKV-subtype in both compartments in 31/32 cases. At the time of transplantation, 8/20 (40%) of biopsies tested positive for BKV detection, whereas concomitant BKV viremia was negative. VP1 sequencing identified a different subtype compared to BKVN in 5/6 of these samples. This was confirmed following transplantation: 8 patients had a BKV+ biopsy before BKV viremia, and VP1 sequencing identified a different subtype compared to BKVN in all of them. After the onset of BKV viremia and prior to BKVN diagnosis, the BKV subtype in BKV+ plasma and kidney biopsy was the same as the one isolated at BKVN. BKV-VP1 NAbs titers were significantly higher at the time of BKVN compared to transplantation (p = .0031), with similar titers across genotypes. CONCLUSION Altogether, our data suggest that among some KTR with BKVN, the BKV genotype from the donor may not be responsible for BKVN pathogenesis.
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Affiliation(s)
- Julien Gras
- Infectious Disease Department, APHP-Saint-Louis Hospital, Paris, France.,INSERM U944, Biology of Emerging Viruses Team, Institut de Recherche Saint Louis, APHP-Saint-Louis Hospital, Paris, France.,Université Paris Cité, Paris, France
| | | | - Marie Noëlle Peraldi
- Université Paris Cité, Paris, France.,Nephrology and Kidney Transplant Department, APHP-Saint Louis Hospital, Paris, France
| | - Lucie Bonnet-Madin
- INSERM U944, Biology of Emerging Viruses Team, Institut de Recherche Saint Louis, APHP-Saint-Louis Hospital, Paris, France
| | - Maud Salmona
- Université Paris Cité, Paris, France.,Virology Department, APHP-Saint Louis Hospital, Paris, France
| | - Jean Luc Taupin
- Université Paris Cité, Paris, France.,Immunology Department, APHP-Saint Louis Hospital, Paris, France
| | - François Desgrandchamps
- Université Paris Cité, Paris, France.,Urology Department, APHP-Saint Louis Hospital, Paris, France
| | - Jérôme Verine
- Pathology Department, APHP-Saint Louis Hospital, Paris, France
| | | | - Ali Amara
- INSERM U944, Biology of Emerging Viruses Team, Institut de Recherche Saint Louis, APHP-Saint-Louis Hospital, Paris, France.,Université Paris Cité, Paris, France
| | - Jean Michel Molina
- Infectious Disease Department, APHP-Saint-Louis Hospital, Paris, France.,INSERM U944, Biology of Emerging Viruses Team, Institut de Recherche Saint Louis, APHP-Saint-Louis Hospital, Paris, France.,Université Paris Cité, Paris, France
| | - Constance Delaugerre
- INSERM U944, Biology of Emerging Viruses Team, Institut de Recherche Saint Louis, APHP-Saint-Louis Hospital, Paris, France.,Université Paris Cité, Paris, France.,Virology Department, APHP-Saint Louis Hospital, Paris, France
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9
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Ganesh K, Abraham MA, Thomas R, Kumar J, Simon S. BK virus nephropathy in renal transplantation and the effect of intravenous immunoglobulin: A prospective longitudinal single-center study in South Asia. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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10
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Zhao Y, Zeng Y, Lu R, Wang Z, Zhang X, Wu N, Zhu T, Wang Y, Zhang C. Rapid point-of-care detection of BK virus in urine by an HFman probe-based loop-mediated isothermal amplification assay and a finger-driven microfluidic chip. PeerJ 2023; 11:e14943. [PMID: 36915661 PMCID: PMC10007963 DOI: 10.7717/peerj.14943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
Background BK virus (BKV)-associated nephropathy (BKVN) is one of the leading causes of renal dysfunction and graft loss in renal transplant recipients. Early monitoring of BKV in urine is crucial to minimize the deleterious effects caused by this virus on preservation of graft function. Methods We report a simple, rapid, sensitive loop-mediated isothermal amplification (LAMP) assay using an HFman probe for detecting BKV in urine. To evaluate the performance of the assay, a comparison of the HFman probe-based LAMP (HF-LAMP) assay with two qPCR assays was performed using urine samples from 132 HIV-1 infected individuals. We further evaluated the performance of HF-LAMP directly using the urine samples from these HIV-1 infected individuals and 30 kidney transplant recipients without DNA extraction. Furthermore, we combined the HF-LAMP assay with a portable finger-driven microfluidic chip for point-of-care testing (POCT). Results The assay has high specificity and sensitivity with a limit of detection (LOD) of 12 copies/reaction and can be completed within 30 min. When the DNA was extracted, the HF-LAMP assay showed an equivalent and potentially even higher sensitivity (93.5%) than the qPCR assays (74.2-87.1%) for 132 urine samples from HIV-1 infected individuals. The HF-LAMP assay can be applied in an extraction-free format and can be completed within 45 min using a simple heat block. Although some decreased performance was seen on urine samples from HIV-1 infected individuals, the sensitivity, specificity, and accuracy of the extraction-free BKV HF-LAMP assay were 95%, 100%, and 96.7% for 30 clinical urine samples from kidney transplant recipients, respectively. Conclusion The assay has high specificity and sensitivity. Combined with a portable finger-driven microfluidic chip for easy detection, this method shows great potential for POCT detection of BKV.
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Affiliation(s)
- Yongjuan Zhao
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yi Zeng
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Renfei Lu
- Nantong Third Hospital Affiliated to Nantong University, Nantong, China
| | - Zhiying Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology, School of Engineering Medicine, Beihang University, Beijing, China
| | | | - Nannan Wu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Tongyu Zhu
- Shanghai Medical College, Shanghai, China.,Zhongshan Hospital, Shanghai, China
| | - Yang Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Shanghai, China
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11
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Peitz T, Möhlendick B, Eisenberger U, Siffert W, Heinemann FM, Kribben A, Friebus-Kardash J. CC Genotype of GNAS c.393C>T (rs7121) Polymorphism Has a Protective Effect against Development of BK Viremia and BKV-Associated Nephropathy after Renal Transplant. Pathogens 2022; 11:pathogens11101138. [PMID: 36297195 PMCID: PMC9609707 DOI: 10.3390/pathogens11101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
The GNAS gene encodes the alpha-subunit of the stimulatory G-protein (Gαs) in humans and mice. The single-nucleotide polymorphism of GNAS, c.393C>T, is associated with an elevated production of Gαs and an increased formation of cyclic adenosine monophosphate (cAMP). In the present study, we analyzed the effect of this GNAS polymorphism on a renal allograft outcome. We screened a cohort of 436 renal allograft recipients, who were retrospectively followed up for up to 5 years after transplant. GNAS genotypes were determined with polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assays. The 393T allele was detected in 319 (73%) recipients (113 recipients with TT and 206 with CT genotype) and the CC genotype in 117 (27%). The CC genotype was associated with a significantly lower frequency of BK viremia (CC, 17 recipients (15%); T 84 (26%)); p = 0.01; TT, 27 vs. CC, 17, p = 0.07; TT, 27 vs. CT, 57, p = 0. 46; CT, 57 vs. CC, 17, p = 0.01) and BKV-associated nephropathy (CC, 3 recipients (3%); T, 27 (8%); p = 0.03; TT,10 vs. CC, 3, p = 0.04; TT, 10 vs. CT,17, p = 0.85; CT, 17 vs. CC,3, p = 0.04) after transplant. BKV-associated nephropathy-free survival was significantly better among CC genotype carriers than among T allele carriers (p = 0.043; TT vs. CC, p = 0.03; CT vs. CC, p = 0.04; TT vs. CT, p = 0.83). Multivariate analysis indicated an independent protective effect of the CC genotype against the development of both BK viremia (relative risk. 0.54; p = 0.04) and BKV-associated nephropathy after renal transplant (relative risk. 0.27; p = 0.036). The GNAS 393 CC genotype seems to protect renal allograft recipients against the development of BK viremia and BKV-associated nephropathy.
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Affiliation(s)
- Tobias Peitz
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, Transplantation Diagnostics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-(0)-201-7236559; Fax: +49-(0)-201-7236907
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12
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BK Virus Nephropathy in Kidney Transplantation: A State-of-the-Art Review. Viruses 2022; 14:v14081616. [PMID: 35893681 PMCID: PMC9330039 DOI: 10.3390/v14081616] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
BK virus maintains a latent infection that is ubiquitous in humans. It has a propensity for reactivation in the setting of a dysfunctional cellular immune response and is frequently encountered in kidney transplant recipients. Screening for the virus has been effective in preventing progression to nephropathy and graft loss. However, it can be a diagnostic and therapeutic challenge. In this in-depth state-of-the-art review, we will discuss the history of the virus, virology, epidemiology, cellular response, pathogenesis, methods of screening and diagnosis, evidence-based treatment strategies, and upcoming therapeutics, along with the issue of re-transplantation in patients.
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13
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Komorniczak M, Król E, Lizakowski S, Dębska-Ślizień A. Screening for Polyomavirus Viruria Like Early Detection of Human Polyomavirus Infection and Replication: The Results of a Single-Center Observation. Transplant Proc 2022; 54:989-994. [DOI: 10.1016/j.transproceed.2022.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
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14
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Wang J, Li J, Chen Z, Xu M, Yang C, Rong R, Zhu T. A Nomogram for Predicting BK Virus Activation in Kidney Transplantation Recipients Using Clinical Risk Factors. Front Med (Lausanne) 2022; 9:770699. [PMID: 35223891 PMCID: PMC8866320 DOI: 10.3389/fmed.2022.770699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
BK virus is a common opportunistic viral infection that could cause BK virus-associated nephropathy in renal transplant recipients. Thus, we retrospectively analyzed clinical and laboratory data associated with a higher risk of BK virus activation from 195 renal transplant recipients by the multivariate logistic regression analysis and performed the external validation. Results showed that patients with BK virus active infection were associated with a deceased donor, had lower direct bilirubin levels, a higher proportion of albumin in serum protein electrophoresis, and lower red blood cells and neutrophil counts. The multivariate logistic regression analyses revealed that the living donor, direct bilirubin, and neutrophil counts were significantly associated with BK virus activation. The logistic regression model displayed a modest discriminability with the area under the receiver operating characteristic curve of 0.689 (95% CI: 0.607–0.771; P < 0.01) and also demonstrated a good performance in the external validation dataset (the area under the receiver operating characteristic curve was 0.699, 95% CI: 0.5899–0.8081). The novel predictive nomogram achieved a good prediction of BK virus activation in kidney transplant recipients.
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Affiliation(s)
- Jiyan Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Jiawei Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
- Zhangjiang Institute of Fudan University, Shanghai, China
- *Correspondence: Cheng Yang ;
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
- Department of Transfusion, Zhongshan Hospital, Fudan University, Shanghai, China
- Ruiming Rong
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
- Tongyu Zhu ;
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15
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Rogers R, Bodziak K, Cheema F, Chobanian M, Ebcioglu Z, Gabardi S, Ghai S, Gilligan H, Gohh R, Goyal N, Kavalam G, Mehri B, Rodig N, Rossi A, Singh J, Wood E, Tan CS, Pavlakis M. Implementing a regional standardized BK polyomavirus screening protocol across eleven transplant centres. Transpl Int 2021; 34:2680-2685. [PMID: 34628685 DOI: 10.1111/tri.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/18/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
BK polyomavirus (BKPyV) reactivation is regularly monitored after kidney transplant to prevent progression to BK associated nephropathy (BKAN). The New England BK Consortium, made up of 12 transplant centres in the northeastern United States, conducted a quality improvement project to examine adherence to an agreed upon protocol for BKPyV screening for kidney transplants performed in calendar years 2016-2017. In a total of 1047 kidney transplant recipients (KTR) from 11 transplant centres, 204 (19%) had BKPyV infection, defined as detection of BKPyV in plasma, with 41 (4%) KTR progressing to BKAN, defined by either evidence on biopsy tissues or as determined by treating nephrologists. BKPyV infection was treated with reduction of immune suppressants (RIS) in >70% of the patients in all but two centres. There was no graft loss because of BKAN during the two-year follow-up. There were nine cases of post-RIS acute rejection detected during this same period. Adherence to the protocol was low with 54% at 12 months and 38% at 24 months, reflecting challenges of managing transplant patients at all centres. The adherence rate was positively correlated to increased detection of BKPyV infection and was unexpectedly positively correlated to an increase in diagnosis of BKAN.
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Affiliation(s)
- Ralph Rogers
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kenneth Bodziak
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Faiqa Cheema
- Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT, USA
| | - Michael Chobanian
- Department of Transplantation Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Zeynep Ebcioglu
- Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT, USA
| | - Steven Gabardi
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep Ghai
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hannah Gilligan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Reginald Gohh
- Division of Transplant Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nitender Goyal
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - George Kavalam
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Basma Mehri
- Division of Transplant Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nancy Rodig
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, GA, USA
| | - Joseph Singh
- Department of Transplantation Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Emily Wood
- Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Chen Sabrina Tan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martha Pavlakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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16
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Dakroub F, Touzé A, Sater FA, Fiore T, Morel V, Tinez C, Helle F, François C, Choukroun G, Presne C, Guillaume N, Duverlie G, Castelain S, Akl H, Brochot E. The impact of pre-graft serology on the risk of BKPyV infection post-renal transplantation. Nephrol Dial Transplant 2021; 37:781-788. [PMID: 34586413 DOI: 10.1093/ndt/gfab279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES BK polyomavirus associated nephropathy, is a troublesome disease induced by BK polyomavirus (BKPyV) infection in immunocompromised renal graft recipients with no effective available treatment, making immunosuppression reduction the only management option. Thus, pre-graft predictive BKPyV replication markers are needed for high-risk viremia patient identification. METHODS we conducted a retrospective study to assess the correlation between the BKPyV pre-transplant serostatus and post-transplant BKPyV infection incidence. Sera from 329 recipients and 222 matched donors were tested for anti-BKV antibodies against BKPyV serotypes I and IV by a VLPs-based IgG ELISA, and BKPyV DNA load was monitored for at least 1 year post transplantation. RESULTS 80 recipients were viruric and 59 recipients were viremic post transplantation. In the post-transplant period, the probability of developing viremia for serotype I was increasing from 4.3% for the D-/R + group to 12.1% for the D+/R + group and climbing to 37.5% for the D+/R- group (p < 0.05). When calculating the recipient mean titers for serotypes I and IV, we observed a clear difference in the proportions of viremia passing from 50% for mean titers < 400 to 13.5% for titers ≥ 400 (p < 0.001) with also a higher proportion of presumptive nephropathy (50% vs 23.1%, p < 0.05). In univariate analysis this parameter has an odds ratio of 6.41 for the risk of developing post-transplant BKPyV viremia (95% CI: 3.16-13.07; p < 0.0001). CONCLUSIONS Both donor and recipient BKPyV seropositivity determination before transplantation and antibody titer may serve as a predictive tool to manage clinical BKPyV infection by identification of patients at high risk.
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Affiliation(s)
- Fatima Dakroub
- Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France.,Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Lebanon
| | - Antoine Touzé
- Infectiologie et santé publique "Biologie des infections à Polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France
| | - Fadi Abdel Sater
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Lebanon
| | - Toni Fiore
- Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Virginie Morel
- Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Claire Tinez
- Department of Virology, Amiens University Medical Center, Amiens, France.,Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - François Helle
- Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Catherine François
- Department of Virology, Amiens University Medical Center, Amiens, France.,Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Gabriel Choukroun
- Department of Nephrology and Transplantation, Amiens University Hospital, Amiens, France
| | - Claire Presne
- Department of Nephrology and Transplantation, Amiens University Hospital, Amiens, France
| | - Nicolas Guillaume
- Department of Haematology and Histocompatibility, Amiens University Hospital, Amiens, France; UR4666, Jules Verne University of Picardie, Amiens, France
| | - Gilles Duverlie
- Department of Virology, Amiens University Medical Center, Amiens, France.,Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Sandrine Castelain
- Department of Virology, Amiens University Medical Center, Amiens, France.,Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
| | - Haidar Akl
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Lebanon
| | - Etienne Brochot
- Department of Virology, Amiens University Medical Center, Amiens, France.,Agents infectieux résistance et chimiothérapie Research Unit, UR4294, Jules Verne University of Picardie, France
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17
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Wang X, Patel SA, Haddadin M, Cerny J. Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus. Ther Adv Infect Dis 2021; 8:20499361211018027. [PMID: 34104434 PMCID: PMC8155777 DOI: 10.1177/20499361211018027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
Human cytomegalovirus and Epstein-Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients' characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft-versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.
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Affiliation(s)
- Xin Wang
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shyam A Patel
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Michael Haddadin
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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18
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Hall IE, Reese PP, Mansour SG, Mohan S, Jia Y, Thiessen-Philbrook HR, Brennan DC, Doshi MD, Muthukumar T, Akalin E, Harhay MN, Schröppel B, Singh P, Weng FL, Bromberg JS, Parikh CR. Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:765-775. [PMID: 33692117 PMCID: PMC8259491 DOI: 10.2215/cjn.18101120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database. RESULTS The multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95). CONCLUSIONS In a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.
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Affiliation(s)
- Isaac E. Hall
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Peter Philip Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sherry G. Mansour
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut,Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Sumit Mohan
- The Columbia University Renal Epidemiology Group, New York, New York,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York,Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yaqi Jia
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Daniel C. Brennan
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mona D. Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Thangamani Muthukumar
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, New York,Department of Transplantation Medicine, New York Presbyterian Hospital–Weill Cornell Medical Center, New York, New York
| | - Enver Akalin
- Einstein/Montefiore Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Meera Nair Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania,Tower Health Transplant Institute, Tower Health System, Philadelphia, Pennsylvania
| | | | - Pooja Singh
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Francis L. Weng
- Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
| | - Jonathan S. Bromberg
- Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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19
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Yazısız H, Uygun V, Çolak D, Mutlu D, Hazar V, Öğünç D, Öngüt G, Küpesiz FT. Incidence of BKV in the urine and blood samples of pediatric patients undergoing HSCT. Pediatr Transplant 2021; 25:e13894. [PMID: 33136312 DOI: 10.1111/petr.13894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/20/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022]
Abstract
The aims were to investigate the incidence of BKV infection and the presence of HC in pediatric patients undergoing HSCT. Twenty-four children patients (M/F: 17/7) undergoing HSCT in a single center over a period of 1 year were included in the study. The presence of BKV DNA was determined by quantitative real-time PCR in plasma and urine samples at the following times: before transplantation, twice a week until engraftment time, and weekly for + 100 days. The mean age of the patients was 7.79 ± 5.03 years, the mean follow-up time was 95.6 ± 25.9 days, and the average number of samples per patient was 15.8 ± 3.2. BKV DNA was detected in at least one urine sample in 91.6% (n: 22) and at least one plasma sample in 75% (n:18) of the patients. The median time to the first BKV DNA positivity in urine and plasma samples was 11 (range: 1-80) and 32 days (range: 2-79), respectively. The median value of BKV DNA copies in urine and plasma were 1.7 × 106 (range: 2.8 × 101 -1.2 × 1014 ) and 1.9 × 103 copies/mL (range: 3-2.1 × 106 ), respectively. Thirteen patients (54.2%) had hematuria with BKV viruria; 8 (33.3%) patients had viremia. The median value of the BKV DNA copies in urine and plasma was 4.4 × 107 (range: 65-1 × 1011 ) and 2.9 × 103 (range: 7-7.8 × 104 ) copies/mL in these patients. Two (15.4%) of the 13 patients with BKV viruria and hematuria were diagnosed with BKV-related HC. BKV DNA viral load monitoring of urine and plasma in pediatric HSCT patients with a high risk for viral infections is valuable for understanding the development of BKV-related HC.
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Affiliation(s)
- Hatice Yazısız
- Department of Medical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Vedat Uygun
- Department of Pediatric Hematology & Oncology, Medical Park Antalya Hospital, Antalya, Turkey
| | - Dilek Çolak
- Department of Medical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Derya Mutlu
- Department of Medical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Volkan Hazar
- Department of Pediatric Hematology & Oncology, MSG Medstar Yıldız Hospital, Antalya, Turkey
| | - Dilara Öğünç
- Department of Medical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Gözde Öngüt
- Department of Medical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Funda Tayfun Küpesiz
- Department of Pediatric Hematology & Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
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20
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Lebel E, Chen C, Paul H, Trudel S, Tiedemann R. Symptomatic BK Virus Disease in Patients With Heavily Pretreated Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e506-e509. [PMID: 33608216 DOI: 10.1016/j.clml.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Eyal Lebel
- Princess Margaret Cancer Centre, Toronto, Canada.
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21
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Nieto-Ríos JF, Benavides-Henao DA, Aristizabal-Alzate A, Morales-Contreras C, Chacón-Jaimes DC, Zuluaga-Valencia G, Serna-Higuita LM. BK virus nephropathy in a heart transplant recipient. J Bras Nefrol 2021; 43:434-439. [PMID: 33527977 PMCID: PMC8428640 DOI: 10.1590/2175-8239-jbn-2020-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/26/2020] [Indexed: 01/11/2023] Open
Abstract
BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.
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Affiliation(s)
- John Fredy Nieto-Ríos
- Hospital Pablo Tobón Uribe, Department of Nephrology and Kidney Transplant, Medellín, Colombia.,University of Antioquia, Nephrology Section, Department of Internal Medicine, Medellin, Colombia
| | | | | | - Carol Morales-Contreras
- University of Antioquia, Nephrology Section, Department of Internal Medicine, Medellin, Colombia
| | | | | | - Lina María Serna-Higuita
- Eberhard Karls University, Institute for Clinical Epidemiology and Applied Biometrics, Tuebingen, Germany
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22
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Intercellular Transmission of Naked Viruses through Extracellular Vesicles: Focus on Polyomaviruses. Viruses 2020; 12:v12101086. [PMID: 32993049 PMCID: PMC7599864 DOI: 10.3390/v12101086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Extracellular vesicles have recently emerged as a novel mode of viral transmission exploited by naked viruses to exit host cells through a nonlytic pathway. Extracellular vesicles can allow multiple viral particles to collectively traffic in and out of cells, thus enhancing the viral fitness and diversifying the transmission routes while evading the immune system. This has been shown for several RNA viruses that belong to the Picornaviridae, Hepeviridae, Reoviridae, and Caliciviridae families; however, recent studies also demonstrated that the BK and JC viruses, two DNA viruses that belong to the Polyomaviridae family, use a similar strategy. In this review, we provide an update on recent advances in understanding the mechanisms used by naked viruses to hijack extracellular vesicles, and we discuss the implications for the biology of polyomaviruses.
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23
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Panou MM, Antoni M, Morgan EL, Loundras EA, Wasson CW, Welberry-Smith M, Mankouri J, Macdonald A. Glibenclamide inhibits BK polyomavirus infection in kidney cells through CFTR blockade. Antiviral Res 2020; 178:104778. [PMID: 32229236 PMCID: PMC7322401 DOI: 10.1016/j.antiviral.2020.104778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023]
Abstract
BK polyomavirus (BKPyV) is a ubiquitous pathogen in the human population that is asymptomatic in healthy individuals, but can be life-threatening in those undergoing kidney transplant. To-date, no vaccines or anti-viral therapies are available to treat human BKPyV infections. New therapeutic strategies are urgently required. In this study, using a rational pharmacological screening regimen of known ion channel modulating compounds, we show that BKPyV requires cystic fibrosis transmembrane conductance regulator (CFTR) activity to infect primary renal proximal tubular epithelial cells. Disrupting CFTR function through treatment with the clinically available drug glibenclamide, the CFTR inhibitor CFTR172, or CFTR-silencing, all reduced BKPyV infection. Specifically, time of addition assays and the assessment of the exposure of VP2/VP3 minor capsid proteins indicated a role for CFTR during BKPyV transport to the endoplasmic reticulum, an essential step during the early stages of BKPyV infection. We thus establish CFTR as an important host-factor in the BKPyV life cycle and reveal CFTR modulators as potential anti-BKPyV therapies. BK polyomavirus (BKPyV) is life-threatening in those undergoing kidney transplant. BKPyV requires CFTR to infect primary kidney cells. Disrupting CFTR function pharmacologically reduces BKPyV infection. CFTR is required during BKPyV transport to the endoplasmic reticulum.
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Affiliation(s)
- Margarita-Maria Panou
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom
| | - Michelle Antoni
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom
| | - Ethan L Morgan
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom
| | - Eleni-Anna Loundras
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom
| | - Christopher W Wasson
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom
| | | | - Jamel Mankouri
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom.
| | - Andrew Macdonald
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, West Yorkshire, LS2 9JT, United Kingdom.
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24
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BK Polyomavirus Hijacks Extracellular Vesicles for En Bloc Transmission. J Virol 2020; 94:JVI.01834-19. [PMID: 31896595 PMCID: PMC7158717 DOI: 10.1128/jvi.01834-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
Reactivation of BKPyV is responsible for nephropathies in kidney transplant recipients, which frequently lead to graft loss. The mechanisms of persistence and immune evasion used by this virus remain poorly understood, and a therapeutic option for transplant patients is still lacking. Here, we show that BKPyV can be released into EVs, enabling viral particles to infect cells using an alternative entry pathway. This provides a new view of BKPyV pathogenesis. Even though we did not find any decreased sensitivity to neutralizing antibodies when comparing EV-associated particles and naked virions, our study also raises important questions about developing prevention strategies based on the induction or administration of neutralizing antibodies. Deciphering this new release pathway could enable the identification of therapeutic targets to prevent BKPyV nephropathies. It could also lead to a better understanding of the pathophysiology of other polyomaviruses that are associated with human diseases. Most people are asymptomatic carriers of the BK polyomavirus (BKPyV), but the mechanisms of persistence and immune evasion remain poorly understood. Furthermore, BKPyV is responsible for nephropathies in kidney transplant recipients. Unfortunately, the sole therapeutic option is to modulate immunosuppression, which increases the risk of transplant rejection. Using iodixanol density gradients, we observed that Vero and renal proximal tubular epithelial infected cells release two populations of infectious particles, one of which cosediments with extracellular vesicles (EVs). Electron microscopy confirmed that a single vesicle could traffic tens of viral particles. In contrast to naked virions, the EV-associated particles (eBKPyVs) were not able to agglutinate red blood cells and did not use cell surface sialylated glycans as an attachment factor, demonstrating that different entry pathways were involved for each type of infectious particle. However, we also observed that naked BKPyV and eBKPyV were equally sensitive to neutralization by the serum of a seropositive patient or commercially available polyvalent immunoglobulin preparations, which occurred at a postattachment step, after endocytosis. In conclusion, our work shows a new mechanism that likely plays a critical role during the primary infection and in the persistence, but also the reactivation, of BKPyV. IMPORTANCE Reactivation of BKPyV is responsible for nephropathies in kidney transplant recipients, which frequently lead to graft loss. The mechanisms of persistence and immune evasion used by this virus remain poorly understood, and a therapeutic option for transplant patients is still lacking. Here, we show that BKPyV can be released into EVs, enabling viral particles to infect cells using an alternative entry pathway. This provides a new view of BKPyV pathogenesis. Even though we did not find any decreased sensitivity to neutralizing antibodies when comparing EV-associated particles and naked virions, our study also raises important questions about developing prevention strategies based on the induction or administration of neutralizing antibodies. Deciphering this new release pathway could enable the identification of therapeutic targets to prevent BKPyV nephropathies. It could also lead to a better understanding of the pathophysiology of other polyomaviruses that are associated with human diseases.
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25
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Krajewski W, Kamińska D, Poterek A, Małkiewicz B, Kłak J, Zdrojowy R, Janczak D. Pathogenicity of BK virus on the urinary system. Cent European J Urol 2020; 73:94-103. [PMID: 32395331 PMCID: PMC7203775 DOI: 10.5173/ceju.2020.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction The polyomaviruses are omnipresent in nature. The major sites of BK virus appearance are the kidney tubular epithelial cells and urinary bladder surface transitional cells. Material and methods A literature search according to PRISMA guidelines within the Medline database was conducted in July 2019 for articles presenting data about BK virus in urologic aspect without setting time limits, using the terms ‘BK virus’ in conjunction with transplantation, nephropathy, stenosis, cancer, bladder, prostate, kidney. Results The BK virus usually stays latent, however, its replication may become active in various clinical situations of impaired immunocompetence such as solid organ transplantation, bone marrow transplantation, AIDS, pregnancy, multiple sclerosis, administration of chemotherapy or biologic therapy. BK virus is associated with two main complications after transplantation: polyomavirus-associated nephropathy in kidney transplant patients and polyomavirus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplant patients. Conclusions The aim of this article was to present available data on urologic aspects of BK virus infection, its detection methods and available treatment.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Adrian Poterek
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Jacek Kłak
- Department of Urology and Oncologic Urology, Lower Silesian Specialistic Hospital, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wrocław Medical University, Wrocław, Poland
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26
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Chen XT, Wang ZY, Huang Y, Wang JY, Yang SC, Chen WF, Chen PS, Li J, Deng RH, Huang G. Combined detection of urine specific gravity and BK viruria on prediction of BK polyomavirus nephropathy in kidney transplant recipients. Chin Med J (Engl) 2020; 133:33-40. [PMID: 31923102 PMCID: PMC7028210 DOI: 10.1097/cm9.0000000000000579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is an important cause of dysfunction and failure of renal transplants. This study aimed to assess the diagnostic performance of morning urine specific gravity (MUSG) in diagnosing BKPyVAN in kidney transplant recipients. METHODS A total of 87 patients, including 27 with BKPyVAN, 22 with isolated BKPyV viruria, 18 with T cell-mediated rejection (TCMR), and 20 with stable graft function, were enrolled in the First Affiliated Hospital of Sun Yat-Sen University from March 2015 to February 2017. MUSG at biopsy and during a follow-up period of 24 months after biopsy was collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of MUSG to discriminate BKPyVAN. RESULTS At biopsy, the MUSG of BKPyVAN group (1.008 ± 0.003) was significantly lower than that of isolated BK viruria group (1.013 ± 0.004, P < 0.001), TCMR group (1.011 ± 0.003, P = 0.027), and control group (1.014 ± 0.006, P < 0.001). There was no significant difference in MUSG among the isolated BK viruria group, TCMR group, and control group (P = 0.253). In BKPyVAN group, the timing and trend of MUSG elevate were consistent with the timing and trend of the decline of viral load in urine and plasma, reaching a statistical difference at 3 months after treatment (1.012 ± 0.003, P < 0.001) compared with values at diagnosis. ROC analysis indicated that the optimal cut-off value of MUSG for diagnosis of BKPyVAN was 1.009, with an area under the ROC curve (AUC) of 0.803 (95% confidence interval [CI]: 0.721-0.937). For differentiating BKPyVAN and TCMR, the optimal MUSG cut-off value was 1.010, with an AUC of 0.811 (95% CI: 0.687-0.934). CONCLUSION Combined detection of MUSG and BKPyV viruria is valuable for predicting BKPyVAN and distinguishing BKPyVAN from TCMR in renal transplant recipients.
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Affiliation(s)
- Xu-Tao Chen
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Ze-Yuan Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yang Huang
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Jin-Yuan Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Shi-Cong Yang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wen-Fang Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Pei-Song Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Jun Li
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Rong-Hai Deng
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Gang Huang
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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27
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Pre-Transplantation Assessment of BK Virus Serostatus: Significance, Current Methods, and Obstacles. Viruses 2019; 11:v11100945. [PMID: 31615131 PMCID: PMC6833059 DOI: 10.3390/v11100945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 02/07/2023] Open
Abstract
The immunosuppression required for graft tolerance in kidney transplant patients can trigger latent BK polyomavirus (BKPyV) reactivation, and the infection can progress to nephropathy and graft rejection. It has been suggested that pre-transplantation BKPyV serostatus in donors and recipients is a predictive marker for post-transplantation BKPyV replication. The fact that research laboratories have used many different assay techniques to determine BKPyV serostatus complicates these data analysis. Even studies based on the same technique differed in their standard controls choice, the antigenic structure type used for detection, and the cut-off for seropositivity. Here, we review the different BKPyV VP1 antigens types used for detection and consider the various BKPyV serostatus assay techniques’ advantages and disadvantages. Lastly, we highlight the obstacles in the implementation of a consensual BKPyV serologic assay in clinics (e.g., the guidelines absence in this field).
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28
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Kornii Y, Chumachenko S, Shablykin O, Prichard MN, James SH, Hartline C, Zhirnov V, Brovarets V. New 2-Oxoimidazolidine Derivatives: Design, Synthesis and Evaluation of Anti-BK Virus Activities in Vitro. Chem Biodivers 2019; 16:e1900391. [PMID: 31479201 DOI: 10.1002/cbdv.201900391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
A series of novel 2-oxoimidazolidine derivatives were synthesized and their antiviral activities against BK human polyomavirus type 1 (BKPyV) were evaluated in vitro. Bioassays showed that the synthesized compounds 1-{[(4E)-5-(dichloromethylidene)-2-oxoimidazolidin-4-ylidene]sulfamoyl}piperidine-4-carboxylic acid (5) and N-Cyclobutyl-N'-[(4E)-5-(dichloromethylidene)-2-oxoimidazolidin-4-ylidene]sulfuric diamide (4) exhibited moderate activities against BKPyV (EC50 =5.4 and 5.5 μm, respectively) that are comparable to the standard drug Cidofovir. Compound 5 exhibited the same cytotoxicity in HFF cells and selectivity index (SI50 ) as Cidofovir. The selectivity index of compound 4 is three times less than that of Cidofovir due to the higher toxicity of this compound. Hence, these compounds may be taken as lead compound for further development of novel ant-BKPyV agents.
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Affiliation(s)
- Yurii Kornii
- Department of Chemistry of Bioactive Nitrogen-Containing Heterocyclic Bases, V. P. Kukhar Institute of Bioorganic Chemistry and Petrochemistry, NAS of Ukraine, 1, Murmanska Str., Kyiv, 02094, Ukraine
| | - Svitlana Chumachenko
- Department of Chemistry of Bioactive Nitrogen-Containing Heterocyclic Bases, V. P. Kukhar Institute of Bioorganic Chemistry and Petrochemistry, NAS of Ukraine, 1, Murmanska Str., Kyiv, 02094, Ukraine
| | - Oleg Shablykin
- Department of Chemistry of Bioactive Nitrogen-Containing Heterocyclic Bases, V. P. Kukhar Institute of Bioorganic Chemistry and Petrochemistry, NAS of Ukraine, 1, Murmanska Str., Kyiv, 02094, Ukraine
| | - Mark N Prichard
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Scott H James
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Caroll Hartline
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Victor Zhirnov
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - Volodymyr Brovarets
- Department of Chemistry of Bioactive Nitrogen-Containing Heterocyclic Bases, V. P. Kukhar Institute of Bioorganic Chemistry and Petrochemistry, NAS of Ukraine, 1, Murmanska Str., Kyiv, 02094, Ukraine
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