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Nunes JM, Kell DB, Pretorius E. Herpesvirus Infection of Endothelial Cells as a Systemic Pathological Axis in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Viruses 2024; 16:572. [PMID: 38675914 PMCID: PMC11053605 DOI: 10.3390/v16040572] [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: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Understanding the pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is critical for advancing treatment options. This review explores the novel hypothesis that a herpesvirus infection of endothelial cells (ECs) may underlie ME/CFS symptomatology. We review evidence linking herpesviruses to persistent EC infection and the implications for endothelial dysfunction, encompassing blood flow regulation, coagulation, and cognitive impairment-symptoms consistent with ME/CFS and Long COVID. This paper provides a synthesis of current research on herpesvirus latency and reactivation, detailing the impact on ECs and subsequent systemic complications, including latent modulation and long-term maladaptation. We suggest that the chronicity of ME/CFS symptoms and the multisystemic nature of the disease may be partly attributable to herpesvirus-induced endothelial maladaptation. Our conclusions underscore the necessity for further investigation into the prevalence and load of herpesvirus infection within the ECs of ME/CFS patients. This review offers conceptual advances by proposing an endothelial infection model as a systemic mechanism contributing to ME/CFS, steering future research toward potentially unexplored avenues in understanding and treating this complex syndrome.
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Affiliation(s)
- Jean M. Nunes
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
| | - Douglas B. Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Building 220, Chemitorvet 200, 2800 Kongens Lyngby, Denmark
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK
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Abbasi F, Kaydani GA, Tahannezhad Z, Nakhaie M, Asnafi AA, Moradi M. Prevalence of Cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) Subclinical Infection in Patients with Acute Immune Thrombocytopenic Purpura (ITP). Int J Hematol Oncol Stem Cell Res 2021; 15:139-144. [PMID: 35082994 PMCID: PMC8748239 DOI: 10.18502/ijhoscr.v15i3.6843] [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: 12/24/2019] [Accepted: 06/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Immune thrombocytopenic purpura (ITP) defined as a bleeding disorder in which the number and production of platelets reduced by the immune system; however, the destruction of peripheral blood platelets also occurs. Although its exact etiology and pathogenesis not already know, several studies have shown that Epstein-Barr virus (EBV) and cytomegalovirus (CMV) known as possible causative agents of ITP. This investigation aims to evaluate the presence of CMV and EBV in two groups of case and control by polymerase chain reaction (PCR). Materials and Methods: we considered the presence of CMV and EBV in 48 acute ITP patients and 48 healthy people. Study participants were recruited from Ahvaz Shafa Hospital between 2017 and 2018 and the presence of two viruses was investigated by (PCR). Results: Out of 48 acute ITP patients, the CMV DNA was detected from the blood of 12 (25%) patients and the EBV DNA from the blood of 2 (4.2%) other patients. In addition, only one patient was (2.1%) co-infected with CMV and EBV. In contrast, in 48 healthy subjects, 3 (6.6%) had CMV and none of the control group was infected with EBV. Conclusion: Due to the presence of both EBV and CMV in the acute ITP patients in Ahvaz, they can be considered as factors in the progression of this disease. Therefore, consideration of the methods of elimination and treatment of these two viruses in these patients may be used as a treatment strategy in ITP patients in the future.
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Affiliation(s)
- Farshad Abbasi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholam Abbas Kaydani
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zari Tahannezhad
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Nakhaie
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Amin Asnafi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Moradi
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, Guillotin V, Malphettes M, Galicier L, Noel N, Darnige L, Terriou L, Guerveno C, Sanchis-Borja M, Moulinet T, Meunier B, Ebbo M, Michel M, Godeau B. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multicentre series. Br J Haematol 2020; 190:e224-e229. [PMID: 32678953 PMCID: PMC7404899 DOI: 10.1111/bjh.17024] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,UMR 1027 Inserm, University of Toulouse, Toulouse, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital (CHU de Bordeaux), Bordeaux, France.,Inserm U1034-University of Bordeaux, Bordeaux, France
| | - Margaux Garzaro
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Etienne Crickx
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Vivien Guillotin
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Marion Malphettes
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Noel
- Department of internal medicine, Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Darnige
- Inserm UMR-S 1140, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Louis Terriou
- Department of Internal Medicine and Immunology, Claude-Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Claire Guerveno
- Department of Internal Medicine, Albi Hospital, Albi, France
| | - Mateo Sanchis-Borja
- Department of pneumology, Hôpital européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Moulinet
- Department of internal medicine, Nancy University Hospital (CHU de Nancy), University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Benoit Meunier
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Mikael Ebbo
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Nishikawa M, Shimada N, Kawazoe T, Sawaki R, Ikuta H, Kanzaki M, Fukuoka K, Fukushima M, Asano K. Long-term Successful Treatment of Rituximab for Steroid-resistant Minimal Change Nephrotic Syndrome and Idiopathic Thrombocytopenic Purpura. Intern Med 2020; 59:983-986. [PMID: 31866629 PMCID: PMC7184077 DOI: 10.2169/internalmedicine.3837-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/04/2019] [Indexed: 01/19/2023] Open
Abstract
A 22-year-old woman had been diagnosed with idiopathic thrombocytopenic purpura (ITP) 5 years earlier. After undergoing splenectomy, she relapsed frequently following prednisolone tapering. She was complicated with minimal change nephrotic syndrome (MCNS) while taking 20 mg of prednisolone. Despite treatment with prednisolone, cyclosporin and low-density lipoprotein-apheresis, MCNS and ITP did not improve. We added rituximab in 4 weekly infusions of 375 mg/m2. MCNS and ITP were in complete remission. After administering rituximab once, all medicines were discontinued. No relapse had occurred by 50 months following the first rituximab administration. Rituximab affects steroid-resistant MCNS and ITP for a long time without complications.
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Affiliation(s)
- Mana Nishikawa
- Department of Nephrology, Kurashiki Central Hospital, Japan
| | | | | | - Ryo Sawaki
- Department of Nephrology, Kurashiki Central Hospital, Japan
| | - Haruka Ikuta
- Department of Nephrology, Kurashiki Central Hospital, Japan
| | - Motoko Kanzaki
- Department of Nephrology, Kurashiki Central Hospital, Japan
| | - Kosuke Fukuoka
- Department of Nephrology, Kurashiki Central Hospital, Japan
| | - Masaki Fukushima
- Department of Internal Medicine, Shigei Research Institute Hospital, Japan
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Tilden W, Valliani S. Severe thrombocytopenia and recurrent epistaxis associated with primary Epstein-Barr virus infection. BMJ Case Rep 2015; 2015:bcr-2014-208018. [PMID: 25858924 DOI: 10.1136/bcr-2014-208018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), generally follows a benign, yet protracted course, with the majority of symptoms being systemic somatic symptoms. Rarely, the clinical picture can be complicated by more acute severe haemotological sequelae of the disease, requiring hospitalisation and causing diagnostic uncertainty, particularly when distinguishing between a viral illness and a lymphoproliferative disorder. We describe the case of a young male patient who presented with headache, recurrent epistaxis and severe thrombocytopenia.
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Padovani JL, Corvino SM, Drexler JF, Silva GF, Pardini MIDMC, Grotto RMT. In vitro detection of hepatitis C virus in platelets from uninfected individuals exposed to the virus. Rev Soc Bras Med Trop 2013; 46:154-5. [PMID: 23559343 DOI: 10.1590/0037-8682-1627-2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 01/16/2013] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Despite hepatocytes being the target cells of hepatitis C virus (HCV), viral ribonucleic acid RNA has been detected in other cells, including platelets, which have been described as carriers of the virus in the circulation of infected patients. Platelets do not express cluster differentiation 81 CD81, the main receptor for the virus in hepatocytes, although this receptor protein has been found in megakaryocytes. Still, it is not clear if HCV interacts with platelets directly or if this interaction is a consequence of its association with megakaryocytes. The aim of this study was to evaluate the interaction of HCV with platelets from non-infected individuals, after in vitro exposure to the virus. METHODS Platelets obtained from 50 blood donors not infected by HCV were incubated in vitro at 37°C for 48h with serum containing 100,000IU∕mL of genotype 1 HCV. After incubation, RNA extracted from the platelets was assayed for the presence of HCV by reverse transcription – polymerase chain reaction RT-PCR. RESULTS After incubation in the presence of virus, all samples of platelets showed HCV RNA. CONCLUSIONS The results demonstrate that, in vitro, the virus interacts with platelets despite the absence of the receptor CD81, suggesting that other molecules could be involved in this association.
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Affiliation(s)
- Juliana Lara Padovani
- Laboratório de Biologia Molecular do Hemocentro de Botucatu, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista -UNESP, Botucatu, SP, Brasil
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Goeijenbier M, van Wissen M, van de Weg C, Jong E, Gerdes VEA, Meijers JCM, Brandjes DPM, van Gorp ECM. Review: Viral infections and mechanisms of thrombosis and bleeding. J Med Virol 2013; 84:1680-96. [PMID: 22930518 PMCID: PMC7166625 DOI: 10.1002/jmv.23354] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Viral infections are associated with coagulation disorders. All aspects of the coagulation cascade, primary hemostasis, coagulation, and fibrinolysis, can be affected. As a consequence, thrombosis and disseminated intravascular coagulation, hemorrhage, or both, may occur. Investigation of coagulation disorders as a consequence of different viral infections have not been performed uniformly. Common pathways are therefore not fully elucidated. In many severe viral infections there is no treatment other than supportive measures. A better understanding of the pathophysiology behind the association of viral infections and coagulation disorders is crucial for developing therapeutic strategies. This is of special importance in case of severe complications, such as those seen in hemorrhagic viral infections, the incidence of which is increasing worldwide. To date, only a few promising targets have been discovered, meaning the implementation in a clinical context is still hampered. This review discusses non‐hemorrhagic and hemorrhagic viruses for which sufficient data on the association with hemostasis and related clinical features is available. This will enable clinicians to interpret research data and place them into a perspective. J. Med. Virol. 84:1680–1696, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- M Goeijenbier
- Department of Virology, Erasmus Medical Centre, University of Rotterdam, Rotterdam, The Netherlands.
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Freeman ML, Burkum CE, Lanzer KG, Roberts AD, Pinkevych M, Itakura A, Kummer LW, Szaba FM, Davenport MP, McCarty OJT, Woodland DL, Smiley ST, Blackman MA. Gammaherpesvirus latency induces antibody-associated thrombocytopenia in mice. J Autoimmun 2012; 42:71-9. [PMID: 23245703 DOI: 10.1016/j.jaut.2012.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 11/20/2012] [Accepted: 11/24/2012] [Indexed: 12/13/2022]
Abstract
Human herpesviruses establish lifelong latency. Viral recrudescence can lead to the development of cancers, immunoproliferative disorders, transplantation complications, and thrombocytopenia. Although platelet-specific autoantibodies have been reported in patients infected with the Epstein-Barr virus (EBV), the mechanisms by which thrombocytopenia is induced remain unclear, as do the relative contributions of lytic viral replication and latent viral gene expression. The human gammaherpesviruses are tightly restricted in their ability to infect other mammals, so they are difficult to study in live animal models. Here we show that infection of mice with murine gammaherpesvirus-68 (γHV68), a rodent-specific pathogen closely related to EBV, induces the production of platelet-binding antibodies and causes thrombocytopenia. Infection of antibody-deficient mice does not lead to thrombocytopenia, indicating the platelet decrease is mediated by antibody. Additionally, infection with a latency-null recombinant γHV68 does not induce thrombocytopenia, suggesting factors associated with viral latency drive the infection-induced antibody-mediated thrombocytopenia. These studies describe an important animal model of gammaherpesvirus-induced autoimmune thrombocytopenia and demonstrate that this pathology is mediated by antibody and dependent on viral latency. This model will allow studies of the underlying mechanisms of disease progression and the testing of therapeutic strategies for the alleviation of virus-induced thrombocytopenia.
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Affiliation(s)
- Michael L Freeman
- Trudeau Institute, 154 Algonquin Avenue, Saranac Lake, NY 12983, USA
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Lucas Sendra R, Velilla Antolín D, Mares Diago FJ, Plaza Miranda MA, Navarro Ortega D. [Infectious mononucleosis and severe thrombocytopenia]. An Pediatr (Barc) 2012; 77:200-2. [PMID: 22465285 DOI: 10.1016/j.anpedi.2012.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/29/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022] Open
Abstract
Infectious mononucleosis by Epstein-Barr virus is usually a benign self-limiting disease. We present two cases admitted in the same week, with suspected co-infection by other viruses (cytomegalovirus and human herpes virus 6), which showed severe thrombocytopenia in the acute phase of the disease. The progress and treatment were different in each case.
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Affiliation(s)
- R Lucas Sendra
- Servicio de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, España.
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Li IWS, To KKW, Tang BSF, Chan KH, Hui CK, Cheng VCC, Yuen KY. Human metapneumovirus infection in an immunocompetent adult presenting as mononucleosis-like illness. J Infect 2008; 56:389-92. [PMID: 18423876 PMCID: PMC7127351 DOI: 10.1016/j.jinf.2008.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 03/10/2008] [Accepted: 03/12/2008] [Indexed: 11/28/2022]
Abstract
A 37-year-old man was presented with incidental findings of neutropenia, atypical lymphocytosis, thrombocytopenia and deranged liver parenchymal enzymes. Four days later, he developed fever, sore throat and cervical lymphadenopathy, compatible with mononucleosis-like illness (MLI). Polymerase chain reaction (PCR) and viral culture of the nasopharyngeal swab showed human metapneumovirus (hMPV). There was a >/=4-fold rise in IgG against hMPV. This is the first case report illustrating the natural clinical course of hMPV-related MLI.
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Affiliation(s)
- Iris W S Li
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong
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