1
|
Feldmann S, Grimm I, Stöhr D, Antonini C, Lischka P, Sinzger C, Stegmann C. Targeted mutagenesis on PDGFRα-Fc identifies amino acid modifications that allow efficient inhibition of HCMV infection while abolishing PDGF sequestration. PLoS Pathog 2021; 17:e1009471. [PMID: 33780515 PMCID: PMC8031885 DOI: 10.1371/journal.ppat.1009471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 04/08/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022] Open
Abstract
Platelet-derived growth factor receptor alpha (PDGFRα) serves as an entry receptor for the human cytomegalovirus (HCMV), and soluble PDGFRα-Fc can neutralize HCMV at a half-maximal effective concentration (EC50) of about 10 ng/ml. While this indicates a potential for usage as an HCMV entry inhibitor PDGFRα-Fc can also bind the physiological ligands of PDGFRα (PDGFs), which likely interferes with the respective signaling pathways and represents a potential source of side effects. Therefore, we tested the hypothesis that interference with PDGF signaling can be prevented by mutations in PDGFRα-Fc or combinations thereof, without losing the inhibitory potential for HCMV. To this aim, a targeted mutagenesis approach was chosen. The mutations were quantitatively tested in biological assays for interference with PDGF-dependent signaling as well as inhibition of HCMV infection and biochemically for reduced affinity to PDGF-BB, facilitating quantification of PDGFRα-Fc selectivity for HCMV inhibition. Mutation of Ile 139 to Glu and Tyr 206 to Ser strongly reduced the affinity for PDGF-BB and hence interference with PDGF-dependent signaling. Inhibition of HCMV infection was less affected, thus increasing the selectivity by factor 4 and 8, respectively. Surprisingly, the combination of these mutations had an additive effect on binding of PDGF-BB but not on inhibition of HCMV, resulting in a synergistic 260fold increase of selectivity. In addition, a recently reported mutation, Val 242 to Lys, was included in the analysis. PDGFRα-Fc with this mutation was fully effective at blocking HCMV entry and had a drastically reduced affinity for PDGF-BB. Combining Val 242 to Lys with Ile 139 to Glu and/or Tyr 206 to Ser further reduced PDGF ligand binding beyond detection. In conclusion, this targeted mutagenesis approach identified combinations of mutations in PDGFRα-Fc that prevent interference with PDGF-BB but maintain inhibition of HCMV, which qualifies such mutants as candidates for the development of HCMV entry inhibitors.
Collapse
Affiliation(s)
- Svenja Feldmann
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
| | | | - Dagmar Stöhr
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
| | - Chiara Antonini
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Peter Lischka
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Christian Sinzger
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
- * E-mail: (CSi); (CSt)
| | - Cora Stegmann
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
- * E-mail: (CSi); (CSt)
| |
Collapse
|
2
|
Zamora D, Krantz EM, Green ML, Joncas-Schronce L, Blazevic R, Edmison BC, Huang ML, Stevens-Ayers T, Jerome KR, Geballe AP, Boeckh M. Cytomegalovirus Humoral Response Against Epithelial Cell Entry-Mediated Infection in the Primary Infection Setting After Hematopoietic Cell Transplantation. J Infect Dis 2021; 221:1470-1479. [PMID: 31734696 DOI: 10.1093/infdis/jiz596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The influence of humoral immunity on the prevention of primary cytomegalovirus (CMV) infection after hematopoietic cell transplantation (HCT) is poorly understood. METHODS To determine whether neutralizing antibodies (nAbs) against CMV pentameric complex (PC)-mediated epithelial cell entry decrease CMV infection after HCT, samples were analyzed from a randomized controlled trial of CMV intravenous immunoglobulin (IVIG) prophylaxis. Weekly serum from 61 CMV donor-positive/recipient-negative (D+/R-) HCT patients (33 control, 28 CMV IVIG) was tested using a PC-entry nAb assay and quantitative CMV polymerase chain reaction (PCR). RESULTS There was a trend toward higher weekly PC-entry nAb titers (P = .07) and decreased CMV infection by PCR at viral load cutoffs of ≥1000 and ≥10 000 IU/mL in the CMV IVIG arm. High nAb titers were not significantly protective against CMV infection later after HCT in both study arms. Among CMV-infected patients, each log2 increase in nAb titer was associated with an average 0.2 log10 decrease in concurrent CMV viral load after infection (P = .001; adjusted for study arm). CONCLUSIONS This study provides initial support that CMV IVIG prophylaxis moderately enhances PC-entry nAB activity in D+/R- HCT recipients.
Collapse
Affiliation(s)
- Danniel Zamora
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Margaret L Green
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Laurel Joncas-Schronce
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rachel Blazevic
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bradley C Edmison
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Meei-Li Huang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Terry Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Adam P Geballe
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Departments of Medicine and Microbiology, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
3
|
Ahn H, Tay J, Shea B, Hutton B, Shorr R, Knoll GA, Cameron DW, Cowan J. Effectiveness of immunoglobulin prophylaxis in reducing clinical complications of hematopoietic stem cell transplantation: a systematic review and meta-analysis. Transfusion 2018; 58:2437-2452. [PMID: 29770447 DOI: 10.1111/trf.14656] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prophylactic immunoglobulin has been used with varying efficacy to reduce complications in hematopoietic stem cell transplant recipients. STUDY DESIGN AND METHODS A systematic review and meta-analysis was conducted of randomized controlled trials that assessed clinical outcomes (overall survival, transplant-related mortality, graft-versus-host disease [GVHD], veno-occlusive disease [VOD], interstitial pneumonitis, disease relapse, cytomegalovirus [CMV] infection and disease, non-CMV infection) of immunoglobulin prophylaxis versus placebo in hematopoietic stem cell transplant recipients. MEDLINE, EMBASE, EBM Reviews, and the Cochrane Central Register of Controlled Trials were searched up to June 2017. Quality of included studies and outcomes were evaluated via Risk of Bias assessment and Grading of Recommendations, Assessment, Development and Evaluation criteria, respectively. RESULTS Of 899 citations screened, 27 studies (n = 3934) were included. Immunoglobulin prophylaxis had no impact on survival (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.88-1.01; 11 studies, n = 1962) but decreased risk of acute GVHD (RR, 0.78; 95% CI, 0.65-0.94; eight studies, n = 1097) and CMV disease (RR, 0.52; 95% CI, 0.28-0.97; two studies, n = 167). Meta-analysis revealed increased risk of VOD (RR, 3.04; 95% CI, 1.10-8.41; three studies, n = 384) and disease relapse (RR, 1.26; 95% CI, 1.07-1.49; seven studies, n = 1647). Other outcomes were small in sample size or nonsignificant. Results should be interpreted cautiously given the low quality of studies and evidence of outcomes. CONCLUSION Immunoglobulin prophylaxis did not have a significant effect on survival. Positive clinical effects were shown for acute GVHD and CMV disease and negative effects against VOD and disease relapse. No studies examined the effect of immunoglobulin treatment in hypogammaglobulinemic patients despite current guidelines, warranting further studies in this population.
Collapse
Affiliation(s)
- Hilalion Ahn
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jason Tay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Renal Transplantation, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Donald William Cameron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada.,Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Juthaporn Cowan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada.,Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Canada
| |
Collapse
|
4
|
Segal BH. Role of Immunoglobulin Therapy to Prevent and Treat Infections. MANAGEMENT OF INFECTIONS IN THE IMMUNOCOMPROMISED HOST 2018. [PMCID: PMC7123824 DOI: 10.1007/978-3-319-77674-3_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Immunoglobulins have been used widely in medicine for a variety of diseases including infectious diseases. While the main clinical applications of immunoglobulin therapy concern their use as replacement for patients with primary immunodeficiencies, or as treatment for autoimmune and inflammatory disorders, their role in infectious disease is limited largely to viral and toxin neutralization and replacement therapy in patients with immunoglobulin deficiencies. Many aspects of the therapeutic regimen of immunoglobulins even in the established indications remain open. Recently, due to the worldwide surge of immunosuppression caused by AIDS, organ transplantation, cancer, and autoimmune therapies, as well as the emergence of multidrug-resistant bacteria, there has been renewed interest in the use of antibody preparation to prevent infections in high-risk groups. Knowing the limitations of the current anti-infective armamentarium, approaches that target the host through manipulations to augment the host immune response provide a helpful aid to conventional treatment options. A substantial body of evidence has demonstrated that strategies aiming to support or stimulate immune response could be feasible approaches that would benefit immunocompromised patients. In the present chapter, we present contemporary indications of immunoglobulin administration for therapy and prophylaxis of infections in the immunocompromised population.
Collapse
Affiliation(s)
- Brahm H. Segal
- Departments of Medicine and Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, New York USA
| |
Collapse
|
5
|
Söderberg-Nauclér C. Treatment of cytomegalovirus infections beyond acute disease to improve human health. Expert Rev Anti Infect Ther 2014; 12:211-22. [PMID: 24404994 DOI: 10.1586/14787210.2014.870472] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Human cytomegalovirus is a common virus that establishes latency and persistence after a primary infection in 50-90% of populations worldwide. In otherwise healthy persons, the infection is generally mild or asymptomatic, although it may cause mononucleosis, prolonged episodes of fever, and hepatitis. However, in AIDS patients and transplant recipients who are immunosuppressed, severe, life-threatening infections may develop. CMV is also the most common congenital infection and may cause birth defects and deafness. Emerging evidence shows a high prevalence of this virus in patients with chronic inflammatory diseases or tumours of different origin, such as breast, colon, and prostate cancer, neuroblastoma, medulloblastoma, and glioblastoma. Several drugs are available to treat CMV infections. This review will highlight the possibility of using anti-CMV therapy to improve outcome not only in patients with acute CMV infections but also in patients with inflammatory diseases and cancer.
Collapse
Affiliation(s)
- Cecilia Söderberg-Nauclér
- Department of Medicine, Center for Molecular Medicine, Karolinska Institute, SE-171 76 Stockholm, Sweden
| |
Collapse
|
6
|
Ichihara H, Nakamae H, Hirose A, Nakane T, Koh H, Hayashi Y, Nishimoto M, Nakamae M, Yoshida M, Bingo M, Okamura H, Aimoto M, Manabe M, Hagihara K, Terada Y, Nakao Y, Hino M. Immunoglobulin prophylaxis against cytomegalovirus infection in patients at high risk of infection following allogeneic hematopoietic cell transplantation. Transplant Proc 2012; 43:3927-32. [PMID: 22172874 DOI: 10.1016/j.transproceed.2011.08.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/15/2011] [Accepted: 08/31/2011] [Indexed: 11/28/2022]
Abstract
Reports on the efficacy of intravenous immunoglobulin (IVIG) prophylaxis against cytomegalovirus (CMV) infection after allogeneic hematopoietic cell transplantation (HCT) have often sparked controversy. In addition, we are not aware of any study that has examined whether prophylaxis with IVIG affects the incidence of CMV infection in high-risk patients--those who are elderly or have received human leukocyte antigen (HLA) mismatched HCT. In the present open-label, phase II study, we addressed this question. We enrolled 106 patients in the study. The cumulative incidences of CMV infection at 100 days after HCT were similar in the intervention and the control groups (68% and 64%, P=.89; 89% and 87%, P=.79, respectively, for patients 55 years or older and those who received HLA-mismatched HCT). In those who received HLA-mismatched HCT, 1-year overall survival after HCT was 46% in the intervention group and 40% in the control group (P=.31); for age≥55 years, the corresponding values were 46% and 40% (P=.27). Our data showed that prophylaxis with regular polyvalent IVIG did not affect the incidence of CMV infections or survival among older patients or those who receive HLA-mismatched HCT.
Collapse
Affiliation(s)
- H Ichihara
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Hsu JL, Safdar N. Polyclonal immunoglobulins and hyperimmune globulins in prevention and management of infectious diseases. Infect Dis Clin North Am 2012; 25:773-88. [PMID: 22054755 DOI: 10.1016/j.idc.2011.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Immunoglobulin therapy has a rich history of use in preventing and treating infectious diseases; however, clinical data on the efficacy of immunoglobulin is lacking for many infectious diseases. Immunoglobulin therapy is routinely used in postexposure prophylaxis for bacterial infections, including tetanus, botulism, and diphtheria, and viral infections, including hepatitis A and B and varicella. Immunoglobulin therapy has also been used in many severe and life-threatening infections where treatments are limited, including toxic shock syndrome, respiratory syncytial virus infection, and cytomegalovirus infection. The authors review the evidence for the use of immunoglobulin therapy in common adult infectious diseases.
Collapse
Affiliation(s)
- Jennifer L Hsu
- Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
| | | |
Collapse
|
8
|
Raanani P, Gafter-Gvili A, Paul M, Ben-Bassat I, Leibovici L, Shpilberg O. Immunoglobulin prophylaxis in hematopoietic stem cell transplantation: systematic review and meta-analysis. J Clin Oncol 2008; 27:770-81. [PMID: 19114702 DOI: 10.1200/jco.2008.16.8450] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Because the role of immunoglobulins (IVIG) prophylaxis in patients undergoing hematopoietic stem-cell transplantation (HSCT) has not been established in terms of survival and infection prevention, we conducted a meta-analysis evaluating these issues. METHODS Systematic review and meta-analysis of randomized-controlled trials comparing prophylaxis with polyvalent IVIG or cytomegalovirus (CMV)-IVIG and control or another preparation or dose. PUBMED, Cochrane Library, LILACS, and conference proceedings were searched. Two reviewers appraised the quality of trials and extracted data. Relative risks (RRs) with 95% CIs were estimated and pooled. RESULTS Thirty trials including 4,223 patients undergoing bone marrow transplantation (BMT) were included. There was no difference in all-cause mortality when polyvalent IVIG or CMV-IVIG was compared to control (RR, 0.99; 95% CI, 0.88 to 1.12; and RR, 0.86; 95% CI, 0.63 to 1.16, respectively). There was no difference in clinically documented infections when polyvalent IVIG was compared with control (RR, 1.00; 95% CI, 0.90 to 1.10; five trials). CMV infections were not significantly reduced with either polyvalent IVIG or CMV-IVIG. Interstitial pneumonitis was reduced with polyvalent IVIG in older studies but not in the more recent ones, nor in studies assessing CMV-IVIG. Polyvalent IVIG increased the risk for veno-occlusive disease (RR, 2.73; (95% CI, 1.11 to 6.71). Graft-versus-host disease was not affected. CONCLUSION Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.
Collapse
Affiliation(s)
- Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
| | | | | | | | | | | |
Collapse
|
9
|
Raanani P, Gafter-Gvili A, Paul M, Ben-Bassat I, Leibovici L, Shpilberg O. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. Cochrane Database Syst Rev 2008; 2008:CD006501. [PMID: 18843719 PMCID: PMC10936547 DOI: 10.1002/14651858.cd006501.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients undergoing hematopoietic stem cell transplantation (HSCT) and those with lymphoproliferative disorders (LPD) have a higher incidence of infections due to secondary hypogammaglobulinemia. One approach is the prophylactic administration of intravenous immunoglobulins (IVIG). Randomized controlled trials (RCTs) showed conflicting results in terms of type, schedule, dose and hematological patients benefiting from IVIG. We therefore performed a systematic review and meta-analysis to evaluate the role of IVIG in these patients. OBJECTIVES To determine whether prophylaxis with IVIG reduces mortality or affects other outcomes in patients with hematological malignancies. SEARCH STRATEGY PubMed (January 1966 to December 2007), CENTRAL (The Cochrane Library, up to 2007, issue 1), LILACS and conference proceedings published between 2002-2007 were searched. The terms "immunoglobulins" or "gammaglobulins" or specific gammaglobulins and similar and the terms "hematologic neoplasms" or "hematologic malignancies" or "transplant" or "autotransplant" or "allotransplant" or "bone marrow transplant" or "peripheral stem cell transplant" and similar were selected. References of all included trials and reviews identified were scanned for additional trials. SELECTION CRITERIA All RCTs comparing prophylaxis of IVIG with placebo, no treatment or another immunoglobulin preparation, different administration schedules or doses for patients with hematological malignancies were included. One author screened all abstracts identified through the search strategy and two reviewers independently inspected each reference identified by the search and applied inclusion criteria. DATA COLLECTION AND ANALYSIS For each trial, results were expressed as relative risks (RR) with 95% confidence intervals (CI) for dichotomous data and weighted mean differences for continuous data. We conducted meta-analysis, where enough similar trials were available, using the fixed- effects model, unless significant heterogeneity was present. We performed sensitivity analyses to assess the effect of individual methodological quality measures on effect estimates, including allocation generation, concealment and blinding. MAIN RESULTS Forty trials were included: thirty included HSCT patients and ten included patients LPD. When polyvalent immunoglobulins or hyperimmune cytomegalovirus (CMV)-IVIG was compared to control for HSCT, there was no difference in all-cause mortality. Polyvalent immunoglobulins significantly reduced the risk for interstitial pneumonitis but increased the risk for veno-occlusive disease and adverse events. In LPD, no benefit in terms of mortality IVIG could be demonstrated but there was a decrease in clinically and microbiologically documented infections. AUTHORS' CONCLUSIONS In patients undergoing HSCT, routine prophylaxis with IVIG is not supported. Its use may be considered in LPD patients with hypogammaglobulinemia and recurrent infections, for reduction of clinically documented infections.
Collapse
Affiliation(s)
- Pia Raanani
- Institute of Hematology, Rabin Medical Center, Institute of Hematology, Rabin Medical Center, Campus Beilinson, Petah-Tikva, Israel, 49100.
| | | | | | | | | | | |
Collapse
|
10
|
Weinberg A, Schissel D, Giller R. Molecular methods for cytomegalovirus surveillance in bone marrow transplant recipients. J Clin Microbiol 2002; 40:4203-6. [PMID: 12409398 PMCID: PMC139700 DOI: 10.1128/jcm.40.11.4203-4206.2002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Two different methods for detection of cytomegalovirus (CMV), PCR and hybrid capture (HC), were compared by using plasma, peripheral blood leukocytes (PBLs), and whole blood (WB) from allogeneic bone marrow transplant recipients. One hundred specimens were obtained from nine children over an 18-month surveillance period. PCR of plasma for CMV was used for clinical management. The proportions of samples positive for CMV DNA by PCR with plasma, HC with WB, and PCR with PBLs were 21, 28, and 37%, respectively. Among 44 samples that were tested by all three methods, 68% had concordant results. By using a robust definition of true-positive samples (positivity by two or more methods or positivity of sequential samples by one method), the sensitivities of PCR with plasma, HC with WB, and PCR with PBLs were 50, 67, and 83%, respectively, and the specificities were 100, 96, and 96%, respectively. Two patients developed CMV-associated end-organ disease (one developed respiratory disease, and one developed gastrointestinal disease). CMV DNA was not detected in the plasma 1 week prior to the development of symptoms in either patient, whereas HC with WB was positive for both patients and PCR with PBLs was for one patient. These data suggest that WB or PBLs might be the preferred sample for use for surveillance for CMV in immunocompromised patients.
Collapse
Affiliation(s)
- Adriana Weinberg
- Departments of Pediatrics, University of Colorado, Denver, Colorado 80262, USA.
| | | | | |
Collapse
|
11
|
Winston DJ, Antin JH, Wolff SN, Bierer BE, Small T, Miller KB, Linker C, Kaizer H, Lazarus HM, Petersen FB, Cowan MJ, Ho WG, Wingard JR, Schiller GJ, Territo MC, Jiao J, Petrarca MA, Tonetta SA. A multicenter, randomized, double-blind comparison of different doses of intravenous immunoglobulin for prevention of graft-versus-host disease and infection after allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 28:187-96. [PMID: 11509937 DOI: 10.1038/sj.bmt.1703109] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2000] [Accepted: 03/07/2001] [Indexed: 11/09/2022]
Abstract
Intravenous immunoglobulin is approved for use in allogeneic bone marrow transplant recipients for prevention of graft-versus-host disease (GVHD) and infections, but the minimally effective dose has not been established. In this multicenter, randomized, double-blind trial, patients undergoing allogeneic marrow transplantation were randomized to receive 100 mg/kg, 250 mg/kg, or 500 mg/kg doses of intravenous immunoglobulin. Each dose was given weekly for 90 days and then monthly until 1 year after transplant. Six hundred and eighteen patients were evaluated. Acute GVHD (grades 2-4) occurred in 39% of the patients (80 of 206) in the 100 mg/kg group, 42% of the patients (88 of 208) in the 250 mg/kg group, and in 35% of the patients (72 of 204) in the 500 mg/kg group (P = 0.344). Among patients with unrelated marrow donors, a higher dose of intravenous immunoglobulin (500 mg/kg) was associated with less acute GVHD (P = 0.07). The incidences of chronic GVHD, infection and interstitial pneumonia were similar for all three doses of intravenous immunoglobulin. The dose of intravenous immunoglobulin also had no effect on the types of infection, relapse of hematological malignancy or survival. Except for more frequent chills (P = 0.007) and headaches (P = 0.015) in patients given the 500 mg/kg or 250 mg/kg dose of immunoglobulin, adverse events were similar for all three doses. These results suggest that 100 mg/kg, 250 mg/kg, and 500 mg/kg doses of intravenous immunoglobulin are associated with similar incidences of GVHD and infections in most allogeneic marrow transplants. These results should be considered when designing cost-effective strategies for the use of intravenous immunoglobulin in allogeneic marrow transplants receiving other current regimens for prophylaxis of GVHD and infection.
Collapse
Affiliation(s)
- D J Winston
- Department of Medicine, UCLA Center for the Health Sciences, Los Angeles, CA 90095, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
DeRienzo SY, Chiang KY, O'Neal WM, Godder K, Abhyankar S, Christiansen NP, Bridges KD, Henslee-Downey PJ. Evaluation of the half-life of intravenous human cytomegalovirus immune globulin in patients receiving partially mismatched related donor bone marrow transplantation. Pharmacotherapy 2000; 20:1175-8. [PMID: 11034040 DOI: 10.1592/phco.20.15.1175.34592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate the pharmacokinetics and use of intravenous human cytomegalovirus immune globulin (CytoGam) in allogeneic bone marrow transplantation (BMT). DESIGN Prospective, nonrandomized, nonblinded, single-center study. SETTING University teaching hospital. PATIENTS Five consecutive patients with hematologic malignancies receiving partially mismatched related donor BMT with a uniform conditioning regimen including total body irradiation and chemotherapy. INTERVENTION Serum immunoglobulin and cytomegalovirus (CMV) titers were measured before and 24 hours after the first CytoGam infusion on day -6 during the conditioning regimen. MEASUREMENTS AND MAIN RESULTS These levels were measured every 5 days, and a second dose was administered when the CMV titer returned to 25-50% of the 24-hour level. The half-life of CytoGam was approximately 7 days. CONCLUSION We believe this is the first report of CytoGam's half-life in allogeneic BMT. The information may prove vital in a future study in which the agent's potential beneficial effects can be maximized.
Collapse
Affiliation(s)
- S Y DeRienzo
- Division of Transplantation Medicine, South Carolina Cancer Center, Palmetto Richland Memorial Hospital, University of South Carolina, Columbia 29203, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Tsinontides AC, Bechtel TP. Cytomegalovirus prophylaxis and treatment following bone marrow transplantation. Ann Pharmacother 1996; 30:1277-90. [PMID: 8913411 DOI: 10.1177/106002809603001113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To provide an overview of the role of cytomegalovirus (CMV) in the bone marrow transplant (BMT) population and update the current methods of prevention and treatment of CMV infection and disease, with emphasis on CMV interstitial pneumonia (CMV-IP). DATA SOURCES The current medical literature, including abstracts presented at recent national and international meetings, is reviewed. References were identified by searching the MEDLINE database from January 1988 through June 1994. The reference lists of the published studies and reviews obtained from the initial literature search were reviewed as well. STUDY SELECTION Data regarding the epidemiology of CMV, the risk factor associated with CMV infection and disease, as well as data on the prevention and the treatment of CMV infection and disease in the BMT population are cited. Specific attention was focused on randomized, placebo-controlled studies pertaining to the prevention of CMV infection and disease in CMV-immunoglobulin G positive recipients undergoing allogeneic BMT. Information from nonrandomized, placebo-controlled studies was included in the absence of stronger data. DATA EXTRACTION Information contributing to CMV in the BMT population was reviewed. Data supporting and disputing specific preventive and treatment modalities are presented. DATA SYNTHESIS The incidence of CMV seropositivity in the general population is high and while BMT becomes a widely accepted treatment modality, CMV reactivation and subsequent disease, especially CMV-IP, becomes a significant prognostic factor of morbidity and mortality. Even though antiviral agents such as ganciclovir and foscarnet can inhibit the viral replication in vivo, they have not been able to treat CMV-IP effectively. It has been suggested that CMV-IP is an immunopathologic process that can cause irreversible damage, hence, the low efficacy of antiviral therapy and the associated high mortality. Immunomodulating agents such as intravenous immune globulin and cytomegalovirus hyperimmune globulin can increase the efficacy of antivirals in the treatment of CMV-IP. This further supports the postulated immunopathologic process of this disease. The lack of understanding of the pathophysiology of the disease compromised the efforts of treatment and led to the development of preventive interventions with antiviral and immunomodulatory regimens that resulted in a significantly lower incidence of infection and disease. As a result of current data, the Eastern Cooperative Oncology Group has published guidelines for the prevention and treatment of CMV infection and disease. CONCLUSIONS The prognosis of CMV disease in the BMT recipients has improved as a result of a wide variety of modifications in the management of BMT recipients. These include an increased understanding of the risk factors associated with CMV infection, routine screening for CMV replication and excretion, and more effective prophylactic regimens. Still, more than half of the patients who develop pneumonia will die, indicating that more studies are needed to increase the understanding of the pathophysiology and refine the preventive and therapeutic regimens against CMV.
Collapse
|
14
|
Gunter KC. Transfusion-transmitted cytomegalovirus: the part-time pathogen. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:515-34. [PMID: 8597838 DOI: 10.3109/15513819509026987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Viral infection is a well-known risk of blood product transfusion and much work has been devoted to the detection of such well-known pathogens as human immunodeficiency virus and hepatitis viruses in blood donors. Cytomegalovirus (CMV) is found in a much larger percentage of donor units than these other viruses but will cause disease in only a minority of recipients. Many pediatric patients (especially premature infants) are at risk for transfusion-transmitted CMV. This review describes work delineating the populations of patients most at risk for transfusion-transmitted CMV, describes methods for detecting CMV in blood donors, evaluates current methods for leuko-depletion of blood products, and provides recommendations for patients most likely to benefit from blood products with low risk of CMV transmission.
Collapse
Affiliation(s)
- K C Gunter
- Children's National Medical Center, Department of Laboratory Medicine, Washington, DC 20010-2970, USA
| |
Collapse
|
15
|
Affiliation(s)
- M Boeckh
- Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA
| | | |
Collapse
|
16
|
Ayata M, Sugano T, Murayama T, Sakamuro D, Takegami T, Matsumoto Y, Furukawa T. Different antibody response to a neutralizing epitope of human cytomegalovirus glycoprotein B among seropositive individuals. J Med Virol 1994; 43:386-92. [PMID: 7525866 DOI: 10.1002/jmv.1890430412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The amino-terminal portion of human cytomegalovirus glycoprotein B (HCMV-gB) was expressed as a fusion protein to analyze the neutralizing epitope recognized by human monoclonal antibody C23 and the humoral immune response to this epitope. The linear neutralizing epitope was further localized to the peptide within 17 amino acids (position 68-84) which were conserved between two HCMV laboratory strains. Ten out of 17 HCMV-seropositive human sera contained the antibody against this epitope. Although seven sera were negative for reacting with the fusion protein, the viruses isolated from the same patients retained the epitope. The immunogenicity of the epitope and the possible application of C23 human monoclonal antibody for passive immunization against HCMV infections are discussed.
Collapse
Affiliation(s)
- M Ayata
- Department of Microbiology, Kanazawa Medical University, Ishikawa, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
Bilgrami S, Almeida GD, Quinn JJ, Tuck D, Bergstrom S, Dainiak N, Poliquin C, Ascensao JL. Pancytopenia in allogeneic marrow transplant recipients: role of cytomegalovirus. Br J Haematol 1994; 87:357-62. [PMID: 7947279 DOI: 10.1111/j.1365-2141.1994.tb04922.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe the clinical course of three cytomegalovirus-antibody-positive allogeneic marrow graft recipients who developed progressive pancytopenia during the third month post-transplant. Bone marrow biopsy cores were hypocellular without evidence of disease recurrence. Haemopoietic progenitor assays demonstrated a decrease of all assayable progenitors. Cytomegalovirus was identified from the blood and urine of all three patients. However, none of the patients developed other manifestations of cytomegalovirus infection such as pneumonitis, hepatitis and enteritis. The therapeutic use of ganciclovir and intravenous immunoglobulins resulted in prompt resolution of both viraemia and viruria in all three patients, and of pancytopenia in two patients.
Collapse
Affiliation(s)
- S Bilgrami
- Department of Medicine, University of Nevada, Reno
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Rusthoven JJ. Biological response modifiers and infectious diseases: actual and potential therapeutic agents. Int J Antimicrob Agents 1994; 3:223-43. [PMID: 18611565 PMCID: PMC7135342 DOI: 10.1016/0924-8579(94)90050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/1993] [Indexed: 12/21/2022]
Abstract
Biological response modifiers (BRMs) are agents which can modify the immune response to cancer or invasion of the organism by infectious agents. An explosive appearance of new BRMs has resulted from the development of recombinant gene technology and the availability of monoclonal antibodies. Colony-stimulating factors first became available for the prevention of neutropenia but may also have a role in the treatment of infections. Interleukin-1 is being tested as a modular of hematopoiesis and may be useful as a helper factor for T- and B-cell function. Immunoglobulins are being used against viral and bacterial infections while interferons can prevent viral upper respiratory infections and suppress or irradicate some viral hepatitides. Other BRMs which show promise include chemical agents and traditional herbal medicines.
Collapse
Affiliation(s)
- J J Rusthoven
- Hamilton Regional Cancer Centre, Ontario Cancer Foundation, Hamilton, Ont., Canada
| |
Collapse
|
19
|
Klaesson S, Ringdén O, Markling L, Remberger M, Lundkvist I. Immune modulatory effects of immunoglobulins on cell-mediated immune responses in vitro. Scand J Immunol 1993; 38:477-84. [PMID: 8235451 DOI: 10.1111/j.1365-3083.1993.tb02591.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intravenous Immunoglobulin (IVIG) at a concentration of 5 mg/ml, significantly inhibited mitogenic responses to phytohaemagglutinin (PHA), concanavalin A (conA) and pokeweed mitogen (PWM) by peripheral blood cells from healthy donors. No difference in inhibition by IVIG was seen when stimulating different T-lymphocyte cell subsets. Inhibition by IVIG was dose-dependent. An increased response was observed when IVIG was added more than 12 h after PHA compared to adding 1 h before [P = 0.05]. Intravenous immunoglobulin added to mixed lymphocyte cultures (MLC), reduced the median response by more than 60% (range 14-89%; P = 0.03) and almost completely abrogated the lymphocyte response to Staphylococcus aureus protein A (SPA), whose median inhibition was 94% (range 90-99%; P = 0.02). When comparing 12 different commercial IVIG preparations at a concentration of 2.5 mg/ml, the median inhibition of the PHA stimulation ranged from 4% to 35% and the MLC response from 0% to 66%. In the presence of IVIG the lymphocyte response to different herpes virus antigens was reduced by > 50%. No difference in inhibitory effect was seen when comparing IVIG and cytomegalovirus (CMV) hyper Ig, but CMV negative Ig resulted in lower inhibition [P = 0.05]. Three out of five IgG preparations (2.5 mg/ml) made from single donors inhibited PHA stimulation significantly more than commercial IVIG [P < 0.05]. Mean inhibition was 61% compared to 35%. Inhibition by pooled IgG from five donors was 56%. F(ab')2 fragments of IVIG inhibited the MLC response by more than 50% (range 34-75%), SPA stimulation by 97% (83-104%) and PHA stimulation by more than 30% (26-37%). One of two Fc preparations tested had an inhibitory effect, but the inhibition was less than that obtained with the F(ab')2 fragments [P = 0.04]. These results further strengthen the notion that IVIG exerts its immune modulatory effect by binding to leukocyte surface receptors. A clear inhibition was obtained with concentrations corresponding to the serum levels obtained when IVIG is given 250-500 mg/kg bodyweight. F(ab')2 fragments have the same inhibitory effect as intact IgG molecules but the role of Fc fragments still remains unclear. Differences in the immunosuppressive effect of various IVIG preparations may be associated with the method of preparation.
Collapse
Affiliation(s)
- S Klaesson
- Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
20
|
Special Considerations for the Patient Undergoing Allogeneic or Autologous Bone Marrow Transplantation. Hematol Oncol Clin North Am 1993. [DOI: 10.1016/s0889-8588(18)30214-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
Biologicals and Hematopoietic Cytokines in Prevention or Treatment of Infections in Immunocompromised Hosts. Hematol Oncol Clin North Am 1993. [DOI: 10.1016/s0889-8588(18)30224-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
22
|
Abstract
BACKGROUND Bone marrow transplantation for the treatment of malignancies is on the increase. Unfortunately, there are no well-validated infection control guidelines for this highly susceptible population. METHODS Literature was reviewed concerning infection risks and interventions to decrease risks for bone marrow transplant recipients. RESULTS Definitive information was generally lacking. However, basic "common sense" infection control recommendations for bone marrow transplantation were made in the following areas: air ventilation systems, design issues, environmental services, patient care issues, barrier precautions, nosocomial surveillance, and discharge planning. Recommendations must be tailored to each facility or setting. CONCLUSION We conclude that validation of many of these recommendations is necessary to provide optimum care for bone marrow transplant recipients.
Collapse
Affiliation(s)
- B R Mooney
- University of Utah Hospital, Salt Lake City 84132
| | | | | |
Collapse
|
23
|
Foot AB, Caul EO, Roome AP, Darville JM, Oakhill A. Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group. J Clin Pathol 1993; 46:415-9. [PMID: 8391547 PMCID: PMC501249 DOI: 10.1136/jcp.46.5.415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIMS To study the association between cytomegalovirus (CMV) excretion and interstitial pneumonitis in allogeneic bone marrow transplant (BMT) recipients, with reference to donor and recipient CMV antibody response. METHODS The incidence of CMV excretion was prospectively studied in 62 allogeneic bone marrow transplantations performed on adults and children. All recipients received CMV seronegative blood products. Prophylaxis with high dose acyclovir and CMV immune globulin was given to high risk patients (donor or recipient, or both, CMV seropositive). RESULTS CMV excretion was detected in eight of 26 (31%) high risk patients but in only one of 36 low risk patients (donor and recipient both CMV seronegative). Five of the eight (63%) excretors in the high risk category developed CMV, of whom four (80%) belonged to the seropositive recipient/seronegative donor group, and included the three CMV seropositive recipients whose CMV complement fixation antibody titres were 64 or greater before transplantation. CONCLUSIONS These findings suggest that there is a subgroup of patients at especially high risk of developing CMV.
Collapse
Affiliation(s)
- A B Foot
- Bone Marrow Transplant Unit, Royal Hospital for Sick Children, Bristol
| | | | | | | | | |
Collapse
|
24
|
Abstract
Over the past two decades, the recognition of viral enzymes and proteins that can serve as molecular targets of drugs has revolutionized the treatment of viral infections. Beginning with acyclovir, a number of systemically administered agents which are both relatively safe and effective for the treatment of herpetic infections and human immunodeficiency virus (HIV) infections have become widely available. Because of increased numbers of herpes virus infections, as well as the rising epidemic of HIV infections, the ophthalmologist is, more likely than ever before to be involved in the treatment of severe and frequent ocular infections caused by herpes viruses. In addition, the acute retinal necrosis (ARN) syndrome has been demonstrated to be caused by herpes viruses and a once rare retinal infection caused by cytomegalovirus is common in patients with the acquired immunodeficiency syndrome (AIDS). In this article, four systemic antiviral drugs (Vidarabine, Acyclovir, Ganciclovir, and Foscarnet) that have demonstrated usefulness in the treatment of ophthalmic disease are reviewed in detail with regard to their mechanisms, applications, effectiveness, and side effects.
Collapse
Affiliation(s)
- S A Teich
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
| | | | | |
Collapse
|
25
|
Schuler U, Ehninger G. Prevention of viral infections after bone marrow transplantation. Ann Hematol 1992; 64 Suppl:A152-7. [PMID: 1322188 DOI: 10.1007/bf01715371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
After bone marrow transplantation, a number of viral infections contribute to the morbidity and mortality of the procedure. Established preventive measures to avoid primary infection and reactivation of herpes-and cytomegaloviruses are outlined. Possible future strategies against these viruses (e. g., monoclonal antibodies, transfer of T-lymphocytes) and the possible role of improved diagnostic tools are briefly discussed.
Collapse
Affiliation(s)
- U Schuler
- Medizinische Klinik, Universität Tübingen, Federal Republic of Germany
| | | |
Collapse
|
26
|
Pirofsky B, Kinzey DM. Intravenous immune globulins. A review of their uses in selected immunodeficiency and autoimmune diseases. Drugs 1992; 43:6-14. [PMID: 1372861 DOI: 10.2165/00003495-199243010-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Intravenous immune globulin (IGIV) was introduced a decade ago as a therapy for primary immunodeficiency diseases. It proved to be a valuable therapeutic substance for this purpose and is now considered to be the treatment of choice. The intent was to supply ubiquitous anti-infectious agent antibodies through passive immunisation to replace deficient circulating antibody content. During such therapy, unexpected benefits were noted in thrombocytopenic patients. Since that time, the therapeutic indications for IGIV infusions have greatly increased, with a particular interest in infectious, haematological and autoimmune diseases. This review summarises the status of IGIV therapy in haematological diseases within the categories of primary immunodeficiency diseases, secondary immunodeficiency states and autoimmune syndromes. The majority of firm data have been gathered on the treatment of patients with primary immunodeficiency disease. These data are reviewed from the aspect of anticipated therapeutic response and side effects. Emphasis should be placed on the IgG circulating blood levels as there is a need for individualizing therapy because of marked interindividual patient variation. The use of IGIV therapy in primary and secondary immunodeficiency states should consider the potential benefits to be attained in haematological malignancies and related complications which may be magnified by chemotherapy and radiation therapy. The mode of action of IGIV in autoimmune diseases, although not yet precisely determined, may involve establishing reticuloendothelial blockade or immunomodulation by supplying anti-idiotype antibodies.
Collapse
Affiliation(s)
- B Pirofsky
- Department of Medicine, Oregon Health Sciences University, Portland
| | | |
Collapse
|
27
|
Stratta RJ, Shaeffer MS, Markin RS, Wood RP, Langnas AN, Reed EC, Donovan JP, Woods GL, Bradshaw KA, Pillen TJ. Cytomegalovirus infection and disease after liver transplantation. An overview. Dig Dis Sci 1992; 37:673-88. [PMID: 1314159 DOI: 10.1007/bf01296422] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cytomegalovirus is the single most important pathogen in clinical transplantation. Although much progress has been made in our understanding of the molecular biology and epidemiology of CMV infection and in our ability to diagnosis and treat CMV disease, it remains a major cause of morbidity but is no longer a major cause of mortality after liver transplantation. Risk factors for CMV disease after liver transplantation include donor and recipient serologic status, the use of antilymphocyte therapy, and retransplantation. CMV disease occurs early after transplantation, and the most frequent site of disease is the hepatic allograft. We have treated 79 patients with intravenous ganciclovir, with ultimate control of disease achieved in 69 patients (87.3%). Preliminary results using intravenous immunoglobulin and oral acyclovir for CMV prophylaxis in high-risk patients have been encouraging. In addition to producing clinical syndromes. CMV may have direct immunologic effects and is a marker of the net state of immunosuppression.
Collapse
Affiliation(s)
- R J Stratta
- Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Dunsmore KP, Friedman HS, Kurtzberg J. The uses of intravenous immunoglobulin in pediatrics. An update. Crit Rev Oncol Hematol 1992; 12:67-90. [PMID: 1590942 DOI: 10.1016/1040-8428(92)90085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- K P Dunsmore
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710
| | | | | |
Collapse
|
29
|
|
30
|
Gehrz RC, Nelson CM, Kari BE. A combination of human cytomegalovirus (HCMV)-specific murine monoclonal antibodies exhibits synergistic antiviral activity in vitro. Antiviral Res 1992; 17:115-31. [PMID: 1313219 DOI: 10.1016/0166-3542(92)90046-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A combination of HCMV-specific monoclonal antibodies (MAbs) reactive with glycoproteins in gcI complexes which exhibit synergistic antiviral activity in vitro is described. MAbs directed against different structural and biological properties of HCMV have been selected to increase the antiviral activity against all possible strains, and to reduce the likelihood that resistant strains will emerge with prolonged exposure. Furthermore, in vitro analysis demonstrates that certain of the MAbs in the combination augment the virus-neutralizing activity of other component antibodies, thereby decreasing the amount of total antibody protein required to inhibit HCMV infection. Certain MAbs have been selected to inactivate extracellular virus during the early phase of HCMV infection, whereas others have been selected to prevent its spread once cells have been infected. These data suggest that a MAb cocktail may be useful for prophylaxis and treatment of patients at risk of life-threatening HCMV infections.
Collapse
Affiliation(s)
- R C Gehrz
- Children's Biomedical Research Institute, St. Paul, Minnesota 55102
| | | | | |
Collapse
|
31
|
Masuho Y. Passive immunoprophylaxis with human monoclonal antibodies. BIOTECHNOLOGY (READING, MASS.) 1992; 20:405-30. [PMID: 1600386 DOI: 10.1016/b978-0-7506-9265-6.50024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
32
|
Louie SG, Jaresko GS. Biological Agents in Infectious Diseases. J Pharm Pract 1991. [DOI: 10.1177/089719009100400505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines the use of classical as well as novel immunological agents to augment the immune system. Strategies to prevent infectious disease using vaccines to prime the immune system are discussed. A prospective overview of acquired immunodeficiency syndrome (AIDS) vaccine development provides insights into the possible agents that may be developed in the near future. The rationale for the use of intravenous immunoglobulin and colony stimulating factors in selected clinical situations is also discussed.
Collapse
Affiliation(s)
- Stan G. Louie
- School of Pharmacy, University of Southern California, Los Angeles
| | | |
Collapse
|
33
|
Abstract
The earliest preparations of immunoglobulins (Ig) decreased the susceptibility of agammaglobulinemic patients to infections caused by pneumococci, Haemophilus influenzae, meningococci, streptococci, and Pseudomonas aeruginosa. Intramuscular administration of such preparations was painful and traumatic, especially for children. Ethanol-fractionated Ig could not be administered intravenously (IV) because the IgG molecules tended to aggregate and thus were more likely to produce anaphylactoid reactions. New Ig preparations, isolated at low pH (e.g., pH 4) in the presence of traces of pepsin to inhibit reaggregation, were well tolerated when administered IV. Thus a new era of treatment and prophylaxis of disease using IV Ig (IVIG) was launched. The IVIG preparations revolutionized the management of virtually all immunodeficiency syndromes characterized by failure of antibody responses. Amelioration of antibody deficiency secondary to certain chronic diseases or surgical trauma can be achieved with these preparations. Newer uses of IVIG include treatment of some autoimmune diseases; in some conditions, the beneficial influences may be attributable to antiidiotype antibodies present in the IVIG. Another likely explanation is that IVIG inhibits damage to cells and tissues by antibody-mediated cellular cytotoxicity or blocks phagocytosis that is facilitated by Fc receptor mechanisms. The value of IVIG in preventing infection in patients undergoing bone marrow or organ transplantation and in the treatment and prophylaxis of life-threatening infections in neonates and premature infants also is reviewed.
Collapse
Affiliation(s)
- R A Good
- Department of Pediatrics, University of South Florida/St. Petersburg 33701
| | | |
Collapse
|
34
|
Harrison CJ, Burger R. Low maternal CD4 count at inception of gestational cytomegalovirus (CMV) infection and impaired humoral response: effect on congenital CMV infection in the guinea pig. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1991; 60:171-80. [PMID: 1676941 DOI: 10.1016/0090-1229(91)90061-e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In humans, the rate and clinical expression of disease in congenitally cytomegalovirus (CMV)-infected infants is modified by maternal immunity to CMV. We used the guinea pig model of congenital CMV infection to compare maternal CD4+ T-cell numbers in nonpregnant animals to those in pregnant dams just before and 7-14 days after inoculation with guinea pig CMV (gpCMV) very early, early, or late in gestation. We also examined ELISA antibody responses to gpCMV in the inoculated nonpregnant and pregnant animals. When compared to nonpregnant uninfected animals, CD4 counts were lower in very early and in late uninfected gestation. CD4 counts also dropped further in the postinoculation period. Compared to nonpregnant gpCMV-inoculated animals, initial antibody responses to gpCMV were also decreased in gpCMV-infected pregnant dams. The group of dams inoculated very early in pregnancy experienced delays in seroconversion to gpCMV, persisting low titers throughout gestation, in utero fetal resorptions, and CNS-infected pups. The group of dams inoculated late in gestation had the lowest geometric mean titers at delivery (almost 50% with no detectable antibody) and a high rate of vertical gpCMV transmission and postnatal pup death. Significantly lower rates of both congenital infection and postnatal pup deaths were observed in litters of late gestation-infected dams that had gpCMV antibody at delivery. Thus, decreased circulating maternal CD4+ T cells very early and late in gestation were further decreased after gpCMV inoculation and were associated with delayed and depressed maternal antibody responses, all of which were associated with poor outcome after primary maternal gpCMV infection, the expression of which varied by time in pregnancy when gpCMV was acquired.
Collapse
Affiliation(s)
- C J Harrison
- Division of Infectious Diseases, Children's Hospital Research Foundation, Cincinnati, Ohio 45229-2899
| | | |
Collapse
|
35
|
Affiliation(s)
- L W Miller
- Department of Internal Medicine, St Louis University Medical Center, MO 63110
| |
Collapse
|
36
|
Kacica MA, Harrison CJ, Myers MG, Bernstein DI. Immune response to guinea pig cytomegalovirus polypeptides and cross reactivity with human cytomegalovirus. J Med Virol 1990; 32:155-9. [PMID: 2177780 DOI: 10.1002/jmv.1890320305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The immune response to guinea pig cytomegalovirus (gpCMV) was evaluated by immunoblotting. Preinoculation guinea pig plasma did not react with gpCMV antigen, whereas convalescent plasma reacted to at least 18 gpCMV-specific polypeptides. The initial immune response was primarily directed at polypeptides with MWs of 100, 75, and 56 kDa. Over 80% of plasma collected more than 29 days after viral inoculation reacted to these polypeptides and also to those with MW of 54, 52, and 38 kDa. In this report, we also demonstrate cross reactivity between gpCMV and human CMV (HCMV). Human immunoglobulin (IVIG) reacted to at least 20 HCMV polypeptides and cross reacted with six gpCMV polypeptides. GpCMV convalescent plasma also reacted with HCMV polypeptides.
Collapse
Affiliation(s)
- M A Kacica
- Division of Infectious Diseases, Children's Hospital Research Foundation, Cincinnati, Ohio 45229-2899
| | | | | | | |
Collapse
|
37
|
Sullivan KM, Kopecky KJ, Jocom J, Fisher L, Buckner CD, Meyers JD, Counts GW, Bowden RA, Peterson FB, Witherspoon RP. Immunomodulatory and antimicrobial efficacy of intravenous immunoglobulin in bone marrow transplantation. N Engl J Med 1990; 323:705-12. [PMID: 2167452 DOI: 10.1056/nejm199009133231103] [Citation(s) in RCA: 293] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) and infection are major complications of allogeneic bone marrow transplantation. Since intravenous immunoglobulin has shown benefit in several immunodeficiency and autoimmune disorders, we studied its antimicrobial and immunomodulatory role after marrow transplantation. METHODS In a randomized trial of 382 patients, transplant recipients given immunoglobulin (500 mg per kilogram of body weight weekly to day 90, then monthly to day 360 after transplantation) were compared with controls not given immunoglobulin. By chance, the immunoglobulin group included more patients with advanced-stage neoplasms; otherwise, the study groups were balanced for prognostic factors. RESULTS Control patients seronegative for cytomegalovirus who received seronegative blood products remained seronegative, but seronegative patients who received immunoglobulin and screened blood had a passive transfer of cytomegalovirus antibody (median titer, 1:64). Among the 61 seronegative patients who could be evaluated, none contracted interstitial pneumonia; among the 308 seropositive patients evaluated, 22 percent of control patients and 13 percent of immunoglobulin recipients had this complication (P = 0.021). Control patients had an increased risk of gram-negative septicemia (relative risk = 2.65, P = 0.0039) and local infection (relative risk = 1.36, P = 0.029) and received 51 more units of platelets than did immunoglobulin recipients. Neither survival nor the risk of relapse was altered by immunoglobulin. However, among patients greater than or equal to 20 years old, there was a reduction in the incidence of acute GVHD (51 percent in controls vs. 34 percent in immunoglobulin recipients; P = 0.0051) and a decrease in deaths due to transplant-related causes after transplantation of HLA-identical marrow (46 percent vs. 30 percent; P = 0.023). CONCLUSIONS Passive immunotherapy with intravenous immunoglobulin decreases the risk of acute GVHD, associated interstitial pneumonia, and infections after bone marrow transplantation.
Collapse
Affiliation(s)
- K M Sullivan
- Fred Hutchinson Cancer Research Center, Seattle, WA 98104
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Weinberg A, Boas LS, Feher O, Strabelli TM, Fink MC, Dulley FL, Uip DE, Bellotti G, Chamone DA, Amato Neto V. Cytomegalovirus and other herpesviruses infections in heart and bone marrow transplant recipients. Rev Inst Med Trop Sao Paulo 1990; 32:338-45. [PMID: 1966923 DOI: 10.1590/s0036-46651990000500005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
From January 1988 to January 1989 all the heart transplant and bone marrow recipients at the Instituto do Coração of the Hospital das Clínicas of the University of São Paulo Medical School were studied for the incidence and morbidity associated with herpesviruses infections after transplantation. Five bone marrow and 5 heart transplant recipients were followed for a mean of 4.2 months post-transplantation. All the patients were seropositive for cytomegalovirus (CMV) before admission and 80% experienced one or more recurrences during the observation period. Of the 12 episodes of CMV infection, that were identified in this study, 83% were accompanied by clinical or laboratory abnormalities. However, there was only one case of severe disease. The overall incidence of infection for herpes simplex (HSV) was 50%. Although most of HSV reactivations were oral or genital, one case of HSV hepatitis occurred. One of the 6 episodes of HSV infections that were treated with acyclovir showed an unsatisfactory response and was successfully managed with ganciclovir. All the individuals had anti-varicella zoster virus antibodies, but none of them developed infection. The study emphasizes the importance of active diagnostic surveillance of herpesvirus infections in transplant patients. Both CMV and HSV reactivations showed high incidence and important morbidity and thus, deserve prophylactic therapy.
Collapse
Affiliation(s)
- A Weinberg
- Virology Laboratory, Instituto de Medicina Tropical, São Paulo, Brasil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Tomiyama T, Matsumoto Y, Sugano T, Fujinaga S, Masuho Y. Preparation of human monoclonal antibodies against a cytomegalovirus glycoprotein complex of 130 and 55 kDa. J Immunol Methods 1990; 131:249-55. [PMID: 1697318 DOI: 10.1016/0022-1759(90)90196-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nine human monoclonal antibodies (MAbs) with neutralization activity against cytomegalovirus (CMV) were obtained by screening human MAbs using a CMV glycoprotein complex of 130 and 55 kDa (gp130/55). The gp130/55 antigen was purified by immunoaffinity chromatography and the purified antigen used to detect anti-gp130/55 MAbs in an enzyme-linked immunosorbent assay. Relatively few of the human anti-CMV MAbs were directed against gp130/55 but all showed high neutralization activities to a variety of clinical isolates with titers (ED50 values) ranging from 0.15 to 7.9 micrograms/ml. Six of the nine anti-gp130/55 MAbs required complement for virus neutralization. Such human MAbs may prove to be useful for passive immunotherapy against CMV infection.
Collapse
Affiliation(s)
- T Tomiyama
- Teijin Institute for Biomedical Research, Tokyo, Japan
| | | | | | | | | |
Collapse
|
40
|
McDonald C, Barbara JA, al-Izzi A, Contreras M. Screening plasma donors for high-titre antibody to cytomegalovirus using a latex agglutination test. Vox Sang 1990; 59:83-5. [PMID: 2173280 DOI: 10.1111/j.1423-0410.1990.tb05014.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cytomegalovirus (CMV) can cause severe morbidity in immunosuppressed patients. Regional transfusion centres in the UK are required to supply high-titre anti-CMV plasma to the Blood Products Laboratory (BPL), now called 'Bio-Products Laboratory', for the production of specific intravenous immunoglobulin at the Protein Fractionation Centre in Scotland. For this purpose, 703 plasmapheresis donors were screened by a modified latex agglutination test to assess their suitability as donors with high-titre anti-CMV. CMV antibodies were found in 48% of the donors. Seropositivity increased with age ranging from 33% in the 20- to 29-year age group to 57% in the 40-49 age group, although the 50-59 age group showed a slight decline to 53%. In all age ranges except the 40-49 group, seropositivity was highest in the female population. With the latex test, 14% of the total donors screened had a titre greater than or equal to 1 in 64, 7% greater than or equal to 1 in 128 and 4.2% greater than or equal to 1 in 256. Samples from 18 donors with titres greater than or equal to 1 in 128 were sent to BPL and all samples were found to have a sufficiently high titre for the production of CMV immune plasma. For BPL the 'cut-off' level for CMV immune plasma is a titre greater than or equal to 1 in 64 by complement fixation. Since the establishment of a panel of donors with high-titre anti-CMV plasma, more than 10 kg of plasma are dispatched monthly from our centre to BPL.
Collapse
Affiliation(s)
- C McDonald
- Department of Microbiology, North London Blood Transfusion Centre, UK
| | | | | | | |
Collapse
|
41
|
Gorensek MJ, Carey WD, Vogt D, Goormastic M. A multivariate analysis of risk factors for cytomegalovirus infection in liver-transplant recipients. Gastroenterology 1990; 98:1326-32. [PMID: 1691121 DOI: 10.1016/0016-5085(90)90352-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thirty-three consecutive liver-transplant recipients were prospectively studied over a 37-mo period for evidence of cytomegalovirus infection. Sixteen (48%) episodes of cytomegalovirus infection were identified; 9 were primary infections and 7 were recurrent infections. Beginning with patient 8, gamma-globulin prophylaxis was routinely administered to most patients. Twelve potential risk factors for cytomegalovirus infection were evaluated and included pretransplant cytomegalovirus serological status of donor and recipient; recipient's age, sex, race, and liver disease; number and type of blood products transfused; type and intensity of immunosuppression; and occurrence of rejection. The Cox proportional hazards model identified positive donor cytomegalovirus serology as the single most important risk factor for subsequent development of cytomegalovirus infection, regardless of recipient cytomegalovirus serological status. In addition, use of gamma-globulin prophylaxis seemed to be protective against the occurrence of disseminated cytomegalovirus disease.
Collapse
Affiliation(s)
- M J Gorensek
- Department of Infectious Disease, Cleveland Clinic Foundation, Ohio
| | | | | | | |
Collapse
|
42
|
Kirklin JK, Bourge RC, White-Williams C, Naftel DC, Thomas FT, Thomas JM, Phillips MG. Prophylactic therapy for rejection after cardiac transplantation. J Thorac Cardiovasc Surg 1990. [DOI: 10.1016/s0022-5223(19)36949-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Metselaar HJ, Balk AH, Mochtar B, Rothbarth PH, Weimar W. Cytomegalovirus seronegative heart transplant recipients. Prophylactic use of anti-CMV immunoglobulin. Chest 1990; 97:396-9. [PMID: 2153508 DOI: 10.1378/chest.97.2.396] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Thirty-two CMV seronegative heart transplant patients received prophylactic anti-CMV immunoglobulin during the first three posttransplant months. One of the 16 recipients of a heart from a seronegative donor acquired CMV infection and developed CMV disease. In eight of the 16 recipients of a heart from a seropositive donor, CMV infection was observed. Viremia was diagnosed in seven of them, but only two of these patients developed CMV disease. The incidence of CMV infection and of CMV disease in the globulin-treated CMV seronegative recipients of a heart from a seropositive donor was comparable to the incidence of CMV infection and of CMV disease in 31 nonglobulin-treated CMV seropositive recipients. This was significantly lower (percentage difference 69 percent, 95 percent CI 42-97 percent, p less than 0.001) than expected on the basis of the data from the literature and indicates that passive immunization with anti-CMV immunoglobulins induces the same protection against CMV disease as natural acquired anti-CMV resistance. This protective effect was temporary, as one patient developed symptomatic CMV infection four months after transplantation at a time when the anti-CMV immunoglobulin levels had decreased to pretransplantation values.
Collapse
Affiliation(s)
- H J Metselaar
- Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, The Netherlands
| | | | | | | | | |
Collapse
|
44
|
Tomiyama T, Masuho Y. Antiviral activities of a human monoclonal antibody against human cytomegalovirus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1990; 278:105-13. [PMID: 1705077 DOI: 10.1007/978-1-4684-5853-4_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- T Tomiyama
- Teijin Institute for Biomedical Research, Tokyo
| | | |
Collapse
|
45
|
Jacobson MA, O'Donnell JJ, Rousell R, Dionian B, Mills J. Failure of adjunctive cytomegalovirus intravenous immune globulin to improve efficacy of ganciclovir in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis: a phase 1 study. Antimicrob Agents Chemother 1990; 34:176-8. [PMID: 2158273 PMCID: PMC171546 DOI: 10.1128/aac.34.1.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Six men with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis, treated with combined ganciclovir induction therapy and hyperimmune globulin (CMV-IGIV) for 10 days followed by CMV-IGIV alone, had a median time to retinitis progression shorter (7 days) than had eight historical controls given ganciclovir maintenance therapy (54 days; P = 0.06) and similar to that in eight controls given ganciclovir for 10 days only (19 days; P = 0.97). CMV-IGIV, which also failed to inhibit CMV replication in blood and urine, did not appear to add markedly to the efficacy of ganciclovir in acquired immunodeficiency syndrome-associated CMV retinitis.
Collapse
Affiliation(s)
- M A Jacobson
- Medical Service, San Francisco General Hospital, California 94110
| | | | | | | | | |
Collapse
|
46
|
Baboonian C, Blake K, Booth JC, Wiblin CN. Complement-independent neutralising monoclonal antibody with differential reactivity for strains of human cytomegalovirus. J Med Virol 1989; 29:139-45. [PMID: 2557384 DOI: 10.1002/jmv.1890290212] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A mouse monoclonal antibody with complement-independent neutralising activity against cytomegalovirus (CMV) and reactive with the 86 kilodalton (kDa) viral glycoprotein H is described. Neutralisation tests against a range of different strains of CMV showed significant crossreactivity, but clear differences were evident between the two prototype viruses AD169 and Davis, and particularly between AD169 and several low-passage recent clinical isolates; CMV present in urine was neutralised weakly if at all.
Collapse
Affiliation(s)
- C Baboonian
- Department of Medical Microbiology, St. George's Hospital Medical School, University of London, England
| | | | | | | |
Collapse
|
47
|
Sullivan KM. Intravenous immune globulin prophylaxis in recipients of a marrow transplant. J Allergy Clin Immunol 1989; 84:632-8; discussion 638-9. [PMID: 2551949 DOI: 10.1016/0091-6749(89)90202-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bone marrow transplantation is a worldwide activity involving more than 250 transplant centers in more than 40 countries. The ultimate success of the procedure depends in large measure on supportive care of the transplant recipient. A major component of this supportive care is the prevention of opportunistic infections. This article reviews the nature of immunoglobulin class and subclass deficiency after marrow transplantation and the role of intravenous immune globulin in preventing infections and associated complications.
Collapse
Affiliation(s)
- K M Sullivan
- Fred Hutchinson Cancer Research Center, Seattle WA 98104
| |
Collapse
|
48
|
van Son WJ, The TH. Cytomegalovirus infection after organ transplantation: an update with special emphasis on renal transplantation. Transpl Int 1989; 2:147-64. [PMID: 2553045 DOI: 10.1007/bf02414602] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cytomegalovirus infections are still the most important infectious complications after organ transplantation. Besides historical notes this review will deal with new aspects concerning the epidemiology of the CMV, diagnostic modalities of CMV infection, the delicate counterbalance between the immune system and the CMV, as well as the symptomatology of this infection. Furthermore, aspects like prophylaxis and new, promising therapeutic regimes for treatment of infection will be dealt with. Although this update is applicable for all types of solid organ transplantation, emphasis will be on renal transplantation.
Collapse
Affiliation(s)
- W J van Son
- Department of Internal Medicine, University Hospital Groningen, The Netherlands
| | | |
Collapse
|
49
|
Bron D, Klastersky J. Immunoprophylaxis of cytomegalovirus infections in transplanted patients. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1989; 25:1365-8. [PMID: 2553421 DOI: 10.1016/0277-5379(89)90088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cytomegalovirus causes severe infections in immunosuppressed patients and anti-viral treatments remain unsatisfactory. In an attempt to prevent life-threatening CMV infections, immunoprophylaxis using hyperimmune immunoglobulins has been studied but led to conflicting results in the literature. The role of passive immunization in allogeneic marrow and renal transplant patients is discussed.
Collapse
Affiliation(s)
- D Bron
- Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
50
|
Vogler WR, Winton EF, Reynolds RC, Heffner LT, Gordon DS. Factors affecting survival in allogeneic bone marrow transplantation. Am J Med Sci 1989; 297:300-8. [PMID: 2655445 DOI: 10.1097/00000441-198905000-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
From 1979 to 1988, 82 allogeneic and 2 syngeneic bone marrow transplants (BMT) were performed in 78 patients (age range 13-49 years) with the following diagnoses: acute myelogenous leukemia (AML) (21 patients); acute lymphoblastic leukemia (ALL) (15 patients); chronic myelocytic leukemia in chronic, accelerated, or blastic phase (CML-CP, AP or BC) (25 patients); myelodysplastic syndrome (MDS) (1 patient); multiple myeloma (MM) (1 patient); Hodgkin's disease (HD) (1 patient); diffuse poorly differentiated lymphoma (DPDL) (1 patient); aplastic anemia (AA) (13 patients). Univariant analyses were carried out to determine factors of importance in predicting outcome. AML patients receiving transplants in remission had 12/19 (63%) survivors. Only one of seven ALL patients receiving transplants in remission survives free of disease, and none of eight patients receiving transplants in relapse survived. Six ALL patients relapsed. In CML, 6 of 16 (40%) patients receiving transplants in CP survive; two of nine patients (22%) in AP or BC survive. Of the 13 aplastic anemias, 8 (62%) survive. Graft-vs.-host disease (GVHD) was evaluated in 75 patients, 24 of 33 (73%) who developed GVHD died, compared to 24 of 44 (55%) who did not develop GVHD. Of the 30 patients given the combination of methotrexate (MTX) plus cyclosporine (CSP), only 23% developed GVHD, compared to 58% of those not given the combination. Interstitial pneumonia (IP) occurred in 16 patients and was fatal in 15. The introduction of daily acyclovir and weekly intravenous gamma globulin in 1985 was associated with little reduction in the frequency of IP (from 20% to 18%). However, survival increased from 21% to 47%.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- W R Vogler
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322
| | | | | | | | | |
Collapse
|