1
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Stathis CJ, Zhu H, Carlin K, Phan TL, Toomey D, Hill JA, Zerr DM. A systematic review and meta-analysis of HHV-6 and mortality after hematopoietic cell transplant. Bone Marrow Transplant 2024:10.1038/s41409-024-02398-w. [PMID: 39245683 DOI: 10.1038/s41409-024-02398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/03/2024] [Accepted: 08/13/2024] [Indexed: 09/10/2024]
Abstract
Human herpesvirus-6B (HHV-6B) reactivation has been associated with non-relapse mortality (NRM) and overall mortality (OM) following allogeneic hematopoietic stem cell transplant (HCT). We performed a systematic review and meta-analysis to better quantify the association. Studies were included if they systematically tested a cohort of HCT recipients for HHV-6 infection or reactivation and described mortality for patients with and without HHV-6B. Random effects models were used to assess the pooled effect of HHV-6B positivity on each outcome of interest. Bayesian aggregation was additionally performed if models included 10 or fewer studies. Eight studies were included in the NRM analysis, which demonstrated a significant association between HHV-6 detection and NRM (pooled effect: 1.84; 95% CI: 1.29-2.62) without significant heterogeneity (I2 = 0.0%, p = 0.55). A Bayesian aggregation of the raw data used to construct the NRM random effects model supported these findings (95% credible interval: 0.15-1.13). Twenty-five studies were included in OM analysis, which showed a significant positive association (pooled effect: 1.37; 95% CI: 1.07-1.76), though considerable heterogeneity was observed (I2 = 36.7%, p < 0.05). HHV-6 detection is associated with NRM and OM following HCT. Randomized trials are warranted to evaluate if preventing or treating HHV-6B reactivation improves outcomes.
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Affiliation(s)
- Christopher J Stathis
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- HHV-6 Foundation, Santa Barbara, CA, 93108, USA
| | - Harrison Zhu
- HHV-6 Foundation, Santa Barbara, CA, 93108, USA
- Baylor College of Medicine, Houston, TX, USA
| | | | - Tuan L Phan
- HHV-6 Foundation, Santa Barbara, CA, 93108, USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Danny Toomey
- HHV-6 Foundation, Santa Barbara, CA, 93108, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, 18509, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Danielle M Zerr
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington, Seattle, WA, USA.
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2
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Noviello M, Lorentino F, Xue E, Racca S, Furnari G, Valtolina V, Campodonico E, Dvir R, Lupo-Stanghellini MT, Giglio F, Piemontese S, Clerici D, Oltolini C, Tassi E, Beretta V, Farina F, Mannina D, Ardemagni A, Vago L, Bernardi M, Corti C, Peccatori J, Clementi M, Ciceri F, Bonini C, Greco R. Human herpesvirus 6-specific T-cell immunity in allogeneic hematopoietic stem cell transplant recipients. Blood Adv 2023; 7:5446-5457. [PMID: 37067947 PMCID: PMC10515312 DOI: 10.1182/bloodadvances.2022009274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023] Open
Abstract
Human herpesvirus 6 (HHV-6) can reactivate after allogeneic hematopoietic stem cell transplant (allo-HSCT) and may lead to severe symptoms. HHV-6-specific immune responses after HSCT are largely unexplored. We conducted a prospective observational study on 208 consecutive adult patients who received allo-HSCT to investigate HHV-6 reactivations and specific immune responses. Interferon gamma-producing HHV-6-specific T cells were quantified using enzyme-linked immunospot assay (ELISpot). HHV-6 reactivation occurred in 63% of patients, at a median of 25 days from allo-HSCT. Only 40% of these presented a clinically relevant infection, defined by the presence of classical HHV-6 end-organ diseases (EODs), based on European Conference on Infections in Leukaemia (ECIL) guidelines, and other possible HHV6-related EODs. Using multivariate analysis, we identified risk factors for HHV-6 reactivation: previous allo-HSCT, posttransplant cyclophosphamide (PT-Cy), and time-dependent steroids introduction. The use of PT-Cy and steroids were associated with clinically relevant infections, whereas higher CD3+ cell counts seemed to be protective. Interestingly, circulating HHV-6-specific T cells were significantly higher in patients with reactivated virus. Moreover, HHV-6-specific T-cell responses, quantified at >4 days after the first viremia detection, predicted clinically relevant infections (P < .0001), with higher specificity (93%) and sensitivity (79%) than polyclonal CD3+ cells per μL. Overall survival and transplant-related mortality were not affected by time-dependent HHV-6 reactivation, whereas a significant association was observed between clinically relevant infections and acute graft-versus-host disease. These results shed light on the role of HHV-6 in allo-HSCT and may affect HHV-6 monitoring and treatment.
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Affiliation(s)
- Maddalena Noviello
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory, Division of Immunology, Transplantation and Infectious Diseases, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Lorentino
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Elisabetta Xue
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Sara Racca
- Laboratory of Microbiology and Virology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | | | - Veronica Valtolina
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory, Division of Immunology, Transplantation and Infectious Diseases, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Edoardo Campodonico
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Roee Dvir
- Laboratory of Microbiology and Virology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | | | - Fabio Giglio
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Simona Piemontese
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Daniela Clerici
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Oltolini
- Infectious Disease Unit, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Elena Tassi
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory, Division of Immunology, Transplantation and Infectious Diseases, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Valeria Beretta
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory, Division of Immunology, Transplantation and Infectious Diseases, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Farina
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Daniele Mannina
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Anna Ardemagni
- Laboratory of Microbiology and Virology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- Università Vita-Salute San Raffaele, Milan, Italy
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Consuelo Corti
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Jacopo Peccatori
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, Ospedale San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory, Division of Immunology, Transplantation and Infectious Diseases, Ospedale San Raffaele Scientific Institute, Milano, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Raffaella Greco
- Haematology and Bone Marrow Transplant Unit, Ospedale San Raffaele Scientific Institute, Milano, Italy
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3
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Hanson DJ, Hill JA, Koelle DM. Advances in the Characterization of the T-Cell Response to Human Herpesvirus-6. Front Immunol 2018; 9:1454. [PMID: 29988505 PMCID: PMC6026635 DOI: 10.3389/fimmu.2018.01454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022] Open
Abstract
Human herpesvirus (HHV) 6 is thought to remain clinically latent in most individuals after primary infection and to reactivate to cause disease in persons with severe immunosuppression. In allogeneic hematopoietic stem cell transplant recipients, reactivation of HHV-6 species B is a considerable cause of morbidity and mortality. HHV-6B reactivation is the most frequent cause of infectious meningoencephalitis in this setting and has been associated with a variety of other complications such as graft rejection and acute graft versus host disease. This has inspired efforts to develop HHV-6-targeted immunotherapies. Basic knowledge of HHV-6-specific adaptive immunity is crucial for these endeavors, but remains incomplete. Many studies have focused on specific HHV-6 antigens extrapolated from research on human cytomegalovirus, a genetically related betaherpesvirus. Challenges to the study of HHV-6-specific T-cell immunity include the very low frequency of HHV-6-specific memory T cells in chronically infected humans, the large genome size of HHV-6, and the lack of an animal model. This review will focus on emerging techniques and methodological improvements that are beginning to overcome these barriers. Population-prevalent antigens are now becoming clear for the CD4+ T-cell response, while definition and ranking of CD8+ T-cell antigens and epitopes is at an earlier stage. This review will discuss current knowledge of the T-cell response to HHV-6, new research approaches, and translation to clinical practice.
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Affiliation(s)
- Derek J Hanson
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David M Koelle
- Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Benaroya Research Institute, Seattle, WA, United States
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4
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HHV-6B infection, T-cell reconstitution, and graft-vs-host disease after hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 53:1508-1517. [PMID: 29795424 DOI: 10.1038/s41409-018-0225-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/30/2022]
Abstract
Successful and sustained CD4+ T-cell reconstitution is associated with increased survival after hematopoietic cell transplantation (HCT), but opportunistic infections may adversely affect the time and extent of immune reconstitution. Human herpesvirus 6B (HHV-6B) efficiently infects CD4+ T cells and utilizes as a receptor CD134 (OX40), a member of the TNF superfamily that antagonizes regulatory T-cell (Treg) activity. Reactivation of HHV-6B has been associated with aberrant immune reconstitution and acute graft-versus-host disease (aGVHD) after HCT. Given that Treg counts are negatively correlated with aGVHD severity, we postulate that one mechanism for the poor CD4+ T-cell reconstitution observed shortly after transplant may be HHV-6B infection and depletion of peripheral (extra-thymic) CD4+ T cells, including a subpopulation of Treg cells. In turn, this may trigger a series of adverse events resulting in poor clinical outcomes such as severe aGVHD. In addition, recent evidence has linked HHV-6B reactivation with aberrant CD4+ T-cell reconstitution late after transplantation, which may be mediated by a different mechanism, possibly related to central (thymic) suppression of T-cell reconstitution. These observations suggest that aggressive management of HHV-6B reactivation in transplant patients may facilitate CD4+ T-cell reconstitution and improve the quality of life and survival of HCT patients.
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5
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Nefzi F, Lambert C, Gautheret-Dejean A, Fisson S, Khebizi Q, Khelif A, Agut H, Aouni M. Cytokine and cellular responses to human herpesvirus-6B in patients with B-acute lymphoblastic leukemia. Microbiol Immunol 2017; 60:770-777. [PMID: 27862208 DOI: 10.1111/1348-0421.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 01/21/2023]
Abstract
Primary infection with human herpesvirus-6 (HHV-6), is followed by its lifelong persistence in the host. Most T-cell responses to HHV-6 have been characterized using peripheral blood from healthy adults; however, the role of HHV-6 infection in immune modulation has not been elucidated for some diseases. Therefore, in this study the immune response to HHV-6 infection in patients with B-acute lymphoblastic leukemia (B-ALL) was analyzed. HHV-6 load was quantified in blood samples taken at the time of diagnosis of leukemia and on remission. The same concentrations of anti- and pro-inflammatory cytokines (IL-4, IL-1, IL-6, IL-8, IL-12p70, IL-17a, TNF-α and IFN-γ) were detected in plasma samples from 20 patients with and 20 without detectable HHV-6 virus loads in blood. Characterization of T-cell responses to HHV-6 showed low specific T-cells frequencies of 2.08% and 1.46% in patients with and without detectable viral loads, respectively. IFN-γ-producing T cells were detected in 0.03%-0.23% and in 0%-0.2% of CD4+T cells, respectively. Strong production of IL-6 was detected in medium supernatants of challenged T-cells whatever the HHV-6 status of the patients (973.51 ± 210.06 versus 825.70 ± 210.81 pg/mL). However, concentrations of TNF-α and IFN-γ were low. Thus, no association between plasma concentrations of cytokines and detection of HHV-6 in blood was identified, suggesting that HHV-6 is not strongly associated with development of B-ALL. The low viral loads detected may correspond with latently infected cells. Alternatively, HHV-6B specific immune responses may be below the detection threshold of the assays used.
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Affiliation(s)
- Faten Nefzi
- Laboratory of Transmissible Diseases and Biological Active Substances, LR99ES27, Faculty of Pharmacy, University of Monastir, Street Avicenne 5000, Monastir, Tunisia
| | - Claude Lambert
- Immunology Laboratory, Georges Friedel Laboratory (CNRS UMR5307); University Hospital of Saint-Étienne, 44 Rue Pointe Cadet, 42100 Saint-Étienne, France
| | - Agnès Gautheret-Dejean
- Sorbonne University, Pierre and Marie Curie University, Center for Immunology and Infectious Diseases of Paris (UMRS CR7), Persistent Viral Infections Team, 4 Jussieu Place, 75005, Paris, France.,Public Assistance-Hospitals of Paris, University Hospitals Pitié Salpêtrière-Charles Foix, Virology Service, 3 Avenue Victoria, 75004 Paris, France
| | - Sylvain Fisson
- INSERM U951, University of Evry Val d'Essonne, UMR_S951, Genethon, F-91002 Evry, France
| | - Quentin Khebizi
- INSERM U951, University of Evry Val d'Essonne, UMR_S951, Genethon, F-91002 Evry, France
| | - Abderrahim Khelif
- Department of Clinical Hematology, Farhat Hached Hospital, Sousse, Tunisia
| | - Henri Agut
- Sorbonne University, Pierre and Marie Curie University, Center for Immunology and Infectious Diseases of Paris (UMRS CR7), Persistent Viral Infections Team, 4 Jussieu Place, 75005, Paris, France.,Public Assistance-Hospitals of Paris, University Hospitals Pitié Salpêtrière-Charles Foix, Virology Service, 3 Avenue Victoria, 75004 Paris, France
| | - Mahjoub Aouni
- Laboratory of Transmissible Diseases and Biological Active Substances, LR99ES27, Faculty of Pharmacy, University of Monastir, Street Avicenne 5000, Monastir, Tunisia
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6
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Greco R, Crucitti L, Noviello M, Racca S, Mannina D, Forcina A, Lorentino F, Valtolina V, Rolla S, Dvir R, Morelli M, Giglio F, Barbanti MC, Lupo Stanghellini MT, Oltolini C, Vago L, Scarpellini P, Assanelli A, Carrabba MG, Marktel S, Bernardi M, Corti C, Clementi M, Peccatori J, Bonini C, Ciceri F. Human Herpesvirus 6 Infection Following Haploidentical Transplantation: Immune Recovery and Outcome. Biol Blood Marrow Transplant 2016; 22:2250-2255. [PMID: 27697585 DOI: 10.1016/j.bbmt.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022]
Abstract
Human herpesvirus 6 (HHV-6) is increasingly recognized as a potentially life-threatening pathogen in allogeneic hematopoietic stem cell transplantation (alloSCT). We retrospectively evaluated 54 adult patients who developed positivity to HHV-6 after alloSCT. The median time from alloSCT to HHV-6 reactivation was 34 days. HHV-6 was present in plasma samples from 31 patients, in bone marrow (BM) of 9 patients, in bronchoalveolar lavage fluid and liver or gut biopsy specimens from 33 patients, and in cerebrospinal fluid of 7 patients. Twenty-nine patients developed acute graft-versus-host disease (GVHD), mainly grade III-IV, and 15 had concomitant cytomegalovirus reactivation. The median absolute CD3+ lymphocyte count was 207 cells/µL. We reported the following clinical manifestations: fever in 43 patients, skin rash in 22, hepatitis in 19, diarrhea in 24, encephalitis in 10, BM suppression in 18, and delayed engraftment in 11. Antiviral pharmacologic treatment was administered to 37 patients; nonetheless, the mortality rate was relatively high in this population (overall survival [OS] at 1 year, 38% ± 7%). A better OS was significantly associated with a CD3+ cell count ≥200/µL at the time of HHV-6 reactivation (P = .0002). OS was also positively affected by the absence of acute GVHD grade III-IV (P = .03) and by complete disease remission (P = .03), but was not significantly influenced by steroid administration, time after alloSCT, type of antiviral prophylaxis, plasma viral load, or organ involvement. Although HHV-6 detection typically occurred early after alloSCT, better T cell immune reconstitution seems to have the potential to improve clinical outcomes. Our findings provide new insight into the interplay between HHV-6 and the transplanted immune system.
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Affiliation(s)
- Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maddalena Noviello
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Racca
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mannina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Forcina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lorentino
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Valtolina
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Rolla
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roee Dvir
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mara Morelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Giglio
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Chiara Barbanti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Oltolini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunogenetics, Leukemia, Genomics, and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jacopo Peccatori
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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7
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Reactivation of Human Herpes Virus-6 After Pediatric Stem Cell Transplantation: Risk Factors, Onset, Clinical Symptoms and Association With Severity of Acute Graft-Versus-Host Disease. Pediatr Infect Dis J 2015; 34:1118-27. [PMID: 26132825 DOI: 10.1097/inf.0000000000000824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS To study clinical symptoms, timing and consequences of human herpesvirus-6 (HHV-6) reactivation after pediatric allogeneic stem cell transplantation (SCT), HHV-6 was investigated by plasma polymerase chain reaction in a cohort of 106 pediatric SCT recipients. RESULTS HHV-6 viremia was detected post-SCT in 48% of the patients with a median time of onset at 20 days after SCT. In week 3 and 4 post-SCT, HHV-6 is the most common infectious agent detected. In up to 30% of the patients with fever of unknown origin, HHV-6 was the only detected infectious agent to explain fever. Patients transplanted with an unrelated donor or receiving serotherapy were at increased risk of HHV-6 reactivation. The onset of HHV-6 reactivation coincided with the appearance of lymphocytes and monocytes in peripheral blood. Treatment with alemtuzumab (MabCampath) delayed both lymphocyte and monocyte engraftment and, concomitantly, onset of HHV-6 reactivation was delayed in those cases. HHV-6 reactivation was not associated with an increased incidence of acute graft-versus-host disease (GvHD). However, progression to grade II-IV GvHD was in 9 of 10 patients associated with HHV-6 reactivation before GvHD (P = 0.006) and HHV-6 was the only infection with such an association. CONCLUSIONS HHV-6 frequently reactivates after pediatric SCT around the time of mononuclear cell engraftment and is associated with an increased severity of GvHD. HHV-6 may explain fever of unknown origin in 30% of the patients early after SCT. Assessment of HHV-6 reactivation in patients early after SCT can be instrumental for clinical decision making.
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8
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Halawi M, Khan N, Blake N. Identification of novel CD8+ T cell epitopes in human herpesvirus 6B U11 and U90. IMMUNITY INFLAMMATION AND DISEASE 2015; 3:118-31. [PMID: 26029371 PMCID: PMC4444154 DOI: 10.1002/iid3.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 12/22/2022]
Abstract
Human herpesvirus 6B (HHV6B) infects over 90% of the population, and normally establishes a latent infection, where episodes of reactivation are asymptomatic. However, in immunocompromised patients HHV6B reactivation is associated with high morbidity and mortality. Cellular immunotherapy has been utilised against other herpesvirus in immunocompromised settings. However, limited information on the immune response against HHV6B has hampered the development of immunotherapy for HHV6B-driven disease. In this study, we have analysed the cellular immune response against four HHV6B antigens in a panel of 30 healthy donors. We show that the base-line level of T cell reactivity in peripheral blood is very low to undetectable. A short-term reactivation step enabled expansion of T cell responses, and all donors responded to at least 1 antigen, but more commonly 3 or 4. A hierarchy of immunogenicity was determined with antigens U90 and U54 being co-dominant, followed by U11 and U39. Putative CD8+ T cell epitopes were mapped to U90 and U11, predicted to be presented in the context of HLA-A1, A29, B39 and C6. T cells reactive against these novel epitopes were able to recognise virus-infected cells. Our data is supportive of the application and on-going development of T cell immunotherapy against HHVB-driven disease in the immunocompromised host.
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Affiliation(s)
- Mustafa Halawi
- Institute of Infection and Global Health, University of Liverpool Liverpool, UK
| | - Naeem Khan
- Department of Clinical Immunology School of Immunity and Infection, University of Birmingham Birmingham, UK
| | - Neil Blake
- Institute of Infection and Global Health, University of Liverpool Liverpool, UK
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9
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Cognate CD4 T-cell licensing of dendritic cells heralds anti-cytomegalovirus CD8 T-cell immunity after human allogeneic umbilical cord blood transplantation. J Virol 2014; 89:1058-69. [PMID: 25378489 DOI: 10.1128/jvi.01850-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Reactivation of human cytomegalovirus (CMV) is hazardous to patients undergoing allogeneic cord blood transplantation (CBT), lowering survival rates by approximately 25%. While antiviral treatment ameliorates viremia, complete viral control requires CD8+ T-cell-driven immunity. Mouse studies suggest that cognate antigen-specific CD4+ T-cell licensing of dendritic cells (DCs) is required to generate effective CD8+ T-cell responses. For humans, this was not fully understood. We here show that CD4+ T cells are essential for licensing of human DCs to generate effector and memory CD8+ T-cell immunity against CMV in CBT patients. First, we show in CBT recipients that clonal expansion of CMV-pp65-specific CD4+ T cells precedes the rise in CMV-pp65-specific CD8+ T cells. Second, the elicitation of CMV-pp65-specific CD8+ T cells from rare naive precursors in cord blood requires DC licensing by cognate CMV-pp65-specific CD4+ T cells. Finally, also CD8+ T-cell memory responses require CD4+ T-cell-mediated licensing of DCs in our system, by secretion of gamma interferon (IFN-γ) by pp65-specific CD4+ T cells. Together, these data show that human DCs require licensing by cognate antigen-specific CD4+ T cells to elicit effective CD8+ T-cell-mediated immunity and fight off viral reactivation in CBT patients. IMPORTANCE Survival rates after stem cell transplantation are lowered by 25% when patients undergo reactivation of cytomegalovirus (CMV) that they harbor. Immune protection against CMV is mostly executed by white blood cells called killer T cells. We here show that for generation of optimally protective killer T-cell responses that respond to CMV, the early elicitation of help from a second branch of CMV-directed T cells, called helper T cells, is required.
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Becerra A, Gibson L, Stern LJ, Calvo-Calle JM. Immune response to HHV-6 and implications for immunotherapy. Curr Opin Virol 2014; 9:154-61. [PMID: 25462448 DOI: 10.1016/j.coviro.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
Most adults remain chronically infected with HHV-6 after resolution of a primary infection in childhood, with the latent virus held in check by the immune system. Iatrogenic immunosuppression following solid organ transplantation (SOT) or hematopoetic stem cell transplantation (HSCT) can allow latent viruses to reactivate. HHV-6 reactivation has been associated with increased morbidity, graft rejection, and neurological complications post-transplantation. Recent work has identified HHV-6 antigens that are targeted by the CD4+ and CD8+ T cell response in chronically infected adults. T cell populations recognizing these targets can be expanded in vitro and are being developed for use in autologous immunotherapy to control post-transplantation HHV-6 reaction.
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Affiliation(s)
- Aniuska Becerra
- Department of Pathology, University of Massachusetts, Medical School, Worcester, MA, United States
| | - Laura Gibson
- Department of Medicine, University of Massachusetts, Medical School, Worcester, MA, United States
| | - Lawrence J Stern
- Department of Pathology, University of Massachusetts, Medical School, Worcester, MA, United States; Department of Biochemistry and Molecular Pharmacology, University of Massachusetts, Medical School, Worcester, MA, United States.
| | - J Mauricio Calvo-Calle
- Department of Pathology, University of Massachusetts, Medical School, Worcester, MA, United States
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