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Pjanic M, Aleckovic-Halilovic M, Basic-Jukic N. JC Virus in Kidney Transplant Population: Are We Cautious Enough? J Clin Med 2024; 13:2217. [PMID: 38673491 PMCID: PMC11050714 DOI: 10.3390/jcm13082217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The John Cunningham virus (JCV) is a polyomavirus that usually infects people at a young age and does not cause any symptoms in immunocompetent individuals. However, in immunocompromised individuals, such as kidney transplant recipients, JCV can cause severe and potentially fatal disease. Unfortunately, JCV has not been researched as extensively as the BK virus and is not mentioned in relevant kidney transplant guidelines. This lack of attention to JCV can lead to less consideration in kidney transplant patients' care. Surveillance using locally available diagnostic methods is of the utmost importance. The presence of JCV can be diagnosed with urine decoy cells, viruria, or viremia verified by the PCR method. A low threshold for considering JCV as a possible cause of any neurological or renal dysfunction in kidney transplant recipients must be maintained. In such cases, kidney and brain biopsy are indicated. Maintaining the appropriate immunosuppression while avoiding over-immunosuppression to prevent JCV disease is crucial, and the approach should be individual, according to overall immunological risk. We hypothesize that the presence of the JCV can indicate overt immunosuppression and identify kidney transplant recipients more prone to opportunistic infections and diseases, including some malignancies. To explore that, future observational studies are needed.
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Affiliation(s)
- Mirha Pjanic
- Clinic for Internal Diseases, Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina;
| | - Mirna Aleckovic-Halilovic
- Clinic for Internal Diseases, Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina;
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
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Muacevic A, Adler JR. Kidney Allograft Dysfunction Due to John Cunningham (JC) Virus Nephropathy. Cureus 2022; 14:e32021. [PMID: 36600814 PMCID: PMC9799239 DOI: 10.7759/cureus.32021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 11/30/2022] Open
Abstract
John Cunningham (JC) polyomavirus-associated nephropathy (JC-PVAN) is a rare cause of polyomavirus-associated nephropathy (PVAN). Although BK polyomavirus (BKPyV) is a relatively proven common infection post kidney transplantation, JC polyomavirus (JCPyV) infection and its impact on graft function have been less studied. Here, we report a case of a deceased donor kidney transplant recipient who was diagnosed with allograft dysfunction due to JC-PVAN six years after transplantation. JC viremia resolved after a reduction in immunosuppression and treatment with intravenous immunoglobulin (IVIG); however, she developed an acute cellular rejection with moderate fibrosis resulting in chronic kidney disease in the allograft.
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3
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Virus-Associated Nephropathies: A Narrative Review. Int J Mol Sci 2022; 23:ijms231912014. [PMID: 36233315 PMCID: PMC9569621 DOI: 10.3390/ijms231912014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022] Open
Abstract
While most viral infections cause mild symptoms and a spontaneous favorable resolution, some can lead to severe or protracted manifestations, specifically in immunocompromised hosts. Kidney injuries related to viral infections may have multiple causes related to the infection severity, drug toxicity or direct or indirect viral-associated nephropathy. We review here the described virus-associated nephropathies in order to guide diagnosis strategies and treatments in cases of acute kidney injury (AKI) occurring concomitantly with a viral infection. The occurrence of virus-associated nephropathy depends on multiple factors: the local epidemiology of the virus, its ability to infect renal cells and the patient's underlying immune response, which varies with the state of immunosuppression. Clear comprehension of pathophysiological mechanisms associated with a summary of described direct and indirect injuries should help physicians to diagnose and treat viral associated nephropathies.
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JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010004] [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] Open
Abstract
The JC polyomavirus (JCPyV/JCV) is a member of the Polyomaviridae family and is ubiquitious in the general population, infecting 50–80% of individuals globally. A primary infection with JCV usally results in an asymptomatic, persistent infection that establishes latency in the renourinary tract. Reactivation from latency via iatrogenic immununosuppression for allograft transplantation may result in organ pathology and a potential life-threatening neuropathological disease in the form of progressive multifocal leukoencephalopathy (PML). Currently, no treatment exists for PML, a rare complication that occurs after transplantation, with an incidence of 1.24 per 1000 persons a year among solid organ transplant patients. PML is also observed in HIV patients who are immununosuppressed and are not receiving antiretroviral therapy, as well as individuals treated with biologics to suppress chronic inflammatory responses due to multiple sclerosis, Crohn’s disease, non-Hodgkin’s lymphoma, rheumatoid arthritis, and other autoimmune-mediated hematological disorders. Here, we describe the proposed mechanisms of JCV reactivation as it relates to iatrogenic immunosuppression for graft survival and the treatment of proinflammatory disease, such as biologics, proposed trafficking of JCV from the renourinary tract, JCV central nervous system dissemination and the pathology of PML in immunosuppressed patients, and potential novel therapeutics for PML disease.
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Assis P, Carvalho CE, Silva MS, Ribeiro B, Carvalho MDG. JC and BK virus DNA detection in archival slides of urine cytospin from renal transplant patients. Transpl Infect Dis 2018; 20:e12901. [DOI: 10.1111/tid.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/29/2018] [Accepted: 02/11/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Patricia Assis
- Laboratory of Molecular Pathology; Pathological Anatomy Service and Pathology Department; Clementino Fraga Filho University Hospital; Federal University of Rio de Janeiro - UFRJ; Rio de Janeiro Brazil
- Serviço de Anatomia Patológica; Subsolo - sala 09 (Citopatologia); Hospital Universitário Clementino Fraga Filho, UFRJ; Rio de Janeiro RJ Brazil
| | - Carlos Eduardo Carvalho
- Laboratory of Molecular Pathology; Pathological Anatomy Service and Pathology Department; Clementino Fraga Filho University Hospital; Federal University of Rio de Janeiro - UFRJ; Rio de Janeiro Brazil
- Serviço de Anatomia Patológica; Subsolo - sala 09 (Citopatologia); Hospital Universitário Clementino Fraga Filho, UFRJ; Rio de Janeiro RJ Brazil
| | - Marcelo Soares Silva
- Laboratory of Molecular Pathology; Pathological Anatomy Service and Pathology Department; Clementino Fraga Filho University Hospital; Federal University of Rio de Janeiro - UFRJ; Rio de Janeiro Brazil
- Serviço de Anatomia Patológica; Subsolo - sala 09 (Citopatologia); Hospital Universitário Clementino Fraga Filho, UFRJ; Rio de Janeiro RJ Brazil
| | - Bruna Ribeiro
- Laboratory of Molecular Pathology; Pathological Anatomy Service and Pathology Department; Clementino Fraga Filho University Hospital; Federal University of Rio de Janeiro - UFRJ; Rio de Janeiro Brazil
- Serviço de Anatomia Patológica; Subsolo - sala 09 (Citopatologia); Hospital Universitário Clementino Fraga Filho, UFRJ; Rio de Janeiro RJ Brazil
| | - Maria da Gloria Carvalho
- Laboratory of Molecular Pathology; Pathological Anatomy Service and Pathology Department; Clementino Fraga Filho University Hospital; Federal University of Rio de Janeiro - UFRJ; Rio de Janeiro Brazil
- Serviço de Anatomia Patológica; Subsolo - sala 09 (Citopatologia); Hospital Universitário Clementino Fraga Filho, UFRJ; Rio de Janeiro RJ Brazil
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Yang D, Keys B, J. Conti D, Foulke L, Stellrecht K, Cook L, Lopez-Soler RI. JC polyomavirus nephropathy, a rare cause of transplant dysfunction: Case report and review of literature. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/27/2016] [Accepted: 09/17/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Doyle Yang
- Department of Surgery; Albany Medical College; Albany NY USA
| | - Brandon Keys
- Department of Surgery; Albany Medical College; Albany NY USA
| | - David J. Conti
- Division of Surgery; Section of Transplantation; Albany Medical Center; Albany NY USA
| | | | - Kathleen Stellrecht
- Center for Immunology and Microbial Diseases; Albany Medical College; Albany NY USA
| | - Linda Cook
- Department of Laboratory Medicine; University of Washington; Seattle WA USA
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Pourjabari K, Makvandi M, Kaydani G, Shahbazian H, Samarbaf-Zadeh AR. Prevalence, reactivation and genotyping of John Cunningham virus among end-stage renal disease and kidney transplant patients. Future Virol 2016. [DOI: 10.2217/fvl-2016-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Infection of John Cunningham virus (JCV) usually occurs in early childhood and can lead to progressive multifocal leukoencephalopathy in immunosuppressed individuals. In this study, prevalence, reactivation and genotypes of JCV were evaluated. Materials & methods: Overall, 128 sex-matched individuals, including 64 patients with end-stage renal disease (ESRD) and 64 kidney transplant (KT) patients were evaluated using PCR and reverse transcriptase-PCR. Results: JCV DNA was detected in the urine samples of 17.2% of KT recipients and 1.6% of ESRD patients. Reactivation of JCV was determined in 12.5% of KT patients. All JCV-DNA-positive samples belonged to Af2 genotype (subtype b). Conclusion: Rare excretion of JCV in the ESRD urine samples can be associated with kidney function. JCV shedding and reactivation occur more frequently in the first 2 years following kidney transplantation. The genotype of Af2-b is circulating among the population of Iran.
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Affiliation(s)
- Keyvan Pourjabari
- Health Research Institute, Infectious & Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Manoochehr Makvandi
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamabbas Kaydani
- Department of Medical Laboratory, School of Paramedic, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Heshmatoallah Shahbazian
- Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Reza Samarbaf-Zadeh
- Health Research Institute, Infectious & Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Divers J, Núñez M, High KP, Murea M, Rocco MV, Ma L, Bowden DW, Hicks PJ, Spainhour M, Ornelles DA, Kleiboeker SB, Duncan K, Langefeld CD, Turner J, Freedman BI. JC polyoma virus interacts with APOL1 in African Americans with nondiabetic nephropathy. Kidney Int 2013; 84:1207-13. [PMID: 23677244 PMCID: PMC3844025 DOI: 10.1038/ki.2013.173] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 02/20/2013] [Accepted: 03/01/2013] [Indexed: 01/22/2023]
Abstract
Individuals with HIV infection and two apolipoprotein L1 gene (APOL1) risk variants frequently develop nephropathy. Here we tested whether non-HIV viral infections influence nephropathy risk via interactions with APOL1 by assessing APOL1 genotypes and presence of urine JC and BK polyoma virus and plasma HHV6 and CMV by quantitative polymerase chain reaction. We analyzed 300 samples from unrelated and related first-degree relatives of African Americans with non-diabetic nephropathy using linear and non-linear mixed models to account for familial relationships. The four groups evaluated were APOL1 0/1 versus 2 risk alleles, with or without nephropathy. Urine JCV and BKV were detected in 90 and 29 patients while HHV6 and CMV were rare. Adjusting for family age at nephropathy, gender and ancestry, presence of JCV genomic DNA in urine and APOL1 risk alleles were significantly negatively associated with elevated serum cystatin C, albuminuria (albumin to creatinine ratio over 30 mg/g), and kidney disease defined as an eGFR under 60 ml/min per 1.73 m2 and/or albuminuria in an additive (APOL1 plus JCV) model. BK viruria was not associated with kidney disease. Thus, African Americans at increased risk for APOL1-associated nephropathy (two APOL1 risk variants) with JC viruria had a lower prevalence of kidney disease, suggesting that JCV interaction with APOL1 genotype may influence kidney disease risk.
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Affiliation(s)
- Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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A review on JC virus infection in kidney transplant recipients. Clin Dev Immunol 2013; 2013:926391. [PMID: 23424601 PMCID: PMC3569895 DOI: 10.1155/2013/926391] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 01/03/2013] [Accepted: 01/03/2013] [Indexed: 01/28/2023]
Abstract
The polyomavirus (PyV), JC virus (JCV), is a small nonenveloped DNA virus that asymptomatically infects about 80% of healthy adults and establishes latency in the kidney tissue. In case of immunodeficient hosts, JCV can lytically infect the oligodendrocytes, causing a fatal demyelinating disease, known as progressive multifocal leukoencephalopathy (PML). Although the reactivation of another human PyV, BK virus (BKV), is relatively common and its association with the polyomavirus associated nephropathy (PyVAN) following renal transplantation is proven, JCV replication and its impact on graft function and survival are less well studied. Here we describe the biology of JCV and its pathological features and we review the literature regarding the JCV infection analyzed in the setting of transplantations.
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