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Wang H, Vannilam A, Hafberg ET, Gillis LA, Kassardjian A, Naini BV, Prasad V, Kelly DR, Mroczek-Musulman EC, Knox K, Correa H, Liang J. Clinical and Histopathologic Characteristics of Acute Severe Hepatitis Associated With Human Herpesvirus 6 Infection. Am J Surg Pathol 2024; 48:1117-1130. [PMID: 38907627 DOI: 10.1097/pas.0000000000002266] [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: 06/24/2024]
Abstract
Acute severe hepatitis associated with active human herpesvirus 6 (HHV-6) infection is a rare life-threatening condition with unclear clinical course and histopathology. In this study, we retrospectively analyzed 5 patients with indeterminate acute severe hepatitis found to have active hepatic HHV-6 infection during care. All patients were previously healthy children presenting with a nonspecific prodrome. Four developed acute liver failure (ALF) and 3 received liver transplantation. The explanted livers and biopsies demonstrated a centrilobular pattern of necroinflammation characterized by moderate to marked central perivenulitis and confluent centrilobular to panlobular necrosis in 4 cases, accompanied by marked hepatocellular swelling and milder portal inflammation in 3. Central perivenulitis was more prominent in comparison to a control of group of ALF without HHV-6 ( P =0.01). When compared with the children with acute severe hepatitis associated with adenovirus encountered in the recent outbreak, both central perivenulitis and centrilobular necrosis were significant predictors for association with HHV-6 ( P <0.01). Liver immunohistochemistry detected HHV-6 structural protein in biliary epithelium in all cases and a predominance of CD8 + T cells in the perivenular inflammatory infiltrate. Among the 4 patients with ALF, one received early anti-HHV-6 therapy and had transplant-free survival, while the other 3 received either general prophylactic antiviral treatment only (n=2) or late anti-HHV-6 therapy (n=1) and needed liver transplantation. Our findings were similar to those in previously reported cases. In summary, acute severe hepatitis associated with HHV-6 tends to affect children, progress to ALF, and exhibit characteristic centrilobular necroinflammation which likely represents an immune-mediated process.
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Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology and Immunology
| | - Annette Vannilam
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Einar T Hafberg
- Landspitali University Hospital, Reykjavík, Capital Region, Iceland
| | - Lynette A Gillis
- Division of Gastroenterology, Department of Pediatrics, University of Louisville, Louisville, KY
| | | | - Bita V Naini
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vinay Prasad
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - David R Kelly
- Department of Pathology and Laboratory Medicine, Children's of Alabama, Birmingham, AL
| | | | | | - Hernan Correa
- Department of Pathology, Microbiology and Immunology
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2
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Inherited Chromosomally Integrated Human Herpesvirus 6: Laboratory and Clinical Features. Microorganisms 2023; 11:microorganisms11030548. [PMID: 36985122 PMCID: PMC10052293 DOI: 10.3390/microorganisms11030548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Inherited chromosomally integrated human herpesvirus 6 (iciHHV-6) is a condition in which the complete HHV-6 genome is integrated into the chromosomes of the host germ cell and is vertically transmitted. The aims of this study were to identify iciHHV-6 prevalence in hospitalized patients and clinical features in individuals carrying this integration. HHV-6 PCR on hair follicles was used to confirm iciHHV-6 status when the blood viral load was more than 5 Log10 copies/mL. From January 2012 to June 2022, HHV-6 DNAemia was investigated in 2019 patients. In particular, 49 had a viral load higher than 6 Log10 copies/mL and HHV-6 DNA in hair follicles was positive. A viral load between 5.0 and 5.9 Log10 copies/mL was observed in 10 patients: 6 infants with acute HHV-6 infection and 4 patients with leukopenia and HHV-6 integration. Therefore, the iciHHV-6 prevalence in our population was 2.6% (53/2019). Adult patients with integration presented hematological (24%), autoimmune (11%), autoimmune neurological (19%), not-autoimmune neurological (22%), and other diseases (19%), whereas 5% had no clinically relevant disease. Although in our study population a high percentage of iciHHV-6 adult hospitalized patients presented a specific pathology, it is still unknown whether the integration is responsible for, or contributes to, the disease development.
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3
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Guo Y, Zhu Z, Cai W, Tao S, Yin D. Intracerebral opportunistic infections caused by immunosuppressants after orthotopic liver transplantation: Report of two cases and literature review. Front Immunol 2022; 13:1003254. [PMID: 36544772 PMCID: PMC9762491 DOI: 10.3389/fimmu.2022.1003254] [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] [Received: 07/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Central nervous system (CNS) infections in adults are rare because of normal immunity and the existence of the blood brain barrier, which prevents the invasion of pathogenic microorganisms. Liver transplant recipients are at an increased risk of opportunistic infections (OI) due to immunosuppressive therapy compared to those with normal immunity. Early diagnosis and timely implementation of treatment are critical for the successful treatment of these infections. We present two cases of intracerebral OI after orthotopic liver transplantation (OLT), with different clinical presentations. Patient 1 presented with epileptic seizures, mainly manifested as unresponsiveness, unconsciousness, and coma complicated with involuntary limb twitching. Patient 2 presented with a consciousness disorder, mainly manifested as unclear consciousness content, poor orientation, calculation power, and logical ability. Next-generation sequencing (NGS) examination of the cerebrospinal fluid confirmed human herpesvirus 6 B (HHV-6B) infection in patient 1 and intracranial Aspergillus infection in patient 2. Intracranial OI has insidious onset and atypical clinical manifestations. NGS can allow for the proper diagnosis and monitoring of the effects of treatment.
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4
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Izquierdo L, Canivet CM, De Martin E, Antonini TM, Roque-Afonso AM, Coilly A, Deback C. Investigation of Inherited Chromosomally Integrated Human Herpesvirus-6A+ and -6B+ in a Patient with Ulipristal Acetate-Induced Fulminant Hepatic Failure. Viruses 2021; 14:v14010062. [PMID: 35062266 PMCID: PMC8778448 DOI: 10.3390/v14010062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 01/01/2023] Open
Abstract
Inherited chromosomally integrated (ici) human herpes virus 6 (HHV-6) is estimated to occur in 0.6–2.7% of people worldwide. HHV-6 comprises two distinct species: HHV-6A and HHV-6B. Both HHV-6A and HHV-6B integration have been reported. Several drugs are capable of activating iciHHV-6 in tissues, the consequences of which are poorly understood. We report herein a case of a woman with iciHHV-6A+ and iciHHV-6B+, who developed ulipristal acetate (a selective progesterone receptor modulator)-induced fulminant hepatic failure that required liver transplantation. We confirmed the presence of ~one copy per cell of both HHV-6A and HHV-6B DNA in her hair follicles using multiplex HHV-6A/B real-time PCR and demonstrated the Mendelian inheritance of both iciHHV-6A and iciHHV-6B in her family members over three generations. Because of the rarity of this presentation, we discuss herein the possible links between reactivated HHV-6 from iciHHV-6A and/or iciHHV-6B and adverse drug reactions, suggesting that iciHHV-6 could be screened before the introduction of any hepatotoxic drugs to exclude HHV-6 active disease or combined idiosyncratic drug-induced liver injury in these patients.
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Affiliation(s)
- Laure Izquierdo
- Laboratoire de Virologie, Institut National de la Santé et de la Recherche Médicale Unité 1193 AP-HP, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France; (L.I.); (A.-M.R.-A.)
| | - Clémence M. Canivet
- Laboratoire HIFIH, UPRES EA3859, SFR 4208, Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Université d’Angers, 49000 Angers, France;
| | - Eleonora De Martin
- Centre Hépato-Biliaire, AP-HP, Institut National de la Santé et de la Recherche Médicale Unité 1193, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France; (E.D.M.); (T.M.A.); (A.C.)
| | - Teresa M. Antonini
- Centre Hépato-Biliaire, AP-HP, Institut National de la Santé et de la Recherche Médicale Unité 1193, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France; (E.D.M.); (T.M.A.); (A.C.)
| | - Anne-Marie Roque-Afonso
- Laboratoire de Virologie, Institut National de la Santé et de la Recherche Médicale Unité 1193 AP-HP, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France; (L.I.); (A.-M.R.-A.)
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP, Institut National de la Santé et de la Recherche Médicale Unité 1193, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France; (E.D.M.); (T.M.A.); (A.C.)
| | - Claire Deback
- Laboratoire de Virologie, AP-HP, Hôpitaux Universitaires Paris Saclay, Hôpital Paul-Brousse, 94800 Villejuif, France
- Inserm U996, Inflammation, Microbiome and Immunosurveillance, Université Paris-Saclay, 92140 Clamart, France
- Correspondence: ; Tel.: +33-141-28-80-00
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5
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Central nervous system infections after solid organ transplantation. Curr Opin Infect Dis 2021; 34:207-216. [PMID: 33741794 DOI: 10.1097/qco.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Significant advances to our understanding of several neuroinfectious complications after a solid organ transplant (SOT) have occurred in the last few years. Here, we review the central nervous system (CNS) infections that are relevant to SOT via a syndromic approach with a particular emphasis on recent updates in the field. RECENT FINDINGS A few key studies have advanced our understanding of the epidemiology and clinical characteristics of several CNS infections in SOT recipients. Risk factors for poor prognosis and protective effects of standard posttransplant prophylactic strategies have been better elucidated. Newer diagnostic modalities which have broad clinical applications like metagenomic next-generation sequencing, as well as those that help us better understand esoteric concepts of disease pathogenesis have been studied. Finally, several studies have provided newer insights into the treatment of these diseases. SUMMARY Recent findings reflect the steady progress in our understanding of CNS infections post SOT. They provide several avenues for improvement in the prevention, early recognition, and therapeutic outcomes of these diseases.
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6
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Bonnafous P, Gautheret-Dejean A. [Role of human herpesviruses 6 (HHV-6) in predisposition to pre-eclampsia]. Med Sci (Paris) 2021; 37:578-581. [PMID: 34180812 DOI: 10.1051/medsci/2021069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pascale Bonnafous
- Sorbonne Université, Inserm U1136, Institut Pierre Louis d'épidémiologie et de santé publique (IPLESP), Faculté de médecine, site Pitié-Salpêtrière, service de virologie, bâtiment CERVI, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Agnès Gautheret-Dejean
- AP-HP, Hôpitaux universitaires La Pitié Salpêtrière-Charles Foix, service de virologie, bâtiment CERVI, 83 boulevard de l'Hôpital 75013 Paris, France - Université de Paris, Inserm UMR-S U1139 3PHM, 4 avenue de l'Observatoire, 75006 Paris, France - Université de Paris, Faculté de pharmacie de Paris, laboratoire de microbiologie, 4 avenue de l'Observatoire, 75006 Paris, France
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7
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Mysore KR, Phan TL, Himes RW, Schady D, Eldin KW, Prusty BK, Munoz FM. Human Herpesvirus 6 Infection in Pediatric Liver Transplantation: Single-Center Study of Incidence, Outcomes, and Management. J Pediatric Infect Dis Soc 2021; 10:599-606. [PMID: 33491073 PMCID: PMC8163056 DOI: 10.1093/jpids/piaa166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/29/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Distinctions between HHV-6 primary infection in seronegative patients and HHV-6 reactivation in seropositive patients remains largely undescribed in pediatric liver transplant (LT) recipients. METHODS We implemented pretransplant serology testing of HHV-6 in a large pediatric hospital and retrospectively assessed the incidence, manifestations and outcomes of HHV-6 infections over a 3-year period. RESULTS Among 101 pediatric LT recipients, 96 had pretransplant HHV-6 serologies; 34 (35.4%) were seronegative and 62 (64.6%) seropositive. Posttransplantation, 8/25 (32%) seronegative patients had HHV-6 DNAemia (primary infection) compared to 2/48 (4%) seropositive patients (p=0.002). Compared to seropositive patients, seronegative patients with HHV-6 DNAemia were younger, and had symptoms of fever and/or elevated aminotransferases in association with higher viral loads, in the first month post-transplant. More than 90% of seronegative patients and 77.8% of seropositive patients had HHV-6 detected by PCR in liver biopsy obtained for concerns of allograft rejection, but most had no detectable concomitant DNAemia. Active replication of virus in the liver was confirmed by in situ hybridization in select cases. While HHV-6 infection occurred among patients on prophylaxis doses of antivirals for CMV, HHV-6 DNAemia and presenting symptoms resolved on treatment doses. CONCLUSIONS HHV-6 DNA-emia occurred more frequently in seronegative pediatric LT recipients, usually in the early posttransplant period, and was subsequently detected in allograft biopsies. HHV-6 cannot be ruled out as a cause of hepatitis in the absence of allograft tissue testing and specialized virological assays, as HHV-6 may disrupt local allograft immune homeostasis while evading traditional screening methods using blood or plasma. The assessment of pre-transplant HHV-6 serological status may be important for risk stratification and post-transplant management of pediatric LT recipients.
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Affiliation(s)
- Krupa R Mysore
- Department of Pediatrics, Section of Pediatric Gastroenterology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Tuan L Phan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- HHV-6 Foundation, Santa Barbara, California, USA
| | - Ryan W Himes
- Department of Pediatrics, Section of Gastroenterology & Hepatology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Deborah Schady
- Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Karen W Eldin
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bhupesh K Prusty
- Institut für Virologie und Immunobiologie, Julius-Maximilians Universität Würzburg, Würzburg, Germany
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
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8
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Wang X, Patel SA, Haddadin M, Cerny J. Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus. Ther Adv Infect Dis 2021; 8:20499361211018027. [PMID: 34104434 PMCID: PMC8155777 DOI: 10.1177/20499361211018027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
Human cytomegalovirus and Epstein-Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients' characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft-versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.
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Affiliation(s)
- Xin Wang
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shyam A Patel
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Michael Haddadin
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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9
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Peri AM, Cagliani R, Bozzi G, Pompa A, Manganaro L, Baldini L, Gori A, Bandera A. Chromosomally integrated human herpesvirus 6 (ci-HHV-6) in autologous bone marrow transplant recipients: are we missing a reactivation or is it just mimicking? J Clin Virol 2021; 139:104823. [PMID: 33910132 DOI: 10.1016/j.jcv.2021.104823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Maria Peri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy.
| | - Rachele Cagliani
- Bioinformatics, Scientific Institute, IRCCS E. MEDEA, 23842 Bosisio Parini, Lecco, Italy
| | - Giorgio Bozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy
| | - Alessandra Pompa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Hematology Unit, Milan, Italy
| | - Lara Manganaro
- INGM, National Institute of Molecular Genetics, Romeo ed Enrica Invernizzi, Milan, Italy
| | - Luca Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Hematology Unit, Milan, Italy
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Departement of Internal Medicine, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
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10
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Wood ML, Veal CD, Neumann R, Suárez NM, Nichols J, Parker AJ, Martin D, Romaine SPR, Codd V, Samani NJ, Voors AA, Tomaszewski M, Flamand L, Davison AJ, Royle NJ. Variation in human herpesvirus 6B telomeric integration, excision, and transmission between tissues and individuals. eLife 2021; 10:70452. [PMID: 34545807 PMCID: PMC8492063 DOI: 10.7554/elife.70452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Human herpesviruses 6A and 6B (HHV-6A/6B) are ubiquitous pathogens that persist lifelong in latent form and can cause severe conditions upon reactivation. They are spread by community-acquired infection of free virus (acqHHV6A/6B) and by germline transmission of inherited chromosomally integrated HHV-6A/6B (iciHHV-6A/6B) in telomeres. We exploited a hypervariable region of the HHV-6B genome to investigate the relationship between acquired and inherited virus and revealed predominantly maternal transmission of acqHHV-6B in families. Remarkably, we demonstrate that some copies of acqHHV-6B in saliva from healthy adults gained a telomere, indicative of integration and latency, and that the frequency of viral genome excision from telomeres in iciHHV-6B carriers is surprisingly high and varies between tissues. In addition, newly formed short telomeres generated by partial viral genome release are frequently lengthened, particularly in telomerase-expressing pluripotent cells. Consequently, iciHHV-6B carriers are mosaic for different iciHHV-6B structures, including circular extra-chromosomal forms that have the potential to reactivate. Finally, we show transmission of an HHV-6B strain from an iciHHV-6B mother to her non-iciHHV-6B son. Altogether, we demonstrate that iciHHV-6B can readily transition between telomere-integrated and free virus forms.
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Affiliation(s)
- Michael L Wood
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
| | - Colin D Veal
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
| | - Rita Neumann
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
| | - Nicolás M Suárez
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Jenna Nichols
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Andrei J Parker
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
| | - Diana Martin
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
| | - Simon PR Romaine
- Department of Cardiovascular Sciences, University of LeicesterLeicesterUnited Kingdom,NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUnited Kingdom
| | - Veryan Codd
- Department of Cardiovascular Sciences, University of LeicesterLeicesterUnited Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of LeicesterLeicesterUnited Kingdom
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center GroningenGroningenNetherlands
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
| | - Louis Flamand
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université Laval, Quebec CityQuébecCanada
| | - Andrew J Davison
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Nicola J Royle
- Department of Genetics and Genome Biology, University of LeicesterLeicesterUnited Kingdom
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11
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Petit V, Bonnafous P, Fages V, Gautheret-Dejean A, Engelmann I, Baras A, Hober D, Gérard R, Gibier JB, Leteurtre E, Glowacki F, Moulonguet F, Decaestecker A, Provôt F, Chamley P, Faure E, Prusty BK, Maanaoui M, Hazzan M. Donor-to-recipient transmission and reactivation in a kidney transplant recipient of an inherited chromosomally integrated HHV-6A: Evidence and outcomes. Am J Transplant 2020; 20:3667-3672. [PMID: 32428994 DOI: 10.1111/ajt.16067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/25/2023]
Abstract
Human herpesvirus (HHV)-6A can be inherited and chromosomally integrated (iciHHV-6A), and donor-to-recipient transmission has been reported in solid organ transplant. However, when HHV-6A reactivation happens after transplant, the source of HHV-6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor-to-recipient transmission and reactivation of iciHHV-6A through kidney transplant. The absence of HHV-6A genome from the nails of the recipient excluded a recipient-related iciHHV-6A. Viral loads > 7 log10 copies/106 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV-6A strains are proof of donor-related transmission. Detection of noncoding HHV-6 snc-RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV-6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV-6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis.
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Affiliation(s)
- Vivien Petit
- Service de Néphrologie, CHU Lille, Lille, France
| | - Pascale Bonnafous
- Sorbonne Department, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), THERAVIR Team, Paris, France
| | - Victor Fages
- Service de Néphrologie, CHU Lille, Lille, France
| | - Agnès Gautheret-Dejean
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, France.,Faculté de Pharmacie de Paris, Laboratoire de Microbiologie, Université de Paris, UMR-S 1139 (3PHM), Paris, France
| | - Ilka Engelmann
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Agathe Baras
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Didier Hober
- Laboratoire de Virologie ULR3610, University of Lille, CHU Lille, Lille, France
| | - Romain Gérard
- Gastroenterology Department, University of Lille, CHU Lille, Lille, France
| | - Jean-Baptiste Gibier
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - Emmanuelle Leteurtre
- Centre de Biologie Pathologie, Institute of Pathology, CHU Lille, Lille, France.,University of Lille, INSERM UMR1172, Lille, France
| | - François Glowacki
- Service de Néphrologie, CHU Lille, Lille, France.,UnivErsity of Lille, Lille, France
| | | | | | | | - Paul Chamley
- Service de Néphrologie, CHU Lille, Lille, France
| | - Emmanuel Faure
- Service de Maladies Infectieuses, CHU Lille, Lille, France.,U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, CHU Lille, UnivErsity of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Bhupesh K Prusty
- Institut für Virologie und Immunobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Mehdi Maanaoui
- Service de Néphrologie, CHU Lille, Lille, France.,University of Lille, INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, Lille, France
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12
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Liu X, Kosugi S, Koide R, Kawamura Y, Ito J, Miura H, Matoba N, Matsuzaki M, Fujita M, Kamada AJ, Nakagawa H, Tamiya G, Matsuda K, Murakami Y, Kubo M, Aswad A, Sato K, Momozawa Y, Ohashi J, Terao C, Yoshikawa T, Parrish NF, Kamatani Y. Endogenization and excision of human herpesvirus 6 in human genomes. PLoS Genet 2020; 16:e1008915. [PMID: 32776928 PMCID: PMC7444522 DOI: 10.1371/journal.pgen.1008915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/20/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022] Open
Abstract
Sequences homologous to human herpesvirus 6 (HHV-6) are integrated within the nuclear genome of about 1% of humans, but it is not clear how this came about. It is also uncertain whether integrated HHV-6 can reactivate into an infectious virus. HHV-6 integrates into telomeres, and this has recently been associated with polymorphisms affecting MOV10L1. MOV10L1 is located on the subtelomere of chromosome 22q (chr22q) and is required to make PIWI-interacting RNAs (piRNAs). As piRNAs block germline integration of transposons, piRNA-mediated repression of HHV-6 integration has been proposed to explain this association. In vitro, recombination of the HHV-6 genome along its terminal direct repeats (DRs) leads to excision from the telomere and viral reactivation, but the expected "solo-DR scar" has not been described in vivo. Here we screened for integrated HHV-6 in 7,485 Japanese subjects using whole-genome sequencing (WGS). Integrated HHV-6 was associated with polymorphisms on chr22q. However, in contrast to prior work, we find that the reported MOV10L1 polymorphism is physically linked to an ancient endogenous HHV-6A variant integrated into the telomere of chr22q in East Asians. Unexpectedly, an HHV-6B variant has also endogenized in chr22q; two endogenous HHV-6 variants at this locus thus account for 72% of all integrated HHV-6 in Japan. We also report human genomes carrying only one portion of the HHV-6B genome, a solo-DR, supporting in vivo excision and possible viral reactivation. Together these results explain the recently-reported association between integrated HHV-6 and MOV10L1/piRNAs, suggest potential exaptation of HHV-6 in its coevolution with human chr22q, and clarify the evolution and risk of reactivation of the only intact (non-retro)viral genome known to be present in human germlines.
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Affiliation(s)
- Xiaoxi Liu
- Genome Immunobiology RIKEN Hakubi Research Team, RIKEN Cluster for Pioneering Research and RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Shunichi Kosugi
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Rie Koide
- Genome Immunobiology RIKEN Hakubi Research Team, RIKEN Cluster for Pioneering Research and RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Jumpei Ito
- Division of Systems Virology, Department of Infectious Disease Control, International Research Center for Infectious Diseases, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroki Miura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nana Matoba
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Motomichi Matsuzaki
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Masashi Fujita
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Anselmo Jiro Kamada
- Genome Immunobiology RIKEN Hakubi Research Team, RIKEN Cluster for Pioneering Research and RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hidewaki Nakagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Gen Tamiya
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Koichi Matsuda
- Laboratory of Molecular Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Laboratory for Clinical Genome Sequencing, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Yoshinori Murakami
- Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Amr Aswad
- Institut für Virologie, Freie Universität Berlin, Berlin, Germany
| | - Kei Sato
- Division of Systems Virology, Department of Infectious Disease Control, International Research Center for Infectious Diseases, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Jun Ohashi
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nicholas F. Parrish
- Genome Immunobiology RIKEN Hakubi Research Team, RIKEN Cluster for Pioneering Research and RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- * E-mail:
| | - Yoichiro Kamatani
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Complex Trait Genomics, Graduate School of Frontier Sciences, The University of Tokyo, Japan
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13
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Human herpesvirus 6 in transplant recipients: an update on diagnostic and treatment strategies. Curr Opin Infect Dis 2020; 32:584-590. [PMID: 31567413 DOI: 10.1097/qco.0000000000000592] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The current review article focuses on recent advances in the approach to the diagnosis and treatment of human herpesvirus 6B (HHV-6B) in hematopoietic cell and solid organ transplant recipients. RECENT FINDINGS Over the past few years, key studies have broadened our understanding of best practices for the prevention and treatment of HHV-6B encephalitis after transplantation. Moreover, important data have been reported that support a potential role of HHV-6B reactivation in the development of acute graft-versus-host disease and lower respiratory tract disease in transplant recipients. Finally, increasing recognition of inherited chromosomally integrated HHV-6 (iciHHV-6) and an expanding array of diagnostic tools have increased our understanding of the potential for complications related to viral reactivation originating from iciHHV-6 in donors or recipients. SUMMARY Recent advances in diagnostic tools, disease associations, and potential treatments for HHV-6B present abundant opportunities for improving our understanding and management of this complex virus in transplant recipients.
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14
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Wang Y, Wang D, Tao X. Human herpesvirus 6B encephalitis in a liver transplant recipient: A case report and review of the literature. Transpl Infect Dis 2020; 23:e13403. [PMID: 32638491 PMCID: PMC7988578 DOI: 10.1111/tid.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
Human herpesvirus 6B (HHV‐6B) encephalitis in a liver transplant recipient is rarely reported. In this report, we presented a case of HHV‐6B encephalitis in a liver transplant recipient and reviewed the relevant literature. A 56‐year‐old man was admitted to the intensive care unit (ICU) with an acute headache and intermittent convulsion 17 days after liver transplantation. Next‐generation sequencing (NGS) of the cerebrospinal fluid (CSF) revealed 30691 sequence reads of HHV‐6B and real‐time polymerase chain reaction (real‐time PCR) of the CSF detected HHV‐6B DNA at 12 000 copies/mL, so the patient was diagnosed with HHV‐6B encephalitis and received ganciclovir treatment promptly. The condition of the patient improved well and returned to the general ward with no neurologic deficits. This case indicated that adequate awareness, early diagnosis, and timely treatment are crucial to a good prognosis of HHV‐6B encephalitis after liver transplantation.
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Affiliation(s)
- Yinfeng Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Di Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Xiaogen Tao
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
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15
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Denner J, Bigley TM, Phan TL, Zimmermann C, Zhou X, Kaufer BB. Comparative Analysis of Roseoloviruses in Humans, Pigs, Mice, and Other Species. Viruses 2019; 11:E1108. [PMID: 31801268 PMCID: PMC6949924 DOI: 10.3390/v11121108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Viruses of the genus Roseolovirus belong to the subfamily Betaherpesvirinae, family Herpesviridae. Roseoloviruses have been studied in humans, mice and pigs, but they are likely also present in other species. This is the first comparative analysis of roseoloviruses in humans and animals. The human roseoloviruses human herpesvirus 6A (HHV-6A), 6B (HHV-6B), and 7 (HHV-7) are relatively well characterized. In contrast, little is known about the murine roseolovirus (MRV), also known as murine thymic virus (MTV) or murine thymic lymphotrophic virus (MTLV), and the porcine roseolovirus (PRV), initially incorrectly named porcine cytomegalovirus (PCMV). Human roseoloviruses have gained attention because they can cause severe diseases including encephalitis in immunocompromised transplant and AIDS patients and febrile seizures in infants. They have been linked to a number of neurological diseases in the immunocompetent including multiple sclerosis (MS) and Alzheimer's. However, to prove the causality in the latter disease associations is challenging due to the high prevalence of these viruses in the human population. PCMV/PRV has attracted attention because it may be transmitted and pose a risk in xenotransplantation, e.g., the transplantation of pig organs into humans. Most importantly, all roseoloviruses are immunosuppressive, the humoral and cellular immune responses against these viruses are not well studied and vaccines as well as effective antivirals are not available.
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Affiliation(s)
- Joachim Denner
- Robert Koch Institute, Robert Koch Fellow, 13352 Berlin, Germany
| | - Tarin M. Bigley
- Division of Rheumatology, Department. of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Tuan L. Phan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70118, USA;
- HHV-6 Foundation, Santa Barbara, CA 93108, USA
| | - Cosima Zimmermann
- Institute of Virology, Freie Universität Berlin, 14163 Berlin, Germany;
| | - Xiaofeng Zhou
- Division of Pulmonary and Critical Care Medicine, Department. of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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16
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Bonnafous P, Phan TL, Himes R, Eldin K, Gautheret-Dejean A, Prusty BK, Agut H, Munoz FM. Evaluation of liver failure in a pediatric transplant recipient of a liver allograft with inherited chromosomally integrated HHV-6B. J Med Virol 2019; 92:241-250. [PMID: 31579937 DOI: 10.1002/jmv.25600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Active infections of human herpesvirus 6B (HHV-6B) are frequent in immunocompromised recipients after transplantation. Nevertheless, they need to be distinguished from latent inherited chromosomally integrated genomes (iciHHV-6) present in about 1% of the population to avoid unnecessary administration of toxic antivirals. METHODS A 5-year-old child presented with acute liver allograft rejection associated with HHV-6 DNA in plasma, which led to an unfavorable outcome. We investigated the possibility of HHV-6 infection derived from an iciHHV-6 present in the donor's liver using molecular and histopathology studies in various tissues, including quantification of HHV-6 DNA, genotyping, sequencing for antiviral resistance genes, relative quantification of viral transcripts, and detection of gB and gH viral proteins. RESULTS The presence of iciHHV-6B was evidenced in the donor with signs of reactivation in the gallbladder and transplanted liver (detection of HHV-6B mRNA and late proteins). This localized expression could have played a role in liver rejection. Low viral loads in the recipient's plasma, with identical partial U39 sequences, were in favor of viral DNA released from the transplanted liver rather than a systemic infection. CONCLUSIONS Determination of iciHHV-6 status before transplantation should be considered to guide clinical decisions, such as antiviral prophylaxis, viral load monitoring, and antiviral therapy.
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Affiliation(s)
- Pascale Bonnafous
- Sorbonne Department, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), THERAVIR team, Paris, France
| | - Tuan L Phan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, Louisiana
- HHV-6 Foundation, Santa Barbara, California
| | - Ryan Himes
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Karen Eldin
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Agnès Gautheret-Dejean
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France
- Department Paris Descartes, Institute de Pharmacie de Paris, UMR-S 1139 (3PHM), Paris, France
| | | | - Henri Agut
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Service de Virologie, Paris, France
| | - Flor M Munoz
- Departments of Pediatrics, Molecular Virology and Microbiology, Hepatology, and Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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17
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Ward KN, Hill JA, Hubacek P, de la Camara R, Crocchiolo R, Einsele H, Navarro D, Robin C, Cordonnier C, Ljungman P. Guidelines from the 2017 European Conference on Infections in Leukaemia for management of HHV-6 infection in patients with hematologic malignancies and after hematopoietic stem cell transplantation. Haematologica 2019; 104:2155-2163. [PMID: 31467131 PMCID: PMC6821622 DOI: 10.3324/haematol.2019.223073] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023] Open
Abstract
Of the two human herpesvirus 6 (HHV-6) species, human herpesvirus 6B (HHV-6B) encephalitis is an important cause of morbidity and mortality after allogeneic hematopoietic stem cell transplant. Guidelines for the management of HHV-6 infections in patients with hematologic malignancies or post-transplant were prepared a decade ago but there have been no other guidelines since then despite significant advances in the understanding of HHV-6 encephalitis, its therapy, and other aspects of HHV-6 disease in this patient population. Revised guidelines prepared at the 2017 European Conference on Infections in Leukaemia covering diagnosis, preventative strategies and management of HHV-6 disease are now presented.
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Affiliation(s)
- Katherine N Ward
- Division of Infection and Immunity, University College London, London, UK
| | - Joshua A Hill
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Petr Hubacek
- Department of Medical Microbiology and Department of Paediatric Haematology and Oncology 2 Medical Faculty of Charles University and Motol University Hospital, Prague, Czech Republic
| | | | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität, Würzburg, Germany
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA and Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Christine Robin
- Department of Haematology, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Catherine Cordonnier
- Department of Haematology, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Université Paris-Est Créteil, Créteil, France
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18
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Pellett PE. An Old Rose and its Newly Revealed Thorns. J Infect Dis 2019; 220:343-345. [DOI: 10.1093/infdis/jiy645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Philip E Pellett
- Department of Microbiology, Immunology, and Biochemistry, Wayne State University School of Medicine, Detroit, Michigan
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19
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Phenotypic and Functional Differences between Human Herpesvirus 6- and Human Cytomegalovirus-Specific T Cells. J Virol 2019; 93:JVI.02321-18. [PMID: 30996090 DOI: 10.1128/jvi.02321-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/09/2019] [Indexed: 11/20/2022] Open
Abstract
Human herpesvirus 6 (HHV-6) infects >90% of the population and establishes a latent infection with asymptomatic episodes of reactivation. However, HHV-6 reactivation is associated with morbidity and sometimes mortality in immunocompromised patients. To date, control of the virus in healthy virus carriers and the failure to control it in patients with disease remain poorly understood. In particular, knowledge of HHV-6-specific T-cell responses is limited. Here, we characterized HHV-6A- and HHV-6B-specific CD4+ and CD8+ T-cell responses from peripheral blood mononuclear cells (PBMCs) of healthy donors. We studied the phenotype of effector HHV-6-specific T cells ex vivo, as well as of induced specific suppressive regulatory CD4+ T cells in vitro poststimulation, in comparison to human cytomegalovirus (HCMV) responses. Compared to that for HCMV, we show that ex vivo T-cell reactivity in peripheral blood is detectable but at very low frequency, both for HHV-6A and -6B viruses. Interestingly, the phenotype of the specific T cells also differs between the viruses. HHV-6A- and HHV-6B-specific CD4+ T lymphocytes are less differentiated than HCMV-specific T cells. Furthermore, we show a higher frequency of HHV-6-specific suppressive regulatory T cells (eTregs) than HCMV-specific eTregs in coinfected individuals. Despite the strong similarity of HHV-6 and HCMV from a virologic point of view, we observed immunological differences, particularly in relation to the frequency and phenotype of effector/memory and regulatory virus-specific T cells. This suggests that different immune factors are solicited in the control of HHV-6 infection than in that of HCMV infection.IMPORTANCE T cells are central to an effective defense against persistent viral infections that can be related to human cytomegalovirus (HCMV) or human herpesvirus 6 (HHV-6). However, knowledge of HHV-6-specific T-cell responses is limited. In order to deepen our knowledge of T-cell responses to HHV-6, we characterized HHV-6A- and HHV-6B-specific CD4+ and CD8+ T-cell responses directly ex vivo from healthy coinfected blood donors. Despite the strong similarity of HHV-6 and HCMV from a virologic point of view, we observed immunological differences, particularly in relation to the frequency and phenotype of effector/memory and regulatory virus-specific T cells. This suggests that different immune factors are solicited in the control of HHV-6 infection than in that of HCMV infection. Our findings may encourage immunomonitoring of patients with viral replication episodes to follow the emergence of effector versus regulatory T cells.
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20
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Oevermann L, Zimmermann C, Voigt S, Künkele A, Lobitz S, Eggert A, Schulte JH, Kaufer BB, Deubzer HE. Transmission of chromosomally integrated human herpes virus-6A via haploidentical stem cell transplantation poses a risk for virus reactivation and associated complications. Bone Marrow Transplant 2019; 55:260-264. [PMID: 30988380 DOI: 10.1038/s41409-019-0530-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Lena Oevermann
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berliner Institut für Gesundheitsforschung (BIH), Anna-Louisa-Karsch-Strasse 2, 10178, Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Cosima Zimmermann
- Institute of Virology, Freie Universität Berlin, Robert-von-Ostertag-Strasse 7-13, 14163, Berlin, Germany
| | - Sebastian Voigt
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Infectious Diseases, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Annette Künkele
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Anna-Louisa-Karsch-Strasse 2, 10178, Berlin, Germany
| | - Stephan Lobitz
- Department of Pediatric Hematology and Oncology, Kinderkrankenhaus, Amsterdamer Strasse 59, 50735, Köln, Germany
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Anna-Louisa-Karsch-Strasse 2, 10178, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Anna-Louisa-Karsch-Strasse 2, 10178, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt B Kaufer
- Institute of Virology, Freie Universität Berlin, Robert-von-Ostertag-Strasse 7-13, 14163, Berlin, Germany
| | - Hedwig E Deubzer
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Anna-Louisa-Karsch-Strasse 2, 10178, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neuroblastoma Research Group, Experimental and Clinical Research Center (ECRC) of the Charité and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, Lindenberger Weg, 8013125, Berlin, Germany
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21
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Pellett Madan R, Hand J. Human herpesvirus 6, 7, and 8 in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13518. [PMID: 30844089 DOI: 10.1111/ctr.13518] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/17/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HHV-6A, HHV-6B, HHV-7, and HHV-8 in the pre- and post-transplant period. The majority of HHV-6 (A and B) and HHV-7 infections in transplant recipients are asymptomatic; symptomatic disease is reported infrequently across organs. Routine screening for HHV-6 and 7 DNAemia is not recommended in asymptomatic patients, nor is prophylaxis or preemptive therapy. Detection of viral nucleic acid by quantitative PCR in blood or CSF is the preferred method for diagnosis of HHV-6 and HHV-7 infection. The possibility of chromosomally integrated HHV-6 DNA should be considered in individuals with persistently high viral loads. Antiviral therapy should be initiated for HHV-6 encephalitis and should be considered for other manifestations of disease. HHV-8 causes Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease and is also associated with hemophagocytic syndrome and bone marrow failure. HHV-8 screening and monitoring may be indicated to prevent disease. Treatment of HHV-8 related disease centers on reduction of immunosuppression and conversion to sirolimus, while chemotherapy may be needed for unresponsive disease. The role of antiviral therapy for HHV-8 infection has not yet been defined.
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Affiliation(s)
- Rebecca Pellett Madan
- Department of Pediatrics, New York University Langone School of Medicine, New York City, New York
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Clinical School, Ochsner Medical Center, The University of Queensland School of Medicine, New Orleans, Louisiana
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22
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Ogata M, Phan TL, Fukuda T. Antiviral therapy for the treatment of HHV-6-associated syndromes after transplant. Am J Transplant 2019; 19:306-307. [PMID: 30102463 DOI: 10.1111/ajt.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Masao Ogata
- Department of Hematology, Oita University Faculty of Medicine, Oita, Japan
| | - Tuan L Phan
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, LA, USA.,HHV-6 Foundation, Santa Barbara, CA, USA
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
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23
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Epstein DJ, Tan SK, Deresinski S. HHV-6 and septic shock: Tenuous proof of causation. Am J Transplant 2019; 19:303. [PMID: 29939480 DOI: 10.1111/ajt.14983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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24
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Eliassen E, Lum E, Pritchett J, Ongradi J, Krueger G, Crawford JR, Phan TL, Ablashi D, Hudnall SD. Human Herpesvirus 6 and Malignancy: A Review. Front Oncol 2018; 8:512. [PMID: 30542640 PMCID: PMC6277865 DOI: 10.3389/fonc.2018.00512] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022] Open
Abstract
In order to determine the role of human herpesvirus 6 (HHV-6) in human disease, several confounding factors, including methods of detection, types of controls, and the ubiquitous nature of the virus, must be considered. This is particularly problematic in the case of cancer, in which rates of detection vary greatly among studies. To determine what part, if any, HHV-6 plays in oncogenesis, a review of the literature was performed. There is evidence that HHV-6 is present in certain types of cancer; however, detection of the virus within tumor cells is insufficient for assigning a direct role of HHV-6 in tumorigenesis. Findings supportive of a causal role for a virus in cancer include presence of the virus in a large proportion of cases, presence of the virus in most tumor cells, and virus-induced in-vitro cell transformation. HHV-6, if not directly oncogenic, may act as a contributory factor that indirectly enhances tumor cell growth, in some cases by cooperation with other viruses. Another possibility is that HHV-6 may merely be an opportunistic virus that thrives in the immunodeficient tumor microenvironment. Although many studies have been carried out, it is still premature to definitively implicate HHV-6 in several human cancers. In some instances, evidence suggests that HHV-6 may cooperate with other viruses, including EBV, HPV, and HHV-8, in the development of cancer, and HHV-6 may have a role in such conditions as nodular sclerosis Hodgkin lymphoma, gastrointestinal cancer, glial tumors, and oral cancers. However, further studies will be required to determine the exact contributions of HHV-6 to tumorigenesis.
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Affiliation(s)
- Eva Eliassen
- HHV-6 Foundation, Santa Barbara, CA, United States
| | - Emily Lum
- HHV-6 Foundation, Santa Barbara, CA, United States
| | - Joshua Pritchett
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Joseph Ongradi
- Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
| | - Gerhard Krueger
- Department of Pathology and Laboratory Medicine, University of Texas- Houston Medical School, Houston, TX, United States
| | - John R Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, CA, United States
| | - Tuan L Phan
- HHV-6 Foundation, Santa Barbara, CA, United States.,Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
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