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Lin F, Zhang Z, Wang C, Liu F, Chen R, Chen J, Fang X, Sun Y, Zhai Y, Xu H, Shen Q. Risk factors and outcome of BK polyomavirus infection in pediatric kidney transplantation. Pediatr Nephrol 2024:10.1007/s00467-024-06473-8. [PMID: 39088057 DOI: 10.1007/s00467-024-06473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/30/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND BK polyomavirus (BKV) infection is a critical complication hindering graft survival after kidney transplantation. We aimed to investigate the risk factors and outcome of BKV infection in pediatric kidney transplantation. METHODS The clinical and follow-up data of pediatric kidney transplant recipients at the Children's Hospital of Fudan University from Jan 2015 to June 2023 were retrospectively analyzed. RESULTS A total of 217 patients were included in the study with mean follow-up time of 24.3 ± 19.9 months. The mean age at transplantation was 9.7 ± 4.2 years. The patient survival rate and graft survival rate were 98.2% and 96.8%, respectively. Twenty-nine patients (13.4%) developed BKV infection, which was detected at 5.8 ± 3.2 months after transplantation. Among these 29 patients with BKV infection, 8 patients (3.6%) developed BKV nephropathy (BKVN), which was diagnosed at 8.3 ± 2.9 months after transplantation, and 2 patients developed graft failure eventually. Compared with the non-BKV infection group (eGFR 76.7 ± 26.1 mL/min/1.73 m2) and BKV infection without BKVN group (eGFR 85.2 ± 23.8 mL/min/1.73 m2), BKVN group had lowest eGFR during follow-up (33.5 ± 11.0 ml/min/1.73 m2, P < 0.001). Younger age at transplant (OR 0.850, 95%CI 0.762-0.948, P = 0.005), CAKUT disease of primary etiology (OR 2.890, 95%CI 1.200-6.961, P = 0.018), and CMV negative recipient serostatus before transplantation (OR 3.698, 95%CI 1.583-8.640, P = 0.003) were independent risk factors for BKV infection. CONCLUSIONS Incidence of BKV infection is quite high within 12 months after pediatric kidney transplantation and children with BKVN have poor graft function. Younger age at transplant, CAKUT disease, and CMV negative recipient serostatus before transplantation increase the risk of BKV infection after kidney transplantation.
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Affiliation(s)
- Fang Lin
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Zhiqing Zhang
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Chunyan Wang
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Feng Liu
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Rui Chen
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Xiaoyan Fang
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Yubo Sun
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
- Department of Urology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yihui Zhai
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China.
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China.
- National Key Laboratory of Kidney Diseases, Shanghai, China.
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China.
- National Key Laboratory of Kidney Diseases, Shanghai, China.
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Zhang H, Luo JQ, Zhao GD, Huang Y, Yang SC, Chen PS, Li J, Wu CL, Qiu J, Chen XT, Huang G. Concurrent JCPyV-DNAemia Is Correlated With Poor Graft Outcome in Kidney Transplant Recipients With Polyomavirus-associated Nephropathy. Transplantation 2024; 108:1802-1811. [PMID: 38499506 PMCID: PMC11262736 DOI: 10.1097/tp.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/29/2024] [Accepted: 02/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Co-infection of JC polyomavirus (JCPyV) and BK polyomavirus (BKPyV) is uncommon in kidney transplant recipients, and the prognosis is unclear. This study aimed to investigate the effect of concurrent JCPyV-DNAemia on graft outcomes in BKPyV-infected kidney transplant recipients with polyomavirus-associated nephropathy (PyVAN). METHODS A total of 140 kidney transplant recipients with BKPyV replication and PyVAN, 122 without concurrent JCPyV-DNAemia and 18 with JCPyV-DNAemia were included in the analysis. Least absolute shrinkage and selection operator regression analysis and multivariate Cox regression analysis were used to identify prognostic factors for graft survival. A nomogram for predicting graft survival was created and evaluated. RESULTS The median tubulitis score in the JCPyV-DNAemia-positive group was higher than in JCPyV-DNAemia-negative group ( P = 0.048). At last follow-up, the graft loss rate in the JCPyV-DNAemia-positive group was higher than in the JCPyV-DNAemia-negative group (50% versus 25.4%; P = 0.031). Kaplan-Meier analysis showed that the graft survival rate in the JCPyV-DNAemia-positive group was lower than in the JCPyV-DNAemia-negative group ( P = 0.003). Least absolute shrinkage and selection operator regression and multivariate Cox regression analysis demonstrated that concurrent JCPyV-DNAemia was an independent risk factor for graft survival (hazard ratio = 4.808; 95% confidence interval: 2.096-11.03; P < 0.001). The nomogram displayed favorable discrimination (C-index = 0.839), concordance, and clinical applicability in predicting graft survival. CONCLUSIONS Concurrent JCPyV-DNAemia is associated with a worse graft outcome in BKPyV-infected kidney transplant recipients with PyVAN.
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Affiliation(s)
- Hui Zhang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jin-Quan Luo
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Guo-Dong Zhao
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yang Huang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Shi-Cong Yang
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pei-Song Chen
- Department of Clinical Laboratory, Department of Laboratory Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Cheng-Lin Wu
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jiang Qiu
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xu-Tao Chen
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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Ferreira Menoni SM, Leon LL, de Lima RG, Lutaif ACGDB, Prates LC, Palma LMP, Costa SCB, Belangero VMS, Bonon SHA. Characterization of Herpesviridae Family Members, BK Virus, and Adenovirus in Children and Adolescents with Nephrotic Syndrome. Viruses 2024; 16:1017. [PMID: 39066180 PMCID: PMC11281385 DOI: 10.3390/v16071017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 07/28/2024] Open
Abstract
Since the significance of viral infections in children and adolescents with nephrotic syndrome (NS) is yet to be defined, this study intended to estimate the occurrence, pattern, and outcomes of some DNA viral infections in children with NS. METHODS A prospective study was conducted to determine the genome identification of the viruses Epstein-Barr (EBV), human cytomegalovirus (HCMV), human herpesvirus 6 (HHV-6 type A and type B) and 7 (HHV-7), polyomavirus (BKV), and human adenovirus (HAdV) in plasma and urine samples of pediatric patients with NS. RESULTS A total of 35 patients aged 1 to 18 years with NS and under immunosuppressant drugs participated in the study. Plasma and urine samples were collected at regular intervals during a median follow-up of 266 days (range 133-595), and DNA was analyzed to detect the selected DNA viruses. Eleven patients (31.4%) had active virus infections, and patterns were classified as coinfection, recurrent, and consecutive. Of these, six patients (54.5%) presented viral coinfection, six (54.5%) viral recurrence, and seven patients (63.3%) had viral consecutive infection. Ten of the eleven patients with active infection had a proteinuria relapse (91%) and eight (72.7%) were hospitalized (p = 0.0022). Active HCMV infection was the most frequent infection and was observed in six patients (54.5%), three of the eleven patients (27.2%) had suspected HCMV disease in the gastrointestinal tract, and one had HHV-7 coinfection. The frequency of other infections was: 9% for HHV-6, 45.5% for BKV, 27.3% for HHV-7, 18.2% for EBV, and 18.2% for HAdV. CONCLUSION viral infections, especially HCMV, can be an important cause of morbidity and nephrotic syndrome relapse in children.
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Affiliation(s)
- Silvia Mendonça Ferreira Menoni
- Laboratory of Virology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (S.M.F.M.); (L.L.L.); (R.G.d.L.); (S.C.B.C.)
| | - Lucas Lopes Leon
- Laboratory of Virology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (S.M.F.M.); (L.L.L.); (R.G.d.L.); (S.C.B.C.)
| | - Rodrigo Gonçalves de Lima
- Laboratory of Virology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (S.M.F.M.); (L.L.L.); (R.G.d.L.); (S.C.B.C.)
| | - Anna Cristina Gervásio de Brito Lutaif
- Integrated Nephrology Center Unit, Pediatric Nephrology, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (A.C.G.d.B.L.); (L.C.P.); (L.M.P.P.); (V.M.S.B.)
| | - Liliane Cury Prates
- Integrated Nephrology Center Unit, Pediatric Nephrology, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (A.C.G.d.B.L.); (L.C.P.); (L.M.P.P.); (V.M.S.B.)
| | - Lilian Monteiro Pereira Palma
- Integrated Nephrology Center Unit, Pediatric Nephrology, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (A.C.G.d.B.L.); (L.C.P.); (L.M.P.P.); (V.M.S.B.)
| | - Sandra Cecília Botelho Costa
- Laboratory of Virology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (S.M.F.M.); (L.L.L.); (R.G.d.L.); (S.C.B.C.)
| | - Vera Maria Santoro Belangero
- Integrated Nephrology Center Unit, Pediatric Nephrology, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (A.C.G.d.B.L.); (L.C.P.); (L.M.P.P.); (V.M.S.B.)
| | - Sandra Helena Alves Bonon
- Laboratory of Virology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo 13083-887, Brazil; (S.M.F.M.); (L.L.L.); (R.G.d.L.); (S.C.B.C.)
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Lv Y, Liu X. Hemorrhagic cystitis induced by JC polyomavirus infection following COVID-19: a case report. BMC Urol 2024; 24:87. [PMID: 38627797 PMCID: PMC11020351 DOI: 10.1186/s12894-024-01464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
JC polyomavirus (JCPyV) is a human polyomavirus that can establish lifelong persistent infection in the majority of adults. It is typically asymptomatic in immunocompetent individuals. However, there is a risk of developing progressive multifocal leukoencephalopathy (PML) in immunocompromised or immunosuppressed patients. Though JCPyV commonly resides in the kidney-urinary tract, its involvement in urinary system diseases is extremely rare. Here, we reported a case of a 60-year-old male patient with coronavirus disease 2019 (COVID-19) infection who developed hemorrhagic cystitis after receiving treatment with nirmatrelvir 300 mg/ritonavir 100 mg quaque die (QD). Subsequent metagenomic next-generation sequencing (mNGS) confirmed the infection to be caused by JCPyV type 2. Then, human immunoglobulin (PH4) for intravenous injection at a dose of 25 g QD was administered to the patient. Three days later, the hematuria resolved. This case illustrates that in the setting of compromised host immune function, JCPyV is not limited to causing central nervous system diseases but can also exhibit pathogenicity in the urinary system. Moreover, mNGS technology facilitates rapid diagnosis of infectious etiology by clinical practitioners, contributing to precise treatment for patients.
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Affiliation(s)
- Yuanjie Lv
- Department of Infection, Hospital of Traditional Chinese Medicine, Xinchang County, No.188 Shijiu Feng Road, Qixing Street, Shaoxing, 312500, China.
| | - Xiaoping Liu
- Department of Infection, Hospital of Traditional Chinese Medicine, Xinchang County, No.188 Shijiu Feng Road, Qixing Street, Shaoxing, 312500, China
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Santana Quintana CA, Gallego Samper R, Pena López MJ, Camacho Galán R, Santana Estupiñán R, Aladro Escribano S, Quevedo Reina JC, Medina García D, Daruiz D'Orazio YS, Pérez Borges P. JC polyomavirus nephropathy in renal transplant patient: An uncommon guest. Nefrologia 2024; 44:303-305. [PMID: 38514305 DOI: 10.1016/j.nefroe.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Affiliation(s)
| | - Roberto Gallego Samper
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María José Pena López
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Rafael Camacho Galán
- Servicio de Anatomía Patológica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Raquel Santana Estupiñán
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Sara Aladro Escribano
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Juan Carlos Quevedo Reina
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Daniel Medina García
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Patricia Pérez Borges
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Abu Jawdeh BG, Smith ML, Hudson MR, Mour GK, Budhiraja P, Rosenthal JL. Case report: JC polyomavirus nephropathy in simultaneous heart-kidney transplantation: the role of viral-specific in situ hybridization staining. Front Med (Lausanne) 2023; 10:1282827. [PMID: 37928458 PMCID: PMC10622943 DOI: 10.3389/fmed.2023.1282827] [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: 08/24/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction JC polyomavirus (JCPyV) is a ubiquitous virus that can be latent in the brain and the kidney. It is the etiologic agent responsible for progressive multifocal leukoencephalopathy, a fatal, demyelinating disease of the central nervous system, and rarely causes polyomavirus nephropathy in immunocompromised kidney transplant recipients. Case description We present the first case of JCPyV nephropathy in a simultaneous heart-kidney transplant patient, where viral-specific in situ hybridization staining of the kidney tissue was utilized to confirm the diagnosis. The patient was diagnosed 6 years after simultaneous heart-kidney transplantation and was treated with immunosuppression reduction and intravenous immunoglobulin. Discussion JCPyV nephropathy should be considered in the differential diagnosis of kidney allograft injury, particularly, with suggestive light microscopy histologic features in the absence of BK polyomavirus viremia and/or viruria. In addition to obtaining JCPyV PCR in the blood, in situ hybridization staining may have a utility in confirming the diagnosis. To date, we lack effective JCPyV-specific therapies, and prompt initiation of immunosuppression reduction remains the mainstay of treatment.
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Affiliation(s)
| | - Maxwell L. Smith
- Division of Anatomic Pathology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | | | - Girish K. Mour
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Pooja Budhiraja
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Julie L. Rosenthal
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, United States
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Peretti A, Scorpio DG, Kong WP, Pang YYS, McCarthy MP, Ren K, Jackson M, Graham BS, Buck CB, McTamney PM, Pastrana DV. A multivalent polyomavirus vaccine elicits durable neutralizing antibody responses in macaques. Vaccine 2023; 41:1735-1742. [PMID: 36764908 PMCID: PMC9992340 DOI: 10.1016/j.vaccine.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
In 2019, there were about 100,000 kidney transplants globally, with more than a quarter of them performed in the United States. Unfortunately, some engrafted organs are lost to polyomavirus-associated nephropathy (PyVAN) caused by BK and JC viruses (BKPyV and JCPyV). Both viruses cause brain disease and possibly bladder cancer in immunosuppressed individuals. Transplant patients are routinely monitored for BKPyV viremia, which is an accepted hallmark of nascent nephropathy. If viremia is detected, a reduction in immunosuppressive therapy is standard care, but the intervention comes with increased risk of immune rejection of the engrafted organ. Recent reports have suggested that transplant recipients with high levels of polyomavirus-neutralizing antibodies are protected against PyVAN. Virus-like particle (VLP) vaccines, similar to approved human papillomavirus vaccines, have an excellent safety record and are known to induce high levels of neutralizing antibodies and long-lasting protection from infection. In this study, we demonstrate that VLPs representing BKPyV genotypes I, II, and IV, as well as JCPyV genotype 2 produced in insect cells elicit robust antibody titers. In rhesus macaques, all monkeys developed neutralizing antibody titers above a previously proposed protective threshold of 10,000. A second inoculation, administered 19 weeks after priming, boosted titers to a plateau of ≥ 25,000 that was maintained for almost two years. No vaccine-related adverse events were observed in any macaques. A multivalent BK/JC VLP immunogen did not show inferiority compared to the single-genotype VLP immunogens. Considering these encouraging results, we believe a clinical trial administering the multivalent VLP vaccine in patients waiting to receive a kidney transplant is warranted to evaluate its ability to reduce or eliminate PyVAN.
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Affiliation(s)
- Alberto Peretti
- Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MD 20892, United States
| | - Diana G Scorpio
- Viral Pathogenesis Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, United States
| | - Wing-Pui Kong
- Virology Core, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, United States
| | - Yuk-Ying S Pang
- Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MD 20892, United States
| | - Michael P McCarthy
- Department of Infectious Diseases-Vaccines, MedImmune, Gaithersburg, MD 20878, United States
| | - Kuishu Ren
- Department of Infectious Diseases-Vaccines, MedImmune, Gaithersburg, MD 20878, United States
| | - Moriah Jackson
- Viral Pathogenesis Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, United States
| | - Barney S Graham
- Viral Pathogenesis Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, United States
| | - Christopher B Buck
- Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MD 20892, United States.
| | - Patrick M McTamney
- Department of Infectious Diseases-Vaccines, MedImmune, Gaithersburg, MD 20878, United States
| | - Diana V Pastrana
- Laboratory of Cellular Oncology, National Cancer Institute, Bethesda, MD 20892, United States
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Bruschi M, Granata S, Candiano G, Petretto A, Bartolucci M, Ghiggeri GM, Stallone G, Zaza G. Proteomic analysis of urinary extracellular vesicles of kidney transplant recipients with BKV viruria and viremia: A pilot study. Front Med (Lausanne) 2022; 9:1028085. [PMID: 36465937 PMCID: PMC9712214 DOI: 10.3389/fmed.2022.1028085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/31/2022] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION To better define the biological machinery associated with BK virus (BKV) infection, in kidney transplantation, we performed a proteomics analysis of urinary extracellular vesicles (EVs). METHODS Twenty-nine adult kidney transplant recipients (KTRs) with normal allograft function affected by BKV infection (15 with only viremia, 14 with viruria and viremia) and 15 controls (CTR, KTRs without BKV infection) were enrolled and randomly divided in a training cohort (12 BKV and 6 CTR) used for the mass spectrometry analysis of the EVs (microvesicles and exosomes) protein content and a testing cohort (17 BKV and 9 CTR) used for the biological validation of the proteomic results by ELISA. Bioinformatics and functional analysis revealed that several biological processes were enriched in BKV (including immunity, complement activation, renal fibrosis) and were able to discriminate BKV vs. CTR. Kinase was the only gene ontology annotation term including proteins less abundant in BKV (with SLK being the most significantly down-regulated protein). Non-linear support vector machine (SVM) learning and partial least squares discriminant analysis (PLS-DA) identified 36 proteins (including DNASE2, F12, AGT, CTSH, C4A, C7, FABP4, and BPNT1) able to discriminate the two study groups. The proteomic profile of KTRs with BKV viruria alone vs. viremia and viruria was quite similar. Enzyme-linked immunosorbent assay (ELISA) for SLK, BPNT1 and DNASE2, performed on testing cohort, validated proteomics results. DISCUSSIONS Our pilot study demonstrated, for the first time, that BKV infection, also in the viruric state, can have a negative impact on the allograft and it suggested that, whether possible, an early preventive therapeutic strategy should be undertaken also in KTRs with viruria only. Our results, then, revealed new mechanistic insights into BKV infection and they selected potential biomarkers that should be tested in future studies with larger patients' cohorts.
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Affiliation(s)
- Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Simona Granata
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Petretto
- Core Facilities—Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Bartolucci
- Core Facilities—Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianluigi Zaza
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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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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10
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Bovine Polyomavirus-1 (Epsilonpolyomavirus bovis): An Emerging Fetal Pathogen of Cattle That Causes Renal Lesions Resembling Polyomavirus-Associated Nephropathy of Humans. Viruses 2022; 14:v14092042. [PMID: 36146848 PMCID: PMC9502773 DOI: 10.3390/v14092042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Bovine polyomavirus-1 (BoPyV-1, Epsilonpolyomavirus bovis) is widespread in cattle and has been detected in commercialized beef at supermarkets in the USA and Germany. BoPyV-1 has been questioned as a probable zoonotic agent with documented increase in seropositivity in people exposed to cattle. However, to date, BoPyV-1 has not been causally associated with pathology or disease in any animal species, including humans. Here we describe and illustrate pathological findings in an aborted bovine fetus naturally infected with BoPyV-1, providing evidence of its pathogenicity and probable abortigenic potential. Our results indicate that: (i) BoPyV-1 can cause severe kidney lesions in cattle, including tubulointerstitial nephritis with cytopathic changes and necrosis in tubular epithelial cells, tubular and interstitial inflammation, and interstitial fibroplasia; (ii) lesions are at least partly attributable to active viral replication in renal tubular epithelial cells, which have abundant intranuclear viral inclusions; (iii) BoPyV-1 large T (LT) antigen, resulting from early viral gene expression, can be detected in infected renal tubular epithelial cells using a monoclonal antibody raised against Simian Virus-40 polyomavirus LT antigen; and (iv) there is productive BoPyV-1 replication and virion assembly in the nuclei of renal tubular epithelial cells, as demonstrated by the ultrastructural observation of abundant arrays of viral particles with typical polyomavirus morphology. Altogether, these lesions resemble the “cytopathic-inflammatory pathology pattern” proposed in the pathogenesis of Human polyomavirus-1-associated nephropathy in immunocompromised people and kidney allograft recipients. Additionally, we sequenced the complete genome of the BoPyV-1 infecting the fetus, which represents the first whole genome of a BoPyV-1 from the Southern Hemisphere. Lastly, the BoPyV-1 strain infecting this fetus was isolated, causing a cytopathic effect in Madin–Darby bovine kidney cells. We conclude that BoPyV-1 is pathogenic to the bovine fetus under natural circumstances. Further insights into the epidemiology, biology, clinical relevance, and zoonotic potential of BoPyV-1 are needed.
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11
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Lin Y, Qiu T, Wei G, Que Y, Wang W, Kong Y, Xie T, Chen X. Role of Histone Post-Translational Modifications in Inflammatory Diseases. Front Immunol 2022; 13:852272. [PMID: 35280995 PMCID: PMC8908311 DOI: 10.3389/fimmu.2022.852272] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Inflammation is a defensive reaction for external stimuli to the human body and generally accompanied by immune responses, which is associated with multiple diseases such as atherosclerosis, type 2 diabetes, Alzheimer’s disease, psoriasis, asthma, chronic lung diseases, inflammatory bowel disease, and multiple virus-associated diseases. Epigenetic mechanisms have been demonstrated to play a key role in the regulation of inflammation. Common epigenetic regulations are DNA methylation, histone modifications, and non-coding RNA expression; among these, histone modifications embrace various post-modifications including acetylation, methylation, phosphorylation, ubiquitination, and ADP ribosylation. This review focuses on the significant role of histone modifications in the progression of inflammatory diseases, providing the potential target for clinical therapy of inflammation-associated diseases.
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Affiliation(s)
- Yingying Lin
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Ting Qiu
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Guifeng Wei
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Yueyue Que
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Wenxin Wang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Department of Pharmacology, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yichao Kong
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Tian Xie
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
| | - Xiabin Chen
- School of Pharmacy, Hangzhou Normal University, Hangzhou, China.,Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, China
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12
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Abolbashari S, Shakeri M, Hami M, Gholoobi A, Hooshyar Chechaklou A, Damavandi M, Movaqar A, Yousefi R, Meshkat Z, Hajebi-Khaniki S. Higher Viral Load of Polyomavirus Type BK but not JC among Renal Transplant Recipients in Comparison to Donors. IRANIAN JOURNAL OF PATHOLOGY 2022; 17:8-14. [PMID: 35096083 PMCID: PMC8794561 DOI: 10.30699/ijp.2021.535072.2690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/13/2021] [Indexed: 12/18/2022]
Abstract
Background & Objective: Polyomaviruses types BK and JC and Cytomegalovirus (CMV) have been shown to be related to kidney transplantation complications. This study aimed to assess the prevalence of these viruses in patients receiving kidney transplantation. Methods: This cross-sectional study was performed on 40 kidney transplant recipients and 44 donors. Urine samples were used for the extraction of viral DNA. The prevalence of JC and BK viruses and their viral loads were determined by real-time polymerase chain reaction. Results: JC and BK viruses were identified in 31% and 92.3% of all subjects, respectively. The frequency of JC and BK cases was not statistically different between the recipient and donor groups (P>0.05). All patients in the donor group and 96.8% of the recipients were positive for CMV IgG antibody. The mean viral load of BK in donors and recipients was 4.5×1010 and 3.3×1011 copies, respectively. The mean viral load of JC was 8.6×107 copies in donors and 2.9×108 copies in recipients. The distribution of BKV was significantly higher in recipients than donors (P=0.001), while no difference was observed between the two studied groups for JCV. Conclusion: This study showed a relatively high prevalence of BK and JC viruria in both renal transplant donors and recipients. The viral load for BKV, but not JCV, was higher in recipients than in donors.
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Affiliation(s)
- Samaneh Abolbashari
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadtaghi Shakeri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Hami
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aida Gholoobi
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohammasadegh Damavandi
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aref Movaqar
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Yousefi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Hajebi-Khaniki
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Uppin M, Veduruvada R, Madireddy N, Koyya S, Guditi S, Taduri G, Raju S. Clinicopathologic features of polyomavirus nephropathy: Our experience - A retrospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_115_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Gajardo M, Delucchi A, Pérez D, Cancino JM, Gálvez C, Ledezma X, Ceballos ML, Lillo AM, Cano F, Guerrero JL, Rojo A, Azócar M, González G, Pinilla C, Correa R, Toro L. Long-term outcome of early steroid withdrawal in pediatric renal transplantation. Pediatr Transplant 2021; 25:e14096. [PMID: 34327777 DOI: 10.1111/petr.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Steroid use in renal transplant is related to multiple adverse effects. Long-term effects of early withdrawal steroids in pediatric renal transplant were assessed. METHODS Renal transplant children with low immunological risk treated on basiliximab, tacrolimus, and mycophenolate with steroid withdrawal or steroid control were evaluated between 2003 and 2019. Clinical variables, treatment adherence, acute rejection, graft loss, and death were analyzed through hazard ratios, and Kaplan-Meier and multivariate analyses. RESULTS The study included 152 patients, 71.1% steroid withdrawal, mean follow-up 8.5 years, 64.5% structural abnormalities, and 81.6% deceased donor. At 12 years of transplant, event-free survival analysis for graft loss or death showed no significant difference between steroid withdrawal and control steroid treatment (85.9% vs. 80.4%, p = .36) nor in acute rejection at 10 years (18.5% vs. 20.5%, p = .78) or in donor-specific antibody appearance (19.6% vs. 21.4%, p = .98). Delta height Z-score was increased in the steroid withdrawal group (p < .01). The main predictor of graft loss or death was non-adherence to treatment (p = .001; OR: 17.5 [3.3-90.9]). CONCLUSIONS Steroid withdrawal therapy was effective and safe for low-risk pediatric renal transplant in long-term evaluation. Non-adherence was the main predictor of graft loss or death.
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Affiliation(s)
- Macarena Gajardo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Hospital Roberto del Río, Santiago, Chile
| | - Angela Delucchi
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Clínica Alemana, Santiago, Chile
| | - Diego Pérez
- Department of Pediatric, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - José M Cancino
- Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Carla Gálvez
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ximena Ledezma
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - María L Ceballos
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Ana M Lillo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Francisco Cano
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - José L Guerrero
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Angélica Rojo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Marta Azócar
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Gloria González
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Cesar Pinilla
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ramón Correa
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clinico Universidad de Chile, Santiago, Chile.,Critical Care Center, Clínica Las Condes, Santiago, Chile
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15
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Lovinfosse P, Weekers L, Pottel H, Bouquegneau A, Bonvoisin C, Bovy C, Grosch S, Hustinx R, Jouret F. [ 18F]FDG PET/CT imaging disproves renal allograft acute rejection in kidney transplant recipients with acute kidney dysfunction: a validation cohort. Eur J Nucl Med Mol Imaging 2021; 49:331-335. [PMID: 34191101 DOI: 10.1007/s00259-021-05467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE [18F]FDG PET/CT may predict the absence of acute allograft rejection (AR) in kidney transplant recipients (KTRs) with acute kidney injury (AKI). Still, the proposed threshold of 1.6 of the mean of mean standardized uptake values (mSUVmean) in the renal parenchyma needs validation. METHODS We prospectively performed 86 [18F]FDG PET/CT in 79 adult KTRs who underwent per-cause transplant biopsy for suspected AR. Biopsy-proven polyoma BK nephropathies (n = 7) were excluded. PET/CT was performed 192 ± 18 min after administration of 254.4 ± 30.4 MBq of [18F]FDG. The SUVmean was measured in both upper and lower poles of the renal allograft. One-way analysis of variance (ANOVA) and Tukey's studentized range test were sequentially performed. The receiver operating characteristic (ROC) curve was drawn to discriminate "AR" from non-pathological ("normal" + "borderline") conditions. RESULTS The median age of the cohort was 55 [43; 63] years, with M/F gender ratio of 47/39. The mean eGFR was 31.9 ± 14.6 ml/min/1.73m2. Biopsies were categorized in 4 groups: "normal" (n = 54), "borderline" (n = 9), "AR" (n = 14), or "others" (n = 2). The median [min; max] mSUVmean reached 1.72 [1.02; 2.07], 1.97 [1.55; 2.11], 2.13 [1.65, 3.12], and 1.84 [1.57; 2.12] in "normal," "borderline," "AR," and "others" groups, respectively. ANOVA demonstrated a significant difference of mSUVmean among groups (F = 13.25, p < 0.0001). The ROC area under the curve was 0.86. Test sensitivity and specificity corresponding to the threshold value of 1.6 were 100% and 30%, respectively. CONCLUSION [18F]FDG PET/CT may help noninvasively prevent inessential transplant biopsies in KTR with AKI.
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Affiliation(s)
- P Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liège, Liège, Belgium
| | - L Weekers
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - H Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - A Bouquegneau
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - C Bonvoisin
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - C Bovy
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
- Division of Renal Pathology, Unilab, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - S Grosch
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
- Division of Renal Pathology, Unilab, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - R Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liège, Liège, Belgium
- GIGA CRC in Vivo Imaging, University of Liège, Liège, Belgium
| | - Francois Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium.
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16
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Reactivation of BK Polyomavirus in Urine Cytology is Not Associated with Urothelial Cell Carcinoma. Viruses 2020; 12:v12121412. [PMID: 33302606 PMCID: PMC7763809 DOI: 10.3390/v12121412] [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: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023] Open
Abstract
BK polyomavirus (BKPyV) has been associated with some high-grade and special urothelial cell carcinoma (UCC) subtypes in immunosuppressed patients. Here, we evaluated the relationship of BKPyV-positive urine cytology specimens (UCS) with UCC. A large single-institution database was retrospectively searched for UCS positive for decoy cells, suggesting BKPyV infection. These were tested for the presence of BKPyV by PCR and immunohistochemistry (IHC) in urine sediments and formalin-fixed paraffin-embedded (FFPE) tissue samples of UCC. Decoy cells were reported in 30 patients out of the database with 22.867 UCS. Of these 30 patients, 16 (53.3%) had no history of UCC. Six patients out of these 16 had a history of transplantation, 4 had a history of severe chronic medical conditions, and 6 had no chronic disease. The other fourteen patients were diagnosed with either in situ or invasive UCC of the urinary bladder (14/30; 46.6%) prior to the detection of decoy cells in the urine. Nine of these UCC patients received intravesical treatment (BCG or mitomycin) after the first presentation with UCC. However, the clinical data on the treatment of the other five UCC patients was lacking. IHC identified BKPyV-positivity in the urine samples of non-UCC and UCC patients, while no BKPyV positivity was found in FFPE tissues of primary UCCs and metastases. In addition, BKPyV-PCR results revealed the presence of BKPyV DNA in the urine of the UCC cases, yet none in the UCC tissues itself. These data strongly indicate that BKPyV reactivation is not restricted to immunosuppression. It can be found in UCS of the immunocompetent patients and may be related to the intravesical BCG or mitomycin treatment of the UCC patients.
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17
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Zanotto E, Allesina A, Barreca A, Sidoti F, Gallo E, Bottino P, Iannaccone M, Bianco G, Biancone L, Cavallo R, Costa C. Renal Allograft Biopsies with Polyomavirus BK Nephropathy: Turin Transplant Center, 2015-19. Viruses 2020; 12:v12091047. [PMID: 32962215 PMCID: PMC7550990 DOI: 10.3390/v12091047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background: In kidney transplant patients, polyomavirus-associated nephropathy (PVAN) represents a serious complication; the key factor for the development of PVAN is immunosuppression level and modulation of anti-rejection treatment represents the first line of intervention. Allograft biopsy and histology remain the criterion standard for diagnosing PVAN. Methods: All consecutive renal biopsies with the diagnosis of PVAN carried out at the University Hospital City of Health and Science of Turin over a five-years period were studied. Renal allograft biopsy was performed due to renal function alterations associated to medium-high polyomavirus BK (BKV)-DNA levels on plasma specimen. Results: A total of 21 patients underwent a first biopsy to diagnose a possible BKV nephropathy, in 18, a second biopsy was made, in eight, a third biopsy, and finally, three underwent the fourth renal biopsy; following the results of each biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN. Conclusions: In this study, the clinical and histological features of 21 kidney transplant recipients with BKV reactivation and development of PVAN are described. To date, the only treatment for PVAN consists in the reduction of immunosuppressive agents, constantly monitoring viral load.
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Affiliation(s)
- Elisa Zanotto
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
- Correspondence:
| | - Anna Allesina
- Nephrology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.A.); (E.G.); (L.B.)
| | - Antonella Barreca
- Pathology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy;
| | - Francesca Sidoti
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
| | - Ester Gallo
- Nephrology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.A.); (E.G.); (L.B.)
| | - Paolo Bottino
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
| | - Luigi Biancone
- Nephrology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.A.); (E.G.); (L.B.)
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy; (F.S.); (P.B.); (M.I.); (G.B.); (R.C.); (C.C.)
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18
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Krajewski W, Kamińska D, Poterek A, Małkiewicz B, Kłak J, Zdrojowy R, Janczak D. Pathogenicity of BK virus on the urinary system. Cent European J Urol 2020; 73:94-103. [PMID: 32395331 PMCID: PMC7203775 DOI: 10.5173/ceju.2020.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction The polyomaviruses are omnipresent in nature. The major sites of BK virus appearance are the kidney tubular epithelial cells and urinary bladder surface transitional cells. Material and methods A literature search according to PRISMA guidelines within the Medline database was conducted in July 2019 for articles presenting data about BK virus in urologic aspect without setting time limits, using the terms ‘BK virus’ in conjunction with transplantation, nephropathy, stenosis, cancer, bladder, prostate, kidney. Results The BK virus usually stays latent, however, its replication may become active in various clinical situations of impaired immunocompetence such as solid organ transplantation, bone marrow transplantation, AIDS, pregnancy, multiple sclerosis, administration of chemotherapy or biologic therapy. BK virus is associated with two main complications after transplantation: polyomavirus-associated nephropathy in kidney transplant patients and polyomavirus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplant patients. Conclusions The aim of this article was to present available data on urologic aspects of BK virus infection, its detection methods and available treatment.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Adrian Poterek
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Jacek Kłak
- Department of Urology and Oncologic Urology, Lower Silesian Specialistic Hospital, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wrocław Medical University, Wrocław, Poland
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19
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Bruminhent J, Srisala S, Klinmalai C, Pinsai S, Watcharananan SP, Kantachuvesiri S, Hongeng S, Apiwattanakul N. BK Polyomavirus-specific T cell immune responses in kidney transplant recipients diagnosed with BK Polyomavirus-associated nephropathy. BMC Infect Dis 2019; 19:974. [PMID: 31744480 PMCID: PMC6862809 DOI: 10.1186/s12879-019-4615-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/04/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adjustment of immunosuppression is the main therapy for BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) after kidney transplantation (KT). Studies of BKPyV-specific T cell immune response are scarce. Here, we investigated BKPyV-specific T cell immunity in KT recipients diagnosed with BKPyVAN. METHODS All adult KT recipients with BKPyVAN diagnosed at our institution from January 2017 to April 2018 were included. Laboratory-developed intracellular cytokine assays measuring the percentage of IFN-γ-producing CD4+ and CD8+ T cells, after stimulation with large-T antigen (LT) and viral capsid protein 1 (VP1), were performed both at the time of diagnosis and after adjustment of immunosuppression. RESULTS We included 12 KT recipients diagnosed with BKPyVAN (7 proven, 4 presumptive, and 1 possible). Those with presumptive BKPyVAN had a median plasma BKPyV DNA load of 5.9 log10 copies/ml (interquartile range [IQR]: 4.9-6.1). Adjusted dosing of mycophenolic acid and tacrolimus with (86%) or without (14%) adjunctive therapies were implemented after diagnosis. There was a significantly higher median percentage of IFN-γ-producing CD4+ T cells to LT at a median of 3 (IQR: 1-4) months after adjustment of immunosuppression compared with at the time of diagnosis (0.004 vs. 0.015; p = 0.047). However, the difference between the median percentage of IFN-γ-producing CD4+ T cells to VP1 and CD8+ T cells to LT and VP1 did not reach statistical significance. Four (33%) patients achieved plasma BKPyV DNA clearance, and the remaining eight (67%) patients had persistent BKPyV DNAemia. Although eight (67%) patients developed allograft dysfunction, none required hemodialysis. CONCLUSIONS We observed a marginal trend of BKPyV-specific CD4+ T cell recovery after adjustment of immunosuppression in KT recipients diagnosed with BKPyVAN. A further study would be benefited to confirm and better assess BKPyV-specific immune response after KT.
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Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
- Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Supranart Srisala
- Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chompunut Klinmalai
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Subencha Pinsai
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriorn P Watcharananan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Kantachuvesiri
- Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suradej Hongeng
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopporn Apiwattanakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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20
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Li P, Cheng D, Wen J, Ni X, Li X, Xie K, Chen J. The immunophenotyping of different stages of BK virus allograft nephropathy. Ren Fail 2019; 41:855-861. [PMID: 31535918 PMCID: PMC6758702 DOI: 10.1080/0886022x.2019.1617168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives: To investigate the immunohistochemical features of different stages of BK virus allograft nephropathy (BKVN) and further elucidate the underlying immunological mechanism involved in the evolution of BKVN. Methods: Fifty-two renal transplant recipients with biopsy proven BKVN were retrospectively selected. According to the third edition of the American Society of Transplantation Infection guidelines, 10 patients were categorized as having mild BKVN (stage A), 25 were moderate (stage B) and 17 were severe (stage C). The differential infiltrations of CD3+ (T lymphocytes), CD4+ (helper T lymphocytes), CD8+ (cytotoxic T lymphocytes), CD20+ (B lymphocytes), CD68+ (macrophages) and CD138+ (plasma cells) cells and the expression of interleukin-2 receptor (IL-2R) and human leukocyte antigen DR (HLA-DR) were compared among the three groups. Results: CD3+, CD4+, CD8+, CD20+, CD138+ and CD68+ cells infiltrations, IL-2R and HLA-DR expression were positive in the BKVN patients. Moreover, with increasing stages of BKVN, the numbers of positively stained inflammatory cells and the expression of IL-2R were significantly increased in the severe group compared to the mild group, whereas no statistically significant differences were observed with regard to HLA-DR expression. Eosinophil and neutrophil infiltration could also be observed in moderate to advanced BKVN. Conclusion: Renal allograft damage caused by BKVN involved T lymphocyte-, B lymphocyte- and mononuclear macrophage-mediated immune responses. Inflammatory cell infiltrations in the renal allograft were probably the driving force for BKVN progression. Additionally, eosinophils and neutrophils may be involved in the pathophysiological mechanism of BKVN.
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Affiliation(s)
- Ping Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dongrui Cheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xuefeng Ni
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xue Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Kenan Xie
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinsong Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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21
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Marx D, Metzger J, Olagne J, Belczacka I, Faguer S, Colombat M, Husi H, Mullen W, Gwinner W, Caillard S. Proteomics in Kidney Allograft Transplantation—Application of Molecular Pathway Analysis for Kidney Allograft Disease Phenotypic Biomarker Selection. Proteomics Clin Appl 2019; 13:e1800091. [DOI: 10.1002/prca.201800091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- David Marx
- Nephrology – Transplantation DepartmentUMR_S. INSERM UMR_S 1109ImmunoRhumatologie MoléculaireFédération Hospitalo‐Universitaire OMICAREFédération de Médecine Translationnelle de StrasbourgInstitut d'Immunologie et d'Hématologie 67085 Strasbourg France
- Laboratoire de Spectrométrie de Masse BioOrganiqueUniversity of StrasbourgCentre National de la Recherche ScientifiqueInstitut Pluridisciplinaire Hubert Curien UMR 7178 67037 Strasbourg France
| | | | - Jérôme Olagne
- Nephrology – Transplantation DepartmentUMR_S. INSERM UMR_S 1109ImmunoRhumatologie MoléculaireFédération Hospitalo‐Universitaire OMICAREFédération de Médecine Translationnelle de StrasbourgInstitut d'Immunologie et d'Hématologie 67085 Strasbourg France
- Department of PathologyUniversity Hospital of Strasbourg 67091 Strasbourg France
| | | | - Stanislas Faguer
- Department of Nephrology and Organ TransplantationUniversity Hospital of Toulouse 31059 Toulouse France
- Institut National de la Santé et de la Recherche Médicale (INSERM)Institut of Cardiovascular and Metabolic Disease U1048 31432 Toulouse France
- Université Toulouse III Paul‐Sabatier 31330 Toulouse France
| | - Magali Colombat
- Department of PathologyCancer University Institute of Toulouse 31100 Toulouse France
| | - Holger Husi
- Division of Biomedical SciencesCentre for Health ScienceUniversity of the Highlands and Islands Inverness IV2 3JH UK
| | - William Mullen
- Institute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow G12 8TA United Kingdom
| | - Wilfried Gwinner
- Department of NephrologyHannover Medical School 30625 Hannover Germany
| | - Sophie Caillard
- Nephrology – Transplantation DepartmentUMR_S. INSERM UMR_S 1109ImmunoRhumatologie MoléculaireFédération Hospitalo‐Universitaire OMICAREFédération de Médecine Translationnelle de StrasbourgInstitut d'Immunologie et d'Hématologie 67085 Strasbourg France
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22
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Li P, Cheng D, Wen J, Xie K, Li X, Ni X, Ji S, Chen J. Risk factors for BK virus infection in living-donor renal transplant recipients: a single-center study from China. Ren Fail 2018; 40:442-446. [PMID: 30052479 PMCID: PMC6070965 DOI: 10.1080/0886022x.2018.1489843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: BK virus (BKV) infection has become one of the main complications in renal transplant recipients (RTRs) with the arrival of newer potent immunosuppressive agents. However, reports on the epidemiology of BKV infection and risk factors in Chinese population after renal transplantation are scarce. Methods: From June 2015 to July 2016, living-donor renal transplant recipients (LDRTRs) who routinely received the quantitative BKV DNA testing of urine and plasma samples using quantitative real-time polymerase chain reaction (PCR) for the first time after transplantation were selected, while dialysis patients and healthy living donors during that period served as controls. Potential variables were compared and analyzed using logistic regression model multivariate analysis to assess the BKV infection related factors in LDRTRs. Results: Among the 52 LDRTRs identified, BKV DNA was detected in 16 urine samples (30.8%), significantly higher than that of dialysis patients (6.3%) and healthy living donors (4.2%) (p < .001). Nevertheless, no statistically significant difference wax noted between the latter two groups in urine samples (p = .842). Meanwhile, BKV DNA detection in blood samples was all negative in the three groups. Univariate analysis shown tacrolimus (Tac) trough level and lymphocyte percentage were associated with BKV infection in LDRTRs. Multivariate regression analysis also showed Tac trough level (HR, 1.644; p = .03), lymphocyte percentage (HR, 0.878; p = .026) were associated with BKV infection in LDRTRs. Conclusions: In Chinese population, the incidence of BKV infection increased significantly after living-donor renal transplantation. Significantly increased Tac trough level and decreased lymphocyte percentage might be the risk factors for BKV infection in LDRTRs.
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Affiliation(s)
- Ping Li
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Dongrui Cheng
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Jiqiu Wen
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Kenan Xie
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Xue Li
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Xuefeng Ni
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Shuming Ji
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Jinsong Chen
- a National Clinical Research Center of Kidney Diseases, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
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23
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Park WY, Kang SS, Jin K, Park SB, Choe M, Han S. Long-term prognosis of BK virus-associated nephropathy in kidney transplant recipients. Kidney Res Clin Pract 2018; 37:167-173. [PMID: 29971212 PMCID: PMC6027809 DOI: 10.23876/j.krcp.2018.37.2.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/20/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022] Open
Abstract
Background The long-term prognosis of BK virus-associated nephropathy (BKVAN) in kidney transplant recipients (KTRs) is uncertain. We evaluated the long-term prognosis in KTRs with BKVAN and the clinical significance of BKVAN on post-transplant clinical outcome. Methods We retrospectively analyzed the medical records of 582 patients who underwent kidney transplant (KT) between 2001 and 2014. We divided the patients into a BKVAN group (15 patients) diagnosed by allograft biopsy and a control group (356 patients). Results The incidence of BKVAN was 4.0%, and the mean follow-up duration was 93.1 ± 52.3 months. Median time from KT to BKVAN diagnosis was 5.9 months (interquartile range [IQR], 4.4–8.7). In the BKVAN group, 9 (60.0%) KTRs with combined acute rejection progressed to graft failure, and the median time from BKVAN diagnosis to graft failure was 36.2 months (IQR, 9.7–65.5). Death-censored graft survival rate and patient survival rate in the BKVAN group were significantly lower than those in the control group. BKVAN and rejection were independent risk factors for graft failure. In the subgroup analysis, death-censored graft survival rate of KTRs with BKVAN with acute rejection was significantly worst in comparison with similar patients without BKVAN regardless of acute rejection (P < 0.001). Conclusion The long-term prognosis of BKVAN with acute rejection was very poor because of graft failure caused by inadequate treatment for acute rejection considering BKVAN. Therefore, we should carefully monitor the allograft status of KTRs through regular surveillance tests after treatment for BKVAN with acute rejection.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
| | - Seong Sik Kang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
| | - Sung Bae Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
| | - Misun Choe
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Keimyung University Kidney Institute, Daegu, Korea
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24
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Peretti A, Geoghegan EM, Pastrana DV, Smola S, Feld P, Sauter M, Lohse S, Ramesh M, Lim ES, Wang D, Borgogna C, FitzGerald PC, Bliskovsky V, Starrett GJ, Law EK, Harris RS, Killian JK, Zhu J, Pineda M, Meltzer PS, Boldorini R, Gariglio M, Buck CB. Characterization of BK Polyomaviruses from Kidney Transplant Recipients Suggests a Role for APOBEC3 in Driving In-Host Virus Evolution. Cell Host Microbe 2018; 23:628-635.e7. [PMID: 29746834 PMCID: PMC5953553 DOI: 10.1016/j.chom.2018.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/05/2017] [Accepted: 03/19/2018] [Indexed: 12/31/2022]
Abstract
BK polyomavirus (BKV) frequently causes nephropathy (BKVN) in kidney transplant recipients (KTRs). BKV has also been implicated in the etiology of bladder and kidney cancers. We characterized BKV variants from two KTRs who developed BKVN followed by renal carcinoma. Both patients showed a swarm of BKV sequence variants encoding non-silent mutations in surface loops of the viral major capsid protein. The temporal appearance and disappearance of these mutations highlights the intra-patient evolution of BKV. Some of the observed mutations conferred resistance to antibody-mediated neutralization. The mutations also modified the spectrum of receptor glycans engaged by BKV during host cell entry. Intriguingly, all observed mutations were consistent with DNA damage caused by antiviral APOBEC3 cytosine deaminases. Moreover, APOBEC3 expression was evident upon immunohistochemical analysis of renal biopsies from KTRs. These results provide a snapshot of in-host BKV evolution and suggest that APOBEC3 may drive BKV mutagenesis in vivo.
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Affiliation(s)
- Alberto Peretti
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eileen M Geoghegan
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Diana V Pastrana
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sigrun Smola
- Institute of Virology, Saarland University, Homburg/Saar 66421, Germany
| | - Pascal Feld
- Institute of Virology, Saarland University, Homburg/Saar 66421, Germany
| | - Marlies Sauter
- Institute of Virology, Saarland University, Homburg/Saar 66421, Germany
| | - Stefan Lohse
- Institute of Virology, Saarland University, Homburg/Saar 66421, Germany
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI 48202 USA
| | - Efrem S Lim
- Departments of Molecular Microbiology and Pathology & Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - David Wang
- Departments of Molecular Microbiology and Pathology & Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Cinzia Borgogna
- Virology Unit, Department of Translational Medicine, Novara Medical School, Novara 28100, Italy
| | - Peter C FitzGerald
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Valery Bliskovsky
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gabriel J Starrett
- Department of Biochemistry, Molecular Biology and Biophysics, Masonic Cancer Center, Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Emily K Law
- Department of Biochemistry, Molecular Biology and Biophysics, Masonic Cancer Center, Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; Howard Hughes Medical Institute, University of Minnesota, Minneapolis, MN 55455, USA
| | - Reuben S Harris
- Department of Biochemistry, Molecular Biology and Biophysics, Masonic Cancer Center, Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455, USA; Howard Hughes Medical Institute, University of Minnesota, Minneapolis, MN 55455, USA
| | - J Keith Killian
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jack Zhu
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marbin Pineda
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paul S Meltzer
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Renzo Boldorini
- Pathology Unit, Department of Health Sciences, Novara Medical School, Novara 28100, Italy
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, Novara Medical School, Novara 28100, Italy
| | - Christopher B Buck
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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25
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Janphram C, Worawichawong S, Disthabanchong S, Sumethkul V, Rotjanapan P. Absence of JC polyomavirus (JCPyV) viremia in early post-transplant JCPyV nephropathy: A case report. Transpl Infect Dis 2017; 19. [PMID: 28805990 DOI: 10.1111/tid.12761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 02/05/2023]
Abstract
JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) occurs in <3% of PVAN cases after renal transplantation. We report the first confirmed case to our knowledge of JCPyVAN diagnosed by kidney biopsy in the early 6 months post transplant in Thailand. In this case report, recovery of renal allograft function was not observed after reduction of immunosuppressive agents and administration of intravenous immunoglobulin and cidofovir. Despite persistent JCPyV viruria, no significant further decline in allograft function was documented at 15 months post transplant.
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Affiliation(s)
- Chitimaporn Janphram
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Division of Renal-Pathology, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasant Sumethkul
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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26
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Swedan SF. Increased incidence of BK virus viraemia among patients undergoing chronic haemodialysis: a case–control study. J Clin Pathol 2017; 71:360-363. [DOI: 10.1136/jclinpath-2017-204707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 11/04/2022]
Abstract
AimsIncidence of BK virus (BKV) viraemia, a major risk factor for nephropathy, among patients undergoing chronic haemodialysis remains poorly investigated. This case–control study evaluated the risk of infection by BKV, in addition to hepatitis C virus (HCV) among haemodialysis subjects (n=100), compared with age-matched controls (n=100).MethodsSubjects’ blood plasma samples were subjected to nucleic acid extraction, followed by real-time PCR to evaluate viraemia by BKV and HCV, while sera samples were subjected to ELISA, to identify IgG seropositivity for HCV.ResultsMean age±SD was 47.8±20.4 and 48.9±17.6 years for the haemodialysis and control groups, respectively. BKV and HCV viraemia was observed among 19% versus 8% (OR 2.38, 95% CI 1.09 to 5.18; p=0.023) and 3% versus 0% (p=0.081) of the haemodialysis and control groups, respectively. Mean BK viral load±SD did not vary significantly among the two groups; 914.8±2868 versus 44.30±74.04 copies/mL for the haemodialysis and control groups, respectively (p=0.4041). HCV seropositivity rates were 6% versus 2% (p=0.149), among the haemodialysis and control groups, respectively.ConclusionsSubjects on haemodialysis may be at increased risk of nephropathy due to increased incidence of BK virus reactivations and may require optimisation of immunosuppressive therapy.
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27
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Alloimmunity But Not Viral Immunity Promotes Allograft Loss in a Mouse Model of Polyomavirus-Associated Allograft Injury. Transplant Direct 2017; 3:e161. [PMID: 28620645 PMCID: PMC5464780 DOI: 10.1097/txd.0000000000000677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background The interplay between viral infection and alloimmunity is known to influence the fate of transplanted organs. Clarifying how local virus-associated inflammation/injury and antiviral immunity can alter host alloimmune responses in transplantation remains a critical question. Methods We used a mouse model of polyomavirus (PyV) infection and kidney transplantation to investigate the roles of direct viral pathology, the antiviral immune response, and alloimmunity in the pathogenesis of PyV-associated allograft injury. We have previously shown that an effective primary T cell response is required in PyV-associated graft injury. Results Here we show that the transfer of primed antidonor, but not antiviral, T cells results in PyV-associated allograft injury. In further studies, we use a surrogate minor antigen model (ovalbumin) and show that only antidonor specific T cells and not antiviral specific T cells are sufficient to mediate injury. Lastly, we demonstrate that local but not systemic virus-mediated inflammation and injury within the graft itself are required. Conclusions These data suggest that in this mouse model, the predominant mechanism of allograft injury in PyV-associated injury is due to an augmented alloimmune T cell response driven by virus-induced inflammation/injury within the graft. These studies highlight the important interplay between viral infection and alloimmunity in a model system.
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28
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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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29
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Broeders EN, Hamade A, El Mountahi F, Racapé J, Hougardy JM, Le Moine A, Vereerstraeten P. Preemptive reduction of immunosuppression upon high urinary polyomavirus loads improves patient survival without affecting kidney graft function. Transpl Infect Dis 2016; 18:872-880. [PMID: 27615506 DOI: 10.1111/tid.12603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/16/2016] [Accepted: 06/29/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polyomavirus (PV) is a major cause of kidney graft disease. Monitoring by polymerase chain reaction (PCR) on blood is currently recommended. In order to avoid irreversible lesions, we investigated the clinical impact of preemptive reduction of immunosuppression (IS) in kidney transplant recipients (KTR) upon detection of high urinary PV (Upv) load, including BK virus and JC virus. MATERIAL AND METHODS From 2000 to 2011, in our single center, 789 consecutive KTR were distributed into 4 groups, according to the maximal Upv levels (by PCR) during the first year and the therapeutic option: (A) Upv <104 copies (cp)/mL (n=573), (B) ≥104 Upv <107 cp/mL (n=100), and (C) Upv ≥107 cp/mL (n=116); in group C, the IS drug doses were reduced in subgroup Ca (n=102) only, as 14 patients (subgroup Cb) were at risk for graft rejection. RESULTS The preemptive reduction of IS (group Ca) increased patient survival as compared with all other groups (P<.05), did not modify graft function, and increased graft survival vs group A (risk ratio: 5.7, confidence interval: 1.8-18.1, P=.003). Differences for risk factors are as follows (groups Ca vs A): incidence of human leukocyte antigen (HLA) immunization (>5% panel reactive antibodies): 3% vs 8% (P=.05), number of HLA mismatches: 2.7 vs 2.5 (P=.049), and incidence of acute rejection: 9.8% vs 24.2% (P=.005). PV-associated nephropathy occurred only in group Ca (2% of total grafts) without effect on patient or graft outcome. CONCLUSION The reduction of IS in patients with high Upv loads is beneficial for patient survival and does not affect graft survival or graft function.
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Affiliation(s)
- Emine Nilufer Broeders
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Anwar Hamade
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Fadoua El Mountahi
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Judith Racapé
- Research Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Michel Hougardy
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Alain Le Moine
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Pierre Vereerstraeten
- Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
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30
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Vigil D, Konstantinov NK, Barry M, Harford AM, Servilla KS, Kim YH, Sun Y, Ganta K, Tzamaloukas AH. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection. World J Transplant 2016; 6:472-504. [PMID: 27683628 PMCID: PMC5036119 DOI: 10.5500/wjt.v6.i3.472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023] Open
Abstract
Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.
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Xing J, Procop GW, Reynolds JP, Chiesa-Vottero A, Zhang Y. Diagnostic utility of urine cytology in early detection of polyomavirus in transplant patients. J Am Soc Cytopathol 2016; 6:28-32. [PMID: 31042631 DOI: 10.1016/j.jasc.2016.08.004] [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: 07/04/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Polyomavirus-associated nephropathy (PVAN) is one of the most common disease affecting transplant patients, mainly caused by BK polyomavirus (BKV) and with <5% of the cases caused by JC polyomavirus (JCV). Screening and early intervention, including appropriate reduction in immunosuppressive therapy, are critical to reduce allograft loss. The presence of decoy cells in the urine is a characteristic cytopathic effect of polyomavirus. The goal of this study was to investigate the significance of decoy cells in urine cytology in transplant patients, comparing with the plasma viral replication level detected by the real-time quantitative BK virus polymerase chain reaction test (Qt-BK PCR). METHODS A cohort of post-transplantation patients with serum BKV level monitored by Qt-BK PCR from 2008 to 2013 was studied. Among them, 35 patients had both urine cytology (UC) analysis and Qt-BK PCR performed. The clinical presentation along with the available UC slides were retrieved and reviewed. RESULTS Compared with Qt-BK PCR, the sensitivity, specificity, positive predictive value, and negative predictive value of urine cytology analyzed within one week apart were 92%, 71%, 85%, and 83%, respectively. The accuracy of the UC was 84%. More interestingly, UC played a key role in identifying a case of JCV associated PVAN whereas Qt-BK PCR from both urine and plasma failed to detect this virus. CONCLUSION Our data suggests that urine cytology is a sensitive surveillance test for early detection of polyomavirus in transplant patients, and it is particularly useful to screen for rare JC polyomavirus.
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Affiliation(s)
- Juan Xing
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Department of Molecular Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andres Chiesa-Vottero
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yaxia Zhang
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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32
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Polyomavirus large T antigen is prevalent in urothelial carcinoma post–kidney transplant. Hum Pathol 2016; 48:122-31. [DOI: 10.1016/j.humpath.2015.09.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/03/2015] [Accepted: 09/18/2015] [Indexed: 01/08/2023]
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33
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Lovinfosse P, Weekers L, Bonvoisin C, Bovy C, Grosch S, Krzesinski JM, Hustinx R, Jouret F. Fluorodeoxyglucose F(18) Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection. Am J Transplant 2016; 16:310-6. [PMID: 26302136 DOI: 10.1111/ajt.13429] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/10/2015] [Accepted: 06/21/2015] [Indexed: 01/25/2023]
Abstract
Management of kidney transplant recipients (KTRs) with suspected acute rejection (AR) ultimately relies on kidney biopsy; however, noninvasive tests predicting nonrejection would help avoid unnecessary biopsy. AR involves recruitment of leukocytes avid for fluorodeoxyglucose F(18) ((18) F-FDG), thus (18) F-FDG positron emission tomography (PET) coupled with computed tomography (CT) may noninvasively distinguish nonrejection from AR. From January 2013 to February 2015, we prospectively performed 32 (18) F-FDG PET/CT scans in 31 adult KTRs with suspected AR who underwent transplant biopsy. Biopsies were categorized into four groups: normal (n = 8), borderline (n = 10), AR (n = 8), or other (n = 6, including 3 with polyoma BK nephropathy). Estimated GFR was comparable in all groups. PET/CT was performed 201 ± 18 minutes after administration of 3.2 ± 0.2 MBq/kg of (18) F-FDG, before any immunosuppression change. Mean standard uptake values (SUVs) of both upper and lower renal poles were measured. Mean SUVs reached 1.5 ± 0.2, 1.6 ± 0.3, 2.9 ± 0.8, and 2.2 ± 1.2 for the normal, borderline, AR, and other groups, respectively. One-way analysis of variance demonstrated a significant difference of mean SUVs among groups. A positive correlation between mean SUV and acute composite Banff score was found, with r(2) = 0.49. The area under the receiver operating characteristic curve was 0.93, with 100% sensitivity and 50% specificity using a mean SUV threshold of 1.6. In conclusion, (18) F-FDG PET/CT may help noninvasively prevent avoidable transplant biopsies in KTRs with suspected AR.
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Affiliation(s)
- P Lovinfosse
- Division of Nuclear Medicine, Department of Medical Physics, University of Liège Hospital, Liège, Belgium
| | - L Weekers
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
| | - C Bonvoisin
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
| | - C Bovy
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.,Division of Renal Pathology, Unilab, University of Liège Hospital, Liège, Belgium
| | - S Grosch
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.,Division of Renal Pathology, Unilab, University of Liège Hospital, Liège, Belgium
| | - J-M Krzesinski
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.,Groupe Interdisciplinaire de Génoprotéomique Appliquée, Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - R Hustinx
- Division of Nuclear Medicine, Department of Medical Physics, University of Liège Hospital, Liège, Belgium
| | - F Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.,Groupe Interdisciplinaire de Génoprotéomique Appliquée, Cardiovascular Sciences, University of Liège, Liège, Belgium
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34
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Chantziantoniou N, Joudeh AA, Hamed RMA, Al-Abbadi MA. Significance, cytomorphology of decoy cells in polyomavirus-associated nephropathy: Review of clinical, histopathological, and virological correlates with commentary. J Am Soc Cytopathol 2016; 5:71-85. [PMID: 31042494 DOI: 10.1016/j.jasc.2015.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 01/23/2023]
Abstract
Human polyomaviruses (PyV) are ubiquitous, remaining predominantly inactive hence asymptomatic in the healthy, immunocompetent population. BK and JC PyV potentially infect pan-urinary tract epithelial cells. With reactivation, PyV disrupt cell cycling mechanisms, facilitating viral replication leading to cell necrosis, exfoliation, and, infrequently, carcinogenesis. Exfoliated PyV-infected cells pose diagnostic pitfalls, hence they are termed "decoy cells" as they may mimic high-grade urothelial carcinoma cells. BK polyomavirus-associated-nephropathy (BKVAN) is an inflammatory disease causing interstitial fibrosis with tubular atrophy in renal transplant recipients, increasing risk of graft loss. BKVAN is confirmed by renal biopsy, and managed by immunosuppression modulation. As voided urine may provide pan-reno-urinary tract sampling, cytopathology may serve a critical diagnostic purpose coupled with decoy cell quantification and indirect BK PyV load gauging. Thus, identification of decoy cells and differentiation from high-grade urothelial carcinoma cells, and degenerated, benign urothelial cells, is clinically essential. PyV virology and pathobiology in the context of renal transplantation, immuno-suppression and BKVAN, and, decoy cell cytomorphology and cytopreparation with commentary are highlighted. Decoy cell overall characteristics: variable degeneration; cytomegaly; comet-like shapes; angular cytoplasmic extensions; eccentric, polar nuclear placements; moderate anisocytosis; typically single cells with high N:C ratios. Cytoplasmic features: moderate-abundance; granular, blue-gray monochromatism. Nuclear features: karyomegaly; haphazardly-scattered chromatin densities; smudged, homogeneous, basophilic ground glass masses displacing chromatin alongside inner periphery of regular, symmetrical nuclear envelopes. Background features: granular cellular debris; inflammatory cells; intact and lyzed erythrocytes. Decoy cells lack coarse chromatin as in high-grade urothelial carcinoma cells. Benign urothelial cells exhibit low N:C ratios with fine chromatin distribution and euchromasia.
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Affiliation(s)
| | - Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Radi M A Hamed
- Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mousa A Al-Abbadi
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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35
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Gossai A, Waterboer T, Nelson HH, Michel A, Willhauck-Fleckenstein M, Farzan SF, Hoen AG, Christensen BC, Kelsey KT, Marsit CJ, Pawlita M, Karagas MR. Seroepidemiology of Human Polyomaviruses in a US Population. Am J Epidemiol 2016; 183:61-9. [PMID: 26667254 PMCID: PMC5006224 DOI: 10.1093/aje/kwv155] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/09/2015] [Indexed: 12/13/2022] Open
Abstract
Polyomaviruses (PyV) are potentially tumorigenic in humans. However, limited data exist on the population seroprevalence of PyVs and individual characteristics that relate to seropositivity. Using multiplex serology, we determined the seroprevalence of 10 human PyVs (BK, JC, KI, WU, MCV, HPyV6, HPyV7, TSV, HPyV9, and HPyV10) among controls from a population-based skin cancer case-control study (n = 460) conducted in New Hampshire between 1993 and 1995. On a subset of participants (n = 194), methylation at CpG dinucleotides across the genome was measured in peripheral blood using the Illumina Infinium HumanMethylation27 BeadChip array (Illumina Inc., San Diego, California), from which lymphocyte subtype proportions were inferred. All participants were seropositive for at least 1 PyV, with seroprevalences ranging from 17.6% (HPyV9) to 99.1% (HPyV10). Seropositivity to JC, MCV, and HPyV7 increased with age. JC and TSV seropositivity were more common among men than among women. Smokers were more likely to be HPyV9-seropositive but MCV-seronegative, and HPyV7 seropositivity was associated with prolonged glucocorticoid use. Based on DNA methylation profiles, differences were observed in CD8-positive T- and B-cell proportions by BK, JC, and HPyV9 seropositivity. Our findings suggest that PyV seropositivity is common in the United States and varies by sociodemographic and biological characteristics, including those related to immune function.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Margaret R. Karagas
- Correspondence to Dr. Margaret R. Karagas, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756 (e-mail: )
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36
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Lunde LE, Dasaraju S, Cao Q, Cohn CS, Reding M, Bejanyan N, Trottier B, Rogosheske J, Brunstein C, Warlick E, Young JAH, Weisdorf DJ, Ustun C. Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival. Bone Marrow Transplant 2015; 50:1432-7. [PMID: 26168069 PMCID: PMC5343753 DOI: 10.1038/bmt.2015.162] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/14/2015] [Accepted: 04/18/2015] [Indexed: 01/16/2023]
Abstract
Although hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic cell transplantation (alloHCT), its risk factors and effects on survival are not well known. We evaluated HC in a large cohort (n=1321, 2003-2012) receiving alloHCT from all graft sources, including umbilical cord blood (UCB). We compared HC patients with non-HC (control) patients and examined clinical variables at HC onset and resolution. Of these 1321 patients, 219 (16.6%) developed HC at a median of 22 days after alloHCT. BK viruria was detected in 90% of 109 tested HC patients. Median duration of HC was 27 days. At the time of HC diagnosis, acute GVHD, fever, severe thrombocytopenia and steroid use were more frequent than at the time of HC resolution. In univariate analysis, male sex, age <20 years, myeloablative conditioning with cyclophosphamide and acute GVHD were associated with HC. In multivariate analysis, HC was significantly more common in males and HLA-mismatched UCB graft recipients. Severe grade HC (grade III-IV) was associated with increased treatment-related mortality but not with overall survival at 1 year. HC remains hazardous and therefore better prophylaxis, and early interventions to limit its severity are still needed.
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Affiliation(s)
- Laura E. Lunde
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sandhyarani Dasaraju
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Qing Cao
- Masonic Cancer Center, Biostatistics & Bioinformatic Core, Fairview Health Services, Minneapolis, MN, USA
| | - Claudia S. Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Fairview Health Services, Minneapolis, MN, USA
| | - Mark Reding
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nelli Bejanyan
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bryan Trottier
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - John Rogosheske
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Claudio Brunstein
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Erica Warlick
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jo Anne H. Young
- Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel J. Weisdorf
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Celalettin Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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37
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Gielis EM, Ledeganck KJ, De Winter BY, Del Favero J, Bosmans JL, Claas FHJ, Abramowicz D, Eikmans M. Cell-Free DNA: An Upcoming Biomarker in Transplantation. Am J Transplant 2015; 15:2541-51. [PMID: 26184824 DOI: 10.1111/ajt.13387] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/01/2015] [Accepted: 05/13/2015] [Indexed: 01/25/2023]
Abstract
After organ transplantation, donor-derived cell-free DNA (ddcfDNA) can be detected in the recipient's blood and urine. Different ddcfDNA quantification techniques have been investigated but a major breakthrough was made with the introduction of digital droplet PCR and massive parallel sequencing creating the opportunity to increase the understanding of ddcfDNA kinetics after transplantation. The observations of increased levels of ddcfDNA during acute rejection and even weeks to months before histologic features of graft rejection point to a possible role of ddcfDNA as an early, noninvasive rejection marker. In this review, we summarize published research on ddcfDNA in the transplantation field thereby elaborating on its clinical utility.
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Affiliation(s)
- E M Gielis
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - K J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - B Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | | | - J-L Bosmans
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Antwerp, Belgium
| | - F H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - D Abramowicz
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Antwerp, Belgium
| | - M Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
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Mbianda C, El-Meanawy A, Sorokin A. Mechanisms of BK virus infection of renal cells and therapeutic implications. J Clin Virol 2015; 71:59-62. [PMID: 26295751 DOI: 10.1016/j.jcv.2015.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022]
Abstract
BK virus (BKV) causes BKV nephritis in renal transplant patients and contributes significantly to the increase of probability of graft loss. BKV, being latent in the urogenital tract, is likely to be transported with the donor kidney to recipients and following reactivation replicates in the nucleus of renal epithelial tubular cells. BKV daughter viruses are released and enter other renal epithelial cells to spread infection. There are still a lot of unknown factors about the mechanism and kinetics of BKV infection. The treatment of BKV infection, with exception of reduction in immunosuppression which increases the risk of allograft rejection, is almost exclusively limited to application of anti-viral drugs with rather inconsistent results. The shortcomings of anti-viral therapies demand the understanding of early steps of infection of permissive cells by BK virus in hope that adequate interventional therapies preventing infection of cells with BK virus could be developed. This review describes the BKV entry in target human cells, intracellular trafficking pathways of BKV particles and potential therapeutic implications based on understanding of mechanisms of BKV infection of renal cells.
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Affiliation(s)
- Christiane Mbianda
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Ashraf El-Meanawy
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Andrey Sorokin
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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39
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Dekeyser M, François H, Beaudreuil S, Durrbach A. Polyomavirus-Specific Cellular Immunity: From BK-Virus-Specific Cellular Immunity to BK-Virus-Associated Nephropathy? Front Immunol 2015; 6:307. [PMID: 26136745 PMCID: PMC4468917 DOI: 10.3389/fimmu.2015.00307] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplantation, BK-virus (BKV)-associated nephropathy has emerged as a major complication, with a prevalence of 1-10% and graft loss in >50% of cases. BKV is a member of the polyomavirus family and rarely induces apparent clinical disease in the general population. However, replication of polyomaviruses, associated with significant organ disease, is observed in patients with acquired immunosuppression. Monitoring of specific immunity combined with viral load could be used to individually assess the risk of viral reactivation and virus control. We review the current knowledge on BKV-specific cellular immunity and, more specifically, in immunocompromised patients. In the future, immune-based therapies could allow us to treat and prevent BKV-associated nephropathy.
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Affiliation(s)
- Manon Dekeyser
- Nephrology Department, IFRNT, Bicêtre Hospital , Le Kremlin Bicêtre , France ; UMRS1197, INSERM , Villejuif , France ; University Paris South , Orsay , France
| | - Hélène François
- Nephrology Department, IFRNT, Bicêtre Hospital , Le Kremlin Bicêtre , France ; UMRS1197, INSERM , Villejuif , France ; University Paris South , Orsay , France
| | - Séverine Beaudreuil
- Nephrology Department, IFRNT, Bicêtre Hospital , Le Kremlin Bicêtre , France ; UMRS1197, INSERM , Villejuif , France ; University Paris South , Orsay , France
| | - Antoine Durrbach
- Nephrology Department, IFRNT, Bicêtre Hospital , Le Kremlin Bicêtre , France ; UMRS1197, INSERM , Villejuif , France ; University Paris South , Orsay , France
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40
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Chan JFW, Ma MKM, Chan GSW, Chan GCW, Choi GKY, Chan KH, Cheng VCC, Chan KW, Choy BY, Yuen KY. Rapid reduction of viruria and stabilization of allograft function by fusidic acid in a renal transplant recipient with JC virus-associated nephropathy. Infection 2015; 43:577-81. [PMID: 25944568 DOI: 10.1007/s15010-015-0721-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/04/2015] [Indexed: 12/22/2022]
Abstract
JC virus (JCV)-associated nephropathy has been increasingly recognized as a cause of allograft dysfunction with graft loss in renal transplant recipients. Like many other opportunistic viral infections in transplant recipients, there are currently limited therapeutic options for this condition. Fusidic acid has previously been reported to exhibit antiviral activity against JCV in in vitro assays. We report the first in vivo study to document the rapid reduction of JC viruria and stabilization of allograft function by oral fusidic acid (fusidate sodium) in a deceased donor renal transplant recipient with JCV-associated nephropathy and acute allograft dysfunction which did not improve initially to surgical relief of hydronephrosis and reduction of immunosuppressants. Rapid reduction of JC viruria detected by quantitative PCR and stabilization of renal function were observed. Fusidic acid has several practical advantages in this clinical setting, including a low EC50 against JCV, high plasma C max, long half-life, availability of both oral and intravenous formulations, excellent oral bioavailability, good patient tolerability, and lack of serious drug interactions with other drugs taken by renal transplant recipients. Further mechanistic and clinical studies are necessary to evaluate this treatment option for JCV-associated nephropathy.
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Affiliation(s)
- Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Maggie Kam-Man Ma
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gavin Shueng-Wai Chan
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gary Chi-Wang Chan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Garnet Kwan-Yue Choi
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Chan
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Wah Chan
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Bo-Ying Choy
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China. .,Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China. .,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China. .,Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
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Aksenova M, Tsetlina V, Gutovskaya E, Mitrofanova A, Balashov D, Maschan A. BK virus nephropathy in a pediatric patient after hematopoietic stem cell transplantation. Pediatr Transplant 2015; 19:E29-32. [PMID: 25484248 DOI: 10.1111/petr.12411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 12/17/2022]
Abstract
We report the case of a seven-yr-old Caucasian girl who presented with progressive deterioration of renal function 13 months after HSCT for myelodysplastic syndrome. BK virus nephropathy was suspected and confirmed. After reduction of immunosuppression and treatment with IVIG, leflunomide, ciprofloxacin, and cidofovir, clearance of BK virus from blood was achieved, and further progression or renal failure was prevented. We believe that BK virus nephropathy should be considered in cases of renal function deterioration in all immunocompromised patients.
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Affiliation(s)
- M Aksenova
- Nephrology Department, Research and Clinical Institute for Pediatrics, the Pirogov Russian National Research Medical University, Moscow, Russia; Department of Clinical Diagnostics, the Rogachev Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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