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Haq K, Malvica S, Rosenberg A, Kant S. Nephrology picture: C4d positive tubules in severe BK virus nephropathy. J Nephrol 2024; 37:501-503. [PMID: 37878180 DOI: 10.1007/s40620-023-01797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Kanza Haq
- Division of Nephrology, Comprehensive Transplant Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Silvia Malvica
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sam Kant
- Division of Nephrology, Comprehensive Transplant Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Holland EM, Gonzalez C, Levy E, Valera VA, Chalfin H, Klicka-Skeels J, Yates B, Kleiner DE, Hadigan C, Dave H, Shalabi H, Hickstein DD, Su HC, Grimley M, Freeman AF, Shah NN. Case Report: Fatal Complications of BK Virus-Hemorrhagic Cystitis and Severe Cytokine Release Syndrome Following BK Virus-Specific T-Cells. Front Immunol 2021; 12:801281. [PMID: 34975916 PMCID: PMC8718506 DOI: 10.3389/fimmu.2021.801281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
BK virus (BKV)-hemorrhagic cystitis (HC) is a well-known and rarely fatal complication of hematopoietic stem cell transplantation (HSCT). Treatment for BKV-HC is limited, but virus-specific T-cells (VST) represent a promising therapeutic option feasible for use posttransplant. We report on the case of a 16-year-old male with dedicator of cytokinesis 8 (DOCK8) deficiency who underwent haploidentical HSCT complicated by severe BKV-HC, catastrophic renal hemorrhage, and VST-associated cytokine release syndrome (CRS). Gross hematuria refractory to multiple interventions began with initiation of posttransplant cyclophosphamide (PT/Cy). Complete left renal arterial embolization (day +43) was ultimately indicated to control intractable renal hemorrhage. Subsequent infusion of anti-BK VSTs was complicated by CRS and progressive multiorgan failure, with postmortem analysis confirming diagnosis of hepatic sinusoidal obstruction syndrome (SOS). This case illustrates opportunities for improvement in the management of severe BKV-HC posttransplant while highlighting rare and potentially life-threatening complications of BKV-HC and VST therapy.
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Affiliation(s)
- Elizabeth M. Holland
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Corina Gonzalez
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
- Immune Deficiency- Cellular Therapy Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Elliot Levy
- Radiology and Imaging Sciences, NIH Clinical Center (CC), Bethesda, MD, United States
| | - Vladimir A. Valera
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Heather Chalfin
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | | | - Bonnie Yates
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Colleen Hadigan
- Pediatric Gastroenterology, NIH Clinical Center (CC), Bethesda, MD, United States
| | - Hema Dave
- Pediatric Oncology, Children’s National Medical Center, Washington, DC, United States
| | - Haneen Shalabi
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Dennis D. Hickstein
- Immune Deficiency- Cellular Therapy Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Helen C. Su
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Disease, NIH Clinical Center (CC), Bethesda, MD, United States
| | - Michael Grimley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital, Cincinnati, OH, United States
| | - Alexandra F. Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Disease, NIH Clinical Center (CC), Bethesda, MD, United States
| | - Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
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3
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Li YJ, Wu HH, Chen CH, Wang HH, Chiang YJ, Hsu HH, Pang ST, Wang RYL, Tian YC. High Incidence and Early Onset of Urinary Tract Cancers in Patients with BK Polyomavirus Associated Nephropathy. Viruses 2021; 13:v13030476. [PMID: 33799453 PMCID: PMC8001968 DOI: 10.3390/v13030476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 12/27/2022] Open
Abstract
Over-immunosuppressed kidney transplant recipients are susceptible to malignancies and BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN). This study aimed to verify the association between BKPyV infection and urinary tract cancers (UTC). A total of 244 kidney transplant recipients were enrolled at Chang Gung Memorial Hospital from June 2000 to February 2020. Biopsy-proven BKPyVAN patients (n = 17) had worse kidney function (eGFR: 26 ± 13.7 vs. 47.8 ± 31.0 mL/min/1.73 m2). The 5-year allograft survival rates for patients with and without BKPyVAN were 67% and 93%, respectively (p = 0.0002), while the 10-year patient survival was not different between the two groups. BKPyVAN patients had a significantly higher incidence of UTC compared to the non-BKPyVAN group (29.4% vs. 6.6%). Kaplan-Meier analysis showed that the UTC-free survival rate was significantly lower in BKPyVAN patients, and the onset of UTC was significantly shorter in BKPyVAN patients (53.4 vs. 108.9 months). The multivariate logistic regression analysis demonstrated that age (RR = 1.062) and BKVAN (RR = 6.459) were the most significant risk factors for the development of UTC. Our study demonstrates that BKPyVAN patients have greater allograft losses, higher incidence, a lower cancer-free survival rate, and an earlier onset with a higher relative risk of developing UTC compared to non-BKPyVAN patients.
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Affiliation(s)
- Yi-Jung Li
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-J.L.); (H.-H.W.); (H.-H.H.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
| | - Hsin-Hsu Wu
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-J.L.); (H.-H.W.); (H.-H.H.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Hsu-Han Wang
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Yang-Jen Chiang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Hsiang-Hao Hsu
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-J.L.); (H.-H.W.); (H.-H.H.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
| | - See-Tong Pang
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Robert Y. L. Wang
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ya-Chung Tian
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-J.L.); (H.-H.W.); (H.-H.H.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.W.); (S.-T.P.)
- Correspondence: ; Tel.: +886-328-1200 (ext. 8181); Fax: +886-328-2173
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Meier RP, Muller YD, Dietrich PY, Tille JC, Nikolaev S, Sartori A, Labidi-Galy I, Ernandez T, Kaur A, Hirsch HH, McKee TA, Toso C, Villard J, Berney T. Immunologic Clearance of a BK Virus-associated Metastatic Renal Allograft Carcinoma. Transplantation 2021; 105:423-429. [PMID: 32091486 PMCID: PMC7837753 DOI: 10.1097/tp.0000000000003193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Metastatic carcinoma of a renal allograft is a rare but life threatening event with a difficult clinical management. Recent reports suggested a potential role of BK polyomavirus (BKPyV) in the development of urologic tract malignancies in kidney transplant recipients. METHODS We investigated a kidney-pancreas female recipient with an history of BKPyV nephritis who developed a rapidly progressive and widely metastatic donor-derived renal carcinoma 9 years after transplantation. RESULTS Histology and fluorescence in situ hybridization analysis revealed a donor-derived (XY tumor cells) collecting (Bellini) duct carcinoma. The presence of BKPyV oncogenic large tumor antigen was identified in large amount within the kidney tumor and the bowel metastases. Whole genome sequencing of the tumor confirmed multiple genome BKPyV integrations. The transplanted kidney was removed, immunosuppression was withdrawn, and recombinant interleukin-2 (IL-2) was administered for 3 months, inducing a complete tumor clearance, with no evidence of disease at 6-year follow-up. The immunological profiling during IL-2 therapy revealed the presence of donor-specific T cells and expanded cytokine-producing bright natural killer cells but no donor-specific antibodies. Finally, we found persistently elevated anti-BK virus IgG titers and a specific anti-BKPyV T cell response. CONCLUSIONS This investigation showed evidence for the potential oncogenic role of BKPyV in collecting duct carcinoma in renal allografts and demonstrated that immunosuppression withdrawal and IL-2 therapy can lead to an efficient antitumor cellular mediated rejection possibly via 3 distinct mechanisms including (1) host-versus-graft, (2) host-versus-tumor, and (3) anti-BKPyV responses.
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Affiliation(s)
- Raphael P.H. Meier
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
- Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Yannick D. Muller
- Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
- Immunology and Transplant Unit, Department Diagnostic, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Jean-Christophe Tille
- Diagnostic Department, Geneva University Hospital, and Department of Pathology and Immunology, University of Geneva Medical School, Geneva, Switzerland
| | - Sergey Nikolaev
- Department of Genetic Medicine and Development, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Ambra Sartori
- Department of Genetic Medicine and Development, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Intidhar Labidi-Galy
- Department of Oncology, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Thomas Ernandez
- Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Amandeep Kaur
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Hans H. Hirsch
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Thomas A. McKee
- Diagnostic Department, Geneva University Hospital, and Department of Pathology and Immunology, University of Geneva Medical School, Geneva, Switzerland
| | - Christian Toso
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
| | - Jean Villard
- Immunology and Transplant Unit, Department Diagnostic, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
- Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Berney
- Abdominal Transplant Surgery, Department of Surgery, Geneva University Hospital and University of Geneva Medical School, Geneva, Switzerland
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Mazzoni E, Bononi I, Pietrobon S, Torreggiani E, Rossini M, Pugliatti M, Casetta I, Castellazzi M, Granieri E, Guerra G, Martini F, Tognon M. Specific antibodies reacting to JC polyomavirus capsid protein mimotopes in sera from multiple sclerosis and other neurological diseases-affected patients. J Cell Physiol 2020; 235:5847-5855. [PMID: 32012272 DOI: 10.1002/jcp.29533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/09/2020] [Indexed: 11/07/2022]
Abstract
Published data support the hypothesis that viruses could be trigger agents of multiple sclerosis onset. This link is based on evidence of early exposure to viral agents in patients affected by this neurologic disease. JC (JC polyomavirus [JCPyV]), BK (BKPyV), and simian virus 40 (SV40) neurotropic polyomavirus footprints have been detected in brain tissue specimens and samples from patients affected by different neurological diseases. In this investigation, serum samples from patients affected by multiple sclerosis and other inflammatory and noninflammatory neurologic diseases, as well as healthy subjects representing the control, were investigated for immunoglobulin G (IgG) antibodies against JCPyV. To this end, an immunologic approach was employed, which consists of employing indirect enzyme-linked immunosorbent assay testing with synthetic peptides mimicking viral capsid protein 1 antigens. A significantly lower prevalence of IgG antibodies against JCPyV VP1 epitopes, with a low titer, was detected in serum samples from patients with multiple sclerosis (MS) and other neurologic diseases than in healthy subjects. Our study indicates that the prevalence of JCPyV antibodies from patients with multiple sclerosis is 50% lower than in healthy subjects, suggesting specific immune impairments. These results indicate that patients affected by neurological diseases, including MS, respond poorly to JCPyV VP1 antigens, suggesting specific immunologic dysfunctions.
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Affiliation(s)
- Elisa Mazzoni
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Ilaria Bononi
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Pietrobon
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Elena Torreggiani
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Marika Rossini
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Maura Pugliatti
- Department of Biomedical Sciences and Specialized Surgeries, Section of Neurology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Ilaria Casetta
- Department of Biomedical Sciences and Specialized Surgeries, Section of Neurology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Massimiliano Castellazzi
- Department of Biomedical Sciences and Specialized Surgeries, Section of Neurology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Enrico Granieri
- Department of Biomedical Sciences and Specialized Surgeries, Section of Neurology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Guerra
- Clinical Laboratory Analysis, University Hospital of Ferrara, Ferrara, Italy
| | - Fernanda Martini
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Mauro Tognon
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy
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Lorentzen EM, Henriksen S, Kaur A, Kro GB, Hammarström C, Hirsch HH, Midtvedt K, Rinaldo CH. Early fulminant BK polyomavirus-associated nephropathy in two kidney transplant patients with low neutralizing antibody titers receiving allografts from the same donor. Virol J 2020; 17:5. [PMID: 31924245 PMCID: PMC6954500 DOI: 10.1186/s12985-019-1275-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND BK Polyomavirus (BKPyV) causes premature graft failure in 1 to 15% of kidney transplant (KT) recipients. High-level BKPyV-viruria and BKPyV-DNAemia precede polyomavirus-associated nephropathy (PyVAN), and guide clinical management decisions. In most cases, BKPyV appears to come from the donor kidney, but data from biopsy-proven PyVAN cases are lacking. Here, we report the early fulminant course of biopsy-proven PyVAN in two male KT recipients in their sixties, receiving kidneys from the same deceased male donor. CASE PRESENTATIONS Both recipients received intravenous basiliximab induction, and maintenance therapy consisting of tacrolimus (trough levels 3-7 ng/mL from time of engraftment), mycophenolate mofetil 750 mg bid, and prednisolone. At 4 weeks post-transplant, renal function was satisfactory with serum creatinine concentrations of 106 and 72 μmol/L in recipient #1 and recipient #2, respectively. Plasma BKPyV-DNAemia was first investigated at 5 and 8 weeks post-transplant being 8.58 × 104 and 1.12 × 106 copies/mL in recipient #1 and recipient #2, respectively. Renal function declined and biopsy-proven PyVAN was diagnosed in both recipients at 12 weeks post-transplant. Mycophenolate mofetil levels were reduced from 750 mg to 250 mg bid while tacrolimus levels were kept below 5 ng/mL. Recipient #2 cleared BKPyV-DNAemia at 5.5 months post-transplant, while recipient #1 had persistent BKPyV-DNAemia of 1.07 × 105 copies/mL at the last follow-up 52 weeks post-transplant. DNA sequencing of viral DNA from early plasma samples revealed apparently identical viruses in both recipients, belonging to genotype Ib-2 with archetype non-coding control region. Retrospective serological work-up, demonstrated that the donor had high BKPyV-IgG-virus-like particle ELISA activity and a high BKPyV-genotype I neutralizing antibody titer, whereas both KT recipients only had low neutralizing antibody titers pre-transplantation. By 20 weeks post-transplant, the neutralizing antibody titer had increased by > 1000-fold in both recipients, but only recipient #2 cleared BKPyV-DNAemia. CONCLUSIONS Low titers of genotype-specific neutralizing antibodies in recipients pre-transplant, may identify patients at high risk for early fulminant donor-derived BKPyV-DNAemia and PyVAN, but development of high neutralizing antibody titers may not be sufficient for clearance.
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Affiliation(s)
- Elias Myrvoll Lorentzen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Stian Henriksen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Amandeep Kaur
- Department Biomedicine Transplantation & Clinical Virology, University of Basel, Basel, Switzerland
| | - Grete Birkeland Kro
- Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Clara Hammarström
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hans H. Hirsch
- Department Biomedicine Transplantation & Clinical Virology, University of Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Karsten Midtvedt
- Department of Transplantation, Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christine Hanssen Rinaldo
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Chen XT, Wang ZY, Huang Y, Wang JY, Yang SC, Chen WF, Chen PS, Li J, Deng RH, Huang G. Combined detection of urine specific gravity and BK viruria on prediction of BK polyomavirus nephropathy in kidney transplant recipients. Chin Med J (Engl) 2020; 133:33-40. [PMID: 31923102 PMCID: PMC7028210 DOI: 10.1097/cm9.0000000000000579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is an important cause of dysfunction and failure of renal transplants. This study aimed to assess the diagnostic performance of morning urine specific gravity (MUSG) in diagnosing BKPyVAN in kidney transplant recipients. METHODS A total of 87 patients, including 27 with BKPyVAN, 22 with isolated BKPyV viruria, 18 with T cell-mediated rejection (TCMR), and 20 with stable graft function, were enrolled in the First Affiliated Hospital of Sun Yat-Sen University from March 2015 to February 2017. MUSG at biopsy and during a follow-up period of 24 months after biopsy was collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of MUSG to discriminate BKPyVAN. RESULTS At biopsy, the MUSG of BKPyVAN group (1.008 ± 0.003) was significantly lower than that of isolated BK viruria group (1.013 ± 0.004, P < 0.001), TCMR group (1.011 ± 0.003, P = 0.027), and control group (1.014 ± 0.006, P < 0.001). There was no significant difference in MUSG among the isolated BK viruria group, TCMR group, and control group (P = 0.253). In BKPyVAN group, the timing and trend of MUSG elevate were consistent with the timing and trend of the decline of viral load in urine and plasma, reaching a statistical difference at 3 months after treatment (1.012 ± 0.003, P < 0.001) compared with values at diagnosis. ROC analysis indicated that the optimal cut-off value of MUSG for diagnosis of BKPyVAN was 1.009, with an area under the ROC curve (AUC) of 0.803 (95% confidence interval [CI]: 0.721-0.937). For differentiating BKPyVAN and TCMR, the optimal MUSG cut-off value was 1.010, with an AUC of 0.811 (95% CI: 0.687-0.934). CONCLUSION Combined detection of MUSG and BKPyV viruria is valuable for predicting BKPyVAN and distinguishing BKPyVAN from TCMR in renal transplant recipients.
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Affiliation(s)
- Xu-Tao Chen
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Ze-Yuan Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Yang Huang
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Jin-Yuan Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Shi-Cong Yang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Wen-Fang Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Pei-Song Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Jun Li
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Rong-Hai Deng
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Gang Huang
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
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Abstract
In 2014, the International Agency for Research on Cancer judged Merkel cell polyomavirus (MCPyV) to be a probable human carcinogen. BK polyomavirus (BKPyV, a distant cousin of MCPyV) was ruled a possible carcinogen. In this review, we argue that it has recently become reasonable to view both of these viruses as known human carcinogens. In particular, several complementary lines of evidence support a causal role for BKPyV in the development of bladder carcinomas affecting organ transplant patients. The expansion of inexpensive deep sequencing has opened new approaches to investigating the important question of whether BKPyV causes urinary tract cancers in the general population.
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Affiliation(s)
- Gabriel J Starrett
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States.
| | - Christopher B Buck
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States
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9
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Bischof N, Hirsch HH, Wehmeier C, Amico P, Dickenmann M, Hirt-Minkowski P, Steiger J, Menter T, Helmut H, Schaub S. Reducing calcineurin inhibitor first for treating BK polyomavirus replication after kidney transplantation: long-term outcomes. Nephrol Dial Transplant 2019; 34:1240-1250. [PMID: 30476254 DOI: 10.1093/ndt/gfy346] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Reducing immunosuppression is the mainstay of treating BK polyomavirus (BKPyV) viraemia after kidney transplantation, but the best approach, efficacy and impact are undefined. We established a standard operating procedure (SOP) treating BKPyV viraemia based on first reducing calcineurin inhibitor ('CNI first'). The aim of this study was to investigate long-term outcomes in 644 consecutive transplantations using this SOP. METHODS Patients were monitored for active BKPyV infection by urinary decoy cells and, if positive, by BKPyV viraemia. In case of sustained BKPyV viraemia >1000 copies/mL, immunosuppression was reduced stepwise according to the SOP. Patients were classified as 'no decoy cells' [n = 432 (66%)], 'decoy cells/no viraemia' [n = 107 (17%)] and 'viraemia' [n = 105 (17%)]. RESULTS At 6-years post-transplant, graft survival was ∼84%, the clinical rejection rate was ∼25% and they were not different among the three groups (P = 0.14; P = 0.91). The median estimated glomerular filtration rate at the last follow-up was similar (range 49-53 mL/min, P = 0.08). Of 105 viraemic patients, 101 (96%) cleared BKPyV viraemia. In 39% of patients, viraemia clearance followed a tacrolimus reduction. A reduction of mycophenolic acid was required in 43% and discontinuation in 3%. No short-term graft loss was directly attributable to BKPyV-associated nephropathy. After a median follow-up of 5 years after clearance of BKPyV viraemia, 11/101 patients (11%) developed clinical rejection: 7 (7%) T-cell-mediated rejection and 4 (4%) antibody-mediated rejection (ABMR). CONCLUSIONS Immunosuppression reduction based on 'CNI first' leads to similar long-term outcomes in patients with/without BKPyV viraemia and is associated with a low risk for ABMR after clearance of BKPyV viraemia. Randomized trials are needed to compare the risks and benefits of immunosuppression reduction strategies in kidney transplant patients with BKPyV viraemia.
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Affiliation(s)
- Nicole Bischof
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Transplantation and Clinical Virology, Department of Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland
- Division of Infection Diagnostics, Department of Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland
| | - Caroline Wehmeier
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Patricia Amico
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Michael Dickenmann
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Patricia Hirt-Minkowski
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Jürg Steiger
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
- Transplantation Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Thomas Menter
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Hopfer Helmut
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
- Transplantation Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- HLA-Diagnostic and Immunogenetics, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
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10
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Solis M, Gallais F, Velay A, Fafi-Kremer S. [BK-virus and pathophysiology of associated diseases]. Virologie (Montrouge) 2019; 23:7-22. [PMID: 31131830 DOI: 10.1684/vir.2019.0757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BK virus (BKV) is a widely distributed polyomavirus in the world population. It is the causative agent of BKV-associated nephropathy in kidney transplant recipients and hemorrhagic cystitis in bone marrow transplant patients. To date, there is no specific antiviral treatment against BKV. A better understanding of the pathophysiology of BKV-associated diseases, especially in immunocompromised patients, may contribute to the development of novel preventive and therapeutic strategies. After a detailed description of the genomic characteristics of the virus, its replication cycle and available model systems, the pathophysiological and immune mechanisms involved in BKV infection are developed and discussed in this review.
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Affiliation(s)
- Morgane Solis
- Hôpitaux universitaires de Strasbourg, Laboratoire de virologie, 3, rue Koeberlé, 67000 Strasbourg, France, Université de Strasbourg, Inserm, UMR-S 1109, 3, rue Koeberlé, 67000 Strasbourg, France
| | - Floriane Gallais
- Hôpitaux universitaires de Strasbourg, Laboratoire de virologie, 3, rue Koeberlé, 67000 Strasbourg, France, Université de Strasbourg, Inserm, UMR-S 1109, 3, rue Koeberlé, 67000 Strasbourg, France
| | - Aurélie Velay
- Hôpitaux universitaires de Strasbourg, Laboratoire de virologie, 3, rue Koeberlé, 67000 Strasbourg, France, Université de Strasbourg, Inserm, UMR-S 1109, 3, rue Koeberlé, 67000 Strasbourg, France
| | - Samira Fafi-Kremer
- Hôpitaux universitaires de Strasbourg, Laboratoire de virologie, 3, rue Koeberlé, 67000 Strasbourg, France, Université de Strasbourg, Inserm, UMR-S 1109, 3, rue Koeberlé, 67000 Strasbourg, France
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11
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An P, Sáenz Robles MT, Duray AM, Cantalupo PG, Pipas JM. Human polyomavirus BKV infection of endothelial cells results in interferon pathway induction and persistence. PLoS Pathog 2019; 15:e1007505. [PMID: 30620752 PMCID: PMC6338385 DOI: 10.1371/journal.ppat.1007505] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/18/2019] [Accepted: 12/05/2018] [Indexed: 01/19/2023] Open
Abstract
Polyomavirus BKV is highly prevalent among humans. The virus establishes an asymptomatic persistent infection in the urinary system in healthy people, but uncontrolled productive infection of the virus in immunocompromised patients can lead to serious diseases. In spite of its high prevalence, our knowledge regarding key aspects of BKV polyomavirus infection remains incomplete. To determine tissue and cell type tropism of the virus, primary human epithelial cells, endothelial cells and fibroblasts isolated from the respiratory and urinary systems were tested. Results from this study demonstrated that all 9 different types of human cells were infectable by BKV polyomavirus but showed differential cellular responses. In microvascular endothelial cells from the lung and the bladder, BKV persistent infection led to prolonged viral protein expression, low yield of infectious progeny and delayed cell death, in contrast with infection in renal proximal tubular epithelial cells, a widely used cell culture model for studying productive infection of this virus. Transcriptomic profiling revealed the activation of interferon signaling and induction of multiple interferon stimulated genes in infected microvascular endothelial cells. Further investigation demonstrated production of IFNβ and secretion of chemokine CXCL10 by infected endothelial cells. Activation of IRF3 and STAT1 in infected endothelial cells was also confirmed. In contrast, renal proximal tubular epithelial cells failed to mount an interferon response and underwent progressive cell death. These results demonstrated that microvascular endothelial cells are able to activate interferon signaling in response to polyomavirus BKV infection. This raises the possibility that endothelial cells might provide initial immune defense against BKV infection. Our results shed light on the persistence of and immunity against infection by BKV polyomavirus.
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Affiliation(s)
- Ping An
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Maria Teresa Sáenz Robles
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Alexis M. Duray
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Paul G. Cantalupo
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - James M. Pipas
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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12
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Jha A, Ahmed W, Pakkyara A, Shaheen F, Al Salmi I. Elimination of BK viremia in renal transplant recipients by optimization of immunosuppressive medications without precipitating acute rejection. Saudi J Kidney Dis Transpl 2018; 29:1073-1081. [PMID: 30381503 DOI: 10.4103/1319-2442.243976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BK Polyomavirus-associated nephropathy (BKVAN) has been recognized as an increasing threat in renal transplant patients (RTP) for more than a decade. Reduction in immunosuppression is the mainstay of treatment through various options of treatment has been suggested. Published reports on these protocols have shown mixed results, and no randomized controlled trials have compared one strategy with another. In this context, we hypothesize that the appearance of BKV in the blood compels one to optimize the immunosuppression with possible long-term beneficial effects. We conducted a retrospective study among the RTP being followed up by the Renal Medicine Department at Royal Hospital who tested positive for BKV-polymerase chain reaction and whose immunosuppression was altered with a final aim to get rid of BK viremia, yet avoiding acute rejection. Results were analyzed by the clinical and statistical approach. Extensive literature review was carried out to look into the prevalence, prognosis, and treatment of BKVAN. In all the patients in whom BKV was detected alteration in immunosuppression resulted in eliminating the virus without precipitating acute rejection. The study shows that in the exercise of eliminating BKV by alteration of immunosuppression, we have "tailored" the immunosuppression in each particular RTPs, without precipitating acute rejection.
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Affiliation(s)
- Amitabh Jha
- Department of Nephrology, Royal Hospital, Muscat, Oman
| | - Wasim Ahmed
- Department of Nephrology, Royal Hospital, Muscat, Oman
| | | | - Faisal Shaheen
- Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia
| | - Issa Al Salmi
- Department of Nephrology, Royal Hospital, Muscat, Oman
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13
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Coomes EA, Wolfe Jacques A, Michelis FV, Kim DDH, Thyagu S, Viswabandya A, Lipton JH, Messner HA, Deotare U. Efficacy of Cidofovir in Treatment of BK Virus-Induced Hemorrhagic Cystitis in Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2018; 24:1901-1905. [PMID: 29679772 DOI: 10.1016/j.bbmt.2018.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
Abstract
BK virus-associated hemorrhagic cystitis (BK-HC) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HCT), with incidences up to 70%. Cidofovir is an antiviral agent with growing evidence as a therapeutic intervention. To assess the safety profile and efficacy of intravenous and intravesical cidofovir in allo-HCT patients with BK-HC, a retrospective study was undertaken of the allo-HCT cohort who received cidofovir for symptomatic BK-HC (hematuria with BK viruria or viremia) from January 2010 until March 2017 in a single transplant center in Ontario, Canada. The primary outcome measure was a reduction in BK-HC severity (graded from 1 to 4); secondary outcomes included overall survival, BK virus titers, and the onset of acute kidney injury. Twelve allo-HCT patients received cidofovir for BK-HC, with pretreatment clinical severity of 3 (50%) or 4 (50%). Cidofovir was administered via intravenous (33%), intravesical (58%), or both modalities (8%). After a median cumulative dose of 10 mg/kg (range, 1 to 37), mean BK-HC grade decreased significantly by 1.8 (3.5 precidofovir, 1.7 postcidofovir, P < .01). Sixty-six percent of patients had at least partial response to cidofovir, with similar response rates between intravenous (66%) and intravesical (62%) administration. Sixty-seven percent of patients died, and 33% of patients experienced renal toxicity, including 2 patients receiving intravesical therapy. In this retrospective series, there was a significant reduction in BK-HC severity after cidofovir administration; most patients achieved at least partial response after cidofovir administration. Even with intravesical instillation, acute kidney injury remains a potential complication of cidofovir. Although cidofovir may be an efficacious therapy for BK-HC, albeit with potential demonstrated toxicities, further prospective trials are needed.
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Affiliation(s)
- Eric A Coomes
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Amanda Wolfe Jacques
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Fotios V Michelis
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Dennis Dong Hwan Kim
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Santhosh Thyagu
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Auro Viswabandya
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hans A Messner
- Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Uday Deotare
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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14
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Mallat SG, Tanios BY, Itani HS, Lotfi T, McMullan C, Gabardi S, Akl EA, Azzi JR. CMV and BKPyV Infections in Renal Transplant Recipients Receiving an mTOR Inhibitor-Based Regimen Versus a CNI-Based Regimen: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials. Clin J Am Soc Nephrol 2017; 12:1321-1336. [PMID: 28576905 PMCID: PMC5544521 DOI: 10.2215/cjn.13221216] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The objective of this meta-analysis is to compare the incidences of cytomegalovirus and BK polyoma virus infections in renal transplant recipients receiving a mammalian target of rapamycin inhibitor (mTOR)-based regimen compared with a calcineurin inhibitor-based regimen. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a comprehensive search for randomized, controlled trials up to January of 2016 addressing our objective. Other outcomes included acute rejection, graft loss, serious adverse events, proteinuria, wound-healing complications, and eGFR. Two review authors selected eligible studies, abstracted data, and assessed risk of bias. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. RESULTS We included 28 randomized, controlled trials with 6211 participants classified into comparison 1: mTOR inhibitor versus calcineurin inhibitor and comparison 2: mTOR inhibitor plus reduced dose of calcineurin inhibitor versus regular dose of calcineurin inhibitor. Results showed decreased incidence of cytomegalovirus infection in mTOR inhibitor-based group in both comparison 1 (risk ratio, 0.54; 95% confidence interval, 0.41 to 0.72), with high quality of evidence, and comparison 2 (risk ratio, 0.43; 95% confidence interval, 0.24 to 0.80), with moderate quality of evidence. The available evidence neither confirmed nor ruled out a reduction of BK polyoma virus infection in mTOR inhibitor-based group in both comparisons. Secondary outcomes revealed more serious adverse events and acute rejections in mTOR inhibitor-based group in comparison 1 and no difference in comparison 2. There was no difference in graft loss in both comparisons. eGFR was higher in the mTOR inhibitor-based group in comparison 1 (mean difference =4.07 ml/min per 1.73 m2; 95% confidence interval, 1.34 to 6.80) and similar to the calcineurin inhibitor-based group in comparison 2. More proteinuria and wound-healing complications occurred in the mTOR inhibitor-based groups. CONCLUSIONS We found moderate- to high-quality evidence of reduced risk of cytomegalovirus infection in renal transplant recipients in the mTOR inhibitor-based compared with the calcineurin inhibitor-based regimen. Our review also suggested that a combination of a mTOR inhibitor and a reduced dose of calcineurin inhibitor may be associated with similar eGFR and rates of acute rejections and serious adverse events compared with a standard calcineurin inhibitor-based regimen at the expense of higher incidence of proteinuria and wound-healing complications.
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Affiliation(s)
| | | | - Houssam S. Itani
- Division of Nephrology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | | | - Ciaran McMullan
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Steven Gabardi
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jamil R. Azzi
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
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15
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Dvir R, Paloschi V, Canducci F, Dell'Antonio G, Racca S, Caldara R, Pantaleo G, Clementi M, Secchi A. IL28B rs12979860 genotype as a predictor marker of progression to BKVirus Associated nephropathy, after kidney transplantation. Sci Rep 2017; 7:6746. [PMID: 28751760 PMCID: PMC5532253 DOI: 10.1038/s41598-017-06915-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 06/05/2017] [Indexed: 12/22/2022] Open
Abstract
BK virus (BKV) associated nephropathy (BKVAN) is still an important cause of allograft dysfunction after kidney transplantation (KT). Recent data have shown that the new interferon (IFN)-λ family has been ascribed antiviral properties similar to IFNα, and that the response to IFNλ in kidney is restricted to epithelial cells, suggesting that the IFNλ system evolves as specific protection of the epithelia. We aimed to test the hypothesis of correlation between a single nucleotide polymorphism (C/T dimorphism rs12979860) in the genomic region of IL28B and BKVAN, in patients after KT. Fifty kidney-transplanted patients were included as follow: Group 1 (BKV+/BKVAN+): 11 patients with active BKV- replication and biopsy-proven BKVAN; Group 2 (BKV+/BKVAN-): 22 patients with active BKV- replication but without evidence of BKVAN; Group 3 (BKV-/BKVAN-): 17 patients without evidence of BKV- replication (control group). Here we show that the C/C genotype was statistically higher in group 2 than in group 1 and BKVAN was detected significantly more frequently in patients with C/T and T/T genotypes than in patients with C/C genotype. We therefore propose IL28B polymorphism (rs12979860), as a predictor-marker to differentiate between patients with self-limited, even if persistent, BKV- reactivation and patients with a high risk of progression towards BKVAN, and to modulate the clinical management of these patients accordingly.
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Affiliation(s)
- Roee Dvir
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
| | - Vera Paloschi
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy
| | - Filippo Canducci
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
- University of Insubria, Dept. of Biotechnology and Life Sciences, Varese, Italy
| | | | - Sara Racca
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
| | - Rossana Caldara
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy
| | - Giuseppe Pantaleo
- UniSR-Social.Lab [Research Methods], Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
| | - Massimo Clementi
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Secchi
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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16
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Dugo M, Mangino M, Meola M, Petrucci I, Valente ML, Laurino L, Stella M, Mastrosimone S, Brunello A, Virgilio B, Rizzolo M, Maresca MC. Ultrasound findings of BK polyomavirus-associated nephropathy in renal transplant patients. J Nephrol 2016. [PMID: 27342655 DOI: 10.1007/s40620-16-0327-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BK polyomavirus (BKV) is an emerging pathogen in immunocompromised patients. BKV infection occurs in 1-9 % of renal transplants and causes chronic nephropathy or graft loss. Diagnosis of BKV-associated nephropathy (BKVAN) is based on detection of viruria then viremia and at least a tubule-interstitial nephritis at renal biopsy. This paper describes the ultrasound and color Doppler (US-CD) features of BKVAN. Seventeen patients affected by BKVAN were studied using a linear bandwidth 7-12 MHz probe. Ultrasound showed a widespread streak-like pattern with alternating normal echoic and hypoechoic streaks with irregular edges from the papilla to the cortex. Renal biopsy performed in hypoechoic areas highlighted the typical viral inclusions in tubular epithelial cells. Our experience suggests a possible role for US-CD in the non-invasive diagnosis of BKVAN when combined with blood and urine screening tests. US-CD must be performed with a high-frequency linear probe to highlight the streak-like pattern of the renal parenchyma.
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Affiliation(s)
- Mauro Dugo
- Nephrology and Dialysis Department, Ca' Foncello Hospital, Treviso, Italy.
| | - Margherita Mangino
- Nephrology and Dialysis Department, Ca' Foncello Hospital, Treviso, Italy
| | - Mario Meola
- S. Anna of Advanced Studies, Internal Medicine University of Pisa, Pisa, Italy
| | - Ilaria Petrucci
- S. Anna of Advanced Studies, Internal Medicine University of Pisa, Pisa, Italy
| | - Maria Luisa Valente
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Licia Laurino
- Pathology Department, Ca' Foncello Hospital, Treviso, Italy
| | - Mario Stella
- Pathology Department, Vincenzo Cervello Hospital, Palermo, Italy
| | | | - Anna Brunello
- Nephrology and Dialysis Department, Ca' Foncello Hospital, Treviso, Italy
| | - Bice Virgilio
- Nephrology and Dialysis Department, Ca' Foncello Hospital, Treviso, Italy
| | - Monica Rizzolo
- Nephrology and Dialysis Department, Ca' Foncello Hospital, Treviso, Italy
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Kariminik A, Yaghobi R, Dabiri S. CXCL9 expression and polyomavirus BK infectivity in renal transplant patients with nephropathy. Cell Mol Biol (Noisy-le-grand) 2016; 62:104-108. [PMID: 26828996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/27/2016] [Indexed: 06/05/2023]
Abstract
Polyomavirus BK is an important risk factor for nephropathy and renal lose after kidney transplantation. CXCL9 is a key immunoregulatory molecule which participates in stimulation and migration of immune cells to the infected sites. Thus, the main aim of this study was to evaluate the expression levels of CXCL9 mRNA and serum levels in the infected polyomavirus BK infected renal transplant patients with and without nephropathy compared with healthy controls. This cross sectional study was performed on three studied groups including: polyomavirus BK infected vs. non-infected renal transplant patients with nephropathy and healthy controls. The mRNA and serum levels of CXCL9 were evaluated on the studied patient and control samples using an in-house comparative real time PCR and ELISA methods, respectively. The mRNA expression and serum levels of CXCL9 were both increased in polyomavirus BK infected compared with non-infected renal transplant patients and also in comparing with healthy controls. This upregulation was significant in the serum level in polyomavirus BK infected vs. non-infected patients and also in comparing with controls. According to these results, polyomavirus BK can induce renal complications via stimulation of inflammatory biomarkers like chemokine. Confirmation of the increasing of the expression and production of CXCL9 as a pro-inflammatory chemokine in renal transplanted polyomavirus BK infected patients with nephropathy need to confirm in further completed studies with longer follow-up.
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Affiliation(s)
- A Kariminik
- Islamic Azad University Department of Microbiology, Shiraz Branch Shiraz Iran
| | - R Yaghobi
- Shiraz University of Medical Sciences Shiraz Transplant Research Center Shiraz Iran
| | - S Dabiri
- Kerman University of Medical Sciences Pathology and Stem cell Research center, Department of Pathology, Afzalipour School of Medicine Kerman Iran
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18
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Umbro I, Tinti F, Muiesan P, Mitterhofer AP. Different behaviour of BK-virus infection in liver transplant recipients. World J Gastroenterol 2016; 22:1532-1540. [PMID: 26819520 PMCID: PMC4721986 DOI: 10.3748/wjg.v22.i4.1532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/10/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Polyomavirus BK (BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A PubMed search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease (CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.
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Lee HM, Jang IA, Lee D, Kang EJ, Choi BS, Park CW, Choi YJ, Yang CW, Kim YS, Chung BH. Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients. Korean J Intern Med 2015; 30:865-72. [PMID: 26552462 PMCID: PMC4642016 DOI: 10.3904/kjim.2015.30.6.865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/16/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression. METHODS From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceased-donor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients. RESULTS BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure. CONCLUSIONS The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.
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Affiliation(s)
- Hae Min Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - In-Ae Jang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dongjae Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Jin Kang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yeong Jin Choi
- Department of Hospital Pathology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong-Soo Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Byung Ha Chung, M.D. Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6066 Fax: +82-2-599-3589 E-mail :
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Kenan DJ, Mieczkowski PA, Burger-Calderon R, Singh HK, Nickeleit V. The oncogenic potential of BK-polyomavirus is linked to viral integration into the human genome. J Pathol 2015; 237:379-89. [PMID: 26172456 PMCID: PMC5042064 DOI: 10.1002/path.4584] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/22/2015] [Accepted: 07/03/2015] [Indexed: 12/16/2022]
Abstract
It has been suggested that BK-polyomavirus is linked to oncogenesis via high expression levels of large T-antigen in some urothelial neoplasms arising following kidney transplantation. However, a causal association between BK-polyomavirus, large T-antigen expression and oncogenesis has never been demonstrated in humans. Here we describe an investigation using high-throughput sequencing of tumour DNA obtained from an urothelial carcinoma arising in a renal allograft. We show that a novel BK-polyomavirus strain, named CH-1, is integrated into exon 26 of the myosin-binding protein C1 gene (MYBPC1) on chromosome 12 in tumour cells but not in normal renal cells. Integration of the BK-polyomavirus results in a number of discrete alterations in viral gene expression, including: (a) disruption of VP1 protein expression and robust expression of large T-antigen; (b) preclusion of viral replication; and (c) deletions in the non-coding control region (NCCR), with presumed alterations in promoter feedback loops. Viral integration disrupts one MYBPC1 gene copy and likely alters its expression. Circular episomal BK-polyomavirus gene sequences are not found, and the renal allograft shows no productive polyomavirus infection or polyomavirus nephropathy. These findings support the hypothesis that integration of polyomaviruses is essential to tumourigenesis. It is likely that dysregulation of large T-antigen, with persistent over-expression in non-lytic cells, promotes cell growth, genetic instability and neoplastic transformation.
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MESH Headings
- Allografts
- Antigens, Viral, Tumor/genetics
- BK Virus/genetics
- BK Virus/metabolism
- BK Virus/pathogenicity
- Biopsy
- Capsid Proteins/genetics
- Carcinoma/genetics
- Carcinoma/pathology
- Carcinoma/surgery
- Carcinoma/virology
- Carrier Proteins/genetics
- Cell Proliferation
- Cell Transformation, Viral
- Chromosomes, Human, Pair 12
- Gene Expression Regulation, Neoplastic
- Gene Expression Regulation, Viral
- Genome, Human
- Genomic Instability
- Humans
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Kidney Neoplasms/virology
- Kidney Transplantation/adverse effects
- Male
- Microscopy, Electron
- Middle Aged
- Molecular Diagnostic Techniques
- Oncogene Proteins, Viral/genetics
- Oncogene Proteins, Viral/metabolism
- Polyomavirus Infections/virology
- Tumor Virus Infections/virology
- Urothelium/pathology
- Urothelium/virology
- Virus Integration
- Virus Replication
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Affiliation(s)
- Daniel J Kenan
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Harsharan K Singh
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Volker Nickeleit
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
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Al-Raisi F, Mohsin N, Kamble P. Management of BK virus nephropathy in kidney transplant recipients at the Royal Hospital - Clinical Audit - Oman. EXP CLIN TRANSPLANT 2015; 13 Suppl 1:156-158. [PMID: 25894146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Nephropathy from BK virus (BKV) infection is a growing challenge in kidney transplant recipients globally. It is the result of contemporary potent immunosuppressives aimed at reducing acute rejection and improving allograft survival. Untreated BK virus infections lead to kidney allograft dysfunction or loss. Decreased immunosuppression is the principle treatment but predisposes to acute and chronic rejection. Screening for early detection and prevention of symptomatic BK virus nephropathy may improve outcomes. Although no approved antiviral drug is available, leflunomide, cidofovir, quinolones, and intravenous immunoglobulin have been used. Since the introduction of the new immunosuppressive agents in the transplant regimen at the Royal Hospital, Few cases of BK virus have been detected, and the challenge was to decide upon the best treatment option. MATERIALS AND METHODS The audit was carried out at the Royal Hospital-Oman between January 2010 and December 2012. The nephrology consultant and the clinical pharmacist reviewed all the BK cases and the Royal Hospital. Extensive literature review carried out by the pharmacist to look into the prevalence, prognosis and treatment of BK nephropathy. A treatment protocol was prepared by the clinical pharmacist through guidance of the consultant and was peer reviewed by team of clinical pharmacists and nephrology doctors and approved by the consultant. RESULTS The audit included 19 patients with positive BK virus ployoma nephropathy. The treatment options were applied stepwise in all the patients with BK virus nephropathy with success rate more than 70%. CONCLUSIONS BK virus nephropathy is emerging at an alarming rate and requires increasing awareness. The uses of current treatment options are still questionable. Our audit confirms that reducing immunosuppression appears to be the criterian standard for the treatment of BK nephropathy.
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Affiliation(s)
- Fatma Al-Raisi
- From the Department of Nephrology, Royal Hospital, Muscat, Oman
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22
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Gheith O, Al-Otaibi T, Zakaria Z, Abdel Halim M, Nampoory N. Human leukocyte antigen Cw7-mediated protection against polyoma BK virus in renal transplant recipients who received grafts from antigen-positive donors. EXP CLIN TRANSPLANT 2015; 13 Suppl 1:383-387. [PMID: 25894195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Nephropathy from BK virus is an increasing problem in renal transplant recipients and has been correlated with newer immunosuppressive agents and the decline in acute rejection rates. We aimed to evaluate the effect of BK virus-positive kidney donors on the outcome of kidney transplant recipients after mean follow-up 21 months. MATERIALS AND METHODS Among 18 kidney donors with BK virus in blood and urine, 5 donors were fit for donation. Clinical information was reviewed for the 5 kidney transplant recipients who received kidney allografts from these donors (mean donor age, 35 ± 3 y). RESULTS All recipients except 1 were women (mean age, 49.4 ± 4.2 y; body weight, 68.2 ± 4 kg, followup, 21.6 ± 4 mo). All patients except 1 received antithymocyte globulin induction, and all 5 patients received steroids, tacrolimus, and mycophenolate mofetil as maintenance therapy. Ureter stenting was a routine procedure in each case. Human leukocyte antigen Cw7 was detected in 4 of 5 recipients, and the fifth case, the antigen was detected in the donor. At last follow-up, all patients were enjoying functioning grafts without recurrence of BK virus infection. CONCLUSIONS Polyoma BK virus-positive people can be accepted safely for kidney donation, especially with a possible protective role of human leukocyte antigen Cw7.
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Affiliation(s)
- Osama Gheith
- From the Department of Internal Medicine and Nephrology, Organ Transplant Center, Ibn-Sina Hospital, Kuwait
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23
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Huang G, Wang CX, Zhang L, Fei JG, Deng SX, Qiu J, Li J, Chen GD, Fu Q, Chen LZ. Monitoring of polyomavirus BK replication and impact of preemptive immunosuppression reduction in renal-transplant recipients in China: a 5-year single-center analysis. Diagn Microbiol Infect Dis 2014. [PMID: 25445121 DOI: 10.1016/diagnmicrobio.2014.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This provides the long-term patient/graft survival and outcome of BK viremia and BK virus allograft nephropathy (BKVAN) in renal transplant recipients in the setting of intensive monitoring and preemptive of reduction of immunosuppression. Quantitative BKV DNA PCR and urinary cytology surveillance were performed regularly after transplantation in 229 kidney recipients. Patients with BK viremia and BKVAN were treated with 30-50% reduction in doses of tacrolimus and/or mycophenolate mofetil and were monitored for BKV every 3-6 months. All the patients were followed for 5 years. Overall 5-year patient and graft survival were 95.6% and 92.1%, respectively, and independent of presence of decoy cells, BK viruria, viremia, or BKVAN. After reduction of immunosuppression, BK viremia (n = 38) resolved in 100% of patients, without increased acute rejection. Recurrent BK viremia was not observed in viremic patients without BKVAN (n = 30). All BKVAN patients (n = 7, 3.1%) cleared viremia with a mean time of 5.9 months (range 1-15 months) and manifested no decline in estimated glomerular filtration rate from 1 month to 5 years after transplantation. Viral monitoring and preemptive reduction of immunosuppression resulted in the successful resolution of BK viremia and BKVAN with excellent graft survival and renal function at 5 years.
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Affiliation(s)
- Gang Huang
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Chang-xi Wang
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Lei Zhang
- Department of Kidney Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, 510260
| | - Ji-guang Fei
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Su-xiong Deng
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Jiang Qiu
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Jun Li
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Guo-dong Chen
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Qian Fu
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080
| | - Li-zhong Chen
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080.
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24
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Gökçe M, Akçay A, Tuğcu D, Erdemir M, Mirasoğlu B. Hyperbaric oxygen therapy for hemorrhagic cystitis. EXP CLIN TRANSPLANT 2014; 12:279-280. [PMID: 24907729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Müge Gökçe
- Pediatric Hematology-Oncology Division, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
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25
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Rech MA, Fleming JN, Moore CL. 25-hydroxyvitamin D deficiency and opportunistic viral infections after kidney transplant. EXP CLIN TRANSPLANT 2014; 12:95-100. [PMID: 24702139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Vitamin D may modulate immune function. The purpose of this study was to evaluate the association of 25-hydroxyvitamin D level at kidney transplant with outcomes after transplant, including opportunistic viral infections (cytomegalovirus infection and BK viremia), acute allograft rejection, and delayed graft function. MATERIALS AND METHODS A retrospective review was performed in kidney transplant recipients who had 25-hydroxyvitamin D levels drawn within 30 days before or after of transplant from January 2004 to May 2009 at Henry Ford Hospital and who were followed for 1 year after transplant. RESULTS There were 89 patients included in the study (mean age, 51 ± 14 y; male, 66%; African American, 49%; living-donor transplant, 26%). There was a significantly lower frequency of opportunistic viral infections in the vitamin D sufficient group (3 patients, 12%) than vitamin D insufficient group (24 patients, 38%; P ≤ .01). Multivariate analysis showed that male sex and vitamin D insufficiency were independently associated with increased incidence of opportunistic viral infection. CONCLUSIONS In kidney transplant recipients, male sex and vitamin D insufficiency are independently associated with increased incidence of opportunistic viral infection. The risk of developing opportunistic viral infections after kidney transplant may be modified by ensuring adequate 25-hydroxyvitamin D levels before transplant.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
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26
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Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR. Prospective study of BK virus infection and nephropathy during the first year after kidney transplantation. Iran J Kidney Dis 2014; 8:145-151. [PMID: 24685738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence and severity of BK virus infection, BK virus nephritis, and related risk factors among kidney transplant recipients. MATERIALS AND METHODS BK viremia during the first year of kidney transplantation was assessed prospectively in 32 successive recipients. BK virus DNA was extracted and determined in all samples by real-time polymerase reaction assay for 1 year after kidney transplantation. RESULTS The mean age of the patients was 33.3 ± 15.3 years. Sixteen patients (50%) received antithymocyte globulin for induction therapy. Living donor transplant consisted of 75% of the kidney donations. Maintenance immunosuppressive therapy included cyclosporine A in 27 patients (84.4%), plus tapering prednisolone and mycophenolate mofetil. BK viremia was detected in 8 patients (25%). The highest detected plasma viral load was less than 4000 copies per milliliter. BK virus was respectively positive in 5 (62.5%), 2 (25%), and 1 (12.5%) patients during the first 4, 8, and 12 months after transplantation. Biopsy-proven rejection and antirejection therapy by methylprednisolone pulses were 5 and 2.3 times more common in patients with BK virus infection (P = .01 and P = .01), respectively. CONCLUSIONS Despite occurrence of BK virus infection in 25% of our patients, BK nephropathy did not develop in any of them. Routine screening of BK virus infection, particularly in centers with low prevalence of BK virus nephritis, may not be cost effective for predicting this disease.
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27
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Kudose S, Dong J. Clinical validation study of quantitative real-time PCR assay for detection and monitoring of BK virus nephropathy. Ann Clin Lab Sci 2014; 44:455-460. [PMID: 25361932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BK virus (BKV) causes nephropathy (BKVN) in renal transplant patients, but monitoring of BKV loads provides an opportunity to prevent BKVN. However, because viral load measurement is not standardized, each laboratory must validate their methodology. We performed a retrospective analysis of 1371 plasma and 600 urine BKV loads measured by the laboratory developed real-time polymerase chain reaction (RT-PCR) of BKV DNA and 346 biopsies from 284 patients in our renal transplant program. We assessed the ability of plasma and urine viral loads to predict the presence of BKVN in biopsy using the receiver-operator characteristic curve. We determined that the cut-offs 3.7 and 7.2 log copies/ml have the best sensitivity (100% and 100%) and specificity (97.6% and 97.5%) for the detection of concurrent biopsy with BKVN by plasma and urine viral load, respectively. Also, we determined that the presence of at least two viral loads greater than 2.8 log copies/ml for plasma and 6.4 log copies/ml for urine within 30 days of biopsy can detect BKVN with similar operating characteristics. Lastly, among pairs of urine and plasma viral loads from the same day, we found that 375 of 376 urine viral loads <4 log copies/ml were accompanied by plasma viral loads <2.6 log copies/ml, a finding which can alleviate the need for plasma viral load for most patients. In summary, our RT-PCR of BKV DNA has good operating characteristics, and our findings above can help in development of a better strategy to monitor BKV.
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Affiliation(s)
- Satoru Kudose
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jianli Dong
- Departments of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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28
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Humar A, Gill J, Johnston O, Fergusson D, House AA, Lebel L, Cockfield S, Kim SJ, Zaltzman J, Cantarovich M, Karpinski M, Ramsay T, Knoll GA. Quinolone prophylaxis for the prevention of BK virus infection in kidney transplantation: study protocol for a randomized controlled trial. Trials 2013; 14:185. [PMID: 23800312 PMCID: PMC3691619 DOI: 10.1186/1745-6215-14-185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/06/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND BK virus infection has emerged as a major complication in kidney transplantation leading to a significant reduction in graft survival. There are currently no proven strategies to prevent or treat BK virus infection. Quinolone antibiotics, such as levofloxacin, have demonstrated activity against BK virus. We hypothesize that administration of a quinolone antibiotic, when given early post-transplantation, will prevent the establishment of BK viral replication in the urine and thus prevent systemic BK virus infection. METHODS/DESIGN The aim of this pilot trial is to assess the efficacy, safety and feasibility of a 3-month course of levofloxacin in the kidney transplant population. This is a multicenter, randomized, double-blind, placebo-controlled trial with two parallel arms conducted in 11 Canadian kidney transplant centers. A total of 154 patients with end-stage renal disease undergoing kidney transplantation will be randomized to receive a 3-month course of levofloxacin or placebo starting in the early post-transplant period. Levofloxacin will be administered at 500 mg po daily with dose adjustments based on kidney function. The primary outcome will be the time to occurrence of BK viruria within the first year post-transplantation. Secondary outcomes include BK viremia, measures of safety (adverse events, resistant infections,Clostridium difficile-associated diarrhea), measures of feasibility (proportion of transplanted patients recruited into the trial), proportion of patients adherent to the protocol, patient drop-out and loss to follow-up,and use of quinolone antibiotics outside of the trial protocol. DISCUSSION Results from this pilot study will provide vital information to design and conduct a large, multicenter trial to determine if quinolone therapy decreases clinically meaningful outcomes in kidney transplantation. If levofloxacin significantly reduces BK viruria and urine viral loads in kidney transplantation, it will provide important justification to progress to the larger trial. If the full trial shows that levofloxacin significantly reduces BK infection and improves outcomes, its use in kidney transplantation will be strongly endorsed given the lack of proven therapies for this condition. TRIAL REGISTRATION This trial was funded by the Canadian Institutes of Health Research (grant number:222493) and is registered at ClinicalTrials.gov (NCT01353339).
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Affiliation(s)
- Atul Humar
- Department of Medicine, Faculty of Medicine & Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - John Gill
- Department of Medicine, St Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Olwyn Johnston
- Department of Medicine, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Andrew A House
- Department of Medicine, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Louise Lebel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Sandra Cockfield
- Department of Medicine, Faculty of Medicine & Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - S Joseph Kim
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Jeff Zaltzman
- Department of Medicine, St Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Marcelo Cantarovich
- Department of Medicine, McGill University Health Center, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada
| | - Martin Karpinski
- Department of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3T 2N2, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Greg A Knoll
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, ON K1H 7W9, Canada
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Abstract
For almost 40 years, polyomavirus JC and BK were the only known human polyomaviruses but in the last 7 years, increased interest and innovative molecular screening techniques have led to the identification of 10 previously unknown polyomaviruses in humans. Two of these, Merkel cell polyomavirus and Trichodysplasia spinulosa polyomavirus, have also been found to cause disease in immunocompromised patients. Seroprevalence studies indicate that human polyomaviruses are transmitted independently of one another in humans and carry different risks of exposure and reexposure throughout life. The potential coexistence of 12 or more different polyomavirus species in the same host and possibly even in the same organ raises the question of potential interactions. Careful review of polyomavirus biology may facilitate new discoveries concerning these formerly underestimated viral agents and their influence on human health.
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30
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Abstract
BK polyomavirus (BKPyV) is a small double-stranded DNA virus that is an emerging pathogen in immunocompromised individuals. BKPyV is widespread in the general population, but primarily causes disease when immune suppression leads to reactivation of latent virus. Polyomavirus-associated nephropathy and hemorrhagic cystitis in renal and bone marrow transplant patients, respectively, are the most common diseases associated with BKPyV reactivation and lytic infection. In this review, we discuss the clinical relevance, effects on the host, virus life cycle, and current treatment protocols.
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Affiliation(s)
- Shauna M. Bennett
- Program in Cellular and Molecular Biology, University of Michigan Medical School, 1150 West Medical Center Drive, 5724 Medical Science II, Ann Arbor, MI 48109-5620, USA
| | - Nicole M. Broekema
- Department of Microbiology and Immunology, University of Michigan Medical School, 1150 West Medical Center Drive, 5724 Medical Science II, Ann Arbor, MI 48109-5620, USA
| | - Michael J. Imperiale
- Program in Cellular and Molecular Biology, University of Michigan Medical School, 1150 West Medical Center Drive, 5724 Medical Science II, Ann Arbor, MI 48109-5620, USA
- Department of Microbiology and Immunology, University of Michigan Medical School, 1150 West Medical Center Drive, 5724 Medical Science II, Ann Arbor, MI 48109-5620, USA
- Comprehensive Cancer Center University of Michigan Medical School, 1150 West Medical Center Drive, 5724 Medical Science II, Ann Arbor, MI 48109-5620, USA
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31
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Delbue S, Comar M, Ferrante P. Review on the relationship between human polyomaviruses-associated tumors and host immune system. Clin Dev Immunol 2012; 2012:542092. [PMID: 22489251 PMCID: PMC3318214 DOI: 10.1155/2012/542092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/11/2012] [Indexed: 02/05/2023]
Abstract
The polyomaviruses are small DNA viruses that can establish latency in the human host. The name polyomavirus is derived from the Greek roots poly-, which means "many," and -oma, which means "tumours." These viruses were originally isolated in mouse (mPyV) and in monkey (SV40). In 1971, the first human polyomaviruses BK and JC were isolated and subsequently demonstrated to be ubiquitous in the human population. To date, at least nine members of the Polyomaviridae family have been identified, some of them playing an etiological role in malignancies in immunosuppressed patients. Here, we describe the biology of human polyomaviruses, their nonmalignant and malignant potentials ability, and their relationship with the host immune response.
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Affiliation(s)
- Serena Delbue
- Laboratory of Transkìlational Research, Health Science Foundation Ettore Sansavini, Corso Garibaldi, 11-48022 Lugo, Italy.
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Ribeiro A, Wörnle M, Motamedi N, Anders HJ, Gröne EF, Nitschko H, Kurktschiev P, Debiec H, Kretzler M, Cohen CD, Gröne HJ, Schlöndorff D, Schmid H. Activation of innate immune defense mechanisms contributes to polyomavirus BK-associated nephropathy. Kidney Int 2012; 81:100-11. [PMID: 21918500 DOI: 10.1038/ki.2011.311] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Polyomavirus-associated nephropathy (PVAN) is a significant complication after kidney transplantation, often leading to premature graft loss. In order to identify antiviral responses of the renal tubular epithelium, we studied activation of the viral DNA and the double-stranded RNA (dsRNA) sensors Toll-like receptor 3 (TLR3) and retinoic acid inducible gene-I (RIG-I) in allograft biopsy samples of patients with PVAN, and in human collecting duct cells in culture after stimulation by the dsRNA mimic polyriboinosinic:polyribocytidylic acid (poly(I:C)), cytokines, or infection with BK virus. Double staining using immunofluorescence for BK virus and TLR3 showed strong signals in epithelial cells of distal cortical tubules and the collecting duct. In biopsies microdissected to isolate tubulointerstitial lesions, TLR3 but not RIG-I mRNA expression was found to be increased in PVAN. Collecting duct cells in culture expressed TLR3 intracellularly, and activation of TLR3 and RIG-I by poly(I:C) enhanced expression of cytokine, chemokine, and IFN-β mRNA. This inflammatory response could be specifically blocked by siRNA to TLR3. Finally, infection of the collecting duct cells with BK virus enhanced the expression of cytokines and chemokines. This led to an efficient antiviral immune response with TLR3 and RIG-I upregulation without activation of IL-1β or components of the inflammasome pathway. Thus, PVAN activation of innate immune defense mechanisms through TLR3 is involved in the antiviral and anti-inflammatory response leading to the expression of proinflammatory cytokines and chemokines.
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Affiliation(s)
- Andrea Ribeiro
- Medizinische Poliklinik Campus Innenstadt, Klinikum der LMU, Munich, Germany
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Mihatsch MJ. Polyomavirus nephropathy: a brief review with special emphasis on clinico-patholgical aspects. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2012; 33:5-22. [PMID: 23425866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
From 1995 Polyomavirus (PyV) nephropathy (PVN) has played an important role in solid organ transplant recipients. The disease is caused by a DNA virus, usually the BK variant, more rarely JC virus. In immune incompetent patients either latent endogenous virus is reactivated, or donated virus can multiply. The frequency of PVN nephropathy (previously 10% or higher) is declining. The disease follows a stepwise course: viruria, viraemia, nephropathy. Nephropathy usually manifests itself during the first year after transplantation. The disease remains clinically silent for long periods, later progressive loss of renal function and renal failure occur. A major risk factor is therapy with potent immune suppressive agents. Morphologically, viral replication produces nuclear inclusions and necrosis, predominantly in the urothelium and tubular epithelium. Inflammation (T and B lymphocytes, monocytes/macrophages and granulocytes) accompanies necrosis. Progression is marked by tubular atrophy, interstitial fibrosis and transplant loss. The virus can be detected by the electron microscope and, better, by immunohistology (preferentially mAb against SV40 Large T antigen). It is often hard to differentiate PVN from an interstitial cellular rejection reaction (Banff 1 A/B). As no effective drug treatment exists, the disease must be diagnosed as early as possible and immune suppression reduced. Screening for polyomavirus reactivation is best done stepwise: search for urinary "Decoy cells" (PyV infected cells), PCR for PyV in the blood and in the case of reduced renal function, renal biopsy. Compliance with a stringent screening algorithm allows early detection and adequate treatment and prevents organ loss.
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Affiliation(s)
- M J Mihatsch
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
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Maia TMC, Silva SFR, Silva SL, Holanda MC, Nascimento JM, Ferreira MVP. Polyomavirus-infected decoy cells in cytocentrifuged urine cytology specimens from renal transplant recipients. Acta Cytol 2011; 55:445-8. [PMID: 21986172 DOI: 10.1159/000329625] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 05/24/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the prevalence of BK virus (BKV) infection in renal transplant recipients based on the detection of urinary decoy cells. METHODS Fifty transplantation patients (56% males) aged 39.9 ± 11 years were screened for urinary decoy cells. The majority (86%) had received grafts from living donors. The inclusion criteria were graft dysfunction, hematuria, and/or leukocyturia. Creatinine and urea serum levels were monitored for 6 months. RESULTS Decoy cells were found in the urine of 12 (24%) patients 1-2 years after transplantation. The immunosuppression regimens most frequently adopted by BKV-positive patients were cyclosporine + azathiprine (50%) and FK + mycophenolate mofetyl + prednisone (25%). A renal biopsy revealed normal structures in 7 patients (58.4%), BKV nephropathy with lymphomononuclear infiltrate and fibrosis in 4 patients (33.3%), and acute cellular rejection with lymphomononuclear infiltrate without fibrosis in 1 patient (8.3%). In the latter patient, BKV-associated nephropathy was confirmed by immunohistochemistry. During the first month, creatinine and urea serum levels were higher among patients with urinary decoy cells. Creatinine levels decreased between the first and the sixth months. CONCLUSION The finding of BKV-associated nephropathy in 33.3% of the patients with urinary decoy cells stresses the importance of screening for BKV with urinary cytology.
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Affiliation(s)
- T M C Maia
- Federal University of Ceará, Fortaleza, Brazil.
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35
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Vanikar AV, Shah PR, Trivedi HL. B.K. polyoma virus nephropathy in renal allograft recipient. Saudi J Kidney Dis Transpl 2011; 22:136-138. [PMID: 21196631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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36
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Derakhshan N, Derakhshan D, Torabinejad S, Derakhshan A. Nephritic-nephrotic syndrome as a presentation of BK virus infection. Saudi J Kidney Dis Transpl 2011; 22:123-125. [PMID: 21196627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BK virus (BKV) is increasingly found as an important cause of allograft nephropathy. Nephrotic syndrome is not a usual manifestation of BKV nephropathy. Here, we report a 12-year-old boy, a case of end-stage renal disease due to nephronophthisis, who got the kidney transplanted from a 16-year-old cadaver, and after 18 months of uneventful transplantation on triple immunosuppressive therapy (mycophenolate mofetil (MMF), cyclosporin and prednisolone), presented with nephrotic feature (edema, heavy proteinuria, hypoalbuminemia and hyperlipidemia). Kidney biopsy was in favor of BKV infection and eventually ended in graft failure.
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Affiliation(s)
- Nima Derakhshan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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37
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Soleymanian T, Rasulzadegan MH, Sotoodeh M, Ganji MR, Naderi G, Amin M, Saddadi F, Hakemi M, Najafi I. Low prevalence of BK virus nephropathy on nonprotocol renal biopsies in Iranian kidney transplant recipients: one center's experience and review of the literature. EXP CLIN TRANSPLANT 2010; 8:297-302. [PMID: 21143095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES BK virus-associated nephropathy in renal transplant recipients has been increasing in frequency in recent years. This rise is probably because of widespread use of highly potent immunosuppressive regimens, and increased immunosuppression load leads to inability of the recipients to increase a successful antiviral immune response. The incidence of BK virus-associated nephropathy in different reports is between 1% and 10%, with an allograft loss in significant numbers of patients, especially when timely diagnosis and treatment is not restored. We report our experience on BK virus nephropathy in our institute. MATERIALS AND METHODS All renal transplant biopsies performed at our center between 2001 and 2006 were immunohistochemically screened for the presence of PV-specific protein (SV40 Ag). The histologic diagnosis of BK virus-associated nephropathy was made upon the observation of morphologic changes in tubular epithelium and confirmation with immunohistochemical staining. We reviewed the clinical records of the subjects for demographic, clinical, and laboratory data. RESULTS BK virus nephropathy was found in 0.93% of all investigated allograft biopsies (1/108) and in 1.04% of all recipients (1/96; mean age of recipients, 36.48±14.10 years; age range, 13-74 years); 54 of them were male (57%). Type of kidney transplant was living-unrelated donor 76 (79%), living-related donor 13 (14%), and deceased donor 7. Seventeen patients (18%) were transplanted for a second time. Immunosuppressive drugs in 87 of recipients (90%) were cyclosporine, mycophenolate mofetil, and prednisolone. Our patient who developed BK virus-associated nephropathy 9 months after transplant was a 37-year-old man on prednisone, cyclosporine, and azathioprine immunosuppresion. He lost his graft 4 months after diagnosis. CONCLUSIONS Although BK virus nephropathy after renal transplant is uncommon, it is a serious complication causing loss of the allograft. It should be included in the clinical differential diagnosis of transplant dysfunction.
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Affiliation(s)
- Tayebeh Soleymanian
- Department of Nephrology Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Shapiro R, Lunz J, Zeevi A, Basu A, Mapara M, Randhawa P, Tan HP, Sharma V, Humar A. 1.7 year follow-up after bortezomib therapy for refractory antibody mediated rejection. Clin Transpl 2010:405-407. [PMID: 21696058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In summary, 1.7 years after transplantation, bortezomib rescue has been durably effective in salvaging our patient with refractory antibody mediated rejection. The only price has been persistently high levels of BK viruria. The presence of ongoing and even recurrent donor specific antibody has made it difficult to reduce immunosuppression further, and the concern that the high levels of BK viruria will eventually progress to viremia and nephropathy necessitates continued therapy with very low dose cidofovir and leflunomide. The absence of C1q binding DSA with stable renal function may provide some reserved optimism that the DSA that is detectable by convention Luminex assay may have reduced pathological implications. However, more data and prolonged follow-up are needed to determine whether or not non-complement binding DSA has an adverse pathological role.
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Affiliation(s)
- R Shapiro
- Univ of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
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39
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Jeffers LK, Madden V, Webster-Cyriaque J. BK virus has tropism for human salivary gland cells in vitro: implications for transmission. Virology 2009; 394:183-93. [PMID: 19782382 DOI: 10.1016/j.virol.2009.07.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 04/28/2009] [Accepted: 07/14/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND In this study, it was determined that BKV is shed in saliva and an in vitro model system was developed whereby BKV can productively infect both submandibular (HSG) and parotid (HSY) salivary gland cell lines. RESULTS BKV was detected in oral fluids using quantitative real-time PCR (QRTPCR). BKV infection was determined using quantitative RT-PCR, immunofluorescence and immunoblotting assays. The infectivity of BKV was inhibited by pre-incubation of the virus with gangliosides that saturated the major capsid protein, VP1, halting receptor mediated BKV entry into salivary gland cells. Examination of infected cultures by transmission electron microscopy revealed 45-50 nm BK virions clearly visible within the cells. Subsequent to infection, encapsidated BK virus was detected in the supernatant. CONCLUSION We thus demonstrated that BKV was detected in oral fluids and that BK infection and replication occur in vitro in salivary gland cells. These data collectively suggest the potential for BKV oral route of transmission and oral pathogenesis.
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Affiliation(s)
- Liesl K Jeffers
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27599, USA
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40
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Ramaswami B, Popescu I, Macedo C, Metes D, Bueno M, Zeevi A, Shapiro R, Viscidi R, Randhawa PS. HLA-A01-, -A03-, and -A024-binding nanomeric epitopes in polyomavirus BK large T antigen. Hum Immunol 2009; 70:722-8. [PMID: 19446588 DOI: 10.1016/j.humimm.2009.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 05/01/2009] [Accepted: 05/08/2009] [Indexed: 11/19/2022]
Abstract
Polyomavirus BK (BKV) infections are increasingly recognized. The development of immune-monitoring strategies against BKV requires definition of antigenic epitopes. Bioinformatic algorithms were used to identify 60 BKV large T-antigen (LT-Ag) peptides predicted to bind HLA class I alleles. In vitro peptide binding was used to select a subset of 19 peptides for interferon (IFN)-gamma ELISPOT assays in 13 healthy subjects and 12 kidney transplant recipients. Four A01-, nine A03-, and five A24-binding immunogenic peptides were identified in 1 to 3 (14-67%) tested subjects in each group. BKV epitope sequences were identical to homologous JC virus sequences for 3 of 19 peptides and homologous SV40 sequences for 5 of 19 peptides. Homology modeling localized these epitopes to the helicase, origin of DNA binding, or J domains, respectively. In conclusion, we have identified multiple 9-mer BKV LT-Ag-derived immunogenic epitopes that bind HLA-A01, -A03, or -A24 molecules. Sequence alignments indicate that two epitopes, FLICKGVNK and RYWLFKGPI, are common to BKV, JC virus, and SV40 virus.
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MESH Headings
- Adult
- Antigens, Viral, Tumor/genetics
- Antigens, Viral, Tumor/immunology
- Antigens, Viral, Tumor/metabolism
- BK Virus/genetics
- BK Virus/immunology
- BK Virus/pathogenicity
- Cells, Cultured
- Computer Simulation
- Epitope Mapping
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Epitopes, T-Lymphocyte/metabolism
- Female
- Graft Rejection/complications
- Graft Rejection/immunology
- Graft Rejection/pathology
- Graft Rejection/virology
- HLA-A Antigens/metabolism
- Humans
- Interferon-gamma/metabolism
- JC Virus/genetics
- JC Virus/immunology
- Kidney Transplantation
- Lymphocyte Activation
- Male
- Middle Aged
- Peptide Fragments/genetics
- Peptide Fragments/immunology
- Peptide Fragments/metabolism
- Polyomavirus Infections/complications
- Polyomavirus Infections/immunology
- Polyomavirus Infections/pathology
- Polyomavirus Infections/virology
- Protein Binding
- Sequence Alignment
- Simian virus 40/genetics
- Simian virus 40/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/pathology
- Tumor Virus Infections/complications
- Tumor Virus Infections/immunology
- Tumor Virus Infections/pathology
- Tumor Virus Infections/virology
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Affiliation(s)
- Bala Ramaswami
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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41
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Lekakis LJ, Macrinici V, Baraboutis IG, Mitchell B, Howard DS. BK virus nephropathy after allogeneic stem cell transplantation: a case report and literature review. Am J Hematol 2009; 84:243-6. [PMID: 19208419 DOI: 10.1002/ajh.21358] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polyomaviruses are increasingly recognized as important human pathogens. Among those, BK virus has been identified as the main cause of polyomavirus-associated nephropathy (PVAN), a major cause of renal allograft failure. PVAN has also been well described in the setting of non-renal solid organ transplantation. The reports of PVAN after hematopoietic stem cell transplantation (HCT) are surprisingly very few. Here, we describe a patient with treatment-related myelodysplastic syndrome who received an unrelated donor HCT after ablative conditioning and in vivo T cell depletion with alemtuzumab. He developed a biopsy-proven BK nephropathy, which contributed to his renal failure. Leflunomide as well as cidofovir were given at different times, both in combination with intravenous immunoglobulin. Both treatments were effective in reducing the BK viral load, the cystitis symptoms and both stabilized but did not really improved the renal function. The patient was still dialysis-dependent when he died from Pseudomonas sepsis 13 months after HCT. A critical review of the literature and the treatment modalities for post-HCT PVAN are provided.
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MESH Headings
- Antiviral Agents/therapeutic use
- BK Virus/pathogenicity
- Cystitis/etiology
- Cystitis/virology
- Cytomegalovirus Infections/complications
- Fatal Outcome
- Graft vs Host Disease/complications
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hepatorenal Syndrome/etiology
- Humans
- Immunoglobulins, Intravenous
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/therapy
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/surgery
- Male
- Middle Aged
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/surgery
- Nephritis, Interstitial/etiology
- Nephritis, Interstitial/virology
- Polyomavirus Infections/complications
- Polyomavirus Infections/transmission
- Postoperative Complications
- Reoperation
- Tacrolimus/adverse effects
- Transplantation Conditioning/adverse effects
- Transplantation, Autologous
- Transplantation, Homologous/adverse effects
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Affiliation(s)
- Lazaros J Lekakis
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA.
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Weiss AS, Gralla J, Chan L, Klem P, Wiseman AC. Aggressive immunosuppression minimization reduces graft loss following diagnosis of BK virus-associated nephropathy: a comparison of two reduction strategies. Clin J Am Soc Nephrol 2008; 3:1812-9. [PMID: 18650404 PMCID: PMC2572268 DOI: 10.2215/cjn.05691207] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 06/13/2008] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES BK virus-associated nephropathy (BKVAN) has emerged as a leading cause of kidney graft loss, with no known predictors for graft loss and no consensus regarding treatment other than reduction of immunosuppression. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS A single-center retrospective analysis was performed of all cases of BKVAN from 1999 to 2005 for clinical predictors of graft loss, with evaluation of the impact of immunosuppression withdrawal (3-drug to 2-drug immunosuppression) within the first month versus reduction of immunosuppression. RESULTS Of 910 kidney transplants, 35 (3.8%) cases of BKVAN were diagnosed at a median of 15 months after transplant (range, 5.5 to 90 months after transplant), 16 (46%) of which progressed to graft failure at a median of 11 months (range, 2 to 36 months) after diagnosis. Depleting antibody induction was a significant risk factor for graft loss on univariate analysis, whereas early drug withdrawal (<1 mo following diagnosis) protected against graft loss. On multivariate analysis, these findings were independent predictors of graft outcomes. Additionally, when patients were comanaged by referring nephrologists and the transplant center before the diagnosis of BKVAN, the risk of graft loss was 11-fold higher (P = 0.03) than if patients were managed solely by the transplant center. CONCLUSIONS Increased awareness and early diagnosis of BKVAN, with aggressive tapering of immunosuppression once established, is critical to preserve kidney graft function. Early drug withdrawal to low-dose two-drug therapy maintenance may be preferable to a general reduction of agents.
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Affiliation(s)
- Andrew S Weiss
- Division of Renal Diseases and Hypertension, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
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43
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Seemayer CA, Seemayer NH, Dürmüller U, Gudat F, Schaub S, Hirsch HH, Mihatsch MJ. BK virus large T and VP-1 expression in infected human renal allografts. Nephrol Dial Transplant 2008; 23:3752-61. [PMID: 18784088 PMCID: PMC2639064 DOI: 10.1093/ndt/gfn470] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We investigated the expression of early and late phase BK virus (BKV) proteins and their interactions with host cell proteins in renal allografts, with ongoing polyomavirus associated nephropathy (PVAN), and correlated this with the nuclear and cell morphology. METHODS Frozen sections from three patients with renal allografts (two biopsies, one explant) with PVAN were analysed by indirect immunofluorescence using BKV specific anti-polyoma large T-antigen and anti-VP-1 antibodies, as well as anti-p53, anti-Ki67, anti-caspase-3, anti-bcl2 and anti-cytokeratin 22 antibodies. Nuclear morphology and size were estimated by DNA Hoechst staining. RESULTS In infected tubular cells the early and late phases of infection could be distinguished according to expression of large T-antigen or VP-1. The early phase revealed almost normal nuclear proportions, whereas in later phases nuclear size increased about 2 to 3 fold. Expression of large T-antigen was strongly associated with accumulation of p53 in the nucleus, accompanied by the activation of the cell cycle associated cell protein Ki67. In contrast, expression of BKV VP1 correlated only weakly with p53. Virus dependent cell lysis was due to necrosis, since neither caspase 3 nor nuclear nor cytoskeleton changes indicated apoptosis. CONCLUSION In our selected patients with PVAN a clear distinction between early and late phases was possible, according to the protein expression patterns of BKV markers. Striking nuclear enlargement is only present in the late phase of infection. In the inflammatory setting of PVAN, BKV dependent effects appear to be mediated by the inhibition of p53, resulting in the activation of the cell cycle. We assume that in PVAN similar BKV mechanisms are operative as in certain in vitro systems.
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Affiliation(s)
- Christian A. Seemayer
- Institute for Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4003 Basel, Switzerland
| | - Norbert H. Seemayer
- Institute of Virology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany
| | - Ursula Dürmüller
- Institute for Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4003 Basel, Switzerland
| | - Fred Gudat
- Institute for Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4003 Basel, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Baseland
| | - Hans H. Hirsch
- Transplantation Virology, Medical Microbiology, University of Basel, CH-4003 Basel, Switzerland
| | - Michael J. Mihatsch
- Institute for Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4003 Basel, Switzerland
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44
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Abend JR, Imperiale MJ. Transforming growth factor-beta-mediated regulation of BK virus gene expression. Virology 2008; 378:6-12. [PMID: 18559281 PMCID: PMC2569840 DOI: 10.1016/j.virol.2008.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 11/14/2007] [Accepted: 05/14/2008] [Indexed: 12/12/2022]
Abstract
The increasing prevalence of BK virus (BKV)-associated diseases in immunosuppressed patients has prompted an investigation of the immune response to BKV, especially the role of cytokines in regulating viral replication. We examined the effect of TGF-beta, a cytokine that is stimulated by certain immunosuppressive therapies, on BKV gene expression during lytic infection of renal proximal tubule epithelial cells. Viral gene expression, and specifically the activity of the BKV early promoter, is regulated by TGF-beta in a strain-dependent manner. Promoter activity is upregulated in the presence of TGF-beta for the TU strain of BKV, and not for the Dik, Dunlop, or Proto-2 strains. Using site-directed mutagenesis, we have identified a small segment of the TU promoter that is required for stimulation in response to TGF-beta. These results demonstrate that BKV strains can respond differently to cytokine treatment and suggest that TGF-beta may play a role in the reactivation of BKV.
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Affiliation(s)
- Johanna R. Abend
- Department of Microbiology and Immunology, and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Michael J. Imperiale
- Department of Microbiology and Immunology, and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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45
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Bohl DL, Brennan DC, Ryschkewitsch C, Gaudreault-Keener M, Major EO, Storch GA. BK virus antibody titers and intensity of infections after renal transplantation. J Clin Virol 2008; 43:184-9. [PMID: 18676176 DOI: 10.1016/j.jcv.2008.06.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/29/2008] [Accepted: 06/03/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND The mean urine BK viral load in kidney transplant recipients increases with the intensity of infection as the infection progresses from transient viruria to sustained viremia. OBJECTIVES This study investigated whether the intensity of infection is associated with the humoral immune response. STUDY DESIGN We measured BKV-specific IgG antibody titers in stored samples obtained serially over a 1-year period from 70 kidney transplant recipients with BKV infection and 17 control recipients without active BKV infection. RESULTS The mean pre-transplant BKV antibody level was lower in recipients who developed viremia than the mean level in those who never developed viremia (p=0.004). Mean antibody titers in recipients who never showed evidence of active BKV infection rose slightly after transplant despite immunosuppression. The magnitude of the rise in the mean antibody titers in recipients who developed active BKV infection correlated with the intensity of infection (p<0.001). CONCLUSIONS The mean antibody level increased in accordance with the intensity of the infection post-transplant. Pre-transplant seropositivity did not protect against sustained viremia and the antibody response was not associated with clearance of the virus.
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Affiliation(s)
- Daniel L Bohl
- Washington University School of Medicine, Department of Internal Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, United States
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Yuste RS, Frías C, López A, Vallejo C, Martín P, Bellas C. Diagnostic value of JC/BK virus antibody immunohistochemistry staining in urine samples from posttransplant immunosuppressed patients in relation to polyomavirus reactivation. Acta Cytol 2008; 52:191-5. [PMID: 18499992 DOI: 10.1159/000325478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the diagnostic value of cytology and immunohistochemistry staining (IHS) of urine samples for polyomavirus reactivation diagnosis. STUDY DESIGN Sixty-eight urine samples collected from 18 immunosuppressed patients were analyzed by Papanicolaou and IHS with a JC/BK virus-specific monoclonal antibody. RESULTS Overall, polyomavirus BK (BKV) was positive in 11 of 18 patients (61.1%) (3 of whom developed hemorrhagic cystitis) and in 23 of 68 urine samples (28%). Of 23 samples, 4 (17%) were positive by 1 of the 2 techniques, only. Of 23 samples, 19 (83%) were positive by both methods. In matching urine samples from the same patient, the number of BKV-infected positive cells detected by IHS in urine slides was higher than those detected by Papanicolaou staining (71.3%). CONCLUSION The main advantage of LHS is that it allowed confirmation of BKV infection diagnosis in urine samples. IHS detected more BKV-infected cells in samples with few positive urothelial cells, which would have gone undetected if only Papanicolaou staining had been used as the BKV screening method. Urine samples testing for BKV by both techniques will improve diagnosis in asymptomatic patients, allowing early therapeutic intervention and a better clinical outcome.
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Affiliation(s)
- Rosario Sanchez Yuste
- Department of Pathology, Hospital Universitario Clínica Puerta de Hierro, Madrid, Spain
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Abstract
Nephropathy from BK virus (BKV) infection is an evolving challenge in kidney transplant recipients. It is the consequence of modern potent immunosuppression aimed at reducing acute rejection and improving allograft survival. Untreated BKV infections lead to kidney allograft dysfunction or loss. Decreased immunosuppression is the principle treatment but predisposes to acute and chronic rejection. Screening protocols for early detection and prevention of symptomatic BKV nephropathy have improved outcomes. Although no approved antiviral drug is available, leflunomide, cidofovir, quinolones, and intravenous Ig have been used. Retransplantation after BKV nephropathy has been successful.
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Affiliation(s)
- Daniel L Bohl
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Viscount HB, Eid AJ, Espy MJ, Griffin MD, Thomsen KM, Harmsen WS, Razonable RR, Smith TF. Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy. Transplantation 2007; 84:340-5. [PMID: 17700158 DOI: 10.1097/01.tp.0000275205.41078.51] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24%, 9%, and 13% of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5%) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100% sensitivity, 96% specificity, 50% positive predictive value, and 100% negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100% sensitivity, 92% specificity, 31% positive predictive value, and 100% negative predictive value. In contrast, urine decoy cells had 25% sensitivity, 84% specificity, 5% positive predictive value, and 97% negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.
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Affiliation(s)
- Helen B Viscount
- Division of Clinical Microbiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Abstract
BK virus (BKV) exhibits many oncogenic properties and has been associated with a variety of tumors in humans. BKV has not been well studied in the context of prostate neoplasia; however, an association of BKV with prostatic adenocarcinoma has been suggested based on the detection of viral DNA sequences and expression of viral proteins in clinical samples. To further investigate the reported association of BKV with prostatic adenocarcinoma and the potential role of the virus in prostate tumorigenesis, 30 cases of adenocarcinoma of the prostate were analyzed for evidence of BKV infection by in situ hybridization and immunohistochemistry. In situ hybridization analysis detected BKV DNA in 2 of 30 (7%) prostatic adenocarcinomas, with positive signals focally identified in less than 1% of the neoplastic cells in both cases. However, none of the tumors evaluated demonstrated evidence of BKV large tumor antigen expression by immunohistochemistry. Among prostatic adenocarcinomas that showed no evidence of BKV infection, BKV DNA was focally observed in the adjacent non-neoplastic prostate tissue in four cases by in situ hybridization in the absence of BKV large tumor antigen immunoreactivity. The findings of the present study indicate rare cases of prostatic adenocarcinoma may be associated with BKV infection. However, lack of localization of BKV to a large population of the neoplastic cells and absence of BKV large tumor antigen expression suggest that the virus does not play a role in the pathogenesis of prostate cancer.
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Affiliation(s)
- Sean K Lau
- Department of Pathology, Beckman Research Institute, City of Hope National Medical Center, Duarte, California 91010, USA.
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Abstract
Primary contact with the human polyomaviruses (HPV) is followed by lifelong persistence of viral DNA in its host. The most prominent organs affected are the kidney, the Central Nervous System (CNS)and the hematopoietic system. Under impairment of immune competence limited activation of virus infection can be followed by prolonged virus multiplication, severe destruction of tissue and disease. The mechanisms responsible for activation episodes of the asymptomatic persistent infection are not understood and questions on cellular localization, routes of dissemination of HPV infection and its activation are controversially discussed. The type of interaction of HPVs with target organs and patients groups is highly differentiated. Organ-specific activation above basic level argues for strong dependence on the respective immune states of risk group patients. However, since immune impairment generally plays an important role in the activation of polyomavirus infection, amplification of virus deoxyribonucleic acid (DNA) and activation of virus replication is also a normal event that is probably subject to immunomodulation in the healthy individual. It also becomes clear that BKV and JCV infection is differentially regulated by mechanisms depending on the balance of immune control as well as on organ-specific signalling.
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Affiliation(s)
- Kristina Doerries
- Institute for Virology and Immunobiology, University of Wuerzburg, Germany
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