Reactivation of BK polyomavirus in patients with multiple sclerosis receiving natalizumab therapy.
AuthorsLonergan, Roisin M
Carr, Michael J
De Gascun, Cillian F
Costelloe, Lisa F
Hutchinson, Michael W
Hall, William W
Tubridy, Niall J
AffiliationDepartment of Neurology, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. email@example.com
Antibodies, Monoclonal/administration & dosage/*adverse effects
Antibodies, Monoclonal, Humanized
Molecular Sequence Data
*Multiple Sclerosis, Relapsing-Remitting/complications/drug therapy/immunology
Tumor Virus Infections/complications/*immunology/virology
MetadataShow full item record
CitationJ Neurovirol. 2009 Sep;15(5-6):351-9.
JournalJournal of neurovirology
AbstractNatalizumab therapy in multiple sclerosis has been associated with JC polyomavirus-induced progressive multifocal leucoencephalopathy. We hypothesized that natalizumab may also lead to reactivation of BK, a related human polyomavirus capable of causing morbidity in immunosuppressed groups. Patients with relapsing remitting multiple sclerosis treated with natalizumab were prospectively monitored for reactivation of BK virus in blood and urine samples, and for evidence of associated renal dysfunction. In this cohort, JC and BK DNA in blood and urine; cytomegalovirus (CMV) DNA in blood and urine; CD4 and CD8 T-lymphocyte counts and ratios in peripheral blood; and renal function were monitored at regular intervals. BK subtyping and noncoding control region sequencing was performed on samples demonstrating reactivation. Prior to commencement of natalizumab therapy, 3 of 36 patients with multiple sclerosis (8.3%) had BK viruria and BK reactivation occurred in 12 of 54 patients (22.2%). BK viruria was transient in 7, continuous in 2 patients, and persistent viruria was associated with transient viremia. Concomitant JC and CMV viral loads were undetectable. CD4:CD8 ratios fluctuated, but absolute CD4 counts did not fall below normal limits. In four of seven patients with BK virus reactivation, transient reductions in CD4 counts were observed at onset of BK viruria: these resolved in three of four patients on resuppression of BK replication. No renal dysfunction was observed in the cohort. BK virus reactivation can occur during natalizumab therapy; however, the significance in the absence of renal dysfunction is unclear. We propose regular monitoring for BK reactivation or at least for evidence of renal dysfunction in patients receiving natalizumab.
- Asymptomatic reactivation of JC virus in patients treated with natalizumab.
- Authors: Chen Y, Bord E, Tompkins T, Miller J, Tan CS, Kinkel RP, Stein MC, Viscidi RP, Ngo LH, Koralnik IJ
- Issue date: 2009 Sep 10
- JCV detection in multiple sclerosis patients treated with natalizumab.
- Authors: Sadiq SA, Puccio LM, Brydon EW
- Issue date: 2010 Jun
- BK viruria and viremia in children with systemic lupus erythematosus.
- Authors: Gupta N, Nguyen CQ, Modica RF, Elder ME, Garin EH
- Issue date: 2017 Apr 11
- No evidence of JC virus reactivation in natalizumab treated multiple sclerosis patients: an 18 month follow-up study.
- Authors: Rinaldi L, Rinaldi F, Perini P, Calabrese M, Seppi D, Grossi P, Mattisi I, Barzon L, Mengoli C, Sanzari M, Palú G, Gallo P
- Issue date: 2010 Dec
- Detection of BK virus and JC virus DNA in urine samples from immunocompromised (HIV-infected) and immunocompetent (HIV-non-infected) patients using polymerase chain reaction and microplate hybridisation.
- Authors: Behzad-Behbahani A, Klapper PE, Vallely PJ, Cleator GM, Khoo SH
- Issue date: 2004 Apr