Impact of Combined Acute Rejection on BK Virus-Associated Nephropathy in Kidney Transplantation

BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.

Polyoma BK virus: an emerging opportunistic infectious agent of the human central nervous system

BK virus, a double-stranded DNA virus, is a member of the Polyomaviridae family which is known to infect humans. Clinical evidence of disease is mostly encountered in immunosuppressed individuals such as AIDS patients or those who undergo renal or bone marrow transplantation where complications associated with BKV infection manifest commonly as a polyomavirus nephropathy or hemorrhagic cystitis, respectively. Recent evidence suggests that in addition to the JC virus (the other member of the same family known to be strongly neurotropic and responsible for the progressive multifocal leukoencephalopathy), BK virus can infect and cause clinically relevant disease in the human central nervous system. In this mini-review, an analysis of the literature is made. A special focus is given to alert clinicians to the possibility of this association during the differential diagnosis of infections of the central nervous system in the immunocompromised host.

Enhancement of thermal effect in virally infected mammalian cells in vitro and its modification by chlorpromazine.

NIH/3T3 cells chronically infected with Moloney murine leukemia virus (M-MuLV) were more thermosensitive than uninfected cells. Cells upregulated by a primary dose of heat formed giant colonies and had an altered response to a second dose of heat. Thermosensitivity depended upon the time elapsed between heat treatments. Heating the cells at either 42 degrees or 42.5 degrees C yielded biphasic survival curves, indicating a mixed population of productively infected and quiescent cells. Hyperthermia at 43 degrees C abolished this effect. Thermal sensitivity of infected cells was correlated with the expression of a viral reporter protein. Chlorpromazine (CPZ), a membrane active drug potentiated the heat effect in both uninfected and virally infected cells. The drug also abolished the biphasic effect of heat in infected cells, suggesting that heat sensitivity of both productively and quiescent cells is membrane mediated. The combined effect of heat at 42.5 degrees C and CPZ was equivalent to the effect of heat alone at 43.5 degrees C. These observations indicate that heat can selectively be lethal to productively infected cells and the membrane active drugs could further amplify this hyperthermic effect.

Tratamento da infecçåo cérvico-vaginal por papilomavírus humano (HPV): estudo aleatorizado com quatro fármacos / Therapeutic of cervicovaginal human papillomavirus infection randomized study with four drugs

Com o objetivo de estabelecer o melhor tratamento para o condiloma plano viral, compararam-se os resultados terapêuticos da podofilina gel 2 por dento, podofilina 4 por dento, gel do ácido metacresol-sulfônico e 5-fluorouracil-creme a 5 por cento, em estudo aleatorizado, cego, de 254 mulheres no período de janeiro/88 a março/91. O grupo controlenåo recebeu qualquer medicamento. No transcorrer do estudo, 110 pacientes foram excluídas por nåo satisfazerem às exigências do protocolo. Utilizaram-se os métodos colposcópico, citológico e histopatológico para o diagnóstico da infecçåo e controle de tratamento. O critério cito-histopatológico adotado foi o proposto por Schneider et al. Os resultados obtidos foram submetidos à análise estatística pelo teste do quiquadrado. Pelos resultados concluiu-se que: 31,3 por cento do grupo controle apresentou remissåo espontânea; o uso do ácido metacresol-sulfônico levou a resultados terapêuticos idênticos aos do grupo controle; a podofilina a 2 por cento nåo se mostrou eficaz; os melhores resultados foram encontrados com a utilizaçåo da posofilina a 4 por cento e 5-fluorouracil (p<0,02); a podofilina a 4 por cento apresentou efeitos adversos de monta, o que contra-indica a sua prescriçåo