Infecção pelo vírus Epstein-Barr em pacientes com lúpus eritematoso sistêmico / Epstein-Barr virus infection in patients with systemic lupus erythematosus

OBJETIVO: Verificar a associação entre a atividade do lúpus eritematoso sistêmico (LES) e a avidez das imunoglobulinas IgG anti-EBV. MÉTODOS: Analisou-se o sangue periférico de 66 pacientes distribuídos em dois grupos: 22 pacientes com LES em atividade e 44 pacientes com doença inativa. A presença e o índice de avidez de anticorpos IgG anti-EBV foram determinados pela técnica ELISA. (Enzygnost anti-EBV - Dade Behring). RESULTADOS: Identificou-se positividade no teste de detecção de IgG para EBV em 21 (95,5 por cento) pacientes do grupo LES ativo e em 40 (90,9 por cento) do grupo LES inativo. O índice de avidez alcançou valores 40 em 54 (88,5 por cento) pacientes, sendo 34 (85 por cento) do grupo LES inativo e 20 (95,2 por cento) do grupo LES ativo; em cinco (12,5 por cento) pacientes do grupo LES inativo, este índice ficou entre 20 e 40 e foi inferior a 20 em dois (3,3 por cento) pacientes. Adotando-se 20, 30 ou 40 como ponto de corte do índice de avidez, para diagnóstico de reativação da infecção por EBV, foram classificados como infecção reativada, nos grupos LES ativo e inativo, respectivamente: 1 (4,8 por cento) x 5 (12,5 por cento) pacientes, 1 (4,8 por cento) x 4 (10 por cento) pacientes e 1 (4,8 por cento) x 5 (12,5 por cento) pacientes. CONCLUSÃO: No presente estudo, não foi demonstrada associação entre a atividade do LES e a reativação do EBV. Esse fato parece indicar que a não eliminação dos linfócitos B infectados se deve à falha no mecanismo de apoptose ou à ação de linfócitos T citotóxicos, permitindo assim a progressão do LES.

OBJECTIVE: To verify the association of SLE activity to the avidity of IgG anti-EBV immune globulins. METHODS: Peripheral blood of 66 patients was analyzed, 22 had active SLE and 44 had inactive SLE. Presence and avidity index of IgG anti-EBV antibodies were determined by the ELISA method (Enzygnost® anti-EBV/IgG - Dade Behring). RESULTS: IgG anti-EBV test was positive for 21 (95.5 percent) patients in the active SLE group and 40 (90.9 percent) in the inactive group. The avidity index was 40 for 54 (88.5 percent) patients of which 34 (85 percent) belonged to the inactive SLE group and 20 (95.2 percent) to the active group. For 5 (12.5 percent) inactive SLE patients, the avidity index reached values ranging from 20 to 40; while for only 2 (3.3 percent) patients this index was lower than 20. Adopting 20, 30 or 40 as a cutoff point of the avidity index for diagnosis of reactivation of the EBV infection, the author classified as having reactivated infection, for active and inactive SLE groups, respectively: 1 (4.8 percent) x 1 (2.5 percent) patient; 1 (4.8 percent) x 4 (10 percent) patients and 1 (4.8 percent) x 5 (12.5 percent) patients. CONCLUSION: Association between EBV activity and SLE was not demonstrated. This appears to indicate that persistence of infected B lymphocytes may be due to failure in the apopotosis mechanism or to the action of T cytotoxic lymphocytes, permitting evolution of SLE.

Establishment of cytotoxic T lymphocytes specific for autologous Epstein-Barr virus in HIV-infected patients: the feasibility study of EBV-specific immunotherapy for patients with EBV-associated lymphoma.

Cytotoxic T lymphocytes specific for Epstein-Barr virus (EBV) have previously been successfully used in immunotherapy of Posttransplant lymphoproliferative disease (PTLD) and Hodgkin's disease. A similar strategy has never been employed in HIV/AIDS patients who also have high risk of developing EBV-associated lymphoma. A total of 5 HIV-infected patients were enrolled to evaluate their EBV-specific T cell responses by Interferon-gamma (IFNgamma) ELISpot assays. Most patients had detectable T cell responses, mainly directed at Epstein-Barr nuclear antigen (EBNA-3). The authors wanted to see whether it was possible to augment magnitude and spectrum of the EBV responses by stimulating patient PBMC with cells presenting autologous EBV antigens. The authors successfully established spontaneously EBV-transformed lymphoblastoid cell lines (EBVh-BCL) and used them for generation of EBV-specific CTL (EBV-CTL). The EBVh-CTL lines established in the present study were not only highly cytotoxic against the autologous virus but also able to secrete IFNgamma detected by ELISpot. The authors are now in the process of generating these lines in a large number and in a clinical grade for adoptive immunotherapy.