Cytomegalovirus as a cause of pancytopenia.

Human cytomegalovirus, HCMV, infects most of the population by adulthood; The primary infection is often accompanied by transient neutropenia and thrombocytopenia, and is followed by a period asymtomatic viral latency. In the setting of bone marrow transplantation, however, the immunosuppressed state of the recipient enables HCMV to re-activate or to infect the individual and cause serious sequelae. These range from hepatitis and gastrointestinal disease to interstitial pneumonia and hematologic abnormalities, which are more common in the allograft. Little is currently known about the mechanisms by which HCMV causes these hematologic abnormalities. In this review, we discuss experimental models which are helping investigators understand the immunology and pathology of CMV infection. We also summarize the vivo studies of the effects of HCMV on human hematopoiesis. Several possible mechanisms that could explain the deleterious effect of HCMV on human hematopoietic function include: 1) alteration of accessory cell function by inducing the production of inhibitory cytokines; 2) perturbation of stromal cell function resulting in a decreased production of hematopoietic factors or by altering cell surface adhesion molecule expression; 3) by direct infection of the hematopoietic stem or progenitor cells. It is likely that the pathogenesis of this syndrome is multifactorial therefore requiring a broad therapeutic approach. This would include the use of the antiviral agents, hematopoietic growth factors and donor derived HCMV specific cytolytic cells.

Detection of human cells in human/sheep chimeric lambs with in vitro human stroma-forming potential.

In utero transplantation of preimmune fetal sheep with human hematopoietic stem cells results in stable long-term hematopoietic chimerism. To clarify the mechanisms of support of human stem cells in chimeric sheep, we established stromas from bone marrow of 30 sheep transplanted in utero with human hematopoietic stem cells from adult bone marrow adult peripheral blood, or fetal liver. We examined the stromas for the presence or absence of human stromal elements in vitro. Human stromal elements were detected in 12 sheep as assessed by polymerase chain reaction (PCR) using human HLA-DQalpha-specific primers. The human origin of the PCR product was confirmed by Southern blotting using an HLA-DQalpha-specific probe. However, none of these stromal cells were positive for CD45 or CD14 as determined by fluorescence-activated cell sorting (FACS) analysis or by message expression using reverse transcriptase (RT)-PCR. In an attempt to further characterize these cells fibroblasts were isolated by panning, and DNA analysis confirmed the human origin of these cells in the same lambs. Of the fetuses injected with the highly enriched cells from adult human bone marrow 36% were found to harbor cells capable of forming human stromal elements in vitro in their marrow. Of those injected with human fetal liver and peripheral blood stem cells, 42 and 40%, respectively, exhibited in vitro human stromal cell-forming ability. These results indicate the long-term persistence of cells capable of giving rise to components of human marrow stroma in vitro in the human/sheep xenograft model.