RESUMO
BACKGROUND: Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction. OBJECTIVE: The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections. METHODS: Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection. RESULTS: IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5. CONCLUSIONS: HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.
Assuntos
Infecções Bacterianas/etiologia , Coinfecção , Infecções por Citomegalovirus/complicações , Citomegalovirus/patogenicidade , Rejeição de Enxerto/etiologia , Herpesvirus Humano 6/patogenicidade , Transplante de Fígado/efeitos adversos , Infecções por Roseolovirus/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Anticorpos Antivirais/sangue , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/imunologia , Infecções Bacterianas/microbiologia , Biópsia , Distribuição de Qui-Quadrado , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/virologia , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/imunologia , Humanos , Transplante de Fígado/imunologia , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Infecções por Roseolovirus/diagnóstico , Infecções por Roseolovirus/imunologia , Infecções por Roseolovirus/virologia , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Ativação Viral , Latência Viral , Adulto JovemRESUMO
The synthesis of two protected large peptides 1--45, and 46--86 covering the entire amino acid sequence of human proinsulin is described. Peptide 1--45, was synthesized from two intermediate fragments 1--23 and 24--45 and purified by countercurrent distribution in dimethylformamide system (K = 0.5). Peptide 46--86 was synthesized from two intermediate fragments 46--70 and 71--86 and purified by countercurrent distribution in two solvent systems, the dimethylformamide system (K = 0.06), and the toluene system (K = 0.16).
