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Human cytomegalovirus (HCMV) long-term shedding and HCMV-specific immune response in pregnant women with primary HCMV infection. Med Microbiol Immunol 2022; 211:249-260. [PMID: 35960328 DOI: 10.1007/s00430-022-00747-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
Human cytomegalovirus (HCMV) shedding has been extensively investigated in newborns and in young children, however, much less is known about it in immunocompetent adults. Shedding of HCMV was investigated in saliva, vaginal secretions and urine of pregnant women experiencing primary infection along with the development of the HCMV-specific immune response. Thirty-three pregnant women shed HCMV DNA in peripheral biological fluids at least until one year after onset of infection, while in blood HCMV DNA was cleared earlier. Significantly higher levels of viral load were found in vaginal secretions compared to saliva and urine. All subjects examined two years after the onset of infection showed a high avidity index, with IgM persisting in 36% of women. Viral load in blood was directly correlated with levels of HCMV-specific IgM and inversely correlated with levels of IgG specific for the pentameric complex gH/gL/pUL128L; in addition, viral load in blood was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ expressing IL-7R (long-term memory, LTM) while viral load in biological fluids was inversely correlated with percentage of HCMV-specific CD4+ and CD8+ effector memory RA+(TEMRA). In conclusion, viral shedding during primary infection in pregnancy persists in peripheral biological fluids for at least one year and the development of both antibodies (including those directed toward the pentameric complex) and memory T cells are associated with viral clearance.
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Haese NN, Burg JM, Andoh TF, Jones IK, Kreklywich CN, Smith PP, Orloff SL, Streblow DN. Macrophage depletion of CMV latently infected donor hearts ameliorates recipient accelerated chronic rejection. Transpl Infect Dis 2021; 23:e13514. [PMID: 33205500 PMCID: PMC8068575 DOI: 10.1111/tid.13514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
Cytomegalovirus (CMV) infection is linked to acceleration of solid organ transplant vascular sclerosis (TVS) and chronic rejection (CR). Donor latent CMV infection increases cardiac-resident macrophages and T cells leading to increased inflammation, promoting allograft rejection. To investigate the role of cardiac-resident passenger macrophages in CMV-mediated TVS/CR, macrophages were depleted from latently ratCMV (RCMV)-infected donor allografts prior to transplantation. Latently RCMV-infected donor F344 rats were treated with clodronate, PBS, or control liposomes 3 days prior to cardiac transplant into RCMV-naïve Lewis recipients. Clodronate treatment significantly increased graft survival from post-operative day (POD)61 to POD84 and decreased TVS at rejection. To determine the kinetics of the effect of clodronate treatment's effect, a time study revealed that clodronate treatment significantly decreased macrophage infiltration into allograft tissues as early as POD14; altered allograft cytokine/chemokine protein levels, fibrosis development, and inflammatory gene expression profiles. These findings support our hypothesis that increased graft survival as a result of allograft passenger macrophage depletion was in part a result of altered immune response kinetics. Depletion of donor macrophages prior to transplant is a strategy to modulate allograft rejection and reduce TVS in the setting of CMV + donors transplanted into CMV naïve recipients.
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Affiliation(s)
- Nicole N. Haese
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
| | - Jennifer M. Burg
- Department of Surgery, Oregon Health Sciences University, Portland, OR 97239
| | - Takeshi F. Andoh
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
| | - Iris K.A. Jones
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
| | - Craig N. Kreklywich
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
| | - Patricia P. Smith
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
| | - Susan L. Orloff
- Department of Surgery, Oregon Health Sciences University, Portland, OR 97239
- Department of Molecular Microbiology & Immunology, Oregon Health Sciences University, Portland, OR, USA
| | - Daniel N. Streblow
- Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Beaverton, OR 97006
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Serum IgG Profiling of Toddlers Reveals a Subgroup with Elevated Seropositive Antibodies to Viruses Correlating with Increased Vaccine and Autoantigen Responses. J Clin Immunol 2021; 41:1031-1047. [PMID: 33656624 PMCID: PMC7927113 DOI: 10.1007/s10875-021-00993-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022]
Abstract
Purpose The human antibody repertoire forms in response to infections, the microbiome, vaccinations, and environmental exposures. The specificity of such antibody responses was compared among a cohort of toddlers to identify differences between seropositive versus seronegative responses. Methods An assessment of the serum IgM and IgG antibody reactivities in 197 toddlers of 1- and 2-years of age was performed with a microfluidic array containing 110 distinct antigens. Longitudinal profiling was done from years 1 to 2. Seropositivity to RNA and DNA viruses; bacteria; live attenuated, inactive, and subunit vaccines; and autoantigens was compared. A stratification was developed based on quantitative variations in the IgG responses. Clinical presentations and previously known genetic risk alleles for various immune system conditions were investigated in relation to IgG responses. Results IgG reactivities stratified toddlers into low, moderate, and high responder groups. The high group (17%) had elevated IgG responses to multiple RNA and DNA viruses (e.g., respiratory syncytial virus, Epstein-Barr virus, adenovirus, Coxsackievirus) and this correlated with increased responses to live attenuated viral vaccines and certain autoantigens. This high group was more likely to be associated with gestational diabetes and an older age. Genetic analyses identified polymorphisms in the IL2RB, TNFSF4, and INS genes in two high responder individuals that were associated with their elevated cytokine levels and clinical history of eczema and asthma. Conclusion Serum IgG profiling of toddlers reveals correlations between the magnitude of the antibody responses towards viruses, live attenuated vaccines, and certain autoantigens. A low responder group had much weaker responses overall, including against vaccines. The serum antibody screen also identifies individuals with IgG responses to less common infections (West Nile virus, parvovirus, tuberculosis). The characterization of the antibody responses in combination with the identification of genetic risk alleles provides an opportunity to identify children with increased risk of clinical disease. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-00993-w.
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Polansky H. How can the latent cytomegalovirus cause an increase in all-cause mortality? An answer based on the microcompetition model. Antivir Ther 2021; 25:349-351. [PMID: 33616550 DOI: 10.3851/imp3384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Many studies showed the existence of a positive association between cytomegalovirus (CMV) seropositivity and all-cause mortality. In this paper, we use the microcompetition model to explain how the latent CMV sequesters the limiting GABP∙p300/CBP transcription complex, which causes abnormal cellular gene expression, a chronic disease and mortality. Since most people harbour the latent CMV, we urge further research on this topic.
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Affiliation(s)
- Hanan Polansky
- Department of Internal Medicine, University of California, San Diego, San Diego, CA, USA
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5
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Hepatic interferon γ and tumor necrosis factor a expression in infants with neonatal cholestasis and cytomegalovirus infection. Clin Exp Hepatol 2021; 6:367-373. [PMID: 33511286 PMCID: PMC7816637 DOI: 10.5114/ceh.2020.102172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Aim of the study To determine the hepatic interferon γ (IFN-γ) and tumor necrosis factor α (TNF-α) levels in infants with neonatal cholestasis (NC) and associated cytomegalovirus (CMV) infection. Material and methods This study was conducted in 21 infants with NC over a period of 6 months from June 2017 to December 2017 to determine the hepatic IFN-γ and TNF-α levels in infants with NC and associated CMV infection. Results IFN-γ levels were positive in 16 (80%), low positive in 3 (16%) and negative in 1 (5%) patients. High positive and positive TNF-α levels were seen in 9 (56.3%) patients with positive liver CMV PCR and low positive levels were seen in 7 (43.7%) patients with positive liver CMV PCR (odds ratio [OR] = 2.6). Positive IFN-γ was present in 13 (81.3%) patients with positive liver CMV PCR and low positive or negative IFN-γ was seen in 3 (18.7%) patients with positive liver CMV PCR (OR = 2.2). Six (60%) patients with positive or high positive TNF-α levels in liver tissue had biliary atresia (BA) whereas 7 (77.7%) with low positive TNF-α levels had non-BA neonatal hepatitis (OR = 5.25). Six (37.5%) patients with positive IFN-γ had BA whereas 2 (50%) patients with low positive or negative IFN-γ had BA (OR = 0.6). Conclusions There is high prevalence of CMV in liver tissues in patients with NC and elevated TNF-α and IFN-γ levels are seen in these patients. Elevated TNF-α is also seen in patients with BA. The association of elevated TNF-α, BA and CMV infection needs to be evaluated further.
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Parker EL, Silverstein RB, Verma S, Mysorekar IU. Viral-Immune Cell Interactions at the Maternal-Fetal Interface in Human Pregnancy. Front Immunol 2020; 11:522047. [PMID: 33117336 PMCID: PMC7576479 DOI: 10.3389/fimmu.2020.522047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
The human decidua and placenta form a distinct environment distinguished for its promotion of immunotolerance to infiltrating semiallogeneic trophoblast cells to enable successful pregnancy. The maternal-fetal interface also successfully precludes transmission of most pathogens. This barrier function occurs in conjunction with a diverse influx of decidual immune cells including natural killer cells, macrophages and T cells. However, several viruses, among other microorganisms, manage to escape destruction by the host adaptive and innate immune system, leading to congenital infection and adverse pregnancy outcomes. In this review, we describe mechanisms of pathogenicity of two such viral pathogens, Human cytomegalovirus (HCMV) and Zika virus (ZIKV) at the maternal-fetal interface. Host decidual immune cell responses to these specific pathogens will be considered, along with their interactions with other cell types and the ways in which these immune cells may both facilitate and limit infection at different stages of pregnancy. Neither HCMV nor ZIKV naturally infect commonly used animal models [e.g., mice] which makes it challenging to understand disease pathogenesis. Here, we will highlight new approaches using placenta-on-a-chip and organoids models that are providing functional and physiologically relevant ways to study viral-host interaction at the maternal-fetal interface.
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Affiliation(s)
- Elaine L. Parker
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rachel B. Silverstein
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Sonam Verma
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Indira U. Mysorekar
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Riis JL, Ahmadi H, Silke O, Granger SW, Bryce CI, Granger DA. Correspondence Between Cytomegalovirus Immunoglobulin-G Levels Measured in Saliva and Serum. Front Immunol 2020; 11:2095. [PMID: 32983163 PMCID: PMC7484902 DOI: 10.3389/fimmu.2020.02095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/03/2020] [Indexed: 12/05/2022] Open
Abstract
Human cytomegalovirus (HCMV) infects more than 80% of the global population. While mostly asymptomatic, HCMV infection can be serious among the immunocompromised, and it is implicated in chronic disease pathophysiology in adulthood. Large-scale minimally invasive HCMV screening could advance research and public health efforts to monitor infection prevalence and prevent or mitigate downstream risks associated with infection. We examine the utility of measuring HCMV immunoglobulin-G (IgG) levels in saliva as an index of serum levels. Matched serum and saliva samples from healthy adults (N = 98; 44% female; 51% white) were assayed for HCMV IgG, total salivary protein, and salivary markers related to oral inflammation, blood, and tissue integrity. We examine the serum-saliva association for HCMV IgG and assess the influence of participant characteristics and factors specific to the oral compartment (e.g., oral inflammation) on HCMV IgG levels and cross-specimen relations. We found a robust serum-saliva association for HCMV IgG with serum antibody levels accounting for >60% of the variance in salivary levels. This relation remained after adjusting for key demographic and oral immune-related variables. Compared to the serum test, the salivary HCMV IgG test had 51% sensitivity and 97% specificity. With improvements in assay performance and sample optimization, HCMV antibody levels in oral fluids may be a useful proxy for serum levels.
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Affiliation(s)
- Jenna L. Riis
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Hedyeh Ahmadi
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
| | - Olivia Silke
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Steve W. Granger
- Salimetrics Research and Technology Center, Carlsbad, CA, United States
| | - Crystal I. Bryce
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, United States
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
- Salimetrics Research and Technology Center, Carlsbad, CA, United States
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Salivary Bioscience Laboratory, Department of Psychology, University of Nebraska–Lincoln, Lincoln, NE, United States
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Bulka CM, Bommarito PA, Aiello AE, Fry RC. Cytomegalovirus seroprevalence, recurrence, and antibody levels: Associations with cadmium and lead exposures in the general United States population. Environ Epidemiol 2020; 4:e100. [PMID: 32832839 PMCID: PMC7423529 DOI: 10.1097/ee9.0000000000000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ubiquitous metals cadmium and lead are immunotoxic, but little is known about their relations to cytomegalovirus (CMV), a widespread herpesvirus. Although CMV infections are mostly asymptomatic, congenital infections are a leading cause of birth defects. In otherwise healthy individuals, there is also some evidence linking subclinical reactivations to accelerated age-related declines in immune function and chronic disease. METHODS Our objective was to evaluate associations of blood cadmium and lead biomarkers with CMV infection in a representative sample of the United States population. In seropositive individuals, we also examined associations with CMV-specific immunoglobulin G (IgG) antibody levels and suspected CMV recurrences. Using cross-sectional data from the 1999-2004 National Health and Nutrition Examination Surveys, we fit multivariable survey-weighted regression models accounting for potential confounding by sociodemographic and lifestyle factors and stratifying by age group to allow for heterogeneity. CMV recurrences were defined according to (1) the presence of either CMV-specific immunoglobulin M in sera or CMV viral DNA in urine, and (2) high CMV-specific IgG avidity. RESULTS We observed null associations for blood cadmium. Increasing blood lead quartiles were related to CMV seropositivity and higher CMV IgG levels (both P trend < 0.01), but not CMV recurrence, only among individuals who were 20-29 years of age. CONCLUSION Blood cadmium levels do not appear to be related to immunological markers of CMV infections. The possibility that lead exposures increase the risk of CMV infection and impair immune control of the virus in young adults was suggested. Prospective studies are needed to confirm.
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Affiliation(s)
- Catherine M. Bulka
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Paige A. Bommarito
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- Curriculum in Toxicology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Non-invasive detection of IgG antibodies from common pathogenic viruses using oral flocked swabs. Diagn Microbiol Infect Dis 2020; 97:115038. [PMID: 32444155 DOI: 10.1016/j.diagmicrobio.2020.115038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 01/03/2023]
Abstract
Salivary antibodies are useful in surveillance and vaccination studies. However, low antibody levels and degradation by endonucleases are problematic. Oral flocked swabs are a potential non-invasive alternative for detecting viral antibodies. Seroprevalence for Cytomegalovirus (CMV), Varicella-Zoster virus (VZV), Epstein-Barr virus (EBV), Measles and Mumps IgG antibodies were determined from 50 matched serum, saliva and swabs samples from healthy volunteers using commercial ELISAs. CMV IgG, VZV IgG, and EBV EBNA-1 IgG, VCA IgG, and Measles IgG swab versus serum sensitivities were 95.8%, 96.0%, 92.1%, 95.5%, 84.5%, respectively, and swabs correlated well with saliva. Sensitivity of Mumps IgG in swabs and saliva was poor at 60.5%, and 68.2%, respectively. Specificities for IgG antibodies were 100% for CMV, EBV and Mumps, but could not be determined for VZV and Measles due to exclusively seropositive volunteers. Except for Mumps IgG, swabs correlate well with serum, are easy to self-collect and are stable at room temperature.
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10
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White JL, Patel EU, Abraham AG, Grabowski MK, Arav-Boger R, Avery RK, Quinn TC, Tobian AAR. Prevalence, Magnitude, and Genotype Distribution of Urinary Cytomegalovirus (CMV) Shedding Among CMV-Seropositive Children and Adolescents in the United States. Open Forum Infect Dis 2019; 6:ofz272. [PMID: 31281866 PMCID: PMC6602884 DOI: 10.1093/ofid/ofz272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background There are limited nationally representative data on correlates of cytomegalovirus (CMV) shedding among children and adolescents. In addition, the genotype distribution of CMV infections has not been well characterized among general populations in the United States. Methods This study characterized urinary CMV shedding among CMV immunoglobulin G-positive 6- to 19-year-olds in the US household population using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CIs). Analyses were weighted and multiple imputation was performed to handle missing data (with the exception of CMV genotypes). Results Prevalence of urinary CMV shedding was significantly lower among 9- to 11-year-olds (20.6%; aPR = 0.61; 95% CI, 0.44-0.83) and 12- to 19-year-olds (7.0%; aPR = 0.21; 95% CI, 0.14-0.30) compared with 6- to 8-year-olds (34.4%). Among CMV shedders, the youngest age group also had the highest urinary CMV viral loads. The prevalence of urinary CMV shedding among obese individuals was significantly lower compared with lean individuals (aPR = 0.68; 95% CI, 0.47-0.99). Among CMV shedders, glycoprotein B (gB)1 (51%) was the most prevalent gB variant, followed by gB2 (29%), gB3 (21%), and gB4 (13%); glycoprotein H (gH)2 (60%) was more prevalent than gH1 (48%). Multiple (≥2) gB (14%) and multiple gH (7%) infections were detected among CMV shedders. Conclusions This study underscores the importance of young children even above the age of 5 years as a potential source of CMV transmission. The detection of multiple CMV strains among CMV shedders may have implications for the transmission of viral diversity as well as vaccine development.
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Affiliation(s)
- Jodie L White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Kate Grabowski
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravit Arav-Boger
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Robin K Avery
- Department Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Stockdale L, Nash S, Nalwoga A, Gibson L, Painter H, Raynes J, Asiki G, Newton R, Fletcher H. HIV, HCMV and mycobacterial antibody levels: a cross-sectional study in a rural Ugandan cohort. Trop Med Int Health 2019; 24:247-257. [PMID: 30506614 PMCID: PMC6378403 DOI: 10.1111/tmi.13188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A growing evidence base implicates human cytomegalovirus (HCMV) as a risk factor for TB disease. We investigated total IgG and mycobacteria-specific antibodies in a cross-sectional study nested within a rural Ugandan General Population Cohort (GPC), in relation to HIV infection and the magnitude of HCMV IgG response. METHODS Sera from 2189 individuals (including 27 sputum-positive TB cases) were analysed for antibodies against mycobacteria (Ag85A, PPD, LAM, ESAT6/CFP10) and HCMV, tetanus toxoid (TT) and total IgG. RESULTS Anti-mycobacterial antibodies increased with age until approximately 20 years, when they plateaued. Higher HCMV exposure (measured by IgG) was associated with lower levels of some anti-mycobacterial antibodies, but no increase in total IgG. HIV infection was associated with a decrease in all anti-mycobacterial antibodies measured and with an increase in total IgG. CONCLUSIONS The increase in anti-mycobacterial antibodies with age suggests increasing exposure to non-tuberculous mycobacteria (NTM), and to M.tb itself. HIV infection is associated with decreased levels of all mycobacterial antibodies studied here, and high levels of HCMV IgG are associated with decreased levels of some mycobacterial antibodies. These findings point towards the importance of humoral immune responses in HIV/TB co-infection and highlight a possible role of HCMV as a risk factor for TB disease.
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Affiliation(s)
- Lisa Stockdale
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Stephen Nash
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Angela Nalwoga
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Medical Research Council/Uganda Virus Research InstituteEntebbeUganda
| | - Lorna Gibson
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Hannah Painter
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - John Raynes
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Gershim Asiki
- African Population and Health Research CenterNairobiKenya
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Robert Newton
- Medical Research Council/Uganda Virus Research InstituteEntebbeUganda
- Department of Health SciencesUniversity of YorkYorkUK
- International Agency for Research on CancerLyonFrance
| | - Helen Fletcher
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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12
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Stockdale L, Nash S, Nalwoga A, Painter H, Asiki G, Fletcher H, Newton R. Human cytomegalovirus epidemiology and relationship to tuberculosis and cardiovascular disease risk factors in a rural Ugandan cohort. PLoS One 2018; 13:e0192086. [PMID: 29408860 PMCID: PMC5800673 DOI: 10.1371/journal.pone.0192086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
Human cytomegalovirus (HCMV) infection has been associated with increased mortality, specifically cardiovascular disease (CVD), in high-income countries (HICs). There is a paucity of data in low- and middle-income countries (LMICs) where HCMV seropositivity is higher. Serum samples from 2,174 Ugandan individuals were investigated for HCMV antibodies and data linked to demographic information, co-infections and a variety of CVD measurements. HCMV seropositivity was 83% by one year of age, increasing to 95% by five years. Female sex, HIV positivity and active pulmonary tuberculosis (TB) were associated with an increase in HCMV IgG levels in adjusted analyses. There was no evidence of any associations with risk factors for CVD after adjusting for age and sex. HCMV infection is ubiquitous in this rural Ugandan cohort from a young age. The association between TB disease and high HCMV IgG levels merits further research. Known CVD risk factors do not appear to be associated with higher HCMV antibody levels in this Ugandan cohort.
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Affiliation(s)
- Lisa Stockdale
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Angela Nalwoga
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Hannah Painter
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Helen Fletcher
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- University of York, Department of Health Sciences, York, United Kingdom
- International Agency for Research on Cancer, Lyon, France
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13
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Alyazidi R, Murthy S, Slyker JA, Gantt S. The Potential Harm of Cytomegalovirus Infection in Immunocompetent Critically Ill Children. Front Pediatr 2018; 6:96. [PMID: 29692984 PMCID: PMC5902572 DOI: 10.3389/fped.2018.00096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cytomegalovirus (CMV) is a ubiquitous infection that causes disease in congenitally infected children and immunocompromised patients. Although nearly all CMV infections remain latent and asymptomatic in immunologically normal individuals, numerous studies have found that systemic viral reactivation is common in immunocompetent critically ill adults, as measured by detection of CMV in the blood (viremia). Furthermore, CMV viremia is strongly correlated with adverse outcomes in the adult intensive care unit (ICU), including prolonged stay, duration of mechanical ventilation, and death. Increasing evidence, including from a randomized clinical trial of antiviral treatment, suggests that these effects of CMV may be causal. Therefore, interventions targeting CMV might improve outcomes in adult ICU patients. CMV may have an even greater impact on critically ill children, particularly in low and middle income countries (LMIC), where CMV is regularly acquired in early childhood, and where inpatient morbidity and mortality are inordinately high. However, to date, there are few data regarding the clinical relevance of CMV infection or viremia in immunocompetent critically ill children. We propose that CMV infection should be studied as a potential modifiable cause of disease in critically ill children, and that these studies be conducted in LMIC. Below, we briefly review the role of CMV in immunologically normal critically ill adults and children, outline age-dependent differences in CMV infection that may influence ICU outcomes, and describe an agenda for future research.
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Affiliation(s)
- Raidan Alyazidi
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Srinivas Murthy
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | | | - Soren Gantt
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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14
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Abdullahi Nasir I, Babayo A, Shehu MS. Clinical Significance of IgG Avidity Testing and Other Considerations in the Diagnosis of Congenital Cytomegalovirus Infection: A Review Update. Med Sci (Basel) 2016; 4:E5. [PMID: 29083370 PMCID: PMC5635769 DOI: 10.3390/medsci4010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 01/22/2023] Open
Abstract
Prompt and accurate laboratory testing of women before or during antenatal days is necessary for detecting humoral immunological responses against cytomegalovirus (CMV) infection and assessing risk of congenital transmission. CMV is the most common viral etiology with the greatest propensity to induce neonatal pathologies. Most healthcare facilities in developing countries rely solely on anti-CMV IgM and IgG assays in diagnosing CMV infections. However, these parameters have some worrisome limitations. This study reviewed the significance of IgG avidity testing as a highly sensitive and specific tool that improves decisions regarding diagnosis of maternal and congenital CMV infections. We conducted this review from relevant published articles using an extensive literature search made through PubMed, Scopus and Google scholar on the concepts of congenital CMV (CCMV) transmission and clinical significance of IgG avidity testing in diagnosis of CCMV infections. Findings from our review revealed that IgG avidity testing in some developed societies was frequently utilized to resolve dilemmas associated with serodiagnosis of CMV infections, however, there is paucity of information in regards to its use in developing countries. The non-inclusion of IgG avidity testing during serological investigations of CMV could be a reason why congenital CMV infections and associated pathologies often go underdiagnosed in developing countries.
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Affiliation(s)
- Idris Abdullahi Nasir
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, FCT Abuja PMB 228, Nigeria.
- Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, PMB 1515 Ilorin, Nigeria.
| | - Adamu Babayo
- Department of Medical Microbiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi PMB 0117, Nigeria.
| | - Muhammad Sagir Shehu
- Immunology unit, Department of Medicine, Ahmadu Bello University, PMB 05 Zaria, Kaduna State, Nigeria.
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15
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Ellington SR, Clarke KEN, Kourtis AP. Cytomegalovirus Infection in Human Immunodeficiency Virus (HIV)-Exposed and HIV-Infected Infants: A Systematic Review. J Infect Dis 2015; 213:891-900. [PMID: 26597258 DOI: 10.1093/infdis/jiv549] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
Abstract
Cytomegalovirus is highly prevalent worldwide and an important opportunistic pathogen in human immunodeficiency virus (HIV)-infected individuals. The effects of cytomegalovirus infection on HIV-exposed infants are poorly understood. We conducted a systematic review to assess the relationship between cytomegalovirus and HIV infections among HIV-exposed infants. Limited evidence suggests that HIV-induced immunosuppression in the mother increases the rate of congenital cytomegalovirus infection, while maternal antiretroviral therapy may reduce it. Limited information exists on the direction of the relationship between cytomegalovirus and HIV transmission among HIV-exposed infants. Only 2 studies have addressed this temporal sequence of events, and they suggest that cytomegalovirus can lead to subsequent HIV infection in HIV-exposed infants. Most evidence suggests that early cytomegalovirus infection accelerates HIV disease progression in infants. Gaps remain in understanding the role that cytomegalovirus infection plays in HIV-exposed infants. Decreasing cytomegalovirus transmission prenatally and in infancy might further decrease HIV transmission and lead to better health among HIV-exposed infants.
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Affiliation(s)
- Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristie E N Clarke
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Athena P Kourtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:1222-6. [PMID: 26424831 DOI: 10.1128/cvi.00460-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/27/2015] [Indexed: 12/27/2022]
Abstract
Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections.
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