title: Epstein-Barr virus replication within pulmonary epithelial cells in cryptogenic fibrosing alveolitis.
abstract: BACKGROUND
  Cryptogenic fibrosing alveolitis (synonymous with idiopathic pulmonary fibrosis) is a clinically heterogeneous condition in which the precipitating factor is unclear. Both environmental and infective factors have been implicated. An association between Epstein-Barr virus (EBV) and cryptogenic fibrosing alveolitis was suggested over a decade ago by a study based on EBV serology, but the significance of this has been unclear.
  
  
  METHODS
  Lung tissue obtained surgically from patients (n = 20) with cryptogenic fibrosing alveolitis was investigated for evidence of EBV replication and compared with lung tissue from 21 control patients. Fourteen of the 20 patients had received no specific therapy for cryptogenic fibrosing alveolitis at the time of biopsy. Monoclonal antibodies directed against the EBV viral antigens, EBV viral capsid antigen (VCA) and gp 340/220 antigen, which are expressed during the lytic phase of the EBV life cycle, were studied.
  
  
  RESULTS
  Fourteen (70%) of the 20 patients with cryptogenic fibrosing alveolitis were positive for both EBV VCA and gp 340/220 compared with two (9%) of the 21 controls. In the patients with cryptogenic fibrosing alveolitis viral replication was localised to pulmonary epithelial cells using epithelial cell markers, and immunohistochemical analysis confirmed the staining to be within type II alveolar cells.
  
  
  CONCLUSIONS
  This is the first report of in vivo EBV replication within epithelial cells of the lower respiratory tract in an immunocompetent human host. Furthermore, this suggests that EBV may be an immune trigger or contribute to lung injury in cryptogenic fibrosing alveolitis, thus offering a potential new avenue of treatment.
authors.affiliation: North West Lung Centre, Wythenshawe Hospital, Manchester, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Egan
authors.forename: J P
authors.initials: JP
authors.lastname: Stewart
authors.forename: P S
authors.initials: PS
authors.lastname: Hasleton
authors.forename: J R
authors.initials: JR
authors.lastname: Arrand
authors.forename: K B
authors.initials: KB
authors.lastname: Carroll
authors.forename: A A
authors.initials: AA
authors.lastname: Woodcock
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D000956:Antigens, Viral / Q000276:immunology; D015415:Biomarkers / Q000032:analysis; D036022:Capsid Proteins; D004848:Epithelium / Q000276:immunology / Q000473:pathology / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000276:immunology / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D014763:Viral Matrix Proteins / Q000276:immunology; D014779:Virus Replication
chemical_list: D000911:Antibodies, Monoclonal; D000956:Antigens, Viral; D015415:Biomarkers; D036022:Capsid Proteins; C037662:EBV-associated membrane antigen, Epstein-Barr virus; C041788:Epstein-Barr viral capsid antigen; D014763:Viral Matrix Proteins