A case of a progressive multifocal leukoencephalopathy patient with four different JC virus transcriptional control region rearrangements in cerebrospinal fluid, blood, serum, and urine.
JC virus (JCV) is the etiological agent of progressive multifocal leukoencephalopathy (PML), a fatal demyelinating disease of the central nervous system (CNS). During the acquired immunodeficiency syndrome (AIDS) epidemic, it was the cause of the death in up to 8% of AIDS patients. The genomic organization of JCV and, in particular, the hypervariability of the transcriptional control region (TCR), a regulatory noncoding region, are well known. Given that the TCR plays a central role in the viral replication of JCV, a crucial role in the determination of the neurotropism and in the pathogenic capabilities of the virus is also suspected. Here the authors describe a case of PML that did not respond to highly active antiretroviral therapy (HAART) therapy. There was a simultaneous presence of JCV strains with four different TCR structures in urine, peripheral blood cells, serum, and cerebrospinal fluid (CSF) samples. These data confirmed that the presence of the archetype TCt is restricted to urine, while also suggesting that the degree of the rearrangement varies and increases from the peripheral blood to CSF.
Delbue
Serena
S
Laboratory of Biology, Don C. Gnocchi Foundation, ONLUS, IRCCS, Milan, Italy.
Sotgiu
Giovanni
G
Fumagalli
Daniela
D
Valli
Marilena
M
Borghi
Elisa
E
Mancuso
Roberta
R
Marchioni
Enrico
E
Maserati
Renato
R
Ferrante
Pasquale
P
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001483:Base Sequence; D004279:DNA, Viral / Q000032:analysis* / Q000235:genetics; D015321:Gene Rearrangement; D006801:Humans; D007577:JC Virus / Q000235:genetics* / Q000302:isolation & purification*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008969:Molecular Sequence Data; D014158:Transcription, Genetic / Q000235:genetics*
D004279:DNA, Viral