title: BK virus-specific immunity kinetics: a predictor of recovery from polyomavirus BK-associated nephropathy.
abstract: Impaired BKV-specific immunity is associated with development of BKV-associated nephropathy. Suitable immunological parameters to identify patients at risk, however, are still debated. We monitored 18 kidney-transplant recipients through the course of self-limited BKV-reactivation (n = 11) and BKV-associated nephropathy (n = 7). BKV-specific cellular immunity directed to nonstructural small and Large T-antigen, and structural VP1-3 was analyzed in an interferon-γ Elispot assay. BKV-specific IgM and IgG were measured using an enzyme-linked immunosorbent assay simultaneously. BKV-specific cellular immunity directed to five BKV-proteins increased significantly from diagnosis to resolution of BKV-reactivation (p < 0.001). Patients with self-limited BKV-reactivation developed BKV-specific T cells without therapeutic interventions, and cleared BKV-reactivation within a median period of 1 month. Patients with BKV-associated nephropathy, however, showed BKV-specific T cells after a median period of 5 months after therapeutic interventions only, and cleared BKV-reactivation after a median period of 8 months. Anti-structural T cells were detected earlier than anti-nonstructural T cells, which coincided with BKV-clearance. Patients with BKV-associated nephropathy showed the highest frequencies of BKV-specific T cells at recovery, the highest increase in BKV-specific IgG and persistence of increased IgM levels (p < 0.05). Our results suggest prognostic values of BKV-specific immune monitoring to identify those patients at risk of BKV-associated nephropathy and to aid in the management of therapeutic interventions.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany. thomas.schachtner@charite.de
authors.forename: T
authors.initials: T
authors.lastname: Schachtner
authors.forename: K
authors.initials: K
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: C
authors.initials: C
authors.lastname: Diezemann
authors.forename: A
authors.initials: A
authors.lastname: Sefrin
authors.forename: N
authors.initials: N
authors.lastname: Babel
authors.forename: P
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000276:immunology*; D000957:Antigens, Viral, Tumor / Q000276:immunology; D001739:BK Virus / Q000276:immunology* / Q000502:physiology; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007674:Kidney Diseases / Q000276:immunology / Q000821:virology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology; D014412:Tumor Virus Infections / Q000276:immunology*; D014775:Virus Activation
chemical_list: D000914:Antibodies, Viral; D000957:Antigens, Viral, Tumor