title: Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms.
abstract: Recent evidence suggesting a potential anti-CMV effect of mTORis is of great interest to the transplant community. However, the concept of an immunosuppressant with antiviral properties is not new, with many accounts of the antiviral properties of several agents over the years. Despite these reports, to date, there has been little effort to collate the evidence into a fuller picture. This manuscript was developed to gather the evidence of antiviral activity of the agents that comprise a typical immunosuppressive regimen against viruses that commonly reactivate following transplant (HHV1 and 2, VZV, EBV, CMV and HHV6, 7, and 8, HCV, HBV, BKV, HIV, HPV, and parvovirus). Appropriate immunosuppressive regimens posttransplant that avoid acute rejection while reducing risk of viral reactivation are also reviewed. The existing literature was disparate in nature, although indicating a possible stimulatory effect of tacrolimus on BKV, potentiation of viral reactivation by steroids, and a potential advantage of mammalian target of rapamycin (mTOR) inhibition in several viral infections, including BKV, HPV, and several herpesviruses.
authors.affiliation: Washington University in St Louis, St Louis, MO 63110, USA. brennan@wudosis.wustl.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: José M
authors.initials: JM
authors.lastname: Aguado
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mueller
authors.forename: Pierre
authors.initials: P
authors.lastname: Merville
authors.forename: Vincent
authors.initials: V
authors.lastname: Emery
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
mesh_terms: D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D014180:Transplantation; D014775:Virus Activation / Q000187:drug effects*; D014777:Virus Diseases / Q000139:chemically induced* / Q000517:prevention & control* / Q000821:virology
chemical_list: D007166:Immunosuppressive Agents