title: Rapid reduction of viruria and stabilization of allograft function by fusidic acid in a renal transplant recipient with JC virus-associated nephropathy.
abstract: JC virus (JCV)-associated nephropathy has been increasingly recognized as a cause of allograft dysfunction with graft loss in renal transplant recipients. Like many other opportunistic viral infections in transplant recipients, there are currently limited therapeutic options for this condition. Fusidic acid has previously been reported to exhibit antiviral activity against JCV in in vitro assays. We report the first in vivo study to document the rapid reduction of JC viruria and stabilization of allograft function by oral fusidic acid (fusidate sodium) in a deceased donor renal transplant recipient with JCV-associated nephropathy and acute allograft dysfunction which did not improve initially to surgical relief of hydronephrosis and reduction of immunosuppressants. Rapid reduction of JC viruria detected by quantitative PCR and stabilization of renal function were observed. Fusidic acid has several practical advantages in this clinical setting, including a low EC50 against JCV, high plasma C max, long half-life, availability of both oral and intravenous formulations, excellent oral bioavailability, good patient tolerability, and lack of serious drug interactions with other drugs taken by renal transplant recipients. Further mechanistic and clinical studies are necessary to evaluate this treatment option for JCV-associated nephropathy.
authors.affiliation: State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
authors.forename: Jasper Fuk-Woo
authors.initials: JF
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Maggie Kam-Man
authors.initials: MK
authors.lastname: Ma
authors.affiliation: Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Gavin Shueng-Wai
authors.initials: GS
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Gary Chi-Wang
authors.initials: GC
authors.lastname: Chan
authors.affiliation: Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Garnet Kwan-Yue
authors.initials: GK
authors.lastname: Choi
authors.affiliation: Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Vincent Chi-Chung
authors.initials: VC
authors.lastname: Cheng
authors.affiliation: Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Kwok-Wah
authors.initials: KW
authors.lastname: Chan
authors.affiliation: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Bo-Ying
authors.initials: BY
authors.lastname: Choy
authors.affiliation: State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China. kyyuen@hku.hk.|Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China. kyyuen@hku.hk.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China. kyyuen@hku.hk.|Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China. kyyuen@hku.hk.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000284:Administration, Oral; D064591:Allografts / Q000502:physiology*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D005672:Fusidic Acid / Q000008:administration & dosage*; D006801:Humans; D007577:JC Virus / Q000302:isolation & purification*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D066027:Transplant Recipients; D016896:Treatment Outcome; D014556:Urine / Q000821:virology*
chemical_list: D000890:Anti-Infective Agents; D005672:Fusidic Acid
keywords: Fusidic acid; JC virus; Nephropathy; Polyomavirus; Renal transplant