Informa\u021bii generale<\/p>\n
Virusul John Cunningham (JC) este un membru al familiei Polyomaviridae, omniprezent \u0219i, de obicei, inofensiv, a\u0219a cum demonstreaz\u0103 anticorpii detectabili la majoritatea popula\u021biei s\u0103n\u0103toase2,3. Studiile de seroprevalen\u021b\u0103 sugereaz\u0103 c\u0103 >50% dintre adul\u021bii cu v\u00e2rsta peste 20 de ani au fost expu\u0219i la acest virus. Este un virus ADN dublu catenar, ne\u00eencapsulat, care, \u00een urma infec\u021biei primare, sufer\u0103 o laten\u021b\u0103 \u00een \u021besutul amigdalian, celulele tubulare renale, m\u0103duva osoas\u0103 sau creier.<\/p>\n
Virusul JC, neurotrop, este agentul etiologic stabilit al bolii demielinizante fatale, leucoencefalopatia multifocal\u0103 progresiv\u0103 (PML), care afecteaz\u0103 de obicei persoanele cu defecte ale imunit\u0103\u021bii mediate celular. Distrugerea citolitic\u0103 a oligodendrocitelor, celulele produc\u0103toare de mielin\u0103 ale sistemului nervos central, este atribuit\u0103 drept mecanism prin care JCV induce demielinizarea.<\/p>\n
PML, a fost la un moment dat o complica\u021bie rar\u0103, dar acum este o boal\u0103 mult mai frecvent\u0103 care afecteaz\u0103 pacien\u021bii de toate v\u00e2rstele, din cauza prevalen\u021bei bolii SIDA. De interes, dovezile in vitro indic\u0103 o interac\u021biune de cooperare \u00eentre JCV \u0219i HIV-1, prin intermediul proteinei de reglare HIV-1, Tat.<\/p>\n
\u00cen plus, s-a demonstrat c\u0103 JCV induce tumori de origine neuronal\u0103 la mai multe modele animale, inclusiv roz\u0103toare \u0219i primate non-umane, \u0219i mai multe rapoarte clinice au sugerat o posibil\u0103 asociere \u00eentre JCV \u0219i tumorile de origine glial\u0103, la oameni. Proteina reglatoare viral\u0103, antigenul T, despre care s-a demonstrat c\u0103 joac\u0103 un rol cheie \u00een orchestrarea evenimentelor ciclului litic viral, este, de asemenea, capabil\u0103 s\u0103 modifice func\u021biile celulare, prin natura interac\u021biunii directe cu proteinele reglatoare celulare \u0219i prin efectul s\u0103u. asupra transcrip\u021biei celulare.<\/p>\n
Condi\u021bia prealabil\u0103 pentru LMP este suprimarea profund\u0103 a imunit\u0103\u021bii mediate celular, indiferent dac\u0103 este asociat\u0103 cu boli, cum ar fi bolile maligne limfoproliferative sau HIV, sau tratamentul cu terapii imunosupresoare sau imunomodulatoare, a\u0219a cum este exemplificat de natalizumab, un anticorp monoclonal care inhib\u0103 migrarea limfocitelor c\u0103tre encefal.<\/p>\n
Virusul poate infecta celulele granulare al cerebelului, provoc\u00e2nd neuronopatie JCPyV (GCN)7, caracterizat\u0103 printr-o infec\u021bie litic\u0103 cu o variant\u0103 JCPyV, care ad\u0103poste\u0219te o muta\u021bie \u00een regiunea de codificare VP1. Deoarece at\u00e2t LMP, c\u00e2t \u0219i GCN apar la nivelul sistemul nervos central, comorbiditatea este probabil\u0103. \u00cen cazuri rare, JCPyV poate fi agentul cauzal al meningitei aseptice. Odat\u0103 cu utilizarea pe scar\u0103 larg\u0103 a terapiei antiretrovirale la pacien\u021bii cu SIDA, inciden\u021ba LMP a sc\u0103zut semnificativ.<\/p>\n
Cu toate acestea, \u00een ultimul deceniu, au fost identificate cazuri de LMP la persoane sub tratament imunomodulator pentru afec\u021biuni precum scleroza multipl\u0103 (SM) sau boala Crohn. Acest lucru a condus la un interes re\u00eennoit pentru JCV \u0219i pentru metodele de laborator utilizate pentru a diagnostica aceast\u0103 infec\u021bie viral\u0103. Testele serologice concepute pentru a detecta anticorpii anti-JCV nu trebuie utilizate in scop diagnostic.<\/p>\n
Aceasta se datoreaz\u0103 faptului c\u0103 > 50% dintre adul\u021bi au fost expu\u0219i la virusul JC \u0219i vor fi pozitivi pentru anticorpii din clasa IgG \u00eempotriva acestui virus, chiar dac\u0103 marea majoritate nu va prezenta niciodat\u0103 niciun simptom. Cu alte cuvinte, o serologie pozitiv\u0103 sugereaz\u0103 doar expunerea anterioar\u0103 la JCV \u0219i nu neap\u0103rat c\u0103 virusul va declan\u0219a boala.<\/p>\n
Serologia este util\u0103 \u00een screeningul pacien\u021bilor pentru expunerea la JCV \u00eenainte de ini\u021bierea anumitor terapii de modulare a imunit\u0103\u021bii, cum ar fi natalizumabul. Deci, un rezultat pozitiv pentru anticorpii anti-JCV va indica un risc crescut pentru o posibil\u0103 dezvoltare a LMP, la persoanele tratate cu natalizumab. \u00cen schimb, un rezultat negativ indic\u0103 faptul c\u0103 o persoan\u0103 nu a fost expus\u0103 la JCV \u0219i nu este expus\u0103 riscului de a dezvolta LMP.<\/p>\n
Pacien\u021bii cu simptome neurologice progresive, care sunt imunosuprima\u021bi sau sub terapie imunomodulatoare, li se va recomanda RMN-ul cerebral pentru a evalua caracteristicile LMP, cum ar fi intensitatea ridicat\u0103 a semnalului \u00een jonc\u021biunea cerebral\u0103 cenu\u0219iu-substan\u021b\u0103 alb\u0103. Dac\u0103 aceste caracteristici radiologice sunt prezente, se va realizat un test PCR pentru validare infec\u021biei JCV. Dac\u0103 rezultatul PCR este pozitiv, diagnosticul de LMP este confirmat.<\/p>\n
Dac\u0103 PCR-ul JCV este negativ, trebuie efectuat\u0103 o analiz\u0103 complet\u0103 pentru alte etiologii poten\u021biale, cum ar fi malignitatea. Dac\u0103 rezultatele tuturor testelor sunt negative, poate fi efectuat\u0103 o biopsie cerebral\u0103 pentru un examen histopatologic.<\/p>\n
Recomand\u0103ri pentru determinarea Polyoma JC ADN din s\u00e2nge<\/p>\n
Diagnosticarea leucoencefalopatiei multifocal\u0103 progresiv\u010312<\/p>\n
Specimen recoltat \u2013 s\u00e2nge venos12<\/p>\n
Recipient de recoltare \u2013 vacutainer cu anticoagulant EDTA12<\/p>\n
Volum prob\u0103 \u2013 0.7 mL12<\/p>\n
Cauze de respingere a probei<\/p>\n
S\u00e2nge venos recoltat \u00een vacutainere cu alt tip de anticoagulant, altul dec\u00e2t EDTA12<\/p>\n
Stabilitate prob\u0103 \u2013 plasma pe EDTA refrigerat\u0103 timp de 30 de zile12<\/p>\n
Metod\u0103 \u2013 Real-Time Polymerase Chain Reaction (RT-PCR)12<\/p>\n
Valori de referin\u021b\u0103<\/p>\n
Cuantificarea ADN-ului virusului JC se bazeaz\u0103 pe amplificarea \u0219i detectarea PCR \u00een timp real a ADN-ului genomic JCV. Intervalul cantitativ al acestui test este cuprins \u00eentre 500-35.000.000 de copii ADN JCV\/mL12.<\/p>\n
\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/p>\n
Kartau, M., Auvinen, E., Verkkoniemi-Ahola, A., Mannonen, L., Helanter\u00e4, I., & Anttila, V. J. (2022). JC polyomavirus DNA detection in clinical practice. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 146, 105051. https:\/\/doi.org\/10.1016\/j.jcv.2021.105051
\nMoens, U., Van Ghelue, M., Song, X., & Ehlers, B. (2013). Serological cross\u2010reactivity between human polyomaviruses. Reviews in Medical Virology, 23(4), 250-264.
\nHanaei, S., Sahraian, M. A., Mohammadifar, M., Ramagopalan, S. V., Ghajarzadeh, M., & Ghajarzadeh, M. (2019). Prevalence of Anti-JC Virus Antibody Seropositivity in Patients with Multiple Sclerosis: A Systematic Review and Meta-Analysis. Intervirology, 62(5-6), 169-173.
\nKartau, M., Verkkoniemi-Ahola, A., Paetau, A., Palom\u00e4ki, M., Janes, R., Ristola, M., \u2026 & Anttila, V. J. (2019, February). The incidence and predisposing factors of John Cunningham virus-induced progressive multifocal leukoencephalopathy in Southern Finland: a population-based study. In Open Forum Infectious Diseases (Vol. 6, No. 2, p. ofz024). US: Oxford University Press.
\nSipil\u00e4, J. O., Soilu-H\u00e4nninen, M., Rautava, P., & Kyt\u00f6, V. (2019). Progressive multifocal leukoencephalopathy in Finland: a cross-sectional registry study. Journal of Neurology, 266(2), 515-521.
\nIacobaeus, E., Burkill, S., Bahmanyar, S., Hakim, R., Bystr\u00f6m, C., Fored, M., \u2026 & Montgomery, S. (2018). The national incidence of PML in Sweden, 1988\u20132013. Neurology, 90(6), e498-e506.
\nWijburg, M. T., Siepman, D., van Eijk, J. J., Killestein, J., & Wattjes, M. P. (2016). Concomitant granule cell neuronopathy in patients with natalizumab-associated PML. Journal of neurology, 263(4), 649-656.
\nKhoury, M. N., Alsop, D. C., Agnihotri, S. P., Pfannl, R., Wuthrich, C., Ho, M. L., \u2026 & Koralnik, I. J. (2014). Hyperintense cortical signal on magnetic resonance imaging reflects focal leukocortical encephalitis and seizure risk in progressive multifocal leukoencephalopathy. Annals of neurology, 75(5), 659-669.
\nTan, C. S., & Koralnik, I. J. (2010). Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. The Lancet Neurology, 9(4), 425-437.
\nAssetta, B., & Atwood, W. J. (2017). The biology of JC polyomavirus. Biological chemistry, 398(8), 839\u2013855. https:\/\/doi.org\/10.1515\/hsz-2016-0345
\nSafak, M., & Khalili, K. (2003). An overview: Human polyomavirus JC virus and its associated disorders. Journal of neurovirology, 9 Suppl 1, 3\u20139. https:\/\/doi.org\/10.1080\/13550280390195360
\nMayo Clinic. Mayo Medical Laboratories. Test Catalog. [on-line]: https:\/\/www.mayocliniclabs.com\/test-catalog\/Overview\/75758#Overview [Accesat la data 22.03.2022].<\/p>","protected":false},"excerpt":{"rendered":"
\u041f\u043e\u043b\u0438\u043e\u043c\u0430\u0432\u0438\u0440\u0443\u0441\u044b \u0447\u0435\u043b\u043e\u0432\u0435\u043a\u0430 \u2014 \u0432\u0438\u0440\u0443\u0441 JC (JCV) \u0438 \u0432\u0438\u0440\u0443\u0441 BK (BKV) \u2014 \u043e\u0434\u0438\u043d\u0430\u043a\u043e\u0432\u043e \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u044b \u0438 \u043d\u0435 \u0432\u044b\u0437\u044b\u0432\u0430\u044e\u0442 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0443 \u0438\u043c\u043c\u0443\u043d\u043e\u043a\u043e\u043c\u043f\u0435\u0442\u0435\u043d\u0442\u043d\u044b\u0445 \u043b\u0438\u0446 (\u0442\u043e \u0435\u0441\u0442\u044c, \u043a\u043e\u0433\u0434\u0430 \u0438\u043c\u043c\u0443\u043d\u043d\u0430\u044f \u0441\u0438\u0441\u0442\u0435\u043c\u0430 \u0444\u0443\u043d\u043a\u0446\u0438\u043e\u043d\u0438\u0440\u0443\u0435\u0442 \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u043e).<\/p>\n
70% \u043d\u0443\u043a\u043b\u0435\u043e\u0442\u0438\u0434\u043d\u044b\u0445 \u043f\u043e\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u0435\u0439 \u0414\u041d\u041a \u0432\u0438\u0440\u0443\u0441\u043e\u0432 JC \u0438 BK \u0438\u0434\u0435\u043d\u0442\u0438\u0447\u043d\u044b.<\/p>\n
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\u0420\u0435\u0430\u043a\u0442\u0438\u0432\u0430\u0446\u0438\u044f \u0432\u0438\u0440\u0443\u0441\u0430 BKV \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0434\u0438\u0442 \u043f\u0440\u0438 \u0438\u043c\u043c\u0443\u043d\u043e\u0434\u0435\u0444\u0438\u0446\u0438\u0442\u043d\u044b\u0445 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u044f\u0445 \u0438 \u0440\u0430\u0437\u0432\u0438\u0432\u0430\u0435\u0442\u0441\u044f \u043f\u043e\u043b\u0438\u043e\u043c\u0430\u0432\u0438\u0440\u0443\u0441-\u0430\u0441\u0441\u043e\u0446\u0438\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u0430\u044f \u043d\u0435\u0444\u0440\u043e\u043f\u0430\u0442\u0438\u044f, \u043e\u0441\u043e\u0431\u0435\u043d\u043d\u043e \u043f\u043e\u0441\u043b\u0435 \u0442\u0440\u0430\u043d\u0441\u043f\u043b\u0430\u043d\u0442\u0430\u0446\u0438\u0438 \u043f\u043e\u0447\u0435\u043a \u0438\u043b\u0438 \u0434\u0440\u0443\u0433\u0438\u0445 \u043e\u0440\u0433\u0430\u043d\u043e\u0432. \u0422\u0430\u043a\u0436\u0435 \u0432\u043e\u0437\u043c\u043e\u0436\u043d\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u0441\u0442\u0435\u043d\u043e\u0437\u0430 \u0443\u0440\u0435\u0442\u0440\u044b. \u041e\u0434\u043d\u0430\u043a\u043e \u0440\u0435\u0434\u043a\u043e \u0432\u043e\u0437\u043c\u043e\u0436\u043d\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u0433\u0435\u043c\u043e\u0440\u0440\u0430\u0433\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0446\u0438\u0441\u0442\u0438\u0442\u0430.<\/p>\n
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