BK virus infection in transplant recipients: clinical manifestations, treatment options and the immune response.
Notice bibliographique
Résumé
Polyomavirus BK (BKV) is ubiquitously present amongst the general population establishing a latent, seemingly asymptomatic infection in immunocompetent individuals. In transplant recipients, however, BKV reactivation is common and can lead to distinctive pathological entities in different patient groups: in renal transplant (RT) recipients, it is associated with nephropathy (BKVN) and ureteral stenosis, and in haematopoietic stem cell transplant (HSCT) recipients with haemorrhagic cystitis (HC). Furthermore, BKV employs several potentially oncogenic mechanisms to promote its replication in cells and has been inconsistently linked to the development of malignancies. BKVN is currently a major cause of allograft failure in RT recipients. HC causes prolonged hospital stay and increased mortality in HSCT recipients. Despite its discovery more than 40 years ago, few advances have been made with regard to therapeutic strategies. Current therapies aim to restore the impaired immune response, e.g. by lowering immunosuppressive agents in RT recipients. However, this is a double-edged sword since it also increases the chance of rejection. Therefore, more specific and effective treatment strategies are urgently needed. Here, we will review the current knowledge on the structure and lifecycle of BKV, characteristics of the BKV-specific immune response, its clinical manifestations and the strengths and limitations of available treatments Polyomavirus BK (BKV) is ubiquitously present amongst the general population establishing a latent, seemingly asymptomatic infection in immunocompetent individuals. In transplant recipients, however, BKV reactivation is common and can lead to distinctive pathological entities in different patient groups: in renal transplant (RT) recipients, it is associated with nephropathy (BKVN) and ureteral stenosis, and in haematopoietic stem cell transplant (HSCT) recipients with haemorrhagic cystitis (HC). Furthermore, BKV employs several potentially oncogenic mechanisms to promote its replication in cells and has been inconsistently linked to the development of malignancies. BKVN is currently a major cause of allograft failure in RT recipients. HC causes prolonged hospital stay and increased mortality in HSCT recipients. Despite its discovery more than 40 years ago, few advances have been made with regard to therapeutic strategies. Current therapies aim to restore the impaired immune response, e.g. by lowering immunosuppressive agents in RT recipients. However, this is a double-edged sword since it also increases the chance of rejection. Therefore, more specific and effective treatment strategies are urgently needed. Here, we will review the current knowledge on the structure and lifecycle of BKV, characteristics of the BKV-specific immune response, its clinical manifestations and the strengths and limitations of available treatments methods.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».