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MxA RNA quantification in febrile patients who underwent hematopoietic cell transplantation for primary
Claudia Ghidini1, Cinzia Zanotti, Sara Boccacci
1Diagnostic Department, Biotechnology Laboratory, Spedali Civili, Piazzale Spedali Civili, Brescia, Italy.
Abstract:
The presence of myxovirus resistance protein A (MxA) RNA was studied in 55 febrile children with primary immunodeficiency, 27 of whom underwent hematopoietic cell transplantation, and in 28 age-matched controls. The level of MxA RNA was above the cutoff, established as the 95th percentile found in controls, with primary immunodeficiency either undergoing transplantation or not in febrile patients, and with a documented diagnosis of infection by adenovirus, cytomegalovirus, Epstein-Barr virus, respiratory syncytial virus, and rotavirus. The presence of rare viral infections, unrecognized among those that more frequently occur in patients with primary immunodeficiency and in patients undergoing transplantation, may explain the high MxA RNA levels observed in some patients with fever but undetectable genomes or antibodies for the more common viruses. The level of MxA in febrile patients with acute graft versus host disease was below the cutoff, with a median level comparable with that observed in patients with primary immunodeficiency, who did not undergo transplantation and were without fever and infections, but significantly lower compared with controls. The level of MxA was well correlated with viral infections in follow-up samples. These data indicate that the measurement of MxA RNA is simple and useful to detect viral infections and in distinguishing them from acute graft versus host disease after allogeneic cell transplantation.
Insights
Myxovirus resistance protein A (MxA) RNA levels can help detect viral infections in febrile children with primary immunodeficiency. MxA RNA is also useful in differentiating viral infections from acute graft versus host disease post-transplantation.
Area of Science:
- Immunology
- Virology
- Pediatrics
Background:
- Febrile illnesses in children with primary immunodeficiency (PID) or undergoing hematopoietic cell transplantation (HCT) pose diagnostic challenges.
- Differentiating viral infections from other inflammatory conditions like graft-versus-host disease (GvHD) is crucial for appropriate management.
Purpose of the Study:
- To investigate the utility of myxovirus resistance protein A (MxA) RNA as a biomarker for viral infections in febrile children with PID.
- To assess MxA RNA's ability to distinguish viral infections from acute GvHD in pediatric HCT recipients.
Main Methods:
- Quantification of MxA RNA levels in peripheral blood samples from febrile children with PID (with or without HCT) and age-matched controls.
- Comparison of MxA RNA levels in patients with documented viral infections versus those with acute GvHD.
- Correlation of MxA RNA levels with viral detection and clinical outcomes.
Main Results:
- Elevated MxA RNA levels were observed in febrile children with PID and documented viral infections (adenovirus, CMV, EBV, RSV, rotavirus).
- MxA RNA levels were significantly lower in febrile patients with acute GvHD compared to controls and those with viral infections.
- MxA RNA levels correlated well with the presence of viral infections in follow-up samples.
Conclusions:
- MxA RNA measurement is a simple and effective tool for detecting viral infections in immunocompromised children.
- MxA RNA can aid in differentiating viral infections from acute GvHD following allogeneic HCT.
