Polyomavirus reactivation in pediatric patients with systemic lupus erythematosus

Area of Science:

• Virology
• Immunology
• Pediatric Nephrology

Background:

• Polyomavirus (PyV) infections are typically asymptomatic in healthy individuals.
• Immunocompromised patients, including those with systemic lupus erythematosus (SLE), have a higher risk of PyV reactivation, potentially leading to severe complications.
• Pediatric SLE patients represent a vulnerable population for viral reactivation due to their disease and treatment regimens.

Purpose of the Study:

• To investigate the prevalence and clinical implications of six PyV types (JC, BK, WU, KI, MC, TS) in pediatric SLE patients.
• To assess the correlation between PyV viruria and urine transforming growth factor (TGF)-β1 levels.
• To identify risk factors associated with PyV reactivation in this cohort.

Main Methods:

• Nested polymerase chain reaction (PCR) was used to detect PyV viruria in urine samples from 50 pediatric SLE patients.
• Urine transforming growth factor (TGF)-β1 levels were quantified using ELISA.
• Clinical data, including medication history, were collected through medical record review.

Main Results:

• JC and BK polyomaviruses were detected in 16% and 32% of patients, respectively; WU, KI, MC, and TS were not detected.
• Higher urine TGF-β1 levels were observed in patients with JC viruria compared to those with BK viruria or no PyV viruria.
• JC reactivation was significantly associated with higher cumulative doses of cyclophosphamide and elevated urine TGF-β1 levels.

Conclusions:

• The prevalence of JC and BK polyomavirus reactivation is elevated in pediatric SLE patients compared to the general population.
• JC virus reactivation in pediatric SLE is linked to high-dose cyclophosphamide treatment and increased urine TGF-β1.
• Routine surveillance for JC virus reactivation is recommended for pediatric patients with severe or chronic SLE undergoing high-dose cyclophosphamide therapy.