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Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms

Daniel C Brennan1, José M Aguado, Luciano Potena

  • 1Washington University in St Louis, St Louis, MO 63110, USA. brennan@wudosis.wustl.edu

Reviews in Medical Virology
|November 21, 2012
PubMed

Insights

Mammalian target of rapamycin (mTOR) inhibitors show potential antiviral effects against cytomegalovirus (CMV) and other viruses common after transplantation. This review consolidates evidence on immunosuppressants and their impact on viral reactivation.

Area of Science:

  • Transplant medicine and virology
  • Immunosuppression and antiviral therapy

Background:

  • Transplant recipients face risks from viral reactivation, including herpesviruses, CMV, and others.
  • Immunosuppressive drugs are essential post-transplant but can influence viral infections.
  • Existing research on immunosuppressants' antiviral properties is fragmented.

Purpose of the Study:

  • To compile evidence on the antiviral activity of common immunosuppressive agents.
  • To review immunosuppressive regimens balancing rejection prevention and viral risk.
  • To explore the impact of specific drugs like mTOR inhibitors on viral infections.

Main Methods:

  • Literature review of studies on immunosuppressants and viral reactivation post-transplant.
  • Analysis of antiviral effects against common transplant-associated viruses (e.g., CMV, EBV, BKV, HPV).
  • Examination of typical immunosuppressive regimens and their viral implications.

Main Results:

  • Evidence suggests mammalian target of rapamycin (mTOR) inhibition may offer advantages against several viruses.
  • Tacrolimus may stimulate BK polyomavirus (BKV) replication.
  • Steroids appear to potentiate viral reactivation.

Conclusions:

  • mTOR inhibitors show promise for managing viral infections in transplant patients.
  • Careful selection of immunosuppressive regimens is crucial to mitigate viral risks.
  • Further research is needed to fully elucidate the antiviral roles of immunosuppressants.

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