cmx-001 and Polyomavirus-Infections

Despite improvements in posttransplant care, BK virus (BKV) remains one of the most challenging posttransplant infections in kidney transplant recipients with high rates of allograft failure. In the absence of well tolerated and efficacious viral specific therapeutics, treatment is primarily focused on reduction of immunosuppression, which poses a risk of rejection and fails to lead to viral clearance in a number of patients.. Recent work has turned toward preventive therapies analogous to those used for other infections like cytomegalovirus. These efforts have focused on the use of quinolone antibiotic prophylaxis to prevent BKV infection and pretransplant vaccination to boost humoral and cellular immunity.. Despite promising in-vitro and observational data, quinolone antibiotic prophylaxis has not been effective in preventing BKV infection in prospective studies. However, prophylaxis with newer less toxic viral specific agents such as brincidofovir - the lipid oral formulation of cidofovir - may yet prove effective. Strategies focused on eliciting a humoral immune response to recombinant virus-like particles or using adoptive transfer of BKV-specific T cells have also shown significant potential to prevent BKV infection in organ transplant recipients.

Topics: BK Virus; Cytosine; Humans; Immunity, Cellular; Immunity, Humoral; Immunosuppression Therapy; Kidney Transplantation; Organophosphonates; Polyomavirus Infections; Postoperative Complications; Prospective Studies; Quinolones; Transplant Recipients; Tumor Virus Infections

Topics: Animals; Antiviral Agents; Brain Chemistry; Chromatography, High Pressure Liquid; Cidofovir; Cytosine; Kidney; Mice; Mice, Inbred C57BL; Organophosphonates; Polyomavirus Infections; Spleen; Tandem Mass Spectrometry

Polyomavirus-associated nephropathy (PVAN) is common in patients who have undergone kidney transplantation and has been reported in hematopoietic stem cell (HSC) transplant recipients. Aside from reduction of immunosuppression, few therapeutic options exist for treatment of PVAN. We report a case of PVAN in a severely immunocompromised allogeneic HSC transplant recipient that was treated with brincidofovir without reduction of immunosuppression. We review our institutional experience of PVAN in HSC transplantation and discuss the potential use of brincidofovir for treatment.

Topics: BK Virus; Cytomegalovirus Infections; Cytosine; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Kidney Diseases; Male; Middle Aged; Organophosphonates; Polyomavirus; Polyomavirus Infections; Tumor Virus Infections; Viremia