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Immune modulatory activity of ribavirin for serious human metapneumovirus disease: early i.v. therapy may improve outcomes in immunosuppressed SCT recipients

Bone Marrow Transplantation volume 41, pages 707–708 (2008)Cite this article

Most hematopoietic SCT recipients with human metapneumovirus (hMPV) infection are symptomless,1 and even prolonged (∼3 months) nasopharyngeal viral shedding is not associated with respiratory dysfunction.2 The occasional hMPV upper respiratory tract infection often resolves spontaneously and the usual brief illness seldom progresses to the lower respiratory tract.3 However, in severely immunosuppressed transplant recipients, hMPV may rarely cause life-threatening pulmonary4, 5 and brain infection.6

Ribavirin disrupts viral purine metabolism and inhibits viral RNA polymerase. It shows good in vivo activity against experimental hMPV infection.7 Ribavirin through upregulation of CD4 and CD8 T-lymphocyte-derived IL-2, tumor necrosis factor-α, interferon-γ and downregulation of T-helper 2 cytokines such as IL-10 enhances containment of viral infection.8 This drug-induced restoration of T-cell hyporesponsiveness that follows prolonged viral replication is critical in resolution of infection.9 It is intriguing to realize that ribavirin may improve outcomes in transplant recipients with serious hMPV infection by direct antiviral effect and restoration of host's cellular immune response.10, 11 Increases in proinflammatory cytokines, however, may potentially worsen and precipitate respiratory failure. Systemic corticosteroids are therefore used to abrogate unwarranted exacerbation of pulmonary inflammation in patients with viral hMPV pneumonitis while receiving ribavirin therapy.7, 11

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References

  1. Debiaggi M, Canducci F, Terulla C, Sampaolo M, Marinozzi MC, Alessandrino PE et al. Long-term study on symptomless human Metapneumovirus infection in hematopoietic stem cell transplant recipient. New Microbiol 2007; 30: 255–258.

    PubMed  Google Scholar 

  2. Debiaggi M, Canducci F, Sampaolo M, Marinozzi MC, Parea M, Terulla C et al. Persistent symptomless human Metapneumovirus infection in hematopoietic stem cell transplant recipients. J Infect Dis 2006; 194: 474–478.

    Article  PubMed  Google Scholar 

  3. Peck AJ, Englund JA, Kuypers J, Guthrie KA, Corey L, Morrow R et al. Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007; 110: 1681–1688.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Englund JA, Boeckh M, Kuypers J, Nichols G, Hackman RC, Morrow RA et al. Brief communication: fatal human Metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med 2006; 144: 344–349.

    Article  PubMed  Google Scholar 

  5. Huck B, Egger M, Bertz H, Peyerl-Hoffman G, Kern WV, Neumann-Haefelin D et al. Human Metapneumovirus infection in a hematopoietic stem cell transplant recipient with relapsed multiple myeloma and rapidly progressive lung cancer. J Clin Microbiol 2006; 44: 2300–2303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Schildgen O, Glatzel T, Geikowski T, Scheibner B, Matz B, Bindl L et al. Human metapneumovirus RNA in encephalitis patient. Emerg Infect Dis 2005; 11: 467–470.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hamelin ME, Prince GA, Boivin G . Effect of Ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection. Antimicrob Agents Chemother 2006; 50: 774–777.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sookoian S, Castano G, Flichman D, Cello J . Effect of Ribavirin on cytokine production of recall antigens and phytohemaglutinin-stimulated peripheral blood mononuclear cells. (inhibitory effects of ribavirin on cytokine production). Ann Hepatol 2004; 3: 104–107.

    PubMed  PubMed Central  Google Scholar 

  9. Brooks DG, McGavern DB, Oldstone MBA . Reprogramming of antiviral T cells prevents inactivation and restores T cell activity during persistent viral infection. J Clin Invest 2006; 116: 1675–1685.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Raza K, Ismailjee SB, Crespo M, Studer SM, Sanghavi S, Paterson DL et al. Successful outcome of human metapneumovirus (hMPV) pneumonia in a lung transplant recipient treated with intravenous ribavirin. J Heart Lung Transplant 2007; 26: 862–864.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kamble RT, Bollard C, Demmler G, LaSala PR, Carrum G . Human metapeumovirus infection in a hematopoietic transplantation recipient. Bone Marrow Transplant 2007; 40: 699–700.

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, Houston, TX, USA

    A Safdar

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Safdar, A. Immune modulatory activity of ribavirin for serious human metapneumovirus disease: early i.v. therapy may improve outcomes in immunosuppressed SCT recipients. Bone Marrow Transplant 41, 707–708 (2008). https://doi.org/10.1038/bmt.2008.80

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