We have described a novel clinical entity caused by JC virus (JCV) infection of cortical pyramidal neurons in an immunosuppressed individual. This patient presented with lesions restricted to the hemispheric gray matter on MRI, developed aphasia, progressive cognitive dysfunction and seizures and had a rapid fatal outcome. We called this disease JCV encephalopathy (JCVE), since it is distinct from Progressive Multifocal Leukoencephalopathy (PML), caused by JCV infection of glial cells. Post mortem histological evaluation demonstrated for the first time a productive and lytic infection of cortical pyramidal neurons by JCV. We have analyzed the full length sequence of a molecular clone of JCV obtained from the brain of this patient, JCVCPN1, which revealed an archetype-like regulatory region (RR), and a novel 143 bp deletion in the Agnoprotein gene. The CPN mutant was subsequently found in the neurons or cerebrospinal fluid of three other patients with PML. We hypothesize that changes in JCV sequence are responsible for the specific infection of cortical pyramidal neurons in this patient. However, whether JCVCPN1 growth in neurons is made possible by its RR, the novel Agnoprotein deletion, or both, remains unclear. Furthermore, we postulate that JCV infection of cortical neurons may also occur in other individuals, including in PML patients with demyelinating lesions located at the gray white- junction or within the gray matter. Finally, we hypothesize that other pyramidal neurons, located in the hippocampus may also be infected by JCV variants, which could lead to the development of seizures. To test these hypotheses, we will pursue the following set of Specific Aims:
Aim 1) Characterize the host cell range of JCVCPN1 in vitro Aim 2) Determine the contributions of the Agnoprotein deletion and archetype-like RR to the phenotype of JCVCPN1 in vitro Aim 3) Characterize the prevalence of JCV infection of cortical pyramidal neurons in archival samples from PML patients and identify the CPN1 mutation using immunohistochemistry and laser capture microdissection Aim 4) Investigate JCV infection of hippocampal pyramidal neurons in immunosuppressed individuals and in patients with hippocampal sclerosis or intractable epilepsy

Public Health Relevance

JC virus infects glial cells and typically causes a disease of the white matter of the brain, called Progressive Multifocal Leukoencephalopathy. We have described a novel clinical entity caused by a JC virus variant infecting cortical pyramidal neurons. We called this disease, restricted to the gray matter of the brain, JCV encephalopathy (JCVE). We will characterize the pathogenesis of this unique JC virus variant in vitro and define the prevalence of JCV infection of pyramidal neurons in immunosuppressed individuals. We will also investigate the role of JCV infection of hippocampal neurons in immunocompetent people with intractable seizures or elderly subjects with hippocampal sclerosis.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS074995-02
Application #
8420424
Study Section
Clinical Neuroimmunology and Brain Tumors Study Section (CNBT)
Program Officer
Wong, May
Project Start
2012-02-15
Project End
2017-01-31
Budget Start
2013-02-01
Budget End
2014-01-31
Support Year
2
Fiscal Year
2013
Total Cost
$359,805
Indirect Cost
$148,711
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Sierra Morales, Fabian; Illingworth, Carlos; Lin, Kathie et al. (2017) PML-IRIS in an HIV-2-infected patient presenting as Bell's palsy. J Neurovirol 23:789-792
Sierra Morales, Fabian; Wright, Robert B; Novo, Jorge E et al. (2017) Glioblastoma in natalizumab-treated multiple sclerosis patients. Ann Clin Transl Neurol 4:512-516
Bialasiewicz, Seweryn; Hart, Gareth; Oliver, Kimberly et al. (2017) A Difficult Decision: Atypical JC Polyomavirus Encephalopathy in a Kidney Transplant Recipient. Transplantation 101:1461-1467
Miskin, Dhanashri P; Herman, Susan T; Ngo, Long H et al. (2016) Predictors and characteristics of seizures in survivors of progressive multifocal leukoencephalopathy. J Neurovirol 22:464-71
Wüthrich, Christian; Batson, Stephanie; Anderson, Matthew P et al. (2016) JC Virus Infects Neurons and Glial Cells in the Hippocampus. J Neuropathol Exp Neurol :
Crossley, Kate M; Agnihotri, Shruti; Chaganti, Joga et al. (2016) Recurrence of progressive multifocal leukoencephalopathy despite immune recovery in two HIV seropositive individuals. J Neurovirol 22:541-5
Kaliyaperumal, Saravanan; Wüthrich, Christian; Westmoreland, Susan V et al. (2015) Simian Virus 40 Infection in the Spinal Cord of Simian Immunodeficiency Virus-Immunosuppressed Rhesus Macaques. J Neuropathol Exp Neurol 74:1071-6
Satyanarayana, Gowri; Hammond, Sarah P; Broge Jr, Thomas A et al. (2015) BK polyomavirus reactivation after reduced-intensity double umbilical cord blood cell transplantation. Transpl Immunol 32:116-20
Chalkias, Spyridon G; Gheuens, Sarah; Bord, Evelyn et al. (2015) Brief Report: Role of Thymic Reconstitution in the Outcome of AIDS-Related PML. J Acquir Immune Defic Syndr 70:357-61
Agnihotri, Shruti P; Koralnik, Igor J (2015) Training for a neurology career in a rare disease: The role of cyberconsults. Ann Neurol 77:738-40

Showing the most recent 10 out of 35 publications