Journal article
Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis
Neurology, Vol.84(19), pp.1948-1955
05/12/2015
DOI: 10.1212/WNL.0000000000001409
PMCID: PMC4433460
PMID: 25695965
Abstract
Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA).
Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen-positive slides were analyzed by PCR for VZV DNA.
VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen-positive TAs. Despite formalin fixation, VZV DNA was detected in 18/45 (40%) GCA-positive VZV antigen-positive TAs, in 6/10 (60%) VZV antigen-positive skeletal muscles, and in one VZV antigen-positive normal TA. Varicella-zoster virions were found in a GCA-positive TA. In sections adjacent to those containing VZV, GCA pathology was seen in 89% of GCA-positive TAs but in none of 18 adjacent sections from normal TAs.
Most GCA-positive TAs contained VZV in skip areas that correlated with adjacent GCA pathology, supporting the hypothesis that VZV triggers GCA immunopathology. Antiviral treatment may confer additional benefit to patients with GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.
Details
- Title: Subtitle
- Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis
- Creators
- Don GildenTeresa White - University of Colorado SystemNelly Khmeleva - University of Colorado SystemAnna Heintzman - University of Colorado SystemAlexander Choe - University of Colorado SystemPhilip J Boyer - University of Colorado SystemCharles Grose - University of IowaJohn E Carpenter - University of IowaApril Rempel - University of Colorado SystemNathan Bos - University of Colorado SystemBalasubramaniyam Kandasamy - University of Colorado SystemKelly Lear-Kaul - Hamilton County CoronerDawn B Holmes - Office of the Chief Medical ExaminerJeffrey L Bennett - University of Colorado SystemRandall J Cohrs - University of Colorado SystemRavi Mahalingam - University of Colorado SystemNaresh Mandava - University of Colorado SystemCharles G Eberhart - Johns Hopkins UniversityBrian Bockelman - Florida International UniversityRobert J Poppiti - Florida International UniversityMadhura A Tamhankar - University of PennsylvaniaFranz Fogt - Texas Oculoplastic ConsultantsMalena Amato - Dell Medical SchoolEdward Wood - University of British ColumbiaVikram Durairaj - The University of Texas at AustinSteve Rasmussen - Landspitali University HospitalVigdis Petursdottir - Assaf Harofeh Medical CenterLea Pollak - Tel Aviv UniversitySonia Mendlovic - Université de Picardie Jules VerneDenis Chatelain - University of Duisburg-EssenKathy Keyvani - University of GöttingenWolfgang Brueck - University of Colorado SystemMaria A Nagel - University of Colorado System
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.84(19), pp.1948-1955
- DOI
- 10.1212/WNL.0000000000001409
- PMID
- 25695965
- PMCID
- PMC4433460
- NLM abbreviation
- Neurology
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Grant note
- P01 AG032958 / NIA NIH HHS R01 EY022936 / NEI NIH HHS NS 067070 / NINDS NIH HHS P30 DK054759 / NIDDK NIH HHS AG032958 / NIA NIH HHS
- Language
- English
- Date published
- 05/12/2015
- Academic Unit
- Stead Family Department of Pediatrics; Infectious Disease (Pediatrics)
- Record Identifier
- 9984354153102771
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