Chronic Epstein-Barr Virus Research Articles

EBV-positive diffuse large B-cell lymphoma of the elderly: 2016 update on diagnosis, risk-stratification, and management.

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is a provisional entity included in the 2008 WHO classification of lymphoid neoplasms. It is a disease typically seen in the elderly and thought to be associated with chronic EBV infection and severe immunosuppression with a component of immunosenescence. Recent research, however, has suggested that EBV-positive DLBCL can be seen in younger, immunocompetent patients. The diagnosis of EBV-positive DLBCL of the elderly is made through a careful pathological evaluation. The differential diagnosis includes infectious mononucleosis (specifically in younger patients), lymphomatoid granulomatosis, Hodgkin lymphoma, and gray zone lymphoma, among others. Detection of EBV-encoded RNA (EBER) is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined. The International Prognostic Index (IPI), and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 is emerging as a potential adverse, and targetable, prognostic factor. Patients with EBV-positive DLBCL should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. It has been suggested, however, that EBV-positive patients have a worse prognosis than EBV-negative counterparts in the era of chemoimmunotherapy. There is an opportunity to study and develop targeted therapy in the management of patients with EBV-positive DLBCL.

Epstein-Barr Virus Infection in Children: Improving the Diagnosis and Treatment Program

Widespread, severe course, frequent development of chronic forms, adverse effects of the Epstein-Barr virus infection to the health of children, the difficulties of diagnosis and therapy dictate the need to improve the diagnostic and treatment programs in this disease. A total of 286 patients with acute and chronic Epstein-Barr virus infection. It was established, that for the timely diagnosis of the disease requires a comprehensive analysis of anamnesis, clinical symptoms, including symptoms of acute and chronic mononucleosis syndrome in combination with multiorgan pathology, and the results of laboratory examination (enzyme immunoassay, polymerase chain reaction, immune status).

Successful Treatment of Macrophage Activation Syndrome in Chronic Lymphoproliferative Disorder of Natural Killer Cells with Cyclophosphamide

Introduction:Chronic natural killer (NK) cell lymphoproliferative disorders comprise a rare subgroup of diseases characterized by proliferation of NK cells with expression of CD3-/CD16+ or CD56+ on flow cytometry. Clinically, these patients present with cytopenias as well as fatigue and B symptoms. The diagnosis can be challenging due to frequent lack of a unique clonal marker. Chronic NK cell lymphoproliferative disorder can be differentiated from NK cell leukemia based on the absence of chronic EBV infection. Macrophage activation syndrome (MAS) can occur in the setting of hematologic malignancies. Due to the rarity of this diagnosis, there are no randomized controlled trials to determine the optimal therapy. We report the case of an elderly gentleman whom we diagnosed with chronic NK cell lymphoproliferative disorder, complicated by transfusion-dependent autoimmune hemolytic anemia, and MAS, and who was successfully treated with oral cyclophosphamide.Case Report:In March 2014, a 75 year old Caucasian male, who was otherwise in good health, had a syncopal episode. Two months earlier, he had reported dyspnea on exertion and cough. He was diagnosed with bronchitis and these symptoms resolved with a course of antibiotics. Cardiac work-up was unremarkable. Complete blood count demonstrated white blood count of 16.8K with 84% lymphocytes, with hemoglobin of 7.8g/dL and platelets of 264K. Lactate dehydrogenase (LDH) was elevated at 615 IU/L, haptoglobin was undetectable, total bilirubin was mildly elevated at 1.5mg/dL and a Coomb's assay was negative. The patient had adequate iron stores with 50% saturation and erythropoietin level was 76.7ug/L. CT of the abdomen/pelvis demonstrated mild splenomegaly of 14cm. CT scan also revealed numerous thoracic-spine soft lesions. Bone marrow biopsy revealed a hypercellular marrow with appropriate trilineage hematopoiesis, erythroid hyperplasia and increased lymphocytes which were CD2+ CD7+ CD16+ and CD 56 negative cells as well as negative for T and B cell markers. This lymphocyte population was identified as NK cells and comprised 16% of his cells. The patient's transfusion dependence did not decrease despite oral prednisone. He transferred to our university medical center. Repeat flow cytometry after one month on prednisone demonstrated an increase to 70% of the lymphocytes. Further, there was a high suspicion for macrophage activation syndrome given his ferritin of 7,358ng/mL, triglycerides of 290mg/dL and interleukin-2 receptor of 7,250pg/mL. There was no evidence of active hemophagocytosis on the bone marrow biopsy. He continued on prednisone 60mg daily, and started on cyclophosphamide 50mg daily. His clinical course over the next several months was complicated by recurrent fevers, night sweats, mental status changes, and hyponatremia. Sepsis was ruled out as a cause of his fevers and his mental status changes were attributed to be secondary to hyponatremia and MAS. Work-up of his hyponatremia revealed syndrome of inappropriate antidiuretic hormone secretion (SIADH). After 2 months of treatment, his sodium level and mental status normalized. His cyclophosphamide was increased to 100mg daily and maintained at that dose. He was then tapered off prednisone. This patient's B symptoms of fevers and night sweats abated after several months of this therapy, and his transfusion dependence and underlying MAS resolved. The patient has been maintained on cyclophosphamide 100mg for 11 months and has shown resolution of his lymphocytosis and normalization of his blood counts.Discussion:Chronic lymphoproliferative disorders of NK cells continue to be a difficult group of diseases to recognize. Moreover, this case was further complicated by MAS based on elevated interleukine-2 receptor, triglycerides and ferritin levels in the setting of B-symptoms and liver enzyme elevations. This constellation of factors has not been previously described in the literature. Due to lack of clonal markers in NK cells, the diagnosis is frequently made by exclusion. The patient has done very well on oral cyclophosphamide and prednisone alone. We present this case to increase provider awareness and hopefully allow for improved diagnosis and treatment options in the future. DisclosuresNo relevant conflicts of interest to declare.

Editorial Commentary:Life After Lyme Disease

<i>Editorial Commentary:</i>Life After Lyme Disease

The Effectiveness of Complex Use of Inosine Pranobex and Recombinant Interferon-

The purpose of research — improvement of treatment programs for chronic Epstein-Barr virus mono-infection and mixed with clamidiosis infection in frequently ill children with use of inosine pranobex (isoprinosine) and recombinant interferon-a2b (viferon). Clinical, serological and immunological examination of 116 patients aged from 3 to 6 years with chronic Epstein-Barr virus infection in the form of mono-infection (48) and mixed with clamidiosis infection (68) is conducted. In the complex therapy of 24 children with mono-infection and 42 patients with mixed infection, inosine pranobex in combination with recombinant interferon-a2b were included. In 24 patients with mono-infection and 26 children with mixed infection, using only recombinant interferon-a2b. In patients with monoinfection, multiorgan pathology (respiratory, lymphoproliferative, cardial, cerebral, arthralgiс syndromes) was found. During serological examination found markers of active Epstein-Barr virus infection (IgM to VСA, IgG to EA, a high level of IgG to EBNA). Changes of the immune status was associated with activation of immune system (increase of CD8, HLA-DR, CD16, IgA, IgM, IgG, metabolic activity of neutrophils) and its damage (reduction of CD3, CD4, CD25, CD20, interferon-a, interleukin-4, reserve possibilities of neutrophils metabolism, increase of CD95, circulating immune complexes). Development of mixed infection led to a deepening of immunological disorders and increased frequency of respiratory, gastrointestinal and lymphoproliferative syndromes. When combined inosine pranobex and recombinant interferon-a2b was going to potentiation antiviral, of immunomodulatory and cytoprotective activity of drugs that reduced the incidence of acute respiratory infections and severity of multiorgan pathology. High efficiency and safety of inosine pranobex and recombinant interferon-a2b combination allow to recommend its inclusion in the complex therapy of patients from frequently ill children group with various forms of chronic Epstein-Barr virus infection.

Lost Immune Markers for Major Affective Disorders: Could They Help Screen Airline Pilots?

In the 1980s it was discovered that quantitative IgG titers for antibodies directed against the hu-man-obligate DNA viruses were reliably and reproducibly correlated negatively with mood in in-dividuals with major affective disorders. This knowledge was lost to confirmation bias and uncontrolled studies that only looked at Epstein-Barr virus antibodies. The latter led to a long American fad of misdiagnosing major affective disorders as a “chronic Epstein-Barr virus syndrome.” This misdiagnosis even became part of the American popular culture during the 1980s. In light of fatal airline crashes intentionally caused by pilots, the antiviral IgG titers should be revisited as a means of screening pilots for current dysphoria or mania/hypomania due to major affective disorders.

Оptimization of Treatment EBV Infectious Mononucleosis in Children

The paper presents the results of observation of 103 children aged from 10 months to 15 years with EBV-associated infectious mononucleosis (IM), determined in 32% by acute primary Epstein-Barr virus infection (AEBVI) and in 68% of cases by reactivation of chronic Epstein-Barr virus infection (CEBVI). Clinical and laboratory characteristics of the course, depending on the form of infection, were investigated. As a clinical outcome of infectious mononucleosis in patients with primary infection latent infection after a year is formed 5.8 times more often than in patients with chronic Epstein-Barr virus infection (CEBVI). The high efficiency of recombinant interferon monotherapy in patients with primary acute infection was recorded and the expediency of combined etiotropic therapy in the treatment of chronic Epstein-Barr virus infection was found out.

Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma arising in a patient with hypersensitivity to mosquito bites.

Hypersensitivity to mosquito bites is defined as the appearance of intense skin reactive lesions and systemic symptoms subsequent to mosquito bites. Most cases of hypersensitivity to mosquito bites reported thus far have been associated with chronic Epstein-Barr virus infection or natural killer cell leukemia/lymphoma. In this study, we describe the case of an 18-year-old Korean boy who had hypersensitivity to mosquito bites associated with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. After a mosquito bite, the patient developed a progressive cutaneous nodule on his left lower leg and regional lymphadenopathy in the left inguinal area. The histopathological and immunohistochemical findings suggested anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Positron emission tomography-computed tomography revealed increased fluorodeoxyglucose uptake in the left T4 vertebrae, left external iliac lymph nodes, left inguinal lymph nodes, and lateral subcutaneous region of the left lower leg. According to the clinical, histopathological, and immunohistochemical findings, as well as the imaging data, the patient was diagnosed with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Consequently, the patient received a total of 6 cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone chemotherapy at 3-week intervals, after which the lesions regressed.

Defect in B Cell Production Driven By GATA2 Mutation Results in Their Absolute Reduction and Mature Phenotype in Pediatric Patients

IntroductionGermline mutations in GATA2 were recently identified as causative for several overlapping syndromes: MonoMAC (monocytopenia, mycobacterial infections), DCML (dendritic cells, monocytes, B and NK cells deficiency), Emberger syndrome (lymphedema, sensorineural deafness, multiple warts) and familiar myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML). Of note, GATA2 mutations were also found in children and young adults with “primary” MDS. Aplastic anemia (AA) constitutes an important differential diagnosis to pediatric MDS, particularly in patients with normal cytogenetics.Because of heterogeneous phenotype of GATA2 mutated patients, defining a set of typical findings would help in their earlier identification and understanding the natural course of the disease. Therefore we aimed to analyze monocytes and lymphocyte subpopulations with the emphasis on B cell lineage by flow cytometry (FC) and polymerase chain reaction (PCR) in all pediatric patients with GATA2 mutation diagnosed in the Czech Republic.Patients and methodsEleven pediatric patients were found to harbor GATA2 mutations in the Czech Republic so far. Three mutations were intronic. There was a clear male predominance (9/11). In 7 patients the disease manifested with MDS in childhood, 2 female patients were followed for immunodeficiency and developed MDS in adulthood. One another patient was diagnosed with interstitial lung disease and chronic EBV infection. His brother, carrying the same mutation, has mild neutropenia. Bone marrow (BM) and peripheral blood (PB) samples were analyzed by FC. The level of intronRSS-Kde recombination excision circles (KREC) and T-cell receptor excision circles (TREC) for assessment of proliferation history of B and T cells was examined by PCR. The control group comprised 26 GATA2 wild-type MDS (“other MDS”) patients and 36 AA patients.ResultsDisturbance of B cell compartment was the most frequently observed anomaly in the patients with GATA2 mutation. We observed a decrease of absolute and relative B cell numbers in PB and BM (n=9/11). In BM there was a decrease of immature CD10pos B cells (n=10) with proportional increase of plasma cells. Peripheral blood B cell immunophenotype was shifted towards memory B cells (n=5/7). Presence of normal B cell precursors CD19pos10pos34pos in BM was observed only in 1 patient in part of follow-up samples. Atypical malignant B lymphoblasts were present in another patient, whose MDS quickly progressed to AML with a clear switch to B lymphoid phenotype. Despite significantly reduced number of B cells the levels of IgG were normal in majority of patients. Only 2 patients had IgG hypogammaglobuliemia, in one patient with chronic active EBV infection IgG hypergammaglobulinemia was present. Slightly decreased IgA level was present in 6 patients. Although B cell numbers in other MDS control patients were significantly lower compared to AA, still the decrease was less prominent in comparison with GATA2.The decrease of immature and naive B cells in patients with GATA2 mutation was reflected in very low level of KREC in PB and BM. Stored newborn dry blood spots from 4 patients were evaluated for TREC and KREC numbers. Strikingly, only one patient had negative KREC levels (the youngest patient from our cohort with MDS diagnosed at age 4). The remaining 3 patients had normal TREC and KREC levels at birth. Thus, the deterioration of de novo production of B cells occurred supposedly postnatally in most patients. Low KREC levels were also present in some patients with other MDS (n=5).Relative monocytopenia was found in 2 patients, low NK cells were present in 6 patients. T cells were mostly of naive non-activated phenotype.ConclusionsChanges in B cell compartment are the most characteristic feature in patients with GATA2 mutation. Decreased number of B cells together with a shift towards mature phenotype and decreased level of KREC reflect history of substantial B cell proliferation in an environment of impaired production. This process appears to happen postnatally and resemble normal ageing process, which is accelerated due to progenitor cell impairment. Immunophenotyping is a useful tool in identifying patients for GATA2 sequencing.Supported by GAUK 802214, IGA NT/14534-3, NT/13462-4, UNCE 204012, GAČR P301/10/1877 DisclosuresNo relevant conflicts of interest to declare.

X-linked immunodeficiency with magnesium defect, Epstein-Barr virus infection, and neoplasia disease: a combined immune deficiency with magnesium defect.

To describe the role of the magnesium transporter 1 (MAGT1) in the pathogenesis of 'X-linked immunodeficiency with magnesium defect, Epstein-Barr virus (EBV) infection, and neoplasia' (XMEN) disease and its clinical implications. The magnesium transporter protein MAGT1 participates in the intracellular magnesium ion (Mg) homeostasis and facilitates a transient Mg influx induced by the activation of the T-cell receptor. Loss-of-function mutations in MAGT1 cause an immunodeficiency named 'XMEN syndrome', characterized by CD4 lymphopenia, chronic EBV infection, and EBV-related lymphoproliferative disorders. Patients with XMEN disease have impaired T-cell activation and decreased cytolytic function of natural killer (NK) and CD8 T cells because of decreased expression of the NK stimulatory receptor 'natural-killer group 2, member D' (NKG2D). Patients may have defective specific antibody responses secondary to T cell dysfunction, but B cells have not been shown to be directly affected by mutations in MAGT1. XMEN disease has revealed a novel role for free intracellular magnesium in the immune system. Further understanding of the MAGT1 signaling pathway may lead to new diagnostic and therapeutic approaches.

Current knowledge on HIV-associated Plasmablastic Lymphoma.

HIV-associated PBL is an AIDS-defining cancer, classified by WHO as a distinct entity of aggressive DLBCL. To date less than 250 cases have been published, of them 17 are pediatric. The pathogenesis of this rare disease is related to immunodeficiency, chronic immune stimulation and EBV. Clinically is a rapid growing destructive disease mainly involving the oral cavity even if extraoral and extranodal sites are not infrequent. The diagnosis requires tissue mass or lymph node biopsy and core needle or fine needle biopsy is acceptable only for difficult access sites. Classically immunophenotype is CD45, CD20, CD79a negative and CD38, CD138, MUM1 positive, EBER and KI67 is >80%. Regarding the therapy, standard treatment is, usually, CHOP or CHOP-like regimens while more intensive regimens as CODOX-M/IVAC or DA-EPOCH are possible options. Use of cART is recommended during chemotherapy, keeping in mind the possible overlapping toxicities. Rituximab is not useful for this CD20 negative disease and CNS prophylaxis is mandatory. Intensification with ABMT in CR1 may be considered for fit patients. For refractory/relapsed patients, therapy is, usually, considered palliative, however, in chemo-sensitive disease, intensification + ABMT or new drugs as Bortezomib may be considered. Factors affecting outcome are achieving complete remission, PS, clinical stage, MYC, IPI score. Reported median PFS ranges between 6–7 months and median OS ranges between 11–13 months. Long term survivors are reported but mostly in pediatric patients. Finally, due to the scarcity of data on this subtype of NHL we suggest that the diagnosis and the management of HIV-positive PBL patients should be performed in specialized centers.

Abstract 389: Epigenetic and proteomic analysis of gastric tumor and its histologically free proximal and distal margins

Abstract Introduction: Gastric cancer (GC) corresponds to the fourth most common malignancy among men and sixth among women in Brazil. GC is a multifactorial disease that results from individual genetic predisposition and exposure to ambient factors such as diet, alcohol consumption, smoking, chronic Helicobacter pylori infection or Epstein-Barr virus (EBV). H. pylori and EBV are known to up-regulate DNA methyltransferases. Aim: Compare the promoter methylation profiles of E-cadherin, p16, DAPK, and Rb genes of histologically tumor free proximal and distal margins from fresh tissues and perform a quantitative proteomic comparison of the tumor, distal and proximal resection margins profiles from the same patient. Methods: 18 samples consisting of six gastric carcinomas, their corresponding proximal margins (PM), and distal margins (DM) were obtained from six patients subjected to gastric resection at the Federal University of Rio de Janeiro, Brazil. DNA was extracted from the fresh tissues by using proteinase K digestion and Phenol-chloroform isoamilic alcohol followed by ethanol precipitation. Methylation-specific PCR analysis was used to determine the methylation status of E-cadherin, p16, DAPK, and Rb genes promoter by bisulfite modification. The presence of EBV was investigated by PCR and a shotgun proteomic analysis of all tissues from the H pilory and EBV negative patient was performed using an Orbitrap Velos. Results: 3 of 6 patients were positive for EBV viz: 3 tumors plus 6 margins. The total methylation for the 4 genes in all 9 samples (p16, E-cadherin, DAPK, and Rb genes) were: 5/36 in PM (esophagus); 5/36 in tumor, and 9/36 for DM (intestinal); in the negative EBV samples: 6/36 in PM; 4/36 in tumor and 8/36 in the DM. The proteomic analysis disclosed 786 proteins identified in the tumor fragment (58 proteins uniquely identified in this tissue), 777 to histologically normal proximal margin (87 unique proteins) and 750 to histologically normal distal margin (132 unique proteins). In all three fragments analyzed, unique proteins related to tumor progression or metastasis were identified; examples are: hepatoma- derived growth (HDGF) in the tumor, Annexin 1A in the PM and Mucin 1 in the DM. Conclusion: Our results show that histologically free tumor margins are molecularly compromised by methylation and by up regulation of proteins correlated to tumor progression and metastasis even in samples not infected with EBV or H.pylori Financial support CNPq Citation Format: Paulo Costa Carvalho, Carlos Eduardo Carvalho, Guilherme Pinto Bravo Neto, Juliana Fischer Carvalho, Thais Mac Cormick, Priscila F. Aquino, Marcelo Mota Silva, Maria da Gloria da Costa Carvalho. Epigenetic and proteomic analysis of gastric tumor and its histologically free proximal and distal margins. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 389. doi:10.1158/1538-7445.AM2014-389

Immune Dysregulation in Renal Transplant Recipients With Chronic High Level EBV DNAemia.

Immune Dysregulation in Renal Transplant Recipients With Chronic High Level EBV DNAemia.

CD8+ T Cell Transcriptional Profiles of Pediatric Heart Transplant Recipients That Carry EBV Loads in Peripheral Blood.

Pediatric heart transplant (HTx) recipients display impaired CD8+ T cellular immune surveillance due to chronic immunosuppression and thus are at increased risk of EBV-associated post-transplant lymphoproliferative disorders (PTLD). Approximately 70% of asymptomatic pediatric HTx patients who seroconvert after HTx carry EBV loads in peripheral blood. One third of these patients display high chronic EBV loads (> 16,000 genomic copies/ml), and have up to 45% rate of progression to late onset PTLD. Here we used microarray analyses to investigate the hypothesis that CD8+ T cell transcriptional signatures are different between asymptomatic pediatric HTx patients that carry EBV loads vs. asymptomatic patients that do not carry EBV loads in peripheral blood. Six EBV seropositive asymptomatic, gender-, age-, and immunosuppression-matched pediatric HTx recipients were recruited to the study and consisted of: (i) undetectable viral load (UVL, n=2) carriers, resembling “normal” EBV latency; (ii) low viral load (LVL n=2) carriers; (iii) high viral load (HVL n=2) carriers. RNA was extracted from highly purified CD8+ T cells, amplified and hybridized to the Affymetrix H133 2.0 Plus Array. Perfect match data were normalized using the RMA method as implemented in BRB Array Tools. Differentially expressed genes were found for each comparison using the J5 test at threshold |J5|>12. Impacted pathways were studied using Pathway Express. Transcriptional signatures (transcripts, pathways, and networks) for pro-inflammatory cytokines and chemokines were significantly increased in CD8+ T cells from LVL and HVL carriers as compared to UVL carriers. In addition, CD8+ T cell from HVL carriers uniquely revealed up-regulation of transcripts relevant for apoptosis and for cross-talk to B lymphocytes, as well as macrophage-specific transcripts critical for cell migration and inflammation. These results indicate significant differences in the transcriptional profiles of CD8+ T cells from patients that carry EBV loads suggesting that these transcriptional signatures could be used as early surrogate biomarkers to monitor and assess patients at risk of complications that may benefit for prompt clinical intervention.

Clinical and laboratory characteristic and age features of the patients with Epstein-Barr virus infection

123 patients with acute and chronic EBV infection were under observation. The aim of this study was to determine differences in clinical course of acute and chronic diseases. Diagnosis in all patients was confirmed by serologic tests results. We described 3 most common variants of chronic EBV infection: reactivation, incomplete remission and atypical reactivation. The most frequent in patients with chronic EBV infection weretoxical, lymphoproliferative, cardiac and arthralgic syndromes.

Hydroa vacciniforme and solar urticaria.

Hydroa vacciniforme (HV) and solar urticaria (SU) are uncommon immunologically mediated photodermatoses. HV occurs almost exclusively in children, usually beginning in childhood and remitting spontaneously by adolescence. Association with chronic Epstein-Barr virus infection has been reported in HV, which raises the possibility of lymphoproliferative disorders in these patients. SU is characterized by skin erythema, swelling, and whealing immediately after sun exposure. Although several treatment options are available, the management of both conditions remains a challenge.

Current research on chronic active Epstein–Barr virus infection in Japan

Epstein-Barr virus (EBV) infection is usually asymptomatic and persists lifelong. Although EBV-infected B cells have the potential for unlimited proliferation, they are effectively removed by the virus-specific cytotoxic T cells, and EBV-associated lymphoproliferative disease develops only in immunocompromised hosts. Rarely, however, individuals without apparent immunodeficiency develop chronic EBV infection with persistent infectious mononucleosis-like symptoms. These patients have high EBV-DNA load in the peripheral blood and systemic clonal expansion of EBV-infected T cells or natural killer (NK) cells. Their prognosis is poor with life-threatening complications including hemophagocytic lymphohistiocytosis, organ failure, and malignant lymphomas. The term "chronic active EBV infection" (CAEBV) is now generally used for this disease. The geographical distribution of CAEBV is markedly uneven and most cases have been reported from Japan and other East Asian countries. Here we summarize the current understanding of CAEBV and describe the recent progress of CAEBV research in Japan.

Direct Infection of Dendritic Cells during Chronic Viral Infection Suppresses Antiviral T Cell Proliferation and Induces IL-10 Expression in CD4 T Cells

Elevated levels of systemic IL-10 have been associated with several chronic viral infections, including HCV, EBV, HCMV and LCMV. In the chronic LCMV infection model, both elevated IL-10 and enhanced infection of dendritic cells (DCs) are important for viral persistence. This report highlights the relationship between enhanced viral tropism for DCs and the induction of IL-10 in CD4 T cells, which we identify as the most frequent IL-10-expressing cell type in chronic LCMV infection. Here we report that infected CD8αneg DCs express elevated IL-10, induce IL-10 expression in LCMV specific CD4 T cells, and suppress LCMV-specific T cell proliferation. DCs exposed in vivo to persistent LCMV retain the capacity to stimulate CD4 T cell proliferation but induce IL-10 production by both polyclonal and LCMV-specific CD4 T cells. Our study delineates the unique effects of direct infection versus viral exposure on DCs. Collectively these data point to enhanced infection of DCs as a key trigger of the IL-10 induction cascade resulting in maintenance of elevated IL-10 expression in CD4 T cells and inhibition of LCMV-specific CD4 and CD8 T cell proliferation.

Chronic Epstein-Barr virus infection causing both benign and malignant lymphoproliferative disorders

The Epstein-Barr virus (EBV) is oncogenic and can transform B cells from a benign to a malignant phenotype. EBV infection is also associated with lymphoid interstitial pneumonia (LIP). Here, we report the case of a 14-year-old boy who was diagnosed with a latent EBV infection and underlying LIP, without any associated immunodeficiency. He had been EBV-seropositive for 8 years. The first clinical presentations were chronic respiratory symptoms and recurrent pneumonia. The symptoms worsened in the following 2 years. The results of in situ hybridization were positive for EBV, which led to a diagnosis of LIP. The diagnosis was confirmed by the results of a thoracoscopic lung biopsy. The EBV titer of the bronchoalveolar lavage specimens obtained after acyclovir treatment was found to be fluctuating. The patient had latent EBV infection for 8 years, until presented at the hospital with intermittent abdominal pain and distension. Physical examination and pelvic computed tomography revealed a large mesenteric mass. A biopsy of the excised mass led to a diagnosis of Burkitt's lymphoma (BL). The patient received combination chemotherapy for 4 months, consisting of vincristine, methotrexate, cyclophosphamide, doxorubicin, and prednisolone. He is now tumor-free, with the LIP under control, and is being followed-up at the outpatient clinic. This is the first report of a Korean case of chronic latent EBV infection that developed into LIP and BL in a nonimmunocompromised child.

IL-6 Promotes Cell Proliferation and Antiapoptosis Through Activation Of The JAK/STAT3 Pathway In Patients With NK/T - Cell Lymphoma and Correlates With Poor Treatmemt Outcome

BackgroudIt has been demonstrated that Natural/killer T-cell lymphoma (NK/TCL) derives from chronic EBV infection of nasopharynx. In recent years, IL-6 has been proved to be associated with a variety of inflammation-related malignancies in terms of carcinogenesis, tumor proliferation and metastasis. However, there hasn't been any report about IL-6 on the pathogenesis and development of NK/TCL. Patients and MethodsFrom January 2005 to December 2012, the paraffin sections of 91 patients with NK/TCL in Sun Yat-sen University Cancer Center were collected. The activation/expression of NF-ΚB(P50, P52, P65), IL-6,P-STAT3(Tyr705),BCL-2 in tumor microenviroment were investigated by immunohistochemistry. The NK/TCL cell lines were treated by IL-6(80ng/ml) and neutralizing IL-6 antibody, then the viability and apoptosis of lymphoma cell lines (NK-YS, SNK-6 and SNT-8) were assessed by CCK-8 and flow cytometry; and the expression of p-STAT3, BCL-2, BCL-XL, MCL-1, Survivin、p-ERK and p-AKT were examined by Western blot . ResultsOverall, ninety-one patients with NK/TCL were analyzed. There were 68 male patients. The median age was 43 years (range 10-68 years). There were 52, 14 and 25 patients diagnosed as stage I, II and IV disease, respectively. Sixty-one patients had B symptoms. The P52 activation was observed in the microenviroment of most patients, while P65 and P50 activation were observed in minority of patients. In patients with P52 activation, P52 activation was observed both in macrophages and lymphoma cells, and vice versa. IL-6 was primarily secreted by macrophages and tumor cells, and 69.2% (63/91) patients were positive (IL-6 secreting cells ≥ 10 / HP). The STAT3 activation was observed in 67.0% (61/91) of patients, most of which were combined with expression of BCL-2. The expression of P52、IL-6、P-STAT3、bcl-2 in the microenvironment of NK/TCL were in uniform (all positive or all negative). Patients with positive expression of IL-6 were associated with fever, advanced stage, high serum level of C-reactive protein (CRP), chemotherapy resistance and poor survival (P < 0.05). Comparing with blank control group and the neutralizing IL-6 antibody group, the cell viability and antiapoptosis ratio of NK-YS、 SNK-6、SNT-8 cells were higher in the IL-6 group (P<0.05). Constitutive activation of p-STAT3, BCL-2, BCL-XL, MCL-1, and survivin were observed in the NK/TCL cell lines. IL-6 could up-regulate the expression of these proteins. The expression of p-ERK and p-AKT were irrelevant with IL-6 or IL-6 antibody treatment. ConclusionsThe NK-κB(P52)/IL-6/STAT3 pathway is activated in tumor microenvironment, and is associated with fever, advanced stage, high serum level of CRP in patients with NK/TCL. IL-6 could activate the JAK/STAT3 pathway in NK/T lymphoma cell lines, and promote lymphoma proliferation and anti-apoptosis. The activation of NK-κB(P52)/IL-6/STAT3 pathway may lead to chemotherapy resistance and poor survival in patients with NK/TCL.▪▪ Disclosures:No relevant conflicts of interest to declare.