The development of some lymphomas has been associated with infections caused by bacterial species discovered in the 1980s, for example, Helicobacter pylori and Borrelia burgdorferi s.l. The first cases of human infection with a bacterial species that was first described in 2004, the tick-borne bacterium Neoehrlichia mikurensis were published in 2010. Patients with malignant B cell lymphomas emerged as a risk group for severe cases of infection, presenting with fever of unknown cause and venous thromboembolism. The infection is missed by routine microbiologic diagnostic procedures such as blood culture and can only be detected by PCR. Vascular endothelium is a likely target of N. mikurensis infection. Asymptomatic carriage of the infection for months to years appears to occur. We hypothesized that N. mikurensis causes latent infections that can reactivate when B cell defenses are compromised. It was whilst conducting a study of patients with malignant B cell lymphomas scheduled to receive treatment with rituximab that we discovered several patients who had the infection already before the start of treatment. This led us to hypothesize that persistent latent infections with N. mikurensis might contribute to the development of certain cases of malignant B cell lymphoma. Splenic engagement, restricted repertoires of the Immunoglobulin heavy chain variable (IGHV) regions, and mutations of the IGHV regions from the germline configuration featured among these cases of lymphoma, which encompassed chronic lymphocytic leukemia, splenic marginal zone lymphoma, mantle cell lymphoma and non-classified indolent splenic lymphoma. Remarkably, three out of five patients could cease lymphoma therapy after eradication of the infection. Our aim is to confirm and expand these findings of a possible causality between N. mikurensis infection and the development of malignant B cell lymphomas. To this end, we are starting a prospective study of the prevalence of N. mikurensis infection in newly diagnosed patients with malignant B cell lymphomas, and the response of such lymphomas to eradication of the infection. We will also attempt to identify a genetic signature of N. mikurensis infection by studying IGHV gene usage, the mutations induced by somatic hypermutations, as well as the physicochemical properties of the complementarity-determining region 3 (CDR3), the most hypervariable part of the B cell receptor of infected patients. This will help establish if it is mainly post-germinal center B cells that undergo malignant B cell transformation in cases of N. mikurensis-associated lymphoma. The research was funded by: the Swedish Research Council, the Swedish Cancer Society, the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement, and the Cancer and Allergy Foundation. Keywords: indolent non-Hodgkin lymphoma, tumor biology and heterogeneity, chronic lymphocytic leukemia (CLL) No conflicts of interests pertinent to the abstract.
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