JC Virus Latency in the Brain and Extraneural Organs of Patients with and without Progressive Multifocal Leukoencephalopathy

JC virus (JCV) is latent in the kidneys and lymphoid organs of healthy individuals, and its reactivation in the context of immunosuppression may lead to progressive multifocal leukoencephalopathy (PML). Whether JCV is present in the brains or other organs of healthy people and in immunosuppressed patients without PML has been a matter of debate. We detected JCV large T DNA by quantitative PCR of archival brain samples of 9/24 (38%) HIV-positive PML patients, 5/18 (28%) HIV-positive individuals, and 5/19 (26%) HIV-negative individuals. In the same samples, we detected JCV regulatory region DNA by nested PCR in 6/19 (32%) HIV-positive PML patients, 2/11 (18%) HIV-positive individuals, and 3/17 (18%) HIV-negative individuals. In addition, JCV DNA was detected in some spleen, lymph node, bone, and kidney samples from the same groups. In situ hybridization data confirmed the presence of JCV DNA in the brains of patients without PML. However, JCV proteins (VP1 or T antigen) were detected mainly in the brains of 23/24 HIV-positive PML patients, in only a few kidney samples of HIV-positive patients, with or without PML, and rarely in the bones of HIV-positive patients with PML. JCV proteins were not detected in the spleen or lymph nodes in any study group. Furthermore, analysis of the JCV regulatory region sequences showed both rearranged and archetype forms in brain and extraneural organs in all three study groups. Regulatory regions contained increased variations of rearrangements correlating with immunosuppression. These results provide evidence of JCV latency in the brain prior to severe immunosuppression and suggest new paradigms in JCV latency, compartmentalization, and reactivation.JC virus (JCV) is the etiologic agent of the often fatal brain-demyelinating disease progressive multifocal leukoencephalopathy (PML) (23a). JCV remains latent in the kidneys, lymph nodes, and bone marrow of healthy and immunosuppressed individuals without PML (2, 21, 24) and, upon reactivation, can cause a lytic infection of oligodendrocytes in the brain, leading to PML (14). Although JCV is often found in the urine of healthy individuals (12, 18), it is not usually detected in the blood of patients without PML (15). The pathway leading to viral reactivation and replication in the brains of immunosuppressed individuals is not well defined. Molecular analysis of JCV has prompted hypotheses on how the virus emerges from latency and becomes pathogenic. JCV has a double-stranded, circular DNA of 5,130 bp. While the coding region is well conserved, the noncoding regulatory region (RR) of JCV is hypervariable. The kidneys and urine usually contain JCV with a well-conserved, nonpathogenic RR which is called the “archetype” (30). The JCV RR detected in the brains and the cerebrospinal fluid (CSF) of PML patients usually has duplications, tandem repeats, and deletions and has been called “rearranged” compared to the archetype. Although it is not clear which form of JCV RR is propagated at the time of primary infection, it has been hypothesized that JCV with the archetype RR remains confined in the kidneys of most healthy individuals and that rearrangements which confer neurotropism need to occur prior to viral migration to the brain to destroy the myelin-producing glial cells. Whether JCV can reach the brain and establish latency in the central nervous systems (CNS) of otherwise-healthy individuals are matters of debate. While some investigators detected JCV DNA in 28 to 68% of frozen (8, 27) and 18 to 71% of formalin-fixed, paraffin-embedded (FFPE) (4, 7, 20) brain samples of patients without PML, others reported negative results (3, 6, 10, 23). Clearly, characterizing JCV sites of latency is imperative in the prevention of viral reactivation and PML. Recently, a group of PML patients has emerged among those treated with monoclonal antibodies, including natalizumab (13, 17, 26), efalizumab (16, 19a), and rituximab (5), for multiple sclerosis, psoriasis, hematological malignancies, and rheumatologic diseases. Mechanisms of JCV reactivation in these patients has yet to be defined. To better understand JCV organ tropism and characterize the types of JCV RRs in different compartments, we used archival pathology samples to detect JCV DNA and proteins and to analyze JCV RRs in various organ systems in HIV-positive individuals with and without PML and in HIV-negative subjects.