[P03.163] Reactivation of Herpes Viruses in Multiple Sclerosis Patients on Natalizumab Therapy

Nicoline Schiess, Baltimore, MD, Jianchao Zong, Baltmore, MD, Gary Hayward, Peter Calabresi, Avindra Nath, Baltimore, MD

OBJECTIVE: To determine whether patients with Multiple Sclerosis (MS) on Natalizumab therapy have increased clinical manifestations or release of herpes virus DNA in saliva and blood when compared to MS patients on no treatment and healthy controls (HC). BACKGROUND: Natalizumab is a monoclonal antibody directed against the 4-integrin chain of the very late activation antigen 4 (VLA-4) dimer on lymphocytes thus preventing entry into the central nervous system and other end organs. MS patients on Natalizumab have been noted to develop herpes labialis and shingles eruptions temporally related to Natalizumab infusions. Multiple herpes viruses are secreted in the saliva. Measurement of herpes viral DNA in the saliva and blood of MS patients could help identify patients at risk for painful dermatologic or encephalitic events. DESIGN/METHODS: IRB approval was obtained to collect saliva and blood samples to assess for herpes virus reactivation and for a questionaire asking about prior herpes infections. Saliva specimens were collected just before Natalizumab infusion and one week after. Using real-time PCR, levels of Varicella Zoster Virus (VZV) were measured in the saliva and blood. RESULTS: Our survey of MS patients on Natalizumab and age/gender matched HC showed that 44% of MS patients have herpes labialis verses 38% of HC. The MS group had triple the rate of annual occurrences than HC (3 eruptions verses 1 respectively). Of the MS group, 40% had recurrences while on Natalizumab. A remarkable number of MS patients reported a history of Infectious Mononucleosis compared to HC [41% verses 9% (p=0.07)]. VZV DNA was detected in saliva of 46% MS patients and 10% HC and in the blood of 50% MS patients and 10% HC. The viral loads for VZV were also significantly higher in the MS patients. CONCLUSIONS/RELEVANCE: There may be remarkable reactivation of symptomatic and asymptomatic herpes virus infections in MS patients treated with Natalizumab.
Category - Infections/AIDS/Prion Disease - Other

Tuesday, April 28, 2009 4:00 PM

Poster Session III: Infections/AIDS/Prion Disease I (4:00 PM-7:00 PM)