Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data

• Published in: International journal of molecular sciences 2020-03, Vol.21 (7), p.2438
• Main Authors: Yokoyama, Yoshihiro, Yamakawa, Tsukasa, Hirano, Takehiro, Kazama, Tomoe, Hirayama, Daisuke, Wagatsuma, Kohei, Nakase, Hiroshi
• Format: Article
• Language: English
• Subjects: Activation; Animals; Antigens; Antiviral Agents - therapeutic use; Binding sites; Bone marrow; Colitis, Ulcerative - complications; Colitis, Ulcerative - pathology; Colon - pathology; Cytokines; Cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - pathology; Cytomegalovirus Infections - therapy; Deoxyribonucleic acid; Diagnostic systems; DNA; Endoscopy; Genes; Genetic testing; HCMV colitis; Health services; human cytomegalovirus; Humans; Infections; Inflammation; Inflammatory bowel disease; Inflammatory Bowel Diseases; Intestinal Mucosa - pathology; Intestine; Mucosa; Opportunist infection; Optimal control; Patients; Prospective Studies; Retrospective Studies; Review; Steroids; Transplants & implants; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Ulcerative colitis; Ulcers; Viral Load
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms21072438

Human cytomegalovirus (HCMV) is a ubiquitous herpesvirus (the human herpesvirus 5) and an opportunistic pathogen that primarily infects HIV-positive and other immuno-compromised patients. Retrospective studies in the field of inflammatory bowel disease (IBD) have suggested a relationship between a concomitant colonic HCMV infection and poor outcomes in patients with an ulcerative colitis (UC) due to the presence of HCMV in surgical specimens of patients with a toxic megacolon or a steroid-resistant UC. Therefore, gastroenterologists have focused on the contribution of HCMV infections in the exacerbation of UC. Numerous studies have addressed the benefits of treating colonic HCMV reactivation in UC using an antiviral treatment. However, its clinical relevance remains uncertain as only a few prospective studies have assessed the direct relationship between clinical outcomes and the viral load of HCMV in colonic tissues. HCMV reactivation can be triggered by inflammation according to fundamental research studies. Thus, optimal control of intestinal inflammation is essential for preventing an HCMV reactivation in the intestinal mucosa. Indeed, several reports have indicated the effectiveness of an anti-tumor necrosis factor-alpha (TNFα) treatment in patients with an active UC and concomitant HCMV infections. In this review, we describe the mechanism of HCMV reactivation in UC cases and discuss the current issues regarding diagnosis and treatment of HCMV infections in UC patients.