Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management

Ramírez-Fort, Marigdalia K.; Zhang, Jianying; Feily, Amir; Ramirez‐Pacheco, Luis A.; Jenrette, Joseph M.; Mayhew, David L.; Syed, Talal; Cooper, Samantha; Linden, Craig; Graybill, Whitney; French, Lars E.; Lange, Christopher S.

doi:10.1016/j.jcv.2017.11.004

Cited by 24 publications

(21 citation statements)

References 101 publications

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“…The possible mechanism of RT induced VZV infection has been well discussed in the review article written by Ramirez-Fort et al [17]. They pointed out that radiation may eradicate the cellular immune component in the irradiated region, which could contribute to the susceptibility of primary viral contraction and/or reactivate existing latent virus (from previous infections).…”

Section: Discussionmentioning

confidence: 99%

Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study

Lai

Kao

et al. 2019

PLoS ONE

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Background/PurposeLimited evidence has been obtained on varicella-zoster virus (VZV) infection in patients with breast cancer as a complication related to adjuvant radiotherapy. We conducted a cohort study aimed to assess the risk of VZV infection in this patient setting.Materials and methodsWe used the National Health Insurance Research Database to identify 65,981 patients with breast cancer in Taiwan who underwent breast surgery between 2000 and 2011. After a 1:1 propensity score match was obtained between patients with and without radiotherapy, a competing risk regression model was constructed to estimate the hazard ratios and the incidence rate difference (IRD) of VZV infection in the patients with breast cancer receiving radiotherapy and those not receiving radiotherapy.ResultsAfter adjusting for covariates, the radiotherapy cohort showed a 1.51-fold higher risk (95% confidence interval = 1.06–5.16, p = 0.02, IRD = 4.98/10000 person-years) of subsequent VZV infection than the nonradiotherapy cohort. Furthermore, VZV infection risk was 3.85-fold higher among patients aged >65 years who received radiotherapy than among those of the same age who did not receive radiotherapy (95% confidence interval = 1.1–13.4, p < 0.05, IRD = 11.09/10000 person-years). The risk increased with adjusted hazard ratio of 6.6 (95% confidence interval I = 1.51–28.8, p < 0.05, IRD = 32.01/10,000 person-years) and 7.08 (95% confidence interval = 1.64–30.5, p < 0.01, IRD = 35.72/10,000 person-years) in follow-up period less than 3 months and 3–5 months respectively.ConclusionRadiotherapy was associated with an increased risk of VZV infection among patients with breast cancer. The risk was significantly higher in older patient (>65 years old) and/or those who received chemotherapy. Regular clinical follow-up and additional serological testing in the first 5 months after radiotherapy are recommended.

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Section: Discussionmentioning

confidence: 99%

Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study

Lai

Kao

et al. 2019

PLoS ONE

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“…VZV latency is controlled largely by cell-mediated immunity and reactivation is due to its decline, disruption or loss [141]. In humans, immunosuppression due to radiation therapy or treatment with immunosuppressive drugs and/or steroids induces reactivation of VZV, causing severe and sometimes fatal zoster, neuritis, PHN and other complications [142,143,144]. VZV does not reactivate in any small animals used to study establishment of latent infection.…”

Section: Simian Varicella Virus (Svv) Infection In Non-human Primamentioning

confidence: 99%

Current In Vivo Models of Varicella-Zoster Virus Neurotropism

Mahalingam

Gershon

et al. 2019

Viruses

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Varicella-zoster virus (VZV), an exclusively human herpesvirus, causes chickenpox and establishes a latent infection in ganglia, reactivating decades later to produce zoster and associated neurological complications. An understanding of VZV neurotropism in humans has long been hampered by the lack of an adequate animal model. For example, experimental inoculation of VZV in small animals including guinea pigs and cotton rats results in the infection of ganglia but not a rash. The severe combined immune deficient human (SCID-hu) model allows the study of VZV neurotropism for human neural sub-populations. Simian varicella virus (SVV) infection of rhesus macaques (RM) closely resembles both human primary VZV infection and reactivation, with analyses at early times after infection providing valuable information about the extent of viral replication and the host immune responses. Indeed, a critical role for CD4 T-cell immunity during acute SVV infection as well as reactivation has emerged based on studies using RM. Herein we discuss the results of efforts from different groups to establish an animal model of VZV neurotropism.

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“…Some studies have reported a significant increase in uptake, activation, transcription, and spread of some viruses after irradiation in vitro and in vivo . Moreover, apoptosis induction by ionizing radiation beams to the virus‐infected cells as the reservoirs of millions of virus particles, might accelerate the spreading of the virus and consequently disease progression 14–17 . Therefore, due to the lack of knowledge about radiation beams' effects on SARS‐CoV‐2 and its infected cells, it is even possible that radiotherapy worsens the progression of the COVID‐19 disease.…”

Section: Against the Proposition: Amirhosein Kefayat MDmentioning

confidence: 99%

Low‐dose radiation as a treatment for COVID‐19 pneumonia: A threat or real opportunity?

Mortazavi

Kefayat

Cai³

2020

Medical Physics

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Low-dose radiation is known to induce anti-inflammatory responses and has been historically used for treating infectious diseases such as pneumonia. As the outbreak of COVID-19 continues globally and effective treatment methods are lacking, low-dose radiation has drawn increasing attention recently. While some are optimistic about the clinical adoption of low-dose radiation for the treatment of COVID-19, others have significant concerns about its effectiveness and safety. This is the premise debated in this month's Point/Counterpoint.

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Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management

Cited by 24 publications

References 101 publications

Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study

Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study

Current In Vivo Models of Varicella-Zoster Virus Neurotropism

Low‐dose radiation as a treatment for COVID‐19 pneumonia: A threat or real opportunity?

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