JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene

Shruti P. Agnihotri, Xin Dang, Jonathan L. Carter, Terry D. Fife, Evelyn Bord, Stephanie Batson, Igor J. Koralnik

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To describe the clinical, neuroimaging, immunologic, and virologic characteristics of JC virus-associated granule cell neuronopathy (JCV GCN) in a natalizumab-treated patient with multiple sclerosis (MS) who developed immune reconstitution inflammatory syndrome (IRIS) after natalizumab withdrawal.

Methods: We obtained longitudinal clinical data as well as MRI and proton magnetic resonance spectroscopy from this patient with MS. We measured JCV-specific cellular immune response in his peripheral blood by intracellular cytokine staining and sequenced a fragment of JCV VP1 capsid gene detected in his CSF. We contrast our findings with the first recently reported case.

Results: This patient presented with worsening cerebellar symptoms and progressive cerebellar atrophy without new MS lesions on MRI after 63 months of natalizumab monotherapy. JCV DNA was detected in his CSF by PCR and harbored novel GCN-type mutations in the VP1 gene. He developed IRIS upon discontinuation of natalizumab and plasma exchange, which manifested itself by a worsening of clinical symptoms and contrast enhancement in the cerebellum on MRI. Treatment with corticosteroids resulted in resolution of IRIS, as demonstrated by proton magnetic resonance spectroscopy. The patient had a strong JCV-specific T-cell response in his peripheral blood and remains alive after 15 months from onset of symptoms, although with significant disability. He did not have MS relapse on glatiramer acetate.

Conclusions: JCV GCN should be considered in patients on natalizumab presenting with progressive cerebellar symptoms and cerebellar atrophy, and is associated with mutations in the JCV VP1 gene. Natalizumab withdrawal may be complicated by JCV GCN IRIS, and require treatment with corticosteroids.

Original languageEnglish (US)
Pages (from-to)727-732
Number of pages6
JournalNeurology
Volume83
Issue number8
DOIs
StatePublished - Aug 19 2014
Externally publishedYes

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JC Virus
Capsid
Immune Reconstitution Inflammatory Syndrome
Multiple Sclerosis
Mutation
Genes
Atrophy
Adrenal Cortex Hormones
Plasma Exchange
Neuroimaging
Cellular Immunity
Cerebellum
Natalizumab
Staining and Labeling
Cytokines
T-Lymphocytes
Recurrence
Polymerase Chain Reaction
DNA
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Medicine(all)

Cite this

Agnihotri, S. P., Dang, X., Carter, J. L., Fife, T. D., Bord, E., Batson, S., & Koralnik, I. J. (2014). JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene. Neurology, 83(8), 727-732. https://doi.org/10.1212/WNL.0000000000000713

JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene. / Agnihotri, Shruti P.; Dang, Xin; Carter, Jonathan L.; Fife, Terry D.; Bord, Evelyn; Batson, Stephanie; Koralnik, Igor J.

In: Neurology, Vol. 83, No. 8, 19.08.2014, p. 727-732.

Research output: Contribution to journalArticle

Agnihotri, SP, Dang, X, Carter, JL, Fife, TD, Bord, E, Batson, S & Koralnik, IJ 2014, 'JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene', Neurology, vol. 83, no. 8, pp. 727-732. https://doi.org/10.1212/WNL.0000000000000713
Agnihotri, Shruti P. ; Dang, Xin ; Carter, Jonathan L. ; Fife, Terry D. ; Bord, Evelyn ; Batson, Stephanie ; Koralnik, Igor J. / JCV GCN in a natalizumab-treated MS patient is associated with mutations of the VP1 capsid gene. In: Neurology. 2014 ; Vol. 83, No. 8. pp. 727-732.
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AU - Koralnik, Igor J.

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N2 - Objective: To describe the clinical, neuroimaging, immunologic, and virologic characteristics of JC virus-associated granule cell neuronopathy (JCV GCN) in a natalizumab-treated patient with multiple sclerosis (MS) who developed immune reconstitution inflammatory syndrome (IRIS) after natalizumab withdrawal.Methods: We obtained longitudinal clinical data as well as MRI and proton magnetic resonance spectroscopy from this patient with MS. We measured JCV-specific cellular immune response in his peripheral blood by intracellular cytokine staining and sequenced a fragment of JCV VP1 capsid gene detected in his CSF. We contrast our findings with the first recently reported case.Results: This patient presented with worsening cerebellar symptoms and progressive cerebellar atrophy without new MS lesions on MRI after 63 months of natalizumab monotherapy. JCV DNA was detected in his CSF by PCR and harbored novel GCN-type mutations in the VP1 gene. He developed IRIS upon discontinuation of natalizumab and plasma exchange, which manifested itself by a worsening of clinical symptoms and contrast enhancement in the cerebellum on MRI. Treatment with corticosteroids resulted in resolution of IRIS, as demonstrated by proton magnetic resonance spectroscopy. The patient had a strong JCV-specific T-cell response in his peripheral blood and remains alive after 15 months from onset of symptoms, although with significant disability. He did not have MS relapse on glatiramer acetate.Conclusions: JCV GCN should be considered in patients on natalizumab presenting with progressive cerebellar symptoms and cerebellar atrophy, and is associated with mutations in the JCV VP1 gene. Natalizumab withdrawal may be complicated by JCV GCN IRIS, and require treatment with corticosteroids.

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