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- Title
Reactivation of Latent Epstein—Barr Virus by Methotrexate: A Potential Contributor to Methotrexate-Associated Lymphomas.
- Authors
Wen-hai Feng; Cohen, Jeffrey I.; Fischer, Steven; Li, Li; Sneller, Michael; Goldbach-Mansky, Raphael; Raab-Traub, Nancy; De Lecluse, Henri-Jacques; Kenney, Shannon C.
- Abstract
Background: Patients with rheumatoid arthritis or polymyositis treated with methotrexate (MIX) develop Epstein-Barr virus (EBV)-positive lymphomas more frequently than patients treated with other, equally immunosuppressive regimens. Here we determined whether MTX, in contrast to other commonly used medications for rheumatoid arthritis or polymyositis, is unique in its ability to induce the release of infectious EBV from latently infected cells. Methods: The effect of MTX and other immunosuppressant drugs on EBV replication in vitro was assessed using latently infected EBV-positive lymphoblastoid and gastric carcinoma cell lines. Inhibitors of signal transduction pathways were used to define requirements for induction of lytic infection. Drug effects on transcription of the two EBV immediate-early promoters (BRLF1 and BZLF1) and on promoter constructs lacking cis-acting sequences required for activation by other effectors was examined using reporter gene assays. EBV viral load in rheumatoid arthritis and polymyositis patients receiving MIX was compared with that in patients receiving other immunosuppressive medications. Statistical tests were two-sided. Results: MTX activated the release of infectious EBY from latently infected cell lines in vitro, and MTX treatment was associated with activation of the two viral immediate-early promoters in reporter gene assays. Induction of lytic EBV infection by MIX required the p38 MAP kinase, P13 kinase, and MEK pathways and specific cis-acting motifs in the two viral immediate-early promoters. Patients treated with MTX-containing regimens had statistically significantly higher mean EBV loads in their blood than patients treated with immunosuppressing regimens that did not include MTX (40 EBV copies per 106 cellular genomes versus 5.1 copies; geometric mean fold difference in copies = 10.8, 95%, confidence interval = 3.0 to 38; P = .011). Conclusion: MTX may promote EBV-positive lympho- mas in rheumatoid arthritis and polymyositis patients by its immunosuppressive properties as well as by reactivating latent EBV.
- Subjects
DRUG resistance in microorganisms; METHOTREXATE; EPSTEIN-Barr virus; ONCOGENIC DNA viruses; ANTINEOPLASTIC agents; ONCOLOGY
- Publication
JNCI: Journal of the National Cancer Institute, 2004, Vol 96, Issue 22, p1691
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/djh313