Acta Neuropathologica

, Volume 129, Issue 3, pp 467–468 | Cite as

High CCR5 expression in natalizumab-associated progressive multifocal leukoencephalopathy immune reconstitution inflammatory syndrome supports treatment with the CCR5 inhibitor maraviroc

  • Lidia Stork
  • Wolfgang Brück
  • Amit Bar-Or
  • Imke Metz

Natalizumab (ntz) treatment for multiple sclerosis (MS) is in rare cases complicated by development of progressive multifocal leukoencephalopathy (PML), an opportunistic viral brain infection. Withdrawal of natalizumab leads to an overwhelming inflammatory reaction targeting the virus. However, this immune reconstitution inflammatory syndrome (IRIS) can itself contribute to clinical deterioration and even death. A recent report has suggested that the CCR5 inhibitor maraviroc is beneficial in treating ntz-associated PML IRIS [1]. CCR5 is expressed predominantly on T cells and macrophages and less on B lineage cells. It is involved in immune cell chemotaxis and CCR5+ cells are found in varying numbers in inflammatory CNS lesions [4].

We considered whether CCR5 is expressed in ntz-associated PML IRIS in situ and were able to provide histopathological evidence to support maraviroc treatment. For this we analyzed CCR5 expression in ntz-associated PML IRIS brain lesions by...


Plasma Cell Progressive Multifocal Leukoencephalopathy Natalizumab Immune Reconstitution Inflammatory Syndrome Progressive Multifocal Leukoencephalopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



IM and WB were supported by grants from the German Ministry for Education and Research (BMBF, ‘‘German Competence Network Multiple Sclerosis’’ (KKNMS), Pattern MS/NMO).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Lidia Stork
    • 1
  • Wolfgang Brück
    • 1
  • Amit Bar-Or
    • 2
  • Imke Metz
    • 1
  1. 1.Department of NeuropathologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Department of Neurology and Neurosurgery and Neuroimmunology UnitMontreal Neurological Institute, McGill UniversityMontrealCanada

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