High CCR5 expression in natalizumab-associated progressive multifocal leukoencephalopathy immune reconstitution inflammatory syndrome supports treatment with the CCR5 inhibitor maraviroc
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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 . 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 .
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...
KeywordsPlasma Cell Progressive Multifocal Leukoencephalopathy Natalizumab Immune Reconstitution Inflammatory Syndrome Progressive Multifocal Leukoencephalopathy
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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