Detection of JC virus DNA in peripheral lymphocytes from patients with and without progressive multifocal leukoencephalopathy

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Abstract
Progressive multifocal leukoencephalopathy (PML) results from lytic infection of oligodendrocytes by JC virus (JCV). Although JCV has been identified in mononuclear cells in bone marrow and hematogenous dissemination of the virus to the central vervous system has been suspected, JCV has never been clearly demonstrated in the peripheral circula‐tion. Using polymerase chain reaction technology, we examined peripheral lymphocytes of 19 patients with brain biopsy–proven PML for the JCV genome. Two non‐PML control groups, consisting of 26 patients seropositive for human immunodeficiency virus type 1 (HIV‐1) and 30 immunocompetent patients with Parkinson's disease, were also examined for the presence of the JCV genome in lymphocytes. Cerebrospinal fluid from 10 patients with PML was exmimined for the presence of the JCV genome as well. The JCV genome was detected in the lymphocytes of 89% (17) of the patients with PML, 38% (10) of the HIV‐1–seropositive patients without PML, and none of the patients with Parkinson's disease. Sequencing of the JCV regulatory region from the lymphocytes of three patients revealed the prototype MAD‐1 strain of JCV in one patient with PML, a MAD‐4 strain in a second patient with PML, and a slightly modified MAD‐4 strain in an HIV‐1–positive patient without PML. Only 3 of 10 patients with PML who had JCV detected in lymphocytes had the JCV genome in their cerebrospinal fluid. These results demonstrate that the JCV genome can be found in circulating lymphocytes from patients with PML and suggest that lymphocytes are an important vector for hematogenous dissemination of JCV to the central nervous system. We also identified the JCV genome in the lymphocytes of a group of HIV‐1–seropositive patients with no clinical evidence of PML, suggesting that they may be at risk for development of PML and can be identified in a presymptomatic state.