Diagnosis and treatment of ulcerative colitis with cytomegalovirus infection: importance of controlling mucosal inflammation to prevent cytomegalovirus reactivation

• Published in: Intestinal research Vol. 12; no. 1; pp. 5 - 11
• Main Authors: Nakase, Hiroshi, Honzawa, Yusuke, Toyonaga, Takahiko, Yamada, Satoshi, Minami, Naoki, Yoshino, Takuya, Matsuura, Minoru
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association for the Study of Intestinal Diseases 01.01.2014; 대한장연구학회
• Subjects: Cytomegalovirus; Review; Tumor necrosis factor alpha; Ulcerative colitis; 내과학; Cytomegalovirus; Tumor necrosis factor alpha; Ulcerative colitis
• ISSN: 1598-9100; 2288-1956
• DOI: 10.5217/ir.2014.12.1.5

Human cytomegalovirus (HCMV) is a member of the herpesvirus family. HCMV infection persists throughout the host lifespan in a latent state following primary infection. The ability of HCMV to escape control by the host immune system and its resulting reactivation suggests the importance of ongoing immune surveillance in the prevention of HCMV reactivation. HCMV is a common cause of opportunistic infection that causes severe and fatal disease in immune-compromised individuals. In inflammatory bowel disease patients, particularly those with ulcerative colitis (UC), HCMV is often reactivated because these patients are frequently treated with immunosuppressive agents. This reactivation exacerbates colitis. Additionally, HCMV infection can induce severe colitis, even in patients with UC who have never been treated with immunosuppressive agents. However, the role of HCMV in colonic inflammation in patients with UC remains unclear. Here, we present previous and current clinical data on the diagnosis and treatment of HCMV infection in UC. Additionally, our experimental data from a newly established mouse model mimicking UC with concomitant CMV infection clearly demonstrate that inflammation could result in the exacerbation of UC disease activity with induction of HCMV reactivation. In summary, optimal control of colonic inflammation should be achieved in UC patients who are refractory to conventional immunosuppressive therapies and are positive for HCMV.