Molecular biology, epidemiology, and pathogenesis of progressive multifocal leukoencephalopathy, the JC virus-induced demyelinating disease of the human brain

MW Ferenczy, LJ Marshall, CDS Nelson… - Clinical microbiology …, 2012 - Am Soc Microbiol
MW Ferenczy, LJ Marshall, CDS Nelson, WJ Atwood, A Nath, K Khalili, EO Major
Clinical microbiology reviews, 2012Am Soc Microbiol
Progressive multifocal leukoencephalopathy (PML) is a debilitating and frequently fatal
central nervous system (CNS) demyelinating disease caused by JC virus (JCV), for which
there is currently no effective treatment. Lytic infection of oligodendrocytes in the brain leads
to their eventual destruction and progressive demyelination, resulting in multiple foci of
lesions in the white matter of the brain. Before the mid-1980s, PML was a relatively rare
disease, reported to occur primarily in those with underlying neoplastic conditions affecting …
Summary
Progressive multifocal leukoencephalopathy (PML) is a debilitating and frequently fatal central nervous system (CNS) demyelinating disease caused by JC virus (JCV), for which there is currently no effective treatment. Lytic infection of oligodendrocytes in the brain leads to their eventual destruction and progressive demyelination, resulting in multiple foci of lesions in the white matter of the brain. Before the mid-1980s, PML was a relatively rare disease, reported to occur primarily in those with underlying neoplastic conditions affecting immune function and, more rarely, in allograft recipients receiving immunosuppressive drugs. However, with the onset of the AIDS pandemic, the incidence of PML has increased dramatically. Approximately 3 to 5% of HIV-infected individuals will develop PML, which is classified as an AIDS-defining illness. In addition, the recent advent of humanized monoclonal antibody therapy for the treatment of autoimmune inflammatory diseases such as multiple sclerosis (MS) and Crohn's disease has also led to an increased risk of PML as a side effect of immunotherapy. Thus, the study of JCV and the elucidation of the underlying causes of PML are important and active areas of research that may lead to new insights into immune function and host antiviral defense, as well as to potential new therapies.
American Society for Microbiology