VZV in biopsy-positive and -negative giant cell arteritis: Analysis of 100+ temporal arteries
Gilden, Don; White, Teresa; Khmeleva, Nelly; Boyer, Philip J.; Nagel, Maria A.
Objective: Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA). Methods: Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen–positive slides were analyzed by PCR for VZV DNA. Results: VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen–positive TAs. Despite formalin fixation, VZV DNA was detected in 18/45 (40%) GCA-positive VZV antigen–positive TAs, in 6/10 (60%) VZV antigen–positive skeletal muscles, and in one VZV antigen–positive normal TA. Varicella-zoster virions were found in a GCA-positive TA. In sections adjacent to those containing VZV, GCA pathology was seen in 89% of GCA-positive TAs but in none of 18 adjacent sections from normal TAs. Conclusions: Most GCA-positive TAs contained VZV in skip areas that correlated with adjacent GCA pathology, supporting the hypothesis that VZV triggers GCA immunopathology. Antiviral treatment may confer additional benefit to patients with GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.
Gilden, Don, & White, Teresa, & Khmeleva, Nelly, & Boyer, Philip J., & Nagel, Maria A.. (March 2016). VZV in biopsy-positive and -negative giant cell arteritis: Analysis of 100+ temporal arteries. NeurologyÂ® Neuroimmunology & Neuroinflammation, 3(2), 1- 3. Retrieved from http://hdl.handle.net/10342/5831
Gilden, Don, and White, Teresa, and Khmeleva, Nelly, and Boyer, Philip J., and Nagel, Maria A.. "VZV in biopsy-positive and -negative giant cell arteritis: Analysis of 100+ temporal arteries". NeurologyÂ® Neuroimmunology & Neuroinflammation. 3:2. (1-3), March 2016. August 16, 2018. http://hdl.handle.net/10342/5831.
Gilden, Don and White, Teresa and Khmeleva, Nelly and Boyer, Philip J. and Nagel, Maria A., "VZV in biopsy-positive and -negative giant cell arteritis: Analysis of 100+ temporal arteries," NeurologyÂ® Neuroimmunology & Neuroinflammation 3, no. 2 (March 2016), http://hdl.handle.net/10342/5831 (accessed August 16, 2018).
Gilden, Don, White, Teresa, Khmeleva, Nelly, Boyer, Philip J., Nagel, Maria A.. VZV in biopsy-positive and -negative giant cell arteritis: Analysis of 100+ temporal arteries. NeurologyÂ® Neuroimmunology & Neuroinflammation. March 2016; 3(2): 1-3. http://hdl.handle.net/10342/5831. Accessed August 16, 2018.