TransplantNCT00677482
Cytomegalovirus (CMV) MicroRNA Expression in Vivo and Immune Evasion Correlates
An observational study of Transplant, run by University of Alberta at 1 site in Canada.
Trial summary
Cytomegalovirus (CMV) is the most common viral infection in patients who have undergone a transplant.Serious infections due to CMV can affect many parts of the body including the lungs, the gut, and the liver. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Transplant
- How many people
- 47 participants
- Where
- 1 siteCanada
- Study dates
- Apr 2008to 23 Sep 2013
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Solid organ tranplant recipients with both asymptomatic CMV viremia and symptomatic CMV disease are eligible for inclusion in the study. This include liver, kidney, heart, pancreas, lung, intestinal and combined transplant recipients.
Who may be able to join
- Male or female patients who fulfill the following criteria are eligible for inclusion:
- Age >=18 years
- Solid Organ Transplant Recipients
- Documented CMV disease or asymptomatic CMV viremia
Who cannot join
- Unable to comply with protocol
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Cytomegalovirus (CMV) microRNA Expression in Vivo and Immune Evasion Correlates
Cytomegalovirus (CMV) is the most common viral infection in patients who have undergone a transplant.Serious infections due to CMV can affect many parts of the body including the lungs, the gut, and the liver. The purpose of this study is to assess how the virus interacts with the patient's immune system, so that in the future it may be possible to develop better ways to prevent and treat the virus infection.
Read the detailed description
Cytomegalovirus (CMV) disease is an important cause of morbidity in solid organ transplantation recipients. Viral reactivation, either of donor origin or endogenous latent virus involves a complex series of steps. A number of factors contribute to the CMV reactivation from latency including exogenous immunosuppression, pre-existing host immunity, and cytokine dysregulation [1,2]. Symptomatic patients are classified as having CMV disease, which presents as a viral syndrome (fever, malaise) or as tissue invasive disease, such as hepatitis or pneumonitis. CMV can also have indirect manifestations due to an immunomodulatory effect of viral replication, resulting in other opportunistic infections and acute and chronic allograft injury [2-4]. CMV disease in organ transplant recipients is generally treated with a finite course of intravenous or oral antiviral therapy. However, the risk of recurrent CMV disease is estimated to be between 25-30% [5-7].
The pathogenesis of CMV reactivation, viral replication, disease progression, and viral persistence is likely related to a number of host factors in transplant patients, including degree and type of immunosuppressive therapy, and pre-existing immunity [8,9]. However, CMV is a remarkably complex virus with a large genome encoding approximately 200 open reading frames. A number of viral factors likely also play a role in determining the risk of CMV disease, the risk of tissue invasion, the response to therapy, and the risk of recurrence once therapy is initiated. The virus commits a large percentage of its total genome coding capacity to the tasks of modulating host cell behaviour and host response to infection [8,9]. These include CMV gene products aimed at escaping host defence mechanisms which are commonly referred to as CMV immune evasion genes [9-11]. Some of these immune evasion genes encode for proteins that can actively interfere with distinct steps in the antigen expression pathway and thus contribute to viral persistence despite an active host immune response. For example US2, US3, US6, and US11 encode for a protein whose ultimate effect is to reduce the levels of MHC class I proteins on the surface of infected cells. The CMV UL141 gene product provides protection against killing by a wide array of NK cell populations, via blocking of surface expression of NK cell-activating ligand CD155 [26]. Also, human CMV expresses several homologues of host G protein-coupled receptors (GPCRs), of which the chemokine receptor homologue US28 is the best characterized [27]. Although the exact significance of US28 has not been determined, the protein product may play a role in cell entry, leukocyte chemotaxis, viral dissemination and immune evasion [27].
MicroRNAs MicroRNAs are recently discovered small endogenous non-coding RNAs. These small RNAs of ~22 nucleotide length are crucial post-transcriptional regulators of gene expression in a wide spectrum of normal and abnormal biological processes including antiviral defence, oncogenesis and development in higher eukaryotes. Recently several virus genomes have also been found to encode microRNAs. The present understanding of the biological functions of virus-encoded microRNAs remains sketchy, with evidence mainly derived from studies on individual or a small set of microRNAs encoded by the viruses and their cognate hosts. Survival strategies of the virus and counter strategies of host cells through miRNAs of host and viral origin and their respective targets form the crux of host virus interactions mediated by microRNAs. Thus microRNAs form a complex link between the regulatory networks of the host and the pathogen. A thorough understanding of the microRNA-mediated host-pathogen interaction is essential in understanding the basic pathophysiological changes associated with viral infections
MicroRNAs and CMV A number of viral microRNAs have been found in CMV. The function of the majority of these is largely unknown. Recently, the function of a specific microRNA (miR-UL-112-1) encoded by CMV was partially elucidated. Stern-Ginossar et al. used a new bioinformatics tool to identify the major histocompatibility complex (MHC) class I-related chain B (MICB) mRNA as a target of a miRNA encoded by CMV. MICB is a cellular ligand for the activating receptor NKG2D, which is expressed on some natural killer cells, γ/δ T cells, and CD8+ T cells. During cellular stress, such as that caused by viral infection, MICB is induced, thus activating natural killer and T cells that can lead to the killing of infected cells. Therefore blocking this process would probably benefit the virus. Stern-Ginossar et al. showed that cells infected with CMV that have been engineered to lack the miR-UL112-1 were more susceptible to being killed in an NKG2D-dependent manner by natural killer cells. The CMV-encoded protein UL16, also provides protection against the detection of infected cells by natural killer cells, by sequestering MICB in the intracellular milieu and preventing it from reaching the cell surface. Why the virus has two different mechanisms to achieve the same goal is not clear, particularly since the closely related NKG2D-ligand MICA is induced during viral infection. Members of my laboratory and I have recently described2 another function of the same miRNA. Successful, persistent infection depends on the maintenance of cell viability despite the production of toxic viral proteins. One way in which CMV can restrict the production of viral proteins is by restricting viral replication. We observed that miR-UL112-1 down-regulates the expression of CMV genes involved in its own replication process, in part by targeting a viral mRNA (encoding a protein called immediate early 72) that regulates the transcription of viral genes required for acute replication.
- Conditions
- Transplant
- Keywords
- liver transplant, lung transplant, kidney transplant, heart transplant, CMV microRNA
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| 1 | Solid organ transplant recipients with both asymptomatic CMV viremia, and symptomatic CMV disease are eligible for inclusion in the study. THis includes liver, kidney, heart, pancreas, lung, intestinal and combined transplant recipients. |
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 May 2008 (estimated)
- Study startApr 2008
- Primary completion27 Jul 2012
- Study completion23 Sep 2013
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for TransplantStudies of the same condition, open and under way.
- More trials run by University of AlbertaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 47 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Alberta
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Atul Humar, MD, Principal investigator, University of Alberta
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00677482
- Sponsor's protocol ID
- 7304
- Status last verified
- May 2015
- First submitted
- 12 May 2008
- Last updated
- 1 Jun 2022
- Results posted
- No
- Data monitoring committee
- No
Publications
Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004 Dec;4(12):725-38. doi: 10.1016/S1473-3099(04)01202-2.
PubMed 15567122Preiksaitis JK, Brennan DC, Fishman J, Allen U. Canadian society of transplantation consensus workshop on cytomegalovirus management in solid organ transplantation final report. Am J Transplant. 2005 Feb;5(2):218-27. doi: 10.1111/j.1600-6143.2004.00692.x.
PubMed 15643981Humar A, Kumar D, Boivin G, Caliendo AM. Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease. J Infect Dis. 2002 Sep 15;186(6):829-33. doi: 10.1086/342601. Epub 2002 Aug 28.
PubMed 12198618Rasmussen L. Molecular pathogenesis of human cytomegalovirus infection. Transpl Infect Dis. 1999 Jun;1(2):127-34. doi: 10.1034/j.1399-3062.1999.010206.x.
PubMed 11428980Tomasec P, Wang EC, Davison AJ, Vojtesek B, Armstrong M, Griffin C, McSharry BP, Morris RJ, Llewellyn-Lacey S, Rickards C, Nomoto A, Sinzger C, Wilkinson GW. Downregulation of natural killer cell-activating ligand CD155 by human cytomegalovirus UL141. Nat Immunol. 2005 Feb;6(2):181-8. doi: 10.1038/ni1156. Epub 2005 Jan 9.
PubMed 15640804
Study at a glance
From the registry record, last updated by the sponsor on 1 Jun 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Cytomegalovirus (CMV) microRNA Expression in Vivo and Immune Evasion Correlates
- ClinicalTrials.gov ID
- NCT00677482
- Acronym / sponsor ID
- 7304
- Conditions
- Transplant
- Keywords
- liver transplant, lung transplant, kidney transplant, heart transplant, CMV microRNA
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 47 participants (actual)
- Lead sponsor
- University of AlbertaUniversity, hospital or other
- Study start
- Apr 2008
- Primary completion
- 27 Jul 2012 (actual)
- Study completion
- 23 Sep 2013 (actual)
- First posted
- 14 May 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cytomegalovirus (CMV) is the most common viral infection in patients who have undergone a transplant.Serious infections due to CMV can affect many parts of the body including the lungs, the gut, and the liver. The purpose of this study is to assess how the virus interacts with the patient's immune system, so that in the future it may be possible to develop better ways to prevent and treat the virus infection.
Detailed description
Cytomegalovirus (CMV) disease is an important cause of morbidity in solid organ transplantation recipients. Viral reactivation, either of donor origin or endogenous latent virus involves a complex series of steps. A number of factors contribute to the CMV reactivation from latency including exogenous immunosuppression, pre-existing host immunity, and cytokine dysregulation [1,2]. Symptomatic patients are classified as having CMV disease, which presents as a viral syndrome (fever, malaise) or as tissue invasive disease, such as hepatitis or pneumonitis. CMV can also have indirect manifestations due to an immunomodulatory effect of viral replication, resulting in other opportunistic infections and acute and chronic allograft injury [2-4]. CMV disease in organ transplant recipients is generally treated with a finite course of intravenous or oral antiviral therapy. However, the risk of recurrent CMV disease is estimated to be between 25-30% [5-7].
The pathogenesis of CMV reactivation, viral replication, disease progression, and viral persistence is likely related to a number of host factors in transplant patients, including degree and type of immunosuppressive therapy, and pre-existing immunity [8,9]. However, CMV is a remarkably complex virus with a large genome encoding approximately 200 open reading frames. A number of viral factors likely also play a role in determining the risk of CMV disease, the risk of tissue invasion, the response to therapy, and the risk of recurrence once therapy is initiated. The virus commits a large percentage of its total genome coding capacity to the tasks of modulating host cell behaviour and host response to infection [8,9]. These include CMV gene products aimed at escaping host defence mechanisms which are commonly referred to as CMV immune evasion genes [9-11]. Some of these immune evasion genes encode for proteins that can actively interfere with distinct steps in the antigen expression pathway and thus contribute to viral persistence despite an active host immune response. For example US2, US3, US6, and US11 encode for a protein whose ultimate effect is to reduce the levels of MHC class I proteins on the surface of infected cells. The CMV UL141 gene product provides protection against killing by a wide array of NK cell populations, via blocking of surface expression of NK cell-activating ligand CD155 [26]. Also, human CMV expresses several homologues of host G protein-coupled receptors (GPCRs), of which the chemokine receptor homologue US28 is the best characterized [27]. Although the exact significance of US28 has not been determined, the protein product may play a role in cell entry, leukocyte chemotaxis, viral dissemination and immune evasion [27].
MicroRNAs MicroRNAs are recently discovered small endogenous non-coding RNAs. These small RNAs of ~22 nucleotide length are crucial post-transcriptional regulators of gene expression in a wide spectrum of normal and abnormal biological processes including antiviral defence, oncogenesis and development in higher eukaryotes. Recently several virus genomes have also been found to encode microRNAs. The present understanding of the biological functions of virus-encoded microRNAs remains sketchy, with evidence mainly derived from studies on individual or a small set of microRNAs encoded by the viruses and their cognate hosts. Survival strategies of the virus and counter strategies of host cells through miRNAs of host and viral origin and their respective targets form the crux of host virus interactions mediated by microRNAs. Thus microRNAs form a complex link between the regulatory networks of the host and the pathogen. A thorough understanding of the microRNA-mediated host-pathogen interaction is essential in understanding the basic pathophysiological changes associated with viral infections
MicroRNAs and CMV A number of viral microRNAs have been found in CMV. The function of the majority of these is largely unknown. Recently, the function of a specific microRNA (miR-UL-112-1) encoded by CMV was partially elucidated. Stern-Ginossar et al. used a new bioinformatics tool to identify the major histocompatibility complex (MHC) class I-related chain B (MICB) mRNA as a target of a miRNA encoded by CMV. MICB is a cellular ligand for the activating receptor NKG2D, which is expressed on some natural killer cells, γ/δ T cells, and CD8+ T cells. During cellular stress, such as that caused by viral infection, MICB is induced, thus activating natural killer and T cells that can lead to the killing of infected cells. Therefore blocking this process would probably benefit the virus. Stern-Ginossar et al. showed that cells infected with CMV that have been engineered to lack the miR-UL112-1 were more susceptible to being killed in an NKG2D-dependent manner by natural killer cells. The CMV-encoded protein UL16, also provides protection against the detection of infected cells by natural killer cells, by sequestering MICB in the intracellular milieu and preventing it from reaching the cell surface. Why the virus has two different mechanisms to achieve the same goal is not clear, particularly since the closely related NKG2D-ligand MICA is induced during viral infection. Members of my laboratory and I have recently described2 another function of the same miRNA. Successful, persistent infection depends on the maintenance of cell viability despite the production of toxic viral proteins. One way in which CMV can restrict the production of viral proteins is by restricting viral replication. We observed that miR-UL112-1 down-regulates the expression of CMV genes involved in its own replication process, in part by targeting a viral mRNA (encoding a protein called immediate early 72) that regulates the transcription of viral genes required for acute replication.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| 1 | – | –Solid organ transplant recipients with both asymptomatic CMV viremia, and symptomatic CMV disease are eligible for inclusion in the study. THis includes liver, kidney, heart, pancreas, lung, intestinal and combined transplant recipients. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Solid organ tranplant recipients with both asymptomatic CMV viremia and symptomatic CMV disease are eligible for inclusion in the study. This include liver, kidney, heart, pancreas, lung, intestinal and combined transplant recipients.
Key inclusion criteria (4 listed)
- Age >=18 years
- Solid Organ Transplant Recipients
- Documented CMV disease or asymptomatic CMV viremia
Key exclusion criteria (1 listed)
- Unable to comply with protocol
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Not reported in the source record.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Jun 2022.
- Background: PubMed 15567122Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004 Dec;4(12):725-38. doi: 10.1016/S1473-3099(04)01202-2.
- Background: PubMed 15643981Preiksaitis JK, Brennan DC, Fishman J, Allen U. Canadian society of transplantation consensus workshop on cytomegalovirus management in solid organ transplantation final report. Am J Transplant. 2005 Feb;5(2):218-27. doi: 10.1111/j.1600-6143.2004.00692.x.
- Background: PubMed 12198618Humar A, Kumar D, Boivin G, Caliendo AM. Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease. J Infect Dis. 2002 Sep 15;186(6):829-33. doi: 10.1086/342601. Epub 2002 Aug 28.
- Background: PubMed 11428980Rasmussen L. Molecular pathogenesis of human cytomegalovirus infection. Transpl Infect Dis. 1999 Jun;1(2):127-34. doi: 10.1034/j.1399-3062.1999.010206.x.
- Background: PubMed 15640804Tomasec P, Wang EC, Davison AJ, Vojtesek B, Armstrong M, Griffin C, McSharry BP, Morris RJ, Llewellyn-Lacey S, Rickards C, Nomoto A, Sinzger C, Wilkinson GW. Downregulation of natural killer cell-activating ligand CD155 by human cytomegalovirus UL141. Nat Immunol. 2005 Feb;6(2):181-8. doi: 10.1038/ni1156. Epub 2005 Jan 9.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Atul Humar, MD principal investigator
University of Alberta
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Transplant, run by University of Alberta at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 1 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00677482, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jun 2022.