Departments of Rheumatology and Anatomical Pathology, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.
Northern Clinical School, University of Sydney, St Leonards, Sydney, New South Wales, Australia.
Rheumatology (Oxford). 2020 Aug 1;59(8):1992-1996. doi: 10.1093/rheumatology/kez556.
There is uncertainty if varicella zoster virus (VZV) triggers GCA. This is based on discordant reports of VZV detection in GCA temporal artery biopsies. We conducted a multimodal evaluation for VZV in the inception Giant Cell Arteritis and PET Scan (GAPS) cohort.
Consecutive patients who underwent temporal artery biopsy for suspected GCA were clinically reviewed for active and past VZV infection and followed for 6 months. Serum was tested for VZV IgM and IgG. Temporal artery biopsy (TAB) sections were stained for VZV antigen using the VZV Mouse Cocktail Antibody (Cell Marque, Rocklin, CA, USA). A selection of GCA and control tissues were stained with the VZV gE antibody (Santa Cruz Biotechnology, Dallas, TX, USA), which was used in previous studies.
A total of 58 patients met inclusion criteria, 12 (21%) had biopsy-positive GCA and 20 had clinically positive GCA. None had herpes zoster at enrolment and only one patient developed a VZV clinical syndrome (zoster ophthalmicus) on follow-up. There was no difference in VZV exposure between GCA and non-GCA patients. None of the 53 patients who had VZV serology collected had positive VZV IgM antibodies. VZV antigen was not convincingly demonstrated in any of the TAB specimens; 57 TABs stained negative and 1 stained equivocally positive. The Santa Cruz Biotechnology VZV antibody exhibited positive staining in a range of negative control tissues, questioning its specificity for VZV antigen.
The absence of active infection markers argues against VZV reactivation being the trigger for GCA. Non-specific immunohistochemistry staining may account for positive findings in previous studies.
带状疱疹病毒（VZV）是否会引发巨细胞动脉炎存在不确定性。这是基于在巨细胞动脉炎颞动脉活检中检测到 VZV 的不一致报告。我们对首发巨细胞动脉炎和正电子发射断层扫描（GAPS）队列进行了 VZV 的多模式评估。
连续对疑似巨细胞动脉炎而行颞动脉活检的患者进行了 VZV 现症和既往感染的临床评估，并随访 6 个月。检测血清 VZV IgM 和 IgG。使用 VZV 鼠鸡尾酒抗体（Cell Marque，加利福尼亚州罗克林）对颞动脉活检（TAB）切片进行 VZV 抗原染色。使用 VZV gE 抗体（德克萨斯州达拉斯市圣克鲁斯生物技术公司）对 GCA 和对照组织进行了选择染色，该抗体以前曾用于研究。
共有 58 例患者符合纳入标准，12 例（21%）有活检阳性巨细胞动脉炎，20 例有临床阳性巨细胞动脉炎。入组时均无带状疱疹，仅有 1 例患者在随访中出现 VZV 临床综合征（眼带状疱疹）。巨细胞动脉炎和非巨细胞动脉炎患者的 VZV 暴露无差异。53 例采集 VZV 血清学的患者均未出现 VZV IgM 抗体阳性。在任何 TAB 标本中均未明确证实 VZV 抗原；57 个 TAB 染色阴性，1 个染色弱阳性。圣克鲁斯生物技术 VZV 抗体在一系列阴性对照组织中呈阳性染色，这对其 VZV 抗原的特异性提出了质疑。
缺乏活动性感染标志物表明 VZV 再激活不是引发巨细胞动脉炎的原因。非特异性免疫组化染色可能解释了之前研究中的阳性发现。
