Cohen-Bucay Abraham, Ramirez-Andrade Silvia E, Gordon Craig E, Francis Jean M, Chitalia Vipul C
Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Nephrology Department, American British Cowdray Medical Center, Mexico City, Mexico.
Kidney Med. 2020 Oct 11;2(6):771-786. doi: 10.1016/j.xkme.2020.06.015. eCollection 2020 Nov-Dec.
Reactivation of BK virus (BKV) remains a dreaded complication in immunosuppressed states. Conventionally, BKV is known as a cause for BKV-associated nephropathy and allograft dysfunction in kidney transplant recipients. However, emerging studies have shown its negative impact on native kidney function and patient survival in other transplants and its potential role in diseases such as cancer. Because BKV-associated nephropathy is driven by immunosuppression, reduction in the latter is a convenient standard of care. However, this strategy is risk prone due to the development of donor-specific antibodies affecting long-term allograft survival. Despite its pathogenic role, there is a distinct lack of effective anti-BKV therapeutics. This limitation combined with increased morbidity and health care cost of BKV-associated diseases add to the complexity of BKV management. While summarizing recent advances in the pathogenesis of BKV-associated nephropathy and its reactivation in other organ transplants, this review illustrates the limitations of current and emerging therapeutic options and provides a compelling argument for an effective targeted anti-BKV drug.
BK病毒（BKV）再激活仍是免疫抑制状态下令人恐惧的并发症。传统上，BKV被认为是肾移植受者发生BKV相关性肾病和移植肾功能障碍的原因。然而，新出现的研究表明，它对其他移植中天然肾功能和患者生存有负面影响，以及在癌症等疾病中的潜在作用。由于BKV相关性肾病是由免疫抑制驱动的，减少免疫抑制是一种方便的治疗标准。然而，由于影响移植长期存活的供体特异性抗体的产生，这种策略容易产生风险。尽管BKV具有致病作用，但明显缺乏有效的抗BKV治疗方法。这种局限性加上BKV相关疾病发病率的增加和医疗保健成本的上升，增加了BKV管理的复杂性。在总结BKV相关性肾病发病机制及其在其他器官移植中再激活的最新进展时，本综述阐述了当前和新出现的治疗选择的局限性，并为有效的靶向抗BKV药物提供了有力论据。
