Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Nutrients. 2022 Aug 19;14(16):3415. doi: 10.3390/nu14163415.
Human parvovirus B19 causes life-threatening anemia due to transient red cell aplasia (TRCA) in individuals with sickle cell disease (SCD). Children with SCD experiencing profound anemia during TRCA often require red blood cell transfusions and hospitalization. The prevalence of vitamin deficiencies in SCD is high and deficiencies are associated with respiratory and pain symptoms, but the effects of vitamins on acute infection with parvovirus B19 remain unclear. We performed a clinical study in which 20 SCD patients hospitalized with parvovirus B19 infections (Day 0) were monitored over a 120-day time course to query relationships between vitamins A and D and clinical outcomes. There were significant negative correlations between Day 0 vitamin levels and disease consequences (e.g., red blood cell transfusion requirements, inflammatory cytokines). There were significant positive correlations (i) between Day 0 vitamins and peak virus-specific antibodies in nasal wash, and (ii) between Day 0 virus-specific serum plus nasal wash antibodies and absolute reticulocyte counts. There was a significant negative correlation between Day 0 virus-specific serum antibodies and virus loads. To explain the results, we propose circular and complex mechanisms. Low baseline vitamin levels may weaken virus-specific immune responses to permit virus amplification and reticulocyte loss; consequent damage may further reduce vitamin levels and virus-specific immunity. While the complex benefits of vitamins are not fully understood, we propose that maintenance of replete vitamin A and D levels in children with SCD will serve as prophylaxis against parvovirus B19-induced TRCA complications.
人细小病毒 B19 可引起镰状细胞病 (SCD) 患者红细胞再生障碍性贫血 (TRCA),从而导致危及生命的贫血。在 TRCA 期间出现严重贫血的 SCD 儿童通常需要输血和住院治疗。SCD 患者的维生素缺乏症患病率很高,且缺乏症与呼吸和疼痛症状有关,但维生素对细小病毒 B19 急性感染的影响尚不清楚。我们进行了一项临床研究,其中 20 名因细小病毒 B19 感染住院的 SCD 患者(第 0 天)在 120 天的时间过程中进行监测,以查询维生素 A 和 D 与临床结果之间的关系。第 0 天的维生素水平与疾病后果(例如红细胞输血需求、炎症细胞因子)之间存在显著负相关。第 0 天的维生素与鼻冲洗中病毒特异性抗体的峰值之间存在显著正相关(i),以及第 0 天的病毒特异性血清加鼻冲洗抗体与绝对网织红细胞计数之间存在显著正相关(ii)。第 0 天的病毒特异性血清抗体与病毒载量之间存在显著负相关。为了解释这些结果,我们提出了循环和复杂的机制。低基线维生素水平可能会削弱病毒特异性免疫反应,从而允许病毒扩增和网织红细胞丢失;由此产生的损害可能会进一步降低维生素水平和病毒特异性免疫。虽然维生素的复杂益处尚未完全了解,但我们提出,维持 SCD 儿童充足的维生素 A 和 D 水平将作为预防细小病毒 B19 引起的 TRCA 并发症的措施。
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