Nemours Biomedical Research
Most of our tests incorporate quantitative real-time PCR technology that rapidly links amplification with detection and quantification of viral DNA. Antiviral therapy is instituted upon viral DNA detection, followed by close monitoring of quantitative viral titers to assess and maintain the balance between immunosuppression and anti-infective therapies.
Currently, our real-time PCR tests detect viral DNA loads that may be indicative of an active infection that may warrant the institution of antiviral therapies and/or a decrease of immunosuppressive therapies.
This lab is CLIA-certified.
Our lab provides a variety of clinical testing services targeted to pediatric patients undergoing transplantation or are otherwise immunocompromised.
EBV occurs commonly in the general population and generally remains latent; however, immunocompromised patients are susceptible to an active EBV infection that can lead to post-transplant lymphoproliferative disorder (PTLD).
Since viremia is considered the best predictor of the disease, monitoring the EBV DNA levels in the blood by quantitative real-time PCR in these patients may allow timely recognition of virus reactivation and permit installment and assessment of antiviral treatment (rituximab) and/or a decrease of immunosuppressive therapies.
Kimura H., Morita M., Yabuta Y., Kuzushima K., Kato K., Kojima S., Takaharu M., and Morishima T. (1999). Quantitative analysis of Epstein-Barr virus loads by using a real-time assay. J Clin Microbiol. Vol 37:132-136
Cytomegalovirus infection (CMV) is a viral infection that rarely causes obvious illness; however, in immunocompromised patients (recipients of solid-organ and bone marrow transplants or individuals infected with HIV), there is an increased risk for difficult eye infections (CMV retinitis), gastrointestinal CMV, and encephalitis.
Monitoring CMV DNA levels in blood by quantitative real-time PCR in these patients may allow timely recognition of virus reactivation and permit installment and assessment of antiviral treatment (ganciclovir) and/or a decrease of immunosuppressive therapies.
Adenovirus (AdV) infections are associated with respiratory, ocular gastrointestinal disease. Among immunocompromised patients, AdV have increasingly been recognized as significant viral pathogens with high morbidity and mortality (Echavarria 2008).
Monitoring AdV DNA levels of blood by quantitative real-time PCR in these patients may allow timely recognition of virus reactivation and permit installment and assessment of antiviral treatment (IVIG and also cidofavir in severe cases) and/or decrease of immunosuppressive therapies. Depending on a patient’s symptoms, other specimens may be tested, such as respiratory and stool samples.
Echavarria M. (2008). Adenoviruses in immunocompromised hosts. Clin Microbiol Rev Oct:704 -715.
ImmuKnow™ — the Cylex® Immune Cell Function Assay detects cell-mediated immunity (CMI) by measuring the concentration of ATP from CD4+ cells following stimulation. This assay is used for the detection of cell-mediated immunity in an immunosuppressed population.
Our research efforts are focused on development of new or improved lab-based assays to aid in the diagnosis and treatment of pediatric disorders.
The detection and monitoring of BK polyomavirus (BKV) quantitative real-time PCR
BK polyomavirus (BKV) is the primary etiological agent of polyomavirus-associated nephropathy (PVNA), which causes irreversible graft loss in 1% to 10% of kidney transplants (Hirsch 2005, Ramos et al., 2002). BKV-associated hemorrhagic cystitis is a major complication of bone marrow transplants (Arthur et al., 1988). Monitoring BKV DNA levels of urine and plasma by quantitative real-time PCR in these patients may allow timely recognition of virus reactivation and permit installment of antiviral treatment (IVIG and Levaquin® when identified in urine) and/or a decrease of immunosuppressive therapies.
Please contact Carrie Paquette-Straub, MS at (302) 651-6818
Clinical Research Assistant
Nemours/Alfred I. duPont Hospital for Children
1600 Rockland Road
Wilmington, DE 19803