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Resumen
La respuesta inmunitaria T frente al citomegalovirus (CMV) es esencial en el control de la replicación viral. La cuantificación de linfocitos T CD4+ y T CD8+ funcionales frente a ciertas especificidades antigénicas del CMV mediante citometría de flujo, ELISPOT o el método comercializado QuantiFERON®-CMV permite estimar con relativa precisión el riesgo de infección activa y enfermedad por el CMV en el marco del trasplante de órgano sólido (TOS). La monitorización virológica e inmunológica conjunta de la infección por el CMV podría permitir individualizar y optimizar los tratamientos antivirales en el TOS, aunque no hay experiencia clínica contrastada al respecto. La transferencia adoptiva de células T autólogas específicas frente al CMV, previa selección con multímeros HLA-péptidos o después de ser activadas y expandidas ex vivo, puede ser una alternativa terapéutica eficaz en el manejo de la infección activa o enfermedad orgánica por el CMV refractario al tratamiento antiviral. Se han desarrollado varias vacunas frente al CMV que se han mostrado seguras e inmunogénicas en ensayos preclínicos o clínicos fase I, pero hasta el momento ninguna ha sido evaluada en ensayos clínicos fase III, por lo que no están licenciadas para uso clínico.
Palabras clave:
Citomegalovirus
Inmunidad celular
Cuantificación de linfocitos T
Infección activa por CMV
Transferencia adoptiva de linfocitos T
Vacunación
Abstract
T-cell response to cytomegalovirus (CMV) is essential in the control of viral replication. Quantification of functional CD4+ and CD8+ T lymphocytes against certain CMV-antigen specificities through flow cytometry, ELISPOT or the QuantiFERON®-CMV kit allows fairly accurate estimation of the risk of active infection and CMV disease in solid organ transplantation (SOT). Combined virological and immunological monitoring of CMV infection could allow antiviral treatments to be individually tailored and optimized in SOT, although clinical experience is currently lacking. The adoptive transfer of CMV-specific T cells before selection with multimer HLA peptides or after activation and expansion ex vivo could be an effective therapeutic alternative in the management of active infection or organic CMV disease refractory to antiviral therapy. Several CMV vaccines have been developed, which have been shown to be safe and immunogenic in preclinical and Phase I clinical trials. However, to date, none of these vaccines has been evaluated in Phase III clinical trials and consequently none has been approved for clinical use.
Keywords:
Cytomegalovirus
Cellular immunity
T-lymphocyte quantification
Active CMV infection
Adoptive T-lymphocyte transfer
Vaccination
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