DISTINCT GENOTYPIC DISTRIBUTIONS OF CYTOMEGALOVIRUS (CMV) ENVELOPE GLYCOPROTEIN IN BONE-MARROW AND RENAL-TRANSPLANT RECIPIENTS WITH CMV DISEASE

A prospective study of the spectrum of glycoprotein B (gB) and glycopr otein H (gB) genotypes of cytomegalovirus (CMV) was conducted with fiv e categories of patients: viremic bone marrow-transplant (BMT) recipie nts who developed CMV disease after BMT (n = 22), viremic BMT recipien ts without CMV disease (n = II), viremic renal-transplant recipients w ho developed CMV disease after transplantation (n = 14), viremic renal -transplant recipients without CMV disease (n = 13), and premature bab ies with asymptomatic congenital CMV infections (n = 13), Genotypic st ability was observed because the gB and gH genotypes of multiple isola tes obtained from a single patient were identical, The distribution of gH genotypes in patients of all groups studied were similar, However, there was a unique distribution of the gB genotype in the first categ ory of patients, i.e., BMT recipients with CMV disease, which was dist inct from those of all other categories (P < 0.05). CMV isolates from 54% of BMT recipients with CMV disease exhibited gB type 2, while isol ates from 46, 50, 69, and 77% of the BMT recipients without CMV diseas e, renal-transplant recipients with and those without CMV disease, and premature babies with congenital CMV infection, respectively, were of gB type 1, An analysis of the clinical characteristics of BMT recipie nts with CMV disease indicated that all underwent either an allogeneic or matched, unrelated donor transplant, and half had severe acute gra ft-versus-host disease (grades 2 to 4), The statistically significant genotypic difference between CMV isolates from BMT recipients with and without CMV disease was not observed between isolates from renal-tran splant recipients with and without CMV disease, We speculate that diff erences in pathogenesis in different patient groups might account for these observations, These findings would also facilitate decision maki ng about the choice of recombinant CMV glycoprotein vaccine required t o immunize transplant donors and the subsequent adoptive transfer of i mmunity to BMT recipients, When the source of CMV DNA required for gen otyping was investigated among renal-transplant recipients, direct use of peripheral blood leukocytes was 95% effective compared to the effe ctiveness of cells obtained from conventional culture of peripheral bl ood specimens.