The effectiveness of cryopreserved human plasma replacement therapy in patients with primary mannose-binding lectin deficiency suffering from chronic active herpes virus infection

Maltsev D.V.

Institute of Experimental and Clinical Medicine at the O’Bogomolets NMU, Kyiv, Ukraine

Aim: to study the effectiveness of replacement therapy by cryopreserved human blood plasma in patients with primary MBL deficiency and chronic active herpes virus infections.

Materials and methods. To achieve this aim, a controlled non-randomized study was conducted based on a retrospective analysis of clinical cases. Patients of the study group (SG) with chronic active herpes virus infections received combination therapy with valganciclovir at a dose of 450 mg twice a day for 3 months and a preparation of cryopreserved human blood plasma at a dose of 10 ml/kg body weight i/v twice a month No. 6 (n = 36 ). Patients in the control group (CG) of the same gender and age composition, also suffering from chronic active herpes virus infections, were treated only with valganciclovir (n = 36).

The diagnosis of primary MBL deficiency was confirmed on the basis of the detection of pathogenic polymorphic variants of promoter and structural genes of MBL2 according to the results of PCR with restriction. The serum concentration of MBL was measured using an ELISA before starting therapy and the day after each administration of a plasma preparation. The total deficiency was considered the concentration of MBL in serum below the level of 50 ng/ml, and partial – from 450 to 50 ng/ml.

Statistical analysis of associations was carried out by calculating the Chi-square (χ2) Pearson criterion, the odds ratio indicator (OR), and the 95% confidence interval (95% CI).

The results of the study. It has been demonstrated that the additional use of cryopreserved human blood plasma preparation for standard therapy with valganciclovir can significantly increase the number of responders to antiviral treatment in cases of HHV-6- (χ2 = 8.533 and p = 0.004; Yeats correction 6.533 and significance 0.011; OR = 11.667 and 95% CI = 1,939-70,180) and HHV-7- (χ2 = 8.846 and p = 0.003; Yeats correction 7.165 and significance 0.008; OR = 6.375 and 95% CI = 1.711-23.758) reactivation, but not EBV in patients with primary MBL deficiency. These achievements are realized against the background of a significant increase in the serum concentration of MBL under the influence of immunotherapy (р<0,05; Z
Conclusions. Immunotherapy with cryopreserved human blood plasma in patients with primary deficiency of MBL increases the effectiveness of antiviral chemotherapy with valganciclovir for chronic active HHV-6- and HHV-7-infections, and the achieved benefit from immunotherapy is at least partially related to the effect of immune substitution, namely with the restoration of the previously reduced pool of MBL in serum, since immunodeficiency compensation is closely associated with the outcome of antiviral treatment.