CMV infection management in post-transplant relies on viral DNA as a marker to avoid the effects of the infection and optimise the therapies, especially those based on antivirals that directly affect viral DNA synthesis. Letermovir opened the way to new drugs acting on viral targets other than the polymerase. In such a scenario, associating CMV DNA quantitation to active viral infections poses a major challenge to clinicians, which may lead to misinterpretation of results, prolonged treatment, and increased exposure to the risk of developing resistance.
Discovered in the early 2000s, CMV UL21.5 mRNA is associated only with mature virions and it is fundamental to elude the host’s immunosystem and support infection propagation. ELITechGroup has recently launched an automated real-time PCR test for detecting the UL21.5 mRNA. The assay’s high sensitivity allows for the reproducible quantification of CMV mRNA levels 10 times lower than those detected by current CMV DNA assays.
In both in vitro and clinical studies, using this assay to investigate CMV DNA and UL21.5 RNA in parallel demonstrates that the presence of this viral mRNA is only associated with subclinical emerging or active infections, instead the absence reflects either fully abortive or absence of viral DNA replication.
The combination of CMV DNA and CMV RNA may potentially provide a new diagnostic algorithm with higher positive predictive value in the CMV monitoring post-transplant and better guidance to clinicians in fine-tuning the antiviral therapy - either with conventional drugs such as ganciclovir, or with new generation drugs such Letermovir. This webinar will explore this new approach to CMV infection monitoring and therapy administration in the post-transplant.
Key Learning Objectives
- Acquiring an updated overview of the current advancements and challenges in monitoring CMV in high-risk transplanted patients
- Understanding the significance of CMV DNA and CMV RNA markers in the propagation of the CMV infection under antiviral therapy
- Acquiring information on the CMV-RNA ELITe MGB assay, and its application in bone marrow and solid organ transplant monitoring
- Exploring new diagnostic algorithm using CMV RNA as pivotal in interpreting the presence of CMV DNA in high-risk patients
