Interferon-β Suppresses Transcriptionally Active Parvovirus B19 Infection in Viral Cardiomyopathy: A Subgroup Analysis of the BICC-Trial

Abstract

Human parvovirus B19 (B19V) is the predominant virus currently detected in endomyocardial biopsies (EMBs). Recent findings indicate that, specifically, transcriptionally active B19V with detectable viral RNA is of prognostic relevance in inflammatory viral cardiomyopathy. We aimed to evaluate B19V replicative status (viral RNA) and beneficial effects in a sub-collective of the prospective randomized placebo-controlled phase II multi-center BICC-Trial (Betaferon In Chronic Viral Cardiomyopathy) after interferon beta-1b (IFN-β) treatment. EMBs of n = 64 patients with B19V mono-infected tissue were retrospectively analyzed. Viral RNA could be detected in n = 18/64 (28.1%) of B19V DNA positive samples (mean age 51.7 years, 12 male), of whom n = 13 had been treated with IFN-ß. Five patients had received placebo. PCR analysis confirmed in follow-up that EMBs significantly reduced viral RNA loads in n = 11/13 (84.6%) of IFN-ß treated patients (p = 0.001), independently from the IFN-ß dose, in contrast to the placebo group, where viral RNA load was not affected or even increased. Consequently, a significant improvement of left ventricular ejection fraction (LVEF) after treatment with IFN-ß was observed (LVEF mean baseline 51.6 ± 14.1% vs. follow-up 61.0 ± 17.5%, p = 0.03). In contrast, in the placebo group, worsening of LVEF was evaluated in n = 4/5 (80.0%) of patients. We could show for the first-time the beneficial effects from treatment with IFN-ß, suppressing B19V viral RNA and improving the hemodynamic course. Our results need further verification in a larger prospective randomized controlled trial.

Stellenwert der endomyokardialen Biopsie in der Diagnostik und Therapie der Kardiomyopathien

“…Daher kann eine kausale Therapieentscheidung nur bei Kenntnis der myokardialen Entzündung und der Virusaktivität getroffen werden. Liegt eine aktive Virusinfektion vor, muss der Patient antiviral mit Interferonbeta behandelt werden, auch wenn eine Entzündung vorhanden ist [13]. Liegt keine aktive Virusinfektion vor, kann der Patient immunsuppressiv behandelt werden [12].…”

Potential of Interleukin (IL)-12 Group as Antivirals: Severe Viral Disease Prevention and Management

“…Patients infected by parvovirus B-19 treated with IFN-β also showed a significant reduction in viral load in the follow-up endomyocardial biopsies (EMBs). The patients continued to show improvement in their hemodynamic profiles six months post-treatment [ 74 ]. Recently, a randomized controlled trial of IFNβ-1a and IFNβ-1b among severe COVID-19 patients showed encouraging findings, particularly the lower in-hospital mortality rate among the admitted patients.…”

Myocardial Oedema as a Consequence of Viral Infection and Persistence – a Narrative Review with Focus on COVID-19 and Post COVID Sequelae

“…In myocarditis due to viral infection, direct antiviral therapy, interferon, and intravenous immunoglobulins may be considered depending on the viral pathogen [399]. In chronic viral myocarditis with entero-, or adenovirus, interferon-β treatment increased viral clearance of entero-, adeno, and parvovirus B19 and reduced endothelial damage in parvovirus B19 infection [340,399,448,449].…”