Chronic Active Human Herpesvirus-6 (HHV-6) Infection: A New Disease Paradigm
by Joseph H. Brewer, M.D.

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References: Comments Section

I. GROUP 1: TRIGGERING EVENT
1. Simms RW, Zerbini CAF, Ferrante et al. Fibromyalgia syndrome in patients infected with human immunodeficiency virus. Am J Med 1992;92:368-372.
2. Leventhal LJ, Naides SJ, Freundlick N et al. Fibromyalgia and parvovirus infection. Arthritis Rheum 1991;34:1319-1324.
3. Dinerman H and Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med 1992;117:281-285.
4. Buskila D, Shnaider A, Neurmann L et al. Fibromyalgia in hepatitis C infection. Arch Intern Med 1997;157:2947-2500.
5. Schedlowski M, Jacobs R, Stratmann G et al. Changes in natural killer cells during acute psychological stress. J Clin Immunol 1993;13:119-126.
6. Siber WJ, Rodin J, Larson L et al. Modulation of human natural killer cell activity by exposure to uncontrollable stress. Brain Behav Immun 1992;6:141-156.
7. Whiteside, TL and Herbman RB. The role of natural killer cells in human disease. Clin Immunol Immunpathol 1989;53:1-23.
8. Welsh RM. Regulation of virus infections by natural killer cells. Nat Immun Cell Growth Regul 1986;5:169-199.
9. Malanti MS, Lusso P, Ciccone E et al. Recognition of virus-infected cells by natural killer cell clones is controlled by polymorphic target cell elements. J Exp Med 1993;178:961-969.
10. Hsu D-H, deWaal Malefyt R, Florentino et al. Expression of interleukin-10 activity by Epstein-Barr virus protein BCRF 1. Science 1990;250:830-832.
11. Schrier RD, Rice GPA and Goldstone MBA. Suppression of natural killer activity and T cell proliferation by fresh viral isolates of human cytomegalovirus. J Infect Dis 1986;153:1084-1091.
12. Walter R, Hartman K, Fleisch et al. Reactivation of herpesvirus infections after vaccinations? Lancet 1999;353:810.
13. Herroelen L, De Keyser J, Ebinger G. Central-nervous-system demyelination after immunisation with recombinant hepatitis B vaccine. Lancet 1991;338:1174-1176.
14. Golightly M, Thomas J, Volkman D et al. Modulation of natural killer cell activity by Borrelia burgdorferi. Ann NY Acad Sci 1988;539:103-111.
15. Rouas-Freiss N, Goncalves RM, Menier C et al. Direct evidence to support the role of HLA-G in protecting the fetus from maternal uterine natural killer cytolysis. Proc Natl Acad Sci 1997;94:11520-11525.
16. Dahl H, Fjaertoft G, Norsted T et al. Reactivation of human herpesvirus 6 during pregnancy. J Infect Dis 1999;180:2035-2038.
17. Vojdani A, Campbell A and Brautbar N. Immune functional impairment in patients with clinical abnormalities and silicone breast implants. Toxicol Ind Health 1992;8:415-429.

II. GROUP 2: GENETIC PREDISPOSITION
18. Pamer EG. Antigen presentation in the immune response to infectious diseases. Clin Infect Dis 1999;28:714-716.
19. Lekstrom-Himes JA, Hohman P, Warren T et al. Association of major histocompatibility complex determinants with the development of symptomatic and asymptomatic genital herpes simplex virus type 2 infections. J Infect Dis 1999;179:1077-1085.
20. Minton EJ, Smillie D, Neal KR et al. Association between MHC Class II alleles and clearance of circulating hepatitis C virus. J Infect Dis 1998;178:39-44.
21. Hogencamp WE, Rodriguez M and Weinshenker BG. The epidemiology of multiple sclerosis. Mayo Clin Proc 1997;72:871-878.
22. Hogencamp WE, Rodriguez M and Weinshenker BG. Identification of multiple sclerosis associated genes. Mayo Clin Proc 1997;72:965-976.
23. Kurtzke JF. Epidemiologic evidence for multiple sclerosis as an infection. Clin Microbiol Rev 1993;6:382-427.

III. GROUP 3: ACTIVE HHV-6 INFECTION
24. Buchwald D, Cheney PR, Peterson DL et al. A chronic illness characterized by fatigue, neurologic and immunologic disorders, and active human herpesvirus type 6 infection. Ann Intern Med 1992;116:103-113.
25. Zorenzenon M, Rukh G Botta GA et al. Active HHV-6 infection in chronic fatigue syndrome patients from Italy: New data. J Chron Fatigue Syndr 1996;2(4):3-12.
26. Soldan SS, Berti R, Salem N et al. Association of human herpesvirue-6 (HHV-6) with multiple sclerosis: Increased IgM response to HHV-6 early antigen and detection of serum HHV-6 DNA. Nature Med 1997;3(6):390-396.
27. Knox KK, Brewer JH, Henry JM et al. Human herpesvirus 6 and multiple sclerosis: systemic active infections in patients with early disease. Clin Infect Dis 2000;31:894-903.
28. Knox KK, Brewer JH, and Carrigan DR. Persistent active human herpesvirus six (HHV-6) infections in patients with chronic fatigue syndrome. J Chron Fatigue Syndr 1999;5:245-246.
29. Brewer JH, Know KK and Carrigan DR. Longitudinal study of chronic active human herpesvirus 6 (HHV-6) viremia in patients with chronic fatigue syndrome. Abstract. IDSA. 37th Annual Meeting. Nov. 18-21, 1999. Philadelphia, Pennsylvania.
30. Singh N and Carrigan DR. Human herpesvirus-6 in transplantation: an emerging pathogen. Ann Intern Med 1996;124:1065-1071.

IV. GROUP 4: ACTIVE HHV-6 INDUCED IMMUNE DEFICIENCY
31. Banks TA and Rouse BT. Herpesviruses – Immune escape artists? Clin Infect Dis 1992;14:933-941.
32. Reyburn HT, Mandleboim O, Vales-Gomez M et al. The class I MHC homologue of human cytomegalovirus inhibits attack by natural killer cells. Nature 1997;386:514-517.
33. Braun DK, Dominguez G and Pellet PE. Human herpesvirus 6. Clin Microbiol Rev 1997;10:521-567.
34. Yakushijin Y, Yasukawa M and Kobayashi Y. Establishment and functional characterization of human herpesvirus 6-specific CD4+ human T cell clones. L Virol 1992;66:2773-2779.
35. Klimas NG, Salvato F, Morgan R et al. Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol 1990;28;1403-1410.
36. Ojo-Amaize EA, Conley EJ and Peter JB. Decreased natural killer cell activity is associated with severity of chronic fatigue immune dysfunction syndrome. Clin Infect Dis 1994;18 (Suppl 1):S157-S159.
37. Caliguri M, Murray C, Buchwald et al. Phenotypic and functional deficiency of natural killer cells in patients with chronic fatigue syndrome. J Immunol 1987;139:3306-3313.
38. Whiteside TL and Friberg D. Natural killer cells and natural killer cell activity in chronic fatigue syndrome. Am J Med 1998;105:27S-34S.
39. Kastrukoff LK, Morgan NG, Zecchini D et al. A role for natural killer cells in the immunopathogenesis of multiple sclerosis. J Neuroimmonol 1998;86:123-133.
40. Brewer JH, Knox KK, and Carrigan DR. Severe dysfunction of natural killer (NK) cells associated with chronic active human herpesvirus-6 (HHV-6) viremia in patients with chronic fatigue syndrome. Abstract. IDSA. 37th Annual Meeting. Nov. 18-21, 1999. Philadelphia, Pennsylvania.
41. Biron CA, Byron KS and Sullivan JL. Severe herpesvirus infections in an adolescent without natural killer cells. N Engl J Med 1989;26:1731-1735.

V. GROUP 5: IMMUNE CELL TROPISM
42. Lusso P, Malnati M, De Maria A et al. Productive infection of CD4+ and CD8+ mature human T cell populations and clones by human herpesvirus 6. J Clin Microbiol 1991;147:685-691.
43. Lusso P, Malnati M, Garzino-Demo A et al. Infection of natural killer cells by human herpesvirus 6. Nature 1993;362:458-462.
44. Flamand L, Gosselin J, D’Addario M et al. Human herpesvirus 6 induces interleukin 1 beta and tumor necrosis factor alpha, but not interleulin-6, in peripheral blood mononuclear cell cultures. J Virol 1991;65:5105-5110.
45. Strauss SE, Tosato G, Armstrong G et al. Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection. Ann Intern Med 1985;102:7-16.
46. Buchwald D, Goldenberg DL, Sullivan et al. The "chronic, active Epstein-Barr virus infection" syndrome and primary fibromyalgia. Arthritis Rheum 1987;10:1132-1136.
47. Golightly M, Thomas J, Volkman D et al. Modulation of natural killer cell activity by Borrelia burgdorferi. Ann NY Acad Sci 1988;539:103-111.
48. Tseng CT and Rank RG. Role of NK cells in early host response to chlamydial genital infection. Infect Immun 1998;66:5867-5875.
49. Lai WC, Bennett M, Pakes SP et al. Resistance to Mycoplasma pulmonis mediated by activated natural killer cells. J Infect Dis 1990;161:1269-1275.

VI. GROUP 6: ENDOTHELIAL CELL TROPISM / VASCULOPATHY
50. Wu CA and Shanley JD. Chronic infection of human umbilical vein endothelial cells by human herpesvirus-6. J Gen Virol 1998;79:1247-1256.
51. Ueda T, Miyake Y, Imoto K et al. Distribution of human herpesvirus 6 and varicella-zoster virus in organs of a fatal case with exanthem subitum and varicella. Acta Paediatr Jpn 1996;38:590-595.
52. Bruggerman CA, Debie WM, Grauls G et al. Cytomegalovirus infection of rat endothelial cells in vitro. Arch Virol 1986;87:265-272.
53. Van Dam-Mieraras MC, Bruggman CA, Muller AD et al. Induction of endothelial cell procoagulant activity by cytomegalovirus infection. Thromb Res 1987;47:69-75.
54. Van Dam-Mieras MC, Muller AD, Van Hinsbergh VW et al. The procoagulant response of cytomegalovirus infected endothelial cells. Thromb Haemost 1992;68:364-370.
55. Berg D, Berg LH and Couvarars J. Is CFS/FM with an undefined hypercoaguable state brought on by immune activation of coagulation? J Chron Fatigue Syndr 1999;3/4:113-114.
56. Cuadrado MJ, Khamashta MA, Ballesteros A et al. Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Medicine 2000;79:57-68.
57. Simpson LO, Murdoch JC and Herbison GP. Red cell shape changes following trigger finger fatigue in subjects with chronic tiredness and healthy controls. N Z Men J 1993;106:104-107.
58. Simpson LO. Nondiscocytic erythrocytes in myalgic encephalitis. N Z Med J 1989;102:126-127.
59. Vandergriff KD and Olson JS. Morphologic and physiological factors affecting oxygen uptake and release by red blood cells. J Biol Chem 1984;259:12619-12627.
60. Buchwald D and Kamaroff AL. Review of laboratory findings for patients with chronic fatigue syndrome. Rev Infect Dis 1991;13(Suppl 1):S12-18.
61. Arnold DL, Bore PJ, Radda GK et al. Excessive intracellular acidosis of skeletal muscle on exercise in a patient with post-viral exhaustion/fatigue syndrome. A 31P nuclear magnetic resonance study. Lancet 1984;1:1367-1369.
62. Lund N, Bengtsson A and Thorberg P. Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 1986;15:165-173.
63. Riley MS, O’Brien CJ, McCluskey DR et al. Aerobic work capacity in patients with chronic fatigue syndrome. Br Med J 1990;1:953-956.
64. Goldstein JA, Mena I, Yunus MB et al. Regional cerebral blood flow by SPECT in chronic fatigue syndrome with and without fibromyalgia (abstract). Arthritis Rheum 1993;36:S222.
65. Mountz JM, Bradley LA, Modell JG et al. Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and caudate nucleus and associated with low pain threshold levels. Arthritis Rheum 1995;38:926-938.
66. Lange G, Wang S, DeLuca J et al. Neuroimaging in chronic fatigue syndrome. Am J Med 1998;105:S50-S53.
67. Adams CWM, Poston RN, Buk SJ et al. Inflammatory vasculitis in multiple sclerosis. J Neurol Sci 1985;69:269-283.

VII. GROUP 7: NEUOTROPISM
68. Caserta MT, Hall CB, Schnabel K et al. Neuroinvasion and persistence of human herpesvirus-6 in children. J Infect Dis 1994;170:1585-1589.
69. Kamei A, Fujiwara T, Hiraga S et al. Acute disseminated demyelination due to primary human herpesvirue-6 infection. Eu J Pediatr 1997;156:709-712.
70. Knox KK and Carrigan DR. Active human herpesvirus six (HHV-6) infection of the central nervous system in the patients with AIDS. J Acq Immune Defic Syndr and Hum Retrovir 1995;9:69-73.
71. Drobyski WR, Knox KK, Majewski D et al. Fatal encephalitis due to variant B human herpesvirus-6 infection in a bone marrow transplant recipient. N Engl J Med 1994;330:1356-1360.
72. Novoa LJ, Nagra RM, Nakawatase T et al. Fulminate demyelinating encephalomyelitis associated with productive HHV-6 infection in an immunocompetent adult. J Med Virol 1997;52:308-310.
73. Challoner PB, Smith KT, Parker JD et al. Plaque associated expression of human herpesvirus-6 in multiple sclerosis. Proc Natl Acad Sci 1995;92:7440-7444.
74. Carrigan DR, Harrington D and Knox KK. Subacute leukoencephalitis caused by CNS infection with human herpesvirus six manifesting as acute multiple sclerosis. Neurology 1996;47:145-148.
75. Carrigan DR and Knox KK. Human herpesvirus six and multiple sclerosis. Multiple Sclerosis 1997;4(5):390-394.
76. Brewer JH, Knox and Carrigan DR. Active human herpesvirus-6 infections are present in the CNS, lymphoid tissues and peripheral blood of patients with multiple sclerosis. Abstract 57. IDSA 36th Annual Meeting. Nov. 12-15. Denver, Colorado.
77. Albright AV, Lavi E, Black et al. The effect of human herpesvirus-6 (HHV-6) on cultured human neural cells: oligodendrocytes and microglia. J Neurovirol 1998;4(5):486-494.
78. Albert LJ and Inman RD. Molecular mimicry and autoimmunity. N Engl J Med1999;341:2068-2074.

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