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Research Letter |

ABO Blood Groups and Risk for Progressive Multifocal Leukoencephalopathy

Michael N. Khoury, MD1; Murray A. Mittleman, MD2; Igor J. Koralnik, MD1
[+] Author Affiliations
1Division of NeuroVirology, Center for Virology and Vaccine Research, Boston, Massachusetts
2Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2013;70(10):1331-1332. doi:10.1001/jamaneurol.2013.3932.
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Progressive multifocal leukoencephalopathy (PML), caused by JC virus (JCV), has remained one of the deadliest opportunistic infections in HIV-infected patients despite combined antiretroviral therapy, with only a 50% 1-year survival rate. Progressive multifocal leukoencephalopathy has also been diagnosed in patients with autoimmune diseases treated with immunomodulators such as natalizumab.1 A consistent feature of PML is the predominant location of lesions in the subcortical white matter on magnetic resonance imaging, with corresponding demyelinating areas at the gray-white junction (GWJ) on histology. Interestingly, 64% of brain metastases are also found at the GWJ.2 This is likely owing to hemodynamic factors, where emboli of cancerous cells bind to endothelial receptors and remain in areas of sudden reduction of vascular caliber. Ultrastructural studies of the cortical microvasculature showed abrupt narrowing of perforating end-arterioles coming from the brain surface into the cortical gray matter, with a dense bed of deep cortical capillaries at the GWJ.3

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