Pathogens & People: Tumors and viruses: What's the connection?

By EDWARD McSWEEGAN, For The Capital

Published 03/01/09

Whatever your political persuasion, I think you would have to agree that Sen. Ted Kennedy is a
lucky man. He has survived decades of ruthless national politics, endless family tragedies,
personal legal problems, and, most recently, a deadly form of brain cancer. He's a survivor in
every sense

What he survived last year was an aggressive brain tumor called glioblastoma multiforme. Each
year, 10,000 Americans are diagnosed with it, and it is usually fatal. The ultimate consequences
of this brain cancer are no mystery, but the ultimate cause of this deadly illness still is. Some
researchers think the cause of Kennedy's type of brain cancer is a virus that is present in 80
percent of the U.S. population.

That virus is called Cytomegalovirus. It is a herpes virus in the same family as chickenpox,
genital herpes and mononucleosis viruses. CMV is spread by close person-to-person contact,
blood transfusions and pregnancy. Studies suggest that between 3 and 11 percent of healthy
adults and 50 percent of children shed the virus in urine or saliva.

Usually CMV produces a "silent" or symptom-free infection. Yet the virus will persist forever in
the host as a "latent" or dormant infection.

Does CMV really cause cancers? If CMV permanently infects 80 percent of the U.S. population,
why don't most of us have brain tumors? If CMV is contagious, are some brain cancers also
contagious? Good questions, but of course, there are no good answers yet.

In 2002, a group of scientists found active CMV in the brain tumor tissue of two dozen patients
suffering from glioblastoma multiforme. More recently, CMV was found to be active in about 90
percent of such brain tumors. But it's a chicken or egg situation: which came first, the virus to
start the tumor or the tumor to awaken the dormant virus? Then there are the statistics. Most
Americans have CMV, yet only one in 30,000 gets a glioblastoma. Last summer, Duke
University neurologist Duane Mitchell told Scientific American, "Most evidence to date does not
support CMV being a cancer-causing virus."

The hunt for such viruses began 100 years ago when a Long Island farmer brought a tumor-
riddled chicken to the Rockefeller Institute in New York City. A curious researcher named Peyton
Rous extracted some cancer cells from the bird, ground them up, filtered the resulting solution
and injected it into healthy birds. They all developed tumors from what would later be known as
the Rous Sarcoma Virus.

Since then, human cervical cancer, liver cancer and a lymphoma have been found to be caused
by three different viruses: the Human Papilloma Virus, Hepatitis B Virus and Epstein-Barr Virus.
New anti-virus vaccines now can prevent many cases of cervical and liver cancer.

Perhaps surprisingly, a CMV vaccine is being tested even though it is not yet clear that CMV
causes malignant brain tumors. Because CMV is often "associated" with tumors, the thinking is
that an anti-CMV vaccine might be a useful "therapeutic" vaccine (as opposed to a preventive
vaccine), and thereby augment the standard radiation, drug and surgical treatments. (It's not clear
whether Kennedy received such an experimental vaccine.)

The pharmaceutical company Novartis also is working on a CMV vaccine, but this one is
intended to prevent CMV infections from starting. Preventing CMV infections may not reduce
the number of people who eventually develop brain tumors, but it might help prevent pregnant
women from passing the virus to their babies and causing serious birth defects.

According the Centers for Disease Control, one in 750 babies the U.S. each year are born with or
develop disabilities from a CMV infection. Some of these disabilities include loss of hearing or
vision, mental disability, motor problems and seizures. Some symptoms of CMV may not appear
for months or even years after birth.

These congenital CMV infections typically occur when a woman is infected for the fist time
during her pregnancy. These are called primary CMV infections, and they occur in 1 to 4 percent
of pregnant women and lead to fetal infections in one-third of pregnancies. In women already
carrying latent CMV, the virus then may reactivate, but cause fetal infections in less than 1
percent of pregnancies.

CMV is a tricky virus, causing few overt symptoms in healthy adults, but then lying in wait for
years or decades, possibly to cause a brain tumor, and certainly to cause serious neonatal
infections. There are few reliable measures to prevent CMV infection, and no good anti-viral
drugs to treat it. The availability of a preventive CMV vaccine would likely ease the angst of
pregnancy and the overall burden of serious disabilities among children.