Human cytomegalovirus inhibits erythropoietin production

Lynn M Butler, Mensur Dzabic, Frank Bakker, Belghis Davoudi, Hannah Jeffery, Piotr Religa, Krzysztof Bojakowski, Koon-Chu Yaiw, Afsar Rahbar, Cecilia Söderberg-Naucler

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Anemia is a feature of CKD and a complication of renal transplantation, often caused by impaired production of erythropoietin. The kidney is a target organ for human cytomegalovirus (hCMV) in such patients, but it is not known whether hCMV effects erythropoietin production. We found that kidneys from patients with CKD were positive for hCMV protein and that blood levels of hCMV IgG inversely correlated with red blood cell count. In mice, systemic murine cytomegalovirus infection decreased serum erythropoietin levels. In human erythropoietin-producing cells, hCMV inhibited hypoxia-induced expression of erythropoietin mRNA and protein. hCMV early gene expression was responsible, as ultraviolet-inactivated virus had no effect and valganciclovir treatment showed that late gene expression was nonessential. Hypoxia-induced gene transcription is controlled by the transcription factors hypoxia-inducible transcription factor (HIF)-1α and HIF2α, which are constitutively produced but stable only under low oxygen conditions. We found that hCMV inhibited constitutive production of HIF2α mRNA. HIF2α is thought to be the master regulator of erythropoietin transcription. Single-cell analysis revealed that nuclear accumulation of HIF2α was inhibited in hCMV-infected cells, and the extent of inhibition correlated with hCMV protein expression. Our findings suggest that renal hCMV infection could induce or exacerbate anemia in patients.

Original languageEnglish
Pages (from-to)1669-1678
Number of pages10
JournalJournal of the American Society of Nephrology
Issue number8
Publication statusPublished - Aug 2014


  • Animals
  • Antibodies, Viral
  • Basic Helix-Loop-Helix Transcription Factors
  • Cell Culture Techniques
  • Cell Hypoxia
  • Cytomegalovirus
  • Erythrocyte Count
  • Erythropoietin
  • Hemoglobins
  • Humans
  • Hypoxia-Inducible Factor 1, alpha Subunit
  • Immunoglobulin G
  • Mice
  • RNA, Messenger
  • Renal Insufficiency, Chronic


Dive into the research topics of 'Human cytomegalovirus inhibits erythropoietin production'. Together they form a unique fingerprint.

Cite this