Book Review

Viruses and Bone Marrow: Basic Research and Clinical Practice

N Engl J Med 1993; 329:1283-1284October 21, 1993

Article

Viruses and Bone Marrow: Basic Research and Clinical Practice
(Hematology. Vol. 16.) Edited by Neal S. Young. 446 pp., illustrated. New York, Marcel Dekker, 1993. $159. ISBN: 0-8247-8833-8

We are told in Leviticus that the blood is the life of the flesh. This perception appears to be shared by several viruses that target blood-forming cells that permit their replication. Studies of virus-blood-cell interaction not only improve our understanding of the pathology related to a particular viral infection but also provide insights into the general physiology of hematopoiesis and the potential of viral vectors for gene therapy. This monograph is particularly timely given the emergence of several therapeutic interventions focused on the bone marrow, including the use of hematopoietic growth factors, mobilization of marrow stem cells for bone marrow transplantation, ex vivo expansion of marrow progenitor-cell populations, and gene therapy directed at primitive hematopoietic stem cells.

The organization of Viruses and Bone Marrow is particularly good. The book begins with a synthesis of current knowledge about basic mechanisms of viral pathogenesis, followed by a description of the host immune response to viral infection. These first two chapters are clear and comprehensive -- not an easy achievement in a book designed for a broad audience. The subsequent chapters, organized according to virus family, cover parvoviruses, herpesviruses, flaviviruses, and retroviruses. The illustrations of viral life cycles, ultrastructure, and clinical syndromes are particularly well done. There is a consistent clarity in presentation that is often not found in review texts. In addition, the references have been well chosen and include both review articles and primary sources.

The reader gains a clear understanding of how different viruses exploit common pathways to attack hematopoietic cells and how they evade certain host defense mechanisms. An exuberant host response to viral infection may also result in tissue damage through elaboration of the mediators of inflammation. It is refreshing to see a book in which lacunas in the precise understanding of pathogenetic mechanisms are clearly noted. This book covers the scientific work that has led to the current state of knowledge and points out the experiments needed to fill in the gaps.

The excellent chapter on gene therapy provides a critical assessment of the advantages and limitations of the various vector strategies currently under study. Gene therapy is becoming a more realistic approach to both inherited and acquired disorders, and this chapter will help educate the nonexpert.

The convergence of virology and hematology has led to some of the most advanced techniques used to understand basic mechanisms of disease and design new treatments. This excellent book will be of value both to those working at the laboratory bench and to those at the patient's bedside.

Jerome E. Groopman, M.D.
New England Deaconess Hospital, Boston, MA 02215