Does gender or mode of HIV acquisition affect virological response to modern antiretroviral therapy (ART)?

OBJECTIVES

Previous UK studies have reported disparities in HIV treatment outcomes for women. We investigated whether these differences persist in the modern antiretroviral treatment (ART) era.

METHODS

A single-centre cohort analysis was carried out. We included in the study all previously ART-naïve individuals at our clinic starting triple ART from 1 January 2006 onwards with at least one follow-up viral load (VL). Time to viral suppression (VS; first viral load < 50 HIV-1 RNA copies/mL), virological failure (VF; first of two consecutive VLs > 200 copies/mL more than 6 months post-ART) and treatment modification were estimated using standard survival methods.

RESULTS

Of 1086 individuals, 563 (52%) were men whose risk for HIV acquisition was sex with other men (MSM), 207 (19%) were men whose risk for HIV acquisition was sex with women (MSW) and 316 (29%) were women. Median pre-ART CD4 count and time since HIV diagnosis in these groups were 298, 215 and 219 cells/μL, and 2.3, 0.3 and 0.3 years, respectively. Time to VS was comparable between groups, but women [adjusted hazard ratio (aHR) 2.32; 95% confidence interval (CI) 1.28-4.22] and MSW (aHR 3.28; 95% CI 1.91-5.64) were at considerably higher risk of VF than MSM. Treatment switches and complete discontinuation were also more common among MSW [aHR 1.38 (95% CI 1.04-1.81) and aHR 1.73 (95% CI 0.97-3.16), respectively] and women [aHR 1.87 (95% CI 1.43-2.46) and aHR 3.20 (95% CI 2.03-5.03), respectively] than MSM.

CONCLUSIONS

Although response rates were good in all groups, poorer virological outcomes for women and MSW have persisted into the modern ART era. Factors that might influence the differences include socioeconomic status and mental health disorders. Further interventions to ensure excellent response rates in women and MSW are required.

Persistence of dual free internal rotation in NH4(+)(H2O)·Hen=0-3 ion-molecule complexes: expanding the case for quantum delocalization in He tagging

To explore the extent of the molecular cation perturbation induced by complexation with He atoms required for the application of cryogenic ion vibrational predissociation (CIVP) spectroscopy, we compare the spectra of a bare NH4(+)(H2O) ion (obtained using infrared multiple photon dissociation (IRMPD)) with the one-photon CIVP spectra of the NH4(+)(H2O)·He1-3 clusters. Not only are the vibrational band origins minimally perturbed, but the rotational fine structures on the NH and OH asymmetric stretching vibrations, which arise from the free internal rotation of the -OH2 and -NH3 groups, also remain intact in the adducts. To establish the location and the quantum mechanical delocalization of the He atoms, we carried out diffusion Monte Carlo (DMC) calculations of the vibrational zero point wave function, which indicate that the barriers between the three equivalent minima for the He attachment are so small that the He atom wave function is delocalized over the entire -NH3 rotor, effectively restoring C3 symmetry for the embedded -NH3 group.

Understanding the ionic liquid [NC4111][NTf2] from individual building blocks: an IR-spectroscopic study

This study explores the interactions underlying the IR spectra of the ionic liquid [NC4111][NTf2] and its deuterated isotopomer [d9-NC4111][NTf2] by first isolating the spectra of charged ionic building blocks using mass-selective CIVP spectroscopy and then following the evolution of these bands upon sequential assembly of the ionic constituents. The spectra of the (1,1) and (2,2) neutral ion pairs are recorded using superfluid helium droplets as well as a solid neon matrix, while those of the larger charged aggregates are again obtained with CIVP. In general, the cluster spectra are similar to that of the bulk, with the (2,2) system displaying the closest resemblance. Analysis of the polarization-dependent band intensities of the neutral ion pairs in liquid droplets as a function of external electric field yields dipole moments of the neutral aggregates. This information allows a coarse assessment of the packing structure of the neutral pairs to be antiparallel at 0.37 K, in contrast to the parallel arrangement found for the assembly of small, high-dipole neutral molecules with large rotational constants (e.g., HCN). The role of an extra anion or cation attached to both the (1,1) and the (2,2) ion pairs to form the charged clusters is discussed in the context of an additional remote, more unfavorable binding site intrinsic to the nature of the charged IL clusters and as such not anticipated in the bulk phase. Whereas for the anion itself only the lowest energy trans conformer was observed, the higher clusters showed an additional population of the cis conformer. The interactions are found to be consistent with a minimal role of hydrogen bonding.

Positive hepatitis B virus core antibody in HIV infection--false positive or evidence of previous infection?

Isolated HBV core antibody (anti-HBc) is defined as the presence of anti-HBc with a negative HBV surface antigen (HBsAg) and HBV surface antibody (anti-HBs <10 IU/l). In patients infected with HIV with isolated anti-HBc, the aim was to determine: The prevalence of isolated positive anti-HBc; The most effective method of identifying which patients have had previous Hepatitis B Virus (HBV) infection; The prevalence of false positive anti-HBc. HBV serology results were identified from 539 patients infected with HIV sampled between January 2010 and December 2012. In those with an isolated anti-HBc and negative anti-HBe, a second anti-HBc test was carried out using a different assay. Samples were also screened for HBV DNA. The anti-retroviral regimens at time of screening were documented. 101/539 had an isolated anti-HBc. Of these, 32 (32%) had a positive anti-HBe (including 1 equivocal) and 69(68%) were anti-HBe negative. Of those negative for anti-HBe, 32 were tested for both DNA and a second anti-HBc. Of these 26 (81%) were on cART at time of HBV testing, with 25 (78%) on ART with anti-HBV activity. The prevalence of isolated anti-HBc was 19%. Only 32% were also anti-HBe positive, whereas 97% of those anti-HBe negative were positive on a second anti-HBc assay suggesting lack of utility of anti-HBe in resolving serological quandaries. One subject (3%) had a false positive anti-HBc. There was no evidence of chronic HBV but 78% patients were on HBV-suppressive combination anti-retroviral therapy.

The utility of genotypic tropism testing in clinical practice

A review of a large number of HIV-1 tropism test requests (n = 1148) performed at a London tertiary referral centre was carried out. The aim was to establish whether these were being performed in line with recommendations from published guidelines and whether this represented the most cost-effective use of these tests in informing prescribing decisions of the CCR5 antagonist drug, maraviroc. The cost of these assays within the UK was covered by commercial funding until April 2013 which has subsequently been withdrawn. Furthermore, all healthcare settings are under increasing cost constraints and hence establishing the real utility and appropriate use of these tests is of vital importance.

Microhydration of contact ion pairs in M(2+)OH(-)(H2O)(n=1-5) (M = Mg, Ca) clusters: spectral manifestations of a mobile proton defect in the first hydration shell

Vibrational predissociation spectra of D2-"tagged" Mg(2+)OH(-)(H2O)n=1-6 and Ca(2+)OH(-)(H2O)n=1-5 clusters are reported to explore how the M(2+)OH(-) contact ion pairs respond to stepwise formation of the first hydration shell. In both cases, the hydroxide stretching frequency is found to red-shift strongly starting with addition of the third water molecule, quickly becoming indistinguishable from nonbonded OH groups associated with solvent water molecules by n = 5. A remarkably broad feature centered around 3200 cm(-1) and spanning up to ∼1000 cm(-1) appears for the n ≥ 4 clusters that we assign to a single-donor ionic hydrogen bond between a proximal first solvent shell water molecule and the embedded hydroxide ion. The extreme broadening is rationalized with a theoretical model that evaluates the range of local OH stretching frequencies predicted for the heavy particle configurations available in the zero-point vibrational wave function describing the low-frequency modes. The implication of this treatment is that extreme broadening in the vibrational spectrum need not arise from thermal fluctuations in the ion ensemble, but can rather reflect combination bands based on the OH stretching fundamental that involve many quanta of low-frequency modes whose displacements strongly modulate the OH stretching frequency.

Ion mobility spectrometry, infrared dissociation spectroscopy, and ab initio computations toward structural characterization of the deprotonated leucine-enkephalin peptide anion in the gas phase

Although the sequencing of protonated proteins and peptides with tandem mass spectrometry has blossomed into a powerful means of characterizing the proteome, much less effort has been directed at their deprotonated analogues, which can offer complementary sequence information. We present a unified approach to characterize the structure and intermolecular interactions present in the gas-phase pentapeptide leucine-enkephalin anion by several vibrational spectroscopy schemes as well as by ion-mobility spectrometry, all of which are analyzed with the help of quantum-chemical computations. The picture emerging from this study is that deprotonation takes place at the C terminus. In this configuration, the excess charge is stabilized by strong intramolecular hydrogen bonds to two backbone amide groups and thus provides a detailed picture of a potentially common charge accommodation motif in peptide anions.

Vibrational spectral signature of the proton defect in the three-dimensional H⁺(H₂O)₂₁ cluster

The way in which a three-dimensional network of water molecules accommodates an excess proton is hard to discern from the broad vibrational spectra of dilute acids. The sharper bands displayed by cold gas-phase clusters, H(+)(H2O)n, are therefore useful because they encode the network-dependent speciation of the proton defect and yet are small enough to be accurately treated with electronic structure theory. We identified the previously elusive spectral signature of the proton defect in the three-dimensional cage structure adopted by the particularly stable H(+)(H2O)21 cluster. Cryogenically cooling the ion and tagging it with loosely bound deuterium (D2) enabled detection of its vibrational spectrum over the 600 to 4000 cm(-1) range. The excess charge is consistent with a tricoordinated H3O(+) moiety embedded on the surface of a clathrate-like cage.

Inspiratory muscle warm-up does not improve cycling time-trial performance

PURPOSE

This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance.

METHODS

Ten cyclists (VO₂ = 65 ± 9 mL kg(-1) min(-1)) performed a habituation 10-km cycling time-trial and three further time-trials preceded by either no warm-up (CONT), a cycling-specific warm-up (CYC) comprising three consecutive 5-min bouts at powers corresponding to 70, 80, and 90% of the gas exchange threshold, or a cycling-specific warm-up preceded by an IMW (CYC + IMW) comprising two sets of 30 inspiratory efforts against a pressure-threshold load of 40% maximal inspiratory pressure (MIP). The cycling warm-up was followed by 2-min rest before the start of the time-trial.

RESULTS

Time-trial performance times during CYC (14.75 ± 0.79 min) and CYC + IMW (14.70 ± 0.75 min) were not different, although both were faster than CONT (14.99 ± 0.90 min) (P < 0.05). Throughout the time-trial, physiological (minute ventilation, breathing pattern, pulmonary gas exchange, heart rate, blood lactate concentration and pH) and perceptual (limb discomfort and dyspnoea) responses were not different between CYC and CYC + IMW. Baseline MIP during CONT and CYC was 151 ± 31 and 156 ± 39 cmH₂O, respectively, and was unchanged following the time-trial. MIP increased by 8% after IMW (152 ± 27 vs. 164 ± 27 cmH2O, P < 0.05) and returned to baseline after the time-trial.

CONCLUSIONS

Improvements in 10-km cycling time-trial performance following an active cycling warm-up were not magnified by the addition of an IMW. Therefore, an appropriately designed active whole-body warm-up does adequately prepare the inspiratory muscles for cycling time-trials lasting approximately 15 min.

Amino acid starvation has opposite effects on mitochondrial and cytosolic protein synthesis

Amino acids are essential for cell growth and proliferation for they can serve as precursors of protein synthesis, be remodelled for nucleotide and fat biosynthesis, or be burnt as fuel. Mitochondria are energy producing organelles that additionally play a central role in amino acid homeostasis. One might expect mitochondrial metabolism to be geared towards the production and preservation of amino acids when cells are deprived of an exogenous supply. On the contrary, we find that human cells respond to amino acid starvation by upregulating the amino acid-consuming processes of respiration, protein synthesis, and amino acid catabolism in the mitochondria. The increased utilization of these nutrients in the organelle is not driven primarily by energy demand, as it occurs when glucose is plentiful. Instead it is proposed that the changes in the mitochondrial metabolism complement the repression of cytosolic protein synthesis to restrict cell growth and proliferation when amino acids are limiting. Therefore, stimulating mitochondrial function might offer a means of inhibiting nutrient-demanding anabolism that drives cellular proliferation.

A rapid, inexpensive, and semi-quantitative method for determining pollen tube extension using fluorescence

BACKGROUND

Pollen tubes extend rapidly when pollen grains are incubated in defined media. Tube extension requires many critical functions of plant cells including molecular signaling, cytoskeleton remodeling, secretion, and cell wall synthesis. Consequently, pollen tube growth has been established as a way to conduct primary screens of chemical libraries to identify compounds that perturb key cellular processes in plants.

RESULTS

Here we report a simple, inexpensive, rapid and semi-quantitative method for measurement of pollen tube growth in microtiter plates. The method relies on Congo Red binding to pollen tubes and correlates dye fluorescence to tube length.

CONCLUSIONS

This method can be used in any laboratory without specialized equipment, and has the potential to enable larger screens as chemical libraries grow and to make chemical screening accessible to researchers building specialized libraries designed to probe pathways in plant biology.

Cryogenic ion chemistry and spectroscopy

The use of mass spectrometry in macromolecular analysis is an incredibly important technique and has allowed efficient identification of secondary and tertiary protein structures. Over 20 years ago, Chemistry Nobelist John Fenn and co-workers revolutionized mass spectrometry by developing ways to non-destructively extract large molecules directly from solution into the gas phase. This advance, in turn, enabled rapid sequencing of biopolymers through tandem mass spectrometry at the heart of the burgeoning field of proteomics. In this Account, we discuss how cryogenic cooling, mass selection, and reactive processing together provide a powerful way to characterize ion structures as well as rationally synthesize labile reaction intermediates. This is accomplished by first cooling the ions close to 10 K and condensing onto them weakly bound, chemically inert small molecules or rare gas atoms. This assembly can then be used as a medium in which to quench reactive encounters by rapid evaporation of the adducts, as well as provide a universal means for acquiring highly resolved vibrational action spectra of the embedded species by photoinduced mass loss. Moreover, the spectroscopic measurements can be obtained with readily available, broadly tunable pulsed infrared lasers because absorption of a single photon is sufficient to induce evaporation. We discuss the implementation of these methods with a new type of hybrid photofragmentation mass spectrometer involving two stages of mass selection with two laser excitation regions interfaced to the cryogenic ion source. We illustrate several capabilities of the cryogenic ion spectrometer by presenting recent applications to peptides, a biomimetic catalyst, a large antibiotic molecule (vancomycin), and reaction intermediates pertinent to the chemistry of the ionosphere. First, we demonstrate how site-specific isotopic substitution can be used to identify bands due to local functional groups in a protonated tripeptide designed to stereoselectively catalyze bromination of biaryl substrates. This procedure directly reveals the particular H-bond donor and acceptor groups that enforce the folded structure of the bare ion as well as provide contact points for noncovalent interaction with substrates. We then show how photochemical hole-burning involving only vibrational excitations can be used in a double-resonance mode to systematically disentangle overlapping spectra that arise when several conformers of a dipeptide are prepared in the ion source. Finally, we highlight our ability to systematically capture reaction intermediates and spectroscopically characterize their structures. Through this method, we can identify the pathway for water-network-mediated, proton-coupled transformation of nitrosonium, NO(+) to HONO, a key reaction controlling the cations present in the ionosphere. Through this work, we reveal the critical role played by water molecules occupying the second solvation shell around the ion, where they stabilize the emergent product ion in a fashion reminiscent of the solvent coordinate responsible for the barrier to charge transfer in solution. Looking to the future, we predict that the capture and characterization of fleeting intermediate complexes in the homogeneous catalytic activation of small molecules like water, alkanes, and CO2 is a likely avenue rich with opportunity.

Speed dating, rejection, and finding the perfect mate: advice from flowering plants

Angiosperm pollen tubes extend through pistil tissue to deliver a pair of immotile sperm cells to female gametes for double fertilization. The extended journey of the pollen tube requires extensive cell:cell interactions that guide the pollen tube to its destination and instruct it to stop growing and burst. Once sperm cells are released the molecular exchanges between male and female continue, resulting in sperm activation and gamete fusion. Finally, there is evidence that gamete fusion can feed back on the pollen tube attraction mechanism so that additional pollen tubes can be attracted only if the first sperm cells fail to fertilize. We review progress toward defining the molecules mediating each of these exchanges and describe how small cysteine-rich peptides are a major mode of cellular communication.