Prostatic basal cell carcinoma treated by chemoradiation with weekly cisplatine: case report and literature review

Background

Basal cell carcinoma of the prostate is a relatively rare entity. Their evolution is characterized by the frequency of local and/or distant relapses. Due to their rarity, the treatment is not consensual in the literature. We report here a case of Basal cell carcinoma of the prostate in a 40-year-old patient.

Case presentation

Our patient initially presented an obstructive lower urinary tract symptoms with a normal initial level of prostate specific antigen (PSA) test (3.5 ng/m). The transurethral resection of the prostate (TURP) was in favor of a prostatic basal cell carcinoma with its specific anatomopathological and immunohistochemical characteristics. The prostatic MRI and thoraco-abdominal CT realized after the TURP revealed a tumoral lesion of the prostatic peripheral zone with extra-capsular extension combined with right seminal vesicle invasion and a suggestion of posterior bladder wall adherence. No evidence of visceral or nodal metastases at this point. Considering the tumor being locally advanced, a concurrent chemoradiotherapy with intensity modulated technique was indicated after a multidisciplinary meeting with a 70 Gy total target dose delivered in 35 fractions and weekly Cisplatin. A year and a half after, he developed a cerebellous metastases revealed by intracranial hypertension with no other visceral lesion and complete local remission with the disappearance of the lower urinary tract symptoms and the pain and the appearance of a prostatic atrophy. The PSA level was still on the upper limit of normal. He underwent metastasectomy, and the anatomopathological study was in favor of a cerebellous metastasis of the known BCC. The patient presented postoperatively paraparesis of lower limbs with balance problems for which he was placed in palliative care with indication of postoperative radiation therapy in case of improvement of his general condition. He did not recover and deceased three months later.

Conclusions

The prostatic basal cell carcinoma is a rare aggressive entity often non-evoked at the clinical or radiological stages because of its unspecific appearance. The diagnostic of these tumors is based on histological examination and a large immunohistochemistry panel. Given its scarity, very few data is available for locally advanced non-metastatic stages treated by radiation therapy. We assess here a good local response with concurrent chemoradiation therapy.

[Pain flare following palliative external beam radiotherapy: Prospective study of 41 cases]

PURPOSE

Radiotherapy plays a major role in relieving pain caused by bone metastases; paradoxically initial flare of symptom is common. Our objectives were to assess prospectively the incidence, and to identify predictor's factors of this acute complication.

PATIENT AND METHODS

Forty-one patients treated with analgesic external beam radiotherapy were followed prospectively. Patients recorded pain severity and analgesic intake was documented. Pain flare was defined as an increase of two points in the intensity of pain on the numerical scale with no reduction in analgesic intake and/or 25% increase of the analgesic intake without decreasing pain intensity.

RESULTS

Primary cancer was the breast, lung and prostate in 49%, 29% and 22% of patients respectively. Twelve patients (29%) had a pain flare. No factor was significantly associated with the occurrence of this complication. A favorable analgesic response was observed in 27 patients. The pain flare was not related to subsequent analgesic response.

CONCLUSION

Radiotherapy is an effective treatment of pain related to bone metastasis, but with a high incidence of painful exacerbation.

Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer

PURPOSE

To evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement.

METHODS AND MATERIALS

Two hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy.

RESULTS

The median follow-up time was 64 months (range, 11-88 months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures.

CONCLUSION

According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.

[Lung cancer: treatment pathway in the radiotherapy department at the National Oncology Institute of Rabat]

L'objectif de cette étude est d'expliquer la discordance entre le nombre important de patients présentant un cancer du poumon localement avancé demandeurs de consultations en service de radiothérapie et le faible nombre de patients effectivement traité. Il s'agit d'une étude décrivant le circuit de soins des patients admis au service de radiothérapie de l'Institut national d'oncologie de Rabat entre le premier mars 2011 et le 29 février 2012 pour la prise en charge d'un cancer du poumon inopérable et/ou non résécable. On a utilisé pour la collecte des données les dossiers cliniques, le registre des nouveaux patients du bureau des admissions de l'institut ainsi que les registres des rendez-vous de consultation et de traitement du service de radiothérapie. 117 patients ont été collectés. Le stade de la maladie n'a pu être déterminé que chez 102 patients, on a ainsi trouvé 53 cancers non métastatiques et 49 cancers métastatiques. Chez les patients avec un cancer non métastatique une radiothérapie palliative a été réalisée chez 9 patients, chez 2 patients la radiothérapie a été contre indiquée, une chimiothérapie néo-adjuvante a été réalisée chez 7 patients et la radio-chimiothérapie concomitante d'emblée fut proposée à 35 patients, mais 34 patients seulement ont pu avoir leur première séance de radiothérapie à visée curative. Cette étude nous a permis de décrire le circuit de soins de nos patients en repérant les points critiques, auxquels on propose des mesures correctives.

[Radiotherapy in the management of painful bone metastases at The National Institute of Oncology in Morocco: data from one year follow-up of 86 patients]

BACKGROUND

Radiation therapy plays an essential role in the management of pain caused by bone metastases Objectives: Evaluate the effect of radiation for the relief of pain caused by bone metastases.

METHODS

We conducted a prospective study of 86 patients suffering from pain associated with bone metastases treated at our department by external radiotherapy between September 2010 and December 2011. Patients recorded pain severity in the numeric rating scale and analgesic requirements before, at the end of irradiation, then weekly for a month, and every month for a year.

RESULTS

The median age of patients was 54 years (28-75 years). There were 45 (52.3%) women and 41 (47.7%) men. Radiotherapy was delivered in a multifraction schedule to a total dose of 30 Gy in 72% of patients or in a single fraction of 8 Gy in 28% of patients. A favorable analgesic response was observed in 59 (68.6%) patients with 8 (9.3%) complete responses and 51 (59.3%) partial responses. The median time-to-response was 2 weeks (0-7 weeks), and the median duration of pain relief was 22 weeks (9-46 weeks).

CONCLUSION

Radiotherapy is effective in relieving pain associated with bone metastases in the majority of patients.

Synthesis and Crystal Structures of ATi[Nb6Cl18] Compounds (A = K, Rb, Cs, In, Tl)

New quaternary niobium cluster chlorides corresponding to the general formula ATi[Nb6Cl18] (A = K, Rb, Cs, In, Tl) have been synthesized in sealed quartz tubes at 720 °C, starting from stoichiometric amounts of NbCl5, niobium metal, TiCl3, and ACl (A = K, Rb, Cs), or In or Tl metals. The structures of RbTi[Nb6Cl18] and CsTi[Nb6Cl18] were determined using single­ crystal X-ray diffraction. RbTi[Nb6Cl18] crystallizes in the rhombohedral crystal system, space group R3̄ (no. 148), Z = 3, with lattice parameters: a = 9.163(4), c = 25.014(14) Å (hexagonal setting). The structure refinement converged to R1 = 0.044 and wR2 = 0.058 for all data. In this structure, discrete [Nb6Cl18]4-cluster units are linked by Rb+ and Ti3+ cations, located in a 12-coordinated anticubeoctahedral and octahedral chloride coordination environment, respectively. In contrast, CsTi[Nb6Cl18] crystallizes in the trigonal crystal system, space group P3̄1c (no. 163), Z = 2. The lattice parameters were determined to be a = 9.1075(6), c = 17.0017(8) Å. The structure refinement gives the reliability factors R1 = 0.029 and wR2 = 0.063 for all data. The structure is built up of discrete octahedral [Nb6Cl18]4- cluster units, linked by Cs+ and Ti3+ cations which are located in a distorted hexagonal antiprismatic and octahedral chloride coordination environment, respectively. The structures of the compounds ATi[Nb6Cl18] (A = K, In, Tl) were found to be isotypic with RbTi[Nb6Cl18], and their unit cell parameters were refined using X-ray powder diffraction analysis.

A new quasi-one-dimensional niobium oxychloride cluster compound Cs2Ti4Nb6Cl18O6: structural effects of ligand combination

The new niobium oxychloride cluster compound, Cs2Ti4Nb6Cl18O6, was obtained by solid-state synthesis techniques in the course of our systematic investigation of metal oxychloride systems aimed at the preparation of low-dimensional cluster compounds. Cs2Ti4Nb6Cl18O6 crystallizes in the trigonal system, with unit cell parameters a= 11.1903(7), c = 15.600(2) A, space group P3bar1c, Z = 2. Its crystal structure was determined by single-crystal X-ray diffraction techniques. The full-matrix least-squares refinement against F(2) converged to R(1) = 0.048 (F(o) > 4sigma(F(o))), wR(2) = 0.069 (all data). The structure is based on an octahedral cluster unit (Nb6Cl(i)6O(i)6)Cl(a)6 in which the six edge-bridging oxide ligands are arranged in two sets of three on opposite sides of the Nb6 octahedron. Ti(3+) ions link the clusters through O(i) and Cl(a) ligands to form linear chains running along the c axis. The location of titanium ions correlates with the arrangement of oxide ligands around the Nb6 metal core. The chains interact with each other through additional Ti(3+) and Cs(+) ions. Interchain interactions are significantly weaker than intrachain interactions, resulting in a quasi-one-dimensional character of the overall structure.

Induction in mice of anti-Tat mucosal immunity by the intranasal and oral routes

Anti-Tat vaccination experiments were carried out in mice with a view to inducing systemic in addition to mucosal immunity. For this, three types of immunizing preparations were tested, which consisted of Tat toxoid embedded in either an adjuvant oily structure (IMS), or nanoparticles of chitosan, or microparticles of polylactide-co-glycolide (PLG). Administered by either the intranasal or oral route all preparations triggered anti-Tat IgG and IgA antibodies. Sera from mice immunized with either of these preparations could also inhibit significantly the Tat transactivating activity. These results open up a new avenue to the development of an effective anti-AIDS protective vaccine.

Structural studies of indium and thallium insertion into the framework of the cluster compound Ti2Nb6Cl14O4

We have investigated the possibility of altering the electronic configuration of the niobium oxochloride cluster compound Ti2Nb6Cl14O4 (I) by doping this material with monovalent cations that can fit into cavities present in its cluster framework. The doping of I with In+ and Tl+ ions resulted in the formation of MxTi2Nb6Cl14-xO4+x (M = In, x = 0.10, 0.20, 0.27; M = Tl, x = 0.10, 0.20) in which the M+ ions partially occupy these cavities. The crystal structure analysis indicated that the additional charge provided by M+ ions is compensated by substitution of chlorine by oxygen, which leads to the cluster electronic configuration being intact. Crystal data: In0.272Ti2Nb6Cl13.728O4.272, space group C2/c (No. 15), a = 12.679(2) A, b = 14.567(2) A, c = 12.632(3) A, beta = 95.26(2) degrees, Z = 4; Tl0.196Ti2Nb6Cl13.804O4.196, space group C2/c (no. 15), a = 12.732(1) A, b = 14.607(2) A, c = 12.662(2) A, beta = 95.28(1) degrees, Z = 4.

Synthesis, Crystal Structure, NMR Studies, and Thermal Stability of Mixed Iron-Indium Phosphates with Quasi-One-Dimensional Frameworks

The hydrothermal synthesis, single-crystal structure analysis, spectroscopic studies, and thermal stability of the compounds Ca(2)(In(1)(-)(x)()Fe(x)())(PO(4))(HPO(4))(2).H(2)O (0 </= x </= 1) are reported. The framework of these new phases is based on linear chains (//[101]) formed by (MO(6)) octahedra and (PO(4))/(HPO(4)) tetrahedra sharing corners. The (HPO(4)) groups and water molecules link the chains through hydrogen bonding to form layers stacked perpendicular to the c axis. The calcium cations are located between the layers and are coordinated by nine oxide anions. Crystal data: Ca(2)In(PO(4))(HPO(4))(2).H(2)O, space group C2/c (No. 15), a = 7.573(1) Å, b = 15.838(1) Å, c = 9.3126(7) Å, beta = 113.55(1) degrees; Ca(2)(In(0.5)Fe(0.5))(PO(4))(HPO(4))(2).H(2)O, C2/c (No. 15), a = 7.548(2) Å, b = 15.670(3) Å, c = 9.241(2) Å, beta = 113.62(3) degrees; Ca(2)Fe(PO(4))(HPO(4))(2).H(2)O, C2/c (No. 15), a = 7.503(2) Å, b = 15.477(2) Å, c = 9.142(1) Å, beta = 113.60(2) degrees. The phases lose two water molecules between 350 and 600 degrees C to form the series Ca(2)(In(1)(-)(x)()Fe(x)())(PO(4))(P(2)O(7)) (0 </= x </= 1), which are isostructural with Ca(2)V(PO(4))(P(2)O(7)). Solid state magic angle spinning (MAS) (31)P NMR of Ca(2)In(PO(4))(HPO(4))(2).H(2)O confirms two phosphorous moieties in roughly a 2:1 ratio. A CP-MAS buildup study yielded polarization transfer rates (T(IS)(-)(1)) of 2128 and 1597 s(-)(1) for the HPO(4) (-2.4 ppm) and PO(4) (-0.9 ppm) sites, respectively. A (1)H-(31)P WISE experiment indicates the presence of motional narrowing and hydrogen exchange between the water molecules and hydroxyl protons.

HPV-16 E7 but not E6 oncogenic protein triggers both cellular immunosuppression and angiogenic processes

HPV-16 E6 and E7 oncoproteins impair the cell cycle in human uterine cervix carcinoma cells (HUCC) by acting on p53 and retinoblastoma proteins, respectively. We recently reported that E7 related into the extracellular compartment by HUCC SiHa cells could inhibit immune T-cell response to recall and alloantigens by a mechanism involving an overproduction of the immunosuppressive IFN alpha by antigen presenting cells (APCs). In this study, we found that besides E7, E6 protein and the vascular endothelium growth factor (VEGF) were released into the SiHa cell supernatants, and we further showed that extracellular E7 but not E6 oncoprotein 1) inhibits the immune cell response to recall and alloantigens, and 2) enhances the release of angiogenic cytokines, including TNF alpha, IL-1 beta and IL-6 by macrophages and/or dendritic cells. VEGF unexpectedly released by cancer cells could also contribute to angiogenesis. Thus in HUCC the same E7 oncoprotein which contributes to controlling the cancer cell cycle has the means in its extracellular configuration to contribute to microenvironmental immunosuppressive and angiogenic processes. Neutralizing anti-E7 antibodies either passively administered or induced by active immunization could represent a new immunotherapeutic endeavour to combat the immunosuppression and/or neoangiogenesis effects of extracellular E7 protein.

Induction of cellular immunosuppression by the human papillomavirus type 16 E7 oncogenic protein

The human papillomavirus type 16 (HPV-16) E7 oncogenic protein is found in the culture supernatant of SiHa cells, a cervical carcinoma cell line. Extracellular E7 protein, acting as a viral toxin in human immune cells, induces the overproduction of the immune suppressive IFN alpha cytokine by APCs, and inhibits the T-cell response to recall and allogenic antigens. These effects should be taken into account for the design of anti-human cervical carcinoma vaccines.

Lectin production by human T-lymphocytes

Cultured human peripheral blood monocytes (PBMC) and the cell line H9 release a lectin. This lectin is not the previously described sarcolectin, since it does not specifically recognize the sugars lactose and sialic acid. The lectinic T-cell factor reduces the release by APCs of IFN alpha--a key cytokine known to inhibit the proliferation of activated T-lymphocytes.

Tat toxoid as a component of a preventive vaccine in seronegative subjects

Because administration of Tat protein, the HIV-1 toxin that induces immunosuppression and apoptosis, may be deleterious to the host immune system, a chemically inactivated but nonetheless immunogenic Tat preparation, Tat toxoid, was used to immunize seronegative individuals against Tat. In an open, controlled, phase I clinical trial, Tat toxoid turned out to be safe, well tolerated, and able to trigger a specific immune reaction. In particular, a threefold to more than 10-fold increase of circulating antibodies directed against the native Tat was observed after immunization in all of 5 immunized study subjects, together with a positive reaction to delayed-type hypersensitivity (DTH) skin test with Tat toxoid in vivo and increased lymphoproliferative response to native Tat in vitro. Persistent (> or =1 year) high levels of circulating anti-Tat antibodies could prevent the Tat-induced immune suppression and, following HIV-1 exposure, allow the anti-HIV-1 cellular immune response, with its early release of protective beta-chemokines, to occur leading to an increase of host resistance, that is, protection.

IFN alpha kinoid vaccine in conjunction with tritherapy, a weapon to combat immunopathogenesis in AIDS

Antiviral therapy, including antiprotease treatment, suppresses viral replication, but it does not restore the HIV-1 induced immunopathogenesis which includes IFN alpha overproduction and cellular immunosuppression. To combat HIV-1 induced immunopathogenesis, anti-IFN alpha kinoid immunization in combination with tritherapy may be beneficial to HIV-1 infected immunodeficient patients.

Amplification of the inflammatory cellular redox state by human immunodeficiency virus type 1-immunosuppressive tat and gp160 proteins

In the course of our studies on oxidative stress as a component of pathological processes in humans, we showed that microintrusion into cells with microcapillary and ultramicroelectrochemical detection could mimic many types of mechanical intrusion leading to an instant (0.1 s) and high (some femtomoles) burst release of H2O2. Specific inhibitors of NADPH enzymes seem to support the assumption that this enzyme is one of the main targets of our experiments. Also, human immunodeficiency virus type 1 (HIV-1) gp160 inhibits the cooperative response of uninfected T cells as well as Tat protein release by infected cells does. In this study, we analyzed in real time, lymphocyte per lymphocyte, the T-cell response following activation in relation to the redox state. We showed that the immunosuppressive effects of HIV-1 Tat and gp160 proteins and oxidative stress are correlated, since the native but not the inactivated Tat and gp160 proteins inhibit the cellular immune response and enhance oxidative stress. These results are consistent with a role of the membrane NADPH oxidase in the cellular response to immune activation.

A prophylactic and therapeutic AIDS vaccine containing as a component the innocuous Tat toxoid

Extracellular Tat can act as a viral toxin on uninfected cells of different tissues, including the CNS and the immune system, thus in order to immunize humans against Tat we have prepared a biologically inactivated but immunogenic Tat (Tat Toxoid). Tat Toxoid is not toxic in mice even at high doses. It triggers high levels of specific Tat Abs in the mouse and rabbit. Furthermore, in humans Tat Toxoid immunization was safe and induced in seronegatives persistent high levels of Tat Abs and in immunodeficient patients a significant rise of these specific Abs. Facing acute HIV-1 infection, the presence of high level of circulating Tat Abs promoted by Tat Toxoid vaccine should prevent Tat-induced immunosuppression and allow anti-HIV-1 cellular response to develop. As a consequence, early release of beta-chemokines could enhance host resistance towards HIV-1, and, in infected people, inhibit viral replication and evolution towards AIDS.

Binding of HIV-1 to RBCs involves the Duffy antigen receptors for chemokines (DARC)

The Duffy Antigen Receptor for Chemokines (DARC) belongs to a family of erythrocyte chemokine receptors that bind C-X-C and C-C chemokines such as interleukin 8 (IL-8), monocyte chemoattractant protein 1 (MCP-1) and regulated-on-activation, normal T cell-expressed and -secreted (RANTES), but not macrophage inflammatory protein 1 alpha (MIP-1 alpha) or MIP-1 beta. DARC has also been identified to a receptor for malaria parasites Plasmodium vivax and Plasmodium knowlesi. In the present study, we show that HIV-1 binds to RBCs from Caucasian individuals via DARC making RBCs able to transmit HIV to peripheral blood mononuclear cells (PBMCs). Furthermore, binding of HIV-1 particles to RBCs is inhibited by treating these cells with recombinant RANTES, but not with recombinant MIP-1 alpha prior to their incubation with HIV-1. This finding suggests that RBCs may function as a reservoir for HIV-1 or as a receptor for the entry of HIV-1 into CD4-cell subsets as well as neurons or endothelial cells.

Potentialization of IL-2 effects on immune cells by oyster extract (JCOE) in normal and HIV-infected individuals

Peripheral blood mononuclear cells (PBMCs) are physiologically activated by interleukin (IL)-2. We found that oyster extract (JCOE) currently used as a functional nutrient enhanced in vitro the IL-2 dependent activation as measured by cell count. 3H-thymidine uptake and up-regulation of a IL-2 receptor. In human immunodeficiency virus (HIV) seropositive individuals, this oyster extract-induced effect was marked in asymptomatic individuals with quasi-normal CD4 cell counts, but was weakly reflected in acquired immunodeficiency syndrome (AIDS) patients.

Distinctive effects of CCR5, CCR2, and SDF1 genetic polymorphisms in AIDS progression

The Genetics of Resistance to Infection by HIV-1 (GRIV) cohort represents 200 nonprogressor/slow-progressor (Slowprog) and 90 fast-progressor (Fastprog) HIV-1-infected patients. Using this unique assembly, we performed genetic studies on three recently discovered polymorphisms of CCR5, CCR2, and SDF1, which have been shown to slow the rate of disease progression. The increased prevalence of mutant alleles among Slowprogs from the GRIV cohort was significant for CCR5 (p < .0001) but not for CCR2 (p = .09) or SDF1 (p = . 12), emphasizing the predominant role of CCR5 as the major HIV-1 coreceptor. However, the prevalence of the CCR2 mutant allele (64I) was significantly increased among Slowprogs homozygous for wild-type CCR5 compared with Fastprogs (p = .04). The prevalence of double mutants SDF1-3'A/3'A genotypes was also increased among Slowprogs homozygous for wild-type CCR5 compared with Fastprogs (p = .05). The effects of the CCR2 and SDF1 mutations are overshadowed by the protective effects of the CCR5 deletion. Predictive biologic markers such as CD4 cell counts or viral load in the Slowprog population did not show significant differences between Slowprog groups with wild-type or mutant alleles for the three genes. Thus, our data suggest that the effects of these genes are exerted earlier in infection and no longer evident in the Slowprog of the GRIV cohort whose average duration of HIV infection is 12 years. We conclude that these genes, whose products serve as viral coreceptors or their ligands, may play a role early in infection and delay the onset of disease. However, among Slowprogs, whose duration of infection is >8 years, they are no longer influential for maintenance of their longterm nonprogression status. Other genetic determinants may be responsible for late protective effects.

Antibodies to the HIV-1 Tat protein correlated with nonprogression to AIDS: a rationale for the use of Tat toxoid as an HIV-1 vaccine

OBJECTIVES

To investigate which immune parameters, such as antibodies against HIV-1 specificities, or viral parameters, such as p24 antigenemia, are predictive of disease progression.

STUDY DESIGN

We performed studies on serum collected from individuals exhibiting two extremes of disease evolution--67 fast progressors (FP) and 182 nonprogressors (NP)--at their enrollment. After a 1- to 2-year clinical follow-up of 104 nonprogressors after their enrollment, we could determine the best serologic predictors for disease progression.

METHODS

We investigated levels of antibodies to tetanus toxoid and to HIV antigens including Env, Gag, Nef, and Tat proteins, as well as p24 antigenemia, viremia, CD4 cell count, and interferon-alpha (IFN-alpha) titers in FPs and NPs, and we correlated these data with clinical and biologic signs of progression.

RESULTS

p24 Antigenemia, a marker of viral replication, and anti-Tat antibodies were highly and inversely correlated in both groups (P < .001). Furthermore, anti-p24 antibodies and low serum IFN-alpha levels were correlated to the NP versus the FP cohort. Finally, among NPs, only antibodies to Tat and not to the other HIV specificities (Env, Nef, Gag) were significantly predictive of clinical stability during their follow-up.

CONCLUSION

Antibodies toward HIV-1 Tat, which are inversely correlated to p24 antigenemia, appear as a critical marker for a lack of disease progression. This study strongly suggests that rising anti-Tat antibodies through active immunization may be beneficial in AIDS vaccine development to control viral replication.

Safety and immunogenicity of HIV-1 Tat toxoid in immunocompromised HIV-1-infected patients

OBJECTIVES

To antagonize the deleterious effects of the HIV-1 toxin extracellular Tat on uninfected immune cells, we developed a new strategy of anti-HIV-1 vaccine using an inactivated but immunogenic Tat (Tat toxoid). Tat toxoid has been assayed for safety and immunogenicity in seropositive patients.

METHOD

The phase I vaccine clinical trial testing Tat toxoid preparation in Seppic Isa 51 oil adjuvant was performed on 14 HIV-1-infected asymptomatic although biologically immunocompromised individuals (500-200 CD4+ cells/mm3).

RESULTS

Following as many as 8 injections, no clinical defects were observed. All patients exhibited an antibody (Ab) response to Tat, and some had cell-mediated immunity (CMI) as evaluated by skin test in vivo and T-cell proliferation in vitro.

CONCLUSION

These results provide initial evidence of safety and potency of Tat toxoid vaccination in HIV-1-infected individuals.

Interferon alpha and Tat involvement in the immunosuppression of uninfected T cells and C-C chemokine decline in AIDS

HIV type 1 (HIV-1) not only directly kills infected CD4(+) T cells but also induces immunosuppression of uninfected T cells. Two immunosuppressive proteins, interferon alpha (IFNalpha) and extracellular Tat, mediate this process because specific antibodies against these proteins prevent generation of suppressor cells in HIV-1-infected peripheral blood mononuclear cell cultures. Furthermore, the production of C-C chemokines in response to immune cell activation, initially enhanced by IFNalpha and Tat, ultimately is inhibited by these proteins in parallel with their induction of immunosuppression. The clinical corollary is the immunosuppression of uninfected T cells and the decline in C-C chemokine release found at advanced stages of HIV-1 infection paralleling rising levels of IFNalpha and extracellular Tat. We, therefore, suggest that IFNalpha and Tat may be critical targets for anti-AIDS strategies.

C-C chemokines, pivotal in protection against HIV type 1 infection

Exposure to HIV type 1 (HIV-1) does not usually lead to infection. Although this could be because of insufficient virus titer, there is now abundant evidence that some individuals resist infection even when directly exposed to a high titer of HIV. This protection recently has been correlated with homozygous mutations of an HIV-1 coreceptor, namely CCR5, the receptor for the beta-chemokines. Moreover, earlier results already had shown that the same chemokines markedly suppress the nonsyncitial inducing variants of HIV-1, the chief virus type transmitted from person to person. CCR5 mutation, as a unique mechanism of protection, is, however, suspect because HIV-1 variants can use other chemokine receptors as their coreceptor. Moreover, recent results have established that infection can indeed sometimes occur with such mutations. Here, we report on transient natural resistance over time of most of 128 hemophiliacs who were inoculated repeatedly with HIV-1-contaminated Factor VIII concentrate from plasma during 1980-1985 before the development of the HIV blood test. Furthermore, and remarkably, 14 subjects remain uninfected to this date, and in these subjects we found homozygous CCR5 mutations in none but in most of them overproduction of beta chemokines. In vitro experiments confirmed the potent anti-HIV suppressive effect of these chemokines.

Absence of clinical, virological, and immunological signs of progression in HIV-1-infected patients receiving active anti-interferon-alpha immunization: a 30-month follow-up report

Twenty-seven HIV-1-infected patients, 16 at early stage of disease and without concomitant antiretroviral therapy and 11 at more advanced stage of disease receiving antiretroviral therapy, have been followed since their enrollment, November 1992 and July 1993, respectively, in phase I/II studies to evaluate safety and immunogenicity of an anti-interferon-alpha (IFN-alpha) vaccine, aimed at modulating the impaired cytokine network in AIDS patients by counteracting IFN-alpha overproduction. We compared clinical, virological, and immunological markers of disease progression, including circulating IFN-alpha levels in a 24- to 30-month follow-up period with those of 62 patients fulfilling the same enrollment criteria and comparable for sex, risk factor, and age, regularly followed at our center. Anti-IFN-alpha immunization consisted of four-six intramuscular injections 1 month apart of a water-in-oil emulsion of 500 micrograms formalin-inactivated recombinant IFN-alpha-2b (iIFN-alpha) followed by intramuscular injections of 250 micrograms iIFN-alpha adsorbed onto calcium phosphate every 3 months. Neither clinical deterioration nor a CD4+ cell count decrease from pretreatment values was observed in IFN-alpha-immunized patients in the follow-up period, whereas clinical and immunological disease progressions were observed among open-comparison patients. Furthermore, statistical analysis showed a strong association between occurrence of clinical manifestations and high circulating IFN-alpha titers, while nonprogression of IFN-alpha-immunized patients was associated with decreased levels of circulating IFN-alpha.

Repair of the in vitro HIV-1-induced immunosuppression and blockade of the generation of functional suppressive CD8 cells by anti-alpha interferon and anti-Tat antibodies

The acute human immunodeficiency virus type 1 (HIV-1) infection of activated peripheral blood mononuclear cells (PBMCs) from normal donors results in inhibition of cell proliferation and generation of functional suppressive T cells. Cultured HIV-1 infected PBMCs but not uninfected PBMCs, following irradiation, can inhibit the proliferation of antigen-activated autologous T cells in a dose-dependent way. CD8+ cell subpopulation is responsible for this inhibition. The presence of anti-alpha interferon (IFN alpha) and anti-Tat antibodies in the culture medium counteracts the HIV-1-induced immunosuppression and prevents the generation of suppressive T cells by these PBMCs. The reported data should have major implications for strategies of AIDS treatment which, in association with antiviral drugs, aim at targetting immune disorders.

Automat and BLAST: comparison of two protein sequence similarity search programs

Since the early 1980s, protein/DNA sequence similarity search has become of major importance to biologists, and the need for fast and efficient tools grows with the size of databanks. Two programs use the strategy of finite state deterministic automatons to accomplish these searches. One of these two is BLAST, which is now widely used, and the other Automat, which has just been published. The differences and similarities in their basic principles, their use and their performances are analysed in this paper in order to allow optimal use of these important softwares.

Contribution of alpha interferon (alpha IFN) to HIV-induced immunosuppression

In the present investigation we have shown that PBLs taken from HIV-positive patients suppressed T-cell proliferation when cultured for at least 12 days. When infected In vitro with HIV-1, these cells become suppressive after 6 days. PBLs collected from seronegative individuals turned out to be non-suppressive even after prolonged culturing. However, when infected in vitro with HIV they were found to be cytostatic also after 6 days. This anti-immune activity, related to HIV infection, is mediated, at least in part, by alpha IFN, since about 50% of this HIV associated activity could be quenched by alpha IFN antibodies. We also showed that this T-cell cytostasis is associated with CD8+ cells. In view of a possible use of suppressive cells for T-cell vaccination, we verified that such cellular functions were abolished by aldehyde treatment.

Are CD4 and Fas peptide identities of gp120 relevant to the molecular basis of AIDS pathogenesis?

The release of virions from HIV-1-infected CD4 cells, although occurring readily as a result of immune activation, does not appear to be the only mechanism mediating T-cell loss in AIDS. Three other interacting HIV-1-induced immune disorders in association with viral release (the source of gp120 molecules) may also account for the constitutive T-cell depletion and functional immune suppression: 1. gp120-induced CD4(+) cell anergy, which can be reproduced in cultures of immune activated normal T-cells in the presence of gp120 or gp120 peptide containing the SLWDQ sequence identity to the CD4 molecule; 2. overproduction of IFNalpha and gamma, 3. activation-driven apoptosis of non infected T-cells. Apoptosis of T-cells could also be: 1. induced by effector components - particularly CTL and lymphotoxins produced by helper T-cells of the anti-Fas autoimmune reaction triggered by gp120 epitopes shared with the Fas/APO-1 molecule; 2. enhanced by IFN overproduction. These molecular mechanisms stress the importance in the progression to AIDS of both the viral load and HIV-induced cytokine dysregulation, including overproduction of IFNalpha, which should be considered as targets in the development of strategies for AIDS prophylaxis and immunotherapy.

Syngeneic adoptive transfer of anti-human immunodeficiency virus (HIV-1)-primed lymphocytes from a vaccinated HIV-seronegative individual to his HIV-1-infected identical twin

Immunotherapy by adoptive transfer of lymphocytes was attempted in identical twins, one who was virus-free and the other who was infected with human immunodeficiency virus-1 (HIV-1), at the stage of acquired immunodeficiency syndrome. The noninfected twin was vaccinated by priming with a recombinant vaccinia virus expressing the envelope glycoprotein of one of his brother's viruses and boosting with the same purified gp160 adsorbed on alum. Vaccination elicited major histocompatibility complex class I-restricted CD8+ cytolytic T lymphocytes specific for HIV-1, but no antibody response. The diseased brother, a 38-year-old homosexual who had developed repeated opportunistic infections since 1990 and had a CD4+ count reduced to practically zero, was treated by infusions of lymphocytes collected from the vaccinated brother by lymphopheresis. After a first transfer of the whole lymphocyte population, no changes were observed in the clinical status and biologic or virologic parameters. A second transfer was then applied with activation of the cells with purified envelope glycoprotein before infusion. The outcome of the treatment was an increase in total lymphocytes, in CD4+ and activated CD8+ DR+ cell counts, and in proliferative responses to HIV antigens. A marked but transient 3-log increase in cellular and plasmatic virus loads was also observed after the second adoptive transfer. These observations will be considered with attention to improve the future adoptive transfer protocols, especially in patients with severe CD4+ depletion.

Involvement of alpha-interferon in HIV-1 induced immunosuppression. A potential target for AIDS prophylaxis and treatment

Since the immune system is impaired in the course of HIV-infection, the purpose of any AIDS vaccine therapy should be the restoration in the patient of an adequate immunocompetence to enable him to respond to the antigenic stimulus represented by the virus. In the present investigation we have shown the antiproliferative action on activated T-cells in culture of: sera taken from HIV-infected, but not seronegative individuals; T lymphocytes taken from seronegative subjects and infected in vitro with HIV but not non infected cells; native alpha-IFN and the time-dependent inactivation of this activity by formaldehyde treatment of alpha-IFN. Thus is confirmed the major contribution provided by alpha-IFN to the immunosuppression occurring in the course of HIV-infection. These results also strongly support the new AIDS vaccine therapy strategy based on the administration to HIV-infected patients of inactivated, but still immunogenic alpha-IFN. To the alpha-IFN treatment could also be combined the administration of fixed autologous suppressive cells. The induction of gamma-IFN in addition to alpha-IFN production by stimulation of cells from healthy donors with gp120 should encourage the use of a vaccine combining both inactivated alpha-IFN and gamma-IFN. On the other hand, the IL-12 cytokine with its potential to restore compromised cell-mediated functions associated with HIV infection should also be a valuable adjuvant treatment.

Lovastatin inhibits HIV-1 expression in H9 human T lymphocytes cultured in cholesterol-poor medium

The effects of the HMG-Coenzyme A reductase inhibitor lovastatin on HIV-1 expression and sterol synthesis have been investigated in the human H9 lymphocytic cell line. To this purpose, sterol synthesis from 14C-acetate, cell multiplication and reverse transcriptase activity have been measured in parallel at various times after cell infection by HIV-1. It was found that nine days after viral loading, lovastatin inhibited both sterol synthesis and viral multiplication as assessed by the reverse transcriptase activity. Since HIV infection has been shown to induce alterations in membrane cholesterol content, suggesting that the virus cycle may be partially dependent upon cellular cholesterol, inhibitors of cholesterol synthesis could be an interesting way of research in order to slower HIV propagation.

Pathogenic disorders involved in immunosuppression and T cell depletion characterizing AIDS

Four cardinal immune disorders interacting with each other may promote the progressive T cell depletion and immunosuppression characterizing AIDS. Immune activation of HIV-1 infected T4 cells leads to virus release and premature cell death. Both virus release with its resulting viral load and dead cells are the source of gp120 stimulus. Anergy of non-infected CD4 cells, resulting in cytokine dysregulation may be promoted by impairing the CD4-MHC interaction during CD4 cell activation either directly through the SLWDQ pentapeptide identity with the CD4 molecule and the CD4 binding region or through a gp120-induced autoimmune reaction to CD4. Overproduction of IFN alpha, the known antiproliferative and cytolytic cytokine may promote in a paracrine manner to neighbouring cells the immunosuppression generated by the lack of IL2 secretion following CD4 cell anergy. Apoptosis of activated non infected T cells could be induced by effector components of the autoimmune reaction (CTL, Lymphotoxins or Abs?) directed towards the 2 consensus gp120 sequence identity/similarity (INCTR and FYCNST) shared with the APO/Fas molecule. These two sequences are known as immunodominant sites of the gp120. Furthermore, IFN alpha overproduction may also render circulating memory T cells competent to apoptosis by upregulating the cascade of metabolic events leading to programmed cell death.

Identification of CD4 and major histocompatibility complex functional peptide sites and their homology with oligopeptides from human immunodeficiency virus type 1 glycoprotein gp120: role in AIDS pathogenesis

CD4 molecules interact with class II major histocompatibility complex molecules as a critical costimulatory signal in CD4+ cell immune activation. CD4 also recognizes a specific region of the human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein gp120 forming a binding site for early stages of HIV-1 infection. We designed two software packages, AUTOMAT and CRITIC, which allowed us to identify similarities between regions of HIV-1 proteins and immunoregulatory protein sequences stored in data banks. In this report we have characterized (i) a pentapeptide, SLWDQ, found in both CD4 and HIV-1 gp120, which surprisingly had remained undetected in these two well-studied molecules until now, and (ii) an HLA sequence corresponding to the putative functional site of H2 I-A. We found that a region of gp120 (residues 254-263) known to be similar to a sequence in HLA class II beta chain overlaps this functional region. We showed experimentally that these two CD4 and HLA peptide segments inhibit CD4+ cell immune activation. There is strong inhibition (50% up to 80%) of immune activation by SLWDQ-containing gp120 segments and a lesser inhibition by the gp120 HLA-homologous segment. In addition, we found that SLWDQ induced in HIV-1-infected individuals a humoral (antibody) and cellular (cytotoxic T lymphocyte) immune reaction. We propose that these HIV-1 gp120 segments, together with the known CD4-binding region, may contribute to the HIV-1-induced immunosuppression by two mechanisms affecting CD4-HLA interaction during T-cell immune activation: autoimmune reaction toward CD4 and direct interference with the CD4-HLA costimulatory signal inducing CD4+ cell anergy with, as a consequence, generation of immunosuppression.

Striking similarities between HIV-1 Env protein and the apoptosis mediating cell surface antigen Fas. Role in the pathogenesis of AIDS

We have designed a computer strategy in order to detect systematically peptidic sites with the potential of interfering with the immune regulatory processes. Applying this software to HIV-1 proteins has led us to unravel a few peptidic sites which could either act directly or be the targets of an auto-immune reaction during HIV-1 infection. We previously reported that the SLWDQ pentapeptide identity with a critical site of CD4 could trigger in HIV-1 infected individuals both an humoral and a cellular autoimmune reaction. In this study, we focused on surprising similitudes unravelled by our software Automat, between HIV-1/2 and another immunoregulatory molecule, the Fas protein which is also called the apoptosis-mediating cell-surface antigen.

HIV-1-induced immune suppression may result from autoimmune disorders including anti-SLWDQ autoantibodies

We have previously unravelled the striking SLWDQ pentapeptide identity between HIV-1 env gp120 and the CD4 molecule. We show here that this pentapeptide is required for the functioning of the co-stimulatory MHC-CD4 signal in T4-cell activation since it suppresses antigen-induced T-cell proliferation. Moreover, concerning the MHC class II counterpart, the LNGQEETGVVSTN sequence which strongly inhibits T-cell immune activation is likely to be part of the functional site of the molecule. Interestingly the MHC/gp120 homology described by Young overlaps this MHC region. We further report that the gp120 SLWDQ peptide triggers an immune reaction which is both humoral (anti-SLWDQ antibodies) and cellular (CTLs against autologous targets carrying the pentapeptide) in HIV-1 infected individuals. Finally, anti-SLWDQ antibodies from patients sera purified by column chromatography strongly inhibit antigen-induced immune T-cell activation. This result led us to postulate that these antibodies found in high titers in HIV-1 infected individuals could contribute to set up the progressive systemic immune T-cell suppression characterizing AIDS.