Therapeutic administration of a cross-reactive mAb targeting the fusion glycoprotein of Nipah virus protects nonhuman primates

No licensed vaccines or therapies exist for patients infected with Nipah virus (NiV), although an experimental human monoclonal antibody (mAb) cross-reactive to the NiV and Hendra virus (HeV) G glycoprotein, m102.4, has been tested in a phase 1 trial and has been provided under compassionate use for both HeV and NiV exposures. NiV is a highly pathogenic zoonotic paramyxovirus causing regular outbreaks in humans and animals in South and Southeast Asia. The mortality rate of NiV infection in humans ranges from 40% to more than 90%, making it a substantial public health concern. The NiV G glycoprotein mediates host cell attachment, and the F glycoprotein facilitates membrane fusion and infection. We hypothesized that a mAb against the prefusion conformation of the F glycoprotein may confer better protection than m102.4. To test this, two potent neutralizing mAbs against NiV F protein, hu1F5 and hu12B2, were compared in a hamster model. Hu1F5 provided superior protection to hu12B2 and was selected for comparison with m102.4 for the ability to protect African green monkeys (AGMs) from a stringent NiV challenge. AGMs were exposed intranasally to the Bangladesh strain of NiV and treated 5 days after exposure with either mAb (25 milligrams per kilogram). Whereas only one of six AGMs treated with m102.4 survived until the study end point, all six AGMs treated with hu1F5 were protected. Furthermore, a reduced 10 milligrams per kilogram dose of hu1F5 also provided complete protection against NiV challenge, supporting the upcoming clinical advancement of this mAb for postexposure prophylaxis and therapy.

Hyperdiluted Botulinum Toxin and Intense Pulsed Light Treatment: A Case Series to Illustrate a Novel Protocol for Hypertrophic Scar Reduction

Hypertrophic scars can have significant and far-reaching effects on patients that range from itching to creating difficulty with mobility, all of which can negatively impact the individual's quality of life. A recent study showed that many patients with recent scars report pain, burning, pruritus, erythema, in combination with psychological difficulties that impact bodily movement, choice of clothing, and participation in leisure activities. Botulinum toxin Type A (BoNTA) and intense pulsed light (IPL) have shown promise in treating such scars. We propose a novel treatment protocol involving a 4-week intervention with hyperdiluted BoNTA injections and supplemental treatment with IPL for erythema, and a 6-month scar scale assessment and photographic documentation that occurs before and 6 months after treatment. We report four cases where using hyperdiluted BoNTA, either alone or in conjunction with IPL, substantially reduced scar size, improved overall scar appearance, and diminished erythema in areas on the face and the breasts. Although this report suggests that a schedule of alternating treatments with BoNTA and IPL may be beneficial in reducing scar size and enhancing appearance, further research is necessary to better understand the most effective dosages, the relationship between BoNTA and IPL, and the optimal management of scarring.

Production and Purification of Antibodies in Chinese Hamster Ovary Cells

Antibodies are versatile biological molecules with widespread applications in research and medicine. This protocol outlines the generation of monoclonal IgG antibodies from Chinese hamster ovary cells. It includes steps for cell maintenance, transient transfection, and antibody purification via protein A affinity chromatography. The methods described are intended for the production of milligram amounts of protein but can be adapted for most small- to mid-scale applications.

Long-term Prophylaxis Against Aerosolized Marburg Virus in Nonhuman Primates With an Afucosylated Monoclonal Antibody

Marburg virus (MARV) causes a hemorrhagic fever disease in human and nonhuman primates with high levels of morbidity and mortality. Concerns about weaponization of aerosolized MARV have spurred the development of nonhuman primate (NHP) models of aerosol exposure. To address the potential threat of aerosol exposure, a monoclonal antibody that binds MARV glycoprotein was tested, MR186YTE, for its efficacy as a prophylactic. MR186YTE was administered intramuscularly to NHPs at 15 or 5 mg/kg 1 month prior to MARV aerosol challenge. Seventy-five percent (3/4) of the 15 mg/kg dose group and 50% (2/4) of the 5 mg/kg dose group survived. Serum analyses showed that the NHP dosed with 15 mg/kg that succumbed to infection developed an antidrug antibody response and therefore had no detectable MR186YTE at the time of challenge. These results suggest that intramuscular dosing of mAbs may be a clinically useful prophylaxis for MARV aerosol exposure.

P3826Gene therapy for cardiac conduction system dysfunction in heart failure

Background and purpose

Heart failure (HF) is characterised by generalised dysfunction of the cardiac conduction system (CCS). Ion channel and structural remodelling in the CCS have been widely demonstrated in animal models of cardiovascular disease. As Purkinje fibres (PFs) are minute strands of tissue, little is known about their ultrastructure and remodelling in disease. Furthermore, given the role for microRNAs (miRs) in CCS molecular remodelling, we aimed to develop a tissue specific method for delivering therapeutic transgenes, such as miR sponges.

Methods

New Zealand rabbits were used for PF ultrastructural studies. HF was induced via pressure and volume overload. Free running PFs were processed for serial block face scanning electron microscopy (SBF-SEM). Manual contrast-based segmentation techniques were used on IMOD software to determine the 3D cellular ultrastructure. To target transgene expression to the CCS, adenoviral plasmids were cloned expressing a GFP reporter gene. GFP transcription was placed under control of the KCNE1 promoter, a K+ channel subunit expressed throughout the CCS, or the HCN4 promoter, a key pacemaker ion channel, to target the sinus node. The strong ubiquitous cytomegalovirus (CMV) promoter was used as a positive control. Adenovirus was produced using via transfection into the 293A cell line for viral packaging and amplification.

Results

Purkinje cells (PCs) formed a central core within PFs, encapsulated by an extensive collagen matrix. PCs were uninucleated and spindle shaped with an irregular membrane. Gap junctions were abundant and distributed along the lateral surface of cells, and there was a trend towards decreased expression in HF (p=0.0526, n=3 cells analysed per group). Hypertrophy and nuclear membrane breakdown were evident in HF PCs, the latter facilitating mitochondrial entry.

Using the CMV-GFP adenoviral construct, abundant GFP expression was conferred in ex vivo sinus node tissue, isolated sinus node myocytes, and neonatal ventricular rat cardiomyocytes (NRCMs). The KCNE1 promoter conferred relatively high GFP expression in NRCMs, greater than that from the HCN4 promoter. In isolated sinus node myocytes, the HCN4 promoter conferred greater transgene expression than in NRCMs. In ex vivo sinus node tissue, only the CMV construct was capable of driving significant GFP expression. Notably, expression was largely confined to the sinus node, with only sparse expression detected in the surrounding atrial muscle.

Conclusions

SBF-SEM revealed ultrastructure of free running PFs in situ, and uncovered novel structural changes in HF that are likely to be pro-arrhythmic. Preliminary data suggest that 1.2 kb and 0.8 kb fragments of the HCN4 promoter are capable of driving sinus node specific transgene expression. Further tests are warranted to confirm the utility of these promoters to express therapeutic transgenes, such as miR sponges to competitively inhibit miR activity in vitro and in vivo.

Acknowledgement/Funding

The British Heart Foundation

Cutaneous myoepithelial carcinoma with disseminated metastases

Primary cutaneous neoplasms of myoepithelial differentiation are uncommon. Cutaneous myoepithelial carcinomas are rare. We report a case of cutaneous myoepithelial carcinoma in a 47-year-old man with a history of end-stage renal disease and renal transplant 19 years prior who presented to the hospital with a 3-month history of diffuse bone pain and an ulcerated scalp mass with multiple satellite lesions. This case illustrates a rare instance of metastatic disease from primary cutaneous myoepithelial carcinoma.

Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications

BACKGROUND

Histopathologic analysis remains the gold standard for the diagnosis of melanoma, however previous studies have shown a substantial rate of interobserver variability in the evaluation of melanocytic lesions.

OBJECTIVE

We sought to evaluate discordance in the histopathological diagnosis and microstaging parameters of melanoma and subsequent impact on clinical management.

METHODS

This was a retrospective review of 588 cases of cutaneous melanoma and melanoma in situ from January 2009 to December 2014 that were referred to Emory University Hospital, Atlanta, GA, for treatment. Per institutional policy, all outside melanoma biopsy specimens were reviewed internally. Outside and institutional reports were compared.

RESULTS

Disagreement between outside and internal reports resulted in a change in American Joint Committee on Cancer pathologic stage in 114/588 (19%) cases, resulting in a change in management based on National Comprehensive Cancer Network guidelines in 105/588 (18%) cases.

LIMITATIONS

Given the retrospective nature of data collection and the bias of a tertiary care referral center, cases in this study may not be representative of all melanoma diagnoses.

CONCLUSION

These findings confirm consistent subjectivity in the histopathologic interpretation of melanoma. This study emphasizes that a review of the primary biopsy specimen may lead to significant changes in tumor classification, resulting in meaningful changes in clinical management.

Effects of angiotensin (1-7) upon right ventricular function in experimental rat pulmonary embolism

Right ventricular (RV) dysfunction contributes to poor clinical prognosis after pulmonary embolism (PE). The present studies evaluate the effects of angiotensin (1-7) (ANG (1-7)) upon RV function during experimental PE in rats. Circulating ANG II increased 8-fold 6 hr after PE (47±13 PE vs. 6±3 pg/mL, control, p<0.05). ACE2 protein was uniformly localized in the RV myocardium of control rats, but showed a patchy distribution with some cells devoid of stain after 6 or 18 hr of PE. RV function decreased 18 hr after PE compared with control treated animals (19±4 vs. 41±1 mmHg, respectively, p<0.05; 669±98 vs. 1354±77 mmHg/sec, respectively, p<0.05), while left ventricular function (LV) was not significantly changed. Animals treated with ANG (1-7) during PE showed improved RV +dP/dt and peak systolic pressure development to values not significantly different from control animals. Protection of RV function by ANG (1-7) was associated with improved arterial blood sO2, base excess and pH. Supplemental delivery of ANG (1-7) reduced the development of RV dysfunction, suggesting a novel approach to protecting RV function in the setting of acute experimental PE.

Foot care education in patients with diabetes at low risk of complications: a consensus statement

AIMS

To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications.

METHODS

A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts' clinical experience and judgement.

RESULTS

Four main health behaviours were identified for those at low risk of developing foot complications, namely: control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine.

CONCLUSION

There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications.

iRaster: a novel information visualization tool to explore spatiotemporal patterns in multiple spike trains

Over the last few years, simultaneous recordings of multiple spike trains have become widely used by neuroscientists. Therefore, it is important to develop new tools for analysing multiple spike trains in order to gain new insight into the function of neural systems. This paper describes how techniques from the field of visual analytics can be used to reveal specific patterns of neural activity. An interactive raster plot called iRaster has been developed. This software incorporates a selection of statistical procedures for visualization and flexible manipulations with multiple spike trains. For example, there are several procedures for the re-ordering of spike trains which can be used to unmask activity propagation, spiking synchronization, and many other important features of multiple spike train activity. Additionally, iRaster includes a rate representation of neural activity, a combined representation of rate and spikes, spike train removal and time interval removal. Furthermore, it provides multiple coordinated views, time and spike train zooming windows, a fisheye lens distortion, and dissemination facilities. iRaster is a user friendly, interactive, flexible tool which supports a broad range of visual representations. This tool has been successfully used to analyse both synthetic and experimentally recorded datasets. In this paper, the main features of iRaster are described and its performance and effectiveness are demonstrated using various types of data including experimental multi-electrode array recordings from the ganglion cell layer in mouse retina. iRaster is part of an ongoing research project called VISA (Visualization of Inter-Spike Associations) at the Visualization Lab in the University of Plymouth. The overall aim of the VISA project is to provide neuroscientists with the ability to freely explore and analyse their data. The software is freely available from the Visualization Lab website (see www.plymouth.ac.uk/infovis).

Inter-individual variability of plasma PAF-acetylhydrolase activity in ARDS patients and PAFAH genotype

BACKGROUND

Platelet activating factor (PAF), a pro-inflammatory phospholipid, stimulates cytokine secretion from polymorphonuclear leukocytes expressing the transmembrane G-protein coupled PAF receptor. Elevated PAF levels are associated with acute respiratory distress syndrome (ARDS) and sepsis severity. The pro-inflammatory effects of PAF are terminated by PAF acetylhydrolase (PAF-AH).

OBJECTIVE

We sought to determine whether allelic variants in the human PAFAH gene (Arg92His, Ile198Thr, and Ala379Val) contribute to variability in PAF-AH activity in patient plasma obtained within 72 h of ARDS diagnosis.

RESULTS

Plasma PAF-AH activity (mean +/- SD) was higher in patients homozygous for the Arg92 allele compared to His92 allele carriers (2.21 +/- 0.77 vs. 1.64 +/- 0.68 U/min; P < 0.01; n = 31 and 21 respectively). Baseline plasma PAF-AH activity was higher among day 7 survivors vs. day 7 non-survivors (2.05 +/- 0.75 vs. 1.27 +/- 0.63, P = 0.05).

CONCLUSION

These data demonstrate an association between PAF-AH allelic variation, plasma activity, and outcome in ARDS.

Interclinician variation in diabetes foot assessment--a national lottery?

AIM

The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.

METHODS

Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.

RESULTS

There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.

CONCLUSIONS

As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial assessment. We therefore recommend that more attention is placed on training for objective clinical testing, at both pre- and postgraduate levels.

The correlation grid: analysis of synchronous spiking in multi-dimensional spike train data and identification of feasible connection architectures

This paper presents a visualization technique specifically designed to support the analysis of synchronous firings in multiple, simultaneously recorded, spike trains. This technique, called the correlation grid, enables investigators to identify groups of spike trains, where each pair of spike trains has a high probability of generating spikes approximately simultaneously or within a constant time shift. Moreover, the correlation grid was developed to help solve the following reverse problem: identification of the connection architecture between spike train generating units, which may produce a spike train dataset similar to the one under analysis. To demonstrate the efficacy of this approach, results are presented from a study of three simulated, noisy, spike train datasets. The parameters of the simulated neurons were chosen to reflect the typical characteristics of cortical pyramidal neurons. The schemes of neuronal connections were not known to the analysts. Nevertheless, the correlation grid enabled the analysts to find the correct connection architecture for each of these three data sets.

Visualisation of synchronous firing in multi-dimensional spike trains

The gravity transform algorithm is used to study the dependencies in firing of multi-dimensional spike trains. The pros and cons of this algorithm are discussed and the necessity for improved representation of output data is demonstrated. Parallel coordinates are introduced to visualise the results of the gravity transform and principal component analysis (PCA) is used to reduce the quantity of data represented whilst minimising loss of information.

Nonphlogistic clearance of late apoptotic neutrophils by macrophages: efficient phagocytosis independent of beta 2 integrins

Neutrophils undergo constitutive death by apoptosis, leading to safe nonphlogistic phagocytosis and clearance by macrophages. Recent work has shown that before secondary necrosis, neutrophils exhibiting classical features of apoptosis can progress to a morphologically defined late apoptotic state. However, whether such neutrophils could be safely cleared was unknown. We now report that human late apoptotic neutrophils could be purified from cultured neutrophil populations undergoing constitutive death and were subsequently ingested by human monocyte-derived macrophages by serum-independent mechanisms that did not trigger the release of IL-8 or TNF-alpha. Such ingestion was specifically inhibited by Abs to thrombospondin-1 and the alpha(v)beta(3) vitronectin receptor. Murine bone marrow-derived macrophage phagocytosis of late and early apoptotic neutrophils occurred by similar mechanisms, proceeding with the same efficiency as that observed for wild-type controls when macrophages from [alpha(m)](-/-) or [beta(2)](-/-) mice were used. We conclude that specific nonphlogistic, beta(2) integrin-independent mechanisms involving thrombospondin-1 and alpha(v)beta(3) allow macrophages to ingest late apoptotic neutrophils without eliciting inflammatory cytokine secretion.

Role for cysteine residues in the in vivo folding and assembly of the phage P22 tailspike

The predominantly beta-sheet phage P22 tailspike adhesin contains eight reduced cysteines per 666 residue chain, which are buried and unreactive in the native trimer. In the pathway to the native trimer, both in vivo and in vitro transient interchain disulfide bonds are formed and reduced. This occurs in the protrimer, an intermediate in the formation of the interdigitated beta-sheets of the trimeric tailspike. Each of the eight cysteines was replaced with serine by site-specific mutagenesis of the cloned P22 tailspike gene and the mutant genes expressed in Escherichia coli. Although the yields of native-like Cys>Ser proteins varied, sufficient soluble trimeric forms of each of the eight mutants accumulated to permit purification. All eight single Cys>Ser mature proteins maintained the high thermostability of the wild type, as well as the wild-type biological activity in forming infectious virions. Thus, these cysteine thiols are not required for the stability or activity of the native state. When their in vivo folding and assembly kinetics were examined, six of the mutant substitutions--C267S, C287S, C458S, C613S, and C635S--were significantly impaired at higher temperatures. Four--C290S, C496, C613S, and C635--showed significantly impaired kinetics even at lower temperatures. The in vivo folding of the C613S/C635S double mutant was severely defective independent of temperature. Since the trimeric states of the single Cys>Ser substituted chains were as stable and active as wild type, the impairment of tailspike maturation presumably reflects problems in the in vivo folding or assembly pathways. The formation or reduction of the transient interchain disulfide bonds in the protrimer may be the locus of these kinetic functions.

Tornado disaster in rural Georgia: triage response, injury patterns, lessons learned

Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military helicopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris.

Diminished epidermal growth factor levels in infants with necrotizing enterocolitis

BACKGROUND/PURPOSE

Because epidermal growth factor (EGF) is trophic to the intestinal mucosa, and neonatal necrotizing enterocolitis (NEC) is associated with a disrupted intestinal mucosal barrier, the authors sought to determine whether diminished levels of EGF were present in infants with NEC.

METHODS

Saliva, serum, and urine specimens were obtained from infants with NEC during a 3-year period (February 1995 to May 1998). Control patients without NEC were chosen based on similar postnatal age and birthweight. EGF levels were determined by enzyme-linked immunosorbent assay (ELISA). Differences between groups were compared using Mann-Whitney Rank sum test with P less than .05 considered significant. Results are presented as mean values +/-SEM.

RESULTS

Twenty-five infants with NEC were compared with 19 control patients. Birth weight (1,616+/-238 g control v. 1,271+/-124 g NEC) and postnatal age (23+/-6 days control v. 22+/-3 days NEC) were similar. Infants with NEC had significantly lower levels of EGF in both saliva (590+/-80 pg/mL control v. 239+/-41 pg/mL NEC; P<.001) and serum (35+/-8 pg/mL control v. 5.6+/-1.9 pg/mL NEC; P<.001). Urinary EGF was also lower in the NEC group, but was not statistically significant.

CONCLUSIONS

Premature infants with NEC have significantly diminished levels of salivary and serum EGF. Reduced levels of this growth factor may distinguish infants at risk for NEC and play a pivotal role in the pathogenesis of the perturbed intestinal mucosal barrier that is central to this condition.

Reversible snaring for proper prosthetic seating during valve replacement

A method of reversible suture snaring is described for evaluating the final valve seating and positioning before knot tying of valve sutures. This allows for alteration of the operative plan before investing substantial ischemic time in a nonfunctional result. The procedure has been used in 577 consecutive prosthetic valve replacements in the past 5 years. The technique maintains proper seating while the valve is permanently anchored in place.

A comparison of qualitative and quantitative research methods used to assess knowledge of foot care among people with diabetes

Many diabetes-related pathologies, especially among neuropathic patients, are potentially avoidable. Prevention, however, requires appropriate knowledge and understanding. To assess our ability to effect change in behaviour we need adequate tools to measure not only knowledge but also understanding and change of behaviour. To assess individuals' knowledge and beliefs towards diabetic footcare, we used both quantitative and qualitative methods: a structured questionnaire composed of 20 questions was completed by the respondent, followed by a semi-structured interview conducted by the chiropodist. Results from the structured questionnaire were inconsistent with those from the interviews (Wilcoxon test, p < 0.008). The former demonstrated an average knowledge score of 45% while performance during the interview generated data which suggested poorer knowledge levels. Respondents who correctly identified a series of statements regarding diabetic footcare within the questionnaire could not then apply this knowledge meaningfully when interviewed. A structured questionnaire may not be the best means of assessing patients' knowledge and understanding. We need not only to improve patient education regarding footcare, but also to improve our means of measuring patient knowledge and understanding, more accurately to assess the success or otherwise of our interventions.

Redox regulation of manganese superoxide dismutase

The importance of reactive oxygen species (ROS) or changes in cellular redox state in signal transduction and gene regulation is becoming increasingly evident. In this study, we tested the hypothesis that ROS are directly involved in the induction of the mitochondrial antioxidant manganese superoxide dismutase (MnSOD) and mediate the induction of MnSOD by tumor necrosis factor-alpha (TNF-alpha). Pretreatment of human pulmonary adenocarcinoma cells H441 with the antioxidants N-acetyl-L-cysteine (NAC) and nordihydroguaiaretic acid (NDGA) blocked MnSOD induction by TNF-alpha, implicating ROS as a signaling agent in this pathway. Treatment of H441 cells with the exogenous oxidants hydrogen peroxide (H2O2) and diamide increased MnSOD mRNA, supporting the hypothesis that ROS directly affect expression of MnSOD. The temporal pattern of MnSOD induction differed for TNF-alpha and H2O2, suggesting distinct signaling pathways. DNA binding of two redox-sensitive transcription factors, NF-kappa B and activator protein (AP)-1, was evaluated. TNF-alpha increased nuclear factor (NF)-kappa B-DNA binding, an effect blocked by pretreatment with NAC. H2O2 did not alter NF-kappa B-DNA binding. There was no evidence of AP-1 binding in cells treated with either TNF-alpha or H2O2. We conclude that ROS directly alter MnSOD expression and are involved in the induction of MnSOD by TNF-alpha.

Antinuclear antibodies using HEp-2 cells in normal children and in children with common infections

Antinuclear antibody (ANA) immunofluorescence tests, using HEp-2 cells, were performed on 100 children without a history of connective tissue disease. Eighteen (18%) were positive at titres greater than or equal to 1:40, nine (9%) being greater than 1:160. Interlaboratory variability was demonstrated with some specimens. No association with possible intercurrent infection was found to account for positive results. Of 44 children with proven infections five (11%) were positive. Antinuclear antibody may be found in some normal children when using the sensitive HEp-2 cell substrate, and in the absence of clinical features should not necessarily suggest the presence of a connective tissue disease.

Transplantation in miniature swine. I. Fixation of the major histocompatibility complex

Three strains of miniature swine, each homozygous for a different allele of the major histocompatibility locus (MHC), have been developed by a selective breeding scheme based on tissue typing of the offspring of each generation. Prior to breeding, the original parents were reciprocally immunized by skin grafts and lymphocyte injections to produce lymphocytotoxic antisera. These antisera were then used to assess the MHC genotype of the offspring by an analysis based on selective absorption of cytotoxicity. Offspring inheriting the same serologically determined genotype were then bred sequentially. Subsequent mixed lymphocyte cultures showed a pattern of reactivity consistent with the serological genotyping, further confirming the homology between the MHC of these miniature swine and those of man and mouse. In addition to their usefulness as a model for large animal surgical transplantation, these animals provide an abundant homozygous source of histocompatibility antigens and of antihistocompatibility antisera for use in chemical characterization of products of the MHC.