An analysis of the association between prostate cancer risk loci, PSA levels, disease aggressiveness and disease-specific mortality

BACKGROUND

Genome-wide association studies have identified multiple single-nucleotide polymorphsims (SNPs) associated with prostate cancer (PCa). Although these SNPs have been clearly associated with disease risk, their relationship with clinical outcomes is less clear. Our aim was to assess the frequency of known PCa susceptibility alleles within a single institution ascertainment and to correlate risk alleles with disease-specific outcomes.

METHODS

We genotyped 1354 individuals treated for localised PCa between June 1988 and December 2007. Blood samples were prospectively collected and de-identified before being genotyped and matched to phenotypic data. We investigated associations between 61 SNPs and disease-specific end points using multivariable analysis and also determined if SNPs were associated with PSA at diagnosis.

RESULTS

Seven SNPs showed associations on multivariable analysis (P<0.05), rs13385191 with both biochemical recurrence (BR) and castrate metastasis (CM), rs339331 (BR), rs1894292, rs17178655 and rs11067228 (CM), and rs11902236 and rs4857841 PCa-specific mortality. After applying a Bonferroni correction for number of SNPs (P<0.0008), the only persistent significant association was between rs17632542 (KLK3) and PSA levels at diagnosis (P=1.4 × 10(-5)).

CONCLUSIONS

We confirmed that rs17632542 in KLK3 is associated with PSA at diagnosis. No significant association was seen between loci and disease-specific end points when accounting for multiple testing. This provides further evidence that known PCa risk SNPs do not predict likelihood of disease progression.

Genetic architecture of prostate cancer in the Ashkenazi Jewish population

Background:

Recently, numerous prostate cancer risk loci have been identified, some of which show association in specific populations. No study has yet investigated whether these single nucleotide polymorphisms (SNPs) are associated with prostate cancer in the Ashkenazi Jewish (AJ) population.

Methods:

A total of 29 known prostate cancer risk SNPs were genotyped in 963 prostate cancer cases and 613 controls of AJ ancestry. These data were combined with data from 1241 additional Ashkenazi controls and tested for association with prostate cancer. Correction for multiple testing was performed using the false discovery rate procedure.

Results:

Ten of twenty-three SNPs that passed quality control procedures were associated with prostate cancer risk at a false discovery rate of 5%. Of these, nine were originally discovered in studies of individuals of European ancestry. Based on power calculations, the number of significant associations observed is not surprising.

Conclusion:

We see no convincing evidence that the genetic architecture of prostate cancer in the AJ population is substantively different from that observed in other populations of European ancestry.

Treatment of poxvirus infections in rabbits with 9-beta-D-arabinofuranosyladenine

The antiviral efficacy of 9-beta-d-arabinofuranosyladenine (ara-A) was evaluated in localized lesions produced by the intradermal inoculation of rabbits with vaccinia virus (VV) and rabbit Shope fibroma virus (SFV). Ara-A administered intraperitoneally suppressed or significantly reduced the cutaneous pustular lesions produced by VV as well as the benign skin tumors caused by the SFV. With a daily dose of 300 mg/kg given for 5 days starting at the time of infection, or with 600 mg/kg daily starting 3 days after inoculation, we were able to suppress completely the formation of tumors induced by the SFV. The appearance of pustular lesions induced by VV was completely suppressed by a dose of 600 mg of ara-A per kg given for 3 days when the treatment was initiated at the time of infection, but a significant reduction in the number of pustular lesions was obtained with a single dose of 600 mg/kg, or with five doses of 300 mg/kg starting 24 h after inoculation. No toxic effect of ara-A was noted in the treated rabbits.

Health status indicators: definitions and national data

In July 1991 the Centers for Disease Control (CDC) released a set of 18 health status indicators and encouraged their use by federal, State, and local health agencies. The indicators were developed in response to Objective 22.1 of Healthy People 2000 through a consensus process described in a previous Statistical Notes. This article recommends detailed definitions, suggests national data sources, and provides national baseline data for each indicator.

Computational identification of noncoding RNAs in E. coli by comparative genomics

Some genes produce noncoding transcripts that function directly as structural, regulatory, or even catalytic RNAs [1, 2]. Unlike protein-coding genes, which can be detected as open reading frames with distinctive statistical biases, noncoding RNA (ncRNA) gene sequences have no obvious inherent statistical biases [3]. Thus, genome sequence analyses reveal novel protein-coding genes, but any novel ncRNA genes remain invisible. Here, we describe a computational comparative genomic screen for ncRNA genes. The key idea is to distinguish conserved RNA secondary structures from a background of other conserved sequences using probabilistic models of expected mutational patterns in pairwise sequence alignments. We report the first whole-genome screen for ncRNA genes done with this method, in which we applied it to the "intergenic" spacers of Escherichia coli using comparative sequence data from four related bacteria. Starting from >23,000 conserved interspecies pairwise alignments, the screen predicted 275 candidate structural RNA loci. A sample of 49 candidate loci was assayed experimentally. At least 11 loci expressed small, apparently noncoding RNA transcripts of unknown function. Our computational approach may be used to discover structural ncRNA genes in any genome for which appropriate comparative genome sequence data are available.

Locoregional cancer treatment with magnetic drug targeting

The specific delivery of chemotherapeutic agents to their desired targets with a minimum of systemic side effects is an important, ongoing challenge of chemotherapy. One approach, developed in the past to address this problem, is the i.v. injection of magnetic particles [ferrofluids (FFs)] bound to anticancer agents that are then concentrated in the desired area (e.g., the tumor) by an external magnetic field. In the present study, we treated squamous cell carcinoma in rabbits with FFs bound to mitoxantrone (FF-MTX) that was concentrated with a magnetic field. Experimental VX-2 squamous cell carcinoma was implanted in the median portion of the hind limb of New Zealand White rabbits (n = 26). When the tumor had reached a volume of approximately 3500 mm3, FF-MTX was injected intraarterially (i.a.; femoral artery) or i.v. (ear vein), whereas an external magnetic field was focused on the tumor. FF-MTX i.a. application with the external magnetic field resulted in a significant (P < 0.05), complete, and permanent remission of the squamous cell carcinoma compared with the control group (no treatment) and the i.v. FF-MTX group, with no signs of toxicity. The intratumoral accumulation of FFs was visualized both histologically and by magnetic resonance imaging. Thus, our data show that i.a. application of FF-MTX is successful in treating experimental squamous cell carcinoma. This "magnetic drug targeting" offers a unique opportunity to treat malignant tumors locoregionally without systemic toxicity. Furthermore, it may be possible to use these magnetic particles as a "carrier system" for a variety of anticancer agents, e.g., radionuclides, cancer-specific antibodies, and genes.

Toward a resolution of the introns early/late debate: only phase zero introns are correlated with the structure of ancient proteins

We present evidence that a well defined subset of intron positions shows a non-random distribution in ancient genes. We analyze a database of ancient conserved regions drawn from GenBank 101 to retest two predictions of the theory that the first genes were constructed by exon shuffling. These predictions are that there should be an excess of symmetric exons (and sets of exons) flanked by introns of the same phase (positions within the codon) and that intron positions in ancient proteins should correlate with the boundaries of compact protein modules. Both these predictions are supported by the data, with considerable statistical force (P values < 0.0001). Intron positions correlate to modules of diameters around 21, 27, and 33 A, and this correlation is due to phase zero introns. We suggest that 30-40% of present day intron positions in ancient genes correspond to phase zero introns originally present in the progenote, while almost all of the remaining intron positions correspond to introns added, or moved, appearing equally in all three intron phases. This proposal provides a resolution for many of the arguments of the introns-early/introns-late debate.

Photorefractive Keratectomy for Hyperopic and Mixed Astigmatism

BACKGROUND

The correction of astigmatism with photorefractive keratectomy has been recommended in simple and myopic astigmatism. Therefore in this study the excimer laser was used to correct compound hyperopic and mixed astigmatism.

METHODS

We present a prospective clinical study of photorefractive keratectomy in 30 eyes of 24 patients with compound hyperopic astigmatism with a mean spherical equivalent of +4.30 D and mean astigmatism of 2.33 D (group I) and in 17 eyes of 15 patients with mixed astigmatism with a mean spherical equivalent refraction of +0.46 D and mean astigmatism of 4.75 D (group II). The excimer laser used in this study was an MEL 60 (Aesculap-Meditec). In both groups an 18-month follow-up study was performed.

RESULTS

In the compound hyperopic astigmatism group after 18 months, 14 of 17 treated eyes (82.3%) were within +/-1.00 D, and 11 (64.7%) were within 60.50 D of the intended correction. In the mixed astigmatism group after 18 months, 10 of 11 eyes (90.9%) were within +/-1.00 D, 8 eyes (72.7%) were within +/-0.50 D of the intended correction. In regard to the stability the 1 year regression of spherical equivalent in the compound hyperopic astigmatism group is 0.78 D and in the mixed astigmatism group 0.37 D. At 18 months, spectacle corrected visual acuity in the compound hyperopic astigmatism group was unchanged or improved in 14 eyes (87.5%); 2 eyes (12.5%) had lost one line. In the mixed astigmatism group at 18 months, spectacle corrected visual acuity was unchanged or improved in 9 eyes (81.8 %); 2 eyes (18.1%) lost one line. Preoperatively, the mean uncorrected visual acuity was 20/100 in the compound hyperopic astigmatism group and the mixed astigmatism group. At 18 months, 14 eyes (93.3%) in the compound hyperopic astigmatism group had an uncorrected visual acuity of 20/40 or better; 4 (26.6%) eyes had an uncorrected visual acuity of 20/20 or better. In the mixed astigmatism group, 9 (81.8%) eyes had an uncorrected visual acuity of 20/40 or better; 4 (36.3%) eyes had an uncorrected visual acuity of 20/20 or better.

CONCLUSION

Photorefractive keratectomy is an efficient and relatively safe procedure for reducing or eliminating compound hyperopic and mixed astigmatism up to 6.00 D.

Native herpes simplex virus glycoprotein D vaccine: immunogenicity and protection in animal models

Mice, guinea pigs, and rhesus monkeys were immunized with immunoaffinity-purified native glycoprotein D (gD) derived from herpes simplex virus type 1 (HSV1). The native glycoprotein has evoked significant in vivo responses even at low doses. Thus, mice immunized with doses as low as 1 microgram were significantly protected from the morbidity and mortality of lethal HSV2 challenge and from establishment of latent HSV2 infection. Protection was dose-related and correlated with prechallenge serum neutralizing antibody titres to HSV. Similarly, immunized guinea-pigs demonstrated significant reductions in the frequency, severity and duration of genital lesions induced by HSV2 vaginal challenge. In long term immunogenicity studies, immunized rhesus monkeys exhibited significant serum neutralizing antibody responses to both HSV1 and HSV2. In vitro stimulation of monkey peripheral blood leucocytes with purified gD resulted in a significant cellular proliferative response. The results obtained in these animal models with a gD subunit vaccine provide an appropriate foundation for the initiation of human studies.

Effect of a thymidine kinase inhibitor (L-653,180) on antiviral treatment of experimental herpes simplex virus infection in mice

Thymidine kinase (TK) inhibitors can block the activity of TK-dependent antiviral drugs in vitro. We have examined the ability of the TK inhibitor (+/-)-9-([(Z)-2-(hydroxymethyl)cyclohexyl] methyl)guanine (L-653,180) to prevent the therapeutic effect of acyclovir (ACV) in experimental herpes simplex virus type 1 (HSV) skin infections of mice. The results showed that ACV given in the drinking water prevents, in a dose-dependent way, the evolution of the viral infection, and that L-653,180 can reverse some of the therapeutic effects of the antiviral drug. Among the parameters used to evaluate the effect of the TK inhibitor mortality was increased compared to ACV treatment alone, only in the presence of low doses of ACV, whereas the establishment of latent infections in sensory ganglia was significantly increased compared to ACV treatment alone, even when high doses of ACV were administered together with L-653,180.

Reinfections and site-specific immunity in herpes simplex virus infections

Studies with human volunteers and patients suffering from recurrent herpes simplex virus (HSV) infections have shown that reinfections with autologous or heterologous strains, occurring at sites distant from those of the recurrences, are possible in a variable proportion of the subjects. Experiments in animals have shown that mice surviving a primary HSV infection in the lumbo-sacral area, can become latently infected in trigeminal ganglia upon reinfection of the orofacial site. Similar results were obtained after vaccination of mice with a thymidine-kinase negative, non-pathogenic HSV-1 mutant. It was also demonstrated that initial HSV-1 eye infection in rabbits prevents superinfection of trigeminal ganglia by other strains.

Intravenous acyclovir therapy of first episodes of genital herpes: a multicenter double-blind, placebo-controlled trial

PURPOSE

A collaborative multicenter double-blind, placebo-controlled trial of intravenous acyclovir treatment of first-episode genital herpes was performed in order to substantiate previous findings on the efficacy and safety of this drug, to evaluate the influence of parenteral therapy on recurrence frequency, and to obtain further data on the natural history of genital herpes.

PATIENTS AND METHODS

Eighty-two patients with first episodes of genital herpes simplex virus (HSV) infection were randomly assigned in a double-blind fashion to treatment with intravenous acyclovir (5 mg/kg every eight hours) or placebo for five days. Before therapy, all lesions in the genital/perineal area and in extragenital sites were cultured. New lesions appearing in both areas after the onset of therapy were cultured separately. Lesions in all groups were cultured until completely healed. Sera were collected from all patients on entry to the study and on Day 21 to determine presence or absence of antibodies to HSV-1 and HSV-2. Time to healing, time to crusting, time to cessation of viral shedding, and appearance of new lesions during therapy were compared for each treatment group.

RESULTS

Patients receiving acyclovir experienced a significant reduction in the median duration of pain (4.3 versus 4.8 days, p = 0.019), viral shedding (1.9 versus 8.4 days, p less than 0.001), and time to healing (8.4 versus 11.5 days, p = 0.02) compared with placebo recipients. These differences were largely attributable to the effect of therapy in the subset of patients with primary disease in whom acyclovir reduced the median duration of pain from 10.6 days to 4.2 days, the median duration of viral shedding from 17.1 days to 1.9 days, and the median time to healing from 14.2 days to 8.3 days. The rate of subsequent recurrence of genital herpes was not altered by acyclovir treatment: 24 of 32 acyclovir recipients (75 percent) experienced one or more recurrences during a mean follow-up of 14 months compared with 19 of 27 placebo recipients (70 percent). Among patients experiencing recurrences, the mean number of recurrences per month among acyclovir recipients was 0.25 compared with 0.19 for patients given placebo.

CONCLUSION

This multicenter trial confirms the efficacy of intravenous acyclovir in the management of first-episode genital herpes, especially in patients with primary infection. However, therapy did not alter the frequency of recurrences.

Spread of herpes simplex virus in lymph nodes after experimental infection of mice

Herpes simplex virus was frequently isolated from ipsilateral popliteal lymph nodes after percutaneous inoculation of the dorsal face of the footpad, and from ipsi- and contralateral submandibular lymph nodes after percutaneous inoculation of the cheek or the orofacial area of mice. Virus was detected only on very rare occasion in nondraining lymph nodes (inguinal or axillary) or in contralateral popliteal lymph nodes, but was frequently isolated in contralateral lumbar lymph nodes after footpad inoculation. The presence of virus in lymph nodes paralleled or followed the invasion of ipsilateral sensory ganglia and was associated with dissemination of virus in contralateral sensory ganglia after unilateral inoculation. In older mice virus was detected only occasionally in lymph nodes and dissemination of virus in contralateral sensory ganglia was generally not observed. The results suggest that lymphatic spread may contribute to dissemination of virus in contralateral sensory ganglia after unilateral inoculation of mice.

Treatment of recurrent genital herpes with topical alpha interferon gel combined with nonoxynol 9

A double-blind, placebo-controlled study was done to evaluate the efficacy of an alpha interferon preparation in 128 patients with recurrent genital herpes. The preparation containing 10(5) or 10(7) U alpha interferon with nonoxynol 9 in a cream base (Exovir-HZ) was applied three times daily for 5 days. The treatment did not cause any adverse reactions. Patients treated with either interferon concentration became negative for viral culture at a faster rate than placebo recipients. The end of new lesion formation, scabbing, and the healing of lesions were all superior in patients treated with 10(5) U to those treated with 10(7) U interferon. End of new lesion formation and scabbing were also statistically different in patients treated with 10(7) U from those patients treated with placebo. Results suggest that topical interferon might be useful in relieving symptoms of severe cases of genital herpes.

Long-term follow-up of serum-interferon and its acid-stability in a group of homosexual men

For a period of over two years 99 volunteer healthy homosexual men were examined periodically for the presence of interferon (IFN) in their serum. Thirty-nine subjects had either undetectable IFN levels in serum or IFN was detected only once in three to five samples tested. In another 45 subjects low IFN levels were detected throughout the study period. None of these subjects had or developed any disease symptoms. In the remaining 15 subjects high serum IFN levels were detected at their enrollment or during the study period. All these subjects started to manifest clinical symptoms compatible with AIDS. In six subjects the mean time elapsed between the first detection of serum IFN and disease symptoms was 6.5 months. In all subjects but one, the IFN was of type alpha. The acid-stability of serum IFN alpha decreased with time, and when its decrease was abrupt it was associated with a more rapid evolution of AIDS. Sera containing acid-labile IFN alpha can induce IFN alpha synthesis in normal lymphocyte cultures (LC), but do not influence IFN gamma synthesis in LC stimulated with phytohemagglutinin. LC stimulated with viral antigens in the presence of serum with acid-labile IFN alpha synthesized IFN with an increased sensitivity for acid treatment. The results confirm the prognostic value of serum IFN alpha in the development of AIDS, and suggest that the transition to acid-lability may be a gradual process.

Effect of 9-(1,3-dihydroxy-2-propoxymethyl)guanine on the acute local phase of herpes simplex virus-induced skin infections in mice and the establishment of latency

The effect of topical and systemic treatment with 9-(1,3-dihydroxy-2-propoxymethyl)guanine on the evolution of herpes simplex virus-induced skin infection in hairless mice was investigated. Systemic (subcutaneous) treatment with a 10-mg/kg dose and topical applications with a 5% cream started up to 48 h after infection prevented the development of severe skin lesions and a fatal outcome. However, the establishment of latent infections was prevented only by topical treatment started at 6 h after infection. Systemic (50 mg/kg) and topical treatments started 48 h after infection reduced virus titers in the skin and ganglia and promoted rapid clearance of virus from these sites. The clearance of infectious virus from ganglia during the acute phase of infection was followed by early establishment of latency. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine (0.03 microgram/ml) significantly inhibited the synthesis of infectious virus in explant cultures of latently infected ganglia, and at concentrations higher than 8 micrograms/ml no infectious virus was detectable in ganglia explant cultures.

Initiation and maintenance of latent herpes simplex virus infections: the paradox of perpetual immobility and continuous movement

During the acute phase of infection, herpes simplex virus (HSV) is taken up by nerve endings and travels, probably as a noninfectious nucleocapsid, toward the neurons of sensory ganglia. Infectious virus can be detected in ganglia for a limited period, after which the virus enters into a latent phase. It appears that synthesis of deoxyribonucleic acid is not required and that an early viral protein and at least one additional late virus gene product are involved in the establishment of latency. The distinction between a "static" and a "dynamic" form of latency depends on the ability to detect viral activities in neurons and on whether these observed activities are expressed continuously or intermittently. The development of recurrent lesions following virus reactivation is an occasional event and is controlled by inducing agents and the state of the organism. The maintenance of latency depends on the number of neurons that become latently infected after the primary episode, the number of neurons in which reactivation takes place, the fate of the neuron after virus reactivation, and the possibility of renewed neuronal infections after each recurrent episode. Exogenous reinfections may also contribute to the maintenance of latency since they can lead to latent infections in nearby or distantly located sensory ganglia. Multiple latent infections may result also from a single primary infection by dissemination of the virus to distantly located ganglia.

Effect of eight antiviral drugs on the reactivation of herpes simplex virus in explant cultures of latently infected mouse trigeminal ganglia

The effect of several antiviral drugs on the reactivation of herpes simplex virus type 1 in explant cultures of latently infected mouse trigeminal ganglia was investigated. Phosphonoacetate and phosphonoformate, which act directly on the virus-induced DNA polymerase, require a drug concentration of 400 micrograms/ml for the inhibition of virus reactivation in latently infected ganglia. Arabinosyladenine and arabinosyladenine monophosphate, which are phosphorylated to triphosphates by cellular enzymes and inhibit virus synthesis either by blocking the DNA polymerase or by incorporation into viral DNA, require a concentration of only 100 micrograms/ml for the inhibition of the reactivation process. Drugs that are phosphorylated by the virus-induced thymidine kinase, such as acyclovir, arabinosylthymine, bromovinyldeoxyuridine, and three fluorinated pyrimidine nucleosides require the lowest drug concentrations for complete inhibition of virus reactivation in latently infected ganglia explant cultures. Our data suggest that the inhibition of virus reactivation is dependent not only on drug concentration, but also on the number of latently infected neurons in the ganglia.

Protection against establishment of latent infections in mice immunized with a non-pathogenic herpes simplex virus mutant and reinfected with the pathogenic parental strain

Immunization of hairless mice with a TK-, ACVr, non-pathogenic herpes simplex virus (HSV) type 1 mutant protected the mice against reinfection with lethal doses of the parental pathogenic HSV strain. The protection conferred by the mutant against the establishment of latency after reinfection with the parental strain was dependent on the site of reinfection; after reinfection at the same site, only 2% of mice became latently infected, compared to 32% after reinfection at a distant site. When inoculation with the mutant was done at two different sites, single reinfections at any site led to the establishment of latency in 4% of the mice. The mutant by itself was almost completely latency-negative: only 4.5% of the mice developed latency in trigeminal ganglia and 2.3% in the spinal ganglia. The rate of mutant-induced latent infections is partly related to the dose of the virus; however, lower doses of the mutant may not colonize the ganglia, and therefore fail to protect against challenge infections.

A collaborative study of patient-initiated treatment of recurrent genital herpes with topical acyclovir or placebo

Patient-initiated treatment of recurrent genital herpes with topical acyclovir was compared with placebo treatment in a multicenter collaborative trial involving 309 patients. No differences were found between the group using acyclovir and that using placebo except that herpes simplex virus was excreted for a shorter period by women using acyclovir. This difference was partially accounted for by the fact that some patients whose viral culture results subsequently proved positive began to use their medication before lesions formed. One hundred patients initially applied ointment within 6 hr of onset of the prodrome and before actual lesion formation. Separate analysis of this group showed a diminished duration of viral excretion by women using acyclovir and a reduced interval between lesion formation and total crusting in men using acyclovir, but both differences were of only borderline significance (.05 less than P less than .10). The results indicate that patient-initiated therapy with topical acyclovir in polyethylene glycol exerts no clinically significant effect on recurrent genital herpes.

Effects of topical applications of phosphonoacetate on colonization of mouse trigeminal ganglia with herpes simplex virus type 1

The effects of topical application of phosphonoacetic acid on the colonization of mouse trigeminal ganglia by herpes simplex virus type 1 were examined. The results showed that the extent of colonization of ganglia by virus is related to the time elapsed between virus inoculation and application of this agent. In most cases, treatment started up to 12 h after inoculation prevented invasion of ganglia by virus. When started up to 24 h after inoculation, treatment reduced and stabilized the amount of virus detectable in trigeminal ganglia during the acute phase of the ganglionic infection. Treatments started 24 h after virus inoculation had little influence on total virus accumulations in trigeminal ganglia. The data also indicate that virus titers in specimens of inoculated and treated skin sites are less affected by topical phosphonoacetic acid treatment than virus titers in ganglia. The experiments may represent a model system for testing effects of other antiviral compounds on colonization of ganglia by virus and may provide some clues regarding the pathogenic mechanism of herpes simplex virus infections.

Kaposi's sarcoma in homosexual men. A seroepidemiologic case-control study

The cases of 20 male homosexuals with Kaposi's sarcoma and the acquired immunodeficiency syndrome were compared with those of 40 age- and race-matched male homosexual controls. Patients with Kaposi's sarcoma had lower OKT4/OKT8 (T-helper/T-suppressor) ratios than controls, due to smaller numbers of OKT4 cells. Serum IgG concentrations and antibody titers to cytomegalovirus in patients exceeded those in controls, but patients had lower antibody titers to Epstein-Barr virus. Logistic regression analysis comparing patients with controls showed significant relative risks for Kaposi's sarcoma associated with the number of partners per month in receptive anal-genital intercourse, occasions per month of " fisting ," and cytomegalovirus antibody titers. Cytomegalovirus titers also were inversely correlated with OKT4 cell concentrations in the control group. Significantly greater OKT4 cell concentrations were found at diagnosis in HLA-DR5-positive patients than in HLA-DR5-negative patients. Patients who have HLA-DR5 may express disease at lesser degrees of immunodeficiency than HLA-DR5-negative patients.

Effect of discontinuous acyclovir treatment on in vitro reactivation of herpes simplex virus from latently infected trigeminal ganglia

Exposing explant cultures of latently infected mouse trigeminal ganglia alternately to acyclovir-containing and drug-free medium led to a significant decrease in the proportion of ganglia containing reactivatable herpes simplex virus. The loss of virus from the explant cultures was not caused by thermal inactivation during prolonged incubation periods. The efficiency of virus elimination may depend on the frequency and duration of the alternating treatment and on the number of latently infected neurons in the ganglia.

Dissemination of herpes simplex virus in ganglia after footpad inoculation in neurectomized and non-neurectomized mice

After unilateral footpad inoculation with herpes simplex virus (HSV) the infection spreads initially to the ipsilateral and afterwards to the contralateral spinal ganglia. In about 25 percent of the mice the virus also reaches the trigeminal ganglia. Furthermore, we have shown that only a complete severance of the nervous connections can prevent the colonization of ganglia with HSV after footpad inoculation. Results of previous experiments in which only the sectioning of the sciatic nerve was able to prevent the invasion of ganglia, are difficult to explain. It appears also that HSV travels in the nerve toward the ganglia in a non-infectious form, and that the infectious virus detectable in nerves originates not from the peripheral inoculation site, but from the infectious virus pool which accumulates in spinal ganglia. A limited role of the circulatory system in the colonization of sensory ganglia by HSV cannot be excluded, since in a few cases virus was detected in ganglia after sectioning of both the sciatic and the femoral nerve.

Arabinosyladenine monophosphate in genital herpes: a double-blind, placebo-controlled study

A double-blind, placebo-controlled study was performed in 55 male patients with recurrent herpes simplex genitalis. The 29 patients who received topical arabinosyladenine monophosphate (ara-AMP) showed no significant difference in viral shedding, duration of pain, healing time or development of new lesions as compared to 26 placebo-treated patients. Ara-AMP was well-tolerated when topically applied. Serum neutralizing antibody titers did not change significantly during the acute and convalescent periods of the patient's recurrent HSG attacks. We conclude that ara-AMP, when applied topically as a 10% gel five times a day within 24 h of onset of recurrent HSG, does not influence the virologic and clinical evolution of the recurrent episode.

Failure of 2-deoxy-D-glucose in the treatment of experimental cutaneous and genital infections due to herpes simplex virus

The effectiveness of 2-deoxy-D-glucose (2-DG) was evaluated in the treatment of cutaneous infections with herpes simplex virus type 1 (HSV-1) in mice and genital infections with HSV type 2 (HSV-2) in mice and guinea pigs. Groups of mice were inoculated in the lumbosacral or orofacial area with HSV-1 and treated topically three times a day with 0.2% or 0.5% 2-DG solution beginning 3 hr after inoculation. No effect on skin lesions, mortality, or latency was observed. Mice were inoculated intravaginally with HSV-2 and treated intravaginally three times a day with 0.2%-5% 2-DG in solution or suspended in miconazole nitrate cream beginning 6 hr, 24 hr, or 48 hr after inoculation. Replication of HSV-2 in the vagina and final mortality were not affected. Guinea pigs were infected intravaginally with HSV-2 and treated both intravaginally and topically on the external genitalia four times a day with 1% or 5% 2-DG in miconazole nitrate cream. Treatment initiated just prior to development of lesions (on day 3 after inoculation) did not alter vaginal virus replication, lesion development and severity, or virus titers in lesions.

Treatment of experimental latent herpes simplex virus infections with acyclovir and other antiviral compounds

Acyclovir can prevent the establishment of latent herpes simplex virus (HSV) in sensory ganglia by early treatment of the primary infection in experimental animals. A delayed treatment may reduce the number of neurons that eventually become latently infected. Acyclovir can prevent virus reactivation in explant cultures of latently infected ganglia, experimentally induced recurrences of latently infected animals, and immunosuppressed patients. This effect is dependent on the continuous presence of the drug in the explant culture medium or organism. The treatment of recurrent lesions with acyclovir reduces the severity of the episode and may also prevent reinfection of ganglia, if this should be common in the maintenance of latency. It might be possible to eradicate a latent HSV, if conditions were created in which drugs such as acyclovir, activated by the virus-induced thymidine kinase, could interact with the enzyme before the assembly of mature virions.

Is myelomeningocele a disappearing disease?

The incidence of major congenital anomalies of the central nervous system was determined in a study of more than 233,000 births in Brooklyn, New York hospitals during the years 1968 to 1979. Anencephaly, myelomeningocele, and hydrocephalus occurred at frequencies of 47.1, 42.4, and 49.3 cases per 100,000 total births, respectively. During the 12 years of the study, the incidence of myelomeningocele decreased at a linear rate of approximately 4.6 cases per 100,000 births per year. A review of comparable reports on births in the northeastern region of the United States shows that a relatively consistent linear decline in myelomeningocele incidence has been proceeding at this rate for the past 50 years. It is concluded that minor local fluctuations and variability in data collection have obscured the steady decrease in occurrence. No significant declines were seen in the incidence rates of anencephaly or hydrocephalus, nor were uniform secular trends for these anomalies evident from previous reports. Epidemiologic differences between myelomeningocele and anencephaly are noted and their common etiology is questioned.

The prevalence of neural tube defects among ethnic groups in Brooklyn, New York

Records of almost 174,000 consecutive births at six Brooklyn hospitals during the years 1968-1976 were reviewed for congenital neural tube defects. Prevalence of anencephaly, myelomeningocele and occipital encephalocele combined was significantly higher in infants delivered to mothers born in Puerto Rico than in offspring of non-Puerto Rican whites or blacks. The association of prevalence rates with ethnicity remained significant after adjustment for several variables. However, when adjustment was made for private or service status the difference between Puerto Ricans and whites, although still appreciable, was no longer statistically significant. No significant differences in prevalence rates between whites and blacks were observed. Sex ratios of affected infants were close to unity in each ethnic group. Statistically significant associations were found between the prevalence of neural tube defects and parity, gravidity and economic status. The patterns of these associations varied among the ethnic groups. A declining trend in the prevalence of myelomeningocele was observed for all ethnic groups.

Pathogenesis of experimental skin infections induced by drug-resistant herpes simplex virus mutants

The comparative analysis of the pathogenicity of a parental herpes simplex virus type 1 strain and its phosphonoacetic acid (PAA)-resistant and acyclovir (ACV)-resistant mutants showed marked differences among them. After orofacial skin inoculation of hairless mice the parental and PAA-resistant viruses were detected during the first 4 days after infection at high and increasing titers in the trigeminal ganglia; the ACV-resistant mutant was present at low and decreasing titers in the ganglia. Severe and slow-healing skin lesions were produced by the parental and PAA-resistant viruses; mild and rapidly healing lesions were produced by the ACV-resistant mutant. Virus titers in ganglia and the intensity of skin lesions were related to the virus dose used in the primary infection. Latent infections became established in trigeminal ganglia of mice inoculated with 10(6.0) plaque-forming units of the parental or PAA-resistant virus; no latent infections were detected in ganglia of mice inoculated with 10(7.0) plaque-forming units of the ACV-resistant mutant. Serum antibody titers attained similar values 4 weeks after primary infection with both mutants and the parental virus. Mice infected with the ACV-resistant mutant were reinfected with the parental and PAA-resistant viruses; the degree of protection against development of skin lesions, mortality, and latency was related to the dose of ACV-resistant virus used in the primary infection. Mortality was prevented by a dose of 10(6.0) plaque-forming units, skin lesions were prevented by a dose of 10(6.5) plaque-forming units, and latency was prevented by a dose of 10(7.0) plaque-forming units of the ACV-resistant mutant. Protection against reinfection with the PAA-resistant mutant was achieved with lower doses than protection against the parental virus. Serum antibody titers showed a 4- to 15-fold increase after reinfection. The results suggest that the ACV-resistant, latency-negative mutant has many attributes of a live attenuated herpes simplex virus vaccine.

Efficacy of a virion envelope herpes simplex virus vaccine against experimental skin infections in hairless mice

Hairless mice were immunized with herpes simplex virus type 1 (HSV-1) envelope antigen (EAG), EAG in association with polyriboinosinic . polyribocytidylic acid-poly-L-lysine complexed with carboxymethylcellulose (PICLC), and inactivated purified HSV-1 (VAG). After 2 weeks the mice were challenged by a percutaneous HSV-1 infection in the orofacial (OF) or lumbosacral (LS) skin area. Following immunization a consistent cell-mediated immune response was observed in all immunized mice, although the humoral immune response was very low, or not detectable. After challenge, a marked secondary humoral and cell-mediated immune response developed in all immunized mice, and the animals were protected against the development of skin lesions and the fatal outcome of infection. However, the establishment of latent infections in the sensory ganglia was not prevented by the immunization procedure.

Effect of acyclovir on latent herpes simplex virus infections in trigeminal ganglia of mice

The inhibition by acyclovir of the in vitro reactivation of herpes simplex virus from latently infected ganglion explant cultures is dependent on the continuous presence of this drug. Administration of acyclovir subcutaneously, orally, or by continuous perfusion to mice with established latent infections did not eliminate latent virus from the trigeminal ganglia.

Experimental skin infection with an acyclovir resistant herpes simplex virus mutant: response to antiviral treatment and protection against reinfection

Skin infections induced in hairless mice with an Acyclovir resistant herpes simplex virus (HSV) mutant were not followed by the death of the animals, and the survivors had no evidence of latent infections in their sensory ganglia. However, mutant virus was detected in the ganglia during the acute phase of the infection. Mice inoculated with the mutant were fully protected against the fatal outcome of the infection when subsequently challenged with the relatively pathogenic parental virus. In addition the frequency of latent infections established after challenge was significantly reduced. Phosphonoacetic acid treatment of the primary mutant-induced infection abolished the protection against reinfection with parental virus. Acyclovir treatment of the primary infection with the mutant virus did not affect the protection against reinfection with parental virus. The results indicate that drug-resistant, latency-negative, HSV mutants are a promising starting point for the development of an attenuated HSV vaccine.

Effect of immune serum on the establishment of herpes simplex virus infection in trigeminal ganglia of hairless mice

Administration of immune serum to herpes simplex virus (HSV)-infected hairless mice could not prevent acute infection in the trigeminal ganglia and the eventual establishment of latency. However, immune serum reduced the amount of free virus in the ganglion during the acute phase of the infection. It appears also that the amount of virus that can be reactivated in the latently infected ganglion is decreased. This was indicated by a prolonged reactivation time and by a reduced virus content of ganglion homogenates prepared after various periods of cocultivation.

Latent infections of sensory ganglia as influenced by phosphonoformate treatment of herpes simplex virus-induced skin infections in hairless mice

Topical treatment with 3% phosphonoformate of herpes simplex virus type 1 (HSV)-induced skin infections of hairless mice reduced the severity of skin lesions when the treatment was initiated 3 h after virus inoculation in the lumbosacral area or 3 and 24 h after inoculation in the orofacial area. The mortality was significantly reduced in lumbosacral-infected mice and was completely prevented in orofacial-infected mice when the treatment was initiated with a delay of 24 h after virus inoculation. However, phosphonoformate did not prevent the establishment of latent herpes simplex virus type 1 infections in the spinal and trigeminal ganglia, even when treatment was initiated as early as 3 h after infection.