Abstract P3-07-59: Stem cell markers are overexpressed in tumorspheres cultured from circulating epithelial tumor cells (CETCs) in patients with breast cancer

Background:

Breast malignancies continuously shed tumor cells which may enter the circulation, spread to other tissue and initiate metastases, but only a small subpopulation among CETCs is capable of metastasis formation. The subpopulation of CETC capable of forming tumorspheres in vitro and carrying stem cells properties is assumed to have metastatic potential. The aim of this study was to characterize the pattern of expression of the tumorspheres as compared to CETCs.

Methods:

Blood samples were obtained from patients diagnosed with breast tumors. CETCs were enumerated with maintrac method and subsequently cultivated in stem cell-selective medium. The expression of stem cell marker genes EpCAM, Nanog, Okt4 Sox2, ALDH and CD133 were detected by RT-PCR in single CETCs and tumorspheres.

Results:

0.1- 10% of CETCs could form non-adherent tumorspheres under stem cell- selective conditions after a period of 14 days. Array qRT-PCR analysis revealed that putative stem cell markers, such as Oct4, Sox2, Nanog, EpCAM, ALDH1 and CD133 are overexpressed in relation to house-keeping genes RPL13a and GAPDH in tumor spheres in contrast to the significantly lower expression level of these stem cell markers in individually isolated CETCs. High expression level of pluripotency genes in tumorspheres was associated with aggressive tumor behaviour in terms of tumor progression and type of cancer.

Conclusion:

Thus, differential expression of stem cell markers in CETCs and tumorspheres substantiates the hypothesis that only a small population of circulating tumor cells possess the stem cell properties and are responsible for metastasis formation.

Citation Format: Zimon D, Pizon M, Mayer V, Pachmann K. Stem cell markers are overexpressed in tumorspheres cultured from circulating epithelial tumor cells (CETCs) in patients with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-59.

Finite-element-modeling of egg white as a substitute for tissue coagulation during bipolar radiofrequency-induced thermofusion

Radiofrequency-induced thermofusion is a frequently used electrosurgical procedure for the sealing of blood vessels. A disadvantage of vessel sealing instruments is that the generated thermal energy spreads to the surrounding tissue and may irreversibly damage it. This is particularly problematic when operating close to sensitive structures such as nerves. Given their advantages, there is nonetheless a lot of interest in using bipolar vessel sealing for surgical procedures. To select instruments that may be safely used in such cases, it is important to reliably quantify the thermal spread to the surrounding tissue. Mathematical models can help to evaluate the transient behavior, that is the evolution of the thermal spread over time, more precisely. A finite element model allows for a detailed analysis of inhomogeneities in the spatial temperature distribution. As a first step towards a finite model of the bipolar vessel sealing process, a model of the coagulation of chicken egg white is presented here. Egg white has thermal and electrical properties that are very similar to tissue, making it suitable as a substitute for the analysis of the coagulation process. It has the additional advantage, that the spatial and temporal evolution of the thermal spread can be visually gauged. The presented model describes the experimentally observed spatial temperature distribution, the shape of the coagulated egg white, and the formation of hotspots. Furthermore, it is shown that the model can correctly predict the shape of the coagulated egg white in further experiments.

Pregnancy and Birth After a Two-Step PGD: Polar Body Diagnosis for Hemophilia A and Array CGH on Trophectoderm Cells for Chromosomal Aberrations

Objective: To demonstrate that a PGD program can be successfully established after the 2011 verdict of the German Bundestag concerning PGD. Material and Method: Eight years previously, the couple had had a daughter who suffered from clinically manifest hemophilia A due to an unbalanced X-inactivation, as well as microdeletion syndrome resulting in severe physical and mental disability. The couple wished to have a second child but refused the idea of a "trial" pregnancy. Given the indications for both, it was necessary to carry out polar body diagnosis (PBD) to rule out hemophilia A and, during the same cycle, a subsequent PGD on the blastocysts to rule out genetic aberrations. The PBD and PGD (trophectoderm biopsy, TEB) were performed after high-dosage ovarian stimulation and ICSI fertilization of the oocytes. A blastocyst was successfully transferred on day 6. Results: The patient conceived immediately. The pregnancy developed normally and the patient gave birth to a girl in the 40th week of pregnancy. Post-natal examinations showed that the baby is free from hemophilia A and is developing normally both physically and mentally. Conclusion: Establishment of a PGD program is now possible after legalization of PGD in Germany. It is possible to apply two investigative techniques in a single treatment cycle if multifactorial diagnosis is required.

Cardiopulmonary resuscitation performance during simulator-based trainings: a comparative retrospective analysis of adherence to 2005 and 2010 guidelines

BACKGROUND

New cardiopulmonary resuscitation (CPR) guidelines have been published in 2010 emphasizing the importance of minimizing interruptions during chest compression. The aim of our study was to compare the simulator-based CPR training performance of physicians not specialized in anaesthesia and intensive care nurses before and after implementation of new resuscitation guidelines.

METHODS

In autumn 2010, a total of 74 scenarios during six 1.5 day simulation-based CPR trainings were performed. Four of them were conducted after the implementation of the 2010 guidelines. During each simulated scenario a programmed script standardized the conditions of the simulator and its reactions on the trainees' actions. CPR relevant parameters were extracted on the basis of the simulator's log files and no-flow-time fraction and median cardiac output of the simulator were calculated. Results before and after the guideline implementation were compared using the Wilcoxon Two Sample Test.

RESULTS

Thirty-four out of 74 scenarios were included into the analysis. During training according to the 2010 guidelines, the no-flow-time fraction was lower (median: 21.8% [IQR: 16.1-27.1%] vs. 29.1 % [IQR: 25.0-30.9 %]; P=0.04). The median cardiac output increased from 1.60 L/min-1 [IQR: 1.50-1.65 L/min-1] to 1.90 L/min-1 [IQR: 1.80-2.10 L/min-1]; P<0.001) when the CPR training was conducted according to the 2010 resuscitation guidelines.

CONCLUSION

Non-anesthesiological physicians and intensive care nurses training demonstrated an improved CPR performance in a high-fidelity human patient simulator with respect to the median cardiac output and duration of no-flow-time when 2010 CPR guidelines were applied.

Creutzfeldt-Jakob disease risk and PRNP codon 129 polymorphism: necessity to revalue current data

The polymorphism at codon 129 (M129V) of the prion protein gene (PRNP) is a recognized genetic marker for susceptibility to Creutzfeldt-Jakob disease (CJD) in the Caucasians. The distribution of this polymorphism in healthy individuals provides an important starting point for the evaluation of CJD risk in the general population. Early studies of reference population cohorts demonstrated that methionine/valine heterozygosity was the most frequent genotype. These studies were performed in relatively small numbers of control subjects and do not correspond with the findings of more recent investigations. In this study, we present an analysis of the codon M129V distribution in 613 corneal donors, representing one of the largest control groups examined to date. Methionine homozygotes represented 48.1%, valine homozygotes 8.7% and methionine/valine heterozygotes 43.2%. While age-related difference was not significant, differentiation according to the gender showed significant difference. The observed highest proportion of methionine homozygotes and statistically significant difference between genders as well as comparison with results obtained in other countries underline the need to re-evaluate the generally used reference data on M129V, including consideration of the gender, age and geographical distribution.

HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia

INTRODUCTION

Aim of the study was to determine risk behaviour and HIV prevalence among commercial sex workers (CSWs) and intravenous drug users (IDUs) in streets of Bratislava and B. Bystrica, SR.

METHODS

HIV antibodies were tested from saliva using ELISA test. Anonymous questionnaire was completed.

RESULTS

121 persons (61 men and 60 women) were involved in the sociological study. Mean age of the participants was 21.9 years. 185.1% of subjects were from Bratislava. 108 participants were tested for the presence of HIV-antibodies, one was confirmed HIV-positive (0.82%). In the past 47.9% of participants and 22.3% of their partners were tested for the presence of HIV-antibodies. 10.8% of subjects proclaimed that they suffered from other sexually transmitted infection (STI) in the past HIV testing of participants significantly correlated with the testing for other STI (p<0.002) as well as with HBV/HCV (p<0.001). 58 participants were using tattooing (47.9%). 46.3% of all participants never used condoms with partners. 31.4% of respondents proclaimed disruption of condom during sexual intercourse. Significant correlation was found between testing of participants for other STI and usage of condoms with their partners (p<0.013). Women used condoms more often by sexual contacts with partners than men used condoms (p<0.094). They were also significantly more tested for other STI in the past (p<0.021) and they suffered from other STI more often than men (p<0.033). 26.5% of person--only women--were involved in commercial sex work. 93.5% of them were taking drugs as well, 21.8% suffered for other STI in the past They were working in sex business on average for 26 months. The average number of their clients per week was 12.3. CSWs used condoms more often with clients than with partners. 98.2% of all participants were taking drugs, 93% of them intravenously. 24.6% of IDUs always used new or their own needles and syringes, while 69.4% shared equipments with the other users. IDUs drug users used condoms significantly less often with their partners than did CSWs (p<0.006). CSWs were significantly more often tested for other STI (p<0.001) and they also more often suffered for other STI than IDUs (p<0.045).

CONCLUSION

More effort should be done to decrease risk behaviour revealed in the groups of CSWs and drug users.

Initial RNA expression in human monocytes after multiple injury: a screening pilot study on potentially trauma-sensitive factors by using the microarray-technique

BACKGROUND

Pathological affection of the immune system is one of the initiating mechanisms for the induction of multiple organ failure (MOF) in patients suffering from multiple injuries. Potential responsible intracellular mechanisms such as initial monocyte mRNA expression of specific mediators remain poorly studied, so far. Hence, we applied the microarray technique for screening of a wide variety of genes in circulating monocytes of multiple injured patients and compare the molecular results to the clinical course of the patients (MOF-score).

METHODS

In our prospective pilot study 6 patients were enclosed presenting with blunt multiple injuries (Injury Severity Score 16 to 57 points). Monocytes were isolated out of sequentially drawn samples (6, 12, 24 and 48 hours after trauma) using magnetic cell sorting (CD14) and a human microarray system was used (Atlas stress 1.2, Clontech, 1176 genes). Alterations in the sequential samples were identified by calculating ratios to baseline levels on admission and cluster analysis was performed (Spotfire Decision).

RESULTS

Only 86 (ca.5%) genes displayed an obvious signal. The house-keeping genes clustered well together in all patients in contrast to a substantial inter-individual variability of the other signal giving genes. No mediator burst of the classical pro- or anti-inflammatory cascade were detected.

CONCLUSION

We demonstrate for the first time a screening analysis of mRNA expression patterns in circulating monocytes of multiple injured patients indicating that only very few genes appeared to be influenced by the traumatic event. So far, no correlation to the severity of trauma or MOF could be detected.

Improvements for multipurpose bacteriological identification tables to suit the diagnosis of Vibrio cholerae

The aim of the study was to reduce to key tests the 4 extensive polyvalent diagnostic biochemical tables most widely used in Croatia and to adapt them for the demonstration of Vibrio cholerae and its differentiation from the 3 Vibrios (V. alvinolyticus, V. mentschikovii, V. fluvialis) important in differential diagnosis. The fourth table has now been adapted to differentiate among all 12 Vibrio species known to be human pathogens (V. mimicus, V. cincinatiensis, V. holisae, V. damsela, V. furnisi, V. parahaemolyticus, V. vulnificus, V. carchariae). Using the inductive Learning by Logic Minimization Method (ILLM), we analyzed 2 tables (i.e. identification matrices) that were a part of bioMérieux's commercial packaged polyvalent identification systems widely used in Croatia (API 20E and ATB 32E), as well as 2 compilation tables by M. T. Kelly et al. The tables contained 27, 32, 59 and 8 tests, respectively. Cutting these solely to the key tests involved rationalizing them from 59 to the 5 necessary to differentiate Vibrio cholerae from 3 related Vibrios. Further rationalizations were from 32 to 2 and from 27 to the 3 necessary to differentiate Vibrio cholerae from 2 related Vibrios. By reducing the table of 8 tests to 7, and adding 4 new ones to these we achieved an optimization permitting mutual differentiation of all 12 known human Vibrio pathogens. Use of the selective TCBS plating medium was the only precondition for making these tables effective.

Bed utilization performances of Slovenian and Croatian acute hospitals systems

With Barber-Johnson-Yates scattergrams (BJYS), the performances of Slovenian and Croatian acute hospital system were explored by taking turnover interval as a predictor variable, length of stay as a dependent variable, and by looking at the variables of bed throughput and percentage of bed emptiness on installed network. The growing influences on the Slovenian hospital system of a cost-containment policy and of the past war on the Croatian hospital system are the best illustrations of the informatics potential inherent in BJYS presentations for the exploratory data analysis (EDA) used to identify systematic relations between variables in a setting of not complete a priori expectations of these relations.

Programmed cell death: will it become a factor in cancer prevention?

Among the factors triggering programmed cell death (PCD) are a number of known carcinogens, and several consequences of DNA abnormalities characteristic of cancer have been shown capable of eliciting the PCD response. So although elimination of a potentially malignant cell is likely to be a rare consequence of PCD it could turn out to be important for cancer development. A brief survey is given of the most well-known triggering factors, the molecular mechanisms of the pathways involved and the emerging experimental and clinical data relating capacity of PCD to cancer initiation and progression. It is suggested that future cancer prevention will have to consider also those factors which may abrogate normal PCD.

[Encephalopathy in AIDS--increased formation of beta-chemokines in monocytes after HIV-1 virus infection: mechanisms of CNS involvement]

The characteristic trait of the family of lentiviruses (Retroviridae) which includes the human immune deficiency virus (HIV), is the tendency to cause a subacute neurologic disease in their animal host. The neuraxis can be inflicted at all its levels. In the advanced stage of HIV disease, more than 60 percent of patients suffer from a clinically evident neurological dysfunction. Neuropathologic changes are demonstrated in 75 - 90 percent of them at autopsy. HIV enters the CNS during the early phase of infection. HIV replicates predominantly in the nervous tissue macrophages which serve also as intrathecal reservoirs of infection. HIV isolated from the CNS is usually macrophagotropic. Neural cells are not susceptible to a productive HIV infection, contrasting with the permissivity of activated astroglial cells. The neuropathological picture of the brain involvement is typical by the giant multinuclear cells, i.e. fused monocytes/macrophages, then neuronal loss and changes in the white matter. The clinical manifestations of CNS involvement (AIDS encephalopathy) in HIV disease are variable protean, frequently associated with dementia. The pathogenesis of the neurological disease remains elusive. The cells supporting the HIV replication in the CNS (microglia, monocytes, astroglia) do not play a major role in dementia development. The neurotoxicity of viral glycoproteins, virus-induced cytokines and neurotoxin produced by CNS macrophages infected with particularly efficiently replicating HIV strains are being intensively studied. Dementia is associated with an increased virus load in the brain in the advanced stage of HIV disease. Neurotoxicity associated with HIV-infected microglial cells and macrophages activity remain to be considered, for the time being, as the most likely pathogenetic mechanism of neural dysfunction and injury. Our investigations have demonstrated that HIV infection of macrophages stimulate considerably the synthesis of MIP-1-alpha, MIP-1-beta RANTES chemokines (subgroup CC). These substances by their chemoattractant and activating properties may participate in the pathogenesis of HIV/AIDS encephalopathy, contributing to leukocytosis and inflammation, increasing thus the population of HIV-susceptible cells, facilitating their infection and enhancing finally the intrathecal spread of virus. (Tab. 2, Ref. 22.)

Clinical and immunological changes in AIDS patients following adoptive therapy with activated autologous CD8 T cells and interleukin-2 infusion

OBJECTIVES

(1) To determine the safety and feasibility of repetitive reinfusions of activated autologous CD8 cells followed by low-dose continuous interleukin (IL)-2 infusion in patients with AIDS. (2) To study the relationships between clinical responses, surface marker phenotypic distributions and cytokine expression patterns of both cultured CD8 cells and lymphocytes in the peripheral blood compartment.

DESIGN

Six adult patients with Centers for Disease Control and Prevention group IV HIV-1 disease ranging from mild to severe, were studied. All patients were receiving zidovudine prior to and during the study period, and had initial CD4 and CD8 cell counts > 50 and 200 x 10(6)/l, respectively.

METHODS

Autologous CD8 T cells (10(8)-10(10)) were reinfused five times after ex vivo culture and stimulation with phytohemagglutinin and recombinant (r) IL-2. The fifth such infusion was followed by 5 days of rIL-2 infusion. Phenotypes and cytokine expression patterns of the expanded cells were determined as well as serum levels of immune mediators throughout the study.

RESULTS

Patients showed stable CD4 and CD8 cell counts, p24 antigenemia, and minimal toxicity over the 24-week protocol study. Clinical improvement was observed in lymphadenopathy (six out of six), oral hairy leukoplakia (three out of four), and Kaposi's sarcoma (KS; two out of two) in the patients studied. In vivo induction of detectable levels of bioactive acid-stable interferon (IFN)-alpha, but not of other cytokines studied, upon activated CD8 cell reinfusion was associated consistently with improvement of oral hairy leukoplakia. However, partial regression of KS was observed after the CD8 cell infusion cycles and without IFN-alpha induction. In one of the two patients studied, KS regression was associated with decreased IL-1 alpha serum levels. In the other patient, who had failed previous IFN-alpha therapy, KS regression was observed after a decline in reinfused CD8 cell-associated gene expression of tumor necrosis factor (TNF)-beta. Both IL-1 alpha and TNF-beta are growth factors for KS cells.

CONCLUSIONS

These observations demonstrate the feasibility and safety of ex vivo CD8 cell activation, expansion, and reinfusion, and rIL-2 infusion in AIDS patients. The findings in this Phase I trial suggest potential clinical efficacy and encourage Phase II trials. The correlations obtained between clinical and immunological states could contribute to an understanding of the relationship between CD8 T-cell function and HIV-1-associated disease progression.

[Barber-Johnson analysis of bed utilization in hospital-based health care in the Croatian Republic during peace and war:1986-1991]

Intensity of bed utilization in Croatia's hospitals in the peace-time period 1986-90 and the war year of 1991 was evaluated. The study covered 32 general-and-teaching hospitals disposing with 21,300 beds in 1986-90 and 27 of these hospitals with 19.000 beds in 1991. Basic information derives from hospital's statistical reports analyses by the Barber-Johnson's technique. While length of stay was reduced in the 1986-90 period, average number of discharges and deaths per available beds increased (1986/26.1; 1990/26.9). In the peace year of 1990 the performances of 11 of the 32 hospitals grouped in a zone limited to 10.0-12.9 days for the length of stays and 1.1-2.5 days for turnover interval. In the war year of 1991 the performances of 10 of the 27 hospitals were grouped in a zone defined by 8.5-10.9 days for length of stay and by 3.1 and 6.2 days for turnover interval. The Barber-Johnson's analysis provides key information in the decision making about hospital beds utilization, as well as in the evaluation of such decisions.

Persistent viral infections in human carcinogenesis

Several taxonomically distinct human pathogenic viruses capable of upholding persistent infections have been recognized as important carcinogens. Jointly they are characterized by going into decade-long interactions with host cells and/or tissues. Tumours arise after a long latent period in a few infected individuals. The cellular changes necessary for malignancy are only in part directly or indirectly caused by virus-cell interactions. Cofactors are assumed to be involved. The different routes to malignancy reflect the distinct strategies of each virus in its interaction with the host, which for the upkeep of chronic infections requires a tight control of both virus and cell multiplication and the extent to which an immune response is provoked. The size of the virus-cancer problem and the possibility of prevention makes virology one of the most promising areas of cancer prevention on a global scale. A much wider use of the vaccination against hepatitis B, especially in children, is warranted in developed countries.

Plasma levels of the anti-HIV drug 3'-azido-2',3'-dideoxythymidine (AZT): determination by RIA and HPLC

The radioimmunoassay (RIA) with two commercial kits and the high pressure liquid chromatography (HPLC) method were employed to test human and dog blood plasma levels of AZT following oral and intravenous administration of AZT preparations Retrovir and Azitidin. A comparison of results obtained by the two RIA kits showed a good correlation. A weaker correlation was established in comparing the results obtained by RIA with those obtained by HPLC. Because of its reliability, rapid availability of results and the price, RIA is more advantageous than HPLC for routine use in monitoring the therapy as well as in determining pharmacokinetic parameters of AZT.

[Inhibition of human immunodeficiency virus replication by azidothymidine (Azitidín Lachema) in cultured cells]

The inhibitory effect of the Czecho-Slovakia azidothymidine (AZT) preparation Azitidin (Lachema) on HIV 1 infection was studied in vitro. Its efficacy was compared with that of the approved AZT preparation Retrovir (Burroughs-Wellcome Co.). HIV 1 infected MT4 cells were cultivated in media containing different concentrations of Azitidin or Retrovir. Complete inhibition of virus production (reverse transcriptase activity) and of the cytopathic effect of HIV 1 was seen at the concentration of 0.1 microM of either preparation. Complete inhibition of viral antigen induction was recorded at the concentration of 1 microM. In the light of the obtained results we can conclude that Azitidin inhibits HIV 1 replication in vitro and its efficacy is fully comparable to that of Retrovir. (Tab. 4, Fig. 2, Ref. 17.)

[Analysis of hospital mortality in the Croatian Republic using selected indicators]

Mortality trends and distribution in a system of 32 general and teaching hospitals in the Republic of Croatia for the years 1966 through 1989, separately for 1986/1987, were evaluated as a possible informational support to the national policies regarding developing of health care system. By means of 13 elaborated and/or selected indicators, using hospital health statistics as a data base, we measured the changes in the dynamics, structure and level of death at institutions, individual medical departments and among patients. Hospitals mortality statistics was found to offer a good informational orientation for monitoring realization of the hospital's restructuring activities envisaged under the Aim 29 of the Croatian strategy Health for All by the Year 2000 as well as for planning technical surveillance and streamlining the special statistical studies on inpatient health care. It can also provide a solid base for the evaluation of the quality of inpatient medical care, if the diagnosis of causes of death is improved, methodology for sentinel-health-events adopted, commissions for the evaluation of inpatient health care organized, medical registration units established and the National Register of Autopsy begun.

HPLC-monitoring of AZT in HIV-infected patient's plasma: a critical study

3'-azido-2', 3'-deoxythymidine (AZT) concentrations in spiked human plasma were determined by means of reversed-phase high performance liquid chromatography (RP-HPLC). Samples were first cleaned-up for analysis using solid-phase extraction (SPE) columns filled with Silipore C18. In the concentration range comprising usual peak plasma concentrations during AZT therapy (0.1-20 mumol/l, i.e. 0.026-5.34 micrograms/ml) mean efficiency of the extraction procedure reached as high as 75.3% of original AZT concentrations in standard unextracted aqueous solutions. Replicate analyses in this range gave satisfactory intra-assay precision and reproducibility with coefficient of variation less than 11.3%. Calibration curves both in water and plasma showed good linearity (r > 0.999). The detection limit in plasma was 2 mumol/l, i.e. 5.3 ng per a 20 microliter of sample injected to the HPLC column. Plasma levels of AZT after a single dose administration, determined by HPLC and RIA showed rather poor correlation (r = 0.8900). In RIA about 1.7-4.5 times higher concentration values were obtained in a relatively short time, and, consequently, this method may better fulfil the needs of routine drug monitoring.

Bacterially expressed core and envelope proteins of human immunodeficiency virus type-1 (HIV-1): comparative evaluation in detection of type-specific antibodies

Recombinant proteins derived from immunodominant conserved domains of HIV-1 env and gag genes were synthesized in E. coli. An immunoblot system using total cell lysates was employed for the analysis of recombinant bacterial clones. Together 427 serum samples obtained from asymptomatic anti-HIV seropositive individuals, AIDS patients, healthy donors and persons suffering from various conditions were comparatively evaluated for the presence of HIV-1 antibodies using recombinant peptides and commercially available western blot (WB) and ELISA assays. The recombinant antigen product of plasmid pEX41 was found to be superior, with respect to sensitivity and specificity, to the viral gp41 which represents a diagnostically important constituent of the WB.

Virus neutralizing antibodies at different stages of the HIV disease: increased levels after azidothymidine treatment

Specific HIV-1 neutralizing activity was measured in single serum samples obtained from 52 individuals suffering from different stage of HIV disease, as well as in serum samples collected during a four years follow up of other 13 HIV-1 seropositive persons, from whose seven developed AIDS. Three of these persons were treated with azidothymidine. In the former group of single serum specimens, the specific neutralizing antibody positivity rate was 81 per cent in symptomless persons, 92 per cent in patients with ARC and 43 per cent in patients with AIDS. From 13 HIV-1 infected individuals, prospectively investigated from 1986 to 1990, six remained asymptomatic and no significant fluctuation of specific virus neutralizing antibody levels was noted. During this time period, remaining seven patients developed AIDS. In the sera of AIDS patients, specific neutralizing activity was either not detected or its titres were rather low before the appearance of clinical disease. Three AIDS patients were administered azidothymidine. Specific neutralizing antibody titres increased significantly one month after the beginning of azidothymidine administration and persisted at relatively high levels over several months of follow up.

Recombinant interferon-alpha 2 inhibits HIV replication in chronically infected promonocytic cells

Promonocytic cells U937 with previously established HIV-1 persistent infection, were treated with increasing doses of the recombinant INF-alpha 2. This resulted in a significant decrease of virion-associated reverse transcriptase levels in medium of the cultures studied, most pronounced by the highest interferon doses, but depending on this cytokine presence. In spite of the marked restrictive effect of the interferon on the infectious virus production the synthesis, of viral structural proteins by the U937 cells, as detected by immunofluorescence, was not affected. The therapeutic index of interferon was considerably high.

HTLV-I virus in Europeans: the continuous spread. A meta-analysis

Published and unpublished data on the HTLV-I seroprevalence in 13 European countries (sample a total of 79.549 persons) was subject to meta-analysis. HTLV-I infection was significantly associated with intravenous drug use, HIV-I seropositivity, geographical area and immigration from endemic areas outside of Europe. Significant percentage of HTLV-I seropositivity was observed in all groups of HIV-I seropositive individuals studies. The overall HTLV-I seroprevalence was 4.16% in intravenous drug abusers, 0.66% in male homosexuals, 0.62% in immigrants from HTLV-I endemic areas and 0.015% in the general population. A major problem in these epidemiological considerations is the uncertain delineation of the serology of HTLV-I versus that of HTLV-II. There have, been no reports from Europe of the specific leukaemic and neurologic indicator diseases associated with the HTLV-I seropositivity. Presently, the HTLV-I/HIV-I co-infected individuals represent an urgent medical problem. The information available shows a need for self-exclusion of all blood donor groups at risk for HTLV-I infection and for active seroepidemiological surveillance in all parts of Europe. However, improvements in diagnostic methods, increased knowledge about the pathogenesis of infection by HTLV-I or HTLV-II virus and the probable detection of new human retroviruses may markedly influence the future requirements for preventive measures.

Enhanced chemiluminescence-based hybridization analysis for PCR-mediated HIV-1 DNA detection offers an alternative to 32P-labelled probes

The efficiency of enhanced chemiluminescence based on a novel generation substrate for alkaline phosphatase, adamantyl-1,2-dioxetane phosphate, was compared with that of 32P-labelled probe for visualization of human immunodeficiency virus type 1 (HTV-1)-specific DNA-DNA hybrids. The probe used for nonisotopic detection was digoxigenin labelled and targeted by anti-digoxigenin antibody Fab-fragments conjugated to alkaline phosphatase. The dot-blot hybridization analysis performed on a dilution series of HIV-1 proviral DNA demonstrated a lower sensitivity limit of 0.5 pg with the nonisotopic method. However, one order of magnitude less DNA could still be detected by a random-primed 32P-labelled probe. The ability of nonradioactive and radioactive probes to detect 590-bp gag gene-specific target sequences generated by the polymerase chain reaction (PCR)-mediated amplification of HIV-1 DNA was also compared. Analysis of 20 samples from individuals at increased risk for HIV infection by using the two assayed systems produced virtually equivalent signal images on corresponding specimens. Furthermore, complete concordance in the performance was found when HIV-1 proviral DNA was investigated by PCR in additional 50 samples of human blood mononuclear cells.

Failure of azidothymidine to inhibit human immunodeficiency virus (HIV) replication in a promonocytic cell line (U937)

The inhibitory effect of azidothymidine (AZT) on HIV replication in the promonocytic cell line U937 was investigated. After infection with HIV-1/LAV virus, U937 cells were cultured for prolonged period in the presence of the drug at a final concentrations of 20 mumol/l or 50 mumol/l, respectively. The antiviral activity was determined according to the inhibition of viral reverse transcriptase activity, and of viral antigen production (immunofluorescence assay). We conclude that virus production was not efficiently influenced during long term passage even at high drug concentrations.

Human immunodeficiency virus inhibition by lysed leukocyte ultrafiltrate

The in vitro effect of partially purified lysed leukocyte ultrafiltrate (LLU) on LAV 1 strain of the human immunodeficiency virus (HIV) was investigated. Decrease of virus production as a function of LLU concentration was observed while the phenotype of cultured lymphocytes has remained unchanged. We observed the same depletion of helper-inducer T-cells in samples treated with LLU as well as in infected controls. LLU did not influence significantly the growth of cultured lymphocytes. Following the effect of LLU on RNA-dependent DNA polymerase, inhibition of the LAV 1 reverse transcriptase by LLU was observed. This inhibition was shown to be LLU dose-dependent, considering its content of proteins and orcinol-reactive material. Kinetic studies revealed that inhibition is reversible and competitive with the substrate (3HTTP) but not with template-primer (poly rA-oligo dT).

Amino acid analysis of selected reversed-phase high performance liquid chromatographic peaks of crude and partially purified lysed human leukocyte ultrafiltrate

Analytic reversed-phase high performance liquid chromatography (RP-HPLC) was performed to separate from the crude lysed human leukocyte ultrafiltrate (LLU) its partially purified most immunoactive subfraction P2/II in vivo. Under conditions used, the highest degree of segregation of both. LLU and P2/II could be observed in the first, as well as in the last two fifth of the water-methanol gradient. The comparison of the RP-HPLC traces of LLU and P2/II suggests that probably some hydrophilic components of LLU have been removed or--at least--diminished. The preliminary amino acid analysis (AA) of the selected peaks showed that none of them lacks Gly, Ser, and Glu. Of the basic amino acid residues Lys has been found with relatively many peaks while hydrophobic as well as aromatic amino acids have been represented very modestly. Further study is warranted in order to determine better the bearings of presented findings for the in vivo situation.

Rehabilitation of common athletic injuries of the hand and wrist

Rehabilitation of athletic injuries of the hand and wrist should begin at the time of injury. Early recognition and prompt medical attention can serve to minimize the initial effects of injury. A systematic evaluation should include assessment of deformity, joint instability, active and passive motion, edema, and nerve and tendon function. In spite of initial negative findings, painful joints should be protected. Joints of the hand and wrist are particularly vulnerable to the effects of aggressive rehabilitation. Signs of reaction to exercises should be closely observed. Upgrading of activity should only occur as soft-tissue healing will allow.

Increased migration inhibition factor production by leukocytes of patients with herpes zoster given the leukocyte ultrafiltrate

Using the direct leukocyte migration inhibition assay, the cell-mediated immune response was followed in together 47 patients suffering from herpes zoster. Of these, 19 persons were treated with partially purified and concentrated lysed leukocyte ultrafiltrate. Enhancement and/or earlier production of the leukocyte migration inhibition factor--in the presence of varicella-zoster virus antigen--was observed by leukocytes from patients given the ultrafiltrate on days 2-3 since the onset of the vesicular stage of the disease. Highly significant (alpha = 1%, P less than 0.01) differences in the migration inhibition values were observed between non-treated patients and patients given one dose of the ultrafiltrate during the days 3-12 after appearance of the first herpes zoster vesicles; on days 13-30 these values were not significant.

Semipurified human leukocyte ultrafiltrate in herpes zoster. I. Large-scale preparation and biochemical analysis

Nine batches of lysed human leukocyte ultrafiltrate (LLU) prepared from buffy coats of random healthy donors, as well as their semipurified subfractions--P2/II--were compared in terms of protein, orcinol-reactive material (ORM) content, and ratios of the average values of their ORM and protein contents. Two-step ethanol precipitation and size exclusion chromatography on Sephadex G-15 were used for partial purification and concentration. In comparison to the starting material, approximately 4.4 - fold increase in the ORM/protein ratio of P2/II has been effected. Relatively high variation in both, protein and ORM content of the crude LLU individual batches (ranges: 365 micrograms/1 ml - 962 micrograms/1 ml; 157 micrograms/1 ml - 660 micrograms/1 ml, respectively), as well as of those of P2/II fractions (ranges: 16.5 micrograms/1 ml - 207.5 micrograms/1 ml; 150 micrograms/1 ml - 480 micrograms/1 ml, respectively) could be observed. The suggested combined purification procedure removed from the LLU about 85% proteins and 33% ORM. The removed material contained inhibitors of the cell-mediated immunity (CMI)-inducing and/or augmenting properties of LLU. This is in good agreement with the observed improved therapeutic effect of P2/II fraction in herpes zoster treatment of otherwise noncompromised adults, as described in the companion paper.

Antibodies to axonal neurofilaments in Creutzfeldt-Jakob disease and other organic dementias

Antibodies reacting with neurofilament proteins were detected by indirect immunofluorescence in the sera from 6 out of 10 patients with verified Creutzfeldt-Jakob disease (CJD), in 4 out of 8 cases of Alzheimer's disease (AD), in a variable percentage (29.4-42.8%) of sera from patients (n = 46) with other dementias of organic or infectious origin and in 5 out of 30 asymptomatic relatives of CJD patients. The occurrence of this antibody did not correlate with the duration or with any other clinical manifestation of CJD. The applicability of the test as differential-diagnostic marker appears limited. The later development of CJD and mental or nervous disease in 3 of 5 asymptomatic relatives with positive serological reaction suggest that the method although nonspecific, may be of certain value in the search for persons at higher risk to develop a degenerative disorder of CNS.

Different types of false positive anti-HIV reactions in patients on haemodialysis

Serum samples of 589 haemodialysis patients were screened for HIV antibody by ELISA methods. Of these, 36 samples were found to be repeatedly reactive. None of the 36, however, could be confirmed by competitive enzyme immunoassays and Western blot; therefore, they were considered to be false positive. The sera could be divided in two groups. The sera of Group 1 were designated as the usual type of false positivity, caused most probably by anti-lymphocyte antibodies. In 19 sera, however, a special type of false positivity was found. These sera reacted strongly with the plates coated with the supernatants of HIV-infected cells but not with those of uninfected H9 cells. Three and two sera showed, respectively, positive immunofluorescence reaction with the HIV-infected, but not with the uninfected, H9 and CEM cells. Reactivity to HIV-infected H9 cells could be adsorbed from a part of these samples with lesser amounts of HIV-infected than uninfected H9 cells. This special type of false positivity was observed frequently (7/65) in patients who rejected a kidney graft. These findings suggest that this type of anti-HIV false positivity is due to antibodies reacting with cellular antigens present in HIV-infected but not in uninfected lymphocytes. Their appearance seems to be associated with the immunological activation occurring at graft rejection.

[False positive results of HIV virus tests in patients undergoing chronic hemodialysis]

The sera of 173 haemodialysis patients treated in two dialysis centers in Hungary were tested for the presence of HIV (HTLV III/LAV) antibodies. Four different commercial enzyme immunoassay (EIA) kits and two types (CEM/LAV, and H9/HTLV III) of indirect immunofluorescence assay (IFA) were used. The Western blot technique was applied as confirmatory test in the study. No confirmed positive results were found in any of the cases. However, in 15 patients (8.7%) false positive (not confirmable by the Western blot assay) results were obtained in at least one but mostly in all of the three type 1 EIA kits (ORGANON, ELECTRONUCLEONICS, SORIN) applied. In 4 patients, the IFA assay also gave false positive results which could be repeated in sequential samples taken from the same patients. Increased reactivity in the control plate (coated with a concentrate of cellular material shed by uninfected H9 cell line) of the SORIN kit was found only in a few false positive samples and no fluorescence with the uninfected H9 or CEM cells was observed in any of the sera showing a false positive IFA. These results indicate that the false positive anti-HIV results frequently observable in haemodialysis patients are not simply the consequence of the presence of antibodies reacting with the uninfected H9 and/or CEM cells but they are most probably due to antibodies against antigens expressed on these cells only after infection with the human immunodeficiency virus.

A biometrical view on normal values of CD4 and CD8 lymphocyte counts in peripheral blood

Statistical methods have been used to determine an optimal approach to the definition of the reference range for CD4 ("helper") and CD8 ("suppressor/cytotoxic") T cell numbers and the CD4/CD8 ratio in the peripheral blood. A graphical presentation of the absolute values for CD4 and CD8 for 85 healthy blood donors showed that a reference ellipse defined by fitting a gaussian distribution to logarithmically transformed data for absolute counts of CD4 and CD8 cells was superior to the fitting of an ellipse to untransformed data. Further analysis for another 147 subjects showed that the 95% tolerance prediction for the CD4/CD8 ratio in health could be stated with 95% confidence as 0.6 to 5.0. This approach allows clear definition of reference ranges for T cell tests in health and would also be applicable to results for patients with a disease such as HIV 1 infection in which a reference range for "well" patients exists and a change in the T cell ratio is of prognostic significance.

Varicella-zoster virus IgG antibodies during primoinfection in competent and transfer factor modulated immunocompromised host: comparison of three indirect assays

Ten patients with acute leukaemia and next three with Hodgkin's or non-Hodgkin's lymphoma, suffering from varicella-zoster-virus (VZV) primoinfection, were given 1 to 2 doses of ultrafiltrate of the human leukocytes lysate (LLU) containing transfer factor (TF) activity (1 dose being equivalent to the product of 10(8) leukocytes). Only LLU administered to patients with acute lymphocytic leukaemia (ALL) at early phases of the illness (days 1 and 2) displayed a notable benefit on the clinical course of varicella. No influence upon the infection, on the other hand, was observed following LLU administration to subjects with lymphoma. The convalescent levels of IgG antibodies to VZV, as detected by indirect immunoperoxidase assay to membrane antigen (IPAMA), demonstrated no significant difference between infected competent and immunocompromised untreated and LLU treated individuals. The performance characteristics of IPAMA are compared with indirect immunofluorescence method (IFA) and non-competitive enzyme-linked immunosorbent assay (ELISA) on the same panel of specimens.

Studies of the sensitivity and reproducibility of commercial kits to detect antibodies to the human immunodeficiency virus

Nine serial three-fold dilutions (1:1 to 1:6561) were prepared from 18 sera obtained from hemophiliacs confirmed to have antibodies to the human immunodeficiency virus. The dilutions were tested with five different commercial enzyme immunoassay kits and twelve sera were retested 5 to 7 months later by different lots of three kits. The dilution that gave an absorbance (OD) equal to the cut-off OD was considered as the titer of antibody. Sensitivities of the kits were compared by statistical and regression analysis; the same approach was used for studying reproducibility from the results of retesting. The highest titers were found with the Wellcome kit, the lowest with Organon and Pasteur kits, whereas intermediate values were found with the Sorin/Biomedica and Electronucleonics kits. With the Organon and Wellcome kits, excellent reproducibility was observed on later retesting; however, a significant change in titers was seen on retesting the Sorin kit.