Exogenous β-mannanase improves feed conversion efficiency and reduces somatic cell count in dairy cattle

Exogenous fibrolytic enzymes have been shown to be a promising way to improve feed conversion efficiency (FCE). β-Mannanase is an important enzyme digesting the polysaccharide β-mannan in hemicellulose. Supplementation of diets with β-mannanase to improve FCE has been more extensively studied in nonruminants than in ruminants. The objective of this study was to investigate the effects of β-mannanase supplementation on nutrient digestibility, FCE, and nitrogen utilization in lactating Holstein dairy cows. Twelve post-peak-lactation multiparous Holstein cows producing 45.5±6.6kg/d of milk at 116±19.0d in milk were randomly allotted to 1 of 3 treatments in a 3×3 Latin square design with 3 periods of 18d (15d for adaptation plus 3d for sample collection). All cows were fed the same basal diet and the 3 treatments differed only by the β-mannanase dose: 0% dry matter (DM; control), 0.1% of DM (low supplement, LS), and 0.2% of DM (high supplement, HS) supplemented to the basal diet. Supplementation of β-mannanase enzyme at the LS dose reduced dry matter intake (DMI) but did not affect milk yield or milk composition. Cows receiving LS produced 90g more milk per kg of DMI compared with control cows. Somatic cell count (SCC) in milk was lower for cows fed the LS diet compared with cows fed control diets. Cows fed LS diet had lower DM, organic matter and crude protein digestibility compared with cows fed control diets. Starch, neutral detergent fiber, and acid detergent fiber digestibility were not affected by LS. Milk yield, DMI, SCC, and nutrient digestibility did not change for HS. Despite the reduced crude protein digestibility, reduced N intake led to similar fecal N excretions in LS cows and control cows (234 vs. 235g/cow per day). Urinary N excretions remained similar between enzyme-fed and control cows (~190g/cow per day), although the percentage of N intake partitioned to urinary N tended to be greater in LS than in control cows (31 vs. 27%). Cows fed LS significantly improved the percentage of apparently absorbed N partitioned to milk protein N (42 vs. 38%). When supplemented at 0.1% of dietary DM, β-mannanase can improve FCE and lower the SCC of dairy cows without affecting milk yield, milk composition, or total manure N excretions of dairy cows.

MiR-133b ameliorates axon degeneration induced by MPP(+) via targeting RhoA

Increasing evidence suggests that microRNAs (miRs) play a significant role in the pathogenesis of Parkinson's disease (PD). MiR-133b, which is significantly decreased in the PD midbrain, has recently been shown to promote neurite outgrowth and enhance neural functional recovery. However, the role of miR-133b in PD has not been clearly established. Here, using a well-established PD model culture based on the neurotoxin 1-methyl-4-phenyl-pyridinium (MPP(+)), we demonstrated that miR-133b could promote axon outgrowth in dopaminergic neurons (DNs) and ameliorated MPP(+)-induced axon degeneration. Additional experiments suggested that the mechanisms of this miR-133b-mediated effect might rely on RhoA inhibition. We demonstrated that RhoA, an inhibitor of axonal growth, was increased in DNs under MPP(+) treatment, and this increase could be attenuated by miR-133b overexpression. Moreover, we demonstrated that the induced expression of miR-133b could inhibit α-synuclein, which is critically involved in the pathological process of PD. Furthermore, we found that overexpression of miR-133b abrogated the MPP(+)-induced decrease in the Bcl-2/Bax ratio and upregulated phosphorylated Akt (p-Akt), which is a pro-survival kinase. Together these findings reveal novel roles for miR-133b in the pathogenesis of PD and provide new therapeutic avenues for the treatment of the disease.

Effect of dietary crude protein and forage contents on enteric methane emissions and nitrogen excretion from dairy cows simultaneously

The study aimed to examine, simultaneously, the effects of changing dietary forage and crude protein (CP) contents on enteric methane (CH4) emissions and nitrogen (N) excretion from lactating dairy cows. Twelve post-peak lactating Holstein cows (157 ± 31 days postpartum; mean ± s.d.) were randomly assigned to four treatments from a 2 × 2 factorial arrangement of two dietary forage levels [37.4% (LF) vs 53.3% (HF) of DM] and two dietary CP levels [15.2% (LP) vs 18.5% (HP) of DM] in a 4 × 4 Latin square design with four 18-day periods. Alfalfa hay was the sole source of dietary forage. Cows were fed ad libitum and milked twice daily. During the first 14 days, cows were housed in a free-stall barn, where enteric CH4 emissions were measured using the GreenFeed system from Days 8 to 14 in each period. Cows were then moved to metabolic cages, where faeces and urine output (kg/cow.day) were measured by total collection from Days 16 to 18 of each period. No dietary forage by CP interactions were detected for DM intake, milk production, enteric CH4 emissions, or N excretions. There was a tendency for DM intake to increase 0.6 kg/day in cows fed LF (P = 0.06). Milk production increased 2.1 kg/day in LF compared with HF (P < 0.01). Milk fat content decreased in cows fed LF compared with HF (1.07 vs 1.17 kg/day; P < 0.01). Milk contents of true protein, lactose and solid non-fat were greater in cows fed LF (P < 0.01). No difference in DM intake, milk yield and milk contents of true protein, lactose and solid non-fat was found between cows fed HP or LP. However, milk fat content increased 0.16 kg/day in cows fed HP (P < 0.05). Enteric CH4 emissions, and CH4 per unit of DM intake, energy-corrected milk, total digested organic matter and neutral detergent fibre were not affected by dietary CP, but decreased by LF compared with HF (P < 0.01). Milk true protein N was not affected by dietary CP content but was higher for LF compared with HF. Dietary N partitioned to milk true protein was greater in cows fed LF compared with HF (29.4% vs 26.7%; P < 0.01), also greater in cows fed LP compared with HP (30.8% vs 25.2%; P < 0.01). Dietary N partitioned to urinary N excretion was greater in cows fed HP compared with LP (39.5% vs 29.6%; P < 0.01) but was not affected by dietary CP content. Dietary N partitioned to faeces was not affected by dietary CP but increased in cows fed LP compared with HP (34.2% vs 27.8%; P < 0.01). Total N excretion (urinary plus faecal) as proportion to N intake did not differ between HP and LP, but tended to be lower in cows fed LF compared with the HF diet (64.2% vs 67.9%; P = 0.09). Both milk urea N (P < 0.01) and blood urea N (P < 0.01) declined with decreasing dietary CP or forage contents. Based on purine derivative analysis, there was a tendency for interaction between dietary CP and forage content on microbial protein synthesis (P < 0.09). Rumen microbial protein synthesis tended to be lower for high forage and low protein treatments. Increasing dietary forage contents resulted in greater CH4 emission (g/kg of energy-corrected milk) and manure N excretion (g/kg of energy-corrected milk) intensities of lactating dairy cows. Cows receiving reduced CP diets had low manure N outputs and improved milk true protein production efficiencies, regardless of dietary forage content.

Serum S100A4 levels as a novel biomarker for detection of acute myocardial infarction

OBJECTIVE

Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. The objective of this study was to determine S100A4 expression in AMI and determine whether S100A4 could be a biomarker for detection of acute myocardial infarction (AMI).

PATIENTS AND METHODS

We measured circulating S100A4 levels in 173 patients (median age 58.3 years) who presented with first-time AMI 8 hours after the incident. The circulating S100A4 levels in 173 healthy volunteers (median age 57.3 years) was also measured. S100A4 was detected using enzyme immunoassay in both groups.

RESULTS

Serum S100A4 levels were significantly higher in patients with AMI [89.6 (4.3-214.6) pg/ml] compared to controls [11.8 (0-41.5) pg/ml] (p < 0.001). We found that a S100A4 level > 41.5 pg/ml had a Sensitivity 76.3% and specificity 87.5% for predicting AMI. S100A4 revealed the higher sensitivity for diagnosing AMI.

CONCLUSIONS

Elevated S100A4 in plasma may be a novel biomarker for early detection of AMI.

VEGF Trapon inhibits tumor growth in papillary thyroid carcinoma

OBJECTIVE

Vascular endothelial growth factor (VEGF) is the most potent inducer of neovasculature, and its increased expression has been related to a worse clinical outcome in many disease. Angiogenesis from thyroid cancer cell plays the important roles in post-surgical persistent, recurrent, and metastatic papillary thyroid cancer (PTC). Vascular endothelial growth factor (VEGF) Trapon is a newly developed VEGF-blocking agent with stronger affinity and broader activity than the anti-VEGF antibody bevacizumab. In this study, we tested the activity of VEGF Trapon on a PTC model in vivo.

MATERIALS AND METHODS

BC-PAP (derived from papillary carcinomas) transfected with a luciferase-expressing vector were injected into the back to mice. I.p. treatment with VEGF Trapon or control protein (25 mg/kg twice weekly) was started shortly after tumor injection to prevent tumor development (prevention model) or after established tumors were formed to inhibit tumor growth and metastasis formation (intervention model).

RESULTS

In the prevention model, VEGF Trapon inhibited tumor growth by 73 ± 12% compared with control (p = 0.014) and significantly prolonged survival. In the intervention model, VEGF Trapon inhibited tumor growth by 68 ± 7% (p < 0.01). Microvascular density was reduced by 56% due to VEGF Trapon treatment (p < 0.01).

CONCLUSIONS

VEGF Trapon is a potent inhibitor of BC-PAP tumor growth, angiogenesis and blocks the biological function of VEGF in vivo. These results support further clinical development of VEGF Trapon for PTC and other cancer types.

The effects of feeding time on milk production, total-tract digestibility, and daily rhythms of feeding behavior and plasma metabolites and hormones in dairy cows

The timing of feed intake entrains circadian rhythms regulated by internal clocks in many mammals. The objective of this study was to determine if the timing of feeding entrains daily rhythms in dairy cows. Nine Holstein cows were used in a replicated 3 × 3 Latin square design with 14-d periods. An automated system recorded the timing of feed intake over the last 7 d of each period. Treatments were feeding 1×/d at 0830 h (AM) or 2030 h (PM) and feeding 2×/d in equal amounts at 0830 and 2030 h. All treatments were fed at 110% of daily intake. Cows were milked 2×/d at 0500 and 1700 h. Milk yield and composition were not changed by treatment. Daily intake did not differ, but twice-daily feeding tended to decrease total-tract digestibility of organic matter and neutral detergent fiber (NDF). A treatment by time of day interaction was observed for feeding behavior. The amount of feed consumed in the first 2h after feeding was 70% greater for PM compared with AM feeding. A low rate of intake overnight (2400 to 0500 h; 2.2 ± 0.74% daily intake/h, mean ± SD) and a moderate rate of intake in the afternoon (1200 to 1700 h; 4.8 ± 1.1% daily intake/h) was noted for all treatments, although PM slightly reduced the rate during the afternoon period compared with AM. A treatment by time of day interaction was seen for fecal NDF and indigestible NDF (iNDF) concentration, blood urea nitrogen, plasma glucose and insulin concentrations, body temperature, and lying behavior. Specifically, insulin increased and glucose decreased more after evening feeding than after morning feeding. A cosine function within a 24-h period was used to characterize daily rhythms using a random regression. Rate of feed intake during spontaneous feeding, fecal NDF and iNDF concentration, plasma glucose, insulin, NEFA, body temperature, and lying behavior fit a cosine function within a 24-h period that was modified by treatment. In conclusion, feeding time can reset the daily rhythms of feeding and lying behavior, core body temperature, fecal NDF and iNDF concentration, and plasma blood urea nitrogen, glucose, and insulin concentration of dairy cows, but has no effect on daily DMI and milk production.

Downregulation of CD24 inhibits invasive growth, facilitates apoptosis and enhances chemosensitivity in gastric cancer AGS cells

BACKGROUND AND AIM

The human CD24 antigen is a small heavily glycosylated cell surface protein, which is expressed in a large variety of solid tumors,including gastric cancer. Enriched on the surface of many tumor cells,CD24 promotes tumor growth,invasion and metastasis and confers resistance to some chemotherapeutic drugs.In this study, we investigated the possible effect of CD24 suppression on proliferation, apoptosis, migration, invasion and chemosensitivity of gastric cancer (GC) cells.

MATERIALS AND METHODS

We down-regulated CD24 expression by RNA interference and investigated the effects on proliferation, apoptosis, chemosensitivity to doxorubicin, malignant and metastatic potential of a human gastric cancer cell line, AGS, CD24-suppressed clones, AGS-CD24-siRNA-C2, AGS-CD24-siRNA-C4 and AGS-CD24-siRNA-C5 in vitro. We evaluated the effects of CD24 suppression in vivo on xenograft tumor growth and metastatic properties following tail iv AGS-CD24-siRNA-C2, AGS-CD24-siRNA-C4 and AGS-CD24-siRNA-C5 clones. We also investigated the effect of CD24-siRNA followed by doxorubicin administration treatment on the xenograft tumor growth.

RESULTS

CD24 suppressed showed significantly decreased proliferation, invasion and increased apoptosis as well as increased chemosensitivity to doxorubicin in vitro and in vivo.

CONCLUSIONS

CD24 involves in proliferation, invasion and chemosensitivity of human gastric cancer cell line AGS, and that down-regulation of CD24 protein expression decreases the metastatic potential and increases chemosensitivity of gastric cancer (GC) cells. Thus, CD24 may be a promising therapeutic target for gastric cancer.

Knockdown of PLA2G2A sensitizes gastric cancer cells to 5-FU in vitro

BACKGROUND-AIM

Elevated expression of the PLA2G2A phospholipase in gastric cancer (GC) is associated with improved patient survival. PLA2G2A is also an important regulator of proliferation, invasion and metastasis in GC. However, no relation about PLA2G2A and chemosensitivity in GC cells was reported. 5-Fluorouracil (5-FU) is widely used for treatment of advanced gastric cancer. However, it is common for such patients to develop resistance to 5-FU, and this drug resistance becomes a critical problem for chemotherapy. The mechanisms underlying this resistance are largely unknown. In the present study, we investigated whether PLA2G2A could confer 5-FU resistance or sensitise in GC cells in vitro.

MATERIALS AND METHODS

The 5-FU sensitivity of GC cell lines SGC-7901, MKN-45, RF-48, N87, AGS, MKN-28, RF-1, MGC-803 were determined by MTT assays. PLA2G2A levels were determined by western blot assays. The effects of 5-FU on PLA2G2A expression were determined in vitro. PLA2G2A was inhibited by silencing of the PLA2G2A using small interfering RNA in vitro. PLA2G2A was overexpressed by transfection of full-long PLA2G2A cDNA in vitro, and the effects were evaluated on 5-FU sensitivity.

RESULTS

The cell lines SGC-7901, MKN-45, RF-48 and N87 were sensitive, whereas AGS, MKN-28, RF-1 and MGC-803 were resistant to 5-FU. Significant correlation was observed between basal PLA2G2A and 5-FU sensitivity. Silencing of PLA2G2A increased 5-FU killing in 5-FU-treated cells, and overexpression of PLA2G2A decreased 5-FU killing in 5-FU-treated cells.

CONCLUSIONS

PLA2G2A was correlated with sensitivity to 5-FU. Silencing of PLA2G2A was sensitive to 5-FU treatment. Thus, PLA2G2A may be a useful therapeutic target for a subset of gastric cancers.

Differential roles for the p101 and p84 regulatory subunits of PI3Kγ in tumor growth and metastasis

Phosphoinositide 3-kinase γ (PI3Kγ) consists of a catalytic subunit p110γ, which forms mutually exclusive dimers with one of the regulatory subunits called p101 and p84/p87(PIKAP). Recently, PI3Kγ emerged as being a potential oncogene because overexpression of the catalytic subunit p110γ or the regulatory subunit p101 leads to oncogenic cellular transformation and malignancy. However, the contribution of the individual subunits to tumor growth and metastasis and the mechanisms involved are not understood. We therefore individually knocked down the PI3Kγ subunits (p84, p101 and p110γ) in MDA-MB-231 cells, which reduced in vitro migration of the cell lines. Knockdown of p110γ or p101 inhibited apoptosis, Akt phosphorylation and lung colonization in SCID mice. Similarly, the knockdown of p110γ and p101 in murine epithelial carcinoma 4T1.2 cells inhibited primary tumor growth and spontaneous metastasis, as well as lung colonization. In contrast, knockdown of p84 in MDA-MB-231 cells enhanced Akt phosphorylation and lung colonization. These findings are the first to implicate differential functions of the two PI3Kγ regulatory subunits in the process of oncogenesis, and indicate that loss of p101 is sufficient to reduce in vivo tumor growth and metastasis to the same extent as that of p110γ.

[Purification of conjugated bilirubin from human urine]

OBJECTIVES

To develop a simple, practical method with fine yield and purity for separating conjugated bilirubin(Bc) from a sustainable and facile material in order that it could serve as a calibrator for total and direct bilirubin determination.

METHODS

Isolating Bc from urine of patients with obstructive jaundice by CHCl3: CH3CH2OH(1:1, V/V) followed by CNBr activated Sepharose 4B-HAS affinity chromatography, we analyzed the products by the use of Doumas J-G diazo method and HPLC, respectively.

RESULTS

Determined by J-G diazo method, the crude product extracted by CHCl3: CH3CH2OH(1:1, V/V) yields 90.2 +/- 5.4%(n = 3) of urine Bc, the ratio of Bc to total dry weight being 67.9 +/- 6.4%(n = 3). The final product purified by affinity chromatography with the ratio of separation of 1.5, 1.737 and analyzed by HPLC has the yield of 46.9% and purity of 94.7%(BDG of 76.2%, BMG of 18.5%).

CONCLUSION

The above data demonstrate that urine conjugated bilirubin can be successfully purified by CHCl3: CH3CH2OH extraction followed by Sephrose-HSA affinity chromatography with sufficient purity and output.

Advanced age a risk factor for illness temporally associated with yellow fever vaccination

In 1998, the Centers for Disease Control and Prevention was notified of severe illnesses and one death, temporally associated with yellow fever (YF) vaccination, in two elderly U.S. residents. Because the cases were unusual and adverse events following YF vaccination had not been studied, we estimated age-related reporting rates for systemic illness following YF vaccination. We found that the rate of reported adverse events among elderly vaccinees was higher than among vaccinees 25 to 44 years of age. We also found two additional deaths among elderly YF vaccinees. These data signal a potential problem but are not sufficient to reliably estimate incidence rates or to understand potential underlying mechanisms; therefore, enhanced surveillance is needed. YF remains an important cause of severe illness and death, and travel to disease-endemic regions is increasing. For elderly travelers, the risk for severe illness and death due to YF infection should be balanced against the risk for systemic illness due to YF vaccine.

Increased resistance to apoptosis in cells overexpressing thymosin beta four: A role for focal adhesion kinase pp125FAK

Loss of adherence to substrate can, by itself, induce apoptosis (anoikis) in epithelial cells, but does not do so in fibroblasts. To test the idea that adherence transmits signals that inhibit apoptosis even in fibroblasts, we took advantage of the greatly increased adherence to the substratum observed in NIH3T3 cell lines that overexpress thymosin beta four. We treated overexpressing (OE) and vector control lines with either ultraviolet light (UV) or tumor necrosis factor alpha (TNF alpha). When the cells were on a substratum, the more adherent OE cells were 2-fold more resistant to apoptosis induced by either treatment than vector controls. In contrast, when the cells were treated with either agent while in suspension, the difference in resistance between OE cells and vector controls was lost. Thus the increased resistance to apoptosis was dependent on adherence. There was no difference in the content of bcl-2 in the OE cells vs the controls. A connection between pp125FAK and resistance to apoptosis has been previously shown in primary cultures of fibroblasts. The Tbeta4 overexpressing cells have approximately 1.4x more pp125FAK than the controls, and the kinase is approximately 2-fold more phosphorylated in adherent OE cells than in the vector controls. The phosphorylation of pp125FAK decreased strikingly when the cells were put into suspension. In addition, twice as much paxillin associated with pp125FAK in OE adherent cells as in vector controls, but this difference was also lost in suspended cells. Our results support the concept of an adherence dependent pp125FAK-paxillin signalling pathway in fibroblasts that inhibits damage-induced apoptosis.

A quantitative analysis of G-actin binding proteins and the G-actin pool in developing chick brain

The large G-actin pool in individual actively motile cells has been shown to be maintained primarily by the actin sequestering protein thymosin beta four (Tbeta4). It is not clear whether Tbeta4 or an isoform also plays a primary role in neural tissue containing highly motile axonal growth cones. To address this question we have made a definitive analysis of the relative contributions of all the known G-actin sequestering proteins: Tbeta4, Tbeta10, profilin, and phosphorylated (inactive) and unphosphorylated (potentially active) forms of both ADF and cofilin, in relation to the G-actin pool in developing chick brain at embryonic days 13 and 17. From our measurements we estimate the intracellular concentration of G-actin as 30-37 microM and of Tbeta4 as 50-60 microM in an 'average' brain cell in embryonic chick brain. No other beta thymosin isoforms were detected in these brain extracts. The ratio of soluble, unphosphorylated ADF to Tbeta4 is only 1:7 at 13 embryonic days, but increases to 1:4 at 17 days. Profilin and cofilin concentrations are an order of magnitude lower than Tbeta4. Combining the contributions of Tbeta4, unphosphorylated ADF and unphosphorylated cofilin, we estimate a mean G-actin critical concentration of approximately 0.45 microM and approximately 0.2 microM, respectively, in day 13 and day 17 embryonic brain extracts, suggesting a significant developmental decrease. We conclude that (a) Tbeta4 is the major actin sequestering protein in embryonic chick brain and the only beta thymosin isoform present; (b) ADF may play a significant developmental role, as its concentration changes significantly with age; (c) the known G-actin binding proteins can adequately account for the G-actin pool in embryonic chick brain.

[Characterization of slowly-growing mycobacteria species by capillary gas chromatography]

A method for the characterization of mycobacteria species by capillary gas chromatography is described. After strains of mycobacteria being hydrolyzed, saponified in an acidic solution, various methyl esters resulted from mycobacteria were studied on an OV-101 column at optimum chromatographic conditions. The constituents of 9 slowly-growing mycobacteria species were analyzed and the results showed that there were obvious differences between different mycobacteria species, but same characteristics were observed between strains of the same species. The 9 species can be identified by the ratio of peak height of C18:1, C18:0 and TBSA. They are C18:1>TBSA>C18:0 for M. tuberculosis, C18:0>C18:1>TBSA for M. triviale, TBSA>C18:1>C18:0 for M. intracellulare, TBSA>C18:0>C18:1 for M. avium and C18:1>C18:0>TBSA for M. bovis, M. kansasii, M. gordonae, M. nonchromogenicum and M. terrae respectively. The 5 latter species can be distinguished by the presence of characteristic peaks of iC16:1 and C19:0. 75 strains of clinical isolated mycobacteria were analysed at the same chromatographic conditions. The results showed that they belonged to 9 different species. The accuracy of the proposed method was examined according to biological analysis.

A trial comparing nucleoside monotherapy with combination therapy in HIV-infected adults with CD4 cell counts from 200 to 500 per cubic millimeter. AIDS Clinical Trials Group Study 175 Study Team

BACKGROUND

This double-blind study evaluated treatment with either a single nucleoside or two nucleosides in adults infected with human immunodeficiency virus type 1 (HIV-1) whose CD4 cell counts were from 200 to 500 per cubic millimeter.

METHODS

We randomly assigned 2467 HIV-1--infected patients (43 percent without prior antiretroviral treatment) to one of four daily regimens: 600 mg of zidovudine; 600 mg of zidovudine plus 400 mg of didanosine; 600 mg of zidovudine plus 2.25 mg of zalcitabine; or 400 mg of didanosine. The primary end point was a > or = 50 percent decline in the CD4 cell count, development of the acquired immunodeficiency syndrome (AIDS), or death.

RESULTS

Progression to the primary end point was more frequent with zidovudine alone (32 percent) than with zidovudine plus didanosine (18 percent; relative hazard ratio, 0.50; P<0.001), zidovudine plus zalcitabine (20 percent; relative hazard ratio, 0.54; P<0.001), or didanosine alone (22 percent; relative hazard ratio, 0.61; P<0.001). The relative hazard ratios for progression to an AIDS-defining event or death were 0.64 (P=0.005) for zidovudine plus didanosine, as compared with zidovudine alone, 0.77 (P=0.085) for zidovudine plus zalcitabine, and 0.69 (P=0.019) for didanosine alone. The relative hazard ratios for death were 0.55 (P=0.008), 0.71 (P=0.10), and 0.51 (P=0.003), respectively. For zidovudine plus zalcitabine, the benefits were limited to those without previous treatment.

CONCLUSIONS

Treatment with zidovudine plus didanosine, zidovudine plus zalcitabine, or didanosine alone slows the progression of HIV disease and is superior to treatment with zidovudine alone. Antiretroviral therapy can improve survival in patients with 200 to 500 CD4 cells per cubic millimeter.

Nevirapine, zidovudine, and didanosine compared with zidovudine and didanosine in patients with HIV-1 infection. A randomized, double-blind, placebo-controlled trial. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group Protocol 241 Investigators

OBJECTIVE

To study the addition of a third human immunodeficiency virus type 1 (HIV-1) reverse transcriptase inhibitor, nevirapine, to the combination of zidovudine and didanosine.

DESIGN

A 48-week, randomized, double-blind, placebo-controlled trial at 16 AIDS (acquired immunodeficiency syndrome) Clinical Trials Units.

PATIENTS

398 adults who had HIV-1 infection, had 350 or fewer CD4+ T lymphocytes/mm3, and had had more than 6 months of previous nucleoside therapy.

INTERVENTION

1) Either nevirapine or placebo (200 mg/d for 2 weeks, then 400 mg/d thereafter) and 2) open-label zidovudine (600 mg/d) and didanosine (400 mg/d for patients weighing > or = 60 kg).

MEASUREMENTS

CD4+ T lymphocyte counts, time to first HIV-1 disease progression event or death, adverse events, and nevirapine levels in plasma samples taken at random were measured in all patients. Plasma levels of HIV-1 RNA HIV-1 infectivity titer in peripheral blood mononuclear cells; serum p24 antigen levels; and plasma levels of zidovudine and didanosine were measured in patients enrolled at half the study sites.

RESULTS

After 48 weeks of study treatment the patients assigned to the triple-combination regimen (nevirapine, zidovudine, and didanosine) had an 18% higher mean absolute CD4 cell count (95% Cl, 7% to 29%; P = 0.001), a 0.32 log10 lower mean infectious HIV-1 titer in peripheral blood mononuclear cells (Cl, 0.05 to 0.59 log10 infectious units per million cells; P = 0.023), and a 0.25 log10 lower mean plasma HIV-1 RNA level (Cl, 0.03 to 0.48 log10 RNA copies/mL; P = 0.028) than did patients assigned to the double-combination regimen (zidovudine and didanosine). Severe rashes were more common among patients assigned to receive the triple combination (9% compared with 2%; P = 0.002). Risk for disease progression did not differ between the two groups (relative hazard of the triple-combination group, 1.24 [Cl, 0.75 to 2.06]; P > 0.2), although the study had only moderate power to detect a major difference.

CONCLUSIONS

Adding nevirapine to zidovudine and didanosine improved the long-term immunologic and virologic effects of therapy and was associated with severe rash among the patients studied, who had had extensive previous therapy. These results support 1) the continuing development of combinations of more than two antiretroviral drugs to increase and prolong HIV-1 suppression and 2) the potential utility of nevirapine in combination regimens.

Antiretroviral monotherapy in early stage human immunodeficiency virus disease has no detectable effect on virus load in peripheral blood and lymph nodes

Initiation of antiretroviral monotherapy early in the course of infection with human immunodeficiency virus may result in a temporary slowing in the rate of disease progression; however, little is known about the virologic effects of early therapy. Virus load was measured in peripheral blood and lymph nodes from 16 antiretroviral-naive patients with a mean CD4 T lymphocyte count of 659 cells/microliter at baseline and after 8 weeks of either no treatment or zidovudine therapy. CD4 T lymphocyte counts and all virologic parameters examined remained unchanged regardless of zidovudine treatment status. Histopathology and virus distribution within lymph nodes remained constant between baseline and week 8 in each patient, indicating that the virologic and histologic parameters examined in a single lymph node are representative of a systemic process. Early antiretroviral monotherapy with zidovudine had no effect on virologic parameters in this group of patients with relatively high CD4 T lymphocyte counts and low measures of virus load at baseline.

Decreased human immunodeficiency virus type 1 plasma viremia during antiretroviral therapy reflects downregulation of viral replication in lymphoid tissue

Although several immunologic and virologic markers measured in peripheral blood are useful for predicting accelerated progression of human immunodeficiency virus (HIV) disease, their validity for evaluating the response to antiretroviral therapy and their ability to accurately reflect changes in lymphoid organs remain unclear. In the present study, changes in certain virologic markers have been analyzed in peripheral blood and lymphoid tissue during antiretroviral therapy. Sixteen HIV-infected individuals who were receiving antiretroviral therapy with zidovudine for > or = 6 months were randomly assigned either to continue on zidovudine alone or to add didanosine for 8 weeks. Lymph node biopsies were performed at baseline and after 8 weeks. Viral burden (i.e., HIV DNA copies per 10(6) mononuclear cells) and virus replication in mononuclear cells isolated from peripheral blood and lymph node and plasma viremia were determined by semiquantitative polymerase chain reaction assays. Virologic and immunologic markers remained unchanged in peripheral blood and lymph node of patients who continued on zidovudine alone. In contrast, a decrease in virus replication in lymph nodes was observed in four of six patients who added didanosine to their regimen, and this was associated with a decrease in plasma viremia. These results indicate that decreases in plasma viremia detected during antiretroviral therapy reflect downregulation of virus replication in lymphoid tissue.