Hepatitis E: the West of Scotland experience

BACKGROUND AND AIMS

Hepatitis E virus is traditionally regarded as a virus of the developing world and is emerging as a leading cause of non-A/B/C hepatitis. We wished to investigate locally acquired transmission of hepatitis E in the West of Scotland and compare our use of traditional serology versus polymerase chain reaction since the introduction of polymerase chain reaction in 2007.

METHODS

Clinical details provided on specimens of blood positive for hepatitis E virus by serology or polymerase chain reaction were collated and analysed.

RESULTS

Since 2007, 30 samples were hepatitis E virus-positive by serology or polymerase chain reaction. Polymerase chain reaction positivity was generally associated with positive serology although four samples were polymerase chain reaction-negative and strongly positive by serology. Interestingly, one-quarter of cases were likely to represent endogenous transmission of the infection.

CONCLUSIONS

Polymerase chain reaction is valuable in reliably diagnosing hepatitis E virus. However, serology is valuable for diagnosing resolved infection. There may be a high level of undiagnosed locally acquired hepatitis E virus in Scotland.

Detailed molecular characterisation of acute myeloid leukaemia with a normal karyotype using targeted DNA capture

Advances in sequencing technologies are giving unprecedented insights into the spectrum of somatic mutations underlying acute myeloid leukaemia with a normal karyotype (AML-NK). It is clear that the prognosis of individual patients is strongly influenced by the combination of mutations in their leukaemia and that many leukaemias are composed of multiple subclones, with differential susceptibilities to treatment. Here, we describe a method, employing targeted capture coupled with next-generation sequencing and tailored bioinformatic analysis, for the simultaneous study of 24 genes recurrently mutated in AML-NK. Mutational analysis was performed using open source software and an in-house script (Mutation Identification and Analysis Software), which identified dominant clone mutations with 100% specificity. In each of seven cases of AML-NK studied, we identified and verified mutations in 2-4 genes in the main leukaemic clone. Additionally, high sequencing depth enabled us to identify putative subclonal mutations and detect leukaemia-specific mutations in DNA from remission marrow. Finally, we used normalised read depths to detect copy number changes and identified and subsequently verified a tandem duplication of exons 2-9 of MLL and at least one deletion involving PTEN. This methodology reliably detects sequence and copy number mutations, and can thus greatly facilitate the classification, clinical research, diagnosis and management of AML-NK.

Meeting report: Spontaneous lesions and diseases in wild, captive-bred, and zoo-housed nonhuman primates and in nonhuman primate species used in drug safety studies

The combination of loss of habitat, human population encroachment, and increased demand of select nonhuman primates for biomedical research has significantly affected populations. There remains a need for knowledge and expertise in understanding background findings as related to the age, source, strain, and disease status of nonhuman primates. In particular, for safety/biomedical studies, a broader understanding and documentation of lesions would help clarify background from drug-related findings. A workshop and a minisymposium on spontaneous lesions and diseases in nonhuman primates were sponsored by the concurrent Annual Meetings of the American College of Veterinary Pathologists and the American Society for Veterinary Clinical Pathology held December 3-4, 2011, in Nashville, Tennessee. The first session had presentations from Drs Lowenstine and Montali, pathologists with extensive experience in wild and zoo populations of nonhuman primates, which was followed by presentations of 20 unique case reports of rare or newly observed spontaneous lesions in nonhuman primates (see online files for access to digital whole-slide images corresponding to each case report at http://www.scanscope.com/ACVP%20Slide%20Seminars/2011/Primate%20Pathology/view.apml). The minisymposium was composed of 5 nonhuman-primate researchers (Drs Bradley, Cline, Sasseville, Miller, Hutto) who concentrated on background and spontaneous lesions in nonhuman primates used in drug safety studies. Cynomolgus and rhesus macaques were emphasized, with some material presented on common marmosets. Congenital, acquired, inflammatory, and neoplastic changes were highlighed with a focus on clinical, macroscopic, and histopathologic findings that could confound the interpretation of drug safety studies.

Efficacy of intranasal administration of a modified live feline herpesvirus 1 and feline calicivirus vaccine against disease caused by Bordetella bronchiseptica after experimental challenge

BACKGROUND

Studies suggest that intranasal vaccination can stimulate nonspecific immunity against agents not contained within the vaccine, but this effect is not reported for cats.

HYPOTHESIS

A modified live feline herpesvirus-1 (FHV-1) and feline calicivirus (FCV) intranasal vaccine will reduce clinical signs of disease caused by experimental infection with Bordetella bronchiseptica.

ANIMALS

Twenty specific pathogen-free 12-week-old kittens.

METHODS

Experimental study. Cats were randomized into 2 groups of 10 cats each. The vaccinated group was administered a single intranasal dose of a commercially available vaccine containing modified live strains of FHV-1 and FCV, and the control group remained unvaccinated. All 20 cats were administered B. bronchiseptica by nasal inoculation 7 days later and were observed daily for clinical signs of illness for 20 days.

RESULTS

In the first 10 days after B. bronchiseptica challenge, vaccinated cats were less likely to be clinically ill than control cats with a median clinical score of 0/180 (range 0-5) versus 2/180 (range 0-8) (P = .01). Nine of 10 control cats and 2 of 10 vaccinated cats were recorded as sneezing during days 1-10 after challenge (P = .006).

CONCLUSIONS AND CLINICAL IMPORTANCE

Intranasal vaccination against FHV-1 and FCV decreased signs of illness due to an infectious agent not contained in the vaccine. This nonspecific immunity could be beneficial for protection against organisms for which vaccines are not available and as protection before development of vaccine-induced humoral immunity.

Uptake of Huntington disease predictive testing in a complete population

Using the Northern Ireland Huntington disease (HD) register, the number of prospectively recorded predictive tests was analysed over a 20-year period. Two hundred and twelve patients completed predictive testing. Ninety-two (43%) received mutation-positive results and 119 (56%) mutation negative. There was one intermediate allele result. There was no significant gender difference. One hundred and eighty affected cases confirmed by molecular genetic testing were alive on 1 January 2001. The uptake of predictive testing in the entire HD 50% at-risk population in 2001 was calculated by three methods giving a range of 12.3-14.6%. Uptake after 20 years was estimated to be 14.7%. The minimum prevalence of affected HD cases was calculated as 10.6/100,000 in 2001. The total uptake of predictive testing was calculated and it suggests that a substantial number of at-risk patients do not come forward for testing until symptomatic. Pre-symptomatic testing for this late-onset condition with no present treatment, and limited management options, still presents challenges for families.

Optical cochlear implants: evaluation of surgical approach and laser parameters in cats

Previous research has shown that neural stimulation with infrared radiation (IR) is spatially selective and illustrated the potential of IR in stimulating auditory neurons. The present work demonstrates the application of a miniaturized pulsed IR stimulator for chronic implantation in cats, quantifies its efficacy, and short-term safety in stimulating auditory neurons. IR stimulation of the neurons was achieved using an optical fiber inserted through a cochleostomy drilled in the basal turn of the cat cochlea and was characterized by measuring compound action potentials (CAPs). Neurons were stimulated with IR at various pulse durations, radiant exposures, and pulse repetition rates. Pulse durations as short as 50 mus were successful in evoking CAPs in normal as well as deafened cochleae. Continual stimulation was provided at 200 pulses per second, at 200 mW per pulse, and 100 mus pulse duration. Stable CAP amplitudes were observed for up to 10 h of continual IR stimulation. Combined with histological data, the results suggest that pulsed IR stimulation does not lead to detectable acute tissue damage and validate the stimulation parameters that can be used in future chronic implants based on pulsed IR.

Short communication: Genetic and nongenetic factors influencing Ostertagia ostertagi antibodies in UK Holstein-Friesian cattle

The purpose of this study was to estimate and discuss the genetic variation, heritability, and effects of nongenetic factors on the ability of Holstein-Friesian cows to produce an immune response by producing IgG antibodies to Ostertagia ostertagi. Total IgG (IgG(1) and IgG(2)) antibody levels were determined using an ELISA and measured using optical density ratio (ODR=OD(sample) - OD(negative control)/OD(positive control) - OD(negative control)) from milk samples collected from 1,276 Holstein-Friesian cattle in 229 commercial dairy farms from 2002 to 2004 during their first (82%) and other (2 to 12) lactations. A sire (n=461) model was fitted to the ODR data using ASREML software, and variance components were estimated. The ability to produce O. ostertagi antibodies as measured by ODR had a heritability of 0.13+/-0.12, and both season of sample and herd had a significant effect on total IgG levels. To conclude, this study has ascertained that genetic variation is present in the ability of dairy cows to mount an immune response to the parasite O. ostertagi. Inasmuch as evidence exists that IgG is linked to protective immunity against the parasite via a reduction in its reproductive ability, this trait may be of potential interest to genetic selection programs as an aid to reduce the effect of O. ostertagi in dairy herds.

α8-integrins are required for hippocampal long-term potentiation but not for hippocampal-dependent learning

Integrins are heterodimeric transmembrane cell adhesion receptors that are essential for a wide range of biological functions via cell-matrix and cell-cell interactions. Recent studies have provided evidence that some of the subunits in the integrin family are involved in synaptic and behavioral plasticity. To further understand the role of integrins in the mammalian central nervous system, we generated a postnatal forebrain and excitatory neuron-specific knockout of alpha8-integrin in the mouse. Behavioral studies showed that the mutant mice are normal in multiple hippocampal-dependent learning tasks, including a T-maze, non-match-to-place working memory task for which other integrin subunits like alpha3- and beta1-integrin are required. In contrast, mice mutant for alpha8-integrin exhibited a specific impairment of long-term potentiation (LTP) at Schaffer collateral-CA1 synapses, whereas basal synaptic transmission, paired-pulse facilitation and long-term depression (LTD) remained unaffected. Because LTP is also impaired in the absence of alpha3-integrin, our results indicate that multiple integrin molecules are required for the normal expression of LTP, and different integrins display distinct roles in behavioral and neurophysiological processes like synaptic plasticity.

A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain

AIM

To compare the effect of an initial early computed tomography (CT) examination versus standard practice (SP) on the length of hospital stay, diagnostic accuracy, and mortality of adults presenting with acute abdominal pain.

MATERIALS AND METHODS

Two hundred and five adults presenting with acute abdominal pain were randomized to undergo an early CT examination or current SP, which comprised supine abdominal and erect chest radiography. One hundred and ninety-eight patients (99 in each arm) were included in the analysis. The primary endpoint was the duration of inpatient stay; secondary endpoints were diagnostic certainty and mortality.

RESULTS

There was no significant difference in the length of hospital stay between the two arms (p=0.20). At randomization 36% (35 of 96) of CT patients and 49% (48 of 98) of SP patients were correctly diagnosed; 24h after randomization the correct diagnosis had been established in 84% of CT patients and 73% of SP patients. This refinement in diagnostic certainty was significantly better in the CT group (p<0.001). There was no difference in mortality between the two trial arms (p=0.31).

CONCLUSION

Early abdominal CT in patients with acute abdominal pain improves diagnostic certainty, but does not reduce the length of hospital stay and 6 month mortality.