The V3 loops of the HIV-1 and HIV-2 surface glycoproteins contain proteolytic cleavage sites: a possible function in viral fusion?

Located close to the crown of the V3 type-specific neutralization loop of the human immunodeficiency virus type 1 (HIV-1) (IIIB) SU glycoprotein gp120, are several potential sites that should be susceptible to proteolytic cleavage by enzymes of trypsinlike or chymotrypsinlike specificity, or by aspartic proteinases. The linkages potentially sensitive to chymotryptic/aspartic proteinase cleavage are retained also within the equivalent domain of HIV-2 (ROD) gp105. We show that thrombin and tryptase cleave HIV-1 gp120 specifically at the tryptic site (GPGR decreases AFVT), and that cathepsin E, an endosomal aspartic proteinase, cleaves at the chymotrypsinlike site (GPGRAF decreases VT). HIV-2 gp105 is also cut by cathepsin E at a site (QIML decreases MSGH) in its V3 loop. Cleavage of HIV-1 gp120 by thrombin is enhanced by sCD4 binding, but is prevented by transient exposure of gp120 to nonionic detergent. Thrombin treatment of HIV-1 gp120 destroys the binding sites for some neutralizing monoclonal antibodies (MAbs) on the V3 loop, but does not affect the affinity of gp120 for sCD4. Conversely, binding of neutralizing MAbs to the HIV-1 V3 loop prior to addition of thrombin or cathepsin E blocks the cleavage reactions, and the binding of some HIV-positive sera to gp120 blocks thrombin cleavage. Analysis of published sequences suggests that all HIV-1, HIV-2, and simian immunovirus (SIV) isolates contain potential proteolytic cleavage sites at similar positions in their V3 loops or equivalent domains. We suggest that cleavage of the V3 loop by a cell surface or endosomal proteinase occurs during the HIV-cell fusion reaction, and that neutralizing antibodies directed against the V3 loop might act by inhibition of this reaction.

Combined intravenous and oral pentoxifylline in the treatment of peripheral vascular disease. A clinical trial

Sixteen patients with severe occlusive vascular disease of the lower extremities were randomised to receive a five day course of combined intravenous and oral Pentoxifylline followed by three months oral treatment only, or identical treatment with a matching placebo. Nine patients received active Pentoxifylline, and 7 placebo, Follow-up by regular clinical examination and haemoreological assessment revealed a marked improvement in claudication distance and an increase in red cell deformability in those receiving Pentoxifylline, there being no change in those receiving placebo. Although both of the above parameters were improved by the treatment, there did not appear to be a direct correlation between red cell deformability and claudication distance in individual patients. A combination of intravenous and oral Pentoxifylline therapy results in an increase in both claudication distance and red cell deformability, but the former may not te a direct consequence of the latter.

Characterization of recombinant gp120 and gp160 from HIV-1: binding to monoclonal antibodies and soluble CD4

We compared four preparations of recombinant HIV-1 envelope glycoprotein: mammalian (Chinese hamster ovary cells) gp120 (Celltech); baculovirus gp120 from American Biotechnologies Inc. (ABT) and from MicroGeneSys (MGS); and baculovirus gp160 (Institute of Virology, Oxford, UK). Each envelope glycoprotein binds to a neutralizing monoclonal antibody (MAb) directed against the V3 loop, confirming the integrity of this type-specific neutralization epitope. MGS gp120 binds abnormally well to a MAb which recognizes an epitope preferentially exposed on denatured gp120. Consistent with this finding, MGS gp120 binds to soluble CD4 (sCD4) with an affinity 50-100-fold lower than that of Celltech gp120. The affinity of Celltech gp120 from sCD4 is 2.3 nM, indistinguishable from that of gp120 extracted from HIV-1 virions. Baculovirus gp120 (ABT) and gp160 also have a high affinity for sCD4. A significant proportion of anti-gp120 antibodies in HIV-positive human sera recognize epitopes that are dependent on the mammalian glycosylation pattern, and a human HIV-positive serum inhibits the binding of mammalian gp120 to sCD4 five- to 10-fold more potently than it inhibits baculovirus gp120 binding to sCD4.

A 125I-radioimmunoassay for measuring androstenedione in serum and in blood-spot samples from neonates

We developed a radioimmunoassay with a gamma-emitting radioligand to measure androstenedione in human serum and in dried blood-spot samples from newborns. Antisera were raised in rabbits against androstenedione linked to bovine serum albumin at positions 3, 6, or 11 on the steroid nucleus. Radioligands were prepared by linking [125I]iodohistamine at positions 3, 6, or 11. Linkages were through either carboxymethyloxime or hemisuccinate bridges. All label and antibody combinations were examined, and the most sensitive and specific combination (antiserum raised against androstenedione-3-carboxymethyloxime-bovine serum albumin with an androstenedione-carboxymethyloxime-[125I]iodohistamine label) was selected for full evaluation. We report the performance of these selected reagents in an immunoassay for androstenedione in both serum and dried blood-spot samples from neonates. We measured concentrations of androstenedione in serum under normal and pathological conditions such as congenital adrenal hyperplasia and polycystic ovarian disease. Diurnal variation in normal men was observed. Androstenedione was measured in blood spots from neonates born at term or prematurely, with respiratory distress syndrome, or with congenital adrenal hyperplasia.

A 125I-radioimmunoassay for measuring androstenedione in serum and in blood-spot samples from neonates

We developed a radioimmunoassay with a gamma-emitting radioligand to measure androstenedione in human serum and in dried blood-spot samples from newborns. Antisera were raised in rabbits against androstenedione linked to bovine serum albumin at positions 3, 6, or 11 on the steroid nucleus. Radioligands were prepared by linking [125I]iodohistamine at positions 3, 6, or 11. Linkages were through either carboxymethyloxime or hemisuccinate bridges. All label and antibody combinations were examined, and the most sensitive and specific combination (antiserum raised against androstenedione-3-carboxymethyloxime-bovine serum albumin with an androstenedione-carboxymethyloxime-[125I]iodohistamine label) was selected for full evaluation. We report the performance of these selected reagents in an immunoassay for androstenedione in both serum and dried blood-spot samples from neonates. We measured concentrations of androstenedione in serum under normal and pathological conditions such as congenital adrenal hyperplasia and polycystic ovarian disease. Diurnal variation in normal men was observed. Androstenedione was measured in blood spots from neonates born at term or prematurely, with respiratory distress syndrome, or with congenital adrenal hyperplasia.

A bloodspot androstenedione assay suitable for home-monitoring of steroid replacement therapy in congenital adrenal hyperplasia

A bloodspot assay has been developed using an antiserum raised against androstenedione-3-carboxymethyloxime-bovine serum albumin (AD-3CMO-BSA) conjugate and 125I-AD-3CMO-histamine tracer. The method has a detection limit of 0.6 nmol/L blood and a working range from 0.6 to 40 nmol/L blood. The between-batch precision ranged from 8.4% to 23.3%. Bloodspot androstenedione (AD) concentrations were measured in 50 neonates (26 male, 24 female) and in 95 children (54 male, 41 female) aged 6 months to 18 years. No sex difference in concentrations was found in neonates, in pre-pubertal children up to 8 years of age, in pubertal children (males 8-16 years, females 8-14 years) or post-puberty. Bloodspot AD concentrations ranged from less than 0.6 to 2.7 nmol/L in neonates, less than 0.6 nmol/L in pre-pubertal children, 0.6-2.1 nmol/L in pubertal children and less than 0.6-4.6 nmol/L post-puberty. Daytime bloodspot profiles in 10 children on replacement therapy for congenital adrenal hyperplasia generally showed good correlation between 17 alpha-hydroxyprogesterone and AD concentrations (r = 0.928, P less than 0.001). Bloodspot AD profiles have advantages over 17 alpha-hydroxyprogesterone profiles for the assessment of the adequacy of glucocorticoid replacement therapy.

Explosive anaesthetic agents. A regional survey on the use of ether and cyclopropane

A total of 156 consultant anaesthetists in the North East Thames Regional Health Authority were circulated with a questionnaire on their personal use of ether and cyclopropane and their attitudes towards restriction or withdrawal of these agents: 144 completed questionnaires were received (92% response). Four anaesthetists (3%) claimed to use ether regularly at least once a month and 27 anaesthetists (19%) felt that their anaesthetic practice would suffer if ether were withdrawn. Cyclopropane had 62 regular users (43%) and 65 anaesthetists (45%) felt that their practice would suffer if it were withdrawn. Ninety-two anaesthetists (64%) were prepared to confine their use of explosive agents to either the anaesthetic room or the operating room; of these, three-quarters favoured the anaesthetic room. There were few notable differences in the pattern of use of explosive agents between anaesthetists with more than 21 years in the specialty and those with less than 21 years.

Subarachnoid hemorrhage: epidemiology, diagnosis, management, and outcome

A population-based study of primary subarachnoid hemorrhage in Auckland (population 829,454), New Zealand, identified 180 cases in a two-year period. This represented an age adjusted incidence rate of 10.5 and 18.3 per 100,000 for men and women respectively. Sixty-eight percent of all cases had a proven intracranial aneurysm or arteriovenous malformation, 15% had negative angiographic findings and in the remaining 17%, the presence or absence of a localized lesion was unknown since neither angiography nor autopsy were performed. Twenty-six patients (15%) died before hospitalization and a further 36 patients (20%) died within 48 hours of onset. Only 94 patients (53% of all patients registered) were fit enough to undergo angiography. A surgical operation was carried out on 60 of the 68 patients in whom an aneurysm was confirmed at angiography. The overall case fatality rate was 36% within the first 48 hours, 43% in the first week and 57% at both six months and one year. The high early case fatality rates are similar to those found in previous population-based studies, suggesting that despite the major advances to individual patients from technological advances, the potential contribution of hospital management to the reduction of subarachnoid haemorrhage mortality rates is likely to be limited.

A new device for delayed hypersensitivity skin testing

A new device for assessment of delayed cutaneous hypersensitivity using seven standardized antigens (Multitest CMI) was compared to conventional intradermal testing with two recall antigens in 83 patients referred for nutritional support. Sixteen patients (19.3%) were anergic to Multitest CMI while four (4.8%) were anergic to conventional testing. Patients anergic to Multitest CMI had a higher complication (intraabdominal abscess, prolonged ileus, sepsis, pneumonia) than those who were immunocompetent by this test suggesting a group at greater risk. This interpretation is consistent with an increased specificity of Multitest CMI over conventional testing in the identification of clinically important anergy.

Evaluation of an automated image analysis system for counting human tumor colonies

The Omnicon FAS II image analysis system was applied to counting tumor colonies grown in a soft agar human tumor clonogenic assay with a detailed protocol designed to assess the instrument's sensitivity, specificity, precision, and accuracy. Comparisons of technician and instrument counts were done on a blinded basis. Sensitivity studies (which used metal microspheres) yielded a correlation coefficient (r) of 0.999 between technicians and the counter. A field-by-field analysis of the instrument's specificity for identifying individual objects correctly as tumor colonies rather than artifacts (as identified by the technician) was excellent (r = 0.95). In the precision studies (determined with repeated automated counting of the same samples for five days), the median coefficient of variation was less than 7%. Accuracy was evaluated on cultures of fresh biopsies from 30 human cancers obtained for drug sensitivity testing as well as on a series of tumor cell lines. The correlation between the mean number of colonies counted by the technicians and by the colony counter was greater than 0.91. Similar comparisons of mean percent survival of tumor colony-forming cells after drug exposure between technician and machine were also quite acceptable (r = 0.85). We conclude that the colony counter provided sufficient reliability to be applied to counting human tumor colonies grown in vitro. In addition, the colony counter performed the Petri dish counts ten times faster than experienced technicians and without associated operator fatigue.

Cephalometric evaluation of the changes in patients wearing complete dentures. A ten-year longitudinal study

This study analyzed the longitudinal cephalometric head films of 37 edentulous patients over a 10-year period. The purpose of the investigation was to document changes within the craniofacial complex, residual ridge resorption, and position of the dentures. The changes were correlated with the following variables: age, sex, skeletal pattern, number of years edentulous, technique of denture fabrication, and nighttime wear of the dentures. Findings in this study suggest the following. The maxillae and the mandible showed sagittal spatial counterclockwise displacement. Complete dentures exhibit a counterclockwise rotation and forward movement. Soft tissue seating is more important than alveolar ridge resorption in the positional changes of complete dentures. Variation in denture techniques had no influence on the observed changes. Artificial porcelain teeth did not show a measurable amount of attrition during the 10-year observation period. Observed changes were not significantly affected by variables such as sex, years edentulous, nighttime wear, or skeletal pattern. Two exceptions were that the skeletal pattern affects prognathism and number of years edentulous affects mandibular ridge resorption.

Autologous bone marrow transplantation in relapsed adult acute leukemia

From March, 1976 to February, 1979, 28 cases of adult acute leukemia of which 24 were evaluable were treated in irreversible relapse with high dose chemotherapy (piperazinedione) and supra-lethal total body irradiation (TBI) in conjunction with autologous bone marrow transplantation (ABMT). The marrow cells grafted were collected and stored in liquid nitrogen at the time of remission. In 12 patients the marrow cells were fractionated using discontinuous albumin gradients in an attempt to separate normal cells from residual leukemic cells. Twelve patients achieved complete remission (CR); in 9 additional patients signs of engraftment were evident but death occurred before achievement of CR. Seven of 12 AML patients, which were treated with bone marrow transplantation as first treatment of their relapse, achieved CR. Four of 5 patients with ALL, whose bone marrows were collected during first remission, reached CR. The median CR duration was 4+ months and the median survival of the patients reaching CR was 6+ months. Autologous bone marrow transplantation offers a good chance of CR (66%) when marrow is collected during first remission and used as first treatment for AML in third relapse and ALL in second relapse.