Interferon inactivator(s) in patients with AIDS and AIDS-unrelated Kaposi's sarcoma

Nutrition and Infectious Diseases in Developing Countries and Problems of Acquired Immunodeficiency Syndrome

Infectious diseases are the major causes of death and morbidity in underdeveloped countries, particularly in children. Increasing evidence suggests that malnutrition—both Protein-Energy type Malnutrition (PEM) and essential micronutrient (vitamins, trace minerals, essential amino acids, polyunsaturated fatty acids) type—is the underlying reason for increased susceptibility to infections. On the other hand, certain infectious diseases also cause malnutrition, which results in a vicious cycle. Before its viral origin was known, acquired immunodeficiency syndrome (AIDS) had been termed the thin disease because cachexia was AIDS' main clinical manifestation.

The relationship between infection and malnutrition is well documented in the literature. Our experience supports this. Preventive and therapeutic measures are suggested.

Interferons and Interferon Inhibitory Activity in Disease and Therapy

Interferon (IFN) resistance is an important factor in the pathophysiology of neoplastic disorders, certain viral infections (e.g., AIDS), and autoimmune diseases (e.g., lupus erythematosus and Wegner's granulomatosis). In addition, in some of these disorders, there is also decreased ability to produce IFNs. The capacity of viruses and neoplastic processes to interfere with the IFN system are thought to represent a “virus-against-host” or “cancer-against-host” defense mechanism. Four resistance factors have been identified: 1) release of free IFN-α/β type 1 receptors into the circulation that, at appropriate concentrations, capture and inactivate IFNs; 2) a new IFN inhibitory protein has been isolated and its chemical structure is under study; 3) prostaglandin E2, which is produced by certain tumor cells, inhibits IFN production; and 4) high levels of cAMP phosphodiesterases present, for example in certain tumor cells, reduces cAMP, an important second messenger in IFN synthesis. Studies are under way to reverse these inhibitory effects and to increase endogenous interferon production.

Free interferon-?/? receptors in the circulation of patients with adenocarcinoma

BACKGROUND

Many viral and neoplastic diseases are resistant to interferon-alpha/beta (IFN-alpha/beta) therapy or develop resistance during the course of IFN treatment. In patients with viral diseases, the authors identified four IFN inhibitors, of which the most important, most likely is a free IFN receptor of type 1 appearing in the circulation that captures and neutralizes IFN-alpha/beta.

METHODS

Ninety-one cancer patients and 25 healthy individuals were studied. Free circulating IFN receptor-alpha/beta type 1 was studied. The patients were ages 35-75 years. The diagnoses were 24 cases of colon carcinoma, 7 cases of prostate carcinoma, 16 cases of breast carcinoma, 8 cases of ovarian carcinoma, 9 cases of uterine carcinoma, 5 cases of lung carcinoma, 3 cases of astrocytoma, 4 cases of transitional cell carcinoma of the bladder, 1 case of osteosarcoma, 3 cases of multiple myeloma, 4 cases of Hodgkin disease, 2 cases of non-Hodgkin lymphoma, 3 cases of myelodysplastic syndrome, and 2 disseminated tumors of unknown origin.

RESULTS

All patients were found to have increased free IFN receptor-alpha/beta type 1 in the circulation, with the highest levels reported in patients with adenocarcinoma.

CONCLUSIONS

High IFN inhibitory activity in patients with cancer may be a significant factor in their increased susceptibility to progressive disease, infectious complications, and resistance to IFN therapy. Ongoing studies are being performed with the objective of overcoming this inhibitory activity.

Serum Interferon Inhibitor Declines in Patients with HIV‐1 Infection After a Change in Antiretroviral Therapy

An inhibitor of interferon antiviral activity, which is absent in healthy HIV-seronegative persons, was detected in the sera of all 29 HIV-seropositive study participants. The relationship of the level of interferon inhibitor to CD4 count and HIV-RNA copy number was statistically significant in distinct models. Levels of interferon inhibitor declined by an average of 41-60% in patients who underwent a change in anti-retroviral therapy. Interferon inhibitor levels appear to decline as CD4 cell count rises and HIV-RNA levels fall. This suggests that interferon inhibitor may have a significant role in the host immune response to HIV infection.

Contradictory Concepts in the Etiology and Regression of Kaposi's Sarcoma. The Ferenc Györkey Memorial Lecture

The Introduction is an overview of 3 decades of works performed by Professor Ferenc Györkey (in many cases in collaboration with the author) and aimed at the elucidation of viral participation in the etiology of arteriosclerosis, SLE, hairy cell leukemia, HD, AIDS and KS. Controversial issues surrounding the etiology, treatment and regression of KS are discussed in terms of paracrine and autocrine loops of growth factors; protooncogene-oncogene activations, immunosuppression and retro- and/or herpesviral etiology. In regressing KS lesions the roles played by Fas, Bcl-2, Bax, TNFß; apoptotic-antiapoptotic events; and antiangiogenesis agents especially that of Hu-r-IFNa are elaborated on.

The limited role of the human interferon system response to respiratory syncytial virus challenge: analysis and comparison to influenza virus challenge

The respiratory syncytial virus (RSV)-induced production of interferon (IFN) by human macrophages and mononuclear leukocytes (MNL) and the sensitivities of RSV to subtypes of IFN-alpha were examined and compared to IFN production induced by influenza virus. Influenza virus induced high titers of total IFN bioactivity, transcription of the IFN-alpha 1 and IFN-beta gene products and production of IFN-gamma. In contrast, RSV induced minimal or no detectable total IFN activity, and the absence of IFN bioactivity could not be attributed to inhibitors of IFN activity. There was no detectable transcription of IFN-alpha or IFN-beta gene products by the cells exposed to RSV. RSV-exposed MNL did produce small amounts of IFN-gamma, consistent with prior sensitization of the cell donors to the virus, but titers were substantially lower than those induced by influenza virus. RSV showed minimal but equivalent susceptibility to several subtypes of IFN-alpha. The data raise the possibility that the IFN system has a limited direct role in early host defense against RSV infection, but results should not be extrapolated directly to in vivo events.

Effect of an interferon inhibitor on the antiproliferative signal of interferon-alpha

We have described a nonantibody type inhibitor of interferons (IFN) in the blood of patients with AIDS, advanced neoplastic disorders, and lupus erythematosus in earlier reports (1,2). In the present study we show that the semipurified inhibitor blocks the antiproliferative signal of IFN-alpha in Daudi cells and the membrane potential shifting ability of IFN-alpha is modulated by the interferon inhibitor preparation (IFI).

The interferon system in carcinoma of the cervix. Effect of radiation and chemotherapy

Thirteen patients with advanced carcinoma of the cervix were studied for parameters of the interferon system compared with 40 age-matched and sex-matched controls. All patients had measurable serum interferon levels; controls did not. All patients had non-antibody-type interferon-inhibitory activity, and controls had none. Interferon-synthesizing potential was higher in controls than in patients. After successful radiation and chemotherapy, these parameters normalized in the patients. No change was seen in one patient who did not respond to therapy.

Spontaneous release of interferon as a predictor of clinical evolution in HIV-positive subjects

In order to establish a correlation with disease progression we prospectively evaluated ten clinical and immunologic parameters in 102 consecutive HIV-positive subjects. The eight immunologic variables were: in vitro spontaneous interferon release by peripheral blood monocytic cells, alpha- and gamma-interferon production induced by Newcastle Disease Virus and PHA, Multitest Mérieux score, PHA- and CON-A-induced lymphocyte transformation, absolute number of CD4+ cells and CD4/CD8 ratio, respectively. The two baseline clinical variables were risk factor and disease presentation. Generalized Wilcoxon analysis indicated a significant correlation of one clinical (disease presentation at entry) and three immunologic variables (spontaneous interferon release, CD4+ cell number, Multitest Mérieux) with disease progression. Baseline spontaneous release of alpha, acid-labile interferon showed the best correlation with disease progression, and appeared to be significantly associated with CD4+ cell loss. Spontaneous release of acid-labile alpha interferon by mononuclear cells in vitro could be highly predictive of disease evolution in HIV-Ab positive, AIDS-free subjects.

The role of interferons in the control of HIV replication in macrophages

Interferons can suppress the replication of certain retroviruses, including oncogenic murine retroviruses. In recent studies of the Lentivirinae subfamily of Retroviridae, an endogenous, immunologically induced interferon was found to restrict the replication of visna in macrophages. Several studies have shown that the replication of a human lentivirus, the human immunodeficiency virus (HIV), is also susceptible to interferon control. Here we review the evidence that interferons can protect macrophages from HIV in vitro. Macrophages treated with interferons or bacterial lipopolysaccharide (LPS) become essentially nonpermissive for HIV replication. Using the polymerase chain reaction to amplify HIV proviral DNA, we now report that interferon and LPS act to restrict the formation of proviral DNA. Effects on any several steps in the HIV life cycle may explain this data, and single-cycle infection studies are needed to define the precise roles of these agents. Taken together, these findings may explain the restricted replication of HIV in macrophages in vivo and suggest an antiviral role for endogenously produced interferon in the maintenance of the prolonged asymptomatic period which typically follows HIV infection. Interferons are currently undergoing clinical trials to determine if they have antiviral effects in HIV-infected patients.

Interferon and interferon inhibitor levels in patients infected with varicella-zoster virus, acquired immunodeficiency syndrome, acquired immunodeficiency syndrome-related complex, or Kaposi's sarcoma, and in normal individuals

PURPOSE

Previous studies had reported that normal individuals do not have measurable levels of interferons in their circulation, whereas high levels have been found in patients in the early stages of AIDS (acquired immunodeficiency syndrome) and in those with AIDS-related complex (ARC). This study was undertaken to compare levels of interferon and interferon inhibitors in plasma samples from patients with AIDS, ARC, Kaposi's sarcoma, or varicella-zoster virus infection, and from control subjects.

PATIENTS AND METHODS

A total of 206 persons were tested for the presence of interferon and interferon inhibitors in their plasma: 76 with ARC or AIDS, with or without Kaposi's sarcoma or lymphoma; 32 with varicella-zoster infection; 12 with AIDS-unrelated Kaposi's sarcoma; and 86 normal control subjects at high or low risk of AIDS with or without positive antibody levels to human immunodeficiency virus-1. Total interferon activity was measured by bioassay and the subtypes were not separated.

RESULTS

Of 86 normal control subjects, 85 had no significant levels of interferon or interferon inhibitor. One disease-free homosexual exhibited measurable interferon levels. Patients acutely infected with varicella-zoster virus showed no measurable interferon or inhibitor levels except if they were in a high-risk group for AIDS. Seventy-six patients with ARC or AIDS exhibited measurable circulating interferon levels. Only patients with AIDS had interferon inhibitors in their circulation. Of 12 patients with Kaposi's sarcoma unrelated to AIDS, none had measurable interferon inhibitor levels, but some exhibited measurable interferon levels.

CONCLUSION

It is suggested that levels of interferon inhibitor should be considered when interferon is used therapeutically in viral or neoplastic diseases.

Augmentation of natural cytotoxicity by leucine enkephalin in cultured peripheral blood mononuclear cells from patients infected with human immunodeficiency virus

Natural Killer (NK) activity of lymphocytes from acquired immunodeficiency syndrome (AIDS) patients is frequently below normal and declines as disease progresses. We studied the potential of leucine enkephalin (leu-enkephalin) to restore this immune parameter by incubating nylon wool nonadherent mononuclear cells from 14 patients in the presence or absence of leu-enkephalin, and measuring NK cytolysis in a standard 51Cr release assay. The NK activity of human immunodeficiency virus antibody positive (HIV+) individuals with some remaining NK lytic ability was significantly augmented by leu-enkephalin concentrations of 10(-10) and 10(-8) M (n = 7). HIV+ patients with no measurable basal level of NK activity (n = 3) were not responsive to stimulation with leu-enkephalin. Human immunodeficiency virus antibody negative (HIV-) individuals (n = 4) responded in a pattern similar to normals. In addition, naloxone, an antagonist of alkaloid and peptide opiates including leu-enkephalin, displayed the properties of an antagonist/agonist, reflecting the immunoregulatory capacities of the endogenous opiate system.

Inhibition of growth of HIV by human natural interferon in vitro

The effect of human natural interferons (IFN) alpha, beta, and gamma on the replication of human immunodeficiency virus (HIV) strain LAV in T cell lines TALL-1 and CCRF-CEM and peripheral blood lymphocytes (PBL) was studied. The growth of TALL-1 was moderately sensitive to these IFN, whereas that of CCRF-CEM was resistant to them. The progeny virus yield of LAV in TALL-1 at the time of its peak was reduced to 10% of the control level at IFN-alpha, beta, and gamma concentrations of 3, 11, and 23 IU/ml, respectively. These concentrations of IFN-alpha, beta, and gamma did not affect the cell growth. In CCRF-CEM, IFN-alpha, beta, and gamma at the concentration of 50, 60, and 76 IU/ml reduced the progeny virus to 10% of the control level. The virus growth in PBL was more sensitive to IFN than that in CCRF-CEM. The progeny virus yield was reduced to 10% of the control level by IFN-alpha and beta concentrations of 5 IU/ml and less than 5 IU/ml, respectively.

Antiviral agents

Potent effective antiviral drugs recently have been licensed for several viral diseases, ushering in a new era in the treatment of viral diseases. Several unique features in the process of a viral infection have been identified as target points for inhibition. The unique steps and the interfering compounds are the subject of this review.

Elevated HLA class I antigen expression on peripheral blood mononuclear cells of HBsAg carriers with coexistent human immunodeficiency virus infection

The density of HLA Class I antigen on peripheral blood mononuclear cells was evaluated by flow cytometry in the following groups of patients: 41 HBsAg carriers; 12 individuals with chronic non-A, non-B hepatitis, and 4 with acute hepatitis B. Fourteen of the carriers were positive for antibody to human immunodeficiency virus, and all were negative for antibody to delta agent. Elevated levels of Class I antigen were observed in only 19% of patients with chronic hepatitis B virus infection alone. In contrast, 86% of HBsAg carriers with coexistent human immunodeficiency virus infection demonstrated increased expression. These data suggest that HBsAg carriers are capable of sustaining a systemic interferon response to another chronic viral infection and further supports the hypothesis that a defective interferon response exists in chronic hepatitis B virus infection.