Surrogate markers for assessing treatment response in HIV disease

Cellular imaging in drug discovery

Traditional screening paradigms often focus on single targets. To facilitate drug discovery in the more complex physiological environment of a cell or organism, powerful cellular imaging systems have been developed. The emergence of these detection technologies allows the quantitative analysis of cellular events and visualization of relevant cellular phenotypes. Cellular imaging facilitates the integration of complex biology into the screening process, and addresses both high-content and high-throughput needs. This review describes how cellular imaging technologies contribute to the drug discovery process.

Shortening of the window period in diagnosis of HIV-1 infection by simultaneous detection of p24 antigen and antibody IgG to p17 and reverse transcriptase in serum with ultrasensitive enzyme immunoassay

Following HIV infection, there is a window period of 6-8 weeks, during which HIV antibodies are not detectable and the infection cannot be diagnosed by methods for detecting HIV antibodies. However, HIV antigens are detectable in the latter part of the window period, although the level of HIV antigens declines as the level of HIV antibodies increases. We developed an ultrasensitive enzyme immunoassay (immune complex transfer enzyme immunoassay) for the simultaneous detection of both p24 antigen of HIV-1 and antibody IgGs to p17 and reverse transcriptase of HIV-1 in a single assay tube and tested 11 HIV-1 seroconversion serum panels and serum samples randomly collected from 79 HIV-1 seropositive subjects and 100 HIV-1 seronegative subjects. The simultaneous detection was shown not only to shorten the window period significantly as compared with conventional methods for HIV-1 antibody detection but also to make possible a reliable diagnosis of HIV-1 infection from the time of seroconversion until late stages of the infection.

Earlier diagnosis of HIV-1 infection by simultaneous detection of p24 antigen and antibody IgGs to p17 and reverse transcriptase in serum with enzyme immunoassay

Serum samples of four HIV-1 seroconversion serum panels were subjected in a single assay tube simultaneously to ultrasensitive enzyme immunoassays (immune complex transfer enzyme immunoassays) for p24 antigen of HIV-1 and for antibody IgGs to p17 and reverse transcriptase (RT) of HIV-1. Signals became positive 7-15 days earlier than the detection of antibodies to HIV-1 by conventional methods and remained strongly positive even after levels of p24 antigen declined. Thus the simultaneous detection of p24 antigen and antibody IgGs to p17 and RT made possible both as early a diagnosis of HIV-1 infection as the appearance of p24 antigen in the circulation, shortening "the window period," and as reliable a diagnosis of the infection as that by the detection of antibodies to HIV-1 from the time of seroconversion until late stages of the infection, since the serum level of antibody IgG to RT was high not only in asymptomatic carriers but also in patients with AIDS-related complex and AIDS.

A survey of endpoint characteristics in periodontal clinical trials published 1988-1992, and implications for future studies

Endpoints are conditions or events that are associated with individual study subjects and that are used to assess treatment efficacy. 2 types of endpoints can be distinguished: "true" endpoints (reflect unequivocal evidence of tangible benefit to the patient) and "surrogate" endpoints (usually a measure of disease process). The purpose of this study was to survey four aspects of endpoint usage in randomized controlled trials (RCT's) on the treatment of periodontitis: (1) the typical number of endpoints per RCT, (2) the proportion of RCTs using the same endpoint, (3) the proportion of RCTs using true endpoints, and (4) whether treatment choice influenced endpoint choice. 92 publications (1988-1992) reporting on 82 RCT's were identified. The typical number of endpoints per RCT was 6 (range: 1-28). The 3 most frequently used endpoints were mean probing depth (78% of the trials), mean probing attachment level (66%), and the plaque index (37%). In total, 153 distinct surrogate endpoints were defined. Most of these were used infrequently; over 80% of the 153 endpoints were used in fewer than 5 of the 82 trials. No trials used tooth loss as a true endpoint. In the design of an RCT, treatment choice influenced surrogate endpoint choice. Surrogate endpoints based on re-entry surgery were exclusively used for regenerative procedures and microbiological surrogate endpoints were mostly used for RCT's on anti-microbials. The conclusion is that the typical RCT used multiple surrogate endpoints, some of which were used infrequently by other trials. Such endpoint usage characteristics are suitable for exploratory RCTs (designed to identify active treatments or to elucidate treatment mechanisms). The question is raised as to whether periodontal research has reached the point of needing properly designed definitive studies, whose purpose it would be to provide unequivocal evidence of tangible benefits to the patient by the various treatments. If a need for definitive randomized controlled trials is perceived, then the use of (multiple) surrogate endpoints as primary outcomes should be questioned. Surrogate endpoint usage has led to both false positive and false negative conclusions in other chronic disease studies. Endpoint selection and validation in RCTs may be an important element in resolving controversies about periodontal treatments.

beta-2 Microglobulin values among human immunodeficiency virus (HIV)-negative, HIV-positive asymptomatic, and HIV-positive symptomatic Ugandans

Mean serum beta-2 microglobulin levels among healthy human immunodeficiency virus-seronegative and asymptomatic and symptomatic human immunodeficiency virus-seropositive Ugandans were found to be 2.35, 3.75, and 5.06 mg/liter, respectively (P < 0.001). The upper limit of the normal range (3.5 mg/liter) is higher in this African population than that reported elsewhere.

Measurement of human immunodeficiency virus type 1 p24 in serum by an ultrasensitive enzyme immunoassay, the two-site immune complex transfer enzyme immunoassay

Human immunodeficiency virus type 1 (HIV-1) p24 antigen was measured by an ultrasensitive enzyme immunoassay (two-site immune complex transfer enzyme immunoassay). The antigen was reacted simultaneously with 2,4-dinitrophenyl-biotinyl-bovine serum albumin-anti-recombinant p24 (rp24) Fab' conjugate and anti-rp24 Fab'-beta-D-galactosidase conjugate. The complex that was formed, comprising the three components, was transferred from polystyrene beads coated with affinity-purified (anti-2,4-dinitrophenyl group) immunoglobulin G (IgG) to polystyrene beads coated with streptavidin. The detection limit of rp24 was 2.4 fg (0.1 amol) per assay or 0.24 pg/ml with as little as 10 microliters of serum. When sera were treated at low pH, p24 was detected in 34 (68%) of 50 serum samples from asymptomatic carriers, in 25 (86%) of 29 serum samples from patients with advanced HIV-1 infection, and in none of 117 serum samples from HIV-1-seronegative individuals. Levels of p24 in serum were inversely correlated to those of anti-HIV-1 p24 IgG, and the recovery of rp24 added to serum decreased to zero with increasing levels of anti-HIV-1 p24 IgG in serum. This sensitive method may be used as a powerful tool for investigating the disease.