West Nile Virus in the New World: trends in the spread and proliferation of West Nile Virus in the Western Hemisphere

The observed patterns and variations in the ecology, epidemiology, distribution and prevalence of the West Nile Virus (WNV) in different areas of the Western Hemisphere make this pathogen of particular importance as a model for understanding the potential risk factors associated with emerging pathogens worldwide, particularly those involving zoonotic pathogens whose epidemiology involves the potential for vertical transmission in arthropod vector species, and horizontal and vertical transmission within and among vertebrate host species. Record numbers of human WNV cases were recorded in Canada during 2007, with >50% more cases than documented in any previous year. Although overall numbers of human infections recorded in the United States were not exceptionally high during 2007 relative to epidemic levels reported in 2002 and 2003, the state of Oklahoma reported that the highest-ever number of human WNV cases and the numbers of human cases recorded in Canada were 50% higher than previous record levels recorded in 2003. The record and near-record numbers of human WNV infections recorded in several regions of North America during 2007 have important implications for the future management and surveillance of WNV vectors and reservoirs in North America. The spatiotemporal distribution of WNV infections in humans and animals recorded during 2007 in North America and South America have important implications for the surveillance and management of public health threats from WNV in the Western Hemisphere. Serological surveys conducted in areas of intense WNV transmission in the United States have reported low prevalence of antibodies to WNV in human s populations, indicating that additional epidemic outbreaks of human disease from WNV can be expected in the future.

Age-specific infection and death rates for human A(H5N1) avian influenza in Egypt

The age-specific infection and death profiles among confirmed human cases of influenza A(H5N1) infection in Egypt differ markedly from those recorded in other countries. The case fatality rate among human H5N1 cases in Egypt is 34%, versus an average of 66% in other countries. In Egypt, children younger than 10 years comprise 48% of reported cases, nearly twice the global average of approximately 25%, and no H5N1 fatalities have been confirmed among individuals in this age group as of 23 April 2009. Females outnumber males among confirmed H5N1 cases by a factor of nearly 2:1, and 90% of reported fatalities in Egypt have been females. The evident age and sex biases in morbidity and mortality among H5N1 cases in Egypt are phenomena that warrant further investigation and analysis.

What retroviruses teach us about the involvement of c-Myc in leukemias and lymphomas

Overexpression of the cellular oncogene c-Myc frequently occurs during induction of leukemias and lymphomas in many species. Retroviruses have enhanced our understanding of the role of c-Myc in such tumors. Leukemias and lymphomas induced by retroviruses activate c-Myc by: (1) use of virally specified proteins that increase c-Myc transcription, (2) transduction and modification of c-Myc to generate a virally encoded form of the gene, v-Myc, and (3) proviral integration in or near c-Myc. Proviral integrations elevate transcription by insertion of retroviral enhancers found in the long terminal repeat (LTR). Studies of the LTR enhancer elements from these retroviruses have revealed the importance of these elements for c-Mycactivation in several cell types. Retroviruses also have been used to identify genes that collaborate with c-Myc during development and progression of leukemias and lymphomas. In these experiments, animals that are transgenic for c-Mycoverexpression (often in combination with the overexpression or deletion of known proto-oncogenes) have been infected with retroviruses that then insertionally activate novel co-operating cellular genes. The retrovirus then acts as a molecular 'tag' for cloning of these genes. This review covers several aspects of c-Myc involvement in retrovirally induced leukemias and lymphomas.

Bioweapons, bioterrorism and biodiversity: potential impacts of biological weapons attacks on agricultural and biological diversity

Diseases and biological toxins have been used as weapons of war throughout recorded history, from Biblical times through to the present day. Bioweapon uses have historically been directed primarily, although not exclusively, against human populations. Specialised technicians and state-of-the-art research facilities are no longer necessary for the production or deployment of many known bioweapon agents and commercially available technologies now permit the large-scale production of bioweapon agents in small-scale facilities at relatively low cost. Failures in the detection and containment of bioweapon and emerging disease outbreaks among populations of wildlife and indigenous peoples in developing countries could result in severe erosion of genetic diversity in local and regional populations of both wild and domestic animals, the extinction of endangered species and the extirpation of indigenous peoples and their cultures. Our ability to understand and control the spread of diseases within and among human and animal populations is increasing but is still insufficient to counter the threats presented by existing bioweapon diseases and the growing number of highly pathogenic emergent infections. Interdisciplinary and international efforts to increase the monitoring, surveillance, identification and reporting of disease agents and to better understand the potential dynamics of disease transmission within human and animal populations in both industrialised and developing country settings will greatly enhance our ability to combat the effects of bioweapons and emerging diseases on biological communities and biodiversity.

Type B leukemogenic virus has a T-cell-specific enhancer that binds AML-1

Type B leukemogenic virus (TBLV) induces rapidly appearing T-cell tumors in mice. TBLV is highly related to mouse mammary tumor virus (MMTV) except that TBLV long terminal repeats (LTRs) have a deletion of negative regulatory elements and a triplication of sequences flanking the deletion. To determine if the LTR triplication represents a viral enhancer element, we inserted the triplication upstream and downstream in either orientation relative to the thymidine kinase promoter linked to the luciferase gene. These experiments showed that upregulation of reporter gene activity by the TBLV triplication was relatively orientation independent, consistent with the activity of eukaryotic enhancer elements. TBLV enhancer activity was observed in T-cell lines but not in fibroblasts, B cells, or mammary cells, suggesting that enhancer function is cell type dependent. To analyze the transcription factor binding sites that are important for TBLV enhancer function, we prepared substitution mutations in a reconstituted C3H MMTV LTR that recapitulates the deletion observed in the TBLV LTR. Transient transfections showed that a single mutation (556M) decreased TBLV enhancer activity at least 20-fold in two different T-cell lines. This mutation greatly diminished AML-1 (recently renamed RUNX1) binding in gel shift assays with a mutant oligonucleotide, whereas AML-1 binding to a wild-type TBLV oligomer was specific, as judged by competition and supershift experiments. The 556 mutation also reduced TBLV enhancer binding of two other protein complexes, called NF-A and NF-B, that did not appear to be related to c-Myb or Ets. AML-1 overexpression in a mammary cell line enhanced expression from the TBLV LTR approximately 30-fold. These data suggest that binding of AML-1 to the TBLV enhancer, likely in combination with other factors, is necessary for optimal enhancer function.

C3H mouse mammary tumor virus superantigen function requires a splice donor site in the envelope gene

Mouse mammary tumor virus (MMTV) encodes a superantigen (Sag) that is required for efficient milk-borne transmission of virus from mothers to offspring. The mRNA used for Sag expression is controversial, and at least four different promoters (two in the long terminal repeat and two in the envelope gene) for sag mRNA have been reported. To determine which RNA is responsible for Sag function during milk-borne MMTV transmission, we mutated a splice donor site unique to a spliced sag RNA from the 5' envelope promoter. The splice donor mutation in an infectious provirus was transfected into XC cells and injected into BALB/c mice. Mice injected with wild-type provirus showed Sag activity by the deletion of Sag-specific T cells and induction of mammary tumors in 100% of injected animals. However, mice injected with the splice donor mutant gave sporadic and delayed T-cell deletion and a low percentage of mammary tumors with a long latency, suggesting that the resulting tumors were due to the generation of recombinants with endogenous MMTVs. Third-litter offspring of mice injected with wild-type provirus showed Sag-specific T-cell deletion and developed mammary tumors with kinetics similar to those for mice infected by nursing on MMTV-infected mothers, whereas the third-litter offspring of the splice donor mutant-injected mice did not. One of the fifth-litter progeny of splice donor mutant-injected mice showed C3H Sag activity and had recombinants that repaired the splice donor mutation, thus confirming the necessity for the splice donor site for Sag function. These experiments are the first to show that the spliced sag mRNA from the 5' envelope promoter is required for efficient milk-borne transmission of C3H MMTV.

CDP is a repressor of mouse mammary tumor virus expression in the mammary gland

Mouse mammary tumor virus (MMTV) transcription is highest in the lactating mammary gland but is detectable in a variety of other tissues. Previous results have shown that MMTV expression is suppressed in lymphoid and other tissues through the binding of the homeodomain-containing repressor special AT-rich binding protein 1 to a negative regulatory element (NRE) in the MMTV long terminal repeat (LTR). Another homeoprotein repressor, CCAAT displacement protein (CDP), also binds to the MMTV NRE, but a role for CDP in MMTV transcriptional suppression has not yet been demonstrated. In this paper, we show that the level of CDP decreases during development of the mammary gland and that this decline in CDP level correlates with the known increase in MMTV expression observed during mammary gland differentiation. Moreover, CDP overexpression was able to suppress MMTV LTR-reporter gene activity up to 20-fold in transient-transfection assays of mouse mammary cells. To determine if this effect was due to direct binding of CDP to the promoter-proximal NRE, we performed DNase I protection assays to map two CDP-binding sites from +835 to +845 and +920 to +931 relative to the first base of the LTR. Mutations engineered into each of these sites decreased CDP binding to the proximal NRE, whereas a combination of these mutations further reduced binding. Subsequently, each of these mutations was introduced into the full-length MMTV LTR upstream of the luciferase reporter gene. Analysis of stable transfectants of LTR constructs showed that CDP binding site mutations in the proximal NRE elevated reporter gene expression two- to sixfold compared to wild-type LTR constructs. Thus, MMTV expression increases during mammary gland development, in part due to decreased CDP levels and CDP binding to the LTR. Together, these experiments provide the first evidence that CDP acts as a repressor of MMTV transcription in the mammary gland.

The c-myc locus is a common integration site in type B retrovirus-induced T-cell lymphomas

Type B leukemogenic virus (TBLV) induces rapidly appearing T-cell leukemias. TBLV insertions near the c-myc gene were detectable in 2 of 30 tumors tested, whereas 80% of the tumors showed c-myc overexpression. TBLV insertions on chromosome 15 (including a newly identified locus, Pad7) may cause c-myc overexpression by cis-acting effects at a distance.

Expression of mouse mammary tumor virus superantigen mRNA in the thymus correlates with kinetics of self-reactive T-cell loss

Mouse mammary tumor virus (MMTV) encodes a superantigen (Sag) that is expressed at the surface of antigen-presenting cells in conjunction with major histocompatibility complex (MHC) type II molecules. The Sag-MHC complex is recognized by entire subsets of T cells, leading to cytokine release and amplification of infected B and T cells that carry milk-borne MMTV to the mammary gland. Expression of Sag proteins from endogenous MMTV proviruses carried in the mouse germ line usually results in the deletion of self-reactive T cells during negative selection in the thymus and the elimination of T cells required for infection by specific milk-borne MMTVs. However, other endogenous MMTVs are unable to eliminate Sag-reactive T cells in newborn mice and cause partial loss of reactive T cells in adults. To investigate the kinetics of Sag-reactive T-cell deletion, backcross mice that contain single or multiple MMTVs were screened by a novel PCR assay designed to distinguish among highly related MMTV strains. Mice that contained Mtv-17 alone showed slow kinetics of reactive T-cell loss that involved the CD4(+), but not the CD8(+), subset. Deletion of CD4(+) or CD8(+) T cells reactive with Mtv-17 Sag was not detected in thymocytes. Slow kinetics of peripheral T-cell deletion by Mtv-17 Sag also was accompanied by failure to detect Mtv-17 sag-specific mRNA in the thymus, despite detectable expression in other tissues, such as spleen. Together, these data suggest that Mtv-17 Sag causes peripheral, rather than intrathymic, deletion of T cells. Interestingly, the Mtv-8 provirus caused partial deletion of CD4(+)Vbeta12(+) cells in the thymus, but other T-cell subsets appeared to be deleted only in the periphery. Our data have important implications for the level of antigen expression required for elimination of self-reactive T cells. Moreover, these experiments suggest that mice expressing endogenous MMTVs that lead to slow kinetics of T-cell deletion will be susceptible to infection by milk-borne MMTVs with the same Sag specificity.

Homeoproteins CDP and SATB1 interact: potential for tissue-specific regulation

Homeoproteins are known to participate in development and cell type specification. The homeoproteins CCAAT displacement protein (CDP) and special AT-rich sequence binding protein 1 (SATB1) have been shown to bind to nuclear matrix-associated regions and to act as repressors of many cellular genes. Moreover, binding of SATB1 to the mouse mammary tumor virus (MMTV) promoter region dramatically affects the tissue-specific transcription of this retrovirus. Because protein-protein interactions are a common means of regulating homeoprotein function, we tested whether SATB1 and CDP interact in vivo and in vitro. SATB1 interacted with CDP through its DNA-binding domain, as demonstrated by glutathione S-transferase (GST) pull-down assays. GST pull-down assays also showed that CDP associated with SATB1 through three of its four DNA-binding domains (CR1, CR2, and the homeodomain). SATB1-specific antisera, but not preimmune sera, precipitated CDP from nuclear extracts, and CDP-specific antisera precipitated SATB1 from the same extracts. Far-Western blotting detected interaction of SATB1 and CDP in several different tissue extracts. Association of purified SATB1 and CDP in vitro resulted in the inability of each protein to bind to DNA in gel retardation assays. CDP overexpression in cultured T cells led to a loss of detectable SATB1 binding to the MMTV promoter region, as measured by gel shift experiments. CDP overexpression also elevated MMTV long terminal repeat reporter gene activity in transient-transfection assays, a result consistent with neutralization of the SATB1 repressor function in T cells. SATB1 is very abundant in certain tissues, particularly thymus, whereas CDP is relatively ubiquitous, except in certain terminally differentiated cell types. Because of the tissue and cell type distribution of SATB1 and CDP, we propose that the SATB1-to-CDP ratio in different tissues is a novel mechanism for homeoproteins to control gene expression and differentiation in mammals.

B and T cells are required for mouse mammary tumor virus spread within the mammary gland

Mouse mammary tumor virus (MMTV) is an infectious retrovirus transmitted through milk from mother to newborns. MMTV encodes a superantigen (SAg) whose activity is indispensable for the virus life cycle, since a genetically engineered virus with a mutation in the sag gene neither amplified in cells of the immune system of suckling pups nor infected their mammary glands. When wild-type MMTV was injected directly into the mammary glands of uninfected pubescent mice, their lymphoid as well as mammary gland cells became virus infected. To test whether this infection of lymphoid cells was dependent on SAg activity and required for virus spread within the mammary gland, we performed mammary gland injections of wild-type MMTV(C3H) into two strains of transgenic mice that lacked SAg-cognate, V beta 14+ T cells. Neither the MTV-ORF or LEL strains showed infection of their mammary glands. Moreover, no MMTV infection of their peripheral lymphocytes was detected. Similar experiments with mice lacking B cells (mu-chain knockouts) showed no detectable virus spread in the mammary glands or lymphoid tissues. These data suggest that SAg activity and MMTV-infected lymphocytes are required, not only for initial steps of viral infection, but also for virus spread within the mammary gland. Virus spread at late times in infection determines whether MMTV induces mammary tumors.

Mutational and functional analysis of the C-terminal region of the C3H mouse mammary tumor virus superantigen

The mouse mammary tumor virus (MMTV) encodes within the U3 region of the long terminal repeat (LTR) a protein known as the superantigen (Sag). Sag is needed for the efficient transmission of milk-borne virus from the gut to target tissue in the mammary gland. MMTV-infected B cells in the gut express Sag as a type II transmembrane protein that is recognized by the variable region of particular beta chains (Vbeta) of the T-cell receptor (TCR) on the surface of T cells. Recognition of Sag by particular TCRs results in T-cell stimulation, release of cytokines, and amplification of MMTV infection in lymphoid cells that are needed for infection of adolescent mammary tissue. Because the C-terminal 30 to 40 amino acids of Sag are variable and correlate with recognition of particular TCR Vbeta chains, we prepared a series of C-terminal Sag mutations that were introduced into a cloned infectious MMTV provirus. Virus-producing XC rat cells were used for injection of susceptible BALB/c mice, and these mice were monitored for functional Sag activity by the deletion of C3H MMTV Sag-reactive (CD4+ Vbeta14+) T cells. Injected mice also were analyzed for mutant infection and tumor formation in mammary glands as well as milk-borne transmission of MMTV to offspring. Most mutations abrogated Sag function, although one mutation (HPA242) that changed the negative charge of the extreme C terminus to a positive charge created a weaker Sag that slowed the kinetics of Sag-mediated T-cell deletion. Despite the lack of Sag activity, many of the sag mutant viruses were capable of sporadic infections of the mammary glands of injected mice but not of offspring mice, indicating that functional Sag increases the probability of milk-borne MMTV infection. Furthermore, although most viruses encoding nonfunctional Sags were unable to cause mammary tumors, tumors were induced by such viruses carrying mutations in a negative regulatory element that overlaps the sag gene within the LTR, suggesting that loss of Sag function may be compensated, at least partially, by loss of transcriptional suppression in certain tissues. Together these results confirm the importance of Sag for efficient milk-borne transmission and indicate that the entire C-terminal region is needed for complete Sag function.

Strain-specific expression of spliced MMTV RNAs containing the superantigen gene

The transmission of milk-borne or exogenous mouse mammary tumor virus (MMTV) requires infection of B cells in the gut-associated lymphoid tissue and expression of the superantigen (Sag) protein at the B-cell surface. Presentation of Sag at the B-cell surface is required for the transmission of MMTV to T cells and subsequent infection of the target mammary gland tissue. Because several different promoters have been reported for MMTV sag mRNA expression, we investigated whether the detection of spliced sag RNAs was dependent upon the cell type infected or the particular MMTV strain examined. In this study, we detected expression of spliced sag RNA from the standard promoter and from an internal U3 promoter in B-cell lines expressing endogenous Mtv-6 by RT-PCR, although expression from the standard promoter appeared to be at least 10-fold higher than that observed from the internal U3 promoter. Sag RNA originating from exogenous C3H MMTV was not observed from either of the U3 promoters in any cell type examined. However, spliced mRNAs containing the exogenous C3H MMTV, endogenous Mtv-8, or endogenous Mtv-17 sag genes could be detected from a previously described promoter in the envelope coding region regardless of the cell type infected. Because sag-specific RNAs can be initiated independently of the LTR promoters, there may be selection for independent control of MMTV sag and structural gene expression.

The matrix attachment region-binding protein SATB1 participates in negative regulation of tissue-specific gene expression

The nuclear matrix has been implicated in several cellular processes, including DNA replication, transcription, and RNA processing. In particular, transcriptional regulation is believed to be accomplished by binding of chromatin loops to the nuclear matrix and by the concentration of specific transcription factors near these matrix attachment regions (MARs). A number of MAR-binding proteins have been identified, but few have been directly linked to tissue-specific transcription. Recently, we have identified two cellular protein complexes (NBP and UBP) that bind to a region of the mouse mammary tumor virus (MMTV) long terminal repeat (LTR) previously shown to contain at least two negative regulatory elements (NREs) termed the promoter-proximal and promoter-distal NREs. These NREs are absent from MMTV strains that cause T-cell lymphomas instead of mammary carcinomas. We show here that NBP binds to a 22-bp sequence containing an imperfect inverted repeat in the promoter-proximal NRE. Previous data showed that a mutation (p924) within the inverted repeat elevated basal transcription from the MMTV promoter and destabilized the binding of NBP, but not UBP, to the proximal NRE. By using conventional and affinity methods to purify NBP from rat thymic nuclear extracts, we obtained a single major protein of 115 kDa that was identified by protease digestion and partial sequencing analysis as the nuclear matrix-binding protein special AT-rich sequence-binding protein 1 (SATB1). Antibody ablation, distamycin inhibition of binding, renaturation and competition experiments, and tissue distribution data all confirmed that the NBP complex contained SATB1. Similar types of experiments were used to show that the UBP complex contained the homeodomain protein Cux/CDP that binds the MAR of the intronic heavy-chain immunoglobulin enhancer. By using the p924 mutation within the MMTV LTR upstream of the chloramphenicol acetyltransferase gene, we generated two strains of transgenic mice that had a dramatic elevation of reporter gene expression in lymphoid tissues compared with reporter gene expression in mice expressing wild-type LTR constructs. Thus, the 924 mutation in the SATB1-binding site dramatically elevated MMTV transcription in lymphoid tissues. These results and the ability of the proximal NRE in the MMTV LTR to bind to the nuclear matrix clearly demonstrate the role of MAR-binding proteins in tissue-specific gene regulation and in MMTV-induced oncogenesis.

Major histocompatibility complex class II I-E-independent transmission of C3H mouse mammary tumor virus

C57BL/6 mice are resistant to C3H mouse mammary tumor virus (MMTV)-induced mammary tumorigenesis and lack major histocompatibility complex class II I-E molecules that are essential for presentation of C3H superantigen to T cells. T cells are needed for transmission of milk-borne MMTV from the gut to the mammary gland. In this report, we show that infectious C3H MMTV is produced by C57BL/6 mice that nurse on C3H mothers but that virus production in the mammary gland is delayed compared with that in I-E+ mouse strains.

Exogenous mouse mammary tumor virus (MMTV) infection induces endogenous MMTV sag expression

The mouse mammary tumor virus (MMTV) superantigen (Sag) protein is involved in the transmission of milk-borne MMTV from virus-infected milk in the gut to the target mammary gland tissue. Using an RT-PCR assay for in vivo MMTV infection, BALB/c or C3H mice nursed on C3H MMTV-infected mothers showed sag mRNA expression in intestine, spleen, and thymus as early as 1 day after infection, whereas uninfected BALB/c control animals had approximately 10- to 30-fold lower sag expression. Further fractionation experiments with small intestine indicated that sag expression occurred in gut-associated lymphoid cells. Restriction enzyme digestion of PCR products indicated that the sag mRNA detected was derived from the endogenous MMTVs, and sequencing analysis confirmed that the PCR products were derived from endogenous MTv-6. Expression of C3H-specific mRNA was detectable in BALB/cfC3H or C3H tissues by RNase protection or by RT-PCR. Endogenous MMTV sag expression was low in spleen and undetectable in thymocytes of C3H MMTV-infected C57BL/6 mice, a strain resistant to C3H MMTV tumorigenesis and defective for MHC class II I-E molecules. The RT-PCR assay for sag mRNA appears to measure the Sag-induced stimulation previously predicted for milk-borne MMTV infection. Together these data suggest that exogenous MMTV sag expression is minimal, but sufficient to rapidly stimulate transcription of endogenous MMTV sag mRNA in B- and T-cells in an MHC class II I-E-dependent manner. The endogenous sag expression on maternal lymphocytes may increase the number of proliferating T-cells available for milk-borne MMTV infection.

Mouse mammary tumor viruses with functional superantigen genes are selected during in vivo infection

Mouse mammary tumor virus (MMTV) encodes a superantigen that is important for viral infectivity in vivo. To determine whether superantigen function was required for infection by milk-borne MMTV, we created HYB PRO/Cla transgenic mice. These mice produced a full-length, packaged viral RNA with a frameshift mutation that caused premature termination of the superantigen protein. Young HYB PRO/Cla mice showed no deletion of their cognate V beta 14+ T cells, although they shed virus in their milk. The nontransgenic offspring of the HYB PRO/Cla mice were infected with this virus, since transgene-specific viral transcripts were detected in their mammary glands. Surprisingly, these offspring demonstrated the progressive deletion of V beta 14+ T cells characteristic of exogenous MMTV (C3H) infection. Sequence analysis demonstrated that these newly acquired viruses had reconstituted superantigen open reading frames resulting from recombination between the HYB PRO/Cla and endogenous Mtv-1 proviral RNAs. Thus, there is selection during the infection process for MMTVs with functional superantigen genes.

A longitudinal study of cytomegalovirus infection in human immunodeficiency virus type 1-seropositive homosexual men: molecular epidemiology and association with disease progression

Cytomegalovirus (CMV) isolates from 234 asymptomatic human immunodeficiency type 1 (HIV-1)-positive men were analyzed for molecular relatedness using junctional hybridization. Of isolates shed simultaneously at two or more body sites, 36% from 22 men were different. Of 180 isolates collected from 67 men over 15 months, different strains were isolated serially from 27 men (40%), most from semen. After follow-up of 58 months (mean), the relative hazard of HIV infection progressing to AIDS was 1.8 (95% confidence interval [CI], 0.9-3.7) for men shedding the same strain of CMV and 3.0 (95% CI, 1.4-6.1) for men shedding different strains compared with men not shedding CMV in semen. The prevalence of CMV-specific IgM was higher in men shedding different versus same CMV strains (32% vs. 18%; P = .244). Thus, presence of multiple CMV strains in HIV-1-positive homosexual men is associated with progression to AIDS, possibly via activation of HIV-1-infected CD4 cells.

The relationship between T-cell levels and CMV infection in asymptomatic HIV-1 antibody-positive homosexual men

To investigate the relationship between cytomegalovirus (CMV) infection and progression of HIV-1 disease, a group of 234 asymptomatic, HIV-1 antibody-positive homosexual men were examined for CMV isolation and levels of CMV IgM antibodies, CMV IgG antibodies, and CD4+ and CD8+ T-lymphocytes. CMV IgG antibodies were present in 100% and CMV IgM antibodies in 22% of the men. CMV was isolated from the semen of 45% of the men. No relationship was observed between CMV IgM antibodies and CMV in semen or CD4+ levels. CD4+ cell levels were significantly lower in those from whose semen CMV was isolated. In addition, an inverse relationship was observed between the concentration of CMV in semen and CD4+ levels. We postulate that the seminal tract may be a reservoir for systemic CMV infection in HIV-infected homosexual men. Reinfection from this or other sources may result in recurrent stimulation of HIV-1 replication and lead to a further decline in CD4+ cells. Clarification of whether persistent CMV infection is secondary to HIV-1-induced immunodeficiency or, conversely, promotes a more rapid decline in immunocompetency will require follow-up studies.

Sequence analysis of the int-2/fgf-3 gene in aggressive human breast carcinomas

A number of primary human breast carcinomas exhibit amplification of the chromosome 11 region containing the int-2/fgf-3 proto-oncogene, and progression of breast cancer has been correlated with int-2 amplification or with certain restriction fragment length polymorphisms (RFLPs) of the int-2 gene. Using the polymerase chain reaction (PCR), we obtained the int-2 coding sequences from six primary tumors, four of which exhibited amplification of the int-2 gene and one of which exhibited amplification of the neu gene. The majority of these tumors (five of six) were aggressive, as judged by their early recurrence, metastasis, or both. Nucleotide sequencing of PCR products revealed that previously described BamHI and PstI RFLPs of the int-2 gene, as well as a new polymorphism at position 9154, were located within the intron between the second and third exons. A seventh tumor was used to localize one of the PstI RFLPs 5 bp from the splice-acceptor site of the third exon. However, none of the tumor DNAs analyzed showed differences in the int-2 protein coding regions when compared with normal placenta DNA. These results imply that aggressive human breast cancers encode an unaltered form of the int-2 protein.

Otolaryngologic manifestations of the mucopolysaccharidoses

A retrospective review of 45 children with mucopolysaccharidoses was performed to determine the frequency of complications related to the head and neck. In this series, every patient had at least one complication involving the head and neck region, and in over half, operative intervention by the otolaryngologist was required. Upper airway obstruction occurred in 17 (38%) and necessitated a tracheostomy in 7 (16%). Cervical spine instability occurred in 8 (18%), making airway management difficult. Recurrent respiratory infections occurred in 17 (38%), and chronic recurrent middle ear effusions were noted in 33 (73%). This review demonstrates that children afflicted with the mucopolysaccharidoses frequently have otolaryngologic-related complications that are common throughout their life span and often the primary management issue in their continuing care. The otolaryngologic management of these patients is outlined based on the results of this study and review of the relevant literature.

Transgenic mouse mammary tumor virus superantigen expression prevents viral infection

Endogenous mouse mammary tumor virus (MMTV) proviruses have recently been shown to cosegregate genetically with the minor lymphocyte-stimulating loci, also termed self-superantigens. The antigenic activity has been localized to the open reading frame (ORF) protein encoded in the long terminal repeat of MMTV. We show here that unlike their nontransgenic littermates, transgenic mice expressing high levels of an ORF protein derived from the C3H exogenous MMTV specifically delete their V beta 14+ T cells and do not become infected with this virus when it is present in their mother's milk. Thus, it appears that MMTV utilizes cells of the immune system in its infection pathway, and mice that retain endogenous MMTVs should be immune to infection by exogenous virus. These results offer possible new approaches to anti-viral therapy or immunization.

Pharyngeal and tonsil infections caused by non-group A Streptococcus

Non-group A streptococci are members of the genus Streptococcus but do not share the notoriety of their cousin from group A. Most physicians, including otolaryngologists and head and neck surgeons, do not associate them with upper respiratory tract and head and neck infections. Some laboratories do not bother to report their presence on culture. At the University of California, Los Angeles they have been shown to cause (1) tonsillitis, painful tonsils lacking exudate and erythema (group C, one case; group F, one case), (2) acute nonexudative tonsillitis (group B, two cases; group C, one case; group F, one case), and (3) acute exudative tonsillitis (group C, one case). It should be remembered when there is a report of their presence that they are usually vulnerable to penicillin and its analogs. By judicious use of these drugs, morbidity can be diminished.

The endogenous Mtv-8 provirus resides within the V kappa locus

The endogenous Mtv-8 provirus previously has been mapped within approximately 0.52 centimorgan from several V kappa markers on mouse chromosome 6. Using Southern blotting and DNA from a recombinant backcross mouse from the C57BL/6 (Mtv-8 positive) and C58 (Mtv-8 negative) strains, Mtv-8 was localized to the same side of the crossover point as immunoglobulin kappa (Ig kappa)-V24 but on the opposite side of the crossover from Ig kappa-V10 and Ig kappa-V21. Molecular cloning and characterization of cellular DNA adjacent to Mtv-8 revealed a functional V kappa 9 gene approximately 4.6 kb downstream and in the same transcriptional orientation as the provirus. These data suggest that Mtv-8 is within the centromere-proximal portion of the V kappa locus.

Branhamella catarrhalis and croup: toxicity in the upper respiratory tract

Branhamella catarrhalis has gained increasing recognition as a pathogen in the respiratory tract. During the past 18 years, since its transfer from the genus Neisseria, it has been associated with infection in cavities of the respiratory tract (sinuses and middle ear). It has been recognized as playing a role in laryngitis. Its isolation in large numbers from the surface and core of acutely and chronically infected tonsils indicates a possible role in these infections. Croup (two patients reported here) can now be added to this list. The toxic potential of B catarrhalis, its movement from commensal to pathogen for the upper respiratory tract, and the pathogenic mechanisms by which this has occurred are reviewed.

Psychosocial predictors of gay men's AIDS risk-reduction behavior

Used psychosocial variables derived from the health belief model (Rosenstock, 1974), Bandura's (1986) self-efficacy framework, and protection motivation theory (Rogers, 1984) to predict self-reported AIDS risk-reduction behaviors in a sample of 389 homosexual men who participated in the Multicenter AIDS Cohort Study in Los Angeles and who knew their HIV antibody status. Hierarchical multiple regression analyses showed that self-efficacy, perceived risk, response efficacy, and prior sexual behavior accounted for approximately 70% of the variance in the total number of sexual partners and the number of anonymous partners over a 6-month interval, controlling for demographic variables, HIV antibody status, and presence of a primary partner. A logistic regression analysis showed that barriers to change predicted increased unprotected anal receptive intercourse over a 6-month interval, controlling for prior behavior. The relation of health beliefs to risk-reduction behavior was substantially different for HIV-seropositive men without primary partners than for other groups of gay men. Implications for interventions are discussed.

Enterococcus faecalis and otitis media with effusion. How to treat

Although microorganisms are cultured in only one out of 3 middle ear effusions, viable and non-viable bacteria are presumed to be responsible in part for otitis media with effusion (OME). Because of this association, antibiotics in sublethal, bacteriostatic, or bacteriocidal concentrations are frequently used as non-surgical therapy for OME. Antibiotic treatment is predicated on the assumption that microorganisms responsible for OME are the same ones which produce acute otitis media. This may not always be the case. Enterococcus faecalis (formerly known as beta-hemolytic group D Streptococcus) was isolated in pure culture from 3 middle ears of two patients with OME. The significance of the isolation of this bacteria, an enteric organism which is infrequently found in upper respiratory tracts, is its lack of susceptibility to the usually prescribed oral antibiotics. In each of the children, failure to respond to antibiotics led to tympanocentesis and culture followed by middle ear drainage with insertion of middle ear ventilating tubes. Unless intravenous antibiotics are used, surgical drainage should be the procedure of choice when E. faecalis is found in the middle ear.

Negative regulation in correct tissue-specific expression of mouse mammary tumor virus in transgenic mice

Mouse mammary tumor virus (MMTV) is an endogenous murine retrovirus that is expressed in the epithelial cells of the mammary and salivary glands, lungs, kidneys, and seminal vesicles and in the lymphoid cells of the spleen and thymus. Several studies have shown that the long terminal repeat (LTR) of this virus can direct the expression of reporter genes to the same tissues in transgenic mice. To determine whether multiple regulatory elements within the LTR are involved in this tissue-specific expression, we have established lines of transgenic mice containing transgenes that have deletions in the MMTV LTR. Deletions of all LTR sequences upstream of -364 or of LTR sequences from -165 to -665 both result in the expression of linked reporter genes such as the simian virus 40 early region or the bacterial enzyme chloramphenicol acetyltransferase in novel sites, such as the heart, brain, and skeletal muscle; expression of endogenous MMTV and transgenes containing the full-length LTR is not detected in these organs. Negative regulation appears to involve more than one region, since deletion of sequences between either -201 and -471 or -201 and -344, as well as sequences upstream of -364, results in inappropriate expression in heart, brain, and skeletal muscle. Therefore, a negative regulatory element(s) in the MMTV LTR can suppress transcription from the viral promoter in several different organs. This represents the first example of generalized negative regulatory elements that act in many different tissues in transgenic mice to prevent inappropriate expression of a gene.

Making tympanocentesis [correction of tympanpanocentesis] easier

Tympanocentesis can be of great value in identifying the etiologic agent of acute otitis media. Unfortunately the trepidation with which clinicians approach this procedure may limit its application. This report of a method of tympanocentesis suggests a short-cut using instruments readily available in emergency departments and in many doctors' offices. The manuscript describes a means of stabilizing the needle in the middle ear during aspiration and details a simple method of handling middle ear aspirates which should ensure the viability of middle ear bacteria until they reach the laboratory.

Analysis of the int-1, int-2, c-myc, and neu oncogenes in human breast carcinomas

We have examined the DNA obtained from 100 primary breast carcinomas for oncogene markers which might have predictive value for poor prognosis. Ninety-six of the tumors were analyzed for the presence of restriction fragment length polymorphisms (RFLPs) previously identified in the int-2 gene. An 8.4-kilobase BamHI fragment and a 3.9-kilobase PstI fragment specific for the int-2 gene, in the absence of other restriction fragments, was found in 17 of 50 (34%) lymph node-negative patients and in 27 of 44 (61%) lymph node-positive patients. This combination of int-2 RFLPs (8.4/3.9) was found in a significantly different proportion (P = 0.02) of patients with greater than 3 positive lymph nodes compared to patients with fewer positive lymph nodes, suggesting that these RFLPs may be valuable for distinguishing among node-negative patients for chemotherapy. In contrast, the observed low frequency of int-1, int-2, neu, and c-myc amplification limited their usefulness as clinical predictors of disease recurrence.

Malignant hyperthermia in the otolaryngologic patient: prospective anesthetic and surgical management of eight children

Malignant hyperthermia (MH) is a rare genetic myopathy whose hallmark is rise in body temperature. This hypermetabolic state is triggered by inhalational anesthetics and/or depolarizing muscle relaxants such as succinylcholine. Even the use of dantrolene may not be protective against the hypermetabolic crisis. Eight patients at risk for MH undergoing tonsillectomy, adenoidectomy, and/or myringotomy with ventilation tube insertion were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants without dantrolene and without complication. Cardiac monitoring and rectal temperatures were followed. In order to provide additional evidence, all eight patients had vastus lateralis muscle biopsies with subsequent caffeine-halothane contracture studies performed. The contracture study showed positive results in seven of eight patients studied, indicating MH-susceptible muscle. No anesthetic or operative complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed relatively safely while undergoing appropriately selected anesthesia.

Lymphomas with acquired mouse mammary tumor virus proviruses resemble distinct prethymic and intrathymic phenotypes defined in vivo

A number of murine T cell lymphomas expressing the T cell Ag Thy-1 contain acquired mouse mammary tumor (MMTV) proviruses. These lymphomas all express detectable levels of MMTV RNA, yet the majority of the tumors fail to produce MMTV particles. To determine if the ability of lymphomas to produce MMTV is a reflection of the differentiation state of the tumor, we examined eight lymphomas for expression of surface B and T cell Ag as well as for rearrangements and expression of TCR genes. All tumors could be grouped into three categories observed in vivo, including early lymphoid, nonmature intrathymic T cells, and immature intrathymic T cells. Cell lines corresponding to all three phenotypes produced MMTV particles, suggesting that production of virus is not linked to the differentiation state of lymphoid cells. These studies highlight the potential advantage of studying T cell lymphomas vs mixed primary populations or T cell hybridomas for evaluation of both phenotypic and molecular markers in clonal T cells.

Lymphomas with acquired mouse mammary tumor virus proviruses resemble distinct prethymic and intrathymic phenotypes defined in vivo

A number of murine T cell lymphomas expressing the T cell Ag Thy-1 contain acquired mouse mammary tumor (MMTV) proviruses. These lymphomas all express detectable levels of MMTV RNA, yet the majority of the tumors fail to produce MMTV particles. To determine if the ability of lymphomas to produce MMTV is a reflection of the differentiation state of the tumor, we examined eight lymphomas for expression of surface B and T cell Ag as well as for rearrangements and expression of TCR genes. All tumors could be grouped into three categories observed in vivo, including early lymphoid, nonmature intrathymic T cells, and immature intrathymic T cells. Cell lines corresponding to all three phenotypes produced MMTV particles, suggesting that production of virus is not linked to the differentiation state of lymphoid cells. These studies highlight the potential advantage of studying T cell lymphomas vs mixed primary populations or T cell hybridomas for evaluation of both phenotypic and molecular markers in clonal T cells.

Emergency ear, nose, and throat procedures

This comprehensive article reviews some of the most common injuries to the ear, nose, and throat, and in addition reviews the relative anatomy of this area of the body. Particular attention is paid to the treatment of the patient with epistaxis, a common presentation to the Emergency Department.

Atypical mycobacteria-induced cervical adenitis. Treatment by needle aspiration

Atypical mycobacteria are among the most frequent causes of cervical adenitis. These unilateral nodes seldom present a treatment problem since surgical excision is curative. Occasionally, however, the affected cervical node lies adjacent to the facial nerve and/or its marginal mandibular branch. There can be a substantial risk of damage to the facial nerve and its branches in excision of such an infected mass with surrounding edema and cellulitis. An alternative and safe method of treatment in these cases is needle aspiration of the contents of mass. Of 17 cases of atypical mycobacteria-induced cervical adenitis seen at UCLA from 1975 to 1985, nine were treated by aspiration alone. None of these required further surgery. All were treated with one or more antituberculous agents during and after aspiration. This method of needle decompression of cervical nodes provides a safe and effective way to treat atypical mycobacteria infection that overlies the facial nerve and its branches.

Mouse mammary tumor proviruses from a T-cell lymphoma are associated with the retroposon L1Md

Four Charon 4A clones containing mouse mammary tumor virus (MMTV) proviruses and their cellular flanking sequences were obtained from partial EcoRI libraries of a C57BL/6 T-cell lymphoma with both endogenous and newly acquired MMTV proviruses. The cellular flanking sequences of three of four MMTV proviruses contained DNA homologous to the 3' end of the long interspersed retroposon L1Md. Two of the three proviruses were newly acquired in the lymphoma DNA, and these MMTV proviruses appeared to be 5 kilobases downstream and in the same transcriptional orientation as the L1 sequence. The third provirus was endogenous Mtv-9 and was located less than 500 base pairs from the 3' end of L1. Seven additional clones containing MMTV proviruses were isolated from partial MboI libraries of a B6 T-cell lymphoma. Five of the seven clones contained L1 elements in the cellular DNA flanking MMTV DNA. At least two clones (including one with the Mtv-8 provirus) had multiple L1 copies flanking the MMTV provirus, and one clone contained a single MMTV long terminal repeat directly integrated into a truncated L1 sequence. Although the frequencies of B1 and L1 in random library clones were similar, only one MMTV-containing clone hybridized to the abundant repetitive element B1. These data suggest a nonrandom association between MMTV and L1Md.

Atrophic rhinitis: antibiotic treatment

Atrophic rhinitis is a term used to describe a rare nasal infection. Although it does not have a fatal outcome, cause osteomyelitis, or produce pain, it does induce bilateral nasal obstruction and a persistent foul odor of which the subject and others are painfully aware. The organism most often associated with atrophic rhinitis is Klebsiella ozenae. Antibiotic susceptibility patterns of this microorganism have made treatment with orally administered antibiotics difficult. K ozenae was cultured from the nasal cavity of three patients. Two patients were treated for two weeks with tobramycin (MIC, 4 micrograms/ml; 4 mg/kg/day). Odor decreased in one patient, but K ozenae failed to clear. In the second patient both odor and K ozenae disappeared. The third patient was treated for 1 week with tobramycin (MIC, 4 micrograms/ml; 4 mg/kg/day); odor decreased, but K ozenae could still be cultured. She was treated for an additional 2 weeks with topical gentamicin (MIC, 0.5 micrograms/ml) with disappearance of both odor and K ozenae. Intravenous aminoglycoside may be helpful in treating atrophic rhinitis, but topical aminoglycoside may provide an effective and cheaper form of treatment.

Supraglottitis and Hemophilus parainfluenzae: pathogenic potential of the organism

Hemophilus parainfluenzae may be a normal inhabitant of the pharynx, but it can have pathogenic potential elsewhere in the body. It has been identified as a cause of bacteremia and meningitis. The case discussed here represents the first report of H parainfluenzae-induced supraglottitis in a child. In reviewing its pathogenic potential in the upper respiratory tract, it appears that its major effect could be the ability to transfer ampicillin resistance to ampicillin-susceptible Hemophilus influenzae.

Predictors of clinical AIDS in young homosexual men in a high-risk area

One hundred and sixty-seven homosexual men in Los Angeles characterized by HIV antibody, T-cell numbers, titres to cytomegalovirus (CMV), and specific sexual practices were followed for two years for immune changes and for more than three years for development of clinical AIDS. Thirty-five per cent had antibody to HIV at baseline. The mean level of T-helper (Th) cells was significantly lower and of T-suppressor (Ts) cells significantly higher in HIV seropositives than in seronegatives. The annualized incidence of HIV seroconversion was 7%. Eight men developed AIDS, an attack rate of 14% in those with HIV antibody at baseline. A number of observations were made: T-cell alterations, except a transient elevation in Ts cells, were unusual in the absence of HIV antibody; a seropositive man with a T-cell alteration was significantly less likely to revert to 'within normal limits' than was a seronegative man; a steady decline in the number of Th cells preceded onset of clinical AIDS; the number of Ts cells remained higher in men subsequently developing AIDS than in other seropositive men; clinical AIDS occurred only in men with HIV antibody whose CMV antibody levels were above the median for the group (1:1600); and the attack rate for clinical AIDS was 50% in men with HIV antibody and elevated CMV who at baseline had either: fewer than 325 Th cells/cc, or whose Th/Ts ratio was below 0.8 (but whose levels of Th and Ts cells were within normal limits).(ABSTRACT TRUNCATED AT 250 WORDS)

The endogenous retrovirus Mtv-8 on mouse chromosome 6 maps near several kappa light chain markers

Endogenous retroviruses are known to affect expression of cellular genes in the vicinity of their integration sites. The endogenous mouse mammary tumor provirus (Mtv-8) previously has been reported to reside on mouse chromosome 6 near the immunoglobulin kappa chain locus. Using pairs of mouse strains on the BALB/c (Mtv-8 positive) and C58 (Mtv-8 negative) backgrounds which are congenic for chromosome 6 genetic markers, we have confirmed the chromosome assignment of this provirus. Moreover, we have analyzed the N1 progeny of a (B6 X C58) X C58 backcross to determine the segregation of the Mtv-8 provirus with respect to polymorphisms in the Igk-VSer and Igk-J loci. The results with congenic and backcross mice together with results of others suggest that Mtv-8 is located approximately 0.52 cM from several closely linked kappa markers on chromosome 6.

Discrete high molecular weight RNA transcribed from the long interspersed repetitive element L1Md

The repetitive element LINE (L1) previously has been shown to contain two long open reading frames which are overlapping and out-of-frame similar to those found in retroviruses (1). In rodents and in human cells, these repeats appear to be transcribed into a heterogeneous population of RNAs in most cell types (2,3,4). No discrete transcript has been reported which is likely to be a mRNA for the open reading frames in rodent cells. In this paper, a discrete RNA species of approximately 8 kb has been identified in most murine lymphoid cells examined. This RNA is cytoplasmic and binds to oligo (dT) cellulose columns. Hybridization with labeled probes indicates that the transcript is of the same strandedness as the open reading frames. These results are consistent with proposals that L1Md is a retroposon with protein-encoding function.

Molecular cloning and characterization of mouse mammary tumor proviruses from a T-cell lymphoma

Five mouse mammary tumor virus proviruses and their flanking cellular DNA sequences have been cloned from a transplanted C57BL/6 (B6) T-cell lymphoma containing additional copies of mouse mammary tumor virus DNA. Characterization of these proviruses and their flanking DNA indicates that B6 lymphomas contain many newly integrated mouse mammary tumor virus copies synthesized by a mechanism(s) which generates polymorphism or deletions or both.

Onset symptoms as predictors of mortality and disability in multiple sclerosis

941 cases of definite/probable multiple sclerosis living in Los Angeles County, California and King and Pierce Counties, Washington in 1970 who had onset between 1960 and 1969 were followed for mortality and disability through 1980. Early age of onset and residence in Washington State were predictors of less rapid and severe subsequent course. Coordination symptoms at onset were prognostic of rapid progression to disability and/or early death, whereas early motor weakness was significantly predictive only for disability. The presence of sensory symptoms in addition to motor and/or coordination symptoms at onset, however, indicated a better prognosis than coordination and/or motor symptoms alone. This observation and the results of regression analyses indicated that specific groupings of symptoms at onset were more important for predicting course than the number of symptoms present at onset.