Correction: Development of highly active anti-Pneumocystis bisbenzamidines: insight into the influence of selected substituents on the in vitro activity

Correction for ‘Development of highly active anti-Pneumocystis bisbenzamidines: insight into the influence of selected substituents on the in vitro activity’ by D. Maciejewska et al., Med. Chem. Commun., 2017, 8, 2003–2011.

Development of highly active anti-Pneumocystis bisbenzamidines: insight into the influence of selected substituents on the in vitro activity

Here we describe the potency of 21 pentamidine analogues against the fungal pathogen, Pneumocystis carinii, in an ATP bioluminescent assay with toxicity profiles in 2 mammalian cell lines. Reduction of two 5-methyl-1,2,4-oxadiazole rings was applied to the synthesis of acid-labile bisamidines. Anti-Pneumocystis activity is discussed in the context of 3 groups of compounds depending on the main structural changes of the pentamidine lead structure. The groups include: 1) 1,4-bis(methylene)piperazine derivatives 1-5; 2) alkanediamide derivatives 6-10; 3) alkane-derived bisbenzamidines 11-21. IC50 values of 18 compounds were lower than the IC50 of pentamidine. Four bisamidines were active at nanogram concentrations. Introduction of sulfur atoms in the alkane bridge, replacement of the amidino groups with imidazoline rings, or attachment of nitro or amino groups to the benzene rings is responsible for remarkable activity of the new leading structures. The vast majority of compounds, including four highly active ones, can be classified as mild or nontoxic to host cells. These compounds show promise as candidates for new anti-Pneumocystis agents.

Experimental assessment of the pathogenicity of the Newcastle disease viruses from outbreaks in Great Britain in 1997 for chickens and turkeys, and the protection afforded by vaccination

The Newcastle disease virus isolated from healthy turkeys in outbreak GB 97/6 was used to challenge 4-week-old turkeys and chickens, which were either not vaccinated or had received a single dose of Hitchner B1 live vaccine 14 days earlier, by one of the intramuscular, intranasal or contact routes. Similar experiments were done in 38-day-old turkeys and chickens using virus isolated from severely sick chickens in outbreak GB 97/1. All vaccinated chickens showed low but measurable immune responses 14 days after vaccination, but only three of the turkeys had detectable antibodies. No vaccinated turkey or chicken showed any clinical sign after challenge with either virus. The virus from healthy turkeys in outbreak GB 97/6 induced clinical signs in 12/30 unvaccinated turkeys after challenge and 7/30 died. In unvaccinated chickens, challenge with this virus produced clinical signs in 25/30 birds and 21/30 died. In challenge experiments with the virus from outbreak GB 97/1 in chickens, 3/30 unvaccinated turkeys showed clinical signs and all three subsequently died. In contrast, 30/30 unvaccinated chickens challenged with this virus showed clinical signs and died. Vaccination did not prevent infection and excretion of either challenge virus. However, when compared with unvaccinated birds, vaccination reduced significantly the length of time virus was excreted and the overall proportion of swabs that were positive.

Antigenic differentiation of avian pneumovirus isolates using polyclonal antisera and mouse monoclonal antibodies

Avian pneumovirus (AVP) isolates F83, CC220 and 1260 from Great Britain and 1556, 657/4, 2119 and 872/S from France, Hungary, Italy and Spain, respectively, were compared in ELISA and virus neutralization (VN) tests for reactions with chicken polyclonal sera against each of the viruses and monoclonal antibodies (MAbs) against two British isolates. ELISA test results using the polyclonal antisera indicated that all seven viruses were antigenically related, but some variation between strains could be detected, especially when antigens were prepared from infected cells using Nonidet P40 (NP40) rather than freezing and thawing. In VN tests results also showed that all viruses tested were related but there was evidence that the three British isolates showed closer relationships with each other than with the viruses from Italy, Hungary and Spain. In ELISA tests, isolates F83 and 1556 bound all 11 MAbs and 1260 reacted with 10/11 MAbs. Isolate CC220 showed reaction with all the MAbs but for 8/11 MAbs the optical density differences were low. Isolates 2119 and 872/S both reacted only with MAb 4 and none of the MAbs reacted with 657/4.

Use of monoclonal antibodies in the characterisation of avian paramyxovirus type 1 (Newcastle disease virus) isolates submitted to an international reference laboratory

A total of 106 Newcastle disease viruses submitted to the International Reference Laboratory at the Central Veterinary Laboratory, Weybridge from field investigations in 15 different countries was characterised using pathogenicity index tests in chickens and mouse monoclonal antibodies raised against NDV-Ulster 2C (Russell and Alexander, Archives of Virology, 75: 243, 1983) and pigeon isolate 617/83. These isolates could be placed into six distinct groups on the basis of their reaction with the monoclonal antibodies although four isolates gave ambiguous results and remained untyped. Forty isolates, obtained from chickens (21), pigeons (16), a duck (1), a sparrow (1) and a kestrel (1), were indistinguishable from isolates which were responsible for the recent panzootic in pigeons. Twenty-one isolates from domestic poultry, one isolate from a pheasant and one from a chicken in quarantine were identified as vaccinal virus of Bi or La Sota type. Thirty-five isolates placed in the same monoclonal antibody group were velogenic viruses. These had been obtained from domestic poultry in Italy, Austria, Mauritius and Saudi Arabia during 1983-1985, commercial pigeons in Hong Kong in 1986 and exotic birds in Italy, Great Britain and the Federal Republic of Germany during 1981-1985. This group was distinguishable from velogenic viruses responsible for disease outbreaks in poultry during the 1970s. Two lentogenic isolates from commercial ducks in England showed different monoclonal antibody binding patterns both of which have been associated with feral ducks. An isolate from chickens in Italy was also placed in one of these groups. A single isolate from a loon (Gavia sp) in the USA showed a monoclonal antibody binding pattern which had not been seen previously. In addition, 11 vaccinal or laboratory viruses were received for confirmatory characterisation which was greatly aided by the use of the monoclonal antibodies.

Pathogenicity of PMV-3/parakeet/Netherlands/449/75 for chickens

Infection of 1-day-old chicks with PMV-3/parakeet/Netherlands/449/75 (449) by intramuscular, intranasal or contact routes resulted in severe impairment of growth in all groups compared to uninfected control birds. In the group infected intramuscularly with 449 virus 16/22 birds died within 14 days of infection. No clinical signs were seen in 6-week-old chickens infected with 449 by intramuscular, intranasal or contact routes. One-day-old chicks infected with a large dose of NDV-B(1) and one-day-old chicks placed in contact with these birds also showed significant impairment of growth compared to uninfected controls.

Partial characterisation of five cloned viruses differing in pathogenicity, obtained from a single isolate of pigeon paramyxovirus type 1 (PPMV-1) following passage in fowls' eggs

Viruses with intracerebral pathogenicity indices (ICPIs) of 0.025, 0.55, 1.013 and 1.3. were cloned from a PPMV-1 isolate with an ICPI of 0.32 by passage in embryonated fowls' eggs. Deduced amino acid sequences of the haemagglutinin-neuraminidase (HN) and precursor fusion proteins (F0) showed them to have only a single amino acid difference: those with an ICPI value <0.7 had proline at amino acid position 453 of the F0 protein, and those with an ICPI value >0.7 contained a serine. The virus with an ICPI of 0.025 was further passaged, and the ICPI of non-cloned virus increased to 0.76/0.79, which was then reduced to 0.49 on cloning. The proline at residue 453 was retained, but there were two nucleotide changes in the virus of ICPI 0.49, T --> C at position 1769 in the untranslated region of the fusion gene and G --> A at position 437 of the HN gene, resulting in the amino acid change G --> R at position 116 in the HN protein.

Rapid in vitro assessment of the virulence of Newcastle disease virus isolates using the ligase chain reaction

The ligase chain reaction was used to assess the virulence of isolates of Newcastle disease virus. In the main study, 18/18 virulent isolates whose nucleotide sequences that code for the cleavage site and fusor peptide regions were known, successfully ligated oligonucleotides in a primer mix for virulent viruses termed VPM. Five of these isolates yielded a more intense ligated product with a second primer mix for virulent viruses called VPM1. No ligation was evident with eight avirulent isolates in tests with VPM or VPM1, however, each of these viruses did yield a strong ligated product with the primer mix for avirulent viruses (AVPM) as did one virulent isolate considered to be a mixture. Two virulent Australian isolates, 1238/1998 and 1248/1998, showed low but seemingly specific ligation with AVPM. In a blind study, 8/9 virulent isolates whose sequences were unknown ligated primers in VPM. Three avirulent and one virulent isolate, the latter again probably a mixture, ligated primers in AVPM. Ligation of oligonucleotides in VPM and AVPM was detectable in mixtures where virulent and avirulent isolates represented 0.1% and 0.01% by volume respectively of the viral population. The results indicate that LCR offers a potential in vitro alternative to current in vivo tests for virulence determination of Newcastle disease virus isolates.

Rapid pathotyping of Newcastle disease virus using a single-chain Fv displayed on phage against the C-terminal end of the F2 polypeptide

Filamentous bacteriophage display technology has been used to generate specific antibody fragments for differentiating virulent and avirulent Newcastle disease virus. A single-chain Fv fragment to the motif (112)RRQ(114), present at the F2 C-terminal end of many virulent Newcastle disease virus isolates, was isolated from a phage display library derived from a rabbit immunized with a peptide conjugate. An ELISA evaluation was carried out to test its ability to differentiate between 11 avirulent and 34 virulent NDV isolates. The antibody fragment reacted with 25/28 virulent viruses with the putative motif (112)RRQ(114). The three exceptions were viruses with an arginine instead of glycine, at position 110 of the fusion protein, just preceding the cleavage site. Five of six virulent isolates, whose predicted motif was different from that usually found in virulent strains, also tested negative. However, the antibody did react with one isolate with the motif (112)KRQ(114). There was no apparent reactivity with any of the avirulent isolates tested. We conclude that this antibody may, in the future, be a useful aid for the pathotyping of NDV isolates.

Growth study of cri du chat syndrome

We compared the growth of children with cri du chat (5p-) syndrome with the 1990 UK growth curves. Most subjects had impaired growth, particularly of head circumference. The more emaciated the child the more pronounced the microcephaly, showing the need for growth and nutrition monitoring.

Widespread occurrence of Pneumocystis carinii in commercial rat colonies detected using targeted PCR and oral swabs

The genus Pneumocystis contains a family of fungal organisms that infect a wide variety of mammalian species. Although it is a cause of pneumonia in immunocompromised hosts, recent evidence suggests that these organisms colonize nonimmunosuppressed hosts. Detection of cryptic colonization with Pneumocystis becomes important in animal studies when infection-free animals are necessary. Provocation by chronic immunosuppression, histology, and serology has been widely used to detect the presence of Pneumocystis in rat colonies, requiring lengthy time periods and/or postmortem tissue. We conducted a study to evaluate the use of PCR amplification of oral swabs for the antemortem detection of Pneumocystis in 12 rat groups from three commercial vendors. Sera were collected upon arrival, and the oral cavity was swabbed for PCR analysis. Ten of these groups of rats were then housed in pairs under barrier and immunosuppressed to provoke Pneumocystis growth. Once moribund, the rats were sacrificed, and the lungs were collected to evaluate the presence of Pneumocystis by PCR and microscopic enumeration. DNA was extracted from oral swabs and lung homogenates, and PCR was performed using primers targeting a region within the mitochondrial large-subunit rRNA of Pneumocystis carinii f. sp. carinii. Upon receipt, 64% of rats were positive for P. carinii f. sp. carinii-specific antibodies, while P. carinii f. sp. carinii DNA was amplified from 98% of oral swabs. Postmortem PCR analysis of individual lungs revealed P. carinii f. sp. carinii DNA in all rat lungs, illustrating widespread occurrence of Pneumocystis in commercial rat colonies. Thus, oral swab/PCR is a rapid, nonlethal, and sensitive method for the assessment of Pneumocystis exposure.

Rapid pathotyping of Newcastle disease virus (NDV) using fluorogenic probes in a PCR assay

Hybridisation of PCR fragments with fluorogenic probes specific for pathotype allowed an estimation of pathogenicity of Newcastle disease virus (NDV) isolates using a modified TaqMan procedure. Six probes were used, designed to recognise nucleotide sequences in the fusion protein gene sequence corresponding to the precursor protein F0 cleavage site of both virulent and avirulent viruses. Forty-three of the 45 isolates tested, including 18 examined in a blind study were pathotyped successfully and rapidly, with close correlation between cleavage site nucleotide sequences, TaqMan results and intracerebral pathogenicity index (ICPI) values. One isolate, which could not be pathotyped by nucleotide sequencing, was shown using the TaqMan system to be a mixture of virulent and avirulent NDV. The results of this study suggest that using this modified TaqMan protocol, the likely virulence of most ND isolates can be determined rapidly and reproducibly.

Inhibitors of sterol biosynthesis and amphotericin B reduce the viability of pneumocystis carinii f. sp. carinii

Pneumocystis carinii synthesizes sterols with a double bond at C-7 of the sterol nucleus and an alkyl group with one or two carbons at C-24 of the side chain. Also, some human-derived Pneumocystis carinii f. sp. hominis strains contain lanosterol derivatives with an alkyl group at C-24. These unique sterols have not been found in other pathogens of mammalian lungs. Thus, P. carinii may have important differences in its susceptibility to drugs known to block reactions in ergosterol biosynthesis in other fungi. In the present study, inhibitors of 3-hydroxy-3-methyglutaryl coenzyme A reductase, squalene synthase, squalene epoxidase, squalene epoxide-lanosterol cyclase, lanosterol demethylase, Delta(8) to Delta(7) isomerase, and S-adenosylmethionine:sterol methyltransferase were tested for their effects on P. carinii viability as determined by quantitation of cellular ATP levels in a population of organisms. Compounds within each category varied in inhibitory effect; the most effective included drugs targeted at squalene synthase, squalene epoxide-lanosterol cyclase, and Delta(8) to Delta(7) isomerase. Some drugs that are potent against ergosterol-synthesizing fungi had little effect against P. carinii, suggesting that substrates and/or enzymes in P. carinii sterol biosynthetic reactions are distinct. Amphotericin B is ineffective in clearing P. carinii infections at clinical doses; however, this drug apparently binds to sterols and causes permeability changes in P. carinii membranes, since it reduced cellular ATP levels in a dose-dependent fashion.

Antigenic and genetic characterisation of Newcastle disease viruses isolated from outbreaks in domestic fowl and turkeys in Great Britain during 1997

Antigenic and genetic analyses of viruses from the 11 outbreaks of Newcastle disease in Great Britain, 12 of the outbreaks in Northern Ireland and the single outbreak in the Republic of Ireland which occurred in 1997, indicated that they were all essentially similar. In addition, the viruses from the British Isles were very similar to viruses isolated from three outbreaks in pheasants in Denmark between August and November 1996, from a goosander in Finland in September 1996, from an outbreak in chickens in Norway in February 1997, and from an outbreak in chickens in Sweden in November 1997. Viruses from outbreaks in other countries during 1995 to 1997 could be distinguished antigenically and/or genetically from the 1996 to 1997 Scandinavian/British Isles isolates, as could viruses responsible for two separate outbreaks in caged birds in quarantine premises in Great Britain in March 1997. Minor nucleotide differences in the 413-base region of the fusion gene and the 187-base region of the haemagglutinin-neuraminidase gene sequenced in this study allowed the 1996 to 1997 Scandinavian/British Isles isolates to be divided into groups. These groups broadly corresponded to the clusters of disease outbreaks, but suggested that the discrete outbreak in Scotland was probably the result of virus spread from Northern Ireland. Overall, the antigenic and genetic analyses of these viruses were consistent with the theory that the virus was introduced into the British Isles by migratory birds moving from north-east Europe. However, it was not possible to rule out other sources, such as the movement of pheasants from Denmark.

Integrative research review of risk behaviors among adolescents in rural, suburban, and urban areas

PURPOSE

The purpose of this integrative review was to describe the state of the science regarding adolescent risk behaviors, with particular emphasis on comparisons among rural, urban, and suburban populations.

METHOD

The review was done at two levels, moving from the major national survey studies which included data collected in the late 1980s up to 1993, to more focused topical areas including studies with data collection and publication between 1990 and 1996 within each identified category of adolescent health issues. A total of 137 published works across several disciplines were reviewed. Suggestions for clinical practice were drawn from the significant research findings. In addition, risk behaviors were compared to national baseline data and objectives.

RESULTS

The level of research in this topic area was primarily descriptive. Currently, only a small portion of the national objectives for decreasing adolescent risk behaviors have been met. Successful intervention programs, although few in number, usually included not only topical education but also adolescent interaction with peers and support systems to raise awareness and change behaviors.

CONCLUSIONS

The risk behaviors for the adolescent population as a whole have been well described. Education alone is not sufficient to change behaviors. Objective outcomes must be identified and health care providers need to use research findings in their practice with adolescents. It is time to intervene with developmentally and culturally appropriate strategies. There was a large gap in the literature regarding risk behaviors and protective factors for rural adolescents. The few studies that included subjects from rural settings indicated that the view that rural adolescents are engaged in fewer or less severe risk behaviors is misleading.

Long-term results of radiologic placement of a central vein access device

OBJECTIVE

We describe our long-term experience with radiologic implantation of the Peripheral Access System (PAS) Port venous access device. Technical efficacy and complications are documented and compared with surgical and radiologic series involving other long-term venous access devices.

SUBJECTS AND METHODS

Fifty-two PAS-Port catheters were implanted in 51 patients during a 30-month period. All procedures took place in the angiography suite and were performed by interventional radiologists with imaging guidance. Patients were followed up through the oncology clinic or the clinic that originally referred the patient. The durability of the catheter was evaluated, and complications were recorded during the study period.

RESULTS

Fifty-two ports have been indwelling for a total of 18,357 patient-days. The mean time of implantation was 372 days, with a range of 30-825 days. Technical success in implanting the device was 100%. Device-related sepsis occurred in one patient (2%), superficial thrombophlebitis in one patient (2%), skin site dehiscence in one patient (2%), and deep vein thrombosis in one patient (2%). No instances of catheter occlusion occurred, and all catheters retained the ability to aspirate blood throughout their use. The overall complication rate was 8% (0.22/1000 patient days).

CONCLUSION

Radiologic placement of this device is safe and effective. It offers many patients a superior alternative to surgically implanted chest wall ports. Complications are fewer, and chances for technical success are greater. In circumstances where cosmesis is deemed highly important, the PAS-Port device may be preferable to tunneled venous access catheters.

Pathogenicity and phylogenetic evaluation of the variant Newcastle disease viruses termed "pigeon PMV-1 viruses" based on the nucleotide sequence of the fusion protein gene

The nucleotide sequences of the entire F genes of two isolates of the pigeon PMV-1 (PPMV-1) variant of Newcastle disease virus (NDV) were determined using RTPCR. The deduced amino acid sequences of the F0 protein showed four differences between isolate 760/83 which had been passaged 4 times in chickens and gave an intravenous pathogenicity index in chickens (IVPI) of 2.01 and isolate 1168/84 which had received six passages in chickens and had an IVPI of 0.00. The F genes of virus from two passage levels of isolate 1447/84, 0 with IVPI value 0.00 and six with IVPI value 0.58, were partially sequenced to cover the areas of variation between 760/83 and 1168/84. The two passage levels of 1447/84 showed identical sequences in these areas which in turn were identical of those of 760/83. It was concluded that the recorded differences in intravenous pathogenicity were unlikely to be associated with differences in the primary structure of the F0 protein. Phylogenetic comparisons of the F gene sequences of the two PPMV-1 viruses with those published for other NDV strains and isolates showed that the PPMV-1 viruses formed a new fourth lineage but were closely related to strain Warwick with which they presumably shared a common origin.

Comparison of Newcastle disease viruses isolated from cormorants in Canada and the USA in 1975, 1990 and 1992

Seventeen Newcastle disease virus (NDV) isolates obtained from cormorants, turkeys, a pelican, and a gull in Canada and the USA collected in 1975, 1990 and 1992 were analyzed for relatedness by monoclonal antibody profiling. In addition, nucleotide sequence analysis was performed in two areas of the fusion (F) gene for 5 of the isolates. No difference in the antigenicity of these 17 viruses, as determined by monoclonal antibody binding patterns, was seen. The amino acid sequences obtained via nucleotide sequencing at the cleavage site of the F protein showed that all the isolates tested had two pairs of basic amino acids immediately upstream of the cleavage site, and a phenylalanine residue at the N-terminus of the F1 protein, which is consistent with velogenic NDV. The deduced amino acid sequence obtained at the cleavage site of the F protein from 6 of the isolates was virtually identical regardless of the species, year of isolation, or location. However, the 1975 cormorant isolate showed marked differences from the 1990-1992 isolates in the nucleotide and deduced amino acid sequence of the F gene signal region. These data indicate that the 1990 and 1992 outbreaks were caused by the same epizootic virus and further suggest that the population of NDV in these wild birds may be very stable. The belief that the velogenic NDV circulating in cormorants in 1992 was transmitted into the free-ranging turkey flocks located near the cormorants in North Dakota is supported by the present study in which no distinction could be made between the viruses isolated from turkeys or wild birds.

Evaluation of the molecular basis of pathogenicity of the variant Newcastle disease viruses termed "pigeon PMV-1 viruses"

The amino acid sequence at the F2/F1 cleavage site was determined for 15 strains of the so-called pigeon PMV-1 (PPMV-1) variant of Newcastle disease virus (NDV) which showed close antigenic identity, determined by their reactions with a panel of 28 monoclonal antibodies, but considerable variation in their pathogenicity for chickens. Thirteen of the isolates possessed the motif 112G-R-Q-K-R-F117. This motif was seen for one virus which had initially low pathogenicity and remained unaltered when virulence of the virus for chickens was increased by bird to bird passage. The two other viruses had the sequence 112R-R-Q-K-R-F117 at the cleavage site which is more typical of virulent viruses, however, pathogenicity index tests indicated that these isolates were of moderate and low pathogenicity. The nucleotide sequence coding for the HN/HN0 extension region was determined for two of the PPMV-1 isolates. In both cases a stop codon was present indicating that the product for these viruses would be HN571. We conclude that the wide variation in pathogenicity of the variant PPMV-1 for chickens is not related to variation in the amino acid motif at the F2/F1 cleavage site nor due to production of HN0 which may also influence pathogenicity. The high virulence of some of the viruses examined confirms that a double pair of basic amino acids in the region of the F2/F1 cleavage site is not necessary for the full expression of virulence.

Anti-lipopolysaccharide antibody levels in patients with AIDS at the onset of Pseudomonas aeruginosa bacteremia

Lipopolysaccharide (LPS) in the cell wall of the P. aeruginosa is a major factor in the pathogenicity and virulence of this organism. Immunotype-specific serum antibodies to this LPS antigen (ALPS) are usually elevated with the onset of the bacteremia, act as opsonins, are protective in high levels, and are significantly associated with improved survival. In the present study, the ability of 11 patients with AIDS to mount a specific ALPS response with the onset of P. aeruginosa bacteria was evaluated prospectively. Of the 11 patients with AIDS only one had a substantial ALPS response, six mounted only a marginal ALPS response, and four had no ALPS response to the infecting strain of the P. aeruginosa. These data suggest most patients with AIDS do not exhibit a marked antigen-specific humoral response at the onset of P. aeruginosa bacteremia; this has important prognostic and therapeutic significance, as high ALPS titers are associated with survival.

Deduced amino acid sequences at the fusion protein cleavage site of Newcastle disease viruses showing variation in antigenicity and pathogenicity

The amino acid sequence at the F2/F1 cleavage site of the F0 fusion protein of 17 strains of Newcastle disease virus (NDV) was deduced from sequencing a 32 nucleotide area of the genome by reverse transcription and polymerase chain reaction (PCR) techniques. With the addition of sequences at the same area previously published for 9 other viruses comparisons were made of a total of 26 NDV strains and isolates (11 of low virulence, 15 of high virulence or mesogenic) covering ten antigenic groups determined by reactions with monoclonal antibodies. All the virulent viruses and the mesogenic strain Komarov showed the amino acid sequence 112R/K-R-Q-K/R-R116 for the C-terminus of the F2 protein and phenylalanine (F) at the N-terminus of the F1 protein, residue 117. The mesogenic isolate of the antigenic variant NDV responsible for the recent panzootic in racing pigeons, often termed "pigeon paramyxovirus type 1", examined in this study had the sequence 112G-R-Q-K-R-F117. The deduced amino acid sequence in the corresponding region of all viruses of low virulence was 112G/E-K/R-Q-G/E-R-L117. The virulent virus, PMV-1/chicken/Ireland/34/90 (34/90), which had a close antigenic relationship to a group of avirulent viruses, three of which were examined in the present study as representatives of the monoclonal antibody group H, showed between 4-6 nucleotide differences from these viruses in the 32 nucleotide region studied. These resulted in differences in the deduced amino acid sequence at residue 112 E-->K, 115 E-->K and 117-->F, giving 34/90 a typical virulent virus motif at the cleavage site. Despite the extremely small portion of the genome studied there were several areas which appeared characteristic for 34/90 and the three group H viruses of low virulence, which suggests that they may have arisen from the same gene pool.

Characterisation of an antigenically unusual virus responsible for two outbreaks of Newcastle disease in the Republic of Ireland in 1990

Antigenic characterisation of two highly virulent virus isolates from outbreaks of Newcastle disease on two closely connected farms in County Monaghan, Republic of Ireland, in 1990 showed the viruses to be indistinguishable but unlike other Newcastle disease viruses so far tested. However, they appeared to be antigenically closest to avirulent viruses isolated from waterfowl from several countries and from chickens in Northern Ireland in 1986. Despite the antigenic differences, chickens vaccinated with a live commercial Hitchner B1 vaccine were protected against intramuscular challenge with one of the virulent isolates.

The role of bactericidal/permeability-increasing protein as a natural inhibitor of bacterial endotoxin

Systemic release of endotoxin (LPS) after Gram-negative infection initiates a cascade of host cytokines that are thought to be the direct cause of shock, multisystem organ failure, and death. Endogenous LPS-binding proteins may play a role in regulating LPS toxicity in vivo. The human neutrophil granule protein bactericidal/permeability-increasing protein (BPI) shares sequence homology and immunocrossreactivity with an acute phase lipopolysaccharide binding protein (LBP) which has been shown to bind to LPS and accelerate LPS activation of neutrophils and macrophages. Although structurally similar, LBP and BPI are apparently functionally antagonistic. We previously showed that BPI inhibits LPS-mediated neutrophil activation in vitro. Here we demonstrate that BPI binds to LPS near the lipid A domain, and formation of the LPS-BPI complex abrogates detrimental host responses to LPS. For example, BPI blocks LPS-stimulated TNF release in vitro and in vivo, and LPS complexed to BPI is not pyrogenic in rabbits. Results demonstrating that BPI is released by stimulated human neutrophils further support the idea that BPI functions extracellularly in vivo to neutralize endotoxin. Taken together, these data argue that BPI neutralizes the toxic effects of LPS in vivo, and that BPI may represent a new therapeutic approach to the treatment of endotoxic shock.

The role of bactericidal/permeability-increasing protein as a natural inhibitor of bacterial endotoxin

Systemic release of endotoxin (LPS) after Gram-negative infection initiates a cascade of host cytokines that are thought to be the direct cause of shock, multisystem organ failure, and death. Endogenous LPS-binding proteins may play a role in regulating LPS toxicity in vivo. The human neutrophil granule protein bactericidal/permeability-increasing protein (BPI) shares sequence homology and immunocrossreactivity with an acute phase lipopolysaccharide binding protein (LBP) which has been shown to bind to LPS and accelerate LPS activation of neutrophils and macrophages. Although structurally similar, LBP and BPI are apparently functionally antagonistic. We previously showed that BPI inhibits LPS-mediated neutrophil activation in vitro. Here we demonstrate that BPI binds to LPS near the lipid A domain, and formation of the LPS-BPI complex abrogates detrimental host responses to LPS. For example, BPI blocks LPS-stimulated TNF release in vitro and in vivo, and LPS complexed to BPI is not pyrogenic in rabbits. Results demonstrating that BPI is released by stimulated human neutrophils further support the idea that BPI functions extracellularly in vivo to neutralize endotoxin. Taken together, these data argue that BPI neutralizes the toxic effects of LPS in vivo, and that BPI may represent a new therapeutic approach to the treatment of endotoxic shock.

Safety, pharmacokinetics, and functional activity of human anti-Pseudomonas aeruginosa monoclonal antibodies in septic and nonseptic patients

A mixture of five IgM human monoclonal antibodies (MAbs) against lipopolysaccharide antigens of Pseudomonas aeruginosa, plus a human IgG1 MAb against exotoxin A, were studied in 12 noninfected patients and 8 patients with P. aeruginosa bacteremia or pneumonia (or both). The preparation was well tolerated over a dose range of 0.3-1.2 ml/kg (0.75-3.0 mg/kg IgM protein). After a single infusion of 1.2 ml/kg (3.0 mg/kg IgM protein), serum antibody titers were boosted into therapeutic range, with serum half-lives ranging from 34 to 99 h. Also, opsonophagocytic activity in serum rose more than 1 log10 for all but one antibody. In no patient was an immunologic response against the MAb preparation detected.

Evaluation of relationships between avian paramyxoviruses isolated from birds of the family Columbidae

The prototype virus for the PMV-7 serotype of avian paramyxoviruses, PMV-7 dove Tennessee/4/75 (Tn 4) and five other isolates obtained from birds of the Columbidae family, which had been shown to be distinct from PMV-1 serotype, were tested for antigenic relationships between themselves and to other avian paramyxoviruses. By serological tests and analysis of structural polypeptides the viruses appeared to be distinct from other avian paramyxoviruses. One isolate appeared to be very closely related to Tn/4. Three other isolates showed only minor relationships to these two but were very closely related to each other. However, the sixth virus, pigeon Japan/Otaru/76, showed high levels of homology in haemagglutination inhibition tests and at least one line of identity in immunodoublediffusion tests with all five of the other isolates.

Opsonic and protective activity of five human IgM monoclonal antibodies reactive with lipopolysaccharide antigen of Pseudomonas aeruginosa

International Antigen Typing Schema (IATS) serotypes 1, 2, 5, 6, 8 and 11 comprise approximately 80% of Pseudomonas aeruginosa strains isolated from blood, wounds and respiratory specimens. Five human immunoglobulin M (IgM) monoclonal antibodies (MAbs) reactive with lipopolysaccharide O antigens of these IATS serotypes were studied in an opsonophagocytic assay. The assay employed human polymorphonuclear leukocytes, 2% guinea pig serum as the complement source and MAb. Each MAb promoted killing of inoculum of the homologous LPS serotype. The opsonic activity of each MAb was complement-dependent. In a murine model of Pseudomonas burn wound sepsis the LD50 of five strains of P. aeruginosa was increased greater than or equal to 22-fold by MAb-treatment (1.0 mg/kg). The mean effective dose of the five MAbs in mice challenged with approximately 10 LD50 of the homologous LPS serotype ranged from less than 0.01 mg/kg to 1.00 mg/kg.

Seventy-one quadruplet pregnancies: management and outcome

This article reviews the epidemiology, management, and outcome of 71 quadruplet pregnancies that occurred between 1980 and 1989. A study of detailed medical questionnaires and medical records revealed that 67 (94%) of the pregnancies followed ovulation induction therapy. A majority of the pregnancies were diagnosed by 9.3 weeks' gestation and bed rest was instituted by 16.7 weeks; 14% of women had cervical cerclages. Tocolytic agents were used in 59 (83%) of the group beginning at 24.5 weeks' gestation. The mean gestational age at delivery was 31.4 weeks and the mean birth weight was 1482 gm. Cesarean sections were performed in 89% of the cases. The average maternal weight gain was 45.8 pounds. Of the 284 fetuses, there were six first-trimester losses (including one ectopic pregnancy), 10 stillbirths and 33 neonatal deaths, resulting in a stillbirth rate of 29 per 1000, and corrected neonatal and perinatal mortality rates of 37 per 1000 and 67 per 1000, respectively. Other than premature labor, the most common maternal complications were first-trimester bleeding (35%), toxemia (32%), and anemia (25%). The quadruplet fetal growth curve parallels the singleton 25th percentile until 34 weeks, when it drops below the 10th percentile. These data suggest that a majority of quadruplets are delivered after 28 weeks and a viable outcome is expected. Because of retarded growth after 34 weeks, delivery should be considered at 34 weeks in most cases.

Use of DBA/2N mice in models of systemic candidiasis and pulmonary and systemic aspergillosis

Mouse models of systemic candidiasis and pulmonary and systemic aspergillosis were established by using DBA/2N mice, which are known to be deficient in the C5 component of complement. In experiments comparing lethality in the respective models in DBA/2N versus outbred CFW mice, results showed that the 50% lethal dose values for the DBA/2N mice were 10- to 1,000-fold lower than those for the outbred mice, depending on the experiment. Additionally, onset of death was somewhat delayed for the DBA/2N mice. In the case of the pulmonary aspergillosis model, administration of cortisone acetate was necessary to ensure lethality after intranasal infection, but only a single dose was necessary.

Hyperacute T-wave criteria using computer ECG analysis

Hyperacute T waves (HATWs) have been described as tall-amplitude, primary T-wave abnormalities sometimes seen in the early phases of transmural myocardial infarction. Despite numerous human and animal studies addressing the presence and significance of HATWs, there are no widely held, reliable ECG criteria for their accurate identification. Using a specially designed computer program on a Hewlett-Packard Realm ECG analysis system, we screened 13,393 adult ECGs to identify those having T-wave amplitudes greater than accepted standards (limb leads, greater than 0.5 mV; precordial leads, greater than 1.0 mV). Patients with other known causes of primary and secondary tall T waves were excluded from the study sample. Patients with tall-amplitude T-waves who then developed clinically verifiable myocardial infarction were labeled the HATW group. The HATW group (21) represented 4.1% of the tall T wave group (513) and 0.16% of the entire sample. The remaining patients, who did not meet HATW criteria, were called the early repolarization variant (ERV) group (51). Both groups underwent comparative computer morphology analysis. Nine parameters were statistically significant in discriminating HATWs from early repolarization variants. A combination of J-point position/T-wave amplitude of more than 25%, T-wave amplitude/QRS amplitude of more than 75%, J-point position of more than 0.30 mV, and age of more than 45 years predicted HATWs from a control group with a specificity of 98.0% and a sensitivity of 61.9% and with positive and negative predictive values of 92.9% and 86.2%, respectively. We conclude that HATWs have characterizable discriminating ECG morphology as determined by computer ECG analysis compared with a control group.

Pseudomonas hyperimmune globulin passive immunotherapy for pulmonary exacerbations in cystic fibrosis

We studied the effect of an intravenously administered gamma globulin [Ps-ivIG] enriched fivefold over conventional ivIG for Pseudomonas aeruginosa lipopolysaccharide [PA LPS] antibodies on ten patients with cystic fibrosis [CF] aged 19-32 years during hospitalization for pulmonary deterioration. All were colonized with greater than or equal to 1 PA phenotype resistant to all antibiotics at the time of admission and they received 500 mg/kg Ps-ivIG intravenously as a single dose in addition to conventional treatment, including antibiotics and chest physiotherapy. No adverse effects occurred. Circulating immune complexes and complement levels remained unchanged from baseline. Serum levels of anti-PA LPS IgG, as measured by ELISA for eight PA LPS immunotypes, increased to 244 +/- 65% (mean +/- SE) of baseline levels 1 hour post-infusion (P less than 0.01), remained significantly elevated during a mean hospital stay of 17 days, and returned to near baseline by follow-up 4 weeks after hospital discharge. Plasma half-life and clearance values were similar to those of other subjects receiving conventional ivIG. Sputum PA density declined from 3.0 to 1.2 x 10(8) cfu/mL 1 week post-infusion (P approximately equal to 0.05), and returned to baseline at follow-up. Serum anti-PA opsonic activity increased after infusion (P less than 0.01), but returned to baseline by 72 hours. Clinical scores improved from admission to discharge (P less than 0.005) without decline at follow-up. Forced vital capacity [FVC] and forced expiratory volume in one second [FEV1] increased from admission to discharge (P less than 0.01 and P less than 0.05, respectively) without decline at follow-up. Using autologous historical control data, standard hospital therapy without Ps-ivIG resulted in no improvement in FVC or FEV1, and a subsequent decline in these parameters (P less than 0.05 for each) during a similar follow-up period. This occurred despite the fact that half the patients did not have antibiotic-resistant PA on the control admission. We conclude that Ps-ivIG is a safe adjunctive therapy for pulmonary exacerbations in moderately ill cystic fibrosis patients colonized with resistant PA, and may be associated with both greater and more prolonged improvement in pulmonary function than standard therapy alone.

Location of neutralizing epitopes on the fusion protein of Newcastle disease virus strain Beaudette C

A panel of eight neutralizing monoclonal antibodies (MAbs) against the fusion (F) protein of Newcastle disease virus (NDV) has been shown to locate a major antigenic site on the basis of competitive binding assay and additivity index studies. Five epitopes (A1 to A5) have been located within this site on the F protein of the Beaudette C strain of NDV on the basis of cross-resistance plaque assays of MAb-resistant mutants raised against these MAbs. Epitopes A1, A4 and A5 are distinct; epitope A2 partially overlaps epitope A3. Nucleotide sequence analysis of the F genes of MAb-resistant mutants showed that each predicted single amino acid substitutions ranging from amino acid residues 157 to 171 for epitope A4 and at residues 72, 78, 79 and 343 for epitopes A1, A2, A3 and A5 respectively. These locations indicate that both the F1 and F2 fragments are involved in the formation of a single antigenic site and suggest the involvement of extensive protein folding in the active form of this F protein.

Treatment of experimental Pseudomonas aeruginosa pneumonia with a human IgM monoclonal antibody

A human IgM monoclonal antibody (MA-1C1) to Fisher immunotype 3 Pseudomonas aeruginosa lipopolysaccharide antigen was evaluated for in vivo activity in a guinea pig model of experimental pneumonia. Pharmacokinetics of MA-1C1 were compared in infected and noninfected animals. Intravenous bolus infusion of MA-1C1, 1 mg/kg, resulted in peak serum antibody concentrations of 3.8 +/- 0.08 and 3.7 +/- 0.05 micrograms/ml in infected and noninfected animals, respectively. Serum half-lives were 25 and 22 h in infected and noninfected groups. Treatment with a single intravenous infusion of MA-1C1 improved survival from pneumonia and was effective over a broad dose range (0.1-2.5 mg/kg). Cumulative survivals were 18 of 47 in the MA-1C1 group and 0 of 31 in controls (P less than .001). Treatment with MA-1C1 also resulted in fewer positive blood cultures 12 h after infection (P = .04). Although MA-1C1 penetrated into inflamed bronchial fluids, local concentrations were only 5% of the concentrations achieved in serum. Thus, MA-1C1 seems to provide significant therapeutic activity against experimental P. aeruginosa pneumonia by preventing dissemination of infection from the lung.

Monoclonal antibody-mediated protection and neutralization of motility in experimental Proteus mirabilis infection

A panel of monoclonal antibodies with specificity for a wound isolate of Proteus mirabilis was established. Of nine antibodies studied in detail, three were broadly reactive with various Proteus isolates, while six reacted in a serotype-specific fashion with the strain used for immunization. Five of the six serotype-specific antibodies were reactive with lipopolysaccharide. The sixth serotype-specific antibody, 4-F (immunoglobulin G1 [IgG1]), was potently protective in a burn wound sepsis model and recognized a protein antigen. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot (immunoblot) analysis were used to determine that 4-F was reactive with flagellar protein. Approximately 1.3 micrograms of the antibody was sufficient to provide protection against 8 50% lethal doses of wound isolate, and approximately 26 micrograms provided full protection against challenge with 333 50% lethal doses. In vitro test results indicated that 4-F inhibited the motility of the wound isolate, and in vivo testing showed that it inhibited dissemination of the inoculum from the burn site to the liver and spleen. Whereas the antibody was highly effective in preventing the death of mice subsequent to challenge at a burn site, no protection was seen following an intraperitoneal challenge. These results may therefore indicate that the protection observed in the burn model is solely a reflection of the capacity of 4-F to neutralize bacterial motility.

Enzyme replacement for lactose malabsorption using a beta-D-galactosidase

We evaluated 10 healthy symptomatic lactose malabsorbers for effect of an oral beta-D-galactosidase derived from Aspergillus oryzae (Lactrase, Kremers Urban Company, Milwaukee, WI, U.S.A.) on symptom and breath hydrogen response to challenge with 50 g lactose. Basally and at 30-min intervals for 8 h after lactose challenge, end-alveolar breath samples were collected and analyzed for hydrogen using gas chromatography. Symptoms were scored at 30 min and hourly for 8 h, rating bloating, cramps, nausea, pain, diarrhea, and flatulence. Four challenges were performed on 4 separate days with at least 3 days between challenges. The first two challenges served as baselines. Just before ingestion of 50 g powdered lactose dissolved in 200 ml water, beta-D-galactosidase capsules were given orally as a 250-mg dose for the third challenge and a 500-mg dose for challenge 4. Hydrogen excretion, quantified by using a trapezoidal method for computing area under the discontinuous curve of breath hydrogen concentration, was decreased in subjects receiving beta-D-galactosidase (base-line I, 346.0 ppm/h; baseline II, 367.2 ppm/h; 250-mg galactosidase 208.2 ppm/h; 500-mg galactosidase, 178.0 ppm/h; p less than or equal to 0.05). Other analyzed parameters of H2 excretion were also decreased. Analysis of symptom response scores showed a dose-related decrease for bloating and flatus (p less than or equal to 0.05) and no statistical difference in the other assessed symptoms. We conclude that beta-D-galactosidase from Aspergillus oryzae, when given just before ingestion of lactose by lactose malabsorbers, can produce a dose-dependent reduction (statistically significant for the 500-mg dose) in breath hydrogen excretion, bloating, and flatus.

Evaluation of mouse monoclonal antibodies raised against an isolate of the variant avian paramyxovirus type 1 responsible for the current panzootic in pigeons

Nine monoclonal antibodies raised against "pigeon variant" avian paramyxovirus type 1 isolate pigeon/England/617/83 were tested for their ability to react with "classical" and other "pigeon variant" isolates. Two of the monoclonal antibodies appeared to be specific for 617/83 reacting with no other virus. The remaining seven monoclonal antibodies bound to cells infected with all other "pigeon" isolates in indirect immunoperoxidase (IIP) tests but four distinct groups of other PMV-1 viruses were formed on the basis of the binding patterns. One of the monoclonal antibodies 161/617 caused haemagglutination inhibition (HI) of all the "pigeon" isolates tested but none of the other PMV-1 viruses and these results reflected the IIP results with this monoclonal antibody. 161/617 was also shown to inhibit viruses of the avian paramyxovirus type 3 serogroup in HI tests. This reaction and the ability to bind to infected cells in IIP tests appeared to be restricted to PMV-3 viruses isolated from exotic birds and did not occur with viruses of ostensively the same serotype from turkeys.

Characterization of paramyxoviruses isolated from penguins in Antarctica and sub-Antarctica during 1976-1979

Nine paramyxovirus isolates obtained from penguins were tested for antigenic relationships amongst themselves and to other avian paramyxoviruses. One of the isolates was shown to be a lentogenic Newcastle disease virus (NDV), i.e., of PMV-1 serotype. By serological tests and analysis of structural polypeptides the other penguin isolates could be placed into three groups. No relationship with other avian paramyxoviruses could be determined except that six of the penguin viruses, representing two of the groups, showed reaction with a monoclonal antibody raised against NDV Ulster 2C and three of the isolates, representing one of the penguin groups, also reacted with another PMV-1 directed monoclonal antibody.