Promising PEGylated cationic dendrimers for delivery of miRNAs as a possible therapy against HIV-1 infection

BACKGROUND

The appearance of resistance against new treatments and the fact that HIV-1 can infect various cell types and develop reservoirs and sanctuaries makes it necessary to develop new therapeutic approaches to overcome those failures.

RESULTS

Studies of cytotoxicity, genotoxicity, complexes formation, stability, resistance, release and particle size distribution confirmed that G2-SN15-PEG, G3-SN31-PEG, G2-SN15-PEG-FITC and G3-SN31-PEG-FITC dendrimers can form complexes with miRNAs being biocompatible, stable and conferring protection to these nucleic acids. Confocal microscopy and flow cytometry showed effective delivery of these four dendrimers into the target cells, confirming their applicability as delivery systems. Dendriplexes formed with the dendrimers and miRNAs significantly inhibited HIV-1 infection in PBMCs.

CONCLUSIONS

These dendrimers are efficient delivery systems for miRNAs and they specifically and significantly improved the anti-R5-HIV-1 activity of these RNA molecules.

POS0277 ANABOLIC EFFECT OF LNA043, A NOVEL DISEASE-MODIFYING OSTEOARTHRITIS DRUG CANDIDATE: RESULTS FROM AN IMAGING-BASED PROOF-OF-CONCEPT TRIAL IN PATIENTS WITH FOCAL ARTICULAR CARTILAGE LESIONS

Background:

LNA043 is a modified, recombinant version of the human angiopoietin-like 3 (ANGPTL3) protein acting directly on cartilage-resident cells to transmit its cartilage anabolic effect. A first-in-human study previously demonstrated the favourable safety profile and the modulation of several pathways involved in cartilage homeostasis and osteoarthritis (OA)1. A previous proof-of-mechanism imaging study used high field (7 Tesla) magnetic resonance imaging (MRI) to show formation of hyaline-like tissue after a single injection of 20 mg LNA043 (unpublished data).

Objectives:

To evaluate non-invasively the chondro-regenerative capacity of multiple intra-articular (i.a.) injections of LNA043 in patients with articular cartilage lesions in the knee (NCT03275064).

Methods:

This was a randomised, double-blind, placebo (PBO)-controlled, proof-of-concept study in patients with a partial thickness cartilage lesion. In total, 58 patients (43 [20 mg LNA043]; 15 [PBO]), stratified by lesion type (condylar or patellar) were treated with 4 weekly i.a. injections. The primary endpoint was T2 relaxation time measurement as a marker of collagen fiber network, and cartilage lesion-volume was a secondary endpoint, both using 3-Tesla MRI. Assessments were performed at baseline, weeks (wks) 8, 16, 28 and 52 (the latter in 23/58 patients). While lesion-volume for the secondary endpoint was determined from manually segmented images, the cartilage volume of 21 sub-regions spanning the entire knee was also measured from 3D isotropic MR images employing an automated segmentation prototype software (MR Chondral Health 2.1 [MRCH], Siemens Healthcare)2. An exploratory analysis evaluated the treatment effect for the additive volume of the 3 subregions in the weight-bearing area of the medial femur.

Results:

No change in T2 relaxation time was detected between treatment and PBO groups. Manual segmentation showed continuous filling of the cartilage lesions up to wk 28 in LNA043-treated patients with femoral lesions (p=0.08, vs PBO) while no effect was detected for patients with patellar lesions. Given the limitations of measuring small, irregularly shaped lesions with manual image-analysis, the MRCH approach was used (Figure 1). In the medial femoral weight-bearing region, refilling was detected over time (Δ=123 mm3 at wk 28, N= 37, p= 0.05). No overgrowth was detected in the lateral femoral condyles without cartilage damage. The overall safety profile was favourable; only mild/moderate local reactions were reported, including a higher incidence of joint swelling (9.3% vs 0%) and arthralgia (11.6% vs 6.7%) for LNA043 vs PBO resolving spontaneously or with paracetamol/NSAIDs. No anti-drug antibodies were detected.

Conclusion:

Treatment with 4 weekly i.a. injections of 20 mg LNA043 resulted in regeneration of damaged cartilage in patients with femoral articular cartilage lesions. Automated measurement of cartilage volume in the femoral index region was able to detect a relevant treatment effect and was found to be more sensitive than the manual segmentation method. No sign of cartilage overgrowth was observed in healthy femoral regions. A Phase 2b study in patients with mild to moderate knee OA is in preparation.

References:

[1]Scotti et al. ACR Convergence 2020; Abstract #1483

[2]Juras et al. Cartilage 2020; Sep 29:1-12

Disclosure of Interests:

Siegfried Trattnig: None declared, Celeste Scotti Shareholder of: Novartis, Employee of: Novartis, Didier Laurent Shareholder of: Novartis, Employee of: Novartis, Vladimir Juras: None declared, Scott Hacker Grant/research support from: Novartis, Brian Cole: None declared, Libor Pasa: None declared, Roman Lehovec: None declared, Pavol Szomolanyi: None declared, Esther Raithel Employee of: Siemens Healthcare GmbH, Franziska Saxer Shareholder of: Novartis, Employee of: Novartis, Jens Praestgaard Shareholder of: Novartis, Employee of: Novartis, Fabiola La Gamba Shareholder of: Novartis, Employee of: Novartis, José L. Jiménez Employee of: Novartis, David Sanchez Ramos Shareholder of: Novartis, Employee of: Novartis, Ronenn Roubenoff Shareholder of: Novartis, Employee of: Novartis, Matthias Schieker Shareholder of: Novartis, Employee of: Novartis

Nanotechnology against human cytomegalovirus in vitro: polyanionic carbosilane dendrimers as antiviral agents

BACKGROUND

Human cytomegalovirus (HCMV) is a worldwide infection, causing different troublesome in immunosupressed patients and very related to Human Immunodeficiency Virus 1 (HIV-1) infection, mainly in developing countries, with a co-infection rate of 80% in Africa. The high cost of present treatments and the lack of routinely tests in these countries urge the necessity to develop new molecules or strategies against HCMV. The new treatments should be low-cost and capable of avoiding the emerging problem of resistant virus. Nanoparticles play an important role in several viral infections. Our main focus is to study the potential activity of polyanionic carbosilane dendrimers (PDC), which are hyperbranched molecules with several sulfonate or sulfate groups in their periphery, against different viruses.

RESULTS

We studied the activity of G1-S4, G2-S16 and G2-S24P PDCs in MRC-5 cell line against HCMV infection by several plaque reduction assays. Our results show that dendrimers present good biocompatibility at the concentrations tested (1-50 µM) for 6 days in cell culture. Interestingly, both G2-S16 and G2-S24P showed a remarked inhibition at 10 µM against HCMV infection. Results on attachment and virucidal assays indicated that the inhibition was not directed to the virus or the virus-cell attachment. However, results of time of addition, showed a longer lasting activity of these dendrimers in comparison to ganciclovir, and the combination of G2-S16 or G2-S24P with ganciclovir increases the HCMV inhibition around 90 %.

CONCLUSIONS

Nanotechnology, in particular polyanionic carbosilane dendrimers, have proved their potential application against HCMV, being capable of inhibiting the infection by themselves or enhancing the activity of ganciclovir, the actual treatment. These compounds represent a low-cost approach to fight HCMV infections.

Increased CD127+ and decreased CD57+ T cell expression levels in HIV-infected patients on NRTI-sparing regimens

BACKGROUND

NRTIs-sparing regimens exert favourable profiles on T-cell homeostasis associated parameters. Our aim was to analyze the effect of NRTIs sparing regimen (NRTI-sparing-cART) vs NRTIs-containing regimen (NRTI-cART), on T-cell homeostasis associated parameters in naive HIV-infected patients.

METHODS

Biomarkers of cell survival (CD127) and replicative senescence (CD57), were measured by multiparametric flow cytometry for T-cell phenotyping on peripheral blood mononuclear cells (PBMCs) samples just before (baseline) and after 48 weeks of undetectable viral load in patients on NRTI-sparing-cART (N = 13) and NRTI-cART (N = 14). After 48 weeks a subgroup of patients (n = 5) on NRTI-cART switched to NRTI-sparing-cART for another additional 48 weeks. In vitro assays were performed on PBMCs from HIV-uninfected healthy donors exposed or not to HIV. To analyze the independent factors associated with type of cART bivariate and stepwise multivariate analysis were performed after adjusting for basal CD4+, CD8+ and nadir CD4+ T-cell counts.

RESULTS

After 48 weeks of a NRTI-sparing-cART vs NRTI-cART patients have higher effector memory (EM) CD4+ CD127+ T-cell levels, lower EM CD4+ CD57+ T-cell levels, higher CD8+ CD127+ T-cell levels, lower CD8+ CD57+ T-cell levels and higher memory CD8+ T-cell levels. This effect was confirmed in the subgroup of patients who switched to NRTI-sparing-cART. In vitro assays confirmed that the deleterious effect of a NRTIs-containing regimen was due to NRTIs.

CONCLUSIONS

The implementation of NRTI-sparing regimens, with a favourable profile in CD127 and CD57 T-cell expression, could benefit cART-patients. These results could have potential implications in a decrease in the number of Non-AIDS events.

Carbosilane dendrons with fatty acids at the core as a new potential microbicide against HSV-2/HIV-1 co-infection

Herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus type 1 (HIV-1) represent the two most frequent sexually transmitted infections (STI) worldwide. Epidemiological studies suggest that HSV-2 increases the risk of HIV-1 acquisition approximately 3-fold mainly due to the clinical and immunological manifestations. In the absence of vaccines against both STI, the development of new preventive strategies has become essential for further studies. We performed the screening of six novel polyanionic carbosilane dendrons to elucidate their potential activity against HSV-2/HIV-1 co-infection and their mechanism of action. These new nanoparticles are carbosilane branched dendrons from first to third generation, with palmitic or hexanoic fatty acids as the core and capped with sulfonate groups, named G1_d-STE2Hx, G2_d-STE4Hx, G3_d-STE8Hx, G1_d-STE2Pm, G2_d-STE4Pm and G3_d-STE8Pm. G3_d-STE8Hx and G3_d-STE8Pm carbosilane branched dendrons showed high viability. These dendrons also showed a great broad-spectrum antiviral activity, as well as a suitable efficacy against HIV-1 even if the mucosal disruption occurs as a consequence of HSV-2 infection. Our results exert high inhibition against HSV-2 and HIV-1 by blocking the entry of both viruses with the median effective concentration EC₅₀ values in the nanomolar range. Additionally, G3_d-STE8Hx and G3_d-STE8Pm retained their anti-HSV-2/HIV-1 activity at different pH values. G3_d-STE8Hx and G3_d-STE8Pm dendrons may be potential candidates as dual-acting microbicides against HSV-2/HIV-1 co-infection.

Acute toxicity of alkylpolyglucosides to Vibrio fischeri, Daphnia magna and microalgae: a comparative study

In this paper, toxicity values of alkylpolyglucosides have been determined by applying the 24-h immobilization test with Daphnia magna, the LumiStox(®) 300 test which employs the luminescent bacteria Photobacterium phosphoreum and the test with Selenastrum capricornutum. Three alkylpolyglucosides with different alkyl chain and degree of polymerisation have been tested. For all tests, the results indicated that Vibrio fischeri was more sensitive to toxic effects from alkylpolyglucosides than was D. magna or S. capricornutum. The results demonstrate considerable variation in toxicity responses within structurally related glucose-based surfactants regardless of the species tested. The toxicity increased as the critical micelle concentration decreased, and as the alkyl chain length and resultant hydrophobicity increased.

Effect of concentration on the primary and ultimate biodegradation of alkylpolyglucosides in aerobic biodegradation tests

This study examines the primary and ultimate biodegradation of a non-ionic surfactant, an alkylpolyglucoside, in ready biodegradability tests. The surfactant concentration was tested by the anthrone method, while the ultimate biodegradation (mineralization) was analyzed by the total organic carbon determinations. The influence of the concentration on the extent of primary and ultimate biodegradation and the kinetics of degradation also were determined. The primary and ultimate biodegradation was studied at different initial concentrations-15, 25, 50, 75, and 100 mg/L. The increasing concentration of test chemical from 15 to 100 mg/L resulted in a decrease in the relative maximum mineralization rate and longer estimated lag times by a factor of approximately 4.3. During the degradative process, two different stages were noted; these are better described with Quiroga and first-order kinetic models, respectively. For the study of the influence of concentration, the parameters characteristic of the biodegradation profiles in the different biodegradation assays were evaluated.

[Prevalence of resistance to antiretroviral drugs in Spain]

INTRODUCTION

The development of resistance to antiretroviral therapy (ART) reduces the effectiveness of these drugs in HIV-infected children.

METHODS

We performed a cross-sectional study in 86 vertically HIV-infected children, divided into four groups according to prior treatment: group 1: nucleoside reverse transcriptase inhibitor (NRTI), group 2: NRTI and non-nucleoside reverse transcriptase inhibitor (NNRTI), group 3: NRTI and protease inhibitor (PI), group 4: NRTI, NNRTI and PI.

RESULTS

In group 1 (11 children), the median treatment duration was 35 months (26 to 108). Nucleoside-associated mutations (NAMs) were found in 10 of these patients and the Q151M multiresistance mutation was found in two. The three children in group 2 were treated for 9, 32 and 42 months with NRTI and NNRTI. One child showed three NAMs and another showed Q151M. Two children had the K103N mutation. Group 3 (36 children) received treatment with NRTI and PI for 48.0 +/- 27.6 and 23.0 +/- 14.6 months, respectively. NAMs were observed in 94 % of the patients in this group, and one child showed the Q151M mutation. In group 4 (36 children) total treatment duration was 70.0 +/- 36.1 months (13.0 +/- 12.1 months with NNRTI, and 39.0 +/- 14.3 months with PI). NAMs were observed in all patients in this group, and Q151M was found in three children. K103N and Y181C were detected in 24 (67%) and 10 (28%) of the children respectively, while 32 (90%) showed primary mutations to PI.

CONCLUSIONS

A high prevalence of resistance mutations to NRTI and early appearance of resistance to NNRTI were observed in treated children.

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction (n = 52); (2) asphyxia (n = 59); (3) multiple trauma (n = 41); (4) natural deaths excluding myocardial infarction (n = 36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.

Can we predict the conformational preference of amides?

To what extent, if any, is the conformation of secondary amides revealed by theory? This question has now been addressed by computational methods using calculations at the B3LYP/6-31G level of theory and (1)H NMR spectroscopy. Both gas-phase and solvent studies predict a Z-anti conformation to be the lowest in energy for an evaluated series of acetamides. Moreover, Z-anti conformations may also be inferred from the chemical shifts of the N-CH alpha protons determined by NMR spectroscopy. Thus, a proton situated anti to the N-H proton consistently appears approximately 0.8 ppm further downfield than a proton situated gauche to the N-H proton. This finding, which could only be derived by using the DFT calculations of conformational preference as a guide to interpret the NMR data, might prove to be useful as a simple and convenient methodology for establishing amide conformation experimentally.

Structural diversity of ex vivo amyloid fibrils studied by cryo-electron microscopy

Cryo-electron microscopy studies are presented on amyloid fibrils isolated from amyloidotic organs of two patients with different forms of hereditary non-neuropathic systemic amyloidosis, caused, respectively, by Leu60Arg apolipoprotein AI and Asp67His lysozyme. Although ex vivo amyloid fibrils were thought to be more uniform in structure than those assembled in vitro, our findings show that these fibrils are also quite variable in structure. Structural disorder and variability of the fibrils have precluded three-dimensional reconstruction, but averaged cryo-electron microscopy images suggest models for protofilament packing in the lysozyme fibrils. We conclude that ex vivo amyloid fibrils, although variable, assemble as characteristic structures according to the identity of the precursor protein.

Dependence on solution conditions of aggregation and amyloid formation by an SH3 domain

The formation of amyloid fibrils by the SH3 domain of the alpha-subunit of bovine phosphatidylinositol-3'-kinase (PI3-SH3) has been investigated under carefully controlled solution conditions. NMR and CD characterisation of the denatured states from which fibrils form at low pH show that their properties can be correlated with the nature of the resulting aggregates defined by EM and FTIR spectroscopy. Compact partially folded states, favoured by the addition of anions, are prone to precipitate rapidly into amorphous species, whilst well-defined fibrillar structures are formed slowly from more expanded denatured states. Kinetic data obtained by a variety of techniques show a clear lag phase in the formation of amyloid fibrils. NMR spectroscopy shows no evidence for a significant population of small oligomers in solution during or after this lag phase. EM and FTIR indicate the presence of amorphous aggregates (protofibrils) rich in beta-structure after the lag phase but prior to the development of well-defined amyloid fibrils. These observations strongly suggest a nucleation and growth mechanism for the formation of the ordered aggregates. The morphologies of the fibrillar structures were found to be highly sensitive to the pH at which the protein solutions are incubated. This can be attributed to the effect of small perturbations in the electrostatic interactions that stabilise the contacts between the protofilaments forming the amyloid fibrils. Moreover, different hydrogen bonding patterns related to the various aggregate morphologies can be distinguished by FTIR analysis.

Synergic effect of vicinal stereocenters in [3 + 2] cycloadditions of carbohydrate azadipolarophiles and mesoionic dipoles: origin of diastereofacial selectivity

The intermolecular [3 + 2] cycloaddition of carbohydrate-derived 1,2-diaza-1,3-butadienes and 1,3-thiazolium-4-olates provides a conceptual basis for the problem of diastereofacial preference in the acyclic series of unsaturated sugars. Experimental results employing a side chain of D-arabino configuration have shown the stereodifferentiation exerted by the first stereogenic center that renders the Re,Re face of the acyclic sugar-chain azadiene eligible for cycloaddition (J. Org. Chem. 2000, 65, 5089). The results of the present work, now utilizing an alternative framework of D-lyxo configuration, evidence the discriminating power of the second stereogenic carbon, which induces the preferential approach to the Re,Si face of the heterocyclic dipole. This scheme of face selectivity is also grounded in theoretical calculations at a semiempirical level. In addition to dihydrothiophenes, which are the expected products of the [3 + 2] cycloaddition, bicyclic systems based on dihydrothieno[2,3-c]piperidine skeleton can also be obtained.

Three- and four-membered rings from cycloadditions of 1,3-thiazolium-4-olates and aldehydes

2-Aminothioisomünchnones, a well-known family of masked dipoles, react with aromatic aldehydes in a domino cascade reaction that produces episulfides (thiiranes) or beta-lactams (2-azetidinones). This sequence is initiated by a [3+2] dipolar cycloaddition followed by ring opening of cycloadducts and intramolecular rearrangement to afford these unusual ring contractions. The nature of the reaction products depends on the structural characteristics of the starting dipole and the experimental conditions. Episulfides are obtained selectively as cis isomers with respect to both aryl groups, whereas beta-lactams are produced as cis/trans mixtures. These structural features were determined unequivocally by X-ray crystallographic analysis. The beta-lactams still possessed a flexible acyclic chain containing sulfur, a salient lead modification of the bioactive cyclic penems and cephems. The preferential production of exo transition structures was rationalized with the aid of computational calculations at the B3LYP/6-31G* level.

Tumor necrosis factor-alpha and nitric oxide in vertically HIV-1-infected children: implications for pathogenesis

We performed a cross-sectional study to investigate the plasma TNF-alpha and nitric oxide (NO) production in 44 vertically HIV-1-infected children, and the relationship with immunological status and viral replication. As a control group, 36 healthy, uninfected children were studied. Plasma TNF-alpha and NO levels were determined by ELISA. Viral load was quantified using standard assays. Cell proliferation, apoptosis and viral replication were evaluated in vitro by incorporation of (3H)-thymidine, flow cytometry and p24 antigen, respectively. Higher plasma TNF-alpha and NO levels were observed in HIV-1-infected children compared with healthy controls. We found a very strong correlation between plasma TNF-alpha and NO levels in HIV-1-infected children (r = 0.98; p < 0.001). Moreover, HIV-1-infected children with higher viral load (> 4.7 log10) showed higher TNF-alpha and NO levels than those with viral load below this threshold. Interestingly, we detected inducible nitric oxide synthase (iNOS) mRNA in T-lymphocytes from HIV-1-infected children. To address their possible patho-physiological significance, we tested the in vitro effects of NO and TNF-alpha in HIV-1 replication. Addition of TNF-alpha and NO donors to mitogen-activated, HIV-1-infected PBMC cultures produced a significant increase in viral replication. Moreover, HIV-1 replication in mitogen-stimulated, PBMC cultures was partially inhibited by iNOS specific inhibitors, and a neutralising, anti-TNF-alpha monoclonal antibody. Our results indicate that TNF-alpha and NO correlated with high viral load in HIV-1-infected children and favoured HIV-1 in vitro replication. These data suggest a detrimental role of NO in HIV-1 infection, and that NOS inhibitors may have some therapeutic benefit in HIV-1-infection.

Regulation of human immunodeficiency virus type 1 replication in human T lymphocytes by nitric oxide

Addition of nitric oxide (NO) donors to mitogen-activated human immunodeficiency virus type 1 (HIV-1)-infected peripheral blood mononuclear cultures produced a significant increase in virus replication, and this effect was not associated with a change in cell proliferation. This effect was only observed with T-tropic X4 or X4R5 virus but not with R5 virus. Moreover, HIV-1 replication in mitogen-stimulated cultures was partially prevented by the specific inhibitors of the inducible nitric oxide synthase (iNOS). NO donors also enhanced HIV-1 infection of the human T-cell lines, Jurkat and MT-2. We have also observed that NO leads to an enhancement of HIV-1 replication in resting human T cells transfected with a plasmid carrying the entire HIV-1 genome and activated with phorbol ester plus ionomycin. Thus, in those cultures NO donors strongly potentiated HIV-1 replication in a dose-dependent manner, up to levels comparable to those with tumor necrosis factor alpha (TNF-alpha) stimulation. Furthermore, iNOS inhibitors decreased HIV-1 replication in HIV-1-transfected T cells to levels similar to those obtained with neutralizing anti-TNF-alpha antibodies. Moreover, HIV-1 replication induced iNOS and TNF-alpha transcription in T cells and T-cell lines. Interestingly, NO donors also stimulated long terminal repeat (LTR)-driven transcription whereas iNOS inhibitors partially blocked TNF-alpha-induced LTR transcription. Therefore, our results suggest that NO is involved in HIV-1 replication, especially that induced by TNF-alpha.

Impaired interleukin-5 (IL-5) production by T cells as a prognostic marker of disease progression in human immunodeficiency virus type 1 (HIV-1)-infected children

We studied cytokine production by stimulated peripheral blood mononuclear cells from 55 HIV-infected children born to HIV-infected mothers, and compared it to that of exposed, but uninfected, age-matched children. Cytokine production was quantified using a commercially available specific ELISA kit. Cell proliferation was evaluated by incorporation of ((3)H) thymidine. A significant defect in type 1 cytokine production of IFN-gamma and IL-2 in HIV-infected children compared to controls was observed, but without a concomitant increase in type 2 cytokines. Indeed, IL-5 production was even lower in HIV-infected children than in controls, the IL-5 decrease being the best predictive marker of immunodeficiency. Furthermore, IL-5 levels were decreased from the early phases of HIV infection, being significantly lower in the clinical category B with respect to controls, and in AIDS with respect to both controls and children in category A. Such a strong correlation with the stage of infection has not been previously described in HIV-infected children. In addition, we found a correlation between SI/X4 viral phenotype and lower IL-5 levels. Our data suggest a dysfunctional cytokine production by PBMC from HIV-infected children as regards both Th1 and Th2 cytokines resulting from quantitative as well as qualitative defects induced by HIV-1.

Reactions of 2-amino-2-thiazolines with isocyanates and isothiocyanates. Chemical and computational studies on the regioselectivity, adduct rearrangement, and mechanistic pathways

2-Amino-2-thiazoline derivatives bearing alkyl or aryl substituents at exocyclic nitrogen have been condensed with different isocyanates and isothiocyanates. The addition occurs at ring endocyclic nitrogen in a regiospecific manner to afford kinetic and enthalpy-favored adducts. The unequivocal assignment of these structures has been confirmed by X-ray diffraction analyses of several compounds. The endo adducts do not rearrange on heating with the sole exception of adducts in which the exocyclic nitrogen remains unsubstituted. Trapping experiments in the presence of other isocyanates or isothiocyanates produce the formation of new endo adducts by acyl exchange in the reaction mixture. Semiempirical PM3 calculations full corroborate the higher stability of endo or exo adducts depending on the substitution pattern. The formation of adducts is compatible with a stepwise reaction mechanism, for which semiempirical transition structures could be located in the potential energy surface, and the global energetics of the process have been determined. The formation of the endo adducts proceeds with a smaller activation barrier.

Structural basis of pore formation by cholesterol-binding toxins

In this paper we describe reconstructions by electron cryo-microscopy of two oligomeric states of the pore-forming toxin pneumolysin. The results are interpreted by the fitting of atomic models of separated domains to the 3-dimensional electron density maps, revealing two steps in the mechanism of pore formation by the family of cholesterol-binding toxins. We briefly describe the observation of the toxin pore in model membranes and contrast the apparent mechanism of pneumolysin with that of other pore-forming toxins.

[Correlation between high plasma viral load and levels of TNF-alpha and cICAM-1 in HIV-1 infected children]

AIM

To assess the relationship among plasma TNF-a and cICAM-1 levels and plasma viral load (VL) in HIV-infected children and to compare these values with those of healthy non-HIV infected children.

PATIENTS AND METHODS

We studied 44 HIV-infected children and 38 non-HIV-infected children. The VL was quantified using standard molecular assay. CD4 and CD8 lymphocyte subpopulations were determined by flow cytometry. TNF-a and cICAM-1 were quantified using commercially available specific enzyme-linked immunosorbent assay (ELISA).

RESULTS

Levels of TNF-a and cICAM-1 were higher in HIV-infected children than in non-HIV infected children. HIV-infected children with VL > 50000 copies/ml had higher levels of TNF-a (12.83; 95% CI: 24.71 to 0.95 pg/ml) and cICAM-1 (248.94; 95% CI: 419.01 to 78.84 ng/ml) than HIV-infected children with VL < 50000 copies/ml. Interestingly, we found an increase of 6.57 pg/ml of TNF-a and 119.97 ng/ml of cICAM-1 levels for each log10 of VL.

CONCLUSIONS

HIV-infected children had higher levels of TNF-a and cICAM-1 than healthy controls. Our data indicate a positive correlation among plasma TNF-a and cICAM-1 and VL levels.

[Role of cytokines and chemokines in the non-progression of HIV infection in vertically infected children]

BACKGROUND

To study the cytokine production in vertically HIV-1-infected children with more of 7 years of HIV infection and different pattern of progression.

PATIENTS AND METHODS

We study 32 HIV-1-infected children: 8 NA children (age > 7 years, asymptomatic or with light symptoms, without antiretroviral treatment and TCD4+ > 25%); 10 NE1 children (> 6 years, symptomatic, with antiretroviral treatment and TCD4+ > 25%); 14 NE2-3 children (> 6 years, symptomatic, with antiretroviral treatment and TCD4+ < 25%) and 16 (C) controls, children non-VIH+. The peripheral mononuclear cells of HIV-infected children (PBLs) were cultivated and cytokine production was quantified in the supernatant.

RESULTS

The non-stimulated PBMC from HIV-infected children produced more TNF-alpha and less IL-2 that C-group. The production of IFN-gamma was lower in the groups NE1 and NE2-3 than in C-group. The production of IFN-gamma was higher in group NA than in NE2-3. In the phytohaemagglutinin (PHA) stimulated PBLs, the production of TNF-alpha was higher in NA and NE1 than in controls. The production of IL-2 was similar in NA and NE1 than in controls. The production of IL-2 was similar in NA and NE1 than in control group, but the groups NE2-3 produced less IL-2 than control and NE1 groups. The production of IFN-gamma and RANTES were significantly higher in NA than in controls. The groups NE1 and NE2-3 produced lower levels of IL-5 than control and NA groups. The groups NE2-3 produced lower levels of IL-10 than control group. The ratio IFN-gamma/IL-5 and IFN-gamma/IL-10 were higher in group NA than in control and NE1.

CONCLUSIONS

In non-progressors HIV-infected children the immune response is conserved and we have observed an increased Th1 response, while in progressors HIV-infected children receiving antiretroviral treatment we could observe a diminished Th2 response. Moreover, our data clearly indicate that the decrease of IL-2 is an early marker of HIV-infection.

Three conformations of an archaeal chaperonin, TF55 from Sulfolobus shibatae

Chaperonins are cylindrical, oligomeric complexes, essential for viability and required for the folding of other proteins. The GroE (group I) subfamily, found in eubacteria, mitochondria and chloroplasts, have 7-fold symmetry and provide an enclosed chamber for protein subunit folding. The central cavity is transiently closed by interaction with the co-protein, GroES. The most prominent feature specific to the group II subfamily, found in archaea and in the eukaryotic cytosol, is a long insertion in the substrate-binding region. In the archaeal complex, this forms an extended structure acting as a built-in lid, obviating the need for a GroES-like co-factor. This extension occludes a site known to bind non-native polypeptides in GroEL. The site and nature of substrate interaction are not known for the group II subfamily. The atomic structure of the thermosome, an archaeal group II chaperonin, has been determined in a fully closed form, but the entry and exit of protein substrates requires transient opening. Although an open form has been investigated by electron microscopy, conformational changes in group II chaperonins are not well characterized. Using electron cryo-microscopy and three-dimensional reconstruction, we describe three conformations of a group II chaperonin, including an asymmetric, bullet-shaped form, revealing the range of domain movements in this subfamily.

[Clinical manifestations and biological markers in the natural history of HIV-1 infection in vertically infected children. Longitudinal study]

OBJECTIVE

To study the relationship among clinical symptoms and biological markers as predictive value of progression to death in HIV-1 vertically infected infants.

PATIENT AND METHODS

We carry out a prospective study in 43 HIV-1 infants with a mean age of 4.27 (range: 0-11.8 months). None of the infants' mothers had received any antiviral treatment during pregnancy. None of the infants were breastfed. They were routinely assessed for clinical symptoms during follow-up.

RESULTS

Cox regression analysis was used to study the hazard ratio (HR) of progression to death. For the median viral load > 5 log10, the HR was 6.42 (95% CI, 1.28-32.03) (p = 0.023) and 6.84 (95% CI, 1.52-30,69) (p = 0.012) for biological phenotype of viral isolates with rapid replication and high titter (R/H-X4). We also study the predictive value of the clinical symptoms and we observe that the symptoms with more HR of progression to death were the progressive encephalopathy (3.60 [95% CI, 0.92-14.06; p = 0.065]) and the cardiopathy (6.29 [95% CI, 1.59-24.85; p = 0.008]).

CONCLUSIONS

Our data indicate that viral load > 5 log10 and biological phenotype R/H-X4 of virus isolates along the study are predictive markers of progression to death. In addition, the progressive encephalopathy and cardiopathy were also markers of progression death.

Understanding diastereofacial selection in carbohydrate-based domino cycloadditions: semiempirical and DFT calculations

The sequential cycloaddition of nitroalkenes with methyl vinyl ether was investigated by semiempirical (PM3) and density functional methods (B3LYP/6-31G*). The asymmetric version was also examined with a threoconfigured carbohydrate auxiliary. This produces a larger, more flexible system that complicates the calculation. Most transition structures were then fully optimized at the PM3 level and further refinement was done at ab initio levels. This study represents a model case that enables the rationalization of the high facial selectivity observed in carbohydrate-based nitrone- and nitronate-alkene cycloadditions. The selective endo orientation of the [4+2] pathway results from Coulombic attraction and secondary orbital interactions in the transition state. The stereochemical outcome is largely influenced by a combination of steric shielding from the bulky chiral substituent at C4 and the anomeric effect that places the nitronate C6-alkoxy group in a pseudoaxial arrangement. The resulting conformation favors the subsequent exo approach of methyl vinyl ether to the less hindered re face of the nitronate. It is also remarkable to note that solvation energies stabilize significantly a particular transition structure, thereby explaining the marked stereoselection observed in a polar medium.

[Prognostic markers of survival in infants younger than 12 month of age vertically infected by human immunodeficiency virus]

OBJECTIVES

To assess the immunological and virological markers as potential predictors of progression to death in HIV-1 infected < 12 months of age.

PATIENTS AND METHODS

Forty-three HIV-1 infants < 12 months of age were evaluated. None of the children received antiviral treatment, neither their mothers during pregnancy. Plasma viremia was quantified by standardised molecular assay. Virus isolation, evaluation of the non-syncytia-inducing (NSI) or syncytia-inducing (SI) phenotype and kinetic of replication was performed in parallel cultures.

RESULTS

Regarding viral load cut off levels of 5 log10 copies/ml appeared to be the best predictors of progression to death. The mean times of progression to death estimated by Kaplan-Meier method were 61.08 months fir children with viral load below that limit, and 19.16 months above this limit (p < 0.013). When the first viral isolate was NSI the mean time of progression to death was of 73.9 months, whereas it was of 26.7 months when was SI (p < 0.003). When the first viral isolate was slow/low (S/L) the mean times of progression to death was 71.8 months, whereas it was of it was of 19.8 months when was rapid/high (R/H) (p < 0.0003). When the first viral isolate was S/L-NSI the mean times of progression to death was of 73.9 months, whereas it was of 19.4 months when was R/H-SI (p < 0.0004). The hazard rate of progression to death in infants with viral load > 5 log10 copies/ml was 4.7, whereas was of 8.07 in those with SI isolates and of 9.32 in those with R/H kinetics.

CONCLUSIONS

Initial HIV-1 biological characteristics are better predictors of progression to death than viral load in untreated infants under 12 months of age. Nevertheless, a correlation exists between viral load over 5 log10 copies/ml and progression to death.

Two structural transitions in membrane pore formation by pneumolysin, the pore-forming toxin of Streptococcus pneumoniae

The human pathogen Streptococcus pneumoniae produces soluble pneumolysin monomers that bind host cell membranes to form ring-shaped, oligomeric pores. We have determined three-dimensional structures of a helical oligomer of pneumolysin and of a membrane-bound ring form by cryo-electron microscopy. Fitting the four domains from the crystal structure of the closely related perfringolysin reveals major domain rotations during pore assembly. Oligomerization results in the expulsion of domain 3 from its original position in the monomer. However, domain 3 reassociates with the other domains in the membrane pore form. The base of domain 4 contacts the bilayer, possibly along with an extension of domain 3. These results reveal a two-stage mechanism for pore formation by the cholesterol-binding toxins.

[Dynamics of immunoglobulin production in non infected children born from HIV-1 infected mothers: effect of zidovudine]

BACKGROUND

To evaluate the possible effect of zidovudine (ZDV) on inmunoglobins production in infants born to HIV-1 infected women.

SUBJECTS AND METHODS

We have studied the immunoglobulins serum levels in 57 non-infected children born to HIV-infected mothers. The children were divided into two groups: group A, 28 children born to HIV-1 infected mothers that received ZDV on protocol 076 conditions, and group B, 29 children born to mothers that did not receive anti-HIV-1 drugs. Quantification of serum IgG, IgA and IgM was performed by nephelometric techniques.

RESULTS

The median time to reach normal IgA values at 12 months, was 25.57 months (confidence interval [CI] 95%: 22.01-29.12) in the children of group A and 12.67 months (CI 95%: 9.90-15.44) in the children of group B (p = 0.01). The median time to reach normal IgM values at 12 months was 15.93 months (CI 95%: 15.21-16.65) in group A children versus 11.20 months (CI 95%: 8.51-13.89) in group B (p = 0.11). The median time to reach normal IgG values at 12 months was 19.67 months (CI 95%: 13.12-16.22) in group A children versus 12.73 months (CI 95%: 11.16-14.30) in group B (p = 0.05). The normal IgA levels were reached 2.36 (CI 95%: 1.16-4.81) times later in group A than in group B children (p = 0.02), whereas normal IgG levels were reached 1.88 (CI 95%: 0.94-3.78) times later in group A than in group B of children.

CONCLUSIONS

Our results indicate that treatment of pregnant mothers with ZDV clearly affect the ability of their newborns to produce inmunoglobulins, which may have important practical implications for their vaccination protocols.

Cryo-electron microscopy structure of an SH3 amyloid fibril and model of the molecular packing

Amyloid fibrils are assemblies of misfolded proteins and are associated with pathological conditions such as Alzheimer's disease and the spongiform encephalopathies. In the amyloid diseases, a diverse group of normally soluble proteins self-assemble to form insoluble fibrils. X-ray fibre diffraction studies have shown that the protofilament cores of fibrils formed from the various proteins all contain a cross-beta-scaffold, with beta-strands perpendicular and beta-sheets parallel to the fibre axis. We have determined the threedimensional structure of an amyloid fibril, formed by the SH3 domain of phosphatidylinositol-3'-kinase, using cryo-electron microscopy and image processing at 25 A resolution. The structure is a double helix of two protofilament pairs wound around a hollow core, with a helical crossover repeat of approximately 600 A and an axial subunit repeat of approximately 27 A. The native SH3 domain is too compact to fit into the fibril density, and must unfold to adopt a longer, thinner shape in the amyloid form. The 20x40-A protofilaments can only accommodate one pair of flat beta-sheets stacked against each other, with very little inter-strand twist. We propose a model for the polypeptide packing as a basis for understanding the structure of amyloid fibrils in general.

Inhibition of phosphodiesterase type IV suppresses human immunodeficiency virus type 1 replication and cytokine production in primary T cells: involvement of NF-kappaB and NFAT

Rolipram, a phosphosdiesterase type IV-specific inhibitor, prevented p24 antigen release from anti-CD3-activated human immunodeficiency virus (HIV)-infected T cells and CD4(+)-cell depletion associated with viral replication in a dose-responsive manner but minimally inhibited T-cell proliferation. Moreover, rolipram reduced the production of tumor necrosis factor alpha (TNF-alpha) and interleukin-10 (IL-10) by HIV-infected T cells. The transcriptional ability of a luciferase reporter gene under control of the HIV long terminal repeat, induced by phorbol myristic acetate plus ionomycin or by TNF-alpha, in primary T and Jurkat cells was also inhibited by rolipram. Rolipram inhibited NF-kappaB and NFAT activation induced by T-cell activation in Jurkat and primary T cells, as measured by transient transfection of reporter genes and electrophoretic mobility shift assays. Exogenous addition of TNF-alpha in the presence of rolipram restored NF-kappaB but not NFAT activation or p24 release. Addition of dibutyryl-cyclic AMP (dBcAMP) mimicked the effects of rolipram on p24 antigen release, NF-kappaB activation, and TNF-alpha secretion, but it did not affect NFAT activation or IL-10 production. The protein kinase A inhibitor KT5720 prevented the inhibition of TNF-alpha secretion but not that of HIV type 1 (HIV-1) replication caused by rolipram. Our data indicate that blockade of phosphodiesterase type IV could be of benefit against HIV-1 disease by modulating cytokine secretion and transcriptional regulation of HIV replication, and they suggest an important role of NFAT in HIV replication in primary T cells. Some of those activities cannot be ascribed solely to its ability to increase cAMP.

[Acute ischemia of the lower limb in a patient with temporal arteritis and rheumatoid arthritis, carrier of anticardiolipin antibodies]

We report a case of Temporal Arteritis, carrier of IgG anticardiolipin antibodies, who presented seronegative polyarthritis with AR criteria after 7 months. Three months later he developed acute ischemia in the right leg, which induced to amputate it. The biopsy showed thrombosis of the femoral arteria, and a dense lymphoplasmocytic infiltrate in its wall. We underline this association (TA-RA) with anticardiolipin antibodies, the exceptional affectation of the femoral arteries in this disease and the probable participation of anticardiolipin antibodies in the genesis of the arterial thrombosis.

Gastric perforation due to ventriculo-peritoneal shunt

Gastric perforation is a complication that can arise from ventriculo-peritoneal (VP) shunting. Careful examination of a newborn girl admitted to our department revealed several neurological problems. A VP shunt was inserted under direct visualization, leaving 20 cm of the catheter in the peritoneal cavity. The infant was discharged 6 days after surgery and readmitted 4 months later due to increasing head circumference and severe malnutrition. Physical examination revealed a soft abdomen, normal peristalsis, and no signs of peritoneal irritation. The patient was submitted to exploratory surgery, which showed that the catheter had penetrated about 6 cm into the stomach. The VP shunt was removed and replaced by a left ventriculo-atrial system. The patient evolved well and was discharged 5 days later. Probable causes of the perforation are discussed in this paper.

[Prognostic factors in HIV-infected heroin addicts: a multivariate analysis of nonspecific serological factors in the evolution of the infection]

We present a prognostic analysis of the quantifying of serum levels of beta 2 microglobulin, neopterina, IL-2 soluble receptor and three major classes of immunoglobulins, in a group of 68 heroin-addicts infected by the human immune deficiency virus, type I, clinically assessed for a period of at least three years. High levels of any of these unspecific serologic factors were correlated with the illness progression. Survival curves were generated with the categorized variables, showed a significant decrease on the time interval prior to the diagnosis of AIDS, in the patients with these variables assigned on the higher groups, being neopterine and IgA the more predictive factors when the Cox proportional regression model is applied. We conclude that the quantifying of these unspecific serum factors provides a useful information regarding the clinical evolution of heroin-addicts with HIV infection.

[New approaches to the measurement of clinical competence]

A new phase in the development of an instrument designed for the measurement of clinical competence is presented. The instrument (exam type) was previously validated; we report its use in three generations of students of a specialization course in internal medicine: those recently admitted to the course (group I); those finishing their first training year (group II) and those finishing the second year (group III). In the exam 304 out of the 600 questions included were classified as "experimental" (dealing with knowledge in internal medicine) and the remaining 296 questions corresponded to "control" questions (dealing with knowledge in other specialties). The variables considered in the exam were: 1) global result; 2) usage of diagnostic indicators; 3) omission of necessary procedures without a iatrogenic effect; 4) commission of unnecessary procedures without a iatrogenic effect; 5) omission of necessary procedures with resulting iatrogenic consequences; 6) commission of unnecessary procedures with resulting iatrogenic consequences; 7) global omission (variables 3 and 5); 8) global commission (variables 4 and 6); 9) global iatrogenesis (variables 5 and 6); 10) knowledge in nosology. Scores obtained by the three groups on the experimental questions differed in accordance with the respective time of clinical experience (group I obtained the lowest scores, group II showed intermediate scores, and group III showed the highest scores). Analysis of variance was significant (p less than 0.05) in variables 1, 2, 6, 8 and 9. The scores obtained by the three groups on the control questions were similar. In conclusion, we believe that this instrument is capable of detecting learning dependent on the time of clinical experience.(ABSTRACT TRUNCATED AT 250 WORDS)

[The challenge of evaluating clinical competence]

The study is divided in two parts. The first one deals with theoretical aspects of evaluation. In the second part, the development of an instrument intended to explore clinical competence is presented. The importance of considering evaluation as part of a research process is emphasized in the first part. The diverse theoretical and action trends in the field of education are synthetized in two main tendencies: the active-participating and the passive-receptive. The influence of these two tendencies in the selection the objects for evaluation is also discussed. An evaluation instrument developed by us to explore clinical competence is placed within the active-participating tendency of education; the present state of this instrument is given in the second part. The instrument consists of multiple choice options of the true, false, don't know type. The instrument in its present version is the result of a long validation process. It explores particularly iatrogenic behaviors by omission or commission. The sample studied were 457 applicants for specialization courses in medicine. Of these, 127 were foreign applicants. The instrument was applied to the whole sample in one single session. The results showed a low general clinical competence, with similar results in mexican and foreign applicants. A clear difference was found in commission iatrogenia which was significantly more frequent than omission iatrogenia. The theoretical superiority of our test in relation the others is discussed.

[Hemodynamic changes in the acute phase of experimental hypertension]

The arterial pressure, heart rate, cardiac output, stroke volume, total peripheral resistance and plasma angiotensin II were measured in Wistar rats and 24 hours after arterial renal constriction by a clip (0.20 mm d.i.). The results were compared with those obtained in a sham operated group. The experimental group showed an increase in arterial pressure and total peripheral resistance without changes in heart rate, cardiac output and stroke volume. In hypertensive animals there was a greater level of plasma angiotensin II than in control group. These studies have demonstrated that 24 hours after renal arterial stenosis the increase in arterial pressure can be mediated by an increased activity of the renin-angiotensin system.