Ectopic ACTH Secretion Secondary to Metastatic Acinic Cell Carcinoma of the Parotid Gland: A Case Report and Review of Current Evidence for Systemic Therapy.

Acinic cell carcinoma is a rare, typically indolent, neoplasm that arises in the salivary glands. Metastatic disease is uncommon, occurring in around 10% of cases. We report the case of a 46-year-old male in whom the first sign of disseminated disease was increased skin pigmentation due to paraneoplastic Cushing's syndrome. He underwent 3 cycles of chemotherapy with carboplatin and paclitaxel with no symptomatic improvement and a mixed response on imaging. There is no evidence that systemic therapy prolongs survival in metastatic acinic cell carcinoma, and we lack a consensus as to which treatment options are most beneficial. A summary of published evidence regarding choice of palliative chemotherapy regimens and response is discussed in relation to the case.

Performance of a foot-and-mouth disease virus reverse transcription-polymerase chain reaction with amplification controls between three real-time instruments.

The foot-and-mouth disease virus (FMDV) is a member of the picornavirus family, possessing an 8-kb single-stranded RNA genome of positive polarity. It is highly contagious among several livestock species and can lead to severe economic consequences, as evidenced by the UK outbreak in 2001. The usage of real-time polymerase chain reaction has facilitated rapid detection of FMDV. Several real-time PCR instruments are available with various capabilities, such as portability and high sample volume analysis. Primers and a dual-labeled TaqMan probe were optimized to detect a single, highly conserved 88-bp segment of the FMDV 3D (RNA polymerase) gene. To increase the confidence of the RT-PCR result, a positive amplification control was synthesized to detect potential false-positive results due to contamination if a wild-type virus is used as positive control. In addition, a preventative measure against false-negative results was developed in which endogenous beta actin mRNA is coamplified by RT-PCR. Assay performance was compared on the LightCycler1.2 (Roche), the SmartCyclerII (Cepheid), and the SDS 7900HT (ABI). These assays successfully identified the FMDV genome and beta actin mRNA from several sources of infected nasal and oral swabs, as well as probang samples.

The roles of national and provincial diagnostic laboratories in the eradication of highly pathogenic H7N3 avian influenza virus from the Fraser Valley of British Columbia, Canada.

In February 2004 a highly pathogenic avian influenza outbreak erupted in the Fraser Valley of British Columbia, Canada. The index farm was a chicken broiler breeder operation comprising two flocks, 24 and 52 wk of age. Birds in the older flock presented with a mild drop in egg production and a small increase in mortality. Pathological specimens taken from the older flock were submitted to the provincial veterinary diagnostic laboratory from which an influenza A virus was isolated. While still under investigation by the provincial veterinary authorities, a spike in mortality was observed in birds belonging to the younger flock. Diagnostic material from both flocks was forwarded to the Canadian Food Inspection Agency's National Centre for Foreign Animal Disease. A low-pathogenicity H7N3 virus was detected in the older flock and a novel highly pathogenic H7N3 virus was found in specimens collected from the younger flock. Despite destruction and disposal of birds on the index farm, the virus spread to adjacent farms. Given the high density of poultry operations in the Fraser Valley and the high level of integration amongst industry support services, a total of approximately 17 million chickens, turkeys, ducks, geese, and speciality birds were put at immediate risk. Despite movement controls the virus spread and established itself in three distinct clusters. To prevent further spread, healthy, marketable birds outside of the surveillance areas were pre-emptively slaughtered. Although highly pathogenic avian influenza is a federal responsibility, the successful control and eradication of this outbreak would not have been possible without the cooperative involvement of federal and provincial diagnostic laboratories. The success of this collaboration was partly responsible for the formation of a national avian influenza laboratory network.

Development and use of a biotinylated 3ABC recombinant protein in a solid-phase competitive ELISA for the detection of antibodies against foot-and-mouth disease virus.

A biotinylated 3ABC recombinant protein was developed and used in a competitive ELISA (cELISA) to detect foot-and-mouth disease virus (FMDV) antibodies in cattle, sheep and pigs. In this report, we describe the cloning and expression of 3ABC protein in Escherichia coli cells as fusion protein with 6xHis and biotin. This cELISA uses streptavidin to capture bacterially expressed and in vivo biotinylated 3ABC antigen. The antigen capture strategy provides a simple and reliable method, which does not require purification of recombinant antigen before the serological assay. An hyperimmune guinea pig antiserum produced against purified 6xHis-3ABC was used as competitor in the test. The potential use of this cELISA for the identification of antibodies induced by FMD virus infection from those induced by vaccination is discussed.

Development and characterisation of neutralising monoclonal antibody to the SARS-coronavirus.

There is a global need to elucidate protective antigens expressed by the SARS-coronavirus (SARS-CoV). Monoclonal antibody reagents that recognise specific antigens on SARS-CoV are needed urgently. In this report, the development and immunochemical characterisation of a panel of murine monoclonal antibodies (mAbs) against the SARS-CoV is presented, based upon their specificity, binding requirements, and biological activity. Initial screening by ELISA, using highly purified virus as the coating antigen, resulted in the selection of 103 mAbs to the SARS virus. Subsequent screening steps reduced this panel to seventeen IgG mAbs. A single mAb, F26G15, is specific for the nucleoprotein as seen in Western immunoblot while five other mAbs react with the Spike protein. Two of these Spike-specific mAbs demonstrate the ability to neutralise SARS-CoV in vitro while another four Western immunoblot-negative mAbs also neutralise the virus. The utility of these mAbs for diagnostic development is demonstrated. Antibody from convalescent SARS patients, but not normal human serum, is also shown to specifically compete off binding of mAbs to whole SARS-CoV. These studies highlight the importance of using standardised assays and reagents. These mAbs will be useful for the development of diagnostic tests, studies of SARS-CoV pathogenesis and vaccine development.

Developments in diagnostic techniques for differentiating infection from vaccination in foot-and-mouth disease.

Foot-and-mouth disease (FMD) is a highly contagious and economically significant disease of cattle, pigs, sheep, goats and wild ruminant species. The FMD virus genome encodes a unique polyprotein from which the different viral polypeptides are cleaved by viral proteases, including eight different non-structural proteins (NSPs). Both structural and non-structural antigens induce the production of antibodies in infected animals. In contrast, vaccinated animals which have not been exposed to replicating virus will develop antibodies only to the viral antigens in the inactivated material. Vaccination against FMD is a key element in the control of the disease in addition to slaughter and movement restrictions. However, countries that vaccinate in the event of an outbreak will have to re-establish their FMD free status to the satisfaction of their trading partners. Because currently available vaccines stimulate the production of antibodies indistinguishable from those produced by infected animals in response to live virus and because vaccinated animals can be infected and become carriers of FMD virus, efforts have been made to develop diagnostic test that can differentiate vaccinated animals from those that are convalescent and from those that have been vaccinated and become carriers following subsequent contact with live virus. Currently the detection of antibodies to non-structural protein's (NSPs) is the preferred diagnostic method to distinguish virus infected, carrier, animals from vaccinated animals. However this is currently only possible at the herd level because of the great variability in the initiation, specificity and duration of the immune response in individual animals to the NSPs shown in many studies. Considerable effort and attention is now being directed toward the development of new methods and techniques for the rapid and accurate detection of anti-NSP antibodies, harmonization and standardization of current diagnostic techniques, as well as the production of defined reagents.

Vaccination against foot-and-mouth disease: the implications for Canada.

Vaccination of susceptible animals against foot-and-mouth disease (FMD) is a well established strategy for helping to combat the disease. Traditionally, FMD vaccine has been used to control a disease incursion in countries where the disease has been endemic rather than in countries considered free of the disease. In 2001, the use of vaccine was considered but not implemented in the United Kingdom (1), whereas vaccine was used to help to control FMD in The Netherlands (2,3). Canadian contingency plans provide for the use of vaccine; Canada is a member of the North American Foot-and-Mouth Disease Vaccine Bank, which could supply vaccine if needed. This article explains why Canada might use FMD vaccine to combat an outbreak and the factors that are relevant to the disposal of vaccinated animals and their products. It concludes that vaccination is an important mechanism in Canada's preparedness for an outbreak of FMD and that products from vaccinated animals are safe for human consumption.

Global FMD control--is it an option?

The outbreaks of foot-and-mouth disease (FMD) in Europe in 2001 identified the vulnerability of the intensive agricultural industries in Europe and North America to the economic consequences of the introduction of a highly infectious animal disease. The very large illegal international trade in animal products bypasses the safeguards recommended by World Animal Health Organization (OIE) and put in place by governments to prevent the importation of foreign pathogens. If it is not possible to stop the entry of FMD virus, what are the options to mitigate the risk by reducing the area of the globe in which FMD is endemic? There are a number of constraints that would prevent global control of FMD; current vaccines are expensive, have a narrow antigenic spectrum, provide only short term immunity and are very fragile; diagnostics are also expensive, require training to use and if not handled properly lose sensitivity and specificity; we still do not understand the significance of carrier animals in the epidemiology of FMD, and whether it is necessary or possible to prevent the carrier state; and many decision support tools, such as models are currently more dangerous than useful in that they fail to fully accommodate all the complexities of the disease. The four national foreign animal disease laboratories in USA, Canada, UK and Australia together with the International Livestock Research Institute have put forward a proposal to address some of these constraints (the Global FMD Research Alliance, GFRA), not only to protect their own national livestock industries, but also to support FMD control programs in countries in which the disease is present.

Susceptibility of pigs and chickens to SARS coronavirus.

An outbreak of severe acute respiratory syndrome (SARS) in humans, associated with a new coronavirus, was reported in Southeast Asia, Europe, and North America in early 2003. To address speculations that the virus originated in domesticated animals, or that domestic species were susceptible to the virus, we inoculated 6-week-old pigs and chickens intravenously, intranasally, ocularly, and orally with 106 PFU of SARS-associated coronavirus (SARS-CoV). Clinical signs did not develop in any animal, nor were gross pathologic changes evident on postmortem examinations. Attempts at virus isolation were unsuccessful; however, viral RNA was detected by reverse transcriptase-polymerase chain reaction in blood of both species during the first week after inoculation, and in chicken organs at 2 weeks after inoculation. Virus-neutralizing antibodies developed in the pigs. Our results indicate that these animals do not play a role as amplifying hosts for SARS-CoV.