A double-blind study of the effect on hemostasis of nabumetone (Relafen) compared to placebo.

A double-blind, placebo-controlled clinical trial comparing the effect on hemostasis of nabumetone (Relafen) to placebo in patients who were about to undergo forefoot surgery was performed. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to inhibit platelet cyclooxygenase activity, resulting in altered platelet function and thus potentially enhanced bleeding. Nabumetone has been reported to have no effect on platelet aggregation and bleeding time in normal volunteers and in patients who have undergone knee arthroscopy. After fulfilling the inclusion criteria and after a 1-week washout period (acetaminophen controlled), 15 patients were enrolled in the nabumetone group and 15 patients were randomized in the placebo group. Hemostatic parameters [prothrombin time (PT), partial thromboplastin time (PTT), and Ivy bleeding time (IBT)] were assessed at baseline, visit 2, visit 3, and final visit. No meaningful differences were observed between treatment groups in any of the measured hemostatic parameters. No significant adverse events were reported. There was no significant change from baseline for PT, PTT, and IBT in the nabumetone group (PT, p < .06; PTT, p < .64; IBT, p < .17) versus the placebo group (PT, p < .61; PTT, p < .63; IBT, p < .25). The lack of bleeding diathesis and significant prolongation of PT, PTT, or IBT in this study suggests that nabumetone in dosages up to 1000 mg/day can be administered safely in the immediate preoperative period to patients undergoing forefoot surgery.

Establishing specific retrovirus-free breeding colonies of macaques: an approach to primary screening and surveillance.

For reasons of occupational safety and animal health, as well as to improve the quality of nonhuman primates used in biomedical research, the establishment and maintenance of specific retrovirus-free breeding colonies of macaques (genus Macaca) are now high priorities. Sensitive and specific screening tests are now available for use in identifying macaques infected with the exogenous simian retroviruses simian immunodeficiency virus (SIV), simian T-lymphotropic virus (STLV), and simian type D retrovirus (SRV/D). A testing algorithm of repeated antibody screening by enzyme immunoassay with confirmatory testing of enzyme immunoassay-reactive sera by Western blot (immunoblot) has proved adequate for identification and exclusion of SIV- and STLV-infected animals in five facilities. In follow-up testing of animals seronegative on primary screening, seroconversions to these two viruses have been rare (0% and < 0.01%, respectively). The testing algorithm for SRV/D must include virus isolation in addition to antibody screening, as some SRV/D-infected animals lack detectable antibody or exhibit a prolonged interval between infection and seroconversion. This parallel testing for SRV/D antibody and virus is critical, especially during primary screening of potential specific pathogen-free stock obtained from external sources. "Indeterminate" immunoblot results, particularly for SRV/D, continue to pose a problem of interpretation. However, preliminary results indicate that newer diagnostic test methods, such as polymerase chain reaction for amplification of proviral DNA, will be useful in resolving SRV/D infection status and will contribute substantially to specific pathogen-free colony development and maintenance.

Anti-cellular antibodies in sera from vaccinated macaques can induce complement-mediated virolysis of human immunodeficiency virus and simian immunodeficiency virus.

Previous studies show that immunization of macaques with preparations of either human immunodeficiency virus (HIV) or simian immunodeficiency virus (SIV) that has been produced in human cells can induce antibodies against both viral antigens and human cellular antigens. This is due to the fact that certain host cell antigens are carried along with the virus during the purification process. The current series of experiments were performed to determine whether these anti-cellular antibodies can activate complement and whether the resultant complement activation could lead to virolysis of either HIV or SIV. Sera from macaques immunized with SIV or HIV (produced in the H9 human cell line) contained anti-cellular antibodies as determined by flow cytometry. Antibodies in these sera were capable of activating complement on uninfected human cells. Sera from the HIV-immunized macaques induced complement-mediated virolysis of both HIV and SIV. Similarly, sera from SIV-immunized macaques induced complement-mediated virolysis of both SIV and HIV. These results suggested that anti-cellular antibody in the sera could induce complement-mediated virolysis of either virus. To investigate this further, sera was absorbed with uninfected cells, which removed all of the virolytic activity for the heterologous virus. These in vitro studies indicate that complement activation can be initiated by anti-human cell antibodies, and that this activation can result in the destruction either HIV or SIV. This unusual antiviral mechanism may account for some portion of the resistance of human cell-immunized macaques to human cell-produced SIV that has been recently reported.

Evidence for a lentiviral etiology in an epizootic of immune deficiency and lymphoma in stump-tailed macaques (Macaca arctoides).

A retrospective study determined that an epizootic of immune suppression and lymphoma in stump-tailed macaques (Macaca arctoides) that began in 1976 was associated with a horizontally spread lentivirus infection. This conclusion was based on serology, epidemiology, pathology, and virus isolation. The lesions found in the stump-tailed macaques were more compatible with lesions seen in SIV-infected rhesus than those seen in rhesus macaques infected with type D retroviruses. A lentivirus, isolated from a rhesus inoculated with lymph node homogenate from a stump-tailed macaque, was designed SIVstm and was pathogenic for rhesus macaques. The isolate was antigenically related to other SIVs as well as to HIV-1 and HIV-2. Two surviving stump-tailed macaques sent to another colony carried SIVstm latently for at least 7 years and disseminated it throughout that colony.

A highly divergent simian immunodeficiency virus (SIVstm) recovered from stored stump-tailed macaque tissues.

We report here the results of molecular analysis of a simian immunodeficiency virus (designated SIVstm) which was isolated from a rhesus monkey inoculated with stored lymph node tissue of an Asian stump-tailed macaque. The latter monkey had died in 1977 during an epidemic of acquired immunodeficiency and lymphoma at the California Regional Primate Research Center (L. J. Lowenstine, N. W. Lerche, P. A. Marx, M. B. Gardner, and N. C. Pedersen, p. 174-176, in M. Girard and L. Valette, ed., Retroviruses of Human AIDS and Related Animal Viruses, 1988). Nucleotide sequence analysis of the gag and env regions indicates that SIVstm is an ancient member of the SIV/human immunodeficiency virus type 2 group; it is quite divergent from known SIVs isolated from African sooty mangabeys as well as from Asian macaques. Furthermore, of all SIV strains described to date, SIVstm is the most closely related to human immunodeficiency virus type 2.

A simple, rapid immunoassay for the detection of simian immunodeficiency virus antibodies.

Detection of simian immunodeficiency virus (SIV) antibodies has proved useful in a wide variety of research studies. Conventional immunoassays, however, are difficult to perform outside the well-equipped laboratory or under field conditions. We have developed an inexpensive, simple, rapid immunoassay for the detection of SIV antibodies that utilizes inactivated SIV antigen and Fast-Chek (F-C) (E.Y. Laboratories, San Mateo, Ca)., which is a membrane/filter paper device that uses protein A gold to detect antibody and/or antigen. This low-cost 10-min assay requires minimal technical skill and no refrigeration, electrical power, or sophisticated laboratory equipment. In a study of 155 banked sera, from a number of monkey species in a variety of geographic locations, F-C and Western immunoblot result concordance was 96%. Relative sensitivity and specificity were 98% and 95%, respectively.

Vaccine protection of rhesus macaques against simian immunodeficiency virus infection.

Rhesus macaques (Macaca mulatta) immunized with an inactivated whole SIVmac vaccine and muramyl dipeptide (MDP), incomplete Freund's adjuvant (IFA), or aqueous suspension were challenged intravenously with 0.1 TCID50 of cell-free SIVmac. Whereas virus was readily recovered from the peripheral blood lymphocytes of 10 of 10 nonvaccinated controls following this challenge dose, virus was not recovered from the three animals that received the vaccine with MDP nor from one of two animals that received the vaccine with IFA and one of three animals that received the aqueous vaccine. The animals that were protected against challenge were those that had detectable SIV antibody response to the envelop, both the outer glycoprotein (gp120) and the truncated transmembrane glycoprotein (gp31). Protected monkeys tended to have higher titers of syncytial inhibition antibody prior to challenge. An anamnestic response after challenge was observed only in the vaccinated monkeys that became infected. Vaccinated animals that became challenge-infected tended to live longer than infected controls. These results confirm those at two other primate centers and indicate that killed whole SIV vaccines can protect against low challenge doses of SIV and prevent early death in those monkeys that do become infected. The mechanism of this protection remains undetermined. This finding adds optimism to the possibility of an eventual AIDS vaccine.

Antigen detection for human immunodeficiency virus.

The recent development of enzyme immunoassay procedures for the direct determination of human immunodeficiency virus (HIV) antigens has been of significant benefit in both clinical and research applications. The historical development of HIV antigen assays as well as their current and future applications for use in the clinical microbiology laboratory are reviewed. A detailed description of selected commercially available assays is presented, and a comparison is made of various parameters, including sensitivity, specificity, and cost. The use of the HIV antigen assay as an alternative to the reverse transcriptase assay in virus culture applications is also discussed. In addition, the diagnostic and prognostic utility of the HIV antigen assay is considered for various patient groups, including neonatal, high-risk asymptomatic, seronegative, and seropositive patient populations. The use of the HIV antigen assay as an adjunct to anti-HIV antibody testing, as well as its utility in assessing the therapeutic efficacy of antiviral drug therapy, is discussed. The biology of HIV antigen expression and modulation of anti-HIV antibody titers during infection are also discussed in terms of two possible models.

Rapid, easy, and economical screening test for antibodies to human immunodeficiency virus.

A new dot enzyme immunoassay (EIA) with a conserved portion of the envelope protein of the human immunodeficiency virus (HIV) as antigen has been designed for use in areas with few laboratory facilities and by personnel with little laboratory experience. Sera were tested in 263 subjects who had AIDS or AIDS-related complex or were at-risk or not-at-risk of AIDS from the USA, Africa, and Asia/Oceania. The dot EIA was 100% sensitive in the American subjects, and there were only 2 false negatives in the others, both of which were negative by commercial EIA. The test is simple to perform, economical, rapid (30 min), and stable.