ABSTRACT
Riparian wetlands are dynamic components of landscapes. Located between uplands and aquatic environments, riparian habitats intercept sediments and nutrients before they enter aquatic environments. They are a source of organic matter and nutrients to aquatic systems, and they provide important habitat for animals, often serving as corridors for the movement of animals between habitats in fragmented landscapes. In this project, we focused on the structure and function of riparian wetlands associated with headwater streams in Alaska that serve as nursery habitats for juvenile salmonids. We asked whether or not the structure and function of headwater wetlands differed between watersheds with and without nitrogen-fixing Alder (Alnus spp.). We found that the aboveground biomass of riparian vegetation was higher in the watershed with Alder, but the largest differences were in the litter layer and belowground where vegetation in the watershed with no Alder had significantly higher root biomass. Interstitial water chemistry also differed between the study sites with significantly higher inorganic N and significantly different characteristics of colored dissolved organic matter at the site with Alder on the watershed. The biomass of litter that hung over the creek bank was less at the site with Alder on the watershed and an in situ decomposition experiment showed significant differences between the two systems. Results of the research demonstrates that watershed characteristics can impact the ecology of headwater streams in ways that had not been previously recognized.
ABSTRACT
Duchenne muscular dystrophy is a monogenic disease potentially treatable by gene replacement. Use of recombinant adeno-associated virus (AAV) will ultimately require a vascular approach to broadly transduce muscle cells. We tested the impact of preexisting AAV antibodies on microdystrophin expression following vascular delivery to nonhuman primates. Rhesus macaques were treated by isolated limb perfusion using a fluoroscopically guided catheter. In addition to serostatus stratification, the animals were placed into one of the three immune suppression groups: no immune suppression, prednisone, and triple immune suppression (prednisone, tacrolimus, and mycophenolate mofetil). The animals were analyzed for transgene expression at 3 or 6 months. Microdystrophin expression was visualized in AAV, rhesus serotype 74 sero-negative animals (mean: 48.0 ± 20.8%) that was attenuated in sero-positive animals (19.6 ± 18.7%). Immunosuppression did not affect transgene expression. Importantly, removal of AAV binding antibodies by plasmapheresis in AAV sero-positive animals resulted in high-level transduction (60.8 ± 18.0%), which is comparable with that of AAV sero-negative animals (53.7 ± 7.6%), whereas non-pheresed sero-positive animals demonstrated significantly lower transduction levels (10.1 ± 6.0%). These data support the hypothesis that removal of AAV binding antibodies by plasmapheresis permits successful and sustained gene transfer in the presence of preexisting immunity (natural infection) to AAV.
Subject(s)
Dependovirus/immunology , Dystrophin/genetics , Gene Expression , Genetic Vectors/genetics , Genetic Vectors/immunology , Plasmapheresis , Animals , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , Dependovirus/genetics , Genes, Reporter , Genetic Vectors/administration & dosage , Green Fluorescent Proteins/genetics , Humans , Macaca mulatta , Male , Muscle, Skeletal/metabolism , Plasmapheresis/methods , Transduction, Genetic , TransgenesABSTRACT
At present there is a renew interest in delineating diagnostic criteria for the Ehlers-Danlos Syndrome type III (EDS-III), condition than even though is not serious, can produce poor quality of life, due to alteration of various organs and the presence of dysautonomia. The fragility of tissues, that causes the symptomatology, can frequently be reflected in some external signs. In this study, some authors have been selected that present facial signs that are characteristic of this syndrome and gives us the opportunity to look in their texts some tracts of this disease, by looking in their autobiographic texts or in their fiction works. This exercise of free association helps us to have a more complete view of their rich and complex personalities and helps us also to appreciate the importance in detecting and preventing the consequences of this disease, that with an adequate management can produce a notable improvement in the quality of life...
Hoy se está produciendo un renovado interés por afinar los criterios diagnósticos del síndrome de hipermovilidad articular (similar al SED-III), condición que, aunque no suele ser grave, puede traducirse en una mala calidad de vida, por trastornos en diversos órganos y la presencia de disautonomía. La debilidad de los tejidos conectivos, causante de la sintomatología, suele reflejarse también en algunos signos externos. En este estudio se seleccionan algunos escritores que presentan signos en el rostro característicos de este síndrome y que nos dan la oportunidad de buscar entre sus textos algunas pistas de esta enfermedad, ya sea en textos autobiográficos o en sus obras de ficción. Este ejercicio de libre asociación nos ayuda a tener una mirada más completa de sus ricas y complejas personalidades, y nos ayuda también a tomar conciencia de la importancia de detectar y prevenir las consecuencias de esta enfermedad, que con manejo adecuado puede traducirse en una mejoría notable de la calidad de vida...
Subject(s)
Humans , Joint Instability/diagnosis , Joint Instability/history , Ehlers-Danlos Syndrome/diagnosis , Ehlers-Danlos Syndrome/history , Primary DysautonomiasABSTRACT
OBJECTIVE: to study the underlying cognitive deficits influencing a stroke patient's ability to relearn to dress. The aim was to investigate how recovery had occurred and whether the nature of cognitive impairment was the reason for persistent dressing problems. METHODS: the dressing performance of 30 stroke patients was compared at the sub-acute stage and three months later. Standardised cognitive and physical tests were carried out, together with a video analysis of patients putting on a polo shirt. RESULTS: thirteen patients with preserved power in the upper limb used both arms to put on the shirt. Despite visuospatial impairment or apraxia in some cases, all were successful given sufficient time. Out of 17 patients with arm paresis, 12 were dependent putting on the shirt. Amongst the five who were independent, significantly fewer cases of cognitive impairment were seen on tests for apraxia (p<0.05) and visuospatial perception (p<0.05). Video analysis confirmed the importance of cognitive problems such as neglect or apraxia. Three patients who failed shirt dressing showed neglect or apraxia at follow up and had persistent arm paresis. Test failures also occurred amongst those who were independent. DISCUSSION: cognitive impairment affected patients attempting to relearn to dress with one hand, but did not affect patients who used both hands. The three patients who remained impaired on cognitive tests at follow up were unable to adapt or learn any compensatory strategies. The influence of cognition on a person's ability to learn compensatory strategies has implications for the design of rehabilitation therapies.
Subject(s)
Activities of Daily Living , Cognition Disorders/complications , Cognition Disorders/etiology , Stroke Rehabilitation , Stroke/complications , Aged , Apraxias , Clothing , Female , Humans , Male , Middle Aged , Space Perception , Task Performance and Analysis , Video Recording , Vision DisordersABSTRACT
Loading of most endogenous peptides on major histocompatibility complex class I molecules is conditional on their transport into the endoplasmic reticulum (ER) by the peptide transporter TAP. We describe an HSV-2/1 cross-reactive cytotoxic T-cell (CTL) epitope that is processed in a TAP1-independent manner in vivo following immunization of TAP1-/- mice with naked DNA or a recombinant vaccinia virus. These data indicated that TAP1-independent processing of endogenous proteins is sufficient to prime CTLs in vivo. TAP1-independent processing of this epitope was not due to ER targeting by signal sequences and exogenous loading of MHC-I molecules and was not influenced by the amino acids flanking this epitope. In contrast, TAP1-/- mice infected with HSV-2 or HSV-2 mutants did not mount a CTL response against this epitope.
Subject(s)
Extracellular Matrix Proteins/deficiency , Nerve Tissue Proteins/deficiency , Simplexvirus/immunology , T-Lymphocytes, Cytotoxic/immunology , Animals , Antigen Presentation , Cell Line , Cross Reactions , Epitopes, T-Lymphocyte/immunology , Extracellular Matrix Proteins/genetics , Female , Herpes Simplex/immunology , Herpes Simplex/prevention & control , Immunization , Mice , Mice, Inbred C57BL , Mice, Knockout , Nerve Tissue Proteins/genetics , Simplexvirus/genetics , Vaccines, DNA/administration & dosage , Vaccinia virus/genetics , Vaccinia virus/immunology , Viral Envelope Proteins/genetics , Viral Envelope Proteins/immunology , Viral Vaccines/administration & dosageABSTRACT
Several retroviruses have recently been shown to promote translation of their gag gene products by internal ribosome entry. In this report, we show that mRNAs containing the human immunodeficiency virus type 1 (HIV-1) gag open reading frame (ORF) exhibit internal ribosome entry site (IRES) activity that can promote translational initiation of Pr55(gag). Remarkably, this IRES activity is driven by sequences within the gag ORF itself and is not dependent on the native gag 5'-untranslated region (UTR). This cap-independent mechanism for Pr55(gag) translation may help explain the high levels of translation of this protein in the face of major RNA structural barriers to scanning ribosomes found in the gag 5' UTR. The gag IRES activity described here also drives translation of a novel 40-kDa Gag isoform through translational initiation at an internal AUG codon found near the amino terminus of the Pr55(gag) capsid domain. Our findings suggest that this low-abundance Gag isoform may be important for wild-type replication of HIV-1 in cultured cells. The activities of the HIV-1 gag IRES may be an important feature of the HIV-1 life cycle and could serve as a novel target for antiretroviral therapeutic strategies.
Subject(s)
Genes, gag , HIV-1/genetics , Ribosomes/physiology , 5' Untranslated Regions , Animals , Blotting, Northern , COS Cells , Open Reading Frames , Protein Biosynthesis , Virus ReplicationABSTRACT
CD8(+) cytotoxic T lymphocytes (CTL) are thought to control hepatitis C virus (HCV) replication and so we investigated why this response fails in persistently infected individuals. The HCV quasispecies in three persistently infected chimpanzees acquired mutations in multiple epitopes that impaired class I MHC binding and/or CTL recognition. Most escape mutations appeared during acute infection and remained fixed in the quasispecies for years without further diversification. A statistically significant increase in the amino acid replacement rate was observed in epitopes versus adjacent regions of HCV proteins. In contrast, most epitopes were intact when hepatitis C resolved spontaneously. We conclude that CTL exert positive selection pressure against the HCV quasispecies and the outcome of infection is predicted by mutations in class I MHC restricted epitopes.
Subject(s)
Antigenic Variation/genetics , Epitopes/genetics , Hepacivirus/immunology , Hepatitis C Antigens/genetics , Hepatitis C/immunology , Mutation , T-Lymphocytes, Cytotoxic/immunology , Viral Envelope Proteins/genetics , Viral Nonstructural Proteins/genetics , Acute Disease , Amino Acid Sequence , Animals , Cell Line/immunology , Epitopes/immunology , Follow-Up Studies , Hepacivirus/genetics , Hepatitis C/virology , Hepatitis C Antigens/immunology , Hepatitis C, Chronic/immunology , Hepatitis C, Chronic/virology , Histocompatibility Antigens Class I/immunology , Molecular Sequence Data , Pan troglodytes , RNA, Viral/genetics , Remission, Spontaneous , Sequence Alignment , Sequence Homology, Amino Acid , Viral Envelope Proteins/immunology , Viral Nonstructural Proteins/immunologyABSTRACT
Single amino acid substitution analogs of the known Mamu A*01 binding peptide gag 181-190 and libraries of naturally occurring sequences of viral or bacterial origin were used to rigorously define the peptide binding motif associated with Mamu A*01 molecules. The presence of S or T in position 2, P in position 3, and hydrophobic or aromatic residues at the C terminus is associated with optimal binding capacity. At each of these positions, additional residues are also tolerated but associated with significant decreases in binding capacity. The presence of at least two preferred and one tolerated residues at the three anchor positions is necessary for good Mamu A*01 binding; optimal ligand size is 8-9 residues. This detailed motif has been used to map potential epitopes from SIVmac239 regulatory proteins and to engineer peptides with increased binding capacity. A total of 13 wild type and 17 analog candidate epitopes were identified. Furthermore, our analysis reveals a significantly lower than expected frequency of epitopes in early regulatory proteins, suggesting a possible evolutionary- and/or immunoselection directed against variants of viral products that contain CTL epitopes.
Subject(s)
Histocompatibility Antigens Class I/metabolism , Peptide Fragments/metabolism , Simian Immunodeficiency Virus/immunology , Viral Regulatory and Accessory Proteins/metabolism , Algorithms , Amino Acid Substitution , Amino Acids/metabolism , Animals , Binding Sites/immunology , Epitopes, T-Lymphocyte/metabolism , Immediate-Early Proteins/chemical synthesis , Immediate-Early Proteins/metabolism , Ligands , Macaca mulatta , Oligopeptides/chemical synthesis , Oligopeptides/metabolism , Peptide Fragments/chemical synthesis , Peptide Mapping , Protein Binding/immunology , Protein Engineering , Simian Immunodeficiency Virus/metabolism , Viral Regulatory and Accessory Proteins/chemical synthesisABSTRACT
We have sequenced the Pan troglodytes class I (Patr) molecules from three common chimpanzees and expressed them as single molecules in a class I-deficient cell line. These lines were utilized to obtain purified class I molecules to define the peptide binding motifs associated with five different Patr molecules. Based on these experiments, as well as analysis of the predicted structure of the B and F polymorphic MHC pockets, we classified five Patr molecules (Patr-A*0101, Patr-B*0901, Patr-B*0701, Patr-A*0602, and Patr-B*1301) within previously defined supertype specificities associated with HLA class I molecules (HLA-A3, -B7, -A1, and -A24 supertypes). The overlap in the binding repertoire between specific HLA and Patr class I molecules was in the range of 33 to 92%, depending on the particular Patr molecule as assessed by the binding of HIV-, hepatitis B virus-, and hepatitis C virus-derived epitopes. Finally, live cell binding assays of nine chimpanzee-derived B cell lines demonstrated that HLA supertype peptides bound to Patr class I molecules with frequencies in the 20-50% range.
Subject(s)
HLA Antigens/metabolism , Histocompatibility Antigens Class I/metabolism , Oligopeptides/immunology , Oligopeptides/metabolism , Pan troglodytes/immunology , Alleles , Amino Acid Motifs/genetics , Amino Acid Motifs/immunology , Animals , B-Lymphocytes/metabolism , Cell Line, Transformed , Genes, MHC Class I , HLA-A1 Antigen/genetics , HLA-A1 Antigen/metabolism , HLA-A3 Antigen/genetics , HLA-A3 Antigen/metabolism , HLA-B Antigens/genetics , HLA-B Antigens/metabolism , HLA-B7 Antigen/genetics , HLA-B7 Antigen/metabolism , Histocompatibility Antigens Class I/genetics , Histocompatibility Antigens Class I/isolation & purification , Humans , Oligopeptides/chemical synthesis , Pan troglodytes/genetics , Protein Binding/genetics , Protein Binding/immunology , Sequence Analysis, DNA , TransfectionABSTRACT
A case of a septic paradoxic embolus due to an infected pacemaker lead associated with a patent foramen ovale (PFO) is described. Treatment consisted of immediate intracardiac embolectomy, pericardial patch closure of the PFO, total removal of the infected pacemaker lead and generator, and placement of a new permanent epicardial lead pacemaker system.
Subject(s)
Embolism, Paradoxical/etiology , Heart Septal Defects, Atrial/complications , Pacemaker, Artificial/adverse effects , Staphylococcal Infections/etiology , Staphylococcus epidermidis , Humans , Male , Middle AgedABSTRACT
In the European Community Respiratory Health Study (ECRHS), airway responsiveness to methacholine was determined using the Mefar dosimeter protocol. Elsewhere, the 2-min tidal breathing method has become the preferred standardized method. The relationship between measurements of responsiveness by these two methods is not well established. This study measured airway responsiveness to methacholine by dosimeter and tidal breathing methods in 47 healthy asthmatic subjects aged 20-44 yrs. Tests were performed within 1 week and in random order. Baseline forced expiratory volume in one second (FEV1) varied by <10% between tests in 42/47 subjects. There was a close association between responsiveness determined by the two methods. A provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) value of < or =8.0 mg x mL(-1) (tidal method) used to categorize airway hyperresponsiveness agreed most closely with a provocative dose of methacholine causing a 20% fall in FEV1 (PD20) value of < or =0.5 mg (dosimeter method) (kappa statistic 0.78). Each doubling or halving of PC20 to define a level of hyperresponsiveness agreed closely with a doubling or halving of PD20. Assessment of airway responsiveness as provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second by the Mefar dosimeter protocol gave a close and predictable relationship with provocative concentration of methacholine causing a 20% fall in expiratory volume in one second assessed using the tidal breathing method. Airway hyperresponsiveness as determined by the accepted criterion of provocative concentration of methacholine causing a 20% fall in expiratory volume in one second < or =8 mg x mL(-1) was best correlated with provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second <0.5 mg by Mefar dosimeter.
Subject(s)
Airway Resistance/drug effects , Bronchial Provocation Tests/methods , Bronchoconstrictor Agents , Methacholine Chloride , Administration, Inhalation , Adult , Asthma/diagnosis , Bronchial Hyperreactivity/diagnosis , Dose-Response Relationship, Drug , Female , Forced Expiratory Volume/drug effects , Humans , Male , Reference ValuesABSTRACT
Despite advances in the clinical management of HIV infection, using combinations of antiretroviral pharmaceuticals, a safe and efficacious vaccine is needed to limit the AIDS pandemic. It is now thought that an effective HIV-1 vaccine should prime both cross-neutralizing antibodies and long-lasting cytotoxic CD8+ T lymphocytes (CTLs) recognizing multiple codominant HIV-1 epitopes. To that end, many novel vaccine strategies have been tested. However, only a few of these strategies, beside those relying on live-attenuated viruses, are able to prime strong CTL responses in nonhuman primates and humans. In this study, three rhesus macaques were immunized with HIV-1 p55gag virus-like particles (VLPs) in the absence of adjuvant to assess the potential of such a vaccine to prime CTL responses. After intramuscular injection of p55gag VLP, all three animals mounted CTL responses against HIV-1 p55gag. Notably, these CTLs primed by vaccination recognized naturally processed peptides and were long lived (>8.5 months) both in the peripheral blood and draining lymph node. Furthermore, these CTLs were directed against multiple HIV-1 p55gag epitopes. This indicated that immunization with p55gag VLP primes strong MHC class I-restricted, CD8+ cell-mediated immune responses and suggested that HIV-1 p55gag VLPs should be a reasonable vaccine candidate, when combined with strategies priming cross-neutralizing antibodies.
Subject(s)
AIDS Vaccines/immunology , Gene Products, gag/immunology , HIV-1/immunology , Protein Precursors/immunology , T-Lymphocytes, Cytotoxic/immunology , AIDS Vaccines/administration & dosage , Animals , Antigen Presentation/immunology , Humans , Lymph Nodes/immunology , Macaca mulatta , Peptides/immunology , Time Factors , Vaccination , Virion/immunologyABSTRACT
Cytotoxic T lymphocyte (CTL) responses against the simian immunodeficiency virus (SIV) envelope and Gag proteins were monitored in a Mamu-A*01-positive rhesus macaque infected with SIVsmE660. Peripheral blood mononuclear cells (PBMC) cultured with synthetic peptides spanning the entire gp160 and Gag coding region recognized a total of three epitopes. One located in Gag was identified as the previously described Mamu-A*01-restricted p11cC-->M epitope (CTPYDINQM). The other two epitopes, designated p15m and p54m, were located in the gp160 envelope protein. Both were nine amino acids in length and were predicted to bind Mamu-A*01 because they contained proline and leucine residues at positions 3 and 9, respectively. Indeed, expression of this class I major histocompatibility complex molecule was required for target cell recognition by envelope-specific CD8(+) T cells directed against both epitopes. These Mamu-A*01-restricted epitopes in the SIV envelope will be useful for monitoring immune responses in vaccinated or infected animals.
Subject(s)
Antigens, Viral/genetics , Antigens, Viral/immunology , Epitopes/genetics , Epitopes/immunology , Simian Immunodeficiency Virus/immunology , T-Lymphocytes, Cytotoxic/immunology , T-Lymphocytes, Cytotoxic/virology , Amino Acid Sequence , Animals , Cytotoxicity, Immunologic , Macaca mulatta , Molecular Sequence Data , Viral Envelope Proteins/genetics , Viral Envelope Proteins/immunologyABSTRACT
To investigate the type of immunity responsible for resolution of hepatitis C virus (HCV) infection, we monitored antibody and intrahepatic cytotoxic T lymphocyte (CTL) responses during acute (<20 weeks) infection in chimpanzees. Two animals who terminated infection made strong CTL but poor antibody responses. In both resolvers, CTL targeted at least six viral regions. In contrast, animals developing chronic hepatitis generated weaker acute CTL responses. Extensive analysis of the fine specificity of the CTL in one resolver revealed nine peptide epitopes and restriction by all six MHC class I allotypes. Every specificity shown during acute hepatitis persisted in normal liver tissue more than 1 yr after resolution. These results suggest that CD8+CTL are better correlated with protection against HCV infection than antibodies.
Subject(s)
Hepacivirus/immunology , Hepatitis C/immunology , Hepatitis C/prevention & control , Acute Disease , Amino Acid Sequence , Animals , CD8-Positive T-Lymphocytes/immunology , Cell Line , Epitopes, T-Lymphocyte/immunology , Female , Genes, MHC Class I/immunology , Hepatitis C/virology , Histocompatibility Antigens Class I/genetics , Histocompatibility Antigens Class I/immunology , Histocompatibility Testing , Liver/virology , Male , Molecular Sequence Data , Pan troglodytes , Prospective Studies , T-Lymphocytes, Cytotoxic/immunology , T-Lymphocytes, Cytotoxic/virologyABSTRACT
The aim of the study was to use Kappa statistical analysis to assess the inter and intraobserver agreement of the interpretation of the osteoarthritis changes observed on a FISP sequence, 1.0 Tesla, MRI analysis of the articular cartilage in 30 knees. The images were read on two separate occasions by three observers. The best agreement was seen in the patello-femoral compartment. The most experienced of the assessors produced the more consistent results. The results of the interobserver agreement had mainly "slight" or "fair" agreement. Our results are disappointing and accordingly, we have reservations about the use of MRI in the assessment of osteoarthritis of the knee.
Subject(s)
Knee Joint/pathology , Magnetic Resonance Imaging/standards , Osteoarthritis/pathology , Humans , Observer Variation , Osteoarthritis/classification , Reproducibility of Results , Severity of Illness IndexSubject(s)
CD4-Positive T-Lymphocytes/immunology , Gene Products, env/immunology , HIV/immunology , Pan troglodytes/immunology , Animals , B-Lymphocytes/immunology , B-Lymphocytes/virology , Cytotoxicity, Immunologic , Disease Models, Animal , Gene Products, env/genetics , HIV/genetics , HIV Infections/immunology , HIV Infections/virology , Humans , In Vitro Techniques , Pan troglodytes/virology , Transformation, GeneticABSTRACT
We investigated whether hepatitis C virus envelope glycoprotein E1 is transported from the endoplasmic reticulum (ER) to the cytoplasm of infected cells for class I MHC processing. Target cells expressing E1 were killed by CTL lines from a hepatitis C virus-infected chimpanzee, and synthetic peptides were used to define an epitope (amino acids 233-GNASRCWVA-241) presented by the Patr-B*1601 class I MHC molecule. An unusually high concentration (>100 nM) of this nonameric peptide was required for target cell lysis, but this could be reduced at least 1000-fold by replacing the asparagine at amino acid position 234 (Asn234) with aspartic acid (Asp), the anticipated anchor residue for NH2-terminal peptide binding to Patr-B*1601. Conspicuously, position 234 is part of an N-glycosylation motif (Asn-Xaa-Ser/Thr), suggesting that the Asn234 to Asp substitution might occur naturally within the cell due to deglycosylation/deamidation of this amino acid by the cytosolic enzyme peptide N-glycanase. In support of this model, we demonstrate that presentation of the epitope depended on 1) cotranslational synthesis of E1 in the ER, 2) glycosylation of the E1 molecule, and 3) a functional TAP transporter to shuttle peptide from the cytosolic to ER compartment. These results indicate for the first time that during infection of the host, viral envelope glycoproteins originating in the ER are processed in the cytoplasm for class I MHC presentation. That a posttranslational change in amino acid sequence from Asn to Asp alters the repertoire of peptides presented to CD8+ CTL has implications for the design of antiviral vaccines.
Subject(s)
Antigen Presentation , Cytoplasm/immunology , Endoplasmic Reticulum/immunology , Hepacivirus/immunology , Histocompatibility Antigens Class I/metabolism , Protein Processing, Post-Translational/immunology , Viral Envelope Proteins/immunology , Animals , Asparagine/metabolism , Cell Line , Cytoplasm/metabolism , Cytotoxicity, Immunologic , Endoplasmic Reticulum/metabolism , Glycosylation , Hepacivirus/metabolism , Hepatitis C/immunology , Liver/immunology , Liver/pathology , Lymphocyte Activation , Pan troglodytes , Peptides/immunology , Peptides/metabolism , Peptides/pharmacology , T-Lymphocytes, Cytotoxic/immunology , T-Lymphocytes, Cytotoxic/metabolism , Viral Envelope Proteins/metabolismSubject(s)
AIDS Vaccines/immunology , HIV Infections/prevention & control , Adenoviridae/genetics , Animals , Clinical Trials as Topic , Cytotoxicity, Immunologic , HIV Antibodies/immunology , HIV Envelope Protein gp120/immunology , HIV Envelope Protein gp160/immunology , HIV Infections/immunology , Humans , Neutralization Tests , Pan troglodytes , Vaccines, Synthetic/immunologyABSTRACT
BACKGROUND: Few reports address the high-risk patient population with concomitant critical carotid and left main coronary disease with left ventricular dysfunction. To decrease the risks involved with the simultaneous and traditional staged surgical approaches, we developed a rapid staging strategy using an intraaortic balloon pump. METHODS: Between 1992 and 1996, 20 patients presented with a high-risk "triad" defined by greater than 70% stenosis of the left main coronary artery, ejection fraction less than 0.30, and greater than 90% stenosis of the internal carotid artery. An intraaortic balloon pump was placed immediately before carotid endarterectomy under angiographic guidance. Less than 24 hours later (mean, 18 hours) coronary artery bypass grafting was performed, and the intraaortic balloon pump was removed the day of coronary artery bypass grafting in all cases (total IABP duration, <36 hours). RESULTS: Eighteen patients (18/20) were extubated on the day of coronary artery bypass grafting (mean, 12 hours). Sixteen patients (16/20) were transferred from the intensive care unit within 48 hours, with total hospital stay ranging from 6 to 12 days (mean, 8 days). There were no 30-day postoperative deaths, myocardial infarctions, or neurologic, vascular, bleeding, or other major complications. At a mean 29.4-month follow-up, there were two noncardiac deaths and no neurologic events. Six-month, 1-year, and 2-year follow-up ultrasounds showed all operative carotid arteries remained patent. CONCLUSIONS: A rapid staged procedure with angiographically guided placement of the intraaortic balloon pump was safe and effective in this very high risk patient population. It may be an option to decrease the risks involved with simultaneous operations and increase the efficiency and safety of "traditional" staged carotid and coronary artery bypass grafting procedures.
Subject(s)
Carotid Stenosis/surgery , Coronary Artery Bypass/methods , Coronary Disease/surgery , Endarterectomy, Carotid/methods , Intra-Aortic Balloon Pumping , Ventricular Dysfunction, Left/surgery , Aged , Carotid Artery, Internal , Carotid Stenosis/complications , Carotid Stenosis/epidemiology , Coronary Disease/complications , Coronary Disease/epidemiology , Female , Follow-Up Studies , Humans , Male , Risk Factors , Time Factors , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/epidemiologyABSTRACT
Vaccination can elicit CD8(+) cytotoxic T lymphocytes (CTL) that recognize peptides presented by class I MHC molecules. Relatively little is known, however, about the genetic factors that shape the repertoire of T cell clonotypes responding to any given epitope. We report here that H-2(b) mice immunized with a plasmid DNA vaccine or vaccinia virus encoding for HIV-1SF2p55gag elicit CD8(+) CTL against the H-2Db-restricted immunodominant epitope (pgagb). This response involved three different T cell populations based on their recognition of alloantigens: one that cross-reacted with the alloantigen H-2Ld, one that cross-reacted with H-2Kd, and one that did not cross-react with either H-2(d) or H-2(k) molecules. Using the TAP-deficient cell line T2-Ld, we showed that pgagb-specific CTL cross-react with H-2Ld and a yet unidentified self-peptide. In mice expressing H-2(b) and H-2(d) allotypes, we investigated whether tolerance to H-2(d) influenced the HIVp55gag-specific CTL repertoire as a consequence of thymic deletion of the cross-reactive CTL repertoire. In (H-2(dxb))F1 mice heterogygosity at the MHC-I level prevented maturation of some but not all TCR combinations specific for H-2Db+pgagb, illustrating the concept that self-tolerance can influence the repertoire of antiviral T cells.