Vpx is required for dissemination and pathogenesis of SIV(SM) PBj: evidence of macrophage-dependent viral amplification.

The viral accessory protein Vpx is required for productive in vitro infection of macrophages by simian immunodeficiency virus from sooty mangabey monkeys (SIV(SM)). To evaluate the roles of Vpx and macrophage infection in vivo, we inoculated pigtailed macaques intravenously or intrarectally with the molecularly cloned, macrophage tropic, acutely pathogenic virus SIV(SM) PBj 6.6, or accessory gene deletion mutants (deltaVpr or deltaVpx) of this virus. Both wild-type and SIV(SM) PBj deltaVpx viruses were readily transmitted across the rectal mucosa. A subsequent 'stepwise' process of local amplification of infection and dissemination was observed for wild-type virus, but not for SIV(SM) PBj deltaVpx, which also showed considerable impairment of the overall kinetics and extent of its replication. In animals co-inoculated with equivalent amounts of wild-type and SIV(SM) Pbj deltaVpx intravenously or intrarectally, the deltaVpx mutant was at a strong competitive disadvantage. Vpx-dependent viral amplification at local sites of initial infection, perhaps through a macrophage-dependent mechanism, may be a prerequisite for efficient dissemination of infection and pathogenic consequences after exposure through either mucosal or intravenous routes.

Phylogeny and natural history of the primate lentiviruses, SIV and HIV.

Studies of primate lentivirus phylogeny over the past decade have established a minimum of five related, but genetically distinct, groups of simian immunodeficiency virus (SIV), each originating from a different African primate species. The hypothesis that HIV-2 (and SIVmac) arose by cross-species transmission from sooty mangabeys (Cercocebus atys has been strengthened by a more detailed characterization of the SIVsm/SIVmac/HIV-2 group of viruses. SIV from all four subspecies of African green monkeys (SIVagm) have been characterized with an apparent chimeric genome structure of SIVagm from West African green monkeys. Although these naturally infected primates remain healthy, cross-species transmission to other primate species may result in immunodeficiency, as caused by SIVsm infection of macaque monkeys (Macaca sp.) and recently, SIVagm infection of pig-tailed macaques (M. nemestrina). Studies of variation within infected individuals have been facilitated by adaptation of the techniques of heteroduplex analysis and single-stranded conformational polymorphism of PCR generated fragments.

Paroxysmal nocturnal hemoglobinuria. Termination in acute myelomonocytic leukemia and reappearance after leukemic remission.

In a 71-year-old man, acute myelomonocytic leukemia developed six years after a diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) had been established. The classic features of PNH disappeared with the onset of the leukemia. Chemotherapy resulted in complete leukemic remission, during which time intravascular hemolysis and a positive acidified serum (Ham's) test recurred; both findings again disappeared when the leukemia recurred. To our knowledge, this is the eighth reported case of PNH terminating in acute leukemia but is the first in which reappearance of PNH has been documented with leukemic remission. The alternating pattern of the two disorders suggests that the PNH clone survivors in the bone marrow when leukemia supervenes.

The role of nonhuman primates in the development of an AIDS vaccine.

Over the past decade, a substantial research investment has generated a vast body of knowledge relevant to the development of an effective AIDS vaccine. Furthermore, studies in nonhuman primates have demonstrated that a number of candidate immunogens can confer a significant degree of protection against a potentially pathogenic SIV or SHIV. Currently, there exists a robust program that supports discovery of new HIV immunogens and a proven successful program for collaborative human trials of promising vaccine candidates. However, we believe that there is a gap between discovery and clinical trials. An orderly process for screening of candidate immunogens prior to human trials would facilitate the vaccine development program. We suggest that nonhuman primates can fill this strategic gap and could accelerate vaccine development. Recognizing that there is considerable controversy about the potential usefulness of the primate models, we have attempted to set forth the relevant practical and biological issues as a series of questions for discussion. The most important biological problem is the absence of a single immune response correlate that will predict vaccine efficacy. Data from primate models indicate that such a single predictive correlate may not exist. In turn, this argues for a vaccine screening protocol that includes a pathogenic virus challenge, an approach only available in the nonhuman primate model. The further assumption is that nonprimate models can be used to predict the relative protective efficacy of diverse immunization protocols, a hypothesis that can only be tested by comparative studies yet to be conducted. A 'standard' set of virus challenges must be selected for comparison of different immunization protocols, and this effort has been initiated. At the practical level, it appears that the large number of candidate immunogens now being developed requires a screening process of the kind proposed, since it would not be practical to test all new immunogens and protocols in humans. In conclusion, it appears timely to crystallize an orderly process for the discovery, screening, and human testing of candidate AIDS vaccines, understanding that a vaccine development program should not be conducted at the expense of investigator-initiated research in the diverse disciplines that support rational vaccine design and development. The components of a rational process of vaccine development are well established and only remain to be welded into one coherent program.

Genetic variation of the SIVagm transmembrane glycoprotein in naturally and experimentally infected primates.

OBJECTIVE: An in-frame stop codon prematurely truncating the transmembrane glycoprotein (TMP) is a common feature of many simian immunodeficiency virus, African green monkey strain (SIVagm) molecular clones. The purpose of this study was to investigate the native form of the SIVagm TMP in a naturally infected African green monkey (AGM) and to study the fate of the stop codon following the passage of SIVagm in primates. DESIGN: Polymerase chain reaction was used to clone the entire intracellular portion of the TMP from: (1) peripheral blood mononuclear cells (PBMC) of the naturally infected AGM 155; (2) an isolate of SIVagm155 in rhesus PBMC and (3) PBMC from pig-tailed macaques and AGM experimentally infected with an SIVagm molecular clone encoding a truncated TMP. RESULTS: PBMC of the naturally infected AGM contained a 'swarm' of related virus genotypes that encoded a full-length TMP, whereas tissue-culture passage in rhesus PBMC resulted in a prematurely truncated form of the TMP. This premature stop codon persisted in PBMC of monkeys experimentally infected with an SIVagm molecular clone. Both macaques and AGM of same subspecies as AGM 155 (Cercopithecus pygerythrus) and other subspecies (C. aethiops and C. sabaeus) became infected with SIVagm155. Genetic drift of this region of env, as assessed by calculation of the nucleotide substitution/site/year rate, was similar to that of other retroviruses. CONCLUSIONS: The native form of the SIVagm TMP is a full-length gp40, similar to the SIV macaque (SIVmac) strain and HIV-1. However, passage of SIVagm in tissue culture can result in point mutations that introduce a premature stop codon. This stop codon persists during subsequent in vivo passage of SIVagm in primates. This contrasts with similar studies in macaques infected with SIVmac, in which reversion of the TMP stop codon was observed.

Antibodies to the putative SIV infection-enhancing domain diminish beneficial effects of an SIV gp160 vaccine in rhesus macaques.

OBJECTIVE: To demonstrate that antibodies against amino acids (aa) 603-622 of the SIV gp41 transmembrane glycoprotein enhance infection of SIV in vivo. DESIGN: A synthetic peptide derived from aa 603-622 of SIVmac251 gp41 was synthesized and tested for immunogenicity in rabbits and SIV-infected rhesus macaques. Next, SIV-naive animals were immunized with either a recombinant vaccinia virus expressing the SIV gp160 envelope glycoprotein (VVrgp160) and boosted three times with aa 603-622 (group 1, four animals), wild-type vaccinia virus and boosted with aa 603-622 (group 2, two animals), or VVrgp160 followed by three doses of an irrelevant peptide (group 3, two animals). Animals were challenged with SIVmac251. RESULTS: Peptide aa 603-622 was immunogenic in rabbits. SIV-infected rhesus monkeys immunized with the peptide developed two-three log increases in antibodies to this peptide and antibodies that could enhance SIV infection in vitro. SIV-naive rhesus macaques in group 1 had higher levels of antibody to the peptide by enzyme-linked immunosorbent assay and higher levels of enhancing antibodies at the time of SIV challenge than the animals in groups 2 or 3. Following challenge with SIVmac251 the group 1 animals had detectable p27 antigen longer than animals in group 2 and 3 and died of simian AIDS before the respective animals in the two control groups (P < 0.05 by log-rank test). CONCLUSIONS: aa 603-622 of SIV gp41, like aa 579-613 of HIV gp41, can stimulate production of antibodies that enhance SIV and HIV infection in vitro. Furthermore, immunization with this peptide suppressed beneficial effects of a gp160 vaccine and appeared to enhance SIV infection in vivo.

Detection of SIV antigens by HIV-1 antigen capture immunoassays.

We tested three commercially available HIV-1 antigen capture systems for their ability to detect simian immunodeficiency viruses (SIV). All three kits detected antigens from six distinct SIV isolates, but with varying degrees of sensitivity. For the overall detection of SIV in cell culture, our assay for reverse transcriptase was more sensitive than HIV-1 antigen capture. HIV-1 antigen capture systems were useful for the detection of SIV antigenemia in experimentally infected macaques. The limited sensitivity of HIV-1-specific antigen capture suggests that SIV-specific antigen capture reagents should be developed.

Pathogenic diversity of simian immunodeficiency viruses.

The SIV family is a diverse group of viruses that vary considerably in pathogenesis and virulence in their natural host species or macaques. Although the disease induced by the SIVsm subtype in particular is remarkably similar to human AIDS, it must be remembered that this is an experimental animal model. Therefore, although the pathogenesis of SIVsm (and other viruses) in macaques offers an relevant animal model for pathogenesis and vaccine trials, the interactions of these viruses in their natural host, and virus-, or host-specific effects have been poorly characterized. This animal model offers a unique opportunity to study the details of the pathogenesis of immunodeficiency and to define host and viral factors responsible for disease progression.

Passive immune globulin therapy in the SIV/macaque model: early intervention can alter disease profile.

One of the major questions in AIDS is the role that the host immune system and the virus play in the dynamics of infection and the development of AIDS in an infected individual. In order to test the role of antibody in controlling viral infection, high-dose SIV-immune globulin was passively transferred to infected macaques early in infection. Immune globulin purified from the plasma of an SIV-infected long-term non-progressor macaque (SIVIG) or a pool of normal immune globulin (normal Ig) was infused into SIVsmE660-infected macaques (170 mg/kg) at one and fourteen days post infection. Animals were monitored for SIV-specific antibodies, viremia, plasma antigenemia, and clinical course. All animals were infected by SIV. At 16 months post infection, five macaques in the combined control groups have been euthanized, one as a rapid progressor with debilitating disease at 20 weeks post infection. Four macaques from the comparison groups have signs of AIDS, accompanied by high and increasing levels of virus and p27 antigenemia. One of the ten control animals had a very low virus load in plasma and peripheral blood and lymph node mononuclear cells at all times tested and has remained disease-free. In the SIVIG treatment group, two macaques were euthanized at 18-20 weeks due to AIDS, rapid progressors to disease. Three macaques in the SIVIG group had an initial high level of virus in plasma, peripheral blood mononuclear cells (PBMC), and lymph node mononuclear cells (LNMC), which dropped to baseline at 6 weeks post infection and has remained very low or negative for 16 months, a disease profile which has not been observed in untreated animals in this model to date. These macaques have remained clinically healthy. The sixth treated animal is also healthy, with very low virus burden that is detectable only by nested set polymerase chain reaction (PCR). All SIVIG-treated macaques had no detectable p27 plasma antigenemia for the first 10 weeks of infection, demonstrating that the IgG effectively complexed with the virus. The immunological correlates in the treated animals include development of de novo virus-specific antibodies and/or cytotoxic T cell (CTL), both of which are hallmarks of long term non-progressors. The two SIVIG-treated macaques that progress to disease rapidly had no detectable de novo humoral immune responses, as is often seen in rapid HIV disease in humans. Envelope-specific and virus neutralizing antibodies alone were not sufficient to prevent disease progression, as the plasma of both non-progressors as well as progressors had high titers of envelope-specific and neutralizing antibodies against SIVsmE660. Poor clinical prognosis was associated with moderate to high and increasing virus loads in plasma, PBMC, and lymph nodes. Good clinical prognosis correlated with low or undetectable post acute viremia in the peripheral blood and lymph nodes. We hypothesize that SIVIG reduced the spread of virus by eliminating or reducing plasma virus through immune complexes during the first four to 8 weeks of infection and then maintaining this low level of viremia until the host immune response was capable of virus control. Reduction of virus burden early in infection by passive IgG can alter disease outcome in SIV infection of macaques. Modifications of this strategy may lead to effective early treatment of HIV-1 infection in humans.

Contributions of CD4+, CD8+, and CD4+CD8+ T cells to skewing within the peripheral T cell receptor beta chain repertoire of healthy macaques.

Diversity in the peripheral T cell receptor repertoire of rhesus (Macaca mulatta) and pig-tailed macaques (Macaca nemestrina) has been studied by examining the profile of CDR3 lengths in TCR beta chains. Expressed CDR3 length distribution profiles for individual TCRBV families were obtained from total peripheral blood mononuclear cells (PBMC) and T cell subsets isolated from PBMC. These studies reveal that the T cell receptor repertoire of PBMC from healthy macaques often exhibits skewing in TCRBV family CDR3 profiles. The skewing of TCRBV family CDR3 profiles was evident as discrete expanded length(s) and was detected in up to 50% of the PBMC profiles. Analyses of separated T cell populations demonstrated that the CD8+ T cell subset was responsible for the majority of observed skewing in CDR3 length profiles. However, CD4+ T cells were also shown to contribute to the skewed peripheral PBMC repertoire in these animals. While certain TCRBV families frequently displayed skewed profiles, there was no concordance in the particular CDR3 lengths expanded among the different animals. Furthermore, an additional feature of the peripheral blood of the animals studied was the presence of an unusual population of extrathymic CD4 and CD8+ (double-positive) T cells (up to 9.6% in the PBMC of rhesus macaques). The double-positive T cells could be differentiated from CD4 single-positive and CD8 single-positive T cells by their increased surface expression of LFA-1 and decreased CD62L expression. The percentage of the double-positive T cells was higher in rhesus than pig-tailed macaques and contributed substantially to the peripheral T cell repertoire.

Receptor function of CD4 structures from African green monkey and pig-tail macaque for simian immunodeficiency virus, SIVsm, SIVagm, and human immunodeficiency virus type-1.

Differences in kinetics of infection, cellular tropism, and cytopathology of SIV and HIV appear to depend on both viral and host factors. We investigated the role of critical CD4 structures from African green monkeys (AGM) a natural SIV host, from pig-tailed macaques (PT) an unnatural SIV host, and from humans, as well as the role of species-specific cellular factors involved in the tropism, kinetics of infection, and cytopathic effects of several SIV and HIV-1. Critical regions of the PT macaque and AGM CD4 genes (V1, V1J1, and V1J1V2J2) were stably expressed as chimeras with the human CD4 gene in human (HeLa and 293) and macaque (CMMT) cell lines. CD4 expressing cell lines were used for infection studies with cell-free SIVsm, SIVmac, SIVsmmPBj, SIVagm, and HIV-1. Results show that both PT CD4 and AGM CD4 supported infection with comparable infection kinetics by all SIV or HIV-1 strains tested. Although structural analysis predicted a major change in secondary structure of AGM CD4/CDR-3, these structural changes did not influence the degree of syncytia formation induced by several SIV and HIV-1. However, the cell line used to express the CD4 gene appeared to be a critical determinant of infection. Thus, SlV strains did not infect human cell lines regardless of the CD4 expressed in these cells. In contrast, HIV-1 did not infect any macaque cell line. This study demonstrates that the differences in CD4 structure among different primate species are clearly not responsible for differences in SIV and HIV infection kinetics, tropism, and cytopathology. However, species-specific factor(s), presumably expressed on the cell surface, markedly influences the ability of SIV or HIV to infect cells expressing CD4.

SIV infection of macaques as a model for AIDS pathogenesis.

Simian immunodeficiency virus (SIV) infection of macaques is the best available animal model for studying the pathogenesis of AIDS. Experimental inoculation of macaques with SIV results in a persistent infection that leads to immunodeficiency, opportunistic infections, and death. Most aspects of the illness, including immunologic and virologic parameters, are easily quantified. Furthermore, pathologic processes can be evaluated throughout the course of experimental infection. Recently, molecular clones of SIV proviral DNA have been used to study genetic variation and specific viral determinants of pathogenesis. Considered together, these observations support the continued detailed study of SIV infection of macaques as a model for human AIDS.

Genetic variation of simian immunodeficiency viruses in nonhuman primates.

The generation of biologically active proviral DNA clones of simian immunodeficiency virus (SIV) that give rise to infectious virions has allowed the detailed examination of genetic variation in experimentally inoculated monkeys. Studies of nucleotide sequences derived directly from circulating leukocytes of infected monkeys show that the SIV genome undergoes rapid and dramatic variation during the course of infection. The env gene is a major site for variation, and within the Env protein, hypervariable regions analogous to those previously defined for the human immunodeficiency virus type 1 (HIV-1) env gene are apparent. A major exception is the region corresponding to the V3 domain in HIV-1, which has been highly conserved in all SIV studies to date. These data notwithstanding, the role of SIV genetic variation in the pathogenesis of AIDS in monkeys remains unclear. Genetic variation within the env gene does not appear to be sufficient for the development of AIDS since significant variation is observed in both pathogenic and nonpathogenic SIV infections. Furthermore, although it generally is believed that env gene variation might allow HIV and SIV to avoid recognition and elimination by host immune responses, this premise has not been rigorously proven. The use of molecularly cloned SIV in monkey models has provided important quantitative and qualitative information on in vivo sequence variation, and these data, in turn, have laid the groundwork for addressing the undoubtedly complex functional significance of this variation.

Plasma SIV RNA viral load determination by real-time quantification of product generation in reverse transcriptase-polymerase chain reaction.

Internally controlled RT-PCR methods (QC-RT-PCR) for quantification of SIV RNA are effective, but are relatively cumbersome, expensive, and time and labor intensive. For greater throughput and efficiency, we have developed a method for quantification of plasma SIV RNA levels by real-time RT-PCR using the Applied Biosystems Prism 7700 sequence detection system. This assay format allows real-time kinetic analysis of PCR product generation, providing a broad linear dynamic range and ensuring that quantification is based on analysis during the exponential phase of amplification, regardless of the input template copy number. Simultaneous amplification and analysis eliminates any requirement for handling amplified products, increasing throughput and eliminating a potential source of assay contamination. The assay we have developed for quantification of SIV RNA has a nominal threshold sensitivity of 300 copy Eq/ml of plasma, although as little as 10 copy Eq/reaction of SIV RNA template can be detected. The linear dynamic range is in excess of 5 logs. Interassay reproducibility averages 25% (coefficient of variation), based on studies of extraction and analysis of replicate aliquots of the same plasma specimens. The combination of sensitivity, precision, and broad dynamic range allows reliable quantification of viral load even during dynamic phases of SIV infection, such as through the onset and resolution of primary infection, or during treatment with antiretroviral agents. The primer-probe combinations we have developed allow quantification of SIV isolates most commonly used for experimental studies. Availability of this assay should greatly facilitate studies of basic pathogenesis and evaluation of therapeutic and prophylactic approaches in the SIV-infected macaque.

An analysis of birth weight by gestational age using a computerized perinatal data base, 1975-1992.

OBJECTIVE: To develop birth weight-for-gestational age nomograms based on a computerized perinatal data base collected prospectively from 1975-1992. METHODS: Using information from over 60,000 singleton deliveries (January 1975 through October 1992) at the MetroHealth Medical Center in Cleveland, Ohio, standard curves for normal birth weights were computed. Nomograms were developed for the overall population and for subgroups determined by factors known to affect fetal growth, including sex, race, smoking status, and gestational diabetes. The nomograms included the tenth, 50th, and 90th percentiles of birth weights for 24-44 weeks' gestation. Gestational age was based on clinical obstetric estimates confirmed by Dubowitz assessment of the neonate. In addition, third-order regression models were developed to predict median birth weight using gestational age. These models were validated using delivery data for the months of November and December, 1992, which were not included in model development. RESULTS: The most significant predictors of median birth weight were the first-, second-, and third-order gestational ages, which explained over 80% of the total variation in birth weight. Other significant factors influencing birth weight included infant gender, maternal race, parity, smoking, and diabetes status. Among the marginally significant factors influencing birth weight were pay status and maternal age. In general, before 33 weeks' gestation, there were few differences in the birth weight percentiles of various groups except for those with diabetes; infants of diabetic women exhibited greater birth weights as early as 26 weeks' gestation. CONCLUSIONS: Considering the large size of the data base and the diverse background of the study population, we believe that these nomograms provide useful norms of birth weight for an indigent urban population. These norms enhance the obstetrician's and neonatologist's ability to identify true cases of retardation or acceleration of intrauterine growth. Simple mathematical models provide easy calculation of the median birth weights for 24-44 weeks while adjusting for many confounding factors.

A macaque adherent cell line that expresses human CD4 is susceptible to SIV: utility for assessing neutralizing antibody.

A macaque CD4 + adherent cell line was generated by stable expression of the human CD4 gene in a rhesus macaque mammary tumor cell line, CMMT. The resulting cell line CMMT/CD4 expressed surface CD4 and was sensitive to infection by a wide range of isolates of simian immunodeficiency virus (SIV) of different subgroups, but was not susceptible to infection with HIV-1. The CMMT/CD4 cell line was used to develop a microassay for measurement of neutralizing antibody in plasma of SIV-infected or immunized animals. Single infected cells could be detected in a monolayer of CMMT/CD4 by immunoperoxidase and a 90% reduction in the number of positive cells was used as a measure of neutralizing activity of two-fold plasma dilutions. This assay had comparable sensitivity to methods based upon detecting a reduction in reverse transcriptase activity of SIV, reduction of viral antigen, or inhibition of cytopathic effect.

Host range restricted, non-replicating vaccinia virus vectors as vaccine candidates.

Three model systems were used to demonstrate the immunogenicity of highly attenuated and replication-defective recombinant MVA. (1) Intramuscular inoculation of MVA-IN-Fha/np induced humoral and cell-mediated immune responses in mice and protectively immunized them against a lethal respiratory challenge with influenza virus. Intranasal vaccination was also protective, although higher doses were needed. (2) In rhesus macaques, an immunization scheme involving intramuscular injections of MVA-SIVenv/gag/pol greatly reduced the severity of disease caused by an SIV challenge. (3) In a murine cancer model, immunization with MVA-beta gal prevented the establishment of tumor metastases and even prolonged life in animals with established tumors. These results, together with previous data on the safety of MVA in humans, suggest the potential usefulness of recombinant MVA for prophylactic vaccination and therapeutic treatment of infectious diseases and cancer.

Hereditary anomaly of neutrophil granulation in Birman cats.

A hereditary anomaly of neutrophil granulation in purebred Birman cats was described with respect to genetic, electron microscopic, histochemical, and functional characters. The trait was inherited in an autosomal recessive manner and was prevalent in the population studied. Affected cats had fine eosinophilic granules in the cytoplasm of neutrophils. The granules had normal morphology as determined by electron microscopy and did not stain for acid mucopolysaccharide. Bactericidal activity, phagocytosis, and oxidative function of affected neutrophils were not different from those of unaffected neutrophils. The anomaly was concluded to be an alteration in the content of lysosomal granules with increased affinity for acidic dyes.