Arthritis and Hepatitis

The evidence relating four clinically distinct rheumatologic syndromes to infection by the hepatitis B virus is reviewed. Acute hepatitis B is not infrequently heralded by a prodromal rash and rheumatoidlike polyarthritis. Chronic active hepatitis B more rarely is associated with transient arthritis or arthralgias. Polyarteritis nodosa may be a manifestation of hepatitis B infection in as many as 40 percent of cases, and recently the syndrome of “essential” mixed cryoglobulinemia has also been linked to infection with this virus. The finding of immune complexes of varying composition, sometimes with the viral antigen or its antibody (or both) contained in both the serum and synovial fluid suggests that these four syndromes are clinical manifestations of immune complex disease resulting from hepatitis B infection.     

Dobrava-Belgrade hantavirus from Germany shows receptor usage and innate immunity induction consistent with the pathogenicity of the virus in humans

Background

Dobrava-Belgrade virus (DOBV) is a European hantavirus causing hemorrhagic fever with renal syndrome (HFRS) in humans with fatality rates of up to 12%. DOBV-associated clinical cases typically occur also in the northern part of Germany where the virus is carried by the striped field mouse (Apodemus agrarius). However, the causative agent responsible for human illness has not been previously isolated.

Methodology/Principal Findings

Here we report on characterization of a novel cell culture isolate from Germany obtained from a lung tissue of “spillover” infected yellow necked mouse (A. flavicollis) trapped near the city of Greifswald. Phylogenetic analyses demonstrated close clustering of the new strain, designated Greifswald/Aa (GRW/Aa) with the nucleotide sequence obtained from a northern German HFRS patient. The virus was effectively blocked by specific antibodies directed against β3 integrins and Decay Accelerating Factor (DAF) indicating that the virus uses same receptors as the highly pathogenic Hantaan virus (HTNV). In addition, activation of selected innate immunity markers as interferon β and λ and antiviral protein MxA after viral infection of A549 cells was investigated and showed that the virus modulates the first-line antiviral response in a similar way as HTNV.

Conclusions/Significance

In summary, our study reveals novel data on DOBV receptor usage and innate immunity induction in relationship to virus pathogenicity and underlines the potency of German DOBV strains to act as human pathogen.     

Differences in activation of human and guinea pig complement by retroviruses.

C type murine leukemia viruses (retroviruses) have been shown previously to possess a receptor for human C1 that activated human but not guinea pig complement. In the present study we provide evidence that the viral receptor also binds guinea pig C1 but that such binding does not lead to activation. However, incorporation of human C1s into guinea pig C1 to form a C1 hybrid results in activation of that hybrid and in viral lysis. In contrast, incorporation of guinea pig C1s into human C1 abolishes activation by the virus. These results demonstrate that C1s governs the activation of C1 of the viral receptor.     

Staphylococcal Cell Wall: Morphogenesis and Fatal Variations in the Presence of Penicillin

The primary goal of this review is to provide a compilation of the complex architectural features of staphylococcal cell walls and of some of their unusual morphogenetic traits including the utilization of murosomes and two different mechanisms of cell separation. Knowledge of these electron microscopic findings may serve as a prerequisite for a better understanding of the sophisticated events which lead to penicillin-induced death. For more than 50 years there have been controversial disputes about the mechanisms by which penicillin kills bacteria. Many hypotheses have tried to explain this fatal event biochemically and mainly via bacteriolysis. However, indications that penicillin-induced death of staphylococci results from overall biochemical defects or from a fatal attack of bacterial cell walls by bacteriolytic murein hydrolases were not been found. Rather, penicillin, claimed to trigger the activity of murein hydrolases, impaired autolytic wall enzymes of staphylococci. Electron microscopic investigations have meanwhile shown that penicillin-mediated induction of seemingly minute cross wall mistakes is the very reason for this killing. Such “morphogenetic death” taking place at predictable cross wall sites and at a predictable time is based on the initiation of normal cell separations in those staphylococci in which the completion of cross walls had been prevented by local penicillin-mediated impairment of the distribution of newly synthesized peptidoglycan; this death occurs because the high internal pressure of the protoplast abruptly kills such cells via ejection of some cytoplasm during attempted cell separation. An analogous fatal onset of cell partition is considered to take place without involvement of a detectable quantity of autolytic wall enzymes (“mechanical cell separation”). The most prominent feature of penicillin, the disintegration of bacterial cells via bacteriolysis, is shown to represent only a postmortem process resulting from shrinkage of dead cells and perturbation of the cytoplasmic membrane. Several schematic drawings have been included in this review to facilitate an understanding of the complex morphogenetic events.     

Viral and Latent Reservoir Persistence in HIV-1–Infected Patients on Therapy

Despite many years of potent antiretroviral therapy, latently infected cells and low levels of plasma virus have been found to persist in HIV-infected patients. The factors influencing this persistence and their relative contributions have not been fully elucidated and remain controversial. Here, we address these issues by developing and employing a simple, but mechanistic viral dynamics model. The model has two novel features. First, it assumes that latently infected T cells can undergo bystander proliferation without transitioning into active viral production. Second, it assumes that the rate of latent cell activation decreases with time on antiretroviral therapy due to the activation and subsequent loss of latently infected cells specific for common antigens, leaving behind cells that are successively less frequently activated. Using the model, we examined the quantitative contributions of T cell bystander proliferation, latent cell activation, and ongoing viral replication to the stability of the latent reservoir and persisting low-level viremia. Not surprisingly, proliferation of latently infected cells helped maintain the latent reservoir in spite of loss of latent infected cells through activation and death, and affected viral dynamics to an extent that depended on the magnitude of latent cell activation. In the limit of zero latent cell activation, the latent cell pool and viral load became uncoupled. However, as the activation rate increased, the plasma viral load could be maintained without depleting the latent reservoir, even in the absence of viral replication. The influence of ongoing viral replication on the latent reservoir remained insignificant for drug efficacies above the “critical efficacy” irrespective of the activation rate. However, for lower drug efficacies viral replication enabled the stable maintenance of both the latent reservoir and the virus. Our model and analysis methods provide a quantitative and qualitative framework for probing how different viral and host factors contribute to the dynamics of the latent reservoir and the virus, offering new insights into the principal determinants of their persistence.     

Characterization of a novel parainfluenza virus,caviid parainfluenza virus 3, from laboratory guinea pigs (Cavia porcellus)

A novel Respirovirus was isolated from nasopharyngeal swab specimens from clinically normal laboratory guinea pigs, and was characterized and named caviid parainfluenza virus 3 (CavPIV-3). The CavPIV-3 is enveloped, is 100 to 300 nm in diameter, and has a characteristic 15-nm-diameter chevron-shaped virus ribonucleocapsid protein. Sequence analysis of the fusion glycoprotein of CavPIV-3 revealed it to be 94% identical to human and guinea pig parainfluenza 3 (PIV-3) viruses and 80% identical to bovine PIV-3. To determine whether CavPIV-3 causes clinical disease in laboratory guinea pigs and to compare the serologic response of guinea pigs to CavPIV-3 and to other paramyxoviruses, an infection study was performed, in which groups of guinea pigs were inoculated with CavPIV-3, Sendai virus, simian virus 5 (SV-5), murine pneumonia virus (PVM), or bovine PIV-3 virus. During the course of the study, guinea pigs were maintained in an infectious disease suite, housed in Micro-Isolator cages, and were only manipulated under a laminar flow hood. Clinical signs of disease were not observed in any of the paramyxovirus-inoculated guinea pigs during the eight-week course of the study, and histologic signs of disease were not evident at necropsy eight weeks after inoculation. Guinea pigs inoculated with CavPIV-3, Sendai virus, PVM, and bovine PIV-3 developed robust homologous or heterologous serologic responses. In contrast, guinea pigs inoculated with SV-5 developed modest or equivocal serologic responses, as assessed by use of an enzyme-linked immunosorbent assay. Further, use of the SV-5 enzyme-linked immunosorbent assay resulted in the highest degree of non-specific reactivity among all of the paramyxovirus assays. In summary, CavPIV-3 is a novel guinea pig Respirovirus that subclinically infects laboratory guinea pigs, resulting in a robust serologic response, but no observed clinical or histologic disease. The CavPIV-3 fusion glycoprotein gene sequence is available from GenBank as accession No. AF394241, and the CavPIV-3 virus is available from the American Type Culture Collection as accession No. DR-1547.     

Effect of delta 9-tetrahydrocannabinol on herpes simplex virus type 2 vaginal infection in the guinea pig

The present investigation was undertaken to determine whether delta 9-tetrahydrocannabinol (delta 9-THC) decreases host resistance to herpes simplex virus type 2 vaginal infection in the guinea pig. The guinea pig was selected as the host since it has been shown to express a spectrum of primary herpes genitalis which is similar to that in humans. Animals were administered delta 9-THC or vehicle intraperitoneally on Days 1-4, 8-11, and 15-18. Herpes simplex virus was introduced intravaginally on Day 2. Host resistance to virus infection was assessed by comparing frequency and severity of lesions, virus shedding, and animal mortalities. Virus-infected animals treated with drug at doses of 4 and 10 mg/kg exhibited significantly greater severity of genital disease during the 30-day period of study when compared to virus-inoculated vehicle controls. A direct relationship was noted between dose of delta 9-THC and cumulative mortalities on Day 14 following primary infection. These results indicate that delta 9-THC decreases host resistance to herpes simplex virus type 2 vaginal infection in the guinea pig.     

New endogenous herpesvirus of guinea pigs: biological and molecular characterization.

Two known guinea pig herpesviruses, guinea pig cytomegalovirus (GPCMV) and guinea pig herpes-like virus (GPHLV), and well characterized. A third herpesvirus (GPXV) was originally isolated from leukocytes of healthy strain 2 guinea pigs. Growth of GPXV in guinea pig embryo fibroblastic cells produced a characteristic cytopathic effect. Electron microscopy of guinea pig cells infected with GPXV revealed the morphological development of a herpesvirus. Cross-neutralization tests and immunoferritin electron microscopy demonstrated that GPXV, GPCMV, and GPHLV were serologically distinct herpeviruses of guinea pigs. To confirm the distinction between these three herpesviruses, DNA genomes were compared by CsCl equilibrium buoyant density measurements and restriction endonuclease cleavage analysis. 32P-labeled viral DNA ws obtained from nucleocapsids isolated from virus-infected cells, and the buoyant density of GPXV DNA differed from that of GPCMV and GPHLV. Cleavage of viral DNAs with restriction endonucleases followed by gel electrophoresis revealed distinct patterns for each virus.     

Lymphocyte transformation studies in drug hypersensitivity

In a group of patients with clinically diagnosed drug hypersensitivity the in vitro lymphocyte response to the suspected drug was assessed by the lymphocyte transformation test. The test gave positive results in all 15 patients with penicillin-induced immediate or accelerated allergic reactions and positive immediate skin-test reactivity to the major or the minor antigenic determinant of penicillin, or both, but in only 3 of the 12 patients with delayed-onset maculopapular rashes induced by penicillin, despite positive immediate reactivity to the skin-test reagents.Lymphocyte stimulation greater than five times the control level was demonstrated for five patients with penicillin-induced erythroderma, Stevens-Johnson syndrome or a serum-sickness-like illness, or with methicillin-induced interstitial nephritis, all of whom had negative reactions to the appropriate skin-test reagents. A low level of stimulation was seen in eight other skin-test-negative patients with possible allergic reactions induced by penicillins. However, in all subjects tested the stimulation was significantly greater than the mean for control subjects.For 9 of 11 patients with isoniazid-induced hepatitis or maculopapular rashes, but for only 8 of 31 patients with eruptions induced by a variety of drugs other than penicillins and isoniazid, significant stimulation occurred in the lymphocyte transformation test.It is concluded that the lymphocyte transformation test is useful in the detection of hypersensitivity to the penicillins (although in IgE-mediated reactions skin testing is clearly preferable) and isoniazid but is of limited value in the demonstration of hypersensitivity to other drugs.     

Dengue virus activates polyreactive, natural IgG B cells after primary and secondary infection

Background

Dengue virus is transmitted by mosquitoes and has four serotypes. Cross-protection to other serotypes lasting for a few months is observed following infection with one serotype. There is evidence that low-affinity T and/or B cells from primary infections contribute to the severe syndromes often associated with secondary dengue infections. such pronounced immune-mediated enhancement suggests a dengue-specific pattern of immune cell activation. This study investigates the acute and early convalescent B cell response leading to the generation of cross-reactive and neutralizing antibodies following dengue infection.

Methodology/Principal Findings

We assayed blood samples taken from dengue patients with primary or secondary infection during acute disease and convalescence and compared them to samples from patients presenting with non-dengue related fever. Dengue induced massive early plasmablast formation, which correlated with the appearance of polyclonal, cross-reactive IgG for both primary and secondary infection. Surprisingly, the contribution of IgG to the neutralizing titer 4–7 days after fever onset was more than 50% even after primary infection.

Conclusions/Significance

Poly-reactive and virus serotype cross-reactive IgG are an important component of the innate response in humans during both primary and secondary dengue infection, and “innate specificities” seem to constitute part of the adaptive response in dengue. While of potential importance for protection during secondary infection, cross-reactive B cells will also compete with highly neutralizing B cells and possibly interfere with their development.     

Difference in the maturation of the three-domain vasopressin precursor in the guinea-pig and rat: identification of a neurophysin-copeptin fragment in the guinea pig

Vasopressin, MSEL-neurophysin and copeptin have been isolated from guinea pig and rat neurophypophyses and their amino acid sequences have been determined. Whereas in rat processing of the three-domain precursor is complete, in the guinea pig a 132-residue fragment including MSEL-neurophysin and copeptin linked by an arginine residue has been characterized. This incomplete maturation (20% of the precursor) could be due to a deletion of an acidic residue in guinea pig copeptin when compared with other mammalian copeptins.     

Latency antigen α-crystallin based vaccination imparts a robust protection against TB by modulating the dynamics of pulmonary cytokines

Background

Efficient control of tuberculosis (TB) requires development of strategies that can enhance efficacy of the existing vaccine Mycobacterium bovis Bacille Calmette Guerin (BCG). To date only a few studies have explored the potential of latency-associated antigens to augment the immunogenicity of BCG.

Methods/Principal Findings

We evaluated the protective efficacy of a heterologous prime boost approach based on recombinant BCG and DNA vaccines targeting α-crystallin, a prominent latency antigen. We show that “rBCG prime - DNA boost” strategy (R/D) confers a markedly superior protection along with reduced pathology in comparison to BCG vaccination in guinea pigs (565 fold and 45 fold reduced CFU in lungs and spleen, respectively, in comparison to BCG vaccination). In addition, R/D regimen also confers enhanced protection in mice. Our results in guinea pig model show a distinct association of enhanced protection with an increased level of interleukin (IL)12 and a simultaneous increase in immuno-regulatory cytokines such as transforming growth factor (TGF)β and IL10 in lungs. The T cell effector functions, which could not be measured in guinea pigs due to technical limitations, were characterized in mice by multi-parameter flow cytometry. We show that R/D regimen elicits a heightened multi-functional CD4 Th1 cell response leading to enhanced protection.

Conclusions/Significance

These results clearly indicate the superiority of α-crystallin based R/D regimen over BCG. Our observations from guinea pig studies indicate a crucial role of IL12, IL10 and TGFβ in vaccine-induced protection. Further, characterization of T cell responses in mice demonstrates that protection against TB is predictable by the frequency of CD4 T cells simultaneously producing interferon (IFN)γ, tumor necrosis factor (TNF)α and IL2. We anticipate that this study will not only contribute toward the development of a superior alternative to BCG, but will also stimulate designing of TB vaccines based on latency antigens.     

Vaccine outlooks

After negative publicity and a series of setbacks over HIV/AIDS and influenza, the prospects for research on new vaccines are improvingVaccine research is at a crossroads between renewed optimism created by fundamental scientific advances, and pessimism from a series of scientific and publicity setbacks over the past decade. Early successes in the field against acute viral diseases, such as smallpox and polio, raised hopes that more serious infectious diseases could be controlled or even eradicated by vaccination, just as it was once thought that penicillin would eradicate major bacterial diseases such as tuberculosis and leprosy....it became clear that many viruses were much tougher nuts to crack in terms of vaccine development...However, it became clear that many viruses were much tougher nuts to crack in terms of vaccine development than had been thought, and it also emerged that not all vaccines were equally safe. Indeed, mounting concerns over the safety of vaccines culminated in the infamous Wakefield paper published in the Lancet in 1998 that associated the MMR vaccine—against measles, mumps and rubella—with autism and inflammatory bowel disease in children. After several studies failed to reproduce these results, the Lancet eventually retracted this paper in 2010, but not before considerable damage had been done to public confidence in vaccination as a whole. Other factors have also sapped confidence in the field—notably the continuing failure to develop an effective vaccine against HIV/AIDS, 15 years after the first hopeful reports that a breakthrough might be imminent (Gorse et al, 1995).Researchers have since developed a string of HIV/AIDS vaccine candidates, some of which have entered clinical trials, but none of which have been sufficiently efficient and safe. The gloom has deepened further after the failure of a vaccine candidate developed by the pharmaceutical company Merck in 2007, that had high hopes for success. This vaccine, called V520, used a weakened adenovirus that carries three HIV genes, to stimulate host production of T cells that it was hoped would kill HIV-infected cells. Early small trials had detected cellular immune responses, but these largely failed to materialize in a subsequent phase II clinical trial. The recombinant vaccine triggered a rapid immune response against itself that actually impaired the T-cell response against the HIV antigens. As a result, the trial was halted in September 2007 (Anon, 2007).Controversially, it has since been suggested that V520 rendered some individuals more liable to subsequent infection, although views on this finding are polarized. According to Steven Patterson, a research fellow specializing in HIV at Imperial College, London, “there was a greater incidence of infection in those individuals who had immunity to adenovirus type 5 before vaccination. Some scientists argue that the numbers [of people who suffered infection during the trial] are relatively low, the results represent a statistical anomaly and that the effect gradually disappeared, suggesting that it was not a real effect. Others, including ourselves, think that in adenovirus type 5-immune individuals the vector activated pre-existing memory CD4 cells migrate to mucosal tissue. Then, because the virus preferentially replicates in activated CD4 T cells and the number of HIV susceptible cells is increased at the site of HIV infection, there is an increase in the number of infections. With time the activated cells return to a resting state which would explain why the effect of adenovirus vaccination gradually disappeared.”Whatever the truth in this case, it highlighted the setbacks in HIV/AIDS research and increased negative sentiments both among the public and, more crucially, funding agencies. “The devastating impact of HIV and its lethality have placed research on vaccines and other preventative measures under an unfamiliar spotlight,” said Colonel Jerome Kim, HIV vaccines product manager for the US Army from the Walter Reed Army Institute of Research. “This has tended to exaggerate both the incremental successes and failures of HIV-1 vaccine research.”The devastating impact of HIV and its lethality have placed research on vaccines and other preventative measures under an unfamiliar spotlightThis might have contributed to a decline in public funding that has been combined with a continuing lack of investment from the private sector (AVERT, 2010). More worryingly, there have been signs that governments are withdrawing funding from vaccine research (Médecins Sans Frontières, 2009). In fact, the US government—through the National Institutes of Health—and the Bill and Melinda Gates Foundation—the charitable trust established in 1994 by Microsoft founder Bill Gates—accounted for 79% of the world''s US$868 million funding for HIV/AIDS vaccine research in 2008 (HIV Vaccines and Microbicides Resource Tracking Working Group, 2010).Other areas of vaccination research have also contributed to negative sentiments towards the field. A universal vaccine against influenza has proved similarly elusive, given the mutability of the virus. The recent swine flu pandemic—the severity of which fell short of many pessimistic expectations—left many governments having spent huge sums on vaccines that they never needed. Furthermore, had swine flu become as virulent as it might have, these vaccine stockpiles might still have been only partially effective.More worryingly, there have been signs that governments are withdrawing funding from vaccine researchAll of these factors are fuelling groups who are opposed to vaccine research for various reasons, according to Joachim Hombach, at the World Health Organization''s Initiative for Vaccine Research in Geneva. “There are certain groups, particularly in the industrialised world, that have an anti-vaccine attitude, and these kinds of cases find very fertile ground there,” he said, referring in particular to the Lancet MMR article. “There is also a different story relating to general attitudes towards acceptance of absolutely no risk associated with vaccines or other medical interventions.” This risk-averse culture exposes vaccines to public scrutiny when side effects occur during trials or afterwards, and has even been spreading to developing countries. “This creates a challenging climate for vaccine research,” said Hombach.There are still strong grounds for optimism, as huge strides have been made in understanding the relationship between viruses and the immune response, which is more subtle and diverse than has been previously appreciated. In a sense, diseases such as polio represent the low-hanging fruit in the orchard of infectious disease; early successes in vaccine development have perhaps created a false sense of optimism. “Diseases that are more chronic, where you have a very delicate balance between the pathogen and the immune response, are very difficult to prevent with vaccines,” Hombach said. “HIV is not the only one and there is also TB for instance, which is quite difficult. It is much easier to develop vaccines against acute diseases.”There is accordingly a need to educate the public about these difficulties, commented Tomáš Hanke, Nuffield professor of medicine specializing in HIV research at Oxford University. “Public confidence is a matter of public education and understanding of the process of scientific discovery,” he said. “The more challenging the aim is, the more explaining the public needs.”Researchers disagree about the major problems hindering the development of new vaccines. In the case of HIV, Kim identified the elimination of CD4⁺ helper T cells by the virus as one of the major problems, because these cells are at the centre of immune control and influence the activities of other cells. It is this disabling of helper T cells that weakens the immune response to other diseases in those who have AIDS.Patterson believes that the greatest problem is the virus''s mutability. “The ability of the virus to quickly mutate and escape from responses that are mounted against specific domains of the virus that are recognized by the immune system is, I think, the major hurdle that we need to overcome,” he said. This is one reason why the traditional strategy of inducing protective antibodies by administering an attenuated virus has not worked for HIV.There are two further problems. First, important regions of the HIV virus are shielded by sugars and second, although antibodies that disable a broad range of HIV viruses have been identified, these tend to be produced too late in the immune response, when infection is already well established. For this reason, there has been increased focus on T-cell vaccines that can recognize and kill infected cells, rather than on efforts to prevent infection in the first place. Crucially though, as Patterson pointed out, this approach still faces the problem of mutation, because this can enable the virus to escape recognition by T cells.This, in turn, suggests that vaccines must target regions of the virus that are well conserved. “A normal T cell immune response tends to be against a small number of so-called dominant epitopes and in the case of HIV these are often against the more variable regions the virus can afford to mutate without any cost to itself,” Patterson explained. “To avoid immune escape, we probably need to induce a T cell response against a number of conserved virus epitopes that the virus could not afford to mutate without severely impairing its replication capacity. I believe this aim is achievable.”While the battle against HIV/AIDS has been catching most of the headlines, a lesser known viral disease, dengue, has been rising quickly up the research agendaMore fundamental research at the molecular level is needed to achieve this goal. Robin Weiss, professor of viral oncology at University College London, leads one team who are trying to identify antigens or targets that might one day become useful in vaccine design. Weiss does not claim to be near an imminent breakthrough, but he believes that a major step might be made soon towards developing a broad-spectrum vaccine that could prevent HIV infection in the first place. The problem, as Weiss pointed out, is not that individuals with HIV fail to produce antibodies, but that HIV elicits too many different ones, nearly all of which are ineffective. Only a few HIV-infected individuals produce potent antibodies and even then, these are often in insufficient concentrations. Now that the crystal structure of the potent antibodies has been defined, this vital molecular information could be used to design new vaccines that elicit production of these antibodies in the host.Valuable information has also come from a US Army sponsored clinical trial in Thailand that studied more than 16,000 healthy individuals between 2003 and 2006. A vaccine containing genetically engineered versions of three HIV genes was used, with an inert form of the bird virus canary pox as the vector. In December 2009, the sponsors reported that the rate of HIV infection among volunteers who received the experimental vaccine was 31% lower than among those who received a placebo (Rerks-Ngarm et al, 2009). “[The trial] showed, for the first time, that a vaccine is able to reduce the risk of HIV infection in humans,” said Kim. “Although our results were modest, they are providing a great deal of information to inform the field. For example, the protection appeared highest at 6–12 months based on post-hoc analysis. If we can sustain or increase this effect, that would be a great accomplishment.”While the battle against HIV/AIDS has been catching most of the headlines, a lesser known viral disease, dengue fever, has been rising quickly up the research agenda. Dengue fever is caused by four related strains of flavivirus that are transmitted by mosquitoes. The disease affects 50–100 million people annually, mostly in urban tropical areas, where an estimated 2.5 billion are at risk (Webster et al, 2009), largely because of growing urban populations. Attempts to develop a vaccine have been inhibited by the host immune response to the vaccine, according to Sarah Rowland-Jones, professor of immunology at the Weatherall Institute of Molecular Medicine in Oxford, UK. “It is a tough target for vaccine development principally because of the possibility that immune mechanisms contribute to pathogenesis, so researchers have to be particularly careful that a dengue vaccine does not make disease more likely because of the kind of immune response it stimulates, rather than leading to protection from infection,” she said.The fact that there are four viruses is another problem, especially as a vaccine protecting against one might actually prime individuals for another serotype. “The best hypothesis for severe dengue is that following a first infection, an individual gains immunity against that serotype but becomes more prone to a second infection with a different serotype,” said Jeremy Farrar, Director of the Wellcome Unit in Vietnam and a professor of tropical medicine at Oxford University. “With that second infection against another serotype, more severe disease develops. Obviously this makes vaccine development difficult as one worries individuals will be ‘primed'' by the vaccine and, when they get a natural infection will have more severe disease.”...the effect of each nucleotide change on virus activity is very small, but the cumulative impact of hundreds of such changes causes strong attenuationHowever, Farrar believes this problem has been fixed with the new generation of ‘chimeric vaccines'' that offer protection against all four serotypes. These are based on an exisiting vaccine against the related disease yellow fever, incorporating a part of the dengue virus that triggers an immune response. This chimeric approach has the potential to be extended to develop vaccines against other diseases.This begs the question of why a dengue virus vaccine has not been developed already, given that the related yellow fever vaccine has been available for years. Part of the reason is that dengue is a tougher target, involving four serotypes, but it is also because its mortality is much lower than the 50% rate of yellow fever. “Dengue hasn''t been top of the agenda because it hasn''t caused so much mortality, but there is a lot of morbidity, and it puts a lot of stress on health authorities and has an epidemic potential,” Hombach said. For this reason it has received more funding recently, with phase III clinical trials likely to begin soon, according to Farrar.An entirely different approach for engineering vaccines might also be emerging. Traditional vaccines use mutated virus strains with limited replication abilities, in order to stimulate the immune system. The main drawback of this approach is that many attenuated strains fail to elicit adequate immunity, and it takes a long time to develop such strains. However, Eckard Wimmer and colleagues at Stony Brook University in New York, have developed a computer-aided approach to create attenuated strains without changing the composition and amino-acid sequence of the virus''s proteins (Mueller et al, 2010).They exploit the redundancy of the genetic code; 64 codons code for just 20 amino acids. As most amino acids are coded for by several codons, it is possible to introduce single-nucleotide changes without altering which proteins are expressed, thereby retaining all antigens that might generate an adaptive immune response. Crucially, however, this alters the expression of some genes, which reduces the ability of the virus to replicate. As Wimmer pointed out, the effect of each nucleotide change on virus activity is very small, but the cumulative impact of hundreds of such changes causes strong attenuation. “We call this ‘death by a thousand cuts'',” he said.Moreover, subsequent natural mutations will probably change only one or two of these nucleotide substitutions back to the original, so the chance that the virus will regain its former virulence is very small. The greatest advantage of this approach, however, is speed. “Clearly, such recoded genomes can only be produced by chemical synthesis,” said Wimmer. “They can be designed rapidly—much faster than any other live vaccine that was isolated after long trials of selection.” This, argues Wimmer, makes the approach ideal for countering emerging pandemics when time is short, especially those caused by influenza. Indeed, Wimmer has demonstrated his approach by designing an influenza vaccine (Mueller et al, 2010).Even if this synthetic approach can generate new vaccine candidates more quickly, it will still require development time and clinical trials to assess their efficacy and safety—as is the case for other emerging techniques. New knowledge and new technologies are filtering through to vaccine development; while the disappointments of the past have provided valuable lessons.     

Coronavirus-like virions associated with a wasting syndrome in guinea pigs

An apparent wasting syndrome was observed in newly arriving 3 to 4 week old guinea pigs characterized by anorexia, weight loss, diarrhea, perineal staining and death. Diagnostic efforts to attribute the disease to husbandry, environmental factors or to known guinea pig pathogens were unsuccessful. Clinical signs, enteric histopathological lesions and diagnostic transmission electron microscopy identification of typical coronavirus-like virions in fecal samples were consistent with enteric coronaviral diseases seen in other species.     

Loss of α1β1 Soluble Guanylate Cyclase,the Major Nitric Oxide Receptor,Leads to Moyamoya and Achalasia

Moyamoya is a cerebrovascular condition characterized by a progressive stenosis of the terminal part of the internal carotid arteries (ICAs) and the compensatory development of abnormal “moyamoya” vessels. The pathophysiological mechanisms of this condition, which leads to ischemic and hemorrhagic stroke, remain unknown. It can occur as an isolated cerebral angiopathy (so-called moyamoya disease) or in association with various conditions (moyamoya syndromes). Here, we describe an autosomal-recessive disease leading to severe moyamoya and early-onset achalasia in three unrelated families. This syndrome is associated in all three families with homozygous mutations in GUCY1A3, which encodes the α1 subunit of soluble guanylate cyclase (sGC), the major receptor for nitric oxide (NO). Platelet analysis showed a complete loss of the soluble α1β1 guanylate cyclase and showed an unexpected stimulatory role of sGC within platelets. The NO-sGC-cGMP pathway is a major pathway controlling vascular smooth-muscle relaxation, vascular tone, and vascular remodeling. Our data suggest that alterations of this pathway might lead to an abnormal vascular-remodeling process in sensitive vascular areas such as ICA bifurcations. These data provide treatment options for affected individuals and strongly suggest that investigation of GUCY1A3 and other members of the NO-sGC-cGMP pathway is warranted in both isolated early-onset achalasia and nonsyndromic moyamoya.     

Thymidine kinase-deficient herpes simplex virus type 2 genital infection in guinea pigs.

In guinea pigs, thymidine kinase-producing strains of herpes simplex virus type 2 replicated to high titer in the vagina and spinal cord, and animals developed severe clinical disease. Infection with thymidine kinase-deficient virus resulted in similar vaginal virus titers; however, animals exhibited little or no clinical illness and only low titers of virus were detected in spinal cord homogenate cultures. Neural and extraneural latent infection as well as recurrent infection were noted in animals inoculated with either thymidine kinase-producing or -deficient viruses. These data suggest that neural pathways are important in the pathogenesis of genital herpes and that virus-coded thymidine kinase may influence virulence but is not required for latency.     

The concept of disease.

The connotations of the term “a disease” were investigated by studying the ways in which both medical and non-medical people used the word. A list of common diagnostic terms was read slowly to groups of non-medical academic staff of a university, secondary-school students, medical academics, and family practitioners, who then indicated whether they thought each word referred to disease.All groups rated illnesses due to infections as diseases, but the doctors, and particularly the general practitioners, were more generous in accepting as diseases the terms for non-infectious conditions. Apart from the nature of the cause, the most influential factor in determining whether or not an illness was considered to be a disease was the importance of the doctor in diagnosis and treatment.These findings provide further evidence that there is ambiguity about the meaning of the term disease. To the layman a disease seems to be a living agency that causes illness. Doctors have obviously accepted more heterogeneous defining characteristics but remain reluctant to adopt unequivocally nominalist ways of thought. The position is not unlike that in the physical sciences, in which there is a good precedent for distinguishing between the formal scientific and the everyday uses of terms such as “force” and “power.”     

Antigenicity of penicillin G in the guinea pig

Antigenicity of penicillin G (PCG) was studied in guinea pigs. PCG 5 mg, 10 mg or 25 mg with Freund's complete adjuvant each on days 0, 7 and 21 was injected to a guinea pig: intramuscularly into both thighs and intracutaneously into four locations on the back. A remarkable antigenicity was induced in animals immunized with 25 mg although only low antigenicity in 5 mg and 10 mg. A maximum serum level of the antibody was observed about 2 weeks after last immunization and all of animals immunized with 25 mg died in active systemic anaphylaxis test. As mentioned above, it has been firstly demonstrated that a remarkable antigenicity of PCG can be produced by immunizing with a high dose of 25 mg in the guinea pig model in which PCG itself is used as immunogen.     

Penicillin-induced changes in the cell wall composition of Staphylococcus aureus before the onset of bacteriolysis

To analyze if chemical cell wall alterations contribute to penicillin-induced bacteriolysis, changes in the amount, stability, and chemical composition of staphylococcal cell walls were investigated. All analyses were performed before onset of bacteriolysis i.e. during the first 60 min following addition of different penicillin G doses. Only a slight reduction of the amount of cell wall material incorporated after penicillin addition at the optimal lytic concentration was observed as compared to control cells. However, the presence of higher penicillin G concentrations reduced the incorporation of wall material progressively without bacteriolysis. Losses of wall material during isolation of dodecylsulfate insoluble cell walls were monitored to assess the stability of the wall material following penicillin addition. Wall material grown at the lytic penicillin concentration was least stable but about 30% of the newly incorporated wall material withstood even the harsh conditions of mechanical breakage and dodecylsulfate treatment. Dodecylsulfate insoluble cell walls were used for chemical analyses. While peptidoglycan chain length was unaffected in the presence of penicillin, other wall parameters were considerably altered: peptide cross-linking was reduced in the wall material synthesized after addition of penicillin; reductions from approx. 85% in controls to about 60% were similar for lytic and also for very high penicillin concentrations leading to nonlytic death. O-acetylation was also reduced after treatment with penicillin; this effect paralleled the occurence of subsequent bacteriolysis at different drug concentrations. The results are not consistent with hypotheses explaining penicillin-induced lysis as a result of an overall weakened cell wall structure or an overall activation of autolytic wall enzymes but not conflicting with the model that ascribes penicillin-induced bacteriolysis as the result of a very restricted, local perforation of the peripheral cell wall (murosome-induced bacteriolysis).Abbreviations CL Cross-linking - DNFB 2,4-dinitro-1-fluorobenzole - MIC Minimal inhibitory concentration - OD Optical density at 578 nm - PEN Penicillin G