Chronic myeloid leukemia and HIV-infection

The incidence of non-HIV-associated hematologic malignancies, including chronic myeloproliferative disorders, is increasing in HIV-infected (HIVþ) patients. This is thought to be due to prolonged survival in the era of highly active antiretroviral therapy (HAART). Previously, only six cases of chronic myeloid leukemia (CML) have been described in HIVþ individuals and limited information is available regarding the management of patients with concurrent CML and HIV- infection. We report three cases of CML in HIVþ patients who were treated with imatinib and HAART. Treatment was generally well tolerated, and cytogenetic response (complete in two patients) was achieved with follow-up ranging from 3 to 69 months. HIV viral load remained undetectable and CD4 cell counts were stable in all three patients. Concurrent treatment with imatinib and HAART can result in appropriate control of CML and HIV-infection as well as long-term survival

Contamination of clinical specimens with MLV-encoding nucleic acids: implications for XMRV and other candidate human retroviruses

Efforts to assess the prevalence of xenotropic murine leukemia virus-related virus (XMRV) in patients with prostate cancer and chronic fatigue syndrome have relied heavily on PCR-based testing of clinical samples and have yielded widely divergent findings. This week in Retrovirology, reports from four independent research groups illustrate the extreme care needed to exclude DNA or RNA contamination in PCR analyses of XMRV. In addition, phylogenetic evidence suggesting that previously-published XMRV sequences originated from a commonly-used prostate carcinoma cell line (22Rv1) is presented. These findings raise important questions regarding the provenance of XMRV and its potential connection to human disease

Proceedings of the 4th bwHPC Symposium

The bwHPC Symposium 2017 took place on October 4th, 2017, Alte Aula, Tübingen. It focused on the presentation of scientific computing projects as well as on the progress and the success stories of the bwHPC realization concept. The event offered a unique opportunity to engage in an active dialogue between scientific users, operators of bwHPC sites, and the bwHPC support team

Absence of XMRV and Closely Related Viruses in Primary Prostate Cancer Tissues Used to Derive the XMRV-Infected Cell Line 22Rv1

The 22Rv1 cell line is widely used for prostate cancer research and other studies throughout the world. These cells were established from a human prostate tumor, CWR22, that was serially passaged in nude mice and selected for androgen independence. The 22Rv1 cells are known to produce high titers of xenotropic murine leukemia virus-related virus (XMRV). Recent studies suggested that XMRV was inadvertently created in the 1990's when two murine leukemia virus (MLV) genomes (pre-XMRV1 and pre-XMRV-2) recombined during passaging of the CWR22 tumor in mice. The conclusion that XMRV originated from mice and not the patient was based partly on the failure to detect XMRV in early CWR22 xenografts. While that deduction is certainly justified, we examined the possibility that a closely related virus could have been present in primary tumor tissue. Here we report that we have located the original prostate tumor tissue excised from patient CWR22 and have assayed the corresponding DNA by PCR and the tissue sections by fluorescence in situ hybridization for the presence of XMRV or a similar virus. The primary tumor tissues lacked mouse DNA as determined by PCR for intracisternal A type particle DNA, thus avoiding one of the limitations of studying xenografts. We show that neither XMRV nor a closely related virus was present in primary prostate tissue of patient CWR22. Our findings confirm and reinforce the conclusion that XMRV is a recombinant laboratory-generated mouse virus that is highly adapted for human prostate cancer cells

Susceptibility of the human retrovirus XMRV to antiretroviral inhibitors

<p>Abstract</p> <p>Background</p> <p>XMRV (xenotropic murine leukemia virus-related virus) is the first known example of an exogenous gammaretrovirus that can infect humans. A limited number of reports suggest that XMRV is intrinsically resistant to many of the antiretroviral drugs used to treat HIV-1 infection, but is sensitive to a small subset of these inhibitors. In the present study, we used a novel marker transfer assay to directly compare the antiviral drug sensitivities of XMRV and HIV-1 under identical conditions in the same host cell type.</p> <p>Results</p> <p>We extend the findings of previous studies by showing that, in addition to AZT and tenofovir, XMRV and HIV-1 are equally sensitive to AZddA (3'-azido-2',3'-dideoxyadenosine), AZddG (3'-azido-2',3'-dideoxyguanosine) and adefovir. These results indicate that specific 3'-azido or acyclic nucleoside analog inhibitors of HIV-1 reverse transcriptase (RT) also block XMRV infection with comparable efficacy <it>in vitro</it>. Our data confirm that XMRV is highly resistant to the non-nucleoside RT inhibitors nevirapine and efavirenz and to inhibitors of HIV-1 protease. In addition, we show that the integrase inhibitors raltegravir and elvitegravir are active against XMRV, with EC₅₀values in the nanomolar range.</p> <p>Conclusions</p> <p>Our analysis demonstrates that XMRV exhibits a distinct pattern of nucleoside analog susceptibility that correlates with the structure of the pseudosugar moiety and that XMRV is sensitive to a broader range of antiretroviral drugs than has previously been reported. We suggest that the divergent drug sensitivity profiles of XMRV and HIV-1 are partially explained by specific amino acid differences in their respective protease, RT and integrase sequences. Our data provide a basis for choosing specific antiretroviral drugs for clinical studies in XMRV-infected patients.</p

Neuroprotective Effect of Ribavirin in Borna Disease Virus Infected Lewis Rats

Die Infektion mit dem Borna Disease Virus (BDV) ruft bei einem weiten Spektrum von Warmblütern ein teilweise progredientes, immunmediiertes neurologisches Syndrom hervor. BDV zeichnet sich durch ein einzelsträngiges RNA Genom negativer Polarität, einen ausgeprägten Neurotropismus und einen nicht-lytischen Replikationszyklus aus, der in viraler Persistenz mündet. In vitro Experimente zeigten kürzlich einen virostatischen Effekt des Guanosinanalogs Ribavirin gegenüber BDV. Ziel der vorliegenden Studie war es, den therapeutischen Nutzen einer intrathekalen Ribavirinapplikation bei akuter Bornascher Erkrankung (BD) im Rattenmodell zu untersuchen. Toxikologische und pharmakokinetische Studien ergaben eine maximal verträgliche tägliche Dosis von 2,5 mg/kg KG. Drei Wochen nach intranasaler Virusinokulation wurde Ribavirin in einer Dosis von 0, 1,25 und 2,5 mg/kg KG/Tag für 7 Tage intrathekal appliziert. Hierdurch gelang es, die klinische Symptomatik akuter BD dosisabhängig zu reduzieren. Die Bestimmung der Konzentration viraler RNA, Proteine, sowie infektiöser Partikel in zentralnervösem Gewebe ergab jedoch keine signifikante Reduktion. Anschließende immunhistologische Untersuchungen konnten eine quantitative Reduktion von T-Lymphozyten und Mikrogliazellen in Hirnparenchym behandelter Tiere nachweisen. Sowohl CD4+, als auch CD8+ T-Lymphozyten sind wesentlich an der progressiven Neurodestruktion im Rahmen von BD beteiligt. Auch für Mikrogliazellen wird eine kausale Beteiligung an der Pathogenese von BD postuliert. Der klinisch protektive Effekt der zentralen Ribavirinapplikation scheint in dem vorliegenden Modell nicht auf eine Inhibition der Virusreplikation, sondern auf die Suppression der neuropathogenen Immunantwort des Wirtsorganismus zurückzuführen zu sein. Wie in anderen Studien wiederholt beschrieben, konnte virale RNA im Blut infizierter Lewis-Ratten detektiert werden. Die Virämie bei hochdosiert behandelten Tieren ist deutlich ausgeprägter. Diese Beobachtung ist vermutlich durch eine systemische Infektion unter insuffizienter Immunkontrolle zu erklären. Hieraus ergeben sich auch Implikationen für die diagnostische Nutzbarkeit des peripheren Nukleinsäurenachweises zur Erkennung von BDV Infektionen. Die intrathekale Ribavirinapplikation ist der erste therapeutische Ansatz für BD, der zu einer Linderung des akuten Krankheitsbildes ohne gleichzeitige verstärkte Virusreplikation führt.Infection with Borna Disease Virus (BDV) leads to a partially progressive, immune-mediated neurological syndrome in a wide range of warm blooded animals. BDV is characterized by a non-segmented single-strand RNA genome of negative polarity, a distinct neurotropism and non-lytic replication causing viral persistence. Recent results from in vitro studies showed an inhibitory effect of the guanosine analog ribavirin on BDV replication. The aim of this study was to investigate a potential therapeutic effect of intrathecal ribavirin application in a rat model of acute Borna Disease (BD). Initial toxicological and pharmacokinetical studies yielded a maximal tolerable daily dose of 2.5 mg/kg BW. Three weeks after intranasal inoculation of BDV ribavirin was administered at doses of 0, 1.25, and 2.5 mg/kg BW per day for 7 consecutive days. This resulted in a prominent dose-dependent reduction of symptoms of acute BD. Quantification of viral RNA, proteins, and infectious particles in CNS tissue did not demonstrate a significant reduction of viral parameters. Subsequent immunhistological studies displayed a quantitative reduction of infiltrating T-lymphocytes and microglia in brains of treated animals. CD4+ as well as CD8+ T-lymphocytes are known to play a prominent role in progressive neurodestruction during the course of BD. A causal role in the pathogenesis of BD is also postulated for microglial cells. In the present model the clinically protective effect of central ribavirin application does not seem to result from inhibition of viral replication but rather from suppression of the neuropathogenic immune response. As known from previous studies, we were able to detect viral RNA in the peripheral blood of BDV infected Lewis rats. Viremia was more prominent in high dose treated animals. These findings most likely result from an insufficient immune control leading to a systemic infection and have implications for the diagnostic potential of peripheral nucleic acid detection for intra vitam diagnosis of BDV infections. Intrathecal application of ribavirin is the first therapeutic approach resulting in a relief of symptoms of acute BD without enabling an aggravated viral replication

Nocardia cyriacigeorgica, an Emerging Pathogen in the United States▿

Nocardia cyriacigeorgica is recognized as an emerging pathogen in many parts of the world. We present the first case description of invasive N. cyriacigeorgica pulmonary infection in the United States identified to the species level by 16S rRNA and hsp65 sequence analysis. A subsequent retrospective molecular screening of recent Nocardia clinical isolates at our New York City medical center yielded an additional six N. cyriacigeorgica isolates. Because routine laboratory algorithms for the phenotypic identification of Nocardia species are limited in practice, the true prevalence of N. cyriacigeorgica infections may be greater than currently appreciated. Indeed, we present evidence confirming that N. cyriacigeorgica is coincident with the unofficial species designation Nocardia asteroides complex antimicrobial susceptibility pattern type VI and distinct from the N. asteroides sensu stricto strain ATCC 19247T. As nocardial species identity can predict antimicrobial susceptibility and guide clinical management, we offer simplified phenotypic and molecular protocols to assist the identification of N. cyriacigeorgica

Absence of echovirus sequences in brain and spinal cord and amyotrophic lateral sclerosis patients

The role of enteroviruses in pathogenesis of amyotrophic lateral sclerosis (ALS) is controversial. A recent study, based on reverse transcription-polymerase chain reaction (RT-PCR) analysis of spinal cord, reported identification of a novel echovirus in 15 of 17 French subjects with ALS and only 1 of 29 subjects with other neurologic diseases. We established a real-time RT-PCR method based on this novel echovirus sequence and used this method and that previously employed for analysis of the French subjects to determine the prevalence of echoviral sequences in spinal cord and motor cortex of sporadic ALS subjects from the United States. No echoviral sequences were found in 20 spinal cord and 10 motor cortex samples from autopsy-confirmed cases of ALS or 13 spinal cord and 5 motor cortex samples from subjects with no motor neuron disease

Neuroprotection and Reduced Proliferation of Microglia in Ribavirin-Treated Bornavirus-Infected Rats

In a rat model of Borna disease, intracerebral ribavirin caused clinical improvement without changes in virus titer or nucleic acid. Levels of microglia and infiltrating CD4 and CD8 cells were decreased, despite increases in mRNAs encoding interleukin-1β (IL-1β), IL-10, and gamma interferon in the brain. Intracerebral ribavirin may reduce morbidity through effects on microglia cell proliferation

Validation of Metagenomic Next-Generation Sequencing Tests for Universal Pathogen Detection.

CONTEXT: - Metagenomic sequencing can be used for detection of any pathogens using unbiased, shotgun next-generation sequencing (NGS), without the need for sequence-specific amplification. Proof-of-concept has been demonstrated in infectious disease outbreaks of unknown causes and in patients with suspected infections but negative results for conventional tests. Metagenomic NGS tests hold great promise to improve infectious disease diagnostics, especially in immunocompromised and critically ill patients. OBJECTIVE: - To discuss challenges and provide example solutions for validating metagenomic pathogen detection tests in clinical laboratories. A summary of current regulatory requirements, largely based on prior guidance for NGS testing in constitutional genetics and oncology, is provided. DATA SOURCES: - Examples from 2 separate validation studies are provided for steps from assay design, and validation of wet bench and bioinformatics protocols, to quality control and assurance. CONCLUSIONS: - Although laboratory and data analysis workflows are still complex, metagenomic NGS tests for infectious diseases are increasingly being validated in clinical laboratories. Many parallels exist to NGS tests in other fields. Nevertheless, specimen preparation, rapidly evolving data analysis algorithms, and incomplete reference sequence databases are idiosyncratic to the field of microbiology and often overlooked. Arch Pathol Lab Med 2017 Jun; 141(6):776-786