Transsylvian selective amygdalohippocampectomy in children with hippocampal sclerosis: seizure, intellectual and memory outcome.

PURPOSE: This study investigates the efficacy of transylvian selective amygdalohippocampectomy (TS SAH) in children with medically intractable epilepsy due to unilateral hippocampal sclerosis. Post-surgical seizure control, intellectual and memory outcomes are examined. METHOD: This study reports on pre- and post-surgical clinical data from 10 patients who underwent TS SAH between 2002 and 2010 after 24 months follow-up. Pre- and post-operative change in seizure frequency, AED use, intellect and memory are compared. RESULTS: At 12 months and 24 months post-surgery, 9/10 (90%) and 7/8 (87.5%) patients respectively, were seizure free (Engel I). No patients were classed as Engel III or IV. No significant improvement or decline at a group level was found on measures of intellect or verbal or visual memory. One hundred per cent improved or remained within 1 SD of their pre-operatives score on verbal and perceptual reasoning learning and reasoning measures. Significant improvement was found post-operatively for both immediate and delayed facial memory. CONCLUSION: Our findings of good post-surgical seizure control and favourable cognitive outcome provides evidence against previous findings that SAH in children may not be effective.

Recombinant varicella vaccines induce neutralizing antibodies and cellular immune responses to SIV and reduce viral loads in immunized rhesus macaques.

The development of an effective AIDS vaccine remains one of the highest priorities in HIV research. The live, attenuated varicella-zoster virus (VZV) Oka vaccine, safe and effective for prevention of chickenpox and zoster, also has potential as a recombinant vaccine against other pathogens, including human immunodeficiency virus (HIV). The simian varicella model, utilizing simian varicella virus (SVV), offers an approach to evaluate recombinant varicella vaccine candidates. Recombinant SVV (rSVV) vaccine viruses expressing simian immunodeficiency virus (SIV) env and gag antigens were constructed. The hypothesis tested was that a live, attenuated rSVV-SIV vaccine will induce immune responses against SIV in the rhesus macaques and provide protection against SIV challenge. The results demonstrated that rSVV-SIV vaccination induced low levels of neutralizing antibodies and cellular immune responses to SIV in immunized rhesus macaques and significantly reduced viral loads following intravenous challenge with pathogenic SIVmac251-CX-1.

Simian varicella virus gene 61 encodes a viral transactivator but is non-essential for in vitro replication.

Simian varicella virus (SVV) is closely related to varicella-zoster virus (VZV), the causative agent of chickenpox and shingles. The SVV and VZV gene 61 polypeptides are homologs of the HSV-1 ICP0, a viral transactivator which appears to play a role in viral latency and reactivation. In this study, the molecular properties of the SVV 61 were characterized. The SVV open reading frame (ORF) 61 encodes a 54.1-kDa polypeptide with 37% amino acid identity to the VZV 61. Homology to the HSV-1 ICP-0 is limited to a conserved RING finger motif at the amino terminus of the protein. A nuclear localization sequence (nls) at the carboxy-terminus directs the SVV 61 to the cell nucleus, while a SVV 61nls(-) mutant is confined to the cell cytoplasm. The SVV 61 transactivates its own promoter as well as SVV immediate early (IE, ORF 62), early (ORFs 28 and 29), and late (ORF 68) gene promoters in transfected Vero cells. The RING finger and nls motifs are required for efficient SVV 61 transactivation. The SVV 61 has no effect on the ability of the major SVV transactivator (IE62) to induce SVV promoters. Generation and propagation of a SVV gene 61 deletion mutant demonstrated that the SVV 61 is non-essential for in vitro replication. SVV gene 61 is expressed in liver, lung, and neural ganglia of infected monkeys during acute simian varicella.

Channel catfish virus gene expression in experimentally infected channel catfish, Ictalurus punctatus (Rafinesque).

Channel catfish virus (CCV) produces an acute haemorrhagic disease in fingerling channel catfish and establishes latent infection in fish that survive the primary infection. This study investigated CCV gene expression in tissues of experimentally infected fish. Reverse transcriptase polymerase chain reaction assays were developed for detection of transcripts expressed by each of the CCV direct repeat region genes in CCV-infected channel catfish ovary cells and in tissues of infected fish. Immediate-early, early and late gene transcripts were detected in the blood, brain, kidney and liver tissues of acutely infected catfish demonstrating active viral replication in multiple tissues during the early stages of CCV infection. However, there was no evidence for viral replication by 24 days post-infection in tissues of fish that survived the acute disease. Viral latency-associated transcripts encoded by CCV direct repeat genes were not detected in latently infected catfish. The results of this study provide a foundation for further studies to investigate the molecular basis of CCV pathogenesis and latency.

Characterization of the simian varicella virus glycoprotein C, which is nonessential for in vitro replication.

The simian varicella virus (SVV) glycoprotein C (gC), which may play an important role in viral pathogenesis, shares extensive homology to the varicella-zoster virus (VZV) gC. The SVV gC gene includes two identical 83 base pair repeat elements which are conserved within the gC genes of epidemiologically distinct SVV isolates. Expression of the gC gene was confirmed by detection of viral gene products. Deletion of the gC gene and replacement with the green fluorescent protein (GFP) gene yields a SVVgC(-)/GFP mutant which replicates as efficiently as wild type virus, demonstrating the SVV gC gene is nonessential for in vitro replication.

Expression of the simian varicella virus glycoprotein L and H.

Simian varicella is used as a model to investigate varicella-zoster virus pathogenesis and to evaluate antiviral therapies. In this study, the simian varicella virus (SVV) glycoprotein L (gL) was characterized along with its association with glycoprotein H (gH). The SVV gL gene encodes a predicted 175 amino acid polypeptide that shares 43.5% and 27.9% amino acid identity with the VZV gL and HSV-1 gL, respectively. The SVV gL polypeptide sequence lacks a consensus glycosylation site and a typical signal sequence, but does possess an endoplasmic reticulum targeting sequence found commonly in chaperone proteins. Transcriptional analysis indicated that the SVV gL and the uracil DNA glycosylase (UDG) genes share a common 5' RNA start site and are co-expressed on a 2.0 kb transcript. gL and gH expression in SVV-infected Vero cells was demonstrated by immunofluorescence and immunoprecipitation analyses using specific antisera generated against gL and gH peptides. Similar to other herpesvirus gH and gL homologs, the SVV gL and gH form a complex within infected cells. gL and gH transcripts and antigens were detected in tissues of monkeys with acute simian varicella. The simian varicella model offers an opportunity to investigate the role of the gL and gH in viral pathogenesis.

Expression of the simian varicella virus glycoprotein E.

Simian varicella virus (SVV) is closely related to human varicella-zoster virus (VZV) and induces a varicella-like disease in nonhuman primates. The SVV genome encodes a glycoprotein E (gE) which is homologous to the gE of VZV and other alphaherpesviruses. The SVV gE was expressed in Escherichia coli and rabbits were immunized with the recombinant gE fusion proteins to generate polyclonal gE antiserum. Immunofluorescence and immunoprecipitation analyses demonstrated that the SVV gE is expressed on the surface and within SVV-infected cells. The gE is also expressed on SVV virions as indicated by serum neutralization assay. The mature SVV gE is glycosylated and is similar in size ( approximately 100 kd) to the mature VZV gE. Immunohistochemical analysis detected gE within skin vesicles and lung tissue of SVV-infected monkeys. Analysis of the humoral immune response to gE in an SVV-infected monkey determined that anti-gE antibody is induced as early as day 9 postinfection and persists at high titer for longer than 4 months. The simian varicella model offers an opportunity to investigate the role of gE in viral pathogenesis and immunity and to evaluate its potential as a varicella vaccine.

The DNA sequence of the simian varicella virus genome.

In nonhuman primates, simian varicella virus (SVV) causes a natural disease which is clinically similar to human varicella-zoster virus (VZV) infections. The SVV and VZV genomes are similar in size and structure and share extensive DNA homology. This report presents the complete DNA sequence of the SVV genome. SVV DNA is 124,138 bp in size, 746 bp shorter than VZV DNA, and 40.4% G + C. The viral genome includes a 104,104-bp unique long component bracketed by 8-bp inverted repeat sequences and a short component composed of a 4904-bp unique short region bracketed by 7557-bp inverted repeat sequences. A total of 69 distinct SVV open reading frames (ORFs) were identified, including three that are duplicated within the inverted repeats of the short component. Each of the SVV ORFs shares extensive homology to a corresponding VZV gene. The only major difference between SVV and VZV DNA occurs at the leftward terminus. SVV lacks a VZV ORF 2 homolog. In addition, SVV encodes an 882-bp ORF A that is absent in VZV, but has homology to the SVV and VZV ORF 4. The results of this study confirm the relatedness of SVV and VZV and provide further support for simian varicella as a model to investigate VZV pathogenesis and latency.

Sequence analysis of the leftward end of simian varicella virus (EcoRI-I fragment) reveals the presence of an 8-bp repeat flanking the unique long segment and an 881-bp open-reading frame that is absent in the varicella zoster virus genome.

Simian varicella virus (SVV) causes varicella (chickenpox) in nonhuman primates, becomes latent in cranial and dorsal root ganglia, and reactivates to produce zoster (shingles). Because the clinical and molecular features of SVV closely resemble those of varicella zoster virus (VZV) infection of humans, SVV infection of primates has served as an experimental model of VZV pathogenesis and latency. The SVV genome has been completely mapped, but attempts to clone the 3600-bp EcoRI fragment located at the leftward end of the virus genome have hitherto been unsuccessful. Herein, we report the cloning and the complete nucleotide sequence of this region. Comparison of the SVV and VZV sequences in this region revealed an 8-bp inverted repeat sequence flanking the unique long segment of the SVV genome; an 879-bp open-reading frame (ORF) A in SVV that is absent in VZV but has 42% amino acid identity to SVV ORF 4 and 49% to VZV ORF 4; a 342-bp ORF B in SVV with 35% amino acid identity to a 387-bp ORF located to the left of ORF 1 on the VZV genome; and a 303-bp ORF in SVV with 27% amino acid identity to VZV ORF 1. No homologue of VZV ORF 2 was detected. Transcripts specific for ORFs A and B were present in SVV-infected cells in culture and in acutely infected monkey ganglia. Overall, there are more than 2000 bp of DNA in the SVV genome that are absent in the VZV genome.

Efficacy of tramadol in treatment of chronic low back pain.

OBJECTIVE: To evaluate the efficacy and safety of tramadol in the treatment of chronic low back pain. METHODS: A 3 phase trial: (1) a washout/screening phase; (2) a 3 week, open label, run-in phase; and (3) a 4 week, randomized, placebo controlled, double blind treatment phase. Three hundred eighty outpatients between 21 and 79 years with chronic low back pain with no or a distant history of back surgery enrolled in the open label phase and were treated with tramadol up to 400 mg/day. At the end of the open label phase, patients who tolerated tramadol and perceived benefit from it were randomized to continue treatment with tramadol or to convert to placebo in the double blind phase. Reasons for discontinuing from the open label phase included adverse events, 78 patients (20.5%); drug ineffective, 23 patients (6.1%); and other reasons, 25 patients (6.6%). Two hundred fifty-four patients entered the double blind phase, during which the daily dose was maintained within the range 200-400 mg tramadol or equivalent amount of placebo. The primary outcome measure in the double blind phase was the time to discontinuation due to inadequate pain relief. RESULTS: The distribution of time to therapeutic failure was significantly (p < or = 0.0001) different in the tramadol group compared to placebo. Kaplan-Meier estimate of the cumulative discontinuation rate due to therapeutic failure was 20.7% in the tramadol group and 51.3% in the placebo group. There were significantly lower (p < or = 0.0001) mean pain visual analog scores (10 cm scale) among tramadol patients (3.5 cm) compared to placebo patients (5.1 cm) at the final visit of the double blind phase. Tramadol patients scored significantly better on the McGill Pain Questionnaire (p = 0.0007) and the Roland Disability Questionnaire (p = 0.0001). Five of 127 tramadol treated patients and 6/127 placebo treated patients discontinued treatment during the double blind phase due to an adverse event. Commonly reported adverse events with tramadol included nausea, dizziness, somnolence, and headache. CONCLUSION: Among patients who tolerated it well, tramadol was effective for the treatment of chronic low back pain.

Identification and characterization of the simian varicella virus uracil DNA glycosylase.

Simian varicella virus (SVV) infection of non-human primates is used as a model to study the pathogenesis and latency of varicella-zoster virus (VZV), the etiological agent of chickenpox and shingles. Uracil DNA glycosylase (UDG) is a DNA repair enzyme responsible for excision of uracil residues misincorporated into DNA. UDG is conserved throughout the herpesvirus family and may play an important role in viral pathogenesis. This study identified a 300 amino acid SVV UDG that shares 53.9% amino acid identity with the VZV UDG. The SVV UDG is expressed in infected Vero cells as determined by reverse transcriptase polymerase chain reaction (RT-PCR) and Northern blot analysis. The SVV UDG is encoded on a 2.0 kb transcript which also appears to encode the SVV glycoprotein L (gL) and the VZV gene 58 homolog. The SVV UDG is enzymatically active as determined by the ability of a SVV UDG-maltose binding protein fusion construct to remove [(3)H]-uracil incorporated into DNA.

Detection of channel catfish virus DNA in latently infected catfish.

Channel catfish virus (CCV) disease is an acute haemorrhagic disease in juvenile channel catfish (Ictalurus punctatus). While fish that survive primary CCV infection are suspected of being carriers of CCV, little is known concerning CCV latency. In this report, fingerling catfish were infected with CCV by experimental immersion challenge. Infected fish displayed clinical signs of CCV disease, but 22% of infected fish survived the acute disease. At 140 days post-infection, PCR analysis detected CCV DNA in the blood, brain, intestines, kidney, liver and peripheral blood leukocytes of latently infected fish. Further analysis indicated the CCV genome may exist as circular or concatemeric DNA during virus latency. This study, employing an experimental model of CCV disease, confirms that CCV establishes a latent infection of channel catfish.

Rapid diagnosis of simian varicella using the polymerase chain reaction.

Simian varicella virus (SVV) causes sporadic epizootics of a varicella-like disease in nonhuman primates. Rapid diagnosis of simian varicella is critical in controlling epizootics. A polymerase chain reaction (PCR)-based diagnostic assay for detection of SVV DNA in cell culture and clinical samples from SVV-infected monkeys was developed. The assay is rapid, specific, and highly sensitive. The SVV DNA is readily detected in skin rash specimens and in peripheral blood lymphocytes of infected monkeys during the early stages of clinical varicella. In addition to providing an important diagnostic tool, the SVV PCR assay is also useful for investigating the epidemiology and pathogenesis of simian varicella.

Experimental simian varicella virus infection of St. Kitts vervet monkeys.

Experimental simian varicella virus (SVV) infection of St. Kitts vervet monkeys was evaluated as an animal model to investigate human varicella-zoster virus (VZV) infections. During the incubation period, viremia disseminated infectious virus throughout the body via infected peripheral blood lymphocytes (PBLs). A vesicular skin rash in the inguinal area, and on the abdomen, extremities, and face appeared on day 7-10 postinfection. Necrosis and hemorrhage in lung and liver tissues from acutely infected monkeys were evident upon histologic analysis. Recovery from simian varicella was accompanied by a rise in the serum neutralizing antibody response to the virus. SVV latency was established in trigeminal ganglia of monkeys which resolved the acute infection. This study indicates that experimental SVV infection of St. Kitts vervets is a useful animal model to investigate SVV and VZV pathogenesis and to evaluate potential antiviral agents and vaccines.

Viral isolates derived from simian varicella epizootics are genetically related but are distinct from other primate herpesviruses.

Epizootics of a natural varicella-like disease occur in populations of nonhuman primates. Several primate herpesviruses have been isolated from these epizootics, but the relatedness of these isolates to each other is not well-defined. In this study, we demonstrated that the restriction endonuclease (REn) profiles of four epidemiologically distinct isolates were similar, although not identical, indicating that simian varicella epizootics are caused by various strains of simian varicella virus (SVV). The genetic variation among the isolates did not map to a specific region of the SVV genome and REn differences were detected within the SVV DNA long component and the inverted repeat region. Southern blot hybridization demonstrated that SVV is more closely related to varicella-zoster virus than to other primate herpesviruses. The study indicates that the current herpesvirus classification scheme should be changed to include SVV as a single taxonomic group within the Varicellovirus genus of alphaherpesviruses. In addition, REn profiles of SVV isolates, derived from primary and secondary episodes of simian varicella in the same monkey, were identical, providing evidence for SVV reactivation in a latently infected monkey.

Identification and analysis of the simian varicella virus thymidine kinase gene.

The thymidine kinase (TK) of herpesviruses, in contrast to cellular TKs, phosphorylates a variety of substrates including antiherpetic nucleoside analogues. This study reports the identification and DNA sequence of the simian varicella virus (SVV) TK gene. A 32P-labeled varicella zoster virus (VZV) TK DNA probe hybridized to the HindIII B subclone of the SVV BamHI B restriction endonuclease (RE) fragment, indicating the presence of a SVV DNA sequence homologous to the VZV TK gene. DNA sequence analysis of the SVV HindIII B subclone revealed a 1014 base pair (bp) open reading frame (ORF) encoding a 337 amino acid polypeptide homologous to herpesvirus TKs. The predicted SVV and VZV TK polypeptides share 51.3% identity, and alignment of the putative protein sequence of several TK homologues suggests the position of a conserved nucleotide binding site and a nucleoside (substrate) binding site in the SVV TK. Identification of the 5' end of the SVV TK transcript by primer extension analysis allowed a comparison of the SVV and VZV TK promoter regions indicating extensive conservation of the DNA sequence and transcription factor binding sites. Plaque reduction assays demonstrate that the SVV TK is active based on the susceptibility of SVV to acyclovir treatment and that SVV is less sensitive to acyclovir than VZV and herpes simplex virus (HSV-1) in infected Vero cells. Identification of the SVV TK ORF will facilitate studies that examine the role of viral TKs in pathogenesis and antiviral sensitivity and provides a potential insertion site for the expression of foreign genes.

The inverted repeat regions of the simian varicella virus and varicella-zoster virus genomes have a similar genetic organization.

Simian varicella virus (SVV) causes a varicella-like disease in nonhuman primates. The DNA sequence and genetic organization of the inverted repeat region (RS) of the SVV genome was determined. The SVV RS is 7559 bp in size with 56% guanine+cytosine (G+C) content and includes 3 open reading frames (ORFs). The SVV RS1 ORF encodes a 1279 amino acid (aa) protein with 58 and 39% identity to the varicella-zoster virus (VZV) gene 62 and herpes simplex virus type 1 (HSV-1) ICP4 homologs, respectively. The predicted 261 aa SVV RS2 polypeptide possesses 52% identity with the VZV gene 63 homolog and 23% identity with the HSV-1 ICP22. The SVV RS3 encodes a 187 aa polypeptide with 56% and 28% identity to the VZV gene 64 and the HSV-1 US10 homologs, respectively, and includes an atypical zinc finger motif. A G+C-rich 16 base-pair (bp) sequence which is repeated 7 times and a putative SVV origin of replication were identified between the RS1 and RS2 ORFs. Comparison with the VZV RS indicates the SVV and VZV RS regions are similar in size and genetic organization.

Simian varicella virus antibody response in experimental infection of African green monkeys.

The humoral immune response to simian varicella virus (SVV) was investigated following primary and secondary experimental infection of African green monkeys. Neutralization and immunoprecipitation assays were used to determine antibody titers to SVV throughout the course of infection. The immune response to specific viral polypeptides was analyzed by immunoprecipitation analysis. The results demonstrate that the simian varicella model offers a useful approach to investigate immune mechanisms in human varicella zoster virus (VZV) infections.

DNA sequence of the simian varicella virus (SVV) gH gene and analysis of the SVV and varicella zoster virus gH transcripts.

The varicella zoster virus (VZV) glycoprotein H (gH) stimulates VZV-specific immune responses and may be involved in virus penetration. This study reports the genomic map position and the DNA sequence of a simian varicella virus (SVV) homologue of the VZV gH gene. A 32P-labeled VZV gH-specific DNA probe hybridized to the HindIII B subclone of the SVV BamHI B restriction endonuclease (RE) fragment. The DNA sequence of the SVV HindIII B subclone was determined and analysis indicated a SVV open reading frame (ORF) homologous to several herpesvirus gH genes. The SVV gH ORF is 2559 base pairs in size and encodes a 852-amino acid protein. The SVV gH contains characteristics of a transmembrane glycoprotein including: 9 consensus N-linked glycosylation sites, a potential amino terminal signal sequence, and a predicted transmembrane segment located near the carboxyl terminus. The SVV and VZV gH genes exhibit 60.0% identity and the predicted polypeptides exhibit 54.5% identity. The SVV and VZV gH transcripts were analyzed and the promoter regions were compared. 32P-labeled SVV and VZV gH-specific DNA probes each hybridized to a single 2.9 kilobase transcript. The mRNA start sites of the SVV and VZV gH genes were determined by primer extension analysis, and alignment of the promoter regions indicated similar content and arrangement. The extensive conservation of SVV and VZV genes and predicted polypeptides further supports the use of SVV infection of non-human primates as a model of VZV infection of humans.

Transcriptional analysis of two simian varicella virus glycoprotein genes which are homologous to varicella-zoster virus gpI (gE) and gpIV (gI).

Simian varicella virus (SVV) causes a natural, varicella-like disease in nonhuman primates. The unique short region of the SVV genome contains four open reading frames (ORFs), two of which encode glycoproteins that exhibit extensive homology with varicella-zoster virus (VZV) gpIV (gI) and gpI (gE). Northern hybridization, primer extension, and RNase protection analyses were employed to define precisely the transcripts mapping to the SVV gpIV and gpI genes. A total of five transcripts composing two coterminal families of RNAs were mapped to the SVV gpIV and gpI ORF region. Based on transcriptional mapping and previous DNA sequence analysis, two transcripts 1.3 and 2.2 kb in size were assigned to the SVV gpIV and gpI genes, respectively. The transcriptional patterns described in this study for the SVV gpIV and gpI ORFs are analogous to those previously reported for the homologous glycoproteins genes encoding the herpes simplex virus type 1 Us7 (gI) and Us8 (gE) and VZV gpIV and gpI genes. In addition, the transcriptional start site for the VZV gpI RNA was determined. DNA alignments of the promoter regions for the SVV and VZV gpIV and gpI genes revealed a number of cis-acting elements which are conserved between the two viruses. The characterization of SVV glycoprotein genes will facilitate future studies to define their role in SVV pathogenesis and immunity and assist in the construction of recombinant vaccines which could be evaluated in the simian varicella model.