Effects of Nutritional Factors on Fat Content, Fatty Acid Composition, and Sensorial Properties of Meat and Milk from Domesticated Ruminants: An Overview.

The meat and milk products from domesticated ruminants are important foods within a balanced diet, offering a rich source of energy, protein, fats, minerals, and vitamins. The sensorial properties of meat and milk are mainly linked to their fat content and fatty acid composition, which are influenced by the feeding background or nutrient composition of diets. While several studies have investigated the nutritional effects on the fat content and fatty acid profile of ruminant meat and milk, as well as their relationship with sensorial properties, a comprehensive overview of these effects is lacking. This paper summarises current literature and discusses changes to fatty acid composition (including ω-3 concentrations), fattiness, and associated quality traits of sheep, goat, beef cattle, alpaca, and llama meat that can be achieved by using different forages or feeds in a total mixed ration. Additionally, it presents the shelf life and nutritional value of meat, milk, and cheeses from the milk of dairy cattle, buffalo, goats, and sheep as influenced by a ruminant diet. Further advancement in these areas will promote the sustainability of ruminant production and its associated feeding systems in achieving premium quality animal-derived foods.

Harnessing the untapped potential of indigenous cow milk in producing set-type yoghurts: case of Thamankaduwa White and Lankan cattle.

This research paper assessed textural, microstructural, sensory and colour properties of set-yoghurts produced using milk from two indigenous cattle types, Thamankaduwa White (TW) and Lankan cattle (LC) compared to two generic cattle breeds, Friesian and Jersey. Instrumental texture profile (firmness, adhesiveness, cohesiveness and springiness), colour space (L* a* b*) and scanning electron micrographs of set-yoghurts during 21 d of storage (4 ± 1°C) were evaluated. Sensory quality attributes were evaluated with 40 untrained panellists using a five-point hedonic scale. Set-yoghurts prepared using indigenous cow milk showed higher (P < 0.05) firmness, cohesiveness and apparent viscosity values compared to those prepared using generic cow milk. As revealed by micrographs, set-yoghurts made from TW milk had lesser and smaller void spaces and a dense protein gel network than gels made from LC and the two generic breeds. The gel network made from Friesian milk showed a comparatively larger porous gel structure and thinner protein strands resulting in a weaker gel than other milk gels. The highest lightness (L*) and yellowness (b*) were observed from set-yoghurt produced from Friesian and LC milk, respectively. Set-yoghurts from TW milk had the highest (P < 0.05) sensory scores for all sensory attributes. The lowest sensory acceptance was recorded in set-yoghurt made from Friesian milk. Thus, milk from TW and LC is likely to be suitable in producing set-yoghurts with superior textural, microstructural and sensory properties, compared to milk from Jersey and Friesian. Our results suggest the merits of using indigenous cow milk in producing set-yoghurts and, thereby, prioritizing the preservation of the genetic pool of these indigenous breeds.

Stereophotogrammetry can feasibly assess 'physiological' longitudinal three-dimensional head development of very preterm infants from birth to term.

Head development is a surrogate for brain development in infants and is related to neurocognitive outcome. There is only limited knowledge on early extra-uterine head shape and size assessment in very preterm infants. Here, 26 very preterm infants with a mean gestational age of 29.1 ± 2.2 weeks and a mean birth weight of 1273.8 ± 427.7 g underwent serial stereophotogrammetric 3D head imaging in weekly intervals from birth to term-equivalent age. The main outcome was the longitudinal assessment of the 'physiological' preterm head development with cephalometric size (head circumference, cranial volume) and shape parameters (cranial index, cranial vault asymmetry index) according to chronological and postmenstrual age (PMA). Potential clinical risk factors for the development of an abnormal low cranial index (dolichocephaly) were analysed. In serial measurements of 26 infants, the estimated head volume (95% confidence interval) increased from 244 (226-263) cm3 at 28 weeks PMA to 705 (688-721) cm3 at 40 weeks PMA. Moderate or severe dolichocephaly occurred in 21/26 infants (80.8%). Cranial index decreased over time (72.4%; 70.7-74 95% confidence interval). Brachycephaly and plagiocephaly were uncommon. No risk factors for severe dolichocephaly were identified. Our study shows that early detection of head shape and size anomalies utilizing 3D stereophotogrammetry is feasible and safe even in very preterm infants < 1500 g and/or < 32 weeks. 3D stereophotogrammetry could be used for timely identification of infants at risk for head shape anomalies. No specific risk factors for head shape anomalies were identified, especially not mode and duration of respiratory support.

Algae-based antioxidant containing selenium yeast (Economase®) enhanced the growth performance, oxidative stability, and meat quality of broiler chickens.

OBJECTIVE: An experiment was conducted to determine the effect of algae-based antioxidant containing Se yeast (EconomasE®) on the growth performance, visceral organ weight, meat quality, and oxidative stability of broiler chickens. METHODS: Nine hundred sixty, day-old male broiler chickens (Cobb, 43.97±0.55 g) were divided into three dietary treatments and allocated into 12 deep litter pens in a completely randomized design giving 4 replicate cages for each treatment. Three dietary treatments were: i) control (CON, basal diet with sufficient nutrient), ii) vitamin E (VitE, basal diet supplemented with 100 IU VitE), and iii) Algae-based antioxidant containing Se yeast (EcoE, basal diet supplemented with 0.2% algae-based antioxidant containing Se yeast: EconomasE®). Maize soybean meal based basal diets were formulated to meet or exceed the nutrition requirement for broiler chickens. Chickens were fed ad-libitum experimental diets during the 42 days experiment period. On days 21 and 42, body weight and feed intake were measured to calculate the feed conversion ratio of the chickens. Intestine and visceral organs were measured together with meat quality and oxidative stability on days 14 and 42. RESULTS: Chickens fed with EcoE showed improved (p<0.05) growth performance, meat quality, and higher (p<0.05) oxidative stability compared to the chicken fed on CON. Moreover, broiler chickens fed with EcoE showed similar (p<0.05) growth performance with better (p<0.05) meat quality and higher oxidative stability compared to the broiler chickens fed VitE (p<0.05). CONCLUSION: The algae-based antioxidant containing Se yeast can be supplemented into commercial broiler diets as a substitution of VitE while maintaining growth performance with enhancing meat quality and oxidative stability of the broiler chickens.

The hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE-an avoidable health risk: the SAFE randomised trial.

BACKGROUND: Worldwide, alcohol-related road traffic accidents represent a major avoidable health risk. The aim of this study was to evaluate the accuracy of self-estimating the degree of acute alcohol intoxication regarding the legal driving limit, and to identify risk factors for misjudgement. METHODS: In this prospective randomised controlled crossover trial, 90 social drinkers (mean age 23.9 ± 3.5 years, 50% female) consumed either beer or wine. Study group subjects were made aware when exceeding the legal driving limit (BrAC = 0.05%). Controls received no information about their BrAC. For crossover, beer or wine were consumed in the opposite order. RESULTS: 39-53% of all participants exceeded the legal driving limit whilst under the impression to be still permitted to drive. Self-estimation was significantly more accurate on study day 2 (p = 0.009). Increasing BrAC positively correlated with self-estimation inaccuracy, which was reproducible during crossover. Multiple regression analysis revealed fast drinking and higher alcohol levels as independent risk factors for inaccurate self-estimation. CONCLUSIONS: Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard. Trial registration The trial was registered prospectively at the Witten/Herdecke University Ethics Committee (trial registration number 140/2016 on 04/11/2016) and at the DRKS-German Clinical Trials Register (trial registration number DRKS00015285 on 08/22/2018-Retrospectively registered). Trial protocol can be accessed online.

Feeling Socially Connected and Focusing on Growth: Relationships With Wellbeing During a Major Holiday in the COVID-19 Pandemic.

Numerous major holidays celebrate socially gathering in person. However, in major holidays that happened during the pandemic, desires to nurture relationships and maintain holiday traditions often conflicted with physical distancing and other measures to protect against COVID-19. The current research sought to understand wellbeing during American Thanksgiving in 2020, which happened 8months into the COVID-19 pandemic, after months of physical distancing and stay-at-home orders. American Thanksgiving is a major holiday not limited to any religion. We asked 404 American adults how they spent Thanksgiving Day and to report on their experiences of that day. Predictors of wellbeing that we drew from self-determination theory were satisfaction of the fundamental needs for social connection (relatedness), for doing what one really wants (autonomy), and feeling effective (competence). The predictors of wellbeing that we drew from regulatory focus theory were a focus on growth (promotion), and a focus on security (prevention). We found that feeling socially connected and focusing on growth related most strongly to wellbeing. Additionally, participants who saw even one other person face-to-face reported significantly higher relatedness satisfaction, promotion focus, and wellbeing than those who did not. Our research could help construct persuasive messages that encourage nurturing close relationships at major holidays while remaining safe against the virus.

The physicochemical, microbiological, and organoleptic properties and antioxidant activities of cream cheeses fortified with dried curry leaves (Murraya koenigii L.) powder.

We aimed to investigate the effects of dried curry leaves powder (CLP) incorporation on physicochemical, microbiological, antioxidant, and sensory properties of cream cheeses. Varying levels of CLP infusions (i.e., T1: 0% [control], T2: 0.15%, T3: 0.2%, and T4: 0.25%; w/w%) were stored for 10 days at 4°C. Antioxidant properties were evaluated using total phenolic content, 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging ability, and ferric reducing antioxidant power using in vitro assays. Total antioxidant capacity significantly (p < .05) increased with the increasing levels of CLP. Physicochemical and microbiological qualities were not significantly affected by the addition of CLP, indicating the suitability of using CLP without compromising the quality of cream cheese. Organoleptic properties were affected with CLP addition, where T3 had the highest scores for color, aroma, flavor, texture, and overall acceptability. The principal component analysis provides the holistic approach of studying the variation associated with cream cheeses and the overall relationship among studied parameters. This provides strong references for novel dairy products added with antioxidant-rich Murraya koenigii L. powder. The study also has merits to promote scientific knowledge concerning, and how the incorporation would influence the physicochemical, organoleptic, and microbiological properties of cream cheese to deliver the value-added or diversified product to emerging consumers.

Lone Atrial Flutter in Children and Adolescents: Is It Really "Lone"?

Atrial flutter (AFL) in children and adolescents beyond the neonatal period in the absence of any underlying myocardial disease ("lone AFL") is rare and data is limited. Our study aims to present clinical and electrophysiological data of presumed "lone AFL" in pediatric patients and discuss the role of endomyocardial biopsy (EMB) and further follow-up. Since July 2005, eight consecutive patients at a median age of 12.7 (range 10.4-16.7) years presenting with presumed "lone AFL" after negative non-invasive diagnostic work-up had electrophysiological study (EPS) and induction of cavotricuspid isthmus (CTI) conduction block by radiofrequency (RF) current application. In 6/8 patients EMB could be taken. Induction of CTI conduction block was achieved in all patients. Histopathological examination of EMB from the right ventricular septum exhibited myocarditis or cardiomyopathy in 4/6 patients, respectively. During follow-up, 4/8 patients had recurrent arrhythmia (AFL n = 2, wide QRS complex tachycardia n = 1, monomorphic premature ventricular contractions n = 1) after the ablation procedure. 3/4 patients with recurrent arrhythmia had pathological EMB results. The remaining patient with recurrent arrhythmia had a negative EMB but was diagnosed with Brugada syndrome during further follow-up. Taking together results of EMB and further clinical course, only 3/8 patients finally turned out to have true "lone AFL". Our study demonstrates that true "lone AFL" in children and adolescents is rare. EMB and clinical course revealed an underlying cardiac pathology in the majority of the individuals studied. EMB was very helpful in order to timely establish the diagnosis of myocarditis or cardiomyopathy.

Type of starter culture influences on structural and sensorial properties of low protein fermented gels.

Organoleptic properties of skimmed milk fermented gels are progressively demanding to produce optimal quality yogurts. Chr-Hansen trademark registered cultures were used to produce low-protein (3.4%) gels to assess the ability to redesign the sensorial and textural properties with the choice of starter culture. Resulting gels were assessed for sensorial, textural, rheological, and microstructural properties and compared with a commercial control (4.5% protein). Mouth thickness, syneresis, firmness, elasticity, and consistency values were lower for polysaccharides-producing cultures. Such cultures contributed to the higher creaminess and tended to give higher ropiness. Observed differences among microstructures of the gel were minute. Microstructural and rheological data corresponded and reflected the instrumental and sensory interpretations. Strong correlations were observed between sensory and instrumental data. Nonprobiotics cultures resulted in promising overall gel properties compared with probiotic cultures according to the principal component analysis. Yet probiotic cultures resulted in lower syneresis than nonprobiotic cultures. Thus, the choice of bacterial culture modifies the sensorial and textural properties of fermented gel with strong correlations, as a result of altered gel network formation with the production of polysaccharides. Inferior textural and sensorial quality aspects, particularly at low protein levels, have negative impact on consumer demand of low protein yogurts. Thus, we attempted to gain required gel textural and sensorial properties with a choice of starter culture with a low protein level. Resulting gel properties at lowered protein content with different starter cultures are not fully known. The present study compares the effect of probiotic and nonprobiotic starter cultures on gel properties, as gel texture and sensory properties are of great interest and thus not willing to be compromised. In addition, we examined the overall texture profile of studied cultures and correlate with sensory properties. Therefore, reducing protein level in milk and achieving required gel properties with the choice of appropriate starter culture is of great commercial interest as a cost-cutting strategy to produce low-cost optimum quality yogurt.

Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group.

Ketogenic dietary therapies (KDTs) are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. In 2009, an expert consensus guideline for the management of children on KDT was published, focusing on topics of patient selection, pre-KDT counseling and evaluation, diet choice and attributes, implementation, supplementation, follow-up, side events, and KDT discontinuation. It has been helpful in outlining a state-of-the-art protocol, standardizing KDT for multicenter clinical trials, and identifying areas of controversy and uncertainty for future research. Now one decade later, the organizers and authors of this guideline present a revised version with additional authors, in order to include recent research, especially regarding other dietary treatments, clarifying indications for use, side effects during initiation and ongoing use, value of supplements, and methods of KDT discontinuation. In addition, authors completed a survey of their institution's practices, which was compared to responses from the original consensus survey, to show trends in management over the last 10 years.

Catheter Ablation of Pediatric Focal Atrial Tachycardia: Ten-Year Experience Using Modern Mapping Systems.

Experience of catheter ablation of pediatric focal atrial tachycardia (FAT) is still limited. There are data which were gathered prior to the introduction of modern 3D mapping and navigation systems into the clinical routine. Accordingly, procedures were associated with significant fluoroscopy and low success rates. The aim of this study was to present clinical and electrophysiological details of catheter ablation of pediatric FAT using modern mapping systems. Since March 2003, 17 consecutive patients <20 years underwent electrophysiological study (EPS) for FAT using the NavX(®) system (n = 7), the non-contact mapping system (n = 6) or the LocaLisa(®) system (n = 4), respectively. Radiofrequency was the primary energy source; cryoablation was performed in selected patients with a focus close to the AV node. In 16 patients, a total number of 19 atrial foci (right-sided n = 13, left-sided n = 6) could be targeted. In the remaining patient, FAT was not present/inducible during EPS. On an intention-to-treat basis, acute success was achieved in 14/16 patients (87.5 %) with a median number of 11 (1-31) energy applications. Ablation was unsuccessful in two patients due to an epicardial location of a right atrial focus (n = 1) and a focus close to the His bundle (n = 1), respectively. Median procedure time was 210 (84-332) min, and median fluoroscopy time was 13.1 (4.5-22.5) min. In pediatric patients with FAT, 3D mapping and catheter ablation provided improved clinical quality of care. Catheter ablation may be considered early in the course of treatment of this tachyarrhythmia in symptomatic patients.

Short communication: Lipolytic activity on milk fat by Staphylococcus aureus and Streptococcus agalactiae strains commonly isolated in Swedish dairy herds.

The objective of this study was to determine the lipolytic activity on milk fat of 2 bovine mastitis pathogens, that is, Staphylococcus aureus and Streptococcus agalactiae. The lipolytic activity was determined by 2 different techniques, that is, thin-layer chromatography and an extraction-titration method, in an experimental model using the most commonly occurring field strains of the 2 mastitic bacteria isolated from Swedish dairy farms. The microorganisms were inoculated into bacteria-free control milk and incubated at 37°C to reflect physiological temperatures in the mammary gland. Levels of free fatty acids (FFA) were analyzed at time of inoculation (t=0) and after 2 and 6h of incubation, showing significant increase in FFA levels. After 2h the FFA content had increased by approximately 40% in milk samples inoculated with Staph. aureus and Strep. agalactiae, and at 6h the pathogens had increased FFA levels by 47% compared with the bacteria-free control milk. Changes in lipid composition compared with the bacteria-free control were investigated at 2 and 6h of incubation. Diacylglycerols, triacylglycerols, and phospholipids increased significantly after 6h incubation with the mastitis bacteria, whereas cholesterol and sterol esters decreased. Our results suggest that during mammary infections with Staph. aureus and Strep. agalactiae, the action of lipases originating from the mastitis pathogens will contribute significantly to milk fat lipolysis and thus to raw milk deterioration.

What are the minimum requirements for ketogenic diet services in resource-limited regions? Recommendations from the International League Against Epilepsy Task Force for Dietary Therapy.

Despite the increasing use of dietary therapies for children and adults with refractory epilepsy, the availability of these treatments in developing countries with limited resources remains suboptimal. One possible contributory factor may be the costs. There is often reported a significant perceived need for a large ketogenic diet team, supplements, laboratory studies, and follow-up visits to provide this treatment. The 2009 Epilepsia Consensus Statement described ideal requirements for a ketogenic diet center, but in some situations this is not feasible. As a result, the International League Against Epilepsy (ILAE) Task Force on Dietary Therapy was asked to convene and provide practical, cost-effective recommendations for new ketogenic diet centers in resource-limited regions of the world.

Phase 2 study of pemetrexed plus carboplatin, or pemetrexed plus cisplatin with concurrent radiation therapy followed by pemetrexed consolidation in patients with favorable-prognosis inoperable stage IIIA/B non-small-cell lung cancer.

INTRODUCTION: There is no consensus chemotherapy regimen with concurrent radiotherapy (RT) for inoperable stage IIIA/B non-small-cell lung cancer. This trial evaluated pemetrexed with carboplatin (PCb) or cisplatin (PC) with concurrent RT followed by consolidation pemetrexed. METHODS: In this open-label, noncomparative phase II trial, patients with inoperable stage IIIA/B non-small-cell lung cancer (initially all histologies, later restricted to nonsquamous) were randomized (1:1) to PCb or PC with concurrent RT (64-68 Gy over days 1-45). Consolidation pemetrexed monotherapy was administered every 21 days for three cycles. Primary endpoint was 2-year overall survival (OS) rate. RESULTS: From June 2007 to November 2009, 98 patients were enrolled (PCb: 46; PC: 52). The 2-year OS rate was PCb: 45.4% (95% confidence interval [CI], 29.5-60.0%); PC: 58.4% (95% CI, 42.6-71.3%), and in nonsquamous patients was PCb: 48.0% (95% CI, 29.0-64.8%); PC: 55.8% (95% CI, 38.0-70.3%). Median time to disease progression was PCb: 8.8 months (95% CI, 6.0-12.6 months); PC: 13.1 months (95% CI, 8.3-not evaluable [NE]). Median OS (months) was PCb: 18.7 (95% CI, 12.9-NE); PC: 27.0 (95% CI, 23.2-NE). The objective response rates (ORRs) were PCb: 52.2%; PC: 46.2%. Grade 4 treatment-related toxicities (% PCb/% PC) were: anemia, 0/1.9; neutropenia, 6.5/3.8; thrombocytopenia, 4.3/1.9; and esophagitis, 0/1.9. Most patients completed scheduled chemotherapy and RT during induction and consolidation phases. No drug-related deaths were reported during chemoradiotherapy. CONCLUSIONS: Because of study design, efficacy comparisons cannot be made. However, both combinations with concurrent RT were active and well tolerated.

Applications of marine nutraceuticals in dairy products.

The concept of nutraceutical has been derived by coining the terms "nutrition" and "pharmaceutical". In this context, active substances with pharmaceutical properties are delivered to the humans through food-based approaches to prevent or treat certain disease conditions. Since the natural sources are recognized as safe for human consumption, the active substances produced in the diverse group of marine organisms have a wide role in the nutraceutical industry. These marine-derived active ingredients include certain polysaccharides, polyphenols, bioactive peptides, polyunsaturated fatty acids, and carotenoids which are known to have anticancer, anti-inflammatory, antioxidant, antiobese, hypocholesteroleic, antimicrobial, prebiotic, and probiotic activity enabling them to be applied as nutraceuticals. As the dairy products are widely accepted by the consumers, the delivering of nutraceuticals through dairy products have received a greater attention of the dairy industry. Since the incorporation of marine-derived active ingredients into the dairy products have caused minimal changes in the physico-chemical properties of the final product, marine-derived substances have been widely applied and have the potential to be applied as nutraceuticals in the dairy industry.

Dietary therapies: a worldwide phenomenon.

At the 2010 Global Symposium on the Dietary Treatments for Epilepsy and other Disorders held in Edinburgh, there was an opening evening 75-min session to highlight the similarities and differences in the use of the ketogenic diet worldwide. Speakers from seven distinct regions of the world briefly presented their successes as well as challenges in using dietary therapies. Additionally, future clinical and research goals for each area were discussed. This article summarizes these talks and the use of the ketogenic diet worldwide.

A case of Italian HIV type 2 infection: a genetic analysis.

Human immunodeficiency virus type 2 (HIV-2), originally restricted to Western Africa, is now spreading to Western European countries because of migration from endemic areas. Therefore, it is mandatory to enforce the surveillance and improve the diagnostics of this neglected infection. In this report, we describe a case of HIV-2 infection affecting an Italian citizen along with three cases from India. Phylogenetic analysis showed that the viral strain identified in the Italian patient clustered with a strain isolated from an immigrant living in France. Of the three Indian strains, two clustered together and were statistically supported, whereas one clustered with a strain from Guinea Bissau. The description of the first case of HIV-2 infection in an Italian citizen indicates that the virus is spreading from endemic areas to countries involved in migration. A strict monitoring and improvement of the diagnostic molecular tools are necessary to avoid misdiagnosis with relevant clinical consequences.

Randomized, phase II trial of pemetrexed and carboplatin with or without enzastaurin versus docetaxel and carboplatin as first-line treatment of patients with stage IIIB/IV non-small cell lung cancer.

INTRODUCTION: Enzastaurin is an oral serine/threonine kinase inhibitor that targets protein kinase C-beta (PKC-ß) and the phosphatidylinositol-3-kinase/AKT pathway. This trial assessed pemetrexed-carboplatin ± enzastaurin to docetaxel-carboplatin in advanced non-small cell lung cancer. METHODS: Patients with stage IIIB (with pleural effusion) or IV non-small cell lung cancer and performance status 0 or 1 were randomized to one of the three arms: (A) pemetrexed 500 mg/m and carboplatin area under the curve 6 once every 3 weeks for up to 6 cycles with a loading dose of enzastaurin 1125 or 1200 mg followed by 500 mg daily until disease progression, (B) the same regimen of pemetrexed-carboplatin without enzastaurin, or (C) docetaxel 75 mg/m and carboplatin area under the curve 6 once every 3 weeks for up to six cycles. The primary end point was time to disease progression (TTP). RESULTS: Between March 2006 and May 2008, 218 patients were randomized. Median TTP was 4.6 months for pemetrexed-carboplatin-enzastaurin, 6.0 months for pemetrexed-carboplatin, and 4.1 months for docetaxel-carboplatin (differences not significant). Median survival was 7.2 months for pemetrexed-carboplatin-enzastaurin, 12.7 months for pemetrexed-carboplatin, and 9.2 months for docetaxel-carboplatin (log-rank p = 0.05). Compared with the other arms, docetaxel-carboplatin was associated with lower rates of grade 3 thrombocytopenia and anemia but a higher rate of grade 3 or 4 febrile neutropenia. CONCLUSION: There was no difference in TTP between the three arms, but survival was longer with pemetrexed-carboplatin compared with docetaxel-carboplatin. Enzastaurin did not add to the activity of pemetrexed-carboplatin.

HIV-2 amino acid substitutions in Gag and Env proteins occurring simultaneously with viral load upsurge in a drug-naïve patient.

It has been reported that the peptides of human immunodeficiency virus type 2 (HIV-2) most frequently recognized by cytotoxic T lymphocytes are firstly in Gag and secondly in Env proteins. In the present case study, we attempted to observe amino acid substitutions in Gag and Env proteins and related parameters possibly associated with an increase in HIV-2 load. A sudden, eightfold, increase in HIV-2 load occurred in a drug-naïve patient with human leukocyte antigen-B*5801 during the last phase of a longitudinal observation period from months 29 to 40. The genetic diversity of Gag and Env increased gradually prior to the HIV-2 load increase. The proportions of synonymous substitutions in both Gag and Env were greater than the proportions of nonsynonymous substitutions at every sampling point for 40 months, and the net charge of the V3-loop increased from months 29 to 40. Three amino acid substitutions (V2861 in Gag, K303T and N337 K/R in Env) were observed from months 29 to 40. Only one amino acid substitution (V286I) was observed with an increase in HIV-2 load in the Gag region where the clustering of epitopes was reported. These results suggest that the sites encompassing these three substituted positions are candidates for HIV-2 epitopes, although further careful examinations will be required.