A unique transcription mode of rabies virus high egg passage-Flury strain detected in infected baby hamster kidney-21 cells.

The transcription mode of rabies virus high egg passage-Flury (HEP) strain was examined and compared with that of Evelyn Rokitniki Abelseth (ERA) strain by northern blot analysis using rabies virus gene-specific probes. The ERA strain was shown to exclusively produce monocistronic mRNAs in transcription. All combinations of multicistronic transcripts, including five monocistronic mRNAs, were detected in the viral RNA transcripts of HEP strain. It was concluded that the unique transcription mode is not due to the nucleotide structure of the genome RNA template, but rather to the viral RNA polymerase of HEP strain. The viral polymerase of HEP strain read through the gene junction at a high frequency. The HEP strain has been passaged many times in chick embryo and cultured cells, and has adapted to propagate well in the baby hamster kidney-21 (BHK-21) cells. Through these passages in various hosts, the HEP strain has acquired a unique transcription mode that might have an advantage in amplification of the virus.

Cardiac valvular surgery in dialysis patients: comparison of surgical outcome for mechanical versus bioprosthetic valves.

PURPOSE: There has been a changing preference for bioprosthetic valves over mechanical valves in dialysis patients, but there is still much controversy. We reviewed our 17-year experience and assessed the influence of prosthesis choice. METHODS: From 1990 to 2007, a total of 63 consecutive dialysis patients who underwent valvular surgery (64 operations including one reoperation) at our hospital were retrospectively reviewed. The mean age of the patients was 58.3 +/- 9.0 years. The reasons for dialysis were glomerulonephritis (n = 32) and diabetes (n = 10). The major preoperative diagnosis was aortic stenosis (n = 44). The surgical procedures included aortic valve replacement (n = 44), mitral valve replacement (n = 7), double valvular replacement (n = 7), and mitral valve repair (n = 5). Prostheses for valve replacement were mechanical valves (n = 37) or bioprosthetic valves (n = 22). Follow-up was accomplished in 95.2%, and the mean follow-up period was 49 months. RESULTS: Actuarial survivals at 1, 5, and 10 years were 85%, 64%, and 45% respectively. Freedom from cardiovascular events at 1 and 5 years was 61% and 41%, respectively. Mechanical valve patients had significantly higher early mortality than bioprosthetic valve patients (P = 0.03). However, both mechanical and bioprosthetic valve patients had similar survival and event-free rates (P = 0.87 and P = 0.27, respectively) in the midterm results. The mechanical group had a higher rate of bleeding events. There was no structural valve deterioration up to the 5-year follow-up. CONCLUSION: The choice of prosthesis did not influence the surgical outcome except for early mortality. Careful consideration of preventive measures against bleeding is important, and prosthesis selection should be based on the patient's profile as well as the criteria for nondialysis patients.

Successful treatment of a patient with severe pulmonary hypertension due to perivalvular leakage at aortic and mitral positions after aortic and mitral valve replacement.

A 33-year-old-man had severe secondary pulmonary hypertension due to perivalvular leakage at the aortic and mitral positions after aortic and mitral valve replacement. Preoperative cardiac catheterization revealed pulmonary artery pressure of 105/45 mmHg and pulmonary vascular resistance of 929 dynes.s.cm(-5) To save the patient, we performed aortic and mitral valve re-replacement, and tricuspid annuloplasty. After surgery, selective pulmonary vasodilators, beraprost sodium, inhaled nitric oxide, and intravenous prostaglandin (PG) I(2) were administered because of persistent severe pulmonary hypertension. Cardiac catheterization on postoperative day 58 showed that the pulmonary artery pressure and pulmonary vascular resistance had decreased to 40/20 mmHg and 87.7 dynes x s x cm(-5), respectively The simultaneous use of inhaled nitric oxide, intravenous PGI(2), and oral beraprost sodium might be useful for treating postoperative persistent pulmonary hypertension.

Mechanical support for patients with fulminant acute myocarditis: strategy for biventricular failure and respiratory failure.

Acute fulminant myocarditis can cause left ventricular dysfunction that predisposes the patients to critical condition. Left ventricular assist device (LVAD) is a useful option for the patient whose condition is resistant to medical therapy. However, when right ventricular dysfunction with hypoxia is complicated with left ventricular dysfunction, it can be difficult to make a prompt decision in order to achieve better outcome. We present our case in which the support on LVAD and extracorporeal membrane oxygenation (ECMO) was effective to treat critically ill patients.

Small red bean (azuki) sheds biologically active substances as a prerequisite step for germination, one of which displays the antiviral activity against the rabies virus infectivity and infections in culture.

When small red beans (azuki bean; Vigna angularis Ohwi et Ohashi) were soaked and warmed in water or saline, the beans began to absorb water to swell and exuded kinds of substances probably as a prerequisite step for seed germination. Such exudate fluids displayed strong antiviral activity against the rabies virus infections in culture. On the other hand, little anti-rabies activity was detected in the aqueous extracts from the red beans when tested soon after the extraction from powdered beans, while low titers of antiviral activity appeared gradually in the extracts during cold storage. In contrast, no antiviral activity was detected in the exudate fluids from non-colored azuki beans (white azuki), implicating that a certain anthocyanin-related substance is involved in the antiviral activity of red beans. Production of antiviral and cytotoxic activities were affected differently depending on the bean-soaking conditions. In addition, the antiviral activity resisted to 10 min-heating in boiling water, while the cytotoxicity was greatly weakened by the heating, suggesting that different substances are involved in the antiviral and cytotoxic activities. Further studies on the antiviral activity of the exudate fluids demonstrated that anti-rabies activity of the bean exudates affected not only the very early phase of infection cycle, but the viral infectivity was also affected similarly, implicating a possible application of azuki bean exudate fluids to post-exposure treatment of rabid dog-bite injuries in combination with vaccination.

Video-assisted thoracoscopy to treat atrial tachycardia arising from left atrial appendage.

A 17-year-old male with tachycardia-induced cardiomyopathy presented with persistent, drug-resistant atrial tachycardia (AT). An electrophysiological study suggested focal abnormal automaticity, and localized the AT origin to the left atrial appendage. Radiofrequency catheter ablation at the site of the earliest endocardial activation during AT failed. A minimally invasive, video-assisted thoracoscopic (VAT) atrial appendectomy terminated the AT and restored left ventricular contractility. The patient remained free of AT and normal left ventricular function was maintained over a 24-month follow-up period. To our knowledge, we are the first to use VAT atrial appendectomy to treat focal AT.

Two different conformations of rabies virus glycoprotein taken under neutral pH conditions.

We previously reported that the rabies virus glycoprotein (G) takes either of two different conformations (referred to as B and C forms) under neutral pH conditions, that could be differentiated by their reactivity to a monoclonal antibody (mAb), #1-30-44, that recognizes the acid-sensitive conformational epitope, and the formation taken is dependent on two separate regions containing Lys-202 and Asn-336 of the protein (Kankanamge et al., Microbiol. Immunol., 47, 507-519, 2003). Semi-quantitative antibody-binding assays demonstrated that only one-third to one-fourth of mature G proteins on the cell surface were taking the 1-30-44 epitope-positive B form even at pH 7.4. The ratio of B to C varied, depending on the environmental pH, but did not decrease to zero even at pH 5.8-6.2, preserving a certain content (about 15-20%) of B form. Immunoprecipitation studies demonstrated that a portion of G proteins were intimately associated with a dimer form of matrix (M) protein in terms of resistance to treatment with a mixture of 1% deoxycholate and 1% Nonidet P-40, and seemed to preserve the B form even at lower pHs. Similar results were also obtained with the virion-associated G proteins, including the intimate association of a portion of the G proteins with the M protein dimer. From these results, we assume that a certain portion of the rabies virion-associated G proteins are associated with a dimer form of M protein, keeping the 1-30-44 epitope-positive B conformation under various pH conditions, which might possibly assure the virion's recognition of host cell receptor molecules in the body.

Successful explantation of ventricular assist device for systemic ventricular assistance in a patient with congenitally corrected transposition of the great arteries.

We report a case of a 13-year-old boy with congenitally corrected transposition of the great arteries after conventional repair who underwent an implantation of ventricular assist device (VAD) due to right (systemic) ventricular failure after tricuspid valve replacement. The anatomical right ventricle (systemic ventricle) was completely unloaded and the function improved over time under LVAD. He had an explantation of the VAD due to bacteremia 43 days after implantation, and his clinical condition improved significantly.

Further studies on the mechanism of rabies virus neutralization by a viral glycoprotein-specific monoclonal antibody, #1-46-12.

We previously reported that a conformational epitope-specific monoclonal antibody (mAb; #1-46-12) neutralized the rabies virus by binding only a small number (less than 20) of the antibody molecules per virion, while a linear epitope-specific mAb (#7-1-9) required more than 250 IgG molecules for the neutralization. We also isolated both the epitope-negative (R-31) and-positive (R-61) escape mutants that resisted mAb #1-46-12. Co-infection studies with wild type (wt) and R-61 mutant have shown that although the infectivity of R-61 mutant was not affected by the binding of about 300 IgG molecules per virion, incorporation of a small number of wt G protein into the R-61 virion resulted in dramatic loss of the resistance. In this study, we further investigated properties of the mutant G proteins. The R-61 G protein lost reactivity to the mAb when solubilized, even keeping a trimer form, suggesting that membrane-anchorage is essential for the maintenance of its epitope-positive conformation. On the other hand, incorporation of wt G proteins into the R-31 virions did not affect their resistance to the mAb very much. Although we have not so far found the presumed conformational changes induced by the mAb-binding, we think that these results are not inconsistent with our previously proposed novel model (referred to as a domino effect model) for the virus neutralization by mAb #1-46-12 other than a classical spike-blocking model, which implicates successive spreading of the postulated antibody-induced conformational changes of G protein to the neighboring spikes until abolishing the host cell-binding ability of the virion.

Further studies on the soluble form (gs) of rabies virus glycoprotein (g): molecular structure of gs protein and possible mechanism of the shedding.

In this study, we investigated the antigenic structures and maturation of some C-terminal-deficient derivatives of rabies virus glycoprotein (G). The Gs protein, a soluble form of G protein shed from infected cells, displayed antigenicity to most of our conformational epitope-specific anti-G mAbs, but took the 1-30-44 epitope-deficient conformation (termed G(C) form). (The 1-30-44 epitope was acid-sensitive and dependent on two separate regions, the Lys-202-containing and Asn-336-containing regions; Kankanamge et al., Microbiol. Immunol., 47: 507-519). Intact G proteins took the 1-30-44 epitope-positive form (referred to as G(B) form) on the cell surface, but not inside the cell. A deletion mutant G(1-429) (termed GDeltaTC), lacking the transmembrane (TM) and cytoplasmic domains, was shown to be accumulated in the rough endoplasmic reticulum (rER) with BiP and did not seem to be shed. Another C-terminal-deficient mutant G(1-462) (termed CT1) was deprived of the whole cytoplasmic domain except for a basic amino acid left at the C-terminus, but was transported to the cell surface, where it showed pH-dependent cell fusion activity and almost full antigenicity to most of the anti-G mAbs with the exception of very weak antigenicity to mAb #1-30-44. No Gs protein could be detected in the CT1-producing cultures. Based on these results, we think that the cytoplasmic domain was not necessary for the G protein to be transported to the cell surface, but was necessary to keep its 1-30-44 epitope-positive G(B) conformation. Gs proteins might have lost the C-terminal regions during the maturation process after being exported from the rER.

Structural difference recognized by a monoclonal antibody #404-11 between the rabies virus nucleocapsid (NC) produced in virus infected cells and the NC-like structures produced in the nucleoprotein (N) cDNA-transfected cells.

We investigated structural changes in the rabies virus (HEP-Flury strain) nucleocapsid (NC) during the virus replication, for which we used two anti-nucleoprotein (N) monoclonal antibodies (mAbs), #404-11 (specific for a conformation-dependently exposed linear epitope) and #1-7-11 (specific for a conformational epitope which is exposed after the nucleocapsid formation). Both mAbs recognized the N protein of the viral NC, but not of the RNA-free N-P complex. The 1-7-11 and 404-11 epitopes could be mapped to the N-terminal and the C-terminal regions of N protein, respectively. Immunoprecipitation studies demonstrated that treatment of the NC either with the alkaline phosphatase or sodium deoxycholate (DOC) resulted in dissociation of most P proteins from the NC and in the reduced reactivity to mAb #404-11, but not to mAb #1-7-11. NC-like structures produced in the N cDNA-transfected cells displayed strong reactivity to mAb #1-7-11; however, reactivity to mAb #404-11 was very weak. And, coexpression with viral phosphoprotein (P) resulted in little increase in reactivity to mAb #404-11 of the NC-like structures, while the reactivity was significantly increased by cotransfection with P and the viral minigenome whose 3'- and 5'-end structures were derived from the viral genome. From these results, we assume that, although the 404-11 epitope is a linear one, the epitope-containing region is exposed only when N proteins encapsidate properly the viral RNA in collaboration with the P protein. Further, exposure of the 404-11 epitope region might be function-related, and be regulated by association and dissociation of the P protein.

Characteristics of hypertrophic obstructive cardiomyopathy refractory to medical treatment and selection of surgical methods.

BACKGROUND AND AIM OF THE STUDY: Treatment for hypertrophic obstructive cardiomyopathy (HOCM) has been reported; however, there has been no report on the characteristics of medication-responsive and -refractory hypertrophic obstructive cardiomyopathy (HOCM). Using the classification of systolic anterior movement (SAM) which has been previously reported, we tried to identify the characteristics and use them to treat HOCM appropriately. METHODS: The clinical, echocardiographic, catheterization, and surgical data of 29 hospitalized patients with HOCM during 1980 to 1999 were analyzed retrospectively. We classified SAM in all patients by echocardiography. Nineteen patients improved with medical treatment (medical group), and 10 patients underwent surgical treatment because of ineffectiveness of medication (surgical group). We studied the relation between types of SAM and medical/surgical groups, and examined the relation between types of SAM and the surgical methods. RESULTS: Type I SAM was significantly more frequent in the medical group, while type II SAM was more frequent in the surgical group (p = 0.047). Patients in the surgical group underwent mitral valve replacement (MVR), myectomy, or a combination of MVR and myectomy. Left ventricular outflow gradient (LVOG) of over 100 mmHg was recognized in almost all patients with type II SAM. CONCLUSIONS: It was suggested that patients with medication-responsive HOCM tended to have type I SAM and those with refractory HOCM tended to have type II SAM. We consider that in type I SAM, if the position of the papillary muscles changed with medication or myectomy, shift of the chordae and type I SAM were reduced or disappeared. However, in type II SAM, even if the position of the papillary muscles changed, SAM did not disappear because lifting of the mitral leaflets remained. It is therefore suggested that patients with type II SAM should undergo at least MVR.

Studies on the conditions required for structural and functional maturation of rabies virus glycoprotein (G) in G cDNA-transfected cells.

When the rabies virus G cDNA was expressed with the help of T7 RNA polymerase provided by a recombinant vaccinia virus (RVV-T7), functional G proteins were produced in terms of their ability to induce low pH-dependent syncytium formation and the formation of conformational epitopes, including the acid-sensitive epitope recognized by mAb #1-30-44. Such an ability and the 1-30-44 epitope formation, however, were not associated with the G gene products when G cDNA was expressed without the help of RVV-T7 using a tetracycline-regulated expression vector (pTet-G), although they were normally transported to the surface of established G protein-producing BHK-21 (G-BHK) cells. But, when the G-BHK cells were treated with 2.5 m M sodium butyrate (NaB) after the removal of tetracycline, we could observe not only a much increased frequency of G protein-producing cells, but also the greatly enhanced maturation of the protein. Another short acylate, sodium propionate (NaP), similarly induced increased G protein synthesis at a concentration of 2.5 m M as NaB; however, such proteins were mostly not endowed with the fusion activity nor the 1-30-44 epitope, while NaP at a higher concentration as 5.0 m M did induce similarly the increased production and enhanced maturation of G protein, including the 1-30-44 epitope formation. From these results, we conclude that functional maturation of G protein to acquire fusogenic activity is correlated with 1-30-44 epitope formation, and 2.5 m M NaB not only stimulates G protein production, but also provides such cellular conditions as are required for the structural and functional maturation of the protein.

Further studies on the hyperphosphorylated form (p40) of the rabies virus nominal phosphoprotein (P).

We investigated possible mechanisms involved in production of a hyperphosphorylated form (p40) of rabies virus P protein, to which two dimensional (2-D) gel electrophoresis was applied. The P gene products produced in Escherichia coli cells could be detected as a single spot of unphosphorylated 37-kDa form (termed as p37-0) in a 2-D gel. The 37-kDa proteins in the virus-infected cells are composed of some phosphorylated forms, including a major p37-1 and more phosphorylated minor forms (e.g., p37-2, p37-3, etc.), but little p37-0 is detected (Eriguchi et al., 2002). When the E. coli -produced P protein analogues were incubated with BHK-21 cell lysates, heparin-sensitive phosphorylation occurred as described previously (Takamatsu et al., 1998), giving an additional 40-kDa spot. However, such a p40-like derivative displayed a little more basic pI value than that of the authentic p40 produced in the infected cells; hence, the former was termed p40-0 (pI=4.78), while the latter, p40-1 (pI=4.73). In contrast, p40 produced in the P cDNAtransfected animal cell was detected at the p40-1 position. In addition, staurosporine did not affect the p40-1 production in virus-infected nor the P cDNA-transfected animal cells, while the agent reduced production of hyperphosphorylated forms of p37, resulting in accumulation of p37-1, but not of p37-0. These results suggest that, although p37-0 may become a substrate for the heparin-sensitive protein kinase (PK) in vitro, only p37-1 is a substrate for p40 production catalyzed by heparin-sensitive PK in animal cells, and staurosporine-sensitive PK is involved in the production of more phosphorylated forms of p37, but not in p37-1 production from p37-0.

Intercontinental LVAS patient transport.

Mechanical circulatory support is currently indicated for patients with cardiac insufficiency as a bridge to transplantation or as a bridge to recovery. These systems continue to evolve and improve, and many patients (after they are stabilized) are now able to be discharged from the hospital. This article reports our experience with the intercontinental transportation of a patient while being supported with a Novacor left ventricular assist system (WorldHeart Corp, Ottawa, Canada). While in Japan, the Canadian patient suffered a myocardial infarction and despite coronary artery bypass grafting, the patient remained in a low cardiac output state. After implantation of the left ventricular assist system in Japan, the patient was stabilized and transported by a commercial airline to Canada where he underwent successful heart transplantation.

Extremely rapid formation of mitral valve ring abscess in infective endocarditis.

A patient with infective endocarditis (IE) due to methicillin-resistant staphylococcus aureus (MRSA) was found to have conversion of the hypoechoic region of the posterior mitral valve ring apparatus into a clearly delineated echolucent space by repeating transthoracic echocardiography at an interval of 1 week. Color Doppler showed features of blood entry into this space. Abscess formation in IE due to MRSA may be quick and repeated echocardiography may help detect the complications of IE. Semiurgent mitral valve plasty was performed for the associated prolapse of the posterior mitral leaflet using a hand-made, rolled, twisted autologous pericardial ring.

Association of rabies virus nominal phosphoprotein (P) with viral nucleocapsid (NC) is enhanced by phosphorylation of the viral nucleoprotein (N).

We investigated possible role(s) of N protein phosphorylation in the rabies virus replication process. A large amount of P proteins are associated with the viral nucleocapsid (NC) in the infected cell, the amount which was greatly decreased by phosphatase-treatment of the isolated NC, indicating that the phosphate group of N and/or P proteins is essential for their stable association with the NC. Immunoprecipitation studies were performed on the coexpressed normal N or phosphorylation deficient N(S389A) and P proteins, demonstrating that the P protein associated with phosphorylation-deficient NC-like structures was much less in amount than that associated with the wild type NC. Similar results were also obtained with a mutant P protein, PDeltaN19, which lacked the N-terminal 19 amino acids and was capable of binding to the NC-like structures but incapable of forming the RNA-free N-P complexes. Immunoprecipitation studies with mAb #402-13 further suggested that the NC-specific linear 402-13 epitope was exposed even on the P proteins which were associated with the phosphorylation-deficient NC-like structures, but such association was very weak as demonstrated by greatly decreased amounts of coprecipitated NC-like structures. From these results, we assume that the phosphorylation of N protein enhances the association between the 402-13 epitope-positive P protein and the NC probably by stabilizing such P-NC binding.

Preparation of virosomes coated with the vesicular stomatitis virus glycoprotein as efficient gene transfer vehicles for animal cells.

The vesicular stomatitis virus (VSV) glycoprotein (G) was used to prepare virosomes as a model vehicle of gene transfer to animal cells, for which viral envelope functions (receptor recognition and binding and the pH-dependent membrane-fusion) were expected to work. Plasmid DNA (pEGFP-N1; Clontech) was first encapsulated into liposomes by a method of repeated freezing and thawing of the mixture of DNA and lipids (phosphatidylcholine, phosphatidylserine and cholesterol mixed at a molar ratio of 5: 1: 4). Then, particle size of the liposomes was stepwise reduced to 200 nm or less in diameter by successive filtrations through a series of plastic filters of various pore sizes (10 micro m, 2 micro m, 0.65 micro m, and then 0.45 micro m). Assembly of the VSV G protein-coated liposomes (VSV G-virosomes) was performed by mixing the DNA-encapsulated liposome suspensions with the purified VSV G proteins at pH 5.5, followed by ultracentrifugation in a discontinuous sucrose gradient. The highest gene-transducing activity was detected in a single band formed between 20% and 45% sucrose layers. Negatively stained electron microscopic images showed that the band contained spherical particles of various sizes, ranging from 40 to 140 nm in diameter, that were covered with viral spike projections. The VSV G-virosomes displayed a roughly similar level of gene-transducing activity to that mediated by cationic liposomes (e.g., Lipofectamine), which was blocked either by pretreatment with anti-VSV G antiserum or by addition of 20 m M NH(4) Cl to transfected cultures. From these results, we assume that the virosome-mediated gene-transduction was first achieved by using the whole functions of VSV G protein, and can also be used for further studies of the protein.