Experimental validation of the GNRB® for measuring anterior tibial translation.

INTRODUCTION: The objective of this study was to validate the technique used to measure anterior tibial translation in cadaver knees using the GNRB® device by comparing it with the gold standard, the OrthoPilot® navigation system. HYPOTHESIS: Simultaneous measurement of anterior tibial translation by the GNRB® and the OrthoPilot® in the chosen experimental conditions will result in significant differences between devices. MATERIAL AND METHODS: Five fresh frozen cadavers were used. The knee was placed in 20° flexion. Four calibrated posterior-anterior forces (134N to 250N) were applied. For each applied force, the anterior tibial translation was measured simultaneously by both devices. Two conditions were analyzed: anterior cruciate ligament (ACL) intact and ACL transected. The primary criterion was anterior tibial translation at 250N. The measurements were compared using a paired Student's t-test and the correlation coefficient was calculated. Agreement between the two methods was determined using Bland-Altman plots. Consistency of the measurements was determined by calculating the intraclass correlation coefficient. RESULTS: For all applied forces and ligament conditions, the mean difference between the GNRB® and the navigation system was 0.1±1.7mm (n.s). Out of the 80 measurements taken, the difference between devices was less than ±2mm in 66 cases (82%). There was a strong correlation, good agreement and high consistency between the two measurement methods. DISCUSSION: The differences between the measurements taken by the GNRB® and the navigation system were small and likely have no clinical impact. We recommend using the GNRB® to evaluate anterior knee laxity. LEVEL OF EVIDENCE: II controlled laboratory study.

Virus burden in lymph nodes and blood of subjects with primary human immunodeficiency virus type 1 infection on bitherapy.

At present, it is not known whether undetectable plasma viremia corresponds to an absence of human immunodeficiency virus type 1 (HIV-1) replication in lymphoid tissues. This issue has been explored in 11 subjects with primary HIV-1 infection treated with zidovudine plus didanosine by evaluating virologic markers in blood and lymphoid tissues 9-18 months after initiation of treatment. These markers include plasma viremia, measured with a sensitive assay with a detection limit of 20 HIV-1 RNA copies/mL, infectious virus titers and proviral DNA in lymph node mononuclear cells, and HIV-1 RNA in lymphoid tissue. Five subjects had plasma viremia <20 copies/mL and showed no evidence of viral replication in lymphoid tissue. Six subjects had both detectable plasma viremia and evidence of HIV-1 RNA in lymphoid tissue. The results indicate that absence of detectable HIV RNA in lymphoid tissue is associated with viremia levels of HIV-1 RNA <20 copies/mL.

Detection of human immunodeficiency virus type 1 (HIV-1) RNA in pools of sera negative for antibodies to HIV-1 and HIV-2.

A total of 234 pools were prepared from 10,692 consecutive serum samples negative for antibodies to human immunodeficiency virus type 1 (HIV-1) and HIV-2 collected at five virological laboratories (average pool size, 45 serum samples). Pools were screened for the presence of HIV-1 RNA by a modified commercial assay (Amplicor HIV-1 Monitor test) which included an additional polyethylene glycol (PEG) precipitation step prior to purification of viral RNA (PEG Amplicor assay). The sensitivity of this assay for HIV-1 RNA detection in individual serum samples within pools matches that of standard commercial assays for individual serum samples, i.e., 500 HIV-1 RNA copies per ml. Five pools were identified as positive, and each one contained one antibody-negative, HIV-1 RNA-positive serum sample, corresponding to an average of 1 infected sample per 2,138 serum samples. Retrospective analysis revealed that the five HIV-1 RNA-positive specimens originated from individuals who had symptomatic primary HIV-1 infection at the time of sample collection and who were also positive for p24 antigenemia. We next assessed the possibility of performing the prepurification step by high-speed centrifugation (50,000 x g for 80 min) of 1.5-ml pools containing 25 microl of 60 individual serum samples, of which only 1 contained HIV-1 RNA (centrifugation Amplicor assay). The sensitivity of this assay also matches the sensitivities of standard commercial assays for HIV-1 RNA detection in individual serum samples. The results demonstrate that both assays with pooled sera can be applied to the screening of large numbers of serum samples in a time- and cost-efficient manner.

Turnover of CD4+ and CD8+ T lymphocytes in HIV-1 infection as measured by Ki-67 antigen.

We investigated CD4+ and CD8+ T cell turnover in both healthy and HIV-1-infected adults by measuring the nuclear antigen Ki-67 specific for cell proliferation. The mean growth fraction, corresponding to the expression of Ki-67, was 1.1% for CD4(+) T cells and 1.0% in CD8(+) T cells in healthy adults, and 6.5 and 4.3% in HIV-1-infected individuals, respectively. Analysis of CD45RA+ and CD45RO+ T cell subsets revealed a selective expansion of the CD8+ CD45RO+ subset in HIV-1-positive individuals. On the basis of the growth fraction, we derived the potential doubling time and the daily turnover of CD4+ and CD8+ T cells. In HIV-1-infected individuals, the mean potential doubling time of T cells was five times shorter than that of healthy adults. The mean daily turnover of CD4+ and CD8+ T cells in HIV-1-infected individuals was increased 2- and 6-fold, respectively, with more than 40-fold interindividual variation. In patients with <200 CD4+ counts, CD4+ turnover dropped markedly, whereas CD8+ turnover remained elevated. The large variations in CD4+ T cell turnover might be relevant to individual differences in disease progression.

Detection of low HIV-1 RNA levels in plasma.

HIV-1 viremia is a marker of choice for staging, prognosis, and monitoring treatment efficiency in HIV infection. Among the commercial assays, the Amplicor HIV Monitor (Roche, Basel, Switzerland) test has the highest sensitivity for HIV-1 RNA quantitation in plasma with a detection limit of 200 copies per milliliter. To measure HIV-1 viremia below this threshold, boosted versions of the Amplicor assay were developed by adding a centrifugation step prior to RNA extraction and by decreasing dilution factors. In the boosted version, the increase in analytical sensitivity for HIV-1 RNA detection directly correlates with the input of plasma. For 1,500 microl of plasma, the sensitivity of the assay increases by a factor of 30. For routine clinical analysis, we use a boosted assay format with an input plasma volume of 500 microl and a lower detection limit of 20 copies/milliliter. Coefficients of intra- and interassay variation are similar to those reported for the standard assay (approximately 30%). Thirteen (45%) of 29 plasma samples of HIV-infected individuals with undetectable viremia in the standard assay had detectable viremia between 20 and 200 copies/milliliter.

Zidovudine plus didanosine in primary HIV-1 infection.

Viraemia levels in the months following primary HIV-1 infection (PHI) predict the subsequent course of the infection. Inhibition of viral replication in PHI patients might improve their clinical prognosis. In this study, we evaluated the antiviral efficacy of the association of two reverse transcriptase inhibitors--zidovudine at 250 mg twice daily and didanosine at 200 mg twice daily--in 12 patients treated for at least 6 months (median 10 months, range 6-15 months). We compared values for viraemia, proviral DNA and CD4:CD8 ratios in these patients with two historical control groups consisting of 16 untreated patients and 15 patients on zidovudine therapy. Significantly lower viraemia was observed between 3 and 12 months in patients on zidovudine-didanosine therapy. Viraemia levels lower than 200 HIV-1 RNA copies/ml were observed in 3/12 patients on zidovudine-didanosine therapy after 3 months, in 8/12 after 6 months and in 3/5 after 12 months. Only one of the 31 historical control patients had undetectable viraemia. For proviral DNA, smaller differences between groups were observed, although with time proviral DNA became undetectable (< 1 copy/7.5 x 10(5) lymphocytes) in four patients from the zidovudine-didanosine group versus one in the control groups. Finally, the CD4:CD8 ratio was significantly higher in the zidovudine-didanosine group and none of the patients in this group developed HIV-1-associated clinical complications. These data suggest a higher efficacy of combined therapy compared with zidovudine monotherapy in PHI patients and indicate that control of viraemia for at least 1 year is achievable in PHI patients.

A rodent cell line permissive for entry and reverse transcription of human immunodeficiency virus type 1 has a pre-integration block to productive infection.

Replication of human immunodeficiency virus type 1 (HIV-1) is restricted to CD4-expressing primate cells. This tropism may be due partly to the absence from nonprimate cells of a species-specific factor which has an accessory role to CD4 during virus penetration. In this study we describe a rat B lymphocyte cell line in which there is efficient CD4-dependent entry of HIV-1. However, this cell line has a block to productive infection of HIV-1 at a stage between reverse transcription and integration. Our results demonstrate that the putative accessory factor for HIV-1 penetration is not restricted to primate cells and that there is a novel, uncharacterized cell-virus interaction at a stage between penetration and integration.

The recognition of chimeras of rat and human CD4 by HIV-1 gp120 and by monoclonal antibodies.

The use of chimeras of rat and human CD4 to probe the HIV-1 gp120 and antibody binding properties of CD4 is reviewed. Short segments of human CD4 sequence were substituted for the equivalent regions of rat CD4 which does not bind gp120, and analysis of the properties of these chimeras established: (i) that residues 33-58 of the NH2-terminal domain of human CD4 encompass the high-affinity gp120 binding site; and (ii) that chimeras containing residues 33-62 mediate HIV-1 infection. The chimera-binding specificities of gp120 and a large panel of anti-CD4 antibodies were also determined. This allowed a critical test of the popular notion that receptor mimics appear at high frequency among antibodies elicited by immunization with receptor ligands and that anti-idiotypic antibodies can be used to identify novel receptors. The data suggest that such mimics appear infrequently, if at all, a result which is consistent with the failure of the anti-idiotype approach to identify new genes encoding receptors with prescribed functions.

A rat CD4 mutant containing the gp120-binding site mediates human immunodeficiency virus type 1 infection.

CD4 is the primary receptor for the human immunodeficiency virus type 1 (HIV-1). Early mutational studies implicated a number of residues of CD4, centered in the region 41-59, in binding to gp120. However, further mutational analyses, together with studies using inhibitory antibodies or CD4-derived peptides, have suggested that other regions of CD4 are also involved in binding or postbinding events during infection. To resolve these ambiguities, we used rat CD4 mutants in which particular regions were replaced with the corresponding sequence of human CD4. We have previously shown that some of these are able to bind HIV-1 gp120, and here we test their ability to act as functional receptors. We find that the presence of human CD4 residues 33-62 is enough to confer efficient receptor function to rat CD4, and we conclude that it is unlikely that regions of CD4 outside this sequence are involved in specific interactions with HIV-1 during either infection or syncytium formation.

Antibody and HIV-1 gp120 recognition of CD4 undermines the concept of mimicry between antibodies and receptors.

It has been proposed that antibodies can mimic the binding of a receptor to its ligand and that anti-idiotype antibodies raised against such antibodies can be used to identify the receptor. A large number of antibodies have been raised against CD4, the receptor on T cells for the envelope glycoprotein gp120 of the human immunodeficiency virus, and the site at which gp120 binds to CD4 has been delineated. It has therefore become possible to contrast the fine specificities of a natural ligand (gp120) and antibodies that interact with the receptor at the same site. Here we report that out of a panel of 225 anti-CD4 antibodies, only one showed fine binding specificity that was broadly like that of gp120, but the evidence was against this being an exact mimic. Thus the data indicate that the production of antibody mimics will occur very rarely or not at all and that the anti-idiotype approach is unlikely to be useful. This contention is supported by a review of the results of attempts to use this approach. Taking strict criteria for success, there is no example for which the anti-idiotype approach has led to the discovery of a previously undescribed receptor or other protein of interest.

Construction of a binding site for human immunodeficiency virus type 1 gp120 in rat CD4.

The human immunodeficiency virus (HIV-1) infects T lymphocytes via an interaction between the virus envelope glycoprotein gp120 and the CD4 antigen of T helper cells. Previous studies demonstrated that mutations in various regions of CD4 domain 1 lead to the loss of gp120 binding. In the present study the gp120 binding site was constructed in rat CD4 by replacing rat with human CD4 sequence. A series of mutants was constructed the best of which bound gp120 with an affinity only twofold less than that of human CD4. The data indicate that the gp120 binding site of human CD4 is constituted by residues 33-58 of domain 1.

[Treatment of septicemias and skin infections in burn patient by teicoplanin. Study of its skin diffusion]. / Traitement des septicémies et infections cutanées chez le brûlé par la téicoplanine. Etude de sa diffusion cutanée.

In this study, teicoplanin was administered to burnt patients by IV and IM route in monotherapy or in association with other antibiotics. 12 cases of septicaemia and 8 severe cutaneous cocci Gram + infections were treated. Dosage varied from 5 mg/kg to 14 mg/kg. Clinical cure was observed in 89% of cases, and eradication of cocci Gram + in 83%. The MICs of Staphylococcus were between 0.25 micrograms/ml and 4 micrograms/ml, with a majority of methicillin-resistant Staphylococcus at 1. Average through serum concentrations were 7.4 micrograms/ml, and peak serum concentrations were 26 micrograms/ml (1 hour after injection). Tolerance was good in 19 of the 20 cases (95%). Skin levels of teicoplanin were found to be 1.6 times the through serum level. It was noted that in burnt patients whose UBS is superior to 100, the dose should be increased by about 50%.