Assessment, by transcription-mediated amplification, of virologic response in patients with chronic hepatitis C virus treated with peginterferon alpha-2a.

Transcription-mediated amplification (TMA) is an isothermal, autocatalytic target amplification method which has the potential to detect less than 50 hepatitis C virus (HCV) RNA copies/ml (10 IU/ml). The TMA assay was used to assess the presence of residual HCV RNA in plasma from patients treated with polyethylene glycol-modified interferon alpha-2a (peginterferon alpha-2a) who showed a virologic relapse after the end of therapy. Stored end-of-treatment and end-of-follow-up plasma samples from 177 of 267 patients treated with peginterferon alpha-2a (S. Zeuzem et al., N. Engl. J. Med. 343:1666--1672, 2000) were available for retesting by TMA. Plasma samples from patients in the same study who exhibited virologic relapse after treatment with standard interferon alpha-2a served as controls. Virologic response during the trial was defined as HCV RNA that was undetectable using a PCR-based test system with a sensitivity of 50 IU/mL (Cobas Amplicor HCV version 2.0) and was compared with TMA-based retesting results (VERSANT HCV RNA Qualitative Assay). Residual HCV RNA was detected in 4 of 60 cases (7%) by the TMA technology in end-of-treatment plasma samples from patients who relapsed after receiving peginterferon alpha-2a and in 6 of 18 patients (33%) following therapy with standard interferon alpha-2a. For peginterferon alpha-2a-treated patients with sustained virologic response, HCV RNA was detectable by TMA in end-of-treatment samples in 3 of 78 cases but in none of the end-of-follow-up samples. For all end-of-treatment and end-of-follow-up plasma samples of virologic nonresponders, a complete concordance between the PCR-based assay and TMA was observed. In conclusion, in patients with virologic relapse after the end of therapy, according to PCR, who were treated with peginterferon alpha-2a or standard interferon alpha-2a, residual HCV RNA was detectable in end-of-treatment samples by the TMA-based assay in 7 or 33% of cases, respectively. The lower rate of residual HCV RNA detection by TMA for patients treated with peginterferon alpha-2a than that for patients treated with standard interferon alpha-2a may be due to the maintained antiviral pressure of the long-acting peginterferon alpha-2a at the end-of-treatment visit.

Latent infection can be established with drastically restricted transcription and replication of the HSV-1 genome.

Viral functions essential for the establishment of latent infection in murine sensory neurons in vivo were investigated by employing a herpes simplex virus type 1 (HSV-1) variant (KD6/B11) deleted for expression of the ICP4 gene and therefore unable to replicate. Since the viral DNA persisted in these cells, the latency-associated transcripts were expressed for prolonged periods of time, and the variant was biologically retrievable by superinfection with an ICP4-competent agent, we concluded that a latent infection had been established. In situ hybridization experiments designed to investigate gene expression during the acute phase of infection with the variant revealed a highly restricted pattern compared to that of the wild-type parent virus HSV-1 KOS(M). While latency-associated transcripts were detected in a large number of infected neurons, expression of other virus genes was limited to a subset of immediate-early and early genes (ICP0, ICP8, ICP27, and HSV-1 DNA polymerase genes). Expression was further limited to a small proportion of the infected neurons (approximately 1% of neurons expressing latency-associated transcripts). No hybridization was detected with probes specific for the viral TK gene and late genes VP5 and gC. Quantitative assays of viral DNA during the acute phase of infection indicated that the input viral DNA did not replicate. From these results we conclude that HSV-1 latent infection can be established in murine sensory neurons under conditions in which viral genetic expression and DNA replication are severely restricted.

Pathways of viral gene expression during acute neuronal infection with HSV-1.

Pathways of viral gene expression were investigated during the acute phase of sensory ganglionic infection with HSV-1. To facilitate these studies we constructed KOS/62-3, an HSV-1 vector in which the Escherichia coli lac-Z gene was inserted behind both copies of the promoter for the viral latency-associated transcripts. Following footpad inoculation of mice with the virus, acutely infected dorsal root ganglion (DRG) neurons were assayed by dual immunofluorescence for the presence of beta-galactosidase and HSV viral antigens. Most infected neurons stained for either beta-galactosidase or viral antigens. Less than 0.2% of neurons staining for viral antigens also expressed beta-galactosidase, and less than 10% of neurons expressing beta-galactosidase also stained for viral antigen. As a consequence of these findings, we propose that there are essentially two populations of HSV-infected neurons during the acute phase of ganglionic infection. In one population of neurons there is abundant viral protein synthesis but minimal transcription of latency-associated transcripts, whereas in a second population of neurons viral gene expression is severely restricted except for the synthesis of latency-associated transcripts. Since DRG neurons are a heterogeneous population of cells, we further sought to determine whether either pathway of gene expression was more likely to occur in a particular neuronal phenotype. To accomplish this, antibodies were used to characterize the DRG neuronal phenotypes acutely infected with the virus. The results indicated that the pathway of neuronal infection characterized by transcription of abundant latency-associated transcripts and minimal viral protein synthesis was much more likely to occur in DRG neurons expressing the cellular antigen SSEA-3. These data indicate that the neuron plays a major role in regulating the outcome of infection with HSV. Finally, we sought to determine whether DNA replication occurs in the course of establishment of a latent infection. We found that the DNA content of neurons latently infected with KOS(M) strain HSV was not affected by treatment with nucleotide analogues during the acute phase of ganglionic infection, suggesting that viral DNA replication does not occur during the establishment of latent infection.

Ocular herpes simplex virus reactivation in mice latently infected with latency-associated transcript mutants.

A mouse model for ocular reactivation of herpes simplex virus type 1 (HSV-1) was modified and used to study the effect of strain difference on the frequency of ocular HSV reactivation. Outbred male NIH white mice were immunized with 1.0 ml of anti-HSV serum with a neutralizing titer of 1:400 24 hr before infection and bilaterally infected at 10(5) plaque-forming units/eye with one of three HSV-1 strains: 17 Syn+, LAT+ (XC-20), or LAT- (X10-13). Latency-associated transcripts (LAT) are produced by strain 17 Syn+ and LAT+ but not by LAT-. The primary infection was monitored by ocular swabbing for HSV. Reactivation was induced by intravenous (i.v.) injection of cyclophosphamide (5 mg) followed 24 hr later by i.v. dexamethasone (0.2 mg). These drugs significantly reduced the white cell count between 0 and 6 days post-administration. The eyes were swabbed for 7 consecutive days to monitor reactivation, and HSV-1 reactivation was induced at the following frequencies in individual eyes: 17 Syn+ (32.5%), LAT+ (18.5%), and LAT- (2.5%) (P less than or equal to 0.002). Co-culture of trigeminal ganglia was done, and random isolates were checked to ascertain their identity. The HSV was recovered from individual trigeminal ganglia at the following frequencies: 17 Syn+ (83%), LAT+ (100%), and LAT- (67%) (P less than or equal to 0.091). These results confirm that the mouse can be used as a reactivation model for ocular HSV infection and that the presence of LAT facilitates reactivation in vivo in the mouse.

A latent, nonpathogenic HSV-1-derived vector stably expresses beta-galactosidase in mouse neurons.

A genetically engineered herpes simplex virus variant was constructed for use as a stable gene vector for neurons. To inhibit replication, the agent possessed a deletion in the immediate early gene ICP4, and to minimize reactivation from the latent state, the gene encoding the latency-associated transcript was deleted. The E. coli beta-galactosidase gene under the control of the Maloney murine leukemia virus long terminal repeat promoter was inserted into the ICP4 region. When introduced into the peripheral nervous system, this virus established latent infections and stably expressed beta-galactosidase in primary sensory neurons. Expression of beta-galactosidase over a more limited time period was observed when the latent infection was established in motor neurons of the hypoglossal nucleus. Agents of this general design have considerable potential for use as gene vectors for studies of neuronal function and correction of genetic defects affecting neurons.

Herpes simplex virus latent phase transcription facilitates in vivo reactivation.

The biological role of latent phase transcripts was studied in a rabbit model of herpes simplex virus type I (HSV-I) ocular reactivation. Virus X10-13, a variant of HSV which does not express latency associated transcripts (LAT), has been previously shown to establish latent infection in mouse sensory nerve ganglia, and LAT(-) virus can be recovered upon explantation and cocultivation of ganglia. In the rabbit, we show here that this virus replicates normally on the cornea and conjunctiva and establishes latent infections in corresponding trigeminal ganglionic neurons. However, X10-13 is not efficiently reactivated after iontophoresis of 0.01% epinephrine into the cornea. In contrast, XC-20, a LAT(+) derivative of X10-13 in which LAT expression had been restored by marker rescue of X10-13 with a cloned HSV-I EcoRI J + K fragment, reactivated at a significantly higher rate. Control experiments indicated that XC-20 and X10-13 established latent infections in an equivalent number of neurons. We conclude that latent phase transcription of HSV facilitates ganglionic reactivation and subsequent ocular shedding of the reactivated virus.

Herpes simplex virus type 1 latency-associated transcription plays no role in establishment or maintenance of a latent infection in murine sensory neurons.

Using herpes simplex viruses deleted and restored for the latency-associated transcripts (LATs), we have quantitatively assessed the role of the transcripts in establishment and maintenance of latent infection. Determination of the number of neurons latently infected and the copy number of viral genomes per latently infected ganglion indicated that there is no difference between viruses expressing and not expressing the transcripts. In addition, the amount of viral DNA present in ganglia latently infected with the LAT-negative virus KOS 8117 did not differ from the value for LAT+ counterparts over an 11-month period of analysis. From these results we conclude that LATs play no role in establishment or maintenance of a latent infection with herpes simplex virus type 1. If these transcripts play a role in latency, they must function during the reactivation step.

Pathogenesis of a lethal mixed infection in mice with two nonneuroinvasive herpes simplex virus strains.

We previously reported that simultaneous inoculation of mice on abraded rear footpads with two nonneuroinvasive viruses (herpes simplex virus type 1 ANG and KOS) resulted in the deaths of 62% of the animals (R. T. Javier, F. Sedarati, and J. G. Stevens, Science 234:746-748, 1986). In the current study, to better understand the events responsible for the pathogenesis of this virus mixture, we investigated replicative capacity and spread of the virus mixture within specific tissues. We found that, compared with neuroinvasiveness of ANG or KOS alone, neuroinvasiveness of the virus mixture related to significantly increased amounts of the virus within spinal cords and brains of the mice. This finding indicates that ANG and KOS have defects in their capacities to spread and replicate within spinal cords. We also examined whether the increased neuroinvasiveness of the virus mixture related to complementation between viruses in tissues of the nervous system, generation and selection of neuroinvasive recombinants, or both. It was found that, although neuroinvasive recombinant viruses could be detected in the spinal cords of the infected animals, most of the viruses (both recombinants and nonrecombinants) isolated from all tissues tested were nonneuroinvasive (i.e., no mice died as a result of footpad infection with high doses of such plaque-purified isolates). As a result of these findings, we propose that the virulence of the virus mixture is a consequence of the complementation as well as the generation and selection of neuroinvasive recombinants in spinal cords of these mice.

Isolation and partial characterization of nucleocapsid forms from cells infected with human cytomegalovirus strains AD169 and Towne.

We characterized nucleocapsid (NC) forms generated during infection with human cytomegalovirus (HCMV) strains AD169 and Towne. Two morphological forms of NC were isolated by Renografin-76 banding of the nuclear (N) or cytoplasmic (C) fractions of infected cells. SDS-PAGE analysis of the N- and C-NC forms of AD169 and Towne showed the presence of three polypeptides (150, 33, and 30 KD). The C-NC contained five additional polypeptides (260, 112, 110, 68, and 54 KD) with a counterpart in the mature virion. An additional polypeptide of 37 KD (Towne) or 39 KD (AD169) was only present in the B-NC and not in the A-NC, C-NC, or the mature virion. These polypeptides were basic as determined by two-dimensional PAGE analysis. The 37-KD (Towne) and the 39-KD (AD169) polypeptides were phosphorylated. The NC polypeptides were HCMV specific as shown by immunoprecipitation using a pool of HCMV-positive human antisera. The B-NC DNA was shown to have a restriction pattern identical to that of the infectious viral DNA, but no DNA was detected in the A-NC form. Analysis of NC forms by pulse-chase experiments identified a 'pre-NC' peak which may serve as a precursor to the A- and B-NC forms.

Biological basis for virulence of three strains of herpes simplex virus type 1.

Herpes simplex virus type 1 (HSV-1) strains F, HF and HFEM were studied with respect to pathogenicity in mice and growth characteristics in vivo and in vitro compared to the neurovirulent HSV-1 strains 17 syn+ and KOS. All three viruses demonstrated reduced virulence in mouse brains and were completely avirulent after footpad inoculation. They were shown to express high levels of thymidine kinase activity. Investigations concerning the virulence phenotype indicated that the defect(s) in strains F, HF and HFEM related to general replication deficiency in mouse cells. It was also shown that although the replication restriction observed for strains F and HF was specific for murine cells, strain HFEM did not replicate well in any cell type tested. Additional studies indicated that the avirulence phenotype which followed peripheral inoculation was related to different genotypes, since strain F complemented HF and HFEM and, as expected, the latter two agents did not complement each other. All three agents were found to complement the non-neuroinvasive strain KOS. Finally, the data also show that two herpesviruses which are highly restricted in murine cells (e.g. strains F and HF) can still interact in the animal and produce a lethal infection.

Two avirulent herpes simplex viruses generate lethal recombinants in vivo.

While it is widely appreciated that infection with a virulent virus can produce disease in an animal, the ability of a mixture of avirulent viruses to produce disease by means of complementation or recombination in vivo has not been established. In this study, two weakly neuroinvasive herpes simplex virus type 1 (HSV-1) strains were simultaneously inoculated onto the footpads of mice. Many (62%) of the animals that received a 1:1 mixture of the viruses died, whereas the animals that received a similar or 100-fold higher dose of each agent alone survived. Of fourteen viruses isolated from the brains of ten mice that died after receiving the mixture of the two weakly neuroinvasive viruses, eleven were recombinants; three of these recombinants were lethal when reapplied to the footpads of mice. These results show that two avirulent HSV-1 variants may interact in vivo to produce virulent recombinants and a lethal infection. They also suggest that different genetic lesions account for the weakly neuroinvasive character of the HSV-1 strains ANG and KOS after footpad inoculation.