Pharmacokinetics and antiviral activity of a novel isonucleoside, BMS-181165, against simian varicella virus infection in African green monkeys.

A novel nucleoside analog BMS-181165 with potent activity against varicella-zoster virus was tested for efficacy in a simian varicella virus infection in African green monkeys. BMS-181165 was effective in preventing the development of a rash, decreasing the development of viremia and preventing death in infected monkeys when administered orally at 4, 16 or 64 mg/kg/day. The compound is well orally absorbed in monkeys, between 44 to 50% oral bioavailability, and may prove of value in therapy of varicella-zoster infections in humans.

Synthesis and antiviral activity of novel isonucleoside analogs.

A series of branched-chain sugar isonucleosides was synthesized and evaluated for antiviral activity against herpesviruses. The preparation of homochiral [3S-(3 alpha, 4 beta, 5 alpha)]-2-amino-1, 9-dihydro-9-[tetrahydro-4,5-bis(hydroxymethyl)-3-furanyl]-6H-purin-6-one (7, BMS-181,164) and related compounds was stereospecifically achieved starting from 1,2-isopropylidene-D-xylofuranose (10). An efficient two-step reduction of the anomeric center of bis-acetate 18 involved formation of the chloride intermediate 19, followed by diisobutylaluminum hydride reduction. Tosylation of the resulting alcohol 20 provided the key intermediate 21, which was coupled with a variety of nucleobase anions. Several members of this new class of compounds possess activity against herpes simplex virus types 1 and 2 (HSV-1 and -2), varicella-zoster virus (VZV), and human cytomegalovirus (HCMV). Compound 7 exhibits potent and selective activity against thymidine kinase encoding herpesviruses, in particular, HSV-1 and HSV-2. Evaluation of compound 7 for inhibition of WI-38 cell growth indicated an ID50 of > 700 microM. Although the antiherpetic activity in vitro of 7 is less than that of acyclovir (1), compound 7 displays superior efficacy in mouse model infections. The (bromovinyl)uridine analog 8 (BMS-181,165) also exhibits selective activity against HSV-1 and VZV, with no cytostatic effect on WI-38 cell growth at > 800 microM. Compound 8 is active against simian varicella virus and is efficacious in the corresponding monkey model.

CD5 expression in B-cell small lymphocytic malignancies. Correlations with clinical presentation and sites of disease.

The authors examined the relationship between CD5 antigen expression and a nodal or extranodal presentation for three subtypes of low-grade non-Hodgkin's lymphoma: small lymphocytic (23 cases), small lymphocytic with plasmacytoid differentiation (10 cases), and lymphocytic lymphoma of intermediate differentiation (IDL) (29 cases). Antigen expression was studied by the avidin-biotin complex immunoperoxidase technique in frozen sections and correlated with expression of other B- and T-cell markers. Lack of CD5 expression was significantly associated with extranodal presentation among the over-all study group (p less than 0.001), as well as for those with small lymphocytic lymphoma and IDL, but not for those presenting with small lymphocytic lymphomas with plasmacytoid differentiation (p less than 0.21). Eleven patients presented exclusively with extranodal disease involving lung and respiratory tract, skin and subcutaneous tissue, salivary gland, stomach, conjunctiva, and uterus. All such lesions were CD5 negative and had been classified as small lymphocytic (four cases), small lymphocytic-plasmacytoid (four cases), and IDL (three cases). Retrospective review of these 11 cases demonstrated common histologic features described as characteristic of lymphomas of mucosa-associated lymphoid tissue (MALT). Two additional patients presented with disseminated nodal disease and involvement of gastrointestinal tract and oropharynx; both were CD5 positive. These findings support the concept that at least two antigenically distinct B-cell subpopulations may be involved in pathogenesis of low-grade small lymphocytic malignancies.

Müllerian adenosarcoma of the uterus with pure angiosarcoma: case report.

We report a case of müllerian adenosarcoma of the uterus with benign endometrioid epithelial component and histologically pure angiosarcoma. This seemingly unique sarcomatous ingredient, among uterine and extrauterine adenosarcomas reported in the English literature, is considered to be a homologous component of the tumor. The patient, a 71-year-old woman with a several-month history of intermittent vaginal bleeding, was found at abdominal hysterectomy to have a large polypoid intrauterine tumor with superficial extension into the myometrium. The patient was treated with 6,000 rad of adjuvant radiation but died a few months after of what clinically appeared to be massive abdominal bleeding. The literature regarding uterine tumors classified as angiosarcoma or malignant hemangioendothelioma is briefly reviewed.

Lymphocytic lymphoma of intermediate differentiation. Morphologic and immunophenotypic spectrum and clinical correlations.

All cases of lymphocytic lymphoma of intermediate differentiation (IDL) referred to the National Cancer Institute were reviewed in order to define the histopathologic spectrum of the disease and to investigate morphologic and immunophenotypic features with potential prognostic relevance. Thirty-three cases were classified as IDL according to histologic criteria. Immunophenotypic analysis was performed in 27 cases, and clinical records were available for 22 patients. The median age was 58 years, and the male-to-female ratio, 3.4:1. All patients presented with stage III or IV disease, and five had extranodal presentations. Median survival was 56.3 months, with only three patients having a prolonged relapse-free survival (greater than 2 years). Morphologically, 14 cases were diffuse or only vaguely nodular; 18 cases showed a mantle zone pattern with naked germinal centers. There was a trend toward prolonged median survival for patients with the mantle zone (77.4 months, p = 0.098). The neoplastic population was composed of irregular or cleaved small lymphoid cells with a mitotic rate ranging from 5 to 62 per 20 high-power fields (hpf). A histologically distinctive variant with blastic cytologic features was identified (seven cases). The blastic variant was associated with a higher mitotic index (51.3 versus 19.0) and shortened survival (24.9 months). In contrast to the histologic progression often observed in follicular lymphomas, in no case was transformation to a large-cell or small noncleaved lymphoma observed. All cases had a mature B-cell phenotype demonstrating monoclonal Ig and B-cell surface antigens. Seventy-eight percent were CD5 positive; three of six CD5-negative cases presented in mucosal-associated extranodal sites. CD10 and CD25 were expressed in 52% and 44%, respectively, but did not show clinical correlations. The proliferative rate measured by Ki-67 positivity correlated with the mitotic index, but neither of these parameters had a statistically significant influence on survival.

Cardiac allograft survival across major histocompatibility complex barriers in the rhesus monkey following T lymphocyte-depleted autologous marrow transplantation. III. Late allograft rejection.

We have studied organ allograft survival in rhesus monkeys conditioned with myeloablative total-body irradiation and T cell-depleted autologous bone marrow transplantation then given a heterotopic MHC-mismatched cardiac allograft in the immediate postmyeloablative period. This model has enabled us to investigate the role of T cells in vascularized organ allograft rejection. We previously reported (1) that recipients of marrow depleted of T cells below a critical threshold (0.16% residual marrow T cells, or 0.14 x 10(5) infused T cells/kg) experienced a period of freedom from acute rejection associated with a profound nonspecific immune deficiency (determined by skin grafting). Resolution of the nonspecific immune deficiency was associated with late graft rejection. In the present report, we correlate the results of peripheral immune reconstitution studies and direct immunohistochemical analysis with allograft status in order to study T cell subsets involved in late rejection. We report that, in contrast with CD8+/CD28- T cells, CD16+ NK cells, and CD20+ B cells, late allograft rejection was associated with the return of peripheral CD4+ T cells and CD8+/CD28+ T cells, suggesting a critical role for one or both of these subsets in late allograft rejection in this model.

Lymphocyte predominant Hodgkin's disease nodular subtype with coexistent "large cell lymphoma". Histological progression or composite malignancy?

Nodular lymphocyte predominant (NLP) Hodgkin's disease (NLP HD) has been recently suggested to be of B-cell derivation on the basis of phenotypic and morphologic findings. Consistent with this view, there are sporadic case reports of coexisting NLP HD and large cell lymphoma (LCL). We describe a compilation of seven unique cases of NLP HD selected from the NIH case consultation files in which lymphohistiocytic mononuclear variant cells (L&H) became clustered into increasingly large aggregates. In areas of the same tumor mass, large confluent sheets of these cells resembled LCL. In contrast to what would be expected for LCL, all patients had localized disease clinically, and six of seven achieved long-term disease-free survival following radiation therapy or chemotherapy (two cases) for HD. None of the patients developed disseminated LCL. Also notable was a high frequency of axillary lymph node involvement (five of seven) and the high rate of occurrence in blacks (six of seven). Immunophenotypic (in two cases) and molecular genetic analysis (in one case) was suggestive of B-cell derivation for the proliferating cells. These findings also raise the possibility that some so-called large cell lymphomas may actually represent histologically progressed NLP HD, and that such cases might be associated with a favorable prognosis comparable to that seen in NLP HD.

Rearranging antigen-receptor genes in enriched Reed-Sternberg cell fractions of Hodgkin's disease.

Molecular genetic analysis of rearranging antigen-receptor genes in non-Hodgkin's lymphomas has revealed the clonality and lineage in the majority of cases. In an analogous approach, we sought to apply gene rearrangement analysis to Hodgkin's disease to understand better the clonality and origin of this disorder. However, the putative neoplastic cell of Hodgkin's disease, the Reed-Sternberg cell and its variants, is extraordinarily rare in most cases of Hodgkin's disease. On the average, Reed-Sternberg cells and variants represent 0.1 per cent of total cell suspensions of nodular sclerosing Hodgkin's disease. As this frequency is below the minimum threshold of sensitivity of the Southern blot assay, we attempted to enrich for Reed-Sternberg cells before DNA extraction and analysis. Using either elutrition or Percoll density gradient centrifugation, we were able to enrich the percentage of Reed-Sternberg cells and variants to above 1 per cent in five cases of nodular sclerosing Hodgkin's disease. In three of these cases, immunoglobulin gene rearrangements were identified, but no T cell receptor gene rearrangements were seen. No rearrangements were detected in unseparated cells or in the Reed-Sternberg cell-depleted fractions. In addition, the L428 Hodgkin's disease cell line was found to have one rearranged and one deleted heavy-chain gene, a rearranged kappa gene, a rearranged lambda gene, and a single rearranged beta allele. No rearrangements of the T gamma gene were found in L428. Taken together, these findings indicate that clonal cell populations are present in Hodgkin's disease and suggest the possibility of a clonally expanded lymphoid cell in this disorder.

Detection of human B-lymphotropic virus (human herpesvirus 6) sequences in B cell lymphoma tissues of three patients.

A survey for HBLV (human B-lymphotropic herpesvirus or human herpesvirus 6) sequences by Southern blot analyses was performed on DNA obtained from a variety of pathologically defined tissues, including a number of lymphomas, leukemias, and tissues from other hematologic disorders. Of the over 50 specimens studied, viral sequences were detected in three lymphomas of B cell derivation: an Epstein-Barr virus-positive African Burkitt's lymphoma, a follicular large cell lymphoma (nodular histocytic lymphoma), and two Epstein-Barr virus-negative tumors from a patient with Sjogren's syndrome. These results are the first indication of HBLV sequences associated with B cell tumors in a limited number of cases and raise the possibility that the virus might be involved in the genesis of some B cell tumors.

Retrospective analysis of stage I and II indolent lymphomas at the National Cancer Institute.

We have retrospectively reviewed the records of 54 patients with Stages I and II indolent lymphoma treated at the National Cancer Institute between January 1958 and December 1984. Patients were treated by a variety of approaches, with 48/54 patients receiving some form of radiation therapy. The median potential follow-up was 9 years (rang 1.7-23.7 years). Overall survival and disease-free survival at 10 years were 69% and 48%, respectively. There were no relapses among Stage I patients after 6.5 years, with 11 of 27 patients followed beyond that time, suggesting that some patients may be cured. Of the 38 patients who received radiation therapy alone as primary treatment, 17 ultimately relapsed. Seventy-one percent of these relapses were nodal. Our data suggest that patients with early stage indolent lymphoma can be treated with curative intent. The finding that most relapses after radiation therapy occur in untreated lymph nodes suggests that total lymphoid irradiation may prolong disease-free survival and, perhaps, overall survival as well.

Molecular genetics and the diagnosis of lymphoma.

Gene rearrangement analysis has emerged as a precise laboratory aid in the diagnosis and classification of malignant lymphoma and leukemia. Both clonality and lineage can be identified in lymphoid neoplasms by the demonstration of rearrangements of antigen receptor genes of the immunoglobulin supergene family--immunoglobulin and T-cell receptor genes. Rearrangement analysis is not only useful in differential diagnosis and classification, but also serves as a sensitive unique clonal marker to detect early occult recurrence in patients after therapy. In a similar manner, chromosomal translocations associated with specific disease types can be detected with DNA probes in Southern blot analysis without the use of conventional cytogenetics. Using this approach, one may diagnose specific chromosomal translocations associated with histologic types of lymphoma and leukemia. When appropriately applied, DNA rearrangement analysis complements conventional histology, immunophenotyping, and cytogenetics.

Diagnostic interpretation of T gamma gene rearrangement: effect of polyclonal T cells.

Rearrangement of the T gamma gene, which encodes one chain of the second T-cell receptor, is an early event in the development of T lymphocytes. In contrast to the T-cell receptor beta chain gene, the T gamma gene contains a very limited V region gene repertoire, accounting for only 8 to 10 rearranging V gamma genes. As a consequence of the limited number of V gamma genes, only seven or eight nongermline restriction fragments are displayed, even by highly polyclonal T cells. Here, we demonstrate that T gamma gene analysis produces a picture of pseudoclonality among polyclonal T lymphocytes accompanying B-cell lymphoma, T-cell lymphoma, and Hodgkin's disease. As little as 10% contamination by polyclonal T lymphocytes is sufficient to detect rearrangements in both clinical samples and in a controlled sensitivity assay. Conversely, polyclonal T cells were found to obscure T-cell clones when polyclonal T cells represented as little as 30% of total cells. We conclude that, due to the unusual genomic structure of the T gamma gene, rearrangement analysis of the T gamma gene carries a significant limitation as a marker of clonality and lineage.

Rearranged antigen receptor genes in Hodgkin's disease.

Despite intensive efforts using a wide variety of approaches, the cellular lineage and clonality of the abnormal cells of Hodgkin's disease have remained an enigma. In the present study, cell separation techniques that enriched for Reed-Sternberg cells and their variants were used to generate sufficient percentages of abnormal cells to allow detection of rearrangements in these cell fractions. DNA from the involved tissues of eight Hodgkin's disease patients was subjected to Southern blot analysis to detect rearrangements of T cell antigen receptor genes and immunoglobulin genes. Immunoglobulin gene rearrangements were found in three of five cases in which Reed-Sternberg cells and their variants were enriched by cell separation techniques to cell frequencies greater than 1%. Rearrangements of immunoglobulin heavy chain genes occurred in two cases, and a lambda light chain gene rearrangement occurred in a third case. Rearrangements were not detected in lymphocyte fractions or in unseparated cells prepared from the same tissues. The putative Hodgkin's cell line, L428, also contained rearrangements of immunoglobulin heavy and kappa and lambda light chain genes and, in addition, harbored a single T cell receptor beta gene rearrangement. These findings indicate that Reed-Sternberg cell-enriched fractions contain clonal cell populations and provide a lead, at the molecular genetic level, to a possible lymphoid derivation of the Reed-Sternberg cell.

SQ 27,786 and SQ 28,853: two angiotensin converting enzyme inhibitors with potent diuretic activity.

SQ 27,786 and SQ 28,853 were designed to possess both angiotensin converting enzyme (ACE) inhibitory and diuretic properties. Both compounds were given to conscious male Sprague-Dawley rats and mongrel female dogs to determine ACE inhibitory and diuretic activities. All animals had previously been equipped with indwelling arterial and venous catheters. Both compounds resulted in dose-related inhibition of an angiotensin I pressor response in rats after i.v. administration. The maximum response and duration of effect of both compounds were similar to that seen with equimolar doses of captopril. Oral doses of SQ 28,853 (50.0 mumol/kg) and SQ 27,786 (15.0 mumol/kg) resulted in 15 and 64% inhibition of ACE, respectively. In conscious normotensive dogs, both compounds (2.0 mg/kg, i.v.) resulted in complete inhibition of ACE. Urine volume was increased by 153 and 667% after SQ 27,786 and SQ 28,853, respectively. Similarly, sodium excretion was increased by 336% after SQ 27,786 and by 650% after SQ 28,853. SQ 27,786 and SQ 28,853 increased potassium excretion by 54 and 115%, respectively. No significant changes in blood pressure were observed with either compound in either species. These results demonstrate that both SQ 27,786 and SQ 28,853 are potent ACE inhibitors and diuretic agents in vivo.

Sinus of Valsalva aneurysm associated with multiple conotruncal congenital malformations.

A case of rupture of a sinus of Valsalva aneurysm in a middle-aged woman with an unusual assortment of associated conotruncal and other cardiac anomalies is reported. The anomalies included bicuspid aortic valve, aortic sinus aneurysm (ruptured), quadricuspid pulmonic valve, membranous coarctation of the aorta, subclavian and common carotid arteries arising directly from aorta, and atrial septal defect. Excluding the atrial septal defect, these anomalies may be explained by a single embryologic event affecting conobulbar septation and aortic arch development occurring at the level of neural crest development.

Disseminated talc granulomatosis. An unusual finding in a patient with acquired immunodeficiency syndrome and fatal cytomegalovirus infection.

The association of disseminated magnesium silicate talc granulomatosis and acquired immunodeficiency syndrome is reported in a male homosexual who used intravenous drugs and who died of overwhelming cytomegalovirus (CMV) infection. Autopsy findings included widespread deposition of talc crystals in the lungs, liver, lymph nodes, bone marrow, and spleen. Typical CMV inclusions were seen in the lungs, kidneys, adrenal glands, gastrointestinal tract, and right eye. There was no evidence of malignancy. Analysis of peripheral blood neutrophil function revealed impaired chemotaxis and chemokinesis, but opsonophagocytosis had remained normal. The CMV infection in the small bowel was extensive and resulted in severe destruction of the muscularis propria and neural plexi, leading to marked dilatation and persistent diarrhea. The terminal course was marked by intractable hypotension, pneumonitis, and malnutrition, which could be attributed respectively to CMV involvement of the adrenal glands, lungs, and small bowel. The etiology and possible role of systemic talc granulomatosis in the development of immunosuppressive illness is reported herein.

Abnormalities of immunoregulation in progressive systemic sclerosis. Evidence for excess helper-cell function and altered B-cell function.

We investigated immunoregulatory function in patients with progressive systemic sclerosis (PSS) in terms of in vitro IgM synthesis. Suppressor-cell function seems normal in regard to the ability of concanavalin A-treated cells to inhibit IgM synthesis by normal cells. At 4 x 10(5) T cells to 3 x 10(5) allogeneic normal B cells per milliliter, T cells from patients with PSS induce significantly more IgM synthesis by normal B cells than do normal T cells. This increased helper T-cell function might be involved in the pathogenesis of the disease.

Suppressor cell defect in SLE: relationship to native DNA binding.

Recent evidence suggests the presence of a suppressor T cell defect in systemic lupus erythematosus. We confirm the presence of such a defect and find a strong quantitative correlation between the loss of suppressor T cell function and the activity of SLE as measured by the presence of antibodies to native DNA. In addition, the serum of patients with active SLE contains a soluble factor which when incubated with normal peripheral blood lymphocytes induces a suppressor T cell defect. These data are consistent with the suppressor cell defect being involved in the propagation and possible the pathogenesis of SLE, and suggests a positive feedback mechanism whereby a suppressor cell defect results in autoantibodies including antibody to suppressor cells.