A detailed characterization of normal human monocyte growth, maturation, and function is limited by difficulties in obtaining sufficient quantities of relatively pure populations of monocyte-macrophages in different stages of maturation. Attempts to culture fresh normal human peripheral blood monocytes for prolonged periods have met with varying results as to length of culture life and properties of the cells involved. These attempts usually result in the development of cultures of adherent monocytoidmacrophage cells exhibiting little or no cell division, which persist for varying lengths of time in culture (1). A few cell lines have been established from leukemic donors which exhibit morphological, cytochemical, and functional properties attr ibutable to cells of the monocyte-macrophage lineage. These include cells classified as histiocytic cell types (2-4) and a recently described monocytoid cell line established from a patient with acute monocytic leukemia (5). Efforts have been made in our laboratory to develop technology for the long-term growth of different classes of human leukocytes in liquid suspension culture, and progress in the growth of normal mature T lymphocytes (6-8), neoplastic mature T lymphocytes (9), B lymphoblasts (10), and myeloid cells of leukemic origin (11, 12) has been made. Much of this work has involved use of specific growth factors, e.g., T cell growth factor (TCGF) 1 (6-8) for T cells. In addition, we have recently described methods using a combination of cell separation and specific culture procedures not requiring addition of exogenous growth factors which routinely support the in vitro replication of normal myeloid-monocytoid cells established from fetal cord blood leukocytes (13). The use of these new procedures to initiate long-term, nonlymphoid cultures from adult human peripheral blood (nine donors) or bone marrow (six donors) resulted in only short-term cell proliferation until leukocytes from normal human donors seronegative for antibodies against Epstein-Barr virus viral capsid antigen (EBV-VCA) and Epstein-Barr virus nuclear antigen (EBNA) were used. In these instances, long-term (~5 mo) cultures composed of replicating monocytes-

Human herpesvirus-6 (HHV-6) is the collective name for HHV-6A and HHV-6B, two closely related betaherpesviruses that have a combined seroprevalence of over 90% in adults worldwide. An increased awareness of diseases associated with HHV-6 acute infection (AI) and reactivation in both immunocompetent and immunocompromised patients has resulted in growing interest in the evaluation of the best treatment options available for the clinical management of HHV-6 disease; however, no compound has yet been approved for the specific treatment of HHV-6 infection. Thus, clinicians most often utilize the anti-cytomegalovirus (CMV) agents ganciclovir, cidofovir, and foscarnet for the treatment of HHV-6 AI and reactivation. This chapter reviews the reported in vitro efficacies of several anti-HHV-6 compounds and discusses current and future approaches to the clinical management of HHV-6 AI.

Oncostatin M (OM), a 30-kDa glycoprotein, recently was identified as a major growth-promoting factor in the conditioned medium (CM) of the 38-0 cell line, a CD4,+ chronically human T lymphotropic virus type (HTLV)-II-infected, transformed T cell line. CM 38-0 induced the proliferation of spindle cells cultured in vitro from AIDS-associated Kaposi's sarcoma (AIDS-KS) cells. To determine how much of the AIDS-KS cell growth activity present in 38-0 CM was because of the presence of OM, we depleted OM by using specific mAb-affinity chromatography. OM purified from this CM stimulated AIDS-KS cell growth in a concentration-dependent fashion. The effluent, completely depleted of OM, failed to induce growth of AIDS-KS cells. To detect the constitutive release of OM by cells acutely or chronically infected with either HTLV-I, HTLV-II, or HIV-1, we utilized an enzyme-linked immunoassay. Whereas the chronically infected cells released significant levels of OM, the acutely infected cells released little or no OM. The presence of OM in HIV-1-infected T-cell CM correlated completely with AIDS-KS cell growth activity. Infrequently, low level AIDS-KS cell growth activity was seen in the absence of OM. This correlated with relatively high levels of IL-6 in the CM. In a CM-containing OM in the absence of detectable IL-6, a neutralizing antibody to OM completely abrogated KS cell growth activity. The presence of specific oncostatin M receptors on the KS cell lines was confirmed by cross-linking experiments. The results shown here suggest that T cells chronically infected with HIV-1 can secrete OM, which may play a role in the initiation or progression of AIDS-KS lesions, either alone, or in concert with IL-6.

We have analyzed by immunoelectron microscopy the early events of binding and internalization of human herpesvirus 6 (HHV-6, strain GS) on a susceptible T-lymphoblastoid cell line, HSB-2. The virions bound to the cell surface at 4-degrees-C were tightly associated with the plasma membrane. Gold immunolabeling of the viral envelope proteins was strong and specific. Warming at 37-degrees-C for different times showed viral internalization through smooth surfaced pits and vesicles. Fusion events of the virions with the cell plasma membrane were never observed. Gold immunolabeling performed in parallel experiments before or after viral internalization showed: (1) absence of viral envelope proteins on the cell plasma membranes at all times of internalization, again excluding fusion events; (2) entry of the virions with their envelopes. Treatment of the cells with chloroquine, a drug known to affect the endocytic pathway, led to an almost complete inhibition of viral infectivity, suggesting that the endocytosed virions are responsible for a successful infection. Comparable results were obtained using a second strain of HHV-6 (BA92), with biologic and molecular characteristics similar to the prototype strain Z29. The chloroquine inhibition was effective on two different T cell lines (HSB-2 and J-Jhan), as well as on phytohemagglutinin-stimulated peripheral blood mononuclear cells.

In vitro and in vivo model systems for the study of human immunodeficiency virus (HIV)-associated Kaposi's sarcoma (KS) were used to evaluate compounds for their potential as therapeutic agents. A sulfated polysaccharide-peptidoglycan compound (SP-PG) produced by bacteria controlled the in vitro growth of acquired immunodeficiency syndrome (AIDS)-associated, KS-derived spindle-shaped cells (AIDS-KS cells) at noncytotoxic concentrations. Angiogenesis induced by AIDS-KS cells in the chicken chorioallantoic membrane assay was blocked by SP-PG, which also inhibited the vascular hyperpermeability response and the angiogenesis associated with the induction of KS-like lesions that develop after subcutaneous inoculation of AIDS-KS cells into nude mice. Suramin, pentosan polysulfate, and interferon alpha, which are currently in use for therapy of KS, were either less effective than SP-PG or much more cytotoxic, or both.

The development of long-term culture of AIDS-KS cells has allowed us to investigate further a possible vascular origin of Kaposi sarcoma. Taking into account the relative specificity of arachidonic acid (AA) metabolism according to cell type, the AA 'cascade' was analyzed in cultured KS-3 cells established from lung biopsies and compared to human umbilical venous endothelial (H-UVE) cells and human myometrial smooth muscle (H-MSM) cells, under basal conditions and after stimulation with vasoactive agents such as histamine or thrombin. Considering strictly the 'prostaglandin' profile given by RIAs, the metabolism of AA was closer, whilst not identical, to H-UVE than to H-MSM cells. However, evaluation of all the eicosanoids released from [3H]AA labeled KS-3 cells revealed that the predominant metabolite was not prostacyclin (PGI2), as suggested from PG RIAs, but an epoxy-eicosatrienoic acid (EET), identified as the 11, 12 isomer by HPLC and MS/MS. The synthesis of this EET is probably cytochrome P-450 monooxygenase dependent. Its potential role in the development of the KS tumor cells is under investigation.

OBJECTIVE To conduct neurologic, immunologic, and virologic studies in patients with a chronic debilitating illness of acute onset. DESIGN Cohort study with comparison to matched, healthy control subjects. PATIENTS We studied 259 patients who sought care in one medical practice; 29% of the patients were regularly bedridden or shut-in. MAIN OUTCOME MEASURES Detailed medical history, physical examination, conventional hematologic and chemistry testing, magnetic resonance imaging (MRI) studies, lymphocyte phenotyping studies, and assays for active infection of patients' lymphocytes with human herpesvirus type 6 (HHV-6). MAIN RESULTS Patients had a higher mean (+/- SD) CD4/CD8 T-cell ratio than matched healthy controls (3.16 +/- 1.5 compared with 2.3 +/- 1.0, respectively; P less than 0.003). Magnetic resonance scans of the brain showed punctate, subcortical areas of high signal intensity consistent with edema or demyelination in 78% of patients (95% CI, 72% to 86%) and in 21% of controls (CI, 11% to 36%) (P less than 10(-9)). Primary cell culture of lymphocytes showed active replication of HHV-6 in 79 of 113 patients (70%; CI, 61% to 78%) and in 8 of 40 controls (20%; CI, 9% to 36%) (P less than 10(-8], a finding confirmed by assays using monoclonal antibodies specific for HHV-6 proteins and by polymerase chain reaction assays specific for HHV-6 DNA. CONCLUSIONS Neurologic symptoms, MRI findings, and lymphocyte phenotyping studies suggest that the patients may have been experiencing a chronic, immunologically mediated inflammatory process of the central nervous system. The active replication of HHV-6 most likely represents reactivation of latent infection, perhaps due to immunologic dysfunction. Our study did not directly address whether HHV-6, a lymphotropic and gliotropic virus, plays a role in producing the symptoms or the immunologic and neurologic dysfunction seen in this illness. Whether the findings in our patients, who came from a relatively small geographic area, will be generalizable to other patients with a similar syndrome remains to be seen.

This chapter presents the events that led to the discovery of human herpesvirus type 6 (HHV-6). The period of 1984–1986 was perhaps one of the most exciting periods in biomedicine because of the epidemic of acquired immune deficiency syndrome (AIDS). HHV-6 was discovered in 1984, and in 1985 it was initially reported as a human B cell lymphotropic virus. A segment of this history relates to the finding of HHV-6 in the Laboratory of Tumor Cell Biology (LTCB) at the National Cancer Institute, in Bethesda. During 1983 and early 1984, it was clear that this newly discovered retrovirus was present in more patients than only those with lymphoadenopathy. In the chapter the author discusses experiences involving specimens from AIDS patients with lymphoma, which led to the discovery of human herpesvirus-6 (HHV-6).

A number of non-human-immunodeficiency-virus (HIV) type 1 disorders are associated with CD4+ T-cell deficiency and dysfunction. However, the etiopathogenesis of CD4+ T-cell immunodeficiency in these disease states remains unclear. Human intracisternal retroviral (HICRV) particles were detected in a lymphoblastoid cell line exposed to mononuclear cells from a patient with severe CD4+ T-cell deficiency without risk factors for HIV infection. Ultrastructurally, the HICRV is distinct from HIV-1, HIV-2, human T-lymphotropic virus (HTLV) type I, and HTLV-II. Supernatants of activated mononuclear cells showed significant reverse transcriptase activity that was predominantly Mn2+ dependent. The patient's mononuclear cells were negative for HIV-1, HIV-2, HTLV-I, and HTLV-II proviruses as demonstrated by the lack of amplification by PCR. Also, the patient's serum was negative for antibodies to HIV-1, HTLV-I, and HTLV-II and for HIV-1 p24 antigen; however, serum was positive for antibodies against the HICRV as demonstrated by Western blot. Similar HICRV particles were detected in a lymphoblastoid cell line exposed to mononuclear cells from the patient's daughter, who showed CD4+ T-cell dysfunction. The HICRV may be associated with CD4+ T-cell immunodeficiency and dysfunction in patients without risk for HIV-1, HIV-2, HTLV-I, and HTLV-II.

Determination of the nucleotide sequences of two molecular clones of human herpesvirus 6 (HHV-6) (strain GS) and comparison with those of human cytomegalovirus (HCMV) has allowed the identification of the genes for the glycoprotein H (gH) and the putative large tegument protein of HHV-6. Two molecular clones of fragments of HHV-6, the BamHI-G fragment (7,981 bp) of the clone termed pZVB43 and a HindIII fragment (8,717 bp) of the clone termed pZVH14, represent approximately 10% of the HHV-6 genome (16,689). An open reading frame within the BamHI-G fragment was designated the gH gene of HHV-6 because of the extensive sequence similarity of its predicted product (79,549 Da) to the HCMV gH gene product. The predicted product (239,589 Da) of an open reading frame within clone pZVH14 showed homology to the predicted product of the proposed gene of HCMV representing the large tegument protein. Computer analyses indicated a closer relationship of the predicted peptides of these HHV-6 genes to those of HCMV than to those of the other human herpesviruses Epstein-Barr virus, herpes simplex virus type 1, and varicella-zoster virus. The gH gene was more conserved among the human herpesvirus group, while significant sequence similarity of the tegument gene could be found only with that of HCMV. The data reported here with one conserved gene (gH) and a more divergent gene (tegument) support previous reports that HHV-6 and HCMV are more closely related to each other than to the other well-characterized human herpesviruses.

The sixth member of the human herpesvirus family, HHV-6, causes early childhood infection with subsequent latency and antibody prevalence of about 60-80%. Active infection is related to a number of acute and chronic diseases such as exanthem subitum, certain cases of infectious mononucleosis and other immunoproliferative syndromes, autoimmune disorders and so-called postinfectious chronic fatigue syndrome. The clinical diagnosis of HHV-6 associated diseases requires detailed clinical differential diagnostic procedures and meticulous serological testing with exclusion of other herpesvirus infections or cross-reactivity between such infections. Diagnostic efforts, however, are warranted by certain indications for therapeutic intervention. The current review summarizes indications, techniques and limitations for the serological diagnosis of HHV-6 infection.