Epstein-Barr virus (EBV)-induced posttransplant lymphoproliferative disease (PTLD) continues to be a serious complication following transplantation. The aim of the present study was to evaluate the EBV load as a parameter for the prediction and monitoring of PTLD. The EBV load was analyzed by a quantitative competitive PCR with 417 whole-blood samples of 59 patients after allogeneic stem cell transplantation (SCT). The EBV load was positive for all 9 patients with PTLD and for 17 patients without PTLD. The viral loads of patients with manifest PTLD differed from the loads of those without PTLD (median loads, 1.4 ؋ 10 6 versus 4 ؋ 10 4 copies/g of DNA; P < 0.0001). A threshold value of 10 5 copies/g of DNA showed the best diagnostic efficacy (sensitivity, 87%; specificity, 91%). However, in patients with less than three major risk factors for PTLD, the positive predictive value of this threshold was rather low. One week prior to the manifestation of PTLD, the EBV load was as low in patients who developed PTLD as in patients without disease (median, 2.2 ؋ 10 4 copies/g of DNA; P was not significant). EBV DNA tested positive first at 20 to 71 days prior to the clinical manifestation of PTLD and occurred with the same delay after transplantation regardless of disease (median delay, 52 versus 63 days; P was not significant). EBV DNA was detected earlier in patients with primary infections than in those with reactivations (33 versus 79 days; P ‫؍‬ 0.01), but the peak levels were similar in the two groups. EBV primary infection or EBV reactivation is frequent in patients after allogeneic SCT but results in PTLD only in a subgroup of patients. Although evaluation of the EBV load has limitations, the EBV load represents a valuable parameter to guide therapy.

An important step in the posttranslational modification of many bioactive neuropeptides, the carboxy-terminal amidation of glycine-extended peptides, is catalyzed by peptidylglycine alpha-amidating monooxygenase (PAM; EC 1.14.17.3). The expression of the gene encoding this enzyme was examined in adult rat brain by in situ hybridization histochemistry and immunocytochemistry. PAM mRNA transcripts and PAM-like immunoreactivity were detected in all major brain areas with the exception of the cerebellum. Very high levels of PAM mRNAs were found in the hypothalamic magnocellular neurons, the hippocampal formation, and olfactory cortex. These areas also showed strong PAM-like immunoreactivity. Regions known to contain high levels of amidated neuropeptides also expressed high levels of PAM mRNA. The observed heterogeneous PAM mRNA levels may reflect differences in the peptidergic activity of different neuronal systems. Interestingly, all pyramidal neurons of the hippocampus expressed very high levels of PAM mRNA, although no identified amidated peptide matches this distribution completely. Furthermore, PAM was not expressed exclusively in neuronal tissue but was also present in non-neuronal tissue. PAM transcripts could be localized in certain ventricular ependymal cells, with the highest expression in the lateral ventricle. Localization of PAM to non-neuronal cells and neurons not known to produce alpha-amidated peptides suggests that these cells may be producing as yet unidentified amidated neuropeptides.

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Our findings demonstrate a homogenous distribution of HIV proviral load in the peripheral blood and the intestinal mucosal immune system. The high viral antigen load in the intestine therefore indicates that mucosal HIV production is upregulated at the transcriptional and/or translational level. The intestinal mucosa is a major reservoir for HIV in HIV-infected patients.

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