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Inheritance of chromosomally integrated human herpesvirus 6 DNA.

Human herpesvirus 6 (HHV-6) genome has been detected in several human lymphoproliferative disorders with no signs of active viral infection, and found to be integrated into chromosomes in some cases. We previously reported a woman with HHV-6-infected Burkitt's lymphoma. Fluorescence in situ hybridization showed that the viral genome was integrated into the long arm of chromosome 22 (22q13). The patient's asymptomatic husband also carried HHV-6 DNA integrated at chromosome locus 1q44. To assess the possibility of chromosomal transmission of HHV-6 DNA, we looked for HHV-6 DNA in the peripheral blood of their daughter. She had HHV-6 DNA on both chromosomes 22q13 and 1q44, identical to the site of viral integration of her mother and father, respectively. The findings suggested that her viral genomes were inherited chromosomally from both parents. The 3 family members were all seropositive for HHV-6, but showed no serological signs of active infection. To confirm the presence of HHV-6 DNA sequences, we performed polymerase chain reaction (PCR) with 7 distinct primer pairs that target different regions of HHV-6. The viral sequences were consistently detected by single-step PCR in all 3 family members. We propose a novel latent form for HHV-6, in which integrated viral genome can be chromosomally transmitted. The possible role of the chromosomally integrated HHV-6 in the pathogenesis of lymphoproliferative diseases remains to be explained.

Burkitt Lymphoma↗

Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness.

OBJECTIVES: This study evaluated the influence of features of community social environment and service system integration on service use, housing, and clinical outcomes among homeless people with serious mental illness. STUDY SETTING: A one-year observational outcome study was conducted of homeless people with serious mental illness at 18 sites. DATA SOURCES: Measures of community social environment (e.g., social capital) were based on local surveys and voting records. Housing affordability was assessed with housing survey data. Service system integration was assessed through interviews with key informants at each site to document interorganizational transactions. Standardized clinical measures were used to assess clinical and housing outcomes in face-to-face interviews. RESEARCH DESIGN: Structural equation modeling was used to determine the relationship between (1) characteristics of the social environment (social capital, housing affordability); (2) the level of integration of the service system for persons who are homeless in each community; (3) access to and use of services by individual clients; and (4) successful exit from homelessness or clinical improvement. PRINCIPAL FINDINGS: Social capital was associated with greater service systems integration, which was associated in turn with greater access to assistance from a public housing agency and to a greater probability of exiting from homelessness at 12 months. Housing affordability also predicted exit from homelessness. Neither environmental factors nor systems integration predicted outcomes for psychiatric problems, substance abuse, employment, physical health, or income support. CONCLUSION: Community social capital and service system integration are related through a series of direct and indirect pathways with better housing outcomes but not with superior clinical outcomes for homeless people with mental illness. Implications for designing improved service systems are discussed.

Case Management↗

Changes in cervical keratinocyte gene expression associated with integration of human papillomavirus 16.

Episomal integration is a critical event in human papillomavirus (HPV)-related oncogenesis, although little information is currently available concerning the effect of integration on the host transcriptome. We have used expression microarrays to investigate the effect of integration of HPV16 on gene expression in cervical keratinocytes, using the unique cell line model W12. W12 was generated from a cervical low-grade squamous intraepithelial lesion "naturally" infected with HPV16 and at low passage contains approximately 100 HPV16 episomes/cell. With passage in vitro, integration of viral episomes is associated with the development of phenotypic and genomic abnormalities resembling those seen in cervical neoplastic progression in vivo. We have used the Affymetrix U95A oligonucleotide array that contains probes for 12,600 human transcripts and have identified 85 genes from a range of host cell pathways that show changes in expression levels after integration of HPV16. Whereas some of the genes have previously been implicated in HPV-related oncogenesis in vivo, we have also identified a range of genes not previously described as being involved in cervical neoplastic progression. Interestingly, integration is associated with up-regulation of numerous IFN-responsive genes, in comparison with a baseline of episomally infected cells. These genes include p48, a component of the primary regulator of the IFN response pathway, IFN-stimulated gene factor 3. The physical state of high-risk HPV may substantially influence the response to IFN in infected keratinocytes.

Blotting, Southern↗

The role of MCH and family planning services in HIV/STD control: is integration the answer?

During the mid 1990s, high HIV and sexually transmitted disease (STD) prevalence led to calls for the integration of effective services with maternal and child health and family planning (MCH/FP) programs. There are advantages and disadvantages to integration, but little evidence existed to assess the practicalities of implementing this policy. Analysis of policy development for integration was conducted in Ghana, Kenya, South Africa, and Zambia. Semi-structured interviews were conducted with policy-makers at national, provincial and district levels and a survey of facilities was undertaken to identify gaps between policy intent and implementation. Significant advances had been made at the national level to formulate policies to integrate reproductive health and primary health care. However, barriers to implementation included entrenched HIV/STD and MCH/FP vertical programs; diverse demands on district managers and providers, such as on-going institutional reform; and conflicting objectives of international donors. Policy-makers need to address conflicting objectives between the needs for vertical accountability and the reality of providing integrated services. More careful consideration of implementation is required at earlier stages of policy design. Increased consultation with those who are to implement and provide integrated services is recommended.

Child↗

The semantic metadatabase (SEMEDA): ontology based integration of federated molecular biological data sources.

A system for "intelligent" semantic integration and querying of federated databases is being implemented by using three main components: A component which enables SQL access to integrated databases by database federation (MARGBench), an ontology based semantic metadatabase (SEMEDA) and an ontology based query interface (SEMEDA-query). In this publication we explain and demonstrate the principles, architecture and the use of SEMEDA. Since SEMEDA is implemented as 3 tiered web application database providers can enter all relevant semantic and technical information about their databases by themselves via a web browser. SEMEDA' s collaborative ontology editing feature is not restricted to database integration, and might also be useful for ongoing ontology developments, such as the "Gene Ontology" [2]. SEMEDA can be found at http://www-bm.cs.uni-magdeburg.de/semeda/. We explain how this ontologically structured information can be used for semantic database integration. In addition, requirements to ontologies for molecular biological database integration are discussed and relevant existing ontologies are evaluated. We further discuss how ontologies and structured knowledge sources can be used in SEMEDA and whether they can be merged supplemented or updated to meet the requirements for semantic database integration.

Databases, Genetic↗

Integrating reproductive health services in a reforming health sector: the case of Tanzania.

Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

Attitude of Health Personnel↗

[Relationship between mutation on precore region of integrated HBV DNA and p53 gene mutation in hepatocellular carcinoma].

BACKGROUND & OBJECTIVE: The chronic infection of hepatitis B virus (HBV) is a recognized risk factor for the development of hepatocellular carcinoma (HCC); however, the precise mechanism of carcinogenesis is unknown. In order to better understand the molecular mechanism of hepatocarcinogenesis, this study was designed to investigate the relationship between the gene mutation on precore region of integrated HBV DNA, the mutation of p53 gene and the development of HCC. METHODS: The integrated HBV DNA, gene mutation on precore region of HBV DNA and p53 gene mutation were detected in 80 specimens of HCC, paratumor cirrhosis, liver cirrhosis, and normal liver tissue using polymerase chain reaction (PCR) and single strand conformation polymorphism (SSCP) technique. RESULTS: (1) The positive rates of integrated HBV DNA in HCC tissues, paratumor cirrhosis tissues, cirrhotic liver tissues, and normal liver tissues were 96.43%, 96.43%, 66.67%, and 6.66%, respectively. There were significant differences of the positive rates between normal liver tissues group and each of the other three groups (P< 0.005). (2) The gene mutation rates on precore region of HBV DNA in the four groups were 70.37%, 48.15%, 25.00%, and 0%, respectively. There were significant differences of the gene mutation rates among the four groups (P< 0.05). (3) The mutation rate (57.14%)of p53 gene in HCC was significantly higher than that in liver cirrhosis (16.67%) (P< 0.05). (4) The p53 gene mutation was positively associated with positivity of integrated HBV DNA and mutation on precore region of integrated HBV DNA in different liver tissues. CONCLUSION: The HBV DNA integration and its gene mutation on precore region and p53 gene mutation probably play synergic roles in the development of HCC.

Adult↗

Clonal growth of hepatitis B virus-integrated hepatocytes in cirrhotic liver nodules.

A total of 83 cirrhotic nodules (pseudolobules) individually collected from 11 cirrhotic livers of hepatitis B virus carrier patient were analyzed for the frequency and mode of hepatitis B virus integration as well as histological features. Southern blot analysis disclosed discrete bands at higher molecular weight region in 26 of 83 nodules (31.3%), indicating a clonal growth of hepatocytes with viral integration. Considerable variation (0-75%) existed in the positive rates for discrete bands in nodules among livers. Molecular cloning revealed the sequence flanking an integrated viral sequence to be host DNA and thus confirmed true integration. Histological analysis, however, did not reveal any neoplastic-appearing foci of growth within nodules, despite the fact that the detection sensitivity would predict clones of more than 10(5) cells to give rise to clonal integration patterns on Southern blot analysis. The question of whether clonal expansion of hepatocytes reflects any viral integration-associated growth advantage and/or a preneoplastic condition awaits future studies.

Adult↗

[Integrated supply models--do we need it at all?].

Much has been written about so-called Integrated Healthcare for a number of years and this healthcare model is regarded by many as the solution to our problems in the German healthcare system. Although the legal framework conditions for integrated healthcare models have existed since 2000, no operating model has yet been realised in the German statutory healthcare system (Gesetzliche Krankenversicherung, GKV). Given past experiences, the question therefore arises as to whether we need integrated healthcare models at all. The German health system provides healthcare at a very high level. It suffers nevertheless from constantly growing problems concerning decreasing quality at increasing costs. One of the reasons for this is the fact that past reforms set in the GKV did not remove structural deficits but were essentially symptom-oriented on a short-term basis. The financial relief of the past reforms therefore held only for a short time until the unresolved deficits then re-emerged as a growing problem--in terms of quality and costs. Structurally new forms of healthcare supply--so called Integrated Healthcare models--should integrate four areas: Contracts, supply, reimbursement and responsibility. The aim should be to achieve a high-quality healthcare supply at acceptable costs by appropriate selection of suitable healthcare providers and installation of efficient processes. International experience shows that a qualitatively better supply at reduced costs might be possible with Integrated Healthcare models.

Cost-Benefit Analysis↗

Integration models in health information systems: experiences from the PlugIT project.

Different approaches are available for the integration of existing health information systems (HIS) in integration projects. Within the PlugIT project in Finland, we have found it necessary to design and implement integration in a collaborative, multidisciplinary and open way. In this paper, we use some generic integration models and relate them to the methods, solutions and experiences of the project. We summarize the results from nine integration teams, methods development and supporting surveys and studies, and discuss these experiences to provide some guidelines for the HIS integration projects in general.

Hospital Information Systems↗

Preferential HIV-1 integration sites in macrophages and HIV-associated malignancies.

HIV-infected individuals are at risk for developing certain types of cancers. While there are data to show that non-random HIV integration may occur, our goal was to identify preferential genomic sites where HIV integration might be targeted leading to oncogenesis. Initially, a linker-primer PCR strategy was used to identify HIV integration in isolated macrophages. Inverse-PCR was then used to analyze specimens from patients diagnosed with HIV-associated malignancies. From isolated macrophages, integration near a toll-like receptor on chromosome 4 was found. Necropsy tissues from 11 cases were analyzed with 1 tumor specimen found to have HIV integrated in chromosome 22q13.2 and within 300 kb of HSCBCIP1 (CAP-binding protein complex interacting homologue). Tumor-specific primers were then used to screen uninvolved tissue from the same patient, which did not amplify the site-specific region. This report demonstrates that in both an in vitro system and human malignant tissue, specific viral integration can be identified.

Base Sequence↗

HIV-1 integration: an interplay between HIV-1 integrase, cellular and viral proteins.

To achieve a productive infection, the reverse transcribed cDNA of the human immunodeficiency virus type 1 (HIV-1) has to be inserted in the host cell genome. The main protein required to accomplish this reaction is the virally encoded integrase. In vitro, the recombinant integrase is capable of catalyzing the two subsequent reactions of the integration process, namely the 3' processing followed by the strand transfer, without other viral and/or cellular proteins. However, a number of studies indicate that the in vivo integration process also involves cellular proteins, assisting the virus to integrate in the cellular genome. These cellular proteins can play a role during different steps of the integration process, including nuclear import, integrase catalysis, integration site selection and DNA gap repair. In this review we summarize the candidate cellular proteins involved in the HIV-1 integration process identified so far and discuss their potential roles during HIV-1 replication.

Apoptosis↗

[Identification of hepatitis B virus integration sites in hepatocellular carcinoma tissues from patients with chronic hepatitis B].

OBJECTIVE: Hepatitis B virus (HBV) integration into the host genome is frequently detected in HBV positive hepatocellular carcinoma (HCC) in China. The aim of this study is to carry out a large-scale screening for the HBV integrations sites in HCC samples from Chinese patients. METHODS: Cellular DNA was extracted from 40 HBV-related HCC by proteinase K digestion/phenol extraction method. One primer specific to HBV sequence and another primer directed to human Alu repeat were used to amplify the virus/cellular DNA junction. To avoid undesirable amplifications between Alu sequences, primers were constructed with dUTPs and destroyed by uracil DNA glycosylase treatment after 15 initial cycles of amplification. Only desirable fragments were then further amplified with specific primers to the known region and to a tag sequence introduced in the Alu-Specific primer. The PCR product was purified and subject to direct sequencing by ABI 3700 Auto sequencer. NCBI (national center for biotechnology information) BLAST and MapViewer search were used for identification of HBV location on human genomes. RESULTS: In 40 HBsAg positive HCC samples, 34 (85%) were showed to have at least one copy of HBV fragment in host genome, indicating HBV-Alu-PCR is a rapid way for identification of new cellular DNA sequences adjacent to HBV. Analysis from the 68 isolated viral-cellular junctions, X gene was found to be interrupted at any length, not specifically at DR1 and DR2 regions. Three-prime-deleted X gene was observed in 65 (96%) cases. HBV preferred to integrate into the intron and the up-stream regulatory region of the cellular genes. In no case HBV inserted into the exon. Our results also demonstrated that the cellular genes targeted by HBV are usually key regulators of cell proliferation and cell death. Three genes, myeloid/lymphoid or mixed-lineage leukemia 4, G protein alpha transducing activity polypeptide 1 and fibronectin, were found to be recurrently targeted by HBV. CONCLUSION: HBV-Alu-PCR is a powerful tool for the study of HBV integration sites. Truncated X is a major form existed in the HBV integrants. HBV integration is not distributed evenly throughout the host genome and viral insertional mutagenesis may play an important role in the development of HCC.

Alu Elements↗

His-1 and His-2: identification and chromosomal mapping of two commonly rearranged sites of viral integration in a myeloid leukemia.

To identify genes that contribute to myeloid leukemogenesis we have cloned viral integration sites from a CasBrM-MuLV-induced interleukin 3-independent myeloid leukemia cell line. Genomic probes derived from cellular sequences flanking two integrated proviruses were used to screen restriction digests of DNAs from a panel of 52 hematopoietic cell lines, 30 of which were established from CasBrM-MuLV- or MoMuLV-induced mouse leukemias. Probes from one integration site (His-1) defined a region that was rearranged in 3/52 cell lines, and probes from a second integration site (His-2) identified a rearrangement in 2/52 cell lines. Both cases of His-2 rearrangements occurred in concert with viral insertions in the His-1 locus. Genetic mapping of these loci using interspecific backcross analysis assigned the His-1 locus to mouse chromosome 2 and the His-2 locus to mouse chromosome 19. In situ hybridization with a probe from the human homologous region mapped the His-1 locus to human chromosome 2q14-q21. No recombinants were observed between His-2 and Gin-1, a common site of provirus integration in Gross passage A MuLV-induced T-cell leukemias, in 131 backcross animals, suggesting that these loci are tightly linked. The His-1 locus maps to mouse chromosome 2 distinct from any known oncogene or common site of integration but near the proximal breakpoint for a deletion that is observed in over 90% of radiation-induced leukemias.

Animals↗

[Integration and expression of human endogenous retrovirus].

Retrovirus has been known to be integrated into host DNA as provirus. In the course of evolution, some of them have been integrated into germ cell DNA and inherited from generation to generation as host genes. Most vertebrates have accumulated tens or hundreds of retroviral sequences. To know the aspect of their integration and expression in human, lambda 4-1 and ERV3 were investigated by using genomic DNA or placental RNA from Japanese origin. Southern-blotting analysis showed more than 30 copies of lambda 4-1 or its related sequences were integrated in human DNA, whereas only one copy of ERV3 was integrated. One of the fragments (2.0 kb, EcoRI) of lambda 4-1 was polymorphic and confirmed to be inherited in Mendelian fashion. The size of ERV3 observed in Japanese after digestion by Pvull was the same as that reported in caucasian suggesting ERV3 might be integrated before ethnic diversion. Transcription of these retroviral genes was investigated in placenta by northern-blotting analysis. 4 species of mRNA; 3.6 kb, 3.0 kb, 2.2 kb, 1.7 kb, were observed by full length of lambda 4-1, whereas 3 species; 9.0 kb, 7.3 kb, 3.0 kb by env of ERV3. The amount of mRNA transcribed in human placenta was well correlated in two endogenous retroviruses (r = 0.66). Furthermore, positive immunofluorescence-staining of placental section by using antibody against lambda 4-1 env protein suggested that env protein might be translated from lambda 4-1 provirus and expressed on human placenta.

Blotting, Southern↗

The relative impacts of vertical and integrated FP/MCH programs in rural Nepal.

The objectives of this analysis were to assess the probable impacts of vertical and integrated FP/MCH programs on family planning (knowledge, use, and intentions to use), family size preferences, fertility, and mortality (child and infant). The following discussion summarizes and draws conclusions regarding the results of this investigation. The vertical program showed a greater impact on knowledge of family planning than the integrated program. Increases in knowledge between 1975 and 1978 while controlling for social and demographic variables were greater in the vertical than the integrated areas. Multiple classification analysis at both household and village levels showed that the vertical program was a better predictor of knowledge and changes in knowledge than the integrated program. In addition, the vertical program showed consistently higher proportions of women with awareness of family planning among those segments of the population that could have the greatest impact on fertility reduction in the future--namely, the younger women who are either childless or just beginning their childbearing and those with husbands who have little or no education. Neither the vertical nor the integrated FP/MCH program showed an impact on current use or ever use of family planning. The very low levels and changes in levels of these factors between the programs showed almost no difference throughout the selected demographic and socioeconomic groups. In both program areas the proportions of ever use and current use increased substantially with the number of living sons, exceeding 14 percent and 10 percent, respectively, among women with three or more sons. There were virtually no family planning users or ever users among women with no sons. This appears to indicate that "son preference" (documented in the Nepal Fertility Survey) is an important factor affecting the incidence of family planning practice and may be a formidable obstacle to a substantial reduction in fertility. Family limitation generally may not be taken seriously until a couple has produced the desired number of sons. Hence, until the value of sons (perhaps as sources of labor, financial support and security in old age, and as performers of funeral rites for fathers) can be altered it is unlikely that a reduction in fertility beyond certain levels could occur. The vertical program showed a slightly greater impact on future intentions to use family planning than the integrated program.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

A reexamination of integrated population activities.

The term integrated population activities came into style at the World Population Conference at Bucharest in 1974, where it was used to refer to national planning that recognizes the integral role of population in development, the use of socioeconomic change to solve a nation's population problem, or the implementation of population activities along with health or agricultural projects. In this paper, Laurel Files calls for a more precise definition of the word integrated and the use of different terminology for other types of coordinating activities. She argues that integrated is meaningful only when it refers to planning or implementation of population activities by several ministries, or to the combination of population activities with related services. Beyond restricting the definition, Files calls into question the habit of appending integrated onto population activities as a kind of halo. "Unintegrated" family planning does not deserve a pejorative connotation, for in some situations it may be more effective than integrated family planning.

Family Planning Services↗

Clonal origin of adenovirus type 12-induced hamster tumors: nonspecific chromosomal integration sites of viral DNA.

The mechanism of tumor induction by human adenovirus type 12 (Ad12) in newborn Syrian hamsters (Mesocricetus auratus) has been investigated further. Tumors were produced in newborn hamsters by the s.c. injection of CsCl-purified Ad12. In 60-70% of the surviving animals, tumors have been observed between 33 and 47 days after injection. In 60 independently elicited tumors, the patterns of Ad12 DNA integration have been studied by restriction enzyme analyses and Southern blot hybridization using Ad12 DNA or its terminal DNA fragments as hybridization probes. Moreover, the integrated viral genomes have been localized on different hamster chromosomes by the fluorescence in situ hybridization technique using either nonradioactively labeled digoxigenin probes and fluorescent antibodies or biotinylated probes and fluorescent avidin. In all of the tumors, 20 and more copies of viral DNA have been found covalently linked to cellular DNA, as apparent from the off-size restriction fragments that do not comigrate during electrophoreses with any of the known virion DNA fragments. In Ad12-induced tumors or Ad12-transformed hamster cell lines, there is no evidence for the persistence of nonintegrated, free viral DNA copies. In general, the multiple copies of Ad12 DNA are inserted into a single chromosomal cellular site, which is different for each tumor. Only in one tumor cell line have the integrated Ad12 DNA copies been localized on two different chromosomes. The off-size fragment patterns generated by restriction and Southern blotting experiments are also unique and different for each tumor. These off-size fragments represent the sites of linkage between viral and cellular DNA but may also contain rearranged viral DNA sequences. We conclude that, upon Ad12 tumor induction in hamsters, Ad12 DNA does not integrate at specific insertion sites or nucleotide sequences into the cellular genome. It is still possible that selective elements exist at the sites of viral DNA insertion, e.g., specific chromatin structures due to transcriptional activity. The data presented also demonstrate (a) that each tumor cell carries Ad12 DNA; (b) that the insertion site appears to be the same in each tumor cell in a given tumor; (c) that, upon continued passage of the tumor cells in culture, the chromosomal site of Ad12 DNA insertion does not change, at least up to 25-32 passages, which correspond to about 75-96 cell generations beyond the tumor stage; and (d) that the integrated Ad12 DNA is localized on different chromosomes in individual tumors. Hence, the Ad12-induced tumors are of clonal origin. Another peculiarity of this viral tumor system is the frequent occurrence of more than one tumor in one animal. By the criteria established above, each individual tumor is characterized by its specific chromosomal integration site and restriction pattern. Thus, multiple induced tumors in one animal exhibit separate and individual clonality. During the time of maximally 7 weeks of observation of Ad12-induced tumors in the animals, metastases into different organ systems have not been observed.

Adenoviruses, Human↗