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The American Journal of Pathology logoLink to The American Journal of Pathology
. 2000 Aug;157(2):497–507. doi: 10.1016/S0002-9440(10)64561-0

Induction of Cell-Cycle Regulators in Simian Immunodeficiency Virus Encephalitis

Kelly L Jordan-Sciutto *, Guoji Wang *, Michael Murphy-Corb , Clayton A Wiley *
PMCID: PMC1850139  PMID: 10934153

Abstract

Neuronal degeneration associated with human immunodeficiency virus encephalitis has been attributed to neurotoxicity of signaling molecules secreted by activated, infected macrophages. We hypothesized that the barrage of signals present in the extracellular milieu of human immunodeficiency virus-infiltrated brain causes inappropriate activation of neuronal cell-cycle machinery. We examined the presence of three members of the cell-cycle control machinery: pRb, E2F1, and p53 in the simian immunodeficiency virus encephalitis (SIVE) model. Compared to noninfected and simian immunodeficiency virus-infected, nonencephalitic controls, we observed increased protein expression of E2F1 and p53 and aberrant cellular localization of E2F1 and pRb. In SIVE, E2F1 was abundant in the cytoplasm of neurons in both neurons and astrocytes proximal to SIVE pathology in the basal ganglia. pRb staining was nuclear and cytoplasmic in cortical neurons of SIVE cases. Antibodies to phosphorylated pRb also labeled the cytoplasm of cortical neurons. These data suggest that in SIVE, cell signaling results in phosphorylation of pRb which may result in subsequent alteration in E2F1 activity. As increased E2F1 and p53 activities have been linked to cell death, these data suggest that the neurodegeneration in SIVE could in part be because of changes in expression and activity of cell-cycle machinery.


Human immunodeficiency virus encephalitis (HIVE) is observed in ∼25% of AIDS autopsies 1-4 and a more variable percentage of simian immunodeficiency virus (SIV)-infected macaques. 5-12 Lentiviral encephalitis is a peculiar chronic encephalitis in that severe neuronal damage occurs despite an absence of significant neuronal infection. 5,6,9,13,14 The pathogenesis of neurodegeneration in HIVE and simian immunodeficiency virus encephalitis (SIVE) is unknown; however, it appears linked to abundant activated and lentiviral-infected brain macrophages. 5,8,12,15-24 Numerous studies have suggested that these activated macrophages may secrete direct or indirect toxins that act on neuroglial elements and lead to synaptic damage and neuronal death. 25-35

Several studies have shown a tight association between the presence of activated and lentiviral-infected central nervous system (CNS) macrophages and aberrant cell-signaling molecules (eg, cytokines, chemokines, neurotrophic factors). 25-35 As some of these molecules are capable of signaling the initiation of cell cycle in nonneuronal cell types, we hypothesized that the aberrant CNS milieu may lead to inappropriate expression of cell-cycle proteins within terminally differentiated neuronal elements leading to their chronic damage and eventual death.

The signaling molecules secreted by HIV-infected macrophages may stimulate a cell to divide, differentiate, or die. These processes are regulated by the activities of p53, pRb, and E2F1 proteins. 36-41 The functions of pRb and E2F1 are linked through direct interaction between these two proteins. 42,43 E2F1 is an activator of transcription that binds DNA as a heterodimer with the DP1 protein. 44,45 This DNA:protein complex acts as a transcriptional repressor when interacting with pRb. 46-49 Phosphorylation of pRb disrupts this interaction allowing the E2F complex to activate expression of genes needed for entry into the cell cycle and completion of S phase. 36,40,50,51 In addition to regulation of S-phase genes, E2F1 has additional functions separate from other members of the E2F family. Both in vivo and in vitro evidence support a role for E2F1 in regulation of cell death. 52,53 Key evidence supporting a role for E2F1 in cell death was the rescue of the severe neuronal death in the CNS of pRb deficient mice by concomitant deletion of E2F1. 54,55 These data are supported by many in vitro studies showing that increased E2F1 expression mediates apoptosis. 53

Given that cell-cycle proteins have been found to participate in neuronal death and the environment in the HIV-infected brain is conducive to cell-cycle protein induction, we proposed to test if cell-cycle proteins were being activated. We elected to use the SIVE model to study the pathogenesis of neurodegeneration seen in AIDS. Depending on the specific simian host and SIV strain, immunocompromised monkeys develop neuropathological changes that share many similarities with the human disease. 5,8,9,11,12,56 Although the time course and anatomical distribution of SIVE is model-dependent, the end-stage histopathology is remarkably similar to that observed in HIVE. We used this model to study the expression patterns of cell-cycle proteins E2F1, pRb, and p53 in response to lentiviral infection by immunohistochemistry and immunoblot analysis.

Materials and Methods

Animal Model

Rhesus macaques were housed and maintained according to strict American Association of Laboratory Animal Care standards. Macaques were derived from vaccine trials, infected, and sacrificed. SIVE was empirically defined as the presence of abundant perivascular mononuclear infiltrate and microglial nodules. Multinucleated giant cells were present in some lesions of all cases.

Protein Extracts and Immunoblotting

Protein extracts were prepared from basal ganglia and frontal cortex of three uninfected control monkeys, two SIV-infected monkeys, and three SIV-infected, encephalitic monkeys as previously described. 57 Tissues were homogenized on ice in phosphate-buffered saline with protease inhibitors (5 mmol/L phenylmethyl sulfonyl fluoride, 2 μg/ml pepstatin A, and 1 μg/ml leupeptin) until there were no large chunks. Separated cells were collected by centrifugation at 3,000 rpm for 5 minutes at 4°C. Supernatants were removed to a separate tube and pellets were resuspended in 4 volumes hypotonic buffer (20 mmol/L Hepes, pH 7.9, 1.5 mmol/L MgCl2, 10 mmol/L KCl, 0.5 mmol/L dithiothreitol, 0.5 mmol/L phenylmethyl sulfonyl fluoride, 2 μg/ml pepstatin A, and 1 μg/ml leupeptin). The suspension was homogenized for 10 seconds and incubated on ice for 15 minutes. The cells were collected by centrifugation at 13,000 × g for 30 minutes. The supernatant was labeled “S1” and the pellet was further extracted with high-salt buffer (0.42 mol/L NaCl, 20 mmol/L Hepes, pH 7.9, 1.5 mmol/L MgCl2, 0.2 mmol/L ethylenediaminetetraacetic acid, 0.5 mmol/L dithiothreitol, 25% glycerol, 0.5 mmol/L phenylmethyl sulfonyl fluoride, 2 μg/ml pepstatin A, and 1 μg/ml leupeptin) on ice for 20 minutes. Residual insoluble material was removed by centrifugation at 14,000 × g for 30 minutes. The supernatant fraction was collected and termed “S2”. Protein concentrations for each fraction were determined by the Biorad protein assay. Two hundred μg of S1 and S2 extract from each sample was loaded onto a 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) for E2F1 and p53 and a 7.5% SDS-PAGE for pRb. These proteins were only detected in the S2 fraction.

The proteins were transferred from the SDS-PAGE to Immun-Blot polyvinylidene difluoride membrane (Bio-Rad, Hercules, CA) by electrophoresis and blocked in 5% normal goat serum in Tris-buffered saline (TBS; 10 mmol/L Tris, pH 8.0, 150 mmol/L NaCl). All antibodies were used at 1:1,000 in 0.5% milk overnight at 4°C. Blots were washed three times in TBST (TBS + 0.1% Tween 20) for 15 minutes. Goat anti-mouse horseradish peroxidase (1:5,000; Jackson Laboratories, Bar Harbor, ME) and goat anti-rabbit horseradish peroxidase (1:5,000; Jackson Laboratories) was used to detect the appropriate primary antibodies. The secondary antibody was washed extensively in TBS, three times for 20 minutes. The antibody was then visualized using enhanced chemiluminescence (Renaissance; NEN Life Science Products, Inc.).

Immunohistochemistry and Immunofluorescence

Paraffin-embedded sections were heated to 50°C for 20 minutes and deparaffinized in Histoclear (3 × 15 minutes) (National Diagnostics, Atlanta, GA). Sections were rehydrated as follows: 100% alcohol for 10 minutes, two times; 95% alcohol for 10 minutes; 90% alcohol for 10 minutes; 70% alcohol for 10 minutes; and H2O for 5 minutes. Endogenous peroxidase activity was inactivated by immersing in 3% H2O2 for 30 minutes. Antigen unmasking was performed by bringing sections to a boil in 10 mmol/L sodium citrate, cooling 5 minutes, and bringing to a boil again in the microwave. After gradual cooling to room temperature, tissue sections were blocked with 10% normal goat serum. Antibodies to E2F1, p53, and pRb previously characterized for immunohistochemistry 58-60 were used at commercially recommended and empirically defined dilutions (Table 1) and detected by the tyramide amplification system (New England Biolabs, Beverly, MA). For immunofluorescent studies, antibodies to MAP2, GFAP, and Ham-56 (Table 1) were used at stated dilutions without amplification. The fluorogen used is listed in the Figure legends. Immunocytochemical staining used an amino ethyl carabazole detection system (Biogenex, San Ramon, CA) and slides were mounted in crystal mount. Immunofluorescent slides were mounted in gelvetol 61 and analyzed by laser confocal microscopy (Molecular Dynamics, Sunnyvale, CA), as previously described. 62

Table 1.

Antibody Dilutions Used for Immunohistochemistry and Immunoblot

Antigen Antibody Type Immunoblot dilution IHC dilution Source
E2F1 Mouse monoclonal 1:1,000 1:100 Santa Cruz Biotechnology, Inc. (Santa Cruz, CA)
pRb Mouse monoclonal 1:1,000 1:100 Santa Cruz Biotechnology, Inc. (Santa Cruz, CA)
p53 Mouse monoclonal 1:1,000 1:100 Santa Cruz Biotechnology, Inc. (Santa Cruz, CA)
Phospho-Rb Rabbit polyclonal 1:1,000 1:100 New England Biolabs, Inc. (Beverly, MA)
GFAP Rabbit polyclonal N/A 1:500 DAKO (Carpinteria, CA)
HAM-56 Mouse monoclonal N/A 1:100 DAKO (Carpinteria, CA)
MAP-2 Mouse monoclonal N/A 1:500 Sternberger Monoclonals, Inc. (Lutherville, MD)

Information on the antibodies used for immunoblot or immunohistochemistry (IHC) is listed. Also indicated are the type and source of each antibody used. NA, not applicable.

Figure 1.

Figure 1.

SIV-infected macaques with encephalitis show increased immunostaining for E2F1 and pRb. A: Macaques infected with SIV but without SIVE showed little to no staining for E2F1 in the basal ganglia. B: Macaques with SIVE showed robust staining for E2F1 in both nuclei and cytoplasm of basal ganglia cells. C: E2F1 staining was particularly intense in the cytoplasm of cells surrounding multinucleated giant cells. D: In the basal ganglia of macaques with SIVE Rb staining was restricted to select nuclei. Eand F: In the cortex of macaques with SIVE Rb staining was observed in both cytoplasm and nuclei of cells with neuronal morphology particularly in regions with microglial nodules (arrows). Scale bar, 20 μm.

Results

SIV-Infected Macaques with Encephalitis Show Increased Immunostaining for E2F1 and pRb

The soluble factors released by activated macrophages have the potential to initiate numerous intracellular signaling cascades. We hypothesized that cell-cycle machinery will be altered in neurons in response to a variety of signals introduced by infiltrating lentiviral-infected, activated macrophages. To examine this hypothesis, we assessed the expression patterns of three key cell-cycle regulators, E2F1, pRb, and p53, in the basal ganglia and frontal cortex of three control monkeys, three monkeys infected with SIV, and three monkeys with SIVE. Both control and SIV-infected monkeys without encephalitis exhibited no staining for E2F1 in the basal ganglia (Figure 1A) or frontal cortex (data not shown). In the basal ganglia of the SIVE cases there was robust E2F1 staining in the nuclei and cytoplasm of numerous cells (Figure 1B) . This cytoplasmic staining was observed in cells surrounding multinucleated giant cells (Figure 1C) , a hallmark pathological feature of SIVE. We did not observe any E2F1 staining in the frontal cortex of SIVE cases.

Staining for pRb was not observed in the basal ganglia and frontal cortex of control and SIV-infected monkeys without encephalitis. In basal ganglia of monkeys with SIVE, pRb was found in select nuclei (Figure 1D) . However, in the frontal cortex of monkeys with SIVE, pRb was cytoplasmic and nuclear in cells with the morphology of neurons (Figure 1, E and F) . Nuclear staining was observed in cells with the morphology of astrocytes. As seen with E2F1, cytoplasmic pRb staining was observed in cells near microglial nodules, a pathological feature of the disease. Figure 1E shows cytoplasmic staining in the vicinity of a microglial nodule (arrows). These data indicate that cytoplasmic pRb increases during SIVE progression. Staining for p53 was predominantly nuclear and was the same in all three experimental conditions.

Rb Stains the Cytoplasm of Neurons in the Frontal Cortex

To confirm that pRb cytoplasmic staining in the frontal cortex occurs in neurons, we performed double-label laser confocal microscopy (DLCM) with pRb and CNS cell markers. Using DLCM we were now able to detect pRb in nonencephalitic controls showing that pRb staining was nuclear predominantly in cells staining positive for MAP2, a neuronal marker (data not shown). In SIVE cases pRb staining was also predominantly nuclear in the frontal cortex, but select cells staining for the neuronal marker, MAP2, showed cytoplasmic staining of pRb (Figure 2 , top). pRb stains the nuclei of select astrocytes as indicated by the presence of pRb staining in GFAP-positive cells (Figure 2 , bottom). pRb was also found in the nuclei of HAM-56-positive microglia (data not shown). In the basal ganglia, nuclear pRb was observed in neurons, astrocytes, and microglia. These data demonstrate that cytoplasmic staining of pRb occurs predominantly in neurons in the frontal cortex during SIVE.

Figure 2.

Figure 2.

In the frontal cortex of macaques with SIVE nuclei of astrocytes and neurons immunostain for Rb as does the cytoplasm of some neurons. Frontal cortex from macaque with SIVE immunostained for pRb (red) and MAP2 (green) (top) and GFAP (green) in (bottom) visualized by double-label immunofluorescent laser confocal microscopy. Single label for the cell type marker (red), pRb (green), and an overlay of the two images. Yellow-orange shows co-localization. Increased Rb staining was predominantly localized to nuclei of neurons and astrocytes, however, some MAP2-positive neurons also show cytoplasmic staining (arrows). Scale bar, 20 μm.

Cytoplasmic Staining of E2F1 Occurs in Neurons of the Basal Ganglia and Frontal Cortex

Immunostaining for E2F1 in the basal ganglia of encephalitic monkeys shows a dramatic increase in cytoplasmic E2F1 staining. To determine whether neurons contained E2F1 cytoplasmic staining, we performed DLCM for E2F1 and the neuronal marker MAP2. Using DLCM we were able to determine that E2F1 was predominantly nuclear in MAP2-positive cells in the basal ganglia and frontal cortex of nonencephalitic controls (data not shown). In the basal ganglia of SIVE cases, cytoplasmic E2F1 was found to co-localize with MAP2 (Figure 3 , top) showing that in the basal ganglia, E2F1 is found in the cytoplasm of neurons. Cytoplasmic E2F1 was also observed in MAP2-positive neurons in SIVE frontal cortex (Figure 3 , bottom), although this staining was less robust than in the basal ganglia. These data suggest that E2F1 is found in the cytoplasm of neurons in both the basal ganglia and the frontal cortex of SIVE monkeys.

Figure 3.

Figure 3.

Neurons of the basal ganglia and frontal cortex of macaques with SIVE show cytoplasmic staining for E2F1, E2F1 (Cy3, red), and MAP2 (FITC, green) labeling in the basal ganglia (top) and frontal cortex (bottom) of a macaque with SIVE. Each marker is shown separately and as an overlay of the two images to show co-localization (yellow-orange). Scale bar, 20 μm.

Cytoplasmic Staining of E2F1 Occurs in Astrocytes of the Basal Ganglia but Not the Frontal Cortex

In the basal ganglia, cytoplasmic E2F1 staining co-localized with GFAP-positive cell bodies and processes (Figure 4 , top). This is in contrast to what we observed in the frontal cortex where E2F1 was predominantly nuclear in GFAP-positive cells (Figure 4 , bottom). Some E2F1-positive cell bodies were observed in the frontal cortex, but process staining was virtually absent. In both brain regions, some GFAP-negative cells exhibited E2F1 staining in the nucleus or cytoplasm. On the basis of their size and morphology these cells are likely neurons. In areas containing HAM-56-positive microglia, E2F1 was found in the nuclei of microglia, but in the cytoplasm of surrounding cells (data not shown). These data support a redistribution of E2F1 from the nucleus to the cytoplasm in neurons and astrocytes of the basal ganglia in areas containing activated microglia, whereas in the frontal cortex, it is the neuronal nuclei and cytoplasm that contain E2F1.

Figure 4.

Figure 4.

In SIVE, cytoplasmic staining of E2F1 occurs in astrocytes of the basal ganglia but not the frontal cortex. Double-label immunofluorescent confocal microscopy for E2F1 (Cy3, red) and GFAP (FITC, green) are shown for the basal ganglia (top) and the frontal cortex (bottom) of a SIVE case. Single labels are shown in the appropriate color followed by double-label on right. Co-localization will appear yellow-orange. In SIVE E2F1 staining extends into the cytoplasm of astrocytes in the basal ganglia, however in the frontal cortex staining is predominantly restricted to nuclei. Scale bar, 20 μm.

The pRb Observed in the Neuronal Cytoplasm of SIVE Cases Is Phosphorylated

Because pRb is regulated by phosphorylation, an antibody recognizing the serine-795 phospho-isoform of pRb was used to assess the phosphorylation status of pRb in SIVE. In nonencephalitic controls, there was no staining for phosphorylated pRb in the frontal cortex (Figure 5 , SIV-CTX). However, in the cortex of SIVE cases, staining for phospho-Rb was observed in the nucleus and cytoplasm of cells with the morphology of neurons (Figure 5 , SIVE-CTX). The staining in the cortex is consistent with the previous observation that pRb is cytoplasmic in neurons suggesting that cytoplasmic pRb in cortical neurons is phosphorylated.

Figure 5.

Figure 5.

The pRb observed in the neuronal cytoplasm of SIVE cases is phosphorylated. SIV-infected macaques exhibit little staining for a phospho-isoform of pRb in the frontal cortex (SIV-CTX). In SIV-infected monkeys with encephalitis phosphorylated pRb is present in the cytoplasm of numerous cells in the frontal cortex (SIVE-CTX).

Expression of E2F1 and p53 Is Increased in Basal Ganglia of SIVE Cases

The robust staining for E2F1 in encephalitic monkey basal ganglia in comparison to the complete absence of staining in the nonencephalitic cases suggests an increase in expression of E2F1. To test this, a quantitative immunoblot was done using protein extracts from the basal ganglia and frontal cortex of three uninfected controls, two SIV-infected, nonencephalitic cases, and three monkeys with SIVE. By immunoblot, E2F1 protein levels increased in the basal ganglia of SIVE cases (Figure 6) . These data suggest that E2F1 expression is altered in SIVE. p53 also exhibited an increase in protein levels in SIVE cases as compared to nonencephalitic controls in the basal ganglia (Figure 6) , whereas pRb remained constant in the basal ganglia and frontal cortex (data not shown, Table 2 ). These data suggest that p53 protein levels increase even though changes in subcellular localization were not detected.

Figure 6.

Figure 6.

Expression of E2F1 and p53 is increased in basal ganglia of SIVE cases. The amount of E2F1 and p53 present in control (lanes 1–3), SIV (lanes 4 and 5), and SIVE (lanes 6–8) cases was determined by immunoblot. Two hundred μg of protein were loaded into each lane of a 10% SDS-PAGE. The gel was immunoblotted for E2F1, p53, and actin as a control. Expression of these proteins was assessed in protein extracts from both the basal ganglia (top) and the frontal cortex (bottom).

Table 2.

Summary of Protein Localization and Expression for pRb, E2F1, and p53

pRb E2F1 p53
Non-E SIVE Non-E SIVE Non-E SIVE
Basal ganglia
Neurons Nuclear Nuclear Nuclear Cyto Nuclear Nuclear
Astrocytes Nuclear Nuclear Nuclear Cyto Nuclear Nuclear
Microglia Nuclear Nuclear Nuclear Nuclear NT NT
Frontal cortex
Neurons Nuclear Cyto Nuclear Cyto Nuclear Nuclear
Astrocytes Nuclear Nuclear Nuclear Nuclear Nuclear Nuclear
Microglia Nuclear Nuclear Nuclear Nuclear NT NT
Protein expression
Basal Ganglia Same-NS Increased in SIVE Increased in SIVE
Frontal Cortex Same-NS Same Same

Subcellular localization of pRb, E2F1, and p53 in specific CNS cell types is indicated as nuclear or cytoplasmic (Cyto). Changes in protein expression are also listed with regard to specific brain regions tested. NT, not tested; Non-E, non-encephalitis; NS, not shown; SIVE, simian immunodeficiency virus encephalitis.

Discussion

Neurodegeneration in lentiviral encephalitis has been linked to several soluble molecules released by activated macrophages including chemokines and neurotrophic factors. Yet the effects of these signals on the cells of the CNS are not understood. Potential targets for these factors include key regulators of the cell cycle: pRb, E2F1, and p53. Here we show changes in expression and subcellular localization of these proteins in SIVE (summarized in Table 2 ).

With respect to pRb, we observed a change in subcellular localization in neurons proximal to microglial nodules. The change in subcellular localization was accompanied by alteration in the state of phosphorylation of pRb. The presence of hyperphosphorylated pRb is consistent with activation of numerous signaling cascades. 38,39,63,64 Although it has not been shown specifically for neurotrophic factor receptors, activation of other tyrosine kinase receptors akin to trkA, trkB, and trkC results in phosphorylation of pRb. 65,66 Hyperphosphorylation of pRb renders it inactive, abrogating its ability to bind the transcriptional activator E2F1. 38,39 When pRb is complexed with E2F1 in the nucleus, expression from promoters containing E2F1 binding sites is repressed. Cytoplasmic localization of hyperphosphorylated pRb would suggest an alteration in the activity of E2F1. The function of cytoplasmic pRb is not clear but its presence in the cytoplasm of neurons has not been previously reported (Figure 7) .

Figure 7.

Figure 7.

Model of the proposed role for cell-cycle regulators in the SIVE progression. In normal neurons, E2F1 and pRb are found in the nucleus in complex with DP1 bound to promoter elements of S-phase-specific genes maintaining low expression of these genes (left). At this time TRAF2 is bound to the death receptor (DR) such as p75NTFR and initiates a survival signal (left). In response to extracellular signals released by infiltrating macrophages, pRb becomes phosphorylated and accumulates in the cytoplasm (right). E2F1 expression increases and accumulates in the cytoplasm where it causes degradation of TRAF2 (right). Degradation of TRAF2 allows the death receptor (DR) to interact with death domain containing proteins. Stimulation of the death receptor by neurotrophic factors (NTF) will lead to activation of the death domain proteins leading to cell death.

Staining for the E2F1 protein was also distinct in SIVE. E2F1 protein levels increased in the basal ganglia where there was abundant cytoplasmic staining in both neurons and astrocytes. This cytoplasmic staining was observed in the vicinity of multinucleated giant cells and activated microglia, suggesting that SIVE alters E2F1 expression and subcellular localization. This spatial association should be further evaluated when double-label protocols are available to co-localize the cell-cycle regulators and SIV.

As a transcription factor, E2F1 activities are believed to take place primarily in the nucleus where increased E2F1 expression normally initiates S phase of the cell cycle. 67 In differentiating neurons increased expression of E2F1 has been found to cooperate in p53 dependent apoptosis or initiate p53-independent apoptosis. 54,55 Increased p53 protein levels may suggest that E2F1 is acting in a p53-mediated apoptotic mechanism. We did not observe altered p53 subcellular localization in SIVE compared to control and SIV nonencephalitic cases, however, by immunoblot analysis there was an overall increase in p53 protein levels in the basal ganglia of SIVE cases. These findings show that components of the cell cycle are altered in neuroglial elements during lentiviral encephalitis. Future studies will examine whether the alteration is associated with altered neuronal function or survival.

A role for E2F1 in cell death independent of p53 has recently been linked to the ability of E2F1 to reduce protein stability of the TRAF2 protein 68 (Figure 7) . TRAF2 prevents apoptosis initiated by death receptor activation. 69 Because changes in TRAF2 stability by E2F1 are dependent on the level of E2F1 protein expressed and not on its transcriptional activity, the observed increase in cytoplasmic E2F1 expression in SIVE may lead to degradation of TRAF2 (or a TRAF2 family member) by E2F1. 68 Cytoplasmic localization of E2F1 in SIVE would be consistent with its role in TRAF2 degradation leading to insufficient TRAF2 levels compromising cell survival. It is possible that either or both of these pathways are contributing to neuronal dysfunction in SIVE. Further investigation is required to elucidate the specific pathways involved.

Increased expression of E2F1 or deregulation of its activity in the nucleus would be expected to result in re-entry into the cell cycle. 50,51 Because neurons are postmitotic, they may have a mechanism to prevent entry of E2F1 into the nucleus. However, if the amount of E2F1 were to exceed the amount of resident pRb, the cell may induce S-phase specific genes. At low levels this may result in production of enzymes needed for DNA and cellular repair. However, at high levels, increased E2F1 levels could turn on genes that would be inappropriate in a terminally differentiated cell. It will be interesting to study whether this leads to neuronal death or CNS dysfunction.

Re-activation of cell-cycle proteins has been implicated in another neurodegenerative disease, Alzheimer’s disease. 70,71 Increased p53 and pRb staining have been reported 72,73 as well as regulators of pRb activity the cyclin dependent kinases and their inhibitors. 74-77 Cyclin dependent kinases, pRb, and E2F activity have been implicated in β-amyloid toxicity in an in vitro model of Alzheimer’s disease. 78 These data suggest that further experiments defining the role of cell-cycle proteins in neuronal loss may have implications for other neurodegenerative diseases.

Deciphering the pathogenesis of lentiviral-associated neurodegeneration remains a daunting task. Primary neuronal damage must in some way be related to activated and infected macrophages, 25-35 but the pathway may be very indirect. Simply deciphering involved cells is complicated by the time course of the disease, number of potentially involved cells and downstream effects of damage between interconnected regions of the brain. The clinical symptomatology and pathology of HIVE suggests that the disease begins in subcortical structures and spreads to cortical regions. 35,79-84 It is not clear that this is the case with SIVE. Nevertheless, our quantitative immunoblots suggest the E2F1 expression in the basal ganglia of SIVE cases exceeds that observed in the frontal cortex. If E2F1 were related to neurodegeneration, this observation would be consistent with early involvement of the basal ganglia.

In the current study we have attempted to examine the hypothesis that induction of cell-cycle regulators may spatially correlate with presence or absence of histopathology. In addition to identifying quantitative increases in cell-cycle regulatory proteins, we localized these proteins to neuroglial elements in differentially involved regions of the brain. Inferences regarding the connection between presence of SIV-infected macrophages and neuroglial levels of E2F1 would be strengthened by quantitation of viral expression and comparison to E2F1 levels. Correlation of E2F1 expression with markers of neuronal dysfunction and cellular death will further delineate mechanisms of dementia in SIVE.

Acknowledgments

We thank Ron Hamilton and Christopher Pittman for the dissection and banking of the monkey brains and Jonette Werley for technical support.

Footnotes

Address reprint requests to Clayton A. Wiley, A-515 UPMC Presbyterian, 200 Lothrop St., Pittsburgh, PA 15213. E-mail: wiley@np.awing.upmc.edu.

Supported by National Institutes of Health grants NS10572, MH46790, and NS35731.

References

  • 1.Davies J, Everall IP, Weich S, McLaughlin J, Scaravilli J, Lantos PL: HIV-associated brain pathology in the United Kingdom: an epidemiological study. AIDS 1997, 11:1145-1150 [DOI] [PubMed] [Google Scholar]
  • 2.Masliah E, DeTeresa RM, Mallory ME, Hansen LA: Changes in pathological findings at autopsy in AIDS cases for the last 15 years. AIDS 2000, 14:69-74 [DOI] [PubMed] [Google Scholar]
  • 3.Bacellar H, Munoz A, Miller EN, Cohen BA, Besley D, Selnes OA, Becker JT, McArthur JC: Temporal trends in the incidence of HIV-1-related neurologic diseases: multicenter AIDS cohort study, 1985–1992. Neurology 1994, 44:1892-1900 [DOI] [PubMed] [Google Scholar]
  • 4.Maehlen J, Dunlop O, Liestol K, Dobloug JH, Goplen AK, Torvik A: Changing incidence of HIV-induced brain lesions in Oslo, 1983–1994, effects of zidovudine treatment. AIDS 1995, 9:1165-1169 [PubMed] [Google Scholar]
  • 5.Baskin GB, Murphey-Corb M, Roberts ED, Didier PJ, Martin LN: Correlates of SIV encephalitis in rhesus monkeys. J Med Primatol 1992, 21:59-63 [PubMed] [Google Scholar]
  • 6.Czub S, Muller JG, Czub M, Muller-Hermelink HK: Impact of various simian immunodeficiency virus variants on induction and nature of neuropathology in macaques. Res Virol 1996, 147:165-170 [DOI] [PubMed] [Google Scholar]
  • 7.Joag SV, Stephens EB, Galbreath D, Zhu GW, Li Z, Foresman L, Zhao LJ, Pinson DM, Narayan O: Simian immunodeficiency virus SIVmac chimeric virus whose env gene was derived from SIV-encephalitic brain is macrophage-tropic but not neurovirulent. J Virol 1995, 69:1367-1369 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Mankowski JL, Flaherty MT, Spelman JP, Hauer DA, Didier PJ, Amedee AM, Murphey-Corb M, Kirstein LM, Munoz A, Clements JE, Zink MC: Pathogenesis of simian immunodeficiency virus encephalitis: viral determinants of neurovirulence. J Virol 1997, 71:6055-6060 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Sharer LR, Michaels J, Murphey-Corb M, Hu FS, Kuebler DJ, Martin LN, Baskin GB: Serial pathogenesis study of SIV brain infection. J Med Primatol 1991, 20:211-217 [PubMed] [Google Scholar]
  • 10.Strelow LI, Watry DD, Fox HS, Nelson JA: Efficient infection of brain microvascular endothelial cells by an in vivo-selected neuroinvasive SIVmac variant. J Neurovirol 1998, 4:269-280 [DOI] [PubMed] [Google Scholar]
  • 11.Westmoreland SV, Halpern E, Lackner AA: Simian immunodeficiency virus encephalitis in rhesus macaques is associated with rapid disease progression. J Neurovirol 1998, 4:260-268 [DOI] [PubMed] [Google Scholar]
  • 12.Zink MC, Amedee AM, Mankowski JL, Craig L, Didier P, Carter DL, Munoz A, Murphey-Corb M, Clements JE: Pathogenesis of SIV encephalitis: selection and replication of neurovirulent SIV. Am J Pathol 1997, 151:793-803 [PMC free article] [PubMed] [Google Scholar]
  • 13.Budka H, Wiley CA, Kleihues P, Artigas J, Asbury AK, Cho E-S, Cornbalth DR, Dal Canto MC, DeGirolami U, Dickson D, Epstein LG, Esiri MM, Giangaspero F, Gosztonyi G, Gray F, Griffin JW, Henin D, Iwasaki Y, Janssen RS, Johnson RT, Lantos PL, Lyman WD, McArthur JC, Nagashima K, Peres N, Petito CK, Price RW, Rhodes RH, Rosenblum M, Said G, Scaravilli F, Sharer LR, Vinters HV: HIV-associated disease of the nervous system: review of nomenclature and proposal for neuropathology-based terminology. Brain Pathol 1991, 1:143–152 [DOI] [PubMed]
  • 14.Budka H: Neuropathology of human immunodeficiency virus infection. Brain Pathol 1991, 1:163-175 [DOI] [PubMed] [Google Scholar]
  • 15.Glass JD, Fedor H, Wesselingh SL, McArthur JC: Immunocytochemical quantitation of human-immunodeficiency-virus in the brain—correlations with dementia. Ann Neurol 1995, 38:755-762 [DOI] [PubMed] [Google Scholar]
  • 16.Tyor WR, Glass JD, Baumrind N, McArthur JC, Griffin JW, Becker PS, Griffin DE: Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology 1993, 43:1002-1009 [DOI] [PubMed] [Google Scholar]
  • 17.Power C, Kong PA, Crawford TO, Wesselingh S, Glass JD, McArthur JC, Trapp BD: Cerebral white matter changes in acquired immunodeficiency syndrome dementia: alterations of the blood-brain barrier. Ann Neurol 1993, 34:339-350 [DOI] [PubMed] [Google Scholar]
  • 18.Achim CL, Wiley CA: Expression of major histocompatibility complex antigens in the brains of patients with progressive multifocal leukoencephalopathy. J Neuropathol Exp Neurol 1992, 51:257-263 [DOI] [PubMed] [Google Scholar]
  • 19.Masliah E, Achim CL, Ge N, DeTeresa R, Terry RD, Wiley CA: Spectrum of human immunodeficiency virus-associated neocortical damage. Ann Neurol 1992, 32:321-329 [DOI] [PubMed] [Google Scholar]
  • 20.Achim CL, Wang R, Miners DK, Wiley CA: Brain viral burden in HIV-infection. J Neuropathol Exp Neurol 1994, 53:284-294 [DOI] [PubMed] [Google Scholar]
  • 21.Wiley CA, Achim C: Human immunodeficiency virus encephalitis is the pathological correlate of dementia in acquired immunodeficiency syndrome. Ann Neurol 1994, 36:673-676 [DOI] [PubMed] [Google Scholar]
  • 22.Achim CL, Wiley CA: Inflammation in AIDS and the role of the macrophage in brain pathology. Curr Opin Neurol 1996, 9:221-225 [DOI] [PubMed] [Google Scholar]
  • 23.Wiley CA, Achim CL, Christopherson C, Kidane Y, Kwok S, Masliah E, Mellors J, Radhakrishnan L, Wang G, Soontornniyomkij V: HIV mediates a productive infection of the brain. AIDS 1999, 13:2055-2059 [DOI] [PubMed] [Google Scholar]
  • 24.Wiley CA, Soontornniyomkij V, Radhakrishnan L, Masliah E, Mellors J, Herman SA, Dailey P, Achim CL: Distribution of brain HIV load in AIDS. Brain Pathol 1998, 8:277-284 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Power C, McArthur JC, Nath A, Wehrly K, Mayne M, Nishio J, Langelier T, Johnson RT, Chesebro B: Neuronal death induced by brain-derived human immunodeficiency virus type 1 envelope genes differs between demented and nondemented AIDS patients. J Virol 1998, 72:9045-9053 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Pulliam L, Clarke JA, McGrath MS, Moore D, McGuire D: Monokine products as predictors of AIDS dementia. AIDS 1996, 10:1495-1500 [DOI] [PubMed] [Google Scholar]
  • 27.Pulliam L, Clarke JA, McGuire D, McGrath MS: Investigation of HIV-infected macrophage neurotoxin production from patients with AIDS dementia. Adv Neuroimmunol 1994, 4:195-198 [DOI] [PubMed] [Google Scholar]
  • 28.Crowe SM: Role of macrophages in the pathogenesis of human immunodeficiency virus (HIV) infection. Aust NZ J Med 1995, 25:777-783 [DOI] [PubMed] [Google Scholar]
  • 29.Heyes MP, Saito K, Lackner A, Wiley CA, Achim CL, Markey SP: Sources of the neurotoxin quinolinic acid in the brain of HIV-1-infected patients and retrovirus-infected macaques. FASEB J 1998, 12:881-896 [DOI] [PubMed] [Google Scholar]
  • 30.Giulian D, Yu JH, Li X, Tom D, Li J, Wendt E, Lin SN, Schwarcz R, Noonan C: Study of receptor-mediated neurotoxins released by HIV-1-infected mononuclear phagocytes found in human brain. J Neurosci 1996, 16:3139-3153 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Gelbard HA, Nottet HSLM, Swindells S, Budka H, Wiley CA, Kleihaus P, Artigas J, Asbury AK, Cho E-S, Cornblath DR, Del Canto MC, DeGirolami U, Dickson D, Epstein LG, Esiri MM, Giangaspero F, Gosztonyi G, Gray F, Griffin JW, Henin D, Iwasaki Y, Janssen RS, Johnson RT, Lantos PL, Lyman WD, McArthur JC, Nagashima K, Peres N, Petito CK, Price RW, Rhodes RH, Rosenblum M, Said G, Scaravilli F, Sharer LR, Vinters HV: Platelet activating factor: a candidate HIV-1-induced neurotoxin. J Virol 1994, 68:4628-46358207837 [Google Scholar]
  • 32.Brouwers P, Heyes MP, Moss HA, Wolters PL, Poplack DG, Markey SP, Pizzo PA: Quinolinic acid in the cerebrospinal fluid of children with symptomatic human immunodeficiency virus type 1 disease: relationships to clinical status and therapeutic response. J Infect Dis 1993, 168:1380-1386 [DOI] [PubMed] [Google Scholar]
  • 33.Lo TM, Fallert CJ, Piser TM, Thayer SA: HIV-1 envelope protein evokes intracellular calcium oscillations in rat hippocampal neurons. Brain Res 1992, 594:189-196 [DOI] [PubMed] [Google Scholar]
  • 34.Lipton SA, Sucher NJ, Kaiser PK, Dreyer EB: Synergistic effects of HIV coat protein and NMDA receptor-mediated neurotoxicity. Neuron 1991, 7:111-118 [DOI] [PubMed] [Google Scholar]
  • 35.Price RW, Brew B, Sidtis J, Rosenblum M, Scheck AC, Cleary P: The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science 1988, 239:586-592 [DOI] [PubMed] [Google Scholar]
  • 36.Scherr C: Tumor surveillance via the ARF-p53 pathway. Genes Dev 1998, 12:2984-2991 [DOI] [PubMed] [Google Scholar]
  • 37.Ross M: Cell division and the nervous system: regulating the cycle from neural differentiation to death. Trends Neurosci 1996, 19:62-68 [DOI] [PubMed] [Google Scholar]
  • 38.Kouzarides T: Transcriptional control by the retinoblastoma protein. Semin Cancer Biol 1995, 6:91-98 [DOI] [PubMed] [Google Scholar]
  • 39.Whyte P: The retinoblastoma protein and its relatives. Semin Cancer Biol 1996, 6:83-90 [DOI] [PubMed] [Google Scholar]
  • 40.LaThangue N: DRTF1/E2F: an expanding family of heterodimeric transcription factors implicated in cell-cycle control. Trends Biochem Sci 1994, 19:108-114 [DOI] [PubMed] [Google Scholar]
  • 41.Adams P, Kaelin WJ: Transcriptional control by E2F. Semin Cancer Biol 1995, 6:99-108 [DOI] [PubMed] [Google Scholar]
  • 42.Chellappan S, Hiebert S, Mudryj M, Horowitz J, Nevins J: The E2F transcription factor is a cellular target for the RB protein. Cell 1991, 65:1053-1061 [DOI] [PubMed] [Google Scholar]
  • 43.Chellappan S, Kraus V, Droger B, Munger K, Howley P, Phelps W, Nevins J: Adenovirus E1A, simian virus 40 tumor antigen, and human papillomavirus E7 protein share the capacity to disrupt the interaction between transcription factor E2F and the retinoblastoma gene product. Proc Natl Acad Sci USA 1992, 89:4549-4553 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Helin K, Wu C, Fattaey A, Lees J, Dynlacht B, Ngwu C, Harlow E: Heterodimerization of the transcription factors E2F-1 and DP-1 leads to cooperative trans-activation. Genes Dev 1993, 7:1850-1861 [DOI] [PubMed] [Google Scholar]
  • 45.Bandara L, Buck V, Zamanian M, Sorensen T, Xu F, LaThangue N: Functional synergy between DP-1 and E2F-1 in the cell-cycle-regulating transcription factor DRTF1/E2F. EMBO J 1993, 12:4317-4324 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Helin K, Harlow E, Fattaey A: Inhibition of E2F1 transactivation by direct binding of the retinoblastoma protein. Mol Cell Biol 1993, 13:6501-6508 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Cress W, Johnson D, Nevins J: A genetic analusis of the E2F1 gene distinguishes regulation by RB, p107, and adenovirus E4. Mol Cell Biol 1993, 13:6314-6325 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Flemington E, Speck S, Kaelin W: E2F1-mediated transactivation is inhibited by complex formation with the retinoblastoma susceptibility gene product. Proc Natl Acad Sci USA 1993, 90:6914-6918 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Hagemeier C, Cook A, Kouzarides T: The retinoblastoma protein binds E2F residues required for activation in vivo and TBP binding in vitro. Nucleic Acids Res 1993, 21:4998-5004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Nevins J: E2F: a link between the Rb tumor suppressor protein and viral oncoproteins. Science 1992, 258:424-429 [DOI] [PubMed] [Google Scholar]
  • 51.Farnham P, Slansky J, Kollmar R: The role of E2F in the mammalian cell cycle. Biochim Biophys Acta 1993, 1155:125-131 [DOI] [PubMed] [Google Scholar]
  • 52.DeGregori J, Leone G, Miron A, Jakoi L, Nevins J: Distinct roles for E2F proteins in cell growth control and apoptosis. Proc Natl Acad Sci USA 1997, 94:7245-7250 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Nevins J: Towards an understanding of the functional complexity of the E2F and retinoblastoma families. Cell Growth Differ 1998, 9:585-593 [PubMed] [Google Scholar]
  • 54.Pan H, Yin C, Dyson N, Harlow E, Yamasaki L, Van Dyke T: Key roles for E2F1 in signaling p53-dependent apoptosis and in cell division within developing tumors. Mol Cell 1998, 2:283-292 [DOI] [PubMed] [Google Scholar]
  • 55.Tsai K, Hu Y, Macleod K, Crowley D, Yamasaki LTJ: Mutation of E2F1 suppresses apoptosis and inappropriate S phase entry and extends survival of Rb-deficient mouse embryos. Mol Cell 1998, 2:293-304 [DOI] [PubMed] [Google Scholar]
  • 56.Lackner AA, Dandekar S, Gardner MB: Neurobiology of simian and feline immunodeficiency virus infections. Brain Pathol 1991, 1:201-212 [DOI] [PubMed] [Google Scholar]
  • 57.Haas S, Gordon J, Khalili J: A developmentally regulated DNA-binding protein from mouse brain stimulates myelin basic protein gene expression. Mol Cell Biol 1993, 13:3103-3112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Riley D, Nikitin A, Lee W-H: Adenovirus-mediated retinoblastoma gene therapy suppresses spontaneous pituitary melanotroph tumors in Rb+/− mice. Genes Dev 1996, 10:1870-1879 [DOI] [PubMed] [Google Scholar]
  • 59.Silverstein M, Poller D, Waisman J, Colburn W, Barth A, Gierson E, Lewinsky N, Gamagami P: Prognostic classification of breast ductal carcinoma-in-situ. Lancet 1995, 345:1154-1157 [DOI] [PubMed] [Google Scholar]
  • 60.Guy C, Zhou W, Kaufman S, Robinson M: E2F1 blocks terminal differentiation and causes proliferation in transgenic megakaryocytes. Mol Cell Biol 1996, 16:685-693 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Ausubel FM, Brent R, Kingston RE, Moore DD, Seidman JG, Smith JA, Struhl K, eds: Current Protocols in Molecular Biology. New York, John Wiley and Sons, Inc., 1994, pp 12.11.1-12.11.8
  • 62.Soontornniyomkij V, Wang G, Kapadia S, Achim C, Wiley C: Confocal assessment of lymphoid tissues with follicular hyperplasia from patients infected with human immunodeficiency virus type 1. Arch Pathol Lab Med 1998, 122:534-538 [PubMed] [Google Scholar]
  • 63.Bates S, Peters G: Cyclin D1 as a cellular proto-oncogene. Semin Cancer Biol 1995, 6:73-82 [DOI] [PubMed] [Google Scholar]
  • 64.Weinberg R: The retinoblastoma protein and cell cycle control. Cell 1995, 81:323-330 [DOI] [PubMed] [Google Scholar]
  • 65.Schlessinger J, Ullrich A: Growth factor signaling by receptor tyrosine kinases. Neuron 1992, 9:383-391 [DOI] [PubMed] [Google Scholar]
  • 66.Chao M: Growth factor signaling: where is the specificity. Cell 1992, 68:995-997 [DOI] [PubMed] [Google Scholar]
  • 67.Dyson N: The regulation of E2F by pRB-family proteins. Genes Dev 1998, 12:2245-2262 [DOI] [PubMed] [Google Scholar]
  • 68.Phillips A, Ernst M, Bates S, Rice N, Vousden K: E2F-1 potentiates cell death by blocking antiapoptotic signaling pathways. Mol Cell 1999, 4:771-781 [DOI] [PubMed] [Google Scholar]
  • 69.Duckett C, Thompson C: CD-30-dependent degradation of TRAF-2: implications for negative regulation of TRAF signaling and the control of cell survival. Genes Dev 1997, 11:2810-2821 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70.Jordan-Sciutto K, Bowser R: Alzheimer’s disease and brain development: common molecular pathways. Front Biosci 1998, 3:100-112 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71.McShea A, Wahl A, Smith M: Re-entry into the cell cycle: a mechanism for neurodegeneration in Alzheimer’s disease. Med Hypotheses 1999, 52:525-527 [DOI] [PubMed] [Google Scholar]
  • 72.Kitamura Y, Shimohama S, Kamoshima W, Matsuoka Y, Nomura Y, Taniguchi T: Changes in p53 in the brains of patients with Alzheimer’s disease. Biochem Biophys Res Comm 1997, 232:418-421 [DOI] [PubMed] [Google Scholar]
  • 73.Masliah E, Mallory M, Alford M, Hansen L, Saitoh T: Immunoreactivity of the nuclear antigen p105 is associated with plaques and tangles in Alzheimer’s disease. Lab Invest 1993, 69:562-569 [PubMed] [Google Scholar]
  • 74.Nagy Z, Esiri M, Cato A-M, Smith AD: Cell cycle markers in the hippocampus in Alzheimer’s disease. Acta Neuropathol 1997, 94:6-15 [DOI] [PubMed] [Google Scholar]
  • 75.Nagy Z, Esiri M, Smith A: Expression of cell division markers in the hippocampus in Alzheimer’s disease and other neurodegenerative conditions. Acta Neuropathol 1997, 93:294-300 [DOI] [PubMed] [Google Scholar]
  • 76.McShea A, Harris P, Webster K, Wahl A, Smith M: Abnormal expression of the cell cycle regulators p16 and cdk4 in Alzheimer’s disease. Am J Pathol 1997, 150:1933-1939 [PMC free article] [PubMed] [Google Scholar]
  • 77.Liu W-K, Williams RT, Hall FL, Dickson DW, Yen S-H: Detection of a cdc2-related kinase associated with Alzheimer paired helical filaments. Am J Pathol 1995, 146:228-238 [PMC free article] [PubMed] [Google Scholar]
  • 78.Giovanni A, Wirtz-Bruger F, Keramaris E, Slack R, Park D: Involvement of cell cycle elements, cyclin-dependent kinases, pRb, and E2F-DP, in B-amyloid-induced neuronal death. J Biol Chem 1999, 274:19011-19016 [DOI] [PubMed] [Google Scholar]
  • 79.Aylward EH, Henderer JD, McArthur JC, Brettschneider PD, Harris JG, Barta PE, Pearlson GD: Reduced basal ganglia volume in HIV-1-associated dementia: results from quantitative neuroimaging. Neurology 1993, 43:2099-2104 [DOI] [PubMed] [Google Scholar]
  • 80.Power C, Johnson RT: HIV-1 associated dementia: clinical features and pathogenesis. Can J Neurol Sci 1995, 22:92-100 [DOI] [PubMed] [Google Scholar]
  • 81.Wiley CA, Masliah E, Morey M, Lemere C, DeTeresa R, Grafe M, Hansen L, Terry R: Neocortical damage during HIV infection. Ann Neurol 1991, 29:651-657 [DOI] [PubMed] [Google Scholar]
  • 82.Glass JD, Wesselingh SL, Selnes OA, McArthur JC: Clinical-neuropathologic correlation in HIV-associated dementia. Neurology 1993, 43:2230-2237 [DOI] [PubMed] [Google Scholar]
  • 83.Portegies P, Enting RH, deGans J, Algra PR, Derix MM, Lange JM, Goudsmit J: Presentation and course of AIDS dementia complex: 10 years of follow-up in Amsterdam, The Netherlands. AIDS 1993, 7:669-675 [PubMed] [Google Scholar]
  • 84.Elovaara I, Poutiainen E, Raininko R, Valanne L, Virta A, Valle SL, Lahdevirta J, Iivanainen M: Mild brain atrophy in early HIV infection the lack of association with cognitive deficits and HIV-specific intrathecal immune response. J Neurol Sci 1990, 99:121-136 [DOI] [PubMed] [Google Scholar]

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