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Previous Volume 334:1292-1297 May 16, 1996 Number 20 Next

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ABSTRACT

Background The recent identification in patients with Kaposi's sarcoma of DNA sequences with homology to gammaherpesviruses has led to the hypothesis that a newly identified virus, Kaposi's sarcoma–associated herpeslike virus (KSHV), has a role in the pathogenesis of Kaposi's sarcoma. We developed serologic markers for KSHV infection.

Methods KSHV antigens were prepared from a cell line (BC-1) that contains the genomes of both KSHV and the Epstein–Barr virus (EBV). We used immunoblot and immunofluorescence assays to examine serum samples from 102 patients with human immunodeficiency virus type 1 (HIV-1) infection for antibodies to KSHV-associated proteins and to distinguish these antibodies from antibodies to EBV antigens. A positive serologic response was defined by the recognition of an antigenic polypeptide, p40, in n-butyrate–treated BC-1 cells and by the absence of p40 recognition in untreated BC-1 cells or EBV-infected, KSHV-negative cells. The detection by the immunofluorescence assay of 10 to 20 times more antigen-positive cells in n-butyrate–treated BC-1 cells than in untreated cells was considered a positive response.

Results Antibodies to the p40 antigen expressed by chemically treated BC-1 cells were identified in 32 of 48 HIV-1–infected patients with Kaposi's sarcoma (67 percent), as compared with only 7 of 54 HIV-1–infected patients without Kaposi's sarcoma (13 percent). These results were confirmed by an immunofluorescence assay. The positive predictive value of the serologic tests for Kaposi's sarcoma was 82 percent, and the negative predictive value 75 percent.

Conclusions The presence of antibodies to a KSHV antigenic peptide correlates with the presence of Kaposi's sarcoma in a high-risk population and provides further evidence of an etiologic role for KSHV.

Source Information

From the Departments of Pediatrics (G.M., L.H., E.G.), Internal Medicine (M.O.R.), Epidemiology and Public Health (G.M.), Molecular Biophysics and Biochemistry (G.M., R.S.), and Genetics (R.S.), Yale University School of Medicine, New Haven, Conn.; St. Luke's–Roosevelt Hospital Center, New York (C.M.); the University of California, San Francisco, School of Medicine, San Francisco (J.A.L.); and the College of Physicians and Surgeons and School of Public Health, Columbia University, New York (C.M., S.-J.G., Y.C., P.M.).

Address reprint requests to Dr. Miller at the Department of Pediatrics, Yale University School of Medicine, 333 Cedar St., Rm. 420 LSOG, New Haven, CT 06520.

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Testing for Antibodies in Kaposi's Sarcoma
Martin J. N., Gerberding J. L., Osmond D. H., Miller G., Rigsby M.
Extract | Full Text  
N Engl J Med 1996; 335:819-820, Sep 12, 1996. Correspondence

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• Haque, M., Chen, J., Ueda, K., Mori, Y., Nakano, K., Hirata, Y., Kanamori, S., Uchiyama, Y., Inagi, R., Okuno, T., Yamanishi, K. (2000). Identification and Analysis of the K5 Gene of Kaposi's Sarcoma-Associated Herpesvirus. J. Virol. 74: 2867-2875 [Abstract] [Full Text]  
• Parravicini, C., Chandran, B., Corbellino, M., Berti, E., Paulli, M., Moore, P. S., Chang, Y. (2000). Differential Viral Protein Expression in Kaposi’s Sarcoma-Associated Herpesvirus-Infected Diseases : Kaposi’s Sarcoma, Primary Effusion Lymphoma, and Multicentric Castleman’s Disease. Am. J. Pathol. 156: 743-749 [Abstract] [Full Text]  
• Martin, J. N., Amad, Z., Cossen, C., Lam, P. K., Kedes, D. H., Page-Shafer, K. A., Osmond, D. H., Forghani, B. (2000). Use of Epidemiologically Well-Defined Subjects and Existing Immunofluorescence Assays To Calibrate a New Enzyme Immunoassay for Human Herpesvirus 8 Antibodies. J. Clin. Microbiol. 38: 696-701 [Abstract] [Full Text]  
• Dittmer, D., Stoddart, C., Renne, R., Linquist-Stepps, V., Moreno, M.E., Bare, C., McCune, J.M., Ganem, D. (1999). Experimental Transmission of Kaposi's Sarcoma-associated Herpesvirus (KSHV/HHV-8) to SCID-hu Thy/Liv Mice. J. Exp. Med. 190: 1857-1868 [Abstract] [Full Text]  
• Doniger, J., Muralidhar, S., Rosenthal, L. J. (1999). Human Cytomegalovirus and Human Herpesvirus 6 Genes That Transform and Transactivate. Clin. Microbiol. Rev. 12: 367-382 [Abstract] [Full Text]  
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• Kliche, S., Kremmer, E., Hammerschmidt, W., Koszinowski, U., Haas, J. (1998). Persistent Infection of Epstein-Barr Virus-Positive B Lymphocytes by Human Herpesvirus 8. J. Virol. 72: 8143-8149 [Abstract] [Full Text]  
• Dittmer, D., Lagunoff, M., Renne, R., Staskus, K., Haase, A., Ganem, D. (1998). A Cluster of Latently Expressed Genes in Kaposi's Sarcoma-Associated Herpesvirus. J. Virol. 72: 8309-8315 [Abstract] [Full Text]  
• Schmid, D. S. (1998). Role of HHV-8 in Kaposi Sarcoma: Abstract and Commentary. JAMA 280: 570-571 [Full Text]  
• Raab, M.-S., Albrecht, J.-C., Birkmann, A., Lang, D., Fleckenstein, B., Neipel, F. (1998). The Immunogenic Glycoprotein gp35-37 of Human Herpesvirus 8 Is Encoded by Open Reading Frame K8.1. J. Virol. 72: 6725-6731 [Abstract] [Full Text]  
• Chatlynne, L. G., Lapps, W., Handy, M., Huang, Y. Q., Masood, R., Hamilton, A. S., Said, J. W., Koeffler, H.P., Kaplan, M. H., Friedman-Kien, A., Gill, P. S., Whitman, J. E., Ablashi, D. V. (1998). Detection and Titration of Human Herpesvirus-8-Specific Antibodies in Sera From Blood Donors, Acquired Immunodeficiency Syndrome Patients, and Kaposi's Sarcoma Patients Using a Whole Virus Enzyme-Linked Immunosorbent Assay. Blood 92: 53-58 [Abstract] [Full Text]  
• Pau, C.-P., Lam, L. L., Spira, T. J., Black, J. B., Stewart, J. A., Pellett, P. E., Respess, R. A. (1998). Mapping and Serodiagnostic Application of a Dominant Epitope within the Human Herpesvirus 8 ORF 65-Encoded Protein. J. Clin. Microbiol. 36: 1574-1577 [Abstract] [Full Text]  
• Regamey, N., Cathomas, G., Schwager, M., Wernli, M., Harr, T., Erb, P. (1998). High Human Herpesvirus 8 Seroprevalence in the Homosexual Population in Switzerland. J. Clin. Microbiol. 36: 1784-1786 [Abstract] [Full Text]  
• Muralidhar, S., Pumfery, A. M., Hassani, M., Sadaie, M. R., Azumi, N., Kishishita, M., Brady, J. N., Doniger, J., Medveczky, P., Rosenthal, L. J. (1998). Identification of Kaposin (Open Reading Frame K12) as a Human Herpesvirus 8 (Kaposi's Sarcoma-Associated Herpesvirus) Transforming Gene. J. Virol. 72: 4980-4988 [Abstract] [Full Text]  
• Oksenhendler, E., Cazals-Hatem, D., Schulz, T. F., Barateau, V., Grollet, L., Sheldon, J., Clauvel, J.-P., Sigaux, F., Agbalika, F. (1998). Transient Angiolymphoid Hyperplasia and Kaposi's Sarcoma after Primary Infection with Human Herpesvirus 8 in a Patient with Human Immunodeficiency Virus Infection. NEJM 338: 1585-1590 [Full Text]  
• Moore, P. S., Chang, Y. (1998). Kaposi's Sarcoma-Associated Herpesvirus-Encoded Oncogenes and Oncogenesis. J Natl Cancer Inst Monogr 1998: 65-71 [Abstract] [Full Text]  
• Sirianni, M. C., Vincenzi, L., Fiorelli, V., Topino, S., Scala, E., Uccini, S., Angeloni, A., Faggioni, A., Cerimele, D., Cottoni, F., Aiuti, F., Ensoli, B. (1998). gamma -Interferon Production in Peripheral Blood Mononuclear Cells and Tumor Infiltrating Lymphocytes From Kaposi's Sarcoma Patients: Correlation With the Presence of Human Herpesvirus-8 in Peripheral Blood Mononuclear Cells and Lesional Macrophages. Blood 91: 968-976 [Abstract] [Full Text]  
• TAMM, M., REICHENBERGER, F., MCGANDY, C. E., STALDER, A., TIETZ, A., DALQUEN, P., PERRUCHOUD, A. P., CATHOMAS, G. (1997). Diagnosis of Pulmonary Kaposi's Sarcoma by Detection of Human Herpes Virus 8 in Bronchoalveolar Lavage. Am. J. Respir. Crit. Care Med. 157: 458-463 [Abstract] [Full Text]  
• Cheng, E. H.-Y., Nicholas, J., Bellows, D. S., Hayward, G. S., Guo, H.-G., Reitz, M. S., Hardwick, J. M. (1997). A Bcl-2 homolog encoded by Kaposi sarcoma-associated virus, human herpesvirus 8, inhibits apoptosis but does not heterodimerize with Bax or Bak. Proc. Natl. Acad. Sci. USA 94: 690-694 [Abstract] [Full Text]  
• Moore, P. S., Boshoff, C., Weiss, R. A., Chang, Y. (1996). Molecular Mimicry of Human Cytokine and Cytokine Response Pathway Genes by KSHV. Science 274: 1739-1744 [Abstract] [Full Text]  
• Martin, J. N., Gerberding, J. L., Osmond, D. H., Miller, G., Rigsby, M. (1996). Testing for Antibodies in Kaposi's Sarcoma. NEJM 335: 819-820 [Full Text]  
• Gao, S.-J., Kingsley, L., Hoover, D. R., Spira, T. J., Rinaldo, C. R., Saah, A., Phair, J., Detels, R., Parry, P., Chang, Y., Moore, P. S. (1996). Seroconversion to Antibodies against Kaposi's Sarcoma-Associated Herpesvirus-Related Latent Nuclear Antigens before the Development of Kaposi's Sarcoma. NEJM 335: 233-241 [Abstract] [Full Text]