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Peripheral Edema with Hypoalbuminemia in a Nonhuman Primate Infected with Simian–Human Immunodeficiency Virus: a Case Report

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Peripheral Edema with Hypoalbuminemia in a Nonhuman Primate Infected with Simian–Human Immunodeficiency Virus: a Case Report Journal of the American Association for Laboratory Animal Science Vol 47, No 1 Copyright 2008 January 2008 by the American Association for Laboratory Animal Science Pages 42–48 Case Report Peripheral Edema with Hypoalbuminemia in a Nonhuman Primate Infected with Simian–Human Immunodeficiency Virus: A Case Report Carol L Clarke,1,* Michael A Eckhaus,2 Patricia M Zerfas,2 and William R Elkins1 A rhesus macaque (Macaca mulatta) infected with simian-human immunodeficiency virus (SHIV) while undergoing AIDS research, required a comprehensive physical examination when it presented with slight peripheral edema, hypoalbuminemia, and proteinuria. Many of the clinical findings were consistent with nephrotic syndrome, which is an indication of glomerular disease, but the possibility of concurrent disease needed to be considered because lentiviral induced immune deficiency dis- ease manifests multiple clinical syndromes. The animal was euthanized when its condition deteriorated despite supportive care that included colloidal fluid therapy. Histopathology confirmed membranoproliferative glomerulonephritis, the result of immune complex deposition most likely due to chronic SHIV infection. Clinical symptoms associated with this histopathol- ogy in SHIV-infected macaques have not previously been described. Here we offer suggestions for the medical management of this condition, which entails inhibition of the renin–angiotensin–aldosterone system and diet modifications. Abbreviations: ACE, angiotensin-converting enzyme; SHIV, simian–human immunodeficiency virus The development of the simian-immunodeficiency virus AIDS is on going.2 The SHIV chimera in the macaque model (SHIV) chimera for HIV-AIDS research was based on findings for AIDS has been useful in vaccine development by serving that SIV is genetically similar to HIV-2, and certain strains of as the challenge agent, with the level of infection assessed by SIV which are endemic and nonpathogenic in African old world monitoring plasma viral RNA load and virus-induced CD4 4 primates—SIVagm from the African green monkey (Chlorocebus T cell depletion. In regards to CD4 T cell depletion, chronic disease as seen in humans is not duplicated in the highly patho- aethiops), and SIVsm from the sooty mangabey (Cercocebus atys)—can cause pathogenic disease when inoculated into genic SHIV macaque model for HIV–AIDS. The course of the Asian macaques.33 Investigators eventually isolated SIV strains CD4 depletion in nonhuman primate is too rapid, resulting from other species of nonhuman primates including the rhesus in death in 3 to 4 mo.22,24,39 However, lentivirus (SIV) infected 33 macaques parallel many of the other clinical syndromes of AIDS monkey (Macaca mulatta), SIVmac. Variants of SIVmac were later created which also had the ability to cause pathogenic disease patients, namely neuropathy, cardiomyopathy, enteropathy, and in macaques.24,39,45,50 nephropathy,3,27,28,35,43,49 with SHIV-infected animals presumed The first-generation SHIV chimera was generated in 1990, to have the same capability. when investigators sought to combine SIVagm and HIV-1 to identify viral determinants for the narrow host range of HIV-1.47 Case Report Initially 2 types of chimeras were created—one virus carried an Case history. In August 2005, a 9.7-kg, 7-y-old, singly housed, HIV-1 core with the SIV envelope, whereas the other had an SIV colony-bred, male rhesus monkey (Macaca mulatta) undergoing core and the HIV envelope. The construct with the SIV envelope AIDS research presented with slightly edematous areas around did not replicate in monkey cells, whereas the one with the HIV the abdomen and below the rib cage and an erythrematous rash envelope did.47 In time, researchers changed from the parental on the medial thighs and left axillary area. Later, edema in the SIV agm strain to SIVmac, creating a construct with an SIV core and scrotal area became apparent. The animal’s simian retrovirus HIV-1 envelope that was infectious in vivo.45 Eventually highly status was unknown, and there was no history of testing for pathogenic SHIVs were derived from nonpathogenic SHIVs Cercopithecine herpesvirus 1 (B virus). A measles vaccine (At- through animal-to-animal passage.24,39,46 The pathogenic strains tenuvax, Merck, Whitehouse Station, NJ) had been administered were able to induce a nearly complete depletion of circulating in July 1999, and the animal was inoculated in June 2002 with CD4 T lymphocytes in macaques within weeks of infection, an SHIV (HIV envelope and SIV core DNA) mixture recovered followed by an AIDS-like syndrome.24,39 from a late-stage infection.21,45 The study was approved by the Research to create a successful vaccine in man against HIV- institutional animal care and use committee, and the research was conducted in accordance with Public Health Service poli- Received: 19 Jul 2007. Revision requested: 24 Aug 2007. Accepted: 12 Nov 2007. cies and federal regulations. 1The Comparative Medicine Branch, National Institute of Allergy and Infectious Disease; 2 Husbandry. The animal was housed in accordance with the Division of Veterinary Resources, Office of Research Services, National Institutes of 37 Health, Bethesda, MD. Guide for the Care of and Use of Laboratory Animals under a *Corresponding author. Email: [email protected] 12:12-h light cycle at a room temperature of 17.8 to 28.9 pC and 42 Edema with hypoalbuminemia in an SHIV-infected macaque Table 1. Hematology PCV RBC Hemoglobin WBC CD4 T cells/Nl Date 39.9–44.9% a 6.6–7.2 t 106/Nla 12.9–14.3 g/dla 8.9–14.7 t 103/Nla 1237b 8/25/2005 28.4 4.32 9.8 12.5 614 9/29/2005 27.7 4.14 9.3 6.01 445 10/27/2005 30 4.54 10.1 9.1 523 11/23/2005 31.4 4.63 10.2 11.3 765 12/7/2005 27 4.24 9.2 10.5 not available aNormal ranges for healthy macaques.6 bBaseline value for this animal. Table 2. Serum chemistry BUN Creatinine Total protein Albumin Cholesterol Date 17–23 mg/dla 1.0–1.2 mg/dla 7.3–8.3 g/dla 4.1–4.9 g/dla 133–177 mg/dla 8/25/2005 43 1.5 4.4 1.2 137 9/29/2005 51 1.3 4.6 1.7 133 10/27/2005 60 1.7 4.2 1.3 187 11/23/2005 71 1.4 4.1 1.3 171 12/7/2005 67 1.5 3.1 0.9 156 aNormal ranges for healthy macaques.6 a relative humidity of 30% to 70%. Water was provided through combined with unremarkable hepatocellular enzyme and total an automatic water system, and the diet consisted of a high-fiber bilirubin values ruled out hepatic impairment as a concurrent chow (Primate Diet 8788, Harlan Teklad, Madison, WI), fruits, condition (Table 2). and treats (Bio-serv, Frenchtown, NJ). Some SIV infections result in cardiomyopathy that ultimately Case history and diagnostic approach. Clinically significant progresses to congestive heart failure with peripheral edema.43,44 findings from the initial hematology and serum chemistry Although this animal was inoculated with an SHIV chimera, we were: anemia (PCV, 22.8%; RBC count, 3.51 t 106/Nl), hypoal- assumed that it had the same predisposition to develop cardiac buminemia (1.2 g/dl), and hypoproteinemia (4.4 g/dl; Table disease as an SIV-infected animal. Radiography, electrocardiog- 1). The urinalysis performed on a pan-collected sample by raphy, and an echocardiogram were performed under ketamine using a chemistry strip (N-Multistix SG Reagent Strip, Bayer, hydrochloride (Ketaset, Fort Dodge Animal Health, Madison, Shawnee Mission, KS) revealed occult hematuria (3 ) and pro- NJ) anesthesia. The cardiac silhouette on the radiographs was teinuria (3 ). The urine specific gravity was 1.012 according to unremarkable, and electrocardiography revealed a normal rate a handheld clinical refractometer (Atago, Tokyo, Japan; Table and rhythm with no apparent conduction disturbances. The 3). Abnormalities included (but were not limited to): clinical echocardiogram (Acuson Cypress portable ultrasound system, peripheral edema, low serum total protein and albumin, ane- Siemens, Malvern, PA) obtained by using a 2.5-mHz transducer mia, proteinuria, and hematuria. Because the macaque was on to generate images in M-mode and Doppler revealed an esti- an automatic watering system that provided continuous access mated ejection fraction of 70%, a right ventricle of normal size to water, assessment of polyuria and polydipsia was difficult. and function, no resting wall motion abnormalities, no evidence Given the available findings, however, a tentative diagnosis of of valvular regurgitation, and no evidence of pericardial effu- protein-losing nephropathy with cystitis was made. sion.29,41 The results of the cardiac work-up ruled out congestive Serial blood samples revealed anemia, azotemia, hypoalbu- heart failure as a factor in the animal’s condition. minema, and hypoproteinemia (Table 2). Proteinuria remained a Medical management. From August to December 2005, the consistent finding on multiple urinalyses, with cytology reveal- animal was placed on various treatment regimens, which in- ing epithelial cells as a predominate finding after centrifugation cluded hydroxyethyl starch (10 to 20 ml/kg; Hextend, BioTime, of urine samples at 55 t g for 4 min (Statspin Cytocentrifuge, Emeryville, CA) combined with lactated Ringer solution, vita- Iris Sample Processing, Westwood, MA). min B complex (0.1 ml/kg IM once daily; Fortified B Complex, We also explored other possibilities for the clinical findings Agri-Labs, St Joseph, MO), iron (1 ml/10 kg IM once daily; Iron (namely, intestinal malabsorption, hepatic impairment, and Injectable, Vedco, St Joseph, MO), cefazolin sodium (25 mg/ cardiovascular disease) to ensure that no other problems were kg IM twice daily; Cefazolin, Eli Lilly, Indianapolis, IN), keto- present. The persistent anemia was surmised to be the combined profen (2 mg/kg IM once daily; Ketofen, Merial, Duluth, GA), result of SHIV infection and renal impairment.
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