The cytotoxic T-lymphocyte response to wild-type simian virus 40 large tumor antigen (Tag) in C57BL/6 (H2 b ) mice is directed against three H2-D b -restricted epitopes, I, II/III, and V, and one H2-K b -restricted epitope, IV. Epitopes I, II/III, and IV are immunodominant, while epitope V is immunorecessive. We investigated whether this hierarchical response was established in vivo or was due to differential expansion in vitro by using direct enumeration of CD8 ؉ T lymphocytes with Tag epitope/major histocompatibility complex class I tetramers and intracellular gamma interferon staining. The results demonstrate that epitope IV-specific CD8 ؉ T cells dominated the Tag-specific response in vivo following immunization with full-length Tag while CD8 ؉ T cells specific for epitopes I and II/III were detected at less than one-third of this level. The immunorecessive nature of epitope V was apparent in vivo, since epitope V-specific CD8 ؉ T cells were undetectable following immunization with full-length Tag. In contrast, high levels of epitope V-specific CD8 ؉ T lymphocytes were recruited in vivo following immunization and boosting with a Tag variant in which epitopes I, II/III, and IV had been inactivated. In addition, analysis of the T-cell receptor ␤ (TCR␤) repertoire of Tag epitope-specific CD8 ؉ cells revealed that multiple TCR␤ variable regions were utilized for each epitope except Tag epitope II/III, which was limited to TCR␤10 usage. These results indicate that the hierarchy of Tag epitope-specific CD8 ؉ T-cell responses is established in vivo.Immunity to the large tumor antigen (Tag) of simian virus 40 (SV40) in C57BL/6 mice is characterized by the development of CD8 (23,34,50,52). An immunological hierarchy has been demonstrated among these four epitopes within Tag. Immunization of C57BL/6 mice with SV40, SV40 Tagtransformed cells, or a recombinant vaccinia virus (rVV) which encodes the full-length Tag leads to the induction of cytotoxic T lymphocytes (CTL) specific for epitopes I, II/III, and IV (26, 41, 51). Frequency estimates from limiting-dilution analysis of splenic lymphocytes obtained 9 days after immunization with SV40 Tag-transformed cells revealed that epitope IV-specific CTL represent 1 in 14,000 splenocytes while epitope I and II/III-specific CTL were less abundant (1 in 67,000) and epitope V-specific CTL were undetectable (41).Although epitope V-specific CTL are not detected following immunization with full-length SV40 Tag, immunization with syngeneic cells carrying inactivating mutations or deletions in Tag epitopes I, II/III, and IV leads to the induction of epitope V-specific CTL (41, 50). Accordingly, epitope V has been characterized as immunorecessive. Additional strategies which enhance the immunogenicity of epitope V include immunization with rVVs which express epitope V as a minigene linked to a secretory signal sequence (ES) or in which the epitope V sequence is inserted into a nonimmunogenic murine self protein, dihydrofolate reductase (26). Precise mechanisms which control the immun...

Purpose: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. Methods: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. Results: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19–0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79–5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34–8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58–170.19; P = 0.02). Conclusions: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.

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