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Subject: Activation of Telomerase in Glioma Cells by Human Cytomegalovirus: Another Piece of the Puzzle -- Cinatl et al. 101 (7): 441 -- JNCI Journal of the National Cancer Institute
Date: Sat, 29 Aug 2009 12:38:17 +0200
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<P><FONT size=3D-1><A =
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<TABLE cellSpacing=3D0 cellPadding=3D0>
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      <H2>EDITORIALS</H2></TD></TR></TBODY></TABLE>
<H2>Activation of Telomerase in Glioma Cells by Human Cytomegalovirus: =
Another=20
Piece of the Puzzle</H2></NOBR><NOBR>Jindrich Cinatl, Jr</NOBR>, =
<NOBR>Michael=20
Nevels</NOBR>, <NOBR>Christina Paulus</NOBR>, <NOBR>Martin =
Michaelis</NOBR>=20
<P><FONT size=3D-1><B>Affiliations of authors:</B> Institut f=FCr =
Medizinische=20
Virologie, Klinikum der Johann Wolfgang Goethe-Universit=E4t, Frankfurt =
am Main,=20
Germany (JC, MM); Institut f=FCr Medizinische Mikrobiologie und Hygiene, =

Universit=E4t Regensburg, Regensburg, Germany (MN, CP) </FONT>
<P><FONT size=3D-1><B>Correspondence to:</B> Jindrich Cinatl Jr, PhD, =
Institut f=FCr=20
Medizinische Virologie, Paul Ehrlich-Str. 40, 60596 Frankfurt am Main, =
Germany=20
(e-mail: <SPAN id=3Dem0>cinatl{at}em.uni-frankfurt.de</SPAN>
<SCRIPT type=3Dtext/javascript><!--=0A=
 var u =3D "cinatl", d =3D "em.uni-frankfurt.de"; =
document.getElementById("em0").innerHTML =3D '<a href=3D"mailto:' + u + =
'@' + d + '">' + u + '@' + d + '<\/a>'//--></SCRIPT>
).</FONT>
<P>In this issue of the Journal, Str=E5=E5t et al. (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB1">1=
</A>)<SUP>=20
</SUP>show that human cytomegalovirus (HCMV) infection induces =
telomerase<SUP>=20
</SUP>activation in human malignant glioma cells and fibroblasts.<SUP>=20
</SUP>These results reveal a novel mechanism that may be relevant<SUP> =
</SUP>for=20
the potential of HCMV to promote oncogenesis and thus provide<SUP> =
</SUP>another=20
piece of the puzzle that has drawn the attention of<SUP> =
</SUP>oncologists and=20
virologists for almost four decades.<SUP> </SUP>
<P>A possible relationship between HCMV and cancer has been =
considered<SUP>=20
</SUP>since the beginning of the 1970s when Fuccillo et al. (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB2">2=
</A>)=20
found<SUP> </SUP>increased anti-HCMV antibody titers in cervix carcinoma =

patients<SUP> </SUP>compared with healthy individuals. Although many=20
subsequent<SUP> </SUP>studies compared HCMV antibody titers between =
cancer=20
patients<SUP> </SUP>and healthy people or investigated the presence of =
HCMV=20
proteins,<SUP> </SUP>DNA, or RNA in tumor tissues from different cancer=20
entities,<SUP> </SUP>the role of HCMV in cancer is still unclear (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>).<SUP>=20
</SUP>
<P>HCMV is a ubiquitous herpesvirus that after (subclinical) =
primary<SUP>=20
</SUP>infection persists for the life of its host. The virus is =
believed<SUP>=20
</SUP>to persist mainly in myeloid cells and may be reactivated in<SUP>=20
</SUP>immunocompromised patients with accompanying signs of HCMV =
disease<SUP>=20
</SUP>and infection in cells of many different tissues. In =
immunocompetent<SUP>=20
</SUP>hosts, subclinical virus reactivations may occur (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB4">4=
</A>).=20
Several<SUP> </SUP>recent investigations suggest that in cancer =
patients,=20
clinically<SUP> </SUP>manifest or subclinical HCMV reactivations occur =
more=20
frequently<SUP> </SUP>than previously supposed. Reactivations may be =
induced by=20
stimuli<SUP> </SUP>such as cancer-related immunosuppression, =
conventional=20
chemotherapy,<SUP> </SUP>gamma radiation, or inflammation (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB5">5=
</A>=96<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB7">7=
</A>).<SUP>=20
</SUP>
<P>Findings from the 1970s suggested that HCMV could transform<SUP> =
</SUP>human=20
embryonal fibroblasts (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB8">8=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB9">9=
</A>).=20
However, these studies failed<SUP> </SUP>to detect HCMV nucleic acids or =

proteins after long-term subculture<SUP> </SUP>of the transformed cells. =

Moreover, HCMV infection did not induce<SUP> </SUP>malignant =
transformation of=20
normal human cells in most other<SUP> </SUP>studies. Although various =
attempts=20
were made to explain the<SUP> </SUP>role of HCMV in oncogenesis (eg, =
hit-and-run=20
hypothesis), the<SUP> </SUP>potential of the virus to initiate =
transformation is=20
regarded<SUP> </SUP>with skepticism, and HCMV is not generally =
considered an=20
oncogenic<SUP> </SUP>virus (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>). We=20
hypothesized a process of HCMV oncomodulation<SUP> </SUP>in the 1990s to =
explain=20
a possible contribution of HCMV to tumor<SUP> </SUP>progression (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB10">=
10</A>).=20
Oncomodulation means that HCMV infects established<SUP> </SUP>tumor =
cells and=20
increases tumor malignancy without necessarily<SUP> </SUP>being =
oncogenic (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB10">=
10</A>).=20
Support for this idea is mainly based<SUP> </SUP>on experimental =
findings=20
indicating that HCMV regulatory proteins<SUP> </SUP>and noncoding RNAs =
may=20
influence properties of tumor cells,<SUP> </SUP>including cell =
proliferation,=20
survival, invasion, immunogenicity,<SUP> </SUP>tumor angiogenesis, and=20
chromosomal stability, as well as inflammatory<SUP> </SUP>processes (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB4">4=
</A>).=20
Conceivably, HCMV infection of nontransformed<SUP> </SUP>cells in tumor =
stroma=20
such as fibroblasts or infiltrating immune<SUP> </SUP>cells may also =
influence=20
tumor behavior. According to the concept<SUP> </SUP>of oncomodulation, =
tumor=20
cells provide a genetic environment,<SUP> </SUP>characterized by =
disturbances in=20
intracellular signaling pathways,<SUP> </SUP>transcriptional control, =
and tumor=20
suppressor proteins, that<SUP> </SUP>enables HCMV to manifest its =
oncomodulatory=20
potential in cancer<SUP> </SUP>cells but not in normal cells.<SUP> =
</SUP>
<P>The cancer that has been most frequently investigated for its<SUP>=20
</SUP>association with HCMV is glioma. HCMV infection was for the<SUP>=20
</SUP>first time correlated with a tumor-promoting activity in =
glioma<SUP>=20
</SUP>cells when the HCMV 72 kDa immediate early (IE) 1 protein was<SUP> =

</SUP>found to decrease the expression of the endogenous =
angiogenesis<SUP>=20
</SUP>inhibitor thrombospondin-1 independently of the tumor =
suppressor<SUP>=20
</SUP>protein p53 (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB11">=
11</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB12">=
12</A>).=20
Other cell culture experiments demonstrated<SUP> </SUP>that HCMV =
infection of=20
glioma cells may stimulate tumor cell<SUP> </SUP>cycle progression and=20
invasiveness (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB13">=
13</A>=96<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB15">=
15</A>).=20
Animal studies<SUP> </SUP>demonstrated that a single HCMV protein =
increases the=20
malignancy<SUP> </SUP>of glioma cells. Human glioblastoma cells =
expressing US28,=20
a<SUP> </SUP>chemokine receptor of HCMV, exhibited increased malignancy=20
after<SUP> </SUP>injection in nude mice. In contrast, US28 induced=20
apoptosis<SUP> </SUP>in nontumorigenic human cells, suggesting that US28 =

oncomodulatory<SUP> </SUP>properties are limited to tumorigenic cells =
(<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB16">=
16</A>).<SUP>=20
</SUP>
<P>Histological studies using highly sensitive techniques for virus<SUP> =

</SUP>detection found genomic sequence and antigens of HCMV in =
tumor<SUP>=20
</SUP>cells but not in adjacent normal tissue in a large fraction<SUP> =
</SUP>of=20
glioma patients (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB4">4=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB7">7=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB17">=
17</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB18">=
18</A>).=20
Groups that used less sensitive<SUP> </SUP>histological methods =
established for=20
the detection of active<SUP> </SUP>(high-level) HCMV infection failed to =
detect=20
low-level HCMV<SUP> </SUP>infection in glioma cells (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB19">=
19</A>=96<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB21">=
21</A>).=20
Clearly, HCMV infection<SUP> </SUP>of glioma tissue(s) does not prove =
that the=20
virus contributes<SUP> </SUP>to tumor progression or increases tumor =
malignancy.=20
However,<SUP> </SUP>additional data suggest that low-grade HCMV =
infection of=20
cancer<SUP> </SUP>cells is sufficient to influence the severity of =
cancer=20
diseases.<SUP> </SUP>In support of a role for the virus in tumor =
progression,=20
increased<SUP> </SUP>numbers of infected cancer cells were associated =
with a=20
more<SUP> </SUP>unfavorable outcome in glioma patients (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB4">4=
</A>). It=20
has also been<SUP> </SUP>reported that the fraction of HCMV-infected =
tumors was=20
higher<SUP> </SUP>in glioblastoma multiforme (79%) than in lower grade=20
tumors<SUP> </SUP>(48%) (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB18">=
18</A>).<SUP>=20
</SUP>
<P>The elegant experiments of Str=E5=E5t et al. describe<SUP> </SUP>a =
novel=20
molecular mechanism that may turn out to be critical<SUP> </SUP>to the=20
relationship between HCMV and cancer (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB1">1=
</A>).=20
The authors<SUP> </SUP>show for the first time that infection with =
several=20
different<SUP> </SUP>strains of HCMV results in the induction of human=20
telomerase<SUP> </SUP>reverse transcriptase (hTERT) expression and =
increases=20
telomerase<SUP> </SUP>activity in normally telomerase-silent human =
diploid=20
fibroblasts.<SUP> </SUP>The authors also found that telomerase induction =

correlated<SUP> </SUP>with increased hTERT promoter activity following =
infection=20
in<SUP> </SUP>both primary fibroblasts and malignant glioblastoma cell=20
lines.<SUP> </SUP>
<P>Str=E5=E5t et al. have further demonstrated that HCMV-dependent<SUP>=20
</SUP>telomerase induction depends on active viral gene expression.<SUP> =

</SUP>In fact, ectopic expression of only one viral protein (IE1),<SUP>=20
</SUP>out of the roughly 200 different HCMV gene products, was =
sufficient<SUP>=20
</SUP>to recapitulate (at least partly) the viral effects on hTERT<SUP>=20
</SUP>promoter activation. This finding may not come as a big =
surprise<SUP>=20
</SUP>for many HCMV researchers because IE1 has long been known to<SUP> =
</SUP>be=20
a promiscuous transcriptional activator of numerous viral<SUP> </SUP>and =
host=20
cell genes. This protein reportedly interacts with<SUP> </SUP>several =
common=20
cellular transcription factors including CTF1,<SUP> </SUP>E2Fs, and Sp1 =
(<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB22">=
22</A>).=20
We have shown that IE1 also targets histone<SUP> </SUP>deacetylases =
(HDACs) to=20
promote histone acetylation (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB23">=
23</A>).=20
Str=E5=E5t<SUP> </SUP>et al. demonstrate that some IE1 are physically =
associated=20
with<SUP> </SUP>hTERT promoter sequences during HCMV infection of=20
fibroblasts.<SUP> </SUP>They also provide evidence that the viral =
protein=20
activates<SUP> </SUP>transcription from the hTERT promoter via =
mechanisms that=20
involve<SUP> </SUP>both Sp1 recruitment and HDAC sequestration, followed =
by=20
increased<SUP> </SUP>histone H3 acetylation. These findings are =
additional=20
confirmation<SUP> </SUP>that epigenetic modifications are of fundamental =

importance<SUP> </SUP>for infection and pathogenesis.<SUP> </SUP>
<P>Several groups have previously reported the presence of the<SUP> =
</SUP>IE1=20
protein in HCMV-positive tumor cells [reviewed in (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>)],<SUP>=20
</SUP>and intriguingly, the authors demonstrate a striking =
correlation<SUP>=20
</SUP>between IE1 and hTERT protein levels in histological =
glioblastoma<SUP>=20
</SUP>samples. This is the first time that expression of a protein<SUP>=20
</SUP>known to play an important part in cancer formation and/or=20
progression<SUP> </SUP>has been directly linked to HCMV infection of =
tumor=20
cells.<SUP> </SUP>
<P>Telomerase activation is also caused by infection with other<SUP>=20
</SUP>prominent tumor viruses including Epstein=96Barr virus,<SUP> =
</SUP>Kaposi=20
sarcoma=96associated herpesvirus, human papillomavirus,<SUP> =
</SUP>hepatitis B=20
virus, hepatitis C virus, and human T-cell leukemia<SUP> </SUP>virus-1 =
(<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB24">=
24</A>).=20
In fact, telomerase is commonly activated in cancer<SUP> </SUP>cells of =
both=20
viral and nonviral origin (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB25">=
25</A>),=20
and hTERT activation<SUP> </SUP>is sufficient to immortalize normal =
diploid=20
cells (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB26">=
26</A>).=20
Besides<SUP> </SUP>elongation of telomeres, telomerase may favor tumor =
cell=20
survival<SUP> </SUP>and proliferation by several other mechanisms. The =
enzyme=20
may<SUP> </SUP>inhibit cancer cell apoptosis, promote cancer cell =
growth,=20
favor<SUP> </SUP>emergence of cancer stem cells, and enhance DNA repair =
(<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB25">=
25</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB27">=
27</A>,<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB28">=
28</A>).<SUP>=20
</SUP>Therefore, HCMV-induced telomerase activation represents a =
mechanism<SUP>=20
</SUP>that is of possible relevance for both (initiation of) =
malignant<SUP>=20
</SUP>transformation and oncomodulation by HCMV infection.<SUP> </SUP>
<P>General antiviral therapeutic strategies (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB29">=
29</A>)=20
or inhibition<SUP> </SUP>of HCMV IE gene expression (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB30">=
30</A>)=20
was shown to revert HCMV-induced<SUP> </SUP>malignant changes in =
experimental=20
models. Such strategies may<SUP> </SUP>also be effective to suppress=20
HCMV-induced telomerase activation,<SUP> </SUP>thus possibly preventing =
tumor=20
progression. Moreover, antiviral<SUP> </SUP>treatment may reverse =
HCMV-induced=20
chemoresistance of tumor<SUP> </SUP>cells as already demonstrated in=20
experimental models (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB3">3=
</A>).=20
The<SUP> </SUP>first clinical trial in which the anti-HCMV drug=20
valganciclovir<SUP> </SUP>was used to treat glioma patients has been =
recently=20
completed<SUP> </SUP>at the Karolinska Institutet (<A=20
href=3D"http://jnci.oxfordjournals.org/cgi/content/full/101/7/441#BIB31">=
31</A>),=20
and information about the<SUP> </SUP>results is eagerly awaited.<SUP> =
</SUP>
<P>Naturally, the report of Str=E5=E5t et al. also leaves<SUP> =
</SUP>some open=20
questions. First, it is difficult to really judge<SUP> </SUP>the role of =

HCMV-induced telomerase activation in a possible<SUP> </SUP>HCMV-induced =

oncogenic transformation process because no transformation<SUP> =
</SUP>was shown.=20
The cell types used were either subject to lytic<SUP> </SUP>infection =
and=20
therefore destroyed by HCMV (human diploid fibroblasts)<SUP> </SUP>or =
already=20
transformed cancer (glioblastoma) cells. Moreover,<SUP> </SUP>the =
oncomodulatory=20
effects that might be exerted by HCMV-induced<SUP> </SUP>telomerase =
activation=20
remain to be defined in functional assays.<SUP> </SUP>Nevertheless, the =
work of=20
Str=E5=E5t et al. represents<SUP> </SUP>a very important step toward the =
elucidation=20
of the complicated<SUP> </SUP>relationship between HCMV and cancer.<SUP> =
</SUP>
<P><FONT size=3D+1><STRONG>R<FONT =
size=3D-1>EFERENCES</FONT></STRONG></FONT>
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rnalCode=3Djnci&amp;resid=3D100/2/98"><NOBR>[Abstract/<FONT=20
color=3D#cc0000>Free</FONT>&nbsp;Full&nbsp;Text]</NOBR></A><!-- =
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53407800012&amp;link_type=3DISI">[Web=20
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6617&amp;link_type=3DMED">[Medline]</A><!-- /HIGHWIRE -->
<P><A name=3DBIB26><!-- null --></A><I>26.</I> Boehm JS, Hahn WC. =
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58257100005&amp;link_type=3DISI">[Web=20
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016%2FS0166-3542%2801%2900126-7&amp;link_type=3DDOI">[CrossRef]</A><A=20
href=3D"http://jnci.oxfordjournals.org/cgi/external_ref?access_num=3D0001=
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<P><A name=3DBIB31><!-- null --></A><I>31.</I> Miller G. Brain cancer. A =
viral=20
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	for(var j=3D0; j<tick_status.length; j++) {
	  if((line_status[i] =3D=3D tick_status[j]) && (tick_status_x[j] =3D=3D =
true)) { ok+=3D"s"; }
	}
	var r=3Ddocument.getElementById("row"+line_id[i]);
	if(ok =3D=3D "ays") {
		if(navigator.appName =3D=3D 'Microsoft Internet Explorer') {=20
			r.style.display =3D 'block';
		} else {
			r.style.display =3D 'table-row';
		}
	} else {
	  r.style.display=3D"none";=20
	}
  }
}


function tickbox_change(tickbox) {
  var name=3Dtickbox.name;
  var value=3Dtickbox.value;
  var checked=3Dtickbox.checked;
  switch(name) {
  	case "Archive": tick_archive_x[value]=3Dchecked; break;
	case "Year"   : tick_year_x[value]=3Dchecked; break;
	case "Status" : tick_status_x[value]=3Dchecked;
  }
  filter();
}

function archive_line(id, archives, year_joined, status) {
  line_count++;
  line_id[line_count]=3Did;
  line_archives[line_count]=3Darchives;
  line_year_joined[line_count]=3Dyear_joined;
  line_status[line_count]=3Dstatus;
}
------=_NextPart_000_0044_01CA28A5.95496310
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://jnci.oxfordjournals.org/javascript/ajax/xmlhttprequest.js

/*=0A=
=0A=
Cross-Browser XMLHttpRequest v1.2=0A=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=0A=
=0A=
Emulate Gecko 'XMLHttpRequest()' functionality in IE and Opera. Opera =
requires=0A=
the Sun Java Runtime Environment <http://www.java.com/>.=0A=
=0A=
by Andrew Gregory=0A=
http://www.scss.com.au/family/andrew/webdesign/xmlhttprequest/=0A=
=0A=
This work is licensed under the Creative Commons Attribution License. To =
view a=0A=
copy of this license, visit =
http://creativecommons.org/licenses/by-sa/2.5/ or=0A=
send a letter to Creative Commons, 559 Nathan Abbott Way, Stanford, =
California=0A=
94305, USA.=0A=
=0A=
Attribution: Leave my name and web address in this script intact.=0A=
=0A=
Not Supported in Opera=0A=
----------------------=0A=
* user/password authentication=0A=
* responseXML data member=0A=
=0A=
Not Fully Supported in Opera=0A=
----------------------------=0A=
* async requests=0A=
* abort()=0A=
* getAllResponseHeaders(), getAllResponseHeader(header)=0A=
=0A=
*/=0A=
// IE support=0A=
if (window.ActiveXObject && !window.XMLHttpRequest) {=0A=
  window.XMLHttpRequest =3D function() {=0A=
    var msxmls =3D new Array(=0A=
      'Msxml2.XMLHTTP.5.0',=0A=
      'Msxml2.XMLHTTP.4.0',=0A=
      'Msxml2.XMLHTTP.3.0',=0A=
      'Msxml2.XMLHTTP',=0A=
      'Microsoft.XMLHTTP');=0A=
    for (var i =3D 0; i < msxmls.length; i++) {=0A=
      try {=0A=
        return new ActiveXObject(msxmls[i]);=0A=
      } catch (e) {=0A=
      }=0A=
    }=0A=
    return null;=0A=
  };=0A=
}=0A=
// Gecko support=0A=
/* ;-) */=0A=
// Opera support=0A=
if (window.opera && !window.XMLHttpRequest) {=0A=
  window.XMLHttpRequest =3D function() {=0A=
    this.readyState =3D 0; // =
0=3Duninitialized,1=3Dloading,2=3Dloaded,3=3Dinteractive,4=3Dcomplete=0A=
    this.status =3D 0; // HTTP status codes=0A=
    this.statusText =3D '';=0A=
    this._headers =3D [];=0A=
    this._aborted =3D false;=0A=
    this._async =3D true;=0A=
    this._defaultCharset =3D 'ISO-8859-1';=0A=
    this._getCharset =3D function() {=0A=
      var charset =3D _defaultCharset;=0A=
      var contentType =3D =
this.getResponseHeader('Content-type').toUpperCase();=0A=
      val =3D contentType.indexOf('CHARSET=3D');=0A=
      if (val !=3D -1) {=0A=
        charset =3D contentType.substring(val);=0A=
      }=0A=
      val =3D charset.indexOf(';');=0A=
      if (val !=3D -1) {=0A=
        charset =3D charset.substring(0, val);=0A=
      }=0A=
      val =3D charset.indexOf(',');=0A=
      if (val !=3D -1) {=0A=
        charset =3D charset.substring(0, val);=0A=
      }=0A=
      return charset;=0A=
    };=0A=
    this.abort =3D function() {=0A=
      this._aborted =3D true;=0A=
    };=0A=
    this.getAllResponseHeaders =3D function() {=0A=
      return this.getAllResponseHeader('*');=0A=
    };=0A=
    this.getAllResponseHeader =3D function(header) {=0A=
      var ret =3D '';=0A=
      for (var i =3D 0; i < this._headers.length; i++) {=0A=
        if (header =3D=3D '*' || this._headers[i].h =3D=3D header) {=0A=
          ret +=3D this._headers[i].h + ': ' + this._headers[i].v + '\n';=0A=
        }=0A=
      }=0A=
      return ret;=0A=
    };=0A=
    this.getResponseHeader =3D function(header) {=0A=
      var ret =3D getAllResponseHeader(header);=0A=
      var i =3D ret.indexOf('\n');=0A=
      if (i !=3D -1) {=0A=
        ret =3D ret.substring(0, i);=0A=
      }=0A=
      return ret;=0A=
    };=0A=
    this.setRequestHeader =3D function(header, value) {=0A=
      this._headers[this._headers.length] =3D {h:header, v:value};=0A=
    };=0A=
    this.open =3D function(method, url, async, user, password) {=0A=
      this.method =3D method;=0A=
      this.url =3D url;=0A=
      this._async =3D true;=0A=
      this._aborted =3D false;=0A=
      this._headers =3D [];=0A=
      if (arguments.length >=3D 3) {=0A=
        this._async =3D async;=0A=
      }=0A=
      if (arguments.length > 3) {=0A=
        opera.postError('XMLHttpRequest.open() - user/password not =
supported');=0A=
      }=0A=
      this.readyState =3D 1;=0A=
      if (this.onreadystatechange) {=0A=
        this.onreadystatechange();=0A=
      }=0A=
    };=0A=
    this.send =3D function(data) {=0A=
      if (!navigator.javaEnabled()) {=0A=
        alert("XMLHttpRequest.send() - Java must be installed and =
enabled.");=0A=
        return;=0A=
      }=0A=
      if (this._async) {=0A=
        setTimeout(this._sendasync, 0, this, data);=0A=
        // this is not really asynchronous and won't execute until the =
current=0A=
        // execution context ends=0A=
      } else {=0A=
        this._sendsync(data);=0A=
      }=0A=
    }=0A=
    this._sendasync =3D function(req, data) {=0A=
      if (!req._aborted) {=0A=
        req._sendsync(data);=0A=
      }=0A=
    };=0A=
    this._sendsync =3D function(data) {=0A=
      this.readyState =3D 2;=0A=
      if (this.onreadystatechange) {=0A=
        this.onreadystatechange();=0A=
      }=0A=
      // open connection=0A=
      var url =3D new java.net.URL(new =
java.net.URL(window.location.href), this.url);=0A=
      var conn =3D url.openConnection();=0A=
      for (var i =3D 0; i < this._headers.length; i++) {=0A=
        conn.setRequestProperty(this._headers[i].h, this._headers[i].v);=0A=
      }=0A=
      this._headers =3D [];=0A=
      if (this.method =3D=3D 'POST') {=0A=
        // POST data=0A=
        conn.setDoOutput(true);=0A=
        var wr =3D new =
java.io.OutputStreamWriter(conn.getOutputStream(), this._getCharset());=0A=
        wr.write(data);=0A=
        wr.flush();=0A=
        wr.close();=0A=
      }=0A=
      // read response headers=0A=
      // NOTE: the getHeaderField() methods always return nulls for me :(=0A=
      var gotContentEncoding =3D false;=0A=
      var gotContentLength =3D false;=0A=
      var gotContentType =3D false;=0A=
      var gotDate =3D false;=0A=
      var gotExpiration =3D false;=0A=
      var gotLastModified =3D false;=0A=
      for (var i =3D 0; ; i++) {=0A=
        var hdrName =3D conn.getHeaderFieldKey(i);=0A=
        var hdrValue =3D conn.getHeaderField(i);=0A=
        if (hdrName =3D=3D null && hdrValue =3D=3D null) {=0A=
          break;=0A=
        }=0A=
        if (hdrName !=3D null) {=0A=
          this._headers[this._headers.length] =3D {h:hdrName, =
v:hdrValue};=0A=
          switch (hdrName.toLowerCase()) {=0A=
            case 'content-encoding': gotContentEncoding =3D true; break;=0A=
            case 'content-length'  : gotContentLength   =3D true; break;=0A=
            case 'content-type'    : gotContentType     =3D true; break;=0A=
            case 'date'            : gotDate            =3D true; break;=0A=
            case 'expires'         : gotExpiration      =3D true; break;=0A=
            case 'last-modified'   : gotLastModified    =3D true; break;=0A=
          }=0A=
        }=0A=
      }=0A=
      // try to fill in any missing header information=0A=
      var val;=0A=
      val =3D conn.getContentEncoding();=0A=
      if (val !=3D null && !gotContentEncoding) =
this._headers[this._headers.length] =3D {h:'Content-encoding', v:val};=0A=
      val =3D conn.getContentLength();=0A=
      if (val !=3D -1 && !gotContentLength) =
this._headers[this._headers.length] =3D {h:'Content-length', v:val};=0A=
      val =3D conn.getContentType();=0A=
      if (val !=3D null && !gotContentType) =
this._headers[this._headers.length] =3D {h:'Content-type', v:val};=0A=
      val =3D conn.getDate();=0A=
      if (val !=3D 0 && !gotDate) this._headers[this._headers.length] =
=3D {h:'Date', v:(new Date(val)).toUTCString()};=0A=
      val =3D conn.getExpiration();=0A=
      if (val !=3D 0 && !gotExpiration) =
this._headers[this._headers.length] =3D {h:'Expires', v:(new =
Date(val)).toUTCString()};=0A=
      val =3D conn.getLastModified();=0A=
      if (val !=3D 0 && !gotLastModified) =
this._headers[this._headers.length] =3D {h:'Last-modified', v:(new =
Date(val)).toUTCString()};=0A=
      // read response data=0A=
      var reqdata =3D '';=0A=
      var stream =3D conn.getInputStream();=0A=
      if (stream) {=0A=
        var reader =3D new java.io.BufferedReader(new =
java.io.InputStreamReader(stream, this._getCharset()));=0A=
        var line;=0A=
        while ((line =3D reader.readLine()) !=3D null) {=0A=
          if (this.readyState =3D=3D 2) {=0A=
            this.readyState =3D 3;=0A=
            if (this.onreadystatechange) {=0A=
              this.onreadystatechange();=0A=
            }=0A=
          }=0A=
          reqdata +=3D line + '\n';=0A=
        }=0A=
        reader.close();=0A=
        this.status =3D 200;=0A=
        this.statusText =3D 'OK';=0A=
        this.responseText =3D reqdata;=0A=
        this.readyState =3D 4;=0A=
        if (this.onreadystatechange) {=0A=
          this.onreadystatechange();=0A=
        }=0A=
        if (this.onload) {=0A=
          this.onload();=0A=
        }=0A=
      } else {=0A=
        // error=0A=
        this.status =3D 404;=0A=
        this.statusText =3D 'Not Found';=0A=
        this.responseText =3D '';=0A=
        this.readyState =3D 4;=0A=
        if (this.onreadystatechange) {=0A=
          this.onreadystatechange();=0A=
        }=0A=
        if (this.onerror) {=0A=
          this.onerror();=0A=
        }=0A=
      }=0A=
    };=0A=
  };=0A=
}=0A=
// ActiveXObject emulation=0A=
if (!window.ActiveXObject && window.XMLHttpRequest) {=0A=
  window.ActiveXObject =3D function(type) {=0A=
    switch (type.toLowerCase()) {=0A=
      case 'microsoft.xmlhttp':=0A=
      case 'msxml2.xmlhttp':=0A=
      case 'msxml2.xmlhttp.3.0':=0A=
      case 'msxml2.xmlhttp.4.0':=0A=
      case 'msxml2.xmlhttp.5.0':=0A=
        return new XMLHttpRequest();=0A=
    }=0A=
    return null;=0A=
  };=0A=
}=0A=

------=_NextPart_000_0044_01CA28A5.95496310
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://jnci.oxfordjournals.org/javascript/ajax/utility.js

/************************************************************************=
*****=0A=
 * javascript/ajax/utility.js=0A=
 *=0A=
 * Utility functions for working with XMLHttpRequest data.=0A=
 *=0A=
 * Copyright 2006 Board of Trustees of the Leland Stanford Junior =
University.=0A=
 =
*************************************************************************=
***/=0A=
=0A=
/*=0A=
 * Copy XML nodes into an HTMLElement. This effectively=0A=
 * clones XML markup which uses XHTML naming conventions=0A=
 * into an HTML DOM.=0A=
 */=0A=
function copy_xml_to_html(src, dst) {=0A=
  if (src.nodeType =3D=3D 1) { /* Node.ELEMENT_NODE */=0A=
    var e =3D document.createElement(src.nodeName);=0A=
    for (var i =3D 0; i < src.childNodes.length; i++) {=0A=
	  copy_xml_to_html(src.childNodes[i], e);=0A=
    }=0A=
    for (var i =3D 0; i < src.attributes.length; i++) {=0A=
      var n =3D src.attributes[i].name;=0A=
      var v =3D unescape_xml_string(src.attributes[i].value);      =0A=
      e.setAttribute(n, v);=0A=
      if (n =3D=3D "class") {=0A=
        e.className =3D v;=0A=
      }=0A=
      else if (n =3D=3D "style") {=0A=
        set_css_style(v, e, "");=0A=
      }=0A=
    }=0A=
    dst.appendChild(e);=0A=
  }=0A=
  else if (src.nodeType =3D=3D 3) { /* Node.TEXT_NODE */=0A=
    dst.appendChild(document.createTextNode(src.nodeValue));=0A=
  }=0A=
}=0A=
=0A=
/* =0A=
 * It is unclear that this is the right thing to be calling=0A=
 * from copy_xml_to_html, but it appears that Safari decides=0A=
 * to convert &amp; to the NCR &#35;, and then encodes that=0A=
 * NCR to &%26%2338;.  So, I'm going to treat the DOM Attr=0A=
 * value as a plain string, and run our XML string input=0A=
 * through the decoding routine below.=0A=
 */=0A=
function unescape_xml_string(s) {=0A=
  return s.replace(/&apos;/g, "'")=0A=
          .replace(/&#39;/g,  "'")=0A=
          .replace(/&quot;/g, "\"")=0A=
          .replace(/&#34;/g,  "\"")=0A=
          .replace(/&gt;/g,   ">")=0A=
          .replace(/&#62;/g,  ">")=0A=
          .replace(/&lt;/g,   "<")=0A=
          .replace(/&#60;/g,  "<")=0A=
          .replace(/&amp;/g,  "&")=0A=
          .replace(/&#38;/g,  "&");=0A=
}=0A=
=0A=
/*=0A=
 * Parse set of CSS rules and apply them to an element.=0A=
 * This is quite horrifying, but I'm unable to determine=0A=
 * how else to handle this with IE 6.  FireFox and other=0A=
 * sane browsers let you simply set the style attribute=0A=
 * or use e.style.setProperty(rule, value, priority),=0A=
 * IE 6 appears to have neither of these capabilities..=0A=
 */=0A=
function set_css_style(css, e, priority) {=0A=
  var rules =3D css.split(";");=0A=
  for (var i =3D 0; i < rules.length; i++) {=0A=
    var nvpair =3D rules[i].split(":");=0A=
    if (nvpair.length =3D=3D 2) {=0A=
      try {=0A=
        var name  =3D nvpair[0]; /* style attribute */=0A=
        var value =3D nvpair[1]; /* attribute value */=0A=
  =0A=
        /*=0A=
         * For each possible style attribute, set the=0A=
         * appropriate style property in the element.=0A=
         */=0A=
        if (name =3D=3D "background") {=0A=
           e.style.background =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-attachment") {=0A=
          e.style.backgroundAttachment =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-color") {=0A=
          e.style.backgroundColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-image") {=0A=
          e.style.backgroundImage =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position") {=0A=
          e.style.backgroundPosition =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position-x") {=0A=
          e.style.backgroundPositionX =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-position-y") {=0A=
          e.style.backgroundPositionY =3D value;=0A=
        }=0A=
        else if (name =3D=3D "background-repeat") {=0A=
          e.style.backgroundRepeat =3D value;=0A=
        }=0A=
        else if (name =3D=3D "behavior") {=0A=
          e.style.behavior =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border") {=0A=
          e.style.border =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom") {=0A=
          e.style.borderBottom =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom-color") {=0A=
          e.style.borderBottomColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom-style") {=0A=
          e.style.borderBottomStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-bottom-width") {=0A=
          e.style.borderBottomWidth =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-collapse") {=0A=
          e.style.borderCollapse =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-color") {=0A=
          e.style.borderColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-left") {=0A=
          e.style.borderLeft =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-left-color") {=0A=
          e.style.borderLeftColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-left-style") {=0A=
          e.style.borderLeftStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-left-width") {=0A=
          e.style.borderLeftWidth =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-right") {=0A=
          e.style.borderRight =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-right-color") {=0A=
          e.style.borderRightColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-right-style") {=0A=
          e.style.borderRightStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-right-width") {=0A=
          e.style.borderRightWidth =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-style") {=0A=
          e.style.borderStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-top") {=0A=
          e.style.borderTop =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-top-color") {=0A=
          e.style.borderTopColor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-top-style") {=0A=
          e.style.borderTopStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-top-width") {=0A=
          e.style.borderTopWidth =3D value;=0A=
        }=0A=
        else if (name =3D=3D "border-width") {=0A=
          e.style.borderWidth =3D value;=0A=
        }=0A=
        else if (name =3D=3D "bottom") {=0A=
          e.style.bottom =3D value;=0A=
        }=0A=
        else if (name =3D=3D "clear") {=0A=
          e.style.clear =3D value;=0A=
        }=0A=
        else if (name =3D=3D "clip") {=0A=
          e.style.clip =3D value;=0A=
        }=0A=
        else if (name =3D=3D "color") {=0A=
          e.style.color =3D value;=0A=
        }=0A=
        else if (name =3D=3D "cssText") {=0A=
          e.style.Sets =3D value;=0A=
        }=0A=
        else if (name =3D=3D "cursor") {=0A=
          e.style.cursor =3D value;=0A=
        }=0A=
        else if (name =3D=3D "direction") {=0A=
          e.style.direction =3D value;=0A=
        }=0A=
        else if (name =3D=3D "display") {=0A=
          e.style.display =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font") {=0A=
          e.style.font =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font-family") {=0A=
          e.style.fontFamily =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font-size") {=0A=
          e.style.fontSize =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font-style") {=0A=
          e.style.fontStyle =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font-variant") {=0A=
          e.style.fontVariant =3D value;=0A=
        }=0A=
        else if (name =3D=3D "font-weight") {=0A=
          e.style.fontWeight =3D value;=0A=
        }=0A=
        else if (name =3D=3D "height") {=0A=
          e.style.height =3D value;=0A=
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------=_NextPart_000_0044_01CA28A5.95496310
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://jnci.oxfordjournals.org/javascript/entrez/callback.js

/************************************************************************=
*****=0A=
 * javascript/entrez/callback.js=0A=
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 * Entrez Linking callback to populate content box.=0A=
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 * Copyright 2006 Board of Trustees of the Leland Stanford Junior =
University.=0A=
 =
*************************************************************************=
***/=0A=
=0A=
/*=0A=
 * Execute callback to fill content box with Entrez Linking information.=0A=
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function entrez_callback(pmid, callback_url) {=0A=
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   * MSIE 5.5 and below have issues with the JavaScript=0A=
   * used for Entrez Linking. For now we have to disable=0A=
   * the callback until we can track down a proper fix=0A=
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=0A=
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}=0A=

------=_NextPart_000_0044_01CA28A5.95496310--

