C. Ganciclovir treatment. 
Ganciclovir treatment will begin 24 hours post virus injection at 5 mg/kg IV over 
1 hour every 12 hours for two weeks (28 doses). For each dose, the lyophilized 
powder, 500 mg supplied in a glass vial, will be dissolved in 10 ml sterile water to give 
a solution of 50 mg/ml. Based upon the patient's weight, the appropriate calculated 
dose volume will be removed from the vial and added to infusion fluid (typically 100 
ml) and delivered over a 1 hr period. 
D. Peri-operative Medications 
1. Antibiotics: All patients will deceive a single dose I.V. of Vancomycin, typically 1 
gram, or the antibiotic defined by standard care just prior to the surgical 
procedure. 
2. Steroids: If clinically indicated patients may receive dexamethasone, typically 20 mg 
I.V. prior to viral injection. 
3. Anticonvulsant: Anticonvulsant therapy will be administered according to the usual 
neurosurgical guidelines. Phenytoin will be the primary anticonvulsant drug used 
unless there are contraindications. 
5. Analgesics: Pain medication may include codeine and small doses of other narcotic 
medications. 
6. Granulocyte colony stimulating factor (G-CSFV Patients may receive G-CSF 
support for neutropenia (<500 cells/mm 3 ). 
E. The ADV/RSV-tk Replication-defective Recombinant Adenovirus Vector. 
Adenoviridae is a family of viruses first isolated in 1953 from tonsils and adenoidal 
tissue from children (Roe et al.). Six sub-genera (A, B, C, D, E and F) and more than 42 
serotypes of adenoviruses have been identified as infectious agents in humans (Graham 
and Prevec, 1991; Horwitz, 1991). Although a few isolates have been associated with 
tumors in animals, none have been associated with tumors in humans. The adenoviral 
vector proposed for this study belongs to the subgenus C, serotype 5 (Ad5). Wild type Ad5 
have not been associated with tumor formation. Infection by Ad5 results in acute mucous- 
membrane infection of the upper respiratory tract, eyes, lymphoid glands and nodes, with 
mild symptoms similar to those of the common cold. Exposure to C type adenoviruses is 
widespread in the population; the majority of adults are seropositive for this type of 
adenovirus. 
Adenoviruses are icosahedrons of 65 to 80 nanometers in diameter containing 13% 
DNA and 87% protein. The viral DNA is approximately 36 kilobases in length, naturally 
found in the nucleus of infected cells as a circular structure held together by the interaction 
of proteins covalently linked to each of the 5’ ends of the linear genome. The ability to work 
with functional circular clones of the adenoviral genome greatly facilitated molecular 
manipulations and allowed the production of replication defective vectors (McGrory, et al. 
1988). 
Recombinant DNA Research, Volume 20 
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