[Granulocytes and oxidative metabolism: role of monoclonal antibodies in superoxide anion release from neutrophils]

We studied the effects on the granulocyte oxidative metabolism of some monoclonal antibodies reacting with a membrane surface antigen fundamental for the functions of these cells. The aim of this investigation was to evaluate the role of CD11b/CD18 membrane glycoproteins on superoxide release from granulocytes. The preincubation with MoAbs 60.1, OKM1, 60.3 determined a significant decrease of anion release from granulocytes stimulated by fMLP.

In vivo and in vitro HeNe laser effects on phagocyte functions

The goal of this work was to evaluate the effect of helium-neon (HeNe) laser irradiation on immunocompetent cells. We used the in vivo skin window method and in vitro granulocyte function tests. The study of cellular migration showed a marked decrease in vitro and in vivo in a dose-independent manner. Superoxide release was not modified by laser irradiation. The granulocyte's aggregation, when using PHA and PMA, presented a reduction that was statistically very significant, not as a subordinate dose. An increase of the release of ATP was demonstrated only at 4 joules and precedes granulocyte aggregation. When using Ca2+ ionophore A23187 as stimulus, laser irradiation at 1, 2 or 4J did not show any modification of granulocyte aggregation. The monoclonal antibody 60.1, which identifies a membrane antigen fundamental for aggregation and chemotaxis, is expressed in normal amounts on granulocyte membranes both before and after irradiation with a HeNe laser. In fact, Laser irradiation preferentially attacks the area of the cellular centrosome that determines a modification of cellular morphology. The electron microscope and immunofluorescence study with a monoclonal antibody have pointed out a disorganization of the microtubules. The alteration of some of the granulocyte functions is correlated to the damage in the centrioles. The granulocyte mitochondrial system and surface membrane remain intact, and this explains the normal production and release of free radicals. Further experiments are necessary to evaluate the clinical application of lasers in various diseases with immunophagocytic pathogenesis.

[Presentation of 2 clinical cases of deficiency of granulocyte membrane glycoproteins]

Two cases of moderate granulocyte adhesion glycoproteins complex deficiency are briefly discussed. These patients presented a clinical history of serious infections at various tissues and organs. Recently, the studies with monoclonal antibodies identified a new group of congenital granulocyte diseases.

[Granulocyte disease caused by glycoprotein complex deficiency correlated with leukocyte adhesion]

This report summarizes the clinical and laboratory findings from a group of our patients and literature reviews from several families who have a genetic deficiency in three related leukocyte membrane surface antigens known as CR3,LFA-1, and p150,95. Each surface antigen has an identical beta-chain noncovalenty linked to one of three distinct alpha-chain types. Patients affected by this autosomal recessive disease have now been identified by several investigators. The patients have an increased susceptibility to bacterial infections that is similar to patients who have other types of neutrophil functional deficiencies or neutropenia. Laboratory tests have indicated that isolated neutrophils from these patients have two major types of functional deficiencies that probably contribute to their reduced ability to overcome bacterial infections. This review focuses exclusively on the phagocytic and cytotoxic abnormalities of neutrophils from these patients.

[In vitro effects of morphine and opioid peptides on neutrophil granulocyte aggregation and ATP release]

The effects of morphine and opioid peptides on neutrophil aggregation and ATP release were studied. Inhibition of human granulocyte aggregation and ATP release was observed in the presence of morphine in a naloxone stereoselective manner, whereas the opioid peptides were ineffective. The effects of DAGO, DADL and Dynorphin 1-9 on the granulocyte aggregation and ATP release were also evaluated, but these opioids peptides are unable to modify neutrophil function. Our studies confirm the role of mu receptors on modulation of polymorphonuclear granulocyte aggregation and suggest a key role of opioid peptides in the regulation of some immune system functions.

New trends in coronary artery disease: the role of granulocyte activation

Circulating granulocytes play an important role in microvascular perfusion and organ pathology. Oxygen radicals released by aggregated and activated neutrophils may exacerbate the tissue damage caused by ischemia. We studied neutrophil aggregation and oxygen metabolites release in 16 patients suffering from coronary artery disease and in 6 control subjects in aorta and coronary sinus blood samples. The neutrophil aggregation (P less than 0.01) and oxidase activity (P less than 0.01) are higher in coronary sinus than aorta samples only in the patients with respect to controls. While the superoxide generation is decreased in coronary sinus (P less than 0.05). Our aggregation assay supported the potential role of granulocytes in neutrophil-endothelial interactions and tissue damage, and our results about oxidase activity and superoxide release suggested the potential role for neutrophil-derived oxygen radicals in the pathogenesis of vascular injury in vivo.

[Breast and skin localization of non-Hodgkin's lymphoma. Description of a clinical case]

A clinical case of a patient suffering from non-Hodgkin lymphoma with breast localization and skin infiltration is reported. Skin lesion was the presenting feature: after diagnosis and chemotherapy the relapse of lymphoma was characterized by breast infiltration. These particular localizations are discussed in terms of their unfavourable prognostic significance in lymphoma.

Effect of piroxicam therapy on granulocyte function and granulocyte elastase concentration in peripheral blood and synovial fluid of rheumatoid arthritis patients

The effect of piroxicam therapy (20 mg/day for 15 days) on various polymorphonuclear granulocyte (PMN) responses and on PMN elastase concentration was investigated in nine patients with active rheumatoid arthritis. Peripheral blood and synovial fluid samples were collected before starting therapy and 12 h after the last dose of the drug. All patients were evaluable for peripheral blood analysis and six for synovial fluid analysis. Piroxicam therapy had no effect on PMN random migration and phagocytosis, while it significantly reduced both FMLP-induced aggregation and FMLP-induced chemotaxis. This seems mainly due to an effect on FMLP binding, as no differences were observed after therapy in PMA- and PHA-induced aggregation as well as in serum-induced chemotaxis. In contrast, a marked impairment of NBT test and PMA- and FMLP-induced superoxide anion (O2-) production was found after piroxicam therapy. This effect was as evident in peripheral blood as in synovial fluid PMN. Also, a significant reduction in synovial fluid PMN number and synovial fluid PMN elastase concentration (elastase-alpha 1-proteinase complex) was found after treatment. It is concluded that piroxicam may act at different sites on various PMN responses. Its effect on O2- generation and PMN elastase concentration in synovial fluid may have an important role in reducing destruction of arthritic joint tissue.

Definition of CD 11a, b, c, and CD 18 glycoproteins on chemotactically deficient granulocyte membranes in patients affected by myeloid disorders

We studied neutrophil chemotaxis and surface membrane glycoproteins in 12 patients suffering from myeloid disorders with abnormal karyotype using in vitro techniques in all 12. Chromosome studies were also carried out virtually simultaneously. We chose to study only patients showing a deficit of chemotaxis (p less than 0.001). Ten of these patients revealed a clonal chromosome abnormality in most of the leukemic cells. The monoclonal antibody technique using MoAb 60.1, 60.3, 60.5, OKM1, LFA-1 and 9E8 demonstrated normal leukocyte membrane glycoproteins CD 11a, b, c and CD 18 and therefore excludes that an abnormality of these is involved in the pathogenesis of altered leukocyte chemotaxis. No correlation between chemotactic deficit and any specific clonal chromosome abnormality was found.

A stereoselective blockade by naloxone of opioid and non-opioid-induced granulocyte activation

Naloxone was found to prevent both opioid and non-opioid-induced migration of human granulocytes in a stereoselective way. Indeed, besides being able to inhibit morphine-induced migration, (-) but not (+), naloxone isomer proved to abolish either casein, serum of fMLP-induced chemotaxis. It is concluded that opioid-induced modulation of granulocyte migration is likely to be mediated through specific receptors, possibly of the mu type. Moreover, the antichemotactic effect of naloxone suggests an involvement of opioid receptors and/or endogenously released opioids in the mechanism of granulocyte activation by different chemoattractants.

Influence of erdosteine, a mucolytic agent, on amoxycillin penetration into sputum in patients with an infective exacerbation of chronic bronchitis

Twenty four patients with acute infective exacerbations of chronic bronchitis received amoxycillin alone or in combination with erdosteine (a mucolytic agent) for a week in a double blind, placebo controlled study. Clinical assessment scores, body temperature, serum and sputum amoxycillin concentrations, and sputum culture results were recorded in each group. Erdosteine significantly increased antibiotic concentrations in sputum but not in serum. The combined treatment also caused a more rapid decrease in sputum viscosity and in body temperature and faster sterilisation of the sputum. These results show that erdosteine increases amoxycillin concentration in sputum in patients with acute exacerbations of chronic bronchitis. This effect may be due to a reduction in the viscosity of the bronchial secretions produced by erdosteine.

Platelet activation in angina at rest. Evidence by paired measurement of plasma beta-thromboglobulin and platelet factor 4

Indexes of in vivo platelet activation, beta-thromboglobulin and platelet factor 4 were measured in triplicate in plasma from venous blood of 69 patients with proven ischaemic heart disease (IHD), discarding samples with a ratio of the plasma concentrations of the two proteins less than 2.6, in order to rule out sampling artifacts. Compared with 60 control volunteers, differences were not significant [for beta-thromboglobulin controls (ng ml-1, mean +/- SD) 27.8-8.6, ischaemic patients 32.3 +/- 17.1; for platelet factor 4 controls 4.3 +/- 1.4, ischaemic patients 5.9 +/- 5.7]. However, when patients were stratified according to disease activity (Group I--patients without spontaneous ischaemic episodes at rest during 4 days of continuous electrocardiographic monitoring; Group II--patients with less than 1 ischaemic episode/day; Group III--patients with greater than 1 episode/day), these indexes were increased in 'active' patients (for beta-thromboglobulin, in Group II--32.4 +/- 10.5 ng ml-1, P less than 0.05 vs. Group I; in Group III--42.6 +/- 14.6 ng ml-1, P less than 0.01 vs. Group I, P less than 0.05 vs. control. Platelet factor 4 was increased only in Group III--8.9 +/- 7.2 ng ml-1, P less than 0.05 vs. control). Beta-thromboglobulin and platelet factor 4 were 25.0 +/- 6.7 ng ml-1 and 4.9 +/- 4.8 ng ml-1, respectively, in Group I (P = NS vs. control). A relationship with the number of spontaneous ischaemic episodes at rest was confirmed by linear regression analysis (in Group III patients for beta-thromboglobulin: r = 0.76, P less than 0.01, and for platelet factor 4 r = 0.62, P less than 0.01). Levels were not elevated in patients with previous myocardial infarction without ischaemia at rest and/or patients with stable angina, and were not influenced by the occurrence of a positive exercise stress test. Coronary angiograms of ischaemic patients were analyzed to assess the extent and severity of atherosclerotic involvement: for both extent and severity, involvement was similar in the three groups. These data support the hypothesis of the occurrence of platelet activation in patients with spontaneous angina at rest, but not in other subsets of IHD patients, and establish the possibility of detecting in vivo platelet activation in IHD by means of such circulating markers.

Organic nitrates: direct antiplatelet effects and synergism with prostacyclin. Antiplatelet effects of organic nitrates

Isosorbide dinitrate inhibits platelet function in vivo at concentrations about 10 times lower than in vitro (10(-7)-10(-6) vs. 10(-6)-10(-5) M). We investigated two possible reasons for this difference. Isosorbide dinitrate and its in vivo longer-lived metabolites, isosorbide-2- and isosorbide-5-mononitrate were incubated for 5 min with human platelet-rich plasma or washed platelets; irreversible aggregation was induced with threshold doses of ADP, adrenaline, collagen, arachidonic acid and thrombin, and thromboxane (TX) B2 production was measured by radioimmunoassay. Moreover, the concentration of exogenous prostacyclin required to inhibit platelet aggregation by 50% (IC50) after preincubation with isosorbide dinitrate or vehicle was determined. At 10(-7) M, only isosorbide-2-mononitrate inhibited aggregation (-12%, p less than 0.05) and TX production (-36%, p less than 0.01) by ADP. At 10(-6) M isosorbide-2-mononitrate inhibited aggregation by adrenaline more than the dinitrate (-41% vs. -25%, p less than 0.05). In addition, at supra-threshold doses of all the aggregating agents, isosorbide dinitrate decreased IC50 of prostacyclin from 2.7 +/- 1.2 to 0.36 +/- 0.2 nM. Generation of a platelet-active metabolite and synergism with prostacyclin are new properties of isosorbide dinitrate that may account for antiplatelet effects in vivo.

Serum, sputum and bronchial concentrations of erythromycin in chronic bronchitis after single and multiple treatments with either propionate-N-acetylcysteinate or stearate erythromycin

Serum and bronchial concentrations of erythromycin were determined in 30 chronic bronchitic patients during an exacerbation phase of bacterial infections. The levels were measured after single and multiple oral treatments with erythromycin-propionate-N-acetylcysteinate (EPAC) or erythromycin stearate (ES) in a double-blind design. EPAC showed higher and longer-lasting erythromycin levels in serum, sputum and pure bronchial mucus than ES. It is believed that EPAC is better absorbed because of its greater stability in the gastrointestinal juices. Higher concentrations in bronchial secretions not always depend on the blood levels. It seems to be possible that the N-acetylcysteine moiety in the molecule of EPAC drug can facilitate antibiotic penetration because of its mucolytic activity. The clinical response (disappearance of fever, clearance of bacterial pathogens from sputum, reduction of quantity and viscosity of sputum) also occurred faster in the EPAC than in the ES group.

Opioid-induced modification of granulocyte function

Inhibition of human granulocyte chemotaxis towards casein was observed in the presence of both the mu and kappa opioid receptor agonists, which, per se, exhibited chemokinetic activity. Naloxone was found to prevent both the opioid-related and opioid-unrelated increase in granulocyte migration. Moreover, morphine inhibited the aggregation response of granulocytes in a naloxone-sensitive way, while the opioid peptides were ineffective. Although opioid agonists with different receptor specificity were capable of strongly modifying human granulocyte migration, no conclusion can be drawn on the role of opioid receptors in regulating migrating activity. On the other hand, opioid receptor activation by morphine is likely to be responsible for aggregation inhibition.

Mechanisms for the in vivo antiplatelet effects of isosorbide dinitrate

We investigated two possible reasons for the greater antiplatelet efficacy of isosorbide dinitrate (ISDN) in vivo as compared to in vitro. ISDN and its two main hepatic metabolites, isosorbide-2-mononitrate (IS-2-MN) and isosorbide-5-mononitrate (IS-5-MN) were compared for their ability to inhibit platelet aggregation and thromboxane B2 generation in vitro in response to threshold concentrations of ADP, adrenaline, collagen, thrombin and arachidonic acid. We also determined the concentration of prostacyclin required to inhibit by 50% platelet aggregation (IC50) in response to supra-threshold doses of aggregating agents. Out of the three nitrates tested, IS-2-MN was more effective than ISDN in inhibition of platelet aggregation and thromboxane B2 formation after ADP (minimum effective concentration: 10(-7) M) and adrenaline (minimum effective concentration: 10(-6) M). In addition, ISDN 10(-4)-10(-6) M decreased IC50 for prostacyclin from 2.7 +/- 1.2 to 0.36 +/- 0.2 nM. Generation of a platelet-active species, IS-2-MN, and synergism with prostacyclin are novel properties of ISDN and may account for in vivo-in vitro differences in antiaggregatory properties and in vivo mechanism of action.

Assessment of lymphocyte and phagocytic cell function in healthy volunteers undergoing short-term phenytoin administration

The effect of short-term (2 weeks) administration of the anticonvulsant drug phenytoin on humoral and cellular immune function and phagocytic cell system activity was tested in nine healthy volunteers. No change either in the absolute or relative counts of leukocytes was found after drug treatment. Moreover, immunoglobulin serum concentration and lymphocyte subsets positive for OKT3, OKT4, OKT8, OKDRIA, OKB2, Leu 7, Leu 11a, anti-beta 2-microglobulin and antitransferrin monoclonal antibodies were not affected by phenytoin administration. A significant impairment of both polymorphonuclear neutrophil migrating activity and stimulated metabolism as measured by nitro blue tetrazolium reduction and superoxide anion generation was found after drug treatment or when phenytoin was added in vitro to the cells at concentrations lying within the anticonvulsant therapeutic range. Monocyte function was unaffected both after phenytoin administration and after direct application to the cells. The phenytoin-induced changes of polymorphonuclear neutrophil function was completely reverted within 2 weeks after drug withdrawal. The phenytoin-induced alterations of the phagocytic cell system are discussed in relation not only to the possible implications in the pathogenesis of adverse effects of anticonvulsant therapy but also to the potential therapeutic exploitation in immunologically mediated disorders.

A study of neutrophil function in a case of associated autoimmune neutropenia and thrombocytopenia treated with high doses of intravenous gammaglobulin (HDIGG)

In autoimmune disorders there is usually only one cell-type involved but occasionally there are more. The cell associated-IgG and -C3 in these disorders are sequestered normally in the spleen and removed by phagocytosis in the reticulum endothelial system (RES). Chronic idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease and normally presents only thrombocytopenia. Infrequently, neutropenia is associated. Recently high doses of intravenous gammaglobulin (HDIGG) have been used to block the cell destruction by RES in these diseases. The patient presented with ITP and associated neutropenia and was treated with HDIGG. We studied some neutrophil function, in relation to therapy (chemotaxis, random migration, latex phagocytosis, NBT reduction, superoxide generation), and performed some cytochemical stains (LAP and myeloperoxidase). We also determined the presence of antiplatelet and antineutrophil functions and resulted in an increase in the platelet and neutrophil count.

Treatment of infections during hematologic malignancies with aztreonam, a new antibiotic

Nineteen patients with hematological malignancies (5 malignant lymphomas, 9 acute leukemia and 5 other hematological diseases) were treated with aztreonam alone or in combination for infection. Four out of five patients in the lymphoma group, 6/9 in the leukemia group and 4/5 in the last group were considered cured of their infection. No important clinical side effects or consistent deterioration of hematology and chemistry tests were observed.

Assessment of polymorphonucleate leucocyte functions in adult epileptic patients undergoing long-term phenytoin treatment

Twelve patients given more than 1 year phenytoin monotherapy and 12 healthy control subjects taking no drugs and matched for sex and age were examined for polymorphonucleate (PMN) functions. To assess PMN activity, cell locomotion and directed migration, phagocytosing ability and bactericidal activity were investigated. No change either in the absolute or relative counts of PMN leucocytes was found in the patients. However, a significant impairment of both PMN chemotaxis and stimulated Nitro Blue Tetrazolium reduction or superoxide anion generation was observed in the patients as compared with the control group of subjects.

[Importance of hyaluronic acid in the modulation of neutrophil migration]

The relationship between JA and phagocyte function has often been reported in the literature. The action of JA may either inhibit or stimulate PMNs function depending on the concentration. On the basis of this experience, the efficacy of JA action, both directly and mediated after incubation was studied. In particular phagocytosis, NBT, superoxide production and chemotaxis were studied in basal conditions and after incubation with hyaluronic acid. In particular chemotaxis was also performed to assay the chemotactic action of the medium in which the monocytes were incubated with JA and the technique was found to produce a distinct progressive improvement in the chemotactic index. In conclusion, it is hypothesised that monocytes incubated with JA produce a chemotactic factor for PMNs.

Prognostic significant of functional defects of granulocytes in myeloproliferative disease

Patients suffering from myeloproliferative diseases are frequently susceptible to infection. We studied granulocyte function and cytogenetics in 32 patients with different myeloproliferative syndromes. In vivo granulocyte function was studied in 10 patients using the skin window technique. Our data demonstrate a deficit in chemotaxis (p less than 0.001) which does not seem to correlate with any specific chromosomal anomaly. Patients showing a deficit in myeloperoxidase activity, phagocytosis, O2- production or NBT reduction also had a much lower median survival with respect to other patients treated with the same protocol but without these deficits (p less than 0.01). By conducting granulocyte function studies at diagnosis one may therefore isolate those patients with an increased risk of contracting infections and a decreased probability of complete remission.

[Effect of methisoprinol on neutrophil functions in patients with rheumatoid arthritis]

Neutrophils and monocytes are fundamental to the inflammatory process. They migrate into inflammatory foci where they manufacture and release numerous substances (enzymes X O2 ions) which if not controlled may injure the tissues they come in contact with. This enhanced response is responsible for the degenerative reaction typical of inflammation which occurs in rheumatoid arthritis. neutrophil and monocyte metabolism are activated in response to various drugs or to chemicals that may be produced either by the inflammatory agents or by other immunocompetent cells. Hence, immune system modulators may be employed to control their response. For this reason neutrophil and monocyte function was studied in subjects with rheumatoid arthritis as was the ability of methisoprinol, a major immunomodulating drug, to control their functional response both in vivo and in vitro. Neutrophils present a defective chemotactic activity attributable to a circulating inhibitory factor, a defect that methisoprinol can correct. The drug also stimulates lymphocytes and monocytes to produce substances that activate neutrophil chemotaxis. Methisoprinol is an excellent drug that can modify the altered cell-mediated immunity of rheumatoid arthritis patients.

[Myelofibrosis caused by cancer: presentation of a clinical case with a very difficult diagnosis]

Fibrosis of the bone marrow or myelofibrosis, is a connective tissue response of the bone marrow, giving rise to alterations of various nature. From an etiological point of view, it may be divided into primitive or secondary forms. Since the therapeutic implications differ, it is important to make a correct differential diagnosis between the 2 forms. With this in mind, particular importance must be given to myelofibrosis secondary to neoplastic metastasis since it frequently presents with a clinical and hematological picture and bone marrow morphology typical of acute or chronic idiopathic myelofibrosis. In such a situation the particular course of the disease and the description fibrosis-sclerosis of the bone marrow are highly suggestive of myelofibrosis secondary to neoplastic metastasis. On the basis of these considerations, we found it interesting to report a case which came under our observations. The patient in this case presented a complex differential diagnosis which offered us the occasion to review and highlight the clinical and histological criteria fundamental to the 2 forms. The patient, a 40 year old woman, presented with a clinical picture typical of myelofibrosis following surgery for a cystic ovary. For 3 years she had felt violent bone pains and had progressively declined in her physical state to the point of cachexia. A careful histological exam of the bone marrow revealed metastasis from the gastric tumor thus giving a clear diagnosis of secondary myelofibrosis.

Skin involvement in hemopathies: specific cutaneous manifestations of acute nonlymphoid leukemias and non-Hodgkin lymphomas

The course of a hemopathy may be characterized by the appearance of cutaneous lesions. In such cases a correct histological investigation is needed, especially when the lesions have an aspecific appearance. It is important, therefore, to recognize the cases characterized by cutaneous involvement of typical systemic disease cells. Lymphomas and leukemias are the hemopathies which more frequently present specific and nonspecific cutaneous manifestations (with an approximate incidence of 3-40 and 6-50%, respectively). In the period 1977-1983 we examined 337 patients affected with acute nonlymphoblastic leukemia and 243 patients affected with non-Hodgkin lymphoma, in order to verify the incidence of specific cutaneous manifestations.

[Chronic brucellosis: diagnostic problems and case presentations]

Chronic Brucellosis is an infection disease, which is still of great clinical interest whether due to the difficulties of diagnosis involved or to the peculiar course of the illness. For this reasons, we have considered several cases of Chronic Brucellosis observed over a period of 10 years, which have presented particular problems of diagnosis. Furthermore, we have underlined the importance in the diagnosis, of intradermal reaction and the hemoreaction to the anamelitina injection. We propose therefore, to consider their diagnostic specificity by analyzing the results obtained.

[Endotoxic contamination of biological products (ribosomal vaccines, viral vaccines and interferon)]

The A.A. have examined by the Limulus assay the possible endotoxin contamination in some biological products (ribosomal vaccines, viral vaccines, interferon). While the preparations of influenza vaccines and a partially purified fraction of ribosomal vaccine from Pseudomonas aeruginosa exhibit a gelation of lysate with high levels of endotoxin, rubeola vaccines, interferon and a purified fraction of ribosomal vaccine, presented a negligible amount of endotoxin. The results are discussed with the aim to examine the possible role of contaminating endotoxin in the mediation of some adverse effects and of the unsuspected extrinsic adjuvant activities developed in clinical and experimental use of these preparations.

[Enterobacteria and endotoxins in abdominal surgical pathology. Critical review and clinico-experimental studies]

A detailed critical review on the role of endotoxins from gram-negative bacteria in the pathogenesis of most of the intestinal experimental models of surgical interest is presented. Data of an investigation on 10 cases of acute appendicitis and 2 cases of intestinal occlusion associated with toxaemia are then presented: in all these cases the Limulus test significatively revealed the presence of endotoxin in the blood and in the peritoneal fluid, also in absence of bacteria in the blood. The implications of these results and the use of the test in clinical practice are discussed.