Study on the possible entry of bacterial endotoxin and prostaglandin E2 into the central nervous system from the blood

Correlation of cerebrospinal fluid endotoxinlike activity with clinical and laboratory variables in gram-negative bacterial meningitis in children

Detection of endotoxinlike activity in cerebrospinal fluid by Limulus amebocyte lysate gelation has been suggested as a useful technique for the diagnosis of gram-negative bacterial meningitis. We prospectively screened 1,503 cerebrospinal fluid specimens with a Limulus amebocyte lysate microassay. The limit of sensitivity of the assay was 0.01 ng/ml. All specimens that were positive for endotoxinlike activity were subjected to confirmatory retesting, after which 38 (86%) remained positive. Comparison with available culture results revealed that 33 of 38 specimens (86%) were culture positive; 3 of the 5 culture-negative specimens were from patients on therapy for gram-negative bacterial meningitis, and 1 was from a neonate. The overall specificity of confirmed positive tests was 99.5%, with a positive predictive value of 97.3%. There was one false-negative specimen, giving an overall sensitivity of 97.3% and a negative predictive value of 99.9%. Endotoxinlike activities of greater than or equal to 150 ng/ml correlated with present illness of less than 2 days' duration (P = 0.024), elevated cerebrospinal fluid protein (P less than 0.05), and seizures (P = 0.004); levels of greater than or equal to 3,000 ng/ml correlated with neutropenia (P = 0.032), and levels of greater than or equal to 3.2 X 10(6) ng/ml correlated with death (P = 0.001). We conclude that the Limulus amebocyte lysate microslide gelation test has prognostic value as a sensitive, specific, simple, inexpensive screening test for gram-negative bacterial meningitis.

Evidence for separate mechanisms of induction of biphasic fever inside and outside the blood-brain barrier in rabbits

1. Intravenous bacterial endotoxin, or endogenous pyrogen, in high concentration both caused biphasic fever in rabbits. In low concentration they produced only the first phase of fever. 2. Subcutaneous indomethacin suppressed the first phase of fever produced by high concentration of intravenous endotoxin or endogenous pyrogen, but not the second phase. 3. Intraventricular cerebral injection of indomethacin reduced the second phase of fever produced by high concentration of intravenous endotoxin or endogenous pyrogen, but not the first phase. 4. Intraventricular cerebral injection of endotoxin or of endogenous pyrogen caused slow monophasic fever. This was suppressed by intraventricular, but not by subcutaneous, indomethacin. 5. It is concluded that the first phase of biphasic fever is caused by pyrogen acting via structures outside the blood-brain barrier, presumably peripheral nerves, and the second phase by pyrogen acting via structures within the blood-brain barrier, presumably hypothalamic neurones.

Prostaglandin E2 and fever: a continuing debate

Prostaglandin (PG) E2 is a potent hyperthermic agent and has been assigned an intermediary function in the response of thermoregulatory neurons to pyrogens. Though attractive, this idea has been challenged on several grounds. The present study confirms that brain PGE2 synthesis increases during fever, the time course of the elevation according with a causative role of the compound. Our experimental data also argue against the involvement of a second cyclooxygenase product, specifically thromboxane (TX) A2, in the action of pyrogens. The sequence of events leading to PGE2 production and fever differs depending on the pyrogen, bacterial vs. leucocytic, and its route of administration. Blood-borne interleukin-1 (IL-1) acts on a discrete site in the central nervous system (CNS) which is tentatively identified with the organum vasculosum laminae terminalis (OVLT). The same site may also be the target for blood-borne endotoxin. In addition, endotoxin may promote PGE2 synthesis in the cerebral microvasculature. Both pyrogens, on the other hand, act diffusely throughout the CNS when given intrathecally. We conclude that PGE2 is well suited for an intermediary role in the genesis of fever and ascribe the reported inconsistencies to methodological factors.

Cerebral hemodynamics, oxygen uptake and cerebral arteriovenous differences of catecholamines following E. coli endotoxin in dogs

In experimental endotoxic shock in dogs, a decrease in cerebral blood flow and an increase in cerebral metabolic rate of oxygen (CMRO2) have been shown to occur. In this situation the blood levels of adrenaline and noradrenaline are markedly elevated. The aim of the present study was to investigate whether a cerebral uptake of circulating catecholamines with a possible influence on CMRO2 takes place in the brain. In eight anaesthetized dogs, arterial blood, superior sagittal sinus blood and cerebrospinal fluid were analyzed for the concentrations of adrenaline, noradrenaline and dopamine before and up to 4 h after an injection of E. coli endotoxin 1.0-1.5 mg . kg-1. The blood levels of adrenaline and noradrenaline, but not dopamine, increased in response to the endotoxin. From about 30 min after the endotoxin injection, arteriovenous adrenaline and noradrenaline differences indicating a cerebral uptake were most often seen. Increased concentrations of noradrenaline, adrenaline and dopamine in cerebrospinal fluid were observed. Noradrenaline gave the highest concentrations and these were correlated to the CMRO2. In some animals the blood and cerebrospinal fluid concentrations of adrenaline seemed to be related. These results indicate that catecholamines might be of importance for the development of an increased CMRO2 in endotoxic shock.

Cerebral blood flow and oxygen uptake in endotoxic shock. An experimental study in dogs

Cerebral blood flow (CBF), cerebral oxygen uptake (CMRO2) and central haemodynamics in anaesthetized dogs with controlled ventilation were studied at intervals for 2 h following an intravenous injection of E. coli endotoxin, 1.0-1.5 mg/kg. CBF showed a 30% decrease within 15 min after the endotoxin administration, while the arterial blood pressure was still not markedly depressed. Autoregulation to arterial blood pressure changes was maintained during endotoxinaemia and the cerebrovascular reaction to changes in arterial carbon dioxide tension (PaCO2) depressed. Normocapnic animals (PaCO2) greater than or equal to 4.0 kPa) showed an increase in CMRO2 of over 40%, that was obvious 1 h after the administration of endotoxin. The intracranial pressure was decreased with 5 min of the administration of endotoxin irrespective of the prevailing arterial blood pressure. Thereafter, it was raised above the control level. Two hours after endotoxin increased protein concentrations in cerebrospinal fluid were seen, results compatible with blood-brain barrier damage and penetration of other substances; e.g. monoamines released during endotoxinaemia could thus be expected to have a direct influence on both cerebral blood flow and metabolism.

The effects of high dose methylprednisolone or fluid volume expansion on cerebral haemodynamics and oxygen uptake in endotoxic shock. An experimental study in dogs

E coli endotoxin has been shown to decrease cerebral blood flow (CBF) and increase cerebral metabolic rate of oxygen (CMRO2) in normocapnic dogs. The aim of this study was to investigate the effects of different clinical treatments on the cerebral and central circulation already under the influence of endotoxin. Thus the animals were treated with either methylprednisolone or a lactated Ringer's solution. CBF, CMRO2 and intracranial pressure were followed. Central haemodynamic parameters, i.e. cardiac output, aortic pressure and pulmonary artery pressure, were also measured. Five dogs were given methylprednisolone (Solu-Medrol) 30 mg/kg 90 min after the endotoxin injection. Following this drug there were no significant changes in CBF when compared to controls. The primarily increased CMRO2 did, however, show a transient decrease. Five animals were treated with a lactated Ringer's solution. (Ringerdex), 30 mg/kg, given intravenously over 20 min starting 90 min after the endotoxin injection. In these animals, the cardiac output as well as CMRO2 returned to the values before endotoxin. CBF did not increase significantly.

Simultaneous induction of histidine and ornithine decarboxylases and changes in their product amines following the injection of Escherichia coli lipopolysaccharide into mice

The injection of Escherichia coli lipopolysaccharide (LPS) into mice produced simultaneous induction of histidine and ornithine decarboxylases in the liver, lung, spleen and kidney. The time courses of the changes in activities of the two enzymes were similar in all the tissues. After the injection, both activities increased within 1.5 hr, peaked at 4.5 hr and returned to the basal levels within 15 hr. The induction of these enzymes was very sensitive to this agent, i.e. as little as 1 microgram/kg of the E. coli lipopolysaccharide produced significant increases in these enzyme activities. An increase in the product amines, histamine and putrescine, followed the rise of enzyme activities. The levels of histamine changed more rapidly than those of putrescine. In spite of the increase in putrescine, there was no increase in spermidine and spermine. In the brain and thymus the LPS induced ornithine decarboxylase, but not histidine decarboxylase. In the blood, the histamine level increased without an increase in the activity of histidine decarboxylase. These results are discussed in relation to the actions of lipopolysaccharide. A simple method for the simultaneous assay of the activities of histidine and ornithine decarboxylases without using radioisotope substrates was used in this study.

Dissociation of systemic and renal effects in endotoxemia. Prostaglandin inhibition uncovers an important role of renal nerves

To elucidate the mechanisms responsible for systemic and renal hemodynamic changes in early endotoxemia, the roles of prostaglandins (PG) and renal nerves were investigated. Endotoxin (E, 3 micrograms/kg i.v.) was given to two groups of anesthetized dogs that had undergone unilateral renal denervation: Group I (n = 9) E only; Group II (n = 11) E + indomethacin (10 mg/kg i.v.) or meclofenamate (5 mg/kg i.v.). A third group of dogs (Group III, n = 5) received indomethacin (10 mg/kg i.v.) only. 1 h after E group I dogs, mean arterial pressure (MAP) decreased from 126 to 94 mm Hg (P less than 0.001), and prostacyclin (6-keto-Fl alpha metabolite, PGI2) increased (from 0.64 to 2.08 ng/ml, P less than 0.005). Glomerular filtration rate (GFR) and renal blood flow (RBF) declined comparably both in innervated and denervated kidneys. In marked contrast, group II dogs had a stable MAP (136-144 mm Hg, NS) and no increase in PGI2 levels. Plasma renin activity (0.7-2.5 ng/ml per h, P less than 0.005) increased, and renin secretion was greater in innervated compared with denervated kidneys (255 vs. 74 U/min, P less than 0.01) in these PG-inhibited dogs. In addition, denervated kidneys in group II dogs had a greater GFR (42 vs. 34 ml/min, P less than 0.01) and RFB (241 vs. 182 ml/min, P less than 0.01) than innervated kidneys after E. Group III animals had no significant changes in systemic or renal hemodynamics, plasma renin activity or PGI2 during the study. These results suggest that PGI2 mediates the systemic hypotension of early endotoxemia in the PG-intact animal. Moreover, PG inhibition uncovers an important effect of E to increase efferent renal nerve activity with a consequent decline in GFR and RBF independent of changes in MAP. Finally, the results demonstrate that renal nerves are important stimuli to renin secretion in early endotoxemia via pathways that are PG-independent.

Ability of human leukocytic pyrogen to stimulate brain prostaglandin synthesis in vitro

Fever is thought to be mediated by leukocytic pyrogen (LP), a polypeptide synthesized by phagocytic leukocytes and which is responsible for the upwards resetting of the hypothalamic thermostat. In an attempt to study the effects of LP directly on brain tissue, purified human LP was incubated with rabbit brain slices in vitro. Because of the well-documented role of prostaglandin (PG) synthesis in both the production of fever and antipyresis, PGE levels were measured on the supernates of brain slices incubated 30 min with LP. Levels of PGE increased 3- to 4-fold in rabbit anterior and posterior hypothalami. In addition, PGE levels were similarly increased in temporal cortex slices when exposed to LP. In another set of experiments, PGE levels increased 4- to 5-fold when brain tissue was incubated with a highly purified preparation of bacterial endotoxin (ET). The ability of ET to increase brain PGE levels was not affected by moderate heating (56 degrees C, 30 min), whereas this temperature destroyed the PGE-inducing properties of LP. The antipyretic ibuprofen markedly reduced the amount of PGE measured in the brain slice supernates after stimulation with LP, suggesting that LP brings about synthesis of PGE and not the release of preformed PG. The results demonstrate that LP is a potent inducer of PGE synthesis in rabbit brain and that receptors for LP are not restricted to the thermoregulatory center, but rather may be distributed throughout the brain.

Central pyrogenic activity of muramyl dipeptide

Fever can be elicited in the rabbit by the intravenous administration of relatively large doses of a synthetic immunoadjuvant, N-acetylmuramyl-L-alanyl-D-isoglutamine, or muramyl dipeptide (MDP). This response could be mediated by endogenous pyrogen because MDP has been shown to induce their production both in vivo and in vitro. The results reported here show that intracisternal injection of minute amounts of MDP could elevate fever without activating the release of endogenous pyrogen in the plasma or in the cerebrospinal fluid. Moreover, indomethacin inhibited hyperthermia produced by intracerebroventricular administration of MDP. Therefore, our findings argue in favor of a direct effect of the glycopeptide on the thermoregulatory centers besides its indirect effect through the production of leukocytic pyrogen. This molecule apparently represents the minimal requirement for the pyrogenicity of bacterial peptidoglycan because administration, even by the intracerebral route, of a mixture of muramic acid and of its dipeptide moiety did not elicit fever.