Locomotion of neutrophil granulocytes from patients with thermal injury. Identification of serum-derived inhibitors

Pathophysiology of the burn wound and pharmacological treatment. The Rudi Hermans Lecture, 1995

The body's reaction to thermal injury is much more than an initial, local inflammatory response. The burn wound is a continuous, severe threat against the rest of the body due to invasion of infectious agents, antigen challenge and repeated additional trauma caused by wound cleaning and excision. The inflammatory mediators which control blood supply and microvascular permeability in the wound have been extensively studied and are largely understood. Attempts to suppress the inflammatory reaction by different drugs, have, however, been less successful. Extensive thermal injury and sepsis also results in immunosuppression. The defects causing immunosuppression are still very much under consideration. An understanding of these defects is essential for the development of therapies. The increasing interest in the control of the inflammatory reactions by cytokines may, in the near future, be of great importance.

Priming of eosinophil and neutrophil migratory responses by interleukin 3 and interleukin 5

In the present study the influence of interleukin 3 and interleukin 5 on the migration of normal eosinophil and neutrophil granulocytes has been investigated. LTB4, PAF, f-MLP, C5a and ZAS were used as chemoattractants, and HSA and pooled normal human serum were used as chemokinetic agents. Recombinant human IL-5 (rh-IL5) at a concentration of 4 x 10(-12) mol/l was chemotactic for eosinophils, while recombinant mouse IL-5 (rm-IL5) attracted both eosinophils and neutrophils. IL-3 (rh-IL3) at a concentration around 10(-12) mol/l exerted a priming effect on eosinophil and neutrophil migration, i.e. chemotactic and chemokinetic responses to all agents tested. Human IL-5 at a concentration of 2 to 20 x 10(-12) mol/l primed the chemotactic and chemokinetic responses of eosinophils to all agents tested. The migration of neutrophils was also primed by rh-IL5, but at higher concentrations, i.e. around 10(-10) mol/l. IL-5 of mouse origin primed the migration of both eosinophils and neutrophils. In conclusion, IL-3 primed the migratory function of both eosinophils and neutrophils, while IL-5 was a more potent primer of eosinophil than of neutrophil migration.

Neutrophil function in patients with primary Sjögren's syndrome: relation to infection propensity

The function of neutrophils was studied in 23 consecutive patients with primary Sjögren's syndrome and in 35 healthy controls. Nineteen patients (83%) had extraglandular symptoms and nine patients (39%) had recurrent bacterial infections. The patients had a marked reduction of neutrophil adherence, especially those with recurrent bacterial infections, and reduced opsonic activity of plasma. Increased random migration of isolated neutrophils was found in the patients with a propensity for bacterial infections. Chemotaxis and chemokinesis, phagocytosis, chemiluminescence production, and the intracellular neutrophil contents of lactoferrin and lysozyme were normal. The various aspects of neutrophil function tested in this study were not related to disease duration or to inflammatory disease activity. The impaired neutrophil adherence may play a part in the increased propensity for bacterial infections seen in patients with primary Sjögren's syndrome.

Migratory responses of eosinophil and neutrophil granulocytes from patients with asthma

In the present study the migratory function of eosinophil and neutrophil granulocytes from patients with asthma were investigated. Fifty-seven patients with asthmatic disease of varying severity were included. Eosinophil and neutrophil chemotactic responses to 5% pooled normal human serum (NHS), 5% allergen-challenge serum, 2.5% zymosan-activated serum, N-formyl-methionyl-leucyl-phenylalanine (10 nmol/L), chemokinetic responses to albumin (2 gm/L) and 5% NHS, and the eosinophil and neutrophil chemotactic and chemokinetic activities of serum were investigated. Eosinophils from patients with asthma demonstrated significantly (p less than 0.02) increased chemotactic responses to allergen-challenge serum, zymosan-activated serum, and N-formyl-methionyl-leucyl-phenylalanine, compared with eosinophils from references. The chemokinetic responses to albumin and NHS were increased (p less than 0.01) by eosinophils from the patients who had blood eosinophilia (greater than 400 X 10(6)/L). Sera from the patients with asthma demonstrated raised eosinophil chemotactic activity (p less than 0.001) and raised eosinophil and neutrophil chemokinetic activity (p less than 0.001). The eosinophil chemokinetic activity of serum was correlated to the relative peak expiratory flow rate of the patients (r = -0.43; p less than 0.02). The increased migratory responses were specific for the eosinophils, since the migratory responses of their neutrophils were not altered compared with that of the references. These results suggest that the eosinophils from the patients with asthma had been exposed to a priming mechanism in vivo.

Evidence of a plasma-mediated "window" of immunodeficiency in rats following trauma

The etiology of immunodeficiency following trauma was investigated. Plasma collected from Fischer rats 1-8 hr following a 40% surface area thermal injury (TI) displays immunosuppressive activity (ISA). Peak ISA (4 hr) exceeded 90% inhibition of Con A3-induced proliferation of normal spleen cells. Splenic macrophage IL-1 secretion and NK activity are also inhibited by 4-hr TI plasma. Most importantly, these same cellular immune functions decline in rats by 4 hr following TI. After a further decline by 16 hr (IL-1 = 19.8% and NK activity = 40% of normal), these cellular immune functions rebound toward normal values by 2 days following TI. Thus, ISA in plasma is both temporally and functionally linked to the cellular immune defects observed. Sham-treatment rats display a similar, although less marked, pattern of plasma-linked transient cellular immune defects indicating a role for stress in these responses. ISA is abolished by mild heat (56 degrees C for 30 min) and wholly contained in the greater than 10-kD fraction of plasma. Together, these results provide evidence that previously unrecognized molecules in plasma induce a "window" of immunodeficiency early following trauma.

Defects in polymorphonuclear neutrophil function and susceptibility to infection in children

Polymorphonuclear neutrophil (PMN) migration, phagocytosis, chemiluminescence production and chemotactic and chemokinetic activities in serum were investigated in 38 infection-prone children, aged 1 month to 15 years, and in healthy controls. The patients were grouped according to the clinical pattern, that is, into children with mainly upper respiratory tract infections, with frequent middle ear infections, with lower respiratory tract infections and with 'multifocal' infections occasionally accompanied by complications, and according to the severity of the infections. Forty-two defects were found in 28 of the 38 patients examined. Good accordance was found between clinical symptoms and abnormal PMN function. Several of the observed abnormalities are most likely inherited and primary causes of the increased susceptibility, but some of them probably occur as a consequence of the infections. The results indicate that defects in oxidative PMN metabolism and defects in Fc-receptor-dependent phagocytosis are major determinants of susceptibility to infection and that such defects seem to be especially common in patients with severe 'multifocal' infections.

The chemokinetic inhibitory factor (CIF) in serum of CLL patients: correlation with infection propensity and disease activity

We have recently described the partial purification and characterization of a neutrophil migration inhibitory activity present in serum from patients with chronic lymphocytic leukaemia (CLL). This new lymphokine, the chemokinetic inhibitory factor (CIF), is produced by B-CLL cells. It is a heat-labile glycoprotein of an approximate molecular weight (m. w.) of 30000. In this extended investigation 64/89 CLL-patients had CIF in their serum. CLL serum diluted to a concentration of 0.02% gave significantly decreased chemokinetic activity, suggesting that CIF is potent at very low concentrations. 31/89 patients had increased infection propensity. Significantly more patients with CIF in serum had infections compared to the group with normal susceptibility to infections. The combination of low Ig levels and CIF in serum discriminated even better between the infection-prone and non-infection-prone patients. CIF in serum was not correlated to tumour cell mass - estimated by Rai clinical staging - tumour progression or deoxythymidine kinase, S-TK, an enzyme that may reflect proliferating cells. The existence of this new lymphokine in serum seems to contribute to the increased susceptibility to infections seen in CLL patients.

Increased in vivo secretory activity of neutrophil granulocytes in patients with psoriasis and palmoplantar pustulosis

The relationship between psoriasis and palmoplantar pustulosis (PPP) is uncertain, as is the role of the neutrophil granulocyte in these conditions. In a previous comparative study of the rate of polymorphonuclear leucocyte (PMN) phagocytosis of IgG- and IgG-C3b-coated particles, an increased uptake rate was found in both diseases. Further information on the in vivo activity of PMNs in these conditions may be obtainable by determining the level of lactoferrin (LF) in serum from such patients, since LF serves as a specific marker of the turnover and activity of the circulating pool of neutrophils. In this study on 19 patients with psoriasis and 20 patients with PPP, elevated levels of LF were found in both conditions. In contrast, the levels of lysozyme and beta 2-microglobulin, which are markers of monocyte-macrophage and lymphocyte activity, respectively, were normal. This suggests the selective activation of neutrophils in these disorders. LF was significantly correlated (P less than 0.05 and 0.001, respectively) to the rates of phagocytosis of IgG- and IgG-C3b-coated particles, but not to the chemotaxis of isolated PMNs. There was no correlation between the severity of the disease and the levels of serum LF. The data suggest the increased in vivo activity of neutrophils in psoriasis and PPP.

Random locomotion in dark-field microscopy of single granulocytes from venous blood, tissue and exudate. Methodological considerations and clinical applications

The random locomotion of granulocytes was studied in dark-field microscopy, and a standardized procedure for the classification of granulocytes into rapid-moving, (RM), slow-moving (SM) and non-moving (NM) cells was developed. When granulocytes from blood donors were tested, 54% were RM, 21% SM and 25% NM with variation between repeated tests, acceptable for a semiquantitative method. When the test was applied in 124 patients with infectious and inflammatory diseases and hematological malignancies, a significantly higher number of NM blood cells was found in patients with septicemia and pneumonia. The method was found especially suitable for samples containing few granulocytes, such as samples from soft-tissue infections, pulmonary infiltrates and neutropenic blood.

The history of burns treatment in Sweden

The history of burns treatment in Sweden shows that not until an organized Burns Unit was established in 1954 was there any real progress in this field. From that date and onward the treatment of burns has continuously been improved based on results from experimental and clinical research. It is interesting to note that most of the burn research during this period has slowly changed from description of different organ failures towards studies of functional disturbances on cell level. The resuscitation following thermal injury is nowadays usually under control. The greatest problems arise later, caused by hypermetabolism, malnutrition and burn wound sepsis. The combined treatment with aggressive surgery, hyperalimentation, environmental control, avoidance of multiple organ failure etc., mainly based on results from the last 20 years of burn research, has significantly increased the survival rate of severe thermal injuries.

Partial characterization and identification of chemokinetic factors in serum

The chemokinetic effect of serum, defined as the stimulation of the rate of polymorphonuclear neutrophil (PMN) migration in the presence of serum has been investigated for the purpose of identifying the major factors in serum contributing to this effect. The chemokinetic activity has been measured in fresh and heated (56 degrees C) serum and in fractions of serum separated by gel filtration. Gel filtration showed the existence of at least three heat-stable chemokinetic factors with approximate molecular weight of 800,000, 150,000, and 70,000. By immunoprecipitation and immunoadsorption the 800,000 mol. wt factor was identified as alpha 2-macroglobulin and the 70,000 mol wt. factor as alpha 1-antitrypsin and orosomucoid. Heat-labile chemokinetic activity was found in fractions representing mol. wts around 200,000 and 50,000. Immunoprecipitation and immunoadsorption indicated that these heat-labile chemokinetic factors were C3-associated. This investigation suggests a new functional role for the acute-phase reactants alpha 2-macroglobulin, alpha 1-antitrypsin, orosomucoid, and C3 in the modulation of PMN migration and also suggests that the chemokinetic activities of these substances are regulated by specific antagonists at various levels.

Identification of a chemokinetic inhibitor in serum from patients with chronic lymphocytic leukaemia

The effects of serum from patients with chronic lymphocytic leukaemia (CCL) on normal polymorphonuclear leucocyte migration (PMN) were examined by means of the leading front technique, using a modified Boyden chamber. 18 randomly selected patients were studied. 13 patients had a reduced chemokinetic activity. The defective migration was explained by the finding in serum from these patients of cell-directed inhibitory activity which was destroyed by heating (56 degrees C, 30 min). The B-lymphocytes as the origin of the inhibitory activity was suggested by the presence of a similar activity in supernatants from cultured tumour cells. 6 of the 18 patients had the combination of a defective chemokinetic activity and low levels of immunoglobulins. These 6 patients had an increased tendency towards infections.