The oxidative stress induced in vivo by Shiga toxin-2 contributes to the pathogenicity of haemolytic uraemic syndrome

Typical haemolytic uraemic syndrome (HUS) is caused by Shiga toxin (Stx)-producing Escherichia coli infections and is characterized by thrombotic microangiopathy that leads to haemolytic anaemia, thrombocytopenia and acute renal failure. Renal or neurological sequelae are consequences of irreversible tissue damage during the acute phase. Stx toxicity and the acute inflammatory response raised by the host determine the development of HUS. At present there is no specific therapy to control Stx damage. The pathogenic role of reactive oxygen species (ROS) on endothelial injury has been largely documented. In this study, we investigated the in-vivo effects of Stx on the oxidative balance and its contribution to the development of HUS in mice. In addition, we analysed the effect of anti-oxidant agents as therapeutic tools to counteract Stx toxicity. We demonstrated that Stx induced an oxidative imbalance, evidenced by renal glutathione depletion and increased lipid membrane peroxidation. The increased ROS production by neutrophils may be one of the major sources of oxidative stress during Stx intoxication. All these parameters were ameliorated by anti-oxidants reducing platelet activation, renal damage and increasing survival. To conclude, Stx generates a pro-oxidative state that contributes to kidney failure, and exogenous anti-oxidants could be beneficial to counteract this pathogenic pathway.

Immunoglobulin M antiplatelet autoantibodies from mice immunized with rat platelets induce thrombocytopenia and platelet function impairment

Antiplatelet monoclonal autoantibodies (mAbs) were derived from CBA mice immunized with rat platelets. Two IgM antiplatelet mAbs were further analyzed. L1C43 mAb bound a 150-160 kDa antigen, recognized activated platelets better than resting ones and impaired platelet adhesion, but not clot retraction. L1H31 mAb recognized a ±95 kDa molecule, bound similarly activated and resting platelets and did not modify platelet adhesion, but inhibited clot retraction. Both mAbs induced in vivo thrombocytopenia most likely through phagocytosis of opsonized platelets. These autoreactive antibodies can thus induce both platelet destruction and impairment of their function. They are reflective of autoantibodies found in human patients and may serve for further analysis of antiplatelet autoantibody pathogenicity and mechanisms of autoimmune disease.

Evaluation of liposomal clodronate in experimental spontaneous autoimmune hemolytic anemia in dogs

OBJECTIVES

Liposomal clodronate (dichloromethylene diphosphonate) has been used to deplete macrophages and block clearance of opsonized cells in mouse models of autoimmune disease. However, liposomal clodronate (LC) has not been previously evaluated in a large-animal spontaneous autoimmune disease model. Therefore, the safety and efficacy of LC treatment was assessed in normal dogs and in dogs with spontaneous autoimmune hemolytic anemia (AIHA).

METHODS

LC was administered intravenously first to healthy dogs and then to dogs with spontaneous, severe AIHA to determine if the treatment was safe and could block clearance of opsonized red blood cells (RBCs) in vivo. Studies were also conducted to assess the in vitro effects of LC on dog macrophages and dendritic cells.

RESULTS

Intravenous infusion of low doses of LC was well tolerated and blocked clearance of opsonized RBCs in normal dogs in vivo. LC was taken up by splenic macrophages and dendritic cells in vivo, and induced killing of macrophages and dendritic cells in vitro. Seven dogs with severe, spontaneous AIHA were treated with LC in a pilot study. Treatment was well tolerated, 2 of 7 LC-treated dogs with AIHA had a decrease in RBC clearance, and LC-treated dogs had significantly increased survival times compared to historical control dogs matched for disease severity.

CONCLUSIONS

These results indicate that LC can be safely administered intravenously to dogs and that even relatively low doses are capable of blocking RBC clearance and improving outcomes in a spontaneous large-animal model of AIHA. Therefore, additional studies of LC for treatment of autoantibody-mediated cytopenias in dogs and humans may be warranted.

Macrophage depletion following liposomal-encapsulated clodronate (LIP-CLOD) injection enhances megakaryocytopoietic and thrombopoietic activities in mice

Megakaryocytopoiesis is the cellular process by which stem cells progress through commitment, proliferation and differentiation, leading to the production of platelets. In the mouse, this process is accomplished within the bone marrow (BM) and spleen microenvironment and is carried out by regulatory molecules and accessory cells, including macrophages, fibroblasts and endothelial-like cells. Previously, we demonstrated that specific macrophage depletion, using liposomal-encapsulated clodronate (LIP-CLOD), induced a rapid recovery of the platelet count in a mouse model of immune thrombocytopenia. We now show that LIP-CLOD treatment also provoked enhancement of both megakaryocytopoiesis and thrombocytopoiesis. In fact, a dose-dependent increase in the number of BM and spleen megakaryocytes was detected after treatment and this pattern correlated inversely to the macrophage count detected in these organs. Furthermore, the mice treated with the higher dose of LIP-CLOD showed signs of enhanced thrombopoiesis as they had an increased frequency of reticulated platelets and an improvement in the total platelet count 2 d later. In addition, the in vitro cytokine-induced megakaryocytopoiesis in BM and spleen cell cultures was significantly augmented in the presence of LIP-CLOD. Taken together, these results suggest that BM and spleen microenvironmental macrophages could be involved in the regulation of megakaryocyte and platelet production.

Clodronate liposomes: perspectives in research and therapeutics

Liposomes encapsulating the bisphosphonate clodronate can be used for the transient suppression of macrophage functions. Given the important role of macrophages in various disorders, the application of clodronate liposomes has been studied in several models of rheumatoid arthritis, neurological disorders such as experimental allergic encephalomyelitis and spinal cord injury, autoantibody mediated disorders such as immune thrombocytopenic purpura (ITP) and for the improvement of the efficacy of gene transfer and drug targeting.