Neutrophil phagocytic and bactericidal dysfunction induced by bilirubin

Modulation of Inflammation and Immune Responses by Heme Oxygenase-1: Implications for Infection with Intracellular Pathogens

Heme oxygenase-1 (HO-1) catalyzes the degradation of heme molecules releasing equimolar amounts of biliverdin, iron and carbon monoxide. Its expression is induced in response to stress signals such as reactive oxygen species and inflammatory mediators with antioxidant, anti-inflammatory and immunosuppressive consequences for the host. Interestingly, several intracellular pathogens responsible for major human diseases have been shown to be powerful inducers of HO-1 expression in both host cells and in vivo. Studies have shown that this HO-1 response can be either host detrimental by impairing pathogen control or host beneficial by limiting infection induced inflammation and tissue pathology. These properties make HO-1 an attractive target for host-directed therapy (HDT) of the diseases in question, many of which have been difficult to control using conventional antibiotic approaches. Here we review the mechanisms by which HO-1 expression is induced and how the enzyme regulates inflammatory and immune responses during infection with a number of different intracellular bacterial and protozoan pathogens highlighting mechanistic commonalities and differences with the goal of identifying targets for disease intervention.

Heme Catabolic Pathway in Inflammation and Immune Disorders

In recent years, the heme catabolic pathway is considered to play an important regulatory role in cell protection, apoptosis, inflammation, and other physiological and pathological processes. An appropriate amount of heme forms the basic elements of various life activities, while when released in large quantities, it can induce toxicity by mediating oxidative stress and inflammation. Heme oxygenase (HO) -1 can catabolize free heme into carbon monoxide (CO), ferrous iron, and biliverdin (BV)/bilirubin (BR). The diverse functions of these metabolites in immune systems are fascinating. Decades work shows that administration of degradation products of heme such as CO and BV/BR exerts protective activities in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS) and other immune disorders. This review elaborates the molecular and biochemical characterization of heme catabolic pathway, discusses the signal transduction and immunomodulatory mechanism in inflammation and summarizes the promising therapeutic strategies based on this pathway in inflammatory and immune disorders.

The Application of Dextran Sedimentation as an Initial Step in Neutrophil Purification Promotes Their Stimulation, due to the Presence of Monocytes

The purification of human neutrophils for in vitro studies is challenging as they are easily activated through ex vivo manipulations. The technique of erythrocyte sedimentation combined with density gradient centrifugation remains widely practiced and was the subject of this study. Since in the sedimentation step the leukocytes are incubated with dextran, we have raised the likelihood that cellular activation would occur with mediator release leading to neutrophil activation. By comparing the activity of neutrophils purified from whole blood by the classical 2-step method of dextran sedimentation followed by low-density Ficoll-Hypaque (1.077 g/mL) medium, and the 1-step high-density Ficoll-Hypaque (1.114 g/mL) gradient centrifugation, we found that neutrophils from the 2-step method had a significant increase in cell surface CD11b expression and CD62L shedding and a marked increase in adhesion. Decreased random migration and chemotaxis and raised baseline oxidative burst activity were also observed. The effect was not specific to dextran, as using Ficoll for erythrocyte sedimentation replicated the elevated neutrophil adherence. Through the depletion of monocytes, lymphocytes, and platelets prior to sedimentation, we deduced that monocytes were responsible for the neutrophil activation. Our findings suggest that care needs to be exercised in choosing the method of neutrophil purification for functional studies.

Effects of bilirubin on neutrophil responses in newborn infants

BACKGROUND

Newborns are susceptible to inflammatory diseases due to defects in clearing activated immune cells from tissues. Therefore, mechanisms have likely evolved to protect neonates from leukocyte-mediated cytotoxicity. Bilirubin has antioxidant activity, and it is possible that it also exerts effects on cellular immune responses in jaundiced infants.

OBJECTIVES

We hypothesize that bilirubin increases expression of antioxidant genes and decreases production of inflammatory proteins in neonatal neutrophils.

METHODS

Neutrophils were isolated from umbilical cord blood, and from adults for comparison, and treated with bilirubin (10-300 µmol/l, equivalent to unbound bilirubin 3-40 nmol/l), in the presence or absence of lipopolysaccharide (LPS). Expression of genes for antioxidant enzymes [superoxide dismutase (SOD), heme-oxygenase-1 (HO-1)] and heme-dependent enzymes involved in inflammation [NADPH oxidase-1 (NOX-1), cyclooxygenase-2 (COX-2)] was measured by PCR. Inflammatory cytokines were measured by bead array analysis using flow cytometry.

RESULTS

We found that LPS induced production of interleukin (IL)-8, IL-1β, and macrophage inhibitory protein-1β (MIP-1β). Bilirubin increased basal production of IL-8 and IL-1β, but downregulated LPS-induced generation of IL-8 and MIP-1β. It also upregulated SOD and HO-1 gene expression. We observed an unexpected bilirubin-induced increase in gene expression of NOX-1 in LPS-activated cells, and of COX-2 in both resting and activated cells.

CONCLUSIONS

These findings suggest that bilirubin suppresses inflammation and increases antioxidant enzyme generation in activated neonatal neutrophils. The unexpected increases in NOX-1 and COX-2 expression may represent an early response, with physiologic effects mitigated by increased antioxidant activity. Further studies will be needed to define levels of bilirubin that optimize its protective effects, while minimizing potential inflammatory toxicity.

Conditioned medium from stimulated mononuclear leukocytes augments human neutrophil-mediated killing of a virulent Acanthamoeba sp

Human neutrophils in the presence of serum containing anti-amoeba antibody either lacked amoebicidal activity or were poorly amoebicidal for Acanthamoeba culbertsoni. In contrast, neutrophils preexposed for 1 h to supernatants from human peripheral blood mononuclear leukocytes (MNLs) stimulated with phytohemagglutinin demonstrated significant amoeba killing in the presence of serum containing anti-acanthamoeba antibodies. Supernatant from MNL cultured in the absence of phytohemagglutinin were not effective in stimulating significant activity in the neutrophils. Serum containing antibody promoted the adherence of many neutrophils to one amoeba. There was no significant difference between the ability of neutrophils treated with supernatants from stimulated MNLs (stimulated conditioned medium [sCM]) and supernatants from nonstimulated MNLs (nonstimulated conditioned medium [nsCM]) in their binding to acanthamoeba. The effects of sCM on neutrophils was a general phenomenon. For example, the sCM but not the nsCM enhanced the antibody-dependent neutrophil-mediated cytotoxicity against three tumor targets (K562 erythroid myeloid leukemia cell line, B16 melanoma, and P815 (DBA/2 mastocytoma). Furthermore, the sCM but not the nsCM increased the bactericidal (against Staphylococcus aureus and Streptococcus pneumoniae) and fungicidal (against Torulopsis glabrata) activity of the neutrophil. The sCM but not the nsCM contained activities which inhibited neutrophil migration and stimulated a respiratory burst in these leukocytes. These results suggest that the neutrophil antimicrobial power can be increased by exposing the leukocytes to MNL mediators.

Immunocompetence of children with frequent respiratory infections

119 children with recurrent respiratory infections were investigated for immunocompetence. They were divided into two groups. The first, group A, comprised children who had had predominantly upper respiratory infections. Group B comprised those who had had repeated pneumonia in addition. The groups were comparable for gender and age (mean 4.2 years). All the children had reduced neutrophil chemotaxis, reduced neutrophil fungicidal capacity, and perhaps reduced T-cell percentages. Group B children had, in addition to the above, decreased neutrophil bactericidal capacity and a more marked depression of neutrophil chemotaxis. In both groups, some children had reduced immunoglobulin concentrations while others had either normal or increased concentrations. Serum complement, neutrophil iodination, and mitogen-induced lymphocyte transformation were comparable with adult controls in both groups.

Homozygous deficiency of the second component of complement presenting with recurrent bacterial meningitis

A girl presented with purulent meningitis at ages 6, 8, and 11 years. She was in good health between these three episodes. When aged 16 one of her brothers also experienced an attack of pneumococcal meningitis. Complement studies showed lack of C2 in the patient and the brother, and intermediate values in the mother and a sister. No other member of the family was available for study.

Immunological abnormalities in the syndrome of poliomyelitis-like illness associated with acute bronchial asthma (Hopkin's syndrome)

In recent years an unusual syndrome of poliomyelitis-like illness, associated with acute bronchial asthma, has been reported from different parts of the world. A further 3 cases are described in this paper. Although the condition resembles poliomyelitis in most respects, particularly with regard to the severe permanent residual weakness usually observed, consistent evidence of a viral aetiology has not been forthcoming. Tests of immune function suggested the presence of varying degrees of nonspecific immune deficiency in our 3 patients, but evidence of viral invasion was inconclusive. It is suggested that a combination of immune deficiency with the stress of the acute asthma attack rendered the patients susceptible to invasion of the anterior horn cells by a viral agent, which may have been of external origin, or may have existed in a latent form within the host.