Effect of antimicrobial agents on human polymorphonuclear leukocyte microbicidal function

The Efficacy and Mechanism Evaluation of Treating Idiopathic Pulmonary fibrosis with the Addition of Co-trimoxazole (EME-TIPAC): study protocol for a randomised controlled trial

BACKGROUND

We hypothesise, based upon the findings from our previous trial, that the addition of co-trimoxazole to standard therapy is beneficial to patients with moderate to severe idiopathic pulmonary fibrosis (IPF). We aim to investigate this by assessing unplanned hospitalisation-free survival (defined as time from randomisation to first non-elective hospitalisation, lung transplant or death) and to determine whether any effect relates to changes in infection and/or markers of disease control and neutrophil activity.

METHODS/DESIGN

The EME-TIPAC trial is a double-blind, placebo-controlled, randomised, multicentre clinical trial. A total of 330 symptomatic patients, aged 40 years old or older, with IPF diagnosed by a multidisciplinary team (MDT) according to international guidelines and a FVC ≤ 75% predicted will be enrolled. Patients are randomised equally to receive either two tablets of co-trimoxazole 480 mg or two placebo tablets twice daily over a median treatment period of 27 (range 12-42) months. All patients receive folic acid 5 mg daily whilst on the trial IMP to reduce the risk of bone marrow depression. The primary outcome for the trial is a composite endpoint consisting of the time to death, transplant or first non-elective hospital admission and will be determined from adverse event reporting, hospital databases and the Office of National Statistics with active tracing of patients missing appointments. Secondary outcomes include the individual components of the primary outcome, (1) King's Brief Interstitial Lung Disease Questionnaire, (2) MRC Dyspnoea Score, (3) EQ5D, (4) spirometry, (5) total lung-diffusing capacity and (6) routine sputum microbiology. Blood will be taken for cell count, biochemistry and analysis of biomarkers including C-reactive protein and markers of disease. The trial will last for 4 years. Recruitment will take place in a network of approximately 40 sites throughout the UK (see Table 1 for a full list of participating sites). We expect recruitment for 30 months, follow-up for 12 months and trial analysis and reporting to take 4 months.

DISCUSSION

The trial is designed to test the hypothesis that treating IPF patients with co-trimoxazole will increase the time to death (all causes), lung transplant or first non-elective hospital admission compared to standard care ( https://www.nice.org.uk/guidance/cg163 ), in patients with moderate to severe disease. The mechanistic aims are to investigate the effect on lung microbiota and other measures of infection, markers of epithelial injury and markers of neutrophil activity.

TRIAL REGISTRATION

International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 17464641 . Registered on 29 January 2015.

Synthesis, structural characterization and influence on the phagocytic activity of human neutrophils of thiazoline and thiazine derivative ligands and their zinc(II) complexes

The zinc(II) complexes dichloro[2-(3,4-dichlorophenyl)imino-kappaN-(2-thiazolin-kappaN-2-yl)thiazolidine]zinc(II) (1) and dichloro[2-(3,4-dichlorophenyl)imino-kappaN-(4H-5,6-dihydro-1,3-thiazin-kappaN-2-yl)tetrahydrothiazine]zinc(II) (2) have been isolated and characterized in the solid state by X-ray diffraction, elemental analysis and IR spectra. In both complexes, the environment around the zinc(II) ion may be described as a distorted tetrahedral geometry, with the metallic atom coordinated to two chlorine atoms [Zn-Cl(1)=2.218(1)A; Zn-Cl(2)=2.221(1)A], one imino nitrogen [Zn-N(3)=2.042(2)A] and one thiazoline nitrogen [Zn-N(1)=2.022(2)A] in complex 1 and to two chlorine atoms [Zn-Cl(1)=2.216(1)A; Zn-Cl(2)=2.192(1)A], one imino nitrogen [Zn-N(3)=2.045(2)A] and one thiazine nitrogen [Zn-N(1)=2.039(2)A] in complex 2. In addition, we also report in this study the crystal structure of the 2-(3,4-dichlorophenyl)imino-N-(2-thiazolin-2-yl)thiazolidine (TdTn) ligand as well as the synthesis and characterization by X-ray diffraction, (1)H and (13)C NMR spectra, elemental analysis, IR and electronic spectra of the 2-(3,4-dichlorophenyl)imino-N-(4H-5,6-dihydro-1,3-thiazin-2-yl)tetrahydrothiazine (TzTz) ligand. Besides, we study the phagocytic function in humans neutrophils treated with each complex and ligand aforementioned.

Effect of antituberculous drugs on human polymorphonuclear leukocyte functions in vitro

The aim of the study was to investigate antituberculous drugs effects on polymorphonuclear leukocyte (PMN) functions (phagocytic activity and intracellular killing activity) in vitro. PMNs obtained from healthy volunteers were incubated with antituberculous drugs (isoniazid [INH], rifampin [RIF], pyrazinamide [PZA], ethambutol [EMB], streptomycin [S], amikacin [A], ofloxacin [OFLX], prothionamide [PTH] and cycloserine [CyC]) and different combinations at therapeutic serum concentrations. Phagocytic activity of PMNs was significantly increased when compared with controls by PTH (p<0.001), A (p<0.001), OFLX (p<0.001), INH+RIF+S combination (p<0.01), A+OFLX combination (p<0.05), A+OFLX+CyC combination (p<0.01) and A+OFLX+CyC+PTH+EMB combination (p<0.01). Intracellular killing activity of PMNs was significantly increased by OFLX when compared with the control (p<0.05). No significant difference was observed in functions of PMN for other drugs when compared with control (p>0.05). Functions of PMN were significantly increased by OFLX when compared with A+OFLX combination (p<0.05). Phagocytic activity of PMNs was significantly increased by A+OFLX+CyC combination and A+OFLX+CyC+PTH+EMB combination when compared with A+OFLX+CyC+PTH combination and A+OFLX+CyC+PTH+PZA combination (p<0.05). No significant difference was found in functions of PMN between the other groups (p>0.05). In conclusion, some antituberculous drugs alone or in combination enhanced PMN functions, although in combination no additive or synergistic effects were detected. Moreover, none of the antituberculous drugs alone or in combination significantly decreased PMN functions. The drugs having adverse effects on immune functions would better be replaced with equally effective drugs or drug combinations having positive effects on PMN functions.

Effects of aztreonam on natural immunity in mice

The influence of the dose and the duration of treatment with aztreonam, a monocyclic beta-lactam antibiotic, on the natural immune response of mice has been investigated. The results show the effects induced by the antibiotic on several immune parameters were affected by the duration of treatment. Thus, treatment with 28 mg/kg per day of aztreonam over 14 days increased every immune parameter tested, while treatment with 57 mg/kg per day of aztreonam for 7 days only enhanced the natural killer (NK) activity of splenocytes. Since aztreonam does not apparently impair the innate immune response, it might be a suitable therapy for the treatment of patients who are immunosuppressed.

Minocycline for the treatment of rheumatoid arthritis

The scientific basis for the use of antibiotics (with special emphasis on tetracycline and its derivatives) in the treatment of RA is discussed. The data on efficacy and toxicity are presented. The possible place of tetracycline derivatives within the overall strategy of RA treatment is also presented.

In vitro effect of cefodizime, imipenem/cilastatin and co-trimoxazole on dexamethasone and cyclosporin A depressed phagocytosis

Phagocytosis is an important part of the host defense against infection. Antibiotics can influence phagocytic function. In the present study, leukocyte metabolic response to phagocytic challenge by latex was assessed in relation to in vitro addition of cotrimoxazole, imipenem/cilastatin, cefodizime, dexamethasone (DXM), and/or cyclosporin A (CsA). Using latex particles as phagocytic challenge, glucose-1-14C utilization and 14CO2 production were measured by liquid scintillation counting. The phagocytic response was impaired by in vitro addition of DXM or CsA and this setup was used as an experimental model of immunodepression. The addition of co-trimoxazole to control samples (without DXM or CsA) depressed the response to latex challenge, whereas imipenem and cefodizime had a neutral effect. In the presence of DXM, co-trimoxazole induced a further decrease. The depressive effect of DXM was partially neutralized in the presence of cefodizime. With CsA depression, co-trimoxazole also induced a further decrease, imipenem had a neutral effect, while cefodizime partially restored the CsA suppressed reaction. Co-trimoxazole depressed the phagocytic response, imipenem had a neutral effect, whereas cefodizime restored the experimentally induced immunosuppression.

Antibiotics commonly used to treat mastitis and respiratory burst of bovine polymorphonuclear leukocytes

The in vitro effects of six doses (2 x 10(-3) to 2 x 10(-8) M) of antimicrobial drugs that are frequently used in udder infusions on the capacity of bovine blood polymorphonuclear neutrophilic leukocytes to generate reactive oxygen species were studied by the measurement of luminol-dependent chemiluminescence after stimulation with phorbol 12-myristate 13-acetate. All drugs, except cloxacillin, significantly decreased chemiluminescence at the highest dose. Doxycyline induced the most severe inhibition, followed by neomycin and dihydrostreptomycin. The effect of ampicillin was due to the scavenging of reactive oxygen species and interactions with luminol. The inhibition observed with oleandomycin, neomycin, lincomycin, and dihydrostreptomycin was not due to direct effects on the production of oxidative metabolites but rather to interference with other components involved in the production of light, such as interference with the interaction between luminol and the myeloper-oxidase-H2O2-halide system. The deleterious effects of doxycycline can be explained by several factors: decreased production of superoxide, yellow color, the scavenging of reactive oxygen species, and Ca2+ chelating effect. In conclusion, the results of this study show that antibiotics may affect neutrophil function at concentrations that are reached in the mammary gland after local and repeated administration.

Effects of erythromycin on chemoattractant-activated human polymorphonuclear leukocytes

1. Erythromycin (2-100 micrograms ml-1) produced a concentration-related inhibition of superoxide generation and elastase release induced by in vitro exposure of human polymorphonuclear leukocytes (PMNs) to the chemotactic peptide N-formylmethionyl-leucyl-phenylalanine (FMLP; 30 nM). 2. By contrast, erythromycin (100 micrograms ml-1) did not alter the leukotriene B4 production elicited by FMLP (30 nM; in the presence of thimerosal 20 microM) or the intracellular calcium changes promoted by FMLP (30 nM; in the absence or presence of thimerosal 20 microM). 3. These results indicate that by reducing chemoattractant-triggered release of oxidative and proteolytic mediators from human PMNs, erythromycin may have clinically useful antiinflammatory effects.

Penetration of brodimoprim into human neutrophils and intracellular activity

The entry of an antibiotic into phagocytes is a prerequisite for its intracellular bioactivity against susceptible facultative or obligatory intracellular microorganisms. Brodimoprim is a dimethoxybenzylpyrimidine that has recently entered into clinical use, and its uptake into and elimination from human polymorphonuclear neutrophils (PMNs), together with its effects on normal phagocytic and antimicrobial mechanisms, have been investigated. Brodimoprim uptake by PMNs was determined by a velocity-gradient centrifugation technique under various experimental conditions and was expressed as the ratio of the intracellular to the extracellular drug concentration (C/E) in comparison with the C/E of trimethoprim, which was used as a control drug. After incubation with 7.5 micrograms of brodimoprim per ml, PMNs accumulated brodimoprim (C/E, 74.43 +/- 12.35 at 30 min) more avidly than trimethoprim (C/E, 20.97 +/- 6.61 at 30 min). The cellular uptake of brodimoprim was not affected by temperature, 2,4-dinitrophenol, or potassium fluoride and was increased with an increase in the pH of the medium. It was reduced in formaldehyde-killed PMNs. The efflux of brodimoprim was very rapid (46% after 5 min). The liposolubility of brodimoprim was about three times that of trimethoprim, as was the uptake. Therefore, a possible passive transmembrane diffusion mechanism might be proposed. Brodimoprim did not decrease either phagocytosis or phagocyte-mediated bactericidal activity, nor did it affect oxidative burst activity, as investigated by luminol-amplified chemiluminescence. On the basis of the pharmacokinetic data for brodimoprim, the concentration of 7.5 micrograms/ml was chosen as the highest concentration attainable in serum by oral therapy, and at this concentration of brodimoprim, the amount of drug that penetrated into PMNs was able to maintain its antimicrobial activity without interfering with the functions of the PMNs.

Antimicrobial therapy for rheumatoid arthritis

New interest in the use of antibiotics in the treatment of arthritis was stimulated by two factors: (1) observations that, in some forms of chronic arthritis, microbial antigens persist in the synovial membrane, and (2) the increasing knowledge of the anti-inflammatory and immunosuppressive effects of antibiotics. Recently, several published controlled studies reported a beneficial effect of tetracyclines on RA and reactive arthritis. Whether the anti-arthritic activity of the tetracyclines investigated is mediated by the antimicrobial, anti-inflammatory or immunomodulatory properties remains to be determined. It may be concluded from these studies that tetracyclines have a beneficial effect on RA, especially when laboratory parameters are considered. The effect on the clinical parameters is not unequivocal. The adverse effects seem to be mild but the long-term efficacy and safety of tetracyclines as disease-modifying antirheumatic drugs remain to be demonstrated.

Antibiotic effects on phagocyte chemiluminescence in vitro

Phagocytes are an essential defence against infection. Since drugs which affect their function may alter the outcome of infections, we have studied the effect of nine antibiotics on phagocyte function in vitro. The effects of antibiotics on the respiratory burst function of phagocytes from healthy adult donors were investigated using lucigenin-enhanced chemiluminescence in response to serum-opsonised zymosan. Aminoglycosides showed dose-dependent suppression of polymorphonuclear leucocyte chemiluminescence, except streptomycin which caused enhancement. Erythromycin caused profound suppression of chemiluminescence from both polymorphonuclear leucocytes and monocytes. Benzylpenicillin and the cephalosporins caused variable suppression of phagocyte chemiluminescence: cefotaxime increased monocyte chemiluminescence in some experiments. None of the drugs produced suppression at clinically relevant plasma concentrations, but erythromycin and some other drugs are preferentially concentrated in phagocytes to levels which suppress their oxidative metabolism in vitro. It is therefore possible that some antibiotics alter phagocyte function: ex vivo studies of phagocyte function in patients taking antibiotics would be valuable.

Comparison of the in vitro effects of several cephalosporins on the oxidative burst of human phagocytes

The metabolic activity (oxygen radical formation) of human phagocytes was not substantially affected by the tested cephalosporins. Therapeutic concentrations caused only a mild suppression or immunopotentiation in some cases or there were no effects altogether.

The tetracyclines in dermatology

Tetracycline is one of the most widely used antibiotics. It may share some properties with conventional immunosuppressive drugs and act as an anti-inflammatory agent in the treatment of inflammatory disease. This article reviews cutaneous diseases that have been treated with tetracyclines and their antiinflammatory and immunosuppressive properties.

Phagocytic function and antibody-dependent cellular cytotoxicity of human neutrophils in the presence of N-formimidoyl thienamycin

The efficacy of an antibiotic in the treatment of bacterial infections depends upon the interactions of the drug, bacteria and phagocytes. We have studied "in vitro" the effect of N-formimidoyl thienamycin (Imipenem), a novel beta-lactamic antibiotic, on the phagocytic function and antibody-dependent cellular cytotoxicity of human neutrophil leukocytes. The incubation of these cells with 50 micrograms/ml of Imipenem similar to the therapeutic levels reached in plasma results in an increase of their adherence capacity to nylon fiber and to substrate, induced mobility or chemotaxis, opsonization, phagocytosis of Candida albicans (with serum, with decomplementarized serum and without serum) and latex beads, candidicidal power and the capacity of NBT reduction. Imipenem at this dose also presents chemoattractant power for neutrophils and enhances the antibody-dependent cellular cytotoxicity (ADCC).

Phagocytic activity of polymorphonuclear leukocytes on Escherichia coli previously exposed to metronidazole

A study was made of the action of different concentrations of metronidazole of the viability of Escherichia coli under aerobic and anaerobic conditions. The viability of E. coli was reduced by 60 to 99% after 24 hours of anaerobic incubation, according to the concentration of metronidazole tested. In addition, there were significant morphological changes in the bacteria. Exposure of antibiotic-induced filaments of E. coli LP 136 to phagocytosis caused the cfu/ml value to drop by 60% after 120 minutes. Under identical conditions, using the mutant strain E. coli RYC 819, which did not become filamented by metronidazole although it did present similar ultrastructural changes, this reduction reached 83%. These results may explain the therapeutic success of metronidazole in polymicrobial infections.

Antibacterial and immunostimulatory properties of chemotactic N-formyl peptide conjugates of ampicillin and amoxicillin

N-Formyl dipeptide conjugates of ampicillin and amoxicillin related to the chemotactic peptide N-formyl-L-methionyl-L-leucyl-L-phenylalanine were synthesized and assessed for antibacterial activity and affinity for the chemotactic peptide receptor of differentiated human promyelocytic leukemia (HL-60) cells. The conjugates and parent beta-lactam antibiotics showed similar antibacterial activities against Escherichia coli and Staphylococcus aureus. The affinity of each conjugate for the chemotactic peptide receptor was determined in a competitive binding assay, using 3H-labeled N-formyl-L-methionyl-L-leucyl-L-phenylalanine. All conjugates bound to the receptor, but with affinities ranging from 1/3 to 1/100 that of the tritiated substrate. There was good correlation between receptor affinity and stimulation of chemotaxis. The peptide-antibiotic conjugates also stimulated the oxidative metabolism of the HL-60 cells by inducing the production of superoxide and hydrogen peroxide as determined by Luminol- and Lucigenin-enhanced chemiluminescence. These conjugates, based on N-formyl-L-methionyl-L-leucyl-L-phenylalanine, thus combine both potent antibacterial and immunostimulatory properties within the same molecule.

Antibiotics and human monocyte function. II. Phagocytosis and oxidative metabolism

The influence of thirteen commonly used antibacterial drugs on the phagocytic and oxidative burst responsiveness of human blood monocytes in vitro was investigated. Cefotaxime and rifampicin produced a significant inhibition of monocyte oxidative metabolism at therapeutic concentrations with increasing inhibition at higher concentrations. The effect of rifampicin was irreversible, which may reflect intracellular accumulation of the drug. Tetracycline, clindamycin, chloramphenicol and tobramycin at high concentrations produced a significant inhibition of monocyte superoxide anion release after stimulation, whereas normal therapeutic concentrations produced insignificant inhibition. Benzylpenicillin, ampicillin, fusidic acid, metronidazole, ofloxacin, sulfamethoxazole and trimethoprim did not alter monocyte oxidative metabolism in vitro. Phagocytosis of yeast cells was significantly suppressed by high concentrations of tobramycin, but otherwise unaffected by the drugs mentioned. These observations suggest that cefotaxime and rifampicin may interfere with blood monocyte oxidative metabolism in vivo, whereas it can be expected that at normal dosage it is unlikely that the other drugs will affect monocyte phagocytosis and oxidative burst activity.

Effects of acetylsalicylic acid on the phagocytic function of human polymorphonuclear leukocytes in vitro

1. In this paper acetylsalicylic acid (aspirin), an anti inflammatory drug, was studied in vitro at doses of 50, 100, 200 and 500 mg/l to see its effects on adherence, chemotaxis, spontaneous mobility, phagocytosis, candidicide power, nitrobule tetrazolium (NBT) reduction as well as the incorporation and metabolism of arachidonic acid in human polymorphonuclear neutrophils (PMNns). 2. Aspirin significantly stimulated neutrophil adherence to nylon fiber at all the doses used, with a correlation between the doses used and the adherence indices found. 3. At the therapeutic dose (100 mg/l) aspirin brings about a significant increase of chemotaxis, but reduces this property at the highest dose (500 mg/l). On the other hand, spontaneous mobility is not altered except with the 500 mg/l dose of aspirin which produces a significative decrease. 4. The ingestion of Cándida albicans by PMNns is significant at the therapeutic dose; the candidicide power is not modified with any of the doses used with 100 mg/l of aspirin nitroblue tetrazolium (NBT) reduction is significantly increased. 5. No changes are observed in the incorporation of arachidonic acid or in the release of its metabolites.

Side effects of antibiotics on immune response parameters and their possible implications in antimicrobial chemotherapy

Antibiotics may influence immune response by quite different ways. By screening the multitude of publications on this subject, the aim of this overview was to arrive at a basic generalizing statement on the relationship between chemical structure or mode of action of antibiotics and the effect on immune response and to get an indication on whether certain in vitro and/or ex vivo parameters could represent comparable effects under clinical conditions. - The influence of antibiotics on immune response may arise by direct effects on immunocompetent cells, i.e. in the absence of microorganisms, or indirectly by changes in structure or metabolic products of germs induced by subminimal inhibitory concentrations (subMIC's). In the former case, stimulatory and inhibitory effects have been observed on phagocytosis and intracellular killing activity, on antibody production including IgE, on different parameters of cellular immunity (e.g. foodpad swelling reaction, MIF-production, mitogen/antigen induced lymphocyte proliferation and delayed type hypersensitivity skin reaction), on mediator production as interleukins or prostaglandins and the expression of corresponding receptors on immunocompetent cells as well as on the course of experimental infections with primary resistant microorganisms. - Indirect effects are related to the influence of subMIC's of antibiotics on the morphology and structure of microorganisms, on their antigenicity/immunogenicity or on their serosensitivity and enzyme and toxin production. - This overview shows that - according to the actual knowledge - antibiotics may exhibit immunological side effects which, however, can not strictly be attributed to certain chemical structures or to a certain mode of action. - It has to be considered that a literary study comparing the results of different authors is rendered difficult by the often nonhomogeneity of experimental procedures and the fact that little is known yet about immunological side effects of antibiotics in man, i.e. under clinical conditions.

Effects of two macrolide antibiotics on human leukocyte membrane receptors and functions

Polymorphonuclear granulocytes (PMNs) and lymphocytes from healthy persons were incubated in varying concentrations of erythromycin and RU 28965, a new macrolide antibiotic. Incubation in erythromycin - even in high dilutions - caused a significant increase in the percentage of PMNs bearing receptors for the Fc portion of IgG (Fc gamma R) and for C3b (C3bR) as measured by rosette formation with EA (erythrocyte-antibody) and EAC (erythrocyte-antibody-complement) indicator cells. This effect could not be removed by extended washing of the cells. Incubation in RU 28965 had a similar effect, except for a decrease in EA and EAC rosetting cells at high concentrations (200 mg/l). Phagocytosis, as measured by chemiluminescence, and random migration of PMNs were unaffected by erythromycin. Chemotaxis under agarose was decreased after incubation in erythromycin or RU 28965. Erythromycin incubation increased the percentage of lymphocytes bearing receptors for sheep erythrocytes (E), but had no effect on the proportion of lymphocytes rosetting with EA or EAC, or on lymphocyte responses to mitogens PHA, conA, or PWM.

Inhibitory effect of tetracycline and doxycycline on resistance of mice to infection with a tetracycline-resistant strain of Listeria monocytogenes

By transposon mutagenesis a tetracycline-susceptible strain of Listeria monocytogenes (MIC 1 mg/l. for tetracycline and 0.25 mg/l. for doxycycline) was rendered resistant (MIC 64 mg/l. for tetracycline and 16 mg/l. for doxycycline). Infection of mice with this resistant strain led to an acute infection. Treatment with 2 x 2 mg tetracycline per day did not influence the course of infection during the first 3 days, indicating that the nonspecific resistance, mediated mainly by macrophages and granulocytes, was not affected by this treatment. The second phase of infection, characterized by a continuous resistance to infection due to macrophages activated by T-lymphocytes was, however, definitely hampered. Even acquired immunity to a secondary infection was impaired by treatment with tetracycline, indicating that cell-mediated immunity can be blocked. The course of infection of athymic, nude mice which are unable to build up a cell-mediated immune response, was not affected by tetracycline treatment. Doxycycline expressed the same activities as tetracycline.

Hydroxyl radical generation by the tetracycline antibiotics with free radical damage to DNA, lipids and carbohydrate in the presence of iron and copper salts

Tetracycline antibiotics caused the degradation of carbohydrate in the presence of a ferric salt at pH 7.4. This degradation appeared to involve hydroxyl radicals since the damage was substantially reduced by the presence of catalase, superoxide dismutase, scavengers of the hydroxyl radical and metal chelators. Similarly, the tetracycline antibiotics in the presence of a ferric salt greatly stimulated the peroxidation of liposomal membranes. This damage, which did not implicate the hydroxyl radical, was significantly reduced by the addition of chain-breaking antioxidants and metal chelators. Only copper salts in the presence of tetracycline antibiotics, however, caused substantial damage to linear duplex DNA. Studies with inhibitors suggested that damage to DNA did involve hydroxyl radicals.

[Macrolides and immunity]

In order to counteract an ever increasing bacterial resistance, a new trend in antibiotic therapy is to try and obtain compounds with "immunostimulating" properties. Although the macrolides have been known for more than 30 years, their interaction with the host defence system has been poorly investigated. These drugs display an outstanding ability to penetrate and concentrate in phagocytes. Few depressive effects on phagocyte functions have been reported, while some macrolides have been shown to exert an immunostimulating effect in vitro and ex vivo. The data published on this subject are summarized in this review paper. Further studies would be required for a better understanding of structure-immunomodulating activity relationships.

The effects of in vivo antibiotics on neutrophil (PMN) activity in rabbits with peritonitis

Antibiotics play an important role in helping the host fight infection; however, the direct cellular effect of antibiotics on polymorphonuclear cells remains undefined. Adherence, chemotaxis, phagocytosis, and superoxide anion production are important steps in the cascade of events initiated by the polymorphonucleocyte in bacterial killing. Previous studies have shown inhibition as well as stimulation of neutrophil antibacterial therapy by antibiotics. Peritoneal and blood polymorphonuclear neutrophils (PMN) respond differently to peritonitis and to external agents. The purpose of this study was to investigate the effects of in vivo clindamycin and netilmicin on infected rabbit peritoneal and blood polymorphonuclear adhesiveness, phagocytosis, chemotaxis, and superoxide anion production. Peritoneal and blood PMNs were obtained from rabbits which had undergone appendiceal devascularization 18 hr earlier: antibiotics were administered intramuscularly 1 hr prior to appendectomy and every 8 hr postoperatively for 5 days; these PMNs were compared to infected rabbits which did not receive antibiotics. Clindamycin and netilmicin in vivo cause significant inhibition of phagocytosis, peritoneal adhesiveness, and, when used in combination, blood adhesiveness and peritoneal superoxide anion production. No effects were seen on chemotaxis. Based on this data we conclude that antibiotics, while vitally important in fighting infections, may in and of themselves be agents of immunosuppression at the cellular level.

Influence of antibiotics on formylmethionyl-leucyl-phenylalanine-induced leukocyte chemiluminescence

The effect of three antimicrobial agents, penicillin G, ampicillin, and chloramphenicol, on luminol-enhanced chemiluminescence of polymorphonuclear leukocytes stimulated by the chemoattractant formylmethionyl-leucyl-phenylalanine was studied. An inhibitory effect of penicillin G and of ampicillin was demonstrated, whereas chloramphenicol gave rise to an enhancement of the chemiluminescence response from polymorphonuclear leukocytes. These effects could be due to interaction between the drugs and the polymorphonuclear leukocytes, but they could also be the result of interference with the generation of light without any effect on the cells. Therefore, the effects of the same antimicrobial agents on the chemiluminescence generated from a cell-free system consisting of myeloperoxidase and hydrogen peroxide were investigated in parallel. The results obtained in the cell-free system were almost identical to those obtained in the cell system; i.e., penicillin G and ampicillin caused an inhibition and chloramphenicol caused an enhancement of the light emission. These results indicate that observed effects induced by drugs in a chemiluminescence assay are not necessarily due to interaction between the drug and polymorphonuclear leukocytes but may be caused by interference with other components of the assay. In view of these findings, the conflicting data reported in the literature on the effects of antimicrobial agents on phagocyte function are discussed.

Enhanced immune responses in mice treated with penicillin-tetracycline or trimethoprim-sulfamethoxazole when colonized intragastrically with Candida albicans

Immune consequences of gastrointestinal colonization of CD-1 and CBA/J mice with Candida albicans in the presence or absence of continuous antibiotic treatment with penicillin-tetracycline or trimethoprimsulfamethoxazole were investigated. Intubation with C. albicans in the absence of antibiotics resulted in the induction of low but detectable delayed-type hypersensitivity (DTH), demonstrable by footpad testing with a C. albicans wall glycoprotein (GP), and in the stimulation of a moderate level of protective immunity, demonstrable by intravenous (i.v.) challenge. DTH to a membrane extract, BEX, could not be detected in such animals. However, animals colonized in the presence of antibiotics and then inoculated cutaneously prior to being tested for DTH or protective immunity developed significantly enhanced levels of DTH to GP and BEX and were protected to an even greater extent than animals colonized in the absence of antibiotics who were not inoculated cutaneously. The priming effect of colonization, particularly with respect to the antigen GP, was also obvious from an enzyme-linked immunosorbent assay for GP-specific antibody with sera of mice surviving the i.v. challenge, in that GP-specific antibody was present in the highest titers in colonized animals that had been inoculated cutaneously prior to i.v. challenge. While the antibiotics promoted higher levels of colonization, as evidenced by stomach and fecal cultures of intubated mice, antibiotic administration was not necessary for the induction of C. albicans-specific responses. Moreover, contrary to reports in the literature, antibiotic administration had no adverse effect on the immune responses measured. Females were innately more resistant than males to i.v. challenge with C. albicans, but each sex was capable of developing protective immunity of equal intensity in response to colonization or immunization by cutaneous challenge.

Effects of cefmetazol, cefoxitin and imipenem on polymorphonuclear leukocytes

1. We have investigated the effects produced in vitro by Cefmetazol, Cefoxitin and Imipenem on the chemotaxis, spontaneous mobility, adherence, phagocytosis and candidicide power of human polymorphonuclear neutrophils (PMNs). 2. The three antibiotics tested significantly stimulated the adherence of neutrophils to nylon fibre at doses either equal (50 mg/l) or superior (500 mg/l) to the therapeutic one. 3. Cefmetazol, Cefoxitin and Imipenem bring about a maximum increase of chemotaxis at the therapeutic dose, whereas the spontaneous mobility diminishes with any one of the doses used. 4. The capacity of the PMNs to phagocytize and produce lysis of Candida albicans is increased in Cefmetazol with therapeutic doses. Cefoxitin produced an increased lysis of candidas.

Interaction of beta-lactam antibiotics with the bactericidal activity of leukocytes against Escherichia coli

The effect of beta-lactam antibiotics on phagocytosis and intracellular killing of four isogenic Escherichia coli strains differing in their 0- and K antigens was studied by adopting the rat polyvinyl-sponge model. The penicillins mezlocillin, ticarcillin and piperacillin rendered all four isogenic E. coli strains more susceptible to intraleukocyte killing; the cefalosporins tested exhibited inhomogenous effects; lamoxactam was marginally effective, whereas cefoxitin was completely ineffective; cefotaxime caused an increase in intracellular killing of the capsule-defective mutant only. The beta-lactam promoted increase in intracellular killing could be inhibited by alpha-methylmannoside but not by alpha-methylglucoside. Free-flow electrophoretic separation of mezlocillin-treated bacteria and guinea pig erythrocytes revealed that co-migration of E. coli and erythrocytes respectively could be inhibited by alpha-methylmannoside but not by alpha-methylglucoside. These data indicate that mezlocillin interferes with the mannose sensitive adhesins of E. coli.

Effect of doxycycline on oxygen-dependent killing mechanisms of human neutrophils

The effects of doxycycline on neutrophil adhesivity, ingestion rate, and oxidative burst by particle and soluble compounds have been analyzed. The rate of bacterial ingestion by neutrophils as well as its subsequently particle-induced oxidative burst comprising oxygen uptake, hydrogen peroxide and superoxide anion productions, and iodination were all inversely correlated to doxycycline concentration included in the assay medium. The neutrophil oxidative burst induced by phorbol myristate (a soluble stimulant) was also inversely correlated to doxycycline concentration. Drug effect was observed at lower concentrations when the neutrophil stimulant was a soluble compound than when it was particles. In contrast doxycycline did not affect neutrophil adhesivity to either nylon fibers or Petri dishes. Further studies are needed to assess whether the activity of the drug on the neutrophil is due only to its ability to chelate calcium and magnesium or to other properties.

Influence of six antifungal agents on the chemiluminescence response of mouse spleen cells

The luminol-enhanced chemiluminescence (CL) assay is a measure of the early events of phagocytosis, leukocyte activation, and immune cell interactions. Reduction in the CL response of immune cells may be indicative of an inhibition of the immune response. This study was undertaken to examine the effects of antifungal agents tested at concentrations above and below therapeutically achievable levels on the CL response of mouse spleen cells. The effects of six antifungal agents--amphotericin B, ketoconazole, miconazole, 5-fluorocytosine, Bay-n-7133, and ICI 153,066--were studied. Changes in the CL response were assessed in terms of peak intensity and area under the intensity-time curve compared with appropriate diluent controls for each drug. Only amphotericin B and ketoconazole caused statistically significant lowering of the peak intensity at levels that are therapeutically attainable (mean peak plasma levels of 2 to 4 and 3.5 to 16 micrograms/ml, respectively). Although amphotericin B and ketoconazole caused reduction in the CL response, removal of the unbound drug in the preparation by centrifugation, washing, and suspension of cells in fresh drug-free medium resulted in a return of CL activity equivalent to the activity observed in cells not exposed to these agents. These results suggest that amphotericin B and ketoconazole at therapeutic concentrations may cause a reduction in immune cell antimicrobial activity; the clinical significance of these observations remains to be determined.

[Effect of adjuvant immunoglobulin therapy on infections in patients in an surgical intensive care unit. Results of a randomized controlled study]

A randomized controlled clinical trial was conducted on the effects of immunoglobulin in therapy for infections in 104 intensive care patients. At the first sign of infection, one group of 50 patients received an i.v. preparation of immunoglobulin (4 X 100 ml) combined with antibiotics. The other 54 control patients received antibiotics alone. The most common infections in these patients were pneumonia, septicemia, peritonitis and wound sepsis. Infections were significantly seldom the cause of death, especially in patients with high-risk surgery who had been treated with immunoglobulin (p less than or equal to 0.05). Likewise ventilation time in the high-risk surgery group averaged only 5.5 days for those receiving immunoglobulin as opposed to 12.7 days in controls (p less than or equal to 0.01). Whereas the control group, in particular patients with pneumonia, remained in intensive care an average of 21.5 days, those receiving immunoglobulin stayed only 14.8 days (p less than or equal to 0.01). In general, patients treated with immunoglobulin recovered more rapidly from infections than did controls (p less than or equal to 0.01).

Design and analysis considerations in evaluating the chemiluminescence response of mouse spleen cells

Chemiluminescence is the result of the respiratory burst generated by phagocytic cells after stimulation by antigen. The measurement of chemiluminescence represents a sensitive means for detecting antigenic stimulation and immune cell function. Although the kinetics of chemiluminescence reactions have been described, appropriate statistical methods for the evaluation of data from chemiluminescence assays have not been reported. Based on examination of data from several studies in which the chemiluminescence response of spleen cells was investigated after stimulation with the particulate antigen zymosan, recommendations are made for the design and statistical evaluation of such studies. Three parameters were used in assessing the chemiluminescence response; peak intensity of the emitted light, time to peak, and the area under the intensity-time curve. The data indicated that peak intensity alone provides an adequate characterization of the chemiluminescence response. Since percent change in response upon treatment is of interest, analysis on the log scale is appropriate, and the statistical procedure of choice in evaluating data of this type is a trend analysis. The need for a balanced allocation of treatments to avoid potential bias is demonstrated. The methods proposed are illustrated with data from two studies in which the effect of preincubation with low concentrations of ketoconazole, an antifungal agent, on the chemiluminescence response of BALB/cBY spleen cells was examined.

Effect of amoxycillin and doxycycline on function of human granulocytes tested in vitro and on chemotaxis of granulocytes from rabbits given the two antibiotics

The effect of amoxycillin and doxycycline on human granulocyte function was studied in vitro. The antimicrobial agents were added to tests of chemotaxis, random motility, yeast phagocytosis, and killing, at progressing concentrations. The effect was also evaluated in vivo by measuring chemotaxis and random motility (agarose technique) of granulocytes from rabbits injected with these antibiotics. Amoxycillin was shown to have a slightly stimulating effect on chemotaxis, demonstrable only at the highest concentration tested (100 micrograms/ml), and no effect on the other variables. Doxycycline had a dose-related inhibitory effect on chemotaxis, random motility, and phagocytosis, and no effect on killing. Chemotaxis and random motility were slightly, but not significantly, stimulated in vivo when rabbits were given amoxycillin. Chemotaxis (but not random motility) was significantly impaired when the rabbits were given doxycycline.

[Antibacterial activity of clindamycin and lincomycin in broth, serum, and in combination with polymorphonuclear leukocytes against Staphylococcus aureus and Staphylococcus epidermidis]

We investigated the antibacterial activity of clindamycin and lincomycin at 1/4 X minimum inhibitory concentration (MIC), 1 X MIC and 4 X MIC against a serum-resistant Staphylococcus aureus and a serum-resistant Staphylococcus epidermidis strain in broth, in serum with and without the presence of leukocytes and in Hank's medium in combination with leukocytes alone. Against both test strains, lincomycin in broth and serum was similarly effective, whereas against S. aureus clindamycin in broth was somewhat more active. In the combined test mixture of serum with leukocytes, even a 1/4 X MIC of clindamycin or lincomycin markedly improved leukocyte killing of S. aureus, whereas both compounds could not further enhance the marked leukocyte killing of S. epidermidis, even at inhibitory concentrations. In Hank's medium with leukocytes alone, clindamycin and lincomycin had at the most only a bacteriostatic effect against both test strains.

Influence of tetracyclines on human polymorphonuclear leukocyte function

Low concentrations of oxytetracycline, doxycycline, or minocycline (less than 10 micrograms/ml) did not influence in vitro polymorphonuclear leukocyte random migration, chemiluminescence, or glucose oxidation. At high concentrations of doxycycline or minocycline (greater than 10 micrograms/ml), chemiluminescence and glucose oxidation were impaired. High concentrations of doxycycline also reduced random migration. Oxytetracycline did not influence these functions in concentrations up to 100 micrograms/ml. The inhibiting effect of doxycycline and minocycline was abolished when 4 mM Mg2+ was added to the reaction mixture, and 4 mM Ca2+ partly restored minocycline-inhibited polymorphonuclear leukocyte functions. This indicates that the major effect of tetracyclines on in vitro polymorphonuclear leukocyte functions is mediated by their divalent cation chelating effect and that the results of in vitro experiments are highly dependent on the concentration of divalent cations in the reaction mixtures. The difference between the tetracyclines may be due to differences in lipid solubility, with solubility being highest for minocycline and lowest for oxytetracycline, or to different divalent cation chelating ability.

Stimulation of granulocyte functions in vitro by imipenem and the renal enzyme inhibitor MK 0791

Imipenem and the renal enzyme inhibitor MK 0791 (dehydropeptidase-I) were tested separately and in a 1:1 combination to delineate their effects on granulocyte functioning. Each component, as well as the combination product, was found to increase granulocyte adherence and chemotaxis at therapeutic concentrations. Phagocytosis and chemiluminescence were not found to be significantly altered by any of the drug combinations.

Antibiotics and phagocytosis

The influence of beta-lactam antibiotics, tetracyclines, aminoglycosides, erythromycin and clindamycin on the phagocytosis process is reviewed. The results of the studies published are summarized in tabular form.

Effect of azlocillin and piperacillin in subinhibitory and inhibitory concentrations on Staphylococcus aureus and Pseudomonas aeruginosa in broth, in serum and in the presence of human polymorphonuclear leukocytes

The bactericidal activity of azlocillin and piperacillin was tested at concentrations of 1/4 the MIC, the MIC and four-fold the MIC agents a serum-resistant Staphylococcus aureus and a serum-resistant Pseudomonas aeruginosa strain in broth, in serum and in the presence of leukocytes. The antibacterial activity of azlocillin and piperacillin in serum against Staphylococcus aureus was slightly better than in broth (p greater than 0.05); both compounds were distinctly less active against Pseudomonas aeruginosa in serum than in broth (p less than 0.05). Both antibiotics enhanced susceptibility of Pseudomonas aeruginosa to leukocyte killing without serum (p less than 0.05), whereas leukocyte killing of Staphylococcus aureus was hardly improved even at the MIC and four-fold the MIC of both compounds. The antibacterial activity of azlocillin and piperacillin against both bacterial strains was most pronounced in the presence of leukocytes and serum. A marked bactericidal effect was achieved at 1/4 the MIC, the effect not being further significantly enhanced (p greater than 0.05) at the MIC or four-fold the MIC.

Effect of beta-lactam antibiotics on migration and bactericidal activity of human phagocytes

The effect of beta-lactam antibiotics upon some functions of human phagocytes was examined. Penicillins (carbenicillin and piperacillin), thienamycin, and cephalosporins (cefotetan, ceftazidime, and moxalactam) had no effect on either the random or directional migration or on the bactericidal activity of neutrophils and monocytes against Staphylococcus aureus. On the contrary, cefoperazone at therapeutic levels was shown to inhibit neutrophil chemotaxis.

In vivo suppression of neutrophil chemotaxis by systemically and topically administered tetracycline

In vivo suppression of neutrophil chemotaxis in humans by orally and topically administered tetracycline (TCN) was examined using both modified Boyden chamber and skin chamber assays. Chemoattractants were derived from serum complement and bacterial culture supernates. The results showed that oral TCN caused significant suppression of neutrophil chemotaxis when measured by both assays and both sources of chemoattractant. Furthermore, application of a commercially available topical preparation containing TCN caused local suppression of chemotaxis as measured by the skin chamber assay. These results show that TCN does suppress neutrophil migration in vivo, and they provide support for an anti-inflammatory effect of TCN mediated in part by suppression of neutrophil chemotaxis.

Comparative effects of moxalactam and gentamicin on human polymorphonuclear leukocyte functions

The in vitro effects of moxalactam and gentamicin on chemotactic, phagocytic, and microbicidal activities of human polymorphonuclear leukocytes have been studied. Incubation of cells with moxalactam (25 to 400 micrograms/ml) resulted in a 10 to 15% inhibition of leukocyte chemotaxis (P less than or equal to 0.10). Incubation of cells with gentamicin (5 to 40 micrograms/ml) inhibited chemotaxis more than 50% (P less than or equal to 0.50). Neither moxalactam nor gentamicin had any effect on phagocytic or microbicidal capacities of leukocytes.

Effect of subinhibitory antibiotic concentrations on the phagocytosis of Staphylococcus aureus

The effect of subinhibitory antibiotic concentrations on the phagocytosis of Staphylococcus aureus was studied by pretreating 3H-thymidine labelled bacteria with one-third the minimal inhibitory concentration of clindamycin, doxycyclin, cefotiam, vancomycin, piperacillin and penicillin G, respectively. Pretreatment with clindamycin and doxycyclin resulted in enhanced uptake of the bacteria by polymorphonuclear leukocytes compared to the untreated control. The augmented phagocytosis was still observed at 1/32 the MIC of clindamycin and 1/64 the MIC of doxycyclin, and when the serum was diluted to a concentration of 1%. Pretreatment of the bacteria with penicillin, cefotiam, piperacillin and vancomycin had no effect on phagocytosis. Inhibitors of bacterial protein synthesis induce alterations of Staphylococcus aureus leading to increased phagocytosis, whereas antibiotics acting on cell wall synthesis are without effect.