Effect of SDZ MRL 953 on the survival of mice with advanced sepsis that cannot be cured by antibiotics alone

Structure-function relationships of bacterial endotoxins. Contribution to microbial sepsis

A substantial body of knowledge has emerged over the past several decades concerning the primary and tertiary, and quaternary structure of endotoxic LPS and their contribution to the pathogenesis of gram-negative sepsis; however, important questions remain. Among them are the precise three-dimensional configuration of the LPS macromolecule and the contribution of the quaternary structure to the ability of these potent microbial factors to interact with host humoral and cellular inflammatory mediator systems. Also remaining to be sufficiently addressed is the relative contribution of endotoxin interactions with the host to the overall manifestation of disease and conditions under which such contributions serve as the pivotal event in determining outcome. The answers to these questions can be expected to provide valuable insights into potential novel therapeutic intervention strategies and approaches that will ultimately reduce both morbidity and mortality in infection from gram-negative microbes.

Downregulation of the Proinflammatory Cytokine Response to Endotoxin by Pretreatment With the Nontoxic Lipid A Analog SDZ MRL 953 in Cancer Patients

Interfering with the endotoxin-mediated cytokine cascade is thought to be a promising approach to prevent septic complications in gram-negative infections. The synthetic lipid A analog SDZ MRL 953 has been shown to be protective against endotoxic shock and bacterial infection in preclinical in vivo models. As part of a trial of unspecific immunostimulation in cancer patients, we conducted a double-blind, randomized, vehicle-controlled phase I trial of SDZ MRL 953 to investigate, first, its biologic effects and safety of administration in humans and, second, its influence on reactions to a subsequent challenge of endotoxin (Salmonella abortus equi). Twenty patients were treated intravenously with escalating doses of SDZ MRL 953 or vehicle control, followed by an intravenous application of endotoxin (2 ng/kg of body weight [BW]). Administration of SDZ MRL 953 was safe and well-tolerated. SDZ MRL 953 itself increased granulocyte counts and serum levels of granulocyte colony-stimulating factor (G-CSF ) and interleukin-6 (IL-6), but not of the proinflammatory cytokines tumor necrosis factor-α (TNF-α), IL-1β, and IL-8. Compared with vehicle control, pretreatment with SDZ MRL 953 markedly reduced the release of TNF-α, IL-1β, IL-8, IL-6, and G-CSF, but augmented the increase in granulocyte counts to endotoxin. Induction of tolerance to the endotoxin-mediated cascade of proinflammatory cytokines by pretreatment with SDZ MRL 953 in patients at risk may help to prevent complications of gram-negative sepsis.

Downregulation of the Proinflammatory Cytokine Response to Endotoxin by Pretreatment With the Nontoxic Lipid A Analog SDZ MRL 953 in Cancer Patients

Interfering with the endotoxin-mediated cytokine cascade is thought to be a promising approach to prevent septic complications in gram-negative infections. The synthetic lipid A analog SDZ MRL 953 has been shown to be protective against endotoxic shock and bacterial infection in preclinical in vivo models. As part of a trial of unspecific immunostimulation in cancer patients, we conducted a double-blind, randomized, vehicle-controlled phase I trial of SDZ MRL 953 to investigate, first, its biologic effects and safety of administration in humans and, second, its influence on reactions to a subsequent challenge of endotoxin (Salmonella abortus equi). Twenty patients were treated intravenously with escalating doses of SDZ MRL 953 or vehicle control, followed by an intravenous application of endotoxin (2 ng/kg of body weight [BW]). Administration of SDZ MRL 953 was safe and well-tolerated. SDZ MRL 953 itself increased granulocyte counts and serum levels of granulocyte colony-stimulating factor (G-CSF ) and interleukin-6 (IL-6), but not of the proinflammatory cytokines tumor necrosis factor-α (TNF-α), IL-1β, and IL-8. Compared with vehicle control, pretreatment with SDZ MRL 953 markedly reduced the release of TNF-α, IL-1β, IL-8, IL-6, and G-CSF, but augmented the increase in granulocyte counts to endotoxin. Induction of tolerance to the endotoxin-mediated cascade of proinflammatory cytokines by pretreatment with SDZ MRL 953 in patients at risk may help to prevent complications of gram-negative sepsis.

The hematoregulatory peptide, SK&F 107647, in combination with antifungal therapy in murine Candida albicans infections

SK&F 107647, a novel synthetic low molecular weight peptide, has been shown to be a potent hematoregulatory agent. We have previously demonstrated that SK&F 107647 administration can prolong survival in both immunosuppressed and normal mice challenged with the opportunistic fungal pathogen Candida albicans. Additionally, we have determined the effect of prophylactic SK&F 107647 treatment combined with conventional antifungal therapy on the survival of mice challenged with a lethal dose of C. albicans. Prophylactic treatment with SK&F 107647 or therapeutic treatment with the antifungals fluconazole or amphotericin B significantly increased the survival rates of immunosuppressed mice challenged with a lethal dose of C. albicans. However, the combination of SK&F 107647 treatment followed by antifungal therapy resulted in statistically significant increases in survival over that observed with either therapy alone. These results indicated that the hematoregulatory factor(s) elicited by SK&F 107647 enhance the survival of mice treated with conventional therapies in a model of experimental systemic candidiasis. Key words: SK&F 107647, Candida albicans, hematoregulatory, fluconazole, amphotericin B.

Effects of pretreatment with SDZ MRL 953, a novel immunostimulatory lipid A analog, on endotoxin-induced acute lung injury in guinea pigs

SDZ MRL 953 (SDZ), a novel immunostimulatory lipid A analog, has been reported to have immunopharmacological activities similar to those of lipopolysaccharide (LPS) but to have little of the toxicity of LPS. We investigated the effects of pretreatment with SDZ on Escherichia coli endotoxin-induced acute lung injury in guinea pigs. Four experimental groups consisted of saline control (n = 16), SDZ (-12 h) plus LPS (2 mg/kg of SDZ per kg of body weight injected intravenously 12 h before intravenous injection of 2 mg of LPS per kg; n = 15), SDZ (-10 min) plus LPS (SDZ injected 10 min before LPS injection; n = 10), and LPS alone (n = 16). The animals were sacrificed, and lung tissue was sampled 4 h after LPS or saline infusion. Lung injury was assessed by measuring the wet weight-to-dry weight ratio and the level of 125I-labeled albumin accumulation in bronchoalveolar lavage fluid relative to that in plasma. In the SDZ (-12 h) plus LPS group, these two parameters of acute lung injury were decreased compared with those in the LPS alone group. However, they were not decreased in the SDZ (-10 min) plus LPS group. We conclude that SDZ attenuates endotoxin-induced acute lung injury when it is administered 12 h before LPS injection. The attenuating effects of SDZ are speculated to be due to down regulation of the response to endotoxin rather than to receptor blocking.

Efficacy of the hematoregulatory peptide SK&F 107647 in experimental systemic Candida albicans infections in normal and immunosuppressed mice

SK&F 107647, a novel synthetic dimeric pentapeptide, has been shown to be a potent hematoregulatory agent. The potential for the hematoregulatory factors elicited by SK&F 107647 to confer protection in experimental models of systemic Candida albicans infection was evaluated in immunosuppressed and immunocompetent mice. Prophylactic treatment with recombinant human interleukin-1 (rhIL-1), recombinant human granulocyte colony stimulating factor (rhG-CSF), or the hematoregulatory peptide SK&F 107647 significantly increased survival times in gamma irradiated immunosuppressed as well as non-irradiated immunocompetent mice challenged with a lethal dose of C. albicans. Protection was also observed in athymic nu/nu "nude" mice. Additionally, significant increases in survival in non-irradiated immunocompetent mice dosed by oral gavage were observed. These results indicate that SK&F 107647 can significantly enhance natural host resistance to experimental C. albicans infections both in immunosuppressed and immunocompetent mice.