Comparative adherence of granulocytes to endothelial monolayers and nylon fiber

Granulocyte Adherence after Intravenous and Intraarterial Injection of Ioxaglate or Iohexol

The effect of iohexol and ioxaglate on granulocyte adherence to nylon fibers was investigated with blood from 15 patients undergoing angiography, and from 24 patients undergoing excretory urography. Decreased adherence and increased numbers of granulocytes in the circulation were observed soon after injection of iohexol or ioxaglate in the aorta, or injection of ioxaglate i.v. Increased adherence and decreased numbers of granulocytes in the circulation were observed soon after injection of iohexol i.v. The differences were small soon after the injection of contrast media (CM). More pronounced decreased adherence and increased numbers of granulocytes were detected 2 and 5 hours after injection in the aorta for both CM.

Contrast Medium Induced Changes in Granulocyte Adherence in Vitro and during Angiography

The effect of ioxaglate and diatrizoate on per cent granulocyte adherence to nylon fibers was investigated in blood to which contrast medium was added in vitro and in blood from patients undergoing angiography. Very high concentrations of contrast medium, added to blood in vitro, directly abolished granulocyte adherence to nylon fibers. Intraaortic bolus injections of ioxaglate, but not of saline, transiently increased granulocyte concentrations in the femoral vein. Fractional granulocyte adherence to nylon fibers increased significantly above the baseline when angiographic dosages of contrast medium were diluted by circulation within the human body. On the other hand, dilute concentrations of contrast medium had no effect on per cent granulocyte adherence when added to whole blood in vitro. This indicates that the increased adherence produced in vivo is an indirect effect, which, usually, cannot be simulated in vitro.

Granulocyte Adherence is Inhibited by Radiographic Contrast Media in Vitro

Different amounts of diatrizoate, ioxaglate, iohexol, iodixanol, NaCl 1000 mOsm/kg, mannitol 1098 mOsm/kg, and meglumine (meglumine concentrations corresponding to the content in the diatrizoate solutions) were added to either whole blood or a suspension of granulocytes in autologous plasma, and the adherence to nylon fibers was determined. At high concentrations all the investigated contrast media (CM) inhibited granulocyte adherence. The degree of inhibition was significantly greater when the ionic CM diatrizoate and ioxaglate were used, as compared with the nonionic media. Meglumine solutions at high concentrations also inhibited adherence but significantly less than diatrizoate solutions containing the same amount of meglumine. Diatrizoate showed the greatest inhibitory effect on granulocyte adherence, and significant inhibition could be detected even with a 1.25% solution.

Perflubron emulsion reduces inflammation during extracorporeal circulation

The recovery from cardiac surgery and cardiopulmonary bypass can be complicated by an acute inflammatory response. Circulating blood through an extracorporeal circuit (ECC) contributes to this complication. Perfluorocarbon-based blood substitutes (PFCs) are under investigation for use as a component of the ECC "prime" solution, because PFCs increase the oxygen-carrying capacity of the diluted blood. Some PFCs may provide the additional benefit of attenuating the ECC-induced inflammatory response. Earlier, we reported that perflubron emulsion (PFE, Alliance Pharmaceutical Corp.) reduced neutrophil (PMN) activation in vivo. However, the potential of PFE to reduce ECC-induced PMN activation has not been investigated. In this study, we used a small-scale ECC model to quantify the extent of PMN activation during circulation and to examine if PFE treatment attenuated PMN activation. ECC circuits were filled with a mixture of blood and Plasmalyte. Two groups were studied: an untreated group containing blood plus PlasmaLyte and a treated group in which some of the Plasmalyte was substituted with PFE (4.5 g/100 ml). Hematology and measures of whole blood PMN activation were made from blood samples taken periodically throughout the 120-min ECC circulation period. We found, for the untreated group, a significant decrease in the number of circulating PMNs and an increase in PMN activation with time. PMN activation was demonstrated as a significant increase in the expression of the PMN adhesion protein CD11b (P < 0.05) and an increase in PMN oxygen free radical production (reactive oxygen species (ROS)). After 120 min of circulation, the PMNs remained capable of a significant response to a second inflammatory stimulus, but PFE treatment significantly attenuated the fMLP-induced increase in PMN ROS at t = 120 min (P < 0.05). These results suggest that PFE may have dual utility in cardiac surgery, to increase oxygen delivery and to serve as an antiinflammatory agent.

The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid in surgical patients with chronic alcohol misuse

The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid was reported to be elevated for a period of up to 22 h following acute alcohol ingestion. Therefore, the ratio could detect continuous alcohol consumption, in what was considered to be a high-risk surgical group, on the evening prior to surgery. The aim of this study was to determine the preoperative ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid in patients with continuous preoperative alcohol misuse. Forty-two patients participated in this institutionally approved study, once their written informed consent had been obtained. Chronic alcoholics were defined by meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders criteria and an ethanol consumption > or =60 g/day. The urine samples were taken preoperatively and determined by means of gas chromatography-mass spectrometry and high performance liquid chromatography. The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid was significantly increased in chronic alcoholics. The ICU stay of these patients was significantly prolonged due to an increased incidence of pneumonia and sepsis. Five chronic alcoholics died, whereas no deaths occurred in the nonalcoholic group (p = 0.05). As the measurement of the urinary ratio of 5-hydroxy-tryptophol to 5-hydroxyindole-3-acetic acid could detect alcohol consumption immediately prior to operation, this marker could assist the carbohydrate-deficient transferrin in screening for patients with high-level dependency; these patients were considered to be at a high risk of developing intercurrent complications.

Neutrophil adhesion and activation during systemic thrombolysis in acute myocardial infarction

In a pilot study, alterations of polymorphonuclear neutrophil function during systemic thrombolysis in acute myocardial infarction have been investigated in humans. The following parameters of neutrophil function were measured before and at 15 and 45 minutes after initiation of systemic thrombolysis with a recombinant tissue-type plasminogen activator in 20 patients with acute myocardial infarction: (1) neutrophil adhesion and (2) neutrophil activation. During systemic thrombolysis a significant decrease was observed in neutrophil adhesion (5.5+/-6.4 to 3.2+/-3.3; p<0.05), in phagocyting neutrophil activation (39+/-18 to 25+/-14%; p<0.05), and in resting neutrophil activation (9+/-7 to 3+/-4%; p<0.05). Successful reperfusion coincided with a significantly higher reduction of phagocyting neutrophil activation (40+/-14 to 20+/-12% vs. 39+/-24 to 26+/-19% in unsuccessful reperfusion; p<0.05), and of neutrophil adhesion (6.2+/-5.7 to 2.7+/-3.0 vs. 4.1+/-3.8 to 3.5+/-4.0 in unsuccessful reperfusion; p<0.05) during thrombolysis. Systemic thrombolysis in acute myocardial infarction is accompanied by a reduction in neutrophil adhesion and activation dependent on thrombolytic success.

Melatonin and the phagocytic process of heterophils from the ring dove (Streptopelia risoria)

A functional connection between the pineal gland and the immune system in mammals and birds has been established. This study investigates the effect of melatonin upon the non-specific immunity of heterophils isolated from the ring dove. The different stages of the phagocytic process: adherence to nylon fiber, spontaneous and induced mobility, ingestion of latex beads and digestion were evaluated for heterophils incubated in the presence of 5, 25, 50, 75, or 100 microM of melatonin. In addition, the chemoattractant power of the hormone for heterophils was studied. The 100 microM melatonin dose possessed a significant chemoattractant ability for heterophils whilst ingestion of latex particles was enhanced at all doses studied. The superoxide anion level, as measured by the free radicals produced during the metabolic burst, is decreased after incubation with 100 microM of melatonin.

Effects of in vivo administration of G-CSF on neutrophil functions in healthy volunteers

The aim of the present study was to investigate the in vivo effects of granulocyte colony-stimulating factor (G-CSF) on neutrophil (PMN) function. G-CSF was administered once daily as s.c. injection for 6 d (d1-6) to healthy male volunteers. PMN migration (modified Boyden chamber), chemiluminescence (CL), adherence to nylon fibers and phagocytosis of IgG- and IgG-C3-coated particles were investigated before (d1), during (d2, d5) and 3 wk after G-CSF 7.5-10 micrograms/kg/d (n = 12). PMN surface expression of adhesion- and Fc gamma-receptors was measured on d1, d5, d8 and 3 wk after G-CSF 3-5 micrograms/kg (n = 12). Results obtained after G-CSF were compared to baseline using Wilcoxon's signed rank test. G-CSF induced PMNs showed a significantly (p < 0.05) decreased chemokinetic response (d5) as well as a reduced chemotaxis towards zymosan activated serum, FMLP and IL-8, respectively. Chemotaxis was reduced both at d2 and d5. Neutrophil adherence, phagocytosis and luminol-enhanced CL increased, whereas G-CSF had no effect on lucigenin-enhanced CL. G-CSF (3-5 micrograms/kg) caused an enhanced expression of CD11b, CD18, CD35, CD64 (Fc gamma RI) and CD32 (Fc gamma RII), respectively. We conclude that neutrophils produced in response to G-CSF have a reduced chemotaxis but an enhanced adherence and phagocytic capacity. G-CSF in vivo does not stimulate the respiratory burst.

Influence of Duraflo II heparin-treated extracorporeal circuits on the systemic inflammatory response in patients having coronary bypass

Cardiopulmonary bypass generates a systemic inflammatory response, including the activation of leukocytes, contributing to postoperative morbidity. To evaluate whether the use of heparin-treated extracorporeal circuits could reduce the inflammatory reaction in patients undergoing cardiopulmonary bypass, we conducted a prospective clinical study on 14 patients having coronary artery bypass in whom perfusion was done randomly with either Duraflo II heparin-treated circuits or with nontreated circuits. In both groups systemic heparinization was performed before cardiopulmonary bypass. The use of heparin-treated circuits resulted in a reduction of systemic inflammatory activation during cardiopulmonary bypass. This was reflected by lower plasma levels of soluble tumor necrosis factor receptors (p < 0.05) and of interleukin-6 and interleukin-8 (p < 0.05), manifest after release of the aortic crossclamp. Furthermore, 6 and 12 hours after aortic crossclamp release significantly lower levels of the soluble E-selectin (p < 0.05) were observed in the Duraflo II group. In patients in whom noncoated circuits were used, a significant decrease in circulating soluble intercellular adhesion molecule 1 (p < 0.05) was found early during bypass. All these observations suggest that the use of a heparin-treated extracorporeal circuit reduces the systemic inflammatory activation and may after the leukocyte-endothelium interaction.

Pulmonary host defenses

Well functioning host defenses in the respiratory tract effectively remove microbes and other debris that reach the conducting airways and alveoli, and this usually prevents infections. People with acute and chronic illnesses can experience failure of any number of these defense mechanisms that allow pneumonia (and bacteremia) to occur, often with considerable morbidity and mortality. People with alcohol-related illnesses are a susceptible group for infections, and many strategies are needed to help them such as moderating alcohol abuse and dependence, providing timely immunizations to create antibody against encapsulated bacteria, anticipating microbial colonization of mucosal areas that can promote infection, giving excellent supporting medical care in crisis situations, and prescribing appropriate antibiotics. New approaches to boosting inflammatory reactions to control lung infections better with cytokines and new immunomodulator therapies must be investigated now.

Measurement of neutrophil and eosinophil adhesion to E-selectin, VCAM-1, and ICAM-1 by the use of transfected fibroblast cell lines

A method which enables the specific measurement of neutrophil and eosinophil adhesion to the endothelial cell adherence receptors E-selectin, VCAM-1 and ICAM-1 has been developed. The method is based on continuous cultures of cell lines of transfected hamster kidney fibroblasts (BHK-21), that selectively express each of the endothelial cell adhesions molecules. Isolated granulocytes are added to the cultured adherent fibroblasts at a ratio of 20:1 and the cells are coincubated for 60 min at 37 degrees C. After removal of the nonadherent granulocytes the amount of adherent granulocytes could be measured by addition of detergent and a peroxidase substrate. Selective measurement of neutrophil and eosinophil adhesion was accomplished by addition of detergent to the adherent cells, collection of extracts followed by measurement of the concentration of an eosinophil (eosinophil cationic protein) and a neutrophil (myeloperoxidase) granule protein, respectively, in the extracts. At basal conditions neutrophils and eosinophils showed significant adhesion to E-selectin and eosinophils a low degree of adhesion to VCAM-1. Significant adhesion of neutrophils and eosinophils to ICAM-1 and of eosinophils to VCAM-1 was selectively induced by addition of manganese ions (Mn2+) at a concentration of 0.5 mmol/l. Neutrophils demonstrated a significantly higher adhesion to E-selectin than eosinophils, while eosinophil adhesion to ICAM-I was significantly higher than that of neutrophils. In conclusion, a method to compare the adhesive capacity of neutrophil and eosinophil granulocytes towards specific endothelial cell adhesion molecules has been developed.

Influence of anti-inflammatory drugs on adhesion of neutrophils to endothelial cells cultured on microcarriers: a novel in vitro system as an alternative to animal experimentation

Pharmacological control of inflammation by steroidal (SAIDs) and nonsteroidal (NSAIDs) antiinflammatory drugs is of substantial clinical importance. To reduce the number of animals used in pharmacological and toxicological evaluation of these drugs we developed a novel assay to determine adhesion of bovine neutrophils (PMN) to bovine aortic endothelial cells (BAEC) cultured on microcarriers in a flow-through system. Pretreatment of BAEC with thrombin (10(-7)-10(-4) M) led to a dose-dependent increase of PMN-adhesion (10(-6)-10(-4) M:P < 0.05); platelet-activating factor (10(-9) M) and 1:200 diluted zymosan-activated serum (ZAS) had similar effects (P < 0.001). Pretreatment of PMN with SAIDs (50.9 and 509 microM dexamethasone, 12.2 and 24.4 microM flumethasone) did inhibit adhesion to ZAS-treated BAEC dose-dependently. Pretreatment of PMN with NSAIDs had a less consistent influence on adhesion to ZAS-stimulated BAEC. While phenylbutazone (0.33 and 3.3 mM), diclofenac (0.392 and 0.574 mM), indomethacine (0.436 and 0.872 mM), and acetylsalicylic acid (3.47 and 16.94 mM) induced dose-dependent inhibition of PMN-adhesion to ZAS-treated BAEC, piroxicam (0.377 and 0.754 mM) inhibited PMN-adhesion strongly (P < 0.001) but not dose-dependently, and ketoprofene (0.614 and 1.228 mM) had no effect on PMN-adhesion. The method presented here is efficient for evaluating the pharmacological modulation of PMN interaction with endothelial cells, and useful for studying further aspects of endothelial cell biology.

In vivo stimulation of neutrophil function by lenograstim (glycosylated rHuG-CSF) in oncohematologic patients: results of a phase I trial

The aim of this work was to study the evolution of neutrophil functions in non-neutropenic cancer patients. Thirty non-neutropenic patients, median age 35 years (range 19-52), with solid tumors (n = 21) or lymphomas (n = 9) entered a phase I study of five days of s.c. (n = 24) or i.v. bolus (n = 6) lenograstim, recombinant human glycosylated granulocyte colony-stimulating factor (rHuG-CSF Chugai-Rhône-Poulenc), with dose escalation from 1 to 40 micrograms/kg/day. Neutrophil functions were studied before lenograstim (D1) and 24 h after the last dose (D6). Granulocyte count rose in a significant way, and enzyme release, phagocytosis and bacterial killing were stimulated. All patients had improvement of at least one neutrophil function. Directed migration was depressed, although it was still in the normal range. These findings confirm that lenograstim is a potent activator of neutrophil functions in non-neutropenic cancer patients and may be useful as an adjunct to conventional antimicrobial therapy.

Effect of pinealectomy upon the nonspecific immune response of the ring-dove (Streptopelia risoria)

The different stages of the phagocytic process by granulocytes of pinealectomized or sham-pinealectomized ring doves (Streptopelia risoria) as well as hematological parameters (total white blood cells, smear, and total protein) and serum hormone levels (triiodothyronine (T3), thyroxine (T4), and corticosterone) were studied. A number of immunological parameters of the phagocytosis process, including adherence capacity, mobility rate, the phagocytosis capacity for inert particles and the digestion capacity of ingested material, were studied. Adult male ring doves were injected intravenously with either 0.1 ml of normal sheep serum (NSS) or saline (SS). Blood samples were collected before injection, and 1 hr, 3 hr, 24 hr, and 4 days afterwards. The results indicate that pinealectomy produces a significant increase in the number of total white blood cells and total protein concentration in plasma in addition to altering different stages of the phagocytic process. During the immunization study, a decrease in the percentage of leukocytes and lymphocytes and an increase in the percentage of heterophils accompanied by an increase in the concentration of serum corticosterone were observed 3 hr following treatment. For the immunological parameters, adherence capacity and latex bead ingestion were increased 3 hr after NSS injection and the NBT reduction test 3 and 24 hr after NSS treatment. In addition, the administration of NSS produced a significant increase in serum T3 and T4 concentrations 4 days following injection. These results show that pinealectomy has a marked effect on both the number and function of immune cells.

Evaluation of the mechanisms of antiepileptic drug-related chronic leukopenia

Antiepileptic drug (AED)-related chronic leukopenia [white blood cell (WBC) count < 4,000/microliters] is a dilemma, especially when the AED is effective in controlling seizures. We evaluated the possible mechanisms of leukopenia in 7 patients. Mean WBC count was 3,000/microliters with a mean of 42% polymorphonuclear leukocytes (PMN). The AEDs were carbamazepine (CBZ) alone in 1 patient or CBZ combined with phenytoin (PHT), primidone (PRM), phenobarbital (PB) and/or valproate (VPA) in 5 patients; one patient was receiving PHT only. Bone marrow (BM) aspirates and PMN antibody studies using chemiluminescence were normal. Two liver-spleen scans showed mild relative splenomegaly. After exercise, WBC count (n = 7) increased by 54% (SEM 12%), while the WBC counts in controls (n = 5) increased by 52 +/- 16%. Antinuclear antibodies (Hep-2) were absent in 6 patients and positive (1:160) in 1. PMN adhesion to nylon wool was decreased (54 +/- 10% in patients vs. 80 +/- 5% in controls: n = 13, p < 0.005). Our data, particularly the appropriate WBC response to the stress of exercise, and normal BM examinations suggest that continuation of AED therapy when leukopenia is stable and the percentage of PMN is normal is probably safe. Caution should be used if the absolute PMN count is consistently < 1,000/microliters. BM examinations need not be performed routinely for every patient with neutropenia due to AEDs, especially if the leukopenia fluctuates in the range of 2,000-4,000 cells/microliters.

Review article: the mode of action of the aminosalicylates in inflammatory bowel disease

Sulphasalazine and other 5-aminosalicylic acid (5-ASA)-containing drugs are used in the treatment of acute inflammatory bowel disease and in the maintenance of clinical remission. Despite their use for over 50 years, the mechanism of action of this class of drugs remains uncertain, although a number of possibilities are discussed in this review. It seems likely that the aminosalicylates are important free radical scavengers, can reduce leukotriene production and can inhibit the cellular release of interleukin-1, all of which are likely to be important in reducing the acute inflammatory response in inflammatory bowel disease. The effects of these drugs on prostaglandin production are more contentious, but it appears that 10(-5) to 10(-4) M concentrations stimulate production of prostaglandins which may be cytoprotective, while higher doses of these drugs inhibit prostaglandin production. The aminosalicylates may maintain remission in inflammatory bowel disease by preventing leucocyte recruitment into the bowel wall. The drugs inhibit the chemotactic response to leukotriene B4, reduce the synthesis of platelet activating factor and also inhibit leucocyte adhesion molecule upregulation.

Ischemia: reperfusion injury and restenosis after coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is a very effective technology that allows, without surgery, successful mechanical revascularization of acutely or chronically obstructed coronary arteries. The success of PTCA in patients with acute myocardial infarction or unstable angina is questioned by early coronary reocclusion and by so-called reperfusion injury. In a biochemical context, reperfusion injury occurs as a very complex interaction between the different tissues that build heart muscle. Free radicals play a pivotal role and initiate a deleterious cascade of events after reperfusion. Protective mechanisms such as superoxide dismutase, glutathione peroxidase, and catalase are normally present in the cell to prevent damage by free radicals. Endothelial cells have a greater number of specific physiologic and metabolic functions and influence the microcirculatory flow. In the presence of exogenous glucose, coronary endothelial cells show a pronounced lactate production under well-oxygenated conditions. Low energy demand and high glycolytic activity may be the cause of why the coronary endothelium is less severely injured than the cardiomyocytes in the ischemic and anoxic heart. The success of PTCA in patients with chronically obstructed coronary arteries (stable angina) is questioned by vessel occlusion and restenosis. Restenosis is a very complex process involving clinical, morphological, procedural, regional flow-dependent, and biological determinants. Early platelet deposition, formation of mural thrombus, coronary vasospasm, and elastic recoil forces of stretched vessel wall may contribute to early restenosis in the first days after PTCA, but the peak incidence of restenosis occurs between two and three months after PTCA. Intimal hyperplasia or proliferation of smooth muscle cells is believed to be the fundamental process of restenosis. To solve the problem of restenosis, much effort has been expended, which includes several technical and pharmacological approaches. Pharmacological strategies, systemically or locally administered, aim at increased vasomotor tone, platelet function, smooth muscle cell proliferation/migration, and fibrocollagenous healing. Up to now none of the proposed drugs has been able to reduce the restenosis rate. There is experimental evidence for a claim that the antioxidant functions of vitamins (E, C, and beta-carotene) may prevent restenosis post-PTCA. Until recently, in most post-PTCA restenosis trials the angiographic analyses were not performed using computerized measurement methods. In order to assess the efficacy of acute or long-term interventions on the natural course or acute complications of coronary artery disease, quantitative measures have been introduced and validated that make use of digital coronary angiography and computerized image processing techniques.(ABSTRACT TRUNCATED AT 400 WORDS)

Polymorphonuclear neutrophil contribution to induced tolerance to bacterial lipopolysaccharide

The objective of this study was to investigate mechanisms by which polymorphonuclear neutrophils (PMNs) contribute to the tolerance induced by repeated lipopolysaccharide (LPS) injections. Tolerance was developed by daily intraperitoneal injections of sublethal doses of LPS for 4 days (LPS-tolerant group); controls were not pretreated (LPS-control group). Both groups were challenged with 9 mg/kg i.v. Escherichia coli LPS, a dose that resulted in 25% survival in LPS-control rats compared with 100% survival in LPS-tolerant rats. LPS injection caused an initial neutropenia in both groups. The neutropenia persisted throughout the experiment in LPS-control rats, whereas in LPS-tolerant rats the circulating PMN count increased dramatically; after 6 hours, the PMN count was 16-fold higher than that in LPS-control rats. Activation of circulating PMNs, PMN adhesion to nylon fibers, and tumor necrosis factor/cachectin activity were all increased in control rats given LPS. In contrast, LPS-tolerant rats had low activation of circulating PMNs, no trend for PMN adhesion to nylon fibers, and markedly reduced tumor necrosis factor activity. To determine whether neutropenia was associated with a trapping of PMNs in the microcirculation, we used a carbon perfusion technique 6 hours after LPS injection and examined histological sections of the myocardium. All of the arterioles and venules in both groups contained carbon; only capillaries showed evidence of obstruction. A significantly higher percentage of obstructed capillaries was observed in LPS-control rats than in LPS-tolerant rats. Obstruction of capillaries was consistently associated with trapped leukocytes. We conclude that PMN cytotoxicity induced by LPS involves microcirculatory entrapment and activation of PMNs. Repeated LPS pretreatment reduces dramatically circulating PMN activation and adhesion and is associated with an elevated circulating PMN count, a low degree of microvascular plugging, and survival after a normally lethal dose of LPS.

Cytosolic free Ca2+ and proteolysis in lethal oxidative injury in endothelial cells

Oxygen free radicals (OFR) are thought to mediate ischemia-reperfusion injury to endothelium of heart, lung, brain, liver, and kidney and contribute to development of atherosclerosis, pulmonary O2 toxicity, and adult respiratory distress syndrome. Increased cytosolic free Ca2+ (Cai2+) has been proposed as a mechanism of injury from oxidative stress, yet the pathways by which an increase in Cai2+ may cause OFR-mediated endothelial cell injury remain unknown. Using multiparameter digitized video microscopy and the fluorescent probes, fura-2 acetoxymethyl ester and propidium iodide, we measured Cai2+ and cell viability in human umbilical endothelial cells during oxidative stress with xanthine (50 microM) plus xanthine oxidase (40 mU/ml). Oxidative stress caused a sustained increase in Cai2+ from a resting level of 90-100 nM to near 500 nM, which was preceded by formation of plasma membrane blebs. The increase in Cai2+ was prevented by removal of extracellular Ca2+ (Cao2+). Prevention of the increase in Cai2+ was associated with prolonged cell viability. Readdition of Cao2+ resulted in an immediate large increase in Cai2+ and rapid onset of cell death. The protease inhibitors, leupeptin and pepstatin, delayed the increase in Cai2+ and prolonged cell viability. The results are consistent with the hypothesis that endothelial cell injury due to oxidative stress may be the result of Cai2+ influx and resultant activation of Ca(2+)-dependent proteases.

Ferret tracheal epithelial cells grown in vitro are resistant to lethal injury by activated neutrophils

Airway inflammation is often accompanied by accumulation of polymorphonuclear leukocytes (PMN) as well as epithelial sloughing. To determine whether PMN contribute to epithelial damage in inflammatory states, we examined the interaction of PMN and tracheal epithelial cells in culture. Ferret tracheal epithelial (FTE) cells were grown in primary culture on collagen-coated multiwell dishes. Confluent monolayers were loaded with [51Cr]O4 and exposed to resting and activated neutrophils. There was no significant increase in cell death as assessed by [51Cr]O4 release over 8 h of exposure, at effector (PMN)-to-target cell (epithelial cell) ratios up to 90:1, whether PMN were activated by maximal activating concentrations of phorbol myristate acetate or formylmethionylleucylphenylalanine with or without cytochalasin B. This result was confirmed by using a [3H]leucine release assay as well as by uptake of a supravital dye. However, exposure of FTE cells to activated PMN for 4 h resulted in separation of adjacent cells and formation of gaps in the monolayer, without significant detachment of epithelial cells from the dish. Gap formation was prevented by alpha 1-antitrypsin, N-methoxysuccinyl-Ala-Ala-Pro-Val-chloromethylketone, or 10% serum, was mimicked by PMN elastase (24 micrograms/ml), but not by hydrogen peroxide in concentrations up to 10 mM, or superoxide generated by xanthine/xanthine oxidase, and was reversible within 24 h of removal of elastase and exposure to fresh medium. We conclude that activated PMN do not kill FTE cells in culture. However, disruption of the epithelial cell monolayer probably by a proteolytic mechanism can result from exposure to activated PMN and may allow alteration of the epithelial barrier during airway inflammation.

Mechanisms of neutrophil-mediated tissue injury

Neutrophil-mediated tissue injury (NMTI) is a prominent mechanism of host autodestruction. It is defined by a sequence of events including neutrophil adherence and sequestration, diapedesis, activation, and secretion of toxic compounds. Knowledge of this sequence is valuable because it outlines points at which intervention may be sought. A limitation of these studies comes in the misunderstanding and misapplication of the tests used to analyze these events. We now realize that neutrophil adherence, sequestration, diapedesis, and secretion of toxic compounds can each occur alone without promoting generalized tissue injury. NMTI is a normally localized process that has gone systemically awry. Influencing this system must be selective and controlled because the inflammatory system is a critical component of host defense. As we gain insight into the pathophysiology of NMTI, we hope to find new avenues for therapeutic intervention in critical care.

Stimulation of phagocytic processes and antibody-dependent cellular cytotoxicity of human neutrophils by cefmetazole

Interactions between antimicrobial agents and phagocytic cells, especially neutrophils, have a potential role in the treatment of infections. The in vitro effects of cefmetazole, a novel beta-lactam antibiotic, at a therapeutic concentration reached in plasma (50 micrograms/ml) on phagocytic and cytotoxic functions of human neutrophils have been studied. In human neutrophils, adherence capacity to nylon fiber and to substrate, chemotaxis, attachment to and ingestion of Candida albicans (with serum, with decomplemented serum and without serum), ingestion of inert particles (latex beads), candidicidal activity and superoxide anion production were all stimulated by cefmetazole. Cefmetazole at this dose was a chemotactic agent for neutrophils. Antibody-dependent cellular cytotoxicity (ADCC) was also increased by this anti-microbial agent.

Simultaneous measurement of endothelial cell damage, elastase release and chemiluminescence response during interaction between polymorphonuclear leukocytes and endothelial cells

Using cultured human umbilical cord vein endothelial cells and human blood neutrophils, the interaction between neutrophils and endothelial cells, in vitro, was studied. The aim of the study was to examine whether a respiratory burst stimulation by neutrophils would be observed by neutrophil/endothelial cell interaction and whether the respiratory burst stimulation of neutrophils by endothelial cells could be enhanced by lipopolysaccharide stimulation of neutrophils. The second aim was whether such an effect, or secretion of elastase, could cause an endothelial cell damage in vitro. Chemiluminescence as an indicator of oxygen-derived metabolites produced by neutrophils, elastase release by neutrophils, and endothelial cell damage, based on 111 In-oxine release from labelled endothelial cells, were measured simultaneously. The present investigation demonstrates that neutrophils can be directly stimulated by endothelial cells. A further amplification of this process following lipopolysaccharide priming up to 10 ng/ml blood could be demonstrated. A slight endothelial cell damage occurs following neutrophil stimulation, although elastase secretion does not increase during interaction between neutrophils and endothelial cells. These results raise the possibility that oxygen-derived metabolites rather than elastase contribute to an endothelial cell damage which might occur in conditions such as endotoxin-induced adult respiratory distress syndrome.

Adherence-induced enhancement of the oxidative burst of human neutrophilic granulocytes: effects of the surface coat and of divalent cations

Neutrophilic granulocytes are capable of adhering to biological or artificial surfaces. In addition to specific interactions between adherence molecules on the cell surface and corresponding structures on other cells or matrix proteins like fibronection or collagen there appeared to be non-specific attachment as well. Adherence augmentation induced by stimulation with chemotactic factors or cytokines was an active process which did not proceed at 4 degrees C and after removal of divalent cations from the medium. Adherence acted as a priming stimulus increasing the amount of superoxide anion and hydrogen peroxide produced in response to stimulation by certain chemotactic factors and cytokines. Adherence priming like priming by GM-CSF was strongly suppressed by chelation of intracellular Ca2+ ions. The two priming mechanisms differed, however, in their requirement for divalent cations in the external medium: whereas Mg2+ suppressed GM-CSF priming, it synergised with Ca2+ in the adherence-augmented oxidative burst.

Modulation of U937 cell adhesion to vascular endothelial cells by cyclic AMP

Adhesion of leukocytes to the endothelium is an essential event in inflammatory cell emigration from intravascular to extravascular compartment. While many mediators (e.g. cytokines) enhance cell adhesion through expression of adhesion molecules on endothelial cells the mechanism of this phenomenon is not known. In this study we examined the role of cAMP in mediation of the adhesion of monocytic cell line, U937 to human umbilical vein endothelial cells (HUVEC). Incubation of HUVEC with cholera toxin (10-500 ng/ml) for 4 hrs greatly enhanced the adhesiveness of HUVEC for U937 cells. The magnitude of adhesion stimulation produced by cholera toxin was comparable to that produced by the cytokines TNF alpha or IL-1 (2-3 folds). Upregulation of U937 cells adhesion to HUVEC was also achieved by short incubation (less than 1 hr) of HUVEC with cAMP elevating agents such as forskolin (10 microM), isoproterenol (0.3-30 microM), epinephrine (10-100 microM), norepinephrine (100 microM) as well as by endogenously added dibutyryl cAMP (0.05-2.0 mM). Dibutyryl cyclic GMP (0.05-2.0 mM) was ineffective in promoting adhesion. These data suggest that cAMP might be an important intracellular modulator of leukocyte adhesion to endothelium and therefore promoter of pro-inflammatory processes.

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).

Quantitation of polymorphonuclear leukocyte adherence to endothelial cells by electronic particle size discrimination

A method for quantitating the number of polymorphonuclear leukocytes (PMNs) adhering to endothelial cells in vitro is presented. Confluent human umbilical vein endothelial cells cultured in 24-well multiplates and treated with tumor necrosis factor alpha (TNF alpha) were incubated subsequently with PMNs which adhere to the endothelial cell as a function of TNF alpha concentration. Adherent PMNs and endothelial cells were proteolytically dissociated from the multiwell and, using an electronic particle counter, the number of endothelial cells and PMNs were determined simultaneously on the basis of size. The average number of PMNs adhering per endothelial cell was then calculated. The method is rapid and precise and offers an alternative to both tedious microscopic counting and the hazardous radiolabeling of PMNs.

Porcine granulocyte functions: evaluation and modulation

Functions of porcine polymorphonuclear neutrophils are evaluated with in vitro test systems. Results are compared with those from human PMN and the relevance for in vivo conditions is discussed. Ethanol was inhibitory to all porcine PMN functions investigated here. Influex, a combination product, containing extracts of Echinacea, Aconitum, Apis and Lachesis stimulated adherence, chemotaxis, and phagocytosis, but inhibited chemiluminescence. These results suggest an effect of the product in the generation of reactive oxygen species.

Purification and partial characterization of platelet-derived adherence-inhibiting factor in guinea pig

Purification and partial characterization of adherence-inhibiting factor (AIF) of platelet-granule fraction in guinea pig were studied. When freshly prepared platelet-granule fraction was subjected to a gel filtration, two neutrophil adherence-inhibiting peaks, designated AIF-I (2,800 kDa) and AIF-II (12 kDa), appeared. AIF-I was sensitive to diisopropylfluorophosphate (DFP) and originated from lysosomes, whereas AIF-II was insensitive to DEP and localized in alpha-granules. Both AIFs were released from platelets by a thrombin stimulation. As the total activity of AIF-I was about 5-fold higher than that of AIF-II, AIF-I was purified and characterized. When purified AIF-I was analyzed on SDS-polyacrylamide gel electrophoresis, the 340 kDa protein band and the other large protein band were observed. Under reducing condition, AIF-I was separated into three components (340, 190 and 165 kDa). AIF-I significantly inhibited neutrophil adherence to artificial substrata and to type IV collagen-coated plastic surface, but not to fibronectin- or plasma-coated plastic surfaces, suggesting that AIF-I inhibits neutrophil adherence not only via nonspecific adsorption sites but also via type IV collagen receptors.

Decreased adherence of polymorphonuclear neutrophils in children with viral infection

The adherence of polymorphonuclear neutrophils was examined in 16 children affected by enteritis, pneumonia, hepatitis and infectious mononucleosis. The results were compared with those obtained in 30 healthy adult volunteers and in 15 healthy children of the same age. Adhesiveness was significantly higher in adults than in healthy children, and significantly higher in healthy children than in children with viral infection. In 7 patients tested one month after regression of the disorder, PMN adhesiveness had returned to normal.

A novel neutrophil adherence test effectively reflects the activated state of neutrophils

We developed a novel and convenient neutrophil adherence test for ascertaining the activated state of neutrophils. Human peripheral blood neutrophils were placed in wells of a 96-well flat-bottom culture plate, and incubated in the presence or absence of neutrophil stimulants for varying periods of time at 37 C in a CO2 incubator (5% CO2, 95% air). After non-adherent cells were completely removed by vibration on a vortex mixer, residual adherent cells were fixed and stained with crystal violet containing 12% formaldehyde and 10% ethanol. After thorough washing, 1% SDS was added to the plate, and the absorbance of each well was measured at 570 nm. Our results correlate well with those of a previously reported method using 51Cr-labeled cells.

Effect of endothelium on basal and on stimulated accumulation and efflux of cyclic GMP in rat isolated aorta

1. The aim of this study was to examine the possible role of the release of guanosine 3':5'-cyclic monophosphate (cyclic GMP) into the extracellular space in the regulation of rat aortic cyclic GMP content. 2. Rat aortic segments incubated in physiological solution released cyclic GMP into the medium in a time-dependent manner. This release was greatly enhanced when intact instead of tissues without endothelium were used. After 120 min of observation, a maximal 33 fold difference in extracellular cyclic GMP content was detected. 3. Treatment of rat aortic preparations with either a Ca2+-free solution or methylene blue, both conditions known to inhibit endothelium-derived relaxing factor (EDRF)-mediated responses, markedly reduced the extracellular accumulation of cyclic GMP from tissues with but not without endothelium. 4. Endothelium-dependent vasodilators such as acetylcholine (10 microM) and carbachol (10 microM) greatly increased tissue cyclic GMP content, in a time-dependent manner in rat aortic preparations with endothelium, but only slightly in tissues without. Maximal increases in intact tissues were obtained after about 1 min of agonist contact and amounted to about 35 and 15 fold respectively, thereafter tissue cyclic GMP content rapidly declined. Histamine (10 microM) elicited only minor effects on tissue cyclic GMP content of both intact preparations and those without endothelium. 5. Acetylcholine (10 microM), carbachol (10 microM) and histamine (10 microM) stimulated a time-dependent release of the cyclic nucleotide into the incubation medium from tissues with endothelium. After 120 min of observation, extracellular accumulation of cyclic GMP from intact tissues was increased by about 2.6, 6.6 and 1.7 fold respectively. Carbachol and histamine induced only minor effects on release from tissues without endothelium. 6. Sodium nitroprusside (0.3 and 10 microM), a direct activator of soluble guanylate cyclase, induced a concentration-dependent accumulation of cyclic GMP in tissues with and without endothelium that was associated with a concentration-dependent accumulation of cyclic GMP in the extracellular space. Peak tissue cyclic GMP content reached similar levels in preparations with and without endothelium, while extracellular cyclic GMP levels were about two times greater when experiments were performed with intact compared to endothelium-denuded tissues. 7. Atriopeptin II, an activator of particulate guanylate cyclase, increased tissue cyclic GMP content by about 8 and 18 fold respectively in tissues with and without endothelium. As was the case with sodium nitroprusside, atriopeptin II-stimulated release was markedly enhanced from intact tissues compared with those without endothelium. After 120 min of observation, there was a 16 fold difference in the amount of extracellular cyclic GMP.

Modulation of endothelial fibronectin synthesis by polymorphonuclear granulocytes

The attachment of polymorphonuclear granulocytes (PMNs) to vascular endothelial cells occurs continually in normal tissues; however, knowledge of the factors that control leukocyte margination is incomplete. In the present study, we used cell cultures of pulmonary artery endothelium to study their interaction with PMNs. Endothelial cells were seeded in Costar 24-well plates following which PMNs were inoculated onto the endothelial monolayers and incubated for 2 to 20 hours. During this period, fibronectin synthesis by endothelial cells was estimated by ELISA. In wells to which PMNs had been added, supernatant fibronectin concentration was increased at all time points during the 20 hour incubation. At 20 hours, supernatants from wells to which PMNs had been added contained approximately 2 1/2 times the control level of fibronectin. Since the amount of fibronectin, as determined by ELISA, adsorbed onto the added PMNs was negligible, these data suggest that PMNs can modulate the synthesis of fibronectin by pulmonary artery cells. Pulse labeling experiments and measurements of endothelial intracellular fibronectin also suggest this possibility. The endothelial response does not appear to be owing to nonspecific physical interaction since similarly sized polystyrene beads did not cause any change in supernatant fibronectin levels while glutaraldehyde-fixed PMNs caused only a 20-25% increase in fibronectin levels.

Role of the LFA-1 adhesion glycoprotein in neutrophil adhesion to endothelium and plastic surfaces

Neutrophil adherence to endothelium is known to be mediated, at least in part, by adhesion molecules such as LFA-1. Deficiency of these adhesion molecules leads to recurrent infection and early death from infection. As screening for defects of these adhesion glycoproteins is often performed by the ability of neutrophils to adhere to plastic plates, in this study a comparison of neutrophil adherence by the CD18/CD11a (LFA-1) mechanism to endothelium and plastic surfaces was examined. Baseline neutrophil adherence was two-fold higher to plastic than to endothelium (17% +/- 9 for plastic, 8% +/- 5 for endothelium). Baseline adherence to endothelium was partially inhibitable by anti-LFA-1 antibodies, whereas no inhibition of adherence occurred on plastic. Neutrophil stimulants increased adherence to both surfaces, although only on endothelium was this increase attributable to the LFA-1 mechanism. IL-1 increased adherence to endothelium, but had no effect on plastic. We conclude that adherence of neutrophils to plastic surfaces probably represents overall activation status through undefined mechanisms, is not by LFA-1 receptor ligand interactions, and is therefore a non-physiological phenomenon. Endothelial receptors are pivotal in neutrophil adherence. It would be more appropriate to screen leucocytes for leucocyte adhesion deficiency by assaying for specific receptor occupancy with monoclonal antibodies, rather than an assay such as adhesion to plastic where the adhesion ligand is non specific.

Endothelial and myocardial injury during ischemia and reperfusion: pathogenesis and therapeutic implications

Early reperfusion remains the most effective way of limiting myocardial necrosis and improving ventricular function in experimental models and human patients. However, the introduction of oxygen and cellular elements, especially the neutrophil, into the ischemic zone may initiate a deleterious cascade of events that limits myocardial salvage after reperfusion. Although the pathogenesis of reperfusion injury remains controversial, recent studies have suggested that the endothelium may play a critical role. Endothelial cells maintain flow in the microcirculation by secreting a number of vasodilatory compounds and substances that prevent plugging of capillaries by inhibiting neutrophil adherence and platelet aggregation. Reperfusion of ischemic myocardium accelerates structural and functional changes in endothelial cells, resulting in a progressive decrease in microcirculatory flow ("no reflow" phenomenon). Numerous studies suggest that activated neutrophils mediate vascular damage by releasing reactive oxygen species and potent proteolytic enzymes. The administration of therapeutic agents that limit endothelial disruption and neutrophil plugging has shown promising results in limiting myocardial reperfusion injury in experimental models.

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.

The leucocytosis of exercise. A review and model

Exercise is known to induce an immediate leucocytosis, the magnitude of which is related, in most instances, to the intensity and duration of the work. On finishing exercise, however, the leucocyte count may change in any one of several different ways. The pattern of postexercise changes in the leucocyte count is determined mainly by the time which has elapsed since beginning exercise, rather than the work intensity or the total work done, if, for example, exercise has been intermittent. Consideration of, firstly, the circumstances under which the plasma concentrations of catecholamines and cortisol have been found separately to correlate with the leucocyte count at the finish of exercise, and, secondly, the effects on the leucocyte count of exogenous administration of these substances has led us to develop a model which can satisfactorily account for all of the principal changes in the leucocyte count that have been noted during and after exercise. It is proposed that catecholamines produced during exercise act to increase the ratio of circulating to non-circulating leucocytes, while cortisol acts, by a mechanism which involves a time lag, to increase the total number of leucocytes in the vascular compartment. Examination of previously published reports shows that many contain results which support this model. Using the model as a basis, some predictions are made that can be tested experimentally, and some experiments are suggested which should help elucidate the mode of action of catecholamines and cortisol.

Increased adherence of human granulocytes to herpes simplex virus type 1 infected endothelial cells

We studied the interaction of human polymorphonuclear leukocytes (PMNs) with umbilical vein endothelial cells infected with herpes simplex virus (HSV) type 1. PMNs labeled with 51Cr were added to endothelial monolayers at varying times after infection and their adherence assessed 1 h later. Granulocyte adherence (GA) to uninfected cells averaged 26.5 +/- 1.9%. Increased adherence began 6 h postinfection and rose to a maximum at 20 to 24 h. HSV-1 glycoproteins seemed to mediate the increase in GA: tunicamycin treatment of infected monolayers for 18 h abolished the increased GA as did incubation of infected cells with F(ab')2 fragments prepared from human antiserum containing HSV-1 antibody.

Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables

The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors.

Development of a high capacity microassay for measurement of neutrophil adhesion

A high capacity semiautomated assay for neutrophil adhesion was developed utilizing the 96 well microtiter plate format. Optimal adhesion occurred with about 150 microliters/well of neutrophils at 5 X 10(6) cells/ml in tissue culture plates that had been precoated with 5% serum. Optimal incubation times were 10 min for f-Met-Leu-Phe-treated cells and 20 min for A23187 or phorbol myristate acetate stimulation. Optimal washing occurred after three washes with a Cetus Pro/pette pump. Adhesion could be effectively blocked by the inhibitors of cellular protein kinase C, an enzyme known to be necessary for the occurrence of neutrophil adhesion.