Multimodal optical mesoscopy reveals the quantity and spatial distribution of Gram-positive biofilms in ex vivo tonsils

Biofilms are known to be present in tonsils, but little is known about their spatial location and size distribution throughout the tonsil. Studies of the location and distribution of biofilms in tonsil specimens have thus far been limited to either high-magnification methods such as electron microscopy, which enables high-resolution imaging but only from a tiny tissue volume, or lower magnification techniques such as light microscopy, which allow imaging of larger specimens but with poor spatial resolution. To overcome these limitations, we report the use of multimodal optical mesoscopy to visualise and quantify the number and spatial distribution of Gram-positive biofilms in fresh, excised paediatric tonsils. This methodology supports simultaneous imaging of both the tonsil host and biofilms in whole mounts of tissue up to 5 mm × 5 mm × 3 mm with subcellular resolution throughout. A quantitative assessment of 36 tonsil specimens revealed no statistically significant difference between biofilm presence on the tonsil surface and the interior of the tonsil. This new quantitative mesoscale imaging approach may prove useful in understanding the role of biofilms in tonsillar diseases and other infections.

Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago

OBJECTIVE

To determine the prevalence of anaemia in antenatal clinic attendees; to investigate the effects of parity, age, gravidity, previous abortions, child spacing and other factors on the prevalence of anaemia in pregnancy.

METHODS

This was a retrospective and cross-sectional study. Antenatal records of 2287 pregnant women attending 40 public healthcare centres from January 2000 to December 2005 in Trinidad and Tobago were used. Data pertaining to the investigated variables were recorded. The national prevalence of anaemia was calculated and chi-square tests, odds ratios and logistic regression were used to assess the relationship between anaemia and each variable.

RESULTS

The prevalence of anaemia was 15.3% (95% CI 13.4%, 16.6%). No significant difference in the prevalence of anaemia was found among the different clinics or counties. At the first haemoglobin reading, age was inversely related to the presence of anaemia, whereas gestational age at first visit was directly related. At the final haemoglobin reading, parity, gravidity, and previous spontaneous abortions were directly related to the prevalence of anaemia, while the number of visits was inversely related. Age was inversely associated to the severity of anaemia while gravidity was directly related.

CONCLUSION

The prevalence of anaemia decreased by 18.7% from 1967. Despite this positive indication, women under 24 years and those commencing antenatal care after the first trimester are still at a higher risk for developing anaemia. Early commencement of antenatal care and close monitoring of the risk groups identified should be strongly advocated.

The association between plasma levels of acute phase proteins, haptoglobin, alpha-1 acid glycoprotein (AGP), Pig-MAP, transthyretin and serum amyloid A (SAA) in Large White and Meishan pigs

During infection, the acute phase response triggers the release of acute phase proteins (APP), alpha-(1) acid glycoprotein (AGP), serum amyloid A (SAA) and Pig-MAP into the circulation, accompanied by a decrease in plasma levels of transthyretin. We quantified the association between these APP in 26 apparently healthy pigs from two breeds, 13 Large White and 13 Meishan (16 male; 10 female). There was a significant correlation between plasma levels of haptoglobin and Pig-MAP (r=0.57; p<0.05), but no significant associations between any of the other APP tested. We also measured the relationship between PigMAP, transthyretin and SAA, and the proportions of peripheral blood mononuclear sub-sets, CD8(+) cells, CD4(+) cells, CD11R1(+) cells, MHC DQ(+) cells, and monocytes. There were correlations between both plasma levels of Pig-MAP and the proportion of monocytes (r=0.55; p<0.05) and plasma levels of transthyretin and the proportion of MHC DQ(+) cells (r=0.40; p<0.01). Breed and sex influenced plasma levels of Pig-MAP but not plasma levels of transthyretin. Overall, these results suggest closer links between the mechanisms that regulate the release haptoglobin, Pig-MAP and monocytes compared to those that regulate the release of AGP, SAA and transthyretin.

Associations of acute phase protein levels with growth performance and with selection for growth performance in Large White pigs

Abstract Acute phase proteins (APP) are released into the circulation in mammals upon infection and may be used to diagnose the health status of managed populations of animals such as pigs. The current study determines APP levels in a population of apparently healthy Large White pigs from a single farm, to address two questions: (1) whether phenotypic associations can be observed between productivity and APP, indicating the effects of possible subclinical infections and (2) whether previous selection for either food intake or ‘lean growth under restricted feeding’ influences APP levels. The APP investigated were alpha1- acid glycoprotein (AGP) and haptoglobin. The APP were measured at 18 and 24 weeks of age in pigs previously selected for high lean growth (no. = 31), low lean growth (no. = 38), high daily food intake (no. = 24) and low daily food intake (no. = 26), but performing under ad libitum feeding conditions. Performance traits and APP levels were constant over the experimental period, indicating that the farm health status did not vary over time. Performance traits and APP were recorded on 119 pigs, of which 80 had both APP and performance measurements. Multiple regression analyses were used to investigate phenotypic relationships between performance traits and APP levels. Plasma concentrations of AGP were higher in 18-week-old pigs compared with 24-week-old pigs (P< 0·01) whereas haptoglobin levels did not vary according to age. Significant sex differences in APP levels were observed. Females had higher circulating levels of AGP than males at both 18 weeks and 24 weeks. Females also had higher levels of haptoglobin at 18 weeks. Levels of AGP had significant negative correlations with daily weight gain (−0·59,P< 0·01 and −0·48,P< 0·05 at 18 and 24 weeks respectively) and with daily food intake (−0·53,P< 0·01 and −0·38,P< 0·05 at 18 and 24 weeks respectively). At age 24 weeks, haptoglobin was negatively correlated with both daily weight gain (−0·35,P< 0·05) and food efficiency (−0·34,P< 0·05). Pigs selected for high lean growth under restricted feeding had higher AGP levels than pigs selected for low lean growth under restricted feeding at 18 (593v. 332 μg/ml,P< 0·01) and 24 weeks of age (313 v. 219 μg/ml,P< 0·05). Selection for daily food intake did not consistently affect AGP levels, and neither selection criteria influenced plasma haptoglobin concentrations. To conclude, we have demonstrated that amongst contemporaneous pigs of the same genotype, higher systemic AGP levels and, to a lesser extent, higher haptoglobin levels are associated with decreased performance, and that genetic selection for ‘efficient lean growth under restricted feeding’ can increase serum AGP levels.

Innate immune traits differ between Meishan and Large White pigs

A panel of innate immune traits were compared between Meishan and Large White pigs. These pigs were of similar age and kept under the same environmental conditions to reduce non-genetically derived variation in immune traits. The animals were all apparently healthy and were not experimentally challenged with any pathogen during the study. The measures only required a small blood sample. Total white cell counts were similar between the pig breeds. However, the numbers of lymphocytes, neutrophils and monocytes differed significantly, with Meishans having higher neutrophil and monocyte counts and lower lymphocyte counts. Flow cytometric methods were used to determine quantitatively the characteristics and function of neutrophils and monocytes. Meishan neutrophils were smaller and less complex than Large White neutrophils, and phagocytosis of Escherichia coli and the ensuing oxidative burst was lower in Meishan neutrophils compared to Large White neutrophils. Monocyte phagocytosis of E. coli was significantly less than that of neutrophils in both breeds but the function of Meishan monocytes as measured by phagocytosis and tumour necrosis factor alpha (TNFalpha) release did not differ from that of Large White monocytes. Levels of acute phase proteins also differed between the breeds with a significantly higher proportion of Meishans having elevated serum amyloid A levels. However, Meishans had lower alpha(1)-acid glycoprotein levels than Large Whites and haptoglobin levels were similar. Such differences in innate immune traits may have implications in the resistance to infection by a broad range of pathogens and subsequent disease effects in these breeds. Further studies are warranted to investigate the genes underlying these traits.

Administering granulocyte colony-stimulating factor to acute liver failure patients corrects neutrophil defects

OBJECTIVES

Neutrophil function is defective in acute liver failure (ALF) and the in vitro ability of granulocyte colony-stimulating factor (G-CSF) to reverse these defects has been reported. The effects of administering G-CSF to ALF patients are presented in this study.

DESIGN

This was a prospective, phase I/II, open label, study.

SETTING

The liver intensive therapy unit at King's College Hospital, London.

PARTICIPANTS

Sequential patients admitted with acute liver failure due to acetaminophen overdose.

INTERVENTIONS

G-CSF was given to four groups (each n = 6) of ALF patients as a daily infusion at 25, 50, 100 or 150 microg/m2. A control group of eight patients did not receive G-CSF.

MAIN OUTCOME MEASURES

Neutrophil phagocytosis and killing of Staphylococcus aureus and superoxide release before G-CSF administration and at 24 and 96 h thereafter.

RESULTS

Neutrophils from patients receiving 50, 100 or 150 microg/m2 G-CSF, but not from control patients or those receiving 25 microg/m2, showed significantly increased phagocytosis and killing at 96 h. Doses of 50 or 150 microg/m2 G-CSF resulted in increased superoxide production at 96 h. No patients discontinued treatment as a consequence of side effects related to G-CSF administration.

CONCLUSIONS

G-CSF administration is a safe and effective means of reversing the neutrophil defects of ALF, and may have a role in the prevention and treatment of infection in these patients. A dose of 50 microg/m2/day is as effective as higher doses and was associated with fewer side effects.

Granulocyte colony-stimulating factor improves function of neutrophils from patients with acute liver failure

OBJECTIVE

To evaluate the in vitro effects of granulocyte colony-stimulating factor (G-CSF) on function of neutrophils in acute liver failure (ALF).

METHODS

Neutrophil functions (superoxide and hydrogen peroxide production; phagocytosis and killing; complement receptor expression) were determined simultaneously in 23 patients with ALF due to paracetamol overdose and compared with 23 healthy control subjects.

RESULTS

Phagocytosis was reduced in neutrophils from ALF patients compared to controls (P< 0.005) and was significantly increased by incubation with 1,000 or 5,000 IU/ ml G-CSF (P< 0.05). This correlated with increased expression of CD11b (r= 0.93) and CD18 (r= 0.98) after incubation with 5,000 IU/ml G-CSF (P< 0.05). Killing was reduced in ALF neutrophils compared to controls (P< 0.005) and was similarly restored by G-CSF (P< 0.005). An increase in killing correlated with increases in production of superoxide (r = 0.96) and hydrogen peroxide (r= 0.97) by ALF neutrophils after incubation with 1,000 and 5,000 IU/ml of G-CSF when formylmethionylleucylphenylalanine (fMLP) was the stimulant. G-CSF at 5,000 IU/ml increased the production of hydrogen peroxide (P< 0.01) when zymosan was the stimulant.

CONCLUSIONS

G-CSF improves the neutrophil dysfunction of ALF.

Randomised placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infection

BACKGROUND

Diabetic foot infections cause substantial morbidity and mortality. Neutrophil superoxide generation, a crucial part of neutrophil bactericidal activity, is impaired in diabetes. Granulocyte-colony stimulating factor (G-CSF) increases the release of neutrophils from the bone marrow and improves neutrophil function. We assessed G-CSF as adjuvant therapy for the treatment of severe foot infections in diabetic patients.

METHODS

40 diabetic patients with foot infections were enrolled in a double-blind placebo-controlled study. On admission, patients were randomly assigned G-CSF (filgrastim) therapy (n = 20) or placebo (n = 20) for 7 days. Both groups received similar antibiotic and insulin treatment. Neutrophils from the peripheral blood of these participants and from healthy controls were stimulated with opsonised zymosan, and superoxide production was measured by a spectrophotometric assay (reduction of ferricytochrome C).

FINDINGS

G-CSF therapy was associated with earlier eradication of pathogens from the infected ulcer (median 4 [range 2-10] vs 8 [2-79] days in the placebo group; p = 0.02), quicker resolution of cellulitis (7 [5-20] vs 12 [5-93] days; p = 0.03), shorter hospital stay (10 [7-31] vs 17.5 [9-100] days; p = 0.02), and a shorter duration of intravenous antibiotic treatment (8.5 [5-30] vs 14.5 [8-63] days; p = 0.02). No G-CSF-treated patient needed surgery, whereas two placebo recipients underwent to amputation and two had extensive debridement under anaesthesia. After 7 days' treatment, neutrophil superoxide production was significantly higher in the G-CSF group than in the placebo group (16.1 [4.2-24.2] vs 7.3 [2.1-11.5] nmol per 10(6) neutrophils in 30 min; p < 0.0001). G-CSF therapy was generally well tolerated.

INTERPRETATION

G-CSF treatment was associated with improved clinical outcome of foot infection in diabetic patients. This improvement may be related to an increase in neutrophil superoxide production.

Neutrophil superoxide and hydrogen peroxide production in patients with acute liver failure

Defects in superoxide and hydrogen peroxide production may be implicated in the high incidence of bacterial infections in patients with acute liver failure (ALF). In the present study, oxygen radical production in patients with ALF due to paracetamol overdose was compared with that of healthy volunteers. Neutrophils from 14 ALF patients were stimulated via the complement receptors using zymosan opsonized with ALF or control serum. Superoxide and hydrogen peroxide production by ALF neutrophils stimulated with zymosan opsonized with ALF serum was significantly reduced compared with the control subjects (P < 0.01). This defect persisted when zymosan opsonized by control serum was used (P < 0.05). Superoxide and hydrogen peroxide production in neutrophils stimulated with formyl-methionyl-leucyl-phenylalanine (fMLP) from a further 18 ALF patients was unaffected compared with control neutrophils. Serum C3 complement levels were significantly reduced in ALF patients compared with control subjects (P < 0.0005). These results demonstrate a neutrophil defect in ALF due to paracetamol overdose, that is complement dependent but independent of serum complement, possibly connected to the complement receptor.

Effect of captopril, enalaprilat and mercaptopropionyl glycine (MPG) on the oxidative activity of human isolated neutrophils

1. Neutrophil NADPH oxidase produces the superoxide anion (O2-) anion radical from oxygen. The thiol containing ACE inhibitor, captopril has been reported to inhibit isolated NADPH oxidase. The above effect of captopril, if present in intact cells, could contribute to the ability of this drug to alleviate neutrophil-mediated tissue damage. We have, therefore, investigated the effect of captopril on the oxidative activity of intact human isolated neutrophils. 2. The effects of captopril on neutrophil oxidative activity were compared with those of enalaprilat (a non-thiol ACE inhibitor) and N-mercaptopropionyl glycine (MPG) (a simple thiol). 3. The oxidative response of PMA-stimulated neutrophils measured by lucigenin chemiluminescence was not affected by any of these test agents. The thiol captopril and MPG (but not enalaprilat) caused an initial delay in luminol chemiluminescence production by PMA-stimulated neutrophils. 4. Captopril and MPG (but not enalaprilat) increased, rather than decreased oxygen uptake, when added to PMA-stimulated neutrophils. Thiol oxidation was determined to be, at least partly, responsible for the excess oxygen uptake observed. 5. NADPH oxidase activity in intact neutrophils was not affected by captopril, MPG or enalaprilat. The inhibition of NADPH oxidase activity is unlikely to contribute to the therapeutic effects of captopril and other thiols.

Does luminol chemiluminescence detect free radical scavengers?

Thiol compounds have been reported to abolish hypoxanthine/xanthine oxidase induced luminol chemiluminescence and this effect has been attributed to scavenging of superoxide (O2-)/(H2O2) produced from hypoxanthine/xanthine oxidase. Yet other workers have reported that thiol compounds have shown little, if any, reactivity towards O2-/H2O2. The aim of this study was to examine the discrepancy between these two sets of findings further. Captopril (a thiol angiotensin-converting enzyme (ACE) inhibitor) and MPG (a simple thiol) were observed to abolish hypoxanthine/xanthine oxidase induced chemiluminescence. The reactivity of captopril and MPG towards O2-/H2O2 was then determined by measurement of thiol oxidation in captopril and MPG after their incubation with hypoxanthine/xanthine oxidase. Incubation (at 10 min, 37 degrees C) with 4 mM hypoxanthine/0.03 u ml-1 xanthine oxidase resulted in 7% and 20% thiol oxidation in captopril and MPG (at 1 mM) respectively. Captopril and MPG, therefore, appeared to be ineffective scavengers of oxidants produced by hypoxanthine/xanthine oxidase. Captopril and MPG also did not affect urate production or oxygen consumption by xanthine oxidase which indicated that captopril and MPG quench luminol chemiluminescence by a mechanism that excludes the inhibition of xanthine oxidase. Hypoxanthine/xanthine oxidase induced luminol chemiluminescence may, therefore, be an unsuitable method for measuring free radical scavenging activity by drugs.

The effect of angiotensin-converting enzyme inhibitors on human neutrophil chemotaxis in vitro

1. Myocardial 'reperfusion injury' has been partly attributed to the production of free radicals which are cytotoxic towards cells. Neutrophils are recruited by ischaemic tissue and are one source of free radicals. Angiotensin-converting enzyme (ACE) inhibitors can reduce 'reperfusion injury' and we decided to determine if ACE inhibitors might contribute to this effect by inhibiting neutrophil chemotaxis. 2. The effects of captopril (a thiol containing ACE inhibitor) and enalaprilat (a nonthiol ACE inhibitor) and N-mercaptopropionyl glycine (MPG) (a simple thiol) on neutrophil chemotaxis were tested in an in vitro Boyden chamber assay. 3. The chemotactic response of human neutrophils to fMLP was reduced by 27.6% with MPG (n = 8; P < 0.05), by 13.2% with enalaprilat (n = 8; P = 0.075) and by 5.2% with captopril (n = 8; P = 0.66) at 5 microM (therapeutic concentration.) 4. Neutrophil chemotaxis was significantly decreased with 50 microM and 500 microM MPG and enalaprilat and 500 microM captopril. 5. Supratherapeutic concentrations of ACE inhibitors can reduce neutrophil chemotaxis at high concentrations and this effect does not appear to be -SH dependent.

Antioxidant effects of angiotensin-converting enzyme (ACE) inhibitors: free radical and oxidant scavenging are sulfhydryl dependent, but lipid peroxidation is inhibited by both sulfhydryl- and nonsulfhydryl-containing ACE inhibitors

With an assay that generates free radicals (FR) through photooxidation of dianisidine sensitized by riboflavin, 4 x 10(-5) M captopril, epicaptopril (SQ 14,534, captopril's stereoisomer), zofenopril, and fentiapril [all sulfhydryl (-SH)-containing angiotensin-converting enzyme (ACE) inhibitors] were shown effective scavengers of nonsuperoxide free radicals whereas non-SH ACE inhibitors were not. Captopril was a more effective FR scavenger at pH 5.0 than at pH 7.5. Captopril (2 x 10(-5) M) also scavenged the other toxic oxygen species hydrogen peroxide and singlet oxygen and inhibited microsomal lipid peroxidation. Finally, captopril reduced the amount of superoxide anion-radical detected after neutrophils in whole blood were activated with zymosan, probably by inhibiting leukocyte superoxide production.