Benjamin J. Darien

Modulation of monocyte signaling and pore formation in response to agonists of the nucleotide receptor P2X7

Previous reports about the nucleotide receptor P2X7, which exhibits ion channel and pore‐forming activity and is known to promote IL‐1β processing, have centered largely on its role in macrophage function, whereas its participation in monocyte activity has been unclear. However, because extracellular ATP has been shown to affect monocytes with respect to IL‐1β release, we hypothesized that the P2X7 receptor is also present and functional in a subpopulation of blood monocytes. Flow cytometric analysis revealed that about 70% of monocytes isolated from normal human donors expressed the P2X7 receptor. Activation of P2X7 receptor‐associated pore formation by the agonist BzATP resulted in a 9‐ to 15‐fold increase in the uptake of the membrane‐impermeant fluorescent dye YO‐PRO, and this dye uptake is markedly inhibited by the P2X7 receptor antagonists KN‐62 and oATP. Evidence supporting the presence of the functional P2X7 receptor in monocytes also includes the observation that BzATP exposure results in a dose‐dependent increase in the activation of mitogen‐activated 2protein kinases and the nuclear translocation of the transcription factor NF‐κB in human monocytes and in THP‐1 human monocytic cells. Furthermore, treatment of monocytes with BzATP induced the expression of cyclooxygenase‐2 (COX‐2) and tissue factor, which are two important endpoints that have not been previously shown to be regulated by nucleotide receptor action in monocytes. Together, these data indicate that a subpopulation of human monocytes express P2X7 receptors that are functional with respect to pore formation, signal transduction, and mediator production, further supporting a key role for this nucleotide receptor in host immune responses.

Low molecular weight heparin prevents the pulmonary hemodynamic and pathomorphologic effects of endotoxin in a porcine acute lung injury model

Tumor necrosis factor α (TNF-α) activity, platelet and neutrophil degranulation and margination, and increased vascular permeability are central to the pathophysiology of endotoxin-mediated acute lung injury. Nonanticoagulant activities of low molecular weight heparin (LMWH) include solubilization of the TNF-α receptor protein, inhibition of neutrophil adhesion, and regulation of thromboxane B2 (TXB2) biosynthesis. In this study, we evaluated the ability of LMWH to modulate TNF-α and TXB2 activity during endotoxemia and the subsequent effects on pulmonary hemodynamics. Domestic pigs 8–10 weeks old were anesthetized and catheterized for standard cardiopulmonary measurements and the lungs harvested for cuff:vessel ratio, myeloperoxidase activity, and permeability index. Pigs were randomly assigned to one of four groups: lipopolysaccharide (LPS) (n = 6), given .5 μg/kg/h Escherichia coli LPS intravenously for 6 h; saline control (n = 5); LMWH (n = 5), given .5 mg/kg LMWH for 30 min, followed by .5 mg/kg/h; and LMWH + LPS (same dosages, n = 6). Administration of LPS resulted in increased plasma TNF-α and TXB2 activity; increased pulmonary arterial pressure, pulmonary vascular resistance, and alveolar-arterial oxygen tension; decreased systemic arterial oxygen tension; and pulmonary edema. The cardiopulmonary parameters for the LMWH-treated pigs did not differ from those of the saline-treated control pigs. Pretreatment with LMWH attenuated the LPS-mediated TNF-α and TXB2 activity and attenuated LPS-mediated pulmonary hypertension, hypoxemia and neutrophil emigration, and edema formation. In conclusion, the data show that the protective effects of LMWH in this model of acute lung injury are associated with altered neutrophil adhesion and TNF-α and thromboxane activity.

Prognostic Value of Clinicopathologic Variables Obtained at Admission and Effect of Antiendotoxin Plasma on Survival in Septic and Critically Ill Foals

This prospective study compared survival rates of critically ill and septic foals receiving 1 of 2 different types of commercial equine plasma and analyzed admission variables as possible predictors of survival. Standardized clinical, hematologic, biochemical, and hemostatic admission data were collected and foals received either conventional commercially available hyperimmune equine plasma or equine plasma specifically rich in antiendotoxin antibodies in a double-blinded, coded fashion. Sepsis was defined as true bacteremia or sepsis score >11. Overall survival rate to discharge was 72% (49/68). Foals that were nonbacteremic and demonstrated a sepsis score of < or = 11 at admission had a 95% (18/19) survival rate. The survival rate to discharge for septic foals was 28/49 (57%), with truly bacteremic foals having a survival rate of 58% (14/24), whereas that for nonbacteremic, septic foals was 56% (14/25). Sensitivity and specificity for sepsis score >11 as a predictor of bacteremia were 74 and 52%, respectively. For the entire study population, a higher survival rate to discharge was documented for those foals receiving hyperimmune plasma rich in antiendotoxin antibodies (P = .012, odds ratio [OR] 6.763, 95% confidence interval [CI]: 1.311, 34.903). Administration of plasma rich in antiendotoxin antibodies also was associated with greater survival in septic foals (P = .019, OR 6.267, 95% CI: 1.186, 33.109). Statistical analyses demonstrated that, among 53 clinical and clinicopathologic admission variables, high sepsis score (P < .001), low measured IgG concentration (P = .01), high fibrinogen concentration (P = .018), low segmented neutrophil count (P = .028), and low total red blood cell numbers (P = .048) were the most significant predictors of overall mortality.

Human Clostridium difficile infection: inhibition of NHE3 and microbiota profile.

Clostridium difficile infection (CDI) is principally responsible for hospital acquired, antibiotic-induced diarrhea and colitis and represents a significant financial burden on our healthcare system. Little is known about C. difficile proliferation requirements, and a better understanding of these parameters is critical for development of new therapeutic targets. In cell lines, C. difficile toxin B has been shown to inhibit Na(+)/H(+) exchanger 3 (NHE3) and loss of NHE3 in mice results in an altered intestinal environment coupled with a transformed gut microbiota composition. However, this has yet to be established in vivo in humans. We hypothesize that C. difficile toxin inhibits NHE3, resulting in alteration of the intestinal environment and gut microbiota. Our results demonstrate that CDI patient biopsy specimens have decreased NHE3 expression and CDI stool has elevated Na(+) and is more alkaline compared with stool from healthy individuals. CDI stool microbiota have increased Bacteroidetes and Proteobacteria and decreased Firmicutes phyla compared with healthy subjects. In vitro, C. difficile grows optimally in the presence of elevated Na(+) and alkaline pH, conditions that correlate to changes observed in CDI patients. To confirm that inhibition of NHE3 was specific to C. difficile, human intestinal organoids (HIOs) were injected with C. difficile or healthy and CDI stool supernatant. Injection of C. difficile and CDI stool decreased NHE3 mRNA and protein expression compared with healthy stool and control HIOs. Together these data demonstrate that C. difficile inhibits NHE3 in vivo, which creates an altered environment favored by C. difficile.

Human Clostridium difficile infection: altered mucus production and composition.

The majority of antibiotic-induced diarrhea is caused by Clostridium difficile (C. difficile). Hospitalizations for C. difficile infection (CDI) have tripled in the last decade, emphasizing the need to better understand how the organism colonizes the intestine and maintain infection. The mucus provides an interface for bacterial-host interactions and changes in intestinal mucus have been linked host health. To assess mucus production and composition in healthy and CDI patients, the main mucins MUC1 and MUC2 and mucus oligosaccharides were examined. Compared with healthy subjects, CDI patients demonstrated decreased MUC2 with no changes in surface MUC1. Although MUC1 did not change at the level of the epithelia, MUC1 was the primary constituent of secreted mucus in CDI patients. CDI mucus also exhibited decreased N-acetylgalactosamine (GalNAc), increased N-acetylglucosamine (GlcNAc), and increased terminal galactose residues. Increased galactose in CDI specimens is of particular interest since terminal galactose sugars are known as C. difficile toxin A receptor in animals. In vitro, C. difficile is capable of metabolizing fucose, mannose, galactose, GlcNAc, and GalNAc for growth under healthy stool conditions (low Na(+) concentration, pH 6.0). Injection of C. difficile into human intestinal organoids (HIOs) demonstrated that C. difficile alone is sufficient to reduce MUC2 production but is not capable of altering host mucus oligosaccharide composition. We also demonstrate that C. difficile binds preferentially to mucus extracted from CDI patients compared with healthy subjects. Our results provide insight into a mechanism of C. difficile colonization and may provide novel target(s) for the development of alternative therapeutic agents.

Equine platelet CD62P (P-selectin) expression: a phenotypic and morphologic study

Acute inflammatory diseases, such as colic, septicemia and endotoxemia are common in equines and have been shown to be correlated to vascular injury and thrombosis. In humans with similar thrombotic conditions, P-selectin and P-selectin glycoprotein ligand-1 (PSGL-1)-mediated platelet-leukocyte adhesion contributes to the pathogenesis of these disorders through the generation of inflammatory mediators and tissue factor. As such, we hypothesized that a P-selectin-PSGL-1 (platelet-leukocyte) interaction, similar to that in humans, may also exist in the horse. The objective of this study was to investigate phenotypic and morphological properties of equine platelet activation with a focus on CD62P (P-selectin) expression and CD62P mediated platelet-leukocyte interactions. To study high levels of platelet activation, we used 1 U/ml thrombin to induce secondary, irreversible aggregation in both human and equine platelets. Addition of glycyl-L-prolyl-L-arginyl-L-proline amide (GPRP) prior to thrombin activation blocked fibrin polymerization, allowing the use of flow cytometry to study alpha-granule expression as a measure of platelet activation. Thrombin activation resulted in high levels of activation, measured as P-selectin expression, in both humans and equines. Interestingly, our research illustrates that in healthy horses, P-selectin is also constitutively expressed on 20-25% of resting platelets. This finding is in direct contrast to humans, in which P-selectin expression is negligible (<5%) in the absence of agonist activation. The high baseline level of P-selectin expression among equine platelets may suggest that they are primed for leukocyte adhesion, possibly resulting in prothrombotic conditions. This phenomenon could be of significant clinical relevance, as it may be related to the rapid clinical decline often seen in equine patients with colic and endotoxemia, where vascular injury and thrombotic complications compromise patient survival. Based on these findings, further investigation into the mechanisms of platelet P-selectin-mediated inflammation and platelet-leukocyte mediated vascular injury in the horse appears warranted.

Estimation of Prothrombin Times of Hispaniolan Amazon Parrots (Amazona ventralis) and Umbrella Cockatoos (Cacatua alba)

Abstract The determination of prothrombin time (PT) has been standardized for domestic chickens; however, validated tests of coagulation are lacking for nondomestic avian species, limiting the investigation of acquired hemostatic disorders in these species. The purpose of this study was to validate the PT assay for chickens in our laboratory using both fresh and frozen plasma and to apply the assay to psittacine bird plasma to establish reference intervals for PT of Hispaniolan parrots (Amazona ventralis) and umbrella cockatoos (Cacatua alba). We used avian tissue thromboplastin, prepared from brain tissue of 2-week-old chickens, for determining all PT values. The reference intervals for PT of chickens (n = 6) were 7.5–10.6 and 7.0–11.1 seconds for fresh and frozen plasma, respectively. The reference intervals for PT of Hispaniolan parrots (n = 6) were 7.5–13.4 and 9.0–11.3 seconds for fresh and frozen plasma, respectively. The reference intervals for PT of cockatoos (n = 14) differed significantly (P < .0001) when 2 different aliquots of avian thromboplastin were used for frozen plasma (11.2–15.8 versus 10.0–13.0 seconds). These PT values should be viewed as estimates for these species because of the small sample sizes in our study. PT values for plasma samples were similar under either fresh or frozen conditions. When the same aliquot of thromboplastin was used, interspecies differences in PT were evident. Variation between aliquots of thromboplastin caused the most significant difference in PT values between avian plasma samples; thus, aliquots of avian tissue thromboplastin should be prepared in volume sufficient to insure that multiple PT assays can be performed for a single patient.

Enhanced bactericidal activity against Escherichia coli in calves fed Morinda citrifolia (Noni) puree.

BACKGROUND Although adequate colostrum intake and properly used antibiotics can provide much protection for the bovine neonate, increased antibiotic scrutiny and consumer demand for organic products have prompted investigations of natural immunomodulators for enhancing calf health. One plant-based immunomodulator, Morinda citrifolia (noni) fruit, is a well-recognized natural product that has a broad range of immunomodulatory effects. HYPOTHESIS Neonatal calves fed noni puree would demonstrate whole blood phagocytic capacity in Gram-negative and Gram-positive in vitro assays. ANIMALS Blood samples from 18 neonatal Holstein bull calves. METHODS Calves were divided into 2 groups: Group 1 comprised control calves, whereas Group 2 received 30 mL of noni puree twice a day in milk replacer. Day 0 blood samples were obtained between 36 and 48 hours of age before the first feeding of puree. Ethylenediaminetetraacetic acid anticoagulated blood was collected from each calf on days 0, 3, 7, and 14. Bactericidal assays were performed to estimate the percentage killing of Escherichia coli and Staphylococcus epidermidis. RESULTS Blood samples from noni puree-fed calves displayed significantly more E. coli bacterial killing than did controls on day 14, and although differences were not significant on days 0, 3, and 7, bacterial killing progressively increased over time. There was no significant difference between the groups for S. epidermidis killing. CONCLUSIONS AND CLINICAL IMPORTANCE The immunomodulatory effect of noni puree may prove valuable in the future as production animal antibiotic use becomes more restricted. Additional clinical trials are warranted to investigate the clinical application of noni puree in promoting calf health.

Coagulation values in normal ferrets (Mustela putorius furo) using selected methods and reagents

BACKGROUND Accurate determination of commonly measured coagulation values would be useful in the diagnosis and management of coagulopathies in domestic ferrets (Mustela putorius furo). We are unaware of reports of coagulation times in this species. OBJECTIVES The purpose of this study was to determine reference values for prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen concentration, and antithrombin (AT) activity in ferrets using selected methods and reagents. METHODS Blood samples obtained from 18 clinically healthy ferrets were anticoagulated with 0.129 M sodium citrate in a ratio of 9 parts blood to 1 part anticoagulant. Plasma was collected and stored at -70 degrees C until analysis. PT and PTT were measured with a fibrometer and with an ACL 3000 automated system. PTT was measured with and without the addition of ellagic acid. Fibrinogen was assayed by a turbidimetric method. AT activity was determined using a chromogenic assay and pooled ferret plasma (100% activity). Differences in methods and reagents were evaluated using paired t tests. RESULTS PT was significantly longer using the fibrometer (12.3+/-0.3, 11.6-12.7 seconds) compared with the ACL (10.9+/-0.3, 10.6-11.6 seconds) (P<.01). PTT was not significantly different with the fibrometer (18.7+/-0.9, 17.5-21.1 seconds) vs the ACL (18.1+/-1.1, 16.5-20.5 seconds), but was significantly longer on both analyzers when ellagic acid was added (fibrometer 20.4+/-0.8, 18.9-22.3 seconds; ACL 20.0+/-1.0, 18.6-22.1 seconds) (P<.01). Fibrinogen concentration was 107.4+/-19.8 mg/dL (90.0-163.5 mg/dL), and AT activity was 96%+/-12.7% (69.3-115.3%). CONCLUSION These coagulation results for healthy ferrets will be useful in the evaluation of ferrets with coagulopathies, provided similar reagents and methods are used.

Leucocytoclastic vasculitis associated with Staphylococcus intermedius in the pastern of a horse.

A pregnant quarterhorse mare became acutely lame as a result of severe swelling of its right hind leg, thought to have been caused by a fracture or a muscle tear. Diagnostic procedures ruled out a traumatic musculoskeletal cause and a physical examination revealed chronic pastern dermatitis (‘scratches’/‘grease heel’). Histopathological evaluation of biopsy samples from the right hind leg was consistent with a leucocytoclastic vasculitis, and culture yielded Staphylococcus intermedius. The treatment and infectious causes of pastern dermatitis are discussed.