George B. Segel

The paradox of the neutrophil's role in tissue injury

The neutrophil is an essential component of the innate immune system, and its function is vital to human life. Its production increases in response to virtually all forms of inflammation, and subsequently, it can accumulate in blood and tissue to varying degrees. Although its participation in the inflammatory response is often salutary by nature of its normal interaction with vascular endothelium and its capability to enter tissues and respond to chemotactic gradients and to phagocytize and kill microrganisms, it can contribute to processes that impair vascular integrity and blood flow. The mechanisms that the neutrophil uses to kill microorganisms also have the potential to injure normal tissue under special circumstances. Its paradoxical role in the pathophysiology of disease is particularly, but not exclusively, notable in seven circumstances: 1) diabetic retinopathy, 2) sickle cell disease, 3) TRALI, 4) ARDS, 5) renal microvasculopathy, 6) stroke, and 7) acute coronary artery syndrome. The activated neutrophilˈs capability to become adhesive to endothelium, to generate highly ROS, and to secrete proteases gives it the potential to induce local vascular and tissue injury. In this review, we summarize the evidence for its role as a mediator of tissue injury in these seven conditions, making it or its products potential therapeutic targets.

The paradox of the neutrophil’s role in tissue injury: a review

The neutrophil is an essential component of the innate immune system, and its function is vital to human life. Its production increases in response to virtually all forms of inflammation, and subsequently, it can accumulate in blood and tissue to varying degrees. Although its participation in the inflammatory response is often salutary by nature of its normal interaction with vascular endothelium and its capability to enter tissues and respond to chemotactic gradients and to phagocytize and kill microrganisms, it can contribute to processes that impair vascular integrity and blood flow. The mechanisms that the neutrophil uses to kill microorganisms also have the potential to injure normal tissue under special circumstances. Its paradoxical role in the pathophysiology of disease is particularly, but not exclusively, notable in seven circumstances: 1) diabetic retinopathy, 2) sickle cell disease, 3) TRALI, 4) ARDS, 5) renal microvasculopathy, 6) stroke, and 7) acute coronary artery syndrome. The activated neutrophilˈs capability to become adhesive to endothelium, to generate highly ROS, and to secrete proteases gives it the potential to induce local vascular and tissue injury. In this review, we summarize the evidence for its role as a mediator of tissue injury in these seven conditions, making it or its products potential therapeutic targets.

Potasssium transport in human blood lymphocytes treated with phytohemagglutinin.

We have confirmed that phytohemagglutinin (PHA) rapidly enhances the uptake of potassium (K+) by human blood lymphocytes. PHA, however, did not produce an increase in lymphocyte K+ concentration. The apparent steady-state of cell K+ concentration despite the marked increase in uptake of 42K+ could be explained by either an increase in K+-K+ exchange or an increase in concentrative (active) K+ accumulation in association with an increase in the leak of K+ from the cell. We compared, therefore, the uptake of 42K+ with the decrement in cellular K+ content when active transport was inhibited by ouabain. These studies established that K+-K+ exchange was negligible in human blood lymphocytes and that the increase in 42K+ uptake after PHA treatment represented concentrative transport. Our studies did indicate that 42K+ exodus from PHA treated lymphocytes increased markedly from 19 to 38 mmol-1 cell water-1-h-1. Within the same time period K+ influx into PHA-treated lymphocytes increased from 20 to 38 mmol-1 cell water-1-h-1. Thus, PHA produces a marked increase in the permeability of the lymphocyte membrane to K+, and the increase in active K+ influx in PHA-treated lymphocytes may represent a homeostatic response by the membrane K+ transport system to the increase in K+ efflux. Increased K+ turnover was observed at the lowest concentrations of PHA which produced an observable increase in [3H]thymidine incorporation into DNA. Thus, PHA produces an increase in K+ permeability that closely parallels its mitogenic effect. The rapid increase in K+ influx preceding blastogenesis and mitogenesis is required, therefore, to maintain normal intracellular K+ concentration. An adequate intracellular K+ concentration is essential for the synthetic processes required for cell transformation or division.

Regulation of Sodium and Potassium Transport in Phytohemagglutinin-Stimulated Human Blood Lymphocytes

Phytohemagglutinin (PHA) or concanavalin A treatment of lymphocytes causes an increase in membrane permeability so that the leak rates of Na and K increase 1.5- to 2-fold. Active Na and K transport increase proportionately in response to the increased membrane permeability. We have examined the role of lymphocyte Na concentration in sustaining the increased Na and K transport observed after PHA treatment. Cell Na concentration increases from 14.8 to 20.5 mmol/liter cell water in PHA-treated lymphocytes (P < 0.001). Four lines of evidence suggest that the 5-6 mmol/liter cell water increase in lymphocyte Na accounts for the increase in active Na and K transport in mitogen-treated lymphocytes. First, PHA does not increase directly the maximal Na, K-ATPase activity of isolated lymphocyte membrane vesicles. Second, when the Na concentration is increased by 6 mmol/liter cell water in unstimulated lymphocytes, Na and K transport increase nearly twofold. Third, the cell Na concentration (15 mmol/liter cell water) is near the K(m) for Na activation of the Na, K-ATPase in lymphocyte membranes. The ATPase activity thus, is capable of increasing as the cell Na rises above normal. Fourth, if lymphocytes are incubated in a medium containing a low Na concentration, K transport does not maintain the internal K concentration and the fall in cell K is accentuated in PHA-treated lymphocytes. These studies indicate that the adaptive acceleration of Na and K transport in mitogen-treated lymphocytes is mediated by a small increase in cell Na.

Thymic retention of CD4+CD25+FoxP3+ T regulatory cells is associated with their peripheral deficiency and thrombocytopenia in a murine model of immune thrombocytopenia

Immune thrombocytopenia (ITP) is a bleeding disorder in which antibodies and/or T cells lead to enhanced peripheral platelet destruction and reduced bone marrow platelet production. Several reports have observed that ITP is associated with a peripheral deficiency of tolerance-inducing CD4+CD25+FoxP3+ T regulatory cells (Tregs). Using a murine model of ITP, we analyzed Tregs in the spleen and thymus. CD61 knockout mice were immunized against wild-type (CD61+) platelets, and their splenocytes were transferred into severe combined immunodeficient (SCID) mice. Compared with SCID mice receiving naive splenocytes, within 2 weeks after transfer, the ITP SCID mice became thrombocytopenic (< 200 × 10(9) platelets/L) and had increased serum anti-CD61 antibodies. The quantity of thymic Tregs by 2 weeks after transfer was significantly elevated, whereas Tregs in the spleens were significantly reduced. Treatment of the ITP mice with 2 g/kg intravenous immunoglobulin raised the platelet counts, reduced antibody production, and normalized the thymic and splenic Treg populations. Compared with thymocytes from ITP mice treated with intravenous immunoglobulin, thymocytes from untreated ITP mice delayed the onset of ITP when administered before engraftment with immune splenocytes. These results suggest that ITP in mice is associated with a peripheral Treg deficiency because of thymic retention and therapy normalizes the Tregs.

Differences in the reactivity of phospholipids with FDNB in normal RBC, sickle cells and RBC ghosts☆

Abstract The reaction of FDNB with phospholipid amino groups in RBC, sickle cells, and RBC ghosts was performed in a completely aqueous isotonic medium containing NaHCO 3 , BSA, glucose and NaCl. During and after the reaction no hemolysis occurred. Within 120 min. the FDNB labeling of PE and PS reached a plateau. 32% of the PE in the normal RBC reacted with FDNB, compared to 21% in the sickle cell and 56% in the RBC ghost. 7% of the PS in the normal RBC reacted compared to 5% in the sickle cell and 15% in the RBC ghost. Thus, the availability of PE and PS amino groups may reflect structural differences in RBC membranes.

Concanavalin A and phorbol ester cause opposite subcellular redistribution of protein kinase C

Concanavalin A and phorbol ester induce human blood monocytes to produce superoxide. We tested whether activation of human monocytes by these agents is accompanied by a subcellular redistribution of protein kinase C. Phorbol ester predictably caused a profound shift of the enzyme from the cytosol to the particulate fraction. In contrast concanavalin A induced a shift of the enzyme from the particulate fraction to the cytosol. The opposite effect of these agents on kinase C translocation was observed also by analysis of the phosphorylation of cytosolic proteins. Kinase C is either not involved in monocyte activation or does so by distinct pathways determined by the activating agent.

Neutropenia in pediatric practice.

1. George B. Segel, MD* 2. Jill S. Halterman, MD, MPH† 1. *Professor, Department of Pediatrics, Division of Hematology Oncology 2. †Associate Professor of Pediatrics, Division of General Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY After completing this article, readers should be able to: 1. Describe when a patient has true neutropenia, understanding the variation with age and ethnic background. 2. Know the relative risk of infection at various values of the absolute neutrophil count. 3. Discuss the differences between inherited and acquired causes of neutropenia. 4. List the initial studies to evaluate patients who have neutropenia. The significance of neutropenia is a common query to hematology specialists from primary care physicians. Severe neutropenia is defined as an absolute neutrophil count (ANC) of fewer than 500/mcL (0.5×109/L) and is a common and expected complication of chemotherapy for childhood neoplasms. This article considers those patients who have neutropenia unrelated to chemotherapy toxicity. This type of neutropenia may be noted when a complete blood count (CBC) is performed in a sick newborn, a febrile child, a child taking chronic medication, or as part of a routine evaluation. Severe hereditary conditions such as Kostmann syndrome and certain immunodeficiency syndromes associated with neutropenia are rare, perhaps 1 per 100,000, and are more likely to present in neonates and infants, although acquired conditions such as immune neutropenia and neutropenia related to infection also occur in this age group. A mild-to-moderate decrease in the ANC (percent neutrophils times the total white count) frequently is seen in viral illness or related to medication use as well as in some healthy persons of African ancestry. A number of inherited conditions associated with neutropenia are associated with other congenital anomalies such as dysplastic thumbs in Fanconi anemia, albinism in Chediak-Higashi syndrome, and dwarfism in the cartilage hair or Shwachman-Diamond syndromes. A CBC is not ordered routinely for well children examined in the pediatricians office or when children present with common febrile illnesses such as upper respiratory tract infections or otitis media. A CBC is warranted if …

Energy metabolism in human erythrocytes: II. Effects of glucose depletion

Normal red cells were incubated in the absence of glucose to develop a system in which total adenosine triphosphate (ATP) turnover could be assessed. After 1 hr, the triose pool had been completely consumed. Thereafter, the metabolism of 2,3-diphosphoglycerate (DPG) to pyruvate and lactate was the sole significant source of ATP synthesis.10(-3)M CuCl(2), which did not enter the cells, diminished ATP utilization by more than 50%. This could be only partially attributed to the inhibition by copper of residual acylation and cation pumping, which were already reduced by glucose depletion. Other membrane enzymes, which presumably function in the maintenance of membrane integrity, must, therefore, use a significant portion of erythrocyte ATP. The behavior of glucose-depleted red cells with respect to cation transport was complex. The addition of ouabain did not decrease ATP utilization in these red cells. Ouabain inhibitable potassium influx was nearly normal after triose depletion, but total potassium influx was decreased. In contrast, the ouabain inhibitable sodium efflux was markedly reduced after triose depletion, although the concentration of ATP was 70% of normal. The dissociation of monovalent cation pumping suggests that the energy for active sodium transport is derived from a specific source (such as the ATP produced by the phosphoglycerate kinase reaction) distinct from that for potassium transport.

Plateletpheresis Residues: A Source of Large Quantities of Human Blood Lymphocytes

The residue from single‐donor plateletpheresis contains a large number of human mononuclear cells. We have been able to harvest more than 1 × 109 viable lymphocytes for laboratory study from the leukocyte‐rich sediment that previously had been discarded. Prior to removal by adherence 5 × 108 monocytes were also available for further purification, if desired. The physical properties and response to phytohemagglutinin were very similar when lymphocytes isolated from plateletpheresis residues were compared with those obtained directly from venous blood.