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Biomedical subjects

D Burnett

Publications and source records attributed to D Burnett.

At least 91 records · Page 5Linked to original sources

Inhibition of human leukocyte elastase bound to elastin: relative ineffectiveness and two mechanisms of inhibitory activity.

Human leukocyte elastase (HLE) has been demonstrated on lung elastic fibers in areas of pulmonary emphysema. In vitro studies in our laboratory have shown that HLE-elastin complexes may be remarkably stable. We tested the possibility that elastin-bound HLE may retain catalytic activity in the presence of inhibitors that are effective against free HLE and found: (1) alpha-1-proteinase inhibitor (alpha 1PI), antileukoprotease (ALP), and eglin C inhibited free HLE on an approximately 1:1 molar basis, measured with either 3H-elastin or a synthetic peptide substrate; (2) the ability of each inhibitor to control catalytic activity of HLE when complexed with elastin was impaired (e.g., in a 24-h assay, a 70-fold molar excess of alpha 1PI gave only 93% inhibition of HLE); and (3) a chloromethyl ketone inhibitor of HLE gave qualitatively similar results, although at the low enzyme concentrations used it was a less effective inhibitor of free and elastin-bound enzyme than were the polypeptide inhibitors. Further, we found evidence for two distinct mechanisms of inhibition of elastin-bound HLE. alpha 1PI and eglin C prevented elastin solubilization largely by enhancing net dissociation of HLE from the complexes; enzyme remaining bound to the substrate retained essentially full activity. In contrast, ALP and the chloromethyl ketone prevented elastin solubilization by binding to the complexes and inhibiting the enzyme in situ. These results may have implications regarding progressive elastin solubilization in vivo and should stimulate further investigation of enzyme activity in heterogeneous systems in which one or more reactants are insoluble.

Elastin↗

A survey of drugs of abuse testing by clinical laboratories in the United Kingdom. Steering Committee for the UK-External Quality Assessment Scheme for Therapeutic Drug Assays.

An external quality assessment survey of testing facilities in UK clinical laboratories for the detection of drugs of abuse was made with nine freeze-dried samples of urine containing representative drugs with their metabolites from the following seven classes; amphetamines and stimulants, barbiturates, cannabinoids, cocaine, minor tranquillisers, opiates and non-opiate narcotics. Reports were received from 120 laboratories. Thirty six per cent of laboratories reported on all seven drug classes and 71% on the five classes excluding cannabinoids and cocaine. A single drug screening technique was used by 32% of laboratories whilst 46% were able to perform tests by both immunological and chromatographic techniques. There was a mean level of false positive reporting of 4.3% and an observed level of false negative reports of 8.4%, the latter underestimating the true frequency. The minor tranquillisers, cocaine and benzoyl ecgonine were the most frequently missed analytes. Several false reports had important potential implications for patient care.

Central Nervous System Agents↗

Primary sclerosing cholangitis: the emerging role for liver transplantation.

Primary sclerosing cholangitis is a progressive liver disease for which orthotopic liver transplantation is the only curative procedure. Questions exist regarding the role of temporizing procedures and the timing of transplantation. During the past 4 yr, we have performed liver transplants in 177 adult recipients. Twenty-six patients (14.6%) with primary sclerosing cholangitis received 30 transplants including 12 men and 14 women. The recipients were examined for a number of preoperative and postoperative variables. The 4-yr actuarial survival in patients with primary sclerosing cholangitis after transplantation was 88%. Patients were segregated according to preoperative risk variables. Twenty patients were low and medium risk, with one death (95% survival). Three patients were high risk, with two deaths (33% survival). In conclusion, orthotopic liver transplantation is safe and effective therapy for primary sclerosing cholangitis. Early referral for transplantation is recommended to reduce the mortality associated with this procedure in those with advanced hepatic failure.

Actuarial Analysis↗

Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones. A national multicenter study.

A prospective multicenter trial was performed to evaluate the use of external shockwave lithotripsy (ESL) and adjuvant medical therapy for the treatment of gallstones. A Medstone STS lithotripter was used together with ursodiol. Two hundred twenty-three patients were treated under general anesthesia (75%) or with intravenous analgesia (25%). Initial treatments were on an inpatient basis, but as centers gained experience, outpatient treatments became more common. Stone fragmentation and clearance were greatest in patients with solitary gallstones less than 2 cm in diameter. In this group of patients, stone fragmentation occurred in 97% of patients, and the cumulative stone-free rates at three and six months were 54% and 90%, respectively. These results indicate that fragmentation of gallstones can be achieved by a dry shock-wave lithotripter and that stone clearance is induced more rapidly by external shock-wave lithotripsy and adjuvant ursodiol therapy than by ursodiol therapy alone.

Adult↗

Patterns of leukocyte chemotaxis to bile after liver transplantation.

The role of chemotactic factors in the recruitment of leukocytes to human liver allografts was assessed by studying the effect of bile from transplant recipients on the chemotaxis of cells from normal subjects. Bile samples taken 2-3 days before clinical rejection were more chemotactic for lymphocytes than samples taken during rejection (p less than 0.01), during stable graft function (p less than 0.001), and from nontransplant patients (p less than 0.007). During clinical rejection there was an increase in bile chemotactic activity for both monocytes and neutrophils compared with samples from stable patients (monocytes: p less than 0.001; neutrophils: p less than 0.001) and nontransplant patients (monocytes: p less than 0.001; neutrophils: p less than 0.001). In serial studies chemotactic activity for lymphocytes reached a peak 1-3 days before the onset of clinical rejection, whereas maximum chemotactic activity for monocytes and neutrophils occurred at the time of rejection, when lymphocyte chemotaxis was decreasing. These results suggest that chemotaxis may be important in the recruitment of inflammatory cells to liver allografts and that chemotactic factors for lymphocytes, which appear in bile before clinical rejection, may be critical in the pathogenesis of rejection.

Bile↗

Effects of plasma, tumour necrosis factor, endotoxin and dexamethasone on extracellular proteolysis by neutrophils from healthy subjects and patients with emphysema.

1. Neutrophils from patients with chronic obstructive bronchitis and emphysema or age-matched control subjects were cultured on a substrate of 125I-fibronectin. The neutrophils from patients with lung disease digested significantly more fibronectin and released more elastase into the culture supernatant than did cells from control subjects. Preincubation of neutrophils from emphysematous patients with plasma from control subjects significantly inhibited fibronectin digestion by the patients' neutrophils by, on average, 10%. Preincubation of control subjects' neutrophils with plasma from emphysematous patients had no effect on fibronectin digestion. 2. Tumour necrosis factor increased fibronectin digestion in a dose-dependent manner when the cytokine was added to the adherent cells but not when preincubated with the polymorphonuclear leucocytes in suspension. Bacterial endotoxin in concentrations above 6 micrograms/ml significantly increased fibronectin digestion by neutrophils, but leukotriene B4, interferon-gamma and interleukin-1 alpha had no significant effects. 3. Dexamethasone inhibited fibronectin digestion by neutrophils in a dose-dependent manner, from 11% at 10(-10) mol/l to 68% at 10(-3) mol/l.

Aged↗

Role of beta-lactamases in the response of pulmonary infections to amoxycillin/clavulanate.

Lung secretions from patients with bronchiectasis have been studied before and during treatment with amoxycillin/clavulanate (Augmentin 750 mg tds). beta-Lactamase activity was usually present in the sputum sol phase and originated from organisms not usually considered to be the major pathogen. The presence of beta-lactamase was related to inactivation of amoxycillin in the lung secretions. Extensive bacteriological investigation of the sputum before therapy showed several organisms to be present in each sample. Six of eight patients showed a good clinical and biochemical response to therapy with amoxycillin/clavulanate. This, however, could not be predicted or explained by the results of bacterial investigation although Haemophilus influenzae was eradicated in three of these responders. beta-Lactamase activity did not change during treatment, and this investigation thus failed to produce indirect evidence of penetration of clavulanate into the secretions.

Amoxicillin↗

Activities and sources of beta-lactamase in sputum from patients with bronchiectasis.

beta-Lactamase activity was measured in secretions from patients with bronchiectasis. Of 28 sputum samples, 23 contained measurable amounts of activity; values were significantly higher (P less than 0.01) in purulent samples than in mucoid or mucopurulent samples. beta-Lactamase activity was usually present in saliva collected before and between sputum expectorations, although values for sputum were higher than for either group of saliva samples (P less than 0.025 and P less than 0.005, respectively). This difference suggests that at least part of sputum beta-lactamase activity originates in the bronchial tree. Detailed microbiological study of a further eight specimens (seven were beta-lactamase positive) led to the isolation of Haemophilus influenzae from six, although only two of these isolates were beta-lactamase positive. Several other beta-lactamase-producing organisms were also isolated, including Staphylococcus aureus (n = 3), Escherichia coli (n = 1), Proteus spp. (n = 1), and Bacteroides spp. (n = 3). Size-exclusion high-performance liquid chromatography of the sputum showed several peaks of beta-lactamase activity which usually coeluted in fractions similar to those of their beta-lactamase-positive isolates. Therefore, sources of sputum beta-lactamases are often bacteria not considered truly pathogenic or not isolated during routine bacteriological assessment. These observations should be considered when embarking on antimicrobial therapy in bronchiectatic patients and suggest that increased dosages of penicillins are indicated.

Albumins↗

Theophylline assay on Kodak Ektachem DTSC--performance and interference by structurally-related compounds and salicylate.

Theophylline was measured with a Kodak Ektachem DTSC using its property of uncompetitive inhibition of alkaline phosphatase. Within- and between-batch reproducibility was satisfactory. Agreement with consensus mean values on quality assessment samples was good as was agreement on patients' samples with a high performance liquid chromatography reference method and an automated fluorescence polarisation immunoassay. At therapeutic theophylline concentrations, no interference was seen with caffeine, theobromine, 1,7-dimethylxanthine, 1,3-dimethyluric acid or 3-propylxanthine. 3-methylxanthine (a theophylline metabolite) gave a positive bias but the concentrations of this metabolite found in serum are such that the clinical significance of this finding is questionable. Salicylate at concentrations which might be found during therapy for paediatric rheumatoid arthritis also gave a positive bias.

Alkaline Phosphatase↗

A catalytically active high-Mr form of human cathepsin B from sputum.

A cysteine proteinase from purulent sputum was partially purified by a method involving affinity chromatography on Sepharose-aminohexanoylphenylalanylglycinaldehyde semicarbazone. It was immunologically related to lysosomal cathepsin B from human liver and was similar in many, but not all, other aspects. It was catalytically active, as demonstrated by active-site-directed radioiodination, and hydrolysed three cathepsin B substrates, two with Km values similar to those of lysosomal cathepsin B. In addition, the rates of inactivation of the sputum and lysosomal forms of the enzyme by L-3-carboxy-2,3-transepoxypropionyl-leucylamido(4-guanidino) butane (Compound E-64) were very similar. However, the sputum enzyme differed from lysosomal cathepsin B in the following respects. Inhibition by chicken cystatin was much weaker for sputum cathepsin B than for the lysosomal enzyme. Sputum cathepsin B had greater stability at pH 7.5 and a higher apparent Mr, even after deglycosylation, than lysosomal cathepsin B. We conclude that the form of cathepsin B found in sputum is probably a truncated form of human procathepsin B, with some differences in properties that could be of physiological importance.

Binding Sites↗

Effect of ambroxol of neutrophil chemotaxis in vitro.

Ambroxol hydrochloride has been shown to protect the lung from damage by polymorphonuclear leucocyte (PMN). In view of this observation we have studied the effect of Ambroxol on PMN chemotaxis using a variety of chemoattractants. The PMN response was inhibited 50-80% by preincubating the cells with concentrations of 10(-4) M Ambroxol. There was no evidence of PMN killing by the drug at concentration of 10(-3) M. The results suggest that Ambroxol my have a role in the management of patients whose chronic lung damage is due to excess PMN recruitment.

Ambroxol↗

Neutrophil chemotaxis in bronchiectasis: a study of peripheral cells and lung secretions.

1. Some bronchiectatic patients persistently expectorate purulent secretions containing many polymorphonuclear leucocytes (PMN) and bacteria, suggesting ineffective microbial clearing from the lung. We have therefore studied several aspects of PMN recruitment to the lung by chemotaxis. 2. Circulating PMN from patients with bronchiectasis show a variable chemotactic response to the synthetic peptide N-formyl-L-methionyl-L-leucyl-L-phenylalanine. This is similar to the response of PMN from healthy controls and suggests that failure to clear microbial organisms is not due to defective chemotaxis as measured here. 3. Purulent sputum solphase demonstrates chemotactic activity against control PMN. This activity is greater (P less than 0.001) than that found with mucoid sputum solphase, which is consistent with the neutrophil content of the secretions in vivo. 4. Successful antibiotic therapy reduces the chemotactic activity of purulent sputum solphase from a median value of 183 (range 28-201) cells/high power field to 33.5 (range 0.7-64) cells/high power field (P less than 0.0025). This indicates that the chemotactic activity is largely associated with bacterial load.

Adult↗

Evidence for lipid-associated serine proteases and metalloproteases in human bronchoalveolar lavage fluid.

1. We have investigated the nature of elastase activity in bronchoalveolar lavage samples from healthy cigarette smokers and subjects with emphysema. 2. Initial experiments with pure human leucocyte elastase showed this enzyme to be inhibited by high concentrations (greater than 10 mmol/l) of ethylenediaminetetra-acetate, indicating that results of previous studies of 'metalloelastase' activity in bronchoalveolar lavage were ambiguous. 3. We have nevertheless demonstrated the presence in bronchoalveolar lavage of an elastase with the characteristics of a metalloproteinase, although samples also contained a substantial amount of activity that was sensitive to serine proteinase inhibitors. 4. Fractionation of lavage fluid supernatant by size-exclusion chromatography demonstrated most of the elastase activity to be of molecular mass greater than 300 kDa. Treatment of samples with lipase or detergent caused a reduction in metalloelastase activity and the generation of lower-molecular-mass components (90-100 kDa and 40 kDa) which were predominantly serine elastases. This suggested that the enzymes were associated with lipid.

Adult↗

Sodium measurements in the presence of paraproteins by four direct ISE methods and flame photometry compared.

Sodium was determined by flame photometry and by direct potentiometry using four different systems (Ektachem DT60, Corning 614, Orion 1020 and Nova-1) in serum samples from patients with normal proteins and paraproteins. Flame photometric and direct potentiometric differences (ISE-flame), showed the expected relationship with total protein whether or not the sample contained paraprotein, an exception being the Ektachem DT60 on normal protein. With the exception of the Ektachem DT60 with samples with normal protein levels, correlation between different ISE-flame estimates was good. Differences between direct potentiometric measurements are probably more attributable to efforts made by manufacturers to relate them to flame photometric measurements in 'normal samples', than to the volume occupied by increased protein content. The apparent lack of influence of protein on ISE-flame for the Ektachem DT60 was shown to relate to the original external reference electrode salt bridge used. A second study showed that changing this fluid to an equi-transferrant high salt content caesium chloride based reference fluid partially unmasked the protein effect.

Electrodes↗