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Biomedical subjects

J A Fuller

Publications and source records attributed to J A Fuller.

36 records · Page 2Linked to original sources

Differential sensitivity of mouse mononuclear phagocytes to CSF-1 and LPS: the potential in vivo relevance of enhanced IL-6 gene expression.

In this report, we compared the responsiveness of subpopulations of mononuclear phagocytes (MNP) to the actions of the monocyte-macrophage colony-stimulating factor (CSF-1) and lipopolysaccharide (LPS), as measured by the expression of the IL-6 (Il6) gene. It was seen that neither monocytes nor elicited peritoneal macrophages (PMphi) responded directly to CSF-1 compared with resident PMphi that were induced to express high levels of Il6 mRNA and release IL-6 protein. Resident PMphi released basal (constitutive) amounts of IL-6, while constitutive release by monocytes and elicited PMphi was barely detectable. Monocytes and elicited PMphi expressed similar levels of sensitivity to LPS, as measured by IL-6 release, and were less reactive than resident PMphi. When CSF-1 and LPS were added simultaneously to resident PMphi, a dose-dependent synergistic release of IL-6 was seen. Elicited PMphi also responded synergistically but required higher levels of CSF-1 and LPS, while monocytes failed to respond synergistically under any conditions. A similar synergistic effect was also seen in vivo when mice were injected with CSF-1 and LPS. Under these conditions, only resident peritoneal cells were shown to release IL-6 ex vivo while blood leukocytes and spleen cells released minimal amounts. These findings indicate that the stage of differentiation/maturation of MNP may be important for the ability of CSF-1 to render the cells sensitive to secondary stimulation, such as by LPS, and determines to what extent MNP subpopulations contribute to inflammatory responses in vivo.

Animals↗

Urokinase is required for the pulmonary inflammatory response to Cryptococcus neoformans. A murine transgenic model.

Urokinase (uPA) is hypothesized to provide proteolytic activity enabling inflammatory cells to traverse tissues during recruitment, and it is implicated as a cytokine modulator. Definitive evaluation of these hypotheses in vivo has previously been impossible because uPA could not completely and irreversibly be eliminated. This limitation has been overcome through the development of uPA-deficient transgenic mice (uPA-/-). Using these mice, we evaluated the importance of uPA in the pulmonary inflammatory response to Cryptococcus neoformans (strain 52D). C. neoformans was inoculated into uPA-/- and control mice (uPA+/+), and cell recruitment to the lungs was quantitated. The number of CFU in lung, spleen and brain was determined to assess clearance, and survival curves were generated. By day 21 after inoculation, uPA-/- mice had markedly fewer pulmonary inflammatory (CD45+), CD4+, and CD11b/CD18+ cells compared with uPA+/+ controls (P<0.0007); pulmonary CFUs in the uPA-/- mice continued to increase, whereas CFUs diminished in uPA+/+ mice(P<0.005). In survival studies, only 3/19 uPA+/+ mice died, whereas 15/19 uPA-/- mice died (p<0.001). We have demonstrated that uPA is required for a pulmonary inflammatory response to C. neoformans. Lack of uPA results in inadequate cellular recruitment, uncontrolled infection, and death.

Animals↗

The potential role of the macrophage colony-stimulating factor, CSF-1, in inflammatory responses: characterization of macrophage cytokine gene expression.

In this report we report that recombinant human monocyte-macrophage colony-stimulating factor-1 (CSF-1) induces resident murine peritoneal cells (PCs) to transcribe several inflammatory cytokine genes, including interleukin (IL)-1 alpha, IL-1 beta, IL-6, and granulocyte-macrophage CSF in a dose-dependent and time-related manner. Peak mRNA levels were seen between 4 and 6 h. CSF-1 did not modulate the expression of tumor necrosis factor-alpha mRNA. The serum content of the culture medium appeared to regulate both the extent of CSF-1-induced gene transcription and the adherence properties of the cells. Decreasing the serum concentration significantly reduced CSF-1-induced transcription and was associated with the rapid spreading of the majority of the adherent cells. This reduced sensitivity to CSF-1 was paralleled by a markedly lower levels of c-fms mRNA encoding the CSF-1 receptor. Induced gene transcription was followed by the release of large quantities of IL-6 only. IL-1 activity remained associated with the cells. Neither supernatant nor cell lysate granulocyte-macrophage CSF activity was inducible above the low levels associated with control cultures. Evidence that the mononuclear phagocytes, as opposed to B or T cells, were the targets of CSF-1 was obtained in two ways: (1) PCs from B6 scid/scid and NOD scid/scid mice consisting of 78-86% MAC-1+, F4/80+ cells and few B or T cells, as shown by flow cytometry analysis, released 5- to 10-fold more IL-6 in response to CSF-1 stimulation than B6 PCs, which contained approximately 30% double-positive cells, and (2) pretreatment of B6 PCs with antibodies to the CSF-1 receptor blocked the CSF-1-induced secretion of IL-6. These data suggest that CSF-1 primes noninflammatory mononuclear phagocytes for a role in inflammatory responses but does not provide the necessary signals for either secretion or translation of all cytokines equally.

Animals↗

Function of the urokinase receptor (CD87) in neutrophil chemotaxis.

During recruitment, leukocytes respond to chemotaxins and traverse matrix barriers. Urokinase-type plasminogen activator (uPA), bound to its receptor (uPAR; CD87) facilitates plasmin formation, which promotes matrix proteolysis. Polymorphonuclear leukocytes (PMNs) are critical to the inflammatory response and express both uPA and CD87. To determine whether uPA and CD87 are required for PMN chemotaxis, PMNs were pretreated with an anti-CD87 monoclonal antibody (mAb), a neutralizing anti-uPA mAb, or uPA. PMN chemotaxis was profoundly suppressed by the anti-CD87 mAb but was unaffected by anti-uPA mAb or uPA. The role CD87 plays in chemotaxis may be related to its ability to associate with CR3. CD87/CR3 coupling can be disrupted by specific saccharides. The same saccharides that disrupt CD87/CR3 coupling (NADG, D-mannose, and mannoside) inhibit PMN chemotaxis. We conclude that CD87 plays a crucial role in PMN chemotaxis in vitro that is independent of uPA enzyme activity but may be related to the ability of CD87 to interact with CR3.

Antibodies, Monoclonal↗

Multivariate Cox regression analysis of covariates for patency rates after femorodistal vein bypass grafting.

Multivariate Cox regression analysis of patency rates for 750 consecutive femorodistal autogenous vein graftings for chronic lower limb ischemia showed that significant independent prognostic covariates were the type of graft (long saphenous or arm vein), presence of diabetes, and absence of a past history of myocardial ischemia. Analysis assumes that patients withdrawn with patent grafts due to death or loss to follow-up would have followed the same course as those who remain, and the degree to which this could distort results was studied. Patients who died with patent grafts were more likely to have had past myocardial ischemia and critical lower limb ischemia. Cox regression analysis for 600 operations after excluding patients who died with patent grafts then showed that significant independent covariates were the type of graft (long saphenous or arm vein) and indication (claudication or critical ischemia); then age, sex, hypertension, diabetes, myocardial ischemia, date of operation, surgeon, site of distal anastomosis, or first compared to repeat operations had no significant influence. Cox regression analysis helps determine which covariates influence graft patency rates, but results are affected by censored data, particularly from patients who die with patent grafts.

Adult↗

Haematological effects of reinfused mediastinal blood after cardiac surgery.

OBJECTIVE: To explore the risk of inducing a coagulation defect in cardiac surgery patients by the reinfusion of mediastinal blood. DESIGN: Ten patients who underwent coronary artery surgery were prospectively studied for the haematological effects of reinfusion of blood drained from the chest drain tubes after the operation by a Sorenson autologous transfusion system. SETTING: Surgery was performed at a private hospital and patient selection was made at the time of reinfusion. PATIENTS: Nine patients had primary coronary artery surgery and one had a reoperation. MAIN OUTCOME MEASURES: Blood samples were taken from the patients before reinfusion, one hour after reinfusion, and 24 hours later as well as from the collected blood. Measurements were made of the haemoglobin content, white cell and platelet counts, fibrinogen and fibrinogen degradation products, D-dimer, antithrombin III and plasma haemoglobin content. Estimations were also made of the prothrombin time, the thrombin clotting time and the activated partial thromboplastin time. The hypothesis to be tested by this study was that the reinfusion of mediastinal blood after the operation did not cause any significant disturbance of the patient's blood clotting profile. RESULTS: An average of 535 mL (range, 400-950 mL) was reinfused after a period of three hours drainage (range, 45 minutes to 5 hours). While the initial patient samples contained a raised plasma haemoglobin level (0.19 g/L) significantly related to the cardiopulmonary bypass time (P less than 0.001), these were free of fibrinogen degradation products except for a sample from one patient who had a reoperation. The blood drained by the Sorenson system was lower in haemoglobin content (7.7 g/dL), and had a significant content of fibrinogen degradation products (147 mg/L) and D-dimer (6.4 mg/L) together with reduced clotting factors when compared with the patients' blood. After reinfusion, the patient sample showed evidence of altered coagulation with mildly increased clotting times (activated partial thromboplastin time 57 s, thrombin clotting time 123 s), the extent of which was related to the volume reinfused (P less than 0.001), but 24 hours later, these effects had all disappeared. All samples were sterile in aerobic and anaerobic culture media. CONCLUSION: We conclude that the Sorenson system of retrieval of mediastinal blood after cardiac surgery provides a safe and simple method of blood conservation provided that the volume of reinfusion is not excessive.

Blood Coagulation↗

Characterization of a novel human corneal endothelial antigen.

The antigenic composition of the human corneal endothelium, a cellular layer essential for maintaining corneal function, has not been well characterized. A novel corneal endothelial antigen was identified by generating a monoclonal antibody (MAb) against normal human corneal endothelial cells. This MAb, designated 2B4.14.1, reacted strongly by immunoperoxidase staining with the endothelium of corneas from all human donors tested but not with other corneal components, including epithelium and stroma. Positive immunohistologic reactions of 2B4.14.1 with several other human tissues, including kidney (parietal epithelium of Bowman's capsule, proximal convoluted tubule, ascending limb of Henle's loop, and distal convoluted tubule), glandular epithelia of numerous organs, and mesothelial linings of several thoracic and abdominal viscera, also were observed. One of the renal antigens recognized by 2B4.14.1 was identified as Tamm-Horsfall glycoprotein (THGP), based on the ability of the antibody to recognize THGP in western immunoblots and the abrogation of immunohistologic reactivity of the antibody by preincubation with purified THGP. These findings raise the possibility that the human cornea expresses a molecule with homeostatic properties similar to those ascribed to THGP. However, it is unlikely that the corneal antigen recognized by 2B4.14.1 is conventional THGP; a MAb specific for THGP did not react with corneal endothelium.

Animals↗

Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?

A total of 1666 patients undergoing isolated coronary artery bypass were studied for the occurrence of postoperative atrial fibrillation. Possible associations of this arrhythmia with various preoperative, intraoperative, and postoperative factors were studied by univariate (chi 2 and t tests) and multivariate (logistic regression) analyses. The overall incidence of postoperative atrial fibrillation was 28.4%, with the major occurrence 2 days after the operation. Both univariate and multivariate studies indicated the patient's age to be the dominant factor promoting postoperative atrial fibrillation, with an increasing prevalence in older patients (p = 0.0001). Multivariate analysis showed that postoperative beta-blocker therapy conveyed considerable protection against postoperative atrial fibrillation (p = 0.001) but was less effective in the older patients. Men were more prone to this arrhythmia (p = 0.02). Although these associations appeared significant, the logistic model proved to be a poor predictor of postoperative atrial fibrillation, which suggests that other factors not studied, or mere chance, may also be responsible.

Adrenergic beta-Antagonists↗

Blood-conservation techniques for coronary-artery bypass surgery at a private hospital.

The utilization of homologous blood and blood products was recorded in 100 consecutive patients who underwent primary coronary-artery bypass surgery. Nine patients underwent saphenous-vein grafts only, 55 patients underwent a single internal-mammary-artery graft that was supplemented by vein grafts and 36 patients underwent bilateral internal-mammary-artery grafts and vein grafts. All patients underwent normovolaemic haemodilution, and autologous blood was collected before bypass surgery. Residual blood was collected from the cardiopulmonary bypass machine and was washed and concentrated in a cell processor, and blood also was scavenged postoperatively from the mediastinal drainage tubes as methods to conserve blood. The mean (+/- SD) utilization of homologous blood was 1.3 +/- 1.5 units with 0.2 +/- 0.7 units of fresh-frozen plasma being used, and 0.8 +/- 2.1 units of platelets being used. The utilization of homologous blood was not different among the three different methods of coronary-artery bypass surgery, but patients who underwent bilateral internal-mammary-artery grafts suffered a greater postoperative loss of blood than did those patients who underwent saphenous-vein grafts or single internal-mammary-artery grafts. A comparison of patients who were taking aspirin or a non-steroidal anti-inflammatory drug preoperatively with those patients who were not showed no difference in the utilization of homologous blood but a statistically-significant difference was found in the loss of blood postoperatively.

Adult↗

Cardiac surgery in a private hospital. With special reference to coronary artery surgery.

In a four-year period in a private hospital there were 1396 open heart operations of which 1275 were for isolated coronary artery disease. The various techniques that were used for coronary artery reconstruction were saphenous vein grafts and internal mammary artery grafts, both singly and sequentially, and endarterectomy. The operative mortality for isolated coronary artery surgery was 1.1% and the perioperative infarction rate was 2.1%. When combined with an endarterectomy of the right coronary artery, the mortality was 3% and the infarction rate was 4% (not significant); when combined with endarterectomy of the left anterior descending coronary artery, the mortality was 11.7% (not significant), and the infarction rate was 11.7% (not significant). The operative risk was no higher in patients with poor ventricular function.

Adult↗

Smoking withdrawal and acupuncture.

Nicotine addiction makes it very difficult for most smokers to quit. This study examined the relapse rate of 194 people (118 men and 76 women) who were given acupuncture treatment to help them stop smoking. Ninety five per cent of patients quit smoking after three acupuncture treatments. Fifty-five (32%) of the 174 patients who replied to a mailed questionnaire said they had not smoked since treatment; the success rate was: one week, 86%; six months 41%; 12 months, 34% and 24 months, 30%. There were no further relapses amongst those patients who abstained for more than 24 months. Eighty-five per cent of those who responded reported that acupuncture had eased the symptoms of smoking withdrawal. However, if the patient's motivation is weak, subsequent relapse will occur.

Acupuncture Therapy↗

The radial artery in reoperative coronary bypass surgery:.

BACKGROUND: Failure of saphenous vein grafts (SVG) is a significant cause for coronary reoperation (redo CABG). The radial artery (RA) because of its availability, and versatility is well suited to use (together with internal thoracic arteries (ITA) in redo CABG, especially to replace failed SVG. We evaluated our experience where the RA was a major conduit in redo CABG over the past 5 years. METHODS: From July 1996 to June 2002, 590 consecutive patients underwent redo CABG where one or both RA(s) were used, together with LITA or RITA. The mean age was 67.3 years, 82% were male, and 19% diabetic, 419 (71%) had Class III or IV angina, 135 (23%) had left main stenosis, and 210 (36%) had an LVEF < 0.50. There were a total of 877 RA conduits (303 single, 287 bilateral), 518 new LITA or RITA. A mean of 2.8 new distal anastomoses constructed 92% (2.6 per patient)of the arterial grafts. Follow-up was at 1 month, 3 months, and then yearly. The results were compared with 6466 primary CABG performed in the same time frame, and with a prior cohort of 741 consecutive patients having redo CABG without an RA in which identical operative techniques had otherwise been used. RESULTS: The 30-day mortality was 3.9% (23 patients). Morbidity was low. Perioperative myocardial infarction occurred in 16 (2.7%) patients, stroke in 10 (1.7%), sternal infection in 10 (1.7%), donor site infection in 2 (0.3%), and IABP use in 23 patients (3.9%)-including 10 preoperatively. The results were better when compared to a prior cohort of 741 patients with redo CABG (1991 to 1996) without use of the RA. The results were inferior to that of the contemporary primary CABG. Operative mortality was 3.9% versus 0.9%, p = 0.002, myocardial infarction 2.7% versus 0.8%, p = 0.03. CONCLUSION: The use of the RA (together with ITA) in redo CABG achieved total arterial revascularization in 92% of cases and is associated with excellent results, at least equal to or superior to those achieved previously.

Adult↗

Internal mammary artery grafting: is this a benign procedure?

2,784 patients had a primary coronary artery reconstruction, between 1977 and 1987. From 1984, one internal mammary artery (IMA) and later both IMAs were used as the grafts of choice, supplemented where necessary with a saphenous vein graft (SVG). As a result, 1,681 patients had SVG, 726 had a single internal mammary artery graft (SIMA), while 377 patients had a bilateral internal mammary artery reconstruction (BIMA). Comparison of the pre-operative data showed that patients who had a SIMA were similar to those who had a SVG except that they were older, had a more stable presentation and they had a higher incidence of myocardial infarction. Patients who had a BIMA reconstruction were younger, more frequently male, presented with more stable symptoms, and had better left ventricular function than patients who had a SVG alone. Despite these favourable findings, the incidence of peri-operative myocardial infarction was higher in the BIMA group, compared with the SVG group. The change from SVG grafting to SIMA grafting was also associated with a higher incidence of post-operative bleeding. The surgical mortality was similar in all 3 groups. These findings suggest that the change to IMA grafting is associated with a slightly increased morbidity and perhaps this operation should be performed on selected patients rather than used routinely.

Coronary Artery Bypass↗

The therapeutic efficacy of murine anti-tumor T cells: freshly isolated T cells are more therapeutic than T cells expanded in vitro.

Adoptive immunotherapy (AIT) involving transfer of tumor-sensitized T lymphocytes in combination with cyclophosphamide (CY)-injection results in the eradication of the C57BL/6J (B6) rhabdomyosarcoma, 76-9 and is associated with the accumulation of a large number of tumor-infiltrating lymphocytes (TIL). Using immune spleen cells (ISC) from B6 and congenic B6. PL. Thy-1a mice, it was shown that most (> or = 97%) of the TIL were donor-derived. This in situ increase in donor-derived T cells was confirmed by using positively-selected Thy- 1.1+ and Thy- 1.2+ TIL for AIT after isolating them from regressing tumors and expanding them in rIL-2. The extent of CD8+ TIL expansion in vivo correlated with the numbers of TIL adoptively transferred and this in turn determined the degree of anti-tumor effects. It was evident, however, that these in vitro-expanded TIL expressing mRNA for TNF alpha and IFN gamma were qualitatively different and therapeutically less efficacious than the T cells associated with ISC or with freshly-isolated TIL. Unlike freshly isolated TIL that expressed specific cytotoxicity towards the 76-9 targets in vitro, IL-2 expanded TIL killed 76-9 cells and unrelated tumor targets to the same extent. A cytotoxic CD8+ T cell line derived from ISC and selected for activity against the 76-9 tumor cells showed no therapeutic efficacy. The data suggest that, in this tumor model, expansion of CD8+ T cells in vitro selects against anti-tumor efficacy.

Animals↗