Search PubMed⌕ Search

Biomedical subjects

W R Clark

Publications and source records attributed to W R Clark.

At least 37 records · Page 2Linked to original sources

Fas (CD95)-dependent cell-mediated immunity to Listeria monocytogenes.

Two distinct and complementary pathways, one mediated by perforin and the other dependent upon CD95 (Fas), effect cell-mediated cytotoxicity. We examined the relative roles of these pathways in host defenses against the intracellular bacterial pathogen Listeria monocytogenes by using murine listeriosis as a model system. Mice which lacked both perforin and Fas (P0L0) were generated, and their responses to primary and secondary listeriosis were compared to those of wild-type (WT), Fas-deficient (L0), and perforin knockout (P0) mice. Relative to WT mice during primary listeriosis, P0 mice exhibited a reduced capacity to clear the infection from their spleens but not their livers whereas L0 mice had elevated bacterial titers in their livers and a modestly increased titer in their spleens. In contrast, bacterial titers in P0L0 mice were increased approximately 50- to 560-fold in their spleens and 230- to 1, 000-fold in their livers; eventual clearance of listeriae from both organs was significantly delayed. Furthermore, the resistance of P0L0 mice to secondary listeriosis was significantly reduced in their spleens and livers compared to that of WT, P0, or L0 mice. In vitro experiments indicated that immune cytotoxic T lymphocytes (CTL) lysed L. monocytogenes-infected hepatocytes primarily via a Fas-dependent, perforin-independent mechanism. The absence of Fas severely abrogated the lysis of infected hepatocytes by immune CD8(+) CTL. Taken together, these results provide the first evidence for Fas-dependent CTL-mediated lysis of L. monocytogenes-infected hepatocytes and demonstrate complementary roles for Fas and perforin in host defenses against an intracellular bacterial pathogen.

Animals↗

Seroprevalence of antibodies against Toxoplasma gondii in free-ranging mammals in Iowa.

Serum samples from raccoons (Procyon lotor), striped skunks (Mephitis mephitis), Virginia opossums (Didelphis virginiana), and free-ranging house cats trapped in Iowa between 1984 and 1988 were tested for antibodies against Toxoplasma gondii using the modified direct agglutination test (MAT). Antibody titers > or = 1:32 were considered indicative of infection. Prevalence rates by species were estimated for raccoons at 134/885 (15%), skunks at 38/81 (47%), opossums at 12/53 (23%), and cats at 16/20 (80%).

Age Distribution↗

Renal replacement therapy in acute renal failure: solute removal mechanisms and dose quantification.

Based on numerous studies demonstrating a direct relationship between survival and delivered hemodialysis (HD) dose in end-stage renal disease (ESRD), quantification of delivered HD is now routinely performed in this setting. Recently, investigators have also begun applying kinetic modeling principles to quantify delivered dialysis dose in patients with acute renal failure (ARF). One purpose of this article is to review these ARF studies. However, a broader objective is to provide an overview of the solute removal capabilities of both intermittent and continuous therapies used in ARF. To achieve this goal, the dialytic removal mechanisms for solutes over a wide molecular weight spectrum are discussed.

Acute Kidney Injury↗

The role of renal replacement therapy quantification in acute renal failure.

The recognition that both morbidity and mortality are inversely related to delivered hemodialysis (HD) dose in end-stage renal disease (ESRD) patients has substantially changed clinical practices in the United States. A number of quantification techniques, which differ greatly in complexity and sophistication, are now used in ESRD patients. Investigators recently have attempted to extrapolate some of these ESRD quantification methods to the acute renal failure (ARF) setting. This review focuses on these recent attempts. Both patient-related and renal replacement therapy (RRT)-related differences in ESRD and ARF are discussed. In addition, the potential pitfalls of extrapolating certain ESRD quantification methods to RRT in ARF are discussed. Prescription considerations for both intermittent HD (IHD) and continuous RRT (CRRT) are presented. The optimal technique for RRT quantification in ARF remains to be determined.

Humans↗

Vancomycin mass transfer characteristics of high-flux cellulosic dialysers.

BACKGROUND: In comparison to conventional haemodialysis membranes, highly permeable membranes allow a broader spectrum of solute removal, including enhanced elimination of vancomycin (1448 Daltons). However, the mass transfer characteristics of vancomycin removal by highly permeable membranes have not been adequately assessed. An understanding of vancomycin's predominant dialytic mass transfer mechanism under a given set of operating conditions, including dialyser type and flow rates, may permit more accurate dosing of the drug. METHODS: We performed a mass transfer analysis of vancomycin removal by a high-flux dialyser, cellulose triacetate (CT). In a cross-over fashion with a 3-week washout between treatments, eight subjects received vancomycin 1000 mg (1) during the last hour of CT haemodialysis; or (2) after dialysis. Serial urea and vancomycin serum concentrations were used to assess dialytic removal. RESULTS: Dialysis removed 26.2% (mean; range 16-44%) of the administered vancomycin dose. While vancomycin removal and (Kt/V)urea were directly correlated (r = 0.88; P < 0.005), no correlation was observed between vancomycin removal and weight-normalized ultrafiltration rate. CONCLUSIONS: These findings suggest that for the CT dialyser and dialysis operating conditions employed in this study, vancomycin clearance was primarily mediated by diffusion. As such, these data challenge the general concept that convection is primarily responsible for the removal of solutes in the same molecular weight class as vancomycin during high-flux dialysis.

Adult↗

Immunohistochemical localization of cysteine-rich intestinal protein in rat small intestine.

Cysteine-rich intestinal protein (CRIP) is a LIM (cysteine-rich motif of leu-11, isl-1, and mec-3 genes) domain protein with a double zinc finger motif. The protein is abundantly expressed in the intestine, peritoneal macrophages, and peripheral blood mononuclear cells. The function of CRIP is not known. The purpose of this study was to determine the cellular distribution of CRIP in rat intestine, as an initial step toward eventual determination of a function. Immunohistochemical and immunogold labeling electron microscopy using a purified polyclonal rabbit antibody to a synthetic peptide representing a zinc finger domain of rat CRIP were carried out on sections of rat duodenum. Western blotting was used to detect signal specificity of the antibodies. These immunohistochemical and electron microscopy studies showed particularly high abundance of CRIP in the cytoplasmic granules of Paneth cells of the intestine. Some evidence of CRIP expression was also found in cells of the villus tip, but abundance was less than that found in the Paneth cells. The localization of CRIP in Paneth cells and its presence in mononuclear cells suggests that CRIP may be involved in host defense mechanisms and/or tissue differentiation/remodeling processes common to these cell types.

Animals↗

Quantification of hemodialysis: analysis of methods and the relevance to patient outcome.

Quantification of small solute removal in patients treated with chronic hemodialysis (HD) is widely used to assessed the adequacy of both prescribed and delivered treatment. Four recent American studies have demonstrated a clear relationship between delivered dialysis dose and outcome in chronic HD patients. Although a number of HD quantification methods have been proposed, no specific technique is accepted as the gold standard at present. The primary goal of this review is to provide a critical assessment of the four recently published studies relating to HD outcome to dialysis dose. As these studies involved a variety of therapy quantification methods, a review of the most common techniques used to measure dialysis dose is also presented. In addition, two unresolved issues that have recently come to the forefront of HD quantification are presented. These issues are the role of dialysate-side measurement of HD dose and the potential limit of the beneficial effect of increasing HD dose on clinical outcome. Finally, the overall design of the NIH HD adequacy trial is discussed, with particular attention paid to the kinetic methods used in the study.

Humans↗

Extracorporeal therapy requirements for patients with acute renal failure.

Renal replacement therapy (RRT) requirements for critically ill patients with acute renal failure (ARF) depend on numerous factors, including the degree of hypercatabolism, patient size, and desired level of metabolic control. However, the current practice at many institutions is to prescribe generally similar amounts of RRT to ARF patients essentially without regard for the above factors. In this study, a computer-based model designed to permit individualized RRT prescription to ARF patients was developed. The critical input parameter is the desired level of metabolic control, which is the time-averaged BUN (BUNa) or steady-state BUN (BUNs) for intermittent hemodialysis (IHD) or continuous RRT (CRRT), respectively. The basis for the model was a group of 20 patients who received uninterrupted CRRT for at least 5 days. In these patients, the normalized protein catabolic rate (nPCR) increased linearly (r = 0.974) from 1.55 +/- 0.14 g/kg per day (mean +/- SEM) on day 1 to 1.95 +/- 0.15 g/kg per day on day 6. The daily urea generation rate (G), determined from the above linear relationship, was utilized to produce BUN versus time curves by the direct quantification method for simulated patients of varying dry weights (50 to 100 kg) who received variable CRRT urea clearances (500 to 2000 ml/h). Steady-state BUN versus time profiles for the same simulated patient population treated with IHD regimens (K = 180 ml/min, T = 4 h) of variable frequency were generated by use of a variable-volume, single-pool kinetic model. From these profiles, regression lines of required IHD frequency (per week) versus patient weight for desired BUNa values of 60, 80, and 100 mg/dl were obtained. Regression lines of required CRRT urea K (ml/h) versus patient weight for desired BUNs values of 60, 80, and 100 mg/dl were also generated. For the attainment of intensive IHD metabolic control (BUNa = 60 mg/dl) at steady state, a required treatment frequency of 4.4 dialyses per week is predicted for a 50-kg patient. However, the model predicts that the same degree of metabolic control cannot be achieved even with daily IHD therapy in patients > or = 90 kg. On the other hand, for the attainment of intensive CRRT metabolic control (BUNs = 60 mg/dl), required urea clearance rates of approximately 900 ml/h and 1900 ml/h are predicted for 50- and 100-kg patients, respectively. This model suggests that, for many patients, rigorous azotemia control equivalent to that readily attainable with most CRRT can only be achieved with intensive IHD regimens. Following prospective clinical validation, this methodology may be a useful RRT prescription tool for critically ill ARF patients.

Acute Kidney Injury↗

Dialysis prescription and kinetics in acute renal failure.

The recognition that both morbidity and mortality are inversely related to delivered hemodialysis (HD) dose in end-stage renal disease (ESRD) patients has substantially changed clinical practices in the United States. A number of quantification techniques, which differ greatly in complexity and sophistication, are now used in ESRD patients. Investigators recently have attempted to extrapolate some of these ESRD quantification methods to the acute renal failure (ARF) setting. This review focuses on these recent attempts. Both patient-related and renal replacement therapy (RRT)-related differences in ESRD and ARF are discussed. In addition, the potential pitfalls of extrapolating certain ESRD quantification methods to RRT in ARF are discussed. Prescription considerations for both intermittent HD (IHD) and continuous RRT (CRRT) are presented. Finally, recent data suggesting survival in critically ill ARF patients is directly correlated with delivered therapy dose are reviewed. The optimal technique for RRT quantification in ARF remains to be determined.

Acute Kidney Injury↗

Regulation of the Fas lytic pathway in cloned CTL.

Cloned murine CTL activated via the TCR or by PMA and ionomycin up-regulate surface Fas ligand and show an increased ability to kill non-Ag-specific Fas+ target cells. This up-regulation starts after 45 to 60 min and has a t1/2 for reversal of about 90 min. Up-regulation of lytic function is accompanied by up-regulation of Fas ligand on the CTL surface, which can be blocked by protein synthesis inhibitors. When up-regulation of Fas lytic function was induced by PMA and ionomycin, EGTA blocked both activation of lytic function and expression of Fas ligand detected by FACS analysis. However, when up-regulation was induced by specific Ag, EGTA blocked activation of lytic function, but not up-regulation of Fas ligand. Moreover, EL-4 cells have very high levels of surface Fas ligand, although they are not cytotoxic. Thus, expression of surface Fas ligand may be required, but not sufficient, for Fas-mediated lysis.

Animals↗

Cell-mediated cytotoxicity results from, but may not be critical for, primary allograft rejection.

Tumor cells insensitive to lysis through the Fas and TNF pathways were injected either subcutaneously or into the peritoneal cavities of allogeneic perforin-less (P0) and perforin wild-type (P2) mice. In three of four cases, the tumors were rejected equally rapidly in both strains of mice. Rejection was accompanied by vigorous in vitro cytotoxicity in P2, but not in P0 mice. The rapid clearance of allografted cells in mice where all three known cytolytic pathways are seriously compromised raises important questions about the involvement of cell-mediated cytotoxicity, as defined by current assay techniques, in primary allograft rejection.

Animals↗

Morphologic and functional characterization of perforin-deficient lymphokine-activated killer cells.

Mice deficient in perforin, a key mediator of lymphocyte-mediated cytolysis, have recently been generated using the gene knockout technique. CTL and NK cells derived from these mice have been shown to be defective in the granule-dependent cytolytic pathway. To investigate whether the granule-formation process has been altered in these perforin-deficient cytotoxic cells, rendering them defective in using the other granule mediators, we have examined in the present study the morphologic and functional characteristics of perforin-deficient LAK cells. Perforin-deficient LAK cells, similar to wild-type LAK cells, were shown to contain a large number of granules in their cytoplasm. By electron microscopy, the morphology of the granules present in these two cell populations appeared indistinguishable. The complete depletion of perforin in LAK cells derived from perforin gene-knockout mice was further confirmed by immunoelectron microscopy using anti-perforin antiserum. The expression of other cytolytic mediators, present either within the granules (granzymes A and B) or elsewhere (Fas ligand), appeared to be unperturbed, as investigated using the reverse transcription-PCR technique. Like the CTL and NK cells isolated from perforin-deficient mice, perforin-deficient LAK cells could lyse only target cells that express high levels of Fas molecule. Furthermore, these perforin-deficient LAK cells, similar to wild-type LAK cells and a CTL clone, were resistant to perforin-mediated cytolysis.

Animals↗

Bcl-2 blocks degranulation but not fas-based cell-mediated cytotoxicity.

The ability of bcl-2 in target cells to block cell-mediated cytotoxicity by allospecific CTL was tested. The blocking effect was variable. Because killing by CTL involves two different pathways, degranulation (perforin plus granzymes) and fas, we examined the effect of bcl-2 on these pathways independently. Bcl-2 in target cells blocked apoptotic cell death induced either by cytotoxic granule extracts or by CTL killing under conditions in which the fas pathway is blocked. On the other hand, bcl-2 had no effect on target cell-killing either by Fas-specific mAb or by CTL capable of killing only via the fas pathway. These data suggest bcl-2 may block apoptotic lysis induced by perforin plus granzymes, but not apoptotic lysis induced via the fas pathway. Thus, any analysis of the effect of bcl-2 on apoptotic cell death in target cells killed by CTL must take into account the relative contributions of the degranulation vs fas pathways.

Animals↗

Plasma protein adsorption to highly permeable hemodialysis membranes.

Although membrane adsorption of plasma proteins is one of several factors determining the biocompatibility and mass transfer characteristics of a hemodialyzer, this process has not been evaluated rigorously. We performed an equilibrium and kinetic analysis of the binding of proteins of differing molecular weight to highly permeable membranes of differing hydrophobicity and surface change. Hydrophobic, anionic polyacrylonitrile (PAN) and hydrophilic, uncharged cellulose triacetate (CT) membrane fragments were incubated in buffer containing radioiodinated beta 2-microglobulin (beta 2m) or bovine serum albumin (BSA). From an initial solution concentration of 50 mg/liter, both membranes adsorbed significantly more beta 2m than BSA at equilibrium (PAN, 352 +/- 30 vs. 32.1 +/- 2.4 ng; CT, 87.0 +/- 0.6 vs. 30.8 +/- 1.7 ng). These results were consistent with membrane pore exclusion of BSA. Comparison of the slopes of the equilibrium isotherm lines (concentration range, 0 to 220 mg/liter) showed the PAN binding affinity for beta 2m and BSA was 28 and 1.4 times that of CT, respectively. In kinetic studies, the approach to equilibrium versus (time)1/2 was assessed. For all protein-membrane combinations, this relationship was linear, consistent with a diffusion-controlled process. This latter characteristic permitted the determination of beta 2m membrane diffusivity values for both PAN and CT, which were found to be 0.30 and 3.25 x 10(-7) cm2/sec, respectively. These data suggest membrane hydrophobicity more significantly influences the binding of low-molecular weight proteins than that of pore-excluded proteins. In addition, these results demonstrate electrostatic membrane-protein interactions may influence the kinetics of both the adsorption and transmembrane mass transfer of plasma proteins.

Adsorption↗

Segmental pulmonary vascular resistance following wood smoke inhalation.

OBJECTIVES: To locate the specific site (i.e., pulmonary arteries, veins, or capillaries) of increased pulmonary vascular resistance after wood smoke inhalation and to demonstrate whether the prostanoids, thromboxane B2 or 6-keto-prostaglandin F1 alpha, play a role in these vascular resistance changes. DESIGN: Prospective, randomized, controlled trial. SETTING: Laboratory at a university medical center. SUBJECTS: Five mongrel dogs. INTERVENTIONS: The isolated canine left lower lobe preparation was used to measure changes in the pressure drop across the pulmonary arteries, veins, and capillaries. The left lower lobe was surgically isolated and perfused by a pump primed with autologous blood. The arterial and venous occlusion technique and the vascular pressure-flow relationship were used to assess changes in pulmonary vascular resistance. After baseline measurements, the left lower lobe was exposed to wood smoke for 2.5 mins and measurements were repeated. MEASUREMENTS AND MAIN RESULTS: Smoke exposure caused an immediate (5 mins post-inhalation) increase in the total pressure gradient across the lobe (baseline = 9.8 +/- 0.5 torr [1.3 +/- 0.06 kPa]); smoke inhalation = 24.3 +/- 3.9 torr [3.24 +/- 0.5 kPa]; p < .05). Total pressure drop was partitioned longitudinally into pressure drops across arteries, veins, and the middle vessels. The increase in total pressure drop was associated with a moderate increase in the pressure drop across the middle vessels (baseline = 1.1 +/- 0.2 torr [0.14 +/- 0.02 kPa]; smoke inhalation = 5.2 +/- 1.1 torr [0.69 +/- 0.14 kPa]; p < .05); a large increase in the pressure drop across the veins (baseline = 4.8 +/- 1.3 torr [0.64 +/- 0.17 kPa]; smoke inhalation = 20.7 +/- 3.4 torr [2.7 +/- 0.45 kPa]; p < .05), and no significant change in the pressure drop across the arteries (baseline = 3.7 +/- 0.4 torr [0.49 +/- 0.05 kPa]; smoke inhalation = 4.8 +/- 0.5 torr [0.64 +/- 0.06 kPa]; p = NS). Increases in the pressure drop across the middle and venous vessels were transient and no longer significantly different from baseline 15 mins after smoke inhalation. Similarly, analysis of the pulmonary artery/blood flow data demonstrated that the mean slope and pressure intercept were greater than baseline only at 5 mins postsmoke inhalation (p < .05). Thromboxane B2 did not significantly change from baseline values after smoke exposure and prostaglandin F1 alpha demonstrated a slight but significant decrease 30 mins postsmoke. Pulmonary edema was measured gravimetrically (wet/dry weight ratio) and smoke significantly increased lung water in the left lower lobe (wet/dry weight ratio = 6.55 +/- 0.4) as compared with the normal left upper lobe (wet/dry weight ratio = 4.97 +/- 0.2). CONCLUSIONS: We conclude that smoke causes an intense but transient increase in the pressure drop across the venous segment that may accelerate the formation of pulmonary edema, which is not mediated by changes in thromboxane B2 or prostaglandin F1 alpha.

Analysis of Variance↗

Comparison of exogenous surfactants in the treatment of wood smoke inhalation.

The goal of this study was to compare the effectiveness of the exogenous surfactants Infasurf and Exosurf in reestablishing surfactant function inhibited by severe smoke inhalation. Mongrel dogs (n = 17) were anesthetized, placed on a ventilator (40% O2), and surgically prepared for hemodynamic and blood gas measurements; venous admixture (QVA/QT) and static lung compliance (Cstat) were calculated. At the conclusion of the experiment, lung samples were taken for lung water and dynamic surface tension (DST, Wilhelmy balance) measurements. Following baseline measurements, dogs were randomly separated into four groups: Group I, smoke+sham instillation; Group II, smoke+saline instillation: Group III, smoke+Exosurf instillation; and Group IV, smoke+Infasurf instillation. The surfactants (Infasurf and Exosurf, 100 mg/kg) or saline (same volume as surfactants) were instilled into the lungs via suction catheter immediately following smoke exposure. Smoke inhalation caused a similar increase in QVA/QT and fall in PaO2 and Cstat in all groups that improved only with Infasurf instillation (Group IV). DST was significantly improved by Infasurf compared with all other groups. We conclude that Infasurf restores normal DST, inhibited by wood smoke, improving lung function. Exosurf was ineffective in the treatment of wood smoke inhalation.

Animals↗