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W R Clark

Publications and source records attributed to W R Clark.

At least 55 records · Page 3Linked to original sources
PubMed1995

Cell-mediated cytotoxicity in perforin-less mice.

We have used a perforin-less (PO) mouse to explore alternate CTL-mediated lytic pathways. PO mice are unable to overcome an infection with LCMV in vivo. Nevertheless, splenocytes from infected mice show vigorous, antigen-specific cytotoxicity that requires the presence of the Fas antigen on target cells. The Fas lytic pathway is virtually indistinguishable, in terms of kinetics and magnitude of cytotoxicity, from perforin/granzyme-mediated lysis. It is rapidly induced in CTL upon occupation of the TcR, and requires protein synthesis for full expression. Upon removal of the activating signal, the capacity for fas-mediated lysis rapidly disappears. PO mice infected with LCMV also undergo what appears to be a CD8-mediated immunopathology, and rarely live beyond one month. The precise basis of this pathology is unknown at present. Given the widespread distribution of Fas in mice, particularly on inflamed tissues, the complete failure to clear virus from any tissue or organ is surprising.

Animals↗
PubMed1995

Azotemia control by extracorporeal therapy in patients with acute renal failure.

The mortality rate for patients with acute renal failure (ARF) requiring renal replacement therapy remains unacceptably high. The cause of death in these patients has been thought to relate primarily to the nature of the condition that precipitated renal failure. However, recent investigations challenge that notion and suggest that the characteristics of the renal replacement procedure itself may influence outcome. The major considerations for the clinician prescribing renal replacement therapy to the patient with ARF are the therapy mode, the type of membrane used, and the dose of delivered therapy. The first two considerations have been discussed extensively in the medical literature and are reviewed elsewhere in this issue. However, the determination of the amount of delivered therapy, although standard practice in patients with end-stage renal disease, has not been assessed routinely in patients with ARF. Furthermore, the influence on patient outcome of the level of azotemia control achieved by the delivered therapy is unknown. The purpose of this review is to provide some insight into quantifying the amount of renal replacement therapy delivered to patients with ARF treated with either continuous or intermittent therapies. The expected level of azotemia control that can be achieved with each of these therapies is discussed. We suggest that quantification of the amount of delivered therapy and the level of azotemia control are important variables to be obtained and evaluated in future investigations seeking to understand the high mortality rate of patients with ARF.

Acute Kidney Injury↗
PubMed1994

Immune function in mice lacking the perforin gene.

Mice lacking the perforin gene were generated by using targeted gene disruption in embryonal stem cells. When infected with lymphocytic choriomeningitis virus (LCMV), perforin-less (-/-) mice showed clear signs of having mounted an immune response based on activation of CD8 T cells but were unable to clear the LCMV infection. This failure to eliminate virus was accompanied by a failure to generate spleen cells capable of lysing LCMV-infected fibroblasts in vitro. Spleen cells from LCMV-infected -/- mice were able to lyse hematopoietic target cells after exposure to phorbol 12-myristate 13-acetate and ionomycin, provided the target cells expressed the Fas antigen. Spleen cells from -/- mice also responded to alloantigen in mixed leukocyte culture by blastogenesis and proliferation. The resulting cells were able to lyse hematopoietic target cells, although not as well as spleen cells from +/+ littermates sensitized in the same manner. However, lysis by -/- cells was again seen only if the target cells expressed Fas antigen. We conclude that perforin-less -/- mice retain and express the Fas lytic pathway as expressed in vitro but that this pathway is insufficient to clear an LCMV infection in vivo.

Animals↗
PubMed1994

The role of the Fas lytic pathway in a perforin-less CTL hybridoma.

The murine CTL hybridoma PMMI has been shown by the most sensitive techniques to be devoid of perforin. We thus used PMMI activated with PMA and ionomycin, to investigate possible alternate lytic pathways in CTLs in the absence of perforin. We found that PMMI is equipped with membrane TNF-alpha as a potential lytic mechanism, but TNF-alpha is unlikely to be involved in acute (4 h) lytic reactions. On the other hand, PMMI readily lyses target cells expressing the gene for the Fas Ag, but does not lyse target cells expressing fas antisense DNA. The generation of fas-dependent lysis required protein synthesis in PMMI, but target cell protein synthesis was not required for lysis. Lysis of Fas-positive target cells by PMMI was accompanied by DNA fragmentation, and both lysis and DNA fragmentation were blocked by inhibition of protein synthesis in the effector cell. We find the relative extent and kinetics of fas-dependent lysis and DNA fragmentation indistinguishable from that seen in "classical" CTL lytic assays. Both fas- and perforin-dependent lysis were blocked by inhibitors of poly(ADP) ribosylation. We found very little difference in the sequence of events in target cells lysed by the fas pathway compared with the classical (probably perforin) lytic pathway. Given the widespread distribution of fas, particularly in hematopoietic target cells, caution may be required in interpreting the relationship between parameters such as DNA fragmentation and 51Cr-release solely on the basis of the granule exocytosis model.

Animals↗
PubMed1994

Effects of wood and cotton smoke on the surface properties of pulmonary surfactant.

The effects of wood and cotton smoke and several known smoke components on the dynamic surface activity of pulmonary surfactant were characterized with a modified Wilhelmy balance. Surfactant was harvested by saline lavage from dog lungs, placed in the balance and a control surface tension/area isotherm (y-A) and surface tension at minimum area (control y/min = 6.6 +/- 1.6 dynes/cm) measured. Hysteresis area (HA), recruitment index (RI), and stability index (SI) were calculated. Following control measurements, smoke (wood or cotton) was gently blown over the surfactant in the balance. Similarly, each of the individual smoke components or Liquid smoke (prepared by bubbling wood smoke through saline) were injected onto the balance. Wood smoke significantly (P < 0.05) altered all surface properties measured, increasing ymin (22.0 +/- 1.6 dynes/cm) and decreasing HA, RI, and SI as compared to control; cotton smoke exposure had almost no effect on surfactant function. A supplementary dose of surfactant was added to the balance, following wood smoke exposure, which decreased ymin (9.4 +/- 2.6 dynes/cm, P = NS vs control) but not the other parameters to control. Acrolein, formaldehyde, and HCl had little effect on any of the surface properties measured whereas isobutyraldehyde and liquid smoke altered the y-A curve but did not increase ymin. These data demonstrate that wood but not cotton smoke inhibit surfactant function, however, surfactant function can be restored, following deactivation by smoke, suggesting that surfactant replacement therapy for victims of severe smoke inhalation may be of benefit.

Animals↗
PubMed1994

Comparison of high-frequency jet to conventional mechanical ventilation in the treatment of severe smoke inhalation injury.

The pathophysiology of smoke inhalation includes surfactant inhibition and pulmonary vascular injury leading to a high permeability pulmonary oedema. It has been shown in surfactant deficient animal models that methods of ventilation (i.e. high-frequency ventilation - HFV) avoiding a large pressure excursion (i.e. pressure change from end expiration to peak inspiration) improves oxygenation and decreases hyaline membrane formation. Therefore, we compared HFV with conventional mechanical ventilation (CMV) on lung function in an acute animal model of smoke inhalation (SI). Mongrel dogs were anaesthetized, surgically prepared for haemodynamic and blood gas monitoring, and placed on either CMV (n = 6) or HFV (n = 7). Following baseline (BL) measurements both groups were ventilated with wood smoke for 10 min. Ventilator settings were not adjusted from baseline following smoke inhalation in either groups; positive and expiratory pressure (PEEP, approximately 6 mmHg) was added in both groups following smoke exposure. At the conclusion of the study (4 h postsmoke inhalation) lung samples were taken for surfactant function and lung water measurements. Smoke inhalation immediately increased the A-a gradient (CMV-BL = 6.9 +/- 2.4 to CMV-SI = 77.3 +/- 1.9; HFV-BL = 10.5 +/- 2.7; HFV-SI = 72.8 +/- 3.7 mmHg), venous admixture (CMV-BL = 6.9 +/- 2.8 to CMV-SI 69.8 +/- 6.6; HFV-BL = 7 +/- 1.7 to HFV-SI = 60.4 +/- 7.9 per cent) and decreased Pao2 (CMV-BL = 110 +/- 3.4 to CMV-SI = 28 +/- 3.5; HFV-BL = 103 +/- 3.6 to HFV-SI = 31 +/- 1.7 mmHg) to a similar level in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Membrane adsorption of beta 2-microglobulin: equilibrium and kinetic characterization.

Enhanced extracorporeal removal of beta 2-microglobulin (beta 2m) may prevent the development of dialysis-related amyloidosis (DRA). One mechanism of beta 2m removal is membrane adsorption. Therefore, we fundamentally characterized beta 2m adsorption to the highly permeable polyacrylonitrile (PAN) membrane. Porous and nonporous PAN fragments were incubated in buffer containing 125I-beta 2m. Over a concentration range of 8 to 60 mg/liter, the equilibrium adsorption isotherm was linear (r = 0.99) for porous PAN while the isotherm for nonporous PAN suggested either multilayer binding or adsorption of proteins with differing orientations. In kinetic analyses, the approach to equilibrium versus (time)1/2 was evaluated. For both porous and nonporous PAN, this relationship was linear (r = 0.99), consistent with a diffusion-controlled process. Adsorption reversibility was assessed by comparing the amount bound at varying residence times (0 to 4 hr) to the amount remaining adsorbed after a subsequent incubation in buffer. The fractions remaining bound at 60, 120, and 240 minutes (0.34 +/- 0.02, 0.36 +/- 0.06, and 0.44 +/- 0.03; mean +/- SEM) were significantly greater (P < 0.05) than the value at five minutes (0.23 +/- 0.01). This suggests membrane-induced conformational changes in adsorbed beta 2m. This investigation permits the comparison of beta 2m adsorptive properties of PAN to those of other membrane-based and nonmembrane-based therapies designed to prevent DRA.

Acrylic Resins↗
PubMed1994

Unilateral smoke inhalation increases pulmonary blood flow to the injured lung.

Smoke inhalation (SI) affects the homogeneity of lung perfusion possibly by increasing alveolar surface tension. Anesthetized dogs (n = 8) were ventilated with a tracheal divider and a dual ventilator. One lung (left or right) was exposed to 5 minutes of SI while the other remained on room air. Total pulmonary blood flow (cardiac output) was measured by thermal dilution and left lung blood flow was measured with an ultrasonic flow probe. Since SI is associated with elevation of alveolar surface tension (AST), we studied a second group of dogs (n = 6) in which AST was increased in one lung with aerosolized dioctyl sodium sulfosuccinate (OT). The OT elevates AST without otherwise damaging the lung. Unilateral SI resulted in systemic hypoxemia (Pao2 fell from 91 +/- 6 to 55 +/- 4 mm Hg) and increased venous admixture (9 +/- 2% to 29 +/- 4%) both of which remained different from baseline values (p < 0.05) for 2 hours. Blood flow to the smoke exposed lung increased gradually and became significantly larger than that to the contralateral normal lung 2 hours following inhalation (smoke lung = 64% +/- 6% and normal lung = 36% +/- 6% of total blood flow). Following smoke exposure, pulmonary vascular resistance (PVR) increased with time in the unexposed normal lung (baseline = 8.7 +/- 1.4; 2 hours post smoke = 22.6 +/- 7.9 mm Hg/L/min, p < 0.05); PVR did not change in the smoke injured lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

A comparison of metabolic control by continuous and intermittent therapies in acute renal failure.

Azotemia control provided by blood pump-assisted continuous hemofiltration has not been rigorously compared with that provided by intermittent hemodialysis (IHD) for critically ill patients with acute renal failure (ARF). The metabolic control achieved by continuous venovenous hemofiltration (CVVH) and IHD was compared. In ARF patients treated with CVVH (N = 11), the normalized daily dose of therapy was 0.59 +/- 0.23 (mean +/- SD) and the normalized protein catabolic rate was 1.82 +/- 0.95 g/kg per day. The serum urea nitrogen concentration (SUN) declined with CVVH from an initial value of 114 +/- 32 to 79 +/- 17 mg/dL at steady state (SUNs). The initial analysis was a theoretical comparison between CVVH azotemia control and the control that would have been provided by IHD. Simulated IHD data were generated by conventional urea kinetic methods. The peak concentration hypothesis was invoked to compare CVVH SUNs and the peak IHD SUN (SUNp). A simulated IHD frequency of five times or more weekly was required to achieve a SUNp that did not differ from the CVVH SUNs. A similar comparison between the CVVH group and a separate group of ARF patients (N = 11) who received IHD was also performed. In the latter group, the normalized protein catabolic rate and the normalized daily dose of therapy were similar to those of the CVVH group. The SUNp (101 +/- 12 mg/dL) in the IHD group was significantly higher than the mean CVVH SUNs (P < 0.05). These data suggest that intensive hemodialysis is required to provide azotemia control similar to that provided by CVVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1993

Role of TNF-alpha in CD8+ cytotoxic T lymphocyte-mediated lysis.

The possibility that lymphokines such as TNF-alpha produced by CD8+ CTL are responsible for acute (short term) target cell damage induced by CTL has been debated for many years. However, the slow kinetics of TNF-induced target cell death stands in sharp contrast to the rapid target cell lysis mediated by CTL. We find that cloned CD8+ CTL activated through their TCR secrete TNF-alpha. On the other hand, our cloned CTL also have a membrane form of TNF-alpha, and they kill TNF-alpha-sensitive target cells not recognized through the TCR in a slow (18-h) lytic reaction using this surface-associated TNF-alpha. There is no secreted TNF-alpha release during this interaction. Cyclosporin A and protein synthesis inhibitors block TNF-alpha secretion, but have no effect on slow lysis mediated by the CTL. On the other hand, TNF-alpha-resistant variants are greatly resistant to slow lysis, and antibodies to TNF-alpha strongly inhibit this slow lysis. Thus, although secreted TNF-alpha does not seem to be the mechanism behind slow lysis, some form of TNF-alpha, most likely the membrane-associated form, must be involved. Not only does surface TNF-alpha appear to be biologically active in these CTL, but its expression is enhanced severalfold upon activation of the CTL through the TCR. This may be important in vivo, where surface TNF-alpha could preserve the localized nature of cytolysis and endow a CTL with an additional, albeit slower, mechanism of cell lysis. Finally, we find that although activated CTL clearly use the membrane form of TNF-alpha in slow lysis, they appear not to use TNF-alpha, in any form, during acute lysis, even under conditions in which degranulation and perforin assembly are blocked.

Animals↗
PubMed1993

Exosurf treatment following wood smoke inhalation.

Pulmonary surfactant deactivation is an important factor in the pathophysiology caused by wood smoke inhalation. Surfactant replacement is beneficial in treatment of surfactant-deficient neonates and possibly the adult respiratory distress syndrome (ARDS). In this study, the effect of exogenous Exosurf treatment for acute wood smoke injury was examined in four groups of rabbits. All groups were anaesthetized, placed on a ventilator, and surgically prepared for haemodynamic, peak airway pressure (P(aw)), and blood gas measurements. Rabbits were monitored for 2 h following smoke or sham smoke inhalation. At the conclusion of the experiment pulmonary oedema and surfactant function were measured. A Control group (n = 5) was followed without intervention. A Smoke group (n = 4) was ventilated with wood smoke for 3 min. A third group (Smoke+Exo, n = 4) was subjected to smoke followed by pulmonary instillation of Exosurf (5 ml/kg). Saline (5 ml/kg) was instilled into the lungs of the fourth group (n = 3) as a control for Exosurf instillation. Saline, Smoke and Smoke+Exo all significantly lowered PO2 and elevated P(aw) compared to baseline and the Control group. Exosurf treatment did not reduce the pulmonary oedema or restore surfactant function caused by smoke exposure. This study indicates that wood smoke inhalation acutely damages the lung and that administration of Exosurf by instillation is not an effective treatment.

Airway Resistance↗
PubMed1993

Prophylaxis of heart transplant rejection with either antithymocyte globulin-, Minnesota antilymphocyte globulin-, or an OKT3-based protocol.

We compared an equine antithymocyte globulin (ATGAM)-based protocol with a Minnesota antilymphocyte globulin (MALG)-based protocol and a murine monoclonal CD-3 (OKT-)-based protocol in 3 groups of heart transplant (HT) recipients. Thirty-four recipients received a four-day course of ATGAM. Thirty HT recipients received a 14-day course of OKT3. Fifteen HT recipients received MALG for an average of 10 days. The ATGAM group received cyclosporine beginning preoperatively, while the OKT3 and MALG groups received CyA beginning on post-transplant day 4. All three groups received identical azathioprine and similar steroid therapy. The 3 groups were similar in age, donor/recipient HLA mismatches, and donor/recipient gender mismatches. The MALG and OKT3 groups had 20% and 17% females, respectively, while the ATG group had 41% (p < 0.05). Average follow-up exceeded 14 months for each group. The ATGAM group received a higher dose of CyA during "induction" therapy than the OKT3 and MALG groups, and experienced a greater rise in post-transplant serum creatinine levels. We found no difference between the 3 groups in: preoperative creatinine levels, one-year post-transplant creatinine levels, number of patients who could be successfully "weaned" from steroids, or one-year survival. Other data are tabulated as episodes/patient: [table: see text] We conclude that ATG plus preoperative CyA is superior for rejection prophylaxis following heart transplantation when compared with either MALG plus postoperative CyA or OKT3 plus postoperative CyA.

Analysis of Variance↗
PubMed1992

Primary radiologic realignment of membranous urethral disruptions.

A forty-two-year-old man with a traumatic, membranous urethral disruption underwent initial suprapubic catheter urinary diversion followed by a primary realignment twenty-one days after injury. Realignment was accomplished radiologically using an anterograde guide wire engaged by a retrograde stone basket and subsequent Foley catheter placement over the wire. The patient has remained totally continent, having partial erections, two years after injury, with no further intervention.

Adult↗
PubMed1992

Demonstration of rabies virus-specific antibody in the sera of free-ranging Iowa raccoons (Procyon lotor).

Between 1984 and 1988, a study was conducted to evaluate the frequency of rabies virus neutralizing antibodies in raccoons (Procyon lotor) in two counties in Iowa. Nine hundred eighty five raccoons were trapped and tagged in Guthrie and Cerro Gordo counties during the spring, summer and fall of each year. Sex, age and weight were recorded for each animal and a blood sample was collected. Serum samples were tested for the presence of serum neutralizing antibodies (SNA) by the rapid fluorescent focus inhibition test (RFFIT), mouse serum neutralization test (MSN), and an indirect fluorescent antibody (IFA) technique for detecting immunoglobulin G. Fifty-one raccoons (5%) were found to have SNA by the RFFIT. Thirty-six serum samples (24 with RFFIT antibody titer greater than 3.0, and 12 less than 3.0) were also tested by the MSN, with results correlating well with the RFFIT results (r = 0.86, P less than 0.01, Kappa = 0.93). In 35 raccoons with SNA by the RFFIT, six individuals had immunoglobulin G binding activity by the IFA test. These results provided serologic evidence of exposure of raccoons to rabies virus in an area free of enzootic raccoon rabies.

Age Factors↗